Characterization of orofacial features in sclerodermatous chronic graft-versus-host disease.

BACKGROUND: Chronic graft-versus-host disease (cGVHD) is a leading cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (alloHCT). The sclerodermatous form of cGVHD can be particularly debilitating; however, orofacial sclerodermatous involvement remains poorly described. OBJECTIVE: To characterize orofacial features of sclerodermatous cGVHD in a single center cohort of patients who underwent alloHCT. STUDY DESIGN: Retrospective data were collected from electronic medical records and analyzed descriptively. RESULTS: There were 39 patients who received alloHCT between 1993 and 2017 and developed orofacial sclerodermatous cGVHD. Concomitant cutaneous sclerodermatous cGVHD was common (n = 20, 51%). Orofacial sclerodermatous cGVHD features included fibrous bands of the buccal mucosa (n = 23, 59%), limited mouth opening (n = 19, 54%), perioral fibrosis (n = 8, 21%), and focal gingival recession (n = 4, 10%). Oral mucosal fibrosis was observed at the site of active or resolved chronic lichenoid inflammation in 30 patients, with all but two also presenting with a history of ulcerations. Management included jaw stretching exercises (n = 10; 6 stable/improved), surgery (n = 3; 2 improved), and intralesional corticosteroid injections (n = 2; 2 improved). CONCLUSIONS: Orofacial involvement with sclerodermatous cGVHD can present with multiple manifestations including fibrous banding, limited mouth opening, perioral fibrosis, and focal gingival recession. Surgical and non-surgical management strategies may improve clinical function and reduce morbidity.

Nationwide exploration: assessing oral microbiome knowledge among dental professionals in Saudi Arabia and its implications for oral health care.

BACKGROUND: The relationship between the microbiome and oral health is intricate, yet there is a lack of comprehensive knowledge regarding the microbiome's impact on oral health. Integrating knowledge regarding the oral microbiome and its significance in oral and systemic diseases holds profound implications for dental professionals in patient care and professional development. This study assessed dental professionals' oral microbiome comprehension and knowledge levels in Saudi Arabia and its implications for oral healthcare. METHODS: Data were gathered using a cross-sectional design by administering a comprehensive online questionnaire to 253 dental professionals from diverse demographic backgrounds. The questionnaire, administered in English, was divided into four sections: (1) Microbiome awareness and understanding, (2) Diet, nutrition, and microbiome relationship, (3) Microbiome and oral and systemic diseases, and (4) Counselling, education, and implications. Statistical analyses were used to identify and understand underlying patterns, including descriptive statistics, chi-squared tests, ANOVA, and post hoc tests. The Spearman rank correlation coefficient was applied to assess self-rated knowledge. RESULTS: Of the 253 participants, 94.6% were familiar with the term "microbiome." Merely 13% of participants considered the oral microbiome to be the second most diverse, following the gut microbiome. About 39.9% of participants knew the connection between oral mucosal diseases and the oral microbiome. Furthermore, only 6.7% thought there was a connection between systemic diseases and the oral microbiome. Participant comprehension of oral microbiome questions averaged 9.19 out of 13, with 83.7% scoring "good". There were significant differences in knowledge scores among dental specializations (F = 7.082, P < 0.001) and years of professional experience (F = 4.755, P = 0.003). Significantly, 53.8% of participants had uncertain self-perceptions of their knowledge of the oral microbiome, while only 0.8% rated their understanding as 'very good'. CONCLUSION: Our findings reveal that dental professionals have varying levels of awareness and comprehension of the oral microbiome. Despite widespread awareness, understanding its diversity and implications for oral and systemic health remains limited. It is essential to address these gaps in knowledge through future research and educational interventions, considering the vital part that dental professionals play in promoting oral health through personalised dietary recommendations, lifestyle changes, and hygiene practices. These initiatives may promote a robust oral microbial community, enhance patient outcomes, and advance oral healthcare locally and globally.

Dentists Behavioral Factors Influencing Early Detection of Oral Cancer: Direct Clinical Observational Study.

This study aimed to investigate the possible factors affecting dentists' behavior relating to performing oral cancer examinations as part of routine clinical examination. A total of 95 direct clinical observation sessions-utilizing an instrument consisting of 19 evidence-based observational criteria for oral cancer examinations-were observed by four calibrated dentists. Thirty-two final-year students, 32 interns, and 31 faculty members of Jazan Dental School were examined between April 9 and May 4, 2017. A descriptive analysis was conducted to investigate the frequencies/percentages of the performed observing criteria by all examiners. ANOVA and Tukey tests were carried out to investigate the difference between the examiner groups. A total number of 32 patients participated in the study, whereby each patient was examined by three different examiners from each group, as well as by the attending observer/s. Fewer than 50% of the examiners performed the clinical steps necessary for an oral cancer examination-for example, taking into account past medical history, as well as extra and intra-oral examinations. More than 90% of the examiners examined hard tissue, whereas fewer than 30% of them educated their patients about possible risk factors. A significant difference between examiner groups was found in favor of faculty members. A gap between knowledge and actual practice of oral cancer examinations was evident: majority of participants failed to perform the necessary steps for an oral cancer examination. Previous experience and confidence in performing oral cancer examination are possible explanations for the dentist's behavior toward oral cancer examination.

Oral lichen planus: comparative efficacy and treatment costs-a systematic review.

OBJECTIVE: To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). MATERIALS AND METHODS: A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered. RESULTS: Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. CONCLUSION: Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.

Potential Myogenous Temporomandibular Disorders Following Iatrogenic Occlusal Disturbance: A Pilot Study.

AIM: There is an inadvertent alteration of the occlusal surface after dental treatment. However, research concerning the effect of these iatrogenic disturbances on the temporomandibular joint (TMJ) is scarce. Hence, the present study aimed to investigate the relationship between sudden iatrogenic occlusal disturbance and its effect on the myogenous temporomandibular disorder (TMD). MATERIALS AND METHODS: A cross-sectional observational study was conducted among 30 female subjects aged 18 years to 38 years who received treatment (direct and indirect restorations altering the occlusal surfaces of teeth, and oral prophylaxis) in the students' clinics at the College of Dentistry Jazan University. The preoperative assessment included a patient interview, a baseline occlusal record, and bite force analysis. All the assessments were repeated 2 weeks after the treatment. Descriptive statistics were calculated. RESULTS: As there was no change observed in bite force as well as occlusal disturbances in the control group, no comparative tests could be applied. The treatment-induced occlusal disturbances were observed in 80% of the participants. The mean change in occlusal force on the treated teeth was found to be 5.6 ± 1.1 Newtons. None of the patients reported any symptoms related to pain or restriction in function in the TMJ. CONCLUSION: No relation was observed between the abrupt changes in the occlusal force due to dental treatment and the development of the myogenous TMD. CLINICAL SIGNIFICANCE: Iatrogenic occlusal interferences may cause/exacerbate TMDs; hence, extreme caution should be exercised by the clinicians to avoid causing harm to the patients. How to cite this article: Alamir AH, Hakami YA, Alabsi FS, et al. Potential Myogenous Temporomandibular Disorders Following Iatrogenic Occlusal Disturbance: A Pilot Study. J Contemp Dent Pract 2019;20(10):1138-1140.

Evaluation of the Current Techniques and Introduction of a Novel Approach for Estimating Maxillary Anterior Teeth Dimensions.

INTRODUCTION: Several techniques and methods have been proposed to estimate the anterior teeth dimensions in edentulous patients. However, this procedure remains challenging especially when preextraction records are not available. Therefore, the purpose of this study is to evaluate some of the existing extraoral and intraoral methods for estimation of anterior tooth dimensions and to propose a novel method for estimation of central incisor width (CIW) and length (CIL) for Saudi population. MATERIALS AND METHODS: Extraoral and intraoral measurements were recorded for a total of 236 subjects. Descriptive statistical analysis and Pearson's correlation tests were performed. Association was evaluated between combined anterior teeth width (CATW) and interalar width (IAW), intercommisural width (ICoW) and interhamular notch distance (IHND) plus 10 mm. Evaluation of the linear relationship between central incisor length (CIL) with facial height (FH) and CIW with bizygomatic width (BZW) was also performed. RESULTS: Significant correlation was found between the CATW and ICoW and IAW (p-values <0.0001); however, no correlation was found relative to IHND plus 10 mm (p-value = 0.456). Further, no correlation was found between the FH and right CIL and BZW and right CIW (p-values = 0.255 and 0.822). The means of CIL, CIW, incisive papillae-fovea palatinae (IP-FP), and IHND were used to estimate the central incisor dimensions: CIL = FP-IP distance/4.45, CIW = IHND/4.49. CONCLUSION: It was concluded that the ICoW and IAW measurements are the only predictable methods to estimate the initial reference value for CATW. A proposed intraoral approach was hypothesized for estimation of CIW and CIL for the given population. CLINICAL SIGNIFICANCE: Based on the results of the study, ICoW and IAW measurements can be useful in estimating the initial reference value for CATW, while the proposed novel approach using specific palatal dimensions can be used for estimating the width and length of central incisors. These methods are crucial to obtain esthetic treatment results within the parameters of the given population.

The Oral Medicine workforce and impact on access to care in the United States.

OBJECTIVES: The objective of this study was to characterize the current oral medicine (OM) workforce by examining the distribution of OM diplomates (OMDs) across the Unites States and to determine the need for expanding access to care. STUDY DESIGN: The OMD access was calculated based on the OMDs per 10,000 state population from the 2020 US Census data as well as their distance from state capitals and most populated cities. OMD penetrance in hospitals and cancer centers was assessed at National Cancer Care Network (NCCN) cancer centers, and Best Hospitals as reported in the 2022 US News and World Report (USNWR). RESULTS: OMDs are present in 64% of the states with an uneven geographic distribution. Primary workplaces included dental schools (47%), hospitals (30%), and private practices (19%). Of the OMDs in private practice, 57% limited their practice to OM. OMDs were noted at 28% of NCCN cancer centers, 30% of USNWR Best Hospitals for Cancer, and 20% of USNWR Best Hospitals. CONCLUSIONS: There is low density and uneven distribution of OMDs with approximately one-third of the population without access to an OMD in their state, thus limiting access to care. This suggests both vast opportunities for growth and expansion of OM, as well as challenges in developing and training the necessary workforce. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Oral medicine education in predoctoral programs in US dental schools.

OBJECTIVE: the purpose of the study was to explore the structure of oral medicine (OM) education in predoctoral dental programs in the United States and to evaluate the students' perception of OM as a dental specialty. METHODS: Two anonymous Qualtrics surveys (Qualtrics, Provo, UT, USA) were distributed electronically to the academic deans of all the Commission on Dental Accreditation (CODA) accredited dental schools in the United States. Upon completing the survey, the academic deans were asked to forward the student surveys to their students. RESULTS: Note that 26.8% (18/67 dental schools) of academic deans that participated in the survey, 224 senior students responded to the student survey. The results showed that the median number of OM specialists involved in teaching OM to predoctoral students was two. Oral cancer screening and diagnosis and management of oral mucosal diseases were identified by the majority of respondents (95.7%; n = 214 and 96.5%; n = 216), respectively, as part of the scope of practice of OM specialists. Although most students reported Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) (18.67% n = 42 each) as postgraduate specialties of interest, students' positive impression in OM increased by a crude average of 0.4 with each additional OM faculty member in the school (p = 0.000; 95% CI 0.207-0.594). CONCLUSION: OM faculty members are in an important position to enhance dental students' perception and interest in OM as a specialty, which would lead to improved awareness of the scope of the specialty and consideration of pursuing specialty training.

Oral squamous cell carcinoma and associated risk factors in Jazan, Saudi Arabia: a hospital based case control study.

BACKGROUND: Oral cancer is the third most common malignancy in Saudi Arabia, the highest incidence of which is reported from Jazan province. The objective of this study was to evaluate the association of various locally used substances, especially shamma, with oral cancer in the Jazan region of Saudi Arabia. MATERIALS AND METHODS: A hospital-based case-control study was designed and patient records were scanned for histologically confirmed oral cancer cases. Forty eight patients who were recently diagnosed with oral cancer were selected as cases. Two healthy controls were selected for each observed case and they were matched with age (+/-5 years) gender and location. Use of different forms of tobacco such as cigarettes, pipe-smoking and shamma (smokeless- tobacco) was assessed. Khat, a commonly used chewing substance in the community was also included. Descriptive analysis was first performed followed by multiple logistic regression (with and without interaction) to derive odds ratios (ORs) and 95% confidence interval (CIs). RESULTS: Mean age of the study sample (56% males and 44% females) was 65.3 years. Multinomial regression analysis revealed that shamma use increased the odds of developing oral cancer by 29 times (OR=29.3; 10.3-83.1). Cigarette (OR=6.74; 2.18-20.8) was also seen to have an effect. With the interaction model the odds ratio increased significantly for shamma users (OR=37.2; 12.3-113.2) and cigarette smokers (OR=10.5; 2.88-3.11). Khat was observed to have negative effect on the disease occurrence when used along with shamma (OR=0.01; 0.00-0.65). CONCLUSIONS: We conclude that shamma, a moist form of smokeless tobacco is a major threat for oral cancer occurrence in the Jazan region of Saudi Arabia. This study gives a direction to conduct further longitudinal studies in the region with increased sample size representing the population in order to provide more substantial evidence.