Sign language based educational interventions vs. other educational interventions to improve the oral health of hearing-impaired individuals: A systematic review and meta-analysis.

OBJECTIVE: Individuals with special needs requiring special care are more vulnerable to oral health problems. Sign language is a communication medium and language of instruction for individuals with hearing impairments. The purpose of this systematic review and meta-analysis was to assess the effectiveness of sign language-based educational interventions compared to other educational interventions in improving the oral health of hearing-impaired individuals. METHODS: PubMed, Scopus, Embase, and Cochrane Central Register of Controlled Trials databases were searched without any restriction on the publication date. Analytical and experimental studies that evaluated and compared the effectiveness of sign language with other educational intervention groups such as videos, posters etc were included. RESULTS: Initially, 5568 records were identified. Three relevant publications from India were eligible and included in the systematic review and meta-analysis. Differences were reported in favour of sign language over other interventions concerning plaque status, gingival health, and oral hygiene status. CONCLUSION: Sign language-based interventions were found to be effective. However, further studies in different locations and populations are required to support their effectiveness.

Effect of family cohesion on oral health predictors in children and adolescents: A systematic review.

OBJECTIVE: The family environment influences oral health conditions and the utilization of dental services. The emotional link between the family members and the degree to which they are resilient and close to each other is represented as family cohesion and adaptability. This systematic review critically appraises and synthesizes existing evidence on the effect of family cohesion on oral health predictors in children and adolescents. METHODS: The protocol was registered in PROSPERO (CRD42023453608). Databases such as PubMed, Embase, and Scopus were electronically searched in September 2023. No restriction of time frame was allowed. Risk of bias was assessed using the Agency for Healthcare Research and Quality tool. RESULTS: Initially, 272 records were identified from PubMed (133), Embase (122) and Scopus (10) databases and other sources, finally leading to 12 cross-sectional studies to be included. Eleven studies were carried out in Brazil and one in USA. Only one study reported moderate risk, whereas the others all reported low risk of bias. The studies were carried out from 2013-2023. The frequency of dental visits, oral health literacy, and self-perceived need for dental treatment were reported to be higher in families with the better cohesive ties. An inconsistent direct association was reported between dental caries and family cohesion. CONCLUSIONS: Family dynamics are important in shaping oral health behaviors and outcomes during a pivotal phase of development. Further exploration through longitudinal studies in this field can elucidate causal pathways and potential moderators.

Oral health status and absence from school among 12 year olds.

OBJECTIVE: To assess dental caries, periodontal status, malocclusion and absenteeism from school among 12-year-olds in Bhopal district, Central India. MATERIALS AND METHODS: Two-stage random sample of 1238 school children. Decayed missing filled teeth (DMFT), Significant caries index (SiC), community periodontal index (CPI) and dental aesthetic index (DAI) were used to record dental caries, periodontal status and malocclusion. Information on absence from school in the previous year due to pain/discomfort in the teeth or mouth was collected via interviews. Generalized structural equation modelling (GSEM) examined the direct and indirect predictors of absence from school. RESULTS: A total of 39.1%, 17.3% and 23.9% of children had dental caries, calculus and gingival bleeding respectively. Mean DMFT and SiC scores were 1.82± 1.36 and 3.15 ± 1.47. 5,127 school hours were missed due to oral health problems per 1,000 children. None of the studied variables predicted absence from school. Utilization of dental care was associated directly with gender and malocclusion (p⟨ 0.001). Periodontal status was associated with male gender, nuclear families, tobacco consumption, and malocclusion (p⟨ 0.001). Higher DMFT was associated with male gender, malocclusion and experience of pain/discomfort (p⟨ 0.001). CONCLUSIONS: Poor oral health and a high prevalence of untreated dental caries were noted. Despite a considerable number of missed school hours reported due to dental conditions, none of the studied variables predicted absence from school.

Is Malocclusion Associated with Dental Caries among Children and Adolescents in the Permanent dentition? A Systematic Review.

OBJECTIVE: To determine the association between malocclusion and the severity of dental caries among children and adolescents in the permanent dentition. METHOD: A search was conducted in Medline, Cochrane databases, Google scholar, Scopus and Web of Science through October 2020 for studies of malocclusion and dental caries among children and adolescents using the Dental Aesthetic Index (DAI) and the Decayed, Missing, Filled Teeth (DMFT) index. Quality was evaluated using the Newcastle-Ottawa tool for cross-sectional studies. Data were extracted using the Cochrane Collaboration guidelines. Meta-analysis used the Cochrane Program Review Manager Version 5. A random effects model was used to assess the association among different categories of malocclusion with dental caries. GRADE analysis assessed the certainty of evidence. RESULTS: Five studies met the inclusion criteria. Handicapping malocclusion was significantly associated with higher mean DMFT scores (Mean difference: 1.03, 95% CI, 0.61, 1.44). Participants with severe malocclusion had higher mean DMFT when compared to subjects with normal occlusion (0.32, 95% CI, 0.13, 0.51). Definite malocclusion was also associated with higher mean DMFT scores (Mean difference: 0.19, 95% CI, 0.03, -0.35). CONCLUSION: Malocclusion is associated with dental caries in the permanent dentition. DMFT scores and the strength of the association increased with severity of malocclusion. Low to moderate certainty of evidence was observed for association between handicapping, severe, and definite malocclusion with dental caries.

Assessment and validation of the oral impact on daily performance (OIDP) instrument among adults in Karnataka, South India.

OBJECTIVES: The objective of the study was to test the applicability of abbreviated version of the oral impact on daily performance (OIDP) inventory among the adults visiting dental outreach centre in Karnataka, South India. BASIC RESEARCH DESIGN: Cross sectional study. CLINICAL SETTING: Dental outreach centre in Udupi District, Karnataka. PARTICIPANTS: 312 adults aged 35-44 years attending the centre. INTERVENTIONS: Face-to-face interview followed by oral health examination. The questionnaire in Kannada version of OIDP, perceived general and oral health and satisfaction with dental appearance were used. MAIN OUTCOME MEASURES: Reliability and Validity of OIDP instrument, Prevalence of oral impacts in study population. RESULTS: Majority of the participants (71.2%) reported oral health problems affecting at least one daily performance in the 6 months preceding the survey. The performance most affected was 'eating' (52.2%) followed by 'cleaning teeth' (32.4%). Cronbach's alpha for the OIDP frequency items was 0.70. Construct validity was proved by significant association of OIDP scores and self-rated oral, general health status and perceived satisfaction with appearance of teeth; with those more satisfied having fewer oral impacts (p < 0.001). Criterion validity was demonstrated in that the OIDP scores increased significantly as the number of decayed and missing teeth increased (p < 0.001). CONCLUSION: The Kannada version of OIDP had excellent psychometric properties for applicability among the adults in Karnataka. Thus, the study highlighted the limits of focusing exclusively on normative needs and suggested the incorporation of oral quality of life measures into the oral healthcare services.

Malocclusion and orthodontic treatment need measured by the dental aesthetic index and its association with dental caries in Indian schoolchildren.

OBJECTIVE: To assess prevalence of malocclusion and orthodontic treatment needs among 12 year old Indians using the Dental Aesthetic Index, and to find its association with dental caries. METHOD: 927 schoolchildren were randomly selected and their DAI and dentition status scores were recorded as per 1997 World Health Organization criteria. Clinical exams were carried out by one trained and calibrated examiner. The Chi-square test, Z-test and Spearman's correlation test were carried out. RESULTS: Mean DAI score was 19.2 (sd 6.8). Differences were found between male and female DAI scores (Z < or = 0.05). 82% of children had DAI scores < 26 with no or minor malocclusion requiring no or little treatment, 3.2% had DAI scores 31-35 with severe malocclusion requiring highly desirable treatment and 1.8% DAI scores > 35 with handicapping malocclusion requiring mandatory treatment. A mean DMFT of 1.15 (sd 1.62) was recorded. Severe and handicapping malocclusions were associated with dental caries. CONCLUSIONS: The distribution of DAI scores among Indian schoolchildren differs from that reported in other populations. Positive correlation was found between severe and handicapping malocclusion with dental caries.

Private initiatives and policy options: recent health system experience in India.

In the recent past the impact of structural adjustment in the Indian health care sector has been felt in the reduction in central grants to States for public health and disease control programmes. This falling share of central grants has had a more pronounced impact on the poorer states, which have found it more difficult to raise local resources to compensate for this loss of revenue. With the continued pace of reforms, the likelihood of increasing State expenditure on the health care sector is limited in the future. As a result, a number of notable trends are appearing in the Indian health care sector. These include an increasing investment by non-resident Indians (NRIs) in the hospital industry, leading to a spurt in corporatization in the States of their original domicile and an increasing participation by multinational companies in diagnostics aiming to capture the potential of the Indian health insurance market. The policy responses to these private initiatives are reflected in measures comprising strategies to attract private sector participation and management inputs into primary health care centres (PHCs), privatization or semi-privatization of public health facilities such as non-clinical services in public hospitals, innovating ways to finance public health facilities through non-budgetary measures, and tax incentives by the State governments to encourage private sector investment in the health sector. Bearing in mind the vital importance of such market forces and policy responses in shaping the future health care scenario in India, this paper examines in detail both of these aspects and their implications for the Indian health care sector. The analysis indicates that despite the promising newly emerging atmosphere, there are limits to market forces; appropriate refinement in the role of government should be attempted to avoid undesirable consequences of rising costs, increasing inequity and consumer exploitation. This may require opening the health insurance market to multinational companies, the proper channelling of tax incentives to set up medical institutions in backward areas, and reinforcing appropriate regulatory mechanisms.

The formation of germtubes by Candida albicans, when grown with Staphylococcus pyogene, Escherichia coli, Klebsiella pneumoniae, Lactobacilius acidophilus and Proteus vulgaris.

The formation of germtubes by twelve clinical isolates of C. albicans was studied in human serum containing per millilitre 10(3) to 10(9) organisms as: Staphylococcus pyegene, Escherichia coli, Klebsiella pneumoniae, Lactobacillus acidophilus and Proteus vulgaris. All the five bacteria inhibited formation of germtubes by C. albicans at all concentrations and the percent germtube formed diminished with increasing concentration of the bacteria. Lactobacillus acidophilus inhibited the formation of germtubes maximally followed by Staphylococcus pyogene, Escherichia coli and Klebsiella pneumoniae. Proteus vulgaris in the concentrations of 10(3) to 10(7) bacteria per millilitre produced only insignificant inhibition of formation of germtubes by C. albicans. Since germtubes of C. albicans are invasive, it is suggested that inhibition of "blastospore-germtube transformation" may be significantly responsible for prevention of infection by C. albicans by coexisting bacterial flora.

Coinfection with Cryptosporidium, Isospora and S. stercoralis in a patient with AIDS--a case report.

A thirty eight year old lady, positive for human immunodeficiency virus (HIV) antibodies, was found to be positive for three different opportunistic parasitic infections. Cryptosporidium, Isospora and S.stercoralis were simultaneously detected from her stool samples. Her CD4 count was 116/cmm. The patient belonged to a slum area with poor sanitation.

Raised serum thiobarbituric acid reactive substance levels in malaria.

To study the extent of serum lipid peroxidation in malaria, 62 patients of falciparum malaria (18 uncomplicated and 44 complicated), 15 patients of vivax malaria and 25 healthy controls were enrolled in this study. The extent of serum lipid peroxidation was evaluated by estimating serum thiobarbituric acid reactive substances (TBARS) colorimetrically. The mean serum TBARS levels were 1.5 +/- 0.29, 1.21 +/- 0.2 and 3.58 +/- 1.35 nmol/ml in controls, vivax malaria and falciparum malaria patients respectively. The TBARS level was significantly more in complicated falciparum malaria patients (4.2 +/- 1.03 nmol/ml) than uncomplicated falciparum malaria patients (2.01 +/- 0.61 nmol/ml). The TBARS level was also more in patients who died (4.82 +/- 0.64 nmol/ml) when compared to the survivors (2.92 +/- 1.05 nmol/ml).