Comparing the effectiveness of two educational methods for oral health management in COVID-19 pandemic among dental professionals.

AIM. The aim of this study was to train dentists on the different oral hygiene measures to be followed by COVID-19 patients via Webinar and Information Education Communication (IEC) Materials and compare the effectiveness of both. METHODOLOGY. A total of 100 dental professionals were included by non-probability convenience sampling. Webinar and IEC Materials on oral hygiene measures, oral symptoms, and management strategies during COVID-19 were created and training was conducted for all dental professionals who registered themselves. An online version of the self-administered questionnaire (English) was created on the official Edantseva website and circulated to all the registered participants to obtain the pre and post-training data. RESULTS. Out of the total 80 participants in the Webinar group, 47 were females and 33 were males. Comparing the mean total scores obtained by the participants in the webinar and IEC groups in the pre and post-test showed that there is a significant difference in the scores obtained by the participants in the two groups in the pre and post-test (p<0.01). CONCLUSION. Educating dentists via IEC Materials was effective in improving their knowledge regarding oral health management during the COVID-19 pandemic. IEC materials being handy and referable at any time was found to be more effective.

Cultural factors and family influences on adolescent oral health: qualitative research in a socially disadvantaged population.

AIM: This qualitative study sought to assess the influence of cultural factors and family on oral health behaviour of 12- to 15-year-old adolescents from the socially disadvantaged population. DESIGN: A qualitative design was developed with focus group discussions (FGDs) among 12- to 15-year-old adolescents. Four focus groups (n = 32 participants) were created from a selected sample to capture oral health beliefs and practices, oral health-seeking behaviour along with other relevant information. Focus group discussions were audio-recorded, transcribed verbatim and translated. Data were analysed thematically and structural coding was applied. RESULTS: Three key themes that emerged from FGDs were importance of oral health; role of family in oral health behaviour; and beliefs influencing access, prevention and treatment of oral diseases. Cultural background, family values and beliefs were imperative in moulding the behaviour of adolescents towards oral health. The use of traditional oral hygiene aides was a norm in this population. CONCLUSIONS: Findings of the study provide greater insights into the authoritative role of family and cultural barriers in the uptake of dental services. The study also highlights the potential value of qualitative research and emphasizes the need to integrate oral health-associated cultural beliefs and attitudes of the adolescents towards a wider evidence base.

Global perspective on child and adolescent oral health: a systematic review and meta-analysis of oral impacts on daily performance.

OBJECTIVE: Several prevalence studies have estimated the region-specific impact of oral diseases on oral health-related quality of life. However, none of them reported and compared the same from a global perspective. This meta-analysis aims to evaluate pooled epidemiologic data about child-oral impacts on daily performance (C-OIDP) globally. METHODS: A search was conducted in PubMed, Science Direct, SciELO, Semantic scholar, and Cochrane databases up to January 2023. Studies evaluating OIDP among 11-18-year-olds were included in the review. Quality of the included studies was evaluated using the health states quality index for cross-sectional studies. The meta-analysis used R package software version 4.3.0. A common effect model was used to calculate the pooled prevalence. The protocol was registered in the PROSPERO (CRD-NIHR) database with Reference ID CRD42023393798. RESULTS: The systematic literature search yielded 257 unique citations. After screening titles and abstracts, 214 irrelevant citations were excluded, leaving 55 for full-text review. Overall, 43 studies from 23 countries were included. The meta-analysis reported a pooled prevalence impact C-OIDP of 53.36% (CI: 52.78-53.95, 43 studies, 16,622 participants). The prevalence of C-OIDP scores among South America, Asia, Europe, Africa and Oceania was 83%, 63%, 58%, 33% and 47%, respectively. The maximum prevalence was reported in South America while the least prevalence was noted in the African population. CONCLUSION: Oral diseases affect the oral health-related quality of life of more than half of children and adolescents globally. Huge variations were noted in the prevalence of oral impacts across different regions. These findings can be utilized by policymakers to draft measures required for reducing impacts of oral diseases and improving the health-related quality of life.

Risk factors and associated pathway for rural and urban unmet dental prosthetic needs among older adults in Central India.

AIM: This study was undertaken to evaluate the risk factors and associated pathways for unmet dental prosthetic needs among older adult population in Central India. METHODS: A total of 11,145 randomly selected older adults participated in the study; 4613 from urban region and 6532 form rural region. Oral examinations were conducted at individual households for recording dental caries, periodontal disease, prosthetic status and needs. Structural Equation Modelling (SEM) was used to examine relationship between a set of exogenous variables and unmet dental prosthetic needs with variables that remained significant in the adjusted multilevel logistic model. Path coefficients were calculated for all variables with 95% confidence interval. Goodness of fit of the model was assessed by several indices. RESULTS: A total of 8433 (75.7%) participants had never visited a dentist and 9139 (82%) had unmet dental prosthetic needs. Dental caries was observed among 3207 (69.5%) and 4644 (71.1%) study participants from urban and rural regions respectively (p < .05). Low utilization of dental services was associated with high dental prosthetic needs in upper arch and lower arch (PC = -0.05, 0.001) and DMFT was associated with lower utilization of dental services (PC = -0.09, 0.001). DMFT was also associated with age, annual income, level of education, paternal education, type of family, tobacco consumption and CPI score in the hypothesized model. The fit indices used indicated that the model was adequate. CONCLUSIONS: Dental prosthetic needs in the proposed pathway model was associated with low utilization of dental services, dental caries, periodontal disease and other socio-demographic factors.

Qualitative Analysis of Opinions and Beliefs Associated with the Use of Tobacco Dentifrice among Individuals Attending a Tobacco Counselling Session.

BACKGROUND: Smokeless tobacco (SLT) use is positively associated with oral, oesophageal, and pancreatic cancers. The tobacco dentifrice is a type of SLT which is applied to the teeth and gums. It is available in different forms which include mishri, gul/gulmanjan, gudhaku, snuff, red tooth powder, and creamy snuff. This qualitative study aims to explore the opinions and beliefs associated with the harmful effects of tobacco dentifrice use. METHODOLOGY: Thirty in-depth interviews were conducted among tobacco dentifrice users visiting a dental hospital. The data were coded and analysed using thematic analysis in ATLAS.ti software 8. RESULTS: A total of 11 codes and six categories were generated which comprised of the reason for the initiation, awareness of health effects, perception of oral tobacco application, perception of quitting, the reason for continued use, and use in society. Family, peers, access to the product, curiosity were important factors to initiate the tobacco dentifrice use. Participants believed in the myth that tobacco dentifrice was beneficial for the teeth, gums, and bowel movements. The participants considered tobacco dentifrice to be less harmful than other forms of tobacco. However, some participants were aware of its adverse effects on health and have tried to quit in the past. None of the participants had taken any professional help for quitting. CONCLUSION: There were strong beliefs and myths among the participants that tobacco dentifrice was beneficial for oral and general health. There is a need to create awareness and improve the standard of the health warning of such products.

Effect of premature loss of primary teeth on prevalence of malocclusion in permanent dentition: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to assess the effect of premature loss of primary teeth in children of mixed dentition age on the prevalence of malocclusion in permanent dentition. MATERIAL AND METHODS: A search was conducted in Medline through PubMed, Cochrane databases, Google Scholar, and Directory of Open Access Journals (DOAJ) through March 2023. All observational studies that evaluated the association between premature loss of primary teeth and malocclusion in permanent dentition were included for analysis. Quality of studies was evaluated using the Newcastle-Ottawa tool. Meta-analysis was conducted using Cochrane Review Manager (RevMan) Version 5.3. The association between different categories of malocclusion and premature loss of primary teeth was assessed using a random-effects model. Heterogeneity was explored through sensitivity analysis. Certainty of evidence was evaluated using GRADE analysis. RESULTS: This meta-analysis showed that the premature loss of primary teeth significantly increases the prevalence of overall malocclusion in permanent dentition (OR=2.54, P=0.003; I2: 83%). Subgroup analysis showed an insignificant relationship of premature loss of primary teeth with Class I malocclusion (OR=1.14, P=0.45; I2: 63%) and Class II malocclusion (OR=1.63, P=0.18; I2: 87%) but statistically significant relationship with Class III malocclusion (OR=3.73, P=0.006; I2: 71%). Sensitivity analysis reflected a significant reduction in I2 values. CONCLUSION: This meta-analysis provides substantial evidence supporting the relationship between premature loss of primary teeth and malocclusion in permanent dentition. Notably, Class III malocclusions exhibited a significant association with premature loss of primary teeth.

Sugar-sweetened beverage consumption and socioeconomic status: A systematic review and meta-analysis.

BACKGROUND: Sugar-sweetened beverages (SSB) are an independent risk factor for obesity and other non-communicable diseases. Socioeconomic status (SES) is one of the key drivers for the purchase and consumption of SSBs among children and adults; however, there is a lack of strong evidence. This study aims to determine the association between SES and consumption patterns of SSBs across populations. RESULTS: The review was conducted according to PRISMA guidelines. PubMed, MEDLINE, Scopus, EMBASE, LILACS, Web of Science, Cochrane, and CINHAL databases were searched for relevant articles until 2022. Participants included children, adolescents, and adults who consumed different SSBs and were assessed based on their SES. The random-effects model was used to obtain the pooled odds ratio (OR). Twenty-one studies (152,070 participants) met the inclusion criteria. The risk of bias was assessed using the Newcastle-Ottawa tool, with the majority of the studies indicating medium to high quality. Eight ORs from four studies (34,454 participants) were considered for meta-analysis. Results showed those belonging to high SES had 48% lower odds of consuming the SSBs (OR 0.52; 95% CI: 0.42-0.61; p = 0.017). The overall quality of evidence was ascertained using GRADE criteria, illustrating a moderate certainty of evidence between SSB consumption and SES. CONCLUSION: Meta-analysis suggests that SES influences the consumption pattern of SSBs, with high SES having lower odds of SSB consumption.

Sugar-sweetened beverages and periodontal disease: A systematic review.

This systematic review aims to determine the association between the consumption of sugar-sweetened beverages (SSBs) and periodontal disease. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct a literature search on five electronic databases till January 2022. Systemically healthy individuals consuming SSBs and presenting periodontal disease (gingivitis/periodontitis) were included. The modified Newcastle-Ottawa Scale and the Grading of Recommendation Assessment Development and Evaluation criteria were respectively used to assess the risk of bias and the evidence's quality. Of the 1303 eligible records identified in the initial search, ten studies (nine cross-sectional and one case-control) were selected for the final review. Among the included articles, five reported SSBs intake in the form of carbonated soft drinks, two as sugary drinks, two as soft drinks, and one as coffee with added sugar. Four studies reported gingivitis as an outcome, while the remaining six studies reported periodontitis using validated indices. The included studies were of medium to high quality. Consumption of SSBs may increase gingival bleeding, thereby gingivitis and the risk of periodontitis. Intake of added sugars like SSBs should be considered as a potential factor during gingival/periodontal risk assessment. Further studies are warranted to establish additional evidence of association.

Effectiveness of a Training Program in School Teachers on the Role of Sugars in Oral and General Health.

BACKGROUND: Schools have a powerful influence on children's development and well-being, and school teachers are considered role models to transmit life values and instill health-related behaviors. The effectiveness of a training program for school teachers in understanding the role of sugars and their impact on oral and overall health has not been previously reported. AIM: The present study aimed to assess the effectiveness of a training program for school teachers on the role of sugars in oral and general health. METHODS: An interventional study was carried out on 308 Kendriya Vidyalaya Sangathan school teachers to evaluate the effectiveness of a training program in improving school teachers' knowledge of the role of sugars in oral and overall health. The training program was carried out using a training module, and a validated questionnaire was utilized to assess school teachers' knowledge before and after the training program. RESULTS: The overall evaluation of mean knowledge change scores revealed significantly higher scores after the training program (8.12 ±1.58) when compared with the pre-training scores (6.84±1.66) Conclusion: A training program on the role of sugars in oral and general health effectively improved school teachers' knowledge.

Serum Lactate Dehydrogenase Enzyme as a Tumor Marker in Potentially Malignant Disorders: A Systematic Review and Meta-Analysis.

BACKGROUND: Oral cancer is often preceded by Potentially Malignant Disorders (PMDs) and important role of biochemical markers for early diagnosis has been well documented; however, there is limited evidence of Serum lactate dehydrogenase (SLDH) as an effective biochemical marker in diagnosis of PMDs. The present meta-analysis was conducted to assess if serum LDH can be a used as standard biomarker for PMDs and consequently aid in diagnosis of oral cancer. METHODS: A comprehensive search was conducted in Medline, Scopus, Web of Science, EBSCO host, Cochrane databases and Google Scholar for studies evaluating estimation of SLDH in PMDs. Search strategy included all types of studies evaluating level of SLDH in patients with PMDs. PRISMA guidelines were followed for the meta-analysis. Fixed-effects model was used to assess the mean differences in SLDH levels between healthy controls and PMDs. RESULTS: A total number of nine studies were included in meta-analysis after screening for inclusion and exclusion criteria. Potentially malignant disorder was significantly associated with increased serum LDH level compared to healthy controls (pooled SMD: 1.83 (95% CI, 1.52, 2.15) (P < 0.00001; Subgroup analysis of OSMF (Oral Submucous Fibrosis) studies showed significant association with increased serum LDH level compared to healthy controls (pooled SMD: 2.57 (95% CI, 2.16, 2.98; P < 0.00001). Sensitivity analysis for the five studies reflected a significant reduction in I2 values to 24 % (P=0.26). Funnel plots were derived for any evidence of publication bias among the studies. CONCLUSION: Meta-analysis suggests that SLDH is increased in potentially malignant disorders compared to healthy controls. The results of this metanalysis should encourage use of SLDH as a biomarker in diagnosis of PMDs.

Universal oral health coverage - Perspectives from a developing country.

Universal Health Coverage (UHC) is where people have access to health services without suffering financial hardship to pay for it, provide equitable health-care services that are appropriate, accessible and affordable for all people, particularly poor and disadvantaged communities. However, optimal intervention in relation to oral disease is not universally available or affordable specifically in developing countries because of limited resources at public sector, escalating costs of treatment and inadequate emphasis on primary prevention of oral diseases. Similar barriers also exist in utilisation of dental services among the Indian population. Integrating oral health into UHC will help improve oral health outcomes and reduce inequalities in access to care. To strengthen the oral health system towards UHC, public sector spending on oral health-care should be equally focused on primary care instead of directing mainly into only tertiary care, which could help reduce the number of complications progress to more expensive and more aggressive treatment.

Global Status of Knowledge, Attitude and Practice on Tobacco Cessation Interventions Among Dental Professionals: A Systematic Review.

BACKGROUND: With the emergence of the WHO Framework Convention on Tobacco Control, globally the use of tobacco has decreased notably, although, it still requires efforts at individual, organizational, community level to decrease the rate further. Dental professionals are at an excellent position to provide tobacco cessation counselling and interventions, however, it is not practiced much due to lack of training and lack of knowledge. Therefore, this systematic review was conducted to assess the global status of knowledge, attitude and practice on tobacco cessation interventions among dental professionals. MATERIALS AND METHOD: A systematic search of 6 databases with no language restriction since 2000 was undertaken. Studies were included if they assessed knowledge, attitude and practice on tobacco cessation interventions among dental professionals using a validated or prevalidated tool. The data obtained for assessment of knowledge, attitude, practice, curriculum and barriers were represented through heatmaps. Quality assessment of the studies was done using Newcastle Ottawa scale. RESULTS: Fifty six studies were included in this systematic review. Majority of the studies were found to be of moderate quality. Knowledge regarding the tobacco cessation interventions was more theoretical than practical. All the studies showed a favorable attitude among dental professionals towards tobacco cessation intervention. CONCLUSION: The included studies lack homogeneity in assessing knowledge, attitude and practice on tobacco cessation interventions. The development and validation of a standardized questionnaire to assess knowledge, attitude and practice on tobacco cessation interventions could be a potentially effective way to uniformly gather data on the subject.

ABO Blood Groups and Its Association with Oral Cancer, Oral Potentially Malignant Disorders and Oral Submucous Fibrosis- A Systematic Review and Meta-Analysis.

OBJECTIVE: The study aimed to evaluate the association between ABO blood groups and oral cancer, other potentially malignant disorders (OPMD), and oral submucous fibrosis (OSMF). MATERIALS AND METHODS: A search was conducted in Medline, Cochrane databases, Google Scholar, Scopus, Web of Science and Directory of Open Access Journals (DOAJ) for studies evaluating ABO blood groups as risk factors for oral cancer and OPMD among cases and controls. The PRISMA guidelines were followed for the meta-analysis. Participants included patients with oral cancer, and OPMD diagnosed using histopathologic investigations.  Sub-group analysis was conducted to evaluate the association between blood groups and OSMF. Quality was evaluated using the Risk of Bias Assessment tool. Fixed effects model was used to assess the odds ratio for the association. RESULTS: There were 1352, 414, and 299 cases of oral cancer, OPMD, and OSMF and 11,699, 7382 and 7307 controls for analysis respectively. Blood group A was significantly associated with both oral cancer (Odds ratio: 1.27 [95% CI, 1.10, 1.47], P= 0.001) and OPMD (Odds ratio: 1.33 [95% CI, 1.01, 1.47], P= 0.04).  No association was noted between blood group B and AB with oral cancer, OPMD, and OSMF. Blood group O was significantly associated with lower chances of oral cancer (Odds ratio: 0.81 [95% CI, 0.71, 0.93], P= 0.002). CONCLUSION: Meta-analysis suggests blood group A has a greater risk for developing oral cancer and OPMD. Blood group O was associated with lower chances of oral cancer. No association was noted between ABO blood group system with OSMF.

Malnutrition and Its Association with Dental Caries in the Primary and Permanent Dentition: A Systematic Review and Meta-Analysis.

Purpose: This study evaluated the evidence for associations between malnutrition and dental caries among children and adolescents in primary and permanent dentition. Methods: A search was conducted in Medline, Cochrane, Google Scholar, Scopus, and Web of Science databases for studies comparing malnourishment and dental caries among children and adolescents. PRISMA guidelines were followed for the meta-analysis. Participants included well-nourished and malnourished children and adolescents ranging in age from six months to 19 years. The primary out-come was the prevalence of dental caries in primary and permanent dentition and early childhood caries (ECC) for children younger than six years. Quality was evaluated using the risk of bias assessment tool. Random-effects model was used to assess the odds ratio of the association between malnutrition and dental caries. Results: Eleven studies met the inclusion criteria. There were 1,851 and 1,395 malnourished and well-nourished children available for analysis. Analysis of the longitudinal studies indicated that malnourished children were associated with a higher presence of caries (odds ratio equals 2.69, 95 percent confidence interval [CI] equals 2.05 to 3.53, P<0.001). Malnourished children were associated with a higher presence of dental caries in permanent dentition (odds ratio equals 3.56, 95 percent CI equals 2.21 to 5.74, P<0.001). Conclusion: Meta-analysis suggests that malnutrition is associated with dental caries in permanent dentition. However, no such association was observed between malnutrition with dental and ECC in the primary dentition.

Genetic Implications of HLA-DR and HLA-DQ Genotype on Tobacco Smoking and Oral Submucous Fibrosis.

PURPOSE: Integration of genetic information into our understanding of oral diseases has fostered the hope to intervene the disease process among genetically susceptible individuals. Oral submucous fibrosis (OSF) (mainly in the Southeast Asia region) and tobacco smoking are two of the major public health problems the world is facing today. With more and more diseases being associated with alleles of the human leukocyte antigen (HLA), the objective of the study was to explore any genetic association of OSF and smoking behaviour with specific HLA Class II DQB1*0503 and HLA DRB1*0301 alleles. MATERIALS AND METHODS: Genomic DNA was extracted from saliva of 64 patients divided into an OSF group, a tobacco smokers group and a control group. This was followed by polymerase chain reaction (PCR) with sequence-specific primer of HLA-DQB1*0503 and HLA DRB1*0301 allele, visualised under 2% agarose gel. RESULTS: A statistically significant difference was observed between the OSF group and controls in presence of HLA-DQB1*0503 allele, with 84% of the patients showing the presence. Frequency of HLA DRB1*0301 allele was also found to be significantly higher (72%) among OSF patients (p <0.001). Similar results were shown in tobacco smokers with 28% cases showing presence of HLA DRB1*0301 allele and 13 (52%) of them having DQB1*0503 allele (p <0.001). CONCLUSION: HLA-DRB1*0301 and HLA-DQB1*0503 are statistically significantly associated with susceptibility to OSF and smoking behaviour.

Loneliness and disability as predictors of oral diseases among 2 groups of older adults in central India.

BACKGROUND: In this study, the authors aimed to assess the association of loneliness and disability with oral health in 2 groups older adults (≥ 60 years) in central India. METHODS: A total of 421 older adults participated in the study; 316 (75.1%) attended outpatient services at the Department of Dentistry, All India Institute of Medical Sciences, Bhopal, India, and 105 (24.9%) were from old age homes. The authors used the Patients Reported Outcomes Measurement Information System's social isolation 8a short form to assess loneliness. Disability was assessed using the 12-item version of the self-administered World Health Organization Disability Assessment Scale. The authors conducted regression analyses to establish the association of loneliness and disability with the decayed, missing, and filled tooth index; periodontal disease; and edentulousness. RESULTS: Poor oral health findings were noted in both groups. Eighty-eight (20.9%) participants had never visited a dentist, and 201 (88.5%) had unmet dental prosthetic needs. Loneliness and disability were associated with decayed, missing, and filled tooth index scores; periodontal disease; and edentulousness, with odds ratios of 1.86, 1.29, 2.37 and 4.63, 3.85, 3.63 respectively (P < .001). Age, sex, socioeconomic status, type of residence, tobacco use, and use of oral health care were also independent variables associated with oral health (P < .001). CONCLUSIONS: Loneliness and disability were found to be significantly associated with oral health. The study results found poor oral health, low use of oral health care, and high unmet need for dental prosthetics in the 2 groups of older adults. PRACTICAL IMPLICATIONS: Practicing dentists need to understand the significance of loneliness and social isolation on oral health. Interventions to reduce isolation and disability can be beneficial in improving the oral health of older adults.

Caries Preventive Effects of High-fluoride vs Standard-fluoride Toothpastes - A Systematic Review and Meta-analysis.

PURPOSE: To determine the efficacy of high-fluoride toothpastes (≥ 2500 ppm) as compared to standard fluoride toothpastes (≤ 1500 ppm) in preventing dental caries. MATERIALS AND METHODS: Randomised controlled trials (RCTs) and cluster-randomised trials comparing high-fluoride dentifrices (≥ 2500 ppm) with lower-concentration fluoride dentifrices (≤ 1500 ppm) with a follow-up period of at least 6 months were included. A random effects model was used to assess the mean differences in caries increment between the two types of dentifrices used. A fixed effects model was used to determine the preventive effect of high-concentration fluoride toothpastes compared with low-fluoride toothpastes. Subgroup and sensitivity analyses were conducted when results indicated heterogeneity. Statistical significance was set at p < 0.05. RESULTS: Eight studies met the inclusion criteria. High-fluoride toothpaste use was statistically significantly associated with lower caries increment scores (pooled mean difference: -0.52 [95% CI, -0.67, -0.37], p = 0.00001). Subgroup analysis for the included studies reflected a significant reduction in I2 values from 99% to 18%. High-fluoride toothpastes were also associated with a greater preventive effect compared with low-fluoride toothpastes (pooled odds: 52.76 [95% CI, 19.74, 141.04], p = 0.95). CONCLUSION: This meta-analysis suggests that high-fluoride toothpastes are superior to low-fluoride toothpastes in reducing caries. The results of this work when used judiciously should encourage the use of high-fluoride toothpaste, specifically among the vulnerable populations, to maximise preventive benefits.

Assessing the nicotine content of smoked and smokeless forms of Tobacco Available in Bhopal.

CONTEXT: Abuse of tobacco, such as drug and alcohol abuse, is a worldwide public health problem. Once a person is addicted to nicotine, quitting smoking is difficult. A measure of the addictive potential of tobacco products is the amount of nicotine available from them. The present study is an attempt to assess the nicotine content of tobacco products available in Bhopal. AIMS: This study aims to assess the nicotine content of some popular brands of smoked (cigarettes and bidis) and chewed forms (pan masalas containing tobacco) of tobacco available in Bhopal. SETTINGS AND DESIGN: This was an in vitro cross-sectional study. SUBJECTS AND METHODS: Six brands of cigarettes (filtered), six brands of bidis, and six brands of chewed tobacco (pan masalas) were used for the study. The methodology published by Association of Official Analytical Chemists was followed, and reagents conforming to American Chemical Society specifications were used. STATISTICAL ANALYSIS USED: One-way ANOVA, Bonferroni post hoc test. RESULTS: The mean nicotine levels for cigarettes, bidis, and chewed tobacco were 7.84 ± 5.10, 16.86 ± 5.66, and 16.30 ± 3.33, respectively. The differences in the mean scores were compared using one-way ANOVA and were found to be statistically significant with F = 6.636 and P = 0.009. Bonferroni post hoc test assessed the difference in mean nicotine content among the groups indicating that the difference between cigarettes versus bidis and cigarette versus chewed tobacco was significant with P = 0.016 and 0.024, respectively. CONCLUSIONS: Bidis had the highest content of nicotine, followed by chewed tobacco (pan masalas) and cigarettes.

Exploring patient satisfaction levels, self-rated oral health status and associated variables among citizens covered for dental insurance through a National Social Security Scheme in India.

OBJECTIVE: To assess patient satisfaction, self-rated oral health and associated factors, including periodontal status and dental caries, among patients covered for dental insurance through a National Social Security Scheme in New Delhi, India. METHOD: A total of 1,498 patients participated in the study. Satisfaction levels and self-rated oral-health scores were measured using a questionnaire comprising 12 closed-ended questions. Clinical data were collected using the Community Periodontal Index (CPI) and the decayed, missing and filled teeth (DMFT) index. Regression analysis was conducted to evaluate factors associated with dental caries, periodontal status and self-rated oral health. RESULTS: Areas of concern included poor cleanliness within the hospital, extensive delays for appointments, waiting time in hospital and inadequate interpersonal and communication skills among health-care professionals. Approximately 51% of the respondents rated their oral health as fair to poor. Younger age, no tobacco usage, good periodontal status and absence of dental caries were significantly associated with higher oral health satisfaction, with odds ratios of 3.94, 2.38, 2.58 and 2.09, respectively (P ≤ 0.001). CONCLUSION: The study indicates poor satisfaction levels with the current dental care system and a poor self-rated oral health status among the study population. Some specific areas of concern have been identified. These findings may facilitate restructuring of the existing dental services under the National Social Security Scheme towards creating a better patient care system.

Severity of illness and extra pyramidal symptoms as predictors for oral diseases among patients with schizophrenia.

OBJECTIVE: The study explores the association between severity of illness (positive, negative, depressive and cognitive symptoms) and extra pyramidal symptoms (EPS) with dental caries, periodontal disease and prosthetic needs among patients with schizophrenia. MATERIAL AND METHODS: A total of 71 schizophrenic patients diagnosed based on ICD-10 criteria participated in the study. Clinical Global Impression - Schizophrenia (CGI-SCH) scale was used to evaluate positive, negative, depressive, cognitive symptoms and overall severity of schizophrenia. Simpson-Angus Scale (SAS) was used for assessment of EPS. Dental examinations were conducted as per WHO (1997) criterion. RESULTS: Mean DMFT and CPI scores with periodontal pockets were 5.57 ± 2.12 and 2.37 ± 0.74; significant differences being noted among those with and without EPS (p < 0.001). Positive and EPS associated with dental caries with odds ratio of 5.26 (1.05, 26.2) and 8.52 (2.31, 31.4) (p < 0.001). Depressive and EPS were associated with periodontal disease with odds ratio of 4.19 (1.53, 32.5) and 5.27 (1.29, 21.5), respectively (p < 0.001). Cognitive and EPS were associated with dental prosthetic needs with odds ratio of 4.33 (1.47, 31.2) (p < 0.001) and 7.78 (1.43, 42.2), respectively (p < 0.001). CONCLUSIONS: Patients with schizophrenia had high dental caries, periodontal disease and unmet dental prosthetic needs. Severity of the schizophrenic and EPS was associated with poor oral health. Efforts need to be focused on strengthening the evidence of its association with oral health indicators through further studies including cohort investigations.