Challenges during implant-assisted prosthetic rehabilitation in fibula reconstructed jaws and its management: a scoping review protocol.

Introduction: Oral cancer is the sixth most prevalent cancer type worldwide. Patients are placed in a crippling predicament due to the functional and psychosocial difficulties brought on by the illness and its treatments. Both surgeons and maxillofacial prosthodontists may encounter challenges with reconstruction and therapy following cancer treatment. Over 20 years, the fibula has remained the mainstay of reconstructions for head and neck cancer. Maxillary and mandibular jaws with fibula reconstructions can use fixed or removable prosthetic rehabilitation solutions. The proposed scoping review aims to ascertain the volume and nature of evidence concerning the difficulties and corrective measures in the prosthetic rehabilitation of fibula-reconstructed head and neck cancer cases. The findings will aid in improving the prosthetic treatment care for the affected population. Materials and Methods: The Joanna Briggs Institute (JBI) scoping review protocol will be followed in developing and reporting the scoping review methodology. Methods to identify the relevant literature will involve the systematic search of databases like PubMed, Scopus, Google Scholar, Cochrane Library, and gray literature sources for pertinent articles on the subject. Only papers published in English literature will be considered for the review, and the data collection period is limited to the past 20 years. The screening process will utilize defined inclusion/exclusion criteria for Title/Abstract and Full-text screening by two independent reviewers in covidence, and a third reviewer will resolve any conflicts. The data extracted will include specific details about the participants, concept, population, study methods, challenges encountered during prosthetic rehabilitation, and their management. Inductive thematic analysis and descriptive statistics will be applied where appropriate. The narrative synthesis of the evidence will be accomplished through data extraction in a tabular format, and the results will be presented as a narrative summary.

Political economy analysis of health: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map the literature on concepts, definitions, frameworks, outcomes, and applications of political economic analysis of health. INTRODUCTION: The political economy of health approach seeks to understand how political and economic domains interact and shape individual and population health outcomes. A political economic analysis can provide insights into health problems and inequalities; however, there needs to be more clarity on how the political economy framework is defined and the methods adopted for conducting political economy analysis concerning health. INCLUSION CRITERIA: Studies focusing on the political economy analysis addressing specific health problems will be included. The study population is not limited to any sociodemographic characteristics, and there will be no restrictions on language or the source of evidence (primary studies or secondary data studies). Both qualitative and quantitative methodologies will included, but narrative and systematic reviews will be excluded, as will conference abstracts and editorials. Studies involving sector- or country-level analysis will be included. METHODS: The review will follow the JBI methodology for scoping reviews. Databases to be searched include MEDLINE, Scopus, Web of Science, Cochrane CENTRAL, CINAHL, Embase, ProQuest, DynaMed, and gray literature via Google Scholar and OAIster. Two reviewers will perform study screening and data extraction using a customized data extraction form. The concepts, definitions, frameworks, outcomes, and applications of the political economy of health will be summarized and discussed. The health problems addressed using political economy analysis will be enumerated. Stakeholder engagement will guide all steps of the study. Results will be presented in tabular and graphical formats accompanied by a narrative summary. REVIEW REGISTRATION: Open Science Framework https://osf.io/4qaxr/.

Prevalence of temporomandibular joint dysfunction among the indigenous population of India.

Purpose: Primary dental care facilities and awareness about temporomandibular disorders are lacking among the indigenous population of Kerala. The aim of the study was to determine the prevalence of temporomandibular joint dysfunction (TMD) disorders among the indigenous populations of Kerala. Methodology: This cross-sectional study included adults aged 18 years and above, visiting primary health care centre in the tribal hamlet in the town of Kalpetta, Wayanad District, Kerala, India, for reasons other than dental. Axis I and II of Research Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) was used to screen for TMD. A local language validated screening questionnaire was used. The clinical examination was carried out as per the DC/TMD by a calibrated examiner. The data was processed using SPSS and the frequencies and proportions for signs and symptoms of TMD were estimated. Results: Among 198 adults screened, 23 (11.6 %) had TMD. Among these 60 % of the adults were aged 31-65 years and predominantly females (86.9 %). 39 % of these patients were dentulous. All affected adults experienced TMD related pain for more than 3 months with 90 % of them experiencing moderate-to-severe pain. Myofascial pain was the most prevalent type. Other findings included moderate anxiety levels in 34.8 % and abnormal oral behaviour and high physical symptoms in 40 % TMD patients. Conclusion: TMD disorders were prevalent among the indigenous population and remained undiagnosed. The study highlights the need for screening and the availability of basic dental care for the indigenous populations.

Effectiveness of silver diamine fluoride application with atraumatic restorative treatment in arresting the progression of dental caries: a systematic review protocol.

OBJECTIVE: This review aims to evaluate the effectiveness of silver diamine fluoride application along with atraumatic restorative treatment in arresting the progression of dental caries when compared with other caries-arresting treatments in children and adults. INTRODUCTION: A combination of silver diamine fluoride with atraumatic restorative treatment is a minimally invasive and cost-effective method to treat dental caries. It offers a solution for the progression of caries and restoration of cavitated lesions in both primary and permanent teeth. A comprehensive summary of the evidence will assist dental clinicians and guide subsequent clinical research. INCLUSION CRITERIA: Randomized controlled trials involving human participants of any age with cavitated dental caries lesions will be included. The intervention arm will evaluate the effectiveness of silver diamine fluoride application with atraumatic restorative treatment in dental caries arrest with a control arm of either atraumatic restorative treatment (ART) or silver diamine fluoride (SDF) application; or composite restoration; or sodium fluoride varnish or a placebo; or a study group with no intervention. METHODS: Systematic searches for relevant studies will be conducted across multiple databases, including MEDLINE, Scopus, Cochrane CENTRAL, Dentistry and Oral Sciences Source, CINAHL, and Web of Science. ProQuest Dissertations and Theses and Google Scholar will also be searched for gray literature. The databases will be searched from January 2016 to the present. No restrictions will be imposed on the country of publication. Data appraisal, extraction, and synthesis will follow JBI guidance for systematic reviews of effectiveness. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system will be used to grade the certainty of evidence, and a Summary of Findings will be prepared. REVIEW REGISTRATION: PROSPERO CRD42023426766.

Prevalence of physical and oral frailty in geriatric patients in Kerala, India.

Background: Physical frailty is a condition where a person has decreased physical reserve and resilience to stressors. Oral frailty, on the other hand, refers to a decline in oral function in conjunction with reductions in cognitive and physical functioning. Poor oral health, encompassing factors such as functional, physiological, psychosocial, and therapeutic aspects, can lead to physical frailty. Objectives: Assess the prevalence of physical and oral frailty in geriatric patients attending health centres in Kerala, India. Methodology: . Design: Cross-sectional study. Setting: Amrita Institute of Medical Sciences (Kochi), Amrita Kripa Charitable Hospital (Wayanad) and Amrita Urban Health Centre in (Kaloor). Participants: 250 geriatric participants above 60 years. Measurements: The participants' physical frailty was evaluated using Fried's Frailty Phenotype, the Reported Edmonton Frail Scale, and sarcopenia screening. The assessment of oral frailty was based on several factors such as current dental status, chewing ability, tongue pressure, the Repetitive Saliva-Swallowing Test, Oral Diadokinetic rates, Xerostomia, and the Oral and Maxillofacial Index. The evaluation was using a questionnaire and clinical examination. Bivariate analysis was performed for additional variables, and multivariate analysis was utilized to examine the relationship between oral and physical frailty. Results: 56 % of study participants were males, and the mean age was 68 ± 6.02 years. 34.4 % were physically frail, and the remaining were pre-frail using Fried Frailty Phenotype. 67 % showed oral frailty using the Oral and Maxillofacial Frailty Index (OMFI). Using six domains of the oral frailty status (Tanaka) showed that 74 % of individuals had an increased risk of new onset of physical frailty. In the adjusted model, individuals with mild oral frailty had lesser chances of being frail (OR = 0.509, 95 % CI = 0.274-1.946, p-value = 0.033). Conclusion: The prevalence of physical frailty was 34.4 %, and oral frailty status was 74 %. The findings implied a need to include oral frailty assessments in the comprehensive general health screening for geriatric patients.

Opioids for acute and chronic pain when receiving psychiatric medications.

BACKGROUND: People with mental health disorders (MHD) like depression and anxiety are more likely to experience substance use disorders (SUDs) than those without MHD. This study assesses opioid prescription patterns for acute or chronic pain management in patients receiving medication for depression and/or anxiety. METHODS AND FINDINGS: Cross-sectional data trend analysis of 24.5 million adult medical claims was conducted using medical and pharmacy data (2012-2019) for adults aged 21-64 from the IBM Watson MarketScan Medicaid Multi-State Database. Information on sex, age, race, provider type, acute or chronic pain, and prescriptions for opioids and antidepressant and/or antianxiety medication from outpatient encounters were analyzed. For those receiving opioid prescriptions within 14 days of a pain diagnosis, ICD-10-CM codes were used to categorize diagnoses as chronic pain (back pain, neck pain, joint pain, and headache); or acute pain (dental-, ENT-, and orthopedic-related pain). Nearly 8 million adults had at least one prescription for antidepressant or antianxiety medications (MHD), with 2.5 million of those (32%) also diagnosed with an acute or chronic pain condition (pain + MHD). Among the pain + MHD group, 34% (0.85 million) received an opioid prescription within 14 days of diagnosis. Individuals with chronic pain diagnoses received a higher proportion of opioid prescriptions than those with acute pain. Among individuals with pain + MHD, the majority were aged 50-64 (35%), female (72%), and non-Hispanic white (65.1%). Nearly half (48.2%) of the opioid prescriptions given to adults with an MHD were provided by physicians. Compared to other physician types, Health Care Providers (HCPs) in emergency departments were 50% more likely to prescribe an opioid for dental pain to those with an MHD, whereas dentists were only half as likely to prescribe an opioid for dental pain management. Although overall opioid prescriptions for pain management declined from 2012 to 2019, adults with an MHD received opioids for pain management at nearly twice the level as adults without an MHD. CONCLUSIONS: Although HCPs have reduced opioids for acute or chronic pain to patients at high-risk for SUD, for example, those with MHD, the use of opioids for pain management has remained at consistently higher levels for this SUD high-risk group, suggesting the need to revisit pain management guidelines for those receiving antidepressant or antianxiety drugs.

Impact of oral conditions on oral health-related quality of life among Indians- a systematic review and Meta-analysis.

OBJECTIVE: This review assessed the impact of oral conditions on Oral Health Related Quality of Life among Indians. METHODS: Databases, including PubMed and Scopus, CINAHL, Web of Science, PsycInfo were systematically searched for English Language studies conducted among Indians up to July 2022. Two independent reviewers assessed studies selected for retrieval for methodological quality using standardised quality assessment instruments for analytical cross-sectional studies in JBI SUMARI. RESULTS: Fourty one publications were included in this review (N = 23,090). Studies includes both cross sectional study and Randomized Controlled Trials. Based on the JBI critical appraisal tools, the quality of the included studies was low to high. Twenty-six studies were considered for the meta-analysis. Individuals with dental caries [OR: 3.54 (95% CI 2.24- 5.60), ten studies, 4945 participants] and malocclusion [ OR: 5.44 (95% CI 1.61, 18.39), six studies, 3720 participants] had poor OHRQoL compared to individuals without oral conditions. CONCLUSIONS: Despite the various definitions of the exposures and instruments used to assess Oral Health-Related Quality of Life, our review found that people with dental caries and malocclusion have a significantly higher experience of poor quality of life. PROSPERO SYSTEMATIC REVIEW REGISTRATION NO: CRD42021277874.

Cross-cultural Adaptation of Oral and Maxillofacial Frailty Assessment Tools for Geriatric Population of Kerala.

AIM: The aim of this study is to translate the oral and maxillofacial frailty index (OMFI) into Malayalam, culturally adapt it, and test its reliability and validity in the Kerala geriatric population. MATERIALS AND METHODS: OMFI was translated, culturally adapted, and validated in Malayalam using a methodological and cross-sectional study design. The Malayalam version of OMFI underwent full linguistic validation and was tested on 200 patients at Amritakripa Hospital in Kalpetta. Principal component analysis with varimax rotation was used for exploratory factor analysis, and Cronbach's alpha was used to assess reliability. RESULTS: Two-hundred patients were recruited in this study. Participants ranged in age from 60 to 83 years; mean age was 68 years (SD: 15.21). In total 55.5% were male participants, and 30.5% were belonging to upper middle class as per the Kuppuswami scale. Only 12% of the participants were living alone. Kaiser-Meyer-Olkin was found to be 0.583, and Bartlett's test of sphericity was significant with a Chi-square test value of 1003.469. A principal axis factor analysis conducted on 20 items with orthogonal rotation (varimax). OMFI Malayalam version (5 items) had a good internal consistency (Cronbach's alpha = 0.751). Item-total correlations were reviewed for the items of OMFI. CONCLUSION: The OMFI Malayalam version demonstrated acceptable validity and reliability and can be used to screen the oral frailty of the geriatric population in Kerala. CLINICAL SIGNIFICANCE: As Kerala is having highest geriatric population in India, we need to assess the oral frailty burden of Kerala. This study provided the first measure to assess the oral frailty in elderly in Kerala.

Bite Force Evaluation in Implant-Assisted Prosthetic Rehabilitation of Reconstructed Jaws Utilizing Vascularized Free Fibula Flap: A Retro-Prospective Cohort Study.

Introduction: Maxillary and mandibular defects due to tumor ablation pose considerable challenges to the reconstructive surgeon and in prosthetic management. Dental implants placed in vascularized fibula free flaps are considered to be a dependable technique for prosthetic rehabilitation in head and neck cancer patients. Although, there is evidence of survival of dental implants in the reconstructed jaw bones, there is lack of information regarding the masticatory performance and prosthetic success. The maximum bite force achieved through the prosthetic appliance is a measure of the therapeutic outcome. The purpose of this study was to determine the maximum bite force achieved through implant-assisted prosthetic rehabilitation in reconstructed jaw bones utilizing vascularized free fibula flap. Methods: The study included a total of 65 implants, from 16 patients who underwent surgical resection of jaw bones due to benign tumors followed by rehabilitation with implant-assisted fixed or removable prosthesis. The maximum bite force was determined with a transducer. Occlusal interferences were analyzed with mounted casts. The parameters were reviewed every 3 months have T 0 marked the baseline assessment, and T 3, T 6, T 9, T 12, and T 15 were subsequent review periods. Results: The mean occlusal force was increased in most of the patients through 15 months (P < 0.01). The maximum bite force measured in the reconstructed mandible and maxilla were 225.63 N and 176.51 N, respectively. Occlusal interferences were absent in 68.8% of the study population. Conclusion: The bite force measured in reconstructed maxilla and mandible is comparable to the masticatory force measured with conventional implant supported prosthesis in native mandible and maxilla.

Oral appliance therapy for the management of obstructive sleep apnea in adults: an umbrella review protocol.

OBJECTIVE: The objective of this review is to summarize the evidence on the effectiveness of oral appliance therapy compared with other therapeutic approaches (continuous positive airway pressure, maxillomandibular and upper airway surgeries, behavioral techniques) for the management of obstructive sleep apnea in adults. INTRODUCTION: For primary snoring, mild to moderate obstructive sleep apnea, and patients with a severe condition who are intolerant of continuous positive airway pressure therapy, an oral appliance is the treatment of choice among conservative procedures. The effectiveness of these appliances is largely determined by a variety of parameters, including the severity of sleep apnea (mild, moderate, severe), materials and methods used to fabricate the appliance, and the degree of mandibular protrusion. Thus, it is important to evaluate the effectiveness of oral appliances in the reduction of sleep apnea. INCLUSION CRITERIA: This review will include systematic reviews of quantitative studies reporting on the effectiveness of oral appliances for the treatment of obstructive sleep apnea of any severity, confirmed using polysomnography. The primary outcome will be measured by reduction in the apnea-hypopnea index. METHODS: A search will be conducted of MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science, CINAHL, Epistemonikos, Embase, ProQuest Dissertations and Theses, and Shodhganga Dissertations and Theses from database inception until the present, with no language restrictions. Google Scholar will be searched manually. Two independent reviewers will screen titles, abstracts, and full-text articles and perform data extraction. Quality assessment will be conducted using the standard JBI critical appraisal tool. Data will be extracted from systematic reviews and a synthesis of the findings will be presented. The certainty will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). REVIEW REGISTRATION: PROSPERO CRD42021258515.

Effectiveness of an oral health curriculum in reducing dental caries increment and improving oral hygiene behaviour among schoolchildren of Ernakulam district in Kerala, India: study protocol for a cluster randomised trial.

INTRODUCTION: Children's learning abilities suffer when their oral health is compromised. Inadequate oral health can harm children's quality of life, academic performance, and future success and achievements. Oral health problems may result in appetite loss, depression, increased inattentiveness, and distractibility from play and schoolwork, all of which can lower self-esteem and contribute to academic failure. An oral health curriculum, in addition to the standard school curriculum, may instil preventive oral hygiene behaviour in school students, enabling them to retain good oral health for the rest of their lives. Because most children attend school, the school setting is the most effective for promoting behavioural change in children. A 'health-promoting school' actively promotes health by enhancing its ability to serve as a healthy place to live, learn and work, bringing health and education together. Making every school a health-promoting school is one of the joint objectives of the WHO and UNICEF. The primary objective of this proposed study is to assess the effectiveness of an oral health curriculum intervention in reducing dental caries incidence and improving oral hygiene behaviour among high school children in grades 8-10 of the Ernakulam district in Kerala, India. If found to be effective in changing children's behaviour in a positive way, an oral health curriculum may eventually be incorporated into the school health curriculum in the future. Classroom interventions can serve as a cost-effective tool to increase children's oral health awareness. METHODS AND ANALYSIS: This protocol presents a cluster randomised trial design. It is a parallel-group comparative trial with two arms having a 1:1 distribution-groups A and B with oral health curriculum intervention from a dental professional and a schoolteacher, respectively. High schools (grades 8-10) will be selected as clusters for the trial. The minimum cluster size is 20 students per school. The total sample size is 2000 high school children. Data will be collected at three time points, including baseline, after 1 year (mid-term) and 2 years (final), respectively. The outcome measures are Decayed, Missing and Filled Teeth Index; Oral Hygiene Index-Simplified; and knowledge, attitude and behaviour. Data collection will be done by clinical oral examination and questionnaire involving oral health-related knowledge, attitude and behaviour items. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Institutional Ethics Committee of Amrita Institute of Medical Sciences and Research Centre (dated 19 July 2022, no: IEC-AIMS-2022-ASD-179). TRIAL REGISTRATION NUMBER: Clinical Trial Registry of India (CTRI/2022/09/045410).

Exploring the perceived sociocultural factors in the initiation of smokeless tobacco among adolescents: a qualitative systematic review protocol.

OBJECTIVE: The objective of the review is to identify and explore the perceived sociocultural factors leading to smokeless tobacco initiation among the adolescent population. INTRODUCTION: Smokeless tobacco use is associated with oral cancer and premalignant lesions. The initiation of smokeless tobacco often occurs in adolescence, with multiple sociocultural factors facilitating the commencement of this habit. An in-depth understanding of the factors influencing smokeless tobacco uptake can assist policymakers and tobacco-control units in establishing global policies and implementing control strategies to prevent adolescents' taking up smokeless tobacco. INCLUSION CRITERIA: This review will consider qualitative studies conducted within the last 20 years on adolescent smokeless tobacco users, focusing on sociocultural factors influencing smokeless tobacco initiation. Studies involving cigarette smoking, other alternative forms of smoking, and any form of tobacco cessation intervention will be excluded. METHODS: A systematic search will be conducted in MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and the Cochrane CENTRAL databases, using a 3-step search process. ProQuest Dissertations and Theses, OAIster, and Google will be searched for unpublished studies. Only studies published from January 2002 until the present and in English will be considered. Study screening, extraction, and critical appraisal will be performed by 2 independent reviewers using the standardized JBI qualitative appraisal and data extraction tools. Data synthesis will involve aggregation of the review findings to generate a set of statements based on similarity of meaning. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021240588.

Association between Body Mass Index and Severity of Periodontal Disease among Adult South Indian Population: A Cross-sectional Study.

Background: Periodontal disease is one of the top six chronic noncommunicable diseases (NCDs) and is recognized as a severe global public health problem. This study aimed to assess the association between various levels of body mass index (BMI) and periodontal disease severity in Indian adults. Material and Methods: The study was designed as a hospital-based cross-sectional study involving 212 participants aged between 18 and 65. A questionnaire assessed by an investigator was used to assess oral health-associated risky behavior and demographical factors. Participants were also assessed using full-mouth clinical periodontal and anthropometric measurements. The mean number of sites with pocket probing depth (PPD) ≥4 mm and the presence of periodontal disease were used as outcome measures. Bivariate analysis and multiple logistic regressions were performed. Results: The overall proportion of participants with periodontal disease was 50%, that is, sites with PPD ≥4 mm (n = 106). Multivariate analysis showed that BMI (odds ratio (OR) = 0.77, 95% confidence interval (CI): 0.43, 1.37) was not associated with periodontal disease, but smoking (OR = 3.90, 95% CI: 1.63, 5.89), alcohol consumption (OR = 1.24, 95% CI: 0.72, 2.13), age (OR = 2.51, 95% CI: 1.08, 5.84), and diabetic mellitus (OR = 1.69, 95% CI: 0.92, 3) were positively associated with periodontal disease. Conclusion: A positive association was found between smoking, alcohol consumption, age, gender, history of diabetic mellitus, and periodontal disease. No significant association exists between obesity and periodontal disease in South Indian adults.

Prevalence of early childhood caries in India: A systematic review and meta-analysis.

This review was designed to assess the pooled prevalence of early childhood caries (ECC) in India. An electronic data search was done in PubMed/MEDLINE and Scopus databases in October 2020. Epidemiological surveys assessing the prevalence of ECC were included, and data on gender, geographic region, sampling strategy, feeding habits, and dmft values were extracted. The risk of bias was assessed, and a meta-analysis was performed for pooled prevalence and mean dmft values. The selection of articles, data extraction, and validity assessment were done independently by the two reviewers (ID and RV). A third reviewer (CJ) resolved any conflict between these two reviewers. A total of seventy-one studies were included for quantitative analysis. The pooled prevalence of ECC estimated from 71 studies with 69,330 participants is 46.9% (confidence interval [CI] 46.5-47.2). Males had a higher prevalence of ECC (47%, CI: 46.4-47.6,40 studies, 26,840 participants) than females (43.8%, CI: 43.2-44.2,40 studies, 24,389 participants). Region-wise analysis showed the highest number of studies (44) in southern India, with a sample size of 35,988 with a pooled prevalence of 44.6% (CI: 44-45.1). The pooled mean dmft (random effect) is 2.23 (1.97-2.48), with males having a higher proportion of 2.26 compared to 2.23 in females. The pooled prevalence of ECC was 46.9%, and the pooled mean was 2.23. The results from this study state that one in every two children in India is suffering from ECC, reflecting its public health relevance.

Effectiveness of 38% Silver Diamine Fluoride Application along with Atraumatic Restorative Treatment for Arresting Caries in Permanent Teeth When Compared to Atraumatic Restorative Treatment in Adults-Study Protocol for a Randomized Controlled Trial.

INTRODUCTION: Dental caries in the adult population that require preventive and therapeutic treatment are generally neglected in rural communities. The determination of the effectiveness of the application of 38% silver diamine fluoride (SDF) in arresting caries lesions when combined with atraumatic restorative treatment (ART) is very important, as it serves as a preventive and restorative procedure to regain the function of the permanent dentition. The assessment of optimal SDF application with ART, in comparison with ART alone, in managing cavitated carious lesions in a pragmatic setting, is the need of the hour to recommend optimal dental care, especially in rural settings which have minimal access to comprehensive dental care. METHODS AND ANALYSIS: The clinical trial will enrol 220 adults (18-65 years) with cavitated carious lesions attending the Amrita School of Dentistry in the Ernakulam district, India. This study is a randomized, controlled trial with a 1:1 allocation ratio in two parallel groups. Study arm 1 will receive 38% SDF application and ART, and study arm 2 will receive ART only. A digital radiograph will be taken immediately after restoration (baseline) as well as at the end of the 6th month for evaluation of caries arrest. The assessment of the survival of the restoration will be done on the 7th day, 30th day, and at the end of the 6th month. The final analysis would include both the tooth and person levels. ETHICS AND DISSEMINATION: This trial adheres to the principles of the Declaration of Helsinki and the guidelines of the Indian Council of Medical Research (ICMR). This study protocol has been approved by the Institutional Review Board. This trial has been registered prospectively with the Clinical Trial Registry of India (Registration No: CTRI/2021/12/038816).

Attitude and perceptions regarding online teaching in dental undergraduate program during COVID-19 pandemic: A mixed method study.

BACKGROUND: Transformation of education to virtual mode during COVID-19 pandemic was a major challenge for a clinical specialty like dentistry. MATERIALS AND METHODS: A sequential explanatory mixed method was adopted with quantitative dominant design. A self-reported questionnaire on attitude and perceptions toward online learning were distributed among dental undergraduate students. The qualitative arm explored perceptions of online teaching among various stakeholders and thematic content analysis was performed. RESULTS: A total of 141 responses were obtained, about 21% of them felt online classes to be highly useful and 78% felt it was moderately useful. About 80% of the students were satisfied with the online education. About 40% of participants felt internet connectivity was a frequent issue. The qualitative data analysis revealed five emergent themes of lecture content and delivery, instructional control, resource management, interaction, and evaluation exploring the perceptions of various stakeholders toward online learning and provided several insights. CONCLUSION: Though online education cannot be compared to traditional education in a clinical specialty like dentistry, it does have its advantages and a portion of student learning can be conducted through this mode.

Comparative evaluation of implant stability using bone expanders and conventional osteotomy.

Aim: The purpose of this study was to compare the implant stability and bone implant contact obtained using bone expanders to conventional osteotomy. Materials and methods: In this multiphasic study, the first phase was conducted on ex vivo porcine models to standardize the procedure and to check its feasibility. The second phase was conducted as human clinical trial. Phase I: A total of 10 implants were placed in the premolar region on five exvivo porcine models in randomized sequence using conventional osteotomy drills and bone expanders/screw spreaders. Implant stability was measured using resonance frequency analyser on the day of implant placement. Radiological analysis was done using micro-CT in two sectional block specimens randomly selected from each study groups. Phase II: Implants were placed on ten patients fulfilling the inclusion criteria. Implants were placed after randomizing the osteotomy sites. Bone expanders were used in 5 sites and conventional osteotomy technique was used in 5 other sites. Implant stability was measured on the day of implant placement and after three months in pre-loaded state using resonance frequency analyser. Results: Phase I: Average implant stability quotient for bone expanders were 71.2% ± 3.8% and 66.4% ± 1.3% for conventional osteotomy respectively. Bone to implant contact ratio values for bone expanders were 84.7% ± 7.9% and conventional osteotomy drills were 66.3% ± 13.6%. Phase II: Average primary stability at the day of surgery was 71.4 ± 1.3 for bone expanders and 65.6 ± 2.4 for conventional osteotomy drills. After three months (per-loaded state), average primary stability of bone expanders were 74.8 ± 1.1 and conventional osteotomy drills were 71.8 ± 2.5. Conclusion: The bone expanders used when indicated can enhance implant stability and bone to implant contact. Thus osteotomy by bone expanders may be suggested as a promising method especially in compromised bone.

Characterizing the Literature on Validity and Assessment Tool of Oral Frailty: A Systematic Scoping Review.

AIM: To systematically review all studies on assessment tools used to diagnose oral frailty in older adults. MATERIALS AND METHODS: A systematic search of PubMed, Google Scholar, and Scopus for articles yielded the tools published from January 2010 to January 2022. The search included articles reporting the use of the Oral Frailty risk assessment tool in older adults. A standardized protocol Joanna Briggs Institute (JBI) was used for data extraction. Flowchart and tables were used to demonstrate the results. RESULTS: A total of 19 studies were eligible out of 58 studies retrieved from selected databases. A total of three tools were structured for oral frailty assessment in older adults as follows: Oral and maxillofacial frailty index, oral frailty index-8 (OFI-8), and oral frailty checklist. The most critical parameter in assessing oral frailty was tongue pressure and dryness of the mouth. Other parameters for assessing oral frailty include the number of remaining teeth, oral diadochokinesis (ODK), masticatory performance, pain, dysphagia, taste alteration, use of dentures, bacterial count in the tongue coat, and presence or absence of periodontitis. The predictive validity of tools for differentiating high and low risks for oral frailty did not explore yet. CONCLUSION: There has not been much research into assessment tools for oral frailty. This comprehensive review of the available literature identified only three structured assessment tools as follows: The oral frailty checklist, the oral and maxillofacial frailty index, and OFI-8. The oral frailty checklist is the only available validated oral frailty assessment tool despite the disproportionately high prevalence of oral frailty and the projected increase. CLINICAL SIGNIFICANCE: Because an oral function examination for the elderly in their 60s is required to promote effective oral frailty countermeasures, an oral frailty assessment tool appropriate for the setting must be developed. This tool can be used as a population-wide standard of practice for screening oral frailty.

Development and validation of cultural competence assessment tool for healthcare professionals, India.

Culture influences an individual's perception of "health" and "sickness". Therefore, cultural competence assessment of healthcare professionals is very important. Existing assessment scales have limited application in India due to the nation's rich cultural diversity and heterogeneous healthcare streams. This study was undertaken to develop and validate a cultural competence assessment tool for healthcare professionals in India. A cross-sectional study using convenience sampling was conducted following all standard steps among 290 healthcare professionals in India. Item reduction was followed by estimation of validity and reliability. Responses were recorded on a five-point Likert scale, ranging from strongly disagree to strongly agree. The resultant tool, named Cultural Competence Assessment Tool-India (CCT-I) showed an acceptable internal consistency (Cronbach's alpha =0.734). Inter-rater agreement was 81.43%. Face, content, and construct validity were demonstrated. There was no statistically significant difference in cultural competence between the healthcare streams based on years of clinical experience. There was statistically significant difference between streams of healthcare (p-value =0.009) and also between dentistry and Ayurveda groups (p-value = 0.003). This comprehensive tool can be used as the first step toward designing cultural competence training of healthcare manpower and the establishment of culturally sensitive healthcare organizations.

Assessment of Common Risk Factors of Non-Communicable Diseases (NCDs) and Periodontal Disease in Indian Adults: An Analytical Cross-Sectional Study.

Risk factors that predispose individuals towards major non-communicable diseases (NCDs) and periodontal disease (PD) often co-occur in the same individual. The common risk factor approach (CRFA) for controlling the risk factors associated with NCDs and PD ensures that modifying a few risk factors has an incredible impact on regulating many chronic conditions. To apply CRFA to NCDs and PD, it is essential to quantify the common risk factors of these conditions. The proposed hospital-based analytical cross-sectional study aims to assess the proportion overlap of risk factors that are common or shared between NCDs (cardiovascular diseases (CVD) and diabetes mellitus (DM) type 2) and PD. The risk factors for PD and NCDs will be estimated in subjects aged 18 years and above, diagnosed with NCDs (DM type 2, CVD) or PD. This will be a non-directional study. The dependent variables analyzed will be PD and NCDs (DM type 2, CVD). The explanatory variables that are assessed will be: age, gender, address, occupation, access and affordability of care, familial pattern, family size, insurance, socioeconomic status, obesity, tobacco usage, physical activity, alcohol consumption, food frequency, stress, and oral hygiene. The research is expected to provide data which will aid in the development of advocacy initiatives to implement CRFA for PD and NCDs.