Compliance of Sections 4-7 of Cigarette and Other Tobacco Products Act (COTPA) 2003 in India-A Systematic Review and Meta-analysis.

In view of the vast variability of the compliance of Sections 4-7 of COTPA in India, a need for a collective evaluation appeared appropriate and timely. The aim of this review was to specifically analyze the country wide compliance of Section 4,5,6a and 6b,7 of COTPA along with the displays of signage on No Smoking (NoSmok) and Tobacco Free Institution (TFI). Studies published between 2003-December 2020 reporting compliance/non compliance (C/NC) were reviewed. Eligible study designs were observational studies and brief reports. To obtain the effect measure, Med Calc version 20 was used. 60 full text articles were assessed for eligibility and included in the qualitative and quantitative synthesis. The compliance for the Sections 4,5, 6b and 7 was 71.97% (95%CI:61.87-81.05, I2 =99.70%), 58.95% (95%CI:44.90-72.28, I2=99.53%), 51.08% (95% CI:39.30-62.81, I2=99.46%), 57.60% (95%CI:37.58-76.40, I2=99.48%) respectively whereas for the NoSmok and TFI board display it was 42.30% (95%CI:32.53-52.39, I2=99.75%) and 26.81% (95%CI:9.94-48.25, I2=99.51) respectively. Compliance of the Section 6a, sale of tobacco products to and by the minors was 66.39% (CI:49.50-81.36, I2=99.69%) and 94.11% (95%CI:78.54-99.99, I2=99.76%) respectively. This study observed a significant variability in compliance of Sections 4-7 of COTPA. It points to a critical need for a robust, self - sustained and effective enforcement mechanism countrywide to eliminate potential for any NC. Amendments to the COTPA appear critical for a policy reform and an optimal implementation.

Prevalence of precancerous lesions and conditions in India: A systematic review and meta-analysis.

BACKGROUND: Smoking and chewing tobacco are associated with numerous oral mucosal lesions and conditions, often leading to cancer progression. AIM: To investigate the prevalence of precancerous lesions and conditions among the Indian population. METHODS: Systematic search was conducted for population or community-based observational epidemiological studies in PubMed, EMBASE, Web of Science, IndMED, Google Scholar, reports of the WHO South-East Asia Region, MOHFW India reports, Science Citation Index, WHO Index Medicus of the South-East Asian Region, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Open Grey from the earliest available up to 31st January 2022. The effect size was calculated for the prevalence of precancerous lesions and conditions. RESULTS: One hundred sixty-two estimates from 130 studies yielded 52 high, 71 moderate, and seven low-quality studies from 823845. Point estimate based on cross-sectional studies for leukoplakia was 4.3% (95%CI: 4.0-4.6), oral submucous fibrosis was 2.7% (95%CI: 2.5-3.0), palatal lesions in reverse smokers and nicotine palatine were 5.8% (95%CI: 4.4-7.2), and Erythroplakia was 1.2% (95%CI: 0.7-1.7), and lichen planus was 1.1% (95%CI: 0.9-1.2). Amongst hospital-based studies, the pooled prevalence for Leukoplakia was 6.7% (95%CI: 6.0-7.3), oral submucous fibrosis was 4.5% (95%CI: 4.2-4.9), lichen planus was 7.5% (95%CI: 5.3-9.6), and erythroplakia was 2.5% (95%CI: 0.4-4.5), and palatal lesions in reverse smokers and nicotine palatini were 11.5% (95%CI: 8.0-15.0). CONCLUSION: Precancerous lesions and conditions are prevailing problems among the Indian population. It is mainly due to tobacco use, the smokeless form of tobacco. The meta-analysis indicates that hospital-based studies have a higher effect size of 6.7% than community-based studies. Patients who have already developed this condition may be advised to reduce their exposure to the risk factor to prevent the condition from progressing further.

Inventory development to assess perceptions and metacognition of dental students toward learning in colleges in Pune, India.

BACKGROUND: Dental education is considered a challenging and taxing program as on successful completion one is required to attain unique and diverse competencies. There is an established perception that students do not enjoy their experiences in the dental institution and they always demand for certain amendments. Therefore, a dental education perceptions and metacognition assessment tool (DEPMAT) was developed for Indian undergraduate and postgraduate dental students for assessing their learning in Deemed University versus Maharashtra University of Health Sciences in Pune, Maharashtra. MATERIALS AND METHODS: This cross-sectional study was conducted among students of four dental colleges of two types of universities in Pune, India, using a 31-item DEPMAT based on Dundee Ready Education Environment Measure and metacognition awareness inventory using five subscales. Psychometric properties were also tested for this new tool. Data were analyzed using the SPSS software. RESULTS: Of 512 participants, 498 (96.88%) students had duly returned the questionnaire. Cronbach's alpha coefficient value for reliability was found to be 0.87 which indicated good internal consistency and test-retest reliability was found to be kw = 0.76, which indicated substantial agreement. Significant difference was found among undergraduates in domains regarding their perception toward academics, infrastructure and learning environment, and health and stress. CONCLUSION: This study suggested that the general perception toward learning among final year postgraduate students was positive in both the universities. However, the perception of final year undergraduates toward learning was negative and students have suggested certain amendments in both the universities. This study also suggested the new tool was effective in assessing the attitude of practice of both undergraduate and postgraduate students.

Association of periodontal status with lung function in patients with and without chronic obstructive pulmonary disease visiting a medical hospital in Pune: A comparative study.

BACKGROUND: The relationship between oral health and systemic conditions has been increasingly debated over recent decades with one such discussion existing about oral hygiene and periodontitis with chronic obstructive pulmonary disease (COPD). Hence, a study was conducted to assess and compare the oral hygiene status and periodontal status of age and gender-matched participants with and without COPD and to correlate oral hygiene status and periodontal status with lung function status among them. MATERIALS AND METHODS: This hospital-based study included a study population of 117 participants (39 patients of COPD and 78 participants without COPD) 35-75 years of age with at least 20 natural teeth. Participant's demographic details and history of smoking were recorded. Lung function was recorded using a spirometer. Periodontal health was assessed by measuring Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), and Oral Hygiene Index (OHI) by a trained and calibrated examiner. RESULTS: Higher mean of PPD, CAL, and OHI is being reported in the present study with 4.07 versus 3.50, 0.58 versus 0.24, and 5.24 versus 3.60, respectively, among patients with and without COPD which was statistically significant. The risk of having COPD was 0.4 times more in participants having poor oral hygiene and 0.07 times more in patients smoking. Smoking and oral hygiene, as independent variables, have a significant influence on COPD which is a dependent variable. A weak correlation was found of poor oral hygiene and loss of attachment among participants with COPD. CONCLUSION: Periodontitis and respiratory disease share a common risk factor, i.e., smoking. Smoking has a definite relation with periodontitis and COPD. Oral hygiene is significantly associated with increased risk for COPD when age and gender effects have been matched and when adjusted for smoking. However, no association was found of PPD with COPD.

Efficacy of T. Cordifolia (Guduchi) against plaque and gingivitis-A clinico-microbiological study.

OBJECTIVES: The present study was conducted to assess the clinical efficacy (against plaque and gingivitis) and antimicrobial efficacy (against gram negative, gram positive and S. mutans counts) of T. cordifolia (Guduchi). METHODOLOGY: A nonrandomized before and after trial for 21 days of intervention was performed involving 17 participants. Plaque index, gingival index were recorded and saliva samples were collected at baseline, 13th day and 22nd day. Repeated measures ANOVA test was performed to compare the before and after results of the clinical parameters, i.e. score of plaque index and gingival index. Freidman's test was applied for comparison between the three intervals (for microbiological evaluation of colony counts). RESULTS: There was statistically significant reduction inplaque score, gingival score, and colony forming units of gram negative organisms and S. mutans from baseline to 22nd day (P = 0.001). There was no significant reduction with gram positive organisms. CONCLUSION: This clinico-microbiological study concluded that twice rinsing of T.cordifolia decoction as mouth rinse in adjunct to scaling and routine brushing of teeth for 21 days shows anti-plaque, anti-gingivitis, and antimicrobial action against gram negative organisms and S. mutans.

Assessment of mother's ability in caries diagnosis, utilizing the smartphone photographic method.

BACKGROUND: Smartphone is proved to be reliable in teledentistry model. The aim of the study was to assess the mother's ability in caries diagnosis, utilizing the smartphone-based photographic method. HYPOTHESIS: Mothers have the ability for caries diagnosis utilizing the smartphone photographic method. METHODS: A cohort of 100 mothers was given health education regarding dental caries diagnosis. Then, their children from the preschools were screened by the dentist for dental caries using visual examination, followed by clicking intraoral photographs using Motorola 3G phone. The photographs were sent through WhatsApp to respective mothers, and they were asked to diagnose their child's dental status. Accuracy and reliability measures of mother's diagnosis were estimated by calculating the sensitivity, specificity, predictive values, and kappa value. RESULTS: The calculated value for sensitivity was 88.3%, specificity was 98.3%, positive predictive value was 92%, negative predictive value was 97%, and accuracy was 96%. There was a strong agreement between mother's and dentist's diagnosis (kappa value of 0.87). CONCLUSION: Following the dental health education, it can be concluded that mothers are in a better position to diagnose their child's dental status through smartphone-based photographs.

Evaluating the Cyberchondria Construct Among Computer Engineering Students in Pune (India) Using Cyberchondria Severity Scale (CSS-15).

BACKGROUND: The Internet has become an important tool in day-to-day life. Reading medical data from Internet sources can have a negative impact on the common man. Anxiety due to excess searching for medical information online is known as cyberchondria. AIM: To evaluate the cyberchondria construct among the computer engineering students in Pune (India) using Cyberchondria Severity Scale (CSS-15). SETTINGS AND DESIGN: A cross-sectional study was conducted among third- and fourth-year computer engineering students. METHODS: The study recruited 180 students. A self-administered, English-translated CSS-15 questionnaire was used to collect the data. The responses were based on the Likert scale. Four constructs were scored from 0 to 4 while the mistrust of medical professional construct was scored in reverse order. STATISTICAL ANALYSIS: Descriptive statistics in the form of numbers and percentages were calculated. RESULTS: The survey was completed by 171 (95%) participants, 77 females and 94 males with the mean age of 19.77 ± 1.07 years. All (100%) participants were affected by excessiveness and reassurance construct, 92% by distress, and 75% by compulsion. Only 19% were found to be affected by mistrust of a medical professional. Among all the domains, reassurance was severely affected among 52.04% of the participants. CONCLUSION: All the computer engineering students were affected by some or the other constructs of cyberchondria. This indicates that the Internet can affect an individual's mental, physical, and social activity by giving a vast amount of information and cause anxiety or distress related to their search.

Efficacy of herbal dentifrice on the prevention of plaque and gingivitis as compared to conventional dentifrice: A systematic review and meta-analysis.

OBJECTIVE: The aim of this study was to review literature on the effects of herbal dentifrice compared to conventional dentifrice on plaque and gingival inflammation. MATERIALS AND METHODS: MEDLINE, Cochrane Central Register of Controlled Trials, and major journals were explored for studies up to September 30, 2017. A comprehensive search was designed and the articles were independently screened for eligibility by two reviewers. Randomized controlled clinical trials, in which oral prophylaxis was undertaken before the intervention was introduced into the oral cavity using toothbrush were included. Where appropriate, a meta-analysis (MA) was performed and standardized mean differences (SMDs) were calculated. RESULTS: Ten articles out of 1378 titles were found to meet the eligibility criteria. A MA showed that for plaque intervention the SMD was 2.14; 95% confidence interval (CI): 0.88-3.41, P = 0.0009; test for heterogeneity: P < 0.00001, I2 = 96% in favor of conventional dentifrice; and for gingival inflammation, the SMD was 1.37; 95% CI: 0.49-2.26, P = 0.002; test for heterogeneity: P < 0.00001, I2 = 94% which also was in favor of conventional dentifrice. Subgroup analysis for plaque intervention and gingival inflammation in case of long-term (more than 4 weeks and up to 6 months) and short-term effects (minimum of 4 weeks) of herbal dentifrice showed no difference when compared to conventional dentifrice. CONCLUSION: Currently, there is no high-quality evidence to support or abnegate the anti-plaque and anti-gingivitis effects of the herbal dentifrice.

Assessment of oral findings of dental patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to a dental college - A cross sectional study.

To assess the oral findings of patients who screen high and no risk for obstructive sleep apnea (OSA) reporting to outpatient department of a dental college. Methods: Patients coming to dental Out Patient Department (OPD) were screened using STOP questionnaire and were categorized into high (n=130) and no risk (n=130) OSA groups. BANG (body mass index, age, neck circumference and gender) was recorded for both the OSA risk group patients. Following this oral and general examination was performed using predetermined criteria for temporomandibular disorder (TMD), Angle's Class of Malocclusion, maxillary arch constriction, facial profile, Mallampati score for uvula, tongue size, depth of palatal vault and periodontitis. Chi-squared statistics was applied to know the significant difference among the two groups. Multivariate logistic regression model was run by including the significant variables. Results: 94 females and 166 males were present in the study with a mean age of 43.67±11.89 in both the risk groups. All the variables except Angle's class of malocclusion and periodontitis showed significant difference among high and no risk OSA groups. Logistic regression confirmed that neck circumference, Class 3 or 4 Mallampati score, large tongue and deep palatal vault were commonly observed among high risk OSA group and were independent risk factors for developing high risk of OSA. Conclusion: Neck circumference>40cm, large tongue, Class 3 or 4 Mallampati score and deep palatal vault were found to be independent predictors of developing high risk of OSA. Dentist can play a vital role in screening such patients as he comes in close vicinity of oral cavity and thus can refer the patients to sleep physician to promote interdisciplinary approach.

Efficacy of green tea-based mouthwashes on dental plaque and gingival inflammation: A systematic review and meta-analysis.

OBJECTIVES: The purpose of this study was to conduct a systematic review and if appropriate a meta-analysis of the efficacy of daily rinsing with green tea-based mouthwashes in terms of plaque index (PI) and/or gingival index (GI) as compared to other mouthwashes in plaque-induced gingivitis patients. MATERIALS AND METHODS: MEDLINE, Cochrane Central Register of Controlled Trials, IndMed, Google Scholar, and major journals were searched for studies up to December 2016. A comprehensive search strategy was designed, and the eligible articles were independently screened for eligibility by two reviewers. Randomized controlled trials in which individuals were intervened with oral mouthwashes of interest were included. Where appropriate, a meta-analysis was performed and standardized mean differences (SMDs) for GI and PI were calculated. RESULTS: A total of 9 articles out of the 311 titles met the eligibility criteria. A meta-analysis was performed for five studies that compared green tea-based mouthwashes with chlorhexidine (CHX). The SMD for PI was -0.14 (95% CI: -1.70, 1.43; P = 0.86 and I2 = 94%), while that for GI was 0.43 ((95% CI: -0.63, 1.49; P = 0.43, I2 = 89%). Both these estimates suffered from significant heterogeneity. For both PI and GI, two studies were in favor of green tea while three studies were in favor of CHX. CONCLUSIONS: Green tea-based mouthwashes can be considered an alternative to CHX mouthwashes in sustaining oral hygiene, especially because of the added advantages provided by such herbal preparations.