Bidirectional Association between Lichen Planus and Hepatitis C-An Update Systematic Review and Meta-Analysis.

Lichen planus (LP) is a chronic, inflammatory mucocutaneous disorder associated with systemic diseases such as hepatitis C (HCV). The objective of this study is to evaluate the association between LP and HCV bidirectionally through a systematic review and meta-analysis. A comprehensive search of studies published was performed in the databases of PubMed, Embase, and Web of Science. Out of 18,491 articles, 192 studies were included. The global prevalence of HCV positive (HCV+) in LP patients registered from 143 studies was 9.42% [95% confidence interval (CI), 7.27-11.58%], and from these, 84 studies showed HCV+ 4-fold more frequent in LP than a control group (OR, 4.48; 95% CI, 3.48-5.77). The global prevalence of LP in patients HCV+ recorded from 49 studies was 7.05% (95% CI, 4.85-9.26%), and from these, 15 registered a 3-fold more LP in HCV (OR, 3.65; 95% CI, 2.14-6.24). HCV+ in LP patients showed great geographic variability (OR, 2.7 to 8.57), and the predominantly cutaneous location was higher (OR, 5.95) than the oral location (OR, 3.49). LP in HCV+ patients was more frequent in the Eastern Mediterranean (OR, 5.51; 95% CI, 1.40-15.57). There is a higher prevalence of HCV+ in LP and vice versa than in the control group, especially in certain geographical areas that should be taken into consideration when doing screening in countries with an upper prevalence of HCV among the general population.

Immunohistochemical analysis of epithelium adjacent to lip cancer: A meta-analysis.

OBJECTIVES: To identify the immunohistochemical pattern of non-tumoral epithelium adjacent to lip cancer (ANTE) to unveil molecular alterations and potential biomarkers in lip cancer patients. MATERIALS AND METHODS: A systematic search at MEDLINE, EMBASE and proceedings Web of Science, OpenGrey and WorldCat. The PICOS outline (Population: lip cancer patients; Intervention: immunostaining with biomarkers in surgical specimens; Comparisons: ANTE versus LC; Outcomes: primary-to identify the immunohistochemical pattern of peritumoral epithelium and secondary-to assess the immunoreactivity of LC epithelium; and Study design: cross-sectional, case-control and cohort studies). RESULTS: A total of 339 records were identified. Seven studies reporting on ANTE and LCs were included in the qualitative synthesis, and 4 of them (p53 immunostaining) were selected for meta-analysis. In the ANTE group, the pooled prevalence of p53 was 0.74 (95% CI: 0.66 - 0.82), while in the lip squamous cell carcinoma group this prevalence was 0.83 (95% CI: 0.75 - 0.89). CONCLUSIONS: Similar immunoexpression was found in lip epithelium adjacent to lip carcinoma, even in epithelia with normal appearance or mild histological alterations. The role of biomarkers in the follow-up of actinic cheilitis patients deserves additional clinical assessment.

Awareness of Oral Disorders Among Community-Dwelling Elderly Spaniards.

Introduction: Oral status has a clear impact on systemic health, a key component of successful aging. Awareness of oral disorders permits early diagnoses and treatments. This study investigates oral disorders awareness among community-dwelling elders. Methods: Community-based survey through face-to-face interviews undertaken in four cities at busy commercial and administrative areas. Results: A total of 789 people were recruited, mostly nonsmoker (60.3%) males (56.9%) with basic education (65.6%). The most frequently recalled disorder was bruxism, followed by periodontal diseases and ulcerations/aphthae. Caries was mentioned by 3.91%. Dentate participants were more aware of dental-related disorders, such as bruxism (p = .001) and periodontitis (p = .010), except for caries (p = .100). Caries awareness was related to educational level (p = .018) and smoking (p = .020), as was oral cancer (p = .019) with former smokers more aware of this neoplasm. Education was strongly related with periodontal awareness (p = .001). Conclusion: Awareness of the main oral disorders is worryingly poor among the elderly population and immediate action is required by taking advantage of the position of family nurses in the treatment of systemic chronic disorders and through educational interventions on this population subgroup to ease preventive behaviors, favor early diagnoses, and promote simpler, more effective treatments with a lower financial burden.

Online audio-visual information on oral cancer for Spanish-speaking laypersons. A cross-sectional study / Información audiovisual online sobre el cáncer bucal para legos de habla hispana. Un estudio transversal

Background: Lack of knowledge and awareness of oral cancer seem to be the main causes of diagnostic delay.Online resources are often used by patients to obtain health/medical information. However, there are no reports onthe quality and usefulness of oral cancer audio-visual resources in Spanish. The aims of this investigation were todisclose the type of information about oral cancer available, and whether it may be useful to shorten the patients’oral cancer appraisal time-interval.Material and Methods: Cross-sectional study undertaken at three video-sharing sites on October, 13th 2019. Key-words: “Cáncer oral”; “cáncer de boca”. The first 100 results in each viewing list were retrieved by three review -ers. Demographical data was recorded, and interaction indexes, viewing rates, comprehensiveness, and usefulnesswere calculated for each video. The presence of non-scientifically supported information was also assessed. Adescriptive analysis was undertaken, and relationships between variables were explored using the Spearman cor-relation test.Results: A total of 127 videos were selected. They were produced mainly by mass-media (46.5%; n=59) andtheir length ranged from 0.28 to 105.38 minutes (median 4.15 minutes; IQR: 2.34-9.67). The most viewed video(10,599,765 views; visualization rate 726,508.9) scored 0 both in usefulness and comprehensiveness. The mostuseful video gathered 44,119 views (visualization rate 2.033.13). A highly significant positive correlation (0.643;p<0.001) could be observed between usefulness and comprehensiveness of the videos, together with negative cor-relations between the visualization rate and usefulness (-0.186; p<0.05), and visualization rate and comprehensive-ness (-0.183; p<0.05). Conclusions: Online audio-visual material about oral cancer in Spanish is incomplete, of limited usefulness, andoften includes non-scientifically supported information. Most of these resources are produced by mass media and...(AU)

Role of Artificial Intelligence in the Early Diagnosis of Oral Cancer. A Scoping Review.

The early diagnosis of cancer can facilitate subsequent clinical patient management. Artificial intelligence (AI) has been found to be promising for improving the diagnostic process. The aim of the present study is to increase the evidence on the application of AI to the early diagnosis of oral cancer through a scoping review. A search was performed in the PubMed, Web of Science, Embase and Google Scholar databases during the period from January 2000 to December 2020, referring to the early non-invasive diagnosis of oral cancer based on AI applied to screening. Only accessible full-text articles were considered. Thirty-six studies were included on the early detection of oral cancer based on images (photographs (optical imaging and enhancement technology) and cytology) with the application of AI models. These studies were characterized by their heterogeneous nature. Each publication involved a different algorithm with potential training data bias and few comparative data for AI interpretation. Artificial intelligence may play an important role in precisely predicting the development of oral cancer, though several methodological issues need to be addressed in parallel to the advances in AI techniques, in order to allow large-scale transfer of the latter to population-based detection protocols.

Efficacy of continuous apical negative ultrasonic irrigation (CANUI) in penetration of simulated lateral canals in extracted teeth.

The aim of this study was to evaluate the efficacy of continuous apical negative ultrasonic irrigation into simulated lateral canals and the apical third in straight and curved root canals. Two simulated lateral canals were created 2, 4 and 6 mm from the working length in 120 single-rooted teeth (6 canals/tooth, n = 360 straight, n = 360 curved). The teeth were randomly divided into 3 experimental groups: positive pressure irrigation (PPI) (n = 20); passive ultrasonic irrigation (PUI) (n = 20); continuous apical negative ultrasonic irrigation (CANUI) (n = 20). 20% Chinese ink was added to a 5% sodium hypochlorite solution and delivered into the root canals. The results showed a significantly higher (P < 0.05) penetration of irrigant into the lateral canals and up to working length in the CANUI group for straight and curved roots. CANUI improves penetration into the lateral canals and up to the working length of the cleared teeth in straight and curved roots.

Study of factors influencing preoperative detection of alveolar antral artery by CBCT in sinus floor elevation.

This study aimed at assessing the prevalence of alveolar antral artery (AAA) detection by CBCT, its related variables, and at describing explanatory models useful in surgical planning, by retrospective evaluation of CBCT explorations. The modelling of the probability for detecting AAA was undertaken using logistic generalized additive models (GAM). The capacity for discriminating detection/no detection was assessed by receiver operating characteristic curves. A total of 466 sinuses were studied. Univariate models showed detection probability was linked to sinus width and thickness of the lateral bony wall, together with the shape and height of the osseous crest. AAA detection probability increased steadily until the thickness of the bony wall reached 6 mm. Multivariate models resulted good discriminators for AAA detection, particularly for females, showing an area under the curve (AUC) of 0.85. Models considering patients altogether, and those including only males offered slightly lower values (AUC = 0.79). The probability of AAA detection by CBCT was influenced by gender (higher in males and for narrow sinuses) and increases with the thickness of the sinus lateral bony wall and the height of the residual alveolar ridge. Besides, and particularly for women, the thickness of the ridge at the basal level seems to improve the explanatory model for AAA detection.

People would rather see a physician than a dentist when experiencing a long-standing oral ulceration. A population-based study in Spain

BACKGROUND: Primary care physicians have been reported to be the first choice for patients with oral ulcerations. This study investigates the health-seeking behaviour of lay public in Galicia (North-western Spain) if experiencing a long-standing oral ulceration. MATERIAL AND METHODS: Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016. RESULTS: A total of 5,727 pedestrians entered the study (response rate: 53%), mostly in the 45-64 age group (30.2%; n = 1,728), 47.7% of them (n = 2,729) were males. Most participants (42.1%; n = 2,411) reported to visit their dentist once a year and had secondary or compulsory education as their highest educational achievement (28.18%, n = 1,614; 28%, n = 1,600 respectively).When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, most participants answered they would go to see their primary care physician (62.8%; n = 3,597) and less than one quarter of the sample (23.8%; n = 1,371) would seek consultation with their dentist. CONCLUSIONS: General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer

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Overall time interval ("Total diagnostic delay") and mortality in symptomatic oral cancer: A U-shaped association.

OBJECTIVES: To assess the impact on survival of the total time interval since the first bodily change (sign/symptom) until the start of treatment in symptomatic oral cancer patients. METHODS: Retrospective, hospital-based study designed within the "Aarhus Statement" conceptual framework, using the overall interval to treatment of 183 oral cancer patients to analyse their survival rates. RESULTS: Overall time interval (T5): 107.1 ± 85.2 days. Overall survival rate: 58.4 (CI: 51.3-66.4%). Recurrence time (median): 724 days (IQR, 223-2963.5). Median survival time: 1744 days (IQR, 479.5-3438). Overall delay (T5) and mortality showed a U-shaped association, where patients with short (24.0-55.5 days) and long T5 intervals (127.5-420 days) had higher mortality than those with medium T5 intervals (55.5-127.5 days). CONCLUSION: There is a non-monotonic association between time interval and mortality. Higher mortality rates are linked to shorter and longer time intervals. This may induce underestimation of the association when time intervals are considered dichotomously.

Family nurses, oral hygiene, and educational implications: a cross-sectional study.

OBJECTIVE: To describe family nurses self-reported oral hygiene practices and to compare them with those of their potential patients in a public, free, and universal primary healthcare system. MATERIAL AND METHODS: Cross-sectional study using an anonymous questionnaire applied to randomly selected participants and their family nurses. RESULTS: A total of 1,394 people entered the study (1,326 laypersons, 66 nurses). Not all nurses reported to brush their teeth daily. Daily interdental cleaning scored percentages lower than mouthwashes. Devices like oral irrigators or tongue scrappers were not used by family nurses. CONCLUSIONS: Nurses' oral self-care routines are similar to those of university graduates, with poor reported interdental cleaning. Oral health promotion activities may contribute to nurse's oral health and could have a positive effect on their patients.

Regular dental attendance and periodontal health knowledge: A cross-sectional survey.

OBJECTIVES: To explore dental clinics' performance on periodontal education by comparing knowledge about periodontal health of regular and inconsistent dental attenders. SUBJECTS AND METHODS: A population-based study with a cross-sectional design was performed in Galicia (Northwestern Spain). Participants were randomly selected from 16 different areas and a questionnaire applied face-to-face. The survey included items on socio-demographic features, habits and routines, periodontal status and periodontal health knowledge. Participants were grouped according to the median of overall knowledge, and a logistic regression analysis was performed to explore the relationship between good periodontal knowledge and frequency of dental visits. RESULTS: A total of 8,206 individuals were invited to enter the study, and 3,553 of them accepted the invitation (43.3%). Most participants (59.3%; n = 1,945) fit within the regular dental attenders' group. Younger women holding a university degree and visiting their dentist regularly elicited higher knowledge about periodontal health. Regular use of dental services increased the chances of being in the higher knowledge group (OR: 1.67; 95% CI: 1.40-2.00). CONCLUSIONS: Reported regular dental attendance is related to periodontal health knowledge. Specific interventions for promoting tailored patient education on periodontal topics during routine dental visits may have a positive effect on laypersons' knowledge about periodontal health.

Association between hospital interval and survival in patients with oral cancer: A waiting time paradox.

BACKGROUND: In early diagnosis studies on symptomatic cancer, survival was the most recommended outcome. The magnitude and impact of the patient interval and primary care interval is well-known in oral cancer; however, the hospital interval and its influence on surviving this neoplasia are not well known. AIMS: To quantify the interval between the first contact with the specialist and the start of treatment for patients with oral cancer and to evaluate whether there was a link between this interval and disease survival. METHODS: We designed a hospital-based study that included 228 patients diagnosed with oral/oropharyngeal squamous cell carcinoma between 1998 and 2008 at A Coruña University Hospital (Spain) who were followed up until 2016. The data were extracted retrospectively from hospital medical charts. The study interval was defined in the context of the "pathways to treatment" model as the interval from the first specialist visit (start point) to the start of treatment (end point). We calculated the total interval (from first symptom to treatment) to evaluate the relative length of the hospital interval, and we considered the variables age, sex, location, comorbidity and tumour classification stage. Survival time was defined as the interval from the first treatment to death or censoring. RESULTS: The median hospital interval was 20 days, with an interquartile range of 15-29.1 days. The most relevant prognostic variable was the tumour stage (III-IV: Exp. ß = 2.8, p = 0.001). The hospital interval was part of the multivariate model, and its association with mortality showed a V-shaped association, where patients with short hospital intervals (3-18 days) and those with long hospital intervals (26-55 days) had significantly higher mortality than those with medium hospital intervals (19-25 days). CONCLUSION: The hospital interval represents a relevant interval for the patient's path towards treatment, has prognostic implications and is subject to a severity bias (waiting time paradox) that should be avoided.

Oral mucosal peeling related to dentifrices and mouthwashes: A systematic review

Background: The aim of this systematic review was to summarise the clinical information available about oral mucosal peeling (OMP) and to explore its aetiopathogenic association with dentifrices and mouthwashes. Material and Methods: PICOS outline: Population: subjects diagnosed clinically and/or pathologically. Intervention: exposition to oral hygiene products. Comparisons: patients using products at different concentrations. Out-comes: clinicopathological outcomes (primary) and oral epithelial desquamation (secondary) after use. Study de-sign: any. Exclusion criteria: reports on secondary or unpublished data, in vitro studies. Data were independently extracted by two reviewers. Results: Fifteen reports were selected from 410 identified. Descriptive studies mainly showed low bias risk, ex-perimental studies mostly an "unclear risk". Dentifrices or mouthwashes were linked to OMP, with an unknown origin in 5 subjects. Sodium lauryl-sulphate (SLS) was behind this disorder in 21 subjects, tartar-control dentifrices in 2, and flavouring agents in 1 case. Desquamation extension was linked to SLS concentration. Most cases were painless, leaving normal mucosa after desquamation. Tartar-control dentifrices caused ulcerations more frequently. Conclusions: OMP management should consider differential diagnosis with oral desquamative lesions, particularly desquamative gingivitis, with a guided clinical interview together with pathological confirmation while discouraging the use of the product responsible for OMP

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Periodontal awareness and what it actually means: A cross-sectional study.

OBJECTIVES: To assess periodontal awareness among laypersons, to characterize the very aware of periodontitis and to disclose whether high awareness implies sufficient periodontal knowledge. SUBJECTS AND METHODS: Cross-sectional study on laypersons randomly selected by quota sampling from March 2015 to June 2016. The questionnaire of periodontal awareness included aspects of aetiology, risk factors, signs and symptoms, related risks, prevention, treatment and related attitudes. It was applied by 12 interviewers in the community in each four province capitals, in a sort of pathfinder survey method. RESULTS: A 43.3% response rate was obtained, and 3,553 people entered the study. "Very aware": 19.4%. "Aware": 42.7%. "Not aware": 37.9%. Age, oral self-care and educational achievements characterized those "very aware." Any additional degree beyond compulsory education halves the chances for being "not periodontally aware." Very aware people likely to have periodontitis were elder, less educated, with a smoking history and less knowledge of the disease. Gaps of knowledge among the "very aware" were identified in all aspects except for "prevention" and "treatment.". CONCLUSIONS: Very periodontally aware people were in their late 40-60 s, followed sound oral care routines and held a degree but elicited insufficient knowledge about aetiology, signs-symptoms, related risks or periodontal risk factors.

Disparities between English and Spanish in readability of online endodontic information for laypeople.

BACKGROUND: In this study, the authors assessed the readability of online endodontic information in English and Spanish. METHODS: The authors performed a systematic search in Google in May 2016. Search queries were "root canal treatment" and "¿Qué es una endodoncia?" without limits or filters. The authors assessed English readability by using Flesch-Kincaid Reading Grade Level, Flesch Reading Ease Score, Gunning Fog Index, Coleman-Liau index, automated readability index, and Simple Measure of Gobbledygook (SMOG) index. The authors calculated readability for Spanish by using the Fernández-Huerta index and INFLESZ (Ines-Barrio). RESULTS: The authors assessed the first 100 consecutive sites identified with each search strategy and selected 117 sites. Readability scores for English-language sites were in the category of normal to read, easily understood by 13- through 15-year-old students (Flesch Reading Ease Score, 63, interquartile range (IQR) [53.9-66.2]; Gunning Fog Index, 10.4, IQR [8.8-12]; Coleman-Liau index, 12.5, IQR [11.6-13.3]; and automated readability index, 8.6, IQR [6.7-9.8]). SMOG results led to the estimation that only 7 years of education would be needed to understand these contents (SMOG, 7.6, IQR [6.5-8.8]). Spanish-language sites had a readability index normal for an adult, equivalent to a seventh or eighth school year (Fernandez-Huerta, 62.3, IQR [59.7-66.6]; INFLESZ, 57.5, IQR [55.1-62.1]). The authors found that 36.6% of English-language sites had some degree of difficulty for readers to understand their contents, whereas 23% of Spanish-language sites had some degree of difficulty (14.46; 95% confidence interval, -3.16 to 30.08). CONCLUSIONS: Spanish- and English-language electronic health information about endodontic treatment is acceptable to read, but-particularly for English-language sites-there is an important proportion of sites scoring difficulty levels well above the recommendations. PRACTICAL IMPLICATIONS: The internet is a useful tool for communicating with patients, but available endodontic information is difficult for laypeople to understand. Endodontists should produce relevant materials in plain language to overcome this problem.

Primary care physicians and nurses: Targets for basic periodontal education.

BACKGROUND: Early diagnosis may improve patients' quality of life and reduce the lifelong social and financial burden inherent to treatment. Growing evidence supports the importance of a healthy periodontium in systemic health. Diagnosis depends on the patient and the healthcare professional. As many patients seek physicians' advice first, this study aims at assessing periodontal knowledge in a general population and their primary care physicians and nurses. METHODS: This is a cross-sectional study using an anonymous questionnaire applied to randomly selected laypersons (March to June 2016), and to physicians and nurses at their workplaces (October to December 2016) in Ourense, Spain. Sample size for the general population was determined by quota sampling. RESULTS: A total of 1,469 people entered the study. All healthcare workers and 624 (47.1%) laypersons were familiar with periodontitis. Bacterial etiology of periodontitis was recognized by 25 (4%) laypersons, 23 (34.3%) physicians, and 11 (16.6%) nurses. The following periodontal problems were experienced: 1) gingival redness: laypersons 14.4%, physicians 16.4%, and nurses 21.2%; 2) gingival bleeding: laypersons 22.2%, physicians 50.7%, and nurses 50%; 3) tooth mobility: laypersons 34.9%, physicians 7.4%, and nurses 6%; and 4) bleeding while toothbrushing: laypersons 44.3%, physicians 8.9%, and nurses 15.1%. More than a third of laypersons (37%) think periodontitis is related to other health problems, together with 53% of physicians and 47% of nurses. CONCLUSIONS: Our results show a low degree of periodontal knowledge both amongst the public and their primary care physicians and nurses and unveil unreliable targets (primary healthcare workers) for educational interventions to improve early diagnosis and treatment of periodontal disorders.

Is Periodontal Disease Associated with Alzheimer's Disease? A Systematic Review with Meta-Analysis.

BACKGROUND: In the last decade, several observational studies have suggested that there exists an association between periodontal disease (PD) and Alzheimer's disease (AD). The aim of this systematic review was to investigate whether or not this link exists. SUMMARY: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline for systematic review was used and registered at PROSPERO (CRD42016035377). The search strategy included using electronic databases and by hand searching articles published up to January 2016. MEDLINE via PubMed, EMBASE and Web of Science were searched by 2 independent reviewers. Observational studies including patients meeting criteria for both AD and PD were eligible to be included in the analysis. Quality assessment of selected studies was performed by the Newcastle-Ottawa Scale. From a total of 550 titles and abstracts, 5 studies were included (2 cross-sectional, 2 case-control and one cohort study) in the review. A fixed effects meta-analysis showed that the presence of PD is associated with the presence of AD (OR 1.69, 95% CI 1.21-2.35). When only severe forms of PD were evaluated, a significant association was also observed (OR 2.98, 95% CI 1.58-5.62). Key Messages: In the present review, a significant association was observed between PD and AD. Further studies should be carried out in order to investigate the direction of the association and factors that may confound it.