Oral Cancer in Young vs Old Individuals: A Systematic Review.

AIM: To compare various parameters associated with oral cancer in young and old patients and systematically compile the data on prognosis or outcome of oral cancer in young and old patients that include case series, matched-pair analyses, institutional series, and database reviews. BACKGROUND: Though oral cancer is considered a disease of old age, a recent clinical scenario witnesses its increasing incidence among young persons. When compared to old patients, young patients with oral cancer are exposed to the carcinogens for a very petite period of time suggesting underlying pathogenesis to be distinct from that in older individuals. Literature reports several studies about the occurrence of oral cancer in young patients; however, no unanimous opinion exists about its prognosis and treatment outcomes when compared to older patients. Keeping this in mind, we have extensively studied all the possible aspects (location, local and regional recurrence, nodal and distant metastasis, overall survival, etc.) from the English literature and systematically compiled the available data on prognosis or outcomes of oral cancer. REVIEW RESULTS: The overall outcome of the case series shows poorer prognosis in young patients, matched-pair analyses, and institutional series suggesting no significant differences whereas the databases favored a better prognosis in young patients. The mean overall survival rate was found to be better for young patients in the database and institutional review whereas worse in the matched-pair analyses. The mean 5-year survival rate was found to be more in young individuals in matched-pair analyses, database reviews, and institutional series as compared to older oral cancer patients. CONCLUSION: Though data extracted from various study designs are heterogeneous, the present review gives a scoping view of the papers published on oral cancer in young vs old patients. More prospective studies are suggested with a larger sample size in the future. CLINICAL SIGNIFICANCE: The present review will help to better understand the nature, course, and biologic behavior of oral cancer in young patients leading to the development of specific treatment strategies to manage the patients based on their age-groups.

Perspective on Forensic Odontology and COVID-19.

Novel coronavirus infection (COVID-19) is the most deadly pandemic disease of the century and is now known for its high infectivity, morbidity, and mortality. It is conceivable to expect the ramifications of this pandemic in the form of depression and frustration. An increase in crime rate and violence is expected in the near future. Forensic experts along with forensic odontologists will be receiving many cases shortly and they should be ready to face the challenges. In the present paper, a critical perspective is presented on COVID-19 and its socioeconomic impact. Recommendations are provided for effectively carrying out the investigative procedures related to forensic odontology. Clinical relevance: Novel coronavirus infection (COVID-19) is the most deadly pandemic disease of the century and is now known for its high infectivity, morbidity, and mortality. Hence, it is recommended to treat every forensic sample as potential COVID-19 infected. In this regard, the present paper gives some important recommendations for handling the samples that are related to forensic odontology. These will prevent the infection spread in the forensic experts, which are considered as the backbone of this critical COVID-19 situation. Keywords: Coronavirus, COVID-19, Forensic medicine, Forensic odontology.

Indian Higher Health Education Institutions and World University Ranking: A Viewpoint.

Competitiveness is very important for growth in any field. Equally important is to create a competitive environment and platform that will push the competitors to showcase their excellence. Worldwide, educational universities are also making efforts to excel and make a mark on various ranking platforms. This has a definite impact on imparting high-quality education and raising the standards. Moreover, ranking systems will help the students in choosing appropriate institutions for their future education. By virtue of this process, universities get international students.

Selective serotonin reuptake inhibitors and dental implant failure-A significant concern in elders?

OBJECTIVE: Depression is a significantly prevalent health concern in geriatric populations. Selective serotonin reuptake inhibitor drugs (SSRI) are the most commonly prescribed antidepressant agents, with increasing rates of prescription. The present report aimed to present a concise review of the current understanding regarding SSRI effects on bone and dental implant outcomes. MATERIALS AND METHODS: A broad-based review and summary of literature pertaining to the effects of SSRI on bone metabolism and on dental implant survival was performed. RESULTS: The available literature indicates that serotonin plays a significant role in bone metabolism and experimental reports demonstrate adverse impacts of SSRI on multiple pathways of bone metabolism. Early clinical reports suggest detrimental effects of SSRI on dental implant survival. The type of SSRI drug, dosage and host-related genetic and metabolic factors could be potential modulating factors. There is a paucity of data regarding SSRI usage and dental implant survival specific to geriatric cohorts. CONCLUSION: As older individuals comprise a high-risk group for both high oral rehabilitation and SSRI use, clinicians should be aware the potential association between SSRI and dental implant failures. Well-designed investigations specific to geriatric cohorts are essential to understand the implications of SSRI use on dental implant prognosis.

Soft and hard tissue changes around laser microtexture single tooth implants--a clinical and radiographic evaluation.

PURPOSE: To investigate the periodontal parameters that affect the soft and hard tissues around Laser microtextured single tooth implants at 18 months after loading. METHODS: Twenty Laser Lok implants were placed in 20 single missing tooth sites using a 2-stage protocol. Clinical Parameters included Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), Bleeding on Probing (BOP), and Crestal Bone Loss (CBL). Clinical and radiographic evaluation was done at loading, 12 months and 18 months after loading. The data collected were analyzed statistically. RESULTS: The PI and GI during the entire follow-up period were well controlled. Eighty-six percent of implant sites were free of BOP at loading and 87% of sites were free of BOP at 18 months. A significant increase in PPD was not observed. The mean CBL was 0.59 mm at the time of loading, 0.80 mm at 12 months, and 1.06 mm at 18 months. CONCLUSION: The Laser Lok implants showed minimal CBL at 18 months than the commonly accepted 1.5 to 2.0 mm. The periimplant soft tissue stability was maintained throughout the study.

Efficacy and Viability of Subgingival Application of Probiotics as an Adjunct to Scaling and Root Planing in Periodontitis.

AIM: This study aimed to compare the efficacy of subgingivally applied probiotics as an adjunct to scaling and root planing (SRP) vs SRP alone in patients with periodontitis. MATERIALS AND METHODS: Patients diagnosed with periodontitis, with probing pocket depth (PPD) of 5-7 mm on at least two teeth on contralateral sites, were selected for the study and randomly allocated to the test group (n = 31) who underwent SRP along with subgingival application of probiotic paste and the control group (n = 31) who underwent only SRP. Clinical parameters were evaluated in both groups at baseline and after 12 weeks. The viability of probiotic bacteria was evaluated in the test group at baseline, day 4 and day 8. RESULTS: All clinical parameters showed a statistically significant difference between baseline and 12 weeks on intragroup and intergroup comparison, with a greater improvement in the test group. Microbiological evaluation showed that the mean colony-forming units (CFUs) in the test group were 38.39 ± 7.76, 7.25 ± 2.72 and 1.57 ± 1.29 at baseline, day 4 and day 8, respectively. The mean CFUs significantly reduced with an increase in time from baseline to 8-day time interval. CONCLUSION: It was seen that the probiotic bacteria remained viable in the periodontal pocket for up to 8 days after placement, but stable improvements were seen in all clinical parameters even at 12 weeks, indicating its prolonged efficacy. Thus, commercially available probiotics can prove to be an inexpensive method to treat periodontitis when combined with SRP.

Assessment of periodontal health status in patients with Parkinson's disease-A systematic review and meta-analysis of cross-sectional studies.

INTRODUCTION: Parkinson's disease (PKD) is neurodegenerative disorder marked by tremors, bradykinesia, muscle rigidity and reduction in precise hand movements which could lead to improper oral hygiene and Periodontal disease. Current systematic review aims to review existing literature and provide assessment of periodontal health in PKD patients through a meta-analysis METHODS: Review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and registered in PROSPERO-CRD42023451700. Databases were searched for studies having sufficient data on periodontal health in patients with PKD compared to healthy controls and reporting outcomes in terms of various periodontal parameters of probing depth (PD), plaque index (PI), clinical attachment level (CAL), presence of bleeding on probing and gingivitis. Quality assessment of included was evaluated using Newcastle Ottawa Scale (NOS). RESULTS: Eleven studies fulfilled the eligibility criteria, of which ten studies were suitable for meta-analysis. Pooled estimate through the SMD showed that all periodontal parameters were altered and significantly deteriorated in PKD compared to controls but this group differences were statistically insignificant (p > 0.05). Publication bias through the funnel plot showed symmetric distribution with absence of systematic heterogeneity. CONCLUSION: Parkinson's disease could be a possible factor in deterioration of periodontal health.

Ten-year prognostic outcomes of molar survival using the Miller-Mcentire Periodontal Prognostic Index - A longitudinal prospective study.

Background: A 10-year survival analysis was performed to assess the predictive validity of the periodontal risk score (formerly known as Miller-McEntire Periodontal Prognostic Index [MMPPI]) to predict long-term survival of periodontally diseased molars in a longitudinally assessed cohort. Materials and Methods: The MMPPI scores were computed at baseline by summarizing scores allocated for individual factors. The cohort was treated, followed up, and placed under regular periodontal maintenance. Molar survival data collected up to 10 years of follow-up were analyzed. Cox proportional regression was performed, and hazards ratio (HR) were computed for each prognostic factor and the MMPPI score. To estimate the predictive value of MMPPI, a receiver operating curve (ROC) curve analysis was performed. Results: From 1032 molars, 155 molars were extracted over the 10-year follow-up duration. Cox proportional hazard analysis showed significant hazard ratios for tooth loss for the component variables significant HR was noted for age: 4.92 (3.34:7.27), smoking: 1.74 (1.38-2.22), diabetes: 1.66 (1.49-1.86), molar type: 1.39 (1.15-1.67), probing depth: 2.00 (1.63-2.46), furcation: 2.64 (2.30-3.03), mobility: 3.45 (2.98-4.01), and total MMPPI score: 1.98 (1.85-2.12). ROC curve analysis showed an area under the curve value of 0.94 for the MMPPI index as a predictor of molar loss at 8 years, and the Youden index was maximized at the optimal cutoff point score of 7. Conclusions: All component scores of MMPPI showed significant hazard ratios at 10 years. These findings support the previous results from the 5-year analysis of this university-based cohort and warrant validation in independent cohorts.

Indian Society of Periodontology Good Clinical Practice Recommendations for Peri-implant Care.

Current implant therapy is a frequently employed treatment for individuals who have lost teeth, as it offers functional and biological advantages over old prostheses. Concurrently, active exploration of intervention strategies aims to prevent the progression of peri-implant diseases and manage the existing peri-implant tissue damage. Indian Society of Periodontology has recognized the need for systematic documents to update the everyday clinical practice of general dental practitioners and has provided evidence-based consensus documents, namely good clinical practice recommendations from time to time to raise the oral health-related awareness and standards of oral health-care delivery across the country. The current clinical practice recommendations focused on peri-implant care to bridge the gap between academic theory and clinical practice by compiling evidence-based suggestions for preventing and treating peri-implant diseases. Twenty-eight subject experts across the country prepared these recommendations after a thorough literature review and group discussions. The document has been prepared in three sections covering peri-implant health and maintenance, peri-implant mucositis, and peri-implantitis. It will be a quick and concise reference for oral implant practitioners in patient management. The guidelines provide distinct definitions, signs, and symptoms, treatment required; recall visit specifications for plausible clinical case situations, and home-care recommendations regarding maintaining peri-implant health. The document advocates combined efforts of oral implant practitioners and the population at large with evidence-based, integrated, and comprehensive peri-implant care. By providing accessible, applicable guidance, these guidelines would empower dental professionals to uphold the well-being of implant patients and ensure the long-term success of implant therapy.

Emerging role of photodynamic therapy as an adjunct to nonsurgical periodontal therapy on periodontal status and glycemic control in patients with type 2 diabetes: A clinical study.

Background: Periodontal disease is considered to be the sixth most common complication of diabetes mellitus (DM). Antibiotics (systemic and local) enhance the outcome of conventional mechanical debridement but frequent use of antimicrobials may develop resistance to microorganisms. To overcome this complicacy, the current study assessed the effectiveness of photodynamic therapy (PDT) in chronic periodontitis patients with type 2 diabetes when used as a combination therapy to standard periodontal therapy by assessing the various clinical and glycemic parameters. Materials and Methods: A total of 16 known cases of chronic Periodontitis patients who were suffering from type 2 DM were allocated into two groups. The test group (n = 8) was treated with standard scaling and root planing (SRP) along with PDT while the control group was treated with SRP alone. Various clinical parameters assessed were plaque index, gingival index, pocket probing depth, clinical attachment level, and Glycated hemoglobin level at baseline and 90 days after therapy. Results: At the end of the study, both the groups showed improvements with regard to all clinical and glycemic parameters compared to baseline. However, the test group presented statistically significant favorable results (all P < 0.05). Conclusion: Conventional periodontal treatment aided with PDT proved to be a beneficial therapeutic measure and effective alternative in patients with chronic periodontitis with diabetes when compared with standard periodontal therapy alone.

Multiple periodontal abscesses with atypical segmental teeth mobility in a nonperiodontitis case: A periodontal alarm of postcoronavirus disease-2019 mucormycosis.

The coronavirus pandemic, constantly mutating virus, and newer complications arising with each passing day have put health workers in jeopardy. One such serious complication being reported is mucormycosis. It is a deadly and rapidly spreading infection resulting in angioinvasion and tissue necrosis. In precoronavirus disease (COVID) era mucormycosis was observed mainly in patients having comorbidities such as diabetes, neutropenia, or previous history of organ transplant. In the present case report, a systemically healthy patient presented with mucormycosis postcoronavirus disease-2019 infection. The patient presented with atypical periodontal findings such as multiple periodontal abscesses, segmental teeth mobility, and deep periodontal pockets confined to the maxillary right quadrant. This form of presentation should be a wake-up call for all dental professionals to be in the constant lookout for any signs and symptoms of mucormycosis even in seemingly nonhigh-risk patients.

Influence of Birth Characteristics and Feeding Practices on Eruption of Primary Teeth in Children: A Preliminary Cross-sectional Observational Study.

Background: The eruption process is under strong genetic control, external environmental factors also significantly contribute to this process. Therefore the present study was undertaken to identify the influence of birth characteristics and feeding practices on the eruption of the first primary tooth among healthy children in Pune, Maharashtra, India. Materials and methods: The study was undertaken among 200 children aged 3-24 months. Children with any underlying conditions, those not accompanied by their mother and with neonatal teeth/natal teeth were excluded. The birth weight, gestational age, and type of delivery were obtained from medical records of the child. Data on feeding practices and the age of eruption of the first primary tooth was recorded after a structured interview of the mother followed by oral examination of the child. Gestational age was categorized into >37 weeks and <37 weeks, birth weight was divided into three groups-<1500, 1500-2500, and >2500 gm and four groups according to feeding practice during the first 6 months of life (exclusively breastfed, exclusively bottle fed, combination of breastfeeding and bottle feeding, and spoon-feeding). Results: The mean age of eruption in the study population was 9.17 months. A9.05 months in males and 9.44 in females. A statistically significant correlation was noted with gestational age, birth weight, and feeding practices. Infants with a gestational age of >37 weeks, higher birth weight and those who were exclusively breastfed for the first 6 months had an earlier eruption of first primary teeth. Conclusion: External factors seem to influence the eruption of the primary tooth. More longitudinal studies with larger sample sizes and matching confounders are needed to clearly understand the factors affecting the primary tooth eruption. How to cite this article: Shetty SS, Mathur A, Gopalakrishnan D, et al. Influence of Birth Characteristics and Feeding Practices on Eruption of Primary Teeth in Children: A Preliminary Cross-sectional Observational Study. Int J Clin Pediatr Dent 2023;16(5):724-727.

Translating Clinical Outcomes to Patient Value Through Use of the Periodontal Risk Score: An Evidence-Based Treatment Approach.

Periodontitis is a chronic, multifactorial inflammatory disease characterized by progressive destruction of the tooth-supporting apparatus. Determining tooth prognosis is of central importance in clinical practice to help both the clinician and patient understand the risks and benefits of treatment while shedding light on the patient's long-term periodontal prognosis and aiding in the development of an individualized treatment plan. Several indexing-type systems have been proposed for determining the prognosis of periodontally involved teeth. The periodontal risk score (PRS) is a simple, evidence-based, motivational tool that can be used in daily clinical practice in both healthy and periodontally involved patients. The PRS incorporates systemic and lifestyle prognostic factors to achieve superior predictive accuracy. With the PRS, patients are encouraged to achieve a target score (representing an "excellent" prognosis) that can be realistically attained through compliance with a periodontal maintenance plan. The purpose of this article is to present to clinicians how to implement this evidence-based tool into their daily practices and thus help patients improve their long-term periodontal prognosis.

Herbal topical anesthetics in dentistry: an exploratory review.

Topical anesthetics are routinely used in dental practice for various purposes. They are usually available at higher dosages and have serious potential adverse reactions, such as seizures, anaphylaxis, and acquired methemoglobinemia. To date, the scope of application of herbal plants and their extracts, which have medicinal properties, has been elaborated in the field of dentistry. The growing interest in herbal medication can be attributed to the increased safety profile of herbal agents, in contrast to synthetic preparations that have a higher risk of systemic complications. Herbal preparations can induce topical anesthesia with minimal side effects. Recently, many studies have reported the use of topical herbal preparations. The current review aimed to evaluate data from various articles comparing the capacity of herbal topical anesthetic formulations and conventional synthetic anesthetics in reducing pain perception when used as local anesthesia before dental procedures.

COVID-19 and oral cancer: Critical viewpoint.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has marked the beginning of a new pandemic named coronavirus disease 2019 (COVID-19). The World Health Organization has announced it as a health emergency that is of international concern. The disease has been reported to cause respiratory illness, pneumonia and even hinder the immunity of an individual. Individuals with disturbed immune responses have been found to be quite susceptible to this viral infection. Oral cancer patients are also at high risk in this pandemic situation and might encounter severe detrimental outcomes. Angiotensin receptors, documented in studies as the path of entry of this virus, are highly expressed in the epithelial cells of oral mucosa, making the group of individuals with oral cancers even more vulnerable. Extracellular matrix metalloproteinase inducer is another potential target for SARS-CoV-2. An exhaustion of angiotensin converting enzyme 2 cell receptors leads to protumoral effects, whereas a downregulation of extracellular matrix metalloproteinase inducer leads to antitumoral effects. Thus, it causes a variation of the biological behavior of the tumor. This article focusses on the molecular mechanisms, effects and patho-physiology of COVID-19 in oral squamous cell carcinoma patients. The different molecular changes in oral squamous cell carcinoma in the background of COVID-19 will modify various environmental factors for this pathology and have an effect on the carcinogenesis process. Understanding the behavior of the tumor will help plan advanced treatment strategies for oral squamous cell carcinoma patients in the background of COVID-19.

Evaluation of periodontally diseased molars in diabetics with Miller-McEntire Periodontal Prognostic Index.

AIM AND OBJECTIVE: The aim of this study was to prospectively determine and establish the periodontal prognosis of diseased molars in diabetic patients using the Miller-McEntire Periodontal Prognostic Index (MMPPI) with an additional criterion for diabetes (changes in glycosylated hemoglobin levels), at 2-year postperiodontal therapy. MATERIALS AND METHODS: A sample of 200 molars in 25 patients with diabetes mellitus (DM) and chronic periodontitis were evaluated. The prognostic parameters evaluated include age, probing depth (PD), mobility, furcation involvement, diabetes, and molar type. The total score calculated from all parameters was used considered prognosis score for each molar. All patients were evaluated at baseline and 2-year posttreatment. RESULTS: The results of this study suggest that following prognostic factors, DM (hazard ratio [HR] =5.2), age (HR = 0.4), and molar type (HR = 0.6) were clinically significant at the end of the 2-year posttherapy from baseline. A total of 4 (2%) teeth were extracted from the 200 teeth with a mean of 0.02 for the tooth lost during 2-year posttreatment. Significant improvements (P < 0.05) in the frequency PD, furcation, and mobility scores were noted at 2 years. CONCLUSIONS: These findings demonstrate that score for DM as prognostic criterion is a valid addition to MMPPI. The factors such as DM, age, and molar type can impact the prognosis of molar survival. Studies with a larger sample size and longer follow-up are required to affirm the findings of this preliminary study.

Prospective evaluation of periodontally diseased molars in smokers using the Miller-McEntire Periodontal Prognostic Index.

BACKGROUND: The purpose of this 2-year prospective survival analysis study is to determine a statistically validated periodontal prognostic score for diseased molars in smokers using the Miller-McEntire Periodontal Prognostic Index (MMPPI). MATERIALS AND METHODS: Two hundred molars were evaluated from 25 patients who were smokers with moderate-to-severe chronic periodontitis. The factors evaluated included age, probing depth, mobility, furcation involvement, smoking, and molar type. A modified, 5 level, scoring criterion for smoking based on smoking-dose was adopted. MMPPI was computed as the sum of scores for all six prognostic factors. Appropriate periodontal treatment and supportive periodontal therapy were provided. All patients were evaluated at baseline and 2 years posttreatment. Hazard risk ratio (HR) was computed for each prognostic factor. RESULTS: A total of 3 (1.5%) teeth of the 200 molars were extracted over the 2-year follow-up duration, with a mean of 0.015 teeth lost. The HR was found as significantly higher for three individual prognostic factors: mobility (HR = 5.57, P = 0.02), smoking (HR = 3.35, P = 0.04), and furcation involvement (HR = 7.30, P = 0.01). Significant and positive HR (HR = 1.70, P = 0.01) was noted for the total MMPPI score, validating its prognostic value for molar survival at 2 years prospectively. CONCLUSIONS: The findings of the current study demonstrate the prognostic validity of MMPPI incorporating a more detailed smoking score criterion. The factors smoking, furcation involvement, and mobility significantly impacted the likelihood of survival of periodontally diseased molars. Further studies with a larger sample size and longer follow-up are required to confirm these findings.

Evaluation of efficacy of a novel resorbable collagen membrane for root coverage of Miller's Class I and Class II recession in the maxillary anteriors and premolars.

BACKGROUND: There are several surgical techniques in literature that have been used to perform root coverage (RC). Currently, the use of a resorbable collagen membrane (RCM) as a guided tissue regenerative material is one of the highly sought treatment modalities. The present study aimed at evaluating the clinical outcome of RC in the treatment of Miller's Class I and II recession defects in maxillary anteriors and premolars by coronally advanced flap (CAF) with and without RCM. MATERIALS AND METHODS: This split-mouth study (bilateral buccal recession defects) was randomized to include 15 test (CAF + membrane) and 15 control (CAF alone) sites. Clinical parameters included gingival recession depth (RD), probing pocket depth (PPD), clinical attachment level (CAL), and keratinized tissue height (KTH) measured at baseline and 9 months postoperatively. RESULTS: Both test and control groups showed statistically significant (P < 0.05) reductions in RD (1.54 ± 0.46 mm and 1.60 ± 0.07 mm), PPD (0.53 ± 0.15 mm and 0.94 ± 0.10 mm), increase in KTH (0.67 ± 0.90 mm and 0.73 ± 0.14 mm) and CAL (1.94 ± 0.27 mm and 2.60 ± 0.19 mm) when comparing the 9-month data from baseline. The present study showed that mean improvement in RD was 1.60 ± 0.507 and 1.53 ± 0.64 mm in both test and control groups, respectively. Mean percent RC was 58.33% ±12.19% and 56.22% ±10.22% for test and control groups, respectively. However, there were no statistically significant differences between groups for RD, PPD, KTH, and CAL. CONCLUSION: The results of this study suggest that both the groups CAF (control) and CAF and RCM (test) could be successfully used to treat Miller's Class I and II gingival recession defects and also demonstrated an overall significant improvement in all the assessed clinical parameters. However, there was a greater reduction of gingival RD with the use of RCM when compared with the group of CAF alone.