TFM classification and Staging of oral submucous fibrosis: A new proposal

Background: We have evaluated the rationale of existing grading and staging schemes of oral submucous fibrosis (OSMF) based on how they are categorized. A novel classification and staging scheme is proposed. Methods: A total of 300 OSMF patients were evaluated for agreement between functional, clinical, and histopathological staging. Bilateral biopsies were assessed in 25 patients to evaluate for any differences in histopathological staging of OSMF in the same mouth. Extent of clinician agreement for categorized staging data was evaluated using Cohen's weighted kappa analysis. Cross-tabulation was performed on categorical grading data to understand the intercorrelation, and the unweighted kappa analysis was used to assess the bilateral grade agreement. Probabilities of less than 0.05 were considered significant. Data were analyzed using SPSS Statistics (version 25.0, IBM, USA). Results: A low agreement was found between all the stages depicting the independent nature of trismus, clinical features, and histopathological components (K = 0.312, 0.167, 0.152) in OSMF. Following analysis, a three-component classification scheme (TFM classification) was developed that describes the severity of each independently, grouping them using a novel three-tier staging scheme as a guide to the treatment plan. Conclusion: The proposed classification and staging could be useful for effective communication, categorization, and for recording data and prognosis, and for guiding treatment plans. Furthermore, the classification considers OSMF malignant transformation in detail

Impact of early extraction of the deciduous canine on relief of severe crowding:

ABSTRACT Objectives To explore whether there were any differences in orthodontic treatment need, treatment complexity, treatment time, or the number of visits between a group of children receiving early intervention (extraction of upper and lower deciduous canines) and an age- and condition-matched control group without intervention. Materials and Methods Patient records and study casts in the late mixed or early permanent dentitions of 46 subjects (20 from the extraction group and 26 from the control group) of an earlier prospective longitudinal study were retrieved. Orthodontic treatment need and complexity were assessed by the index of complexity, outcome, and need (ICON). Statistical calculations were performed by t-test for parametric outcome variables (treatment time, number of visits, and orthodontic treatment need) and Fisher exact test for the categorical variable (tooth extractions). Results There were no statistically significant differences between the groups in ICON scores of orthodontic treatment need (extraction group, mean score 59.8; control group, mean score 52.8), number of visits (mean of about 15 visits for both groups), or treatment time (extraction group, mean 21.5 months; control group, mean 20.3 months). The extraction of permanent teeth was more prevalent in the deciduous canine extraction group (59%) as compared with the control group (28%); however, this was not statistically significant (P = .07) but showed a tendency toward worsening the crowding and the future need of orthodontic extractions. Conclusions Early removal of deciduous primary canines will reduce neither the need for later orthodontic treatment nor its complexity, nor will it shorten the treatment time. </jats:sec

Impact of early extraction of the deciduous canine on relief of severe crowding : Does it influence later orthodontic interventions?

Objectives: To explore whether there were any differences in orthodontic treatment need, treatment complexity, treatment time, or the number of visits between a group of children receiving early intervention (extraction of upper and lower deciduous canines) and an age- and condition-matched control group without intervention.Materials and Methods: Patient records and study casts in the late mixed or early permanent dentitions of 46 subjects (20 from the extraction group and 26 from the control group) of an earlier prospective longitudinal study were retrieved. Orthodontic treatment need and complexity were assessed by the index of complexity, outcome, and need (ICON). Statistical calculations were performed by t-test for parametric outcome variables (treatment time, number of visits, and orthodontic treatment need) and Fisher exact test for the categorical variable (tooth extractions).Results: There were no statistically significant differences between the groups in ICON scores of orthodontic treatment need (extraction group, mean score 59.8; control group, mean score 52.8), number of visits (mean of about 15 visits for both groups), or treatment time (extraction group, mean 21.5 months; control group, mean 20.3 months). The extraction of permanent teeth was more prevalent in the deciduous canine extraction group (59%) as compared with the control group (28%); however, this was not statistically significant (P = .07) but showed a tendency toward worsening the crowding and the future need of orthodontic extractions.Conclusions: Early removal of deciduous primary canines will reduce neither the need for later orthodontic treatment nor its complexity, nor will it shorten the treatment time.</p

Breath Alkane as an index of severity for oral submucous fibrosis: A new perspective?

Item does not contain fulltextOral submucous fibrosis (OSMF) is a devastating disease commonly seen in the Asian subcontinent that results in significant functional morbidity for patients and has a high potential for malignant transformation. Over the last three decades, different diagnostic methods have been described to quantify and grade OSMF severity. Some methods have been used with perceived favorable outcomes although recurrence and malignant transformation remains a problem in many cases, and OSMF presents a major therapeutic challenge. We present a simple, noninvasive and less time-consuming diagnostic method which measures the severity of OSMF, helping to predict its malignant transformation and monitoring the effect of medical therapy on this disease

Arabic patient-reported outcome measures for xerostomia and oral mucositis: Translation and cross-cultural adaptation

Introduction: Xerostomia and oral mucositis (OM) are common oral complications of head-and-neck cancer (HNC) radiotherapy. Aims: This study aimed to translate and assess the key validity and reliability properties of the Summated Xerostomia Inventory (SXI) and the patient-reported OM symptom (PROMS) in the Arabic patient cohort. Materials and Methods: This observational study was conducted at King Saud University Medical City, Riyadh, Saudi Arabia. Six expert clinicians translated both instruments and assessed them for content validity. They then evaluated validity (face and construct validity) and reliability (internal consistency and test–retest reliability) with adult participants who received radiotherapy for HNC. Results and Discussion: Thirty-eight patients (males = 19, females = 19) were recruited with a mean age of 50 years (±16). The Arabic SXI (SXI-Ar) and Arabic PROMS (PROMS-Ar) were considered relevant, sufficient, and understandable. Furthermore, high internal consistency was demonstrated by SXI-Ar (α = 0.851) and PROMS-Ar (α = 0.957). However, there were moderate to poor agreements between both instruments’ 1st and 2nd-week completions, as shown by the average correlation coefficients of 0.407 and −0.364, respectively. It was also evident that both xerostomia and OM scores were significantly correlated (r = 0.372, P = 0.043). Conclusions: SXI-Ar and PROMS-Ar showed preliminary satisfactory measurement properties. Both instruments could be used in daily clinical consultations and clinician-reported assessments in oncology, nutritional, and maxillofacial care settings. However, further assessments of hypotheses testing, criterion validity, and responsiveness with a large patient cohort are needed

Effect of Plant-Based Mouthwash (<i>Morinda citrifolia</i> and <i>Ocimum sanctum</i>) on TNF-α, IL-α, IL-β, IL-2, and IL-6 in Gingival Crevicular Fluid and Plaque Scores of Patients Undergoing Fixed Orthodontic Treatment

Background and Objectives: To investigate the antiplaque properties of two plant-based mouthwashes, Morinda citrifolia (MC) and Ocimum sanctum (OS), and their effect on TNF-α, IL-α, IL-β, IL-2, and IL-6 in gingival crevicular fluid (GCF) of patients undergoing fixed orthodontic treatment. Materials and Methods: Seventy-five individuals were recruited according to defined inclusion and exclusion criteria. This study was structured into two distinct phases. Phase I was a combination of toothbrushing using toothpaste containing fluoride (Protocol A), while Phase II toothbrushing included fluoride toothpaste and use of a mouthwash (Protocol B). For Phase II, individuals participating in this study were allocated into different groups through a randomization process: Group 1—0.12% CHX, Group 2—5% MC, and Group 3—4% OS. Each individual’s Phase I and Phase II scores were assessed. GCF was measured in three phases to determine the level of inflammatory biomarkers. The paired t-test evaluated the disparities between the pre- and post-plaque index. Categorical data were subjected to crosstab analysis to assess qualitative variables. The mean values of cytokine levels were presented. An unpaired t-test was employed to assess the levels of cytokines between individuals in Phase I and Phase II. Results: Toothbrushing, fluoride toothpaste, and the supplementary use of mouthwash (Phase II) resulted in mean plaque scores significantly lower than group A (p Conclusions: In conjunction with fluoridated toothpaste and brushing, OS and MC can serve as a viable alternative to conventional synthetic mouthwash CHX. This combination demonstrates reducing mean plaque scores and diminishing the levels of cytokines TNF-α, IL-α, and IL-β

Levels of Inflammatory and Bone Metabolic Markers in the Gingival Crevicular Fluid of Individuals Undergoing Fixed Orthodontic Treatment in Comparison to Those Utilizing Invisalign

Background and Objectives: Evaluation of the levels of cytokine and bone metabolic biomarkers (BMBs) in patients receiving fixed orthodontic therapy (FOT) and Invisalign. Materials and Methods: Sixty participants were enrolled after meeting the predefined inclusion criteria. Patients then underwent either FOT or Invisalign by allocating them randomly to each group (n = 30). The basic periodontal assessment was performed, including the plaque index (PI), gingival index (GI), and bleeding on probing (BoP), at baseline and again after 4 weeks. Gingival crevicular fluid (GCF) samples were taken from each individual at baseline and after 4 weeks. An enzyme-linked immunosorbent assay (ELISA) technique was used to determine the cytokine and BMB levels. An unpaired t-test compared the FOT and Invisalign group&rsquo;s means and SDs. Paired t-tests examined the difference between T0 baseline and T1. Results: Patients treated with either FOT or Invisalign presented no statistically significant difference in terms of periodontal parameters such as PI, GI, and BoP (p &gt; 0.05). The levels of IL-6 were significantly higher in patients treated with FOT as compared to Invisalign at T1 (p &lt; 0.05) The other tested cytokines, IL-10, 13, 17, and GM-CSF, were not significantly different in either the FOT or Invisalign group at baseline and 4 weeks follow-up (p &gt; 0.05). Regarding BMBs, it was detected that NTx and OC levels in both of the investigated groups were not significantly different at baseline and after 4 weeks (p &gt; 0.05). However, NTx levels rose significantly (p &lt; 0.05) and OC levels fell from T0 to T1. Conclusions: FOT and Invisalign displayed comparable outcomes in terms of cytokine and BMB levels. However, only IL-6 and NTx were significantly different at week 4 from baseline

A potential new oral mapping (OM) method in the clinical evaluation and documentation of oral submucous fibrosis A prospective clinical crossover study

Background: Despite much research, there is a lack of a definite protocol or method for documenting oral submucous fibrosis (OSMF) site presentation. In this study we propose a new potential oral mapping (OM) method and evaluated its use in recording OSMF affected mucosal sites. Methods: 50 OSMF patients were evaluated by 15 primary care dental practitioners using both, a conventional subjective recording method and a new OM method, to document the degree of involvement of affected oral mucosa with a crossover study design. Mann-Whitney test (Non-parametric test) was used to make comparison between groups to determine any significant differences between the two identification methods. Wilcoxon tests were used to evaluate any significant differences in the difficulty in identification of two methods. Results: There was a low agreement between the two methods used to detect OSMF in affected mucosal surfaces (p-value <0.0001). More lesions were identified using the proposed OM method and less discrepancy was found among dental practitioners. A difference in difficulty of OSMF documentation was found (Wilcoxon z = 3.615, p-value <0.001), with the proposed OM method found to be easier. Conclusion: The proposed OM method appears to be useful for documentation, can easily be adapted in clinical practice and effectively administered in clinical research. Additionally, it could be a useful tool to helping to maintain an OSMF database