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It has long been considered that the oral microbiome is tightly connected to oral health and that dysbiotic changes can be detrimental to the occurrence and progression of dysplastic oral mucosal lesions or oral cancer. Improved understanding of the concepts of microbial dysbiosis together with advances in high‐throughput molecular sequencing of these pathologies have charted in greater microbiological detail the nature of their clinical state. This review discusses the bacteriome and mycobiome associated with oral mucosal lesions, oral candidiasis, and oral squamous cell carcinoma, aiming to delineate the information available to date in pursuit of advancing diagnostic and prognostic utilities for oral medicine. [ABSTRACT FROM AUTHOR]

To compare the frequency of patients’ oral health problems and prevention needs among Slovenian and international dentists with the aim to validate the four oral health-related quality of life (OHRQoL) dimensions across six clinical dental fields in all World Health Organization (WHO) regions.

Background: Early childhood caries (ECC) is a serious public health issue affecting children around the world. Severe symptoms and complications commonly found with ECC are adverse effects on health and growth retardation triggered by sensitivity, pain, and abscesses associated with decayed teeth, premature tooth loss, and insufficient food intake due to difficulty in chewing and keeping food in the mouth. Objective: This article aims to provide an overview of the most recent and current evidence on the association between ECC and nutritional status with an aim to stimulate further research and to identify the impact of nutritional status on ECC and vice versa. Methods: PubMed, Web of Science, and Google Scholar databases were used to search the studies conducted between 2016 and 2022. The included studies were searched using some keyword combinations and saved in Mendeley Desktop for review and referencing. All books, policy briefs, thesis/dissertations, and non-peer-reviewed articles were excluded, and 47 studies were selected for this narrative review. Results: Many studies have identified long-term, frequent, and nocturnal bottle-feeding and breastfeeding as well as frequent consumption of sugary food and beverages as high-risk factors for ECC. Adverse nutritional status assessed by anthropometric measures, vitamin D status, and iron-deficiency anemia have been studied as risk factors for ECC. Conclusions: Most of the prevailing studies are either case-control or cross-sectional studies, which are unable to provide strong evidence to prove the direction of causality. Thus, further prospective studies are needed to clarify the association between ECC and the nutritional status of children. Graphical Abstract This is a visual representation of the abstract. [ABSTRACT FROM AUTHOR]

Simple Summary: In Sri Lanka, the authors are encouraging a cost-effective way to reduce the number of people developing oral cancer, which is a common cancer among men. The authors wanted to find out how well dentists can find signs of oral cancer and potential problems in their patients, and they did this by asking dentists questions in an online survey. Surprisingly, most of the dentists thought it would be better to only check people who are at a higher risk for oral cancer instead of checking everyone. Only about two thirds of the dentists regularly look for signs of oral cancer when people come for dental check-ups. The authors found that these dentists, on average, had noticed about 34 patients with concerning signs in the past year. Almost all the dentists believed that they needed more training to spot these problems. So, while opportunistic screening at the dentist's office is good, dental professionals also need to focus on other ways to prevent oral cancer, like checking high-risk groups and giving dentists more confidence to spot potential issues. In Sri Lanka, opportunistic screening is encouraged as a cost-effective tool to bring down the prevalence of oral cancer, which is the most common cancer among males. The objectives of the study were to determine the practices, attitudes, and level of competency of dental surgeons regarding the early detection of oral cancer and oral potentially malignant disorders (OPMDs) through opportunistic screening. A prospective study was conducted online via a Google form using a pretested, self-administered questionnaire of 22 close-ended questions and 3 open-ended questions. Out of the 137 dental surgeons who responded, 88% (121/137) of the participants believed that screening high-risk target groups would be more effective in the early detection of oral cancer rather than opportunistic screening. Only 64% (88/137) of the participants frequently check for oral cancer and OPMDs when patients visit for dental treatment. Participants recalled an average of 34 patients (4628/137) with clinically suspicious lesions being diagnosed during examination at general dental practice during the past year, and 98% (134/137) of the participants believed that they should receive additional training in order to identify and diagnose clinically suspicious OPMDs and oral cancer. Opportunistic screening in general dental practice as an oral-cancer prevention strategy is appreciable, but due emphasis should be given to other prevention strategies such as population screening and screening high-risk target groups. The level of confidence of general dental practitioners in the early detection of oral cancer has to be raised in order to achieve higher standards in oral cancer prevention through opportunistic screening. [ABSTRACT FROM AUTHOR]

Over the years, Sri Lanka achieved excellent scores in health indicators relative to the national expenditure on health. However, due to several challenging situations such as the 2019 Easter bombings, COVID-19 pandemic and economic crisis, there was a depletion of the GDP as well as rising inflation. This created a humanitarian crisis for all socioeconomic groups. Among them, the health sector was widely affected, including healthcare providers and healthcare recipients. The objective of this study was to elaborate on the challenges faced in dental care delivery by private general dental practitioners and the impact on dental education for undergraduate and postgraduate dental students during the economic crisis. A descriptive cross-sectional survey-based questionnaire (n = 28) was conducted and assessed among the dental surgeons of various districts in Sri Lanka. An interviewer-based questionnaire was carried out via telephone conversation by the principal investigator of dental surgeons for those who managed and owned the respective dental clinic. Data from the computed questionnaires were analyzed using the SPSS Statistical Software Package (SPSS, Version 21). Descriptive statistics were expressed as frequency distributions and percentages. Based on the results, a significant decrease was observed in the number of patients requesting restorative dental procedures including implant crowns (36.29%), implant over dentures (35.63%), crowns (39.03%), bridges (49.12%), amalgam restorations (47.38%), composite restorations (42.11%) and dentures (49.69%). In surgical dental treatment, the extractions and surgical removal of teeth were reduced by 2.11% and 43.71%, respectively. The availability of dental materials such as light care composite (LCC) bonding, silver amalgam, impression materials and surgical consumables was reduced in the post-economic crisis situation compared to the pre-economic crisis status. Furthermore, dental laboratory charges per item, fees per procedure, salaries to support staff, utility bills including electricity and water, payments to government bodies, travelling costs to the clinic (for the doctor) and other expenses have increased in the post-economic period. [ABSTRACT FROM AUTHOR]

Background and Aims: Qigong and Tai Chi (QTC) are mind‐body exercises involving a sequence of graceful movements, which promote self‐healing, meditation, and self‐cultivation. There is growing evidence that Qigong and/or Tai Chi therapy may improve the physical and psychological health among adults with multiple health conditions including joint movement. This systematic review aims to synthesize the available evidence on the type and effectiveness of QTC therapies used in the management of temporomandibular joint (TMJ) dysfunction. Methods: This systematic review followed the AMSTAR‐2 guideline, and it was reported based on guidelines in the PRISMA checklist. The review involved a systematic search of nine electronic databases. After deduplication and screening of the literature retrieved from the search, only one article was included based on the review's inclusion criteria. Data was extracted from this article and synthesized. Results: The only included article was on a non‐randomized control trial which investigated the role of Tai Chi Qigong (a form of Qigong) therapy in improving joint mobility and alleviating trismus among 52 survivors of nasopharyngeal carcinoma who had TMJ disorders. The study reported, at different time intervals (at pretest; at mid‐intervention; at posttest; and at follow‐up posttest), that no significant difference (p > 0.05) was observed concerning mouth opening capacity between the intervention group and the control group. However, over time, less severe deterioration in mouth‐opening was noted among the participants in the intervention group (p = 0.181) as compared to the control group (p < 0.001). Conclusion: The role of QTC therapies in improving joint mobility and alleviating trismus is not yet fully understood, but it seems promising. The available evidence is inadequate to categorically conclude on the efficacy of these therapies. Further studies will be required to fully assess the effectiveness of QTC therapies in the management of TMJ dysfunction. [ABSTRACT FROM AUTHOR]

Oral cancer (OC) is the 16th most common cancer worldwide. In Sri Lanka, OC is the most prevalent cancer among men and the eighth among women. In most instances, OC is preceded by clinically recognizable disorders appearing on the oral mucosa, termed oral potentially malignant disorders (OPMD). The distribution of OC among low- and middle-income socioeconomic groups contributes to various factors. Poor oral health literacy, a lower quality of higher education, and the economic burden results in neglected oral health. The further economic recession has led to the formation of risk habits, such as chewing betel quid, smoking and the consumption of alcohol, among these groups to minimize stress levels. But with a lack of oral health awareness, the incidences of OC increase in this category. This review elaborates on a few cross-sectional studies conducted in various locations in Sri Lanka, discussing the low awareness of neglected oral health, the usage of tobacco in a smokeless and non-smokeless manner, consuming alcohol, and the chewing of betel nuts. This review aims to overcome the barriers in these low- and middle-income socioeconomic groups in developing nations such as Sri Lanka by creating more awareness and minimizing the incidence and diagnosis and treatment at early stages to improve the quality of life as well as longevity. [ABSTRACT FROM AUTHOR]

Objectives: Over the past several decades, oral cancer has been the most common malignancy among Sri Lankan males and the top 10 cancer among females, disproportionately affecting low socio‐economic groups. Sri Lanka is a lower‐middle‐income developing country (LMIC), currently striking through an economic crisis, and social and political unrest. Occurring at an accessible body site and predominantly attributed to potentially modifiable health‐related behaviours, oral cancer should be preventable and controllable. Unfortunately, broader contextual factors that are socio‐cultural, environmental, economic, and political and mediated through social determinants of people's lives consistently hinder progress. Many LMICs with a high burden of oral cancer are now gripped by economic crises, consequent social and political unrest, all compounded by reduced public health investments. The aim of this review is to provide a critical commentary on key aspects of oral cancer epidemiology including inequalities, using Sri Lanka as a case study. Methods: The review synthesizes evidence from multiple data sources, such as published studies, web‐based national cancer incidence data, national surveys on smokeless tobacco (ST) and areca nut use, smoking and alcohol consumption, poverty headcount ratios, economic growth, and Gross Domestic Product (GDP) health expenditure. National trends in the oral cancer, ST use, smoking and alcohol consumption in Sri Lanka are identified alongside inequalities. Results: Using these evidence sources, we discuss 'where are we now?', together with the availability, accessibility and affordability of oral cancer treatment services, oral cancer prevention and control programmes, tobacco and alcohol control policies, and finally, outline macroeconomic perspectives of Sri Lanka. Conclusions: Finally, we speculate, 'where to next?' Our overarching goal of this review is to initiate a critical discourse on bridging the gaps and crossing the divides to tackle oral cancer inequalities in LMIC such as Sri Lanka. [ABSTRACT FROM AUTHOR]

Background and Aims: Cytotoxicity is a key disadvantage of using chemotherapeutic drugs to treat cancer. This can be overcome by encapsulating chemotherapeutic drugs in suitable carriers for targeted delivery, allowing them to be released only at the cancerous sites. Herein, we aim to review the recent scientific developments in the utilization of nanotechnology‐based drug delivery systems for treating oral malignancies that can lead to further improvements in clinical practice. Methods: A comprehensive literature search was conducted on PubMed, Google Scholar, ScienceDirect, and other notable databases to identify recent peer‐reviewed clinical trials, reviews, and research articles related to nanoplatforms and their applications in oral cancer treatment. Results: Nanoplatforms offer a revolutionary strategy to overcome the challenges associated with conventional oral cancer treatments, such as poor drug solubility, non‐specific targeting, and systemic toxicity. These nanoscale drug delivery systems encompass various formulations, including liposomes, polymeric nanoparticles, dendrimers, and hydrogels, which facilitate controlled release and targeted delivery of therapeutic agents to oral cancer sites. By exploiting the enhanced permeability and retention effect, Nanoplatforms accumulate preferentially in the tumor microenvironment, increasing drug concentration and minimizing damage to healthy tissues. Additionally, nanoplatforms can be engineered to carry multiple drugs or a combination of drugs and diagnostic agents, enabling personalized and precise treatment approaches. Conclusion: The utilization of nanoplatforms in oral cancer treatment holds significant promise in revolutionizing therapeutic strategies. Despite the promising results in preclinical studies, further research is required to evaluate the safety, efficacy, and long‐term effects of nanoformulations in clinical settings. If successfully translated into clinical practice, nanoplatform‐based therapies have the potential to improve patient outcomes, reduce side effects, and pave the way for more personalized and effective oral cancer treatments. Highlights: Surgery, radiation, and chemotherapy are the solely available treatments for cancer.Oral cancer includes cancers of the mouth and the back of the throat.With selective targeting and distribution of these anticancer medications to tumor tissues, nanotechnology has traditionally been used in cancer therapy to enhance pharmacokinetics and lower the systemic toxicity of chemotherapy.Nanotechnology has the potential to overcome many shortcomings of chemotherapy, enable drugs to precisely target tumor cells, reduce unfavorable side effects on nearby healthy tissues, and thus pave the way to create cutting‐edge treatments for oral cancer. [ABSTRACT FROM AUTHOR]

Objective: To describe the development of a platform for image collection and annotation that resulted in a multi‐sourced international image dataset of oral lesions to facilitate the development of automated lesion classification algorithms. Materials and Methods: We developed a web‐interface, hosted on a web server to collect oral lesions images from international partners. Further, we developed a customised annotation tool, also a web‐interface for systematic annotation of images to build a rich clinically labelled dataset. We evaluated the sensitivities comparing referral decisions through the annotation process with the clinical diagnosis of the lesions. Results: The image repository hosts 2474 images of oral lesions consisting of oral cancer, oral potentially malignant disorders and other oral lesions that were collected through MeMoSA® UPLOAD. Eight‐hundred images were annotated by seven oral medicine specialists on MeMoSA®ANNOTATE, to mark the lesion and to collect clinical labels. The sensitivity in referral decision for all lesions that required a referral for cancer management/surveillance was moderate to high depending on the type of lesion (64.3%–100%). Conclusion: This is the first description of a database with clinically labelled oral lesions. This database could accelerate the improvement of AI algorithms that can promote the early detection of high‐risk oral lesions. [ABSTRACT FROM AUTHOR]

Inferior alveolar canal (IAC) is an important anatomical landmark in dentistry. It is a bony canal in the mandible, one on each side and transmit inferior alveolar neurovascular bundle. However, it has been reported to have anatomical variations in its course. IAC is visible on radiographs and cone beam computed tomography (CBCT) has been identified as the one of the best methods to assess IAC preoperatively. An interesting case of IAC anatomy in a CBCT is presented here. There were accessory mandibular foramina, retromolar foramina on both sides, accessory mental foramen on the right side and lingual foramina in the midline as well as on the body of the mandible. The IAC was showing several branching within ramus as well as in the body of the mandible. This case report highlights the possible anatomical variations and importance of careful assessment of IAC in dental and maxillofacial procedures which can cause damage to the neurovascular bundle. [ABSTRACT FROM AUTHOR]

Over the past decade, omics technologies such as genomics, epigenomics, transcriptomics, proteomics, and metabolomics have been used in the scientific understanding of diseases. While omics technologies have provided a useful tool for the diagnosis and treatment of diseases globally, there is a dearth of literature on the use of these technologies in Africa, particularly in the diagnosis and treatment of oral cancer. This systematic scoping review aims to present the status of the omics research capacity on oral cancer in Africa. The guidelines by the Joanna Brigg's Institute for conducting systematic scoping reviews will be adopted for this review's methodology and it will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The literature that will be reviewed will be scooped out from PubMed, SCOPUS, Dentistry and Oral Sciences Source, AMED, CINAHL, and PsycInfo databases. In conclusion, the findings that will be obtained from this review will aid the in-depth understanding of the status of oral cancer omics research in Africa, as this knowledge is paramount for the enhancement of strategies required for capacity development and the prioritization of resources in the fight against oral cancer in Africa. [ABSTRACT FROM AUTHOR]

Background and Aims: The use of lasers has been increasing in various surgical procedures. Its specific characteristics have conquered the scalpel used to a major extent in certain surgical procedures. This scoping review aimed to assess the empirical evidence that exists on the quality of life (QoL) of dental patients treated with laser surgery. Methods: This scoping review was conducted in accordance with the Arksey and O'Malley's guidelines for scoping reviews. Four electronic databases (PubMed, SCOPUS, CINAHL Complete, and APA PsycInfo) were systematically searched through a stepwise approach, informed by the PEO (Population [P], Exposure [E], and Outcome [O]) framework, to retrieve literatures relevant to the review question. After a two‐staged and Rayyan‐aided screening process, only those literatures meeting the inclusion criteria were included into the review. From the included literatures, data were extracted, collated, summarized, and presented. Results: The literature search retrieved 246 articles, of which only 10 articles were selected according to the inclusion criteria. Five of the studies were from the United Kingdom and three were from Italy. Study designs were either cohort (60%) or randomized controlled trials (40%). A vast variation was observed in the study populations. The used QoL instruments were mostly disease/condition‐specific and oral cancer was the most reported disease in the included articles. The patients who underwent laser surgery had better QoL on the 7th day postoperatively, although it was not significant in later days. Conclusion: Depending on the indication, Laser is a safe surgical approach that could enhance the clinical outcome as well as the QoL of dental patients. Laser effects were more significant in the domain of postoperative pain. Due to the limited number of studies evaluated in this review, further longitudinal studies are needed to corroborate the findings of this review. [ABSTRACT FROM AUTHOR]

Objective: Oral submucous fibrosis (OSF) is a well‐established oral potentially malignant disorder (OPMD) that affects South Asian countries including Sri Lanka where the traditional habit of areca nut chewing prevails. The main aim of this study was to evaluate the demographic and clinical characteristics of OSF among patients presented to the Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. Materials and methods: A retrospective cohort of 503 patients, diagnosed with OSF, followed up in the Oral Medicine Clinic, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka for the past 22 years were included in this study. Results: Patients ranging from 3 to 81 years (394 males [78.3%] and 109 females [21.7%]; mean age, 43.4 years) with the diagnosis of OSF were included in this study. The main presenting complaint of the patients was a burning sensation (45.3%), whereas 56 patients complained either of an ulcer or a white/red patch. The majority of 69.8% had the habit of betel chewing only, whereas 18.1% had the synergistic habit of betel chewing and smoking. About 69.8% had the involvement of the buccal mucosa with the presence of fibrous bands on the initial visit with 25.8% demonstrating restricted tongue movements. A large number of patients (35.2%) presented with dysplasia in the initial biopsy indicating severe disease at presentation. Conclusion: The clinical characteristics of OSF disease patterns may vary in different regions due to habit variations. [ABSTRACT FROM AUTHOR]

Oral cancers (OC) are among the most frequent malignancies encountered in Southeast Asia, primarily due to the prevalent habit of betel quid (BQ) and smokeless tobacco use in this region. Areca nut (AN), the primary ingredient in BQ, contains several alkaloids, including arecoline, arecaidine, guvacoline, and guvacine. These have been associated with both the AN abuse liability and carcinogenicity. Additionally, variations in AN alkaloid levels could lead to differences in the addictiveness and carcinogenic potential across various AN-containing products. Recent studies based on animal models and in vitro experiments show cellular and molecular effects induced by AN. These comprise promoting epithelial-mesenchymal transition, autophagy initiation, tissue hypoxia, genotoxicity, cytotoxicity, and cell death. Further, clinical research endorses these undesired harmful effects in humans. Oral submucosal fibrosis, a potentially malignant disease of the oral cavity, is predominantly reported from the geographical areas of the globe where AN is habitually chewed. OC in chronic AN users presents a more aggressive phenotype, such as resistance to anti-cancer drugs. The available evidence on the carcinogenicity of AN based on the findings reported in the recently published experimental studies is discussed in the present review. [ABSTRACT FROM AUTHOR]

Simple Summary: The incidence of oral cancer is increasing with little improvement in survival. This is due to late diagnosis with most cases diagnosed at a stage beyond a cure. In Sri Lanka, oral cancer is the most common cancer in males, carrying a high mortality rate. Identifying markers that can help in early detection is important for improving patient outcome. Here, we present findings from a study in Sri Lanka that assessed salivary interleukins in oral cancer and precancer patients compared to disease-free controls. Our results clearly show that the salivary protein levels of these interleukins progressively increase from disease-free participants through different grades of dysplasia with the highest levels reported in cancer patients. This has significant clinical potential, as assessment of salivary levels of these interleukins can be developed into non-invasive risk assessment tools for detecting disease progression in dysplasia, and as screening tests for early detection of oral cancer. The incidence of oral squamous cell carcinoma (OSCC), and its precursor, oral epithelial dysplasia (OED), is on the rise, especially in South Asia. OSCC is the leading cancer in males in Sri Lanka, with >80% diagnosed at advanced clinical stages. Early detection is paramount to improve patient outcome, and saliva testing is a promising non-invasive tool. The aim of this study was to assess salivary interleukins (lL1β, IL6, and IL8) in OSCC, OED and disease-free controls in a Sri Lankan study cohort. A case-control study with OSCC (n = 37), OED (n = 30) patients and disease-free controls (n = 30) was conducted. Salivary lL1β, IL6, and IL8 were quantified using enzyme-linked immuno-sorbent assay. Comparisons between different diagnostic groups and potential correlations to risk factors were assessed. Salivary levels for the three tested interleukins increased from disease-free controls through OED, and were highest in OSCC samples. Furthermore, the levels of IL1β, IL6, and IL8 increased progressively with OED grade. The discrimination between patients (OSCC and OED) and controls, as assessed by AUC of receiver operating characteristic curves, was 0.9 for IL8 (p = 0.0001) and 0.8 for IL6 (p = 0.0001), while IL1β differentiated OSCC from controls (AUC 0.7, p = 0.006). No significant associations were found between salivary interleukin levels and smoking, alcohol, and betel quid risk factors. Our findings suggest that salivary IL1β, IL6, and IL8 are associated with disease severity of OED, and are potential biomarkers for predicting disease progression in OED, and the screening of OSCC. [ABSTRACT FROM AUTHOR]

Oral squamous cell carcinoma (OSCC) is one of the most common epithelial malignancies of multifactorial etiology linked with considerable mortality and morbidity. Generally, OSCC arises from pre-existing oral lesions quoted as oral potentially malignant disorders. Early diagnosis of OSCC is an attractive strategy to increase the survival rate of patients. Despite the accessibility of prominent diagnostic tools, many factors restrain the successful application of these approaches. The discovery of novel alternative methods to diagnose cancer definitively with higher selectivity and sensitivity has aroused scientific interest. Metabolomics is an unbiased analytical approach for qualitative and quantitative analyses of different metabolites in cells, tissues, or biological fluids and their alterations in response to pathophysiological stimuli. Several coupled techniques, together with chromatographic platforms, have facilitated metabolic profiling and, at the same time, detected cancer biomarkers, which are crucial for an effective treatment process. This overview discusses some of the most recent technological advances in metabolomics and focuses on their application to reveal the underlying causes of OSCC and their potential implications for personalised medicine. [ABSTRACT FROM AUTHOR]

Surgery is the current first choice for oral cancer treatment. Intensity-modulated radiation therapy, molecular targeted drugs, and immune checkpoint inhibitors are still used as adjuvant therapy for advanced cancer. In addition, postoperative rehabilitation and multidisciplinary treatment have also been developed in recent years. Multidisciplinary team approaches and supportive care in oral cancer treatment reportedly shorten the time to treatment and improve outcomes. Although there is enough evidence confirming the role of oral and maxillofacial surgeons, dentists, and dental hygienists in supportive care in oral cancer treatment, there are very few systematic studies. In particular, oral health management is a concept that encompasses oral function management, oral hygiene management, and oral care during oral cancer treatment. We provide a narrative review focusing on oral health management from a multidisciplinary and supportive care perspective, applicable in oral cancer treatment. [ABSTRACT FROM AUTHOR]

Objectives: Cancer of the oral cavity is the leading malignancy amongst males in Sri Lanka, and eighth amongst women. Almost all malignancies are developed from a clinically visible precursor stage called an oral potentially malignant disorder (OPMD). The objective of this study was to estimate costs of managing patients with OPMD in Sri Lanka for a 12‐month period from diagnosis. Methods: A hospital‐based costing study was conducted in Sri Lanka in the years 2016‐2017. Three selected treatment centres participated. For societal perspectives, healthcare, household and indirect costs were used. Costs to the healthcare system included clinic visits, diagnostic biopsy, consumables and drug costs. Capital costs included apportioned value of land, buildings, equipment and furniture. Household costs consisted of out‐of‐pocket expenditure and indirect costs of lost income. Results: Sixty‐two patients were recruited (39 male and 23 female). The majority had awareness of oral potentially malignant disorders (OPMDs). Total average cost of managing a single patient with an OPMD for 1 year was SLR 19 547 (US$ 140) which includes a health system cost of SLR 7320 (US$ 52) and household cost of SLR 12 227 (US$ 87). Travel loss and income loss were a substantial burden to patients and their families. Conclusions: Managing patients with an OPMD, even with annual monitoring, is less costly than managing patients with oral cancer. Out‐of‐pocket costs are very high, and these could be reduced by revising the National Management Guidelines to allow care closer to home. [ABSTRACT FROM AUTHOR]

Objective: Oral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region. Methods: A mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey. Results: The identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested. Conclusion: The findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Areca-nut (AN) and added smokeless-tobacco (SLT) are considered agents that may cause addiction to betel-quid (BQ). However, the primary addictive substance in AN is not clearly understood. Objective: The present review evaluates possible addictive chemicals in AN with their mechanisms of action for progression to BQ dependence, as it is essential to overcome barriers in BQ cessation. It also identifies innovative treatment modalities in BQ cessation including the scope for research on pharmacotherapy using Monoamine-oxidase Inhibitors, Selective Serotonin Re-uptake Inhibitors and Norepinephrine Dopamine Reuptake Inhibitors. Methods: This is a narrative review on addictive properties of BQ and trials undertaken to promote cessation of SLT or AN use. Results: Twenty interventional studies, three by behavioral therapy and seventeen using pharmacotherapy were reviewed. There was heterogeneity in reported follow up times, most studies reporting data at 12 weeks with abstinence rates of 45–55% for SLT cessation and at 8 weeks with abstinence rates around 35% for AN cessation. Conclusion: Even though literature reveals a few cessation programs through behavioral support for BQ addiction, its success has been limited in certain instances mainly due to addictive properties of AN, resulting in withdrawal and relapse. Hence, in line with pharmacotherapy in tobacco smoking cessation, potential pharmacological agents to assist in cessation of SLT and AN require more attention. Several clinical trials for SLT cessation have been carried out with varying levels of success using Nicotine Replacement Therapy and Varenicline while trials on antidepressants for SLT and AN cessation are also emerging. [ABSTRACT FROM AUTHOR]

Introduction: E-learning resulted in a revolution in dental education with continuous educational experiences. General objective of this study was to assess the perspective of undergraduate dental students on effectiveness of e-learning in the Bachelor of Dental Surgery (BDS) programme. Specific objectives were to identify students’ opinion on the factors that promote e-learning, awareness on the effectiveness of using different platforms and social media, barriers imposed and suggestions for the improvement of e-learning in the BDS programme. Methods: This was a cross sectional descriptive study among undergraduate dental students of the Faculty of Dental Sciences, University of Peradeniya, Sri Lanka using a self-administered pre-tested questionnaire administered via a web-based survey form. Frequencies and percentages were obtained for categorical data and Chi-square test was used to determine the association between variables. Results: The majority received the e-learning experience well. Fifty-four percent of the participants felt it was better compared to traditional face-to-face learning and the difference between the semesters (p=0.000) and genders was statistically significant (p=0.000). Difference in overall satisfaction on e-learning material across the different semesters was statistically significant. Students felt that e-learning should be used as a supplementary tool mainly by means of procedural videos during delivery of the skill component. Fifty percent participants felt that conducting assessments online is fair for all the students. Conclusion: A positive learning experience was achieved through the e-learning modalities in comparison to traditional face-toface learning though in terms of skills training, e-learning modalities should only be considered as a supplementary tool. [ABSTRACT FROM AUTHOR]

Objective. The objectives of this study were to evaluate the linear and volumetric measurements of the maxillary sinus in relation to sex and side on cone beam computer tomographic (CBCT) images in a Sri Lankan population. Methods. A total of 20 sets of CBCT images selected from the database at the Division of Oral Medicine and Radiology, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka, were evaluated. Linear measurements were obtained in a craniocaudal (height), anteroposterior (length), and mediolateral (width) dimensions. Volume was computed by using the same data using a computerized 3D modeling software developed for 3D measurements and calculations. Results. The maximum mean craniocaudal dimension was at the level of the 1st and the 2nd molar tooth bilaterally. The largest average craniocaudal, mediolateral, and anteroposterior extensions of the maxillary sinus using CBCT were 31.71 ± 5.44 mm , 21.28 ± 5.09 mm , and 32.92 ± 4.31 mm , respectively. The differences between the sides and sex showed no statistical significance (P > 0.05), except for the maximum average value in craniocaudal dimension which showed a statistically significant difference in relation to gender (P = 0.02). Conclusion. There is no significant difference in the largest average craniocaudal, mediolateral, and anteroposterior extensions of the maxillary sinus when gender and side were compared. However, the maximum average value in craniocaudal dimension had a statistically significant difference in relation to gender. This study provides valuable knowledge of the anatomical dimensions of the maxillary sinus which may help clinicians in treatment planning. [ABSTRACT FROM AUTHOR]

Background Dental practitioners are some of the most vulnerable professionals exposed to the risk of contracting the Corona Virus Disease-19 (COVID-19), by virtue of the aerosol generating procedures (AGPs). Hence, an evidence based and detailed knowledge of the disease is important in order to mitigate the effects of the COVID-19 transmission. Aim To identify the perspective, knowledge, and attitudes of Sri Lankan dental surgeons on the COVID-19 pandemic. Methods An online web-based, self-administered questionnaire survey (Google) was conducted among Sri Lankan dental surgeons. All questions, in the pre-tested questionnaire were close-ended, and formulated to elicit data on the views, knowledge, attitudes, and infection control practices related to the COVID-19 pandemic. Results One quarter of the cohort responded and the majority (44.7%) were 30-40 years old with a marginal female preponderance (52.3%). In general, females were significantly more knowledgeable than males on COVID-19, and the post-pandemic preparedness for dental practice (p<0.05). One sixth (18.2 %) incorrectly surmised that, i) pet animals were a source of infection, ii) COVID-19 is not transmitted via surface contact and iii) hand hygiene is not important in preventing infection transmission. All respondents correctly identified AGPs as a high-risk procedure for infection transmission, but approximately two thirds failed to identify specific AGPs in dentistry. Conclusion Taken together, the knowledge, attitudes and practices of Sri Lankan dental surgeons on the COVID-19 pandemic appear satisfactory, but there are knowledge gaps that need to be fulfilled through further continuous education courses. [ABSTRACT FROM AUTHOR]

Oral Submucous fibrosis (OSMF) has traditionally been described as "a chronic, insidious, scarring disease of the oral cavity, often with involvement of the pharynx and the upper esophagus". Millions of individuals are affected, especially in South and South East Asian countries. The main risk factor is areca nut chewing. Due to its high morbidity and high malignant transformation rate, constant efforts have been made to develop effective management. Despite this, there have been no significant improvements in prognosis for decades. This expert opinion paper updates the literature and provides a critique of diagnostic and therapeutic pitfalls common in developing countries and of deficiencies in management. An inter-professional model is proposed to avoid these pitfalls and to reduce these deficiencies. [ABSTRACT FROM AUTHOR]

This report describes a case of proliferative verrucous leukoplakia (PVL) of the gingiva with no discernible aetiology, which presented in a 36-year-old female. The initial nonscrapable gingival lesion was treated with CO2 laser ablation, and the histopathological evaluation was carried out. The presence of koilocytic cells in the superficial epithelium led to immunohistochemical investigations with p16 antibody, which showed strong nuclear positivity and slight cytoplasmic positivity in >50% of the cells with >25% confluency. However, it was not possible to confirm the presence of HPV infection with further investigations due to logistic reasons. The lesion recurred twice within a short time despite the surgical resection following the first recurrence. Thus, this paper presents a case of proliferative verrucous leukoplakia, which demonstrated a significant resistance to routine treatment protocols recommended in the management of such lesions. [ABSTRACT FROM AUTHOR]

Objective Cancer of the oral cavity is the leading malignancy among males in Sri Lanka, and sixth among women. This study aimed to estimate costs of managing patients with oral cancer (OCA) in Sri Lanka for a 12 month period from diagnosis. Design Hospital based costing study. Settings Four selected cancer treatment centres in Sri Lanka. Participants Sixty-nine OCA patients: 60 were males and 12 had recurrent tumours. Outcome Societal perspectives (healthcare, household and indirect costs) were itemised. Costs to the healthcare system included surgery, Intensive Care Unit (ICU) care, chemotherapy and radiotherapy. Capital costs including apportioned value of land, buildings, equipment and furniture. Household costs consisted of out of pocket expenditure for healthcare and indirect costs of lost income. Costs were estimated from the stage of presentation for treatment to 1 year of follow-up. Results Mean cost of managing a single stage II OCA patient for 1 year was Sri Lankan rupees (SLR) 58 979 (US$394, at the midyear exchange rate in 2016) to the health system. Mean household cost was SLR 77 649 (US$518). The annual cost of managing a stage III or IV patient was SLR 303 620 (US$2027), with household costs of SLR 71 932 (US$480). Conclusions Owing to the high incidence of OCA in Sri Lanka, the economic costs associated with these diseases are enormous, resulting in negative impacts on both the healthcare system and individual families, seriously impacting the country's economy. Policy-makers should take note of this burden and increase steps for prevention and control of this devastating disease. [ABSTRACT FROM AUTHOR]

Background: Long non‐coding RNAs (lncRNAs) have important roles in regulating gene expression pertaining to cell proliferation, survival, migration and genomic stability. Dysregulated expression of lncRNAs is implicated in cancer initiation, progression and metastasis. Objectives: To explore, map and summarize the extent of evidence from clinical studies investigating the differential expression of lncRNAs in oral/tongue squamous cell carcinoma. Methods: PubMed, Scopus and Web of Science were used as search engines. Clinical, full‐length, English language studies were included. PRISMA‐ScR protocol was used to evaluate and present results. The present scoping review summarizes relationships of the differential expression of lncRNAs with the presence of tumour and with clinicopathological features including survival. Results: Almost half of the investigated transcripts have been explored in more than one study, yet not always with consistent results. The collected data were also compared to the limited studies investigating oral epithelial dysplasia. Data are not easily comparable, first because of different methods used to define what differential expression is, and second because only a limited number of studies performed multivariate analyses to identify clinicopathological features associated with the differentially expressed lncRNAs. Conclusions: Standard methods and more appropriate data analyses are needed in order to achieve reliable results from future studies. [ABSTRACT FROM AUTHOR]