Visual Oral Examination Research Articles

Real-world diagnostic potential of bacterial biomarkers of canine periodontitis.

The objective of this study was to investigate the diagnostic potential of bacterial biomarkers by comparing the performance of molecular detection assays with clinical assessments of dog's oral health performed by veterinarians. Supragingival and subgingival plaque samples were collected from 127 client-owned dogs, pre-booked for procedures under general anesthesia, visiting veterinary practices in the United States. DNA was extracted and bacterial biomarkers quantified using quantitative polymerase chain reaction. Gingivitis and periodontitis were recorded by a trained clinician using the Weighted Gingivitis Periodontitis Score which involved assessing the buccal surfaces of 18 teeth while under general anesthesia. Intraoral dental radiographs of the left and right mandibular first molar teeth were also obtained. These data were then used to establish the diagnostic performance of the molecular assay to detect periodontitis. An initial conscious, visual oral examination performed by the veterinarian identified 67.7% of dogs as having periodontitis, but examination under general anesthesia indicated a higher proportion (86.6%). Analysis of supragingival plaque samples collected by veterinarians from conscious and unconscious dogs demonstrated the assay had an accuracy of 77.7 to 80.9%, a sensitivity of 77.6 to 81.0%, and a specificity of 80.0%. Use of this molecular screening tool in conscious dogs has the potential to improve early periodontal disease detection and support veterinary decision making, ultimately improving the oral health of dogs and consequently their quality of life.

Operator, patient and parental Level of acceptance between Visual Intraoral Examination and Intraoral Camera in Seven to Twelve year Old Children

Introduction There are variety of methods for intraoral examination, visual examination being the most popular method. Intraoral camera is one of the innovative technologies which are being developed. Materials and Methods Thirty 7-12 year old children were examined using both the methods and a self-administered questionnaire was administered to them. Fifteen operators were also given a questionnaire. Quantitative data was expressed as frequency with percentages and qualitative data was analysed through thematic analysis. Results 87 % children and 63 % parent preferred Intraoral camera over Visual examination method. Operators preferred visual examination for diagnosis and Intraoral camera for patient and parental education. Conclusions Oral examination using Intraoral camera was perceived positively and preferred by children and parents. As Paediatric dentists, we can use Intraoral camera along with the visual oral examination method. Key Words Children, Intraoral camera, Visual oral examination

Feasibility, Reliability, and Effectiveness of Oral cancer screening in South Asia and Southeast Asian countries: A systematic review and Meta-analysis.

The incidence of oral cancer is significantly high in South Asia and Southeast Asia. Organized screening is an effective approach to early detection. The aim of this systematic review and meta-analysis was to evaluate the reliability, diagnostic accuracy, and effectiveness of visual oral screening by community health workers (CHWs) in identifying oral cancer/oral potentially malignant disorders (OPMDs) in this region. We conducted a bibliographic search in PubMed, Scopus, the gray literature of Google Scholar, ProQuest dissertations, and additional manual searches. Twelve articles were included for qualitative synthesis and six for meta-analysis. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and forest plot analysis were performed. Meta-analysis showed CHWs identified 8% (n = 6365) as suspicious and 92% (n = 74,140) as normal. The diagnostic accuracy of visual oral screening by CHWs showed a sensitivity of 75% (CI: 74-76) and specificity of 97% (CI: 97-97) in the detection of OPMDs/oral cancer. Forest plots were obtained using a random effects model (DOR: 24.52 (CI: 22.65-26.55)) and SAUC: 0.96 (SE = 0.05). Oral visual examination by trained CHWs can be utilized for community screenings to detect oral cancer early. This approach can be used in primary healthcare to triage patients for further referral and management.

IJCM_229A: A Community-based screening programme for oral, breast, and cervical cancer in the rural area of Dakshin Kannada

Background: Karnataka recorded 87304 new cancer cases in the year 2021. Breast, lip and oral cavity, cervix were the top cancer sites amongst all sexes and are preventable. Despite the nation-wide launch of Population-based screening (PBS) in 2016, the reported coverage of individuals who were screened for these three cancers in Dakshin Kannada was 0.4% (NFHS-5). The study introduces on-site screening for oral and breast cancer in the community. Objectives: To estimate the proportion of pre-cancerous lesions of oral, breast, and cervical cancer, through community-based screening in adults aged 18 to 65 years, in the catchment area of a medical college in Dakshina Kannada Methodology: This observational study was conducted among all persons aged 18 to 65years, residing in the rural catchment area of a medical college in Mangalore taluk of Dakshina Kannada and consenting for the study. Pregnant women and persons with prior diagnosis of oral, breast or cervical cancer were excluded. Two-stage cluster sampling was used to enrol an estimated sample of 1120 beneficiaries. The study comprised of house-to-house survey, cancer awareness sessions, and community-based screening. Screening tests included Oral visual examination, clinical breast examination, iBreast examination (iBE; electronic palpation by ibreast device), and Pap smear tests. Participants who screened positive were referred for diagnostic tests and management. Results: The study was completed with survey of 556 households, 3 cancer awareness sessions, and screening of 525 beneficiaries (325 females and 200 males) for oral, breast, and cervical cancer. Three participants screened positive for oral cancer, and one participant for breast cancer, who were referred for management to tertiary care hospital attached to the medical college. 25% of female participants underwent cervical cancer screening, with no one detected with pre-cancerous lesions. Conclusion: A combination of house-to-house and camp-based approaches along with awareness sessions results in improved coverage of PBS in the community.

Knowledge, Attitude, and Practice toward Early Childhood Caries among Pediatricians and Pediatric Residents in Karnataka

Abstract Introduction: Early childhood caries (ECC) is a significant worldwide oral health problem. Pediatricians can be a perfect source for children’s oral health promotion and disease prevention. Hence, the study was conducted to determine knowledge, attitude, and practice about early dental caries among pediatricians and pediatric residents. Materials and Methods: A questionnaire survey was conducted among 350 pediatricians and pediatric residents which covered aspects of knowledge, attitude, and practices regarding dental caries. The questionnaire consisted of 22 close-ended questionnaires. Data were tabulated and analyzed using SPSS software. Results: Most pediatricians had adequate knowledge regarding the appropriate age to start oral hygiene as well as performed visual oral examination but very few had instruments to diagnose dental caries. Only 37% of pediatricians advised dental visits below 1 year and only 27% advised the use of fluoridated toothpaste below 1 year. Conclusion: Most of the pediatricians had adequate knowledge and awareness of dental care and hygiene. The lack of dental knowledge and training during postgraduation limits the pediatricians’ role in promoting children’s oral health.

Community cancer screening at primary care level in Northern India: determinants and policy implications for cancer prevention

ObjectiveDespite the established cancer screening programme for oral, breast and cervical cancer by the Government of India, the screening coverage remains inadequate. This study aimed to describe the determinants for...

Integrating Cutting-Edge Methods to Oral Cancer Screening, Analysis, and Prognosis.

Oral cancer (OC) has become a significant barrier to health worldwide due to its high morbidity and mortality rates. OC is among the most prevalent types of cancer that affect the head and neck region, and the overall survival rate at 5 years is still around 50%. Moreover, it is a multifactorial malignancy instigated by genetic and epigenetic variabilities, and molecular heterogeneity makes it a complex malignancy. Oral potentially malignant disorders (OPMDs) are often the first warning signs of OC, although it is challenging to predict which cases will develop into malignancies. Visual oral examination and histological examination are still the standard initial steps in diagnosing oral lesions; however, these approaches have limitations that might lead to late diagnosis of OC or missed diagnosis of OPMDs in high-risk individuals. The objective of this review is to present a comprehensive overview of the currently used novel techniques viz., liquid biopsy, next-generation sequencing (NGS), microarray, nanotechnology, lab-on-a-chip (LOC) or microfluidics, and artificial intelligence (AI) for the clinical diagnostics and management of this malignancy. The potential of these novel techniques in expanding OC diagnostics and clinical management is also reviewed.

Tobacco use and Oral Premalignant Lesions among Auto-Rickshaw Drivers in Belagavi, North Karnataka.

Auto-rickshaw drivers (ARDs) are under constant physical and mental pressure due to illiteracy, poverty, lack of awareness about hazards of addictions, and other factors that lead to various habits majority being tobacco use. Studies have found that tobacco use is very prevalent among ARDs in comparison to general population. Tobacco use is commonly associated with cancers. Oral Pre-Malignant Lesions (OPMLs) are the strongest risk factor for majority of oral cancers. We studied the prevalence of OPML among ARDs of Belagavi and their association with tobacco use. It was a cross-sectional study conducted among 600 regular ARDs of Belagavi City during January to December 2016. We selected two ARDs that were the last in line from 300 major auto-rickshaw stands. We adapted the questionnaire from Global Adult Tobacco Survey questionnaire. After getting informed consent, we collected the data by personal interview and performed an oral visual examination for OPML for all the study participants. Data were analyzed using SPSS software. Institutional Ethics Committee approved the study. Prevalence of tobacco was 62.17%. One-third of participants (30.17%) had OPMLs. Leukoplakia (62.43%) was the most common lesion. OPMLs were significantly associated with tobacco use and duration of tobacco use. About 30% of ARDs had an OPML. Chewing tobacco, gutkha, lime with tobacco, and cigarette were significantly associated with OPML.

PREVALENCE OF ORAL MUCOSAL LESIONS IN PATIENTS WITH PSYCHIATRIC DISORDERS IN A TERTIARY MEDICAL CENTER

Background: Psychological stress adversely affects the physiological effectiveness of a person to an abundant point of melancholy. Considering the high prevalence of oral health problems in psychiatric patients, the present study was conducted to assess prevalence of oral mucosal lesions in psychiatric patients attending psychiatric outpatient department (OPD) at Nobel Medical College Teaching Hospital. Methods: The descriptive cross-sectional study was conducted in Outpatient Department of psychiatry at Nobel Medical College Teaching Hospital in Biratnagar. A total number of 130 patients diagnosed with oral mucosal lesions and stress related conditions were screened. Data for this research was collected by Oral visual examination. Statistical analysis was carried out by using spss software version 21 with use of descriptive statistics like mean and percentage. Results: Majority of the participants were females constituting of 61% of the study group and male subjects with 39 % of the sample size. Major participants were of 38-48 years of range and least from 58 years and above. Schizophrenia was most prevalent psychiatric disorder. Lichen planus was mostly associated with 38% of females, while apthous ulcers were predominant in 40 % of male populations. Conclusions: Oral mucosal Lesions lessen the quality of life of patients, the role of stress and other psychogenic factors cannot be ruled out. The present study highlights the association of stress and anxiety in development of mucosal lesions in patients with psychiatric disorders.

Improving the Diagnostic Performance by Adding Methylation Marker to Conventional Visual Examination in Identifying Oral Cancer.

Background: Visual oral examination (VOE) is a conventional oral cancer screening method. This study aimed to evaluate the value of methylation marker to assist VOE in identifying oral epithelial dysplasia and oral squamous cell carcinoma (OED/OSCC) from non-cancerous lesions in a real-world situation. Methods: 201 patients with high-risk personal habits who self-perceived oral anomaly were VOE examined, ZNF582 methylation (ZNF582m) tested, and histologically diagnosed. Results: Among them, 132 patients (65.7%) were histologically diagnosed OED/OSCC. Using VOE, 56.1% OED/OSCC patients had possible oral cancer, whereas 37.7% non-OED/OSCC patients had leukoplakia. ZNF582m-positive was detected in 90.2% OED/OSCC patients and 44.9% non-OED/OSCC patients. Various logistic regression models were postulated to evaluate the diagnostic performance of conventional VOE and new strategies using ZNF582m. ROC analysis and its corresponding C-index demonstrated that either triage or co-testing models of VOE and ZNF582m could improve diagnostic performance and discriminative abilities compared with the VOE only approach. Conclusions: In conclusion, methylation marker test shows equivalent performance to an experienced judgment by oral maxillofacial surgeons and plays a significantly supplementary role in increasing the efficacy in identifying oral malignant lesions. ZNF582m may be an especially important tool for family physicians or general dentists to properly diagnose suspicious oral lesions.

Comprehensive Review on Development of Early Diagnostics on Oral Cancer with a Special Focus on Biomarkers

One of the most frequent head and neck cancers is oral cancer, with less than half of those diagnosed surviving five years. Despite breakthroughs in the treatment of many other cancers, the prognosis for people with OSCC remains dismal. The conventional methods of detection include a thorough clinical examination, biochemical investigations, and invasive biopsies. Early identification and treatment are important for a better chance of extending a patient’s life. Early diagnosis may be possible by identifying biomarkers in biological fluids. Currently, the primary method for diagnosing oral lesions is a visual oral examination; however, such a technique has certain drawbacks, as individuals are recognized after their cancer has advanced to a severe degree. The first section of this review discusses several diagnostic techniques for cancer detection, while the second section discusses the present state of knowledge about known existing predictive markers for the timely identification of malignant lesions, as well as disease activity tracking. The aim of the paper is to conduct a critical review of existing oral cancer diagnostic processes and to consider the possible application of innovative technology for early detection. This might broaden our diagnostic choices and enhance our capacity to identify and treat oral malignant tumors more effectively.

Familial Aggregation Pattern of Non-Syndromic Combined Aplasia of Maxillary Lateral Incisors and Third Molars

Congenitally missing teeth, the most common dental anomaly, refers to teeth whose germ did not develop sufficiently to allow the differentiation of the dental tissues.
 This study aimed to determine the importance of genetic investigations on oral health-related quality of life in children with congenitally missing lateral incisors.
 We are presenting a genetic study performed by the A.S. Division of Medical Genetics, in Bucharest, Romania, in the case of a patient (16-year-old boy) presenting bilateral maxillary lateral incisor agenesis in the permanent dentition, a hereditary, non-syndromic familial hypodontia in three successive generations, which suggest an autosomal dominant inheritance, combined with aplasia of maxillary third molars.
 The oral visual examination and the radiological exam of the patient were completed with the oral photographic examination, the family historyinvestigation, the pedigree, and the analysis of the studied family’s genealogical tree, after acquiring the signed informed consent of the patient.
 The genetic investigations of the congenitally missing lateral incisors, allow the calculation of the anomaly recurrence risk amongst offspring, and the direct and specialized monitoring of affected families, in order to limit the potential complications.

Performance of a simplified scoring system for risk stratification in oral cancer and oral potentially malignant disorders screening.

Impact and efficiency of oral cancer and oral potentially malignant disorders screening are most realized in "at-risk" individuals. However, tools that can provide essential knowledge on individuals' risks are not applied in risk-based screening. This study aims to optimize a simplified risk scoring system for risk stratification in organized oral cancer and oral potentially malignant disorders screening. Participants were invited to attend a community-based oral cancer and oral potentially malignant disorders screening program in Hong Kong. Visual oral examination was performed for all attendees and information on sociodemographic characteristics as well as habitual, lifestyle, familial, and comorbidity risk factors were obtained. Individuals' status of those found to have suspicious lesions following biopsy and histopathology were classified as positive/negative and this outcome was used in a multiple logistic regression analysis with variables collected during screening. Odds ratio weightings were then used to develop a simplified risk scoring system which was validated in an external cohort. Of 979 participants, 4.5% had positive status following confirmatory diagnosis. A 12-variable simplified risk scoring system with weightings was generated with an AUC, sensitivity, and specificity of 0.82, 0.71, and 0.78 for delineating high-risk cases. Further optimization on the validation cohort of 491 participants yielded a sensitivity and specificity of 0.75 and 0.87 respectively. The simplified risk scoring system was able to stratify oral cancer and oral potentially malignant disorders risk with satisfactory sensitivity and specificity and can be applied in risk-based disease screening.

A two-year study of the effects of secondhand smoke exposure as measured by a urinary cotinine biomarker concurrent with visual oral examination among university dental hygiene students

A two-year study of the effects of secondhand smoke exposure as measured by a urinary cotinine biomarker concurrent with visual oral examination among university dental hygiene students

Current Insights into Oral Cancer Diagnostics.

Oral cancer is one of the most common head and neck malignancies and has an overall 5-year survival rate that remains below 50%. Oral cancer is generally preceded by oral potentially malignant disorders (OPMDs) but determining the risk of OPMD progressing to cancer remains a difficult task. Several diagnostic technologies have been developed to facilitate the detection of OPMD and oral cancer, and some of these have been translated into regulatory-approved in vitro diagnostic systems or medical devices. Furthermore, the rapid development of novel biomarkers, electronic systems, and artificial intelligence may help to develop a new era where OPMD and oral cancer are detected at an early stage. To date, a visual oral examination remains the routine first-line method of identifying oral lesions; however, this method has certain limitations and as a result, patients are either diagnosed when their cancer reaches a severe stage or a high-risk patient with OPMD is misdiagnosed and left untreated. The purpose of this article is to review the currently available diagnostic methods for oral cancer as well as possible future applications of novel promising technologies to oral cancer diagnosis. This will potentially increase diagnostic options and improve our ability to effectively diagnose and treat oral cancerous-related lesions.

Cost-effectiveness of oral cancer screening approaches by visual examination: Systematic review.

The present study is the first systematic review of papers that have performed a full economic evaluation on oral cancer screening strategies using visual oral examination. The review questions were (1) Is screening a cost-effective strategy in oral cancer? (2) What is the most cost-effective strategy among the different screening approaches in oral cancer? The main outcome measure was the incremental cost-effectiveness ratio. The study identifies and reviews seven full economic evaluations. The included studies scored 75%-100% on the methodological appraisal. Majority of the studies reports that oral cancer screening is a cost-effective strategy, especially in an opportunistic setting and high-risk subset of patients. The results were sensitive to cost and effectiveness parameters. Oral cancer screening, though found cost-effective, the uncertainty around these parameters necessitates additional studies that include better estimates in the modeling assessments. The heterogeneity in studies limited comparison and generalization.

Visual Examination, Fluorescence-Aided Caries Excavation (FACE) Technology, Bitewing X-Ray Radiography in the Detection of Occlusal Caries in First Permanent Molars in Children.

To compare the effectiveness of visual examination, radiographic examination and fluorescence-aided caries excavation (FACE) in detecting occlusal caries in first permanent molars in 150 children aged 6-14 years with intact occlusal surface with caries lesions without cavitation, or with darkened or deep fissures that had no clear diagnosis. Two dentists independently performed a visual oral examination, FACE and bitewing radiography. The inter-rater reliability of each detection method was determined and their specificity and sensitivity. All caries detection methods showed high inter-rater reliability with absolute agreement between raters above 90%. Most caries lesions were detected by visual (75.8%) and FACE (79.1%), while only 28.8% of lesions were detected by radiography. Detection by visual examination was strongly correlated with detection by FACE (X2=37.9, Phi=0.498, p<0.001). A lower, yet statistically significant, correlation was found between visual examination and X-ray radiography (X2=5.53, Phi=0.190, p<0.001). FACE had higher sensitivity (87%) and specificity (65%) for detecting occlusal caries in comparison with radiography (60% specificity and 55% sensitivity). Although visual examination remains the best method to detect occlusal caries in young permanent molars in children, FACE is an effective and accurate diagnostic tool that may aid in detection and treatment decisions.

Tobacco use among urban slum dwellers attending a cancer screening clinic in the National Capital Region of India: a cross-sectional study.

BackgroundTobacco consumption in India varies based on the place of residence (urban/rural). Minimal, exclusive information exists regarding the same for ‘urban slum’ dwellers. The current study determines the tobacco use pattern among such individuals in Noida, Uttar Pradesh (India).MethodsA cross-sectional study was conducted among the urban slum residents visiting the institutional clinic between December 2016 and June 2019. Apart from tobacco history, routine recording of the basic demographic details and oral visual examination was carried out for the participants. For categorical data, the percentage of different parameters was calculated and for quantitative data, descriptive statistics were calculated. Chi-square or Fisher’s exact tests were employed to determine the association between the two categorical variables. To find the strength of association between tobacco use and the socio-demographic factors, univariate and multivariable binary logistic regression was used.ResultsAmong 2,043 urban slum respondents (602 male, 1441 female), 15.0% (n = 308) currently consumed tobacco. The majority were smokeless tobacco (SLT) users (among both males and females). Among males, khaini (42.1%) and gutkha (32.5%) and among females gul (36.1%) were the most widely used tobacco products.ConclusionThe majority of the Noida urban slum population attending the screening clinic consumed SLT. Gender variation in the tobacco form and product-specific consumption patterns indicates that the undertaking of urban slums-specific surveys is essential. Tobacco control programmes must incorporate appropriate strategies addressing such subgroups of tobacco users.

Screening for oral cancer utilising risk-factor analysis is ineffective in high-risk populations

Screening for oral cancer by direct visual examination is believed to be ineffective because of the difficulty in differentiating a small number of malignancies from the much more prevalent benign oral mucosal lesions (OML) that are found in high-risk individuals. Standardised clinical diagnoses were recorded for all the OMLs identified during oral visual examination of 1111 individuals with risk factors for oral cancer, including tobacco and areca nut (paan) consumption. Suspicious lesions were referred for biopsy and definitive diagnosis. A total of 1438 OMLs with 32 different clinical diagnoses were identified in 604 participants. Analysis of referrals revealed two distinct groups: visually benign lesions (VBLs) none of which was referred, and visually complex lesions (VCLs) comprising 661 OMLs with nine different clinical diagnoses. After biopsy the VCLs included known potentially malignant disorders (PMDs) as well as benign lesions such as paan mucositis. VCLs (but not VBLs) share risk factors with oral cancer (p<0.05 for paan 5.82 (CI: 1.98 to 8.43), and smoking 3.59 (CI: 1.12 to 4.47)). They are clinically indistinguishable from, but much more prevalent than, oral cancer, and most will never undergo malignant change. They therefore can prevent dentists from accurately detecting malignancy during the clinical examination of high-risk patients. However, they can easily be differentiated from other benign lesions by visual examination alone. Further research into diagnostic technology is needed to help differentiate them from oral cancers.

A Successful Model of Cancer Screening in Low Resource Settings: Findings of an Integrated Cancer Screening Camp from a Rural Setting of North India

Background: Cancers of cervix, breast and oral cavity claims millions of deaths each year globally and are the three most common cancers in India. There is need to develop and test models for organizing integrated cancer screening camps in low resource settings with inter-sectorial co-ordination between different stakeholders. Methods: A community based integrated cancer screening camp was organized in a rural setting of north India in co-ordination with district health administration and local governing body (Panchayati Raj Institution). Screening methods included Clinical Breast Examination (CBE) for breast cancer, visual inspection under 5% acetic acid (VIA) for cervical cancer and oral visual examination (OVE) for oral cavity cancer. Men and women found to be screen positive in the camp were referred to the district hospital and a tertiary care center for further diagnostic tests and were followed up. Results: A total of 90 individuals (40 men and 50 women) above 30 years of age attended the screening camp. Of them, one (2.5%) male was screened positive for precancerous lesion of oral cavity. Out of the 50 women attending the camp, two were detected with suspected breast lumps, which on further diagnostic tests at district hospital were diagnosed as benign tumors. Only half (52.0%) of the women consented for cervical cancer screening, out of which one (3.9%) was screened positive on VIA which on colposcopy examination and biopsy at referral center was confirmed as early stage cancerous lesion of cervix and was instituted on treatment. Conclusion: The screening camp sets a successful example of community based cancer control activity for early detection and management of three common cancers through inter-sectoral co-ordination in low resource settings.