The goal of this resident survey study was to investigate preparedness among orthodontic residents in providing orthodontic treatment with clear aligners and manage the digital workflow for in-house fabrication of clear aligners. A survey questionnaire was emailed to all active AAO resident members which included recent graduates of 2021 (n=1,124) to evaluate didactic edu-cation, clinical experience, confidence levels and the residents' future prac-tice plans with regards to clear aligner therapy. Inferential statistics were restricted to bivariate analysis employing Pearson's chi-square tests, CMH tests, and unpaired Student's t-test (p=0.05). A total of 277 Orthodontic residents responded to the survey, with an overall response rate of 25%. Nearly 50% of the residents did not receive didactic classes on clear aligner therapy or fabrication. About 13-17% of the respond-ents did not have access to CBCT, digital teeth alignment software or 3D printed models. A significant decrease in confidence was found among resi-dents who did not receive this training in their residency programs. Based on the findings of our survey, thorough training and education of the technology used in clear aligner therapy has the potential to improve resi-dents' confidence and competence in utilizing 3D technology and clear align-ers in their future practice. (Semin Orthod 2022; 28:80-84) (c) 2022 Elsevier Inc. All rights reserved.

Surveillance of people's health takes on an important meaning in the practice of public health because it allows monitoring of diseases and prompt response to change in proportions and rates at which diseases occur in populations. Improving health of populations requires establishment of an effective public health system. Population level data and analysis is critically important in government policy and program development and monitoring. Lack of or inadequate information about the health of populations leads to ineffective policies that may often attenuate health problems instead of solving them. Australia's current oral health surveillance is mostly through ad hoc sentinel surveys, which lack recency in time. This position paper is to present the need for real-time oral health surveillance in Australia, which can be used to inform health decision-making in a timely manner.

Ethical clinical practice requires that clinical staff adhere to moral principles when treating patients and engaging with patient caregivers. Bioethics and medical literature are sparse regarding methods for implementing ethical principles into everyday clinical situations. Many cases may be complex and cut across several disciplines. In this article, we describe a case in which the overriding principle of veracity on the part of a patient party came into question and how the situation was managed.

AbstractBackgroundEarly‐life dental caries is a major global health problem. Children's first dental visit is recommended at 2 years age. The VicGeneration (VicGen) oral health birth cohort study aims to understand the multifactorial nature of early childhood caries. This report describes the baseline characteristics of children in the VicGen study.MethodsWe merged data between the first (at birth) and fourth waves (18 month age) to assess dental caries among children (primary outcome) and other oral diseases (secondary outcomes) employing t tests, chi‐square tests, Fisher's exact tests, and Cochran‐Mantel‐Haenszel tests using IBM‐SPSS(v25).ResultsMost children lived in metros with two‐parent families. Most guardians were women graduated from high school. Twenty‐seven of 389 (6.94%) 18‐month‐old children experienced dental caries. More children living in rural areas (vs. urban) experienced caries. Females were more likely to experience caries (OR: 2.16). Several children had other oral health problems. In early life, children's oral examination was conducted by midwives, breastfeeding/lactation consultants, hospital nurses, speech pathologists, and breastfeeding clinic staff.ConclusionVicGen baseline characteristics show that almost 7% of the 18‐month‐old children experienced caries. There is a need to advance children's recommended first dental visit date and to train early‐life healthcare professionals about oral diseases.

Pancreatic cancer(PCa) is one of the most lethal cancers with few known consistent nutrition-related risk factors. Epidemiologic associations between the trace element selenium and PCa are inconsistent. This study examined the association of pre-diagnostic serum selenium with incident PCa.

BACKGROUND:It is estimated that, as of 2010, there were 32 million orphaned children in India. There is little published information on the oral health of children in orphanages in India.AIM:To determine caries status and associated risk factors among children in orphanages in Kerala, India.METHODS:This cross-sectional study assessed caries using World Health Organization (WHO) criteria, and caries experience was reported as decayed, missing and filled primary or secondary teeth (dmft or DMFT, respectively). A brief questionnaire captured information on child oral health behaviours. Mean [standard deviation (SD)] and median [interquartile range (IQR)] scores were used to describe caries rates. Multivariable logistic regression analysis was conducted to identify independent disease predictors. Study design complexities, such as clustering by orphanage and stratification by district, were accounted for in the multivariable regression analysis. This was carried out using the survey commands in STATA 13. A value of P<0.05 was considered as statistically significant.RESULTS:Overall, 1,137 children residing in 31 orphanages across the State of Kerala were recruited to the study. Female children made up 82% of the sample. In 6-year-old children the prevalence of caries was 77% and the mean dmft score was 3.60 (SD= 3.50); in 12-year-old children the prevalence of caries was 44% and the mean DMFT score was 1.35 (SD = 1.96). Among 12-year-old children, those who reported being shown how to clean their teeth were less likely to have caries (odds ratio = 0.62; 95% confidence interval: 0.38-0.95).CONCLUSION:Caries rates among children in orphanages were much higher than among children in the general population in Kerala. There is an urgent need for evidence-based and sustainable primary prevention strategies to reduce the burden of caries in this highly vulnerable population.

Dental amalgam (DA) has been widely used as a restorative dental material since the 1800s. In October 2011, the World Health Organization released a report suggesting a global phasedown of DA use over time. However, DA does not contribute to mercury-related harmful issues in any significant manner, and DA fillings have been the mainstay of strong, lasting, inexpensive, easy-to-deliver, and safe fillings for a very long time. Several generations around the world have had DA fillings and responded very well to them. Any phaseout of such a filling material must consider risks/benefits of the decision and make an ethical case for or against. DA is not only time tested and proven to be the most stable and inexpensive dental filling material, but no equivalent replacements are available. Current alternatives—resin-based materials—have much shorter stability and life span, and they also have drawbacks. However, evidence for harmful effects of both DA and resin-based materials is unclear. The only potential ethical argument that can be put forward for DA phaseout could be to invoke a precautionary principle, that is, to prevent any possible purported harm that might occur with DA use, which would equally apply to resin-based materials. It is argued that the precautionary principle is not an unyielding fixed compass for action, because any study, however questionable, can then derail any intervention. In the case of DA, evidence of harm is only indicative, through minimal and methodologically limited studies. We discuss the ethics and pros and cons of replacing a time-tested filling material having minimal side effects with more expensive, less stable materials using principles of nonmalfeasance, beneficence, and justice, keeping in perspective the precautionary principle and rational resource allocation principles.

This high mortality in sepsis has prompted intensive research into the development of new adjunctive therapies in the management of sepsis.Over the past decade, a number of randomized, controlled clinical trials have been conducted Abstract Introduction : A prospective, observational study was conducted in the intensive therapy units (ITU) of an urban tertiary care hospital in Kolkata, India to determine the clinical Association between outcomes and other factors of severe sepsis among adult patients.Method : All patients admitted to ITU from June 2006 -August 2008 were screened daily for Systemic Inflammatory Response Syndrome (SIRS), organ dysfunction and severe sepsis as defined by the ACCP and SCCM.Association between outcomes and other factors in patient with severe sepsis were analyzed employing t-tests and chi-sq tests.Results: Out of total of 3,010 ITU admissions, SIRS with organ dysfunction was found in 365 (11.97 %) patients, of which 234 (66.1 %) were due to severe sepsis.Incidence proportion of severe sepsis was 7.77 % of all ITU admissions.Those severe sepsis patients having received blood transfusion (OR: 2.92), having been on mechanical ventilation (OR: 19.51) and having had a procedure performed in ITU (OR: 10.03) were at greater risk of dying.Mean age, Apache-II score, number of days with mechanical ventilation were higher among those who died, but were not statistically significantly different. Conclusions:Mortality related to severe sepsis was 8 %.ITU mortality was higher compared to data from Western reports.Those receiving blood transfusion, mechanical ventilation and some procedure in ITU were at greater risk of death.

Cancer registration, an important component of cancer surveillance, is essential to a uni ed, scienti c and public health approach to cancer prevention and control. India has one of the highest cancer incidence and mortality rates in the world. A good surveillance system in the form of cancer registries is important for planning and evaluating cancer-control activities. Cancer registration in India was initiated in 1964 and expanded since 1982, through initiation of the National Cancer Registry Program (NCRP) by the Indian Council of Medical Research. NCRP currently has twenty-six population based registries and seven hospital based registries. Yet, Indian cancer registries, mostly in urban areas, cover less than 15% of the population. Other potential concerns about some Indian registries include accuracy and detail of information on cancer diagnosis, and timeliness in updating the registry databases. It is also important that necessary data collection related quality assurance measures be undertaken rigorously by the registries to ensure reliable and valid information availability. This paper reviews the current status of cancer registration in India and discusses some of the important pitfalls and issues related to cancer registration. Cancer registration in India should be complemented with a nationwide effort to foster systematic investigations of cancer patterns and trends by states, regions and sub populations and allow a continuous cycle of measurement, communication and action.

Oral submucous fibrosis (OSF), first described in 1952, is a potentially malignant disorder associated with betel quid and areca nut chewing, mostly prevalent in the population of the Indian subcontinent and South East Asia. Malignant transformation of OSF to squamous cell carcinoma (SCC) has been estimated to be between 2% and 8%. Our study aimed to review the histopathologic changes that contribute to the understanding of the malignant transformation of OSF. Changes in epithelial thickness and dysplasia characterized by micronuclei, altered AgNOR counts and distribution, keratin protein alteration, and alteration of P63 and E-cadherin characterize the epithelial changes during the transformation of OSF to SCC. Common mechanisms have been proposed to be involved in OSF and SCC, through collagen maturation and their interaction with myofibroblasts and mast cells. Fibrosis-driven vascular constriction that results in epithelial hypoxia has also been proposed as an important mechanism for the malignant transformation of OSF. However, reassessment of the classical view is required, because with demonstration of large blood vasculature in the connective tissue stroma of OSF, the hypothesis associated with tissue hypoxia-induced malignant transformation of OSF can be questioned.

Oral submucous fibrosis (OSF) is prevalent mostly in Southeast Asia, particularly in the Indian subcontinent. Chewing betel nuts and betel leaves, with or without tobacco, has been associated with OSF. Betel quid contents including guvacine, arecoline, guvacoline, arecaidine, and chavibetol are considered to play an important part in the occurrence of OSF. Transformation of OSF to squamous cell carcinoma (SCC) is variable, but up to 13% conversion of OSF to SCC has been reported. Various genetic and molecular mechanisms impact the malignant transformation of OSF, causing changes in the cell cycle, DNA, keratinocytes, and keratin; tumor-cell proliferation and survival; angiogenesis; fibrosis through epithelial-mesenchymal transitions (EMTs), and tissue hypoxia. All are reviewed here, including potential biomarkers for malignant transformation of OSF. These interactions are not fully understood, but a critical mass of knowledge is building up to ultimately allow the understanding of all mechanisms involved.

Cervical cancer (CaCx) is the second most fatal cancer contributing to 14% of cancers in Indian females, which account for 25.4% and 26.5% of the global burden of CaCx prevalence and mortality, respectively. Persistent infection with high-risk human papilloma virus (HPV- strains 16 and 18) is the most important risk factor for precursors of invasive CaCx. Comprehensive prevention strategies for CaCx should include screening and HPV vaccination. Three screening modalities for CaCx are cytology, visual inspection with acetic acid, and HPV testing. There is no Indian national policy on CaCx prevention, and screening of asymptomatic females against CaCx is practically non-existent. HPV vaccines can make a major breakthrough in the control of CaCx in India which has high disease load and no organized screening program. Despite the Indian Government's effort to introduce HPV vaccination in the National Immunization Program and bring down vaccine cost, challenges to implementing vaccination in India are strong such as: inadequate epidemiological evidence for disease prioritization, duration of vaccine use, parental attitudes, and vaccine acceptance. This paper reviews the current epidemiology of CaCx and HPV in India, and the current status of HPV vaccination in the country. This article stresses the need for more research in the Indian context, to evaluate interventions for CaCx and assess their applicability, success, scalability and sustainability within the constraints of the Indian health care system.

BACKGROUND:Changes in the incidence of oral cancer based on anatomic location and demographic factors over time have been reported in the United States. The purpose of this study was to use recent data to examine oral cancer incidence trends and disparities by demographic factors and anatomic location. METHODS:Surveillance, Epidemiology, and End Results (SEER) incidence data from 2000 to 2010 were used to characterize and analyze oral cancer incidence trends by anatomic region and subsite, age at diagnosis, gender, race/ethnicity, and stage at diagnosis. Poisson regression was used to compare incidence risk by select demographic factors. RESULTS:About 75,468 incident oral cancer cases were diagnosed from 2000 to 2010. The tonsil was the most frequently diagnosed anatomic subsite (23.1%) and the subsite with the greatest contribution to the overall, age-standardized cumulative incidence rate of 8.4 cases per 100,000 (95% confidence interval (CI): 8.3, 8.4). An increasing incidence trend was observed for cancers in the oropharyngeal region, in contrast to a decreasing trend seen in the oral cavity region. In the Poisson regression model, all race/ethnicity groups showed a lower incidence risk relative to whites for oral cavity and oropharyngeal cancer, and white males displayed the highest incidence rate of all race/ethnicity-gender groups during the study period (14.1 per 100,000; 95% CI: 14.0, 14.2). CONCLUSIONS:This study's epidemiological findings are especially important for oral health care providers, patient education, and the identification of risk profiles associated with oral cancer. The distinct epidemiological trends of oral cavity and oropharyngeal cancers dictate that oral cancer can no longer be viewed as a discrete entity. Oral health providers should have a strong understanding of the different risk factors associated with oral cavity and oropharyngeal cancers and educate their patients accordingly.

There is strong evidence for causal association between human papillomavirus (HPV) and cervical cancer, evidence of association of HPV and oropharyngeal cancer is beginning to mount. Objectives: To review the HPV-oral cancer literature for a comprehensive assessment of the issues involved. Methods: Literature search conducted using PubMed, Google Scholar and Google search engine. Results: Both available HPV vaccines are efficacious and safe although expensive. Policy for mandatory HPV vaccination for cervical prevention is mired in political issues stemming from negative cost-effectiveness balance. Dental professionals are not ready to discuss the role of HPV vaccine in cancer prevention. This review discusses the impact of HPV on cervical cancer, transmission of HPV among humans, impact of HPV in oral health, and its plausible role in oral and oropharyngeal cancer, prevention of HPV transmission, available vaccines against HPV, testing, cost, policy and use of HPV vaccines internationally and dentists readiness related to HPV associated health communication. Conclusions: Given the mounting literature on the association between HPV and oropharyngeal cancer, the dental community must be prepared to answer patients' HPV-related questions and to educate patients about the role of HPV as a risk factor for oral and oropharyngeal cancers.

This study aims to investigate the incidence and determinants of colorectal cancer (CRC) and its screening in District of Columbia (DC), and identify modifiable risk factors. Data (2000–2009) from the DC Cancer Registry, Behavioral Risk Factor Surveillance System (BRFSS-DC) and Surveillance Epidemiology and End Results (SEER) were used to estimate CRC incidence in eight DC Wards. Risk factors and CRC screening were analyzed using uni-, bi-, and multivariable statistical methods with survey procedures in SAS (version 9.2) including binary, unconditional multivariable logistic regression analysis. Factors measured included stage of diagnosis, age, gender, race/ethnicity, smoking, alcohol, exercise, body weight, health insurance, education, employment, and income. Over the study time, CRC screening increased from 48.4% to 68.6%. Mean age at diagnosis was 67years. CRC incidence is high in DC. Furthermore, CRC incidence rates in DC below 50years age were higher than the SEER18 average. Disparities exist between CRC incidence and screening among DC Wards. Identified risk factors for CRC are smoking, obesity, and low physical activity; screening was less prevalent among the uninsured and low socio-economic group. Local variations in CRC occurrence exist and may vary from average national experiences. Identification of local regions which vary from national trends in disease occurrence is important for comprehensive understanding of the disease in the community.

Eastern Mediterranean (EM) region countries include countries from the Mediterranean region and North Africa representing regions with wide variations in their politics, economy, peaceful status, and healthcare infrastructure. Commonly known lip and oral cancer risk factors such as consumption of tobacco and alcohol are widely prevalent in the region. Globocan data suggests that age-standardized incidence rates and age-adjusted mortality rates are higher in the region compared to world averages whereas 1-, 2-, and 3-year prevalence proportions are lower. These statistical profiles are generally similar for men and women. Within the region, in general, incidence, mortality, and prevalence is greater in men than women. However, there are important differences in overall incidence, prevalence, and mortality; differences between genders in these statistics which vary between countries. This manuscript describes and compares oral cancer statistics of the countries in the EM region.

Introduction: Accurate length of stay (LOS) prediction of severe sepsis patients in intensive care unit (ICU) is critical for resource management. Acute Physiology and Chronic Health Evaluation-IV (APACHE-IV) model is commonly used forpredicting LOS. This study assesses the ICU-LOS predictability of APACHE-IV system for severe sepsis patients.Methods: Following ethical clearance, we used ICU data (06/2006 – 08/2008: from a hospital in India) to compare APACHE-IV score and predicted LOS of severe sepsis patients with actual observed ICU-LOS. We employed t-test, correlations, ANOVA andlinear regression of suitably transformed variables as needed.Results: Out of 3,949 ICU admissions, 198 were severe sepsis admissions where 134 patients (80%) had usable data. Of these 75 had verifiable APACHE-IV scores (final sample) with 55% men; median age: 67 years (IQR: 21) 53% did not have dialysis; 87% were on mechanical ventilation (MV). Mean ICU-LOS (10.1 days + 6.4) was significantly greater than predicted ICU-LOS (5.6days + 1.8 ; p<.001). ICU-LOS was very strongly correlated with days on MV (r=0.9). Mean ICU-LOS was significantly greaterfor those receiving blood transfusion (p<.001); on MV (p<.001); having surgery (p<.001) and having high frequency of dialysis (p<.001) – differences not predicted by APACHE-IV. Overall, the predicted ICU-LOS underestimation was by 4.5 days.Conclusions: The results provide a preliminary indication that APACHE-IV model may be a poor predictor of ICU-LOS insevere sepsis cases.

OBJECTIVE The goal of this analysis was to describe income-related inequality in untreated caries among children in the United States over time. METHODS The analysis focuses on children ages 2-12 years in three nationally representative U.S. surveys: the National Health and Nutrition Examination Survey (NHANES) 1971-1974, NHANES 1988-1994, and NHANES 1999-2004. The outcome of interest is untreated dental caries. Various methods are employed to measure absolute and relative inequality within each survey such as pair-wise comparisons, measures of association (odds ratios), and three summary measures of overall inequality: the slope index of inequality, the relative index of inequality, and the concentration index. Inequality trends are then assessed by comparing these estimates across the three surveys. RESULTS Inequality was present in each of the three surveys analyzed. Whether measured on an absolute or relative scale, untreated caries disproportionately affected those with lower income. Trend analysis shows that, despite population-wide reductions in untreated caries between NHANES I and NHANES III, overall absolute inequality slightly increased, while overall relative inequality significantly increased. Between NHANES III and NHANES 1999-2004, both absolute and relative inequality tended to decrease; however, these changes were not statistically significant. CONCLUSIONS Socioeconomic inequality in oral health is an important measure of progress in overall population health and a key input to inform health policies. This analysis shows the presence of socioeconomic inequality in oral health in the American child population, as well as changes in its magnitude over time. Further research is needed to determine the factors related to these changes and their relative contribution to inequality trends.

Objectives: To estimate dental expenditures in 2006, to analyse dental expenditures by potential explanatory factors for 2006 and to explore trends in dental expenditures from 1996-2006. Methods: Medical Expenditure Panel Survey (MEPS) data were used. T-tests and analysis of variance were used to test for significance. Multivariable linear regression analysis was conducted to identify independent predictors of dental expenditures. The trend analysis was conducted for the 11-year period, 1996-2006, on adults aged 25 years and older. Expenditures were inflation adjusted to 2006 dollars using the annual average Consumer Price Index. Data were analysed using the MEPS query tool and SASv9.2 (R). Results: In the 2006 MEPS sample, 8,001 adults had dental expenditures and when weighted represented about 93 million non-institutionalised adult US civilians. The mean dental expenditures for this weighted sample were $611 (sd 1,309), median $233 (inter-quartile range 466). As expected, in 2006, dental expenditures increased with age. Those adults who reported their self-perceived health status as 'excellent' were observed to have lowest dental expenditures in this category. After adjusting for other variables in the multivariable linear regression analysis of dental expenditures, age, race/ethnicity, income, geographic location, perceived health status and dental insurance coverage remained significant. Conclusion: Dental expenditures for 2006 were $611 (mean) and $233 (median). The time-trend showed substantial but non-uniform annual changes in real dental expenditures between 1996 and 2006.

OBJECTIVES:To evaluate the role of partial recording protocols (PRPs) in reporting prevalence and severity of dental fluorosis and assess whether prevalence/severity estimates derived from PRPs differ by race/ethnicity. METHODS:Data from the National Health and Nutrition Examination Survey (NHANES) for the years 1999-2004 were analyzed with Stata(®) v.11. Prevalence of dental fluorosis obtained from a full-mouth examination (28 teeth gold standard) was compared with estimates derived from four subsets of teeth (maxillary canine-to-canine; maxillary first-premolar-to-first-premolar; all-premolars; all-molars). Sensitivity, negative predictive value (NPV), absolute bias, and correction factors were calculated against gold standard estimate. Analysis was stratified according to race/ethnicity to assess differences in estimates derived from PRPs. RESULTS:All subsets underestimated prevalence albeit to varying degrees. Two subsets (all-premolars and all-molars) had prevalence and severity estimates closest to gold standard estimates. The all-molars subset (eight teeth) recorded the highest sensitivity (84.5%) and the lowest absolute bias (3.5%) of all subsets relative to gold standard. Subsets derived from esthetically relevant teeth produced the lowest fluorosis prevalence. For instance, the maxillary canine-to-canine subset underestimated prevalence by 9.5%; incorporating the maxillary first premolars in the span improved prevalence estimate by 31%. Among non-Hispanic Whites, the all-premolars subset produced estimates closest to gold standard while the all-molars subset produced estimates closest to the gold standard among non-Hispanic Blacks and Hispanics. CONCLUSION:While the majority of dental fluorosis in the United States is very mild, concerns regarding its growing prevalence underscore the need for careful monitoring. The use of PRPs offers an alternative method of assessment, with validity of reported prevalence and severity dependent on choice of subset.