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Jones A, Veale B, Li T, Aggarwal VR, Twigg J. Interventions for managing oral submucous fibrosis. Cochrane Database Syst Rev 2024; 2:CD007156. [PMID: 38415846 PMCID: PMC10900301 DOI: 10.1002/14651858.cd007156.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Oral submucous fibrosis (OSF) is a chronic disease of the oral cavity that causes progressive constriction of the cheeks and mouth accompanied by severe pain and reduced mouth opening. OSF has a significant impact on eating and swallowing, affecting quality of life. There is an increased risk of oral malignancy in people with OSF. The main risk factor for OSF is areca nut chewing, and the mainstay of treatment has been behavioural interventions to support habit cessation. This review is an update of a version last published in 2008. OBJECTIVES To evaluate the benefits and harms of interventions for the management of oral submucous fibrosis. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 5 September 2022. SELECTION CRITERIA We considered randomised controlled trials (RCTs) of adults with a biopsy-confirmed diagnosis of OSF treated with systemic, locally delivered or topical drugs at any dosage, duration or delivery method compared against placebo or each other. We considered surgical procedures compared against other treatments or no active intervention. We also considered other interventions such as physiotherapy, ultrasound or alternative therapies. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. participant-reported resumption of normal eating, chewing and speech; 2. change or improvement in maximal mouth opening (interincisal distance); 3. improvement in range of jaw movement; 4. change in severity of oral/mucosal burning pain/sensation; 5. ADVERSE EFFECTS Our secondary outcomes were 6. quality of life; 7. postoperative discomfort or pain as a result of the intervention; 8. participant satisfaction; 9. hospital admission; 10. direct costs of medication, hospital bed days and any associated inpatient costs for the surgical interventions. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We included 30 RCTs (2176 participants) in this updated review. We assessed one study at low risk of bias, five studies at unclear risk of bias and 24 studies at high risk of bias. We found diverse interventions, which we categorised according to putative mechanism of action. We present below our main findings for the comparison 'any intervention compared with placebo or no active treatment' (though most trials included habit cessation for all participants). Results for head-to-head comparisons of active interventions are presented in full in the main review. Any intervention versus placebo or no active treatment Participant-reported resumption of normal eating, chewing and speech No studies reported this outcome. Interincisal distance Antioxidants may increase mouth opening (indicated by interincisal distance (mm)) when measured at less than three months (mean difference (MD) 3.11 mm, 95% confidence interval (CI) 0.46 to 5.77; 2 studies, 520 participants; low-certainty evidence), and probably increase mouth opening slightly at three to six months (MD 8.83 mm, 95% CI 8.22 to 9.45; 3 studies, 620 participants; moderate-certainty evidence). Antioxidants may make no difference to interincisal distance at six-month follow-up or greater (MD -1.41 mm, 95% CI -5.74 to 2.92; 1 study, 90 participants; low-certainty evidence). Pentoxifylline may increase mouth opening slightly (MD 1.80 mm, 95% CI 1.02 to 2.58; 1 study, 106 participants; low-certainty evidence). However, it should be noted that these results are all less than 10 mm, which could be considered the minimal change that is meaningful to someone with oral submucous fibrosis. The evidence was very uncertain for all other interventions compared to placebo or no active treatment (intralesional dexamethasone injections, pentoxifylline, hydrocortisone plus hyaluronidase, physiotherapy). Burning sensation Antioxidants probably reduce burning sensation visual analogue scale (VAS) scores at less than three months (MD -30.92 mm, 95% CI -31.57 to -30.27; 1 study, 400 participants; moderate-certainty evidence), at three to six months (MD -70.82 mm, 95% CI -94.39 to -47.25; 2 studies, 500 participants; moderate-certainty evidence) and at more than six months (MD -27.60 mm, 95% CI -36.21 to -18.99; 1 study, 90 participants; moderate-certainty evidence). The evidence was very uncertain for the other interventions that were compared to placebo and measured burning sensation (intralesional dexamethasone, vasodilators). Adverse effects Fifteen studies reported adverse effects as an outcome. Six of these studies found no adverse effects. One study evaluating abdominal dermal fat graft reported serious adverse effects resulting in prolonged hospital stay for 3/30 participants. There were mild and transient general adverse effects to systemic drugs, such as dyspepsia, abdominal pain and bloating, gastritis and nausea, in studies evaluating vasodilators and antioxidants in particular. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that antioxidants administered systemically probably improve mouth opening slightly at three to six months and improve burning sensation VAS scores up to and beyond six months. We found only low/very low-certainty evidence for all other comparisons and outcomes. There was insufficient evidence to make an informed judgement about potential adverse effects associated with any of these treatments. There was insufficient evidence to support or refute the effectiveness of the other interventions tested. High-quality, adequately powered intervention trials with a low risk of bias that compare biologically plausible treatments for OSF are needed. It is important that relevant participant-reported outcomes are evaluated.
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Affiliation(s)
- Adam Jones
- Oral Surgery, School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Benjamin Veale
- Oral and Maxillofacial Surgery, Airedale General Hospital, Keighley, UK
| | - Tiffany Li
- Oral and Maxillofacial Surgery, Leeds Teaching Hospitals, Leeds, UK
| | - Vishal R Aggarwal
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Joshua Twigg
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Department of Restorative Dentistry, Leeds Dental Institute, Leeds, UK
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Chen X, Xie H, Guo J. Drug treatment for oral submucous fibrosis: an update. BMC Oral Health 2023; 23:748. [PMID: 37828490 PMCID: PMC10568776 DOI: 10.1186/s12903-023-03488-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE The aim of this review is to evaluate the different medicinal interventions available for the management of oral submucous fibrosis (OSF). MATERIALS AND METHODS We conducted a comprehensive electronic search on PubMed, Web of Science, and Cochrane Library databases for articles related to OSF patients treated with medications from December 2011 to September 2022. GRADE system was used to evaluate the evidence quality. The reporting of the systematic review is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The main outcomes were the improvement of maximum mouth opening, burning sensation, cheek flexibility, and tongue protrusion. RESULTS Twenty-nine randomized controlled trials (RCTs), five clinical trials (CCTs) were included, and the use of drugs for OSF treatment were evaluated. Drugs like steroids, hyaluronidase, pentoxifylline, lycopene, curcumin, dpirulina, aloe vera, omega3, oxitard, allicin, colchicine have been used. It was found that drugs with evidence high quality were salvia miltiorrhiza combined with triamcinolone acetonide, lycopene, pentoxifylline, curcumin, and aloe vera, and those with evidence moderate quality were allicin, colchicine, omega 3, and oxitard. CONCLUSION Based on the results of our comprehensive analysis, for long-term treatment, we found lycopene with low side effects, whereas for relieving the symptoms of severe burning sensation, aloe vera is the most effective. Although the recent review has made some progress, drug therapy for OSF remains unclear, and more high-quality RCTs are needed to identify better treatments for OSF.
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Affiliation(s)
- Xueru Chen
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, 410006, China
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Hui Xie
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, 410006, China
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China
| | - Jincai Guo
- Department of Pharmacy, Changsha Stomatological Hospital, Changsha, 410006, China.
- School of Stomatology, Hunan University of Chinese Medicine, Changsha, 410006, China.
- School of Pharmacy, Hunan University of Chinese Medicine, Changsha, 410208, China.
- Changsha Stomatological Hospital, No. 389 Youyi road, Tianxin district Changsha, Hunan, China.
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Nihadha PM, Chugh A, Kaur A, Kumar S, Naveen KH, Bhatia PK, Kumar P, Chaudhry K. Transdermal fentanyl patch versus standard analgesia in postoperative oral submucous fibrosis patients: a triple blinded, randomised control trial. Br J Oral Maxillofac Surg 2022; 60:1246-1253. [PMID: 35970681 DOI: 10.1016/j.bjoms.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/17/2022] [Accepted: 07/11/2022] [Indexed: 11/17/2022]
Abstract
Severe pain experienced by patients with oral submucous fibrosis (OSMF) compromises their physiotherapy and negatively affects the surgical outcome and the patient's compliance. The main aim of this study was to develop a protocol for pain control in the management of OSMF postoperatively. This was a prospective, parallel with active control, double-arm, triple-blinded, randomised control trial (RCT) with 48 OSMF patients, randomised into two groups - Group A (control, n = 25): received non-opioid analgesics (NSAIDs) and Group B (cases, n = 23): received transdermal fentanyl patches (TFP). Pain and interincisal opening were measured on postoperative days 1, 3, 5, 7, 9, and 15, and on the1st and 3rd postoperative months. Quality of Life (QoL) was assessed preoperatively, on the 15th day postoperatively, and 3rd month postoperatively, and compliance was documented postoperatively on the 9th day. The transdermal fentanyl patch was found to have statistically significantly more effect in controlling severe pain during active mouth opening exercises, and thus significantly increased the patients' compliance. Although there was increased mouth opening and QoL in the fentanyl group, the differences were statistically insignificant. Our study recommends the use of TFP for better pain control and compliance in postoperative OSMF patients.
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Affiliation(s)
- P M Nihadha
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical sciences, Jodhpur, India.
| | - Ankita Chugh
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical sciences, Jodhpur, India.
| | - Amanjot Kaur
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical sciences, Jodhpur, India.
| | - Shailendra Kumar
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical sciences, Jodhpur, India.
| | - K H Naveen
- Department of Community Medicine, All India Institute of Medical Sciences, Jodhpur, India.
| | - Pradeep Kumar Bhatia
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, India.
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India.
| | - Kirti Chaudhry
- Oral and Maxillofacial Surgery, Department of Dentistry, All India Institute of Medical Sciences, Jodhpur, India.
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Patil B, Hegde V, Sridhara S, Narayanaswamy H, Naik MK, Patil KKR, Rajashekara H, Mishra AK. Exploring the Impact of Climatic Variables on Arecanut Fruit Rot Epidemic by Understanding the Disease Dynamics in Relation to Space and Time. J Fungi (Basel) 2022; 8:jof8070745. [PMID: 35887500 PMCID: PMC9319122 DOI: 10.3390/jof8070745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/11/2022] [Accepted: 07/16/2022] [Indexed: 12/10/2022] Open
Abstract
To understand the spatio-temporal dynamics and the effect of climate on fruit rot occurrence in arecanut plantations, we evaluated the intensity of fruit rot in three major growing regions of Karnataka, India for two consecutive years (2018 and 2019). A total of 27 sampling sites from the selected regions were monitored and the percentage disease intensity (PDI) was assessed on 50 randomly selected palms. Spatial interpolation technique, ordinary kriging (OK) was employed to predict the disease occurrence at unsampled locations. OK resulted in aggregated spatial maps, where the disease intensity was substantial (40.25–72.45%) at sampling sites of the Malnad and coastal regions. Further, Moran’s I spatial autocorrelation test confirmed the presence of significant spatial clusters (p ≤ 0.01) across the regions studied. Temporal analysis indicated the initiation of disease on different weeks dependent on the sampling sites and evaluated years with significant variation in PDI, which ranged from 9.25% to 72.45%. The occurrence of disease over time revealed that the epidemic was initiated early in the season (July) at the Malnad and coastal regions in contrary to the Maidan region where the occurrence was delayed up to the end of the season (September). Correlations between environmental variables and PDI revealed that, the estimated temperature (T), relative humidity (RH) and total rainfall (TRF) significantly positively associated (p = 0.01) with disease occurrence. Regression model analysis revealed that the association between Tmax, RH1 and TRF with PDI statistically significant and the coefficients for the predictors Tmax, RH1 and TRF are 1.731, 1.330 and 0.541, respectively. The information generated in the present study will provide a scientific decision support system, to generate forecasting models and a better surveillance system to develop adequate strategies to curtail the fruit rot of arecanut.
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Affiliation(s)
- Balanagouda Patil
- Department of Plant Pathology, University of Agricultural and Horticultural Sciences, Shivamogga 577255, Karnataka, India; (H.N.); (M.K.N.)
- Division of Crop Protection, ICAR-Central Plantation Crops Research Institute, Kasaragod 671124, Kerala, India;
- Correspondence: (B.P.); (A.K.M.)
| | - Vinayaka Hegde
- Division of Crop Protection, ICAR-Central Plantation Crops Research Institute, Kasaragod 671124, Kerala, India;
| | - Shankarappa Sridhara
- Center for Climate Resilient Agriculture, University of Agricultural and Horticultural Sciences, Shivamogga 577255, Karnataka, India;
| | - Hanumappa Narayanaswamy
- Department of Plant Pathology, University of Agricultural and Horticultural Sciences, Shivamogga 577255, Karnataka, India; (H.N.); (M.K.N.)
| | - Manjunatha K. Naik
- Department of Plant Pathology, University of Agricultural and Horticultural Sciences, Shivamogga 577255, Karnataka, India; (H.N.); (M.K.N.)
| | - Kiran Kumar R. Patil
- Department of Agricultural Economics, University of Agricultural and Horticultural Sciences, Shivamogga 577255, Karnataka, India;
| | - Hosahatti Rajashekara
- Division of Crop Protection, ICAR-Directorate of Cashew Research, Puttur 574202, Karnataka, India;
| | - Ajay Kumar Mishra
- Khalifa Centre for Genetic Engineering and Biotechnology, United Arab Emirates University, Al Ain P.O. Box 15551, United Arab Emirates
- Correspondence: (B.P.); (A.K.M.)
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Sarode SC, Sarode GS, Sengupta N, Yuwanati M, Gadbail A, Gondivkar S, Ingle Y. Management of burning sensation in oral submucous fibrosis: more concerns than clarity. Oral Oncol 2021; 122:105557. [PMID: 34634667 DOI: 10.1016/j.oraloncology.2021.105557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sachin C Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune: 411018, MH, India.
| | - Gargi S Sarode
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune: 411018, MH, India
| | - Namrata Sengupta
- Department of Oral Pathology and Microbiology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune: 411018, MH, India
| | - Monal Yuwanati
- Department of Oral Pathology and Microbiology. Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, India
| | - Amol Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra 440018, India
| | - Shailesh Gondivkar
- Department of Oral Medicine and Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Yashwant Ingle
- Department of Dentistry, Yashwantrao Chavan Memorial Hospital, Sant-Tukaram Nagar, Pimpri, Pune 411018 (MH), India
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Balanagouda P, Sridhara S, Shil S, Hegde V, Naik MK, Narayanaswamy H, Balasundram SK. Assessment of the Spatial Distribution and Risk Associated with Fruit Rot Disease in Areca catechu L. J Fungi (Basel) 2021; 7:jof7100797. [PMID: 34682220 PMCID: PMC8540003 DOI: 10.3390/jof7100797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 01/04/2023] Open
Abstract
Phytophthora meadii (McRae) is a hemibiotrophic oomycete fungus that infects tender nuts, growing buds, and crown regions, resulting in fruit, bud, and crown rot diseases in arecanut (Areca catechu L.), respectively. Among them, fruit rot disease (FRD) causes serious economic losses that are borne by the growers, making it the greatest yield-limiting factor in arecanut crops. FRD has been known to occur in traditional growing areas since 1910, particularly in Malnad and coastal tracts of Karnataka. Systemic surveys were conducted on the disease several decades ago. The design of appropriate management approaches to curtail the impacts of the disease requires information on the spatial distribution of the risks posed by the disease. In this study, we used exploratory survey data to determine areas that are most at risk. Point pattern (spatial autocorrelation and Ripley’s K function) analyses confirmed the existence of moderate clustering across sampling points and optimized hotspots of FRD were determined. Geospatial techniques such as inverse distance weighting (IDW), ordinary kriging (OK), and indicator kriging (IK) were performed to predict the percent severity rates at unsampled sites. IDW and OK generated identical maps, whereby the FRD severity rates were higher in areas adjacent to the Western Ghats and the seashore. Additionally, IK was used to identify both disease-prone and disease-free areas in Karnataka. After fitting the semivariograms with different models, the exponential model showed the best fit with the semivariogram. Using this model information, OK and IK maps were generated. The identified FRD risk areas in our study, which showed higher disease probability rates (>20%) exceeding the threshold level, need to be monitored with the utmost care to contain and reduce the further spread of the disease in Karnataka.
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Affiliation(s)
- Patil Balanagouda
- Department of Plant Pathology, University of Agricultural and Horticultural Sciences, Shivamogga, Karnataka 577255, India; (P.B.); (M.K.N.); (H.N.)
- Division of Crop Protection, ICAR-Central Plantation Crops Research Institute, Kasaragod, Kerala 671124, India;
| | - Shankarappa Sridhara
- Center for Climate Resilient Agriculture, University of Agricultural and Horticultural Sciences, Shivamogga, Karnataka 577255, India
- Correspondence: (S.S.); (S.K.B.)
| | - Sandip Shil
- Research Centre, Division of Social Sciences, ICAR-Central Plantation Crops Research Institute, Mohitnagar, Jalpaiguri, West Bengal 735102, India;
| | - Vinayaka Hegde
- Division of Crop Protection, ICAR-Central Plantation Crops Research Institute, Kasaragod, Kerala 671124, India;
| | - Manjunatha K. Naik
- Department of Plant Pathology, University of Agricultural and Horticultural Sciences, Shivamogga, Karnataka 577255, India; (P.B.); (M.K.N.); (H.N.)
| | - Hanumappa Narayanaswamy
- Department of Plant Pathology, University of Agricultural and Horticultural Sciences, Shivamogga, Karnataka 577255, India; (P.B.); (M.K.N.); (H.N.)
| | - Siva K. Balasundram
- Department of Agriculture Technology, Faculty of Agriculture, Universiti Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: (S.S.); (S.K.B.)
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Wu YH, Lin PY, Yang JH, Kuo YS, Wu YC, Chiang CP. Significantly higher serum tumor marker levels in patients with oral submucous fibrosis. J Dent Sci 2021; 16:846-853. [PMID: 34141098 PMCID: PMC8189891 DOI: 10.1016/j.jds.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background/purpose Our previous study showed that carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), and ferritin are significantly higher in patients with oral potentially malignant disorders (OPMDs including oral leukoplakia, oral erythroleukoplakia, and oral verrucous hyperplasia) than in healthy controls (HCs). Oral submucous fibrosis (OSF) is also recognized as an OPMD. This study evaluated whether these three serum tumor marker levels were also significantly higher in OSF patients than in HCs. Materials and methods The serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients and 164 HCs were measured and compared. Patients with serum CEA level ≥3 ng/mL, SCC-Ag level ≥2 ng/mL, and ferritin level ≥250 ng/mL were scored as serum positive for CEA, SCC-Ag, and ferritin, respectively. Results We found significantly higher mean serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients than in 164 HCs (all P-values < 0.05). Moreover, 41 OSF patients had significantly higher serum positive rates of CEA (39.0%), SCC-Ag (19.5%), and ferritin (53.7%) than 164 HCs (all P-values < 0.05). Of the 41 OSF patients, 26 (63.4%), 7 (17.1%), and 2 (4.9%) had serum positivities of one, two, or three tumor markers including CEA, SCC-Ag, and ferritin, respectively. Conclusion There are significantly higher mean serum CEA, SCC-Ag, and ferritin levels and significantly higher serum positive rates of CEA, SCC-Ag, and ferritin in OSF patients than in HCs. The serum CEA, SCC-Ag, and ferritin levels may be served as tumor markers for evaluation of malignant potential of OSF lesions.
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Affiliation(s)
- Yu-Hsueh Wu
- Department of Stomatology, National Cheng Kung University Hospital, Tainan, Taiwan.,Institute of Oral Medicine, School of Dentistry, National Cheng Kung University, Tainan, Taiwan.,Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ping-Yi Lin
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ju-Hsuan Yang
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ying-Shiung Kuo
- Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yang-Che Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Dentistry, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Chun-Pin Chiang
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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Shirzaiy M, Neshat F. Effect of Areca Nut on Oral Health: A Review. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2020. [DOI: 10.29252/jrdms.5.3.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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