Quality of Life-related "Patient-reported Outcome Measures" in Oral Submucous Fibrosis Patients

Malignant transformation in oral submucous fibrosis: Tertiary level evidence: An umbrella review

OBJECTIVES

An umbrella review is a systematic review of systematic reviews, which provides a tertiary level of evidence. This umbrella review of systematic reviews and meta-analysis (SR-MA) aimed to determine the proportion of oral cancer (OC) development in oral submucous fibrosis (OSF) patients.

MATERIALS AND METHODS

We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane and grey literature. Two reviewers independently screened abstracts and assessed for eligible papers. The methodological quality of SR-MA was evaluated using AMSTAR2, and we also checked the quality of evidence of the included papers.

RESULTS

Out of 454 papers identified in the primary search, 105 underwent eligibility screening. Inclusion criteria were met by four SR-MA. OC ratios ranged between 4.2% and 6% for OSF. Substantial heterogeneity was observed for this outcome in all four MA (I2 = 71.31% to 86.37%). None of the SRs assessed the quality of evidence, and half of them were judged to be of critically low methodological quality.

CONCLUSION

There is lack of quality of evidences and critically low methodological quality among SRs and MA leading to substantial heterogeneity. However, due to potentially malignant nature, OSF patients should be monitored carefully for early detection of OC.

Assessment of quality of life of patients with oral sub mucous fibrosis before and after treatment with topical curcumin

Background and aim: Oral Submucous Fibrosis (OSMF) is potentially pre-malignant condition of the oral cavity with a high malignant transformation rate. The condition not only affects the oral function of the patients but has a huge impact on their social and psychological wellbeing affecting the overall quality of life. To evaluate the effectivity of the treatment assessing the quality of the life of these patients before and after treatment is of utmost importance but till now has not been an integral part of the management strategy. This study was carried to assess the change in quality of life before and after treatment with curcumin in patients with OSMF. Methods: Quality of life was assessed before and after 3 months of treatment with topical curcumin in 50 patients with OSMF using European Organization for Research and Treatment of Cancer Quality of Life head and neck Questionnaire (EORTC QLQ35). Results: At the end of 3 months there was significant (p < 0.05) change in the quality of life of patients with OSMF as suggested by assessment of the multi-item and single item scale used in the questionnaire. Conclusion: The study emphasizes the use of assessing Quality of life as an integral part of treatment strategy for OSMF and suggests curcumin as a promising treatment modality for patients with OSMF.

Quality of Life in Oral Submucous Fibrosis- A Case Report with a Literature Review

Introduction:

Oral Submucous Fibrosis (OSMF) is a potentially malignant disorder commonly found in the Southeast Asian region, classically characterized through restricted mouth opening and burning sensation in the mouth on consuming spicy food. The etiopathogenesis and treatment aspects of OSMF have been extensively researched and reviewed. However, the effect of this condition on the Quality of Life (QoL) of patients has not gained much consideration. The aim of our case report is to highlight the importance of evaluating the QoL in an OSMF patient by using discipline-specific questionnaire and also to present to the readers a review of the recently published research articles on the application of QoL questionnaires in OSMF patients.

Results:

It was observed that most of the researchers used generic and discipline-specific questionnaire for evaluating the quality of life in OSMF patients.

Conclusion:

Evaluation of QoL is recommended during the treatment of OSMF patients. There is a need to develop and employ more of disease-specific QoL instruments for OSMF patients.

Clinical efficacy of mouth exercising devices in oral submucous fibrosis: A systematic review

Background

The management of oral submucous fibrosis (OSF) is primarily focused towards minimizing patient's symptoms and to prevent cancer development. Mouth exercise physiotherapy independently or in combination with other modalities is considered to be a mainstay for increasing the mouth opening (MO). The present systematic review was performed to identify different mouth exercising devices (MEDs) used and to provide detailed information on the fabrication and clinical efficacy of these devices among OSF patients.

Methods

PubMed, Scopus, Web of Science, Google Scholar and CINAHL were searched for relevant literature until February 2019 and the information was extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All full text papers describing use of MED in OSF patients were considered eligible.

Results

Initial search resulted in 88 hits. After removing duplicates and screening of titles and abstracts, five papers that met the inclusion criteria were included. We identified five MEDs used for increasing the MO in OSF patients. Only one study administered additional treatment with topical steroids, oral antioxidants and ice-cream stick regime. The follow-up across studies ranged from 8 weeks to 6 months. Majority of the studies reported significant improvement in the MO without any relapse and side effects.

Conclusions

MED could play an important role in the management of OSF. Limited researches in this area suggest a dire need for the further investigations using randomized controlled trials.

Treatment outcomes of laser therapy in oral submucous fibrosis-a systematic review

Background

The mainstay of oral submucous fibrosis (OSF) management is to increase the mouth opening; thereby improving oral functionalities. In modernized dentistry, laser therapy (LT) could play a major role for trismus relief in OSF patients. The present review was performed to systematically analyze the published literature on LT for OSF management.

Methods

PubMed, Scopus, Web of Science and CINAHL databases were searched until June 2019 using suitable key words and the information was extracted according to the PRISMA guidelines. All full text papers that assessed efficacy of LT for OSF management without limitations on age, gender, ethnicity, or socioeconomic status of the participants were considered eligible. Participants were allocated to the LT alone or in adjunct to oral physiotherapy and medicinal treatment. Outcome parameters included the reduction in trismus. Review articles, case reports, editorial, conference abstracts and in vitro studies were excluded. No restriction was applied on date and language of the publications.

Results

Out of 97 published papers, 7 studies met the inclusion criteria and were included for the analysis. All the studies were clinical and mainly included stage II and III OSF patients. Although different laser types and other parameters were used, all the studies reported improvement in mouth opening in the range of 6.84 mm and 23.7 mm. Additionally, two studies noticed reduced burning sensation and increased tongue protrusion and cheek flexibility. Conclusion: The LT can provide a promising and better means for relieving trismus and probably OSF-related other symptoms in moderate stages of the disease.

Assessment of oral health-related quality of life instruments for oral submucous fibrosis: A systematic review using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist

Quality of life (QoL) instruments are becoming increasingly important in research and often used in clinical practice. Various QoL instruments have been developed/ validated for assessment of oral health-related QoL (OHRQoL) in patients with oral submucous fibrosis (OSF). Selection of an adequate instrument is challenging in routine practice due to lack of information on psychometric quality of measurement instruments. This systematic review gives an extensive overview of quality of all the currently available measurement instruments for use in OSF patients. PubMed, Scopus, Web of Science and CINAHL were searched for relevant literature until December 2018 and the information was extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the identified studies was assessed per measurement property according to the COnsensus-based Standards for the selection of health Measurements Instruments (COSMIN) checklist. Four studies that met the inclusion criteria were included. Three generic and one disease-specific QoL instruments were identified. Information regarding important measurement properties was often incomplete. The evidence for the quality of measurement instruments was found to be variable, none of the instruments performed sufficient on all measurement properties. Based on the available information, OHRQoL-OSF appeared to have adequate COSMIN measurement properties. As recently published, newer QoL instruments have not yet been evaluated in an adequate manner for use in OSF. We suggest future studies should implement OSF-specific OHRQoL-OSF to better understand OSF patients' perspectives and help inform clinicians to propose treatment strategies as per patients' needs.

Comparison of generic and condition-specific oral health-related quality of life instruments in patients with oral submucous fibrosis

PURPOSE

With the growing interest in health economics, there is a demand for best valid instrument to assess quality of life (QoL) in patients with oral submucous fibrosis (OSF). The objective of this study was to compare the convergent and discriminative properties of the condition-specific OHRQoL-OSF and generic OHIP-14 in OSF patients.

METHODS

The OHRQoL-OSF and OHIP-14 instruments were administered concurrently to 300 clinically diagnosed OSF patients. Analysis of both the instruments was carried out by using descriptive statistics. The internal consistency and reproducibility of the instruments were assessed using Cronbach's alpha and intra-class correlation coefficient respectively. The convergent and discriminative validity were then determined and compared.

RESULTS

The OHRQoL-OSF and OHIP-14 exhibited good psychometric properties for internal consistency (Cronbach's alpha > 0.88) and reproducibility (ICC > 0.85). A positive associations were observed between both the instruments, but a high prevalence of patients with no impact was noted using the OHIP-14. Both the instruments were able to discriminate between patients with different clinical stages of OSF, but OHRQoL-OSF was more responsive in the early stages of OSF. The OHRQoL-OSF demonstrated greater sensitivity for 'discomfort and functional impairment'.

CONCLUSIONS

The condition-specific OHRQoL-OSF identified OSF patients with impaired oral health-related QoL more easily with greater discriminative properties. To better understand patient reported experiences in OSF, these results may guide the choice of instrument in future researches and surveys.

Impact of socioeconomic inequalities on quality of life in oral submucous fibrosis patients

AIM

The purpose of this study was to analyze the impact of socioeconomic characteristics on oral health-related quality of life (OHRQoL) in patients with oral submucous fibrosis (OSF).

METHODS

 A total of 300 OSF patients' quality of life (QoL) data were obtained using OHRQoL-OSF and global self ratings of oral health and overall wellbeing. The socioeconomic status (SES) of participants was analyzed by using modified Kuppuswamy scale.

RESULTS

OSF patients with lower SES had worse OHRQoL as compared with those with middle and upper SES (p < 0.001). The household income of the family was found to be strongly associated with poor OHRQoL.

CONCLUSION

Socioeconomic characteristics should be considered in the holistic management of OSF as it has been strongly associated with the OHRQoL of these patients.

Usage Analysis of WhatsApp for Dentistry-related Purposes among General Dental Practitioners

INTRODUCTION

To assess the knowledge and extent of WhatsApp usage for dentistry related purposes among general dental practitioners (GDPs).

MATERIALS AND METHODS

A cross-sectional study was conducted among 105 randomly selected GDPs from Pune, Maharashtra, India. Data was collected in a personalized manner by means of validated questionnaire. Results and observations: A total of 105 dentists participated in the survey: 96.19% of dentists had WhatsApp installed in their phones; 67.32% of dentists sought second opinion on WhatsApp; 60.29% of dentists received prompt replies, while 38.23% received late replies; 98.52% of dentists sent clinical photographs and radiographs for second opinion. 88.11% of dentists were a part of various 'dentistry related groups' and 72.27% of dentists told that patients ask their queries on WhatsApp. 36.76% of GDPs obtained verbal consent from the patients for sending clinical materials for second opinion. Majority of population of GDPs 63.23% (43) did not obtain any form of consent from the patients.

CONCLUSION

Majority of GDPs uses WhatsApp for 'dentistry related purposes' and it has become an integral part of their day-to-day practice. GDPs should obtain written consent before sending clinical materials for second opinion.

CLINICAL SIGNIFICANCE

Till date, the extent of WhatsApp usage by general dental practitioners was not reported in the literature. It appears that, WhatsApp application has become an integral part of general dental practice in India. By virtue of this, obtaining second opinion, taking appointments and solving queries of patients are no longer a time consuming events. In future, instant messaging services might play major role in providing efficient services in health care industry.

Quality of life and oral potentially malignant disorders: Critical appraisal and prospects

Quality of life (QoL) is a vital and often required health outcome measure that is relevant to patient care. A healthy oral cavity enables person to perform daily activities without any limitations. However, any disturbance may result in impaired QoL. The oral health-remains an essential element of people’s health and well-being. In recent years, the tradition of clinical practice and research has been changed by incorporating QoL assessment, as it helps in assessment of patients’ needs and monitoring treatment responses. Oral potentially malignant disorders (OPMDs) are a group of chronic disorders including oral leukoplakia (OL), oral lichen planus and oral submucous fibrosis (OSF). It is evident that patients with OPMDs experience significant health-related symptoms, functional limitations and psycho-social impairment, compromising their QoL. Moreover, the worsening of QoL has been associated with advanced stages of OPMDs. Despite of increasing number of OPMD cases in recent decades, limited literature is available regarding QoL in this population. Although, there is higher prevalence of habit-related OPMDs, particularly OSF and OL in Southern Asian countries, only a few studies have been performed in these populations. Moreover, these studies administered generic QoL instruments, which offer less sensitivity to clinical changes. However, condition-specific instruments are more sensitive and allows better measurement of QoL. As the impacts of different conditions on OHRQoL may vary, the development and validation of a QoL instrument specific to each clinical entity of OPMDs is currently needed.

Bibliometric analysis of 100 most cited articles on oral submucous fibrosis

BACKGROUND

Citation analysis reflects the scientific recognition and influential performance of an article in the scientific community. The objective of this study was to identify and characterize the 100 most cited articles on oral submucous fibrosis (OSF).

METHODS

A list of 100 most cited articles related to OSF was retrieved from the Science Citation Index-Expanded tool of Scopus database in May 2018. The articles were further reviewed, and basic information was recorded including the number of citations, citation density, journals, with its impact factor, category and quartile, publication year, authors, institution and country of origin, article type and level of evidence. Descriptive statistics were used to summarize the results.

RESULTS

The most frequently cited article received 780 citations, while the least frequently cited article received 49 (mean 107.5 citations per article). There were 38 different journals with Journal of Oral Pathology and Medicine having the most citations (n = 22). The 100 most cited articles were published from 1966 to 2013, with 81% published after 1990. Thirteen authors listed 5 or more articles in the top 100 list, and India was found to be the most prolific country with 38 articles. In terms of article type, there were 72 research articles and 28 review articles.

CONCLUSIONS

This first citation analysis of the 100 most cited articles renders a historical perspective on the progress of research in the field of OSF and enables the comprehensive identification and recognition of the most important and relevant research topics concerned.

"Mind" in Betel-quid Use and Related Disorders

Oral squamous cell carcinoma is characterized by a unique predisposing state called oral potentially malignant disorders (OPMDs). Wide variety of carcinogenic insult in the form of detrimental habits can contribute to the causation of variety of OPMDs.1,2.