Salivary Interleukin Levels in Oral Squamous Cell Carcinoma and Oral Epithelial Dysplasia : Findings from a Sri Lankan Study

Acknowledgments The authors would like to thank the laboratory staff at the Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka. The authors would like to thank Thilini Nisansala and Chamikara Liyanage for their help in the laboratory analysis. Funding N.S.P. was financially supported by the Elphinstone Scholarship, University of Aberdeen, UK and the University Grants Commission, Sri Lanka.Peer reviewedPublisher PD

Proliferative Verrucous Leukoplakia of the Gingiva: An Early Lesion Refractory to Surgical Excision

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

Oral Cancer Disease among the Poor: A Sri Lankan Context

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

Spontaneously Regressing Neonatal Oral Aphthous Ulceration of the Palate

Background. Neonatal oral aphthous ulceration of the palate also known as Bednar’s aphthae is not an uncommon presentation. They clinically present as spontaneously regressing, shallow, and symmetrical ulcers on the posterior palate of newborns from 2 days up to 6 weeks of age. Case Presentation. We, herein, report a case of a one-month-old baby girl who presented with an ulcer in the posterior palate and intermittent mild fever. The patient was admitted and monitored in the ward. Haematologic investigations disclosed features of ongoing infection. Nasogastric feeding was commenced to avoid any irritation of the ulcer, and glycerine was applied on the ulcer. Antibiotic therapy was continued because of the intermittent mild fever. The lesion healed spontaneously within one week, and fever subsided afterwards. Currently, the patient is faring healthily without any complications. Conclusion. Although Bednar’s aphthae is not a rare presentation, clinicians are often met with a diagnostic dilemma due to the alarming clinical presentation of this condition. Therefore, it leads to overinvestigation and overtreatment. With this case report, we would like to highlight the importance of being aware of this condition to provide the patients with the appropriate treatment

Comparison of topical tacrolimus and clobetasol in the management of symptomatic oral lichen planus: A double-blinded, randomized clinical trial in Sri Lanka

AimOral lichen planus (OLP) is a common, chronic inflammatory disease of the oral mucosa. Although several studies have shown the efficacy of different treatment modalities, a definitive cure has not yet been established. The present trial compares the effectiveness of topically-applied clobetasol and tacrolimus in the symptomatic management of OLP.MethodsA randomized, comparative, double-blind study with 68 patients (43 females, 25 males; mean age: 46.76 years) was undertaken. Patients were randomly divided into two groups of 34 patients each to receive topical tacrolimus 0.1% cream or clobetasol propionate 0.05% cream for 3 weeks.ResultsAfter 3 weeks of treatment, the mean pain score dropped by 1.59 (right) and 1.53 (left) in the tacrolimus group, while in clobetasol group these values were 0.94 and 0.85, respectively. The mean scores for clinical appearance reduced by 1.18 (right) and 1.0 (left) in the tacrolimus group compared with a reduction of 0.5 and 0.26, respectively, in the clobetasol group. These reductions were statistically significant (P ConclusionThe results suggest that tacrolimus 0.1% cream is an effective alternative to topical steroid and can be considered a first-line therapy in OLP. However, further studies are needed to confirm the effectiveness of this treatment before it is recommended for use in clinical practice.<br/

Economic burden of managing oral cancer patients in Sri Lanka: A cross-sectional hospital-based costing study

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

Linear and Volumetric Analysis of Maxillary Sinus Pneumatization in a Sri Lankan Population Using Cone Beam Computer Tomography

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

Effectiveness of “fill in the blanks” over multiple choice questions in assessing final year dental undergraduates

Background: Possibility of guessing in Multiple Choice questions (MCQ) when assessing undergraduates is considered a weakness. There are limited studies on the use of “Fill in the Blanks” (FIB) to overcome this issue. Objective: To assess the effectiveness of FIB in MCQ for assessing final year dental undergraduates. Methods and materials: A total of 134 final year dental undergraduates were randomly assigned to Group A and B. Group A was given a questionnaire with fifteen single best answer MCQ questions, and then the FIB questionnaire (which included the same questions in FIB form). At the same time Group B was given the FIB questionnaire initially, and then the MCQ questionnaire in the given period of time. The mean scores of the two groups were then compared. Results: Group A obtained a mean score of 10.94 (SD ± 3.203) for MCQ, and 10.48 (SD ± 2.993) for FIB, whereas Group B obtained a mean score of 6.8 (SD ± 2.949) for FIB and 10.05 (SD ± 2.619) for MCQ. There was a statistically significant difference in the mean scores obtained for the two types of tests between Group A (P = .04) and Group B (P = .0001). The difference in the mean scores obtained for the FIB were statistically significant (P = .0001) between the groups, whereas the results were not statistically significant for MCQ (P = .127). Conclusion: MCQ results revealed that the knowledge of the two groups was similar. The differences in the scores obtained for the two types of assessment tools suggest further research is needed to investigate the factors that led to the above observation. Resumen: Antecedentes: Posibilidad de valorar si las preguntas de opción múltiple (MOM) son el punto débil cuando se evalúa a los estudiantes de último año. Hay estudios limitados sobre el uso de «rellenar los espacios en blanco» (REB) para superar este problema. Objetivo: Evaluar la eficacia de REB sobre MOM en la evaluación de los estudiantes de último año de odontología. Métodos y materiales: Se asignó aleatoriamente a un total de 134 estudiantes universitarios de último año de odontología a los grupos A y B. Al grupo A se le entregó un cuestionario con 15 MOM para seleccionar la mejor opción y luego un cuestionario REB (que incluía las mismas preguntas con planteamiento REB). Al mismo tiempo, al grupo B se le entregó el cuestionario REB inicialmente y luego el cuestionario MOM en el período de tiempo determinado. A continuación se compararon las notas medias de los 2 grupos. Resultados: Un grupo obtuvo una puntuación media de 10,94 (DE ± 3,203) en MOM y de 10,48 (DE ± 2,993) en el REB, mientras que el grupo B obtuvo una puntuación media de 6,8 (DE ± 2,949) en el REB y de 10,05 (DE ± 2,619) en el MOM. Hubo una diferencia estadísticamente significativa entre las notas medias obtenidas de los 2 tipos de pruebas entre el grupo A (p = 0,04) y el grupo B (p = 0,0001). La diferencia en las notas medias obtenidas del REB fue estadísticamente significativa (p = 0,0001) entre los grupos, mientras que los resultados no fueron estadísticamente significativos en el MOM (p = 0,127). Conclusión: Los resultados del MOM revelaron que el conocimiento de los 2 grupos era similar. Las diferencias en las notas obtenidas de los 2 tipos de instrumentos de evaluación sugieren que se necesita más investigación para analizar los factores que llevaron a la reflexión anterior. Keywords: Fill in the blanks, Multiple choice questions, Guessing, Effectiveness, Palabras clave: Rellenar los espacios en blanco, Preguntas de opción múltiple, Valorar, Eficaci