Prevalence of Tobacco Smoking/ Smokeless Tobacco in Patients with Oral Lichen Planus
Sivesh Sangar1, Jayanth Kumar Vadivel2*, Visalakshi Ramanathan3
1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Reader, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Senior Lecturer, Department of Prosthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Jayanth Kumar Vadivel,
Reader, Department of Oral Medicine and Radiology, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai
600077, Tamil Nadu, India.
E-mail: jayanthkumar@saveetha.com
Received: July 30, 2021; Accepted: August 11, 2021; Published: August 18, 2021
Citation:Sivesh Sangar, Jayanth Kumar Vadivel, Visalakshi Ramanathan. Prevalence of Tobacco Smoking/ Smokeless Tobacco in Patients with Oral Lichen Planus. Int J Dentistry Oral Sci. 2021;8(8):4005-4009. doi: dx.doi.org/10.19070/2377-8075-21000818
Copyright: Jayanth Kumar Vadivel©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
The aim of the study was to determine the prevalence of tobacco smoking/ smokeless tobacco in patients with oral lichen planus. The purpose of the study was to determine if the usage of tobacco is associated with an increase in the occurrence of oral lichen planus among the patients attending Saveetha Dental Hospital, Chennai. A hospital based cross-sectional study was conducted by collecting data by reviewing patients data and analysing the data of 86000 patients between June 2019 and March 2020. 59 patients with oral lichen planus attending Saveetha Dental Hospital, Chennai were included in the study. The data were gathered through semi- closed ended questionnaires and clinical examinations. Results showed that patients who do not consume tobacco have a higher rate of oral lichen planus compared to patients who consume tobacco (13.6%). Data analysis was done using a chi square analysis between tobacco habits with clinical variants (chi-square-3.181; df-5; p-0.023) we found the results were statistically significant (P<0.05) which implies that there was a higher prevalence of erosive and reticular forms of oral lichen planus. Prevalence of smoking/ smokeless tobacco in patients with oral lichen planus is significantly lower than patients who do not consume any form of tobacco.
2.Introduction
3.Conclusion
4.References
Keywords
Oral Lichen Planus; Prevalence; Smoking; Smokeless Tobacco.
Introduction
Lichen planus (LP) is a chronic mucocutaneous disorder of the
stratified squamous epithelium that affects oral and genital. Mucous
membranes, skin, nails and scalp. Oral lichen planus (OLP)
is the mucosal counterpart of cutaneous LP. It is derived from
the Greek word “leichen” which means tree moss and Latin word
“planus” means flat. Lichen planus is one of the mucocutaneous
disorders in which oral involvement preceded the appearance of
other symptoms or lesions at other locations [1-2]. Etiology of
lichen planus as such is not known clearly, but at present it has
been linked to an autoimmune disorder [3-4]. There are cases of
OLP linked to poor oral hygiene [5-6]. Ironically, the usage of tobacco
is not lined to the occurrence of OLP [7-8]. The lesion of
OLP has six different presentation patterns viz, reticular, erosive,
papular, ulcerative, plaque like and bullous forms [9].
In India, tobacco consumption is responsible for half of all the
cancers in men and one- fourth of cancers in women. The World
Health Organisation predicts that tobacco deaths in India may
exceed 1.5 million annually by 2020 [10-11]. Tobacco use in India
differs from the globe. The documented form of tobacco used
globally is cigarettes; however in India only 20% of the tobacco
are consumed as cigarettes, 40% is consumed as bidi, and the rest
in the form of smokeless tobacco [12-13].
The malignant transformation potential of OLP depends on the
clinical variant of OLP. The erosive form of OLP has a high malignant
transformation potential which can go upto 20%. The oral
cancers account for over 30% of all cancers in India; this difference
can be attributed to regional variation in the prevalence
and pattern of habits [14-15]. However, epidemiological data of
the changing trends are lacking. There is inadequate data regarding
the smokeless tobacco use among the population in Chennai,
India.
The aim of this study was to investigate the prevalence of tobacco
smoking/smokeless tobacco in patients with oral lichen
planus visiting Saveetha Dental Hospital, Chennai. Previously our
team has a rich experience in working on various research projects
across multiple disciplines [16-30]. Now the growing trend in this
area motivated us to pursue this project.
Materials and Methods
This retrospective study was conducted under a hospital based
university setting. The study was done among the 86000 cases records
of patients visiting the out patient department of Saveetha
Dental College. The case records of the patients were analysed
and 59 patients with OLP were recorded. Ethical approval for
this study was obtained from the institutional ethical committee
(ethical approval number: SDC/SIHEC/2020/DIASDATA/
0619-0320).
The upside of this study is the presence of validated data as all
the data were already recorded into the system. The downside of
the study is the geographic restriction as the study was only conducted
in one specific area/ region that is in and around Chennai,
India.
They were 2 reviewers involved in the study with data taken
from patients visiting Saveetha Dental Hospital from June 2019
to March 2020. Cross checking of data is done by random verification.
Patients with incomplete follow ups are called on the
telephone. Random verification is done for 10% of the patient
samples.
The internal validity is done by creating a study design followed
by complete data collection and validation of data. The external
validity is done by creating a study design followed by setting up
a clinical setup and creation of duplicatable data. Data collection
was done by the SPSS software system with independent variables
such as smoking and oral lichen planus. Dependent variables
present are age and gender. Data analysis was done using a chi
square analysis between tobacco habits with clinical variants (chisquare-
3.181;df-5;p-0.023) we found the results were statistically
significant (P<0.05) which implies that there was a higher prevalence
of erosive and reticular forms of oral lichen planus.
Results & Discussion
A total of 59 patients belonging to the age group of 20 to 73
years of age with a mean age of 46.1 years. The data plotted as a
histogram with a normal curve shows a near normal distribution
of cases. Fig 1. The gender distribution when analysed shows 35
(59.32%) of the patients were females and 24 (40.67%) of the
patients were males. Fig 2.
In this sample of 59 patients only 8(13.55%) of patients had
the habit of tobacco consumption. We could observe that there
were no significant differences between the gender population
which shows that Oral lichen planus does not have a predilection
of gender. When compared among smokers or those who
consume tobacco, only one out of the 35 females consumed tobacco
whereas for the males there were 7 smokers out of the 24
patients diagnosed with oral lichen planus. The comparison of
gender with tobacco consumption predilection were analysed and
charted into a comparative bar chart. Fig 3.
There are various clinical variants present in oral lichen planus,
they are; reticular, erosive papular, pigmented, ulcerative and bullous.
We made a correlation of the patients with these clinical
variants and found that the majority of the patients had erosive
and reticular lichen planus with it being 27 and 24 patients respectively.
Other variants had less than 3 patients each. The findings
for both tobacco and non- tobacco users were similar with its majority
being erosive followed by reticular but a tobacco user had a
papular variant as well. This has been tabulated in Fig 4.
Tobacco consumption in multiple forms is an emerging, significant
and growing threat to health. More than 7000 different chemicals
have been found in tobacco and tobacco smoke. Among these
more than 60 are considered as carcinogenic. Smokeless form
of tobacco is practiced more commonly than smoking in India.
Among the smokeless forms of tobacco, commercially available
sachets are becoming common, especially among teenagers and
young adults than in the older age groups. A definite association
has been recorded between tobacco habits and oral mucosal lesions
such as pre malignant diseases and oral cancer. [11, 31, 32].
Oral lichen planus affects about one to two percent of the adult
population. It usually affects adults around 50- 60 years of age,
although they do agency younger adults and children as well. It
is more common in women than in men (1.4: 1). A history of
lichen planus in family members is sometimes present [33]. The
clinical features alone may be sufficiently diagnostic, particularly
in the reticular variant. The evidence regarding the need and value
of biopsy for histological confirmation of the diagnosis is not
definitive [6]. Studies have shown variability in both interobserver
and intraobserver reliability in the clinicopathological assessment
of OLP [34].
In lieu of the elimination of precipitating or provoking factors
is the initial step in the management of oral lichen planus[35].
Patient education and the undertaking of active measures to resolve
or minimize mechanical trauma from dental procedures,
sharp cusps, rough dental restorations, and ill-fitting prosthesis,
or chemical trauma from acidic, spicy, or strongly flavored foods
and beverages should be encouraged and can lead to symptomatic
improvement, or, more rarely, resolution of the disease [36]. The
accumulation of bacterial plaque, often as a result of discomfort
associated with oral hygiene procedures in patients with gingival
involvement, may also exacerbate the condition [37].
In comparing the oral habits such as smoking and tobacco usage
with oral lichen planus, it was noticed that the prevalence of oral
habit was found to be much higher in males than in females in this
study and similar findings are reported by other authors [38, 39].
Moreover, the habit was highly prevalent at the earlier age group
among earlier age groups. These findings are similar to the earliest
studies reported by Mehrota et al., [40, 41]. Prevalence of oral
habits in India reported by various authors in different geographical
areas are as follows at Chennai region 6.99%, Belgium region
21.8%, Allahabad 21% and Bangalore region 7.53% [42, 43].
13.6% of patients with oral lichen planus had used some form
of tobacco in the past based on our study. Kaveri Hallikeri et al,
the prevalence of lichen planus among patients who have a habit
of tobacco usage is 5.5% [44]. In a study done by Prashant Patil
[45], the prevalence of oral lichen planus amongst patients with
the habit of smoking/smokeless tobacco is 0.9%. The difference
in prevalence rate is duly caused by the difference in sample sizes
taken up for this study.
The clinical variants of oral lichen planus are divided into 6 categories,
they are erosive, reticular, popular, bullous, pigmented
and ulcerative. In tobacco users, the highest clinical variant found
is erosive followed by reticular and papular. In non-tobacco users,
erosive clinical variant is the highest followed by reticular and
pigmented.
The limitations found in the study are geographic restrictions as
the patients are from around the same region. Besides, there was
only a single ethnicity as the group of people are from the same
ethnicity group. A number of patients were excluded as they did
no report for follow up appointments as they failed to adhere to
their appointments dates.
The future scope of exploration in regards to oral lichen planus
with a more widely carried out study in different regions of the
world and not confined to a single geographical location. An additional
scope which involves the types of tobacco consumption in
the aspect of both smoking form of tobacco as well as smokeless
forms of tobacco. Our institution is passionate about high quality
evidence based research and has excelled in various fields [46-56].
We hope this study adds to this rich legacy.
Figure 1: The histogram depicts the age distribution of the pulpitis patients. X-axis shows the age of the patients and Y-axis shows the percentage of patients with oral lichen planus. The mean age was 46.1 years.
Figure 2: The pie chart shows the gender distribution. Males(blue) account for 24 cases and females account for 35 cases.
Figure 3: This is a clustered bar graph showing the relationship between gender with tobacco habits. X axis gives the tobacco habits and Y axis gives the percentage. The prevalence rate of oral lichen planus is higher in non-tobacco users. On a chi square analysis between gender with prevalence of recurrent oral lichen planus (chi-square-8.408;df-1;p-0.004) we found the results were statistically significant(P<0.05) which implies that there were higher prevalence of recurrent oral lichen planus.
Figure 4: The clustered bar graph showing the relationship between tobacco habits with clinical variants. X axis gives the tobacco habits and Y axis gives the percentage. The prevalence rate of oral lichen planus is higher in non-smokers with the highest form of clinical variants being erosive forms. On a chi square analysis between tobacco habits with clinical variants (chi-square-3.181;df-5;p-0.023), the results were statistically significant(P<0.05) which implies that there was a higher prevalence of erosive and reticular forms of oral lichen planus.
Conclusion
Within the limits of the study, patients who have been diagnosed
with oral lichen planus are mostly non- tobacco users when compared
to tobacco users.
References
-
[1]. Suwal P. ‘General Systemic Evaluation of Prosthodontic Patients: A Literature
Review’, 2013;13(2):90–94.
[2]. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005 Nov 19;366(9499):1809-20.
[3]. Mootha A, Malaiappan S, Jayakumar ND, Varghese SS, Toby Thomas J. The Effect of Periodontitis on Expression of Interleukin-21: A Systematic Review. Int J Inflam. 2016;2016:3507503.Pubmed PMID: 26998377.
[4]. Varghese SS, Thomas H, Jayakumar ND, Sankari M, Lakshmanan R. Estimation of salivary tumor necrosis factor-alpha in chronic and aggressive periodontitis patients. Contemp Clin Dent. 2015 Sep;6(Suppl 1):S152-6. Pubmed PMID: 26604566.
[5]. Ramesh A, Varghese SS, Jayakumar ND, Malaiappan S. Chronic obstructive pulmonary disease and periodontitis–unwinding their linking mechanisms. J. Oral Biosci. 2016 Feb 1;58(1):23-6.
[6]. Priyanka S, Kaarthikeyan G, Nadathur JD, Mohanraj A, Kavarthapu A. Detection of cytomegalovirus, Epstein-Barr virus, and Torque Teno virus in subgingival and atheromatous plaques of cardiac patients with chronic periodontitis. J Indian Soc Periodontol. 2017 Nov-Dec;21(6):456-460.Pubmed PMID: 29551863.
[7]. Foz AM, Artese HP, Horliana AC, Pannuti CM, Romito GA. Occlusal adjustment associated with periodontal therapy--a systematic review. J Dent. 2012 Dec;40(12):1025-35.Pubmed PMID: 22982113.
[8]. Herrera D, Roldán S, González I, Sanz M. The periodontal abscess (I). Clinical and microbiological findings. J Clin Periodontol. 2000 Jun;27(6):387- 94.
[9]. Khalid W, Vargheese SS, Lakshmanan R, Sankari M, Jayakumar ND. Role of endothelin-1 in periodontal diseases: A structured review. Indian J Dent Res. 2016 May-Jun;27(3):323-33.Pubmed PMID: 27411664.
[10]. Khalid W, Varghese SS, Sankari M, Jayakumar ND. Comparison of Serum Levels of Endothelin-1 in Chronic Periodontitis Patients Before and After Treatment. J Clin Diagn Res. 2017 Apr;11(4):ZC78-ZC81.Pubmed PMID: 28571268.
[11]. Avinash K, Malaippan S, Dooraiswamy JN. Methods of Isolation and Characterization of Stem Cells from Different Regions of Oral Cavity Using Markers: A Systematic Review. Int J Stem Cells. 2017 May 30;10(1):12-20. Pubmed PMID: 28531913.
[12]. Ramamurthy JA, Mg V. Comparison of effect of Hiora mouthwash versus Chlorhexidine mouthwash in gingivitis patients: A clinical trial. Asian J Pharm Clin Res. 2018 Jul 7;11(7):84-8.
[13]. Nyman SR, Lang NP. Tooth mobility and the biological rationale for splinting teeth. Periodontol 2000. 1994 Feb;4(1):15-22.
[14]. Nyman S, Lindhe J. Persistent tooth hypermobility following completion of periodontal treatment. J Clin Periodontol. 1976 May;3(2):81-93.Pubmed PMID: 1064597.
[15]. Mühlemann HR. Tooth Mobility: The Measuring Method. Initial and Secondary Tooth Mobility. J Periodontol. 1954 Jan;25(1):22–9.
[16]. Schulte W, d'Hoedt B, Lukas D, Maunz M, Steppeler M. Periotest for measuring periodontal characteristics--correlation with periodontal bone loss. J Periodontal Res. 1992 May;27(3):184-90.Pubmed PMID: 1608031.
[17]. Castellini P, Scalise L, Tomasini EP. Teeth mobility measurement: a laser vibrometry approach. J Clin Laser Med Surg. 1998 Oct;16(5):269-72.Pubmed PMID: 9893508.
[18]. Goellner M, Berthold C, Holst S, Wichmann M, Schmitt J. Correlations between photogrammetric measurements of tooth mobility and the Periotest method. Acta Odontol Scand. 2012 Jan;70(1):27-35.Pubmed PMID: 21504267. [19]. Mühlemann HR. 10 years of tooth-mobility measurements. J. Periodontol. 1960 Apr;31(2):110-22. [20]. Persson R. Assessment of tooth mobility using small loads. II. Effect of oral hygiene procedures. J Clin Periodontol. 1980 Dec;7(6):506-15.Pubmed PMID: 7012187.
[21]. Persson R. Assessment of tooth mobility using small loads. III. Effect of periodontal treatment including a gingivectomy procedure. J Clin Periodontol. 1981 Feb;8(1):4-11.Pubmed PMID: 6941976.
[22]. Serio FG. Clinical rationale for tooth stabilization and splinting. Dent Clin North Am. 1999 Jan 1;43(1):1-6.
[23]. Forabosco A, Grandi T, Cotti B. The importance of splinting of teeth in the therapy of periodontitis. Minerva Stomatol. 2006 Mar;55(3):87-97.Pubmed PMID: 16575381.
[24]. Thamaraiselvan M, Elavarasu S, Thangakumaran S, Gadagi JS, Arthie T. Comparative clinical evaluation of coronally advanced flap with or without platelet rich fibrin membrane in the treatment of isolated gingival recession. J Indian Soc Periodontol. 2015 Jan;19(1):66.
[25]. Ravi S, Malaiappan S, Varghese S, Jayakumar ND, Prakasam G. Additive Effect of Plasma Rich in Growth Factors With Guided Tissue Regeneration in Treatment of Intrabony Defects in Patients With Chronic Periodontitis: A Split-Mouth Randomized Controlled Clinical Trial. J Periodontol. 2017 Sep;88(9):839-845.Pubmed PMID: 28474968.
[26]. Panda S, Jayakumar ND, Sankari M, Varghese SS, Kumar DS. Platelet rich fibrin and xenograft in treatment of intrabony defect. Contemp Clin Dent. 2014 Oct;5(4):550.
[27]. Ramesh A, Ravi S, Kaarthikeyan G. Comprehensive rehabilitation using dental implants in generalized aggressive periodontitis. J Indian Soc Periodontol. 2017 Mar;21(2):160.
[28]. Kavarthapu A, Thamaraiselvan M. Assessing the variation in course and position of inferior alveolar nerve among south Indian population: A cone beam computed tomographic study. Indian J Dent Res. 2018 Jul- Aug;29(4):405-409.Pubmed PMID: 30127186.
[29]. Ramesh A, Vellayappan R, Ravi S, Gurumoorthy K. Esthetic lip repositioning: A cosmetic approach for correction of gummy smile - A case series. J Indian Soc Periodontol. 2019 May-Jun;23(3):290-294.Pubmed PMID: 31143013.
[30]. Ramesh A, Varghese SS, Doraiswamy JN, Malaiappan S. Herbs as an antioxidant arsenal for periodontal diseases. J Intercult Ethnopharmacol. 2016 Jan 27;5(1):92-6.Pubmed PMID: 27069730.
[31]. Soares PB, Fernandes Neto AJ, Magalhães D, Versluis A, Soares CJ. Effect of bone loss simulation and periodontal splinting on bone strain: Periodontal splints and bone strain. Arch Oral Biol. 2011 Nov;56(11):1373-81.Pubmed PMID: 21550587.
[32]. Jain AR. Prevalence of partial edentulousness and treatment needs in rural population of South India. World J. Dent. 2017 Jun;8(3):213-7.
[33]. Varghese SS, Ramesh A, Veeraiyan DN. Blended Module-Based Teaching in Biostatistics and Research Methodology: A Retrospective Study with Postgraduate Dental Students. J Dent Educ. 2019 Apr;83(4):445-450.Pubmed PMID: 30745352.
[34]. Ashok V, Ganapathy D. A geometrical method to classify face forms. J Oral Biol Craniofac Res. 2019 Jul 1;9(3):232-5.
[35]. Padavala S, Sukumaran G. Molar incisor hypomineralization and its prevalence. Contemp. Clin. Dent. 2018 Sep;9(Suppl 2):S246-50.
[36]. Ke Y, Al Aboody MS, Alturaiki W, Alsagaby SA, Alfaiz FA, Veeraraghavan VP, et al. Photosynthesized gold nanoparticles from Catharanthus roseus induces caspase-mediated apoptosis in cervical cancer cells (HeLa). Artif Cells Nanomed Biotechnol. 2019 Dec;47(1):1938-1946.Pubmed PMID: 31099261.
[37]. Ezhilarasan D. Oxidative stress is bane in chronic liver diseases: Clinical and experimental perspective. Arab J Gastroenterol. 2018 Jun;19(2):56-64.Pubmed PMID: 29853428. [38]. Krishnan RP, Ramani P, Sherlin HJ, Sukumaran G, Ramasubramanian A, Jayaraj G, et al. Surgical Specimen Handover from Operation Theater to Laboratory: A Survey. Ann Maxillofac Surg. 2018 Jul-Dec;8(2):234-238. Pubmed PMID: 30693238.
[39]. Ezhilarasan D, Sokal E, Najimi M. Hepatic fibrosis: It is time to go with hepatic stellate cell-specific therapeutic targets. Hepatobiliary Pancreat Dis Int. 2018 Jun;17(3):192-197.Pubmed PMID: 29709350.
[40]. Pandian KS, Krishnan S, Kumar SA. Angular photogrammetric analysis of the soft-tissue facial profile of Indian adults. Indian J. Dent. Res. 2018 Mar 1;29(2):137-43.
[41]. Ramamurthy JA, Mg V. Comparison of effect of Hiora mouthwash versus Chlorhexidine mouthwash in gingivitis patients: A clinical trial. Asian J Pharm Clin Res. 2018 Jul 7;11(7):84-8.
[42]. Gupta P, Ariga P, Deogade SC. Effect of Monopoly-coating Agent on the Surface Roughness of a Tissue Conditioner Subjected to Cleansing and Disinfection: A Contact Profilometric In vitro Study. Contemp Clin Dent. 2018 Jun;9(Suppl 1):S122-S126.Pubmed PMID: 29962776.
[43]. Vikram NR, Prabhakar R, Kumar SA, Karthikeyan MK, Saravanan R. Ball Headed Mini Implant. J Clin Diagn Res. 2017 Jan;11(1):ZL02-3.
[44]. Paramasivam A, Vijayashree Priyadharsini J, Raghunandhakumar S. N6- adenosine methylation (m6A): a promising new molecular target in hypertension and cardiovascular diseases. Hypertens Res. 2020 Feb;43(2):153- 154.Pubmed PMID: 31578458.
[45]. Palati S, Ramani P, Shrelin HJ, Sukumaran G, Ramasubramanian A, Don KR, et al. Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes. Indian J Dent Res. 2020 Jan-Feb;31(1):22-25.Pubmed PMID: 32246676.
[46]. Samuel SR, Acharya S, Rao JC. School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial. J Public Health Dent. 2020 Jan;80(1):51-60.Pubmed PMID: 31710096.
[47]. Ebeleseder KA, Glockner K, Pertl C, Städtler P. Splints made of wire and composite: an investigation of lateral tooth mobility in vivo. Endod Dent Traumatol. 1995 Dec;11(6):288-93.Pubmed PMID: 8617165.
[48]. Kumbuloglu O, Saracoglu A, Ozcan M. Pilot study of unidirectional E-glass fibre-reinforced composite resin splints: up to 4.5-year clinical follow-up. J Dent. 2011 Dec;39(12):871-7.Pubmed PMID: 22001066.
[49]. Sekhar LC, Koganti VP, Shankar BR, Gopinath A. A comparative study of temporary splints: bonded polyethylene fiber reinforcement ribbon and stainless steel wire + composite resin splint in the treatment of chronic periodontitis. J Contemp Dent Pract. 2011 Sep 1;12(5):343-9.Pubmed PMID: 22269194.
[50]. Bhawna G. Burden of smoked and smokeless tobacco consumption in India - results from the Global adult Tobacco Survey India (GATS-India)- 2009-2010. Asian Pac J Cancer Prev. 2013;14(5):3323-9.Pubmed PMID: 23803124.
[51]. Kinane DF, Chestnutt IG. Smoking and periodontal disease. Crit Rev Oral Biol Med. 2000 Jul;11(3):356-65.
[52]. Sobouti F, Rakhshan V, Saravi MG, Zamanian A, Shariati M. Two-year survival analysis of twisted wire fixed retainer versus spiral wire and fiberreinforced composite retainers: a preliminary explorative single-blind randomized clinical trial. Korean J Orthod. 2016 Mar;46(2):104-10.Pubmed PMID: 27019825.
[53]. Akcali A, Gümüs P, Özcan M. Clinical comparison of fiber-reinforced composite and stainless steel wire for splinting periodontally treated mobile teeth. Braz. Dent. Sci. 2014 Aug 25;17(3):39-49.
[54]. Vijayashree Priyadharsini J. In silico validation of the non-antibiotic drugs acetaminophen and ibuprofen as antibacterial agents against red complex pathogens. J Periodontol. 2019 Dec;90(12):1441-1448.Pubmed PMID: 31257588.
[55]. Pc J, Marimuthu T, Devadoss P, Kumar SM. Prevalence and measurement of anterior loop of the mandibular canal using CBCT: A cross sectional study. Clin Implant Dent Relat Res. 2018 Apr 6;20(4):531-4.
[56]. Ramesh A, Varghese S, Jayakumar ND, Malaiappan S. Comparative estimation of sulfiredoxin levels between chronic periodontitis and healthy patients - A case-control study. J Periodontol. 2018 Oct;89(10):1241-1248.Pubmed PMID: 30044495.
[57]. Ramadurai N, Gurunathan D, Samuel AV, Subramanian E, Rodrigues SJ. Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial. Clin Oral Investig. 2019 Sep;23(9):3543-50.
[58]. Sridharan G, Ramani P, Patankar S, Vijayaraghavan R. Evaluation of salivary metabolomics in oral leukoplakia and oral squamous cell carcinoma. J Oral Pathol Med. 2019 Apr;48(4):299-306.
[59]. Ezhilarasan D, Apoorva VS, Ashok Vardhan N. Syzygium cumini extract induced reactive oxygen species-mediated apoptosis in human oral squamous carcinoma cells. J Oral Pathol Med. 2019 Feb;48(2):115-121.Pubmed PMID: 30451321.
[60]. Mathew MG, Samuel SR, Soni AJ, Roopa KB. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clin Oral Investig. 2020 Sep;24(9):1-6.Pubmed PMID: 31955271.
[61]. Samuel SR. Can 5-year-olds sensibly self-report the impact of developmental enamel defects on their quality of life? Int J Paediatr Dent. 2021 Mar;31(2):285-286.Pubmed PMID: 32416620.
[62]. R H, Ramani P, Ramanathan A, R JM, S G, Ramasubramanian A, et al. CYP2 C9 polymorphism among patients with oral squamous cell carcinoma and its role in altering the metabolism of benzo[a]pyrene. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Sep;130(3):306-312.Pubmed PMID: 32773350.
[63]. Chandrasekar R, Chandrasekhar S, Sundari KKS, Ravi P. Development and validation of a formula for objective assessment of cervical vertebral bone age. Prog Orthod. 2020 Oct 12;21(1):38.Pubmed PMID: 33043408.
[64]. Vijayashree Priyadharsini J, Smiline Girija AS, Paramasivam A. In silico analysis of virulence genes in an emerging dental pathogen A. baumannii and related species. Arch Oral Biol. 2018 Oct;94:93-98.Pubmed PMID: 30015217.
