Oral lichen planus (OLP) is a chronic inflammatory immune-mediated condition that has been identified as a potentially malignant oral disorder. Various therapies have been proposed for its management as alternative to corticosteroids. However, no definitive treatment has been identified that can result in complete remission or minimal recurrence. Hyaluronic acid has recently been used as an alternative therapy for the management of OLP. This study aimed to systematically review the effectiveness of Hyaluronic acid in the management of symptomatic OLP. Online electronic databases and manual searches were performed for randomized controlled trials (RCTs) published in English between January 2010 and April 2022. RCTs were identified that compared the efficacy of hyaluronic acid and other interventional therapies at baseline and during follow-up. The Cochrane Risk of Bias tool was used to assess the quality of the included studies. Visual analog scale (VAS) scores, Thongprasom sign scores, lesion size, degree of erythema, clinical severity, and disease severity were assessed both quantitatively and qualitatively. Seven studies were analyzed. Five studies reported a high risk of bias while the remaining two studies reported an unclear risk of bias. The overall quantitative assessment of size, symptoms, degree of erythema, and sign score in OLP lesions treated with HA was not statistically significant compared to that in the control group (P > 0.05). In addition, subgroup analysis comparing HA with placebo or corticosteroids did not yield statistically significant (P > 0.05) results. Qualitatively, both HA and tacrolimus resulted in an effective reduction in signs and symptoms. Clinical/disease severity index/scores were inconsistent. A high degree of heterogeneity was observed among the included studies. None of the included studies reported the side effects of HA. These findings suggest that corticosteroids, tacrolimus, placebo, and HA could be equally effective in OLP management. The clinical/disease severity index or score reduction cannot be determined with certainty. Thus, OLP can be treated with HA as an alternative therapy. Owing to limited clinical trials on HA, high heterogeneity, and high risk of bias in the included studies, definitive conclusions cannot be derived.
Introduction: Dental students are subjected to high levels of stress during their academic performance. The quality of sleep could also be affected in those with increased stress levels. Stress and sleep quality could be considered as risk factors in Temporomandibular Joint Disorders (TMD). Identification of the risk factors in TMD at the initial stages can lead to minimising the long term effects. Aim: To investigate the relationship between TMD symptoms, sleep quality and stress among dental students. Materials and Methods: A cross-sectional questionnairebased survey was conducted in the Department of Oral Medicine and Radiology, Sinhgad Dental College and Hospital, Pune, Maharashtra, India, from November 2021 to December 2021 among 255 dental students. Fonseca Anamnestic Index (FAI) questionnaire was used for evaluation of TMD, while Perceived Stress Scale (PSS) and Pittsburgh Sleep Quality Index (PSQI) were used to assess stress scores and sleep quality, respectively. The students were surveyed to categorise them, if they were showing any symptoms of mild, moderate or severe TMD. Similarly the sleep quality and stress scores were assessed. The relationship between TMD with stress and sleep quality was also evaluated. Data analysis was done using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) version 26.0. Comparison of frequencies of scores of PSS, PSQI and FAI within groups was done using Chi-square test. Bivariate correlation between PSS/PSQI, PSS/ FAI ad FAI/PSQI was assessed using correlation coefficient. Results: Out of 255 participants, 182 were females and 73 were males. It was observed that 221 (86.7%) students reported moderate stress levels, 21 (8.2%) students showed mild and 13 (5.1%) subjects showed high stress levels. Temporomandibular symptoms were reported as mild, moderate and severe in 130 (51%), 21 (8.2%) and 9 (3.5%) students, respectively. A total of 229 (89.8%) students showed poor sleep quality and 26 (10.2%) students showed good sleep quality. Moderate stress was correlated with poor sleep quality and mild TMD. Conclusion: The stress levels were significantly correlated with sleep quality and TMD symptoms. Thus, increased stress and poor sleep may be considered as risk factors of TMD. However, longitudinal studies in large samples are required to determine the cause and effect relationships between sleep quality, stress levels and TMD.
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