Oral Health: An Unmet Need

Oral diseases contribute to a major health care burden in many countries. These diseases affect people throughout their life. This can also be supported by the fact that WHO in 2019 has included oral health in Political Declaration on Universal Health Coverage. It was further endorsed with regional strategies for action on the oral health status of individuals of Africa, South East Asia, and the Pacific region [2]. Oral diseases are known to cause pain, discomfort, disfigurement, or even death. Most dental patients present with oral diseases like dental caries (tooth decay), periodontal diseases, oral cancers, oral manifestations of systemic diseases, oro-facial trauma, cleft lip/palate, and noma. According to The Global Burden of Disease Study in 2017, oral diseases affect approximately 3.5 billion people worldwide, with caries of permanent teeth as the most common condition [3]. It is of interest to note that most of these mentioned oral diseases are preventable and are treatable at early stages to minimize morbidity [3, 4]


INTRODUCTION
We all know that oral health is crucial for the overall health of an individual, with pertinent evidence in the literature. Several organizations even acknowledge the fact that oral health is a medical issue. However, there is a lag in integrating oral health with medical care [1].
Oral diseases contribute to a major health care burden in many countries. These diseases affect people throughout their life. This can also be supported by the fact that WHO in 2019 has included oral health in Political Declaration on Universal Health Coverage. It was further endorsed with regional strategies for action on the oral health status of individuals of Africa, South East Asia, and the Pacific region [2]. Oral diseases are known to cause pain, discomfort, disfigurement, or even death. Most dental patients present with oral diseases like dental caries (tooth decay), periodontal diseases, oral cancers, oral manifestations of systemic diseases, oro-facial trauma, cleft lip/palate, and noma. According to The Global Burden of Disease Study in 2017, oral diseases affect approximately 3.5 billion people worldwide, with caries of permanent teeth as the most common condition [3]. It is of interest to note that most of these mentioned oral diseases are preventable and are treatable at early stages to minimize morbidity [3,4] It is also important to note that the prevalence of the oral disease is increasing continuously owing to increased urbanization in most low and middle-income countries. It can be attributed to inadequate exposure to fluorides as well as poor exposure to oral healthcare services.
Henceforth, we can say that oral diseases range from simple dental caries to mortality and morbidity associated with benign and malignant tumours. As far as oral cancer is concerned, its prevalence is estimated at 4 cases per 100 000 people, and it ranks among the top three cancers in Asian-Pacific countries [4,5].
As for the population affected, there is an association between socioeconomic status and the prevalence/severity of oral diseases [2]. The disease disproportionately affects individuals of low socioeconomic status. However, it is also well known that public health intervention can reduce the burden of these oral diseases. These interventions can address the risk factors associated with the disease, including a balanced diet, quitting deleterious habits like consuming tobacco and alcohol, and encouraging the use of protective equipment during sports.
So this issue will address the problems related to oral health and para oral structures; the diagnostic modalities related to the diagnosis of such problems, e.g., maxillofacial imaging or conventional radiology; or management of such problems. Following articles were included in this guest issue:

ANALYSIS OF EXPRESSION OF MYOFIBROBLASTS IN ORAL SUBMUCOUS FIBROSIS: AN IMMUNOHISTOCHEMISTRY STUDY
This present study was conducted to evaluate the expression of myofibroblasts (MF) in normal oral mucosa and oral mucosa affected with different grades of OSMF. The sample consisted of 80 specimens from clinically and histopathologically confirmed OSMF patients. For analysis, the expression of myofibroblasts was categorized as strong, moderate, weak, and absent. It was concluded that myofibroblasts expression is significantly raised in OSMF patients. Henceforth it was suggested that myofibroblasts could be assessed as a marker for analysing the progression of OSMF.

GINGIVAL SQUAMOUS CELL CARCINOMA MASQUERADING AS LOCALIZED PERIODONTAL DISEASE IN THE MAXILLA: A CASE REPORT
This case report emphasized the vital role of a dental professional in being cognizant of how an inflammatory lesion can mimic a serious condition like squamous cell carcinoma. A patient who visited the screening clinic for an ulcerated lesion in the gingiva was otherwise healthy and was treated for pseudoepitheliomatous hyperplasia, based on the current condition. Radiographic examination revealed metastasis of the entity. It highlights the role of advanced imaging as a vital tool in determining the extent of the disease. It was concluded that if any persistent lesion exhibits features that are not responding to conventional gingival and periodontal treatment options for more than two weeks, it should be referred for further evaluation to rule out cancer.

CURRENT TRENDS IN ANTICANCER DRUG DELIVERY SYSTEM OTHER THAN OR IN COMBINATION WITH CONVENTIONAL THERAPY IN ORAL CANCER -A COMPREHENSIVE REVIEW
This review article discusses different targeted drug delivery vehicles used in the treatment of oral cancer and their future perspectives. Literature search limited to the English language was accomplished using Google scholar, PubMed, EBSCO, Embase, and Scopus databases using the terms oral buccal thin films, Hyperthermia and Thermoablation, Intratumoral, Photodynamic, Immunotherapy, photothermal, and ultrasound therapy in oral cancer. The scientific publications from the last 15 years, i.e., 2005 to 2020, were included. The articles were scrutinized, and those which were not relevant were omitted. The main focus was on understanding the various aspects of different targeted drug delivery vehicles used in the treatment of oral cancer, including advantages, disadvantages, and their future perspectives.

ANALYSING THE SOCIAL RESPONSIBILITY AMONG DENTISTS OF ETHIOPIA
This study was aimed to analyze the social responsibility among dentists of Ethiopia. A cross-sectional study was conducted among 200 dentists practicing in Addis Ababa and Jimma, Ethiopia, in the academic year 2017-18. The data was recorded by filling the predesigned self-administered questionnaire performed by dentists. It was concluded that the dentists know their responsibility for providing better access to dental care to the undeserved, but most of them have seen finance as the major barrier.

EXPLORING DENTAL STUDENTS' PERCEPTIONS OF MENTAL ILLNESS TO ADDRESS UNMET NEEDS A PRELIMINARY STUDY
This brief report aims to explore dental student knowledge and skill gaps in providing oral health care to people with SMI along with attitudes about working with this underserved population. Post-graduate dental students in the United States at a large northeastern university were asked to provide feedback and responses to 5 open-ended questions prior to an educational module about working with people with SMI to inform the lecture. Qualitative content analysis was used to code responses using independent coding and consensus meetings. It was concluded that additional attention to mental illness in dental education could assist future professionals in their skills and knowledge to address the extensive unmet oral health needs of people with SMI.

COMPARISON OF UNSTIMULATED SALIVA ESTROGEN IN POSTMENOPAUSAL WOMEN WITH AND WITHOUT ORAL DRYNESS AND EFFECT OF HRT ON ESTROGEN LEVELS: A CASE-CONTROL STUDY
This study aims to compare the unstimulated salivary estrogen levels in postmenopausal women with and without oral dryness and evaluate the efficacy of Hormone Replacement Therapy (HRT) in relieving oral dryness symptoms in such patients. A case-control study was carried out on 70 selected postmenopausal women. A questionnaire related to oral dryness was given to all the patients to evaluate their response to oral dryness. Patients were asked to spit in a plastic container, and their unstimulated saliva samples were obtained and were analyzed for estimation of salivary estrogen levels by ELISA technique. After analyzing the results of salivary estrogen levels, the patients in the case group with low levels of estrogen were subjected to HRT under the guidance of a gynaecologist. It was concluded that estrogen levels were reduced in oral dryness. HRT showed significant improvement in relieving symptoms of oral dryness. Henceforth, HRT can be considered in the management of oral dryness in postmenopausal women.

CONCLUSION
From the articles compiled in this guest issue, it can be ascertained that systemic diseases link with oral health. So there is a need to learn more about this intimate connection between oral health and overall health. Further, several oral diseases actually affect general health indirectly. But the patient and practitioner are sometimes unaware.
Hence this issue consists of original contributions inclined towards the role and importance of Oral health. Further, this issue will promote the art and science of oral health and provide a platform for different oral physicians to highlight their valuable research that may be of use to the healthcare community and the public.