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OBJECTIVE: Importance of oral health during pregnancy has been well reported. To prevent the occurrence of oral diseases and maintenance of oral health, a number of guidelines have been developed by different organizations. However, despite numerous efforts in development of these guidelines, a critical evaluation of the quality of guidelines has not been carried out. Thus, we aimed to perform a systematic review to assess the quality of guidelines on oral health care during pregnancy. METHODS: PubMed, Embase, Scopus and Cochrane Databases were electronically searched in March 2024. STUDY ELIGIBILITY CRITERIA: We included guidelines that were carried out within last 10 years and focused on oral health during pregnancy were included in this review. Guidelines focused for both oral health professionals and non-oral health professionals were included in this review. The assessment of the guidelines in this review was carried out using the AGREE II instrument. The four appraisers who carried out the assessment comprised of a gynecologists, a dental practioners, a public health expert and a dental public health professional. The instrument comprises of 23 key items within six domains and two additional global rating items. RESULTS: We included eight guidelines in this review. The AGREE II showed two domains with mean score of more than 70% scores across the guidelines. A comparative evaluation of all the guidelines revealed consistently higher scores in scope and purpose (81.71 + 6.3) and clarity of presentation (71.61 + 11.7). Lowest mean scores were reported for editorial independence (47.87 + 7.21) followed by rigour of development (56.19 + 16.97), applicability (57.50 + 13.7) and stakeholder involvement domain (63.17 + 14.31). CONCLUSION: Although many guidelines have demonstrated adherence to systematic methodologies, there still exists a scope of improvement in domains such as editorial independence, rigour of development, applicability and stakeholder involvement. Addressing these shortcomings is essential for promoting evidence-based oral health care practices and improving maternal and neonatal health outcomes.

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Background: Tobacco usage is a major global public health concern, contributing to millions of deaths annually. This study focuses on security guards, an occupational group facing unique challenges, to investigate tobacco prevalence, usage patterns, and associated oral health risks. Methods: A cross-sectional study was conducted among security guards at a Tertiary Health Care Centre, from October 2022 to February 2023. Data on demographics, tobacco habits, and comorbidities were collected via a structured questionnaire. Clinical oral examinations provisionally diagnosed Oral Potentially Malignant Disorders (OPMDs) based on clinical findings. Appropriate Statistical analyses were employed. Results: Among 696 security guards, 40.1% used tobacco, including 15.0% smokers and 74.5% engaging in smokeless tobacco. Additionally, 10.3% reported using both smoking and smokeless forms. Non-tobacco users accounted for 59.9%. Tobacco users showed a higher prevalence of OPMDs (11.4%) compared to non-tobacco users (1.4%). Discussion: Security guards demonstrated a higher tobacco prevalence, with smokeless tobacco being predominant. Gender disparities in tobacco use emphasize the need for gender-specific interventions. The study highlights the significant impact of tobacco on oral health, especially the risk of OPMDs. Conclusion: A high prevalence of tobacco usage (40.1%), particularly smokeless tobacco, among security guards, emphasizes the importance of targeted interventions within this occupational group. Oral Potentially Malignant Disorders (OPMDs) were significantly more prevalent (11.4%) in tobacco users. The association between tobacco usage and OPMDs reaffirms the well-established association between tobacco and adverse oral health outcomes.

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AIM. The aim of this study was to train dentists on the different oral hygiene measures to be followed by COVID-19 patients via Webinar and Information Education Communication (IEC) Materials and compare the effectiveness of both. METHODOLOGY. A total of 100 dental professionals were included by non-probability convenience sampling. Webinar and IEC Materials on oral hygiene measures, oral symptoms, and management strategies during COVID-19 were created and training was conducted for all dental professionals who registered themselves. An online version of the self-administered questionnaire (English) was created on the official Edantseva website and circulated to all the registered participants to obtain the pre and post-training data. RESULTS. Out of the total 80 participants in the Webinar group, 47 were females and 33 were males. Comparing the mean total scores obtained by the participants in the webinar and IEC groups in the pre and post-test showed that there is a significant difference in the scores obtained by the participants in the two groups in the pre and post-test (p<0.01). CONCLUSION. Educating dentists via IEC Materials was effective in improving their knowledge regarding oral health management during the COVID-19 pandemic. IEC materials being handy and referable at any time was found to be more effective.

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AIM: To evaluate the systematic reviews assessing the effectiveness of any type of school-based oral health programs in children and adolescents. METHODOLOGY: A two-staged search strategy comprising electronic databases and registries based on systematic reviews was employed to evaluate the effectiveness of school-based interventions. The quality assessment of the systematic reviews was carried out using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool. The Corrected Covered Area was used to evaluate the degree of overlap. RESULTS: Nine reviews were included in this umbrella review. The Critical Covered Area reported moderate overlap (5.70%) among the primary studies. The assessment of risk of bias revealed one study with a high level confidence; one with moderate whereas all other studies with critically low confidence. Inconclusive evidence related to improvements in dental caries and gingival status was reported whereas, plaque status improved in a major proportion of the reviews. Knowledge, attitude, and behavior significantly increased in students receiving educational interventions when compared to those receiving usual care. CONCLUSIONS: The evidence points to the positive impact of these interventions in behavioral changes and clinical outcomes only on a short term basis. There is a need for long-term follow-up studies to substantiate the outcomes of these interventions.

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AIM: To systematically review the evidence from published literature about the impact of war on oral health among children and adults. METHODOLOGY: The electronic search was carried out in the following databases Pubmed, Cochrane, Scopus, Embase, Google Scholar. In vitro studies, cross-sectional, case control studies, and randomized controlled trials conducted during the war time were included. Cross-sectional and case control studies were assessed based on the Newcastle-Ottawa Scale, whereas randomized controlled trials were assessed based on the ROBINS-I tool. In-vitro studies included in this review were assessed using the United States national toxicology program tool. RESULTS: The search strategy yielded a total of 5126 articles and finally 21 articles were included in the review. The influence of war on oral health was categorized among both the children and adult population. A total of 14 studies were carried out in children whereas the remaining seven studies were carried out in adults. A decrease in dental caries was observed in more war-prone areas due to the limited availability of carbohydrates and sugar. Severe periodontal disease in the adult population, mainly due to less availability of food and diminished oral hygiene habits, was also reported. CONCLUSIONS: This review underscores the multifaceted impact of war on oral health, revealing a notable prevalence of periodontal problems, craniofacial injuries and varying rates of dental caries across affected populations.

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BACKGROUND: Individuals with bleeding disorders have been reported to have a number of oral health issues due to varying conditions. A comprehensive evaluation of the different oral health conditions has not been carried out in the past. This systematic review and meta-analysis was carried out to collate and critically analyse existing research, and provide a comprehensive overview of the current state of knowledge on oral health. METHODS: A comprehensive search was conducted in electronic databases, including PubMed, Scopus and Embase, in October 2023. No restriction on time frame or language was applied. The risk of bias for cross-sectional studies was assessed using the Agency for Healthcare Research and Quality (AHRQ) tool, and case control studies were assessed using the New Castle Ottawa Scale (NOS). RESULTS: Twenty-two articles were included in the final analysis with a total sample size of 2422 subjects. Of the 22 articles assessed, nine quantitative assessments were included in the Meta analysis. Pooled data analysis was carried out. A total of 13 studies reported medium risk whereas the remaining nine studies showed low risk of bias. The weighted mean DMFT scores in individuals with bleeding disorders were found to be 2.43 [0.62. 4.24], mean dmft was 2.79 [1.05, 4.53] and mean OHI-S was reported to be 1.79 [1.00, 2.57], respectively. CONCLUSION: The findings emphasize that these individuals have fair oral hygiene and lower dmft/DMFT scores. Oral bleeding emerged as an important oral health component to be cautiously dealt with particularly during the stages of exfoliation/shedding.

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AIM: This qualitative study sought to assess the influence of cultural factors and family on oral health behaviour of 12- to 15-year-old adolescents from the socially disadvantaged population. DESIGN: A qualitative design was developed with focus group discussions (FGDs) among 12- to 15-year-old adolescents. Four focus groups (n = 32 participants) were created from a selected sample to capture oral health beliefs and practices, oral health-seeking behaviour along with other relevant information. Focus group discussions were audio-recorded, transcribed verbatim and translated. Data were analysed thematically and structural coding was applied. RESULTS: Three key themes that emerged from FGDs were importance of oral health; role of family in oral health behaviour; and beliefs influencing access, prevention and treatment of oral diseases. Cultural background, family values and beliefs were imperative in moulding the behaviour of adolescents towards oral health. The use of traditional oral hygiene aides was a norm in this population. CONCLUSIONS: Findings of the study provide greater insights into the authoritative role of family and cultural barriers in the uptake of dental services. The study also highlights the potential value of qualitative research and emphasizes the need to integrate oral health-associated cultural beliefs and attitudes of the adolescents towards a wider evidence base.

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AIM: The Oral Health Values Scale is a multidimensional instrument that identifies and measures a person's values related to oral health. This scale has been validated in American respondents. This study aims to evaluate the adaptability and validity of the Oral Health Values Scale in the Hindi language (H-OHVS). METHODOLOGY: A total of 240 adults participated in the study that was carried out from July to November 2022. An offline one-to-one survey was carried out to collect data by an investigator blinded to the study protocol. The translation and testing of the OHVS were carried out based on the cross-cultural adaptation guidelines of the American Academy of Orthopedic Surgeons (AAOS) Evidence-Based Medicine Committee. The content validity was assessed by an expert panel. Construct validity was analyzed through Exploratory Factor Analysis (EFA), utilizing principal component analysis with varimax rotation. The internal consistency of the Hindi version of OHVS was evaluated using Cronbach's alpha. RESULTS:  The results showed that H-OHVS had an Item-level Construct Validity Index (I-CVI) ranging from 0.82 to 1.00. Two components, compliance and hesitance, were formed on H-OHVS accounting for 63.91% of the cumulative variance. The resulting model fit indices on confirmatory factor analysis presented an adequate fit to the data. The overall Cronbach's alpha coefficient for H-OHVS (α = 0.868) presents excellent internal consistency. CONCLUSIONS: The study findings provide a certain degree of evidence in favor of this scale and establish the Oral Health Values Scale (OHVS) as a psychometrically sound measure.

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AIM: This study was undertaken to evaluate the risk factors and associated pathways for unmet dental prosthetic needs among older adult population in Central India. METHODS: A total of 11,145 randomly selected older adults participated in the study; 4613 from urban region and 6532 form rural region. Oral examinations were conducted at individual households for recording dental caries, periodontal disease, prosthetic status and needs. Structural Equation Modelling (SEM) was used to examine relationship between a set of exogenous variables and unmet dental prosthetic needs with variables that remained significant in the adjusted multilevel logistic model. Path coefficients were calculated for all variables with 95% confidence interval. Goodness of fit of the model was assessed by several indices. RESULTS: A total of 8433 (75.7%) participants had never visited a dentist and 9139 (82%) had unmet dental prosthetic needs. Dental caries was observed among 3207 (69.5%) and 4644 (71.1%) study participants from urban and rural regions respectively (p < .05). Low utilization of dental services was associated with high dental prosthetic needs in upper arch and lower arch (PC = -0.05, 0.001) and DMFT was associated with lower utilization of dental services (PC = -0.09, 0.001). DMFT was also associated with age, annual income, level of education, paternal education, type of family, tobacco consumption and CPI score in the hypothesized model. The fit indices used indicated that the model was adequate. CONCLUSIONS: Dental prosthetic needs in the proposed pathway model was associated with low utilization of dental services, dental caries, periodontal disease and other socio-demographic factors.

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OBJECTIVE: Several prevalence studies have estimated the region-specific impact of oral diseases on oral health-related quality of life. However, none of them reported and compared the same from a global perspective. This meta-analysis aims to evaluate pooled epidemiologic data about child-oral impacts on daily performance (C-OIDP) globally. METHODS: A search was conducted in PubMed, Science Direct, SciELO, Semantic scholar, and Cochrane databases up to January 2023. Studies evaluating OIDP among 11-18-year-olds were included in the review. Quality of the included studies was evaluated using the health states quality index for cross-sectional studies. The meta-analysis used R package software version 4.3.0. A common effect model was used to calculate the pooled prevalence. The protocol was registered in the PROSPERO (CRD-NIHR) database with Reference ID CRD42023393798. RESULTS: The systematic literature search yielded 257 unique citations. After screening titles and abstracts, 214 irrelevant citations were excluded, leaving 55 for full-text review. Overall, 43 studies from 23 countries were included. The meta-analysis reported a pooled prevalence impact C-OIDP of 53.36% (CI: 52.78-53.95, 43 studies, 16,622 participants). The prevalence of C-OIDP scores among South America, Asia, Europe, Africa and Oceania was 83%, 63%, 58%, 33% and 47%, respectively. The maximum prevalence was reported in South America while the least prevalence was noted in the African population. CONCLUSION: Oral diseases affect the oral health-related quality of life of more than half of children and adolescents globally. Huge variations were noted in the prevalence of oral impacts across different regions. These findings can be utilized by policymakers to draft measures required for reducing impacts of oral diseases and improving the health-related quality of life.

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OBJECTIVE: This systematic review was conducted to explore the factors influencing access to oral health services and to identify and examine the strategies to improve the access. MATERIALS AND METHODS: PubMed, Scopus and Embase databases were searched. Studies except editorials reported in English regardless of the study design were included. Risk of Bias assessment was carried out using Agency for Healthcare Research and Quality, Newcastle Ottawa Scale and The Joanna Briggs Institute tool for cross-sectional, case-control and cohort and qualitative studies, respectively. RESULTS: In total, 11,372 records were initially identified, eventually leading to 12 relevant publications to be included in the review. Individuals valued oral health but found it difficult to access oral health services. Dental care was mainly accessed during emergencies and participants felt apprehensive in visiting dentists. Caregiver's and dentist's perspective was also reported. CONCLUSION: There is a need for provision of education, training and increasing awareness on dental hygiene and annual dental checkups to improve access.

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OBJECTIVES: Most studies focusing on oral hygiene status in hearing impaired individuals are cross-sectional and focus on specific populations. A comprehensive literature search and evidence-based analysis was carried out to assess the oral hygiene status in this special group of population. METHODS: Searches were conducted in four databases with no restriction on publication date. Cross-sectional and comparative cross-sectional studies assessing the oral hygiene status and periodontal status of hearing impaired individuals using standardized evaluation criteria were included. Study selection, data extraction, and assessment of bias were carried out by four reviewers and oral hygiene, plaque, and gingival status were assessed. The risk of bias assessment was carried out by New Castle Ottawa Quality Assessment Scale. 29 relevant publications that fulfilled the eligibility criteria were included in the systematic review whereas six studies each assessing oral hygiene and plaque status and five studies evaluating the gingival status were included in the Meta-analysis. RESULTS: Eight thousand eight hundred and ninety (8890) potentially relevant references were identified in the systematic literature search. The overall analysis of the included studies revealed a mean oral hygiene index score of 1.60 (95% CI 0.91-2.30), Gingival Index scores 1.27 (95% CI 1.02-1.51), and Plaque Index score 0.99 (95% CI 0.75-2.30) among the hearing impaired individuals. CONCLUSION: The present study reported fair oral hygiene, fair plaque status, and moderate gingivitis among the hearing impaired individuals.

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BACKGROUND: Smokeless tobacco (SLT) use is positively associated with oral, oesophageal, and pancreatic cancers. The tobacco dentifrice is a type of SLT which is applied to the teeth and gums. It is available in different forms which include mishri, gul/gulmanjan, gudhaku, snuff, red tooth powder, and creamy snuff. This qualitative study aims to explore the opinions and beliefs associated with the harmful effects of tobacco dentifrice use. METHODOLOGY: Thirty in-depth interviews were conducted among tobacco dentifrice users visiting a dental hospital. The data were coded and analysed using thematic analysis in ATLAS.ti software 8. RESULTS: A total of 11 codes and six categories were generated which comprised of the reason for the initiation, awareness of health effects, perception of oral tobacco application, perception of quitting, the reason for continued use, and use in society. Family, peers, access to the product, curiosity were important factors to initiate the tobacco dentifrice use. Participants believed in the myth that tobacco dentifrice was beneficial for the teeth, gums, and bowel movements. The participants considered tobacco dentifrice to be less harmful than other forms of tobacco. However, some participants were aware of its adverse effects on health and have tried to quit in the past. None of the participants had taken any professional help for quitting. CONCLUSION: There were strong beliefs and myths among the participants that tobacco dentifrice was beneficial for oral and general health. There is a need to create awareness and improve the standard of the health warning of such products.

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Purpose: To evaluate the effectiveness of an oral health mobile application on the oral health knowledge, behavior, and practices (KBP) of child-parent dyads. Methods: This was a pre-post, single-arm, hospital-based pilot study. Fifty-two dyads were assessed for KBP using a self-structured questionnaire. The oral hygiene of children was evaluated using the plaque index (PI). The Healthy-Smile Swasth-Muskaan mobile application was installed on the phones of participants, and they were encouraged to use the application regularly. After one month of the app instalation, post-KBP and PI were assessed. Results: A significant improvement was seen in the parents' total knowledge, behavior, and oral hygiene practices of the children (P<0.001). A significant reduction was observed in the mean plaque scores of the children (P<0.001). Conclusions: The Healthy-Smile Swasth-Muskaan mobile app is associated with improved oral health knowledge and behavior of the child-parent dyads and im- proved oral hygiene of children. Further randomized clinical trials are needed to determine the impact of mobile apps on the oral health knowledge, behavior, and practices of parents and children.

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OBJECTIVE: This systematic review and meta-analysis aimed to assess the effect of premature loss of primary teeth in children of mixed dentition age on the prevalence of malocclusion in permanent dentition. MATERIAL AND METHODS: A search was conducted in Medline through PubMed, Cochrane databases, Google Scholar, and Directory of Open Access Journals (DOAJ) through March 2023. All observational studies that evaluated the association between premature loss of primary teeth and malocclusion in permanent dentition were included for analysis. Quality of studies was evaluated using the Newcastle-Ottawa tool. Meta-analysis was conducted using Cochrane Review Manager (RevMan) Version 5.3. The association between different categories of malocclusion and premature loss of primary teeth was assessed using a random-effects model. Heterogeneity was explored through sensitivity analysis. Certainty of evidence was evaluated using GRADE analysis. RESULTS: This meta-analysis showed that the premature loss of primary teeth significantly increases the prevalence of overall malocclusion in permanent dentition (OR=2.54, P=0.003; I2: 83%). Subgroup analysis showed an insignificant relationship of premature loss of primary teeth with Class I malocclusion (OR=1.14, P=0.45; I2: 63%) and Class II malocclusion (OR=1.63, P=0.18; I2: 87%) but statistically significant relationship with Class III malocclusion (OR=3.73, P=0.006; I2: 71%). Sensitivity analysis reflected a significant reduction in I2 values. CONCLUSION: This meta-analysis provides substantial evidence supporting the relationship between premature loss of primary teeth and malocclusion in permanent dentition. Notably, Class III malocclusions exhibited a significant association with premature loss of primary teeth.

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AIMS: The purpose of the systematic review and meta-analysis was to assess the dental caries status in individuals with hearing difficulties. METHODS AND RESULTS: Searches were conducted in six databases with no restriction on publication date. The cross-sectional and comparative cross sectional studies assessing the dental caries status of hearing impaired individuals using standardized evaluation criteria were included. PubMed, Web of Science, Cochrane, Wiley Online, Lilacs, and Scopus databases were searched to identify the relevant papers published before August 1, 2021. The risk of bias assessment was carried out by New Castle Ottawa Quality Assessment Scale. Three thousand three hundred thirty five potentially relevant references were identified in the systematic literature search. Thirteen relevant publications that fulfilled the eligibility criteria were included in the systematic review and the meta analysis. The overall analysis of the included studies revealed pooled dental caries prevalence of 58.0% (95% CI 0.41-0.74) among the hearing impaired individuals. The overall dental caries experience of the included studies showed a mean pooled DMFT of 2.68 (95% CI 1.24-4.12). CONCLUSION: The present systematic review and meta-analysis reported high dental caries prevalence in hearing impaired individuals.

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BACKGROUND: Sugar-sweetened beverages (SSB) are an independent risk factor for obesity and other non-communicable diseases. Socioeconomic status (SES) is one of the key drivers for the purchase and consumption of SSBs among children and adults; however, there is a lack of strong evidence. This study aims to determine the association between SES and consumption patterns of SSBs across populations. RESULTS: The review was conducted according to PRISMA guidelines. PubMed, MEDLINE, Scopus, EMBASE, LILACS, Web of Science, Cochrane, and CINHAL databases were searched for relevant articles until 2022. Participants included children, adolescents, and adults who consumed different SSBs and were assessed based on their SES. The random-effects model was used to obtain the pooled odds ratio (OR). Twenty-one studies (152,070 participants) met the inclusion criteria. The risk of bias was assessed using the Newcastle-Ottawa tool, with the majority of the studies indicating medium to high quality. Eight ORs from four studies (34,454 participants) were considered for meta-analysis. Results showed those belonging to high SES had 48% lower odds of consuming the SSBs (OR 0.52; 95% CI: 0.42-0.61; p = 0.017). The overall quality of evidence was ascertained using GRADE criteria, illustrating a moderate certainty of evidence between SSB consumption and SES. CONCLUSION: Meta-analysis suggests that SES influences the consumption pattern of SSBs, with high SES having lower odds of SSB consumption.

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This systematic review aims to determine the association between the consumption of sugar-sweetened beverages (SSBs) and periodontal disease. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to conduct a literature search on five electronic databases till January 2022. Systemically healthy individuals consuming SSBs and presenting periodontal disease (gingivitis/periodontitis) were included. The modified Newcastle-Ottawa Scale and the Grading of Recommendation Assessment Development and Evaluation criteria were respectively used to assess the risk of bias and the evidence's quality. Of the 1303 eligible records identified in the initial search, ten studies (nine cross-sectional and one case-control) were selected for the final review. Among the included articles, five reported SSBs intake in the form of carbonated soft drinks, two as sugary drinks, two as soft drinks, and one as coffee with added sugar. Four studies reported gingivitis as an outcome, while the remaining six studies reported periodontitis using validated indices. The included studies were of medium to high quality. Consumption of SSBs may increase gingival bleeding, thereby gingivitis and the risk of periodontitis. Intake of added sugars like SSBs should be considered as a potential factor during gingival/periodontal risk assessment. Further studies are warranted to establish additional evidence of association.

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BACKGROUND: Schools have a powerful influence on children's development and well-being, and school teachers are considered role models to transmit life values and instill health-related behaviors. The effectiveness of a training program for school teachers in understanding the role of sugars and their impact on oral and overall health has not been previously reported. AIM: The present study aimed to assess the effectiveness of a training program for school teachers on the role of sugars in oral and general health. METHODS: An interventional study was carried out on 308 Kendriya Vidyalaya Sangathan school teachers to evaluate the effectiveness of a training program in improving school teachers' knowledge of the role of sugars in oral and overall health. The training program was carried out using a training module, and a validated questionnaire was utilized to assess school teachers' knowledge before and after the training program. RESULTS: The overall evaluation of mean knowledge change scores revealed significantly higher scores after the training program (8.12 ±1.58) when compared with the pre-training scores (6.84±1.66) Conclusion: A training program on the role of sugars in oral and general health effectively improved school teachers' knowledge.

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BACKGROUND: Oral cancer is often preceded by Potentially Malignant Disorders (PMDs) and important role of biochemical markers for early diagnosis has been well documented; however, there is limited evidence of Serum lactate dehydrogenase (SLDH) as an effective biochemical marker in diagnosis of PMDs. The present meta-analysis was conducted to assess if serum LDH can be a used as standard biomarker for PMDs and consequently aid in diagnosis of oral cancer. METHODS: A comprehensive search was conducted in Medline, Scopus, Web of Science, EBSCO host, Cochrane databases and Google Scholar for studies evaluating estimation of SLDH in PMDs. Search strategy included all types of studies evaluating level of SLDH in patients with PMDs. PRISMA guidelines were followed for the meta-analysis. Fixed-effects model was used to assess the mean differences in SLDH levels between healthy controls and PMDs. RESULTS: A total number of nine studies were included in meta-analysis after screening for inclusion and exclusion criteria. Potentially malignant disorder was significantly associated with increased serum LDH level compared to healthy controls (pooled SMD: 1.83 (95% CI, 1.52, 2.15) (P < 0.00001; Subgroup analysis of OSMF (Oral Submucous Fibrosis) studies showed significant association with increased serum LDH level compared to healthy controls (pooled SMD: 2.57 (95% CI, 2.16, 2.98; P < 0.00001). Sensitivity analysis for the five studies reflected a significant reduction in I2 values to 24 % (P=0.26). Funnel plots were derived for any evidence of publication bias among the studies. CONCLUSION: Meta-analysis suggests that SLDH is increased in potentially malignant disorders compared to healthy controls. The results of this metanalysis should encourage use of SLDH as a biomarker in diagnosis of PMDs.

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