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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Evaluation of Oral Health Status and Temporomandibular Joint in Patients with Various Psychiatric Disorders in a Tertiary Care Center of Maharashtra, India
Correspondence Address :
Kadambari Vivek Kakde,
Indira Girls Hostel, DMIMS Campus, Sawangi (Meghe), Wardha-224001, Maharashtra, India.
E-mail: kakdekadambari@gmail.com
Introduction: Living a physically and mentally healthy lifestyle is equally vital. It occurs at all socio-economic levels and affects individuals of all backgrounds. It is estimated that 450 million people are suffering from mental problems worldwide. Irrespective of the cause, everyone should be aware that poor dental health impacts overall health.
Aim: To assess the level of oral health for people with different psychiatric illnesses and to determine whether these people’s level of oral health correlates with other characteristics and also to determine the extent of the issue with dental health and the best way to address it.
Materials and Methods: In this cross-sectional study, ninety-eight patients receiving care at the Psychiatric Department of Maharashtra, India, between April and May 2022 were included. A case history performa was prepared to gather detailed information on all aspects. The oral examination was done by examining lymph nodes, lips, tongue, gums and tissue, saliva, natural teeth, oral cleanliness, and dental pain with a sterile mouth mirror and probe using Oral Health Assessment Tool (OHAT) for dental screening modified from Kayser-Jones. Dental caries was reported using the Decayed, Missing, and Filled Teeth (DMFT) index. Furthermore, Helkimo’s TMJ Index was used to assess Temporomandibular Joint (TMJ). Descriptive statistics were used to observe frequency variation.
Results: The participant patients mean age were 41.33±13.58 years, and their range of age was 21-65 years. The female:male ratio of the study population was 1.1:1. Sleep disorders (24.50%) and anxiety (22.40%) were the most prevalent psychiatric conditions impacting the research population. The oral health examination of the patients described changes in the oral cavity and associated factors, including lips, tongue, gums and tissues, saliva, natural teeth, oral cleanliness, and dental pain. Total 59.10% of the participants had moderate to severe TMJ dysfunction. The range of the DMFT score was 3 to 17 (mean 7.89±3.21). The participants’ TMJ Index score ranged from 0 to 17 (mean 5.51±4.48). More than half of the participants (59.10%) had moderate to severe TMJ dysfunction.
Conclusion: Maharashtra’s psychiatric patients have poor oral health conditions, highlighting the need for oral health education and expanding access to dental care for these patients.
Dental caries, Mental disorder, Oral health status examination, Psychiatric illness
One of the essential components of a healthy lifestyle is mental health. Regarding the UN, the World Health Organisation (WHO) founding document, health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Several studies prove that physical health affects mental well-being (1). Both are necessary for better maintenance of wellness (2). Psychiatric diseases impact individuals from every socio-economic group and reaching more than 450 million globally (3).
Dental anxiety, phobia, psychosis, eating disorders (such as anorexia and bulimia nervosa), alcohol and drug misuse, and mood disorders are omission psychiatric conditions that can negatively impact dental health. People who are dependent on drugs or alcohol frequently disregard their nutritional requirements, personal hygiene, and personal circumstances, all of which contribute to poor dental health (4). Inflammation-based periodontal and caries disorders are widespread oral health issues around the globe. Because of stigma, misinformation, fear, and unfavourable views, psychiatric patients make up a sizable segment of the population that need particular care yet are frequently overlooked. Mental or psychiatric illnesses impact a person’s general behavior, level of functioning and perceptions, resulting in poor oral health and inefficient self-care (5).
According to Reddy VM and Chandrashekar CR, meta-analysis, India has 58 people with mental illnesses per 1,000 residents (6). According to Ranjan LK et al., it is 122 per 1,000 people in South Asian countries, compared to Ganguli HC, estimates of 70.5% (rural) and 73% (urban) (7),(8).
Oral health is directly linked to general health, irrespective of whether a person has a mental illness. Medical diseases, including cardiovascular disease, type 2 diabetes, low birth weight, aspiration pneumonia, osteoporosis, and rheumatoid arthritis, are strongly associated with oral health issues (9). The difficulties these people face in receiving dental treatment are their inexperience, lack of motivation, apathy, low willingness to cooperate, difficulty adapting to new prosthetic devices, mobility issues, fear of treatment, poor communication, and financial concerns (10).
An inadequate understanding of dental pathology and the psychological repercussions of oral disease exists among psychiatrists and their patients. The best part is that numerous studies have shown that those who receive education, direction, and reminders will have improved dental health and hygiene and that adaptive education- instruction can help them to learn new skills (11),(12),(13),(14).
The researchers found that only 40% of the 19,609 patients in the study by Teng PR et al., visited the dentist (15). People are becoming more and more aware of the significance of oral health. India has few published data (5),(16),(17),(18) on the oral health of those suffering from psychiatric disorders (16).
Comprehensive data on all the components of the stomatognathic system, including the soft and hard tissues of the oral cavity and the TMJ is required. Thus, the purpose of this study was to assess the level of oral health for people with different psychiatric illnesses in the Indian community, to determine whether these people’s level of oral health correlates with other characteristics, and to determine the extent of the issue with dental health and the best way to address it.
This cross-sectional study was conducted in the Department of Psychiatry at Acharya Vinoba Bhave Rural Hospital in Sawangi (Meghe), Wardha, India, from April to May 2022. Ethical clearance was obtained from the Institutional Ethics Committee (IEC) of Datta Meghe Institute of Medical Sciences, Deemed to be University, with IEC Number DMIMS (DU)/IEC/2022/978).
A convenient sample of ninety-eight patients receiving care at the Psychiatric Department of Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi (Meghe), Wardha, Maharashtra, India, were included in this study. Participants, their parents and guardians, and the personnel of the Psychiatry Department were informed about the study. Informed consent was obtained from the individual after receiving their guardian?s approval. A case history proforma was prepared to gather detailed information on all aspects. Performa entails collecting socio-demographic information and thorough examination of the oral cavity and TMJ.
Inclusion criteria:
1. Patients diagnosed with any psychiatric disorder.
2. Patients aged more than 21 years.
Exclusion criteria:
1. Patients with any significant systemic disorder.
2. Patients with a physical disability.
Procedure
The patient was informed about the study and acquired consent. The patient and their relatives were then asked about their demographic information, daily activities, and health-related behaviors. Age, gender, and length of mental illness were the recorded demographic factors. The clinical medical records of the patients were utilised to retrieve the medical variables, which included the mental condition diagnosis and the drugs taken.
After gathering the patient’s demographic and medical information in the clinic; an oral examination was performed with the patient sitting straight and facing natural daylight. The oral examination was done by examining lymph nodes, lips, tongue, gums and tissue, saliva, natural teeth, oral cleanliness and dental pain with a sterile mouth mirror and probe using Oral Health Assessment Tool (OHAT) for dental screening (19) modified from Kayser-Jones et al. Aditionally, lymph nodes and pairs of teeth in chewing position were also assessed according to The Kayser-Jones BOHSE (20). Dental caries was reported using the DMFT index. To assess individuals with Temporomandibular Disorders (TMDs), the Helkimo Clinical Dysfunction Index (HCDI) is a rapid and easy test. The exam provides a brief overall assessment that could be very helpful at various stages of care by evaluating movement, joint function, pain, and muscles. The HCDI is a viable and accurate assessment tool; it has good clinimetric qualities and a decent capacity to distinguish between people with and without TMD (21).
Statistical Analysis
Descriptive statistics were used to observe frequency variation. Chi-square test was used for statistical analysis. A p-value<0.05 was considered significant.
The participants’ mean age was 41.33±13.58 years, and their range of age was 21 to 65. The female:male ratio of the study population was 1.1:1. The study population’s demographic details are shown in (Table/Fig 1).
Out of the 98 patients studied, 44 patients stated that they brush their teeth twice a day, while 54 reported brushing only once. A total of 34 individuals have had a drinking habit for 8-10 years, and 43 have been smoking for 5-7 years. About the sugar intake, 60 reported consuming sugar twice daily, 7 reported consuming it three times a day, and 31 reported consuming it once daily. Of the patients, 74 had been suffering from an illness for 3-4 months and were visiting the hospital for the first time. Fifteen were undergoing treatment for two months, and eight had been receiving treatment for six months. Only 23 patients who were receiving treatment were taking medications, which included tab clonazepam, tab paroxetine, and tab sertraline.
Mental health: The most prevalent psychiatric condition impacting the research population was sleep disorder and anxiety (Table/Fig 2).
The oral health examination of the research population (Table/Fig 3) describes changes in the oral cavity and associated factors, including lymph nodes, lips, tongue, gums and tissues, saliva, natural teeth, oral cleanliness, dental pain and pairs of teeth in chewing position. An 88 (89.8%) of the patients had gum and tissue alterations, whereas 74 (75.5%) had tongue changes. A 90 (91.8%) of the patients had impaired salivary flow. 72 patients did not have any lymph nodes enlargement, 20 had enlarged but non tender lymph nodes while in 6 paitients, the lymph nodes were enlarged and tender. Moreover, 88 patients had 12 or more pairs of teeth in chewing position, 6 had 8-11 pairs and in 2 patients only 0-7 pairs of teeth were found in chewing position.
The range of the DMFT score was 3 to 17 (mean 7.89±3.21). Decayed teeth were 1 to 10, with a mean (1.67±1.75). Only 30 (30.6%) of the participants had missing teeth; the average number of missing teeth was 1.63±3.19. Furthermore, 34 (65.3%) of the participants had filled teeth in their oral cavities.
The participants’ TMJ index score ranged from 0 to 17 (mean 5.51±4.48). More than half of the participants (59.10%) had moderate to severe TMJ dysfunction (Table/Fig 4).
To determine whether these people’s level of oral health correlates with other characteristics and the extent of the issue with dental health, the oral health findings of the study had been associated with the various psychiatric disorders (Table/Fig 5).
The outcomes of this study revealed a concerning trend in the oral health of psychiatric patients. With a high prevalence of caries, alterations in the oral cavity supporting tissues, and some degree of TMJ dysfunction, it is evident that the dental health of this population is not being adequately addressed.
Lisping is a speech disorder that affects the pronunciation of the “s” and “z” sounds, and it can be associated with anxiety and stress. According to research, individuals who struggle with lisping may experience low self-esteem, social avoidance, and other negative emotions related to their speech difficulties (22). Speech therapy is often recommended as a treatment for lisping, as it can help individuals develop the motor skills needed to produce the correct sounds and build their confidence when speaking (23).
Studies conducted in different nations have demonstrated how mental illness can negatively impact the dental health of psychiatric patients. The mean DMFT score (7.89±3.21) of the current study was higher compared to a study conducted in Ethiopia (1.9461±2.12) (24), but lower than a study conducted in Singapore (21.6±9.7) (25).
A study by Adeniyi AA et al., found that the dental health of mental health outpatients in Nigeria could be better and they should receive comprehensive care that includes oral health (3). A study by Teng PR et al., in China found that patients with serious mental illness receive less preventive dental care compared to the general population (15).
Other studies by Aditya A et al., and Ngo DYJ et al., (25) have also shown similar results with higher mean DMFT scores in psychiatric patients (3),(19),(25).
This trend is consistent with other studies (3),(9),(10),(15) that have shown higher mean DMFT scores in psychiatric patients compared to the general population. (Table/Fig 6) includes a comparison of similar Indian and international studies from literature with the present study (3),(4),(12),(15),(16),(17),(24),(25).
The findings of this study underscore the importance of dental health care for psychiatric patients. Poor oral health can have a significant impact on a person’s overall well-being, affecting their ability to eat, speak, and smile with confidence. In addition, dental problems can cause pain, negatively impact self-esteem, and lead to social isolation.
Given the unique challenges faced by psychiatric patients, it is crucial to provide comprehensive care that considers their oral health. Mental health professionals should be trained to assess their patients’ dental needs and refer them for treatment as necessary. Patients with mental illness should be encouraged to prioritise their dental health and seek the care they need.
To address the dental health needs of this underserved population, it is important to create a closer and more coordinated effort between the hospitals’ social and dental care units. With a unified approach, mental health and dental professionals can work together to provide the comprehensive care that psychiatric patients need and deserve.
Limitation(s)
The limitations of the present study are: Firstly, no causal relationship could be inferred because of its cross-sectional nature. Secondly, because of the relatively small size of our sample, additional research with a bigger sample size is required to support our findings. Authors did not compare our individuals to a control group of people not suffering from psychiatric conditions.
Based on the results of the present study, it is concluded that psychiatric outpatients have poor dental health. Psychiatric illness significantly impacts oral health, the associated factors and TMJ. Furthermore, it may further lead to several oral complications, if neglected. Therefore, measures should be taken by counseling the patient and his/her caretaker about paying attention to dental health as a part of their overall care. Dental treatments can aid the development of general well-being and quality of life.
Authors want to thank the staff of the Department of Psychiatry, AVBRH, Sawangi (Meghe), Wardha for all their constant support during our study. We would also like to thank the participants for actively participating in our study.
DOI: 10.7860/JCDR/2023/61404.17762
Date of Submission: Nov 10, 2022
Date of Peer Review: Dec 05, 2022
Date of Acceptance: Feb 11, 2023
Date of Publishing: Apr 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 11, 2022
• Manual Googling: Jan 28, 2023
• iThenticate Software: Feb 07, 2023 (14%)
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