|Year : 2021 | Volume
| Issue : 4 | Page : 379-384
Stem cells application in oral mucosal disorders: Awareness and knowledge of indian oral and maxillofacial diagnosticians – A cross-sectional study
Ashwini Nerkar Rajbhoj1, Vikram V Khare1, Amita Aditya1, Suhas Pande1, Daisy Happy2, Nayana Anasane3
1 Department of Oral Medicine and Radiology, Dr. DY Patil Dental College, Pune, Maharashtra, India
2 Department of Periodontology, Dr. DY Patil Dental College, Pune, Maharashtra, India
3 Department of Prosthodontics, Dr. DY Patil Dental College, Pune, Maharashtra, India
|Date of Submission||19-Mar-2021|
|Date of Decision||12-Jul-2021|
|Date of Acceptance||25-Jul-2021|
|Date of Web Publication||27-Dec-2021|
Dr. Ashwini Nerkar Rajbhoj
Departments of Oral Medicine and Radiology, Dr. DY Patil Dental College, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Regenerative medicine, tissue engineering, and surgery coupled with advances in materials science form an alliance of emerging interdisciplinary fields that combines the principles of cellular and molecular biology and biomedical engineering to support intrinsic healing and replace or regenerate cells, tissues, or organs, with the restoration of impaired function. The present-day treatment modalities for oral mucosal lesions are not satisfactory. Various studies have shown the successful role of stem cell therapy in the treatment of precancerous conditions, oral ulcers, wounds, and mucositis. The awareness among and knowledge of oral medicine and radiology (OMR) specialists regarding the therapeutic application of stem cells for the treatment of oral mucosal disorders is a relatively unexplored arena. Aim and Objectives: The present study was conducted to assess the awareness among and knowledge of OMR specialists regarding the application of stem cells for the treatment of oral mucosal disorders and compare the results based on age, area of work, and years of experience of the participants. Materials and Methods: The present study included a rapid, short, cross-sectional online survey. It was conducted using a web-based survey platform called Google Forms. A total of 203 OMR specialists were selected by simple random method for participating in the study. A self-administered, 10-point questionnaire in the form of an online survey was used to assess the awareness and knowledge of OMR specialists. A Chi-square test was used for statistical analysis. Results and Conclusions: Overall, awareness and knowledge were found to be more in the participants below 29 years of age, doing specialty practice, and with an experience of fewer than 5 years. A significant association of age, and area of work with awareness and knowledge was observed.
Keywords: Awareness, knowledge, oral medicine and radiology specialists, stem cells
|How to cite this article:|
Rajbhoj AN, Khare VV, Aditya A, Pande S, Happy D, Anasane N. Stem cells application in oral mucosal disorders: Awareness and knowledge of indian oral and maxillofacial diagnosticians – A cross-sectional study. J Indian Acad Oral Med Radiol 2021;33:379-84
|How to cite this URL:|
Rajbhoj AN, Khare VV, Aditya A, Pande S, Happy D, Anasane N. Stem cells application in oral mucosal disorders: Awareness and knowledge of indian oral and maxillofacial diagnosticians – A cross-sectional study. J Indian Acad Oral Med Radiol [serial online] 2021 [cited 2022 May 21];33:379-84. Available from: https://www.jiaomr.in/text.asp?2021/33/4/379/333880
| Introduction|| |
Most of the time, remedies in the medical field are an outcome of human inquisitiveness to know nature and duplicate it. The evolution of stem cell therapy has raised hopes for the treatment of incurable diseases. Although certain studies have confirmed the effectiveness of stem cell therapy in oral mucosal disorders such as oral submucous fibrosis, for diseases such as oral ulcers and mucositis, the research is mainly confined to animal stem cells in their management. Oral Medicine and Radiology (OMR) specialists provide clinical care to patients presenting with a wide variety of orofacial conditions, including oral mucosal diseases, orofacial pain syndromes, salivary gland disorders, and oral manifestations of systemic diseases. The present-day treatment modalities for oral mucosal lesions such as ulcerative lesions, premalignancy, and malignancies mainly consist of steroids and antioxidants (which provide only a short-term and symptomatic relief) and surgery with or without chemo-/radiotherapy (which leave the patient with a certain amount of morbidity).,
All of the human body cell types come from a pool of stem cells in the early embryo. Stem cells are classified based on their differentiation potential into totipotent, pluripotent, and multipotent cells. Based on the source of origin, they are divided into two broad categories, namely, embryonic stem cells (ESCs) and adult stem cells (ASCs). ESCs produce stable cell lines from all three germ layers. ASCs, on the other hand, can be derived from any postnatal organ and are multipotent in differentiation. They act as a rich source of primitive cells, which can expand rapidly and present with minimal chances of graft versus host disease (GVHD). Mesenchymal stem cells (MSCs) originate from the mesodermal layer of the fetus and are found in various adult tissues, including hepatic stem cells, dermal stem cells, and dental stem cells (DSCs). Induced pluripotent stem cells are embryonic-like stem cells that are derived by reprogramming adult somatic cells with limited differentiation potential. A variety of ASC populations are found in dental tissues, which are collectively known as DSCs. The DSCs, based on their origin, are further classified as dental pulp stem cells, stem cells from human exfoliated deciduous teeth, periodontal ligament stem cells, stem cells from the gingiva, stem cells from the apical papilla, and tooth germ progenitor cells obtained from third molars.,,
Specific orofacial structures, which are already being targeted by regenerative medicine strategies, include the salivary glands, tongue, craniofacial skeletal muscles, and component structures of the temporomandibular joint, Hence, these advances in stem cell technology have opened new vistas for the treatment of oral mucosal lesions.,, The awareness among and knowledge of OMR specialists regarding the therapeutic application of stem cells for the treatment of oral mucosal disorders is a relatively unexplored arena, and it should be studied to obtain baseline information, which can be useful for building future programs. Thus, the present study was the first-ever study designed to assess the awareness among and knowledge of OMR specialists regarding the application of stem cells for the treatment of oral mucosal disorders conducted in the form of a cross-sectional online survey.
| Materials and Methods|| |
A quantitative approach was used for this study, and the research design chosen was quasi-experimental.
Variables in the study
Independent variables were age, area of work, and years of experience.
Dependent variables were awareness among and knowledge of OMR specialists regarding the application of stem cells for the treatment of oral mucosal disorders.
Tools in the study
The following tools were used for data collection.
The tools had three parts:
Part-1: Sociodemographic profile,
Part-2: Structured questionnaire to assess the awareness, and
Part-3: Structured questionnaire to assess the knowledge regarding the application of stem cells for the treatment of oral mucosal lesions.
The survey was validated by distributing it among a small group of participants as a pilot procedure to determine its relevance.
A random sampling technique was used for selecting the participants of the study. Institutional ethical permission was obtained from the Institutional Ethics Committee, PGIDS (via certificate no PGIDS/AII/8200 dated 24/06/2020). The final sample size was calculated to be 205 and sample size was estimated based on the following formula:
Where z is normal deviate, d is the level of precision adjusted at 0.07. Prevalence was considered to be at 70%. Design effect of 2 was taken to compensate for the cluster effect. As it was an online survey, to compensate for the 50% non- participation another 50% was added to the sample. Thus, the final sample size was calculated to be 250.After circulating the online form for almost 2 weeks and eliminating all the unfilled n partially filled forms, we could receive total 205 responses for this survey.
OMR specialists who were willing to participate in the study were included in the study. A link to the survey was emailed and/or sent across through social media platforms such as Facebook and WhatsApp group of the Indian Academy of Oral Medicine and Radiology. As the first question of the survey was regarding the consent to participate in the survey, those who filled the forms were considered to have consented to participate in the study. The study was conducted by following all the protocols and principles under the purview of the Helsinki Declaration (1964 and later). The questionnaire was available on Google Forms for 2 weeks. Incomplete forms were scrutinized, and the cleaning of the data was done by asking the respondents to rectify the improper or partially filled forms.
Descriptive Statistics: (a) Frequency and percentage distribution was used to describe sociodemographic variables, level of awareness, and knowledge; (b) mean, mean percentage, and standard deviation were used to analyze the level of awareness and knowledge of OMR specialists.
Inferential Statistics: “Chi-square” test was done to determine the association between the level of awareness and knowledge with selected sociodemographic variables. Cronbach's alpha reliability test was conducted with α score of 0.618 indicating acceptable reliability. Significance for all statistical tests was predetermined at a P- value of ≤0.05. The prevalence anticipated rate was calculated up to 20%.
| Results|| |
The overall statistical distribution details of 203 received responses of participants regarding gender, age, area of work, and years of experience are illustrated in [Graph 1].
The overall awareness about the stem cells, their types, their potential application in treating oral mucosal disorders and stem cell banks, as well as knowledge about stem cells in treating precancerous lesions, malignant disorders, ulcerative lesions and GVHD was found to be more in the participants below 29 years of age, doing specialty practice, and with experience of fewer than 5 years [Graph 2]. None of the participants chose “I don't know” as an answer.
When the association of age and area of work with awareness among and knowledge of OMR specialists regarding the application of stem cells in the treatment of oral mucosal disorders was evaluated using Chi-square test, the difference between the two groups, that is, diagnosticians below 29 years, and above 29 years of age and participants having specialty practice and participants having general practice, was found to be statistically significant with a P- value of < 0.005 [Table 1] and [Table 2]. But the difference between the two groups, that is, participants with less than 5 years of experience and participants with more than 5 years of experience, was found to be statistically insignificant with a P- value of > 0.005 [Table 3].
|Table 1: Association of age with awareness and knowledge of oral maxillofacial diagnosticians regarding application of stem cells in the treatment of oral mucosal disorders using Chi-square test|
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|Table 2: Association of area of work with awareness and knowledge of oral maxillofacial diagnosticians regarding application of stem cells in the treatment of oral mucosal disorders using Chi-square test|
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|Table 3: Association of experience (in years) with awareness and knowledge of oral maxillofacial diagnostician's regarding application of stem cells in the treatment of oral mucosal disorders using Chi-square test|
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| Discussion|| |
The level of awareness regarding the use of DSCs was found to be 97.4%. Similarly, higher levels were also reported in studies conducted by Chitroda et al., Katge et al., and Sede et al. Dentistry started with the extension for prevention, moved to conservation, and today it is regeneration. This is a result of our constant perseverance to be demigods. The benefits of stem cell research have such a great outcome that it outweighs the ethical issues and costbenefit analysis.
In the present study, the majority of participants were aware of the different types of DSCs in comparison with 69.6% as reported by Chitroda et al. and 60.3% as reported by Goyal. During early development, as well as later in life, various types of stem cells give rise to the specialized or differentiated cells that carry out the specific functions of the body, such as skin cells, blood cells, muscle cells, and nerve cells. This property makes the stem cells appealing to the researchers, dentists, medicos, and the like seeking to create medical treatments that replace lost or damaged cells.
In this study, nearly all the participants were aware of the presence of stem cell banks in India. According to Goyal, only 43.7% were aware of their existence in India. Contradictory to the present study results, earlier studies carried out by Katge et al. showed more than 50% of participants were unaware of the presence of dental stem cell banks in India. Chitroda et al. reported that about 64% of the respondents were unaware of any such banks in India. This increasing level of awareness regarding the existence of stem cell banks in India could be due to the vast amount of information regarding stem cells and their application being made available by different books, magazines, research articles, web/internet, various social platforms such as YouTube, and various other apps.
The awareness regarding the application of stem cells for the treatment of oral mucosal disorders was found to be the highest among all the participants. The results of none of the previous studies can be compared with these results, as this is the first study of its kind enlightening this topic and that too among OMR specialists. The results with respect to the question of awareness regarding the application of stem cells for the treatment of oral mucosal disorders suggest that the awareness among younger OMR specialists is excellent.
The assessment of level of knowledge among participants regarding the use of stem cells in treating oral premalignant and malignant disorders was reported to be the highest (91.2%) among all the participants. Thus, the results suggest that the level of knowledge among specialty practitioners is pretty good, but still not up to the mark. In treating oral cancer, stem cell therapy helps in neoangiogenesis, which removes dead cells by supplying scavenger cells, and thus the state of hypoxia can be reversed. Cancer stem cells are multipotent and can regenerate, and their rate of proliferation is also very high. Targeting these cancer cells will ensure increased therapeutic efficacy and will prevent tumor recurrence. The results of this question again justify that the knowledge or the baseline information regarding the working mechanism of stem cells is more among OMR specialists, maybe because of the various platforms available nowadays such as YouTube videos, various researcher's groups depending on the area of interest, various advanced biotechnology labs, and so on.
The level of knowledge regarding the use of stem cells in ulcerative lesions, graft versus host tissue disorder, and healing of the wound was reported to be 96.7%, which is the highest finding among all the participants. Thus, the results suggest that the knowledge among younger OMR specialty practitioners is excellent. Stem cell therapy can restore the tissue into a state before the injury took place, that is, a pre-injured state. MSCs have shown advancements in wound healing and promoting angiogenesis., Earlier research has shown effective advances in the quality and rate of healing during the delivery of stem cells, particularly in MSCs.
If a large number of stem cells are transplanted, there is a risk of teratoma formation or ectopic engraftment. Thus, for providing successful treatment, the cells number must be optimal. In the present study, the answer to the teratoma question was found to be answered correctly by almost 99.3% of younger OMR specialty practitioners. There were no results available from the previous studies for comparison.
Limitations and Future prospects
As this was an online survey, there were certain limitations of the study such as poor response rate, difficulty in judging the seriousness of the responses, and the absence of potential participants lacking internet skills. Response bias was also considered to be one of the limiting factors, as the participants respond mandatorily and not voluntarily in such surveys. Also, the sample size of the present study was small. A larger sample size could have reduced the effect of confounding factors. Hence, future studies can be conducted using one on one interview method and including further parameters such as financial implications. Also, a study with a larger sample size including participants from all over the world needs to be carried out.
| Conclusion|| |
Stem cell therapy can be stated as one of the noninterventional and innovative treatment modalities. It is the need of the hour to give this topic the due attention it deserves. Various intractable afflictions have their cure hidden in the unexplored potential of these cells. In India, it is now the time to look for efficiency and growth in OMR specialty by looking up to widening the scope and ensuring the application of stem cell therapy for the treatment of oral mucosal lesions. Thus, it becomes imperative for OMR specialists to be aware of the various aspects of stem cells. The pivotal role of stem cell therapy in oral mucosal lesions is primarily aimed at neoangiogenesis, tissue regeneration, increased cellularity, modulation of collagen gene expression, and immunomodulation. To understand this basic concept, different methods must be adopted. Incorporating elaborate and in-depth information about this topic in curriculum books at the postgraduate level can be done. Organizing symposiums, seminars, and conferences regarding the same with discussions about the nature, types, isolation, storage, banking, and potential advanced applications and the guidelines required to be followed for the application of these cells should be taken up. Educational programs and workshops providing professional training can be organized to create awareness and acquire a clear understanding of these cells. With increasing awareness among the general population about their preservation, it becomes necessary for the diagnosticians to be aware of stem cells, so that correct guidance can be provided at the right time.
Declaration of patient subject consent
The authors certify that they have obtained all appropriate study participants consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]