In the wake of the COVID-19 pandemic, it is crucial to assess the application of a multitude of effective diagnostic specimens for conducting mass testing, for accurate diagnosis and to formulate strategies for its prevention and control. As one of the most versatile and amenable specimen options, saliva offers great advantages for widespread screening strategies due to its non-invasive properties, cost-effectiveness, excellent stability and minimal risk of cross-infection. This review attempts to outline the scientific rationale for detection of SARS-COV-2 in saliva specimens. By combining the data obtained from ten chosen published clinical studies, we calculated the pooled sensitivity and specificity using an online calculator. Through evidence, we established that SARS-COV-2 is detectable in saliva with a high degree of diagnostic sensitivity (87%) and specificity (98%). We also presented a review of emerging technologies approved by the FDA for detection of SARS-COV-2 in oral fluids (saliva and sputum) using polymerase chain reaction methods. Given the challenges involved in obtaining invasive specimens from the naso- and oropharynx, saliva can serve as an easy to collect diagnostic specimen for screening in the work environment, schools and for home testing. Furthermore, saliva offers the opportunity to screen early cases that can be missed by invasive sampling.

Objective Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity. Setting This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan. Participants In total, 187 of 700 patients who underwent oesophago–gastro–duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded. Primary and secondary outcome measures Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument. Results Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20). Conclusion Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.

Introduction: The Oral Health Impact Profile (OHIP-14) has been used extensively to measure the impact of oral disease on oral health-related quality of life (HRQoL) but has not been validated in the Urdu language or tested in gastroenterology. Aims: To validate the OHIP-14 for use in Pakistan and its ability to assess oral health in patients with upper gastrointestinal (GI) and hepatic disorders. Design: Multicentre, cross-sectional. Setting: Four major tertiary care hospitals. Methods: The OHIP-14 was tested for reliability and validity in 700 patients referred for oesophago-gastro-duodenoscopic (OGD) investigation of the symptoms of upper GI or hepatic disease. Socio-demographic details and oral examination findings (for oral lesions and DMFT) were recorded. Results: The mean (±standard deviation) total OHIP-14 score (range 0–56) was estimated to be 23.38 ± 10.47, indicating a significant impact of upper gastrointestinal and hepatic disorders on oral health. The reliability coefficient of the OHIP-14 was above 0.7 threshold, and the tool had good internal consistency (α = 0.83). When associated with worsening DMFT (decayed, missed, and filled teeth) index value, the highest correlations (p < 0.01) were detected with functional limitation (rs = 0.234), physical disability (rs = 0.230), and psychological discomfort (rs = 0.221). Conclusion: The OHIP-14 is a precise and valid instrument for assessing oral-HRQoL in a gastroenterological setting amongst Pakistani population.

Tobacco use remains a major cause of preventable morbidity and mortality worldwide. The World Health Organization states that 19.1% of the Pakistani population consumes smoked or smokeless tobacco (SLT). Although many population focused studies have focused on the use of SLT in Pakistan, but they have failed to address the use of SLT among laborers, especially the niche population of public and heavy load drivers (that is, transporters). This study aimed to estimate the prevalence of SLT consumption among this population and the relationship of this parameter with knowledge, attitudes, and practices regarding SLT use. From a sample size of 714 participants, 615 responses were obtained, generating an overall response rate of 86%. The prevalence of SLT consumption in the study population was 93.7%; here, gutka was the most frequently consumed preparation (60.2%), followed by naswar (35.8%), paan (32.4%), and Mawa (16.7%). A masticatory habit was the most commonly cited factor leading to dependence (87.8%), followed by the influence of friends and family (83.9%), peer pressure (80.7%), and increased alertness (52.8%). However, 61.3% of participants reported experiencing strong withdrawals upon ceasing SLT use and believed themselves to be addicted and unable to quit usage. These findings suggest that for transporters, a high-risk occupational group dependent on SLT consumption, specific, tailored tobacco-cessation programs and medical assistance are needed to reduce the burden of tobacco-related morbidity and mortality. Key words: Smokeless tobacco (SLT), tobacco use, gutka, heavy load and public drivers, transporters, Karachi.