JOURNAL OF KHYBER COLLEGE OF DENTISTRY

2026-06-30

ARTIFICIAL INTELLIGENCE IN ORAL PATHOLOGY: REVOLUTIONIZING DIAGNOSIS WHILE PRESERVING HUMAN EXPERTISE

Hina Shabir — 2026-06-30

Artificial intelligence has progressed from a speculative concept to a practical clinical tool, and oral pathology is at a notably crucial juncture. The field of oral pathology relies on microscopic analysis of tissue specimen, the exact task that machine learning has shown exceptional skill in automating. The issue isn’t whether AI will replace the oral pathologist, but rather how the field can leverage it while maintaining the discernment that characterizes accurate diagnosis.

Diagnosing oral epithelial dysplasia, grading oral squamous cell carcinoma, and differentiating reactive from neoplastic lesions all involve subjective interpretation, and interobserver variability remains a known challenge even with standardized criteria. Whole-slide imaging has made it possible to digitize glass slides with high reliability, and deep learning algorithms trained on these images have shown encouraging results in detecting dysplasia, identifying malignant features, and classifying oral squamous cell carcinoma — facilitating rapid screening of extensive case volumes and highlighting specimens requiring further examination.

Oral squamous cell carcinoma is a major world-wide health challenge, but its impact is heavily concentrated in South Asia. Timely diagnosis continues to be the strongest indicator of survival; however, delays in reporting continue, and there is a shortage of trained oral pathologists in Pakistan. AI-powered systems, combined with telepathology, could bridge that access gap and bring specialist-level evaluations even into disadvantaged regions — as long as the necessary infrastructure, data protection, and faculty training are established to facilitate it.

None of this positions AI as a complete answer. Model performance depends on the data it was trained on, and many published systems rely on small, single-institution datasets that may not generalize across populations, scanners, or staining protocols. Algorithms built on data from developed countries should not be implemented locally without independent validation. The ethical questions are just as unsettled: most deep learning systems remain “black boxes,” and in a field where diagnosis directly shapes patient outcomes, that lack of explainability is a real barrier to trust, not a minor inconvenience.

In addition, fundamentally, histopathological diagnosis is not solely pattern identification. It requires recording accurate clinical history, radiographic findings, and molecular data, and clear communication with clinicians and patients—skills no algorithm currently replicates.

The future of oral pathology will be defined by collaboration with AI rather than competition. Pathologists who understand AI, contribute to its development, and critically assess evolving tools will shape how it is used—and will keep it accountable to patient welfare rather than convenience. The task now is not simply to adopt these tools, but to guide their implementation through research, training, and sound validation. The microscope is becoming a digital platform; the judgment behind it still has to be human.

EVALUATION OF POSTMENOPAUSAL WOMEN'S VITAMIN D LEVELS, PERIODONTAL HEALTH, AND ORAL MANIFESTATIONS

Muhammad Ifham Khan Jadoon — 2026-06-30

Objectives: Women's periodontal health may be impacted by the hormonal changes that occur throughout puberty, pregnancy, and menopause. When there is no underlying illness and amenorrhea lasts for 12 months, natural menopause takes place. Whether the menopause was forced or spontaneous, the time after the final menstrual cycle is referred to as the post-menopause.
Materials and Methods: Fifty postmenopausal women between the ages of 50 and 65 who were in good overall health were included. Every participant possessed at least 20 natural teeth. A history of hysterecto my & hormone alternate therapy, the use of xerogenic medications & vitamin D supplements, a history of periodontal handling within the previous 12 months, & adverse habits were the exclusion criteria.
Results: In postmenopausal women, an evaluation of oral symptoms revealed that 20 (40%) had taste change, 27 (54%) had burning mouth syndrome, and 32 (64%) had xerostomia. 31 (62%) of the patients had a lower salivary flow rate. Forty-three (86%) participants had in sufficient salivary vitamin D levels while, five subjects (10%), and two subjects (4%), had deficient and sufficient salivary vitamin D levels respectively.
Conclusion: The study concludes that postmenopausal women's oral and periodontal health is greatly impacted by hormonal changes that occur after menopause, including estrogen deficit and vitamin D insufficiency.

THE EFFECT OF BIOACTIVE RESTORATIVE MATERIALS ON ORAL MICROBIOME AND GINGIVAL HEALTH: A CROSS-SECTIONAL STUDY

Asmat Ullah — 2026-06-30

Objectives: The current study objective was to compare the oral microbiota diversity of patients with bioactive restorations verses traditional materials restorations.
Materials and Methods: The current study comprised patients who visited the institution's operative dentistry and had various restorations (such as conventional composites, fluoride-releasing composites, and bioactive glass). Saliva and plaque samples were used to gather data for the microbiome study (16S rRNA sequencing). The inflammation was asses by useing periodontal probing and gingival index.
Results: The greatest benefits were seen by bioactive glass restorations, with decreased inflammation, improved gingival health (gingival index: 1.2 ± 0.3), and decreased cariogenic bacteria (↓40%). Comparing fluoride-releasing composites to conventional composites, the former showed superior periodontal health and a moderate reduction in germs (± 25%). More sensitivity (35%) and pain (40%), higher pathogenic bacterial load, poorer gingival scores (2.1 ± 0.5), and deeper periodontal probing depths (3.5 ± 0.6 mm) were resulted from conventional composites.
Conclusion: The strongest beneficial effects were shown by bioactive materials, with decreased inflammation, enhanced gingival health, and decreased cariogenic bacteria. Higher bacterial loads, more gingival irritation, and deeper periodontal probing depths were seen in conventional composites.

EVALUATION OF ORAL STEREOGNOSTIC ABILITY IN RELATION TO COMPLETE DENTURE WEARERS

Muhammad Hadee Aziz — 2026-06-30

Objectives: To measure the mean difference of oral stereognostic ability (OSA) in edentulous patients before and one month after the time of denture insertion.
Materials and Methods: A total of 175 edentulous patients were included in the study. The OSA was assessed and recorded in two phases for each patient: first, at the time of primary impression and secondly, one month following denture insertion, respectively.
Results: Before insertion, the mean OSA score was 8.22±1.45, indicating lower sensory function. One month after denture insertion, the mean OSA score increased markedly to 11.44±0.66, reflecting enhanced oral sensory perception. The statistical analysis yielded a p-value of p<0.001, demonstrating that the observed improvement was statistically significant.
Conclusion: In conclusion, there was a significant improvement in oral stereognostic ability in edentulous patients one month after denture insertion, as evidenced by the increased mean score and highly significant statistical results.

EXPRESSION OF PROGRAMMED DEATH LIGAND-1 (PD-L1) IN ORAL POTENTIALLY MALIGNANT DISORDERS (OPMDS): A COMPARATIVE IMMUNOHISTOCHEMICAL STUDY

Ammara Khattak — 2026-06-30

Objectives: This study aimed to assess PD-L1 expression in Oral Potentially Malignant Disorders (OPMDs) and compare it with Oral Squamous Cell Carcinoma (OSCC).

Materials and Methods: Nineteen OPMD samples (14 biopsies and 5 cytology) were included in the study. Histopathological reports confirmed the diagnosis of biopsy samples and grouped them into dysplasia (n=6), chronic inflammation (n=5), verrucous leukoplakia VL (n=1), oral lichen planus OLP (n=1), and oral submucous fibrosis OSMF (n=1). The cytology samples were grouped into white oral lesions (n=3), and chronic oral ulcerative lesions (n=2) based on their clinical features. Additionally, five OSCC cases and five normal oral mucosa (NOM) samples were taken as positive and negative controls, respectively. Immunohistochemical staining was done to determine the qualitative and quantitative expression of PD-L1 using Image J software.

Results: There was 74% expression of PDL-1 in the OPMDs biopsy samples, 80% in OPMDs cytology samples, and 88% in the OSCC samples. A statistically significant difference was noted for PD-L1 expression between the OPMDs biopsy and OSCC groups (p-value=.013). However, this difference was insignificant in terms of cell count (p=0.47). Among OPDMs, the highest expression was seen in the Chronic oral ulcerative lesion among cytology (96%) samples and dysplasia (78%) among the biopsies.

Conclusion: Increased expression of PD-L1 in OPMDs suggests its role in immune-modulation and progression to malignancy. Therefore, it could serve as a predictive diagnostic marker for the malignant transformation of OPMDs.

BEHAVIORAL CORRELATES OF ORAL HEALTH STATUS AMONG SCHOOLCHILDREN IN KARACHI, PAKISTAN: A CROSS-SECTIONAL STUDY

Alssa Uqaily — 2026-06-30

Objectives: This study aimed to evaluate the association between lifestyle behaviors, traditional practices, and oral health status among school children.
Materials and Methods: A cross-sectional study was conducted among 142 students aged 10–18 years at a government school in Karachi, Pakistan. Behavioral information was collected through a structured interviewer-administered questionnaire assessing tooth brushing frequency, floss use, dietary habits, betel nut consumption, stress-related neglect of oral care, and traditional practices such as miswak use. Clinical oral examinations were performed following World Health Organization (WHO) criteria to record gingival bleeding and tooth sensitivity. Data were analyzed using SPSS version 26. Descriptive statistics and chisquare tests were applied, with statistical signifi cance set at p<0.05.
Results: Dental caries were present in 46.5% of participants, while 41.5% reported tooth sensitivity and 38% exhibited gingival bleeding. A significant association was observed between brushing frequency and dental caries (p=0.007). Gingival bleeding was also significantly associated with tooth sensitivity (p=0.027). No statistically significant association was observed between dental caries and betel nut consumption, miswak use, or snack frequency.
Conclusion: Oral hygiene behaviors, particularly tooth brushing frequency, were the most important determinants of oral health status among schoolchildren. The findings highlight the need for strengthened school-based oral health education and preventive interventions aimed at improving daily hygiene practices.

DISORDERED EATING BEHAVIORS AND THEIR ASSOCIATION WITH DEPRESSION AND ANXIETY AMONG MEDICALAND DENTAL STUDENTS: A CROSS-SECTIONAL STUDY

Amna Ijaz — 2026-06-30

Objectives: The study aims to determine the prevalence of disordered eating behaviors among university-going adolescents and young adults aged 18–25 years, and to evaluate their association with depression,anxiety and stress.

Materials and Methods: A cross-sectional study was conducted on 271 medical and dental students in Karachi. Data was collected through convenience sampling. Stress, anxiety, and depression were measured with DASS-21 scale, and disordered eating behaviors were measured using the Eating Attitudes Test-26 (EAT-26). Correlation between variables were assessed using Spearman's correlation coefficient.

Results: With a median EAT-26 score of 23, 67.9% of individuals were screened positive for eating disorder risk. Over half of the students reported moderate to severe stress, 44.3% displayed extremely severe anxiety and 77.4% indicated some degree of melancholy, indicating a large prevalence of psychological distress. EAT-26 scores were shown to be strongly positively linked with depression (r = 0.705), stress (r = 0.695), anxiety (r = 0.594), and BMI (r = 0.640), indicating a considerable correlation between disordered eating patterns, psychological distress, and body weight.

Conclusion: University students frequently engage in disordered eating practices, which are closely linked to stress, anxiety, depression, and BMI. To prevent long-term mental health repercussions and lessen the public health cost associated with eating-related psychopathology, it is crucial to address disordered eating attitudes throughout adolescence and early adulthood.

THIRD MOLAR EXTRACTION PAIN, OEDEMA, AND TRISMUS PREVENTION REGIMES COMPARED ACCORDING TO TYPE, DOSAGE, AND ADMINISTRATION METHOD OF CORTICOSTEROIDS: A SYSTEMATIC REVIEW

Khawaja Ahmad Mohsin — 2026-06-30

Objectives: To compare the effectiveness of various corticosteroid regimens (type, dose, and route) in preventing pain, swelling, and trismus following third molar surgery.

Materials and Methods: A systematic search was conducted in PubMed/MEDLINE, Scopus, Web of Science and the Cochrane Library until December 2025. Randomized controlled trials (RCTs) comparing any corticosteroid regimen to placebo or another active regimen were included. 15 RCTs (1,342 procedures) met eligibility criteria. Information about pain (Visual Analogue Scale), swelling, and trismus was gathered. Researchers conducted systematic reviews using random-effects models and the Cochrane RoB2 tool to assess risk of bias.

Results: Corticosteroids had a significant effect on swelling and trismus compared with placebo, but a moderate impact on pain. Oral dexamethasone (8mg) was not inferior to intramuscular administration of swelling (72h Mean Difference (MD): 0.6mm, 95% Confidence Interval (CI): -0.5 to 1.7). An 8 mg dose was superior to a 4 mg dose of Dexamethasone. The submucosal route had a meaningful benefi t compared with oral, producing less trismus (48h MD: 3.2mm, 95% CI: 1.1 to 5.3).

Conclusion: Methylprednisolone and dexamethasone were similar. There were no severe adverse incidents. Dexamethasone (8 mg) was an effective oral standard treatment. The submucosal route is also a worthy alternative, with particular advantages in cases of trismus. The choice of regimen may be determined according to clinical requirements, and all steroids are used as a supplement to the primary analgesia.

EXPLORING DENTAL STUDENTS PERCEPTIONS OF CAREER PATHWAYS IN DENTISTRY

Muhammad Khawaja Hammad Uddin — 2026-06-30

Objectives: Globally students are often confused with respect to their career choices and the future prospects. This cross-sectional study aims to identify these issues among dental students as a cross-sectional survey study.
Materials and Methods: The sample size calculated for the study is 264, and the study was conducted at the Dow University of Health Sciences campuses for the duration of 8 months. Data collected via a custom-made questionnaire were input into SPSS, and chi-square was used to interpret and compare different motivational factors.
Results: The results indicate that 64.7% males and only 47% females had made up their minds regarding their prospects in dentistry; the majority of respondents (35.3% males and 44.1% females) stated they chose dentistry as a way of serving the community. The study also reported the inclination of male respondents to pursue further studies abroad.
Conclusion: This study concluded that most of the participants feel they are in the right place. Personal interest and desire motivated them to choose dentistry, and most want to pursue postgraduate study, particularly overseas, and the majority prefer practising the profession as a private dentist or in state-owned hospitals.

EVALUATION OF PERIODONTAL STATUS IN PATIENTS WITH ESSENTIAL HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL STUDY

Abdul Manan — 2026-06-30

Objectives: This study aimed to explore whether essential hypertension is associated with periodontitis.

Materials and Methods: A comparative cross-sectional design was used at Periodontology OPD of Frontier Medical and Dental College Hospital, Abbottabad from October 2025 and January 2026. The study included 130 adults (both sexes, aged 25–60 years), divided into a normotensive control group and an essential hypertension test group. Periodontal parameters were recorded using standard indices. Sample size (n =130) was determined with 80% power, alpha = 0.05, and an anticipated effect size of 0.5, accounting for unequal group distribution.

Results: Clinical attachment loss (CAL) did not differ statistically meaningful between controls (1.37 ± 1.29) and hypertensives (1.38 ± 1.25), p = 0.974. Likewise, no meaningful difference emerged for bleeding index (p = 0.458) or plaque index (p = 0.099).

Conclusion: Although periodontitis is defined by plaque accumulation, gingival bleeding, pocket formation and attachment loss, the current findings indicate that essential hypertension does not show statistically significant association with periodontal health within the constraints of this study. Larger, longitudinal studies are needed to clarify this relationship and to assess whether periodontal therapy might improve blood pressure outcomes.