As a result of scientific technological advancements in medical diagnostics, treatment modalities of non-communicable and communicable diseases, and palliative care approaches, the life expectancy of women is soaring than men across the globe, due to the longer telomere length and other protective factors. The main symptoms of menopause broadly be divided into psychological somatovegetative and urogenital. Neglected menopausal symptoms can lead to debilitating comorbidities which may end up in mortalities. Fortunately, modern treatment and therapeutic formalities based on pharmaceutical preparations, as well as lifestyle- modifications have provided long-lasting relief for the pre-menopausal woman. This can be done as per her preference if she is knowledgeable, resourceful, and cheerful. Menarchae is the “ alpha” and menopause is the “omega” phase in the reproductive lifecycle of any woman. Reproductive health is essentially an integral part of women’s health. In this 4^th industial revolution era information technology and digital science go hand in hand to improve the quality of life of populations across the globe irrespective of their educational and professional status. Health literacy among disadvantageous sub populations increased. Positive attitudes, perception and evidence-informed knowledge on adolesecent girls about not only ‘period pains’ but menopausal symptoms as an inevitable phase in a woman’s reproductive health may make a better sense at the dawn of evidence based medicine even in a low middle income country like Sri Lanka. Hence, this timely communication strengthens by, Do not fear when menopause is near: The Importance of a Preparatory Time and Space to face the consequences of Menopaus. How to forget the fact that alpha and the omega are inevitable phases in woman’s reproductive health trajectory. Moreover, the importance of a preparatory time and space well in advance preferably in peri-menopausal time to prevent and control the inevitable health consequences. Moreover, to invest in menopause for a brighter future in the modern personalized medicine era based on global scientific evidence.

At present there is a huge demand for experimental periodontal models to expand the knowledge in periodontal health related to Microbiome Medicine. Thus far none of the periodontal pathogens or cocktail of pathogens reported as aetiological agents of infectious chronic periodontitis to link with oral squamous cell carcinoma as the way Helicobactor pyroli linked with gastric carcinoma and other related gastric malignancies. Nevertheless, invasive pathogenic mechanisms of virulent strains of Porphyromonas gingivalis and Fusobacterium nucleatum singly as well as a duo demonstrated the progression and devastation of oral, pancreatic, and colorectal cancers in different study populations. Periodontal disease may be an inevitable consequence or complication of oral cancer patients who comprise a section of digestive tract cancers, due to suboptimal or poor oral hygiene practices due to unbearable pain and other complications of stage four oral cancer. Periodontitis is a reversible oral condition when it is treated properly at the correct stage and good oral hygiene practices and treating chronic periodontitis showed successful interventions in the prognosis of oral cancer. In the light of these scientifically proven epidemiological, laboratory, and clinical evidence this communication highlights the implication of ATP scavenging behavior and upregulation of immune regulatory receptors by intracellular Porphyromonas gingivalis based on in-vitro models on the prognosis of digestive tract cancers regarding the oral cancer patients.

The proportion of human cells to the microbial cell is 1:1. These procaryotes use efflux pumps and enzymes to prevent cellular intoxication of ions and compounds respectively. There is promising evidence on the role of the gut microbiome and its enzymes in metabolizing xenobiotics. The genetic potential of oral bacteria in drug and xenobiotic metabolism is yet to be unveiled. This study aimed to characterize the bacteriome associated with oral fibroepithelial polyps (FEP) and to predict the genetic potential. A representative sub-sample of 22 clinically diagnosed oral FEP (the control group) was selected from a main case-control study. Amplification of nucleotides of extracted DNA from frozen tissues was performed for the V1 to V3 region and sequencing of the amplicon with Illumina’s 2 X 300–bp chemistry. Classification of high-quality nonchimeric merged reads was done to the species level with a prioritized BLASTN-based algorithm. Downstream compositional analysis was performed with QIIME (Quantitative Insights into Microbial Ecology). Functional prediction of bacteriome was obtained by PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States). Rothia mucilaginosa, Streptococcus mitis, Gamella haemolysans, Streptococcus sp. oral taxon 431, and Rothia dentocariosa accounted for the top five taxa among 810 bacterial species according to the percentage of average relative abundance. Rothia mucilaginosa was elevated statistically significantly (p< 0.05). The genetic potential of xenobiotics and drug metabolism catalyzed by the P450 enzymes was observed for the first time as an attribute of bacteriome associated with oral FEP tissues dominated by R. mucilaginosa. This finding needs further investigation.

Diabetes mellitus and dental caries (tooth decay) are not only common Non Communicable Diseases (NCDs) contributing to high burden of diseases but costly diseases to manage. Diabetes mellitus is a leading cause of mortality and reduced life expectancy across the globe. Early child hood dental caries (ECC) denotes a common chronic childhood disease and cariogenic dietary patterns dominated by refined sugar is one of the main causative factors. Thus, high burden of ECC could be a proxy indicator of excessive refined sugar consumption of a child. If such unhealthy dietary patterns are continued through to adolescent to adulthood, there is a high probability of an individual becoming a diabetic. Therefore, it is rational to argue high ECC burden in a country could be an indicator of future burden of diabetes. Moreover, ECC provides a critical period and a window of opportunity across life-course perspective, to intervene with cariogenic dietary patterns underpinned by common risk factor approach. This could be achieved by tailored dietary counseling for parental care givers of children with ECC. A healthy dietary pattern fostered in the childhood, most probably would continue to adulthood which may become beneficial in reducing the incidence of diabetes. Against this backdrop, we provide a perspective from Sri Lanka: a lower-middle-income country (LMIC) which records the highest prevalence of diabetes and pre-diabetes in south Asia. Our perspective will provide novel insights and innovative ideas into prevention and control of diabetes burden in LMICs, harnessing the potential of preventive dentistry.

Introduction: COVID-19 is an unprecedented global public health emergency currently impacting India in an unprecedented manner. Aim of this study was to assess knowledge, awareness, perceptions and related factors of Indian dentists on COVID-19. Methodology: A cross-sectional, on-line questionnaire-based study was conducted over one week between 3rd May, 2020 to 10th May, 2020. The sample comprised 403 Indian dentists in solo, group practices and in the academic arena. The self-administered questionnaire assessed 1) knowledge/awareness on factors related to COVID-19 patient identification and symptomatology, 2) knowledge/awareness of COVID-19 transmission and 3) perceptions of COVID-19 history taking procedure. Statistical analyses were conducted using Statistical Package for Social Sciences for Windows, version 21.0 (IBM Corp., Armonk, NY., USA). Frequency distributions and logistic regression analyses were used. Results: Indian dentists demonstrated an overall modest level of knowledge on identification of patients with COVID-19. Moreover, they had a high level of awareness of the COVID-19 transmission means, and the generally accepted procedural perceptions on patient history taking. However, there were some gaps in specific aspects of knowledge and perceptions. Those who were aged ≥ 30-years had a significantly higher level of knowledge of patient identification means than those who were < 30-years (OR=1.78:1.12-2.83); p=0.01. Moreover, specialized dentists were significantly knowledgeable of COVID-19 transmission means than the general dentists (OR=1.89:1.22-2.93; p=0.004). Conclusions: Our findings demonstrate identifiable gaps in knowledge/awareness and perceptions of COVID-19 in Indian dental professionals. These gaps should be fulfilled, at the earliest, due to the rising burden of COVID-19 in India, to ensure safe dental care delivery.

Background: Studies employing next-generation sequencing (NGS) show that the oral fungal community (mycobiome) is far more complex than hitherto thought. However, the role of the oral mycobiome in health and disease, including oral carcinogenesis, has not been explored. Objective: To characterize the mycobiome associated with oral squamous cell carcinoma (OSCC). Methods: Tissue biopsies [cases: 25 OSCC; controls: 27 intra-oral fibro-epithelial polyp (FEP)] were collected from oral and maxillofacial units in Sri Lanka. Total DNA was extracted and subjected to sequencing of the fungal ITS2 region using Illumina’s 2x300 bp chemistry. High quality, non-chimeric merged reads were classified to species level using a BLASTN-algorithm with UNITE’s named species sequences as reference. Downstream analyses were performed using QIIME and LEfSe. Results: 364 species representing 160 genera and 2 phyla (Ascomycota and Basidiomycota) were identified, with Candida and Malassezia making up 48% and 11% of the average mycobiome, respectively. However, only 5 species and 4 genera were detected in ≥50% of the samples. The species richness and diversity were significantly lower in OSCC. At the genus level, Candida, Hannaella and Gibberella were overrepresented in OSCC while Alternaria and Trametes were more abundant in FEP. Species-wise, C. albicans, C. etchellsii and Hannaella luteola-like species were enriched in OSCC while Malassezia restricta, Aspergillus tamarii, Alternaria alternate, Cladosporium halotolerans, and Hanseniaspora uvarum-like species were the most significantly abundant in FEP. Conclusions: A dysbiotic mycobiome dominated by C. albicans was found in association with OSCC. Whether this dysbiosis plays a role in oral carcinogenesis warrants further investigation.