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OBJECTIVE: To assess the financial impact of COVID-19 on employers of private dental practices of Pakistan in the month of April and May 2020. METHODOLOGY: In this cross sectional study, the employers of dental practices of Pakistan were inquired about their financial management during COVID 19 outbreak. The data was analyzed using IBM-SPSS version 23.0. Percentages and Chi-square tests were used for statistical analysis at p <0.05. RESULTS: 52.7% owners opened their practices whereas 37.8% of tenants’ clinics remained closed (p<0.01). 38.3% of tenant employers provided inadequate PPE whereas 53.2% owners provided adequate PPE to their staff (p=0.02). 64% of owners easily arranged PPE for staff whereas 70.4% tenants found it difficult to arrange PPE because of its high cost. Employers with less than 10 years of practice reported less than 5% whereas those with more than 10 years of practice reported up to 24% of revenue generation income (p<0.01). Most of the employers paid full salary to their employees. If this condition persists till the end of August, 40.8% employers (<10 years practice) planned to adjust staff salaries whereas 33% employers (>10 years of practice) planned to find innovative ways to lower their operating costs (p<0.01). CONCLUSION: Due to minimal patient turnover, dental employers are facing incredible challenges in managing the expenses. Those with more than 10 years of practice are more economically stable as compared to the employers with less than 10 years of practice. KEYWORDS: COVID-19, finances, dental clinic, Pakistan. HOW TO CITE: Sarwar H, Qureshi NR, Fatima S, Naeem MM, Inayat A. A nation-wide survey on financial impact of COVID-19 on employers of private dental practices of Pakistan. J Pak Dent Assoc 2020;29(4):172-178.

Chewing habits of tobacco, betel quid (paan), and betel nut (chhaliya) are common traditions in Pakistan. Different other preparations and combination of flavors with tobacco, paan, and chhaliya ingredients are commonly available in the market and have received considerable attention as sources of carcinogens that promote OSCC. Mutagens can damage DNA and generate promutagenic lesions. The germ line mutation/polymorphism of p53 gene has been reported to be involved in multiple steps of carcinogenesis. This study aims to find out the loss of TP53 functions due to mutation/polymorphism caused by genomic alteration and interaction with tobacco-related ingredients.Tissue and blood specimens from 260 OSCC patients were collected and compared with blood samples of 260 age- and sex-matched controls. Mutations in exons 2-11 of p53 gene were examined by PCR-SSCP and directly sequenced.A novel mutation was found in exon 7 of p53 gene. This mutation was observed in the tumors of the OSCC patients. The blood samples of the patients and the controls did not show the nucleotide change in this region. The "AGT" to "ACT" missense mutation was identified at position 719 at TP53. This results in the substitution of amino acid serine with threonine at codon 240 of p53 protein.This novel missence mutation in the DNA-binding domain indicated that the DNA structure may be damaged by the use of exogenous DNA-damaging agents, including tobacco-related carcinogens present in gutka, niswar, and manpuri, which may result in the loss of p53 protein function.

Objectives: Oral Squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity. The study was done with the aim to determine the clinical pattern of OSCC seen in tertiary care hospital of Karachi, Pakistan. The frequency of neck metastasis in different staging of squamous cell carcinoma was also recorded. Study Design: Retrospective study. Setting: Department of Oral & Maxillofacial Surgery Liaquat College of Medicine and Dentistry. Period: June 2013- July 2016. Material & Methods: It included 35 males and 25 females which presented with different sites and stage of squamous cell carcinoma. Clinically patients were staged as stage I, stage II, stage III and stage IV and comprised of 3, 8, 30 & 19 patients respectively. Patients presented with cancer of buccal mucosa (31 patients), retromolar region (12 patients), maxillary alveolus (8 patients), tongue (2 patients), floor of mouth (4 patients) & lip (3 patients). Right side was most common, 48 patients as compare to left side, 12 patients while lip cancers was in upper lip in all patients including commissure. Results: Total 60 patients were included in the study with the male to female ratio of 1.4:1. No significant association was seen between age and gender of the patient (p-value 0.933). Majority of patients were male involving buccal mucosa (51.67%) as the most frequently involved site followed by retromolar area (20%) and tongue (13.3%). Mean age of patients included in the study was 50.87 ± 5.53. Conclusion: Most of the cases of OSCC were seen in older patients with increased number of cases involving buccal mucosa as their primary site. Majority of the tumors were classified as stage III followed by Stage IV, Stage II and stage 1 respectively.