{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,4,4]],"date-time":"2022-04-04T22:21:31Z","timestamp":1649110891643},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T00:00:00Z","timestamp":1631577600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Nutritional deficiencies are common worldwide and is most notable in low and middle income countries. In the early weeks of September 2018, oral sores mostly affecting the tongue were reported in three central schools under Tsirang district, Bhutan. A total of 204 students were affected in the three central schools. All the affected students have been assessed on the outbreak and nutritional survey was conducted in the three schools<jats:bold>.<\/jats:bold><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A total of 204 students who complained of different oral lesions in the affected three schools were screened by the dental surgeon for clinical assessment and administered questionnaire for nutritional assessment by the nutritionist. Twenty-one students randomly selected were sent for blood tests for micronutrient assays and complete blood count. 41 students were tested for Exfoliative cell cytology to test for fungal elements. The collected data was double entered and validated using Epi-Data version 3.1 and analysed using Stata 15 IC. The characteristics of the participants are presented as frequencies, percentages, mean and standard deviation (SD).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Almost all the affected students in all the three schools had complaints of Burning Sensation (n\u2009=\u2009158) followed by Pain (n\u2009=\u2009153), Impaired Taste Sensation (n\u2009=\u2009100) and Intolerance to Spicy Food (n\u2009=\u200995). Nutritional assessment analysis suggested schools not meeting the Recommended Dietary Allowance (RDA) for all components of Vitamin B complexes and Iron.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Clinical assessments and nutritional survey analysis found inadequate vitamin rich dietary intakes among all the three schools. Implementation of a strict school feeding program with a balanced diet has been suggested accordingly.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12903-021-01808-5","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T12:05:37Z","timestamp":1631621137000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outbreak of oral ulcers (glossitis) among the students of three central schools under Tsirang district Bhutan, 2018"],"prefix":"10.1186","volume":"21","author":[{"given":"Tshewang","family":"Gyeltshen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lham","family":"Dorji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leki","family":"Dorj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kuenga","family":"Choden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"issue":"10","key":"1808_CR1","doi-asserted-by":"publisher","first-page":"e31","DOI":"10.2105\/AJPH.2014.302110","volume":"104","author":"A O\u2019Neil","year":"2014","unstructured":"O\u2019Neil A, Quirk SE, Housden S, Brennan SL, Williams LJ, Pasco JA, et al. Relationship between diet and mental health in children and adolescents: a systematic review. Am J Public Health. 2014;104(10):e31-42.","journal-title":"Am J Public Health"},{"issue":"10","key":"1808_CR2","first-page":"1207","volume":"78","author":"AL Rice","year":"2000","unstructured":"Rice AL, Sacco L, Hyder A, Black RE. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bull World Health Organ. 2000;78(10):1207\u201321.","journal-title":"Bull World Health Organ"},{"key":"1808_CR3","volume-title":"Preventing and controlling micronutrient deficiencies in populations affected by an emergency","author":"World Health Organization","year":"2007","unstructured":"World Health Organization. Preventing and controlling micronutrient deficiencies in populations affected by an emergency, vol. 1. Geneva: World Health Organization; 2007."},{"key":"1808_CR4","first-page":"1","volume-title":"Vitamin and mineral requirements in human nutrition","author":"FAO, World Health Organization","year":"1998","unstructured":"FAO, World Health Organization. Vitamin and mineral requirements in human nutrition. 2nd ed. Geneva: World Health Organization; 1998. p. 1\u201320.","edition":"2"},{"issue":"6","key":"1808_CR5","first-page":"36","volume":"65","author":"M Pflipsen","year":"2017","unstructured":"Pflipsen M, Zenchenko Y. Nutrition for oral health and oral manifestations of poor nutrition and unhealthy habits. Gen Dent. 2017;65(6):36\u201343.","journal-title":"Gen Dent"},{"key":"1808_CR6","unstructured":"White Paper on Bhutan School & Hospital Feeding Program (2019)."},{"issue":"4","key":"1808_CR7","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1034\/j.1601-0825.2003.02933.x","volume":"9","author":"N Avcu","year":"2003","unstructured":"Avcu N, Kanli A. The prevalence of tongue lesions in 5150 Turkish dental outpatients. Oral Dis. 2003;9(4):188\u201395.","journal-title":"Oral Dis"},{"issue":"5","key":"1808_CR8","first-page":"627","volume":"81","author":"BV Reamy","year":"2010","unstructured":"Reamy BV, Derby R, Col LT, Bunt CW. Common tongue conditions in primary care. Am Fam Physician. 2010;81(5):627\u201334.","journal-title":"Am Fam Physician"},{"issue":"1","key":"1808_CR9","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/S0733-8635(02)00057-8","volume":"21","author":"JA Byrd","year":"2003","unstructured":"Byrd JA, Bruce AJ, Rogers RS. Glossitis and other tongue disorders. Dermatol Clin. 2003;21(1):123\u201334.","journal-title":"Dermatol Clin"},{"issue":"3","key":"1808_CR10","doi-asserted-by":"publisher","first-page":"118","DOI":"10.36685\/phi.v2i3.76","volume":"2","author":"L Dzed","year":"2016","unstructured":"Dzed L, Thinley S, Tshomo D, Dechen K, Mongar B, Palzang T, et al. Investigation of suspected peripheral neuropathy outbreak in Dechentsemo Central School, Thinleygang, Punakha. Public Health Indones. 2016;2(3):118\u201324.","journal-title":"Public Health Indones"},{"key":"1808_CR11","unstructured":"Pradhan D. Acute Encephalopathy in children admitted to PICU of National Referral Hospital in Bhutan Dinesh Pradhan Pediatric Resident, Khesar Gyalpo University of Medical Sciences, Thimphu, Bhutan Christoph Funk Pediatric Intensivist, Dietrich-Bonhoeffer-Klinik (2019)."},{"key":"1808_CR12","unstructured":"Ministry of Education B. Annual Education Statistics-2019. 1377."},{"key":"1808_CR13","unstructured":"Education M of, WFP. Food & Dietary Guidelines for School Aged Children in Bhutan. J Chem Inf Model."},{"key":"1808_CR14","unstructured":"Research IC of M. Recommended dietary allowances and RDA of Indians (ICMR 2010) and their uses in planning diets (2010)."},{"key":"1808_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12903-016-0215-y","volume":"16","author":"J Kim","year":"2016","unstructured":"Kim J, Kim M, Kho H. Oral manifestations in vitamin B 12 deficiency patients with or without history of gastrectomy. BMC Oral Health. 2016;16:1\u20139. https:\/\/doi.org\/10.1186\/s12903-016-0215-y.","journal-title":"BMC Oral Health"},{"issue":"3","key":"1808_CR16","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/j.jaad.2008.09.011","volume":"60","author":"J Graells","year":"2009","unstructured":"Graells J, Ojeda M, Muniesa C, Gonzalez J. Glossitis with linear lesions: an early sign of vitamin B 12 deficiency. J Am Dermatol. 2009;60(3):498\u2013500. https:\/\/doi.org\/10.1016\/j.jaad.2008.09.011.","journal-title":"J Am Dermatol"},{"issue":"1","key":"1808_CR17","doi-asserted-by":"publisher","first-page":"49","DOI":"10.47811\/bhj.08","volume":"1","author":"L Dzed","year":"2015","unstructured":"Dzed L, Dorji T, Dorji you prefer to, Dhakal GP, Yangchen P, Wangmo K. Status of Thiamin deficiency in boarding school children from seven districts in Bhutan with previous history of peripheral neuropathy outbreaks: a cohort study. Bhutan Heal J. 2015;1(1):49\u201356.","journal-title":"Bhutan Heal J"},{"issue":"08","key":"1808_CR18","doi-asserted-by":"publisher","first-page":"507","DOI":"10.23958\/ijirms\/vol04-i08\/735","volume":"4","author":"L Dzed","year":"2019","unstructured":"Dzed L, Pokhrel HP, Zangpo L, Pelzom D, Dendup U. Vitamin B12 deficiency among boarding school children from seven districts of Bhutan. Int J Innov Res Med Sci. 2019;4(08):507\u201311.","journal-title":"Int J Innov Res Med Sci"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-021-01808-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-021-01808-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-021-01808-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T12:06:44Z","timestamp":1631621204000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcoralhealth.biomedcentral.com\/articles\/10.1186\/s12903-021-01808-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,14]]},"references-count":18,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1808"],"URL":"https:\/\/doi.org\/10.1186\/s12903-021-01808-5","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,14]]},"assertion":[{"value":"18 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval has been approved by the Research Ethics Board of Health (REBH), Ministry of Health, Royal Government of Bhutan vide approval number <i>Ref. No. REBH\/Approval\/2019\/067.<\/i> An informed consent has been obtained from the individual participants for the use of photographic materials while the use of data and consent to participate had been obtained from the legal guardians (Principal of the school). For participants below 18\u00a0years of age, consents were granted by the legal guardian (Principal of the school). All methods were carried out in accordance with relevant guidelines and regulations as enshrined in Helsinki Declarations 1964.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Individual written consents have been obtained for use of photographic materials using the consent form as per Biomed-central consent form. Copies of written consent forms are available for review by the Editors of the journal. Informed Consent for Publications for participation of students in the study was obtained from the school principals and the Ministry of Education, Royal Government of Bhutan.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"444"}}