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   Table of Contents - Current issue
Coverpage
March-April 2019
Volume 30 | Issue 2
Page Nos. 163-326

Online since Wednesday, May 29, 2019

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EDITORIAL  

Data interpretation and statistical significance Highly accessed article p. 163
SM Balaji
DOI:10.4103/ijdr.IJDR_363_19  PMID:31169142
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ORIGINAL RESEARCH: EVALUATIVE STUDY Top

A study on impact of oral health on general health among the elderly residing in a slum of Kolkata: A cross-sectional study p. 164
Shobhit Garg, Aparajita Dasgupta, Swanya Prabha Maharana, Nazrul Mallick, Bobby Pal
DOI:10.4103/ijdr.IJDR_491_17  PMID:31169143
Context: Oral health means more than only good teeth. It is a state-of-being-free from mouth and facial pain, oral and throat cancer, oral infections, periodontal diseases, tooth decay or loss, and other diseases/disorders. The age distribution of the world's population is changing. With advances in medicine, the proportion of older people continues to increase worldwide. Aims, Setting, Materials and Methods: A cross-sectional study was carried out among 158 elderly (>60 years) residing in a slum of Kolkata during the period from April 2017 to June 2017 to assess the impact of oral health on general health. Data were collected using a pretested predesigned schedule containing Geriatric Oral Health Assessment Index. Data analysis was performed in R software. Poisson regression was used to find the associates of the impact of oral health. Results: Mean (standard deviation) age was 68.54 (5.9) years. A total of 104 (65.8%) participants reported; foul breath as a problem and 88 (55.7%) reported gum bleeding as a problem. All participants used to clean their teeth daily but only 36.1% used to clean their teeth at least twice daily. More than half the participants reported that they have limited the kind of food they eat due to dental/gum condition and trouble chewing. Conclusion: There is a need to provide sensitive oral health services that are accessible, affordable, appropriate, and acceptable. Knowledge regarding oral health and hygiene should be provided to all elderly, especially diabetics. Further research with the broader conceptual framework, in different age groups and in different settings are warranted.
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Knowledge and attitude of general and specialist dentist in pediatric dentistry: A pilot study in Odisha, India p. 170
Sonu Acharya
DOI:10.4103/ijdr.IJDR_428_17  PMID:31169144
Background: Pediatric dentists (PDs) treat children in a manner that builds a positive dental attitude in them. The treatment modalities for pulpally involved teeth in children are different by general dentists (GDs) as compared to PDs. Aim and Objectives: The aim of this study is to determine the attitudes of PDs, GDs, and dentists of other specialties toward endodontic treatment of primary teeth. Materials and Methods: A structured 14-item questionnaire was formulated in English and distributed to PD, GDs, and dentists of other specialties. The filled questionnaire survey was statistically analyzed using simple descriptive analysis, and inferential analysis was performed. Results: Of the total survey respondents, 12 (20.68%) were PDs, 28 (48.27%) were GDs, and 18 (31.03%) were from other specialties. About 91.6% of the total respondents preferred endodontic procedures in the primary teeth. Conclusion: The study concluded that the GDs, PDs, and dentists of other specialties differ in their treatment recommendations for primary teeth. The GDs and dentists of other specialties were regularly performing pulp therapy in the primary teeth and should frequently update their knowledge about endodontic procedures in the primary teeth.
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Evaluation of academic performance of undergraduate dental students in a government medical university in Kerala, India Highly accessed article p. 175
PK Sudhir, KG Varghese, B George
DOI:10.4103/ijdr.IJDR_692_17  PMID:31169145
Introduction: Dentistry is considered to be a high-stress profession. The educational period in dental schools is viewed as a highly demanding and stressful learning environment. The aim of the study was to evaluate the academic performance of undergraduate dental students of 2010, 2011, and 2012 batches admitted at Kerala University of Health Sciences. Materials and Methods: The present retrospective study evaluated the performance of dental students of 2010, 2011, and 2012 batches from their first Bachelor of Dental Surgery (BDS) to the completion of final BDS Part 2 examination. The study was carried out from August 2010 to March 2017. The data were analyzed using SPSS version 19 software. Chi-square test was used for analyzing the significance of difference between proportions. The level of significance was set at P < 0.05. Results: The results of first BDS students of 2010, 2011, and 2012 batches were 35.8%, 49.9%, and 55.5%, respectively. Whereas, the results of the final BDS Part 2 students of 2010, 2011, and 2012 batches were 92.6%, 88.4%, and 92.5%, respectively. Conclusion: The present study shows a decline in performance of dental students at the time of inception of the university, and as time progressed, the results of the students showed significant improvement.
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Translation and validation of hindi version of oral health impact profile-14, a measure of oral health-related quality of life of geriatrics p. 180
Swati Verma, Hunny Sharma
DOI:10.4103/ijdr.IJDR_729_17  PMID:31169146
Background: The oral health impact profile-14 (OHIP-14) scale developed originally in English has been translated from time to time in different languages revealing to be valid and reliable instruments. Aim: The present study was carried out with an aim to translate and validate Hindi Version of OHIP-14 instrument among geriatrics to measure the oral health-related quality of life. Methodology: This was a descriptive cross-sectional study, which employed 400 individuals aged 60 years and above who were residents of Durg, Chhattisgarh India. Participants were selected through convenient sampling method. The English version of the OHIP-14 was translated into Hindi, pretested and subsequently administered to the participants by a trained interviewer. Each patient signed informed consent and responded to the Hindi version of the questionnaire. Result: Cronbach's alpha of the translated scale was 0.89–0.90 when words were deleted individually. Comparison of English and translated Hindi version of OHIP-14 by unpaired t-test showed no significant difference (P = 0.562). Pearson correlation coefficient test showed very strong positive correlation (0.892). Furthermore, a very strong positive correlation was observed between the recorded OHIP-14 scores and Decayed Missing Filled Teeth (DMFT) scores of examined geriatric individuals (Pearson correlation coefficient = 0.952 and P = 0.001). Conclusion: The Hindi translation of the OHIP-14 is a valid and reliable instrument to measure the oral health-related quality of life in older adults of India.
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Mutations in FGFR3 gene associated with maxillary retrognathism p. 185
Ravi M Subrahmanya, Sreenivas V Prasad, Rajendra B Prasad, Subraya Mogra, Veena Shetty, Vamana Rao
DOI:10.4103/ijdr.IJDR_113_18  PMID:31169147
Context: Understanding the role of fibroblast growth factor receptor (FGFR) in the regulation of bone development and disease will ultimately lead to better prevention and treatment of related bone deformities and disorders. Aims: To evaluate the role of gene FGFR3 in individuals with retrognathic maxilla by polymerase chain reaction (PCR) technique at molecular level and evaluate the significance of the same. Settings and Design: Hospital based fundamental research involving individuals having maxillary retrognathism. Methodology: A total of 62 individuals (30M and32F) who were willing to take part in the study were selected from cephalometric measurements of N I A and the length PNS to ANS. The institution based basic genetic research study involved collection of fresh blood samples, DNA extraction, PCR analysis, and amplification using the specifically designed forward and reverse primers for targeting the commonly occurring mutations in FGFR3 gene. Further the products were sequenced to evaluate the presence of any novel mutations. Results: The targeted single-nucleotide polymorphisms, at position 1138 in exon 10 of the FGFR3 gene were not identified in the analyzed blood samples. The detailed sequencing of full gene revealed the presence of 2 novel mutations, Exon 3: A213G and Exon 3: A223A/G in one individual. Conclusions: The present study indicated 2 novel mutations in gene FGFR3 in individual with maxillary retrognathism. The genetic–environmental interactions might have played a significant role in the expression of retrognathic maxilla.
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Clinical evaluation of biodentine: Its efficacy in the management of deep dental caries p. 191
S Kusumvalli, Abhinav Diwan, Shiraz Pasha, Madhuri R Devale, Chava Deepak Chowdhary, Priyanki Saikia
DOI:10.4103/ijdr.IJDR_333_17  PMID:31169148
Background: The advancement in the dentin regeneration aiming at the preservation of pulpal vitality has challenged the traditional concept of substituting diseased tooth with inert materials. Clinical studies, demonstrating preservation of pulpal vitality with the use of biomimetic materials in deep carious lesions, are lacking in the literature. Objective: This clinical study aims to assess the treatment outcome of vital pulp therapy using Biodentine in cases of deep carious lesion in a single visit treatment protocol. Methodology: Twelve posterior teeth with deep carious lesion with no signs of irreversible pulpitis were selected for the study. After rubber dam application, excavation of caries was performed until all infected dentin was removed leaving behind affected dentine. Biodentine was applied followed by immediate restoration with bonded composite resin. The patient was recalled at time intervals of 1 day, 1 month, 3 months, 6 months and up to 1 year for clinical and radiographic evaluation. Outcome was described in terms of success and failure. Success was defined as clinical absence of signs and symptoms, response to sensibility test on every recall visits, no tooth discoloration seen, and radiographical absence of periapical pathosis. Results: All the 12 patients were recalled at the end of 1 year for follow-up. The overall success rate was 83.4%. Two of the twelve cases required root canal treatment to relieve painful pulpitis. On clinical and radiographic examination, no signs of periapical pathosis were noted in the 10 successful cases. Conclusion: In deep carious lesions, vital pulp therapy with Biodentine has proven to maintain the pulpal vitality in permanent teeth with single visit treatment protocol.
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ORIGINAL RESEARCH: COMPARATIVE STUDY Top

Effectiveness of musical toothbrush on oral debris and gingival bleeding among 6–10-year-old children: A randomized controlled trial p. 196
Nivedha Subburaman, Parangimalai Diwakar Madan Kumar, Kiran Iyer
DOI:10.4103/ijdr.IJDR_128_17  PMID:31169149
Context: Motivation serves to be an integral part of health promotion to children at the learning phase of their life. Aim: Evaluation of the effectiveness of musical toothbrush over regular toothbrush in the debris and gingival bleeding scores among children. Settings and Design: This was a single-blinded parallel, randomized controlled trial conducted among 6–10-year-old schoolchildren in Chennai. Methods: One hundred participants with allocation ratio of 1:1 were assigned to musical and regular toothbrush group by simple randomization. After baseline evaluation (T0) of Debris Index-Simplified (DI-S) and Gingival Bleeding Index (GBI), outcome variables were assessed for a period of 3 months (T1, T2, and T3). Statistical Analysis Used: Friedman test and Mann–Whitney statistical test were used to compare the outcome variables within and across the two groups. Results: Thirty-two boys and 68 girls (mean age: 8.53 years) participated in the study. Statistically significant difference was seen in DI-S score among musical toothbrush group (mean: 0.50 [T3] and GBI score: 8.18% [T3]) when compared to regular toothbrush group (mean: 1.59 [T3] and GBI score: 23.54 [T3]) at the end of the 3rd month. Conclusion: Although both the musical and regular toothbrushes effectively reduced the DI-S and GBI scores, former showed effective change among children when compared to the latter.
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The relationship between overweight/obesity and dental erosion among a group of Saudi children and adolescents p. 200
Nahla Jastaniyah, Ibrahim Al-Majed, Aayed Alqahtani
DOI:10.4103/ijdr.IJDR_774_17  PMID:31169150
Background: As childhood obesity is emerging in Saudi children and adolescents with high prevalence, it is considered as one of the major public health concerns. Therefore, it has been studied in relation to other diseases as a cause factor. Aim: The aim of this study is to investigate whether childhood obesity is a risk indicator for dental erosion and to obtain information on dietary habits that are related to dental erosion in overweight/obesity in a group of Saudi children and adolescents. Study Design: The study involved 370 children of both genders aged 4-18 years. The convenient sample included 190 overweight/obese children attending obesity clinic and 180 controls. Materials and Methods: Body mass index (BMI) (kg/m2) was calculated and BMI percentile obtained based on the age- and sex-specific according to the Centers for Disease Control chart (normal 5th to <85th percentile, overweight 85th to <95th percentile, and obese ≥95th percentile). Dental examination and questionnaire were carried out by one calibrated and trained examiner on these children using the UK Children's Dental Health Survey Classification for dental erosion. Results: The prevalence of dental erosion was more significant in the study group (8.42%) than the normal group (2.78%). Its severity was higher in the form of loss of enamel surface characterization in the study group (86.36%) compared to controls (13.64%). Carbonated drinks that were taken at night and drinks that were taken at night and drunk without a straw showed higher prevalence of dental erosion (33.3% and 10.3%) in overweight/obese participants. Conclusions: Dental erosion can be regarded as a risk indicator of childhood obesity in the form of loss of enamel surface characterization. Efforts should be taken to reduce carbonated drinks intake and to change the method of drinking erosive potential drinks among overweight/obese children.
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Orofacial conditions and their relation to the sense of coherence among participants afflicted with leprosy in West Bengal State: A cross-sectional study p. 207
Poulami Mishra, Nusrath Fareed, P Jagan
DOI:10.4103/ijdr.IJDR_381_17  PMID:31169151
Introduction: About 4 million people are disabled by leprosy. Eighty-six percent of leprosy patients reside in Southeast Asia and Brazil. India accounts for up to 70% of total cases. In India, it is highest in West Bengal, Maharashtra, Uttar Pradesh, and Bihar. Objective: The objective of the study is to assess the quality of life in terms of sense of coherence (SOC) among patients afflicted with leprosy in the state of West Bengal (located in eastern India on the Bay of Bengal). Methodology: A cross-sectional descriptive epidemiological study was conducted among estimated sample size of 350 participants who were afflicted with leprosy drawn from across the state of West Bengal, India. Data were collected on a specially designed pro forma. Results: Most of the participants afflicted with leprosy were in the age group of 40–77 years, and there was predominance of males, with most of them belonging to the upper-lower socioeconomic class. On evaluating the incidence of extraoral lesions through ranking, facial nodules and facial spots were highest 182 (52%), while among intraoral lesions such as melanin pigmentation 176 (50%) and inflammatory papillary hyperplasia 150 (42.8%), was seen in greater fraction. The results of bivariate analysis between SOC and variables under investigation show that majority of the cases, i.e., 258 (47.14%) revealed the SOC interpretation as “poor.” Statistical analysis showed significant difference in relation to age (P ≤ 0001) and socioeconomic status (P = 0.053) of participants. Conclusions: We conclude that 52% of the population were having facial nodules and facial spots and 50.2% of the population had intraoral manifestation such as melanin pigmentation. Analysis of SOC revealed that majority of the cases were interpreted as “poor.”
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Effect of non-surgical periodontal therapy on stress and salivary Chromogranin-A levels: A clinico-biochemical study p. 213
Ratika Lihala, Praveen Jayaram, Anirban Chatterjee, Astha Joshi
DOI:10.4103/ijdr.IJDR_273_17  PMID:31169152
Aim: The aim of the study was to compare chromogranin A (CgA) and stress levels before and after non-surgical periodontal therapy (NSPT). Materials and Methods: A sample of 40 patients in the age range 25–60 years were included in the study and were divided into gingivitis (10 subjects), chronic periodontitis (CP) (15 patients) and aggressive periodontitis (AgP) (15 patients). The patients were asked to complete two sets of stress questionnaires, plaque index, gingival index, probing depth and clinical attachment levels (CAL) were recorded. Salivary samples were taken at baseline and were repeated three months post NSPT. Results: CgA was detected in saliva samples of all the groups. A statistically significant correlation was established between levels of CgA and stress parameters, which was shown to be the highest in AgP (P < 0.001), followed by CP group (P < 0.005) at baseline. Following NSPT, an overall reduction was observed in the levels of CgA, which was correlated with the overall reduction in stress levels for AgP group (P < 0.005) followed by CP group (P < 0.037). Amongst the clinical parameters, CAL showed the strongest correlation with CgA both at baseline and after NSPT (P < 0.001). Conclusion: Stress was directly correlated to the levels of salivary CgA levels, which was the highest for aggressive periodontitis at baseline. NSPT showed a marked improvement in all the parameters. Levels of CgA and CAL showed a significant correlation in both the CP and AgP groups.
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ORIGINAL RESEARCH: PROSPECTIVE STUDY Top

Superoxide dismutase, glutathione peroxidase, and catalase antioxidant enzymes in chronic tobacco smokers and chewers: A case–control study p. 219
Poonam Agarwal, Anjana Bagewadi, Vaishali Keluskar, DP Vinuth
DOI:10.4103/ijdr.IJDR_268_12  PMID:31169153
Objective: Tobacco has a time dependent effect on the antioxidant system of the body. This study was designed to determine and compare alteration in levels of erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) in blood subgroups of tobacco smokers and chewers with controls. Materials and Methods: Blood samples were collected from 30 tobacco smokers (> 20 cigarettes daily), 30 tobacco chewers (> 10 packets gutka daily) and 30 controls. These groups were further divided into three subgroups (n=10) based on duration of habit (<5 yrs, 5-10 yrs, >10 yrs). The level of erythrocyte SOD, GPx and CAT were measured using standard procedures. Results: The SOD and CAT levels were significantly decreased in all subgroups of smokers and chewers whereas GPx level was significantly increased. Positive correlation was observed between SOD, GPx and CAT levels with change in duration of habit in all subgroups. No significant difference observed in SOD and CAT activity between tobacco smokers and chewers. Conclusions: The findings suggested that antioxidative enzyme activities have significant correlation with change in the duration of tobacco use. Measurement of markers of free radical activity might be useful for estimating the level of oxidative stress caused by tobacco use.
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Oral care in cancer nursing: Practice and barriers p. 226
Radhika R Pai, Ravikiran Ongole, Sourjya Banerjee
DOI:10.4103/ijdr.IJDR_343_17  PMID:31169154
Background: Oral health awareness and oral care are crucial aspects of oncology nursing practice. However, very few studies concentrate on the oral care of cancer patients undergoing cancer treatment and nursing practice in the Indian subcontinent scenario/situation. Most of the published studies have been conducted in the Western and European countries. Aims: This study aimed to determine the nurses' practice and barriers regarding oral care in cancer patients undergoing chemotherapy and radiation therapy. Materials and Methods: A cross-sectional descriptive survey was conducted among 158 staff nurses working in oncology-related areas from four different hospitals of Dakshina Kannada district and Udupi district of Karnataka state, India. Statistical Analysis: Descriptive and inferential statistics was used by using SPSS 16 version. Results: More than half of respondents [54 (34.2%)] did not perform oral care as a part of routine duties. Maintenance of various records, lack of manpower, and lack of standard operating procedures were major barriers in providing oral care. Documentation audit revealed that nurses recorded oral care in the chart only when order was present in the care sheet, but oral problem assessment was not recorded at all. In all four hospitals surveyed, there was no protocol specifically designed for oral care of cancer patients. Conclusion: Nurses expressed that oral care in cancer patients was one of the most ignored aspect in oncology nursing. Our result highlights the need to develop evidence-based oral care intervention protocol and motivate staff nurses to attend continuing nursing educations regularly to keep themselves abreast of the latest trends in order to render comprehensive care to the patients.
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Regular dental scaling associated with decreased tooth loss in the middle-aged and elderly in Korea: A 3-year prospective longitudinal study p. 231
Ga Yeong Lee, Sang Baek Koh, Nam Hee Kim
DOI:10.4103/ijdr.IJDR_566_17  PMID:31169155
Context: Tooth loss exacerbates the deterioration of physical function and induces illness. Numerous studies have identified the risk factors for tooth loss, and several have identified an association of tooth loss with sociodemographic factors, general health status, and lifestyle. Aims: The objective of the present cohort study was to elucidate the relationship between regular dental scaling and tooth loss in middle-aged and elderly individuals in Korea. Settings and Design: The study was 3-year prospective longitudinal study and conducted in Wonju-si of South Korea. Methods: In total, 557 subjects (219 men, 338 women; 40–75 years) were included in our 3-year follow-up survey (2010–2014). Data from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KOGES-ARIRANG) were used. All subjects underwent an oral examination and face-to-face interview for taking oral health behavior, sociodemographic status, and the utilization of dental service. Statistical Analysis Used: Logistic regression analysis was used to determine the effects of regular dental scaling on tooth loss after adjusting for history of oral examinations and dental visits, oral health behavior, and sociodemographic status. Results: In total, 263 subjects (47.2%) experienced a loss of one or more teeth during the 3-year period, and lost a mean of 1.54 ± 2.53 teeth. The incidence of tooth loss was 1.87 (1.03–3.38) times higher in participants who did not undergo dental scaling during the 3-year period than in those who regularly received dental scaling. Conclusions: This study showed the potential causal relationship between tooth loss and regular dental scaling for preventing oral disease. Further study is needed to consolidate the evidence that regular dental scaling is effective in preventing tooth loss.
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ORIGINAL RESEARCH: RETROSPECTIVE STUDY Top

Prevalence of impacted third molars among orthodontic patients in different malocclusions p. 238
Sandhya Jain, Sharmila Debbarma, SV Prasad
DOI:10.4103/ijdr.IJDR_62_17  PMID:31169156
Objectives: The aim of this retrospective study was to investigate the prevalence and pattern of third molar impaction and missing third molars in patients over 18 years in different anteroposterior skeletal patterns among central Indian populations. Materials and Methods: The study reviewed 357 orthopantomograms of patients attending the Government College of Dentistry, Indore, Madhya Pradesh. Patients were evaluated to determine the prevalence of third molar impaction, angulation, and level of eruption in Class I, Class II, and Class III patients using Winter's classification to determine angulation of third molars and Pell and Gregory classification for level of impaction. Results: Out of 357 patients, 187 (52.3%) were present with at least one impacted teeth. The third molar impaction was most commonly present in Class II malocclusion (60.65%). Overall, the most common angulation of impaction in both genders was the mesioangular (39%), and the most common level of impaction in both arches was Level B. In Class I, Class II and Class III malocclusion vertical angulation was the most common finding in the maxillary arch and mesioangular angulation in the mandibular arch. No significant association was observed between different types of malocclusion and third molar impaction (P > 0.4648). Conclusion: This study found that almost half of the adult patients above 18 years had at least one impacted third molar. The anteroposterior relationship does not have any significant role for the third molar impaction.
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A detailed description and 16-year validation of a new suturing method for stabilizing connective tissue grafts at recipient sites for root coverage and gingival augmentation p. 243
Om Nemichand Baghele
DOI:10.4103/ijdr.IJDR_614_17  PMID:31169157
Background: Which are the different ways of stabilizing connective tissue grafts (CTGs) for root coverage and gingival augmentation by means of placement of sutures? There are various defined and undefined ways of stabilizing CTGs depending on experience and personal preferences. Most of the techniques profess use of absorbable sutures in separate interrupted fashion (sutures at the corners of the graft wherever possible). Aim: This paper describes a new suturing method, “the lingually-tied horizontal mattress contouring suture,” for stabilization of CTGs with or without epithelialized collar at the recipient site, for use with papilla retention and sparing techniques to treat marginal tissue recessions. Methods and Material: The suturing technique is described in detail. It can be indicated for good number of root coverage cases, with additional objectives of gingival augmentation, specifically developed for papilla sparing and papillary buccal de-epithelialization recipient site preparations. Results: Over a period of last 16 years this suturing technique showed promising results in terms of graft stabilization and survival. The main advantage of this technique lies in the use of cost-effective nonabsorbable sutures that usually retain some amount of tension on the soft tissues longer. Conclusion: The primary objective of the suturing technique, per se, is to stabilize the CTG firmly along the contours of the root surface and to expedite a very close adaptation to the interdental soft tissues as well. The secondary objective of the article or publication is to disseminate the knowledge acquired through long periods of performance and observation for the benefit of the periodontal community as whole. Further validation is advocated.
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ORIGINAL RESEARCH: IN VITRO STUDY Top

Treatment of dentinal hypersensitivity using propolis varnish: A scanning electron microscope study p. 249
Krishna Kripal, Kavita Chandrasekaran, Srinivasan Chandrasekaran, Vinaya R Kumar, Sunil Kumar D Chavan, Aiswarya Dileep
DOI:10.4103/ijdr.IJDR_400_18  PMID:31169158
Background: Dentin hypersensitivity (DH) affects all age groups in a population and is perceived as pain to any stimuli. From time immemorial, researchers have sought herbal or natural solutions to treat hypersensitivity. Propolis is one such natural, nontoxic resinous substance produced by honey bees, which is useful in various applications in dentistry and effective in treating dentinal hypersensitivity. Aim: The aim of this in vitro study is to assess the effect of propolis varnish on occlusion of dentinal tubules thus aiding in the treatment of dentinal hypersensitivity. The objective is to evaluate the effectiveness of the proposed treatment using scanning electron microscope (SEM) imaging. Materials and Methods: Twenty naturally extracted teeth were collected and stored until in vitro assessment. Discs obtained from each tooth were divided into two groups of 20 each – I (test) and II (control), with each tooth acting as its own control. Propolis varnish was applied only to the acid-etched surface of the exposed dentin of discs in the test group, whereas all the discs were subjected to SEM imaging. Results: Statistical analysis showed a significant reduction in open tubules (P < 0.001) from 160 ± 6.97 before treatment to 61.20 ± 9.10 after propolis varnish application in the test group. Conclusion: This study showed the promise of propolis varnish as a natural treatment modality for DH.
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An in vitro comparative evaluation between virtually planned implant positions on interactive implant software versus actual implant positions achieved using sterolithographic open guide system p. 254
Avni Sharma, Subodh Kumar Agarwal, Hari Parkash, Praful Mehra, Abhishek Nagpal
DOI:10.4103/ijdr.IJDR_938_18  PMID:31169159
Purpose: To evaluate and compare the positional and angular accuracy of virtual implant positions planned on cone-beam computed tomography and final implant positions achieved using a universal open guide system. Materials and Methods: A dual scan of a partially edentulous jaw model along with prosthesis was done, and virtual implant planning was performed. Three implant positions in relation to 35, 36, and 37 were simulated (Group A). In total, 24 implants were placed in eight replaceable bone blocks (Group B) in the same region on the model using an open stereolithographic template. The linear positions and angulation of the placed implants were determined using Vision Measuring Machine. Deviations between virtually planned and surgically placed implants were analyzed in terms of linear and angular measurements. Data were analyzed with the independent-sample t-test with differences P ≤ 0.05 being considered statistically significant. Results: The linear distance (mean ± standard deviation [SD]) in mesiodistal direction between implants in relation to 35 and 36, 36 and 37, 35 and 37 in Group A was 8.79 ± 0 mm, 8.71 ± 0 mm, and 17.50 ± 0 mm, respectively, and in Group B was 7.70 ± 0.58 mm, 8.11 ± 0.30 mm, and 15.80 ± 0.48 mm. All these above values were found to be statistically significant (P ≤ 0.05). The linear distance (mean ± SD) in the vertical direction (mesial) for implants placed in the region of 35, 36, 37 for Group A was 1.51 ± 0 mm, 1.51 ± 0 mm, and 2.47 ± 0 mm, respectively, and for Group B was 1.37 ± 0.32 mm, 1.65 ± 0.48 mm, and 1.79 ± 0.36 mm, respectively. The linear distance (mean ± SD) in the vertical direction (distal) for implants placed in the region of 35, 36, 37 for Group A was 3.37 ± 0 mm, 1.51 ± 0 mm, and 1.51 ± 0 mm, respectively, and for Group B was 1.86 ± 0.48 mm (P ≤ 0.05), 1.56 ± 0.23 mm, and 1.29 ± 0.39 mm (P ≤ 0.05), respectively. The angular deviation (perpendicularity) values for virtually planned implants (Group A) were 90.00° ± 0° and for implants placed in the region of 35, 36, and 37 (Group B) were 84.52° ± 5.4°, 83.57° ± 1.52°, and 80.41° ± 2.37°, respectively, which are highly significant (P ≤ 0.05). Conclusions: The stereolithographic universal open guide used in the study may be considered accurate for placement of implants in mesiodistal position and also in terms of perpendicularity but not in the vertical position. Stereolithographic open guide may be recommended for more accurate implant position, especially for the placement of multiple implants.
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Quantitative analysis of copper levels in areca nut plantation area – A role in increasing prevalence of oral submucous fibrosis: An in vitro study p. 261
Aurelian Jovita Alexander, Pratibha Ramani, Herald J Sherlin, S Gheena
DOI:10.4103/ijdr.IJDR_431_17  PMID:31169160
Background: Oral submucous fibrosis (OSMF) commonly seen in the South Asian countries is mostly associated with the chewing of areca nut (AN). Copper content in the AN has been implicated to play a major role in the pathogenesis of OSMF. It was found that most of the AN plantations in South India commonly use a copper-based fungicide, Bordeaux mixture (BM). Objective: To evaluate the level of copper in the AN, root, and soil of the AN plantation with and without the application of BM and to correlate the role of copper in the pathogenesis of OSMF. Materials and Methods: ANs, roots, and soil were obtained from plantations located in Tanniadi, Kerala. Four areas were selected from the plantation with and without BM application. The samples were collected twice with the interval of 6 months during January 2015 and July 2015, respectively. Statistical Analysis: Arithmetic mean and standard deviation were calculated. The differences between means were calculated by paired sample t-test. Results: There was statistically significant difference in the copper content of ANs, soil, and roots from both groups (P < 0.05). Samples treated with BM showed significantly higher copper levels as compared to their counterparts in January and July 2015. Conclusions: External copper from BM and increased processing for the commercial products could collectively increase the total copper content of the commercial AN products, and this high copper concentration may be implicated to the pathogenesis and the increasing prevalence of OSMF.
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Marginal microleakage of glass ionomer cement with two different cavity conditioners on primary anterior teeth – An in vitro study p. 267
Surej Unnikrishnan, Navin Hadadi Krishnamurthy, C Nagarathna
DOI:10.4103/ijdr.IJDR_695_17  PMID:31169161
Background and Objective: Glass ionomer cements (GICs) are the most commonly used restorative material in pediatric dentistry. They have numerous advantages; however, they show some marginal microleakage at the restoration–tooth interface. Various conditioning agents have been tested for alteration or dissolution of smear layer which has been attributed to the occurrence of microleakage; however, very limited studies have been done using primary teeth. Aims: To evaluate and compare the effect of 10% polyacrylic acid and 17% EDTA on marginal microleakage of high-viscosity GIC. Settings and Design: Experimental, in vitro study. Methodology: Class V cavities of standardized dimensions were prepared on 60 primary anterior teeth and were randomly divided into three groups. Except Group I, the cavities of Groups II and III were conditioned with 10% polyacrylic acid and 17% EDTA, respectively. All the 60 teeth were then restored with high-viscosity GIC. The samples were thermocycled and immersed in methylene blue solution for 24 h. The teeth were removed from the stain, rinsed, and sectioned buccolingually and were observed under stereomicroscope at 30× to score the marginal microleakage. Statistical Analysis Used: Kruskal–Wallis test followed by Mann–Whitney post hoc analysis were used to compare the mean marginal leakage scores between the three study groups. Results: Statistical significance difference was found between all the three groups (P < 0.05). The mean marginal microleakage score was maximum for Group I (control group; 3.00), whereas it was the least for Group II (1.30) where 10% polyacrylic was used for conditioning the cavity surface. Conclusion: Among the study groups, none of them was completely devoid of microleakage in all its samples. 10% polyacrylic acid emerged as a better conditioning agent when compared with 17% EDTA in altering or removing the smear layer thereby resulting in better adhesion.
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The difference in biofilm molecular weight in Streptococcus mutans and Aggregatibacter actinomycetemcomitans induced by sucrose and soy protein (glycine soja) p. 273
Indah Listiana Kriswandini, Markus Budi Rahardjo, Hendrik Setia Budi, Risma Amalia
DOI:10.4103/ijdr.IJDR_183_17  PMID:31169162
Context: Biofilms consist of microbial cells and extracellular polymeric substance (EPS). Streptococcus mutans and Aggregatibacter actinomycetemcomtans are bacteria that can form biofilms and generate EPS. Biofilm formation can be induced by specific substances such as sucrose and protein. Aims: To identify the molecular weight that determines biofilm protein profile expression of S. mutans and A. actinomycetemcomitans induced by sucrose (carbohydrate) and soy protein (glycine soja). Settings and Design: Experimental laboratory study. Materials and Methods: Sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS-PAGE) was used to determine the molecular weight. Statistical Analysis Used: Nil. Results: The results of analysis of protein SDS-PAGE showed the presence of 28 protein bands on A. actinomycetemcomitans biofilm in the media trypticase soy broth (TSB), 20 protein bands on biofilms of S. mutans in the media TSB, 29 protein bands on biofilm A. actinomycetemcomitans in the media brain heart infusion (BHI) + sucrose 2%, and 13 protein bands on biofilms of S. mutans in the media BHI + sucrose 2%. Conclusion: There are differences in biofilm protein profile expression that determine the molecular weight of S. mutans biofilm and A. actinomycetemcomitans induced by sucrose (carbohydrate) and soy protein (glycine soja).
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Comparative evaluation of microleakage of three different direct restorative materials (silver amalgam, glass ionomer cement, cention N), in Class II restorations using stereomicroscope: An in vitro study p. 277
Paromita Mazumdar, Abiskrita Das, Utpal Kumar Das
DOI:10.4103/ijdr.IJDR_481_17  PMID:31169163
Aim: The aim of the study is to compare the microleakage of three different direct restorative materials (amalgam [AA], glass ionomer cements [GICs], and Cention N [CN]) in Class II restorations using stereomicroscope. Materials and Methods: A standardized Class II cavity preparation was made involving the proximal and occlusal surfaces. All prepared samples were randomly divided into 3 experimental groups, with 10 teeth each according to the restoration material used: Group I-AA; Group II-GICs; and Group III-CN. The restored teeth were stored for 24 h in distilled water and thermocycled for 500 cycles between 5°C and 55°C with a dwell time of 30 s in each bath. Samples were immersed in 0.5% basic fuchsin dye for 24 h. The teeth were sectioned along the mesiodistal direction. The dye penetration of the occlusal and gingival margins of each section was evaluated independently by the observer using a stereomicroscope. Results: Statistical analysis revealed lower microleakage scores in GIC and CN. Higher microleakage was observed in Group AA. Mean microleakage score of Group-I (AA) was the highest of all groups. Mean microleakage score of Group-III (CN) was the lowest of all groups. As per the critical differences (CD), the mean microleakage score of Group-III CN) was significantly lower than that of Group-I (AA), Group-II (GIC) (P < 0.01). There is no significant difference between the mean microleakage score of Group-I (AA) and Group-II (GIC). Conclusion: Out of all the restorative materials, CN a newer restorative material displayed minimum microleakage compared to AA and GICs.
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SYSTEMATIC REVIEW Top

Effect of nonfluoridated remineralizing agents on initial enamel carious lesions: A systematic review p. 282
Sharath Asokan, PR Geethapriya, V Vijayasankari
DOI:10.4103/ijdr.IJDR_200_18  PMID:31169164
Background: Although fluoride enables remineralization, presence of calcium and phosphate ions is necessary to promote the process. So, various nonfluoridated remineralizing agents have been emerging to treat the noncavitated carious lesions. Aim: The aim of this systematic review was to assess the clinical effectiveness of nonfluoridated remineralizing agents on initial enamel carious lesions. Methods: Seven electronic databases were searched using the key words. In total, 158 human clinical trials were retrieved in the search from January 1950 to October 2016. Seventy-one repeated articles were excluded. Among the 87 articles obtained, 53 articles were eliminated after reading the title and abstracts. After assessing the full text, 28 articles were excluded. Three more studies were included from the cross references of the articles chosen. Results: All the nine trials included assessed the clinical effectiveness of casein phosphopeptide amorphous calcium phosphate (CPP ACP). They showed a positive effect of CPP ACP on the remineralization of white spot lesions. Conclusion: The use of CPP ACP resulted in significant reduction of the white spot lesion size measured using visual examination methods. This systematic review indicated a lack of reliable evidence supporting the clinical effectiveness of other commercially available nonfluoridated remineralizing agents.
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REVIEW OF LITERATURE Top

Teeth in forensics: A review p. 291
Preetam Shah, Priyam R Velani, Laxmi Lakade, Siya Dukle
DOI:10.4103/ijdr.IJDR_9_17  PMID:31169165
With the ever-increasing crime rate in our society, the field of forensic sciences has become highly evolved. Forensic dentists play a pivotal role in various areas of crime scene investigations and thereby help solve innumerable mysteries. Teeth appear to be vital pieces of evidence in several such investigations. Teeth are preserved in the closed cavities of the mouth and are generally resistant to the threatening environmental conditions that may be associated with the death of an individual, making them very useful in postmortem analysis. Teeth thus obtained may be useful in age estimation of the deceased victim or in determining his blood group. Identification of individuals in mass disasters can also be performed based on the unique morphological characteristics of the human dentition and through dental DNA fingerprinting. Again teeth play an all important role in catching a culprit through the positive correlation of the bite marks left behind at the crime scene and the suspect's own teeth marks. Thus, teeth prove to be an important adjunct in forensics. Its scope is ever-increasing with time, and a great amount of research is being carried out to implement the same. A PubMed, MEDLINE, and Scopus search was conducted of the past 70 years using several search terms like “Forensic odontology,” “history of forensic odontology,” “dental DNA fingerprinting,” “forensic age estimation,” “age estimation from teeth” and “bitemarks.” Other articles and textbook references which were considered to be important were also included in this study. The articles gathered were divided into the following groups: history of forensic odontology, teeth and DNA (dental DNA fingerprinting), teeth and blood grouping, teeth and age estimation, and teeth in bite marks.
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EPIDEMIOLOGICAL WORK Top

Evaluation of anxiety levels and their characteristics in dental care: Cross-sectional study p. 300
Renata P Piano, Walbert A Vieira, Juliana Sousa-Silva, Luiz R Paranhos, Lilian Rigo
DOI:10.4103/ijdr.IJDR_325_18  PMID:31169166
Context: Anxiety is defined as an emotion produced by a set of feelings and physical changes. Many patients are afraid of some procedures involved in dental therapy. Aim: The objective of this study was to verify the anxiety of patients regarding the visits to dental clinics of a higher education institution, as well as to observe the moment of greatest anxiety. Settings and Design: It is a cross-sectional observational study including 94 patients from the dental clinics of an educational institution in a city of southern Brazil. Materials and Methods: The Corah Dental Anxiety Scale, composed of four questions, was used to evaluate the dental anxiety levels of all patients. The sample universe included registered patients under treatment in the clinics of the studied institution, from August to November of 2016. We included only healthy patients over 18-year old who were subjected to surgical and nonsurgical procedures. Statistical Analysis: The data were analyzed through descriptive statistic to verify the frequency distribution of all variables. Pearson's Chi-square test, at 5% significance level and 95% confidence interval, was used to evaluate the association between the dependent variable (dental treatment anxiety) and the independent variables (demographics), aided by the SPSS software 20.0. Results: It was found that most of the participants were not anxious (69.1%) and the moment of greatest anxiety reported was before local anesthesia. In addition, statistics showed no correlation among gender, age group, and type of procedure performed. It was possible to conclude that the level of anxiety of the patients regarding the dental care performed in the clinics of the studied institution was low for both surgical and nonsurgical procedures. Conclusion: This survey revealed that the moment of greatest anxiety for the patients was before the anesthetic procedure, and gender, age, and type of procedure did not influence the level of anxiety felt by the patient.
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Factors affecting the interrelationship between cynical hostility and dental anxiety among dental patients p. 305
Shashidhar Acharya, Kalyana Chakravarthy Pentapati, Samuel Raj Srinivasan, Sachin Khatri
DOI:10.4103/ijdr.IJDR_112_17  PMID:31169167
Objectives: The objectives of this study were to assess the relationship between dental anxiety and cynical hostility in a sample of dental patients and to study the possible role of socioeconomic status (SES) in this relationship. Materials and Methods: A total of 288 dental patients completed a self-administered questionnaire consisting of the cynical distrust scale (CDS) and the modified dental anxiety scale (MDAS). Data on sociodemographic characteristics were also collected. Results: Dental anxiety as reflected by mean MDAS scores was significantly higher among the younger age group (P = 0.002), among females (P = 0.025), and the lower SES groups (P = 0.001). Cynical hostility was significantly higher among the older age group (P = 0.03), among males (P = 0.02), and among the lower SES groups, respectively, (P = 0.001). When the CDS scores for individuals with and without dental anxiety were compared within the context of the three socioeconomic strata, there was a statistically significant difference (P = 0.029) in scores between the two anxiety groups in the middle socioeconomic strata where the cynical distrust scores were lower among the anxiety group. Discussion: Mediation analysis revealed that SES played an important role in the association between dental anxiety and cynical hostility. It also showed that the mediating effect is not uniform across socioeconomic strata and may be different in different societies with their own unique population structures and classes.
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CASE REPORTS Top

Modified functionally generated path technique to develop occlusal scheme in single complete denture p. 310
Anshika Agarwal, Chandana Nair, MK Singhal, Piyush Upadhyay
DOI:10.4103/ijdr.IJDR_197_17  PMID:31169168
Single maxillary denture often represents vigorous challenge to the practicing dentists. The difficulty arises when the maxillary dentures are set to fit the occlusion of natural mandibular teeth. The functionally generated pathway technique registers occlusal pathways of the posterior teeth in functional wax and is described as the “three-dimensional static expression consists of dynamic tooth movement.” The current article represents a technique for a patient who was rehabilitated with a maxillary complete denture, and a harmonious occlusion was achieved between the complete denture and the mandibular natural dentition. Functional maxillary denture is therefore in medical dentistry the successful culmination of human's high practice and represents the golden goal sought by every dental practitioner and expected by every denture patient.
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Bilateral taurodontism in permanent maxillary first molar p. 314
Rohit Nair, Sandhya Khasnis, Jayaprakash D Patil
DOI:10.4103/ijdr.IJDR_770_17  PMID:31169169
Taurodontism is a dental anomaly caused due to the failure of Hertwig's epithelial sheath to invaginate at the proper horizontal level. A huge pulp chamber, displacement of the pulpal floor apically, and no constriction at the level of the cementoenamel junction are the key features representing a taurodontic tooth. This condition is most commonly associated with permanent molars. This clinical entity occurs in the form of an isolated, singular trait in majority of the cases. However, seldom, it may be associated with syndromes or ectodermal anomalies. The large and deep pulp chamber makes instrumentation of canals difficult, thereby challenging an endodontist. This case report describes the endodontic challenge faced in cases of taurodontism as well as the clinical steps involved in its successful endodontic management. Furthermore, it shows the typical presence of bilateral hypertaurodontism with respect to the maxillary first molar.
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Transzygomatic, transcondylar excision of the sarcoma of infratemporal fossa p. 318
SM Balaji, Preetha Balaji
DOI:10.4103/ijdr.IJDR_282_19  PMID:31169170
Malignant peripheral nerve sheath tumor (MPNST) is a rare pathologic lesion in a patient with solitary neurofibroma. A 32-year-old man presented with a firm and slightly tender mass in the right infratemporal region involving the right preauricular and temporomandibular joint area. The patient has a history of removal of a solitary neurofibroma 22 years back in the same region. The lesion had enlarged rapidly over the past 3 months, and a spindle cell lesion was diagnosed through a superficial incisional biopsy. Surgical removal of the lesion using modified preauricular transzygomatic approach was done. Histopathologically, it was diagnosed as an MPNST.
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Isolated angiokeratomas of the tongue: A rare entity p. 322
Rizwan Hamid, Altaf H Chalkoo, Inderpreet Singh, Suhail Wani, Sheikh Bilal
DOI:10.4103/ijdr.IJDR_644_17  PMID:31169171
Angiokeratomas consist of ectasias of dermal capillaries associated with an acanthotic and hyperkeratotic overlying epidermis. These dark red-to-purple, papular vascular anomalies can vary considerably in size, depth, and location. It is a skin disorder that rarely involves oral cavity. It can occur in localized or generalized form and is often associated with underlying metabolic disorder such as Fabry's disease and fucosidosis. It has many clinical variants with the same underlying histopathology. Mucosal involvement, including the oral cavity, is occasionally found either as a component of the systemic variety, called angiokeratoma corporis diffusum, or associated with cutaneous lesions in more locations. Isolated oral involvement seems to be rather infrequent, and only eighteen cases have been described in the world literature thus far. Isolated multiple angiokeratomas of tongue without plaque formation have been reported only four times before this. Here, we report a fifth case of isolated multiple angiokeratomas of tongue in a 16-year-old female which was confirmed by immunohistochemical pattern in consonance with a blood vessel origin, with expression of CD31, CD34, and von Willebrand factor. The lesion did not express D2-40 and CD45. No other malformation or metabolic disorder was found in the patient.
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