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   2011| May-June  | Volume 22 | Issue 3  
    Online since November 3, 2011

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Orofacial manifestations of hematological disorders: Anemia and hemostatic disorders
Titilope A Adeyemo, Wasiu L Adeyemo, Adewumi Adediran, Abd Jaleel A Akinbami, Alani S Akanmu
May-June 2011, 22(3):454-461
DOI:10.4103/0970-9290.87070  PMID:22048588
The aim of this paper is to review the literature and identify orofacial manifestations of hematological diseases, with particular reference to anemias and disorders of hemostasis. A computerized literature search using MEDLINE was conducted for published articles on orofacial manifestations of hematological diseases, with emphasis on anemia. Mesh phrases used in the search were: oral diseases AND anaemia; orofacial diseases AND anaemia; orofacial lesions AND anaemia; orofacial manifestations AND disorders of haemostasis. The Boolean operator "AND" was used to combine and narrow the searches. Anemic disorders associated with orofacial signs and symptoms include iron deficiency anemia, Plummer-Vinson syndrome, megaloblastic anemia, sickle cell anemia, thalassaemia and aplastic anemia. The manifestations include conjunctiva and facial pallor, atrophic glossitis, angular stomatitis, dysphagia, magenta tongue, midfacial overgrowth, osteoclerosis, osteomyelitis and paraesthesia/anesthesia of the mental nerve. Orofacial petechiae, conjunctivae hemorrhage, nose-bleeding, spontaneous and post-traumatic gingival hemorrhage and prolonged post-extraction bleeding are common orofacial manifestations of inherited hemostatic disorders such as von Willebrand's disease and hemophilia. A wide array of anemic and hemostatic disorders encountered in internal medicine has manifestations in the oral cavity and the facial region. Most of these manifestations are non-specific, but should alert the hematologist and the dental surgeon to the possibilities of a concurrent disease of hemopoiesis or hemostasis or a latent one that may subsequently manifest itself.
  53,377 2,119 22
Bone allografts: A review of safety and efficacy
Vishakha Grover, Anoop Kapoor, Ranjan Malhotra, Sonia Sachdeva
May-June 2011, 22(3):496-496
DOI:10.4103/0970-9290.87084  PMID:22048602
Although bone allografts are being widely used in dentistry, many of clinicians appear to be unfamiliar with their preparation and processing as well as their use as safe and effective graft materials. The major concerns associated with these materials are antigenicity and risk of disease transmission from donor to recipient. To minimize this risk, the production of an allograft worthy of distribution and implantation requires strict attention to detail through a comprehensive process. With an increasing clinical requirement for bone grafting procedures, there is a commensurate increase in patients' demands for assurance that bank bone will not be infected with pathogens. To ensure the patients, dental surgeons should be able to cite factual information and recommendations by responsible organizations regarding safety of allografts. Knowledge of human bone allograft procurement, processing, and tracking may allow dentists to better educate patients and address concerns about this valuable treatment option. The purpose of this review is to furnish and update the current knowledge on processing, safety, and efficacy of allograft materials.
  15,691 786 26
Treatment of oral submucous fibrosis with ErCr: YSGG laser
Zainab Chaudhary, Mahesh Verma, Shruti Tandon
May-June 2011, 22(3):472-474
DOI:10.4103/0970-9290.87073  PMID:22048591
Oral submucous fibrosis (OSMF) is one of the most poorly understood and unsatisfactorily treated diseases. Various medical and surgical treatments have been used but with limited benefits. However, with advent of lasers, oral surgeons are provided with new modality for treating OSMF. This case report highlights the pioneering effort in treating a moderate case of bilateral OSMF with Erbium Chromium Yttrium Scandium Gallium Garnet (ErCr:YSGG) laser showing promising result during follow-up.
  15,003 914 7
Failures in implants
E Prashanti, Suresh Sajjan, Jagan Mohan Reddy
May-June 2011, 22(3):446-453
DOI:10.4103/0970-9290.87069  PMID:22048587
The burning problem that all the implantologists are confronted today is the complications and failures occurring with the treatment of osseointegrated implants. To further optimize the treatment outcome, etiologies and factors associated with implant failures should be elucidated. Conceivably such knowledge is needed for developing adequate treatment and prevention strategies. Hence, this paper is intended to provide an insight regarding various aspects of failures that affect dental implants.
  12,696 1,533 2
Comparative evaluation of formocresol and mineral trioxide aggregate as pulpotomy agents in deciduous teeth
Daya Srinivasan, M Jayanthi
May-June 2011, 22(3):385-390
DOI:10.4103/0970-9290.87058  PMID:22048576
Aim: To evaluate and compare mineral trioxide aggregate (MTA) and formocresol as pulpotomy medicaments by clinical and radiographic assessments and to assess the histological features of both pulpotomy medicaments in deciduous teeth. Materials and Methods: This study was performed on 100 mandibular deciduous molar teeth requiring pulpotomy treatment. Children between age four and six years were randomly selected and divided into formocresol or MTA group. The patients were recalled after 3, 6, 9, 12 months respectively and evaluated clinically and radiographically. Histological assessment was done on lower deciduous canine teeth, which were undergoing serial extraction for interceptive orthodontic purpose. Pulpotomy was done on four teeth with formocresol and another four teeth with MTA. The teeth were extracted after six months following pulpotomy procedure and histologically evaluated. Two freshly extracted carious teeth were taken as controls. Results: Clinical and radiographic criteria were laid and Chi analysis revealed significant difference in mobility ( P≤0.05), periodontal ligament widening ( P≤0.01 level) and inter - radicular radiolucency ( P≤0.02 level) between two groups at the end of 12 months. Histologically, in MTA group, a layer of new dentine formation with less dentinal tubules at the pulpotomized site was found. In formocresol group, increased inflammatory cells, a zone of atrophy, were noted in radicular portion of pulp. Conclusion: MTA is superior to formocresol clinically, radiographically. Histological analysis showed better reparative ability with hard tissue barrier formation with MTA compared to formocresol.
  11,757 477 27
Application of Botulinum toxin Type A: An arsenal in dentistry
Lakshmana B Rao, Rajashekar Sangur, S Pradeep
May-June 2011, 22(3):440-445
DOI:10.4103/0970-9290.87068  PMID:22048586
An extremely effective way of preventing damage to and enhancing treatment of dental hard tissues and restorations would be to ''de-programme'' the muscles responsible for excessive destructive forces and other gnathological-related diseases. The new paradigm is the intramuscular injection of Botulinum toxin type A (BOTOX) into the affected muscles. It is a natural protein produced by anaerobic bacterium, Clostridium botulinum. The toxin inhibits the release of acetylcholine (ACH), a neurotransmitter responsible for the activation of muscle contraction and glandular secretion, and its administration results in reduction of tone in the injected muscle. There are seven distinct serotypes of Botulinum toxin, viz., A, B, C, D, E, F, and G, which differ in their potency, duration of action, and cellular target sites. This paper describes the different applications of BOTOX in dentistry.
  11,115 525 9
Dental perspective on biomedical waste and mercury management: A knowledge, attitude, and practice survey
Ashima Garg Sood, Abhinav Sood
May-June 2011, 22(3):371-375
DOI:10.4103/0970-9290.87055  PMID:22048573
Context: Management of waste generated in any health-care facility is a critical issue as it poses a direct threat to human health as well as to the environment. The biomedical waste generated in the dental scenario includes sharps, used disposable items, infectious waste (blood-soaked cotton, gauze, etc.), hazardous waste (mercury, lead), and chemical waste (such as spent film developers, fixers, and disinfectants). A major concern in our field is management and disposal of mercury. Aims: To obtain information about the knowledge, attitude, and practices of dental institutions and dental practitioners in the disposal of waste. Settings and design: A self-administered questionnaire, composed of 50 questions was designed. Materials and Methods: The questionnaire was distributed among the participants, chosen randomly, including dental students, faculty from dental colleges and private practitioners in and around Delhi, India. Statistical analysis used: The percentage response for each question from all the participants was obtained and the data was calculated. Results: Many dentists have knowledge about the waste management but they lack in the attitude and practice. Conclusions: There is need for education regarding hazards associated with improper waste disposal at all levels of dental personnel. It is imperative that waste should be segregated and disposed off in a safe manner to protect the environment as well as human health.
  8,927 680 9
Two-step procedure for root coverage using a free gingival graft and a subepthelial connective tissue graft
R Vijayendra, A Suchetha, Sharadha Jaganath, Khalid Gurfan
May-June 2011, 22(3):478-481
DOI:10.4103/0970-9290.87075  PMID:22048593
Gingival recession is a multifaceted problem, for which several treatment options are available. Both epithelized and subepithelial connective tissue grafts offer predictable solutions for the treatment of gingival recession.The case report involved a 30-year-old man with gingival recession of 8 mm on 41 (Miller's class II recession). Before surgery, full mouth scaling and polishing were performed. Recession height, width, probing depth, clinical attachment level (CAL), and width of the attached gingiva (WAG) were measured at the baseline, two months postoperatively, and six months postoperatively. Four weeks after scaling, the first step of increasing the width of the attached gingiva was carried out, using a free gingival graft. Two months after this step, the subepithelial connective tissue was harvested from the palate and placed in relation to 41, to cover the residual defect.Two months postoperatively, there was a 3 mm gain in WAG and 35% root coverage. Six months postoperatively there was a significant increase in WAG, CAL; and reduction in height and width of recession (root coverage achieved was 75%). These results suggested that this two-stage surgical procedure could be successful for root coverage in case of deep recession and lack of attached gingiva in the mandibular anterior region.
  8,840 239 2
Awareness among Indian dentist regarding the role of physical activity in prevention of work related musculoskeletal disorders
Pooja Sharma, Vineet Golchha
May-June 2011, 22(3):381-384
DOI:10.4103/0970-9290.87057  PMID:22048575
Background: The prevalence of work-related musculoskeletal complaints in dentists is high and the past two decades have witnessed a sharp rise in the incidence of various disorders. The prevalence of musculoskeletal pain ranges between 64% and 93%. The most effected regions have been back and neck. Various studies have been done to record stress levels and health-related behaviors of dentists in other countries but limited data is available among the Indian dentists. Materials and Methods: Therefore a questionnaire survey was carried out among 102 Indian dentists belonging to different fields having at least one musculoskeletal disorder in last 6 months. Results: The total sample consists of 80 males and 22 females. Out of the 102 over 97 of dentists had sought medical advice for these disorders during the previous 06 months and 74 of them also consulted the physiotherapist for exercises and ergonomic advice. The number of sessions taken for regular physical exercises was minimum 6 till 44 the most. The percentage of improvement in symptoms varied between 20% and 80%. Conclusions: A significant direct correlation between the number of sessions taken for physical activity and the self-perceived improvement in the symptoms was found using the Pearson correlation test. The work-related musculoskeletal disorders among dentists not only decrease their efficiency but also is a major concern among them. Self-awareness and benefits of regular exercise is the need of the hour.
  6,873 497 18
Oral health status in relation to socioeconomic factors among the municipal employees of Mysore city
BR Chandra Shekar, CVK Reddy
May-June 2011, 22(3):410-418
DOI:10.4103/0970-9290.87063  PMID:22048581
Aim: To assess the prevalence of dental caries, periodontal diseases, oral pre-malignant and malignant lesions in relation to socioeconomic factors among the municipal employees of Mysore city. Settings and Design: The study was cross sectional in nature. Materials and Methods: All the available employees (1187) during the study period were considered. World Health Organization (WHO) Oral Health Assessment form (1997) and a preformed questionnaire were used to collect the required data. Modified Kuppuswamy scale with readjustment of the per capita income to suit the present levels was used for classifying the individuals into different socioeconomic status (SES) categories. Data were collected by a single, trained and calibrated examiner (dentist) using mouth mirror and community periodontal index (CPI) probe under natural daylight. Data analysis was done using SPSS windows version 10. Quantitative data were analyzed using one-way analysis of variance (ANOVA) with Tukey's post hoc test and qualitative data were analyzed using chi-square or contingency coefficient. Results: The age range of the study population was 19-57 years (mean 40.74 years, standard deviation 9.17). The prevalence of dental caries in the upper SES category was lesser (43.3%) compared to that in lower SES category (78.6%). 16.4% of the subjects in the upper category had a CPI score of 0 (healthy periodontium) and none of the subjects in the lower middle, upper lower and lower SES category had this score. The prevalence of oral pre-malignant and malignant lesions was higher in lower SES category (17.9%) than in upper class (0%). Conclusion: There was an inverse relationship between oral health status and SES. The overall treatment need was more in the lower class people than in the upper class.
  6,370 467 15
Tooth in the line of fracture: Its prognosis and its effects on healing
Sachin Rai, Raghvendra Pradhan
May-June 2011, 22(3):495-496
DOI:10.4103/0970-9290.87083  PMID:22048601
Aims and Objective: The aim of this prospective study was to compare the postoperative results of mandibular angle fracture cases treated by open reduction and internal fixation wherein the third molar in the line of fracture was preserved in one group while it was extracted in the second group. Materials and Methods: Group I consisted of 30 patients in which the mandibular third molar in the line of fracture was preserved and group II consisted of 24 patients in which it was extracted following specific criteria. Various parameters like postoperative healing, infection, occlusion, tooth vitality, and mobility were graded numerically. Statistical analysis using a t-test was done. Data were expressed as mean±SD and a probability (P) value of <0.05 was considered significant. Results: The presence of infection with pain and tenderness was higher in group I. Osteogenesis was higher in group I till the end of the third week but the difference was not significant later. Discrepancy in occlusion was more in group II. Mobility of tooth decreased and status of periodontal tissue improved significantly with time. In the tooth involved, the return of vitality and decrease in pain/tenderness was significant after 1 week and continued till 24 weeks to normalcy. Two teeth showed mild root resorbtion and none showed ankylosis. Conclusion: Postoperative occlusal discrepancy is less but infection is higher when the tooth in the line of fracture is preserved as compared to when it is removed. More than half of the teeth in the fracture line show complete recovery within a period of 6 months to 1 year. Despite the risk of an increase in the rate of complications, the tooth in the line of fracture should be preserved for its merits.
  6,183 317 17
Assessment of noise levels of the equipments used in the dental teaching institution, Bangalore
Sushi Kadanakuppe, Padma K Bhat, C Jyothi, C Ramegowda
May-June 2011, 22(3):424-431
DOI:10.4103/0970-9290.87065  PMID:22048583
Context: In dental practical classes, the acoustic environment is characterized by high noise levels in relation to other teaching areas, due to the exaggerated noise produced by some of these devices and use of dental equipment by many users at the same time. Aims: To measure, analyze and compare noise levels of equipments among dental learning areas under different working conditions and also to measure and compare noise levels between used and brand new handpieces under different working conditions. Materials and Methods: Noise levels were measured and analyzed in different dental learning areas that included clinical, pre-clinical areas and laboratories selected as representatives of a variety of learning-teaching activities. The noise levels were determined using a precision noise level meter (CENTER® 325 IEC 651 TYPE II) with a microphone. The mean of the maxima was determined. The data were collected, tabulated, and statistically analyzed using t tests. Results: The noise levels measured varied between 64 and 97 dB(A).The differences in sound levels when the equipment was merely turned on and during cutting operations and also between used and brand new equipments were recorded. The laboratory engines had the highest noise levels, whereas the noise levels in high-speed turbine handpieces and the low-speed contra angle handpieces were decreased. Conclusion: The noise levels detected in this study are considered to be close to the limit of risk of hearing loss.
  6,059 213 13
Role of ultrasound in detection of metastatic neck nodes in patients with oral cancer
P Sureshkannan, Vijayprabhu , Reena John
May-June 2011, 22(3):419-423
DOI:10.4103/0970-9290.87064  PMID:22048582
Introduction: Head and neck cancer is one of the most physically and emotionally devastating cancers and often leaves the patient disabled and disfigured. The presence of cervical metastasis is one of the factorsthat influence the outcome of the patients. Cervical lymph node metastasis plays an essential role in the treatment and prognosis of head and neck cancer patients. The assessment of the cervical lymph node status still remains an unsolved problem. We conducted a study to compare the diagnostic accuracy of clinical palpation and ultrasonogram (USG) in the detection of metastatic cervical nodes from oral squamous cell carcinoma patients. Materials and Methods: Ten patients (age range, 45-63 years; mean age, 54 years) with squamous cell carcinoma in the head and neck region underwent clinical palpation and USG. The results of each modality were analyzed for sensitivity, specificity, positi ve predictive value, negative predictive value and accuracy. Pathologic analysis of the surgical resection served as the reference standard. Results: USG yielded a sensitivity, specificity, positive, negative predictive value and accuracy as 85.7%, 90%, 92.3%, 81.8% and 87.5% whereas clinical palpation yielded a sensitivity, specificity, positive, negative predictive value and accuracy as 68.7%, 87.5%, 91.6%, 58.3% and 75%. Conclusion: USG is a reliable and valuable tool for metastatic lymph node screening in head and neck cancer patients. It is a cheap, noninvasive, easy-to-handle and cost-effective diagnostic method. USG performed better than clinical palpation in detecting cervical metastatic nodes.
  5,872 325 15
Prevalence of dental diseases in 5- to 14-year-old school children in rural areas of the Barabanki district, Uttar Pradesh, India
Meghna Singh, Ashish Saini, Charanjeet S Saimbi, Anoop K Bajpai
May-June 2011, 22(3):396-399
DOI:10.4103/0970-9290.87060  PMID:22048578
Background: Epidemiological studies are helpful in planning and implementing oral health programs in a given population. This initiative is a consequence of the absence of any information on any study being conducted in the past on the prevalence of dental diseases in the Barabanki district of Uttar Pradesh (UP). Aims: The aims were to (1) assess the prevalence of gingivitis, fluorosis, and malocclusion in the school-going children of rural areas of district Barabanki and (2) evaluate the pattern of above-mentioned diseases in different age groups and genders. Materials and Methods: A total of 836 school-going children comprising 430 boys and 406 girls were examined. A total of 238 children were in the age group of 5-7 years. A total of 277 and 321 children were in the age groups of 8-10 and 11-14 years, respectively. Statistical Analysis: A chi-square test was used for deriving results. Results: The prevalence of gingivitis, fluorosis, and malocclusion was 78.35%, 33.37%, and 34.09%, respectively. The difference between age groups for the prevalence of gingivitis was highly significant, and was more among girls as compared to boys. A significant increase in the prevalence of malocclusion was observed with age. No significant difference was found among genders for the prevalence of malocclusion. An increase in the prevalence of fluorosis was highly significant with age. The difference in fluorosis was insignificant between boys and girls.
  5,597 429 9
Concomitant hypo-hyperdontia with dens invaginatus
BS Manjunatha, D Nagarajappa, Santosh Kumar Singh
May-June 2011, 22(3):468-471
DOI:10.4103/0970-9290.87072  PMID:22048590
Although developmental anomalies of tooth number are quite common in permanent dentition, concomitant occurrence of hypohyperdontia is a very rare mixed numeric anomalous condition of teeth. Very few cases of this condition have been reported in the English literature. Here we report such a rare case noted in a 26 year-old male dental graduate with no other associated systemic condition or syndrome.
  5,477 157 5
Two-piece hollow bulb obturator
Subramaniam Elangovan, Elangbam Loibi
May-June 2011, 22(3):486-488
DOI:10.4103/0970-9290.87077  PMID:22048595
There are various types of obturator fabrication achievable by prosthodontist. Maxillectomy, which is a term used by head and neck surgeons and prosthodontists to describe the partial or total removal of the maxilla in patients suffering from benign or malignant neoplasms is a defect for which to provide an effective obturator is a difficult task for the maxillofacial prosthodontist. Multidisciplinary treatment planning is essential to achieve adequate retention and function for the prosthesis. Speech is often unintelligible as a result of the marked defects in articulation and nasal resonance. This paper describes how to achieve the goal for esthetics and phonetics and also describes the fabrication of a hollow obturator by two piece method, which is simple and maybe used as definitive obturator for maximum comfort of the patient.
  4,861 435 7
A comparative evaluation of healing with a computed tomography scan of bilateral periapical lesions treated with and without the use of platelet-rich plasma
Bruhvi Parikh, S Navin, P Vaishali
May-June 2011, 22(3):497-498
DOI:10.4103/0970-9290.87087  PMID:22048605
Periradicular surgery aims to achieve complete wound healing and regeneration of the periodontal unit. Platelet-rich plasma (PRP) is a platelet concentrate that is widely used to promote tissue healing, and bone induction through its various growth factors has been used in this study. This case report describes the use of PRP unilaterally in a bilateral periapical lesion in the same patient. The site treated with PRP showed better healing than the untreated site. This was confirmed with computed tomography (CT) scan readings. It was hypothesized that PRP could promote tissue regeneration and alveolar bone repair.
  4,977 206 6
Natal teeth in an infant with congenital hypothyroidism
C Venkatesh, B Adhisivam
May-June 2011, 22(3):498-498
DOI:10.4103/0970-9290.87088  PMID:22048606
Teeth erupting at birth are referred to as natal teeth. It is a common and benign finding in the neonatal period. However, they may be associated with genetic syndromes like Ellis Van Creveld syndrome and Hallermann-Streiff syndrome. We report here a case of natal teeth in an infant with congenital hypothyroidism.
  4,950 162 1
Comparative evaluation of marginal adaptation between nanocomposites and microhybrid composites exposed to two light cure units
Ruchi Dhir Sharma, Jaideep Sharma, Anuradha Rani
May-June 2011, 22(3):495-495
DOI:10.4103/0970-9290.87082  PMID:22048600
Background: Recent advances in resin adhesives and restorative materials, as well as an increased demand for esthetics, have lead to the introduction of newer resin-based composites like nanocomposites and light-curing units like light emitting diodes (LEDs). Aim: The present study was conducted to evaluate the effect of conventional quartz tungsten halogen (QTH) curing unit and blue LED on marginal adaptation of microhybrid composite (Filtek Z250) and nanocomposite (Filtek Z350) resins. Materials and Methods: Eighty Class V cavities were prepared on, extracted human premolars and were divided into four groups of 20 each. The four groups were designed according to the restorative resin and light cure unit used microhybrid/QTH, nanocomposites/QTH, microhybrid/LED and nanocomposites/LED. After thermocycling and immersion in 2% Basic Fuschin dye solution, the teeth were sectioned and dye penetration was observed under a stereomicroscope at 20X magnification. Statistical Analysis: All the samples were scored and results were analyzed using the "Kruskal Wallis and Mann Whitney tests" with "Wilcoxone correction." Results: The results revealed least microleakage in microhybrid composites exposed to QTH and maximum in nanocomposites exposed to LED. Conclusion: Microhybrid composites exhibited lesser microleakage than nanocomposite resins.
  4,682 239 4
Validation of implant stability: A measure of implant permanence
Neha Mall, B Dhanasekar, IN Aparna
May-June 2011, 22(3):462-467
DOI:10.4103/0970-9290.87071  PMID:22048589
Implant stability is a requisite characteristic of osseointegration. Without it, long-term success cannot be achieved. Continuous monitoring in a quantitative and objective manner is important to determine the status of implant stability. Measurement of implant stability is a valuable tool for making decisions pertaining to treatment protocol and also improves dentist-patient communication. Owing to the invasive nature of histological analysis, various others methods have been proposed like radiographs, cutting torque resistance, reverse torque, modal analysis, resonance frequency analysis and Implatest® . This review focuses on objectives and various methods to evaluate implant stability.
  4,665 256 12
Non-surgical management of a mutilated maxillary central incisor with open apex and large periapical lesion
Puneet Ajwani, Nalini Saini
May-June 2011, 22(3):475-477
DOI:10.4103/0970-9290.87074  PMID:22048592
A 24-year-old female patient reported with a mutilated maxillary left central incisor. The coronal tooth structure remaining was very less, discolored, and brittle. She gave history of trauma about 15 years back when the tooth got fractured. An intraoral periapical radiograph revealed an open apex and a large periapical lesion. The case was managed successfully by conservative means using intracanal calcium hydroxide and mineral trioxide aggregate (MTA) apical barrier followed by a fiber post and a core. The final crown restored back esthetics and function. A 6-month follow-up demonstrated a clinically asymptomatic and adequately functional tooth, with radiological signs of healing.
  4,628 227 3
Analgesic efficacy of diazepam and placebo in patients with temporomandibular disorders: A double blind randomized clinical trial
GV Pramod, P Shambulingappa, MC Shashikanth, Shailesh Lele
May-June 2011, 22(3):404-409
DOI:10.4103/0970-9290.87062  PMID:22048580
Aim: The aim of the study was to evaluate and compare the analgesic efficacy of placebo and diazepam in patients with temporomandibular disorder. Materials and Methods: Thirty-five patients were recruited with a diagnosis of temporomandibular disorder based on standard clinical diagnostic criteria for temporomandibular disorder. The patients were put in to one of the two groups: placebo or diazepam at random. The average pain intensity was recorded with visual analog scale (VAS) at pretreatment, at weekly interval till the completion of a three-week trial and at post-treatment visit on the eighth week from baseline. The secondary outcome measures were changes in masticatory muscle tenderness, viz. massater muscle, lateral pterygoid muscle, medial pterygoid muscle and temporalis muscle and changes in mouth opening. Statistical Analysis: Intra-group comparison for analgesic efficacy and mouth opening was carried out by Wilcoxon's signed ranked test. Inter-group comparison for analgesic efficacy was also carried out using Mann-Whitney's test. Results: A statistically significant (P<0.01) decrease in temporomandibular disorder pain in the placebo group (65%) and statistically highly significant (P<0.001) decrease in the diazepam group (72%) were observed on VAS after three weeks of treatment. The inter-group comparison demonstrated no statistically significant difference between the groups. Conclusion: This study suggests that the placebo can give near similar results as diazepam can. So the role of placebo should also be considered as one of the important management strategies. In the short term, reduction in the masticatory muscle tenderness and significant improvement in the mouth opening in both the groups were observed.
  4,517 187 11
Gingival fibromatosis with hemi-osseous hyperplasia of jaws, focal maxillary viral papillomatosis of gingiva, fissured tongue and congenitally missing anterior teeth: A case report and surgical management of a new syndrome
M Sesha Reddy, Ravikanth Manyam, M Narendera Babu, TR Saraswathi
May-June 2011, 22(3):489-492
DOI:10.4103/0970-9290.87078  PMID:22048596
Gingival fibromatosis is characterized by fibrotic enlargement of the gingiva that can occur as inherited or sporadic form. Inherited form can be an isolated trait or as a component of a syndrome. This article reports a 35 year old male patient affected by gingival fibromatosis associated with hemiosseous hyperplasia of mandible, maxilla, and zygoma on the right side, viral papillomatosis of maxillary anterior gingiva, fissured tongue and congenitally missing anterior teeth. The patient was subjected to phase I and phase II periodontal therapy. There was no evidence of recurrence of the enlargement after one year but the papillomatosis recurred. Gingival fibromatosis has been reported to be associated with various other abnormalities but not with those described in our case. This observation raises the possibility that the coexistence of these entities in our case may represent a new syndrome.
  4,418 113 -
Evaluation of buccolingual inclination of posterior teeth in different facial patterns using computed tomography
Suomo Mitra, MS Ravi
May-June 2011, 22(3):376-380
DOI:10.4103/0970-9290.87056  PMID:22048574
Background and Objective: Buccolingual inclination of teeth is an essential factor in establishing good occlusion. The objective of this study was to evaluate the buccolingual inclination of molar teeth in different vertical skeletal patterns by using computed tomography scans. Materials and Methods: Coronal section of the jaws obtained from computed tomograms were used to measure the buccolingual inclination of the long axis of the molars relative to their skeletal base. Forty male adult individuals with class I dental occlusion were selected. They were classified as short (Group 1), average (Group II), and long faced (Group III) as per their skeletal patterns measured by GoGn-SN, FH-MP, Y-axis and facial height index in cephalograms. Statistical Analysis: ANOVA and Tukey HSD tests were applied to calculate if there were any significant differences in the mean molar inclination between the groups. Pearson's coefficients of correlation were calculated between the facial parameters and tooth inclination. Results: The differences in the mean molar inclination between the short, average, and long faced groups is significant for mandibular 1 st and 2 nd molars and maxillary 2 nd molars. Conclusion: Variations in mean molar inclination values are observed between short, average, and long faced groups.
  4,251 161 8
Comparison between five commonly used two-dimensional methods of human bite mark overlay production from the dental study casts
Saritha Maloth, KS Ganapathy
May-June 2011, 22(3):493-493
DOI:10.4103/0970-9290.87079  PMID:22048597
Aim: The present study was conducted to determine the most accurate bite mark overlay fabrication technique by studying two physical characteristics, i.e., area and rotation of biting edges of anterior teeth of thirty volunteers. The objective of the study was to evaluate the reliability and efficacy of five commonly used methods of human bite mark overlays using two dimensional (2D) digital images of dental study casts as a gold standard, to rank different methods according to statistically based determination of relative accuracy of each method and to determine its feasibility in Forensic science. Materials and Methods: Overlays were produced from the biting surfaces of six upper and six lower anterior teeth of 30 volunteers using the following five methods: a) hand tracing from study casts, b) hand tracing from wax impressions, c) xerographic method, d) radiopaque impression method and e) 2D computer-based method. Area of the biting edges of the anterior teeth and relative rotation of each anterior tooth were measured and compared. Results: The xerographic method was determined to be the more accurate method with respect to tooth area and rotation. Hand tracing methods, from either wax impressions of teeth or directly from study casts, were determined to be inaccurate and subjective. Conclusions: It is recommended that forensic odontologists discontinue the use of hand tracing overlays in bite mark comparison cases as there is lot of scope for manipulation and observer bias.
  4,028 263 2
Restoration of an atrophic eye socket with custom made eye prosthesis, utilizing digital photography
Gaurav P Jayaswal, SP Dange, AN Khalikar
May-June 2011, 22(3):482-485
DOI:10.4103/0970-9290.87076  PMID:22048594
Ocular defects may cause several ocular and orbital disorders, which require surgical intervention. These defects are psychologically disturbing for the patients, and therefore, they require immediate management and rehabilitation by a team of specialist. Ocular prosthesis may be either readymade (stock) or custom made. Fabrication of a custom ocular prosthesis allows for a range of variations during construction. The iris can also be custom made by ocular painting or by digital photography. The optimum cosmetic and functional results of a custom-made prosthesis enhance the patient's rehabilitation to a normal life style. This paper elaborates the technique for fabrication of a custom-made ocular prosthesis for an atrophic eye socket utilizing digital photography.
  3,953 244 3
Hemangiopericytoma - The need for a protocol-based treatment plan
Murugesan Krishnan, K Sree Kumar, T Sowmiya
May-June 2011, 22(3):497-497
DOI:10.4103/0970-9290.87086  PMID:22048604
Hemangiopericytoma is a vascular tumor which comprises only 1% of all vascular tumors. The frequency of occurrence in the head and neck accounts for about 16-33% of all hemangiopericytomas. In this paper we discuss the surgical management, the difficulties in decision-making and treatment-planning in a case of a maxillary tumor in a five-year-old boy with a two-year follow-up. A five-year-old boy presented with a large unilateral maxillary tumor with nasal obstruction. Computed tomography revealed a heterogeneous mass completely occupying the right maxillary sinus and displacing the lateral wall of the nose and nasal septum. The lesion was diagnosed as hemangiopericytoma after histopathological confirmation. The option of surgical resection (total maxillectomy) was carried out after evaluating the available literature. Various treatment modalities like surgery, chemotherapy and radiotherapy were taken into consideration as the tumor has an aggressive nature. Due to the inadequate literature on definitive treatment options for these types of tumors, there was difficulty in arriving at a protocol-based treatment plan.
  3,812 121 7
Quantitative assessment of expression of cell adhesion molecule (CD44) splice variants: CD44 standard (CD44s) and v5, v6 isoforms in oral leukoplakias: An immunohistochemical study
Pournima Y Godge, Leena S Poonja
May-June 2011, 22(3):493-494
DOI:10.4103/0970-9290.87080  PMID:22048598
Aim: The aim of this study was to semiquantitatively analyze the immunohistochemical expression pattern of CD44 standard (CD44s) and variant (CD44v) isoforms in leukoplakias using a panel of monoclonal antibodies recognizing epitopes of CD44s and of the variant exons v5 and v6. Objective: To evaluate the efficacy of CD44s and CD44 v5, v6 immunoexpression as possible molecular markers in detecting high-risk leukoplakias when screening for this oral precancer. Materials and Methods: Samples of oral leukoplakia (40 cases) and of normal mucosa (10 cases) were evaluated. Oral leukoplakia was graded into: hyperkeratosis without dysplastic change (8 cases), mild dysplasia (13 cases), moderate dysplasia (10 cases), and severe dysplasias (9 cases). Expression of CD44s,v5, v6 was analyzed by immunohistochemistry in a semiquantitative manner. Three areas of epithelium were scored B, S, and C, i.e., stratum basale, stratum corneum, and stratum spinosum, respectively in leukoplakias. Scoring of all specimens followed a two-parameter system, which implemented percentage of positive cells and staining intensities. Statistical analyses for each parameter of all groups and normals, mean, and standard deviation were calculated by using computer software package EPISTAT. Results: In normal epithelium CD44s, CD44v5, and CD44v6 were expressed as membranous proteins localized on the surface of epithelial cells. Both basal and spinous layer of epithelia expressed strong positive staining of CD44s, v5, v6 which then gradually faded into the negative staining of the superficial keratin layer. Profile of CD44s and v5 revealed that the mean levels of stratum B, S, and C in normal cases were comparable to the study cases and by Student 't' test P>0.05 not significant. There was, however, a statistically significant decrease in the expression of v6 with increasing grades of dysplasias when compared with normal mucosa. Conclusion: Among CD44s and its variant isoforms,v5, v6, in this study, variant isoform v6 may serve as a marker in detecting high-risk leukoplakias.
  3,608 197 15
Assessment of combination techniques in enhancing the regenerative potential of tricalcium phosphate graft in treatment of infrabony periodontal defects
Ashish Saini, Meghna Singh, Nand Lal, Jaya Dixit
May-June 2011, 22(3):391-395
DOI:10.4103/0970-9290.87059  PMID:22048577
Aims: The purpose of the present study was to evaluate and compare the clinical outcome of infrabony defects following reconstructive surgery with the use of tricalcium phosphate (TCP) alone; TCP and citric acid (CA) root conditioning; and TCP, CA, and oxidized regenerated cellulose (ORC) membrane. Materials and Methods: Thirty-nine systemically healthy subjects with vertical infrabony defect were initially selected based on intraoral periapical radiographs and clinical examination to record probing pocket depth (PPD) and clinical attachment level (CAL). Only 21 defects revealed two-walled configuration on surgical debridement. These defects were selected and randomly allotted to the study groups. Group 1 defects were treated with TCP, group 2 with TCP+CA, and group 3 with TCP+CA+ORC. PPD, CAL, defect depth (DD), and level of alveolar crest (AC) were evaluated at the time of initial surgery and after 6 months at surgical re-entry. These measurements were utilized to calculate PPD reduction, CAL gain, defect fill (DF), %defect fill (%DF), and crestal resorption (CR). Statistical Analysis: A paired t-test was used for assessing changes in each group. Unpaired t-test was used for intergroup comparisons. Results: All three groups showed statistically significant PPD reduction, CAL gain, DF, and %DF, but insignificant CR at the end of 6 months. On intergroup comparison, no statistically significant differences were noted between the groups for all the parameters. Conclusion: Efficacy of combination techniques using TCP+CA; TCP+CA+ORC in treatment of periodontal infrabony defects is at least equal to that of TCP alone.
  3,413 146 5
Questionnaire vs clinical surveys: The right choice?-A cross-sectional comparative study
Aswini Y Balappanavar, Varun Sardana, L Nagesh, Anil V Ankola, Pradnya Kakodkar, Mamata Hebbal
May-June 2011, 22(3):494-494
DOI:10.4103/0970-9290.87081  PMID:22048599
Purpose: To investigate the practical value of using questionnaires (self perceived assessment) as compared with clinical examinations (normative assessment) and to evaluate the role of socioeconomic status and implications of the results in understanding the public perception of oral health. Materials and Methods: This was a cross-sectional single-blind study. A purposive sample of 860 bank employees of Belgaum city, India, were asked to fill in a close-ended questionnaire inquiring about their socioeconomic status, dental, periodontal health levels and treatment needs. Clinical examinations, employing the WHO dentition status and Community Periodontal Index, were performed to determine normative status and needs. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values. Results: The kappa values ranged from 0 (treatment needs) to 0.67 (for prosthesis). The degree of agreement with the following kappa values and sensitivity was seen in filled teeth (0.52, 60%), missing teeth (0.62, 83.8%), and prosthesis (0.67, 58.3%). However, the disagreement was seen with all other questions with average kappa value of 0.20. Conclusions: Self-assessment questionnaires were of low value in evaluating dental, periodontal health status and treatment needs in the study subjects. Findings reflect a low level of awareness that may influence care-seeking behavior and socioeconomic status has a clear role to play in dental health perception.
  3,220 258 6
Bond strength of composite-resin and resin-modified glass ionomer to bleached enamel: Delay bonding versus an antioxidant agent
Hamid Mazaheri, Maryam Khoroushi, Ehsan Shafiei, Reza Ghorbanipour, Fateme Majdzade
May-June 2011, 22(3):432-435
DOI:10.4103/0970-9290.87066  PMID:22048584
Objectives: As enamel bond strength of the resin-modified materials is reduced after bleaching, a delay bonding of at least 1 week is recommended. This study investigated the efficacy of 10% sodium ascorbate hydrogel on the bond strength of bleached enamel as an antioxidant agent. Materials and Methods: Ninety-six human, sound molars divided into eight groups. Buccal enamel surfaces of specimens in two negative control groups after preparation were bonded by the Z100 CR using the single-bond adhesive and Vitremer RmGI. Specimens in other groups after enamel preparation were bleached with 9.5% hydrogen peroxide. In two positive control groups, bonding of CR and RmGI was performed immediately after bleaching. Specimens in two other groups were immersed in distilled water after bleaching, and then CR and RmGI were bonded after 1 week. In last two groups, 10% sodium ascorbate hydrogel was applied after bleaching, and then they were bonded by CR and RmGI. The specimens were placed under shear force. Statistics: ANOVA and Duncan's multiple range tests were used for data analysis. Results: Application of 10% sodium ascorbate hydrogel immediately before bonding and delay bonding for 1 week eliminated the negative effects of bleaching on CR and RmGI enamel bond strength. Conclusion: Application of 10% sodium ascorbate hydrogel or 1 week period elapsed after bleaching could significantly increase the enamel bond strength to a normal value.
  3,298 150 12
Need of implant dentistry at undergraduate dental curriculum in Indian dental colleges
Ramesh Chowdhary, Nagalakshmi Chowdhary
May-June 2011, 22(3):436-439
DOI:10.4103/0970-9290.87067  PMID:22048585
Edentulism is the major problem in the developing countries, and is widely spread in the current population, although the prevalence is declining and incidence of tooth loss is decreasing in the developed nations. The prevalence of edentulism in India varies from 60% to 69% of 25 years and above age group. It is obvious that the number of lost teeth increases with age leading to an increase in prevalence of partially edentulous patients. From a biological point of view, the replacement of a single missing tooth with an implant rather than a three-unit fixed partial denture, and the implant-supported complete denture has been proved more efficient in improving the mastication and maintaining the bone for a longer time and also more cost-effective treatment. Many dental schools throughout Europe and America have to a various extent introduced implant dentistry as part of the compulsory undergraduate curriculum. Thus, it becomes more essential to introduce implant dentistry at undergraduate level in Indian dental schools to manage the higher percentage of edentulism.
  2,859 215 6
Tobacco cessation and counseling: A dentists' perspective in Bhopal city, Madhya Pradesh
Shanthi Amit, Ajay Bhambal, Vrinda Saxena, Sakeena Basha, Sudhanshu Saxena, Amit Vanka
May-June 2011, 22(3):400-403
DOI:10.4103/0970-9290.87061  PMID:22048579
Introduction: Dental team has high potential to help smokers to better oral/general health but to achieve this; they need to be clear about their role. Considering the importance of tobacco cessation, the authors carried out this study aimed at assessing the role, knowledge, current practices, different barriers, and tools to overcome the same as perceived by dentists in Bhopal city. Materials and Methods: A self-administered structured, coded questionnaire was distributed to 200 private practitioners and the teaching staff in all the dental colleges in Bhopal city. Results: Out of 200 dentists to whom questionnaire was administered, 168 responded within a week's time resulting in a high response rate of 84%. A total of 97% of the dentists agreed that it is the duty of every dentist to advice patients about tobacco cessation. A total of 58% strongly agree that formal training will be an effective tool to provide the guidelines to dentists in tobacco cessation and counseling. Conclusion: Monitoring of effective planning and execution of these programs by appropriate authorities at regular intervals is vital for successful achievement of the goal of "Tobacco Free Society."
  2,624 248 4
Inherited proliferative oral disorder: A reductionist approach to proliferative verrucous leukoplakia
Raghu Radhakrishnan
May-June 2011, 22(3):365-366
DOI:10.4103/0970-9290.87053  PMID:22048571
  2,485 190 1
Increasing the prosthodontic awareness of an aging Indian rural population
Swapnil Parlani, Arvind Tripathi, Saumyendra Vikram Singh
May-June 2011, 22(3):367-370
DOI:10.4103/0970-9290.87054  PMID:22048572
Objective: The aged are prone to biological, social, and psychological problems, especially those residing in the rural areas. The rural aging population in contrast to their urban counterparts is illiterate, poor, and ignorant; cumulative is the fact that the youth are leaving rural areas for money and better opportunity to urban areas. An educational and motivational program to increase prosthodontic awareness was therefore undertaken and it was studied whether this translated into an increased demand for prosthodontic services. Materials and Methods: The study area consisted of a group of six villages collectively known as "Sarora" situated in Lucknow, Uttar Pradesh, India. The study population was divided on the basis of age, sex, education, and economic status and comparisons were made in between these groups. Interview and clinical examination were the tools of the study. Data were collected before and after the educational program and was subjected to statistical analysis. Results: The educational program led to more subjects adopting tooth brushing and neem twig chewing as a method of oral hygiene maintenance. The prosthodontic need fulfillment increased from 3.5% before the program to 13.6% after education and motivation. Conclusion: It was concluded that mobile dental clinics, dental camps, and prosthodontic outreach programs could be solutions to spread awareness and disseminate treatment.
  2,441 207 5
A remarkable role of growth factors in resolving oral and specific periodontal pathologies: A strategic review
Sarita Dabra, Preetinder Singh
May-June 2011, 22(3):496-497
DOI:10.4103/0970-9290.87085  PMID:22048603
The knowledge and the understanding of the role of growth factors, their mechanisms of action, and molecular signaling pathways, which have been reviewed in this article, suggest the potential for many novel therapeutic targets, not only for applying growth factors but also for the potential use of growth factor inhibitors or agents that target specific parts of the intracellular signaling pathways in controlling oral pathologies. There remains an enormous challenge to convert some of the knowledge from basic studies of bone cell physiology and inflammatory cells to therapeutically useful techniques for the future.
  2,253 190 -
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