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   Table of Contents - Current issue
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July-December 2016
Volume 8 | Issue 2
Page Nos. 79-142

Online since Friday, December 16, 2016

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GUEST EDITORIAL  

Oral and maxillofacial pathology............. need to evolve? p. 79
K Ranganathan
DOI:10.4103/0975-8844.195907  
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ORIGINAL ARTICLES Top

Oral and maxillofacial malignancies: An analysis of 77 cases seen at an academic medical hospital p. 80
Adebayo Aremu Ibikunle, Abdurrazaq Olanrewaju Taiwo, Ramat Oyebunmi Braimah
DOI:10.4103/0975-8844.195919  
Introduction: Oral and maxillofacial malignancies (OMMs) consist of a wide range of lesions, which constitute varying proportions of the total incidence of malignancies in the human population. Available epidemiological data vary across racial, geographical, gender, and occupational divides. They are often associated with significant impairment of patients' quality of life. Materials and Methods: A review of hospital records of patients with histologically diagnosed primary OMM, who presented to the Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, over a 5-year period, was done. Data including age, gender, site, and type of tumor, and histological grade of tumor were retrieved and analyzed with the SPSS version 20.0. Results: A total of 77 cases of OMMs were identified with a male/female ratio of 1:1.03. The mean (±standard deviation) age was 50.1 (17.8) years. Squamous cell carcinoma was the most frequently seen epithelial malignancy constituting 35.1% of all malignancies, with most patients in advanced stages of the disease. Osteosarcoma was the most frequently diagnosed sarcoma, constituting 11.7% of all malignancies seen. Salivary gland malignancies constituted 29 (37.7%). Other malignancies seen include, malignant peripheral nerve sheath tumor, leiomyosarcoma, and malignant melanoma. Conclusion: OMMs constitute a significant health burden in our region. Thus, adequate resources should be allocated toward improving awareness among the populace. Policy shifts and regular dental visits which may increase the likelihood of early intervention should be instituted.
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Effectiveness of peripheral neurectomy in refractory cases of trigeminal neuralgia p. 86
Narayan Sharma Lamichhane, Xiaoyan Du, Shanchang Li, Dhruba Chandra Poudel
DOI:10.4103/0975-8844.195908  
Context: Trigeminal neuralgia (TN) is a commonly diagnosed neurosensory disease of orofacial region involving the fifth cranial nerve. Patient refractory to pharmacotherapy or with clinical and/or laboratory side effects sufficient to demand drug cessation is subjected to surgical technique. Aims: The aim of this study is to investigate the efficacy of peripheral neurectomy in the management of refractory TN. Settings and Design: This retrospective study on forty patients refractory to carbamazepine was conducted in the department of oral and maxillofacial surgery in the Northeast part of China from September 2011 to September 2014. Patients and Methods: Patients treated with neurectomy were followed up at regular intervals to assess the duration of pain-free period, and the pain was assessed using visual analog scale and the success of the surgery was defined accordingly. Statistical Analysis Used: Descriptive statistical analysis was carried out using IBM SPSS-20. Results: The mean age of the patients was 67.92 years (46–86 years), with higher incidence in females (F:M = 1.6:1). The 3rd division of trigeminal nerve was most commonly affected by the disease. The right side was more common than the left side. Duration of postsurgical pain-free period varied from 12 to 36 months with mean pain-free duration of 23.25 months. Recurrent cases were treated with low dose of carbamazepine, and majority of them were relieved of symptoms. Conclusions: Peripheral neurectomy is a minimal invasive surgery; safe and effective for elderly patients, especially in rural areas where advanced neurosurgical facilities are not available and for those who are reluctant to major neurosurgical procedures.
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Detection and prevalence of Capnocytophaga in periodontal Health and disease p. 92
Pushpa S Pudakalkatti, Abhinav S Baheti, Sanjeevini A Hattarki, Soumya S Kambali, Reshma M Naik
DOI:10.4103/0975-8844.195911  
Context/Background: Periodontal disease is a multifactorial disease, in which bacteria play a major role. Capnocytophaga species form a part of human oral flora both in health and disease. They have been implicated as putative periodontal pathogens, and yet, they are less understood members of plaque flora. No studies have been conducted on the association of Capnocytophaga species with periodontal diseases in India. Aim: The aim of this study was to detect the prevalence of Capnocytophaga species in patients with healthy periodontium, gingivitis, and periodontitis using culture method. Methods: Forty patients each with healthy periodontium, gingivitis, and periodontitis were selected. Subgingival plaque samples were collected from all the patients using sterile curettes and transferred to transport medium and sent to the laboratory. The plaque samples were inoculated on blood agar and trypticase-blood-bacitracin-polymyxin agar to grow Capnocytophaga species. Later, Gram-staining and microscopy were done to confirm the presence of Capnocytophaga in each sample. The prevalence of Capnocytophaga species was statistically analyzed using Chi-square test, Kruskal–Wallis analysis of variance, and Mann–Whitney U-test. Results: Capnocytophaga was detected in 21 (52.50%) samples out of 40 samples of gingivitis group, 11 (27.50%) samples of healthy group, and 12 (30%) samples of periodontitis group. Conclusions: Capnocytophaga is more prevalent in gingivitis compared to healthy periodontium and periodontitis. Capnocytophaga has the potential to cause periodontal disease, but as it is less competitive in the periodontal pocket, it is usually overgrown by other rapidly growing bacteria.
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Knowledge and attitude of pediatric dentists, general dentists, postgraduates of pediatric dentistry, and dentists of other specialties toward the endodontic treatment of primary teeth p. 96
P Devendra Patil, A Farhin Katge, D Bhavesh Rusawat
DOI:10.4103/0975-8844.195917  
Background: Pediatric dentists (PDs) play an important role in treating primary teeth and oral health care needs for children. Pulp therapy is widely used in the treatment of primary teeth. The choice of endodontic treatment modality changes among general dentist (GD) and PD. Aim and Objectives: The aim of this study is to determine the attitudes of PDs, GDs, postgraduates (PGs) of pediatric dentistry and dentists of other specialties toward endodontic treatment of primary teeth. Materials and Methods: A structured 20-item questionnaire was formulated in English and distributed to PD, GD's, PGs of pediatric dentistry, and dentist of other specialties. The filled questionnaire survey was statistically analyzed using simple descriptive analysis and inferential analysis was performed using Chi-square t- test. Results: Out of the 237 survey respondents, 27.43% were BDS (GD's), 16.88% were MDS (PD), 12.66% were PG's (pediatric dentistry), and 43.04% were MDS (other than PD). About 91.6% of the total respondents preferred endodontic procedures in primary teeth. Conclusion: The study concluded that the GD's, PD's, and dentist of other specialty differ in their treatment recommendations for primary teeth. The GDs and dentist of other specialty were regularly performing pulp therapy in primary teeth and should frequently update their knowledge about endodontic procedures in primary teeth.
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Radiographic structural findings in mandibular condyle of orthodontically treated young patients, a possibility of an iatrogenic temporomandibular joint involvement p. 102
Arati Panchbhai, Rahul Bhowate
DOI:10.4103/0975-8844.195916  
Aim: Temporomandibular disorders joint disorders (TMD) are commonly seen in population. There can be varied etiology to this. The purpose of the study was to study the possible association between orthodontic treatment and TMD. Materials and Methods: For the present study, the 720 subjects were assessed in 2 groups as orthodontically treated group (370) and control group without malocclusion (350). The structural findings were assessed as per the criteria. The data were subjected to statistical analysis using Chi-square test and Pearson's correlation. Results: For all the intergroup and intragroup, the findings were insignificant. Though insignificantly, marginal erosion was common finding followed by flattening and rarefaction. Conclusion: Overall, the study could not confirm the association that orthodontic treatment may lead to TMD. The next extensive study needs to be conducted considering clinical signs and symptoms and the long-term follow-ups.
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The evaluation of relationship between body mass index and mental foramen area using computer-aided methods p. 109
Ali Ozyanik, Pelin Guneri, Suzan Sirinturk, Figen Govsa, Yelda Pinar
DOI:10.4103/0975-8844.195914  
Objective: Anatomical structure of the mental foramen (MF) is an essential orientation point particularly for implant planning at surgical clinics of dentistry, for genioplasty operations, and plastic surgery. The aim is to determine the influential factors such as the patient age, gender, and body mass index (BMI) on MF anatomy of dental periapical radiograms. Materials and Methods: Our study evaluated the BMI, gender, and age relationship with the calculated areas of the MF based on symmetrically taken 202 periapical dental radiography with a parallel technique of the bottom premolar region of total 101 people ages ranging from 17 to 70 weighing 46–108 kg. Patient age, BMI, and gender were recorded and statistically tested for correlations on the area of the MF. Digital imaging and communications in medicine were measured MF area. Results: Right MF area was measured as 0–20.8 mm2 (mean: 4.98 mm2) and left as 0–17.3 mm2 (4.93 mm2). There was not a difference in the areas of MF between the two sides. Furthermore, it was determined that ANOVA test and BMI, Pearson test with age and gender did not appear to have an effect on MF areas. Only within the obese people, left MF area was significantly different than those with other BMI groups. A negative effect on image quality was found statistically significantly correlated with age and MF. None of the investigated MFs were garbled by any of the investigated influence factors. Conclusion: In incidences in which the anatomical structure of the MF and the areas were crucial; age, gender, height, and weight of the individual were not determinant factors. BMI and MF appeared to have a negative impact.
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Assessment of dental caries in primary dentition employing caries assessment spectrum and treatment index p. 115
Karthik Anchala, Ramasubbareddy Challa, Yamini Vadaganadham, Rekhalakshmi Kamatham, Vemula Deepak, Sivakumar Nuvvula
DOI:10.4103/0975-8844.195913  
Background: Caries assessment spectrum and treatment (CAST) index was developed as an innovative instrument for evaluating dental caries in epidemiological studies. Aim: The aim of the study was to assess the usefulness of CAST in evaluating caries prevalence and treatment needs among children in primary dentition stage. Materials and Methods: Children in the age range of 5-6 years were selected and their caries status, along with the treatment needs, was recorded using CAST index. The differences in caries status between maxillary and mandibular arches, right and left quadrants as well as boys and girls were assessed using Mann–Whitney U test with the level of significance set at 0.05 and correlation of the distribution of CAST codes among the evaluated teeth was explored through Spearman's rank correlation coefficient. Results: A strong correlation was found between the status of the teeth from the right and left sides of the oral cavity. The correlation coefficient (r) for neighboring maxillary anteriors was 0.67 and 0.57, whereas 1 for all mandibular anteriors (P < 0.001). The correlation coefficient (r) for neighboring maxillary posteriors was <0.3, whereas it was 0.48 and 0.18 for mandibular posteriors (P < 0.001). Correlations were found to be weak (r 0.07-0.29) between maxillary and mandibular arches. Conclusions: In the evaluated population, the strongest correlation was found for the distribution of caries stages in primary incisors as well as molars on the right side of the mouth and the percentage of molars with carious lesions was especially high for second primary molars.
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Gingival displacement methods used by dental professionals: A survey p. 120
SV Giridhar Reddy, M Bharathi, B Vinod, K Rajeev Kumar Reddy, N Simhachalam Reddy
DOI:10.4103/0975-8844.195909  
Aim: The aim of the present study was to identify the methods used by dental professionals for gingival displacement before making impressions for fixed prostheses. Materials and Methods: A printed questionnaire was distributed to over 600 dentists at a National Dental Conference held in Hyderabad. The questionnaire was designed to know the preferred method of gingival displacement, medicament used, frequency of performing gingival displacement, etc. The results were analyzed and represented in the form of percentage. This method of survey distribution was selected to reach dental professionals in a wide range. Results: Of 600 dentists who received the questionnaire, 63.3% returned properly filled forms. Sixty-eight percentage of respondents advocate gingival displacement for all fixed prostheses cases, 23% of respondents use for long span fixed prostheses cases, and 9% of respondents use gingival displacement only for selected cases. Among the respondents, 69% preferred to use chemicomechanical method, 16% surgical method, 9% of respondents preferred to use the mechanical method. Conclusion: The choice of technique and material for gingival displacement depends on the operator's judgment of the clinical situation apart from the availability of the materials.
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Orofacial cancers in the West of Iran: A 10-year study p. 123
Somayyeh Azimi, Marc Tennant, Estie Kruger, Jamileh Bigom Taheri, Marziye Sehatpour, Babak Rezaei
DOI:10.4103/0975-8844.195918  
Background: Orofacial cancer remains a substantial life-threatening disease in developing countries. Late diagnosis and treatment still lead to many avoidable deaths. The differences in incidence and prevalence between different geographical and ethnic groups remain an important issue for service planning and international action against cancer. Methods: In this retrospective study, cancer of the orofacial region for the 10-year period (April 2002–March 2012) was evaluated. Age, sex, histopathological type, and the primary site of tumor were recorded according to the International Classification of disease for Oncology. Descriptive analyses were used to describe basic features, means (±standard deviation) were reported, and appropriate tests of significance were used. Results: Squamous cell carcinoma was the most common malignancy (55.8%) followed by mucoepidermoid carcinoma (9.4%). The male to female ratio was 5:4 and the average age was 63 years. The most common site was lower lip (22%), followed by tongue (15%) and parotid salivary gland (13%). Conclusion: This 10-year retrospective study analyzed frequency of orofacial malignancies. Considering the difference in incidence and mortality of head and neck cancer in less developed versus more developed regions, this kind of research in various population provides better understanding of cancer for global programming in terms of prevention, detection, and treatment.
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Knowledge of dental ethics and jurisprudence among dental practitioners in Chennai, India: A cross-sectional questionnaire study p. 128
R Kesavan, A Vinita Mary, M Priyanka, B Reashmi
DOI:10.4103/0975-8844.195915  
Introduction: Ethics is a science of ideal human character and behavior in situations where the distinction should be made between what is right and wrong. Dental jurisprudence is a set of legal regulations set forth by each state's legislature describing the legal limitations and regulations related to the practice of dentistry. Objectives: (1) To assess the dental practitioners' awareness about dentists (Code of Ethics) regulation and jurisprudence. (2) To assess the awareness of dentists regarding Consumer Protection Act (COPRA) and its implications in dentistry. Materials and Methods: A cross-sectional questionnaire survey was conducted. A pilot study was conducted to validate the questionnaire and to get the required sample size which was 346. A specially designed questionnaire consisting of 24 close-ended questions divided into two sections was used. The resulting data were coded, and statistical analysis was done using Statistical Package for Social Sciences (SPSS) software version 17.0. Results: The results showed that about 65% of the dentists were aware that the Dentist Act was given in the year 1948 and 76% knew that the dentists (Code of Ethics) regulation was given by the Dental Council of India. Only 33% knew that it is not unethical for a dental surgeon to supply or sell drugs related to dentistry in his clinic. Only 31% responded correctly that it is not necessary to obtain informed consent for clinical examination and routine radiography. Nearly, half of the respondents (43%) were not aware of professional indemnity insurance. Conclusion: The study concludes that majority of the dental practitioners are aware of dental ethics but their knowledge on jurisprudence and COPRA needs to be enriched. Although recommendations can be made to the dental profession to alter their behavior, real improvement is unlikely without changes in legislation and social policy.
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CASE REPORTS Top

Triunity of mandibular deciduous anteriors: A rarity in morphology p. 135
Kenchappa Mallikarjun, Parameshwarw Poornima, Indavara Eregowda Neena, Priya Meharwade
DOI:10.4103/0975-8844.195912  
An uncommon developmental anomaly such as a triple tooth may result from fusion, gemination, or concrescence that may occur between two and more teeth or between normal tooth and a supernumerary tooth. This anomaly may occur as a result of conjoining or twining defects that affect both primary and permanent dentition. In this article, we report an unusual case of triplication of primary teeth occurring unilaterally between the lower left lateral incisor and the canine, where the lateral incisor is geminated and it is fused to the canine. The triple tooth was extracted under local anesthesia and its crown portion was sectioned at three levels that are coronal, middle, and cervical one-third, respectively, following which, the sections were observed under a stereomicroscope. Based on the clinical and histologic findings, final diagnosis of gemination of lateral incisor with fusion to the canine is confirmed.
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Esthetic and phonetic rehabilitation with combined maxillofacial prosthesis p. 139
Aline Úrsula Rocha Fernandes, Mateus Veppo dos Santos, Rodrigo Antonio de Medeiros, Patrice Fernandes Lopes
DOI:10.4103/0975-8844.195910  
Basal cell carcinoma is the most common malignant neoplasia affecting the skin. Its prevalence is higher in the face, mainly in the nasal and zygomatic areas. In several cases, the treatment requires surgical intervention which causes facial deformities that impair basic functions (i.e., sight and smell), social interaction, and self-esteem of the patient. Maxillofacial prosthesis is an important way to rehabilitate and reintegrate these patients to their private and social life. The present clinical report aimed to present a prosthetic rehabilitation with combined oculopalpebral and nasal prosthesis of a patient to replace the nasal, zygoma, and orbital tissues after basal cell carcinoma surgical treatment. In addition, the patient was treated with conventional complete dentures to replace the lost teeth due to chemotherapy. The present treatment restored the chewing and speech functions and improved the self-esteem, social life, and quality of life of the patient.
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