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   Table of Contents - Current issue
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January-June 2022
Volume 14 | Issue 1
Page Nos. 1-79

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EDITORIAL  

Artificial Intelligence in Oral and Maxillofacial Radiology: It is Here p. 1
Steven Richard Singer
DOI:10.4103/jofs.jofs_134_22  
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ORIGINAL ARTICLES Top

Gaseous Ozone Treatment Augments Chondrogenic and Osteogenic Differentiation but Impairs Adipogenic Differentiation in Human Dental Pulp Stem Cells In Vitro p. 3
Lavanya Pasalkar, Mahesh Chavan, Avinash Kharat, Avinash Sanap, Supriya Kheur, Bhonde Ramesh
DOI:10.4103/jofs.jofs_106_22  
Introduction: Stem cells have gotten a lot of attention because of their unique ability to differentiate and regenerate. Stem cells perform an important function in tissue regeneration and repair. Human dental pulp stem cells (hDPSCs) are a popular source of stem cells for accelerating wound healing. Over the last few decades, the use of ozone (O3) has progressed in medical specialties all over the world, resulting in significant clinical successes in the treatment of bone, vascular, and immunological ailments, as well as pain management. However, in the domain of tissue regeneration and differentiation, the effect of ozone on stem cells has received little attention. This is the first study to show that ozone therapy has an effect on hDPSCs. Materials and Methods: hDPSCs were isolated and grown in vitro from healthy extracted teeth. The culture media were allowed to absorb gaseous ozone. The ozone treatment was administered at concentrations of 0, 5, 10, 15, 20, 25, and 30 μg/mL, with a control concentration of 0 μg/mL. Proliferation was measured using the MTT reagent after 48 hours. The effect of ozone on the differentiation of DPSCs into osteoblasts, chondroblasts, and adipocytes was studied using the optimal ozone concentration. Results: One-way Analysis of variance (ANOVA) comparison between different concentrations of ozone showed statistically significant result (F = 23.895; P < 0.001). Maximum metabolic activity was observed with 10 μg/mL ozone. The proliferation increased up to 15 μg/mL; with further increase in O3 concentration, there was a marked reduction in proliferation. With 10 μg/mL, post-ozone treatment marked increase in osteogenic and chondrogenic. Chondrogenic differentiation was found to be statistically significant (P < 0.001) whereas marked decrease was seen with adipogenic differentiation. Conclusion: About 10 μg/mL ozonization slightly increased the proliferation in hDPSCs and distinctly increased the differentiation potential in chondrogenic and osteogenic lineages. But decreased adipogenic differentiation. With these findings, future studies will help to explain how ozonization affects hDPSCs to enhance their potency for clinical applications.
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Comparative Evaluation of Enterococcus faecalis Counts on Different Tapers of Rotary System with Different Irrigating Solutions: An In Vitro Study p. 12
Rahimath Shettybettu Hydros Shariq, Harish Kumar Shetty, Prathap Mulakkal Sreekantan Nair, Vivian Flourish D’Costa
DOI:10.4103/jofs.jofs_32_22  
Introduction: The conservation of tooth structure and prevention of extrusion of obturating materials have been cited as primary advantages of minimal apical enlargements. The aim of this study is to compare the effects of different rotary file tapers and two irrigating solutions and a combination of two irrigating solutions on E. faecalis counts. In this study, 84 freshly extracted single rooted single canal human premolars were selected and enlarged to ISO #20 K-file. Materials and Methods: The samples were sterilized and inoculated with E. faecalis for 72 hours, divided into six experimental groups, and prepared with #30 nickel-titanium rotary files with 0.04 and 0.06 tapers. Group I was irrigated with 2 mL of 3% sodium hypochlorite, Group 2 was irrigated with 2 mL of 2% chlorhexidine (CHX), and Group 3 was irrigated with 2 mL of a combination of 3% sodium hypochlorite, saline, and 2% CHX irrigation after each file. Cleaning efficacy was evaluated in terms of the reduction of colony forming units. Comparison of the E. faecalis among the groups at 0.04 taper was performed using the Kruskal-Wallis test after establishing normality of variance using the Shapiro-Wilk test. A comparison of the E. faecalis between 0.04 and 0.06 taper within the group was performed using the Mann-Whitney test. Results: Group 1 (3% sodium hypochlorite) and Group 3 (3% sodium hypochlorite + saline + 2% chlorhexidine gluconate) showed no statistically significant difference between the subgroups (0.04 and 0.06 taper), whereas statistically significant difference with E. faecalis was seen with respect to Group 2 between 0.04 and 0.06 taper (2% chlorhexidine gluconate). Conclusion: The study proved the use of sodium hypochlorite, saline, and CHX in combination at both 0.04 taper and 0.06 taper gave better results with no significant change.
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Evaluating the Interrelationship Between Salivary Cortisol and Glycemia in Type 2 Diabetics p. 17
Tharani Vijaya Kumar, Vinoth Vasanthi, Thayalan Dinesh Kumar, Madhu Narayan, Bose Divya, Raj Kumar Krishnan, Ramya Ramadoss
DOI:10.4103/jofs.jofs_96_22  
Introduction: Diabetes mellitus is a multifactorial metabolic condition marked by high blood sugar levels as well as problems with carbohydrate, lipid, and protein metabolism. Impaired insulin secretion and hepatic gluconeogenesis cause high blood sugar levels. Cortisol in the saliva is the unbound, free hormone, with absolute quantities between 30% and 50% fewer than in blood. The aim of the study was to evaluate the levels of salivary cortisol in normal healthy controls and type 2 diabetics. The objective was to evaluate the morning and evening levels of salivary cortisol in normal and type 2 diabetics by enzyme-linked immunosorbent assay (ELISA). Materials and Methods: 20 patients in the age group of 30 to 60 years with type 2 diabetes with HbA1c <6.5% were included in Group I. Twenty participants in the age group of 30 to 60 years were included in Group II. Salivary samples were collected and centrifuged at –4°C at 3500 rpm and ELISA was performed. Data were analyzed using Statistical Package for the Social Sciences version software version 16. Paired sample t test was used. Results: The mean morning salivary cortisol level of diabetic patients (Group I) was 1.62 mmol/dL and the evening was 1.34 mmol/dL. The difference was statistically significant (P = 0.00001). The mean salivary cortisol level of healthy subjects in the morning was 0.47 mmol/dL and evening was 0.29 mmol/dL, which is statistically significant (P = 0.00001). Conclusion: From this study, we can conclude that the salivary cortisol level is increased in patients with type 2 diabetes when compared to healthy individuals. There are no obvious changes in morning and evening salivary cortisol levels of diabetes patients.
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Evaluation of the Association of Alveolar Bone Dimensions in Unilateral Palatally Impacted Canine: A Cone-Beam Computed Tomography Analysis p. 21
Amir Hooman Sadrhaghighi, Sajad Farrokhi, Maryam Rad, Mahsa Eskandarinezhad
DOI:10.4103/jofs.jofs_79_22  
Introduction: Maxillary canine impaction is directly associated with changes in dentoalveolar dimensions and adjacent teeth displacement. This investigation aimed to perform skeletal and dentoalveolar measurements of unilateral palatally impacted canines and compare them with the unaffected contralateral side using cone-beam computed tomography (CBCT). Materials and Methods: This cross-sectional study examined unilaterally impacted canines of the maxilla in 46 CBCT scans. The lateral incisor angulations, nasal cavity width, alveolar bone height, bucco-palatal width, and arch perimeter were measured and compared on both impaction and unaffected sides. All statistical tests were two-sided and analyzed using the paired sample t test and the Kolmogorov-Smirnov test using SPSS 26.0. A P < 0.05 was deemed statistically meaningful. Results: On the impacted side, a significant decrease was observed in the width of the alveolar bone at the height of 2 mm (P = 0.001). Furthermore, at the height of 10 mm, the impacted side was significantly thicker (P = 0.001). There was a statistically significant difference between the maxillary arch width on the nonimpacted and impacted sides (P = 0.001); the distance of mid-palatine raphe to the first premolar and canine proximal bone on the non-impaction side was significantly lower (13.251 ± 1.75 mm) compared to the impacted side (14.334 ± 1.80 mm) (P = 0.01). The external angle of the lateral maxillary incisor on the impacted side (86.803 ± 8.425°) showed a significant decrease (P = 0.001) compared with the contralateral side (91.403 ± 6.791°). Conclusion: The lateral incisors’ lateral angulations, the inter-premolar width, and the alveolar bone thickness can be affected by palatally impacted canine teeth. However, the height of the alveolar bone and the width of the nasal cavity are not affected.
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Multilayer Perceptron to Assess the Impact of Anatomical Risk Factors on Traumatic Dental Injuries: An Advanced Statistical Approach of Artificial Intelligence in Dental Traumatology p. 28
Mohammad Kamran Khan, Mahendra Kumar Jindal
DOI:10.4103/jofs.jofs_42_22  
Introduction: Traumatic dental injuries (TDIs) are the public dental health concern, with variable prevalence reported worldwide. Although, TDI is not a disease rather, it is a result of various risk factors. This study was performed to assess the influence of anatomical risk factors such as accentuated overjet, overbite, molar relationship, and lip competency in determining the number of traumatized teeth per affected individual by using the advanced statistical method of multilayer perceptron (MLP) model of deep learning algorithm of artificial intelligence (AI). Materials and Methods: A cross-sectional study consisted of 1000 school children (boys and girls) of index age groups between 12 and 15 years selected through multistage sampling technique. Orofacial anatomical risk factors associated with TDI were statistically analyzed by MLP model of deep learning algorithm of AI using IBM SPSS Modeler software (version 18, 2020). Results: MLP method revealed results in terms of normalized importance as overbite (100%) was the strongest risk factor for the occurrence of TDI in number of teeth of affected participants, followed by molar relationship (90.2%), overjet (87.7%), and the lip competency was found as the weakest risk factor. Conclusion: Using the MLP as statistical method, overbite was found as the strongest anatomical risk factor in determining the number of traumatized teeth per affected individual as compared to molar relationship, overjet, and lip competence.
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Evaluation of Dimensionality and Reliability of the Autonomy over Smoking Scale among South Indian Smokers p. 35
Nalini Parimi, Nalini Bikkina, Vikramsimha Bommireddy, Viswa Chaitanya Chandu, Busi Ruth Anupama, Madasu Gowthami
DOI:10.4103/jofs.jofs_169_21  
Introduction: In spite of the efforts being directed at reducing the tobacco use among public, it remains a significant concern facing India today. In the quest of providing tobacco cessation counseling, documentation of the tobacco dependence of the individuals is quintessential. This study aims to assess the psychometric properties of the autonomy over smoking scale (AUTOS) among patients seeking oral health care at a teaching dental institution in southern India. Materials and Methods: The study sample constituted 199 subjects who satisfied the eligibility criteria of self-reported current smoking and were willing to participate in the study. Participants’ age, gender, and years of smoking were documented along with their nicotine dependence by administration of Fagerstrom test for nicotine dependence (FTND) and AUTOS by a trained interviewer. The dimensionality of AUTOS was verified by confirmatory factor analysis using the Classical and Bayesian Instrument Development software program. Correlation analysis between FTND and AUTOS subscale scores was performed along with multiple linear regression analyses to identify the predictors for AUTOS subscale scores. Results: The symptom type-wise subscales of AUTOS and the overall scale demonstrated good internal consistency reliability (Cronbach alpha ≥0.758). Significant positive correlation was observed between age, years of smoking, FTND score, and all the AUTOS subscale scores. Linear regression analyses showed that the number of years for which the subject had been smoking was a significant predictor of all the three AUTOS subscale scores. Conclusion: AUTOS was observed to be a very useful tool with good internal consistency reliability that measures tobacco dependence in consistence with FTND among South Indian population, and while doing so, it captures the various forms of tobacco dependence in an independent manner.
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Assessment of Anterior Loop of Inferior Alveolar Nerve – A Cone Beam Computed Tomography Study p. 41
Juluri Sairamya Suneetha, Yalamanchili Samatha, Alaparthi Ravi Kiran, Nunsavathu Purnachandra Rao Naik, Boddu Naveen Kumar, Garikapati Anoop
DOI:10.4103/jofs.jofs_147_21  
Introduction: The anterior loop (AL) of the inferior alveolar nerve (IAN) and the mental foramen (MF) are important anatomical structures that should be taken into consideration during preoperative planning in the anterior mandibular region. This study aims to assess the prevalence, length, and type of the AL of the IAN in males and females in a South Indian population. Additionally, the distance from the MF to the lower border of the mandible is assessed. Materials and Methods: A total of 115 cone-beam computed tomography (CBCT) scans of 230 sides of mandibles were taken using a Carestream Select CS9300 CBCT machine (Carestream Dental LLC, Atlanta, USA). The scans were selected from archives and divided into three different age groups (<40, 41–60, >61 years). The scans were analyzed to detect the canal of the AL of the inferior alveolar nerve canal (IANC). The IANC, along with the AL canal and part of the incisive nerve canal, was traced using the CS 9300 software. The length of the mandibular nerve was measured for each patient in cross-sectional and panoramic views. Results: The AL was present in 92.6% of the 115 participants. Overall anterior loop length ranged between 0.9 and 15.2 mm. The mean length of AL in panoramic view on the right side was 3.284 ± 2.314 mm and it was 3.015 ± 2151 mm on the left side. Y-shaped AL was more predominant when compared to T-shaped AL in the sample. Conclusion: The prevalence of AL was relatively higher in subjects ranging from 41 to 60 years with a slight increase in female predominance.
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The Electrical Conductivity and Dielectric Properties of Dental Glass Ionomer Cements: In Vitro Study p. 47
Kola Srikanth Reddy, Dungavath Nareshnaik, Veera Venkata Naga Sunil, Mirmujahed Ali, Ganapathy Aruna Kumari, Jemina Shiny Chatta
DOI:10.4103/jofs.jofs_260_21  
Introduction: Glass ionomer cements find extensive use as dental restoratives for their biocompatibility, favorable mechanical properties, and sustained fluoride ion release. The measurement of the dielectric constant and resistivity of these materials has been used to monitor their setting characteristics. The aims was to study the conductivity and dielectric constant of the dental glass ionomer cement. Materials and Methods: Commercially available GIC cement was mixed according to the manufacturer’s instructions. The resistivity of the samples was measured using an Inductance(L), Capacitance(C), Resistance(R) meter. The measurements were made both in the initially set samples and after the samples were set for 24 hours. The conductivity and dielectric constant of the samples were calculated. Results: There was an increase in the resistivity of the samples and hence a decrease in the conductivity and decrease in the dielectric constant of the samples with an increase in setting time. Conclusion: With the progression of the setting reaction, the Glass ionomer cement changes from ionic to nonionic state, hence causing an increase in the resistivity and decrease in the conductivity and dielectric constant, which suggests that GIC acts as an insulator to thermal and galvanic currents.
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Oral Microbes Associated with Pulp and Periapical Infections p. 52
Bonnis Benny, Varun Raghavan Pillai, Anna Joseph, Jayanthi Pazhani, Vinod Mony
DOI:10.4103/jofs.jofs_268_21  
Intoduction: Endodontic treatment procedures are designed to eradicate infection and prevent germs from infecting or reinfecting the root and/or periapical tissues. As a result, a thorough understanding of the endodontic microbiome is critical to the efficacy of endodontic treatment in diverse types of illness. We conducted a thorough and critical assessment of original research articles that looked into the microbiota of pulp and periapical infections for this study. Primary apical periodontitis, secondary apical periodontitis, and apical abscess are the endodontic diseases included in this study. Materials and Methods: The PRISMA statement and Cochrane criteria for systematic reviews were followed in the preparation of this systematic review’s methodology. For works published between 2000 and 2020, a thorough literature search was undertaken independently by two researchers in the PubMed, SCOPUS, and EMBASE databases. We found all of the papers that contained original data on oral microorganisms in pulp and periapical diseases. Anecdotal evidence, case reports, and reviews were excluded from the study. The complete text of 36 articles that satisfied the inclusion criteria were retrieved and reviewed for sample methodology, sequencing strategy, and microbiome makeup. All 36 publications were critically examined independently by three authors, following the Joanna Briggs Institute Reviewer’s Manual of 2017. Results: Firmicutes, Bacteroidetes, Proteobacteria, Actinobacteria, and Fusobacteria were the most common phyla represented. Conclusion: All infection types are associated with an exceedingly diverse microbiome. These studies together map out an exhaustive chart of the taxa inherent in endodontic infections.
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Effectiveness of a New Technique for Oral Cancer Screening – A Pilot Study p. 62
Audrey Madonna D’Cruz, Pushparaja Shetty, Urvashi Ashwin Shetty, Vinayak Kamath Bola, Vishnudas Dinesh Prabhu
DOI:10.4103/jofs.jofs_43_22  
Introduction: Screening programs with the use of specific diagnostic tools in asymptomatic patients are useful in identifying suspicious oral lesions and aid in the early diagnosis of oral cancer. The objective of the present study was to compare the oral rub and rinse technique with the conventional exfoliative cytology in the screening of oral malignant and potentially malignant diseases. Materials and Methods: An oral cancer screening program was conducted in the Dakshina Kannada district of Karnataka, India. The oral rub and rinse technique was performed on patients who had red/white lesions in the oral mucosa followed by the conventional exfoliative cytology. Scalpel biopsy was performed to confirm for presence or absence of malignancy in cases wherever indicated. Descriptive statistics (frequency and percentage) were used in the present study. Results: A total of 848 subjects were screened for oral cancer and precancer. About 112 participants had premalignant/malignant lesions and biopsy was performed on 30 subjects. Of these, 27.7% were Class I smears, 39.3% were Class II smears, 22.3% were Class III smears, 4.5% were Class IV smears, and 6.2% were unsatisfactory using the conventional technique, whereas the oral rub and rinse technique showed 26.8% Class I smears, 42.9% Class II smears, 19.6% Class III smears, 6.2% Class IV smears, 0.9% Class V smears, and 3.6% unsatisfactory. Conclusion: Although both the techniques could detect malignancy, the oral rub and rinse technique showed better cellular clarity and sample adequacy when compared to conventional exfoliative cytology, which makes it a practical tool in resource-challenged settings.
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Evaluation of Effect of Simethicone Oral Disintegrating Drug on Salivary Constituent Transformation: A Clinical Prospective Study p. 66
Ahila Singaravel Chidembaranathan, Deepa Balu, Vidhya Madana Gopal, Muthukumar Balasubramanium
DOI:10.4103/jofs.jofs_93_22  
Introduction The most common problems encountered by human beings are bloating and discomfort due to accumulation of gas in the stomach. The study aimed to evaluate and compare the effect of simethicone sublingual drug on salivary amylase and flow rate before and after ingestion. Materials and Methods: A total of 12 healthy subjects between 20 and 30 years of age with frequent bloating problems and discomfort in the stomach for more than a year were recruited and the subjects with xerostomia, hormonal imbalance, pediatric patients, psychological disturbances, and taking medicines for any other systemic illness like diabetes, blood pressure, spinal cord injury, and autoimmune disorders were excluded from this study. The subjects were ingested one after the breakfast. The salivary samples were collected before the drug was administered and after 1 and 2 hours of postingestion. The salivary amylase level was calculated using biochemical test kit and the salivary flow rate was calculated by physiologic drooling method. Comparison of salivary amylase was done using repeated chi-square test. Results: The cross tabulation showed statistically significant change in salivary amylase level and salivary flow rate before and after ingestion of simethicone after ingestion. Conclusion: There is a significant increase in level of salivary amylase and salivary flow rate after ingestion of simethicone, hence it can be used in completely edentulous xerostomia patients to control bloating and stomach discomfort.
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Microinvasive Oral Squamous Cell Carcinoma Redefined by Using Modified Cajal Trichrome Differential Stain − A Histochemical Study p. 71
Vaishnavi Srinivasan, Gundamaraju Kiran Kumar, Naragani Durga Venkata Naga Shyam, Vaishali Narayen, Paremala Konda, Korra Swetha Rani
DOI:10.4103/jofs.jofs_234_21  
Introduction: In histopathologic laboratories, hematoxylin and eosin (H and E) staining is the routine and gold standard technique employed for biopsy tissues. But, few differential stains are being used in questionable diagnostic cases of oral squamous cell carcinoma (OSCC) to confirm its final diagnosis. Modified Cajal trichrome stain (CTS) is one such stain which may be employed as an adjunctive supporting aid for arriving at a conclusive diagnosis. To assess epithelial and connective tissue components in normal oral mucosa, oral epithelial dysplasia (OED), and OSCC cases stained with routine H and E and modified CTS. And also to compare and evaluate the efficacy of Modified CTS with that of H and E stain. Materials and Methods: A total of 40 tissue samples, 10 each of normal oral mucosa and OED, 20 cases of OSCC (10 cases each of microinvasive and frank OSCC) were stained with standard H and E and modified CTS simultaneously. Results: Modified CTS showed statistically significant and better results in differentiated terms of parameters such as depth of tumor invasion and differentiation between epithelial and connective tissue components in OSCC cases. Epithelial basement membrane interface and microinvasion are clearly appreciated in challenging cases of early epithelial malignancies such as microinvasive OSCC using this stain. Conclusion: As this stain can easily delineate epithelial structures from various connective tissue components, it may be utilized as an auxiliary diagnostic support along with routine H and E stain for confirmatory diagnosis.
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