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   Table of Contents - Current issue
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July-September 2019
Volume 31 | Issue 3
Page Nos. 193-283

Online since Monday, September 30, 2019

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EDITORIAL  

Learning Together for Patient Care p. 193
Ajay P S Parihar
DOI:10.4103/jiaomr.jiaomr_161_19  
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ORIGINAL ARTICLES Top

Facial soft tissue thickness in South Indian adults with varied occlusions – A cone beam computed tomography study p. 194
Manasa A Meundi, Chaya M David
DOI:10.4103/jiaomr.jiaomr_83_19  
Background: Facial soft tissue (FST) thickness is crucial to reconstruct a recognizable face from an unknown skull. Straight, convex, and concave profiles of the human face in class I, class II, and class III occlusal patterns, respectively, suggest the possibility of skeletal class to have a significant influence on FST thickness of an individual. The aim of this study was to collect and compare FST thickness in South Indian adults based on gender and varied occlusions. Materials and Methods: Cone beam computed tomography scans of 90 South Indian subjects (45 of each gender) age 18–35 years were categorized according to their dentoskeletal relationships as class I (ANB = 2–40), class II (ANB >40), and class III (ANB <20) with 30 subjects in each class and FST thickness at 34 landmarks (12 midline and 11 bilateral) were measured. Results: Significant differences were present at nasion, mid-nasal, rhinion, subnasal, labrale superius, and mid-supraorbital and infra canine in men and at mentolabial sulcus and gonion in women demonstrating variation in soft tissue thickness among different occlusions. In addition, gender-based differences were observed among the skeletal classes with men having thicker tissues at a majority of the measured landmarks. Sexual dimorphism was distinct in skeletal classes I and III occlusal patterns. Conclusion: Dentoskeletal morphology-related variations in FST thickness observed in this study highlight the need for anthropological analysis of the skull focusing on occlusal pattern along with age and sex during facial reconstruction to achieve better results.
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Morphometric assessment of soft palate in oral submucous fibrosis using cone beam computed tomography: A cross-sectional study p. 203
Pooja Khare, Ramachandra Reddy, Anish Gupta, Vijayta Sharva, Manoj Gupta, Pooja Singh
DOI:10.4103/jiaomr.jiaomr_121_19  
Context: Oral submucous fibrosis (OSMF), a chronic disorder, presents with limited mouth opening and fibrosis of the lining mucosa of the upper digestive tract involving the oral cavity, oropharynx, and commonly the upper third of the esophagus. Studies assessing morphological changes of soft palate using cone beam computed tomography (CBCT) may construe functional alterations. Aims: The objective of our study was to assess (1) the morphological variations of soft palate, (2) its comparison with different OSMF grades and control groups by CBCT, and (3) velopharyngeal incompetency. Setting and Design: The study attributed the clinical features of OSMF based on Pindborg's classification. Patients were scanned for morphometric assessment of soft palate. Materials and Method: CBCT images of 45 OSMF patients and 45 control-group patients were analyzed using Statistical Package for the Social Sciences version 20 (SPSS Pvt Ltd. Chicago, IL, USA). Two investigators performed the morphometric analysis, and the average was taken.Statistical Analysis: Independent t-test was applied. Results: A total of 90 patients were imaged. Leaf-type morphology was the most common, and Stage III had the maximum of butt-type morphology. Mean velar width was significantly higher in the OSMF group compared to the control group. Conclusions: The study illustrated three-dimensional soft palate images including the morphology in different OSMF grades, thereby accurately measuring various parameters of soft palate. As OSMF progresses, the morphology of soft palate changes eventually from Type I to other types. Morphological changes can be reversed or arrested from further worsening if assessed in the first phase of OSMF.
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Miseries and remedies of myofascial pain dysfunction syndrome: Comparative study p. 210
Payal Tripathi, Hemant Mathur, Supratim Tripathi, Vasu Siddhartha Saxena, Junaid Ahmed
DOI:10.4103/jiaomr.jiaomr_76_18  
Background: Myofascial pain dysfunction syndrome (MPDS) has been recognized as the most common, nontooth-related chronic orofacial pain condition that confronts dentists. A variety of therapies have been described in literature for its management. Objectives: This study is a prospective study carried out to evaluate the efficacy of occlusal splint therapy and compare it with transcutaneous electrical nerve stimulation (TENS) in the management of MPDS. Materials and Methods: Sixty patients who reported to the Department of Oral Medicine and Radiology, Pacific Dental College, Udaipur, since September 2009, in the age range of 17–55 years were included in the study and were randomly assigned to two equally sized groups, A and B. Group A patients received TENS therapy, whereas Group B patients received soft occlusal splint therapy. All the patients were evaluated for pain using visual analog scale (VAS), maximum comfortable mouth opening, temporomandibular joint (TMJ) clicking, and tenderness during rest and movement, as well as for the number of tender muscles at the time of diagnosis, after the first week of initiation of therapy, and every month for 3 months of follow-up. Results: There was a progressive decrease in VAS, number of tender muscles, TMJ clicking, and tenderness with various jaw movements, and there was a significant improvement in mouth opening in patients on occlusal splint therapy during the follow-up period when compared with TENS therapy group. Conclusion: Occlusal splint therapy has better long-term results in reducing the symptoms of MPDS. It has better patient compliance, has fewer side effects, and is more cost-effective than TENS therapy; hence, it can be chosen for the treatment of patients with MPDS.
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Assessment of correlation between serum cotinine levels and bone mineral density among male tobacco users p. 217
Rohini Praveen Sarnaik, Anjana S Bagewadi, Vashali K Keluskar
DOI:10.4103/jiaomr.jiaomr_131_18  
Osteoporosis is a progressive systemic skeletal disease causing reduced bone density. It is characterized by low density of bone tissue. Consequently, a bone becomes fragile with increased susceptibility to fracture. Tobacco exposure has been implicated as a risk factor for decreased bone density, which might result in osteoporosis. The early identification of individuals with low bone mineral density (BMD) and clinical risk factors, accurate diagnosis of osteoporosis and osteopenia, and initiation of appropriate treatment are crucial to reducing the incidence of fractures. Cotinine, a metabolite of nicotine, is commonly used as a marker for tobacco exposure. Objectives: The objective of the present study was to measure the serum cotinine levels and correlate these findings with BMD among male tobacco users either in smoke or smokeless form. Materials and Methods: A total of 120 subjects were included in the study and divided into 4 groups. Group I comprised 30 subjects with a history of tobacco chewing at least for a period of 1 year. Group II comprised 30 subjects with a history of tobacco smoking at least for a period of 1 year.Group III comprised 30 subjects with a history of both tobacco chewing and smoking at least for a period of 1 year. Group IV comprised 30 subjects with no habits of tobacco consumption either in smoke or smokeless form. Serum cotinine levels were assessed among all the four groups (Group I, Group II, Group III, and Group IV) using commercially available cotinine ELISA kit. The BMD was measured among all four groups by bone densitometry using ultrasound. Statistical analysis was done by one-way ANOVA test for comparison of BMD among study groups.Correlation was assessed between bone density, that is, t-score, and serum cotinine levels (in ng/ml) by Karl Pearson's correlation coefficient in four study groups. Chi-square test was done to know the association of BMD among the four groups. Results: The study result revealed that BMD was less among all the three groups when compared to control group (P = 0.2011), with indication of osteopenia. The mean density of bone was less among chewers (Group II) when compared to smokers (Group I) and subjects who used tobacco in both the form (Group III); also, the osteopenic subjects were more in the group who used tobacco in both form. The serum cotinine levels were significantly high among all the three groups when compared to control group (P = 0.00001). Conclusion: Thus, the present study affirms that use of tobacco affects the bone density among male tobacco users. This effect is more among those who use tobacco in smokeless form.
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Vitamin D in the treatment of oral lichen planus: A pilot clinical study p. 222
Juhi Gupta, Anshul Aggarwal, Md Asadullah, Masood H Khan, Neha Agrawal, Kauser Jahan Khwaja
DOI:10.4103/jiaomr.jiaomr_97_19  
Introduction: Lichen planus is an autoimmune disease with unknown etiology. Vitamin D not only affects the health of the bone but also has an impact on immunity. To understand the possible role of vitamin D in the pathophysiology of oral lichen planus (OLP), a clinical study was conducted on patients suffering from OLP who reported to the dental outpatient department of our dental college in Aligarh. Aims: To evaluate the possible co-relation between the OLP with vitamin D deficiency and the effect of vitamin D supplementation on the treatment of the OLP lesion. Settings and Design: A pilot clinical study was conducted in a dental college in Aligarh. Materials and Methods: Patients with clinical presentation of OLP were included in our study. Patients with drug-induced oral lesion or lesion associated with dental restoration (lichenoid reactions) were excluded from the study. Patients were divided into three different groups depending on factors such as stress, low vitamin D levels, or a combination of the above factors. Patients with severe vitamin D deficiency were supplemented with vitamin D. Statistical Analysis Used: Fisher's exact test. Results: There was a statistically significant improvement in both subjective and objective symptoms in patients who were supplemented with vitamin D with or without psychological counseling apart from topical steroid application for a short period. Conclusion: Marked improvement and long-term remission in the symptoms in vitamin D–deficient patients after restoration of normal vitamin D level suggests its role in pathogenesis of OLP like other autoimmune diseases. Therefore, further study and research work need to be carried out to understand the pathway through which vitamin D is related to the pathogenesis of OLP.
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Evaluation of oral health related quality of life in subjects diagnosed with head and neck malignancies undergoing chemotherapy, radiotherapy, and surgery p. 228
Giridhar S Naidu, Stuti Shukla, Ravleen Nagi, Supreet Jain, Ramanpal Singh Makkad
DOI:10.4103/jiaomr.jiaomr_71_19  
Background: Oral cancer is a significant public health problem in India, which accounts for 90% of all head and neck (H and N) cancers and 3--4% of malignancies. It has mutifactorial etiology, and tobacco usage in smoke and smokeless form is considered to be a major risk factor. The prevalence of smoking habit is related to lifestyle, various methods were employed earlier to interpret and analyze, among them Oral Health Impact Profile-14 questionnaire is one of the most accepted instrument to analysis. Aim and Objective: To evaluate oral health-related quality of life (OHRQoL) in subjects undergoing chemotherapy, surgery, and radiotherapy.The objective of the study was to evaluate OHRQoL in H and N cancer patients using Oral Health Impact Profile-14 questionnaire. Materials and Methodology: A descriptive questionnaire based cross-sectional study of 4 months involving 50 patients undergoing treatment of H and Natcancer Hospital, Raipur city, were included.OHRQoL was assessed by OHIP-14 questionnaireand Chi-square test was used to determine statistical significant difference for the responses given by H and N cancer subjects. Results: 62.5%patients were unable to perform daily functions because of problem with their teeth and denture. Males with mean age of 55 years were found to have poorer quality of life than females. Conclusion: The OHIP-14 questionnaire proved to be reliable and valid tool for assessment of OHRQoLof cancer patients. It should be considered in the treatment protocol of cancer patients to prevent the treatment related oral health complications and for their optimal well-being.
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Comparative evaluation of unstimulated whole salivary flow rate and oral symptoms in healthy premenopausal and postmenopausal women - An observational study p. 234
Navneet Gill, Pritesh Ruparelia, Oshin Verma, Kosha Ruparelia
DOI:10.4103/jiaomr.jiaomr_104_19  
Introduction: Menopausal women undergo many physiological changes, most of which are due to decreased estrogen production. Little is understood about the relationship between menopause and oral health. Aim and Objectives: To evaluate the association of menopausal status on subjective reports of oral discomfort and on the objective measurement of unstimulated whole salivary flow rate in healthy women. Materials and Methods: A total of 200 women, including 100 postmenopausal and 100 premenopausal women, were divided into two groups based upon their menstrual status. Group I consisted of 100 postmenopausal women in the age group of 44–76 years. Group II consisted of 100 premenopausal women in the age group of 31--45 years. Settings and Design: A standardized visual analog scale questionnaire was administered to obtain subjective sensation of oral discomfort. Unstimulated whole saliva was collected for 5 min by spitting method and the flow rate of saliva was measured per minute. Statistical analysis used: Chi-square, Student's t test, and analysis of variance (ANOVA) were applied. Results: The prevalence and intensity of the subjective symptoms of oral discomfort was significantly higher in postmenopausal women as compared to the premenopausal women (P < 0.001). The unstimulated whole salivary flow rates in pre- and postmenopausal women were 0.4 ± 0.13 and 0.2 ± 0.11 ml/min, respectively (P < 0.001). A significant association between symptoms of oral discomfort [burning sensation (P = 0.001), taste disorders (P < 0.001), dry mouth (P < 0.001)], and unstimulated salivary flow rate was seen in postmenopausal women. Conclusion: The results from this cross-sectional study of healthy females not being treated for any systemic disease, and not taking medications for any medical disorders indicated that the objective measurements of unstimulated whole salivary flow rate are influenced by menopause. In addition, subjective symptoms of oral discomfort are also associated with menopause.
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FORENSIC ODONTOLOGY: ORIGINAL ARTICLES Top

Knowledge, awareness and practice of forensic odontology among the dentists of Punjab p. 239
Damanpreet Kaur Isher, Parminder Pal Singh Isher, Navneet Kaur, Jaismeen Rakhra
DOI:10.4103/jiaomr.jiaomr_108_19  
Introduction: Forensic odontology involves application of dental sciences in the identification of deceased individuals through comparison of ante-mortem and post-mortem records. Forensic odontology plays an important role in criminal, monetary disputes, marital, social, and burial and the identification of individuals missing for prolonged periods. Aim: To study knowledge, awareness, attitude, and practice of forensic odontology among the dentists of Punjab. Materials and Methods: A questionnaire based cross-sectional survey that included a total of 15 questions was conducted on 644 subjects of Punjab state which were further divided on the basis of their degree as undergraduate and postgraduate students, BDS and MDS dental practitioners. These were further categorized into urban and rural dentists. Results: In our study, the general awareness about forensic odontology is more among the undergraduates than postgraduates of Punjab. Overall, there is lack of adequate knowledge, awareness, and practice of forensic odontology among the dentists of Punjab. However, the practitioners did have a positive attitude toward the field and were keen to learn more about it. Conclusion: Conducted on 644 dentists of Punjab, this study reflects the current situation of Punjab in the field of forensic odontology. It also reveals significant lack of record maintenance, inadequate knowledge, poor attitude, and lack of practice prevailing among these study subjects of Punjab. This condition can be improved if necessary steps are taken to make forensic odontology a part of our course and need more exposure from practical point of view.
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Gender determination using mandibular canine index in general population p. 246
Rakhee R Modak, Amit A Mhapuskar, Darshan Hiremutt, Santosh Jadhav, Manjula Hebbale, Harshal Varpe
DOI:10.4103/jiaomr.jiaomr_75_19  
Context: Gender determination of skeletal remains is part of archeological and medicolegal examination. In forensic investigations mandibular canines provide excellent material to identify gender as they are more likely to survive in disaster. Dimorphism in mandibular canines is of immense use in forensic investigation. Aim: The aim of study was to establish mandibular canine index (MCI) for gender determination in general population for age group of 18--30 years and to find out efficiency of MCI in establishing gender identity of individual. Setting and Study Design: Patients reporting to Department Of Oral Medicine and Radiology are selected for study after applying inclusion and exclusion criteria. Materials and Methods: The study was conducted on 200 subjects in general population; (100 males and 100 females). Following parameters were considered in study; mesiodistal width of right and left mandibular canine, intercanine arch width and right and left MCI. All measurements were taken intraorally and then on dental casts of same individuals followed by MCI calculation. Statistical Analysis Used: In the entire study the P –value less than 0.05 was considered to be statistically significant. The entire data were statistically analyzed by using (SPSS ver 16, IBM corporation, USA). Results: Using the MCI value, gender can be correctly predicted up to 81% in females and 85% in males. Overall, percentage accuracy of MCI in prediction of gender was 83%. The standard MCI value was 0.2661. Also, right canine was found to exhibit more dimorphism than left canine. Conclusion: It was evident from this study that MCI is a good tool for determining gender. It is quick, reliable, and inexpensive method. Along with other parameters it increases percentage accuracy of predicting gender.
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REVIEW ARTICLES Top

T-scan system in the management of temporomandibular joint disorders – A review p. 252
Garlapati Komali, Ancy V Ignatius, G Swetha Srivani, Kammari Anuja
DOI:10.4103/jiaomr.jiaomr_46_19  
Temporomandibular disorder (TMD) is a very common problem affecting up to 33% of individuals worldwide. TMD is a musculoskeletal disorder within the masticatory system presenting with typical signs and symptoms of pain, limited mouth opening, joint sounds, mandibular deviation, and chewing disability. Pain is the most important symptom of TMD which drives the patient to seek medical help. The etiology of TMD is complex and multifactorial. The role of dental occlusion as an etiological factor for TMD has been hypothesized by several authors. A balanced dental occlusion plays an important role for the healthy functioning of the masticatory system. Premature occlusal contacts and occlusal-articulating interferences cause occlusal trauma which can induce changes in the tooth-supporting tissues (the mucosa, periodontal tissues, and bone), in the muscles of mastication and the temporomandibular joint. In dental practice, articulating paper has been established as the most widely used diagnostic aid to mark the contact points between the maxillary and mandibular teeth. The articulating paper can readily highlight the occlusal contacts; however, it can neither accurately quantify the intensity nor measure the magnitude of the generated occlusal forces. T-scan computerized occlusal analysis technology eliminates the process of subjective interpretation of occlusal contacts obtained using articulating paper marks and precisely pinpoints the excessively forceful contact locations and displays them for analysis in a colourful three-dimensional view thus helping the diagnostician to understand the overall occlusal force distribution. This article deals with T-scan system and its role in temporomandibular disorders.
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Clinical and radiological signs of importance for the oral physician and oral surgeon p. 257
Abhay S Kulkarni, Rajendra S Birangane, Pratik C Parkarwar, Abdullah Zakaria Kazi
DOI:10.4103/jiaomr.jiaomr_68_18  
Diagnosis of any disease depends on careful observation and documentation of signs. The careful observation of signs is important for diagnosis of diseases. Almost all major diseases and syndromes have some or other forms of oral manifestations, and many a times these are the first signs and symptoms of the disease or condition. The oral physician is at an advantageous position to detect these changes and diagnose the condition at the earliest, thus improving the overall standard of patient care. Most of the signs give the impression since beginning and some have to be provoked by the examiners. The objective of this review is to highlight the signs manifesting in orofacial area clinically and radiologically and increasing the awareness and knowledge of these entities for use in clinical practice.
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CASE REPORTS Top

Benign fibromatosis of submandibular gland - Radiological and immunohistochemical characteristic features p. 263
Giridhar S Naidu, Juhi Bhandari, Ravleen Nagi, Ramanpal Singh Makkad
DOI:10.4103/jiaomr.jiaomr_98_19  
Fibromatosis are benign well-differentiated fibroblastic proliferations that can occur anywhere in the body, but their occurrence in maxillofacial region is rare entity. Clinically, these tumors are intermediate grade neoplasms, present as firm nodular mass, are locally invasive, have high propensity of recurrence particularly in the head and neck area but do not metastasize. We report a rare case of 45-year-old female patient, who presented with the swelling in the left submandibular region which was confirmed as benign fibrous tumor, fibromatosis, histopathologically, and by immunohistochemical analysis.
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Tuberculous granuloma of the gingiva – A forgotten entity p. 270
MS Archana, Anu Babu, B Vikas Prasad, Meenal Verma
DOI:10.4103/jiaomr.jiaomr_90_19  
Tuberculosis (TB) claims to be one of the most deadly communicable diseases. Mycobacterium tuberculosis is identified as the causative micro-organism. Extrapulmonary TB is quite rare, of which oral TB lesions account to less than 1% and exists as primary and secondary lesions. In recent times, the number of cases reported with extrapulmonary TB is on the rising trend due to an increase in the number of immunocompromised patients. To highlight the extrapulmonary oral TB lesion, we hereby present a case report on oral TB.
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Rhinosporidiosis of maxillary sinus: A case report p. 274
Abdullah Zakaria Kazi, Hassaan Zakaria Kazi, Rashmi Chandrakant Channe, Abhay S Kulkarni
DOI:10.4103/jiaomr.jiaomr_114_18  
Rhinosporidiosis is a chronic granulomatous inflammatory disease inducing polyps of the affected mucous membrane and is caused by Rhinosporidium seeberi. Seldom mimicking other more malignant and vigorous pathologies of the involved part. As rhinosporidiosis primarily affects orofacial and sino-nasal region, it is of great value to the oral physician, oral radiologist and oral surgeon and a necessary differential diagnosis to be kept in mind for sino-nasal masses. As the causative organism is an aquatic protistan parasite and cannot be cultured in vitro, the diagnosis depends on clinical and histopathological findings. Treatment is complete surgical excision but recurrence is quite common at 10% to 30%. Use of cryosurgery and electrocautery reduce the recurrence. Also, systemic dapsone therapy is used as an adjunct to surgical intervention and helps in preventing recurrences. In this case report, the clinical, radiological and pathological features of a case presenting in a 55-year old male has been described. The involvement, erosion and destruction of the various walls of maxillary sinus and maxillary osteomyelitis as in this case is very rare and only a few cases have been recorded in the literature. The surgical and pharmacologic management along with 18 months follow up has been discussed and a short review of literature has been made.
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Unilateral myositis ossificans traumatica of medial pterygoid muscle: Case report and review p. 280
Pinakapani Ramakrishna, Biswajit Mishra, Sanjay Jadwani, Seema Dengra
DOI:10.4103/jiaomr.jiaomr_105_19  
Myositis ossificans is a rare disease that is characterized by nonneoplastic, heterotopic bone formation within a muscle. It rarely involves the masticatory muscles. Since 2001 to 2015 only 20 cases involving the masticatory muscles have been reported. This case report is one such rare case of myositis ossificans traumatica involving left medial pterygoid muscle in a 37 year-old female patient. Surgical excision of the entire muscle was done and adequate mouth opening was achieved. One-year post surgery no signs of recurrence was observed and there was presence of adequate mouth opening. The article also reviews the literature of myositis ossificans of the masticatory muscles.
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