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   Table of Contents - Current issue
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January-March 2019
Volume 31 | Issue 1
Page Nos. 1-91

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EDITORIAL  

A year of change and rejuvenate p. 1
Ajay Parihar
DOI:10.4103/jiaomr.jiaomr_74_19  
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GUEST EDITORIAL Top

Change has become a necessity: Curricular reforms and change management is what we need p. 2
Vasanti Lagali-Jirge
DOI:10.4103/jiaomr.jiaomr_199_18  
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ORIGINAL ARTICLES Top

Knowledge, attitudes, and practices regarding sterilization protocol among undergraduate dental students in Faridabad City: A questionnaire-based study p. 4
Akshat Sachdeva, Aditi Sharma, Sumit Bhateja, Geetika Arora
DOI:10.4103/jiaomr.jiaomr_186_18  
Aim: To assess the level of knowledge, attitudes, and practices regarding sterilization/infection control measures among undergraduate dental students. Materials and Methods: A total of 300 dental students from Manav Rachna Dental College, Faridabad, Haryana participated in this study. A questionnaire survey comprising 24 questions regarding knowledge, attitudes, and practices was completed by the participants. Results: It was observed that a majority of the students were highly concerned regarding the sterilization and infection control protocol. 96.9% students dispose of their gloves after use. About 89% are aware of the exact specifications of sterilization via autoclave. Use of mouth masks and head caps as effective infection control measures was practiced among 82.4% students. A large fraction of students comprising about 85% believed that proper sterilization could not be achieved by simple boiling of instruments. Conclusion: The level of knowledge and attitude of sterilization measures were acceptable, although compliance and practice of the same needs to be more worked upon.
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A comparative study of efficacy of intralesional corticosteroids and hyaluronidase therapy with and without ultrasound therapy in patients with oral submucous fibrosis p. 11
Harika Guduru, Komali Garlapati, Raji Viola Solomon, Ancy V Ignatius, Mounika Yeladandi, Nithika Madireddy
DOI:10.4103/jiaomr.jiaomr_158_18  
Background: Oral submucous fibrosis (OSMF) is a potentially malignant disorder affecting any part of the oral cavity, sometimes pharynx associated with trismus and burning sensation. Physical therapies such as ultrasound therapy was found to have therapeutic benefits of decreasing inflammation and accelerating healing process in OSMF patients. Hence, this study was designed to evaluate the therapeutic benefit of ultrasound treatment when compared to empirical combination of intralesional dexamethasone and hyaluronidase treatment alone in OSMF patients. Objectives: To evaluate and compare the clinical efficacy of intralesional infiltration of 2 ml dexamethasone (4 mg/ml) + hyaluronidase 1500 IU, ultrasound therapy in combination with intralesional infiltration and only ultrasound therapy, in reducing the signs and symptoms in patients with OSMF. Materials and Methods: The present study was performed in the Department of Oral Medicine and Radiology, with a total sample of 33 participants grouped into Group A (intralesional infiltration of 2 ml dexamethasone 4 mg/ml + hyaluronidase 1500 IU dissolved in 0.5 ml of 2% lignocaine twice a week for 8 weeks), Group B (a combination treatment of intralesional infiltration twice a week for 8 weeks and ultrasound therapy for 15 days), and Group C (only ultrasound therapy for 15 days). The collected data were subjected to statistical analysis using SPSS 16 software. Results: Statistical analysis revealed that there was a significant difference in M.M.O in Group A (1.3 ± 0.48), Group B (2.55 ± 0.75), and Group C (1.65 ± 1.20) and also VAS score of 42% ± 0.10, 41% ± 0.13, and 15% ± 0.05, respectively, after treatment. Conclusion: The results revealed that therapeutic ultrasound can be used as an adjuvant treatment, as it can alleviate the signs and symptoms of patients suffering from OSMF, thus improving the quality of life.
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Comparison between conventional radiograph and 3D volumetric radiograph for determining the morphology and morphometry of mental foramen p. 17
Rakashree Chakraborty, Sourav Sen, Arati Panchbhai, Rahul R Bhowate, Aditya Dupare
DOI:10.4103/jiaomr.jiaomr_169_18  
Objective: Mental foramen is a vital anatomical structure in human mandible as they are important for dental surgeons for extraction, implant placement, osteotomy procedures, anesthetists in nerve block, and surgical procedures to avoid injury to neurovascular bundle in mental foramen area. The aim of this study was to compare the position, shape, size, and distinctness of mental foramen using orthopantomogram (OPG) and digitalized volumetric tomography (DVT). Materials and Method: This study was conducted on 25 individuals for both the genders. Position, shape, size, and distinctness of mental foramen were compared using OPG and DVT and were evaluated by Expert three-dimensional (3D) software in DVT and Annotation software in OPG. Results: Mental foramen was found to be on the vicinity of the second premolar region with respect to apices of premolars and molars and was more common in the middle third region of the jaw bone with respect to superoinferior cortex of the mandible in vertical plane. There was no significant difference in the position of the mental foramen using OPG and DVT. The commonest shape of mental foramen was found to be oval and was better defined in DVT. The size of the mental foramen was observed to be 0.49 ± 0.05 and 0.51 ± 0.06 cm in OPG and DVT, respectively, and more distinctly visible in DVT. There was no significant difference in the position, shape, size, and distinctness of the mental foramen among genders. Conclusion: Conventional radiography can be initially done for the position of the mental foramen but the details must be confirmed using 3D volumetric radiography to avoid any kind of procedural complications.
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Role of immunological alterations in oral submucous fibrosis p. 24
Sarada Malempati, Vamshi Krishna Guttikonda, Thejasri Vishnubhatla, Mahesh Neerupakam, Sridevi Koduri, Krishnaveni Buduru
DOI:10.4103/jiaomr.jiaomr_181_18  
Background: Oral Submucous fibrosis (OSMF) is a premalignant condition affecting the oral mucosa. It is observed to have a multifactorial etiology including genetic predisposition and autoimmune origin. This study aimed to study the etiological role of immunological factors in OSMF. Settings and Design: It was a prospective study carried out in the Department of Oral Medicine and Radiology at Lenora Institute of Dental Sciences, Rajahmundry. Aims and Objective: To estimate and compare the serum IgG and IgA between the OSMF subjects and controls. To assess the statistical significance of the difference in the levels of albumin, globulin, total protein, IgG and IgA between study group and control group if any. Materials and Methods: It was an observational study in which the serum albumin, serum globulin, total protein, IgG and IgA were evaluated in a total of 60 patients who gave consent to participate in the study. Results and Discussion: Increase of IgG was observed in 9 (30%) subjects of the OSMF group and in 4 (13.2%) of the control group. IgA level was increased in 2 (6.6%) subjects of OSMF group and in 5 (16.6%) subjects of the control group. However, this difference was not statistically significant. Conclusion: The findings from the study indicated an alteration in the immunoglobulin level in patients with OSMF. However, the association was not significant. Therefore, further and larger studies are advocated to verify the immunological association with OSMF. One important observation made in the study was a positive association between the duration of exposure and stage of OSMF. This implies that interventions which modify the arecanut chewing habits can bring about a reduction in OSMF and in turn oral cancer.
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Comparison of conventional pharmacological therapy and holistic approaches (Naturopathy and Yoga) in the management of chronic orofacial pain: A randomized controlled study p. 29
Khushboo Bhalla, Nagaraju Kamarthi, Sangeeta Singh Malik, Sumit Goel, Swati Gupta
DOI:10.4103/jiaomr.jiaomr_3_19  
Background: Orofacial pain disorders and their management forms an important and integral part of our oral medicine specialty. Only oral physicians are well-trained to provide non-surgical treatment of these complex disorders. Today, the escalating costs of drugs and several adverse effects associated with modern medicines have led to the search of alternative systems all over the world. Hence, this study is an effort to assess the efficacy of holistic approaches (naturopathy and yoga) alone as well as in combination with pharmacological therapy in the treatment of chronic orofacial pain of non-odontogenic origin. Materials and Methods: The present study was conducted on 60 patients who were randomized into three groups A, B and C, each group consisting of 20 patients (10 of myofascial pain and 10 of trigeminal neuralgia). In group A it was prescribed conventional medicines for their respective treatment. Holistic approaches (naturopathy and yoga) were added with conventional pharmacological therapy in group B and only holistic approaches were performed in group C. The duration of treatment was of 3 months a and the patients were analysed using pain scale, quality of life scale (QOL) and stress scale after every ten days follow-up. Results: The patients of trigeminal neuralgia showed best result when treated with pharmacological treatment. The holistic approaches showed significant results only when combined with pharmacological therapy for the treatment of trigeminal neuralgia. On the other hand, holistic approaches works best in myofascial pain both alone and in combination with pharmacological therapy. Acupuncture and facial massage along with yoga have a great impact on quality of life by reducing stress and anxiety of the patient. Conclusion: Holistic approaches are useful means in treating patients with chronic orofacial pain as it eliminates the risk of adverse effects associated with long term use of muscle relaxants and anti-convulsants.
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Comparative evaluation of citric acid and TENS as means for salivary stimulation in adults: An Invivo study p. 36
Mimansha Pandey, Vanaja Reddy, Panjab V Wanjari
DOI:10.4103/jiaomr.jiaomr_210_18  
Introduction: Xerostomia and salivary gland hypofunction are associated with advancing age, autoimmune diseases such as Sjφgren's syndrome, head and neck radiation, smoking and recreational drug usage. Palliative management of xerostomia included topical agents such as ice chips, saliva substitutes, increasing water intake, paraffin and systemic agents like pilocarpine had been used. The above mentioned agents had side-effects and have led to find newer modalities like electrical and chemical stimulation. Aim: The present study was undertaken to evaluate the effectiveness of citric acid and transcutaneous electric nerve stimulation (TENS) as a means of stimulating salivary function in healthy adult subjects. Materials and Methods: Hundred adult subjects, 50 males and 50 females between the age group of 18-45 years, with no history of salivary gland disorder were randomly enrolled in the study. During the first visit unstimulated whole saliva was collected in a graduated tube and aafter 1 hr stimulated saliva was collected using citric acid and obtained saliva was measured and recorded. At the second visit, unstimulated whole saliva was collected in a graduated tube and after 1 hr stimulated saliva was collected with TENS and obtained saliva was measured and recorded. Results: The obtained data of unstimulated and stimulated saliva of the subjects was tabulated and subjected to statistical analysis using paired and unpaired t-test. The results showed increased salivary flow rate with both the modalities. And comparative evaluation revealed greater salivary flow rate with citric acid when compared to TENS. Conclusion: The present study substantiated the fact that citric acid as well as TENS can be used as an effective and wholesome method in stimulation of whole salivary flow rate in patients with xerostomia and salivary gland hypofunction.
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Prevalence of Stafne's Cyst – A retrospective analysis of 18,040 Orthopantomographs in Western India p. 40
Sugandha Arya, Ashish Pilania, Jitender Kumar
DOI:10.4103/jiaomr.jiaomr_188_18  
Introduction: Stafne's cyst (SC) is a bone depression found on the lingual side of the mandible. It is a sharply demarcated osteolytic lesion of the mandible, caudal to the inferior alveolar nerve and restricted to the regions of the molars and mandibular angle. Purpose: Stafne's bone cyst is usually asymptomatic being diagnosed on the routine radiographs as an incidental finding hence, its actual prevalence is unknown. Moreover, the lesion simulates many odonogenic pathologies thereby, and the entity remains a diagnostic challenge. So, the present study was conducted to investigate the prevalence of SC in Jodhpur population of Western India. Materials and Methods: A retrospective analysis of 18040 OPGs was done on the basis of diagnostic criteria described by Stafne. Results: A total of 6 cases fulfilled diagnostic criteria of SC (0.03%), 4 cases were reported in men (66.6%), at a mean age of 50.75 years, and 2 cases in women (33.3%), at a mean age of 31.5 years. Involvement of SC on left and right side of the mandible was given as 4:2 in ratio. All 6 cases of SC was found in the body of mandible (100%). Rare case of double unilateral form of SC was reported in 1 patient. Conclusion: Orthopantomographs (OPGs) may ensure initial opinion regarding the diagnosis of SC and alert the clinicians to exclude other potential pathologies to avoid invasive procedures.
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Efficacy of aloe vera and triamcinolone acetonide 0.1% in recurrent aphthous stomatitis: A preliminary comparative study p. 45
Versha R Giroh, Manjula Hebbale, Amit Mhapuskar, Darshan Hiremutt, Priya Agarwal
DOI:10.4103/jiaomr.jiaomr_203_18  
Introduction: Aloe vera has various pharmacological actions due to which it has been selected as an alternative treatment modality in treating various oral diseases. It has antibacterial, antifungal, antiinflammatory, antioxidant, antitumor, and immune boosting. It has been used for the management of oral lesions such as oral lichen planus, oral submucous fibrosis, radiation-induced mucositis, burning mouth syndrome, xerostomia, recurrent aphthous ulcers. Aim: The aim of this study is to the compare the effects of the topical aloe vera gel and triamcinolone acetonide 0.1% in patients with minor ulcers of aphthous stomatitis. Materials and Methods: Thirty-four patients presenting with clinical signs and symptoms of aphthous stomatitis were included for the randomized single blinded study after informed consent. Group A patients received topical aloe vera gel (Forever Bright Aloe vera Gel), and Group B patients received topical triamcinolone acetonide 0.1% (kenacort oral paste) three times a day for 7 days or till the ulcer heals completely. The parameters such as the size of the ulcer, burning sensation, and pain were recorded at each visit. Results: In this study, kenacort oral paste was found to be effective than aloe vera in wound healing (measured by the diameter of ulcer). In contrast, aloe vera gel had a better response in terms of pain and burning sensation. Conclusion: Aloe vera has a wide spectrum of unique properties and uses. It is a promising agent in treating oral lesion in the field of oral medicine. It can be used as an alternative medicine and in patients who are allergic to steroid medication.
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Morphological evaluation of soft palate in various stages of oral submucous fibrosis and normal individuals: A digital cephalometric study p. 51
Supriya Rathore, Neelkant Patil, Mohit Sareen, Manoj Meena, Pallavi Baghla, Nitesh Tyagi
DOI:10.4103/jiaomr.jiaomr_209_18  
Aim of Study: The aim of the study was to evaluate the morphology of soft palate in different stages of oral submucous fibrosis (OSMF) patients using digital lateral cephalogram. Materials and Methods: Total 100 participants were enrolled for the study. They were divided into two groups, Group 1 consisted of first 50 patients diagnosed with OSMF and Group 2 consisted of first 50 non-OSMF patients. Results: Morphology of soft palate was divided into eight types and was compared. Leaf shape (Type 1) was found to be most common and bifid shape least common. It was observed that as the grade of OSMF increases, the size of soft palate also shortens and becomes bulkier as compared to initial stages or non-OSMF group, and results were highly significant with a P value of > 0.05. Conclusion: The soft palate has variable radiographic appearances on lateral cephalometry. The classification system and statistical findings here may help the research of velopharyngeal closure in cleft palate individuals and etiological study of obstructive sleep apnea syndrome and other conditions.
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FORENSIC ODONTOLOGY: ORIGINAL ARTICLE Top

Tongue replica for personal identification: A digital photographic study p. 57
C Sreepradha, MR Vaishali, Maria Priscilla David
DOI:10.4103/jiaomr.jiaomr_59_19  
The tongue is a vital internal organ well encased within the oral cavity and protected from the environment. The morphology and surface features are characteristics of every individual, and these traits can be used for forensic identification. Aims: To examine and classify variations in morphological characteristics of the tongue as observed on digital photographs and to assess the usefulness of tongue replica for personal identification in forensic science. Settings and Design: A study was conducted in the Department of Oral Medicine and Radiology, M.R. Ambedkar Dental College, Bangalore, for a period of 3 months. Materials and Methods: In total, 100 (50 male and 50 female) study participants with an age range of 21 − 40 years were included in the study. The tongue was subjected to visual examination following which digital photographs of the dorsal surface of the tongue were taken to evaluate different morphological characteristics of the tongue. Statistical Analysis Used: Chi-square test. Results: The predominant shape of the tongue in both males and females was U-shape, V-shaped tongue with a sharp tip was observed in more number of females compared to males. Scalloped borders were more common in females compared to men. Single fissures were more common in females, and multiple fissures were more common in males. Conclusions: Variations in morphology and surface features of the tongue may constitute distinctiveness, which can be adopted by dentists as a chairside technique on a regular basis. This could serve as a database and a guide for personal identification. The lingual photographic image can enhance personal identification along with other techniques in forensic science.
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REVIEW ARTICLE Top

Medicated chewing gums - A novel targeted drug delivery p. 62
Nimesh Jain, Manisha Jadhav, Rajeshwari G Annigeri, Pratik R Pipaliya
DOI:10.4103/jiaomr.jiaomr_111_18  
The potential of medicated chewing gum (MCG) for buccal delivery, fast onset of action makes it an attractive delivery form. It is considered as vehicle or a drug delivery system to administer active principles that can improve health and nutrition. Chewable tablets and chewing gum (CG) permit more rapid therapeutic action compared to per-oral dosage forms. Chewable tablets and CGs have been very well received by the parents for use in children with full dentition. MCG is feasible in local treatment of diseases of oral cavity as well as treatment of systemic conditions. This newer drug delivery system could be a boon in treating oral diseases as it is a non-invasive mode of drug delivery.
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CASE REPORTS Top

Sonographic appearance of cysticercosis of the masseter muscle: A case report p. 66
Hemant Sawhney, Sanjeev Laller, Anju Anu Jose, Mamta Malik
DOI:10.4103/jiaomr.jiaomr_180_18  
Cysticercosis is an infection with the larval (cysticercus) stage of Taenia solium. The larvae form cysts commonly in brain, meninges, and eyes, which together constitute 86% of cases with remainder located in the muscles, heart, lungs, and peritoneum. Cases in the maxillofacial region, including tongue and cheek muscles are rare. We report a rare case of cysticercosis involving right masseter muscle presenting as a facial swelling, diagnosed on the basis of fine-needle aspiration cytology and high-resolution ultrasonography and managed conservatively.
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Odontogenic myxoma involving maxilla: A case report p. 70
Abhijeet Alok, Kamal Hasan, Shivani Singh, Preeti T Bhattacharya
DOI:10.4103/jiaomr.jiaomr_173_18  
Odontogenic myxoma is a rare benign odontogenic tumor of the oral cavity which is locally aggressive and non metastasizing. The mandible is more commonly involved than maxilla. It usually presents as a painless swelling in second to third decade of life. Radiographically, it can be unilocular or multilocular, so the diagnosis is not easy many times. It poses a diagnostic and therapeutic challenge because of its morphology and biologic behavior. We represent a case of 35-year-old female who had an asymptomatic swelling in maxillary right region since 7 months.
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Desmoplastic fibroma of the mandible – A rare benign tumor mimicking malignancy p. 74
Saranya Konikoth, Tinky Bose, IV Anupama, Remya Yogidas
DOI:10.4103/jiaomr.jiaomr_213_18  
Desmoplastic fibroma (DF) is a rare benign intra-osseous tumor with provincially aggressive nature. The tumor constitutes <1% of bone tumors, and mandibular involvement is common with a reported frequency of approximately 40% of the various bony sites. It may progress to bone destruction and displays a tendency to invade the soft-tissues if untreated. Inadequate treatment accounts for the high propensity for local recurrence. We report a case in a 6-year-old female child with a swelling over the left body of the mandible, an expansile lytic lesion with the destruction of lingual and buccal cortex noted on computed tomography (CT) scan. The child underwent left hemimandibulectomy and reconstruction of the sick jawbone. Recognition of this entity is important because it may histologically and radiographically resemble benign fibrous lesions. The non-specific clinical appearance of the DF implies an extensive imaging study before in order to establish a proper therapeutic approach. We hope that our case report will shed new light on this special entity.
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Diagnosis of bilateral parotid enlargement (Sialosis) by sonography: A case report and literature review p. 79
Sugandha Arya, Ashish Pilania, Jitender Kumar, Sanjay Talnia
DOI:10.4103/jiaomr.jiaomr_168_18  
Alcoholism is a common cause of sialosis. We describe a case of sialosiswith diffuse painless bilateral parotid gland enlargement associated with alcoholism. The diagnosis was based on clinical appearance, biochemical investigations and ultrasonography. The parotid swelling resulting from sialadenosisis asymptomatic, which concerns the patient because of cosmetic reasons. The dental practitioner needs to be able to differentiate sialosisfrom other pathological states that demonstrate bilateral parotid swelling to avoid unnecessary treatment.
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Diagnostic approach to recurrent multiple odontogenic Cyst—Gorlin–Goltz syndrome p. 84
Jeena Sebastian, Nikhilraj , GK Shakunthala, CN Roshin
DOI:10.4103/jiaomr.jiaomr_164_18  
The occurrence of multiple odontogenic cysts in jaw bones is not a very common entity. Such occurrence should be ruled out for any association with the Gorlin–Goltz syndromes. It is important to diagnose the lesion and their associations with other features of the syndrome. Oral health care professionals play a very important role in early diagnosis and help in multidisciplinary approach to manage the condition for betterment of the patient. This paper highlights the multiple clinical manifestations of the syndrome with appropriate management strategies and recall protocols.
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A diagnostic dilemma of progressive, unilateral mandibular swelling: A mirage unveiled p. 88
Anwesha Bhattacharjee, S Bhuvaneshwari, Saba Khan, Bipin A Bulgannawar
DOI:10.4103/jiaomr.jiaomr_217_18  
Ossifying fibroma is a rareentity among the other type of fibro-osseous lesions. It is a non-odontogenic, benign tumor of the jaw, which arises from the multipotential cells of the periodontal ligament. Previously in 1992, WHO classified this type of lesion into ossifying fibroma and cemento-ossifying fibroma. Now the term- “cemento-ossifying fibroma” is replaced with “ossifying fibroma” in recent WHO classification (2005). These tumors are slow growing, painless and occur more commonly in the mandible and in the third and fourth decades of life with slight female predilection. Hereby, in this article, an unusual case of central ossifying fibroma in an 80-year-old female patient with expansile swelling of the right side of mandible since 2 months is repotred. The diagnosis was further confirmed by Cone beam computed tomography (CBCT) and histopathological evaluation. The main objective of this article is to enlighten about the diagnostic dilemma of mandibular swellings and atypical clinical behavior of central ossifying fibroma.
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