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   Table of Contents - Current issue
Coverpage
July-September 2020
Volume 32 | Issue 3
Page Nos. 203-319

Online since Tuesday, September 29, 2020

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EDITORIAL  

Psychological impact of COVID-19 pandemic on dental professionals Highly accessed article p. 203
Aravinda Konidena
DOI:10.4103/jiaomr.jiaomr_169_20  
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GUEST EDITORIAL Top

Review of salivary diagnostics – A current scenario p. 205
Sadaksharam Jayachandran
DOI:10.4103/jiaomr.jiaomr_159_20  
Human saliva is produced by the three major salivary glands (the parotid gland, submandibular gland, and sublingual glands) and minor salivary glands. It contains several hormones, antibodies, cytokines, proteins, enzymes, and antimicrobial constituents that act as biomarkers. It also contains variable amounts of gingival crevicular fluid (GCF), mucosal transudate, desquamated epithelial cells, bacteria, viruses, fungi, food debris, microorganisms, serum, and some blood derivatives. Saliva has simple collection methods (non-invasive), handling procedure, reliable sensitivity and specificity, good cooperation from patients, and the possibility to perform dynamic studies. Salivary analysis can determine various systemic diseases, metabolic disorders, and infections. Hence, it serves as a potential diagnostic and prognostic tool with widespread clinical and research applications in various fields of science and medicine.
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ORIGINAL ARTICLES Top

Assessment of service quality in special care dentistry department using SERVQUAL model p. 209
Prasanthi Sitaraman, Karpagavalli Shanmugasundaram, Arvind Muthukrishnan
DOI:10.4103/jiaomr.jiaomr_69_20  
Background: Special care dentistry, also known as special needs dentistry includes treating patients who are physically disabled (congenital, traumatic, and/or physiological), medically compromised (systemic, genetic, and/or acquired), and cognitive deficit (mental, sensory, emotional, and/or behavioral) who experience barriers to preventive and routine dental care. Aim: The purpose of this study was to assess the quality of treatment received by the patients in the special care dentistry department using SERVQUAL model. Setting and Design: This descriptive, cross-sectional study was conducted at the special care dentistry department, Unit of Oral Medicine and Radiology department. Materials and Methods: The study population consisted of 384 patients treated in the Special care dentistry department from December 2017 – December 2019. Each participant's demographic data and reason for referral was recorded. Participant or the participant's caregiver was asked to fill the expectation questionnaire of the SERVQUAL model and required dental treatment was provided. Post treatment, the participant was asked to fill up the perception questionnaire. Each question was assessed using a 5-point Likert scale. Multiple statistical analyses was done to calculate the discrepancy between perception and expectation scores which is denoted by the statistical term “Gap value.” Results: Most patients belonged to the age range of 51–60 years. The commonest reason for referral was being medically compromised. All five domains of the SERVQUAL model showed high expectation, perception scores, and positive gap values. Conclusion: The SERVQUAL model has been validated as an effective service assessment tool. In our study, this SERVQUAL model which was employed in the special care dentistry, Unit of Oral Medicine Department for patients with special needs showed positive expectation and perception scores in all five domains which denotes effective patient care.
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Combination of trypsin, rutoside, bromelain and diclofenac sodium in the management of internal derangement of temporomandibular joint: A randomized clinical trial Highly accessed article p. 216
Prashant Gupta, Shantala R Naik, L Ashok, R Poornima, Ranjani Shetty
DOI:10.4103/jiaomr.jiaomr_45_20  
Background: Internal derangement of temporomandibular joint (TMJ) is a chronic disease which causes a considerable amount of pain and reduced chewing ability and thus compromising patients eating ability and lifestyle. Aims: This study was carried out to evaluate the clinical effectiveness of enzymes like trypsin, rutoside, bromelain, and diclofenac combination against the use of diclofenac alone in the treatment of internal derangement (ID) of TMJ. Settings and Design: This study was done in the OPD of Oral Medicine and Radiology department at dental institute and is a randomized case-controlled clinical trial. Methods and Materials: 30 subjects were enrolled in the study by simple random sampling and were diagnosed clinically as ID and radiographically screened. They were divided into 2 groups of 15 each. Group I was given oral diclofenac sodium and group II was given an oral combination of trypsin, rutoside, bromelain, and diclofenac sodium for a span of 14 days. Statistical Analysis: It was done by comparing the mean, median, and standard deviation of each variable. Comparative analysis was done using the Mann–Whitney U test, Friedman's test, Chi-square test, Student's t-test, and ANOVA to find the P- value and confidence interval. Results: Both the groups had reduced pain, improved chewing ability and mouth opening, and reduction in joint noise and jerky mandibular movements. Group I, patients had better results when compared to group I and the differences were highly significant. Conclusion: We recommend the use of a combination of enzymes and diclofenac for the management of ID of TMJ.
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Evaluation of condyle- fossa position and articular eminence angulation in dentate and edentate patients – A cephalometric pilot study p. 222
Pradhuman Verma, Princy Mahajan, Samar Ali Faraz, Konkati Srikanth, B Ravichandra, Natasha Bathla
DOI:10.4103/jiaomr.jiaomr_71_20  
Background: Temporomandibular joint is a mobile synovial joint where articulated bones are separated by a joint cavity. Its functional harmony is disrupted by a long standing period of edentulousness which could be analyzed using lateral Cephalograph. Aim and Objectives: To evaluate the condyle–fossa position and articular eminence angulation in dentate and edentate patients using a lateral cephalogram along a different axis. Materials and Methods: Cross-sectional study consisted of randomly selected 40 patients with 20 dentulous patients (Group I), and age- matched 20 completely edentulous patients (Group II), within an age group 45–65 years. Lateral cephalograms were performed for all selected patients using single Kodak 8000C digital OPG/Ceph machine, (Rochester, New York, United States). All the radiographs were digitally traced and evaluated twice for condyle- fossa position along X and Y axis and articular eminence angulation by an Oral & maxillofacial radiologist at an interval of two days. The collected data was tabulated and analyzed using SPSS Software version 20 using unpaired t-test and tests of normality. Results: Significant difference in condyle - fossa distances along the X and Y axis in two study groups was suggestive of more upwards and forwardly placed condyles and more anteriorly placed glenoid fossae in Group II patients. Also, articular eminence angulation was noted more in edentulous patients but the difference was statistically insignificant. Conclusion: A great variation in condylar–fossa position was observed in the edentulous patient when compared to the dentulous patient due to remodeling or degenerative changes that occur during the period of edentulousness.
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Presurgical assessment of alveolar ridge dimensions before dental implant procedures by OPG&CBCT – A comparative study based on fryback & thornbury model p. 229
Purv S Patel, Jigna S Shah, Bhavin B Dudhia, Purva B Butala
DOI:10.4103/jiaomr.jiaomr_82_20  
Background and Aims: Replacing missing teeth is one of the most common challenges faced by the dental surgeon. The invention of dental implants has brought about a great change in successfully delivering a fixed prosthesis to the patient. Precise radiographic assessment of available alveolar bone is of prime importance for dental implant placement. Panoramic radiograph provides an overview of the jaw bones and is considered adequate in the initial evaluation of the implant site; however, they do not provide the buccolingual dimension of the implant site. CBCT provides volumetric imaging with the ability to visualize the imaged region in virtually any plane. The objective of this study was to compare panoramic radiography (OPG) with cone-beam computed tomography (CBCT) for pre-surgical implant site evaluation. Materials and Methods: A total of 150 potential implant sites in 94 patients who were subjected to OPG and CBCT imaging previously were selected for the study. The height, width, and length of the available bone were measured for all the implant sites (except bone width which was measured on CBCT alone). Out of these, OPG & CBCT findings of 60 potential implant sites were evaluated by comparison with the surgical gold standard dimensions of actual dental implant placed. A comparison of all the values obtained with the two imaging modalities was done and the data was tabulated for statistical analysis. Results: The mean value of bone height using OPG and CBCT were found to be 12.15 mm and 11.99 mm, respectively. The mean value of the length of the edentulous jaw segment using OPG and CBCT was found to be 8.10 mm and 8.98 mm respectively. The mean value of the width of the crestal bone below the height of the crest using CBCT was found to be 5.46 mm. Conclusion: The overall results suggested that CBCT is better in depicting the bone height and bone width as compared to OPG; however, the length of the edentulous jaw segment is better depicted by OPG as compared to CBCT.
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Probiotics an adjuvant in the management of recurrent aphthous ulcer: A randomized clinical trial p. 235
Mercy S Yendluru, Rakesh K Manne, N Kannan, Aneesa Shaik Bepari, Adarsh Anumula, Sudeepthi Pulimi
DOI:10.4103/jiaomr.jiaomr_47_20  
Background: Recurrent Aphthous Stomatitis (RAS) is benign ulcerated lesions in the oral cavity. RAS is one of the most common ulcers and known to affect 20% of the population Aim: To assess the efficacy of probiotics as an adjuvant to tetracyclines in the management of RAS. The study was a randomized clinical trial. Materials and Methods: Forty participants were assigned to two groups. Group 1, 20 patients received Bacillus. coagulants (Sporolac) & Tetracycline capsules 250 mg (Resteclin) twice daily for 7 days. Group 2, 20 patients received only Tetracycline capsules 250 mg (Resteclin) twice daily for 7 days. Assessment of pain, size, and average duration of the ulcer was carried out at baseline, 4th and 7th day. Statistical Analysis: Comparison of the parameters between the two groups was performed using the Mann Whitney U test. Results: The Probiotic group achieved a significant reduction in all the parameters in 4 days. Conclusion: Probiotics acts as adjuvant therapy for the treatment and management of RAS.
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Qualitative analysis of serum estrogen, parathyroid and calcium levels in postmenopausal women with oral dryness- A case-control study p. 241
Balwinder Singh, Vela Desai, Rajeev Sharma, Kirandeep Kaur, Ramandeep S Narang, Sukhdeep Kahlon
DOI:10.4103/jiaomr.jiaomr_58_20  
Background: The emergence of oral dryness unrelated to salivary flow volume has always raised many questions over the hypothesis of oral dryness in postmenopausal women. The current research article tries to focus on qualitative changes in saliva in the postmenopausal women suffering from oral dryness. Aim and Objectives: To correlate the severity of oral dryness with qualitative changes in serum estrogen, serum parathyroid (PTH), serum calcium levels in postmenopausal women. Materials and Methodology: This case-control study was carried out on 60 postmenopausal women with 30 forming the case groups as having oral dryness and 30 forming control group without oral dryness. The severity of oral dryness was assessed through the Xerostomia Inventory Score (XI Score). Serum estrogen and serum parathyroid levels were assessed by the ELISA method and serum calcium levels were assessed by Arsenazo III reaction using a semi-autoanalyzer in all participants. Statistical analysis was done by student's t- test and Pearson correlation. Results: Significant differences were observed in the mean values of serum estrogen levels, serum parathyroid levels, and XI score between the case and control groups. (P < 0.001). Serum calcium levels did not show significant variation (P= 0.385) between the groups. The correlation proved that there was an inverse correlation between estrogen levels and XI scores (r-value -0.777). Conclusion: The severity of oral dryness was associated with decreased levels of estrogen and increased levels of parathyroid hormones in postmenopausal women. Fall in estrogen levels is associated with an increase in oral dryness.
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An insight on innovative teaching strategies: A cross-sectional survey among the oral medicine and radiology faculties in Tamil Nadu and Pondicherry, India p. 247
S Ramasamy, Varsha K Pavithran, J Reni Anjalin
DOI:10.4103/jiaomr.jiaomr_94_20  
Background: Education in recent years has evolved in leaps and bounds. Traditional pedagogical methods may still be useful, but education today revolves more around encouraging the students to awaken their curiosity and desire to learn. Many new methods have emerged using technology in the classroom, giving education a new lease of life allowing us to approach ideas in new ways. Aim: This survey was conducted to assess the awareness of new teaching methods among the Oral Medicine and Radiology (OMR) faculties in Tamil Nadu and Pondicherry and their perception towards practice of new teaching methods in dental curriculum. Methods: Purposive sampling was done and self-administered, online questionnaire was sent to the faculties of Oral Medicine and Radiology in Tamil Nadu and Pondicherry to collect data regarding the interest and practice of new teaching methods and their perception of new teaching methods towards enhancement of students skills. Results: A response rate of 94.56% was obtained. About 92% of faculty members found that new methods will be effective in dental education but only 56% of teaching faculty felt that it would replace the conventional methods. The faculties agreed that various skills of the students will improve with new teaching methods. Statistically significant difference (P < 0.05) was found among the various designations of OMR teaching faculties and their perception towards enhancing the students skills. Conclusion: Thus, the faculties were aware and accepted that the new teaching methods were the need of the hour to improve students skills, independent learning and engage them in continuous learning.
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Efficacy of toluidine blue, lugol's iodine and acetic acid for detecting oral lesions of Leukoplakia and erosive lichen planus – A cross-sectional study p. 253
Sivasankari Thirunavukarasu, Philips Mathew, Ravi David Austin, Kumar Chandan Srivastava, S Ramasamy, V Usha
DOI:10.4103/jiaomr.jiaomr_22_20  
Background and Objectives: Early detection and treatment of oral cancer will significantly improve the survival rate and prognosis of the patients. Adjunctive diagnostic aids such as vital staining have been developed to supplement clinical examination and improve the diagnosis. The current study was conducted to evaluate the diagnostic efficacy of acetic acid (2%) (AA), lugol's iodine (3% dilution) (LIS), and toluidine blue (1%) (TBS) in oral leukoplakia (OL) and erosive variant of oral lichen planus (OLP). Materials and Methods: A hospital-based, cross-sectional study was conducted with 30 randomly selected subjects having clinically proven cases of OL and erosive OLP. Every patient underwent AA, LIS, and TBS application to their oral lesions in a sequential manner. Subsequently, clinical and histopathologic diagnosis was compared with staining results of each. Cases which were diagnosed as epithelial hyperplasia were considered as a control group. Data are presented in numbers and percentages. Chi-square test was used to compare between TBS, LIS and AA. Diagnostic efficiency and reliability was calculated by sensitivity and specificity test in terms of its utility in predicting the dysplastic nature of the lesion. Results: Sensitivity of both TBS and LIS staining was calculated as 90.48% whereas the specificity of the former test was 22.22% and latter was 11.11%. AA test showed a sensitivity of 57.14% and specificity of 33.33%. Multiple comparisons of staining with three agents and the histopathologic variants did not show any statistically significant difference. Conclusion: TBS and LIS staining showed high sensitivity in diagnosing OL and erosive OLP compared to AA. The specificity of all three modalities used was low.
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FORENSIC ODONTOLOGY: ORIGINAL RESEARCH ARTICLE Top

Precision of 3D laser optical in assimilation of experimental bite marks in chocolate p. 259
Alekhya Kanaparthi, Manasa Anand Meundi, Chaya M David, Datturao Ramanand Mahesh, Soujanya L Krishnappa, Ramya Katyayani Kastala
DOI:10.4103/jiaomr.jiaomr_84_20  
Aims: To analyze the accuracy of a three-dimensional (3D) optical scanner-GOM® (Gesellschaft für Optische; Messtechnik, Braunschweig Germany) model-ATOS triple II optical Scanner (Advanced topometric Sensor) in examination and identification of experimental bite marks (BM) in chocolate using Styrofoam exemplar (SE). Materials and Methods: The study was conducted with 25 volunteers from whom the dental cast exemplar (CE), SE, and experimental BMs in chocolate, were made. These were then digitized using the GOM® ATOS optical scanner and 3D models were generated using GOM® ATOS software. Data analysis was performed using independent t-test for inferential statistics. Results: On 3D analysis, the experimental BM matched with the presumed biters correctly using both SE and CE. The mean percentage matching of BM vs SE was found to be 92.55 ± 1.757, and in BM vs CE, the mean matching percentage was found to be 96.09 ± 1.311. Statistical analysis of the data was obtained using independent t-test, and the mean difference in percentage matching was significant (P < 0.05) Conclusion: Three-dimensional BM analysis using 3D optical scanner proved to be a reliable, accurate, and permanent method of documentation compared to the conventional two-dimensional methods.
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Mandibular morphometric analysis for sex assessment: A retrospective radiographic study p. 266
Raghdaa A Mostafa, Mona Abou El-Fotouh
DOI:10.4103/jiaomr.jiaomr_60_20  
Objectives: The purpose of this study was to determine the value of mandibular morphometric measurements in sex assessment using digital panoramic radiographs in a sample of dentate Egyptian patients. Methods: A total of 200 digital panoramic radiographs (i.e.,100 males, 100 females) with age ranges between 20 and 60 years were selected. The samples were divided into 4 age groups with 10 years intervals. Maximum ramus width, minimum ramus width, condylar length, coronoid length, ramus length, gonial angle, ramus notch depth, bigonial width, horizontal length, and diagonal length were measured digitally for each subject. A comparison between different sex groups and age ranges was carried out and the mean values were calculated. Results: Mean results for minimum ramus width, condylar length, coronoid length, and ramus length were statistically significant for gender differences (P < 0.05).The mean of all measurements, except for gonial angle, ramus notch depth, and horizontal length, in males, was higher than that of females. Conclusions: Mandibular morphometric measurements assessed using panoramic radiographs can be used for sex assessment when compared to a known population standard.
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Study of Palatal Rugae Pattern among population of Mewar and Hadoti Region p. 271
Sumera Saleem, Karandeep Singh Arora, GV Ramachandra Reddy, Gurpreet Kaur, Shreeyam Mohapatra, Ankita Khokhar Deswal
DOI:10.4103/jiaomr.jiaomr_56_20  
Objectives: Whenever there is a loss of a tooth, palatal rugae (PR) is suggested as an alternative technique for personal identification. The present study was carried to determine area-specific uniqueness of the rugae pattern among the population of Mewar and Hadoti region by evaluating the number and shape of the rugae pattern and its variation among genders of the same population. Materials and Method: Study included 500 subjects (250 males and 250 females) aged between 17 and 25 years as per the inclusion and exclusion criteria. The rugae pattern was classified based on their length, shape, direction, and unification proposed by Lysell (1955) and later modified by Thomas and Kotze (1983). The observations recorded were evaluated for their statistical significance and specificity using unpaired t-test. Results: Total number of rugae on the right side in both genders was 2089 showing a significant difference between males and females and on the left side, the total number was 2088 not showing a statistically significant difference between genders. The wavy pattern was the most predominant pattern, followed by curved and straight patterns. The wavy pattern was found to be significant between males and females. Conclusion: The present study demonstrated the difference in PR distribution and uniqueness in different individuals and the importance of studying the characteristics based on ethnicity. Also, we can say that gender can be determined using a wavy pattern.
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REVIEW ARTICLES Top

Neurotrophins (NTs) and Neurotrophin Receptors (NTRs) as emerging therapeutic paradigm in head and neck tumors - A mini review p. 278
Thuckanickenpalayam Ragunathan Yoithapprabhunath, Krubakar RachelSarahVinodhini, Shanmugam Mohanapriya, Joseph Babu Susai Raj, Vasudevan Kalaiselvi, Ramadas Madhavan Nirmal
DOI:10.4103/jiaomr.jiaomr_125_20  
Cells of the human biological system emerge from various concerted processes of cell growth, differentiation, repair, and regeneration to a degree. Neurotrophins (NTs) and Neurotrophin Receptors (NTRs) have robust effects on proliferation, differentiation, migration, survival, and synapse formation through physiologic regulatory signals. Dysregulation of such neurotrophic factors not only results in various age-related degenerative conditions but also paves the way to oncogenesis in neuronal and non-neuronal tissues. This review aims to highlight the emerging role of neurotrophins (NTs) and Neurotrophin Receptors (NTRs) in Oral Health and Disease and its molecular signaling pathway in physiologic and pathologic conditions. The electronic databases PubMed, MEDLINE, Scopus, and Google Scholar were searched for available data in the present review. A database search yielded more than 100 articles out of which 45 were included based on the core data. The role of NTs and NTRs in dental diseases is less explored and this was the very first attempt to collect the literature data of NTs and NTRs pertaining to head and neck tumors. The results and subsequent conclusions were extracted and reviewed. Expression of NTs and NTRs in neuronal and non-neuronal tissue is a spatial and time-bound event like odontogenesis. Recently NTs and NTRs expressions were detected in a few head and neck tumors. Unraveling the molecular signaling pathway of NTs and NTRs in head and neck tumors will help in elucidating the molecular pathogenesis and the prognosis, therefore, paving a path to expand our knowledge to understand and develop therapies for many pathologic conditions.
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Management of oral Lichen Planus based on the existing clinical practice guidelines p. 284
TN Uma Maheswari, Manjari Chaudhary
DOI:10.4103/jiaomr.jiaomr_55_20  
Lichen planus is a chronic inflammatory mucocutaneous disorder that affects oral and genital mucous membranes, skin, nails, and scalp. Oral lichen planus (OLP) is the mucosal counterpart of cutaneous Lichen planus. Clinical practice guidelines (CPG) are statements that include recommendations intended to optimize patient care. These guidelines are formulated by using a systematic review of evidence and an assessment of the benefits and harms of alternative care options. Diagnosis and management of patients with OLP continue to challenge even the most experienced clinician. To provide optimum care to the patients a decision tree algorithm needs to be formulated. This article compares the existing clinical practice guidelines available in the literature and a formulated decision tree algorithm.
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CASE REPORTS Top

Insidious fatal perforation of palate: A diagnostic challenge p. 293
R Guru Prasad, Akshay Sujith, Neeta Sharma, Brijesh Kumar
DOI:10.4103/jiaomr.jiaomr_52_20  
Granulomatosis with polyangiitis (GPA) is considered as a systemic triad of necrotizing granulomatous vasculitis of the upper and lower respiratory tracts (pulmonary vasculitis) and a rapidly progressive glomerulonephritis. Few cases of a superficial form with only oral involvement are reported. The purpose of this article is to describe the steps in reaching a conclusive diagnosis in lesions involving the palate. Since in most cases the histopathological report will turn inconclusive, proper clinical evaluation and definitive diagnostic test like the estimation of cytoplasmic-antineutrophilic cytoplasmic antibody will be mandatory for obtaining a conclusive result.
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Dentigerous cyst with ameloblastomatous proliferation as well as calcifications: An unusual presentation p. 297
Shreya S Saha, Harpreet K Gandhoke, Basudev Mahato, Tushar Deb
DOI:10.4103/jiaomr.jiaomr_209_19  
Dentigerous cyst is an odontogenic cyst that is of developmental origin associated with the crown of an impacted tooth usually the third molars and canines. This is one of the most common types of developmental odontogenic cysts. The prognosis of dentigerous cyst is excellent but this cyst might undergo neoplastic transformation into ameloblastoma/squamous cell carcinoma/mucoepidermoid carcinoma. In this case report, we have studied the lining wall of the dentigerous cyst which has shown ameloblastomatous transformation along with sporadic calcification in the deeper layers of the connective capsule. This type of calcification rarely occurs with the dentigerous cyst.
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Glandular odontogenic cyst in a young Indian female: A rare case report with review of literature p. 300
Vishwas D Kadam, Govind R Changule, Sneha H Choudhary, Lalitkumar P Gade
DOI:10.4103/jiaomr.jiaomr_34_20  
Glandular odontogenic cyst (GOC) is a developmental odontogenic cyst of jaw bones, described in 1987 by Gardner et al. The cyst is rare in occurrence, especially in Indians, unpredictable in nature, potentially aggressive in its behavior and has a very high recurrence rate. Clinically, the age, gender, and site of occurrence of GOC as per the literature are 5th- 6th decade of life, slight male predilection and mandibular anterior region. This article presents a case of GOC in a 28-year-old female patient in the posterior mandibular region which is a rare combination of age, gender and site of occurrence for GOC.
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Birthmark: Journey from aesthetic to unalluring p. 303
Sakshi Sharma, Pratiksha Hada, Vikram Singh, Mamta Singh
DOI:10.4103/jiaomr.jiaomr_9_20  
Encephalotrigeminal Angiomatosis, also known as Sturge Weber Syndrome (SWS), Dimitri disease, Sturge Kalischer Weber Syndrome is specifically non familial, congenital rare disorder consisting of hamartomatous malformations that may affect eye, skin, and CNS. Failure of proper vascular development is believed to be the most likely cause of the condition. The malformed blood vessels may lead to port wine stains, epilepsy, and glaucoma depending on its location. We are presenting here a triad of case reports on Sturge Weber Syndrome representing individuals belonging to varied age groups.
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A large complex infected odontome: Case report and review of literature p. 308
Jiji V Unni, Deepak Daryani, Vinod Kumar, MP Uthkal
DOI:10.4103/jiaomr.jiaomr_4_20  
Odontomas are benign, slow-growing, and nonaggressive tumors of the jaw. Odontomas are largely considered as hamartomatous lesions but their exact etiology is still a matter of debate. Odontomes are usually asymptomatic, but sometimes they may interfere with the eruption of the associated tooth leading to its impaction. This case report illustrates large symptomatic infected complex odontome in the left mandibular third molar region. Very interestingly, the patient presented with typical features mimicking osteomyelitis. Various investigations including cone-beam computed tomography (CBCT) were done to differentiate and localize the lesion. This article also discusses the various atypical presentations of odontome described in the literature so far and also the benefits of CBCT in terms of diagnosis and localization of odontomas, especially with respect to impacted tooth and mandibular canal.
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Oral proliferative verrucous leukoplakia: An enigmatic lesion with emphasis on its differential diagnosis p. 312
Pooja Madki, Ruheena Khan, ML Avinash Tejasvi, Shilpa Javudi
DOI:10.4103/jiaomr.jiaomr_44_20  
Oral proliferative verrucous leukoplakia (OPVL) is a distinct clinical form of oral leukoplakia (OL). It is one of the rare clinicopathological entities that is considered as a potentially malignant oral mucosal disorder with an increased rate of progression to oral squamous cell carcinoma (OSCC) and a very high recurrence rate. Initially, the condition develops as focal clinical hyperkeratosis that progresses gradually and becomes a wide multifocal disease with gross exophytic features. It is a slow-growing, long-term progressive, and enigmatic lesion that is difficult to define and disclose. We report here, a case of OPVL in the right mandibular alveolar ridge, clinical and diagnostic aspects, differential diagnosis, and histologic features of this relatively rare entity.
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Diagnostic dilemma of a silent tumor p. 315
Anisa Noorulla, Hemalatha Ramakrishna, Kandasamy Murugan, Duraiselvi Paneerselvam
DOI:10.4103/jiaomr.jiaomr_153_19  
Ameloblastoma is a true neoplasm of odontogenic epithelium. It is a benign, persistent, aggressive, locally invasive tumor, capable of increasing in size and eroding bone. Unicystic ameloblastoma (UA) is a rare odontogenic tumor, which has unique clinical, radiographic, and histologic features of jaw tumors. The lesion histologically shows typical ameloblastomatous epithelium lining part of the cystic cavity with or without and/or mural tumor growth. This article reports a rare case of UA presenting as a multilocular lesion of a mandible in a 60-year-old female patient.
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