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   Table of Contents - Current issue
January-March 2021
Volume 33 | Issue 1
Page Nos. 1-114

Online since Friday, March 26, 2021

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Integrating oral health and medical care Highly accessed article p. 1
Deepak Gupta
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Imaging obstructive sleep apnea: Role of oral medicine and maxillofacial radiologists Highly accessed article p. 3
Ashok Lingappa
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Assessment and comparison of condylar position based on joint space dimensions and gelb 4/7 grid using CBCT Highly accessed article p. 6
Sairam Vankadara, Baandhavi Akula, Kolluri Nissi
Background: Temporomandibular joint (TMJ) is a unique joint. An optimal position of the mandibular condyle in the glenoid fossa is a fundamental question in dentistry, and there is no quantitative standard. Thus, the most common condylar position in the glenoid fossa can be determined by the dimension of the joint space and Gelb 4/7 grid using cone-beam computed tomography (CBCT). Aim: To analyze the position of the condyle and joint spaces in the normal temporomandibular joint and to compare the efficacy of the Gelb 4/7 grid over dimensions of joint spaces to assess optimum condylar position using CBCT. Materials and Methods: CBCT images of 40 patients (right and left) without a history of TMJ disorders were selected. Anterior (Ajs), superior (Sjs), and posterior joint spaces (Pjs) on sagittal slices, medial (Mjs), and lateral (Ljs) on coronal view were measured and Gelb 4/7 grid on sagittal slices used to assess the condylar position. Results: Significant difference between right and left sides in Ajs, Sjs, Mjs, and Ljs values. Significant differences were noticed in Mjs, Ajs values between males and females. Centric position is the most common position of the condyle, and 4/7 position is the most common according to Gelb 4/7 grid. Conclusion: Gelb 4/7 position was found to be the most common anatomical position of the condyle in healthy TMJs, and centric relation position was the most common based on joint space dimensions.
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Whatsapp as an E-learning tool of dental radiograph interpretation among dental undergraduates - A pilot study p. 12
Anjana Bagewadi
Background: The number of smartphone users and social media has increased exponentially. The applications have been used for teaching, learning, and assessment. WhatsApp allows sharing of images with multiple users and is a great platform for discussions. Hence, it was decided to teach interpretation of intra-oral periapical radiographs (IOPA) for dental undergraduates. Aim: The study aimed to know the perception and acceptability for WhatsApp as an e-learning tool for learning IOPA radiograph interpretation. Methodology: Seventy-five third year students of Bachelor of Dental Surgery participated in the study. They were further grouped into smaller groups, containing 7-8 students in one batch. Every student made and posted five IOPAs images with interpretation in the WhatsApp group. The next day, the facilitator clarified the doubts. At the end of the posting, students answered a questionnaire with a 4-point Likert scale of 10 items. The analysis was done manually by calculating aggregate percentages of responses. Results: 98.6% of students felt WhatsApp facilitates group discussion and provides the flexibility of time. 96% of students agreed that it encourages participation. 89% felt it helped them clear doubts. Conclusion: All the students participated enthusiastically. They could learn at their convenient time and without the fear of face-to-face interaction. Hence, WhatsApp can be an adjunct teaching methodology for interpretation of IOPA.
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Genotoxic and cytotoxic biomonitoring in patients exposed to panoramic dental radiography: Comparison between five different age groups p. 16
S Anbumeena, A Kannan, CL Krithika, V Vasanthi
Introduction: Radiography is an inseparable tool in dentistry. Radiation can induce DNA damage as well as cellular damage. Aims and Objectives: To estimate the genotoxicity and cytotoxicity after taking Orthopantomograph (OPG). To compare the result between five different age groups. Materials and Methods: Buccal mucosal smears were collected from the participants and stained using the PAP method and PAS method. It was evaluated for genotoxicity and cytotoxicity. Settings and Design: The study group consisted of 60 participants. They are divided into five different groups with 12 in every single group. Statistical Analysis Used: Wilcoxon Signed Ranks Test was used within groups. Kruskal–Wallis test was used for continuous data. Results: The mean of cytotoxicity after taking OPG was significantly increased (P < 0.05). Though there was an increase in micronuclei expression, no statistically significant difference was evidenced (P > 0.05). Conclusion: The result of our study reveals that OPG did not cause any chromosomal damage, but it is capable of inducing cytotoxicity in buccal mucosal cells in all age groups.
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Asymptomatic shedding of herpes simplex virus in oral cavity p. 22
Abhay Kulkarni, Shruti Wadne, Rajendra Birangane, Rohan Chaudhari, Nitin Kole, Supriya Sankpal
Herpes simplex virus (HSV) is a significant human pathogen. Dental surgeons and Dental Hygienists come across many patients which are not having clinical symptoms but are the carriers of the disease. The person working in the oral cavity is at high risk for getting infected and also the risk of cross-infection in the general population. Aim: In this study, we determine the prevalence of HSV qualitatively and quantitatively in the oral cavity in apparently asymptomatic patients. Study Setting: Institutional and PCR testing Labs. Methods & Materials: The study analyzed saliva samples derived from 220 individuals which were collected with sterile swabs. The traditional PCR method was done for qualitative analysis and real-time PCR for the quantitative analysis. Results: The results of qualitative analysis showed that HSV-2 was more commonly shed than HSV-1 in the oral cavity, while the infected persons showed more genomic copy numbers. Conclusion: The presence of asymptomatic shedding of HSV-2 may be an indicator of future immunosuppression which should be followed up.
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To evaluate the efficacy and tolerability of topical 5% imiquimod in cases of oral leukoplakia: A pilot study p. 27
Swati Mane, Bhakti Patilsoman, Poorvi Bhate, Deepa Das, Pratik Malusare, Nalini Tomar
Background: Oral leukoplakia is a condition commonly associated with tobacco use. The literature also has documentation pertaining to likely cancerous transformation of leukoplakia. It is always a challenge to discover a therapeutic modality to prevent this transformation. Imiquimod is an immune response modifier possessing antiviral and anti-tumor activity which is being explored as an off label use in many cancerous conditions. Aim: To show any regression in oral leukoplakia and to test its safety and tolerability. Setting and Design: This is a randomized, open-label, single-centered clinical pilot study carried out with Imiquimod. Material and Methods: Two groups OPD of dental college with topical 5% Imiquimod and Topical Vitamin A (50,000 IU) were compared for their efficacy in the management of oral leukoplakia, pre- and post-treatment clinically and regression of oral dysplasia was observed histopathologically. Unit of improvement was noted for assessing the effectiveness of treatment. Statistical Analysis: Quantitative data were analyzed by Wilcoxon signed test. Results: Topical 5% Imiquimod application resulted in good clinical response +1, +2 unit of improvement with more regression of lesion noted in non-homogeneous leukoplakia and areas with less salivary contamination. Topical Imiquimod 5% is the best alternative to conservative management of moderate to severe dysplasia cases where we can offer more to the patient than just observation, and it is also better than a surgical option where surgery leads to more morbidity, in recurrent cases.
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Variations in anatomical landmarks of mandible using cone beam computed tomography - A cross-sectional study p. 32
Nitesh Tyagi, Neelkant Patil, Mohit Sareen, Manoj Meena, Supriya Rathore, Shobhit Kaswan
Background: Cone beam computed tomography (CBCT) is a diagnostic imaging modality for implant and surgical procedures in anterior and posterior mandibular area. It provides adequate information concerning maxillofacial regions, optimum image quality, excellent geometric accuracy, and low radiation dose. Aim: The aim of this study was to evaluate prevalence and anatomical variations in Mandible (Mandibular Incisive canal, Lingual Foramen, Mental Foramen, and Mandibular canal) in CBCT scans of the maxillofacial region. Methodology: All CBCT cross-sectional images of 40 study participants was analyzed for the presence of anatomical landmarks. All the anatomical parameters were compared with respect to age groups, dentition, gender, and right and left side and their respective distances from the inferior border of mandible and alveolar crest were measured using CS 3D imaging software (Kodak). Results: Lingual Foramen, Mental Foramen, and Mandibular Foramen were seen in all (100%) study samples, incisive foramen 83% and anterior loop in 25% of study samples. On statistical analysis, the difference of the mean distance of incisive foramen, mental foramen, anterior loop and mandibular foramen from lower border of mandible and alveolar crest was significant with relation to gender (P = 0.006) and with relation to dentate, partially dentate, and edentulous were found to be significantly different (P < 0.001). Conclusions: Careful assessment of the anatomical landmarks is essential to avoid neurosensory and bleeding complications using CBCT.
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Knowledge, awareness and outlook on the COVID-19 disease among the dental professionals in Tamil Nadu p. 40
K S. Sethna Muth Lakshmi, CL Krithika, A Kannan, Yesoda Aniyan
Aim: The aim of this study was to analyze the knowledge, level of awareness, and the attitude of the dental professionals towards the pandemic disease (COVID-19). Materials and Methods: This questionnaire-based survey was conducted among 295 dental professionals residing in Tamil Nadu through an online portal. The questionnaire consisted of four sections that addressed the demographic data, knowledge, awareness, and outlook of the COVID-19 disease by dental professionals. All the received responses were tabulated and the results were represented graphically. Result: The result of the study showed significant awareness among dental professionals towards COVID-19. The dental professionals needed more attention towards the precautions to be followed during this pandemic as personal protection and a safe environment are essential for a secure practice. Conclusion: This study emphasizes the role of oral health professionals in the prevention of the transmission of coronavirus among the public along with the management of dental emergencies with appropriate personal protective measures. This study also enforced the need to enrich the knowledge about infection, transmission, prevention, and control towards COVID-19. This may act as a source of information for the future pandemic crisis.
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Estimation and correlation of serum and salivary C-reactive protein in oral potentially malignant disorders p. 47
Mansimranjit Kaur Uppal, Asha R Iyengar, BV Subash, Seema Patil, Manisha Lakhanpal Sharma, Sahil Thakar
Background: A large proportion of oral cancers arise from oral potentially malignant disorders (OPMDs). Very few studies have assessed serum and salivary C-reactive protein (CRP) levels in OPMDs warranting further research. Furthermore, no study has evaluated the correlation of serum and salivary CRP in OPMDs to the best of our knowledge. Objectives: The study aimed to compare serum and salivary CRP levels between subjects with OPMDs and controls along with their correlation. Materials and Methods: A total of 60 subjects with 30 subjects each in the study (Group 1) and control group (Group 2) were included. Group 1 was further categorized into group 1a, 1b, and 1c comprising 10 subjects each of Leukoplakia, Oral lichen planus (OLP), and Oral submucous fibrosis (OSMF). Group 2 comprised of 30 age and gender-matched controls. Results: Higher mean serum and salivary CRP levels were found in subjects of Group 1 (5.91 ± 3.11 mg/L and 1.00 ± 0.45 mg/L, respectively) as compared to group 2 (2.18 ± 0.66 mg/L and 0.48 ± 0.33 mg/L) with a statistically significant difference (P < 0.001). There was a positive correlation between serum and salivary CRP levels values in both group 1 (P < 0.001) and group 2. Conclusion: Higher serum and salivary CRP levels in OPMD subjects in comparison with controls indicate its role as a potential biomarker in the early detection of oral cancer. A positive correlation between the two potentiates the use of saliva as a non-invasive diagnostic tool for detection of CRP.
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Correlation of pain score with ulcer size in oral aphthous ulcers using 2% curcumin gel and 0.1% triamcinolone oral paste - A parallel comparison study p. 53
Praveena Raman, H Raghuram Pitty
Background: Recurrent aphthous stomatitis (RAS) is a common inflammatory condition affecting the oral mucosa causing interference with mastication and speech with significant impact on quality of life. The use of topical steroids remains the mainstay as the primary therapeutic approach and they are often considered to be the first choice of treatment. Turmeric has been used in the Indian traditional medicine for centuries. Its anti-inflammatory and wound healing activities are demonstrated by the rapid healing of the ulcers. Aim: The primary aim of this study was to assess and correlate pain score with ulcer size using topical curcumin 2% gel and triamcinolone acetonide oral paste 0.12% in recurrent minor oral aphthous ulcerations. Methodology: Following convenient sampling, 60 volunteered students with oral aphthous ulcers were included to take part in this single-blinded randomised study. Randomization was done by flip coin method. Group I received Topical Curcumin oral gel 2% and Group II received Topical Triamcinolone acetonide 0.1%. Statistical Analysis: Qualitative data was expressed in percentage and quantitative in mean (SD). Independent sample t test and correlation was done. Results: The ulcer size was smaller initially and gradually increased in the next few days and the size decreased upon ulcer healing. Initially, the pain score was higher and gradually decreased as the ulcer healed. Positive correlation of ulcer size and pain score was obtained in Group I on the 1st day, 4th day and 5th day with statistical significance of P < 0.001 and negative correlation on 2nd day without statistical significance. Ulcer size and pain score in Group II was correlated negatively on Day 1, 2, 6 and 7 without statistical significance and positively correlated from Day 3-5 without statistical significance. Ulcer size and pain score was negatively correlated with statistical significance for Day 6 and 7. Conclusion: Our study showed that Curcumin performed on par with triamcinolone and there is no positive correlation between ulcer size and pain score with topical management of Curcumin and Triamcinolone in aphthous ulcers. Though both the drug was effectively able to bring down the pain and size without any side effects, with a borderline favorable result with steroid.
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Efficacy of cryogun versus diode laser therapy in the management of oral leukoplakia p. 60
K Naga Venkata Sai Praveen, Gajendra Veeraraghavan, T Ramesh, T Navya Teja, G Upendra, Y Kalyan
Background and Aim: This study was aimed to clinically evaluate the effectiveness of 810 nm diode laser and cryosurgery in the management of oral leukoplakia (OL) in terms of healing outcomes. Materials and Methods: Thirty subjects clinically and histo-pathologically diagnosed as having OL were randomly allocated into two groups. Group-1 consisting of 15 subjects each treated with cryotherapy, Group-2 was treated with an 810 nm diode Laser. VAS scale was used for evaluating the postoperative discomfort due to pain and Bates- Jensen Wound Assessment Tool was used to evaluate clinical wound healing. Results: Data analysis was done by using one-way ANOVA for intragroup variations. For intergroup comparisons Paired t- test was used. A statistically significant number of recurrences was noticed in the cryo group compared to the LASER group. Conclusion: This study results suggest that both cryosurgery and laser therapy were effective in terms of patient comfort. However more number of recurrences and mild post operative edema in the cryo group make LASER therapy a better management option.
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Correlation of Serum Vitamin B12 and Iron as etiologic factors in recurrent aphthous stomatitis: A case-control study p. 66
Thalamalai Saravanan, Subha Manoharan, C Saravana Bharathi, KR Shakila
Objective: This study aimed to estimate and correlate the levels of serum vitamin B12, iron, and their association with family history and cigarette smoking in patients with recurrent aphthous stomatitis (RAS). Methods: Sample size was calculated using the earlier prevalence studies with a power of 85% and rounded to 30 considering other confounding factors. Thirty patients with RAS and 30 control subjects were included in this controlled prospective study. A proforma on demographic details and case history was filled followed by serum analysis for Iron and B12. The collected data were analyzed using SPSS 20. Results: Family history is a significant predisposing factor for RAS. Vitamin B12 was found to have a significant positive correlation with RAS. Patients with vitamin B12 deficiency, positive family history, and nonsmoking status have been found to have the highest risk for having RAS. Binary logistic regression analysis revealed a significant relationship between vitamin B12 and RAS (probability P =0.001). Conclusion: Our study had shown a positive correlation of RAS with family history and vitamin B12 deficiency.
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Foramen magnum as determinant of sexual dimorphism in Sri Ganganagar population: A radiographic study p. 71
Pradhuman Verma, Nidhi Gupta, Y Sameera, Samar Ali Faraz, Prabal Sharma, Bhumika Sharma
Background: In explosions, mass disasters, and warfare, human remains are got in fragmented states. Only strong bones that resist fracture can be used for personal identification in forensics. The foramen magnum (FM) dimension at the base of the skull is one such region that can be used for sex discrimination using radiographs. Aim and Objectives: To test evaluate sexual dimorphism in FM morphometric measurements and shape using digital submentovertex (SMV) radiograph among the Sri Ganganagar population. Materials and Methods: 100 digital SMV radiographs (50 males and 50 females) were randomly selected from the daily radiographic record of the patients with an age range of 25 to 65 years who visited the OPD and require SMV radiographs for diagnosis. The selected SMV radiographs were assessed for FM dimensions (longitudinal and transverse diameters, circumference, area, and FM index). Also, one particular shape was assigned to FM based on the radiographic image according to Chethan et al. classification. All the measurements were performed by two maxillofacial radiologists independently, and the data thus obtained were subjected to discriminant analysis for the evaluation of sexual dimorphism. Results: Values of four parameters out of five (transverse diameter, circumference, area, and foramen index) were found statistically significantly higher in males. The most common morphology of FM was an egg shape (50%), whereas round (3%) was the least common morphology. Circumference FM was the best indicator of gender determination followed by area, transverse diameter. and foramen index. The SMV radiographs for FM showed an overall accuracy of 69.73% in sex determination. Conclusion: The study showed that SMV radiographic FM morphometric measurements can be used for sex determination among the Sri Ganganagar population.
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Establishment of sexual dimorphism by odontometric analysis of permanent maxillary and mandibular canines p. 77
Gunduji Sireesha, P Ramaswamy, Ch Saikiran, M Swathi, B Mrudula Raju
Background: In forensic identification, gender estimation is one of the most important parameters. Being the main component of the masticatory apparatus of the skull, teeth are a good source of material for the civil and medico-legal purpose. Gender estimation using dental features is mainly based on the comparison of tooth dimensions. Aim: This study aims at investigating and analyzing the presence of sexual dimorphism in maxillary and mandibular canine using crown dimensions. Settings and Design: The study sample consisted of a total of 204 subjects. The greatest mesiodistal (MD), labiolingual (LL) diameter, and crown height (CH) of the maxillary and mandibular canines were recorded clinically on the subjects with the help of a Digital Vernier Caliper and tight divider. Statistical Analysis: The data sample was computed using SPSS statistical program, version 21. Discriminant analysis was used to find the dimorphism in canine measurements between males and females. Results: This study revealed that males showed greater mean CH and mesiodistal dimensions for mandibular canine teeth in comparison to females. Out of the four canines, the mesiodistal dimensions of right maxillary and mandibular canines and CH of maxillary left and mandibular right canines were significantly different in males compared to those in females. According to the study, the right mandibular canine and left maxillary canine show highly consistent results for sexual dimorphism. Conclusion: The findings support the usefulness of odontometric analysis of the canine teeth in gender estimation. Therefore, it can be used as an adjunct along with other procedures for gender estimation.
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Tobacco cessation is a challenge during COVID-19 pandemic: Is it a good time to quit?: A systematic review p. 82
Ravleen Nagi, Sujatha S Reddy, N Rakesh, Tarun Vyas
Introduction: COVID-19 is a global health crisis experienced ever, caused by novel severe acute respiratory syndrome coronavirus-2 (SARS CoV -2); unfortunately, this pandemic is still progressing, affecting over millions of people worldwide. Evidences have revealed that psychological stress experienced during pandemic is making tobacco users more addictive, therefore to prevent especially youth from harmful effects of tobacco, tobacco cessation is the need of the hour. Aim: The aim of this systematic review was to compile evidence-based studies pertaining to tobacco use during COVID-19 pandemic and highlighting the challenges incurred towards successful quit attempts by the tobacco user. Materials and Method: Computerized literature search was performed from December 2019 till June 2020 to select eligible articles from the following databases: PUBMED [MEDLINE], SCOPUS, SCIENCE DIRECT, and COCHRANE DATABASE using specific keywords. The search was limited to articles published as full text in English, which were screened by two reviewers for eligibility. Results: Six studies satisfied our inclusion criteria. Two studies found that tobacco users have achieved successful quitting during lockdown period, and contrary to this three studies suggested that users have become more addictive to smoking due to psychological stress experienced during pandemic. One study suggested current smokers to be higher risk of acquisition of severe disease. Conclusion: Oral physicians should extend extra support to tobacco users to quit by brief or moderate interventions by means of telephonic consultation or video conferencing during this pandemic. In future more studies should be conducted to understand the effect of pandemic on tobacco use pattern.
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Novel physiotherapy appliance in the management of oral submucous fibrosis p. 91
GV Ramachandra Reddy, Christopher V Shinde, Pooja Khare
Background: Limitation of mouth opening is one of the most common sequelae of various pathological processes leading to compromised nutritional state in addition to physical and psychological disabilities. OSMF is one such condition with severe trismus, debilitment, and an increased risk for malignancy. Methodology: This prospective clinical study describes the fabrication and use of a new functional appliance known as Shekar's appliance. Three OSMF patients were selected and enrolled in the study and appliance was fabricated. Assisted supervised oral physiotherapy session was performed with the appliance. Result: Excellent improvement in mouth opening was observed in all the three patients treated with the appliance. The mean increase in mouth opening was recorded as 8.6 mm. Conclusion: Oral physiotherapy induces tissue remodeling in OSMF to increase mouth opening.
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Mc cune albright syndrome - Clinicoradiological diagnosis of a rare case p. 95
Anka Sharma, Anirudh Upmanyu, Vikrant O Kasat, Amit R Parate
Mc Cune Albright Syndrome (MAS) is a rare, sporadic disorder characterized by a triad of symptoms: fibrous dysplasia, cafe-au-lait spots, and endocrinopathy. It is thought to be caused by the mutation of the GNAS1 gene and is predominantly a disease of females. We hereby report a case of a 40-year-old man who presented with suppuration and mobility of teeth in the maxillary left posterior region. The patient also had a history of recurrent fractures of limbs since childhood. Clinical examination revealed asymmetry of the face, brownish-tan macules on the nape of the neck, back, and bilateral buccal mucosa as well as lower labial mucosa. The radiological investigation confirmed the presence of polyostotic fibro-osseous lesion while the biochemical investigations revealed endocrinopathy (hyperparathyroidism). This case report emphasizes the role of an oral physician in arriving at the diagnosis of a complex disorder like MAS.
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A rare case report of congenital granular cell epulis p. 99
KR Vijayalakshmi, R Priyanka, Ankitha S Pai
Congenital granular cell epulis is a very rare tumor first described by Neumann in 1871. It is of mesenchymal origin with the female predilection in the ratio of 8:1. The lesion appears as a large protuberant mass and is commonly associated with obstruction causing difficulty in feeding and deglutition. We report a case of a newborn female who had feeding difficulty because of a protuberant mass arising from the oral cavity. The mass was surgically excised under general anesthesia and was histopathologically proven as congenital granular cell epulis. The follow-up for 3 months showed no recurrence. There are reported complications prenatally and postnatally. Hence, the treatment should be initiated early. The treatment of choice is complete surgical excision and no recurrence has been reported.
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Chronotherapy in the treatment of oral pemphigus vulgaris: A case report p. 103
Mandavi Waghmare, Sejal S Puthenveetil
Oral vesiculobullous lesions are highly dynamic in their presentation making the current treatment strategies fall short of expected complete remission. With continuing research on the various treatment modalities of these lesions it is suggested that treating a disorder by following the biological and physiological behavior of the various bodily enzymes and hormones and their circadian rhythm helps in alleviating the symptoms faster with lesser or no side effects. This concept is termed “Chronotherapy.” It works by timing the treatment with the intrinsic timing of illness.
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Nodular malignant melanoma of maxillary gingivae: A rare presentation and a proposed clinical classification of oral malignant melanoma p. 107
Jigna S Shah, Himali A Shah, Yogesh Rathva
Malignant melanoma arises from melanocytic cells. Oral mucosal melanoma is a rare malignancy with the tendency to metastasize and locally invade tissues more readily than other malignant tumors of the oral cavity. Here, a very rare entity of the pigmented nodular variety of the oral malignant melanoma of maxillary buccopalatal gingiva with regional lymph node involvement and distant metastasis to the lungs is reported. A new proposed clinical classification of oral malignant melanoma is explained. Early detection is very important for a better prognosis.
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Central giant cell granuloma in a 10-year-old pediatric patient - A rare entity in posterior mandible with CBCT findings: A case report p. 111
Divya Jose, Kandasamy Murugan, Anisha Cynthia Sathiasekar, Dhineksh Kumar
Central giant cell granuloma (CGCG) of bone constitutes about 7% of all benign lesions of the jawbones. CGCG, as described by Jaffe in 1953, is an idiopathic non-neoplastic proliferative lesion. The mandible anterior to the first molar is the frequently affected site, and has a tendency to cross the midline. Though CGCG is a benign reactive osseous lesion, it has been classified into two types based on its clinic-radiologic features into a slow growing asymptomatic, nonaggressive lesion, and an aggressive type encountered in younger patients which is painful and grows rapidly into a large size, perforating the cortex causing root resorption, and has a tendency to recur. We report a rare case of aggressive CGCG with massive destruction in molar region and angle of mandible.
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