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   Table of Contents - Current issue
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April-June 2021
Volume 33 | Issue 2
Page Nos. 115-232

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EDITORIAL  

From the desk of editor in chief Highly accessed article p. 115
Dipti Bhatnagar
DOI:10.4103/jiaomr.jiaomr_150_21  
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IAOMR NEWS Top

Tribute Highly accessed article p. 116
P Ramachandra Reddi
DOI:10.4103/jiaomr.jiaomr_168_21  
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ORIGINAL ARTICLES Top

Analysis of fractal dimension and radiomorphometric indices of mandible on panoramic radiographs in end-stage renal disease at a tertiary care centre in South India p. 117
Anju Redhu, B Suman
DOI:10.4103/jiaomr.jiaomr_186_20  
Background and Objectives: Chronic kidney disease (CKD), especially, end-stage renal disease (ESRD), is associated with endocrinal and metabolic alterations that negatively affect the skeletal system, and can result in renal osteodystrophy (ROD) and secondary osteoporosis. These changes can affect the mandibular density and thus can be reflected in mandible on panoramic radiographs (PR), which are frequently assessed by oral physicians. This study attempted to evaluate these mandibular skeletal alterations using radiomorphometric indices (RI) and fractal dimension (FD) analysis, in patients with ESRD, thereby aiding in their appropriate management for the dental treatment. Material and Methods: Retrospective data (including digital PRs) of 30 patients with CKD (ESRD) who were above 18 years of age were retrieved and 30 age and sex-matched healthy individuals having met the selection criteria were selected. Digital PR were used to assess the mandibular cortical index (MCI), mental index (MI), panoramic mandibular index (PMI), and FD by using ImageJ program. Results: No statistically significant difference was noted among the study groups and controls for the mean values of PMI, FD, and distribution of MCI category (P > 0.05). However, the mean value of MI was significantly reduced among the kidney patients as compared to the controls (P < 0.05). No significant correlation was noted between duration of diseases, RI (MCI, MI, PMI) and FD. Conclusion: MI values of patients with ESRD were found to be lower than those in control subjects. This finding suggests that MI analysis might be a promising, simple, and cost-effective tool for evaluating cortical bone structure in this high-risk population and any signs of osteoporosis could be withheld at the earliest stage with a prompt referral.
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Evaluation of pain management and quality of life among oral cancer patients - A cross sectional study p. 124
John W Baliah, Vaishali Keluskar, David W Livingstone, Arun Panwar
DOI:10.4103/jiaomr.jiaomr_171_20  
Background: Oral cancer is a health concern in India, accounting for 90% of all head and neck cancers. Recent advances in treatment have improved survival rates, but unbearable pain creates a poor quality of life. Intense pain at the primary site significantly impairs speech, mastication, and swallowing. The use of extensive pain evaluation questionnaire may yield false responses from patients due to severe pain. Aim: The study aims to assess pain management and quality of life using an 8-point questionnaire among patients with squamous cell carcinoma of oral cavity, pharynx, and esophagus undergoing treatment procedures. Materials and Methods: A total of 64 oral cancer patients from two cancer hospitals were interviewed using the self-designed questionnaire to assess their pain level and quality of life. Statistical Analysis: Descriptive analysis was used to describe the frequencies and percentages. Chi-square test was used to determine statistical significance. Results and Conclusion: In 33% of the oral cancer patients, pain medication did not have an analgesic effect; 32.8% of the patients needed stronger pain medication; 36% had severe mood swings; 31.3% had severe sleep disturbance; and 39.1% had severe interference in eating food. On using numeric pain intensity scale, 42.2% had severe pain and 51.5% had moderate pain due to oral, pharyngeal, and esophageal squamous cell carcinoma and its treatment. This simplified questionnaire can be used as a preliminary tool to evaluate oral cancer pain and quality of life.
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Cone-Beam computed tomographic evaluation of pneumatized articular eminence and roof of glenoid fossa in north- east Indian population p. 129
Saumya Verma, Sri Krishna Koppula, Anand Choudhary, Devarshi Nandi, Ashutosh Kumar, Babita Rawat
DOI:10.4103/jiaomr.jiaomr_256_20  
Background: Pneumatized articular eminence (PAT) and roof of the glenoid fossa (PRGF) are recognized when accessory air cells are found within the zygomatic process of the temporal bone. Pneumatization in this region facilitates the spread of tumors and fractures. During Zygomatic implant placement and TMJ surgical procedures, namely eminectomy and miniplate insertions, various complications might arise due to pneumatized PAT and PRGF. Cone-beam computed tomography (CBCT) provides reliable and accurate information to determine the characteristics, the extent of pneumatization, and its relationship to the adjacent structures. So, recognizing the variations of PAT and PRGF in different populations is of clinical importance. Objective: The purpose of this study was to assess the prevalence of pneumatization of articular tubercle (PAT) and pneumatization of PRGF in the North- East Indian population by using CBCT. Materials and Methods: The study was carried out among 500 patients. The prevalence and significance of differences among the variables were carried out by analysis of variance (ANOVA) and Chi-square test. Data were analyzed by using Statistical Package for the Social Sciences (SPSS) software program, version 21 (IBM). Results: The mean age with pneumatization was 45.27 ± 18.00 years. The prevalence of PAT and PRGF was found to be 24.6% and 24.4%, respectively. Bilateral PAT was detected in (6%) patients. The occurrence of unilateral PAT cases was found to be more than bilateral PAT cases (<0.042). Conclusion: There is a greater prevalence of PAT and PRGF in the North- East Indian population when compared to other similar studies in the literature.
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Assessment of Clinical Efficacy of Microbiome and Topical Hyaluronic Acid Gel Combination Therapy in Minor Aphthous Ulcer Management – A comparative study p. 135
Shilpa Shree Kuduva Ramesh, Jayachandran Sadaksharam
DOI:10.4103/jiaomr.jiaomr_236_20  
Aim: This study aimed to determine the clinical efficacy of the combination of microbiomes and 0.2% topical hyaluronic acid gel, alongside topical monotherapy with 0.2% hyaluronic acid gel and steroids, respectively, in minor aphthous ulcer management. Subjects and Methods: A total of 45 patients were divided into three groups: Group A (n = 15) –– a combination of microbiome therapy––pre- and probiotics capsules p. o. and topical 0.2% hyaluronic acid gel; Group B (n = 15)––topical 0.2% hyaluronic acid gel; and Group C (n = 15)––0.1% triamcinolone acetonide oromucosal paste. Numerical rating scale (NRS) for pain, ulcer dimensions measured by Digital Planimetry using android mobile application to determine the degree of ulcer healing (%) and occurrence of new ulcers were recorded on 0, third, and seventh days of treatment. Statistical Analysis Used: One-way ANOVA with post hoc Tukey test among the groups and independent t - test for the degree of ulcer healing between third and seventh days were applied. Results: NRS for pain at day 3 showed a statistically significant pain reduction in Group A compared with Groups B and C (P = 0.04, 0.01, respectively). Though Group A showed the highest grade of closure (93.4 ± 2.5%) and a greater decrease in mean NRS score (0.2 ± 0.42) on the seventh day when compared to Groups B and C, results were not statistically significant (P > 0.05). Conclusion: Microbiome and topical hyaluronic acid gel combination therapy helps in immediate pain relief and faster healing. Hence, it could be an excellent alternative for topical steroid management.
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Comparison of the CBCT, CT, 3D printing, and CAD-CAM Milling options for the most accurate root form duplication required for the root analogue implant (RAI) protocol p. 141
Saloni Kachhara, Deepak Nallaswamy, Dhanraj Ganapathy, Padma Ariga
DOI:10.4103/jiaomr.jiaomr_244_20  
Background: A computerized tomography (CT) scan or a cone beam computerized tomography (CBCT) imaging techniques can be used for tooth segmentation and acquisition of a three-dimensional (3D) reconstruction using CADCAM milling and 3D printing methods. Aim: This experimental study was done to assess the accuracy of CBCT, CT, CAD-CAM milling, and 3D printing for acquiring the most accurate duplication for root analog implant (RAI). Materials and Methods: The study was an ex-vivo feasibility study comparing CBCT, CT, CAD-CAM milling, and 3D printing methods for acquiring the most accurate duplication for root analog implant (RAI). Informed consent was obtained from patients for the study purpose for recording CT and CBCT scans and to utilize the extracted teeth for research purpose. The teeth were segmented from the DICOM files of CBCT and CT scans of the patients and Standard Tessellation Language files (STL) were obtained for individual teeth. The STL files of the individual teeth obtained were printed and milled in polymethylmethacrylate material (PMMA). The study thus consisted of 5 groups—Natural teeth as control, CBCT milled group, CT milled group, CBCT printed group and CT printed group of 16 samples each. Morphological differences in the three dimensions namely apico-coronal, bucco-lingual, and mesio-distal between the natural tooth and the 3D replicas were assessed using the one-way ANOVA test using the statistical software. Results: There was no statistically significant difference among the dimensions between the CBCT, CT, CAD-CAM milling, and 3D printing groups with respect to the most accurate duplication for root analog implant (p > 0.05). Conclusion: Within the limitations of this study, the CBCT segmentation and the Milling technique produce the least distortion for fabricating the root analog implant.
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Salivary ki-67 and micronucleus assay as potential biomarker of OSCC in betel nut chewers p. 146
Maulina Triani, Haris B Widodo, Dody Novrial, Dewi Agustina, Gita Nawangtantrini
DOI:10.4103/jiaomr.jiaomr_265_20  
Introduction: Oral cancer is often associated with various factors, such as betel nut consumption, which usually causes specific premalignant lesions. The most common oral cancer is oral squamous cell carcinoma (OSCC) which has a low 5-year survivor rate because early detection of the malignancies is not widely used and not routinely carried out in dental practice. Early detection of malignancy can be done by measuring the salivary Ki-67 level and micronucleus assay from the buccal smear. Aims and Objectives: The study aimed to examine the potency of the salivary Ki-67 level and micronucleus assay for early detection of OSCC in betel nut chewers. Materials and Methods: This study was conducted in 17 betel nut chewers and 17 healthy people as a control group. Saliva was collected with the passive drooling technique and then analyzed using Enzyme-linked immunosorbent assay (ELISA). Buccal smears were taken, then a cytological slide was made and stained using Papanicolaou. Settings and Design: This study was a cross-sectional analytic survey that was conducted in the Banyumas District of Indonesia with a post-test- only control group design. Statistical Analysis: The statistical analysis used is a non-parametric test using Mann–Whitney and Kruskal–Wallis tests. Results: There was a significant difference between the Ki-67 level and micronucleus in the betel nut chewers group and the control group. There was a significant difference between Ki-67 and micronucleus levels in the various types of oral lesions that were found in the betel nut chewer's group. Conclusion: Examination of Ki-67 and micronucleus assay is effective as an alternative early biomarker for OSCC.
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A baleful combination of trigeminal neuralgia and menopause: An epoch of cognizant p. 152
Vishal Mehrotra, Rohan Sachdev, Kriti Garg, Shubhra Saxena, Sheenam Sambyal
DOI:10.4103/jiaomr.jiaomr_233_20  
Introduction: Menopause is found to be associated with several adverse changes in the oro-facial complex, which may affect neural mechanisms because of attribution of the estrogen imbalance. Aim: The present study was conducted on female patients suffering from trigeminal neuralgia and was either in the peri-menopausal or menopausal age groups. The aim of the present study was to find out the incidence of trigeminal neuralgia in peri-menopausal and menopausal females. Material and Methods: In 2 years period, a total of 169 women patients with clinically diagnosed trigeminal neuralgia were included in the study. Based on neuralgic symptoms and gynecologist confirmation, selected patients were subdivided into groups based on age which were further subdivided into perimenopause and menopause. Collected data was tabulated and calculations were made with SPSS v21 and Chi-square test. Results: In the present study, 70.4% of patients were of 46–55 years of age which was the maximum proportion. Trigeminal neuralgia was more common in the age group of 46–55 years (82.2%), and the incidence of neuralgic pain was more common in the lower jaws (75.1%) and the right side of the face. In the present study, the lower jaw (79.8) was commonly involved as compared to the upper jaws in both perimenopausal (67.2%) and menopausal women (85.9%). Conclusion: This study stated that trigeminal neuralgia affects more commonly the older age group with a high incidence in postmenopausal women as compared to the perimenopausal women, where the lower jaw is more commonly affected in older and postmenopausal females.
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Association of pattern of mandibular invasion in MDCT with recurrence in oral cancers p. 157
Vishal Thakker, Manali Arora, Nisarg Thakkar
DOI:10.4103/jiaomr.jiaomr_10_21  
Background: Mandibular invasion has been a long-debated criterion for predicting prognosis in oral cancers. Though the American Joint Committee on Cancer (AJCC) marks cortical erosion in oral lesions as T4 disease, it is often challenged that mere superficial bony erosion should not be used to demark T4 disease. Aim: This study aimed to evaluate the association of pattern of mandibular erosion in preoperative Multi-Detector CT (MDCT) of oral cancers with the presence of recurrent loco-regional malignant disease. Materials and Methods: A retrospective study was done in the Department of Radio-Diagnosis of a tertiary center in Western India. MDCT Neck findings in 56 consecutive postoperative patients clinically suspected for recurrent oral carcinoma over a period of 1 year were assessed. Preoperative MDCT of all patients was evaluated for presence and pattern of mandibular involvement by primary malignancy. These patterns were compared with the presence of recurrent disease in the postoperative scan. Association between two findings was tested by Fisher's exact test. Results: Forty-eight patients showed features of recurrent malignancy on MDCT confirmed by biopsy; of which 10 patients had shown no bony invasion in the preoperative scan, 14 had shown cortical erosion and 24 showed medullary invasion. P value for association of recurrence and bony invasion pattern was found to be 0.6705 (insignificant) for cortical erosive lesions and 0.0469 (significant) for medullary infiltrative lesions. Conclusion: Only medullary infiltrative lesions of the mandible have a statistically significant association with recurrent disease and may be used as a prognostic factor. Cortical erosions are statistically insignificant in predicting recurrence similar to no bone invasions.
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A study on micronuclei in tobacco and related habits p. 163
Twinkal S Patel, Anjani R Chaudhary, Bhavin B Dudhia, Parul V Bhatia, Purv S Patel, Yesha V Jani
DOI:10.4103/jiaomr.jiaomr_178_20  
Introduction: Oral cancer is one of the ten most common causes of mortality in developing countries like India. A micronucleus (MN) is a small extra nucleus separated from the main one, generated during cellular division by late chromosomes or by chromosome fragments. Micronucleus is a potential biomarker for malignancy. Aim and Objectives: The study attempts to analyze micronuclei in buccal smear from patients with tobacco and related habits; and to determine its reliability as a biomarker for carcinogenesis. Study Design: A total of 400 consisting of normal subjects, patients with potentially malignant lesions and patients with malignant lesions were included in the study. Oral exfoliated cells were collected by scrapings of buccal mucosa of both control and study groups with a tooth brush. The scrapings collected from right and left buccal mucosa of each subject were studied under two separate slides. A total of 500 cells were examined from each slide. All the micronucleus cells located on each slide were examined again under the 100X magnification. Results: The P value for intergroup difference in average number of micronuclei in cells of buccal mucosa among all groups was <0.001 which was highly significant. The P value for micronucleated cells of buccal mucosa among all groups was <0.001 which was highly significant. Conclusion: A stepwise increase in MN counts from normal to potentially malignant to carcinoma suggested a link of this biomarker with neoplastic progression. Micronuclei can be used as a biomarker for early detection of premalignant and malignant lesions of the oral cavity.
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Comparative evaluation of the efficacy of gabapentin and gabapentin in combination with nortriptyline in the management of pain-related temporomandibular disorders p. 171
Mohsin Muzaffar Tak, Altaf Hussain Chalkoo, Tariq Ahmad Bhat, Tauseefa Jan
DOI:10.4103/jiaomr.jiaomr_204_20  
Background: Temporomandibular disorders (TMDs) are considered the most common orofacial pain conditions of nonodontogenic origin. The current perspective regarding TMD is multidimensional. If the pain becomes chronic, it can have a great impact on the social and emotional behavior of the patient. Materials and Methods: A total of 40 patients between the age groups of 18 and 45 years were included in the study. These patients were divided into two groups comprising 20 patients each. Group I was prescribed gabapentin and was advised to take the medicine twice daily. Group II was prescribed gabapentin along with nortryptyline twice daily. Patients in each group were evaluated at the end of every week using a visual analog scale (VAS) score for pain, maximum interincisal mouth opening, and several muscle tenderness sites for 3 weeks, and a comparison was made. Results: The age range in group I was 19–45 years, whereas in group II it was 18–45 years with a P value of 0.711. Female predominance was observed in both groups as 65% of patients were females in group I and 60% were females in group II and P value obtained was 0.74. VAS score decreased more rapidly in group II than group I. The P value obtained was <0.001 at the end of the third week. Comfortable moth opening shows a more effective increase in group II than group I. The P value (0.003) shows significance at the end of the third week. The mean number of muscle tenderness sites at the end of 3 weeks in group I and group II reduced to 1.15 and 0.40, respectively. Conclusion: The combination therapy of gabapentin with nortryptyline was found to be more effective than gabapentin alone.
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Obstructive sleep apnea: Dental perspective from upright to supine p. 177
Rupsa N Rout, Sanat K Bhuyan, Arpita Priyadarshini, Damodhar Bhindhani, Mamata Singh, Satya Mohapatra
DOI:10.4103/jiaomr.jiaomr_254_20  
Aim: To evaluate diagnostic cephalometric parameters and their influence on skeletal and soft tissue components in obstructive sleep apnea (OSA). Materials and Methods: The study is a prospective case study of 40 diagnosed cases (as diagnosed by Type IV level study) of obstructive sleep apnea who were reported to the Department of Oral Medicine and Radiology with their age ranging from 28 to 75 years. Lateral cephalometric radiographs in upright and supine posture were taken, with teeth in centric relation, and the head aligned with Frankfort horizontal (FH) plane parallel to the floor. The focus-coronal plane distance was 5 feet, the film-coronal plane distance was 15 cm, and the magnification was 10%. Results: OSA patients experience an increase in values of sella nasion point A (SNA) and sella nasion point B (SNB) at the supine position with respect to the upright position and experience a decrease in values of nasion sella turcica odontoid process tangent (NSL-OPT) and nasion sella turcica- cervical vertebra tangent (NSL-CVT) at the supine position with respect to the upright position. The parameters of paramount importance in the pathogenesis of OSA are soft palate thickness, length, and tongue length. Conclusion: SNA, SNB and NSL-OPT, NSL-CVT are inversely related to each other and play a role in the consequence or pathogenesis of OSA. Tongue height is of the least significance in the pathogenesis of OSA. The cephalometric findings are of paramount importance to know the exact site of obstruction in the pathogenesis of OSA.
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Anatomical variations of mandibular canal using cone-beam computed tomography - A retrospective study p. 183
Satarupa Chanda, Reema Manoj, Easwaran Ramaswami, Vasavi Santosh, Mandavi Waghmare, Sonal Vahanwala
DOI:10.4103/jiaomr.jiaomr_229_20  
Background: Precise anatomy and course of mandibular canal is important to obtain the desired outcome of different mandibular surgical procedures and circumvent various surgical complications. This study aimed to document the presence, frequency, and type of mandibular canal variations using cone-beam computed tomography (CBCT). Materials and Methods: CBCT images of 100 patients with a total of 200 sides (right and left) were obtained retrospectively from the database of Government Dental College and Hospital, Mumbai. The presence and type of mandibular canal variation were evaluated and classified according to Naitoh et al. classification (2009) along with Rashsuren et al. modification (2014). Prevalence rates were determined according to gender, side of the mandible, and type. Morphometric analysis of the mandibular canal variations was made. Statistical analysis with Chi-square, analysis of variance (ANOVA), and Scheffe's tests were performed. Results: Mandibular canal variations were found in 13% of patients and 8% of total sides. Type I dental canal (37.50%) was the most common type of accessory canal followed by Type II retromolar canal (31.25%), Type III forward canal type (25%), Type V trifid canal (6.25%), and Type IV buccolingual canal (0%). The retromolar canal had the maximum length and diameter and most of the accessory mandibular canals (60%) had a diameter of more than 50% of that of the main canal. Conclusion: Bifid mandibular canal was the most common anatomical variation of the mandibular canal found in this study with dental canal type being the most frequent type. To avoid iatrogenic injuries, a presurgical detailed evaluation of the mandibular canal using CBCT was suggested.
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Evaluation of serum immunoglobulin (IgG, IgM, IgA) in oral cancer patients – A case control study p. 189
Vivek M Tarsariya, Nilesh Raval, Dhaval N Mehta, Mukesh K Asrani, Vijay K Asrani, Kaushik S Barot
DOI:10.4103/jiaomr.jiaomr_240_20  
Background: Very few studies have been done to evaluate the level of serum immunoglobulins (IgG, IgM, and IgA) in patients with oral cancer as tumor markers. Aims and Objectives: The aim of this study was to estimate the serum immunoglobulins level (IgG, IgM, and IgA) in oral cancer patients and its comparison with control groups and whether these values can be used to predict the severity of disease or not. Materials and Methods: A total of 30 patients with different clinical stages oral cancer and 30 healthy controls were selected at random and subjected for analysis of serum IgG, IgA, and IgM. Statistical methods used were the mean, standard deviation and t test. Results: Significantly elevated levels of all the immunoglobulins was observed in oral cancer patients when compared with the control group and levels were increasing with clinical stages (P < 0.05). Conclusion: All these immunoglobulins are indicative of tumor burden or transformation of malignancy in higher stage and might be used as prognostic indicators in oral cancer.
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Prevalence of Haller Infraorbital Ethmoidal Cells on Panoramic Radiograph – A prospective study p. 195
Shridevi Adaki, Amol Karagir, Kaushal Shah, Raghavendra Adaki
DOI:10.4103/jiaomr.jiaomr_166_20  
Background: Haller's cells are anatomical variations in the development of the nose and paranasal sinuses. Numerous pathologies and symptoms are associated with this entity. So the present study was planned to evaluate the prevalence and the characteristics of Haller's cells on panoramic radiographs. Aim: The aim was to determine the prevalence and evaluate the characteristics of Haller's cells on panoramic radiographs. Settings and Design: Sample was selected from the Department of Oral Medicine, Diagnosis and Radiology, and the study was carried out for 1 year. The panoramic radiographs were evaluated for the presence of Haller cells. Materials and Methods: The study included 860 patients of both genders with an age range of 18–60 years. A panoramic radiograph was made and evaluated for the presence of Haller's cells and also side, shape, number of cells, and number of loculae (unilocular or multilocular) were evaluated. Statistical Analysis Used: Descriptive statistics, Chi-square test was done Results: Haller's cells were noted in 190 patients, with a prevalence of 22.09%. Out of these, 66.84% were unilateral and 33.15% were bilateral. The majority of the cells were round and irregular in shape. The unilocular type of Haller's cells occurring unilaterally was statistically significant. Conclusion: The results of the present study revealed that panoramic radiographs can depict and provide a clear delineation of Haller's cells. The description of the Haller cells is useful in the identification of entities and helps in differential diagnosis for patients having intractable orofacial pain. Further studies will be planned to look for such entities in cases of intractable orofacial pain which will help to alter the treatment planning accordingly.
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A New Approach to Tobacco Cessation by Using Chart of 5A's Based on National Guidelines p. 200
Rupali V Mhaske, Lata M Kale, Sonia Sodhi, Vishwas D Kadam, Amruta M Bansode, Kapil Pawar
DOI:10.4103/jiaomr.jiaomr_115_20  
Background: The use of tobacco is linked to cultural and social practices in India. It is the primary cause of oral cancer. Dental health professionals are trained to identify signs of tobacco use following visual examinations of the oral cavity. Through the establishment of Tobacco cessation centers in dental colleges, the dentist receives training in providing tobacco cessation counseling to tobacco users. Thus each patient that seeks dental treatment in dental colleges is also screened for tobacco use and then counseled as appropriate.Aim and objectives: (1) To assess the nicotine dependence. (2) To assess the prevalence of oral diseases. (3) To carry out a detailed and effective tobacco cessation program.(4) To use the newly made chart of 5A's and assess the usefulness of the chart in tobacco cessation counseling. Materials and Methods: The sample size of 100 patients who were tobacco users age 15 to 80 years was selected. 06 questions from the Fagerstrom test for nicotine dependence were used to elicit the nicotine dependence. The tobacco cessation program and detailed counseling were carried out. Statistical Analysis: Data collected were subjected to statistical analysis. Results: Of 100 patients, 57 were highly dependent, 38 were moderately dependent, and 5 were minimally dependent on Nicotine. After Tobacco cessation counseling patients reported back within 8 months, and their nicotine dependence was assessed again using the Fagerstrom questionnaire and was found that: 28 patients were tobacco-free having 0 scores of nicotine dependence, 67 patients were minimally dependent having scored from 1 to 3, 06 patients were moderately dependent having score from 4 to 7. Not a single patient of 100 was highly dependent on nicotine. Conclusions: Establishing a Tobacco cessation center using cognitive and behavioral counseling through the pictorial chart of 5AS, informative leaflets, awareness videos, and regular follow-up has proven effective in helping tobacco users to quit tobacco.
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FORENSIC ODONTOLOGY: ORIGINAL ARTICLE Top

Sex Determination by Odontometric Diagonal Measurements Using Discriminant Function p. 208
Gunjan V Moon, Ramhari S Sathawane, Rakhi M Chandak, Ashish B Lanjekar, Kshitia Bhakte, Vidyarjan A Sukhdeve
DOI:10.4103/jiaomr.jiaomr_260_20  
Introduction: Forensic odontology is one of the most unexplored and captivated branches of forensic sciences. Teeth are far excellent material for the anthropological, genetic, odontogenic, and forensic scenario as the morphology of teeth remains unchanged in extreme environmental conditions even after a long period. Aim and Objectives: The study aims to determine the sex of an individual by odontometric diagonal measurements using discriminant function. The objectives are to measure and compare the diagonal measurements of teeth in males and females using crown diagonal diameters of the permanent dentition and to evaluate their sexual dimorphism. Material and Methods: The study sample included 380 maxillary and mandibular dental casts obtained by alginate impressions of 190 subjects (95 males and 95 females) in the age range of 19–35 years selected from Out patient department of Oral Medicine and Radiology. Mesiolabioincisal-distolinguoincisal (MBDL) and distolabioincisal-mesiolinguoincisal (DBML) measurements of right permanent maxillary and mandibular teeth excluding third molars were taken separately using a digital Vernier caliper. Results: The highest mean tooth dimension of MBDL and DBML in both the jaws is of the first molar. The accuracy rate for males (100% for MBDL and 97.89% for DBML) is greater than females (MBDL 93.68% and DBML 94.21%). The overall accuracy rate of maxillary and mandibular MBDL is greater (96.8%) than DBML measurement (95.8% and 94.8%, respectively). Conclusion: The overall accuracy rate for sex determination is 96.8% for MBDL dimensions. The maxillary and mandibular second premolars are the strongest predictors for sex determination.
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REVIEW ARTICLE Top

Oral medicine practice during COVID-19: A scoping review p. 215
Krishna S Kumar, Ramanarayanan Venkitachalam, Beena Varma, Priya K Nair, Aravind M Shanmugham, Renju Jose
DOI:10.4103/jiaomr.jiaomr_4_21  
Oral healthcare providers work near the face of the patients and are at an increased risk of being infected or transmitting the infection to the patients. Standard practice guidelines have to be modified to reorganize Oral Medicine care in the new normality of the COVID-19 pandemic to minimize the negative impacts of the infection on oral and systemic health. This scoping review aims to assess the guidelines for the safe practice of Oral Medicine during the COVID-19 pandemic. The literature search was done using Medline and Pubmed as the database and 23 articles were identified related to 8 domains. Utilization of teledentistry, efficient triaging of the patients with strict adherence to the infection control protocols, knowledge of the possible oral manifestations, and management of patients based on their presenting symptoms can help for the safe practice of Oral Medicine during the COVID-19 pandemic.
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CASE REPORTS Top

Mucocutaneous pemphigus vegetans-A rare case report p. 222
R Jayapriya, Manjari Chaudhary, TN Uma Maheswari, Arvind Muthukrishnan
DOI:10.4103/jiaomr.jiaomr_282_20  
Pemphigus vegetans, a rare clinical variant of pemphigus vulgaris which is a group of vesiculobullous autoimmune diseases. The characteristic clinical feature of pemphigus vegetans is formation of vegetative plaques in oral mucosa. A 40 year old female patient reported with mucocutaneous ulcerative lesions with lip crustations. This patient was under 8 months follow up with periodic remissions and exacerbation. Hence, this case report highlights the significance of early diagnosis, appropriate therapeutic intervention and periodic follow up of pemphigus vegetans to achieve complete remission and prevent adverse complications of long term immunomodulatory therapy.
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Pneumosinus dilatans: A rare case report and review of literature p. 226
Priya Ramani, VR Nithya, J SreeDevi, AC Vinod Kumar
DOI:10.4103/jiaomr.jiaomr_253_20  
Pneumosinus dilatans is a rare entity that is documented only by a few reports. It is an abnormal expansion of the aerated frontal sinus, with sinus walls of normal thickness. The bone expansion is focal. A case was reported in our dental college; a 28-year-old male complaining of prominence on his forehead and it has an unknown cause and no functional problems. Computed tomography shows extension pneumatization and expansion of frontal sinus, which is extended from one side of the skull to the other side. It is benign and found to be asymptomatic. No evidence of pathological changes and no bone destruction seen. We discuss this case of etiology, clinical features, and radiological features.
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Hibernoma: A rare benign tumor p. 230
R Thriveni, Sunitha Bhosle, DN S. V. Ramesh, AH Praveen
DOI:10.4103/jiaomr.jiaomr_97_20  
Hibernomas are rare soft-tissue benign neoplasms composed of brown adipose tissue. In 1906, Merkel named these tumors Pseudolipoma, then in 1914, Grey coined the term as Hibernoma because of its similarity to brown fat in hibernating animal species. Symptoms secondary to extrinsic compression of neighboring structures may be present, although these tumors are uniformly benign. Hibernomas may be found anywhere in normal fetal brown fat but are most commonly located in the thigh. The etiology of Hibernomas is unknown. Molecular genetics show mutation in chromosome 11 which encodes the tumor suppressor gene MEN 1 [Multiple Endocrine Neoplasia type 1]. Among all benign lipomatous tumors approximately 1.6% accounts for Hibernomas.
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