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   2017| July-September  | Volume 29 | Issue 3  
    Online since November 20, 2017

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Study on evaluation of normal range of maximum mouth opening among Indian adults using three finger index: A descriptive study
Ravleen Nagi, Shashikant Sahu, Dharmendra Gahwai, Supreet Jain
July-September 2017, 29(3):186-190
Introduction: Early recognition of decreased or limited mouth opening in many pathological conditions is necessary for prompt diagnosis and to plan the treatment options judiciously. Therefore, it is essential to establish what constitutes normal opening for the population. Aim: This study was designed with an aim to consider the applicability of this method as an index to measure the maximum mouth opening (MMO) among different age groups in an Indian population. Materials and Methods: Total 400 healthy participants were studied in the age range of 17 to 60 years and stratified into four groups according to their age ranges. The maximum interincisal distance and width of three fingers (index, middle, and ring fingers) at the first distal interphalangeal folds of both right and left hand were measured using Vernier caliper. Statistical analysis was done using SPSS version 21 software package. Results: Results suggested that mean value and range of MMO for males was 51.00 mm (33.0–68.0 mm) and for females it was 46.3 mm (39.0–58.0 mm). Mean values of MMO correlated significantly with the width of three fingers of left and right hand as shown by Pearson correlation test. Conclusion: The study suggested that three finger index is a convenient and reliable tool for assessing normal MMO and is a most appropriate method to normal from restricted mouth opening.
  6,172 365 -
Scrofuloderma: A rare cutaneous manifestation of tuberculosis
Anuradha Ganesan, Gautham Kumar
July-September 2017, 29(3):223-226
Scrofuloderma, cutaneous tuberculosis in the orofacial region, is rare and is often a confusing and challenging diagnosis for a dental physician. Here, we present a case report of a 7-year-old girl who had two ulcers in the right side of the face. Only with a proper history, general, and local examination and along with various investigative findings, the diagnosis was confirmed.
  5,546 415 -
Relationship between the morphological variation of sella turcica with age and gender: A digital radiographic study
Talkad Subbaiah Mahesh Kumar, Poornima Govindraju
July-September 2017, 29(3):164-169
Introduction: Sella turcica is a saddle-shaped concavity located in the middle cranial fossa of the skull. The exact dimensions of sella turcica are an important consideration in the diagnosis, prognosis, and treatment of diseases related to the pituitary gland and brain. The sella turcica size and morphology is different from person to person. Thus, obtaining any data in this regard will be a great help in detecting abnormalities within this anatomic area. Aim: The objective of this study was to find out the correlation between the morphological variations of sella turcica with age and gender. Materials and Methods: Study sample consisted of 311 cephalograms of patients with age ranging 6–40 years. The contour of the sella turcica was traced and the linear measurements – length, depth, and diameter of sella turcica – were measured according to Silverman. Results: Morphology of sella turcica appeared to be normal shape in 27.3% of the study population followed by combination (26.7%), irregular (15.8%), pyramidal (10.6%), bridge (10%), oblique anterior wall (5.5%), and double contour (4.2%). Gender-wise comparison of the linear measurement was not statistically significant. Among the linear measurement, the parameter depth and diameter were statistically significant (P < 0.001) when correlated with age. On comparison of shape of sella turcica with linear measurements, the parameter length was statistically significant (P < 0.001). Conclusion: There is no significant relationship between the linear measurements and gender. There exists a significant relationship between the mean depth and mean diameter with age. That is, as age increases, the depth and diameter increase. There is a significant relationship between the length and the different shapes of sella turcica.
  2,563 497 -
Atypical presentation of Paget's disease with secondary osteomyelitis of mandible
Sadaksharam Jayachandran, Ramiah Vasudevi, Luis Kayal
July-September 2017, 29(3):227-230
Paget's disease (PD) is a chronic progressive disease of the bone characterized by abnormal bone resorption and deposition affecting either single bone (monostotic) or many bones (polyostotic). The precise etiology of the disease is unknown but it is likely that the disease is a result of a viral infection of the osteoclasts in a genetically susceptible host. It is inherited as an autosomal dominant trait with high penetrance. The patients affected are usually over forty years of age, and disease is often asymptomatic. The diagnosis is mainly based on biochemical markers of bone turnover and radiological examinations. Normal levels of calcium phosphates and markedly elevated serum alkaline phosphatase (SAP) is a constant feature of this disease. It is regarded as uncommon in Asians, Scandinavians, and black Africans. In India, Paget's disease is rare. Here, we report a rare case of PD with secondary osteomyelitis of mandible with biochemical, radiological, and dual X-ray absortiometry findings. The patient is currently undergoing treatment successfully using bisphosphonates (Alendronate), an anti-resorptive drug to decrease the morbidity associated with the disease.
  2,025 215 -
Cervical lymphnode metastasis in oral squamous cell carcinoma: Correlation of manual palpation, ultrasonographic, and histopathological findings
Sathya P Dongade, Mangala Meti, Devara Neela Sundara Venkata Ramesh
July-September 2017, 29(3):170-173
Introduction: The staging of cervical lymphadenopathy is an important consideration in the management of oral cancer as it determines the patients' prognosis. Ultrasound is used to image the cervical lymph nodes for staging because it is noninvasive and there is no radiation exposure to the patient. Aim: To investigate the applicability and diagnostic relevance of sonography in staging cervical lymphnode metastases. Materials and Methods: Cervical lymphnodes of the patients were subjected to manual palpation and ultrasound evaluation for its size, number, shape, borders, internal echoes, echogenic hilus, and central necrosis. The manual palpation findings and ultrasound features of the lymphnodes were compared with the histological features for malignant and nonmalignant nodes. Results: When short axis of node is more than 10 mm, 86% were metastatic, nodes with irregular borders were metastatic in 84%, in the absence of the echogenic hilus, 93% were metastatic, 81% were metastatic with heterogeneous nodes, and nodes with central necrosis showed 90% metastasis. Conclusion: By using ultrasound no single parameter showed high sensitivity, specificity, and accuracy.
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Mandibular ramus: A predictor for sex determination - A digital radiographic study
Kotya Naik Maloth, Vinay Kumar Reddy Kundoor, Sri Sai Lakshmi Preethi Vishnumolakala, Sunitha Kesidi, Modali Venkata Lakshmi, Moni Thakur
July-September 2017, 29(3):242-246
Aim: To evaluate mandibular ramus linear measurements on digital panoramic radiographs and to assess the usefulness of mandibular ramus in sex determination. Material and Methods: A retrospective study was conducted on 100 patients (50 males and 50 females) using digital panoramic radiographs of Khammam population with age ranging from 20 to 50 years. Standard digital panoramic radiographs were taken without any errors by Sirona, ORTHOPHOS XG 5 machine. The following five mandibular linear measurements were performed in cm such as upper ramus breadth, lower ramus breadth, condylar ramus height, projective ramus height, and coronoid ramus height. The obtained data were analyzed with the software SPSS 13.0 for statistical analysis using discriminate methods. Results: In the present study, all the linear measurements of mandibular ramus on digital panoramic radiographs showed a statistically significant difference between the genders. Conclusion: We conclude that the use of mandibular ramus is recommended as an aid for sex determination in forensic science due to their unique feature of sexual dimorphism.
  1,361 300 -
Effectiveness of soft tissue diode laser in treatment of oral mucosal lesions
Amanpreet Kaur, Neeta Misra, Deepak Umapathy, Ganiga Channaiah Shivakumar
July-September 2017, 29(3):238-241
Soft tissue diode lasers are becoming popular among clinicians due to their potential value in surgical procedures providing surface sterilization, dry surgical field, and increased patient acceptance. Two patients with different soft tissue lesions were selected, and soft tissue diode laser was used for excision and wound healing was assessed by visual method with photographs. No discomfort to the patient during and after the laser procedure was observed. Inspite of using minimal local anesthesia, avoiding placement of sutures, and not prescribing any antibiotics, minimal bleeding, no edema, and good wound healing was observed. We conclude that lasers treatments can be superior to conventional approaches with regards to easy ablation, decontamination, and hemostasis, and are less painful during and after the procedure.
  1,287 317 -
Dental professionals as a counsellor for tobacco cessation: A survey
Vijay Chandar Vinod, Lavina Taneja, Palkin Mehta, Sridevi Koduri
July-September 2017, 29(3):209-212
Aim: To evaluate the role of oral physicians as a counsellor in tobacco cessation. Material and Methods: A questionnaire was designed and distributed among 110 randomly selected participants, i.e., students (interns) and dental professionals. The questions were meant to assess the level of the knowledge, attitude, and effectiveness of dental students and professionals towards tobacco cessation. Result: A total of 100 participants responded to the survey, thus the response rate was 90.9%. A total of 77.4% were comfortable handling patients with tobacco dependence, 78.6% stressed on history pertaining to tobacco, and 87.6% did counselling habitually. Only 5.4% had received additional training for the same and only 5% thought training received was sufficient. Majority of dentists were doing counselling by asking and advising, and limited participants were using nicotine replacement therapy and other pharmacological and behavioural therapies, and only 24.7% were referring patients of high dependence to psychiatrists. Conclusion: The present study concluded that though dentists had a positive attitude towards tobacco cessation and were stressing on history and warning and advising to quit, more emphasis on pharmacological and behavioral therapies should be given. This can be achieved through alteration in the curriculum and attending more continuing dental education (CDE) programmes to update the knowledge regarding tobacco cessation intervention means and referring patients with heavy dependence to psychiatrists.
  1,211 302 -
Peripheral neurectomy in treatment of trigeminal neuralgia: A case report
Abhijeet Alok, Kamal Hasan, Abhinav Jha, Dashmesh Thakur
July-September 2017, 29(3):235-237
Neuropathic pain is nonadaptive and does not contribute to healing, such as would be the case with pain attributable to tissue inflammation, where pain results in adaptive behaviors, such as use limitation, guarding, rest, and avoidance, which contribute to healing. Trigeminal neuralgia is a debilitating, lancinating, and excruciating orofacial pain illness. Tic douloureux is the other popular name of trigeminal neuralgia because of the facial expression accompanying the episodic pain. Here we report a case of trigeminal neuralgia of infraorbital and greater palatine nerve in a 54-year-old female patient. Peripheral neurectomy was done under local anesthesia as the treatment.
  1,303 197 -
Genetic association in chronic periodontitis through dermatoglyphics: An unsolved link?
Sowmya Astekar, Vineet Garg, Madhusudan Astekar, Ashutosh Agarwal, Aditi Murari
July-September 2017, 29(3):195-199
Introduction: Because dermatoglyphic features are strongly affected by genetic and environmental factors, using it as supportive evidence in the diagnosis of hereditary disorders becomes a reality. Offspring of patients suffering from chronic periodontitis have a high prevalence rate of periodontal breakdown, suggesting strong familial influence. Aims: The present study intends to evaluate and compare the dermatoglyphic patterns in controls and periodontally compromised patients. Settings and Design: A hospital based cross-sectional study was conducted, including a total of 60 individuals, divided into study and control groups of 30 each. The study group included clinically diagnosed periodontitis patients.Materials and Methods: The digital prints were collected using biometric scanner and palmer prints using digital flatbed scanner. Care was taken to ensure that full prints of ridges were obtained. The periodontal status of all 60 participants was assessed clinically for attachment level and pocket depth. Later, Russell's periodontal index was also calculated. Statistical Analysis: The data obtained was subjected to statistical analysis using chi square and Student's t-test. Results: Among the finger ridge patterns, whorl pattern was found to be the most common in the study group whereas loop pattern was the most common in the control group. Mean total finger ridge count in the study group (165.69 ± 25.30) was significantly higher (P = 0.001) than the control group (125.4 ± 16.38). Mean dat angle was significantly higher (P = 0.039) in the study group (60.60 ± 2.76) than the control group (59.20 ± 2.62). Conclusion: Dermatoglyphics may serve as an early predictor in identifying high risk group individuals of developing diseases like periodontitis.
  1,237 256 -
Ultrasonography as a diagnostic tool in orofacial swellings
Sunidhi Garg, Mysore K Sunil, Sahil Jindal, Ashwarya Trivedi, Eeraian N Guru, Sugandha Verma
July-September 2017, 29(3):200-204
Introduction: For several years, ultrasonography has played a major role as a diagnostic and therapeutic tool in various medical fields. Only recently has it been used for maxillofacial imaging. Aims and Objectives: To evaluate the reliability of ultrasonography as an alternative tool in the diagnosis of swellings in the orofacial region. Materials and Methods: Ultrasonographic examination of 30 patients of both the sexes aged between 8 and 70 years with swelling in the orofacial region was conducted. Doppler investigation was done in some cases to evaluate the vascularity. The following six sonographic parameters were recorded: shape, boundary echo, internal echo, distribution of internal echoes, posterior wall echoes, and vascularity. Following the clinical and ultrasonographic diagnosis, the lesion was subjected to histopathological examination and a final diagnosis was made. The ultrasonographic diagnosis was correlated with the clinical and histopathological diagnosis. Results: A significant association was observed between both clinical and histopathological diagnosis and ultrasonographic diagnosis (contingency = 0.888, P value = 0.000). Conclusion: Along with clinical and histopathological examinations, ultrasonography works out as a valuable adjunct in the diagnosis of orofacial swellings as it provides several advantages like it is non-invasive, easily reproducible, widely available, rapid, and inexpensive.
  1,041 344 -
Clinical and radiological spectrum of cleidocranial dysplasia: A rare case report
Sneha H Choudhary, Lata M Kale, Sunil S Mishra, Nilofar S Zaidi
July-September 2017, 29(3):231-234
Cleidocranial dysplasia (CCD) is a rare congenital disorder which affects the bones and teeth. CCD usually has an autosomal dominant inheritance pattern, however, it may appear spontaneously in some cases. The most common features seen in CCD are aplastic or hypoplastic clavicles, late closure of fontanelle, open skull sutures, delayed exfoliation of deciduous teeth, delayed or failed eruption of permanent teeth, and supernumerary teeth. Here, we report a case of CCD in a 17-year-old female without any family history who presented with the complaint of missing teeth.
  1,084 222 -
Pleomorphic adenoma: An unusual presentation on upper lip - A case report
Deena C Thomas, Vivek V Nair, Sunila Thomas
July-September 2017, 29(3):217-219
Pleomorphic adenoma (PA) is a benign epithelial tumor arising from the major salivary glands. Only 6.4% occur in minor salivary glands. Among minor salivary glands, palate is considered as the most common intraoral site, followed by cheek and very rarely in upper lip. Clinically, the lesion occurs as a painless, slow-growing, dome-shaped mass with a smooth surface. The microscopic examination shows a mixture of glandular epithelial and myoepithelial cells within a mesenchyme-like background. The treatment consists of surgical excision down to the underlying periosteum. This case report describes a rare and unusual lesion found in a 12-year-old male patient, which was diagnosed as PA of the minor salivary gland in the upper lip.
  1,032 186 -
Prevalence and calcification of stylohyoid complex in North West part of India and its correlation with general and dental health condition
Shalu Rai, Deepankar Misra, Nivedita Singh, Mansi Khatri, Kuber Tyagi, Priyank Mallick
July-September 2017, 29(3):174-179
Aim: This study was conducted to evaluate the variation and clinical significance of stylohyoid complex and to correlate it with general and dental health among different age groups and gender using panoramic radiographs. Materials and Methods: The study included 1,000 subjects indicated for panoramic radiographs. Styloid processes >30 mm were correlated age wise and gender wise. The morphology of the calcified stylohyoid complexes was allocated into 12 different patterns and their length was measured directly on the radiographs. Serum calcium levels and cholesterol levels were obtained from subjects with elongated styloid process and their heart rate, blood pressure measurement, weight, height, number of teeth present, and community periodontal index (CPI) was assessed. Results: Out of 978 detected styloid processes, 267 (27.3%) were more than 30 mm. The average length of the calcified styloid complex was 26.40 mm. The most common pattern of calcification was found to be E pattern, 64 (34.03%) in number which had statistically significant correlation with age (P value <0.001). Pearson's correlation coefficient association of body weight with elongated styloid process (left and right) was 0.163 (P value 0.162) and 0.300 (P value 0.001) respectively which was found to be statistically significant on right side. Twenty seven subjects who showed no elongation but evident calcification patterns according to gender and age on panoramic radiographs were also recorded and were called mineralized styloid termed as mineralization. Conclusion: Calcification of the styloid complex is commonly observed on panoramic radiographs and the present and previous studies indicate that the panoramic radiographs include information on general and dental health condition.
  914 245 -
Ameloblastic carcinoma: Presentation of a rare case
Palak H Shah, Rashmi Venkatesh, Chandramani B More, Vassandacoumara Vaishnavee
July-September 2017, 29(3):213-216
Ameloblastic carcinoma is a rare malignant tumor of odontogenic origin. It is an aggressive neoplasm that is locally invasive and can spread to regional lymph nodes or distant sites such as lung and bones. Histopathology is a vital tool for diagnosis of ameloblastic carcinoma and is also required to differentiate it from ameloblastoma. Its biologic behavior recommends necessity of early diagnosis and prompt treatment. However, due to lack of case reports with long-term follow-up, there is no established treatment protocol for these cases. Here, we are presenting a unique case of ameloblastic carcinoma of left mandible in a 48-year-old female patient treated successfully with resection and reconstruction by fibular graft.
  881 223 -
An epidemiological study of tobacco-related oral habits in Mahabubnagar district of Telangana, India
Ramesh K Koothati, Gangili Vivekanandh Reddy, Gantala Ramlal, Leela K Prasad, Venkateshwarlu James Anil Kumar, Archana Pokala
July-September 2017, 29(3):205-208
Aim: To assess the prevalence of tobacco-related oral habits (TROH) in Mahabubnagar district of Telangana, India. Materials and Methods: A cross-sectional study was conducted among 3200 participants in Mahabubnagar district of Telangana, India. People aged 16–75 years and both men and women in same proportions were included in the study. Data was obtained by interviewing individual participants regarding various TROH. Results: Out of 3200 participants, 750 (23.44%) had TROH, whereas 2450 (76.56%) did not have any tobacco habits. In 750 participants who had TROH, the habit of tobacco chewing was more common (44.5%) followed by the habit of smoking (42.7%) and both smoking and chewing (12.8%). Conclusion: From the present study, we can conclude that prevalence of TROH is alarmingly high in this district. Oral physicians have an important role in tobacco control as they can directly see the harmful effects of tobacco in the mouth.
  865 184 -
Dermatoglyphics in patients with oral potentially malignant diseases and oral cancer
Prashant B Patil, Jyothsna Jayaram Reddy, Vajendra Joshi, Kotagudda Ramaiah Kiran Kumar, Ravishankar Thayi Shilpa, Pathalapati Satyanarayana
July-September 2017, 29(3):191-194
Aim: To study and compare the dermatoglyphic and palmar prints of subjects without tobacco chewing/smoking habit, with tobacco chewing/smoking habits without lesions, with potentially malignant diseases, and with oral cancer. Material and Methods: A comparative preliminary study was conducted in 60 subjects who visited Department of Oral Medicine and Radiology, Navodaya Dental College and Hospital, Raichur, Karnataka, India. The subjects were divided into four groups; 15 healthy controls (Group A), 15 subjects with tobacco habits and without associated lesions (Group B), 15 subjects with potentially malignant diseases (Group C), and 15 subjects with oral cancer (Group D). Dermatoglyphic and palmar prints were obtained by standard India ink method. Prints were analyzed by single observer twice at an interval of 15 days. The data obtained was subjected to statistical test using SPSS software 19 version. Chi-square test was applied to compare the different patterns among groups, and weighted kappa test for intraobserver variability. Results: Among dermatoglyphic patterns, whorl pattern was increased by 60.66% in Group C and 46% in Group D. Oral cancer subjects showed significant decrease in mean accessory tri-radii digital angle (37.13°). Conclusion: Dermatoglyphics can aid as a screening tool for early detection of high-risk individuals with potentially malignant disorders and oral cancer.
  753 249 -
Aggressive central giant cell granuloma: A rare case report
Sunanda Chavva, Canchi Dhawalraj, Raj K Badam, Nallan CSK Chaitanya
July-September 2017, 29(3):220-222
Giant cell granuloma is a benign proliferative pathological lesion of the bone accounting for less than 7% of lesions of the jaw, predominant in females and most commonly seen in anterior segment of jaws. Mandible is more commonly affected. Radiographically, the lesion may present with diffuse or irregular borders, sometimes leading to expansion of cortex, displacement of teeth, or root resorption. We present a case of aggressive central giant cell granuloma in a 45-year-old female patient in the right mandibular alveolar ridge presenting as an irregular mass causing displacement of teeth.
  709 167 -
The prevalence, radiographic appearance and gender predilection of bifid mandibular condyles in Punjabi population of North India: A retrospective study
Bhawandeep Kaur, Sarfaraz Padda
July-September 2017, 29(3):180-185
Aim: The aim of this study was to determine the prevalence and gender predilection of bifid mandibular condyle (BMC) in Indian population using extra oral radiographs. Material and Methods: Previous record of 800 patients was evaluated by the observers who had undergone extra oral radiography for any diagnostic or treatment purposes between years 2012 and 2014. Results: Out of 800 extra oral radiographs, bifid condyles were found in 28, giving an overall prevalence of 3.5%. Out of 28 bifid condyles, 20 were in females (2.5%) and eight were in males (1.7%). The prevalence of BMC was found to be more in females as compared to the males and this difference was statistically significant with P value equivalent to 0.001. Among 28 bifid condyles, 19 were unilateral (2.4%) and nine were bilateral 1.5%. Chi-square test shows non-significant P value. Conclusion: It is possible that BMC is a more frequent condition than is commonly perceived. However, because of the minimal symptoms associated with this condition, the authors believe that it will remain an incidental finding upon routine radiographic examination, rather than a clinical observation.
  682 183 -
From the desk of the Editor-in-Chief
Vinay Kumar Reddy Kundoor
July-September 2017, 29(3):163-163
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