Development and validation of oral health-related quality of life measure in oral submucous fibrosis.

OBJECTIVE: The aim of this study was to develop and assess the validity and reliability of disease-specific oral health-related quality of life (OHRQoL) instrument for oral submucous fibrosis (OSF). MATERIALS AND METHODS: Items for the OHRQoL-OSF were generated from personal interviews and focus group discussions, the existing questionnaires, reviews of literature and inputs from expert's panel. Item reduction was performed by clinical impact method followed by pretesting of the developed questionnaire. The validity and reliability of the instrument were then examined. RESULTS: Forty-five items were generated from qualitative data and item pooling from various sources. After item reduction, 17 items were finalized with four domain-structure having Eigenvalues greater than 1. OHRQoL-OSF was shown to be valid in distinguishing patients with varying degrees of OSF severity. For the concurrent validity, the observed impact of OSF based on OHRQoL-OSF significantly correlated with Oral Health Impact Profile and global self-ratings of oral health and overall well-being. OHRQoL-OSF and all its domains demonstrated good internal consistency reliability with Cronbach's alpha ˃0.7 and excellent test-retest reliability (ICC = 0.96). CONCLUSION: The first disease-specific OHRQoL-OSF instrument appeared to be highly reliable and valid measure for assessing impact of OSF on life quality.

Assessment of cross-sectional thickness and activity of masseter, anterior temporalis and orbicularis oris muscles in oral submucous fibrosis patients and healthy controls: an ultrasonography and electromyography study.

OBJECTIVES: Oral submucous fibrosis (OSMF) is an insidious chronic disease that is associated with significant functional morbidity and an increased risk for malignancy. It initially affects the lamina propria of the oral mucosa, and, as the disease progresses, it involves the submucosa and deeper tissue, including muscles of the oral cavity, resulting in loss of fibroelasticity. OSMF is a pre-malignant condition mainly caused by areca nut chewing. The aim of this study was to find out the involvement of muscles of mastication and facial expression in patients with OSMF by assessing the cross-sectional thickness and activity of the masseter, anterior temporalis and orbicularis oris muscles by ultrasonography and electromyography and comparing with healthy controls and also to find out any correlation between the ultrasonographic cross-sectional thicknesses of the masseter, anterior temporalis and orbicularis oris muscles with electromyographic activity. METHODS: 40 patients with OSMF were included in the study group, and the patients were divided into four groups on the basis of interincisal mouth opening, i.e. Group I (mouth opening >35 mm), Group II (mouth opening between 30 and 35 mm), Group III (mouth opening between 20 and 30 mm) and Group IV (mouth opening <20 mm). Ultrasonographic cross-sectional thickness and electromyographic activity (amplitude and duration) of the masseter, anterior temporalis and orbicualris oris muscles were recorded in patients with OSMF and 20 controls. Intergroup comparison of ultrasonographic cross-sectional thickness and activity (amplitude and duration) was done, and Pearson's correlation coefficient was applied to find out any relation between ultrasonographic and electromyographic findings. RESULTS: Thickness and activity of the masseter muscle was significantly reduced in Group IV (mouth opening <20 mm) when compared with the control group. The anterior temporalis and orbicularis oris muscles remained unaffected. A positive correlation was observed between the thicknesses of the masseter muscle and the amplitude in Groups I, II and III; the anterior temporalis muscle in Group II and the control group; and the orbicularis oris muscle in Groups II, III and IV. CONCLUSIONS: It was concluded that, among the muscles studied, there was an early involvement of the masseter muscle in patients with OSMF compared with that of other muscles.

Rugae patterns as an adjunct to sex differentiation in forensic identification.

It is widely acknowledged that in some forensic situations there are limitations to identification of the deceased by fingerprints, DNA and dental records. Palatal rugae pattern of an individual may be considered as a useful adjunct for sex determination for identification purposes. The aim of this study was to identify and compare the rugae pattern in Indian males and females, as an additional method of differentiating the sexes in various postmortem scenarios. Dental stone casts of 120 Indians: 60 males and 60 females were obtained. The method of identification of rugae patterns was that of Thomas and Kotze (1983) and Kapali et al (1997) which includes the number, length, shape and unification of rugae. Our study revealed no significant difference in the total number or various length measurements of rugae between the two sexes which conforms to previous results. However, in terms of the different types of rugae shape, the converging type of rugae were statistically greater in number in females whilst the circular type of rugae were statistically greater in number in males, which contrasts with earlier studies. The use of logistic regression analysis (LRA) enabled highly accurate sex prediction (>99%) when all the rugae shapes were analyzed. It may be concluded that rugae pattern through the use of LRA can be an additional method of differentiation between the Indian male and female and assist with the identification process in conjunction with other methods such as visual, fingerprints and dental characteristics in forensic sciences.

Rapidly maturing juvenile ossifying fibroma: a case report.

This report describes an unusual case of juvenile ossifying fibroma (JOF) in a 16-year-old female patient with a clinical presentation of a single large, well-circumscribed swelling on left side of the palate. Ossifying fibromas are normally slow growing benign lesions. Radiographically they can present as radiolucent, mixed or radiopaque lesions depending on the degree of maturity. A period of at least 6 years is required for the lesion to pass from the radiolucent to radiopaque stage. All previously reported cases of JOF have been either radiolucent or mixed density lesions, but our case is unusual because the lesion had shown apparently rapid transformation into an almost complete radiopaque stage at a very early age.

Comparative evaluation of gustatory function between postmenopausal women and age-matched men.

OBJECTIVE: The aim of the study was to compare the gustatory function between postmenopausal women and age-matched men. SUBJECTS AND METHODS: During a period of 4 months, 30 postmenopausal women and 30 age-matched men were prospectively evaluated for gustatory function. Each subject was given a symptoms questionnaire for self-assessment of taste function. Then, whole mouth taste test was performed in which the quality identification and intensity ratings of taste solutions were measured. RESULTS: Regarding correct quality identification, the results were statistically non-significant (P > 0.05). As far as the intensity judgments are concerned, significant difference exists between postmenopausal women and age-matched men. Intensity of taste perception for sucrose was significantly lower in postmenopausal women than intensity of taste perception for other tastes (P < 0.05). One of the noticeable findings is that 15 (50%) postmenopausal women reported a change in dietary habits; all expressed liking for sweeter food. CONCLUSION: Postmenopausal women appeared to have a reduced perception of sucrose, which can alter eating habits, such as intake of more sweet foods, whereas no significant difference is observed in taste perception of NaCl, citric acid and quinine hydrochloride between postmenopausal women and age-matched men. Fifteen (50%) postmenopausal women stated fondness for sweet taste.

Evaluation of the efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy.

OBJECTIVES: The purpose of the study was to evaluate the efficacy of colour Doppler ultrasound (CDUS) to differentiate between benign and malignant cervical lymph nodes. METHODS: During a period of 12 months, 100 untreated patients with clinical evidence of cervical lymphadenopathy (50 patients with clinically suspected malignant/metastatic cervical lymphadenopathy and 50 patients with clinically suspected reactive/benign cervical lymphadenopathy) were prospectively evaluated with CDUS. CDUS was performed for 168 cervical lymph nodes in these 100 patients. Histopathological confirmations were obtained by fine needle aspiration biopsy and/or excisional biopsy. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological/histological features of enlarged cervical lymph nodes was then done. RESULTS: Initially, clinical examination evaluated 143 cervical lymph nodes. CDUS evaluation discovered additional 25 lymph nodes (143+25 = 168). Correlation of patterns of colour Doppler flow signals with pathological diagnosis showed that central flow for benign nodes and peripheral flow for malignant nodes were highly significant parameters (P < 0.01). CDUS has a higher specificity than clinical evaluation, being 94.28% and 58.76%, respectively. Accuracy of the CDUS examination was also definitely higher than clinical evaluation at 92.85% and 63.67%, respectively. CONCLUSIONS: Nodal vascularity can be used to differentiate benign from malignant lymphadenopathy. Proper judicious CDUS examination provides an opportunity to eliminate the need for biopsy/FNAC in reactive nodes.

Orofacial lesions in treated central Indian leprosy patients: a cross sectional study with review of literature.

OBJECTIVE: The goal of this study was to evaluate the orofacial lesions in treated leprosy patients. PATIENTS AND METHODS: 160 treated patients at Maharogi Seva Samithi, Warora were examined clinically. RESULTS: Of 160 patients studied, 140 (87.5%) was of lepromatous types, 100 patients presented with depressed nasal bridge, 64 presented with hypopigmented macules on face. Intraoral examination revealed tongue abnormalities as a most common finding, with fissured tongue being the commonest feature. CONCLUSION: We conclude that though active lesions of leprosy are not present, manifestations such as fissured tongue may remain in treated leprosy patients.

Peeping through heart's window: a case report of Fallots tetralogy.

Tetralogy of Fallot is a congenital heart defect. A combination of four abnormalities in heart allow oxygen rich and oxygen-depleted blood to mix. The resulting low-oxygen blood then circulates through the body. A child with the condition tends to develop slowly, eat poorly and grow slowly and may experience "blue" spells on crying and dyspnea on exertion. A 12 year old child with this congenital heart defect and cleft palate with cleft lip is discussed. Details of the latest diagnostic and treatment procedures are also presented.

Chronic mucocutaneous candidiasis: a case report.

Chronic mucocutaneous candidiasis is a immuno deficiency disorder primarily due to T cell dysfunction characterized by persistent candidal infection of mucous membrane, skin, scalp and nails. Chronic mucous membrane candidiasis has an onset in infancy or childhood; the primary affected site is the oral cavity; however, lesions may occur on trunk, hands, feet and scalp. This paper describes a 12-year-old girl with candidial infection of the oral mucosa and extra oral involvement of fingers, nails, toes and intertragus area.

Placement of prosthesis after total maxillectomy in edentulous patient.

It is very difficult to retain the prosthesis in edentulous patient after total maxillectomy as there are no teeth on the opposite side around which clasp can be applied, however if holes are drilled in obturator and in alveolar ridge and wire is passed through it, prosthesis can be retained satisfactorily.

Community based oral precancerous lesions/conditions : an analysis of associated factors.

Despite overwhelming evidence documenting the carcinogenic effects of tobacco, the per capita consumption of tobacco is alarmingly increasing. A base line survey has been conducted in 4 villages in central India. Tobacco users were identified and interviewed. The oral mucosa was examined for the clinical lesions. Odds ratios for the oral precancerous lesions/conditions were assessed utilising the woolfs method. Out of the 3088 rural pupulation examined, 21.6% were found to be habituated to tobacco. Out of 668 tobacco users, 492 (73.6%) were chewing tobacco with lime. Premalignant lesions (leukoplakia) was observed in 111 cases. Premalignant condition (oral sub mucous fibrosis) was found in 12 cases. Out of 138 adult tobacco chewers who began the habit at or before the age of 14 years, 68.8% chewed 10 grams or more of tobacco per day compared with 42.8% (51 out of 119) of those who started the habit when they were 25 years or older (P< 0.001).

Dental health amongst 11-15-year-old children in Sevagram, Maharashtra.

A study to assess the caries experience and periodontal health in 11-15 year old rural school children was carried out in Sevagram, Wardha. No restoration were found. Of the 802 children, 53.50% had dental caries and 59.35% had gingivitis. The mean DT score +/- SD, was 1.2068 +/- 0.2058. Prevalence of dental caries (p < 0.01) and gingivitis (p < 0.05) was increasing as the age increased. Oral hygiene Index +/- SD, was 0.73 +/- 0.45 in children using toothpaste and brush which was very low in comparison to other material used for teeth cleaning.

Melanotic neuroectodermal tumor of infancy: a case report.

The melanotic neuroectodermal tumor of infancy is a rare benign neoplasm that appears as a rapidly enlarging mass, most commonly in the anterior part of the palate. The tumor is believed to be of neurocrestal origin. The case report of a 3-month-old infant with a rapidly growing melanotic neuroectodermal tumor of infancy is presented. The tumor was surgically excised, and no evidence of recurrence has been found.