Effectiveness of Transcutaneous Electrical Nerve Stimulation Therapy on whole Salivary Flow in Patients with Xerostomia and Healthy Adults

ABSTRACT Objective: To evaluate and compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on whole salivary flow in patients with xerostomia and healthy adults. Material and Methods: Thirty subjects with a history of xerostomia and subjects withunstimulated salivary flow equal to or less than 0.5 ml in 5 min were included in the study group, and 30 healthy subjects were included in the control group. Low forced spitting unstimulated saliva was collected for five minutes in a test tube fitted with a funnel. Then electrode pads of the TENS unit were applied bilaterally on skin overlying the parotid glands and at optimal intensity, stimulated saliva was collected for 5 minutes with the same method in a separate graduated test tube. The salivary flow rate (per minute) was calculated by dividing the amount of collected saliva (volume in mL) by the duration of collection period (5 minutes) and the salivary flow rates prior and after electrostimulation were compared for both groups. The Student's t-test (unpaired and paired) was performed for group-wise comparisons. Results: In study group, the mean unstimulated salivary flow rate was 0.07 ± 0.01 mL/min. There was an 85.71% increase in salivary flow (0.13 ± 0.03 mL/min) during the TENS application and the difference was highly significant (p<0.001). In control group, the mean unstimulated salivary flow rate was 0.37 ± 0.07 mL/min. There was a 21.62% increase in salivary flow (0.45 ± 0.07 mL/min) during the TENS application and the difference was highly significant (p<0.001). An increase in mean salivary flow rate both in males and females after TENS application in both groups (p<0.001) was noted. The difference between unstimulated, stimulated and mean difference in salivary flow rate between males and females was notstatistically significant in both groups (p<0.05). Conclusion: TENS can be an effective therapy in increasing whole salivary flow rates in patients with xerostomia.

Digitization in forensic odontology: A paradigm shift in forensic investigations.

Forensic dentistry deals with proper handling, examination, and evaluation of dental records, which are then presented in the interest of law for justice. It plays a major role in identification of deceased individuals who cannot be identified visually or by other means after mass disasters or crimes. Digital forensics has revolutionized the traditional forensic investigations in terms of acquisition, analysis, and reporting of forensic evidence and its application is becoming common in the mass disasters, earthquakes, and terrorism. Sophistication of software and advent of digital technologies such as computers, computer-aided design computer-aided manufacturing systems, digital records, facial reconstruction, touch-free autopsy, and virtopsy has resulted in quick identification and extraction of a large amount of data with reduced sampling bias. This paper focuses on the evolution of forensic dentistry for effective detection and resolution of medico-legal matters and also highlights the use of comparison microscopes and new robotic tools by few forensic laboratories for automation of deoxyribonucleic acid sampling processes for human identification.

New evolution of cone-beam computed tomography in dentistry: Combining digital technologies.

Panoramic radiographs and computed tomography (CT) play a paramount role in the accurate diagnosis, treatment planning, and prognostic evaluation of various complex dental pathologies. The advent of cone-beam computed tomography (CBCT) has revolutionized the practice of dentistry, and this technique is now considered the gold standard for imaging the oral and maxillofacial area due to its numerous advantages, including reductions in exposure time, radiation dose, and cost in comparison to other imaging modalities. This review highlights the broad use of CBCT in the dentomaxillofacial region, and also focuses on future software advancements that can further optimize CBCT imaging.

Natural agents in the management of oral mucositis in cancer patients-systematic review.

INTRODUCTION: Oral mucositis is most severe complication of cancer therapy characterized by ulcerative lesions of oral mucosa causing negative impact on patient's quality of life. Wide variety of therapeutic agents are available to reduce the lesions of mucositis. Currently, natural herbal remedies have become popular in treating this condition due to fewer side effects than synthetic drugs. AIM: The aim of this systematic review is to compile evidence based studies to evaluate the effectiveness of natural agents in the management of oral mucositis induced by chemotherapy or radiotherapy in cancer patients. MATERIALS AND METHOD: Computerized literature searches were performed to identify all published articles in the subject. The following databases were used: PUBMED [MEDLINE], SCOPUS, COCHRANE DATABASE, EMBASE and SCIENCE DIRECT using specific keywords. The search was for limited articles published in English which were read in full by two authors. RESULTS: Twenty six randomized controlled trials satisfied our inclusion criteria. Most studies showed statistically significant result demonstrating the efficacy of natural agents with minimal side effects except manuka honey which was not tolerated by few patients. CONCLUSION: Natural agents proved to be promising in healing cancer induced oral mucositis but future demands further randomized controlled clinical trials on these agents which should also be focused on drug interactions of the natural remedies.

Psychometric analysis of stress, anxiety and depression in patients with recurrent aphthous Stomatitis-A cross-sectional survey based study.

BACKGROUND: Recurrent Aphthous Stomatitis is a chronic inflammatory immune mediated condition associated with single or multiple, painful recurring ulcers of the oral mucosa. Psychological stress is a common trigger factor identified for the onset and progression of this condition. The study aimed to evaluate stress, anxiety and depression using the Hospital Anxiety and Depression scale and stress by the General Health Questionnaire in subjects with Recurrent Aphthous Stomatitis (RAS). MATERIAL AND METHODS: The study evaluated subjects with a history of Recurrent Aphthous Stomatitis and compared their psychological stress, anxiety and depression alteration to normal subjects. Seventy-five study subjects were divided into three groups; test group 1 (25 subjects) presenting with RAS, test group 2 (25 subjects) with a history of RAS but without oral ulcers, and 25 normal subjects with no history of RAS formed the control group. Chi square and student t test was used to determine the relationship between psychological variables and recurrent aphthous ulcers. RESULTS: Comparison of stress, Anxiety and Depression between test group 1 and control group, test group 2 and control group was not found to be statistically significant (p< 0.05). Hence, differences were evident when individual questions were analyzed for stress anxiety and depression. Stress and depression were more prevalent in females, students and patients with a history of RAS. CONCLUSIONS: Higher depression and stress levels were evident in subjects with a history of RAS. Psychological stress is a utmost trigger factor for the initiation of recurrent ulcers. Overall, test group patients had a more psychological impact on the quality of life than the control group. Key words:Anxiety, depression, General Health Questionnaire, Hospital Anxiety and Depression scale, Recurrent Aphthous Stomatitis, stress.

Dentinogenic ghost cell tumor-a rare case report with review of literature.

Dentinogenic ghost cell tumors (DGCT) are very rare tumors considered as solid variants of calcifying epithelial odontogenic cysts (CEOC). They are locally invasive neoplasms and their main characteristic features are ameloblastoma like odontogenic epithelial proliferation, an aberrant keratinization in the form of ghost cells and dysplastic dentin. DGCT occur as two forms intraosseous (central) and extra osseous (peripheral), of which more aggressive intraosseous variety requires careful monitoring and aggressive local resection to prevent recurrence. This paper discusses a case of a 14-year-old male patient with a complaint of swelling in his right mandibular premolar molar region since 4 months and missing permanent right mandibular canine and first premolar was also observed. The lesion was diagnosed with radiological, cytological and histopathological investigations which revealed it to be rarest entity.

Tooth coronal index and pulp/tooth ratio in dental age estimation on digital panoramic radiographs-A comparative study.

BACKGROUND: Assessment of an age of an individual whether living or dead through teeth is one of the most reliable and simple method to calculate age than skeletal remains especially when they are in poor conditions. OBJECTIVES: The study was carried out with aim of (i) to evaluate reliability of dental age assessment through two different methods for adults i.e. tooth coronal index and pulp/tooth ratio using digital panoramic radiographs and (ii) to compare these methods for their accuracy in age determination. MATERIALS AND METHODS: The digital panoramic radiographs of 180 subjects of Chhattisgarh aged 15-70 years were selected for the study. The measurements were performed on the JPEG images of selected panoramic radiographs by using Adobe Acrobat 7.0 professional software. For tooth coronal index (TCI), height of the crown i.e. coronal height (CH) and the height of the coronal pulp cavity i.e. coronal pulp cavity height (CPCH) of mandibular second premolars and first molars was measured in millimeter (mm) and then TCI was calculated for each tooth and calculated age was compared with chronological age. For pulp/tooth ratio, the measurements of pulp chamber height (PCH) and crown root trunk height (CRTH) were performed on the mandibular first and second molar teeth, the pulp chamber crown root trunk height ratios (PCTHR) of selected tooth were calculated. The acquired data were subjected to Pearson correlation test, unpaired t test and Analysis of Variance (ANOVA) analysis. RESULTS: Results suggested that TCI (mandibular first molar r=-0.178), second premolar (r=-0.187) and PCTHR(mandibular first molar r=-0.921, second molar r=-0.901) correlated negatively with chronological age suggesting decrease in size of pulp cavity. Mandibular first molar was found to be most reliable tooth to estimate dental age. CONCLUSION: The study showed that both PCTHR and TCI have negative association with chronological age. PCTHR showed slightly higher negative correlation and proved as a better tool for age estimation than TCI. Statistically significant differences were observed between chronological and calculated age by both methods thus emphasizing the need for future clinical trials.

Botulinum toxin in the management of head and neck disorders.

Botulinum toxin is a polypeptide protoxin synthesized by Clostridium botulinum that results in localized reduction of muscle activity by inhibiting acetylcholine release at the neuromuscular junction. In 2004, the US Food and Drug Administration approved its application in the treatment of various medical conditions, such as facial wrinkles, strabismus, cervical dystonia, blepharospasm, and hyperhidrosis. Later, its application extended to improving dental esthetics and gummy smile. It was found to be a safe and effective alternative to medical therapy to treat various head and neck disorders that have a neurologic component. In this review, we will highlight the mechanism of action and therapeutic benefits of botulinum toxin in the management of head and neck disorders.

Clinical Effectiveness of Aloe Vera in the Management of Oral Mucosal Diseases- A Systematic Review.

INTRODUCTION: Aloe vera is well known for its medicinal properties which lead to its application in treating various diseases. Its use in treating oral lesions has not been much documented in literature. AIM: Although, systematic reviews on aloe vera and its extracts have been done earlier, but in relation to oral diseases this is the first systematic review. The aim of the present systematic review was to compile evidence based studies on the effectiveness of Aloe vera in treatment of various oral diseases. MATERIALS AND METHODS: Computerized literature searches were performed to identify all published articles in the subject. The following databases were used: PUBMED [MEDLINE], SCOPUS, COCHRANE DATABASE, EMBASE and SCIENCE DIRECT using specific keywords. The search was limited to articles published in English or with an English Abstract. All articles (or abstracts if available as abstracts) were read in full. Data were extracted in a predefined fashion. Assessment was done using Jadad score. RESULTS: Fifteen studies satisfied the inclusion criteria. Population of sample study ranged from 20 patients to 110 patients with clinically diagnosed oral mucosal lesions. Out of 15 studies, five were on patients with oral lichen planus, two on patients with oral submucous fibrosis, other studies were carried on patients with burning mouth syndrome, radiation induced mucositis, candida associated denture stomatitis, xerostomic patients and four were on minor recurrent apthous stomatitis. Most studies showed statistically significant result demonstrating the effectiveness of Aloe vera in treatment of oral diseases. CONCLUSION: Although there are promising results but in future, more controlled clinical trials are required to prove the effectiveness of Aloe vera for management of oral diseases.

Antibacterial Effect of Aloe Vera Gel against Oral Pathogens: An In-vitro Study.

INTRODUCTION: Natural herbal remedies have shown promising anti-microbial property and fewer side effects compared to synthetic anti-microbial therapy. Aloe Vera is a medicinal plant used for management of various infections since ancient times as it has anti-inflammatory, anti-microbial, and immune-boosting properties. AIM: The aim of the present study was to determine the anti-microbial and inhibitory activities of various concentration of Aloe Vera Gel (AVG) against oral pathogenic bacteria. MATERIALS AND METHODS: Subgingival calculus and aspiration of periapical abscess and periodontal abscess was done in 20 patients and the sample transferred to thioglycolate broth, which was incubated in Mutans Sanguis agar, blood agar and cultured in anaerobic gas chamber. The colonies formed were identified further by gram staining methods and biochemical fermentation tests (IMViC). Each isolated colony of identified bacteria were cultured separately in Muller-Hilton broth and incubated at 37°C for 24 hours. Anti-microbial activity of the AVG was tested by the disc diffusion method and minimum inhibitory concentration was determined by broth micro-dilution method. RESULT: Various staining and biochemical tests confirmed that the sample contained Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans), Clostridium bacilli (C. bacilli), Streptcoccus mutans (S. mutans) and Staphlococcus aureus (Staph. aureus). AVG showed anti-bacterial property at 100% and 50% concentration ('t' value = 7.504, p-value <0.001). At lower concentration there was no effect against the bacteria. At 100% AVG concentration, zone of inhibition measured was 6.9mm in A. actinomycetemcomitans, 6.3mm in C. bacilli, 6.8mm in S. mutans and 6.6mm in Staph. aureus. The standard drugs were also used to compare anti-bacterial property of AVG. Result showed that higher concentration (100%, 50%) of AVG has comparable zone of inhibition with Ofloxacin (5mcg) and Ciprofloxacin (30mcg). CONCLUSION: AVG at higher concentration showed anti-bacterial property and can be used as a promising adjunct for oral health care.