Comparison of Buccal and Lingual-Based Triangular Flap During Mandibular Third Molar Extraction for Reducing Postoperative Complications: A Randomized Controlled Trial.

Background: Surgical removal of the mandibular third molar requires reflection of the mucoperiosteal flap. Several studies have suggested different varieties and innovative designs for flap reflection. We have designed a randomized controlled trial (RCT) to check the feasibility of two flap designs: lingual-based triangular flap (LBTF) and buccal-based triangular flap (BBTF) by calculating the duration of surgery and evaluating postoperative complications such as pain, swelling, and trismus. Materials and Method: It was a non-inferiority parallel-group RCT. The trial was registered in the Control Trial Register of India (CTRI/2021/10/037182) and was performed according to Consolidated Standards of Registered Trial (CONSORT) guidelines. Intraoperative surgery time and postoperative pain, swelling, and trismus were measured and analyzed by a two-sample t test. The Chi-square test was used to measure gender distribution in the study. Result: Of the total of 88 required subjects, gender distribution and performed surgical time were statistically insignificant with a p-value of 0.76 and 0.48, respectively. The pain was significantly higher in the LBTF group in the 5th and 7th postoperative days with a p-value of 0.02 and 0.028. The swelling was statistically higher during all the follow-ups except for the 28th day in the LBTF group with values of 0.006, 0.002 and 0.003, respectively. There was no significant difference in inter-incisional distance (IID) between the groups during postoperative check-ups. Conclusion: LBTF shows no edge over BBTF during mandibular third molar disimpaction.

Morphometric Analysis of Sella Turcica and a Proposed Novel Sella Turcica Index - A Digital Lateral Cephalometric Study.

Background: The sella turcica is a structure readily seen on lateral cephalograms and sella point is routinely traced for various cephalometric analyses. The aim of the present study was to evaluate the morphometric variation in size and shape of sella turcica via lateral cephalogram. The objectives were to introduce a novel sella turcica index (STI) and assess its reliability that could be helpful in gender determination. Materials and Methods: A total of 80 lateral cephalograms of the patients of age group 10-30 years were included for the study. The morphological variations of the sella turcica was done based on the classification given by Axelsson et al. (2004). The length, depth and perimeter of the sella turcica was measured and STI derived and calculated. The data was further subjected to discriminant analysis to validate the gender outcome. Reliability of the novel index was determined by calculating the sensitivity and specificity. Results: The overall most common morphological type of sella turcica was Type A (56.25%) followed by Type B (18.75%) and Type E (13.75%). The mean perimeter and depth of sella turcica was higher in females whereas the mean length of sella turcica was higher in males. The mean STI was higher in males and statistically highly significant. The sensitivity and specificity of this index was 72.5% and 90% respectively. Conclusion: A significant relationship was observed between the morphometric measurements of sella turcica and gender. STI could be of great help as a reliable tool for personal identification in forensic sciences. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-04082-9.

Increased vitamin B12 levels in patients with oral cancer.

Background: Oral cancer (OC), which happens to be one of the leading causes of death in the Indian population, is caused primarily by tobacco use, although other factors are also responsible. Serum vitamin B12 is important in maintaining the immune system and also repairing the damaged deoxyribonucleic acid (DNA) of cells. The aim of our study was to evaluate the serum B12 levels in patients with OC and look for any association between the two. Methods: One hundred subjects were selected for the study and divided into two groups: group A having OC (including cases of oral squamous cell carcinoma (OSCC), verrucous carcinoma and oropharyngeal carcinoma; 50 patients) and group B had age- and gender-matched healthy controls (50 healthy volunteers). Patients diagnosed clinically and histopathologically confirmed as OC were selected for the study. All the patients were subjected to haematological investigation to assess serum vitamin B12. Results: Males subjects in the 4th and 5th decades of life were predominantly affected. Serum vitamin B12 was significantly increased in OC patients when compared with controls, which was statistically significant. The mean serum vitamin B12 was slightly higher in males than in females, which was statistically non-significant. Conclusion: Our study found increased vitamin B12 levels in OC patients, and it was statistically significant.

Curcuma Longa in the Treatment of Symptomatic oral lichen planus: A non-randomized controlled trial.

Introduction: Oxidative stress has been suggested as pathogenesis of oral lichen planus (OLP), implicating the vital role of antioxidants in its treatment. Curcumin, naturally found in turmeric has potent antioxidant and inflammatory properties and can be useful in reducing spread and subsiding burning and pain sensation in patients with OLP. The present study was done to evaluate the role of curcumin in the treatment of symptomatic OLP compared with the control group. Materials and Method: A total of 40 patients with symptomatic OLP were divided into 2 groups of 20 subjects each. Group A was treated with curcumin oral gel and a multivitamin capsule containing zinc, whereas Group B was given multivitamin containing zinc only. Patients were followed-up twice, that is, after 1 month and 3 months. A modified REU (reticulation/keratosis, erythema and ulceration) score for spread and Visual analogue scale for pain/burning sensation was used and the difference of score was calculated by t test. Results: During F1 period, 0.61 (Group A) and 0.19 (Group B) points improvement and in F2 period, the REU score further increased significantly to 1.36 (Group A) and 0.43 (Group B), respectively. The mean score reduction in Visual analogue scale during F1 period was 1.71 and 0.71, which further increased significantly to 2.88 and 1.24 during F2 period in Groups A and B, respectively. Conclusion: Curcumin, an active ingredient of turmeric is commercially available in gel form to treat different oral lesions and significantly effective in reducing spread and providing symptomatic relief in OLP without any adverse effects.

Skin Prick Test in Educating Population of Rural Part of Eastern India and Promoting Health in Allergic Rhinitis: An Epidemiological Study.

Skin prick testing (SPT) is one of the most extensively used screening and diagnostic tool in contemporary allergy practice. It plays a vital role in diagnosis of type 1 hypersensitivity reaction in patients with rhinoconjunctivitis, asthma, urticaria, anapylaxis, atopic eczema and suspected food and drug allergy. The present study was undertaken to evaluate the pattern of allergenicity of aero-allergens and mites in the rural part of Eastern India using SPT. A total of 50 subjects (25 males and 25 females) were selected for the present study. Complete history and clinical symptoms were recorded according to ARIA guidelines. All the patients were subjected to SPT using 35 allergens. Positive sensitization was recorded in terms of frequency and measured in terms of maximum wheal diameter. The most common allergens observed were Gynandropsis gynandra (positive sensitization in 33 cases with wheal of 4.18 mm diameter) followed by Dermatophagoides farinae (25 cases, 6.12 mm diameter), Ageratum conyzoides (19 cases, 3.36 mm diameter), Cannabis sativa (17 cases, 3.52 mm diameter) and Cassia occidentalis (17 cases, 3.58 mm diameter). When the sensitivity was being compared between the most common allergens, statistical significance was obtained for Ageratum conyzoides and Cannabis sativa with Dermatophagoides farina (p value-0.0001). SPT is a reliable, minimally invasive procedure with immediate results useful in detection and promoting health of patients suffering from allergic rhinitis.

Prevalence and pattern of maxillofacial injuries and treatment outcome after bear attacks in Jharkhand population.

Introduction: Sloth bear, a native species of Indian subcontinent, has a population estimate of 1200-1500 in Jharkhand. Human habitats in proximity to forest reserve cause frequent human-bear interactions and thus bear attack injuries. Face is the most common site affected. This is a prospective study performed to evaluate the incidence and pattern of maxillofacial trauma after bear attack and the outcome of the treatment provided to them. Materials and Methods: Patients with bear attack injuries reporting to the outpatient department were recruited for the study. The incidence was recorded in terms of time, month, and site. Details of maxillofacial wounds and fractures were noted. The variables used to analyze the outcome of the treatment were ugly scar, facial asymmetry (eyelid, nose, cheek, and lips), facial nerve paralysis, loss of vision, and alopecia. Results: Majority of the cases were reported in April and March. Victims were from Ranchi 4 (26.6%), Gumla 3 (20%), Lohardaga 2 (13.3%), Latehar 2 (13.3%), Simdega 1 (6.6%), Ramgarh 1 (6.6%), Khunti 1 (6.6%), and West Singhbhum 1 (6.6%) districts of Jharkhand. Zygoma (10) was the most affected fractured bone, followed by frontal (9) and mandible (6). Minor ugly scar was found in 14 (93.3%) of the patients, postoperative facial deformity in 12 (80%), unilateral facial paralysis in 2 (13.3%), and alopecia patch in the scalp in 1 (13.3%). Conclusion: Spring and early summer are the breeding seasons of sloth bears in Jharkhand. Mahua petal which attracts the wild bear falls from trees during these months causing such human attacks. Loss of vision describes the mutilating nature of bear attack.

Incidence of Maxillofacial Trauma Amid COVID-19: A Comparative Study.

Introduction: Pandemic caused by novel coronavirus has created an unprecedented situation of lockdown in India. This retrospective study was undertaken to evaluate the impact of COVID-19 restrictions on cases of maxillofacial trauma and its etiologic variation by comparing it with the previous year archived data. Materials and Methods: Patients with maxillofacial fracture visiting during the lockdown period (Phase) were compared to the patient's record during the same time period in the year 2019 (Control). They were subcategorised based on the etiology of trauma, i.e., road traffic accident (RTA), self-fall, physical assault and animal attacks. Age and gender variations were also assessed. Degree of significance was calculated using t test and p value obtained. Result: Mean age of trauma patients during lockdown and control period was 32.66 and 27.93 years, respectively. Number of cases of overall trauma had significantly decreased. Cases of RTA and self-fall were 22 and 4 in lockdown compared to 135 and 16 during control phase. Cases of physical assault increased by 50%, i.e., from 9 to 6 on comparison of both the phases. Animal attack maxillofacial injuries were 2 in each group. Conclusion: RTA and subsequent drop in numbers of maxillofacial trauma can be shown as the benefit of lockdown nonetheless on the other side increase in number of physical assaults also shows how isolation and restrictions have psychological negative impact on society.

Reduced levels of serum vitamin B12 in symptomatic cases of oral lichen planus: A cross-sectional study.

OBJECTIVES: Oral Lichen Planus (OLP) is an immune mediated disease and causes oro-mucosal burning sensation that reduces food intake and hence resulting in nutritional deficiency. The present study was done to evaluate the serum levels of vitamin B12 in patients with symptomatic OLP and establish an association between reduced B12 levels and OLP. MATERIALS AND METHOD: Serum vitamin B12 was assessed in 60 symptomatic cases of oral lichen planus and 60 healthy age and gender matched controls. RESULTS: Serum vitamin B12 was significantly reduced (p value < 0) in patients with oral lichen planus when compared to healthy individuals. 43.33% of cases (26 out of 60) had B12 levels less than 187 pg/ml. CONCLUSION: Oral lichen planus causes serum vitamin B12 deficiency. Vitamin B12 is linked with normal functioning of immune and neuropsychologic system which has a role to play in etiopathogenesis and malignant transformation of oral lichen planus.

Prevalence of periodontitis and caries on the distal aspect of mandibular second molar adjacent to impacted mandibular third molar: A guide for oral health promotion.

OBJECTIVES: Pericoronitis of mandibular third molars is commonly encountered in our day to day practice. Most of the case extraction becomes mandatory. This study was carried out to find the incidence of periodontitis on the distal aspect of the second molar adjacent to impacted third molar. MATERIALS AND METHODS: A total of 400 patients were included in the study. Patient selection was randomly done. Whoever came with a chief complaint of pain in the third molar area were included in the study. They were evaluated both clinically and radiographically with an orthopantomogram. Patients' age, gender, type of impaction, presence or absence of bone loss, type of bone loss, and presence or absence of caries was evaluated radiographically and noted. RESULTS: Periodontitis was observed in 39% of the cases and caries in 26% of the cases. CONCLUSIONS: These percentages are alarming and could be used to prophylactically extract the impacted third molars and thereby promoting the oral health of the individual.

Comparative Evaluation of 3d Locking Versus Non-Locking Titanium Miniplates in the Treatment of Mandibular Fracture.

The introduction of 3-dimension systems for the treatment of mandibular fractures and continuity has offered certain advantages over other plating system. The present study was undertaken to compare 2.0 mm 3D titanium locking and non-locking miniplates in the management of mandibular fractures. A prospective study was conducted on 40 patients (20 in each group) of mandibular fractures treated by open reduction and internal fixation. Group A patients underwent osteosynthesis using 2.0 mm 3-D titanium locking miniplates while Group B used non-locking miniplates. Subsequent follow-up was assessed for pain, swelling, infection, paresthesia, malocclusion, mobility between fracture fragments and hardware failure in these patients. Functional occlusion was achieved postoperatively in all the patients. At 12 weeks of the time intervals, significant pain was observed in group B. At 1 week interval, 6 (30%) patients in both groups reported with swelling. Only one (10%) patient in each group had paresthesia which got resolved gradually over a period of 3 months. Infection was observed in only 2 (10%) patient in Group B at 3 months. Only 2 (10%) patient in Group B had hardware failure at 3 months interval. Statistically, there was no significant difference between both the groups at any time interval (p > 0.05). 3D titanium locking miniplates are effective in the treatment of mandibular fractures with lesser overall complications as compared to non-locking miniplates.

Serum Immunoglobulins as Diagnostic Markers in Smokeless Tobacco Users for Prevention of Oral Potentially Malignant Disorders.

BACKGROUND: Smokeless tobacco (SLT) remains a threat amongst a large population across the globe and particularly in India. Among the 28 known carcinogens in SLT, tobacco-specific nitrosamines are considered to be the most potent and it has been shown to cause immunomodulatory effects making the individual susceptible to various diseases. Immunoglobulins (Ig) form the defense against pathogens at the mucosal surfaces and SLT might interfere with its production and function. Therefore, the present study was undertaken to estimate the level of IgG and IgA in SLT patients and establish a correlation between them. MATERIALS AND METHODS: A total of 60 subjects (34 khaini users and 26 gutkha users) were selected for the study. Complete demographic data and history was taken and clinical examination done to evaluate any oral mucosal changes. Venous blood samples were taken to analyze the serum immunoglobulin parameters. RESULTS: Significant changes were observed in the serum IgA and IgG level in SLT users. Serum IgG level had a positive correlation whereas serum IgA had a negative correlation with the form of SLT and were statistically insignificant. CONCLUSION: The present study might serve as an early diagnostic tool and helpful in creating awareness on the hazards of using SLT among the Indian population as a despicable substitute to smoking tobacco. It also confers an imperative role into SLT mediated effects on immunoglobulins levels.

Primary closure after surgical extraction of mandibular third molar with or without tube drain: A prospective study.

INTRODUCTION: The surgical removal of impacted third molars is considered one of the most frequent procedures in oral and maxillofacial surgery. The utilization of drain is suggested for the reduction of postoperative complications, because it permits the drainage of the fluids located in the tissue spaces. MATERIAL AND METHODS: A prospective randomized clinical study was conducted with 30 patients each in two groups undergoing surgical extraction of mandibular third molars with and without drain. For the group with drain, a small no. 8 size rubber drain was used. Patients were evaluated for postoperative pain, swelling, and trismus. RESULT: The trismus was greater (highly significant with P < 0.001) on the first, third, and seventh postoperative days in the control group. When swelling was being evaluated, highly significant statistical difference was observed between the two groups on the first and third postoperative days (P < 0.001), but on the seventh postoperative day, there was no statistically significance (P > 0.05). On comparison of postoperative pain, there was no statistically significant difference between any follow up days. CONCLUSION: Use of tube drain is effective in reducing the postoperative discomfort in terms of pain, swelling and trismus after surgical removal of impacted mandibular third molar.

Liver and thyroid profile in educating smokeless tobacco users and its role in oral health promotion.

BACKGROUND: Smokeless tobacco (SLT) usage contributes about 40% of the total tobacco used in India. Among the 28 known carcinogens in SLT, tobacco-specific nitrosamines are considered to be the most potent. This has challenged the metabolic condition leading to a rise in the inflammatory status, hepatic injury, and apoptosis of the liver and thyroid tissues. Therefore, the present study was undertaken to evaluate the adverse effects of SLT on the liver and thyroid and establish a correlation between them in Jharkhand population. MATERIALS AND METHODS: A total of 100 individuals (50 SLT users and 50 healthy individuals) were selected for the study. A complete history was obtained, and clinical examination was done to evaluate any oral mucosal changes. Venous blood samples were taken to analyze the liver function test and thyroid profile. RESULTS: Significant changes were observed in the liver enzyme levels and thyroid profile in SLT users when compared to healthy controls. All the parameters of liver function test had a positive correlation with the form of SLT, whereas thyroid profile had a negative correlation. CONCLUSION: This study might be helpful in creating awareness on the hazards of using SLT among the Indian population as a despicable substitute to smoking tobacco. It also acts as a diagnostic tool and warning alarm in chronic tobacco users.

Determination of Serum IgE and Eosinophils as a Diagnostic Indicator in Allergic Rhinitis.

Allergic Rhinitis is a chronic, inflammatory disease induced by an IgE-mediated reaction and identified clinically by the presence of symptoms of nasal discharge, itching, sneezing and nasal congestion. The aim and objectives of the study was to determine serum IgE and eosinophil levels in patients with allergic rhinitis and healthy controls, men and women, different age groups and to establish a correlation between serum IgE and eosinophil. A retrospective study was conducted in the outpatient department of ENT in ICARE institute of medical sciences and research, Haldia during the time span of March 2016 to February 2017. A total of 155 subjects (113 cases and 42 controls, 74 men and 81 women) of age 1 month-75 years were selected for the study. Blood samples obtained were analyzed to determine serum IgE and eosinophil levels and the results were subjected to statistical analysis using STATA 12 software. The mean values and standard deviation of the serum log IgE and eosinophil levels in cases and healthy controls, men and women, various age groups were obtained and tabulated using paired t test and MV test. Pearson's correlation was performed to establish a relationship between serum log IgE and eosinophil levels. The mean values of serum log IgE and eosinophil levels were found to be higher in cases (log IgE-5.65, IgE-814.36 IU/ml, eosinophil-4.49%) when compared to controls (log IgE-4.43, IgE-96.62 IU/ml, eosinophil-2.36%). Men predominance was seen in mean serum log IgE levels (IgE-1018.5 IU/ml, log IgE-5.92) whereas women predominance in mean eosinophil counts (4.96%) in allergic rhinitis. A weakly positive correlation of 0.194 was established between serum log IgE and eosinophil levels. Estimation of serum IgE and eosinophil can serve as a simple, non-invasive and reliable investigative tool in the diagnosis of allergic rhinitis.

Smokeless Tobacco and Its Adverse Effects on Hematological Parameters: A Cross-Sectional Study.

BACKGROUND: Smokeless tobacco (SLT) as a drug substance has been used throughout the world although it has dangerous effects on human health. Among the 28 known carcinogens in SLT, tobacco-specific nitrosamines are considered to be the most potent. This has challenged the metabolic condition leading to a rise in the inflammatory status, increased apoptosis, and red blood cell (RBC) membrane damage. Therefore, the present study was undertaken to evaluate the adverse effects of SLT on hematological parameters and establish a correlation between them. MATERIALS AND METHODS: A total of 100 subjects (50 SLT users and 50 nonusers) were selected for the study. Complete demographic data and history were taken and clinical examination was done to evaluate any oral mucosal changes. Venous blood samples were taken to analyze the hematological parameters. RESULTS: Significant changes were observed in the complete blood profile in SLT users when compared to nonusers. All the hematological parameters had a negative correlation with form of SLT except for total leucocyte count which had a positive correlation. CONCLUSION: The current study confers an imperative role into SLT mediated effects on a complete hemogram and might be beneficial in spreading awareness against its usage. It also serves as a forewarning alarm among the population consuming SLT as an alternative to smoking tobacco.

Knowledge, awareness, and attitude regarding teledentistry among postgraduate dental students of Kanpur city, India: A questionnaire study.

BACKGROUND: Teledentistry is a rapidly forming subset of dentistry being used extensively in urban as well as rural areas addressing problems related to cost-effectiveness, efficiency, and quality in delivering oral health-care services. The present study aims to evaluate the knowledge, awareness, and attitudes regarding teledentistry among the dental postgraduates of Kanpur city, India. MATERIALS AND METHODS: A cross-sectional descriptive survey was carried out on a total of 120 postgraduate students. A pretested, self-structured, close-ended questionnaire was administered that consisted of 20 questions were included. The data collected was compiled in a systemic manner and analyzed in terms of frequency (yes/no). RESULTS: Only 77 postgraduate students responded, and it was observed that 74.4% of students had knowledge regarding teledentistry and 79.2% of students contemplated to practice teledentistry in the future. The overall awareness and attitudes regarding teledentistry were found to be 71.7%. CONCLUSION: The knowledge, awareness, and attitudes were found to be satisfactory among the postgraduate dental students.

Is panoramic mandibular index a reliable marker in the evaluation of bone mineral density and sexual dimorphism??

INTRODUCTION: Osteoporosis is a silent, progressive, and chronic disease affecting bones of the adults, especially postmenopausal women. Its effect on mandibular bone quality has also been described by some authors in men inferring that gender and age are factors that may influence bone mineral density (BMD) and prognosis. The panoramic radiograph is used widely for the early detection of osteoporosis. The present study was undertaken to evaluate whether the panoramic mandibular index (PMI) is useful for BMD and sexual dimorphism. MATERIALS AND METHODS: A total of 60 patients (30 males and 30 females) in the age group of 25-40 years were selected for the study. Orthopantomograph was taken and PMI determined with the help of Sidexis next-generation software. All the measurements were performed by four observers and data subjected to the statistical analysis. RESULTS: The mean superior PMI was 0.22-0.27, and the inferior PMI was 0.28-0.34. The mean superior and inferior linear measurements from the mental foramen were higher in males than females and statistically significant. The mean mandibular cortical width was 3.8-4.7 mm but did not show much gender difference. CONCLUSION: PMI is a reliable indicator for determining BMD but is not much influenced by gender variation.

A Novel Computer-Assisted Method of Bite Mark Analysis for Gender Determination.

Background: Bite mark analysis is an imperative area of forensic odontology and considered the commonest form of dental evidence presented in the criminal court. The process of comparing bite marks with a suspect's dentition includes analysis and measurement of shape, size, and position of an individual's teeth. The present study was aimed to evaluate the bite marks of males and females using a novel indirect computer-assisted method and explicate its application in forensic odontology. Materials and methods: 60 subjects (30 males and 30 females) with normal occlusion were included in the present study. Bite registrations were obtained with help of modelling waxes, and positive replicas were prepared with dental stone and barium powder. Intraoral periapical radiographs were taken for the same. The radiographs obtained were scanned and analyzed by measuring tools using Sidexis Next Generation software. Intercanine distance (ICD), line AB, angle ABX, and angle ABY were measured. The Kruskal-Wallis test was performed to compare the bite marks of males and females. Results: The mean ICD of males and females was found to be 32.95 mm and 29.84 mm, respectively, and was statistically highly significant with a p value <0.001. The mean ICD, line AB, and angle ABX were found to be higher in males when compared to females. Conclusion: Analysis of bite marks using this novel computer-assisted method is a simple, reliable, easily reproducible, and economical technique with confidentiality of the identity of the participants involved.

Infantile Alexander Disease: Case Report and Review of Literature.

Alexander Disease (AD) is an autosomal dominant leukodystrophy and occurs predominantly in infants and children. It usually results in death within ten years after onset. Among the four subtypes, infantile form comprises the most of affected individuals. It presents in the first two years of life, typically with progressive psychomotor deficiency, loss of developmental milestones, seizures, and pyramidal signs. Clinical and magnetic resonance image findings usually establish diagnosis of AD. Here, we present a case of Infantile AD with characteristic clinical and radiological features.

Cephalometric Analysis for Gender Determination Using Maxillary Sinus Index: A Novel Dimension in Personal Identification.

Purpose. Radiography is important in forensic odontology for the identification of humans. The maxillary sinus is the largest of the paranasal sinuses and first to develop. Sinus radiography has been used for identification of skeletal remains and determination of gender. Hence, the aim and objectives of the present study were to establish a new method for gender determination using maxillary sinus index from lateral cephalometric radiographs and to establish the reliability of maxillary sinus for gender determination. Methods. A total of 50 adult digital lateral cephalometric radiographs (25 males and 25 females) were included in the study. The maxillary sinus analysis was performed on these radiographs using the height and width measurement tools of Sidexis XG software. Maxillary sinus index was calculated, discriminant function analysis performed, and discriminant equation derived for determination of gender. Results. The mean maxillary sinus height and width were found to be higher in males, whereas the maxillary sinus index was greater in females. The discriminant function analysis derived in the study was able to differentiate the sex groups with sensitivity of 68% and specificity of 76%. Conclusions. From the results of the present study, it may be concluded that morphometric analysis of maxillary sinus can be used as a reliable tool in gender determination.