Diagnosing Emergencies in Undifferentiated Acute Vertigo.

Background: Patients with undifferentiated acute dizziness usually report with rapid onset of severe, often disabling illusion of movement with many other features. This accounts for roughly 50 to 100 million visits globally in emergencies annually. The causes may be numerous. Thus, the perplexed clinician needs to pursue advanced diagnostic imaging and unnecessary hospital admission in these patients. Aims and objectives: This study aims to assess the validity of HINTS Plus (head impulse test-nystagmus-test of skew + hearing assessment) test in diagnosing central causes of vertigo in patients with acute undifferentiated vertigo presenting within 72 h of onset of symptoms. The other objectives are to understand epidemiology and describe the assessment and management of these patients. Method: The data of 82 patients who visited the clinic within 72 h of the onset of symptoms as mentioned earlier during two years from August 2021 to 2023 at Ankush Hospital was stratified and analyzed. The outcome is reported here. Results: Among 82 patients, peripheral vestibular cause accounts for 84%. 12% were due to ischemic stroke and cardiovascular reasons. The sensitivity of HINTS Plus in isolating central acute vestibular vertigo was 100%, and the specificity was 95.6%. Conclusion: The risk for central and cerebrovascular causes of dizziness increases in the elderly with the presence of neurological signs and other comorbidities. The sensitivity and specificity of HINTS plus (4 Components) is very high in identifying central causes of undifferentiated acute vestibular in the first 72 h of onset of symptoms when undertaken by a trained clinician. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04493-2.

Comparative evaluation of root surface morphology after planing and root conditioning with tetracycline hydrochloride--an in vitro SEM study.

BACKGROUND AND OBJECTIVES: Tetracycline hydrochloride has been shown to produce changes on periodontally involved root surfaces that can potentially enhance periodontal regeneration. This in vitro study was carried out to compare the root surface changes after scaling and root planing alone, and scaling and root planing followed by application of 100 mg/ml tetracycline hydrochloride under the Scanning Electron Microscope. MATERIALS AND METHOD: Fifteen periodontally compromised freshly extracted single-rooted teeth were thoroughly cleaned. The teeth were then sectioned into thirty blocks and divided into two groups. Group I (control) consisted of teeth which received scaling and and root planing alone and Group II received scaling and root planing followed by application of 100 mg/ml tetracycline hydrochloride under the Scanning Electron Microscope. RESULTS: Tetracycline hydrochloride solution showed statistically highly significant removal of smear layer at 100 mg/ml solution (p < 0.001) and enlargement of dentinal tubule diameter (1.46 microm). CONCLUSION: It can be concluded that tetracycline hydrochloride at concentration 100 mg/ml effectively removes the smear layer and enlarges the dentinal tubules.

Bond strength and interfacial morphology of different dentin adhesives in primary teeth.

OBJECTIVE: To evaluate the interfacial morphology and the bond strength produced by the three-step, two-step and single-step bonding systems in primary teeth. MATERIALS AND METHODS: Occlusal surfaces of 72 extracted human deciduous teeth were ground to expose the dentin. The teeth were divided into four groups: (a) Scotchbond Multipurpose (3M, ESPE), (b) Adh Se (Vivadent), (d) OptiBond All-in-One (Kerr) and (e)Futurabond NR (VOCO, Cuxhaven, Germany). The adhesives were applied to each group following the manufacturer's instructions. Then, teeth from each group were divided into two groups: (A) For viewing interfacial morphology (32 teeth), with 8 teeth in each group, and (B) For measurement of bond strength (40 teeth), with 10 teeth in each group. All the samples were prepared for viewing under SEM. The statistical analysis was done using SPSS version 15.0 software. RESULTS: Observational measurement of tag length in different adhesives revealed that Scotchbond had the most widely spread values with a range from 12.20 to 89.10µm while OptiBond AIO had the narrowest range (0 to 22.50). The bond strength of Scotchbond Multipurpose was significantly higher (7.4744±1.88763) (p<0.001) as compared to Futurabond NR (3.8070±1.61345), Adhe SE (4.4478 ± 1.3820) and OptiBond-all-in-one (4.4856±1.07925). CONCLUSION: The three-step bonding system showed better results as compared to simplified studied bonding systems.

Combined endodontic therapy and periapical surgery with MTA and bone graft in treating palatogingival groove.

A 37-year-old male patient reported to our department with chief complaint of pain and pus discharge from the labial marginal gingiva in the maxillary right lateral incisor region since last 4 months. Clinically, the tooth was hypersensitive to percussion and palpation but failed to respond to pulp sensitivity testing. After periodontal probing, a palatal groove was observed which started at the cingulum and travelled apically and laterally, associated with a pocket depth of 8 mm. Occlusal radiograph showed circumscribed radiolucency measuring 5 mm×7 mm in diameter at the apex of the tooth. A clinical diagnosis of chronic apical abscess was established. The case was treated with a combination of mineral trioxide aggregate and bone graft. At the 6-month follow-up visit, the tooth showed progressive healing without sinus track and sulcular bleeding.

Comparative evaluation of the effect of different bonding agents on the ultramorphology of primary tooth dentin and the resin dentin interface.

AIM: To analyze and compare the changes in the ultramorphology of dentin in primary teeth using different bonding agents and to study the resin/dentin interface produced by them. MATERIALS AND METHODS: Occlusal surfaces of 50 extracted human deciduous teeth were grounded to expose the dentin. The teeth were divided into two groups (A) For viewing surface morphology- 18 teeth divided into four groups: (a) for viewing dentinal morphology (3 teeth), (b) Scotchbond multi-purpose (5 teeth), (c) Adhe SE (5 teeth), (d) Futurabond (5 teeth). (B) For viewing interfacial morphology- 32 teeth divided into four groups with 8 teeth each: (a) Scotch Bond Multipurpose (3M, ESPE),), (b) Adhe Se (Vivadent), (c) Optibond All-in-One (Kerr), (d) Futurabond NR (VOCO, Cuxhaven, Germany). The adhesives were applied to each group following the manufacturer's instruction. All the samples were then prepared for viewing under SEM. RESULTS: The photographs were graded using a four-step (0-3) scale method proposed by Ferrari et al. For Scotchbond, 12 (75%) were graded as 2 Grade 3 was observed in only 1 observation in the entire lot of materials. The results obtained for Adhe SE and Optibond AIO were similar, i.e. in 5 (31.25%) observations each the scores were 0 and in 11 (68.75%) observations each the scores were 1. In case of Futurabond, 3 (18.75%) observations were graded as 0 and 13 (81.25%) were graded as 1, thus showing a mean score of 0.81±0.40. CONCLUSION: Three- step bonding agent results in the complete removal of smear layer. While the self- etch approach is not efficient in removing the smear layer and opening of the dentinal tubules. The longest resin tags with lateral branches were seen in two groups- Scotch bond multipurpose and Optibond FL.

Butterfly rash with periodontitis: A diagnostic dilemma.

Rashes can occur in any part of the body. But rash which appears on face has got both psychological and cosmetic effect on the patient. Rashes on face can sometimes be very challenging to physicians and dermatologists and those associated with oral manifestations pose a challenge to dentists. Butterfly rash is a red flat facial rash involving the malar region bilaterally and the bridge of the nose. The presence of a butterfly rash is generally a sign of lupus erythematosus (LE), but it can also include a plethora of conditions. The case presented here is of a female with butterfly rash along with typical bright red discoloration of gingiva. The clinical, histopathological and biochemical investigations suggested the presence of rosacea.