Establishing a new staging system for oral submucous fibrosis and correlation of the proposed staging system to traditional histopathological grading: A clinico-histopathological study.

BACKGROUND & OBJECTIVES: Oral submucous fibrosis (OSF) is a potentially malignant disorder of the oral cavity leading to reduction in mouth opening. Mouth opening assessment is used as one of the methods to assess the severity of the disease. In this study the normal maximum mouth-opening capacity of an individual is considered in assessing the reduction in mouth opening. This study was done to establish a new clinical staging pattern in OSF and to evaluate the relationship between the proposed staging system and traditional histopathological grading system of OSF. MATERIALS AND METHODS: The study included 50 clinically diagnosed OSF patients. Normal mouth opening was established by measuring three-finger index (TFI). Existing maximum mouth opening was established by measuring the interincisal distance. Presence of palpable vertical bands was recorded. Histopathological grading was done according to Pindborg and Sirsat. Percentage of reduction in mouth opening (PRMO) was calculated and the mean of PRMO in different clinical and histopathological stages was analysed by fisherman's extract test. A new staging pattern for OSF was proposed from the data. RESULTS: PRMO was assessed at different clinical stages. A range between 16% and 47% was obtained, and statistically the p value of <0.001 was very highly significant. Similarly, a range between 17% and 45.6% was obtained when PRMO was assessed at different histopathological grading; again the statistical value was very highly significant with a p value of <0.001. CONCLUSION: With the data obtained from our study, the following clinical staging pattern can be adapted: stage I indicates that the PRMO is <30%, Stage II between 30-45%, and stage III >45%. Hence it may be appropriate to asses the disease severity and stage by assessing the degree of disability (i.e., mouth opening reduction considering the individual normal mouth opening ability). The determination of PRMO may be a useful tool in this direction.

A Study to Analyze Different Patterns of Quid Usage among Subjects with Oral Submucous Fibrosis in Mangalore Population.

Aim and Objectives. Oral submucous fibrosis (OSF) is a potentially malignant disorder associated with the usage of areca nut. Usage of processed forms of areca nut is popular among the youth and its carcinogenic effects are not well known. Due to large immigrant population, various patterns of areca nut usage are seen. The aim of this study is to assess the various quid chewing patterns and their association with severity of OSF. Materials and Methods. A cross-sectional study was carried out with 250 cases clinically and histologically diagnosed as having OSF lesion that were selected and subjected to a detailed habit history which was recorded through preformed questionnaire. The data obtained was statistically analyzed. Results. Among the 250 subjects, males were seen to be affected more than females within the age group of 26-35 years and were having clinical stage I OSF. A combination of processed areca nut and processed tobacco was used by the majority of the subjects with duration of 1 to 5 years, at a frequency of 3 to 5 quids per day. Conclusion. The present study confirms the association between oral submucous fibrosis and the quid containing processed areca nut and processed tobacco and also highlights the increasing youth population using the processed forms of areca nut.

Evaluation of normal range of mouth opening using three finger index: South India perspective study.

AIMS: The frequency, with which restricted mouth opening is encountered in the clinical practice, makes it essential to establish what constitutes the normal range. This study was undertaken to evaluate the normal range of mouth opening in adult population in south India. SETTINGS AND DESIGN: randomized clinical study conducted on dentate adult patients to evaluate the normal range of mouth openin. MATERIALS AND METHODS: 500 healthy patients aged between 18-59 were randomly selected and divided into four groups according to their age ranges. The maximum inter-incisal distance and width of right and left three fingers at the first distal inter-phalanges were measured using vernier calipers. STATISTICAL ANALYSIS USED: ANOVA test, student t test and pearsons correlation test. RESULTS: The mean value and range of maximum mouth opening of 50.3 mm ± 6.26 mm for males and 49.9 mm ± 6.74 mm for females was recorded. These values were significant and correlated with the width of three fingers. It was found that the greatest mean maximum mouth opening was recorded in youngest age group and lowest was recorded in older age group in both genders. CONCLUSIONS: The mean mouth opening value decreases with age and is lesser in females as compared to males of same age. This study demonstrated that individuals in all the four groups were able to vertically align their right and left three fingers between the upper and lower central incisors upto the first distal interphalangeal folds thus suggesting that, width of three fingers can be used as 'tool' to distinguish 'normal' from 'restricted' mouth opening.

Oral mucosal diseases in anxiety and depression patients: Hospital based observational study from south India.

OBJECTIVES: The objective of this study was to evaluate the prevalence of different Oral Mucosal diseases in Anxiety and Depression patients. MATERIAL AND METHODS: A hospital based observational Study was conducted in the department of Psychiatry and department of Oral Medicine and Radiology. Patients who were diagnosed with Anxiety or Depression by the psychiatrists using Hamilton Anxiety and Depression scale were subjected to complete oral examination to check for oral diseases like Oral Lichen Planus (OLP), Recurrent Aphthous Stomatitis (RAS), and Burning Mouth Syndrome (BMS). Equal number of control group subjects were also included. RESULTS: In this study statistically significant increase in the oral diseases in patients with anxiety and depression than the control group was recorded. Oral diseases were significantly higher in anxiety patients (20.86%) than in depression (9.04%) and control group patients (5.17%). In anxiety patients, the prevalence of RAS was 12%, OLP was 5.7%, and BMS was 2.87%. In depression patients, the prevalence of RAS was 4.02%, OLP was 2.01% and BMS was 3.01%. In control group the prevalence was 2.2%, 1.33% and 1.62% in RAS, OLP and BMS respectively. RAS and OLP were significantly higher in the younger age group (18-49) and BMS was seen between the age group of 50-77 years in both study and control groups. CONCLUSIONS: The results of the present study showed a positive association between psychological alterations and changes in the oral mucosa, particularly conditions like OLP, RAS and BMS. Thus psychogenic factors like anxiety and depression may act as a risk factor that could influence the initiation and development of oral mucosal diseases. Hence psychological management should be taken into consideration when treating patients with these oral diseases. Key words:Lichen planus, anxiety, depression, burning mouth syndrome, recurrent aphthous stomatitis.

Transcutaneous electrical nerve stimulation therapy: An adjuvant pain controlling modality in TMD patients - A clinical study.

BACKGROUND: The use of transcutaneous electrical nerve stimulation (TENS) in dentistry was first described in 1967, by Shane and Kessler, but it has yet to gain widespread acceptance in dentistry. A study was undertaken to evaluate the effectiveness of TENS therapy as an adjuvant modality and to compare it with the conventional medication in controlling pain in temporomandibular disorder (TMD) patients. MATERIALS AND METHODS: The study was carried out in the Department of Oral Medicine and Radiology, Yenepoya Dental College and Hospital, Mangalore. A total of 40 patients with the clinical symptom of pain associated with TMDs were randomly divided into two groups. Group A (control) patients were treated with medication (analgesics and muscle relaxants) alone, while group B patients were treated with TENS therapy in combination with medication. The intensity of the pain was assessed using the Visual Analog Scale (VAS). The results were analyzed with the student's 't' test. A P-value < 0.05 was considered as significant. RESULTS: A significant improvement was observed in both the TENS and the control group in terms of pain control. On comparative analysis, adjuvant TENS therapy was found to be more effective than medication alone, in controlling pain. (P value = 0.019). CONCLUSION: The observed data suggest that TENS therapy can be used as an adjuvant modality in the management of pain associated with TMDs. This study justifies the use of TENS therapy in the management of TMD.

Partial expression of the Papillon-Lefevre syndrome.

Papillon-Lefevre Syndrome (PLS) is a rare autosomal recessive genodermatosis characterized by palmar-plantar hyperkeratosis, and destructive periodontitis. It is transmitted with an estimated frequency of one to four per million individuals. The two hallmarks of the syndrome, dermatological lesions and destructive periodontitis, are known to occur as an independent diseases. We present a unique case of Papillon-Lefevre syndrome in a 28 years old woman with its pathognomonic dermatological features without oral features.

Mandibular ameloblastic carcinoma.

Ameloblastic carcinoma is a rare aggressive odontogenic tumour that exhibits malignant histologic features in the primary site or in metastasis. This rare tumour needs immediate attention because of its aggressive and infiltrative nature. However, there are controversies regarding the definitive treatment because of the very few cases in the literature database. Here, we report a case of a 64-year-old male Asian patient who presented with a non-tender exophytic proliferative mass of 3 months duration. It was finally diagnosed as ameloblastic carcinoma and promptly treated surgically with a regular follow-up. Local long-term control and follow-up is imperative in such patient laying emphasis on potential pulmonary metastasis.

Efficacy of spirulina as an antioxidant adjuvant to corticosteroid injection in management of oral submucous fibrosis.

BACKGROUND AND OBJECTIVES: Oral submucous fibrosis (OSF) is a chronic condition of the oral cavity which results in permanent disability. A number of studies have proven that the management of premalignant diseases should include antioxidants. Therefore, a study was carried out to evaluate the efficacy of spirulina as an antioxidant adjuvant to corticosteroid injections in the management of 40 oral submucous fibrosis subjects of south Karnataka and north Kerala. MATERIALS AND METHODS: An intervention study was conducted on 40 oral submucous fibrosis cases, 40 patients were divided into two groups, group A (spirulina group) and group B (placebo group). Group A received spirulina 500 mg twice daily and biweekly intralesional steroid injection of Betamethasone 4 mg/ml for 3 months and group B was given placebo capsules twice daily and biweekly intralesional steroid injection of Betamethasone 4 mg/ml for 3 months. The results were analyzed with the paired "t" test and the unpaired "t" test. RESULTS: Clinical improvements in mouth opening was significant in the posttreatment period in both Spirulina and placebo groups. Both the groups showed statistically significant reduction in burning sensation. However, when both groups were compared, mouth opening and burning sensation was found to be statistically very highly significant in favor of the spirulina group. CONCLUSION: Spirulina can bring about clinical improvements in OSF patients. The observed effects suggest that spirulina can be used as an adjuvant therapy in the initial management of OSF patients. However, studies involving larger samples and longer period of treatment follow up are suggested in the future.

Occurrence of epidermolysis bullosa along with Amelogenesis imperfecta in female patient of India.

Epidermolysis bullosa (EB) is an inherited disorder, which is characteristically presented as skin blisters developing in response to minor injury. Junctional variety of EB is also associated with enamel hypoplasia. Amelogenesis imperfecta presents with abnormal formation of the enamel both in deciduous and permanent dentition. This article describes a previously unreported case of Amelogenesis imperfecta with complete loss of enamel in a young female patient with EB.

Bilateral inflammatory cysts of the jaw: report of an unusual case.

Radicular cyst is the most common odontogenic cyst occurring in the jaws. The cyst is commonly found in relation to the maxillary anterior teeth in the third and fifth decade of life. Although multiple radicular cysts are not uncommon in the jaws, bilaterally symmetrical representation of these cysts is rare. Radiographs prior to extraction help in diagnosis of these cysts and thereby prevent further morbidities. We report a case of 16-year-old male patient who presented bilateral radicular cysts symmetrically in the mandible.

Apert syndrome: a case report.

Apert syndrome (acrocephalosyndactyly) is a rare congenital disorder characterized by craniosynostosis, midfacial malformation and symmetrical syndactyly. We present a 10-month-old infant having all the features of classical Apert syndrome. How to cite this article: Khan S, Chatra L, Shenai P, Veena KM. Apert Syndrome: A Case Report. Int J Clin Pediatr Dent 2012; 5(3):203-206.

Prevalence of Talon cusp in Indian population.

AIM: To investigate the prevalence of the talon cusps in a sample of Indian dental patients and their distribution among different types of teeth. To determine the presence of other dental anomalies associated with the talon cusps. METHOD: 2740 out patients (1523 males and 1217 females) attending Oral Medicine department from November 2010 to January 2011 were screened for the presence of talon cusps and were subjected to Intra Oral Peri-apical (IOPA) radiograph to rule out any associated anomalies or peri-apical changes. RESULTS: Talon cusps were detected in 16 out of 2740 patients (person prevalence 0.58%). Thirty one teeth were found to have talon cusp. Maxillary lateral incisors were the most commonly affected teeth (54.8%, 17 teeth), followed by maxillary central incisors and canines (16.12%, 5 teeth).Talon cusp was found in two mandibular central incisors (6.45%) and one each in mandibular second and third molar (3.22% each). Seventeen teeth in 7 patients (54.83%) were found to be associated with anomalies like dens invagination (6 teeth, 19.35%), impacted 13, 23 (6 teeth, 19.35%), partial anodontia (3 teeth, 9.67%), geographic and fissured tongue (2 teeth, 6.45%). Peri-apical granuloma was found in one tooth with talon cusp associated with dens invaginatus. None of the patients were found to be associated with any syndromes. CONCLUSION: Attention should be paid to the presence of the talon cusp and the associated anomalies. Early diagnosis of the talon cusp can help the clinician in preventing the further complications. Key words:Orthopantomography, atheroma, stroke.

A case of a massive mandibular schwannoma.

Schwannoma, a benign nerve sheath tumor is relatively rare in occurrence and even rarer in sites, such as jaw bones. There are only 45 reported cases of intraosseous schwannoma of the jaws reported in the literature. We report a rare case of mandibular schwannoma in a 50-year-old Indian male. The clinical features resembled that of a residual cyst, fibro-osseous lesion or an odontogenic tumor/cyst. Radiological differential diagnoses of ameloblastoma or odontogenic keratocyst was made based on the findings of the orthopantomogram. The lesion was examined histopathologically and a final diagnosis of schwannoma arising from the inferior alveolar nerve was made. The aim of this report is to add information to the existing sparse literature on intraosseous schwannomas of the jaw.

Talon cusps in mandibular incisors: an unusual presentation in a child patient.

Talon cusp is a dental anomaly also known as an eagle's talon. It is an extra cusp on an anterior tooth which arises as a result of evagination on the surface of a crown before calcification has occurred. The exact etiology is unknown. The inci-dence of talon cusp is less than 6%. Commonly involved teeth are maxillary incisors, usually unilateral but in some instanc-es bilateral. The classical radiographical feature of talon cusp is double teeth appearance. The anomaly has been reported to be unusual in the mandibular dentition. This article reports an unusual case of talon cusp of permanent mandibular central incisors.

Bone invasion in oral cancer patients: a comparison between Orthopantamograph, conventional computed tomography, and single positron emission computed tomography.

BACKGROUND AND OBJECTIVES: One of the important factors in the pretreatment evaluation of patients with squamous cell carcinoma is the detection of the presence and extent of bone invasion by the tumor, which is significant for planning the therapy and determining the prognosis. Therefore, a study was undertaken with an objective to compare the accuracy and predictability of an Orthopantamograph (OPG), conventional Computed Tomography (CT), and Single Positron Emission Computed Tomography (SPECT) in the detection of bone invasion in squamous cell carcinoma patients scheduled to undergo surgery. MATERIALS AND METHODS: A descriptive study was carried out on 15 patients with clinically and histopathologically diagnosed squamous cell carcinoma. OPG, conventional CT, and SPECT were carried out on all patients. Subsequently, the bone adjacent to the tumor was assessed histopathologically and served as a gold standard. The various imaging modalities were compared with the gold standard. RESULTS: The study revealed that the tumor infiltration into the bone was positive in eight out of fifteen cases and seven were negative for bone invasion. OPG and conventional CT showed the presence of bone invasion in six out of eight cases with a sensitivity of 75% and a specificity of 100%. The positive predictive value for OPG was 100% and the negative predictive value was 78%. SPECT showed the presence of bone invasion in eight out of eight cases with a sensitivity of 100% and a specificity of 14.3%. The positive predictive value for SPECT was 57% and the negative predictive value was 100%. CONCLUSION: The present study showed that SPECT was highly sensitive, but with a very low specificity due to an increase in false positive values. However, OPG and conventional CT showed an acceptable degree of sensitivity and specificity.