Accessory lingual mental foramen: A case report of a rare anatomic variation.

INTRODUCTION: The mandibular nerve and the mental foramen have occasionally shown variations in its anatomy. This report aims to present a case of lingual mental foramen recognised on three-dimensional cone beam computed tomographic imaging (CBCT). CASE REPORT: Routine Orthopantomogram (OPG) and CBCT images were evaluated to assess the status of impact third molars in a 31-year-old female who had visited the dental clinics in our institution. The OPG image failed to reveal any anatomic variation in the position of the mental foramen. On tracing the course of the mandibular canal in CBCT images, two foramina were traced at the region of premolar. One opened towards the buccal cortical plate at the normal position of the mental foramen and an accessory lingual mental foramen had an opening on the lingual cortical bone at the same level as the mental foramen. CONCLUSION: Understanding variations of the mental foramen is extremely essential in dentistry to carry out successful anaesthetic or surgical interventions and to avoid complications such as nerve damage or excessive bleeding.

Unusual localized gingival redness: a case report.

Inflammation of the gingiva is one of the most common and routine findings in dental practice. These routine appearances of inflammatory gingivae can show peculiarity when associated with an underlying systemic condition or because of reactive, benign, or malignant pathologies. This case highlights minute clinical signs of the gingiva that deviate from the routine presentation and warrant further investigations. A 63-year-old woman presented with a chief complaint of severe pain in relation to the lower front teeth region for 1 month. Intraoral examination revealed a gingival lesion on the labial aspect of 41, 42, and 43, and an intraoral periapical radiograph showed mild bone loss. The lesion persisted despite oral prophylaxis, and a biopsy was advised. The final diagnosis was stage 1 gingival squamous cell carcinoma (GSCC). It is important to note that the non-descript presentation of GSCC in early stages often mimics benign traumatic or inflammatory lesions of the gingiva. Peculiar clinical features of GSCC of note include the lack of traditionally associated risk factors and localized red or ulcerative lesions with increased bleeding tendencies that do not respond to routine periodontal treatment within 2 weeks.

Prevalence of Incidental Maxillary Sinus Anomalies on CBCT Scans: A Radiographic Study.

CBCT significantly impacts dental procedures and has brought significant reforms to our approach to diagnosis and treatment planning despite its limitations in differentiating soft tissues. It is an excellent imaging modality and quickly identifies sinus opacification and provides valuable insight into paranasal sinus pathologies, with considerably lower radiation exposure. The present study aimed to investigate the occurrence of maxillary sinus abnormalities in CBCT scans, identify the frequency, type, and location of these findings, and find the correlation between the distance of periapical lesions and radiographic changes in the maxillary sinus. Two examiners independently evaluated 117 patients to diagnose and classify the cases into different abnormality subtypes. The periapical lesions most closely related to the sinus were recorded. The diameters of the left and right maxillary sinus ostium and the distance of the ostium's lower border to the sinus's osseous floor were recorded. The findings were correlated with the age and gender of these patients. The present study reveals that sixty-one patients were diagnosed with mucosal thickening (52.1%). The sinus wall most affected by mucosal thickening was the maxillary sinus floor, followed by the medial and lateral walls. Of 19 patients with periapical lesions, 15 had maxillary sinus mucosal thickening, which is statistically significant (p = 0.004). The high occurrence of abnormalities in the maxillary sinus emphasizes the importance for the radiologist to comprehensively interpret the whole volume acquired in CBCT images, including the entire sinus. Incidental findings may be considered in the individual clinical context of signs and symptoms, reducing the risk of overestimating the real impact of radiographic findings.

Investigating the link between frontal sinus morphology and craniofacial characteristics with sex: A 3D CBCT study on the South Indian population.

Background: Measurement of craniofacial parameters plays an important role in sex determination in forensic science. The present study was done using cone beam computed tomography (CBCT) scans to evaluate the morphologic structure of the frontal sinuses and compare it with the width of nasal, cranial, maxillary and mandibular width which might help us in sex determination. Methods: A cross-sectional retrospective study was conducted using 142 full field of view (FOV) scans of patients archived from the department. The width of the nose, cranium, maxilla, and mandibular width was measured and compared with the frontal sinus between the two sexes. Results: A paired t-test was done to compare the linear measurements for both sexes' right and left frontal sinuses. The measurements were higher in males when compared to females. There was a statistically significant asymmetry (larger dimension on the left side) of the anterioposterior (p-value of 0.012) and superior-inferior dimensions in males (p-value of 0.135). Spearman's correlation showed that frontal sinus correlated with other craniofacial parameters like nasal, cranial, maxillary and mandibular width among both sexes. The frontal sinus, nasal, cranial, maxillary and mandibular widths were higher in males when compared to females (independent t-test). Discriminant function scores showed 66-68% accuracy to discriminate sex, using the anteroposterior dimension and mandibular width. Conclusions: The measurement of craniofacial parameters using CBCT can aid in determining the sex of unidentified and decomposed bodies.

Childhood abuse and anxiety, depression - An interprofessional approach to optimize knowledge and awareness among young adult health professions students of Arunachal Pradesh, India.

BACKGROUND: Child abuse is a major public health concern with deep rooted squeal events on adult mental health. The childhood negligence and abusive events is connected invariably with anxiety and depressive disorders in adult life. OBJECTIVES: The study focused to determine the prevalence of child abuse, and connection of child abuse with depression and anxiety in course of adulthood, and to evaluate the effect of Interprofessional approach on the knowledge and awareness on child abuse and legal polices among young adult students of health professions in Arunachal Pradesh, India. PARTICIPANTS AND SETTING: Four hundred sixty-one young adult health professions students from Tomo Riba Institute of Health and Medical Sciences (TRIHMS) and related health sciences institutes in the Itanagar capital complex region of Arunachal Pradesh between age group of 18-25 years. METHODS: A semi structured self-administered questionnaire was adopted to measure the prevalence of child abuse, Patient Health Questionnaire-9 (PHQ-9) questionnaire to grade the severity of depression and Generalized Anxiety Disorder-7 (GAD-7) questionnaire to grade severity of anxiety. Interprofessional intervention interactive sessions with a psychologist, psychiatrist, and advocate were held after pre-test. Before and after the intervention, the participants' awareness and knowledge on various types of child abuse& negligence and legal policies were assessed. RESULTS: The overall prevalence of child abuse in any form was 73.42 %. Physical abuse was the most frequent form, accounting for 65.26 %, followed by childhood negligence (62.63 %), emotional abuse (53.15 %), and sexual abuse (23.42 %). Higher incidence of psychological distress with depression (80 %) and anxiety (55.52 %) was observed in participants with previous history of childhood abuse. There was a significant improvement in the knowledge and awareness on various forms of child abuse and negligence (p < 0.05) and legal policies (16.05 % before intervention, 85.90 % after intervention) (p < 0.05) after intervention sessions with interprofessional members. CONCLUSIONS: The interprofessional interactive sessions exhibited significant improvement in the knowledge and awareness in terms of child abuse and policies in all domains. Utmost need and necessity of including implementation of interprofessional intervention interactive sessions or counselling program in academic institutions specially in developing states where there is a lack of awareness and easy access to services.

Evaluation of Malnutrition and Quality of Life in Patients Treated for Oral and Oropharyngeal Cancer.

BACKGROUND: Oral and oropharyngeal cancer is a debilitating disease with high morbidity and mortality. Depending on the site and extent of the involvement of the cancer and the type of treatment modality, these patients can develop pain, trismus, xerostomia, dysphagia, and taste disturbances, compromising them socially and nutritionally. The aim of the study was to evaluate malnutrition and quality of life in patients treated for oral and oropharyngeal cancer. Methodology. A cross-sectional study was conducted which included 97 patients treated for oral and oropharyngeal cancer. The quality of life of the selected patients was assessed by using a validated European Organization for the Research and Treatment of Cancer's Quality of Life Questionnaire, Head and Neck and Mandibular Function Impairment Questionnaire. Pre- and posttreatment weight of the patients were assessed, and weight loss of ≥10% of pretreatment weight was considered as malnutrition. The chi-square test was used to correlate the symptoms with the quality of life. A paired t test was used to assess the differences in weight before and after treatment, and a p value of <0.005 was considered as significant. RESULTS: The most commonly reported symptoms were xerostomia (93.81%), pain (81.44%), and dysphagia (76.3%). A total of 40.2% of the individuals in the study had malnutrition. Malnutrition was comparatively lower in the group who had nutritional supplements. CONCLUSION: The quality of life in patients treated for oral and oropharyngeal cancer deteriorates immediately after the treatment; however, it significantly improves over time.

Morphological Assessment of TMJ Spaces, Mandibular Condyle, and Glenoid Fossa Using Cone Beam Computed Tomography (CBCT): A Retrospective Analysis.

Background The temporomandibular joint (TMJ) is included in the category of ginglymoarthrodial synovial joints. The mandibular condyle plays a vital part in the development of the craniofacial complex. Hence, the evaluation and assessment of the condylar volume and its morphology are of utmost importance. Aim The aim of this research was to use cone beam computed tomography (CBCT) imaging modality to evaluate the morphology of the mandibular condyle and glenoid fossa in a selected population and document any morphometric changes. Setting and Design It is an observational study. Materials and Methods A retrospective CBCT analysis was performed on 119 patients. The length, width, height, linear measurements of the joint spaces (anterior, posterior, and superior), volume of the condyle, and roof of glenoid fossa thickness were evaluated on both the left and right sides in both males and females. Results The height, width, and length of mandibular condyle were significantly increased in males on both sides. Except for the left anterior space, all other spaces were significantly larger in males. Overall, the volume of the condyles in males was significantly increased on both sides. Conclusion CBCT can be a valuable diagnostic aid in the evaluation of various dimensions, joint spaces, and condylar volume in different planes and thus, can be a useful predictor in the assessment of treatment outcomes of disorders affecting the TMJ.

Critical Assessment on Unmet Oral Health Needs and Oral Health-related Quality of Life Among Old Age Home Inhabitants in Karnataka, India.

PURPOSE: To critically assess the unmet oral health needs and oral health-related quality of life among old age home inhabitants in Karnataka, India. METHODS: A total of 96 older adults (males=32, 33.33%, females=64, 66.67%) aged 60 years and above, residing in old age homes were included in this cross-sectional study. The mean age of the participants included in the study was 69.25±7.99 years. Oral health status and dental needs were assessed using the Oral Hygiene Index Simplified (OHIS) and the WHO Oral Health Assessment forms. Oral health-related quality of life was evaluated by administrating the Geriatric Oral Health Assessment Index (GOHAI) questionnaire through an interview format. STATISTICAL ANALYSIS: The Statistical Package for Social Sciences (SPSS) version 17 was used. Descriptive statistics was tabulated for oral health status and GOHAI scores. Student's t-test and ANOVA were applied to check the association of the GOHAI responses with the number of years of residence in old age homes, age groups, gender, and dentition status. RESULTS: The mean age of the participants included in the study was 69.25±7.99 years. Twenty-six (27.1%) participants reported diabetes mellitus and hypertension. Most of the participants 89 (91.7%) visited the dentist when they had dental complaints. Among the dentulous study population, the majority of the participants had untreated dental caries indicated for dental extraction and needed periodontal therapy. Amongst the participants, 68 (70.82%) required prosthetic rehabilitation. More than 10 years of residence in old aged homes, over 80 years of age, being female, and completely edentulous groups showed lower total GOHAI scores compared to their counterparts. CONCLUSION: The majority of the participants showed unmet oral health needs and lower GOHAI scores indicating poor oral health-related quality of life.

Polymorphous Adenocarcinoma: A Rare Case Report with Unique Radiographic Appearance on CBCT.

BACKGROUND: Polymorphous low-grade adenocarcinoma (PLGA) is a slow growing malignant tumor of minor salivary glands and is generally of indolent nature. However, according to the most recent WHO Classification of Salivary Gland Tumors (2017), the cancer is classified as Polymorphous AdenoCarcinoma (PAC). PAC presents as a less aggressive tumor, though it could on rare occasions demonstrate distant metastasis. Case Presentation. A 47-year-old man who was referred by a private practitioner for a CBCT scan in reference to a proliferative soft-tissue growth in the hard palate. The growth was mild and tender and there was Grade III mobility in relation to all the maxillary teeth. Panoramic radiograph taken previously had revealed evidence of alveolar bone loss in relation to the maxillary teeth and was inconclusive of any other findings. The CBCT scan revealed evidence of moth-eaten appearance of maxilla with destruction of medial and lateral walls and floor of maxillary sinus. There was also evidence of involvement of right eustachian tube, ethmoidal wall, and nasopalatine canal. An intraosseous malignancy of the palate was suspected, and a total maxillectomy was performed. The tissue sample was sent for histopathological assessment wherein changes diagnostic for polymorphous low-grade adenocarcinoma of the palate were observed. CONCLUSION: PAC is a distinct, yet commonly occurring, minor salivary gland tumor with varied clinical and histologic appearance. This case report highlights the importance of CBCT in diagnosing the intraosseous involvement of such tumors which can help shed some light in enhancing our knowledge about the minor salivary gland malignancies like PAC.

Influence of Psychosocial Factors and Parafunctional Habits in Temporomandibular Disorders: A Cross-Sectional Study.

INTRODUCTION: Temporomandibular disorders (TMDs) are abnormalities affecting the temporomandibular joint, jaw muscles, or both. An intrinsic relationship reportedly exists between TMDs and psychosocial factors, including stress. Parafunctional habits such as bruxism and clenching are also known to be responsible for TMDs. OBJECTIVE: To determine the association of anxiety, depression, and bruxism with TMD symptoms and their relationship with age and sex. METHODS: Patients included in the study reported, as their chief concern, pain lasting for more than a week in the temporomandibular joint area and/or masticatory muscles. The patients were divided into age groups as follows: Younger than 20 years, 21 to 30 years, 31 to 40 years, 41 to 50 years, 51 to 60 years, and above 60 years. Patients were examined clinically and were asked to complete an anamnestic questionnaire (modified version of Helkimo Anamnestic Index) and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Seventy-five patients (55 women, 20 men) were included in the study. The prevalence of TMDs was higher in female patients, of whom 33 (60%) had moderate to severe TMDs. Of the 20 male patients, 12 (60%) had signs and symptoms of moderate TMDs. Anxiety and depression scores were higher in female patients. No significant correlation was found between degree of malocclusion and TMDs. DISCUSSION: We found correlations between the degree of TMD with age, sex, parafunctional habits, and psychosocial factors. Symptoms of TMD seemed to increase in patients with parafunctional habits, from younger to older age groups, and with increased anxiety and depression scores. CONCLUSION: The degree of TMDs is higher in women, and TMDs are associated with higher anxiety and depression scores. Correlation between these factors paves the way for preventive actions aimed at those with moderate and severe signs of TMDs.

Comparison of Transcutaneous Electric Nerve Stimulation (TENS) and Microcurrent Nerve Stimulation (MENS) in the Management of Masticatory Muscle Pain: A Comparative Study.

Introduction: Temporomandibular disorders (TMDs) are a heterogeneous group of pathologies affecting the temporomandibular joint (TMJ), the jaw muscles, or both. Epidemiological studies of TMD reveal a prevalence of 82% in the general population with 48% of them presenting with clinical features of muscle tenderness and difficulty in mouth opening. TMD are considered to be the most common orofacial pain conditions of nondental origin. Methods: The patients with TMD were randomly divided into two groups, A and B, based on their VAS scale. Group A consists of two subgroups 1 and 2 each consisting of 15 patients. Group B consists of two subgroups 3 and 4 consisting of 15 patients. Patients in Group A were given TENS for twenty minutes, and the frequency is adjusted as follows: (i) subgroup 1: TENS frequency at a range of 0-5 (VAS measuring 1-5) and (ii) subgroup 2: TENS frequency at a range of 5 and above (VAS measuring 6-10). Patients in Group B were given MENS for twenty minutes, and the frequency adjusted as follows: (i) subgroup 3: MENS frequency at range of 0-5 (VAS measuring 1-5) and (ii) subgroup 4: MENS frequency at a range of 5 and above (VAS measuring 6-10). Each patient was recalled for five consecutive days for the treatment, and the same intensity and frequency were maintained throughout the treatment period. Results: The improvement in VAS is seen to be highly significant statistically in MENS subgroup 4 (moderate-to-severe pain). Subgroups 1 and 3 had improvement in VAS which was comparable in both TENS and MENS groups. Conclusion: In the present study, it was found that TENS and MENS are equally effective in improving the functional mouth opening. MENS showed better and immediate effect in relief of pain. Microcurrent also has the advantage of being subthreshold, and hence the side effects such as tingling sensation and paresthesia seen to occur in some patients following TENS are absent. TENS and MENS can be considered as the first line of treatment in patients with acute and chronic masticatory muscle pain and also as an effective treatment option in cases of functional mouth opening.

Challenges in Early Diagnosis of Oral Cancer: Cases Series.

Oral cancer has an overall survival rate of only 50%. This prognosis is significantly improved when this disease is diagnosed and treated in its early stages. Oral cancer is usually associated with classical clinical features associated with malignancy resulting in accurate diagnosis. However, certain cases of oral cancer, especially in its early stages, can be clinically deceptive and can be misdiagnosed. There is a recent trend of changing demographics and etiology associated with oral cancer adding to the diagnostic challenges faced by the clinician. The awareness of these changing trends is needed to aid in early diagnosis of oral cancer. In this case series, we have presented three cases of patients with challenging aspects.

Hypercementosis: a rare finding in a patient with systemic lupus erythematosus.

Hypercementosis is excessive deposition of non-neoplastic cementum over normal root cementum, which alters root morphology. This cementum may be either hypocellular or cellular in nature. The aetiopathogenesis of hypercementosis is ambiguous. Although most of the cases are idiopathic, several local and systemic factors are also linked to this condition, such as Paget's disease, acromegaly, vitamin A deficiency, etc. We report two rare cases of hypercementosis associated with systemic lupus erythematosus, not previously described in the literature, and also discuss the possible aetiopathogenesis.

Calcifying odontogenic cyst: a rare report of a nonneoplastic variant associated with cholesterol granuloma.

AIM: To report a case of a non-neoplastic variant of calcifying odontogenic cyst (COC) with the lining epithelium showing ameloblastomatous proliferation and capsule exhibiting features of a cholesterol granuloma. The importance of delineating this histologic variant from unicystic ameloblastoma and the formation of cholesterol granuloma in this variant is discussed. BACKGROUND: Calcifying odontogenic cyst is a developmental jaw cyst, which presents itself as both the neoplastic and the non-neoplastic forms. The ameloblastomatous variant of COC is often mistaken for unicystic ameloblastoma and treated aggressively. CASE REPORT: A 68-year-old female who presented with a cystic enlargement of the posterior mandible on the right side was suggestive of unicystic ameloblastoma based on radiography and initial biopsy report. Microscopic examination of the excision specimen, however, was fitting in favor of calcifying odontogenic cyst with ameloblastomatous proliferation. CONCLUSION: Identifying the non-neoplastic ameloblastomatous variant of COC from a cystic ameloblastoma is crucial as the treatment of the two lesions vary considerably. CLINICAL SIGNIFICANCE: This case emphasizes the need for thorough examination of the entire surgical specimen before arriving at an appropriate diagnosis.