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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 34 | Issue 4
Page Nos. 377-497

Online since Friday, December 9, 2022

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EDITORIAL  

From the desk of editor in chief p. 377
ML Avinash Tejasvi
DOI:10.4103/jiaomr.jiaomr_331_22  
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GUEST EDITORIAL Top

Scope of pharmacogenomics in oral medicine Highly accessed article p. 378
D Rama Raju
DOI:10.4103/jiaomr.jiaomr_329_22  
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ORIGINAL ARTICLES Top

Estimation of Malondialdehyde Levels and Determination of Total Antioxidant Capacity in Serum and Saliva of Patient Affected with Sickle Cell Anemia Highly accessed article p. 380
Megha Bahal, Sanjay Nyamati, Shweta Hegde, Abhinav Kakkar, Idha Sood, Salona Kalra
DOI:10.4103/jiaomr.jiaomr_146_22  
Introduction: Hemoglobinopathy is an inherited blood disorder in which an individual has an abnormal form of hemoglobin (variant) or decreased production of hemoglobin. The molecular pathogenesis of sickle cell disease explains the phenomenon well when there is adeficiency of oxygen carriage by the erythrocytes. The horrendous patterns of sickling/unsickling bring about the accumulation of lipid oxidation items and reactive oxygen speciesthat gather inside sickle-shaped red blood cells (RBCs). Aims: To estimate the malondialdehyde levels and determine the total antioxidant capacity in serum and saliva of sickle cell anemic patients. Methods and Material: Fiftysubjects aged 5–40 years were selected for the study. The subjects were divided into two groups. Blood and saliva samples were collected from both groups and were subjected to the phosphomolybdenum method. Absorbance was read spectrophotometrically at 695 nm. SPSS software was used, and statistical analysis was performed using Student's unpaired ttests. Results: Oxidative stress results f an imbalance between reactive oxygen species formation and enzymatic and non-enzymatic antioxidants. Conclusion: Salivary levels of total antioxidant capacity, malondialdehyde, and electrolytes make saliva a potential prognostic and diagnostic medium as there is an alteration of oxidative stress in sickle cell anemia (SCA).
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Comparison of antifungal activity of probiotics, coconut oil and clotrimazole on candida albicans – An In vitro study Highly accessed article p. 385
V Divyadharsini, TN UmaMaheswari, S Rajeshkumar
DOI:10.4103/jiaomr.jiaomr_137_21  
Background: Oral candidiasis is the most prevalent opportunistic infection of oral cavity. Candida albicans causes oral lesions in the vast majority of cases. Antifungal regimens such as azoles and polyenes are commonly used to control candida infections. Virgin coconut oil has been proven to have antifungal, antimicrobial, and antioxidant properties. Probiotic bacteria have been used to modify microflora ecosystems and also have antifungal activity. Aim: To evaluate the antifungal activity of probiotics, coconut oil, and clotrimazole against oral Candida albicans species. Materials and Methods: Coconut oil and probiotics were tested against clotrimazole, a positive control. Candida albicans were isolated and incubated in Rose Bengal Agar at 30° C for 48 h. The growth inhibitory effect of the test materials was evaluated using the direct contact method by adding 25, 50, and 100 μL of the test material as well as control to candida in a sterile tube and incubated at 37° C aerobically for 24 h. Results: The mean zone of inhibition for clotrimazole was 36 mm, whereas for coconut oil it was 13.6 mm, and for probiotics, it was 11.6 mm. Clotrimazole had the highest inhibitory effect at 100 μL concentration. The difference between the groups was statistically significant (P-value 0.002). Conclusion: The antifungal activity of clotrimazole was found to be higher than that of coconut oil and probiotics against C. albicans. Future studies should concentrate on other herbal alternatives which will be as effective as clotrimazole for the management of oral candidiasis.
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Evaluating the role of salivary oxidative stress marker malondialdehyde in dental caries—A comparative study p. 390
S Sivaranjani, Rameshkumar Annasamy, Amritha James, Rajkumar Krishnan, Ramya Mahalingam, Preethi Arunachalam
DOI:10.4103/jiaomr.jiaomr_109_22  
Introduction: Free radical-induced damage on the lipids results in the creation of a novel oxidative stress marker—malondialdehyde (MDA). MDA-induced cell damage affects the immune mechanisms of saliva and may lead to the initiation and progression of bacterial diseases like periodontitis and even dental caries. Aim and Objectives: To determine the salivary levels of the oxidative stress marker—malondialdehyde (MDA) in subjects with dental caries before and after treatment to assess the role of MDA in the initiation and evolution of dental caries. Materials and Methods: The study included 40 patients in total. Based on the number of caries teeth present at the time of diagnosis, patients were divided into two groups: Group I: Subjects with dental caries in 1–2 teeth, N = 20; Group II: Subjects with dental caries in 3–4 teeth, N = 20. The patients were further divided into two groups after undergoing treatment: Group III: Group I subjects who undertook treatment for dental caries, N = 20; Group IV: Group II subjects who underwent treatment for dental caries, N = 20. The whole saliva was obtained from all subjects before treatment and one month after treatment. Estimation of MDA levels was done using ELISA. Statistical analysis was conducted using Student's t-test and Pearson's correlation coefficient. A P value ≤ 0.05 was considered significant. Results: Elevated levels of MDA were evident in subjects with greater carious lesions. The levels of MDA decreased significantly in post-treatment subjects. Pearson's correlation analysis also showed a strong positive correlation with the R-value of 0.832 between Group I and Group II. Conclusion: MDA levels increased with an increase in carious lesions and significantly reduced following treatment proving the role of salivary MDA in the evolution of dental caries.
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Comparative analysis of autologous blood injection and conservative therapy for the management of chronic temporomandibular joint dislocation p. 394
Jigna S Shah, Kinjal Joshi, Swati Jha, A Mathumathi
DOI:10.4103/jiaomr.jiaomr_199_21  
Aim: To evaluate the efficacy, safety, and stability of TMJ autologous blood injection for the treatment of recurrent TMJ dislocation in an effort to standardize the procedure and compare it with the conservative management. Materials and Methods: Twenty patients diagnosed with chronic recurrent TMJ dislocation (complete/incomplete) were treated by conservative method, and five patients who did not respond to conservative therapy were treated by injections of autologous blood into the upper joint space and around the TMJ capsules. Statistical Analysis Used: Statistical analysis of collected data was done using SPSS version 23. The values were evaluated statistically with t-test and Kruskal–Wallis test for descriptive, intergroup, and intragroup comparison. Results: Hundred percent of successful outcome and required no further treatment at their 3-month follow-up in autologous blood injection. Conclusion: This procedure has proven to be safe, simple, and cost-effective for the treatment of chronic recurrent TMJ dislocation.
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Comparison of oral submucosal thickness in oral submucous fibrosis patients before and after treatment using ultrasonography – A hospital-based study p. 400
Manjima Sasidharan, Vaishali K Keluskar, Anjana S Bagewadi, Santosh D Patil
DOI:10.4103/jiaomr.jiaomr_218_22  
Background: Oral submucous fibrosis (OMFS) is a chronic progressive, potentially malignant disorder of the oral cavity. The diagnosis is usually based on clinical findings, and normally, biopsy is not performed as it can result in scarring and worsening of the condition. The prognosis of the treatment is judged by clinical assessment, and it can vary among clinicians. Ultrasonography is a non-invasive technique used in diagnostic imaging for many decades, including oral and maxillofacial pathologies. Aim and Objective: The present study aimed to compare the oral submucosal thickness in OSMF patients before and after treatment using ultrasonography. Materials and Methods: Fifty OSMF patients were selected and recalled biweekly for two months for injecting dexamethasone and hyaluronidase intralesional injections. Each patient was subjected to ultrasonographic evaluation of oral mucosa before and at the end of treatment. Pre- and post-treatment ultrasonographic thickness of oral submucosa was compared using paired t-test. Result: The inference of the present study showed a reduction in the thickness of oral submucosa after treatment in OSMF. The decrease in thickness of the submucosa was statistically significant (p-value < 0.00), and also, there was a correlation between mouth opening and ultrasonographic measurements of the submucosa. Conclusion: Hence, ultrasonography can be used as a non-invasive tool for evaluating OSMF by comparing the change in the thickness of submucosa before and after treatment.
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Effectiveness of a mouth-exercising device in adjunct to topical steroid and antioxidants in OSMF—A clinical study p. 405
Syed Shahbaz, Sadia Shahana, Girish Katti, Syeda Arshiya Ara, Kahekashan Tanveer
DOI:10.4103/jiaomr.jiaomr_237_22z  
Objective: To evaluate the effectiveness of a mouth-exercising device (MED) on mucosal burning sensation and interincisal distance in adjunct to topical steroids and antioxidants in oral submucous fibrosis (OSMF) patients. Material and Methods: The study consisted of a total sample size of 60 subjects diagnosed with OSMF with no other systemic diseases. Group I includes 30 patients on topical application of triamcinolone 0.1% and oral antioxidant capsule along with receiving MED. Group II includes 30 patients on topical application of triamcinolone 0.1% and oral antioxidant capsule without receiving MED. Evaluation for mucosal burning sensation (BS) and interincisal distance (IID) was determined by VAS & digital Vernier caliper. Results: Group I patients using MED showed a statistically significant reduction in burning sensation and increasing interincisal distance compared to group II after six months. Conclusion: The MED helps enhance the rate of reduction of mucosal burning sensation and it is effective in increasing interincisal distance compared to the non-mouth-exercising device in OSMF.
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Comparison of efficacy of topical application of bleomycin with adjuvant antioxidants vs. Topical curcumin oral gel with adjuvant antioxidants in the treatment of oral leukoplakia p. 409
A I Samu Fathima, G V. Murali G. Manoharan
DOI:10.4103/jiaomr.jiaomr_201_22  
Introduction: Oral leukoplakia (OL) is an oral premalignant disorder (OPMD) defined as a white plaque of questionable risk, and the diagnosis is by exclusion. Aim: We aimed to compare the effectiveness of topical bleomycin with that of topical curcumin in patients with oral leukoplakia (OL). Materials and Methods: Bleomycin was assigned for group A and curcumin for group B patients. Both the drugs were applied topically with adjuvant oral antioxidants for both groups. Results: Group A (n = 10) patients showed partial to complete resolution of the leukoplakic lesions with a P value of 0.01, whereas in group B (n = 10) patients, resolution of the clinical lesion was not substantial, but a reduction of the erythroid component was observed along with histopathological improvement of dysplasia with a P value of 0.01. Conclusion: Comparatively, bleomycin was more efficient in producing clinical and histopathologic resolution of OL than curcumin.
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Association of vitamin D serum concentration and oral lichen planus: A randomized controlled clinical trial p. 414
Vinaya R Pawar, Sowmya Krishna, TA Deepak, GA Prarthana, Supriya Vyavahare, Rashmi D Jujare
DOI:10.4103/jiaomr.jiaomr_216_21  
Introduction: Vitamin D plays a crucial role in regulating immunity by reducing the multiplication of helper T cells, activating regulatory T cells, and inhibiting the release of immunoglobulins. Vitamin D levels must be measured in a disease mediated by the immune system, such as oral lichen planus (OLP). Aim: This study aimed to identify the potential association between vitamin D serum levels and OLP. Material and Methods: A randomized case-control study was conducted with 50 volunteers divided into two groups: 20 case subjects and 30 controls. 2.5 ml of venous blood was extracted from the median cubital vein of both patients and controls. The total quantity of 25-hydroxyvitamin D was determined by an electrochemiluminescence binding assay. Statistical Analysis Used: The independent student's t-test was performed to compare the serum vitamin D levels between the two groups. Results: The mean vitamin D values in OLP patients and healthy controls were 15.11 and 26.10 ng/ml, respectively. In OLP cases, vitamin D3 deficiency was more prevalent than in control subjects. These distinctions were statistically significant (P-value < 0.05). Conclusion: Vitamin D levels might portray a significant factor in the aetiopathogenesis of OLP and could influence the disease's course and prognosis.
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Correlation of a new binary system in grading of oral leukoplakia for its prediction of malignant transformation - A retrospective record-based study p. 418
NC Sangamesh, Vinay Suresan, KC Vidya, Dhirendra K Singh
DOI:10.4103/jiaomr.jiaomr_52_22  
Introduction: Oral Leukoplakia is a premalignant lesion with an increased risk of developing oral cancer when the lesion is non-homogeneous. There is a need to validate clinical presentations of a commonly occurring Leukoplakia lesion and its probability of dysplastic changes over some time. Aim: To correlate the Diagnostic accuracy of clinical lesion diagnosed as Leukoplakia and the presence or absence of dysplasia through its histopathological correlation. Materials and Methods: This study gathered data retrospectively during 2016–2021 with an initial diagnosis of oral Leukoplakia. A set of 611 slides were included in the study that was signed out as oral Leukoplakia. We tested the hypothesis that a binary grading system categorizes lesions as “presence” or “absence” of oral epithelial dysplasia. A logistic regression analysis was used in predicting the presence of dysplasia among the various clinical criteria. Results: Most of the mild dysplasia was reported in the buccal mucosa (n = 195; 31.91%), followed by 6 (0.98%) cases in the vestibule. A mean age of 32.33 ± 7.0 was observed for severe dysplasia. A statistically significant relationship between the risk estimates for the clinical diagnosis and dysplasia was noted for all the lesion types. Conclusion: The study concludes that the clinical presentation of a lesion can predict the underlying dysplastic changes, and mixed red and white lesions with growth possess the highest risk of malignant transformations.
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Evaluation of the spatial relationship of impacted mandibular third molar to mandibular canal using CBCT: A descriptive study p. 423
Jesmith Elsa Jacob, Anita Balan, C Tinky Bose, AK Nabeel, KL Girija, Sunu Ramachandran
DOI:10.4103/jiaomr.jiaomr_282_21  
Introduction: Impaction is defined as the “lack of eruption of a tooth in the oral cavity within the time and physiological limits of the normal eruption process.” The prevalence of damage to the inferior alveolar nerve during surgical extraction of impacted mandibular third molars, resulting in transient/permanent dysesthesia or paresthesia, is around 0.4% to 13.4%. Aims and Objectives: The study's goal was to use cone beam computed tomography (CBCT) to examine the three-dimensional anatomic association between the impacted mandibular third molars and the mandibular canal and to develop a risk prediction model to screen inferior alveolar nerve injuries. Materials and Methods: DICOM files of 300 cases were retrieved and analyzed according to the parameters. Descriptive statistics and a Chi-square test were used to assess the association between different variables and logistic regression to develop a risk prediction model to screen inferior alveolar nerve injuries. Results: Inter-observer and intra-observer agreements were excellent for all CBCT variables. Direct contact of the third molar with the mandibular canal was seen in 61.7% of the cases. Statistically significant association was found for loss of corticalization (OR-5.95; P = 0.000), narrowing (OR-18.916; P = 0.000), and dilacerations of roots (OR-3.8; P = 0.004) with “direct contact” of the impacted mandibular third molar to the mandibular canal. Conclusion: Preoperative assessment with CBCT entails the opportunity to ascertain the “high-risk” impacted mandibular third molars at a cheaper cost, with less equipment maintenance and reduced exposure, compared to computed tomography (CT) imaging.
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Prevalence of artifacts in cone-beam computed tomography: A retrospective study p. 428
KP Mahesh, Prasannasrinivas Deshpande, S Viveka
DOI:10.4103/jiaomr.jiaomr_142_22  
Introduction: In dentistry, cone-beam computed tomography (CBCT) is an essential diagnostic technique. To use CBCT imaging technology efficiently, it is vital to understand its benefits and limits. Artifacts are discrepancies between the reconstructed visual image and the actual content of the subject that can reduce anatomic accuracy. Aims and Objectives: This study aimed to assess the prevalence of artifacts in CBCT images. Materials and Methods: Three hundred sixty-five CBCT images were retrospectively studied to identify artifacts, and the prevalence of different artifacts was recorded. Frequency and percentages are used for descriptive statistics. The Chi-square test was used for interventional statistics. Results: Artifacts were observed in two hundred forty-five images examined. The most prevalent image artifact recorded was the beam hardening artifact that falls under the physics-based category. Conclusion: Physics-based and scanner-based artifacts may be avoided by concentrating on X-ray parameters and scanner detector state, respectively. To limit the frequency of patient-based artifacts in CBCT images, patients should be instructed to remove any metallic jewelry and be stabilized appropriately. Scan time should be maintained to a minimum.
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Comparative study of mouth exercise program and with combination of ultrasound therapy in temporomandibular disorder p. 432
Shravani Daruri, Sambhana Sailaja, Reddy Lavanya, C Tirumala Ravali, Swathi Dhanabalan, Swetha Bojanapu, Sowmya Komanduri
DOI:10.4103/jiaomr.jiaomr_176_21  
Introduction: Temporomandibular disorders (TMDs) are multifactorial, with several clinical presentations. The treatment is extensive and diverse, involving several therapies. Objectives: To evaluate and compare the combination of ultrasound therapy and mouth exercise with a mouth exercise program alone on pain and pain-free maximum mouth opening (inter-incisal distance) in TMD patients. Materials and Methods: A total of 30 patients who were clinically diagnosed with TMDs were equally divided into two groups. VAS score and pain-free mouth opening were recorded before and during the treatment for four weeks in all the patients. Results: Statistical analysis revealed a mean difference of 0.33 ± 0.09, 0.47 ± 0.01 in the VAS score in ultrasound with physiotherapy and physiotherapy alone. The pre- and post-treatment change in mean mouth opening (MMO) was 2.60 ± 0.21, 0.30 ± 0.87 in ultrasound with physiotherapy group and 0.27 ± 0.23, 0.20 ± 0.03 in the physiotherapy group alone, respectively. These differences in VAS score and mouth opening were statistically significant (P < 0.05). Conclusion: Both treatment modalities were effective in giving symptomatic relief, but ultrasound therapy with mouth exercises outstands showed better results in reducing pain and improving joint function.
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Prevalence of recurrent aphthous ulcers (RAUs) in the population of Ludhiana p. 437
Damanpreet K Isher, Ashima B Behl, Amanpreet Singh, Parminder P S. Isher, Gursimran Kaur, Harleen Kaur
DOI:10.4103/jiaomr.jiaomr_86_21  
Introduction: Recurrent aphthous ulcer (RAU) is one of the most common oral mucosal disorders characterized by recurrent and painful ulcerations on movable or nonkeratinized oral mucosa. It affects approximately 20% of the general population. These present as recurrent, multiple, small, round, or ovoid ulcers with circumscribed margins, having yellow or gray floors, surrounded by erythematous halos. Aims and Objectives: To compare the prevalence and occurrence of RAU among the age group from 20 to 80 years. To compare the prevalence and occurrence among the gender. To correlate the causes of the recurrent aphthous stomatitis (RAS). To check for tobacco and its role in the occurrence of RAS. Materials and Methods: A cross-sectional study was conducted, and a total of 600 questionnaire forms were distributed and filled by students (undergraduates and postgraduates), staff, skilled workers, and patients reporting to the department over a period of 3 years. Results and Discussions: In total, 71.1% had experienced oral aphthous ulcerations. When both the genders were compared, RAS more commonly affected females (60.33%) than males (39.67%). The regression coefficient for gender revealed that females were more prone to RAS than males. Conclusion: Understanding the prevalence and distribution of recurrent aphthous ulceration among the population of Ludhiana gives an indication of the section of people who suffer from the condition. Based on the results of our study, females were more commonly affected than males, and the second- and third-decades age groups were affected.
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Antibiotic susceptibility of the bacteria causing odontogenic infections: An observational study p. 442
Neeraj Kumar, Vikram V Khare, Anshuman Jamdade, Amrita Aggarwal, Niharika S Rathore, Satyapal Yadav
DOI:10.4103/jiaomr.jiaomr_194_22  
Introduction: Odontogenic infection is polymicrobial, consisting of various facultative and strict anaerobes. The dominant isolates are strictly anaerobic gram-negative rods and gram-positive cocci. Aims and Objectives: To identify the most common microorganisms responsible for causing infection and different species in oral infections. To evaluate the common types of dental infections and its site. To identify the sensitivity and resistance of antibiotics. Materials and Method: This study was conducted on 62 subjects, of which 11 showed no pathogens. After collection of the sample, it was sent to the microbiology laboratory for aerobic and anaerobic culture, gram staining, and antibiotic susceptibility test. Results: Staphylococcus (40.3%, n = 25) was the most commonly found microorganism. Maxillary anterior (32.25%, n = 20), maxillary posteriors (32.25%, n = 20), and mandibular posteriors teeth (27.4%, n = 17) showed almost similar occurrences. Maximum resistance was shown to co-trimoxazole (70.5%), amoxicillin (62.7%), erythromycin (54.9%), and azithromycin (37.25%). Linezolid (78.4%), amoxiclav and gentamicin (39.2%), vancomycin, imipenem, doxycycline showed (56.9%), and cefuroxime showed 37.25% sensitivity. Conclusions: Appropriate and correct use of antibiotics is essential to ensure that effective and safe treatment is available. The result of the present study should not be considered an absolute one; however, they can serve to increase awareness about the pathogens responsible for different infections and the sensitivity and resistance toward different antibiotics.
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In Vitro study of the effect of conservative endodontic cavities on fracture strength in mandibular molars using CBCT analysis p. 447
Uppalapati Vishwaja, Jayaprada R Surakanti, Harikumar Vemisetty, Vikram R Guntakandla, Sai Krishna Bingi, Swathi Reddy Vantari
DOI:10.4103/jiaomr.jiaomr_127_22  
Background: Endodontically treated teeth with conservative cavity preparation show better fracture resistance than traditional designs. Objective: To compare the fracture strength of endodontically treated teeth using traditional endodontic cavity (TEC), conservative endodontic cavity (CEC), truss access cavity (DDC), and ninja endodontic cavity (NEC) access designs. Methods: In an in-vitro study, 50 freshly extracted human intact mandibular molars with two separate roots were selected. The anatomic crown height, buccolingual, and mesiodistal dimensions were measured and randomized to control (intact teeth), TEC, CEC, DDC, and NEC groups (n = 10). Using cone-beam computed tomography, TEC, CEC, DDC, and NEC access cavity outlines were planned. Following endodontic treatment, the fracture strength of teeth was assessed using a universal testing machine and fracture type with a stereomicroscope. Results: The mean volume percentage of the coronal hard tissue removal was significantly lower in the NEC group than in the TEC, and CEC groups (P < 0.05), while the difference was comparable between the NEC and DDC groups (P > 0.05). The fracture strength of teeth prepared with the TEC design was significantly lower than teeth prepared by CEC, DDC, NEC, and control groups (P < 0.05). Conclusion: Teeth with traditional access preparation showed lower fracture strength than the conservative approaches.
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Correlation of the mandibular inferior cortical index and panoramic mandibular index on digital panoramic radiographs with total serum calcium and maximum hand-grip strength in the elderly – A prospective study p. 452
Bipasha Das, Shivanand B Bagewadi
DOI:10.4103/jiaomr.jiaomr_205_21  
Introduction: Panoramic radiograph classification can be used in general dental practice to identify the suspected risk of osteoporosis. Objective: The study aimed to compare the values of mandibular inferior cortex (MIC) classification and panoramic mandibular index (PMI) in the digital panoramic radiographs of elderly males and females to investigate whether there was a relationship between the indices and total serum calcium (TSC) and maximum hand-grip strength. Methods: Forty healthy elderly males and females were included in the study. The PMI and MIC were measured using a digital panoramic machine. Their TSC was evaluated, and the maximum hand-grip strength was recorded using a dynamometer. The correlation of the indices with TSC was analyzed to evaluate osteoporotic changes in the mandible. Results: The hand-grip strength was significantly higher in males than in females. The class 2 MIC was significantly higher compared to that in class 1 and class 3. The kappa value of the intraobserver agreement was almost perfect. The mean rank of MIC classification of females was significantly higher than that of males. The correlation among the MIC, PMI, and TSC was statistically significant. Conclusion: The present study showed that the MIC classification might be a better indicator/predictor for detecting early osteoporotic changes in older women.
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Evaluation of diagnostic efficacy of improved interproximal program and bitewing program in proximal caries detection- an extraoral radiographic comparative study p. 456
Bilahari Naduvakattu, Laxmikanth Chatra, K Prasanth Shenai, KR Ashir, Suresh Kandagal Veerabhadrappa, Devika Shetty
DOI:10.4103/jiaomr.jiaomr_215_22  
Background: To look for an alternative to intraoral bitewing radiographs when the intraoral placement of film is not feasible or multiple teeth have to be screened. Objectives: A study to evaluate and compare the efficacy of improved interproximal and bitewing programs for detection of proximal caries Planmeca ProMax was conducted. Materials and Methods: Fifty patients who were screened for proximal caries and confirmed with intraoral bitewing radiography were subjected to improved interproximal program and bitewing program in Planmeca ProMax (Planmeca Oy, Helsinki, Finland) after obtaining informed consent. These radiographs were evaluated by three observers. Intra- and interclass correlation was done to check reliability of the observers, and ROC analysis was done to evaluate the diagnostic accuracy. Critical ratio analysis was done to know the significance. Results: Both improved interproximal program and bitewing programs have similar diagnostic efficacy. ROC curve area of improved interproximal program was 0.833 while bitewing program showed 0.878. Bitewing program showed specificity value of 76% compared to 67% in improved interproximal program while both were equally sensitive. Conclusion: Both bitewing program and improved interproximal program are highly sensitive in detecting proximal caries when compared to intraoral bitewing radiography which is still considered the gold standard in diagnosis of an interproximal caries.
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Soft tissue calcifications in the head and neck region: A CBCT based retrospective study p. 462
B G Harsha Vardhan, K Saraswathi Gopal, M Ragu Ganesh, N Nagammai, Abubakker Siddique
DOI:10.4103/jiaomr.jiaomr_32_21  
Background: Soft tissue calcifications are most commonly seen in two-dimensional radiographs. Some may be physiological, and some may be pathological and need treatment. CBCT images provide valuable information about anatomic structures and pathologies. These soft tissue calcifications can be seen clearly in CBCT without superimposition and can be diagnosed appropriately. Aim and Objectives: This study aimed to assess the type and prevalence of calcifications found in CBCT volumes obtained for various diagnostic purposes. The objective of the present study was to determine the prevalence of soft tissue and to find their anatomic location, size, and type as well as their relation to age and gender. Materials and Method: Three hundred full-skull CBCT volumes were retrieved retrospectively from the age-group of 9–75 yrs and were evaluated for calcifications. The study sample included CBCT volumes taken for all diagnostic purposes, and those which contained artifacts were excluded. Results: Of 300 CBCT volumes, 133 were females, and 167 were males. Among them, 446 calcifications were encountered in 177 individuals. Their distribution was pineal gland calcification (24.8%), tonsillolith (18%), choroid plexus calcification (24%), pulp stone (12.4%), calcified stylohyoid chain (8%), sialolith (4%), triticeous cartilage calcification (2%), phlebolith (3%), and extracranial carotid artery calcification (1%). Conclusion: Although most of the calcifications are asymptomatic and require no treatment, correct identification of these findings will reduce further diagnostic assessment and provide more appropriate treatment plans. It will also provide the ability to evaluate underlying diseases comprehensively, and practitioners will have life-saving information by early diagnosis.
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Prevalence of Haller Cell and Accessory Maxillary Ostium: A Cone-Beam Computed Tomographic Study p. 466
Subharina Mahapatra, Manjula Hebbale, Meenal Tepan, Rajshekhar Halli, Simran Singh, Rakhee Modak
DOI:10.4103/jiaomr.jiaomr_154_22  
Introduction: Haller cell and accessory maxillary ostium (AMO) do not represent a diseased state, but they can be responsible for the development of maxillary sinusitis. Aim and Objectives: The study aimed to evaluate the frequency and volumetry of Haller cell and the prevalence of AMO on cone-beam computed tomography (CBCT). Materials and Methods: The two hundred CBCT scans of patients (400 bilateral maxillary sinus region) were evaluated for the presence of Haller cell, and AMO coronal, axial, and sagittal plane was inspected; then, volumetric measurement was carried out at the maximum mediolateral dimension. Based on the size, two observers arbitrarily categorized the Haller cell into small, medium, and large. Finally, descriptive statistics and Chi-square test were done. Results: Fifty-six Haller cell were identified with a prevalence of 28%, of which 20% were unilateral, and 8% were bilateral. Small-sized Haller cell was seen in 11%, medium-sized was seen in 13%, and large sized was seen in 4%. AMO was present unilaterally in 5% of the studied scans. Conclusion: Knowledge of Haller cell and accessory maxillary ostium may aid in interpreting CBCT, which may also forewarn surgeons before surgeries.
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SYSTEMATIC REVIEW Top

“Comparative evaluation of laser and surgical treatment modalities of oral leukoplakia” -A systematic review p. 470
Sukanya Das, Anuj P Maini, Vikram V Khare, Trupti V Gaikwad
DOI:10.4103/jiaomr.jiaomr_277_20  
Introduction: Oral leukoplakia (OL) is considered a potentially malignant lesion of the oral cavity. Aim: This systematic review aims to evaluate effectiveness of different laser and surgical treatment in management of OL. Materials and Methods: A comprehensive search was done using the MeSH [medical subject headings] terms and keyword search in the electronic databases, namely PubMed and Google Scholar. The search was limited to articles published as full text in English, which were screened by two reviewers for eligibility. Results: The search yielded nine articles out of which seven articles were only included based on the inclusion criteria. The outcome measure evaluated blood loss, pain, malignant transformation, recurrence, healing, scarring, and adverse outcomes. Conclusion: Lasers are more effective in treating OL lesions, but further comparative studies needed to assess their long-term efficacy.
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SHORT COMMUNICATIONS Top

Salivary micrornas (miRNAs) expression and its implications as biomarkers in oral cancer p. 475
Jimsha V Kumaran, Venkatapathy Ramesh, M Jonathan Daniel
DOI:10.4103/jiaomr.jiaomr_172_22  
Oral cancer is a major public health concern in Asian countries, with India alone contributing 34% of the global incidence. Oral squamous cell carcinoma (SCC) is the most common. Carcinogenesis is a complex process in the development and progression of cancer. Delay in oral cancer diagnosis remains one of the major causes of high morbidity and mortality. Non-invasive methods such as liquid biopsy are being explored as biomarkers in the body fluid of individuals affected by oral cancer. Small non-coding RNAs called microRNAs (miRNAs) regulate gene expression, which plays an important role in the pathogenesis of cancer. This short communication further enlightens the knowledge of miRNA and its implications for oral cancer.
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Dysgeusia: A misdiagnosed case of an early manifestation of varicella-zoster infection p. 477
Anlin Anto, KR Ashir, Niyas Ummer, Auswaf Ahsan
DOI:10.4103/jiaomr.jiaomr_351_21  
Bitter taste dysgeusia is a rare symptom where patients experience all foods as bitter. While its cause is still unknown, it has been increasingly reported in infections. The altered taste sensation associated with herpes zoster infection is not uncommon. However, it is rare in primary varicella infections. In this case report, we present what we believe to be the first case of bitter taste dysgeusia presenting as a prodromal symptom in primary varicella zoster infection.
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Novel classification system based on mental attitude for patients with oral leukoplakia: A proposal p. 479
Sanpreet S Sachdev, Tabita J Chettiankandy, Sonali Kadam, Vijayalaxmi Nimma
DOI:10.4103/jiaomr.jiaomr_147_22  
The patient's mental attitude is crucial in accepting the condition and compliance with tobacco cessation counseling. Even so, it was not considered a contributory factor in any of the earlier risk assessment systems. In this context, we have proposed a classification system to categorize patients with leukoplakia based on their mental attitude about understanding the risk associated with the disease and their motivation toward tobacco cessation.
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CASE REPORTS Top

A diagnostic challenge of growth on the tongue in geriatric patient—A rare case report p. 481
Jayachandran Sadaksharam, Iswarya Kathiresan, Sophia Jeba Priya Vimal, Anitha Palanisamy
DOI:10.4103/jiaomr.jiaomr_291_21  
Verruciform xanthoma (VX) is an uncommon benign inflammatory mucocutaneous condition of uncertain etiopathology which occurs on the oral mucosa. Histologically, VX is distinguished from other lesions by the presence of large numbers of foam cells in connective tissue papillae. The treatment of the VX one involves local surgical excision, and recurrence is rare. An 82-year-old male patient presented with a painless growth in the tongue for the past year. On clinical examination, a white exophytic lesion was found on the right lateral border of the tongue, and a solitary cauliflower-like growth was seen on the left ventral surface of the tongue, which was painless on palpation. That was provisionally diagnosed as squamous papilloma on the left side and verrucous carcinoma on the right side. This case report describes an unusual case of two different lesions present in the tongue that have features of VX and squamous cell carcinoma.
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“Fruit in a tooth” - A rare non - Syndromic anomaly - 2 rare case reports with a genetic analysis p. 484
Arul Jothi Murugan, G Anuradha, A Kannan, Krithika Chandrasekar Lakshmi
DOI:10.4103/jiaomr.jiaomr_84_22  
Tooth agenesis is one of the most common developmental anomalies affecting function and aesthetics. Genetic mutations cause non-syndromic tooth agenesis and involve the interaction of genes of tooth epithelium and mesenchyme odontogenesis. This article is the first in the literature to present non-syndromic cases of two siblings reported with mulberry molars, morphological changes in teeth (hypodontia and microdontia), and a genetic study performed to substantiate the involvement of Paired box gene 9 in tooth agenesis and morphogenesis.
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Chronic sinusitis or malignancy? Role of an oral and maxillofacial radiologist in comprehending the dilemma: A case report p. 488
Anka Sharma, Hemant Sawhney, Richa Mishra, Jayant Kumar
DOI:10.4103/jiaomr.jiaomr_343_21  
Maxillary sinus malignancies are rare, constituting just 0.44% of all neoplasms. These malignancies have a male predilection, with a ratio of 2:1. Men in the age range of 39–89 years are mostly affected. The patient presents with a plethora of symptoms that can mimic an odontogenic infection or paranasal sinusitis. This case report discusses and describes the cone-beam computed tomography (CBCT) findings of a patient with malignancy of maxillary sinus misdiagnosed as chronic sinusitis.
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Syndromic multiple cystic lesions: A rare case report p. 491
Rahila K Patwegar, Arati G Paranjpe, Raghavendra S Byakodi, Avinash B Kshar
DOI:10.4103/jiaomr.jiaomr_186_22  
Odontogenic cystic lesions of the jaw usually present as a single lesion and rarely occur as multiple cysts occupying more than one quadrant of the jaw. Multiple cysts are usually a part of a syndrome. Cystic lesions of the jaw are rarely symptomatic in pediatric age and, thus, very difficult to identify at an early age. Here, we present a case of multiple cysts in a pediatric patient and a review.
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An unusual presentation of spindle cell tumor on palate: A case report p. 495
Jasbir Kaur, Rohit Chopra, Anantpreet Singh
DOI:10.4103/jiaomr.jiaomr_107_22  
Spindle cell tumors are rarely reported in the oral cavity. Since the subtypes of these lesions are very difficult to diagnose, immunohistochemistry is a useful diagnostic tool. Here, we report a case of benign spindle cell tumor on palate. A 49 year old male presented with irregular mass of approximately 2 × 2 cm on maxillary right posterior region of palate since 2 months. Excisional biopsy and immunohistochemistrydetermine it as benign spindle cell tumor.
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