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   Table of Contents - Current issue
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July-September 2022
Volume 34 | Issue 3
Page Nos. 241-375

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EDITORIAL  

Editorial Inscription From the desk of editor in chief Highly accessed article p. 241
ML Avinash Tejasvi
DOI:10.4103/jiaomr.jiaomr_259_22  
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ORIGINAL ARTICLES Top

Comparative evaluation of efficacy of therapeutic ultrasound and phonophoresis in myofascial pain dysfunction syndrome Highly accessed article p. 242
Rajamohan Radhamani Mahendra Raj, Thalaimalai Saravanan, Paramasivam Preethi, Ilamurugan Ezhilarasi
DOI:10.4103/jiaomr.jiaomr_100_22  
Introduction: Myofascial pain dysfunction syndrome (MPDS) is a common presenting condition in the dental office. No specific therapy has proven its superiority over the other in managing myofascial pain dysfunction syndrome. Since phonophoresis was beneficial for other musculoskeletal medical conditions, the same strategy was adopted to prove its efficacy in MPDS. Aim and Objective: The aim of the study is to compare and evaluate the effectiveness of therapeutic ultrasound (ThUS) and diclofenac and thiocolchicoside gel phonophoresis in MPDS. Materials and Methods: Thirty patients with MPDS were randomly assigned into two groups. Group 1 (n = 15), therapeutic ultrasound was applied with ultrasound gel without any therapeutic ingredient for 10 min and five sessions. Group 2 (n = 15), ultrasound was applied with ultrasound gel with diclofenac and thiocolchicoside gel for 10 minutes and five sessions. Pain and mouth opening was taken as evaluation parameters. Result: A comparison of results obtained from the two groups before and after treatment at the end of each session shows significant improvement in both the parameters. However, in Group 2 more improvement in all outcome variables can be seen compared with group 1. Conclusion: Phonophoresis with diclofenac and thiocolchicoside (analgesic and muscle relaxant) proved to be an excellent treatment in MPDS. They proved more effective than therapeutic ultrasound in controlling pain and improving mouth opening.
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Assessment of onset and progression of chemoradiotherapy induced oral complications in head and neck cancer patients - A prospective study Highly accessed article p. 246
V Sharon Keziah, Sreedevi Dharman, Gopal Maragathavalli
DOI:10.4103/jiaomr.jiaomr_3_22  
Background: Patients with head and neck cancer (HNC) undergoing chemoradiotherapy (CRT) are susceptible to acute oral complications that have deleterious effects on oral health, reducing the patients' quality of life. Aim: To assess the onset and progression of oral complications in head and neck cancer patients undergoing chemoradiotherapy. Materials and Method: This was a prospective study conducted among 40 patients with HNC undergoing CRT. Oral complications onset and grades of severity at different time points on a weekly basis for six weeks were assessed. Weekly pairwise comparisons of oral complications was done using the Friedman one-way repeated measure analysis of variance (ANOVA). The Chi-squared test was done in oral candidiasis to determine the significance between groups (P < 0.05). Results: Among 40 HNC patients who completed CRT and showed oral complications, 27 (67.5%) were males and 13 (32.5%) females, with peak age of 51–60 years (40%). All the oral complications had onset first noticed in the second week of CRT except dysphagia that occurred in the first week. A statistically significant difference in oral complications grading during week 1 to week 6 with P < 0.001 was present. All the patients had oral mucositis (OM), xerostomia, and dysgeusia observed in the fourth week, and dysphagia in fifth week. Severity in grading was noticed in the sixth week for all the complications. Candida albicans were more predominantly found in the later weeks as the dose of CRT increased (P < 0.001). Conclusion: In our study, a majority of oral complications had onset by second week of CRT and disease severity progressed in the sixth week of CRT. Awareness of the nature of oral complications by clinicians will aid in developing novel strategies and management in the near future that may help to improve the quality of life of the patient with HNC undergoing CRT.
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Reliability of toluidine blue and colposcopy in determining biopsy site among patients with oral leukoplakia – A comparative study p. 254
Karunakar Naik, D Sujatha, H Kiran Raj, Anuradha Pai, Pooja Naik, M Shruthi
DOI:10.4103/jiaomr.jiaomr_83_22  
Background: To date, no simple and reliable method can replace oral biopsy site detection using Toluidine blue for early identification and treatment of potentially malignant oral disorders (OPMDs). Aims and Objectives: The study was conducted to assess the feasibility of using the colposcope and compare the findings with the toluidine blue staining method for selecting the biopsy site. Materials and Methodology: Study group included 30 patients; five patients dropped out as regression was seen in the lesion. Twenty patients with homogenous leucoplakia and five patients with nonhomogenous Leukoplakia formed a study group. An area with the most extensive cell change in the colposcopic examination was selected by the first version, Image J 1. x Software. After toluidine, blue staining was done. Dark blue-stained sites were considered positive, and site selection for the biopsy was made. Results: Normal vascular pattern in six (24%) cases, 10 (40%) cases showing punctuate vascular pattern, four (16%) of cases showed the mosaic vascular pattern, five (20%) of cases were with the atypical vascular pattern were assessed in colposcopic examination with statistically significant P value (0.009). Fourteen cases out of 20 cases of homogenous and all five cases of nonhomogenous leukoplakia were correctly diagnosed for the biopsy site with both toluidine blue and colposcopic techniques. Conclusion: In this study, Toluidine blue and colposcopic technique showed 76% accuracy for detecting the biopsy site. So colposcope can be an alternative diagnostic aid to toluidine blue in detecting biopsy sites for PMD.
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Prevalence of calcified carotid artery atheromas on digital panoramic radiographs in type 2 diabetic and non-diabetic patients p. 259
K Roja Ramani, K Vinay Kumar Reddy
DOI:10.4103/jiaomr.jiaomr_332_21  
Introduction: Panoramic radiographs are routinely used in dental clinics and are of great value in the diagnosis of calcified carotid artery atheromas. So the present study is aimed to know the prevalence of calcified carotid artery atheromas on the digital panoramic radiographs of patients with Type 2 diabetes mellitus and non-diabetic. Aim and Objectives: To determine the prevalence of calcified carotid artery atheromas in Type 2 diabetes mellitus and to assess the reliability of digital panoramic radiographs in detection of calcified carotid artery atheromas. Materials and Methods: A total of 100 subjects were included in the present study, 50 Type 2 diabetic patients and 50 age and sex matched healthy individuals were chosen as controls. Blood samples were collected and a digital panoramic radiograph was advised. To confirm those carotid artery calcifications (CACs) which were evident on panoramic radiograph further ultrasound Color Doppler was advised. Results: Among 50 Type 2 diabetic patients 9 (18%) patients showed CACs on digital panoramic radiograph and among 50 controls there were no CACs on digital panoramic radiograph with a statistically significant P value of 0.0022 (P < 0.05). Type 2 diabetes who exhibited CACs on digital panoramic radiograph also showed CACs on ultra sound Color Doppler. Conclusion: Our study concludes that people with Type 2 diabetes mellitus have more prevalence of calcified carotid artery atheromas on digital panoramic radiographs than non-diabetics.
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Assessment of lornoxicam as a mouth dissolving film in management of post extraction pain-A randomized control trial p. 263
M Aparna Vijayan, KP Mahesh, Karthikeya Patil
DOI:10.4103/jiaomr.jiaomr_119_22  
Background: Mouth dissolving film (MDF) is a fast-dissolving drug delivery system that provides a practical means to administer drugs not just to special populations with swallowing difficulties but also to the general public. MDFs are novel dosage forms that dissolve and disintegrate quickly within the mouth. Aim: To assess the efficacy of lornoxicam mouth dissolving film as a potent analgesic and drug delivery system and compare it with the aceclofenac tablet in the management of post-extraction pain. Methodology: The study group comprised 60 subjects of either sex of age group 20–50 years who were divided into an experimental group (group A) and a control group (group B). Group A was administered lornoxicam MDF and group B was administered aceclofenac tablets. Pre-treatment and post-treatment pain assessments were recorded using a visual analog scale (VAS) and an oral pain scale (OPS). Results: In a comparison of the mean value of pre-treatment VAS and VAS after 24 h, the percentage of pain reduction in group A was 86.66%, and in group B was 75%. When comparing the mean value of pre-treatment OPS and OPS after 24 h, the percentage of pain reduction in group A was 93.33% and in group B was 75%. These results were statistically significant, with a P value of 0.00 in both groups. Conclusion: Lornoxicam as an MDF showed promising results in managing post-extraction pain. The potential delivery of lornoxicam through the MDF was safe, with better patient compliance, and no reported cases of adverse effects.
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Liver-Expressed antimicrobial peptide as an early predictor of dysplasia in oral submucous fibrosis: An experimental trial p. 268
Tejavathi Nagaraj, Bhavana T Veerabasavaiah, HN Santosh
DOI:10.4103/jiaomr.jiaomr_161_22  
Background: Liver-expressed antimicrobial peptide 1(LEAP1) plays a major role in dysplasia. Oral potentially malignant disorders (OPMDs) are on the rise, and the rate of malignant transformation is alarming. Iron (Fe) deficiency in anemia of chronic disease may be because of the presence of oral submucous fibrosis (OSMF). The metabolism of Fe is altered in dysplasia, leading to dysregulation of Fe homeostasis. Aim and Objective: This study aimed to estimate the levels of serum LEAP1 in subjects having OSMF and OSMF with dysplasia and to establish the role of LEAP1 in dysplasia associated with OSMF and in iron homeostasis. Materials and Methods: This study was registered with the CTRI [Clinical Trial Registry of India (REF/2019/06/026566)] as a clinical trial. Twenty participants were selected. Ten participants with OSMF and 10 with OSMF along with dysplastic changes were chosen and categorized as group I and group II. Serum LEAP was estimated in the 20 subjects with clinically diagnosed OSMF. Baseline hematologic investigations like complete blood count (CBC), peripheral smear, and LEAP1 were done. Statistics: Statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) software version 11.5 (IBM, New York, USA). To assess the correlation between serum LEAP1 and OSMF, the one-way analysis of variance (ANOVA) test was used. To obtain the interconnection between serum LEAP1 and dysplasia, independent t-test was used. By calculating the effect size, clinical significance was established. Results: Serum LEAP1 levels in group I (OSMF with dysplasia) showed a remarkable increase in the value in comparison with group II (OSMF without dysplasia). The correlation between the values of serum LEAP1 and dysplasia was significant with P < 0.001. Clinical Significance: Alterations in the iron metabolism are observed in dysplasia; hence, LEAP1 can be a novel marker in the early detection of cancer and can lead to effective treatment and increased survival rate in oral cancer. Conclusion: This research explores new avenues by linking LEAP1 levels to the presence of dysplasia. We can conclude that improvement in the body's iron stores leads to a decrease in serum LEAP1. Therefore, to assess iron storage in OSMF serum, LEAP1 can be used as a novel diagnostic marker.
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Evaluation of serum urea, uric acid and creatinine in OSMF patients: A clinical and biochemical stusdy p. 272
Swati Verma, Rahul R Bhowate
DOI:10.4103/jiaomr.jiaomr_151_21  
Introduction: Oral submucous fibrosis (OSMF) is described as a chronic debilitating disease of the submucosal tissue. Leaching out compounds from areca nut is the main etiology for OSMF. Biochemical examinations have concentrated on demarcating changes in the blood, serum, or tissues of patients with this disease. Such examinations have given insights into the possible pathogenesis of OSMF. Aim: Estimation of serum urea, uric acid (UA), and creatinine (Cn.) in OSMF patients. Objective: To estimate the level of serum urea, UA, and Cn. in OSMF patients and compare them with habitual betel nut chewers. Materials and Methods: The purposive samples were selected from patients attending the OPD of the Oral Medicine and Radiology (OMR) Department. In total 180 patients were included and divided into three groups. Group I-Patients suffering from OSMF, Group II-Habitual control, and Group III-Healthy control. Results: The mean value of serum UA (mg/dL) in Group I was 7.82 ± 2.18, Group II was 5.83 ± 1.22, and Group III was 5.28 ± 1.10. The mean value of serum Cn. (mg/dL) in Group I was 1.05 ± 0.27, Group II was 1.15 ± 0.22, and Group III was 0.72 ± 0.21. One-way analysis of variance (ANOVA) was applied between the groups and significant differences were found for both serum UA and Cn. with P < 0.0001, whereas no significant difference was found for serum urea. Conclusion: It can be concluded from this study that serum urea, UA, and Cn. of OSMF patients should be evaluated for liver and renal involvement and for overall improving the disease prognosis.
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Comparison of effects of honey and 0.1% triamcinolone acetonide in the management of recurrent aphthous stomatitis - A randomised, single-blind study p. 276
Amit A Mhapuskar, Shweta Thakare, Isha P Kale, Pradnya Karmarkar, Darshan R Prasad Hiremutt, Abhijeet Jadhav
DOI:10.4103/jiaomr.jiaomr_157_22  
Introduction: Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease known to humans and are characterized by the development of painful, recurring solitary or multiple ulcers confined to the oral mucosa. RAS is often painful and worsens during drinking and talking. Aim: To evaluate and compare the effects of honey and 0.1% triamcinolone acetonide in patients with ulcers of recurrent aphthous stomatitis minor. Materials and Methods: Sixty patients having RAS minor were divided into two groups of 30 participants each by simple random sampling. Group A was treated with application of 0.5 ml of honey thrice a day for a week or until complete healing of the ulcer. Group B was treated with application of 5 g of 0.1% triamcinolone acetonide oral paste thrice a day for a week or until complete healing of the ulcer. For all the individuals, baseline parameters like the size of the ulcer, pain, and burning sensation were recorded on day 0, reassessment was done on day 4 and day 7, followed by statistical analysis. Results: The study showed that the reduction in the size of ulcers, VAS score for pain, and VAS score for burning sensation were similar in patients receiving honey as compared to patients receiving 0.1% triamcinolone acetonide. No adverse effects were reported in patients receiving honey, and there were mildly adverse reactions in some patients receiving 0.1% triamcinolone acetonide oral paste. Conclusion: Honey, a natural anti-inflammatory agent, seems to hold immense potential as an alternative medication for managing RAS minor ulcers. It has better patient compliance as compared to 0.1% triamcinolone acetonide.
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Prevalence of temporomandibular disorders and their correlation with gender, anxiety, and depression in dental students − A cross-sectional study p. 281
S Lokesh Kumar, Zameera Naik, Arun Panwar, M Sridhar, Anjana Bagewadi
DOI:10.4103/jiaomr.jiaomr_65_22  
Context: The role of anxiety and depression in causing temporomandibular disorders (TMDs) has been well established in the past; however, there are no studies on dental students that evaluate both the TMD and psychological factors. Aim: To determine the prevalence of TMD among dental students and its correlation with gender, anxiety, and depression. Materials and Methods: The study included 384 dental students (both undergraduates and postgraduates). The prevalence and severity of TMD were assessed with an anamnestic questionnaire. The severity of anxiety and depression was evaluated by Hospital Anxiety and Depression Scale after eliciting a detailed case history to include/exclude the participants. Statistical tests, including Shapiro-Wilk's, Chi-square, and Spearman's rank correlation coefficient, were done to check the normality distribution, association, and correlation, respectively. Results: The results revealed that 52.9% of the students had some degree of TMD. There was no statistically significant difference in the TMD severity between different gender (P = 0.373). About 51% of the students had anxiety, and 24% had depression. There was a statistically significantly high level of anxiety in females than in males (P = 0.046); however, not for depression (P = 0.312). There was a significant positive correlation between TMD severity and anxiety (P < 0.001) but not depression (P = 0.10). Conclusions: A high TMD prevalence was observed in dental students. There was a significant positive correlation between TMD severity with anxiety but not gender and depression. Psychological counseling and appropriate management are the need of the hour to prevent further complications.
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Evaluation of orofacial symptoms and oral health-related quality of life among COVID-19 patients attending a tertiary hospital in Thiruvananthapuram: A cross-sectional study p. 286
MM Mini, BC Tinky, S C R. Fathima, K Aswathi, Sunu Ramachandran, KL Girija, S Ramesh
DOI:10.4103/jiaomr.jiaomr_110_22  
Background: Researchers have been perplexed by the diverse clinical symptoms of COVID-19 spikes, and its oral symptoms are not frequently documented. Objectives: To estimate the prevalence of orofacial symptoms associated with confirmed COVID-19 cases and to assess the oral health–related quality of life among these patients. Methods: After audio consent, a pre-tested structured questionnaire was used to gather data from COVID-19-confirmed patients, and cases from a tertiary dental care facility in Thiruvananthapuram were also included. Results: Out of 200 participants, 86 (43%) were females, and 114 (57%) were males. The mean age was 40 years, ranging from 10 to 75 years. It was found that loss of taste (111, 56%), dry mouth (54, 27%), oral ulceration (18, 9%), white discoloration (12, 6%), burning sensation (9, 4.5%), red discoloration (7, 3.5%), tooth mobility (4, 2%), osteomyelitis (3, 2%), mucormycosis (4, 2%) and gingival bleeding (1, 0.5%) were the orofacial symptoms present in the participants. Conclusion: The prevalence of orofacial symptoms was 68% in COVID-19 patients, with loss of taste, dry mouth, and oral ulcerations as predominant symptoms. The mean oral health impact profile (OHIP) value of the COVID patients who showed oral manifestations was 17.44, whereas for those who did not show oral manifestations, it was only 7.46.
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Effect of Covid and its Treatment Protocols on Chronic Generalized Periodontitis- A Prospective Study p. 290
S Hari Krishna Reddy, Chandrasekhar Reddy Madu, Hanusha Bathula, Chiranjeevi Vedula, Venugopal Kunthsam, K V S P. Gupta
DOI:10.4103/jiaomr.jiaomr_38_  
Background: COVID-19 causes an inflammatory response that intensifies and can cause death. Periodontitis is also characterized by an inflammatory response elicited by microbial plaque, which intensifies and inflicts damage to the tissues. To address the effect of immunoinflammatory mechanisms, steroids were used extensively as a lifesaving drug and stayed as the mainstream drug in treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. The present study aimed to investigate the possible impact of COVID-19 treatment protocols in chronic periodontitis patients. Materials and Methods: A total of 103 COVID-19-positive patients with a hospitalization period of at least 5 days with dental records were enrolled in the study. Based on Periodontal Index (PI) values, the subjects were categorized as having mild, moderate, and severe periodontitis. These patients, after undergoing treatment for COVID-19 were recalled after 6 months for periodontal status evaluation. Statistical analysis was made to test for any significant variation in the periodontal status before and after COVID-19 treatments. Results: The mean comparison of Periodontal Index (PI) values before and after COVID were 4.02 and 4.40, with a statistically significant (P ≤ 0.05). PI values of the patients on Dexamethasone pre and post COVID –b 19 were compared and found to be 3.86 and 4.83, respectively. Conclusion: The present study indicates that COVID-19 and its different treatment protocols were strongly associated with elevated periodontal disease worsening in COVID-19 survivors at 6-month follow-up.
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MRI Evaluation of Salivary Gland Involvement by Buccal Squamous Cell Carcinoma p. 295
Aarati Panchbhai
DOI:10.4103/jiaomr.jiaomr_137_22  
Introduction: The salivary gland involvement by oral squamous cell carcinoma (OSCC) and diagnostic delays may influence the recurrence and survival of OSCC cases. Aims and Objective: To estimate salivary gland involvement in buccal OSCC cases. Materials and Methods: For 91 histopathologically proven cases of buccal OSCC, the primary tumor and salivary gland were evaluated using magnetic resonance imaging (MRI) sequences as T1-T2-weighted, diffusion-weighted, short tau inversion recovery, and contrast-enhanced images. Results: Out of 91 buccal OSCC patients, 10 (10.98%) cases showed salivary gland involvement, primarily the ipsilateral submandibular gland involvement with heterogeneous enhancement and few areas of necrosis. Conclusion: The considerable proportion of buccal OSCC cases with salivary gland involvement as evaluated in MRI was demonstrated in the present study. The study findings underscore the need for careful pre-treatment evaluations toward salivary gland involvement, especially in occult cases.
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Evaluation of patterns of mandibular bone invasion in CBCT of patients with oral squamous cell carcinoma: A descriptive study p. 300
Prashanth Shenoy, P Archana, Laxmikanth Chatra, KM Veena, Rachana V Prabhu, Prathima Shetty
DOI:10.4103/jiaomr.jiaomr_99_22  
Background: One of the crucial factors in the pretreatment analysis of patients with oral squamous cell carcinoma (OSCC) is the detection of the presence of bony invasion. This will indicate aggressiveness, and its patterns may also express the conduct of the lesion. The extent of bony invasion by the tumor will alter the treatment planning and increases the morbidity rate and quality of life. Aim: To evaluate the mandibular invasion patterns in cone beam computed tomography (CBCT) of patients with OSCC. Methodology: A total of 31 CBCT images of OSCC involving the mandible with bony invasion were included and assessed for various invasion patterns. Bony invasion is classified into three patterns: erosive, infiltrative, and mixed. Results: Descriptive analysis was carried out to assess the frequency among various bony invasion patterns. Chi-square test was carried out to find significance between the inferior alveolar nerve canal (IANC) involvement among various patterns of OSCC, which found be to be highly significant. Conclusion: Erosive pattern is the common pattern observed and the mixed pattern was the most frequently associated pattern with the IANC involvement.
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Radiographic analysis of idiopathic osteosclerosis of jaws in Indian sub-population: A cross-sectional study p. 304
Harini Parthiban, Suman J Lakshmi, Elangovanz Somasundaram, B Senthil Kumar
DOI:10.4103/jiaomr.jiaomr_116_22  
Context: Idiopathic osteosclerosis may be congenital or developmental in origin and are asymptomatic. It usually manifests as an incidentaloma and hence it can be encountered in the panoramic radiograph during routine radiographic examination. Aim: This study aims to determine the prevalence of idiopathic osteosclerosis in the Indian population using digital panoramic radiographs. Methods and Material: A cross-sectional study was carried out with a total of 2000 digital panoramic radiographs for the presence of idiopathic osteosclerosis in the Indian sub-population. The area that appeared as an obvious bony island, either round, oval, or irregular shape with a definite internal structure, was selected as a criterion for diagnosis and categorized into five types based on location: inter radicular, inter radicular and separate, apical and inter radicular, apical, and separate. After evaluation, it was correlated based on age, gender, type, and location. Statistical Analysis Used: Statistical analysis was performed using Pearson's Chi-square test. Results: A total of 90 areas of osteosclerosis were found, and a prevalence rate of 4.5% was obtained. The separate type of osteosclerosis showed the highest rate of occurrence. The prevalence rate was identified to be higher in female subjects, and the majority of the lesions occurred among the age group of 12-21 years. Conclusions: This study showed the prevalence of 4.5% on digital panoramic radiographs and found a significant value (p-value 0.042) between the types of idiopathic osteosclerosis and its location.
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Comparison of Cone Beam Computed Tomography Performance at Different Voxel Sizes in the Evaluation of Mandibular Canal – An In vitro Study p. 309
Rini Joy, A Kannan, Krithika C Lakshmi, D K S. Lakshminrusimhan, Anitha Roy
DOI:10.4103/jiaomr.jiaomr_244_21  
Background and Aim: Even though cone beam computed tomography (CBCT) imaging is a propitious tool to track the mandibular/ inferior alveolar canal (MC) course, documentation regarding indefectible CBCT imaging strategy for MC localization is sparse. This study aimed to appraise CBCT's functioning at specified voxel sizes for deducing an explicit voxel size setting that simplifies MC evaluation in individual imaging sections. Materials and Methods: CBCT scan of 12 dry human mandibles was produced at 0.5, 0.3, 0.25, and 0.2 mm voxel settings. Two specialists/assessors explored the generated images in coronal (buccolingual) and curved (anterior-posterior) sections. Statistical Analyses: Mann–Whitney U, Kruskal–Wallis, post-hoc Tukey HSD, and Kappa statistics. Results: All voxel specifications revealed appreciable statistical variance; coronal sections comparatively excelled in serving the study objective. Statistical authentication was spotted among voxel sizes 0.5–0.2 mm and 0.5–0.25 mm (both assessors, either section), 0.3–0.2 mm (first specialist, curved), and 0.3–0.5 mm (second specialist, curved). Inter-observer agreement was excellent for voxels 0.25 mm (coronal) and 0.2 mm (curved). Conclusion: Precise voxel setting to trace MC is 0.3 mm and the suitable imaging section is coronal.
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Frequency of Recommending Cone Beam Computed Tomography in Comparison to Panoramic Radiograph, While Diagnosing a Pathology/Status of Vital Structures Around Mandibular Impacted Third Molar p. 314
Veena Naik, Saurabh Prakash, Ng Wen Chuan, Nishanthisri , Ooi Chin Ying
DOI:10.4103/jiaomr.jiaomr_156_21  
Objective: This study assesses the quantity and quality of reliability of both conventional and cone-beam computed tomography (CBCT) in evaluating external root resorption (ERR) and proximity of inferior alveolar canal (IAC) around impacted mandibular third molars and also the practicability to advise CBCT as the first radiographic examination in every patient with above pathology. Methodology: A prospective cross-sectional study was conducted with a sample of 73 individuals, aged between 18 and 40 years, irrespective of their sex. Digital panoramic radiograph (PAN) and CBCT were carried out for individuals with mandibular impacted third molars, which were evaluated by three observers independently for ERR and relation of impacted teeth with inferior alveolar nerve (IAN) canal (resorption of IAN cortical plate, impingement, and approximation). The data was analyzed by Kappa test and the PAN and CBCT findings were compared using Wilcoxon signed-rank test. Results: Out of 73 subjects, 13 subjects showed resorption of the IAN cortical plate in CBCT, among which only five were confirmed in PAN. Forty-three cases showed impingement of the third molar on the IAN in PAN, which was completely absent in CBCT. Among 14 subjects who presented contact or approximation of the third molar with the canal in PAN, only seven were confirmed in CBCT. Twenty-five cases actually showed ERR in CBCT, whereas PAN confirmed only eight cases. Pathologies seen on PAN were considerably very less in comparison with CBCT. Conclusion: Thus, we conclude that two-dimensional (2D) radiographs are the first choice of diagnostic radiographs, even though the CBCT is accurate in displaying the pathology; however, the decision to advise CBCT image should depend on whether the information from CBCT changes the surgeon's diagnosis and treatment planning.
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Cone-Beam computed tomography a dynamic tool for assessment of canalis basilaris medianus a skull anomaly – A retrospective study p. 320
Lavanya H Pasalkar, Mahesh S Chavan, Shrutika R Sonawane, Arunima Sarma, Bharti Helge, Sanket Tilekar
DOI:10.4103/jiaomr.jiaomr_329_21  
Introduction: Canalis basilaris medianus (CBM) is an anomaly of basiocciput in the clivus at the skull's base, demonstrating six different morphological varieties. CBM can be associated with recurrent meningitis and various other cranial pathologies. It can be seen on maxillary cone-beam computed tomography (CBCT) scan with comparatively less radiation dose than computed tomography (CT). Aim: The aim of this study is to determine a prevalence of CBM on CBCT. Objectives: The objectives of this study are: 1. To identify CBM on CBCT 2. To classify CBM according to their morphological types using CBCT. Methods and Material: This study included 300 maxillary CBCT scans retrieved from archival records from the CBCT diagnostic center, Department of Oral Medicine and Radiology, and the existence of CBM were examined. Scans of both genders with all age groups were selected. The existence of CBM was examined and classified based on its morphological type. Results: Chi-square test was used to carry out the descriptive statistics. The presence of CBM was found in 16 scans with a prevalence rate of 5.33%. Out of 16 scans, 10 (62.5%) were females, and 6 (37.5%) were males. Among them, 13 (81.25%) scans were superior recess variety, and 3 (18.75%) were inferior recess variety; other morphological types were absent. Conclusion: Although the prevalence rate of this anomaly is low, it is clinically significant as it may cause the spread of nasopharyngeal infections to the skull base. The present study revealed that a CBCT scan of the maxillary arch could provide a clear delineation of CBM with comparatively less radiation dose than CT. To the best of our knowledge, the recorded values of the prevalence rate of CBM available in current literature are lower compared to this first-ever study carried out in India.
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Prevalence and anatomic variations of lingual foramina and lingual canal in anterior mandible using cone beam computed tomography – A cross-sectional study p. 324
Sindhu Poovannan, T Sarumathi
DOI:10.4103/jiaomr.jiaomr_34_22  
Introduction: Rich neurovascular supply in the anterior mandible necessitates a preoperative radiological assessment of the lingual foramina/canal where cone beam computed tomography (CBCT) could produce promising results. Aim: To assess the prevalence of lingual foramina and canal in mandible and variations in their anatomy in a hospital-based population in Chennai. Methodology: Sagittal sections of the anterior mandible from CBCT images of 140 patients were evaluated for number, location of the lingual foramen, length of the lingual canal, a distance of lingual foramen from the alveolar crest and inferior border of the mandible, and thickness of the lingual cortex. Results: A total of 166 lingual foramina-canals were identified in 140 individuals; 82.1% presented with one, 15.1% with two, and 2.1% with three lingual foramina canals. The majority of foramina (79.51%) were located above the genial tubercles. The mean lengths of the superior, middle, and inferior canals were 5.45 ± 1.34, 5.00 ± 1.73, and 3.92 ± 1.10 mm, respectively. The mean thickness of the lingual cortex was 2.35 ± 0.55 mm. The distance from the inferior lingual foramina to the alveolar crest was significantly greater in males (P = 0.001). Conclusion: Anatomical characteristics of lingual foramen-canal varied significantly across the total sample.
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Assessment of Mandibular Anterior Nutrient Canals in Patients with and without Periodontal Disease: A Cone Beam Computed Tomographic Study p. 329
Surekha Ramrao Rathod, Vrushali Lathiya, Yogesh Rathod, Ameya Bhide
DOI:10.4103/jiaomr.jiaomr_45_22  
Background: Nutrient canals (NCs) are radiolucencies in the bone that transit blood vessels and nerves. Aim: To use cone beam computed tomography (CBCT) to assess the incidence, diameter, and location of NC in healthy and periodontal disease patients and correlate it with the extent of alveolar bone loss. Materials and Methodology: About 200 CBCTs (100 healthy and 100 with periodontal disease) were selected and analyzed. The prevalence, diameter, and location of the NCs were comparatively evaluated between the two groups. The frequency and diameter of the canals were also correlated with the severity of bone loss, age, and gender. Results: Subjects in group II had a significantly greater frequency of NCs (P = 0.0001). NCs in group II had a larger mean diameter. The NCs were nearer to the alveolar crest in group II (16.70 ± 6.31 mm) than in group I (18.08 ± 5.72 mm). Their frequency was significantly greater when the bone loss was greater than two-thirds of the root length (P = 0.043). Conclusion: In patients with periodontal diseases, the incidence and diameter of NCs were higher and correlated positively with the extent of bone loss.
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Evaluation of the accuracy of measurements made at probable implant site using cone-beam computed tomography: A retrospective in vivo study p. 333
Hasan Sarfaraz, Mallika Shetty, K Harini, Sanath K Shetty, Sazia Amreen, Rachana Prabhu
DOI:10.4103/jiaomr.jiaomr_346_21  
Introduction: Computed Tomography (CT) was the most used 3D radiographic diagnostic technique for years, but cone-beam computed tomography (CBCT) was created to reduce radiation exposure, costs, and accessibility issues. Aim: To evaluate the accuracy of CBCT measurements made at probable implant sites. Materials and Methodology: This was a retrospective study that compared panoramic reconstructed CBCT with RVG measurements at 77 probable implant sites, especially mandibular posterior tooth-bounded edentulous areas. Measurements made were the mesiodistal width of the edentulous area at the crest and at the highest point of the adjacent tooth's contour and the length of the natural teeth in the mandibular first molar region from the highest cusp to the apex next to the edentulous area. Statistical analysis was done with the Statistical Package for the Social Sciences (SPSS) and the independent t-test. Results: The mean difference between CBCT and radiovisiography (RVG) readings for mesiodistal width at the crest and highest contour of the edentulous bounded two neighboring teeth was −0.21039 and 0.02961, respectively, which was not statistically significant. The mean difference between CBCT and RVG readings along the tooth was 0.80481, which was statistically significant (P = 0.018). RVG outperformed CBCT (SD = 1.7) in estimating tooth length. Conclusion: Conventional RVG radiographic measurements were similar to real tooth length, whereas CBCT panoramic reconstructions underestimated the lengths by 15% but were clinically acceptable. Clinical CBCT application requires operator abilities and knowledge with software. It is critical to pay close attention to the calibration of data obtained from clinical examination and CBCT.
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Significance of mandibular canal position and its foramina in cone beam computed tomography images of mandible for analysing sexual dimorphism- A retrospective study p. 338
Malabika Shil, Sambhana Sailaja, Reddy Lavanya, T Ravali, P Raziya Fathima, T Yamini Aparna
DOI:10.4103/jiaomr.jiaomr_288_21  
Background: Determination of gender from unidentified skeletal residue remains an arduous task in a forensic setting and for medico-legal assessment. The use of mandible in the field of human identification is less explored. Therefore, this study was done to analyze sexual dimorphism by identifying the relative location of mandibular canal and the mandibular and mental foramina using cone beam computed tomography images in a sample of south Indian inhabitants. Materials and Methods: This study was done on one hundred twenty cone beam computed tomography images (sixty males and sixty females) with an age range of twenty to sixty years. In these images, eight measurements were performed: six measurements in the coronal view and two measurements in the axial view. The variables between the sexes were compared using a student's t-test with level of significance of < 0.05. Results: All the eight variables were significant in predicting gender (P < 0.05). The mean values of all the measurements were higher in males except for one measurement which was higher in females. A logistic formula was obtained with all the variables to predict gender. Conclusion: The mandibular canal and the foramina showed significant differences among males and females of the study population. Therefore, the location of the mandibular canal and mental foramina can be used for gender determination in the study population.
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Assessment of accuracy of two different radiographic methods for age estimation to chronological age – A Comparative CBCT Study p. 343
Delphia Thomas, Pushpanjali , Mala Dayanandam, Navyasree Kondoj, Vishal Anakarla, Swathi Dhanabalan
DOI:10.4103/jiaomr.jiaomr_26_22  
Introduction: Assessment of age in adults is a difficult task in forensic medicine. In craniofacial structures, the mental, mandibular foramina and teeth are useful in age estimation. Because the pulp-to-tooth area ratio (PTR) based on secondary dentin deposition and the distance between the inferior border of the mental foramen and lower border of the mandible stays largely consistent over the course of a person's life, PTR and position of mental foramen are sensitive age markers. Aim: This study aims to assess an accurate method for age estimation, by comparing the results of the two different age estimation techniques such as mandibular canine's PTR and vertical position of the mental foramen using cone beam computed tomographic (CBCT) images. Materials and Methods: In 80 mandibular CBCT images, the pulp area and tooth area of the canine were measured from the axial section and a ratio was obtained. The same process was used for the sagittal sectional image. Another method involved measuring the mental foramen's four variables (X1, X2, X3, and X4) using a panoramic sectional image. The procured data were subjected to statistical analysis. Results: A negative linear relationship was acquired among the pulp cavity width, the height of the mandible (X1), and the age. Cubic regression analysis was performed, and the regression formulae were acquired. A mean difference of 2.11 years in axial section, 3.93 years in sagittal section, and 11.23 years in the mental foramen vertical position was acquired among the age estimated and chronological age. Conclusion: The sagittal sectional image of the mandibular canine's PTR is more accurate for determining age when compared with the vertical position of the mental foramen.
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SYSTEMATIC REVIEW AND META-ANALYSIS Top

Association of maxillary sinus mucosal thickening and peri-apical lesion in cone-beam computed tomographic images: A systematic review and meta-analysis p. 348
Apeksha Dhole, Divya Dube, Mukta Motwani
DOI:10.4103/jiaomr.jiaomr_37_22  
Maxillary sinusitis is one of the most common pathologies worldwide and a substantial cause of sinus mucosal thickening. Around 10–86% of maxillary sinusitis reported odontogenic origin. A systematic review and meta-analysis were designed and aimed to evaluate the association of maxillary sinus mucosal thickening and peri-apical lesions using cone-beam computed tomography (CBCT). An extensive bibliographic search with directed vocabulary (MeSH terms in PubMed) and free-text terms were used in databases such as PubMed, Google Scholar, and EBSCO. A total one 8427 articles were identified through the electronic database [Pubmed (34), Ebscohost (0), Google Scholar]. For the meta-analysis, six articles were selected following PRISMA guidelines. One of the major causes of sinus mucosal thickening is reported to be periapical lesions, and the results of the review and meta-analysis concluded that maxillary mucosal sinus thickening was associated with periapical lesions evaluated by CBCT. The results put forward by this review are of utmost importance in treating patients with regenerative and implant procedures related to the posterior maxillary region.
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Accuracy of machine learning in identification of dental implant systems in radiographs – A systematic review and meta-analysis p. 354
Veena Benakatti, Ramesh P Nayakar, Mallikarjun Anandhalli, Vasanti Lagali-Jirge
DOI:10.4103/jiaomr.jiaomr_86_22  
Machine learning has played a promising role in medical diagnosis. The aim of this systematic review was to evaluate the accuracy of machine learning in identification of dental implant systems from radiographs. This systematic review was conducted by searching four electronic databases, PubMed, SCOPUS, Cochrane Library, and Google Scholar. Inclusion criteria were studies that used machine learning for implant identification. Our search yielded 87,189 studies, of which a total of eight studies were found which used machine learning for implant identification. Of the included studies, three studies provided the required data to conduct meta-analysis. The overall pooled estimate of accuracy of the three included studies was 95.43%. Machine learning appears to be practically efficient in implant recognition. The findings of this review suggested an inadequate reporting of studies due to a lack of standardized guidelines for reporting and conducting the studies that investigate machine learning in implant identification. This could limit the reliable interpretation of the reported accuracy.
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SHORT COMMUNICATION Top

Electronic cigarettes use and pharmacological strategies as an intervention for tobacco cessation: Myth or reality? p. 359
Ravleen Nagi, Arvind Muthukrishnan, Sujatha S Reddy, Rakesh Nagaraju
DOI:10.4103/jiaomr.jiaomr_246_21  
Tobacco use is a single leading preventable cause of death worldwide. It contains nicotine, which is one of the most addictive psychoactive drugs; thus, successful quitting becomes a challenging process. Occupation has a profound influence on tobacco use patterns, and in the majority of scenarios, users are unable to achieve abstinence to maintain the need for the psychoactive effect of nicotine to cope up with job stresses and to remain energetic. Various tobacco cessation aids are available with variable success rates. Electronic cigarettes (e-cigarettes) or vaping has become popular, particularly in Western Countries and among occupational workers as they contain less harmful chemicals than combustible cigarettes and can help heavy smokers to quit the habit. Reports of short- and long-term health effects of vaping have currently led to a ban on the production, manufacturing, and advertising of e-cigarettes. Pharmacological interventions such as bupropion and varenicline have been proven to provide long-term abstinence; however, neuropsychiatric side effects limit their use. This paper focusses on the hypothesis that whether the electronic nicotine delivery system (ENDS) or vaping and pharmacological interventions are an effective tobacco cessation interventions.
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CASE REPORTS Top

White sponge nevus: A Case report and clinical update on the diagnosis p. 363
Ranjana Garg, Vivek V Gupta, Anand S Tegginamani, Vanishree H Shivakumar
DOI:10.4103/jiaomr.jiaomr_70_22  
Hereditary white lesions are a rare occurrence in the oral cavity. These lesions are usually harmless and benign. But these lesions resemble the other pathological oral white lesions having the risk of malignant transformation. The diagnosticians should be aware of the existence of these benign white lesions to avoid misdiagnosis and timely intervention for potentially malignant disorders. We have reported the occurrence of white sponge nevus in a young male patient and his mother. The patient's family history, complete clinical examination, and histological report validated the clinical diagnosis.
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A rare case report of cervicofacial necrotizing fasciitis: The flesh-eating bacteria syndrome p. 366
Shrutika Ravindra Sonawane, Harshawardhan Babanrao Sawane, Lavanya H Pasalkar, Arunima Sarma
DOI:10.4103/jiaomr.jiaomr_345_21  
Cervicofacial necrotizing fasciitis is a fatal infection of the orofacial region that spreads rapidly through the subcutaneous tissues and fascia causing extensive necrosis and gas formation. Due to high morbidity and mortality rates, accurate diagnosis and immediate treatment are of utmost importance to avoid the devastating complications associated with it. This case report is of a 55-year-old male, reported with suppuration in the left aspect of the neck. Due to acute, aggressive, and rapidly progressive character of the infection, this report was written to create awareness about such a fatal infection and highlight the importance of accurate diagnosis and prompt treatment.
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Leukocyte adhesion deficiency-1 with oral manifestations – A rare case report p. 369
Sethumanjusha Saranu, Yalamanchili Samata, Nunsavathu Purnachandra Rao Naik, Garikipati Anoop
DOI:10.4103/jiaomr.jiaomr_336_21  
Leukocyte adhesion deficiency 1 (LAD) is a rare, inherited disorder portrayed by the inability of leukocytes to emigrate from the bloodstream toward sites of inflammation. LAD should be considered a rare but possible disorder in patients with persistent periodontal problems. This paper presents a case of leukocyte adhesion deficiency in an 18-year-old girl and a brief literature review.
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Schwannoma in the Buccal Mucosa-An Unusual Presentation p. 372
Jayaprasad Anekar, Krishna S Kumar, Jayalakshmi Baipadavu, H Supriya, Ivin E John
DOI:10.4103/jiaomr.jiaomr_184_21  
Intraoral schwannomas are rare benign neural neoplasm that originates from the Schwann cells of the peripheral nerves and present as asymptomatic, solitary, slow-growing, submucosal mass and their occurrence is seen in the second-third decade of life. The most favored intraoral sites are the tongue, palate, buccal mucosa, floor of the mouth, gingiva, and lips. Histopathological examination with immunohistochemistry is the gold standard for the diagnosis. As malignant transformation and recurrence rate is rare, surgical excision is the preferred treatment. This article provides an insight into a rare case of schwannoma of the buccal mucosa with a review of the literature.
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ERRATUM Top

Erratum: Efficacy of cryogun versus diode laser therapy in the management of oral leukoplakia p. 375

DOI:10.4103/0972-1363.356948  
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