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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 34 | Issue 1
Page Nos. 1-119

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EDITORIAL INSCRIPTION  

From the desk of editor in chief Highly accessed article p. 1
ML Avinash Tejasvi
DOI:10.4103/0019-5049.340767  
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GUEST EDITORIAL Top

Scope of oral medicine and radiology speciality in dentistry: Indian prespective Highly accessed article p. 2
Prashanth Shenoy, Laxmikanth Chatra
DOI:10.4103/0019-5049.340765  
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IAOMR NEWS Top

A Tribute to Dr. Ajit Dinkar p. 3

DOI:10.4103/0019-5049.340766  
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ORIGINAL ARTICLES Top

Estimation of invitro antifungal activity of ethanolic crude extract of punicagranatum peel and woodfordiafruticosa leaves on isolates of candida species p. 5
Sujanamulk Bhavana, Kotya N Maloth, Ramesh K Koothati, Rajalakshmi Chintamaneni, K Navadeepak Kumar, Nayanala Venkata Anusha
DOI:10.4103/0019-5049.340736  
Introduction: The Candida species which are opportunistic fungi especially the species of C. albicans, C. glabrata, C. tropicalis have been causing oral candidiasis. Due to resistance of conventional antifungal agents, the scientists are in verge of exploring novel antifungal drugs such as traditional medicinal plants. Hence we aimed in studying the antifungal effect of Woodfordia fruiticosa and Punicagranatum which are plants of Lythraceae on Candida species. Materials and Methods: The ethanolic extracts of both the plants were prepared using soxhlet extraction method and the obtained metabolites were confirmed by Thin Layer Chromatography. The Paper discs were prepared by Whatman filter paper No. 1 The disc was moistened with 10 μL from the prepared stock solution. Were kept at 4°C for 3 hours for diffusion and incubated for 48 hours. Then the diameters of the circular inhibition zones were measured. Results: The obtained data was expressed as mean and standard deviation. Chloroform fraction of Woodfordia fruticosa showed superior antifungal effect when compared to Punicagranatum peel. Conclusion: The invitro antimicrobial activity of Woodfordia leaf depicted superior antifungal activity against Candida isolates with effective anticandidal effect when compared to Punica peel. In future both of these plants could serve as basis for the new anti-candidal agents.
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Evaluation of efficacy of three treatment modalities in the management of symptomatic oral lichen planus—A Prospective comparative study p. 11
CJ Sanjay, Karthikeya Patil, Mahima V Guledgud, Prasannasrinivas Deshpande, Nagabhushana Doggalli, Romali Panda
DOI:10.4103/jiaomr.jiaomr_173_21  
Context: Oral lichen planus (OLP) is a relatively common chronic inflammatory condition of the oral mucosa. OLP is currently managed by various treatment protocols, the most common being topical and systemic corticosteroid therapy. Low-level laser therapy (LLLT), or photo-biomodulation, is gaining popularity as a palliative treatment for OLP. Aim: The present study was aimed to compare the efficacy of LLLT, topical corticosteroid therapy, or a combination of both in the management of OLP. Settings and Design: Thirty patients who were clinically and histopathologically diagnosed as OLP were randomly selected and divided into three groups: Group 1 (n = 10) received topical corticosteroid therapy (TCT); Group 2 (n = 10) received LLLT; and Group 3 (n = 10) received combination of both the therapies. Materials and Method: Each group of patients received treatment in five sessions of their respective therapy over the course of 15 days, with a three-day interval between each follow-up. The VAS (visual analogue scale) was used to collect data on pain. The percentage of healing was calculated using the WHO oral mucositis assessment scale, the global healing index, and the WU et al. (2010) disease grading system. Results: A reduction in scores in VAS, WHO oral mucositis assessment scale, global healing index, and WU et al. (2010) disease scoring system with the combination of LLLT and topical corticosteroid therapy was observed. Conclusion: Both LLLT and TCT were effective against the symptom control and improvement in clinical manifestation of oral lichen planus, nevertheless; a combination of the two was found to be more beneficial in treatment of symptomatic OLP.
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Therapeutic Evaluation of 5% Topical Amlexanox Paste and 2% Curcumin Oral Gel in the Management of Recurrent Aphthous Stomatitis- A Randomized Clinical Trial p. 17
Jeevitha Gauthaman, Anuradha Ganesan
DOI:10.4103/0019-5049.340739  
Background: Recurrent aphthous stomatitis (RAS) minor is a painful oral condition that is characterized by shallow ulcers with an erythematous halo. These ulcers cause difficulty in mastication and speech and have a high recurrence rate. Objective: The present study aims to compare the size of the ulcer, erythema, pain score, and recurrence rates in patients using 5% topical amlexanox and 2% curcumin oral paste in the management of RAS minor. Materials and Methods: The present study was conducted among 48 participants who were randomly assigned into two groups. Group A comprised participants who were given 5% topical amlexanox paste and Group B comprised participants who were given 2% curcumin oral gel for application. The participants were evaluated on days 1, 4, and 7 for the size of ulcers, erythema level, and pain score. They were reviewed on days 30, 60, 90, and 180 and recurrence episodes were documented. Results: There was a significant reduction in erythema (0.041) and pain scores (0.012) in Group B participants who used curcumin. The size of the ulcer had reduced in both the groups though there was no significance. Recurrence rates were high in participants who used amlexanox (92%) and were comparatively low in the curcumin using group (50%). Conclusions: Curcumin is a potent, safe substitute in the management of RAS minor for its effectiveness in reducing erythema, pain, and recurrence rates. Further studies should be conducted for evaluating the efficacy of curcumin in various clinical types of RAS.
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Analysis report of adherence to consort statement for reporting randomized controlled trials (RCTs) Associated with temporomandibular disorders (TMDs): A cross-sectional study p. 22
Anagha Shete-Motgi, Mrinal Shete, Kalyani Bhate, Kapil Kshirsagar, Pradnya Kakodkar
DOI:10.4103/jiaomr.jiaomr_273_21  
Purpose: Temporomandibular disorders (TMDs) and their management are widely sought after by clinicians. They often refer to the reported randomized controlled trials (RCTs) in the literature. The Consolidated Standards of Reporting Trials (CONSORT) statement aims to improve the quality of published RCTs and is endorsed by healthcare journals. Despite the widespread acceptance of CONSORT, its use for reporting clinical trials in the journals remains suboptimal. The purpose of this study was to evaluate, to what extent RCTs related to TMDs have adhered to the CONSORT statement. Methodology: RCTs related to TMDs, published in PubMed from January 2017 to March 2021 were retrieved. Each article was assessed for its adherence to the CONSORT statement by four trained and calibrated investigators. Results: 88 articles were evaluated. Out of 37 items in the checklist, only 4 items demonstrated 100% adherence (item 2a, 2b, 5, 12a, and 16). The most under-reported items were 7a, 8b, 9, 10, 17a, 17b, 19, 23, and 24 (less than 50%). The mean percentage of adherence remained 71.2 ± 12.6. Only one study showed 100% adherence and three studies had less than 50% adherence. Considering adherence of abstract checklist, three items demonstrated 100% adherence (items 4, 5, and 6). Poor reporting was noted with items 8, 13, 15, and 16. The mean percentage of adherence to abstract reporting remained 68.60 ± 11.79. Conclusion: The present study indicates good adherence to CONSORT statement in reporting RCTs related to TMD management. Probably the mandatory instructions from the journals and increasing awareness among the researchers about CONSORT reporting might have done the trick.
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Therapeutic assessment of intralesional corticosteroids and ultrasound therapy in management of oral submucous fibrosis: A comparative study p. 27
Shilpa J Parikh, Priyanka R Parmar, Jigna S Shah
DOI:10.4103/0019-5049.340729  
Background: Oral submucous fibrosis (OSMF) is a premalignant condition with a chronic, debilitating, and resistant nature. Various treatment modalities have been proposed for this condition including steroid injections and surgical interventions. In literature, there are very few studies signifying the role of therapeutic ultrasound in OSMF and this still remains a hidden field which needs to be explored further. Aims and Objectives: To evaluate and compare the clinical efficacy of ultrasound therapy with and without physical exercise with intralesional injection (I/L) of 2 ml dexamethasone (4 mg/ml) + hyaluronidase 1500 IU with physical exercise in patients with OSMF. Materials and Method: A total of 30 patients with OSMF were selected irrespective of age and gender and were allocated into groups A, B and C randomly. Group A: 10 patients treated with I/L injection of dexamethasone and hyaluronidase with physical exercise. Group B: 10 patients treated with therapeutic ultrasound and soft tissue mobilization with physical exercise. Group C: 10 patients treated with therapeutic ultrasound and soft tissue mobilization without physical exercise. All the patients were evaluated weekly for 1 month and findings were compared with those at the beginning of treatment. Result: Ultrasound in combination with exercises leads to more improvement in mouth opening compared to ultrasound alone. Improvement in mouth opening of ultrasound with exercise was almost similar to intralesional injection of steroids. Conclusion: Ultrasound therapy interventions definitely show a significant improvement in the patient's condition with no reported side effects; hence it should be included in the treatment protocol for patients with OSMF.
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Efficacy of crystallization test in screening of potentially malignant oral disorders p. 33
Vijaya Manikrao Ingle, Lata M Kale, Amol S Gawai, Hitendra R Jain, Rupali V Mhaske
DOI:10.4103/jiaomr.jiaomr_12_21  
Context: Pfeiffer in 1938 observed the crystallization pattern of cupric chloride on admixture with blood of cancer patient. Most of the oral squamous cell carcinoma develops from potentially malignant disorders (PMDs). Aim: The aim of this study is to validate the efficacy of crystallization test in screening of oral PMDs. Setting and Design: The study was carried out in the Department of Oral Medicine and radiology and oral Pathology and Microbiology. Methods and Material: The study included 20 oral PMDs and 20 normal healthy participants. One drop of blood was collected and dilution of 6% hemolyzed blood was done; 0.1 to 0.2 cc of this blood sample is added to 10 cc of 20% cupric chloride solution and further is subjected to crystallization test. Statistical Analysis Used: The Chi-square test was applied and “P” value was found to be significant. This indicates that crystallization test was statistically significant for the detection of oral PMDs. Results: In this study, sensitivity 85% and specificity 90% of crystallization test in screening PMDs was observed. Among 20 PMDs, 17 were positive and 3 were negative and among 20 normal cases, 18 were negative, and 2 were positive for the crystallization test. Positive predictive value and negative predictive value was found to be 89.47% and 85.47% respectively. Conclusion: This test is simple, less invasive, economical and can be used at the community level in mass screening of high-risk individuals more prone to develop potentially malignant oral lesions.
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Identification & correlation of candida strains with CD4+ count among HIV patients on HAART and evaluation of in-vitro susceptibility to fluconazole and voriconazole p. 38
Naidu Harika, Koduri Sridevi, Buduru Krishnaveni, Nalli Prasanth Kumar, Gutta Mounika, Adari Devi Naga Deepika
DOI:10.4103/0019-5049.340768  
Background: HIV is a life-threatening disease that increases morbidity and mortality due to the alterations of the body's immune system, leading to several opportunistic infections due to the progressive loss of CD4+ T lymphocytes. Aim: To identify and correlate the Candida strains with CD4+ count in Human Immunodeficiency Virus (HIV) patients on Highly active antiretroviral therapy (HAART) and evaluate the in-vitro susceptibility to fluconazole and voriconazole. Materials and Methods: A total of 100 HIV-positive patients who were not under HAART therapy were examined at three different intervals for the presence of Candida strains along with their CD4+ count and evaluated for in-vitro susceptibility to fluconazole and voriconazole. The obtained values were analyzed using the Spearman correlation test and Chi-square tests with a significant P value of 0.005 and SPSS version 20.0 software. Results: C. albicans was the most common species isolated, followed by C. krusei, C. glabrata, and C. tropicalis. C. glabrata showed a positive correlation with CD4+ count at 6 months of HAART therapy. The variation in CD4+ count prior to HAART therapy and at 3 and 6 months of HAART therapy showed a significant increase in the CD4+ count. Antifungal susceptibility testing showed that all Candida strains were resistant to fluconazole and susceptible to voriconazole. Conclusion: The correlation of CD4+ count with Candida strains and in-vitro susceptibility of voriconazole to all the identified strains of Candida as observations from the present study suggests the need for more periodic studies among different sample populations with larger sample size.
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A clinical comparative study with evaluation of gustatory function among oral submucous fibrosis patients, gutka chewers, chronic smokers and healthy individuals p. 45
Snehjyoti Jha, NC Sangamesh, S Bhuvaneshwari, Silpiranjan Mishra, Atul A Bajoria, Abhik Sikdar
DOI:10.4103/jiaomr.jiaomr_294_21  
Context: Oral submucous fibrosis (OSMF) is a chronic debilitating disease with significant malignant potential. The most common symptoms of the condition include burning sensation, trismus, swallowing, and speech impairment as well as gustatory alteration. Aims: The aim of the study was to evaluate and compare the efficacy of gustatory functions in oral submucous fibrosis patients, gutka chewers, chronic smokers and healthy individuals. Methods and Material: A total of 112 individuals were selected for the study and divided into four groups of 28 participants, each comprising OSMF patients, gutka chewers, chronic smokers with gutka-chewing habits, and healthy individuals. Each participant was assessed for gustatory function using four different tastants for sweet, sour, salty, and bitter, and the taste perception was recorded as hypogeusia, hypergeusia, dysgeusia, and ageusia. Statistical Analysis Used: Data obtained were analyzed with SPSS software version 26. A comparison between the four groups was made separately for the four different tastes and the five parameters. A P value of ≤0.05 was considered statistically significant. Results: For OSMF patients, gutka chewers, and chronic smokers with gutka-chewing habits, salty taste showed normal perception, sweet taste showed hypogeusia, and bitter taste reported ageusia. The healthy individuals mostly showed normal perception for almost all tastes. Conclusions: It can be concluded that OSMF and habitual consumption of areca nut and tobacco appear to have a significant impact on the alteration of the gustatory function, although the type of taste sensation that is affected may vary from person to person.
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T-Scan guided occlusal equilibration as an effective treatment in the management of symptomatic temporomandibular disorders: An open clinical trial p. 53
Ancy V Ignatius, Komali Garlapati, Nallan CSK Chaitanya, Asra Saba, Pallavi Kandi, Chelluri Shreya Reddy
DOI:10.4103/0019-5049.340761  
Background: Temporomandibular disorders (TMDs) constitute clinical problems that involve the masticatory muscles, the temporomandibular joints, associated structures, or both. The etiology of TMDs is multifactorial. The association between occlusal interferences and TMD is controversial.. Objectives: This study is designed to evaluate the clinical outcome of T-Scan guided occlusal equilibration in patients suffering from TMD associated with occlusal discrepancies. Materials and Methods: A total of 15 patients clinically diagnosed with TMD based on the Diagnostic Criteria for Temporomandibular Disorders and with positive occlusal interferences were included in the study. The occlusal equilibration was achieved by performing T-Scan guided Immediate Complete Anterior Guidance Development. Results: The obtained data was subjected to statistical analysis using SPSS version 20.0 software. There was a statistically significant reduction in the occlusion time, i.e., from 0.77 ± 0.6 pre-treatment to 0.31 ± 0.2 post-treatment (P = 0.005), and also disclusion time, i.e., from 1.71 ± 1.09 pre-treatment to 0.11 ± 0.03 post-treatment (P = 0.000). There was a statistically significant reduction in the VAS score post-treatment (P = 0.000). Conclusion: T-Scan guided occlusal equilibration in TMD patients has resulted in significant improvement of symptoms. Hence, we emphasize the importance of the identification and correction of occlusal interferences in the management of symptomatic TMDs.
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Assessment of Oral Health and Treatment Needs in Population with Visual Impairment p. 60
Abarna Jawahar, G Maragathavalli
DOI:10.4103/0019-5049.340744  
Background: Visually impaired individuals when compared to healthy have poor oral health status as they cannot visualize the plaque deposits on the tooth surface, leading to poor understanding of the importance of oral hygiene which results in development of dental caries as well as inflammatory disease of the periodontium and loss of tooth structure. Aim: The study aims to assess the oral health and treatment needs of patients with visual impairment using WHO Oral Health Assessment form for adults 2013. Materials and Methods: A cross-sectional study was conducted on 207 visually impaired patients who visited the special care dentistry department, a unit of Oral Medicine and Radiology in a private dental college & hospital and a private blind institute. WHO Oral Health Assessment form was filled after oral examination was done using Type III clinical examination. Statistical Analysis: Descriptive analysis was used to describe the frequencies and percentages. Chi-square test was used to determine statistical significance. Results and Conclusion: Dental caries were present in 129 (62.3%) study participants. Oral mucosal lesion was prevalent in 14% of the study population. 146 (71%) participants required prompt dental treatment such as scaling, restorations, extractions, 58 (28%) participants required immediate dental treatment due to presence of pain or infection of dental origin such as advanced dental caries, periapical abscess and OPMD. Only 3 (1%) participants out of 207 did not require any dental treatment. The findings of the study suggest that the dental treatment needs are high and unmet in the visually impaired population.
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Assessment of knowledge and awareness of probiotics among the dental post-graduate students- A questionnaire study p. 68
Mahendra R Patait, Kedar V Saraf, Priya M Wakchaure
DOI:10.4103/0019-5049.340742  
Background: Probiotics are viable microorganisms, and when they are administered in an adequate amount, they provide health benefits to the host. The use of probiotics is said to be an important aspect in dentistry in the prevention and treatment of caries, periodontal disease, etc. Aims: The purpose of the present research was to access knowledge and awareness of probiotics among dental postgraduate students. Settings and Design: A total of 104 dental postgraduate respondents from Maharashtra state were surveyed regarding the knowledge of probiotics.The study includes first, second, and third-year dental postgraduate students. A well-structured and administered questionnaire including 15 questions was used to elicit the responses from the dental postgraduate students.Methods and Material: The online survey was distributed via email and social media platforms using snowball sampling and was open for a week. The questions were modeled based on those used in previously published studies on the knowledge of probiotics. The questionnaire consisted of 15 questions. The survey took less than 15 minutes on average to complete.Statistical Analysis Used: Data entries were done in Microsoft Office Excel 2010, and analyses of results were done using Statistical product and service solution (SPSS) version 21 software. Descriptive statistics such as frequencies and percentage/proportion were calculated. Pearson Chi-square test was used to find out the difference between responses of study subjects.Results: Of the 104 postgraduate students in total, 68.3% of respondents were females, and 31.7% were males. The study reveals 98% of participants are aware of the term probiotics and 94.1% of respondents correctly answered that constituents of probiotics are live microorganisms. More than half of the respondents (52%) had taken probiotics as a therapeutic drug for gastrointestinal purposes. 76.5% of respondents thought it helps in the improvement of oral health.Conclusions: In the present study, a good level of knowledge was observed among dental postgraduate students. Most of them were aware of the beneficial effects of probiotics on the human body in terms of food digestion and immunity. However, they still lack the other health benefits of probiotics. Also, there was little less knowledge and clarity about the term prebiotic.
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Quantitative and qualitative palatal rugae pattern analysis in population of Punjab p. 76
Ashima B Behl, VC Vinod, Jaswinder Kaur, Puneeta Vohra, Sumit Kaur, Vikram Bali
DOI:10.4103/0019-5049.340738  
Background: Palatal rugae are irregular, asymmetric ridges of mucous membrane extending laterally from incisive papillae and anterior part of palatal raphe. Palatal rugae patterns are unique to individuals. Aim and Objectives: The aim of the study was to identify a pattern of palatal rugae in terms of size, shape, number, and to compare rugae patterns in males and females of Punjab population. Material and Methods: A total of 420 diagnostic maxillary casts (210 men and 210 women) were randomly collected from various dental clinics and were subjected to visualization using graphite pencil and magnifying glass under adequate light. Student t test using SPSS software version 20 was utilized for statistical analysis. Results: Total of 3,465 rugae were observed. Out of the total rugae examined, primary type of rugae were found to be more followed by secondary and fragmentary/tertiary. On the basis of shape, it was found to be straight followed by wavy, curved, and circular. On the basis of modified Kapali classification, converging type of rugae were found to be more in men and diverging type were found to be more in women. The mean rugae were found to be more in women than men. Statistically significant values were observed in relation to size (secondary type), and shape (curved and circular). Conclusion: The present study was localized to the population of Punjab. Not many studies with such a large sample size have been done for this region. Palatal rugae pattern is definitely a sufficient characteristic to discriminate between genders.
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Assessment of the usefulness of morphometric and volumetric analysis of mastoid process for gender determination in forensic odontology: A retrospective cone beam computed tomographic study p. 82
Binindita Mondal, MR Vaishali, Maria P David, G Roopashri, Vinod Kumar, Indira A Ponnuswamy
DOI:10.4103/0019-5049.340741  
Background: Personal identification is crucial in natural mass disasters and in man-made disasters when the body is highly mutilated and fragmented. The mastoid process of the skull is important in this regard for sex determination, since it is one of the most protected region and is resistant to damage. Aim: To assess the usefulness of morphometric and volumetric analysis of the mastoid process for gender determination in forensic odontology. Materials and Methods: The study comprised of 60 retrospective CBCT skull images (30 males and 30 females) of known sex within the age group of 17–65 years. Radiographic measurements of the length, width, height and volume of the right and left mastoid processes were made using customized software. Statistical Analysis: The Wilcoxon signed-rank test, the Mann–Whitney U test, and discriminant functional analysis (DFA) were used to analyze all the collected data. Results: In the present study, the mean values of length, height, width and volume of the mastoid process were found to be higher in males than in females. The height of the mastoid process was found to be a good indicator of gender determination, with a sensitivity of 76.7%, a specificity of 76.7%, and an overall accuracy of 76.7%. Conclusion: We conclude that the mastoid process is a good indicator of gender determination. The volume can also be included as an additional parameter along with length, height, and width. We therefore recommend the use of the mastoid process for gender determination in personal identification in forensic odontology.
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Correlation of pulp-to-tooth area ratio with age and gender using CBCT of maxillary central incisor and canine: A comparative study p. 87
Vineet Bansal, Aravinda Konidena, Ravleen Nagi, Ajay Pal S Kataria, Nirvana Yumnam, Farheen Farooq
DOI:10.4103/0019-5049.340762  
Introduction: Dental age estimation of living or deceased individuals through radiographic methods are popular, among which pulp-tooth ratio is a sensitive indicator. The aim of this study was to estimate and compare age based on the pulp-to-tooth area ratio (PTR) of maxillary canines and central incisors from sagittal, coronal, and three levels on axial section from CBCT data. Methods and Materials: Sixty adults of Indian origin (31 men and 29 women) aged between 20 and 65 years visiting the Department of Oral Medicine and Radiology of our institution requiring CBCT of anterior maxilla for their diagnosis or treatment planning were included as study subjects. The sagittal, coronal, and axial images of maxillary central incisor and canine were imported to AutoCAD 2016 computer-aided drafting program. For each image, 30 and 10 points were marked on the tooth and pulp outlines, respectively, using the point tool on AutoCAD Toolbox. PTR was calculated and subjected to statistical analysis. Results: There was a declining trend in PTR with advancing age in maxillary central incisor in all sections and axial section at CEJ in canine. When the PTR values were compared, axial section at one-fourth, axial section at mid-root, sagittal and coronal sections for maxillary incisor showed significant differences between the age groups. There was no significant difference in PTR values between the genders. The best predictor for age was coronal and sagittal sections for central incisor, and sagittal section for maxillary canine. Maxillary central incisor yielded a better estimate with an SEE of 8.258 years than canine for age estimation. Conclusion: Results revealed a declining trend in PTR with advancing age in maxillary central incisor in all sections and axial section at CEJ in canine.
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Reliability and reproducibility of a conversion factor for grayscale values obtained from CBCTS assessed at various anatomical regions- A retrospective study p. 95
TR Prasanna Arvind, Ravindra Kumar Jain
DOI:10.4103/0019-5049.340727  
Background: Bone density assessment in dental practice is required for dental implant planning and placement, Orthodontic tooth movement, and establishing mid palatal suture maturation. Establishing a linear relationship between grayscale values and Hounsfield units (HUs) in softwares can improve the ease of diagnosis and treatment planning. Aim: To determine a conversion factor and test its reliability and reproducibility for grayscales values to HUs obtained in Cone-beam computed tomography (CBCT) s at various anatomical regions using Galileos Sirona CBCT Viewer Software and Philips DICOM Viewer. Methods: Eighty-seven (87) CBCTs were included in this retrospective study and 343 sites were assessed across different anatomical regions. Sites assessed were isolated in both softwares at identical locations. Grids were used for standardizing reference planes at different anatomical sites. Reference landmarks were isolated 1) between anterior interdental regions 2) between posterior interdental regions, and 3) at radio-opaque regions. Grayscale value was divided with HU to obtain conversion factors at different sites, which was the primary outcome of the study. The reproducibility of the factor obtained was also assessed to improve its clinical correlation. Results: In anterior interdental regions, grayscale values were 7.6 times greater than HUs. In posterior interdental regions, gray scale values were 4.5 times greater than HUs. The reliability of values obtained was verified using Kappa's correlation test. In radio-opaque regions, grayscale values were 1.4 times greater than HUs and highly reliable (r = 0.972). Conclusion: In well-exposed regions, a defined conversion factor can be established between grayscale values and HUs in Galileos Software. This factor determined is highly reproducible and reliable in radio-opaque regions, and adequately reliable in anterior and posterior interdental regions.
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Piloting of “blended learning” - An innovative educational intervention in oral medicine and radiology p. 100
Zameera Naik, S Lokesh Kumar, Anjana S Bagewadi, Vaishali Keluskar
DOI:10.4103/0019-5049.340750  
Context: Various universities have set in a wave of adapting to the newer concepts of teaching–learning to keep pace with the millennial learners. Blended learning is a new teaching–learning method that combines online activity along with face-to-face activity. Flipped classroom approach is the use of Web-enabled strategies that free up class time to allow teachers to spend more time guiding their students. Aim: To assess the impact of flipped classroom approach on the teaching–learning outcomes of dental undergraduates. Settings and Design: A prospective comparative educational intervention was conducted in the Oral Medicine and Radiology department of a private dental college in Belagavi. Methods and Materials: Forty third-year undergraduates were equally allocated into the traditional learning group (20) and flipped classroom learning group (20). A pretest/posttest format was employed with mandatory feedback. For flipped classroom approach, an audio/video lecture of 10 minutes duration was shared through learning management software. The assessment was MCQs and case-based. Statistical Analysis: Mann–Whitney U and Wilcoxon matched-pairs tests were used for intergroup and intragroup comparisons, respectively. Results: The mean posttest score was significantly higher in flipped classroom method than in the traditional method (P = 0.0001). Performance on case-based questions was highly statistically significant in the flipped classroom group with a mean rank of 29.8 (P < 0.001). Intragroup comparison between the mean pretest and posttest scores in the flipped classroom showed a high statistical significance (P = 0.0001). Conclusions: Flipped classroom teaching should be recommended as it has the advantages of providing students with a pace of learning, peer learning, instant feedback, and using classroom time effectively. Faculty have to invest time, but nothing is greater than a meaningful teaching–learning experience.
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REVIEW ARTICLE Top

Evaluation of ayurvedic treatment modalities for oral lichen planus – A systematic review p. 106
Subhadeep A Gupta, Vikram V Khare, Trupti V Gaikwad, Mahesh S Chavan
DOI:10.4103/jiaomr.jiaomr_276_20  
Oral lichen planus (OLP), a chronic inflammatory disease that affects the oral mucosa, may cause pain or discomfort along with increased burning sensation. There are numerous treatment modalities available that have several side effects. The aim of this study was to determine the effectiveness of Ayurvedic management for oral Lichen Planus. Two sources of Internet were used to search appropriate articles which satisfied the purpose of study including PubMed and Google scholar. Studies which were done on Indian population, PubMed search including articles that were published between January 1, 2000 and October 31, 2019, Studies published in English or which could be translated to English, randomized clinical trials, controlled clinical trials and longitudinal studies with essential data on Ayurvedic approach were included. Patients having Oral Lichen Planus where ayurvedic approach was used for treatment. Out of 09 articles, included in systematic review, in almost all the studies improvement in pain, erythema and burning sensation were reported in score scale. Administration of topical herbal antioxidants and topical application of herbal medicines prove to be effective approach in minimizing the signs and symptoms of Oral Lichen Planus. Long-term use of steroids has many side effects while the herbal medicines almost have none. So, herbal medicines can be used for better efficacy with least side effects for OLP.
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CASE REPORTS Top

Dental Radiography of Special Needs Patients: Report of Two Cases p. 112
Supannee Suyalan, Sarunya Chaikantha, Suchaya Pornprasertsuk-Damrongsri
DOI:10.4103/0019-5049.340748  
In recent decades and an aging society, the prevalence of special needs dental patients has increased noticeably both in children and adults. In most dental patients, the dental radiograph is one of the essential diagnostic tools that help make the proper diagnosis and treatment plan. In this article, we report two cases of special needs patients; aging, bedridden, and teenage autism. In the first case, the periapical bisecting-angle and occlusal topographic radiography were taken with the patient on the mobile hospital bed. In the second case, the oblique lateral radiographs were performed for diagnosis of third molar impaction. The principle of periapical bisecting-angle, occlusal topographic, and oblique lateral radiography is also reviewed.
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Adenoid cystic carcinoma of palate: A unique case report p. 116
Mainak Datta, Rupam Sinha, Soumyabrata Sarkar, Sayani Shome
DOI:10.4103/jiaomr.jiaomr_178_21  
Adenoid cystic carcinoma (ADCC) is one of the malignant salivary gland neoplasm and constitutes for 1% of head and neck malignancies and 22% of all salivary gland malignancies. Palate is the most common site to be involved in the oral cavity followed by parotid region, tongue, and floor of mouth. It is commonly seen in middle age population with slight female predilection. It usually appears as asymptomatic, slow growing infiltrative growth with high recurrence, often presence of perineural invasion which appears as pain. In this present case of ADCC, a 65-year-old female patient reported with a swelling on the left side of hard palatal area since 3 months with occasional pain and history of epistaxis, which was diagnosed clinically, radiographically, and histopathologically and confirmed by immunohistochemistry as Grade III solid variety of ADCC with a poor prognosis.
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