Background: Studies have unveiled that in CBCT the degree of x-ray attenuation is shown by gray scale (voxel value) that is used in determining the pathologic lesion. Gray value is to assess the density or quality of bone and the density varies depending on radiation attenuation. CBCT gray values are considered approximate values and its measurement allows differentiation of soft tissue and fluid with that of hard tissue. Aim and Objective: We aimed to evaluate the application of CBCT gray scale value of cysts and tumors to assess the difference of bony changes and to determine the significance in diagnosing the contents of the lesions. Materials and Methods: The study was conducted in the department of Oral Medicine and Radiology. Patient clinically diagnosed either with cysts or tumors over a period of 18 months were included in the study. The gray scale reading was taken and radiological diagnosis was made which was further compared with the histopathological report of cysts and tumors. Results: CBCT gray scale value was found to be effective and superior to conventional radiographic tool and more useful in diagnosing the nature of cysts and tumors pre-operatively. Conclusion: CBCT gray value can be considered as a major tool in diagnosis of cyst and tumor and other soft or hard tissue lesion without any microscopic evaluation. CBCT gray scale measurement is superior to conventional intraoral radiographic methods for diagnosing the nature of lytic lesion of jaw.

Introduction: Research in early cancer detection has led to discovery of many immunological tumor markers that contribute considerably to supplement the method of diagnosis. High serum immunoglobulin A (IgA) values in patients with cancer have been used as tumor markers. Aims and Objectives: To evaluate and compare the serum IgA levels in nontreated, treated oral squamous cell carcinoma (SCC) patients, and control group. Materials and Methods: A total of 60 patients were included in the study. 20 biopsy confirmed oral SCC patients, who have received no medical treatment, 20 oral SCC patients treated with surgery and/or radiotherapy and 20 normal healthy individuals. Venous blood samples were collected from anterior cubital vein and were delivered to the biochemistry laboratory for the estimation of serum IgA level by nephelometry method. Statistical Analysis Used: Statistical method employed were the Pearson's Chi-square test and One-way analysis of variance (Welch) followed by Games-Howell post-hoc test. Results: We observed significant difference for serum IgA between study subjects in control, nontreated and treated oral SCC patients (P < 0.001). Serum IgA level in nontreated group was significantly higher than treated group and there was an approximately two-fold increase in serum IgA level in nontreated oral SCC patients when compared to that of the normal healthy individuals. Conclusion: Serum level of IgA might be employed as diagnostic and prognostic indicators in oral cancer.

Introduction: Oral lichen planus (OLP) is a relatively prevalent chronic inflammatory disease, which affects the skin and mucous membrane. The etiology of OLP is unknown and there is controversy over the role of stress as an etiologic factor of OLP. Aim: To assess the salivary cortisol levels and psychological factors in OLP patients. Material and Methods: This study investigated the salivary cortisol level in 30 clinically and histopathologically proven OLP patient and 30 healthy individual. Salivary cortisol levels were analyzed by enzyme-linked immunosorbent assay methods. The psychological factors of study and control groups were assessed by DASS 21questionnaire (depression anxiety stress scale). Salivary cortisol levels and psychological factors were compared by using student's t-test. Results: The mean salivary cortisol level among study group was 9.90 ± 3.09 ng/dL as compared to the 6.92 ± 2.21 ng/dL of the control group with P < 0.001 which was highly significant. Study showed significantly higher stress anxiety and depression levels when compared to controls. Conclusion: Hence, it is concluded that increased salivary cortisol levels and psychological factors showed positive results in development of OLP.

Introduction: The maxillary sinuses (MS) are of particular importance to dentist because of their close proximity to the teeth and their associated structures, so increased risk of maxillary sinusitis has been reported with periapical abscess, periodontal diseases, dental trauma, tooth extraction, and implant placement. Complications of MS are related to its anatomic and pathologic variations. Thus, study was conducted to assess the prevalence of anatomic variations in MS by using cone-beam computerized tomography (CBCT). Aims and Objectives: To determine different anatomical variations in MS by using CBCT. Materials and Methods: CBCT scans of 150 subjects were collected between the age group of 18 years to 70 years and were analyzed for MS anatomical variation. Statistical Analysis: The distribution of age, sex, reasons for CBCT, and dimensions of sinus calculated using descriptive statistics and distribution of other anatomic findings using Chi-square test. Results: Prevalence of obstructed ostium is 23.3% and septa is 66.7%. Average height, width, and antero-posterior (A-P) dimensions for right MS are 34.13 mm, 26.09 mm, 37.39 mm and that of left MS are 33.24 mm, 26.11 mm, 37.72 mm respectively. Average distance between lower border of ostium to sinus floor in right MS is 32.17 mm and that of left is 32.69 mm. Average diameter of ostium in right MS is 1.88 mm and that of left is 1.67 mm. Conclusion: Study highlights the importance of accurate assessment of MS and its variations in order to properly differentiate the pathologic lesions from anatomic variations avoiding unnecessary surgical explorations.

Introduction: Impaction is a pathologic condition defined by the lack of eruption of a tooth in the oral cavity within the time and physiological limits of the normal eruption process. Imaging of impacted teeth is often mandatory for the exact localization and to know the precise relationship with adjacent anatomic structures. The aim of this study was to assess the reliability of digital trans-tomography in the localization of impacted teeth. Objectives: To assess the localization of impacted teeth, buccolingual or buccopalatal orientation, and to estimate the spatial relationship with the vital anatomical structures like mandibular canal, maxillary sinus, etc. To determine the intra- and inter-observer reliability of cross-sectional digital transtomography in the localization of impacted teeth. Materials and Methods: A total number of 100 patients ranging from 19 years to 30 years were included. Thorough clinical examination was done following which cross-sectional digital transtomographs were taken, localization was assessed, and the linear measurements were estimated on transtomographic images. All measurements were repeated twice within a period of 1 month by two observers. Results: Intra- and inter-observer reliability for crown and root position was calculated and was significant at 1% level, in turn indicating the existence of intra- and inter-observer reliability. The relationship with adjacent anatomical structures were calculated which was significant at 1% level which infers existence of correlation in relation to impacted teeth and vital structures. Conclusion: Transtomographic examination provided cross-sectional information regarding localization of impacted teeth, relationship with adjacent vital structures in buccolingual direction, and linear measurements. The repeated observations showed good correlation and therefore digital transtomography was found to be reliable and accurate in the localization of impacted teeth.

Introduction: Dental students encounter tobacco users on a daily basis but fail to perform their role as health care providers and neglect habit-related issues that require proper counselling and support. This is due to lack of knowledge and confidence in counselling, which in turn is caused by lack of proper training. This study attempts to teach tobacco cessation counselling (TCC) skill to dental students. Aims and Objectives: To train undergraduate dental students in TCC. Materials and Methods: Third-year dental students were taught TCC protocol using lectures and a video. Students practiced TCC skills, and their competency was evaluated using an objective structured clinical examination (OSCE) on a standardized patient. After evaluation, the students filled a written feedback. Settings and Design: A prospective, interventional study was conducted among third year dental students in the Department of Oral Medicine and Radiology. Statistical Analysis Used: Descriptive statistics describing the frequency and percentage of responses of each question/performance/feedback at 95% confidence interval; percentage of those who performed very good were compared using t-test for proportions. Results: This study showed that educational interventions such as didactic instructions and practical training increases the counselling skills of students and helps patients in quitting. Conclusion: This training improved the skill of the students and helped patients to quit tobacco in an effective and professional manner. Therefore, including the TCC protocol in the dental curriculum should be considered.

Introduction: The section of the inferior alveolar nerve (IAN) in front of the mental foramen and just before its ramification to the incisive nerve is known as anterior loop (AL) of IAN. Surgeries in the area of the anterior mandible may violate the AL resulting in neurosensory disturbances. Cone beam computed tomography (CBCT) is a new imaging modality that provides a multidimensional view of the facial skeleton. Aim: To evaluate the efficacy of CBCT in measuring the anterior looping of IAN. Objectives: To determine the prevalence of AL of IAN using CBCT, and to determine AL length using CBCT. Materials and Methods: Out of the total 1075 reported patients, 193 study participants fulfilling the inclusion criteria constituted the sample size were assessed for estimating the prevalence and determining the length of AL of IAN. They were scanned with a suitable digital imaging system for a variety of clinical indications using appropriate Dental Imaging Software. Results: The prevalence of anterior looping was found to be 37.3% and was highest (43.5%) in the age group of 36–56 years and was found to be statistically significant. The mean length of anterior looping was found to be 3.661 mm (SD ± 1.9933) with a maximum loop length of 8.8 mm. Conclusion: CBCT provides an accurate means to determine the anterior looping of IAN, measures its length, and thereby, helps in preoperative surgical planning.

Introduction: Oral cancer is the sixth most common cancer worldwide. Oral submucous fibrosis (OSMF) is one of the commonest potentially malignant disorders in India. Hypolipidemia can be considered as one of the biochemical marker in early detection of cancer. Context: This study is undertaken to evaluate the role of serum lipids as tumor markers in the diagnosis of oral precancerous lesions and oral cancer. Aim: To determine the significance of total cholesterol (TC), high-density lipid cholesterol (HDLC) triglycerides as tumor markers in the diagnosis of OSMF. Materials and Methods: Study was conducted in outpatient Department of Oral medicine and Radiology. Thirty cases each of clinically diagnosed and histopathologically confirmed oral squamous cell carcinoma (OSCC), OSMF, and 30 controls were selected and serum lipid analysis was done. Statistical Analysis Used: Unpaired t-test (student t-test) was used for statistical analysis in this study. Results: The serum lipid level was statistically significantly lowered in patients with oral cancer and OSMF when compared with normal control group. There is an inverse relationship between serum lipid profile pattern in oral cancer as well as in OSMF. Conclusions: The serum lipid level was statistically significantly lowered in patients with oral cancer and OSMF when compared with normal control group. The lower serum lipid status may be considered as a useful biochemical marker for early detection of cancer.

Introduction: Haller cells, an anatomical variation in paranasal sinuses, have also been suggested as a causative factor in maxillary sinus disease because of their ability to cause narrowing of the infundibulum because of their complex positioning. Research in the past had suggested the probable etiology for maxillary pathology from the obstruction at the osteomeatal complex leading to localized infection and inflammation. These further proceed to the sequel of another sinus pathology. Aim and Objective: The purpose of this study was to calculate the prevalence of Haller cells and to evaluate the association of the presence of Haller cells with maxillary sinus diseases. Materials and Methods: Cone beam computed tomography (CBCT) image volumes of 200 patients were retrieved from Planmeca ProMax 3D Mid machine and evaluated using Romex 3.1 software, in coronal section and keeping slice thickness of 4 mm. In total, 400 sites were analyzed for Haller cells and maxillary sinus disease. Haller cells were identified using criteria given by Mathew et al. Data obtained were subjected to the Chi-square test and Cohen' kappa test for statistical analysis and P values of <0.05 were considered statistically significant. Results: Out of 400 sites, Haller cells were noted at 129 sites and reported with the prevalence of 49%. Maxillary sinus pathology was noted at a total of 144 sites out of which 68 were associated with Haller cells. Maxillary sinusitis in association with Haller cells was reported at 50 sites where as benign mucosal cyst was reported at 18 sites. Conclusion: Haller cells should be used as an important anatomical variation in maxillary sinus pathologies.

Background: Pyogenic granuloma is a common, non-neoplastic reactive growth of the oral cavity. Treatment consists of conservative surgical excision, cryosurgery, or laser surgery. These are usually adequate but often result in scars and recurrence. Therefore, this study was undertaken to determine the effectiveness of sclerotherapy in the treatment of oral pyogenic granuloma. Materials and Methods: Forty clinically diagnosed cases of oral pyogenic granuloma were included in the study. After topical anesthesia application, 0.2–0.5 mL of sodium tetradecyl sulfate was delivered by insulin syringe into the base of lesions till the solution leaked out. Each patient was recalled after 1 week and evaluated. If the lesion did not resolve, second and third injections were given consecutively. Results: All the 40 patients showed complete regression of the lesion after one to four consecutive shots in weekly interval. Conclusion: Intralesional sclerotherapy can be considered as an effective non-surgical treatment procedure for oral pyogenic granuloma.

Background: The mastoid process characteristics are of great utility in the determination of sex. Studies on human skeletal remains for sex determination have been a topic of interest among researchers. Osteometric studies using individual bones exhibiting sexual dimorphism have been reported among different populations. Skull is important in this regard as it resists adverse environmental conditions over time. The mastoid process can be used as a marker of sex determination in unidentified human skull remains. Objective: The objective of this study is to evaluate the use of mastoid process as a tool for sex determination in unidentified skeleton. Aim: The aim of this study was to evaluate the accuracy of different craniometric parameters of mastoid process in sex determination. Materials and Methods: In the present study, 50 adult human skulls of Telangana population were studied to determine the accuracy of mastoid process in sex determination. Parameters studied were length, breadth, antero-posterior diameter, size, and area of mastoid process. Results: Statistics revealed high significance (P < 0.0001) for mastoid length and size for sex determination. Conclusion: To our knowledge, this is the only study including various craniometric parameters of mastoid process.

Aim: Identification of human bite marks on victims and to analyze them by computer-based superimposition technique using Adobe Photoshop software. Materials and Methods: Five bite mark cases were selected for this study. Five bite marks were identified on patients attending the hospital and were analyzed with computer-based superimposition technique using Adobe Photoshop software by two observers. Results: All the five bite marks on victims were analyzed by computer-based superimposition technique using Adobe Photoshop software and categorized as “not excluded as having made the bite mark with suspects dentition.” Conclusion: Computer-based superimposition technique using Adobe Photoshop software is an accurate and cost-effective method for bite mark analysis.

Background: Assessment of age through teeth is one of the most reliable and simple method than skeletal remains, to calculate age of an individual. Objectives: The study was carried out with an aim to evaluate reliability of dental age assessment through tooth coronal index (TCI) method. Materials and Methods: The digital panoramic radiographs of 100 subjects of Chhattisgarh aged 20–70 years were selected for the study. The measurements were performed on the JPEG images of selected panoramic radiographs by using Adobe Acrobat 7.0 professional software. The height of the crown, i.e., coronal height, and the height of the coronal pulp cavity, i.e., coronal pulp cavity height, of mandibular second premolars and first molars were measured in millimeter (mm) and then TCI was calculated for each tooth. Actual age of a subject was compared with TCI of tooth and the acquired data were subjected to Pearson's correlation and unpaired t-tests. Results: Negative correlation was observed between the real age and TCI of mandibular first molar (r = −0.092, P = 0.365) and second premolar (r = −0.168, P = 0.096). Statistically significant difference was observed between real age and TCI for mandibular second premolar and first molar (P = 0.000) by unpaired t-test. Conclusion: TCI has the potential to estimate age of an individual on dental radiographs. It is simple, cost effective than histological methods and can be applied to both living and unknown dead.

Soft tissues of the oral cavity are often affected by various mucocutaneous disorders of variable etiology, affecting both the skin and mucosae, with severe clinical manifestations such as blisters involving the tissues; and therefore their appropriate management relies on their correct diagnosis. Clinical signs to elicit characteristics of blisters are a crucial part of the examination of patients with such disorders. It is therefore essential for clinicians to be familiar with, or rather be expert at eliciting these signs to frame an accurate diagnosis, since proper treatment and follow-up will depend on which disease is involved. The Nikolsky's sign is one such sign that can be helpful in the clinical diagnosis of pemphigus group of disease and differentiating it from other blistering dermatoses. This review gives an overview of sign of Nikolsky and other related sign, its clinical presentation and their diagnostic implications, using PubMed and Medline databases searching for articles written in English. Peer-reviewed articles were targeted using the keywords “Nikolsky's sign”, “mucocutaneous disorders” and “pemphigus”. Available full-text articles were read, and related articles were also scrutinized and finally the search was subsequently refined to articles concerning to “Nikolsky's sign”. It was concluded that early recognition of these signs are necessary to prevent delayed diagnosis and for early institution of appropriate treatment of these potentially serious mucosal and dermatological diseases.

Synovial chondromatosis (SC) is a benign pathology that usually affects the joints of axial skeleton and being rare in temporomandibular joint region. Clinically, the presentation can be in the form of swelling, pain, clicking sounds, and mouth opening limitation. Imaging is a vital component to distinguish the conditions similar to SC. A case of SC diagnosed with the help of imaging has been discussed in the present paper along with a brief review of differential diagnosis.

Ameloblastoma is second most common odontogenic tumor of jaws that presents with typical clinical, radiological, and histopathological appearances. Provisional diagnosis of this tumor is based on clinical and radiological features; however, final diagnosis is made by histopathological examination which classifies it in to various types, i.e. follicular, plexiform, acanthomatous, granular cell, desmoplastic, and basal cell type. Follicular and plexiform patterns are most common. Hybrid ameloblastoma (HA) is rare entity in which conventional types (follicular and plexiform) of ameloblastoma co-exist with desmoplastic ameloblastoma (DA). Its radiological appearance differs from conventional ameloblastomas and sometimes resembles fibro-osseous lesions (FOL). There are only 35 cases of HA reported in literature. We present a novel case of hybrid desmoplastic/follicular ameloblastoma of anterior mandible with emphasis on its radiologic features. Differential diagnosis of the lesion from conventional ameloblastomas and FOL are discussed.

The term “plasma cell granuloma (PCG)” is used to describe a localized benign proliferation of mature plasma cells. Intraoral PCGs involving the tongue, lip, oral mucosa, and gingiva have been reported in the past. This case presents a 16-year-old female with maxillary anterior gingival overgrowth. Histological examination revealed inflammatory cell infiltrate containing sheets of plasma cells. This case highlights the need that tend to locate in the oral cavity, primarily on the periodontal tissue. It reinforces the existence of PCG on the gingiva that it is extremely uncommon.

Desmoplastic ameloblastoma (DA) is a rare variant of ameloblastoma, and less than 170 patients have been reported in the literature. The present case deserves special importance because of its rare occurrence, unfamiliar appearance, potentially aggressive nature, and high chances of misdiagnosis. Moreover, the radiographic features of this lesion rarely point towards ameloblastoma. Desmoplastic variant of ameloblastoma tends to infiltrate between bone trabeculae. The risk of recurrence is high. This report is an attempt to help the dental community in developing familiarity with the clinical presentation and at the same time advocating to develop a high index of suspicion in recognizing such cases.

Glanzmann's thrombasthenia is a rare congenital bleeding disorder which is associated with mutations in the genes encoding glycoproteins, gpIIb or gpIIIa resulting in platelet dysfunction. Here we present a case of 10 years old female patient with spontaneous bleeding gums since 4 days seeking dental treatment. She was under medical supervision following a diagnosis of some bleeding disorder before 4 years. With careful early diagnosis and proper supportive care Glanzmann's thrombasthenia has a very good prognosis.

Cornelia de-Lange syndrome (CdLS) is a rare multisystem developmental disorder characterized by psychomotor retardation and delayed growth associated with a series of malformations, including facial dysmorphia, upper-extremity malformations, hirsutism, cardiac defects, and gastrointestinal abnormalities. There is no definitive biochemical or chromosomal marker for the prenatal diagnosis of syndrome so it is important for the clinician to know etiopathological aspects and characteristic features to provide health care and help improve the quality of life of affected individuals.

Background and Objectives: Recurrent aphthous ulcers are common painful mucosal conditions affecting the oral cavity. Despite of so many treatment modalities, there is no specific and definitive treatment. Hence a study was carried out to evaluate the clinical effects Single Application of Doxycycline Hyclate 100 mg for Recurrent apthous Stomatitis (RAS). Materials and Methods: Forty study subjects were included in the study. Patients were randomly assigned into two groups. There were 20 patients in each group; Group A patients received Doxycycline Hyclate 100 mg in the first visit, Group B patients received placebo. The results were analyzed with unpaired 't' test. Results: The data indicated a significant reduction in pain in group A (i.e., faster reduction in pain) compared with group B. Interpretation and Conclusion: A single application of doxycycline hyclate decreased pain and speeded recovery.