Objective: This study aimed to determine the prevalence of temporomandibular disorders (TMDs) in Chennai city population. Materials and Methods: To obtain a representative sample, a house-to-house survey was conducted in three zones of Chennai and a total of 4197 individuals were randomly selected for the study. Among 4197 individuals, 1158 were excluded from the study, based on the exclusion criteria. Finally, a total of 3039 individuals were included in the study population. Results: More than half of the study sample (53.7%) in the present study had one or more clinical signs and symptoms of TMD. Deviation of mandible on mouth opening (42.1%) and clicking sound (38.6%) made up the highest percentage. Females aged 18 years and older reported higher prevalence of TMD signs and symptoms than men. However, these differences were not significant for all signs and symptoms in all age groups. Prevalence of TMD was reported in this study according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) system of classification, and myofacial pain dysfunction syndrome (MPDS) was reported in 0.8% of the population, internal derangement in 38.3%, and osteoarthritis in 14.6% of the population. Conclusion: Our study, in comparison to other prevalence studies, had a higher sample size and was representative of a cross section of the population. The results of this study show that a significant percentage of the population has signs of TMDs and there are chances that they may develop symptoms of TMDs. Further studies are needed for early identification and initiation of preventive measures which could prevent TMDs progressing to advanced stages where management becomes difficult.

Introduction: The styloid process (SP) is an anatomical structure whose clinical importance is not well understood. Aims and Objectives: This study aimed to study the type of SP as per Langlais' classification and to assess the feasibility of digital panoramic radiographs in measuring the length of SP. Materials and Methods: Eighty digital panoramic radiographs of patients with dental problems were retrieved from archives of our department as soft copies. The radiographs were taken using a digital panoramic system. The radiographic length of SP was measured on both sides using measurement toolbars on accompanying analysis software. The type of elongation patterns of SP was classified as per Langlais' classification. Finally, the data were subjected to statistical analysis. Results: The average length of the left and right side SPs was 29.1882 ± 6.86 and 28.16 ± 6.44, respectively. Majority of patients were found to be asymptomatic, and Langlais' Type I elongated SP was more common than others. Conclusion: Digital panoramic radiographs are valuable tools in early detection of elongated SP. Digital radiographs help in avoiding a misdiagnosis of tonsillar pain or pain of dental, pharyngeal, or muscular region.

Introduction: Accurate diagnosis of periapical lesions may be necessary not only to predict the treatment outcome but also to decrease the incidence of root canal treatment failure. Ultrasound imaging is an easy, reproducible technique, which is based on the evaluation of reflected echoes and has the potential to differentiate the periapical lesions. Aim: To compare the diagnostic accuracy of conventional radiography, digital radiography, and ultrasound imaging in the detection of periapical lesions. Materials and Methods: Thirty patients aged between 20 and 40 years, presenting with well-defined periapical radiolucencies in relation to anterior maxillary or mandibular teeth, indicated for extraction or periapical surgery were subjected to conventional and digital radiographic examination by paralleling technique followed by ultrasonological examination. Three observers (A, B, C) gave their radiographic diagnosis twice at an interval of 2 weeks. A sonologist assessed the size, contents, echogenicity and vascular content of the lesions. The diagnosis was compared with histopathological examination of tissues obtained by extraction or periapical surgery. Results: The diagnostic accuracy of ultrasound imaging was 83.33%, which was higher than conventional radiographic examination by all observers (53.33-76.66%) and digital radiographs by observers A and B (70-80%). Conclusion: Our study revealed that ultrasound with color Doppler was an efficient tool for diagnosing periapical lesions as it had better diagnostic accuracy than conventional and digital radiography.

Aim: The aim of the study was to evaluate an accurate, inexpensive and low-radiation conventional radiograph suitable for localization of impacted maxillary permanent canine. Materials and Methods: The study comprised 38 subjects in the age group of 13-50 years of both the genders with 50 impacted canines. Panoramic radiographs (OPGs) (on which Chaushu et al. criteria was applied) and intraoral periapical radiographs (IOPARs) (on which Clark's rule was applied) of the subjects were made and the accuracy of the above two radiographic techniques were compared with computed tomography (CT) axial sections or with surgical exposure, which was considered as the standard guide for localization of impacted maxillary permanent canine. The data obtained was tabulated and subjected to statistical analysis using the statistical package for SAS software. Results: Localization of impacted maxillary permanent canine tooth done with SLOB (Same Lingual Opposite Buccal)/Clark's rule technique could predict the bucco-palatal canine impactions in 98% of cases. OPG using differential magnification index could predict location only in 68% of bucco-palatal canine impactions and in 72% based on vertical position. Conclusion: In 68% of cases the bucco-lingual position of the canine in OPG (by magnification index) coincided with the location as per CT/surgical exposure. In 98% of cases localization with SLOB technique coincided with CT/surgical exposure. 72% of cases showed coincidence with vertical position of the canine on OPG with CT/surgical exposure. IOPARs taken with SLOB technique are more accurate than OPGs for localization of impacted permanent maxillary canine teeth.

Introduction and Objectives: The soft palate plays a vital role in velopharyngeal closure which is strongly dependent on a close coordination of the velum and the contiguous pharyngeal structures. It is reasonable to hypothesize that these structures may have different characteristics to match up to different soft palate morphologies. Considering this, the present study was done to investigate the variation in the morphology of the soft palate. Materials and Methods: A total of 200 patients belonging to both the genders, in the age group 5-55 years, were selected from the outpatients visiting the Department of Oral Medicine and Radiology. All the study samples were subjected to lateral cephalogram and the morphology of the soft palate was categorized as described by You et al. Any additional finding was further differentiated as type 7 and so on. The length of soft palate was also evaluated using Sidexis next generation software. The data obtained were tabulated and subjected to statistical analysis. Results: The morphology of soft palate was categorized into eight types. Type 1 was the commonest type observed. The relationship between the different types of soft palate in various age groups was found to be non-significant. The mean length of the soft palate was found to be more in group V (46-55 years). The mean length of soft palate was found to be higher in males. There was a positive correlation between age and type of soft palate. Conclusion: The present study draws a new set of morphological classification for the soft palate.

Introduction: The problems associated with age-related skeletal osteopenia have received attention since the human skeleton undergoes a continuous physiologic decrease in bone mass with advancing age. Bone status at various sites can be assessed using dual-energy X-ray absorptiometry (DXA) or quantitative computed tomography. It would be useful to answer whether radiographic changes in the mandible indicate skeletal osteopenia. Aims and Objectives: The aim and objective of the study was to examine the mandibular cortical index (MCI) and panoramic mandibular index (PMI) on panoramic radiograph and to establish a relationship between the two indices (MCI and PMI) with the bone mineral density (BMD) in postmenopausal women. Materials and Methods: The study consisted of 15 postmenopausal women within the age group of 45-75 years. BMD was performed by DXA and measured at the lumbar spine and femoral neck and values were recorded. Panoramic radiographs of the same women were obtained for measuring MCI and PMI. There were two groups taken as C1 and C2 for determination of MCI and PMI. Results: The Pearson correlation analysis revealed a significant correlation between age and T-score (r = −0.59, P < 0.05), i.e., as age increased the T-score decreased. Comparing the T-score of two MCI groups, t-test revealed MCI was 69.1% lower in C2 as compared to C1. The value of P < 0.001 and t-test revealed significantly different and lowered (32.4%) inferior cortex level in C2 as compared to C1 (t = 4.76, P < 0.001). Conclusion: Results suggest that in this study panoramic radiography could be a reliable tool in screening for BMD.

Introduction: Oral submucous fibrosis (OSMF) is the most prevalent precancerous condition in India, with high prevalence rates found in North Gujarat. In spite of the high prevalence and its potential to undergo malignant transformation, this condition has not been widely investigated with respect to the serum lipid levels. The changes in lipid profile have long been associated with cancer as lipids play a key role in the maintenance of cell integrity. Aim: To investigate the alterations and clinical significance of serum lipid profiles in OSMF patients. Materials and Methods: A total of 50 subjects were included in the study and divided into two groups. Group I consisted of 40 clinically diagnosed OSMF subjects and group II consisted of 10 healthy subjects. After taking a thorough history, clinical examination, and informed consent, all the patients were sent for lipid profile estimation, which consisted of (i) serum total cholesterol (TC), (ii) low density lipoprotein (LDL) cholesterol, (iii) high density lipoprotein (HDL) cholesterol, (iv) very low density lipoprotein (VLDL) cholesterol, and (v) serum triglycerides (TG). Results: The serum lipid levels were significantly lower in patients with OSMF than in the controls, which was most evident in stage IV OSMF. From the present results, it is evident that the level of serum lipids decreases with the progression of the disease. Conclusion: This study suggests that decrease in lipid levels may be considered as a useful marker in the early diagnosis of oral premalignant conditions like OSMF.

Introduction: The taste receptors responsible for salivary secretion are constantly being affected by the harmful by-products of tobacco, and it is believed that tobacco usage on a long-term basis can decrease the sensitivity of taste receptors leading to decreased salivary reflex. It is hypothesized that long-term tobacco usage might lead to altered taste receptors' response, changing the salivary flow rate (SFR). Unstimulated whole mouth SFR and salivary pH play an important role in the causation of various oral changes and conditions. Aims: The aim of this study is to determine the effects of long-term use of tobacco on SFR and salivary pH and the oral and dental health among tobacco chewers, smokers, and control group. Settings and Design: Cross-sectional study. Materials and Methods: The study comprised a total of 90 patients who were grouped into smokers (group A), smokeless tobacco chewers (group B), and controls (group C). Each group consisted of 30 healthy male adults. Resting whole mouth saliva was collected from every patient; SFR was calculated and then salivary pH was assessed using the salivary pH strips, depending on the color change of the indicator paper strip when compared with a color chart. Statistical Analysis Used: Data were analyzed using the Statistical Package for Social Service (SPSS) computer software. Student's t-test, analysis of variance (ANOVA), and Z-test were applied to assess between-group differences. Results: The mean (±SD) SFR was found to be 0.77 (±0.23) ml/min for group A, 0.63 (±0.16) ml/min for group B, and 1.08 (±0.08) ml/min for group C, and on comparing the groups, the result was significant. The mean (±SD) pH was found to be 6.8 (±0.20) for group A, 6.65 (±0.30) for group B, and 7.06 (±0.23) for group C and was also found to be significant on comparison. Conclusions: It is concluded from this experimental study on long-term tobacco users that smokeless and smoked forms of tobacco adversely affect salivary reflex, salivary secretion, and salivary pH, with the smokeless form being more harmful than the smoked form of tobacco. The effect of tobacco on long-term usage can lead to vulnerable changes in the oral mucosa and dental structures.

Objective: To evaluate the efficacy of laser as a monotherapy and in combination with exercise therapy in comparison to only exercise in the treatment of Myofascial Pain Dysfunction Syndrome (MPDS) or Temporomandibular Myofascial Pain. Materials and Methods: A total of 60 patients with MPDS were included in the study and were randomly divided into three groups: exercise, laser, and the combination of both (exercise and laser). Results: Significant reduction in pain at rest and pain on movement was observed with all three types of treatment modalities. Pain reduction was more in those patients who received combination of exercise and laser therapy. Similarly, decrease in the muscle tenderness was more when combination of exercise and laser therapy was used. Conclusion: The ideal therapy should be fast, cheap, and have a long-term effect. Laser (Helium Neon) as monotherapy or in combination with exercise had shown promising results and can be used as an effective treatment modality for the treatment of MPDS.

Introduction: Dental caries was considered to be an irreversible disease, but this concept of caries is changing because of the availability of many newer products for its treatment. One of such product is casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). Aim: The present in vitro study was aimed to evaluate remineralization of artificial caries-like lesion by topical application of CPP-ACP paste. Materials and Methods: In this study, 40 caries-free premolar and molar teeth requiring extraction for orthodontic reasons and impactions were used. Artificial caries-like lesion was produced on sound enamel surface by immersing the samples in demineralizing solution for 96 h. Longitudinal sections were made through the white spot lesion with hard tissue microtome and were subjected to polarized light microscopic evaluation. The sections were divided into CPP-ACP group (Group I), positive control (Group II), and negative control (Group II). The Group I and Group II samples were subjected to 10 days of pH cycling, and all the samples were evaluated by polarized light microscopy. The lesion depth was calculated, and all the data was subjected to statistical analysis. Results: CPP-ACP group showed 27.306% decrease in lesion depth after 10 days of pH cycling. Conclusion: Based on the findings of this study, it can be concluded that the CPP-ACP paste can cause remineralization of white spot lesion and can be prescribed as topical application paste for the treatment of initial caries lesions.

C-reactive protein (CRP) is a plasma phase protein that takes part in systemic responses to inflammatory reactions. Its serum concentration can increase up to 1000 folds or more in relation to acute stimuli due to infections, tissue injuries, and malignant disorders. It is highly resistant to proteolysis, principally synthesized in the liver in response to proinflammatory cytokines, i.e. interleukin (IL)-6, IL-1β, and tumor necrosis factor. These cytokines are seen to be related to neoplastic disorders. It forms an integral component of innate immunity and serves primarily to recognize potential pathogens and damaged cells. The present article summarizes the importance of CRP and its significance in oral cancer and associated disorders. It was found that a lowered CRP level may prove to be beneficial in prevention and treatment of oral cavity cancer.

Actinic cheilitis (AC) is a chronic inflammatory disorder of the lips that is caused by prolonged exposure to sunlight in susceptible individuals. It affects the vermilion region of the lower lip almost exclusively. UV-B rays with a wavelength of 290-320 nm are held responsible for the sunlight-induced damage. The exact mechanism of the development of AC is unclear. It is considered to be potentially malignant.

Lichen planus (LP) is a chronic mucocutaneous, immune-mediated inflammatory disorder affecting middle-aged adults. It is a T-cell mediated disease in which the cytotoxic CD8+ T cells trigger apoptosis of the basal cells of the oral epithelium. It has different variants wherein the severe form includes bullous and ulcerative types. LP can significantly affect the quality of life with burning sensation and pain. Although a wide spectrum of treatment modalities are available for treating LP, the right choice of medicaments and/or combinations largely influence the final outcome of the treatment. We present a case of severe form of atrophic and ulcerative LP in a 17-year-old female in which we used a combination therapy for treatment, which resulted in a good prognosis on follow up.

Osteonecrosis of jaws is a common complication of parenteral nitrogen-containing bisphosphonates and recently medication-related osteonecrosis of the jaw (MRONJ) is contributing to the growing number of similar osteonecrosis cases which involve maxilla and mandible associated with other anti-resorptive and anti-angiogenic therapies. A 70-year-old male patient with multiple myeloma and discontinued chemotherapy reported with non-healing extraction site for past 1 year. He also complained of pus discharge extraorally for past 3 months. This case report describes the imaging findings of multiple myeloma in mandible and MRONJ.

Cone beam computed tomography (CBCT) is an imaging modality that enables to visualize the dental structures in three dimensions, which is beyond the scope of conventional radiographs being used. A thorough understanding of the complexity of dental structures is necessary to devise a proper treatment plan and assure the best prognosis. This is made possible by the use of CBCT in all the specialties of dentistry. This case report presents the incidental findings as visualized on CBCT, viz., C-shaped canal and a molar with six root canals, which may pose a problem while being treated endodontically. Thus, the use of CBCT while treating them ensured the success of treatment and its prognosis.

Ameloblastic fibro-odontoma (AFO) is a rare mixed odontogenic tumor. It occurs predominantly in children and young adults with no sex predilection, mostly in the mandible posterior region. A painless swelling is the most common clinical sign of AFO. Radiographically, AFO shows a circumscribed radiolucency, which contains radiopaque foci of various sizes and shapes. Histological examination reveals a fibrous soft tissue, islands of odontogenic epithelium, and a disordered mixture of dental tissues. Treatment of AFOs usually consists of enucleation or surgical curettage, which is possible due to their benign biological behavior. Here, we are reporting a case of AFO in a 20-year-old male.

Lipomas are benign soft tissue neoplasms of mature adipose tissue usually seen in the head and neck region. Intraoral lipomas are rare lesions, which may be discovered during routine dental examinations since they present as a slow-growing, painless, and asymptomatic yellowish mass. Fibrolipoma is one of the rare variants of the lipoma, and very few cases have been reported in the oral cavity. These lesions infrequently cause pain, but may grow to large size causing difficulty in speech and mastication. Surgical excision is the treatment of choice, and the prognosis is generally good as recurrence rate is very less. Here, we present two cases of fibrolipoma and a brief review of literature.

Verrucous carcinoma (VC) is a variant of squamous cell carcinoma. It most commonly affects the oral cavity with buccal mucosa being the most common site affected. Clinically it has proliferative finger-like projections or a cauliflower-like appearance which is a significant factor in its diagnosis. It is more common in tobacco user males. The histopathological diagnosis of VC is difficult and requires immense experience to report a case of VC. Though VC is described as a benign lesion with minimum aggressive potential but long-standing cases have shown transformation into squamous cell carcinoma. Therefore, early diagnosis and surgical excision of the lesion are the most appropriate treatment modality of VC.

Osteomas are benign slow-growing lesions. A very few cases of the peripheral type arising from periosteum have been reported. In the facial region, periosteal osteomas mostly occur in the paranasal sinuses; thus, solitary osteomas of the jaws bones are rare. The etiology is unknown although it could be attributed to as a developmental anomaly, due to trauma or infection. Herein, we have reported two cases of large solitary peripheral osteoma discussing the clinical, radiological, and histological features of the lesion located in the buccal and lingual surface in the left posterior part of mandible causing facial asymmetry and the other being asymptomatic.

Hemifacial microsomia (HFM) is a congenital facial deformity involving the structures derived from first and second pharyngeal arches like temporomandibular joint, mandibular ramus and body, muscles of mastication, ear and sometimes facial nerve. HFM is the second most common developmental craniofacial anomaly after cleft lip and palate, which usually occurs unilaterally, but also may occur bilaterally. In the present article, we have reported a case of HFM in an 8-year-old boy with unilateral facial hypoplasia, deformed ear and partial conductive hearing loss on the right side.

Radiolucent mandibular lesions are commonly evident on head and neck imaging and present a diagnostic dilemma for the radiologist. These may represent a broad spectrum of lesions arising from both odontogenic and nonodontogenic structures. Furthermore, few radiolucent lesions are often identified as incidental lesions by the radiologist on imaging performed for different reasons. Location of the lesion, borders, internal structure, and its effect on surrounding structures are the key points to narrow the differential diagnosis. Imaging is essential not only for the diagnosis of lesions, but also to guide therapy and monitor the treatment response. Here is a case report on traumatic bone cyst that presented as an asymptomatic radiolucent lesion in right posterior mandible and was discovered incidentally on routine radiograph. The lesion was diagnosed based on patient's anamnesis and radiographic examination. This paper aims at discussing the differential diagnosis, various radiological characteristics, and their prediction in prognosis of the lesion.

Eagle's syndrome is a diagnostic dilemma. Sometimes, it is diagnosed as an accidental finding whereas at other times, it is diagnosed as a syndrome based on complex clinical and radiological findings. Elongated styloid process can impinge on a number of nerves and vessels in the adjoining area, and symptoms can easily be confused with a variety of orofacial pain conditions. Hence, for the treatment and management of such cases, proper diagnosis is very important, and a dentist should always keep Eagle's syndrome in mind while encountering patients with chronic orofacial pain.

Hand, foot, and mouth disease (HFMD) is a highly contagious enterovirus infection mainly affecting children less than 5 years of age. In a majority of cases, it is caused by coxsackievirus A16 (CVA16), although instances have been described in which A5, A6, A7, A9, A10, B2, B5, or human enterovirus 71 (HEV-71) has been isolated. The disease occurs rarely in adults, and has been reported in immunocompromised patients. It usually has a benign and self-limiting course with an incubation period of 3-10 days. The prodromal symptoms include fever, malaise, and sore throat. This initial phase is usually followed by erythematous macules, papules, and vesicles on palm and soles, lateral and dorsal surfaces of hands and feet, and also the oral cavity. The purpose of this article is to highlight to the general practitioner about the atypical presentation in healthy adults as well. In the present paper, we describe three cases of HFMD in otherwise healthy adults, with complete recovery.

Pachydermoperiostosis (PDP) is a rare osteo-arthro-dermopathic syndrome, the diagnosis of which can be made on the basis of the classic clinical and radiological presentations. The primary form of the disease, also called as Touraine-Solente-Gole Syndrome, contributes to approximately 3-5% of the cases of hypertrophic osteoarthropathy (HOA). The authors present here a rare case of familial primary osteoarthropathy with significant dental findings which, to the best of our knowledge, is seldom reported in English literature.

Gardner syndrome is a rare, autosomal dominant syndrome that follows a positive course with diagnosis and treatment by medical and dental specialists. General dental physicians can diagnose the syndrome through radiological images taken in addition to dental and skeletal findings. In this article a 45-year-old male patient with previously undiagnosed Gardner's syndrome who presented for removal of painful mobile tooth is reported to illustrate the importance of detection and proper referral.