This is an era of digital revolution where the world is shifting from analogue to digital electronics. This revolution has led to the invention miniaturization of devices and one such invention is hand-held X-ray devices. With the introduction of new technology in dental radiology, there is a need to change or update old guidelines that many states use to regulate the use of ionizing radiation. Currently, there are voluntary guidelines promulgated by the NCRP for dental radiation protection. Many states use the Conference of Radiation Control Program Directors Suggested State Regulations for the Control of Radiation to regulate the use of X-ray equipment. Hand-held portable X-ray devices are increasingly used for intraoral radiography. This development introduced new challenges to operator and patient safety, for which new or revised risk assessments must be made and acted upon prior to use.

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Background: Trigeminal neuralgic (TN) pain has been known as the world's worst pain. Omega-3 fatty acids have been recently studied extensively in neuralgic pain. Carbamazepine has been known to be the first drug of choice in treating TN pain. In the present study, the potential benefits of omega-3 fatty acids in addition to the carbamazepine were assessed. Objective: The objective of the study was to evaluate the role of omega-3 fatty acids in the neuralgic pain along with carbamazepine in treating neuralgic pain. Materials and Methods: The present study was undertaken on 114 patients with TN pain. The patients were divided in two groups. The group I consisted of patients who were on carbamazepine only, and group II comprised patients who were on carbamazepine and omega-3 fatty acids. The pain was assessed using Brief Pain Inventory questionnaire, which is the most widely used questionnaire for chronic pain. The patients were evaluated on the day of reporting and on subsequent follow-up at 2 weeks, 6 weeks, and 15 weeks interval. The data obtained was subjected to statistical analysis to assess the additional benefits of omega-3 fatty acids in TN pain. Results: The results obtained showed that the intensity of pain reduction and life quality was better in patients receiving carbamazepine and omega-3 fatty acids by the end of the 15^th week compared to the patients receiving carbamazepine alone. Conclusion: The present study demonstrates the reduction in neuropathic pain on long-term usage of omega-3 fatty acids, signifying that omega-3 fatty acids may offer better relief in neuralgic pain.

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Background: Temporomandibular disorders (TMDs) are a collection of medical and dental conditions that affect the muscles of mastication along with transmittable tissue components. Physical modality such as ultrasound (US) therapy is considered to be an important treatment to relieve musculoskeletal pain, to reduce inflammation, and to restore oral motor function. Settings and Design: It was a prospective study and was carried out in the Department of Oral Medicine and Radiology at Teerthanker Mahaveer Dental College and Research Centre, Moradabad, to evaluate the efficacy of therapeutic US massage therapy in management of temporomandibular joint (TMJ) disorders. Aims and Objective: To determine the effectiveness of US massage therapy in patients with TMDs. Materials and Methods: This study included 10 patients with TMDs, according to research diagnostic criteria (RDC), within the age group of 18–50 years. All the patients were treated with US, once a week for 4 weeks for 8 min and pain intensity was evaluated using visual analog scale, at every sitting. Statistical Analysis Used: SPSS version 22 software was used and Student's t-test value was used. Results and Discussion: A significant pain reduction was found in US massage therapy. There was a decrease in pain in TMJ from 7.30 ± 1.70 to 4.00 ± 2.53 and mouth opening improved from 40.40 ± 6.50 to 41.80 ± 5.97 which was statistically significant. This therapy appears to be a valuable physiotherapy method for pain reduction in TMDs. Conclusion: US massage therapy appears to be useful in relieving pain and improves subsequent mouth opening, and hence can be considered as a valuable physiotherapy method. Thus, US massage therapy serves as a potent and independent therapeutic modality in TMDs.

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Introduction: Apical root resorption (ARR) is a common condition associated with periapical pathologies which is invariably detected by intraoral periapical radiographs. Although it is common, its distribution in different periapical pathologies has not been assessed so far. The aim of this study was to determine the distribution and severity of ARR in common inflammatory periapical pathologies. Materials and Methods: A cross-sectional radiographic study was conducted on 333 patients who visited SEGi Oral Health Centre in the 6-month period of the study. Digital intraoral periapical radiographs of patients with clinically established periapical pathologies were taken. Data were collected using a structured proforma regarding the type of periapical lesions, presence or absence of ARR. Collected data were analyzed using SPSS version 21 and Chi-square test was applied to check the association between ARR and periapical pathologies. Results: During this study period, 333 patients with inflammatory periapical pathologies were reported. Of which 135 (40.5%) showed definite ARR. Among 135 ARR, 97 (71.9%) were moderate resorption and 38 (28.1%) were severe resorption. ARR was significantly greater in periapical granuloma and cyst (72.8%) followed by periapical abscess (35%) and acute apical periodontitis (18.1%) which was statistically significant (P < 0.001). Young adults (40.7%) and male patients (58.5%) had higher ARR compared to old-aged adults and female patients. Conclusion: The presence of ARR is the concern for the infection control in endodontics, as these conditions provide a favorable environment for bacterial colonization and also exact working length determination is difficult as there is altered apical constriction.

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Introduction: Oral and maxillofacial radiology is the daily part and parcel of dental practice. It does contribute a major section to the biomedical waste generated in the dental clinic. Pollution can be controlled only if the clinicians are aware about appropriate waste collection and disposal methods. This study aims toward evaluating the knowledge of clinicians toward this issue. Materials and Methods: A survey was performed for a sample size of 100 dental clinicians. A multiple-choice response type of questionnaire was designed with close-ended questions with a maximum choice of four responses. Responses were evaluated to extract the results. Results: An overall analysis yields total correct results which have been reported to be <50%, almost 14 out of 20 questions. This represents constrain in knowledge of the clinicians. Conclusion: Lack of knowledge may lead to serious health and environmental hazards. A governing body needs to be set-up to provide guidelines and handle proper disposal of radiologic waste.

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Hyperparathyroidism is a common endocrine disorder affecting multiple vital organs. The three types of hyperparathyroidism show oral as well as systemic manifestations, including brown tumor, neurological disorders, nephrolithiasis, and pancreatitis. Oral manifestations form an integral part in diagnosing the underlying parathyroid pathology, which is presented in this case series.

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Dengue fever is an acute infection of viral origin caused by female Aedes aegypti mosquito. It has a flu-like illness that can be fatal if left untreated. Several systemic complications such as hypovolemia and circulatory shock with organ failure, oral complications such as post-extraction bleeding, and candidiasis have been reported. Rare complications such as lock jaw and osteonecrosis can also manifest in severe form of dengue fever. Very scanty literature exists to document this association. This case report is an evidence to document and emphasize that these complications develop in severe cases of dengue fever even without any preexisting odontogenic or periodontal etiology.

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Background: Demirjian et al. (1973) put forth a method of age prediction, which used seven mandibular teeth on the left side. The technique has been widely applied but revealed variations in age estimates in other populations, including Indians. The aims and objectives of our study were to validate the Demirjian 8-teeth method using orthopantomogram to estimate the reliability of age estimation after incorporating the third molar and to predict the accuracy of age estimation using Indian-specific formulae. Materials and Methods: The study was conducted on the local population with 49 subjects (mean = 18, f = 31) less than 18 years of age. The soft copies of the radiographs of selected subjects were retrieved from the computer attached to the digital orthopantomogram machine (Orthophos XG5; Sirona Dental Systems). Staging of each tooth of left mandibular side was done using Demirjian 8-teeth method. Dental age was calculated using the modified formula given by Acharya et al. and statistical methods were used to compare it with chronological age. Results: The overall mean absolute error (MAE) of the 49 subjects was 0.911 ± 1.65. The highest MAE was in the 13-year age group (1.82 years) while it was lowest in the 18-year age group (0.43 ± 1.10 years). In all, 15 subjects (30.6%) had an error in age estimation which is less than 1 year and 12 subjects (24.5%) had an error of more than 2 years The accuracy of age estimation was found to be better in 16–18 years age group as compared to younger age group, probably because of better development of the third molar by this age. Conclusion: The reasonably good results obtained in this study assert the use of Demirjian's 8-teeth method with Indian cubic functions in the local population.

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Most common and difficult problem while taking intraoral periapical radiographs in the posterior region of the jaw is gagging. Thus, in an attempt to obtain the radiographs of maxillary and mandibular third molar without causing much discomfort and additional financial burden to the patient, an alternative technique was devised. This technique requires a dental chair, intraoral dental X-ray machine, regular size 2 periapical film, and artery forcep. The film is placed parallel to the occlusal plane as in case of occlusal radiography with the embossed dot side facing towards the teeth to be radiographed and exposures are made. The resulting radiographs showed complete image of third molars without causing stimulation of gag reflex and without superimposition of zygomatic process on roots of maxillary third molars. Thus, the present technique can be used satisfactorily for taking third molar radiographs in patients with severe gag reflex.

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Background: This questionnaire study aims to assess the precise knowledge of dental radiography along with cone beam computed tomography (CBCT) in dental fraternity. Materials and Methods: The data in questionnaire were completely filled by 500 participants including Master of Dental Surgery and Bachelor of Dental Surgery (BDS) working as faculty and/or general practitioners, interns, and postgraduates. It consisted of multiple choice questions on CBCT. Overall assessment of answers obtained for each part was analyzed category-wise, specialty-wise, and qualification-wise. Results: A definite gap in knowledge of CBCT applications exists between different categories of dental specialists. Dental students should be provided with appropriate CBCT education supported by practical experience and guidance of oral medicine and maxillofacial radiologists. It is also recommended that all the CBCT scans should be performed under the guidance of an oral radiologist and the interpretation of these scans should be done by a trained oral and maxillofacial radiologist only. Conclusion: From the study it is evident dental practices are positively affected by high-end quality practice. More efforts for spreading awareness about this imaging modality, through inclusion of CBCT in curriculum of BDS and through lectures/Continuing Dental Education CDEs, should be undertaken to ensure better knowledge among dentists.

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Aim and Objectives: To assess the attitude and awareness about radiation protection among dental surgeons in North Karnataka. Materials and Methods: The study participants comprised 200 dental practitioners (general and specialist) in North Karnataka. The information was collected from each participant through structured questionnaires regarding attitude and awareness towards radiation protection. Pearson correlation coefficient test was used to assess the validity and reliability of questionnaire, and any P ≤ 0.05 was considered as statistically significant. Results: Among 200 dentists, 98.5% of the dentists considered clinical examination of patients before taking radiograph, almost 51% of the dentists explained to the patient about radiation risks/benefits before the radiographic exposure, but 56.5% of the dentists did not take informed consent of the patient before acquiring radiograph. Nearly 81% of the dentists were aware that collimator was used in X-ray unit/machine. Approximately 70.5% of the dentists stood behind the lead shield when they were not using lead apron. Majority of the dentists did not use lead apron and thyroid collars during radiographic examination, and 60% of the dentists got the radiography equipment periodically checked. Conclusion: The current study shows the utmost need for further implementation of radiation protection principles among dental surgeons in North Karnataka. Majority of them did not practice radiation protection procedures. Emphasis on radiation safety, mandatory continuing professional education, and development of radiographic selection criteria is recommended.

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Aim: The aim of this study was to compare the efficiency of conventional and digital radiography in assessing alveolar bone loss. Materials and Methods: The study group comprised 50 participants (25 males and 25 females) between 25 and 45 years of age. The participants were screened for all clinical features of periodontitis. A series of conventional bitewing radiographs of right and left of both maxillary and mandibular posterior region (15,16,17,25,26,27,35,36,37,45,46,47) were taken for each of 50 patients by examiner 1. Similarly, a series of digital bitewing radiographs were taken by examiner 2 for each 50 patients by using RVG of Planmeca Dixi 2 B Series. In digital bitewing radiographs, the measurement was done by examiner 2, using Planmeca Dixi 2 B Digital Software, by dragging the cursor to make a line by joining the linear points. Bone level less than 2 mm from the cementoenamel junction (CEJ) was considered normal while above that was considered bone loss. In case of conventional bitewing radiographs, alveolar bone loss was measured by the same examiner by measuring the distance from the CEJ to the most apical level of crestal bone using a divider and transparent ruler. The above collected data of examiners 1 and 2 were handed over to examiner 3 for statistical evaluation. Results: Comparison of conventional and digital radiographic techniques in left maxilla, left and right mandible, and between maxilla and mandible in the total sample and in females aged 25–35 and 36–45 years yielded a significant correlation while comparison of the two techniques in the right maxilla and between maxilla and mandible in males yielded a nonsignificant correlation. Conclusion: Direct digital radiography provides an edge over conventional radiography in assessing the periodontal bone destruction.

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Aim: This study was done to evaluate the alteration in serum lipid profile pattern in patients with oral submucous fibrosis, with various histological grades of Oral Sub Mucous Fibrosis along with controls. Materials and Methods: The study included 150 participants, out of those 120 were having oral submucous fibrosis, and 30 cases of controls matched for age and sex were selected from the routine patients attending the Department of Oral Medicine and Radiology. Serum lipids, including total cholesterol (TC), LDL cholesterol (LDLC), HDL cholesterol (HDLC), VLDL cholesterol (VLDLC), and triglycerides (TG) were analyzed using kit ACCUREX [Bio-medicals limited, India] as per the instructions provided by manufacturer using SEMI AUTO ANALYSER [Tulip Coral 3000 Indian]. Statistical Analysis Used: Data were summarized as Mean ± SD (standard deviation). Groups were compared by Student's t-test. Groups were also compared by one way analysis of variance (ANOVA) and the significance of mean difference between (inter) the groups was done by Tukey's HSD (honestly significant difference) post hoc test after ascertaining normality by Shapiro–Wilk's test and homogeneity of variance between groups by Levene's test. A two-tailed (α = 2) P < 0.05 was considered statistically significant. Analyses were performed on SPSS software (windows version 17.0). Results: All the cholesterol showed a significant decrease in patients with OSMF than controls, and as the severity of disease increases the decrease in plasma lipid becomes more significant. Thus, this study proves the alteration in plasma lipid in patients with OSMF. Conclusions: This study concluded that the lower serum lipid levels may serve as a diagnostic indicator or marker in the early diagnosis of oral premalignant and malignant lesions.

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Objectives: To carry out a survey among dentists to assess the awareness about radiation protection, attitude of the practitioner toward radiation protection, methods of radiation protection being used, and type of radiographic equipment being used in dental practice. Materials and Methods: A research was conducted among 1000 dentists who were using dental radiology. A review of literature of several articles related to the research was done. After analysis of these articles was done, a 33 question-long questionnaire was prepared. The questionnaire was then distributed among the dentists. The dentists were informed about the anonymous processing of the questionnaires. Once the questionnaires were completed, they were collected in person, the answers were tabulated, and were then sent for statistical analysis. Results: A total of 1394 dentists were approached for this study; however, only 1000 dentists returned our questionnaire. The overall correct knowledge of dentists regarding safety standards of dental radiology was found to be 29.9%. The overall correct attitude of dentists regarding safety standards of dental radiology was found to be 76.3%. The overall correct practice of dentists regarding safety standards of dental radiology was found to be 19.8%. Conclusion: On the basis of the result of the study conducted, we concluded that the dentists should be made aware about the adverse effects of radiation exposure, and as the overall compliance of the dentist is low, Continuing Dental Education programs should be conducted in order to educate dentists who are already using X-ray machines and to keep them updated with the latest technology.

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Ameloblastoma is a slow-growing and locally aggressive true neoplasm of enamel organ-type tissue which does not undergo differentiation to the point of enamel formation. It is most commonly seen in the posterior region of mandible, less commonly in anterior region, and rarely crossing the midline. It occurs in age ranging from 20 to 50 years with equal frequencies between sexes. It has a high recurrence rate due to its capacity to infiltrate marrow spaces with pseudopods without concomitant resorption of trabecular bone. As a result, the margins of the tumor are not clearly evident radiographically or grossly during operation, and the lesion frequently recurs after inadequate surgical removal. Here, we report a rare case of acanthomatous ameloblastoma present in a young male in the anterior mandibular region crossing the midline, along with an added emphasis on its review.

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Mucoepidermoid carcinoma (MEC) usually arises from salivary glands, representing 5–10% of all salivary gland tumors, and rarely arises in the jaws. MEC mainly occurs in the parotid gland; intraorally MEC appears as asymptomatic swellings in minor salivary glands, mostly on the palate, and contributes for 2.8–15% of all salivary gland tumors. Due to its great biological diversity, treatment and prognosis depend on the histological grade, location, and tumor stage. Here, we present a case of MEC in a female patient aged 65 years with emphasis on the importance of early diagnosis and proper management of the disease. Even when its clinical appearance is not suggestive of malignancy, the diagnosis of MEC should be considered in cases of proliferative oral lesions.

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Osteopetrosis is an inherited disorder of the bone caused by mutations in gene that encode for carbonic anhydrase. This results in defective osteoclast function leading to resorption defects and formation of bones that are extremely dense and prone to fractures. In addition, it causes a variety of clinical manifestations in endocrine, nervous, orthopedic, hematologic, nephrologic, and dental. Among dental manifestations, osteomyelitis is the most serious complication caused by compromised blood supply resulting from encroachment of the medullary spaces by cortical bone. There are three subtypes of the disease—an autosomal dominant form also known as Albers–Schonberg disease or ADO II, malignant recessive infantile form, and an intermediate form. The ADO II can have an extremely varied clinical presentation ranging from an accidental finding from routine radiographic examination to poor prognosis. Here, we present two cases of ADO II with varied clinical, radiographic, and biochemical manifestations and discuss their management and dental implications.

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Adenomatoid odontogenic tumor is a benign (hamartomatous), noninvasive lesion with slow but progressive growth. It develops from the dental lamina or its remnants. There are two variants of this tumor: Central and Peripheral. Central variant further get classified as follicular and extrafollicular on the basis of its association with the unerrupted tooth. Clinically this tumor has resemblance with other odontogenic lesions like dentigerous cysts, ameloblastoma etc. Thus histopathological examination is an important aid to confirm its diagnosis. Here we report a rare case of follicular type of Adenomatoid odontogenic tumor associated with impacted mandibular premolar.

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Tuberous sclerosis complex (TSC) is an autosomal-dominant neurocutaneous syndrome with an approximate incidence of 1 in 10,000–50,000. The cardinal features of TSC are skin lesions, convulsive seizures, and mental retardation. Here, we report a case of TSC in a male patient who presented with oral and cutaneous manifestations without mental retardation or history of convulsive seizures, which is very rarely reported to the best of authors' knowledge.

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Primary malignant melanoma of the oral cavity is a rare neoplasm. In this article, we report the case of a 55-year-old woman with primary malignant melanoma of the maxillary gingiva. Based on the clinical and histopathological examination, a final diagnosis of malignant melanoma was given. Despite its rarity, melanoma is the most important pigmented lesion of oral cavity because of its deadly nature. Early detection and treatment are essential for better prognosis in mucosal malignant melanoma.

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Nevoid basal cell carcinoma or Gorlin–Goltz syndrome is an autosomal dominant inherited disorder that results in numerous basal cell carcinomas (BCC) as well as a number of other facial and skeletal findings. The estimated prevalence varies from 1/57000 to 1/256000 with a male-to-female ratio of 1:1. Main clinical manifestations include multiple BCCs, odontogenic keratocysts of jaws, intracranial ectopic calcifications, and skeletal abnormalities affecting the ribs, vertebra, and skull. Management requires a multidisciplinary approach, with surgical removal of odontogenic keratocysts; surgery for BCCs should be indicated when the number of such lesions is limited. We report a case that was managed surgically, with a follow-up of more than 2 years having no signs of recurrence and relevant literature review.

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