The influence of the mandibular gonial angle on the occurrence of mandibular angle fracture.

BACKGROUND/AIMS: Angle fractures represent the largest percentage of mandibular fractures. They pose as a unique entity because of their codependent morphological dynamic factors, rendering the understanding of the mechanism, and treatment challenging. The aim of this study was to analyze the association between the mandibular gonial angle and the risk of mandibular angle fracture while highlighting its clinical relevance. MATERIALS AND METHODS: A retrospective analysis of radiographs of patients treated for mandibular fractures was done. The factors studied were as follows: the presence of a high gonial angle and an impacted third molar. The outcome was mandibular angle fracture. The gonial angle was measured using Planmeca Digital Software 3.7.0.R. Status of the third molar was also noted. Data obtained were analyzed using SPSS 22 (IBM Corp, Armonk, NY). RESULTS: The sample comprised 70 mandibular fractures (32 angle fractures and 38 non-angle fractures). The mean gonial angle in the angle fracture group was 128.5 ± 5.4º which was 10.2° larger than in the non-angle group (mean 118.5 ± 4.4º; P = 0.0001). Patients with a high gonial angle were 8.7 times more likely to sustain an angle fracture than those with normal or low gonial angles. A statistically significant relationship between the presence of impacted third molar and patients sustaining mandibular angle fractures was noted (P = 0.0001). CONCLUSION: Subjects with a high gonial angle and an impacted third molar are at an increased risk for mandibular angle fracture due to direct and indirect morphological factors.

Necrotic oral lesions: a narrative review.

OBJECTIVES: Necrotic lesions affecting the head and neck region are of significance to dental professionals as they pose challenges in diagnosis and management. Necrotic oral lesions manifest with symptoms like pain, burning, altered sensation, oral malodor, fistula, exposed bone, and pathologic fracture of the bone in extensive cases. The manifestation of necrosis is a definitive clinical sign which helps to narrow down the exhaustive list of causative conditions. This article provides a comprehensive review of the pathogenesis, causative conditions, and management aspects of various necrotic lesions affecting the maxillofacial region. The prompt identification of the cause helps in streamlining the management aspects of necrotic lesions thus reducing the morbidity caused by these conditions. (Quintessence Int 2023;54:250-260; doi: 10.3290/j.qi.b3652393).

Structural and functional abnormalities of the tongue: An epidemiological study from a tertiary care center in India.

Background: The tongue is a prominent muscular organ of the oral cavity and the integrity of the tongue mucosa frequently can reflect the overall health of an individual. Many notable structural and functional alterations can affect the tongue. These changes may be symptomatic or asymptomatic. Hence, the aim of the study was to determine the prevalence of structural and functional abnormalities of the tongue in a population reporting to a tertiary care center. We also assessed the prevalence of the normal variants and evaluated the normal tongue protrusion measurement in the study population. Methods: The cross-sectional study included 1,143 dental outpatients above 18 years of age who visited the Department of Oral Medicine and Radiology between October 2021 to February 2022. Demographic details of the patients were noted. Participants were asked questions regarding any symptoms or abnormalities noticed on the tongue. The tongue was examined thoroughly for any structural/ functional abnormalities. The maximal tongue protrusion for each participant was measured by asking them to extend their tongue out. Medical history, drug history, and social history were recorded. Results: The study included 564 male and 579 female participants; tongue lesions were positive in 66.5% of the study population. Coated tongue (26.2%) was the most frequent structural abnormality that was noted in the present study. Taste dysfunction (4.6%) was the most frequent functional abnormality. The lesions were mostly in the anterior two-thirds (4.2%) of the tongue. Functional abnormalities of the tongue were noted in 8.7% of the study participants. Conclusions: The results of the present study showed that structural and functional abnormalities of the tongue were present in 66.5% of the population. Careful and detailed evaluation of the tongue examination is mandated in routine dental checkups. This shall help in the prompt identification of various etiological factors causing structural and functional abnormalities of the tongue.

Age Assessment through Root Lengths of Mandibular Second and Third Permanent Molars Using Machine Learning and Artificial Neural Networks.

The present study explores the efficacy of Machine Learning and Artificial Neural Networks in age assessment using the root length of the second and third molar teeth. A dataset of 1000 panoramic radiographs with intact second and third molars ranging from 12 to 25 years was archived. The length of the mesial and distal roots was measured using ImageJ software. The dataset was classified in three ways based on the age distribution: 2-Class, 3-Class, and 5-Class. We used Support Vector Machine (SVM), Random Forest (RF), and Logistic Regression models to train, test, and analyze the root length measurements. The mesial root of the third molar on the right side was a good predictor of age. The SVM showed the highest accuracy of 86.4% for 2-class, 66% for 3-class, and 42.8% for 5-Class. The RF showed the highest accuracy of 47.6% for 5-Class. Overall the present study demonstrated that the Deep Learning model (fully connected model) performed better than the Machine Learning models, and the mesial root length of the right third molar was a good predictor of age. Additionally, a combination of different root lengths could be informative while building a Machine Learning model.

Impact of the COVID-19 pandemic on graduating dental interns: the students' perspective.

Background: COVID 19 pandemic has caused an unprecedented change in the way of life of the individual as well as of the society globally. Medical and healthcare education has become virtual, complex, and challenging with minimal real-time experience. Dental education has faced major impacts affecting the skills and preparedness of the graduates. This study aimed to assess the overall impact of the COVID 19 pandemic on graduating dental interns. Methods: This cross-sectional survey was conducted among the graduating dental interns from various states across India. A specially designed questionnaire was used in our study which consisted of multiple-choice, Likert scale, dichotomous response, open-ended response questions. The 15 item questionnaire focused on 5 domains (i) demographic details (ii) perceptions regarding disrupted academic schedule and switch to E-education (iii) perceptions on its impact on the career (iv) items concerning the mental health and stress (v) potential solutions suggested by the interns. Results: 316 dental interns responded to this survey. Only 13.6% of them felt that the e-platforms were useful tools for learning. The dental interns felt that Conservative Dentistry and Oral Surgery postings had the maximum impact on clinical skills. Less than one-fourth (23.1%) of them agreed with the fact that they were under parental pressure; 43.4% agreed that the pandemic had affected the confidence and preparedness to start their clinical practice. Conclusion: It was observed that the interns faced major challenges due to the missed hours of clinical practice, which affected them in terms of preparedness and confidence in facing their future.

Rhinocerebral mucormycosis: a systematic review of case reports and case series from a global perspective.

OBJECTIVE: Rhinocerebral mucormycosis (RCM) is the most common variant and the presenting features in the head and neck region are seldom pathognomonic. The aim of this systematic review was to obtain a thorough insight into the predisposing factors, clinical features, disease course, management protocol, outcome, and prognosis. STUDY DESIGN: An electronic search was carried out using MEDLINE by PubMed, Scopus, Google Scholar, Web of Science, and EMBASE databases. Articles in which the clinical findings on the extra- and intraoral features of RCM were included for systematic review. Descriptive statistics was applied to obtain the results. RESULTS: A total of 124 case studies (90 case reports, 34 case series) which yielded 219 patients. Diabetes mellitus (57.40%) was the most common comorbid condition. Neurologic manifestations were noted in 23.3% of the individuals. Maxillary/hard palate involvement was a common occurrence (59.2%). Intra-oral necrotic lesions with eschar were noted in 75/219 patients. Amphotericin B was the commonly used drug for the management, and surgical debridement was performed in majority of the cases. The mortality rate was 18.4%. CONCLUSIONS: The clinical manifestations often mimic odontogenic symptoms, hence a sound knowledge about the pathogenesis and course of the disease will aid in the prompt diagnosis and management.

Changing trends in the outpatient dental visits during the COVID - 19 pandemic in a tertiary care hospital.

The coronavirus pandemic has caused a global public health crisis with an unprecedented shutdown of major establishments and non-emergency services. Disruptions across the country in dental hospitals led to challenges in addressing patient's dental complaints. The present study aimed to analyse the difference in the pattern of the Outpatient dental visits during the pandemic period in comparison to that of the pre-pandemic period in a tertiary care hospital. This retrospective study was carried out by retrieving the patient data from the diagnostic register of the Department of Oral Medicine and Radiology for a period of one year. The data that was retrieved from 24th September 2019 to 23rd March 2020 was categorized under the pre-pandemic period and the data from 24th March 2020 to 24th September 2020 was grouped under the pandemic period. Patient data regarding the age, gender and clinical diagnosis was recorded and categorized under three main categories: "Emergency", "urgent" and "elective". 7550 patients during pre-pandemic period and 4035 patients during the pandemic period visited the dental hospital during the study period. Under the "emergency dental care" category, during the pre-pandemic period, majority of the cases reported of acute dental pain (71.0%) followed by cellulitis and space infection (20.1%) and maxillofacial trauma (8.7%). During the pandemic period, acute dental pain consisted of all emergency visits (n = 307). The proportion of emergency dental visits during the pandemic were significantly higher than the pre-pandemic period. Elective dental visits were significantly higher during pre-pandemic period in comparison to the pandemic period. (P < 0.001). There was a notable change in the outpatient trend of the dental visits during the COVID-19 pandemic in comparison to the pre-pandemic period. Emergency dental services were utilized at a higher rate during the pandemic period in comparison to the pre-pandemic counterpart.

Smart-phone based telemedicine: Instant messaging application as a platform for radiographic interpretations of jaw pathologies.

OBJECTIVE: To evaluate the reliability of WhatsApp in comparison to the images viewed on a workstation monitor (gold standard) for the identification and interpretation of radiographic images of jaw pathologies. METHODS: 150 panoramic radiographs were screened for the assessment of jaw pathologies in the workstation monitor. The radiographs were sent to two observers (Observer A and B) via WhatsApp® Messenger which were viewed independently on smartphones. A structured proforma was prepared to evaluate the radiographs for the presence or absence of various radiographic pathological characteristics. RESULTS: The reliability of WhatsApp for observers A and B concerning various characteristics like vital structures, pathological fractures, periodontal ligament widening, and root resorption indicated almost perfect agreement (0.8-0.97). The Kappa coefficients for WhatsApp for observers A and B for pre-categorized radiographic impressions were 0.95 and 0.97 which indicated almost perfect agreement. CONCLUSION: WhatsApp based expert teleradiology consultation can be a suitable and effective alternative for radiographic interpretations.

Sex Assessment by Morphological Analysis of Palatal Rugae Patterns in a South Indian Adult Population.

BACKGROUND: Palatal rugae are asymmetric and irregular ridges on the anterior palatal region, which have proven to be useful in the field of forensic dentistry. This study aims to use morphological analysis of palatal rugae patterns to assess sex in a South Indian adult population. MATERIALS AND METHODS: This cross-sectional study was undertaken to evaluate a total of 300 maxillary dental casts (150 males and 150 females). The rugae patterns were marked by one observer and classified as per Thomas and Kotze criteria by another observer. The rugae patterns were classified based on the total number of rugae, shape, predominant direction of rugae, and unification of rugae. RESULTS: The palatal rugae in female participants showed a higher incidence of circular rugae and backward directed rugae, while male participants showed more forward-directed rugae. The logistic regression analysis showed a significant association of with circular (OR=1.48; 95% CI= 1.02-2.13), forward (OR=0.87; 95% CI= 0.78-0.97) and backward (OR=1.23; 95% CI= 1.08-1.41) palatal rugae with sex. CONCLUSION: Certain palatal rugae patterns can be used for the assessment of sex with limited accuracy.

Occupation-related musculoskeletal disorders among dental professionals.

BACKGROUND AND AIM: Dentists are exposed to a wide range of work-related factors that may result in various occupational diseases of which musculoskeletal disorders (MSDs) are common. The purpose of this study was to determine the prevalence and distribution of MSDs among dental professionals of our institution and to compare the prevalence of MSDs among the various dental specialists. METHODS: A self-administered questionnaire, which included basic demographic details, work experience in dentistry, and work profile related questions along with the Standard Nordic Questionnaire, was administered to the study participants. Statistical analysis for the data obtained was performed using SPSS Version 16.0 (Chicago, SPSS Inc.). The chi-square test was applied to test the association between MSD and variables such as gender, designation, type of dentistry and usage of computers. The Mann Whitney U test was used to assess the relationship between MSD and age, experience, sick leave, number of patients attended per day. A p-value < 0.05 was considered significant. RESULTS: 151 subjects participated in the study, and the prevalence of MSD in the last 12 months among dental professionals was 58.3% (88 out of 151 subjects). The most common site affected by MSD was the neck (66.7%). Also, it was noted that among various dental specialists, the Endodontists suffered the maximum (88.02%) musculoskeletal pain. Fifty individuals (33.11%) suffered from pain in multiple sites. CONCLUSION: Work-related musculoskeletal disorders and pain can be reduced through proper operator-patient positioning, taking adequate breaks between patients, maintaining good physical health through regular exercises.

Awareness About Medication-Related Osteonecrosis of the Jaw Among Dental Professionals: A Multicentre Study.

PURPOSE: Bisphosphonates and non-bisphosphonate antiangiogenic and antiresorptive agents are widely used in the management of bone diseases and cancer. A subset of patients receiving these drugs can manifest with medication-related osteonecrosis of the jaw (MRONJ) and it is one of the major complications faced in dental practice. Dentoalveolar and periodontal surgery are the major risk factors associated with it. Therefore, a dentist must have adequate knowledge to promptly identify patients at risk and efficiently manage the condition. This multicentre study was designed with an aim to assess the level of knowledge and awareness regarding MRONJ among dentists from six dental schools. METHODS AND MATERIALS: An online self-administered questionnaire was sent to all the dentists from six dental schools through Google forms. The results obtained were statistically analysed. The Kolmogorov-Smirnov test was performed to check for normality of data, while the Mann-Whitney U-test and chi-square test were used to compare the responses to each question. RESULTS: The questionnaire was sent to 570 dentists, out of which 234 responses were obtained. The majority of participants were aware of the term 'MRONJ' (83.3%), clinical indications of bisphosphonates (61.5%) and its mechanism of action (72.2%). However, 68.4% and 61.5% of dentists had no knowledge about the 'drug holiday' concept and risk factors associated with MRONJ, respectively. CONCLUSION: Although most of the participants had knowledge regarding certain aspects of MRONJ, such as mechanism of action and clinical indications of bisphosphonates, there was a lack of awareness about the drug holiday concept and drug-associated risk factors. This emphasises the need to spread awareness among the dental community, not only in tertiary healthcare centres, but also among private dentists and dental interns to prevent cases of MRONJ.

Medication related osteonecrosis of jaw in a leukemia patient undergoing systemic arsenic trioxide therapy: A rare case report.

Osteonecrosis of the jaw is a potential side effect of certain pharmaceutical agents used in the field of medicine. Early diagnosis and effective management of this condition can be challenging to the clinicians. Bisphosphonates and other anti-angiogenic agents are the most common drugs that are attributed to cause medication-related osteonecrosis of the jaw. In the past, arsenic-based compounds were commonly used local agents for pulp devitalization therapy. Arsenic is also one of the components of the chemotherapeutic regimen in the management of refractory leukemia. Although local diffusion of the arsenic compounds is known to cause osteonecrosis, there are no reports of the same caused by its systemic administration. Here, we present the first ever case of mandibular bone necrosis in a patient with acute promyelocytic leukemia who underwent systemic arsenic trioxide therapy.

Utility of Panoramic Radiographs in the Screening of Individuals with Edentulous Arches: A Need-Analysis Study

Abstract Objective: To evaluate the utility of panoramic radiographs in pre-prosthetic screening of edentulous arches. Material and Methods: Panoramic radiographs taken for three years were retrospectively analyzed. Observations from the radiographs shall be categorized and classified into either of the two categories, namely: 'findings with minimal impact on denture fabrication' and 'findings which affect denture fabrication and require further evaluation.' Anatomic variations, jaw pathologies, and residual ridge resorption patterns were assessed. Results: This study included the initial screening of 23,020 panoramic radiographs, out of which 505 (showing either one or both edentulous arches) were included for the study purpose. The age range of the subjects was from 21 to 94 years. 52.6% of the radiographs showed positive findings. More than half of the radiographs belonged to the males (52.5%). Hyperpneumatization of the maxillary sinus, crestal position of the mental foramen, and retained root fragments were the most common entities noted in the radiographs. Changes in the mental foramen were significantly higher in males than females (p=0.002). Conclusion: Observations from this study showed that panoramic radiographs have high utility for screening edentulous arches, and they should be used in routine clinical practice before denture fabrication.

Oral hygiene and dentition status in children and adults with hemophilia: A case-control study.

BACKGROUND & OBJECTIVES: People with hemophilia constitute a significant proportion of the population and an oral health care professional faces a considerable challenge while treating them. This study aimed to assess the oral health and dentition status as well as fear of dental treatment in patients with hemophilia and compare it with age-matched healthy subjects. PATIENTS & METHODS: This single-center, case-control cross-sectional study was performed on 100 subjects with hemophilia and 100 age-matched healthy controls. Oral health and dentition status was recorded for all the subjects and scored using the simplified oral hygiene index (OHI-S), plaque index, and the dmft/DMFT index. RESULTS: There were a total of 41 children and 59 adults in the hemophilia group and 36 children and 64 adults in the healthy group. When compared to healthy subjects it was observed that individuals with hemophilia had higher debris and calculus scores which was indicative of poor orodental status. There was no significant difference observed in the DMFT scores among the study groups. INTERPRETATION & CONCLUSIONS: The oral hygiene of the hemophilics was poorer when compared to the healthy controls. The findings highlight the need for establishing interdisciplinary care for such individuals.

Generalised fibrotic gingival enlargement in a psoriatic patient: an association or a coincidence?

Gingival fibromatosis is a rare, benign, slow progressive fibrous overgrowth of gingiva, with great genetic and clinical heterogeneity. It can be inherited as an isolated trait (hereditary/idiopathic gingival fibromatosis), and/or as a component of a syndrome. We report a case of a young girl suffering from psoriasis who also presented with an unusual generalised idiopathic gingival fibromatosis. Psoriasis, a chronic inflammatory skin disease, of multifactorial origin, is characterised by keratinocyte hyperproliferation, dedifferentiation, neoangiogenesis and inflammation. T cell-mediated immunity is considered to be the key element in the disease process. The existence of oral mucosal alterations in patients with psoriasis is a controversial topic, as histopathological correlations are not clearly evident, and oral and cutaneous lesions do not follow a parallel course. However, this article highlights a possible association of T-lymphocyte stimulation inducing fibroblasts to undergo epidermal hyperproliferation and increased collagen production in the gingiva, which in turn may be responsible for inducing gingival hyperplasia.

Oral Hygiene and Dentition Status in Patients with Congenital Hemorrhagic Disorders: A Comparative Study

Abstract Objective: To compare the status of oral hygiene and dentition in patients with congenital hemorrhagic disorders with their age-matched healthy counterparts. Also, the prevalence of fear of dentists/ dental treatment among these patients was assessed. Material and Methods: This study was performed on children and adults with von Willebrand disease (vWD), hemophilia (A or B), and healthy subjects. Oral health and dentition status was assessed using the simplified oral hygiene index (OHI-S), plaque index, and the decayed, missing, filled teeth (dmft/DMFT) index. One-way ANOVA test was employed to compare the oral hygiene and dentition status of subjects in the three groups. A p-value of <0.05 was considered statistically significant. Results: The DMFT score did not vary significantly between the groups (p>0.05). Higher OHI-S scores and a poor oral hygiene status was observed more in the hemophilia group than the vWD group and healthy controls. A total of 27.3% of the subjects in the vWD group, 18.2% of subjects in the hemophilia group, and no subjects in the healthy group had a fear of dentists or dental treatment. Conclusion: Subjects with vWD had a higher number of carious teeth when compared to the other groups. Poor oral hygiene status was observed in subjects with hemophilia.

Association of Impacted Mandibular Third Molar with Caries on Distal Surface of Second Molar

Objective: To evaluate the relationship of impacted mandibular third molars (M3M) status with caries on distal surface (CODS) of mandibular second molars (M2M). Material and Methods: A retrospective study on digital panoramic radiographs. Information on age, gender, eruption status of impacted mandibular third molars and mandibular second molars caries on distal surface were recorded. Winters' classification and Pell and Gregory classification were used to classify impacted mandibular third molars. The Chi-square test and Poisson regression were used. A p-value of <0.05 was considered statistically significant. Results: A total of 1497 radiographs were evaluated out of which 2704 sites were recorded. A total of 33.2% M3M were impacted and 1053 (38.9%) M2M had caries on distal surface. Among the total M3M teeth, 39.1% of erupted and 38.6% of impacted teeth had CODS of M2M. However, there was no significant difference in the distribution of CODS of M2M in erupted and impacted mandibular third molars teeth (p=0.796). As per Winters classification, mesio-angular and horizontal impaction types were significantly associated with CODS (p<0.001). Conclusion: All impacted mandibular third molars may not be associated with caries on distal surface of mandibular second molars. But, the angulation like mesioangular and horizontal, class I and II may predispose to caries on distal surface of mandibular second molars.

Assessment of Awareness About Various Dental Waste Management Practices Among Dental Students and Practicing Clinicians

Abstract Objective: To evaluate the knowledge of students and dental practitioners about dental and biomedical waste disposal and to impart emphasis on important aspects such as eco-friendly waste management. Material and Methods: This questionnaire-based study involved 186 participants which comprised of 5 domains, namely laws regarding biomedical waste, steps of waste management, categories of dental waste, general hazards of improper waste disposal and certain material/process specific questions Results: Assessment of the first domain showed that only 58.4% of participants were able to correctly identify the Pollution Control Board of India as the regulatory body for the transport of medical waste. The second domain assessment revealed that 55.9% of subjects were adequately aware of the knowledge handling hospital waste. Assessment of the third domain displayed that the majority of the respondents (91.9%) knew categories of dental waste generated. Evaluation of fourth domain exhibited that 89.8% students agreed that biomedical waste management (BWM) must be made a practical exercise in dental schools to reduce "Know-Do gap" between undergraduates and postgraduates and the last domain demonstrated that only 32.3% of the participants knew the environmentally friendly technique to convert organic waste into commercially useful byproducts Conclusion: It was found that postgraduates had a better awareness of the proper methods to dispose of healthcare waste when compared to students and interns. However, the overall level of awareness was less than adequate. The need for special training in BWM in the clinical set up was highlighted through this study.