Validation of ICMR index for identification of dental fluorosis in epidemiological studies.

BACKGROUND & OBJECTIVES: The Indian Council of Medical Research (ICMR) formulated a Task Force on dental fluorosis and recommended the subgroup to develop a simplified index for identification and grading of dental fluorosis to be used by the health workers. This study was conducted to pre-test the 'ICMR Index for Dental Fluorosis' in the field to check its reliability and reproducibility. METHODS: A total of 600 photographs were taken, 150 in each grade of fluorosis by screening 14-17 yr school children from eight schools of Hisar (Haryana) and South west Delhi. Eighty photographs were finalized (20 in each grade) before calibration to be used for training of field workers. Calibration exercise was conducted involving the five member survey team on 100 diagnosed cases of dental fluorosis. The members again screened 74 children with dental fluorosis in the field to categorize in to different grades of fluorosis for assessment of inter-examiner reliability. RESULTS: The ICMR criteria showed more difference in agreement in very mild and mild categories during calibration. The inter-examiner reliability (κ) ranged from 0.59-1. The criteria was further modified and inter- examiner reliability (κ) found to be 0.83-0.98 which was almost perfect agreement. INTERPRETATION & CONCLUSIONS: The tool developed by the ICMR to assess dental fluorosis can be used in a field set up by non-dental personnel reliably with high degree of reproducibility.

Esthetic Rehabilitation of Severely Mutilated Anterior Primary Teeth Using Fiber Post - Case Reports.

Premature loss of primary teeth due to early childhood caries could be treated with different options. Presented cases discuss the clinical sequence of rehabilitation of maxillary anterior primary teeth. Endodontic treatment was followed by composite resin restoration reinforced with fiberglass post. Two case reports present a treatment option for severely mutilated primary maxillary incisors due to early childhood caries.

A Case Report of Fracture of the Segment of Maxillary Alveolar Process Involving Primary Incisors.

Traumatic dental injuries (TDIs) have significant long-term consequences for the oral cavity's hard and soft tissues. Alveolar process fractures are particularly complicated. This case report describes the management and 12-month follow-up of a segmental maxillary alveolar process fracture involving laterally luxated primary incisors. A case of a 4-year-old boy was reported to the hospital 1 hour after an accidental fall at school, which resulted in a fracture of the maxillary alveolar process. Emergency treatment consisted of fracture reduction and repositioning of the primary incisors, followed by a semirigid splint between maxillary canines. The splints were removed at the end of week 4, and the affected primary incisors remained asymptomatic.

Please spare my teeth! Dental procedures and trigeminal neuralgia.

BACKGROUND: The correct diagnosis of trigeminal neuralgia (TN) is still a far cry and the patients suffer from unnecessary dental procedures before getting the definite treatment. In this study, we evaluated, if the patients have undergone dental procedures for their misdiagnosed TN before receiving definite treatment for the same. METHODS: A total of 187 patients received GKRS for their TN (excluding secondary TN) in two institutes from 2010 to 2019. We did a retrospective analysis of these patients' primary complaints on a standard questionnaire. RESULTS: One hundred and seventeen of the 187 patients responded. About 55.5% of patients had a toothache and 65.8% did visit a dentist for the pain. About 41.8% of patients underwent one dental procedure; 18.8% suffered from worsening of the pain while 8.5% received some partial improvement. About 19.6% also underwent root canal treatment while 6.8% had a nerve block. Mean of 1.6 teeth was extracted per person. About 71% of patients were satisfied with their Gamma Knife radiosurgery for TN at a median follow-up of 49 months. CONCLUSION: There is a need for a better understanding of the disease among the dentists and the patients for the timely and correct treatment, without losing their teeth. The onus lies on neurosurgeons/neurologists disseminate knowledge regarding proper diagnosis and treatment modalities.

Comparative evaluation of manual scaling and root planing with or without magnification loupes using scanning electron microscope: A pilot study.

AIM: The aim of the present study is to compare the amount of remaining calculus, loss of tooth substance, and roughness of root surface after scaling and root planing with or without magnification loupes using scanning electron microscope. MATERIALS AND METHODS: In the study, 30 teeth indicated for extractions due to severe chronic generalized periodontitis were included in the study. In test Group I, scaling and root planing was performed without magnification loupes, and in test Group II, scaling and root planing was performed with magnification loupes before extraction. In control Group III, no procedure was performed. After scaling and root planing, teeth were extracted followed by preparation of specimens. Specimens were then sent for scanning electron microscope study. RESULTS: Statistically significant (P ≤ 0.05) differences were found among different test groups. Results showed that test Group II with magnification loupes had less remaining calculus and smoother surface with lesser amount of loss of cementum layer. CONCLUSION: From this, it was concluded that test Group II was more efficient in root debridement than test Group 1, so scaling and root planing done with magnification loupes will cause less damage to the tooth surface.

Comparative Evaluation of Apical Transportation and Canal Centric Ability in Apical Region of Newer nickel-titanium File Systems Using cone-beam computed tomography on Extracted Molars: An In Vitro Study.

BACKGROUND: Objective in root canal preparation is to develop a shape that tapers from apical to coronal, maintaining the original canal shape. With advent of instruments manufactured from nickel-titanium (NiTi) alloys, there was a significant improvement of quality of root canal shaping, with predictable results and less iatrogenic damage. AIM: The aim of the study was to evaluate the canal centric ability and apical transportation in apical region of newer NiTi file system in root canal using cone-beam computed tomography (CBCT) on extracted molars. MATERIALS AND METHODS: Root canal of thirty extracted human permanent teeth with mature root apices with 20°-40° of curvature were collected and divided into three groups after initial bio-mechanical preparation: Group 1: canal prepared using ProTaperNext (PTN) file system; Group 2: canal prepared using Mani silk system; and Group 3: canal prepared using V-taper file system. All samples were scanned before and after biomechanical preparation using CBCT. The data collected were evaluated using the Kruskal-Wallis analysis of variance test and Mann-Whitney U-test. RESULTS: It was observed that in apical region Group I (PTN) showed significantly lower mean apical transportation and canal centric ability as compared to Group II (Mani Silk) and Group III (V-taper). CONCLUSION: It was concluded that PTN rotary system has no canal transportation and maintained centric ability in comparison to Mani and V-taper rotary file system in apical region of curved root canal.

A comparative evaluation of the effect of diclofenac sodium with and without per-orally administered methylprednisolone on the sequelae of impacted mandibular third molar removal: A cohort randomized double-blind clinical trial.

AIM AND OBJECTIVES: This study evaluated the efficacy of oral methylprednisolone and diclofenac sodium on post-operative sequelae after third molar surgery. SETTINGS AND DESIGN: A randomized double-blind clinical trial was conducted (with institutional and university approval for dissertation) to evaluate the effect of methylprednisolone with diclofenac sodium (group A) as compared with diclofenac sodium and placebo (group B) on three variables: Pain, swelling and trismus, after third molar surgery. MATERIALS AND METHODS: Thirty consecutive consenting patients for surgical removal of mandibular impacted third molar were randomly placed into two groups of 15 each (groups A and B). Pain, swelling and trismus were observed by visual analog scale, facial measurements and inter-incisal opening. Scores were recorded after 24 and 72 h and on the seventh post-operative day. Results were subjected to the Chi-square test and independent sample t-test (P = 0.05). RESULTS: Mean difference in pain experienced between the two groups was statistically significant at 24 h (P = 0.015) and 72 h (P = 0.001) and on the seventh day (P = 0.005). Difference in inter-incisal distance was insignificant (P = 0.239) pre-operatively, but significant after 24 h (P = 0.014) and 72 h (P = 0.001) and on the seventh post-operative day (P = 0.001). Mean difference in swelling was highly significant after 24 h (P = 0.001) and 72 h (P = 0.0001) and on the seventh post-operative day (P = 0.047). CONCLUSIONS: The combination of oral dose of methylprednisolone (a corticosteroid) diclofenac sodium (a non-steroidal anti-inflammatory drug) was found to be more effective than diclofenac sodium alone on the sequelae of surgical removal of impacted mandibular third molar.

A rare case report and appraisal of the literature on spontaneous tooth exfoliation associated with trigeminal herpes zoster.

BACKGROUND: Reports of post herpetic maxillofacial complications have been very rarely documented in the literature that includes periapical lesions, calcified and devitalized pulps, resorption of roots, osteonecrosis, and spontaneous exfoliation of teeth. The atypical feature of the case of concern to the dental surgeon is the rare complication of spontaneous tooth exfoliation following herpes zoster. CASE REPORT: This case reports a male patient of age 47 years who reported to the Department of Periodontology with the chief complaint of mobility in the left upper central incisor. Patient history revealed herpes zoster infection that began 11 days earlier along with underlying diabetes mellitus condition. We hereby report a known diabetic patient with history of herpes zoster infection who presented with rare complication of spontaneous tooth exfoliation involving the maxillary division of the trigeminal nerve. DISCUSSION: Limited number of cases has been reported in the literature regarding spontaneous teeth exfoliation secondary to herpes zoster. The exact pathogenesis regarding the spontaneous exfoliation of teeth in herpes zoster patient is still controversial. Thus, an oral health care provider should be aware of this rare complication while managing a case of tooth mobility with the previous history of herpes zoster of trigeminal nerve.

Variations in the frenal morphology in the diverse population: A clinical study.

BACKGROUND: The upper labial frenum is a normal anatomic structure with inherent morphological variations. Frenum has variations depending upon the attachment of fibers along with the presence of structural variations. AIM: The aim of this study was to evaluate the prevalence of frenal variations in a diverse ethnic population of Sundernagar, Himachal Pradesh. MATERIALS AND METHODS: This study was conducted on 500 subjects within age group of 16-40 years (285 females, 215 males). Intraoral examination was done to evaluate the variations in frenum and photographs were taken. RESULTS: In this study, depending upon structural variations, normal frenum was most common followed by frenum with nodule while frenum with appendix was found to be least common. However, no significant difference was found between males and females (P > 0.05) with respect to all frenal attachments. Furthermore, other structural variations were found in the diverse population of Sundernagar, Himachal Pradesh. CONCLUSION: Upper labial frenum is a small anatomical landmark in the oral cavity found to have diverse morphology. The dentist needs to give due importance for frenum assessment during the oral examination.

Visibility of gingiva - An important determinant for an esthetic smile.

BACKGROUND: Need for having better esthetics is the new emerging trend seen in patients' demands and expectations. Various periodontal procedures including the mucogingival procedures have been designed to enhance the esthetics. The amount of gingival display of the patient is also an important parameter while considering the esthetics of the patient. Till date, very few studies have been done in which the amount of gingival visibility have been determined. So, the aim of this study was to evaluate the amount of visibility of gingiva during natural smile and forced smile in the patients visiting Himachal Dental College and Hospital. MATERIALS AND METHODS: A total of 400 patients (242 females and 158 males), aged between 18 to 49 years, attending the outpatient department of Himachal Dental College, were included in this study. Patients were divided into two groups according to age and gender. Clinical photographs of the patients were taken and analyzed according to the following classification: (1) Very high smile line that is more than 2 mm of marginal gingiva visible or more than 2 mm apical to the cementoenamel junction visible for the reduced but healthy periodontium, (2) high smile line that is between 0 and 2 mm of marginal gingiva visible or between 0 and 2 mm apical to the cementoenamel junction visible for the reduced but healthy periodontium, (3) average smile line in which only gingival embrasures are visible, (4) low smile line in which gingival embrasures and cementoenamel junction not visible. Examination of the gingiva was done for both natural smile and forced smile. RESULTS: During smile analysis, the following results were revealed for Natural smile and forced smile. Natural smile analysis revealed following: C1: 1%, C2: 6%, C3: 43.50% and C4 was 49.50%. Forced smile analysis revealed the following: C1: 1%, C2: 15.50%, C3: 59% and C4: 24.50%. CONCLUSIONS: Excessive gingival display is an esthetic concern both to the patient and clinician. Therefore, understanding the etiology and treatment options is crucial for the treatment of such patients. So, it becomes utmost duty of the dentist to see that visual attractiveness of the smile is associated strongly with the health of the periodontium.

Central giant cell granuloma of the maxilla.

Central giant cell granuloma (CGCG), formerly called giant cell reparative granuloma, is a non-neoplastic proliferative lesion of an unknown aetiology. It occurs most commonly in the mandible. The case reported here resembled a wide variety of conditions that led to a misdiagnosis both on clinical and radiographic examinations but was histopathologically diagnosed as CGCG. We managed this case by endoscopic excision and curettage via nasal route without producing external scar and avoiding damage to the un-erupted tooth.