Correlation of Clinical Features in Oral Submucous Fibrosis: A 9-Year Retrospective Study.

BACKGROUND: Oral Submucous Fibrosis is a chronic debilitating disease and potentially malignant disorder of the oral cavity known in medical literature for a long time. The study aims to correlate the clinical staging of Oral Submucous Fibrosis with various clinical findings of the oral mucosa like hyperpigmentation, erosions, ulcerations, VAS score, tongue protrusion, and cheek flexibility. METHODS: A retrospective observational study was undertaken and records of 1267 clinically diagnosed cases of OSMF were included in the study. Clinical grading was done as per criteria by Lai DR et al. The observations were tabulated and subjected to statistical analysis using SPSS software. RESULTS: In our study, the incidence of hyperpigmentation, erosions, and ulcerations was higher in Group C OSMF. Visual analog scores in the range of 5-6 was noted in 40.9% of the total subjects, out of which 36.2% belonged to Group C OSMF. Tongue protrusion of less than 25 mm was seen in 10.65% of the subjects. Cheek flexibility of less than 0.6 cm was seen in 19.62% of the subjects, most of which belonged to Group D. CONCLUSION: In our study, we found an increase in the occurrence and severity of symptoms with an increase in grades of OSMF, but this increase was not observed to be consistent. Hence classification based on a single clinical entity cannot be sufficient and correlations to other clinical findings should be studied over a large population and a multi-tier classification could be proposed in the future.

Oral submucous fibrosis and its impact on psychological stress: a case-control study.

Our aim was to evaluate the impact of OSF on psychological stress. Ninety OSF cases and age and sex-matched controls, enrolled from relatives or accompanying person were included in the study. Psychological stress was evaluated by the Psychological General Well Being Index short version (PGWBI-S). Sets of the psychological component were generated by principal component analysis (PCA). Association between components was accommodated for confounder and interaction was evaluated by conditional stepwise logistic regression analysis. Psychological component generated was component 1 (depressed mood, lack of positive well being, low vitality, anxiety, low vitality, and low self-control). The odds ratio (OR) of low score of component 1 for OSF was 3.66. Depressed mood, lack of positive well being, low vitality, anxiety, low vitality, and low self-control were associated with OSF. Psychological intervention should, therefore, be included in the management of OSF.

The prevalence of oral squamous cell carcinoma with oral submucous fibrosis.

OBJECTIVE: The objective of the study was to find out the prevalence of oral squamous cell carcinoma (OSCC) with oral submucous fibrosis (OSF) in patients with OSF. MATERIALS AND METHODS: Of 48,757 patients, we found 300 OSF subjects. Three hundred patients of OSF were checked for OSCC. Both OSF and OSCC with OSF (OSCCwOSF) were diagnosed histopathologically. The prevalence of OSCCwOSF was calculated. Descriptive analysis was done. Chi-square test and t-test were calculated for proportions and mean, respectively, to check any difference among OSF and OSCCwOSF groups. Age-specific relative risk was calculated in OSF and OSCCwOSF groups. Multiple logistic regression analysis was done among odd ratios of the different variable between OSF and OSCCwOSF groups. RESULTS: The prevalence of OSCCwOSF among OSF was 13.7% over a period of 1 year. The mean age of OSCCwOSF group was 43.95 ± 10.22 years in comparison to the OSF group that was 35.51 ± 11.26 years (P < 0.00). The mean habit duration was significantly less in the OSF group when compared to OSCCwOSFgroup for mishri (P = 0.002). Age-specific adjusted relative risk of OSCC in OSF patient increases from 0.33 (18-34 years) to 3.86 (≥65 years). CONCLUSION: It could be concluded that a 13.7% prevalence rate of OSCCwOSF in OSF patients should alert the clinician. Clinicians should, therefore, anticipate OSSC in OSF patients. This awareness could lead to the early diagnosis and management of such OSCC.

Atypical extragingival occurrence of lobular capillary hemangioma: A report of two cases.

Capillary hemangiomas and pyogenic granuloma (PG) are well-recognized benign entities of the oral cavity which are vascular in origin. PG is said to have a predilection for gingival area, whereas capillary hemangioma involves the lips, cheek, and tongue. They may mimic more serious conditions such as malignancies making the clinical diagnosis quite challenging. There have been cases reported where PG was found on extra-gingival sites such as the palate, lips, and tongue. We present the two cases of lobular capillary hemangioma (LCH) on extragingival sites, namely the palate and buccal mucosa, which manifested as a different lesion clinically and histopathological examination was indicative of LCH. The cases reported here show that relatively common pathologies can present on rare or atypical regions inside the oral cavity, and hence, it is imperative for the clinician to consider such lesions while formulating a diagnosis.

Radiographic extent of maxillofacial Gorham's disease and its impact on recurrence: A systematic review.

OBJECTIVE: This systematic review assessed the radiographic extent of maxillofacial Gorham's disease and its impact on recurrence. STUDY DESIGN: PubMed and Cochrane databases were searched. The key words were (Gorham Disease OR Vanishing Bone Disease OR Gorham Stout Syndrome) AND (Jaw OR Maxilla OR Mandible OR Maxillofacial). RESULTS: Forty-one cases from 39 articles were included. Based on radiographic extent, the lesions were classified as large or small. Most cases occurred in the mandible (24), followed by a combination of maxilla and/or mandible and other bones (12), both mandible and maxilla (3), and maxilla only (2). Only mandibular cases were analyzed for radiographic extent. Of the 24 mandibular lesions, 16 were large and 8 were small. Nine of the large lesions occurred in the young age group with 2 recurrences, followed by 5 in the middle-aged group with 1 recurrence. Small lesions were nearly equally distributed over the age groups, with 2 recurrences in the middle-aged group and 1 recurrence in the adult age group. Age, sex, and lesion size had no significant effect on recurrence. CONCLUSIONS: Radiographic extent of the lesion does not impact recurrence, suggesting a possible existence of aggressive and nonaggressive variants of maxillofacial Gorham's disease.

Assessment of the dimensions of the pterygoid hamulus for establishing age- and sex-specific reference standards using cone-beam computed tomography.

PURPOSE: This study was conducted to establish age- and sex-specific reference standards for pterygoid hamulus (PH) dimensions using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT scans of 1,000 patients (493 males and 507 females) were retrospectively assessed in coronal sections for length and width measurements of the PH by 3 investigators. The study data were divided into 3 age groups (group 1: <20 years, group 2: 20-50 years, group 3: >50 years). Length and width were compared using one-way analysis of variance and the t-test for age and sex, respectively. RESULTS: The length of the PH on the right side significantly increased from group 1 (6.11±1.47 mm), through group 2 (6.65±1.67 mm) to group 3 (6.99±1.79 mm) and on the left side from group 2 (6.58±1.63) to group 3 (6.98±1.70). The width of the PH significantly decreased from group 1 (1.81±0.39 mm) to group 2 (1.61±0.39 mm) on the right side, and similarly from 1.87±0.36 mm to 1.67±0.37 mm on the left side. PH length (7.18±1.81 mm on the right side and 7.10±1.72 mm on the left side) and width (1.68±0.38 mm on the right side and 1.74±0.36 mm on the left side) were significantly greater in males than in females. CONCLUSION: The length of the PH increased with age, whereas width first decreased and then increased. Length and width measurements were significantly higher in males than in females. These findings will aid in the diagnosis of untraceable pain in the oropharyngeal region related to altered PH morphology.

Efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and QOL in patients with OSF.

OBJECTIVES: To assess the efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and quality of life (QOL) in patients with oral submucous fibrosis. STUDY DESIGN: Sixty patients were divided in 4 groups; group A received 8 mg of betamethasone, group B received 3000 IU of hyaluronidase, group C received the combination of betamethasone and hyaluronidase and group D received saline injections biweekly for 5 weeks. Patients were also assessed using QOL questionnaire. RESULTS: Mouth opening and oral burning of the four groups for final visit, using the pretreatment opening as a covariate showed significant difference for group A, B, C. CONCLUSION: Betamethasone and hyaluronidase injections appears to be a viable option to increase mouth opening with reduction in burning sensation.

Validity of Diagnostic Criteria for Temporomandibular Joint Disorder in the Diagnosis of Disc Displacement Disorders of Temporomandibular Joint.

OBJECTIVE: The objective of this study is to assess the validity Diagnostic Criteria for Temporomandibular joint Disorder (DC/TMD) in the diagnosis of disc displacement (DD) disorders of temporomandibular joint (TMJ). STUDY DESIGN: It was a prospective study in which total of 55 patients accounting to 110 TMJ; with clinical diagnosis of DD disorder as per DC/TMD criteria and all above age of 18 years were included. All the patients with clinical diagnosis of DD disorder were advised MRI. All the MRI scans were read by single radiologist. Clinician and Radiologist were blinded to each others findings. MRI diagnosis and clinical diagnosis were compared and results were formulated. RESULTS: The use of the Kappa statistic test indicated a good diagnostic agreement (k = 0.68) between the clinician and the radiologist. The DC/TMD criterion was found to have good validity and reliability in the diagnosis of DD disorders with sensitivity of 91.57% and specificity of 77.78%. The positive predictive value and negative predicted value calculated were 92.68% and 78%, respectively. The positive and negative likelihood ratio found was 4.12 and 0.11, respectively. CONCLUSION: DC/TMD is a simple, reliable, valid, cost-effective tool in the diagnosis of DD disorders.

Proximity of the roots of maxillary posterior teeth to the floor of maxillary sinus and cortical plate: A cone-beam computed tomography assessment.

INTRODUCTION: The purpose of the study is to assess the vertical and horizontal relationship between the roots of maxillary posterior teeth and neighboring structures like the floor of the maxillary sinus and cortical plates using cone-beam computed tomography (CBCT). METHOD AND MATERIALS: 100 CBCT scans of the patients from the Indian population were analyzed. Vertical and horizontal relationship between the roots of maxillary posterior teeth and the floor of the maxillary sinus was divided into 4 types and 3 types, respectively. Distances between the root apices and the floor of the maxillary sinus and cortical plate was measured for each root and results were formulated. RESULTS: In total 365 teeth were assessed, 185 first molar and 180 second molar. It was found that the roots of first molar and second molar usually had type 2 (root apices in close contact with the floor of maxillary sinus) and type 3 (roots projecting laterally into the sinus, but its apices are outside the sinus border) vertical relationship respectively with the floor of maxillary sinus. The deepest portion of the floor of the maxillary sinus was most commonly seen projecting between buccal and palatal roots. The mean distance between the cortical plate and root was highest for the distobuccal root of second molar i.e., 1.20 mm SD = 0.97. CONCLUSION: The distobuccal root of the first molar and mesiobuccal root of the second molar are closest to the sinus floor, hence clinician should be extra cautious while working on these roots during endodontic or surgical procedures in the Indian population.

Apert's syndrome: A rare craniofacial disorder.

Apert's syndrome (AS) which is a rare congenital disorder is a form of acrocephalosyndactyly. This syndrome is characterized by craniosynostosis, midface hypoplasia, and syndactyly of hands and feet. We report a case of 13-year-old boy in India presenting features of AS such as exophthalmos, hypertelorism, strabismus, steep forehead, parrot beak nose, depressed nasal bridge, and retruded middle third of the face. The purpose of this report is to present a case of AS by highlighting the craniofacial characteristics.

Andersen-Tawil Syndrome and Hypothyroidism: A Case Report with an Unusual Association.

Andersen-Tawil syndrome (ATS) is an autosomal dominant disorder, characterized by the triad of muscular paralysis, skeletal, and craniofacial anomalies and prolonged QT interval on echocardiogram with a tendency toward malignant ventricular arrhythmia. Although the patient may express one or two of the three components of triad, hypothyroidism is an endocrine disorder resulting in the delayed eruption of teeth, defective mineralization of bone and teeth, and speech and hearing deformity. Here, we report a case of ATS with hypothyroidism. To the best of authors' knowledge, no such association has been reported in the literature.

Attitude and awareness of general population towards radiation hazards and safety: An institutional study.

CONTEXT: Radiological investigations play a pivotal role in the diagnosis and treatment of a wide range of procedures. AIM: To assess the knowledge regarding adverse consequences of radiological examination and encourage awareness regarding radiation protection amongst general public. SETTINGS AND DESIGN: A questionnaire-based cross-sectional study conducted amongst patients visiting the dental outpatient department. MATERIALS AND METHODS: 1,000 adult male and female patients within the age of 20-70 years who visited the outpatient department during May-July 2017 were included in the study. STATISTICAL ANALYSIS: Comparison of frequencies of responses to each item with age and gender was done using chi square test. For all statistical tests, P < 0.05 was considered to be statistically significant, keeping α error at 5% and ß error at 20%. RESULTS: 85.3% participants had visited a hospital earlier and 69.3% had undergone the procedure of an X-ray earlier. Out of those patients, only 24.7% of the participants had any knowledge about the equipment or the procedure while taking a radiograph. 5.2% of the participants were given any safety measures during the radiological procedure. 14.4% had knowledge of the risks and hazards associated with radiation. CONCLUSIONS: This short study showed that there is a need for educating the general population about the hazards and risks associated with radiation exposure.

Diagnostic Value of Extraoral Periapical Radiograph in Comparison to Intraoral Periapical Radiograph: A Cross-sectional, Institutional Study.

BACKGROUND: Radiographs form an invaluable adjunct in diagnosis, treatment planning, and postoperative evaluation during patient management in the dental office where intraoral periapical (IOPA) radiographs are the ones most commonly used. However, certain conditions render the placement of film difficult. In such cases, a panoramic radiograph may be taken, but it has the disadvantage of higher radiation exposure and cost. Extraoral periapical (EOPA) technique allows radiographs to be taken on an IOPA film by placing it extraorally. We aimed to evaluate its diagnostic accuracy compared to intraoral bisecting angle technique. MATERIALS AND METHODS: Forty-five patients were randomly selected. Ninety radiographs were taken; two for each patient. First image was obtained by intraoral bisecting angle technique and second by EOPA technique. A scale was devised for the comparison of radiographs taken by the two techniques. Two experienced oral radiologists rated them based on the scale followed by statistical analysis. RESULTS: Patients reported increased compliance with the EOPA technique. 84.40% of the EOPA radiographs (EOPARs) were diagnostically acceptable; sensitivity and specificity was 84% and 55%, respectively. CONCLUSION: EOPAR is beneficial in cases where intraoral film placement is difficult, and a radiograph is necessary for patient management, even though it demonstrates comparatively lesser diagnostic accuracy.

Analysis of Intercanine Distance and Dimensional Changes in Bite Marks on Foodstuffs Using Cone Beam Computed Tomography.

Bite marks on foodstuff at the crime scene provide a 3-dimensional imprint of the suspect's dentition. The bite mark analysis can provide useful evidences, leading to the inclusion or exclusion of the individual under investigation. This study was designed to assess bite marks on various common foodstuffs (chocolate, apple, chewing gum, cheese) for different time intervals using cone beam computed tomography (CBCT) to evaluate the dimensional changes in the foodstuffs. Analysis of variance test was used to compare the bite marks measured using CBCT in maxillary and mandibular arches with significance set at P < 0.05. The results show that teeth can transfer their characteristics to the bitten foodstuffs. The highest accuracy for comparative bite mark analysis was observed in chocolate followed by cheese, chewing gum, and apple. The CBCT-assisted analysis of bite marks is a nondestructive, accurate, and efficient method. The CBCT documentation has no distortion artifacts, and subsequent analysis in 3-dimensional space is possible.

Cone Beam Computed Tomography Assessment of Accessory Infraorbital Foramen and Determination of Infraorbital Foramen Position.

There is no evidence about evaluating accessory infraorbital foramen by 3-dimensional analysis like multi slice computed tomography or cone beam computed tomography (CBCT) in human subjects. To authors' best knowledge this is a first study to assess the accessory infraorbital foramen and position of infraorbital foramen in relation to crown of maxillary teeth using CBCT. This study primarily aimed to assess the location and number of accessory infraorbital foramen (AIOF), to measure the distance between main infraorbital foramen and AIOF and secondarily to determine the position of infraorbital foramen in relation to crowns of maxillary second premolar, first molar, and second molar. Cone beam computed tomography volumes of 200 patients were retrieved from the digital imaging and communications in medicine archive folder. Accessory infraorbital foramen was recognized in 29% of the patients among whom 46.6% were present on the right side, 31% on the left side, and 22.4% located bilaterally. The most frequent position of infraorbital foramen was found to be in line with crown of second premolar. The presence of AIOF and inability to recognize it in preoperative evaluation could be considered among the other reasons of failure or incomplete anesthesia.

Prevalence of Ponticulus Posticus on Lateral Cephalometric Radiographs, its Association with Cervicogenic Headache and a Review of Literature.

OBJECTIVES: The aim of this study was to calculate the prevalence of ponticulus posticus (a small bony bridge on the dorsal aspect of the atlas on lateral digital cephalometric radiographs) and classify it into a complete ring or an incomplete ring. The study also investigated its association with the presence or absence of cervicogenic headache in the examined population; a literature review of ponticulus posticus is also presented. METHODS: The presence and types of ponticuli posticus were investigated on 500 digital lateral cephalograms and the same patients were questioned for a history of cervicogenic headache. RESULTS: In 500 patients, 79 ponticulus posticus (34 complete and 45 incomplete) were identified on the lateral cephalograms; therefore, the prevalence was 15.8%. The distribution of the type of ponticulus posticus was 13.1% in males and 17.9% in females in the studied sample. The overall prevalence of cervicogenic headache was 6% in the studied sample with a significant association between cervicogenic headache and type of ponticulus posticus. CONCLUSIONS: The study shows that ponticulus posticus is not a rare finding and its association with unexplainable headache, neck pain, and other symptoms as well as its importance and implications during management of cervical spine surgical procedures, especially those requiring lateral mass screw placements in the atlas, imply that radiologists and dentists in general should closely inspect the vertebral region on a lateral cephalogram.

Cone-beam computed tomography analysis of accessory maxillary ostium and Haller cells: Prevalence and clinical significance.

PURPOSE: This study aimed to evaluate the prevalence of Haller cells and accessory maxillary ostium (AMO) in cone-beam computed tomography (CBCT) images, and to analyze the relationships among Haller cells, AMO, and maxillary sinusitis. MATERIALS AND METHODS: Volumetric CBCT scans from 201 patients were retrieved from our institution's Digital Imaging and Communications in Medicine archive folder. Two observers evaluated the presence of Haller cells, AMO, and maxillary sinusitis in the CBCT scans. RESULTS: AMO was observed in 114 patients, of whom 27 (23.7%) had AMO exclusively on the right side, 26 (22.8%) only on the left side, and 61 (53.5%) bilaterally. Haller cells were identified in 73 (36.3%) patients. In 24 (32.9%) they were present exclusively on the right side, in 17 (23.3%) they were only present on the left side, and in 32 (43.8%) they were located bilaterally. Of the 73 (36.3%) patients with Haller cells, maxillary sinusitis was also present in 50 (68.5%). On using chi-square test, a significant association was observed between AMO and maxillary sinusitis in the presence of Haller cells. CONCLUSION: Our results showed AMO and Haller cells to be associated with maxillary sinusitis. This study provides evidence for the usefulness of CBCT in imaging the bony anatomy of the sinonasal complex with significantly higher precision and a smaller radiation dose.

Maxillofacial trauma patterns associated with external auditory canal fractures: Cone beam computed tomography analysis.

BACKGROUND/AIMS: There is a paucity of literature on external auditory canal (EAC) fractures secondary to maxillofacial trauma, with most of the literature on EAC fractures consisting of isolated case reports. To the authors' best knowledge, this is the first study to use cone beam computed tomography to evaluate the EAC region. The aim of this study was to assess the prevalence of external auditory canal (EAC) fracture following maxillofacial trauma and to evaluate the association between EAC fracture and other maxillofacial fractures and the region of trauma. MATERIALS AND METHODS: One hundred patients were prospectively evaluated over 6 months from February to August 2016. The patients were referred for CBCT regarding temporomandibular joint or condylar fractures following maxillofacial trauma. Two observers (both experienced radiologists) assessed the EAC and associated fractures in the maxillofacial region. RESULTS: External auditory canal (EAC) fracture was confirmed in 32% of the patients. Of the EAC fractures, 68.75% and 31.25% were associated with mandibular fractures and non-mandibular fractures, respectively. Of the EAC fractures, 68.75% were single fractures and 31.25% of patients had multiple comminuted fractures. Significant association was observed on cross-tabulation of the fractured region and region of trauma with the presence of EAC fracture using chi-square test. CONCLUSION: External auditory canal (EAC) fracture is associated with maxillofacial fractures with increased incidence in mandibular fractures compared to non-mandibular fractures.

Multiple Calcifying Hyperplastic Dental Follicles: A Case Report and Literature Review.

Enlarged follicles associated with multiple unerupted teeth always comprise an area of considerable interest for oral and maxillofacial surgeons. The condition of multiple calcifying hyperplastic dental follicles is extremely rare and is characterized by multiple unerupted teeth with abundant calcifications and odontogenic epithelial rests in the enlarged dental follicles. We report an interesting case of multiple calcifying hyperplastic dental follicles in a 16-year-old healthy male patient.

Nevoid Basal Cell Carcinoma Syndrome - Clinical and Radiological Findings of Three Cases.

Nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder, characterized by skeletal anomalies and multiple keratocystic odontogenic tumors of the jaws. The skeletal anomalies of this syndrome are mandibular prognathism, bossing of frontal and parietal bones, high-arched palate, and bifid rib. We report three cases with NBCCS, emphasizing the clinical and radiographic findings, the importance of the early diagnosis of NBCCS, and a preventive multidisciplinary approach in the management of NBCCS.