Prevalence and Variation of Medical Comorbidities in Oral Surgery Patients: A Retrospective Study at Jazan University.

BACKGROUND An aged population is susceptible to chronic diseases, which impacts oral surgery treatment procedures. This retrospective study aimed to evaluate the incidence of medical comorbidities in 640 oral surgery patients treated at the College of Dentistry, Jazan University. MATERIAL AND METHODS This single-center observational study investigated medical records of outpatients who visited Jazan University Dental College Hospital in a 1-year period (2018-2019). Patients’ clinical and radiographic archives were screened to obtain relevant data. Categorical and continuous variables were expressed in terms of frequency and mean values, respectively. Differences in variables were statistically analyzed using the chi-square goodness of fit and proportional test, with a probability value P≤0.05 considered significant. RESULTS Analysis of 640 patient records included records of 300 men and 340 women who underwent oral surgery, of whom 176 patients (27.5%), including 97 men and 79 women, had medical comorbidities. The most common comorbidities were endocrine disease (7.03%), cardiovascular disease (6.71%), respiratory disease (4.53%), and hematological disorders (3.43%). Individual diseases that showed higher prevalence were diabetes mellitus (4.68%), hypertension (3.43%), bronchial asthma (2.65%), and anemia (1.4%). Differences by sex were observed in many individual disorders. CONCLUSIONS Outpatients in oral surgery clinics presented a significant variance in the incidence of medical comorbidities, among which diabetes and hypertension were most common. A proper case history is the best preventive measure that helps a surgeon avert medical emergencies and post-surgical complications.

Comparison of the effects of two different styles of orally prescribing prednisolone on postoperative sequelae of surgical extraction of an impacted mandibular third molar: a single-blind randomized study.

Objectives: Surgical intervention for removal of an impacted third molar can lead to significant pain and swelling. Corticosteroids show promise for mitigating postoperative sequelae across various surgical contexts. The use of corticosteroids following minor oral surgery, though controversial, has already been proven effective. However, little research has explored peroral prescription of corticosteroids despite its convenience for outpatients and for non-surgeons like implantologists and periodontists and others who don't have access to needle injections. The aim of this study was to address a void in the literature by comparing the effects of two styles of preoral administration of prednisolone after surgical removal of the mandibular third molar and to determine which style minimizes postoperative sequelae. Materials and Methods: A randomized, split-mouth clinical study was conducted to investigate the efficacy of two different styles of preoral prednisolone in mitigating postoperative sequelae following surgical extraction of impacted mandibular third molars. Fifteen participants were enrolled in the study. Random selection was used to determine the prescription style for the right and left mandibular arch. Group A included those who received a single dose of prednisolone 25 mg, while group B received prednisolone 5 mg postoperatively for a period of three days (5 mg three times/day on the first postoperative day, 5 mg twice/day on the second postoperative day; 5 mg once/day on the third postoperative day). Results: There was a significant difference in the distance between the corner of the mouth and tragus, which decreased with the time interval with respect to group B when compared to group A. Conclusion: The present study showed that a three-day tapered dose of prednisolone postoperatively was more effective in reducing post-extraction sequelae than a single-dose regimen.

Reviewing the oral pigmented lesions of human immunodeficiency virus with emphasis on the effect of highly active antiretroviral therapy.

Acquired immunodeficiency syndrome a disease with high mortality rates is caused by the well-known human immunodeficiency virus. The disease is characterized by several opportunistic infections owing to the decreased CD4 lymphocyte counts. Oral manifestations of human immunodeficiency virus are vital as they are one of the early manifestations of the disease. Also, they serve as prognostic markers as they correlate with the CD4 lymphocyte counts of the affected individuals. Human immunodeficiency virus is not only common in the adult population but also can affect pediatric patients through vertical transmission. The initial therapeutic strategy for the management of the virus was only the prevention of opportunistic infections. Later in the mid-1990s, antiretroviral therapy was introduced but there was no significant improvement in prognosis. After the advent of combination therapy or the use of three antiretroviral drugs also known as highly active antiretroviral therapy, there has been a marked reduction in human immunodeficiency virus-associated mortality rates. The highly active antiretroviral therapy has several effects on the oral manifestations of the human immunodeficiency virus. The present paper aims to review the oral pigmented lesions associated with human immunodeficiency virus with an emphasis on the effect of highly active antiretroviral therapy.

Procedures and pitfalls in incisional biopsies of oral squamous cell carcinoma with respect to histopathological diagnosis.

This review has addressed the issues faced by a diagnostic pathologist during routine assessment of haematoxylin and eosin stained incisional biopsies from oral squamous cell carcinoma patients. Herein, the pragmatic means undertaken, has highlighted routinely faced problems & encounters determined at various levels as clinical, laboratory and diagnostic pitfalls, when possible, tips offered towards procedures and guidance. Also, dealt with subtypes of oral squamous cell carcinoma, differential diagnosis, and relevant prognostic indicators that can navigate the surgeon to take quick decisions. It speaks of the journey of biopsied material from the clinician to the laboratory until the generation of the final report. Although histopathological evaluation is a confirmatory tool for any clinically suspected lesion it mandates the co-operation of faculty from varied disciplines. The onus lies on a pathologist to establish standard protocols to oversee, audit the laboratory operating procedures from time and again. Technical errors and faults at the office desk doesn't come under the purview of this review.

Unusual foreign object in a tooth: A case report and review of literature.

Foreign body impactions in the tooth are common findings in the oral cavity of children because of their frequent habits of placing various objects in their mouth. The present case describes an 11-year-old boy with a foreign object in the maxillary left first molar tooth of which he was unaware. Foreign objects can not only be a source of infection but also be aspirated or ingested by the child. The discovery of foreign objects in the teeth is usually accidental. A detailed case history, consisting of a history of the ordinary placement of the object and clinical and radiographic examinations is necessary to determine the nature, size, and location of the foreign body, as well as the difficulty involved in its retrieval. The foreign object may sometimes fracture inside the tooth during exploration by the parent or child. Such an object may act as a potential source of infection and lead to complications.

A Rare Case Series: Impacted Distomolars.

BACKGROUND: The occurrence of multiple supernumerary teeth in individuals without any associated syndrome is rare. Supernumerary teeth may occur in any region of the dental arch and are frequently observed in the maxillary region. But the occurrence of distomolars is rare, particularly mandibular distomolars are extremely rare. CASES PRESENTATION: In this paper, we present a series of case reports of maxillary and mandibular distomolars. CONCLUSION: The occurrence of distomolars is rare, but when detected patients should be kept under observation.

Knowledge and Awareness of Medical Practitioners of Jazan City towards Oral and Maxillofacial Surgery as a Specialty.

BACKGROUND: In many health services communities the scope of oral and maxillofacial surgery (OMFS) as a discipline is frequently not probably understood. Good awareness towards OMFS among different branches of health services providers is essential for better referral strategies and will be for the benefit of the patient. MATERIALS AND METHODS: The cross-sectional study was done using a specially prepared questionnaire distributed randomly to 125 general medical practitioners working in Jazan province. In this questionnaire, there were also some close-ended questions to evaluate awareness regarding a variety of conditions treated by the oral and maxillofacial surgeons. RESULTS: Out of 125 participants, 105 (84%) were aware of the oral and maxillofacial surgery as a speciality branch of dentistry. Only 52 (41.6%) participants were aware of the different treatment modalities coming under the scope of oral and maxillofacial surgery. Also in the referral of cases to the oral and maxillofacial surgeon, 50 (40%) participants referred their oral and maxillofacial region cases to OMS. Tooth removal was the only procedure where most of the medical practitioners knew it is a speciality procedure of the oral and maxillofacial surgeon. For facial fractures, 76 medical practitioners believe it comes under the scope of the orthopaedic surgeon. Similarly, for facial abscesses, 81 and 36 practitioners responded that it is a job of a general surgeon and OMS respectively. CONCLUSION: There is low awareness toward the scope of oral and maxillofacial surgery in the medical community. Knowledge and awareness of the scope of oral and maxillofacial surgery can improve the success and promptness of delivery of health services.

Knowledge and Preparedness of Dental Practitioners on Management of Medical Emergencies in Jazan Province.

Medical emergencies are one of the most stressful situations the staff in a dental practice might encounter. The duty of care toward the attending patients obligates suitable preparedness to provide the necessary care if such emergencies ensue. Unfortunately, we found that 22% of the investigated dental clinics had no emergency kit available. Only 38% of the interviewed dentists felt confident to perform CPR, and 18% had no confidence to manage any medical emergency. An MCQ test of 20 questions examining the dentists' knowledge in medical emergencies was distributed, and the level of knowledge was found to be suboptimal. The average score of the interviewed dentists was 10.87 out of 20. Experience and specialty training had a negligible effect on the level of knowledge.

Twelve Impacted Supernumerary Teeth in a Nonsyndromic Patient: A Rare Case Report.

Teeth in excess number than the normal count are called supernumerary teeth. They can be either unilateral or bilateral and single or multiple, found at any place in the dental arch, but most commonly found in the anterior maxillary region. Supernumerary teeth are commonly associated with syndromes when present in more numbers, but can be idiopathic. The present study shows a case report of a 16-year-old female patient who reported with overretained deciduous teeth. A panoramic radiograph showed multiple impacted supernumerary teeth. Based on clinical features and radiographic examination, a diagnosis of idiopathic hyperdontia was given. In such types of patients, management must be planned by a multidisciplinary approach.

Oral Myiasis Affecting Gingiva in a Child Patient: An Uncommon Case Report.

Certain dipteran flies larvae causing invasion of the tissues and organs of the humans or other vertebrates are called as myiasis, which feed on hosts dead or living tissues. It is well documented in the skin and hot climate regions; underdeveloped countries are affected more commonly. Oral cavity is affected rarely and it can be secondary to serious medical conditions. Poor oral hygiene, alcoholism, senility, or suppurating lesions can be associated with the oral myiasis. Inflammatory and allergic reactions are the commonest clinical manifestations of the disease. In the present case, gingiva of maxillary anterior region was affected by larval infection in a 13-year-old mentally retarded patient.

Oral submucous fibrosis: an update.

Oral submucous fibrosis (OSF) is a premalignant condition caused by betel chewing. It is very common in Southeast Asia but has started to spread to Europe and North America. OSF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption. OSF is a diagnosis based on clinical symptoms and confirmation by histopathology. Hypovascularity leading to blanching of the oral mucosa, staining of teeth and gingiva, and trismus are major symptoms. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrosis. A variety of extracellular and intracellular signaling pathways might be involved. Treatment of OSF is difficult, as not many large, randomized controlled trials have been conducted. The principal actions of drug therapy include antifibrotic, anti-inflammatory, and antioxygen radical mechanisms. Potential new drugs are on the horizon. Surgery may be necessary in advanced cases of trismus. Prevention is most important, as no healing can be achieved with available treatments.

Oral submucous fibrosis and its dermatological relation.

Oral submucous fibrosis is a chronic insidious disease and is well-recognized as a premalignant condition. It is a collagen related disorder associated with betel quid chewing and characterized by progressive hyalinization of the submucosa. The oral submucous fibrosis needs to be differentiated from scleroderma showing oral manifestations, as these diseases have different pathogenesis and prognostic aspects. The patients of oral submucous fibrosis can approach the dermatologist. The aim of this article is to present concise overview of the disease and its dermatological relation.

Anti-helminthic drugs in recurrent apthous stomatitis: A short review.

Recurrent aphthous stomatitis (RAS) is a common mucosal condition producing painful ulcerations in the oral cavity and considerable clinical morbidity. The etiology remains obscure, though local trauma, psychologic stress, hematinic deficiencies and immune dysregulation have been implicated. Though the primary goals of therapy are symptomatic relief of pain, the clinicians are aiming toward reducing the frequency, duration, number of ulcerations and increasing ulcer free periods with systemic drug therapy if topical medications appear ineffective. Levamisole, an antihelminthic drug has been tried with promising results in patients with severe RAS providing long-term benefits.

Efficacy of 3-Dimensional plates over Champys miniplates in mandibular anterior fractures.

BACKGROUND: Mandibular fractures are treated surgically by either rigid or semi-rigid fixation, two techniques that reflect almost opposite concept of craniomaxillofacial osteosynthesis. The shortcomings of these fixations led to the development of 3 dimensional (3D) miniplates. This study was designed with the aim of evaluating the efficiency of 3D miniplate over Champys miniplate in anterior mandibular fractures. MATERIALS & METHODS: This study was done in 40 patients with anterior mandibular fractures. Group I consisting of 20 patients in whom 3D plates were used for fixation while in Group II consisting of other 20 patients, 4 holes straight plates were used. The efficacy of 3D miniplate over Champy's miniplate was evaluated in terms of operating time, average pain, post operative infection, occlusion, wound dehiscence, post operative mobility and neurological deficit. RESULTS: The mean operation time for Group II was more compared to Group I (statistically significant).There was significantly greater pain on day of surgery and at 2nd week for Group II patients but there was no significant difference between the two groups at 4th week. The post operative infection, occlusal disturbance, wound dehiscence, post operative mobility at facture site, neurological deficit was statistically insignificant (chi square test). CONCLUSION: The results of this study suggest that fixation of anterior mandibular fractures with 3D plates provides three dimensional stability and carries low morbidity and infection rates. The only probable limitation of these 3D plates may be excessive implant material, but they seem to be easy alternative to champys miniplate. How to cite the article: Barde DH, Mudhol A, Ali FM, Madan RS, Kar S, Ustaad F. Efficacy of 3-Dimensional plates over Champys miniplates in mandibular anterior fractures. J Int Oral Health 2014;6(1):20-6.

Comparative Study of Blood Loss, Quality of Surgical Field and Duration of Surgery in Maxillofacial Cases with and without Hypotensive Anesthesia.

BACKGROUND: Oral and maxillofacial surgeons are concern about the intraoperative bleeding because blood supply to face is very generous. Increased blood loss may lead to the need for transfusion of blood and blood products and hence patients are exposed to the risks associated with it. Hence, this study was undertaken to compare whether there is any significant difference in blood loss, surgical field and duration of surgery in patients undergoing maxillofacial surgeries with and without hypotensive anesthesia. MATERIALS AND METHODS: The study was conducted on patients undergoing various maxillofacial surgeries. The patients were randomly divided into two groups, the study group and the control group. In the study group patients, induced hypotension was used in order to maintain systolic pressure of 80-90 mm Hg. In the control group patients, normotensive anesthesia was used. Estimation of blood loss (EBS), quality of the surgical field and duration of surgery was calculated for both groups in three types of surgical procedures. Statistical analysis was performed by using two-tailed Pearson correlation test. RESULTS: EBS was found to be significantly less in all the surgical procedures carried out under hypotensive anesthesia (P < 0.05). The quality of the surgical field was better in cases with induced hypotension, but there was no significant difference in duration of the procedures with and without induced hypotension. CONCLUSION: Our study shows that hypotensive anesthesia can be safely used in almost all maxillofacial surgical procedures with reduced blood loss and improved surgical field.

Oral submucous fibrosis: Comparing clinical grading with duration and frequency of habit among areca nut and its products chewers.

AIMS AND OBJECTIVES: To evaluate the effect of frequency, duration and type of areca nut products on the incidence and severity of oral submucous fibrosis (OSMF). MATERIALS AND METHODS: Patients with the limited mouth opening and associated blanched oral mucosa with palpable fibrous bands were included in this study. Biopsies were done and the informed consent was taken from each patient included in this study. The tissues were taken from the affected areas and then studied histopathologically. The data was analysed statistically using X(2)-test. RESULTS: In this present prospective study done in 197 subjects (189 males and 8 females) who were screened and diagnosed clinically having OSMF with age ranging from 22 to 61 years with mean 38.8 years. Gutkha-chewing habit alone was identified in 58 subjects and those associated with gutkha and tobacco were 33 with mean age of 28.2 years and 32.3 years, respectively. The number of people getting affected with OSMF is more associated with gutkha and areca nut with the P-value of the analysis ranging from 0.05 to 0.01. CONCLUSION: The occurrence of OSMF is related to areca nut and its products. The duration and frequency of its use and type of areca nut product has effect on the incidence and severity of OSMF. Gutkha and pan masala have more deleterious and faster effects on oral mucosa. The gutkha-chewing habit along with the other habits does not have any significant effect on the rate of occurrence and incidence and severity of the OSMF.

Assessment of Facial Golden Proportions among North Maharashtri-an Population.

BACKGROUND: Divine Proportion in Orthodontics and Prosthodontics has always been intriguing. This was applied to the North Maharashtrian population to evaluate the relationship between facial esthetics and the golden proportions. MATERIALS & METHODS: Facial proportions were assessed by examining photographs of sum total of 300 subjects of North Maharashtrian population. Young adults with a skeletal and dental Class 1 occlusion, competent lips, and balanced facial proportion were selected. Photographic prints were taken and manually parameters were plotted and analysis was done. RESULTS: The measurements of anterior facial height showed proportionality with the total facial height. The values showed shorter lower anterior facial height and deviation of facial width parameters from the divine proportion indicating small mouth, nose, and narrow-set eyes with respect to the inter-temporal width. CONCLUSION: There is soft-tissue facial balance of North Maharashtrian population in comparison with the golden proportion. However, certain parameters show some deviation from the divine proportion.. How to cite this article: Sunilkumar L N, Jadhav K S, Nazirkar G, Singh S, Nagmode P S, Ali F M. Assessment of Facial Golden Proportions among North Maharashtrian Population. J Int Oral Health 2013; 5(3):48-54.

Evaluation of the Amount of Debris extruded apically by using Conv-entional Syringe, Endovac and Ultrasonic Irrigation Technique: An In Vitro Study.

BACKGROUND: To compare the amount of debris extruded apically by using conventional syringe, Endovac & Ultrasonic irrigation. MATERIALS & METHODS: Thirty freshly extracted mandibular premolars were selected, working length was determined and mounted in a debris and collection apparatus. The canals were prepared. After each instrument change, 1 ml. of 3% sodium hypochlorite was used as irrigation. Debris extruded apically by using conventional syringe, endovac& ultrasonic irrigation tech, was measured using the electronic balance to determine its weight and statistical analysis was performed. The mean difference between the groups was determined using statistical analysis within the groups &between the groups for equal variances. RESULTS: Among all the groups, significantly less debris were found apically in the Endovac group (0.96) compared to conventional and ultrasonic group (1.23) syringe. CONCLUSION: The present study showed that endovac system extrudes less amount of debris apically as compared to ultrasonic followed by conventional so incidence of flare up can be reduce by using endovac irrigation system. How to cite this article: Tambe V H, Nagmode P S, Vishwas J R, Saujanya K P, Angadi P, Ali F M. Evaluation of the Amount of Debris extruded apically by using Conventional Syringe, Endovac and Ultrasonic Irrigation Technique: An In Vitro Study. J Int Oral Health 2013; 5(3):63-66.

The use of controlled release locally delivered 10% doxycycline hyclate gel as an adjunct to scaling and root planing in the treatment of chronic periodontitis: clinical and microbiological results.

BACKGROUND: Local delivery of antimicrobial agents provides higher concentration of the drug in the periodontal site for longer periods than systemically delivered methods. In the present study an attempt is made to know the efficacy of controlled local drug delivery of doxycycline as an adjunctive treatment in the management of chronic periodontitis. MATERIALS AND METHODS: A total of 12 patients, diagnosed as Chronic Periodontitis in the age of 25 to 55 years, were selected of both the sexes in this study. They were divided into Experimental group consisted of 30 sites who received complete scaling and root planing (SRP) followed by placement of Atridox gel and control group consisted of 30 sites who received only SRP. Clinical parameters were recorded at, baseline, days 30, 90 and 180. Parameters were plaque index, gingival index, gingival bleeding index and microbial analysis, probing pocket depth and Clinical attachment level (CAL). The microbiological analysis was done at baseline visit and at 90th day. Probing pocket depth and CAL were recorded only on day 0 and 180th day. RESULTS: In 180 days study, both the groups exhibited a significant improvement in periodontal status. Significant gain in attachment level was observed in both the group. Between both the groups the clinical parameters in the experimental groups exhibited better results as compared to the control group. Both the groups exhibited significant reduction in the number of spirochetes. CONCLUSION: Combination therapy of SRP and 10% DH gel demonstrated better results at all levels suggesting that this therapy can play a significant role as an adjunct to SRP in the management of chronic periodontitis.

Dentigerous cysts in four quadrants: a rare and first reported case.

The dentigerous cyst is a developmental odontogenic cyst which usually occurs in the second and third decade of life. Dentigerous cyst is one of the most prevalent types of odontogenic cysts associated with partially erupted, developing, or impacted teeth. The mandibular third molars have a high predictability followed by maxillary canines. Occurrence of dentigerous cyst bilaterally is generally observed in syndromic cases. Non-syndromic dentigerous cyst occurring bilaterally or involving both arches at the same time is very rare. This presented case is rare and unique in which all four quadrants shows the presence of dentigerous cyst. In this case there are well-defined cysts associated with impacted molars as well as with supernumerary teeth in all the four quadrants of jaws. The clinical documentation of such a case in available literature is found to be first time.