An Observational Study on Cystic Alterations in Normal Dental Follicles Associated with Impacted Lower Third Molar for Early Intervention.

AIM: To evaluate the cystic changes in the radiographically normal dental follicle associated with impacted mandibular third molar. MATERIALS AND METHODS: This study was conducted on 80 patients. Samples were selected using a convenient sampling technique from the patients who had impacted mandibular third molars in Pell and Gregory's positions B and C, with follicular space less than 2.5 mm in diameter. After surgical removal of an impacted tooth, the dental follicle was sent for histopathologic evaluation. RESULTS: Pathologic alterations were found in 19% of cases out of 80 samples. Odontogenic keratocystic and dentigerous cystic changes were found in 7% of cases. A statistically significant cystic alteration was found in female patients and distoangular impacted teeth. CONCLUSION: This study shows a significant cystic alteration in the radiologically normal dental follicles. Clinical and radiographic features alone may not be a reliable indicator of the absence of pathology. Early intervention of impacted teeth will help to reduce morbidity due to the development of pathology. CLINICAL SIGNIFICANCE: This study will help educate patients on the risks of retaining impacted teeth, based on scientific facts, in order to minimize the risks and to assess the correlation of pathologic alterations with the depth of impaction and angular position of the impacted tooth.

A Study to Evaluate the Efficacy of Ultrasonography as a Diagnostic Screening Tool in Maxillofacial Fractures: A Prospective Study.

AIM: The aim of the study was to estimate the diagnostic efficacy of high-resolution ultrasonography (USG) in the diagnosis of maxillofacial fractures. MATERIALS AND METHODS: A descriptive diagnostic evaluation study was carried out on 30 patients with suspected maxillofacial fractures, out of which 26 were male (86.7%) and 4 were female (13.3%). After initial management, detailed clinical examinations were carried out and significant findings were noted. Computed tomography (CT) scans were performed in fracture-suspecting patients followed by USG examination which was done in a standardized pattern on both sides of the face. The result of USG was compared with the CT scan report. RESULT: Based on CT findings, 65 sites were found to be fractured, and this was considered the gold standard. Ultrasonography detected 58 fractures at these 780 sites, of which 54 were true fractures, while 4 were false-positive results. However, USG was not able to detect eleven fractures. The overall sensitivity and specificity of USG were 83.1% and 99%, respectively. The positive and negative predictive values were 93% and 98%, respectively. CONCLUSION: According to our study, it may be concluded that USG may be recommended as a diagnostic screening tool to detect superficial maxillofacial fractures. CLINICAL SIGNIFICANCE: Ultrasonography provides a safe, cost-effective, reliable, non-invasive, easily available, and portable imaging modality to screen for maxillofacial fractures.

Evaluating the Clinical Efficacy of Maxillary Labial Frenectomy Procedure Using Diode Laser (980 nm) and Conventional Scalpel: An Observational Study.

Aim: This is an era of minimally invasive and least traumatic surgical interventions being focused on. The traditional scalpel frenectomy technique offers an increase in post-operative sequelae. To unravel this scenario a comparative evaluation is carried out to find out the clinical outcomes and quality of life after maxillary labial frenectomy using a conventional scalpel and diode laser frenectomy of 980 nm. Materials and Methods: Thirty-six subjects age ranging between 18 and 45 years reported to the Department of Oral and Maxillofacial Surgery, MES Dental College, Perinthalmanna with an aberrant frenal attachment of maxillary labial frenum were randomly assigned into two groups. Group A underwent the conventional scalpel technique and group B for the diode laser-assisted (980 nm) frenectomy technique. The post-operative parameters of ooze from the surgical site, pain, wound healing, and discomfort or acceptance of the procedure were assessed on day 1, day 7, and day 14, respectively. Results: The diode laser group exhibited statistically significant clinical and healing outcomes. Less pain, minimal or absent ooze, increased healing, and better acceptance of the procedure with diode laser at 1, 7, and 14 days recall visit. Conclusion: Surgical interventions involving needle puncture and the associated post-operative sequelae are the most dreaded experiences that make patients indifferent toward surgical treatments. Thus in terms of better clinical outcomes and improved quality of life diode laser frenectomy is an excellent alternative wherein a needleless anesthetic success followed by minimal surgical intervention and less post-operative sequelae with fast recovery is possible.

Conventional Rotary Technique and Piezosurgical Technique in the Removal of Impacted Mandibular Third Molar: A Comparative Study.

AIM: To compare the operating time, postoperative pain, edema, trismus, and patient acceptance following surgical removal of impacted third molar using piezosurgery and conventional rotary technique. MATERIALS AND METHODS: About 42 patients with impacted mesioangular mandibular third molars were included in this study. Subjects are divided into two groups: group I (treated with conventional rotary technique) and group II (treated with piezosurgery). Duration of surgery, pain, trismus, and swelling were assessed. The patients were evaluated on the 1st, 3rd, and 7th postoperative days. RESULTS: Postoperative pain, trismus, and edema were reduced with piezosurgery compared with conventional technique. Even though the duration of time was longer with piezosurgery, patient comfort was found to be better. CONCLUSION: Piezosurgery is a meticulous and innovative ultrasonic technique with selective bone cutting and better postoperative outcomes. However, it is expensive, and the operating time is prolonged. CLINICAL SIGNIFICANCE: Piezosurgery is an alternative in the surgical removal of third molars as it ensures precise and selective cutting, with no injury to the surrounding soft tissues. Postoperative outcome and patient acceptance are improved with piezosurgery.

Evaluation of Microbial Adherence on Antibacterial Suture Materials during Intraoral Wound Healing: A Prospective Comparative Study.

AIM: To assess the efficacy of antiseptic-coated silk sutures with triclosan-coated polyglactin 910 suture in reducing bacterial colonization after oral surgical procedures. MATERIALS AND METHODS: The patients who required multiple sutures after surgical procedures in the mandible were the study subjects. The sites of suturing were divided into three groups. Group A - surgical site receiving black-braided silk suture (control group). Group B - surgical site receiving triclosan-coated Polyglactin 910 suture (experimental group). Group C - surgical site receiving antiseptic-coated silk suture (experimental group). Evaluation was done on the 3rd postoperative and 7th postoperative day. Microbial adherence was evaluated by microbiological study. RESULTS: The mean comparison of microbial count between 3rd and 7th post-op day in the three groups shows an increased microbial colonization in the control group when compared with the experimental groups. The combined mean microbial adherence in the three groups showed microbial count in the uncoated silk suture (group A) as 10.35 ± 3.74, triclosan-coated suture (group B) as 6.28 ± 2.17 and iodoform + calendula oil-coated suture (group C) as 7.1 ± 2.02 which is statistically significant (p < 0.05). CONCLUSION: The present research concluded that the pomade-coated silk suture is as efficient as triclosan-coated VICRYL PLUS Polyglactin 910 sutures in reducing the bacterial colonization in intraoral wound healing. CLINICAL SIGNIFICANCE: The pomade (iodoform + calendula oil) may be advocated in the field of oral and maxillofacial surgery for impregnating the suture materials which act as an antiseptic agent and a promoter of wound healing which is easily accessible and also cost-effective.

Low-concentration Povidone-iodine and Normal Saline as Irrigant on Reducing Postoperative Complications after the Third-molar Surgery: A Comparative Study.

AIM: This study was conducted to compare the efficacy of using 0.5 mg/mL povidone-iodine solution as an irrigant and coolant in reducing postoperative sequelae like swelling, trismus, and pain with the conventional normal saline irrigation during the surgical removal of the impacted lower third molar. MATERIALS AND METHODS: The research was conducted out toward the MES Dental College in Perinthalmanna, Kerala, in the Department of Oral and Maxillofacial Surgery. After mandibular third-molar surgical removal, researchers studied 60 individuals, 30 of whom had normal saline irrigation (group I), and 30 of whom received 0.05% povidone-iodine irrigation (group II). The postoperative discomforts were measured on the second and seventh days after surgery, respectively. After that, the data were analyzed using SPSS. The data analysis considered p-values less than 0.05 to be significant. RESULTS: At the second postoperative visit, patients in the povidone-iodine group reported much less pain, swelling, and reduced mouth opening than those in the normal saline group. But on the seventh postoperative day, there was not much difference between either group. CONCLUSION: Following the surgical removal of teeth, it was revealed that povidone-iodine solution (0.5 mg/mL) was more effective as irrigation and cooling aid than regular saline solution. CLINICAL SIGNIFICANCE: Low-concentrated povidone-iodine is a better option in dentistry as irrigant.

Paramassetric Subcutaneous Dirofilariasis: A Rare Entity.

Dirofilariasis is an uncommon zoonotic parasitic infection affecting humans due to the bite of a mosquito vector. It is an endemic caused by Dirofilaria which is characterized in humans as nodules in lungs, subcutaneous tissue, peritoneal cavity, eyes. We present a case of Dirofilariasis with subcutaneous presentation in paramassetric region.

A longitudinal study to evaluate the bleeding pattern of patients on low dose aspirin therapy following dental extraction.

BACKGROUND AND AIMS: Antiplatelet dugs are often interrupted preceding invasive dental extraction because of concern of bleeding complications. The fear of uncontrolled bleeding often prompts medical and dental practitioners to stop aspirin intake for 7 to 10 days before any surgical procedure, which puts the patient at risk from adverse thrombotic events. The aim of the study conducted was to evaluate the bleeding pattern after routine dental extraction among patients on low dose long term aspirin therapy. METHODS: A total of 104 subjects in the age group of 30-65 years, who continued to have aspirin intake during extraction were included in the study. Dental extraction was performed without stopping aspirin therapy under local anesthesia. The post-operative blood loss was quantified by weighing the gauze pre and post operatively and adding total volume of fluid in the suction jar. RESULTS: Of these 104 patients treated, 87% of patients had mild bleeding (<20 ml) and 13% of patients had moderate bleeding (20-30 ml). The total study population showed a mean blood loss of 16.15 ± 3.5 ml. CONCLUSION: Within in the limitations, our study concluded that the routine dental extraction in patients under low dose aspirin therapy did not cause clinically significant post extraction hemorrhage. Aspirin intake can be continued during routine dental extraction as post extraction bleeding encountered will be negligible.

Comparative Evaluation of Classical Inferior Alveolar Nerve Block and Gow-gates Nerve Block for Surgical Removal of Mandibular Third Molar: A Prospective Study.

BACKGROUND: The most commonly used nerve block procedure to anesthetize the mandibular arch is the classical inferior alveolar nerve block (IANB). In 1973, Gow-Gates developed a new procedure known as the Gow Gates nerve block, to achieve anesthesia in the same area with fewer complications. METHODOLOGY: The study comprised 80 patients who reported for the surgical removal of impacted third molar. The patients were randomly assigned into two groups- Group I received Gow-gates nerve block and Group II were administered classical IANB. Positive aspiration, meantime for the onset of anesthesia, mouth opening before and after each block and pain during the surgical procedure were compared. RESULTS: Group 1 yielded positive aspiration in 2.5% of the cases (one patient) and 15% had positive aspiration in Group 2 (six patient). The mean time taken for onset of anesthesia was 6.16 min in Group 1 as compared to 2.78 min in Group 2. While comparing the quality of anesthesia between the blocks, 87.5% of the patients in Group 1 and Group 2 had successful anesthesia equally i.e., 35 of the 40 patients fell into category 1 and 2 of the eight-point category rating scale in both the groups and the remaining five patients (12.5%) in both the groups had unsuccessful anesthesia. CONCLUSION: Both approaches offer quality anesthesia in the posterior mandibular area when meticulously followed. The percentage of unsuccessful anesthesia in the Gow-Gates group could be attributed to the inexperience of the operator. Postoperative comfort and patient satisfaction were greater in the other group.

Study of Patterns of Maxillofacial Injuries: An Institution-based Observational Study.

Maxillofacial fractures are one of the common presentations in an emergency department. They are considered to be one of the significant and dominant conditions that requires treatment as the fractures can result in morbidity, mortality, psychological, functional disability, and facial mutilation. The incidence, patterns, and etiology of maxillofacial fractures vary from one country to another due to the geographical, cultural, social, and economic differences. The present study included 176 patients from January 2019 to September 2020 that aimed to evaluate the pattern of maxillofacial fractures and to learn the etiology for the same.

Postoperative pain, edema and trismus following third molar surgery - A comparitive study between submucosal and intravenous dexamethasone.

BACKGROUND: Third molar surgey always needs primary intervention as it can lead to various complications and pathologies. Considering other ways for postoperative anesthesia it was infered that submucosal group which showed simple injection technique and direct surgical site administration is more beneficial. It was noticed as a patient comfort method which can be the preferred as the drug of choice over intravenous route of dexamethasone injection. INTRODUCTION: Impaction of third molar is a common affliction and surgical removal is the only treatment option. The post-operative sequelae following the third molar surgery are pain, edema and trismus. The use of corticosteroids is to counteract it via various routes. Still, controversy exists in the literature regarding the administration of corticosteroids over the routes and time of administration. The purpose of this study was to compare the postoperative pain, edema and trismus following third molar surgery while using preoperative intravenous and submucosal routes of dexamethasone, in terms of pain, facial swelling, and trismus. MATERIALS AND METHODS: This study consisted of 64 patients presented with mesioangular impacted mandibular third molar for surgical removal. Preoperative measurements of edema, trismus were analyzed. Postoperative pain was estimated using visual analogue scale. Edema was assessed by the extra oral facial measurements. Trismus was measured by recording the interincisal opening in millimeters. Dexamethasone was administered intravenously or submucosally according to the choice of operating surgeon and were divided into 2 groups. RESULTS: Mean and standard deviation calculated for continuous variables. Changes in parameters was analysed using t test and Mann-Whitney U test. Here, submucosal group were reported with increased pain on the second postoperative day. On seventh postoperative day mean value turns to 0.7 ± 1 for submucosal and 0.6 ± 1.2 for intravenous group. On overall observation, intravenous group expressed statistically significant (P < 0.01) reduction in pain compared to the submucosal group during immediate and second postoperative days. CONCLUSION: Analyzing the previous studies, and from the experience of the present one, it could be reasonably found out that administration of submucosal dexamethasone is beneficial for overall patient compliance.

Efficacy of various intracanal medicaments against aerobic and facultative anaerobic microorganism found in human primary teeth with necrotic pulp: A randomized clinical trial.

AIM: The aim of this in vivo study is to evaluate the antimicrobial efficacy of calcium hydroxide (Ca(OH)2), chlorhexidine (CHX), and metronidazole gel as intracanal medicaments against aerobic and facultative anaerobic microorganisms found in root canals of human primary teeth with necrotic pulp. SETTING AND DESIGN: It is a double-blinded randomized clinical trial. MATERIALS AND METHODS: Pulp canals of 45 single-rooted primary maxillary anterior teeth with pulp necrosis in 34 children were included in the study. They were divided into three groups of 15 samples each: Group I: Ca(OH)2; Group II: 1% CHX gel; and Group III: 1% metronidazole gel. Microbial count was obtained from each tooth at two different stages - (1) after instrumentation and (2) after placement of the medication. Statistical analysis using the SPSS 10.0 software program (SPSS Inc., Chicago, IL, USA) with Wilcoxon signed-rank test after grouping the samples was performed. RESULTS: Ca(OH)2, 1% CHX gel, and 1% metronidazole gel were ineffective in completely eliminating aerobic and facultative anaerobic microorganism from root canal of human primary teeth with necrotic pulp. CONCLUSION: None of the commonly used intracanal medicaments, that is Ca(OH)2, 1% CHX gel, and 1% metronidazole gel, was effective in completely eliminating aerobic and facultative anaerobic microorganism from root canal of human primary teeth with necrotic pulp. Ineffectiveness of these medicaments against aerobic and facultative anaerobic microorganism has opened new door of research regarding the manner of bacterial growth in unfavorable environmental and nutritional conditions, the way root canal environment favors biofilm formation and the use of suitable intracanal medicaments against single and multispecies biofilms.

Clinical diagnostic dilemma in an uncharacteristic rapidly enlarging swelling of the anterior maxilla: extranodal diffuse large B cell lymphoma.

Extranodal non-Hodgkin lymphoma (NHL) is infrequent in the oral cavity and constitutes 3.5% of oral cancers, and less than 2.2% of maxillofacial lymphomas. Diffuse large B cell lymphoma (DLBCL) accounts for 40% of NHL and has a 5-year survival rate of less than 30%. Early detection of extranodal NHL by dental personnel is extremely important as a delay in diagnosis can result in the cancer being diagnosed at an advanced stage and a poor prognosis. A 60-year-old male presented with an uncharacteristic asymptomatic rapidly enlarging swelling of the anterior maxilla, which on histopathological and immunohistochemical analysis was diagnosed as DLBCL. Imaging studies showed bone invasion and lymph node metastasis with poor prognosis. The patient received radiotherapy and chemotherapy but died within 3 months of diagnosis. A literature search revealed one another case with anterior maxilla occurrence, as the few oral DLBCL so far reported have appeared on the posterior palate or other intraoral sites.

Recent trends in prevention of oral cancer.

Oral cancers often occurs out of long standing potentially malignant lesions and conditions so called premalignant lesions and conditions. Oral precancer is a intermediate state with increased cancer rate which can be recognized and treated obviously with much better prognosis than a full blown malignancy. Oral cancer risk can be lowered or even prevented by simply understanding basic oral hygiene, different bacteria found in the mouth, and how diet influences oral cancers. Currently, research is being done on the relationship between diet and oral cancer. Oral cancer is a very serious disease that can be prevented. Practicing good oral hygiene is key to help keep the oral cavity clean. Limiting the use of tobacco and alcohol products is also important because these are the causes of most oral cancers. Lastly, eating a well balanced diet that has protective affects can reduce the risk of oral cancer. This includes a diet high in fruits, vegetables, and fish and low in high fat and cholesterol meats, rice, and refined grains.

A double blind study on the efficacy of local application of hemocoagulase solution in wound healing.

AIM: The present double blind study has been designed to evaluate the efficacy of local application of hemocoagulase solution as compared to a placebo in wound healing following dental extraction. MATERIALS AND METHODS: A total of 20 patients who required dental extraction for orthodontic intervention were included. The hemocoagulase solution and a placebo were locally applied to the extraction sockets and the efficacy of the solution in terms of bleeding control, anti-inflammatory responses, its antiseptic properties and efficacy in wound healing were evaluated. RESULTS: The mean time required to achieve hemostasis was found to be 1.37 minutes in side A (test) and 2.33 minutes in side B (control) indicating that side A achieved faster hemostasis when compared to side B. At the 6th hour postoperatively, bleeding was not evident on either sides, and the amount of pain in side A was found to be less compared to side B. The number of RBCs, polymorphs, chronic inflammatory cells were not different in both the groups, whereas at 3rd postoperative day epithelial cells were greater in side A (test) compared to side B (control). Biopsy reports on the 12th postoperative day indicated that the number of fibroblasts, epithelial cells, collagen count was found to be greater in side A (test) compared to side B (control). CONCLUSION: The topical hemocoagulase solution may be advocated in the field of oral and maxillofacial surgery, as a hemostatic agent and promoter of wound healing. However, further studies, with large number of cases and different clinical situations should be considered to authenticate the efficacy of this hemocoagulase solution in the practice of oral and maxillofacial surgery. CLINICAL SIGNIFICANCE: Wound healing plays an important role in the success of any surgical procedure, such as extractions, and the hemocoagulase system may act as a hemostatic agent and a promoter of wound healing.

Effect of tongue cleaning methods and oral mutans streptococci level.

INTRODUCTION: Tongue scraping and brushing have been appreciated for hundreds of years but are still appreciated or used by the public. Scientific evidence has validated the need to practice habitual and tongue cleaning as part of daily home oral hygiene procedures. OBJECTIVE: To assess and compare the effect of tongue scraping and tongue brushing on oral Mutans streptococci level. MATERIALS AND METHODS: A total of 20 healthy subjects aged 14 to 15 years were randomly selected. Flat plastic tongue scraper and Nylon multitufted small headed toothbrush are the two tongue cleaning devise used. Unstimulated salivary samples were obtained at 4 intervals from each individual. Salivary samples were inoculated on Mitis Salivary Agar Plate and Sorbital Broth was used for identification of Mutans streptococci group. RESULTS: Paired and unpaired 't' test were employed. Reduiction in the Mutans streptococci level from 48.4 × 10(4) CFU and 38.3 × 10(4) CFU at baseline in tongue scraping and tongue brushing group respectively to 0.34 × 10(4) and 0.39 × 104 CFU after 7th day. CONCLUSION: Both tongue coating removal methods evaluated were efficient in reducing mutans streptococci level. This implies that physical removal of the coating on the dorsum of the tongue is important and not the method used for the same.