Establishing legal threshold of 18-years based on the assessment of mandibular molars using three different methods - An observational study.

BACKGROUND: The study evaluates the feasibility of employing the radiographic visibility of the root pulp and periodontal ligament in mandibular molars for age estimation, particularly focusing on the 18 years of age threshold. This study additionally investigates the potential of root canal width reduction in mandibular molars, as a reliable method for forensic age estimation in living individuals. MATERIALS AND METHODS: A cross-sectional study was conducted to assess the radiographic visibility of the root pulp (RPV) and the root canal width (RCW) of mandibular first, second, and third molars along with the radiographic visibility of the periodontal ligament (PLV) of mandibular third molars, in a sample of 403 individuals aged 16-25 years (220 males and 183 females). Data regarding age for different stages of RPV and PLV and various types of RCW were recorded and observed for sex-based differences. Results obtained were tabulated and descriptive statistics were applied to summarise the findings. RESULTS: Individuals over 18 years old were classified with higher accuracy using stage 3 of the RPV scoring system in all mandibular molars (first, second, and third) compared to stage 2, which was also effective for the second and third molars. This result held regardless of sex and side examined. Additionally, root canal width (RCW) assessment demonstrated that individuals with RCW types A, B, and C were more likely to be under 18 years old in both sexes. Conversely, individuals with RCW type U on the right side for males and the left side for females exhibited a higher likelihood of being above 18 years old. CONCLUSION: The study suggests that the assessment of mandibular molars could potentially serve as an auxiliary tool in age estimation methods, particularly for approximating individuals around the 18 years of age threshold. Further investigation is warranted to explore the potential application of root canal width measurements in forensic age estimation.

Correlation of spheno-occipital synchondrosis and mandibular condylar cortication with chronological age using computed tomography in Indian population- A cross-sectional study.

BACKGROUND: Forensic age estimation is a procedure which utilises many methods to estimate the age of both living and deceased individuals, including those who have died in natural disasters or man-made catastrophes. The pattern and closure of spheno-occipital synchondrosis (SOS) fusion, along with subchondral ossification of the mandibular condyle, can be used to estimate age. AIM AND OBJECTIVES: This study aims to estimate age using computed tomographic (CT) images of spheno-occipital synchondrosis fusion (SOS) and mandibular condylar cortication (MCC), and to correlate these findings with chronological age. MATERIALS AND METHODS: The present study included 435 CT images of individuals aged 10-25 years. SOS fusion was assessed using a four-stage system, and MCC was assessed bilaterally using a three-stage system on the sagittal plane. Data on fusion stages and cortication types were entered along with chronological age, and then statistically analysed. RESULTS: SOS fusion stage 2 occurred at similar age in males (19.82 ± 2.67 years) and females (19.23 ± 2.93 years). Earlier fusion of other stages was observed in females by a mean age of 2 years. MCC was completed 1 year earlier in females, with statistically significant differences (p ≤ 0.001). When comparing cortication types and different fusion stages, only type II cortication showed statistically significant differences compared to different fusion stages (p ≤ 0.001). CONCLUSION: Mandibular condylar cortication (MCC) and spheno-occipital synchondrosis (SOS) fusion were positively correlated with chronological age, suggesting that these parameters can be used as an adjunct method for age estimation.

Reliability of gender determination from paranasal sinuses and its application in forensic identification-a systematic review and meta-analysis.

This systematic review aims to determine whether linear or morphometric analysis of paranasal sinuses can be used for accurate determination of gender and to appraise which sinus can be evaluated for accurate gender determination.A comprehensive search of the specialized databases (PubMed/MEDLINE, Science Direct, Clinical Key, ProQuest, Google Scholar, Epistomonikos, LILACS, OpenGrey) and other institutional repositories was performed for including the studies which assessed paranasal sinuses for gender determination. Quality assessment was carried out with the AQUA tool. The meta-analysis was performed with the eligible study data at 95% CI and p ≤ 0.05 in the random-effects model.Forty-six studies evaluating frontal sinus (13), maxillary sinus (26), frontal and maxillary sinus (5), or three paranasal sinuses (2) were included. All the included studies assessed height, length, width, and volume, respectively, and other additional parameters (area, perimeter) if wherever applicable. Frontal sinus had significantly higher values for males compared to females except for left height (LH) and left volume (LV). Maxillary sinus measurements were significantly higher in males contrasted to females except for LH. Sub-group analyses revealed that analyses involving the population had statistically significant results for all the measured parameters for both the sinuses (p < 0.05 and p = 0.00, respectively).Measurements obtained from assessing sinuses reveal that there are variations in size, among populations in different geographic regions. Hence, more studies with improved sample sizes and standardized measurement protocols should be carried out on different populations to see the diversity and their reliability.

Efficacy of topical tulsi (Ocimum sanctum) paste for the management of oral submucous fibrosis - A clinical study.

Context: Oral submucous fibrosis (OSMF) is a chronic insidious oral potentially malignant disorder characterized by increased collagen deposition and reduced collagen degradation causing burning sensation and difficulty in mouth opening. Aim: To assess the efficacy of topical Tulsi (Ocimum sanctum) paste for the management of OSMF. Settings and Design: Institution-based clinical trial. Materials and Methods: The study included a total of 60 OSMF patients categorized into three Groups A, B and C (20 in each) depending on the severity according to Lai DR et al. classification. The patients were advised for topical Tulsi paste application and were evaluated for the reduction in the burning sensation and improvement in mouth opening every month for 3 subsequent months using the numeric pain rating scale (NRS) and a Vernier calliper, respectively. Statistical Analysis: The baseline and 3-month recordings were subjected to inter- and intra-group statistical analysis using Kruskal-Wallis analysis of variance (ANOVA), Mann-Whitney U, one-way ANOVA, Tukey's multiple post-hoc and Wilcoxon matched-pairs tests. Results: There was a reduction in the burning sensation and improvement in the mouth opening in all three groups. The reduction in the burning sensation was statistically significant among all the groups (P < 0.05) and the NRS scores after 3 months among the three groups were not statistically significant (P > 0.05). There was a statistically significant difference (P < 0.05) in the improvement of mouth opening between Group A and B; A and C; but not between B and C. Conclusion: Tulsi paste showed a significant reduction in the burning sensation and improvement of the mouth opening thereby proving to be a safe and promising medicament for OSMF.

Comparative efficacy of topical coconut cream and clobetasol propionate ointment for the management of oral lichen planus: A double-blinded randomized control trial.

CONTEXT: Oral lichen planus (OLP) is a quite common chronic inflammatory mucocutaneous disorder affecting the oral cavity and skin. The current treatment relies on systemic or topical corticosteroids but is known to cause side effects thereby demanding a search for an alternative. AIM: This study aims to assess and to compare the efficacy of topical Coconut (Cocos nucifera) 50% cream and Clobetasol propionate 0.05% ointment for the management of OLP. SETTINGS AND DESIGN: An institution-based double-blinded randomized control trial. MATERIALS AND METHODS: Sixty clinically diagnosed OLP patients were allotted to two groups (30 in each): Group I (Coconut cream-50%) and Group II (Clobetasol Propionate ointment-0.05%). Patients were examined every 15 days until two months for a change in the lesion size and reduction in the burning sensation. The measurement of lesion size and burning sensation was done using Adobe Photoshop software (version CS3) and Numeric Pain Rating scale (NPS), respectively. STATISTICAL ANALYSIS USED: The recordings were subjected to the statistical analysis using Wilcoxon matched-pairs and Mann-Whitney U tests for intra-group and inter-group comparisons, respectively. RESULTS: There was an 85% regression in the size of the lesion in Group I whereas Group II had it to be 95%, and a 100% reduction in the NPS score in Group I whereas Group II had it to be 95%. CONCLUSION: The Coconut cream showed a significant decrease in the size of the lesion and the burning sensation with no side effects neither any signs of toxicity reported during the treatment or follow-up, thereby proving to be a safe and promising medication for OLP.

Comparative evaluation of serum alpha-1antitrypsin levels in patients with oral squamous cell carcinoma and in subjects with tobacco habit without carcinoma.

AIM/OBJECTIVES: To evaluate serum levels of Alpha-1 antitrypsin in patients with oral squamous cell carcinoma and compare them with that of healthy subjects with and without tobacco habits. MATERIALS AND METHOD: The sample of 83 subjects was divided into three groups: 30 subjects with oral squamous cell carcinoma formed Group A. The age, sex, habit matched 23 healthy subjects with tobacco habit formed Group B and 30 healthy without history of consumption of tobacco formed Group C. Analysis of the samples was done using Alpha 1 antitrypsin kit and spectrophotometer. RESULTS: There was a 2.33-fold rise in serum levels of Alpha 1 antitrypsin in Group A compared to Group B, 3.71-fold rise in Group A compared to Group C and 1.59-fold rise in Group B compared to Group C (P < 0.001). A definite rise in serum Alpha 1 antitrypsin levels in patients with oral squamous cell carcinoma as compared with healthy subjects with and without tobacco habits was observed. CONCLUSION: Alpha1-antitrypsin can be used as an adjunct to various diagnostic procedures implied for the evaluation of oral squamous cell carcinoma.

Superoxide dismutase, glutathione peroxidase, and catalase antioxidant enzymes in chronic tobacco smokers and chewers: A case-control study.

OBJECTIVE: Tobacco has a time dependent effect on the antioxidant system of the body. This study was designed to determine and compare alteration in levels of erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) in blood subgroups of tobacco smokers and chewers with controls. MATERIALS AND METHODS: Blood samples were collected from 30 tobacco smokers (> 20 cigarettes daily), 30 tobacco chewers (> 10 packets gutka daily) and 30 controls. These groups were further divided into three subgroups (n=10) based on duration of habit (<5 yrs, 5-10 yrs, >10 yrs). The level of erythrocyte SOD, GPx and CAT were measured using standard procedures. RESULTS: The SOD and CAT levels were significantly decreased in all subgroups of smokers and chewers whereas GPx level was significantly increased. Positive correlation was observed between SOD, GPx and CAT levels with change in duration of habit in all subgroups. No significant difference observed in SOD and CAT activity between tobacco smokers and chewers. CONCLUSIONS: The findings suggested that antioxidative enzyme activities have significant correlation with change in the duration of tobacco use. Measurement of markers of free radical activity might be useful for estimating the level of oxidative stress caused by tobacco use.

Comparison of effectiveness of Calendula officinalis extract gel with lycopene gel for treatment of tobacco-induced homogeneous leukoplakia: A randomized clinical trial.

AIM: The aim of the study is to assess the efficacy of Calendula officinalis gel as cost-effective treatment modality in comparison to lycopene gel in the treatment of leukoplakia. MATERIALS AND METHODS: The study comprised of sixty patients of clinically diagnosed and histopathologically confirmed cases of homogeneous leukoplakia which were divided into Group I and Group II with thirty patients each. Group I patients were dispensed C. officinalis extract gel whereas Group II patients were given lycopene gel. The therapy was instituted for 1 month to assess the change in the size of the lesion at the baseline and posttreatment. RESULTS: The results revealed a statistically significant difference in both Group I and Group II when the pre- and post-treatment results were compared in the same group. The mean difference in the reduction in size before and after treatment for Group I was 2.0% ±1.0 cm while for the Group II, it was 1.57% ±0.87 cm. The intergroup comparison for the evaluation of reduction in the size of the lesion did not reveal statistically significant results. CONCLUSION: C. officinalis extract gel can be effectively used as an alternative to conventional treatment modality.

Multiple jaw cysts-unveiling the Gorlin-Goltz syndrome.

Gorlin-Goltz syndrome or basal cell nevus syndrome is a comparatively rare syndrome characterized by basal cell nevi, odontogenic keratocysts, and skeletal anomalies. Diagnosis is based on the major and minor clinical and radiographic criteria. Dentist plays a major role in the diagnosis of this disease due to the oral and maxillofacial manifestations of the syndrome. In some cases, jaw cysts are diagnosed by routine radiographs advised by the dentists. Odontogenic keratocysts in such syndromic patients will be multiple and extensive and in some cases results in cortical expansion and facial disfigurement. Thorough clinical examination and investigations prompt an early confirmation of the syndrome, which is very essential to avoid morbidity associated with the syndrome. Here, we report a case of multiple odontogenic cysts in a 16-year-old patient which later was diagnosed as a case of Gorlin Goltz syndrome.

Assessment and comparison of phagocytic function and viability of polymorphonuclear leukocytes in saliva of smokers and non-smokers.

OBJECTIVES: Tobacco use is one of the most important public health problems worldwide. It is also linked to impairment of normal immunologic surveillance and defence mechanism of polymorphonuclear leukocytes. Tobacco smoke and its components have been seen to affect the phagocytic ability and viability of polymorphonuclear leukocytes suggesting the pathogenesis of tobacco induced oral diseases. Aim of this study was to assess and compare the phagocytic function and viability of polymorphonuclear leukocytes in saliva of smokers and non smokers. DESIGN: The study comprised of 35 smokers and 35 non-smokers, age matched. Saliva was collected by rinsing method and the polymorphonuclear leukocytes were separated. Phagocytic activity was determined by using latex spheres as targets. Cell viability was measured using trypan blue stain. RESULTS: Salivary polymorphonuclear leukocytes in smokers showed significant reduction in the phagocytic activity by ingesting few latex spheres when compared to the non-smokers. The viability of these cells in saliva of smokers was significantly reduced. CONCLUSIONS: The present study revealed reduced phagocytic activity and viability of salivary polymorphonuclear leukocytes in smokers compared to non-smokers. These findings indicate that smokers are more prone to gingival, periodontal and other oral diseases. Thus indicating that the health care professionals should encourage smoking cessation as an aid in preventing oral diseases.

Comparison of effectiveness of curcumin with triamcinolone acetonide in the gel form in treatment of minor recurrent aphthous stomatitis: A randomized clinical trial.

INTRODUCTION: Recurrent aphthous stomatitis (RAS) is an unfortunately most common disease occurring in oral cavity. Although the lesion is usually self-limited, its painful presentation, high frequency of occurrence, and multifactorial etiology leads to significant morbidity. So, an efficient therapeutic strategy is needed to provide relief to the patients. AIM: To assess and compare the efficacy of Curcumin with Triamcinolone acetonide in the gel form in treatment of minor RAS. MATERIALS AND METHODS: As a randomized clinical trial, 60 patients of either sex with clinically diagnosed RAS were randomly divided into 2 groups-Curcumin gel group (Group I) and Triamcinolone Acetonide gel group (Group II). Patients in either group were asked to apply the gel three times a day on each ulcer. Assessment of efficacy of gel was done on the basis of time required for regression in pain, size, and number of the ulcers. RESULTS: The results showed significant difference in size, pain, number, and duration of ulcers in Group I and Group II within a period of 7 days. However, no significant difference was noted in both the groups in the treatment of RAS. To evaluate the efficacy, Mann-Whitney U test was used and statistical analysis was done using Statistical Package for the Social Sciences (SPSS) 19 software. CONCLUSION: Curcumin has strong antioxidant, with anti-inflammatory, immunomodulatory and analgesic properties, which according to the results obtained from the present study, can be used as an effective alternative to steroids in treatment of RAS.

Assessment of serum enzymatic antioxidant levels in patients with recurrent aphthous stomatitis: a case control study.

Background and Aim. Recurrent aphthous stomatitis (RAS) is a common oral mucosal disorder characterized by recurrent, painful oral aphthae. Despite extensive research, the exact etiology of RAS remains elusive. Recently oxidant-antioxidant imbalance of the body has been implicated in the pathogenesis of recurrent aphthous stomatitis. Thus, the aim of the study was to evaluate the enzymatic antioxidant levels in patients with recurrent aphthous stomatitis. Materials and Methods. The serum levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) were measured in 30 patients with recurrent aphthous stomatitis and compared to the control group, which included 30 healthy subjects. Student's t-test was performed for statistical evaluation. Results. The mean levels of superoxide dismutase (130.2 ± 15.94 U/mL) and glutathione peroxidase (3527.93 ± 488.32 U/L) were found to be significantly lower in study group as compared to control group (211.9 ± 20.93 U/mL, 8860.93 ± 1105.31 U/L, resp.) (P = 0.000) while level of catalase in study group was significantly higher when compared to control group (10981.00 ± 1018.07 U/mL versus 9764.00 ± 1621.19 U/mL) (P = 0.000). Conclusion. Enzymatic antioxidant system is impaired in recurrent aphthous stomatitis patients and seems to play a crucial role in its pathogenesis.

Estimation and comparison of levels of salivary nitric oxide in patients with oral lichen planus and controls.

BACKGROUND: Normal salivary function is considered to be critical for the maintenance of healthy oral mucosa. Oral fluids provide an easily available, non-invasive medium for the diagnosis of wide range of diseases and clinical situations. The objective of this study was to estimate and compare salivary nitric oxide levels in patients with oral lichen planus and healthy individuals. METHODS: Saliva was collected by spitting method. Unstimulated whole saliva thus collected was refrigerated at 4°C, and processed within 24 h for the estimation of nitric oxide levels which was done using Griess reaction. The results were analyzed using Student's "t" test. RESULTS: There was statistically significant difference in the levels of salivary nitric oxide between the study and control groups. CONCLUSIONS: The present study clearly indicates a significant increase in salivary nitric oxide levels in oral lichen planus patients as compared to controls.

Estimation of serum beta carotene levels in patients with oral submucous fibrosis in India.

Oral submucous fibrosis (OSMF) is a chronic, insidious and disabling condition affecting the oral cavity, being especially prevalent in India and South East Asia. However, considering its high prevalence and potential to undergo malignant transformation, OSMF has not been widely investigated with respect to levels of antioxidants, especially beta carotene. In the present study, an attempt was made to analyze serum levels of beta carotene in 45 patients with oral submucous fibrosis and 45 age- and sex-matched controls. The serum beta carotene level was estimated using the Bradley and Hornbeck method. The serum beta carotene level was significantly lower in the patients with oral submucous fibrosis than in the controls. When the values were compared between different disease stages, the maximum reduction of beta carotene was evident for Grade III OSMF, as compared with Grade I and II. From the present results, it is evident that beta carotene plays an important role in the pathogenesis of OSMF, and that its level decreases with disease progression. OSMF patients should be treated with a diet rich in beta carotene to reduce disease severity and progression towards malignancy.

The microbial flora associated with oral carcinomas.

OBJECTIVE: Changes in the microbial flora on the oral mucosa after cancerous alteration may lead to both local and systemic infections. In this study, we assessed the microbial flora associated with the surfaces of oral squamous cell carcinoma. A comparative evaluation of these microbial contents was made with that of the contralateral healthy mucosa and control (healthy) mucosa. We also assessed the microbial flora from the saliva culture in subjects with oral squamous cell carcinoma and healthy controls. METHOD AND MATERIALS: The case control study was made up of 30 subjects with oral squamous cell carcinoma as the study group; 30 healthy age-, sex-, habit-, and dentition-matched subjects served as the control group. In the study group, microbial samples were collected from the carcinoma site, contralateral healthy mucosa, and saliva, whereas in the control group, samples were collected from the healthy mucosa and saliva. These samples were stored on ice and subsequently transported to the laboratory in 2 mL of thioglycollate transport media, where the microbial cultures were carried out. RESULTS: Oral squamous cell carcinoma sites harbor significantly more microbial flora (bacteria and yeasts) compared to those of healthy mucosa (control group). The microbial flora predominantly isolated from the carcinoma site were Streptococcus species, Staphylococcus species, Moraxella species, Enterococcus feacalis, Aerobic spore bearers, Klebsiella species, Citrobacter species, Proteus species, Pseudomonas species, and Candida albicans. The median number of colony forming units (CFU)/mL at carcinoma sites (3.85 x 105 CFU/mL) was significantly higher than that of the healthy mucosa (0.571 x 105 CFU/mL; P = .0000, Wilcoxon nonparametric test). Similarly, in saliva of carcinoma subjects, the median number of CFU/mL (2.408 x 105 CFU/mL) was significantly higher than that of saliva in control subjects (0.78 x 105 CFU/mL; P = .0000, Wilcoxon nonparametric test). CONCLUSION: The present study clearly indicates that the subjects with oral squamous cell carcinoma harbor significantly more microbial flora. Emphasis has to be given to preventing microbial flora in the oral cavity and treating these patients with appropriate antimicrobial agents, thus reducing their morbidity.

Gardner's Syndrome.

Gardner's syndrome is an autosomal dominant disease and is a subtype of familial adenomatous polyposis. It is characterized by adenomatous intestinal polyps, multiple osteomas in the skull, maxillae, mandible, and multiple cutaneous and subcutaneous masses (epidermoids and desmoid). Intestinal polyps, if not treated, have 100% chance of becoming malignant. We report a case of a 25-year-old female patient with Gardner's syndrome, with clinical manifestations including impacted supernumerary teeth, odontomes, sebaceous cyst on the scalp, and osteomas. It is important for the general dental practitioners to be aware of the clinical and radiological characteristics of Gardner's syndrome.

Giant submandibular sialoliths: a report of two cases.

Sialolithiasis is the second most common disease of the salivary glands. Sialolithiasis accounts for the most common cause of salivary gland obstruction, leading to recurrent painful swelling of the involved gland, which often becomes worse while eating. Sialoliths can occur in any of the salivary glands but appear most frequently in the submandibular gland and its duct. Very few cases of giant submandibular sialoliths have been reported in the literature. This article reports two cases of unusually large submandibular sialoliths, with clinical and radiographical signs and management. The article also reviews the various diagnostic modalities and treatment options available.

Evaluating and comparing phagocytic functions of salivary and blood neutrophils in patients with recurrent aphthous ulcers and controls.

OBJECTIVE: To assess the possible role of neutrophils in the pathogenesis of recurrent aphthous ulceration (RAU) by evaluating and comparing the phagocytic functions of salivary and peripheral blood neutrophils in patients with recurrent aphthous ulcers and in healthy subjects. METHOD AND MATERIALS: The study comprised 30 RAU and 30 healthy subjects. Neutrophils were separated from the unstimulated saliva and peripheral blood of RAU patients and healthy subjects. Then, the phagocytic activity and ingestion ability were determined using Candida as targets. RESULTS: Salivary and peripheral blood neutrophils in RAU patients showed significant reduction (P < .05) in phagocytic activity as compared to controls. The ingestion ability of salivary and blood neutrophils was reduced in RAU patients, but not significantly as compared to controls. The ingestion ability of salivary neutrophils was significantly reduced (P = .019) in comparison to blood neutrophils in RAU patients. There was no significant difference between the phagocytic activities of salivary and blood neutrophils in RAU. CONCLUSION: Phagocytic functions of salivary and peripheral blood neutrophils were reduced in RAU patients as compared to healthy subjects. The ingestion ability of salivary neutrophils was also decreased with that of peripheral blood neutrophils in RAU patients. All the above findings revealed that RAU is characterized by consistent changes in salivary and peripheral blood neutrophil functions, thus suggesting that the pathophysiology of RAU may be associated with reduction in phagocytic functions of neutrophils.

Effectiveness of transcutaneous electrical nerve stimulation and microcurrent electrical nerve stimulation in bruxism associated with masticatory muscle pain--a comparative study.

OBJECTIVES: To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS) and microcurrent electrical nerve stimulation (MENS) on masticatory muscles pain bruxism patient. MATERIALS AND METHODS: A total of 60 subjects with the clinical diagnosis of bruxism were randomly allocated to two study groups. Group A received TENS (50 Hz, pulse width 0.5 mSec, intensity 0-60 mA for 20 minutes for a period of seven days) and Group B received MENS (0.5 Hz, intensity 1,000 muA for 20 minutes for a period of seven days). The outcome measures were assessed in term of Visual Analog Scale (VAS) and digital pressometer of 2 Kgf. RESULTS: The study showed significant change in intensity of pain as per VAS score ( P

Compound composite odontome erupting into the oral cavity: A rare entity.

Odontomas are the most common odontogenic tumors. They are usually asymptomatic and are often discovered during routine radiography. Eruption of an odontome into the oral cavity is rare. Odontomas are the most common odontogenic tumors. They are usually asymptomatic and are often discovered during routine radiography. Eruption of an odontome into the oral cavity is rare. We report an unusual case of erupting compound composite odontoma. we report an unusual case of erupting compound composite odontoma.