"Spectrum of 46 XY Disorders of Sex Development": A Hospital-based Cross-sectional Study.

BACKGROUND: Disorders of sex development (DSD) are a wide range of relatively rare conditions having diverse pathophysiology. Identification of an underlying cause can help in treating any coexisting hormone deficiencies and can help with anticipating any other immediate or long-term health concerns. OBJECTIVE: To study the clinical and biochemical profile of patients with 46 XY DSD along with androgen receptor (AR) gene mutation status in selected group of patients. METHODS: A cross-sectional study was conducted after enrolling the eligible DSD patients. Thorough elicitation of history and detailed clinical examination was done. Assays for luteinizing hormone, follicle-stimulating hormone, testosterone, dihydrotestosterone, androstenedione, AMH & Inhibin B (where indicated), and human chorionic gonadotropin stimulation were done as per protocol. RESULTS: In total, 48 patients were included in the study. Ambiguous genitalia (58.3%) followed by hypospadias (33.3%) were common presentation. Androgen biosynthetic defect were the most commonly encountered diagnosis followed by androgen insensitivity syndrome (AIS). Swyer syndrome was diagnosed in 4.2% of cases; partial gonadal dysgenesis, ovotesticular DSD, and vanishing testis syndrome contributed to 2% of cases each. Eight cases (16.7%) who presented with isolated proximal and midshaft hypospadias for whom no diagnosis was found were categorized in the "etiology unclear" group. AR gene mutation analysis designed against specific exons did not yield any results. CONCLUSION: 46 XY DSD is a heterogeneous group of patients with a varying age of presentation and a diverse clinical profile. Most patients are reared as males and maintained the same gender identity except in isolated cases. Diagnosis of AIS remains a clinical challenge as a definite hormonal criterion does not exist and genetic mutations in AR gene may be negative. Flanking region sequencing, whole genome sequencing, and promoter region sequencing may reveal pathogenic variants. Variations in other genes regulating AR pathway may also be candidates to be studied.

A study on the evaluation of bite force, prosthetic and nutritional status in adult cleft patients in Kolkata.

CONTEXT: Altered orofacial morphology and poor dental status affects the dietary intake of cleft patient, making susceptible to nutritional imbalance. Oral health care planning for this population is impossible without the evaluation of stomatognathic functional status as well as prosthetic and nutritional status and need. AIMS: The aim of this study was to evaluate prosthetic status and prosthetic treatment need, bite force and nutritional status, in adult cleft patients and to compare them with the adult noncleft population of similar definition. SETTINGS AND DESIGN: Cleft (n = 250) and noncleft (n = 250) individuals of either sex, aged 18 years or above, excluding severe medically compromised and differently abled, were examined and individual biteforce was measured after obtaining written consent and ethical clearance from the two institutions in Kolkata. SUBJECTS AND METHODS: A "raw data sheet" was prepared according to the parameters of the "Oral Health Surveys: Basic methods," World Health Organization (1997) for evaluation of prosthetic status and need, dentition status and Mini-Nutritional Assessment, Nestlé (1994) for the evaluation nutritional status. A Gnathodynamometer was used to record bite force. STATISTICAL ANALYSIS USED: Statistical analysis was performed using SPSS 20.0.1, Graph Pad Prism version 5, Student's t-test, and Chi-square test. RESULTS: The mean bite force of frontal area in cleft group (3.4356 ± 0.9457 kgf) was found to be significantly lower (P < 0.0001) than in noncleft (22.8749 ± 5.3644 kgf) group. The difference of mean bite force in the right side (2.4576 ± 0.6131 kgf) and left side (1.2708 ± 0.1036 kgf) in cleft group was found to be statistically significant (P < 0.0001). Prosthetic need in maxillary arch was found to be significantly (χ2: 490.0000; P < 0.0001) higher in cleft than in noncleft group. Nutritional status was observed to be significantly (χ2: 179.4049; P < 0.0001) higher "at risk" in cleft than in noncleft group. CONCLUSIONS: Lack of adequate Government concern leading to significantly higher prosthetic need and lower prosthetic status, hence lower bite force resulting lower nutritional status in adult cleft patients in Kolkata.

A study on the accuracy of horizontal condylar guidance values in edentulous patients using preprosthetic diagnostic radiographs.

CONTEXT: Determination of horizontal condylar guidance (HCG) by various clinical and radiographic methods was performed by several investigators. If a correlation between HCG values using lateral radiographic tracing and protrusive interocclusal records can be established, the necessity of performing elaborate recording procedures can be eliminated. AIMS: The aim of this study is to evaluate and to compare the correlation between HCG values in edentulous people using the protrusive interocclusal records mounted on a semi-adjustable articulator with the manual tracing of panoramic radiograph and lateral cephalogram. MATERIALS AND METHODS: A total of 20 completely edentulous individuals of either sex from 45 to 75 years (mean age 63.15 years) fulfilling the inclusion criteria were included in this in vivo study. In all the participants, HCG angles were determined clinically using protrusive interocclusal records and semi-adjustable articulator after intraoral gothic arch tracing. Radiographically, it was obtained by cephalometric tracing of panoramic radiograph and lateral cephalogram. RESULTS: The present study shows mean HCG ± standard deviation (SD) of 28.17° ± 5.99° for interocclusal protrusive record while cephalometric tracing method yielded HCG ± SD of 38.95° ± 4.77° and 35.2° ± 4.94° for lateral cephalogram and orthopantomogram, respectively. A statistically significant positive correlation (P < 0.0001) was found among these three methods. CONCLUSION: HCG can be successfully determined in edentulous participants by using three aforementioned methods. HCG values from cephalometric tracing of diagnostic radiographs can be used as an adjunct to the clinical method but cannot be used independently for programming a semi-adjustable articulator.

A comparative analysis of salivary factors and maxillary denture retention in different arch forms: An in vivo study.

AIMS: This study aims to find the effect of change in different salivary factors before and after complete denture insertion and to measure the maxillary denture retention in different arch forms. MATERIALS AND METHODS: Thirty completely edentulous individuals (10 each of square, tapered, and ovoid arch form of maxilla) belonging to the age group of 40-70 years were selected. Salivary factors (flow, density, pH, viscosity, and total protein) were evaluated before and after denture insertion. Retention of maxillary denture was measured in all the different arch forms. STATISTICAL ANALYSIS: Student's independent sample's t-test was applied. The correlation was analyzed by Pearson's correlation analysis. RESULTS: While mean flow rate and pH of saliva increased, mean viscosity, total protein, and density of saliva decreased after maxillary complete denture insertion. A positive correlation was found between retention and total maxillary basal surface area. Retention value was found to be greatest in square type and least in tapered type. CONCLUSIONS: Complete denture acts as a mechanical stimulant thus increasing flow rate and pH immediately after complete denture insertion. Density, total protein, and viscosity of saliva decreased after complete denture insertion which may be due to increase in water content of saliva. The retention of maxillary complete denture does not seem to depend on the rate of change of the salivary factors, before and after complete denture insertion. Total basal surface area and maxillary denture retention values were highest in square arch form and least in tapered arch form.

A comparative study to correlate between clinically and radiographically determined sagittal condylar guidance in participants with different skeletal relationships.

CONTEXT: Many authors have conducted studies that determine horizontal condylar guidance (HCG) using various methods, articulator systems, and recording materials. However, there is a dearth of literature on variability existing in HCG in individuals with different skeletal relationships. This study is an attempt to verify whether such a difference exists or not. AIMS: The aim of this study is to determine and correlate the HCG in individuals with Angle's Class I, Class II, and Class III malocclusion using radiographic and clinical methods. SETTINGS AND DESIGN: HCG was recorded for thirty individuals, ten of each class. For each individual, HCG was recorded clinically as well as radiographically. SUBJECTS AND METHODS: Clinically, HCG was recorded using protrusive check bites and a semi-adjustable articulator. Radiographically, two methods were employed. First, a "tangent method" wherein the angle made by a tangent to the posterior slope of articular eminence with the Frankfurt horizontal (FH) plane was considered as the HCG, and second, a "protrusive method" where the position of the condyle at maximum intercuspation and 6 mm protrusion were traced, and the angle this path made with the FH plane was recorded as the HCG. STATISTICAL ANALYSIS: Descriptive statistical analysis along with Tukey's test and analysis of variance was used to calculate and compare the mean values. Pearson correlation coefficient was used to establish correlation between various means. RESULTS: A significant difference in the HCG of three skeletal relationships was seen, with Class II having a steeper angle than the other two. Among the various methods used, a correlation was found between the clinical and the protrusive method; however, the tangent method yielded greater values of HCG. CONCLUSIONS: The average value of HCG should not be used as it differs according to the skeletal relationship. Radiographic method can be used to yield consistent HCG; however, the protrusive method should be employed.

Comparative assessment of the effectiveness of different cleaning methods on the growth of Candida albicans over acrylic surface.

CONTEXT: This study evaluated the efficacy of denture adhesive, cleanser, chlorhexidine, and brushing against Candida albicans biofilm developed on an acrylic surface and predicted the most effective, simple, and inexpensive way to maintain denture health, thereby preventing denture stomatitis. AIMS: To find the best possible method for maintaining denture hygiene. SETTINGS AND DESIGN: This retrospective analysis was conducted in the Guru Nanak Institute of Dental Sciences and Research, Kolkata, and this in vitro study was designed to minimize denture stomatitis among denture wearing population. SUBJECTS AND METHODS: Sixty acrylic discs of equal dimensions after exposure to C. albicans were treated for a duration of 24 h with denture adhesive, cleanser, 0.2% chlorhexidine individually, or in combinations simulating clinical conditions dividing in six groups, ten samples each (n = 10). STATISTICAL ANALYSIS USED: After treatment, colony count was evaluated and statistically analyzed by post hoc Tukey's test and Dunnett's test to determine the most effective way of prevention. RESULTS: The statistical post hoc analysis (Tukey's test and Dunnett's test) showed high significance (P < 0.0001). The group treated with adhesive showed high fungal growth compared to the control group, whereas chlorhexidine showed high potency to prevent C. albicans, whereas adhesive increased the adhesion of C. albicans to acrylic surface. CONCLUSIONS: Denture adhesive increases the adherence of C. albicans to denture surface. Other cleaning chemicals such as cleanser and chlorhexidine decrease the adherence. Moreover, among the all denture cleaning protocol, chlorhexidine drastically inhibit the adherence, as well as growth of C. albicans over denture surface.

Overtreatment in Caries Management? A Literature Review Perspective and Recommendations for Clinicians.

Dentistry, like various branches in the healthcare profession, is susceptible to overtreatment, especially in the management of dental caries, due to the adoption of an aggressive restorative approach. This philosophy provides no actual benefits to the patient in terms of arresting the disease process, which initially led to the carious lesions. Yet practitioners routinely continue to initiate restorative treatment procedures without attempting to understand and alter the biologic factors contributing to the caries process. This paper examines the available scientific literature in this regard and makes recommendations to the clinicians of today based on the available evidence. CPD/Clinical Relevance: The paper provides clinicians an approach to avoiding overtreatment by adhering to established clinical guidelines and accepted operative strategies.

Use of digital panoramic radiology in presurgical implant treatment planning to accurately assess bone density.

STATEMENT OF PROBLEM: No cost-effective method of ascertaining bone density from 2-dimensional radiographic images is currently available for dental implants before surgery. PURPOSE: The purpose of this in vivo study was to use digital panoramic radiology and dental computed tomography (CT) to evaluate the bone density of specific points in the jaw near the tooth-bearing areas. The objective was to determine whether digital panoramic radiology can be used in assessing bone density as an alternative to a more expensive and complex dental CT. MATERIAL AND METHODS: This study involved determining bone densities at predetermined anatomic landmarks near tooth-bearing areas of the jaws of 20 participants, using digital panoramic radiology in gray-level scale with a lead step wedge. Subsequently, the bone densities of the same points were determined in Hounsfield units (Hu) with dental CT. The data collected after interpretation of the panoramic radiograph and CT were tabulated and analyzed statistically. RESULTS: Bone density measured using CT correlated with the first 3 steps of (A, B, and C) the digital scale of gray. Further analysis conducted using the Mann-Whitney U test showed a significant association between step A to detect D4 bone, step B to detect D3 bone, and step C to detect D2 type bone. CONCLUSIONS: The digital scale of gray obtained from a lead step wedge can be effectively used with digital orthopanoramic radiology to assess bone density before the placement of implants, but with certain restrictions.

Comparative evaluation of bond strength of all-metal crowns with different luting agents after undergoing various modes of surface treatments: An in-vitro study.

AIM: This study includes a comparative evaluation of the various surface treatments of the intaglio surface of crowns in combination with various luting agents for maximal retention. MATERIALS AND METHODS: Totally, 150 dies of a standard complete crown preparation were fabricated. Wax pattern with a loop on the occlusal surface was prepared on each die using standard procedures, and then crowns were cast with nickel-chromium alloy. These crowns were randomly divided into five groups as per the surface of the intaglio surface of the metal copings. The crowns in each group were again subdivided randomly into three groups as per the luting agents used resin-modified glass ionomer cement, glass ionomer cement, and zinc phosphate cement. Retention was measured (MPa) by separating the metal crowns from the metallic die under tension on a Universal testing machine. STATISTICAL ANALYSIS USED: The data were recorded and statistically analyzed using one-way analysis of variance followed by Tukey's test. RESULTS: The retention differed both with surface treatment and type of luting agents. Untreated group showed the least bond strengths < sandblasting with 50 µm alumina < sandblasting with 50 µm alumina with ultrasonic cleaning < sandblasting with 110 µm alumina < sandblasting with 110 µm alumina along with ultrasonic cleaning. For luting agents, glass ionomer cement showed least bond strength because there was no chemical bonding present between metal crown and metallic die, followed by zinc phosphate cement and maximum bond strength were found for resin-modified glass ionomer cement. CONCLUSION: Among all types of surface treatments used in this study, maximum bond strength was yielded by sandblasting with 110 µm alumina + ultrasonic cleaning and the best luting agent was resin-modified glass ionomer cement.

Toward smoke-free homes: A community-based study on initiatives of rural Indian women.

CONTEXT: Since the home is the primary source of exposure of children to second-hand smoke (SHS), measures to restrict smoking at home should be introduced to protect children from its adverse health consequences. AIMS: Objectives of the study were to assess the level of awareness of rural Indian women on the health impacts of SHS on children and to look into the strategies they used to reduce children's exposure to SHS at home. MATERIALS AND METHODS: A community-based cross-sectional study was conducted among 438 rural women using a survey questionnaire. Information on socio-demographic characteristics, knowledge on specific health effects of SHS on children, and attitude toward having a smoke-free home were collected. The perceived reasons that made it difficult to have smoke-free homes were also explored. RESULTS: A total of 75.8% of women agreed that SHS was a serious health risk for children. Knowledge on health impacts of SHS on children identified asthma as the most common problem. Smoking by husbands (89.7%) was the major source of exposure to SHS at home. While 67.6% of women reported having taken measures to limit SHS exposure in their homes, only 12.8% of them had tried to introduce a complete ban on smoking at home. On a five-point evaluation scale, 73.3% of the women indicated a failure of their initiatives to have smoke-free homes. CONCLUSIONS: Women's initiatives to introduce restrictions on smoking at home had very limited success and did not produce an appreciable change in smoking behavior at home. Lack of empowerment of women in rural India probably rendered the interventional measures ineffective.