Comparative evaluation of platelet rich plasma in socket healing and bone regeneration after surgical removal of impacted mandibular third molars.

Background. Surgical removal of mandibular third molars results in pain, swelling and bony defects, causing prolonged postoperative recovery. The growth factors present in platelet-rich plasma (PRP) can accelerate the healing, thereby shortening postoperative recovery period. This study was undertaken to evaluate the role of PRP in postoperative socket healing, pain, swelling and bone regeneration following surgical removal of impacted mandibular third molars. Methods. The present case‒control study was conducted on 20 patients with identical bilateral mandibular third molar impaction. PRP was placed randomly on one side of 3rd molar extraction socket and the contralateral side was used as control. Evaluation of soft tissue healing, pain, swelling and radiologic bone density was carried out. Results. Soft tissue healing was better in the PRP compared to the control site. Immediate postoperative assessment of pain scores showed no significant difference between the two groups (Mann-Whitney U test). On the 7th day, pain scores were lower in case site compared to the control site. Measurement of swelling on the 1st, 3rd and 7th day showed statistically significant differences between the case and control sites (P<0.0001). Postoperative mean bone density at the 3rd and 6th postoperative months was significantly higher in the case site compared to the control site (P=0.00001). Conclusion. The results showed an improvement in wound healing and swelling and an increase in the bone density at PRP site. The growth factors in PRP would improve the hard and soft tissue healing 3 months after molar surgery.

Phenotypic switch: The enigmatic white-gray-opaque transition system of Candida albicans.

Candida albicans represents the most common commensal and opportunistic fungal pathogen colonizing humans. As a member of the normal microflora, it is present on the skin and the mucous membranes of the upper respiratory tract, gastrointestinal tract and female genital tracts. It is therefore not transmitted. It lies in wait for a change in some aspect of the host physiology that normally suppress growth and invasiveness through an enigmatic phenomenon called Phenotypic Switch System or White-Opaque Transition. This system involves reversible and heritable switching between alternative cellular phenotypes. White-opaque switching in Candida albicans was first discovered in 1987. This was initially identified in strain WO-1. Switching has been demonstrated to occur at sites of infection and to occur between recurrent episodes of infection in select cases esp. AIDS and diabetes.

Large plunging schwannoma of the floor of the mouth involving the mylohyoid nerve: a case report and review of the literature.

Extracranial schwannomas are rare in the oral cavity, accounting for only 1% of all tumors of this type. This article presents a case study of a schwannoma arising from the mylohyoid nerve that presented as a large nodular swelling in the floor of the mouth extending into the submandibular space.

Glucose Level Estimation in Diabetes Mellitus By Saliva: A Bloodless Revolution.

BACKGROUND: Diabetes mellitus is a massive, growing, silent epidemic that has the potential to cripple health services in all parts of the world. Currently, a diagnosis of diabetes is achieved by evaluating plasma glucose levels. Saliva offers some distinctive advantages. Whole saliva can be collected non-invasively and by individuals with limited training. The present study was aimed to estimate and correlate the plasma and salivary glucose levels in diabetic and non diabetic subjects, with special reference to age. METHOD: The study population consisted of three groups: Group I consisted of diabetics with BGL>200mg/dl and Group 2 consisted of diabetics with BGL 130-200mg/dl based on their random plasma glucose levels. Group 3 consisted of healthy population as controls with BGL <130 mg/dl. 2 ml of peripheral blood was collected for the estimation of random plasma glucose levels and unstimulated saliva was collected for the estimation of salivary glucose RESULTS: The salivary glucose levels were significantly higher in group 1 and group 2 diabetics when compared with controls. The salivary glucose levels show a significant correlation with plasma glucose levels between study populations, suggesting that salivary glucose levels can be used as a monitoring tool for predicting glucose level in diabetic patients. CONCLUSION: The present study found that estimation of salivary glucose levels can be used as a noninvasive, painless technique for the measurement of diabetic status of a patient in a dental set up.

Implementation of Oral Health Education to Orphan Children.

OBJECTIVE: To determine the knowledge and oral hygiene status of orphanage children in Pune and changes in them after health education. STUDY DESIGN: Interventional study. PLACE AND DURATION OF STUDY: Centers for Orphan Children in Pune, India, from April to June 2014. METHODOLOGY: A specially designed questionnaire was used to assess the dental problems and existing oral hygiene maintenance practice among children between 5 - 12 years of age (n=100) in an orphanage center. Pre- and postinterventional intra-oral examination was carried out to check their oral hygiene status which included DMFS [Decayed Missing Filled Tooth Surfaces index (for permanent teeth)], OHIS (Simplified Oral Hygiene Index) and gingival indices. Intervention was in the form of oral health education, demonstration of correct brushing technique, diet counselling and maintenance of overall oral hygiene. RESULTS: Present study shows that the orphans had multiple dental problems along with improper oral hygiene practices and careless attitude towards oral health. Pre- and post-interventional DMFS was compared using Wilcoxon sign rank test, which was not significant; while OHIS and gingival indices were compared by using repeat measures ANOVA(p < 0.001) which was significant for each, respectively. CONCLUSION: There was considerable improvement in the oral hygiene status of orphans due to educational intervention. Oral health education at right age can help to cultivate healthy oral hygiene practices in orphans which will benefit them for lifelong. Caretakers should be educated and trained about oral hygiene practices so that they can implement it and supervise the orphan children.

Large Plunging Ranula Presenting as Isolated Neck Swelling: Steps in Diagnosis and Surgical Steps in Management.

Ranula is a salivary gland cyst which typically present as localized superficial swelling over the floor of mouth. Complex or plunging ranulas develop when the mucus extravasation extends through or around the mylohyoid muscle, deeper into the neck, and present with neck lump along with or without swelling over floor of mouth. We report a case of large plunging ranula presenting as an isolated large neck mass in a 38-year-old female patient. The steps in diagnosis and surgical steps in management of the pathology are systematically described.

Mucormycosis in a healthy elderly patient presenting as oro-antral fistula: Report of a rare incidence.

Mucormycosis is a rare opportunistic fungal infection that commonly affects patients who are immuno-compromised. It invariably presents as an acute spreading infection, with very poor prognosis if not treated promptly. We report a case of mucormycosis in immuno-competent elderly patient, presenting as oro-antral communication. Patient's history, clinical and laboratory evaluation revealed no systemic predisposing factors. The disease was non-fulminant, localized and showed remission after local measures, without parentral anti-fungal therapy. Key words:Mucormycosis, maxilla, elderly, oroantral communication.

Comparative evaluation of thickness of jaw-closing muscles in patients with long-standing bilateral temporomandibular joint ankylosis: a retrospective case-controlled study.

OBJECTIVES: The aim of the study was to compare the thickness and cross-sectional area (CSA) of masseter and medial pterygoid muscles in young patients with long-standing bilateral temporomandibular joint ankylosis (bTMJA) in relation to controls. METHODS: Axial sections of computed tomography scans of patients with bTMJA from two tertiary care university hospitals were reviewed from 1995 to 2010 and compared to age- and sex-matched controls. The outlines of masseter and medial pterygoid muscles corresponding to a predefined reference plane were traced onto acetate paper. The thickness and CSA of the muscles were calculated using an image-analyzing software and calibrated according to the scale provided in the CT scan slides. RESULTS: Out of a total of 167 cases of temporomandibular joint ankylosis (TMJA), 15 fulfilled the inclusion criteria. The mean thickness and CSA of masseter and medial pterygoid muscles in cases of bTMJA were 19.4 mm (SD 2.3), 734.9 mm(2) (SD 156.7), 11.53 mm (SD 1.35), and 267.4 mm(2) (SD 65.35), respectively. For the control group, respective values were 10.5 mm (SD 1.8), 430.1 mm(2) (SD 66.8), 9.2 mm (SD 1.2), and 254.6 mm(2) (SD 45.7). There was a statistically significant increased thickness and CSA of the muscles in cases of bTMJA as compared to control as evaluated by Mann-Whitney U test. CONCLUSIONS: The results show that thickness and CSA of masseter and medial pterygoid muscles in patients with bTMJA were larger as compared to controls. This may suggest that, muscular hyperactivity, may be a cofactor in the pathogenesis of TMJA. CLINICAL SIGNIFICANCE: Although temporomandibular joint ankylosis is one of the most restrictive musculoskeletal disorder in the maxillofacial region, there is little information on the form and function of jaw muscles in this condition. This study evaluates thickness and cross-sectional areas of jaw elevator muscles and indicates that muscle hyperactivity might be associated with ankylosis, thereby providing a probable hypothesis on the etiopathogenesis of this condition.

Idiopathic huge pyogenic granuloma in young and old: An unusually large lesion in two cases.

Pyogenic granuloma (PG) is a reactive hyperplasia of connective tissue in response to local irritants, chronic irritation and hormonal changes. It is a tumor-like growth of the oral cavity frequently located in the region surrounding the anterior teeth or skin. It usually arises in response to various stimuli, such as low-grade local irritation, traumatic injury, hormonal factors or certain kinds of drugs. Clinically, the lesion appears as a smooth, lobulated, exophytic mass, exhibiting pink to reddish-purple color which can bleed on slight manipulation. PG has no malignant potential, but recurrence is common after surgical excision. Histologically, the surface epithelium may be intact and may show foci of ulcerations or exhibit hyperkeratosis. Gingiva is the most common site affected followed by buccal mucosa, tongue and lips. The size of lesion varies from millimeters to several centimeters; rarely exceeding 2-2.5 cm. PG larger than 2.5 cm are seldom reported. Estrogen has been considered as a major contributing factor in most of the cases. Thus, occurrence of PG is mostly seen in premenopausal age due to high levels of estrogen. In this article, two unusually large oral PG have been reported. In the first case, a 25-year-old young male patient and in the second case, 70-year-old female patient have been described. In both the cases, the size of lesion was more than 5 cm which has been rarely reported before. Also one of the cases describe here is of a postmenopausal female, which questions role of estrogen as an etiological factor.

Reconstruction of maxillectomy defects using deep circumflex iliac artery-based composite free flap.

Reconstruction of maxillectomy defects is a challenging endeavor, and various methods have been described to rehabilitate these defects, out of which composite free tissue transfer has an established role in reconstruction of the maxillary defects. The deep circumflex iliac artery (DCIA) flap has distinct advantages regarding the volume and length of the bone in reconstruction. The contour of the iliac bone is similar to the maxilla and provides good esthetic result. Good volume of bone allows placement of osseointegrated implant for dental rehabilitation. We present 8 cases of maxilla reconstruction using DCIA flap (3 osteocutaneous and 5 osseous flaps) for benign and malignant pathologies of the maxilla. DCIA flap is difficult to harvest, has variable anatomy, and needs meticulous planning for optimum result.