Rituximab in Childhood and Juvenile Pemphigus Vulgaris: A Systematic Review.

Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by the loss of intraepithelial adhesion, affecting the skin and mucous membranes. Both males and females are affected, although it predominantly affects females in their fifth and sixth decades of life. Approximately 1.4 to 3.7% of PV cases occur in the pediatric population (≤18 years of age), and may be classified into childhood/pediatric PV, which affects individuals under 12 years old, and juvenile/adolescent PV, affecting those between 12 and 18 years old. Due to its rare occurrence in children and adolescents, there is often a delay in diagnosis and treatment in this age group. A systematic literature search was conducted on MEDLINE/PubMed, Web of Science, EMBASE, SCOPUS, and Cochrane Library databases to evaluate the efficacy of rituximab (RTX) in childhood and juvenile PV patients. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was employed to assess the risk of bias in case reports and series, while the Cochrane ROBINS-I tool was utilized for evaluating observational studies or non-randomized intervention studies. A total of 18 studies encompassing 46 juvenile or childhood PV patients in the pediatric and adolescent age groups were included for qualitative synthesis. The studies included nine case reports, two case series, five retrospective studies, one prospective study, and one open-label pilot study. Almost all cases of childhood and juvenile PV achieved either complete or partial remission after undergoing RTX treatment during the final follow-up periods. Furthermore, most cases reported no relapse, and only minor adverse events were noted in the RTX treatment group. Despite its potential benefits, the utilization of RTX in pediatric patients raises concerns due to the scarcity of evidence and the absence of controlled studies specific to this age group. Further exploration is necessary to establish a standardized treatment regimen for RTX in pediatric PV, which involves identifying the optimal dosage, frequency, treatment cycle duration, and maintenance therapy duration.

Juvenile pemphigus vulgaris: Literature review and a rare case report.

Pemphigus vulgaris (PV) is a chronic autoimmune blistering disorder characterized by the loss of intraepithelial adhesion affecting the skin and mucous membranes, predominantly affects females in their fifth and sixth decades of life. Due to its rare occurrence in children and adolescents, there is often a delay in diagnosis and treatment in this age group. PV should always be considered in the differential diagnosis of oral ulcerative and vesiculobullous lesions in both children and adolescents.

Nasopalatine Duct Cyst with Impacted Inverted Mesiodens: A Rare Case Report and Literature Review.

Nasopalatine duct cyst (NPDC) is a non-odontogenic, developmental epithelial cyst that accounts for 1% of maxillary cysts. It often arises due to the spontaneous proliferation of the epithelial tissue remnants, although trauma, bacterial infection, and mucous retention may also trigger the proliferation. Owing to its slow-growing, asymptomatic nature, the cyst is often discovered as an accidental finding during routine clinical and radiographic examinations. However, the majority of cases present as a tiny, asymptomatic swelling just posterior to the palatine papillae. Radiographically, it appears as a well-defined oval or round radiolucency in the maxillary anterior teeth region and should be differentially diagnosed with inflammatory periapical lesions and a wide incisive foramen. A pulp vitality test is essential to rule out lesions of endodontic origin. Microscopically, NPDCs display a mixed pattern of the epithelial lining and exhibit neurovascular bundles (small to medium-sized nerves, arteries, and veins), and minor salivary glands in the cystic connective tissue, a distinctive feature facilitating a confirmatory diagnosis. Enucleation and marsupialization remain the treatment of choice. NPDC associated with impacted mesiodens is an extremely uncommon entity. A comprehensive literature search carried out on the PubMed and Google Scholar search engines revealed only three cases of NPDC with impacted mesiodens to date. The purpose of this study is to report an extremely rare case of NPDC associated with an impacted inverted mesiodens in a 19-year-old male patient who presented with an asymptomatic swelling in the maxillary anterior teeth region. To the best of our knowledge, this is only the fourth reported case of NPDC with impacted mesiodens.

Prevalence of nutrient canals in mandibular anterior intra-oral periapical radiographs (IOPARS) in patients with chronic systemic diseases - a cross-sectional study.

Nutrient canals (NCs) are passages containing neurovascular bundles (blood vessels, lymph vessels, and nerves). Best visualized on mandibular anterior intraoral periapical radiographs (IOPAR), their presence is usually associated with underlying pathological such as diabetes mellitus (DM), hypertension (HTN), advanced periodontitis, calcium deficiency, tuberculosis, and disuse atrophy. This study aimed to (a) evaluate NC prevalence in patients with DM, HTN, and chronic periodontitis and (b) correlate the detection of NCs as an important preliminary screening tool for inherent systemic diseases like DM, HTN, and chronic periodontitis and as an investigative clue in age and gender determination. This cross-sectional study was conducted on 200 subjects. Patients with complaints of pain in the mandibular anterior teeth, deep dentinal caries, abrasion, and attrition were subjected to IOPAR of the mandibular anterior teeth region to assess NCs. An increased frequency of NCs in DM (84%), HTN (66%), and periodontitis (52%) with a significant p-value was observed. Most NCs were seen beyond the root apex (72.4%). A notable association between the duration of disease and the presence of NCs in the diabetic and hypertensive cohorts (p-value 0.047 & 0.012, respectively) was observed. However, we could not establish any association between the prevalence of nutrient canals with age and gender. Our study suggested that a higher frequency of NCs on mandibular anterior IOPAR may be employed as an ancillary screening and investigative support in underlying systemic disorders.

Perception of dental students towards the online method of dental education during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has changed the education system drastically. The shift from traditional learning to online mode during the quarantine period affected dental education substantially. The present study aimed to determine the impact of online learning on dental education and the potential challenges being faced by the dental students. METHODS: An online survey-based questionnaire was distributed to 103 BDS students and feedback was recorded. RESULTS: The study yielded a response rate of 57% comprising of female(56%)and male(44%) respondents. The participants were categorized into two groups with age brackets of 22 years& above. Majority of the female students (86.2%) were more inclined towards offline learning than male students (57.8%) (p = 0.001). More predilection for offline mode was observed in 83% of the students (>22 years of age) than 66.1%students (<22 years) (p = 0.05).BDS 1st (59.6%),2nd (74.1%) 3rd (93.8%)& 4th year (100%) students preferred offline mode for exams (p = 0.005). Most of the students (77.7%) including male (86.7%) and female (70.6%) (p = 0.05) strongly disagreed to continue E-learning in future. The students (<22 years) (98.2%) were more accessible to the internet than students (>22 years) (93.2%) (p = 0.02). The students (>22 years) found more difficulty in using different online platforms (87.2%) than students (<22 years) i.e., 69.6% (p = 0.03).BDS 3rd and 4th year (100%) appeared for the exams in greater numbers than BDS 1st year (76.6%) and 2nd year (92.6%) (p = 0.02). CONCLUSION: Online learning had a detrimental impact on dental education. The students agreed that online mode cannot substitute conventional face-to-face learning.

Isolated Lichen Planus of the Lower Lip: Report of a Rare Case with an Updated Literature Review.

Lichen planus (LP) is a chronic inflammatory, autoimmune entity typically affecting the skin, oral and genital mucosa, and skin appendages, with an underlying malignant potential. Oral lichen planus (OLP) represents the mucosal counterpart of the cutaneous LP and exhibits episodes of exacerbation and remissions. OLP typically manifests as bilateral symmetrical lesions on the buccal mucosa, followed by tongue, and gingiva. However, the occurrence of LP lesions solely on the lip is rarely reported in the literature. The altered clinical appearance of the lip lesions poses a diagnostic threat and raises the possibility of a misdiagnosis. Our aim was to report an unusual case of isolated lower lip LP, and also to carry out a literature review about isolated lip LP lesions, thus, emphasizing the demographic, clinicopathologic attributes, and therapeutic regimen. We report an uncommon occurrence of an isolated lichen planus on the lower lip in a 53-year-old male patient. Clinical evaluation revealed a diffuse erosive crusted lesion bordered by peripheral lacy radiating streaks on the lower lip. After a confirmed OLP histopathology, the patient was treated with low potency topical steroids and Vaseline therapy, with almost completely resolved lesions after 2 months of therapy. We report a rare case of isolated lip LP, and our detailed review revealed 44 reported cases of lip LP till date. The majority of the cases were seen on the lower lip and exhibited an age and gender affinity (mostly in middle-aged males). Significant healing was observed after topical steroid therapy.

Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis.

OBJECTIVE: The goal of this systematic review and meta-analysis is to determine the performance of 4% Articaine vs. 2% Lidocaine for mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis (IP). METHODS: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Gray were used to conduct a thorough literature search. A manual search of the reference lists of the publications found was also carried out. Two reviewers critically evaluated the papers for inclusion and exclusion criteria, and data extraction was done on the selected publications. The Cochrane Collaboration Tool and the Minors checklist were used to assess the quality of the selected studies for randomised controlled trials (RCTs) and non-randomised studies, respectively. The RevMan software was used to perform a meta-analysis of the pooled data and subgroups according to the technique of anaesthetic solution delivery, as well as a sensitivity analysis (P < 0.05). RESULTS: A total of twenty-six papers were included in the qualitative synthesis, with twenty-two of them being included in the meta-analysis. There were fifteen studies with a low potential for bias, three with a moderate potential for bias, and seven with a high potential for bias. The combined results of the 19 trials in the tooth level unit revealed that 4% articaine had a success rate 1.37 times greater than 2% lidocaine for mandibular teeth (RR, 1.37; 95% CI [1.17-1.62]; P = 0.0002). For the maxillary buccal infiltration method, the combined results from the three trials revealed that 4% articaine resulted in a success rate 1.06 times greater than 2% lidocaine (RR, 1.06; 95% CI [0.95-1.2]; P = 0.3). Excluding subgroups with a single study in sensitivity analysis for mandibular teeth revealed a substantial improvement in the success rate of the articaine group in treating IP when compared to the lidocaine group. CONCLUSION: The findings of this meta-analysis back up the claim that articaine is more effective than lidocaine in providing anaesthesia in patients with IP. PROSPERO Registration No.: CRD42020204606 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020204606).

"Looks Can be Deceptive" - Radicular Cyst Mimicking a Developmental Origin Cyst.

ABSTRACT: Cysts of the jaws are not rare, among them the radicular cyst being the most common. It is an inflammatory type of odontogenic cyst forming as a consequence of a long-standing sequel of pulpal necrosis. In contrast to its usual location of occurrence (ie, the maxilla), herewith we report a case of successful management of a 45 year old female patient with a large radiolucent lesion in the left mandibular posterior region with a mandibular ramus extension. The pathology which was strongly presenting as a developmental variety of odontogenic cyst radiographically, was diagnosed as a radicular cyst after histopathological confirmation. To the authors best of knowledge radicular cyst extending into the mandibular ramus is extremely rare and has never been reported previously.

Comparative evaluation of 6% cranberry, 10% green tea, 50% aloe vera and 10% sodium ascorbate on reversing the immediate bond strength of bleached enamel: In vitro study.

OBJECTIVES: The present study aimed to assess antioxidant activity of herbal antioxidants namely 6% cranberry extract, 10% green tea, 50% aloe vera and 10% sodium ascorbate and their effect on reversal of bond strength in bleached enamel. MATERIALS AND METHOD: From one hundred and twenty extracted maxillary central incisors enamel blocks of 5 â€‹× â€‹5 â€‹mm were prepared and arbitrarily divided into six experimental groups (n â€‹= â€‹20): Group A: no bleaching, Group B: only bleaching protocol, Group C - bleaching â€‹+ â€‹6% cranberry extract solution, Group D - bleaching +10% Green Tea extract, Group E - bleaching â€‹+ â€‹50% aloe vera extract, Group F - bleaching â€‹+ â€‹10% Sodium Ascorbate. After bleaching antioxidants were applied for 10 â€‹min and were subjected to bonding procedures. The specimens were sectioned into 120 small strips of size (1 â€‹× â€‹1 â€‹× â€‹8 â€‹mm). Sixty sticks were analyzed to micro tensile bond strength using Universal testing machine and fractured segment were observed for failure modes (Adhesive, Cohesive and Mixed) under stereomicroscope. Remaining 60 sticks were observed for interface gap between tooth and composite resin under SEM. The %AA (antioxidant activity) was assessed with spectrophotometric analysis. RESULTS: Data was statistically analyzed using ANOVA and Post Hoc Tukey's test. Group A (91.68 â€‹± â€‹2.24 Mpa) showed higher mean micro tensile bond strength versus group D (82.14 â€‹± â€‹1.45 Mpa), followed by group E (75.26 â€‹± â€‹1.92Mpa), group F (63.89 â€‹± â€‹1.95Mpa), group C (57.58 â€‹± â€‹1.96 Mpa) and least in group B (31.5 â€‹± â€‹1.27 Mpa). The %failure mode inferred maximum adhesive mode of failure (86.25%). CONCLUSION: All the four antioxidants were able to reverse the compromised bond strength comparatively after bleaching maximum being green tea followed by aloe vera, sodium ascorbate, and minimum in cranberry. CLINICALLY SIGNIFICANCE-: Easily available, biocompatible, cost effectual, and potent herbal antioxidants could be used considerably for immediate esthetic cases where time is a restricting factor.

Oral lichen planus in an 8-year-old child: A case report with a brief literature review.

Lichen planus (LP) is a chronic autoimmune condition of uncertain etiopathogenesis and usually affects the skin, oro-genital mucosa, nail and scalp appendages. LP is primarily seen in middle-aged individuals, and oral lesions of LP in children are relatively uncommon. Herewith, we report a case of oral LP in an 8-year-old boy, which regressed well with the treatment modality.

Factors associated with Oral Health Related Quality of Life of children with severe -Early Childhood Caries.

BACKGROUND: Early Childhood Caries (ECC) is a chronic childhood disease affecting children worldwide. Severe cases of ECC can significantly affect child's Oral Health Related Quality of Life (OHRQoL) owing to its consequences. The purpose of present study was to find out association between severe early childhood caries (s-ECC) and OHRQoL of children and their parents/care-givers visiting a Government dental hospital in Delhi, India. METHODS: Data was collected from a hospital - based sample of 454 child-parent pair. OHRQoL of the child and parent was assessed using the Hindi version of Early Childhood Oral Health Impact Scale (Hi-ECOHIS). Children with s-ECC were identified as per definition given by American Academy of Paediatric Dentistry. Chi square test and Binary regression analysis were used to evaluate the effect of s-ECC on OHRQoL and to study role of various socio demographic factors. RESULTS: The prevalence of s-ECC was 77.1% (n = 350).The mean dmft index score was 5.67 ( ±3.72) and dmfs was 11.21 ( ±11.03). The mean overall ECOHIS score was 7.02 ( ±5.47). Child impact items such as Pain, fever, caries associated swelling along with difficulty in eating food, halitosis, disturbed sleep, frequent absenteeism from school were found to be more significantly more frequent in children with s-ECC than ECC. Children with bottle-feeding habit of more than one year, having fewer siblings, and whose parents belong to upper socio economic class were at higher odds of suffering from s-ECC.Conclusion: s-ECC has significantly more detrimental impact on the OHRQoL of children and their parents in comparison to ECC.

Assessment of oral health status of children with special needs in Delhi, India

Introduction: Children with special needs are considered to be a high risk group for dental diseases especially dental caries and periodontal diseases. Objective: Assessment of oral health status of children with special needs in Delhi, India. Material and methods: A cross sectional survey was conducted on 414 children with special needs belonging to four different disability groups i.e. Intellectually Disabled (ID), Physically Challenged, visually and hearing impaired. WHO Oral Health Assessment Form for children, 2013 was used for assessment of various parameters of oral health among the study population. Results: Of the 414 children, 305 were males and 109 females. Overall caries prevalence was 38%. Mean DMF value was 3.71 with ID children having higher mean than the other groups. A significant positive correlation was also observed between age and dental caries. Gingival condition was also worse in ID children and best in physically challenged ones. Highest numbers of trauma cases were recorded in visually impaired group. Delayed eruption of permanent teeth was most common in hearing impaired. 98.7% children required some form of dental treatment. Conclusion: Oral health of children with special needs was poor and urgent attention is required to plan a comprehensive dental health care programme for them.