The efficacy of intralesional dexamethasone versus intravenous dexamethasone in surgery for impacted third molars: A randomized controlled trial.

OBJECTIVES: A randomized prospective double-blind study was conducted to determine the efficacy of sub-mucosal local infiltration vs. intravenous dexamethasone in reducing postoperative pain, swelling and trismus after surgical removal of impacted mandibular third molars. MATERIALS AND METHODS: Forty five patients were included in the study and were randomly divided into three groups. Each group consisted of 15 patients for which the first and second groups were given 8 mg of dexamethasone intrlesionally & intravenously respectively, at 30 minutes prior to surgery; the third group served as control. Duration of facial swelling was evaluated subjectively by the patients themselves. Severity of postoperative pain was quantified by counting the number of analgesics taken by the patients during and after surgery (six subsequent days). Postoperative trismus was determined by measuring the maximum incisal opening before surgery and on the seventh day. RESULTS: Results showed that duration of postoperative edema was almost the same in the three test groups. During surgery, the intravenous dexamethasone group showed a significantly lesser pain than the other two groups; the intralesional dexamethasone group showed less marked pain than the control group. Additionally, patients who had taken steroids had a marked increase in the incisal opening postoperatively over the control group. Trismus was significantly reduced in the methylprednisolone group as compared to the dexamethasone group. CONCLUSION: It is concluded that both preoperative local infiltration and intravenous administration of dexamethasone significantly reduced postoperative pain and trismus after surgical removal of mandibular third molars. An intravenous dexamethasone is more effective in reducing postoperative inflammatory sequelae than its intralesional route.

Repeated peripheral alcohol injection is an effective treatment of Trigeminal Neuralgia in non-drug compliance patients.

INTRODUCTION: Trigeminal neuralgia (TN) is an uncommon disorder seen in dental and neurologic practice, which presents with brief lancinating pain in the face, in the area distributed by the trigeminal nerve. The wide ranges of treatments currently used for TN are ample evidence that there is no simple answer to how it should be managed. PURPOSE: In this study, we want to evaluate, if repeated peripheral alcohol injection is an effective treatment of TN patients. MATERIAL AND METHODS: Retrospective data analysis of patients treated with peripheral alcohol injections from November 2011 to July 2017 were conducted. We selected the patients who reported at least three times for alcohol injection and duration of pain relief recorded as reported by patients. RESULTS: Effects of 96% absolute alcohol injection alcohol injection ranging from 13 to 15 months pain relief, but in second or third time, this duration was decreased to 11-12 months, whereas no much significant complication were observed. CONCLUSION: Even single time neurectomy is not permanent cure, so patients choose less invasive option such as peripheral alcohol injections in repeated use instead of a surgical option.

Circulating MicroRNA-21 Expression as a Novel Serum Biomarker for Oral Sub-Mucous Fibrosis and Oral Squamous Cell Carcinoma

Background: Circulating miRNAs (miRs) in the biofluids such as serum and plasma act as potential biomarkers for early diagnosis, treatment and prognosis. In the present study, an attempt made to see the expression of miR-21 in serum of 20 cases of Oral sub-mucous fibrosis (OSMF), 20 cases of Oral squamous cell carcinoma and 40 healthy volunteers. The expression of miR-21 was evaluated in relation to different demographical and clinicopathological features such as sex, tobacco, pan-masala, alcohol, smoking and clinical staging respectively with an aim to identify correlation with oral pre-cancer and cancer stages. Materials and Methods: The relative expression level of miR-21 was determined by quantitative real-time RT-PCR (qRT-PCR) in the sera of 20 OSCC, 20 OSMF patients and 40 healthy subjects as a control. Association between expression of miR-21 and OSCC clinical stages and demographical parameters such as sex, pan-masala, tobacco, smoking, alcohol have also been analyzed in detail. Results: The results obtained by t-test revealed significant increase in the expression level of miR-21 in OSCC as compared to OSMF. The study also revealed the positive correlation between higher miR-21 expression and pan-masala chewers as shown by t-test. The statistical test, ANOVA has also indicated a positive correlation between up-regulation of miR-21 in the clinical stages of the OSCC. Conclusion: The results of present study indicated up-regulation of circulating miR-21 in serum of OSCC as compared to OSMF (p=0.001), this study also elucidated the positive correlation between miR-21 expression in OSCC/OSMF patients, only one demographical parameter (Pan-masala) and negative correlation for other parameters such as sex, tobacco, smoking, alcohol etc. Other findings suggested a significant increase (p=0.000) in the expression of miR-21 in clinical staging (I-IV) of oral cancer. More studies are needed to validate it as potential diagnostic and prognostic biomarker for OSMF and OSCC for better management.

Feasibility of Dentascan in planning of implant surgery in posterior maxilla and mandible.

OBJECTIVES: The present evaluate the feasibility of Computed tomography (Dentascan), in assessment of the implant site in posterior maxilla & mandible. MATERIAL AND METHODS: data of total 11 patients with 20 implant sites were involved in the present study. Out of the 20 implant sites selected 10 were in posterior maxilla and 10 in posterior mandible. All the patients were routinely examined by panoramic radiography and CT. All images obtained i.e., conventional panoramic radiograph, and film based Dentascan MPR- CT images were evaluated for the detectability of mandibular canal at the mental foramen, 1 cm, 2 cm, and 3 cm posterior to mental foramen. The judgments were then compared by using the four point grading score. RESULTS: Both the statistical analysis and radiographic observation showed that Dentascan MPR CT gives significantly clearer images at the mental foramen and 1 cm, 2 cm , 3 cm posterior to it. Dentascan also provides significantly better visualization of the vital structures along with the bone density. The panoramic and Dentascan MPR CT images did not show a significant difference in visualization of the crest of alveolar ridge in both maxillary as well as the mandibular arch. CONCLUSION: The Dentascan MPR- CT images revealed significantly clearer images as well as better visualization of the vital structures than conventional panoramic radiography. Apart from providing clearer images Dentascan also gives the buccopalatal/buccolingual dimension at the implant site, along with the density of the available bone.

Effect of scaling & root planing on the activity of ALP in GCF & serum of patients with gingivitis, chronic and aggressive periodontitis: A comparative study.

INTRODUCTION: Host response and environmental factors are known to modify periodontal status adversely. Presently serum, saliva, and GCF are being investigated for its biochemical constituents. GCF contains array of biochemical factors, offering potential use as a diagnostic or prognostic biomarker of the biologic state of the periodontium in health and disease. Alkaline phosphatase is produced locally in the periodontium and shows positive correlation with disease activity and PD. Present study was designed to analyze the levels of ALP in GCF and serum of patients with gingivitis, chronic & aggressive periodontitis before and after SRP & to compare the difference within the study groups. METHODS: OPD patients grouped into: Gingivitis, Aggressive periodontitis & chronic periodontitis patients. Clinical parameters recorded for each patient prior to therapy. Pooled GCF samples collected using micro capillary tubes from the deepest pocket sites for each patient and stored at -70° C. Serum samples also collected and stored at -20° C. Each patient was subjected to scaling and root planing with two weeks maintenance recall. After 6 to 8 weeks GCF and serum samples collected again and all clinical parameters rerecorded. GCF and serum samples analyzed for levels of ALP by using para nitro phenol assay for the three groups. RESULTS: ALP levels in GCF increased significantly during active phase of disease followed by statistically significant reduction after phase I therapy. Baseline levels of ALP in GCF was CP > AP > G with maximum reduction in GCF ALP after SRP in G > CP > AP group.

The effect of sodium bicarbonate oral rinse on salivary pH and oral microflora: A prospective cohort study.

AIM: Present study is designed to explore the effect of sodium bicarbonate oral rinse on salivary pH and oral micro flora. MATERIALS AND METHODS: Twenty five healthy subjects were recruited for the study in department of dentistry in Era Medical College. Subjects were abstained from tooth brushing overnight pre rinse (control) samples were collected after one hour of dinner and were asked to rinse with pre calibrated freshly prepared sodium bicarbonate solution. The salivary samples were then collected the following morning using sterile gauze in marked bottles. Aerobic bacterial culture was done by plating the sample directly from the swab on the surface of Blood agar and Mac Conkeys media respectively. The colony forming units and ph were calculated for the pre rinse and post rinse saliva sample. RESULT: Results shows that salivary pH increased significantly after sodium Bicarbonate oral rinse. There was a marginal decrease in number of CFU/ml for bacteria especially Viridans Streptococci, Moraxella species. CONCLUSION: Sodium Bicarbonate oral rinse may be considered as a cheap and effective alternative for chlorhexidine and alcohol based mouth wash, especially where long duration usage is required.

Wisdom tooth--complications in extraction.

The purpose of this study is to analyze the incidence of complications in a group of 171 patients in whom extractions of impacted mandibular third molar have been performed by two oral surgeons between the period April 2010 and March 2012. This retrospective study comprises evaluation of 270 impacted mandibular third molars which were classified into two groups A and B on the basis of procedure of osteotomy only and osteotomy and odontotomy both respectively. Total no of complications reported were 40 (14.81%). Maximum no of cases reported alveolar osteitis (AO) (11.11%) while other complications reported root tip fractures (2.22%), lingual nerve parasthesia and TMJ problems (each 0.74%) in descending frequency. Conclusion drawn is that the risk of complications in extractions of impacted mandibular third molars always exists, and extractions associated with both osteotomy and odontotomy are associated with higher risk of complications.