Age Estimation Using the Tooth Coronal Index on Mandibular First Premolars on Digital Panoramic Radiographs in an Indian Population.

Objectives: Age estimation is a crucial aspect of forensic odontology, and the Tooth Coronal Index (TCI) has been widely used for forensic purposes in determining age. The aim of this research was to evaluate the effectiveness of TCI in age estimation. Materials and Methods: A retrospective study was conducted, and TCI was calculated for the mandibular first premolar in 700 digital panoramic radiographs. Age was divided into five groups: 20-30 years, 31-40 years, 41-50 years, 51-60 years, and >61 years. Bivariate correlation was used to establish the relationship between TCI and age. Linear regression was calculated for the different age groups and genders. Inter-observer reliability and agreement were assessed using one-way ANOVA. P-values less than 0.05 were considered statistically significant. Results: Comparison of the mean difference from actual age showed underestimation in males aged 20-30 years and overestimation in males over 60 years of age. The least difference between actual and calculated age was found in females aged 31-40 years. Inter-age comparison using ANOVA for females demonstrated a statistically highly significant difference from actual age in all age groups (P<0.01), with the highest mean in females aged 51-60 years and the lowest in females aged 31-40 years. Inter-group comparison of mean TCI revealed statistically non-significant differences in males and statistically highly significant differences in females (P<0.01). Conclusion: Age estimation using TCI on mandibular first premolars can be recommended as an easy, non-invasive, and less time-consuming method. This study suggests that regression formulas were more accurate for males aged 31-40 years.

Epithelial Atrophy, Fibrosis and Vascularity Correlation with Epithelial Dysplasia in Oral Submucous Fibrosis, a Prospective Study.

Background: The pathogenesis of oral submucous fibrosis (OSF) still remains conflicting and has been linked to alterations in epithelial thickness, fibrosis, and vascularity. Although changes in these individual parameters have been extensively studied in relation to epithelial dysplasia their combined relation with dysplasia has not been studied much. Any such relation, if present, may further help in understanding this disease process. Therefore, the aim of this study was to assess the relationship between epithelial thickness, fibrosis, and vascularity with dysplasia in OSF. Materials and Methods: The study consisted of 30 OSF patients. Incisional biopsy was taken from the most fibrosed area of the buccal mucosa. Hematoxylin-Eosin-stained slides were assessed for epithelial thickness, fibrosis, and vascularity using image analysis software. The slides were also assessed for epithelial dysplasia. Relationship of epithelial atrophy, fibrosis, and vascularity with dysplasia was assessed using one-way ANOVA. Pearson's correlation coefficient was used for evaluating the relationship between epithelial thickness, fibrosis, and vascularity. Results: Epithelial dysplasia was found in all patients. Eleven patients had mild (36. 67%), thirteen had moderate (43.33%), and six had severe (20%) dysplasia. None of the parameters were found to have a significant relationship with dysplasia. However, moderate and positive correlation was found between epithelial thickness and fibrosis. This relation was statistically significant. Conclusion: Positive correlation between epithelial thickness and fibrosis in present study therefore contradicts the hypothesis of fibrosis induced epithelial atrophy. As dysplasia is influenced by multiple factors therefore habits and burning sensation needs to be incorporated in future studies assessing dysplasia in OSF.

Correlation of Clinical Features in Oral Submucous Fibrosis: A 9-Year Retrospective Study.

BACKGROUND: Oral Submucous Fibrosis is a chronic debilitating disease and potentially malignant disorder of the oral cavity known in medical literature for a long time. The study aims to correlate the clinical staging of Oral Submucous Fibrosis with various clinical findings of the oral mucosa like hyperpigmentation, erosions, ulcerations, VAS score, tongue protrusion, and cheek flexibility. METHODS: A retrospective observational study was undertaken and records of 1267 clinically diagnosed cases of OSMF were included in the study. Clinical grading was done as per criteria by Lai DR et al. The observations were tabulated and subjected to statistical analysis using SPSS software. RESULTS: In our study, the incidence of hyperpigmentation, erosions, and ulcerations was higher in Group C OSMF. Visual analog scores in the range of 5-6 was noted in 40.9% of the total subjects, out of which 36.2% belonged to Group C OSMF. Tongue protrusion of less than 25 mm was seen in 10.65% of the subjects. Cheek flexibility of less than 0.6 cm was seen in 19.62% of the subjects, most of which belonged to Group D. CONCLUSION: In our study, we found an increase in the occurrence and severity of symptoms with an increase in grades of OSMF, but this increase was not observed to be consistent. Hence classification based on a single clinical entity cannot be sufficient and correlations to other clinical findings should be studied over a large population and a multi-tier classification could be proposed in the future.

Oral submucous fibrosis and its impact on psychological stress: a case-control study.

Our aim was to evaluate the impact of OSF on psychological stress. Ninety OSF cases and age and sex-matched controls, enrolled from relatives or accompanying person were included in the study. Psychological stress was evaluated by the Psychological General Well Being Index short version (PGWBI-S). Sets of the psychological component were generated by principal component analysis (PCA). Association between components was accommodated for confounder and interaction was evaluated by conditional stepwise logistic regression analysis. Psychological component generated was component 1 (depressed mood, lack of positive well being, low vitality, anxiety, low vitality, and low self-control). The odds ratio (OR) of low score of component 1 for OSF was 3.66. Depressed mood, lack of positive well being, low vitality, anxiety, low vitality, and low self-control were associated with OSF. Psychological intervention should, therefore, be included in the management of OSF.

The prevalence of oral squamous cell carcinoma with oral submucous fibrosis.

OBJECTIVE: The objective of the study was to find out the prevalence of oral squamous cell carcinoma (OSCC) with oral submucous fibrosis (OSF) in patients with OSF. MATERIALS AND METHODS: Of 48,757 patients, we found 300 OSF subjects. Three hundred patients of OSF were checked for OSCC. Both OSF and OSCC with OSF (OSCCwOSF) were diagnosed histopathologically. The prevalence of OSCCwOSF was calculated. Descriptive analysis was done. Chi-square test and t-test were calculated for proportions and mean, respectively, to check any difference among OSF and OSCCwOSF groups. Age-specific relative risk was calculated in OSF and OSCCwOSF groups. Multiple logistic regression analysis was done among odd ratios of the different variable between OSF and OSCCwOSF groups. RESULTS: The prevalence of OSCCwOSF among OSF was 13.7% over a period of 1 year. The mean age of OSCCwOSF group was 43.95 ± 10.22 years in comparison to the OSF group that was 35.51 ± 11.26 years (P < 0.00). The mean habit duration was significantly less in the OSF group when compared to OSCCwOSFgroup for mishri (P = 0.002). Age-specific adjusted relative risk of OSCC in OSF patient increases from 0.33 (18-34 years) to 3.86 (≥65 years). CONCLUSION: It could be concluded that a 13.7% prevalence rate of OSCCwOSF in OSF patients should alert the clinician. Clinicians should, therefore, anticipate OSSC in OSF patients. This awareness could lead to the early diagnosis and management of such OSCC.

Atypical extragingival occurrence of lobular capillary hemangioma: A report of two cases.

Capillary hemangiomas and pyogenic granuloma (PG) are well-recognized benign entities of the oral cavity which are vascular in origin. PG is said to have a predilection for gingival area, whereas capillary hemangioma involves the lips, cheek, and tongue. They may mimic more serious conditions such as malignancies making the clinical diagnosis quite challenging. There have been cases reported where PG was found on extra-gingival sites such as the palate, lips, and tongue. We present the two cases of lobular capillary hemangioma (LCH) on extragingival sites, namely the palate and buccal mucosa, which manifested as a different lesion clinically and histopathological examination was indicative of LCH. The cases reported here show that relatively common pathologies can present on rare or atypical regions inside the oral cavity, and hence, it is imperative for the clinician to consider such lesions while formulating a diagnosis.

Radiographic extent of maxillofacial Gorham's disease and its impact on recurrence: A systematic review.

OBJECTIVE: This systematic review assessed the radiographic extent of maxillofacial Gorham's disease and its impact on recurrence. STUDY DESIGN: PubMed and Cochrane databases were searched. The key words were (Gorham Disease OR Vanishing Bone Disease OR Gorham Stout Syndrome) AND (Jaw OR Maxilla OR Mandible OR Maxillofacial). RESULTS: Forty-one cases from 39 articles were included. Based on radiographic extent, the lesions were classified as large or small. Most cases occurred in the mandible (24), followed by a combination of maxilla and/or mandible and other bones (12), both mandible and maxilla (3), and maxilla only (2). Only mandibular cases were analyzed for radiographic extent. Of the 24 mandibular lesions, 16 were large and 8 were small. Nine of the large lesions occurred in the young age group with 2 recurrences, followed by 5 in the middle-aged group with 1 recurrence. Small lesions were nearly equally distributed over the age groups, with 2 recurrences in the middle-aged group and 1 recurrence in the adult age group. Age, sex, and lesion size had no significant effect on recurrence. CONCLUSIONS: Radiographic extent of the lesion does not impact recurrence, suggesting a possible existence of aggressive and nonaggressive variants of maxillofacial Gorham's disease.

Assessment of the dimensions of the pterygoid hamulus for establishing age- and sex-specific reference standards using cone-beam computed tomography.

PURPOSE: This study was conducted to establish age- and sex-specific reference standards for pterygoid hamulus (PH) dimensions using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT scans of 1,000 patients (493 males and 507 females) were retrospectively assessed in coronal sections for length and width measurements of the PH by 3 investigators. The study data were divided into 3 age groups (group 1: <20 years, group 2: 20-50 years, group 3: >50 years). Length and width were compared using one-way analysis of variance and the t-test for age and sex, respectively. RESULTS: The length of the PH on the right side significantly increased from group 1 (6.11±1.47 mm), through group 2 (6.65±1.67 mm) to group 3 (6.99±1.79 mm) and on the left side from group 2 (6.58±1.63) to group 3 (6.98±1.70). The width of the PH significantly decreased from group 1 (1.81±0.39 mm) to group 2 (1.61±0.39 mm) on the right side, and similarly from 1.87±0.36 mm to 1.67±0.37 mm on the left side. PH length (7.18±1.81 mm on the right side and 7.10±1.72 mm on the left side) and width (1.68±0.38 mm on the right side and 1.74±0.36 mm on the left side) were significantly greater in males than in females. CONCLUSION: The length of the PH increased with age, whereas width first decreased and then increased. Length and width measurements were significantly higher in males than in females. These findings will aid in the diagnosis of untraceable pain in the oropharyngeal region related to altered PH morphology.

Efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and QOL in patients with OSF.

OBJECTIVES: To assess the efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and quality of life (QOL) in patients with oral submucous fibrosis. STUDY DESIGN: Sixty patients were divided in 4 groups; group A received 8 mg of betamethasone, group B received 3000 IU of hyaluronidase, group C received the combination of betamethasone and hyaluronidase and group D received saline injections biweekly for 5 weeks. Patients were also assessed using QOL questionnaire. RESULTS: Mouth opening and oral burning of the four groups for final visit, using the pretreatment opening as a covariate showed significant difference for group A, B, C. CONCLUSION: Betamethasone and hyaluronidase injections appears to be a viable option to increase mouth opening with reduction in burning sensation.

Imaging Analysis of Onodi Cells on Cone-Beam Computed Tomography

Abstract Introduction Onodi cells are the most posterior ethmoid air cells, and extend superolaterally to the sphenoid sinus. The identification of Onodi cells is essential to because they can have some significant anatomic variations and relationships to vital adjacent structures, like the optic canal, the sphenoid sinus, and the internal carotid artery. Objective The present study aimed to assess the prevalence of Onodi cells and their position with respect to sphenoid sinus. To the authors' best knowledge, this is the first study that uses cone-beam computed tomography (CBCT) to assess the prevalence and position of Onodi cells. Methods We collected CBCT scan records from November 1st, 2016, to July 31st, 2017; the patients who fulfilled the eligibility criteria were included in the present study. The CBCT scans were reviewed by two independent observers. The descriptive statistics was performed using the Statistical Package for the Social Sciences (SPSS, SPSS, Inc., Chicago IL, US) software, version 17.0. A cross-tabulation of gender with the presence and position of Onodi cells was evaluated using the Chi-squared (χ2) test. The inter- and intraobserver agreements were evaluated using Kappa (κ) statistics. Results Onodi cells were identified in 86 (42.8%) out of 201 patients. A subgroup analysis revealed that Onodi cells were present in 45 (43.3%) female and 41 (42.3%) male patients. The position of the Onodi cells was superior with respect to the sphenoid sinus in 43 (50%) of the patients, superolateral in 36 (41.9%), and lateral to the sphenoid sinus in 7 (8.1%) of the patients. Conclusion The present study indicated a high prevalence of Onodi cells, with approximately equal distribution among males and females, and mostly superior in position in relation to the sphenoid sinus.

Imaging Analysis of Onodi Cells on Cone-Beam Computed Tomography.

Introduction Onodi cells are the most posterior ethmoid air cells, and extend superolaterally to the sphenoid sinus. The identification of Onodi cells is essential to because they can have some significant anatomic variations and relationships to vital adjacent structures, like the optic canal, the sphenoid sinus, and the internal carotid artery. Objective The present study aimed to assess the prevalence of Onodi cells and their position with respect to sphenoid sinus. To the authors' best knowledge, this is the first study that uses cone-beam computed tomography (CBCT) to assess the prevalence and position of Onodi cells. Methods We collected CBCT scan records from November 1st, 2016, to July 31st, 2017; the patients who fulfilled the eligibility criteria were included in the present study. The CBCT scans were reviewed by two independent observers. The descriptive statistics was performed using the Statistical Package for the Social Sciences (SPSS, SPSS, Inc., Chicago IL, US) software, version 17.0. A cross-tabulation of gender with the presence and position of Onodi cells was evaluated using the Chi-squared (χ 2 ) test. The inter- and intraobserver agreements were evaluated using Kappa (κ) statistics. Results Onodi cells were identified in 86 (42.8%) out of 201 patients. A subgroup analysis revealed that Onodi cells were present in 45 (43.3%) female and 41 (42.3%) male patients. The position of the Onodi cells was superior with respect to the sphenoid sinus in 43 (50%) of the patients, superolateral in 36 (41.9%), and lateral to the sphenoid sinus in 7 (8.1%) of the patients. Conclusion The present study indicated a high prevalence of Onodi cells, with approximately equal distribution among males and females, and mostly superior in position in relation to the sphenoid sinus.

Validity of Diagnostic Criteria for Temporomandibular Joint Disorder in the Diagnosis of Disc Displacement Disorders of Temporomandibular Joint.

OBJECTIVE: The objective of this study is to assess the validity Diagnostic Criteria for Temporomandibular joint Disorder (DC/TMD) in the diagnosis of disc displacement (DD) disorders of temporomandibular joint (TMJ). STUDY DESIGN: It was a prospective study in which total of 55 patients accounting to 110 TMJ; with clinical diagnosis of DD disorder as per DC/TMD criteria and all above age of 18 years were included. All the patients with clinical diagnosis of DD disorder were advised MRI. All the MRI scans were read by single radiologist. Clinician and Radiologist were blinded to each others findings. MRI diagnosis and clinical diagnosis were compared and results were formulated. RESULTS: The use of the Kappa statistic test indicated a good diagnostic agreement (k = 0.68) between the clinician and the radiologist. The DC/TMD criterion was found to have good validity and reliability in the diagnosis of DD disorders with sensitivity of 91.57% and specificity of 77.78%. The positive predictive value and negative predicted value calculated were 92.68% and 78%, respectively. The positive and negative likelihood ratio found was 4.12 and 0.11, respectively. CONCLUSION: DC/TMD is a simple, reliable, valid, cost-effective tool in the diagnosis of DD disorders.

Proximity of the roots of maxillary posterior teeth to the floor of maxillary sinus and cortical plate: A cone-beam computed tomography assessment.

INTRODUCTION: The purpose of the study is to assess the vertical and horizontal relationship between the roots of maxillary posterior teeth and neighboring structures like the floor of the maxillary sinus and cortical plates using cone-beam computed tomography (CBCT). METHOD AND MATERIALS: 100 CBCT scans of the patients from the Indian population were analyzed. Vertical and horizontal relationship between the roots of maxillary posterior teeth and the floor of the maxillary sinus was divided into 4 types and 3 types, respectively. Distances between the root apices and the floor of the maxillary sinus and cortical plate was measured for each root and results were formulated. RESULTS: In total 365 teeth were assessed, 185 first molar and 180 second molar. It was found that the roots of first molar and second molar usually had type 2 (root apices in close contact with the floor of maxillary sinus) and type 3 (roots projecting laterally into the sinus, but its apices are outside the sinus border) vertical relationship respectively with the floor of maxillary sinus. The deepest portion of the floor of the maxillary sinus was most commonly seen projecting between buccal and palatal roots. The mean distance between the cortical plate and root was highest for the distobuccal root of second molar i.e., 1.20 mm SD = 0.97. CONCLUSION: The distobuccal root of the first molar and mesiobuccal root of the second molar are closest to the sinus floor, hence clinician should be extra cautious while working on these roots during endodontic or surgical procedures in the Indian population.

Apert's syndrome: A rare craniofacial disorder.

Apert's syndrome (AS) which is a rare congenital disorder is a form of acrocephalosyndactyly. This syndrome is characterized by craniosynostosis, midface hypoplasia, and syndactyly of hands and feet. We report a case of 13-year-old boy in India presenting features of AS such as exophthalmos, hypertelorism, strabismus, steep forehead, parrot beak nose, depressed nasal bridge, and retruded middle third of the face. The purpose of this report is to present a case of AS by highlighting the craniofacial characteristics.

Andersen-Tawil Syndrome and Hypothyroidism: A Case Report with an Unusual Association.

Andersen-Tawil syndrome (ATS) is an autosomal dominant disorder, characterized by the triad of muscular paralysis, skeletal, and craniofacial anomalies and prolonged QT interval on echocardiogram with a tendency toward malignant ventricular arrhythmia. Although the patient may express one or two of the three components of triad, hypothyroidism is an endocrine disorder resulting in the delayed eruption of teeth, defective mineralization of bone and teeth, and speech and hearing deformity. Here, we report a case of ATS with hypothyroidism. To the best of authors' knowledge, no such association has been reported in the literature.

Attitude and awareness of general population towards radiation hazards and safety: An institutional study.

CONTEXT: Radiological investigations play a pivotal role in the diagnosis and treatment of a wide range of procedures. AIM: To assess the knowledge regarding adverse consequences of radiological examination and encourage awareness regarding radiation protection amongst general public. SETTINGS AND DESIGN: A questionnaire-based cross-sectional study conducted amongst patients visiting the dental outpatient department. MATERIALS AND METHODS: 1,000 adult male and female patients within the age of 20-70 years who visited the outpatient department during May-July 2017 were included in the study. STATISTICAL ANALYSIS: Comparison of frequencies of responses to each item with age and gender was done using chi square test. For all statistical tests, P < 0.05 was considered to be statistically significant, keeping α error at 5% and ß error at 20%. RESULTS: 85.3% participants had visited a hospital earlier and 69.3% had undergone the procedure of an X-ray earlier. Out of those patients, only 24.7% of the participants had any knowledge about the equipment or the procedure while taking a radiograph. 5.2% of the participants were given any safety measures during the radiological procedure. 14.4% had knowledge of the risks and hazards associated with radiation. CONCLUSIONS: This short study showed that there is a need for educating the general population about the hazards and risks associated with radiation exposure.

Validity of Chronic Oral Mucosal Diseases Questionnaire in oral submucous fibrosis.

OBJECTIVE: To validate the use of Chronic Oral Mucosal Diseases Questionnaire in oral submucous fibrosis. MATERIALS AND METHODS: Hundred consecutive oral submucous fibrosis (OSF) patients were requested to respond to Visual Analogue Scale (VAS) score and complete the Oral Health Impact Profile 14 (OHIP 14) and COMDQ. Spearman's rho correlation was used to assess the relationship between VAS and COMDQ score and COMDQ and OHIP 14 score. The reliability of the instrument was assessed using Cronbach's alpha analysis. Discriminant analysis was used to assess if COMDQ significantly differentiated between OSF population with and without any prior treatment done as well as OSF with mouth opening less than and more than or equal to 25 mm. RESULTS: The Spearman's correlation coefficient showed a high significance between the different domains of COMDQ and OHIP 14 and COMDQ and VAS. This study demonstrated a good convergent validity between the overall COMDQ and OHIP 14 scores (0.88).The overall Cronbach's alpha value was found to be 0.75 indicating an acceptable internal consistency reliability of COMDQ. The tool was unable to differentiate between patients with mouth opening between less than and more than or equal to 25 mm and patients with and without prior treatment. CONCLUSION: These results provide evidence that COMDQ can be used for OSF patients. CLINICAL RELEVANCE: COMDQ could be used as a valid and reliable tool for further clinical OSF research.

Diagnostic Value of Extraoral Periapical Radiograph in Comparison to Intraoral Periapical Radiograph: A Cross-sectional, Institutional Study.

BACKGROUND: Radiographs form an invaluable adjunct in diagnosis, treatment planning, and postoperative evaluation during patient management in the dental office where intraoral periapical (IOPA) radiographs are the ones most commonly used. However, certain conditions render the placement of film difficult. In such cases, a panoramic radiograph may be taken, but it has the disadvantage of higher radiation exposure and cost. Extraoral periapical (EOPA) technique allows radiographs to be taken on an IOPA film by placing it extraorally. We aimed to evaluate its diagnostic accuracy compared to intraoral bisecting angle technique. MATERIALS AND METHODS: Forty-five patients were randomly selected. Ninety radiographs were taken; two for each patient. First image was obtained by intraoral bisecting angle technique and second by EOPA technique. A scale was devised for the comparison of radiographs taken by the two techniques. Two experienced oral radiologists rated them based on the scale followed by statistical analysis. RESULTS: Patients reported increased compliance with the EOPA technique. 84.40% of the EOPA radiographs (EOPARs) were diagnostically acceptable; sensitivity and specificity was 84% and 55%, respectively. CONCLUSION: EOPAR is beneficial in cases where intraoral film placement is difficult, and a radiograph is necessary for patient management, even though it demonstrates comparatively lesser diagnostic accuracy.

Analysis of Intercanine Distance and Dimensional Changes in Bite Marks on Foodstuffs Using Cone Beam Computed Tomography.

Bite marks on foodstuff at the crime scene provide a 3-dimensional imprint of the suspect's dentition. The bite mark analysis can provide useful evidences, leading to the inclusion or exclusion of the individual under investigation. This study was designed to assess bite marks on various common foodstuffs (chocolate, apple, chewing gum, cheese) for different time intervals using cone beam computed tomography (CBCT) to evaluate the dimensional changes in the foodstuffs. Analysis of variance test was used to compare the bite marks measured using CBCT in maxillary and mandibular arches with significance set at P < 0.05. The results show that teeth can transfer their characteristics to the bitten foodstuffs. The highest accuracy for comparative bite mark analysis was observed in chocolate followed by cheese, chewing gum, and apple. The CBCT-assisted analysis of bite marks is a nondestructive, accurate, and efficient method. The CBCT documentation has no distortion artifacts, and subsequent analysis in 3-dimensional space is possible.