Temporomandibular disorders in North Indian population visiting a tertiary care dental hospital.

BACKGROUND: The terminology "temporomandibular disorders" (TMDs) encompasses a wide spectrum of conditions. Several hypothesized causes are occlusal disharmony, muscle hyperactivity, central pain mechanisms, psychological distress, and trauma. In day-to-day practice, TMDs had become more prevalent in Indian population due to changed dietary pattern and food habits, excessive stress of modern life, and other environmental causes. This study is an attempt to find the prevalence of TMDs in North Indian population. AIMS: The present study is taken into account to determine the prevalence of TMDs on the basis of signs and symptoms based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). MATERIALS AND METHODS: The present cross-sectional study was conducted in the Department of Oral Medicine and Radiology. A total of 1009 patients aged between 6 and 80 years with a mean age of 42.04 ± 16.8 years seeking dental treatment from January 2016 to June 2017 were included in the study. All the patients were screened for TMD sign and symptoms. The demographic data and the signs and symptoms of TMDs were recorded in designed structured questionnaires which were based on the RDC/TMD criteria. RESULTS: The study population consisted of 1009 patients aged between 6 and 80 years. In the present study population, based on RDC/TMD criteria, the incidence of clicking sound (42.5%) was highest in TMD joint followed by deviation of mandible on mouth opening (40.8%), internal derangement (36.8%), myofacial pain dysfunction syndrome (33.7%), osteoarthritis (29.5%), crepitus (25.8%), joint tenderness (5.8%), and pain on mouth opening (4.8%). CONCLUSION: Clicking sound was the most common sign of TMD disorders in Indian population.

Serum DHEA-S levels could be used as a comparable diagnostic test to assess the pubertal growth spurt in dentofacial orthopedics.

BACKGROUND: Pubertal growth spurt assessment guides the timing of intervention for correcting the skeletal discrepancies in dentofacial orthopedics. Serum hormones are being studied for the skeletal age assessment to avoid unnecessary radiographic exposure. The present study is to evaluate the relationship of serum hormones dehydroepiandrosterone-sulfate (DHEA-S), insulin-like growth factor (IGF-1), and cervical vertebral stages (CS stages) in the skeletal age assessment of orthodontics patients around the circumpubertal age. METHODS: A total of ninety subjects with age ranging from 7 to 21 years were selected and divided into two groups based on the sex (45 males, 45 females). They were further distributed in each group based on the six CS stages determined from the lateral cephalogram. Blood samples from each subject were collected to evaluate the serum DHEA-S and IGF-1 levels by using the enzyme-linked immunosorbent assay (ELISA). Collected data were analyzed in SPSS software with a test of normalcy, unpaired t test, and one-way analysis of variance (ANOVA) followed by the least significant difference (LSD) post hoc comparison test and univariate regression analysis. RESULTS: The highest mean serum hormone levels were found in CS 4 in group A (male) and CS 3 in group B (female). ANOVA results showed that there was a significant difference in the serum hormone levels among the different CS stages in both the groups for both the hormones. Statistically, a significant difference was found between each CS stages for both the hormones except in the DHEA-S levels between CS 5 and CS 6. CONCLUSIONS: The mean serum DHEA-S levels followed a typical pattern from the CS 1 till CS 6 which was comparable and similar to the mean serum IGF-1 levels in respect to CS stages. Thus, serum DHEA-S levels could be used as a possible diagnostic test for the assessment of the skeletal pubertal growth spurt in dentofacial orthopedics.

Management of severe skeletal Class III malocclusion with bimaxillary orthognathic surgery.

Orthognathic surgery in conjunction with fixed orthodontics is a common indication for interdisciplinary management of severe skeletal Class III malocclusion. A thorough analysis of pretreatment investigations and development of a surgical visual treatment objective is essential to plan the type of surgical technique required. Bimaxillary orthognathic surgery is the most common type of surgical procedure for severe skeletal discrepancies. The present case report is a combined ortho-surgical team management of a skeletally Class III patient. The severity of the case required bilateral upper first premolar extraction for dentoalveolar decompensation and simultaneous "Two-jaw surgery" with maxillary advancement of 4 mm and mandibular setback of 7 mm. Postsurgery, a pleasing good facial profile was achieved with Class II molar relation and positive overjet.

Evaluation of facial divine proportion in North Indian Population.

OBJECTIVE: To evaluate the facial divine proportion and its relationship with facial attractiveness in North Indian population. MATERIALS AND METHODS: For evaluation of various facial proportions, standardized frontal facial photographs of total 300 subjects between 18 and 30 years of age were obtained. Black and white copies of these photographs were presented in front of an evaluation jury for assigning scores of facial attractiveness and finally 130 attractive subjects were selected. These subjects were divided into two groups, Group I (attractive females n = 65) and Group II (attractive males n = 65) and they were further analyzed for various parameters of facial proportions. Unpaired Student's t-test was used to compare both groups. RESULTS: Group I showed that five of seven vertical facial proportions were close to divine proportion (1.618) whereas only two vertical proportions in Group II were close to it. Transverse facial proportions in both groups deviated more from divine proportion (1.618) and were closer to silver proportion (1.414). CONCLUSIONS: Most of the facial proportions of attractive females in the North-Indian population were close to the divine proportion. Thus, facial divine proportion could be an important factor in the perception of facial attractiveness of North-Indian attractive females.

Treatment of Bi-maxillary Protrusion with Impacted Maxillary and Mandibular Canines: Case Report.

Bi-maxillary protrusion in adolescent patients has traditionally been treated by extraction of the four first premolars and retraction ofthe anterior teeth. The ectopic eruption of the maxiIlary permanent canines is a frequently encountered clinical problem. Orthodontic treatment of the impacted teeth remains a challenge for clinicians. If it is associated with other dental and skeletalproblems, there will be further complications to the treatment plan. In such cases, if we extract canines, then problems with this approach are restricted to anatomical and functional limitations ofpremolars substitution of canines. Here, we are presenting a case report of bi-maxillary dento-alveolar protrusion with the impacted maxillary and mandibular left canines and its management.

Cephalometric norms for the upper airway in a healthy North Indian population.

OBJECTIVE: The aim was to obtain normative data for cephalometric measurements of the upper airway in the North Indian population. DESIGN: Observational study. SETTING: University department and teaching hospital out-patient clinic. SUBJECTS AND METHODS: A total of 180 healthy patients were included out of which 90 were males (age range, 8-16 years), and 90 were females (age range, 8-16 years), with normal skeletal facial profile, no history of snoring, sleep apnea, upper airway disease, tonsillectomy or adenoidectomy, obesity, or pathology in the pharynx. Twenty cephalometric airway measurements, including size of the tongue, soft palate, nasopharynx, oropharynx, hypopharynx, and relative position of the hyoid bone and valleculae were obtained. Landmarks on cephalometric radiographs were digitized and measurements were made using a specially designed computer program. Error analysis of measurements was performed and comparison of measurements according to sex was made. RESULTS: Significant sex dimorphism was seen for the majority of measurements, with the exception of minimal depth of the airway, oropharyngeal depth of the airway, and the soft palate angle with the hard palate. CONCLUSION: A minimum sagittal dimension of the upper airway was evident despite differences in measurements between sexes. Findings from this study should be a useful reference for the assessment of sleep apnea in the North Indian population.

Evaluation of mixed dentition analyses in north Indian population: A comparative study.

INTRODUCTION: Mixed dentition regression equations analyses (Moyers, Tanaka-Johnston) are based on European population, reliability of these methods is questionable over other population. MATERIALS AND METHODS: The present study was conducted on total 260 study models. This study was done in two phases. In the first phase, linear regression equations were made. In the second phase, comparison of actual values of sum of mesiodistal width of canine, first and second premolars with the predicted values proposed by Moyers, Tanaka-Johnston, and the new proposed mixed dentition analysis for North Indian population were made. RESULTS: Set of four linear regression equations for predicting sum of mesiodistal width of permanent canine, first premolar and second premolar in North Indian population from sum of mesiodistal width of mandibular incisors and mandibular first molars, were proposed as; (a) for males, maxillary arch, Y = 2.9 + 0.40X, (b) mandibular arch Y = 3.91 + 0.37X (c) for females, maxillary arch Y = 0.56 + 0.45X (d) mandibular arch Y = 1.14 + 0.42X. Moyers and Tanaka-Johnston, mixed dentition analysis, is found to be overestimating the mesiodistal width of unerupted canine and premolars in North Indian population.

A comparison of shear bond strength of orthodontic brackets bonded with four different orthodontic adhesives.

OBJECTIVES: The objective of this study is to compare the shear bond strength (SBS) of stainless steel (SS) orthodontic brackets bonded with four different orthodontic adhesives. MATERIALS AND METHODS: Eighty newly extracted premolars were bonded to 0.022 SS brackets (Ormco, Scafati, Italy) and equally divided into four groups based on adhesive used: (1) Rely-a-Bond (self-cure adhesive, Reliance Orthodontic Product, Inc., Illinois, USA), (2) Transbond XT (light-cure adhesive, 3M Unitek, CA, USA), (3) Transbond Plus (sixth generation self-etch primer, 3M Unitek, CA, USA) with Transbond XT (4) Xeno V (seventh generation self-etch primer, Dentsply, Konstanz, Germany) with Xeno Ortho (light-cure adhesive, Dentsply, Konstanz, Germany) adhesive. Brackets were debonded with a universal testing machine (Model No. 3382 Instron Corp., Canton, Mass, USA). The adhesive remnant index (ARI) was recordedIn addition, the conditioned enamel surfaces were observed under a scanning electron microscope (SEM). RESULTS: Transbond XT (15.49 MPa) attained the highest bond strength. Self-etching adhesives (Xeno V, 13.51 MPa; Transbond Plus, 11.57 MPa) showed clinically acceptable SBS values and almost clean enamel surface after debonding. The analysis of variance (F = 11.85, P < 0.0001) and Chi-square (χ(2) = 18.16, P < 0.05) tests revealed significant differences among groups. The ARI score of 3 (i.e., All adhesives left on the tooth) to be the most prevalent in Transbond XT (40%), followed by Rely-a-Bond (30%), Transbond Plus with Transbond XT (15%), and Xeno V with Xeno Ortho (10%). Under SEM, enamel surfaces after debonding of the brackets appeared porous when an acid-etching process was performed on the surfaces of Rely-a-Bond and Transbond XT, whereas with self-etching primers enamel presented smooth and almost clean surfaces (Transbond Plus and Xeno V group). CONCLUSION: All adhesives yielded SBS values higher than the recommended bond strength (5.9-7-8 MPa), Seventh generation self-etching primer Xeno V with Xeno Ortho showed clinically acceptable SBS and the least amount of residual adhesive left on the enamel surface after debonding.

Alignment of palatally impacted canine with open window technique and modified K-9 spring.

The patient was an 18-year-old female who had an Angle Class I malocclusion with a left palatally impacted maxillary canine. The orthodontic treatment of a palatally impacted canine is aimed at bringing the tooth into its correct position in the dental arch without causing any periodontal damage. To achieve this goal, a variety of surgical and orthodontic techniques have been proposed in relation to the position of the impacted tooth and there are various treatment methods used for traction. The duration of the traction was 3 months and alignment duration was 12 months the total treatment time was 15 months. In the following case, we presented that maxillary palatally impacted canine was brought into the arch with open window method for canine exposure and modified K-9 spring for traction, that is simple spring for orthodontic traction of the palatally impacted canines.

Treatment of facial lesions of multicentric reticulohistiocytosis by carbon dioxide laser.

The carbon dioxide (CO2) laser is a versatile tool that has applications in ablative lasing and caters to the needs of routine dermatological practice as well as the esthetic, cosmetic, and rejuvenation segments. We report a case of multicentric reticulohistiocytosis with cosmetically disfiguring confluent papules over the scalp, forehead, nasolabial folds, chin, and retroauricular region. We used CO2 laser in superpulse mode for ablating the lesions in three sittings. The lesions regressed completely and no recurrence was observed over a regular follow-up of 8 months.

Dynamics of a smile in different age groups.

OBJECTIVE: To evaluate smile in different age groups and to detect gender differences in smile. MATERIALS AND METHODS: Digital videographic records of 241 randomly selected subjects were obtained for smile analysis. The subjects were divided into four groups by age (15-20 years, 21-30 years, 31-40 years, and 41-50 years). Each group was further subdivided by gender. After 41 subjects were excluded, the smile dimensions of 200 subjects were analyzed by two-way multivariate analysis of variance (MANOVA) with Duncan's multiple range post hoc test. RESULTS: All dynamic measurements (change in upper lip length, upper lip thickness, commissure height, and intercommissural width from rest to smile) decreased with age in both males and females. Changes in upper lip length and commissure height on smiling were greater in males as compared with females of the same age groups. Changes in intercommissural width on smiling were greater in females as compared with males in all age groups. CONCLUSION: Smile changes with increase in age, and the changes differ between males and females. Females had a wider smile as compared with males of similar age groups.

Miswak in oral cavity - An update.

Miswak, scientifically known as Salvadora persica, is a species of Salvadora belonging to family Salvadoraceae. It is considered as "Nature's little toothbrush" as it is a popular chewing stick throughout Indian subcontinent. In India, it is commonly known as arak tree, meswak, peelu, kharjal or jhank. It also serves as a natural toothpaste with antibacterial, anti-caries, anti-periopathic disinfectant having anti-plaque and anti-fungal properties. Miswak sticks are being used by majority of people who cannot afford to buy the commercial western toothbrush and toothpaste mainly in rural areas of developing countries. The present review is an attempt to define the potential of the miswak in preventing and treating the common diseases of oral cavity and teeth.

Rare sweat gland tumors of vulva: Report of two cases.

Syringomas and Fox-Fordyce disease are appendageal skin disorders. While syringomas represent an adenoma of the intraepidermal eccrine duct, Fox Fordyce disease occurs due to blockage of the apocrine sweat duct. In both conditions, extragenital sites are more frequently involved than the genitalia. We herein report two young females, one with syringomas on the face and vulva and the other with Fox Fordyce disease involving axilla, areola and vulva, thereby citing the importance of examination of genitalia in these disorders.

Cephalometric evaluation of hyoid bone position and pharyngeal spaces following treatment with Twin block appliance.

OBJECTIVE: To evaluate the position of hyoid bone in the subjects treated with Twin block appliance. MATERIALS AND METHODS: The sample consisted of 40 Angle's Class II division 1 subjects treated with Twin block appliance. Lateral radiographs were taken before and after treatment. According to Schudy's facial divergence angle (SN-MP), the subjects were classified in to three groups: group I (hypodivergent, SN-MP: <31° (27°-30°), n=15), group II (normodivergent, SN-MP: 31°-34°, n=15), and group III (hyperdivergent, SN-MP: >34° (35°-38°), n=10). Lateral cephalograms were traced and analyzed manually. After measurements of variables, Student's t-test and one-way analysis of variance (ANOVA) were performed. RESULTS: Post treatment with Twin block therapy, hyoid bone shifted significantly (P<0.01) forward in horizontal dimension in all three groups, although it was highest in group III. However, there was no significant difference amongst the groups. In vertical dimension, hyoid bone shifted in upward direction in all three groups; however, the shift was significant (P<0.01) only in group I and there was a significant difference between group I and rest of the two groups. Width of upper airway significantly (P<0.01) increased and ANB angle significantly (P<0.001) decreased in all three groups with forward movement of mandible. CONCLUSIONS: After treatment with Twin block appliance, significant changes occurred in horizontal dimension (anterior displacement), which resulted in significant increase in width of upper pharynx in all three groups.

An ultrasonographic evaluation of masseter muscle thickness in different dentofacial patterns.

OBJECTIVES: The aim of this study is to compare the masseter muscle thickness in different vertical dentofacial patterns and identify the possible sexual dimorphism and also to correlate masseter muscle thickness with craniofacial morphology using cephalometric parameters. MATERIALS AND METHODS: The masseter muscle thickness was measured using ultrasonography in 60 subjects (30 females and 30 males). Standardized lateral and posteroanterior cephalograms were taken to determine the facial morphology. The subjects were divided into three vertical pattern groups (I, II, and III) according to their Jarabak ratio: hypodivergent ( n = 20), normodivergent (n = 20), and hyperdivergent (n = 20). The sample was further subdivided into males and female subgroups. RESULTS: Masseter muscle thickness relaxed (MMTR) in hypodivergent group was 13.94 ± 1.51. Mean value of MMTR in normodivergent group was 12.53 ± 1.21 and the MMTR in hyperdivergent group was 11.13 ± 1.18. The mean value of masseter muscle thickness contracted (MMTC) in hypodivergent group was 15.46 ± 1.33. Mean value of MMTC in normodivergent group was 13.81 ± 1.38 and the mean value of MMTC in hyperdivergent group was 12.27 ± 1.26. MMTC showed a significant, negative correlation with mandibular plane angle and gonial angle. Posterior facial height, symphysis width, intermolar width of maxillary first molars, maxillary width, and facial width (bizygomatic width) showed significant ( P < 0.05 or P < 0.01) positive correlation. CONCLUSION: The masseter muscle thickness varied among the three vertical dentofacial patterns and sexual dimorphism also existed except in the hyperdivergent group. Masseter muscle thickness was found to be negatively correlated to vertical facial pattern and positively associated with transverse craniofacial morphology.