Neural mobilization in low back and radicular pain: a systematic review.

BACKGROUND: Low back pain can present with radicular pain caused by lumbosacral nerve root pathology. Neural mobilization (NM) is a treatment technique used to treat low back and radicular pain (LBRP). PURPOSE: To evaluate the effectiveness of NM interventions in improving pain, disability, and function in adults with LBRP. DATA SOURCES: CINAHL Plus, MEDLINE (Ovid), Physiotherapy Evidence Database, and Cochrane databases were searched. STUDY SELECTION: Randomized controlled trials assessing the effect of NM on pain, disability, and/or function in adults with LBRP. DATA EXTRACTION: Authors reviewed studies and used the PEDro scale and the revised Cochrane risk-of-bias tool to assess methodological quality and risk of bias. DATA SYNTHESIS: Eight studies were included. Six of the eight studies found the addition of NM to conservative treatment improved all measured outcomes. One study found improvements in some but not all functional measures, and delayed improvements in pain. One study found improvements in measures of neural sensitivity, but not overall pain and disability. CONCLUSIONS: NM may be an effective tool for short-term improvements in pain, function, and disability associated with LBRP. Additional high quality research is needed. STUDY REGISTRATION: : This systematic review protocol was registered with PROSPERO (registration number: CRD42020192338).

Oral manifestations of systemic leukemia-first sign of presentation.

Acute myeloid leukemia (AML) is an aggressive hematopoietic malignancy that left untreated or undiagnosed can lead to death within few days. Hence, early diagnosis and appropriate treatment become necessary. Oral manifestations in AML could be the presenting feature or could a part of systemic manifestations. Gingival lesions appear as generalized enlargement with hemorrhagic discoloration with or without spontaneous bleeding. Sometimes, gingival lesions itself could a presenting sign without any other systemic manifesto. We report a similar case which was undiagnosed earlier and the patient came with a complaint of only the gingival swelling.

Comparison of dry needling and trigger point manual therapy in patients with neck and upper back myofascial pain syndrome: a systematic review and meta-analysis.

BACKGROUND: Patients with myofascial pain syndrome of the neck and upper back have active trigger points and may present with pain and decreased function. Dry needling (DN) and trigger point manual therapy (TMPT) techniques are often used to manage MPS. OBJECTIVE: To compare DN and TPMT for reducing pain on the Visual Analog Scale (VAS) and Pressure Pain Threshold (PPT) scores and improving function on the Neck Disability Index (NDI) in patients with neck and upper back MPS. METHODS: PubMed, PEDro, and CINAHL were searched for randomized controlled trials within the last 10 years comparing a group receiving DN and the other receiving TPMT. Studies were assessed using PEDro scale and Cochrane risk-of-bias tool to assess methodological quality. Meta-analyses were performed using random-effect model. Standardized mean differences (Cohen's d) and confidence intervals were calculated to compare DN to TPMT for effects on VAS, PPT, and NDI. RESULTS: Six randomized controlled trials with 241 participants total were included in this systematic review. The effect size of difference between DN and TPMT was non-significant for VAS [d = 0.41 (-0.18, 0.99)], for PPT [d = 0.64 (-0.19, 1.47)], and for NDI [d = -0.66 (-1.33, 0.02)]. CONCLUSIONS: Both DN and TPMT improve pain and function in the short to medium term. Neither is more superior than the other.

Orodental manifestations in cases with partial agenesis of corpus callosum-rare phenomena.

UNLABELLED: This article focuses on the associated signs and symptoms of patients with partial agenesis of the corpus callosum. The orodental manifestations of such cases have been given special weightage which will prove to be of great help to oral physician when encountered with such cases. CASE DETAILS: Two siblings, aged 14 and 16 years, reported with a chief complaint of severe crowding of teeth with mouth breathing habit. They were low birth-weight babies and had been born to non-consanguinous parents. The distinguishing features of these children were craniofacial abnormalities, delayed developmental milestones, mild mental retardation and abnormal gait. The nosological features and the clinical manifestations of this syndrome and the plausible autosomal recessive inheritance of this rare syndrome have been elicited. The diagnosis was based on characteristic phenotype, in particular striking craniofacial and skeletal abnormalities and neuroimaging. CONCLUSION: It is a challenge for healthcare professionals to help these youths to maximize their potential as human beings and help them achieve a meaningful adulthood. On the other hand, diagnosing such cases can be a challenge to dentistry. A systematic protocol, if adhered, can lead to a more appropriate diagnosis. Managing such cases in a clinical setup involves a multispeciality and interdisciplinary approach.

Herpes zoster on the face in the elderly.

Herpes zoster is a localised disease caused by reactivation of the varicella zoster virus that enters the cutaneous nerve endings during an earlier episode of chicken pox, travels to the dorsal root ganglia, and remains in latent form. The condition is characterised by occurrence of multiple, painful, unilateral vesicles and ulceration, and shows a typical single dermatome innervated by single dorsal root or cranial sensory ganglion. Involvement of three or more dermatomes is known as disseminated zoster and seen in immunocompromised individuals. Complications of herpes zoster include ocular sequelae, bacterial superinfection of the lesions, meningoencephalitis and postherpetic neuralgia. The incidence of herpes zoster increases with age and immunosuppression, therefore prompt management is necessary to avoid morbidity and mortality in these individuals. We present two case reports of herpes zoster, one involving the maxillary and mandibular branches of the trigeminal nerve while the other involves all branches of the trigeminal nerve.

Sialochemical Analysis: Windfall to the Oral Physician (A Hospital-based Clinical Cross-Sectional Study in Depressive Disorders).

BACKGROUND: Depressive disorders, worldwide, may rank second by the year 2020. In India; about 10 million people suffer from depressive disorders, the prevalence rate being recorded as 31.2 for every 1000 individuals. A significant impairment of all personal hygiene may occur due a depressive episode which in turn may result in altered biochemical composition of some important salivary parameters. The present study was conducted in Bhopal, the heart of Madhya Pradesh, India. It was done to assess the relationship and bring about a comparison of certain selective sialochemical alterations between normal and subjects with depressive disorders. MATERIALS AND METHODS: The research participants signed a free and informed consent form authorizing their voluntary participation in the research. A total number of 150 subjects were selected and were distributed equally between 3 groups - Group I (normal), Group II (subjects with depressive disorders who were only on psychiatric counseling) and Group III (subjects with depressive disorders who were on medication for at least 1 month). The effect of three antidepressant drugs, which were commonly prescribed by the psychiatrists were considered for the study. Stimulated whole saliva was analyzed biochemically for α-amylase, calcium, sodium, potassium, total proteins, and urea. RESULTS: Stimulated salivary calcium and total protein levels were found to be statistically significant among all three groups (P < 0.0001). Salivary amylase levels between Groups II and III and between Groups I and III (P < 0.0001) was statistically significant while the salivary urea levels between Groups I and II and between Groups I and III were found to be statistically significant (P < 0.0001). However, there was no statistical difference in their sodium and potassium levels. CONCLUSIONS: It was observed that drugs do affect the salivary composition. It was observed that cyclic antidepressants produced significant alteration in the sialochemical constituents of saliva as compared to tricyclic antidepressants and tetracyclic antidepressants. How to cite the article: Milton BA, Bhambal A, Nair P. Sialochemical analysis: Windfall to the oral physician (A hospital-based clinical cross-sectional study in depressive disorders). J Int Oral Health 2014;6(3):82-9.

Maxillary molar distalization with first class appliance.

Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation.

Phase dependent modulation of soleus H-reflex in healthy, non-injured individuals while walking with an ankle foot orthosis.

OBJECTIVE: To examine the dynamic modulation of the soleus H-reflex while walking with a posterior leaf spring ankle foot orthosis (PAFO). METHODS: Soleus H-reflexes were evoked on randomly chosen lower limb of fourteen healthy individuals (age range of 22-36 years, 7 women) while walking on a treadmill with and without a PAFO. In order to capture excitability across the duration of the gait cycle, H-reflexes were evoked at heel strike (HS), HS+100ms, HS+200ms, HS+300ms, HS+400ms in the stance phase and at toe-off (TO), TO+100ms, TO+200ms, TO+300ms, TO+400ms in the swing phase respectively. RESULTS: H-reflex excitability was significantly higher in the form of greater slope of the rise in H-reflex amplitude across the swing phase (p=0.024) and greater mean H-reflex amplitude (p=0.014) in the swing phase of walking with a PAFO. There was no change in the slope (p=0.25) or the mean amplitude of H-reflexes (p=0.22) in the stance phase of walking with a PAFO. Mean background EMG activity between the two walking conditions was not significantly different for both the tibialis anterior (p=0.69) and soleus muscles (p=0.59). CONCLUSION: PAFO increased reflex excitability in the swing phase of walking in healthy individuals. Altered sensory input originating from joint, muscle and cutaneous receptors may be the underlying mechanism for greater reflex excitability. The neurophysiological effect of PAFOs on reflex modulation during walking needs to be tested in persons with neurological injury. The relationship between the sensory input and the reflex output during walking may assist in determining if there exists a neurological disadvantage of using a compensatory device such as a PAFO.

Eustachian tube dysfunction in OSMF- often present seldom discovered.

OBJECTIVES: To evaluate the effect of OSMF on the eustachian tube function and to correlate it with various grades of the disease. STUDY DESIGN: Twenty OSMF patients (40 ears) and 20 healthy controls (40 ears) were evaluated for eustachian tube function by eustachian tube function test, tympanometry and audiometry. RESULTS: The audiometric and tympanometric analysis showed no significant differences in hearing abilities of OSMF patients and controls and between various grades of OSMF, indicating no hearing impairment. However, eustachian tube function test revealed a statistically significant difference in eustachian tube function in OSMF patients and controls. Further, there was a significant increase in severity of dysfunction with increase in severity of disease. CONCLUSIONS: From the present study it is evident that the subjective function of Eustachian tube may be affected by disease process. But, probably the amount of deviation found in function of the eustachian tube is non contributing to cause a conductive hearing loss. Key words:Oral submucous fibrosis, eustachian tube function, tympanometry.

The road to radiation protection: a rocky path.

Radiation has intrigued us with its magnificent properties of imaging and healing. But this discovery, like many others, came with a heavy price. The pioneers of this form of energy themselves often succumbed to its devastating effects and hence, paved a way for future generations to be wary of it, while continuing to use it. This paper attempts to salute those masters who have helped make the radiation world a safer place to live and work in.

Serum vitamin c and iron levels in oral submucous fibrosis.

BACKGROUND: In this study Serum Vitamin C and Iron levels in Oral submucous fibrosis (OSMF) were estimated. The objective was to evaluate the correlation between Serum Vitamin C and Iron levels in OSMF individuals. Serum Iron content can be a predictor for the progression of this condition. OSMF is basically a disorder of collagen metabolism where Vitamin C gets utilized in conversion of proline into hydroxyproline, this hydroxylation reaction requires ferrous Iron and Vitamin C. Many studies regarding micronutrients and other antioxidants levels have been emphasized, but very few studies are done on the Serum levels of Vitamin C and its correlation with Iron in OSMF patients. METHODS: Thirty five OSMF patients and 50 deleterious habit free healthy individuals (controls) were selected. Two ml of venous blood was collected from each individual. Vitamin C level in serum was estimated by 2-4 dinitrophenylhydrazine method and Iron estimated by Tripyridyl method. RESULTS: The level of Serum Vitamin-C and Iron was significantly decreased in OSMF patients when compared to controls which were statistically significant. CONCLUSION: On the basis of these observations, it seems possible that the chemical, thermal and/or mechanical factors associated with the use of areca nut may act in conjunction with the Vitamin C and Iron deficiency leading to the development of OSMF. Therapeutic substitution of vitamin C and Iron may be recommended in the management of OSMF.

Insight to a tobacco user's mouth: An epidemiological study in Bhopal.

BACKGROUND: The rampant tobacco abuse is escalating the Indian health sector towards a future overburdened with high prevalence of cancer and potentially malignant conditions. Thus manifestations of tobacco abuse have become a widely recognized but poorly tackled public health issue. To understand the same, a study was conducted in a dental college of Bhopal, India. METHODOLOGY: A hospital based cross sectional study was done over a period of 1.5 years. Patients giving history of deleterious habits were included in the study. The form of tobacco/areca nut used, duration and frequency of usage and awareness regarding their ill-effects were recorded. All documented data was subjected to statistical analysis using chi-square test. RESULTS: Out of 2033 individuals studied 21% were below the age of 25 years, 53% in 26-50 years, 20% in 51-75 years and 6% above 76 years of age with 85% being males. 67% used smokeless form, 21% smoked and 12% used tobacco in both smokeless and smoking form. 58% of the individuals had tobacco associated lesions, of which oral submucous fibrosis (OSMF) was the most prevalent. The relation between duration and frequency of abuse and occurrence of lesion was found to be statistically significant (p < 0.05). CONCLUSION: The smokeless form was most widely abused in this part of the country especially the younger population. OSMF, a premalignant condition with debilitating effects on the lifestyle, was the most prevalent lesion associated with tobacco use. These findings call for early and aggressive intervention methods be put into action.

Desmoplastic ameloblastoma of mandible.

Desmoplastic ameloblastoma is one of the six histopathological subtypes of ameloblastoma. The age and gender groups affected by desmoplastic are similar to those affected by the conventional ameloblastoma. It usually presents as a painless enlargement of the jaw. Owing to its deceptive radiological appearance as a mixed radiopaque-radiolucent lesion, it is often mistaken as a fibro-osseous lesion. Histologically, desmoplastic ameloblastoma has a densely collagenised and hypocellular stroma, where the epithelium tends to proliferate in the form of cords and nests instead of cellular islands. Most desmoplastic ameloblastomas display occasional classic islands of follicular ameloblastoma among the predominant strands and cords. Studies have shown that desmoplastic ameloblastoma shows a tendency to recur. We present a rare case of a tumour occurring in the anterior mandibular region in a 60-year-old man over a period of 11/2 months.

Pneumosinus dilatans multiplex associated with hormonal imbalance.

Pneumosinus dilatans describes an abnormal dilation of one or more paranasal sinuses without radiological evidence of localised bone destruction, hyperostosis or mucous membrane thickening. Dilation of mastoid air cells also occurs rarely along with involvement of paranasal sinuses. This rare combination of unknown aetiology was reported in two cases in the literature and termed 'Pneumosinus Dilatans Multiplex' (PSDM). It is usually asymptomatic, and is detected incidentally on plain radiography, CT or MRI. If left untreated, it can further erode the bone leading to complications such as facial asymmetry, neurological disorders and pathological fractures. The aetiology of the condition remains obscure. Various hypotheses proposed are the presence of gas-forming microorganisms, spontaneous drainage of a mucocele, the presence of a one-way valve, dysregulation of hormonal levels leading to a disturbance of osteoblastic and osteoclastic activity. This paper describes a case of PSDM possibly secondary to hormonal disturbance.

Familial ectodermal dysplasia: a peers' agony.

Ectodermal dysplasias include a various group of inherited disorders which share primary defect in the development of two or more tissues of embryonic ectodermal origin. Though there are many subtypes, ectodermal dysplasias are mainly hidrotic ectodermal dysplasia and hypohidrotic ectodermal dysplasia, among which the most common variety is X linked hypohidrotic ectodermal dysplasia. We report a rare case of X linked hypohidrotic ectodermal dysplasia occurring in a family with various skin, hair and oral abnormalities.

Spindle cell carcinoma in maxilla.

Spindle cell carcinomas (sarcomatoid carcinomas) are rare tumours. It is a variant of squamous cell carcinoma which has spindled tumour cells, which simulate a true sarcoma, but are epithelial in origin. They are extremely uncommon in the head and neck region. Only five cases with maxillary origin have been discussed in the literature. As compared to squamous cell carcinoma of maxilla, this variant is associated with poor diagnosis and advanced disease at presentation, as is demonstrated in the case presented. There are no standard recommendations for management owing to the rarity of this histology. Surgery and radiotherapy form the mainstays of treatment. We report a rare case of spindle cell carcinoma involving the maxilla.

Ameloblastomatous calcifying odontogenic cyst: a rare histological variant.

The calcifying odontogenic cyst (COC) occurs mainly as an intraosseous lesion in mandible or maxilla, but the peripheral variation of COC has also been reported. The confusion regarding its nature as cyst or tumour has not been resolved and a vast diversity has been noted in clinicopathological aspects of COC. We report a case of COCs with minimal mural ameloblastomatous proliferation in a 13-year-old girl, who presented with a painless swelling in the left jaw causing mild facial asymmetry.

Diversities in presentations of extrapulmonary tuberculosis.

The incidence of extrapulmonary tuberculosis (EPTB) has been increasing worldwide over the last few years. Tuberculous lymphadenitis is the most common form of the disease and is reported to occur in 25-60% of all EPTB cases. It is commonly seen in the cervical lymph nodes, but may also be in the larynx, pharynx, parotid and rarely, in the sinuses and petrous bone. The posterior triangle, supraclavicular and jugular nodes are most frequently affected. They are usually unilateral, although diffuse adenopathy may occur. TB involving cervical lymph nodes represents 50% of extrapulmonary TB. A series of six cases of tuberculous lymphadenitis with varying clinical features is documented here to alert one of its prevalence in developing countries.

Immature fibrous dysplasia: a mixed radio-opaque radiolucent lesion.

Fibrous dysplasia is a bone pathology characterised by abnormal differentiation of osteoblasts leading to replacement of normal marrow and cancellous bone by immature bone and fibrous stroma. A case report of a 20-year-old female patient with a chief complaint of a swelling in the right upper back tooth region, of 6 months duration which was diagnosed as an immature fibrous dysplasia is presented.

Alveolar bone exostoses subsequent to orthodontic implant placement.

Alveolar bone exostoses (ABE), also known as a buttress bone formation, are not uncommon to the literature. Although, exostoses in response to the trauma from occlusion are a popular concept proposed more than 45 years ago, still the aetiological factors behind this development are unclear. Various risks and complications associated with orthodontic implants have been published, but buttress bone formation subsequent to this procedure has not been reported till date. This article describes a case of ABE, subsequent to the placement of orthodontic mini implants, where after careful evaluation, resective osseous surgery was performed.