Fractal Dimension and Lacunarity Analysis in the Dentulous and Edentulous Mandibular Posterior Region Using Cone-beam Computed Tomography: A Cross-sectional Retrospective Study.

AIMS: This cross-sectional retrospective study was conducted to assess the differences in the microarchitecture of the trabecular bone of the posterior mandibular region at dentulous and edentulous sites with the help of fractal dimension (FD) and lacunarity using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Ninety CBCT scans were analyzed for the purpose of the present study. Inclusion criteria included subjects with unilaterally missing mandibular molars or premolars and an with intact contralateral opposing tooth. The coronal view of the dentulous and edentulous sites was used, and the region of interest (ROI) was selected 2.6 mm below the apex of the tooth present. These images were then transferred to ImageJ Software, and fractal analysis was done using the box-counting method of the FracLac plug-in. A paired samples t-test was performed to compare the means of FD and lacunarity, and a Kendall correlation was performed to check correlations. A p-value less than 0.05 was considered to indicate statistical significance. RESULTS: Statistical analysis revealed that the mean FD of the edentulous side was significantly greater than that of the dentulous side (p-value = 0.011). Additionally, the mean lacunarity of the edentulous side was marginally significantly greater than that of the dentulous side (p-value = 0.089). A significant negative correlation was detected between the FD and lacunarity of the edentulous region (p-value = 0.017), and a marginally significant negative correlation was detected between edentulous lacunarity and dentulous lacunarity (p-value = 0.081). CONCLUSION: The differences in occlusal forces exerted in dentulous and edentulous regions can lead to a change in the trabecular pattern of the bone in these regions. This change in the microarchitecture of bones can be detected by FD and lacunarity, which can further help us assess changes pre- and post-implant. CLINICAL SIGNIFICANCE: The advanced technology, the assessment of microarchitecture of the bone has been made easy, using FD and lacunarity, as done in the present study. This analysis can further aid us in both pre- and post-implant analysis to prevent failure of the implant. How to cite this article: Bhoraskar M, Denny C, Srikant N, et al. Fractal Dimension and Lacunarity Analysis in the Dentulous and Edentulous Mandibular Posterior Region Using Cone-beam Computed Tomography: A Cross-sectional Retrospective Study. J Contemp Dent Pract 2024;25(6):581-587.

Health-related quality of life among oral and oropharyngeal cancer patients: An exploratory study.

OBJECTIVES: To comprehensively explore the effect of several sociodemographic-, patient- and tumour-related factors on the health-related quality of life (HRQoL) of oral and oropharyngeal cancer patients. METHODOLOGY: Patients diagnosed with oral and oropharyngeal cancers were included in the present cross-sectional study. Information pertaining to various sociodemographic-, patient- and tumour-related factors was recorded. HRQoL was assessed using standard 12-item Short Form Health Survey version 2 (SF12V2), and oral health-related quality of life (OHRQoL) was assessed by Oral Health Impact Profile-14 (OHIP). RESULTS: A total of 108 patients participated in the present study. Results revealed that nodal metastasis, histological differentiation and pain were significant predictors of OHRQoL, while site, size, stage, histological differentiation and pain were significant predictors of HRQoL. Pain was the single most significant negative determinant of HRQoL that was associated with worst total OHIP (B = 2.01, ß = 0.45, p < .0001), physical (B = -0.88, ß = -0.21, p = .017) and mental (B = -1.00, ß = -0.22, p = .016) component summary scores. CONCLUSIONS: Number of sociodemographic-, patient- and tumour-related factors emerged as significant predictors of HRQoL and OHRQoL. Study results might help in formulating targeted treatment plan, optimising patient care and follow-up.

Medication-related tooth discoloration: a review.

Tooth discoloration is a common problem for which patients seek dental care. Various medications can directly or indirectly result in tooth discoloration. As clinicians, it is our responsibility to know these therapeutic drugs which can cause tooth discoloration and educate our fellow colleagues to take necessary precautions when prescribing these medications. Therefore, the objective of this paper is to give an overview of the various medications that can be linked to tooth discoloration and to suggest the precautionary measures that can be taken to avoid or minimize it. Clinical Relevance: Dental discoloration potential of medications always needs to be considered before prescribing them.

Investigating the link between frontal sinus morphology and craniofacial characteristics with sex: A 3D CBCT study on the South Indian population.

Background: Measurement of craniofacial parameters plays an important role in sex determination in forensic science. The present study was done using cone beam computed tomography (CBCT) scans to evaluate the morphologic structure of the frontal sinuses and compare it with the width of nasal, cranial, maxillary and mandibular width which might help us in sex determination. Methods: A cross-sectional retrospective study was conducted using 142 full field of view (FOV) scans of patients archived from the department. The width of the nose, cranium, maxilla, and mandibular width was measured and compared with the frontal sinus between the two sexes. Results: A paired t-test was done to compare the linear measurements for both sexes' right and left frontal sinuses. The measurements were higher in males when compared to females. There was a statistically significant asymmetry (larger dimension on the left side) of the anterioposterior (p-value of 0.012) and superior-inferior dimensions in males (p-value of 0.135). Spearman's correlation showed that frontal sinus correlated with other craniofacial parameters like nasal, cranial, maxillary and mandibular width among both sexes. The frontal sinus, nasal, cranial, maxillary and mandibular widths were higher in males when compared to females (independent t-test). Discriminant function scores showed 66-68% accuracy to discriminate sex, using the anteroposterior dimension and mandibular width. Conclusions: The measurement of craniofacial parameters using CBCT can aid in determining the sex of unidentified and decomposed bodies.

Oral healthcare considerations for the pregnant woman.

UNLABELLED: Pregnancy is a period of both joy and anxiety in a woman's life and is characterized by various physiological changes in her body brought about by the circulating female sex hormones. The oral cavity is also the seat of changes and these physiologic changes of pregnancy need to be addressed while managing the pregnant woman in the dental clinic. The main goal is to minimize the occurrence of any complications that might harm the mother-to-be and/or the unborn child. Preventive, emergency, and routine dental procedures are all deemed suitable during various phases of pregnancy, with some treatment modifications and initial planning. CLINICAL RELEVANCE: The dentist should be in a position to manage pregnant women in clinical practice effectively.

Dentists' perceptions on present and future dental practice during the COVID-19 pandemic: An embedded study.

BACKGROUND: The emergence of the COVID-19 pandemic has placed a significant burden on everyone. Although dental professionals are at an increased risk of COVID-19 infection, currently, very little is known about how oral health professionals and their professions could be affected by the pandemic. This study aims to investigate dentists' perceptions on present and future dental practice in light of the COVID-19 pandemic.  Methods: We conducted an embedded mixed-methods study at Manipal College of Dental Sciences, Mangalore, with Indian dentists registered with the Dental Council of India.   Results: Of the 976 participating dentists, 61% were females, 32% were 40 years of age or younger. Nearly half of the respondents (54%) acknowledged that the lockdown measures caused them a severe financial burden, and 56% were seriously concerned about being a source of infection to their family, friends, and community. Although 79% felt very comfortable or somewhat comfortable going back to work, they were all worried that Personal Protective Equipment (PPE) use would increase their financial burden and impact the number of patients seeking care. Even though a vast majority received the necessary information regarding returning to practice from their concerned dental regulatory bodies, some were unsure about the reuse of the PPEs because of the conflicting information they received.  Conclusion: The COVID-19 pandemic affected participants' professional lives negatively. Their major concerns were being a source of infection to their families and community. Providing information to dental professionals in a timely manner may prepare dentists to provide safe care to their patients while protecting themselves, their staff, and their families.

Morphometric anlaysis of mandibular coronoid, condyle and sigmoid shape using panoromic view for personal identification in south Indian population.

Objective: The shape of the condyle, coronoid, and the intervening sigmoid notch is unique due to attachments and direction of pull of temporalis muscle, different chewing habits, hormones, etc. So morphometric variation of these mandibular landmarks can be used in individual identification. Material And Methods: The study was carried out on 500 panoramic view images. Visual tracing assisted assessment of thousand sides (left and right) was done. Sexual dimorphism of left and right mandibular ramus parts (sigmoid notch bordered by coronoid and condylar process). The shape of coronoid process, condyle, and sigmoid notch were interpreted. Results: The most prevalent shape of sigmoid notch was wide variant (41.2%), condyle was convex type (50%) and coronoid was round (53.4%). Condyle and coronoid showed asymmetry between right and left with p-value 0.001 and 0.019, respectively. This study has illustrated that triangular-shaped coronoid was more in females (p-value 0.012). Conclusion: Sexual dimorphism is observed in the shape of the mandible due to masticatory activity at the point of insertion of temporalis muscle, biting force, hormones, and various genetic reasons. The results have exemplified that the morphometric variation of condyle, coronoid and sigmoid notch can be used as a tool for personal identification.

CBCT analysis of pharyngeal airway volume and comparison of airway volume among patients with skeletal Class I, Class II, and Class III malocclusion: A retrospective study.

Objective: To study the influence of skeletal malocclusion on the oropharyngeal airway volume and the difference in the airway volume among gender and the different types of skeletal malocclusion.Methods: A retrospective analysis of 180 full-field of view (FOV) CBCT scans (55 in Class 1, 55 in Class II, and 70 in Class III) were assessed to measure the oropharyngeal airway volume, ANB angle, SNB angle, and Wits appraisal. The values were compared among different skeletal malocclusions and were correlated to gender.Result: There was a significant result in terms of oropharyngeal airway volume among different types of skeletal malocclusion and ANB angle, SNB angle, and Wits appraisal among males and females.Conclusion: CBCT is a cheaper, more convenient option than polysomnography (PSG) when assessing airways, and thus, a maxillofacial radiologist is importantly placed in the assessment of the retropalatal and retroglossal volume of the oropharyngeal airway.

Challenges in Early Diagnosis of Oral Cancer: Cases Series.

Oral cancer has an overall survival rate of only 50%. This prognosis is significantly improved when this disease is diagnosed and treated in its early stages. Oral cancer is usually associated with classical clinical features associated with malignancy resulting in accurate diagnosis. However, certain cases of oral cancer, especially in its early stages, can be clinically deceptive and can be misdiagnosed. There is a recent trend of changing demographics and etiology associated with oral cancer adding to the diagnostic challenges faced by the clinician. The awareness of these changing trends is needed to aid in early diagnosis of oral cancer. In this case series, we have presented three cases of patients with challenging aspects.

Tobacco Cessation Scenarios Among Healthcare Profession Students: A Multidisciplinary Study

Background: It is acknowledged that the most effective means to contain the tobacco epidemic is to involve healthcare providers across various disciplines. The present study was undertaken to gain a comprehensive insight into various factors that determine the efficacy of multidisciplinary approaches in tobacco control. Methods: A cross sectional study design using a structured, pretested and self-administered questionnaire was employed in the present study, conducted among medical and dental interns and final year nursing students. Respondent demographics, knowledge, attitude, behaviour, perceived effectiveness and barriers, and willingness to participate in tobacco cessation were assessed. Results: A total of 268 subjects participated, with mean knowledge, attitude, behaviour, perceived effectiveness and barrier scores of 69. 7%, 89.0%, 72.0%, 80.6% and 88.6% respectively. There were significant differences among the mean scores of the study domains across the 3 disciplines. The majority (92.91%) of the respondents were willing to participate in tobacco cessation activities, but only 14.2% had previously received relevant training. Regression analysis revealed that the significant predictors of behaviour scores were gender, course, attitude and perceived effectiveness; those for willingness to undertake tobacco cessation activities were course, attitude, behaviour and perceived barriers. Conclusions: The study highlighted the willingness but low previous training among the participants and also identified factors that determine t behaviour and willingness to undertake tobacco cessation activities. The study emphasizes the need for modification in the policies pertaining to curricula of medical, dental and nursing training programs.

Determinants of Smokeless Tobacco Consumption and its Cessation among its Current Users in India.

INTRODUCTION: Global Smokeless Tobacco (SLT) consumption is on the rise and constitutes a major Public Health problem. Controlling SLT intake is central to containing the increasing tobacco menace. AIM: The present study was undertaken to comprehensively explore various factors involved in SLT consumption and its cessation among current SLT users. MATERIALS AND METHODS: Present study was conducted among current SLT users visiting Department of Oral Medicine and Radiology, Manipal College of Dental Sciences (MCODS), Manipal University, Mangalore, Karnataka, India. A structured, pretested and self-administered questionnaire was employed for the present study. Knowledge, attitude, behaviour, worksite practices of respondents towards SLT consumption and its cessation, barriers to SLT cessation were explored. Information about socio-demographic variables was also collected. RESULTS: Overall, 170 current SLT users participated in the present study. Results revealed that the mean knowledge, attitude, worksite related practices and barrier scores were 9.96(55.33%), 48.89(81.48%), 2.70(33.75%) and 54.25(60.27%) respectively. Correlation analysis revealed significant association of socio-demographic factors with knowledge, attitude and worksite related practices (p<0.05). SLT cessation related practices revealed that majority wished to quit (90%) and significant associations were noted amongst wish to quit with higher attitude scores; actual quit attempts with higher attitude, lower barrier scores and difficulty to quit with higher barrier scores (p<0.05). CONCLUSION: The present study draws attention towards involvement of complex interactions of various parameters including socio-demographic factors in SLT consumption and its cessation. Hence, it is imperative to implement multifactorial SLT control approach in order to contain tobacco menace spread across the globe.

Assessment of quality of life in patients with chronic oral mucosal diseases: a questionnaire-based study.

CONTEXT: A validated discipline-specific questionnaire has been developed recently to assess the quality of life (QOL) in patients with chronic oral mucosal diseases. OBJECTIVE: Use the Chronic Oral Mucosal Diseases Questionnaire for evaluating a diverse group of patients with chronic oral mucosal disease after therapy. DESIGN: Prospective convenience sample. MAIN OUTCOME MEASURE: Quality of life. METHODS: Seventy patients seen in the Department of Oral Medicine and Radiology with oral lichen planus, recurrent aphthous ulcers, pemphigus, and other chronic oral mucosal diseases were included in the study. Patients completed the questionnaire after undergoing treatment of their oral mucosal disease to assess their QOL. RESULTS: Patients older than age 35 years reported significantly lower QOL (p = 0.015) in the domain of social and emotional status. Significant age-related differences in QOL were not observed in other domains. Older individuals also reported a significantly lower overall QOL. Men reported significantly better oral health-related QOL than women did in pain and functional limitation: 16.14 ± 8.94 vs 21.44 ± 7.696, respectively (p = 0.010). Significant differences were not observed between sexes for other domains. Significant differences were observed between the disease groups only for recurrent aphthous ulcers and pemphigus (p = 0.005). Patients with pemphigus had the worst overall QOL (73.6 ± 5.6). CONCLUSION: Even after treatment, chronic oral mucosal diseases negatively affect patients' QOL. Use of the Chronic Oral Mucosal Diseases Questionnaire may allow physicians to more effectively care for their patients with these diseases.

Insights into the state of radiation protection among a subpopulation of Indian dental practitioners.

PURPOSE: Radiographs is an integral part of patient management in dentistry, despite their detrimental effects. As the literature pertaining to radiation protection among Indian dental practitioners is sparse, exploring such protection is needed. MATERIALS AND METHODS: All private dental practitioners in Mangalore, India were included in the study. A structured, pre-tested, self-administered questionnaire was employed to assess the knowledge, attitudes, practices, previous training, perceptions towards the need to spread awareness, and willingness to gain and implement knowledge about radiation hazards and protection. Information regarding each respondent's age, gender, education, and type and duration of practice was collected. RESULTS: Overall, 87 out of 120 practitioners participated in the study. The mean knowledge, attitude, and practice scores were 9.54±2.54, 59.39±7.01, and 5.80±3.19, respectively. Overall, 25.3% of the respondents had undergone training in radiation protection, 98.9% perceived a need to spread awareness, and 94.3% were willing to improve their knowledge. Previous training showed a significant correlation with age, sex, and duration of practice; attitude was significantly correlated with education and type of practice; and knowledge scores showed a significant correlation with type of practice. CONCLUSION: Although the knowledge and practices of respondents were poor, they had a positive attitude and were willing to improve their knowledge. Age, sex, and duration of practice were associated with previous training; education and type of practice with attitude scores; and type of practice with knowledge scores. The findings of this study suggest a policy is needed to ensure the adherence of dental practitioners to radiation protection guidelines.

Insights into smoking and its cessation among current smokers in India.

BACKGROUND: Initiation, perpetuation and cessation of smoking are all multifactorial. It is essential to explore interactions among various parameters influencing smoking and its cessation for effective smoking cessation interventions. OBJECTIVES: To obtain insights into smoking and its cessation among current smokers in India. MATERIALS AND METHODS: The present study was conducted among current smokers visiting the Department of Oral Medicine and Radiology, Manipal College of Dental Sciences (MCODS), Manipal University, Mangalore. Knowledge, attitudes, behavior, worksite practices towards smoking and its cessation, barriers to smoking cessation and socio-demographic variables were explored using a structured, pretested, self-administered questionnaire. RESULTS: A total of 175 current smokers participated in the study. Mean knowledge, attitude, worksite practice and barrier scores were 15.2±5.67 (66.1%), 57.5±7.67(82.1%), 4.18±2.02 (41.8%) and 57.4±12.37 (63.7%) respectively. Correlation analysis revealed: association of knowledge with education, occupation and religion; attitude with education and occupation; worksite practices with occupation; knowledge with attitude; and barriers negatively with worksite practices. The majority (85.7%) of respondents intended to quit smoking and this was associated with higher attitude scores, whereas actual quit attempts were associated with high knowledge, attitudes, worksite practices and low barrier scores. CONCLUSIONS: Various socio-demographic factors associated with smoking and its cessation were identified. The present study highlights the importance of identifying and targeting these interactions while framing guidelines and interventions for effective tobacco cessation in a developing country like India.

Dental consultation in patients planned for/undergoing/post radiation therapy for head and neck cancers: a questionnaire-based survey.

BACKGROUND: Mouth and pharyngeal cancers account for approximately 6% of cancers worldwide. Radiotherapy is one of the means of treatment of head and neck cancer. Consultation with a dental team experienced in caring for patients undergoing treatment for head and neck cancer will improve the quality of life of such patients. AIMS AND OBJECTIVES: To evaluate the attitude of oncologists toward dental consultation to patients planning for/prior to/undergoing/post radiation therapy for head and neck cancers and to evaluate the number of radiation oncologists who encounter oral complaints and consider worth referring to a dentist. MATERIALS AND METHODS: A questionnaire-based study was carried out following mailing of covering letter and self-administered questionnaire comprising 11 items, to 25 radiation oncology centers selected in India based on convenient sampling. RESULTS: Out of the 25 centers, we received response from 20 centers with 60 completely filled questionnaires. Five centers did not respond for further correspondences. CONCLUSION: The study indicated a need for awareness and education among radiation oncologists regarding dental consultation in patients planned/undergoing /post radiation therapy for head and neck cancer.