Diagnostic conundrum in an ambiguous posterior mandibular osseous lesion: Case report and radiological review.

INTRODUCTION AND IMPORTANCE: Non-odontogenic osseous lesions of the mandible are relatively uncommon entities compared to odontogenic lesions. Although the posterior mandible is not a usual site, it is not rare either for these osseous lesions, making the diagnosis ambiguous, and if misdiagnosed leading to different treatment protocols. CASE PRESENTATION: A 43-year-old female presented with a hard tissue lesion of the posterior mandible, misdiagnosed as a sialolith of the submandibular salivary gland in two other centers due to overlapping of symptoms, anatomic complexity, and inadequate investigations. The lesion was later diagnosed to be an osteoma of the posterior mandible with added investigations, and surgically excised. Histopathology confirmed the diagnosis. CLINICAL DISCUSSION: A variety of hard tissue lesions are known to occur in the posterior mandible like Submandibular sialolith, Osteomas, Calcified Submandibular lymph nodes, Phlebolith, and Tonsillolith. However, due to the region's structural complexity, localization of a hard tissue lesion may not always be forthright, even with radiographs. Moreover, in cases with conflicting symptoms, as was in this case there are more chances of misdiagnosis. The reasons for such diagnostic challenges are deliberated with radiological review of posterior mandibular osseous lesions. Recommendations are also suggested for proper investigations, thereby management of these posterior mandibular osseous lesions. CONCLUSION: Misdiagnosis of these posterior mandibular lesions may lead to the patient undergoing unnecessary surgical procedures as different lesions require different management. Differential diagnosis and adequate protocol for investigations are required.

Single blind, randomized study comparing clinical equivalence of Trusilk ® and Mersilk ® silk sutures for mucosal closure following surgical removal of mesioangular impacted mandibular third molar.

Background: Mesioangular impacted mandibular third molar is a common dental anomaly, for which surgical extraction is required. Post-surgery closure of mucosa reduces the prevalence of pain and other surgery-associated complications. We compared tissue reaction/inflammation after 3 and 7 days of mucosal closure with Trusilk ® and Mersilk ® silk sutures, following impacted mandibular third molar removal. Methods: This multicenter, prospective, two-arm, parallel-group, randomized (1:1), single-blind study (July 2020-November 2021) included subjects (Trusilk ®, n=65 and Mersilk ®, n=64), requiring mucosal suturing following impacted mandibular third molar removal. The primary endpoint, incidence of pain, swelling and trismus at the extraction area on post-surgery day 3 and 7 was evaluated. The secondary endpoints, incidence of tissue reaction, wound infection, suture loosening, other complications, operative time, amount of anesthesia, intraoperative suture handling, time needed for complete wound healing and suture removal, and adverse events were also recorded. Results: Socio-demographic and intra-oral characteristics were comparable between the groups. In Trusilk ® and Mersilk ® groups, a gradually decreasing pain score, starting from day 0 post-surgery (42.17±22.38 vs. 45.97±22.20) to day 7 (8.40±11.93 vs. 8.28±12.13) to day 30 (1.98±0.89 vs. 1.75±0.76) was witnessed. After the surgery, 21.54% and 17.19% subjects in Trusilk ® and Mersilk ® groups, respectively, had no post-operative swelling, while at the last two visits none of the subjects had swelling. Non-significant difference in wound infection, suture loosening, wound healing, bleeding, taste changes, operative time, amount of anesthesia, intraoperative suture handling, and time needed for complete wound healing and suture removal was noted among the groups. No suture-related adverse events were recorded. Conclusions: The results indicated that the Trusilk ® and Mersilk ® silk sutures are clinically equivalent and can be used for mucosal closure after removal of an impacted mandibular third molar with a minimal rate of pain, swelling and trismus. Clinical Trial Registry of India Registration: CTRI/2020/03/024100 (20/03/2020).

Evaluation of Dental Program for Older Adults Living in Long-Term Care Facilities.

INTRODUCTION: Compared to the general population, older adults living in long-term care facilities have poorer oral health. Also, they seldom have access to dental care services. Given that, a dental health program was initiated by Manipal College of Dental Sciences, Mangalore (MCODSM), to deliver dental care to the residents of St. Antony Home (SAH), a long-term care facility in Mangalore, India. This study aimed to evaluate the dental program by investigating the views and recommendations toward the program through its stakeholders. METHODOLOGY: The stakeholders were divided into three groups: Group 1, transport personnel; Group 2, coordinator and administrators of the program from both the sites; and Group 3, the residents of SAH who received dental care at the MCODSM. Data were collected through a structured questionnaire to measure satisfaction levels of the participants. Data analyses included calculating the frequencies required to describe the evaluation outcomes narrative. RESULTS: A total of 19 stakeholders participated in the study, of them 12 were SAH residents (Group 3). These Group 3 participants received various kinds of dental care. Almost all stakeholders were satisfied with the program and reported that the program was beneficial to the SAH residents. The stakeholders of the program were satisfied with transportation, the time allotted for the treatment, and the attitude of the dentists who delivered the program. CONCLUSION: The dental program was successful in delivering the most needed dental care to SAH residents. It provided an opportunity to provide treatment to SAH residents, and the stakeholders were highly satisfied with the program. That said, there are opportunities to improve the program, especially in relation to transporting the SAH residents to the program site, having a single window to deliver the dental treatment, and acquiring more supporting staff. Future evaluations are warranted using well-designed evaluation procedures and larger samples.

Critical Assessment on Unmet Oral Health Needs and Oral Health-related Quality of Life Among Old Age Home Inhabitants in Karnataka, India.

PURPOSE: To critically assess the unmet oral health needs and oral health-related quality of life among old age home inhabitants in Karnataka, India. METHODS: A total of 96 older adults (males=32, 33.33%, females=64, 66.67%) aged 60 years and above, residing in old age homes were included in this cross-sectional study. The mean age of the participants included in the study was 69.25±7.99 years. Oral health status and dental needs were assessed using the Oral Hygiene Index Simplified (OHIS) and the WHO Oral Health Assessment forms. Oral health-related quality of life was evaluated by administrating the Geriatric Oral Health Assessment Index (GOHAI) questionnaire through an interview format. STATISTICAL ANALYSIS: The Statistical Package for Social Sciences (SPSS) version 17 was used. Descriptive statistics was tabulated for oral health status and GOHAI scores. Student's t-test and ANOVA were applied to check the association of the GOHAI responses with the number of years of residence in old age homes, age groups, gender, and dentition status. RESULTS: The mean age of the participants included in the study was 69.25±7.99 years. Twenty-six (27.1%) participants reported diabetes mellitus and hypertension. Most of the participants 89 (91.7%) visited the dentist when they had dental complaints. Among the dentulous study population, the majority of the participants had untreated dental caries indicated for dental extraction and needed periodontal therapy. Amongst the participants, 68 (70.82%) required prosthetic rehabilitation. More than 10 years of residence in old aged homes, over 80 years of age, being female, and completely edentulous groups showed lower total GOHAI scores compared to their counterparts. CONCLUSION: The majority of the participants showed unmet oral health needs and lower GOHAI scores indicating poor oral health-related quality of life.

Multidisciplinary management of delayed eruption of permanent mandibular first molar associated with dentigerous cyst.

The absence of a tooth in the oral cavity may be the result of some obstruction with the process of tooth eruption. Physical obstruction can result from many different causes, such as supernumerary teeth, mucosal barrier, scar tissue, and cysts or tumors. Their removal will usually permit the affected tooth to erupt. This case report describes the delayed eruption of the permanent mandibular first molar in a 9-year-old boy due to the dentigerous cyst associated with it. The management was done through a multidisciplinary approach. Surgical removal of cystic sac through marsupialization along with the removal of the barrier was done. As a consequence of delayed eruption of the permanent first molar, the opposing tooth had supraerupted, which was intruded using mini-implants. Following this, the tooth erupted satisfactorily into the oral cavity to establish class I molar relation.

Epidermoid cyst of the floor of the mouth.

Dermoid cysts are malformations that are rarely seen in the oral cavity. An intraoral dermoid cyst grows slowly, but may enlarge and interfere with deglutition and speech, or can pose a critical risk to the airway and therefore require immediate surgical intervention. Dermoid cysts may develop above or below the mylohyoid muscle, causing a submental or submandibular swelling. Surgical excision is the treatment of choice and recurrence is rare. An intraoral approach for the treatment of large lesions presenting above the mylohyoid muscle provides good cosmetic and functional results. We report a case of a 26-year-old female who developed an epidermoid cyst presenting as a large sublingual swelling causing speech and swallowing difficulties. The lesion was surgically excised using an intraoral approach. Microscopic examination revealed a dermoid cyst of the epidermoid type. This case shows that dermoid cysts may be successfully diagnosed and managed using a series of simple yet effective clinical procedure.

Accuracy of intraoperative frozensection in assessing margins in oral cancer resection.

OBJECTIVES: To study the accuracy of intraoperative frozen section diagnosis in assessing margins in oral cancer resection and to evaluate the role of frozen section diagnosis as a guide in resection of oral cancer lesions. PATIENTS AND METHODS: The fresh tissue samples from the margins of lesions of patient with preoperative diagnosis of oral squamous cell carcinoma were used. The frozen sections are prepared immediately and examined by oral pathologist for the study. The results of these sections were compared with the results of histologic findings obtained by routine paraffin embedded Haemotoxylin and eosin method. RESULTS: The total of 184 margins, from 47 patients were examined. 178 margins showed concordance with the permanent section of the same tissue sample (seven false negative and one false positive), an accuracy rate of 96.74%. CONCLUSION: Frozen section is a helpful tool in intraoperative decision making in indicated situation. The results are highly specific but only moderately sensitive. The surgeon and the pathologist must understand the limitations of frozen sections.