Ajay G Nayak

Unilateral segmental odontomaxillary hypoplasia: an unusual case report

Facial asymmetry is not an uncommon occurrence in day to day dental practice. It can be caused by various etiologic factors ranging from facial trauma to serious hereditary conditions. Here, we report a rare case of non-syndromic facial asymmetry in a young female, who was born with this condition but was not aware of the progression of asymmetry. No relevant family history was recognized. She was also deficient in both deciduous and permanent teeth in the corresponding region of maxilla. Hence, the cause of this asymmetry was believed to be a segmental odontomaxillary hypoplasia of left maxilla accompanied by agenesis of left maxillary premolars and molars and disuse atrophy of corresponding facial musculature. This report briefly discussed the comparative features of segmental odontomaxillary hypoplasia, hemimaxillofacial dysplasia, and segmental odontomaxillary dysplasia and justified the differences between segmental odontomaxillary hypoplasia and the other two conditions.

The hazards of gutka chewing

To the Editor: The review by Javed et al. addresses a very important health problem: gutka chewing, facing the populace of the Indian subcontinent and migrants thereof. It was interesting to read the concepts put forth, especially where the authors have focussed on gutka as a form of smokeless tobacco, thereby giving an impression that areca nut is only a secondary component. However, we would like to point out that gutka is primarily an areca nut–based product with processed additives that also include tobacco. Oral submucous fibrosis (OSF) is mentioned to be more common in gutka chewers than in nontobacco chewers, an erroneous comparison, because it has been conclusively proven that OSF occurs because of areca nut consumption and is not associated with tobacco. If tobacco had been a causative factor for OSF, then other forms of tobacco usage, such as raw tobacco chewing and cigarette/beedi/cigar/pipe smoking should manifest OSF; however, clinically it is never seen in individuals practicing exclusively tobacco abuse. By the same yardstick, the explanation of nicotine causing synergistic damage to fibroblasts does not hold true, as fibroblast damage in exclusive tobacco usage has never been reported. It is well known that fibroblast metabolism is altered owing to activation of procollagen genes, elevation of procollagen proteinase levels, and up-regulation of lysyl oxidase activity brought about by chewing areca nut, leading to increased fibrosis in the oral submucosa. In the discussion, the authors state that cessation of the habit may help to reduce the severity of the condition. Again in the context of OSF, the fibrotic bands once formed do not regress by just cessation of the habit, although the progression may be halted, but the risk of malignant transformation still exists. The review has relied chiefly on articles based on case-control studies, which although they provide very valuable information, tend to have an element of selection bias that is under the control of the investigators depending on the decided/set inclusion and exclusion criteria. Moreover, these studies appear to have been conducted in tertiary care establishments that may not be as accessible to the people of the Indian subcontinent as compared with their western counterparts, and thereby may not represent the true picture of the ground reality in the community at large. Population-based

Pulp polyp - A periapical lesion: Radiographic observational study

Introduction: Pulp polyp (PP) is a chronic hyperplastic condition resulting in formation of granulation tissue and proliferative mass. The radiographic appearance of PP has innumerable presentations. Diagnosing and treatment planning of periapical lesions, heavily relies on the radiographic changes surrounding the root structures. Objective: To evaluate different radiographic periapical changes in clinically detected PP patients. Materials and Methods: Patients reporting to Department of Oral Medicine and Radiology and who were clinically diagnosed with PP by an oral diagnostician were subjected to radiographic examination. Digital intraoral periapical radiographs of 50 patients with PP were taken. Various periapical changes in the digital radiographs were recorded by a skilled oral radiologist. The data obtained was subjected to statistical analysis using SPSS ver 17.0 and P-value was set at <0.05 as significant. Result: Periapical changes like periodontal space widening (PDLW), loss of lamina dura, periapical abscess, periapical granuloma, hypercementosis, condensing osteitis and root resorption were noted. Periodontal space widening was seen in all patients (100%), loss of lamina dura was noted in 72%, periapical rarefying osteitis in 56%, condensing osteitis in 8%, hypercementosis, periapical granuloma, and root resorption were seen in 4% of PP patients. Majority of PP were asymptomatic (66%). Pulp polyp was commonly seen in mandibular first molar followed by mandibular second molar and maxillary first molar. Statistically significant difference was noticed between periapical changes in PP patients (P value <0.0001). All PP patients showed definite periapical changes suggesting it to be a periapical lesion. Conclusion: Pulp polyp is confined to the pulpal portion of the tooth which, may or may not cause changes in periapical region. The results of the present study showed that majority of the PP patients were associated with definite periapical changes. This observation suggests that clinically detected PP are radiographically associated with definite periapical changes suggesting it to be a periapical lesion.