Namita Raghav

Comparison of the efficacy of conventional radiography, digital radiography, and ultrasound in diagnosing periapical lesions

OBJECTIVES The aim of this study was to evaluate the efficacy of conventional radiography, digital radiography and ultrasound imaging in diagnosing periapical lesions. STUDY DESIGN Twenty-one patients aged between 15 and 45 years with well defined periapical radiolucency associated with anterior maxillary or mandibular teeth requiring endodontic surgery or extraction were selected and consented to the study. Preoperative intraoral periapical radiographs and digital images using charge-coupled device obtained by paralleling technique were assessed by 3 specialist observers who gave their diagnosis of the periapical lesions. Then ultrasound examination was performed and the images were assessed for size, contents, and vascular supply by 3 ultrasonographers. It was followed by curettage of periapical tissues to enable histopathologic investigation, which is the gold standard in diagnosis. The data were statistically analyzed using SPSS, analysis of variance, and kappa statistics. RESULTS The percentage accuracy of diagnosing periapical lesions using conventional radiography was 47.6%, digital radiography 55.6%, and ultrasound 95.2%. Ultrasound had the highest sensitivity and specificity: 0.95 and 1.00, respectively. CONCLUSION Conventional and digital radiography enable diagnosis of periapical diseases, but not their nature, whereas ultrasound provides accurate information on the pathologic nature of the lesions, which is of importance in predicting the treatment outcome. Therefore ultrasound can be used as an adjunct to conventional or digital radiography in diagnosing periapical lesions.

Inflammatory linear verrucous epidermal nevus syndrome with its polymorphic presentation - A rare case report

Epidermal nevi are hamartomatous lesions that are typically present at birth, but can occur anytime during childhood and may rarely appear in adulthood. An estimated one-third of individuals with epidermal nevi have involvement of other organ systems; hence, this condition is considered to be an epidermal nevus syndrome. There are four distinct epidermal nevus syndromes recognizable by the different types of associated epithelial nevi: linear sebaceous nevi, linear nevus comedonicus, linear epidermal nevus, and inflammatory linear verrucous epidermal nevus (ILVEN). Each type may be regarded as a part of a syndrome with other systemic manifestations. We report a rare case of ILVEN syndrome in a 23-year-old female patient with a wide spectrum of mucosal, cutaneous, and skeletal abnormalities, demonstrating the polymorphic presentation of this condition.

Sialography: report of 3 cases.

Salivary gland examination is an important part of oral examination, especially because of its involvement in most of the systemic diseases. Patients most commonly seek medical attention when the major salivary glands like parotid and submandibular gland become enlarged or painful. The various imaging modalities practiced to check the salivary gland disorders include conventional radiography, sialography, ultrasonography, computerized tomography, radionuclide imaging and magnetic resonance imaging. Sialography is one of the oldest imaging procedures and still most commonly practiced, as it is a chair side procedure, simple to perform, and cost effective. We report the role of sialography as an adjuvant in the diagnosis of bacterial sialadenitis and sialadenosis and as a diagnostic and therapeutic aid in a case of juvenile recurrent parotitis.

Correlation of dental pulp stones, carotid artery and renal calcifications using digital panoramic radiography and ultrasonography.

Background: The human tissues continuously undergo modification as deposition of calcium (CA) salts either in an organized or disorganized pattern. The latter pattern usually occurs in the soft tissues such as in arteries, brain, kidneys, lungs, and dental pulp. The purpose of this study is to evaluate the presence of pulp calcification and carotid artery calcification (CDC) as a marker for renal calcification and altered serum biomarkers such as serum CA, phosphorus (P), and alkaline phosphatase (ALP). Materials and Methods: Digital panoramic radiographs of 50 patients with the presence of pulp stones and suspected CAC were subjected to carotid artery and renal ultrasonography (USG) examination for the presence of vascular calcification and also to evaluate the alterations in serum CA, P, and ALP levels. Data were analyzed statistically using Chi-square test. Results: Panoramic radiographs of 50 patients showed 88.28% of teeth with the presence of pulp stones stones and 91% carotid arteries with calcification. The sensitivity of panoramic radiograph was greater than that of USG (93.67%), but the specificity of USG was more than the panoramic radiograph (44.44%) in detecting CAC. The prevalence rate of renal calcification on USG was 92%. The statistical difference between the patients with or without alteration in serum Ca levels was not significant (χ2 = 0.581 and P = 0.446). On comparison of serum P and ALP, the difference was found to be statistically significant. Conclusion: Presence of pulp stones and CACs on panoramic radiograph have remarkably proved to establish the chances of renal artery calcification associated with alterations in serum CA levels.

Pyknodysostosis: A rare case report

Pyknodysostosis is a rare autosomal recessive disorder characterized by the postnatal onset of short limbs, short stature, and generalized hyperostosis along with acro-osteolysis with sclerosis of the terminal phalanges, a feature that is considered essentially pathognomonic. Other features include persistence of fontanelles, delayed closure of sutures, wormian bones, absence of frontal sinuses, and obtuse mandibular gonial angle with relative mandibular prognathism. Here, we report a case of pyknodysostosis found to be having the classical features during intraoral examination and general physical examination.

Papillon-Lefevre syndrome

Papillon-Lefevre syndrome (PLS) is a very rare syndrome of autosomal recessive inheritance characterized by palmar-plantar hyperkeratosis and early onset of a severe destructive periodontitis, leading to premature loss of both primary and permanent dentitions. The palmar-plantar keratoderma typically has its onset between the ages of 1 and 4 years and severe periodontitis starts at the age of 3 or 4 years. The exact pathogenesis of these clinical events remains mainly speculative. An early diagnosis of the syndrome can help preserve the teeth by early institution of treatment, using a multidisciplinary approach. This paper describes a case of PLS with classic clinical features and briefly reviews the relevant literature.

Report of a rare case of juvenile recurrent parotitis and review of literature

BACKGROUND: Juvenile recurrent parotitis (JRP) is a rare salivary gland disease of obscure aetiology that affects children. It is characterized by multiple episodes of unilateral or bilateral parotid inflammation over a period of years. CASE REPORT: A 14 year old boy presented with multiple episodes of recurrent bilateral swellings of the parotid glands since 1 year of age with no relevant past medical and dental history, TREATMENT: Included prescription of antibiotic Dicloxacillin 500 mg tid for 7 days and analgesics as a combination of Diclofenac 50 mg and Paracetamol 500 mg tid for 10 days, to resolve acute infection followed by sialography using Iopromide (ultravist-300) twice at an interval of 6 months for glandular lavage which helps to clear the mucous plugs that form during the acute phase. FOLLOW-UP: It was satisfactory as there has been no recurrence of parotitis during 18 months.