Nandita Shenoy

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.

Impaired Glucose Tolerance and its Association to Oral Cancer

Background: Diabetes mellitus is a serious and leading health problem worldwide and is associated with severe acute and chronic complications that negatively influence both the quality of life and survival of affected persons. Growing epidemiologic evidence suggests that people with diabetes are at significantly greater risk for cancer in general and recent studies also demonstrated that glucose intolerance was associated with a higher risk of oral cancer death, beginning in the prediabetic range of glucose intolerance. Aim: We undertook this study with the aim of finding out an association between impaired glucose tolerance and oral cancer along with finding out prevalence of other risk factors for oral cancer. Subjects and Methods: 45 cases and 45 controls were selected for the study. Oral glucose tolerance was performed on subjects who satisfied inclusion criteria and were willing to sign informed consent form. Results and Conclusion: Fifty three percent of the cases had abnormal glucose tolerance as compared to Thirty one percent of the controls. It was statistically significant with a p value of 0.032. To conclude, hyperglycemia (which includes IFG, IGT and diabetes) increase the risk of oral cancer two folds, however Impaired Glucose tolerance alone as defined by ADA does not appear to play a role.

The pain management in orthodontics.

Pain and discomfort are the frequent side-effects of the orthodontic therapy with fixed appliances. The people who experience orthodontic pain are likely to self-medicate with nonprescription pain relievers before seeing the dentist. It is imperative for an orthodontist to address questions that might arise in a clinical setting from the viewpoint of the clinicians and the patients/parents. This article will provide an overview of the current management strategies which are employed for alleviating orthodontic pain.

Salivary protein markers: a noninvasive protein profile-based method for the early diagnosis of oral premalignancy and malignancy

Abstract. An ultra-sensitive hyphenated technique, high-performance liquid chromatography-laser-induced fluorescence detection protein profiling of saliva, is evaluated for early detection and diagnosis of oral premalignancy and malignancy. Calibration sets of protein profiles of unstimulated whole saliva are collected from clinically/pathologically normal, premalignant, and malignant subjects and used as standards. Three parameters—scores of factors, sum of squared residuals, and Mahalanobis distance—derived from principal component analysis of protein profiles of the standard calibration sets, and blind samples are used for “match/no-match” diagnosis of the blind samples. Analyses of the results show that the method is capable of differentiating normal, premalignant, and malignant conditions with the sensitivity and specificity of 79% and 78%, respectively. The technique provides a fast, highly objective (free from personal judgment and statistically defined), and noninvasive diagnostic method for screening and early detection of oral cancer.

Detection of human papilloma virus in potentially malignant and malignant lesions of the oral cavity and a study of associated risk factors.

Background: Squamous cell carcinoma of the head and neck is the 6 th most frequently occurring cancer worldwide, with over 400,000 cases projected annually. Multiple factors such as tobacco, alcohol, irradiation, virus, and chronic irritants are involved in the development of oral squamous cell carcinomas (OSCCs). The most important risk factors are chronic exposure to tobacco and alcohol. Although the evidence that implicates virus is increasing, particularly (human papillomavirus [HPV]), in the carcinogenesis process, the role of virus is not well established. Aim and Objective: This study is designed to assess the presence of HPV in potentially malignant and malignant lesions of the oral cavity as well as to correlate the presence of HPV with addictive habits and histopathological grading of the disease. Materials and Methods: Biopsy samples of OSCC and potentially malignant lesions were obtained and 3, 5 μm thickness sections were cut using a microtome. The sections were collected using a sterile brush and transferred to an Eppendorf tube. DNA extraction and polymerase chain reaction for the detection of HPV were done. Results and Conclusion: The association between histopathological grading and presence of HPV was assessed using Chi-square test and the values thus obtained were found to be statistically significant. HPV was more predominantly seen in well-differentiated carcinomas and moderately differentiated carcinomas as compared to poorly differentiated carcinomas.

Oral Cytology for HIV: A New Diagnostic Tool?

Aim: To asses morphological and morphometrical alterations of oral squamous epithelial cells in HIV infected individuals, and determine its diagnostic significance for HIV infection. Materials and Methods: Informed Consent was obtained from all study subjects. 40 adult HIV infected patients (experimental group) and 40 adult non-infected volunteers (control group) participated. Age, occupation, and relevant medical history were recorded. The following laboratory tests reports were recorded: complete blood cell counts, blood glucose levels, serum iron and erythrocyte sedimentation rate. Oral smears were collected from normal appearing tongue and buccal mucosa of the individuals by exfoliative cytology. The cells were morphologically analysed and the nuclear area (NA), the cytoplasmic area (CA) and the nucleus-to-cytoplasm area ratio (NA/CA) were calculated. Cell yield, cell cohesion, presence/absence of inflammatory cells and candida were observed. Results: The cytological smears of HIV patients showed abundant cell yield and the epithelial cells were found to be in close cohesive clusters and both findings were found to be statistically significant. Nuclear cytoplasmic ratio was seen to be increased in 93.8% of HIV positive patientsand Mild to moderate pleomorphism was observed in 17.9% of HIV positive patients. HIV positive patients had a diminished inflammatory response and this was found to be statistically significant. Conclusion: Statistically significant deviations from normal oral epithelium were found in the study conducted. With further research, oral exfoliative cytology may form a new, painless, inexpensive diagnostic method for HIV infections.

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.

Add a third dimension to your patient care with cone beam computed tomography

Cone-beam computed tomography (CBCT) has been specifically designed to produce undistorted three-dimensional information of the maxillofacial skeleton, including the teeth and their surrounding tissues with a significantly lower effective radiation dose compared with conventional computed tomography. The revolutionary introduction of CBCT in all fields of dentistry is unprecedented as it has created a true paradigm shift from a conventional two-dimensional approach to a three-dimensional understanding. In doing so it has expanded the role of imaging from its traditional one in diagnosis to image guidance of operative and surgical procedures. Clinical Relevance To Interdisciplinary Dentistry Detecting anatomical variants such as accessory neurovascular canals, bony undercuts, and local alterations in trabecular patterns, all of which influence implant treatment planning Identification of root canal system anomalies and determination of root curvature for successful endodontic practice Cone beam computed tomography, offers an opportunity to see inside the bone and pinpoint and measure densities in small localized areas such as a vertical periodontal defect or alveolar bone graft Three-dimensional and cross-sectional evaluation of the implant patient and it allows virtual implant placement that can guide the implantologist in terms of density and thickness of the alveolar bone.

Comparison of effects of preoperative piroxicam and ibuprofen on pain after separator placement: A randomized controlled trial

Introduction: Orthodontic therapy causes significant pain for a large percentage of patients. It is one of the main reasons that discourage patients from seeking orthodontic treatment. Pain during orthodontic treatment may have a negative influence on cooperation and can also reduce the compliance. This study assessed the effectiveness of a single dose of preoperative Piroxicam in reducing the incidence and severity of pain after orthodontic separator placement when compared to ibuprofen. Materials and Methods: The study was a randomized, placebo-controlled, double-blind, parallel-arm study. Sixty eight patients were recruited for this study and were randomly assigned to one of the three experimental groups: 1. 20 mg of Piroxicam followed by two doses of multivitamin placebo ( n = 30); 2. 400 mg of Ibuprofen in three doses ( n = 20) and 3. A multivitamin placebo ( n = 18). All the three groups were administered the first dose of the respective medication one hour prior to separator placement, the successive two doses were given at 3 hours and 7 hours after separator placement. The pain experienced by the patient was assessed at the time intervals 2 hours, 4 hours, 6 hours, bedtime, on awakening the following day and 24 hours after administration using a visual analogue scale. Results: A comparison of pain perception between all three groups with the repeated measures analysis of variance (ANOVA) and a comparison of pain perception between the first and second group using the Student t test revealed that preemptive Piroxicam therapy significantly lower pain levels experienced at all-time intervals starting from 2 hours after separator placement till 24 hours after placement. Conclusion: A single dose of Piroxicam taken 60 minutes before separator placement reduces pain due to separator placement experienced in the first 24 hours following separator placement.

Acupuncture and Its Implications in Dentistry

Acupuncture, an alternative therapy which originated in China is now practised in various countries of the world It is a technique that involves the use of needles placed transcutaneously at specific points to cure the diseases. Its applications and popularity has grown over the years and is practised by various healthcare professionals for lower back pain, migraine, knee osteoarthritis, fibromyalgia, nausea and vomiting, headache, dysmenorrhea etc. Its use has been extended to the field of dentistry and promising results have emerged in cases of temporomandibular disorders, dental pain, chronic facial pain, xerostomia and gagging. This manuscript reviews the uses of acupuncture in dentistry and its future growth.