Prashanth Shenai

Areca nut and its role in oral submucous fibrosis

Areca nut, commonly called as betel nut or supari, is a fruit of areca catechu palm tree, which is native of South Asia and Pacific Islands. The seed or endosperm is consumed fresh, boiled or after sun drying or curing. Chewing areca nut is thought to have central nervous system stimulating effect and along with this it is known to have salivary stimulating and digestive properties. According to the traditional Ayurvedic medicine, chewing areca nut and betel leaf is a good remedy against halitosis. It is also used for its deworming property. Along with these beneficial effects of areca nut one of its most harmful effects on the human body in general and oral cavity in particular is the development of potentially malignant disorder called Oral Submucous Fibrosis. The present paper discusses in detail the effects of the components of areca nut on pathogenesis of Oral Submucous Fibrosis. Key words:Areca nut, oral submucous fibrosis, potentially malignant disorder, supari.

Compound odontoma in deciduous dentition

Odontomas are benign tumors containing all the components of the odontogenic tissue. Disturbances in tooth eruption are one of the most common complications associated with odontomas. They are generally asymptomatic and are usually seen in second and third decades of life, rarely seen below 10 years of age. Herewith, we report an unusual occurrence of compound odontoma in a 4-year-old child visualized as a swelling of the cortical bone in the anterior maxilla.

Prevalence of Talon cusp in Indian population.

Aim: To investigate the prevalence of the talon cusps in a sample of Indian dental patients and their distribution among different types of teeth. To determine the presence of other dental anomalies associated with the talon cusps. Method: 2740 out patients (1523 males and 1217 females) attending Oral Medicine department from November 2010 to January 2011 were screened for the presence of talon cusps and were subjected to Intra Oral Peri-apical (IOPA) radiograph to rule out any associated anomalies or peri-apical changes. Results: Talon cusps were detected in 16 out of 2740 patients (person prevalence 0.58%). Thirty one teeth were found to have talon cusp. Maxillary lateral incisors were the most commonly affected teeth (54.8%, 17 teeth), followed by maxillary central incisors and canines (16.12%, 5 teeth).Talon cusp was found in two mandibular central incisors (6.45%) and one each in mandibular second and third molar (3.22% each). Seventeen teeth in 7 patients (54.83%) were found to be associated with anomalies like dens invagination (6 teeth, 19.35%), impacted 13, 23 (6 teeth, 19.35%), partial anodontia (3 teeth, 9.67%), geographic and fissured tongue (2 teeth, 6.45%). Peri-apical granuloma was found in one tooth with talon cusp associated with dens invaginatus. None of the patients were found to be associated with any syndromes. Conclusion: Attention should be paid to the presence of the talon cusp and the associated anomalies. Early diagnosis of the talon cusp can help the clinician in preventing the further complications. Key words:Orthopantomography, atheroma, stroke.

Bone invasion in oral cancer patients: A comparison between Orthopantamograph, conventional computed tomography, and single positron emission computed tomography

BACKGROUND AND OBJECTIVES One of the important factors in the pretreatment evaluation of patients with squamous cell carcinoma is the detection of the presence and extent of bone invasion by the tumor, which is significant for planning the therapy and determining the prognosis. Therefore, a study was undertaken with an objective to compare the accuracy and predictability of an Orthopantamograph (OPG), conventional Computed Tomography (CT), and Single Positron Emission Computed Tomography (SPECT) in the detection of bone invasion in squamous cell carcinoma patients scheduled to undergo surgery. MATERIALS AND METHODS A descriptive study was carried out on 15 patients with clinically and histopathologically diagnosed squamous cell carcinoma. OPG, conventional CT, and SPECT were carried out on all patients. Subsequently, the bone adjacent to the tumor was assessed histopathologically and served as a gold standard. The various imaging modalities were compared with the gold standard. RESULTS The study revealed that the tumor infiltration into the bone was positive in eight out of fifteen cases and seven were negative for bone invasion. OPG and conventional CT showed the presence of bone invasion in six out of eight cases with a sensitivity of 75% and a specificity of 100%. The positive predictive value for OPG was 100% and the negative predictive value was 78%. SPECT showed the presence of bone invasion in eight out of eight cases with a sensitivity of 100% and a specificity of 14.3%. The positive predictive value for SPECT was 57% and the negative predictive value was 100%. CONCLUSION The present study showed that SPECT was highly sensitive, but with a very low specificity due to an increase in false positive values. However, OPG and conventional CT showed an acceptable degree of sensitivity and specificity.

Twin tooth on either side: A case report of bilateral gemination

Gemination is an anomaly caused by a single tooth germ that attempted to divide during its development, resulting in a bifid crown. They are found more frequently in the primary than in the permanent dentition unilaterally, but bilateral gemination is very rare. It is caused by complex interactions among a variety of genetic and environmental factors. This developmental anomaly may cause clinical problems including esthetic impairment, periodontal problems, caries, and tooth crowding. Here, we report a unique case of bilateral gemination of permanent maxillary central incisors.

Multiple Peripheral Osteomas of Forehead: Report of a Rare Case

Osteoma is a benign slow growing osteogenic lesion, composed of well-differentiated mature bone tissue, characterized by the proliferation of compact or cancellous bone, almost exclusively found in the head and neck region. Central, peripheral and extra skeletal are the three variants of osteoma. Trauma, inflammation, developmental disorders and genetic defects are considered as the etiologic factors. Paranasal sinuses are the favourite locations of peripheral osteoma of the craniofacial region; frontal and ethmoidal sinuses being the common ones. Although, peripheral osteomas are usually benign, innocuous lesions, their size and prominent location on the visible parts of the face makes the surgical intervention necessary. We report case of multiple peripheral osteomas of forehead, without involvement of the frontal sinus, which is a rare variety.

A case of a massive mandibular schwannoma

Schwannoma, a benign nerve sheath tumor is relatively rare in occurrence and even rarer in sites, such as jaw bones. There are only 45 reported cases of intraosseous schwannoma of the jaws reported in the literature. We report a rare case of mandibular schwannoma in a 50-year-old Indian male. The clinical features resembled that of a residual cyst, fibro-osseous lesion or an odontogenic tumor/cyst. Radiological differential diagnoses of ameloblastoma or odontogenic keratocyst was made based on the findings of the orthopantomogram. The lesion was examined histopathologically and a final diagnosis of schwannoma arising from the inferior alveolar nerve was made. The aim of this report is to add information to the existing sparse literature on intraosseous schwannomas of the jaw.

Bilateral inflammatory cysts of the jaw: report of an unusual case

Radicular cyst is the most common odontogenic cyst occurring in the jaws. The cyst is commonly found in relation to the maxillary anterior teeth in the third and fifth decade of life. Although multiple radicular cysts are not uncommon in the jaws, bilaterally symmetrical representation of these cysts is rare. Radiographs prior to extraction help in diagnosis of these cysts and thereby prevent further morbidities. We report a case of 16-year-old male patient who presented bilateral radicular cysts symmetrically in the mandible.

Concurrent occurrence of dens evaginatus and dens invaginatus in maxillary incisors: a case report and review

Dens evaginatus (DE) and dens invaginatus (DI) are developmental anomalies that affect the shape of the teeth. Although they have been found singly and in association with other developmental anomalies in the same patient, it is uncommon to observe these two anomalies in the same tooth. There are only a few published cases of concurrent DI and DE in the same tooth. The patient in the case reported here was a 27-year-old man who exhibited a novel combination of DE and DI in permanent maxillary incisors. Early diagnosis of this anomaly is necessary. The clinician then can take particular care when performing prophylactic odontoplasty for the DE, keeping in mind that the associated DI presents an increased risk of early pulpal involvement. This article focuses on the management aspects of DE and DI.

Oral mucosal diseases in anxiety and depression patients: Hospital based observational study from south India.

Objectives: The objective of this study was to evaluate the prevalence of different Oral Mucosal diseases in Anxiety and Depression patients. Material and Methods: A hospital based observational Study was conducted in the department of Psychiatry and department of Oral Medicine and Radiology. Patients who were diagnosed with Anxiety or Depression by the psychiatrists using Hamilton Anxiety and Depression scale were subjected to complete oral examination to check for oral diseases like Oral Lichen Planus (OLP), Recurrent Aphthous Stomatitis (RAS), and Burning Mouth Syndrome (BMS). Equal number of control group subjects were also included. Results: In this study statistically significant increase in the oral diseases in patients with anxiety and depression than the control group was recorded. Oral diseases were significantly higher in anxiety patients (20.86%) than in depression (9.04%) and control group patients (5.17%). In anxiety patients, the prevalence of RAS was 12%, OLP was 5.7%, and BMS was 2.87%. In depression patients, the prevalence of RAS was 4.02%, OLP was 2.01% and BMS was 3.01%. In control group the prevalence was 2.2%, 1.33% and 1.62% in RAS, OLP and BMS respectively. RAS and OLP were significantly higher in the younger age group (18-49) and BMS was seen between the age group of 50-77 years in both study and control groups. Conclusions: The results of the present study showed a positive association between psychological alterations and changes in the oral mucosa, particularly conditions like OLP, RAS and BMS. Thus psychogenic factors like anxiety and depression may act as a risk factor that could influence the initiation and development of oral mucosal diseases. Hence psychological management should be taken into consideration when treating patients with these oral diseases. Key words:Lichen planus, anxiety, depression, burning mouth syndrome, recurrent aphthous stomatitis.