Sandhya Maheshwari

Laser in dentistry: An innovative tool in modern dental practice.

The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.

Natural head position: key position for radiographic and photographic analysis and research of craniofacial complex

The Frankfort horizontal is a useful compromise for studying skulls but not for orienting the natural head position (NHP) in the living because it is normally distributed around a true extracranial horizontal. Nonetheless, orthodontists dealing with living subjects, rather than inert crania, have used this Frankfort horizontal faithfully in cephalometry. Because the cant or inclination of all intracranial reference lines is subjected to biologic variation, they are unsuitable for meaningful cephalometric analysis. Registration of head posture in its natural position has the advantage that an extracranial vertical or a horizontal perpendicular to that vertical can be used as reference line for cephalometric analysis. Purpose of this paper is to provide an updated review of various methods to reproduce and record the NHP.

Neuromuscular dentistry: Occlusal diseases and posture

Neuromuscular dentistry has been a controversial topic in the field of dentistry and still remains debatable. The issue of good occlusion and sound health has been repeatedly discussed. Sometimes we get complains of sensitive teeth and sometimes of tired facial muscles on getting up in the morning. Owing to the intimate relation of masticatory apparatus with the cranium and cervico-scapular muscular system, the disorders in any system, draw attention from concerned clinicians involved in management, to develop an integrated treatment protocol for the suffering patients. There may be patients reporting to the dental clinics after an occlusal restoration or extraction, having pain in or around the temporomandibular joint, headache or neck pain. Although their esthetic demands must not be undermined during the course of treatment plan, whenever dental treatment of any sort is planned, occlusion/bite should be given prime importance. Very few dentist are able to diagnose the occlusal disease and of those who diagnose many people resort to aggressive treatment modalities. This paper aims to report the signs of occlusal disease, and discuss their association with TMDs and posture.

Recent advances in the management of obstructive sleep apnea: The dental perspective.

Obstructive sleep apnea (OSA) is common in adult population. OSA shows detrimental effects on health, neuropsychological development, quality-of-life, and economic potential and now it is recognized as a public health problem. Despite the availability of expanded therapeutic options, polysomnography and nasal continuous positive airway pressure (CPAP) are the gold standards for the diagnosis and treatment for OSA. Recently, American Academy of Sleep Medicine has recommended oral appliances for OSA. Hence the therapeutic interventions that are directed at the site of airway obstruction in the maxillofacial region are within the scope of dentistry. Treatment of OSA can improve vitality, social and daytime functioning, family life and mental health of a person and hence the quality-of-life. Obesity is the main predisposing factor for OSA. Other than obesity, craniofacial abnormalities such as micrognathia and retrognathia, age, ethnic background and genetic predisposition, consumption of alcohol, smoking, and sedatives may also predispose to OSA. Treatment modalities for OSA are behavior modification, diet and medication, CPAP devices, surgical (maxillo-mandibular advancement surgery), and oral appliances. Treatment of a patient with OSA not only improves the physical health of the patients but also the mental and social well-being.

Role of oral health professional in pediatric obstructive sleep apnea.

Sleep disordered breathing (SDB) in children is common. The impact of SDB on the growth and development of child may have detrimental effects on health, neuropsychological development, quality of life, and economic potential; therefore, SDB in children should be recognized as a public health problem as in the adult population. The coexistence of obesity and obstructive sleep apnea (OSA) not only appears to yield increased morbidity rates and poorer responses to therapy, but also is altogether associated with a distinct and recognizable clinical phenotype. Therapeutic options have somewhat expanded since the initial treatment approaches were conducted, to include not only surgical extraction of hypertrophic adenoids and tonsils, but also nonsurgical alternatives such as continuous positive air pressure, anti-inflammatory agents and oral appliances (OAs). Now, American academy of sleep medicine (AAOSM) has recommended OAs for OSA, hence the therapeutic interventions that are directed at the site of airway obstruction in the maxillofacial region are within the scope of dentistry. Among the physicians treating the children, dentists are more likely to identify adenotonsillar hypertrophy. Hence, the dentist can play an important role in identifying and treating those cases with OAs, who refuse the surgery, or those with structural abnormality in which myofunctional appliances are beneficial.

Soft tissue airway dimensions and craniocervical posture in subjects with different growth patterns

OBJECTIVE To compare the dimensions of the nasopharynx and oropharynx of subjects with different growth patterns and to determine whether any correlation exists with their craniocervical posture. MATERIALS AND METHODS Cephalometric radiograph of 60 subjects (16-25 years old), taken in natural head position, were divided into three groups according to the mandibular plane angle: hypodivergent (SN/MP <26°), normodivergent (SN/MP 26°-38°), and hyperdivergent (SN/MP <38°). Correlations were calculated between nasopharyngeal area, oropharyngeal area, and craniocervical posture. Continuous variables were compared by one-way analysis of variance, and the significance of mean difference between the groups was done by the Tukey post hoc test. A value of P < .05 was considered statistically significant. RESULTS Patients in the hyperdivergent group were found to have significantly smaller nasopharyngeal and oropharyngeal areas than the other groups (P < .001 and P < .05, respectively). Similarly, the oropharyngeal area in the normodivergent group was significantly smaller than that in the hypodivergent group (P < .05). However, no significant differences were found in the nasopharyngeal area between the hypodivergent and normodivergent groups and between the hyperdivergent and normodivergent groups (P > .05). Reduced pharyngeal airways were typically seen in patients with a large craniocervical angle and a large mandibular inclination. CONCLUSIONS Smaller nasopharyngeal and oropharyngeal airways were seen in connection with a large craniocervical and a large mandibular inclination. We therefore suggest that the vertical skeletal pattern may be one of the factors that contribute to nasopharyngeal and oropharyngeal obstruction.

Soft tissue cephalometric analysis applied to regional Indian population.

Introduction: Importance of soft tissue consideration in establishing treatment goals for orthodontics and orthognathic surgery has been recognized and various cephalometric analysis incorporating soft tissue parameters have evolved. The great variance in soft tissue drape of the human face and perception of esthetics exists and normative data based on one population group cannot be applied to all. The study was conducted to compare the standard soft tissue cephalometric analysis (STCA) norms with norms derived for population of western Uttar Pradesh region of India. Materials and Methods: The sample consisted of lateral cephalograms taken in natural head position of 33 normal subjects (16 males, 17 females). The cephalograms were analyzed with soft tissue cephalometric analysis for orthodontic diagnosis and treatment planning, and the Students t test was used to compare the difference in means between study population and standard STCA norms. Results: Compared with established STCA norms, females in our study had steeper maxillary occlusal plane, more proclined mandibular incisors, and less protrusive lips. Both males and females showed an overall decrease in facial lengths, less prominent midface and mandibular structures and more convex profile compared with established norms for the White population. Conclusions: Statistically significant differences were found in certain key parameters of STCA for western Uttar Pradesh population when compared with established norms.

Acute gingival bleeding as a complication of dengue hemorrhagic fever

Dengue fever is mosquito borne disease caused by dengue virus (DENV) of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history.

Nano-orthodontics revolutionizing oral health care

Nanotechnology involves the structuring and manipulation of materials at a molecular level. This technology is being applied to produce newer materials with enhanced properties and providing a direct control over matter at nano-scale. The applications of nanotechnology are being explored in various arenas including health care. The use of this technology would aid in improving the quality of health care being rendered to the patients. Nanotechnology has paved its way into various specialties of dentistry including orthodontics. Current research and applications of nanotechnology in orthodontics involve the use of nanomaterials like nanocomposites, nano-coated wires and brackets. The present article aims to provide an insight into the applications of nanotechnology and its future perspectives in orthodontics.

Periodontal ligament distraction: A simplified approach for rapid canine retraction

Distraction osteogenesis is a method of inducing new bone formation by applying mechanical strains on preexisting bone. The process of osteogenesis in the periodontal ligament during orthodontic tooth movement is similar to the osteogenesis in the midpalatal suture during rapid palatal expansion. A new concept of “distracting the periodontal ligament” is proposed to elicit rapid canine retraction in two weeks. At the time of first premolar extraction, the interseptal bone distal to the canine was undermined with a bone bur, grooving vertically inside the extraction socket along the buccal and lingual sides and extending obliquely toward the socket base. Then, a tooth-borne, custom-made, intraoral distraction device was placed to distract the canine distally into the extraction space. It was activated 0.5 mm/day, immediately after the extraction. Canine was distracted 6.5 mm into the extraction space within two weeks.