Sujatha S Reddy

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.

Estimation of nicotine content in popular Indian brands of smoking and chewing tobacco products.

OBJECTIVES To estimate the nicotine content of some popular Indian brands of smoking tobacco (cigarettes and bidis) and pan masalas (chewable tobacco). MATERIALS AND METHODS Commercially available cigarettes, bidis, and pan masalas (chewable tobacco) were obtained from local retail outlets for the study. Nicotine was estimated using gas-liquid chromatography. RESULTS The analyses showed relatively higher levels of nicotine in tobacco from bidis (26.9 mg gm) as compared to cigarettes(15 mg/gm); the difference is statistically significant ( P P > 0.01). Nicotine concentration in chewing tobacco was 3.4 mg/gm. CONCLUSION The study concludes that the nicotine content of Indian brands of smoking tobacco was slightly high compared to other international brands. Higher concentration of nicotine was found in bidis compared to cigarettes. The nicotine content in commercially available chewing tobacco products was found to be much lower than in the smoking form of tobacco, but the average daily consumption made it comparable to the smoking form.

Tumour associated tissue eosinophilia as a predictor of locoregional recurrence in oral squamous cell carcinoma

Objectives: The increasing global burden of oral cancer has driven much of the focus of research to the determination of reliable prognostic markers which may have significant effects on survival and the control of post-treatment morbidity. This study was undertaken to evaluate tumour associated tissue eosinophilia (TATE) quantitatively in oral cancer specimens and observe for its possible association with tumour stage, patterns of locoregional recurrence and overall prognosis. Study Design: 14 patients undergoing surgical resection for primary oral squamous cell carcinoma (OSCC) were subjected to grey scale ultrasonography (USG) to assess tumour dimensions. The findings were compared with the cTNM stage initially documented. TATE was evaluated along the invasive tumour front (ITF) using H & E stained sections of histopathological specimens for 10 continuous high power fields (HPF) and graded as mild, moderate or intense. Patients were followed up over 5 years and observed for patterns of recurrence. Results: Loco regional recurrence was significantly associated with intense degree of TATE. (p<0.001) cTNM stage as well as USG stage did not correlate with the degree of TATE with p=0.419 and 0.772 respectively. None of the patients with mild/ moderate dysplasia developed locoregional recurrence within the period of follow up. Conclusions: Analysis of TATE in OSCC patients may provide an early indication of future locoregional recurrence. Identification of an appropriate biopsy site representing the ITF where TATE analysis can be performed may be a simple, inexpensive method of obtaining valuable prognostic information at the time of diagnosis. Key words:Tumour associated tissue eosinophilia, oral cancer, prognosis.

Clinical implications of prescribing nonsteroidal anti-inflammatory drugs in oral health care—a review

Nonsteroidal anti-inflammatory drugs (NSAIDs), including both the traditional nonselective NSAIDs and the selective cyclooxygenase (COX)-2 inhibitors, are widely used for their anti-inflammatory and analgesic effects. They are routinely prescribed in dental practice for the management of pain and swelling. Their use in treating acute dental pain and chronic orofacial pain, as adjuncts to the treatment of periodontal disease, and to minimize edema following surgical procedures is well documented. However, long-term utilization of nonselective NSAIDs could increase the risk of gastrointestinal symptoms, ranging from mild (e.g., dyspepsia, nausea, or vomiting) to serious gastric problems (e.g., gastric bleeding or perforation). Therefore, selective COX-2 inhibitors have been developed with fewer GI side effects but the recently identified cardiovascular adverse reactions limit their routine use in dental practice. Another major concern for oral physicians is NSAID-induced mucosal lesions and prolongation of bleeding time during invasive dental procedures. This article reviews therapeutic and analgesic uses of NSAIDs in dentistry. The various issues surrounding NSAID-induced adverse reactions and their implications in dentistry are also discussed.

Evaluation of the accuracy, precision and validity of hydrophylic vinyl polysiloxane impression material for bite mark analysis

The present study was undertaken to assess the accuracy, precision and validity of hydrophilic Vinyl Poly Siloxane [VPS] impression material for bite mark documentation and analysis. Medium body VPS impressions of maxillary and mandibular anterior teeth among thirty subjects were taken and dental stone casts prepared. Hollow volume overlays were made and metric analysis was done using advanced imaging software like Adobe Photoshop - 9 and Image J. These values were compared to the measurements taken from bite mark impressions of the same 30 individuals on wax wafers using light body VPS material. The mean differences in the parameters measured by the different techniques were compared using Intra Class Correlation Coefficients [ICCC]. Additionally validity parameters such as sensitivity, specificity, positive and negative predictive value were computed.

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.

Clinical evaluation of photodynamic therapy for the treatment of refractory oral Lichen planus- A case series

Oral lichen planus (OLP) is a chronic inflammatory, immune mediated mucocutaneous disorder of uncertain etiology. Psychologic stress has been found to be a main contributing factor in onset and progression of lesions. Most erosive OLP patients are refractory to available therapies, even corticosteroids, and report remarkable side effects. As photodynamic therapy (PDT) has proved it to be an effective and safe alternative treatment of abnormal or neoplastic cells we employed PDT for this diagnosis. Due to limited literature on application of this method for treatment of refractory erosive OLP, we present a series of 10 cases of bilateral erosive LP treated by 5 -Aminolevulinic acid mediated PDT. Outcome of our clinical cases showed remarkable improvement in lesions with reduction in Reticulation, Erythema, Ulceration (REU) score (from 5 to 3) and burning sensation as recorded by Visual Analogue Scale (Pretreatment VAS ranged from 5 to 8, posttreatment VAS was 0-1). PDT could be used as a complementary treatment method for symptomatic resistant OLP lesions, although our findings necessitate further research to validate the efficacy of this method for control of resistant oral lichen planus.

Clinical applications of extra-oral periapical radiography

Radiographic examination forms an integral part of clinical dentistry, with some form of radiographs necessary on the majority of patients. Intra-oral periapical (IOPA) radiographs form the backbone of imaging for diagnosis and follow-up of various dento-facial pathologies. However, certain patient populations are unable to tolerate intra-oral films/sensors due to various reasons. A not-so recent development called extra-oral periapical (EOPA) radiography may be a useful adjuvant to such a situation, at least in the near future. It is essentially a technique where the film is placed extra-orally overlying the tooth of interest. The following manuscript is an attempt to throw light on this technique and the impact it may have on various disciplines of dental practices. The advantages and disadvantages of EOPA radiography and its comparison to IOPA radiography has been discussed.

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.