Sunit Kumar Jurel

Peripheral giant cell granuloma

Peripheral giant cell granuloma or the so-called “giant cell epulis” is the most common oral giant cell lesion. It normally presents as a soft tissue purplish-red nodule consisting of multinucleated giant cells in a background of mononuclear stromal cells and extravasated red blood cells. This lesion probably does not represent a true neoplasm, but rather may be reactive in nature, believed to be stimulated by local irritation or trauma, but the cause is not certainly known. This article reports a case of peripheral giant cell granuloma arising at the maxillary anterior region in a 22-year-old female patient. The lesion was completely excised to the periosteum level and there is no residual or recurrent swelling or bony defect apparent in the area of biopsy after a follow-up period of 6 months.

Etiological factors of temporomandibular joint disorders

The temporomandibular joint receives its name from the two bones that enter into its formation, namely the temporal bone and the mandible. This complex synovial system is composed of two temporomandibular joints together with their articulating ligaments and masticatory muscles. This articulation affects other synovial joints that relate specifically to masticatory function. The causes of temporomandibular disorders are complex and multifactorial. There are numerous factors that can contribute to temporomandibular disorders. In some instances a single factor may serve one or all of these roles. Iatrogenic injuries can act as both initiating as well as predisposing factors. The term craniomandibular disorder is used synonymously with the term temporomandibular disorders and is considered a major cause of nondental pain in the orofacial pain region. The successful management of temporomandibular disorders is dependent on identifying and controlling the contributing factors. The temporomandibular disorders are more common in females, the reason is not clearly known. The following article provides detailed information regarding temporomandibular joint disorders.

Assessment of the quality of life in maxillectomy patients: A longitudinal study

PURPOSE To longitudinally assess the quality of life in maxillectomy patients rehabilitated with obturator prosthesis. MATERIALS AND METHODS Thirty-six subjects were enrolled in the span of 16 months, out of which six were dropouts. Subjects (age group 20-60 years) with maxillary defects, irrespective of the cause, planned for definite obturator prosthesis, were recruited. The Hindi version of European Organization for Research and Treatment of Cancer, Head and Neck version 1 of Quality of Life Questionnaire was used before surgical intervention and one month after definitive obturator. Questionnaire includes 35 questions related to the patients physical health, well being, psychological status, social relation and environmental conditions. The data were processed with statistical package for social science (SPSS). Probability level of P<.05 was considered statistically significant. RESULTS The quality of life after rehabilitation with obturator prosthesis was 81.48% (±13.64) on average. On item-level, maximum mean scores were obtained for items problem with teeth (1.87 ± 0.94), pain in mouth (1.80 ± 0.92), trouble in eating (1.70 ± 0.88), trouble in talking to other people (1.60 ± 1.22), problems in swallowing solid food (1.57 ± 1.22) and bothering appearance (1.53 ± 1.04); while minimum scores were obtained for the items coughing (1.17 ± 0.38), hoarseness of voice (1.17 ± 0.53), painful throat (1.13 ± 0.43), trouble in having social contacts with friends (1.10 ± 0.40) and trouble having physical contacts with family or friends (1.10 ± 0.31). CONCLUSION Obturator prosthesis is a highly positive and non-invasive approach to improve the quality of life of patients with maxillectomy defects.

Formalin-Induced Iatrogenic Cellulitis: A Rare Case of Dental Negligence

Formalin is a 35% to 40% standard aqueous solution of formaldehyde. In dentistry, it is used as a disinfectant, antiseptic, and tissue preservative. It is a toxic substance that mainly affects the gastrointestinal tract, respiratory tract, and skin. Exposure to formalin vapors may lead to symptoms such as irritation and watery eyes, conjunctival redness, cough, dyspnea, palpitations, bronchospasm, and laryngeal and pulmonary edema. Skin exposure to formalin is likely to cause firstand second-degree burns. Oral intake may induce alimentary mucosal burns with abdominal pain, nausea, and vomiting. The fatal dose after oral ingestion of 40% formalin is approximately 50 to 100 mL. Systemic formaldehyde intoxication has not yet been adequately described because of an insufficient number of reports on the effect of local injection of formalin. There have been a few cases of formalin ingestion reported wherein several deaths occurred. In dentistry, there was a case eported where formalin was used accidently as irrigatng solution during third molar surgery instead of normal aline solution. Our case report highlights the carelessness of a dental staff member leading to administration of formalin instead of local anesthesia for extraction of a tooth in a healthy adult man. Because the administered dose was very low, the patient survived the accidental formalin administration without any systemic complications.

Genes and oral cancer

Oral cancers have been one of the leading causes of deaths particularly in the developing countries. Prime reason for this high mortality and morbidity is attributed to the delay in diagnosis and prompt treatment. Relentless research in the field of oncology has led to the advent of novel procedures for the early detection of oral cancers. Molecular biology is highly promising in this regard. It is a procedure that detects alterations at a molecular level much before they are seen under a microscope and much before clinical changes occur. Molecular studies serve as the basis by which we will eventually be able not only to augment clinical assessment and classification of oral lesions but also predict malignant potential of oral lesions, thus reducing the incidence and increasing the scope for early diagnosis and treatment of oral cancers. However, making such sophisticated tools available for the common man in developing countries is one of the most important challenges faced today.

High Performance Liquid Chromatographic Determination of Residual Monomer Released from Heat‐Cured Acrylic Resin. An In Vivo Study

PURPOSE Heat-polymerized acrylic resins are used in dentistry for complete denture fabrication. Despite the polymerization method, conversion of monomer into polymer is often incomplete with free or unreacted residual monomer remaining in the polymerized resin. The aim of this study was to determine the amount of residual monomeric methyl methacrylate (MMA) leaching in the saliva of patients wearing complete dentures in their postinsertion period. MATERIALS AND METHODS Thirty edentulous participants as first-time complete denture wearers (age 60 to 65 years) were selected. All the prostheses were fabricated using a similar standard technique with a heat-cured acrylic resin denture base material. Saliva samples were collected at time intervals of 1 hour, 1 day, and 3 days postdenture insertion. Participants were asked to discharge saliva every 30 seconds into a pre-weighed screw-capped container for a 5-minute period. MMA levels were measured using high performance liquid chromatography. Data were analyzed by ANOVA and Tukey-HSD. RESULTS The maximum concentration of monomer released into saliva peaked 1 day after insertion of the complete dentures. The mean (SD) MMA content was 0.04 ± 0.01 (μg/ml) 1 hour after insertion, and 0.3 ± 0.09 (μg/ml), and 0.05 ± 0.01 (μg/ml) on the first and third days postinsertion, respectively. CONCLUSIONS Although the released monomeric MMA was not at toxic levels, it could potentially sensitize complete denture patients or elicit an allergic reaction. The risk of the residual material as a primary irritant for a sensitizing reaction could be minimized by immersion of the denture in water for 24 hours before insertion.

Evaluation of various treatment modalities in sleep bruxism

STATEMENT OF PROBLEM Sleep bruxism (SB) is an oral condition that is associated with tooth wear, orofacial pain, and interference with sleep. The most recommended management technique is the use of an occlusal splint. Although the mandibular advancement device (MAD) has shown good results, few well-designed randomized controlled trials are available with which to compare these treatment options. Therefore, an evaluation of the effect of these 2 appliances on SB is needed. PURPOSE The purpose of this study was to evaluate the effect of a MAD and a maxillary occlusal splint (MOS) on the sleep quality and SB activity of participants with SB. MATERIAL AND METHODS In this randomized controlled trial, 28 participants were randomly supplied with either a MAD or MOS. The sleep quality of the participants was evaluated with the Pittsburgh Sleep Quality Index (PSQI) and their SB activity with electromyographic activity of the masseter with polysomnography. These variables were measured at baseline, 1 month, and 3 months. RESULTS Of 32 participants, 28 had data available for statistical analysis, as 4 participants did not return for follow-up examination. Both the MOS and MAD significantly reduced the PSQI and SB episodes and bursts in participants after 3 months (P<.05). The MAD provided greater reduction in SB episodes per hour after 3 months compared to the MOS. Participants supplied with a MAD reported more discomfort in their feedback form than participants using a MOS. CONCLUSIONS Both the MAD and MOS provided significantly improved sleep quality and a decrease in SB episodes at 3 months.

Lost salt technique for severely resorbed alveolar ridges: An innovative approach

The success of a complete denture relies on the principles of retention, stability and support. The prosthodontist skill lies in applying these principles efficiently in critical situations. Severely resorbed maxillary edentulous ridges that are narrow and constricted with increased inter ridge space provide decreased support, retention and stability. The consequent weight of the processed denture only compromises them further. This article describes a case report of an edentulous patient with resorbed ridges where a simplified technique of fabricating a hollow maxillary complete denture using lost salt technique was used for preservation of denture bearing areas. The hollowing of the denture reduces the weight of the denture, thereby enhancing stability and retention, reducing the further resorption of the jaws.

Changes in alveolar bone density around immediate functionally and nonfunctionally loaded implants

STATEMENT OF PROBLEM Few studies compare the radiographic changes in bone density associated with immediate implant loading protocols. PURPOSE The purpose of this longitudinal study was to quantitatively assess radiographic changes in alveolar bone density around immediate functionally and nonfunctionally loaded implants. MATERIAL AND METHODS A prospective longitudinal study was conducted in which 20 participants with partially edentulous mandibles received implants that were immediately loaded either functionally (IFL) or nonfunctionally (INFL). Standardized intraoral periapical radiographs were made at baseline, 3, and 6 months. These were digitized and analyzed using the histogram tool of the GNU Image Modulation Program for changes in alveolar bone density at crestal and lateral apical levels around the implant. RESULTS An increase in the mean lateral apical pixel grayscale values of 4.68 ±0.80 at 3 months and 4.15 ±0.29 at 6 months was observed with IFL, while INFL demonstrated an increase of 5.66 ±0.53 at 3 months and 6.07 ±0.59 at 6 months. A decrease in the mean crestal pixel grayscale values of -24.40 ±7.41 with IFL and -16.86 ±5.14 with INFL was found from baseline to 3 months. CONCLUSIONS On the basis of this longitudinal study, it was concluded that immediate loading stimulated alveolar bone formation at 6 months after implant placement. The immediate functional loading of implants resulted in a significantly greater degree of bone demineralization at the alveolar crest from implant placement up to 3 months compared with immediate nonfunctional loading.

Three-dimensional Quantitative Analysis of the Bone Density of Mandibular Condyle in Dentulous and Edentulous Jaws: An In Vivo Study

Studies have reported that masticatory function and occlusal force are low in edentulous patients, which brings about a change in the density, thickness, and alignment of bony trabeculae. However, studies that have quantitatively measured the differential cortical and medullary bone densities of the mandibular condyle in vivo remain rare. This study determined and compared the cortical and medullary bone density of the mandibular condyle in dentulous and edentulous jaws, using multidetector computed tomography (CT). Forty mandibular condyles with no clinical signs of temporomandibular disorders were investigated in 2 groups with 10 subjects (aged 50-80 yr) in each group (group I: dentulous subjects with maintained occlusion; group II: completely edentulous patients) with multidetector CT. The density of condylar cortical and medullary bone was determined by using bone density analysis algorithms available within the proprietary software. Data were analyzed statistically with the 1-way analysis of variance test (p<0.05). The mean cortical bone density of the right and left condyles of group I was 686.11±102.78 Hounsfield unit (HU) and 775.91±89.62 HU, respectively and that of group II was 531.33±289.73 HU and 648.53±294.39 HU, respectively. The mean medullary bone density of the right and left condyles was maximum in group I subjects (429.69±102.62 HU and 486.62±108.60 HU, respectively) than in group II subjects (214.89±104.37 HU and 205.36±90.91 HU, respectively) with a statistically significant decrease in the mean scores (p<0.001). Within the limitations of this study, it can be concluded that the cortical and medullary densities of the mandibular condyle are more in dentulous than the edentulous jaws.