International journal of dental and medical specialty

3-4

Authors: Ammu Thampi Susheela

“With great power comes great responsibility,” our profession is a breathing example of this adage. While we graduate as doctors, we take the Hippocratic Oath, which emphasizes “Primum non-nocere” meaning “do no harm.” Still during the course of our practice, we come across situations that challenge our capacity for judgment to do the minimal amount of harm. Triage is one such situation.

10-14

Authors: Vipul Srivastava , Neetika Jain , Soumyojeet Bagchi , Mahendra Pal Singh Negi

Aim: The sixth generation apex locators served as an efficient diagnostic tool for detecting root perforations as these are based on the principle of impedance rather than the conventional gradient method. However, their diagnostic accuracy not evaluated well. In the existing study, we assessed and compared the efficacy of two apex locators for diagnostic perspective. Materials and Methods: A total of 32 extracted teeth were perforated and mounted using alginate (Alginate Impression Material, 3M ESPE, USA). Two different apex locators - Raypex® 6 Apex Locator (VDW) and ProPex Pixi (Dentsply, USA) were used to detect the intentionally created root perforations (i.e., distance from file tips to external outline of the root surface). The two apex locators measured the same root perforations and compared statistically. Results: The mean distance from file tips to external outline of the root surface was found significantly different and lower (59.9%) in Raypex® 6 Apex Locator as compared to Propex Pixi (mean ± standard deviation: 0.39 ± 0.04 vs. 0.16 ± 0.02, t = 30.57, P < 0.001). Conclusion: We found Raypex® 6 Apex Locator better for root perforations.

22-27

Authors: Gurleen Kaur Dhillon, Bikramdeep Singh, Meenakshi Iyer, Shalu Chandna

Hereditary epidermolysis bullosa (EB) refers to a group of rare genodermatoses and mutational impairment of the structural and functional integrity of skin, i.e., intra-epidermal adhesion and dermo-epidermal anchorage. It is a group of inherited heterogenous mechano- bullous disease that appears on the skin (Fragile) and mucosa (mucous membrane) in the form of blisters associated with minimal mechanical trauma. It is a dermatological condition formed in severe auto-immune disease. EB dystrophica has been presented with various oral manifestations, and earlier dental treatment was restricted to an extraction of all permanent teeth with a construction of complete denture. However, patients suffering from EB also respond well to conventional periodontal therapy. We present the case report of the 20-year-old female patient diagnosed with EB, who reported with the chief complaint of gingival bleeding and diffi culty in chewing food due to the mobile teeth. A comprehensive interdisciplinary treatment planning was employed. We fi nd this case report interesting, being one of the rare conditions, reporting periodontal alterations in the patient suffering from EB.

3-9

Authors: Cristian Eugeniu Marin , Radu Costea , Rodica Luca

Aim: The aim of this descriptive cross-sectional epidemiological research in the private dental clinic was to evaluate the preventive measures and oral health condition status that could take place inside the private dental office. The primary objective was to obtain a protocol by calculating and evaluating various indexes for the preventive measures in the private room. Materials and Methods: The study comprised of 499 patients in which 260 females and 239 were males from Romanian population who were checked and evaluated for complete oral health condition and decayed teeth (DT) by the decayed, missing, and filled teeth (DMFT) index, for the periodontal disease by community periodontal index treatment needs (CPITN) and gingival index, and for masticatory function by functional teeth unit index and new invented group strategy treatment index (SGTI) index. The data were obtained before and after the preventive treatment in DMFT and was compared and evaluated. Using a preformed Performa for this study all patients’ oral health status data were recorded and observed. Results: Obtained data by SGTI index and others we found that poor oral hygiene and bad periodontal condition was observed (P < 0.001) in Romania tribes. Using preventive measures, giving education to patients for oral hygiene maintenance and dental implants we manage to pull back the DMFT index (P < 0.001) for 18% of the studied persons from an average of 14-30 DMFT to 12-20. The other indexes have showed a better health status with percentages between 0% and 87%. Conclusions: The results of our study could lead to a new approach to evaluate and prevent from initial caries, periodontal disease, and DT by restoration and treatment of missing teeth using implants, etc., inside the private dental practice. This is an original Research that presents two new and unprecedented ideas for decreasing DMFT index by using implants and rematerializing procedures, and the use of a newly invented index named SGTI for group strategy treatment. The use of epidemiologic index inside the private dental offi ce is also an original approach to the dental procedures.

15-20

Authors: Samir Kumar Rama , Dipankar Chakraborty , Asif Iqubal Nizami

Incidence of deep vein thrombosis (DVT) is 2-10 times more in human immunodeficiency virus (HIV)-infected persons than non-HIV cohort. Risk factors involved with DVT in HIV-infected patients are age older than 45 years, use of protease inhibitor in highly active antiretroviral therapy (ART), most common indinavir, hospitalization and presence of AIDS-defining opportunistic infections such as cytomegalovirus, Pneumocystis jiroveci (is a yeast like fungus particularly in immunecompromised host), and Mycobacterium-intracellular. Others well known thrombogenic risk factors include are such as immobility, cigarette smoking, advanced age, pregnancy, pelvic surgery, and personal or family history of DVT may be absent in HIV-infected patients presenting with DVT. Inflammation and venous thrombosis are related to each other, and the associations between them are strong when the inflammation or the infection has occurred recently, or the inflammation is active. A 29-year-old HIV-positive soldier on first line ART with poor adherence presented with fever pain abdomen and diarrhea and was diagnosed to have an enteric fever with immunological and clinical failure. He was treated for enteric fever but during treatment of enteric fever he complains of painful left lower limb swelling after 4 weeks and was suspect to have DVT of left lower limb based on Doppler studies. After confirmation of DVT by Doppler images, thrombolytic therapy was started, and gradually improvement was seen in the condition. Recent Infection or inflammation has a strong association with the development of thrombosis in HIV-positive patients, absent with classical predisposing factors of DVT. Physicians involved in the care of HIV-positive patients should be aware of this condition and the associated aggravating risk factors in them so as to provide timely management.

29-36

Authors: Sudhanshu Shekhar , Sanjeev Mittal

The final and quality restoration of endodontically treated teeth involves a critical decision-making step, especially when in cases where diffi cult, complex prosthetic rehabilitations are required. Regarding single tooth undergoing an endodontic procedure, there are high-level requirements for the restorative components and the application of all necessary treatment steps to achieve the fi nal restoration. Teeth that are affected by caries, fractured teeth or any pathology and tooth having multiple restorations that can be treated endodontically or conservatively are considered for endodontic surgical procedures. In addition to supposed teeth for a desirable endodontic procedure and under curative nature for endodontic treatment that is already weakened due to any anomaly it will further lead to weakening of internal as well as external tooth structures. Therefore, it is well accepted fact that on the basis of previous literatures and researched that endodontically treated teeth are structurally weaker, and they require special consideration for final restoration which should involves increased retention procedures to increase lifespan of that tooth, while maintaining adequate root strength. Different materials and techniques have been developed and or proposed to restore such teeth while retaining their function, strength, and longevity.

2-4

Authors: Isha Gupta , Bimal Kumar Agrawal , Anand Jindal

The giant goiter is enormously a common endocrine abnormality and the interesting phenomenon of enlarged thyroid gland almost exclusively confined to regions of endemic goiter. Goiters can result from biosynthetic defects, iodine deficiency, autoimmune disease or nodular diseases and if left untreated can lead to some symptoms of dyspnea, dysphagia and hoarseness by compressing the trachea, esophagus, and recurrent laryngeal nerve respectively. A majority of patients with giant goiter frequently desire surgical excision for structural distortion (cosmetic) and social reasons. Some of them, however, experience repeated attacks of intercurrent respiratory tract infection which can complicate the postoperative prognosis and cure. About a fifth of giant goiter patients frequently present with acute respiratory distress that requires emergency surgical intervention like tracheostomy. The peri-operative management of this endocrine disease is both formidable and hazardous. The operative time is not merely larger than for a standard thyroidectomy but mortality can also be unacceptably high. Here, we present a case report of a giant euthyroid goiter found in a 70-year-old female patient. The patient underwent fine-needle aspiration cytology examination.

9-14

Authors: Majumder M I, Harun M A S I

Background: Osteoporosis is imposing public health burden especially in postmenopausal women and elderly population. It is leading cause of morbidity and mortality in postmenopausal women. Among multiple modalities of osteoporosis diagnosis, bone mineral density (BMD) is considered as a gold standard by WHO. Aim: Evaluate the alveolar bone changes in osteopenic and osteoporosis condition of postmenopausal women. Materials and Methods: Totally 1315 postmenopausal women were included in this study. All patients were evaluated by dual-energy X-ray absorptiometry for BMD and dental radiograph such as orthopantomography and radiovesiography. Among those women 72 were normal, 276 were osteopenic and 967 were osteoporotic. Mandibular cortical index (MCI), pixel intensity (PI), mandibular alveolar bone mass (MABM), and Alveolar bone resorption pattern (ABRP) were evaluated from the dental radiograph. Calculation of mean and standard deviation, as well as correlation and difference, were performed using SPSS 11.5 for Windows (Windows XP). Results: The changes in the MCI (C2 and C3) were more in osteoporotic condition (87.48%) rather than osteopenic (31.34%) and normal (12.50%). The numbers of presenting teeth were more in normal and osteopenic women rather than osteoporotic women. PI and MABM were significantly different from normal vs. osteopenic and osteoporosis, osteopenic versus osteoporosis. Horizontal ABRP was more in osteoporosis women (91.21%). Conclusion: Changes in postmenopausal alveolar bone were strongly correlated with the BMD of systemic skeletal bone. This combined relationship can be used as an easy diagnosis tool for innovations in osteoporotic condition.

19-23

Authors: Rajnish Nagarkar, Shirsendu Roy, Mohammad Akheel, Vijay Palwe, Nayana Kulkarni, Prakash Pandit

Aim: Thyroid disorders are common endocrine disorders encountered in the African continent. Environmental and nutritional factors are often implicated in the occurrence of most thyroid disorders that occur in the most part of the world. This is a narrative review that seeks to document the pattern, prevalence, and management of thyroid disorders in the continent. To find the incidence and prevalence of thyroid disorders from total body malignancies at our cancer center. Objective: Implementation of thyroid screening camps among the general population. In India, thyroid disorders in childhood and adolescence have not been sufficiently studied. Where studies are available, they were either conducted decades ago or they involved only adults. The objectives of this study are to describe the pattern of thyroid disorders in each individual seen in our hospital and to highlight the management challenges encountered. Materials and Methods: This is a retrospective medical record analysis performed in our tertiary care cancer center in Nasik, Maharashtra for a period of 6 years from January 2008 to December 2014. The clinical examination, biochemical studies, serological and histological parameters were used to characterize and evaluate the patients of thyroid disorders. Investigations done, surgical treatment type, types and complications of thyroid disorders, incidence according to age, sex and prognosis were all documented in this analysis. Results: Of 16933 cancer patients, 128 patients suffered from thyroid disorders and the prevalence was 0.8%. The prevalence of thyroid disorders was significantly higher in females than males (33.6% vs. 66.4%, χ2 = 27.56, P < 0.001). The prevalence of thyroid disorders was significantly higher in higher aged (≥31 years) patients as compared to lower aged (≤30 years) patients (14.1% vs. 85.9%, χ2 = 132.30, P < 0.001). Of total thyroid disorders, 99 (77.3%) patients had cancers with highest prevalence of follicular cancer (58.6%). Of total thyroid disorders, 79 (61.7%) patients underwent surgery with no postoperative complications and were discharged on 3rd day of surgery. The mortality rate was 4.6%. Conclusion: There are a high risk and burden of thyroid disorders in India due to lack of nutrition and unavailability of proper therapeutic resources. There are a lack and paucity of data on the epidemiology of thyroid disorders. Due to lack of resources, complete screening for thyroid diseases in the general population is not cost-effective. There must be complete family screening with all genetic relatives in all patients with juvenile autoimmune thyroiditis.

28-31

Authors: Shah A, Shah R, Tyagi R, Botchu R

Plasmacytomas occur in bone marrow or in extramedullary sites, typically in the head and neck. Intramuscular plasmacytoma is rare and reported occurring in the orbits and upper limbs. We report a rare case of intramuscular extramedullary plasmacytoma (EMP) occurring in the gluteus medius muscle. In this case, an elderly lady with known multiple myeloma, presented with a lump in her right buttock. Subsequent imaging demonstrated a non-specific intramuscular mass in the right gluteus medius. Treatment is traditionally surgical resection plus/or adjuvant chemotherapy or autologous stem cell transplant. Plasmacytoma was considered among the differentials, despite the non-specific imaging features, and atypical location. It allowed for a rapid multi-disciplinary team discussion about the risks and benefits of a biopsy. Unfortunately, the patient died before treatment could be started. The purpose of this report is to remind clinicians to include plasmacytoma as a differential for soft tissue masses, even in atypical locations. We also discuss the relevant imaging features and management of EMPs.

2-6

Authors: Marin Cristian Eugeniu, Costea Radu, Popescu Vlad

Aim: The aim of this clinical study over 310 patients is to evaluate the success rate using Chlorhexidine (CHX) as a cleaning solution and lubricant during the endodontic treatment, compared with sodium hypochlorite (NaOCl). Materials and Methods: Group A consisted of 169 teeth, from which 78 were in a pulpitis stadium and 69 in a gangrenous stage. They were treated with CHX solution during endodontic dental procedures. The Group B consisted of 76 pulpits and 65 gangrenous teeth irrigated with NaOCl. Biostatistical analyzes using t-test with IBM SPSS 22.0 were applied to validate the results for P < 0.05. Results: The results show a success rate of 97% and a treatment success rate 3.5 times higher when using CHX in a much shorter time of treatment. 38.5% of cases were completed in the fi rst session of treatment, 42.5% in the second session and only 19% of cases being completed in the third treatment session. In Group A was obtained 100% success in pulpitis and 94.5% from gangrene was successfully cured, compared with 88% average success rate in Group B (6.5% failure rate in the pulp disease and 24% in gangrene). Conclusions: The advantages of using CHX instead of NaOCl in endodontic treatment proved by this study, in conjunction with results published since the early 80’s, show the supremacy of CHX solution in endodontic treatment.

14-17

Authors: Prasad Uma, Prasad Usha, Sushma J, Rema Nair Sarkar

Meckel–Gruber syndrome (MGS) is an rare lethal autosomal recessive genetic disorder, characterized by a unifi cation of renal cysts or cystic renal dysplasia, developmental anomalies of the central nervous system, hepatic dysgenesis and postaxial polydactyly. MGS (MS) is a rare and lethal syndrome characterized by a triad of occipital cephalocele, postaxial polydactyly and dysplastic cystic kidneys. It is a rare syndrome with the highest incidence in Gujarati Indians and Finnish population. We report a case of MGS in non-Gujarati Indian, which was diagnosed on fetal autopsy. The incidence of MGS ranges from 1 in 13,250 to 1 in 40,000 live birth.

24-29

Authors: Rajnish Nagarkar, Shirsendu Roy, Mohammad Akheel, Vijay Palve, Prakash Pandit, Nayana Kulkarni

Aim: The aim was to perform a retrospective audit of rare vascular neoplasm - Carotid body tumor (CBT) in our cancer center. Materials and Methods: An institutional retrospective audit was performed in Curie Manavata Cancer Centre, Nasik, India from 30th June 2013 to 30th June 2014. Total of 5 patients were diagnosed with CBT in a period of 6 months. Results: Out of 5 patients who were diagnosed with CBT, 2 (40%) were males and 3 (60%) were females with a ratio of 1:1.5. The types of CBT were familial in 2 patients (40%), sporadic in 2 patients (40%) and hyperplastic in 1 patient (20%). The clinical presentation of the 5 cases was, 3 patients (60%) had a painless, progressive swelling, 2 patients (40%) had pre-auricular pain, and 1 patient (20%) was identifi ed in routine follow-up. All patients underwent surgical excision of CBT with no need to pre-operative embolization. 40% of patients had cranial nerve injury and hematoma formation. 1 out of 5 patients received post-operative adjuvant radiotherapy due to large tumor size and lymphatic spread. No recurrence was found after a follow-up of 6 months. Conclusion: Surgical management of CBT remains a challenge for head and neck surgeon. Despite a reduction in stroke and mortality, there can be a signifi cant morbidity associated inadvertent adjacent cranial nerve injuries. However, our audit shows these tumors can be managed well with meticulous planning and execution of the surgery.