International journal of dental and medical specialty

3-9

Authors: Mahabubul Islam Mazumder , N Shakib , M A S I Harun , M Al-Amin , T Ahmed

Objective: The consequences of aging often involve the risk of osteoporosis, leading to an impaired quality of life of the elderly patients specially postmenopausal women. Osteoporosis accounts 0.83% of non-communicable disease globally having significant health and economic impact. The aim of this study was to evaluate and correlate the changes of mandibular cortical bone with bone mineral density (BMD) in postmenopausal osteoporotic patient. Materials and Methods: 300 postmenopausal osteoporotic patients included in these study. All patients were evaluated by dual-energy X-ray absorptiometry for BMD, and orthopantomograph (OPG). Mandibular cortical index (MCI) was seen from OPG categorized into C1, C2, and C3 as the appearance of the mandibular inferior cortex distal to the mental foramen. The criteria of C1 endosteal margin of the cortex is even sharp on both sides of the mandible, C2 endosteal margin has semilunar defects (resorptive cavities) with cortical residues one to three layers thick on one or both sides, C3 endosteal margin consists of thick cortical residues and is clearly porous. Results: The result of this study was showed that mean femoral neck T-score in C1 group and C2 were 2.26 ± 0.81 versus 2.88 ± 0.73, respectively, (P< 0.05) that was statistically significant, lumbar spine T-score in C1 group and C2 were 2.49 ± 0.96 and 2.62 ± 0.72, respectively, (P> 0.05) was not statistically significant and mean femoral neck T-score in C2 group and C3 were 2.88 ± 0.73 vs 2.49 ± 0.96, respectively, (P> 0.05) that was not statistically significant, lumbar spine T-score in C2 group and C3 were 2.62 ± 0.72 and 3.21 ± 1.18, respectively, (P< 0.05) was statistically significant. MCI-C3 is almost perfect indicator of osteoporosis. Conclusion: Changes of MCI are correlated significantly (P< 0.01) well with osteoporosis variable. Simple, low-cost investigation OPG determining MCI may be helpful as diagnostic tool for osteoporosis

16-19

Authors: Farhan Usmani , Poonam , Manish Kumar Sinha , S. S. Haque , Rekha Kumari

Background: Vitamin D, serum calcium (Ca) and inorganic phosphorus deficiency during pregnancy is a significant public health problem in many parts of the world. It is associated with an increased risk of pre-eclampsia, gestational diabetes, and preterm births. Approximately, 99% of the Ca and magnesium in the human body is located in the skeleton. Ca is a essential nutrient and mineral consumed in food and supplements. The mineral is stored bones where it is used to promote strength and support changes and growth throughout life. There is also free Ca in blood used by cells during the normal cellular function. The objective of this study was to assess the role of Ca, phosphorous and vitamin D level in pregnant women at different age groups compare to nonpregnant women in East Indian population. Materials and Methods: This cross-sectional study was conducted on 180 normal women between 22 and 45years of age in their first 24-28 weeks of pregnancy and 50 normal nonpregnant women. After 3 months of follow-up, serum levels of vitamin D and Ca and inorganic phosphorous were measured. Written informed consent was obtained from the subjects. Results: The mean age of women in the study group was 25.34 ± 5.40 years; while that in the control group was 25.80 ± 5.90 years. The age of study and control groups was matched. The result shows that serum Ca and inorganic phosphorous in pregnant women lower significantly (P< 0.001), especially in the third trimester as compared to controls. However, vitamin-D levels in pregnant women lower significantly (P< 0.001) at all trimester as compared to controls. Conclusion: Vitamin D deficiency coupled with Ca and inorganic phosphorous deficiency may found to be highly prevalent in pregnant East Indian women. The decrease in serum vitamin-D, Ca and inorganic phosphorous levels parallels increase in gestational age. This may result from mineral transfer from mother to developing fetus

03

Authors: Nirma Yadav

Today dentistry is not only about extracting and restoration of the decayed tooth but very excellently developing branches in health sciences with numerous specialities and researches going on in various colleges, universities, and research institutions. Out of various branches, one of a branch of dentistry is periodontics: The branch which deals with your smile, preserving your teeth, providing strength to gums and periodontium, and protection of primary structure of your teeth - The periodontium and the gingiva. Today the periodontics is not only limited to complete oral mouth prophylaxis, but it has also exceeded to do the surgeries such as soft tissue surgeries and osseous surgeries.

10-14

Authors: Mukesh Kumar, Sommya Kumari

Developed in 1992 and ADA specification number-92, glass ionomer cement (GIC) (silicate glass powder and an aqueous solution of polyacrylic acid) is widely used as restorative material in conservative dentistry for luting, for restoration (esthetic and reinforced), orthodontic treatment, cavity base, and buildups. While the modified resin GIC, the simplest form of GI cement which contains a small quantity of a water-soluble and polymerized resin component is widely used restorative material and in orthodontic practice also known as traditional GIC. Due to lack of moisture sensitivity, low mechanical strength, and impaired translucency in 1988, resin-modified GI (RMGI) cement were introduced by adding polymerizable hydrophilic resin to CGI (Conventional GI) formulations. Its adhesive nature of getting adhere to both enamel and dentin makes it more attractive to use in orthodontic and in various other branches of dentistry. Orthodontic usage of GIC increased dramatically with the development of resin-modified GIC. These are adhesive cement with improved physical properties and more stable hydrogels compared with GIC. This article critiques the literature to evaluate the cement for its credibility as orthodontic cement, both regarding varied applications as well as physical properties attributed when compared to other commonly used cement available for applications in orthodontic.

20-23

Authors: Afshan Bey , J R Mahira Kirmani , Shagufta Moin , Saif Khan

Desquamative gingivitis is an oral inflammatory disease that leads to tissue damage. Medical and dental research has been largely remains focused on an individual factor in desquamative gingivitis, for example, microbes or host. Nowadays, good clinical outcomes are obtained in gingival disease control, but effective management of desquamative gingivitis is still critical. The oxidative DNA damages may play an important part in pathogenesis of many chronic conditions including gingival conditions. Oxidative stress can result in DNA damage, including the oxidation of nucleoside. 8-Hydroxydeoxyguanosine is an oxidized stress derivative DNA damage of deoxyguanosine and is one of the major products of DNA oxidation. This review has largely focused on the role of reactive oxygen species in desquamative gingivitis; oxidative species play important roles in the development of much pathology.

2-5

Authors: Ayanat Husain, Huma Firdaus, Saurabh Pathak

Background: Laparoscopic surgery widely, known as single incision laparoscopic cholecystectomy (LC), has been proved as the gold standard surgical technique and is now considered the treatment of choice as well as preferred surgical technique in cholecystectomy. The use of laparoscopic technique in cholecystectomy is widely used for cholelithiasis patients. An abdominal ultrasonography (USG) often precedes this surgery and can verify the diagnosis, as well as help in showing possible complications during the perioperative period. Aim: A prospective study was conducted to evaluate the pre operative with and without (based on clinical findings) USG findings and predictive difficulties in cholelithiasis patients comparing with surgical findings in LC. The post-operative evaluating criteria were as follows: (1) Duration of surgery, (2) Bleeding, (3) Dissection of Calot’s triangle, (4) Dissection of gallbladder wall, (5) Spillage of bile and stone, (6) Difficulty of gall bladder stone. Methods: We studied and evaluated surgical difficulties in 150 patients of cholelithiasis who underwent abdominal USG test for surgical LC. Variables such as identification and amount of gallstones involved were evaluated, both in preoperative USG and during surgery to evaluate sensitivity, specificity, concordance and positive and negative predictive values. All patients had routine blood tests (including liver function tests), electrocardiography, chest X-ray, and abdominal ultrasound scan performed preoperatively. All patients received general anesthesia, and the standard Reddick and Olsen technique was performed. The harmonic scalpel was used in all cases. Results: On evaluation of surgical difficulties in cholelithiasis patients, we found 135 females and 15 males for surgical LC. Out of which 36 (24.0%) cases to be predicted as difficult, 26 (17.33%) were laparoscopic converted for open surgery, 36 (24.0%) were technically difficult. 54 (36.0%) cases were predicted easy to perform on USG. On evaluation, our findings were found to be significant, and hence, we concluded that pre-operative ultrasound examination if of importance for predicting difficulties in LC, but still required further studies.

12-15

Authors: Shivaji Patil, Anannya Mukherji, Akshaya Shetty

Background: Hyponatremia is defined as common electrolyte disturbance or decline blood sodium concentration in critically ill patients. Hyponatremia often results in intensive care unit (ICU) admissions and are also associated with significant mortality and morbidity. The study was undertaken to assess the follows points: (1) To assess the incidence of hyponatremia in patients in ICU. (2) To describe the etiological factors responsible for hyponatremia. (3) To describe clinical manifestations of hyponatremia. (4) To describe treatment modalities for hyponatremia in ICU patients. Materials and Methods: (1) Study design - Cross-sectional. (2) Study period - 01/09/2014 to 01/05/2015 data on patients admitted to the hospital in the ICU with hyponatremia were collected. (3) Inclusion criteria - Patients admitted to the ICU with serum sodium levels ≤130 mEq/L, age of patients >18 years. (4) Exclusion criteria - Patients, who did not give consent, age of the patients <18 years, patients admitted to the ICU with serum sodium levels >130 mEq/L, and post-operative patients. (5) Sample size: 100 cases. (6) Sampling type: Purposive. Results: A total of 100 hyponatremic and 50 non-hyponatremia critically ill admitted patients in ICU were observed and evaluated out of which 41 (hyponatremic) [Table 2] were males and 59 were females in the study. We have included the non-hyponatremia patients to evaluate with hyponatremia patients. In our study, we observed that in hyponatremic patients, 66% patients had neurological manifestations. These include seizures, reduced consciousness level, confusion, unsteadiness, and falls. Conclusion: Hyponatremic patients should be diagnosed early in ICU, and the treatment should be start accordingly. It is frequent finding in critically ill patients admitted to ICU. Most etiological factors involved in it are severe sepsis, renal failure, liver cirrhosis, trauma, hypothyroidism, and hypocortisolism. A patient with hyponatremia needs longer duration stay in ICU with higher mortality rate and longer ventilation days.

20-24

Authors: K P Mohammed Sadique, Benny Varghese, Elsy P Simon, Sandeep Lal Cherukara, Nithu Marina Terence

Periapical inflammatory lesions occur in response to the ingress of microbes from the root canal. The treatment rendered in endodontic procedures includes root canal cleaning and shaping followed by obturation. In an event when the pathology cannot be cleaned due to obturation, surgical intervention has to be delivered. The rationale of surgical endodontics is to eliminate the pathological tissue in an infected necrotic tooth present at the apex of a root canal and throughout the apex and retrofill the space inside the root canal with biologically inert material so as to achieve a tight seal. Herein we are documenting a case report of 26-year-old male patient with a chief complaint of swelling and pain in the upper front teeth region and a large bony defect radiologically in which a periapical endodontic surgery was performed. The surgical defect was filled with platelet-rich fibrin (PRF). Clinical examination revealed uneventful wound healing. Radiologically, the defect has been almost entirely replaced by new bone at the end of 8 months. On the evidence of the outcomes obtained in our case report, we hypothesize that healing process was enhanced by an autologous PRF and can be used as a regenerative material of choice in such type of endodontic procedures.

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.