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   Table of Contents - Current issue
July-December 2020
Volume 12 | Issue 2
Page Nos. 85-194

Online since Monday, December 14, 2020

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Mental Health of Dental Professionals during COVID-19 Pandemic p. 85
Sonali Vijay Deshmukh
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Novel Coronavirus brings a New Challenge for Oral Health-Care Professionals Highly accessed article p. 87
Tarun Vyas, Aravinda Konidena, Ravleen Nagi, Deepankar Misra
A flare-up of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]) started in the city of Wuhan in China and is viewed as another strain that has not been distinguished earlier in people. SARS-COV-2 dominatingly causes sickness that ranges from the basic virus to progressively SARS. Clinical highlights of the disease involve respiratory side effects as fever, hack, brevity of breath, and sore throat. Assessment and treatment of patients during COVID-19 pandemic is a test for the dental experts because of close face to face contact with the patients, thus implicating the requirement of prudent disease control measures. This article reviews the dental contemplations during COVID-19 flare-up in dental settings and prescribed administration conventions to dental experts in influenced territories.
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Dentistry and Risk Management – A Challenging Balance in an Era of COVID-19 Highly accessed article p. 94
Amina Sultan, Neetika Singh, Akanksha Juneja
The novel severe acute respiratory syndrome (SARS-CoV-2) originated in Wuhan, Hubei Province of China, in December 2019, and due to its rapid spread rate, the WHO declared COVID-19 a pandemic and a public health emergency of international concern. The transmission of any infection in a dental office can occur while coming in direct contact with body fluids of an infected patient, environmental surfaces or contaminated dental instruments, or from the infectious particles that have become airborne. Even though the main source of transmission are the patients showing symptoms of COVID-19, recently, asymptomatic patients and patients in their incubation period are reported to be also the carriers of SARS-CoV-2, thereby increasing the risk of spread to close contacts and health-care workers. Because any patient could be a potential asymptomatic COVID-19 carrier, it is advisable to perform tele-screening of all the patients reporting to the clinic. As the transmission of 2019-nCoV via droplets and aerosol is of grave concern, as despite all the precautions taken, it is almost impossible to reduce droplet and aerosol production to zero during dental procedures, hence it is wise that the dental health professionals should not be dependent on any single infection control strategy.
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Role of Occlusion as a Risk Factor in Periodontal Disease Highly accessed article p. 102
Ashutosh Nirola, Priyanka Batra, Kanika Mohindra, Tejasveen Kaur
Occlusion can be described in very simple terms as an intercuspal relationship between the set of maxillary and mandibular teeth. It plays an important role in the pathogenesis of periodontal diseases and traumatic lesions are often manifestation of faulty occlusion. Mc neil defined occlusion as the functional relationship between the components of the masticatory system, temporomandibular joint (TMJ), and craniofacial skeleton. From a research point of view, the TMJ serves primarily as a reference from which mandibular movements are duplicated. Most patients function with the built-in discrepancies in occlusion throughout their life. Periodontal treatment modalities may be required when alterations or abnormalities in the occlusal relationship place undue stress on the periodontium and TMJ, thereby causing dysfunction. The role of trauma from occlusion (TFO) in periodontal disease is still controversial. According to American Academy of Periodontology (AAP), the lesion of TFO may occur in conjunction with, or independent of, inflammatory periodontal diseases. Pathologic occlusion has been proposed as a risk factor for periodontitis. In certain cases, traumatogenic occlusion can cause periodontal destruction, and therefore, occlusal adjustment occasionally is indicated as part of periodontal therapy. The present review focuses on TFO as a risk factor and its impact on the periodontium and its treatment.
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Review: Endodontic Bacterial Characterization p. 110
Asha Kiran Panda, Bibhuti Prasad Barik
Microorganisms, more specifically bacteria, are well known for endodontic pathogenesis. The motivation for quick identification of endodontic bacterial species is to inhibit their growth and to reduce the inflammation. Molecular characterization of these pathogens shall surely aid in understanding endodontics, preservation of oral health, and exploration of finest therapeutics. Characterizing endodontic bacteria structurally and functionally is crucial. Approaches such as microscopic, genotypic, and proteomic identification and molecular phylogeny have been effectively realistic to identify rapidly evolving endodontic strains. Developments of high-throughput DNA sequencing practices are believed to be having high success strategies in investigating community genome data following classical approaches. The existing dynamic metagenomic tools may be directed toward the development of innovative systems biology approaches for effective one-to-one therapeutic strategies.
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Severe Early Childhood Caries in IVF Children: An Observational Study with Comparative Evaluation p. 115
Sudipta Kar, TK Pal, SL Seal, Gautam Kumar Kundu
Context: Severe early childhood caries (S-ECC) is one of the major problems affecting the tooth structure in childhood before 71 months of age. It may affect both In vitro fertilization (IVF) and spontaneously conceived children. Aims: This study was aimed to evaluate, identify, and compare the prevalence of S-ECC in the deciduous dentition of IVF and spontaneously conceived children before 71 months of age. Settings and Design: In a cross-sectional, observational, case–control study, the S-ECC status of children aged 24–71 months was assessed. The studied case group comprised term, singleton babies who were the outcome of IVF in the studied area. The control group comprised term, first child, singleton, and spontaneously conceived 24–71-month-old children who were also resident of the studied area. A sample of 103 IVF and 162 spontaneously conceived children was examined utilizing Caries Assessment Spectrum and Treatment (CAST). Statistical Analysis Used: Statistical analysis was done using Chi-square tests (c2) or Z test. Results: A statistically significant difference was found in some aspects among the studied, i.e., IVF children, and control group, i.e., spontaneously conceived children. Conclusions: IVF children are considered better than spontaneously conceived children in some aspects when studied in relation to S-ECC status evaluated through CAST.
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Comparison of Pain Perception and Discomfort with Three Types of Nickel–Titanium Arch Wires during the Initial Alignment with Fixed Orthodontic Treatment in Lower Arch: An Observational Study p. 119
Tanu Joshi, Amit Bhardwaj, Nandlal G Toshniwal, Shubhangi Mani, Vaibhav Kumar Choudhary, Shalini Patel
Introduction: This observational study with the random sampling was done to locate maximum discomfort and pain experienced with three different nickel–titanium (NiTi) arch wires during the initial leveling and aligning phase of orthodontic treatment in moderate crowding in mandibular arch, and variations in pain and discomfort level associated with area, gender, and age. Materials and Methods: This observational survey was conducted on a sample of 60 orthodontic patients (20 in each group of arch wire) taking little’s irregularity (moderate 4–6 mm) crowding as criteria. The survey has started on the day of bonding along with three different types of initial arch wires (Superelastic NiTi, thermoelastic NiTi, or conventional NiTi), On the same day of bonding appointment and arch wire insertion, all participants were given the Modified Mc Gill pain questionnaire with the Visual Analog Scale and asked to fill and submit to the investigator on their next appointment positively. Results: The results were statistically insignificant in relation to the objectives of an observational study. Conclusion: Any of the three arch wires independent of age, gender, and area can be used by orthodontist during initial leveling and alignment phase of the treatment since the pain and discomfort level for all of them are same.
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Correlation between A, B, and O Blood Group System and Dental Anxiety in Children of Age 6–12 Years in East Bengaluru p. 127
Swathi Kakathkar, Ila Srinivasan, Jyothsna V Setty, P Akhil, Clarissa Suting, KM Nayana
Background: Dental anxiety is a term used to describe fear or stress in a dental setting which a pedodontist has to face routinely. Studies have shown that genetics of blood group plays an important role in human behavior. The genes which code for ABO blood group system are also responsible for the activity of certain neurotransmitters like dopamine. The aim of this study was to assess the correlation between dental anxiety and different blood groups in children. Materials and Methods: The study included 80 healthy children of age 6–12 years requiring Class I and Class II cavity restorations. Dental anxiety was measured using the Animated Emoji Scale during the procedure. Data regarding the blood group of patients were collected using past medical records from parents or guardians. Results: The results showed that the mean dental anxiety score was highest in blood Group AB (3.60), followed by B (2.48), O (2.19), and A (2.00) which was statistically significant. No statistically significant results were found in terms of gender and Rh factor. Conclusion: Dental anxiety scores show a correlation with blood groups.
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Correlating the Age Estimated by Nolla's Method and Modified Demirjian Method with Cervical Vertebral Maturation Index: A Cross-Sectional Study p. 132
Jampani Nancy Priyanka, Nallan C S K Chaitanya, Gomattam Swetha Srivani, Yeladandi Mounika, Gummakonda Rishitha Reddy, Bhargavi Priya, Cheeti Rao Sanjna, Raju Sahiti
Introduction: Among various methods of dental age (DA) estimation, Demirjian method and Nolla’s method are commonly used. One of the methods of determining cervical vertebral morphology was given by Hassel and Farman. Indian age-specific modified Demirjian method by Acharya has not been utilized in the Hyderabad population, and the age derivation information is sparse. Objectives: To correlate the DA using modified Demirjian’s method and Nolla’s method using orthopantomograph with skeletal maturation by cervical vertebral maturation index (CVMI) method using lateral cephalogram. They were compared and correlated for assessing chronological age (CA) and determining the accuracy. Materials and Methods: Among 200 boys and girls (100 each) between 6 and 21 years, the DA was evaluated using orthopantomogram by Ashith Acharya’s modified Demirjian method and also by Nolla’s method. The skeletal maturation was assessed by CVMI method given by Hassel and Farman using lateral cephalogram. These were compared and correlated with CA. The data derived were statistically analyzed using SPSS software 20.0 version. Results: The maximum underestimation of age was found within the age group of 19–19.9 years using Ashith Acharya’s modified Demirjian method and 18-18.9 years using Nolla’s method with median values of −5.05 and −5.03, respectively. Statistically significant difference was found between CAs and cervical vertebral maturation stages in both genders (P = 0.000). The study showed that girls had a late dental development compared to corresponding cervical maturation. Conclusions: The methods of age estimation were not reliable in predicting the accurate age in the Indian population.
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Comparison of Anxiety and Depression Scores in Patients with Oral Lichen Planus and Normal Individuals p. 140
Darshan R Prasad Hiremutt, Amit Anil Mhapuskar, Priya Singh, Nitin Gupta
Introduction: Oral lichen planus (OLP) is a common chronic inflammatory, psycho-mucocutaneous disease affecting about 1%–4% of the general population associated with psychoneuroendocrine and psychoimmunological comorbidities. Lichen planus although it is not an infectious disease, its cause is unknown, it is classified as an autoimmune disorder that may be precipitated or exacerbated by psychosocial stress. The Hospital Anxiety and Depression Scale (HADS) was originally developed to indicate the possible presence of anxiety and depressive states in the setting of a medical outpatient clinic and was found to perform well in assessing the anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population. Aims: The aim of this study is to evaluate the levels of psychological status and the impact of treatment on psychological status in OLP individuals and compare it with normal individuals. Materials and Methods: Forty OLP patients along with the same number of age- and gender-matched healthy controls were included in the study. HADS questionnaire was administered to all 40 OLP (start of therapy) and 40 non-OLP individuals. In the OLP Group (40 participants): 20 were given “active” intervention with Cyclosporine Oral Solution (Group A), 20 were given “placebo” intervention (Group P). HADS questionnaire was given to all the twenty participants of Group A and all twenty participants of Group P at the end of therapy. The questionnaire consisted of 14 questions; 7 questions pertaining to anxiety and 7 pertaining to depression. Results: High level of anxiety (47.5%) and depression (85%) was observed in participants with OLP as compared to non-OLP (0%). After the active intervention, 14 participants were relieved of anxiety as compared to 8. Comparison of the prevalence of depression in OLP individuals before and after getting “active” intervention revealed that on getting active intervention the depression present in all 20; 1 (10%) mild and 9 (90%) frank came down to 1 (10%), and 4 (40%) mild. Five (50%) participants were completely relieved of depression. Conclusion: Lichen planus is to some extent a psychosomatic or somatopsychic disease or both. The present study results matches with the majority of the studies, showing a positive association between anxiety and depression levels in OLP patients, suggesting counseling along with traditional treatment can be effective in reducing the size of the lesions. Oral healthcare providers should pay attention to the emotional state of their patients. Emotional factors are important as evidenced by higher frequency of psychiatric symptoms, poor quality of life, higher level of anxiety, and neuroendocrine and immune dysregulations. Counseling may help in ameliorating symptoms, improving quality of life, and enhancing recovery.
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Three-Dimensional Analysis of the Nasopalatine Canal in Dentulous and Edentulous Maxilla – A Cone-Beam Computed Tomography Study p. 148
Gayatri Mehrotra, Ajay Bhoosreddy, Seema Bhoosreddy, Chetan Bhadage, Komal Sharma, Karan Shah
Introduction: Dental esthetics has become an important concern today, and the patients consider the esthetic outcome to be an important factor in the anterior maxilla. Nasopalatine canal (NPC) plays an important role in making decisions regarding implant placement in the anterior maxilla. The aims of the present study were to analyze and compare the length and diameter of NPC and bone dimensions anterior to the canal in dentulous and edentulous maxilla for dental implant consideration using cone-beam computed tomography (CBCT). Materials and Methods: Sixty CBCT scans were collected retrospectively for the examination of NPC of individuals who had undergone CBCT scans for dental treatment purposes. The length of the canal and bone dimensions anterior to the canal were measured in multiplanar reformation. Results: The mean canal length was less in edentulous than dentulous patients. Moreover, the bone width anterior to the canal and bone height were also more in dentulous patients, with mean bone width being 8.518 ± 1.9 mm and bone height 7.993 ± 1.4 mm. The bone width and bone height in edentulous cases were 6.910 ± 1.44 mm and 5.183 ± 1.1 mm, respectively. Conclusion: Although there are variations in each patient, thorough knowledge of NPC and bone dimension is essential for implant placement to avoid any complication.
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Canal Localization in Dry Mandibles: Two-Dimensional versus Three-Dimensional Imaging p. 154
Ajay Chandran, Puttaraj T Kattimani, S Nachiappan, Marbon A Joevitson, Sreetama Chatterjee, Aarti M Rajambigai, Maneesha Das, Abhishek Singh Nayyar
Context and Aim: Dental implants are widely used for the rehabilitation of edentulous arches. Yet, placement of oral implants in the mandible is associated with numerous complications, including hemorrhage and neurosensory disturbances. Enumerating precise information concerning the vital structures of the mandible, thus, becomes all the more important before the placement of implants. The aim of the present study was to determine the efficiency and accuracy of digital orthopantomography (OPG) and cone-beam computed tomography (CBCT) in determining the location of mandibular canal in preoperative assessment of the mandibles for implant placement. Materials and Methods: Ten dry edentulous mandibles of adult humans were selected for this study which comprised two phases, namely a radiographic phase and an in vitro phase. The radiographic phase was based on the obtaining digital orthopantomographs and cone-beam computed tomograms. During the in vitro phase, all the mandibles were sectioned at an angle of 90° to the inferior border of the mandible, and in vitro measurements were obtained. Statistical Analysis Used: Statistical analysis was done using IBM SPSS statistics 20 (Chicago, IL, USA). Paired and unpaired t-tests were used to do a comparative analysis of the two modalities used. P < 0.05 was considered to be statistically significant. Results: The results of the present study revealed that the measurements of both the vertical (D1 and D2) and the buccolingual distances of the mandible (D3 and D4) obtained by CBCT were in accordance with the ones obtained with the help of in vitro measurements, and there was no statistically significant difference in the studied variables (D1, D2, D3, and D4) between the two measurements. On the contrary, there was a significant statistical difference between the values obtained from digital OPG (D1 and D2) when compared to the values obtained by in vitro measurements. Conclusion: The findings of the present study implied that CBCT is the most efficient and accurate diagnostic tool available to locate the course of mandibular canal in the selection of potential implant sites. The accuracy of the CBCT was found to be superior to the digital panoramic images in the present study because of multiplanar three-dimensional reconstructions.
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Orocutaneous Fistulae Mimicking as Dermatological Lesion: A Diagnostic Dilemma p. 166
Rajeev Pandey, Jitender Kumar, Fatema Bootwala, Mahashweta Nag
Orocutaneous lesions of odontogenic origin are rare, and sometimes, they can mimic as dermatological lesions. They are usually misdiagnosed, and as a result, the treatment is delayed leading to the chronicity of the lesion and enlargement of the fistula and bone loss. These cases require multispecialty consultation for proper diagnosis and treatment. Here, we report a case series of orocutaneous fistulae, due to misdiagnosis, the treatment rendered was improper, leading to enlargement of the lesion along with bony defect and loss of tooth.
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Dental Surgery in an Asplenic Patient p. 173
Om Nemichand Baghele, Smita Umakant Malbhage, Vishnudas Dwarkadas Bhandari, Sharvaree Ratnakar Deshpande, Saleem Khan Gaffar Khan, Sunanda Gaddaley
Nonsurgical endodontic treatment is a highly predictable treatment option in most cases, but surgery may be indicated for teeth with persistent periradicular pathosis unresponsive to it. The persistence of infection usually, but not always, indicates reduced immunological resistance. In such scenario, the clinician should be vigilant and find out the source of immunological incompetence before implementing treatment. Following splenectomy, individuals have an elevated risk of infection, in particular to encapsulated bacteria, Gram-negative pathogens such as Capnocytophagia carnimorsus and Bordetella holmesii, and intra-erythrocyte parasites such as malaria and babesia. After splenectomy, there are alterations in cell counts, cell quality, and immunological responses. Initially, after splenectomy, a reactive thrombocytosis and leukocytosis is observed. Splenectomized individuals are at risk to, overwhelming bacterial sepsis (overwhelming postsplenectomy infection). The complications are now infrequent because of pneumococcal vaccinations, prophylactic penicillin, and prompt medical attention at the first sign of fever. This case presents relevant management of a periradicular lesion in a 32-year-old male who has undergone splenectomy because of idiopathic thrombocytopenic purpura. The tooth was first endodontically treated that was followed by periodontal and periapical surgical treatment.
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Long-term Clinical Evaluation of Coronally Advanced Flap with Chorion Membrane for the Treatment of Multiple Adjacent Gingival Recession Defects p. 184
Deepak Sharma, Pravesh Kumar Jhingta, Vinay Kumar Bhardwaj, Arun Singh Thakur
Multiple adjacent recessions are challenging defects since they present a number of critical anatomic features as large surgical field, frequently shallow vestibules and prominent roots as well as a variation in the size of defects and residual keratinized tissue. Different surgical techniques have been proposed for the treatment of multiple adjacent recessions, mainly derived from the coronally advanced flap with or without connective tissue graft or from tunnel approaches. Harvesting of connective tissue graft is time consuming, it is limited in quantity and exposes patient to another surgical wound. The overall objective of this study is to evaluate the effectiveness of Coronally advanced flap with Chorion membrane for the treatment of multiple adjacent gingival recession defects.
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Modified Nance Palatal Arch: A Novel Appliance p. 191
Pritesh N Gawali, Geetanjali Jeevan Jadahav, Anand B Shigli, Rahul J Hegde, Priyanka K Garje
The following case report presents a new and innovative technique for the preservation of space due to tooth loss as well as the interception of anterior cross-bite. The novel appliance fabricated fully satisfies the demand of the adolescent patient, while fulfilling the esthetic and functional requirements presented by the case.
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