Dental Research Journal
Volume:10 Issue: 6, Nov 2013

The Diagnosis and classification of periodontal diseases has remained a dilemma since long. Two distinct concepts have been used to define diseases: Essentialism and Nominalism. Essentialistic concept implies the real existence of disease whereas; nominalistic concept states that the names of diseases are the convenient way of stating concisely the endpoint of a diagnostic process. It generally advances from assessment of symptoms and signs toward knowledge of causation and gives a feasible option to name the disease for which etiology is either unknown or it is too complex to access in routine clinical practice. Various classifications have been proposed by the American Academy of Periodontology (AAP) in 1986, 1989 and 1999. The AAP 1999 classification is among the most widely used classification. But this classification also has demerits which provide impediment for its use in day to day practice. Hence a classification and diagnostic system is required which can help the clinician to access the patient’s need and provide a suitable treatment which is in harmony with the diagnosis for that particular case. Here is an attempt to propose a practicable classification and diagnostic system of periodontal diseases for better treatment outcome

Cancer is marked by the uncontrolled growth of cells، tissue invasion and metastasis to various organs via the circulatory and lymphatic systems. Recent data have expanded the concept that inflammation is a critical component of tumor progression. Many cancers arise from sites of infection، chronic irritation، and inflammation. The tumor microenvironment، which is largely orchestrated by inflammatory cells، is an indispensable participant in the neoplastic process، fostering proliferation، survival، and migration. Periodontal disease، a chronic inflammatory condition is characterized by an oral bacterial infection leading to inflammation within the supporting tissues of the teeth، which often leads to the destruction of the periodontal tissues and alveolar bone that support the teeth. This oral inflammation often has systemic effects leading to an increased concentration of circulating inflammatory markers with the severity of disease being correlated directly with levels of serum inflammatory markers. Periodontal infection has been linked to organ and systemic diseases. There is documented evidence of significant associations between cancer of the lung، kidney، pancreas، hematological and oral cancers، and periodontal disease. This articles reviews and summarizes the possible biological mechanisms involved between periodontal infection and cancer.

Ever since Gregor Johan Mendel proposed the law of inheritance, genetics has transcended the field of health and has entered all walks of life in its application. Thus, the gene is the pivoting factor for all happenings revolving around it. Knowledge of gene mapping in various diseases would be a valuable tool in prenatally diagnosing the condition and averting the future disability and stigma for the posterity. This article includes an array of genetically determined conditions in patients seen at our college out-patient department with complete manifestation, partial manifestation and array of manifestations not fitting into a particular syndrome.

The purpose of the present study was to discuss some new concepts of the desirable characteristics of smile tooth display. Due to the increasing application of cosmetic dental treatments, there is an increasing need for better understanding of the esthetic principles. In the present descriptive study, with 212 participants, included were patients with no history of orthodontic treatment, loss or prosthetic replacement of anterior teeth, extracted teeth, lips with asymmetry or a history of trauma. Chi-square test was used to determine possible significances in the relation of smile line to Angle occlusion class, overbite and overjet and arch form. A P level of <0.05 was set as to be significant. Chi-square test indicated that there was a significant difference between thesmile design and overbite, overjet and gender but no statistically significant association was found between the smile design and crossbite, molar Angle classification and arch form. Within the limitations of such studies, it might be concluded that there is a significant and important relation between some occlusal parameters and smile design, which must be considered.

To find out if there is an association between levels of salivary Mutans Streptococci (MS) of mothers and salivary MS and Caries experience of their Children. A cross sectional study was designed among 180 mother-child pair attending Vanivilasa Children Hospital, Bangalore, India. Caries was diagnosed using WHO criteria. Ninety children with Early Childhood Caries (ECC) with their mothers were included in case group and 90 caries free children with their mothers were included in the control group. Whole non-stimulated saliva was collected from mothers and children and cultured for MS. Colonies were counted and compared. Data was analyzed using SPSS version 10. Chi-square test and t-test were used to find differences between groups. P value of 0.05 was considered as significant. Among 180 children, 80 of them had a high MS count. Among them, 60 (75%) had ECC and only 20 (25%) were caries free. This difference was significant with P < 0.001. Among 180 mothers, 100 had a high MS count. Among them, 60 (60%) belonged to case group and 40 (40%) to the control group (P = 0.003). Forty nine of the Children in case group with a high count also had mothers with high count as against only 14 in the control group (P < 0.001). Present study showed a strong association between maternal and child salivary MS levels indicating that mother’s MS count could be an important risk indicator for ECC development.

The aim of this retrospective study was to describe the distribution of the nonsyndromal supernumerary teeth (NSST) in a population of patients who attended the clinics of Riyadh Colleges of Dentistry and Pharmacy (RCsDP), Riyadh, Saudi Arabia. The study reviewed 1521 panoramic radiographs of Saudi and non-Saudi subjects who attended RCsDP clinic from November 2009 to November 2010. The data were analyzed using the Statistical Package for Social Sciences, utilizing Chi-square. Eighteen (1.2%) patients were found to have NSST, comprising twelve males 66.7%), and six females (33.3%). The most common supernumerary teeth (ST) were the pre molars six cases (33.3%), followed by the mesiodens, five cases (27.8%). The canines and distomolars three cases (16.6%) each respectively, while the least were the lateral incisors and paramolars of the two cases (11.1%) each. Consanguinity appeared to have a role in the development of hyperdontia in Saudi population because 13 cases (72.2%) out of 18 cases had consanguineous parents, while all patients having consanguineous parents had eumorphic ST.

Scuba diving is one of the fastest growing sports in the world. The objective of this study was to evaluate the effect of pressure variations to which divers are exposed on the pull out strength of glass fiber post luted with different cements. In this in vitro study, 120 extracted, single-rooted lower premolars were endodontically treated. They were randomly divided into six groups and restored using the glass fiber post (Ivoclar Vivadent AG) and the following luting agents: Zinc phosphate, conventional glass ionomer, resin reinforced glass ionomer, resin cement with etch-and-rinse adhesive, resin cement with self-etching adhesive, and self-adhesive resin cement. Each group was randomly divided into two equal subgroups, one as a control, and the other to be used experimentally. After 7 days of storage, experimental groups were pressure cycled. The force required to dislodge each post was recorded in Newton (N) on Universal testing machine (Star Testing System) at a crosshead speed of 1 mm/min. Data were statistically analyzed using the ANOVA and Student’s t-test (P < 0.001). The pull out strength of posts cemented with zinc phosphate and conventional glass ionomer in pressure cycle group was significantly less than their control group. Although, no significant difference was found between pressure cycle and control group using resin reinforced glass ionomer cement and resin cements. Dentist should consider using resin reinforced glass ionomer or resin cement, for the cementation of glass fiber post, for the patients such as divers, who are likely to be exposed to pressure cycling.

The success of combined periodontal and orthodontic approach in the treatment of aggressive periodontitis patients with the pathologic extruded anterior teeth is a main concern and stability of the treatment results is an important factor to evaluate the treatment. The present study investigated the periodontal parameters at the end of the orthodontic treatment in patients with the aggressive periodontitis. Eight patients with an aggressive periodontal disease, extruded maxillary incisors, infrabony defects and probing depth of ≥5 mm were enrolled in this clinical trial (before, after). After periodontal therapy, orthodontic treatment was carried out for intrusion and alignment of teeth. Plaque index (PI), probing pocket depth (PPD), distance between incisal edge and interdental papilla, root length (RL), and defect dimensions (depth and width) were examined at the end of treatment and three as well as 6 months afterward. The data were subjected to repeated measure ANOVA test. P < 0.05 was considered as significant. There was statistically significant decrease in PPD, PI, and depth of the defects during T0, T3 and T6 (P < 0.05). No significant differences were observed in the RL and distance between incisal edge and interdental papilla (P = 0.95). Furthermore, width of the defects demonstrated significant decrease up to T3 (P = 0.042) while no significant changes from 3 months to 6 months were noted (P = 0.59). The results showed that combined periodontal and orthodontic approach would be a successful treatment with acceptable stability in the case of regular follow-up visits and controlled oral hygiene habits.

Currently, orofacial sequelae are recognized as very influential on the qualityof- life for a victim of orofacial damage. Therefore, correct forensic assessment for indenisation purposes is mandatory. However, orofacial damage is frequently reduced to organic components, which results in a forensic assessment process, which are inadequate. This study aims to improve the orofacial damage assessment through the development of an auxiliary tool, the orohanditest. A preliminary inventory was constructed, using relevant bibliographic elements and retrospective study of forensic examinations reports concerning orofacial trauma. This inventory was then utilized in the assessment of 265 orofacial trauma victims for validation. Validity was studied by analyzing the internal construct validity (exploring factorial validity and assessing internal consistency) and the external construct validity (assessing convergent validity and discriminant validity). The level of significance was defined as P < 0.05. The final inventory (orohanditest) was comprised of the three components of body (8 items), functions (10 items) and situations (24 items), which were found to be statistically reliable and valid for assessment. The final score (orofacial damage coefficient) reflects the orofacial damage severity. Orohanditest provides a reliable, precise, and complete orofacial damage description and quantification. Therefore, this method can be useful as an auxiliary tool in the orofacial damage assessment process. Key Words:

Ultrasonic vibrations are used to remove a cemented post from a root canal requiring endodontic retreatment. Various results have been reported from the studies that evaluated the effect of ultrasonic instruments in removing the posts cemented with resin cements. The aim of this study was to evaluate the effect of ultrasonic energy on the retention of prefabricated metal post cemented with Panavia or Maxcem Elite cements. In this in vitro study, forty eight extracted single root premolars were decoronated with a diamond disc leaving a 13 mm long root and endodontically treated. The root canals were obturated by gutta-percha up to 5 mm with vertical condensation method and the 8 mm post-space was prepared to receive a no. 2 long Dentorama post. The roots were placed in an incubator for 48 h in 37°C and 100% humidity. After mounting the teeth in acrylic blocks, posts were cemented in the root canals using Panavia F2.0 in 24 specimens and Maxcem Elite in 24 others. For half of the specimens in each subgroup, an ultrasonic device was applied for 4 min. Universal testing machine was used to measure the force needed to remove the posts with a crosshead speed of 1 mm/min until the post came out of the canal. Kruskal-Wallis test was used for statistical analysis at 5% level of significance. The removal force was not significantly different among the groups (P > 0.05). Ultrasonic energy did not decrease the retention of posts cemented with Panavia or Maxcem Elite cements. Furthermore, it seems that there is no significant difference between removal force of self-etch (Panavia) and the self-etch self-adhesive (Maxcem Elite) resin cements.

The extraction of teeth for orthodontic purpose has always been a controversial subject in the speciality. The aesthetics impact of the soft-tissue profile might play a key role in deciding on premolar extraction or non-extraction (NE) treatment, particularly in borderline patients. The purpose of this cephalometric study was to examine the soft-tissue treatment effects of Class II Division 1 malocclusion undergoing extraction of all first premolars in comparison with patients undergoing treatment with a NE approach. Hundred post-pubertal female patients of Class II Division 1 malocclusion were selected. Group 1, treated with four first premolar extractions, consisted of 50 female patients with a mean age of 14 years 1 month. Group 2, treated without extractions, consisted of 50 patients with a mean age of 13 years 5 months. Pre-treatment and post treatment lateral cephalograms of the patients were obtained. The pre-treatment and post treatment stage comparison and the intergroup comparison of the treatment changes were conducted between extraction and NE groups of Class II malocclusion samples with t tests. The levels of significance tested were P < 0.05 and P < 0.01. The main soft-tissue differences between the groups at the end of treatment were a more retruded lower lip and a more pronounced lower labial sulcus in those patients subjected to extraction. In Class II Division 1 patients, the extraction or NE decision, if based on sound diagnostic criteria, seems to have no systematic detrimental effects on the facial profile.

Human immunodeficiency virus (HIV) causes severe immunosuppression due to progressive decrease in the CD4 T lymphocyte cells during the course of the disease and this affects all the body systems including glandular secretions. A number of lesions affecting the salivary glands have been noted in HIV infection. The objective of this study was to evaluate the salivary pH and the buffering capacity in HIV positive individuals and comparing it with the HIV negative healthy individuals. The study was carried out on 200 HIV positive subjects aged 20 40 years, divided into two groups on the basis of CD4 count and 100 HIV negative healthy individuals as control group. Both unstimulated and stimulated saliva were collected and the pH and buffering capacity ascertained using the saliva check kit. (GC Asia Dental Pvt. Ltd., Singapore, 508724). All the three groups were compared using the ANOVA and it was found there was highly significant decrease in pH and buffering capacity with increase in immunosuppression. The intergroup comparison was carried out using the Tukey honestly significant difference (HSD) and the Chi square test. Group 1; CD4 count <200 and Group 2, CD4 count >200 showed a significant decrease in unstimulated salivary flow, stimulated salivary flow, and pH in comparison to HIV negative individuals; however, change in buffering capacity in Group 2 was not significant. There is a decrease in pH and buffering capacity in HIV infected patients. This decrease may be one of the factors responsible for increased caries in HIV infected population.

The aim of this study was to compare the skeletal and dental changes of a toothborne (Hyrax) and a bone-borne (Smile distractor) expansion devices using three-dimensional model of a human skull. A finite element model of human skull was generated using data from 3-D CT scans of an 11-year-old female child. Then a Hyrax expander (tooth-borne appliance) and Smile distractor (bone-borne appliance) in three different positions were adapted to the finite element model and expanded for 0.5 mm simulating the clinical situation. The 3-D pattern of displacement and stress distribution was then analyzed. The results of this study showed that screw position affects the stress and displacement pattern within the nasomaxillary complex and maxillary dental arch. Closer teeth feel more stress and undergo more displacement than the farther ones. Moreover, skeletal effects of the Smile distractor were greater than of Hyrax in all different positions.

Tumor associated tissue eosinophilia is believed to play a significant role in the biological behavior of the carcinoma. Eosinophil infiltrate in association with the head and neck squamous cell carcinoma (SCC) have been reviewed from time-to-time. The significance of such an association has been variably thought to be either a potential diagnostic tool for stromal invasion or as a prognostic indicator. We aimed to evaluate the efficacy of Congo red staining to differentiate eosinophils in the inflammatory infiltrate in oral squamous cell carcinoma (OSCC) and whether this eosinophilia is associated with the histologic grading in OSCC. The eosinophil infiltration in hematoxylin and eosin (H and E) and Congo red stained sections of 50 biopsies of OSCC were examined. The eosinophil distribution was quantitatively evaluated in both sections as either diffuse or focal and scored as mild, moderate and severe grades. The average number of eosinophils obtained in OSCC stained by H and E and Congo red were then statistically compared by univariate analysis carried out using Student’s t-test. P < 0.01 was used to determine the statistical significance. In the OSCC, the eosinophil infiltration was seen in 43 out of 50 (86%) cases. The elevation of eosinophil count was more diffuse than focal (36 vs. 7 [83.72 vs. 16.27%]). The staining efficacy of Congo red stain over H and E stain to differentiate eosinophils was excellent and found to be statistically significant (P < 0.01). No significant correlation was found with the eosinophil infiltration and the histologic grades of OSCC. Our study showed a strong infiltration of eosinophils in OSCC though no significant correlation was found with the eosinophil infiltration and the histologic grades of OSCC. Congo red staining showed a high sensitivity in staining eosinophils over routine H and E. This staining technique could therefore provide an adjunct to routine H and E in evaluating eosinophils in dysplasia and OSCC cases.

Injection of local anesthesia is one of the most important reasons for development of avoidance behavior in children. Efforts have been performed to decrease pain perception of injection. The present research evaluated the effect of cooling the injection site on pain perception before infiltration of local anesthetics. A prospective single-blind crossover clinical trial was used to investigate pain perception in 50 healthy pediatric patients who needed bilateral buccal infiltration of local anesthetics for dental treatment. They received a topical anesthetic agent (Benzocaine) on one side (control) for 1 min and topical anesthetic agent plus one minute of ice pack on the other side (trial) prior to the injection. A dentist blind to the study assessed the patients’ reaction during injection. Wilcoxon and Mann-Whitney U tests were used for statistical analysis. Statistical significance was defined at P < 0.05. The means of sound, eye, and motor scales (SEM) were 4.06 ± 1.32 and 5.44 ± 1.79 for the study and control groups, respectively. The means of visual analogue scales (VAS) for the study and control groups were 42.20 ± 12.70 and 58.40 ± 16.83, respectively; with statistically significant differences between the two groups (P < 0.05). Cooling the injection site before infiltration of local anesthetics in the buccal mucosa for 1 min, reduced pain perceived by pediatric patients.

Considering the possibility of remaining bacteria in the cavity or invading via microgaps, the use of antibacterial agents in adhesive restoration may be beneficial. This study evaluated the effect of chlorhexidine on immediate and long-term shear bond strength of adhesives with and without antibacterial agent to dentin. In this in vitro study, the occlusal surfaces of 80 intact human premolars were removed to expose the flat midcoronal dentin. The teeth were assigned to four groups. Two adhesive systems, Clearfil SE Bond (SE) and Clearfil Protect Bond (PB) were used according to manufacturer’s instructions as the control groups. In the experimental groups, 2% chlorhexidine was applied prior to acidic primer of two adhesives. Then, resin composite was applied. Half of the specimens in each group were submitted to shear bond test after 24 h without thermocycling, and the other half were submitted to water storage for 6 months and thermocycling before testing. The data was analyzed using three-way analysis of variance (ANOVA) and t-test (a = 0.05). Chlorhexidine application significantly decreased the initial bond strength (BS) of the two self-etch adhesives to dentin (P < 0.05). There was a significant reduction in BS of SE and PB after aging compared to initial bonding (P < 0.05). However, there was no significant difference between BS of the control and chlorhexidine-treated groups for the tested adhesives after aging. PB showed a lower BS than SE in two time periods (P < 0.05). Chlorhexidine was capable of diminishing the loss of BS of these adhesives over time. However, considering the negative effect of chlorhexidine on the initial BS, the benefits of chlorhexidine associated with these adhesives cannot possibly be used.

Cyclosporin A (CsA) is a known immunosuppressive agent and can be considered as a lifesaving drug in the organ transplantation cases. However, it is associated with many side-effects on different tissues and body organs including the periodontal tissues. The present animal study was undertaken to evaluate the effects of CsA targeting the tissue triad of periodontal tissues, i.e., gingiva, alveolar bone and cementum in rats. Twelve 6-week-old male Wistar rats weighing 150-200 g were considered for the case-control study in rats. The rats were divided into 2 groups: (1) CsA (test) group (2) Saline (control) group and were administered the same subcutaneously daily once for 45 days. Impressions were taken and study casts were prepared on weekly basis for the morphometric analysis. At the end of 45 days, rats were sacrificed and specimens were analyzed for histomorphometric analysis. CsA and saline groups were analyzed to test of association using the Student t test at99% confidence interval. The morphometric examination showed significant gingival overgrowth in the CsA group, whereas no such growth in the saline group. Similarly, on histomorphometric analysis, there was a significant loss of alveolar bone in CsA group as compared with control. Furthermore, there was large amount of cementum formation accompanied by insertion of new connective tissue fibers especially in the cervical region of the tooth in CsA group rats. CsA targets the periodontal tissues (gingiva, alveolar bone and cementum) in different pattern. Its role in cementogenesis can be utilized for periodontal regeneration, if its local application is testified and verified in the future animal studies.

The ameloblastic carcinoma is a rare malignant counterpart of the ameloblastoma. Ameloblastic carcinoma is a malignant lesion with characteristic histologic features and behavior that dictates a more aggressive surgical approach than that of a simple ameloblastoma. However, reliable evidence of its biologic activity is currently unavailable due to the scarcity of well-documented cases. We present a rare case of a large ameloblastic carcinoma occurring in the mandible of 44-year old female highlighting its unique histopathologic features and aggressive behavior treated by radical surgery and reconstruction. Involvement of left ramus to right ramus of the mandible makes this case unusual.

Epidermolysis bullosa (EB) is an inherited disorder, which is characteristically presented as skin blisters developing in response to minor injury. Junctional variety of EB is also associated with enamel hypoplasia. Amelogenesis imperfecta presents with abnormal formation of the enamel both in deciduous and permanent dentition. This article describes a previously unreported case of Amelogenesis imperfecta with complete loss of enamel in a young female patient with EB.

Metastasis to the oral region is very rare and accounts for less than 1% of oral malignant tumors. Breast, lung, kidney, adrenal, gastro intestinal tract and prostates are most common primary tumors from which metastasis to oral region occur frequently. Metastasis from thyroid gland is extremely rare to oral region. We present an unusual case of metastatic follicular carcinoma of thyroid in maxilla. The significance of this report is that the secondary lesion was the only symptom of the primary tumor and helped us in diagnosis and treatment of disease.

The present report aimed to study an uncommon case of a pair of twins that presented a discordant dental phenotype. Family investigation, clinical, radiographic examination and molecular analysis were performed in both girls. Molecular analysis confirmed the monozygosity by deoxyribonucleic acid chip technology. One twin presented tooth agenesis in left upper lateral incisor and peg shaped on the contra lateral side while the other twin had no dental alterations. The dental casts study employed digital caliper to compare morphological dimensions and showed alteration only in peg-shaped tooth. In conclusion, this study provide support that one or more mutated gene could cause discordances in dental phenotype in these monozygotic twins.