BACKGROUND:Pediatric oncology patients are highly susceptible to oral complications during chemotherapy. Awareness amongst parents and oral hygiene practices play a crucial role in preventing and managing these issues. AIM:To assess parental knowledge and awareness about the oral hygiene practices and reported oral manifestations associated with chemotherapy in pediatric oncology patients. MATERIALS AND METHODS:This was a questionnaire-based cross-sectional study conducted in the Department of Pediatric Oncology over one year. Parents of 66 children aged 0-18 years completed a structured questionnaire covering dental care utilization, oral hygiene practices, awareness regarding oral health, pre-treatment dental status, and self-reported oral side effects after therapy. RESULTS:Only 25.7% of children had ever visited a dentist, and 12.1% underwent dental evaluation before oncology treatment. While 57.6% brushed once daily, 51.5% required assistance, and 63.6% consumed snacks between meals. Parental awareness regarding the impact of diet and oral health on general health was low (30.3%). More than half of parents (57.6%) reported oral changes after the initiation of therapy, with oral ulcers (40.9%), difficulty eating (30.3%), and taste alteration (27.3%) being most common. Despite these symptoms, only 3% underwent dental treatment post-therapy initiation. CONCLUSION:The study reveals inadequate dental care utilization, suboptimal oral hygiene practices, and lack of awareness amongst parents of pediatric oncology patients. Routine dental screening, structured oral hygiene education, and multidisciplinary collaboration is essential to minimize oral complications and improve oral health during chemotherapy.

Objectives:Individuals with special health care needs, face unique oral health challenges due to physical, cognitive, and behavioral limitations. They often exhibit a significantly higher burden of dental caries and periodontal diseases. The objective of the study was to assess the oral health status of individuals with special needs in five special schools and evaluate their oral hygiene practices and determine the influence of demographic factors on clinical outcomes such as dental caries, oral hygiene, and gingival inflammation. Methods:A cross-sectional study was conducted among 209 subjects with special needs residing at five special schools. Participants were examined for simplified oral hygiene index (OHI-S), decayed, missing and filled teeth (DMFT) index, and gingival index. Sociodemographic data and oral hygiene practices were also recorded. Statistical comparisons between groups were made using independent t tests and analysis of variance. Results:Autism was the most prevalent condition, affecting 72.2% of the participants. Although 98.1% of them reported brushing their teeth, the OHI-S score was 3.04 ± 1.4 and DMFT score was 3.21 ± 0.61, indicating a significant oral disease burden. Gender-specific analysis showed that males had significantly higher OHI-S scores (3.12 ± 0.7) compared to females (2.70 ± 0.6, P = 0.04), whereas females had a significantly higher number of missing teeth (1.47 ± 0.5) compared to males (0.66 ± 0.4, P = 0.049). Also, participants aged >20 years demonstrated the worst oral health indices, with significant increases in OHI-S, missing teeth, and gingival inflammation (all P < 0.05). Conclusion:The findings of this study indicate toward a severe oral health burden among individuals with special needs despite good basic oral hygiene routines. Hence, there is a need for targeted interventions, enhanced caregiver education, and early intervention programs to address the barriers affecting oral health in these individuals.

Background & Objectives:The Greater Palatine Foramen (GPF), is a vital anatomical landmark for palatal nerve blocks. Hence imaging of this structure to understand its anatomy is important. Our study aimed to explore the radiomorphometric parameters of the greater palatine canal and pterygopalatine fossa using CBCT images in different age groups and gender. Subjects Materials and Methods:100 CBCT images showing both right and left maxillary sinus region were analysed for length of the greater palatine canal, the upper and lower opening diameters, and the intra-canal curvature. The recorded values were statistically analysed. Results:The right greater palatine canal length was significantly shorter in individuals >25 years (Mean = 31.72 mm, SD = 4.30 mm, p-value = 0.021). The left upper opening diameter increased significantly with age (Mean = 5.90 mm, SD = 1.47 mm, p-value = 0.006). Males exhibited longer canals (Avg. length mean = 33.23 mm, SD = 4.19 mm, p-value = 0.095). And larger lower opening diameters (Avg. mean = 5.69 mm, SD = 1.18 mm, p-value = 0.073) than females. Canal curvature was predominantly curved across both the age groups, but age group 18-25 years showed a significantly higher prevalence of curved canals on both sides. Conclusion:The present study showed significant variations in the morphology of the greater palatine foramen and canal curvature with respect to age and sex. Variations in GPC length, diameter, and curvature can influence the success of palatal nerve blocks, that reduce the risk of injury to the greater palatine nerve. Recognizing these differences through preoperative CBCT enables accurate anesthesia delivery, safer flap design, and precise osteotomy planning.

Purpose:Thyroid hormones have a catabolic effect on bone mineral homeostasis. Hypothyroid patients have shown changes in bone mineral density with increased risk for osteoporosis and bone fractures. Radiomorphometric parameters on panoramic images are good indicators of bone mineral density. The aim of the study was to compare the radiomorphometric parameters in dental panoramic images of patients diagnosed with hypothyroidism with age- and gender-matched control populations. Methods:Panoramic radiographs of 47 patients diagnosed with hypothyroidism were measured for radio morphometric indices like mental index (MI), The inferior panoramic mandibular index (PMI), antegonial index (AGI), gonial Index (GI) and mandibular cortical Index (MCI). The measurements were compared with age and gender matched 50 healthy controls. Results:The mean values of MI (3.11), PMI (0.28), and GI (1.38) were lower in hypothyroidism than in 50 healthy controls which was 3.17, 0.30 and 1.33, respectively. However, only AGI (3.14) showed statistically significant differences (p = 0.03). Conclusion:This study showed radiomorphometric parameters like MI, PMI, GI and AGI are valuable indicators of bone changes in mandible of patients with systemic diseases like hypothyroidism. Although statistically significant difference was seen only in AGI compared to healthy controls. Further studies with larger samples can provide substantial data. Applying newer technologies like machine learning can also help us determine whether mandibular morphometric parameters can predict changes in bone mineral density in hypothyroid cases.

New tools aid in the diagnosis of diseases and thus help in advancing patient care. “Fractal Analysis” is a versatile method of applying nontraditional mathematics to patterns that are beyond understanding with traditional Euclidean concepts. This analysis can be used on radiographic and non-radiographic images in dentistry. In this review we aim to identify the usefulness of fractal analysis in dentistry in radiographic images, its applications and future scope. Articles published between 1992 and 2024 were retrieved through an electronic search of Medline via PubMed, Scopus, and Google Scholar databases. The search, which was limited to articles published in English, aimed to identify relevant studies by employing the following keywords: “fractal analysis,” “dental radiographs,” “mandibular,” “panoramic radiographs,” and “radiography.” Ultimately, 76 articles that addressed the application of fractal analysis in dental radiographs were selected. Fractal analysis can reveal alterations in bone and in images of morphologically altered tissue, however no set values exist which could be used as a standard for diagnosing various conditions. Fractal Analysis can potentially be used as an adjunct to diagnostic tests as it is shown to identify alterations in bony and trabeculae patterns.

Accurate segmentation of the Inferior Alveolar Nerve (IAN) in Cone Beam Computed Tomography (CBCT) is critical for improving patient outcomes and reducing surgical risks in dental and maxillofacial procedures. This study explored UNet, Residual UNet, and Attention UNet models combined with preprocessing techniques like image sharpening and Contrast Limited Adaptive Histogram Equalization (CLAHE) for IAN segmentation. Evaluation metrics included precision, recall, F1 score, accuracy, and Intersection over Union (IoU). Preprocessing led to a significant improvement in performance. Residual UNet with CLAHE and image sharpening achieved the highest results, with an accuracy of 0.940, precision of 0.916, recall of 0.833, F1 score of 0.872, and IoU of 0.675. These findings highlight the effectiveness of Residual UNet combined with CLAHE and image sharpening for accurate IAN segmentation. This method enhances the segmentation accuracy and may lead to better clinical decision-making in oral surgery.

Aim:This comparative study evaluated the effectiveness and safety profile of topical amlexanox and triamcinolone for the management of erosive oral lichen planus (EOLP). Materials and Methods:This prospective, observational study included 21 patients diagnosed clinically and histopathologically with EOLP and categorized into two groups. Subjects in the two groups were prescribed topical amlexanox and triamcinolone, respectively, for 4 weeks. The area of the erosive lesion and burning sensation was measured at baseline, at the end of the first, 2second, and fourth week. These outcome measures were documented and statistically analyzed. The statistical analyses were performed using the IBM SPSS Statistics version 22. Analysis for age distribution was done by independent sample t test. Analysis of sex distribution was done by chi-square test. Variations within a single group for both the outcome parameters were calculated by Wilcoxon signed rank test. (P < 0.05 statistically significant). Results:A total of 30 erosive sites were evaluated in 21 patients over a 4-week duration. The most common site was the buccal mucosa in both groups (23 of 30; 76.67% of total lesions assessed), followed by the tongue (5 of 30; 16.67% of total lesions assessed), the palate (1 of 30; 3.33% of total sites assessed), and the maxillary attached gingiva (1 of 30; 3.33% of total sites assessed). Group 1 (amlexanox) was comprised of 11 subjects, whereas Group 2 (triamcinolone) was comprised of 10 subjects. Pre and posttreatment comparison revealed no statistically significant difference (P = 0.756; 0.512, respectively), for the area of the erosion and burning sensation. Intragroup analysis showed that in Groups 1 and 2, there was a statistically significant reduction in the measures posttreatment (P < 0.05). Conclusions:Amlexanox provides an earlier onset of pain relief in the treatment of EOLP, whereas providing a comparable reduction in the erosive area compared with triamcinolone. Topical amlexanox appears to be as effective as triamcinolone and is a promising alternative in the management of the erosive lichen planus with minimal adverse effects.

Thyroid hormones have a catabolic effect on bone mineral homeostasis. Hypothyroid patients have shown changes in bone mineral density with increased risk for osteoporosis and bone fractures. Radiomorphometric parameters on panoramic images are good indicators of bone mineral density. The aim of the study was to compare the radiomorphometric changes in dental panoramic images of patients diagnosed with hypothyroidism with age- and gender-matched control populations. Materials and Methods Panoramic radiographs of 47 patients diagnosed with hypothyroidism was measured for Radio morphometric indices like Mental index (MI), The inferior panoramic mandibular index (PMI), The antegonial index (AGI), Gonial Index (GI) and Mandibular cortical Index (MCI). The measurements were compared with age and gender matched healthy controls. Results The mean values of mental index, inferior panoramic mandibular index, and gonial index were observed in hypothyroidism than in healthy controls. However, only AGI showed statistically significant differences between cases and controls (p = 0.03). Conclusion Further studies with larger samples, comparing the dosage of hormone replacement therapy and hormone levels with bone changes, can provide substantial validated data

Introduction:Dental age estimation using third molars is a reliable method for estimating the age of individuals. Recently, magnetic resonance imaging (MRI) of the head and neck has been found to be applicable for age estimation of third molar teeth. In the present study, we aimed to apply the Modified Demirjian method of age estimation to magnetic resonance (MR) image sections for dental age estimation by determining the mineralization patterns of the maxillary third molars. Methods:MRI scans of the patients were performed using SIGNA™ 3.0Tesla MRI GE Healthcare (Chicago, USA) with a moving, multifunctional coil. Two expert radiologists with more than three years of experience independently analyzed the image sections using the open-source Digital Imaging and Communications in Medicine (DICOM) viewer software. The age and sex of the patients whose images were included in the study were recorded using a specially designed proforma. The stage of development of the maxillary third molars was determined using the modified Demirjian method. Inter observer agreement was calculated using the intra class correlation coefficient. Simple linear regression analysis was used to predict the actual age at the third molar development stage. Results:There was excellent agreement between observers (ICC =0.99 (95% CI = 0.98-0.99)). There was also a significant association between the maxillary third molar tooth development stage and chronological age of the individual (P=0.001; B=1.54; 95% CI = 0.71-2.37). Discussion:The findings from the present study establish that the Modified Demirjian method can also be reliably applied for dental age assessment in MR sections.

Background The application of AI algorithms for the detection of the mandibular canal in Cone Beam Computed Tomography (CBCT) holds immense promise in dentistry. Aim This review aimed to identify the semi and fully automated algorithm to localize the mandibular canal. An extensive search was conducted and, out of which 12 articles are considered for review. The result revealed using various AI algorithms achieved better accuracy in localizing the mandibular canal with reporting sensitivity and specificity above 90%. In conclusion, it is noted that the application of AI algorithms in dentistry can provide significant benefits like improving the accuracy of reporting.

Background Dental radiology has significantly benefited from cone-beam computed tomography (CBCT) because of its compact size and low radiation exposure. Canal tracking is an important application of CBCT for determining the relationship between the inferior alveolar nerve and third molar. Usually, canal tacking is performed manually, which takes a lot of time. This study aimed to develop an artificial intelligence (AI) model to automate classification of the mandibular canal in relation to the third molar. Methods This retrospective study was conducted using 434 CBCT images. 3D slicer software was used to annotate and classify the data into lingual, buccal, and inferior categories. Two convolution neural network models, AlexNet and ResNet50, were developed to classify this relationship. The study included 262 images for training and 172 images for testing, with the model performance evaluated by sensitivity, precision, and F1 score. Results The performance of the two models was evaluated using a 3 × 3 confusion matrix, with the data categorized into 3 clases: lingual, buccal, and inferior. The mandibular canal and third molar have a close anatomical relationship, highlighting the need for precise imaging in dental and surgical settings. To accurately classify the mandibular canal in relation to the third molar, both AlexNet and ResNet50 demonstrated high accuracy, with F1 scores ranging from 0.64 to 0.92 for different classes, with accuracy of 81% and 83%, respectively, for accurately classifying the mandibular canal in relation to the third molar. Conclusion The present study developed and evaluated AI models to accurately classify and establish the relationship between the mandibular canal and third molars using CBCT images with a higher accuracy rate.

Oral cancer is increasing in prevalence and its treatment is associated with high degree of morbidity and mortality. Thus, prevention of oral cancer is of utmost importance. Chemoprevention is the use of natural, synthetic, or biologic compounds to halt, reverse, or prevent the initial phases of carcinogenesis or the progression of neoplastic cells to cancer. This modality has been extensively researched in the last two decades for the prevention of oral cancer with the emergence of new information. Retinoids were the first chemopreventive agents to be tested in clinical settings. Since then, a number of new agents such as COX2 inhibitors, EGFR inhibitors, p53 targeted agents, thiazolidinediones and several natural agents have shown promise in oral cancer prevention. Chemopreventive trials in oral cancer tend to be long term studies and are thus challenging. This review article looks into the clinical evidence for the application of chemopreventive agents in clinical settings and also highlights the recent trends in oral cancer chemopreventive trials.

Background: Cone beam computed tomography (CBCT) is a specialized medical equipment and plays a significant role in the diagnosis of oral and maxillofacial diseases and abnormalities; however, it is attributed to risk of exposure of ionizing radiation. The aim of the study was to estimate and determine the amount of scattered radiation dose to the thyroid gland in dental CBCT during maxilla and mandible scan.Materials and Methods: The average scattered radiation dose for i-CAT 17–19 Platinum CBCT (Imaging Sciences International) was measured using a Multi-O-Meter (Unfors Instruments), placed at the patient’s neck on the skin surface of the thyroid cartilage, with an exposure parameter of 120 kVp and 37.07 mAs. The surface entrance dose was noted using the Multi-OMeter, which was placed at the time of the scan at the level of the thyroid gland on the anterior surface of the neck.Results and Discussion: The surface entrance dose to the thyroid from both jaws scans was 191.491±78.486 μGy for 0.25 mm voxel and 26.9 seconds, and 153.670±74.041 μGy from the mandible scan, whereas from the maxilla scan the surface entrance dose was 5.259±10.691 μGy.Conclusion: The surface entrance doses to the thyroid gland from imaging of both the jaws, and also from imaging of the maxilla and mandible alone were within the threshold limit. The surface entrance dose and effective dose in CBCT were dependent on the exposure parameters (kVp and mAs), scan length, and field of view. To further reduce the radiation dose, care should be taken in selecting an appropriate protocol as well as the provision of providing shielding to the thyroid gland.

Background: Lingual plate thickness, density, and proximity to the tooth are linked as risk factors for various complications associated with third molar extraction. The present study aimed to assess the lingual plate thickness, and density in the mandibular third molar region using cone beam computed tomography and to estimate its correlation with type and level of impaction, number of roots, age, and gender as the risk factorsMethods: This was a retrospective study on CBCT images of 648 mandibular third molars. The lingual plate thickness at three different root levels - cervical, mid-root, and apex along with the position of the tooth, number of roots, density of lingual plate, age, and gender were evaluated. The measurements were done on Invivo 5-Anatomage software. Statistical comparison of the categorical variables was done by Chi-square test, and Fisher's exact test, and univariate and multivariate analysis were done using binomial logistic regression.Results: Lingual plate thickness of the third molars at the cervical, mid root, and apex were 1.28 mm, 1.42 mm and .01 mm (mean). A significantly higher proportion of subjects with thin lingual plates at mid-root (p-value=0.01) and apex (p-value=0.05) were in the 21-30 age group. Lingual bone density was significantly associated with the thickness of the lingual plate at the mid-root. A significantly higher proportion of thinner lingual plates at the mid-root level were associated with mesioangularly placed third molars (p-value=0.002). Conclusion: Our study presented that lingual plate thickness has a strong association with age, angulation, and the number of roots. about these risk factors is imperative the of third molar impactions.

Introduction: The objective of this study was to observe the effects of the duration of handheld mobile phone usage on the salivary flow, salivary immunoglobulin A (IgA) level, and salivary markers for oxidative stress. Materials and Methods: Eighty-one students were categorized into three groups based on their duration of mobile phone usage after age- and gender-matching. Students were grouped as: mobile phone usage < 20 min/day (Group A), mobile phone usage 20-60 min/day (Group B), and mobile phone usage > 60 min/day (Group C). Saliva was collected to evaluate salivary flow rate, salivary IgA level, and salivary markers for oxidative stress. Results: The salivary flow rate showed no statistically significant difference between the three groups (P = 0.180). There was no statistically significant difference in the salivary IgA between the three groups (P = 0.237). There was a statistically significant difference in the malondialdehyde (MDA) level between the three groups (P = 0.042). On pair comparison between the groups, group B and group C had a statistically significant difference (P = 0.019) in the MDA level. There was no statistically significant difference in the salivary thiol level between the three groups (P = 0.237). Conclusion: The duration of handheld mobile phone usage did not show any significant effects on the salivary flow rate, salivary IgA, and thiol levels. There was an increase in the salivary MDA concentration in subjects using handheld mobile phones for a longer duration, indicating higher oxidative stress in salivary glands exposed to mobile phone radiofrequency electromagnetic waves for a longer duration.

Objective: To test the modified Demirjian's method of dental age estimation on the South Indian population and correlate it with the patient's chronological age. Material and Methods: This retrospective radiographic study was performed on digital panoramic radiographs taken during a one-year duration. Radiographs of patients in the age range from 8 to 18 years were included in the study. The radiographs were examined and according to the stage of the crown and root status of the left side mandibular teeth. The stage of calcification was observed for eight teeth in the mandibular arch and was recorded in a specially designed proforma. Each rated tooth with stage was converted into a score using a conversion table specified for girls and boys. Results: 224 digital panoramic radiographs were retrieved from the radiologic database. Out of total study sample, 49.5% (n=111) were boys and 50.5% (n=113). The mean chronological and estimated dental age using dental maturity scores resulted in an overestimation of 3 years and eight months. Also, it was noted that there was a strong positive association between chronological (real) and dental age. Conclusion: It was observed that there was a strong correlation between chronological and dental age. A new formula for determining the chronological age from the estimated dental age was derived. Further studies on a larger population may prove the reliability of this age estimation method.

Trigeminal neuralgia is the most common neuralgia affecting the orofacial region. The condition characterized by sudden, severe electric shock like pain on the face with pain free periods and is termed as refractory period.Management of this condition is achieved through various drug therapies and in some cases, surgical intervention may be required. Refractory trigeminal neuralgia is a condition that is non responsive to the traditional line of therapy. This poses a challenge to the clinicians to offer the patients alternate options for pain control in these patients. In this review, an attempt has been made to discuss the various drug therapies in the management of refractory trigeminal neuralgia.

Cleidocranial Dysplasia (CCD) is a rare autosomal dominant syndrome that occurs in approximately 1 per million individuals worldwide. This syndrome is characterized by skeletal, orofacial, and dental manifestations like hypoplastic or aplastic clavicle, shoulder hypermobility, patent or delayed closure of fontanelles, and multiple impacted supernumerary teeth with delayed eruption pattern. Early diagnosis and management with a comprehensive team approach are crucial for an overall better prognosis. In this paper, we describe three generations of cleidocranial dysplasia presented in the same family with their clinical features and treatment strategies.

OBJECTIVE:The present study aimed to test the reliability and diagnostic efficacy of the evaluation of radiographs transmitted by email and through instant messaging in the diagnosis of maxillofacial fractures.STUDY DESIGN:Screening of radiographs of 150 patients by a senior maxillofacial radiologist was performed as the gold standard method for the assessment of fractures by using a workstation monitor. The radiographs were sent to the Gmail accounts of 2 observers, who used their laptop computers to independently evaluate the radiographs for fractures. The same radiographs were sent to the smartphones of the observers via WhatsApp Messenger and were evaluated on the smartphone screens. Intra- and interobserver reliability, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated.RESULTS:The reliability of the observers' diagnoses for both modalities ranged from 0.96 to 1.00 compared with the gold standard. Intra- and interobserver reliability ranged from 0.85 to 0.98. Measures of diagnostic efficacy ranged from 93.5% to 100% for images sent by Gmail and from 95.2% to 99.9% for radiographs transmitted through WhatsApp Messenger.CONCLUSIONS:The present study demonstrated that email and instant messaging applications can be reliable tools for the assessment of maxillofacial fractures by radiologists located at remote sites.

Introduction: Temporomandibular Disorders (TMD) encompass several entities, which may have differing etiologies Aim: To identify risk factors for painful TMD among the Indian population presenting to the dental outpatient. Methodology: Subjects with Painful TMD were classified into one of the following three groups: Group 1 (n=24): myofascial pain only, Group 2 (n=38): arthralgia only and Group 3 (n=41): myofascial pain and arthralgia. Forty-one subjects were included in the asymptomatic control group. Adjusted odds ratios (OR) were calculated from multiple logistic regression models that included the relevant risk factors. Results: Increased risk of myofascial pain with arthralgia was significantly associated with clenching (OR: 7.9, CI: 2.1-30), trauma (OR: 12.3, CI: 2.1-69.9), third molar extraction (OR: 3.7, CI: 1.1-12.6), and nonspecific physical symptoms (NPS) with pain (OR: 8.1, CI: 1.8-35.4). Increased risk of myofascial pain only was associated with clenching (OR: 5.5, CI: 1.3-23.3), trauma (OR: 13.2, CI: 2.2-77.5), and NPS with pain (OR: 6, CI: 1.3-26.7). Increased risk of arthralgia only was associated with trauma (OR: 9, CI: 1.8-45.4). Conclusion: A high proportion of subjects with painful TMD reported having clenching, trauma, NPS with and without pain, and depression.