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Objectives The aim of this study was to assess the reliability, frequency, and clinical significance of temporomandibular joint (TMJ) medial and lateral disk positions, observed in the coronal–oblique plane, to determine their importance in clinical diagnosis and for routine imaging. Study Design This cross-sectional study involved secondary data analysis (clinical and imaging) of 401 participants of the TMJ Impact Study. We used the χ2 statistic to evaluate the associations between coronal disk positions with (1) anterior disk displacements with reduction and without reduction; and (2) familiar TMJ pain resulting from excursive movements and palpation, range of motion, and joint sounds. Results Anterior disk displacements of any type occurred in 67.5% of joints; in contrast, medial and lateral disk positions occurred in 16% and 24% of joints, respectively. Radiologist reliability was as follows: sagittal posterior band position: right κ = 0.68, left κ = 0.60, average 84% agreement; and medial or lateral disk position: right κ = 0.36, left κ = 0.32, average 70% agreement. Medial and lateral disk positions were associated with sagittal displacements (P Conclusions Coronal disk position does not contribute to clinical symptomatology or findings and currently lacks sufficient evidence to support its inclusion into standard TMJ imaging protocols or into a clinical diagnostic category.

Objectives Given the evolving drug therapy options and consequent opportunistic infections, antifungal drug resistance is a major concern in patients with human immunodeficiency virus (HIV) undergoing highly active antiretroviral therapy (HAART), prompting the need for clinically relevant antifungal susceptibility testing. The goals of the present study were to determine the asymptomatic oral fungal carriage and species distribution in patients with HIV infection receiving HAART in Kerala State, India, and to evaluate the antifungal susceptibility/resistance profile of these oral fungal isolates. We also sought to identify any correlation between antifungal susceptibility/resistance with respect to the duration of HAART therapy and if there was an association between oral fungal colonization, CD4 counts, and risk factors. Methods Thirty HIV-positive patients receiving HAART were divided into 2 groups based on duration of HAART (group 1, 2 years). A detailed history, including demographic characteristics, treatment details, and presence of any risk factors for candidiasis, was taken before saliva sample collection by the oral rinse method. Candidal growth and colonies were evaluated on the Sabouraud slope. Germ tube, sugar assimilation, and fermentation tests were used for identification of species. When conventional methods failed to identify any fungal isolates, they were verified using the automated VITEK-2 YST system (bioMerieux, Marcy l'Etoile, France). The Wilcoxon signed-rank test was used to compare the CD4+ lymphocyte count before and after initiation of HAART. The association of risk factors with candidiasis was analyzed using the chi-square test. Results Overall culture positivity was 83.3%. Candida albicans was the most prevalent species (57.7%), followed by Candida tropicalis (26.9%). All except for 1 patient had a single fungal isolate. In vitro antifungal susceptibility testing of the isolates revealed that all candidal species were sensitive to amphotericin B. Candida krusei showed 100% resistance to fluconazole. All candidal species except Geotrichum klebahnii showed increased resistance to itraconazole. Comparison between initial and recent CD4+ counts revealed improvement in the CD4+ count after HAART, but no change in fungal population. Of the study sample, 63.3% had risk factors for candidiasis other than being immunocompromised, and colonization was increased in those with risk factors compared with those without risk factors. Conclusions The present study showed the distribution of yeast species and the antifungal drug susceptibility of fungal isolates in patients with receiving HAART.

Levamisole is an imidothiazole derivative with a wide variety of applications in medical field. It has long been used as an anti-helminthic where its primary action is through the opening of acetyl choline receptor channels. It is widely used as an immunomodulatory drug through its action on dentritic cells and by enhancing the release of cytokines like interleukins 12 and 10. The antioxidant action of levamisole is by the enhancing effect on the major cellular redox systems like glutathione, enzymes like superoxide dismutase, catalase and also possible effects on glutathione related enzymes. On the other hand, the anti-inflammatory action is by the inhibition of TNF-alpha (tumor necrosis factor) and interleukin 6. Anti-neoplastic action of levamisole is by two ways that is, through its apoptotic action causing cell cycle inhibition and increased endothelial cell adhesion and the second action is through its anti-angiogenic property. This article enlightens upon the various mechanisms of action of levamisole at molecular level describing its diverse uses as an anti-helminthic, immunomodulatory, anti-neoplastic, anti-inflammatory and antioxidant drug.

Purpose Temporomandibular disorders (TMDs) affect 8–12 % of the adolescent and adult population, resulting in patient discomfort and affecting quality of life. Despite the growing incidence of these disorders, an effective screening modality to detect TMDs is still lacking. Although magnetic resonance imaging is the gold standard for imaging of the temporomandibular joint (TMJ), it has a few drawbacks such as cost and its time-consuming nature. High-resolution ultrasonography is a non-invasive and cost-effective imaging modality that enables simultaneous visualization of the hard and soft tissue components of the TMJ. This study aimed to evaluate the correlations between the clinical signs and symptoms of patients with chronic TMJ disorders and their ultrasonographic findings, thereby enabling the use of ultrasonography as an imaging modality for screening of TMDs.

In Louise Erdrich’s “Rape on the Reservation,” a February 26, 2013, op-ed piece for The New York Times, she brings readers’ attention to the complex history of the Violence Against Women Act and the struggle to persuade Congress to reauthorize the act with provisions that allowed for an expansion of Tribal authority in the prosecution of non-Native offenders. The article evidences her interest in bearing witness to this issue, which has plagued tribal communities for generations. How can a community find redress, and its attendant peace, without any means of official justice? On the reservation, then, the search for justice and accountability often looks like violent retribution or revenge. Violence against Native American women, with perpetrators acting with impunity, is the central theme in her National Book Award-winning novel, The Round House (2012). In fact, the theme of justice has been central to a trio of Erdrich’s most recent novels, which I refer to as the “Justice” trilogy: The Plague of Doves (2008), The Round House (2012), and LaRose (2016). Each novel takes up the situational complexities of vigilante justice and the enduring, even generational, consequences of such actions on Native American individuals, families, and communities. None of Erdrich’s novels is as focused on the theme of revenge as the “Justice” trilogy. The three works revolve around different moments of violence introduced in the opening chapters: The Plague of Doves investigates the murder of a local farmer and his family and the subsequent killing of three innocent Ojibwe men and one child from a neighboring reservation by a white lynch mob from the farming community; The Round House narrates the violent rape and attempted murder of an Ojibwe woman; and LaRose begins with the accidental shooting of an Ojibwe boy by his Ojibwe neighbor. Each novel then asks the reader to consider one central question: What are a person’s or a family’s or a community’s options for avenging an act of violence when no legal framework exists to mete out justice or accountability? This chapter explores Erdrich’s answer to that question through an analysis of the three novels.

Facial swellings are commonly encountered in the dental office, the cause of which could range from a congenital etiology to an acquired one or it may even be a manifestation of an underlying systemic disease. The clinician must have a thorough knowledge of the various clinical and imaging manifestations and the sites of occurrence of the various conditions to arrive at the appropriate diagnosis. Facial swellings can be classified into different groups which include acute swellings with inflammation, nonprogressive swellings, and slowly or rapidly progressive swellings. The various imaging modalities like CT and MRI are useful for assessing the extent of the swelling as well as evaluating the soft tissue and osseous involvement of the swelling. Multiple myeloma represents clonal proliferation of plasma cells and is a condition in which a facial swelling might be present, though not common. This paper reports a case of a patient with a unilateral facial swelling, which on investigation led to a diagnosis of multiple myeloma.

Filariasis is an endemic disease in tropical and subtropical countries. Filarial nematodes can infect humans through vectors, commonly mosquitoes. Human infection can manifest as lymphatic filariasis, subcutaneous or pulmonary nodules and with eye involvement. Intra-oral presentation is very rare and often poses a diagnostic dilemma to the dentist. We report a case of intra-oral Dirofilaria repens infection in a 54-year-old female patient, involving the buccal mucosa. History was unremarkable and on clinical examination, a diffuse swelling with no significant signs and symptoms was seen. Laboratory investigations and radiographs were non-contributory to diagnosis. Ultrasound findings revealed a hypo-echoic lesion in the muscular layer of the left cheek. Differential diagnoses considered were minor salivary gland tumor, parotid sialolith, and cysticercosis among others. The presence of a Dirofilaria worm in the excised nodule confirmed the diagnosis. Medical awareness of the risk of intra-oral nematode infection is essential. A detailed travel history, awareness of endemic status of certain diseases, proper diagnosis and management helps in better prognosis for the patient.

Context: Topical corticosteroids are the treatment of choice for oral lichen planus (OLP) due to its potential anti-inflammatory effect. However, chronic nature of OLP often requires long-term and frequent applications, exposing patients to local and systemic side effects. Aim: To detect the systemic absorption of 0.1% triamcinolone acetonide (TAC) through the oral mucosa of patients with OLP. Subjects and Methods: This was a pilot pharmacokinetic study carried out in the Department of Oral Medicine and Radiology in collaboration with the Department of Toxicology, over 10 months. A total of twenty patients with OLP were included and advised to apply 0.1% TAC 3 times/day for 2 weeks and 2 times/day for next 2 weeks. Blood samples were obtained on the first and second visits and analyzed for triamcinolone using High pressure liquid chromatography (HPLC). Statistical Analysis Used: Paired t-test was done to compare visual analog scale (VAS) score for burning sensation at the first and second visits, statistically significant if P < 0.05. The baseline demographic data were analyzed using descriptive statistics. Results: Paired t-test was done to compare VAS score for burning sensation at the first and second visits, which turned to being statistically significant (P = 0.001). Although HPLC is an established method for the detection of TAC, none of the study populations showed evidence of steroid (TAC) in the blood sample during 4 weeks of treatment duration. Conclusions: 0.1% triamcinolone is a relatively safe drug to be used with no systemic absorption in the standard dose regimen for oral lichen palnus.

Introduction: Oral Lichen Planus (OLP) is a chronic inflammatory mucocutaneous disease affecting the oral cavity which has been associated with severe burning sensation which in turn affects the quality of life of the patients. Currently, the effective treatment of choice remains the use of corticosteroids. The chronicity and recalcitrant nature of the disease demand the long term use of these drugs with ensuing adverse effects. Turmeric and its active ingredient, “curcumin”, have been found to have anti-inflammatory, antioxidant and anticancer properties. Hence, this intervention study was done to evaluate the efficacy of curcumin oral gel in the management of oral lichen planus. Aim: The study was conducted to compare the efficacy of 1% curcumin gel with the conventional mid-potent topical corticosteroid, triamcinolone acetonide 0.1% in managing the signs and symptoms of OLP. Materials and Methods: An intervention study was conducted on 75 patients diagnosed with OLP divided into three groups, Group 1 (0.1% triamcinolone acetonide oral paste thrice daily in tapering doses), Group 2 (curcumin oral gel thrice daily) and Group 3 (curcumin oral gel six times daily). The patients were analysed for the symptom (burning) and sign (erythema and ulceration) using the numerical rating score and Modified Oral Mucositis Index (MOMI) for a period of three months on a bimonthly basis. The results were analysed using Students t-test and unpaired t-test. Results: Intragroup comparison using paired t-test showed statistically significant reduction in burning sensation (p

Introduction: It has long been recognized that vitamin D is a hormone and were many studies reporting that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation. Aim: To evaluate the effect of vitamin D and calcium supplementation in reducing gingival inflammation, using clinical parameters like gingival index (GI), oral hygiene index-simplified (OHIS), probing pocket depth (PPD), clinical attachment level (CAL) and bone density (BD). Also, to assess whether calcium and vitamin D oral supplementation influences alveolar Bone Density (BD). Design and Settings: A nonrandomised clinical trial done in Amrita School of dentistry, Kochi, India. Materials and Methods: Group A taking vitamin D (250IU/ day) and calcium (500 mg/day) supplementation, and Group B were not taking oral supplementation. All subjects had at least one or more teeth with chronic moderate periodontitis. Digital Orthopantomogram images were taken to assess bone density. Data were collected at baseline and three months. Statistical Analysis used: OHI-S, GI, PPD, CAL, and Bone Densities (BD) were calculated per group. Karl Pearson Coefficient of correlation was used to test correlation of bone density with GI and OHI -S. Intergroup comparison of parameters were done using Independent two Sample t-test. Intragroup comparison of parameters at recall interval was done using Paired sample t-test. The results were considered statistically significant when p-value was

Advances in radiology have helped in early diagnosis, surveillance and proper management of disease processes. SPECT scintigraphy is an imaging modality that helps in the detectiondiagnosis of facialskull osteomyelitis and is also useful for detecting silent lesions. Pentoxifylline-tocopherol together helps in faster healing of diseased bone. Pentoxifylline reduces blood viscosity and thus improves microcirculation. Tocopherol has a synergistic action with pentoxifylline and increases the oxygenation of tissues. Here, a case of chronic multifocal osteomyelitis, involving the mandible and occipital bone is presented which was diagnosed with conventional radiographs and gallium 67 bones SPECT. Simultaneous treatment with pentoxifylline-tocopherol and antibiotics relieved the patient's symptoms.

Background: A review of literature revealed that, although the involvement of temporomandibular joint (TMJ) in rheumatoid arthritis (RA) patients is not uncommon, variation in presentation persist. Comparative studies of bony changes in the right and left TMJ with the right and left peripheral hand (Metacarpophalangeal-MCP)/wrist joints have not been done, to the best of our knowledge. Materials and Methods: In this cross-sectional study, the temporomandibular and hand (MCP) and wrist joints of fifteen rheumatoid arthritis patients were evaluated with questionnaires, clinical and lab assessment and radiographically using conventional radiographs and computed tomography. Students t-test was applied for the statistical analysis of the data obtained and a P value of 0.05 was considered as statistically significant. Results: Comparisons between the right TMJ with right MCP/wrist joint and left TMJ with left MCP/wrist joint did not reveal statistically significant results. Radiographically, flattening and erosions were the common manifestations. MCP joints were more affected than the wrist, but whenever the wrist was involved, it was more likely to be bilaterally affected. Conclusions: Although the TMJ showed osseous changes of a higher grade than the hand (MCP) and wrist joints radiographically, it was observed that patients were more aware of the peripheral joint discomfort. There were no significant differences between TMJ and peripheral joints on both right and left sides.

Schwannomas, also known as neurilemmomas, are uncommon neoplasms, derived from schwann cells. These neoplasms, although rare, should be considered in the differential diagnosis of slow growing tumour masses of the oral cavity. The growth of these tumours sometimes causes displacement and compression of the nerve of origin, giving rise to clinical signs and symptoms. It can develop at any age and there is no sex predilection. Intraorally, the tongue is the most common site followed by the palate, floor of the mouth, buccal mucosa, lips and jaws. Surgical excision is the treatment of choice for schwannomas, with few reports of recurrence or malignant transformation. In this paper, the authors report two cases of patients with intraoral schwannoma, where the preoperative clinical diagnosis was inconclusive and final diagnosis was established based on radiographic and histopathological examination.