Introduction: Periodontitis is a chronic bacterial infection characterized by persistent inflammation, connective tissue breakdown and alveolar bone destruction mediated by pro-inflammatory mediators. Tumor necrosis factor-alpha (TNF-α) is an important pro-inflammatory mediator that produced causes destruction of periodontal tissues. Objective: The aim of the study is to estimate the salivary TNF-α in chronic and aggressive periodontitis and control participants and further correlate the levels with clinical parameter such as gingival index (GI), plaque index (PI), probing pocket depth (PPD) and clinical attachment loss. Materials and Methods: The study population consisted of 75 subjects age ranging from 25 to 55 years attending the outpatient section of Department of Periodontics, Saveetha Dental College and Hospital. The study groups included Groups 1, 2, and 3 with participants with healthy periodontium (n = 25), generalized chronic periodontitis (n = 25) and generalized aggressive periodontitis (n = 25), respectively. Salivary samples from the participants were used to assess the TNF-α levels using enzyme-linked immunosorbent assay. Results: GI and PI were found to be significantly higher in chronic and aggressive periodontitis compared to the controls. The mean TNF-α value in chronic periodontitis patients (12.92 ± 17.21 pg/ml) was significantly higher than in control subjects (2.15 ± 3.60 pg/ml). Whereas, in aggressive periodontitis patients the mean TNF-α (7.23 ± 7.67) were not significantly different from chronic periodontitis or healthy subjects. Among periodontitis participants, aggressive periodontitis subjects exhibited a significant positive correlation between the salivary TNF-α and PPD. Conclusion: Salivary TNF-α levels are significantly higher in chronic periodontitis than in healthy subjects, but there was no significant correlation with the clinical parameters.

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Introduction: The dimensions of gingiva and different parts of the masticatory mucosa have a profound impact in periodontics as it governs the way; the gingival tissue reacts to various physical, chemical, or bacterial insults. The purpose of the following study was to assess the gingival thickness (GT) and correlate it to gender, presence of recession, and width of keratinized gingiva (WKG) in a subset of the Indian population. Methods: A total of 400 subjects in the age range of 20–35 years (200 males and 200 females) were included in the study. Clinical parameters such as probing depth, recession depth, WKG, and GT were recorded for all the patients. Results: The prevalence of thin biotype was 43.25%, and that of thick gingival biotype was 56.75%. The mean GT of central incisor, lateral incisor, and canine in Group I was 1.11 ± 0.17, 1.01 ± 0.16, and 0.82 ± 0.17 mm, respectively. No significant association was observed between the gender and the presence of gingival recession to GT. The mean WKG of central incisor, lateral incisor, and canine in Group I was 4.38 ± 1.18, 5.18 ± 1.25, 4.16 ± 1.16 mm, respectively. A positive correlation exists between WKG and the GT (P < 0.05). Conclusion: It was concluded that the prevalence of thick and thin gingival biotype is 56.75% versus 43.25%, respectively, and there is no significant relationship between age, gender, and the presence of recession to gingival biotype. A positive correlation exists between WKG and the GT.

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Background: The human tissues continuously undergo modification as deposition of calcium (CA) salts either in an organized or disorganized pattern. The latter pattern usually occurs in the soft tissues such as in arteries, brain, kidneys, lungs, and dental pulp. The purpose of this study is to evaluate the presence of pulp calcification and carotid artery calcification (CDC) as a marker for renal calcification and altered serum biomarkers such as serum CA, phosphorus (P), and alkaline phosphatase (ALP). Materials and Methods: Digital panoramic radiographs of 50 patients with the presence of pulp stones and suspected CAC were subjected to carotid artery and renal ultrasonography (USG) examination for the presence of vascular calcification and also to evaluate the alterations in serum CA, P, and ALP levels. Data were analyzed statistically using Chi-square test. Results: Panoramic radiographs of 50 patients showed 88.28% of teeth with the presence of pulp stones stones and 91% carotid arteries with calcification. The sensitivity of panoramic radiograph was greater than that of USG (93.67%), but the specificity of USG was more than the panoramic radiograph (44.44%) in detecting CAC. The prevalence rate of renal calcification on USG was 92%. The statistical difference between the patients with or without alteration in serum Ca levels was not significant (χ² = 0.581 and P = 0.446). On comparison of serum P and ALP, the difference was found to be statistically significant. Conclusion: Presence of pulp stones and CAC's on panoramic radiograph have remarkably proved to establish the chances of renal artery calcification associated with alterations in serum CA levels.

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Background: In the current scenario pathogenesis of majority of the diseases is deeply linked with the oxidative stress, irrespective of its etiology. Enumerable data suggests that reactive oxygen species play a key role in multistage carcinogenesis. Oral submucous fibrosis (OSMF) is considered as a potentially malignant disorder. Its increased incidence over recent years in the Indian subcontinent is a major health concern to oral physicians. However, the role of oxidative stress has not been widely investigated in OSMF. Aims: Is to evaluate both antioxidant and oxidant status in OSMF and to compare with controls. Settings and Design: Twenty patients and 20 controls of the same age group were enrolled in the study. Subjects and Methods: Five milliliters of blood were collected from each individual and serum was separated. Malondialdehyde (MDA) estimation using thiobarbituric acid (TBA) method, and antioxidant activity (AOA) using principle of TBA reactive substances was done using this serum, with a calorimetric method. Statistical Analysis Used: Student's t-test and ANOVA test. Results: The mean serum AOA status was seen to significantly decrease in OSMF patients, as compared to controls (P = 0.013). The increase in mean serum MDA level was highly significant in OSMF patients, as compared to controls (P < 0.001). Conclusion: The disparity between AOA and MDA levels in the patients clearly demonstrates the role of oxidative stress in the disease process. The results also suggest the use of antioxidants in the management of OSMF.

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In the contemporary era, use of drugs is the dominant paradigm of health care. The most quotidian drug used for fever and pain is paracetamol. Although adverse reactions to paracetamol in India are rare, at times they can cause life-threatening situations. Stevens-Johnson syndrome (SJS) is one such potentially lethal adverse drug reaction. The most reported cases of analgesic-induced SJS were due to oxicams or propionic acid derivatives. There are very few detailed reports of SJS due to the use of paracetamol. We report a case of SJS, which occurred due to the use of paracetamol. The clinical features of this condition and multidisciplinary management of the patient are described in brief.

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Benign fibrous histiocytoma (BFH) is a soft tissue neoplasm which occurs mostly on the skin of extremities. BFH rarely occurs in bone and may affect femur, tibia, and pelvic bone. Jaw bone involvement is very unusual with only 11 cases reported till date. This report describes a case of BFH occurring in a 30-year-old female patient affecting left mandibular posterior region. Computed tomography revealed a well-defined expansile lytic lesion in the posterior mandible. Gross examination of the tumor revealed an admixture of fibroblasts and histiocytes in a fascicular and storiform pattern. Immunohistochemical staining was positive for CD68.

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Background: Osteoporosis is a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to bone fragility, and enhanced susceptibility to fractures. Dental radiographs, especially panoramic images, have been used to predict bone mineral density. A number of indices, (mandibular cortical index [MCI], mandibular cortical width [MCW], and panoramic mandibular index [PMI]) have been developed to assess and quantify the quality of mandibular bone mass and to observe the signs of resorption. Objectives: The objectives of the study were to assess mental index (MI), MCW index, and PMI with bone density in identifying risk group for osteoporosis and also to investigate influence of age and gender on MI, MCI, and PMI. Materials and Methods: After obtaining consent, details regarding age, gender, systemic health status, and oral parafunctional habits were recorded in each patient. Then a digital panoramic radiograph was taken. The image thus obtained was subjected to calibrations and morphometric analysis using Digora version 2.7. The obtained values of indices were compared with the mean values of indices, to evaluate subjects whether they are prone to osteoporosis or not. The obtained information was subjected to statistical analysis for the significance of the parameters. Results: Data analysis showed that calibration indices were highly significant in the assessment of risk group for osteoporosis than noncalibration index. The subjects at a higher risk for development of osteoporosis were old-aged adults with higher prevalence being reported in women compared to male subjects. Conclusion: In conclusion, our results suggest that higher percentage of subjects with undetected decreased bone mineral density may be identified based on trained general dental practitioners analyses of their panoramic radiographs using simple screening analytical calibration MI and MCI.

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Background: Variations in the structure of teeth have always been a great curiosity to the dentist from the scientific and practical point of view. Aim: To evaluate the prevalence of a few aberrant morphological features namely, cusp of Carabelli in primary maxillary second molar and in permanent first molar, five cusp in primary maxillary second molar and permanent first molar, shoveling and double shoveling with respect to permanent maxillary central incisors, four cusped primary mandibular second molar and permanent first molar, six cusped primary mandibular second molar and permanent first molar and seven cusped primary mandibular second molar and permanent first molar in 6–10 year old children belonging to the East Bengaluru, a City in India. Design: A cross-sectional survey was conducted among 2111 children by two stage sampling method. Type III examination was performed. The findings were subjected to Chi-square test. Results: 83.8% of the studied population had one or more of the variations checked for, as mentioned above. The variation most commonly seen was double shoveling (66.6%) followed by shoveling (65.7%). No significant results were observed in any trait with respect to gender.Conclusion: This study is the first of its kind, providing a baseline data of the prevalence of morphological details in the pediatric Indian population.

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Background: Oral submucous fibrosis (OSMF) is a debilitating, potentially cancerous oral condition. Although areca nut is the most important causative agent, it is also considered that the disease is immunologically mediated. Aim of the Study: To establish that autoimmunity and nutritional deficiency play a role in the etiopathogenesis of OSMF. Objectives of the Study: To show that serum immunoglobulin markers (immunoglobulin-G [IgG], immunoglobulin-A [IgA]) and nutritional parameters such as total serum protein (TSP), Hemoglobin (Hb) play a role in causing OSMF and also to correlate serum, salivary IgG, IgA levels in OSMF patients. Settings and Design: A case-control study was done with 50 patients (25 patients who were provisionally diagnosed as OSMF - Group I, and 25 patients who were chronic smokeless tobacco chewers and who did not have any intraoral lesion - Group II). Materials and Methods: Five milliliters of blood and saliva were collected from both the groups. Quantitative analysis of serum, and salivary IgG, IgA was done by turbidometric immunoassay. TSP and Hemoglobin (Hb) were estimated by spectrophotometry. Statistical Analysis: Results were analyzed by independent samples t-test and one-way analysis of variance (ANOVA). Results: All patients of OSMF showed significant (P < 0.01) increase in serum IgG, IgA, and salivary IgG levels as compared to smokeless tobacco chewers. The salivary IgA levels showed a significant decrease in OSMF patients (P < 0.05). TSP and Hb levels showed significant (P < 0.01) decrease in OSMF patients as compared to smokeless tobacco chewers. Conclusion: The elevation of immunoglobulin levels supports the concept of autoimmunity. The decrease in TSP and Hb suggests that nutritional deficiency plays a defined role in the occurrence as well as a further progression of OSMF.

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Aims and Objectives: The purpose of the study was to evaluate and compare the microhardness of enamel after the application of anticay on bleached enamel with fluoride containing and fluoride free bleaching agent. Materials and Methods: Twenty freshly extracted teeth decoronated and divided mesiodistally into two halves were randomly divided into five groups with 10 samples in each group. The enamel surface was treated as follows: Group 1 - no treatment, Group 2 - fluoride free bleaching agent, Group 3 - fluoride containing bleaching agent, and Group 4 - fluoride free bleaching agent followed by anticay application. The samples were subjected to indentation to test the microhardness using Vicker's hardness analyzer. Conclusion: Enamel microhardness significantly increased in samples where anticay was used after the application of bleaching agent.

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Amyloidosis is a rare disease of difficult diagnosis that occurs due accumulation of amyloid substance localized or systemic. The oral cavity is an unusual site and can be related to both localized and systemic forms and for that reason a full investigation is necessary to determine the extent of the disease. This study reports a case of a 58-year-old melanoderm male patient referred to the Department of Oral and Maxillofacial Surgery with white plaques on the tongue and multiple nodules in the region of the buccal mucosa and labial commissure, with 6 months of evolution and painful symptoms. An incisional biopsy was performed on both sites and histological examination indicated the presence of eosinophilic amorphous material within the connective tissue, positive for crystal violet staining, consistent with amyloidosis. At the present time, there is no consensus on the management of local amyloidosis. Surgical treatment of localized forms is indicated in some cases to reduce the functional prejudice. Moreover, follow-up is mandatory, both to manage recurrences and to monitor the possible evolution of the disease to the systemic form.

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Aims: To suggest the best predictor/s for determining the mesio-distal widths (MDWs) of canines (C) and premolars (Ps), and propose regression equation/s for hitherto unreported population. Methods: Impressions of maxillary and mandibular arches were made for 201 children (100 boys and 101 girls; age range: 11–15 years) who met the inclusion criteria and poured with dental stone. The maximum MDWs of all the permanent teeth were measured using digital vernier caliper. Thirty-three possible combinations (patterns) of permanent maxillary and mandibular first molars, central and lateral incisors were framed and correlated with MDWs of C and Ps using Pearson correlation test. Results: There were significant correlations between the considered patterns and MDWs of C and Ps, with difference noted between girls (range of r: 0.34–0.66) and boys (range of r: 0.28–0.77). Simple linear and multiple regression equations for boys, girls, and combined sample were determined to predict MDW of C and Ps in both the arches. Conclusions: The accuracy of prediction improved considerably with the inclusion of as many teeth as possible in the regression equations. The newly proposed equations based on the erupted teeth may be considered clinically useful for space analysis in the considered population.

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Reduced number of teeth with underdeveloped alveolar ridges poses a greatest prosthetic challenge in rehabilitation of ectodermal dysplasia patients (ED). Furthermore, surgical risks and financial constraints may preclude the implant supported prosthesis, the most desirable treatment option in an adult ED patient. Long edentulous span does not permit fixed dental prosthesis (FDP) as well. Telescopic denture by incorporating the best of both fixed and removable prosthesis can be a viable treatment alternative for ED patients with compromised dentition and limited finances. A 21-year-old young girl presented with chief complaint of esthetics and mastication due to missing upper and lower teeth. A provisional diagnosis of ED was made based on familial history, physical, and oral examination. This clinical report describes management of an adult ED patient by means of telescopic overdenture prosthesis in mandibular arch and FDP in maxillary arch which restored esthetics, function, and social confidence of the patient in a cost effective manner.

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Recently, an innovative, nonsurgical regenerative endodontic treatment protocol “SealBio” was introduced to manage mature nonvital permanent teeth with periapical lesions. This paper explains the management of an unusual case of dens evaginatus and an attached supernumerary tooth/an odontome associated with two distinct radiolucencies in a mandibular premolar with “SealBio” technique and discusses the various hypotheses on the pathogenesis of unusual malformation and associated pericervical cyst-like radiolucency in the involved tooth.

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Background: Exfoliated oral cancer cells in saliva samples from patients with oral squamous cell carcinoma (OSCC) can be used to determine the incidence and type of mutations of the p53 tumor suppressor gene. The purpose of this study was to identify C-deletion mutation in exon 4 codon 63 of p53 gene in the saliva of OSCC patients by polymerase chain reaction (PCR). Materials and Methods: Saliva samples of 20 newly histopathologically diagnosed OSCC patients and 5 healthy volunteers were subjected to isolation of the total genomic DNA and PCR amplification for C-deletion on exon 4 of p53 gene. The resulting products were resolved by agarose gel electrophoresis, viewed and photographed on ultraviolet-transilluminator. Results: The relationship between the frequencies of genetic alterations was assessed by Chi-square test. Differences with values of P < 0.05 were statistically significant. Conclusion: The study concluded a 100% presence of C-deletion mutation in exon 4 codon 63 of p53 in the saliva of OSCC patients. This study suggests that detection of mutation in exon 4 codon 63 of p53 by PCR is a fast, reliable, accurate, and sensitive molecular method for OSCC diagnosis.

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Background: Oral conditions are known to affect various aspects of quality of life. Similarly, the social consequence of the quality of life in the day to day living is also equally important. Several studies have quantified the social consequences of diseases through activity limitations in people's daily living. The instruments which cover a broad spectrum of life are proposed to be compared with the clinical oral hygiene status of people from different social classes. Aim: To assess the validity of dental impact on daily living (DIDL) questionnaire measuring subjective dental problems and their impact in the day to day life among tribes of Wayanad. Study Design: Cross-sectional. Materials and Methods: DIDL questionnaire developed by Leao and Sheiham was used. We recorded the clinical oral health status using decayed, missing, filled, simplified oral hygiene index, and community periodontal index indices, to correlate the subjective findings of dental impact tribe to obtain construct validity of the questionnaire. Analysis: Descriptive statistics and Spearman's correlation using IBM SPSS software version 20. Results: In the study population of 250 participants, the majority of the participants were from the age group between 36 and 50 years (40%) and females were in the majority (64%). The clinical status of the participants was poor in the majority while their perceived impact in their day to day living was found to be relatively satisfied. The study results show the DIDL tool had weak validity in relation to the clinical status with relevance to the social status of Indian tribal population. Conclusion: The study result shows that there was insignificant and weak validity between the DIDL tool and the oral health status among these tribes who were from a low social class. This might be because their priority in life which is different from what a person from high social class. So the dental problem is ignored at the level of individual depending on his/her priority and at the community level by the policy makers.

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Objective: To test the hypothesis that there is no difference between Class I (CI) normal occlusion, Class II division 1 (CIId1) and CII division 2 (CIId2), and Class III (CIII) malocclusion with respect to arch widths, width of the maxillary and mandibular arches, gender dimorphism within groups, and gender comparisons. Materials and Methods: Samples of 40 CI subjects, 40 CIId1 subjects, 40 CIId2 subjects, and 34 CIII subjects were studied. All subjects were Indians with no history of orthodontic treatment. An analysis of variance and Duncan's test statistically compared the groups and genders. Results: CIId1 malocclusion showed the narrowest maxillary arch compared with the other types of malocclusions. CIII malocclusion showed largest mandibular arch than other types of malocclusions. Gender dimorphism is more commonly seen in CI normal occlusion than other types of malocclusions. Gender dimorphism is not observed in CIId1 group. Gender comparisons revealed arch width differences between different types of malocclusions more pronounced in males than in females. The maxillary/mandibular intermolar width difference is positive for CI normal occlusion and negative for CIId1, CIId2, and CIII malocclusions, which suggested, the presence of crossbite tendency in CII and CIII malocclusions. Conclusion: The hypothesis is rejected by the findings of this study.

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Background and Objective: Fc gamma receptors (FcγRs) are the members of the immunoglobulin superfamily and may play a role in the pathogenesis of periodontitis. Genetic variation in these receptors and its link with various forms of periodontitis is being studied in different populations. The aim of the present study is to determine whether specific FcγRIIa, FcγRIIIa, and FcγRIIIb alleles and/or genotypes are associated with risk for susceptibility to generalized chronic periodontitis (GCP) in South Indian population. Materials and Methods: The study population consisted of 120 South Indian subjects; 60 with GCP and 60 periodontally healthy. Deoxyribonucleic acid (DNA) was extracted from samples collected by scrapping buccal epithelium. FcγRIIa and FcγRIIIa genotyping were performed by polymerase chain reaction (PCR) amplification of DNA with allele-specific primers followed by allele-specific restriction digestion of the products. However, FcγRIIIb genotyping was done by allele-specific PCR. Results: No significant difference in the distribution of FcγRIIa H/R and FcγRIIIa NA1/NA2 genotypes or their respective alleles was observed in GCP patients and healthy subjects. For FcγRIIIa F/V genetic polymorphism, the homozygous V/V genotype and V allele were significantly overrepresented in GCP patients while F/F genotype and F allele in controls. Conclusion: The present study demonstrates that FcγRIIIa V/V genotype, as well as V allele, could be a possible risk factor for chronic periodontitis in South Indian population.

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Introduction: Oral malodor is generally ascribable to oral microbial putrefaction generating malodorous volatile sulfur compounds. The aim of the present study is to correlate organoleptic recordings with a small handheld portable volatile sulfide monitor and periodontal clinical parameters and correlate the levels of halitosis causing bacteria in plaque between baseline, 1-week, and 1-month. Materials and Methods: A total of 20 systemically healthy subjects with self-reported halitosis were subjected to organoleptic examination and FitScan^®. Subgingival plaque samples for anaerobic culturing were harvested followed by an assessment of plaque index (PI), gingival bleeding index (GBI), and pocket probing depth. Data derived were subjected to statistical analysis using Wilcoxon signed rank test and Spearman's rank test (P < 0.05). Results: No correlation was seen between organoleptic measurements and portable volatile sulfide monitor at any time interval. There was a statistically significant (P < 0.05) correlation between the scores of PI, gingival index, GBI, and myeloproliferative disease with organoleptic readings at all-time intervals. Anaerobic culture has shown to identify Fusobacterium species, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia. However, no correlation could be established in between total microbial load with organoleptic and FitScan^®reading at any time interval (P < 0.05). Conclusion: Significant correlation could be established between organoleptic readings and periodontal parameters.

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Background: Autism is a neurobiological disorder characterized by impaired social interaction, communication difficulties, and lacking manual dexterity. These limitations make the oral hygiene maintenance very difficult. Aim: The aim of this present study is to evaluate and compare the efficacy of low fluoridated and calcium phosphate-based dentifrice formulations when used with powered and manual toothbrush in children with autism. Setting and Design: Sample comprised 22 children with autism who daily visited a day care and education center named ARUSHI - a center for children with special health care needs in Bhopal. Methods: Children were divided into two groups (Group A and B) according to toothbrush used and further divided into subgroups (A1 and B1 [low fluoridated − Pediflor toothpaste] and A2 and B2 [calcium sucrose phosphate − Enafix toothpaste]). Oral hygiene instructions and brushing technique demonstration were given every day for a period of 1-month. Oral health status was evaluated before and after the study using simplified oral hygiene index (OHI-S) and its Miglani's modification for primary dentition, plaque index (PI), gingival index (GI), and decayed, missing, and filled teeth (DMFT)/deft index. The perception of parents regarding oral hygiene practices for their kids was also evaluated by an awareness and attitude questionnaire. Statistical Analysis: OHI-S, GI, PI, and DMFT/deft were statistically evaluated using Mann–Whitney U- test. Results and Conclusion: Mean value of OHI-S decreased significantly with powered toothbrush (0.035 [P < 0.05]) in both groups. However, PI decreased significantly for Enafix when used with powered toothbrush (0.042 [P < 0.05]). Perception of parents was seen to improve significantly after 1-month study (0.000 [P < 0.05]).

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Supernumerary teeth are extra teeth or toothlike structures which may have either erupted or unerupted in addition to the 20 deciduous teeth and the 32 permanent teeth. Mesiodens is one of these located in the midline between the two central incisors. Their presence may give rise to a variety of clinical problems. This paper describes a rare case of palatal placed, inverted and impacted mesiodens associated to two supernumerary teeth which were detected during a radiographic examination for delayed eruption of permanent central incisors in the case of a healthy 8-year-old girl monitored at the oral surgery service while discussing the usefulness of cone beam computed tomography for accurate diagnosis and management.

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Formation of black triangles between teeth due to loss of interdental palpilla is one of the common problems encountered in routine clinical practice, as extreme importance is given to esthetics. This paper discusses two different surgical approaches in treating three cases with papillary loss in the first case the reconstruction of papilla was achieved by using a semilunar coronally repositioned papilla technique and in second and the third case reconstruction of the papilla was achieved by modification of Nodland's microsurgical technique. In all the three cases a free connective tissue graft was used to reconstruct the lost volume of interdental papilla. Complete reconstruction of the lost papilla was achieved in all the three cases 6 months postoperatively.

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Objective: In Indian scenario, Gorlin–Goltz syndrome (nevoid basal cell carcinoma syndrome [NBCCS]) has been rarely reported. The clinical, radiological, and histopathological findings and major and minor criteria in five cases of NBCCS in North Indian population have been presented along with a discussion of the role of gene mutation analysis in early diagnosis of syndrome. Materials and Methods: The diagnostic findings of Gorlin–Goltz syndrome in 5 patients were compared with other reports in Indian population and with reports of this syndrome in other parts of the world. Results: The most common features seen were keratocystic odontogenic tumors (100%), calcifications of falx cerebri (60%), palmar-plantar pits (80%), rib anomalies (80%), macroencephaly (60%), ocular hypertelorism (80%), and frontal bossing (60%) in our series. Retained deciduous teeth seen in 80% patients whose association has not been previously reported has been presented. None of our patients had basal cell carcinoma, syndactyly or polydactyly, pectus deformity, bridging of sella turcica, pigmented nevi, or family history of this syndrome in contrast to such findings in other Indian patients. Medulloblastoma has not been reported in any Indian patient so far compared to this finding in other studies conducted worldwide. Conclusions: Combining the features of 48 patients in 38 cases of NBCCS being published in Indian literature with five cases of our series and on comparison with other studies in the world, a wide disparity in different ethnic groups and a wide variation in presentation of syndrome within the same population is suggested.

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Aim: This study aimed at evaluating the anti-microbial activity of spore powder of Ganoderma lucidum on Prevotella intermedia isolated from subgingival plaque from chronic periodontitis patients. Settings and Design: Written informed consent was obtained from each subject enrolled in the study. The Institutional Ethics Committee granted the ethical clearance for the study. Materials and Methods: This study included 20 patients diagnosed with chronic periodontitis. Pooled subgingival plaque samples were collected using sterile curettes from the deepest sites of periodontal pockets. The collected samples were then transported in 1 mL of reduced transport fluid. The organisms were cultured and confirmed. These organisms were then used for minimum inhibitory concentration (MIC) procedure. Statistical Analysis: Mean of the MIC value obtained was calculated. Results: Thirteen out of the 20 clinical samples were tested that showed sensitivity at various concentrations. Five samples showed sensitivity at all concentrations. Twelve samples showed sensitivity at 8 mcg/ml. Eleven samples showed sensitivity at 4 mcg/ml, 8 samples showed sensitivity at 2 mcg/ml, and 5 samples showed sensitivity even at 1 mcg/ml. Mean MIC value of G. lucidum spore powder for P. intermedia obtained was 3.62 mcg/ml. Conclusion: G. lucidum with its multipotential bioactivity could be used as an anti-microbial, in conjunction with conventional therapy in periodontal disease.

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Introduction: Obstructive sleep apnea (OSA) is considered to be a potentially life threatening disorder, which is characterized by repeated collapse of the upper airway during sleep with cessation of breathing. The cephalometric method despite being a static, two-dimensional evaluation of dynamic three-dimensional structures of the head and neck is useful in diagnosing patients with OSA, as they have shown that significant differences exist between asymptomatic controls and patients with OSA. Aims and Objectives: This study is designed to compare and validate the craniofacial morphology in patients with OSA using lateral cephalometry in both upright and supine position. Materials and Methods: Sixty subjects participated in the study of which 30 were patients with OSA diagnosed by questionnaire and 30 were healthy control group with age range of 25–45 years. Results: The study group demonstrated an increased ANB, mandibular plane angles (GoGn-SN), lower anterior facial height which are statistically significant with a significant P < 0.05. Significant decrease in posterior airway space, increased soft palate length, tongue length, and thickness suggesting reduced airway space in supine posture. Conclusion: Evaluation of craniofacial morphology in OSA patients using lateral cephalometry helps in recognizing the morphological changes induced by altered sleep pattern and for appropriate treatment planning.

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Oral leprosy, a granulomatous disease is classified under the term oro-facial granulomatosis which comprises a group of diseases characterized by noncaseating granulomas affecting the soft tissues of the oral and maxillofacial region. The most common clinical presentation of oro-facial granulomatous conditions is persistent swelling of one or both lips. Due to its rare incidence and clinical findings overlapping with other granulomatous conditions such as sarcoidosis, Crohn's disease, and cheilitis granulomatosa; it is practically difficult for a dental surgeon to easily diagnose this condition. This study presents a case of leprosy causing macrocheilia as the only clinical presentation and diagnosed initially as Miescher's cheilitis based on exclusion criteria.

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Peripheral ossifying fibroma (POF) is a local gingival reactive lesion, thought to be originating from the superficial periodontal ligament. It is found most often in the anterior maxilla with predilection for females and high recurrence rate. Clinically, the lesion is observed in gingiva or interdental papilla and manifested either as sessile or pedunculated mass which may appear ulcerated or erythematous or exhibit no color difference from the adjacent healthy gingival tissue. The present case report describes the diagnosis, treatment of POF, and immediate management of residual functional and cosmetic mucogingival defect which originated as a sequel of excisional biopsy of recurrent POF by utilizing modification of Grupe and Warren technique (modified laterally displaced flap). Clinical healing was uneventful at 2 weeks, and excellent coverage of residual mucogingival defect without any evidence of recession and or recurrence of POF was observed at surgical site 9 months postoperatively.

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Timely and accurate diagnosis of a medical/dental condition is the first critical step to ensure appropriate treatment. Lack of astuteness in diagnosis may assume many forms. Each medical/dental practitioner is morally and legally bound to perform his or her duties to a specified standard of care. The cause of misdiagnosis may be hurriedness, lack of testing, or a simple mistake; failure to diagnose can constitute a breach of that duty, making the medical/dental provider liable for any resulting damages. The following case report highlights one such misdiagnosed case.

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Aim: Despite fixed professional opinion of what might constitute optimal treatment, patients must be informed of the various treatment options available in orthodontics to manage their clinical problem. The purpose of this study was to compare and evaluate the knowledge and awareness among practicing orthodontists and patients with regard to informed consent in clinical practice and research. Materials and Methods: Twenty-five orthodontists and 25 patients were enrolled in a questionnaire study which was descriptive and cross-sectional in the nature. The questionnaire focused on the following aspects; contents of informed consent, at what age and who can give consent. Results: The study showed a majority of orthodontists (79.14%) were aware of knowledge regarding informed consent when compared to patients(35.14%). Conclusion: The overall result showed the huge gap that exists between orthodontists and patients and thus making it categorical for patients to be more involved in the decision-making process.

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