Pathologies of impacted teeth: A cone-beam computed tomography diagnosis

An impacted tooth is the one which fails to erupt into its anatomic position due to various factors such as malposition, lack of space, or other impediments. The prevalence of impacted tooth varies with geographic locations and has been estimated to be between 8% and 38%. An impacted tooth can be a nidus for dental caries, infection, destruction of adjacent teeth, periodontal disease, and even oral and maxillofacial cysts or tumors. Therefore, careful evaluation of the history and the clinical and radiographic findings and knowledge about the various maxillofacial cysts and tumors help a clinician to arrive at early diagnosis and render proper treatment to a patient. The recent advancements made in the field of radiology, especially the cone-beam computed tomography (CBCT), is a boon to dentistry. The three-dimensional imaging has made CBCT the preferential imaging modality for the evaluation of unerupted/impacted or supernumerary teeth and also in the evaluation of odontogenic and nonodontogenic cysts/tumors of the jaws. The varied radiographic appearances of cysts/tumors in the maxillofacial region help in precise differentiation of the pathology and prompt the clinicians to arrive at an accurate early diagnosis. This article discusses three case reports of maxillofacial cysts/tumors associated with an impacted tooth where radiology plays an important role in the diagnosis of the lesions

Zinc Therapy in Treatment of Symptomatic Oral Lichen Planus

Lichen planus is a chronic inflammatory disease, which involves skin, mucous membrane, and nails. Prevalence of oral lichen planus varies between 0.5% and 2.6% of adult population worldwide with overall female preponderance. It is considered as a potentially malignant disorder with rate of transformation to oral cancer varying between 0.5% and 2%. Oral lichen planus may either be unilateral or bilateral, or may involve multiple sites. Although the exact etio-pathogenesis of this condition is unknown, it is believed that stress, use of medications, dental fillings, genetics, immunity, and hypersensitivity reactions may contribute to its pathogenesis. It is a T-cell-mediated autoimmune disorder in which CD8+ T cells are involved which release various cytokines such as tumor necrosis factor-α and interleuking-12 leading to disruption of basement membrane integrity. Zinc activates caspase-3 and DNA fragmentation, resulting in the apoptosis of keratinocytes. By prevention of matrix metalloproteinase (MMP)-1 activation, it inhibits T-cell accumulation in oral lichen planus, and by inhibiting MMP-9 it prevents cleavage of collagen IV resulting in maintaining the integrity of the basement membrane. The present case series describes the use of oral zinc acetate (50 mg) in patients having symptomatic oral lichen planus with favorable outcome in terms of size of lesion and global index score

A New Intraoral Appliance for Trismus in Oral Submucous Fibrosis

Trismus is the most common sequelae of various pathological processes leading to compromised nutritional state in addition to physical and psychological disabilities. Therapeutic interventions are available to relieve trismus, which range from oral usage of pharmacological agents to intralesional steroid therapy. Intraoral appliance therapy can be employed as an alternative or adjuvant treatment for radiotherapy-induced fibrosis and autoimmune disorders such as scleroderma, psychogenic trismus, and oral submucous fibrosis, decreasing the adverse effects associated with other pharmacological interventions. A novel intraoral appliance—“Nallan C-H”—has been developed and tried for trismus producing better results. A report on three such cases having trismus due to a premalignancy has been presented. It is hypothesized that the same appliance can be used for treating inoperable trismus in palliative care setting additionally or as an adjuvant to pharmacological approach

A New Scoring System of Oral Lichen Planus

Lichen planus (LP) is a chronic, immune-mediated mucocutaneous disorder increasingly becoming common in the general population with female predominance. Clinically, there are different forms of lichen planus with the presence of the main characteristic feature of Wickham striae. Literature, to date, is abundant with various scoring systems of oral lichen planus, and among them, the most commonly followed scoring system was the one proposed by the Thongprasom system because of its simplicity and ease of application.AimThe aim of the present study is to critically review all the disease scoring systems on oral lichen planus (OLP) that have been reported in the literature during the past decades. A systematic literature search was performed using PUBMED, MEDLINE, EMBASE, and COCHRANE Library with language restriction to English. The search was carried out incorporating the published literature from 1980 to 2020 using the MeSH (medical subject heading) terms. A literature search was done using keywords: Staging, Grading, Oral lichen planus, Diagnostic, and Therapeutic. Out of 25 publications, related to search strategy, 22 full articles, which were related to the disease scoring system for oral lichen planus, were acquired for further inspection. Out of the 22 articles, 15 articles met the inclusion criteria. The data was collected and a brief summary of the studies regarding the different disease scoring systems for oral lichen planus was explained. Taking into consideration, the parameters were not included in the previous disease scoring system. A new proposal encompassing a scoring system for oral lichen planus considering the missing parameters along with an amalgamation of histopathological criteria of dysplasia is presented. It also proposes to grade and stage the lesions and recommend appropriate therapy for each of such lesions