Depigmentation of oral mucosa as the earliest possible manifestation of oral submucous fibrosis in Sri Lankan oreschool children

This article reports the presentation of oral submucous fibrosis in five Sri Lankan preschool children, aged 2–3 years, with loss of pigmentation of the lips as the sole clinical feature. Oral submucous fibrosis has not been reported in this age group of children. The five 2–3 year olds did not display any classical features of oral submucous fibrosis, due to the disease having been detected at a very early stage. The present study attempts to establish that depigmentation of the lips and oral mucosa is perhaps the earliest feature to develop in the natural history of oral submucous fibrosis. The differential diagnosis of oral mucosal depigmentation relevant to these cases is also discussed. Previously-reported cases of oral submucous fibrosis in children are reviewed

Use of single- and multi-drug regimens in the management of classic (idiopathic) trigeminal neuralgia: an 11-year experience at a single Sri Lankan institution

Aim: The aim of this retrospective study was to evaluate the outcome of medical treatment of classic trigeminal neuralgia and to assess the factors affecting the choice of drug regimen (single or multiple), and the duration of treatment for pain control.\ud \ud Methods: A total of 260 consecutive patients were included in the study. Sixty-one patients with less than 6 months' follow up were excluded. All patients were treated with carbamazepine alone or in combination with other drugs. The dosage was adjusted according to the level of pain control and side-effects.\ud \ud Results: Treatment was terminated in 99 patients (49.7%) after a mean follow-up period of 36.46 months (standard deviation: ±26.5). Of these, 39.4% were on a single drug. Carbamazepine was the drug used in 36 patients. The rest (61%) needed various combinations of drugs. One-hundred patients (50.3%) continued with medical treatment during the follow-up period. Of these, 67.4% were on multi-drug therapy.\ud \ud Conclusion: The present study showed that the administration of multidrug regimens is a useful alternative in controlling trigeminal neuralgia in patients who are unable to tolerate higher doses of carbamazepine. Age, sex, ethnicity, and the side of affliction did not have a significant influence on the choice of drug regimen and the duration of treatment for pain control

Validation of the Malay version of the Modified Dental Anxiety Scale and the prevalence of dental anxiety in a Malaysian population

Aim: The aims of the present study were to evaluate the reliability and validityof the Malay version of the Modified Dental Anxiety Scale (MDAS), and todetermine the prevalence of dental anxiety and associated factors in a Malaysianpopulation.Methods: A Malay-language questionnaire with questions to elicit demographicand dental care-related information, and the Malay version of the MDAS, wereadministered to 455 patients at the dental outpatient clinics of the HospitalUniversiti Sains Malaysia. Factor analysis and internal consistency statisticswere generated. A test–retest of the questionnaire was performed with 30 participants.Results: Cronbach’s alpha was 0.854, indicating good internal consistency. Factoranalysis yielded results showing good validity. Approximately 3.5% of theparticipants expressed the highest levels of anxiety. Dental anxiety was significantlyhigher among females than males. Age correlated inversely with dentalanxiety. Individuals seeking dental care only if a problem appeared had significantlymore anxiety than regular attendees. Patients who postponed treatmentbecause of fear had significantly higher anxiety levels than those who delayedtreatment for other reasons. Past adverse dental experience exacerbated dentalanxiety.Conclusion: The Malay version of the MDAS had good reliability and validity.Anxiety levels found in the Malaysians studied were comparable to participantsfrom other countries

Juvenile recurrent parotitis: clinical, sialographic and ultrasonographic features

Objective. Juvenile recurrent parotitis (JRP) is a rare salivary gland disease of obscure aetiology that affects children. The aim of this study was to investigate the patterns of clinical presentation, and the sialographic and ultrasonographic features of JRP in Sri Lankan children.\ud \ud Methods. The authors analysed the hospital records of 26 subjects who had been diagnosed with JRP between January 2003 and April 2006.\ud \ud Results. The subjects consisted of 15 males and 11 females (male:female ratio = 1.4:1). The age range of the sample was 2.5–16 years (mean = 8.4 years). The age of onset was biphasic, with two major peaks at 6 years (n = 6) and 10 years (n = 5) (mean = 6.73 years). Unilateral involvement was seen in 69.2% of patients. The commonest clinical features were swelling (100%), pain (80.8%) and fever (50.0%). The average frequency of recurrences of JRP in 18 patients was 7.1 times per year. The average duration of an individual episode, also in 18 patients, was 5.44 days. Sialography in 17 patients had revealed punctate sialectasis, whereas ultrasonography in 16 patients had demonstrated multiple hypoechoic areas and heterogeneous echoes\ud \ud Conclusions. This study documents the clinical features of JRP in Sri Lankan children. It has established the usefulness of sialography and ultrasonography in the diagnosis of JRP

Comparison of topical tacrolimus and clobetasol in the management of symptomatic oral lichen planus: A double-blinded, randomized clinical trial in Sri Lanka

AimOral lichen planus (OLP) is a common, chronic inflammatory disease of the oral mucosa. Although several studies have shown the efficacy of different treatment modalities, a definitive cure has not yet been established. The present trial compares the effectiveness of topically-applied clobetasol and tacrolimus in the symptomatic management of OLP.MethodsA randomized, comparative, double-blind study with 68 patients (43 females, 25 males; mean age: 46.76 years) was undertaken. Patients were randomly divided into two groups of 34 patients each to receive topical tacrolimus 0.1% cream or clobetasol propionate 0.05% cream for 3 weeks.ResultsAfter 3 weeks of treatment, the mean pain score dropped by 1.59 (right) and 1.53 (left) in the tacrolimus group, while in clobetasol group these values were 0.94 and 0.85, respectively. The mean scores for clinical appearance reduced by 1.18 (right) and 1.0 (left) in the tacrolimus group compared with a reduction of 0.5 and 0.26, respectively, in the clobetasol group. These reductions were statistically significant (P ConclusionThe results suggest that tacrolimus 0.1% cream is an effective alternative to topical steroid and can be considered a first-line therapy in OLP. However, further studies are needed to confirm the effectiveness of this treatment before it is recommended for use in clinical practice.<br/

The Sinhala version of the Pain Catastrophizing Scale: validation and establishment of the factor structure in pain patients and healthy adults

Objective: This study was conducted to translate the Pain Catastrophizing Scale into and adapt it to the Sinhala language and to examine its psychometric properties and factor structure in pain patients and healthy adults in Sri Lanka.\ud \ud Setting and Design: A cross-sectional study was conducted, recruiting pain patients from multiple clinics and healthy adults from the community as convenience samples.\ud \ud Methods: Cross-cultural adaptation of the Pain Catastrophizing Scale for Sinhala speakers was carried out using recommended methods. The adaptation's psychometric properties and factor structure were tested in 149 pain patients and 172 healthy adults. Temporal stability was tested in a sample of 104 young adults. Pain intensity of patients was assessed using a visual analog scale, and personality traits of all participants were assessed with the Eysenck Personality Questionnaire.\ud \ud Results: Factor analysis revealed that the three-factor structure of the original version of the Pain Catastrophizing Scale was the best fit to the data from participant samples. Cronbach's alpha values of the three components and total scores for patients and healthy adults ranged from 0.72 to 0.87. Pain catastrophizing exhibited moderate positive correlations with neuroticism in patients and healthy adults and with pain intensities in patients. A high intraclass correlation coefficient of agreement (0.81) revealed an acceptable temporal stability in young adults.\ud \ud Conclusions: The results suggest that the Sinhala version of the Pain Catastrophizing Scale retains the original three-factor structure. It is a stable, valid and sufficiently reliable tool to assess pain catastrophizing in Sinhala-speaking individuals in Sri Lanka