International Poster Journal of Dentistry and Oral Medicine, 03/2024

Oral soft tissue growths and swellings encompass focal reactive overgrowth (FROG), benign and malignant tumours. The diagnosis of these lesions is usually based on characteristic clinical and histopathological features. On rare occasions the clinical appearance of these is deceptive, exhibiting a benign appearance, whereby histopathology of the lesion will resolve the problem. This poster presents a rare case of high grade mesenchymal chondrosarcoma (MS) of mandibular gingiva in a 34 year-old male that was clinically misdiagnosed as pyogenic granuloma (FROG). MS is rare and represents approximately 1% of all chondrosarcomas with a predilection to affect the maxillofacial skeleton area. MS usually presents as a lobulated firm mass with a tendency to erode and expand bony confines. The current case radiologically showed ill-defined and ragged borders originating from the medullary portion. Histologically the tumour exhibited a classic biphasic pattern. The diagnosis was confirmed with IHC markers. This case illustrates the importance of a thorough clinical, radiological and histopathological evaluation to avoid mismanagement. Keywords: mesenchymal chondrosarcoma , misdiagnosis, focal reactive overgrowth, rare, maxillofacial skeleton, ragged borders, biphasic

Aim: To establish a protocol for effective rehabilitation after maxillofacial injury, with loss of soft tissue, alveolar and basal bone. Background: Gunshot injuries to the head, neck and face account for 33.57% of overall gunshot injuries from North India, with interpersonal conflicts being the most common reason of all. Cavitation produced by short ranged projectiles cause extensive hard and soft tissue damage with degloving injuries. The complexity in facial skeletal anatomy poses multiple medical and surgical challenges to an operating surgeon, demanding elaborate soft and hard tissue reconstruction. The following case illustrates management of maxillofacial trauma caused by a point blank pistol projectile resulting in a degloving injury to the upper lip, premaxillary and mandibular anterior region. Case Description: Management of such critical cases commences with basic life support and ends with prosthetic rehabilitation. Hard tissue reconstruction was performed with a cortico-cancellous iliac crest bone graft and soft tissue restoration with microvascular radial artery forearm flap. After complete healing, mandibular cortical and maxillary zygomatic implants were placed. After successful loading with an interim prosthesis, a final prosthesis was planned. Conclusion: A multidisciplinary approach with an oral and maxillofacial surgeon, ENT surgeon, prosthodontist is indispensable to avoid therapeutic and restorative mishaps. Keywords: corticobasal implantology, firearm injury, rehabilitation, zygomatic implants

Introduction: Oral potentially malignant disorders (OPMDs) are a group of conditions that have the potential to transform into cancer if left untreated. Approximately 16–62% of OPMDs undergo a malignant transformation and eventually develop into oral squamous cell carcinoma (OSCC). The five-year survival rates of OSCC patients decrease from 80 to 40% if diagnosed at an advanced stage. Early detection of OPMD allows for prompt intervention and treatment. Although biopsy is the gold standard, patients still prefer a non-invasive approach for diagnosing his/her disease. Aim: This poster aims to present a review on the current advances in non-invasive tools for early diagnosis of oral potentially malignant disorders. Method: A comprehensive search of online databases including Pubmed, Medline and Scopus were conducted to identify studies from (January 2010 to Dec 2022) using search keywords ‘Oral screening devices’, ‘autofluorescence’, ‘chemiluminescence’, ‘oral malignant lesions’, ‘imaging techniques’, ‘non-invasive tools’, ‘oral dysplasia’, etc. A total of 24 studies were reviewed and evaluated based on their sensitivity and specificity. Result: Results of the studies were tabulated and representation of their sensitivity and specificity was done to evaluate the diagnostic accuracy. Conclusion: None of the analysed techniques based on assessing oral images can replace biopsy. Further studies are needed to explore the role of these emerging techniques to identify an early non-invasive screening method for early detection of OPMDs. Keywords: autofluorescence, chemiluminescence, imaging techniques, non-invasive tools, oral dysplasia, oral malignant lesions, oral screening devices, oral potentially malignant disorders

Introduction: Pain, swelling, pus discharge and ulceration of gingival tissue are the most common complaints that an oral physician encounter. Most of the time, these symptoms indicate gingival or periodontal pathology. Although this scenario is very common, such cases should be investigated thoroughly. We are presenting a similar case which presented to us with pain, swelling, pus discharge, and ulceration of gingival tissue. An episode of high-grade fever, malaise, nausea, and dysphagia led us to investigate the case further, thus identifying a severe disease. Case presentation: We present a case of acute necrotising ulcerative gingivitis (ANUG) in a 51-year-old woman with a history of diabetes and hypertension. The patient presented with a one-week history of fever and white, necrotic patches on the surface of the gingiva. Oral examination revealed halitosis, ulcerated, and painful and swollen gingiva, especially the anterior part. The differential diagnoses considered were gingival ulcers of viral origin and desquamative gingivitis. CBCT revealed mild to moderate bone loss. Lab investigation revealed underlying leukopenia, which later improved, and poorly controlled diabetic status. The case was managed by conservative oral treatment and management of the underlying systemic condition. Conclusion: This case highlights the importance of a thorough case history and appropriate investigations in diagnosing ANUG. In addition, a successful outcome of acute necrotising gingivitis depends on a multidisciplinary approach involving an oral medicine specialist, periodontist and general physician. Keywords: painful and swollen gingiva, purulent discharge, systemic pathology

Background: This retrospective study describes the prevalence of dental caries and tooth number anomaly in primary and permanent dentition in children with a cleft lip and palate (CLP). Methods: In 47 children with CLP (24 boys, 23 girls; age 4-14 years) panoramic x-rays were investigated, 28 with primary and 23 with permanent dentition. Caries index dmft/DMFT was applied. Gender, type of the cleft (LAHSAL classification), and number of teeth in both dentitions were recorded. The statistics were performed using the chi-squared test, significance level p=0.05. Result: There was tooth agenesis in 34 % (n=16) children. The most commonly missing tooth was maxillary lateral incisor. The prevalence of supernumerary teeth was 45 % (n=21), praecaninus being the most common (n=20). There was a relationship in supernumerary teeth prevalence between cleft of primary and secondary palate (p=0.01). The prevalence of caries in children with primary dentition was 79 % (n = 22), in permanent dentition 56.5 % (n=13). No association between caries prevalence and gender was found. The average dmft was 4.64 (boys 4.0; girls 5.5); the average DMFT was 1.61 (boys 0.9; girls 2.31). There was no significant difference in DMFT in children with cleft of the primary and secondary palate. Conclusion: The prevalence of caries in children with CLP was higher in primary dentition and lower in permanent dentition than previously reported in a Czech population. There was no significant association between caries prevalence and gender. There were significantly more supernumerary teeth in children with cleft of the primary palate. Keywords: cleft lip and palate, dental caries, tooth number anomaly

Introduction: Cancer-related malnutrition is often an unnoticed problem, although almost 60% of all oncological patients are already malnourished before diagnosis and more than 25% die of the consequences. Material and methods: In this prospective observational study, the nutritional status of patients with oral squamous cell carcinoma (OSCC) was assessed pre-, peri- and postoperatively using Body Mass Index (BMI), Subjective Global Assessment (SGA) and Bioelectrical Impedance Analysis (BIA) over four months. Patients with orthognatic surgery served as a control group due to comparable nasogastric tube feeding. Results: Patients with OSCC showed a worse nutritional status pre-therapeutically than the control group and fulfilled the criteria for malnutrition in SGA and BIA. Peri- and post- operative, the nutritional status deteriorated in both groups. In the group of OSCC patients, the nutritional status improved from the second postoperative week, but at the end of the observation period, the status was still predominantly in the pathological range according to BIA and SGA. In the control group, the nutritional status returned to baseline during the observation period. Conclusion: Based on these data, malnutrition is also widespread in the collective of oncological patients with OSCC. In order to improve the nutritional status of OSCC patients in general and thus also the prognosis of the patient, it is recommended to assess the nutritional status before therapy. Standard procedures such as SGA or BIA should be established and used. BMI alone is not suitable for this purpose. Professional nutrition therapy should be introduced as an integral part of the therapy in order to improve the patients’ prognosis. Keywords: malnutrition, OSCC, observation study, cancer-related cachexia, nutrition treatment

Introduction: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder causing hyperandrogenism and menstrual dysfunction. Periodontitis and PCOS are associated with systemic inflammation and insulin resistance and may influence each other. Hence, these two disorders may be linked through common pathophysiologic pathway. Therefore, reduction of insulin resistance offers the possibility of improving effects of metabolic derangements and inflammation. For this purpose many insulin-sensitising agents like metformin and myoinositol have been tried. Metformin decreases serum CRP levels where as myoinositol helps in reduction of inflammation by increasing plasmalogen synthesis. The aim was to assess inflammatory periodontal status in PCOS patients undergoing different medical treatments. Materials and Method: Patients (n=75) were recruited and divided into three groups: Control Group: Newly diagnosed PCOS Women, Group A: Patients taking metformin for 6 months, and Group B: Patients taking myoinositol for 6 months. The clinical examination included a full-mouth periodontal assessment: BOP (bleeding on probing), PD (probing depth), CAL (clinical attachment level), PI (plaque index) and GI (gingival index). Results: The comparison between the control group and test groups showed significant differences with respect to GI and BOP whereas non-significant differences were seen with respect to AGE, PI and PD and CAL. Non-significant differences were seen in periodontal parameters between group A and group B. Conclusion: Newly diagnosed PCOS females have higher measures of GI and BOP as compared to PCOS women on medical treatment, whereas no significant difference is seen in periodontal parameters between women taking different medical treatment. Thus despite having different mechanisms of action, both drugs may reduce the systemic inflammation and hence are helpful in reducing the local inflammation. Keywords: polycystic ovary syndrome, gingivitis, bleeding on probing, insulin resistance

Background: The aim of study was to evaluate parents’ and children's perception of two ways of conscious sedation in outpatient practice (inhalation nitrous oxide-oxygen factory prepared mixture N, and peroral intake midazolam mixture - M), and change in children's approach to food and oral hygiene afterwards. Methods: Parental informed consent was obtained for every patient. Inclusion criteria were ASA I, II, no medical contraindications for N/M, and fasting prior to sedation followed EAPD guidelines. 129 children (66 M ♀27♂39, mean age 5.07; 63 N ♀23♂40, mean age 6.63) participated in the study. Parents were asked to complete a short questionnaire immediately after sedation and were questioned about the change in the children's approach to food and oral hygiene at the next check-up. The Wilcoxon sign-ranked test was used to compare study groups at 5 % statistical significance level. Results: All parents would choose the same type of sedation next time p<0.001. Parental reasons for children's sedation were not dependent on sedation type, p = 0.17. Parents of M-treated children had more information about the sedation prior to it, p<0.001. There was a change in the children's approach to oral hygiene (p=0.018) and to sweet food (p=0.048) after N. Conclusions: No differences in parental perception between the two sedation methods were found. They would choose the sedation method they already experienced for the child at the next visit. Results revealed significant changes in the children's approach to food and oral hygiene after nitrous oxide sedation. Keywords: Conscious sedation, children, nitrous oxide, midazolam, dentistry

Objective: The advent of AI in the field of dentistry and in forensic odontology is gaining momentum in the recent times. The current systematic review aims to determine the use of AI in dental age estimation. Methods: Using PRISMA guidelines, original articles from “PubMed”, “Scopus” and “Google Scholar” were searched using terms, viz “dental age estimation”; “artificial intelligence”; “neural networks”; and “convolution networks” from the period of 2017 to present. Inclusion criteria included English language original research with completely free access. Non-English, in vitro studies, and abstract only articles were excluded from the study. Results: Total 11 articles were included in the study. The studies were retrospective in nature. The studies showed that AI-based applications estimate the dental age more precisely and in a large population. The majority of the studies used machine learning, deep convolutional networks, and deep learning types of AI in their study. Conclusion: The use of AI in age estimation is an excellent tool for dental age estimation of large populations with precision. Further, large-scale studies using other imaging modalities are recommended. Keywords: artificial intelligence, dental age estimation, deep learning, machine learning, neural networks, forensic odontology

Introduction: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset during pregnancy and is associated with increased feto-maternal morbidity. Chronic inflammation has been implicated in the pathogenesis of GDM. Saliva being a biofluid can serve as a non-invasive and economical alternative to serum for diagnosing various local and systemic diseases. Objectives: To assess the relationship between salivary inflammatory biomarkers and GDM. Methodology: A PICOS framework was developed and keywords used to electronically search the relevant literature in PubMed. Four relevant and authentic articles were included which are written in English and published from 2011 to 2023. Result: Obesity and GDM in pregnant patients have been found to be associated with raised salivary inflammatory biomarker. A direct relationship was observed between GDM and salivary inflammatory biomarkers. Conclusion: GDM have a recognized association with systemic inflammation, and they are also at risk for adverse pregnancy outcomes. Saliva provides an easy, non-invasive, cost effective alternative to frequent serum inflammatory markers estimation. This review shows the potential of salivary inflammatory biomarkers as an adjunctive to serum biomarker and a potential scope of further research on larger more homogeneous populations, preferably following a longitudinal design to form statistically sound recommendations. Keywords: pregnancy, pregnant females, gestational females, gestation, saliva, inflammatory biomarkers, inflammatory mediators, gestational diabetes mellitus, GDM, pregnancy-induced diabetes mellitus

Objective: The aim of this study was to investigate patients with classical (cEDS) and hypermobile (hEDS) Ehlers-Danlos syndrome (EDS) with regard to the prevalence and quality of temporomandibular disorders (TMD). In addition, the connection to chronic pain and psychological distress was investigated. EDS are classified as rare diseases, of which 13 subtypes can be distinguished according to the current classification (1). hEDS and cEDS are among the two most common subtypes (1,2). A characteristic feature is hypermobility of the joints. According to current literature, patients with EDS suffer more frequently from temporomandibular joint problems (3). The study conducted here is intended to be a further step in the research of the disease and the development of individualised treatment methods. Methods: Participants were recruited via self-help groups in Germany, Austria and Switzerland as well as via social media and subjected to an online questionnaire. Free-text questions on TMD-specific symptoms and previously diagnosed TMDs and their treatment, the German version of the Depression Anxiety and Stress Scale and the German version of the Graded Chronic Pain Status were used. Results: 259 participants were included (230 hEDS/29 cEDS). 49.2% of participants had painful or restricted jaw movements, and 84.9% had pain in the masticatory muscles, with 46.3% having a previously diagnosed TMD. A significance analysis showed a 2.5-fold higher risk of chronic pain in participants with diagnosed TMD. 22% of participants had a critical score for depression, 53.3% had a critical score for anxiety and 34.0% had a critical score for stress. Conclusion: CMD problems and chronic pain are common in patients with cEDS and hEDS. The lack of knowledge about these problems can lead to psychological distress. Further research is needed to adequately treat patients with EDS and to develop individualised treatment concepts. Keywords: Ehlers-Danlos syndrome, oral health, rare diseases, temporomandibular disorder

The dental treatment of patients with epidermolysis bullosa is complex and challenging. In general, a fixed restoration should be aimed for, as this puts only minimal strain on the fragile mucosa. Implants can significantly improve the quality of life of these often young patients. This case report describes the treatment of a 19-year-old female patient with epidermolysis bullosa. All of her impacted teeth were first removed and auxiliary implants were inserted. Bone was then augmented so that eight implants could subsequently be inserted. Finally, the patient received a fixed prosthetic restoration. Keywords: epidermolysis bullosa, implant, oral diseases