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   Table of Contents - Current issue
Coverpage
July-August 2019
Volume 9 | Issue 4
Page Nos. 311-426

Online since Wednesday, August 7, 2019

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REVIEW ARTICLES  

Recent advances of pacemakers in treatment of xerostomia: A systematic review p. 311
Rayapati Srinivasa Rao, Rajesh Akula, Tammineedi S V Satyanarayana, Venkatagiri Indugu
DOI:10.4103/jispcd.JISPCD_389_18  
Objectives: Treatment of dry mouth is the most common clinical challenge in the dental field. Although some remedies have been used to improve the signs and symptoms of xerostomia, none of them are absolutely satisfactory for the patients who have this alteration. In the current years, non-pharmacological treatments based on neuro-electro-stimulation for the treatment of xerostomia were developed. This review aimed at presenting recent developments for the treatment of xerostomia, applying neuro-electro-stimulation by miniaturized intraoral electrostimulators. Materials and Methods: A thorough literature search between 1986 and 2018 was carried out using PubMed Central, Scopus, National Science Library, ProQuest, and Google Scholar databases; the results were reviewed, prioritized, and the findings were compiled. Twenty-two studies were evaluated for the review. Results: This tool increases salivary secretion and improves xerostomia symptoms. Scientific trials have been carried out, which have revealed the wetting effect of the method described in this text. Conclusion: Neuro-electro-stimulation of the salivary gland plays an important role in the stimulation of saliva in patients who need further therapy and have poor quality of life. Intraoral electrostimulator offers a new non-pharmacological method for treating dry mouth.
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Zika virus: A global public health menace: A comprehensive update Highly accessed article p. 316
Shamimul Hasan, Shazina Saeed, Rajat Panigrahi, Priyadarshini Choudhary
DOI:10.4103/jispcd.JISPCD_433_18  
Zika virus (ZIKV) is a RNA virus and belongs to genus Flavivirus and family Flaviviridae. The virus was first discovered from a febrile primate from the Zika forests of Uganda in 1947 and the first human case was documented in 1954. The nonspecific clinical manifestations of ZIKV pose diagnostic dilemmas and delays early and effective treatment. Dental professionals should have a thorough knowledge about the virus and should follow standard infection control measures as the virus has been demonstrated in various body secretions (including salivary secretions). The disease is managed by symptomatic and supportive care and no vaccine exist till date. Recent ZIKV outbreaks and increase association of microcephaly with congenital ZIKV and neurological complications (Guillain-Barré syndrome) has drawn global public health attention. The World Health Organization declared it a public health emergency of international concern in 2016. This review article provides a detailed overview on ZIKV; it is clinical and oral manifestations, diagnostic aids, differential diagnosis, preventive aspects, and management protocol.
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The Changing landscape in treatment of cystic lesions of the jaws p. 328
Bushabu Fidele Nyimi, Yifang Zhao, Bing Liu
DOI:10.4103/jispcd.JISPCD_180_19  
Objective: Cystic lesions of the jaw are common pathologies of chronic swelling of the jaw in oral and maxillofacial regions. Different treatment modalities have been described in the literature. However, the existence and proper treatment of these cysts remains a contentious topic. The aims of this review were to discuss the complexity of various surgical treatment and as factors with potential to influence outcome treatment. Finally, a practical and a rational clinical guideline for the management of such lesions have been suggested. Materials and Methods: A literature search without language limitation was performed in 2018 using MEDLINE, PubMed, Scopus, and Embase. Keywords for the search included the following terms: jaws cyst, cystic lesions, odontogenic cysts, cystic tumors, pseudocysts, treatments, therapy, wound healing, bone regeneration, and teeth involved cysts. Prospective or retrospective clinical studies with a sample size of n ≥ 5 were evaluated and included in this review. The exclusion criteria were studies with unclear reporting of the treatment applied or outcome, nonhuman studies, case reports, letters, preface, comments, and cystic lesions associated to syndrome. After the full reading, 30 articles were included in the quantitative synthesis for the review. No meta-analysis could be performed due to the heterogeneity of the studies included. Clinical radiographic images were presented to illustrate the principles of some surgical treatments. Conclusion: Conservative surgery with primary closure defect (less than 4cm) remains an initial approach, which reduces the morbidity of aggressive surgeries and obtains the complete bone healing before 24 months of postoperative. Marsupialization is considered as the most common option for the treatment of large cystic lesions when cases are carefully selected. Evocyst is an attractive new technique of obtaining complete bone defect healing within <3 months.
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ORIGINAL ARTICLES Top

Influence of radius of curvature at gingival embrasure in connector area on stress distribution of three-unit posterior full-contour monolithic zirconia Fixed Partial Denture on various amounts of load application: A finite element study p. 338
Kalamalla A SaranBabu, Dinesh Kumar Perisetty, Gunaranjan Thota, Mahammad Rasool, Mungara Niharika, Sannapureddy Swapna
DOI:10.4103/jispcd.JISPCD_20_19  
Objectives: To test the hypothesis that radius of curvature at gingival embrasure in connector area significantly affects the fracture resistance of full-contour monolithic zirconia three-unit posterior Fixed partial denture (FPD) on various amounts of load application. Materials and Methods: In this study, two types of three-dimensional finite element models of a three-unit posterior full-contour monolithic zirconia FPD with two gingival embrasure radii (rGE I, 0.45mm and rGE II, 0.25mm) were constructed. The components modeled through finite element modeling were subjected to 400, 600, and 800N vertical loads at the central fossa of the pontic, and further analysis was carried out. Results: All the results were displayed by post-processor finite element analysis software (ANSYS). The study revealed that with increase in the amount of load application as well as decrease in the gingival embrasure radii, stress concentration values were increasing gradually for both the full-contour monolithic zirconia FPD. Conclusion: The fracture resistance of the zirconia posterior FPD was significantly affected by the gingival embrasure radii and the mode of load application. When there is a clinical situation of heavier occlusal forces, the fracture resistance can be increased by designing greater gingival embrasure radii in the connector region.
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Barrier to access and dental care utilization behavior with related independent variables in the elderly population of Saudi Arabia p. 349
Abed Al-Hadi Hamasha, Mohammed N Aldosari, Abdulmajed M Alturki, Saud A Aljohani, Ibrahim F Aljabali, Rakan F Alotibi
DOI:10.4103/jispcd.JISPCD_21_19  
Objectives: The study aimed to evaluate barriers associated with access and utilization of dental services among the elderly population of Saudi Arabia. Materials and Methods: A systematic random sample of 350 elderly people recruited from various gathering places of the elderly including all nursing home residents (n = 73) was included in this study. The data were collected through face-to-face structured interviews related to access and utilization of dental services, and sociodemographic, behavioral, medical, and financial barriers to dental services. Statistical analysis included frequency distributions, chi-squared tests, and regression analysis using the Statistical Package for the Social Sciences (SPSS) program. Results: Approximately 37% of the elderly had proper access to and utilization of dental services. Independent variables that affect access and utilization of dental services were low income (odds ratio [OR] = 2.23, confidence interval [CI] = 1.34–3.72), unmarried participants (OR = 3.25, CI = 1.75–6.05), community residents (OR = 5.15, CI = 2.52–10.53), smokers (OR = 1.93, CI = 1.02–3.68), irregular users of toothbrushing (OR = 3.53, CI = 2.09–5.95), no dental insurance (OR = 1.88, CI = 1.06–3.37), and unaffordable price (OR = 2.55, CI = 1.38–4.69) in the bivariate analysis. In logistic regression analysis, the significant variables that were associated with proper access and utilization of dental services were having dental insurance (OR = 2.24, CI = 1.15–3.82), affordable prices (OR = 2.19, CI = 1.21–3.70), brushing regularly (OR = 3.58, CI = 2.01–6.37), higher education (OR = 1.87, CI = 1.10–3.20), and being married (OR = 1.68. CI = 0.97–2.91). Conclusion: Lack of perceived need, no dental insurance, unaffordable price, transportation, and fear from dental treatment were the most common significant barriers to dental services.
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Evaluation of roots and canal systems of mandibular first molars in a vietnamese subpopulation using cone-beam computed tomography p. 356
Khoa Van Pham, Anh Hoang Lan Le
DOI:10.4103/jispcd.JISPCD_52_19  
Objectives: The aim of this study is to determine the prevalence of the first lower molars that have two roots or three roots and the number of the root canals of the mandibular first molars in the Vietnamese subpopulation using cone-beam computed tomography (CBCT). Materials and Methods: The study was conducted on 166 patients who had CBCT as indicated by dentists in Nguyen Trai Dental CT Center, Ho Chi Minh City using the Picasso Trio (Ewoo Vatech, Korea). The number of root canals of the first lower molars was examined by moving cross-sectional slices from the pulpal floor to the apex. The orifices, middle thirds, and apical thirds of the canals of the first lower molar were observed, and the root canals of each root of the mandibular first molars were observed in three planes. Results: The prevalence of two, three, and four root canals of the mandibular first molars was 4.5%, 66.8%, and 28.9%, respectively. For the distal roots of these molars, a classification of Vertucci type I was the most common at a rate of 80.8%–97.6%. Whenever these teeth had three roots, a Vertucci type I was the classification of 100% of distolingual roots. Conclusion: Majority of the mandibular first molars has two roots and three canals. CBCT is appropriate equipment useful in investigating the complex root canal morphology of human teeth.
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Oral submucous fibrosis: Correlation of clinical grading to various habit factors p. 363
Vikash K Jha, Srinivas Kandula, Sangamesh Ningappa Chinnannavar, Purnendu Rout, Silpiranjan Mishra, Atul A Bajoria
DOI:10.4103/jispcd.JISPCD_92_19  
Objectives: The aim of this study was to correlate the clinical grading of oral submucous fibrosis (OSMF) with various habit factors and to observe the habit factors associated with the severity of OSMF. Materials and Methods: This study was carried out in the Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India. Two hundred patients clinically diagnosed with OSMF were included in the study. The observations were tabulated and subjected to statistical analysis using chi-square test and Spearman’s rank correlation test. Results: A total of 200 subjects participated in the study of which 182 were males and 18 were females. Forty-eight males and nine females had Grade I OSMF. One hundred nineteen males and eight females had Grade II OSMF. Fifteen males and only one female had Grade III OSMF. On the basis of functional staging, the total participants in stage I, stage II, and stage III were 185, 14, and 1, respectively. The participants having Grade I, Grade II, and Grade III OSMF with functional staging I were 57, 122, and 6, respectively. The participants having Grade II and Grade III OSMF with functional staging II were 5 and 9, respectively. Conclusion: It is alarming that nearly half of the total subjects were in the younger age group and were having OSMF. Also, as the age increased, the subjects were found to be more attracted to consuming areca nut derivatives in the form of betel quid with or without tobacco. It is recommended that community-oriented outreach programs on oral health awareness be developed, emphasizing children who represent the upcoming future, to avoid/quit areca nut and its derivatives.
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Application of a systematic protocol in the treatment of TMDs with occlusal appliances: Effectiveness and efficiency in a longitudinal retrospective study with medium-term follow up p. 372
Doria Tolevski Meshkova, Paola Di Giacomo, Fabrizio Panti, Anna D’Urso, Emanuela Serritella, Carlo Di Paolo
DOI:10.4103/jispcd.JISPCD_106_19  
Objectives: This study aimed to assess effectiveness, efficiency, and feasibility of a systematic protocol for the choice and management of occlusal splints (OA) in the treatment of temporomandibular disorders (TMDs). Materials and Methods: A longitudinal retrospective study was conducted. Two different samples, G1 + G2 (337 patients), between January 2011 and January 2014, were selected according to inclusion and exclusion criteria. G1 was composed of patients visited at Policlinico Umberto I, Head-Neck Department, Sapienza University of Rome, Italy, and patients in G2 visited at a private structure in Rome. Pain records and functionality were compared before (T0) and at the end of therapy (T1). A follow-up group, composed of 100 patients randomly selected among those who completed treatment for at least 1 year (T2), was analyzed and symptomatology records were compared. Descriptive statistical analysis was performed. Results: In the entire sample, joint and muscular pain, joint noises and mandibular functionality, headache, and neck pain improved from T0 to T2. The average time for articular and muscular recovery was 6.4 months. Comparing treatment outcomes, there were not statistically significant differences between the two groups. Conclusions: Treatment outcomes using this setting of protocol showed a positive trend also in the medium term. The use of a systematic protocol seems to reduce operator-dependent factors.
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Etiology of malocclusion and dominant orthodontic problems in mixed dentition: A cross-sectional study in a group of Thai children aged 8–9 years Highly accessed article p. 383
Sirate Rapeepattana, Angkana Thearmontree, Supanee Suntornlohanakul
DOI:10.4103/jispcd.JISPCD_120_19  
Background: Etiology of malocclusion can be the cause of deviation in the skeleton, dental, and soft tissue development in children. Identifying etiology of malocclusion and dominant orthodontic problems as well as early detection could help in future effective treatment, management, and public health planning. Materials and Methods: A cross-sectional study was performed among 202 children. Consensus process was carried out between experienced orthodontic experts in etiology of malocclusion, dominant orthodontic problems, type of early treatment, and malocclusion severity. Fisher’s exact test and descriptive statistics were used to explain the study results. Results: Etiology of malocclusion was detected in both congenital and acquired etiology (64.3%), followed by acquired etiology only (29.7%). The top three dominant orthodontic problems were caries (22.5%), early loss of primary tooth (15.6%), and tendency of crowding in permanent dentition (14.6%). Nearly all the children needed restoration (86.4%) and interceptive orthodontic treatment (69.3%), whereas severe malocclusion level was found in one-fourth of the children (26.0%). Statistical significance was found between type of early treatment and malocclusion severity (P < 0.001). Conclusion: Acquired etiology was very high. Caries and early loss of primary teeth were dominant orthodontic problems. An early treatment, especially preventive orthodontic treatment, was needed in almost all children. Malocclusion severity higher than moderate level was found in more than half of the children.
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Clinical and radiographic evaluation of Allium sativum oil (garlic oil) in comparison with formocresol in primary molar pulpotomy p. 390
Mehrdad Kahvand, Majid Mehran, Roza Haghgoo, Taraneh Faghihi
DOI:10.4103/jispcd.JISPCD_145_19  
Background: Given the side effects of formocresol as a common substance in dental pulpotomy, its substitution with a safe substance seems mandatory. Aim: To compare the clinical and radiographic success of Allium sativum oil and formocresol in the pulpotomy of the primary molars. Materials and Methods: A randomized, split-mouth, double-blind, controlled clinical trial was conducted on children with at least two asymptomatic primary molars requiring pulpotomy. A total of 90 teeth were examined in this study. They were randomly divided into two groups: the A. sativum (ALL) group (n = 45) and the formocresol (FC) group (n = 45). After pulpotomy, A. sativum oil was applied to the radicular pulp in the ALL groups and formocresol in the FC group. The pulp chamber was then filled with reinforced Zinc oxide Eugenol and finally restored by a stainless steel crown. Three and six months after the intervention, the teeth were evaluated by a colleague based on a modified criteria system. The results were analyzed using Wilcoxon’s test. Results: The clinical success rate was 100% in both groups after 3 and 6 months. The radiographic success rate in the ALL group and the FC group after 3 and 6 months was 82.2% and 80% and 88.9% and 84.4%, respectively. The difference between the two groups was not statistically significant (P = 0.46). Conclusion: According to the results of this study, A. sativum oil can be used in the pulpotomy of the primary molars.
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Comparative evaluation of saliva’s oxidant–antioxidant status in patients with different clinicopathological types of oral leukoplakia p. 396
Kumar Chandan Srivastava
DOI:10.4103/jispcd.JISPCD_179_19  
Objectives: Despite advancements in the management of oral cancer, the mortality rate associated with it still remains a matter of concern. Early identification and intervention of precursor lesions such as leukoplakia have always been emphasized, as this can drastically improve the scenario. The oxidative stress has been implicated in the pathogenesis of several diseases, including oral cancer. The aim of this study was to evaluate salivary oxidant and antioxidant levels in patients with different clinicopathological stages of oral leukoplakia. Materials and Methods: An analytical study with case–control study design was conducted. Forty newly diagnosed cases of oral leukoplakia were considered in the case group. The equal number of age- and gender-matched subjects was included in the control study group. Unstimulated whole-saliva supernatant was used to determine the levels of lipid peroxidation, glutathione S-transferase, nitrites, and uric acid using ultraviolet visible spectrophotometer. The statistical comparisons were performed by independent Student’s unpaired t test and one-way analysis of variance with post hoc analysis. Correlation analysis was performed among salivary parameters and with baseline variables. Results: End products of free radical damage and nitrite levels were significantly increased in patients with oral leukoplakia compared to controls. Conversely, levels of glutathione S-transferase and uric acid were significantly decreased in the study group in comparison with healthy subjects. Similar trends were seen along the clinical stages and histopathological grades of leukoplakia. Conclusion: Elevated levels of reactive species with a concomitant reduction in antioxidants in leukoplakia indicate its potential as an early diagnostic marker.
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Qualitative and quantitative evaluation of the efficiency of the application of foams with false xerostomia p. 403
Marianna G Arakelyan, Maria A Polyakova, Ksenia S Babina, Nina E Novozhilova, Edita G Margaryan, Vladlena Y Doroshina, Alina V Arzukanyan, Maria K Makeeva
DOI:10.4103/jispcd.JISPCD_191_19  
Aims: Xerostomia syndrome is a significant medical and social problem. It is manifested by objective and subjective symptoms of a “dry mouth” and a decrease in sialometry. The aim of the study was to determine the dental status of students of different nationalities, to identify xerostomia induced on a background of stress, and to assess the effectiveness of the use of moisturizing foams in alleviating xerostomia. Materials and Methods: A prospective cohort study survey (Fox test) of 100 students of the dental faculty was conducted to detect false xerostomia. The study involved 60 people with false xerostomia, divided into four groups of 15 each according to the nationality. The level of oral hygiene was determined using the Simplified Oral Hygiene and Silness-Loe indices and the rate of salivation was assessed with sialometry method by Pozharitskaya. Oral hygiene instructions were given to the participants. They were to apply moisturizing foams with lactoferrin, lactoperoxidase, and aloe vera, two–three times during the day for 3 weeks. A set of statistical programs was used (Microsoft Excel [2007] and the Statistical Package for the Social Sciences [SPSS], version 23) to perform Kolmogorov–Smirnov, Shapiro–Wilk, Kruskal–Wallis, and Wilcoxon tests. Results: A statistically significant improvement in oral hygiene was observed in all study participants. A significant increase was detected in the rate of salivation in students from Russia (P = 0.005), Transcaucasian countries (P = 0.006), and Arab countries (P = 0.005). Conclusion: It has been established that the use of moisturizing foam has a positive effect on the rate of salivation and improves the level of oral hygiene, thereby improving the quality of life for patients.
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Oral and dental status of Lebanese and Syrian refugees living in proximity to Deir Kanoun Ras El Ain dump in Lebanon p. 409
Jamilah Borjac, Shereen Badr, Manal ElJoumaa, Issa Daas, Riham Kobeissi
DOI:10.4103/jispcd.JISPCD_214_19  
Aims: In this study, we aimed at investigating the oral and dental health conditions of Lebanese and Syrian refugees living in proximity to Deir Kanoun Ras El Ain dump whereby its leachates influx into a canal used for irrigation and drinking purposes. Materials and Methods: This observational study involved oral and dental examinations of 589 Lebanese and Syrian Refugees participants living in the three villages: Deir Kanoun Ras El Ain, Klayleh, and Smaiyeh. Differences in oral and dental examination results were analyzed between different villages, sexes, nationalities, and age groups. Correlation tests were conducted between dental fluorosis, staining, papilla swelling, and several sociodemographic factors. Results: Dental fluorosis, staining, and papilla swelling were the most prominent problems among total participants. The highest percentages of individuals with the studied diseases were shown to be in Klayleh village, among females, and individuals aged between 21 and 40 years. Significant associations were observed between dental fluorosis and nationality; between dental staining and gender, nationality, age, and smoking; as well as between papilla swelling and age, smoking, and diabetes. Conclusions: Our study investigated and highlighted the prevalence of several oral and dental diseases among Lebanese and Syrian inhabitants that are related to environmental, social, and economic determinants and not just by individual behaviors. It also showed gaps of oral and dental health knowledge that recommend implementing health systems that focus on preventing oral diseases.
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Comparing caries experience between Azadirachta indica chewing stick users and toothbrush users among 35-44-year-old rural population of Southern India p. 417
Srinivas Pachava, Viswa C Chandu, Suresh C Yaddanapalli, Ankineedu B Dasari, Hussein M Assaf
DOI:10.4103/jispcd.JISPCD_428_18  
Objectives: To compare the caries experience between Azadirachta indica chewing stick users and toothbrush users among 35-44-year-old rural population in Southern India. Materials and Methods: This ex post facto research was conducted in the rural parts of two sub-administrative areas of a district in the Southern Indian state of Andhra Pradesh. The sample size for the study was determined to be 400, with 200 subjects in each group. Subjects following indigenous oral hygiene methods were identified using an interviewer-administered questionnaire. After obtaining 200 subjects using A. indica chewing sticks, age, gender, and socioeconomic status matched controls using toothbrush were identified. American Dental Association type III examination was carried out to record caries experience (decayed missing filled teeth (DMFT) Index) after obtaining informed consent and thus obtained data were subjected to statistical analysis using the Statistical Package for the Social Sciences (SPSS) software, version 20. Results: It was observed that the caries experience was more in toothbrush users compared to subjects following indigenous methods (DMFT, 4.38 ± 1.93 vs. 3.54 ± 1.02). Similar results were obtained when the decay component of DMFT index was exclusively compared. No significant difference in the plaque scores and the mean number of filled, missing teeth was observed between the two groups. Conclusion: Though conclusive results cannot be drawn from this study about the positive influence of indigenous methods on caries experience, the results emphasize the cardinal need to more thoroughly understand the potential benefits of indigenous methods before dismissing them as retrogressive approaches.
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CASE REPORT Top

Removable prosthetic treatment in oral pemphigus vulgaris: Report of three cases p. 423
Massimo Corsalini, Biagio Rapone, Daniela Di Venere, Massimo Petruzzi
DOI:10.4103/jispcd.JISPCD_421_18  
Pemphigus vulgaris (PV) is the most common clinical phenotype affecting the oral mucosa. Although rare, this vesicular disease may represent a severe complication in the management of edentulous or partially dentate patients because of the priority of care in handling the oral tissues. Analysis of the dental literature indicated a lack of evidence about the possibility of rehabilitating PV patients with removable prosthesis. Our study aimed to evaluate and describe the possibility of rehabilitating three patients who suffered from oral PV with removable prosthesis, although the friction of the prosthesis on oral soft tissues is one of the causes of the development of vesicular lesions which could break, causing oral mucosal pain and erosion. Three patients, referred to the Oral Pathology and Medicine section of the Dental School in Bari University, underwent biopsy, direct and indirect immunofluorescence tests, and enzyme-linked immunosorbent assay to confirm the diagnosis of oral PV. For each patient, a systemic corticosteroid therapy was planned. After the clinical remission of the PV signs, the patients were planned for an oral rehabilitation with removable prosthesis. As long as certain precautions are followed, patients with PV in a phase of clinical remission, induced by treatment, can be treated successfully with removable prosthesis. Although some authors have previously cautioned about the use of removable prosthesis for the treatment of patients with oral pemphigus, it is our view that, if patients follow the rigorous and periodic follow-up as discussed above, along with a corticosteroid immunosuppressive therapy, they may not show any deterioration of their clinical symptoms.
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