Journal of Scientific Dentistry Vol 8 Iss 1 Jan-June 2018

P-ISSN No: 2277-7687 E-ISSN No: 2278-3865

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JOURNAL OF SCIENTIFIC DENTISTRY An official publication of

Indira Gandhi Institute of Dental Sciences, Puducherry

Volume 8 Issue 1 January-June 2018

The whole purpose of education is to turn 'mirrors'into 'windows'- Sydney J Harrison

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 MISSION STATEMENT

Journal of Scientific Dentistry, published by Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth, Puducherry, is a peer-reviewed, indexed, bi-annual journal with an aim to reinforce the scientific foundation of the art of Dental Sciences, by providing a platform for sharing and disseminating high quality, evidence based knowledge among the clinicians and the academicians of all branches of this fraternity.

 PATRON

Shri. M.K. Rajagopalan

 ADVISOR

Prof. S. C. Parija

 EDITOR IN CHIEF

Dr. Saravana Kumar R

 Narrative review editors

Dr. Vezhavendhan N

 Original research editors

Dr. Pratheba Balu Dr. Vikneshan M

 Case report editors

Dr. Sivaramakrishnan M Dr. Jananni M Dr. Suganya R

 Technical report / Short communication editors

Dr. Shivasakthy M

 Product Profile editors

Dr. Senthil M

 Student Editors

Dr. John Shibin(PG) Dr. Gayathri (PG)

 Publication and Circulation Manager

Dr. Rajkumar E

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JOURNAL OF SCIENTIFIC DENTISTRY Web site: http://igids.ac.in/jsd/jsdindex.html

 CONTENTS Journal of Scientific Dentistry, Volume 8, Issue 1

From the Editor’s desk

Saravanakumar. R

1

R. J. Shobana priya, R. Palanivel pandian, Sangeeta Chavan, K.S. Premkumar, S. Shrimathi, K. Umesh

2

Mucocele –A Case Report

R. Muthukumaran, A. Santha Devy, K.R. Premlal, S. Vidyalakshmi.

7

Twinning in Primary Dentition – A Case Report

Vinothini V, Sanguida A, Prathima G S

10

Manoharan PS, Anand V, Arjun S

13

Effectiveness of Tacrolimus over Triamcinolone Acetonide in The Treatment of Oral Lichen Planus

Ashna Mariya Benny, Laxmipriya .S, Vezhavendhan. N

16

Pentoxifylline Therapy in the Management of Oral Submucous Fibrosis – A Review

Khaaviya.N, Fahmitha Parveen .S, Vezhavendhan .N, Sivaramakrishnan .M

19

Topical Honey Application for Treatment of Herpes Labialis: A Review

Fathimuthu Johara .A, Elsie Sunitha Ebenezer, Vezhavendan, Suganya

22

 Original Article Dentistry by Volition or by Happenstance – A Questionnaire Study

 Case Report

 Technical Report A Simplified Approach for Beading and Boxing Elastomeric Impressions

 Review Article

JOURNAL OF SCIENTIFIC DENTISTRY From the Editor’s desk....

A patient’s informed consent to investigations or treatment is a fundamental aspect of the proper provision of dental care. Without informed consent to treatment, a dentist is vulnerable to criticism on a number of counts, not least those of assault and/or negligence – which in turn could lead respectively to criminal charges and/ or civil claims against the dentist. Furthermore, the question of consent arises increasingly at the heart of complaints made under the Complaints Procedure, and complaints to the Dental Council on matters on professional ethics and conduct. It is self-evident, therefore, that every practicing dentist, therapist and hygienist needs not only a thorough understanding of the principles of consent, but also an awareness of how to apply these principles in the wide variety of circumstances that can arise in the practice of dentistry. The law is continually changing and developing, as the courts interpret both the common law and legislation. The doctrine of precedent means that judgments from a higher court will bind a lower court. At the same time, clinical knowledge and ability have developed, and this makes the interpretation of what constitutes informed consent and who can give it, a constantly changing perspective. Clinicians have a responsibility to ensure that every effort is made to keep abreast of changing standards, to show not only that the optimum treatment is being given to their patients, but also that the patients themselves have had the best opportunity to be involved in decision making about the care of their bodies Informed consent actually is a process, not a form. However, most dental offices today opt for informed- consent forms.

The forms should describe all pertinent facts of a given procedure and provide a section for the patient`s signature as written documentation. A form ensures that all facts have been discussed, and a signature on the form implies that the patient understands these facts. Informed consent is very important, but it does not protect against all forms of misinformed consent consists of a patient`s understanding of several issues surrounding treatment.

In order for consent to be valid, it must be given freely and voluntarily, without any pressure or influence being brought to bear on the patient. This pressure might be from a family member, parent or a health care professional. It is important when seeking to obtain consent that you satisfy yourself that consent has been freely given.

1. First and foremost, respect any patient’s fundamental right to decide whether or not they wish to proceed with any dental treatment.

2. Assess the patient’s competence to consent, bearing in mind their age and their ability to understand a. the nature of the proposed treatment b. its purpose c. any risks and limitations d. comparisons with any alternative treatment options which are available (including that of doing no treatment at all) 3. Satisfy yourself regarding the authority of the patient (or that of anyone else acting on the patient’s behalf) to give consent to the proposed treatment.

4. Provide the patient with as much information as is appropriate and relevant (and as is required by the patient) regarding the points raised at 2 (a) (b) (c) (d) above. Invite questions from the patient, and answer any such questions fully, truthfully and fairly, trying to avoid making any dismissive comments about any possible risks.

5. Satisfy yourself that consent has been given voluntarily.

6. Bear in mind the situations where it might be sensible to give written information/ warnings as part of the process of obtaining a valid consent from the patient.

7. Keep good and careful records of all matters concerning the question of consent.

Prof. Saravana kumar. R Editor - in - Chief Journal of Scientific Dentistry

Original Article

Dentistry by Volition or by Happenstance-A Questionnaire Study R. J. Shobana Priya1, R. Palanivel Pandian2, Sangeeta Chavan3, K.S. Premkumar4, S. Shrimathi5, K. Umesh6 ABSTRACT Introduction: The present study contemplates about the profile of first year dental students and their attitudes towards choosing dentistry as a career.

Aim and objectives : To assess the factors that leads to the choice of dentistry as an occupation among the first year students in one of the private dental colleges in Madurai, Tamil Nadu, India.

Materials and methods: The study sample includes first year students in one of the private dental colleges in Madurai, who were enrolled during the academic year of 2017-2018. A cross sectional survey was conducted among 75 students of first year BDS using a self-administered questionnaire. The survey form consisted of ten close ended questions. Information was collected, evaluated and delineated as numeral and percentage.

Results: The response rate of the study participants was 100%. Majority of the participants 58.7% of them have chosen dentistry because they were unable to get an admission in medical course.

Discussion: Majority of the students in the study have chosen dentistry as an alternative to medicine and few of them by their family impact.

Key-words: Dental education, profession, chance, dentistry, post graduation.

Introduction During childhood, each children have their own dreams about their profession, it may be either doctor, engineer, teacher, etc as days passes this imagination dissipates either due to internal or external factors and they are pushed into a situation to deviate from their dream either by their own interest or by others compulsion. Career is an individual’s metaphorical journey through learning, work and other aspects of life.1 The working condition, financial situation, status, security and interest of the individual play an important role in deciding a career.2 The choice of dentistry as a career is a ingenious decision and it is considered passionate which has a great impact on the future.3 Dental education is the institution where the students are sculptured to sculpt the smile of other.4 The students entering the dental education can be divided into three categories, Dentistry by choice – where dentistry is their passion, Dentistry by chance and where they pick up the profession under compulsion.5 Dentistry is a branch of medicine that consists of the evaluation, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. The scope of dental education is based on training and experience which also has an impact on professional ethics and applicable law.6 A study carried out based on the attitude of the dental students reveals that 2

one of the obtained elements of an individual is attitude, initiating and sustaining proper attitudes by dental students have effect on the standard of curative care delivered to the patients.7 The duration of undergraduate training for Bachelor of Dental Surgery (BDS) in India is 4years and 1year of compulsory rotatory internship as prescribed by the Dental Council of India, the regulatory body of dental education. The aim of our study was to assess the factors that led to the choice of dentistry as an occupation among the first year dental students in one of the private dental colleges in Madurai, Tamil Nadu.

Methodology A descriptive cross sectional survey was conducted among 75 students in one of the private dental colleges in Madurai, over a period of 1 month from June 23rd to July 23rd 2018.

Ethical approval was obtained from institutional review committee. Students were informed about the survey; informed consent was obtained from all the students before the start of the study. A self administered structured questionnaire was prepared in English language. The survey form consisted of ten close ended questions was used to collect the data based on the previous studies conducted by AL-Bitar et al, Hallisey et al, Bernable et al, with some additions related to surrounding influences.2, 8, 9 The study was carried out in the first year lecture hall and Journal of Scientific Dentistry, 8(1), 2018

Dentistry by Volition or By Happenstance - A Questionnaire Study

the questionnaire was distributed to the participants by two investigators. All the participants were given 20 minutes time to fill the questionnaire in the college first year lecture hall and retrieved immediately. It was made clear to the students that their identity would not be disclosed to avoid the social desirability bias. The time limit set for collection of data was for a period of 2 days in the month of June, 2018. The survey questionnaire includes items related to choosing dentistry, their alternative choice of interest, reasons to choose dentistry and their mentality towards serving rural or urban sectors. The content validity of the questionnaire was evaluated by the experts. A pilot study was conducted to check the feasibility of the questionnaire and it was conducted among 10 students in one of the private dental colleges, Madurai, Tamil Nadu. Based on the interpretation of the pilot study, necessary modifications were made in the questionnaire and cross sectional survey were conducted among 75 students. The data were entered into Microsoft excel and statistical package for social sciences (IBM SPSS statistics for windows version 20) was used.

Results The study was done to assess the reason for choosing dentistry as a career choice, among the total study group of 75 students out of which 60 were females and 15 were male students from the first year BDS. The gender distribution of the study participants is shown in the bar graph no: 1. Majority of the students who got into dentistry by chance as a professional career was 58.7%. Nearly half of the participants 58.7% of them choose dentistry because they were unable to get an admission in medical course, 28% of them choose dentistry out of interest, 13.3% of them were due to their family influence and the alternative choice of interest for 68% of the students was medicine, other than dentistry. About 77.3% of the students felt that dentistry is not related to aesthetics alone. Nearly 38.7% of the students felt that dentistry could help them to serve people by providing good oral health services, only 10.7% of them felt that it would

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Shobana priya et al

help earning for their livelihood and 24% of them felt that dentistry was a prestigious career. Majority of the students 42.7% were aware that dentistry is not only confined to dental treatment of tooth problems and improving aesthetics but also the surgical correction of maxillofacial anomalies. Nearly half of the study participants 55.3% of them would like to serve the rural population. After completion of their undergraduate course in dentistry, 64% of the students were interested in postgradution and 25.3% of the study participants have a dream to establish their own clinical practice. The gender wise responses to the question asked are described in Table 1.

Discussion The purpose of the present study was to obtain information about the reasons for choosing dentistry as a career either by choice or chance, among the first year students in one of the private dental colleges in Madurai. The students can obtain admittance into a dental institution through the National Eligibility cum Entrance examination (NEETUG) is an examination in all over the India conducted by Central Broad of Secondary Education. The present study confessed that choosing dentistry as a career has a certain reasons nearly half of the study participants (58.7%) got dentistry by chance, because they have chosen dentistry as an alternative to medicine and remaining few of them choose this branch out of interest, similar results were obtained in the study conducted by Ashish et al where most of the dental students(78%)of them chose dentistry as an alternative to medicine.10 This might be due to the common perception of the vicinity that medical students relish highly honoured social status than dentistry.11 This was dissimilar to the study conducted by Augiar et al where (67.8%) most of the students felt that dentistry to be superior status in the professional career and for one’s own accomplishment.12 In the present study only a few 25.3% of them were interested to establish their own clinical practice because the value of investment for clinical setting is very high when compared to their return earnings in India. This result was in contrast to the study conducted by Jonathan et al, where nearly half of the participants(57.4%) planned to establish clinical practice because in United States, an average dentist in clinical practice works for about 32 hours a week and the income is also very high when compared to India.13 A study conducted by Brand at al, Sofola et al, where students choose dentistry for clinical practice as a common motive but it was a difficult option for them due to financial pressure and in a way that agrees with the present study.14,15 The current study shows that 38.7% of them felt that they could serve people through dentistry.

This result was similar with the study conducted by Singh 3

Dentistry by Volition or By Happenstance - A Questionnaire Study

Shobana priya et al

Table 1: Responses of study participants to the questions Questions

Males

1. You chose dentistry by Choice Chance

Females

Total

09 [60%] 06 [40%]

22 [36.6%] 38 [63.3%]

31[41.3%] 44[58.7%]

2. What is the reason for choosing dentistry as a career Unable to get a seat in medicine Family influence Interest in dentistry

08 [53.3%] 02 [13.3%] 05 [33.3%]

36 [60%] 08 [13.3%] 16 [26.6%]

44[58.7%] 10[13.3%] 21[28%]

3. Whether dentistry is related to aesthetics only Yes No

02 [13.3%] 13 [86.6%]

15 [25%] 45 [75%]

17[27.7%] 58[77.3%]

4. Factors influencing in choosing dentistry Career choice Self-employment Family influence

05 [33.3%] 10 [66.6%] 0

20 [33.3%] 26 [43.3%] 14 [23.3%]

25[33.3%] 36[48%] 14[18.7%]

05 [33.3%] 03 [20%] 04 [26.6%] 03 [20%]

24 [40%] 05 [8.3%] 14 [23.3%] 17 [28.3%]

29[38.7%] 08[10.7%] 18[24%] 20[26%]

04 [26.6%] 01 [6.6%] 08 [53.3%] 02 [13.3%]

14 [23.3%] 05 [8.3%] 24 [40%] 17 [28.3%]

18[24%] 06[8%] 32[42.7%] 19[25.3%]

07 [46.6%] 07 [46.6%] 01 [6.6%]

32 [53.3%] 28 [46.6%] 0

40[55.3%] 35[45.3%] 01[1.3%]

10 [66.6%] 01 [6.6%] 04 [26.6%]

41 [68.3%] 07 [11.6%] 12 [20%]

51[68%] 08[10.7%] 16[21.3%]

10 [66.6%] 04 [26.6%] 01 [6.6%]

38 [63.3%] 15 [25%] 07 [11.6%]

48[64%] 19[25.3%] 08[10.7%]

11 [73.3%] 04 [26.6%]

47 [78.3%] 13 [21.6%]

58[77.3%] 17[22.7%]

5. Dentistry as a profession can Help people Help me make money Prestige Others 6. What is your view about dentistry Confined only to the treatment of tooth problem To improve aesthetics Surgical correction of maxillofacial anomalies Others 7. Population you like to serve Rural Urban Both 8. Alternative choice of interest other than dentistry Medicine Engineering Others 9. After completing BDS do you like to Do post-graduation Clinical practice Others 10. Are you happy with your decision in choosing dentistry Yes No

et al in which the 51% of the students felt that dental treatment helps to serve the people and it enhances the standard of living.16 This finding shows disparity with the study conducted by Umesh et al, on Indian students where (85.3%)most of the students felt that dentistry would help them to be financially stable and only a few felt that dentistry as a profession can help people.17 As stated by the present study medicine was the 1st priority for most of the students and they choose dentistry with lack of 4

interest. The reason behind this was according to the study coordinated by Parsa et al, most of the participants felt that medicine as an high-brow testing profession which provides the chance to save lives, highly respectable job, availability of job vacancy, expected earnings, and to look after the public health.18 An appropriate reason for choosing dentistry as a second fiddle by the students, this was due to lack of job vacancy and not competent enough to start their own clinical practice in the dental Journal of Scientific Dentistry, 8(1), 2018

Dentistry by Volition or By Happenstance - A Questionnaire Study

field because maximum number of experienced dentists are available in this field so the fresher’s are not getting an opportunity to expose their hand skills, as reported in the study conducted by Brand at al.14 Eighty percent of the students participating in the present study were females, this was similar to the other studies conducted by Rashmi et al, Nupur et al.19,20 In the present study the participants have chosen dentistry because of their family impact, this finding was similar to the study conducted by Marino et al, Nadya et al, Halawany et al, have disclosed a robust family influence on their career decisions.21-23 This finding shows variation in the study conducted by Skelly et al, Tom et al, Khami et al, where majority of the students have chose dentistry by choice as a professional career because of their own interests in science and research, use of personal or manual skills, financial rewards, security and higher social hierarchy,24,25,26 and Farid et al conducted a study in which the parental influence was considered to be very sparse and this also varies with present study.27 Majority of the students in the present study have chosen dentistry as a optional career, due to family impact, unable to procure a admission in medical course, this findings shows disparity to the study conducted by Crossley et al, where most of the students chose dentistry for professional status, job security and financially profitable.28 In the current study the overall population was only 75 students and this population was less when compared to other studies. Most of the students were the first graduate from their family and they have lack of ideas about choosing their tertiary education and majority of them were from rural sectors. More studies with higher sample size and strong sampling model are needed to conclude this result.

Conclusion The present study concludes that majority of the first year dental students choose dentistry as their career chance because as they were unable to get an admission in medical course so they choose dentistry as their second chance priority, some of them choose this branch due to their family impact. Most of the participants in the current study were females. Majority of them in the study were willing to do post graduation in the field of dentistry.

In the present study most of the students have lack of awareness about the field of dentistry so they felt that the field of medicine is superior in status when compared to dentistry, therefore in order to overcome these types of thoughts from the students mind, our government should establish an teaching methodology which is compulsory where in after their secondary education, the aptitude

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Shobana priya et al

of the students should be identified and students who are willing to go for dental and medical fields should be encouraged.

Acknowledgements I would like to express deep gratitude to R. Jothi basu and J. Nirmala for their encouragement and support throughout the course of my work.

I would like to thank all my friends for their help in the whole process leading to the conceptualization of the project.

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17. Umesh K, Chavan S, Singh S. Dentistry by choice or chance. J Indian Assoc Public Health Dent 2011;17 (Supp II) :662-5.

18. Parsa S, et al. Freshmen versus interns speciality interests. Arch Iran Med 2010;13(6):509-15.

19. Rashmi M, Virjee K, Yadava TS, Vijayakumar N, Shoba M. Dentistry as a career: Motives and perception of dental students attending Dental Colleges in Bengaluru city, Karnataka, India. J Indian Assoc Public Health Dent 2014;12:194-8.

20. Sharma N, Kabasi S, Pati AR. Perception of 1st year dental students studying in Odisha toward career choice: A cross-sectional survey.

J Indian Assoc Public Health Dent 2015;13:499-53.

Address of Correspondence

R.J. Shobana priya, (CRRI) Ultra’s Best Dental Science College.

Email id: shobykiddy@gmail.com Phone no: 9952184648

Shobana priya et al

21. Marino RJ, Morgan MV, Winning T, Thomson WM, Marshall RJ, Gotjamanos T, et al. Sociodemographic backgrounds and career decisions of Australian and New Zealand dental students. J Dent Edu 2006;70(2):169-78.

22. Avramova N, et al. First year dental students motivation and attitudes for choosing the dental profession. Acta Med Acad.2014;43(2):113-121.

23. Halawany HS. Career motivations, perceptions of the future of dentistry and preferred dental speacialities among Saudi dental students. Open Dent J 2014;8:129-135.

24. Skelly AM, Flemming GJ. Perceptions of a dental career among successful applicants for dentistry compared with those of fifth year dental students. Prim Dent care 2002;9:41-6.

25. Tom K, et al. Reasons for choosing dentistry as a career-Survey of dental students in AIMST University. Malasiyan J Dent 2014,Vol.36 Issue 1, p1-4.4p.

26. Khami MR, Muratomaa H, Jafarian M,Vehkalahti MM, Virtanen JI. Study motives and career choice of Iranian dental students.

Med Princ Pract 2008;17(3):221-6.

27. Bourzgui F, et al. Motivational factors influencing career choices of Moroccan dental students. Oral Health Dent Manag.

2014;13(2):390-4.

28. Crossley ML, Mubarik A. A comparative investigation of dental and medical students’ motivation towards career choice. Br Dent J 2002;193:471-3.

Authors (CRRI) ultra’s best dental science college

1

Senior lecturer in public health dentistry in ultra’s best dental science college

2

Reader in public health dentistry in ultra’s best dental science college

3

Principal of the ultra’s best dental science college,

4

II year PG in public he alth dentistry in ultra’s best dental science college

5

Head of the Department in Public health dentistry in ultra’s best dental science college

6

How to cite this article : R .J. Shobana Priya, R. Palanivel Pandian, Sangeeta Chavan, K.S. Premkumar, S. Shrimathi, K. Umesh. Dentistry by Volition or

By Happenstance - A Questionnaire Study. Journal of Scientific Dentistry 2018;8(1):2-6 Source of support : Nil, Conflicts of Interest : None declared

6

Journal of Scientific Dentistry, 8(1), 2018

Case Report

Mucocele –A Case Report R. Muthukumaran1, A. Santha Devy2, K.R. Premlal3, S. Vidyalakshmi4.

ABSTRACT Mucocele is one of the common lesion of oral mucosa encountered that results from an alteration of minor salivary glands.

Two histological types exist - extravasation and retention, with different causative factors such as trauma leading to severance of the duct with spillage of mucin into the adjacent connective tissue and obstruction respectively Clinically they consist of a soft, bluish and transparent cystic swelling which normally resolves spontaneously. Treatment frequently involves surgical removal micro marsupialization, cryosurgery, steroid injections and CO2 laser. As mucocele is a common lesion and affects the general population it is stressed to emphasis and share the perspectives of it.

Key words: Retention cyst, Extravasation phenomenon, mucocele.

Introduction Mucocele is defined as mucus-filled cavities, which can appear in the oral cavity, appendix, gallbladder, paranasal sinuses, and lacrimal sac. The term mucocele is derived from a Latin word, mucus and cocele means cavity. (1) (2) Mucocele is the 17th most common salivary gland lesions seen in the oral cavity (3) which result from accumulation of liquid or mucoid material due to the alteration in the minor salivary gland which causes limited swelling. It is characterized by a round, well-circumscribed, transparent swelling which is bluish tinged and is variable in size.

Mostly they are soft in consistency and fluctuate on palpation. It is usually painless and has the tendency to relapse.

Mucocele is subdivided into two types: 1. Mucus extravasation type, which is regarded as being a result of trauma, such as lip biting. 2. Mucus retention type, which results from the obstruction of the duct `of a minor and/or accessory salivary gland (1,4 & 5) Mucocele manifest within few days after minor trauma with diameter ranging from few millimeters to few centimeters, and persist unchanged for months unless it is treated. If not intervened, an episodic decrease and increase in size may be observed, based on rupture and subsequent mucin production.(1,6)

initially small in size and progressed to the present size and not associated with pain. Patient gives history of lower lip biting occasionally. On inspection, a soft tissue swelling measuring 2 X 2 cms noticed in the lower lip ( labial mucosa) in relation to 41 and 42. Mediolaterally extending from 41 till 42 and superioinferiorly 2 cms from the vermilion border to 2cm from the labial sulcus..

It is oval in shape, pink in colour, well defined and no surface changes noticed. On palpation, the inspectory findings such as borders and extent of the growth are confirmed. The swelling is soft and fluctuant and non tender on palpation.

Figure 1: Dome shaped translucent swelling on the lower lip

Case Report A 18 years female patient reported with the chief complaint of swelling in the lower lip for the past 6 months. Patient was apparently normal 6 months back after which she noticed a small swelling in the lower lip which was Journal of Scientific Dentistry, 8(1), 2018

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Mucocele –A Case Report

Grossing features Figure 2: Entire gross specimen measuring 1x1x1 cms grey in colour with lobulated surface.

Muthukumaran et al

Dense fibrous connective tissue resembling a capsule is also appreciated. Based on these findings and correlating with the clinical findings, the histopathopathology is diagnosed as Mucocele (Extravasation phenomena type) Figure 5: Low power view exhibiting the capsule, spillage of mucin and inflammatory cells

Figure 3: Cut surface appears translucent and pale in colour surrounded by capsule

Etiopathogenesis Microscopic features The microscopic features exhibited connective tissue with spilled mucin infiltrated with inflammatory cells such as lymphocytes and plasma cells. Adjacent minor salivary glands predominantly of serous type are also present.

Figure 4: Low power view exhibiting the spillage of mucin and minor salivary gland surrounded by fibrous capsule

There are two etiological factors proposed that is responsible in mucocele. One is trauma related (extravasation ) and other cause is obstruction of salivary gland ducts (retention). Extravasation mucoceles are caused by extravasation of fluid into the surrounding tissue from the ducts or acini and elicit inflammatory changes.The obstruction type may be due to salivary calculi that causes retention of the saliva hence dilation of the duct. Literature states that among the two types of 95% were extravasation and also it undergoes three evolutionary phases.

1. Mucous spills diffusely from the excretory duct into conjunctive tissues where some leucocytes and histiocytesare found.

2. Granulomas appear during the resorption phase due to histocytes, macrophages and giant multinucleated cells associated with a foreign body reaction.

3. Connective cells form a pseudo capsule without epithelium around the mucosa Discussion Mucoceles, of minor salivary gland origin,is on of the common mucosal lesion affecting the general population.

Trauma and obstruction to the salivary gland duct are the 8

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Mucocele –A Case Report

two main etiological factor responsible for the lesion. There are two types of mucocele which has different etiological factors, that are painless, asymptomatic swellings that have a relatively rapid onset enlarge and then appear to involute because of the rupture of the contents into the oral cavity or resorption of the extravasated mucus or retention of the mucin. The patient may relate a history of recent or remote trauma to the mouth or face, or the patient may have a habit of biting the lip. The duration of the lesion is usually 3-6 weeks; however, it may vary from a few days to several years in exceptional instances.(6,8) Often, an individual may rupture or un roof the vesicles by creating a suction pressure. In such situations the affected individuals reports a chronic and recurrent history.(6,7) There are few strong contributing factors that aids in the diagnosis of mucocele such as the appearance,clinical findings; consistency. Literatures suggest that lip biting is one of the common factor responsible that causes mucocele.The role of radiograph has minimal contribution, ruling out for any calcified structure such as sialolith would definitely contribute to the pathogenesis for the type of mucocele especially for the Retention type (9,10). Histopathologically the extravasated type is not lined by the epithelium (pseudo cyst) and in case of retention type (true cyst) it is lined by epithelium.

In our case report correlation of the clinical findings, history of lip biting and based on the histopathology the final diagnosis was in favour of Mucous extravasation phenomenon. Moreover positive findings of history of lip biting and histopathologically absence of epithelial lining and with the presence of spilled mucin and granulation tissue it was diagnosed as Mucocele of extravasation type.

Conventional surgical removal is the most common method used to treat this lesion. Other treatment options include CO2 laser ablation, cryosurgery, intralesional corticosteroid injection, micro marsupialization, marsupialization and electrocautery.(6,7,8) The importance

Address of Correspondence

R. Muthukumaran, Department of oral pathology and microbiology, Indira Gandhi Institute of Dental Sciences Email id: mthkumaran85@gmail.com Phone no: :(+91) 9042184953: 9962425379

Muthukumaran et al

of this article is clinically the lesion is mistaken for benign salivary gland tumors and salivary gland duct cyst that requires different treatment plan.

Conclusion Mucocele are mostly benign and self‑limiting nature, diagnosed based on clinical findings followed by definitive diagnosis based on the histopathological investigation.

Trauma and habitual lip biting is proposed to be one of etiological factors. Hence the importance of the lesion may be emphasised as a part of awareness as the lesion is common in general population.

References 1. Baurmash HD. Mucoceles and Ranulas. J Oral Maxillofac surg 2003; 61:369-78 2. Ozturk K,Yaman H, Arbag H,Koroglu D,Toy H. Submandibular Gland Mococele : Report of two cases. Oral Surg oral Med Oral Pathol Oral Radiol Endod 2005;100:732-5.

3. Flaitz CM,Hicks JM. Mucocele and Ranula.eMedicine ;2015.

4. Delbem AC,Cunha RF,Vieira AE,Ribeiro LL. Treatment of Mucous Retention Phenomenon in children by the Micro marsupilization technique ;case Reports. Pediatr Dent 2000; 22:155-8.

5. Porter SR,Scully CKainth B,Ward-Booth P.Multiple salivary Mucoceles in a Young boy. INT JPaediatr Dent 1998;8:149-51.

6. Ata-Ali J, Carrillo C, Bonet C, Balaguer J, Peñarrocha M, Peñarrocha M.Oral mucocele: review of the literature. J Clin Exp Dent.2010;2(1):e18-21.

7. Shafer’s Textbook of Oral Pathology. 2009. Sixth edition: 541542.

8. Neville, Damm, Allen, Bouquot. Oral and Maxillofacial pathology. 3rd edition. Page nos- 454- 456.

9. Nallasivam KU, Sudha BR. Oral mucocele: Review of literature and a case report.J Pharm Bioall Sci 2015;7:S731-3.

10. Yamasoba T, Tayama N, Syoji M, Fukuta M. Clinicostatistical study of lower lip mucoceles. Head Neck. 1990;12:316–20.

Authors Post Graduate Student, Department of Oral pathology and microbiology, Indira Gandhi Institute of Dental Sciences.

1

Professor and Head of the Department of Oral pathology and microbiology, Indira Gandhi Institute of Dental Sciences.

2

Reader in Department of Oral pathology and microbiology, Indira Gandhi Institute of Dental Sciences.

3,4

How to cite this article : R . Muthukumaran, A. Santha Devy , K.R. Premlal, S. Vidyalakshmi. Mucocele –A Case Report. Journal of Scientific Dentistry 2018;8(1):7-9 Source of support : Nil, Conflicts of Interest : None declared

Journal of Scientific Dentistry, 8(1), 2018

9

Case Report

Twinning in Primary Dentition – A Case Report Vinothini V1, Sanguida A2, Prathima G S3 ABSTRACT Twinning is usually asymptomatic and is associated with poor esthetics, caries, malocclusions, arch-length discrepancies, periodontal disease, hyperdontia or hypodontia of the permanent successors, and eruption abnormalities. The present case report describes the management of a carious necrotic twinned primary central incisor followed up for one year. Twinning anomaly is characterized by the presence of mirror image teeth.

Key Words: Dental anomalies, Gemination, Schizodontia

Introduction In 1963 Tannenbaum and Ailing defined gemination as the formation of the equivalent of two teeth from the same follicle, with evidence of an attempt of the tooth to separate, this indicated clinically by a groove or depression delineating the two components. Radiographically, there appears to be only one pulp chamber. They stated that in gemination, if the bifid tooth is counted as one entity, the total number of teeth in the dental arch is otherwise normal.1 The term schizodontia can be given if there is a complete splitting, which results in “twinning� leading to hyperdontia. Twinning is said to result in a mirror image teeth.2 Twinning is associated with poor esthetics, caries development, malocclusions, arch-length discrepancies and periodontal disease. It may also be associated with hyperdontia or hypodontia of the permanent successors and eruption abnormalities.3 This article describes the management of a carious twinned primary incisor in a child.

Figure 1: Frontal view showing germinated 51 with dental caries in mesial and distal components and sinus tract

Figure 2: Intraoral periapical radiograph showing separate roots for each component of the geminated crown of 51.

Case Report A 5 year old girl reported with a chief complaint of decayed tooth in upper front teeth region. Her medical history was not remarkable. On clinical examination tooth number 51 showed gemination and caries involving enamel and dentin in both the components of the double tooth. There was clinical pulp exposure in the mesial component and arrested caries in the distal component. The tooth was associated with a draining sinus tract (Figure 1). Intraoral periapical radiograph revealed presence of separate roots for the two components resulting in mirror image teeth. Permanent incisors did not show any anomalies (Figure 2). The caries in the mesial component of the twinned 51 appeared deep and hence it was decided to 10

Journal of Scientific Dentistry, 8(1), 2018

Twinning in Primary Dentition

perform pulpectomy for the mesial component first and restore the distal component with GIC and observe for the healing of sinus (Figure 3).The sinus tract persisted for more than one week after initiation of pulpectomy in the mesial component and hence pulpectomy was performed for the distal component also. After one week it was observed that the sinus was healing and canals were obturated with metapex and tooth restored with composite (Figure 4). The child’s mother preferred the double tooth to be restored as a single component. Figure 5 shows one year follow up in which no abnormalities were detected in relation to twinned 51.

Figure 3: Pulpectomy in mesial component of twinned 51

Figure 4: Obturation of both the root canals

Figure 5: Review after a year

Vinothini et al

Discussion In a study among 65 children with dental anomalies in a primary dentition, it was observed that double teeth were present in 75% of the cases in which 94% were fusion and 6% were geminated.4 Gemination is an anomaly in size, shape and structure of teeth and it occurs commonly in maxillary incisors (unilateral) and rarely in mandibular permanent central incisor.5 The terms gemination and twinning have been defined in the literature by various synonyms such as dichotomy, connation, double tooth, linking tooth, synodontia and schizodontia, mirror-image double tooth, fused teeth, and geminated composite odontoma. Although “twinning” is sometimes used as a synonym for gemination, it actually means complete cleavage of the tooth bud, resulting in the formation of an extra tooth that is usually a mirror image of its partner.3 The term “twinning” has also been used to designate the formation of equivalent structures by division resulting in one normal and one supernumerary tooth.6 The above presented case reported complete cleavage of the affected tooth resulting in mirror-image teeth.

Gemination occurs more frequently in the primary dentition than in the permanent dentition with no gender preference. The prevalence is around 0.5 percent in children and 0.1 percent in adults. A prevalence of 0.02 percent was found for bilateral twinning in both primary and permanent dentitions. The condition is seen primarily in the incisor and canine region although it can occur in the premolar and permanent molar areas as well.7 The anomalies of primary dentition are strongly associated with anomalies in the permanent dentition.3 In the present case no anomalies were associated with the permanent incisors. Yet, early diagnosis of the anomaly has a considerable importance and it should be followed by careful clinical and radiographic observations. The child in the present report should be followed up till the eruption of permanent incisors as there is a possibility of delayed exfoliation and interference with eruption of permanent incisor.

Conclusion Tooth shape anomalies in general dental practice may be rare, but the dentist should be aware of the nature of the problems encountered and the specific treatment needs. Carious involvement of double teeth should be treated promptly to avoid complications associated with endodontic treatment of such teeth. Early identification and proper follow-up of such cases is very important during the developing stages of the dentition.

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Twinning in Primary Dentition

Acknowledgement Nil

References 1. Tannenbaum KA, Ailing EE. Anomalous tooth development: case reports of gemination and twinning. Oral Med and Oral Path1963;16:883-7.

2. Schuurs AHB, Van Loveren C. Double teeth: review of the literature. J Dent Child 2000;67(5):313-25.

3. Sanguida A, Sangwan S, Mathur S, Dutta S. Schizodontia in primary dentition: Report of 2 cases. Indian J Dent 2012;3(2):102-5.

Address of Correspondence

Vinothini V, Department of Paedodontics and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences, Email id: vinothinibds@gmail.com Phone no: 8344545723

Vinothini et al 4. Nik-Hussein NN, Abdul Majid Z. Dental anomalies in the primary dentition: distribution and correlation with the permanent dentition. J Clin Pediatr Dent 1996;21(1):15-9.

5. Beltran V, Leiva C, Valdivia I, Cantin M, Fuentes R. Dental gemination in a permanent mandibular central incisor: an uncommon dental anomaly. Int J Odontostomat 2013;7(1):69-72.

6. Shafer, Hine, Levy. Developmental disturbances of oral and paraoral structures. In: A textbook of oral pathology. 4th ed.

Philadelphia, PA: W.B. Saunders Company; 1993. p. 38.

7. Oliver F, Michael W, John C. Bilateral twinning: report of case.

J Dent Child 1998;65(4):268-71.

Authors Post Graduate Student, Department of Paedodontics and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences.

1

Reader, Department of Paedodontics and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences.

2

Professor and Head of the Department, Department of Paedodontics and Preventive Dentistry, Indira Gandhi Institute of Dental Sciences.

3

How to cite this article : V inothini V, Sanguida A, Prathima G S. Twinning in Primary Dentition – A Case Report. Journal of Scientific Dentistry 2018;8(1):10-2 Source of support : Nil, Conflicts of Interest : None declared

12

Journal of Scientific Dentistry, 8(1), 2018

Technical Report

A Simplified Approach for Beading and Boxing Elastomeric Impressions Manoharan PS1, Anand V2, Arjun S3 ABSTRACT Beading and Boxing is performed to obtain the artistic portion of the cast. In an elastomeric impression for edentulous ridges, creation of a land area and base is crucial for a master cast. The techniques mentioned in the literature use plaster, plaster pumice mix, wax sheets, caulking compound, denture flask and play dough. Those techniques have their disadvantages being cumbersome, clumsy, time consuming and demand for skill and dexterity. Presented below is a modification of an existing technique by Vyas A et al [2011]. The new technique does not need addition of extra wax for securing the beading wax. It is rapid, neat and easy to learn and can be adopted for zinc-oxide eugenol impressions.

Key Words: beading, boxing, edentulous-impressions, land-area, artistic-portion of cast.

Beading and Boxing is performed to develop the artistic portion of the cast. Most of the techniques mentioned in the past are time consuming, require additional skill and dexterity.1 Some need additional time to finish the cast and are clumsy which make the simplicity of the technique questionable2. Other methods in the literature Figure 1: Application of cyanoacrylate adhesive

THE PROCEDURE 1. Apply cyanoacrylate adhesive or tray adhesive, on the surface of the elastomeric impression material 2-3mm below the sulcus depth, where beading has to be carried out. Care is taken, so that the adhesive does not contact with the skin or gloves.

Wait for 10 -15 seconds.

2. Mix the base and catalyst of the putty elastomer and adapt it over the adhesive with thumb, index and the forefinger as shown in the figure, so that the width of the beaded area is approximately 3-4mm. Adhesive application and putty beading can be done in sections along the border of the impression as shown in Figure 2 Figure 2: Adaptation of putty over the adhesive

have used materials such as wax1, plaster and pumice2, caulking compound and paddle3, fast setting irreversible hydrocolloid4, denture flasks5, Solvite material [H J Bosworth Co., Chicago, III]6 and plaster.7 Presented below is a simple technique that can be followed for elastomeric impression materials. This is a modification of an existing technique8 that uses beading and boxing wax. The modified technique involves a neat and rapid method using elastomer putty to develop the land and base of the cast, which can be accomplished in 5- 8 minutes with minimal or no use of wax.

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A Simplified Approach for Beading and Boxing Elastomeric Impressions

3. After beading the entire border of the maxillary and mandibular impression, the tongue space of the mandibular impression is closed by using a used radiographic film or transparency sheet, which is cut according to the space and adhered using the cyanoacrylate adhesive. If radiographic film is difficult to adapt you can use stapler pins over the putty and use utility wax, modeling wax for the tongue space as it adapts well to the curves as shown in the Figure 3.

Manoharan et al

Figure 4: Boxing with radiographic film

Figure 3: Tongue space closure

6. The same method can also be adopted for zincoxide eugenol impression.

7. Now the beaded and boxed impression is ready for pouring the cast. Note that the retrieved casts require minimal finishing as shown in Figure 5.

Figure 5: Master casts

4. The edges of the putty beading can be trimmed to refine using a sharp scalpel.

5. Cut a radiographic film or a transparency sheet for the desired length to be used for the boxing of the impression. Apply the above mentioned adhesive along the beaded edges and adapt the boxing film or sheet and hold it under pressure with rubber bands till it is adhered as shown in Figure 4.

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A Simplified Approach for Beading and Boxing Elastomeric Impressions

Manoharan et al

References

5. Powter RG, Hope M. A Method of Boxing Impressions: J Prosthet Dent 1981;45(2):224-5.

1. Hickey JC, Zarb CA, Bolender CL. Boucher’s Prosthodontic Treatment for Edentulous Patients. 9th ed. St. Louis: CV Mosby, 1985:218-20.

6. Groove HF, Broering LF. Impression Boxing and Cast Pouring: J Prostheti Dent 1980;43:112-15.

2. Dexter W S, Moore D J. A new, clean and inexpensive boxing procedure: J Prosthet Dent 1995;73:496-8.

3. Rudd KD, Morrow RM,Seldman EE. Dental Laboratory Procedures. Vol I: Complete Dentures. 2nd ed. St. Louis: CV Mosby, 1986: 57-79.

7. Bolouri A, Hilger TG, Gowrylok MD. Boxing Impressions. J Prosthet Dent 1975;33:692-5.

8. Vyas A, Maru K, Bali S K, Jain S, Shukla J, Kataria N. A New Simplified Beading and Boxing Procedure for Elastic Impression: J Indian Prosthodont Soc . 2011;11(1):52–54.

4. Stipho HD. Boxing Impressions with Irreversible Hydrocolloids.

J Prosthet Dent 1985;53:740-1.

Address of Correspondence

Manoharan P S, Professor and Head, Department of Prosthodontics and Crown & Bridge, Indira Gandhi Institute of Dental Sciences, Email id: manodent_2000@yahoo.com Phone no: +91 9865019673

Authors Professor and Head, Department of Prosthodontics and Crown & Bridge, Indira Gandhi Institute of Dental Sciences.

1

Post Graduates, Department of Prosthodontics and Crown & Bridge, Indira Gandhi Institute of Dental Sciences.

2,3

How to cite this article : M anoharan P S, Anand V, Arjun S. A Simplified Approach for Beading and Boxing Elastomeric Impressions. Journal of Scientific Dentistry 2018;8(1):13-5 Source of support : Nil, Conflicts of Interest : None declared

Journal of Scientific Dentistry, 8(1), 2018

15

Review Article

Effectiveness of Tacrolimus over Triamcinolone Acetonide in The Treatment of Oral Lichen Planus Ashna Mariya Benny1, S.Laxmipriya2, Vezhavendhan .N3 ABSTRACT Aim: The aim of the review article was to compare the efficacy of topical Tacrolimus ointment with that of Triamcinolone acetonide ointment on patients suffering from oral lichen planus.

Materials and method: A review study was done to analyse the efficacy of topical Tacrolimus ointment with that of Triamcinolone acetonide ointment on patients suffering from oral lichen planus. Over 5 articles were referred from Pubmed and Google database meeting our eligibility criteria (August 2006 - December 2016). A total of 240 patients who were clinically diagnosed with Oral Lichen Planus from a total of 5 studies with 3 randomized control trials and 2 clinical trials were included for this review.

Result: Tacrolimus belongs to macrolide family and is caused by streptomycin tukubaensis. It inhibits the activation and proliferation of T-lymphocytes by inhibiting the phosphatase activity of calcineurin. The articles used for the review conclude that the application of Topical Tacrolimus helps in the alleviation of all clinical symptoms in over 80% of the patients under study.

Key words: Tacrolimus, Triamcinolone acetonide, oral lichen planus

Introduction Oral Lichen Planus (OLP) is a chronic inflammatory, non-infectious, muco-cutaneous disease characterised by a cellular inflammatory infiltrate enriched in CD4+ cells, by the presence of acidophilic bodies that may represent apoptotic epithelial cells and by vacuolating degeneration of the basal epithelial layer. This disease affects 0.5 – 2% of the population and has a female predilection (4:1). It occurs in six different forms ranging from lacy white streaks to white plaques to eroded ulcers. The white lesions are painless while eroded ones elicit burning sensation and soreness. The reticular, atrophic/ erosive and plaque type are symptomatic which appears on buccal mucosa, tongue, gingiva, palate, lips and retromolar pad area. OLP is characterised histopathologically by variable epithelial thickness, basal cell destruction, and a band like infiltrate of mononuclear cells in the lamina propria.

Although the pathogenesis of Oral Lichen Planus is still an area of active investigation, it is well documented that OLP represents the cell mediated immune response with the infiltrating cell population composed of both T4 and T8 lymphocytes. There is no curative treatment for OLP. Therapy is aimed at alleviation of symptoms and consists generally of topical corticosteroids. Systemic corticosteroids are not preferred due to their adverse effects.

16

The treatment of symptomatic OLP is challenging.

Various drugs such as corticosteroids cyclosporine, retinoids, grisofulvin, dapsone and hydroxyl-chloroquine have been used alone or in combination orally,parentally or topically. Recently topical tacrolimus was reported effective in a number of pilot studies. Tacrolimus belongs to macrolide family and is caused by Streptomycin tukubaensis. It inhibits the activation and proliferation of T-lymphocytes by inhibiting the phosphatase activity of calcineurin. The purpose of this review article is to compare the efficacy of tacrolimus 0.1% with triamcinolone acetonide 0.1%in the treatment of OLP.

Methodology The following sources were searched from August 2006 to December 2016, in Pubmed and Google database.

The keywords that were used are oral lichen planus, triamcinolone acetonide, tacrolimus and corticosteroid therapy. The primary focus of this search were clinical trials and randomised control trials which used corticosteroids namely tacrolimus and triamcinolone acetonide in the treatment of Oral Lichen Planus (OLP). The outcome of all the studies showed improvement in the clinical signs like soreness and regression of lesion in 3-4 weeks.

Journal of Scientific Dentistry, 8(1), 2018

Effectiveness of Tacrolimus over Triamcinolone Acetonide in the Treatment of Oral Lichen Planus

Results This review article was compiled using 5 studies that met the selection criteria (3 randomised control trials and 2 clinical trial) for assessing the efficacy of tacrolimus over triamcinolone acetonide in the treatment of OLP. 4 studies compared tacrolimus (study group) with triamcinolone acetonide (control group) and one study compared tacrolimus with triamcinolone acetonide and placebo group. 220 patients were divided into the study and control groups and 40 patients were divided into study, control and placebo groups. The parameters evaluated were the clinical signs(area of erythema, ulceration and white striation) and adverse effects. Study and control group were administered 0.1% topical tacrolimus in orabase and 0.1% triamcinolone acetonide in orabase respectively, 4 times a day for a mean duration of 3 weeks to 3 months.The lesion was clinically graded by a 6 score scale and their pain was assessed using visual analogue scale (VAS). The scale used for the analysis of the efficiency of drugs were done by the student paired t-test, fisher’s exact test and exact ᵡ2 trend test. The Kruskal – Wallis sample test was used for the analysis of the pain severity scores. On an average, 73% of the study population showed improvement of clinical signs and the pain severity in study and control group was 8.2 and 7.8 at the beginning of treatment, and 3.5 and 3.2 at the treatment respectively. There was statistically significant reduction in pain severity in both groups.

Tacrolimus also proved to have better therapeutic results when compared to the placebo group over a period of 9 weeks. Tacrolimus is available in concentration of 0.1% and 0.03%, however the formulation of 0.1% was found to be more effective. Adverse effects like burning sensation at the site of application of ointment, transient taste disturbance and hyperpigmentation was noticed in the study group. Recurrence of lesions were also noticed in the study and control groups over several weeks after cessation of treatment.The data obtained from reviewing the articles were statistically significant in proving that topical Tacrolimus showed better therapeutic effects as compared to topical Triamcinolone acetonide.

Discussion Oral Lichen Planus (OLP) is a chronic, autoimmune, mucocutaneous disease. It can affect the oral mucosa, skin, genital mucosa, scalp and nails. The clinical history confirms the relationship between OLP and oral cancer, although the degree of the risk involved is controversial.

Therefore, OLP should be considered a precancerous lesion, emphasizing the importance of periodic followups in all the patients. Oral Lichen Planus (OLP) is characterised by burning sensation, painful, thickened Journal of Scientific Dentistry, 8(1), 2018

Ashna Mariya Benny et al

patches on the tongue, inflammation of tongue and erosive or ulcerative lesions in cases of symptomatic OLP. Various treatment modalities have been elucidated to alleviate the symptoms of OLP, although a definitive cure has not yet been found. This article reviews the efficacy of topical tacrolimus with topical triamcinolone acetonide in the treatment of OLP. Cell mediated immunity seems to play a critical role in the pathogenesis of lichen planus. Although the specific antigens, responsible for the activation of T-cells has not been identified, studies have demonstrated the interaction of T-cells and mast cells in a cyclical nature via the production of cytokines, such as RANTES (regulated on activation, normal T-cell, and Secreted) and TNF-α, which may explain the chronic nature of the disease. Investigations have demonstrated the production of RANTES and the presence of specific RANTES receptors such as CCR1. This suggests that RANTES, CCR1 and TNFα may be involved in the accumulation of inflammatory cells in OLP. Tacrolimus belongs to macolide family and is caused by the streptomycin tukubaensis. It was initially used to prevent solid organ allograft rejection while topical formulations of tacrolimus were developed for the use of atopic dermatitis. The pharmacological actions of tacrolimus is similar to cyclosporine although it penetrates deeply in the mucosa, in this form it is said to be 10-100 times more potent. It suppresses T- cell activation by binding to cytosolic FK-binding protein which in turn interferes with calcium/ calmodulin. This ultimately results in the inhibition of cytokine gene transcription including interleukin 2 and TNF-α.Very recently there have been topical tacrolimus in concentration of 0.1%, 0.3% and 0.03% in orabase. The formulation of 0.1% is found to be more effective.

Triamcinolone acetonide on the other hand is a synthetic corticosteroid. It is 8 times as effective as prednisone and there were few side effects like skin redness, burning and itching. The efficacy of Triamcinolone acetonide is mainly due to local anti-inflammatory properties of suppressing T cell function.

In the studies done in 2006 and in October – December 2012, during the follow-up evaluation 40% of patients treated with tacrolimus revealed side effects like burning sensation at the site of application, transient taste disturbance, intermittent headaches and melanin pigmentation at the site of the lesion indicating the healing phase of LP. Maximum incidence of pigmentation was seen in patients with erosive LP. The fact is substantiated 17

Effectiveness of Tacrolimus over Triamcinolone Acetonide in the Treatment of Oral Lichen Planus

by increased melanocytic activity at the basement membrane during the healing and post-healing phase.

All the studies concluded that treatment with topical tacrolimus 0.1% ointment four times daily induced a better initial therapeutic response than triamcinolone acetonide 0.1% ointment in patients with symptomatic OLP. However relapses occurred frequently in both groups within several weeks after cessation of both the treatments. Prolonged or intermittent use of topical tacrolimus ointment in patients with symptomatic OLP may be useful, but remains to be clearly established in large, well designed clinical studies. Nonetheless, at present, topical tacrolimus may be a valuable addition to the already existing therapeutic modalities for treating patients with OLP.

Conclusion Treatment of symptomatic oral lichen planus remains a challenging problem. Various treatment modalities have been tried including topical and systemic steroid, retinoids, immunosuppressive drugs, surgery, lasers and photochemotherapy. According to the studies reviewed, topical tacrolimus ointment is safe, well tolerated and effective therapy for OLP recalcitrant to traditional

Address of Correspondence

Ashna Mariya Benny, CRRI, Indira Gandhi Institute of Dental Sciences.

Email id: ashnamariyabenny@gmail.com Phone no: 8754014511

Ashna Mariya Benny et al

therapies and may be used for those cases which are resistant to conventional treatment. It may be a valuable addition to the already existing therapeutic modalities for treating patients suffering from OLP. However this drug has only the palliative effect and not the curative one.

References 1. Manjunatha M Revanappa, Venkatesh G Naikmasur, Atul P Satt. Evaluation of Efficacy of Tacrolimus 0.1% in Orabase and Triamcinolone Acetonide 0.1% in Orabase in the Management of Symptomatic Oral Lichen Planus Randomized Single Blind Control Study. Journal of Indian Academy of Oral Medicine and Radiology. 2012;24(4):269-27.

2. Ronald Laeijendecker, Bhupendra Tank, Sybren K. Dekker and H. A. Martino Neumann.A Comparison of Treatment of Oral Lichen Planus with Topical Tacrolimus and Triamcinolone Acetonide Ointment.Acta Derm Venerol 2006;86:227-229.

3. Arash azizi, shirin lawaf . The comparison of efficacy of adcortyl ointment and topical tacrolimus in treatment of erosive oral lichen planus. J Dent Res Dent Clin Dent , 2007;1(3):99-102.

4. Javed a qazi. Treatment of oral lichen planus with topical Tacrolimus and triamcinolone acetonide ointment - a comparative study. Pakistan oral & dental journal 2010;30:19-21.

5. M Spionen L Huuskonen, Skallio-Pulllinen, Pnieminen, T Salo.

Topical tacrolimus, triamcinolone acetonide, and placebo in oral lichen planus: a pilot randomized controlled trial.Oral Dis2017 Jul;23(5):660-668.

Authors CRRI, Indira Gandhi Institute of Dental Sciences,

1,2

Professor, Department of Oral Pathology, Indira Gandhi Institute of Dental Sciences.

3

How to cite this article : A shna Mariya Benny, S. Laxmipriya, Vezhavendhan. N. Effectiveness of Tacrolimus over Triamcinolone Acetonide in the Treatment of Oral Lichen Planus. Journal of Scientific Dentistry 2018;8(1):16-8 Source of support : Nil, Conflicts of Interest : None declared

18

Journal of Scientific Dentistry, 8(1), 2018

Review Article

Pentoxifylline Therapy in the Management of Oral Submucous Fibrosis – A Review Khaaviya.N1, Fahmitha Parveen .S2, Vezhavendhan .N3, Sivaramakrishnan .M4 ABSTRACT Aim: Oral sub mucous fibrosis is a high risk pre malignant condition predominantly seen in the Indian subcontinent. The aim of the study was to review the effect of Pentoxifylline on the clinical and pathologic course of OSMF. Material and methods: A review study was done to analyse the efficacy of Pentoxifylline in the treatment of OSMF. We searched over PubMed and Google database for studies meeting our eligibility criteria (august 2006 to July 2017). A total of 270 patients who were clinically diagnosed as OSMF from a total of 6 studies with one meta-analyses, 2 randomized control trial, three clinical trials were included for this review.

Results: Pentoxifylline is a methyxanthine derivative, which showed considerable improvement in mouth opening, tongue protrusion, difficulty in speech and swallowing. The total symptom score improved by 85.8% in Pentoxifylline. Dexamethasone and Pentoxifylline showed significant mouth opening and reduction in burning sensation.

Conclusion: Pentoxifylline can bring about significant improvement in all clinical signs of maximal mouth opening, tongue protrusion, burning sensation thereby improving the quality of life. Conflicting to the above findings, one randomized clinical trial showed no significant advancement in burning sensation, mouth opening, tongue protrusion.

Introduction Oral sub-mucous fibrosis is a premalignant condition of the oral cavity and oropharynx seen predominantly in the Southeast Asian countries and in the Indian sub- continent.

The pathophysiology of this condition is complex, and various factors such as, ingestion of spicy food, genetic susceptibility, nutritional deficiencies, altered salivary constituents, autoimmunity and collagen disorders are thought to be involved in the pathogenesis. The alkaloids and tannins of areca nut have been proved to induce the chronic inflammation in the mucosa trigger the fibrogenetic reaction. The condition is preceded by burning sensation of the oral cavity, vesicles, ulceration and pain.

It is characterized by blanching and depigmentation of the oral mucosa, reduced movement and depapillation of tongue and progressive reduction of mouth opening.

Nasal twang due to fibrosis of nasopharynx and hearing impairment due to stenosis of Eustachian tube may be observed in advanced stages of the condition4.

Pentoxifylline is a tri-substituted methyl xanthine derivative, with numerous biologic activities including vasodilation, anti- inflammatory, immune-modulatory, fibrinolytic property. It is termed as a "rheologic modifier."

It improves microcirculation and decreases aggregation of platelet as well as granulocyte adhesion. It increases leukocyte deformability as well as inhibits neutrophil adhesion and activation3. It increases production of Journal of Scientific Dentistry, 8(1), 2018

prostaglandin E2 and prostaglandin I2 by vascular epithelium and maintain cellular integrity and homeostasis after acute injury. In addition, it causes degranulation of neutrophils, promotes natural killer cell activity and inhibits T-cell and B-cell activation. Pentoxifylline has also shown a direct effect on inhibiting burn scar fibroblasts4.

The present review was carried out to analyse the efficacy of Pentoxifylline in the management of OSMF.

Material And Methods The following sources were searched from august 2006 to July 2017: PubMed, Google database. The following keywords were used, oral sub mucous fibrosis and treatment, Pentoxifylline, dexamethasone, local heat therapy and multivitamin tablets. The primary focus of this search was meta-analysis1, randomized control trials which used Pentoxifylline in the treatment of OSMF. clinical trials without randomization and other experimental studies were considered. The outcome measures used were improvement in symptoms and signs of OSMF like ulceration, burning sensation, blanching and trismus.

Results 6 studies that met the selection criteria (one meta-analyses, 2 randomized control trial, three clinical trials were 19

Pentoxifylline Therapy in the Management of Oral Submucous Fibrosis – A Review

included for this review with a total of 270 patients. One meta-analyses, analysed the efficacy of Pentoxifylline in the treatment of OSMF. Four studies compared the efficacy of placebo, multivitamin tablet, dexamethasone and local heat therapy with Pentoxifylline.

Discussion Oral sub mucous fibrosis is a chronic progressive scarring oral disease which is common in patients chewing areca nut in Indian subcontinent. It is a common premalignant condition affecting the oral mucosa. It is characterized by progressive build-up of constricting bands of collagen in the cheek and the adjacent structures of mouth, oropharynx which can severely restrict mouth opening, tongue movements as well as it causes problems with speech and swallowing5. Treatment of OSMF is based on severity of the disease, various treatment modalities have been elucidated to alleviate symptoms and signs associated with OSMF. If the disease is noted prior to the development of trismus, cessation of the betel habit will often resolve the objective signs and subjective symptoms. once trismus have been developed the goal of the therapy is to maintain the oral function and also to limit the progression of the disease5. As OSMF is a chronic mucosal inflammatory disease, control of the inflammation or the factors contributing the inflammatory tissue reaction should form the basis of definitive management. Combination of drugs such as steroids, human placental extracts, hyaluronidase, chymotrypsin, collagenase, Pentoxifylline, iron and multivitamin supplements including lycopene have been used. Laser ablation and surgery which includes the cutting of fibrous bands of the jaw muscles and TMJ have been used for more extreme cases5. However, the present review analysed the meta-analysis, randomized controlled trial, as well as clinical trial providing additional insight of the trials so that the types of interventions needed can be evaluated with the evidence.

Pentoxifylline is an anti-inflammatory, vasodilating, immune-modulatory, fibrinolytic drug. The pharmacokinetics of Pentoxifylline is that, it is almost completely observed after oral administration, 400mg releases short peak plasma Pentoxifylline concentrate 2- 3 hrs post administration. It is extensively metabolised.

Active main metabolite 1 (5-hydroxy),3,7, (dimethylxanthine) is measurable in twice the concentration in plasma of that of its parent substance. It is eliminated by kidneys. The pharmacodynamics is that it improves capillary blood flow by increasing erythrocyte flexibility and reducing blood viscosity.

20

Khaaviya et al

Pentoxifylline increases the production of prostaglandins (specifically E2 & I2) by vascular epithelium which is important in maintaining cellular integrity and haemostasis after acute injury4. The degree of vascularity of the diseased mucosa in OSMF as well as a matter of dispute, Pentoxifylline improves red blood cell membrane deformability by increasing the amount of membrane adenosine tri phosphate. It also alters red blood cell membrane, protein phosphorylation patterns, increases protein kinase activity and decreases calcium 2+ - dependant k+ efflux6 which promotes vasodilating property. Its immunomodulatory actions3 include increase in leucocyte adhesion. It also neutrophil degranulation and the release of peroxides, promotes natural killer cell activity and the production of tumour necrosis factor and inhibits T and B cell activation. The results of experimental studies7 have shown that fibroblast cultured in the presence of Pentoxifylline produced twice as much collagenase activity and decreased amounts of collagen, glycosaminoglycan’s, and fibronectin. Interleukin-1 – induced fibroblast proliferation is also inhibited by Pentoxifylline which promotes fibrinolytic property.

Most side effects caused by Pentoxifylline involve the gastro intestinal tract and central nervous system. The most frequent gastro intestinal complaints include nausea, vomiting, bloating, flatus and bleeding. The overall incidence of adverse effects was higher in patients who received Pentoxifylline in capsule forms than in those who received commercially available sustained release tablets which showed slow drug delivery and minimize gastric intolerance2,3,4,5,6. Their side effects are dose related and can be minimized by dose reduction.

Pentoxifylline 400mg twice daily, used for 3 months showed considerable improvement in mouth opening, tongue protrusion, difficulty in speech and swallowing, when compared to placebo in OSMF patients. Significant improvement was noticed when Pentoxifylline administrated 400mg twice daily for a period of 3 months and later hiked to 3 times daily for a period of 6-7 months4,5. Long- term 7 months Pentoxifylline therapy showed significant improvement in mouth opening, reduction of burning sensation, intolerance to spicy food, reduction in anterior and perioral fibrotic bands when compared to multivitamin therapy and local heat therapy but with no significant improvement in tongue protrusion and fibrotic bands in the posterior buccal mucosa and bands in the junction of hard and soft palate3.

The total symptom score improved by 85.8% in Pentoxifylline and 38.2% in multivitamin group.

Pentoxifylline therapy also showed significant Journal of Scientific Dentistry, 8(1), 2018

Pentoxifylline Therapy in the Management of Oral Submucous Fibrosis – A Review

Khaaviya et al

improvement in inter-incisal mouth opening and reduction in burning sensation when compared to standard intralesion combination treatment regime of dexamethasone, lignocaine, hyaluronidase injection6. Intra- lesion injection is painful and sometimes intolerable to the patients with high dropout ratio. Meta- analysis, on the effect of Pentoxifylline showed maximum benefit when used for longer duration of more than one month with statistically significant improvement in the signs and symptoms of OSMF.

effects in the patients who were administered the drug.

Pentoxifylline can be used as promising alternative treatment modalities to intra-leisional steroid for the treatment of OSMF.

Contradictory to the above findings, one randomized clinical trial showed no improvement in burning sensation, mouth opening, tongue protrusion and histopathological parameters like microvascular density, severity of fibrosis and inflammatory components but significant improvement noticed in the average area percentage occupied by blood vessels and this highlighting finding might be due to vasodilating property of Pentoxifylline2.

2. Namdeo prabhu, Sanjay s rao, S M kotrashetti, Shridhar D Baliga, Seema R Hallikerimath, Punnya V Angadi and Rakhi Issrani. Pentoxifylline in patients with oral submucous fibrosis- A randomized clinical trial. J Maxillofacial Oral Surg.2013;14(1)81-89.

Conclusion Treatment of OSMF has been a challenge ever since the evolution of the disease. Newer drugs have been persistently evolving for the management of this complex disease. Pentoxifylline can bring about significant clinical improvements in the symptoms like mouth opening and tongue protrusion on long term usage (7 months), thereby improving the quality of life of the affected individuals.

Even though Pentoxifylline does show vasodilation at the histological level, clinical improvement is at par with other drugs and local therapies used which showed no significant improvements over the short term usage of Pentoxifyl line2. However, it has been shown few side

Address of Correspondence

Khaaviya .N, CRRI, Indira Gandhi Institute of Dental Sciences, Email id: kaviyanedumaran@gmail.com Phone no: 9566613070

References 1. Liu J, Chen F, Wei Z, Qiu M, Li Z, Dan H, Chen Q, Jiang L. Evaluating the efficacy of pentoxifylline in the treatment of oral submucous fibrosis: A meta-analysis. Oral Dis. 2018;24(5):706716.

3. Rajendran R, Rani V, Shaikh S. Pentoxifylline therapy : A new adjunct in the treatment of oral submucous fibrosis. Indian J Dent Res [serial online] 2006 [cited 2019 Jan 22];17:190-8.

4. Santhosh patil, Sneha Maheswari. Efficacy of pentoxifylline in the management of oral submucous fibrosis. Journal of orofacial sciences vol:6 2014: 94-98.

5. Patil S, Maheshwari S. Effi cacy of pentoxifylline in the management of oral submucous fi brosis. J Orofac Sci 2014;6:94-8.

6. Ravi Mehrotra, HP Singh, SC Gupta, M Singh, S Jain. Pentoxifylline therapy in the management of oral submucous fibrosis. Asian pacific journal of cancer prevention 2011;12(4):971-74.

7. Jayachandran Sadaksharam, Sureshkumar Mahalingam.

Pentoxifylline therapy: Evaluation of oral pentoxifylline in the management of oral submucous fibrosis – An ultrasonographic study.Contemp Clin Dent. 2017 Apr-Jun; 8(2): 200–204.

8. Berman B, Wietzerbin J, Sancean J et al: Pentoxifylline inhibits certain constitutive and tumor necrosis factor-a induced activities of human normal dermal fibroblasts, J Invest Dermatol 98: 70612,1992.

Authors CRRI, Indira Gandhi Institute of Dental Sciences.

1,2

Professor, Department of Oral pathology, Indira Gandhi Institute of Dental Sciences.

3

Senior lecturer, Department of Oral pathology, Indira Gandhi Institute of Dental Sciences.

4

How to cite this article : K haaviya.N, Fahmitha Parveen .S, Vezhavendhan .N, Sivaramakrishnan .M. Pentoxifylline Therapy in the Management of Oral Submucous Fibrosis - A Review. Journal of Scientific Dentistry 2018;8(1):19-21 Source of support : Nil, Conflicts of Interest : None declared

Journal of Scientific Dentistry, 8(1), 2018

21

Review Article

Topical Honey Application for Treatment of Herpes Labialis: A Review Fathimuthu Johara .A1, Elsie Sunitha Ebenezer2, Vezhavendan3, Suganya4 ABSTRACT Introduction: Cold sores – herpes labialis infects 90% of people worldwide, of whom only 30% will experience recurrent herpes labialis, which can last up to 10 days. The common treatment protocol for treating herpes labialis is antiviral drugs.

Honey is readily available home remedy, herbal and biocompatible extract with antibacterial, antiviral & immune stimulatory effects. The present review is focussed to analyse the efficacy of topical application of honey in treating herpes labialis.

Methods And Analysis: The primary focus of the search was on randomised control trail of honey versus acyclovir in the treatment of herpes labialis. The randomised control trail, clinical trials without randomization and other experimental studies were considered.

Discussion: Honey is found to have antiviral properties, which is used in the treatment of herpes labialis. The component called NO (nitric oxide) has antiviral property. Reduction in signs and symptoms of herpetic lesions by honey application is due to inhibition of prostaglandin at lesion site.

Conclusion: It is concluded that the mean duration healing time of honey is little lesser than acyclovir with the time period of 3-4 days. Pain reduction is comparable with acyclovir and acceptability of honey is good.

Key Words: Herpes Labialis, Acyclovir, Honey.

Introduction Herpes labialis is also known as cold sores or fever blisters, primarily affects the lip, caused by herpes simplex virus1 (HSV-1). HSV-1 belongs to herpeviridae family, contains 9 types of viruses that are harmful for humans (HSV-1, HSV-2, varicella zoster virus, cytomegalovirus, Epstein Barr virus, HHV-6, HHV-7, simian herpes virus B). Of all manifestation of herpes labialis, stage 3 and 4 blisters and ulcers are painful, which are going to produce more discomfort for the patient. The existing line of treatment for herpes includes pain control, supportive care & definitive treatment1. 2% viscous lidocaine, liquid diphenhydramine, 0.1% didonine hydrochloride, benxydaimine, analgesic is used for pain control. Hydration, ice chips or popsicles, soft bland diet, antipyretics as supportive care and Definitive treatment: antiviral medication like topical acyclovir 5% cream (6 times per day for 10 days), 3% pencicloyir cream, oral acyclovir tablet 400mg TDS-10 days, severe cases IV 5mg per kg infused over 1 hour kept for 8 hourly for 10 days. Valacyclovir prodrug of acyclovir has 3-5 times the bioavailability of acyclovir.

Acyclovir inhibits viral replication and is activated by virally produce thymidine kinase1.

The adverse effects of antiviral drugs are tingling and burning sensation in each application. When orally taken 22

causes headache, nausea, malaise & CNS manifestation (tremors, lethargy, disorientation, hallucinations, convulsions & coma in higher doses). In IV line causes rashes, sweating, emesis and fall in Blood pressure.

Ayurvedic products like honey, aloe Vera, curcumin (turmeric) were used for herpes labialis infection with less adverse effect1.

Honey is readily available home remedy, inexpensive, herbal and biocompatible with fewer side effects. Honey has antibacterial, antiviral and immune stimulatory effects. There are different types of honey with varying composition. The kanuka honey was brought into the eyes of the world with tremendous advantages. The present review has carried out to analyse the efficacy of topical application of honey in herpes labialis.2

Materials And Methods The following sources were searched from 2004 to 2017 PUBMED and Google database, to explore the role of honey in comparison of acyclovir in treating herpes labialis. The following key words were used herpes labialis, acyclovir and honey. The primary focus of the search was on randomised control trail of honey versus acyclovir in the treatment of herpes labialis. The randomised control trail, non-randomised clinical trials Journal of Scientific Dentistry, 8(1), 2018

Topical Honey Application for Treatment of Herpes Labialis: A Review

without randomization and other experimental studies were considered. The outcome measures used were improvement in signs and symptoms of herpes labialis like pain, ulcer healing time.

Discussion Honey is the nectar collected by honey bees, is a sweet natural gift of nature4. It is used as food and medicine for treatment of various systemic diseases. Honey is found to have antiviral properties, which is used in the treatment of herpes labialis.5 The component called NO (nitric oxide) has antiviral property against RNA and DNA of several viruses.

Many drugs are available for treating herpes simplex virus, including foscavir, famciclovir, Valacyclovir and acyclovir1.

Though topical acyclovir ointment has poor penetration, the intravenous and oral forms decrease both healing time and viral shedding1. In addition, acyclovir has been used to supress recurrence of genital herpes. It has been known that acyclovir inhibits viral enzyme DNA polymerase. Though acyclovir is a safe drug, it may induce nephrotoxicity and neurotoxicity. Honey was used as an alternative treatment to manage recurrent episodes of herpetic lesions5.

Honey And Its Types Honey is comprised of water, sugar, amino acids, enzymes, Vitamins, minerals, flavonoids, phenolic acids, ascorbic acid, carotenoid-like substances, organic acids and several other compounds. D-fructose and D-glucose are the predominant sugars; sucrose occasionally exceeds 1 % of the total sugar content while maltose may be found at levels three times higher than that of sucrose4.

The mineral fraction of honey is mainly composed of potassium and smaller amounts of magnesium, sodium, calcium, phosphorous, iron, manganese, cobalt and copper.

Enzymes such as invertase, amylase, catalase and glucose oxidase are also present. Proline is the major amino acid constituent comprising about half the content of total free amino acids4. The beneficial role of honey is attributed to its antibacterial property with regards to its high osmolality, acidity (low pH) and content of hydrogen peroxide and nonperoxide components i.e., the presence of phytochemical components like methylglyoxal (MGO). Most types of honey generate Hydrogen peroxide, which thus attributes the antimicrobial activity. But the peroxide activity in honey can be destroyed easily by heat or the presence of catalase4.

Honey is collected from different geographical location has its own unique properties. Raw honey can be sourced from any plant, but it is unique in that it hasn’t undergone any heat processing before it is sold, resulting in a ‘raw’ or uncooked product with bioactive Journal of Scientific Dentistry, 8(1), 2018

Fathimuthu Johara et al

compounds. Kanuka honey is derived from the flower pollen of kunzeaericoides is found along north and south island of New Zealand. The bee’s native to the area where the kanuka trees flower help in extracting the nectar and producing the honey. The kanuka honey contains an ingredient called arabinogalactan protein (type 2) this component acts as antiviral, as they are present in the nectar of kanuka flowers.

Manuka honey is derived from plant leptospermum scoparium; these trees are found in New Zealand. The key ingredient of Manuka honey is methylglyoxal that gives antibacterial property; it is heat stable in order to express the total antibacterial property, it is given a score called unique Manuka factor (UMF) score to indicate its antibacterial potency.

Recently it was identified as nitric oxide (NO) metabolites, nitrite and nitrate in various honeys. It is known that NO is an important active molecule that plays a role in host defence against bacteria, protozoa and tumour cells.

NO has antiviral effects against DNA and RNA of several viruses. NO may inhibit herpes simplex virus ocular lesion5.

Prostaglandin is the immune mediators for simulating recurrent herpes labialis. It involves HSV- 1&2 infections by supressing the T- Cell function allowing for clinical recurrence. Prostaglandin increases adhesion between cells infected with herpes cells and uninfected cells5. They are potent immune suppressive agents lower in antibody titre in thymus dependent and thymus independent during primary & secondary immune responses. Prostaglandins are mediators for pain and inflammation. Honey lowers prostaglandin concentration in various biological fluids such as plasma and urine5. Therefore reduction in signs and symptoms of herpetic lesions by honey application is due to inhibition of prostaglandin at lesion site5.

Two randomized clinical trial and one non randomized clinical trial estimated the efficacy of honey in recurrent herpes labialis. Two randomized control trail compared 5% acyclovir and honey, primary outcome is healing time and secondary outcome is pain acceptability of the intervention. The mean duration of healing of acyclovir is 5 days and honey is little lesser than acyclovir with the time period of 3 – 4 days. Pain reduction is comparable with acyclovir and acceptability of honey is good with visual mean analogue scale score of 81.92.

Duration of pain, occurrence of crust and mean healing time with honey treatment were better than with acyclovir. Symptoms of pain tingling and burning were reduced and resolved completely within 24 hrs. With the use of acyclovir, no pain relief was seen in first 24 hrs.

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Topical Honey Application for Treatment of Herpes Labialis: A Review

No side effects were encounter with repeated application of honey, and the patients reported greater satisfaction with honey application than with acyclovir treatment4.

Antimicrobial Activity The enzymatic glucose oxidation reaction and its physical properties plays important factors in antimicrobial activity. Other factors include high osmotic pressure, low pH (acidic environment), low protein content, high carbon to nitrogen ratio and low redox potential due to the high content of reducing sugars.

Honey is a supersaturated sugar solution which has low water activity to support the growth of bacteria and yeast. The natural acidity pH of honey will inhibit many pathogens. The minimum pH value for some infected wounds ranges from 4.0 - 4.5. Glucose oxidase is an enzyme secreted by the bees, which converts glucose in the presence of water and oxygen to gluconic acid and hydrogen peroxide. The resulting acidity and hydrogen peroxide preserve and sterilize the honey.

Transition ions and ascorbic acids rapidly decompose hydrogen peroxide to oxygen and water. Dilution of honey results in a 2,500 - 50,000 increase in enzyme activity, not all honey are created equal in antimicrobial activity due to differences in levels of peroxide and non – peroxide production4.

Antibacterial Activity The antibacterial activity of honey is associated with the release of hydrogen peroxide, from oxidation of glucose to glucolactone and then to gluconic acid in presence of the enzyme glucose oxidase. Manuka honey which has been demonstrated to be effective against several human pathogens like E. coli, Methicillin resistant staphylococcus aureus, beta haemolytic streptococci and enterococci4.

Address of Correspondence

Fathimuthu Johara .A, CRRI, Indira Gandhi Institute of Dental Sciences, Email id: fmjohara96@gmail.com Phone no: 9566802561

Fathimuthu Johara et al

Antiviral Activity The antiviral property of honey is exerted by flavonoids such as chrysin which has inhibitory effects against HSV-1. Apigenin is an antiviral substance against HSV-2. Experiments performed on monkey kidney cell culture infected with the rubella virus shows anti – rubella activity. Important flavonoids of honey such as chrysin, acacetin and Apigenin can even inhibit the human immunodeficiency virus (HIV-1) activation via inhibition of viral transcription4.

Conclusion Based on the search underwent from different resources we conclude that the mean duration healing time of acyclovir is 5 days and honey is little lesser than acyclovir with the time period of 3 – 4 days. Pain reduction is comparable with acyclovir and acceptability of honey is good. Further Randomised clinical control trails study with large sample may strongly support the efficacy of honey in treating Herpes labialis.

Reference 1. Burket, Lester W, Martin S G, Michael G. 2003. Burket's Oral Medicine: Diagnosis & Treatment. Hamilton, Ont: BC Decker.

2. James F, Andrew C, Davit S, Nicola C, Irene B, Mark W, Richard B. Randomized Controlled Trail of Topical Kanuka Honey For The Treatment of Cold Sores. Science direct .2014;1(3):119-123.

3. Alex Semprini, Joseph Singer, Nicholas Shortt, Irene Braithwaite, Richard Beasley. Protocol for a randomised controlled trial of 90% kanuka honey versus 5% aciclovir for the treatment of herpes simplex labialis in the community setting. BMJ Open 2017;e017766.doi:10.1136/bmjopen-017017766.

4. P. Saranraj, S. Sivasakthi and Glaucio Dire Feliciano.

Pharmacology of Honey: A Review. Advances in Biological Research.2016; 10 (4): 271-289.

5. Noori S. Al-Waili.Topical honey application vs. acyclovir for the treatment of recurrent herpes simplex lesions.Med Sci Monit.2004;10(8):94-98.

6. Sally A El–Haddad and maysara D . Al-Shawaf. Effects of honey for treatment of some common oral lesions: follow up of 50 cases.

Journal of dentistry and oral hygiene 2013;5(6).55-61.

Authors CRRI, Indira Gandhi Institute of Dental Sciences.

1,2

Professor, Department of Oral pathology, Indira Gandhi Institute of Dental Sciences.

3

Reader, Department of Oral pathology, Indira Gandhi Institute of Dental Sciences.

4

How to cite this article : F athimuthu Johara .A, Elsie Sunitha Ebenezer, Vezhavendan, Suganya. Topical Honey Application for Treatment of Herpes Labialis: A Review. Journal of Scientific Dentistry 2018;8(1):22-4 Source of support : Nil, Conflicts of Interest : None declared

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Journal of Scientific Dentistry, 8(1), 2018

Workshop on Cadavers in Reconstructive Maxillofacial Surgery

Hands on Workshop on Cadavers in Reconstructive Maxillofacial Surgery was held on 10.11.2017 at MGMCRI ground floor, lecture hall. It was jointly organized by department of Oral and Maxillofacial Surgery, IGIDS, Department of Anatomy and Department of Plastic Surgery, MGMCRI. Invited speaker Dr. Srinivasa R. Chandra (Clinical Assistant Professor, OMFS, University of NEBRASKA, USA) delivered lecture on oral oncology and planning in reconstruction and conducted HANDS-ON workghop in harvesting various free and pedicle flaps.

JOURNAL OF SCIENTIFIC DENTISTRY Web site: http://igids.ac.in/jsd/jsdindex.html

 CONTENTS Journal of Scientific Dentistry, Volume 8, Issue 1

From the Editor’s desk

Saravanakumar. R

1

R. J. Shobana priya, R. Palanivel pandian, Sangeeta Chavan, K.S. Premkumar, S. Shrimathi, K. Umesh

2

Mucocele –A Case Report

R. Muthukumaran, A. Santha Devy, K.R. Premlal, S. Vidyalakshmi.

7

Twinning in Primary Dentition – A Case Report

Vinothini V, Sanguida A, Prathima G S

10

Manoharan PS, Anand V, Arjun S

13

Effectiveness of Tacrolimus over Triamcinolone Acetonide in The Treatment of Oral Lichen Planus

Ashna Mariya Benny, Laxmipriya .S, Vezhavendhan. N

16

Pentoxifylline Therapy in the Management of Oral Submucous Fibrosis – A Review

Khaaviya.N, Fahmitha Parveen .S, Vezhavendhan .N, Sivaramakrishnan .M

19

Topical Honey Application for Treatment of Herpes Labialis: A Review

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22

 Original Article Dentistry by Volition or by Happenstance – A Questionnaire Study

 Case Report

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 Review Article