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Narayana Dental Journal Vol I Issue 1.pdf Final 1 PDF
Narayana Dental Journal Vol I Issue 1.pdf Final 1 PDF
Official Journal of
NARAYANA DENTAL COLLEGEEGE & HOSPITAL
Narayana Medical Campus, Chinthareddypalem, Nellore--524003, Andhra Pradesh, India.
Phone: +91-861-2313841
+91 Ext.2802; Fax: +91-861--2305092; +919490471078
email: dentkan1@gmail.com, ndc2001@gmail.com
Narayana Journal of
Research in Dental
Specialties
Editorial
Editorial Advisory Boards
ICMJE Recommendations
Original articles
Nellore.
Lavanya Dalasari, Natarajan Kannan, Rakesh Kumar Manne, Prathi Venkata Sarath,
Swapna Sreedevi Beeraka, .Koliparthi Venkata Suneel
Morphology in Adults
Sonika Priyadarshan, Ashutosh Shetty, Vivek Bhaskar, U.S. Krishna Nayak
Case Reports
Review Articles
The Narayana Journal of Research in Dental Specialties (NAJORDS) aims to provide platform for publication of
original research papers in all dental specialties.
Topics intended to be covered include the management of oral mucosal diseases, periodontal diseases, pulpal
diseases, all types of restorative dental treatments, dental biomaterials science, clinical trials including
epidemiology and oral health, new scientific instrumentation or procedures, as well as clinically relevant oral
biology and translational research.
Narayana Journal of Research in Dental Specialties (NAJORDS) is a peer-reviewed, journal that publishes original
research articles, review articles, and clinical studies in all areas of dentistry, including Periodontal diseases, Dental
Implants, Oral Medicine, Maxillofacial Radiology, Orthodontics, Oral Pathology, Pedodontia, Prosthodontics, Public
Health Dentistry and Oral and Maxillofacial Surgery.
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the authors, the editors, nor the publisher can be deemed to be legally responsible for any errors or omissions in
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1 1
Lavanya Dalasari Post graduate student
2 2
Natarajan Kannan Professor and Head
3 3
Rakesh Kumar Manne Reader
4 4
Prathi Venkata Sarath Reader
5 5
Swapna Sreedevi Beeraka Reader
6 6
Koliparthi Venkata Suneel Reader
1-6
Department of Oral Medicine and Radiology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh.
ABSTRACT:. Antibiotic are one of the most commonly prescribed medications by dentists all over the world. These are
usually prescribed for prophylactic or therapeutic purpose. Occasionally these are prescribed for therapeutic diagnosis.
Pharmacology is studied extensively by dentists in the second year of the B.D.S. and this knowledge is expected to be used
by them during their clinical postings in the later years of graduation and their clinical practice. The guidelines get modified
as a result of advancements in knowledge and advent of newer antibiotics. This study was intended to assess the levels of
awareness and updated knowledge regarding prescription of antibiotics among dental practitioners. The study revealed
considerable gaps between ideal and actual antibiotic prescription due to lack of appropriate knowledge updates.
Incorporation of guidelines for mandatory updating of knowledge for renewal of licence to practice would help in correcting
the anomaly and ensure proper antibiotic prescriptions.
INTRODUCTION
1
In India, the oral care infrastructure includes prescription of prophylactic antibiotics. The aim of our
1,80,000 dentists as of 2012, serving over one billion study is to determine the Antibiotic prescribing practices
12
population. These dentists are an important personnel, for Dental diseases & to Evaluate the knowledge on
other than the medical practitioners, who use the LIFE prescription of Prophylactic antibiotics among Dental
SAVING DRUGS (The Antibiotics) in their day to day Practitioners in Nellore, Andhra Pradesh, India.
practice for therapeutic and prophylactic purposes.
Scientific literature evidence suggests that dentists MATERIALS AND METHODS
prescribe around 7-11% of common antibiotics (beta
lactams, macrolides, tetracycline, clindamycin, A questionnaire was designed to assess dental
7
metronidazole). Studies revealed that 15% of the dentists practitioners knowledge of prescribing antibiotics both
5
prescribe antibiotics on a daily basis. therapeutically, and prophylactically for their patients. The
proposed study was reviewed by the ethical committee of
The Irrational use of antibiotics will lead to an the institution and clearance was obtained. A specially
increased burden on the patient and the society by prepared format exclusively designed for recording all the
increasing treatment costs, adverse events and also the required relevant general information and information
10
risk of development of resistant bacterial species. In the related to antibiotic prescribing patterns was used as a
past 10 years, the incidence of penicillin resistance in tool for data collection.Voluntary, written informed consent
odontogenic infections in the UK has increased from 5% to was obtained from each dentist who participated in this
9
55%. Antibiotic abuse has already been considered as a study. The questionnaire was tested on a small group of
pandemic community issue by World Health Organization dentists by conducting a pilot study, to check the feasibility
18
(WHO). So WHO announced the theme for the year and applicability. After the pilot study, necessary
2011 as Antibiotic resistance: No action today, No cure corrections were made and the questionnaire was
7
tomorrow and has pressed for an international action. finalized. The interviewer, in person carried the
questionnaire to the respective clinics and dental
Keeping all the problems of lack of knowledge on practitioners marked the answers of their choice.
the use of antibiotics based on previous studies showing
2-5
inappropriate use of antibiotics by dentists, over Criteria for inclusion in the study were dentists having a
The third part of the questionnaire included The most commonly used antibiotic was
questions regarding the safe drugs to be prescribed in Amoxycillin in agreement with the study conducted by
1 3 4
pregnant and lactating patients. The last part of the Palmer et al. , Skucaite et al. , Vessal et al. , Antonio
5 7 9
questionnaire included questions regarding cardiac et.al. , Karibasappa et.al. , kuriyama et al. , Palmer et
22
conditions that need antibiotics prophylactically, and the al. . Amoxycillin + Clavulanic Acid has a broader
dental procedures that needed the prescription of spectrum of activity with lesser risk of development of
prophylactic antibiotics. bacterial resistance but can be given for a shorter duration
3
of time. Some studies show they are being commonly
All questions had space to mark a tick and used as they are effective against most of the oral
1,7
choose the answers. There were single options and 4 microbes.
questions were given with multiple options as All the
Above / option 2 and 3 as required. The duration of antibiotics in our study was
considered as 5 days by 48% and as 3 days by 46% of the
All returned forms were coded by a single dental practitioners. It is a subject of ongoing debate as
operator and the data were checked and entered twice in shorter courses of antibiotics might aggravate the alarming
4
a personal computer. Blank or multiple answers were all problem of antibiotic resistance. There are few countries
treated as missing values. Only single unequivocal replies that prescribe for 5 days in order to eliminate the
5
were included in calculating percentages. infection. In recent years, more attention has been given
32
to short courses. Patients are reported to be partly
32-35
benefitted after 2 or 3 days of antibiotic therapy. There
RESULTS are several advantages of short course therapy: increased
convenience, improved compliance, and improved
12,36
A total of 109 questionnaires were administered tolerability. Antibiotics should be used aggressively
to dental practitioners in Nellore. The questionnaires which and for as short period as is compatible with remission of
37
were incomplete were 8 in number and they were the disease. The ideal antibiotic duration is the shortest
excluded from the study. The age of the dental time that will prevent both clinical and microbiological
practitioners ranged from 25yrs. to 40yrs.Amongst all the relapse.
participants, 73% had only private practice and 27% were
attached to an educational institution and also had a private There were a total of 86% of dental practitioners
practice. 47% had a post graduate qualification while 53% who prescribed Antibiotics if needed in pregnancy & 69%
had a graduation. The demographic details of gender are of dental practitioners who prescribed in the lactating
given in the table-I mothers. Amoxycillin is one of the safest drug in them
26,27
belonging to category B in pregnancy and is safe in
28
DISCUSSION lactating mothers. Pregnant women are usually given
medication doses and schedules identical to those of non
29
The use of antibiotics can never be a substitute pregnant adults. This study 35% dental practitioners use
1
for good surgical and septic operative techniques. The the regular dosage of antibiotics in pregnancy But some
unsystematic prescribing of antibiotics by health care suggest to keep the dosage at the lower end of the regular
28
professionals is a major factor to be considered. Evidence range of drug .
of the inappropriate use of antibiotics in dentistry has
increased and this could lead to the problem of The most common antibiotic used for pulpal
4
antimicrobial resistance. diseases observed in our study was amoxycillin +
clavulanic acid (47%) followed by amoxicillin(44%), while
Vol. I Issue 2 Jul - Dec 2015 2
Original articles Narayana Journal of Research in Dental Specialties
Amoxicillin + Amoxicillin +
Most commonly Amoxicillin 38% Ofloxacin 11%
Clavulanic acid Metronidazole
prescribed Antibiotic
34% 17%
Modification of Drug
Increase the The same dose
dose based on the
dose 43% 57%
Physical Build
Prescription of
Routinely prescribed Avoid
Antibiotics in
86% antibiotics14%
Pregnancy
Safest Antibiotic in
Amoxycillin 50% Cephalosporins 5% Erythromycin 3%
pregnancy
Prescription of
Antibiotics in Routinely prescribed Avoid antibiotics
Lactating mothers 69% 31%
Safest antibiotic in
Amoxycillin 50% Erythromycin 3% Cephalosporins 3%
Lactating mothers
All are safe 13%
Contraindicated
Cephalosporins
antibiotics in Ciprofloxacin 38% Both of them 29%
43%
lactating mothers
Most commonly
prescribed Amoxycillin + Amoxycillin +
Amoxycillin 44%
Antibiotic in pulpal Clavulanic acid 47% Metronidazole 9%
diseases
Allergic to
Penicillin in pulpal Azithromycin 9% Cephalosporins11%
Erythromycin 76% Clindamycin 4%
diseases
Most commonly
prescribed Amoxycillin + Metronidazole 16%
Antibiotic in 32% Amoxycillin + Metronidazole 20% Clavulanic acid + Amoxycillin +
periodontal Clavulanic acid Metronidazole 19% Metronidazole13%
diseases
Allergic to
penicillin in
Erythromycin 56% Clindamycin 19% Cephalosporins 7%
periodontal Azithromycin 18%
diseases
Table .6. Awareness of Prophylactic Antibiotics for Dental patients with Cardiac Diseases
Awareness on the cardiac Dental practitioners Unaware 94% Dental practitioners Aware 6%
conditions that need antibiotic
prophylaxis
Dental Procedures that require Dental practitioners Aware 84% Dental practitioners Unaware 16%
prophylaxis
23
Antibiotics are commonly prescribed by the Antibiotic therapy is an art and a science. There
4,7
dental practitioners for space infections. Amoxycillin was are so many confounding variables, such as suspected
4
the most commonly prescribed antibiotic. In case of pathogen, ability to establish drainage, pharmacokinetic
allergy to penicillin, Clindamycin was most commonly properties of the drug, mechanism of action of the
prescribed but some dental practitioners tended to antibiotic, virulence of the infection, the current health
4
prescribe erythromycin in case of allergy to penicillins. status of the host, and host defense mechanisms, that it is
not possible to make antibiotic therapy into a mechanistic
24
There is inadequate knowledge on the cardiac technologic science. The most important decision for the
conditions that require antibiotic prophylaxis as per the dental practitioner to make is not which antibiotic to use
5
recent American Heart association 2015 with 94% being but whether to use one at all. Trends of antibiotic
unaware & 6% being aware in agreement with Palmer et consumption should be monitored and recommendations
1 3
al. , for antibiotic therapy should be updated periodically. .
Introducing guidelines and re-auditing after a few years
The need for development on programs on would be an important step in implementing rational
appropriate use of antibiotics against odontogenic antibiotic use. Public needs to be educated at mass level
infections as there is poor understanding on use of against self-medication with antibiotics and about
2
Antibiotics in dental practice as per Palmer et al. The completing the entire course of antibiotics which will help
most important decision for the dental practitioner to make us in curbing antibiotic resistance to a greater extent.
is not which antibiotic to use but whether to use one at
23
all. When the decision is made to use an antibiotic, it is REFERENCES
important to adhere to basic principles of antibiotic dosing:
(a) use high doses for short durations; (b) use an oral 1. N. A. O. Palmer, R. Pealing ; A study of prophylactic
antibiotic loading dose; (c) achieve blood levels of the antibiotic prescribing in National Health Service
antibiotic at 2 to 8 times the minimum inhibitory concentration; general dental practice in England ; British Dental
(d) use frequent dosing intervals; and (e) determine duration Journal, Vol 189, No. 1, July 8 2000
of therapy by remission of disease (8). The use of antibiotics 2. N. A. O. Palmer , M.V. Martin ; Antibiotic prescribing
for minor infections, or in some cases in patients without knowledge of National Health Service General dental
infections, could be a major contributor to the world problem practitioners in England and Scotland ; Journal of
23
of antimicrobial resistance. Antimicrobial Chemotherapy , 47, 2001
The limitations of our study are the presence of 3. Neringa Skuait , Vytaut Peiulien ; Antibiotic
20-25 questions in order to avoid a lengthy questionnaire prescription for treatment of endodontic pathology ;
which tried to cover the common dental diseases but did Medicina (Kaunas) 2010;46(12):806-13
not specifically cover every possible infection. 4. G. Vessal A. Khabiri ; Study of antibiotic prescribing
among dental practitioners in Shiraz, Islamic
It is recommended that knowledge of antibiotics Republic of Iran ; Eastern Mediterranean Health
should be integrated with teaching about infections for Journal ; Vol. 17 No. 10 , 2011.
2
which they are used. As there is overuse of antibiotics 5. Antonio Rodriguez-Nunez , Rafael Cisneros-
especially prophylactics antibiotics before surgical Cabello ; Antibiotic Use by Members of the Spanish
1
procedures as per Palmer et al. , poor prescribing Endodontic Society ; Journal of Endodontics ;
30
knowledge amongst students in some dental colleges. Volume 35, Number 9, September 2009
More use of antibiotics for all the dental procedure except 6. Dr. Karibasappa G.N, Dr.Sujatha A ; Antibiotic
7
orthodontic treatment as per karibasappa et al. The Resistance A Concern for Dentists? ; Journal of
increasingly inappropriate prescription of antibiotics by Dental and Medical Sciences; Vol 13, Issue 2 Ver.
1,22,23,25
dental practitioners which is contributing to IV. Feb. 2014
.1,3,4
antibiotic resistance in the population The overuse 7. N. A. O. Palmer, Y. M. Dailey ; Can audit improve
can be due to patients insistence on being prescribed antibiotic prescribing in general dental practice?
antibiotics for all conditions, even when uncertain about British Dental Journal; vol 191 no. 5 september 8
22
diagnosis , high workload among busy practitioners and 2001
3,5
lack of sufficient time allocation to a patient. There is a 8. T. Kuriyama,E. G. Absi ; An outcome audit of the
clear need to re evaluate the teaching of antibiotic usage treatment of acute dentoalveolar infection: impact of
to undergraduates to see that better guidelines are put into penicillin resistance ; British Dental Journal ; vol 198
2,4,22
practice. There is a need to conduct more number no. 12 june 25 2005
CDE Programmes that will enhance the recent updates on
Vol. I Issue 2 Jul - Dec 2015 5
Original articles Narayana Journal of Research in Dental Specialties
9. T. Kuriyama, E. G. Absi ; An outcome audit of the 25. An Investigation of antibiotic prescribing by general
treatment of acute dentoalveolar infection: impact of Dental practitioners : A pilot study : Prime Dental
penicillin resistance ; British Dental Journal ; vol 198 caries : 1997 J 11- 14 UKTIS ; Amoxicillin ; July
no. 12 june 25 2005 2012. Version: 2
10. Dr. Akilesh Ramasamy ; A review of use of 26. Krista et.al ; Antibacterial medication use during
antibiotics in dentistry and recommendations for pregnancy and risk of Birth defects ;Nov 2 , 2009 ,
rational antibiotic usage by dentists ; The vol 163 , No.11
International Arabic Journal of Antimicrobial agents ; 27. Benjamin Bar-Oz, Mordechai Bulkowstein ; Use of
Vol. 4 No. 2:1 2014. Antibiotic and Analgesic Drugs during Lactation ;
11. The Attitudes of Dentists Towards the Prescription Drug Safety ; Nov 2003, Vol 26, Issue 13, pp 925-
of Antibiotics During Endodontic Treatment in North 935 Nov 2012
of Saudi Arabia ; Journal of Clinical and Diagnostic 28. Joanne Cono, Janet D. Cragan ; Prophylaxis and
Research. 2015 May, Vol-9(5) Treatment of Pregnant Women for Emerging
12. Healthcare and Dental Industry in India Infections and Bioterrorism Emergencies ; Emerging
13. Ankita Jain, Dara John Bhaskar ; Drug prescription Infectious Diseases ; Vol. 12, No. 11, Nov 2006
awareness among the 3rd year and final year dental 29. Shivayogi Charantimath, Angel Dutta : Evaluating
students: A crosssectional survey ; Journal of knowledge, attitude among the interns from two
Indian Association Of Public Health Dentistry ; Vol. institution in belgaum district towards antibiotics ;
13, Issue 1, January-March 2015. international journal of pharmacology and
14. K. Pavan Kumar, Mamta Kaushik ; Antibiotic therapeutics ; Vol 3 Issue 3
Prescribing Habits of Dental Surgeons in
Hyderabad City, India, for Pulpal and Periapical
Pathologies: A Survey ; Advances in Corresponding Author
Pharmacological Sciences ; Vol : 2013
15. Characteristics and Cost Impact of Severe
Odontogenic Infections ; Dispatch May/June 2013
16. Shivayogi Charantimath, Angel Dutta ; Evaluating Dr. Lavanya Dalasari
Knowledge, Attitude among the interns from two Postgraduate student
institution in Belgaum district towards antibiotics ; Department of Oral Medicine and
International journal of Pharmacology and Radiology,
Therapeutic ; Vol 3 Issue 3 2013.
Narayana Dental College and
17. Rafael Poveda Roda 1, Jos Vicente Bagn ;
Antibiotic use in dental practice. A review ; Med Oral Hospital,
Path Oral Cir Bucal 2007; 12: Nellore, Andhra Pradesh
18. WHOs first global report on antibiotic resistance India-524003
reveals serious, worldwide threat to public health ;
30 April 2014 | Geneva
19. SR Goud, L Nagesh ; Are we eliminating cures with
antibiotic abuse? A study among dentists ; Nigerian
Journal of Clinical Practice Apr-Jun 2012 Vol 15
Issue 2
20. Steven Schwartz ; Commonly Prescribed
Medications in Pediatric Dentistry ; Continuing
Education Course, Dec 13, 2012
21. How are odontogenic infections best managed? ;
JCDA 2010 , Vol. 76, No. 2
22. N. A. O. Palmer,R. Pealing ; A study of therapeutic
antibiotic prescribing in National Health Service
general dental practice in England ; British Dental
Journal, Vol 188, NO. 10, May 2000
23. N. A. O. Palmer, R. Pealing : A study of therapeutic
antibiotic prescribing in National Health Service
general dental practice in England ; British Dental
Journal, Vol 188, No. 10, May 27 2000.
24. Nicole M. Yingling, B. Ellen Byrne ; Antibiotic Use
by Members of the American Association of
Endodontists in the Year 2000: Report of a National
Survey ; Journal of Endodontics ; Vol. 28, No. 5,
May 2002.
ABSTRACT:. Oral cancer is one of the most serious health problems faced by the mankind today. In India,
genetic, cultural, ethnic, geographic factors and the prevalence of a myriad of addictive habits, causes the
frequency of oral cancer to be high. The stage at which oral cancer is diagnosed is a major determinant of
mortality and morbidity following treatment. Early detection is the single most critical intervention influencing
survival.Dental and ENT professionals do commonly come across these PMDs in their practice. Literature on
KAP of PMDs among ENT professionals is sparse and no single survey has been reported in pub med
search till today. The present study intends to evaluate KAP of ENT professionals for early diagnosis and
appropriate treatment of PMDs. Knowledge and opinions related to PMDs were determined by means of a
cross sectional study of a probability sample of ENT surgeons in Nellore district. A 32-item questionnaire was
constructed from items previously tested for validity and new ones unique to this survey. The survey was self-
administered, voluntary and anonymous. The survey had questions in four major categories consisting of (4)
demographic questions, (22) on knowledge of PMDs & (6) on attitude & practice of ENT professionals
towards oral (mucosal) potentially malignant disorders. The entire data was tabulated & subjected to multi
variable statistical analysis.
INTRODUCTION
precancers, precursor lesions, or premalignant
Oral pharyngeal cancer constitutes the most life- lesions. Potentially malignant disorders (PMD) of oral
threatening of all dental and craniofacial conditions. cavity were classified as lesions and conditions by
The U.S. five-year survival rate of 52 percent for WHO in 1978.1 It was considered that in lesions, the
these cancers is one of the lowest and has not cancer would correspond with the site of PMD. On the
changed in decades. An estimated 32,000 new cases other hand, in conditions, cancer may arise in any
are diagnosed annually. In addition, more than 8,000 anatomical site of the oral cavity. It is now known that
deaths are attributable to oral cancer each year. even the clinically normal appearing mucosa in
When it is detected early, the likelihood of survival is patients harbouring a precancerous lesion may have
remarkably better than that for many other cancers. dysplasia on the contra lateral anatomic site or
Oral cancer presents with high mortality rates & the molecular aberrations in other oral mucosal sites
likelihood of survival is remarkably better when suggestive of a pathway to malignant transformation,
detected early. Ninety percent of cancers of the oral and that cancer could subsequently arise in
cavity are squamous cell carcinomas (SCCs) arising apparently normal tissue. Hence, the current Working
from the mucosal lining. The other 10 percent of oral Group (WHO) does not favour such subdivisions and
cancers are malignant melanomas, salivary gland refers to all the clinical presentations that carry the
tumors, sarcomas of the soft tissues or jaw bones, risk of oral squamous cell carcinoma (OSCC) as
non Hodgkins lymphomas, or metastases from extra- potentially malignant disorders.PMDs are oral
oral primary tumors. Most oral cancer is preceded by lesions that include leukoplakia, erythroplakia, lesions
visible premalignant lesions. Since not all of the palate from reverse smoking (placing the
premalignant lesions progress to cancer, the World lighted end of a cigarette in the mouth), sub mucous
Health Organization recommends classifying them as fibrosis, and actinic keratosis (with potential for lip
potentially malignant disorders (PMDs), rather than cancer). Whether lichen planus and discoid lupus
1 Type of service/practice
A. Public. B. Private. C. Teaching institution
2 Place of service/practice
A. Urban. B. Rural C. Teaching institution
3 Age/Gender: __________
e. What are the most common potentially malignant disorders you come across?
6 Which are the following disorders / factors do you think can carry some risk and/or predispose oral mucosa to
develop squamous cell carcinoma?
a. Old age (Above 70 years) A. Yes B. No C. Dont know
b. Low socioeconomic status A. Yes B. No C. Dont know
c. Specific blood group (ABO blood grouping) A. Yes B. No C. Dont know
If yes, a. Group A. b. Group B c. Group AB d. Group O
CONCLUSION
1-4
Department of Orthodontics, AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka
ABSTRACT:. Introduction: Craniofacial morphology is influenced by many factors, and understanding the
relationship between tongue posture and skeletal structures is vital to understand the growth and development of
the face. This study aims to assess the relationship between length of lingual frenum and the resultant
craniofacial morphology. Methods: One hundred and eight South Indian patients were included in the study and
divided into 3 groups: Group-1: thirty six patients with Class I skeletal relationship, Group-2: thirty six patients
with Class II skeletal relationship, Group-3: thirty six patients with Class III skeletal relationship on the basis of
their ANB angle. The lingual frenum was measured with a direct and indirect method and correlated with
cephalometric readings. Results:The median lingual frenulum length was significantly longer in the skeletal
Class III subjects when compared with the skeletal Class I and Class II subjects. The maximum opening of the
mouth was significantly reduced in the skeletalClass III subjects compared with Class I and Class II subjects.
Significant positive correlations were also found among the MLFL & MMOR, and the cephalometric variables
such as the SNB, Wits appraisal, mandibular length, and negative correlation with ANB and interincisal angle.
Conclusion: The present study supports the hypothesis that skeletal Class III malocclusion is related to long
median lingual frenulum oral tongue-tie tendency. Patients with tongue tie might have a tendency toward skeletal
Class III malocclusion.
INTRODUCTION
the cells undergo apoptosis during the
The relationship between tongue posture development of the tongue. Tongue tie or
and skeletal structures of the face is an essential Ankyloglossia could occur at this stage of
element in understanding the growth and programmed cell death if there are any
development of craniofacial structures, the disturbances. This is an inborn abnormality, in
etiology of malocclusions, and the prediction of which the lingual frenum attaches the ventral
stability after orthodontic treatment. The teeth surface of the tongue to the floor of the mouth.
and alveolus are packed in the middle of the This results in restriction of the frenulum length,
buccal mucosa, lips and the tongue and an which causes malocclusion, speech defects and
equilibrium among these is present, for (912)
breast feeding problems.
(1-2)
preservation of the position of the dentition. It
has been suggested that concurrence between Previous literature focused more on the
the genetic elements and the soft tissues improper tongue posture and effects of tongue
organization in the oral and facial region as a tie .However there wasnt any much literature on
(3, 4, 5)
cause of malocclusion. the influence of the lingual frenulum in relation to
(4-6)
dentoalveolar anomalies.
The fibro-mucosal fold that connects the
under surface of the tongue and the mucosa of Studies show that improper tongue posture
(8)
oral pavement is called lingual frenum. Lingual and variable frenulum length lead to various
frenulum withdraws away from the tongue tip as malocclusions. So the purpose of this study was
Vol. I Issue 1 Jan - Jun 2015 13
Original Articles Narayana Journal of Research in Dental Specialties
to find out the relationship between the length of The measurements made by this
the lingual frenulum and craniofacial method were taken using a lingual
morphology and to test the hypothesis that frenulum ruler , having a resolution of
skeletal Class III malocclusion is related to
0.01 mm, a nominal capacity of 150 mm
tongue-tie, which presents with short lingual
frenulum is short and restricts the mobility of the (Hebich Technical Training Institute [
(16) HTTI ] , Mangalore ,Karnataka
tongue.
The isthmus of the ruler was fully
inserted into the patients oral cavity
MATERIALS AND METHODS and the other end of the lingual
frenulum ruler touching on the lower
SOURCE OF DATA
incisors in order to measure the median
One hundred and eight South Indian patients lingual frenulum length.
visiting the Dept. of Orthodontics and This measurement is representative of
Dentofacial Orthopaedics, A. B. Shetty the maximum lingual frenulum length in
Memorial Institute of Dental Sciences, the center of the tongue-tie.
Mangalore for Orthodontic treatment were
In order to reduce the error caused due
included in the study. The patients were divided
into 3 groups: to pressure of the hand while taking
measurement , lingual frenulum length
INCLUSIVE CRITERIA FOR SAMPLE was recorded with the ruler touching on
SELECTION the soft tissue as lightly as possible.
On the basis of ANB angle, patients were Maximum mouth opening reduction
categorised into three groups. The first group (INDIRECT METHOD):
o
was the skeletal Class I group in which ANB is
o o o o A digital caliper (Aero Space - Digital
greater than 0 and lesser than 4 (0 <ANB<4 ),
second group was the skeletal Class II group Caliper ) was used to measure the
o o
where in ANB is greater than 4 (ANB angle > maximum mouth opening.
o
4 ), and the third group was the skeletal Class The patient was asked to open his or
o is o
III group where in ANB less than 0 (ANB her mouth as widely as possible and
o
angle<0 ) and each group has 36 patients. the caliper was positioned so that its
extremities will be in contact with the
EXCLUSIVECRITERIA FOR SAMPLE
SELECTION incisal margins of the maxillary central
incisor and the mandibular homolateral
Previous lingual frenectomy, Previous central incisor. This measurement is
orthodontic treatment, Previous orthognathic considered as T1.
surgery, Disorders of the temporomandibular The patient were requested to put the
joint and jaw-muscle.
tip of the tongue on the incisive papilla
METHODOLOGY maintaining it on that point and to open
the mouth again to the maximum gap
The purpose and methodology of the study and the measurement thus taken is
were explained to the subjects. 108 patients considered as T2.
satisfying the above criteria were selected The reduced amount of maximum
irrespective of their sex.
mouth opening was then calculated by
In this study the length of the lingual frenum the difference of the 2 measurements
was measured using two methods; first method (T1- T2).
being the Direct Method and second method
being the indirect method.
.
FIG 1- Armamentarium used in the study. FIG 2. The lingual frenulum length
Median lingual frenulum ruler. measured by using median lingual
frenulum ruler
Cephalometric analysis:
RESULTS
1. The lateral cephalograms was taken in
habitual occlusion by using a The students unpaired t test revealed no
genderdifference for the MLFL & MMOR
standardized technique and fixed
among the three skeletal groups. Hence, data
anodemidsagittal plane distance. for both genders in each group were clubbed
2. The lateral cephalograms of each together.Descriptive statistical analysis and
subject were traced and cephalometric statistical comparisons of the MLFL & MMOR
analysis was carried out. measurements in 3 groups are shown in
(Graph
Cephalometric variables
I). The mean MLFL were 3.8 +/- 0.7 mm in
SNA angle, SNB angle,ANB angle,Wits skeletal Class I group, 3.7 +/- 2.6 mm in
appraisal (mm),Mandibular length (Co- skeletal Class II group, and 4.3 +/-1.4 mm in
skeletal Class III group.
Pog) (mm),Interincisal angle
0.2
0
MLFL MMOR
-0.2
-0.4
Corresponding Author
1,5,6
Department of Conservative Dentistry & Endodontics, Narayana Dental College, Nellore, A.P
2
Faculty of Dentistry, AIMST Dental Institute, Malaysia.
3
In private practice, U.K.
4
Department of Conservative Dentistry & Endodontics, MNR Dental College and Hospital, Telangana
ABSTRACT:. Objective: Comparison of resistance of marginal ridge to fracture in tunnel cavities restored with
three different materials. Materials& Methodology: Forty premolar teeth were taken and tunnel cavities prepared
on the teeth maintaining the marginal ridge thickness of 2mm and height of 2.5 mm. All the teeth were mounted in
acrylic block and were divided into 4 groups of each having 10 teeth. Group 1 left unrestored (control group),
Group2 restored with Biodentine, Group 3 restored with Chemfil Superior, Group 4 filled with FUJI - IX Glass
ionomer cement (GIC). Then all samples were tested using universal testing machine for marginal ridge resistance
to fracture and values obtained were subjected to ANOVA. Results: Restorative material had a significant
(P<0.05) effect on mean score of tunnel prepared teeth. Results showed that Biodentine restored teeth were more
resistant to fracture than teeth restored with Chemfil Superior and FUJI IX GIC. ANOVA statistical analysis
showed statistifically significant difference between all groups and biodentine was superior among three materials
used. Significance: Premolars tunnel-restored with Biodentine were strong compared to Unrestored teeth, teeth
restored with Chemfil superior and FUJI - IX GIC.
.
KEYWORDS: Biodentine, Chemfil Superior, FUJI IX GIC, Tunnel preparation
INTRODUCTION
GV Black (1917) laid down principles for the due to difficulties in regaining the contact point, and
2
design of cavities for restoring carious lesion nearly failure to contour the proximal surface properly.
100 years ago. Conventionally for small proximal
carious lesions, the intact marginal ridge as well as The tunnel concept accesses proximal carious
the contact point has to be sacrificed in order to lesions from the occlusal surface. It preserve the
1
access the lesion area. It leads to food impaction marginal ridge and to minimize loss of healthy tooth
and decreased masticatory efficiency due to structure One of the most frequently reported
difficulties in regaining the contact point and reasons for the clinical failure of total tunnel
2
contour . restorations was marginal ridge fracture. It is
influenced by the strength of the marginal ridge after
3 4
Knight and Hunt (1980) introduced the tunnel preparation and the mechanical properties of
tunnel concept as a more conservative design than the restorative material used.
Blacks Class II preparation.
In Class II cavity the marginal ridge and Glass ionomer cements were commonly used
contact point should involve to access into proximal for restoring tunnel cavities for many years. In this
lesion regardless of its size, so even for a small study, three different restorative materials like
carious lesion. This kind of treatment often leads to Biodentine, Chemfil superior and FUJI IX GIC
food impaction and decreased masticatory efficiency were used for restoring tunnel cavities.
1 1
Keerthi GK Post graduate student
2 2
Mahesh P Professor and Head
3 3
Divya Jyothi G Post graduate student
1,2,3
Department of Prosthodontics, Narayana Dental College, Nellore, A.P
ABSTRACT:. The success of complete denture prosthesis relies on principles of retention, stability and
support and the prosthodontists skill in applying these principles efficiently in critical situations. Severely
resorbed edentulous ridges that are narrow and constricted with increased inter ridge space provide
decreased support, retention and stability. The consequent weight of the processed denture compromises
them further. This article describes a case report of an edentulous patient with resorbed ridges where a
simplified technique of fabricating a light weight maxillary complete denture was used for preservation of
denture bearing areas.
.
KEYWORDS: Neutral zone, Residual Ridge Resorption, Unconventional Complete
Dentures.
INTRODUCTION
Figure 8: Packing of Hollow Denture Figure 9: Denture with access for salt removal
CONCLUSION:
attain the position with help of which teeth can Days and nights change, so do men,
be set. Also, excessively resorbed ridges result so do tissues, so do our treatments. All the
in increased inter ridge distance, which diseases cannot be treated with a single drug;
increases the height, weight of the maxillary similarly all the tissues cannot be treated with
denture which also effects the retention and single technique. It lies in the uniqueness of the
18,19,20
stability of the prosthesis. It is the dentists dentist to diagnose and treat according to the
responsibility to reduce the weight of the clinical situation. Hollow denture is a simplified
prosthesis and make it stable and comfortable technique for decreasing the weight of the
to the patient. maxillary prosthesis and increasing the stability
of the mandibular prosthesis to improve the
comfort of the patient.
1 1
Ramya D Post graduate student
2 2
Vandana Raghunath Professor and Head
3 3
Ajay Reginald Professor
4 4
Firoz Kamal Reader
1-4
Department of Oral Pathology and Microbiology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh.
ABSTRACT:. Adenomatoid odontogenic tumor (AOT) is an unusual benign tumor accounting for 3% of all odontogenic
tumors, unique to the maxillofacial area. Mainly affects females in their second decade & exhibiting predominance for
anterior maxillary region. It is categorized into three variants follicular, extrafollicular & peripheral. Follicular variants
involving all four canines & only maxillary canines accounts for 60% & 40% respectively. Three such rare cases are
presented which occurred in relation to maxillary right premolar, lateral & canine in 2nd, 3rd & 4th decades respectively
INTRODUCTION
CASE REPORT 1:
Adenomatoid odontogenic tumor (AOT) is an
uncommon benign epithelial lesion of odontogenic origin. A 16 year-old female reported to the hospital with a
chief complaint of a swelling of the right cheek associated
It was first described by Steensland in 1905 and Dreibaldt
with pain since 3 months. The pain was dull in intensity
in 1907 as pseudo adenoameloblastoma. Harbitz in 1915
and intermittent in nature. The patient was moderately
described it as a cystic adamantinoma. In 1948 Staphne
built and moderately nourished. There were no signs of
considered it as a distinct pathological entity. pallor, icterus, cyanosis, clubbing, and koilonychias. All
her vital signs were within normal limits. On intraoral
AOT contributes about 2-3 % of all odontogenic examination, there was a firm well- defined swelling
tumors. In the WHO classification of 2005, AOT is extending from the distal side of upper right central incisor
included under odontogenic epithelium with mature, to the mesial side of the second premolar of the same
fibrous stroma without odontogenic ectomesenchyme. side. The swelling was nontender. The overlying mucosa
Dental lamina remnants likely represents the progenitor was non tender & normal in color. The right first premolar
cells. Philpsen et al. subdivided this condition into three was missing. A lymph was palpated in the right
submandibular region. None of the teeth were tender on
groups referred to as follicular, extrafollicular, and
percussion. The patient was subjected to radiological
peripheral. The rare peripheral type occurs almost
examination for this lesion.OPG showed unilocular
exclusively in the anterior maxillary gingival. Intraosseous
radiolucency with well defined margins, in relation to apical
AOT may be found in association with unerupted regions of upper right canine to second premolar of the
permanent teeth (follicular type ), in particular the four same with upper right first premolar tooth impacted .
canines that accounts for 60 % with the maxillary canines
alone accounting for 40 %. Here we report a case of a The mass was enucleated completely along with the
large follicular AOT or which could be a possible hybrid impacted premolar. The specimen was subjected for
variant apart from three types already established in the histopathological examination. The macroscopic
literature. It is associated with a Dentigerous cyst in the examination revealed a cystic lesion surrounding
anterior maxilla in association with an impacted premolar, completely crown of a single rooted teeth, 3 x3 cms, 2 mm
thickness. When it was cut open, outer surface is brownish
canine and lateral respectively in 3 cases.
in color and inner surface is creamish with tiny nodular
growths.
CASE REPORT-1
Case Report 1: Gross examination shows Case Report 1:Cut section shows outer
cystic lesion surrounding completely crown brownish, inner creamish with tiny nodular
of a single rooted tooth growths
Case Report 1: Ducts lined by columnar cells and Case Report 1 : Capsule is fibrocellular, spindle-
containing eosinophilic material shaped cells forming rosette-like
CASE REPORT-2
Case Report 2: Gross examination shows grayish brown in color with attached 13, oval in shape. Cut section
shows smooth surface soft consistency which appeared cystic.
Case Report 2: A cystic lining of 2-4 layers along with luminal proliferations. Ducts lined with columnar
cells and containing eosinophilic material are seen scattered. Spindle cells forming rosette like structures.
CASE REPORT-3
Case Report 3 : Swelling extends from distal side of Case Report 3: Unilocular radiolucency with well
central incisor to mesial of canine defined margins from apical of 11-13, with 12
impacted
Case Report 3: On gross examination shows 3 x3.5 cm along with 12, thickness of 2 mm, bifurcated root of the
upper right lateral incisor. Cut surface shows cyst was attached to neck of 12.
Case Report 3: Shows a discontinuous odontogenic epithelial cyst lining of variable thickness from 3-8 cell layers
which is proliferating in areas. A large area of luminal proliferation which is detached shows many spindle, ovoid
and cuboidal odontogenic epithelial cells arranged in the form of whorls/ sheets/ strands with scattered eosinophilic
hyaline droplets and a hyaline stroma.
CASE REPORT-3(cont..,.)
Case Report 3: Ducts lined with columnar cells and containing eosinophilic material are also seen scattered.The capsule is
fibrocellular with many spindle / plump fibroblasts and parallel aligned collagen bundles. Few calcifications are seen close
to lining. Immature bony trabeculae are seen at the periphery of the capsule forming a discontinuous rim.
odontogenic epithelial cells arranged in the form of whorls/ supported by both morphological and immune
sheets/ strands with scattered eosinophilic hyaline histochemical evidence. According to this hypothesis, the
droplets and a hyaline stroma. Ducts lined with columnar lesions grow next to or into a nearby dental follicle lading
cells and containing eosinophilic material are also seen to the envelopmental theory.
scattered. The capsule is fibrocellular with many spindle/
plump fibroblasts and parallel aligned collagen bundles. If the tumour grows after cystic expansion, then
Few strands and small islands of odontogenic epithelial this makes certain its orgin from a dentigerous cyst. If it
cells and small/ large basophilic calcifications are noted occurs before cystic expansion, then tumor tissue will fill
close to the lining. Immature bony trabeculae are seen at the follicular space and the AOT will present as a solid
the periphery of the capsule forming a discontinuous rim. tumor.
Based on these histological findings a diagnosis of
Adenomatoid odontogenic tumor arising from Dentigerous Some features of AOT arising from Dentigerous cyst
Cyst (hybrid variant) was given to above all three cases. are these are entirely cystic with AOT like proliferation,
attached at CEJ, more amount of straw colour fluid.
DISCUSSION Histologically the cystic lining is reduced enamel
epithelium ie 2-4 layers / non keratinized stratified
AOT was first recognized as a distinct squamous epithelium or solid masses of AOT in walls of
pathological entity by Stafne in 1948. It has been reported connective tissue wall or dentigerous cyst lining may
that some odontogenic cysts occur in association with proliferate in the wall or AOT proliferation can be seen in
odontogenic tumors or epithelial lining from cyst transform the lumen also.
into odontogenic neoplasm like ameloblastoma or AOT.
Because neoplastic and hamartomatous lesions can occur Radiologically, it should be differentiated from
at any stage of odontogenesis, odontogenic tumors with dentigerous cyst, which most frequently occurs as a
combined features of epithelial and mesenchymal pericoronal radioucency in the jaws. Dentigerous cyst
components may arise within the odontogenic cyst. encloses only the coronal portion of the impacted tooth,
Garica-pola et al. described the proliferation of an whereas the AOT shows radiolucency usually surrounding
adenomatoid odontogenic cyst in the epithelial border of a both the coronal and radicular aspects of the involved
dentigerous cyst. tooth. However, the irregularity in the wall of the cyst may
indicate the development of AOT. These lesions may often
The structure of the cyst in this case and its appear completely radiolucent; however, they contain fine
insertion around the crown of an unerupted tooth were specks of dystrophic calcifications or tooth material like
typical of dentigerous cyst. Some believe that they enamel, dentin, enamel and dentin, cementum, dentin and
originate from the odontogenic epithelium of a dentigerous cementum, a feature differentiating AOT from dentigerous
cyst. Therefore, the hypothesis that follicular AOT arise cyst.
from the reduced enamel epithelium that lines the follicles
of unerupted teeth is fairly conclusive. This is further
REFERENCES
1,2,3
Department of Orthodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh.
ABSTRACT:. Distraction osteogenesis is one of the latest techniques for the correction of bone deformities.
Distraction osteogenesis is gaining popularity as it not only grows bone but also it grows the surrounding soft tissue
and neurovascular bundle. Its application in dentistry is increasing day by day. It can be used to correct various
deformities which may congenital, pathological resection, craniofacial anomalies and alveolar ridge for prosthetic
purposes. Mandible is the jaw bone most commonly used for doing distraction osteogenesis.
INTRODUCTION
One of the most common dentofacial deformities includes 3. Mandibular corpus distraction osteogensis:
mandibular deficiency in any one or all dimensions. It may
4
be present as individual entity or in combination with other According to Diner et al, mandibular corpus
deformities or associated with syndromes. Traditionally lengthening can be done in all cases except
these problems are corrected using orthodontics alone or OSAS patient below 4 years. This includes young
with combination with orthognathic surgery. But recently patients with unsuccessful functional treatment
new technique distraction ontogenesis, which has become and severe mandibular deficiencies (greater than
1 7mm).
a boon for these type of deformities.
It is composed of two geared distraction rods with Mandibular Distraction with a Dynamic
one freely movable rider. Both rods are connected in the Osteosynthesis System (MD-DOS) device is used for
middle by a special joint piece with attachments for two mandibular lengthening in mandibular retrognathism. It
11
fixation pins, permitting double-level lengthening. In was introduced in 1997. The MD-DOS device consists of
addition, the central piece has two universal joint four major components: a posterior fixation unit (PFU), a
mechanisms allowing each arm to have independent spacer, a distraction unit (DU), and an anterior fixation unit
three-dimensional rotation. (AFU).
12
ROD technique was developed by Razdolsky et al. It
relies primarily on tooth borne distractors. This method
provides a predictable, convenient, less costly method for
correction of Class II mandibular skeletal deficiency
compared with traditional surgical advancement. In
addition, it is now possible to distract first and then
decompensate the teeth by moving them into the new
regenerate bone, thus eliminating the need for presurgical
extractions of lower premolar in Class II cases with lower
incisor crowding or protrusion.
The ROD Devices are intraoral, custom made distraction
The Multi-Guide Mandibular Distraction Device devices preprogrammed along a desired vector of
12
also consists of two distraction rods with gradually sliding distraction.
clamps connected in the middle by a universal hinge.
ABSTRACT:. Improved health outcomes for the mother and unborn child are the ultimate goal yet, The
achievement of optimal oral health in pregnant women hampered by myths surrounding the safety of dental care
during pregnancy. Prenatal care providers integrate oral health into the care of their pregnant patients so that
mother and baby can lead healthy lives. Fortunately, opportunities exist to educate health professionals who
work with women about the importance of oral health care during the perinatal period and to engage these
health professionals in promoting womens oral health during that period that could result in improved oral as
well as general health of expectant mothers and to their children.
KEYWORDS: Perinatal, Oral health care, Foetal health, Cariogenic, Microbial Transmission
INTRODUCTION
Routine preventive efforts should include wiping an Dr. Naveen Kumar Kolli
infant mouth with a soft cloth or gauge cloth after every Postgraduate student
breast or bottle feed, tooth brushing, optimizing the childs Department of Pedodontics
fluoride exposure and limiting the childs frequency of
Narayana Dental College and Hospital,
carbohydrate intake.
Nellore, Andhra Pradesh
All primary health care professionals who serve India-524003
pregnant women should provide education on the etiology
and prevention of Early Childhood Caries(ECC). Oral
health counselling and referral for a comprehensive oral
examination and treatment during pregnancy is especially
important for the mother.
CONCLUSION:
REFERENCES:
1,2,3
Department of Periodontics, Narayana Dental College and Hospital, Nellore, Andhra Pradesh.
ABSTRACT: The Periodontal pocket, one of the definitive signs of periodontal disease, is the most common
parameter to be assessed by dental clinicians. Periodontal probes have been the instruments most commonly used
to locate and measure these pockets. Regular use of periodontal probes in routine dental practice facilitates and
increases the accuracy of the process of diagnosing the condition, formulating the treatment, and predicting the
outcome of therapy. Advances in the field of periodontal probing have led to the development of probes that may
help reduce errors in determining this parameter used to define the state of active periodontal disease. One such
advance is the emergence of probes that purportedly assess periodontal disease activity noninvasively. The
selection of periodontal probe depends on the type of dental practice: A general dental practitioner would require first
or second generation probes, while third through fifth-generation probes generally are used in academic and
research institutions as well as specialty practices.
INTRODUCTION
A clinical diagnosis of periodontitis is made by However, periodontal probing has its limitations. Reading
measuring the loss of connective tissue attachment to the errors may result from naturally occurring states, such as
root surface (clinical attachment loss) and loss of alveolar interference from the calculus on the tooth or root surface,
bone (bone sounding and radiographic assessment). The the presence of an overhanging restoration, or the crown's
word probe is derived from the Latin word Probe, which contour. Another factor is operator error, such as incorrect
means "to test." Periodontal probes are used primarily to angulation of the probe, the amount of pressure applied to
detect and measure periodontal pockets and clinical the probe, misreading the probe, recording the data
2
attachment loss. In addition, they are used to locate imprecisely, and miscalculating the attachment loss.
calculus; measure Gingival Recession, width of attached Various factors, such as probe-tip size, angle of insertion of
Gingiva, and size of Intraoral Lesions; identify tooth and the probe, probing pressure, precision of probe calibration,
soft-tissue anomalies; locate and measure furcation and degree of inflammation in the underlying periodontal
involvements; and determine Muco Gingival relationships tissues, affect the sensitivity and reproducibility of
1 3
and bleeding tendencies. measurements. Because the probe passes through the
junctional epithelium into the underlying connective tissue
The third edition of G.V.Blacks Special Dental in an inflamed gingival sulcus, readings of clinical pocket
Pathology published in 1924 after his death mentions The depth obtained with the periodontal probes do not normally
use of very thin flat explorers to determine the depth of coincide with the measurements up to the base of the
3
Periodontal Pockets. These instruments were not pocket.
1
calibrated and they were not used for decades.
The National Institute for Dental and Craniofacial
Periodontal probes are used to locate, measure, and Research (NIDCR) has defined eight criteria for overcoming
4
mark pockets, as well as determine their course on the limitations of conventional periodontal probing. Table 1
individual tooth surfaces. Periodontal probe and its use shows how conventional probing criteria has been altered
were first described by F.V. Simoton of the University of by the NIDCR for this objective.
California, San Francisco in 1925. Typical probe is a
tapered, rod like instrument calibrated in millimeters, with a Generations of Periodontal Probes
1
blunt rounded tip.
For consistency of use and academic purposes, in 1992,
5
Pihlstrom et al. classified probes into three generations.
Vol. I Issue 1 Jan - Jun 2015 46
Review Articles Narayana Journal of Research in Dental Specialties
Table 1: National institute for dental and craniofacial research criteria
First generation
Advantages Disadvantages
Easily available and inexpensive Heavy
Tactile sensitivity is preserved Probing force is not controlled so the tip
of the probe may pass beyond the base
Even in presence of sub gingival of the pocket
calculus, probe can be inserted with Errors during visualizing the readings are
little navigation by operator possible
Tip is rounded to avoid tissue trauma An assistant is needed to transfer the
Many are colour coded for easier and readings to chart
faster
Second generation probes
standardization of probing forces Probe tip may pass beyond the junctional
Comfortable to the patient epithelium in inflamed sites
Readings have to be taken manually and
an assistant is needed to record them
on the patient chart. No computer
storage of data
Third Generation
Advantages Disadvantages
Standardization of probing forces Tactile sensitivity is decreased
Errors in reading the data are eliminated Probe may pass beyond the transferring
Printout of data from the computer can be junctional epithelium in inflamed sites,
used for the patent education overestimating pocket depth
After inflammation has resolved, probe
may not penetrate beyond the long
junctional epithelium, leading to
underestimation of the pocket depth
6
In 2000, Watts extended this classification by adding The depth of clinical probe penetration has been shown
fourth- and fifth-generation probes. These various to be influenced by the force to be applied. Previously force
generations, along with their advantages and of 25 g, 50 g and 75 g has been used
disadvantages, are in table 2.
10
The use of traditional clinical parameters for identifying Freed and co-workers (1983) documented that intra
patients and sites at risk for current or future clinical examiner variations occur during the clinical probing of
attachment loss has been the subject of controversy. individuals with healthy periodontium. Specifically, they
Studies have shown that the penetration of the probe is found that clinicians tended to probe around teeth in
positively correlated with probing force. This has been anterior regions with less force than around teeth in
solved with the development of pressure-sensitive probes, posterior regions. They also showed that distal surfaces
which have a standardized controlled insertion pressures. were probed with greater force than other surfaces and that
These studies show that with forces of up to 30g, the tip of facial surface were probed with the least amount of force.
the probe seems to remain within the junctional epithelium. The results of this investigation tend to confirm that a
Forces of up to 50 g are necessary to diagnose periodontal similar phenomenon takes place when clinicians probe
8 9
osseous defects. Osborn J B. et al (1992) compared individuals with evidence of past exposure to periodontitis.
measurements obtained from Florida Probe, Florida Disk Greater probing depths indicating greater probing force
Probe, and conventional periodontal probe in persons were consistently obtained on the facial and lingual
having moderate to severe periodontitis and concluded that surfaces with the pressure-controlled technique. Probing
use of the Florida Probe and Florida Disk Probe may offer depths obtained on the posterior disto-lingual surfaces tend
significant advantages in reducing measurement error for to indicate that greater probing force was used with manual
10
some clinical examiners. probing in that region.