ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
NAME OF THE CANDIDATE AND ADDRESS:
P.M.N.M. DENTAL COLLEGE AND HOSPITAL
NAME OF THE INSTITUTION:
P.M.N.M. DENTAL COLLEGE AND HOSPITAL
COURSE OF STUDY AND SUBJECT:
M.D.S. (MASTER OF DENTAL SURGERY)
ORAL MEDICINE AND DIAGNOSTIC RADIOLOGY
DATE OF ADMISSION TO COURSE:
6th JUNE 2013
TITLE OF THE TOPIC:
“PREVALENCE OF JAW LESIONS IN BAGALKOT POPULATION – A CLINICAL AND RADIOGRAPHIC STUDY”
BRIEF RESUME OF THE INTENDED WORK:
NEED FOR THE STUDY
Health systems require accurate information regarding disease occurrence to effectively allocate resources and frame government health policies. The incidence rates of many common cancers and diseases are calculated yearly to observe trends over selected time periods, to estimate the future disease burden, monitor mortality rates and direct future health planning.1
The need for this study is to identify meticulously the various radiographic changes that occur following a pathological condition, may be an inflammatory, a benign or a malignant disease, or a manifestation of a systemic disease.
The study comprises of a comprehensive clinical evaluation of the existing pathological condition. The systematic recording and compilation of various clinical and radiographic features of the pathological conditions manifested in the jaws and estimating the prevalence and incidence of various diseases in this group of population is the need of the hour.
Such a study will have future perspectives like analyzing the causative factors of highly prevalent diseases. This will open new vistas for research in identifying the cause of a particular disease state, treatment options and preventive measures.
REVIEW OF LITERATURE:
A radiographic survey of periapical jaw bone lesions was conducted in clinics of the Faculty of Dental Medicine in Jerusalem. Full mouth periapical radiographs of 889 patients were thoroughly scrutinized by two independent examiners and were classified into one of the following radiologic categories, 1)Rarefying osteitis 2)Radicular cyst 3)Condensing osteitis 4)Combined rarefying and Condensing osteitis 5)Hypercementosis 6)Enostosis 7)Periapical cemental dysplasia 8)External resorption. Age and sex of the patients, location of the lesion and its relation to tooth pathosis were recorded on a chart.
Results of the study showed that out of the 889 patients 469 exhibited various
radiologic bone changes in the periapical jaw region. Total of 770 inflammatory
periapical lesions were diagnosed in 449 patients with an average incidence of 1.9
lesions per patients. Most commonly encountered lesion was rarefying osteitis,
which accounted for 80% of all periapical inflammatory lesions. Condensing osteitis
was present in 55 patients with significant female predominance. Combination of
condensing and rarefying osteitis was identified in 85 teeth of 68 patients. 37
periapical lesions were cysts distributed among 20 patients. External root resorption
occurred in 5% of teeth. Hypercementosis and supernumerary teeth were rare. In 20
patients with non inflammatory processes, periapical cemental dysplasia was
observed in 5 women. Enostosis was present in 15 patients.2
Panoramic radiographs of 1203 patients – 581 males and 622 females were selected out of an approximately 5000 population for radiographic investigation of idiopathic osteosclerosis in Japanese dental outpatients. Radiographs were reviewed and evaluated for the presence of uniform radiopacities within the jaw bones located in the vicinity of sound teeth or teeth with small restorations or were separated from the teeth except for cases of periapical cemental dysplasia, Gardner’s syndrome, Familial polyposis of the colon and other diseases with bone metabolic disturbances which were excluded. Radiopaque areas were grouped into following three types according to their location in relation to teeth and in consideration of differential diagnosis 1) Solitary enostosis (SE). 2) Periapical enostosis I(PE I).
3) Periapical enostosis II (PE II).
Results have shown that 134 focal radiopacities were identified in 117(9.7%) patients
out of 1203 examined. SE was the most common accounting for 59.7% followed by
PE I (23.1%) and PE II (17.2%). 14 patients had two or more opacities.3 Case reports and clinicopathologic features of each case of Primary intraosseous carcinoma published between 1951 and 1991 were collected. Age and sex of the patient, location of the lesion, condition of the oral mucosa, sensory disturbance status, pain, radiographic findings, presence of metastasis to the regional lymph nodes and survival time were surveyed and lesions were classified as the anterior region or the right or left posterior region.
Results have shown that 24 reports, describing 39 cases, patients ranged from 4 to 76 years with mean of 51 years. 7 cases were excluded as age was not recorded. Of 4 lesions located in maxilla 3 were in the anterior region. 26 of the 35 mandibular lesions were located in posterior region. Mucosal swelling had been noted at the affected site in 25 cases. In all of the 31 cases osteolytic bone changes had been noted. In 38 cases, well to poorly differentiated squamous cell carcinoma, with various degree of prominent keratinization had been demonstrated histologically.4
A 4-year prospective study on epidemiology of odontogenic tumors was conducted between 1999 and 2003, included all patients with odontogenic tumors referred from all dental clinics and other health facilities in Tanzania to the only 4 referral centers. Demographic data, clinical and histopathologic findings were recorded. Histopathologic specimens were examined by expert pathologists. Surgery included conservative removal of the lesion in the case of benign nonaggressive tumors like ameloblastic fibroma or odontoma to radical excision of the tumor with margin of healthy bone in aggressive tumors like ameloblastoma or myxoma. Some selected patients with ameloblastomas, depending on the size of the tumor, were treated by resection of the mandible and immediate reconstruction.
Results have shown that a total of 116 patients with odontogenic tumors were seen
during this 4-year period. Ameloblastoma was seen with the highest frequency
(80.1%) followed by odontogenic myxoma (7%). Based on the population of
Tanzania of 34 million, the calculated incidence rate of ameloblastoma found in this
study was 0.68 per million per year while that of odontogenic myxoma was
0.07. Most (71%) patients with odontogenic tumors were in the age group of 10 to 39
years with a mean of 32 years. Ameloblastoma had an equal distribution between
males and females and occurred with a mean age of 35 years. There were 9 patients
(9.6%) who had unicystic ameloblastoma with an age range of 15 to 50 years
(mean 27 years). 43% of all ameloblastomas were located in the body- ramus
region of the left or right side of the mandible. 21% occurred in the symphysis only,
another 30%, however, occupied not only the symphysis but also other parts of the
A study of the radiographic appearance of radiopaque lesions of the jaw bones was conducted without the knowledge of the medical histories by taking panoramic radiographs of 3,513 patients retrieved from 10 practices in Northern Greece. Of the final sample, 1,750 radiographs belonged to female and 1,763 to male subjects. Only 1 radiograph from each subject was included in the study. Descriptive data of the radiopacity, including location, shape, size and condition of the adjacent and opposing teeth were recorded. All radiographs were examined jointly by the first 2 authors of the study and the following strict criteria were defined: The radiopaque masses included in the study were well defined, localized, elliptical, circular, or irregular in form and of varying size; they were located at the alveolar bone and their internal aspect was uniformly radiopaque. In case of disagreement between the first 2 authors as to the outcome of an examination, the third author was consulted.
Results have shown that out of 3,513 radiographs examined in the study, 69 radiographs (1.96%) exhibited radiopaque lesions in the jaws. 3 radiographs exhibited 2 involved areas therefore a total of 72 radiopacities were identified in 69 panoramic radiographs out of 3,513 examined. Radiopacities were present in 47 of the 1,750 female patients (2.70%) and in 22 of the 1,763 male patients (1.24%), showing a greater female predilection, 14.5% of the lesions were located in edentulous areas and 7.2% in other locations. Of the lesions identified, 30.4% were surrounding the apex of the involved tooth, 2.9% were located mesially, 14.5% distally, 21.7% apically and 14.5% were distant. Radiopacities associated with intact teeth occurred in 30.4% of teeth, whereas 2.9% were associated with teeth with shallow caries and 11.6% with teeth with shallow fillings, 2.9% of the radiopacities were associated with teeth with deep caries, 23.2% with deep fillings and 15.9% with reconstructions and 14.5% of the radiopacities were related to endodontically treated teeth.6
In a Chinese population, a study of 1309 cases of odontogenic tumors (OT) out of 33,354 accessed cases, were retrieved from the files during the period 1985 to 2006. The clinical details, including age and gender of the patient, duration, location and extent of the lesion, were collected. Available radiographs of some cases were also referred. With regard to the site of occurrence, each jaw was divided into three parts: anterior, premolar and molar. In the case of the mandible, the molar area also included the angle and ramus. Any tumor involving two areas or more was assigned to the region approximating the center of the lesion.
Results have shown that 1309 OTs constituted 3.92% of all cases and 8.99% of all oral tumors and tumor-like lesions diagnosed during the same period. Compared with salivary gland tumors (10.53% of all cases), oral squamous cell carcinomas (8.32%) and cysts of the jaws (7.08%), OTs were less common. Of the 1309 cases, 94.04% were benign and 5.06% were malignant. The most frequent benign tumor was keratocystic odontogenic tumor (KCOT, 38.73%). The second most common tumor was ameloblastoma (including four subtypes 36.52%), followed by odontomas (6.11%). Prominent among the 78 malignant odontogenic tumors were primary intraosseous squamous cell carcinoma (PIOSCC, 3.74%) and ameloblastic carcinoma (AC, 1.3%). The age of patients at diagnosis ranged from 1 to 83 years with a mean of 34.48 years and peaked at the second to fourth decade. In benign tumors, ameloblastic fibroodontoma, compound odontoma and Adenomatoid odontogenic tumour (AOT) showed a predilection for children and teenagers with more than half of the tumors occurring in patients younger than 20 years.7
6.3OBJECTIVES OF THE STUDY:
To screen all the patients attending the Oral Medicine department by doing a thorough clinical examination.
Jaw lesions will be further clinically assessed and investigated (radiographs, advanced imaging modalities and laboratory investigations).
To systematically interpret the radiographic features, classify, diagnose the disease state and correlate with the histopathology.
To estimate the prevalence, frequency and incidence of the various jaw diseases/ pathology.
MATERIALS AND METHODS:
SOURCE OF DATA:
The study design includes patients attending ORAL MEDICINE AND
RADIOLOGY department from November 2013 to August 2015 of P.M.N.M
DENTAL COLLEGE AND HOSPITAL, BAGALKOT. Inclusion criteria: -
Patients of any age, both genders, all racial and ethnic groups with oral diseases or systemic diseases with oral manifestations that fulfills the objectives.
Patients who willingly give consent will be considered for this study.
Exclusion criteria: -
Patients with any significant cognitive impairment will be excluded.
METHOD OF COLLECTION OF DATA:
This cross-sectional, prospective study will include all patients with oral diseases or systemic diseases involving the jaws. The study will be carried out from November 2013 to August 2015. All the patients attending the outpatient department will be thoroughly examined clinically by using a clean, sterile mouth mirror and probe under proper illumination. Significant jaw manifestations will be systematically recorded on a case history proforma. Digital/conventional radiographs
(intraoral/extraoral/advanced diagnostic imaging) will be made for the jaw lesions and if required laboratory investigations will be done.
Photographs will be taken and systematic interpretation of the diagnostic images (radiographs, advanced imaging) will be recorded on the proforma.
Further the patients will be referred for biopsies and histopathology findings will be recorded. The cases will be compiled and based on the clinical, radiographic and histopathology the prevalence and incidence of the jaw lesions will be statistically evaluated.
DOES YOUR STUDY REQUIRE ANY INVESTIGATION
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMAL
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3? Yes
LIST OF REFERENCES:
Johnson NR, Savage NW, Kazoullis S, Batstone MD. A prospective epidemiology study for odontogenic and non odontogenic lesions of the maxilla and mandible in Queensland. Oral Surg Oral Med Oral Pathol 2013;115:515-512.
Marmary Y, Kutiner G. A radiographic survey of periapical jaw bone lesions. Oral Surg Oral Med Oral Pathol 1986;61:405–408.
Kawai T, Hirakuma H, Murakami S, Fuchihata H. Radiographic investigation of idiopathic osteosclerosis of the jaws in Japanese dental outpatients. Oral Surg Oral Med Oral Pathol 1992;74:237-42.
Suei Y, Tanimoto K, Taguchi A, Wada T. Primary intraosseous carcinoma: Review of the literature and diagnostic criteria. J Oral Maxillofacial surgery 1994;52:580 – 583.
Simon E N M, Merkax M A W, Vuhahula E, Ngassapa D, Stoelinga P J W. A 4 – year prospective study on epidemiology and clinicopathological presentation of odontogenic tumors in Tanzania. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:598–602.
Avramidou FM, Markou E, Lambrianidis T. Cross-sectional study of the radiographic appearance of radiopaque lesions of the jawbones in a sample of Greek dental patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:e38–e43.
Luo HY, Li TJ. Odontogenic tumors: A study of 1309 cases in Chinese population. Oral Oncology 2009;45:706 –711.