Background: One of the most distressing complications of head and neck cancer patients on chemoradiotherapy is mucositis. There is no proper tool to predict its occurrence in these patients. Aim: This study was conducted to develop a risk-scoring system to predict probable incidence and severity of mucositis in head and neck cancer patients on chemoradiotherapy. Materials and Methods: This is a retrospective analysis conducted at a tertiary care cancer center with approximately 2,000 new cases of head and neck cancer patients annually. We Hypothesized were age, comorbid conditions, leukocyte count, nutritional status, oral hygiene, tobacco use, erythrocyte sedimentation rate (ESR); Eastern cooperative oncology group (ECOG) performance status (PS) and TNM (tumor, node, metastasis) stage as possible risk factors. Receiver operating characteristic (ROC) curves were drawn to predict the cutoff values for risk factors, and a final scoring system was developed with sensitivity and specificity data. Results: A total of 218 patients on chemoradiation receiving cisplatin 40 mg/m ² /week along with local radiation of 60-70 Gy depending on primary site were analyzed. Based on ROC analysis, the following cutoff values were selected: age > 40 years, ECOG PS > 2, WBC < 3000/μL, elevated ESR, albumin < 3 gm/dL and > stage III disease. The remaining factors were indicated as present or absent. A score of 1 was assigned for the above risk factors. For patients, the final score of 3 or less there is 17% probability of developing grade 3 or 4 mucositis, while patients having score of 6 or more have 76% probability. Conclusion: The current tool is fairly accurate in predicting development of mucositis in head and neck caner patients on chemoradiotherapy. This will further help clinicians to adopt preventive strategies as well as better counseling.

Children under the age of 5 years generally spend most of their time with their parents and guardians, especially mothers, even when they attend pre-schools or nurseries. It has been found that young children's oral health maintenance and outcomes are influenced by their parent's knowledge and beliefs. This study was done to assess the mother's knowledge about the oral health of their pre-school children in Moradabad, India. Mothers of children aged 1-4 years, attending the hospital for vaccination or regular checkups in the pediatric division of government hospitals, were invited to participate in the study. A 20-item questionnaire covering socio-demographic characteristics, dietary practices, oral hygiene practices and importance of deciduous teeth, was distributed to their mothers, during their visit to the hospital. Responses of the mothers were recorded on a Likert Scale. The sample comprised 406 mothers, with the mean age of children being 3.8 years. Three hundred (73.8%) mothers had a good knowledge about diet and dietary practices, while only 110 (27.1%) and 103 (25.4%) mothers were found to have a good knowledge about the importance of oral hygiene practices and importance of deciduous teeth, respectively. Mothers with higher educational qualification and information gained through dentist had a better knowledge about child's oral health. Oral hygiene habits and dietary habits are established during pre-school days and the parents, especially mothers, function as role models for their children.

Bizarre parosteal osteochondromatous proliferation, otherwise known as Nora's lesion, is surface tumor of bone with high probability of local recurrence. The author reports a case of Nora's lesion of the proximal phalanx of the second toe, successfully managed by en bloc excision of the swelling. At four-year follow-up there was no evidence of recurrence.

Aim : The purpose of this in vitro investigation was to evaluate the influence of double application and application of hydrophobic layer on marginal adaptation of four self-etch adhesive systems (XENOIII, ALLBONDSE, CLEARFIL SE TRI BOND, FUTURA BOND). Materials and Methods : One hundred and twenty class V cavities were prepared on intact, extracted human premolars and were divided into three groups of ten teeth each for all four adhesives. Group 1: Application of bonding agents as per manufacturer directions. Group 2: Double application of bonding agents. Group 3: Application of hydrophobic layer. The specimens were restored with composite and light cured. After thermocycling and immersion in 2% Basic Fuchsin dye solution, the teeth were sectioned and dye penetration was observed under a stereomicroscope at 20× magnification. All the samples were scored and results were analyzed using Kruskal-Wallis and Mann-Whitney tests. Results : Group 3, in which the adhesive systems were coated with hydrophobic layer, showed significantly decreased microleakage, followed by Group 1 and Group 2 for all the adhesive systems. And there is no significant different between Group 1 and Group 2. Conclusion : Marginal permeability of one-step adhesives can be minimized by the application of more hydrophobic resin layer, and the double application of one-step self-etch system can be safely performed without jeopardizing the performance of adhesives.

An increasing number of patients with osteogenesis imperfecta are undergoing pamidronate therapy to prevent the incidence of fragility fractures. The authors herein report a child aged 3 years who received five cycles of pamidronate, resulting in metaphyseal bands, known as "zebra lines."

Pure trisomy due to nondysjunction of chromosome 21 is responsible for 96% of Downs with a recurrence risk of less than 1%. Parental karyotype is not required in nondysjunction type of trisomies. Majority of fetuses with Trisomy 13, 18, monosomy XO and triploidy display major malformations on USG. Recurrence for all of the above nondysjunction numerical aberration is low. Hence, pregnancies with previous history of any of the above confirmed on fetal karyotype, can be followed up by serial ultrasound scans. Translocation of chromosome 21 (4% of Downs), the recurrence risk varies between 10-25% if one parent is a carrier of a translocation. The risk of unbalanced translocation in the offspring will depend on the type of translocation in the parents, which parent is involved and whether translocation is between homologous or non homologous chromosome. Once an unbalanced translocation in the fetus / child has been identified, parental karyotype is essential. More than 50% of translocations in fetus occur denovo. So if parents have a normal karyotpe, no matter what the translocation in the fetus, recurrence risk is minimal <1%.

Background: Fractures of the capitellum are rare injuries of the elbow usually seen in the adolescents. This fracture is often missed in the emergency room if a proper radiograph is not available. Recent reports have described many modalities of treatment favoring headless screw for fixation. The facility for headless screw fixation, however, is not available in most centers. This paper presents the diagnosis and management of type 4 capituller fractures (Mckee) with gadgets available in a district hospital. Materials and Methods: Between 2004 and 2007 three patients with right sided type IV capetullar fracture were treated in a district hospital. There were two boys aged 15 and 17 and one 33 years old lady. In one case, the fracture was missed in the emergency room. A double arc sign in the lateral views of the X-rays of the elbow was seen in all the cases. In each case a preoperative CT scan was done and a diagnosis of Mckee type IV fracture of the capitellum was made. Under tourniquet, using extended lateral approach, open reduction and internal fixation was done using 4mm partially threaded AO cancellous screws (n=2) and 2.7 mm AO screws (n=1), under vision from posterior to anterior direction from the posterior aspect of lateral condyle of humerus avoiding articular penetration. Results: All the fractures united uneventfully. At the end of one year follow-up, two cases had excellent elbow function; implants were removed and there were no signs of AVN or arthritis. The third case had good elbow ROM at 11 months without AVN. Conclusion: Double arc sign on lateral X-rays of the elbow along with pre-operative CT scan evaluation is important to avoid a missed diagnosis and analysis of type IV capitellur fracture. Fixation with non-cannulated ordinary AO screws using extended Kocher's lateral approach has given good results.

Transient osteoporosis of hip is a condition of unknown etiology, presenting as painful limping, and characterized by osteopenia of the involved joint without preexisting disease or immobilization. Most of the cases were reported in middle-aged men, and one-third of the cases develop in women in the third trimester of pregnancy. The hypothesis that this condition leads to avascular necrosis of the hip has been disproved by various reports and hence does not warrant any surgical interference. This is a self limiting condition, which needs regular follow-up. The authors report a case of migrating transient osteoporosis of the hip in a 30-year-old man successfully treated with antiresorptive treatment.

Aim: The purpose of this in vitro investigation was to evaluate the influence of hydrophobic layer and delay in placement of composite on marginal adaptation of two self-etch adhesive systems (XENO-III and ALL-BOND SE). Materials and Methods: Eighty class V cavities were prepared on intact, extracted human premolars and were divided into 4 groups of 10 teeth each. Group 1: Application of bonding agents as per manufacturer directions and immediate placement of composite; Group 2: Application of bonding agent and composite similar to group1, with hydrophobic layer curing before composite placement; Group 3: Application of bonding agent similar to group 1, with 2 min delay in composite placement; and Group 4: Application similar to group 2 with 2-min delay in composite placement. The specimens were restored and light cured. After thermocycling and immersion in 2% basic Fuchsin dye solution, the teeth were sectioned and dye penetration was observed under a stereomicroscope at 20x magnification. All the samples were scored and results were analyzed using Kruskal-Wallis and Mann-Whitney tests. Results: In group 1, the microleakage along the both enamel and dentin margin was significantly higher than the other groups for both the adhesive systems. There is no significant difference between groups 2, 3 and 4. Conclusion: The addition of a more hydrophobic resin layer and delay in composite placement significantly improves the marginal adaptation of self-etch adhesive resin systems.