Etiology and Complications of Dental Trauma Among 7-18 Year Old - A Retrospective Study
Pooja Umaiyal. M1, Deepa Gurunathan2*, Jaiganesh Ramamurthy3
1 Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Professor and Head, Department of Pedodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Professor and Head, Department of Periodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Deepa Gurunathan,
Professor and Head, Department of Pedodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai
600077, Tamil Nadu, India.
E-mail: deepag@saveetha.com
Received: July 30, 2021; Accepted: August 10, 2021; Published: August 17, 2021
Citation:Pooja Umaiyal. M, Deepa Gurunathan, Jaiganesh Ramamurthy. Etiology and Complications of Dental Trauma Among 7-18 Year Old - A Retrospective Study. Int J Dentistry Oral Sci. 2021;8(8):3886-3891. doi: dx.doi.org/10.19070/2377-8075-21000795
Copyright: Deepa Gurunathan©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Study of dental trauma and its associated factors is a common dental finding or at times an emergency that can facilitate planning of preventive measures, better assessment and effective treatment to carry out. The aim of this study is to evaluate the incidence of etiology and complications of dental traumas among children aged 7 to 18 years. We reviewed and analysed the data of 86000 patients between June 2019 and March 2020, among which 158 children in the age group of 7-18 years who had dental trauma were examined from the recorded details provided by the institute. Documented information included patients’ age, gender, dental status, tooth involved, type of trauma, etiology of trauma and treatment done. The collected data was then tabulated and analysed using SPSS software. Chi Square test was performed and the p value was determined to evaluate the significance of the variables. Among 158 children participating in this study, 75.3% were males. Falls were the leading cause of traumatic dental injuries as reported by 96.56% of the children. The most predominantly affected tooth during trauma was the permanent incisors (96.2%). Fracture of the coronal portion of the tooth was highly prevalent among the patients when compared to the occurrence of other forms of dental trauma. In terms of treatment, root canal treatments were predominantly performed over the patients with the most delayed consultation period being less than 10 days. Within the limits of the study, overall occurrence of dental trauma was predominantly higher among males than females. Falls were the leading cause of trauma with permanent incisor being affected the most. Long term prognosis of the tooth depends on the treatment and immediate consultation. Treatment of dental injuries is usually delayed and not given as much attention as other treatments which can explain the occurrence of pulpal and periodontal complications.
2.Introduction
3.Conclusion
4.References
Keywords
Dental Trauma; Tooth Fracture; Fall; Road Traffic Accidents.
Introduction
Traumatic dental injury (TDI) to the teeth only or other hard and
soft tissues around and within the vicinity of the mouth. It is
a consequence of certain unavoidable factors that pose risk in
life. It’s usually unexpected, sudden, accidental and often needs
emergency attention [30]. Dental trauma is one of the most common
reasons for dental emergencies, which is followed by oral
bleeding, dental infections and TMJ disorders [54]. TDIs among
children majorly occur as a result of their activities, so these dental
issues will be persistent as long as children remain active [19].
Permanent tooth to be injured is often a traumatic experience to
the children due to the occurrence of pain, discomfort and damage
to the aesthetic appearance of the child [34].
Traumatic injuries are classified into various luxations, fractures
and a combination of both the types might occur as well. Furthermore,
usually they are associated with other possible types
of maxillofacial injuries and soft tissue injuries. TDIs may bring
about changes in the quality of life if not corrected or treated.
These may also affect the psychology of the child, cause pain, loss
of certain factors like speech, esthetics and eventually might lead
to pulpal necrosis and periapical pathosis [54].
Factors that are associated with TDIs are age, gender, incisal overjet that is greater than 5 mm and an anterior open bite. Subsequently
the most affected teeth are the anteriors, with a male:
female ratio of 3:1. Among the age group of 0-6 years, the oral
traumas comprise about 17% [8]. A dental injury to the permanent
teeth or dentition (58.6%) is more prevalent than in primary
dentition which constitutes about 36.8% only [32, 18]. Dental
trauma sums upto 66% of the total dental emergencies that occur.
It is highly recommended that educational programs be held for
parents to create awareness about the immediate management of
traumatized teeth as they seek delayed care for these injuries [3].
Previously our team had conducted numerous clinical
trials(Christabel and Linda Christabel, 2015 [7]; Govindaraju and
Gurunathan, 2017 [14]; Govindaraju, Jeevanandan and E. Subramanian,
2017 15), in-vitro studies(Somasundaram et al., 2015 [55];
Subramanyam et al., 2018 [57]), comparative studies (Govindaraju,
Jeevanandan and E. M. G. Subramanian, 2017a [15]; Jeevanandan
and Govindaraju, 2018 25; Nair et al., 2018 36; Panchal, Jeevanandan
and Subramanian, 2019 [42]), case reports(Jeevanandan, 2017
[24]), surveys (Gurunathan and Shanmugaavel, 2016 [22]; Govindaraju,
Jeevanandan and E. M. G. Subramanian, 2017b [17]; Ravikumar,
Jeevanandan and Subramanian, 2017 [50]) and reviews
(Packiri, Gurunathan and Selvarasu, 2017 [39]; ‘Fluoride, Fluoridated
Toothpaste Efficacy And Its Safety In Children - Review’,
2018 [13]) over the past many years. Now we are focusing on
epidemiological studies. The idea for this study stemmed from the
current interest in our community.
Previously our team has a rich experience in working on various
research projects across multiple disciplines. (Jain, 2017 [23]),
(Varghese, Ramesh and Veeraiyan, 2019 [58]), (Ashok and Ganapathy,
2019 [2]), (Padavala and Sukumaran, 2018 [40]), (Ke et al.,
2019 [27]), (Ezhilarasan, 2018 [10]), (Krishnan et al., 2018 [28]),
(Ezhilarasan, Sokal and Najimi, 2018 [12]), (Pandian, Krishnan
and Kumar, 2018 [43]), (Ramamurthy and Mg, 2018 [48]), (Gupta,
Ariga and Deogade, 2018 [21]), (Vikram et al., 2017 [61]), (Paramasivam,
Vijayashree Priyadharsini and Raghunandhakumar,
2020 [44]), (Palati et al., 2020 [41]), (Samuel, Acharya and Rao,
2020 [53]). Now the growing trend in this area motivated us to
pursue this project.
The aim of the study is to evaluate the incidence of etiology and
complications of dental traumas among children aged 7 to 18
years.
Materials And Methods
A retrospective institutional based study was conducted. The advantage
of this study was the ease of Data Collection containing
similar ethnicity with the involvement of both the genders. Ethical
clearance was obtained from the institutional ethical committee.
We reviewed and analysed the data of 86000 patients visiting
an institutional dental hospital from June 2019 to March 2020,
among which 158 children in the age group of 7-18 yrs who had
dental trauma were examined. Data was collected from the patient
records maintained by the hospital and was then tabulated in excel
and then imported into SPSS software. Incomplete data was verified
with the concerned department or patient or excluded from
the study.
Documented information included patients’ age, gender, dental
status, tooth involved, type of trauma, etiology of trauma and the
type of treatment done.
A statistical test was done using a chi-square test with SPSS by
IBM. Independent variables included age and gender of the participants,
whereas the dependent variables included the type of
trauma and the aetiology of trauma. All of these were analysed
using correlation and association.
Results
A total of 158 patients had a history of dental trauma, among
them 75.3% were predominantly of males. The prevalence of
dental trauma was higher among the age group of 11-14 years with 43% (Table 1). The prevalence of permanent teeth being
affected by dental trauma was predominant with 96.2% (Graph
1). According to the etiology of trauma, fall was the predominant
reason for trauma with 95.56% prevalence followed by violence
(3.8%) and road traffic accidents accounted for 0.6% of the cases
(Graph 2). Time between the date of trauma and the date of consultation
differs between patients. Delay of less than 10 days was
the most predominant with 43.04% followed by a delay of more
than 30 days (42.31%) (Graph 3). Tooth fracture was predominantly
high among patients with fall as the etiology of trauma
(74.05%) followed by violence (3.8%) and RTA (0.63%). Predominance
of tooth fracture was followed by avulsion with 7.59%
among patients with fall as the etiology of trauma (Graph 4). In
terms of the treatment required, prevalence of RCT was predominantly
high among the study population with 28.48% performed
on fractured teeth and 2.53% on non-vital teeth followed by restoration.
The association between the type of treatment and type
of trauma caused was found to be statistically significant with a p
value <0.05 (Graph 5). According to the type of trauma, patients
among the age group of 7-10 yrs and 11-14 yrs most frequently
had tooth fracture 31.65% and 25.32% respectively (Graph 6).
In accordance to gender, the prevalence of tooth fracture was most predominant among males (62.03%) than females (16.46%)
(Graph 7).
Graph 1: Bar chart represents the frequency distribution of the type of teeth affected by dental trauma among the study population. X axis denotes the type of tooth involved and Y axis denotes the number of patients in terms of percentage. The prevalence of permanent teeth being affected by dental trauma was predominant with 96.2%.
Graph 2: Bar chart represents the frequency distribution of the aetiology of trauma among the study population. X axis denotes the aetiology of trauma and Y axis denotes the number of patients in terms of percentage. According to the aetiology of trauma, the prevalence of fall (grey) was the most predominant among the study population with 95.57% followed by violence (violet) (3.80%) and the least frequent being the road traffic accidents (RTA) denoted by black with 0.63%.
Graph 3: Bar chart represents the frequency distribution of consultation delay among the study population. X axis denotes the consultation delay in terms of days and Y axis denotes the number of patients in terms of percentage. The prevalence of consultation delay less than 10 days (pink) was the most predominant with 43.04% followed by a delay of more than 30 days (42.31%) denoted by teal.
Graph 4: Bar chart denotes the association of the type of trauma caused based on the etiology of trauma. X axis denotes the type of trauma based on the aetiology of trauma and Y axis denotes the number of teeth injured. The prevalence of tooth fracture was predominantly high among the study population followed by avulsion. However the association between the etiology and type.
Graph 5: Bar chart denotes the correlation of the type of treatment done based on the type of trauma. X axis denotes the type of treatment done based on the type of trauma and Y axis denotes the number of patients. The prevalence of RCT was predominantly high among the study population followed by restoration. The association between the type of treatment and type of trauma caused was found to be statistically significant with a p value <0.05. Pearson Chi Square= 558.824, df= 60, p value=0.000 (<0.05).
Graph 6: Bar chart denotes the association of the type of trauma based on the age group of the study population. X axis denotes the type of trauma based on the age group of the population and Y axis denotes the number of teeth injured. The prevalence of tooth fracture was most predominant among 11-14 yrs followed by 7-10 yrs. The association between the type of trauma and the age group of the population was found to be statistically significant with a p value <0.05. Pearson Chi Square= 26.761, df= 12, p value=0.008 (<0.05).
Graph 7: Bar chart denotes the association of the type of trauma based on gender of the study population. X axis denotes the type of trauma based on gender and Y axis denotes the number of teeth injured. The prevalence of tooth fracture was most predominant among males than females. The association between the type of trauma and gender was found to be statistically significant with a p value <0.05. Pearson Chi Square= 13.851, df= 6, p value=0.031 (<0.05).
Table 1: Describes the distribution of study population based on Age and Gender. It is found that the majority of the participants had been subjected to dental trauma at the age of 11-14 yrs.
Discussion
The present study showed that males had greater risk for traumatic
dental issues than the female population, which is in agreement
with the other studies(Ekanayake and Perera, 2008 [9]; Gulinelli
et al., 2008 [20]; Lam et al., 2008 [29]; Noori and Al-Obaidi, 2009
[37]; Lauridsen et al., 2012 [31]; Bücher et al., 2013 [5]; Borin-
Moura et al., 2018 [4]). Higher prevalence in males among the
children can be attributed to their involvement in certain activities
like sports and also due to their violent nature of behaviour.
In our study 96% of the dental trauma was caused due to fall.
This was in agreement with Kavre’s study done by Dr. Deepti
Shrestha et al., reporting fall 43.8% being the majority of the aetiology
of the trama, in accordance with another study conducted
in Palestine by Vaida Zaleckiene et al., which had 64.2% of the
etiology as fall. This could be explained by the fact that the children
as a whole, usually get involved in fighting and boys in general
engage themselves more in contact sports. Whereas, girls at
this age display maturity or mature behaviour and tend to engage
themselves in passive games [38, 26, 46].
In the present study, it was observed that children among the age
group of 11-14 years experienced more trauma than the children
of other age groups. This result differed from those of Ohio et
al. [38, 26, 46], who reported those three quarters of the injuries
caused by trauma occurred between 10-12 years of age. Whereas,
the results correlated and differed with those of Murithi et al.
[35], who found 5.3% of 12 years old children to have experienced
dental traumas more than those of 13 years (4%). 14 years
(3.6%) and 15 years (3.6%) having lower prevalence. It is notable
that Muriithi’s study was hospital based and the duration elapsed
since when the injury occurred 55.6% of 13 years old in the current
study reported to have been more than a year ago, which
mean injury occurred at 12 years or younger and thus they might
have been injured in 10-12 years of age bracket.
Majority of the children who had traumatic dental injuries had
not sought any treatment following injury, this finding is in agreement
with the study by AI-Khateeb et al. [1], in Jordan. The permanent
teeth are more prone to fracture than luxate when injured
as compared to primary teeth, because the permanent teeth are
firmly embedded in the alveolar bone.
Maxillary central incisors or the permanent tooth in general
(96.2%) were the most affected teeth in dental trauma. Similar
findings have been reported by Vaida Zaleckiene et al., involves
66.7% of the trauma affecting the maxillary incisors. This can be
explained by the location of teeth which is most vulnerable and
also its morphology. This finding is very important as their incisors
play an important role in the children’s aesthetic, functional
activities and phonetics.
Our institution is passionate about high quality evidence based
research and has excelled in various fields ( (Pc, Marimuthu and
Devadoss, 2018 [45]; Ramesh et al., 2018 [49]; Vijayashree Priyadharsini,
Smiline Girija and Paramasivam, 2018 [60]; Ezhilarasan,
Apoorva and Ashok Vardhan, 2019 [11]; Ramadurai et al., 2019
[47]; Sridharan et al., 2019 [56]; Vijayashree Priyadharsini, 2019
[59]; Chandrasekar et al., 2020 [6]; Mathew et al., 2020 [33]; R et al., 2020 [51]; Samuel, 2021 [52]). We hope this study adds to this
rich legacy.
The limitation of the study conducted includes the reduction or
availability of the data, the unequal distribution of the cases and
the unavailability of location specific datas. Hence, the results of
this study must be interpreted within the limitations of this study
and further cohort studies must be done including larger data size.
Such study should also include the other associated parameters
like abuse, physical limitations, environmental factors, etc.
Conclusion
Within the limits of the study, overall occurrence of dental trauma
was predominantly higher among males than females. Falls
were the leading cause of trauma with permanent incisor being
affected the most. Long term prognosis of the tooth depends on
the treatment and immediate consultation. Treatment of dental
injuries is usually delayed and not given as much attention as other
treatments which can explain the occurrence of pulpal and periodontal
complications.
References
-
[1]. Abitha T, Santhanam A. Correlation between bizygomatic and maxillary
central incisor width for gender identification. Brazilian Dental Science.
2019 Oct 31;22(4):458-66.
[2]. Oliveira Alves MG, Almeida JD, Balducci I, Guimarães Cabral LA. Oral lichen planus: A retrospective study of 110 Brazilian patients. BMC Res Notes. 2010 Jun 3;3:157. Pubmed PMID: 20525297.
[3]. Azeem RA, Sureshbabu NM. Clinical performance of direct versus indirect composite restorations in posterior teeth: A systematic review. J Conserv Dent. 2018 Jan-Feb;21(1):2-9. Pubmed PMID: 29628639.
[4]. Campisi G, Giovannelli L, Aricò P, Lama A, Di Liberto C, Ammatuna P, D'Angelo M. HPV DNA in clinically different variants of oral leukoplakia and lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Dec;98(6):705-11. Pubmed PMID: 15583544.
[5]. Chainani-Wu N, Silverman S Jr, Lozada-Nur F, Mayer P, Watson JJ. Oral lichen planus: patient profile, disease progression and treatment responses. J Am Dent Assoc. 2001 Jul;132(7):901-9. doi: 10.14219/jada.archive. 2001.0302. PMID: 11480643.
[6]. Chandrasekar R, Chandrasekhar S, Sundari KKS, Ravi P. Development and validation of a formula for objective assessment of cervical vertebral bone age. Prog Orthod. 2020 Oct 12;21(1):38. Pubmed PMID: 33043408.
[7]. Chen F, Tang Y, Sun Y, Veeraraghavan VP, Mohan SK, Cui C. 6-shogaol, a active constiuents of ginger prevents UVB radiation mediated inflammation and oxidative stress through modulating NrF2 signaling in human epidermal keratinocytes (HaCaT cells). J Photochem Photobiol B. 2019 Aug;197:111518. Pubmed PMID: 31202076.
[8]. Chen QM, Deng JX, Zeng X. [Development and chinization of diagnostic criteria for oral lichen planus]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2020 Mar 9;55(3):191-195. Chinese. Pubmed PMID: 32193918. [9]. Costa NL, Gonçalves JAM, de Lima SLG, de Arruda JAA, Miranda ACC, Mesquita RA, da Silveira ÉJD, Batista AC. Evaluation of PD-L1, PD-L2, PD-1 and cytotoxic immune response in oral lichen planus. Oral Dis. 2020 Apr 7. Pubmed PMID: 32259363.
[10]. Crincoli V, Di Bisceglie MB, Scivetti M, Lucchese A, Tecco S, Festa F. Oral lichen planus: update on etiopathogenesis, diagnosis and treatment. Immunopharmacol Immunotoxicol. 2011 Mar;33(1):11-20. Pubmed PMID: 20604639.
[11]. Day T, Wilkinson E, Rowan D, Scurry J; ISSVD Difficult Pathologic Diagnoses Committee*. Clinicopathologic Diagnostic Criteria for Vulvar Lichen Planus. J Low Genit Tract Dis. 2020 Jul;24(3):317-329. PMID: 32205763.
[12]. Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol. 2002 Feb;46(2):207-14. Pubmed PMID: 11807431.
[13]. Ezhilarasan D, Apoorva VS, Ashok Vardhan N. Syzygium cumini extract induced reactive oxygen species-mediated apoptosis in human oral squamous carcinoma cells. J Oral Pathol Med. 2019 Feb;48(2):115-121. Pubmed PMID: 30451321.
[14]. Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol. 2010 Jan-Feb;28(1):100-8. Pubmed PMID: 20082959. [15]. Gheena S, Ezhilarasan D. Syringic acid triggers reactive oxygen species-mediated cytotoxicity in HepG2 cells. Hum Exp Toxicol. 2019 Jun;38(6):694- 702. Pubmed PMID: 30924378.
[16]. Govindaraju L, Neelakantan P, Gutmann JL. Effect of root canal irrigating solutions on the compressive strength of tricalcium silicate cements. Clin Oral Investig. 2017 Mar;21(2):567-571. Pubmed PMID: 27469101.
[17]. Gupta V, Ramani P. Histologic and immunohistochemical evaluation of mirror image biopsies in oral squamous cell carcinoma. J Oral Biol Craniofac Res. 2016 Sep-Dec;6(3):194-197. Pubmed PMID: 27761383.
[18]. Hannah R, Ramani P, Sherlin HJ, Ranjith G, Ramasubramanian A, Jayaraj G, Don KR, Archana S. Awareness about the use, ethics and scope of dental photography among undergraduate dental students dentist behind the lens. Res J Pharm Technol. 2018;11(3):1012-6.
[19]. Hasan S. Lichen planus of lip - Report of a rare case with review of literature. J Family Med Prim Care. 2019 Mar;8(3):1269-1275. Pubmed PMID: 31041290. [20]. Jablonska E, Garley M, Surazynski A, Grubczak K, Iwaniuk A, Borys J, Moniuszko M, Ratajczak-Wrona W. Neutrophil extracellular traps (NETs) formation induced by TGF-ß in oral lichen planus - Possible implications for the development of oral cancer. Immunobiology. 2020 Mar;225(2):151901. Pubmed PMID: 31882256.
[21]. Jangid K, Alexander AJ, Jayakumar ND, Varghese S, Ramani P. Ankyloglossia with cleft lip: A rare case report. J Indian Soc Periodontol. 2015 Nov- Dec;19(6):690-3. Pubmed PMID: 26941523.
[22]. Jayaraj G, Sherlin HJ, Ramani P, Premkumar P, Anuja N. Cytomegalovirus and Mucoepidermoid carcinoma: A possible causal relationship? A pilot study. J Oral Maxillofac Pathol. 2015 Sep-Dec;19(3):319-24. Pubmed PMID: 26980959.
[23]. Jayaraj G, Ramani P, Sherlin HJ, Premkumar P, Anuja N. Inter-observer agreement in grading oral epithelial dysplasia–A systematic review. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2015 Jan 1;27(1):112-6.
[24]. Jayaraj G, Sherlin HJ, Ramani P, Premkumar P, Natesan A. Stromal myofibroblasts in oral squamous cell carcinoma and potentially malignant disorders. Indian J Cancer. 2015 Jan-Mar;52(1):87-92. Pubmed PMID: 26837985.
[25]. Kämmerer, P. (no date) ‘QUANTIFIABLE ANGIOGENESIS PARAMETERS IN ASSOCIATION WITH THE GRADUAL MALIGNANT TRANSFORMATION AND THE PROGNOSIS OF LEUKOPLAKIADERIVED ORAL SQUAMOUS CELL CARCINOMA’.
[26]. Krasowska D, Pietrzak A, Surdacka A, Tuszynska-Bogucka V, Janowski K, Rolinski J. Psychological stress, endocrine and immune response in patients with lichen planus. Int J Dermatol. 2008 Nov;47(11):1126-34. Pubmed PMID: 18986442.
[27]. Liu W, Ma L, Song C, Li C, Shen Z, Shi L. Research trends and characteristics of oral lichen planus: A bibliometric study of the top-100 cited articles. Medicine (Baltimore). 2020 Jan;99(2):e18578. Pubmed PMID: 31914037. [28]. Lozada-Nur F, Miranda C. Oral lichen planus: epidemiology, clinical characteristics, and associated diseases. Semin Cutan Med Surg. 1997 Dec;16(4):273-7. Pubmed PMID: 9421218. [29]. Manohar J. A Study on the Knowledge of Causes and Prevalance of Pigmentation of Gingiva among Dental Students. Indian J Pub Health Res Dev. 2019 Aug 1;10(8).
[30]. Mathew MG, Samuel SR, Soni AJ, Roopa KB. Evaluation of adhesion of Streptococcus mutans, plaque accumulation on zirconia and stainless steel crowns, and surrounding gingival inflammation in primary molars: randomized controlled trial. Clin Oral Investig. 2020 Sep;24(9):3275-3280. Pubmed PMID: 31955271.
[31]. Munde AD, Karle RR, Wankhede PK, Shaikh SS, Kulkurni M. Demographic and clinical profile of oral lichen planus: A retrospective study. Contemp Clin Dent. 2013 Apr;4(2):181-5. Pubmed PMID: 24015006.
[32]. Murti PR, Daftary DK, Bhonsle RB, Gupta PC, Mehta FS, Pindborg JJ. Malignant potential of oral lichen planus: observations in 722 patients from India. J Oral Pathol. 1986 Feb;15(2):71-7. Pubmed PMID: 3083065. [33]. Muthukrishnan A, Warnakulasuriya S. Oral health consequences of smoke less tobacco use. Indian J Med Res. 2018 Jul;148(1):35-40. Pubmed PMID: 30264752.
[34]. Prasad TS, Nair AK, Sreela LS. Oral Lichen Planus-Clinical and Psychological Stress Profile-A Preliminary Study.
[35]. Nosratzehi T. Oral Lichen Planus: an Overview of Potential Risk Factors, Biomarkers and Treatments. Asian Pac J Cancer Prev. 2018 May 26;19(5):1161-1167. Pubmed PMID: 29801395.
[36]. Ozbagcivan O, Akarsu S, Semiz F, Fetil E. Comparison of serum lipid parameters between patients with classic cutaneous lichen planus and oral lichen planus. Clin Oral Investig. 2020 Feb;24(2):719-725. Pubmed PMID: 31129877.
[37]. Palati S, Ramani P, Shrelin HJ, Sukumaran G, Ramasubramanian A, Don KR, Jayaraj G, Santhanam A. Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes. Indian J Dent Res. 2020 Jan-Feb;31(1):22-25. Pubmed PMID: 32246676.
[38]. Paramasivam A, Vijayashree Priyadharsini J, Raghunandhakumar S. N6- adenosine methylation (m6A): a promising new molecular target in hypertension and cardiovascular diseases. Hypertens Res. 2020 Feb;43(2):153- 154. Pubmed PMID: 31578458.
[39]. J PC, Marimuthu T, C K, Devadoss P, Kumar SM. Prevalence and measurement of anterior loop of the mandibular canal using CBCT: A cross sectional study. Clin Implant Dent Relat Res. 2018 Aug;20(4):531-534. Pubmed PMID: 29624863.
[40]. Vijayashree Priyadharsini J, Smiline Girija AS, Paramasivam A. In silico analysis of virulence genes in an emerging dental pathogen A. baumannii and related species. Arch Oral Biol. 2018 Oct;94:93-98. Pubmed PMID: 30015217.
[41]. Priyanka S, Kaarthikeyan G, Nadathur JD, Mohanraj A, Kavarthapu A. Detection of cytomegalovirus, Epstein-Barr virus, and Torque Teno virus in subgingival and atheromatous plaques of cardiac patients with chronic periodontitis. J Indian Soc Periodontol. 2017 Nov-Dec;21(6):456-460. Pubmed PMID: 29551863.
[42]. Rakhshan A, Toossi P, Amani M, Dadkhahfar S, Hamidi AB. Different distribution patterns of plasmacytoid dendritic cells in discoid lupus erythematosus and lichen planopilaris demonstrated by CD123 immunostaining. An Bras Dermatol. 2020 May-Jun;95(3):307-313. Pubmed PMID: 32299739.
[43]. Ramadurai N, Gurunathan D, Samuel AV, Subramanian E, Rodrigues SJL. Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial. Clin Oral Investig. 2019 Sep;23(9):3543-3550. Pubmed PMID: 30552590.
[44]. Ramesh A, Varghese S, Jayakumar ND, Malaiappan S. Comparative estimation of sulfiredoxin levels between chronic periodontitis and healthy patients - A case-control study. J Periodontol. 2018 Oct;89(10):1241-1248. Pubmed PMID: 30044495.
[45]. R H, Ramani P, Ramanathan A, R JM, S G, Ramasubramanian A, K M. CYP2 C9 polymorphism among patients with oral squamous cell carcinoma and its role in altering the metabolism of benzo[a]pyrene. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Sep;130(3):306-312. Pubmed PMID: 32773350.
[46]. SA Anandan S, Prasanthi G. Oral Lichen Planus. Lichen Planus. 2013:97– 97.
[47]. Sachdev R, et al. Demographic Prevalence of Oral Lichen Planus in Males: A Retrospective Study. Acta Scientific Dental Sciences. 2019;3(8):111–114. [48]. Samuel SR. Can 5-year-olds sensibly self-report the impact of developmental enamel defects on their quality of life? Int J Paediatr Dent. 2021 Mar;31(2):285-286. Pubmed PMID: 32416620.
[49]. Samuel SR, Acharya S, Rao JC. School Interventions-based Prevention of Early-Childhood Caries among 3-5-year-old children from very low socioeconomic status: Two-year randomized trial. J Public Health Dent. 2020 Jan;80(1):51-60. Pubmed PMID: 31710096.
[50]. Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg. 2008 Jan;46(1):15-21. Pubmed PMID: 17822813.
[51]. Kumar A, Sherlin HJ, Ramani P, Natesan A, Premkumar P. Expression of CD 68, CD 45 and human leukocyte antigen-DR in central and peripheral giant cell granuloma, giant cell tumor of long bones, and tuberculous granuloma: An immunohistochemical study. Indian J Dent Res. 2015 May- Jun;26(3):295-303. Pubmed PMID: 26275199.
[52]. Hema Shree K, Ramani P, Sherlin H, Sukumaran G, Jeyaraj G, Don KR, Santhanam A, Ramasubramanian A, Sundar R. Saliva as a Diagnostic Tool in Oral Squamous Cell Carcinoma - a Systematic Review with Meta Analysis. Pathol Oncol Res. 2019 Apr;25(2):447-453. Pubmed PMID: 30712193.
[53]. Sitharthan R, Sundarabalan CK, Devabalaji KR, Yuvaraj T, Mohamed Imran A. Automated power management strategy for wind power generation system using pitch angle controller. Measurement and Control. 2019 Mar;52(3-4):169-82.
[54]. Sivaramakrishnan SM, Ramani P. Study on the Prevalence of Eruption Status of Third Molars in South Indian Population [Internet]. Vol. 07, Biology and Medicine. 2015.
[55]. Sridharan G, Ramani P, Patankar S, Vijayaraghavan R. Evaluation of salivary metabolomics in oral leukoplakia and oral squamous cell carcinoma. J Oral Pathol Med. 2019 Apr;48(4):299-306. Pubmed PMID: 30714209.
[56]. Sridharan G, Ramani P, Patankar S, Vijayaraghavan R. Evaluation of salivary metabolomics in oral leukoplakia and oral squamous cell carcinoma. J Oral Pathol Med. 2019 Apr;48(4):299-306. Pubmed PMID: 30714209.
[57]. Sridharan G, Ramani P, Patankar S. Serum metabolomics in oral leukoplakia and oral squamous cell carcinoma. J Cancer Res Ther. 2017 Jul- Sep;13(3):556-561. Pubmed PMID: 28862226.
[58]. Swathy S, Gheena S, Varsha SL. Prevalence of pulp stones in patients with history of cardiac diseases. Res J Pharm Technol. 2015;8(12):1625-8.
[59]. Thangaraj SV, Shyamsundar V, Krishnamurthy A, Ramani P, Ganesan K, Muthuswami M, Ramshankar V. Molecular Portrait of Oral Tongue Squamous Cell Carcinoma Shown by Integrative Meta-Analysis of Expression Profiles with Validations. 2016 Jun 9;11(6):e0156582. Pubmed PMID: 27280700.
[60]. Thorn JJ, Holmstrup P, Rindum J, Pindborg JJ. Course of various clinical forms of oral lichen planus. A prospective follow-up study of 611 patients. J Oral Pathol. 1988 May;17(5):213-8. Pubmed PMID: 3144584.
[61]. Varghese SS, George GB, Sarojini SB, Vinod S, Mathew P, Mathew DG, Sebastian J, George A. Epidemiology of Oral Lichen Planus in a Cohort of South Indian Population: A Retrospective Study. J Cancer Prev. 2016 Mar;21(1):55-9. Pubmed PMID: 27051650.
[62]. Venu H, Raju VD, Subramani L. Combined effect of influence of nano additives, combustion chamber geometry and injection timing in a DI diesel engine fuelled with ternary (diesel-biodiesel-ethanol) blends. Energy. 2019 May 1;174:386-406.
[63]. Vijayashree Priyadharsini J. In silico validation of the non-antibiotic drugs acetaminophen and ibuprofen as antibacterial agents against red complex pathogens. J Periodontol. 2019 Dec;90(12):1441-1448. Pubmed PMID: 31257588.
[64]. Viveka TS, Shyamsundar V, Krishnamurthy A, Ramani P, Ramshankar V. p53 Expression Helps Identify High Risk Oral Tongue Pre- malignant Lesions and Correlates with Patterns of Invasive Tumour Front and Tumour Depth in Oral Tongue Squamous Cell Carcinoma Cases. Asian Pac J Cancer Prev. 2016;17(1):189-95. Pubmed PMID: 26838208.
[65]. Wang F, Tan YQ, Zhang J, Zhou G. Insulin-like growth factor 1 exhibits the pro-autophagic and anti-apoptotic activity on T cells of oral lichen planus. Int J Biol Macromol. 2019 Jul 15;133:640-646. Pubmed PMID: 31026523.
[66]. Wang Y, Zhang Y, Guo Y, Lu J, Veeraraghavan VP, Mohan SK, Wang C, Yu X. Synthesis of Zinc oxide nanoparticles from Marsdenia tenacissima inhibits the cell proliferation and induces apoptosis in laryngeal cancer cells (Hep-2). J Photochem Photobiol B. 2019 Dec;201:111624. Pubmed PMID: 31722283.
[67]. Jayaraj G, Sherlin HJ, Ramani P, Premkumar P, Natesan A. Stromal myofibroblasts in oral squamous cell carcinoma and potentially malignant disorders. Indian J Cancer. 2015 Jan-Mar;52(1):87-92. Pubmed PMID: 26837985.
[68]. Wu F, Zhu J, Li G, Wang J, Veeraraghavan VP, Krishna Mohan S, Zhang Q. Biologically synthesized green gold nanoparticles from Siberian ginseng induce growth-inhibitory effect on melanoma cells (B16). Artif Cells Nanomed Biotechnol. 2019 Dec;47(1):3297-3305. Pubmed PMID: 31379212.
