Oral submucous fibrosis (OSF) is a premalignant condition caused by betel chewing. It is very common in Southeast Asia but has started to spread to Europe and North America. OSF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption. OSF is a diagnosis based on clinical symptoms and confirmation by histopathology. Hypovascularity leading to blanching of the oral mucosa, staining of teeth and gingiva, and trismus are major symptoms. Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrosis. A variety of extracellular and intracellular signaling pathways might be involved. Treatment of OSF is difficult, as not many large, randomized controlled trials have been conducted. The principal actions of drug therapy include antifibrotic, anti-inflammatory, and antioxygen radical mechanisms. Potential new drugs are on the horizon. Surgery may be necessary in advanced cases of trismus. Prevention is most important, as no healing can be achieved with available treatments.

The occurrence of OSMF is related to areca nut and its products. The duration and frequency of its use and type of areca nut product has effect on the incidence and severity of OSMF. Gutkha and pan masala have more deleterious and faster effects on oral mucosa. The gutkha-chewing habit along with the other habits does not have any significant effect on the rate of occurrence and incidence and severity of the OSMF.

Oral submucous fibrosis is a chronic insidious disease and is well-recognized as a premalignant condition. It is a collagen related disorder associated with betel quid chewing and characterized by progressive hyalinization of the submucosa. The oral submucous fibrosis needs to be differentiated from scleroderma showing oral manifestations, as these diseases have different pathogenesis and prognostic aspects. The patients of oral submucous fibrosis can approach the dermatologist. The aim of this article is to present concise overview of the disease and its dermatological relation.

Background:Trigeminal neuralgia is a commonly diagnosed neurosensory disease of head, neck and face region, involving 5th cranial nerve. Carbamazepine is the first line drug if there is decrease in efficacy or tolerability of medication, surgery needs to be considered. Factors such as pain relief, recurrence rates, morbidity and mortality rates should be taken in to account while considering which technique to use. Peripheral neurectomy is a safe and effective procedure for elderly patients and in rural and remote centers where neurosurgical facilities are not available. It is also effective in those patients who are reluctant for major neurosurgical procedures. Although loss of sensation along the branches of trigeminal nerve and recurrence rate are associated with peripheral neurectomy, we consider it as the safe and effective procedure in rural practice, which can be done under local anesthesia.Aims:The aim of this prospective study is to evaluate the long term efficacy of peripheral neurectomy with and without the placement of stainless steel screws in the foramina and to calculate the mean remission period after peripheral neurectomies for different branches of trigeminal nerve.Setting and Design:The sample was divided into 2 groups by selecting randomly the patients, satisfying inclusion criteria. Both groups were operated under local anesthesia by regional nerve blocks. In one group of patients after peripheral neurectomy, the proximal nerve stump was left alone in the foramina, and in another group of patients, obturation of foramina was done with stainless steel screws after peripheral neurectomy.Materials and Methods:Peripheral neurectomy was done on the terminal branches of trigeminal nerve in 14 patients. We selected only those cases that were experiencing pain after Carbamazepine therapy, all our patients were from rural and remote areas where facilities to neurosurgical centers are limited. Elderly patients who were unfit for surgical procedures and those patients who were reluctant for major neurosurgical treatments were considered for the study.Results:Post-surgical pain relief varied from 15 months to 24 months in cases where neurectomy was done without placing stainless steel screws in the foramina. Those cases where peripheral neurectomy was done along with the placement of stainless steel screws in the foramina, none of the patient had painful symptoms even after minimum 2 years of follow-up. Student's `t`-test of 2 groups showed the remission period to be statistically highly significant in patients with stainless steel screw obturation, having P-value <0.0005.Obturating the foramen with stainless steel screws can prevent nerve regeneration. Thus, remission of pain can be prolonged.Conclusion:Peripheral neurectomy is thus a safe and effective procedure for elderly patients, for those patients living in remote and rural places that cannot avail major neurosurgical facilities, and for those patients who are reluctant for major neurosurgical procedures.

Medical emergencies are one of the most stressful situations the staff in a dental practice might encounter. The duty of care toward the attending patients obligates suitable preparedness to provide the necessary care if such emergencies ensue. Unfortunately, we found that 22% of the investigated dental clinics had no emergency kit available. Only 38% of the interviewed dentists felt confident to perform CPR, and 18% had no confidence to manage any medical emergency. An MCQ test of 20 questions examining the dentists' knowledge in medical emergencies was distributed, and the level of knowledge was found to be suboptimal. The average score of the interviewed dentists was 10.87 out of 20. Experience and specialty training had a negligible effect on the level of knowledge.