Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2010 | Month : December | Volume : 4 | Issue : 6 | Page : 3664 - 3669

Misdiagnosis In Exodontia-Our Experience

SHALLU BANSAL* ,RAJESH SINGHLA**

*Assistant professor, Department of oral & maxillofacial surgery, Surendera dental college and research institute . ** professor, Department of oral & maxillofacial surgery Surendera dental college and research institute .

Correspondence Address :
Dr. Bansal shallu. Mds,
H. H. Garden, power house road,
Sriganganagar-335001
Rajasthan, india
Ph: +91-9414343004
Fax: +91-154-2440102
Email: drshallu23@yahoo.com

Abstract

Exodontia is a common dental procedure which is routinely dispensed in our practice. Although the extraction of the tooth has become, in most of the cases, the last resort of treatment, dentists often consider tooth extraction as a minor and unimportant procedure.
Sometimes dental surgeons attempt extraction without doing proper diagnosis, hoping that all will go well, but it can become an expensive lesson in ‘chasing without catching’.
This paper is designed for general dental practitioners who desire to improve and want to obtain a wide variety of practical clinical information. In this paper, we are presenting the cases which are misdiagnosed and are negligently handled by the local dental practitioners.

Keywords

exodontia, misdiagnosis, extraction

INTRODUCTION
Misdiagnosis in exodontia can and does occur at a reasonable rate in our day to day practice. Definite diagnosis is the most essential part of the treatment. The most fascinating thing about the diagnosis is that it can be like solving a Sherlock Holmes detective mystery; the evidence of the disease is obvious, but the clues to the actual causes are so subtle that they may be overlooked, so that any mobile tooth should not be underestimated as they can be having some underlying pathology. It is prudent to confirm a diagnosis via methods such as taking a proper history and by seeking a second opinion.
According to Geoffrey. L. Howe, “The ideal tooth extraction is the painless removal of the whole tooth or the tooth root with minimal trauma to the investigating tissue, so that the wound heals uneventfully and no post operative prosthetic problem is created.” (1)

The dental surgeon should endeavour to make every tooth extraction that he performs, an ideal one. Before undertaking the extraction of the tooth, one should thoroughly evaluate the problems which are involved. (2)

The dental practitioner must conduct a thorough clinical and radiological examination the particular areas that are affected. Here, we are presenting a few cases reports where a misdiagnosis was made in the routinely dispensed exodontia procedure. The purpose of this paper is to demonstrate that good clinical judgment prevails before recommending any excessively herotic treatment plan. It is a simple attempt to add to the contemporary knowledge of the ideal treatment of this kind of routinely done minor dental procedures.

Case Report

Case 1
A 62 years old male reported with a complaint of ulcer in his left lower back tooth region since 15 days (Table/Fig 1). His past dental history revealed the extraction of the painful and mobile left lower premolars; 15 days back. His detailed history revealed that he had mobility and pain in that particular area since one month. His personal history was suggestive that he was a bidi smoker and a chronic alcoholic. On clinical examination, it was found that there was an ulcerative growth (appx. 1.5 x 1cm) extending from 33 to 36. The ipsilateral submandibular lymph nodes were palpable and tender, but not fixed. The OPG (Table/Fig 2) showed a diffused radiolucency with respect to 34 and 35.. The medical history was unremarkable. A provisional diagnosis of CA alveolus was made and an incisional biopsy was performed, which confirmed moderately differentiated squamous cell carcinoma. The patient was then operated for segmental resection and supraomohyoid neck dissection and is under follow up.
Case 2
A 48 years old male patient was referred by a local dental practitioner for an unhealing wound after extraction in the right lower back tooth region. (Table/Fig 3) The patient gave a history of extraction with respect to that area app. 30-40 days back, due to the mobility of the tooth and difficulty in chewing in that particular region. He was being treated for dry socket. His detailed medical history revealed that he was diagnosed to have carcinoma of the larynx one year back and was treated with radiotherapy for the same. The last dose of radiation was given 5 months back.

On clinical examination, it was found that there was a necrotic bone in relation to 46, 47 and 48. A provisional diagnosis of osteoradionecrosis was made. A radiographical examination was done and the patient was explained about the condition. After getting the general physician’s consent, a gentle curettage of the necrotic mass was done under antibiotic coverage and with thorough irrigation (Table/Fig 4). At six months of follow up, it was observed that there was no recurrence (Table/Fig 5).
Case 3
A 35 years old female reported to our department with the complaint of pain and swelling in relation to the right lower part of the face since 10 days. (Table/Fig 6) The patient gave a history of extraction in relation to the right lower back tooth region 15 days back. On clinical examination, it was found that there was a soft fluctuant swelling of app. 2x1.5 cm on the right lower third of the face and intraorally, there was a healing wound in relation to the 46 socket. No abnormality was detected in the surrounding tooth structures. The OPG (Table/Fig 7) showed a carious impacted right lower molar. Her medical history and blood investigations were within the normal limits. A diagnosis of periapical abscess, secondarily due to a carious impacted molar, was made. The impacted carious tooth was surgically removed and I and D was done for the extra oral abscess (Table/Fig 8). Within 7 days, the patient was free of the signs and symptoms. (Table/Fig 9)
Case 4
One of the most commonly misdiagnosed cases in exodontia is the case of trigeminal neuralgia. A 65 years old male patient, with a history of multiple extractions of the teeth, reported to our department with a chief complaint of pain in relation to the right lower back tooth region since 8-9 months (Table/Fig 10) and [Table/Fig 11]. His detailed history revealed that the pain was sharp shooting in nature, was intermittent and was radiating towards the ipsilateral temporal region from the right lower back tooth region. The aggravating factor for the pain was the chewing of food on the same side, which was relieved after some time. A selective nerve block with local anaesthetic infiltration (2% xylocaine; 1:80,000) confirmed the diagnosis of trigeminal neuralgia. The patient was then prescribed carbamezapine therapy (200mg- tds dose) after the routine blood investigations. Presently, the patient is on follow up, with no symptoms of recurrence.

Discussion

The extraction of teeth is an important technique and a skill that many practitioners will not be able to master by practice and experience alone. (3) The extraction procedure must incorporate a thorough health history and a review of the systems before the dental treatment begins. As the general population ages, the patients who require extraction may present additional challenges which are secondary to their medical treatment. (4),(5)

Before the initiation of tooth extraction, a thorough clinical and radiographical examination of the area is essential. The clinical inspection of the area where the object tooth or teeth are located is simply not enough. Instead, an oral examination with an emphasis on the object tooth or teeth is required. The practitioner should examine the patient’s ability to open the mouth completely. Any swelling, lump and subtle changes in the gingival or other surrounding tooth structures should not be overlooked.

A radiograph of the object teeth is essential before the extraction is performed. Irrespective of whether the radiograph is of panoramic or periapical view, it must show the entire tooth and the surrounding bone for inspection. The bone in the area of the object tooth should also be examined radiologically and abnormal radiolucencies and radiopacities should be noted and investigated. The time spent with the patient, seeking a second opinion and thorough examination is important to reach a certain diagnosis. (6)

In our cases, the local practitioners have missed one or another part before performing any treatment plan. In our first case, some subtle changes might have been present, which were suggestive of the tumour which had been overlooked. The extraction of the tooth which is associated with the tumour can be problematic. Irrespective of whether the tumour is benign or malignant, it is important to have a treatment plan before the extraction. If the teeth which are associated with the tumour are improperly treated, it can result in recurrence of the tumour and can cause further damage to the nearby associated structures. In the case of known malignant tumours, no teeth should ever be removed because the surgical insult could cause the dissemination of the cells and thereby hasten the metastatic process.

In our second case, the patient went for radiotherapy about which the dental practitioner was not aware. Extraction is contraindicated in the irradiated area before 6 months, as ORN is likely to develop due to alteration in the blood flow to the tissue and it diminishes the flow of saliva from the glands. Hyperbaric oxygen therapy can assist the damaged tissues in their attempt to be healed (7),(8), and (19). If a patient requires the removal of a tooth from an irradiated region, the tooth should be removed as atraumatically as possible, and a small mucoperiosteal flap should be developed to gain primary closure. Post radiation extractions in the maxilla have a less chance of developing ORN than those in the mandible, owing to the cancellous nature of the bone and the collateral blood supply to the region. The decreased blood supply to the bone is permanent and does not improve with time and so, the dentist should consider HBO (hyper baric oxygen) therapy.

The focus of infection refers to a circumscribed area of the tissue which is infected with exogenous pathogenic microorganisms and is usually located near a mucous or cutaneous surface. There may be single or multiple foci of infection. (10) In our subsequent case, we were having multiple foci of infections. In our third case, a thorough radiological investigation before the extraction might have solved the inconvenience which could be caused to the patient.

Trigeminal neuralgia is one of the cases with a common misdiagnosed pathology. The patient usually suffers from a sudden onset of severe unilateral pain along the distribution of the trigeminal nerve, which is along the scalp, forehead, eyes, nose, lips and jaw. The onset of the symptoms is usually triggered by brushing teeth, chewing, a breeze, by stress or even by just touching the cheek. Due to the nerve distribution pattern, the patients wrongly assume that the pain could be related to the teeth. Our last case was going for multiple extractions to get relief from pain. Although he was giving a characteristic history of neuralgic pain with a trigger zone, he was also giving the subtle clue which was hinting towards the diagnosis which was missed.

The extraction of tooth is one of the basic components of the dental procedure. The above mentioned case reports have proved that every tooth extraction procedure is alike and that they should be guided by clinical examination and radiological assessment, with a thorough detailed medical history which is integrated with the clinician’s expertise.

Conclusion

There are certain criteria which make us dentists rather than technicians and correct diagnosis is definitely one of them. Few minutes which are spent with the patients, can avoid lots of problems. We want to conclude from our experience that there is always the possibility that we can be wrong. Complications are a part of our profession. Our work creates complications and no work means, no complications. But our main aim should be to reduce the incidence of complications.

References

1.
Geoffery L. Howe. The extraction of teeth 2000 ,2nd ed, Butterworth & Co.,page-1.
2.
Daniel M. Laskin. Oral and Maxillofacial Surgery. St. Louis, Mosby ,1997,Vol 2, page 3.
3.
Raymond J. Fonseca; Oral And Maxillofacial Surgery,first edition, Saunders,2000,volume 1;2000
4.
Archer WH: Oral And Maxillofacial Surgery, ed 5. Philadelphia, WB Saunders, 1975;32;1628-1637
5.
Kruger GO: Textbook of Oral and Maxillofacial Surgery, ed 6. St. Louis, Mosby, 1984;5;237-248
6.
Peterson LJ, Ellis EE, Hupp JR, Tucker MR: Contemporary Oral and Maxillofacial surgery. St. Louis, Mosby, 1998;47;931-942
7.
Epstein J et al: Postradiation osteonecrosis of mandible. Oral Surg 1997; 83:657.
8.
Marx RE, Johnson RP, Klevin SN: prevention of osteoradionecrsis: A randomized prospective clinical trail of hperbaric oxygen versus pencillin. J Am Dent Assoc 1985; 11:49.
9.
Maxymiw WG, Wood RE, Liu F:Post radiation dental extarctions without hyperbaric oxygen. Oral Surg 1991; 72: 270.
10.
Shafer, Hine, Levy; Shafer`s textbook of oral pathology, ed 5, Elsevier, 2006;532-548

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