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

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On Sep 2018

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On Sep 2018

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"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."

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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
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 ones 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
(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 journalsNo manuscriptsNo 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.
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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)
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.
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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.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2011 | Month : June | Volume : 5 | Issue : 3 | Page : 669 - 674

The Prevalence of the Developmental Defects of Enamel in a group of 8 -15 years old Indian children with developmental disturbances


Deptt. Of Oral & Maxillofacial Pathology, National Dental College & Hospital, Derabassi, Mohali, Punjab, India Professor & HOD, Deptt. Of Oral & Maxillofacial Pathology, Sinhgad Dental College & Hospital, Pune Senior Lecturer, Deptt. Of Oral & Maxillofacial Pathology, DAV(C) Dental College & Hospital, Yamunanagar, Haryana

Correspondence Address :
Chhavi Jindal
Senior Lecturer, Deptt. Of Oral & Maxillofacial Pathology,
National Dental College & Hospital, Derabassi,
Mohali, Punjab, India
Phone numbers: 094171-01415, Facsimile numbers: Nil
E-mail address


Aims: To find the overall prevalence of the developmental defects of enamel among the total number of disabled children in the Panchkula district of Haryana, India. To compare the prevalence of this dental developmental anomaly with the various types of disabilities like mental handicap, locomotor handicap, hearing impairment, partial sight and multiple handicaps.

Material and Methods: A total of 996 subjects (499 controls and 496 disabled children) were examined for the developmental defects of enamel by using a Modified DDE index. The 496 disabled children included 189 with mental retardation, 203 with locomotor handicaps, 39 with hearing impairment, 31 with partial sight and 34 with multiple handicaps.

Statistical analysis:
The data which was obtained was analyzed by using the SPSS package version 13. The differences weretested for statistical significance by using the Pearson’s Chi- Square test.

The percent prevalence of the developmental defects of enamel among the disabled group was 40.9% and in the controls it was 5.4%. The percent prevalence of the various developmental defects of enamel,in decreasing order, among the various disabled groups was found to be as follows: 73.5% in the group with multiple handicaps, 56.4% in the group with the hearing impairment, 39.4% in the group with the locomotor handicaps, 37.6% in the group with the mental handicap and 16.1% in the group with the partial sight. Conclusions: Overall, a high prevalence rate of the developmental defects of enamel was observed in this study in the disabled children. This reflects the association of various systemic disturbances with the development of the tooth.


Developmental, Defects, Disabled, Enamel, Enamel Hypoplasia

The developmental defects of enamel are one of the most frequently observed developmental abnormalities of the human dentition. These may be the defects of enamel matrix formation or mineralization or maturation with reduced or altered amounts of enamel which is caused by an insult to the ameloblast cells (1).

It has become evident that systemic or local environmental stresses or genetic factors or a combination of these are responsible for disrupting the metabolism of the ameloblasts which results in the tooth defects. Hence, the tooth enamel often acts as a repository of information on the systemic insults which are received during the development (2). Such influences may begin before or after birth so that the deciduous or permanent or both teeth may be involved. Usually, it is the permanent teeth that are influenced and, in all instances only those that are not completely formed at the time of the disturbance are affected.

The recognition and identification of the dental anomalies are of great importance for a timely and accurate diagnosis of the numerous genetic abnormalities of the craniofacial region. The developmental defects in enamel especially in the primary teeth, may become useful as biological markers for the timing and in some cases, the nature of the insult to the tooth germ (3).

Although studies which are related to the increased prevalence of dental caries, poorer oral hygiene and a greater prevalence and the increased severity of periodontal diseases in disabled children have been well documented [4,5,6], the data on the prevalence of the dental developmental anomalies in these special group of children isscarce. Hence, an attempt has been made to find out the prevalence of the developmental defects of enamel in disabled children.

Material and Methods

The prevalence of enamel hypoplasia was studied in a sample of 995 subjects who were aged 8-15 years, including 496 subjects with developmental disturbances (189 with mental retardation, 203 with locomotor handicaps, 39 with hearing impairment, 31 with partial sight and 34 with multiple handicaps) and a control group of 499 school children who were free from any of the above mentioned developmental disturbances. The disabled children included those students with special needs, who were studying in formal schools along with normal children under the scheme of ‘Integrated Education for Disabled children’ (IED), which was implemented by the Ministry of Human Resource Development (Department of Secondary and Higher Education). Before examination, a written consent was taken from the heads of the respective institutions.

Examination procedure
All the children were examined in their respective schools while they were seated on ordinary chairs, unless they were confined to wheel chairs. The oral examination was done under natural light by using a standard mouth mirror and a probe. All the teeth were screened for the developmental enamel defects of the teeth.

The developmental enamel lesions were diagnosed without drying or cleaning the teeth prior to the examination. The type and the localization of the developmental defects of enamel were classified according to the modified DDE index (7) which was introduced by Clarkson J and O’Mullane D (7).

The data which was obtained was analyzed by using the SPSS package, version 13. The differences were tested for statistical significance by using the Pearson’s Chi-Square test.

A total of 995 subjects were examined for the developmental defects of enamel, of which 499 were controls and 496 were disabled children. Out of the 499 controls, 303 (60.7%) were males and 196 (39.3%) were females. Among the 496 disabled children, 322 (64.9%) were males and 174 (35.1%) were females. Of the total of the 496 disabled subjects who were examined, 189 were mentally handicapped (107 males, 82 females); 203 were locomotor handicapped (151 males, 52 females); 39 were hearing impaired (22 males, 17 females); 31 were partially sighted (20 males, 11 females) and 34 were multiple handicapped (22 males, 12 females).
(Table/Fig 2) (Table/Fig 3) represents the percentage prevalence of the developmental disturbances of enamel in the different groups of subjects.

By comparing the prevalence of the developmental defects of enamel among the different groups by using Chi square tests, it was found that the “p” value was less than .001 i.e this was highly significant for the comparisons among the control and the mentally handicapped, the control and the locomotor handicapped, the control and the hearing impaired and the control and the multiple handicapped groups (Table/Fig 3).

The “p” value was (0.01-0.05) i.e. significant among the control and the partially sighted groups [Table/Fig- 3]. The distribution of the total sample size according to the types of the developmental defects of enamel has been shown in [Tables/Fig 4] [Tables/Fig 5].

The incisors were the most common teeth which were affected by the enamel hypoplasia in the subjects among the different groups followed by the molars, the canines and the premolars (Table/Fig 6).


In the present study, an attempt has been made to compare the prevalence of the developmental defects of enamel among the various types of disabilities like mental handicap, locomotor handicap, hearing impairment, partial sight and multiple handicaps and to find the overall prevalence of this dental developmental anomaly among the total number of disabled children in the Panchkula district.

The ameloblasts are very sensitive to a wide range of systemic and genetic disturbances and are unable to recover once they are damaged. Hence, the tooth enamel often acts a repository of information on the systemic insults which are received during the development and these present as the developmental defects of enamel. All the subjects who were examined were in the 8 to 15 years age group. A similar age group was recommended by Clarkson JJ and O’Mullane DM (7), stating that the children who were aged 8 and 15 years gave a range of ages which were sufficiently wide to determine the prevalence of the defects on the early and late erupting teeth and the changes over time.

In the present study, the percent prevalence of the developmental defects of enamel among the normal children was 5.4% (Table/Fig 2). This was comparable with the studies of Yonezu T et al (8) and Goodman AH et al (9), who reported the populations with the lowest enamel hypoplasia from Japan (2%) and Mexico (6%) respectively. The slight deviation in the figures could be attributed to the racial differences and the diversity of the methodological procedures which were used.

In general, a higher prevalence of enamel hypoplasia has been reported among malnourished children (10) (11), very low birth weight children (12) and in patients with sensori-neurological defects (13).

The present study gave a percent prevalence of the 40% developmental defects of enamel among the total number of disabled children who were examined (Table/Fig 2). These findings were comparable with those of Dummer PMH et al (14) and Kanchanakamol et al (15), who reported a prevalence rate of 48.9% and 32% respectively in malnourished children. Chaves AMB et al (16), Pascoe L and Seow WK (17), Fyffe HE et al (18) and Lai PY et al (19) observed a prevalence rate of 78.9%, 64.8%, 50% and 96% for enamel hypoplasia in their respective studies, which were quite higher than those of present study.

These differing prevalence figures for the developmental defects of enamel could be attributed to the differences in the populations which were studied and the diversity of the methodological procedures which were used. Furthermore, as the teeth lacked previous cleaning in some studies, this led to the underestimation of the prevalence rates. Also, according to Seow WK (20), the rapid development of caries in the teeth which were affected by the enamel defects made the diagnosis of a pre existing defect more difficult.

The percent prevalence of the dental developmental defects of enamel among the mentally handicapped was 37.6% in the present study [Table/Fig 3], which was similar to the results of Martinez A et al (21), where 37.06% of the children with neurological disorders and mental retardation had the developmental defects of enamel. This could be attributed to the fact that several systemic disturbances which affect the neurological development also alter the development of the tooth germ. Because enamel cannot be recovered once it is damaged, it provides information on the timing and the nature of the insults which potentially affect other ectodermally derived structures like the brain.

39.4% of the locomotor handicapped subjects showed the developmental defects of enamel in the present study [Table/Fig 3]. The results were comparable to those of Korchagina VV and Diakova SV (22), who found a 44.5+/- 3.5% incidence of enamel hypoplasia among children with the congenital and hereditary developmental defects of the CNS and the locomotor system.
A 56.4% prevalence of the developmental defects of enamel was found in the present study in the hearing impaired disabled subjects [Table/Fig 3]. Murray GS and Johnsen DC (23) have reported 11 children with enamel defects out of 18 children who were examined for hearing defects. It may be pointed out that the cochlea and dental enamel develop over the same periods in the foetal life.

Although McMillan RS et al (24) described the relationship of the enamel hypoplasia to the cerebral and the ocular disorders.Hover the present study, we could find only a 16.1% prevalence of the developmental defects of enamel among the partially sighted disabled subjects (Table/Fig 3).

A high (73.5%) prevalence of the developmental enamel defects in the multiple handicapped disabled subjects [Table/Fig- 3] showed more chances of ameloblastic damage as multiple defects in various tissues were present in these subjects.

Statistical comparisons of the mentally handicapped, the locomotor handicapped, the hearing impaired and the multiple handicapped subjects with the controls were highly significant in the present study (Table/Fig 3), thus laying an emphasis on the delicate nature of the ameloblasts which could be affected by genetic and sensori-neural disturbances.

But our findings were in contrast to those of Warnakulasuriya KAAS (25) and Li Y et al (1), who found the prevalence of the localised hypoplasia to be higher than that of the opacities i.e 11.9% and 7.3% and 22.2% and 1.6% in the respective studies. The lower prevalence of the opacities which were reported might be due to the poor illumination and the lack of the examination facilities which were needed to detect the enamel lesions. The higher prevalence of hypoplastic teeth may be due to untreated infections of the primary predecessors and a high incidence of childhood illnesses such as diarrhoea, which may affect tooth formation.

In the present study, the demarcated opacities were highest in the hearing impaired group (25.6%), followed by the multiple handicapped group (23.5%), the locomotor handicapped group (12.3%) and the mentally handicapped group (9.5%) and they were least in the partially sighted group (3.2%). The diffuse opacities were maximum in the multiple handicapped group (32.4%), followed by the hearing impaired group (18.9%), the mentally handicapped group (14.3%) and the locomotor handicapped group (11.8%) and they were least in the partially sighted group (9.7%). Hypoplasia was found to be highest in the multiple handicapped group (11.8%), followed by the mentally handicapped group (8.5%), the locomotor handicapped group (7.4%) and the hearing impaired group (5.1%) and they were least in the partially sighted group (3.2%). Other defects were found to be more in the locomotor handicapped group (7.9%), followed by the multiple handicapped group (5.9%) and the mentallyhandicapped group (5.3%) and they were least in the hearing impaired group (5.1%) (Table/Fig 4).

Comparison with other studies is a little difficult because of the lack of common terminologies and classifications. The formation of enamel involves a rythmic sequence of cellular activity, interspersed with resting phases. The selective involvement of only those ameloblasts that were currently active at the time of a particular disturbance, may account for the variability in the development of the enamel hypoplasia. Some of the affected ameloblasts may die and stop secreting enamel whereas others may recover and continue to secrete normal enamel over the defective spots, which could also help in explaining the variability of the enamel lesions.

The possible explanation for this variation in the types of enamel defects could be that the demarcated opacities result from either a sudden severe disturbance to a discrete number of cells during their maturation state or from a less severe but longer lasting disturbance during their secretory phase. The diffuse opacities result from a chronic, less severe insult during the secretory and / or the post secretory phases, thus causing a delay in the completion of the mineralisation process.

The teeth which were examined in the present study presented more qualitative i.e opacities in both the control and the disabled groups; 4.6% and 33.6% respectively than the quantitative defects i.e hypoplasia which accounted only for 1.2% and 7.7% respectively (Table/Fig 5). These findings were consistent with those of Chaves AMB et al (16), where 13.9% were qualitative defects against 11.2% quantitative defcts and with those of Lunardelli SE and Peres MA (26) where the opacities (qualitative defects) were 23% and hypoplasia (quantitative defects) was 11.1%. This might be attributed to the fact that the teeth suffered injury during the calcification and thematuration of the enamel, rather than during the cell differentiation and the matrix secretion.

In the current study, among the disabled group, the developmental defects in the enamel were found to be highest in the maxillary incisors, followed by the mandibular incisors, the mandibular molars, the maxillary molars, the mandibular canines and the maxillary and the mandibular premolars. The least affected were the maxillary canines [Table/Fig- 6]. A higher incidence of the enamel defects in the upper incisors than in the lower ones was observed in the present study, which was in agreement with the results of Li Y et al (1), Pascoe L and Seow WK (17), Rugg-Gunn AJ et al (27) and Chaves AMB et al (16). These findings can be explained on the basis of the observations made by Suga et al (28), who suggested that the difference in the enamel thickness could be the reason for this. Suga et al (28) speculated that the ameloblasts which were responsible for the thick enamel were more susceptible to the systemic disorders than the ameloblasts which were associated with the thin enamel. The diffusion of calcium ions from the ameloblasts into the matrix and the removal of organic substances from the matrix are slower in the thick enamel than in the thin enamel. Therefore, the teeth are exposed to the systemic injuries for a longer period of time.

The analysis revealed a significant difference between the disabled children and the control group. The developmental defects of enamel belong to a group of non specific abnormalities and may be present in a number of syndromes. When associated with congenital malformations, they may point to the disorders of various tissues and systems, and may occasionally present as the leading symptoms of these states, thus being the key elements in their diagnosis for genetic counselling.

It is essential to understand the various aspects of development because only then we can have a sound knowledge about developmental disturbances. Although they were neglected for long, these disabled children are now considered as an integral part of the society and are rightly known as “children with special abilities”.

This study not only reflects the dental abnormalities in disabled children, but also inspires us to take appropriate preventive measures for the betterment of this group of the population, which can be achieved by: • Making provisions for these special children to seek dental and medical aids. • Conducting free dental checkup camps. • Periodic follow up.

• Convincing various health providing organizations about the treatment needs of these special children.


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