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    Table of Contents - Current issue
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May-August 2021
Volume 25 | Issue 2
Page Nos. 209-375

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EDITORS DESK  

From the editor's desk Highly accessed article p. 209
Smitha Thammaiah
DOI:10.4103/0973-029X.325102  
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GUEST EDITORIAL Top

Will the COVID-19 pandemic be a harbinger of change in dental education Highly accessed article p. 210
Keya Sircar
DOI:10.4103/0973-029X.325103  
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LIVING LEGEND Top

Dr. J. V. Tupkari p. 213
Tabita Joy Chettiankandy
DOI:10.4103/0973-029X.325115  
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INVITED REVIEW Top

An unconventional career path for an oral pathologist: Sharing personal insights from experience as a part of medical publishing industry p. 215
Priyanka Kardam, Kanu Jain, Monica Mehendiratta, Vikas Kumar Sant
DOI:10.4103/0973-029X.325116  
Oral pathologists or dentists in general opting for alternate career paths are very common nowadays. Financial security, lesser availability of jobs and work satisfaction are the most commonly observed reasons for this openness to switch career. While there is a multitude of alternate career options available such as medical writing and pharmacovigilance in this review, we aim to give an insight specifically on opportunities available in the medical journals aspect of the publishing industry. Oral pathologists can opt to take this field as a full-time engagement and attain a constant growth in terms of finances, knowledge and personal development. One of the authors has opted for this career path and has provided personal opinions about the scope, opportunities and perks of working in this industry.
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EMERGING HOT TOPICS - LETTER TO EDITOR Top

Post-COVID mucormycosis: Ascertainment of the pathological diagnostic approach Highly accessed article p. 219
Anubhuti Sood, Vivek Nayyar, Deepika Mishra, Aanchal Kakkar, Harsh Priya
DOI:10.4103/0973-029X.325117  
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EMERGING HOT TOPICS - SHORT COMMUNICATION Top

Understanding the mechanism of commonly occurring COVID-19-associated oral lesions p. 223
Susmita Saxena, Sanjeev Kumar
DOI:10.4103/0973-029X.325118  
Covid-19 pandemic is a novel disease with gradual emergence of its signs and symptoms. Oral healthcare providers had a setback in their dental practices due to the high rate of infectivity and the risk of contracting the disease through the patients carrying the virus. Once the dental practice resumed to its normalcy the dental surgeons came across a variety of oral manifestations in patients with a history of Covid and post recovery. An attempt is made to recognise the Covid-19 oral manifestations with plausible explanation of the mechanism of development of such oral signs.
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ORIGINAL ARTICLES Top

Analysis of ENAM gene single-nucleotide polymorphism rs3796704 with caries susceptibility in young adult Tamil population p. 226
Niveditha Thampan, R Ramya, R Swarnalakshmi, K Rajkumar, S Savithri, G Divyalakshmi
DOI:10.4103/0973-029X.325119  
Background: Dental caries is as primeval as humanity, but still, investigations are undergoing regarding the etiopathogenesis behind this multifactorial disease. Genetics is known to play a vital role in the etiology behind dental caries in addition to environmental and socioeconomic factors. Genetic variations like single-nucleotide polymorphisms (SNPs) were extensively studied in the past decade to portray the etiopathogenesis contributing to dental caries. Aim: This investigation was undertaken to analyze the ENAM gene SNP rs3796704 with caries susceptibility in ethnic young adult Tamil population of India. Materials and Methods: Out of 370 patients included, 215 patients belonged to the high caries group (Decayed, Missing and Filled Tooth [DMFT] ≥2) and 155 patients belonged to the low caries group (DMFT ≤ 1). DNA was extracted from the blood of all the individuals. SNP genotyping was performed utilizing tetra-primer amplification refractory mutation system–polymerase chain reaction with specific primers. Results: The genotyping results showed that there were no differences in allelic (P = 0.114) and genotypic frequencies (P = 0.159) between the high caries and low caries groups. Conclusion: Future studies can be conducted in larger samples and different ethnicities around the globe to analyze the role played by SNPs of enamel formation genes in cariogenesis.
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Estimation and comparison of salivary flow rate and its composition in diabetic patients and nondiabetic patients: A pilot study p. 232
S Dhanarathna, Nadeem Jeddy, B Sabarinath, GB Protyusha
DOI:10.4103/0973-029X.325120  
Background: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia irregularities in the metabolism of carbohydrates, lipids and protein. It is often associated with the development of microvascular and macrovascular complications and neuropathies. The health of oral tissues is known to be related to the quality and quantity of saliva both of which may be altered in diabetes. Aim: The aim of the present study was to determine the salivary flow rate, electrolytes and total proteins in saliva of Type II diabetic patients. Materials and Methods: A total number of 120 participants were included in this study, in which 80 patients were suffering from Type II DM (which included both controlled and uncontrolled diabetes) and 40 nondiabetic persons (controls). The study population included both the genders, with an age range of 40–70 years. The study population was divided into three groups. Results: The values of total protein, sodium, potassium and salivary flow rate among controls, controlled diabetes and uncontrolled diabetes were collected, formulated and multiple comparisons between the groups using the analysis of variance and post hoc Tukey honestly significant difference analysis were done in version 16.0 of SPSS software. Conclusion: Studies with larger sample size are warranted to know the exact pathophysiology of controlled and uncontrolled Type II DM in terms of salivary flow rate, salivary electrolytes and total protein.
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Expression of matrix metalloproteinase-9 in histological grades of oral squamous cell carcinoma: An immunohistochemical study p. 239
Rekha Patil, Aarti Mahajan, GL Pradeep, Nilima Prakash, Swapnil Patil, Sabiha Mohiddin Khan
DOI:10.4103/0973-029X.325121  
Context: Oral squamous cell carcinoma (OSCC) is characterized by a high degree of local invasiveness and metastasis to cervical lymph nodes and distant sites. Degradation of extracellular matrix (ECM) requires the concerted action of several extracellular enzymes, the most prominent of which are matrix metalloproteinases (MMPs). Proteolytic degradation of ECM components by (MMP-9) facilitates carcinoma cell invasion, enhances angiogenesis and tumor progression. Objective: To assess and correlate the immunohistochemical expression of MMP-9 with clinicopathological parameters and histological grades of OSCC. Settings and Design: Thirty histopathologically diagnosed cases of OSCC including 12 cases of well-differentiated squamous cell carcinoma, 12 cases of moderately differentiated squamous cell carcinoma and 6 cases of poorly differentiated squamous cell carcinoma were included in the study group. Materials and Methods: The samples were subjected to staining using monoclonal antibodies against MMP-9 and visualized using the polymer-HRP detection system. Expression of MMP-9 was assessed in tumor epithelium/parenchyma and connective tissue stroma separately, and the mean of both was considered as average MMP-9 expression. Statistical Analysis: The parametric independent samples “t” test, one-way ANOVA test and Pearson's correlation test were used for the statistical analysis. Results: Immunoexpression of MMP-9 increased with advancing stage and histological grade of OSCC with statistically significant results. Conclusion: MMP-9 plays an important role in invasion and metastasis and can serve as an independent prognostic marker.
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Immunohistochemical expression of stathmin in oral dysplasia: An original study with an insight of its action on microtubules p. 247
Purnima Vadla, G Deepthi, Chippalapally Arun Kumar, Rithika Bashamalla, Neelam Syeda, Srikanth Naramala
DOI:10.4103/0973-029X.325122  
Background and Objectives: Stathmin is a phosphoprotein, which in its phosphorylated/unphosphorylated states plays a major role in polymerization/depolymerization of microtubules, respectively. Assembly of microtubules is an important aspect of cell division called mitosis. Hinderance in the function of stathmin could lead to damage in the mitotic process resulting in aneuploidy which is common manifestation of malignancies. Hence, stathmin could be used as a tumor marker for oral dysplasias and cancers. The purpose of the study is to compare the expression of stathmin in normal subjects to the patients with oral leukoplakia and to correlate its expression with different histopathological grades of oral leukoplakia This is the first ever study conducted to examine the expression of stathmin in oral dysplasia. Methodology: Thirty histopathologically confirmed cases of oral dysplasia were selected for the study. These tissues were evaluated immunohistochemically for stathmin. To enumerate the stathmin stained cells, 300 cells were examined manually in at least 5 areas and a mean percentage of positive–stained slides were determined. Then, each sample was assigned to one of the following staining scores: (0) – (<10% of stained cells); (1) – (11%–25% of stained cells); (2) – (26%–50% of stained cells); (3) – (51%–75% of stained cells); (4) – (76%–90% of stained cells) and (5) – (91%–100% of stained cells). The results were analyzed statistically using ANNOVA test. Results: When comparison was made with respect to staining scores of stathmin between normal and dysplasia groups, the results were found to be statistically significant with a P = 0.0001. A statistically significant difference was observed between various histopathological grades of dysplasia with respect to stathmin immunohistochemistry scores with a P = 0.0001. Conclusion: These results suggest stathmin as a tumor marker and prognostic indicator.
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Epithelial expression of epithelia-cadherin in different grades of oral squamous cell carcinoma p. 253
Debkamal Kar, Sohini Banerjee
DOI:10.4103/0973-029X.325123  
Background: The incidence of oral squamous cell carcinoma (OSCC) has been increasing day by day in the Southeast Asian countries. There is variation in the incidence rates in various parts of the world, with the highest recorded in Southeast Asian countries such as Sri Lanka, India, Bangladesh, and Pakistan. The survival rate for OSCC has remained generally unchanged in the past three decades, underlining the need for more biomarkers to be developed to aid prognostication and effective treatment planning and management. The prognostic potential of epithelia-cadherin (E-cadherin) expression in OSCCs has been variable in previous studies has been correlated with improved prognosis in other cancers. The aim of the present study was to investigate and analyze the expression of E-cadherin in different histopathological grades OSCC, to understand its potential as prognostic biomarker of most common oral cancer. Materials and Methods: E-cadherin expression was examined by immunohistochemistry in 35 cases of OSCC of the buccal mucosa and 5 of normal buccal mucosa. Results: In our study, E-cadherin expression appeared in widely differentiated squamous cell carcinoma (130.75 ± 30.64) moderately differentiated squamous cell carcinoma (123.66 ± 13.17), and poorly differentiated squamous cell carcinoma (88.52 ± 30.11). Conclusions: E-cadherin expression is reduced with higher grades of OSCC. However, the present results suggest that E-cadherin expression may be useful as prognostic markers for OSCC.
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Quantitative assessment of tumor-associated tissue eosinophilia and nuclear organizing region activity to validate the significance of the pattern of invasion in oral squamous cell carcinoma: A retrospective study p. 258
Hidangmayum Denish Sharma, Jyothi Mahadesh, Wakambam Monalisa, Pillai Arun Gopinathan, BL Laxmidevi, Nelson Sanjenbam
DOI:10.4103/0973-029X.325124  
Introduction: Pattern of invasion (POI) in scoring system of oral squamous cell carcinoma (OSCC) can predict local recurrence and overall survival rate. Argyrophilic nucleolar organizer region (AGNOR) counts are considered to reflect the biosynthetic and nucleolar activity of a cell and thus serve as an indicator of the rapidity of the cell cycle thereby indicating the proliferative index of the tumor. It is implied that higher tumor associated tissue eosinophilia (TATE) showed lesser venous invasion, lymph node metastasis and clinical recurrence. The aim of the study was to assess and evaluate the following criteria's: POI-1 to POI-4 as defined by Bryne et al. in OSCC, proliferative index by AgNOR stain and TATE with carbol chromotrope stain in OSCC, validity of POI by correlating the AgNOR proliferative index and TATE. Materials and Methods: Forty samples of formalin fixed paraffin embedded tissue blocks diagnosed of OSCC were taken for the study. Three sections were taken from a single block and then the tissues were stained differently with H & E Stain, AgNOR stain and Carbol chromotrope stain. First section stained with H & E was observed for POI and grading was done according to Bryne's criteria. The second and third sections were stained with AgNOR stain and Carbol chromotrope stain for proliferative index and TATE. One way analysis of variance was used to test the significance. Results: Mean AgNORs count increases gradually from type 1 to type 4, depicting the increase in the nucleolar proliferative index of the cells and was statistically significant. In the case of the mean eosinophilic count, type 1 shows the highest mean eosinophilic count and the count shows drastic decrease till type 3 and from type 3 to type 4 the decrease is more gradual and was statistically significant. Conclusion: The study validated that POI is a good predictor for prognosis and also can be included in grading OSCC along with routine histopathological criteria.
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Coculture method for in vitro cultivation of uncultured oral bacteria p. 266
Preethi Kusugal, Kishore G Bhat, Preeti Ingalagi, Sanjivani Patil, Geeta Pattar
DOI:10.4103/0973-029X.325125  
Purpose: The purpose of the study is to culture uncultured oral bacteria with helper strains using the coculture method from the subgingival plaque samples of chronic periodontitis patients. Materials and Methods: The samples were processed and inoculated on a blood agar medium enriched with hemin and Vitamin K. A helper strain Propionibacterium acnes (ATCC 6919) was cross-streaked across the inoculums to facilitate coculture. The plates were then incubated for 7 days with subsequent subculturing and further incubation. Results: Satellite colonies around helper strain showed one colony type of Porphyromonas gingivalis, one was of nonpigmented Prevotella, three were of Fusobacterium nucleatum and five isolates remained unidentified. Conclusions: Coculture could be used effectively as one of the methods in the isolation and in vitro cultivation of oral bacteria. Incubation using the anaerobic jar technique was found to be economical and efficient for the growth of anaerobic oral bacteria.
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Histopathologic and immunohistochemical findings of odontogenic jaw cysts treated by decompression technique p. 272
Syed Mustansir-Ul-Hassnain, Vidyadevi Chandavarkar, Mithilesh Narayan Mishra, Pavan Manohar Patil, Deepak Bhargava, Ritika Sharma
DOI:10.4103/0973-029X.325126  
Context: Odontogenic cysts are among the most common lesions to affect the oral and maxillofacial region. Cysts are capable of causing significant bony disfigurement, tooth displacement and pathological fractures. Several surgical approaches exist for the management of larger cysts of the jaws. These include enucleation, marsupialization and decompression. Aims:
  1. Analysis of histopathologic findings in odontogenic cysts before and after decompression
  2. Analysis of Ki-67 expression in odontogenic jaw cysts before and after decompression.
Settings and Design: Decompression technique was used for the treatment of 10 cases of odontogenic cysts in the study. Incisional biopsies of cystic lining (pretreatment) and corresponding excisional biopsies (posttreatment) were received for histopathologic and immunohistochemical examination. Subjects and Methods: Hematoxylin and eosin stain was used for histopathologic findings, and Ki-67 was used for immunohistochemical findings using antibody Ki-67 in fresh tissue samples. Results: Overall, radicular cysts, dentigerous cysts, and sialo-odontogenic cyst contained fewer Ki-67+ cells than odontogenic keratocysts. The average scores were found to be 2.2 and 1 for before and after decompression, respectively. A statistically significant difference was observed between the two groups. The two-tailed P value was found to be <0.0001. The confidence interval was found to be 95%. Conclusions: The proliferative activity evaluated by Ki-67 marker was greater in predecompression epithelial lining compared to postdecompression. Our study infers that proliferative rate of the cystic epithelial lining is significantly diminished after decompression.
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Erosive oral lichen planus inflicts higher cellular stress than reticular type p. 279
Abhishek Jana, Jincy Thomas, Pratiti Ghosh
DOI:10.4103/0973-029X.325127  
Background: Lichen planus is a chronic inflammatory mucocutaneous disease which frequently involves the oral mucosa. The most common types of oral lichen planus (OLP) are reticular (asymptomatic) and erosive (ulcerative) with malignant potentiality. The aims of the present study are to assess the cellular stress level in both types of OLP lesions with respect to oxidative stress, DNA damage and inflammation. Materials and Methods: Freshly diagnosed untreated 25 OLP reticular type and 25 OLP erosive (OLP-E) type patients aged 35–55 years were enrolled in the study along with age and sex-matched 25 healthy subjects as control. Tissue antioxidant enzymes were measured biochemically, single-cell DNA damage was measured by comet assay and the molecular markers for inflammation were assessed by using semi-quantitative reverse transcriptase–polymerase chain reaction. Statistical analyses were performed using one-way ANOVA and Tukey's post hoc test. Results: Oxidative stress was significantly greater in OLP-E type compared to the reticular. mRNA expression of cyclooxygenase-2 was significantly elevated (P < 0.0001) in erosive form, but such expression of nuclear factor kappa beta, tumor necrosis factor-alpha, Interleukin-6 and inducible nitric oxide synthase did not significantly differ between the two disease groups. Comet assay revealed a higher degree of DNA strand breakage in erosive lesions. Conclusions: The unhandled free radicals may imbalance the homeostatic network toward pro-inflammatory, DNA damaging responses, creating a vicious cell-damaging spree resulting in stress. Molecular analyses showed that erosive lichen planus is more under stress than the reticular form.
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Efficacy of curcumin in the treatment of denture stomatitis: A randomized double-blind study p. 286
Ramesh Tatapudi, SK Abdul Samad, Ravikanth Manyam, Divya Dasari, Roja Vara Lakshmi
DOI:10.4103/0973-029X.325128  
Background: The prevalence of denture stomatitis has been shown to vary from 15% to 65% in complete denture wearers. In recent years, a number of studies across the globe have investigated the various biological effects of curcumin, curcumin, a polyphenolic compound derived from dietary spice turmeric, possesses diverse pharmacologic effects including anti-inflammatory, antioxidant, antiproliferative and antiangiogenic activities. The aim of this study was to evaluate the efficacy of curcumin local application with common antifungal agent clotrimazole for the treatment of denture stomatitis. Materials and Methods: A randomised double-blind clinical trial with approval of institutional ethical committee consisting fifty participants divided into two groups (17 men–33 women) with the clinical signs and symptoms of oral candidiasis. The diagnosis was supported by microbiological cultures. Group A patients were prescribed the clotrimazole and Group B patients were prescribed the curcumin ointment which was dispensed in similar amber coloured bottles. Data were analyzed using Chi-squared tests, Wilcoxon's signed rank sum test and Mann-Whitney test. Results: The mean candidal colony counts before treatment in Groups A and Group B were 63.960 and 37.080, respectively. The mean candida colony counts after treatment in both the groups were 14.080 and 3.720, respectively. There was a statistically significant difference between the two groups when mean candida colony counts were calculated before and after treatment. However, intergroup comparison between the two groups considering the mycological eradication showed that there was no statistically significant difference with P = 0.404. Conclusion: Topical application of curcumin as a natural ingredient could be an effective agent for the treatment of denture stomatitis as an alternative to regular clotrimazole therapy.
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Comparative analysis of cytocompatible properties of the root surface exposed to diode laser (970 nm) as adjunct to scaling and root planing: An in vitro study p. 292
AM Savita, GR Nageswaran, Roopa Reddy
DOI:10.4103/0973-029X.325129  
Aims: The aim of the current study was to examine the effects of diode laser (970 nm) when used as adjunct to mechanical debridement on reattachment of fibroblast cell cultures to the root surface. Materials and Methods: Eighteen extracted single-rooted human teeth were used in the study. Briefly, the anatomical crowns were removed; roots were sectioned and preserved in antiseptic solution. The sections were divided into three groups: (i) scaling and root planing (SRP), (ii) SRP followed by diode laser exposure and (iii) untreated control group. All the sections were inoculated with NIH 3T3 mouse fibroblast cell lines and cell attachment was confirmed by scanning electron microscopy analysis and growth was quantitatively assessed by MTT assay after days 1, 3 and 5. Results: On intragroup analysis, there was significant cell proliferation seen on day 1 and day 5. However, no significant differences were observed between the treatment groups at the various time points. Conclusion: 970-nm diode laser exposure had a positive effect in enhancing the fibroblast reattachment to root surfaces. However, to ascertain the role of laser treatment in enhancing the rapid cell growth compared to SRP, further quantitative studies with more sample numbers are required.
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Cedarwood oil as an alternative to xylene as a clearing agent in histopathological tissue processing – A comparative study p. 299
Snega Thamilselvan, Herald J Sherlin, Gifrina Jayaraj, KR Don, Archana Santhanam
DOI:10.4103/0973-029X.325232  
Background: Clearing in histopathological tissue processing should be able to make the tissues translucent and clear for the tissues to be visible under light microscopy and should render the clearing agent to be miscible with the dehydrant and the impregnation wax in the preceding and following processing steps. Xylene is a gold standard clearing agent but increasing concerns about the potential carcinogenicity, implementing eco-friendly agents in routine histopathology is necessary. Aim: The aim of the study is to assess the clearing ability of Cedarwood oil as an alternative to Xylene in routine tissue processing. Materials & Methods: The study was carried out in the Department of Oral Pathology and Microbiology. Formalin fixed 50 tissue samples of size 3-7mm were taken and subsequent dehydration done with acetone and alcohol. The dehydrated tissue is later processed using 90ml of Cedarwood oil with few drops of Xylene and Thymol. After clearing the tissues were subjected to impregnation and embedded in paraffin wax, later which sections were made and stained using H & E stain. Results: The results of our study on comparison showed better outcome in tissues processed with cedarwood oil than xylene. Statistical Significant correlation was observed in nuclear staining (p value = 0.001) ; cytoplasmic staining (p value = 0.08) and background staining ( p value = 0.045) indicating a positive results on using cedarwood oil as clearing agent. Conclusion: The cedarwood oil can be considered as a safer natural alternative to xylene in laboratories. The cedarwood oil is eco - friendly and easily available with enhanced tissue processing qualities.
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Antifungal effects of tulsi, garlic, cinnamon and lemongrass in powder and oil form on Candida albicans: An in vitro study p. 306
Mitul Prajapati, Monali Shah, Amena Ranginwala, Prakhar Agrawal, Dhruval Acharya, Shreya Thakkar
DOI:10.4103/0973-029X.325233  
Introduction: The use of plants for treating diseases is as old as the human species. Medicinal plants have been a major source of therapeutic agents for alleviation and cure of diseases. Objectives: The objective of the study was to evaluate and compare the antifungal activity of garlic, cinnamon, lemongrass and tulsi in powder and oil form at different concentrations on Candida albicans. Materials and Methods: Powder and oil of garlic, cinnamon, lemongrass and Tulsi dissolved in inert solvent dimethyl formamide to obtain different concentration. Stock solution of different concentration was inoculated on Petri plates containing C. albicans and incubated at 30°C for 48 h. The inhibition zones were measured in millimeters using Vernier caliper. The collected data were analyzed using statistical test like mean value and one-way analysis of variance. Results: Maximum zone of inhibition for the C. albicans was 42 mm at concentrations of 50% for the oil of lemongrass; followed by cinnamon 40 mm, garlic 24 mm and tulsi 20 mm. The P value obtained 0.050, 0.040, 0.036 and 0.031 were found to be statically significant for C. albicans at 20%, 30%, 40% and 50% concentrations of the various oil preparations, respectively. The P value obtained 0.043, 0.033, 0.032 and 0.027 were found to be statically significant for C. albicans at 20%, 30%, 40% and 50% concentrations of various plant powder, respectively. Conclusions: Lemongrass and cinnamon oil shows best antifungal effect against C. albicans as compared to garlic and tulsi. Compared to powder preparations, the oil preparations are better to inhibit the growth and higher the concentrations, greater the zone of inhibition seen in all the plant extracts and in oil.
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In vitro anticancer activity of a pentacyclic triterpenoid via the mitochondrial pathway in bone-invasive oral squamous cell carcinoma p. 313
Pooja Narain Adtani, Malathi Narasimhan, Dinesh M Girija
DOI:10.4103/0973-029X.325234  
Context: Oral cancer is the most dreadful cancer worldwide with a 5-year survival rate of approximately 50%. Anticancer therapies such as chemotherapy and radiotherapy result in severe side effects. Aim: We aimed to evaluate the in vitro anticancer activity of Asiatic acid (AA) on bone-invasive oral squamous cell carcinoma (BHY) cell line. Settings and Design: This was an in vitro laboratory setting. Materials and Methods: BHY cell lines were used for the experiment. Confocal microscopy was used to observe cellular alterations. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay was performed to determine the IC50 concentration of AA and flow cytometry to analyze the percentage of cells in each phase of the cell cycle post treatment. Immunoblot assays and semiquantitative reverse transcriptase-polymerase chain reaction (rt-PCR) were used to study the expression level of genes involved. Statistical Analysis Used: Student's t-test and one-way analysis of variance were used for statistical analysis. Results: IC50 concentration of AA was 15.6 μM. On flow cytometry analysis, treatment with 15.6 μM and 31.25 μM of AA for 24 h increased the percentage of cells in the G2/M phase to 45.63% and 53.12%, respectively, compared to 9.62% in control group. Immunoblot analysis and semiquantitative rt-PCR demonstrated an upregulation of p53, cyclin-dependent kinase inhibitors (p21 and p27), caspase-3, caspase-9, cytochrome c and Bax in a time-dependent manner and downregulation of cyclins and anti-apoptotic protein Bcl-2 (**P < 0.05, ***P < 0.001 versus control) post AA treatment. Conclusion: AA induces apoptosis via the mitochondrial-dependent pathway and causes cell cycle arrest at the G2/M phase in BHY cell line.
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Neutrophil-to-lymphocyte ratio as a prognostic factor in oral squamous cell carcinoma – A single-institutional experience from a developing country p. 322
Vigyan Mishra, Subhranshu Hota, Subrat Kumar Sahu, Ranjana Giri, Urmila Senapati
DOI:10.4103/0973-029X.325235  
Background: Cell-mediated inflammatory response, neutrophils, lymphocytes and monocytes are being recognized as an important role in carcinogenesis. Neutrophil-to-lymphocyte ratio (NLR) has been used as an independent prognostic factor in varieties of cancers. NLR can be easily determined from complete blood count, and it could be considered as a simple and inexpensive prognostic marker. Aim: In this study, we evaluate the prognostic significance of NLR in patients with oral squamous cell carcinoma (OSCC). Materials and Methods: Clinical and epidemiological data of all biopsy-proven nonmetastatic OSCC treated between 2014 and 2018 were taken into consideration. Pretreatment absolute neutrophil and lymphocyte counts were used to get NLR. Using univariate and multivariate analysis, the impact of NLR on overall survival (OS) and progression-free survival (PFS) was investigated. Results: A total of 50 patients of OSCC with median pretreatment NLR ratio of 2.52 were identified. Based on the median NLR as a cutoff, patients were classified into two groups, i.e., high NLR and low NLR. Elevated NLR was significantly associated with lymph node metastasis (P = 0.01). Four-year OS and PFS were significantly better for patients with low NLR when compared with high NLR group (51.4% vs. 100%, P = 0.001). Four-year PFS for high and low NLR groups was 38.8% and 87.8% (P = 0.002). Multivariate analysis confirmed that NLR is an independent prognostic factor (P = 0.003). Conclusion: Pretreatment NLR provides a simple, cheap and early predictor of outcome in this group of patients. However, an optimal cutoff value of NLR should be determined, for which larger sample size and prospective studies are required.
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REVIEW ARTICLES Top

Secretory carcinoma of salivary gland – A systematic review of pediatric case reports and case series p. 327
V Vasanthi, R Ramadoss
DOI:10.4103/0973-029X.325236  
Aim: Mammary analog secretory carcinoma (MASC) is a new pathological entity of salivary gland origin recognized as Secretory Carcinoma (SC) in the WHO 2017 classification. Pediatric cases of MASC were reviewed systematically from 2010 to 2019. Materials and Methods: Databases were searched from 2010 to 2019 for pediatric case reports and case series, excluding retrospective studies. A total of 12 manuscripts were reviewed for clinical, histological and immunohistochemical findings. Results: A total of 13 pediatric cases (11 case reports and 1 case series of 2 cases) of MASC in pediatric patients were found. The youngest reported age was 5 years. The common site was parotid gland usually presenting as a slowly growing firm, painless mass. Conclusion: MASC should be considered in the differential diagnosis of salivary gland tumors in pediatric population, especially from parotid gland. Extended research on such recent entities with more inputs from new cases reported in literature may outstretch the possibilities of therapeutic fusion inhibition in future.
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Recognizing the salivary panomics for the clinical application in oral potentially malignant disorders p. 332
Kavitha Muthu, Mohan Narayanan
DOI:10.4103/0973-029X.325237  
Oral cancer arises as a result of multistep carcinogenic progress from precursor lesion to oral squamous cell carcinoma through collective mutational process occur in the stem cells of mucosal epithelium. The detection of such oral potentially malignant disorders (OPMDs)/cancer in subclinical level will greatly improve the prognosis of a patient. The highly specific and sensitive salivary biomarkers have functioned in detection, prediction, surveillance and therapeutic monitoring of the diseases of interest. The aim of the review is to appraise various salivary biomarkers for the clinical utility in OPMDs. An electronic web-supported search was performed via PubMed, ScienceDirect and Google Scholar search engine since the year 2015–2019. A total of 28 research articles were selected for the review after screening and assessment. The various genomic, transcriptomic, proteomic, metabolomic and miscellaneous markers were analyzed and their characteristics and clinical application in OPMD patients were discussed. miR-21, miR-31, miR-84, H3F3A mRNA + IL-8P, matrix metalloproteinase-9, chemerin, tumor necrosis factor-alpha, cytokeratin-10, ornithine + O-hydroxybenzoate + R5F, 8-hydroxy-2-deoxyguanosine, malondialdehyde, Vitamin E and Vitamin C are identified as potential markers for OPMD patients. Scientifically validated, reliable and economical clinical biomarkers in OPMDs would serve as evidence-based treatment from patient point of view. Further longitudinal studies are needed to verify the accuracy and validate the applicability of these diagnostic/prognostic markers. Saliva has been reported as a valuable noninvasive valuable tool in biomarker identification. Recent advancements in salivary biomarker identification techniques lead to various potential biomarkers with precise outcome. The utilization of these biomarkers for the clinical application in OPMDs depends on the feasibility and personal choice of the clinician.
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CASE REPORTS Top

Orofacial granulomatosis: A case report and a proposal of a diagnostic algorithm for oral granulomatous lesions p. 346
Nisha Shetty, R Venkata Subramanyam, Gadicherla Srikanth, Monica Charlotte Solomon
DOI:10.4103/0973-029X.325238  
Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder with multifactorial etiology and pathogenesis affecting the orofacial region which appears usually as a persistent and/or recurrent swelling that may involve one or both the lips and/or recurrent ulcers along with other orofacial features. The diagnosis of OFG is challenging and it should be ruled out from other conditions characterized by granulomatous inflammation. This article describes a case of a 30-year-old female patient with upper lip swelling as the main manifestation without any systemic involvement and we have also laid down a proposal of a diagnostic algorithm for differential diagnoses and treatment modalities for OFG which could be helpful for the clinician and dentists alike to rule out other granulomatous disorders thus in effective management of OFG.
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Melanotic neuroectodermal tumor of infancy of maxilla: Report of a case with review of literature p. 351
Monica Chillal, Suresh Menon, S Archana, ME Sham
DOI:10.4103/0973-029X.325239  
Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, fast-growing, pigmented neoplasm of neural crest origin. Despite of its rapid and locally infiltrative growth, it is still considered benign with high recurrence rate and malignant potential, so early diagnosis is extremely important to limit its local expansion. Recurrences can be expected primarily because of incomplete excision, tumor dissemination, or due to its multicentric nature. We report a case of MNTI originating in the maxilla of a 7-month-old male infant, which was managed with complete surgical excision of the tumor, with no signs of recurrence after a 1-year follow-up period. In addition, a complete literature review has been reported, in an attempt to understand the origin, histopathologic and immunohistochemistry features with surgical modalities and advantages of radiotherapy and chemotherapy in cases where complete surgical extirpation is questionable.
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Odontogenic myxoma with pain and uncommon histological feature in the mandible: A case report and review the literature p. 356
Armaghan Tarjan, Mostafa Rezaee, Hossein Danesteh, Nazafarin Samirani-Nezhad
DOI:10.4103/0973-029X.325240  
Odontogenic myxoma (OM) is a rare benign painless, slow-growing lesion with local aggressive behavior. Pain and sensory disturbance and fibro-osseous appearance in histopathology have been rarely reported in OM. The authors reported a 52-year-old male case presented with a large gingival mass around a mobile mandibular right first molar extended to the distal aspect of the third molar. Microscopic examination of the incisional and excisional biopsy revealed an OM with numerous newly formed bone or cementum-like material present throughout the specimen like those seen in fibro-osseous lesions. For avoiding to recurrence, a segmental mandibulectomy was performed and a metal plate was inserted to the right mandible defect under general anesthesia. Rehabilitation was completed with the placement of implants. We review and discuss about this variety.
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Salivary amylase crystalloids in Warthin's tumor: An aspiration cytodiagnosis p. 361
Subhransu Kumar Hota, Ranjana Giri, Tarun Sharma, Urmila Senapati
DOI:10.4103/0973-029X.325241  
Crystalloids may be seen in a variety of salivary gland lesions, but their presence is not common. Among various types of crystalloids, amylase crystalloids are usually found in benign lesions of the salivary gland. Here, we report a case of a 76-year-old male with swelling on the angle of the mandible left side for 15 days. Local examination showed a solitary soft-to-firm swelling of size 4.7 cm × 4.1 cm × 2.8 cm. Ultrasonography (USG) showed a well-defined cystic lesion with the solid component. Fine-needle aspiration cytology cytosmears showed predominantly mixed inflammatory cells; few epithelial cell clusters with numerous crystalloids which are rectangular to rhomboid shape with nonparallel sides. Cytological features are suggestive of benign cystic sialadenitis with amylase crystalloids. However, after 3 months of follow-up, as the swelling did not subside, excisional biopsy was done and histopathology showed features of Warthin's tumor with crystalloids. The presence of amylase crystalloids in any type of salivary gland lesion with cystic change; multiple aspirations followed by histopathological examination should be done to rule out neoplastic etiology.
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FORENSIC CORNER Top

Geometric morphometric analysis for sex determination using lateral cephalograms in Indian population: A preliminary study p. 364
Abraham Johnson, Sraddha Singh, Anju Thomas, Nipa Chauhan
DOI:10.4103/0973-029X.325242  
Background: Orthodontic science centers primarily on the growth, development and advancement of the craniofacial structures. Geometric morphometrics (GMM) is a new approach for shape identification in forensic sciences. Purpose: The aim of this study was to examine the shape variation in the Indian sample in order to assess sexual dimorphism by application of two-dimensional GMM. Materials and Methods: The sample comprised a total of 105 lateral cephalograms (54 males–51 females) of Angle's Class I malocclusion patients that were later subjected to principal component (PC) analysis and discriminant analysis. Results: The PC analysis showed over 96% of shape variation. The initial three PCs were statistically significant that depicted as 58.37% of total shape variability, with PC1 represent for the most significant variance 28.48%, PC2 described 18.83% and PC3 11.06%. Conclusion: Sex of an individual was clearly associated with occlusion of teeth and showed considerable variation. GMM is an alternative research tool and can be utilized for diagnosing individual characterization and classification of malocclusion.
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ONLINE ONLY ARTICLES - ORIGINAL ARTICLES Top

Comparison of orosomucoid-1 immunoexpression and angiogenesis between oral squamous cell carcinoma cases with different histological grades p. 368
Celeste Sanchez-Romero, Ronell Bologna-Molina, Rogelio Gonzlez-Gonzlez, Sirced Salazar-Rodriguez, Nataly Barreiro Mendoza
DOI:10.4103/0973-029X.325243  
Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy in this region, and thus, further elucidation of its tumoral mechanisms is important. One of the main roles of the acute-phase protein orosomucoid-1 (ORM1) is the promotion of angiogenesis, which is key for tumor nutrition and growth. Aim: Our aim was to evaluate the immunohistochemical expression of ORM1 and the angiogenic activity indicated by microvascular density (MVD) in OSCC samples according to histological grade. Materials and Methods: Formalin-fixed, paraffin-embedded sections from 45 OSCC cases were submitted to immunohistochemistry: 25 were well-differentiated OSCC, 18 were moderately differentiated OSCC and 2 were poorly differentiated OSCC. ORM1 staining was evaluated by a semiquantitative method, and CD34-positive blood vessels were quantified to calculate the MVD. The results were statically analyzed. Results: All cases exhibited immunoexpression of ORM1 and CD34. However, no significant differences were found between the expression of both markers among the histological grades. In addition, the presence of ORM1 in inflammatory cells and in the extracellular matrix was detected in most cases. Conclusion: These results suggest that the induction of angiogenesis is not the main role of ORM1 in OSCC and may be associated with the regulation of the immune/inflammatory response or the transport of protumoral molecules, such as sialyl-Lewis X or phorbol esters, which requires confirmation in future studies.
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A comparative assessment of pomegranate extract, sodium hypochlorite, chlorhexidine, Myrrh (Commiphora molmol), tulsi extract against Enterococcus faecalis, Fusobacterium nucleatum and Staphylococci epidermidis p. 369
Mallwika Sisodiya, Shadab Ahmed, Ranjan Sengupta, Priyanka , Ankit Kumar Saha, Gourav Verma
DOI:10.4103/0973-029X.325252  
Background: The presence of pathogenic bacteria, toxins and byproducts in the root canal system show a decisive part in success of endodontic therapy. Thus, the complete removal of this bacterium is highly desirable. Several intracanal medicaments were tried to disinfect the root canal before obturation. Aim: The present study was conducted to compare Pomegranate, sodium hypochlorite, Chlorhexidine, Myrrh (Commiphora molmol), tulsi extract against Enterococcus faecalis, Fusobacterium nucleatum and Staphylococci epidermidis. Settings and Design: Cross-sectional observational prospective study. Materials and Methodology: Aqueous extract of 20% pomegranate peel, 20% pomegranate peel, 0.2% CHX, 2.5% sodium hypochlorite, Tulsi extract and Myrrh (Commiphora molmol) was used as agent against E. faecalis, F. nucleatum and Staphylococci Epidermidis. Zone of inhibition and minimum inhibitory concentration (MIC) was calculated and compared using analysis of variance and Mann–Whitney test. The information was statistically evaluated with SPSS software version 20 with P < 0.05. Results and conclusion: The mean zone of inhibition against E. faecalis, F. nucleatum and S. Epidermidis was highest in chlorhexidine and sodium hypochlorite groups compared to herbal groups. MIC was least with group III followed by group II against all bacterial species (P < 0.05). Sodium hypochlorite found comparatively better followed by chlorhexidine and other agents against E. faecalis, F nucleatum and S. epidermidis.
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The temporomandibular joints disorders in patients with osteoporosis p. 369
Ali Qays Lilo Lilo, Maytham Riad Ali, Ali Mihsen Hussein Alyassiri
DOI:10.4103/0973-029X.325254  
Background: Osteoporosis is a skeletal and progressive behavioral disease with physically and psychologically significant consequences. Aims of the Study: Evaluate the presence and effects of Temporomandibular Joints Disorders in osteoporotic patients. Materials and Methods: Fifty-eight (58) patients with osteoporosis participated in this study as they were already diagnosed by Rheumatologists, physical and sport Rehabilitation physicians in Merjan Medical city/Babylon – Iraq between period February and August 2019. Results: Twenty-seven (27) patients with T. M. J clicking as anterior disk displacements, Seventeen (17) patients with spasm in muscles of mastication, and then finally Fourteen (14) out of 58 patients with subluxation and dislocation. Conclusions: Osteoporosis can have a significant impact on oral health.
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ONLINE ONLY ARTICLES - REVIEW ARTICLES Top

A systematic review on the guidelines for nutritional assessment for head and neck cancer patients managed by surgery p. 370
Shrikanth Muralidharan, Arunkumar Acharya, Pramila Mallaiah, B Anil Babu
DOI:10.4103/0973-029X.325255  
There are a number of guidelines to assess the nutrition status of cancer cases. None of these guidelines are specifically head and neck cancer related; except for the European guidelines. This article reviews the different guidelines in nutrition for cancer cases and also their drawbacks.
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Immunotherapy: The future of cancer treatment p. 371
Manisha Sahu, Hemakumari Suryawanshi
DOI:10.4103/0973-029X.325257  
Head and neck squamous cell carcinomas (HNSCCs) are one of the most common cancers worldwide. A large number of patients are diagnosed with locally advanced disease and require multimodal treatment approaches. Standard treatment modalities ranging from surgery to chemotherapy and radiation are yielding mixed results. To overcome this hurdle, newer innovative approaches are required to reduce the morbidity and mortality of the patients. In the last few decades, immunotherapy has become an important part of treating some types of cancer. The immune system plays a key role in the development, establishment and progression of HNSCC. A greater understanding of the dysregulation and evasion of the immune system in the evolution and progression of HNSCC provides the basis for improved therapies and outcomes for patients. Newer types of immune treatments are now being studied, and they will impact how we treat cancer in the future. This article provides a brief overview of the current immunotherapeutic strategies for cancer with emphasis on HNSCC.
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Association between Smokeless Tobacco and risk of malignant and premalignant conditions of oral cavity: A systematic review of Indian literature p. 371
Shivesh Acharya, Shruti Singh, Sarabjot Kaur Bhatia
DOI:10.4103/0973-029X.325258  
Causative linkages of tobacco use with oral potentially malignant disorders and cancers of oral cavity have been studied. Oral squamous cell carcinoma is one of the most common cancers in India. The International Agency for Research on Cancer (IARC) monograph found a significant association between smokeless tobacco (SLT) use and oral cancer. However, only a few limited studies have been represented on the IARC monograph. Published meta-analyses have provided pooled risk estimates for oral cancers caused by tobacco, both on global and regional levels. This systematic review was aimed at summarizing all the available studies exclusively in India by collecting data from PubMed and Medline. Emphasis was laid on cohort and case–control studies, and a few cross-sectional studies for premalignant lesions were also discussed. A significant association was noticed on SLT and premalignant and malignant oral cavity lesions.
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ONLINE ONLY ARTICLES - CASE REPORTS Top

A case of progressive systemic sclerosis/lupus overlap syndrome: Presenting with parotid swelling p. 372
R Ramya, R Swarnalakshmi, Arunachalam Preethi, R Pradeep
DOI:10.4103/0973-029X.325259  
An overlap syndrome is a medical condition which shares features of at least two more widely recognized disorders. Autoimmune connective tissue diseases include systemic lupus erythematosus (SLE), scleroderma, polymyositis, dermatomyositis, rheumatoid arthritis and Sjögren's syndrome where overlap syndrome most commonly seen in combination with SLE and systemic sclerosis (SSc). Sjogren's is an autoimmune exocrinopathy, in which systemic diseases such as arthritis, interstitial lung disease and renal disease may develop in addition to the pathognomonic features such as dry eyes and mouth. The other associated disease with Sjogren's includes sialadenitis. Sialadenitis of the parotid gland is one of the major disorders of salivary gland. This article presents a rare case report of a patient diagnosed with sialadenitis of the parotid gland and associated with progressive SSc/lupus overlap syndrome and secondary Sjogren's.
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A case of chronic myeloid leukemia presenting as oral ulcers p. 372
Neethu Telagi, BR Mujib Ahmed
DOI:10.4103/0973-029X.325260  
The oral signs and symptoms may reflect undetected serious systemic diseases. Depending on the oral manifestation, the dentists and physicians make attention and focusing on specific diagnoses. Here, we represent one such case which was diagnosed after oral signs and symptoms followed by peripheral smear report as chronic myeloid leukemia. Leukemia is among the most prevalent neoplasia, which represents between 30% and 51% of that total. Leukemia is characterized by uncontrolled production of immature white blood cells, causing a series of clinical and oral manifestations, which are important in disease diagnosis. Due to their clinical importance, all such lesions deserve the full attention of dental doctors. Early detection of leukemia is very important because it provides a favorable prognosis.
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Imaging of Gorlin-Goltz syndrome: Series of 2 cases p. 373
Suhail Rafiq, Farzana Manzoor, Musaib Ahmad Dar, Rassieq Aslam
DOI:10.4103/0973-029X.325261  
Gorlin–Goltz syndrome (GGS) is a rare autosomal dominant disorder with multisystemic involvement. It is characterized by the triad of multiple baso-cellular epitheliomas, odontogenic keratocysts (OKC) in the jaws and skeletal anomalies. Later, it was found that calcification of falx is also highly specific. We present radiological findings in case series of two cases, one with multiple OKC, calcified falx, skin lesions, and fibrous dysplasia of sphenoid and second with multiple OKC, calcified falx, vertebral anomaly and medulloblastoma.
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Supernumerary tooth in the nasal cavity p. 373
Stuti Mathur, Bhavika Verma, Yogesh Dabholkar, Akansha Saberwal
DOI:10.4103/0973-029X.325262  
Intranasal ectopic dentition is a rare clinical entity. The presence of teeth has been reported in ovaries, testes, anterior mediastinum and presacral regions. In the maxillofacial region, teeth have been found in maxillary sinus, mandibular condyle, coronoid process, chin, nose and even orbit. A 21-year-old female patient presented with complaints of intermittent right-sided epistaxis and a history of occasional headache for 6 months. An anterior rhinoscopic examination revealed a hard white mass surrounded by granulation tissue lying in the floor of the right nasal cavity. The clinical appearance was that of a rhinolith. Supernumerary teeth are extra to normal complement in dentition. They may occur unilaterally or bilaterally, single or multiple. A variety of complications can occur ranging from crowding to cyst formation. Hence, early identification and treatment are essential for management.
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Plexiform neurofibroma with nevus of ota-rare presentation p. 374
Lavina Taneja, Sushil Kumar Dokwal, Jyoti Prajapat, Vishal Arya
DOI:10.4103/0973-029X.325263  
Plexiform neurofibroma (PNF) is a rare form of neurofibromatosis type 1 which is rarely seen isolated. This generally spreads along the peripheral nerve and may affect some nervous rami. This is a poorly circumscribed and locally invasive tumor. About 21% of patients with NF-I are affected with PNFs. The nevus of Ota also called oculodermal melanocytosis is a macular discoloration of the face. It is most commonly found in the Japanese and very rare in the Indian subcontinent. It is unilateral oculodermal melanosis along the first two branches of the trigeminal nerve. We hereby present a very rare case of occurrence of isolated PNF (not associated with neurofibromatosis type 1) along with nevus of ota of the left side of the face in a 28-year-old female with thorough radiographic work up.
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Osteosarcoma: A case report and evaluation p. 374
Adesh S Manchanda, Ramandeep Singh Narang, Sanah Mahajan
DOI:10.4103/0973-029X.325264  
Osteosarcoma (OS) comprises 2.1% of all malignant oral and maxillofacial tumors. OS arising from the jaw OS differs from OS of the long bones in its biological behavior, presenting a lower incidence of metastasis and a better prognosis. The morphologic and behavioral heterogeneity observed in OS and the perplexity of the varied histological features mimicking other primary and metastatic bone tumors has emphasized the need of advanced molecular techniques in its diagnosis. Hereby, we present a case of OS which was diagnosed by immunohistochemical analysis, aiding in establishing its histogenetic origin.
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ONLINE ONLY ARTICLES - FORENSIC CORNER Top

Analysis of the positions of anterior teeth in orthodontically treated and untreated population: A proof of uniqueness p. 375
Nishita Anthwal, Ankur Joshi, Neeraj Grover, Vineeta Gupta, Nutan Tyagi, Himanshu Gupta
DOI:10.4103/jomfp.JOMFP_168_20  
Aim: To compare the uniqueness of human dentition in both orthodontically treated and untreated populations and evaluate the reliability of bitemark analysis. Materials and Methods: A total of 1464 maxillary and mandibular casts were fabricated from orthodontically treated and nontreated population. After careful examination of the study teeth, 326 nontreated maxillary cast (Group 1), 333 nontreated mandibular cast (Group 2), 336 orthodontically treated maxillary cast (Group 3), and 320 orthodontically treated mandibular casts (Group 4) were selected for the analysis. For uniformity, the sample size of 320 was selected from each group for comparison. Results: The arch width was a major cause of variance. In Group 1, only 6.87% of similarity rate was seen, whereas in Group 3, the match rate increased to 55% showing similarity. In Group 2, only 1.87% similarity and Group 4 showed 42.7% match rate. Conclusion: The human dentition may be unique, but it loses its uniqueness once any dental treatment is carried out.
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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007