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    Table of Contents - Current issue
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April-June 2022
Volume 26 | Issue 2
Page Nos. 137-291

Online since Tuesday, June 28, 2022

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EDITORIAL  

From the editor's desk Highly accessed article p. 137
T Smitha
DOI:10.4103/jomfp.jomfp_213_22  
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LIVING LEGEND Top

Dr Sharada P p. 138
Priya
DOI:10.4103/jomfp.jomfp_243_22  
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GUEST EDITORIAL Top

Importance of ethics in oral pathology Highly accessed article p. 140
Neeraj Grover
DOI:10.4103/jomfp.jomfp_140_22  
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INVITED REVIEW Top

Hyposalivation and oral candidiasis-A short review p. 144
N Aravindha Babu, N Anitha
DOI:10.4103/jomfp.jomfp_161_22  
Oral candidiasis is an opportunistic fungal infection commonly encountered in immunocompromised individuals. The oral cavity harbours numerous microbes and along with immunity saliva also maintains oral health. The Candida species form biofilm over the tissue and prosthetic surfaces. The biofilm formation results in persistent colonisation and persistent infection. The saliva in the oral cavity maintains the integrity of the oral environment by washing away the microbes through its flow and with its antimicrobial agents. The significant role of salivary histatins as an antifungal agent diminishes with hyposalivation. The importance of saliva in preventing fungal colonisation and infection is discussed in this review.
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ORIGINAL ARTICLES Top

COVID-19 Associated Mucormycosis (CAM): A Single Hospital-Based Study Highly accessed article p. 147
Manjunath M Vijapur, Vasanth Kattimani, VK Varsha, HC Girish, Mamata Kamat, Bhargav Ram
DOI:10.4103/jomfp.jomfp_152_22  
Background: Opportunistic fungal infections like Mucormycosis in Coronavirus Disease 2019 (COVID-19) patients have posed a great challenge to health care professionals, especially in developing countries like India. Hence, there is a need to understand the biological behaviour of COVID-19 associated Mucormycosis (CAM) to establish standard treatment Protocols and to reduce mortality. Aims: This study aims is to assess the type of Mucormycosis among COVID-19 patients in study population and compare the findings with clinical, radiological and haematological parameters along with treatment and surgical management. Methods and Material: This retrospective, observational study included 60 cases of CAM reported to the Department of Oral and Maxillofacial Surgery at the tertiary care centre, Karnataka Institute of Medical Sciences, Hubli. Data about various parameters were tabulated and analysed statistically. Statistical Analysis Used: Bivariate analysis was done using the Chi-Square test to assess the relationship between the type of Mucormycosis and other variables. Spearman's Correlation test was used to assess the correlation between types of Mucormycosis with the other variables. Linear regression analysis was performed to assess the response variable related to the type of Mucormycosis. Results: About 50% of subjects presented with “Rhino orbital” type of Mucormycosis. Palatal discoloration and palatal erosion was the most common oral manifestation among “only Sinus” and “Rhino orbital” types of Mucormycosis (P = 0.00). Significant association (P = 0.29) was found between the type of Diabetes mellitus and Mucormycosis. Conclusions: The study indicates that DM is the most commonly associated comorbidity in CAM patients. Hence, a thorough understanding of the underlying comorbidity and its close monitoring during and after COVID-19 infection is mandatory for successful treatment outcomes.
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Myofibroblasts as important diagnostic and prognostic indicators of oral squamous cell carcinoma: An immunohistochemical study using alpha-smooth muscle actin antibody p. 156
Piyush Gandhi, Manmeet Kaur, Ramandeep Singh Punia, Thippeswamy Shamenahalli Halappa, Harkanwal Preet Singh
DOI:10.4103/jomfp.jomfp_389_20  
Background: Oral squamous cell carcinoma (OSCC) is the most common malignancy of the oral cavity, with multifactorial etiopathogenesis. Data from the past literature suggest that myofibroblasts (MFs) can also contribute significantly to the pathogenesis of the disease. Hence, the present study was undertaken for assessing the expression of MF in well-differentiated OSCC (WDOSCC), moderately differentiated OSCC (MDOSCC), poorly differentiated OSCC (PDOSCC) and healthy controls by immunohistochemistry using alpha-smooth muscle actin (α-SMA) antibody. Methodology: Forty cases each of WDOSCC, MDOSCC, PDOSCC and healthy controls were included. 4-μm thick sections from each tissue sample were stained with routine hematoxylin and eosin as well as immunohistochemically using α-SMA. Among different grades of OSCC, expression of MFs was compared. All the results were subjected to statistical analysis. Results: While comparing the expression of MFs in between different grades of OSCC, nonsignificant results were obtained. While comparing the expression of MF in between OSCC cases and normal controls, significant results were obtained. Conclusion: MFs are one of the vital pathogenetic components in OSCC cases in predicting their invasive behaviors. We advocate the use of MFs as a stromal marker for visualizing invasion and progression in OSCC patients.
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Capacity of Candida species to produce acetaldehyde at various concentrations of alcohol p. 161
Mamatha G S Reddy, Pradnya Kakodkar, Gayatri Nayanar
DOI:10.4103/jomfp.jomfp_494_20  
Background: Along with tobacco use, alcohol consumption is one of the crucial factors for oral cancer. Acetaldehyde (ACH), a byproduct of alcohol, is reported as carcinogenic. One of the producers of ACH from alcohol is Candida species. The aim of the study was to quantify the ACH produced by Candida species at various concentrations of alcohol. Materials and Methods: Clinical isolates of Candida, namely Candida albicans, Candida krusei and Candida tropicalis and C. albicans ATCC 18,804, were subjected to various concentrations of alcohol. Alcohol dehydrogenase and ACH were estimated using spectrophotometry and headspace gas chromatography, respectively. Results: Out of all three clinical isolates, C. tropicalis produced more ACH (412.1 μM) at 10 mM alcohol concentration by 105 colony-forming unit/ml followed by C. albicans (233 μM) and C. krusei (53.7 μM). C. albicans of clinical isolate and ATCC species (222 μM) did not show much difference. Conclusion: The study results conclude that Candida species are capable of producing carcinogenic levels of ACH on exposure to various concentrations of alcohol.
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Role of S100 A7 as a diagnostic biomarker in oral potentially malignant disorders and oral cancer p. 166
Anubhuti Sood, Deepika Mishra, Om Prakash Kharbanda, Shyam S Chauhan, Siddharth Datta Gupta, Suryanarayana S V Deo, Rahul Yadav, Ranju Ralhan, Ramniwas Kumawat, Harpreet Kaur
DOI:10.4103/jomfp.jomfp_402_20  
Background: S100 proteins have been implicated in the tumorigenesis of different human cancers and in oral dysplasia, as they are keratinocytes. Materials and Methods: In the present study, we have attempted to compare the expression of S100-A7 within young-onset (age ≤45 years, Group 1) oral squamous cell carcinoma (OSCC), OSCC in older age groups (age >45 years Group 2), oral potentially malignant disorders (OPMDs, Group 3) and inflammatory lesions (Group 4). The tissue sections were scored based on the percentage of immunostained cells and staining intensity. Nuclear, cytoplasmic and membrane immunoreactivity were also scored. Results: The present study comprised 153 histopathologically diagnosed case subjects of OSCC >45 years (n = 41), OSCC <45 years (n = 36), OPMD (n = 40) and inflammatory lesions (n = 36). The present study revealed a statistically significant difference of distribution with regard to S100A7 staining (cytoplasmic and nuclear) between OPMDs and OSCC (P < 0.05). The nuclear, cytoplasmic and membrane staining as well as the staining intensity had significantly different scoring patterns among the OSCC group, OPMD group and the inflammatory lesions with the OSCC group having the highest scoring of the S100A7 staining (irrespective of the age). Conclusions: The present study concludes that S100A7 can be used as a diagnostic biomarker to differentiate between OPMDs and OSCC lesions. However, the marker is unable to distinguish between OSCCs in younger and older patients as the molecular pathogenesis of tumors in either of these age groups is probably similar.
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Anti-fibrotic activity of licorice extract in comparison with colchicine on areca nut-induced fibroblasts: An in vitro study p. 173
Amritha James, Nandhini Gunasekaran, Rajkumar Krishnan, Preethi Arunachalam, Ramya Mahalingam
DOI:10.4103/jomfp.jomfp_110_21  
Objective: Oral submucous fibrosis (OSMF) is a debilitating chronic disease of the oral cavity with a high potential for malignant transformation. The main etiological agent attributed to the development of OSMF is the use of smokeless tobacco products like areca nut. There is no known cure for the disease. Current modalities of treatment do not provide a complete cure and often prove invasive for the patient. Herbal preparations using natural compounds and medicinal plant extracts have long since been used in India, as an acceptable, noninvasive and cost-effective method in the treatment of various diseases. Hence, the present study aims to assess the anti-fibrotic effect of licorice in comparison with colchicine on areca nut-induced fibroblasts. Materials and Methods: Extracts of areca nut, licorice and colchicine were prepared in accordance with established protocols. Human fibroblast cell lines were procured from ATCC® (PSC-201-018). Fibroblast cultures were established, and upon reaching confluence the cells were subjected to the 25 μg/ml areca nut extract for 24 h to induce fibrosis, with CCl4 used as control fibrosing agent. The areca nut and CCl4 induced cells were then subjected to varying concentration of the test antifibrotic agent, licorice extract for the periods of 24 and 48 h, with colchicine used as positive control. Total collagen quantification was done using spectrophotometry. Results: Collagen accumulation decreased with increase in the concentration of licorice extract with maximum reduction seen at 200 μg/ml. Kruskal–Wallis test was done to analyze the difference in collagen accumulation. Analysis revealed that the P < 0.05 for both periods in both the areca and CCl4 induced cell lines following the addition of licorice extract. The data were found to be statistically significant. Conclusion: The current study proves the antifibrotic efficacy of licorice in areca nut induced cell lines and hence, this agent can be used for the therapeutic management of OSMF.
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Knowledge, attitude and preparedness to combat COVID-19 infection among dental professionals: A student-centric pilot study p. 179
S Meenakshi, Anupama Aradya, HS Sreeshyla, Narahari Ranganatha, Smitha Thammaiah
DOI:10.4103/jomfp.jomfp_431_21  
Background: In the COVID-19 age, attempts are being made to raise student awareness and improve best practices to contain the outbreak. Methodology: The target population was interns and 3rd year undergraduate students from JSS Dental College and Hospital, Mysuru. COVID-19 knowledge, awareness and attitude of the students and interns and the preparedness to tackle the current COVID 19 pandemic were assessed. Results: 120 respondents responded via a contented validated self-administered questionnaire with regard to knowledge, attitude and practices and preparedness to address the COVID 19 pandemic by undergraduates and interns. The student participants irrespective of their years into practice were aware of the guidelines being issued by Health care authorities and to address the COVID 19 pandemic. Among the respondents, 57.5% were 3rd year dental students and 42.5% were interns. Regarding knowledge about COVID infection, 42.9% (3rd year students) and 57.1% of the interns were aware of the recent developments, 34.1% of the III year students were aware of the safe distance to be maintained between patients, 42.4% of the students and 57.6% of interns were aware of the authority to be contacted with suspected COVID 19 infections. The participants were also aware of the vaccine trial which was conducted. Most of the respondents (64.3% of the students and 78.6% of the interns) were aware of fumigation in clinical or high-contact areas on a daily basis and biweekly in nonclinical areas. Conclusions: The results suggest a strong need to encourage the current training program among students in health care-related fields.
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Glucose transporter 1 expression in ameloblastoma and odontogenic keratocyst – A comparative immunohistochemical study p. 185
Sindhuri Pragallapati, Ravikanth Manyam
DOI:10.4103/jomfp.jomfp_9_21  
Introduction: Facilitative glucose transporters (GLUTs), which mediate glucose transport across the cell membrane, differ in their tissue distribution and affinity for glucose. GLUT1 is ubiquitously present and help in the basal uptake of glucose into the cells. Its expression is known to be elevated in conditions that induce hypoxia and by growth factors. GLUT1 is known to be increased in many malignant tumors to meet the metabolic requirements, but its role in odontogenic tumors is not known. Objective: The objective of this study is to evaluate and compare the immunohistochemical expression of GLUT1 in ameloblastoma (AM) and odontogenic keratocyst (OKC). Materials and Methodology: Thirty cases each of AM and OKCs were immunohistochemically stained using anti-GLUT1 antibody according to the standard protocol. Qualitative assessment of GLUT1 expression was done under the categories of distribution, intensity and localization of staining. Quantitative assessment was done using Image J software. The results were tabulated and statistically analyzed. Results: GLUT1 positivity was observed in 25 (83.3%) cases of OKC and 26 (86.7%) of AM cases. The majority of cells in the suprabasal layer of OKC showed positivity, whereas the equal distribution of staining was observed in the central and peripheral cells of AM. Conclusion: GLUT1 expression in these tumors is suggestive of an increased glucose uptake and probably increased utilization of energy, which may be correlated with their aggressive behavior.
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Cemental annulation: An approach to age estimation in transverse and longitudinal sections using three different microscopes p. 192
Aishwarya Patil, B N V S Satish, Rony Tomy Kondody, Vishal Wali
DOI:10.4103/jomfp.jomfp_48_21  
Background: Estimation of age is an important aspect in determining a person's identity. Since teeth are resistant to decay and degradation, estimation of age using dental structures may be a valuable tool in human identification. Recent research suggests that tooth cemental annulation could be used as an effective method for age estimation than other morphologic or histological parameters. Materials and Methods: A total of 100 extracted teeth were chosen. Using a hard tissue microtome (SP 1600) longitudinal and transverse ground sections of 100 μm thickness of each tooth were prepared. It is further examined under light microscopy, polarized microscopy and phase-contrast microscopy. The images of longitudinal and transverse were magnified on a computer and the cemental lines were counted. Results: The present study showed is a strong positive correlation for cemental annulation between the calculated age and estimated age when phase-contrast microscopy was used in both longitudinal and transverse sections when compared with other microscopes. The correlation coefficient value was found more significant in the longitudinal section which implies that the phase-contrast microscope was highly reliable and had a significant correlation (P < 0.001) with the actual age compared to other microscopes. Conclusion: Cemental annulation by various microscopes improves accuracy in the prediction of age and also it allows for age estimation in cases where skeletal fragments are poorly preserved.
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Senescent Fibroblast in Oral Submucous Fibrosis Aids in Disease Progression and Malignant Transformation p. 199
Shyamala Karnam, HC Girish, Vaidhehi N Nayak
DOI:10.4103/jomfp.jomfp_115_21  
Aim: To study the role of senescent fibroblasts (SFs) and its secretory phenotypes promoting fibrosis and malignancy in oral submucous fibrosis (OSMF). Material Methods: A total of 20 cases of OSMF and 20 normal oral mucosal tissues were taken for the study. The tissue sections were stained for IHC-immunohistochemistry with senescent cell marker p16INK4a. The supernatant solution of the transport medium was studied for leached out senescent associated secretory proteins (SASP): matrix metalloproteinases 9 (MMP9), interleukins 6 (IL6), vascular endothelial growth factor (VEGF). Tissues were studied for malignant transformation with p53 and Ki67. Fibrosis in the OSMF was tested with lysyloxidase (LOX). The Statistical Package for the Social Sciences (SSPS) statistical software was used to analyze the data. Results: IHC staining for p16INK4a showed positivity in the connective tissue of OSMF cases which was statistically significant. Antibody assay using enzyme-linked immunosorbent assay (ELISA) showed elevated levels of secretoproteins IL6, MMP9, VEGF in OSMF cases. LOX enzyme levels were also significantly increased in OSMF cases. Proliferative markers Ki67 and p53 were positive in IHC staining in the epithelium of OSMF. Conclusion: This study confirms the presence of SF and its secreto phenotypes in OSMF and showed increased LOX expression which is implicated in fibrosis. These findings suggest that SF may contribute to fibrosis in OSMF. The study also confirms the malignant transformation of the overlying epithelium as shown by p53 and Ki67 positivity.
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Comparative evaluation of alteration in taste perception among Gutkha chewers with and without OSMF and healthy subjects: A prospective case-control study p. 208
TC Harini, Anbu Ila, Anil Kumar Nagarajappa, Ajay Chandran, Deepak R Kolte, Srikanth Gunturu
DOI:10.4103/jomfp.jomfp_38_21  
Context and Aim: The major afflictions such as odynophagia (painful swallowing) and trismus that occur in patients with oral submucous fibrosis (OSMF) are well documented, but the impairment of gustatory functions has not received much consideration in the past. The present study was planned with a similar intent to assess and compare the alteration in taste perception among gutkha chewers with and without OSMF and healthy subjects. Materials and Methods: The present study was designed as a prospective case–control study comprising 90 individuals within an age range of 15–50 years who were divided into three groups with Group A consisting of 30 patients who were gutkha chewers with OSMF, Group B consisting of 30 individuals who were gutkha chewers but without OSMF and Group C consisting of 30 healthy subjects who were included as normal controls. The taste intensity response scores for the four basic tastes were recorded and the results obtained were, then, subjected to statistical analysis. Statistical Analysis Used: The data were analyzed using SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Chi-square test, analysis of variance and Tukey's post-hoc test. P < 0.05 was considered statistically significant. Results: The findings of the present study suggested that all taste sensations were affected more in Group A patients than the Group B and Group C individuals. Conclusion: The results obtained in the present study were found to be encouraging as it was demonstrated that taste perception varied significantly among the patients with OSMF as against those having habit of betel nut/gutkha chewing but those who did not develop OSMF and the normal healthy controls and this data, though, initial, might be used on a scientific basis to improve the quality of life in the affected patients as well as to prevent the further progression of the disease process.
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Utility of serum and salivary lactate dehydrogenase and uric acid levels as a diagnostic profile in oral squamous cell carcinoma patients p. 218
G Anitha, K Vinod Kumar, Gururaj Deshpande, M Nagaraj, Veerbhadra Kalyani
DOI:10.4103/jomfp.jomfp_26_22  
Background: Lactate dehydrogenase (LDH), an intra-cellular enzyme present in all cells of the body, catalyses the final step of anaerobic glycolysis. This intra-cellular enzyme is released into the extra-cellular space after tissue disintegration, which is evident in oral squamous cell carcinoma (OSCC). However, investigations comparing Lactate dehydrogenase (LDH) levels in OSCC and healthy controls have shown conflicting findings in both serum and saliva samples. Further, Uric acid's anti-oxidant activity has been demonstrated in several diseases. Several cancers have been linked to increased uric acid levels. However, uric acid levels in oral squamous cell cancer have varied. There exists limitted research comparing serum and salivary uric acid with OSCC. Thus, the present investigation was conducted to evaluate the combined diagnostic abilities of serum and salivary LDH and uric acid in OSCC. Aim and Objective: To compare and correlate LDH and uric acid levels in serum and salivary samples of OSCC patients and healthy individuals. Material and Methods: LDH levels and uric acid levels were measured using an enzymatic method in serum and salivary samples of OSCC cases (n = 18) and healthy individuals (n = 18). Results: This study indicated statistically significant elevated levels of LDH in serum and saliva samples of OSCC patients when compared to healthy individuals. Furthermore, serum and salivary uric acid were higher in OSCC patients than in controls. This increased levels of uric acid was significant only in serum but not in saliva samples. However, salivary uric acid was found to be co-relating with serum uric acid. In addition to this, the receiver operating characteristic (ROC) curve when plotted to assess combined diagnostic abilities of all the investigations to predict oscc, indicating the diagnostic ability to be 77%. Conclusion: This study found an increase in uric acid levels in OSCC patients, which contradicts previous existing litratures. Salivary uric acid and LDH levels may be effective indicators for OSCC screening. However, because of the limited sample size, these findings should be viewed with caution.
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REVIEW ARTICLES Top

Leaving no stone unturned: Role of profibrotic genes in oral submucous fibrosis – A systematic review p. 228
Amritha James, Lekshmy Jayan, Ramya Ramadoss, Preethi Arunachalam
DOI:10.4103/jomfp.jomfp_102_21  
Introduction: Understanding the molecular pathogenesis of an entity helps in devising the mode of progression as well as mode of therapy. Even with years of research to claim the understanding of the molecular pathogenesis of oral submucous fibrosis (OSMF) is limited. More deeper knowledge of the genes responsible for this will help in understanding and managing this disease better. Materials and Methods: The articles published during a time period of 1990–2020 were chosen in accordance with the inclusion and exclusion criteria according to the PRISMA guidelines. Results: From a total of 80 articles obtained from both electronic search of PUBMED, EMBASE, MEDLINE and Cochrane registry as well as the manual search only 21 articles were selected and analyzed. Conclusion: Careful analysis of the samples revealed that transforming growth factor-beta may be a potential biomarker or a candidate for targeted therapy in OSMF.
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Lipoid proteinosis: Review of Indian cases p. 236
Jigna S Shah, Himali A Shah
DOI:10.4103/jomfp.jomfp_249_21  
Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the deposition of amorphous hyaline material in the dermis and submucosal connective tissue. To date <500 cases of LP have been described and oral manifestations described in a very few reports. Indian cases are much less reported and reviewed. Hence, here review of 51 Indian LP cases along with a case of histologically proven LP in 12-year-old male patient with typical skin, ocular, laryngeal, oral and radiographic features is done. Cases from 1969 to 2021 were collected using keyword LP on google and google scholar and Indian cases were analyzed afterward. Review with case presentation regarding oral manifestations will help the oral physician to diagnose LP in early stage.
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Sarcoidosis – A review article p. 242
C Sreeja, A Priyadarshini, Premika, N Nachiammai
DOI:10.4103/jomfp.jomfp_373_21  
Sarcoidosis is a granulomatous disorder of multiple organs, with lungs and lymphatic systems being the most frequently affected sites of the body. It was first reported in 1877 and has continued to engross both clinicians and scientists since that time. Because sarcoidosis being a diagnosis of exclusion, it demands the physician to rule out all the possible diagnosis. Most of the patients remain asymptomatic and this makes the disease remain unnoticed for a prolonged period. Later after years, the disease could be diagnosed after witnessing the patient being symptomatic or suffering from organ failures. It could affect middle aged people of any sexes, often its clinical features correlate with tuberculosis. On immunological and histopathological examination, it reveals noncaseating granuloma in simple terms. Glucocorticoids remain the standard drug now and then. Further research has to be done to know the exact pathogenesis, early detection and betterment in treatment plan of sarcoidosis. The current review article gives a brief knowledge about etiopathogenesis, Clinical features, upgraded diagnostic methods such as biomarkers detection and the organized treatment plan to treat sarcoidosis.
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CASE REPORTS Top

Noneruption of teeth in amelogenesis imperfecta: A report of two cases and review p. 254
Jaygopal G Ray, Sayani Dutta, Snehanjan Sarangi, Priyanka Yadav
DOI:10.4103/jomfp.JOMFP_471_20  
Amelogenesis imperfecta (AI) comprises a complicated group of conditions, involving a structural defect of the tooth enamel, owing to certain genetic disturbances. It is expressed as an autosomal dominant, autosomal recessive or X-linked recessive trait. The structural pattern and clinical appearances of all the teeth, including those in the deciduous as well as the permanent dentition, are affected. It may be differentiated into three main divisions such as hypoplastic, hypocalcific and hypomaturative patterns. Eruption of tooth refers to a complex coordinated physiological process characterized by the movement of a tooth from its initial developmental position within the jaws to its final functional position in the occlusal plane, dictated crucially by dental follicle, bony remodeling metabolic alteration and molecular determinants. Alteration involving any one of the factors might cause hindrances. Herein, we report two cases with AI associated with noneruption.
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Intraoral malignant glomus tumor p. 259
Satheesh Chandran, Arun Elangovan, Saranya Vijayakumar, K Sai Sarath Kumar
DOI:10.4103/jomfp.jomfp_444_21  
Glomus tumors are uncommon, benign solitary tumors derived from the glomus apparatus. We report here a case of a malignant glomus tumor in an 8-year-old child presenting as a multilocular ill-defined radiolucency of the mandible. The lesion microscopically showed sheets of round basophilic cells with high nuclear-cytoplasmic ratio, indistinct cell boundaries, nuclear hyperchromatism and nuclear pleomorphism. Immunohistochemically, the tumor was positive for vimentin and smooth muscle actin.
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Primary amelanotic malignant melanoma of parotid and submandibular salivary gland: A rare case report p. 263
Mehebuba Sultana, Rudra Prasad Chatterjee, Sanchita Kundu, SK Abdul Mahmud
DOI:10.4103/jomfp.jomfp_183_21  
Primary amelanotic malignant melanomas (AMMs) of the parotid and submandibular salivary glands are extremely rare with only a few reported cases due to its low incidence and misdiagnosis. Malignant melanoma (MM) has a high predilection for the head-and-neck region and majority of the cases in the parotid gland reported as association with metastasis in and around the gland from a cutaneous primary tumor. Immunohistochemistry is solely needed for confirmation of diagnosis and MMs give positive reactivity for melan-A, HMB-45, and S–100. Prognosis for AMM in the mucosal or salivary gland regions is much poorer than cutaneous regions because of anatomic considerations and its delayed diagnosis. The treatment of choice is radical surgery and parotidectomy along with radiotherapy and chemotherapy.
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Oral metastatic clear-cell tumours: To and fro: Unusual case reports p. 268
Preeti Sharma, Vijay Wadhwan, Roli Singh
DOI:10.4103/jomfp.jomfp_104_21  
We report two extremely rare cases of metastatic clear-cell carcinomas, which metastasized from and to the oral cavity and both presented clinically in the oral cavity. First case was a primary lesion in the oral cavity, which showed distant metastatic deposits in liver, kidney, bone and brain. Histopathologically, lobules of pleomorphic clear cells were evident descending from the overlying mucosa, raising the suspicion of renal cell carcinoma. Immunohistochemical staining for CD10 was negative and the case was diagnosed as clear-cell type of oral squamous cell carcinoma which had disseminated to distant organs. In the second case, dysplastic clear granular cells were seen invading the bone. Immunohistochemical staining for CD10 showed focal mild positivity, confirming the diagnosis as clear-cell renal carcinoma which had metastasized to the oral cavity. Metastatic tumours must be considered in the differential diagnosis of rapidly growing ulcero proliferative lesions in the oral cavity.
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Granular cell ameloblastoma as a solitary peripheral growth after twenty years of segmental resection of the mandible: A rare case of recurrence p. 273
Chetan A Fukate, Shivani P Bansal, Neelam N Andrade, Rajiv S Desai
DOI:10.4103/jomfp.jomfp_24_22  
The ameloblastoma is a slowly growing, locally invasive, benign epithelial odontogenic neoplasm of the jaws with a high rate of recurrence if not removed adequately. We report an interesting case of granular cell ameloblastoma, which presented as a solitary, peripheral, soft tissue growth 20 years after initial segmental resection of the left mandible. The basal layer of oral mucosa could be the possible source of peripheral ameloblastoma in our case. In order to reduce the chances of recurrence, we suggest to incorporate mucosal stripping along with the conventional treatment as a mandatory rather than an elective procedure while treating ameloblastoma.
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FORENSIC CORNER - ORIGINAL ARTICLE Top

Sexual dimorphism of inferior alveolar canal location: A record- based CBCT Study in Eastern India p. 277
Rachna Rath, NC Sangamesh, Rashmi Rekha Acharya, Gaurav Sharma
DOI:10.4103/jomfp.jomfp_139_21  
Background: Sex determination from unidentified skeletal remains a daunting task in forensic odontology. The mandible is the strongest and most durable of bones available for post-mortem profiling and its morphometric characteristics have been investigated. Less explored is the location of the mandibular canal which in a few populations has shown gender dimorphism. Aim: The present cross-sectional study explores sexual dimorphism in an eastern Indian population of Odisha from an analysis of cone-beam CT system (CBCT) images for the relative position of the mandibular canal and its foramina. Method and Materials: A total of 120 CBCT images from either gender (1:1 ratio) of adult dentate individuals aged 18–60 years were analysed for the relative position of the mandibular canal. Ten measurements (8- coronal and 2- from axial slices) concerning the mandibular canal; at the level of the mandibular foramen, mandibular first molar and mental foramen were performed. Unpaired Student's t-test was employed to compare variables between the sexes at P < 0.05 level of significance. Results: The results revealed statistically significant differences (P < 0.05) between the genders in most of the variables (8/10), with higher mean values in males compared to females except in the distance between mandibular foramen and anterior border of the ramus (2.648 ± 0.67 mm in females, 2.527 ± 0.75 mm in males) and in the distance between the canal and lingual cortical plate in the region of the first molar (14.515 ± 1.33 mm in females, 14.288 ± 2.01 mm in males). Conclusion: The relative position of the mandibular canal and its associated foramina show sexual dimorphism in an adult eastern Indian population.
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Papillary synovial metaplasia-like change in oral mucoceles: A retrospective institutional study of 105 cases p. 283
Deepak Pandiar, Rahul Anand, Mala Kamboj, Anjali Narwal, Anju Devi
DOI:10.4103/jomfp.jomfp_466_20  
Background: Mucoceles are mucus-filled cavities and are broadly of two types: mucus retention cysts and mucus extravasation phenomenon. A wide variety of histological features have been documented in the literature. The present study was an attempt to study these histological features: papillary synovial metaplasia-like changes (PSM-like changes) in particular. Materials and Methods: One hundred and five tissue samples of mucoceles were retrieved and evaluated for age, gender, type, site, color, etiology, symptoms, dimension of the lesion and presence or absence of PSM-like changes. The results were documented on Microsoft Excel spreadsheet and analyzed by using SPSS. Results: All 105 cases were of mucus extravasation phenomenon with a definitive male preponderance. The mean age of occurrence was 25.82 ± 11.65 years and a predilection for the lower lip. PSM-like changes were seen in 31 cases (Group II), and the remaining 74 cases did not show a definite presence of these features (Group I). The cases in Group II were statistically larger in dimension than Group I cases. No difference was noted in age, gender and laterality. Conclusion: PSM-like changes appear to be an underrecognized histological alteration seen in oral mucoceles and must be recognized to differentiate from other salivary gland entities showing papillary architecture.
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Identification of genetic instability in peripheral blood lymphocyte of oral squamous cell carcinoma patients assess by comet assay p. 284
Kamlesh Dekate, Suresh Barpande, Jagdish Tupkari, Mansee Thakur, Niharika Swain
DOI:10.4103/jomfp.jomfp_70_20  
Context: Studies established that human cancer is principally a genetic disease; it arises as accumulation of a set of genetic changes. In the pathogenesis of cancer, genetic instability is the sequential event to a carcinogenic stimulus resulting in various genomic changes including DNA damage. Aims: To assess genetic instability, as susceptibility to DNA damage, we used single-cell gel electrophoresis (comet assay) to study double strand breaks in associated with the risk of oral squamous cell carcinoma (OSCC). Materials and Methods: We used comet assay to measure double strand break in individual peripheral blood lymphocytes from 50 individuals with OSCC and 30 healthy control subjects. All personal information was gathered from subjects including tobacco history. DNA damage was visualized as comet assay and quantified by movement of damaged strands as length of tail. Results: Study results of OSCC patients were observed in relation to clinical staging and histological grading of carcinoma. On the basis of clinical observation, cases were grouped in to Stage I, Stage II, Stage III and Stage IV. No stage I cases were in study sample. The mean DNA damage migration length was observed 4.600 ± 0.4613 μm in stage II, whereas in Stage III and Stage IV, it was observed to be 4.961 ± 0.5620 μm and 4.883 ± 0.410 μm, respectively. The DNA damage length in histological grades of squamous cell carcinoma patients in Grade I was 4.6437 ± 0.3061 μm and Grade II was 5.3533 ± 0.3831 μm. In comparison with control group and squamous cell carcinoma group, it was observed in the range of 0.02–0.36 μm and varied from 4.04 to 5.84 μm range, respectively. Thus, the results were statistically significant with the histological grading of OSCC. Statistical Analysis: Unpaired' test and “ANOVA” test are used for statistics. Conclusion: The amount of DNA strand breaks in peripheral lymphocytes are measured by comet assay which is associated with relative risk of OSCC.
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Rapid economical acetic acid Papanicolaou staining procedure versus conventional staining procedure in normal oral mucosa p. 285
Karthika Panneerselvam, K Raghavendhar Karthik, Ramya Ramadoss, A Ramesh Kumar, K Rajkumar
DOI:10.4103/jomfp.JOMFP_135_20  
Background: Papanicolaou (Pap) staining technique is a conventional technique used in cytology but it is time consuming. Aim: The aim of the study was to determine the efficacy of Rapid Economical Acetic acid Papanicolaou stain (REAP) over conventional staining technique in studying normal oral mucosa. Materials and Methods: Eighty patients were selected and were grouped based on their habits. Two smears were obtained from each patient and were subjected to both the staining techniques. A total of 160 slides were studied for features such as cellular outline, nuclear outline, nuclear details, cellular differentiation, micronuclei and cellular transparency. Results: The conventional staining procedure showed 79 cases of optimal cellular staining, 78 cases of optimal nuclear staining, 35 cases of optimal nuclear details, 57 cases of optimal differentiation and 27 cases of optimal transparency and 33 cases of optimal micronuclei. REAP staining showed 75 cases of optimal cellular staining, 64 cases of optimal nuclear staining, 20 cases of optimal nuclear details, 36 cases of optimal differentiation and 28 cases of optimal transparency and 25 cases of optimal micronuclei. Conclusion: REAP staining effectively reduces the time and the cost factor, but the cytological details are well observed under conventional staining technique in normal patients.
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Evaluation of e-cadherin and vimentin expression for different grades of oral epithelial dysplasia and oral squamous cell carcinoma – An immunohistochemical study p. 285
Nagiredla Puneeta, Tummidi Santosh, Isha Mishra, Pravin Gaikwad, Anshuta Sahu
DOI:10.4103/jomfp.JOMFP_166_20  
Background: Oral cancer is the 11th common cancer in the world and ranks 6th globally in deaths. The incidence of oral cancer in India accounts for approximately 30%–40% of all cancers. Aims and Objective: The present study was undertaken to evaluate the expression of Vimentin and E-cadherin in different grades of oral epithelial dysplasias (OEDs) and oral squamous cell carcinoma (OSCC). Materials and Methods: Biopsies/blocks of oral cavity lesions were retrieved from the archives of the department. Normal oral mucosa (5 cases), oral epithelial dysplastic (60 cases) and different grades of OSCC (60 cases) evaluated by hematoxylin and eosin sections. Immunohistochemical analysis was done on the blocks and expression of E-cadherin and Vimentin was recorded. Results: Our study included various grades of OED, OSCC and normal mucosa as control cases. The mean age of OED and OSCC was 49 and 56 years, respectively, with male predominance. Tobacco habit was present in approximately 90% cases, and buccal mucosa was the most commonly involved site in oral cavity with whitish patch and ulceroproliferative lesions being the common clinical presentations respectively. In OED, downregulation and altered localization of e-cadherin (81.6%) and increased expression of vimentin (52.3%) along with their concurrent increase in the stroma represent epithelial mesenchymal transition. In OSCC, reduction in expression (<50%) for e-cadherin (56.6%) with altered localization for e-cadherin was seen in 88.3% of OSCC along with neoexpression of vimentin in the epithelial cells was seen in 68.3% suggestive of mesenchymal phenotypic modification (P = 0.05). Conclusion: It is very crucial to evaluate the invasiveness of dysplasia and tumor with specific molecular biomarker that may help in early prediction of malignancy and also guide in deciding best treatment strategy for established cases of malignancy.
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Comparison of culture and polymerase chain reaction–restriction fragment length polymorphism for identification of various Capnocytophaga species from subgingival plaque samples of healthy and periodontally diseased individuals p. 287
Ulka Idate, Kishore Bhat, RD Kulkarni, Vijayalakshmi Kotrashetti, Manohar Kugaji, Vijay Kumbar
DOI:10.4103/jomfp.jomfp_172_21  
Introduction: Capnocytophaga are facultative anaerobic Gram-negative bacilli and recognized as opportunistic pathogens of various extraoral infections. Only a few studies attempted to identify all the seven species of Capnocytophaga phenotypically and genotypically in healthy individuals and patients with chronic periodontitis. Studies to determine the prevalence of Capnocytophaga in subgingival plaque samples from healthy individuals, chronic gingivitis and periodontitis among Indian population are lacking. Aim: The aim of this study was to identify and compare the presence of Capnocytophaga species phenotypically through microbial culture and biochemical tests and genotypically through polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) in subgingival plaque of healthy individuals and patients with chronic gingivitis and chronic periodontitis. Materials and Methods: A total of 300 subjects, 100 each with gingivitis, periodontitis and periodontally healthy gingiva subjected, were included. Subgingival plaque was collected and was cultured for phenotypic identification (microbial culture and biochemical test), and for genotypic identification, DNA extraction was done and PCR-RFLP analysis was performed to identify the genus Capnocytophaga and also to identify different species of Capnocytophaga. Results: Of 300 individuals, Capnocytophaga species were identified from 237 (79%) individuals by PCR and 82 (27.33%) by culture. The prevalence of Capnocytophaga ochracea was found to be higher with both the methods followed by Capnocytophaga gingivalis and Capnocytophaga granulosa. Capnocytophaga genospecies, Capnocytophaga leadbetteri and Capnocytophaga Sputigena were isolated only by culture with very low prevalence that is 1.33%, 1.33% and 0.66%, respectively. We could not get any isolate of Capnocytophaga haemolytica by any of the two methods. Conclusion: Capnocytophaga species could be found in gingival sulci as well as periodontal pockets and can be detected by culture and PCR-RFLP. However, higher prevalence of these species in healthy compared to disease requires further analysis to determine their role in healthy and diseased periodontium.
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Detection and comparison of prevalence of Porphyromonas gingivalis through culture and Real Time-polymerase chain reaction in subgingival plaque samples of chronic periodontitis and healthy individuals p. 288
Preeti Ingalagi, Kishore G Bhat, RD Kulkarni, Vijayalakshmi S Kotrashetti, Vijay Kumbar, Manohar Kugaji
DOI:10.4103/jomfp.jomfp_163_21  
Introduction: The micro-flora of oral cavity is a myriad of micro-organism. Any infection of oral cavity leads to diseased condition which is a transitional transformation of the micro-organism in a specific paradigm depending upon the diseased condition. Periodontitis is one of the predominant chronic diseases which is a multifactorial infection. Porphyromonas gingivalis is a key etiological agent in causing periodontitis. To study the predominance of these bacteria in the diseased condition is important to detect, quantify and to find its efficacy by comparing different methods for identification. Aim and Objectives: The aim of the study is to determine the prevalence of P. gingivalis by anerobic culture and by real-time polymerase chain reaction (PCR) from subgingival plaque samples of chronic periodontitis and healthy individual and to compare efficacy of two methods. Materials and Methods: A total of 400 subjects were considered, and subgingival plaque was collected using paper points. Individual were equally divided into two groups: chronic periodontitis (200) and healthy individuals (200). Each plaque sample collected was divided into two aliquots of which the first aliquot was subjected for anerobic culture to isolate P. gingivalis. Phenotypical identification was done morphologically and biochemically further quantification of P. gingivalis was done by colony-forming unit. The second aliquot was subjected for DNA extraction and real-time PCR was conducted to detect and quantify P. gingivalis using specific primer. Results: Out of 400 samples, 73% showed detection of P. gingivalis by culture method and through reverse transcription-PCR (RT-PCR), the detection was 75%. Individual detection of P. gingivalis by culture in chronic periodontitis was 89.5% and 54.4% in healthy individuals, while detection by RT-PCR was found to be 91.5% in chronic periodontitis and 58% in healthy individuals. However, comparison between two techniques in detection of P. gingivalis was statistically insignificant. Conclusion: When we compared RT-PCR with culture RT-PCR showed higher positivity. RT-PCR is more sensitive and requires less time to detect. However, in the present study, culture also showed good positivity, suggesting proper dilution and with extended incubation, the specificity of culture can be improved to a great extent.
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Unveiling the arcanum of formalin-fixed paraffin-embedded archival tissue blocks: A valuable resource for genomic DNA extraction p. 289
Sameera Begum, Vishnudas Prabhu, Varshasnata Mohanty, K Krishnaraj Upadhyaya, Riaz Abdulla
DOI:10.4103/jomfp.jomfp_424_20  
Background: Formalin-fixed paraffin-embedded (FFPE) tissue blocks are routinely preserved after pathological diagnosis and possess tremendous potential for biomarker discovery. These archival samples are prone to degradation on prolonged storage due to the formalin cross-linking. Aims: This study aimed to evaluate whether the storage period of the formalin-fixed paraffin-embedded tumor blocks had a significant impact on the yield and purity of the isolated DNA archived for 11 years. Settings and Design: A retrospective study was carried out in the Department of Oral Pathology and Microbiology in accordance with the Institutional Ethics Committee. Materials and Methods: Genomic DNA extraction was performed using TaKaRa DEXPAT Easy DNA kit from 40 FFPE tissue blocks of oral squamous cell carcinoma archived for 11 years (2006–2017). NanoDrop spectrophotometer was used to determine the DNA yield (A260) and purity (A260/A280 ratio). The quality of DNA fragments was validated using agarose gel electrophoresis. Statistical Analysis Used: Statistical analysis was obtained by SPSS 22, MS Excel and analyzed using the analysis of variance (ANOVA) test. P < 0.05 was set for statistical significance. Results: There was no statistically significant difference observed both in terms of DNA yield (P = 0.996) and purity (P = 0.997) of FFPE tumor blocks archived for 11 years among the study groups. Conclusions: It was concluded that, irrespective of years of storage of the FFPE, it is possible to extract genomic DNA and use it for molecular studies.
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ONLINE ONLY ARTICLES - CASE REPORTS Top

Non-Hodgkin lymphoma of a palate: A case report of a highly destructive lesion p. 289
Cintia M Milani, Claudia F Stadler, Larissa L Gomes da Silva, Paulo A P. Milani
DOI:10.4103/jomfp.jomfp_332_21  
Non-Hodgkin lymphoma (NHL) is a haematolymphoid neoplasm that can affect nodal and extra-nodal sites. It is a rare disease in the oral cavity, accounting for only 2% of all extra-nodal lymphomas. Its aetiology is multi-factorial, being strongly associated with viral infections. The average age group most affected is 66 years old, with a slight predilection for males. The most common histological sub-type in the oral cavity is diffuse large B-cell lymphoma, with Waldeyer's ring being the most affected site in the nodal form, and extranodally, it may involve the tongue, hard/soft palate, maxilla, and mandible. It presents as a nodular lesion with a smooth or ulcerated surface. The initial treatment approach is chemotherapy, but this may vary according to the stage of lymphoma. The aim of this study was to report a case of NHL in the palate of a 54-year-old female patient, with extensive tissue destruction.
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Giant Osteochondroma of the mandibular condyle and temporomandibular joint - A case report p. 290
Amit Mahajan, Deepa J Patil, Vandana Shah, Mrudula Mulay
DOI:10.4103/jomfp.jomfp_112_22  
Osteochondroma is one of the common bone tumours but is rarely seen in the head and neck region. Osteochondroma of the mandibular condyle, extending to the temporomandibular joint (TMJ) is an infrequent occurrence. Patients commonly present with restricted mouth opening and malocclusion. Due to the significant overlap in features between chondromas and condylar hyperplasia, it is very likely to be misdiagnosed, resulting in treatment errors. In this report, an interesting case of a large osteochondroma of the mandibular condyle extending into the zygomatic and petrous part of the temporal bone involving the left TMJ in a 35-year-old female patient is described who presented with facial asymmetry and restricted mouth opening. This paper outlines the clinico-radiographic and histopathological features for diagnosis and appropriate treatment of osteochondroma.
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An unusual case report of basal cell ameloblastoma and a detailed review of literature p. 291
Kirti Buva, Ajinkya Deshmukh, Pratibha Kavle, Anish Gupta
DOI:10.4103/jomfp.jomfp_95_22  
Ameloblastoma is an odontogenic tumour derived from the remnants of odontogenic epithelium. Ameloblastoma shows versatile clinical and histological variants. Basal cell ameloblastoma is a rare variant among all histopathological variants of ameloblastoma. We present a case of a 25-year-old male patient with painless swelling on the lower left side of the face for 1 year, which had gradually increased in size and histologically showed features of basal cell ameloblastoma. The aim of the present paper is to understand this rare variant of ameloblastoma and review the literature.
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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007