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    Table of Contents - Current issue
January-March 2022
Volume 26 | Issue 1
Page Nos. 1-135

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From the Editor's Desk p. 1
T Smitha
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Dr. K. Ambika p. 2
S Hari
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TAT for TIT – Technology augmented teaching for traditionally inclined teaching p. 4
Venkata Subramanyam Ramadugula
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The diverse role of oral fibroblasts in normal and disease p. 6
RJ Vijayashree, B Sivapathasundharam
Fibroblasts are the major cellular component of the connective tissue. They differ both structurally and functionally based on their location. The oral fibroblasts vary from the dermal fibroblasts in their origin, properties and also functions. These cells play an important role in wound healing, tumor progression and metastasis, allergic reactions. In this review, the various functions of the oral fibroblasts are discussed in detail.
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Use of Machine Learning for Oral Pathology- A Technological Advancement p. 14
Anish Gupta, Swati Shrikant Gotmare
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Coronavirus disease: Dental review p. 16
Saurabh Pratap Singh, Pratyush Singh, Om Prakash Gupta, Shalini Gupta
COVID-19 was declared a pandemic outbreak by the World Health Organization, creating a significant impact on health care system. Realizing the high risk associated with this disease and its high rate of transmission, dentists were instructed by health authorities, to stop providing treatment which includes aerosols and droplets and only except emergency complaints. This was mainly for protection of dental healthcare personnel, their families, contacts, and their patients from the transmission of virus. Hence, this review focuses on the life cycle of COVID-19, its clinical symptoms and several issues concerned directly to dental practice in terms of prevention, treatment, and orofacial clinical manifestations.
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Role of nano curcumin on superoxide dismutase levels in leukoplakia p. 21
Sunanda Deb, Deepak Bhargava, Puja Bansal, Vijay Kanuru
Introduction: Oral leukoplakia has an estimated prevalence of 2% of the oral cavity, one of the risk factors for oral cancers. The most commonly linked etiology being tobacco smoking causing reactive oxygen species (ROS) induced DNA damage. Curcumin, a polyphenol derivative from herbal remedy, possesses diverse properties ranging from centuries old documented anti-inflammatory properties to recently documented anticancer properties. Aims: Role of nano curcumin on superoxide dismutase (SOD) levels in leukoplakia patients' pre- and post-treatment Materials and Methods: The study group comprised thirty test subjects. Single capsule of 250 mg (Brecan Plus) was given to the test group for 30 days with weekly follow-up. Blood samples were taken from the test group and were evaluated for SOD levels before and after the completion of the trial. Results: In the study, there was a decrease in size of the lesion, number of lesions, down staging of the disease, and increase in serum SOD levels after the therapy. Binary logistic retrogression analysis was done to assess the predictive ability of serum SOD-dependent variable, and a positive association was noted between increase in serum SOD level and down staging of the disease. Conclusion: Nano curcumin is an excellent medical nutrition intervention derived from traditional natural products. The study has demonstrated the clinical efficacy of these new classes of therapeutic nutraceuticals such as nanocurcumin in treating oral leukoplakia, which are suitable for long-term use.
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Evaluation of salivary oxidative stress in oral lichen planus using malonaldehyde p. 26
Shruti Singh, Jaya Singh, Basavaprabhu C Biradar, Manjari Sonam, Shaleen Chandra, Fahad M Samadi
Background: Oral lichen planus is a chronic, mucocutaneous, inflammatory disease, with an unknown etiology. Reactive oxygen species and oxidative damage to the tissues might be the cause. Malonaldehyde (MDA), a low molecular weight end product of lipid peroxidation reaction is a suitable biomarker of endogenous DNA damage. monitoring the oxidant-antioxidant status of saliva may serve as an efficient marker of disease development in oral lichen planus patients. Aim and Objectives: To evaluate salivary oxidative stress in oral lichen planus subject using MDA and compare it with control subjects. Furthermore, to compare MDA levels in erosive and hypertrophic lichen planus. Materials and Methods: The current study is case–control study. Unstimulated salivary samples in the morning hours were taken from oral lichen planus subjects (n = 25) and controls subjects without any oral disease (n = 25). The saliva was centrifuged at 900 g for 10 min at a temperature of 4°C. Then, the entire filtrate was transferred to Eppendorf test tubes and frozen at–80°C until analysis. Salivary MDA was done through thiobarbituric acid reactive substance assay as per the protocol laid down by the manufacturer (Sigma Aldrich Lipid Peroxidation Assay Kit). Results: The data were expressed as the mean ± standard deviation and the statistical analysis was done using Student's t-test using SPSS version 21 IBM software. The salivary level of MDA was significantly higher than that of controls (P < 0.05). Conclusion: The higher level of MDA in patients with oral lichen planus suggests that free radicals and the resulting oxidative damage may be important in the pathogenesis of oral lichen planus lesions.
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Salivary metabolite signatures of oral cancer and leukoplakia through gas chromatography-mass spectrometry p. 31
Shoborose Tantray, Seema Sharma, Kanika Prabhat, Nazima Nasrullah, Manu Gupta
Background: Saliva contains a large array of metabolites, many of which can be informative for the detection of diseases. Gas chromatography-mass spectrometry (GC-MS) is a system that has long been used for metabolite profiling owing to its sensitivity, specificity, reproducibility and synchronized analysis; it has relatively broad coverage of compound classes including sugars, sugar alcohols, glycosides and lipophilic compounds. Aim and Objectives: The present study was conducted to explore the use of GC-MS in assessing variation in salivary metabolites and to recognize the metabolites which can be used as disease diagnostic tools and metabolite markers for detection of oral squamous cell carcinoma. Materials and Methods: The present study included clinically and histopathologically confirmed oral squamous cell carcinoma (OSCC) and oral leukoplakia patients (OLK) and the control group. Patients were divided into three groups: OSCC (n = 30), OLK (n = 30) and healthy individuals as controls (n = 30). Patients were refrained from eating, drinking, smoking or oral hygiene procedures for at least 1.5 h before the collection. Saliva was collected between 9.00 and 10.00 am. Samples were stored at −80°C. Filtered samples were used for GC-MS. Results: Fifteen compounds differed significantly between control, OLK and OSCC. These metabolites were decanedioic acid, 2-methyloctacosane, eicosane, octane, 3,5-dimethyl, pentadecane, hentriacontane, 5, 5-diethylpentadecane, nonadecane, oxalic acid, 6-phenylundecanea, l-proline, 2-furancarboxamide, 2-isopropyl-5-methyl-1-heptanol, pentanoic acid, Docosane. Conclusion: The findings of the study suggest the application of salivary metabolomics as a promising tool in the identification of tumor-specific biomarkers in early diagnosis and prediction of OSCC and oral leukoplakia. In future, standardizing the protocol for salivary analysis and overcoming some of the limitations will be helpful to establish salivary metabolomics as a reliable, the highly sensitive and specific method for clinical use as an independent diagnostic aid.
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Anti-plaque efficacy of Hi-Ora mouthrinse and 0.12% chlorhexidine gluconate in patients with chronic gingivitis: A case–control study p. 38
Melwin Mathew, C Joyshree, Velagapalli Jessie Ratan, Votturu Kartheek, S Thirumalai, Mohan Nayak Banothu
Background: Chlorhexidine (CHX) gluconate has remained the gold standard chemical plaque control agent till date, though, being associated with several disadvantages including its tendency to stain teeth and leading to irritation of soft tissues. To overcome these inherent disadvantages, there has been a surge of studies in the recent past to evaluate the efficacy of herbal mouthrinses as against CHX. Objective: The present study was planned to compare the anti-plaque efficacy of Hi-Ora mouthrinse as against 0.12% CHX in patients with chronic gingivitis. Materials and Methods: The present study was designed as a case–control study including 90 patients with chronic gingivitis who were divided into 3 groups including Group A in which 0.12% CHX was prescribed, Group B in which patients were prescribed Hi-Ora and Group C in which normal saline was prescribed after oral prophylaxis while the mean Gingival Index (GI) and Plaque Index (PI) scores were recorded on the 5th postprocedural day. Results: The mean GI score in CHX group was found to be 0.70 ± 0.25 as against 0.66 ± 0.16 in Hi-Ora and 1.59 ± 0.55 in normal saline groups. Similarly, the mean PI score in CHX group was found to be 0.80 ± 0.31 as against 0.77 ± 0.30 in Hi-Ora and 1.86 ± 0.61 in normal saline groups. Conclusions: The results of the present study suggested Hi-Ora to be more effective than 0.12% CHX in reducing the mean GI and PI scores among all the 3 groups.
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Immunohistochemical expression and evaluation of cyclin D1 and minichromosome maintenance 2 in oral squamous cell carcinoma and verrucous carcinoma p. 44
TR Menaka, S Shamala Ravikumar, K Dhivya, N Thilagavathi, J Dinakaran, Vinoth Kalaichelvan
Background: The study of cell proliferation is important for assessing the tumor behavior, prognosis and patient survival of oral carcinomas. As literature search did not reveal sufficient studies of immunohistochemical expression of cyclin D1 and minichromosome maintenance 2 (MCM2) in oral squamous cell carcinoma (OSCC) and verrucous carcinoma (VC), the present study was undertaken. Materials and Methods: The study group included 20 cases of histopathologically diagnosed OSCC, 10 cases of VC and 10 cases of normal mucosa (NM). All samples were evaluated for the expression of cyclin D1 and MCM2 using standard Immunohistochemistry (IHC) procedure. The present study involved both qualitative and quantitative analyses. Qualitative analysis was done by evaluation of intensity and area of staining. Quantitative analysis was done by calculating the percentage of positively stained cells and assessing the labeling index (LI). Data obtained were subjected to statistical analysis using SPSS statistical package (version 23.0). Results: On evaluating and comparing the intensity of staining and area of staining of cyclin D1 and MCM2 between the study groups, statistically significant values (P < 0.05) were obtained using Kruskal–Wallis ANOVA. Comparison of LI of cyclin D1 and MCM2 in NM, OSCC and VC statistically significant results (P < 0.05) was obtained using Mann–Whitney U-test. Mean LI of MCM2 was found to be significantly higher than mean LI of cyclin D1 in all the study groups. Conclusion: From the present study, we conclude that MCM2 has the potential to serve as a novel cell proliferation biomarker in OSCC and VC when compared to cyclin D1.
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Fine-needle aspiration cytology of salivary gland lesions p. 52
A Rameeza, M Hemalata
Background: Fine-needle aspiration cytology (FNAC) is a sensitive, specific, cost-effective tool and has been widely used as a diagnostic tool for the management of various head-and-neck lesions. Salivary gland lesions constitute the most common head-and-neck lesions. These lesions can range from inflammatory to neoplastic, which can be either benign or malignant. Materials and Methods: The study was performed on 104 patients who presented with salivary gland swelling to the department of pathology at a tertiary care center from January 2016 to June 2020. FNAC was performed using a 22–24G needle, and smears were stained with Giemsa, hematoxylin and eosin and Papanicolaou stain. Histopathology was assessed on routine hematoxylin- and eosin-stained paraffin sections. The cytological and histopathological slides were studied, analyzed and correlated. Sensitivity, specificity, positive predictive value and negative predictive were calculated. Results: The study included 104 cases in the age range of 10–70 years and a mean of 45 years (±16 standard deviation). There was a male preponderance with a male-to-female ratio of 1.6:1. The parotid gland was the most common site 91 (87%). On cytology, 71 (68%) were neoplastic, of which 58 (81%) were benign and 13 (19%) were malignant. Histopathological correlation was available in 36 cases (50%), 24 (67%) of which were benign and the remaining 12 (33%) were malignant. The sensitivity, specificity, positive predictive value and negative predictive value of the present study are 95%, 85%, 91% and 92%, respectively. Conclusion: FNAC of the salivary gland is a safe, reliable and cost-effective technique which can be used as the first line of investigation in evaluating salivary gland lesions.
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Relationship between ABO blood group and Rh factor with oral potentially malignant disorder p. 57
IP Mahalakshmi, Pooja Sinha, Tejavathi Nagaraj, Durga Okade, S Nonitha, Bhavana T Veerabasaivaiah
Introduction: Oral cancer is the most life threatening of all oral diseases. It has a prolonged natural history with oral potentially malignant disorders (OPMD) as the precursor. Recognition and diagnosis of OPMD will help in early treatment, patient survival and in reducing morbidity related to treatment of oral cancer. OPMDs has multifactorial etiologies and is significantly associated with risk factors of the individual's lifestyle, particularly, chronic use of tobacco, spicy food, alcohol and smoking. Genetic factors also play an important role in the etiology of OPMDs. It is proven by many studies like Dermatoglyphics, Salivary miRNA, micronuclei in buccal mucosa etc., one of such kind is ABO blood group and Rh factor.OBJECTIVE: Aim of our study is to evaluate if any of the ABO blood group and Rh factor is associated with an increased risk for OPMDs. Methodology: A cross sectional study was conducted in Sri Rajiv Gandhi College of Dental Sciences included 55 patients with clinical and histopathologically proven OPMD's. Blood grouping was determined for all the patients using standardised agglutination method. Result: This study showed that people with blood group B+ are 1.46 times at a greater risk to develop OPMDs. Conclusion: Our study concludes that subjects with B+ blood group and habit of tobacco chewing and smoking are at higher risk to develop OPMDs than subjects with other blood groups.
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Orthokeratinized versus parakeratinized odontogenic keratocyst: Our institutional experience p. 60
Jyoti Ravi, Vijay Wadhwan, Suhasini Palakshappa Gotur
Introduction: The odontogenic keratocyst (OKC) is quite unique among odontogenic cysts in its specific histological features and in clinical characteristics. The OKC has two variants orthokeratinized odontogenic cyst (OOC) and parakeratinized odontogenic cyst (POC), and POC is considered to be more aggressive and has a high recurrence rate. Therefore, OKC has generated considerable controversy with regard to its true nature. Aim: The purpose of this study was to determine the differences between POC and OOC variants of odontogenic cysts on the basis of clinical as well as radiological features. Materials and Methods: A total of 85 cases were included in the present study. There was a marked difference in the age of occurrence, sex, location and radiological presentation of both these entities. Results: Our institutional experience suggests that POC is more common than OOC and both the variants were commonly found in males. Most of the cases of POC were found in the third decade of life and most of the cases of OOC were frequently seen in the second, fourth and fifth decades. Mandibular posterior area was frequently occurring in both variants. Left side involvement was seen in maxilla and right side in mandible in both variants. Most of the cases were clinically diagnosed as OKC. Conclusion: The treatment and prognosis varies in both the variants of OKC, hence such epidemiological studies are helpful to ensure proper treatment for these distinct entities.
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Evaluation of immunohistochemical expression of E-cadherin in pleomorphic adenoma and adenoid cystic carcinoma p. 65
Bhavani Nagendra Sangala, Vandana Raghunath, Pratibha Kavle, Anish Gupta, Swati Shrikant Gotmare, Venkata Subhash Andey
Background: Pleomorphic adenoma (PA) and adenoid cystic carcinoma (ADCC) are benign and malignant salivary gland tumors, respectively, with distinct behavior. They have similar origins and cell components. E-cadherins are the main homophilic cell adhesion molecules, which play a central role in maintaining epithelial integrity, functioning in intercellular adhesion and differentiation. Hence, changes in E-cadherin function are reflected in the morphologic events associated with the cellular arrangement, movement and wound healing. Aim: To study and compare the expression of E-cadherin immunostaining in PA and ADCC. Materials and Methods: Fifteen cases of each PA and ADCC were immunohistochemically stained with E-cadherin. Five cases of normal salivary gland tissues were taken as the positive control. Mann–Whitney U-test was used for statistical analysis. Results: About 86.6% of PA cases showed homogeneous staining. 66.6% of cases of ADCC showed heterogeneous staining. PA, cribriform and tubular patterns of ADCC predominantly showed moderate immune-staining and solid patterns of ADCC exhibited predominantly mild immunostaining. Depending on the intensity of staining, we found a significant P value between PA and the solid variant of ADCC. Conclusion: E-cadherin proved to be a better marker for epithelial phenotypes in PAs. In ADCC difference in staining intensity between different histological subtypes suggests that further studies should be done to assess the usefulness of an immuno-marker to know the aggressive behavior of ADCC.
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Evaluation and comparison of the efficacy of coconut oil as a clearing agent with xylene p. 72
Bharadwaj Bordoloi, Rohit Jaiswal, Aanchal Tandon, Amrita Jayaswal, Abhinav Srivastava, Nandita Gogoi
Background: Xylene is a routinely used clearing agent in histopathology. It is potentially toxic and flammable in nature. Histotechnicians are routinely exposed to this hazardous chemical. Because xylene is used so pervasively in histopathology, it has always been a concern for pathologists and laboratory workers, as its regular and prolonged exposure have serious health effects. Considering its toxicity, different biocompatible xylene substitutes have been evaluated. Aim and Objective(s): This study was conducted to evaluate the efficacy of coconut oil as a clearing agent and compare with xylene. Materials and Methods: Two equal halves of 45 soft-tissue specimens were processed simultaneously in xylene and coconut oil as clearing agents. The xylene-treated specimens and coconut oil-treated specimens were checked for gross and histological features, and a comparison was done between the two groups. Results: Significant shrinkage was noted in xylene-treated specimens compared to that in coconut oil-treated specimens. No difference was found in either of the sections when checked for staining quality, overall morphological features and cellular details. Conclusion: It may be substituted for xylene without loss of information.
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Comparison of blood parameters between periodontitis patients and healthy participants: A cross-sectional hematological study p. 77
Hirak S Bhattacharya, Rishabh Srivastava, Shiva Shankar Gummaluri, Manvi Chandra Agarwal, Preeti Bhattacharya, Madhusudan S Astekar
Background: Bacteria and their products involved in periodontitis evoke an immunoinflammatory response in the host tissue. Inflammatory diseases, such as periodontitis, are often not just a local event, but may have systemic ramifications, including elevations in the numbers of circulating leukocytes, acute-phase proteins and oxidative stress markers. It is now emerging that also erythrocytes are affected by chronic inflammatory diseases. This phenomenon, named “anemia of inflammation,” is not caused by marrow deficiencies or other diseases. The present study aimed to assess whether there was any relation between chronic periodontitis and hematological parameters. Materials and Methods: A total of 80 patients were included in the study and were divided into the healthy and periodontitis groups. Blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes, platelets, red blood cell (RBC) distribution width (RDW), mean corpuscular volume (MCV), platelet count and neutrophil–leukocyte ratio (NLR). Further, the values were gathered and subjected to statistical analysis. Unpaired t-test was performed to assess the statistical significance between the groups and P < 0.05 and < 0.001 were considered to be statistically significant. Results: Results show statistically significant difference seen in leukocytes, lymphocytes, RDW, MCV, platelet count and NLR which was higher in patients with periodontitis, all other parameters are nonsignificant. Conclusion: Thus, within limitations, it can be concluded that increased levels of leukocytes, lymphocytes, RDW, MCV, platelet count and NLR depict the inflammatory state and destructive nature of periodontitis.
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Membrane-organizing extension spike protein and its role as an emerging biomarker in oral squamous cell carcinoma p. 82
Sushma Bommanavar, Sujata R Kanetkar, Kailas D Datkhile, Ashwini L More
Oral squamous cell carcinoma (OSCC) is the most malignant tumor worldwide with a relatively poor prognosis. This can be due to lack of using new specific biomarkers as a mode of pristine interventional therapy for detecting the lesions at an early stage, thereby not allowing it to proceed to a severe advanced stage. Biomarkers, being the products of malignant cells, can prove to be promising prognostic factors in understanding the molecular pathogenesis of oral cancer. One such biomarker is membrane-organizing extension spike protein (MOESIN). Belonging to the family of ezrin/radixin/MOESIN proteins, MOESIN acts as a structural linker between plasma membrane and actin filament of the cell moiety and is involved in regulating many fundamental cellular processes such as cell morphology, adhesion and motility. This narrative review is a systematic compilation on MOESIN and its role as an emerging biomarker in OSCC.
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Oral microbiome research – A Beginner's glossary p. 87
Priya Nimish Deo, Revati Shailesh Deshmukh
Oral microbiome plays a key role in the etiology of oral diseases and is linked to many diseases in other parts of the body as well. This makes the oral microbiome an area of interest for researchers globally. A meticulous planning of the research project is the first and most crucial step while conducting an oral microbiome study. For beginners in this field, it is essential to be familiar with the terminologies used in oral microbiome research for a better understanding. The purpose of this article is to familiarize new researchers to the frequently used terms for the field of oral microbiome research.
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Bilateral talon cusp in permanent maxillary lateral incisors: A case report, clinico-pathological review and proposal of an integrated classification p. 93
Vivek Mehta, Aman Chowdhry, Priyanka Kapoor
Talon cusp (TC) is an uncommon developmental anomaly resulting from the invagination of inner enamel epithelium cells. It is primarily seen in people of Asian descent. Maxillary lateral incisors are the teeth most commonly affected by this dental malformation. Early detection and management are pertinent to prevent complications that may be associated with the TC. We describe the successful diagnosis and management of a rare case of nonsyndromic bilateral TC in permanent maxillary lateral incisors with conservative therapy. Further, while discussing the case, we present a brief clinicopathological review on TC and also propose an “integrated classification of talon cusp (ICTC) to describe the morphological aspects as well as indicate the severity and difficulty in the management of cases. An early specific diagnosis along with multidisciplinary treatment approach is recommended for TC, especially to avoid pulpal complications in teeth.
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Concurrent autoimmune orofacial lesions: A rare occurrence! p. 98
Apurva Nayak, Panjami Marish, Sunitha Carnelio, Gabriel Rodrigues
Autoimmune disorders occur either as a solitary lesion or in pairs, but it is unusual to find two autoimmune disease lesions in the oral cavity in a single patient, who has been previously treated for psoriasis. We present the case of a 30-year-old male who presented with complaints of severe burning in the oral cavity. Examination revealed the presence of co-occurrence of vitiligo with oral lichen planus with a history of psoriasis and was managed conservatively with good response to treatment.
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A novel mucocele: Myxoglobulosis p. 101
Rutuja Gajanan Vidhale, Subraj Shetty, Nikita Kamble, Treville Pereira
Oral extravasation mucoceles are among the most widely recognized submucosal lesions which are usually a result of trauma involving salivary glands and their ducts. This paper reports a case of a 40-year-old female patient with a chief complaint of a painless swelling on the lower lip since 6 months. Upon a provisional diagnosis of mucocele, surgical excision was carried out. Histopathological examination revealed a mucus extravasation cyst having lumen filled with unique mucinous globular structures similar to a rare variant of appendiceal mucocele, myxoglobulosis.
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Multiple myeloma with presentation in the oral cavity p. 104
Pooja Kamath, Cathy Babu, Avinash Tamgadge, Treville Pereira
Plasma cell neoplasms may present in the bone as monoclonal gammopathy of undetermined significance, solitary plasmacytoma of bone, multifocal plasma cell neoplasm of bones known as multiple myeloma (MM) and in soft tissues as extramedullary plasmacytoma. MM is a malignant disease of atypical plasma cells characterized by their multifocal proliferation and production of monoclonal immunoglobulins. Often, the initial clinical feature of this disease is subtle and requires trained primary health-care providers to identify this illness and put together a suitable treatment plan. This case report describes a patient with a swelling in the buccal vestibule which on clinical and pathologic investigation turned out to be MM.
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Physical height and crown dimensions of primary teeth: A dental morphometric study in Saudi Arabian children p. 108
Fadwa Saeed Alasmari, Tasneem Sakinatul Ain, Rafi Ahmad Togoo, Ghadah Zayed Maalawi, Alhanouf Delaim Almoghamer, Alhanouf Abdulwahab Alalshikh
Background: Teeth morphometrics have been considered to be integral in identifying an individual as it is correlated with the body stature. Aim: The aim of the study was to determine the association between crown length and physical height of children and derive mathematical equations for the prediction of physical height from crown length of primary maxillary anterior teeth. Setting and Design: A dentomorphometric study was carried out among 100 Saudi Arabian children of 3–6 years of age. Maxillary arch impressions were taken for all participants. Clinical crown length and physical height were measured using digital Vernier Caliper and Physician Mechanical Beam Scale, respectively. Regression analysis, correlation analysis and unpaired t-test were performed for data analysis. Results: In female children, a statistically significant moderate positive correlation between primary maxillary right lateral incisor and primary maxillary left central incisor and height of the children, and highly significant association between primary maxillary left lateral incisor and height of the children was found. Whereas for male children, there was a significant moderate positive correlation between primary maxillary right central incisor, primary maxillary right canine and primary maxillary left central incisor with physical height of children. Conclusions: The research has established a significant positive correlation between the clinical crown length and the height of the children in combined sample for teeth numbers 51, 52, 53, 61 and 62. The study has derived the mathematical equations for the prediction of physical height from crown length of few maxillary anterior teeth, for both male and female children. Clinical Significance: The estimation of physical height from the tooth-crown dimensions can prove to be quite beneficial aid in forensic investigations as teeth are resistant to huge traumatic forces such as in case of mass disasters.
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Age estimation in Western Indian population by Cameriere's and Drusini's methods p. 116
Palak H Shah, Rashmi Venkatesh, Chandramani B More
Objectives: The aim of the present study is to determine applicability of Cameriere's and Drusini's methods in Western Indian population. Methodology: Panoramic radiographs of total 300 Gujarati individuals, equally divided into four study groups were studied by two investigators. The pulp/tooth area ratio (AR) were calculated for maxillary and mandibular canines and tooth coronal indexes (TCI) i.e., the ratio between coronal pulp cavity height and crown height were calculated for mandibular premolars and first and second molars. The acquired data were subjected to correlation and regression analysis and also inter and intraobserver reliability was obtained for both the investigators. Results: The ARs and TCIs for all the respective teeth were significantly correlated with the age of the individuals. The individual regression formulae were derived for all the teeth and were then used separately to calculate the age. There was no statistically significant difference between the mean chronological age and mean calculated age for all the teeth.(P > 0.05). The mean absolute errors for all the teeth were <10 years. Conclusion: The findings of this study prove the applicability of Cameriere's and Drusini's age estimation methods for Western Indian population. However, the weak correlation coefficients suggest the need for further studies to get more accurate results.
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Assessment of knowledge and awareness of forensic odontology among dentists in Tamil Nadu – A systematic review p. 121
T Dineshkumar, M Rekha
Aim: The aim of the study is to analyze the knowledge, attitude and practice of forensic odontology among dental practitioners in Tamil Nadu. Materials and Methods: Forensic odontology has immense importance in examining dental evidence and in the identification of victims of mass disaster, abuse or organized crimes. Hence, a cross-sectional survey study was conducted in a sample of 252 dental practitioners practicing in various cities in Tamil Nadu. A questionnaire comprising 22 questions (both open ended and close ended) was prepared, and the survey was conducted to analyze the knowledge and attitude of dentists toward forensic odontology. Results: Many of the practicing dentists had a basic knowledge about forensic odontology, but only 22% knew about the existence of a national association for forensic odontology. Forty-five percent of them knew about cheiloscopy. Seven percent of them only knew about the forensic courses available in India. Ninety-eight percent of them did not have any formal training related to forensic odontology. Seventy-two percent of them were not confident about giving an opinion for a forensic case. Most of them felt that our country has very limited resources for forensic odontology. Conclusion: This study showed that the branch of forensic odontology is still in the infant stage in the state. This condition, however, could be improved if more formal training courses are conducted by the specialist associations imparting knowledge and training in the field.
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Relationship between dental anxiety with dental caries and periodontal disease among army recruits in Bangalore city - A cross sectional study p. 126
Padma K Bhat, Manish Shekar, MY Jayachandra
Introduction: Dental anxiety can affect the dental health status of an individual leading to avoidance behavior, poor oral hygiene and periodontal health and delay in seeking necessary treatment. Objectives: This study aimed to assess the prevalence of dental anxiety in army recruits in Bangalore city and to explore the relationship of dental anxiety with dental caries and periodontal disease among army recruits in Bangalore city. Methodology: The total population of the army recruits in Army Service Corps Center and College was around 1000. General information included name, age, sex educational qualification, address, number of dental visits and age of first visit. The closed ended multiple-choice questionnaire consisting of 4 questions based on previous dental experience given by Corah was used to assess the anxiety level of the individual. Clinical examination of dental and periodontal health was noted using Decayed, Missing, Filled and Surface (DMFS) Index and Community Periodontal Index and Treatment Needs (CPITN) Index. Results: The mean Dental Anxiety Scale score was 9.64 with a standard deviation of 3.6. Of the 836 participants in the study, 444 (53.1%) reported no dental anxiety at all. Two hundred and sixty-three (31.5%) were moderately dental anxious (scoring 9–12), 10.4% were highly anxious (scoring 13–14) and 5% were severely anxious (scoring 15–20). Anxious individuals had poorer periodontal health necessitating treatment compared to nonanxious individuals. The mean DMFS of the study population was highest among those having high and severe dental anxiety (mean DMFS = 11.0 and 12.59, respectively) which was statistically significant (P < 0.001). Conclusion: The present study showed a prevalence of dental anxiety of 47%. Impact of dental anxiety on oral health was found to be obvious as higher DMFT/DMFS was evident among dentally anxious subjects; dental anxiety also showed a strong association with higher CPITN scores.
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Immunohistochemical study of epidermal growth factor receptor, human epidermal growth factor receptor 2/neu, p53, and Ki67 in oral squamous cell carcinoma p. 127
Neelam Sureshrao Mohanapure, Siddhi Gaurish Sinai Khandeparkar, Pradnya B Saragade, Bageshri P Gogate, Avinash R Joshi, Sameera Rajendra Mehta
Introduction: Oral squamous cell carcinoma (OSCC) is the most common malignant tumor occurring in the oral cavity. Aim: The present study was conducted to evaluate the biomarkers such as epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2/neu), p53 and Ki67 expression in OSCC cases, and its correlation with other well-established clinicopathological parameters. Materials and Methods: Seventy cases of OSCC cases diagnosed between 2015 and 2019 were included in the study. A technique of manual tissue microarray was employed for the analysis of expression of IHC markers such as EGFR, HER2/neu, p53, and Ki67 in all cases. Results were subjected to the statistical analysis. Results: A statistically significant positive association was noted between EGFR expression and tumor grade, tumor stage, and p53 immunoexpression in OSCC cases. Increased EGFR expression was noted insignificantly in OSCC cases with lymph node (LN) metastasis and Ki67 positive cases. Statistically significant positive association was noted between HER2/neu expression and tumor grade and stage of oral SCC cases. Increased HER2/neu expression was noted insignificantly in OSCC cases with LN metastasis, p53 and Ki67 positive OSCC cases. A statistically significant positive association was noted between percent of tumor cells expressing EGFR, HER2/neu, p53 and Ki67, and grade of OSCC. Conclusion: This study intends to document prognostic utility of EGFR and HER2/neu expression in OSCC cases in the Indian setting and contribute to the data pool which could aid in formulating individual tailored therapy that includes targeted therapy in oral SCC cases.
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Perspective of nuclear fractal dimension in diagnosis and prognosis of oral squamous cell carcinoma p. 127
Juber Rahman, Swagatika Panda, Santisudha Panigrahi, Neeta Mohanty, Tripti Swarnkar, Umashankar Mishra
Background: Owing to the restricted predictive value of conventional prognostic factors and the inconsistent treatment strategies, several oral squamous cell carcinoma (OSCC) patients are still over-treated or under-treated. In recent years, computer-assisted nuclear fractal dimension (nFD) has emerged as an objective approach to predict the outcome of OSCC. Objective: This study is an attempt to find out the differences in nFD values of epithelial cells of normal tissue, fibroepithelial hyperplasia, verrucous carcinoma, and OSCC. Further effort to evaluate the predictive potential of nFD of tumor cells for cervical lymph node metastasis (cLNM) was also assessed. Methodology: Formalin-fixed paraffin-embedded blocks of OSCC tissues of patients treated with neck dissection were collected. Photomicrographs of H-&E-stained sections were subjected to the image analysis by ImageJ and Python programming to calculate nFD. The association of categorical variables with nFD was studied using cross-tabulation procedure and the Fisher exact test. Receiver operating curve analysis was performed to find out cutoff value of nFD. A logistic regression model was developed to test the individual and combined predictive potential of grading and nFD for cLNM. Results: A significant difference between the mean nFD of healthy cells and malignant epithelial cells was observed (P = 0.01). nFD was not found to be an independent predictor of cLNM, although nFD and grading together demonstrated significant predictive potential (P = 0.004). Conclusion: nFD combined with grading can predict lymph node metastasis in OSCC. To the best of our knowledge, this is the first study of its kind.
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Risk of liver disease in areca nut habitual: A systematic review p. 128
Suwarna B Dangore Khasbage, Rahul R Bhowate, Nazli Khatib
Background: Areca nut (AN) is one of the addictive substances known to cause deleterious effects on oral cavity as well as on various body organs including liver. But, scanty information is available reporting the adverse effects of AN chewing on the liver. Aim: To study the risk of liver disease in AN habitual based on the relevant published data. Methods: The literature search was performed by an electronic search of the PubMed/Medline, Scopus and Google Scholar databases using proper MESH headings and retrieved the articles published from 1998 to 2021. The eligibility criteria included: Human studies, AN habitual as study participants, use of controls and articles published in English. Data were extracted regarding characteristics of studies, characteristics of AN exposure, effect estimate and outcome of the studies. Results: Total 253 articles were identified from various databases and 15 studies were selected that met the inclusion criteria. Among these, thirteen studies showed an association between AN habit and attenuation of risk of liver disease as determined by relative risk/odds ratio/hazard ratio. Eleven studies described additive effect of AN and HBsAg and/or Anti hepatitis C virus status on development of liver disease. However, two of the studies showed opposite results. The heterogeneity in the study designs, exposure characteristics, outcomes and confounders precluded further meta-analysis. Conclusion: The association between AN chewing and an increased risk of developing liver disease is noted which necessitates the need for AN cessation campaign.
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The first case of proliferative fasciitis of tongue coexistent with squamous cell carcinoma: Case report of a rare lesion p. 129
Vaishali Baburao Nagose, Vikrant Vilas Vaze, Neha Amrut Mahajan, Vipin Narendra Todase
Proliferative fasciitis (PF) is a rare pseudosarcomatous myofibroblastic benign tumor, a subcutaneous counterpart of proliferative myositis. Usually seen in upper extremities, no case has yet been documented in tongue or any other subsites in oral cavity. The present case becomes the first to be reported at this site as well as the first case of synchronous coexistent PF with squamous cell carcinoma (SCC) of tongue. The patient was 50 years male, having a polypoidal swelling at right lateral border of tongue with an ulcer adjacent to it. Histopathologically, the swelling was diagnosed as PF and ulcer as SCC; both the diagnoses were confirmed by immunohistochemistry. The polypoidal lesion was immunopositive for smooth muscle actin and calponin and immunonegative for pan cytokeratin, cytokeratins (5/6), P40 and P63, proving it to be a non-SCC lesion, different from its adjacent ulcerative one.
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Parosteal lipoma of the mandible: A case report and review of the literature p. 129
Julie Potter, Charlotte Richards, John Collin
Introduction: Lipomata are soft-tissue mesenchymal neoplasms that are benign in nature and often asymptomatic. Lipomata commonly occur in the body, however, only 1%–5% are identified within the oral cavity, and lipomata with osseous metaplasia account for <1% of all lipomata. This report describes a patient presenting with an ossifying lipoma with parosteal localization at the mental protuberance. This is followed by review of the current literature for this rare entity. Materials and Methods: A PubMed literature review designating search terms including “oral” and “parosteal lipoma” or “lipoma with osseous metaplasia” or “ossifying lipoma” or “osseous lipoma” was conducted. Results: The literature review identified two previous reports of parosteal localization of lipomata in the mandible and 22 cases of lipomata with osseous metaplasia within the oral cavity. Conclusions: With the initial suspicion of a more malevolent diagnosis, this rare entity, with only two other cases identified, is important to consider in the clinician's differential diagnoses.
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Incidental finding of orthokeratinized odontogenic cyst with unusual features p. 130
DB Nandini, T Premlata Devi, BS Deepak, Ngairangbam Sanjeeta
Orthokeratinized odontogenic cyst (OOC) is a rare developmental odontogenic cyst occurring in the jaw with debated etiology. It was originally believed to be a variant of odontogenic keratocyst (OKC) but is now considered to be a distinct entity. The majority of the cases occur in the third and fourth decades of life. The common site is the mandibular posterior region with a male predilection. Swelling is the most common symptom which may be accompanied by pain, although in most cases, the lesion is asymptomatic. These lesions mostly present as unilocular radiolucency often associated with an impacted tooth. They may mimic dentigerous cyst and OKC in radiologic and histopathologic presentation, however, differ in biological behavior, pathogenesis and prognosis in comparison. Hence, making an accurate diagnosis is essential. This article describes an incidental finding of OOC in a 28-year-old female during radiographic investigation for orthodontic treatment. This case showed some rare features such as multilocular radiolucency, nonkeratinized epithelium in areas of inflammation, few cholesterol clefts with giant cells, presence of dentinoid-like material and dystrophic calcification in the capsule.
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Calcifying odontogenic cyst: Report of an uncommon entity with a brief literature review p. 131
Syed Ansar Ahmad, Deepika Bablani Popli, Keya Sircar, Shamimul Hasan
The aim of this clinical report is to document a rare and unusual case of calcifying odontogenic cyst (COC) in the maxillary anterior region in a 13-year-old girl. A COC is an extremely uncommon developmental, odontogenic entity and accounts for 0.3%–0.8% of odontogenic cysts. The lesion presents as an array of varied radiographic and clinicopathological characteristics and biological attributes and exists in three histomorphologic patterns – benign cystic, solid (neoplastic) and aggressive (malignant) forms. Thus, several nomenclatures and classifications have been put forth to explain the nature of the clinical entity. However, ambiguities regarding the exact nature of the lesion still prevail. Due to nonspecific clinicoradiographic features, histopathological interpretation remains the key for diagnosis. We report an uncommon occurrence of COC in a 13-year-old female who reported to our Outpatient Department with an asymptomatic right midfacial swelling. The clinical and radiographic findings were suggestive of adenomatoid odontogenic tumor and dentigerous cyst. The decision to enucleate the lesion was considered, and histopathological features were compatible with the diagnosis of COC. Re-ossification with no recurrence was noticed after a 1-year follow-up. COC is an unusual developmental odontogenic cyst that clinically and radiologically simulates other more common jaw entities. Thorough knowledge of the bizarre presentation and biological attributes of such lesions are imperative for an early diagnosis and definitive treatment. Long-term follow-up is advocated to prevent recurrences.
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Enteric duplication cyst of the tongue in a newborn: A case report and literature review p. 131
Ariel Antonio Arteta, Alejandro Cardona Palacio, Efrain Alvarez Martinez
Enteric duplication cysts (EDCs) are congenital anomalies. We report the case of a 5-day-old girl with a 2.0 cm congenital oral mass in the tongue, an extremely uncommon site of EDC. The tongue mass was resected without complication; microscopic findings were characteristic of an EDC, and the patient is doing very well. The English literature was researched for the cases of single congenital oral cavity masses diagnosed prenatally or at birth as EDC or EDC-like lesions. Cystic lesions of the oral cavity partially lined by gastrointestinal epithelium, without teratoma features, have received several names. Similarities between EDC and EDC-like lesions favor the idea of one lesion with several morphologies manifest along a spectrum and that the necessity for EDC diagnosis of the smooth muscle coat criteria could be re-evaluated to improve the categorization of these lesions and better understand the pathogenic mechanism.
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Internal root resorption: A rare complication of vital pulp therapy using platelet-rich fibrin p. 132
Dilshad Kersi Mandviwala, Ankit V Arora, Sonali Vinod Kapoor, Purnil Bhupendrakumar Shah
Internal root resorption (IRR) is a specific type of pulp disease categorized by the loss of dentin as a consequence of the action of clastic cells stimulated by pulpal inflammation. It is one of the rare complications following a vital pulp therapy (VPT) procedure. Reported here is a case of IRR as a complication of VPT platelet-rich fibrin pulpotomy procedure in a mature permanent tooth. Diagnosed using cone-beam computed tomography and management of the resorptive defect using biodentin with a follow-up of 1 year.
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Hemangiomatous Ameloblastoma with Spindle Cell Proliferation: A Rare Case Report and Review of Literature p. 132
Pavan D Puri, Abhinandh Krishna, Suchitra Gosavi, Vivek Nayyar
Ameloblastoma is a locally aggressive neoplasm with varied histological patterns. The histomorphologic variants of ameloblastoma bear no prognostic or biologic behavioral significance with possible exceptions of desmoplastic and hemangioameloblastoma. The present paper aims at reporting a case of 38-year-old male with a huge lesion present in the mandibular symphysial region crossing the midline, histopathologically showing hemangiomatous component in follicular and plexiform ameloblastoma along with spindle cell differentiation in the ameloblastic follicles. Spindle cell differentiation in ameloblastoma is rarely reported and the prognostic significance is yet not clear. The present paper also reviews the literature since the diagnosis of this lesion is must as it may lead to surgical complications.
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Mandibular metastasis of follicular thyroid carcinoma: A case report along with the concise review of literature p. 133
MK Jawanda, R Narula, S Gupta, P Gupta
Metastasis is one of the most common consequences of malignant tumors, and it is one of the leading causes of morbidity and mortality. Metastatic cancers to oral cavity are extremely rare. Moreover, the true incidence has yet to be determined. Despite their rarity, they are important clinically, since they can be the first and the only evidence of spread in many situations. Breast, kidney, lung, prostate and gastrointestinal tract are the most common sources of metastases in the oral cavity. Thyroid carcinoma is the most prevalent type of endocrine cancer, yet it rarely spreads to the oral cavity. After papillary thyroid carcinoma, follicular thyroid carcinoma is the second-most frequent kind of thyroid cancer. Jawbones are more commonly affected than soft tissues. Literature research revealed that till date, 44 cases of metastatic follicular thyroid cancer to the jawbones have been documented with mandibular preponderance (40 cases). With the rising occurrence of oral metastatic tumors in recent years, it has become increasingly important to diagnose them early to avoid future consequences. We present here an unusual case of metastatic follicular thyroid cancer in the mandible of an elderly adult along with a comprehensive review of the literature.
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Lip print patterns: Similarities among the parents and their children p. 134
J Chandrakala, G Suganya, T Satish Yadava, Vidya Doddawad, J Nagarathna, M Kalavathi
Background: The wrinkles and grooves visible on the lips form the characteristic pattern of an individual and imprints produced is termed as “lip print.” The study of these prints is known as “cheiloscopy.” Variations in patterns among males and females could help in sex determination. Lip prints, therefore, can constitute material evidence left at a crime spot, equivalent to fingerprints. These patterns are heritable and are believed to be unique and permanent. The lip prints of parents and children and those of siblings have been shown to have some similarities. The influence of inherited lip print patterns among family members is still a new concept and studies are scanty in literature. Objectives: The objectives are to determine the most common patterns and gender-wise distribution among the study population and to analyze the inherited lip print patterns from parents to their offspring. Materials and Methods: Lip prints of 30 families were obtained using lipstick and cellophane tape. Based on criteria given by Suzuki and Tsuchihashi, patterns were recorded and analyzed from four quadrants of the lips using a magnifying lens. Results: The positive resemblance of lip print patterns from parents to their offsprings showed statistically significant resemblance in one quadrant and rest of the three quadrants showed no significant association between parents and offspring. Conclusion: Positive resemblance among the family members can be attributed to the genetics and inheritance. Lip print can be considered as an auxiliary method of identification.
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Erratum: Dentinogenic ghost cell tumor: Case report of a rare central variant and literature review p. 135

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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007