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    Table of Contents - Current issue
May-August 2017
Volume 21 | Issue 2
Page Nos. 185-323

Online since Friday, August 18, 2017

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From the Editor's Desk p. 185
T Smitha
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What are Indian oral pathologists talking about? p. 186
K Ranganathan
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Prof. Dr. R. Viswanathan p. 188
K Ranganathan
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Trends in oral squamous cell carcinoma: Diagnosis for effective, evidence-based treatment 2017 p. 189
Rooban Thavarajah, Kannan Ranganathan
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The so-called “combined epithelial odontogenic tumor”: A specific entity or not? p. 192
Kunal Sah
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Influence of legislations and news on Indian internet search query patterns of e-cigarettes p. 194
Rooban Thavarajah, Anusa Arunachalam Mohandoss, Kannan Ranganathan, Srinivas Kondalsamy-Chennakesavan
Background: There is a paucity of data on the use of electronic nicotine delivery systems (ENDS) in India. In addition, the Indian internet search pattern for ENDS has not been studied. We aimed to address this lacuna. Moreover, the influence of the tobacco legislations and news pieces on such search volume is not known. Given the fact that ENDS could cause oral lesions, these data are pertinent to dentists. Methods: Using a time series analysis, we examined the effect of tobacco-related legislations and news pieces on total search volume (TSV) from September 1, 2012, to August 31, 2016. TSV data were seasonally adjusted and analyzed using time series modeling. The TSV clocked during the month of legislations and news pieces were analyzed for their influence on search pattern of ENDS. Results: The overall mean ± standard deviation (range) TSV was 22273.75 ± 6784.01 (12310–40510) during the study with seasonal variations. Individually, the best model for TSV-legislation and news pieces was autoregressive integrated moving average model, and when influence of legislations and news events were combined, it was the Winter's additive model. In the legislation alone model, the pre-event, event and post-event month TSV was not a better indicator of the effect, barring for post-event month of 2nd legislation, which involved pictorial warnings on packages in the study period. Similarly, a news piece on Pan-India ban on ENDS influenced the model in the news piece model. When combined, no “events” emerged significant. Conclusions: These findings suggest that search for information on ENDS is increasing and that these tobacco control policies and news items, targeting tobacco usage reduction, have only a short-term effect on the rate of searching for information on ENDS.
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Cytological spectrum of salivary gland lesions and their correlation with epidemiological parameters p. 203
Vaneet Kaur Sandhu, Upender Sharma, Navtej Singh, Arun Puri
Background: The role fine-needle aspiration (FNA) in the diagnosis of salivary gland lesions has evolved over the years. Although clinical and radiological parameters help to narrow the differential diagnosis the tissue diagnosis still remains the gold standard. Materials and Methods: This study is from January 2013 to December 2015 in our Department of Pathology where 170 salivary gland lesions were aspirated. The aim of the present study was to analyze adequacy rate in relation to the size of lesion and to evaluate varied cytological spectrum of salivary gland lesions with emphasis on differential diagnosis and to correlate cytological diagnosis with age, gender and anatomical site. Results: The 170 cytological smears were categorized into two groups: Group 1 adequate aspirations (88.2%), Group 2 inadequate aspirations (11.7%). The adequate aspirations were subdivided as neoplastic (53.33%) and nonneoplastic (46.66%). The distribution of the various neoplastic lesions (80; 53.33%) were 66 (82.5%) benign, 12 (15%) were malignant and 2 (2.5%) were suspicious of malignancy. Among benign neoplasms, the pleomorphic adenoma (62; 93.3%) was the most frequent followed by Warthins tumor (4; 6%). The most common malignant neoplasms were adenoid cystic carcinoma (6; 50%), followed by mucoepidermoid carcinoma (4; 33.3%), malignant lymphoma (1; 8.3%) and metastatic carcinomatous deposits (1; 8.3%). In two cases, cytological picture indicated suspicion for malignancy however specific tumor typing could not be done. The neoplasms occurred more frequently in the parotid gland (65%), followed by submandibular gland (21.3%) and minor salivary glands (13.8%). The nonneoplastic lesions (70) included 68.6% cases of chronic sialadenitis, 17.1% cases were reported as mucocele, 11.4% cases of acute sialadenitis 2.9% cases as tubercular granulomas. Conclusion: FNA cytology provides useful information on the management of salivary gland lesions and prevents unnecessary surgery in cases of nonneoplastic lesions and identification of malignancy helps the surgeon in deciding type and extent of surgery.
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Validation of immunoexpression of tenascin-C in oral precancerous and cancerous tissues using ImageJ analysis with novel immunohistochemistry profiler plugin: An immunohistochemical quantitative analysis p. 211
Deepa Rajesh Mane, Alka D Kale, Chetan Belaldavar
Background: Immunohistochemistry (IHC) is a molecular technique that has grown tremendously over the years. However, the assessment is only qualitative which is subjective and causes errors. Due to this limitation, several excellent markers have not gained importance and reached clinical trials. Hence, we aimed to quantify IHC by ImageJ analysis with a novel IHC profiler plugin. ImageJ has not been tried in oral precancerous tissues with minimal attempt for matrix markers. Aim: This study aimed to validate the quantification of immunoexpression of tenascin-C (TN-C) in oral precancerous tissues and oral squamous cell carcinoma (OSCC) using ImageJ software with IHC profiler plugin. Materials and Methods: After IHC staining for TN-C and image acquisition, ImageJ analysis was performed as per the standard recommended algorithm. Assessment was done by two observers by blinding the histopathological diagnosis. The immunoscore was assessed for interobserver variability using Kohen's kappa statistics. Results: All our cases were in agreement and found to be statistically significant with P < 0.005. Moderate agreement was for mild dysplasia, moderate dysplasia and oral lichen planus. Substantial agreement was for oral submucous fibrosis and OSCC and almost perfect agreement noted for cases of severe dysplasia. Conclusion: IHC can now be quantified using freely downloadable software ImageJ analysis in oral precancerous tissues and OSCC. This software with good threshold control can quantify matrix marker such as TN-C. Hence, herewith, we propose that IHC markers should be quantified using ImageJ by our entire oral pathology fraternity so as to have a standard immunoscore for all markers.
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Immunohistochemical analysis of stromal fibrocytes and myofibroblasts to envision the invasion and lymph node metastasis in oral squamous cell carcinoma p. 218
Sowmya J Rao, Jyothi Bellur Madhava Rao, PP Jagadish Rao
Background: Tumor cells work in close coordination with stromal elements from its stage of emergence to metastasis. The study was designed to assess the presence and distribution pattern of stromal fibrocytes and myofibroblasts in oral squamous cell carcinoma (OSCC). Possibility of using these stromal cells as a marker for invasion and lymphnode metastasis was evaluated. Materials and Methods: A total of 40 cases of OSCC consisting twenty cases of each lymph node positive (pN+) and lymph node negative (pN0) samples and ten normal oral mucosa (NOM) tissues were subjected to double immunostaining using CD34 and alpha-smooth muscle actin (α-SMA) antibodies. Stained sections were evaluated semiquantitatively. Results: CD34 fibrocytes were seen in 70% of NOM and none of OSCC samples. α-SMA myofibroblasts were seen in 80% of OSCC and none of NOM samples. A statistically significant difference was found in fibrocyte values (P < 0.001) and myofibroblast values (P < 0.001) between NOM and OSCC study samples. No statistical significance in myofibroblast values between pN0 and pN+ study groups; however, their distribution pattern appreciably varied. Conclusions: This study suggested that fibrocytes could be used as one of the markers for early invasion. Abrupt loss of fibrocytes at the transition zone toward carcinoma and statistical significance in their values supported this inference. Heterogeneity in the distribution pattern of myofibroblasts in tumor stroma indicates that this variability may predict the tumor behavior toward nodal metastasis rather than their mere presence or absence.
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Cytomorphometric analysis of gingival epithelium and buccal mucosa cells in type 2 diabetes mellitus patients p. 224
Manisha Sahu, Hema Suryawanshi, Sushruth Nayak, Pramod Kumar
Background: The global prevalence of type 2 diabetes continues to rise. Interest has been increasing recently in noninvasive diagnostic procedure. Hence, an attempt has been made by the present study to analyze the changes in cytomorphometry in exfoliated buccal and gingival mucosa cells in type 2 diabetic patients. Aim: The aim of this study was to analyze the cytomorphometric changes in exfoliated cells of gingiva and buccal mucosa as an adjunct to diagnosis of diabetes. Materials and Methods: In the present study, fifty known type 2 diabetic patients were taken as study group, and the control group was comprised of fifty healthy individuals. Smear was prepared from buccal mucosa and gingival epithelium of both study and control groups and was stained by rapid Papanicolaou (Pap) stain. Stained smears were subjected to cytomorphometric analysis using Lynx Biolux (Lawrence and Mayo) image analysis software. In each Pap smear, 100 cells were evaluated for nuclear area (NA), cytoplasmic area (CA) and cytoplasm to nuclear ratio (CNR). Results: Mean NA was significantly higher (P < 0.05) in study group whereas mean CA did not exhibit any statistically significant difference (P > 0.05). The mean CNR was significantly lower in the study group (P < 0.05). Conclusion: This study contributes to the general understanding of the alterations in the cellular pattern of buccal and gingival mucosa cells in diabetic patients and can be used as an additional tool to aid in the evaluation of oral mucosal alterations in diabetes mellitus.
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Mast cells and angiogenesis in malignant and premalignant oral lesions: An immunohistochemical study p. 229
Daisy Laishram, Kavita Rao, HS Uma Devi, NS Priya, T Smitha, HS Sheethal
Introduction and Objectives: Angiogenesis is a complex event facilitated by angiogenic factors released from neoplastic and host immune cells. Among host immune cells, mast cells (MCs) may have greater significance in tumor progression through angiogenesis. The objectives of the study were to evaluate and correlate mast cell density (MCD) and microvessel density (MVD) in normal gingival tissue, leukoplakia with and without dysplasia and oral squamous cell carcinoma (OSCC) cases. Materials and Methods: Among eighty selected cases, twenty were of normal gingiva, twenty each of leukoplakia without and with dysplasia and twenty of OSCC. The slides were stained with CD34 and counterstained with 0.1% toluidine blue, followed by quantification of MCD and MVD per high-power field (×40) using Image-Pro Express software. Statistical Analysis: Chi-square test and correlation coefficient were used for statistical analysis. Observation and Results: A statistically significant difference in the values of MVD and MCD between normal gingival tissue, leukoplakia with and without dysplasia and OSCC (P = 0.000) was observed. MVD and MCD showed a positive correlation between the study groups. Conclusion: MVD and MCD increased significantly in cases of OSCC as compared to leukoplakia with and without dysplasia and normal gingival tissue. It was concluded that MCs may play a significant role in angiogenesis by releasing pro-angiogenic and angiogenic factors which may in turn favor the progression of premalignant lesion to a malignant one.
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Glandular odontogenic cyst: Series of five cases p. 239
Aadithya B Urs, Priya Kumar, Jeyaseelan Augustine, Rewa Malhotra
Introduction: Glandular odontogenic cyst (GOC) is a clinically rare and histopathologically unusual type of developmental odontogenic cyst with unpredictable and potentially aggressive behaviour. Materials and Methods: Archival data of cases histopathologically identified as GOC were analyzed from the Department of Oral Pathology over the past six years. The clinical, radiographic, histopathological features and treatment were evaluated. Special stains such as periodic acid Schiff, mucicarmine along with immunohistochemical staining for cytokeratin 19 were employed to confirm the histopathological diagnosis. Results: The study indicated a strong female predilection with slightly more number of cases found in maxilla than mandible. Most cases showed a well defined multilocular radiolucency. The microscopic features which aid in its differentiation from its mimickers such as central mucoepidermoid carcinoma, lateral periodontal cyst, dentigerous cyst and botryoid odontogenic cyst which were observed included presence of variable thickness of the lining epithelium, epithelial plaques and whorls, hobnail cells, ciliated cells, clear cells and goblet cells. Conclusion: The present case series aims to throw light on the clinical, radiographic and microscopic features of GOC, which may aid in its definitive diagnosis in problematic cases.
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Alteration of cellular metabolism in cancer cells and its therapeutic prospects p. 244
Biranchi Narayan Biswal, Surya Narayan Das, Bijoy Kumar Das, Rachna Rath
Transformation of a normal cell into a cancerous phenotype is essentially backed by genetic mutations that trigger several oncogenic signaling pathways. These signaling pathways rewire the cellular metabolism to meet the bioenergetic and biomass requirement of proliferating cell, which is different from a quiescent cell. Although the change of metabolism in a cancer cell was observed and studied in the mid-20th century, it was not adequate to explain oncogenesis. Now, equipped with a revolution of oncogenes, we have a genetic basis to explain the transformation. Through several studies, it is clear now that such metabolic alterations not only promote cancer progression but also contribute to the chemoresistance of cancer. Targeting specific enzymes and combinations of enzymes can improve the efficacy of cancer therapy and help to overcome the therapeutic resistance.
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Epigenetics in oral squamous cell carcinoma p. 252
KN Hema, T Smitha, HS Sheethal, S Angeline Mirnalini
Oral squamous cell carcinoma (OSCC) is the most common type of oral neoplasm, accounting for over 90% of all oral malignancies and 38% of head and neck tumors. Worldwide, OSCC is the eighth most common human cancer, with more than 500,000 new cases being diagnosed every year with a fairly onerous prognosis, encouraging further research on factors that might modify disease outcome. Genetic and/or environmental risk factors associated with the development of oral cancer have been sufficiently understood (smoking, alcohol, betel, diet, living habits, etc.). Knowledge of the genetic basis in oral carcinogenesis is still a challenging task. To improve the diagnosis and prevention, a previously unknown type of chromatin modification, known as epigenetic, which is defined as heritable DNA changes that are not encoded in the sequence itself and which are reversible and increasingly appear to serve fundamental roles in cell differentiation and development are studied. Tumors shed their DNA into the blood and epigenetic changes that occur early during tumorigenesis, sometimes even in premalignant lesions, can provide valuable biomarkers. Key components involved in epigenetic regulation are DNA methylation, histone modifications and modifications in micro ribonucleic acids (miRNAs). Epigenetic modifications may contribute to aberrant epigenetic mechanisms seen in oral precancers and cancers. In the near future, epigenetic variations found in oral dysplastic cells can act as a molecular fingerprint for malignancies.
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Current concepts of pemphigus with a deep insight into its molecular aspects p. 260
Jayakiran Madala, Rithika Bashamalla, M Praveen Kumar
Pemphigus vulgaris is an autoimmune bullous disease involving both the skin and mucosal areas, which is characterized by intraepithelial flaccid blisters and erosions. The pathogenesis of this disease is not yet completely established, but novel intuitions into its pathogenesis have recently been published. An unanswered question in its pathophysiology is the mechanism of acantholysis or loss of keratinocyte cell adhesion. Acantholysis seems to result from a communal action of autoantibodies against numerous keratinocyte self-antigens, of which desmogleins 1 and 3, desmocollins and nondesmosome components, such as the mitochondrion, might take part in the disease initiation. Lately, apoptosis was described as a possible underlying mechanism of acantholysis. Likewise, apoptolysis is assumed to be the association between suprabasal acantholytic and cell death pathways. Hence, the present review focuses on the current concepts in the pathogenesis of the pemphigus in a nutshell.
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Fine-needle aspiration cytology of cysticercosis in submandibular gland p. 264
Vaneet Kaur Sandhu, Upender Sharma, Navtej Singh, Geetika Goyal
Fine-needle aspiration cytology (FNAC) has emerged as simple, minimally invasive, low-cost, outpatient diagnostic modality for the evaluation of nodules caused by parasites. Cysticercosis is caused by larval stage of Taenia solium, pork tapeworm. It is endemic in Southeast Asia, Latin America and South Africa. We report a case of cysticercosis in a 25-year-old male who presented with painless swelling of submandibular gland which was diagnosed on FNAC. The patient was recommended antihelminthic therapy which resulted in complete resolution of the swelling.
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Unicystic ameloblastoma in conjunction with peripheral ameloblastoma: A unique case report presenting with diverse histological patterns p. 267
Sravani Ghattamaneni, Shilpa Nallamala, Venkateswara Rao Guttikonda
Ameloblastomas are benign epithelial odontogenic neoplasms which are locally aggressive with an insidious growth pattern. Based on the clinical, radiographic, histopathology and behavioral and prognostic aspects, four variants of ameloblastoma are distinguished. They include solid/multicystic ameloblastoma, unicystic ameloblastoma (UA), peripheral ameloblastoma (PA) and desmoplastic ameloblastoma. UA and PA are two variants that have no clinical or radiological resemblance to each other. A case of simultaneous occurrence of these two lesions displaying an array of different histopathological entities together, with a note on pathological insight, has been reported in a 59-year-old adult male patient.
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Oral focal mucinosis of posterior maxilla p. 273
Kumar Nilesh, Huzaifa S Kothi, Rahul Patil, RC Pramod
Oral focal mucinosis (OFM) is a rare connective tissue disorder characterized by myxoid degeneration of submucosal connective tissue. It usually presents as gingival or mucosal overgrowth. Due to its uncommon occurrence and lack of pathognomonic clinical or radiological features, diagnosis mainly relies on histopathological evaluation. The paper reports a rare case of large OFM in a 58-year-old female patient involving the posterior maxilla and hard palate. Diagnosis of the lesion was established based on histopathological and immunohistochemical analysis. The lesion was excised surgically and showed no recurrence at 1 year follow-up. The cases presented intend to bring OFM to the attention of oral pathologists and clinicians while considering the differential diagnosis of myxoid lesions of oral cavity.
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A rare coexistence of aspergillosis with actinomycosis p. 277
B Hari Vinay, Aditya Mohan, P Haritha, K Roja Lakshmi
Aspergillosis is a common systemic mycosis which affects immunocompromised and immunocompetent hosts. Aspergillus spp. is wide spread in the environment in most countries, which renders an invasive form of disease. The presence conidial heads are pathognomic to aspergillosis in diagnosis. Actinomycosis is a subacute-to-chronic infection that causes sinus fistula, tract or abscess due to the invasion surrounding the soft tissue. Cervicofacial infection accounts for 50%–60% of all actinomycosis cases. The mandible and nasopharynx are the sites of predilection, but maxillary infection is rare. Aspergillosis and Actinomycosis each of them was reported in case, but mixed infection of both organisms is rare, only one case has been reported. This paper discussed about a case report of coexistence of aspergillosis with actinomycosis in 38-year-old male.
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Hemangiolymphangioma of buccal mucosa: A rare case report p. 282
Selvamani Manickam, Prem Sasikumar, B Nanda Kishore, Sheethal Joy
Vascular anomalies are mainly classified under two headings, i.e. under vascular tumors and vascular malformations. Hemangioma and lymphangioma are examples for such a vascular anomalies. Malformations may be seen in different combinations of vascular elements, and histologically these vessels may be filled with blood and named lymphangiohemangioma or hemangiolymphangioma according to the dominant tissue structure present. It is a rare developmental anomaly. This paper reports a case of lymphangiohemangioma in a 21-year-old female patient.
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Small cell neuroendocrine carcinoma of the paranasal sinus with intraoral involvement: Report of a rare case and review of the literature p. 286
Anita Spadigam, Anita Dhupar, Shaheen Syed, Shruti U Nagvekar
The diffuse neuroendocrine system continues to be an enigmatic topic of study in pathology due to its controversial embryologic origins, biology and a variety of tumors engendered. Originally thought to be localized to the classic neuroendocrine organs (pituitary, thyroid, pancreas and adrenal medulla), the neuroendocrine cells are now known to be distributed in every organ system of the body. A number of human diseases have been linked to aberrations in the functioning of the neuroendocrine cells. Neoplasms of the neuroendocrine system can thus occur in myriad primary sites and range in behavior from benign to lethal. Small cell neuroendocrine carcinoma (SNEC) is a high-grade neuroendocrine tumor, rarely presenting in the sinonasal region. This article reports a case of a 68-year-old male patient with primary paranasal SNEC showing intraoral involvement. The diagnosis is based on a thorough clinical, histopathological and immunohistochemical workup to differentiate it from the other small round blue cell tumors.
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Gingival mesenchymal stem cells p. 296
Deepak Venkatesh, KP Mohan Kumar, Jyoti B Alur
The human gingiva, characterized by its outstanding scarless wound healing properties, is a unique tissue and a pivotal component of the periodontal apparatus, investing and surrounding the teeth in their sockets in the alveolar bone. In the last year's gingival mesenchymal stem/progenitor cells (GMSCs), with promising regenerative and immunomodulatory properties, have been isolated and characterized from the gingival lamina propria. These cells, in contrast to other mesenchymal stem/progenitor cell (MSC) sources, are abundant, readily accessible and easily obtainable through minimally invasive cell isolation techniques. This short communication summarizes the current scientific evidence on GMSCs.
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Ultrastructural changes in cell death p. 299
BK Charan Gowda, Ganganna Kokila
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Nonmetric traits of permanent posterior teeth in Kerala population: A forensic overview p. 301
Tibin K Baby, S Sunil, Sharlene Sara Babu
Introduction: Dental morphology is a highly heritable characteristic which is stable with time and has a fairly high state of preservation. Nonmetric dental traits have crucial role in ethnic classifications of a population that helps in forensic racial identification purposes. Aims and Objectives: To determine the frequency and variability of possible nonmetric tooth traits using extracted permanent posterior teeth from Kerala population for discerning racial ethnicity. Materials and Methods: This qualitative, cross-sectional study was carried out using 1743 extracted intact permanent posterior teeth collected from different dental clinics situated all over Kerala. Results: The more common features on premolars were multiple lingual cusps (31.21%), distal accessary ridges (16.28%) and Tom's root (17.9%). In upper first molars, Carabelli trait expression was 17.78% and other common features included metaconulo, cusp 5 and enamel extensions. Conclusion: Posterior tooth traits had variable expression in the study population. Low prevalence rate of Carabelli trait in this study is characteristic of Asian population. This research explored new elements of invaluable tooth traits values to understand racial ethnicity of Kerala population.
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Analysis of lip print and fingerprint patterns in patients with type II diabetes mellitus p. 309
P Manjusha, S Sudha, PM Shameena, R Chandni, Sujatha Varma, Deepak Pandiar
Background and Objectives: Globally, the prevalence of diabetes is soaring high in the recent times. There is an ardent search in the scientific community for a reliable and cheap early predictor which can serve the purpose of mass screening of a genetically vulnerable population. Hence, the present study was conducted to assess the predictive role of cheiloscopy on type II diabetes mellitus (T2DM). Several studies have established the association of dermatoglyphics with diabetes. However, results are still far from satisfaction. Thus, we also evaluated fingerprint analysis along with cheiloscopy. Materials and Methods: The study was conducted on 100 uncontrolled T2DM patients and 50 healthy controls. Lip prints were obtained using lipstick and cellophane paper analyzed and classified using Suzuki and Tsuchihashi's classification. Fingerprints were obtained using kajal stick, analyzed and classified using Henry's system of classification. Results: Type IV pattern of lip prints was found significantly more in the diabetic patients. Howbeit, fingerprint analysis did not reveal any significant association with diabetes. Conclusion: The present study showed a ray of hope for application of cheiloscopy as a potential biomarker in the early diagnosis of T2DM which can be used in mass screening. Further studies are warranted to confirm the findings.
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A relationship between salivary flow rates and Candida counts in patients with xerostomia p. 316
Suchetha Devendrappa Nadig, Deepak Timmasandra Ashwathappa, Muniraju Manjunath, Sowmya Krishna, Araleri Gopalkrishna Annaji, Praveen Kunigal Shivaprakash
Context: Most of the adult population is colonized by Candida in their oral cavity. The process of colonization depends on several factors, including the interaction between Candida and salivary proteins. Therefore, salivary gland hypofunction may alter the oral microbiota and increase the risk for opportunistic infections, such as candidiasis. Hence, it is necessary to evaluate the relationship between salivary flow rates (SFRs) and Candida colony counts in the saliva of patients with xerostomia. Aims: This study aims to determine and evaluate the relationship between SFRs and Candida colony forming units (CFUs) in patients with xerostomia. Settings and Design: This study was a descriptive study. Subjects and Methods: The study participants were taken from the patients attending outpatient department in a private dental college. Fifty patients, who reported xerostomia in a questionnaire of the symptoms of xerostomia, were selected. Chewing stimulated whole saliva samples were collected from them and their SFRs were assessed. Saliva samples were inoculated in the Sabouraud dextrose agar culture media for 24–48 h, and Candida CFUs were counted. Statistical Analysis Used: Chi-squared test was used to analyze the data. Results: There was a significant inverse relationship between salivary flow and candida CFUs count when patients with high colony counts were analyzed (cutoff point of 400 or greater CFU/mL). Females had less SFR than males. Most of the patients who had hyposalivation were taking medication for the underlying systemic diseases. Candida albicans was the most frequent species. Conclusions: There was a significantly negative correlation between SFRs and Candida CFUs in the patients with xerostomia.
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Use of jaggery and honey as adjunctive cytological fixatives to ethanol for oral smears p. 317
Deepak Pandiar, Harakh Chand Baranwal, Sandip Kumar, Vellaichamy Ganesan, Piyush Kumar Sonkar, Kausik Chattopadhyay
Background: Ethanol has satisfactorily been used as cyto-fixative. Owing to its limitations, pathologists have always searched for new fixatives. The present study was conducted to evaluate the efficacy of two natural sweeteners as cyto-fixatives. An attempt has also been made to understand the underlying mechanism by which these fixatives fix the oral mucosal cells. Materials and Methods: Three smears were collected from 25 healthy volunteers. One smear was fixed in ethanol and the other two in 20% aqueous honey solution and 30% aqueous jaggery solution for 15–30 min followed by Papanicolaou staining. Slides were evaluated for nuclear staining, cytoplasmic staining, cell morphology, clarity of staining and uniformity of staining randomly irrespective of the fixatives. Chi-square test and Bonferroni post hoc test were done using SPSS software. P < 0.05 was considered to be statistically significant. In addition, cytological fixatives were analyzed for the pH and amount of reducing sugars. Results: It was found that for all the characteristics studied, no statistically significant difference was seen between the three fixatives. The pH of the both tested fixatives remained acidic even after 1 week. The amount of reducing sugars in 20% aqueous honey solution and 30% aqueous jaggery solution was 19.3 g/100 mL and 2.07 g/100 mL, respectively. Conclusion: Both the test fixatives gave results equivalent to ethanol and thus can be used as alternative fixatives for oral smears. It is proposed that 20% aqueous honey and 30% aqueous jaggery fix the oral smears satisfactorily in a mechanism akin to ethanol by coagulating and denaturing proteins.
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Evaluation of two flap designs on the mandibular second molar after third molar extractions p. 317
Nabeeh A Alqahtani, S Khaleelahmed, Farheen Desai
Background: The extraction of third molars is associated with some clinical outcomes and periodontal problems. It is imperative to note that the type of incision used in the surgery for the removal of the impacted third molar is critical. The design of the flap influences the healing of the surgically created defect and damage to the distal periodontal area of the adjacent second molar. However, till date, there have been conflicting reports on the influence of different flap designs used for the surgical removal of impacted third molars. Aim: The present study aimed to comparatively evaluate the clinical outcomes and periodontal status of the adjacent second molar, when two different flap designs, namely, the envelope and the modified triangular flap designs were used. Materials and Methods: Sixty female patients with bilateral impacted third molars completed the study with envelope flap on one side and modified triangular flap design on the other side of the mandible for third molar removal. Clinical parameters including pain, dehiscence and swelling were assessed postoperatively and periodontal probing depth (PPD) on the distal aspect of adjacent second molar were assessed both pre- and post-operatively. Results: The results were assessed on 1, 3 and 8 days for pain using visual analog scale. The subjective perception of swelling was evaluated on 3, 7 and 15 days postoperatively in a similar manner. The results of the periodontal parameters were evaluated both preoperatively and 3 months postoperatively, with cautious exploration using a University of North Carolina (UNC)-15 periodontal probe. The statistically significant results for swelling and PPD were noted for the two flap groups using the Chi-square test (P < 0.05). Conclusion: The study revealed that the modified triangular flap had lesser postoperative PPDs and dehiscence. The envelope flap was better when swelling was analyzed. The pain scores, though slightly higher for the modified triangular flap group, were not statistically significant.
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Evaluation of paxillin expression in patients with oral squamous cell carcinoma: An immunohistochemical study p. 318
Saurabh Shekhar, Punnya V Angadi
Background: Oral squamous cell carcinoma (OSCC) is the tenth most common cancer in the world. The diagnosis of OSCC remains problematic, especially in advanced-stage tumors. Aims: The present study was conducted to understand the pattern of expression of paxillin in varying grades of carcinomas and also to ascertain whether its expression has an association with increasing grades. Methods: A total of ninety formalin-fixed paraffin-embedded tissues of OSCC were included in the study comprising thirty cases of each of well-differentiated squamous cell carcinomas, moderately differentiated squamous cell carcinomas (MDSCCs) and poorly differentiated squamous cell carcinomas (PDSCCs). The tissue sections were subjected to immunohistochemical staining of paxillin using super polymer-sensitive polymer 3,3' diaminobenzidine detection kit. All the three groups were analyzed on various parameters including staining intensity, location and percentage of staining. SPSS 19.0 was used to analyze the data. Results: Paxillin stain positivity was observed in 95.5% of the cases. Predominant intense paxillin staining was demonstrated in 17 (56.6%) cases of well-differentiated squamous cell carcinoma, 28 (93.3%) cases of moderately differentiated squamous squamous cell carcinoma and 15 (50%) cases of PDSCC. A predominant cytoplasmic staining was observed in 21 (70%) cases of PDSCC and cytoplasmic plus membrane staining in 14 (46.6%) cases of MDSCC. Conclusion: The present study provides evidence that paxillin may be involved in the development and progression of OSCC. Thus, paxillin could be considered a useful biomarker for patient management and prognosis.
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Adenoid ameloblastoma with dentinoid: A rare hybrid variant p. 319
Harishchandra K Rai, Shaila M Pai, Anitha Dayakar, H Supriya
Odontogenic tumors comprise an unusual group of lesions of the jaw and present diverse histological patterns. Derived from the primordial tooth-forming tissues, they represent a heterogeneous group of lesions that range from hamartomas to benign and malignant neoplasms of variable aggressiveness. Sporadic case reports and diverse complex histogenetic source also defy categorization of odontogenic tumors. Many can be diagnosed accurately based on the distinctive clinical, radiological and histopathological presentation. Considerable variations in the clinicopathological presentation of odontogenic tumors can be confusing, increasing the chance of misdiagnosis. An interesting case of adenoid ameloblastoma reported in a 55-year-old male patient in the mandible, presenting with a diverse and intriguing histopathology, is discussed here.
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Primary intraosseous squamous cell carcinoma - A rare odontogenic malignancy p. 320
Arush Thakur, Jagdish V Tupkari, Tabita Joy, Ajas A Gogri
Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare epithelial odontogenic malignancy affecting the jaws, especially in elderly population. It is a rare lesion, because very few cases of PIOSCC have been reported in the literature with not much of research done on this particular entity. In the present article, we report a case of PIOSCC with detailed discussion of clinical, radiographic and histopathologic features along with review of literature.
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Management of squamous cell carcinoma of the maxillary sinus p. 320
Kanva Ramasanjeevaiah Jnanadev, HS Sheethal, HS Suraj, KB Rudresh
Surgical management of malignant tumors disfigures and demoralizes individuals. Management of such patients requires concern humane approach, meticulous planning and judicious management of a case. It is the responsibility of a dentist to restore the lost function, speech and esthetics. This clinical case report signifies the role of the dentist starting from diagnosis, presurgical phase, surgical phase and postsurgical phase of a patient diagnosed with squamous cell carcinoma of the right maxilla.
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Eosinophilic ulcer of the tongue masquerading as malignant ulcer: An unexplored distinct pathology p. 321
Kunal Sah, Sunira Chandra, Anil Singh, Shweta Singh
Eosinophilic ulcer (EU) is a rare self-limiting chronic benign ulcerative lesion of the oral mucosa often misdiagnosed as oral malignancy. Its etiopathogenesis is ambiguous, but trauma plays an important role in the development. Microscopically, it is characterized by a polymorphic inflammatory infiltrate with a prominent eosinophilic component and large mononuclear cells extending deep into the submucosa, underlying muscle and salivary glands. We discuss a case of EU in a 55-year-old male, which presented with a symptomatic nonhealing ulcer on the right lateral border of the tongue and was further clinically misdiagnosed as malignant ulcer.
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Darier disease: A rare genodermatosis p. 321
Hema Suryawanshi, Akshay Dhobley, Aparna Sharma, Pramod Kumar
Darier disease (DD), also known as keratosis follicularis or dyskeratosis follicularis, is a rare autosomal dominant genodermatosis with high penetrance and variable expressivity. It is caused by mutations of ATP2A2 gene which encodes the sarco/endoplasmic reticulum Ca2+ ATPase isoform 2. It is clinically manifested by hyperkeratotic papules primarily affecting seborrheic areas on the head, neck and thorax, with less frequent involvement of the oral mucosa. When oral manifestations are present, they primarily affect the palatal and alveolar mucosa, are usually asymptomatic and are discovered in routine dental examination. Histologically, the lesions show suprabasal clefts with acantholytic and dyskeratotic cells. We present a case of 35-year-old female patient with typical clinical and histological features of DD.
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Erupted odontome associated with a primary molar: A unique clinical presentation, 4-year follow-up Highly accessed article p. 322
Shaik Hasanuddin, E Rajendra Reddy
Erupted odontomas occur very rarely in both the primary and permanent dentitions. The present case report discusses an unusual erupted odontome associated with a primary first mandibular molar. A 7-year-old female patient with an erupted odontome in the oral cavity was reported. The surgical extraction of odontome was performed under local anesthesia to allow eruption of underlying premolar tooth. After 4 years of follow-up, the first premolar had erupted with an unusual occlusal morphology, similar to that of a primary first molar. Orthopantomogram revealed no supplemental/supernumerary teeth in the vicinity of the erupted tooth. Early evaluation, precise diagnosis of odontogenic lesions interfering with erupting teeth, especially in the first decade of life is essential for prevention of malocclusion in young children. Erupted permanent successor should be differentiated from a primary first molar to avoid unnecessary extraction.
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Erratum: Odontogenic tumor: Indian scenario p. 323

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