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    Table of Contents - Current issue
September-December 2019
Volume 23 | Issue 3
Page Nos. 315-483

Online since Thursday, December 19, 2019

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From the Editor's Desk p. 315
T Smitha
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To be or not to be an oral pathologist Highly accessed article p. 316
V Ramesh
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Tumor budding is a potential histopathological marker in the prognosis of oral squamous cell carcinoma: Current status and future prospects Highly accessed article p. 318
Alka D Kale, Punnya V Angadi
Tumor budding (TB) is a histopathologically evident feature that represents a scattered pattern of invasion consisting of isolated single tumor epithelial cells or tumor cells in small clusters (up to 5 cells) seen primarily at the invasive front dispersed within the stroma for variable distance. Presence of TB has been linked with lymph node metastasis, recurrence, distant metastasis and reduced survival in numerous cancers including oral squamous cell carcinoma (OSCC). Tumor buds are also considered as histopathological markers of epithelial–mesenchymal transition which is a molecular process implicated as a hallmark for invasion and metastasis. This review gives an overview of the current evidence regarding TB assessment in OSCC and its future prospects.
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Prof. (Dr.) V R Brave p. 324
Rajiv S Desai
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The dendritic cell tool for oral cancer treatment p. 326
Vidya Mallipattana Anne Gowda, T Smitha
The link between oncology and immunology has a long history, and its development is forced by the necessity to develop innovative and highly efficient modalities for the immunological destruction of malignant cells. The success of cancer immunotherapy depends on two major factors: adequate tumor-specific antigens and a vehicle capable of inducing a tumor-specific immune response by effective delivery of these antigens. Dendritic cells (DCs) are the most powerful antigen-presenting cells, because of their unique characteristics, and these cells are actively used in cancer immunotherapy. DCs form a critical interface between innate and adaptive immunity. They integrate signals derived from tissue infection or damage and present processed antigen from these sites to naive T-cells in secondary lymphoid organs while also providing multiple soluble and surface-bound signals that help to guide T-cell differentiation. They are sentinel of immune system, as they are deployed through the body and monitor their surroundings for antigens and danger signals derived from pathogens or tissue damage. These cells (DCs) with their potent antigen-presenting ability are considered as critical factor in antitumor immunity. In recent years, the existence of immunosuppressive regulatory DCs in tumor microenvironment is well described. Monocytic myeloid-derived suppressor cells can contribute to the pool of tumor-associated DCs by differentiating to inflammatory DCs, which appear to have specific phenotype and are critical components of antitumor response. There is currently much interest in modulating DC function to improve cancer immunotherapy. Many strategies have been developed to target DCs in cancer, such as the administration of antigens with immunomodulators that mobilize and activate endogenous DCs and the generation of DC-based vaccines. Here, we highlight the role of DCs along with other DC subsets in the regulation of immune responses in cancer treatment.
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Cell budding p. 330
Deepak Venkatesh, T Smitha
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Antifungal activity of solvent extracts of Piper betle and Ocimum sanctum Linn on Candida albicans: An in vitro comparative study p. 333
Basireddy Sivareddy, Bernard Ajay Reginald, D Sireesha, Meda Samatha, K Himakar Reddy, G Subrahamanyam
Background: Oral candidiasis is a common fungal infection caused by Candida albicans. In recent years, Candida species have shown resistance against many synthetic drugs, which has highlighted the need for novel antifungal drugs with fewer side effects for effective management of candidiasis. Several studies have suggested that some plant species possess promising antimicrobial compounds. Piper betle and Ocimum sanctum Linn are such common medicinal plants that show strong antimicrobial activity by the release of secondary metabolites. However, the effect of these plants on oral candidiasis has not been studied and hence, the present study aimed to evaluate the antifungal activity of these plant extracts on the subcultures of C. albicans and compared with a standard drug, fluconazole. Materials and Methods: Subcultures of C. albicans obtained from oral thrush patients were used in the present study. Ethanolic and ethyl acetate extracts of P. betle (betel) and O. sanctum L. (tulsi) leaves were prepared by cold extraction method. The anticandidal activity and minimum inhibitory concentration (MIC) were evaluated using disc diffusion method and microbroth dilution method, respectively. Values were compared with the standard drug fluconazole. Results: Both the extracts exhibited anticandidal activity on the subcultures of C. albicans. The ethyl acetate extract of mature betel leaf showed a maximum zone of inhibition (26 mm) when compared with tulsi and fluconazole (13 mm). Betel leaf extract showed better MIC values (125 μg/ml) than tulsi (2000 μg/ml). However, these values were high when compared with those of fluconazole (62.5 μg/ml). Conclusion: Ethyl acetate extract of mature betel leaf exhibited good anticandidal activity than that of tulsi and fluconazole.
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Stromal desmoplasia as a possible prognostic indicator in different grades of oral squamous cell carcinoma p. 338
Heena Zainab, Ameena Sultana, Shaimaa
Introduction: One of the major aspects of tumor cell invasion and metastasis is the interaction between cancer cells and the extracellular matrix component. The invasion of epithelial tumor cells into the underlying connective tissue stroma causes dynamic changes in its microenvironment, which can be seen as radical changes in the stroma. The characteristics of the stroma in relation to the invading malignant epithelial cells and the interdependence between the stroma and the tumor cells are always a matter of discussion and interest. Aim: The aim of this study is to predict the biological behavior of oral squamous cell carcinoma (OSCC) by evaluating stromal desmoplasia and its possible use as important prognostic indicators. Objective: To assess the desmoplastic reaction in varying histopathological grades of OSCC. Materials and Methods: The study included a total of 30 histopathologically prediagnosed cases of OSCC (well, moderate and poorly differentiated grades of OSCC). Picrosirius red stain in conjunction with polarizing microscope was used to evaluate the stromal desmoplastic reaction. Results: The results of the study revealed that, in the initial grades, cancer invasion induces a desmoplastic reaction, whereas in the later stages, there is degradation of the stroma, thereby facilitating tumor invasion. Conclusion: The study would emphasize the importance of stromal desmoplasia as a prognostic indicator and may help to reflect the biological diversity of oral cancer and predict the clinical outcomes.
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Evaluation of salivary alkaline phosphatase levels in tobacco users to determine its role as a biomarker in oral potentially malignant disorders p. 344
TR Menaka, G Vasupradha, S Shamala Ravikumar, K Dhivya, J Dinakaran, V Saranya
Background: Elevated salivary alkaline phosphatase (S-ALP) levels have been observed in oral squamous cell carcinoma, but its status in tobacco users and in individuals with oral potentially malignant disorders (OPMDs) is less explored. Aims and Objectives: The aims and objectives were to estimate and compare the levels of S-ALP among tobacco users, nonusers and in individuals with OPMD. Materials and Methods: The study population comprised 42 individuals, categorized into four groups with/without tobacco usage habit and with/without lesion. 5 ml of unstimulated saliva sample was collected, centrifuged at 3000 rpm for 15 min and supernatant separated. S-ALP was estimated in the supernatant by using kinetic photometric method in an automatic analyzer. Results: Data obtained were subjected to statistical analysis. The mean S-ALP was 18.00 IU/L for normal individuals without tobacco usage, 4.60 IU/L for smokers without lesion, 7.50 IU/L for tobacco chewers without any lesion and 64.90 IU/L for individuals with OPMD. The mean difference between the groups was statistically significant (P < 0.001) using Kruskal–Wallis' ANOVA. No statistically significant difference (P > 0.05) was obtained in the S-ALP levels between tobacco users and nonusers and between smokers and tobacco chewers, using Mann–Whitney U-test. S-ALP levels in individuals with OPMD were statistically significantly higher (P < 0.001) than those without lesions, with or without tobacco usage habit, using Mann–Whitney U-test. Conclusion: We conclude that S-ALP could be used as a reliable noninvasive biomarker in monitoring OPMD.
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Calretinin expression in odontogenic cysts and odontogenic tumors and the possible role of calretinin in pathogenesis of ameloblastoma p. 349
Amrutha Rudraraju, Aparna Venigalla, Suresh Babburi, Pinnisetti Soujanya, RV Subramanyam, K Roja Lakshmi
Introduction: Histopathological diagnosis of odontogenic cysts and tumors is a task mostly accomplished with hematoxylin and eosin staining. However, the use of additional diagnostic modalities such as immunohistochemistry may be necessary in histologically similar lesions. The reports of studies which have used calretinin as an immunohistochemical marker for ameloblastoma have been conflicting. Aim: The aim of the study was to evaluate the use of calretinin as a specific diagnostic marker for ameloblastoma and observe its expression in odontogenic cysts and other odontogenic tumors. Materials and Methods: Formalin-fixed, paraffin-embedded sections were taken from the archives which included 15 cases each of dentigerous cyst, radicular cyst, odontogenic keratocyst and ameloblastoma five cases of adenomatoid odontogenic tumor and three cases of ameloblastic carcinoma. Immunohistochemistry was done with calretinin antibody. Results: All ameloblastomas were positive for calretinin, whereas no other tumor or cyst showed positivity. Differences in proportion of calretinin expression were statistically significant with P = 0.000. Conclusion: Calretinin can be considered as a specific marker for ameloblastomas.
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Histomorphological comparison of pleomorphic adenoma in major and minor salivary glands of oral cavity: A comparative study p. 356
S Nonitha, TL Yogesh, S Nandaprasad, B Uma Maheshwari, IP Mahalakshmi, Bhavana T Veerabasavaiah
Background and Objectives: Pleomorphic adenoma, being the most common benign tumors of salivary gland, is morphologically characterized by a biphasic pattern containing the epithelial and mesenchymal components. The modified myoepithelial cells present are thought to play an important role in its histologic diversity by the formation of extracellular matrix. The aim of the present study was to observe, compare and correlate the histomorphological diversity of epithelial and stromal components along with different morphological cell types of modified myoepithelial cells. Materials and Method: Histomorphological features were compared in twenty cases of pleomorphic adenoma of major salivary glands and twenty cases of minor salivary glands using hematoxylin and eosin stains. The features were analyzed by observing under the light microscope. Results: Statistical analysis showed significance of plasmacytoid cells, and squamous metaplasia was extensive with formation of keratin cyst-like structure resembling cystic pleomorphic adenoma, in minor salivary gland tumors. Conclusion: Plasmacytoid cells, squamous cells and areas of hyalinization were observed predominantly in major salivary gland tumors compared to minor salivary glands. Keratin pearls were predominant in minor salivary gland tumors.
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Evaluation of relationship between serum homocysteine and Vitamin B12 levels in oral submucous fibrosis patients using chemiluminescence immunoassay p. 363
Mukta Vijaykumar Vanjani, Rashmi G S Phulari, Rajendrasinh Rathore
Background: Serum homocysteine (Hcy), a nonessential amino acid, is considered as a helpful indicator of vitamin status for its strong correlation with Vitamin B12. Although Hcy levels in oral submucous fibrosis (OSMF) have been studied, the relationship between Hcy and Vitamin B12 has not been studied yet. This study is the first one to compare and correlate the levels of serum Hcy and Vitamin B12 in OSMF patients. Materials and Methods: The study group comprised 60 patients. Serum Hcy and Vitamin B12 estimation were done by chemiluminescence immunoassay. These levels in OSMF patients were compared and correlated with corresponding levels in healthy controls. Results: Hcy levels were elevated in OSMF and were found to be statistically significant (P = 0.014) as compared to healthy controls. On the contrary, although Vitamin B12 levels were found to be higher in healthy controls, the difference was statistically nonsignificant (P = 0.657). A significant correlation was found (P = 0.01) between Hcy and Vitamin B12 in both groups, i.e., decreased Vitamin B12 levels led to elevated Hcy levels but vice versa was not found. No correlation was found between levels of Hcy and the severity of OSMF (P = 0.806). Conclusion: Chronic inflammation in OSMF leads to hyperhomocysteinemia, which may also be seen in cases of Vitamin B12 deficiency and certain systemic disorders. Thus, while serum Hcy could be used as biomarker for OSMF, Vitamin B12 deficiency and certain systemic disorders should be ruled out.
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Tumor necrosis factor-like weak inducer of apoptosis expression in healthy oral mucosa, oral dysplasia and oral squamous cell carcinoma p. 369
Swetha Acharya, Prashant Prabhu, Vidya Patil, Anirudh B Acharya, Anil Desai, Krithi Nikhil
Objective: Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) has been implicated in the pathogenesis of cancer, as it participates in the progression of internal malignancies. However, its role in the biology of squamous cell carcinoma (SCC) is uncertain. Studies regarding TWEAK in SCC have shown inconsistent results. We aimed to study the expression of TWEAK in healthy oral mucosa, oral dysplastic lesions and in oral SCC (OSCC). Methods: Immunohistochemistry for TWEAK was performed on one hundred oral mucosal tissues, healthy control (HC) (n = 20), oral dysplasia (OD) (n = 20) and OSCC (n = 60). Staining intensity, extent of staining (ES) and immunoreactive Score (IRS) were assessed for each sample. Kruskal–Wallis ANOVA, Mann–Whitney U, Chi-square and Spearman's rank correlation coefficient were applied. Results: TWEAK was expressed in 55% of HC, 90% of OD and in all cases of OSCC, with variable intensities. A significant difference in the ES and IRS of TWEAK was noted among the three groups. ES and IRS were highest in OSCC group. ES of TWEAK was significantly higher at invasive tumor front (ITF) than in the whole tumor, with a significant positive correlation. TWEAK expression showed a significant association with invasive front grading, pattern of invasion and surgical margins of OSCC. Conclusions: TWEAK may contribute to the progression of OSCC. It might also sustain altered differentiation, invasion and migration of tumor cells at ITF.
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Diagnostic challenges in malignant tumors of nasal cavity and paranasal sinuses p. 378
C Padmavathi Devi, K Maruthi Devi, Praveen Kumar, RV Amrutha Sindhu
Introduction: Malignant tumors of sinonasal tract are extremely rare and comprise 3% of all head and neck malignant tumors. They constitute 0.2% of all invasive carcinomas. Sinonasal space is a small anatomical place, but is the site of origin for tumors with diverse histological features. Many of the tumors are similar to those that occur in various parts of the body and have overlapping histological features. A panel of immunohistochemical (IHC) markers is essential to diagnose these tumors. Most of the tumors arise in the maxillary sinus followed by ethmoid sinus. History and complete head and neck examination along with biopsy are mandatory for evaluating the disease. Aim and Objectives: To study the age-, sex- and site-wise incidence of different malignant lesions of the nasal cavity and paranasal sinuses. To subtype and classify the malignant tumors as per the WHO guidelines. Materials and Methods: Forty-seven cases of sinonasal tumors reported over a period of 3 years were retrieved from the archives of the department of pathology. The tissues were subjected to paraffin processing and stained with hematoxylin and eosin. IHC was done with a panel of markers, wherever necessary. Results: The present study included a total of 47 malignant lesions. Of which, 24 cases (51.06%) were squamous cell carcinomas (five cases each of well-differentiated SCC and moderately differentiated SCC and 14 cases of nonkeratinizing SCC). Five (10.63%) cases each were of neuroendocrine carcinoma and non-Hodgkin's lymphoma. Conclusion: Malignant neoplasms of sinonasal tract have overlapping clinical and pathological findings; establishing the correct diagnosis is difficult without using a panel of IHC markers.
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Evaluation of antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on Streptococcus mutans, Lactobacillus species and Actinomyces viscosus: An in vitro study p. 383
Panjanathan Mahalakshmi, Annasamy Rameshkumar, Gunasekaran Sudha, Thayalan Dineshkumar, Haridass Vinoth, AD A Malar
Introduction: The Ayurvedic system of medicine is popular in India and has gone through various change and remains as the mainstay of medical relief to a large population. Dental caries is the one of the major issue in the recent time, and there is no definite caries prevention method so far apart from Topical fluoride application, regular oral hygiene measures, pit and fissure sealants and diet measure. In spite of the above mentioned preventive measures the people are still prone to dental caries. In order to find a better solution the present study evaluates the antimicrobial properties widely available and cost effective herbal extracts of Solanum xanthocarpum and Pistacia lentiscus extract on cariogenic oral microbial flora. Aim: To Evaluate the Antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on cariogenic oral microbial flora. Methodology: The antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on cariogenic oral microbial flora (streptococcus mutans, lactobacillus, actinomyces viscosus) by different culture techniques to estimate the zone of inhibition (well diffusion method) and minimum inhibitory concentration (tube dilution method). Results: The antimicrobial efficacy of Solanum xanthocarpum and Pistacia lentiscus on test bacteria were analysed using kurskal wallis test and values of 0.003 and 0.002 were obtained respectively, since the p values were less than 0.005, indicating that both herbal products possess statistically significant antimicrobial properties. Conclusion: The antimicrobial effects of the herbal extracts were almost on par with commercially available allopathic agents like chlorhexidine on oral cariogenic microbes. The efficacy should be further validated in a large scale studies and can be utilized for caries prevention in the form of mouth rinses, dentifrices and topical application in the future.
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Comparison of penetrating depth of chlorhexidine and chitosan into dentinal tubules with and without the effect of ultrasonic irrigation p. 389
Ganesh Arathi, Arasappan Rajakumaran, Sinha Divya, Narasimhan Malathi, Varadarajan Saranya, Deivanayagam Kandaswamy
Background: Long term success of root canal treatment depends on complete removal of micro-organisms and their by-products. This can be effectively achieved by the ability of the irrigant to penetrate into the dentinal tubules, which is limited in the conventional mechanical debridement of the root canal system. Irrigant activation technique aids in movement of irrigants into the dentinal tubules. Aim: To compare the depth of penetration of root canal irrigants into the dentinal tubules with and without ultrasonics using light microscope. Materials and Methods: Forty noncarious mandibular premolars were used, all the tooth specimens were inoculated with an ATCC 29212 strain of E.faecalis and incubated under nutrient rich aerobic conditions at 37°C. Teeth were sectioned below the cementoenamel junction to obtain a standard length of 8 mm and instrumented with K-files, irrigated with 5.25% sodium hypochlorite and a final rinse of 17% EDTA. Teeth were divided into four groups of ten each. Group IA was irrigated with 2% Chlorhexidine (CHX) and agitated ultrasonically, Group IB was irrigated with 2% Chlorhexidine, Group IC was irrigated with 2% Chitosan and ultrasonically agitated, Group ID was irrigated with 2 % Chitosan. The tooth specimens were sectioned and subjected to gram staining and viewed under 100X oil immersion microscope. A micrometer grid was attached to the eyepiece to enable measurement of the depth of penetration of the irrigants. Group IA (2% Chlorhexidine with ultrasonic agitation) showed better penetration into the dentinal tubules as compared to Groups IB, IC, ID. Results: Irrigation with 2% Chlorhexidine with ultrasonic agitation had depth of penetration into the dentinal tubules upto 2350 μm. 2% Chlorhexidine without ultrasonic agitation penetrated upto 1800 μm. Chitosan with ultrasonic agitation penetrated upto1250 μm and Chitosan without ultrasonic agitation penetrated upto 44.80 μm. Conclusion: 2% Chlorexidine as irrigant with ultrasonic agitation was found to have maximum depth of penetration into the dentinal tubules when compared with Chitosan.
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Exophytic verrucous hyperplasia in oral submucous fibrosis: A single-center study p. 393
Aakruti M Shah, Shivani Bansal, Pankaj M Shirsat, Pooja Prasad, Rajiv S Desai
Introduction: The present study analyzed the occurrence of exophytic verrucous hyperplasia (EVH) in the background of oral submucous fibrosis (OSF), which presents clinically as a solitary verrucopapillary lesion (VPL) mimicking malignancy. We also aimed to obtain additional information on VELscope appearance and histopathological features of EVH. Materials and Methods: The prevalence of EVH in OSF background was assessed from January 2014 to December 2018 using VELscope and histopathological examination. Results: Six hundred and sixty-two OSF patients were examined. Thirteen patients presented with solitary VPL in OSF background. A VELscope examination found ten cases with increased autofluorescence (fluorescence visualization increase, FVI), two cases with autofluorescence loss (fluorescence visualization loss, FVL), whereas one case exhibited dual autofluorescence (focal areas of FVL within FVI regions). Histopathologic examination revealed two FVL cases as oral verrucous carcinoma (OVC) and oral squamous cell carcinoma (OSCC) and one dual autofluorescence case as OVC, while six FVI cases showed nondysplastic epithelium having verrucopapillary pattern without connective tissue invasion, consistent with the clinicopathological diagnosis of EVH. Conclusion: The present study demonstrated the evidence of EVH in OSF background, which on histopathological examination revealed nondysplastic epithelium exhibiting the verrucopapillary pattern. A VELscope examination of these lesions showed increased autofluorescence, suggesting its nonneoplastic nature of clinically malignant-looking exophytic VPLs in OSF background. Present study suggests newer perspective for using the term oral verrucous hyperplasia (OVH) and EVH with justification and also proposes to introduce new terminology such as oral verrucous dysplasia and exophytic verrucous dysplasia.
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Immunoexperssion of cancer stem cell marker (CD44) in ameloblastoma p. 400
Manjushri Madhukar Vanje, Shahela Tanveer, Syed Afroz Ahmed, Shravan Kumar, Tejashree Vanje
Background: Ameloblastoma is the most frequently encountered benign, locally invasive tumor. Attempts to surgically resect the tumor often leave small islands of tumor, which later result in recurrence in 50%–90% of cases. This has raised questions regarding the tumor cell populations that are responsible for tumor growth and recurrence. In ameloblastoma, whether or not cancer stem-like cells are present remains undetermined. However, if cancer stem-like cells are present in ameloblastoma, it is important to identify which type of cell possesses the stem-like characteristics and is responsible for ameloblastoma progression and recurrence. Aim: Our study aims at analyzing immunohistochemical staining to detect the expression of cancer stem cell (CSC) marker CD44 in relation to proliferative activity of tumor cells in histopathologically diagnosed cases of ameloblastoma variants and to derive a correlation between the CD44 expression and biologic behavior of the lesion. Materials and Methods: A retrospective study, was conducted on total 25 cases ameloblastoma and were immunostained for CD44 expression. Results obtained were statistically analyzed. Results: A positive correlation was observed between staining intensity of CD44 marker and the known biological behavior of the lesion. Intense staining reaction was found to be only in 8% cases, whereas 76% cases demonstrated moderate intensity and remaining 16% displayed mild immunoreactivity to CD44 marker. Staining location was more to be in stellate reticulum-like (SR-like) cells when compared to ameloblast-like (AB-like) cells. Intense immunostaining was localized in the small tumor follicles, especially in SR-like cells situated in close vicinity of peripheral AB-like cells whereas mild intensity of staining was observed in keratinizing areas. Conclusion: CSCs marker positive expression in benign tumor like ameloblastoma may be responsible for its aggressiveness and recurrence. CD44 marker may be of great value in predicting the biological behavior and growth potential of ameloblastoma.
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Assessment of the antimicrobial efficacy of hydroalcoholic fruit extract of cranberry against Socransky complexes and predominant cariogenic, mycotic and endodontic climax communities of the oral cavity: An extensive in-vitro study p. 407
Vaibhav Kumar, Anil V Ankola, Roopali Sankeshwari, Sagar Jalihal, V Deepak, Harshvardhan S Jois
Background and Objective: Contemporary global complementary and alternative practices in dentistry envisage to manipulate the molecules from traditionally used plant derivatives as adjuncts. The aim of this study was to assess the in-vitro antimicrobial efficacy of hydro-alcoholic fruit extract of cranberry against Socransky complexes and predominant cariogenic, mycotic and endodontic climax communities of the oral cavity. Materials and Methods: An extract of Vaccinium macrocarpon was prepared using a hydro-ethanolic solvent (water – 30%: ethanol – 70%) using the standardized maceration protocol. Standard American Type Cell Culture and Microbial Type Culture Collection and Gene Bank strains of Streptococcus mutans, Lactobacillus acidophilus, Candida albicans, Enterococcus faecalis, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans were used. The minimum inhibitory concentration was determined by the serial broth dilution. The minimum bactericidal concentration was obtained by subculturing method. Results: The extract showed satisfactory inhibitory and bactericidal effects against all test pathogens. Conclusion: V. macrocarpon can prove to be an adjunct to the existing antimicrobial complexes being routinely used to combat pathogenic oral climax community.
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Immunohistochemical expression of human telomerase reverse transcriptase in oral cancer and precancer: A case–control study p. 412
Namrata Mishra, Nishi Tandon, Naseem Fatima, Anand N Srivastava, Nirupma Lal, Vijay Kumar
Introduction: Telomere Length is critically important in normal cells and telomere shortening in combination with other oncogenic changes— promotes genome instability, potentially stimulating initiation of the early stages of cancer. Aim: The present study was carried out to detect human telomerase reverse transcriptase expression in oral cancer and pre-cancerous lesions by immunohistochemistry. Materials and methods: An observational study was planned in which a total of 45 biopsy specimen of oral mucosa was obtained. Of these, 15 (33.3%) belonged to normal subjects, 15 (33.3%) to subjects found to have Oral submucousal fibrosis and 15 (33.3%) subjects with Oral squamous cell carcinoma. Results: Among cases of OSCC, majority was of well differentiated grade (80.0%), only 1 (6.7%) case was poorly differentiated and rest was of moderately differentiated (13.3%) Labelling intensity of OSCC (78.07 ± 22.31) was maximum followed by that of Normal (44.47 ± 6.32) and minimum of OSMF (26.67 ± 15.05) and intergroup difference and between group differences were also found to be significant. Labelling score of OSCC (154.47 ± 94.74) was maximum followed by that of Normal (84.73 ± 51.51) and minimum of OSMF (46.73 ± 44.25) and intergroup difference and between groups differences (Normal vs OSCC, and OSMF and OSCC) were found to be statistically significant. Conclusion: The present study highlights only the discriminating ability of hTERT for differentiating the malignant condition from premalignant and normal mucosa. Hence, further studies on a larger sample size, with inclusion of other premalignant conditions too are recommended in order to understand the pattern of hTERT expression changes.
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Labial hydatid cyst – A rare entity p. 418
Abhishek Banerjee, Elampavai Elangovan, Kumar Shankar Mitra, Alangkar Saha
Hydatid cyst is a parasitic infestation by tapeworm Echinococcus. This endemic disease is prevalent in the Middle East and Southeast Asian populations. This zoonotic disease is mainly transmitted by cattle and dogs. Few studies have been reported in the head-and-neck region. There are very few isolated cases have been reported within the oral cavity region. No case until now has been isolated from the labial mucosa. We now present one such case here.
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Benign cementoblastoma involving left deciduous first molar: A case report and review of literature p. 422
Jigna Pathak, Rashmi Maruti Hosalkar, Sunil Sidana, Niharika Swain, Shilpa Patel
Cementoblastoma, a benign mesenchymal odontogenic neoplasm is derived from ectomesenchymal cells of the periodontium. Cementoblastomas associated with primary teeth are extremely rare as permanent mandibular first molars are mostly affected. Only 17 cases of those associated with deciduous dentition have been reported so far. The present case report describes a true cementoblastoma of an 8-year-old male child in relation to the left first primary mandibular molar along with emphasis on differential diagnosis.
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Intraoral salivary duct cyst: Report of rare entity p. 429
Saurabh R Nagar, Nishant L Pandey, Shivani Bansal, Rajiv S Desai
Salivary duct cysts (SDCs) are true cysts caused by obstruction of the salivary ducts and are rare in minor salivary glands. A 62-year-old male reported with a painless swelling in the left buccal mucosa for 2 years. Excision of the entire lesion was performed under local anesthesia following which histopathological examination was performed. Microscopically, a dilated salivary gland duct composed of 1–2 layers of cuboidal cells with intraluminal mucous plug was observed. Cystic lumen lined by mucous cells, squamous cells and ciliated cells was seen. Oncocytic metaplasia was also present at various places. Histopathologically, it was consistent with the diagnosis of SDC. Intraoral SDCs and mucoceles clinicopathologically mimic salivary gland neoplasms, making diagnosis difficult and subject to errors in treatment. It is important for oral and maxillofacial surgeons to include SDC in the differential diagnosis of swelling affecting buccal mucosa.
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Odontogenic keratocyst with granular cell changes: A distinctive finding p. 432
Revati Shailesh Deshmukh, Radhika M Bavle, Priya Nimish Deo, Surekha Chavan
Odontogenic keratocyst (OKC) originates from the dental lamina and is more commonly seen in the posterior mandible than in the maxilla. OKC is the most aggressive cyst of the oral cavity and is known for its rapid growth and its tendency to invade bone of the adjacent tissues. The recurrence rate of OKC is very high due to various reasons debated upon. Cases of OKC have shown the presence of calcifications, dentinoid formation and ossification. Here, we report the first case of OKC in a 27-year-old male showing granular cell changes.
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Florid cemento-osseous dysplasia in a young Indian female: A rare case report with review of literature p. 438
Sneha H Choudhary, Narendra B Supe, Ashok Kumar Singh, Amar Thakare
Florid cemento-osseous dysplasia (FCOD) is a reactive bone dysplasia that involves tooth-bearing areas of the jaws. It most commonly affects females and is seen less frequently in Caucasian and Asian groups. The age group may vary from 19 to 76 years and typically presents in the fourth and fifth decades. FCOD associated with impacted teeth and bony expansion is very rare and only a few familial cases have been reported in literature. Till date, <2% cases in Indians have been reported in literature. Here, we report a case of nonfamilial FCOD in a 27–year-old young Indian female with cortical plate expansion, one over-retained and one impacted teeth.
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Glucose transporter 1 in health and disease p. 443
Sindhuri Pragallapati, Ravikanth Manyam
Glucose, a major source of energy for all cells, is transported into cells with the help of glucose transporters (GLUTs). These transporters are of two types, namely sodium-dependent GLUTs and facilitative GLUTs. These transporters are present in a tissue-specific pattern and have substrate specificity. Among these transporters, GLUT1 (facilitative GLUT) is present ubiquitously on all tissues of the body and helps in the basal uptake of glucose. GLUT1 is known to have many physiological functions in the body from the time of implantation of an embryo and is also seen associated with pathologies, including cancers. This review mainly focuses on GLUT1 in physiological and pathological conditions and the recent advances related to its role in cancer development and applications in cancer therapeutics.
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Meta-analysis on risk factors of squamous cell carcinoma of the tongue in young adults p. 450
Khadijah Mohideen, C Krithika, Nadeem Jeddy, R Bharathi, B Thayumanavan, S Leena Sankari
Tongue squamous cell carcinoma (TSCC) generally affects the older age group exposed to tobacco for an extended period. However, recent research points out that there is an increased incidence of TSCC in the younger age group without any traditional risk factors making TSCC as a distinct biological entity in this group. This study aims to assess the prevalence and risk factors of tongue carcinoma in the younger group of patients. This article included studies that addressed the TSCC involving young patients and that which are PubMed indexed. Initially, 390 articles were considered; but after refined evaluation, 123 articles had their titles and abstracts matching to this present work. After the extraction of the case reports, review articles and the articles without the assessment of the parameter of harmful habits, we have included only 23 articles in the sample matching the title. The statistical analysis was formed by using chi-square tests using IBM SPSS ver. 20.0. The cohort of the younger population in these studies was mostly in the 35- to the 45-year age group. The majority of reports (64%) classified the patients below 40 years of age as a young group. Though male predominance is reported to be 55%, female patients are also more affected (40%) in the younger age group compared with, the more typical and usual group of head and neck carcinoma patients. TSCC in older adults predominantly reported in tobacco users (70%) whereas in young adults, TSCC was associated with a higher incidence in nonsmokers (53%); the causes of these cancers in young adults remain unclear. The identification of the potential risk factors aside from traditional factors is vital to control the incidence of TSCC in young patients.
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Frequency and variability of five non metric dental crown traits in the permanent maxillary dentitions of a racially mixed population from Bengaluru, Karnataka p. 458
Deepak Venkatesh, V Sanchitha, T Smitha, Geeta Sharma, Shivaprasad Gaonkar, KN Hema
Introduction: Evaluation of Tooth Crown non metric traits benefits to assess the biological distance between populations. It is well known that these traits are characterised by a high inter-population differentiation, low sexual dimorphism, and their recording is loaded by relatively small intra and inter observer error. The dental morphological traits are successfully used in the description and explanation of the microevolutionary and ethnogenetic processes. This paper presents the results of the permanent maxillary dentition tooth crown traits differentiation of human populations from Bengaluru. Materials and Methods: The comparative analysis was carried out on the basis of 4 groups for 5 Tooth Crown non metric traits in maxillary permanent dentition using Arizona State University Dental Anthropology System for morphological scoring system of each trait and each score was charted on Osteoware Dental Morphology software. Results: Study analysed 400 dental casts from 4 different ethnic groups. Traits Winging, shovelling, lingual tubercle showed highest expression in Iranians while Cusp of Carabelli's trait expression showed 87% of prevalence in the surveyed group but the Hypocone trait showed the highest expression in Muslims. Conclusion: Traits of the human dentition can be a valuable diagnostic tool for anthropological studies in classifying and characterizing different ethnic groups. According to the results obtained from this study, it can be said that the groups Hindus, Muslims and Christians (Indians) belong to Sundonts, while Iranians fall under sinodonts population group.
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Microabscess reconnoiter p. 466
Mala Kamboj, Vanshika Makkar, Pooja Sharma, Rahul Kumar Raman
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Swelling of the submandibular gland region: Cystic or neoplastic entity? p. 468
Susmita Saxena, Sanjeev Kumar, Jitin Kharbanda
A 43-year-old male patient reported with a swelling in the left submandibular region of 3–4 months' duration. The soft fluctuant swelling was painless and cystic on palpation. The excised submandibular gland was submitted for histopathological examination, which showed the presence of a bluish, thin-walled cystic cavity containing gelatinous straw-colored fluid. H and E-stained sections showed thin cystic lining with papillary projections of salivary glandular cells and multiple cystic spaces. Immunohistochemistry was recommended to differentiate between acinic cell carcinoma of papillary-cystic variant and low-grade mucoepidermoid carcinoma.
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Crossword p. 472

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Impact of electronic cigarette smoking on the Saudi population through the analysis of literature: A systematic review p. 473
Sanjeev Balappa Khanagar, Salman Siddeeqh, Vineet Khinda, Paramjit Khinda, Darshan Devang Divakar, Chitra Jhugroo
Tobacco usage is harming the health, the treasury and the spirit of Saudi Arabia. Every year, more than 7000 of its people are killed by tobacco-caused diseases. Still, more than 20,000 children and 3,352,000 adults continue to use tobacco each day. Likewise, the usage of electronic (e)-cigarette is also increasing; this could be because of the publicity and marketing strategies adopted by the manufacturers of these products which are attracting the younger population. This review was taken up to determine the usage and attitude toward e-cigarette smoking among the Saudi population through the analysis of literature. This review identified peer-reviewed articles using several search terms and databases from 2010 to 2018. PubMed, ISI-Web of Science, Medline and Google Scholar were searched using the following alternate terms for e-cigarettes: electronic cigarettes, electronic nicotine delivery systems following which hand search was conducted through the reference list of articles. The search results only found descriptive data on these e-cigarettes among the Saudi population. This literature review reported that the usage of these e-cigarettes was high among this population and recorded a wide variety of reasons for using e-cigarettes. Reducing tobacco use, considering e-cigarette as less harmful, less addictive, for pleasure and peer influence, lower cost and curiosity were the most commonly reported reasons. Recognizing the dangerous impact of smoking and usage of other type of tobacco, the aggressive marketing of these e-cigarettes needs to be controlled.
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Collagen during odontogenesis and in ameloblastoma: A polarizing microscopic study p. 474
Ponnapalli Haripriya, Anuradha Ananthaneni, Vijay Srinivas Guduru, Puneeth Kuberappa Horatti, Mohammad Asif Kiresur, Joy Thomas Vara
Background: Odontogenesis is a highly coordinated and complex process which depends on cell–cell interactions that result in initiation and generation of tooth. Tissue remnants of developing tooth can form odontogenic tumors possibly, reflecting different developmental stages in tooth formation. In both odontogenesis and odontogenic tumors, stroma plays a prominent role in maintaining epithelial tissues with continuous molecular interactions. As the collagen forms an integral part of connective tissue stroma, in the present study, polarization colors and thickness of the collagen fibers were assessed in both tooth germ papillae and ameloblastoma using picrosirius red (PSR) stain. Materials and Methods: Collagen fibers in 20 cases of ameloblastoma and 10 tooth germs from the human fetus were evaluated with PSR stain and examined under polarizing microscopy. Results: Polarization colors of red-colored collagen fibers with greater diameter were more in ameloblastoma when compared to tooth germ papillae in which green-colored collagen fibers with smaller diameter being more. Conclusion: The absence of hard tissue formation in ameloblastoma might be due to the presence of significantly more number and greater thickness of red-colored collagen fibers. Thus, the nature of collagen fibers can predict the nature in terms of biologic behavior and prognosis.
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The micronucleus assay in the oral exfoliated cells of tannery workers p. 474
Mohd Shadab Kalim, Abhisheik Khare, Balasundari Shreedhar, Safiya Hadari, Vivek Gupta, Anupama Mahendra
Context: Micronuclei, tannery workers, chromium, papanicolaou (PAP) stain. Aims: The presence of micronuclei are biomarkers broadly used; the detection of micronuclei offers a great opportunity to monitor individuals or populations exposed to mutagenic, genotoxic or teratogenic events, mainly the evaluation of micronucleogenic cells presence in epithelial tissues. Settings and Design: Tannery workers with and without tobacco usage was considered for microneuceli assessment using PAP stain, 50 patients without usage of tobacco was taken and 50 patients with usage of tobacco was considered. Subjects and Methods: Cytological smears were produced and stained with PAP stain for the evaluation of micronuclei. Statistical Analysis Used: Students t- test, analysis of variance. Results: Our findings concluded that chromium exposure causes instability of the genetic material in the tannery workers and can be taken as an indication that these individuals have increased cancer risks. The present study also concluded that PAP could be used as a specific marker for micronuclei assessment. Conclusions: In our case study, we have seen increasing number of micronuclei frequencies in tobacco user's tannery workers than nonuser's tannery workers, which we can use as a predictor marker of premalignant and malignant lesion.
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Analysis of optical mineralogy of cemento – enamel junction in deciduous dentition p. 475
Preethi Arunachalam, R Ramya, R Swarnalakshmi, Amritha James, M Ramya, K Rajkumar
Background: Optical analysis of mineralized tissues with polarized microscopy is based on the mechanism of light interaction with biological tissues and spatial distribution of light. Understanding the light propagation mechanisms in mineralized tissues has huge clinical relevance in terms of esthetics and restoration. The present study aims to analyze the mineralogy characteristics of the cementoenamel junction (CEJ), which is a vital region involving merger of tissues with varied embryological origins. Aim: To analyze the mineralogy characteristics and CEJ patterns in deciduous teeth. Objectives: The variations of CEJ pattern in deciduous teeth and mineralogy characteristics such as retardation and birefringence are compared to the adjacent regions of underlying dentin corresponding to the permanent dentition. Results: Mineralogy characteristics showed variation near the CEJ when compared to the adjacent regions of underlying dentin (statistically significant [P < 0.05]). When compared to permanent dentition, they showed a numerical difference, but the values were statistically insignificant. CEJ pattern analysis predominantly showed edge-to-edge interrelation, followed by root cementum overlapping the enamel and gap type. Conclusion: Analyzing CEJ in primary dentition is of paramount importance as it is a vulnerable zone in terms of caries progression and restorative margins. Increased edge-to-edge type of CEJ suggests a natural shield-like protection offered by enamel. Variations in mineralogy characteristics in the CEJ of deciduous dentition suggest the increased mineral content than in the adjacent regions of underling dentin. However, further investigations using advanced techniques for mineralogy analyses such as atomic force microscopy can help yield more intricacies of hard tissues of tooth.
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Immunohistochemical and clinical significance of matrix metalloproteinase-2 and its inhibitor in oral lichen planus p. 476
Neha Agarwal, Sunitha Carnelio, Gabriel Rodrigues
Background: Matrix metalloproteinases (MMP) are being considered important mediators in cancer invasion, and plenty of research is in progress. Our objective was to evaluate the presence of MMP-2 and tissue inhibitor of metalloproteinase (TIMP-2) in oral lichen planus (OLP) and to assess its role in the pathogenesis of OLP and as an indicator of malignant transformation. Materials and Methods: Immunohistochemical analysis for MMP-2 and TIMP-2 was performed in thirty histopathologically confirmed, formalin-fixed, paraffin-embedded specimens of OLP (24 cases of reticular and 6 cases of erosive LP). A semi-quantitative analysis was done to assess the expression and distribution of this marker in these lesions. Results: In all cases of OLP, MMP-2 expression was seen mainly in areas of lymphocytic inflammatory infiltrate (100%) in the lamina propria within the overlying epithelium. TIMP-2 expression was seen more than 50% in the fibroblasts and basal and parabasal cells. Conclusion: The expression of MMP-2 and TIMP-2 was observed in all cases of OLP. However, a clinical 5-year follow-up of the lesion revealed no progression of the disease except for chronic exacerbation and regression of these lesions. Although our study considers MMP-2 and TIMP-2 as mediators in the pathogenesis of OLP, it still remains debatable whether they have a direct role to play in the disease process or whether they are suitable biomarkers to assess the disease progression.
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Cocktail of periodic Acid–Schiff and papanicolaou: Novel staining technique for the identification of leukemic eosinophils – A pilot study p. 476
Lavanya Mallika, SV Sowmya, Roopa S Rao, Dominic Augustine, Vanishri C Haragannavar, K Shwetha Nambiar
Background: Tissue eosinophilia may be caused due to reactive, neoplastic or idiopathic reasons. Reactive eosinophils in allergic and inflammatory conditions are transient and recruited from the circulation in response to various stimuli, whereas neoplastic eosinophils of leukemias and hematological malignancies are involved in the pathogenesis of the disease. The differentiation of reactive from neoplastic eosinophils has a serious implication on the treatment and prognosis of diseases. However, both these types of eosinophils display variation in morphology and staining characteristics in routine histopathology leading to a diagnostic dilemma. Aim: The aim of this study is to evaluate the efficacy of special stains for the demonstration of eosinophils in normal/reactive lesions and leukemias. Methodology: A retrospective study comprising twenty histologically diagnosed cases each of reactive oral lesions and leukemias were obtained from institutional archives. These tissue sections were subjected to staining with routine and special stains – Carbol chromotrope, Congo red, Leishman's stain, Periodic Acid–Schiff-papanicolaou (PAS-PAP) and PAS. Statistical analysis was performed using Pearson's Chi-square test to compare the various parameters in the evaluation of the staining efficacy. Results: Carbol chromotrope and Congo red staining showed increased staining efficacy in normal/reactive eosinophils while PAS-PAP followed by PAS and Leishman's stain showed enhanced features such as homogenicity, specificity, increased staining intensity, enhanced nuclear and cytoplasmic details in leukemic eosinophils. Conclusion: Combined PAS-PAP is a novel and cost-effective staining technique in differentiating reactive and leukemic eosinophils. It is significant in recognizing leukemic eosinophils of routine biopsies and alerts the clinician to rule out any underlying malignancies.
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A complex case of brown tumors as initial manifestation of primary hyperparathyroidism in a young female p. 477
Bhari Sharanesha Manjunatha, Sharad Purohit, Ashutosh Harsh, Nagamahita Vangala
Brown tumor is one of the lesions that develop in patients with hyperparathyroidism (HPT) and represents the terminal stages of bone remodeling process. Any of the skeletal bones can be affected including the craniomaxillofacial ones. Many a times, brown tumor was detected after a final diagnosis of HPT is made. However, on occasions, brown tumor can be the first clinical sign of the disease. Primary HPT is an uncommon systemic disease usually caused by hyperplasia or adenoma of the parathyroid glands. It causes overproduction of parathormone, which may affect the entire skeleton, causing bone resorption appear as cyst-like lesions called osteitis fibrosa cystica or brown tumors. Here, we report such a rare case in which multiple radiolucent lesions were noticed in the ramus part of the mandible and premolar region bilaterally, as the initial signs of primary HPT are presented in this report.
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Dentinogenic ghost-cell tumor of the maxilla: A case report and review of literature p. 478
Shally Gupta, Simranjit Singh, Rubina Anjum, Radhika Sharma
Dentinogenic ghost-cell tumor (DGCT) is a rare, odontogenic neoplasm which is considered to be a solid variant of the calcifying odontogenic cyst (COC) with locally aggressive behavior and is characterized by ameloblastoma-like epithelial islands, ghost cells and dentinoid. It accounts for only 2%–14% of all COCs. Herewith, we report the case of DGCT in a 40-year-old male patient with clinical presentation as swelling on the right side of the face.
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Clinical, radiological and histological features of an unique case of calcifying epithelial odontogenic tumor p. 478
Farul Sarkar, Swagata Gayen, Sanchita Kundu, Mousumi Pal
Calcifying epithelial odontogenic tumor (CEOT), also known as Pindborg tumor, is a rare benign but locally aggressive odontogenic neoplasm, accounts for <1% of all odontogenic tumors. CEOT is usually seen in the posterior area of the mandible in-between 30 and 50 years of age without definite sex predilection. A painless, slow-growing swelling with bone expansion is the most common clinical feature of CEOT. Radiographically, it presents as a mixed radiographic lesion may or may not be associated with any impacted tooth. Confirmation of the diagnosis is made by histopathological examination. The tumor has a recurrence rate of 10%–20% and so periodic follow-up is necessary. A unique case of CEOT involving the right mandibular molar–premolar in a 25-year-old female patient with clinical behavior, radiological, histopathological features and surgical managements is discussed herewith.
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Submandibular gland actinomycosis: A rare disease – Worth to mention p. 479
Bharti Varshney, Vidhu Sharma, Jyotsna Naresh Bharti, Sourabha Kumar Patro
Cervicofacial actinomycosis (AM) is a well-documented entity; however, primary AM of the submandibular gland is infrequent. The diagnosis is difficult due to its nonspecific clinical presentation and it usually mimics chronic granulomatous infection or malignant lesion. We report the case of a young female with AM of submandibular gland, presented as recurrent infection of submandibular gland, underwent its excision and confirmed on microscopy as Actinomyces.
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Hypohidrotic ectodermal dysplasia with autosomal recessive inheritance pattern: Report of a rare and unusual case with a brief review of literature p. 479
Shamimul Hasan, Murali Govind, Madhuri Alankar Sawai, Mohammad Dilshad Ansari
Ectodermal dysplasia (ED) is a congenital disorder primarily affecting the ectodermal tissue, with infrequent dysfunction of mesodermally derived tissues. Clinically, there are two major forms seen, hypohidrotic/Christ–Siemens–Touraine syndrome and hidrotic/Clouston syndrome, depending on the number and function of sweat glands. A multidisciplinary treatment protocol is usually followed and necessitates collective efforts by medical and dental professionals. Dental intervention should be done as early as possible to ameliorate the patient's esthetics and enhance the emotional and psychological quotient in these patients. This case report aims to highlight a rare and interesting report of hypohidrotic ED in a young female patient with a possible autosomal recessive inheritance pattern.
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Sex determination using maxillary arch width of pediatric population of Namakkal district, India: A forensic study p. 480
S Shankar, R Madhavan Nirmal, MB Aswathnarayanan, M Kruthika, M Afrose Fathima
Aim and Objectives: The aim of the study is to compute a new formula for sex determination using maxillary arch width of a pediatric population of Namakkal district. Materials and Methods: The sample consisted of 146 females and 218 males of South Indian origin aged between 4 and 6 years. Alginate impressions of the upper and lower dental arch were made, and casts were poured immediately. A digital vernier caliper was used to obtain measurements. Arch width at canine, first molar and second molar for both maxilla and mandible were considered for measurement. Statistical analysis was performed using the Statistical Package for the Social Sciences Version 20.0 software. Results: The Student's t-test was used to find out the significance between male and female among the different predictor variables at P < 0.05. Significant sexual dimorphism was found in maxillary intercanine width and maxillary first and second intermolar width with conical discriminant function coefficient of 0.732, −0.177 and −0.244, respectively. Conclusion: The formula derived from the present study could be of great value in sex determination of pediatric populations of Namakkal district.
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Crossword Solutions p. 481

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Erratum: Evaluation of candidal species among individuals with oral potentially malignant disorders and oral squamous cell carcinoma p. 482

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Erratum: The World Health Organization classification of odontogenic and maxillofacial bone tumors: An appraisal p. 483

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