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    Table of Contents - Current issue
Coverpage
May-August 2019
Volume 23 | Issue 2
Page Nos. 167-313

Online since Tuesday, August 20, 2019

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EDITORS DESK  

From the editor's desk p. 167
T Smitha
DOI:10.4103/jomfp.JOMFP_200_19  
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GUEST EDITORIAL Top

Hypothesis-driven Research p. 168
Umadevi Krishnamohan Rao
DOI:10.4103/jomfp.JOMFP_161_19  
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LIVING LEGEND Top

Dr. T. R. Gururaja Rao p. 170
T Smitha
DOI:10.4103/jomfp.JOMFP_169_19  
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CANCER NEOTERICS Top

Dichotomy of exosomes in oral squamous cell carcinoma: Prey or play! p. 172
HR Shwetha, T Smitha
DOI:10.4103/jomfp.JOMFP_198_19  
Exosomes are nano-sized particles which belong to the family of extracellular vesicles (EVs) that are produced in the endosomal compartment of those cells which mediate intercellular communication. These particles can be found abundantly in the biological body fluids such as urine, blood, saliva, cerebrospinal fluid and breast milk. These vesicles can transfer genetic materials such as the microRNAs, noncoding RNAs, DNA and lipids by means of direct or indirect cell-to-cell interaction. Consequently, there has been lot of growing interest related to cancer exosomes as biomarkers and as potential therapeutics. There are studies done which demonstrate the exosomes in relation to cancer, by targeting specific cells and also promote the tumor progression. The other part of the spectrum has stressed the importance of exosomes stability and its potential role in targeting cancer cells through drug delivery system of anticancer molecules. The dichotomy allied with exosomes and their role in oral squamous cell carcinoma biomarkers or as therapy enhancement will be highlighted.
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ENIGMATIC MORPHO INSIGHT Top

The “hallmark” cells p. 176
Deepak Pandiar, T Smitha
DOI:10.4103/jomfp.JOMFP_177_19  
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INVITED REVIEW Top

The World Health Organization classification of odontogenic and maxillofacial bone tumors: An appraisal Highly accessed article p. 178
B Sivapathasundharam, Protyusha Guha Biswas, S Preethi
DOI:10.4103/jomfp.JOMFP_211_19  
Classification is the process of grouping similar entities under one category for the ease of their comprehension and better handling. Medical classification dates back to the days of William Farr who is credited with the development of a nosology, which later served as the forerunner for the modern-day disease classification by ICD. The WHO system of classification is a time-honoured system that has prevailed from decades together and is under constant evolution. The classification of odontogenic tumours was first formulated by Pierre Paul Broca and has undergone several transformations over years. Though the earlier classifications and their modifications by several authors and even by the WHO appeared to be fitting for their time, the latest edition of WHO classification of odontogenic and maxillofacial bone tumours neither seems to be complete nor perfect, even at the present context. It is unfortunate that even with the advancement of molecular biology, the present WHO classification on Odontogenic and Maxillofacial bone tumours, fails to serve as a 'reference standard' in the true sense of the term. This article highlights the limitations of the current classification with constructive criticism that may help in further improvement.
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ORIGINAL ARTICLES Top

Telomerase in saliva: An assistant marker for oral squamous cell carcinoma p. 187
Fahad Mansoor Samadi, Shaista Suhail, Manjari Sonam, Mohammad Kaleem Ahmad, Shaleen Chandra, Mohammad Saleem
DOI:10.4103/jomfp.JOMFP_83_19  
Introduction: Telomerase is a ribonucleoprotein complex responsible for de novo telomere synthesis and addition of telomeric repeats to existing telomeres. Telomerase activity is generally found to be absent in normal tissues. Telomerase is known to be induced upon malignant transformation of human cells. Method: In the present study, we analyzed both telomere length and telomerase activity in saliva samples from oral carcinoma patients. The study was done to investigate the presence of telomerase activity in oral squamous cell carcinoma by TRAP assay. Result: Telomerase activity was detectable in 79 of 100 human OSCC and 51 of 100 premalignant cases and 8 of 100 normal patients. Conclusion: These results indicate that telomerase is activated frequently during the late stage of oral premalignancy and may play a crucial role in OSCC.
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Salivary calcium as a diagnostic tool for screening of osteoporosis in postmenopausal women p. 192
Shweta Vinayak Kumbhojkar, Alka Dinesh Kale, Vinayak R Kumbhojkar, Karishma Madhusudan Desai
DOI:10.4103/jomfp.JOMFP_133_19  
Background: Women's health undergoes physiological, pathological and psychological changes after menopause. Reduced estrogen levels have been implicated in the pathogenesis of osteoporosis in postmenopausal women. Estrogen is also known to affect the salivary gland functions. To understand the association between serum estrogen, osteoporosis and salivary calcium, the present cross-sectional study was undertaken. Aim: The aim of this study is to determine salivary calcium levels and its use for the diagnosis of osteoporosis in postmenopausal women. Methodology: Ninety individuals divided into three groups of healthy controls, pregnant women and postmenopausal women were selected. Serum estrogen, salivary calcium and bone mineral density (BMD) at the heel region were estimated. Statistical analysis using the Mann–Whitney U-test was done to compare the results within the groups. Results: Mean estrogen levels were 115.8 ± 80.18 pg/mmol in control group, 7729.4 ± 907.6 pg/mmol in pregnant group and 51.2 ± 74.51 pg/mmol in postmenopausal group, respectively. The mean salivary calcium in control, pregnant and postmenopausal groups was 3.12 ± 0.63, 3.19 ± 0.62 and 7.12 ± 0.79 μg/dl, respectively. Paired comparison within the groups showed high statistical significance (P = 0.0000) in the salivary calcium levels. The mean BMD of −2.3 (standard deviation [SD] ± 0.83) in the postmenopausal group was significantly lower than −0.6 (SD ± 0.99) and −0.2 (SD ± 1.42) of pregnant and control groups, respectively. Conclusion: A negative correlation was found between estrogen and bone density. A significant difference in salivary calcium was noted in the study groups, highlighting the role of salivary calcium in the detection of early bone changes in postmenopausal women.
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Characterization of oral fibroblasts: An in vitro model for oral fibrosis p. 198
Pooja Adtani, Malathi Narasimhan, Kannan Ranganathan, Alan Punnoose, Prathibha Prasad, Prabhu Manickam Natarajan
DOI:10.4103/jomfp.JOMFP_28_19  
Background: Oral submucous fibrosis (OSMF) is a chronic debilitating condition of the oral mucosa that has been classified as a potentially malignant disorder with a malignant transformation rate of 2%–8%. Several in vitro and in vivo experiments have been performed to formulate a treatment modality for OSMF, yet no ideal in vitro primary oral fibroblast model has been developed. Aim: To establish an in vitro primary oral fibroblast model. Setting and Design: In vitro laboratory setting. Materials and Methodology: Primary cell culture protocol was performed after obtaining normal oral tissue. Karyotyping was performed to rule out chromosomal abnormalities. Immunofluorescence staining was carried with a panel of fibroblast-specific markers (vimentin, phalloidin, transforming growth factor-β receptor 1 [TGFβR1] and s100a4) and Masson trichrome staining (MTS) to demonstrate the presence of extracellular matrix (ECM) qualitatively. Results: A monolayer of oral fibroblasts was observed on the 9th-day postseeding. No chromosomal abnormality was observed in the patient samples. Positive staining was observed with vimentin, phalloidin, TGFβR1 and s100a4, thereby confirming the cell type. MTS revealed fibroblasts with spindle morphology and scanty ECM. Conclusion: The present study lays down a protocol to design and characterize primary buccal fibroblast cell culture model that would aid researchers in performing in vitro preliminary experiments in areas concerning fibrosis.
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Expression of cluster differentiation-44 stem cell marker in grades of oral epithelial dysplasia: A preliminary study p. 203
Sashi Kiran Sanapala Venkat Naga, Poosarla Chandra Shekar, Kiran Kumar Kattappagari, Kantheti Lalith Prakash Chandra, Gontu Sridhar Reddy, Baddam Venkat Ramana Reddy
DOI:10.4103/jomfp.JOMFP_308_18  
Introduction: Oral cancer is one among the alarming diseases related to oral cavity. Its prevalence and incidence have increased in many folds, in the past decade. This has led the investigators to find the preliminary stages and related early evaluating methods to restrain it. Few clinical lesions such as leukoplakia, erythroplakia, oral submucous fibrosis and lichen planus reflected malignant changes. These premalignant disorders provided scope to assess the underlying cellular and molecular events, which shall be helpful in early detection, aggressiveness and prognosis of the patient. Materials and Methods: Forty formalin fixed, paraffin embedded blocks were utilized and evenly subdivided into Group I – control tissue, Group II – mild epithelial dysplasia, Group III – moderate epithelial dysplasia and Group IV – severe epithelial dysplasia. The study group was categorized based on the WHO classification of dysplasia 2005. Routine staining was performed to reconfirm the diagnosis of all the samples. Simultaneously, immunohistochemical staining was done with cluster differentiation-44 (CD44) antibody. Positive cells were counted on 10 representative fields with a minimum of 100 cells per field using ×20. Statistical Analysis: Comparison of four groups with respective to number of positive cells was done using Kruskal–Wallis ANOVA test. Pair-wise comparison of three grades of oral epithelial dysplasia and the controls was done using Mann–Whitney U test. Results: The mean of Group I is 745.50, Group II is 665.20, Group III is 530.10 and Group IV is 322.90. A statistically significant P = 0.00001 was ascertained on comparison of the mean between the groups. Conclusion: CD44, a cell membrane marker could help in cell adhesion and cell-cell interactions. Loss of CD44 expression enhances the binding of the growth factors with their principle receptors that enhances the cellular proliferation. It can be used as a prognostic marker for identifying the rate of malignant transformation in these disorders.
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Evaluation of bone formation using recombinant human bone morphogenetic proteins-7 in small maxillofacial bony defects p. 208
Vaibhav Anand, U Vignesh, Divya Mehrotra, Sumit Kumar
DOI:10.4103/jomfp.JOMFP_292_18  
Context: Bone morphogenetic proteins (BMP) are multifunctional molecules of transforming growth factor-β superfamily that induces the differentiation of fibroblasts into osteoblasts to form bone. Aims: This study was undertaken to evaluate the effects of recombinant human BMP-7 (rhBMP-7) in bone healing of small maxillofacial bone defects and assess the serum levels of osteopontin (OPN) and receptor activator of nuclear factor kappa-B ligand (RANKL) biomarkers for bone remodeling. Materials and Methods: Twenty patients with small maxillofacial bony defects were enrolled in this study and randomly allocated to two groups; wherein after apicoectomy of the involved teeth, the control group had defect filled with collagen sponge only while the experimental group had rhBMP-7 impregnated collagen sponge placed in the defect. Results: The clinical parameters showed no significant difference between the two groups (P > 0.05). The radiographic parameters showed a significantly slower rate of reduction in bone defect volume (P < 0.01) in control group than the experimental group when followed at 2, 4 and 24 postoperative weeks. RANKL and OPN serum levels showed no significant changes in pre- and post-operative stage. Conclusion: This study confirms that rhBMP-7 in collagen definitely accelerates bone healing in maxillofacial bone defects and minimizes postoperative complications. RANKL and OPN biomarkers in serum may not show bone remodeling, hence tissue samples may be used to assess their levels.
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Salivary cortisol and dehydroepiandrosterone as oral biomarkers to determine stress in patients with recurrent aphthous stomatitis p. 213
S Vandana, B Kavitha, B Sivapathasundharam
DOI:10.4103/jomfp.JOMFP_282_18  
Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral ulcerative diseases with a multifactorial etiology. Although psychological stress is an exacerbating factor, the role of salivary stress hormones, cortisol, and dehydroepiandrosterone (DHEA) in this oral disease has not been extensively reported. The study aimed to estimate and compare the salivary cortisol and DHEA levels in RAS patients and healthy control group with the aid of ELISA microplate reader. Subjects and Methods: Sixty patients were enrolled in our study, which included 30 patients with clinically diagnosed RAS and 30 healthy controls. Two mL of unstimulated whole saliva was collected and salivary cortisol and DHEA levels were measured using ELISA kit, and the values were read by microplate ELISA reader and recorded in both groups. Results and Conclusion: The mean salivary cortisol and DHEA levels were elevated in the RAS patients compared to the healthy controls and were statistically significant. Salivary cortisol and DHEA can serve as oral biomarkers to determine stress in patients with RAS. However, the present study necessitates further studies with larger sample size and an improved protocol to ascertain the actual role of these presumed oral biomarkers as well as anxiety and stress as triggers in the pathogenesis of RAS.
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Utility of smooth muscle actin and CD117 as reliable markers in the diagnosis of salivary gland neoplasms p. 218
Subhasri Raman, Herald J Sherlin
DOI:10.4103/jomfp.JOMFP_225_18  
Objective: The aim of this study is to analyze the utility of immunohistochemical markers such as CD117 and smooth muscle actin (SMA) in the diagnosis of various benign and malignant salivary gland neoplasms. Materials and Methods: The study comprises 17 samples categorized into three groups: Group I consisted of 5 histopathologically normal salivary gland tissue; Group II comprised 7 cases, of which 3 cases were pleomorphic adenoma, 3 cases were myoepithelioma and 1 case was Warthin's tumor; and Group III consisted of 5 cases, of which 1 was mucoepidermoid carcinoma and 4 cases were adenoid cystic carcinoma. The selected cases were subjected to immunohistochemistry (IHC) procedure to assess the expression pattern of CD117 and SMA. Results: In SMA, 85.8% showed severe-to-moderate intense expression among the tumor cells in benign salivary gland tumor. All the 5 malignant tumors showed the expression of SMA and 3 cases demonstrated severe expression among the tumor cells. An intense expression pattern of SMA was observed in both benign and malignant neoplasms in the periphery and stromal components of the tumor. Only two cases were positive for CD117, and connective tissue components were completely negative in both malignant and benign salivary gland neoplasms. Conclusion: Alpha-SMA can be utilized as reliable IHC markers for salivary gland neoplasms due to its diagnostic importance in tumors with myoepithelial origin indicative of the histogenesis of salivary gland tumors.
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Expression of p-16, Ki-67 and p-53 markers in dysplastic and malignant lesions of the oral cavity and oropharynx p. 224
Priyanka Yadav, Reeni Malik, Sharda Balani, Rajendra Kumar Nigam, Pramila Jain, Puneet Tandon
DOI:10.4103/jomfp.JOMFP_299_18  
Background: Understanding the markers for predicting degree of dysplasia and progression to malignancy can help early identification and prompt treatment of patients with oral cancers. In this study, we aim to identify and characterize different tumor suppressor genes such as p-53 and p-16 and proliferation marker Ki-67 in defining stages of dysplasia of oral mucosa and grading of tumor. Settings and Design: Oral biopsy tissues (for neoplastic lesions) received for histopathological evaluation were included in the study. The sections were processed for H&E staining, and 112 cases were chosen for immunohistochemical study. The data were analyzed by Chi-square and z-tests using software SPSS. Results: We found significant correlation between degree of dysplasia and p-16 immunoexpression with 16.7% of cases showing positivity in oral intraepithelial neoplasia (OIN) I cases as compared to 25% in OIN II and 77.8% in OIN III. Ki-67 immunoexpression correlated significantly with both histological type and grade of tumor with increased expression and intensity seen in malignant cases (66.3%) as compared to benign (10%) and premalignant cases (37%) and higher Ki-67 immunoexpression in poorly differentiated tumors (75%) than well-differentiated tumors (12.2%). Regarding p-53 immunoexpression, positive staining was seen in only malignant cases and premalignant cases. Conclusions: Ki-67 and p-16 can be useful as a marker of degree of dysplasia and transformation to malignancy. Ki-67 can also serve as a marker of degree of differentiation of tumors. Hence, they can serve as important ancillary markers to analyze the transition to carcinoma, dysplasia and progression of tumor.
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Antimicrobial susceptibility pattern of oral isolates of Aggregatibacter actinomycetemcomitans p. 231
Kishore G Bhat, Preeti Khot, Suvarna Patil, Geetha Pattar, Sanjeevini Majukar
DOI:10.4103/jomfp.JOMFP_123_19  
Background: Aggregatibacter actinomycetemcomitans is involved in the etiology of localized aggressive periodontitis (LAP), a condition that frequently requires supplemental antibiotic therapy. Information on antimicrobial susceptibility pattern and guidelines for oral antibiotic therapy are not available on Indian patients. Aim: The main aim of the present study was to screen clinical isolates on a panel of antibiotics commonly used for oral/systemic therapy. Materials and Methods: The study included 40 strains of A. actinomycetemcomitans isolated from patients with LAP. The subgingival plaque was plated onto Trypticase Soy Serum Bacitracin Vancomycin Agar medium and incubated for 72 h, and suspected colonies were confirmed by phenotypic tests. Each isolate was tested against a panel of 12 antibiotics using MIC gradient strip test. ATCC strains of A. actinomycetemcomitans serotype A and C were used as standards. Performance and interpretation of the test were done according to the manufacturers' instructions. Distribution of MICs among isolates (n = 40) were used to calculate concentrations inhibiting 50% (MIC50) and 90% (MIC90) of strains. Results: Moxifloxacin, cefotaxime and ceftriaxone showed excellent activity with 100% growth inhibition followed by amoxicillin, amoxiclav and doxycycline (>90% activity). The bacterial strains were moderately susceptible to cefuroxime, cefazolin and tetracycline but displayed poor susceptibility to clindamycin and azithromycin. All isolates were resistant to metronidazole. Conclusion: The isolates of A. actinomycetemcomitans displayed a high level of resistance to azithromycin and clindamycin. Development of resistance against tetracycline also appears to be significant. Variable resistance among the different members of the cephalosporin group is a factor to be investigated further since susceptibility profile against these antibiotics and interpretative criteria for oral bacteria are not available.
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Quantification of Mycobacterium tuberculosis and Mycobacterium avium complex in human immunodeficiency virus-infected individuals with and without tuberculosis p. 236
Yashovardhan Naishadham, Vijay Kumar Jogishetty, Venkat Baghirath Pacha, Sudheer B Balla, B Hari Vinay, Parameshwar Naishadham
DOI:10.4103/jomfp.JOMFP_194_18  
Context: For a dental practitioner, HIV-TB co-infection which is a lethal aliment is an occupational hazard by the virtue of abundant aerosol formation in day to day dental practice. Aim: To assess the prevalence of TB co-infection among HIV patients. To assess the infectivity by culturing Mycobacterium Tuberculosis and Mycobacterium avium complex using Lowenstein Jensen medium and Middlebrook medium. Setting and Design: One hundred and forty one recently diagnosed HIV seropositive patients were selected. They were divided into two group based on their clinical symptomatology. Sputum samples, CD4 counts and brief case history were collected from these patients. Subjects and Methods: Sputum samples were homogenized using modified Petroff's method. The samples were cultured using Lowenstein Jensen and Middlebrook media. Cultures were interpreted after two weeks of incubation and the cultures were quantified based on their number of colonies produced on them. Statistical Analysis: Descriptive statistical analyses followed by Chi square test were performed to assess the prevalence and variation of TB co-infection. Results: Prevalence of TB in our sample is 25.53%. Higher CFU of MTB and MAC are obtained in patients symptomatic for TB. MB yields higher CFU than LJ. Conclusion: Clinical symptoms alone cannot act as basis for suspecting TB in HIV patients. Mycobacterial cultures should be used as diagnostic aids and preferably both the mediums have to be used.
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Ex vivo culture of oral keratinocytes using direct explant cell culture technique p. 243
HR Shwetha, Vijayalakshmi S Kotrashetti, N Chaitanya Babu, Vijay Kumbar, Kishore Bhat, Roopa Reddy
DOI:10.4103/jomfp.JOMFP_105_19  
Background: Culture of cells and tissues is a standard research method practiced in many laboratories. In most of the cases, these cultures are being used as substrates for cell products or as investigative tools for delving the mechanism of gene expression, cell proliferation and transformation. Primary monolayer cell culture has been beneficial to study the general biology of both oral and skin keratinocytes. There are two different techniques of primary cell cultures followed, which include direct explant and enzymatic techniques. Aims: The aim of the study was to optimize the culture of keratinocytes obtained from patients with normal oral mucosa by direct explant technique. Materials and Methods: Keratinocytes were isolated from 15 patients and were cultured in vitro and observed under an inverted microscope. The cultured cells were characterized by immunocytochemistry method using pan-cytokeratin. Results: The total success rate of primary culture of the oral epithelial cells by direct explant technique was 88.6%. No contamination of microorganisms in the primary cell cultures was obtained. Conclusion: Within the limited numbers of samples used in the current pilot study, we conclude that the direct explant technique appears to be a simple and successful technique for the isolation of oral mucosal keratinocytes if we follow the appropriate protocol.
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“SKILL TO KILL” – Oral cancer and potentially premalignant oral epithelial lesions (PPOELs): A survey approach. Emerging of a new system and professionals p. 248
Nawal Khan, Radhika M Bavle, Soumya Makarla, SR Amulya, Paremala Konda, M Sudhakara
DOI:10.4103/jomfp.JOMFP_107_19  
Background: Oral cancer is said to be the 6th most common cancer in men and 12th in women. Potentially malignant disorders/potentially premalignant oral epithelial lesion (PMDs/PPOELs) have shown an increased risk of progressing to cancer. In this regard, lack of awareness about identification of oral PMDs among healthcare providers in general and oral pathologists in particular is said to be responsible for the diagnostic delay. Oral cancer is said to be the most common cancer in men and 3rd most common in women in the Indian subcontinent. PMDs have shown an increased risk of progressing to cancer. The various rates of conversion include 14%–51% for erythroplakia, 60%–100% for proliferative verrucous leukoplakia and 7%–26% for oral submucous fibrosis (OSMF). In this regard, early detection at PPOEL level will lead to prevention of malignant transformation. Aims and Objectives: The purpose of this survey was: 1. To determine if awareness among professionals is essential/key to challenge the progression of PMDs of the oral cavity. 2. To examine and/ordiscern if oral pathologists felt enough was being done to address the issue of early detection and prevention and how the scenario could be improved further. Materials and Methods: A survey was designed to assess the interest, zeal, knowledge and skill of healthcare providers in general and oral pathologists in particular in careful examination of the oral cavity and early detection of PMDs. A questionnaire with 18 questions was designed to address these issues/points and distributed among post-graduate students and practicing oral pathologists on online platforms. Results: The results of the esurvey were collected, analyzed and the results discussed question wise. The validity and reliability of the questionnaire was assessed and confirmed with Aiken's index for validity and Cronbach's alpha for reliability. Inferential statistical analysis was performed using Chi square test with P = 0.05 being statistically significant. Conclusion: On evaluation of the survey, we found that 85% of the surveyees are on agreement that PPOELs should be registered in a standard format and should be included in the list of recognizable diseases. 89.2% and 87.8% of the respondents would like to be part of an active body for early detection and diagnosis and for Cancer screening in our country respectively. In conclusion, the oral pathology fraternity is eager to work for and tackle these PPOELs head on, provided the right opportunities and training are meted out to them.
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REVIEW ARTICLES Top

The role of myofibroblasts in the progression of oral submucous fibrosis: A systematic review p. 257
Vijay Wadhwan, Arvind Venkatesh, Vandana Reddy, Sangeeta Malik
DOI:10.4103/jomfp.JOMFP_238_18  
Oral Submucous Fibrosis (OSMF) is a chronic progressive scarring oral disease predominantly affecting people of South Asian origin. It is characterized by juxtaepithelial inflammatory cell infiltration followed by fibrosis in the lamina propria and submucosa of the oral mucosa. The pathogenesis of the disease is not well established and a number of mechanisms have been proposed regarding the pathogenesis. A renewed interest has been shown in myofibrobasts which have been implicated to play a significant role in the pathogenesis of OSMF. The myofibroblast were initially identified by means of electron microscopy in granulation tissue of healing wounds as a modulated fibroblast exhibiting features of smooth muscle cells, with prominent bundles of microfilaments, dense bodies scattered in between, and gap junctions. The presence of myofibroblasts has successively been described in practically all fibrotic situations characterized by tissue retraction and remodeling. This review paper is an attempt to identify all the studies involving myofibroblasts and explaining the pathogenesis in a simplified manner.
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Structure, function and role of CD44 in neoplasia p. 267
Mithilesh N Mishra, Vidyadevi Chandavarkar, Ritika Sharma, Deepak Bhargava
DOI:10.4103/jomfp.JOMFP_246_18  
CD44 is a group of protein molecules which perform a variety of functions. Their wide range of functions are mainly based on their multiple variations in their molecular structure. Furthermore, they are distributed in various tissues of the human body. They have a unique property of cell adhesion, which can lead to interaction between two different cells or a cell and its pericellular matrix. CD44 as a cell surface adhesive molecule helps in aggregation and migration of tumor cells. CD44 plays an important role in cancer of bladder, liver, lungs, pancreas, etc. Expression profile of CD44 has been seen in the epithelia of the lip, tongue, gingiva, hard palate, floor of the mouth, buccal mucosa and pharynx. The relationship between the expression of CD44 v6 and regional lymph node metastasis has been studied immunohistochemically. The expression of CD44 v6 was apparently downregulated in oral squamous cell carcinoma, but not in normal oral mucosa. Carcinomas expressing lower levels of CD44 v6 exhibited more frequent regional lymph node metastasis. No significant relation was found between the expression of CD44 v6 in primary and metastatic lesions. Still, the precise function of CD44 in the metastatic process and the degree of involvement in human malignancies is yet to be established.
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Cell-free tumor DNA: Emerging reality in oral squamous cell carcinoma p. 273
Deepa Babji, Ramakant Nayak, Kishore Bhat, Vijayalakshmi Kotrashetti
DOI:10.4103/jomfp.JOMFP_36_19  
The intention of this review was to condense ongoing findings on the use of circulating DNAs from bodily fluids (blood, serum and plasma) as cancer biomarkers in patients with oral squamous cell carcinoma. Studies were collected after searching databases: PubMed and Google library. Additional search was performed through cross-check on the bibliography of selected articles. After the selection process made by two of the authors, articles which met the inclusion criteria were included in the review. Results revealed that circulating DNAs from blood, serum or plasma appear as favorable candidates as cancer biomarkers in patients suffering from oral cancer. The possibility to forecast recurrences and metastases through follow-up by quantification of candidate DNAs serve as another possible characteristic to be directed in forthcoming studies. However, methodological standardization and even sampling are required to increase the power and accuracy of results.
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CASE REPORTS Top

Painless osteoid osteoma in the maxilla of an elderly female patient p. 280
Iván Alejandro Díaz-Rengifo, Antonio José Díaz-Caballero, Katherine Redondo-De Oro, Yuritza Yoleinnis Hernández-Arenas
DOI:10.4103/jomfp.JOMFP_295_18  
Osteoid osteoma is an osteoblastic benign bone tumor more frequent in long bones of young male patients. It is the third most commonly diagnosed benign bone tumor and has distinctive symptomatology, nocturnal pain that relieves with nonsteroidal anti-inflammatory drugs. Nowadays, total resection is the preferred management. In the present paper, an unusual variant in the maxilla of a female elderly patient without previous symptomatology is exposed; it was surgically removed without signs of reappearance in 12 months of follow-up. Although it is not a common site of appearance, the manifestation of this tumor in the skull bones seems to be associated with a different pattern in contrast to the skeletal type as can be seen in the present case and others previously reported. The authors consider due to the clinical similarity between this and other tumors that it should be taken into consideration for future diagnosis dilemma.
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Diffuse large B-cell lymphoma: An immunohistochemical approach to diagnosis p. 284
Aashka Sethi, Ankita Tandon, Harshi Mishra, Iqbal Singh
DOI:10.4103/jomfp.JOMFP_294_18  
Diffuse large B-cell lymphoma (DLBCL) is an aggressive type of non-Hodgkin's lymphoma (NHL) that develops from the B-cells of the lymphatic system. It is the most common subtype of NHL accounting for 30%–40% of all cases. In addition to determining if NHL is indolent or aggressive and whether it is B-cell, T-cell or NK-cell lymphoma, it is very important to determine the subtype of NHL. This is because each subtype can behave differently and may require different treatments. This warrants the need for an accurate and explicit subtype-specific diagnosis that catalogs the molecular prognostic indicators. Moreover, retrospective studies have confirmed that diagnosis to treatment interval is strongly associated with prognostic clinical factors and outcome in newly diagnosed cases of DLBCL. Therefore, an expeditious histological and immunohistochemical investigation should be compassed in cases of oral lymphomas.
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KNOW THE FIELD Top

Oral cysticercosis in a vegetarian female: A diagnostic dilemma p. 289
Kunal Sah, Neeraj Grover, Sunira Chandra, Sonia Gulia
DOI:10.4103/jomfp.JOMFP_291_18  
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SHORT COMMUNICATION Top

Virtual microscopy made economical and effortless using the Foldscope and a smartphone with screen mirroring p. 292
Ram Prakash, Krishna Prakash
DOI:10.4103/jomfp.JOMFP_148_18  
Context: Virtual Microscopy. Aim: The aim of this study was to demonstrate, as a proof of concept, the integration of a Foldscope, along with a smartphone and screen mirroring devices, into the regular academic teaching program for use with all types of regular slides for economical virtual microscopy. Setting, Design & Methods: For the purpose of this demonstration, a microscopic slide of a ground section of a tooth, a smartphone (iPhone6), a Foldscope and an Apple TV module were chosen to demonstrate the integration of a low-cost unbreakable microscope along with a smartphone to facilitate immediate viewing, capture, sharing and even projection of the image by screen mirroring, if required, in a classroom setting. Conclusion: The Foldscope microscope (Foldscope Instruments, Palo Alto, CA, USA) invented by Manu Prakash is an extremely economical, Origami style, fold to assemble microscope available from popular online retailers at approximately Rupees 500 aimed at simplifying and enabling diagnostics and education worldwide. The Foldscope, integrated with a smartphone, allows for easy screen casting thus proving invaluable as an educational tool by creating an effortless bridge between analogue input and digital output, facilitating instant digitization of slides for viewing, display, communication and storage. This article demonstrates the use of the Foldscope for virtual microscopy in a classroom scenario, by employing the screen mirroring capabilities of a smartphone.
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FORENSIC CORNER Top

Morphological analysis of various rugae patterns among Dravidian population p. 295
Manickam Selvamani, PK Bindiya, Nandakishore Bhojaraju, TS Bastian, HS Suhana, Melwin Mathew
DOI:10.4103/jomfp.JOMFP_277_18  
Aim: The aim of this study was to analyze and identify differences in the palatal rugae patterns and genderwise distributions in three different populations (Kerala, Mahe and Puducherry). Materials and Methods: Ninety maxillary study models (30 from each group including males and females) were examined in the age group ranging from 18 to 25 years. The palatal rugae pattern was analyzed for shape. Results: After analyzing the rugae patterns among the groups, the most common pattern was the wavy pattern (53.57%) followed by curved (18.22%) and straight (13.66%). The least was circular (1.3%). When compared between sex, the most common pattern was found to be wavy (male – 54.3% and female – 53.09%), while the curved pattern was more common among the females (21.09%) than males (13.97%). The straight pattern was more common among the males (18.8%) than females (10.18%). The least common pattern was found to be the circular in both sexes which accounted for around 1%. Conclusion: This study shows no two palates are identical in terms of their rugae pattern. Palatal rugae possess unique characteristics as they are absolutely individualistic. Study also confirms that the “wavy” type of palatal rugae pattern was the most predominant among these three populations.
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ONLINE ONLY ARTICLES - ORIGINAL ARTICLES Top

Evaluation of genotoxicity by micronucleus assay in oral leukoplakia and oral squamous cell carcinoma with deleterious habits p. 300
Praveen Kumar Singam, Sumit Majumdar, Divya Uppala, Sreekanth Kotina, Madhurya Namana, Kameswara Rao Ayyagari
DOI:10.4103/jomfp.JOMFP_221_19  
Background: Oral cancer is the 12th most common cancer in women and the 6th in men. Of all oral malignancies, more than 92-95% is Oral Squamous Cell Carcinoma (OSCC). The high risk was due to Lifestyle-related habits such as smoking, alcohol consumption, chewing of areca nut related products which are considered as the major risk factors in OSCC. The exogenous carcinogens from tobacco smoke may induce a defective DNA damage response, which may alter the expression of genes that protect us against cancer that may result in genomic instability and this DNA damage can be assessed by studying the chromosomal aberrations, sister chromatid exchanges and the varied forms of the micronucleus. Aims and Objectives: The aim of this study was to evaluate the risk of development of oral leukoplakia (OLP) and OSCC due to DNA damage by studying micronuclei count in the east coast of Andhra Pradesh population with tobacco consumption habit and habit-free controls using Fluorescent microscopy. Materials and Methods: A total of 60 subjects, 20 normal controls, 20 oral leukoplakia and 20 OSCC patients were selected from the outpatient patients of GITAM Dental College and Hospital, Rushikonda, Visakhapatnam and peripheral cancer hospitals in and around Visakhapatnam. Exfoliated cells were collected by giving 5-6 gentle strokes with spatula in a continuous unidirectional movement and then were uniformly spread on the previously cleaned microscopic slide. Fluorescent stain 4′, 6′-diamidino-2 phenylindole (DAPI) was used for MN analysis. Results: Mean of cells with MN in controls, leukoplakia and OSCC cases was observed to be 1, 5.1,10.1 (F = 112.396, P < 0.001) respectively. Mean of the cells with MN in different grades of leukoplakia. (F = 35.594, P < 0.001) Mean of the cells with MN in different grades of OSCC. (F = 39.752, P < 0.001). Conclusion: The present study revealed an increase in mean frequency of cells with micronucleus from healthy individuals however similar studies in larger sample has to be done. This study concludes that MN index can be used as a screening test among high risk groups.
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Expression of cyclooxygenase 2 in oral submucous fibrosis: An immunohistochemical pilot study p. 301
Shruthi Rangaswamy, Rajkumar Garudanahally Chikkalingaiah, P Sharada, Vinod K Kumar
DOI:10.4103/jomfp.JOMFP_191_18  
Introduction: Oral submucous fibrosis (OSF) is associated with inflammatory changes in at least some stages of the disease. Prostaglandin is one of the main inflammatory mediators and its production is controlled by various enzymes such as cyclooxygenase (COX). The genetic and pharmacological data strongly indicate that COX-2 should be investigated as a potential target for the prevention and treatment of OSF. Methodology: The study group comprised histologically confirmed specimens (n = 10 each) of early OSF, moderate OSF, advanced OSF and normal oral mucosa for comparison. Immunohistochemistry was performed with avidin–biotin technique and evaluated with scoring methods. Results: The difference in percentage of expression in normal tissue and OSF was statistically highly significant (P < 0.001). Positive COX-2 exhibited cytoplasmic staining. One-way analysis of variances test was performed to evaluate COX-2 expression in different grades of OSF. Cytoplasmic staining assessed in terms of intensity, percentage of expression and Q Score did not show any statistical difference (percentage of expression F = 0.029, P = 0.971; Q Score F = 0.154, P = 0.858). Conclusions: Our study indicates that COX-2 may be an important marker of disease progression and might be a reliable prognostic indicator.
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Quantification of micronuclei in exfoliated cells of human immunodeficiency virus/AIDS-infected female patients p. 301
Snehal Shah, Sasidhar Singaraju, Einstein T Bertin, Medhini Singaraju, Ashish Sharma
DOI:10.4103/jomfp.JOMFP_251_17  
Background: Micronucleus (MN) is a biomarker for cytotoxicity, which is formed during cell division. Increased MN scoring has been successfully used to recognize population groups at risk for cancers of oral cavity, cervix, urinary bladder and esophagus. Incorporating MN score along with cytological smear testing gives a better and cost-effective screening for high-risk patients. Objective: This study evaluated the effectiveness of using MN score assessed from Papanicolaou (PAP) smears, as a biomarker for chromosomal damage in human immunodeficiency virus (HIV) patients. Materials and Methods: Oral smears of 25 female HIV/AIDS patients, without habits such as chewing or smoking tobacco, and taking antiretroviral therapy (ART) at ART center, were recruited for the study. After careful oral examination and oral rinsing with normal saline, smears were prepared on slides by scraping the buccal mucosa with a wooden spatula. All the slides were fixed in 95% ethyl alcohol and stained with PAP stain, and 1000 cells were counted per patient. Based on Tolbert et al.'s criteria, MNs were identified, and quantitative scoring of MN was done on the basis of morphological assay. Results: Mean ± standard deviation values of frequency of MNs in HIV-infected females were 73.40 ± 19.70 and in normal females were 38.08 ± 8.56. Conclusion: MN scoring on the epithelial cells of buccal mucosa can be used as a biomarker in screening procedures for HIV patients.
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Evaluation of candidal species among individuals with oral potentially malignant disorders and oral squamous cell carcinoma p. 302
Saurabh Kumar Roy, Madhusudan Astekar, Gaurav Sapra, Rajesh Kumar Chitlangia, Nitish Raj
DOI:10.4103/jomfp.JOMFP_111_18  
Context: Cancer afflicts almost all communities worldwide. Although it arises de novo in many instances, a significant proportion of oral squamous cell carcinoma (OSCC) develops from potentially malignant disorders (PMDs). Further, the association of Candida with various potentially malignant and malignant lesions has been reported as a causative agent. Aims: The aim of the study is to evaluate and intercompare the predominant candidal species among individuals with PMD and OSCC. Subjects and Methods: The swab samples were collected for the microbiological culture followed by incisional biopsy for histopathological confirmation. The swab samples were streaked and incubated on Sabouraud-dextrose agar medium and positive candidal colonies were incubated on CHROM agar for speciation. Settings and Design: A total of clinically diagnosed 95 subjects of which 25 as normal controls, 30 as PMDs and 40 as OSCC were included. The collected swab samples were initially streaked and incubated on Sabouraud dextrose agar (SDA) medium, and later, only positive candidal colonies were incubated on CHROM agar for speciation. Statistical Analysis: Chi-square test was utilized. Results: Positive candidal growth on SDA medium was seen in 24%, 43% and 82% and negative in 76%, 57% and 18% individuals of normal controls, PMDs and OSCC, respectively. On evaluation on Chromagar medium, Candida species was present in 20%, 40% and 77% and absent in 80%, 60% and 23% individuals among controls, PMDs and OSCC group, respectively. On speciation of Candida in CHROMagar among the controls, PMDs and OSCC, Candida albicans species was present in 4 (16%), 7 (23%) and 4 (10%); Candida krusei in 1 (4%), 5 (17%) and 10 (25%); Candida glabrata in nil, nil and 6 (20%) and Candida tropicalis in nil, nil, and 2 (5%) cases, respectively. Conclusion: There was predominant carriage of candidal species in PMDs and OSCC, but whether Candida has specific establishment in PMDs or in malignancy is still a matter of debate.
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Verrucous carcinoma: A clinicopathological study p. 303
HN Santosh, Tejavathi Nagaraj, Swati Saxena, Arundhati Biswas, Sushant Anant Pai
DOI:10.4103/jomfp.JOMFP_59_19  
Objective: The purpose of this study is to identify a co-relation between clinical and histopathological features of verrucous carcinoma. Materials and Methods: This study was conducted based on Knowledge Attitude and Practice (KAP) questionnaire comprising of 3 sets of questions covering clinical and histopathological aspects of the oral verrucous carcinoma. The target subjects were specialists in the field of Oral Medicine and Radiology, Oral and Maxillofacial Surgery and Oral Pathology. Results and Conclusion: Verrucous carcinoma is a low grade variant of squamous cell carcinoma and the clinical features of both are very similar. The treatment of both differs widely; we fail to diagnose it correctly. This study correlates the clinic-pathologic features of oral verrucous carcinoma by means of statistically analyzing the varied clinical features and pathological impressions. This is helpful in eliminating the diagnostic dilemma and thus channelizing the data to present a clear treatment planning.
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Toxicity of xylene in occupationally exposed workers: A high-performance liquid chromatography analysis p. 303
Sharada T Rajan, Malathi Narasimhan, K Bharath Rao, Tina Elizabeth Jacob
DOI:10.4103/jomfp.JOMFP_297_18  
Background: Xylene is one of the most commonly used solvents in industrial and medical technologies. Several health hazards of xylene have been documented in literature. Workers in certain forces appear to have the greatest potential for exposure to high concentrations of xylene – histopathology technicians and painters are two such groups. This study was undertaken with the aim to determine the level of xylene exposure and the various systemic health effects among these groups. Methodology: The study was performed by analyzing the urine samples of the participants for methylhippuric acid, the established biomarker of xylene with the aid of high-performance liquid chromatography. Results and Conclusion: The work hours per week of the occupationally exposed participants were statistically analyzed with that of the excretory values of the metabolites of xylene, and the P value was found to be highly significant. Various side effects of xylene including respiratory, dermatological, neurological and gastrointestinal symptoms were observed among the study groups.
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Application of in vivo stain of methylene blue as a diagnostic aid in the early detection and screening of oral cancerous and precancerous lesions p. 304
Manas Gupta, Kriti Shrivastava, Vikalp Raghuvanshi, Sakshi Ojha, Ankita Gupta, S Sasidhar
DOI:10.4103/jomfp.JOMFP_242_17  
Background: Periodic clinical examination of the oral cavity is the mainstay for the early detection of oral cancers which can be further aided by screening individuals with high-risk factors that will identify candidates who should receive treatment to prevent cancer progression and reduce patient mortality. Among the diagnostic tools, in vivo staining is advocated as a simple, inexpensive and fairly sensitive method. Materials and Methods: The present study involved the examination of fifty patients suspected of oral malignant or precancerous lesions by methylene blue staining. The results of methylene blue uptake were compared with a simultaneous biopsy of these lesions, while benign epithelial lesions were included as the negative subjects of screening. Results: The results revealed a sensitivity of 89%, a specificity of 91%, a positive predictive value of 97% and a negative predictive value of 73%. Conclusion: We recommend that methylene blue staining is a useful diagnostic adjunct in a large, community-based oral cancer screening program for high-risk individuals.
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Architectural changes in the regional lymph nodes of oral squamous cell carcinoma p. 305
Swetha Acharya, Nishitha Kumari, Pragya Srivastava, Dewin Arnold, Krithi Nikhil
DOI:10.4103/jomfp.JOMFP_71_18  
Background: The lymph nodes (LNs) in oral squamous cell carcinoma (OSCC) are enlarged as a result of reactive lymphadenopathy, metastasis or both. In response to tumor-associated antigens, diverse cell populations of LNs react in different ways, giving rise to a multitude of morphological patterns (MPs). The prognostic value of MPs has been contested. Hence, the aim of the study was to evaluate morphological alterations in the LNs related to LN metastasis (LNM), tumor size, grade and stage and the prognostic value for OSCC. Materials and Methods: LN sections of 40 OSCCs were evaluated. Six MPs were observed: germinal center predominance (GCP), lymphocyte predominance (LP), sinus histiocytosis (SH), vascular transformation of sinuses (VTS), lymphocyte depleted (LD) and granulomatous reaction (GR). The data were subjected to Chi-square test. Results: Four-hundred and eighteen nodes were evaluated, of which 24 were metastatic and 394 nonmetastatic. The predominant MP of LN reactivity was of VTS (116 nodes) followed by GCP (105); LP (90), LD (52), SH (43) and GR (12). A significant association was noted between LN status and the MPs. Risk of LNM with LP was less (13%) when compared with GCP (79%). A statistically significant relation was noted between the predominant MP and metastatic and nonmetastatic cases and with the tumor stage. Conclusion: GCP pattern prevails in metastatic and advanced-stage tumors. LP or VTS/SH is prominent in early-stage tumors and nonmetastatic cases. MPs indicate the immune status and aid in foreseeing susceptibility to LNM, thus serving as a surrogate marker.
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Evaluation of the antifungal efficacy of different concentrations of Curcuma longa on Candida albicans: An in vitro study p. 305
Jeevitha Murugesh, Rajeshwari G Annigeri, GK Mangala, P Hema Mythily, J Chandrakala
DOI:10.4103/jomfp.JOMFP_200_18  
Background: Candidal infections have increased significantly in denture wearers, especially in immunocompromised patients. The increase in resistance to existing antifungal drugs and number of patients at risk, in conjunction with the restricted number of commercially available antifungal drugs that still present many side effects, are the cause for this problem. These limitations emphasize the need to develop new and more effective antifungal agents with lesser side effects. Materials and Methods: The present study was undertaken to investigate the possible antifungal action of the alcoholic extract of different concentrations of Curcuma longa on four dilutions of Candida albicans (1:10, 1:20, 1:40 and 1:80) and to determine its minimum inhibitory concentration (MIC) and minimum fungicidal concentration using Sabouraud's agar medium. Results: There was complete inhibition of the growth of all four dilutions of Candida at a concentration of 800 μl which is considered as the MIC of alcoholic extract of turmeric on C. albicans, and the minimum fungicidal concentration was at 1600 μl. Conclusion: This study indicates a potent antifungal action of C. longa against C. albicans.
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Bcl-2 expression in reactive oral lesions with atypical epithelium and in oral epithelial dysplasia associated with carcinogen exposure p. 306
K Nitya, GS Madhushankari, Praveen S Basandi, KP Mohan Kumar, NK Priya, Ashwini Ramakrishna
DOI:10.4103/jomfp.JOMFP_195_18  
Background: Reactive lesions of the oral cavity are nonneoplastic proliferations with very similar appearance to benign neoplastic lesions and are associated with chronic local irritation or trauma. Although these lesions are uncommonly associated with carcinogen exposure, at times, they present histopathologically with dysplastic epithelium, thus making it difficult to differentiate it from true potentially malignant disorders. Hence, the present study was conducted to evaluate the expression of Bcl-2 protein, an antiapoptotic marker, in reactive lesions with and without atypical epithelium and in true epithelial dysplasia, which clinically presents as premalignant disorders. Materials and Methods: The samples included 15 cases each of normal oral mucosa (NOM), reactive lesions with and without dysplasia and oral epithelial dysplasia (OED) associated with carcinogen exposure. All the samples were subjected to immunohistochemical staining using Bcl-2 antibody. The total number of cells in the basal and parabasal layers in each field and total number of cells expressing Bcl-2 among them and the staining intensity were assessed. Statistical Analysis: Kruskal–Wallis ANOVA test was used to compare the number of positive cells among the four groups. The comparison of average percentage of positive cells between the study groups was done using Mann–Whitney U-test. Results: The immunohistochemical staining for Bcl-2 protein was identified in few cells in the basal layers of NOM, reactive lesions without atypical epithelium and in the basal and parabasal layers in reactive lesions with atypical epithelium and OED, as a granular cytoplasmic staining and as an accentuation around the nuclear membrane. There was a gradual increase in the expression and intensity of staining from Group I to IV. Interpretation and Conclusion: The altered or increased expression of Bcl-2 oncoprotein in reactive lesions with atypical epithelium and in OED with carcinogen exposure may lead to prolonged cell survival and can be considered as an early molecular event in carcinogenesis, helping us in understanding the nature of dysplasia in reactive lesions, which was not considered during the histopathology reporting.
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Eosinophils: An imperative histopathological prognostic indicator for oral squamous cell carcinoma p. 307
G Deepthi, Pavan G Kulkarni, SR K Nandan
DOI:10.4103/jomfp.JOMFP_111_19  
Background: Inflammation in tumor microenvironment assists in both promotion and growth of tumor. Tumor-associated tissue eosinophilia (TATE) is the term used when eosinophils are observed in a tumor tissue with inflammatory infiltrate. Although carcinogenesis with inflammation is one of the important hallmarks, the exact role of eosinophils remains unclear. Various studies on oral squamous cell carcinoma (OSCC) that focused on eosinophils reported both favorable and unfavorable prognosis in cancer tissue, because of which the exact function of eosinophils still remains uncertain. Aims and Objectives: The present study aims at identifying the role of TATE in OSCC and in malignant transformation of oral epithelial dysplasia (OED). Materials and Methods: The study includes 70 samples that divided into two groups, of which 50 histopathologically proven cases of different grades of OSCC and 20 cases of OED (oral leukoplakia). Congo red stain was used to stain the tissue sections. Each slide was viewed under high power in 10 consecutive microscopic fields for counting of eosinophils. Results: Statistical analysis of values obtained was done using ANOVA, unpaired t-test and Mann–Whitney test. The results were statistically significant (P < 0.05) with a mean total eosinophil count of 2.12 in OED and 4.31 in OSCC. Conclusion: The present study showed higher eosinophil counts in OSCC when compared to dysplasia which should prompt for a thorough evaluation of tumor front for invasiveness. Therefore, tissue eosinophil count may be used as an adjunct to predict the malignant transformation of dysplastic lesions to OSCC.
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An immunohistochemical study of p53 expressions in oral submucous fibrosis p. 308
Sandesh Manjunath, C Girish Himadal, Darshan Devang Divakar, Shaista Haleem, Hussain Ahmed Mohammad Faqeeh, Mohammed Yahya M Alshadidi
DOI:10.4103/jomfp.JOMFP_277_17  
Background: The objective of this histopathological study was to identify the expression of tumor suppressor gene p53 and to detect the correlation between p53 expression and the degree of dysplasia in oral submucous fibrosis (OSMF). Methods: A sample size of 30 OSMF patients irrespective of sex was taken up for the study. The tissue samples obtained were subjected to immunohistochemical method to detect p53 protein. The technique used was indirect super sensitive Polymer-HRP IHC detection system. The p53 positive samples were evaluated on a 4-point scale, which ranged from 3+ to negative. Results: Out of 30 cases 3(10%) cases were negative for p53 expression and 13(43.3%) showed + expression, and 14(46.6%) showed ++ expression. On application of Mantel-Haenszel Chi-Square test a statistically significant P <=0.05 i.e. (P=0.012) was obtained and there was Linear-by-Linear association between p53 expressions and dysplasia that showed the point probability of 0.006. Conclusion: Immunohistochemistry is a powerful tool to identify distinct patterns of gene expression in premalignant disorders and also Oral Squamous Cell Carcinomas (OSCC) from different populations. In the present study, a significant number of samples of OSMF were positive for p53 protein.
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Assessment of epithelial–mesenchymal transition signatures in oral submucous fibrosis p. 308
R Shesha Prasad, Anuradha Pai, K Shyamala, Abhishek Bhadranna, Sadhana Shenoy, Anisha Yaji
DOI:10.4103/jomfp.JOMFP_177_18  
Background: Recently, the concept of field cancerization has questioned the accuracy of biopsy site selection clinically. Oral submucous fibrosis (OSMF) has a global malignant transformation rate of 7.6% despite having less dysplastic changes clinically or histologically. Hence, this study was undertaken to evaluate the expression of vimentin, epithelial-cadherin (E-Cad) and collagen IV in OSMF, using immunohistochemistry and polymerase chain reaction (PCR). Materials and Methods: One hundred and eighty- five patients with OSMF (61), with habits and no OSMF (61) and patients without habit and OSMF (63) were subjected to biopsy for sample collection. The samples were analyzed immunohistochemically for vimentin, E-Cad and collagen IV. The PCR values for vimentin and E-Cad were also done. Results: Vimentin expression was increased in OSMF patients, whereas E-Cad expression was decreased in OSMF patients. Conclusion: Epithelial–mesenchymal transition signatures are definitely positive in OSMF cases.
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ONLINE ONLY ARTICLES - CASE REPORTS Top

Dentin dysplasia Type I: A rare case report p. 309
EJ Akhil Jose, Plato Palathingal, Deepak Baby, Joseph Mathew Thachil
DOI:10.4103/jomfp.JOMFP_132_19  
Dentin dysplasia (DD) is an uncommon developmental disturbance affecting dentin, resulting in enamel with atypical dentin formation and abnormal pulpal morphology. Type I (radicular) and Type II (coronal) are the two types of DD. Type I is more common, and both types include single or multiple teeth in primary and permanent dentition. Combinations of both types have also been described in literature. Four distinct forms of Type I and one form of Type II were identified. This case report documents one such rarity of DD in an 11-year-old female with clinical and radiographical findings and management aspects.
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Clear cell carcinoma of soft palate- A case report p. 310
Tayyeb Sultan Khan, Tarannum Ajaz Khan, Manish Sharma, Gaganjot Kaur Sharma
DOI:10.4103/jomfp.JOMFP_101_19  
Clear-cell carcinoma (CCC) of the salivary gland is a very rare malignancy. It is recently introduced in the WHO classification of salivary gland tumors. CCC is considered a low-grade tumor, which is commonly seen in elderly females. The most common intraoral sites affected by CCC are palate and tongue. CCC comprises 1% of all salivary gland tumors. CCC has a silent course and a limited nodal metastasis. A hyalinized variant of CCC has good prognosis and requires wide surgical excision with or without adjuvant radiotherapy. Microscopically, it is characterized by the presence of nests of glycogen-rich monomorphic clear cells within a hyalinized stroma. Immunohistochemistry analysis of CCC depicts tumor cells which are positive for epithelial markers and negative for S-100. Here, we report the case of a hyalinized CCC of minor glands of the palate which was misdiagnosed as poorly differentiated squamous cell carcinoma.
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ONLINE ONLY ARTICLES - SHORT COMMUNICATION Top

Third dimension on histopathological aspect of oral lichen planus: An innovation in teaching oral pathology Highly accessed article p. 310
Sandhya Tamgadge, Avinash Tamgadge
DOI:10.4103/jomfp.JOMFP_262_18  
Oral lichen planus is a chronic mucocutaneous disorder. There are plethora of 2D histopathological images, but 3D images and 3D animation video of the same have not been published so far. Therefore, this article is a preliminary attempt to present the same which the author has designed herself.
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ONLINE ONLY ARTICLES - REVIEW ARTICLE Top

Microchimerism: A new concept p. 311
Sandhya Shrivastava, Rupali Naik, Hema Suryawanshi, Neha Gupta
DOI:10.4103/jomfp.JOMFP_85_17  
Microchimerism is the presence of cells from one individual in another genetically distinct individual. Pregnancy is the main cause of natural microchimerism through transplacental bi-directional cell trafficking between mother and fetus. In addition to a variety of cell-free substances, it is now well-recognized that some cells are also exchanged in pregnancy. Furthermore, it is now known that microchimerism persists decades later both in mother and in her progeny. The consequences of pregnancy-related microchimerism are under active investigation. However, many authors have suggested a close relationship linking fetal microchimerism and the development of autoimmune diseases. Fetal microchimerism is emerging as a potential contributing factor in certain diseases, including cancer. Parallel studies in animal and human pregnancy suggest that microchimeric fetal cells play a role in wound healing. Role of these microchimeric cells in human health and disease is discussed here.
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ONLINE ONLY ARTICLES - FORENSIC CORNER Top

Stature estimation from regression analysis of facial anthropometry in Indian population p. 311
Achla Bharti Yadav, Alka D Kale, Deepa R Mane, Sumit Kumar Yadav, Seema Hallikerimath
DOI:10.4103/jomfp.JOMFP_140_19  
Background: Stature or body height is one of the most important and useful anthropometric parameters which determines the physical identity of an individual. As craniofacial structures have the advantage of being composed largely of hard tissue which is relatively indestructible, the careful study of these can enable reliable determination of stature of the person in life. Studies pertaining to stature estimation from facial measurements are limited in an Indian population. The present investigation attempts to estimate stature from anthropometric dimensions of face. Materials and Methods: The material for the present study comprises 361 Indian students (151 males and 210 females) in the age range of 21–45 years. Stature and six facial measurements were taken on each participant following standard methods and techniques. Karl Pearson's correlation coefficient and linear regression were done to estimate stature. Results: The results indicate that facial measurements are strongly and positively correlated (P < 0.001) with stature. The accuracy of the computed equations was further tested on 50 randomly selected study participants of each group, which shows close approximation of actual and estimated stature. Conclusion: Within the limits of this study, we conclude that facial dimensions can be used as a supplementary approach for the estimation of stature but with caution, as these are population-specific approach.
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NOTICE OF RETRACTION Top

Retraction: Estimation of salivary and serum alkaline phosphatase level as a diagnostic marker in type 2 diabetes mellitus with periodontal health and disease: A clinico biochemical study p. 313

DOI:10.4103/0973-029X.264838  
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Journal of Oral and Maxillofacial Pathology | Published by Wolters Kluwer - Medknow
Online since 15th Aug, 2007