Autoimmune Diseases Affecting the Orofacial Region – An Overview

Introduction: Diseases result from abnormal divergence of the normal structural and functional well-being of an organism. It can be brought about by physical, biological, chemical, genetic, or autoimmune causes. Autoimmune diseases occur when the body’s defence system targets its own healthy cells and tissues. The clinical signs and symptoms vary depending on the target tissues. Oral lesions such as ulcers, blisters, mucositis, and gingivitis are seen in many autoimmune diseases and may be an early sign, first recognized by the dental surgeon. Objective: To review the various autoimmune diseases affecting the orofacial region and update the clinicians about their oral manifestations. Materials and Methods: Case reports, review articles and original research papers published in various electronic databases like PubMed, Cross reference, Google scholar, and data collected from books are compiled in this review article. Result and Conclusion: This review gives an overview of some of the common autoimmune diseases affecting the head and neck region, their pathogenesis, clinical features, histopathological features and laboratory findings.

Oral squamous cell carcinoma in patients with and without predisposing habits in glossal and extra‑glossal site: An institutional experience in South India.

INTRODUCTION: We report our cohort of oral squamous cell carcinoma (OSCC) patients with or without predisposing habits in glossal and extraglossal sites. MATERIALS AND METHODS: A retrospective analysis of OSCC cases over a period of 13.75 years from the archives of Ragas Dental College and Hospital, Chennai, India. Demographic details, site, details of habits, and grade of OSCC were retrieved. Social Package for Social Service version 17.0 was used to analyze the data. Descriptive statistics, Chi‑square test, and comparison of mean were employed appropriately. RESULTS: There were 151 OSCC cases, of which 60.9% (92/151) were males, 21.2% (32/151) were aged ≤40 years and 27.82% (42/151) occurred in the tongue. The glossal to extraglossal site ratio was 1:2.6. Predisposing habits were present in 52.4% of glossal OSCC and 82.6% with extra‑glossal sites (P = 0.000). Besides tobacco, exclusive areca nut chewing was observed in 15.23% (23/151) patients. Thirty‑nine (25.8%) belonged to non‑tobacco, non‑areca nut, non‑alcohol (NTND) group with male to female ratio was1:3. DISCUSSION: In our cohort, 112 of 151 OSCC (74.8%) had at least one predisposing habit. Chewing of areca nut alone was a predisposing habit by itself. In addition, there was a small, subset of cases that were not associated with history of any habits. This study brings to focus the subsets of OSCC predisposed by areca nut and NTND, that needs to be studied further.

A study of sister chromatid exchange in patients with dental amalgam restorations.

Study Background: Dental amalgam is still widely used as a restorative material in developing countries due to its low cost and ease of manipulation. The health risks associated with the components of this restorative material has always been a matter of concern. Our study was designed to address this question regarding dental amalgam. Objective: To study sister chromatid exchange (SCE) as an indicator of systemic genotoxicity, due to the exposure from the components of amalgam restorations during its placement and chronic use. Materials and Methods: Systemic genotoxicity in subjects exposed to amalgam during its placement (Group II; n = 5) and subjects with chronic exposure to amalgam (Group III; n = 5) were compared with controls (Group I; n = 5) by SCE assay in cultured peripheral blood lymphocytes. Result: Subjects exposed to amalgam during its placement and subjects having chronic exposure to amalgam showed an increase in the frequency of SCE, but the change was not statistically significant (P = 0.84, P = 0.123 respectively). Conclusion: Systemic genotoxicity was not observed due to the components of amalgam restorations released during its placement and chronic use. The findings of this study can be considered as preliminary information on the systemic toxicity due to the components of amalgam restorations.

Stem cells of the dental pulp.

Stem cells of the dental pulp are a population of postnatal stem cells with multilineage differentiation potential. These cells are derived from the neural ectomesenchyme, similar to most craniofacial tissues, and specific niches in the pulp have been identified. Since the isolation of dental pulp stem cells (DPSC) and stem cells from exfoliating deciduous teeth (SHED), numerous studies have attempted to define and characterize these cells, and embryonic stem cell features have been reported in both DPSC and SHED. These cells have a vast repertoire of differentiation - osteogenic, odontogenic, myogenic, adipogenic, neurogenic, and melanocytic, and have even demonstrated transdifferentiation to corneal cells and islet cells of pancreas. The combined advantages of multipotency/pluripotency and the relative ease of access of pulp tissue for autologous use render DPSC/ SHED attractive options in regenerative dentistry and medicine. This review gives a bird's eye view of current knowledge with respect to stem cells from the dental pulp.

Allergic Contact Stomatitis: A Case Report and Review of Literature.

Allergic contact stomatitis is a well-recognized entity, which may be easily overlooked by the clinician since its signs and symptoms are similar to various other oral lesions. Accurate diagnosis warrants adequate treatment that will help in providing prompt relief and will also prevent further recurrences. We present a case report of a 27-year-old South Indian male student, who presented with multiple erythematous erosions involving much of the nonkeratinized oral mucosa. History revealed that there was a previous episode of a similar lesion, associated with intake of food with flavoring agents. Based on the history and clinical features, we arrived at a diagnosis of allergic contact stomatitis and successfully treated the lesions with topical and systemic antihistamines.

Prevalence and correlates of tobacco use among urban adult men in India: A comparison of slum dwellers vs non-slum dwellers.

Background: Tobacco use is reported to be rampant in urban slums in developing countries. Demographical variations in tobacco use between males living in urban slums vs those living in non-slum areas in India has not been reported, and this study was undertaken to address this issue. Materials and Methods: Secondary data analysis of National Family Health Survey-3 (NFHS-3) was undertaken to study demographical variations in tobacco use between urban slum dwellers and non-slum dwellers in eight Indian cities. Demographic determinants for use of smoking and chewing forms of tobacco in the two groups were analyzed. SPSS® version 16.0 (SPSS Inc., IL, USA) was used for statistical analysis. Result: The study population comprised 6887 (41.8%) males from slum areas and 9588 (58.2%) from non-slum areas of eight urban cities. Cigarette/beedi smoking was the commonest form of tobacco use among the study population. Pan masala use was the least common form of smokeless tobacco use, next only to snuff. There was a high statistical significance observed within the various demographic parameter studied in both the slum and non-slum dwelling males in study population. However, on studying the differences between the two groups, it was observed that statistical significance of P≤.001 was observed with age (15-49), secondary education, religion, household structure and marital status. The difference between the two groups in the mean number of cigarettes/beedis smoked was not statistically significant (P=.598). Discussion and Conclusion: Male slum dwellers are a distinct urban population, whose health needs assessment requires a different approach than that for non-slum dwellers who often can afford the services that an urban Indian city can offer.

Disseminated infection with Strongyloides stercoralis in a diabetic patient.

A 58-year-old male diabetic who was operated for carcinoma larynx 4 years back was admitted with exertional dyspnoea and bilateral leg swelling for the past 2 years. Over the last 2 months, there was a progressive worsening of symptoms. Echocardiography done 2 years back showed pericardial effusion. Echo done during the current admission also showed pericardial effusion with preserved left ventricular function; cytological examination of the pericardial fluid showed larvae of Strongyloides stercoralis. He was treated with antinematodal drugs. A follow-up echo done at discharge showed no pericardial effusion and the patient was completely asymptomatic. To our knowledge, this is the first reported case of Strongyloides pericardial effusion in a diabetic patient.

Matrix metalloproteinase-1 expression in oral submucous fibrosis: An immunohistochemical study.

Context: Oral submucous fibrosis (OSF) is a form of pathological fibrosis affecting the oral mucosa. There is compelling evidence to implicate the habitual chewing of areca nut with the development of OSF. Because collagens are the major structural components of connective tissues, including oral submucosa, the composition of collagen within each tissue needs to be precisely regulated to maintain tissue integrity. Arecoline stimulates fibroblasts to increase the production of collagen by 150%. Aim: As the role of collagenase is implicated in cleaving the collagen under physical conditions, this study was carried out to evaluate the role of collagenase-1 (matrix metalloproteinase [MMP]-1) in a pathologic condition like OSF. Settings and Design: A total of 40 patients were included in the study, comprising of 30 OSF as Group 1 and 10 normal buccal mucosa tissue as Group 2. Materials and Methods: Both the groups were stained for MMP-1 by the immunohistochemical method using the streptavidin HRP-biotin labeling technique. MMP-1 expression intensity in the epithelium and connective tissue was decreased in Group 1 when compared to Group 2. Statistical Analysis Used: Chi-square test of association was used to determine the difference in the expression of MMP-1 between OSF and normal buccal mucosa and among different histological gradings of OSF. Results: The results were statistically significant. However, there was no statistically significant difference between the expression of MMP-1 among different histological grades of OSF in Group 1.

Sociodemographic correlates of male chewable smokeless tobacco users in India: A preliminary report of analysis of national family health survey, 2005-2006.

Objective : To estimate the prevalence, the socioeconomic and demographic correlates of chewable smokeless tobacco consumption among males in India. Design : A cross-sectional, nationally representative population-based household survey. Subjects : 74,369 males aged 15-54 years who were sampled in the National Family Health Survey-3 (2005-2006). Data on tobacco consumption were elicited from male members in households selected for the study. Materials and Methods : The prevalence of various smokeless tobacco use currently was used as outcome measures. Simple and two-way cross tabulations and univariate logistic regression analysis were the main analytical methods. Results : Thirty-four percent of the study population (15 years or older) used chewable smokeless tobacco. Smokeless tobacco consumption was significantly higher in poor, less educated, scheduled castes, and scheduled tribe populations. The prevalence of tobacco consumption showed variation with types. The prevalence of chewing also varied widely between different states and had a strong association with an individual's sociocultural characteristics. Conclusion : The findings of the study highlight that an agenda to improve the health outcomes among the poor in India must include effective interventions to control tobacco use. Failure to do so would most probably result in doubling the burden of diseases-both communicable and noncommunicable-among India's teeming poor. There is a need for periodical surveys using more consistent definitions of tobacco use and eliciting information on different types of tobacco consumed.

Reach of mass media among tobacco users in India: A preliminary report.

Background : Tobacco use is a health hazard and its use is attributed to a lack of knowledge regarding the ill effects of tobacco. Aim and Objective : To identify the exposure of different mass media among a representative cohort population in the Indian subcontinent and compare the reach of the different mass media among tobacco users and nonusers using the "reach of HIV information" as a model. Design : Secondary Data Analysis of Indian National Family Health Survey-3. Predictor Variables : Any tobacco use, gender, source of HIV information. Outcome Variables : Use of mass media. Results : Of the study group, 27% of males and 54.4% of females never read newspaper or magazine; 29.3% of males and 52.6% of females never heard radio; 12.4% of males and 25% of females never see television; and 79.3% of males and 93.46% of females did not see a movie at least once a month. The most common source of information of HIV was television among males (71.8%) and females (81%), whereas the least common source was leaders among males (0.8%) and females (0.2%). Discussion : Television is the single largest media used by both genders and was a major source of HIV information dissemination. A well-designed tobacco control program similar to HIV awareness program will help to curb tobacco use. Conclusion : The reach of different media among Indian tobacco users is presented and HIV model of information dissemination may prove to be effective in tobacco control.

The prevalence of oral mucosal lesions in alcohol misusers in Chennai, south India.

AIMS AND OBJECTIVES: This study was conducted to assess the prevalence of various oral mucosal lesions (OML) among alcohol misusers attending a rehabilitation center in Chennai, south India. MATERIALS AND METHODS: Qualified dental surgeons examined 500 consecutive alcohol misusers at Ragas Dental College and Hospital and TTK Hospital, India. Thorough history and oral findings were recorded in a pre-determined format. Data entry and statistical analysis were done using SPSS 10.0.5beta. The variables for this study were OML, Oral Hygiene Index (OHI), age, smoking, and alcohol misuse (type and units consumed and duration of misuse). RESULTS: Of the 500 patients, 77% were in the 25-44 years old age group and 84% were married. The mean age of initiation of alcohol misuse was 34 years. In addition to alcohol, 72% smoked tobacco and 96% used other psychoactive substances. The mean alcohol use duration was 12.6 years. A total of 25% of the study group had at least one OML. The common oral lesions were smoker's melanosis (10.2%), oral submucous fibrosis (8%), and leukoplakia (7.4%). Those who misused spirits had a higher incidence of OML than those who misused beer or both. Patients with fair oral hygiene had an odds ratio (OR) of 2.96 for OML compared with an OR of 2.08 for those who had OML with good oral hygiene. CONCLUSION: This study indicates that subjects who misuse alcohol have poor oral hygiene and are at risk for the development of periodontal disease and OML. This survey indicates that oral examination and treatment should be a part of the standard care for alcohol misusers at rehabilitation centers.

Oral submucous fibrosis: a clinico-histopathological study in Chennai.

BACKGROUND: Oral submucous fibrosis (OSF) is a precancerous condition associated with the use of areca nut in various forms. There are very few reports to correlate the clinical stage to histopathological grading in OSF. MATERIALS AND METHODS: A hospital-based study was conducted on 75 OSF cases who visited our hospital in Chennai from 2000-2003. A detailed history of each patient was recorded along with a clinical examination. Biopsy was performed for histopathological correlation. Clinical stage of the disease in terms of the ability to open one's mouth was correlated with histopathological grading. RESULTS: The male to female ratio of OSF cases was 6:1. All forms of areca nut products were associated with OSF. Chewing of paanmasala was associated with early presentation of OSF as compared to chewing of the betel nut. Out of 57 cases, which were in clinical stage II, 91.2% had histological grading of I and II in equal proportions and 8.8% had histological grade III. Out of 13 cases that showed a clinical stage of III, 52% showed a histological grade of II, 40% grade III and 8% grade I. CONCLUSION: In the present study, there was no direct correlation between clinical stages and histopathological grading. The possibility of difference in the severity and extent of fibrosis in different regions of the oral mucosa and involved muscles were considered as contributory factors for this variation.

Greater severity and extent of periodontal breakdown in 136 south Indian human immunodeficiency virus seropositive patients than in normal controls: a comparative study using community periodontal index of treatment needs.

Apart from the more or less distinctive forms of periodontal disease associated with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome there remains considerable uncertainty as to whether or not conventional destructive periodontitis is exacerbated in HIV positive individuals. This is especially so in developing countries, from which few studies have been reported. The present study compared the severity and extent of periodontal break down in 136 HIV positive individuals from Chennai, South India, with 136 age-matched controls from the same low socio-economic and ethnic group. All surfaces of all teeth were scored for the community periodontal index of treatment needs (CPITN). Statistical analysis was performed using SPSS package. The results of the present study show that CPITN is a simple, useful technique to assess periodontal status in immunosuppressed patients and that periodontitis is associated with immunosuppression and oral candidiasis. The assessment of periodontal statuscould thus be a useful tool in minimally invasive screening of populations for HIV disease, especially in those parts of the world, like India and Africa, with high prevalence and rising incidence.

Prevalence of oral lesions in relation to habits: Cross-sectional study in South India.

BACKGROUND: Smoking, drinking and chewing tobacco product, common habits in India have been positively associated with oral lesions. No study has been conducted in this part of Tamilnadu regarding the prevalence of oral lesions in relation to habits. METHODS: A hospital based cross-sectional study was carried out at Ragas Dental College, Chennai. Already existing data of two thousand and seventeen consecutive patients from sub-urban areas of Chennai, who attended the outpatient department, at Ragas Dental College, for dental complaints during a period of three months in 2004, who underwent oral examination and interviewer based questionnaire was used. RESULTS: Oral soft tissue lesions were found in 4.1% of the study subjects. The prevalence of leukoplakia, OSF and oral lichen planus was 0.59%, 0.55%, and 0.15% respectively. The prevalence of smoking, drinking alcoholic beverages and chewing was 15.02%, 8.78% and 6.99% respectively. Smoking and chewing were significant predictors of leukoplakia in this population. DISCUSSION: The prevalence of leukoplakia, OSF and oral lichen planus in our study population is similar to those found in other populations. The prevalence of consumption of alcoholic beverages in our study population was higher when compared to the Indian National Sample Survey study. However the prevalence of smoking and chewing was found to be lower. Smokers were more likely to develop smoker's melanosis compared to other lesions. Among those who consumed alcoholic beverages alone, the prevalence of leukoplakia was higher compared to other lesions. OSF was the most prevalent lesion among those who chewed panmasala or gutkha or betel quid with or without tobacco.

Effect of glutathione on arecanut treated normal human buccal fibroblast culture.

BACKGROUND: Experimental studies have shown arecanut to be a cytotoxic substance with mutagenic and carcinogenic potential. OBJECTIVE: The present study was undertaken to evaluate the effect of glutathione on arecanut treated human buccal fibroblast culture and its potential as a chemopreventive agent. MATERIALS AND METHODS: Fibroblast culture was done in Dulbecco's Modified Eagle's Medium MEM) supplemented with 10% Fetal Calf Serum (FCS) and antibiotic at 370C degrees in an atmosphere of 5% carbon di-oxide and 95% air. The fibroblast cells were subjected to different concentrations of aqueous extracts of raw and boiled arecanut. Fibroblasts were plated in two 24-well culture plates and in each plate, cells were dividt,ednto 2 groups; 600gg microml of reduced glutathione was added to the first group of cells; subsequently, aqueous extracts of raw and boiled arecanut at least and highest concentrations i.e., 20j. microml and 100lg microml were added to the first group of cells in the respective plates whereas the second group served as a control. The morphological alterations and cell survival were assayed at 24, 48, 72, and 96 hours. Results Morphologically, the initial (10 hours) attached fibroblast cells were converted from spheroidal shape towards hexagonal and finally to a fully extended spindle shaped configuration. The three morphological types of fibroblasts at 48 hours were F-I, F-II and F-III. Aqueous extract of raw arecanut exhibited significant cytotoxicity (p < .0 001) at all time periods studied, when compared against the control values of untreated fibroblasts. Addition of reduced glutathione to cultures showed a significant (p < 0. 001) reduction in cytotoxicity, as indicated by higher optical density values and morphological reversion to the spindle-shaped configuration. CoCONCLUSION:Addition of glutathione reduced the cytotoxic and morphological alterations of the fibroblasts treated with aqueous extracts of both raw and boiled arecanut.

Effect of habitual arecanut chewing on resting whole mouth salivary flow rate and pH.

BACKGROUND: Resting whole mouth salivary flow rate (SFR) and pH play a significant role in pathogenesis of various oral diseases and conditions. AIM: To observe the effect of habitual use of arecanut and various arecanut containing products (AN) on SFR and pH. DESIGN: Cross sectional. SETTING: Outpatient Department of Dental College. PARTICIPANTS: AN chewers and non-chewers attending Dental college. MEASUREMENTS: SFR and pH. VARIABLES: Type, frequency, duration and exposure time of AN, Smoking and Alcohol habit. MATERIALS AND METHODS: Subjects study was divided into chewers (n=110) and non- chewers (n=50). The SFR (expressed in mL/10min) and pH measured. RESULTS: The difference between the mean SFR for chewers and non-chewers was not statistically significant. The difference between mean pH of chewers and non-chewers was statistically significant. (P=0.02). Difference in pH was statistically significant among the different types of AN chewers (P=0.024). With chewing raw AN, an increase in frequency and exposure time increased SFR and pH respectively. In processed AN chewers, increase in duration and frequency of consumption increased SFR and decreased pH respectively. For chewers with betel quid with tobacco, increase in duration was significantly associated with decrease in salivary pH. CONCLUSION: SFR and pH are altered in AN chewers, rendering the oral mucosa vulnerable to the toxic effects of AN.

A light microscopic study of fibrosis involving muscle in oral submucous fibrosis.

Oral submucous fibrosis (OSF) is a common pre-malignant condition of the mouth in arecanut chewers in Indian subcontinent. It is characterized by restriction in opening of the mouth, tongue protrusion, and cheek flexibility. Reports of muscle changes in OSF, using light microscopy are few. Incisional biopsy sections of thirty OSF patients were stained with Masson's Trichrome stain, to study the fibrosis involving the muscle. Wide spectrum of changes were observed where fibrosis was being evident sub-epithelially, not extending in to the muscle to cases where only a few remnants of muscle fibers were seen and the missing muscle bundle area being replaced by fibrous tissue. The probable mechanism by which these changes occur is discussed.

Cytological study of copper in oral submucous fibrosis.

BACKGROUND: Habitual arecanut chewing is associated with Oral Submucous Fibrosis (OSF). High copper content in arecanut plays a vital role in pathogenesis of OSF. This study evaluates the copper-staining pattern of buccal epithelial cells in oral cytological smears of non-chewers, chewers, and OSF. MATERIALS & METHODS: Alcohol fixed buccal epithelial smears of 10 histopathologically confirmed cases of OSF, 10 chewers without lesion, and 5 nonchewers were stained with modified Rhodamine technique and studied under the light microscope. Buccal epithelial smears of non-chewers dipped in copper sulphate solution were used as known positive for copper. RESULT: Copper appeared as shades of palered within the cytoplasm of chewers and did not show any stain in non-chewers. Intense red stain was seen in OSF smears as dark granules within the cytoplasm. CONCLUSION: Intense staining of copper in OSF buccal smears, than in the chewers supports the role of copper in the pathogenesis of OSF.

Oral intra vascular papillary endothelial hyperplasia in the floor of the mouth.

Intravascular papillary endothelial hyperplasia (IPEH) is an unusual vascular lesion of proliferating endothelial cells. It is more frequently seen in the extremities, particularly in the fingers. Oral IPEH has been reported with the common sites being lip, tongue, and buccal mucosa. In this article, we present a case of oral IPEH of the floor of the mouth, an unusual location, presenting in a 9-month-old male. The histogenesis, histologic features, and ultrastructural features are also reviewed. A misdiagnosis of angiosarcoma can be made in a case of IPEH due to similar histopathologic features. It is imperative to rule out this error by an elaborate histopathologic evaluation ofthese lesions.