Levamisole Monotherapy in Treatment of Oral Lichen Planus-A Clinical Study

Background Oral lichen planus is a chronic inflammatory disease of oral mucosa which rarely undergoes spontaneous remission and has potential for malignant transformation. There are several different kinds of treatment that have been used to treat chronic oral lichen planus. Most commonly advised treatment is steroid therapy to treat oral lichen planus either in topical form or systemically. As steroid therapy has various underlying adverse effects other alternative drug has to be used in the treatment of oral lichen planus. Objective The aim of the study is to evaluate the efficacy of levamisole monotherapy in oral lichen planus. Methods Seven patients who had oral lichen planus were treated with levamisole 50 mg thrice daily for 3 consecutive days and not administered for the following 4 days. Result After 2 weeks of treatment, four patients reported with partial response, three patients had no response and no patients showed clearance of the lesion. Furthermore, after 2 months of treatment, five patients showed clearance of lesion, one patient showed partial response and one patient had no response to therapy. There were no significant side effects noted. Conclusion Levamisole therapy can be a substitute to steroid therapy in treating oral lichen planus in patients who can't take steroids.

Reduction and Fixation of Zygomatic Complex Fractures with Miniplates at the Fronto-zygomatic Suture and Zygomatic Buttress Area-A Clinical Study

Background Zygomatico-maxillary complex fractures are one of the most frequently occurring injuries of the facial skeleton due to its position and also the facial contour. The principal aetiologic factors that may result in zygomatic bone fracture include assaults, road traffic accidents and also falls. There are many methods of fixation that have been applied for treatment of zygomatic arch fractures. Aim To reduce and fix the zygomatic complex fracture using miniplates at the fronto-zygomatic suture and zygomatic buttress area. Material and method The present study includes five cases of zygomatic complex fractures who visited the Department of Oral and Maxillofacial Surgery in Government Dental College and Hospital, Hyderabad. The operative procedure adopted was the lateral bow incision for exposure of fronto-zygomatic suture, the Gillie temporal approach for reducing the zygoma and intra-oral incision for exposure of zygomatic buttress fracture. Fixation was done with miniplates at the fronto-zygomatic suture and the zygomatic maxillary buttress suture. Result All the cases were successfully treated without any post-operative complications and with uneventful restoration of aesthetics and function.

A Case Report on Marfan Syndrome

Marfan syndrome (MS) is a disorder of the connective tissues characterised by various phenotypical and genetic manifestations. About 75% of the time, the condition is inherited from a parent, whereas 25% of the time, it is a new mutation. It involves a mutation to the gene that makes fibrillin. People with Marfan tend to be tall and thin, with long arms, legs, fingers and toes. They also typically have long face, prognathic maxilla, high arched palate, irregularly aligned teeth, flexible joints and scoliosis. The most serious complications involve the heart and aorta with an increased risk of mitral valve prolapse and aortic aneurysm. Other commonly affected areas include the lungs, eyes, bones and the covering of the spinal cord. Here, we report a case of Marfans syndrome with focus on oral manifestations to increase the awareness among dental practitioners to avoid complications due to infective carditis and cardiac defects.

Papillon-Lefevre Syndrome-A Report of Two Cases

Papillon-Lefevre syndrome is a rare autosomal recessive trait characterised by palmoplantar hyperkeratosis and precocious loss of both deciduous and permanent teeth. The aetiology is multifactorial with genetic, immunological, microbiological factors being considered a main etiopathogenic factors. We present here two cases of two siblings affected with Papillon-Lefevre syndrome.

Revisiting the Efficacy of Immunomodulatory Effect of Hydroxychloroquine in Oral Lichen Planus: A Case Series

Oral lichen planus (OLP) is a common inflammatory, autoimmune disorder that affects stratified squamous epithelium. The exact etiopathogenesis of this mucocutaneous disease is still uncertain. Although OLP has been associated with altered Quality of Life and considerable morbidity, with important note for erosive type of OLP, its treatment is often disappointing and controversial. Though corticosteroids remained the first line of treatment for OLP, the associated adverse effects of corticosteroids are not acceptable. Hence, there is a need of drugs with steroid sparing effect. Use of immunomodulators is systemic pathologies is widely encountered. However, their use in oral lesions is not frequently seen. Use of hydroxychloroquine (HCQ), an age-old disease-modifyinganti-rheumatic-drug, has been widely used in various autoimmune diseases; however, it received little attention in treatment of OLP. This article presents a case series of three patients with erosive OLP which were managed with HCQ. The results presented allow the authors to consider systemic HCQ as a newer therapy for atrophicerosive lichen planus.

Evaluation of Plasma Fibrinogen Degradation Products and Total Serum Protein Concentration in Oral Submucous Fibrosis

Background Oral submucous fibrosis (OSF), a potentially malignant disorder, is a chronic, inflammatory, progressive debilitating disease of the oral cavity with a multifactorial etiology. As an inflammatory response, more fibrinogen and its degradation products are produced by the body in OSF patients. Detection of these plasma fibrinogen degradation products (FDP) in OSF patients has contributed a new direction to enlighten the etiopathogenesis of OSF. Objectives To ascertain the role of FDP of OSF patients in betel nut chewers and in control subjects and also to estimate serum levels of proteins in the patients. Materials & Methods The study included 25 clinically diagnosed oral submucous fibrosis patients with betel nut chewing habit & 25 healthy controls without any deleterious habits. All the patients were evaluated for fibrinogen degradation productions and total serum protein concentration (TSP) by agglutination and Biuret method respectively. The results were analysed using unpared ttest and Pearson chi square test. Results The study revealed an increased FDP level in all the betel nut chewers with OSF when compared with the healthy individuals. There was a marginal increase in Total serum Protein concentration levels in OSF patients, thus inferring to a positive correlation between FDP and TSP in all OSF cases. Conclusion This study validates the relationship of plasma FDPs in the etiology of OSF and can be used to measure the prognosis of the disease. Plasma FDP may also be useful as a nonsurgical diagnostic tool in suspected OSF cases without necessitating a histopathological confirmation. However, further studies with a larger sample size may be required to elucidate the precise role of plasma FDP levels and detailed fractional analysis of protein in OSF, thus facilitating to obtain more conclusive results. It can be suggested that biochemical assessment of patients with areca nut chewing habit may help in the earlier diagnosis of OSMF and thus may lead to a better prognosis of these lesions.

A Comparative Study of Micronuclei in Oral Exfoliated Epithelial Cells in Potentially Malignant and Oral Squamous Cell Carcinoma

Background Micronuclei are small, additional nuclei formed as a result of exclusion of chromosome fragments or the whole-chromosome lagging at mitosis. Micronuclei indirectly reflect the chromosomal breakage or impairment of mitotic apparatus. Micronuclei in exfoliated oral epithelial cells are widely used as biomarkers of chromosomal damage, genome instability and cancer risk in humans. Micronuclei scoring can be used as a biomarker to identify different preneoplastic conditions much earlier than manifestations of clinical features and might specifically be exploited in screening of high-risk population for a specific cancer. Aim To correlate frequency of micronuclei in oral exfoliated cells in clinically diagnosed cases of potentially malignant disorders (PMDs) and oral squamous cell carcinoma. Material and Methods The study subjects consisted of clinically and histopathologically diagnosed cases of oral squamous cell carcinoma, oral sub mucous fibrosis and leucoplakia. Healthy subjects without any tobacco consumption habits formed the control group. The cytosmear from all the four groups were stained with Papanicolaou stain. Micronuclei were identified according to the criteria given by Tolbert et al. (1992). Result The frequency of micronuclei was higher in patients with oral squamous cell carcinoma as compared to the other subject groups and the difference was found to be highly significant. Conclusion This study concluded that there is gradual increase in micronuclei counts from normal oral mucosa to PMDs to oral carcinoma.

Estimation of Serum Folate and Homocysteine Levels in Oral Submucous Fibrosis-A Prospective Study

Aim & Objective The aim of the study was to evaluate the levels of serum folate and homocysteine in clinical stages of Oral submucous fibrosis (OSF) patients. Methodology The study sample comprised of 40 clinically and histopathologically diagnosed OSF patients those who are not undergoing treatment and 10 healthy controls. OSF was categorised by clinical staging. Serum foliate and homocysteine levels estimation was done by reverse phase high performance liquid chromatography analysis unit and chemiluminescence immuno assay, respectively. Results were statistically analysed using one-way ANOVA [Analysis of variance]. Results Irrespective of age and gender, serum folate deficiency and high levels of homocysteine were noted in OSF patients when compared with healthy controls. Conclusion Serum hyper homocysteinemia and folate deficiency were noted with the progression of the disease. Folate supplements can be given to decrease the levels of homocysteine, to arrest the progression of the disease. However, further longitudinal studies are needed to establish an association between serum homocysteine and serum folate.

Modified Bisecting Angle Technique: A Novel Method to Eliminate Zygomatic Superimposition over the Apices of Maxillary Molars

Objectives Intra oral radiographic imaging is the most widely used method for obtaining information about root canal anatomy and working length determination. Measuring exact working length is the most essential step for the success of root canal treatment. Bisecting angle technique (BAT) is the most widely used technique for this purpose. However, zygomatic superimposition over the apices of maxillary molars makes it difficult for the dentist to estimate exact working length. The present study made certain modifications in BAT to overcome these undiagnostic shadows. The aim of the study is to compare three techniques, namely paralleling cone technique (PCT), BAT and modified bisecting angle technique (MBAT) to prevent such superimposition over molar apices. Materials and Methods A total of 53 patients requiring endodontic treatment for maxillary molars were included in the study. Three radiographs one with each PCT, BAT, MBAT were made. Each radiographic image was recorded acceptable or unacceptable based on the zygomatic superimposition. The data thus collected was subjected to statistical analysis using chi-square test. Results The percentage of acceptability in MBAT was 56.6% (n = 30) when compared with BAT which was only 28.3% (n = 15) and PCT was 58.3% (n = 31) indicating statistically significant difference between BAT and MBAT. But no statistically significant difference was found between MBAT and PCT. Conclusion In the present study, MBAT was found to be more accurate than BAT, and it was relatively as accurate as PCT in eliminating zygomatic superimposition over the apices of maxillary molars.