Dysbiosis linking periodontal disease and oral squamous cell carcinoma-A brief narrative review.

An association between periodontal disease and oral squamous cell carcinoma (OSCC) has been recognized. However, there is no causal relationship between the two. The polymicrobial etiology of periodontal disease is confirmed, and so are the proven etiological factors for OSCC. Inflammation lies at the core of periodontal pathogenesis induced by the putative microbes. OSCC has inflammatory overtures in its pathobiology. Bacterial species involved in periodontal disease have been extensively documented and validated. The microbial profile in OSCC has been explored with no specific conclusions. The scientific reasoning to link a common microbial signature that connects periodontal disease to OSCC has led to many studies but has not provided conclusive evidence. Therefore, it would be beneficial to know the status of any plausible microbiota having a similarity in periodontal disease and OSCC. This brief review attempted to clarify the existence of a dysbiotic "fingerprint" that may link these two diseases. The review examined the literature with a focused objective of identifying periodontal microbial profiles in OSCC that could provide insights into pathogen commonality. The review concluded that there is great diversity in microbial association, but important bacterial species that correlate with periodontal disease and OSCC are forthcoming.

Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions.

BACKGROUND: Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long-term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users. METHODS: A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB-2 was used to evaluate the methodological quality of the included studies. RESULTS: A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ-related parameters from baseline to follow-up intervals. Temporary increases in TMJ-related pain or symptoms at the beginning of the follow-up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs. CONCLUSION: The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ-related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.

Changes in Pulp and Roots of Deciduous Teeth during Different Stages of Physiologic Resorption: A Histologic Study.

Background: Resorption of primary teeth and eruption of permanent teeth involves a complex series of changes. The cellular and histological changes occurring during the process of resorption vary stagewise. The knowledge of the changes occurring in the pulp of deciduous teeth would provide information about the resorptive process. Aim: To evaluate the histologic changes of the pulp of deciduous teeth related to different stages of physiologic root resorption. Study setting and design: To establish the cause and effect relationship, a contrived histologic study design was planned. Materials and methods: A total of 60 extracted deciduous incisors, canines, and molars were included in the study. The remaining root length (RRL) was determined based on the standardized photographs. The teeth were then grouped into three based on the percentage of RRL. The teeth were subjected to decalcification with 5% nitric acid, following which histological processing was performed. Statistical analysis: The present study being a qualitative study design, descriptively explains the histologic findings, and no statistical tests have been applied. Results: During the initial stages of resorption, there were no histological alterations noted in the pulp, particularly in the cervical 3rd, with the cellular structure relatively maintained. As the resorption progresses, reversal lines were evident, indicating a process of repair occurring simultaneously during the process of resorption. With further advancement, the repair is overtaken by the resorption indicated by the presence of resorptive cells. Neovascularization and an increase in immune cells are also evident in advanced stages. Conclusion: The pulp exhibits progressive changes as the resorption continues from stage I to stage III. The changes vary from a smaller number of immune cells and odontoclasts in stage I to increasing number of the same as resorption progresses. How to cite this article: Murthy P, Bhojraj N, Hegde U. Changes in Pulp and Roots of Deciduous Teeth during Different Stages of Physiologic Resorption: A Histologic Study. Int J Clin Pediatr Dent 2023;16(3):437-443.

Adult-onset Langerhans cell histiocytosis - A Trojan horse of oral cavity: A case report with rare clinical presentation.

Langerhans cell histiocytosis (LCH), earlier recognised as histiocytosis X, is a rare haematological illness involving infants and young children. LCH is caused by unrestrained stimulation and proliferation of usual antigen presenting cells, Langerhans cells (LCs) and the disease demonstrates extensive clinical and radiographic features involving multiple sites. Since the incidence is relatively low limited data is available regarding the epidemiology of LCH, with approximation of 2-5 cases per million populations per year. LCH has male predilection with jaws involved in 10-20% cases and only 1% of the cases affecting maxilla, masquerading as periodontal or periapical pathology. We report a case of 48-year-old female with LCH involving posterior maxilla. This is a unique presentation corresponding to age, gender, location and severity. Dental clinicians should be aware of this and consider it to be a part of their differential diagnosis pertaining to unresolved periodontal pathology as it mimics clinically and radiographically.

Micrometastasis detection using modified papanicolaou stain in nodal tissues of oral squamous cell carcinoma - A histological study.

CONTEXT: Cervical lymph node metastasis is the most important prognostic factor in Squamous Cell Carcinoma of Head and Neck (SCCHN). Detection and evaluation of micro-metastasis forms the basis for diagnosis, staging, treatment options and prognosis. Lymph node prognostic factors are extremely important for the survival and recurrence in the patient. Assessing lymph node metastasis in the absence of clinical enlargement is challenging. AIM: To evaluate micrometastasis and individual tumor cells (ITC) in regional lymph nodes of oral squamous cell carcinoma (OSCC) by modified papanicolaou (PAP) stain and re-evaluate the tumor staging. SETTINGS AND DESIGN: The retrospective study was executed at MS Ramaiah University of Applied Sciences. METHODS AND MATERIALS: The current study constituted a total of 40 lymph nodes from OSCC patients, metastatic (n=20) and non-metastatic lymph nodes (n=20). All sections were stained with H & E followed by modified PAP stain. Modified PAP was used for identification of micrometastasis deposits. STATISTICAL ANALYSIS USED: The Chi square test was employed to analyze significance. RESULTS: Modified PAP stain proved to be more accurate (p = 0.006) than H and E stain in detecting micrometastasis which accounted for 15% of non-metastatic lymph node sections used in our study. CONCLUSION: Special stain like modified PAP stain is valuable and sensitive in detecting micro-metastasis over H and E stain. Detection of micrometastasis in OSCC patients is advantageous for the patient as it influences staging, it modifies the treatment plan in terms of both radiotherapy and chemotherapy.

Immunohistochemistry: An indispensable aid in diagnosis and management of infantile myofibroblastoma.

Myofibroma is a benign tumor of myofibroblasts occurring commonly in infants and children. It can occur as a solitary lesion or as multiple lesions in the soft tissues or intraosseously. The presence of the solitary lesion is common in the soft tissues of the head-and-neck region but rare in jawbones. Histologically, it has a biphasic pattern of presentation and mimics spindle cell tumors. Immunohistochemistry is essential for its confirmatory diagnosis. This article describes a case of this rare lesion presenting as a solitary lesion in the left body of the mandible in a 7-month-old boy baby. The diagnostic and therapeutic challenges have been discussed.

Primary intraosseous squamous cell carcinoma ex-odontogenic cyst.

Squamous cell carcinomas of the oral cavity are quite common, but primary intraosseous squamous cell carcinomas (PIOSCCs) are rare. Their origin from lining of different odontogenic cysts has been documented. More than 50% of such cases have been reported to occur in periapical inflammatory cysts, and less than 10 cases are reported to arise from odontogenic keratocyst (OKC). One such rare case of a PIOSCC, which presented as an OKC initially, is being reported.

Surface Nanohardness of Normal and Fluorosed Enamel Adjacent to Restorative Materials: An In Vitro Study and Polarized Light Microscopy Analysis.

AIM AND OBJECTIVE: To evaluate nanohardness of normal and fluorosed enamel in teeth restored with Cention N (CN), Equia forte (EF), glass ionomer cement (GIC), and resin composite using the nanoindentation test. MATERIALS AND METHODS: Eighty freshly extracted human premolars were selected. Standardized cavities were prepared on the buccal surface of normal (40) and fluorosed (40) teeth. Based on the type of the restorative material, the teeth were subgrouped into (n = 10): CN, EF, Type VIII GIC, and Tetric N-Ceram (TNC). The teeth were subjected to pH cycle (progressive caries test), which consisted of alternative demineralization (18 hours) and remineralization with artificial saliva (6 hours) for 3 consecutive days. Surface nanohardness was determined using a nanoindenter at distances of 100, 200, and 300 µm from the restoration-tooth margin. A polarized light Microscope was used to correlate the effect of remineralization on the enamel. Data were analyzed by one-way ANOVA with the Scheffe's post hoc and independent t-test. RESULTS: Nanohardness values of the fluorosed/normal enamel adjacent to various materials in descending order were as follows: EF 3.67/2.95 GPa, GIC 3.33/3.15 GPa, CN 3.13/3.23 GPa, and TNC 1.17/1.82 GPa, respectively. Statistically significant differences were found among various materials in both types of the enamel (p < 0.05). CONCLUSION: Based on the nanohardness test, EF can be a better choice for restoration in fluorosed teeth, followed by CN and GIC; GIC was better in normal enamel; however, this was not significant compared to CN and EF. Tetric N-Ceram composite resin had least influence on increasing the nanohardness of the adjacent enamel. CLINICAL SIGNIFICANCE: The surface nanohardness of normal and fluorosed enamel can be influenced by the type of restorative material used. The results of present study deserve clinician's attention while selecting restorative materials especially in dental fluorosis.

A clinical evaluation on the effect of astringent on keratinization of oral mucosa before and after the insertion of complete denture.

CONTEXT: Conventional complete dentures still remain a viable method of treatment for many patients in this era of fixed prosthesis like dental implants. All patients undergoing complete denture treatment need nonsurgical preprosthetic treatment for the preparation of healthy denture bearing mucosa as well-keratinized healthy mucosa is desirable for a complete denture. AIMS: To evaluate and compare the keratinization before and after denture insertion at intervals of 1 week and 1 month. SETTINGS AND DESIGN: The present study was conducted on 24 completely edentulous male subjects divided into control and study groups. Each patient in study group was asked to massage with astringent on the denture bearing mucosa over a 4-week period. SUBJECTS AND METHODS: Exfoliative cytology was used to collect the surface cells from the palatal mucosa and buccal mucosa. The first smear was taken before the denture insertion. The second and third smears were taken after the stimulation treatment with astringent gel for each patient after 1 week and after 4 weeks. Each smear was stained with the Papanicolaou's technique. The number of basal cells, intermediate cells, and superficial cells were recorded to calculate the degree of keratinization. STATISTICAL ANALYSIS USED: Descriptive statistics, paired samples t-test, independent t-test, and repeated-measures analysis of variance. RESULTS: The result showed statistically significant increase in the keratinization of palatal mucosa after 4 weeks of astringent therapy and no effect was noted in the keratinization of buccal mucosa. CONCLUSIONS: Astringent has shown to increase keratinization of palatal mucosa, and so it can be used to increase the quality of the denture bearing mucosa; moreover, the astringent stimulation has no effect on the keratinization of buccal mucosa.

Role of community health worker in a mobile health program for early detection of oral cancer.

BACKGROUND: The global incidence of oral cancer occurs in low-resource settings. Community-based oral screening is a strategic step toward downstaging oral cancer by early diagnosis. The mobile health (mHealth) program is a technology-based platform, steered with the aim to assess the use of mHealth by community health workers (CHWs) in the identification of oral mucosal lesions. MATERIALS AND METHODS: mHealth is a mobile phone-based oral cancer-screening program in a workplace setting. The participants were screened by two CHWs, followed by an assessment by an oral medicine specialist. A mobile phone-based questionnaire that included the risk assessment was distributed among participants. On specialist recommendation an oral surgeon performed biopsy on participants. The diagnosis by onsite specialist that was confirmed by histopathology was considered as gold standard. All individuals received the standard treatment protocol. A remote oral medicine specialist reviewed the uploaded data in Open Medical Record System. Sensitivity, specificity, positive and negative predictive values were calculated. Inter-rater agreement was analyzed with Cohen's kappa coefficient (κ) test, and the diagnostic ability of CHWs, onsite specialist, and remote specialist was illustrated using receiver operating characteristic curve. RESULTS: CHWs identified oral lesions in 405 (11.8%) individuals; the onsite specialist identified oral lesions in 394 (11.4%) individuals; and the remote specialist diagnosed oral lesions in 444 (13%). The inter-rater agreement between the CHW and the onsite specialist showed almost perfect agreement with the κ score of 0.92, and a substantial agreement between CHW and remote specialist showed a score of 0.62. The sensitivity, specificity, positive and negative predictive values of CHWs in the identification of oral lesion were 84.7, 97.6, 84.8, and 97.7%, respectively. CONCLUSION: The trained CHWs can aid in identifying oral potentially malignant disorders and they can be utilized in oral cancer-screening program mHealth effectively.

Pigmented calcifying cystic odontogenic tumor associated with compound odontoma: Report of a rare case and review.

Calcifying cystic odontogenic tumor (CCOT) is a rare lesion accounting for only 2% of all odontogenic cysts and tumors. CCOTs can occur alone or in association with other odontogenic tumors such as odontomas. Pigmented intraosseous odontogenic lesions are rare. Among them, pigmented CCOT is known to occur with greater frequency. Only six cases of combination of pigmentation CCOT associated with odontoma have been reported in the literature. We herein present such a rare case occurring in the maxillary anterior region in a 13-year-old female patient.

Enamel Surface Morphology: An Ultrastructural Comparative Study of Anterior and Posterior Permanent Teeth.

INTRODUCTION: Enamel is one of the most important structures of the tooth, both functionally and aesthetically. Because of the highly mineralized nature of enamel, its structure is difficult to study under routine light microscopy. Since scanning electron microscopy (SEM) offers the possibility of studying structures under very high magnification without altering the gross specimen, it is one of the best methods to study the enamel surface. AIMS AND OBJECTIVES: To study and compare the surface morphology and morphometry of enamel on various surfaces of permanent dentition. MATERIALS AND METHODS: A total of 20 permanent teeth were analyzed under the SEM. In both anterior and posterior teeth, four surfaces - mesial, distal, labial, and lingual - in three thirds - cervical, middle, and incisal - were studied. In addition, the occlusal surface was also studied for the posterior teeth. The different prism morphology and prism dimensions were recorded. RESULTS: Based on our observations, we could definitely identify striae of retzius, debris, and cracks under ×50 magnification. Three morphological patterns of prism arrangement were identified: Type 1 - shallow prisms, Type 2 - well-defined prisms, Type 3 - microporosities, on analyzing the mesial, distal, labial, lingual, and occlusal surfaces of the permanent teeth, at ×3000 magnification. The prisms were measured under ×6000 magnification and the results showed larger prisms in posterior than in anterior teeth. CONCLUSION: The study aided us in categorizing the enamel prism structure based on morphology and morphometry in anterior and posterior teeth of the permanent dentition.

Chondroid Tenosynovial Giant Cell Tumor of Temporomandibular Joint.

Tenosynovial giant cell tumor (TGCT), a benign proliferative lesion arising from the synovial membrane of the joints, is rarely seen in the temporomandibular joint. It frequently presents as a painful, preauricular swelling and affects the jaw functions. Two types of TGCT seen are diffuse TGCT (TGCT-D) and localized TGCT. A case of TGCT-D is described here, the highlight of the case being extensive areas of chondroid metaplasia which mimicked chondroid lesions, but was ruled out based on negative immunohistochemical findings within the tumor cells.

Inter- and Intra-Observer Variability in Diagnosis of Oral Dysplasia

Background: Oral potentially malignant disorders (OPMDs) are lesions from which malignancy is more likely to develop that from other tissues. The potential for malignant transformation of OPMDs is estimated by determining the degree of dysplastic changes in the epithelium. Dysplasia grading has been criticized for lack of reproducibility and poor predictive value but is still considered the gold standard for diagnosing OPMDs. Since grading of dysplasia is based on architectural and cytological changes, there can be considerable inter- and intra-observer variability due to subjective impressions. This aim in this study was to assess the degree of agreement between two pathologists grading dysplasia in the same patients and review the existing grading system. Materials and Methods: In this hospital-based cross-sectional study, 100 patients with clinically diagnosed OPMDs were subjected to biopsy followed by histopathological examination. The slides were examined by two pathologists using WHO and binary systems of classification and both were blinded to the clinical and each other's histological diagnosis. For statistical analysis the Chi square test was applied. Results: Statistical analysis showed poor inter-observer variability with P values of 0.8 using the WHO classification and 0.3 using the binary classification. Conclusion: Our study provides evidence that the existing systems for grading dysplasia are not competent to rule out subjectivity. There is a need for a classification system that can overcome this drawback.

Pseudolymphoma versus lymphoma: An important diagnostic decision.

Small innocuous growths on the face usually do not pose difficulty in diagnosis on histopathology. However, some benign inflammatory lesions might mimic malignancy and hence need further investigations for final diagnosis. The distinction between a benign/inflammatory/malignant lesion needs no emphasis as the treatment plan, prognosis and the patient's well-being depends on it. Lymphocytoma cutis, or Spiegler-Fendt Sarcoid, is classed as one of the pseudolymphomas, referring to inflammatory disorders in which the accumulation of lymphocytes on the skin resembles, clinically and histopathologically, cutaneous lymphomas. To obtain an accurate diagnosis, careful clinical evaluation, as well as histopathological and immunohistochemical examination is needed. One such case of an otherwise unassuming growth mimicking malignancy is being presented.

Comparison of Microwave Versus Conventional Decalcification of Teeth Using Three Different Decalcifying Solutions.

BACKGROUND: In routine histopathology, decalcification of teeth is an essential and important step during tissue processing. The present study was attempted to decalcify teeth using microwave method and to compare it with conventional decalcification method. AIM: To compare microwave decalcification with conventional decalcification method with respect to the speed of decalcification, preservation of tissue structure, and efficacy of staining. MATERIALS AND METHODS: A total of 72 single-rooted premolars were used for both conventional and microwave decalcification methods. Three different types of decalcifying agents at 5% and 7% were used. Decalcifying agents included nitric acid, formic acid, and trichloroacetic acid, each at 5% and 7%. About 6 teeth were included in each category and were decalcified by both conventional and microwave method. After decalcification, all the teeth were examined macroscopically and microscopically. Cramer's V-test was used to determine the statistical significance. RESULTS: The results have shown that microwave method using 5% and 7% nitric acid were the fastest. Structural details and good staining characteristics were better in teeth decalcified by 5% nitric acid and 5% trichloroacetic acid by both the methods. CONCLUSIONS: 5% nitric acid by microwave method proved to be the best decalcifying agent as it was fast and gave good structural details and staining characteristics.

Smokeless Tobacco-associated Lesions: A Mobile Health Approach.

AIM: Globally, India accounts for the highest number of oral cancer cases. The survival rates are about 30% lower than those in developing countries. The main reason for these dismal figures is the late presentation of patients. In order to downstage oral cancer in such a scenario, screening and diagnosis at an early stage is warranted. A pragmatic approach is needed for an oral cancer screening program, hence a mobile health (mHealth) approach was used. In this approach, health workers were empowered with mobile phones with decision-based algorithm. Risk stratification of tobacco habit enables us to identify lesions associated with particular habits. MATERIALS AND METHODS: A specific cohort of factory employees who predominantly had pure tobacco chewing habit was chosen to examine the effect of pure tobacco on oral mucosa. One thousand three hundred and fifty-seven subjects were screened in two phases. In the first phase, habits and oral lesions were identified and photographed. The photographs were remotely diagnosed by an oral medicine specialist and those subjects requiring biopsy were recalled for phase II. Cytology and biopsy were performed in phase II. RESULTS: The predominant habit was smokeless tobacco (SLT), in 582 subjects. The most commonly encountered lesion was tobacco pouch keratosis seen in 397 subjects. Biopsy was performed for 71 subjects, most cases showed hyperkeratosis and mild dysplasia. One subject had moderate dysplasia. CONCLUSION: There was minimal alteration of tissues in our study subjects, which can be considered as low-risk. Use of mHealth empowered frontline healthcare workers to identify subjects with lesions and enabled remote diagnosis by specialist in resource-constrained settings. CLINICAL SIGNIFICANCE: Use of mHealth enabled us have an electronic record of subject details. This data shall be used for a planned follow-up of the same cohort after 3 years.

Treatment guidelines and prognosis of immune reconstitution inflammatory syndrome patients: a review.

Immune reconstitution inflammatory syndrome (IRIS) is an "unmasking" or paradoxical worsening of a pre-existing infection after commencement of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV) - infected patients. The use of HAART in the management of HIV patients restores immune responses against pathogens however in few patients, the reconstituted immune system leads to IRIS. As the treatment protocols are not standardized for IRIS, this leads to short-term morbidity or in some cases also mortality. Therefore, treatment in these patients is a huge challenge and further more research regarding the immunopathogenesis, diagnosis and management of IRIS should be well thought-out. To understand the immunopathogenesis of IRIS it will be difficult to elucidate the intrinsic dynamics of immune cells after initiation of HAART but, there are few biomarkers which help to predict or diagnose IRIS and develop specific treatment, following initiation of HIV therapy. This review is an attempt to put light on those patients with IRIS with treatment guidelines for the management of the progression of it.

Lipoid proteinosis: a rare encounter in dental office.

Lipoid proteinosis is a sporadic congenital metabolic disorder which is characterized by deposition of hyaline material in dermis, submucosal connective tissue, and various internal organs. It has an extremely low prevalence rate with less than 300 cases reported so far. This progressive disease has a vast spectrum of manifestations ranging from asymptomatic lesions to fatal seizures and respiratory obstruction making timely diagnosis of this rare disorder an imperative task for oral health care practitioners. We report a case of characteristic oral manifestations of lipoid proteinosis in a 28-year-old male patient along with a review of relevant prevailing literature.

Enriched vascularity in ameloblastomas, an indeterminate entity: Report of two cases.

Vascularity is a highly essential element that is required for the growth, development, and functioning of the body and variations in it can cause pathologies. It is one of the prime features of a proliferating lesion, where it aids in the growth of the lesion through its nutrition supply. Highly increased vascularity in a disease can itself affect the prognosis of the lesion, and in malignancies, it can induce tumor seeding and secondaries. Most of the pathologies including tumors, related to blood vessels, and vascularity are well established. There are some conditions, wherein altered vascularity is one of the prime components along with other diagnostic components of an established disease. In such cases, these lesions are diagnosed with special names, with varying biological behavior and prognosis in comparison to that of established entity. However, there still are few similar conditions whose nature is uncertain due to the rarity of the lesion and the insufficient scientific evidence which eludes the diagnostician. Here is the report of two cases of ameloblastoma, an established entity, with significant vascularity whose nature is indeterminate.