Nasopalatine Duct Cyst with Impacted Inverted Mesiodens: A Rare Case Report and Literature Review.

Nasopalatine duct cyst (NPDC) is a non-odontogenic, developmental epithelial cyst that accounts for 1% of maxillary cysts. It often arises due to the spontaneous proliferation of the epithelial tissue remnants, although trauma, bacterial infection, and mucous retention may also trigger the proliferation. Owing to its slow-growing, asymptomatic nature, the cyst is often discovered as an accidental finding during routine clinical and radiographic examinations. However, the majority of cases present as a tiny, asymptomatic swelling just posterior to the palatine papillae. Radiographically, it appears as a well-defined oval or round radiolucency in the maxillary anterior teeth region and should be differentially diagnosed with inflammatory periapical lesions and a wide incisive foramen. A pulp vitality test is essential to rule out lesions of endodontic origin. Microscopically, NPDCs display a mixed pattern of the epithelial lining and exhibit neurovascular bundles (small to medium-sized nerves, arteries, and veins), and minor salivary glands in the cystic connective tissue, a distinctive feature facilitating a confirmatory diagnosis. Enucleation and marsupialization remain the treatment of choice. NPDC associated with impacted mesiodens is an extremely uncommon entity. A comprehensive literature search carried out on the PubMed and Google Scholar search engines revealed only three cases of NPDC with impacted mesiodens to date. The purpose of this study is to report an extremely rare case of NPDC associated with an impacted inverted mesiodens in a 19-year-old male patient who presented with an asymptomatic swelling in the maxillary anterior teeth region. To the best of our knowledge, this is only the fourth reported case of NPDC with impacted mesiodens.

Calcifying odontogenic cyst: Report of an uncommon entity with a brief literature review.

The aim of this clinical report is to document a rare and unusual case of calcifying odontogenic cyst (COC) in the maxillary anterior region in a 13-year-old girl. A COC is an extremely uncommon developmental, odontogenic entity and accounts for 0.3%-0.8% of odontogenic cysts. The lesion presents as an array of varied radiographic and clinicopathological characteristics and biological attributes and exists in three histomorphologic patterns - benign cystic, solid (neoplastic) and aggressive (malignant) forms. Thus, several nomenclatures and classifications have been put forth to explain the nature of the clinical entity. However, ambiguities regarding the exact nature of the lesion still prevail. Due to nonspecific clinicoradiographic features, histopathological interpretation remains the key for diagnosis. We report an uncommon occurrence of COC in a 13-year-old female who reported to our Outpatient Department with an asymptomatic right midfacial swelling. The clinical and radiographic findings were suggestive of adenomatoid odontogenic tumor and dentigerous cyst. The decision to enucleate the lesion was considered, and histopathological features were compatible with the diagnosis of COC. Re-ossification with no recurrence was noticed after a 1-year follow-up. COC is an unusual developmental odontogenic cyst that clinically and radiologically simulates other more common jaw entities. Thorough knowledge of the bizarre presentation and biological attributes of such lesions are imperative for an early diagnosis and definitive treatment. Long-term follow-up is advocated to prevent recurrences.

Isolated Lichen Planus of the Lower Lip: Report of a Rare Case with an Updated Literature Review.

Lichen planus (LP) is a chronic inflammatory, autoimmune entity typically affecting the skin, oral and genital mucosa, and skin appendages, with an underlying malignant potential. Oral lichen planus (OLP) represents the mucosal counterpart of the cutaneous LP and exhibits episodes of exacerbation and remissions. OLP typically manifests as bilateral symmetrical lesions on the buccal mucosa, followed by tongue, and gingiva. However, the occurrence of LP lesions solely on the lip is rarely reported in the literature. The altered clinical appearance of the lip lesions poses a diagnostic threat and raises the possibility of a misdiagnosis. Our aim was to report an unusual case of isolated lower lip LP, and also to carry out a literature review about isolated lip LP lesions, thus, emphasizing the demographic, clinicopathologic attributes, and therapeutic regimen. We report an uncommon occurrence of an isolated lichen planus on the lower lip in a 53-year-old male patient. Clinical evaluation revealed a diffuse erosive crusted lesion bordered by peripheral lacy radiating streaks on the lower lip. After a confirmed OLP histopathology, the patient was treated with low potency topical steroids and Vaseline therapy, with almost completely resolved lesions after 2 months of therapy. We report a rare case of isolated lip LP, and our detailed review revealed 44 reported cases of lip LP till date. The majority of the cases were seen on the lower lip and exhibited an age and gender affinity (mostly in middle-aged males). Significant healing was observed after topical steroid therapy.

Saliva and COVID 19: Current dental perspective.

Oral health care providers are at a higher risk of being infected by novel coronavirus due to close proximity to patient's face and exposure to saliva while working on the patient. Thus, there is an urgent need to interpret the available literature in order to establish safe practices for dental professionals as well as limit the spread of infection through saliva. The study intends to provide up-to-date, compiled evidence-based information related to saliva and its association with COVID-19. It further provides suggestions for safe practices in dentistry in current pandemic times. Oral symptoms may be strongly suggestive of early diagnosis and disease progression in COVID-19 patients. Viral loads in saliva are reported higher than standard nasopharyngeal swabs in few studies, majorly in the 1st week of symptom onset. Besides, salivary diagnostics has many additional advantages of being noninvasive, comfortable to the patients with the possibility of point-of-care testing for diagnosing COVID-19. High-efficiency particulate arrestor filter, rubber dam application and high-volume evacuator can reduce spatter and droplets/aerosol production. Povidone-iodine-based mouthwash maybe mouthwash of choice before any dental examination or procedures due to its ability to decrease severe acute respiratory syndrome- coronavirus 2 viral loads in the mouth. Salivary diagnostics related to COVID-19 should be integral part of dental teaching programs. There is a tremendous scope to study saliva in health and diseases.

Strengthening health care research and academics during and after COVID19 pandemic- an Indian perspective.

The world-wide crisis of COVID-19 pandemic has disrupted daily lives, global economies, intra/inter-countries political outlook and educational systems. Schools and colleges in India and abroad are under lock-down to maximize social distancing and minimize the spread of infection amongst students and teaching staff. Health sciences related universities and researchers are forced to adopt non-contact teaching and research. Present article highlights the positive impact and opportunities provided by COVID-19 crisis to health care research and academic set-up. We have compiled ethical, effective and practical guidelines to mitigate the impact on health care related research and academic front during these pandemic times in an Indian perspective. These guidelines and management suggestions can be modified to suit region based cases and can be applied in global perspective also. The suggestions in the current article provide a working collaboration of students and teachers to effectively connect on virtual platforms to strengthen their research output, giving suggestions of data-sharing and rapid review of proposals by online review ethical boards. This time is proposed to be used for generating a positive impact on health and research sector to use each adversity as an opportunity.

Telomerase: An exploration toward the end of cancer.

BACKGROUND: The distinguishing feature of cancer cells is their ability to proliferate indefinitely, which is in contrast to the restricted cell multiplication potential for somatic cells. A better understanding of this contrasting behavior was provided in the early 1990s with the discovery of a relationship between telomeres, telomerase, aging, and cancer. Telomeres (tandem repeat DNA sequence TTAGGG) are protective caps at the ends of human chromosomes. Normal human cells experience telomere shortening with each successive cell division. However, in tumor cells, an overexpression of telomerase confers limitless replicative potential to tumor cells by continuous elongation of telomeres. The objective of this review was to systematically assess the data available on telomerase expression in oral cancer, with special reference to its role in diagnosis, prognosis, and treatment. MATERIALS AND METHODS: A systematic review of studies that investigated the telomerase expression in oral squamous cell carcinoma (OSCC) was registered with PROSPERO. Subsequent to registration, a predetermined search strategy in accordance with PRISMA guidelines was formulated, and a literature search was conducted using online databases along with hand searching. RESULTS: Eighty-nine articles from PubMed, 83 from Scopus, 5 from BioMed Central, 43 from Google Scholar, and 2 from hand search were identified. A total of 21 articles were shortlisted that met strict inclusion and exclusion criteria and quality assessment. Each study was evaluated for the markers under study, type of sample used, study design/methodology, and statistical analysis. The studies were then grouped into three subheads depending on their implications in the diagnosis, prognosis, and treatment of OSCC. CONCLUSION: This review explains the basic biology and the clinical implications of telomerase-based diagnosis and prognosis, the prospects for its use in anticancer therapy, in the context of oral cancer.

Pigmented oral compound nevus of retromolar area - A rare case report.

Solitary pigmented melanocytic intraoral lesions of the oral cavity are rare. Oral nevus is a congenital or acquired benign neoplasm. Oral compound nevus constitutes 5.9%-16.5% of all oral melanocytic nevi. The oral compound nevus is commonly seen on hard palate and buccal mucosa and rarely on other intraoral sites. The objective of this article is to present a rare case report of oral compound nevus in the retromolar pad region along with a review of literature. A 22 year old female reported with a solitary black pigmented papule at retromolar pad region which was surgically removed and microscopic investigation confirmed the diagnosis of oral compound nevus.

The role of tobacco as an etiological agent for oral cancer: Cytomorphometrical analysis of the buccal mucosa in tobacco users.

BACKGROUND: Histopathological diagnosis of lesions arising from the intake of tobacco is based on subjective evaluation of morphological alterations within the lesional tissue. Oral exfoliative cytology is a non-invasive diagnostic technique for early detection of oral premalignant and malignant lesions. Morphometric techniques have been advocated as objective and reproducible methods of detecting changes before they are visible by routine microscopy and can facilitate differentiation of normal and abnormal epithelium. This study was conducted to assess the morphometric parameters (cell diameter, nuclear diameter and nuclear cytoplasmic ratio [N:C ratio]) in tobacco smokers and chewers and to evaluate the variations, if any. MATERIALS AND METHODS: The study was conducted on cytological smears obtained from oral lesions of patients with habit of tobacco smoking (Group B) and tobacco chewing (Group C). Group A comprised of subjects free from oral lesions and not using tobacco in any form. Patients with both the habits were excluded. The smears were stained using Papanicoloaou staining method. For morphometric analysis, Microimage 3.0 image analysis software was employed. The statistical test employed was an analysis of variance and P < 0.05 was considered as significant. RESULTS: The results of this study showed that the cellular diameter was progressively reduced and nuclear diameter progressively increased from Group A to Group B to Group C. The N:C ratio also showed a progressive increase from Group A to Group C. CONCLUSION: The results confirmed that tobacco chewing and smoking influenced the cytomorphology of normal appearing buccal mucosa and the degree of these changes were found to be greater in chewers as compared to smokers.

Image manipulation: Fraudulence in digital dental records: Study and review.

INTRODUCTION: In present-day times, freely available software allows dentists to tweak their digital records as never before. But, there is a fine line between acceptable enhancements and scientific delinquency. AIMS AND OBJECTIVE: To manipulate digital images (used in forensic dentistry) of casts, lip prints, and bite marks in order to highlight tampering techniques and methods of detecting and preventing manipulation of digital images. MATERIALS AND METHODS: Digital image records of forensic data (casts, lip prints, and bite marks photographed using Samsung Techwin L77 digital camera) were manipulated using freely available software. RESULTS: Fake digital images can be created either by merging two or more digital images, or by altering an existing image. DISCUSSION AND CONCLUSION: Retouched digital images can be used for fraudulent purposes in forensic investigations. However, tools are available to detect such digital frauds, which are extremely difficult to assess visually. Thus, all digital content should mandatorily have attached metadata and preferably watermarking in order to avert their malicious re-use. Also, computer alertness, especially about imaging software's, should be promoted among forensic odontologists/dental professionals.