Predicting transition from oral pre-malignancy to malignancy via Bcl-2 immuno-expression: Evidence and lacunae.

Bcl-2 (B cell Lymphoma -2) family comprises of both anti-apoptotic and pro-apoptotic proteins whose altered expression or change in ratio inhibits apoptosis, and promotes tumor progression. The aim of this study is to assess the usefulness of Bcl-2 in distinguishing dysplastic or malignant epithelium from non-dysplastic or normal epithelium to aid in prediction of malignant transformation potential. MATERIAL AND METHOD: Study group comprised of 30 cases of clinically diagnosed leukoplakia (OPMD), 15 cases of Oral Squamous Cell Carcinoma (OSCC) and 5 normal tissue samples. The labeling index of Bcl-2 was analyzed in immunohistochemically stained sections. Different statistical tools were used to analyze the data and to compare Bcl-2 expression qualitatively and quantitatively among all the groups. RESULTS: An increasing trend of Bcl-2 immunoexpression was observed from normal epithelium to non-dysplastic and from non-dysplastic to dysplastic lesions. In OSCC, the peripheral cells in the differentiating epithelial islands (within the connective tissue) showed Bcl-2 immuno-reactivity, which gradually decreased towards the center. In contrast, intense and diffuse Bcl-2 immuno-reactivity was seen in poorly differentiated carcinoma. But the overall Bcl-2 positivity was less in OSCC as compared to dysplastic lesions. CONCLUSION: Increased expression of Bcl-2 oncoprotein in sequentially progressing epithelial dysplasia and down-regulation in differentiating carcinoma (well and moderately differentiating OSCC) unveils the clinical relevance of Bcl-2 in early stages of OSCC tumorigenesis. The heterogenous expression of Bcl-2 in carcinoma with different grades of differentiation renders them unable to be used as an independent tool for predicting transition from oral pre-malignancy to malignancy.

Salivary glucose levels and oral candidal carriage in Type 2 diabetics.

BACKGROUND: To assess the correlation between salivary glucose and blood glucose levels in diabetics and non diabetics and to study the association between salivary glucose levels and oral candidal carriage in patients with Type 2 diabetes mellitus. MATERIAL AND METHOD: The study sample was divided into two groups, control and study group. The study group was again divided into two separate groups controlled diabetics and uncontrolled diabetics. Blood and saliva samples (for fasting and postprandial) were taken from each individual. RESULTS: The salivary glucose levels, highly correlated with blood glucose levels in both diabetic as well as non diabetics subjects. Salivary candidal carriage was more in oral cavity of Type 2 diabetic subjects than control subjects. CONCLUSION: Saliva has the potential to be used as a noninvasive tool to monitor glycemic status of diabetic patients.

Quantitative analysis of Argyrophilic Nucleolar organizer regions in odontogenic cysts and tumor - A comparative study.

BACKGROUND: The nucleolar organizer region (NOR) is by definition part of a chromosome, and nucleolus is a structure containing this chromosomal part and in addition the material which accumulate around the NOR, mostly rRNAs and their precursors as well as specific ribosomal proteins. Argyrophilic Nucleolar organizing region (AgNOR) are silver binding NORs often used to study cell proliferation in various types of tumors. AIM: Quantitative assessment of Argyrophilic Nucleolar organizing region count and its comparison among dentigerous cyst, keratocystic odontogenic tumor and ameloblastoma. MATERIAL AND METHOD: Forty-five histologically confirmed cases, 15 cases each of keratocystic odontogenic tumor, dentigerous cysts and ameloblastomas were examined for Argyrophilic Nucleolar organizing region. The sections were obtained and Argyrophilic Nucleolar organizer regions staining was done for comparing the proliferative capacity among these lesions. RESULT: Post hoc analysis for inter-group comparison and one way ANOVA were done in all three groups in this study. P < 0.001 was considered significant. The results of AgNOR counts were higher in KCOTs as compared to ameloblastoma and least in dentigerous cysts. The mean AgNOR counts between the study groups were compared using one way ANOVA test and the differences were found to be significant (P < 0.001). CONCLUSION: AgNOR counts were significantly higher in KCOT and ameloblastoma as compared to dentigerous cyst suggesting that these lesions have a higher proliferative capacity than dentigerous cyst. The finding of a significantly higher AgNOR counts in KCOT as compared to ameloblastoma represent a difference in proliferative activity and greater growth potential between these two lesions.

Giant keratocystic odontogenic tumor: a challenging diagnosis.

The keratocystic odontogenic tumor, although a benign lesion, is peculiarly aggressive with a high recurrence rate. Its involvement with the maxillary antrum is atypical. We report the unusual case of a 20-year-old male patient with an extensive antral tumor associated with an impacted third molar, which was initially misdiagnosed as a dentigerous cyst. Clinical, radiographic, and histopathologic aspects were analyzed to provide useful information for the correct diagnosis, treatment, and prognosis within a multidisciplinary approach.

Immunohistochemical expression of vascular endothelial growth factor in orofacial lesions - A review.

Angiogenesis is considered to be an important biological process in disease progression and tumorigenesis. Among the various factors associated with angiogenesis, vascular endothelial growth factor (VEGF) is a leading candidate. VEGF induces the proliferation, differentiation, and migration of vascular endothelial cells, increases capillary permeability, and enhances endothelial cell survival by preventing apoptosis. This article reviews and highlights the role of VEGF in health, and various oral diseases.

The role of vascular endothelial growth factor in proliferation of odontogenic cysts and tumors: An immunohistochemical study.

BACKGROUND: Vascular endothelial growth factor (VEGF) is capable of initiating angiogenesis in blood vessels and may act as mitogenic agent for epithelium of odontogenic cysts and tumors. This study was conducted to evaluate the role of epithelial VEGF expression in odontogenic cysts and ameloblastoma and its correlation with argyrophilic nucleolar organizer region counts to assess its role in their biological behavior. MATERIALS AND METHODS: In this retrospective cross-sectional study, 45 histologically confirmed cases, 15 cases of each of keratocystic odontogenic tumors (KCOTs), dentigerous cysts, and ameloblastomas were examined for immunohistochemical expression for epithelial VEGF, and argyrophilic nucleolar organizer regions (AgNORs) (used as secondary marker in this study) staining was done for comparing the proliferative capacity with VEGF. RESULTS: KCOT shows mild expression within the basal layers and strong expression in the suprabasal layer whereas, in dentigerous cysts, a majority showed no VEGF expression whereas ameloblastomas showed strong expression in all cases by stellate reticulum-like cells at the center of the follicles and suprabasal layers of epithelium. The results of AgNOR counts were higher in KCOTs as compared to ameloblastoma and least in dentigerous cysts. CONCLUSION: VEGF expression by the epithelium of odontogenic cysts and tumors may play a role in epithelial proliferation via autocrine mechanism as reflected by increased AgNOR counts. The angiogenic activity via paracrine pathway may be responsible for the difference in growth rate and neoplastic behavior of the lesions.

Central granular cell odontogenic tumor: Report of an unusual case.

Central granular cell odontogenic tumor (CGCOT) is an unusual benign odontogenic neoplasm characterized by the presence of granular cells associated with apparently inactive odontogenic epithelium. These tumors tend to occur in the posterior mandible and usually present as well-defined unilocular or multilocular radiolucent lesions. So far, only <40 cases of CGCOT have been described in the literature under various terminologies. Though these tumors were not considered as distinct entity in the recent WHO classification of odontogenic tumors, long-term follow-up is recommended as malignant counterpart of CGCOT has already been reported. The main aim of this article is to report an additional case of CGCOT to the literature, occurring in a 73-year-old male.

Prevalence of ocular defects among patients visiting in an institutionalized hospital setting: A cross-sectional study.

PURPOSE: The purpose of this study was to analyze the prevalence of ocular defect among different age groups, gender, side involved, and etiology. MATERIALS AND METHODS: A retrospective study was conducted among referred ocular defect patients in a dental college in southern part of India over a 5 years period (2008-2012). Information regarding general identification, gender, age, affected side, and etiology was collected. The collected data were analyzed and grouped according to different age groups, gender, side involved, and etiology. RESULTS: The ocular defects were more frequently observed in the young male population (66%). Trauma (46%) and pathogenic (44%) causes were the main reasons over nonspecific (8%) and congenital (2%) reasons. CONCLUSION: High prevalence of injuries and infections in young adults (mostly males) predominantly causing ocular bulb loss.

Comparison of salivary flow and candidal carriage in patients with oral submucous fibrosis.

BACKGROUND: Oral submucous fibrosis (OSMF) is a high-risk precancerous condition that predominantly affects Indians due to prevalent gutka chewing. Changes in the salivary flow rate and its effect on candidal carriage in patients suffering from OSMF have not been extensively explored. AIM: The aim of this study is to compare the salivary flow rate and salivary candidal carriage in OSMF patients and healthy individuals. MATERIALS AND METHODS: This pilot study included a total of 30 OSMF patients and 30 healthy individuals. Salivary flow was estimated using preweighed cotton rolls placed at the openings of major salivary duct for 5 min. The cotton rolls were then removed from the oral cavity and weighed again. The difference in weight was recorded. Salivary samples were collected by the oral rinse technique and cultured on Sabouraud agar medium. The cultured yeast colonies were identified based on Gram's staining, periodic acid-Schiff (PAS) and germ tube formation. RESULT: There was statistically significant (P < 0.001) decreased salivary flow rate in OSMF individuals as compared to the control. Salivary flow rates constantly reduced with different grades of OSMF patients, although candidal carriage was seen in grade II and grade III OSMF patients. CONCLUSION: A higher incidence of Candida was observed in OSMF patients when compared to the healthy individuals. The results of our study suggest that a higher candidal carriage in grade II and grade III OSMF patients could be related to decreased salivary flow rate.

Expression of p63 in potentially malignant and malignant oral lesions.

BACKGROUND: p63, a member of p53 family, known to be expressed in embryonic tissues and basal regenerative layers of many epithelial tissues in the adult, is also expressed in various benign and malignant lesions of body including lesions of oral cavity. To evaluate the expression of p63 and compare the expression qualitatively and quantitatively in normal buccal mucosa, epithelial dysplasia, oral submucous fibrosis (OSMF), and oral squamous cell carcinoma (OSCC). METHODS: The study material consisted of 45 archival cases which were divided into Group I with 5 cases of normal buccal mucosa, Group II with 15 cases of epithelial dysplasia, and Group III with 10 cases of OSMF and 15 cases of OSCC. Immunohistochemical expression of p63 was assessed by using mean, standard deviation, and analysis of variance. RESULTS: Overexpression of p63 was seen in epithelial dysplasia, OSMF, and squamous cell carcinoma with an increased suprabasal expression in cases of epithelial dysplasia. The mean labeling index (LI) of p63 was found to be in increasing order from normal oral mucosa (33.75%), OSMF (57.37%), epithelial dysplasia (63.87%) to squamous cell carcinoma (69.76%). CONCLUSION: The results suggest a possible role of p63 in oral carcinogenesis, and an increased LI as well as increased suprabasal expression of this gene in dysplastic lesions may have a potential to be utilized as a marker for premalignancy.

Molecular and genetic aspects of odontogenic tumors: a review.

Odontogenic tumors contain a heterogeneous collection of lesions that are categorized from hamartomas to benign and malignant neoplasms of inconstant aggressiveness. Odontogenic tumors are usually extraordinary with assessed frequency of short of 0.5 cases/100,000 population for every year. The lesions such as odontogenic tumors are inferred from the components of the tooth-structuring contraption. They are discovered solely inside the maxillary and mandibular bones. This audit speaks to experiences and cooperation of the molecular and genetic variations connected to the development and movement of odontogenic tumors which incorporate oncogenes, tumor-silencer genes, APC gene, retinoblastoma genes, DNA repair genes, onco-viruses, development components, telomerase, cell cycle controllers, apoptosis-related elements, and regulators/conttrollers of tooth development. The reasonable and better understanding of the molecular components may prompt new ideas for their detection and administrating a better prognosis of odontogenic tumors.

Evaluation of cell proliferation in malignant and potentially malignant oral lesions.

AIMS: To evaluate the cell proliferation rate by the expression of proliferating cell nuclear antigen (PCNA) and argyrophilic nucleolar organizing region (AgNOR) counts and to assess its usefulness as a marker for malignant potential in oral epithelial lesions. MATERIALS AND METHODS: The study group included 30 cases of leukoplakia, 15 nondysplastic (NDL), 15 dysplastic (DL), 15 cases of oral squamous cell carcinoma (OSCC) and 5 cases of normal oral mucosa. Formalin fixed paraffin embedded tissues were subjected to immunohistochemical staining for PCNA and AgNOR technique. The PCNA labeling index (LI) and the AgNOR dots were evaluated for the entire sample. STATISTICAL ANALYSIS USED: ANOVA, Tukey honestly significant difference, Pearson's correlation. RESULTS: In this study, the AgNOR count of OSCC was lower than the DL lesions moreover the AgNOR counts were found to be higher in normal mucosa as compared to the DL and the NDL epithelium. The study results also showed that the mean AgNOR count failed to distinguish between DL and NDL lesions. Overall we observed increased PCNA expression from normal epithelium to NDL to DL lesion. CONCLUSIONS: Based on the findings of the present study on oral epithelial precancerous and cancerous lesions we conclude that mean AgNOR count alone cannot be a valuable parameter to distinguish between the normal, NDL, DL epithelium and OSCC but, on the other hand, we found out that PCNA can be a useful biomarker for delineating normal epithelium from DL epithelium and OSCC.

Keratoameloblastoma or Kerato-odontoameloblastoma: report of its soft tissue recurrence with literature review.

Keratoameloblastoma (KA) is a rare histological variant of the ameloblastoma with extensive keratin production within the odontogenic islands as well as in the fibrous stroma. Pindborg first reported it in 1970, since then only 18 cases have been reported in the literature. We report a soft tissue recurrence of KA, involving right posterior region of the lower jaw in a 27-year-old female.

Efficacy of argyrophilic nucleolar organizing region analysis using computer-assisted and manual in oral leukoplakia: A comparative study.

OBJECTIVE: Nucleolar organizer regions are loops of DNA containing ribosomal RNA genes and presumably are associated with ribosomal RNA activity, protein synthesis, and cell proliferation. Argyrophilic nucleolar organizer region (AgNOR) count has been suggested as an objective method in differentiating dysplastic lesions from non-dysplastic lesions. MATERIALS AND METHODS: This descriptive study was done on archival paraffin blocks (n = 60), consisting of 10 normal human oral epithelium, 22 cases of non-dysplastic leukoplakia (NDLK), and 28 cases of dysplastic leukoplakia (DLK). The AgNORs were counted with the aid of a manual using conventional light microscopy and photographs of the same were taken and analyzed using Image Pro Express 6.0 (Media Cybernetic Inc., USA) for windows. RESULTS: The mean AgNOR count per nucleus was found to be higher in patients with DLK as compared to NDLK and controls using both manual counting and image analysis method and on comparing both the techniques, image analysis provide a more accurate reflection of AgNOR counts than manual counting. CONCLUSION: To conclude, reliability of computerized image technique of AgNOR count is the most appropriate marker to differentiate between dysplastic and NDLK. Computer-assisted image analysis system was found to be an effective tool in achieving high reproducibility as compare to manual.

Lymphoepithelial carcinoma arising from the maxillary antrum: a clinicopathological report of a rare lesion in an unusual site.

Lymphoepithelial carcinoma (LEC) of the maxillary sinus is an exceedingly rare malignancy. It may be asymptomatic or present with non-specific obstructive nasal symptoms which makes its pre-operative diagnosis very challenging. This report describes our clinical and radiological findings in a 45-year-old Indian female patient with locally-advanced LEC of the right maxillary antrum. Histopathological and immunohistochemical results are also discussed. The case was effectively managed by external beam radiotherapy and the patient has remained disease-free at 20-month follow-up.

Keratoameloblastoma: Report of a rare variant with review of literature.

Ameloblastoma has intrigued clinicians as well as pathologists due to its diverse clinical behavior and histomorphologic presentations. Keratoameloblastoma is a rare histologic sub type, characterized by extensive keratin formation within ameloblastic epithelium, with only a handful number of cases described in the literature. Here, we report a case of this uncommon sub type of ameloblastoma in a young female patient presenting as an extensive lesion in mandibular ramus area. The radiological and fine needle aspiration findings suggested of a keratinizing cystic lesion and incisional biopsy showed features of ameloblastoma. Patient underwent segmental mandibulectomy and histological examination of excisional specimen revealed features of ameloblastoma with abundant keratinization leading to a diagnosis of keratoameloblastoma. The diagnostic pitfalls related with the lesion have been discussed along with a short review of the literature.

Chondrolipoma: Report of a rare intra oral variant with review of histiogenetic concepts.

Chondrolipomas are benign mesenchymal tumors characterized by the proliferation of mature adipocytes associated with variable amounts of mature cartilaginous tissue. Herein, we describe a case of chondrolipoma of the tongue in a 35-year-old Indian male. The lesion presented as a nodular, sessile, pink mass on posterio-dorsal surface of left side of the tongue since approximately 20 years. Histopathologically, the mass revealed a well circumscribed, encapsulated proliferation of mature adipocytes with islands of well formed mature cartilaginous tissue. Chondrolipomas are uncommon in the oral cavity, with only 14 cases being reported in the English literature.

Quantitative and qualitative assessment of DNA extracted from saliva for its use in forensic identification.

UNLABELLED: Saliva has long been known for its diagnostic value in several diseases. It also has a potential to be used in forensic science. OBJECTIVE: The objective of this study is to compare the quantity and quality of DNA samples extracted from saliva with those extracted from blood in order to assess the feasibility of extracting sufficient DNA from saliva for its possible use in forensic identification. MATERIALS AND METHODS: Blood and saliva samples were collected from 20 volunteers and DNA extraction was performed through Phenol Chloroform technique. The quantity and quality of isolated DNA was analyzed by spectrophotometery and the samples were then used to amplify short tandem repeat (STR) F13 using the polymerase chain reaction. RESULTS: Mean quantity of DNA obtained in saliva was 48.4 ± 8.2 µg/ml and in blood was 142.5 ± 45.9 µg/ml. Purity of DNA obtained as assessed by the ratio of optical density 260/280, was found to be optimal in 45% salivary samples while remaining showed minor contamination. Despite this positive F13 STR amplification was achieved in 75% of salivary DNA samples. CONCLUSION: Results of this study showed that saliva may prove to be a useful source of DNA for forensic purpose.

Status of forensic odontology in metro and in tier 2 city in urban India.

UNLABELLED: Dentist can play a significant role in identifying the victims or perpetrators of crime as well as in disasters. Knowledge about the various aspects of forensic science as well as dental and related evidences can help a dental practitioner in assisting the civil agencies in such cases. AIM: To evaluate the awareness and knowledge of forensic odontology among dentists in a metropolitan and a tier 2 city. MATERIALS AND METHODS: Seven hundred and seventy four dentists were included in this survey. Questionnaire was designed to assess the knowledge, aptitude, and status of practice of forensic odontology. Data was analyzed by comparing overall awareness of forensic odontology among dentists in metro and tier 2 city as well as between the different groups. RESULTS: Apart from the source of knowledge, no significant differences were seen in respondents of metropolitan and tier 2 city. Significantly higher proportion of subjects in metro reported journals as source of knowledge (P < 0.001), whereas it was newspaper in tier 2 city (P = 0.001). On comparing the mean scores of knowledge (k), aptitude (a), and practice (p) among different study groups, it was found that all the three scores were highest for practitioner cum academician (PA) group (k - 2.37, a - 0.69, P - 0.17). Knowledge scores were minimum for pure practitioner (PP) group (1.98), and attitude and practice scores of pure academician (A) group were minimum (a - 0.53, P - 0.06). CONCLUSION: Respondents had low knowledge about the applications of forensic odontology in routine practice; hence, steps must be taken to educate the dental practitioners about its clinical applications.

Trends in frequency and duration of tobacco habit in relation to potentially malignant lesion: A 3 years retrospective study.

BACKGROUND: Oral cancer is one of the most debilitating and disfiguring of all malignancies; it is one of the most frequently occurring cancers in the body. The high incidence of oral cancer in India has been attributed to widespread tobacco usage among the population either in chewable or smoked form. AIM: In the current study, we retrospectively analyzed 191 cases (2007-2009) of potentially malignant oral lesions, which had been biopsied in our hospital, in order to assess their relationship with tobacco usage. MATERIALS AND METHODS: Based on the histopathology, these lesions were classified as high-risk lesions (HRL), low-risk lesions, and questionable risk lesions. The data obtained were then analyzed to find out the correlation between the occurrence of risk level with various demographic parameters such as age and gender as well as with type, frequency, and duration of tobacco habit. RESULTS: Out of 191 cases, 122 patients reported with tobacco habit (chewers, smokers, and both) and frequency (<5 and >5 packets/day) were seen in 109 cases and duration (<5 and >5 years) seen in 99 cases. These parameters were correlated with histopathological diagnosis and results showed that both the groups came under the high-risk category. Further analysis of decategorized group (age and gender) was also done. CONCLUSION: Analysis showed that overall histopathologically diagnosed HRLs were seen more in males and smokers compared to female and chewers, respectively.