Clinicopathologic features and risk factors associated with oral squamous cell carcinoma (OSCC): A comprehensive descriptive study analyzing the burden of OSCC in a tertiary-level hospital in North Kerala, India.

BACKGROUND: Oral cancer is one of the most common types of cancer worldwide, and India shows a high incidence of oral squamous cell carcinoma (OSCC) cases. Kerala accounts for a sizeable number of these cases, most of which can be attributed to the deleterious habits prevalent in a vast majority of the population. A comprehensive descriptive-prospective study was done in our institution over 18 months to identify the possible risk factors, to describe the clinical and sociodemographic variables of OSCC, and to understand the burden of this dreaded disease in the North Kerala population. MATERIALS AND METHODS: Data collection was done using a structured pro forma. The data were tabulated and organized; uni- and bivariate analysis were performed along with cross-tabulations for various parameters and relevant variables. A total of 243 histopathologically confirmed cases of OSCC during 18 months comprised the sample in this study. RESULTS: Among the 243 cases, 220 patients had deleterious habits. Betel chewing was the most predominant habit. Buccal mucosa was the commonly affected site. Twenty-three patients had no history of any habits. Majority of the patients presented in stage 3 and 4 of the disease. Moderately differentiated squamous cell carcinoma was the major histologic type. CONCLUSION: The majority of the patients had clinical lesions corresponding to the habit usage, showing a low awareness of tobacco cessation and intervention programs and a high burden of OSCC in the North Kerala population.

Rare Case Reports: A Rarity?

The basic principle of science is to always think of the simplest explanation for a condition. But in post graduate training, distinguishing a rare case from a common case is a dilemma for the naïve clinician. Often the eager and enthusiastic resident trainees are more prone to fall into this "rare case phenomenon." Innumerable rare case reports in countless scientific journals may give the false impression to the budding trainee that uncommon cases are encountered every now and then. This article stresses on the importance of applying certain rules that can help in making the diagnostic process systematic and simpler. The chance of encountering rare cases are in fact rare and limited, wherreas in some circumstances, can diagnose life threatening conditions too.

High prevalence of oral mucosal lesions in elderly: Call for revolutionizing geriatric dental care strategies.

CONTEXT: World'spopulation is ageing and increase in geriatric population demands improved oral health care. Previous epidemiologic studies in general population of India and particularly in Kerala (state with maximum proportion of elderly) provided very little information about oral mucosal lesions in elderly. AIMS: To find out the prevalence, pattern and distribution of oral mucosal lesions in geriatric patients and to explore their association with different study variables. SETTINGS AND DESIGN: A descriptive, hospital-based, cross sectional study was conducted for a period of 9 months in the out-patient clinic, Department of Oral Medicine and Radiology, Government Dental College, Kozhikode (tertiary healthcare centre in Kerala, India). METHODS AND MATERIALS: Participants aged 60 and above were selected by consecutive sampling. Data were collected through clinical examination and by using a structured proforma. STATISTICAL ANALYSIS USED: Descriptive statistics with tests of significance of associations were done. RESULTS: The geriatric population (N=750, 66.89 ± 6.07, M: F=1.4:1), was recruited by screening 43,180, and 447 (67.29 ± 6.15, M: F=2:1) were identified having oral mucosal lesions withprevalence of 59.6% (95% CI=56.05-63.05). Most common lesion group was red and white (73.2%), followed by pigmented (15.5%). Oral mucosal lesions were significantly associated with age over 65, male gender, presence of habit and denture usage (P < 0.05). CONCLUSIONS: The prevalence of oral mucosal lesions in geriatric people is high. Hence setting up of geriatric dental clinics, with appropriate preventive and palliative intervention strategies is mandatory.

Caries Risk Assessment and Referral Tool (CRA-RT)-A novel risk scoring system for early childhood caries in community settings.

OBJECTIVE: To develop a brief and simple, easy-to-administer, culturally sensitive, reliable and valid risk scoring system for early childhood caries based only on behavioural and other nonclinical risk factors. The purpose was to allow risk scoring by child care providers without clinical examination in order to guide dental referral in a community setting. METHODS: A cross-sectional study using stratified multistage cluster sampling was conducted among 559 preschool children and their mothers in Anganwadi centres and Preprimary schools in Thiruvananthapuram district, Kerala, India. All steps in the development of a new tool were carried out. Exploratory factor analysis and principal component analysis with Varimax rotation were employed for item reduction. Reliability and validity assessments were also performed. Past caries experience was recorded as dmft scores and the validity hypothesis of higher dmft scores in children with higher caries risk scores was also verified as an additional measure of construct validity. RESULTS: The newly developed Caries Risk Assessment and Referral Tool (CRA-RT) is presented as a unidimensional, 11-item, discriminative tool which showed high test-retest reliability (ICC = 0.8), high inter-rater reliability (ICC = 0.8) and acceptable internal consistency (Cronbach's alpha = 0.6). Face, content and construct validity have been demonstrated. Children with higher CRA-RT scores were having higher dmft scores, and it provided an additional evidence for the construct validity of the tool. CONCLUSION: CRA-RT is a simple, valid and reliable novel risk scoring system for ECC, to be used in a nondental, nonmedical setting. The proposed tool contains those behavioural risk or protective factors, the presence or absence of which could be assessed by interviewing the mother. The quick and the easy risk scoring pattern with a cut-off score can guide the dental referral of preschool children by child care providers in a community setting.

Cervical Lymph Node Evaluation in Oral Squamous Cell Carcinoma Patients Using Ultrasound-Guided Fine-Needle Aspiration Cytology - A Descriptive Diagnostic Evaluation Study in a Tertiary Care Center.

BACKGROUND: Oral cancer is the most frequent type of cancer of the head and neck area, with squamous cell carcinoma (SCC) being the most common single entity. Worldwide, oral cancer accounts for 2%-4% of all cancer cases, the prevalence being highest in India. Lymph node metastases occur in about 40% of patients with oral cancer. Clinically, their manifestations are hidden in rates of 15% to 34%. More accurate imaging techniques can reduce the risk of undiagnosed metastasis. Ultrasonography has gained wide acceptance as a diagnostic aid in the evaluation of reactive and metastatic lymph nodes. The present study is an attempt to assess the earliest evaluation of the cervical lymph nodes by ultrasound-guided fine-needle aspiration cytology (FNAC). METHODOLOGY: A descriptive diagnostic evaluation study was carried out to find out the sensitivity and specificity of ultrasound-guided FNAC in detecting metastasis to cervical lymph nodes from oral SCC in the Department of Oral Medicine and Radiology, Government Dental College, Thiruvananthapuram, in collaboration with the Department of Imageology, Regional Cancer Centre, Thiruvananthapuram during the time period from July 2015 to September 2016. RESULTS: A total of 112 patients with histologically proven oral SCC having palpable lymph nodes were evaluated clinically and ultrasonographically. In this study, sensitivity and specificity of >90% were obtained for ultrasonographic criteria such as the long axis to short axis ratio <2, the absence of hilum, heterogeneous architecture, and altered vascularity in the evaluation of metastatic lymph nodes. The diagnostic yield in the detection of metastatic lymph nodes was much higher in the ultrasonographic examination. CONCLUSION: Ultrasound-guided FNAC offers an opportunity to enhance patient prognosis through early detection and a specific diagnosis (92.5%) when compared to clinical examination (78.6%) in the current study.

Forum for Injection Technique 2.0 Addendum 1: Insulin use in indoor settings.

Insulin is a frequently used drug in the indoor setting. Comprehensive recommendations for best practice in insulin injection technique have been published by the forum for injection technique (FIT), India. This addendum focuses on insulin use in indoor settings, and complements the FIT 2.0 recommendations. It discusses insulin use and disposal in critical care and noncritical care settings. It also highlights the need to ensure continuing nursing and medical education, and frame insulin policies for such use.

A Radiological Review of Ewing's Sarcoma of Mandible: A Case Report with One Year Follow-up.

Ewing's sarcoma (ES) is an uncommon round cell tumor with an aggressive course affecting mainly children and young adults. Only 1% of cases is reported with jaw involvement and have mandibular predilection. Radiographic finding in ES reflect many destructive nature of the lesion, like osteolysis, cortical erosion, periostitis and soft tissue mass. A case of ES of the mandible is reported with special consideration to the radiological appearance. How to cite this article: Krishna KBB, Thomas V, Kattoor J, Kusumakumari P. A Radiological Review of Ewing's Sarcoma of Mandible: A Case Report with One Year Follow-up. Int J Clin Pediatr Dent 2013;6(2):109-114.

Mucosal disorders with oral epithelial dysplasia risk--development of a simple screening tool for general health care setting.

OBJECTIVES: Oral visual screening can avert oral cancer mortality. Oral premalignancies are currently considered as separate, individual disorders. The objective was to develop a simple clinical screening tool to detect oral premalignancies in general health care setting and validate diagnostic accuracy against Oral Medicine specialist examination as gold standard. MATERIALS AND METHODS: All steps in development of new tool, from item generation to item selection and item reduction were carried out. Item generation was done using qualitative methods. After pre-testing and piloting, junior dental house surgeon administered the refined tool, to patients attending dental outpatient department (n=255). Subsequent evaluation by an Oral Medicine specialist using consensus clinical criteria, detected 59 screen positive cases. Each case was recoded as per scores assigned by binary logistic regression coefficients and total score computed. The Receiver Operator Characteristic (ROC) was performed against specialist examination as gold standard. Performance ability and reliability coefficient of final tool was assessed. A simple score was assigned to indicate stage and clinical severity. RESULTS: Screening Tool for Oral Premalignancies (STOP) has sensitivity 96.6%, specificity 99.0% and accuracy 98.4% with reliability coefficient 0.874. Scores detect clinical signs and staging reflect clinical severity alerts. CONCLUSION: Oral Potentially Malignant Disorders need to be evaluated as single entity, under a common umbrella - Mucosal Disorders with Oral Epithelial Dysplasia risk (MD-OEDr). STOP is a simple tool for opportunistic general health care screening of MD-OEDr.

Psammomatoid and trabecular variants of juvenile ossifying fibroma-two case reports.

Juvenile ossifying fibroma (JOF) is an uncommon fibro-osseous lesion occurring in the facial bones. It is highly aggressive and has a strong tendency to recur. It has been recognized as a separate histopathological entity among the fibro-osseous group of lesions. Surgical resection is the preferred line of treatment. Here we report two cases of JOF who reported to the oral medicine and radiology department; the two cases had different clinical features, history, radiological appearance, and aggressiveness. Under the recent classification system, both cases were recognized as histopathological variants of JOF: one psammomatoid and the other trabecular.