Hand-off orientation in oral pathology: Bridging the gap for better patient care.

The practice of hand-off orientation in oral pathology plays a pivotal role in ensuring efficient and high-quality patient care. Given the intricate nature of oral health, the seamless transition of patient care from one healthcare provider to another is critical. Hand-off orientation in oral pathology begins with a comprehensive referral of oral biopsy specimens from a general dentist or clinical specialist to the oral pathology laboratory. Obtaining detailed information about oral biopsy tissue and complete patient information from clinicians is indeed crucial for a variety of reasons, including accurate diagnosis and treatment planning. This collaborative approach ensures that patients receive timely and accurate care, reducing the potential for misdiagnosis or treatment delays. In the field of oral pathology, effective hand-off orientation is a cornerstone of patient safety and positive outcomes.

Role of MMP1 and MMP10 in local invasion and distant metastasis in different levels of oral squamous cell carcinoma - A immunohistochemical comparative study.

Background: Matrix metalloproteinases (MMPs) are basically a part of a large family of proteolytic enzymes. They play an important role in degrading extracellular matrix and basement membrane, which is a basic mechanism in local invasion and tumour metastasis. The aim of this study was to evaluate immunohistochemically the expression of MMP1 and MMP10 in tumour invasion locally and at distant levels, including lymph nodes at different levels in oral squamous cell carcinoma (OSCC). Materials and Methods: A total of 50 tissue samples with clinically confirmed OSCC and 15 normal oral mucosal tissues will be included in the study. Immunohistochemical staining will be performed for the demonstration of MMP1 and MMP10 in lesional tissue, perilesional tissue, and lymph nodes of different levels that were evaluated with respect to microscopic features. Results: All OSCC cases had MMP1 and MMP10 expression levels. The expression increased as the nodal level increased from level I to level V. This difference was statistically significant at P < 0.001 Both MMPs were not expressed in normal epithelial cells. There was no significant correlation between MMP1 and MMP10 expression. Conclusion: This study showed that MMP1 and MMP10 are expressed in the tissues of OSCC and may serve as prognostic indicators for the disease.

Role of hypoxia and epithelial-mesenchymal transition in the formation and maintenance of oral cancer stem cells in oral squamous cell carcinomas and metastatic lymph node: An immunohistochemical analysis.

Background: Inspite of having advanced treatment modalities the overall survival rate in oral squamous cell carcinoma (OSCC) remains poor. This is considered to be mainly due to local recurrence and distant metastasis. Various studies have concentrated on the role of oral cancer stem cells (OCSCs) in the progression and metastasis of OSCC. However, the role of tumor microenvironment components has been less delved into. Hence clarity on cell biology and metastatic potential OCSCs is essential for the development of more effective anti-cancer treatment. Aim: To establish the role of OCSCs in different grades of OSCC and metastatic lymph nodes through the expression of cluster of differentiation 44 (CD44). To demonstrate and correlate the role of hypoxia and Epithelial mesenchymal transition (EMT) in the various grades and metastatic lymph nodes in the formation and maintenance of OCSCs by employing Hypoxia-inducible factor-1 Alpha (HIF 1α) and Snail respectively. Method and Material: A total of 36 cases of OSCC, 12 from each grade and 12 normal oral mucosal tissues were included in the study. Immunohistochemical staining was performed for the demonstration of CD44, HIF1α, and Snail. Statistics: Descriptive analysis, Chi-square, and Spearman's rank correlation were used to analyze frequency and proportion, to compare expression and correlate between lesion proper and lymph node in each group respectively. Results: Significant expression of CD44, HIF1 α, and Snail among advancing grades of OSCC and their metastatic lymph node were observed. A positive correlation was seen between them. Conclusions: The prognosis of OSCC can be improved by better understanding and targeting the molecules involved in the formation and maintenance of OCSCs.

Evaluation of Her-2 protein in histologically tumor-free margins of oral squamous cell carcinoma: An immunohistochemical study.

Background: The status of the 5-year survival rate and loco-regional recurrence in oral squamous cell carcinoma (OSCC) has remained unchanged over the decades. Recent advances in oral cancer research have revealed that the presence of molecular alterations in histologically tumor-free margins of OSCC has a prognostic significance and can aid in designing therapeutic strategies. However, the literature on molecular studies on histologically tumor-free margins is scant, especially in the Indian population. Considering the prognostic implications of Her-2 in malignancies of the breast, ovary, and OSCC, we aimed to assess the expression of Her-2 protein in histologically tumor-free margins of OSCC and to establish correlation with clinico-pathological parameters. Methods: 4 µ m thick sections from formalin-fixed paraffin-embedded tissue blocks of 40 histologically tumor-free margins of OSCC affecting the buccal mucosa and/or lower gingiva-buccal sulcus and 40 normal oral mucosa samples were subjected to immunohistochemical analysis for the Her-2 antibody. The obtained data were analyzed statistically. Results: The mean ages in study and control groups were 49.83 years (SD ± 10.43) and 37.28 years (SD ± 8.61), respectively, with male predominance. Local recurrence was seen in 52.5% of patients. Follow-up data revealed that a total of 71.4% of patients succumbed to mortality and all of them had reported local recurrence. Overall, the presence of local recurrence and the status of survival showed a statistically significant association (p = 0.0001). All the samples in the study and control groups were negative for Her-2 immuno-expression. Conclusion: The study indicated the lack of Her-2 immuno-expression in histologically tumor-free margins of OSCC with several speculated explanations. As it is a preliminary study, further studies employing both immunohistochemistry (IHC) and gene amplification in histologically tumor-free margins of OSCC affecting different anatomical sites are warranted. This will aid in identifying the subset of patients that may benefit from targeted therapy.

COVID-19 Associated Mucormycosis (CAM): A Single Hospital-Based Study.

Background: Opportunistic fungal infections like Mucormycosis in Coronavirus Disease 2019 (COVID-19) patients have posed a great challenge to health care professionals, especially in developing countries like India. Hence, there is a need to understand the biological behaviour of COVID-19 associated Mucormycosis (CAM) to establish standard treatment Protocols and to reduce mortality. Aims: This study aims is to assess the type of Mucormycosis among COVID-19 patients in study population and compare the findings with clinical, radiological and haematological parameters along with treatment and surgical management. Methods and Material: This retrospective, observational study included 60 cases of CAM reported to the Department of Oral and Maxillofacial Surgery at the tertiary care centre, Karnataka Institute of Medical Sciences, Hubli. Data about various parameters were tabulated and analysed statistically. Statistical Analysis Used: Bivariate analysis was done using the Chi-Square test to assess the relationship between the type of Mucormycosis and other variables. Spearman's Correlation test was used to assess the correlation between types of Mucormycosis with the other variables. Linear regression analysis was performed to assess the response variable related to the type of Mucormycosis. Results: About 50% of subjects presented with "Rhino orbital" type of Mucormycosis. Palatal discoloration and palatal erosion was the most common oral manifestation among "only Sinus" and "Rhino orbital" types of Mucormycosis (P = 0.00). Significant association (P = 0.29) was found between the type of Diabetes mellitus and Mucormycosis. Conclusions: The study indicates that DM is the most commonly associated comorbidity in CAM patients. Hence, a thorough understanding of the underlying comorbidity and its close monitoring during and after COVID-19 infection is mandatory for successful treatment outcomes.

Association of bedtime with recurrent aphthous stomatitis: A cross-sectional study among health-care professional students.

Background: Although recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease, the etiology remains poorly understood till date. In addition, RAS lacks definitive therapeutic options, and hence, it becomes even more important to know the etiological factor so as to relieve the symptoms and render treatment effectively. Recently, late bedtime has been shown to be associated with RAS. Due to prolonged duty hours along with lengthy learning and training periods, late bedtime is a frequent observation among health-care professional students. However, this is a less explored field in the previous studies on RAS. Aims: This study aimed to evaluate the role of bedtime in the causation of RAS among health-care professional students. Methods: This present cross-sectional survey was carried out among medical, dental and nursing students studying in our medical campus, using an anonymous, self-administered questionnaire consisting of 18 items. The collected data was statistically analyzed and interpreted. Descriptive analysis and Chi-square tests were employed to assess the association of RAS with various variables. Results: Among a total of 1111 students who participated in the study, 39.8% (n = 442) experienced RAS. Factors such as history of digestive tract disease, family history and stress showed a positive correlation with RAS. Interestingly, both during examination and nonexamination period, RAS was more prevalent among students with bedtime >11pm than in students with bedtime <11 pm. Conclusion: The study indicates that late bedtime is an independent risk factor for RAS and thus clinicians should focus on recommending a healthy lifestyle with adequate sleep to patients with RAS. This would benefit patients with RAS, especially health-care professional students, and could probably contribute to long-term remission in RAS.

Rapid tissue processing technique: A novel method using methyl salicylate.

INTRODUCTION: Tissue processing involves transition of the biopsy tissue in graded concentration of various chemicals to make the tissue amiable for sectioning. The entire process takes 2-3 working days before a microscopic slide is ready for diagnosis. In order to shorten the turnaround time, rapid tissue processing method using methyl salicylate was developed. AIM: The aim of this study is to develop a rapid tissue processing technique using methyl salicylate as a clearing agent and to compare it with routine tissue processing technique. MATERIALS AND METHODS: A total of 70 tissue specimens were cut into two equal halves. One each was processed by routine processing technique (RoPT) and rapid processing technique (RaPT). Tissue specimens were measured before and after processing. Quality of staining and cellular-level shrinkage were observed and scored for specimens. Statistical analysis using Welch's unequal variances t-test was performed. Costs of chemicals in both the techniques were compared to see the cost-effectiveness of RaPT. RESULTS AND CONCLUSION: Outcomes of both the processing techniques were comparable with statistically not significant P values for all the parameters. Hence, the results of RaPT technique are satisfactory, and the use of this technique may prove beneficial to pathology laboratories.

Concurrent central odontogenic fibroma and dentigerous cyst in the maxilla: A rare case report.

Central odontogenic fibroma (COF) represents a rare group of benign odontogenic tumor, while dentigerous cyst (DC), on the other hand, is the odontogenic cyst that encloses the crown of an unerupted tooth. A combination of COF and DC is rare and not reported in literature till date. The aim of this paper is to report a case of COF occurring concurrently with DC. The simultaneous occurrence of COF and DC raises the question of whether it is a collision tumor or their simultaneous occurrence is just a coincidence. In our case, the probable cause of simultaneous occurrence might be that COF would have displaced 23 resulting in the formation of DC.

Stereomicroscopic study on unsectioned extracted teeth.

INTRODUCTION: Age has been considered as a reliable marker for establishing the identity of a person in the field of forensic medicine. Teeth are useful skeletal indicators of age at death since it can survive for decades. Nondestructive methods ensure the evident preservation of dental hard tissues that reflect age changes from the cradle to the grave. Therefore, an attempt was made for estimating the age using the nondestructive method. AIMS AND OBJECTIVES: The aim of this study to assess whether physiological changes of the teeth allow possible correlation for accurate age estimation and to establish a graduation standard by microscopic observation for a better age correlation. MATERIALS AND METHODS: The study was carried on 209 teeth samples extracted for orthodontic treatment or periodontal diseases comprised both maxillary and mandibular teeth across different age groups. The assessment of these changes was carried out by well-established standard methods with some proposed modifications. RESULTS: Pearson correlation analyses revealed root dentin translucency with the highest correlation (r = 0.97) followed by periodontal ligament attachment (r = 0.95), root dentin color (r = 0.95), and attrition being the least correlated (r = 0.90). All the parameters taken for the study contributed to stepwise linear regression analysis (R = 0.98; P < 0.01) indicating a strongly positive relationship between age and the changes observed. A regression formula was obtained with mean error age difference ±1.0 years. CONCLUSION: The present study showed that extracted tooth is highly significant in identifying the age without being sectioned or further processed and also signifies the use of microscope for observation of these changes, thus reducing the errors of calibrating the age.