Evaluation of plasma fibrinogen degradation products, D-dimer, and mast cells in oral submucous fibrosis.

Background: Oral submucous fibrosis (OSF), a premalignant condition, demands early diagnosis and treatment for an improved prognosis of the patients. Being a chronic inflammatory disease, various markers of inflammation can be used to predict the prognosis of the disease. The present study was undertaken to assess the plasma levels of fibrinogen degradation products (FDPs), D-dimer, and mast cell density (MCD) in patients with OSF. Materials and Methods: Forty histopathologically confirmed cases of OSF and 10 age- and sex-matched individuals were included in the study. Two ml of venous blood was obtained from all the study participants and was evaluated for the levels of FDPs, d-dimer, and mast cell densities. Results: Comparison of mean plasma levels of FDPs and D-dimer showed a statistically significant increase with the increase in the grades of OSF. Also, a significant association was evident between the plasma FDPs and D-dimer levels. The values of mean mast cell densities from grade I to grade IV OSF were 191.1/mm2, 258.5/mm2, 182.4/mm2, and 165.7/mm2, respectively, and were significantly higher than the value in NOM i.e., 86.5/mm2. There was a statistically significant increase in the values of mast cell densities from grade I to grade II OSF, with grade II OSF showing the highest mast cell densities among all the grades, and the values decreased toward grades III and IV OSF, with grade IV showing the least mast cell densities. Conclusion: Excessive areca nut chewing may stimulate collagen synthesis by fibroblasts, enhancing fibrosis, and in turn, raising the plasma fibrinogen levels and thereby the FDPs and d-dimers associated with the advancement of the grade of OSF.

Oral lymphangiomas - clinical and histopathological relations: An immunohistochemically analyzed case series of varied clinical presentations.

Lymphangiomas are benign malformations that represent hamartoma of malformed lymphatics and are composed of cystically dilated lymphatic channels which do not communicate or drain into other lymphatic channels or veins leading to accumulation of lymph. They are congenital malformations with rare occurrence in oral cavity within which tongue dorsum is the most affected site. Venous malformations are often difficult to differentiate from lymphatic malformations leading to the development of several lymphatic markers like D2-40 which seems to be useful for distinguishing vascular from lymphatic vessels. The most effective treatment is surgery having good prognosis for most of the patients but depending on their location (neck/tongue) and size (large size) they may cause airway obstruction causing death. Herewith, we present the rare cases of oral lymphangiomas of tongue, palate and buccal mucosa with varied and characteristic clinical presentations.

Early Stage Oral Submucous Fibrosis is Characterized by Increased Vascularity as Opposed to Advanced Stages.

INTRODUCTION: The degree of vascularity of the diseased mucosa in Oral Submucous Fibrosis (OSMF) has always been a matter of debate with conflicting results. Knowledge of this aspect is important to understand pathogenesis of OSMF, which in future could be translated into therapeutic strategies. AIM: In the present study, attempt has been made to investigate parameters like Mean Vascular Density (MVD), Total Vascular Area (TVA) and Mean Vascular Area (MVA) using CD34 antibody. MATERIALS AND METHODS: Forty five previously untreated histopathologically diagnosed cases of OSMF were retrieved from archives and fifteen age and sex matched healthy volunteers without habits were included in the control group. Sections were immunohistochemically stained for CD 34 and morphometric analysis was performed. For statistical analysis ANOVA, Kruskal Wallis test and Mann Whitney U tests were used and p-values <0.05 were considered statistically significant. RESULTS: MVD was more in Stage I OSMF followed by Control, Stage II and Stage III with statistically significant differences (p< 0.001). Statistically significant differences were observed in the MVD between control versus Stage III OSMF. Similarly, TVA was statistically significant when compared between control versus OSMF, control versus Stage II OSMF, control versus Stage III OSMF, Stage I versus Stage II OSMF, Stage I versus Stage III OSMF, and Stage II versus Stage III OSMF. For MVA, significant differences were between control versus OSMF, control versus Stage II OSMF, control versus Stage III OSMF, Stage I versus Stage III OSMF and Stage II versus Stage III OSMF. CONCLUSION: Angiogenesis is seen in early stages of OSMF with decreasing trend in advanced stages. Decreased vascular areas seen in advanced stages could be attributed to the increasing fibrosis surrounding the blood vessels.

Various terminologies associated with areca nut and tobacco chewing: A review.

Globally, arecanut and tobacco are among the most common addictions. Tobacco and arecanut alone or in combination are practiced in different regions in various forms. Subsequently, oral mucosal lesions also show marked variations in their clinical as well as histopathological appearance. However, it has been found that there is no uniformity and awareness while reporting these habits. Various terminologies used by investigators like 'betel chewing','betel quid chewing','betel nut chewing','betel nut habit','tobacco chewing'and 'paan chewing' clearly indicate that there is lack of knowledge and lots of confusion about the exact terminology and content of the habit. If the health promotion initiatives are to be considered, a thorough knowledge of composition and way of practicing the habit is essential. In this article we reviewed composition and various terminologies associated with areca nut and tobacco habits in an effort to clearly delineate various habits.

Exuberant Oral Myiasis Caused by Musca domestica (Housefly).

Tissues of oral cavity, when invaded by the parasitic larvae of houseflies, the condition is called as oral myiasis. It is a rare disease that is most common in developing countries and is associated with conditions leading to persistent mouth opening along with poor oral hygiene, suppurative lesions, severe halitosis and maxillofacial trauma. A case of exuberant oral myiasis in a 42-year-old female patient is described here. She reported with swelling, pain, mobility of teeth and foul odor. Diagnosis was based primarily on history and clinical features. Management included use of turpentine oil, mechanical removal of larvae followed by extraction of mobile teeth and curettage along with supportive antibiotic and analgesic therapy. Supportive nutritional supplements and timely institution of treatment encompassing removal of the offending larvae and carious teeth with proper education and motivation of the patient including oral hygiene instructions led to the resolution of these lesions.

Papillary cystadenocarcinoma of the hard palate.

Papillary cystadenocarcinoma (PCC) is an uncommon malignant tumour of the salivary gland, sometimes involving the minor salivary gland. Previously this entity was classified as an atypical type of adenocarcinoma, malignant papillary cystadenoma, low-grade papillary adenocarcinoma or mucus producing adenopapillary carcinoma. PCC is a glandular tumour with an indolent biological behaviour characterised by cysts and papillary endophytic projections. We report two cases of PCC involving the minor salivary gland of the hard palate. Both the patients presented with a swelling in the palate with difficulty in chewing. MRI revealed an extensively destructive lesion involving hard palate, alveolar ridge and maxillary antrum. Clinical and radiological features suggested the malignant nature of the lesion. Histopathology of incisional biopsy revealed tumour proliferation in a multicystic pattern, with extensive papillary proliferation. Diverse and cellular cytomorphology, and cellular and nuclear pleomorphism with few mitotic figures were the prominent features. Both the lesions were confirmed as PCC.

Demonstration of iron in exfoliated buccal cells of ß-thalassemia major patients.

BACKGROUND: Thalassemia is a genetic disorder of hemoglobin synthesis, which requires regular blood transfusion therapy leading to iron overload in the body tissues. Transfusional hemosiderosis is a major cause of morbidity and mortality in these patients. Reliable methods for evaluation of iron overload are either invasive, costly or remotely available. Therefore, a simple technique of monitoring iron overload is desirable. AIM: To know whether iron can be demonstrated in exfoliated buccal cells of ß-thalassemia major patients using Perls' Prussian blue method and to correlate it with serum ferritin levels. MATERIALS AND METHODS: Smears were obtained from buccal mucosa of 60 randomly selected ß-thalassemia major patients and 30 healthy subjects as controls. Smears were stained with Perls' Prussian blue method. Blood samples were taken for estimation of serum ferritin levels. STATISTICAL ANALYSIS: Chi-square, Mann-Whitney, and Spearman Rank's Correlation tests. RESULTS: Perls' positivity was observed in 71.7% of thalassemic patients with a moderately positive correlation to serum ferritin levels. CONCLUSION: Oral exfoliative cytology can be a useful tool in demonstration of iron overload in thalassemic patients, however, further research in this field in the direction of quantification of these procedures is required, which can establish this non-invasive procedure as an ideal screening tool.

Oral cysticercosis: a clinical dilemma.

Cysticercosis is a potentially fatal parasitic disease caused by cysticercus cellulosae, the larval stage of Taenia solium. Oral cysticercosis is a rare entity and represents difficulty in clinical diagnosis. This article reports two cases of oral cysticercosis involving buccal and labial mucosa. Both the cases presented with solitary, nodular swelling that had been clinically diagnosed as a mucocele. Histopathology of excisional biopsy revealed it to be cysticercosis. Single, cystic nodular swelling of oral cavity may be the only evidence of cysticercosis and may present first to dentist. These cases emphasise the role of dentist and thorough histopathological examination in the early diagnosis of disease that can prevent potential systemic complication.

Multiple non-syndromic odontogenic keratocysts in three siblings.

Occurrence of multiple cysts (MC) involving the jaw is rare. When multiple, it is usually associated with a syndrome. Occurrence of MC without syndromic association is extremely rare. Multiple odontogenic cysts mostly could be odontogenic keratocysts or dentigerous cysts. Odontogenic keratocyst shows involvement of mandible over maxilla, with peak incidence in second and third decade and it is exceedingly rare before 10 years of age. However multiple odontogenic keratocysts found in children are often reflective of nevoid basal cell carcinoma syndrome. Here is a case report which documents multiple jaw cysts involving both the jaws, in three siblings of ages 10, 13 and 17 years with negative parental history. All three reported cases were free of any systemic involvement. As odontogenic keratocyst spreads through bone marrow, destruction is more before any clinical manifestation. Therefore, early detection and intervention are essential in preventing extensive destruction.

Unusually large quiescent ancient schwannoma of hypoglossal nerve.

Ancient schwannoma is considered as a variant of schwannoma, comprising about 10% of all schwanommas. Schwannoma is a benign neoplasm derived from the nerve sheath of peripheral motor, sensory and sympathetic nerves and from the cranial nerve pairs. It usually presents as a solitary soft-tissue lesion which is slow growing, encapsulated and is often associated with nerve attached peripherally. Diagnosis is often confirmed with the microscopic examination. The long standing schwannoma attributes to degenerative changes and is termed "ancient" schwannoma. Present case is of a 68-year-old female patient who reported with an asymptomatic large swelling below mandible on the left side since last 23 years. The lesion was surgically excised under general anesthesia.

Diagnosis and management of bilateral nasolabial cysts.

Nasolabial cysts are painless, submucosal, non-odontogenic jaw cysts presenting as soft tissue swellings in the maxillary anterior mucolabial fold lateral to midline, leading to elevation of nasal ala. Present case documents bilateral nasolabial cysts in a 69-year-old Asian female patient. In the present case, extraoral swelling of maxillary lip and elevation of nasal ala was observed on right side of the face. Intraorally, soft and fluctuant bilateral cysts were observed. Straw-colored fluid was aspirated from the right cyst. Radiographically, erosion of bone in a "cupping" fashion was observed in the region of left cyst. The cysts were enucleated using intraoral approach. Histopathology of the right-sided cyst revealed a cystic cavity lined by stratified squamous cells along with a few mucosal cells. At few places, stratified squamous and pseudostratified columnar epithelia with many cilia and goblet cells were also evident. Capsule was loosely arranged with fibrous tissue and chronic inflammatory infiltrate. Left-sided cystic specimen showed two or more layered stratified squamous lining epithelium with thin capsule. Diagnosis of bilateral nasolabial/nasoalveolar cysts was confirmed.

Oral squamous cell carcinoma associated with myiasis.

Myiasis is a general term for infection by fly larvae feeding on the host's necrotic or living tissue. Although infestation by fly larvae is much more prevalent in animals, it is a relatively frequent in occurrence. Oral myiasis is a rare pathology in humans and is associated with poor oral hygiene. Larvae cause itching and irritation due to their crawling movements and can destroy vital tissues, inducing serious or even life-threatening haemorrhage. The treatment is a mechanical removal of the maggots one by one; however, a systemic treatment with macrolide antibiotics, have been recently used for treatment. We present a case report of a 70-year-old man indigent, alcohol-dependent with an extensive necrotic wound in mandible and fetid odour. The prevention of human myiasis is by education, but unfortunately in the developing countries some people live in low social condition, predisposing the occurrence of the infestation.

Interrelationship between pyogenic granuloma and peripheral ossifying fibroma: a case report.

PURPOSE: Pyogenic Granuloma (PG) is an inflammatory hyperplasia which is non-neoplastic in nature. Because of the high incidence of oral PG, critical need exists for its proper diagnosis and treatment. Peripheral Ossifying Fibroma (POF) is a focal reactive overgrowth occurring in young adults. Though clinically similar to PG, it is important to differentiate the lesions based on the histopathological findings that facilitate the management of the lesion, which is diverse in nature when compared to PG. Proper treatment of such overgrowths and appropriate oral hygiene instructions shall ensure no recurrence of the lesion. There are very few case reports published depicting the recurrence of 1 lesion into another reactive overgrowth, and fewer case reports exists describing the interrelationship between these 2 lesions. Hence this case report depicts the interrelation between these 2 reactive fibrous overgrowths having different histomorphologic representation. Also, the importance of histopathologic diagnosis and a proper treatment plan is emphasized to prevent unnecessary distress to the patient regarding the severity of such lesions. An irregular gingival overgrowth occurring in the mandibular anterior region diagnosed histopathologically as PG in a 35 year old female is described. The lesion was excised. Furthermore, it recurred after a year in the same region and the histopathologic diagnosis of the lesion confirmed it as POF. The overgrowth was excised and thoroughly curetted. The case was followed up to 1 year without any signs of recurrence.

Dentigerous cyst associated with multiple complex composite odontomas.

Odontomas are considered to be hamartomatous malformations rather than true neoplasms. This most common odontogenic lesion results from the growth of completely differentiated epithelial and mesenchymal cells that give rise to ameloblasts and odontoblasts. Dentigerous cyst is an epithelium-lined sac enclosing the crown of an unerupted tooth. Apparently, the dentigerous cyst arises by the accumulation of fluid between reduced enamel epithelium and the tooth crown. Occasionally it is associated with supernumerary tooth or odontoma. We report a case of dentigerous cyst associated with complex composite odontoma and an impacted lateral incisor in a 30-year-old male patient.

Global manipulation of digital images can lead to variation in cytological diagnosis.

BACKGROUND: With the adoption of a completely electronic workflow by several journals and the advent of telepathology, digital imaging has become an integral part of every scientific research. However, manipulating digital images is very easy, and it can lead to misinterpretations. AIM: To analyse the impact of manipulating digital images on their diagnosis. DESIGN: Digital images were obtained from Papanicolaou-stained smears of dysplastic and normal oral epithelium. They were manipulated using GNU Image Manipulation Program (GIMP) to alter their brightness and contrast and color levels. A Power Point presentation composed of slides of these manipulated images along with the unaltered originals arranged randomly was created. The presentation was shown to five observers individually who rated the images as normal, mild, moderate or severe dysplasia. Weighted κ statistics was used to measure and assess the levels of agreement between observers. RESULTS: Levels of agreement between manipulated images and original images varied greatly among observers. Variation in diagnosis was in the form of overdiagnosis or under-diagnosis, usually by one grade. CONCLUSION: Global manipulations of digital images of cytological slides can significantly affect their interpretation. Such manipulations should therefore be kept to a minimum, and avoided wherever possible.

Correlation of salivary and serum IgG, IgA levels with total protein in oral submucous fibrosis.

Oral submucous fibrosis (OSMF) is a disabling, potentially malignant condition of the oral cavity. The aetiology of OSMF is multifactorial but remains obscure. Although arecanut is considered to be the most important causative agent, responses observed in individuals using arecanut vary in relation to quantity and duration. It is considered that an immunological process is responsible for the pathogenesis of disease. We correlated salivary immunoglobulin A (IgA), salivary immunoglobulin G (IgG) and serum immunoglobulin A (IgA), serum immunoglobulin G (IgG), levels by turbidometric immunoassay. We estimated the levels of total serum protein (TSP) and haemoglobin (Hb) to determine the role of nutritional deficiency. The study population comprised 30 cases of OSMF and 10 controls. Five milliliters of blood and 2 ml of saliva were collected. Quantitative analysis of serum and salivary IgG, IgA was done by turbidometric immunoassay. TSP and Hb were estimated by Biuret and cyanmethaemoglobin methods, respectively. All patients showed significant (P < 0.01) increase in serum and salivary IgG, IgA levels as compared to controls. TSP patients showed significant (P < 0.01) decrease as compared to controls. Results of Hb in patients were not significant. The estimation of immunoglobulin levels is important to support the concept of autoimmune basis. Estimation of TSP and Hb suggests that nutrition has a definite role in OSMF.

Palatal rugoscopy: Establishing identity.

UNLABELLED: Palatal rugae are irregular, asymmetric ridges of the mucous membrane extending laterally from the incisive papilla and the anterior part of the palatal raphe. The uniqueness and the overall stability of palatal rugae suggest their use for forensic identification. OBJECTIVE: The purpose of this study was to compare the palatal rugae patterns in 2 different populations in India (Madhya Pradesh and Kerala), and furthermore, to assess the predominant pattern if any in the selected groups. MATERIALS AND METHODS: 60 maxillary study models (30 from each group) were examined in the age group ranging from 17 to 23 years. Palatal rugae pattern were examined in both the sexes on right and left sides of the palate for the total number (quantitative), length, shape, and predominant direction (qualitative). RESULTS: After analyzing the rugae patterns in both the groups and between the 2 sides of the palate, the wavy pattern was found to be predominant followed by curved, straight, unification, circular, and nonspecific in decreasing order in the overall population. CONCLUSION: Straight rugae pattern on the right side of the palate in the male subjects was found to be significantly predominant in the MP population, whereas wavy shape was predominant in Keralites; however, rugae patterns on the right side of the palate in female subjects exhibited no significant difference.

Effects of high temperature on different restorations in forensic identification: Dental samples and mandible.

INTRODUCTION: The forensic odontologist strives to utilize the charred human dentition throughout each stage of dental evaluation, and restorations are as unique as fingerprints and their radiographic morphology as well as the types of filling materials are often the main feature for identification. The knowledge of detecting residual restorative material and composition of unrecovered adjacent restoration is a valuable tool-mark in the presumptive identification of the dentition of a burned victim. Gold, silver amalgam, silicate restoration, and so on, have a different resistance to prolonged high temperature, therefore, the identification of burned bodies can be correlated with adequate qualities and quantities of the traces. Most of the dental examination relies heavily on the presence of the restoration as well as the relationship of one dental structure to another. This greatly narrows the research for the final identification that is based on postmortem data. AIM: The purpose of this study is to examine the resistance of teeth and different restorative materials, and the mandible, to variable temperature and duration, for the purpose of identification. MATERIALS AND METHODS: The study was conducted on 72 extracted teeth which were divided into six goups of 12 teeth each based on the type of restorative material. (Group 1 - unrestored teeth, group 2 - teeth restored with Zn(3)(PO(4))(2), group 3 - with silver amalgam, group 4 with glass ionomer cement, group 5 - Ni-Cr-metal crown, group 6 - metal ceramic crown) and two specimens of the mandible. The effect of incineration at 400°C (5 mins, 15 mins, 30 mins) and 1100°C (15 mins) was studied. RESULTS: Damage to the teeth subjected to variable temperatures and time can be categorized as intact (no damage), scorched (superficially parched and discolored), charred (reduced to carbon by incomplete combustion) and incinerated (burned to ashes).