Radicular Cyst Associated with Type 3B Dens Invaginatus in a Permanent Maxillary Lateral Incisor.

Dens invaginatus (DI) is a developmental abnormality of the tooth resulting in the invagination of the enamel organ into the dental papilla before the calcification of dental tissues. DI is one of the common dental deformities, but its association with the radicular cyst (RC) is still very uncommon. Oehler's Type 3B DI has a deep invagination that extends apically communicating with the apical area. This allows the entry of irritants predisposing for dental caries, periapical lesions, and pulp pathology if there is a communication with pulp. The sequelae of undiagnosed and untreated coronal invaginations include abscess formation, retention of neighboring teeth, displacement of teeth, cysts, and internal resorption. Identifying this anomaly early will prevent further complications. This presentation describes a case of RC associated with Type 3B DI in a permanent maxillary lateral incisor in a 9-year-old girl. A brief review of both pathologies is also discussed.

Correlation of the activities of antioxidant enzymes superoxide dismutase and glutathione reductase with micronuclei counts among areca nut chewers of Manipuri population using exfoliative cytology: A preliminary study.

Context: Areca nut (AN) is a potent cytotoxic and genotoxic agent. Oxidative stress-induced by chewing of AN can cause DNA damage leading to nuclear anomalies such as micronuclei (MN) and also alters antioxidant defense mechanisms, leading to genomic instabilities and the development of oral cancer. Aims: The aim of this study is to study the correlation between the levels of glutathione reductase (GR) and superoxide dismutase (SOD) in exfoliated buccal mucosal cells and the genotoxicity levels (MN count) in chronic AN chewers. Materials and Methods: The present study was conducted with the approval of the Research Ethics Board in 60 individuals; 40 cases (Group I-20 raw AN chewers, Group II-20 dried areca with tobacco chewers), and 20 controls as Group III in the age group of 18-68 years who attended the outpatient department of our college. Estimation of SOD and GR and MN assessment was done using buccal exfoliated cells. Statistical Analysis Used: Statistical analysis was performed using the Student's t-test and one-way ANOVA. Results: Antioxidant levels were found to be significantly reduced in both Group I and Group II in comparison to the control group. Group II showed significantly reduced level of GR in comparison to Group I. The MN count was significantly increased in Group II in comparison to Group I. The MN counts showed an inverse correlation to the activities of the antioxidant enzymes. Greater activities of antioxidant enzymes correlated with decreased MN counts. Conclusions: Detection of MN in AN chewers with or without tobacco can be a useful biomarker for clinical screening procedures that may be used as a risk marker for oral cancer. It is important to increase the awareness programs to educate the public about the deleterious effects of AN chewing, emphasize on early intervention of AN chewing habit and thus prevent the development of oral cancer.

Incidental finding of orthokeratinized odontogenic cyst with unusual features.

Orthokeratinized odontogenic cyst (OOC) is a rare developmental odontogenic cyst occurring in the jaw with debated etiology. It was originally believed to be a variant of odontogenic keratocyst (OKC) but is now considered to be a distinct entity. The majority of the cases occur in the third and fourth decades of life. The common site is the mandibular posterior region with a male predilection. Swelling is the most common symptom which may be accompanied by pain, although in most cases, the lesion is asymptomatic. These lesions mostly present as unilocular radiolucency often associated with an impacted tooth. They may mimic dentigerous cyst and OKC in radiologic and histopathologic presentation, however, differ in biological behavior, pathogenesis and prognosis in comparison. Hence, making an accurate diagnosis is essential. This article describes an incidental finding of OOC in a 28-year-old female during radiographic investigation for orthodontic treatment. This case showed some rare features such as multilocular radiolucency, nonkeratinized epithelium in areas of inflammation, few cholesterol clefts with giant cells, presence of dentinoid-like material and dystrophic calcification in the capsule.

Recurrent episodes of angina bullosa hemorrhagica of the tongue.

Angina bullosa hemorrhagica is a relatively rare lesion of uncertain etiology affecting the oral cavity and the oropharynx characterized by blood-filled blisters or bullae of varying size. The lesions are sudden in onset, usually asymptomatic and bullae often rupture leaving ulcers which heal without scarring. No specific treatment is usually advised since it is a self-limiting lesion. Rarely, larger lesions in the oropharynx may cause air obstruction and require immediate attention. The clinical presentation of this lesion may cause apprehension to the patient and diagnostic challenge to the clinician since they clinically mimic other serious disorders such as blood disorders and vesiculobullous lesions. An awareness among clinicians is needed to prevent misdiagnosis and unnecessary diagnostic procedures of this distinct entity.

A Comparison of Pre- and Postbreakfast Tooth Brushing in Caries Prevention through the Estimation of Streptococcus mutans Counts: A Prospective Clinical and Microbiological Study.

Objectives: The purpose of this study was to compare the efficacy of prebreakfast tooth brushing (PrBTB) and postbreakfast tooth brushing (PoBTB) with or without a prebrushing rinse in caries prevention through the estimation of Streptococcus mutans count. Materials and Methods: Sixty consenting dental students were divided into three age-matched groups of 20 each and instructed to follow prebreakfast, postbreakfast tooth brushing, and prebreakfast rinsing plus PoBTB using the Bass technique. Plaque samples were collected at the start and at the end of every quarter for a total of 6 quarters (18 months) for the evaluation of S. mutans colony-forming unit (CFU) counts. The decayed missing filled surface (DMFS) index of participants was also recorded and compared at the beginning and end of the study period. Results: The post-breakfast tooth brushing group with pre-breakfast rinse (RPoBTB) and without pre-breakfast rinse (PoBTB) showed a highly significant reduction in total S. mutans CFU counts per ml (38% and 29% respectively) at the end of the study. The changes in DMFS value were not significant and did not show any correlation with the S. mutans counts. Conclusion: Our study revealed that PoBTB with or without a prebreakfast rinse reduces the total counts of the cariogenic bacteria S. mutans more efficiently than PrBTB. Although further proof in the form of clinical trials is essential, this study provides the proof of concept for a minor change in the tooth brushing habit, which can significantly enhance caries prevention.

Fibrolipoma of the Buccal Mucosa in a Geriatric Patient.

Lipoma is the most common mesenchymal tumor seen in the trunk and extremities. It is rarely found in the mouth. Clinically, it resembles other lesions and is not considered in the initial diagnosis. Histopathological evaluation is needed for accurate diagnosis. Surgical excision is the main treatment modality. Histologically, many variants are described of which fibrolipoma is thought to have some recurrence. This article describes a case of fibrolipoma of the buccal mucosa in a geriatric patient.

Cheiloscopy and dermatoglyphics in normal and obese individuals: A study in Indian subpopulation.

BACKGROUND: The prevalence of obesity has been steadily increasing worldwide. Reliable and noninvasive tools that can be used to diagnose such conditions may help us in mass screening and prevention. Finger prints and lip prints have been used as the genetic markers in some diseases such as diabetes mellitus. Studies to correlate a possible association of such markers among obese individuals have not been reported in India to date. The present study was conducted to determine and compare the lip print and finger print patterns in normal and obese individuals and also to evaluate any possible correlation between the lip prints and finger prints in both the study groups. METHODOLOGY: Lip and finger print patterns of 100 obese and equal number of age- and sex-matched healthy individuals were analyzed. Right thumb, right index, left thumb and left index finger prints were evaluated. Gender-wise comparison was also made. RESULTS: Lip prints revealed no significant difference between obese and nonobese individuals. Predominant Type I lip print was observed in both the study groups. Comparison of finger prints between obese and nonobese individuals revealed a highly significant results for all the fingers. Predominant finger print patterns in the right thumb, right index, left thumb and left index among obese individuals were whorl (51%), loop (83%), whorl (79%) and arch (74%), respectively. No correlation between the lip prints and finger prints was noted. CONCLUSION: Finger prints in the obese individuals showed significant differences when compared to the normal controls while lip prints failed to reveal any significant difference. Lip prints did not correlate with the finger prints. Right thumb revealed a significant gender difference among obese individuals.

Bilateral gemination of permanent maxillary canine with labial and palatal talon's cusps: A rare entity.

Gemination is a morphologic anomaly of the tooth characterized by the formation of a macrodont. Bilateral presentation is rarely reported in permanent canines. Talon's cusp is an accessory cusp projecting lingually from the cingulum to the incisal edge and may be seen facially sometimes. Simultaneous occurrence of facial and lingual talons on the same tooth is rare. Concurrent occurrence of all the three entities has not been reported. These anomalies can cause unpleasant esthetic appearance due to irregular morphology. The presence of deep grooves on these teeth increases the susceptible to caries and periodontal disease requiring an endodontic intervention. Proper clinical and radiographic examination provides an accurate diagnosis and helps the clinician in the proper treatment planning and avoiding further complications. This article presents a unique case of simultaneous occurrence of bilateral gemination in the permanent maxillary canines with labial and palatal talon's cusps, which has not been reported in the literature till date.

Novel therapies in the management of oral cancer: An update.

An estimated 4% of all cancers are of the oral cavity or oropharyngeal. Presently, management of the oral cancers mainly includes surgery, radiotherapy, and chemotherapy either alone or in combination depending on the individual case. Each of these techniques has their advantages and disadvantages. Surgery demands removal of cancerous tissue causing disfigurement and functional impairment. Radiotherapy has significant side effects like mucositis, myelosuppression, xerostomia and dental caries. With the advent of newer treatment methods like the targeted therapy, immune therapy and gene therapy, treatment outcomes are better with fewer side effects. This has generally improved survival rates and quality of life of cancer patients.

Sulforaphane in broccoli: The green chemoprevention!! Role in cancer prevention and therapy.

Isothicyanates present in cruciferous vegetables are known to exhibit chemoprevention by various mechanisms. Presently, there is growing evidence that a phytochemical compound known as sulforaphane in these green leafy vegetables is found to be effective in preventing and treating various cancers such as prostate cancer, breast cancer, colon cancer, skin, urinary bladder and oral cancers. This component is naturally present in the broccoli sprouts, kale, cabbage, cauliflower and garden cress and is available as a commercial supplementary pill called Broccoli extract. Availability of many bioactive substances such as vitamins, polyphenols, sulfides, glucosinolates and antioxidants makes broccoli consumption important in daily diet regularly. Researchers have named it as "Green chemoprevention." It is easily affordable and more cost-effective than the traditional chemopreventive drugs. Results from the epidemiological and experimental studies have emphasized the role of sulforophane as a complementary or alternative chemopreventive agent.

Effects of salivary thiocyanate levels on oral mucosa in young adult smokers: A biochemical and cytological study.

BACKGROUND AND OBJECTIVES: Cigarette smoking is one of the major global health issues. Accurate measurement of smoking is essential for accepting patterns of adolescent smoking behavior and for the evaluation of health education programs aimed at reducing or preventing the habit. The aim of the present study was to estimate and compare the salivary thiocyanate levels in young adult smokers and nonsmokers and also to evaluate and correlate the cellular and nuclear changes in cytological smears with salivary thiocyanate levels. MATERIALS AND METHODS: The study included a total of 70 individuals in the age range of 18-25 years comprising of 35 smokers and 35 nonsmokers. A volume of 2 ml unstimulated whole saliva samples were collected by spitting method and were carried in a vaccine carrier with ice pack to the laboratory to avoid biochemical changes. Each sample was analyzed on the same day of collection by spectrophotometric method. In addition, cytosmears were prepared using Cytobrush® plus and stained with rapid Papanicolaou stain for cytological evaluation. RESULTS: Salivary thiocyanate levels were significantly higher in smokers than nonsmokers. When these levels were compared with pack-years, there was a progressive significant increase in salivary thiocyanate levels as the pack-years increased. Duration of habit showed no statistically significant effect on salivary thiocyanate levels. Cytological evaluation revealed increase in nuclear-cytoplasmic area ratio and number of micronuclei in smokers than nonsmokers. The correlation between salivary thiocyanate levels and cytological changes showed insignificant result. CONCLUSION: Salivary thiocyanate levels were significantly higher in smokers than controls and showed significant correlation with the number of pack years. Although the present study failed to reveal any significant correlation between salivary thiocyanate level and cytological alterations, few early alterations in the oral mucosa even in the absence of clinical manifestations were detected by exfoliative cytology. Salivary thiocyanate determination is a safe, inexpensive, noninvasive method to differentiate early smokers from nonsmokers.

Oral carriage of cariogenic bacteria and Candida albicans in asthmatic adults before and after anti-asthma medication: A longitudinal study.

BACKGROUND: Antiasthmatic medications such as ß2 agonists and corticosteroids have shown potential side effects such as increased caries risk and oral candidiasis. Studies evaluating microbial changes in adult asthmatics are very scanty in the literature. The present study aimed to evaluate the effects of asthma and its medication on cariogenic bacteria and Candida albicans in adult asthmatics. AIM AND OBJECTIVES: Our aim was to evaluate and compare counts of Streptococcus mutans (SM) and lactobacilli in plaque and C. albicans in saliva samples of adult asthmatics with controls and during the course of medication longitudinally. METHODOLOGY: Samples were collected from twenty recently diagnosed asthmatic adults and twenty controls for estimation of microbial counts at baseline and at 3rd and 6th month after initiation of medication among cases. RESULTS: Asthmatics at baseline had higher microbial counts than controls, but the difference was not statistically significant. Comparison between asthmatics at baseline and 3rd month after initiation of medication showed an increase in counts of SM, lactobacilli and decreased C. albicans counts though the difference was not significant. Comparison between asthmatics at baseline and 6th month and also between 3rd and 6th month showed significantly increased counts of SM. Although there was an increase in counts of lactobacilli and decreased C. albicans counts, significant results were not noted. Asthmatics showed increased microbial counts than controls overall. CONCLUSION: Asthmatics were found to have higher microbial counts than controls at baseline. Increase in SM and lactobacilli counts in asthmatics after medication emphasizes the need to monitor these patients regularly.

Estimation of salivary Candida albicans counts in asthmatic adult patients taking anti-asthmatic medication for 3-5 years.

BACKGROUND: Bronchial asthma is a chronic inflammatory disease of airways. The disease itself along with the principal medication used makes the oral cavity susceptible to most common opportunistic infection, i.e., oral candidiasis. There are many species of Candida causing oral candidiasis, but the most prevalent among them is Candida albicans. Hence, assessing C. albicans count in response to disease and its treatment is necessary. This enables us to educate asthma patients about side effects of medication and highlight the necessity for oral health care, thereby improving their quality of life. AIMS: The present study aims to evaluate the effects of asthma and its medication on C. albicans count in saliva samples of asthmatic adult patients taking medication for 3-5 years and compare C. albicans count in saliva samples among cases and controls. MATERIALS AND METHODS: Thirty asthmatic adults taking medication for asthma since 3-5 years' age ranging from 20 to 50 years and equal number of age- and sex-matched healthy participants were included in the study. In both groups, saliva was collected and inoculated on Sabouraud Dextrose Agar culture plates for estimation of C. albicans counts. C. albicans counts were assessed in colony-forming unit/milliliter. STATISTICAL ANALYSIS: Mann-Whitney U-test and Fisher's exact t-test were used. RESULTS: The C. albicans count is significantly higher among asthmatics than healthy individuals. CONCLUSIONS: The present study concludes that there is increased candidal growth among asthmatics as compared to their normal healthy counterpart.

Benign chondroid syringoma affecting the upper lip: Report of a rare case and review of literature.

Chondroid syringoma (CS) (mixed tumor of the skin) is a rare neoplasm of the sweat glands, which presents itself as a slow-growing, painless, nonulcerated, subcutaneous or intracutaneous mass often occurring in the head and neck region. The clinician may miss the diagnosis of this lesion due to its rarity. CS should be considered in the differential diagnosis of any subcutaneous nodules, especially in the head and neck region. The diagnosis of CS is mainly based on the histopathologic examination. This article presents a 35-year-old male with a mass on the upper lip that was histopathologically diagnosed as an apocrine variant of benign CS with squamous metaplasia after surgical excision. No sign of recurrence is evident till date during the follow-up. We report this case because of its rarity. A brief literature review and all the reported cases in the lip have been listed.

White sponge nevus: Report of three cases in a single family.

White sponge nevus (WSN) is an interesting hereditary oral mucosal disorder that commonly manifests as bilaterally symmetrical, thickened white, corrugated or velvety, diffuse plaques that predominantly affects the buccal mucosa. The lesions may develop at birth or later in childhood or adolescence. Because it is asymptomatic and benign, WSN requires no treatment. Recognition of this disorder is important due to its potential confusion with other lesions that may be found in the oral cavity. Emphasis should be given to the early and correct diagnosis of this disorder to avoid unnecessary treatment. This report presents three affected members of a single family.

A comparative study of efficacy of single rooted and double rooted teeth in age estimation using dentin translucency.

BACKGROUND: Among various methods of age estimation using dental tissues, measurement of root dentin translucency (RDT) is said to be the most accurate. Numerous studies have estimated age by measuring RDT in single and double rooted teeth and have shown conflicting results. Only few studies have compared efficacy of using single and double rooted teeth for RDT measurement in age estimation. AIM: To analyze the efficacy of single rooted teeth (SRT) and double rooted teeth (DRT) for measurement of sclerotic dentin (SD) and age estimation. METHOD: Study was conducted on 120 freshly extracted SR and DR teeth with 60 teeth in each group. Ground sections of 150 µ thickness were observed under stereomicroscope and photographed. The sclerotic dentin length was measured on the images captured using image analysis software. RESULTS AND CONCLUSION: The present study did not reveal significant difference (p = 0.012) between SRT and DRT when RDT was used for age estimation. However DRT provided more accurate age estimation than SRT with less mean age difference.

Revascularization of immature, nonvital permanent tooth using platelet-rich fibrin in children.

The purpose of this paper was to present a new approach wherein revascularization of the immature, nonvital permanent tooth was performed using platelet-rich fibrin (PRF) as a novel scaffold material. This was performed after disinfection of the root canal space using triple antibiotic paste followed by placing a PRF membrane in the root canal. The patient was followed up regularly at three-, six-, nine-, and 12-month intervals for review. After 12 months, clinical examination showed negative response to percussion and palpation tests but positive response to cold and electric pulp tests. Radiographic examination revealed continued thickening of the root dentinal walls, narrowing of root canal space, root lengthening, and closure of the root apex with normal periradicular architecture. However, more clinical research using large samples is necessary to prove it advantageous for regenerative endodontic therapy in children.

Diagnostic dilemma of a double tooth: a rare case report and review.

Gemination or Schizodontism is a developmental anomaly affecting the tooth shape which is often confused with fusion. It affects primary dentition more often than permanent. It is a rare occurrence in the posterior teeth. Its etiology, pathogenesis, prevalence, differential diagnosis and management are discussed and a rare case of gemination of maxillary premolar is reported here.

Imaging techniques in endodontics: an overview.

This review provides an overview of the relevance of imaging techniques such as, computed tomography, cone beam computed tomography, and ultrasound, to endodontic practice. Many limitations of the conventional radiographic techniques have been overcome by the newer methods. Advantages and disadvantages of various imaging techniques in endodontic practice are also discussed.