A clinicobiochemical evaluation of curcumin as gel and as buccal mucoadhesive patches in the management of oral submucous fibrosis.

OBJECTIVE: The objective of this study was to evaluate and compare the efficacy of topical curcumin gel and buccal mucoadhesive patches in the management of oral submucous fibrosis (OSMF). STUDY DESIGN: Forty patients clinically diagnosed with OSMF were randomly divided into 2 groups. Group A received curcumin gel and group B received curcumin mucoadhesive patches, to be used twice daily for 8 weeks. Evaluation was done every 2 weeks. Serum lactate dehydrogenase (LDH) levels were measured before and after treatment and also in 20 healthy controls. RESULTS: A 100% reduction in burning sensation was observed in all 40 patients at the end of 4 weeks. Mouth opening improved by 5.45 ± 1.64 mm in group A and 5.9 ± 2.00 mm in group B. Pretreatment LDH was 359.72 ± 77.02 IU/L in patients with OSMF, which was significantly higher than that in healthy volunteers (173.2 ± 46.20 IU/L). In group A, LDH values reduced from 341.85 ± 71 IU/L to 264.95 ± 65.09 IU/L and in group B, values reduced from 377.6 ± 79.76 IU/L to 286.15 ± 72.95 IU/L after treatment. CONCLUSION: Curcumin gel and mucoadhesive patches were effective in improving mouth opening and reducing burning sensation in patients with OSMF. They can therefore be considered as safe, noninvasive modalities for treatment of OSMF.

Comparative analysis of oral health and treatment necessities in hemophilia individuals of Davangere population - A case control study.

BACKGROUND: The integrated approach towards the oral care of individuals with special needs requires proper motivation and prophylactic guidance by primary health care professionals, including musculoskeletal support to psychological therapy. In developing countries like India, oral care is not of primary importance as oral hygiene practices are less performed by compromised individuals suffering from hemophilia. Here, primary health care professionals play a significant role. The present study was commenced to evaluate oral health and treatment necessities in hemophilic individuals of Davangere population, Karnataka. OBJECTIVE: The present study was conducted to assess and compare the oral hygiene, dentition status, and treatment needs of individuals with hemophilia. METHODS: Simplified Oral Hygiene Index (OHI-S), decayed, missed, filled tooth (DMFT) indices and treatment needs in 50 hemophiliac patients registered at Karnataka hemophilia society were evaluated along with an Oral health-related quality of life (OHR-QoL) questionnaire. They were matched with healthy controls of the same age and gender. The data was analyzed using t test and Chi square test. RESULTS: The oral hygiene was fair in both hemophilic and healthy individuals with a mean value of 1.82 ± 0.79 and 1.83 ± 0.73, respectively. All the parameters such as OHIS, DMFT indices, and teatment needs were not statistically significant. The spontaneous oral bleeding was the only significant factor in OHR-Qol questionnaire. CONCLUSION: The present study concluded that oral hygiene, dental caries prevalence, and treatment needs were similar in both hemophiliac and control groups. With proper guidance, motivation, and preventive care by primary health care professionals, it was relatively easy for individuals with congenital blood disorder (CBD) to maintain oral health-related quality of life in Davangere population, Karnataka.

Angiomyoma - A requisite in differential diagnosis of palatal growths.

Vascular variant of leiomyomas termed angioleiomyomas rarely present in the oral cavity. They present themselves as well-circumscribed, slow-growing, superficial lesions covered by normal mucosa and sometimes bluish or purple in color. Clinicians often tend to overlook this entity due to the rarity and asymptomatic nature of the lesion. Scrupulous knowledge of this entity and a thorough examination is of value, as the lesion can impersonate or transform to malignancy, as a malignant counterpart exists. We present a case of angiomyoma of hard palate in a 46-year-old patient with a detailed review.

Evaluation of the antifungal efficacy of different concentrations of Curcuma longa on Candida albicans: An in vitro study.

BACKGROUND: Candidal infections have increased significantly in denture wearers, especially in immunocompromised patients. The increase in resistance to existing antifungal drugs and number of patients at risk, in conjunction with the restricted number of commercially available antifungal drugs that still present many side effects, are the cause for this problem. These limitations emphasize the need to develop new and more effective antifungal agents with lesser side effects. MATERIALS AND METHODS: The present study was undertaken to investigate the possible antifungal action of the alcoholic extract of different concentrations of Curcuma longa on four dilutions of Candida albicans (1:10, 1:20, 1:40 and 1:80) and to determine its minimum inhibitory concentration (MIC) and minimum fungicidal concentration using Sabouraud's agar medium. RESULTS: There was complete inhibition of the growth of all four dilutions of Candida at a concentration of 800 µl which is considered as the MIC of alcoholic extract of turmeric on C. albicans, and the minimum fungicidal concentration was at 1600 µl. CONCLUSION: This study indicates a potent antifungal action of C. longa against C. albicans.

Efficacy of Spirulina along with Different Physiotherapeutic Modalities in the Management of Oral Submucous Fibrosis.

CONTEXT: Oral submucous fibrosis (OSMF) is an insidious, chronic, disabling disease that mainly affects the oral mucosa. Spirulina is a freshwater microalga which is considered as superfood by the WHO. Due to its antioxidant, anti-inflammatory, and immunomodulating properties, spirulina has shown promising results in the management of OSMF. A wide range of treatment modalities have been tried ranging from medical, physical, or surgical interventions, but combinations of these have shown better results. AIMS: The study aimed to evaluate the efficacy of spirulina along with different physiotherapeutic modalities in the management of OSMF. SETTING AND DESIGN: The present comparative study was conducted in the Department of Oral medicine and radiology, College of Dental Sciences, Davangere, Karnataka, India. The block randomization technique was used in the present study to enroll patients into three different groups. METHODS: The study consisted of 45 OSMF patients who were divided randomly into three groups. All patients were given spirulina 500 mg twice a day for 3 months. Group A patients were instructed to perform isometric mouth exercises for 20 min, twice daily. Group B patients and Group C patients perform exercises using threaded tapered screw and mouth stretching device (MSD), respectively, ten times bilaterally twice a day. Clinical parameters such as burning sensation, mouth opening, tongue protrusion, and cheek flexibility were assessed every 15 days. STATISTICAL ANALYSIS USED: Descriptive data that included mean, numbers, and percentages were calculated for each group and were used for analysis. For intra- and inter-group comparison, paired t- and unpaired t-test was used, respectively. For all the tests, P = 0.05 or less was considered for statistical significance. RESULTS AND CONCLUSION: All the groups have shown statistically significant improvement in burning sensation, mouth opening, tongue protrusion, and cheek flexibility (P < 0.05). Group C patients have shown better results followed by Group B and Group A patients. In the present study, spirulina along with different physiotherapeutic modalities was well tolerated by the patients, and significant improvement was seen in the MSD group.

Characterization of saliva in immunocompromised patients and tobacco users: A case-control study.

OBJECTIVE: The aim of the study was to assess salivary flow rate, salivary pH, and salivary albumin concentration in systemically compromised subjects and tobacco users and its comparison to healthy controls. MATERIALS AND METHODS: Sixty patients were selected and then were equally divided into systemically compromised group, tobacco users, and control group with 20 in each group. Saliva flow rate was assessed using modified Schirmer test (MST), salivary pH was estimated by pH meter, and salivary albumin concentration was determined using bromocresol green method. RESULTS: The salivary flow rate readings measured by MST were 22.65 ± 2.79, 22.6 ± 3.57, and 33.22 ± 2.30 mm/3min in systemically compromised individuals, tobacco users, and control group, respectively (P < 0.001). The salivary pH was 6.80 ± 0.24, 6.81 ± 0.25, and 7.18 ± 0.17 in systemically compromised subjects, tobacco users, and control group, respectively (P < 0.001). The salivary albumin concentration was 2.49 ± 0.61, 0.73 ± 0.13, and 1.14 ± 0.12 g/dl in systemically compromised subjects, tobacco users, and control group, respectively (P < 0.001). CONCLUSION: MST can be routinely used as chair-side investigation to evaluate salivary flow which is objective, inexpensive, easy-to-perform, and patient-friendly. The salivary flow rate, salivary pH, and salivary albumin level in systemically compromised subjects, tobacco users, and normal individuals showed significant differences.

Translational research in oral cancer: "A challenging key step in moving from bench to bedside".

This review summarizes and interprets the rate of improvement in cancer treatments which have remained frustratingly slow despite considerable investment in oncological research. Hence, this review emphasizes on minimizing exposure of patients to ineffective investigational therapies by decreasing the number of poorly designed clinical trials through stronger collaboration between industry and academia which can be done by multidisciplinary teams who are essential to facilitate future cancer outcome studies focused on improving clinical care of cancer patients and implementing effective interventions to ultimately improve the quality and duration of survival. Hence, it is recommended to explore all these factors which contribute toward translational lag between implementation of discoveries from basic research into clinical use.

Relative Efficacy of Quercetin Compared with Benzydamine Hydrochloride in Minor Aphthae: A Prospective, Parallel, Double Blind, Active Control, Preliminary Study.

BACKGROUND AND OBJECTIVES: Recurrent aphthous stomatitis is an inflammatory condition present since ancient era wherein numerous treatment modalities have been tried. But complete eradication of the disease has not been possible and hence newer agents are being introduced. One such agent is a flavonoid named quercetin with proven antioxidant, anti-inflammatory, and ulcer healing properties. METHODS: 40 patients with minor aphthous ulcers were divided equally into two groups: A and B. Group A patients were advised to apply quercetin gel and Group B patients were advised to take benzydamine hydrochloride mouth wash. Clinical evaluation including assessment of ulcer size and pain score and questionnaire about the acceptability of both the drugs in terms of taste and ease of application was carried out. Each criterion was compared and statistically analyzed. RESULTS: There was statistically significant reduction in the mean score of pain sensation and ulcer area in both the groups. Quercetin showed statistically highly significant ulcer size reduction as compared to benzydamine hydrochloride. CONCLUSION: From the present study, it is evident that quercetin is safe, well tolerated, and effective therapy which promotes complete ulcer healing in a short duration of time.

Evaluation of diagnostic value of AgNOR and PAP in early detection of dysplastic changes in leukoplakia and lichen planus - a preliminary case-control study.

BACKGROUND AND OBJECTIVES: Early detection of oral cancer has been the most effective approach to reduce morbidity and mortality of cancer patients. If a lesion is clinically considered suspicious, an easily practicable, non-invasive, painless, safe, and accurate screening method for detection of the dysplastic changes is necessary. In an attempt to procure this, a study was conducted with the aim of determining the diagnostic accuracy of rapid Papanicolaou stain (PAP) and silver-stained nucleolar organizer regions (AgNOR) in brush biopsies of potentially malignant lesions for early detection of oral cancer. METHODOLOGY: Brush biopsies taken from 25 cases of leukoplakia and lichen planus each were stained with rapid PAP and silver nitrate stains. Histopathological correlation was performed and further compared with rapid PAP and AgNOR for its diagnostic validity. RESULTS: Statistically significant increase in the mean AgNOR count was seen from normal epithelium to lichen planus to that of leukoplakia. When compared with rapid PAP, a linear correlation was seen in AgNOR counts and stages of dysplasia in leukoplakia which was also found to be statistically significant. Diagnostic accuracy for AgNOR in leukoplakia was found to be 84%, lichen planus 73%, whereas RAPID PAP showed 72% accuracy. CONCLUSION: AgNOR analysis may be useful as a quantitative marker of incipient cellular alterations and hence would be helpful in assessing suspicious lesions and thus can be regarded as a valuable adjunct.

Clinicobiochemical evaluation of turmeric with black pepper and nigella sativa in management of oral submucous fibrosis-a double-blind, randomized preliminary study.

OBJECTIVE: To investigate the effectiveness of turmeric with black pepper and nigella sativa in oral submucous fibrosis (OSMF). STUDY DESIGN: Forty OSMF patients were randomly divided into two groups. The study was performed under a double-blind, randomized design. Group A received turmeric with black pepper and group B received nigella sativa for 3 months. Clinical evaluation was done every 15 days. Patients' serum superoxide dismutase (SOD) levels were assessed before and after treatment and also compared with healthy controls. The response to treatment was analyzed using analysis of variance, paired t test, and unpaired t test. RESULTS: After the treatment, groups A and B showed 3.85 ± 0.22 mm and 3.6 ± 0.07 mm improvement in mouth opening, respectively (P < .01); 87.90% and 78.91% reduction in burning sensation, respectively (P < .01); and +0.62 U/mL and +0.74 U/mL improvement in serum SOD levels, respectively (P < .05). The maximum mouth opening achieved was 8 mm in group A and 7 mm in group B. The mean pretreatment SOD level for controls and patients was 3.61 ± 0.24 U/mL in group A and 2.63 ± 0.18 U/mL in group B. CONCLUSION: Turmeric with black pepper and nigella sativa improved mouth opening, burning sensation, and SOD levels in the present OSMF study patients; however, further investigations are needed.

Autophagy: A boon or bane in oral cancer.

Autophagy is a catabolic process involving cellular recycling and is believed to play a distinct role in cell survival especially when exposed to stressors, rendering it comparable to the elixir sustaining life. It plays a significant role in various conditions like cancers, neuropathies, heart diseases, auto-immune diseases, etc. Its role in tumorigenesis and cancer therapeutics is worth exploring. Autophagy is believed to help in survival and longevity of cancer cells by buffering metabolic stress. Inhibition of autophagy in an environment of nutrient deprivation leads to cell death. Autophagy is also seen to facilitate metastasizing tumor cells in surviving the conditions of metabolic deprivation and in recovery when conditions turn favorable. Many current cancer therapies tend to inflict metabolic stress, thus autophagy inhibitors may be useful in cancer treatment. As per the adage, "excess of anything is bad", the autophagy promoters can also be exploited as beneficial tools in the fight against cancer. Another method for tumor-cell elimination can be by inducing autophagic cell death through over-stimulation. Oral cancers are becoming a leading cause of deaths worldwide. Much remains to be explored about the role autophagy plays in progression of head and neck cancers, so as to harness it in the therapeutics of these cancers. Research on autophagy is still in its infancy. There are knowledge gaps in understanding this complex process. But there is no doubt that understanding exact mechanism behind autophagy will open up new avenues in cancer therapeutics and even prevention.

Verrucous carcinoma-an enigma: Case report and review.

Verrucous hyperplasia, verrucous keratosis, and VC may not be distinguished clinically or may coexist. Though it appears remarkably harmless, the histopathological diagnosis of VC should be accompanied with careful identification of tumors with a greater chance to become frank cancers. Here, we report two cases of OVC, referring all the diagnostic intricacy occurring in the clinicopathological examination along with a review of the scientific literature.

Digitized morphometric analysis of dental pulp of permanent mandibular second molar for age estimation of Davangere population.

OBJECTIVE: The aim of the present study is to estimate the age of Davangere population by evaluating the pulp to tooth area ratio (PTR) by using digitized intraoral periapical radiographs of permanent mandibular second molar. METHODS: 400 intraoral periapical radiograph (IOPA) of permanent mandibular 2nd molar of both the sexes aged 14-60 years were used. Digital camera was used to image the radiographs. Images were computed and PTR was calculated by AUTOCAD software. Intra and Inter observer variability was also assessed. Regression analysis was used to estimate the age of an individual by taking PTR as dependent variable. RESULTS: The mean PTR of males and females was 0.10 ± 0.02 and 0.09 ± 0.02 respectively. Negative correlation was observed, when age was compared with PTR {r = -0.441, -0.406 & -0.419 among males, females and total subjects (p < 0.001)}. Regression analysis showed a Standard Error of Estimate (SEE) of 12 years. The Kappa coefficient value for the intra and inter examiner variability was 0.85 & 0.83 respectively. CONCLUSION: Our results showed that permanent mandibular 2(nd) molar can be taken as an index tooth for estimating the age of the adults using digitized periapical radiograph and AUTOCAD software. Also high differences were observed between estimated and chronological age of 12 years which is not in the acceptable range. But it provides a new window for research in the forensic sciences in estimating the adult age.

Role of oxidative stress in the pathogenesis of oral submucous fibrosis: A preliminary prospective study.

BACKGROUND: In the current scenario pathogenesis of majority of the diseases is deeply linked with the oxidative stress, irrespective of its etiology. Enumerable data suggests that reactive oxygen species play a key role in multistage carcinogenesis. Oral submucous fibrosis (OSMF) is considered as a potentially malignant disorder. Its increased incidence over recent years in the Indian subcontinent is a major health concern to oral physicians. However, the role of oxidative stress has not been widely investigated in OSMF. AIMS: Is to evaluate both antioxidant and oxidant status in OSMF and to compare with controls. SETTINGS AND DESIGN: Twenty patients and 20 controls of the same age group were enrolled in the study. SUBJECTS AND METHODS: Five milliliters of blood were collected from each individual and serum was separated. Malondialdehyde (MDA) estimation using thiobarbituric acid (TBA) method, and antioxidant activity (AOA) using principle of TBA reactive substances was done using this serum, with a calorimetric method. STATISTICAL ANALYSIS USED: Student's t-test and ANOVA test. RESULTS: The mean serum AOA status was seen to significantly decrease in OSMF patients, as compared to controls (P = 0.013). The increase in mean serum MDA level was highly significant in OSMF patients, as compared to controls (P < 0.001). CONCLUSION: The disparity between AOA and MDA levels in the patients clearly demonstrates the role of oxidative stress in the disease process. The results also suggest the use of antioxidants in the management of OSMF.

Relative efficacy of pimecrolimus cream and triamcinolone acetonide paste in the treatment of symptomatic oral lichen planus.

BACKGROUND AND OBJECTIVES: Oral lichen planus (OLP) is a relatively common, chronic inflammatory condition that frequently presents with symptoms of pain and burning sensation. It is generally a very unrelenting disorder despite several kinds of treatment. Only symptomatic OLP requires treatment, and it remains a challenging predicament. Efforts are made in a sustained manner for searching for novel therapies for symptomatic OLP. Therefore, this study was aimed to compare the efficacy of treatment with topical pimecrolimus cream 1% with that of triamcinolone acetonide oral paste 0.1% in subjects with symptomatic OLP. MATERIALS AND METHODS: A prospective, parallel-group, randomized, active control clinical study was conducted among 30 symptomatic OLP subjects (20 females and 10 males, with 15 patients in each treatment group) treated with topical pimecrolimus 1% cream and triamcinolone acetonide 0.1% oral paste four times daily for two consecutive months and treatment-free follow-up was performed for 2 months. Pain or burning sensation, mean clinical score and presence of erythematous areas were assessed. The data obtained were statistically analyzed using Wilcoxon's Rank test and the Mann Whitney test. RESULTS: Subjects in both the groups showed significant improvement in symptom scores; however, the overall treatment response was higher in the pimecrolimus group compared with the triamcinolone acetonide group. On intergroup comparison, there was no statistically significant difference between the groups in the reduction in burning sensation (P = 0.18) and erythematous area (P = 0.07), but there was a statistically highly significant improvement in reduction of clinical scoring (P < 0.01%). Following the termination of the treatment, sustained remission of symptoms and long-lasting therapeutic effects was detected in 93.3% of the patients treated with pimecrolimus. INTERPRETATION AND CONCLUSION: Topical pimecrolimus 1% cream showed better therapeutic response compared with triamcinolone acetonide 0.1% oral paste in subjects with symptomatic OLP.

Effect of yogurt and pH equivalent lemon juice on salivary flow rate in healthy volunteers - An experimental crossover study.

BACKGROUND: Xerostomia is a common clinical problem, and different medications have been tried in its management. In the present study, routine dietary products are used to assess their effect on salivary flow. AIM: To assess the efficacy of yogurt and lemon juice on increase in salivation and its comparison with that of unstimulated saliva. MATERIALS AND METHODS: A total of 40 volunteers (aged 19-48) were selected. The pH of yogurt was calculated, and equivalent pH lemon juice was prepared. First, normal resting saliva was collected as baseline followed by every 1 min for 5 min. Patients were given lemon juice or yogurt and then crossed over to the other group to assess the impact of the stimulants on salivary flow from 1 to 5 min. RESULTS: The results were analyzed statistically. Comparisons between baseline saliva secretion and that by yogurt and lemon juice (using the ANOVA test) showed that there was a significant increase after treatment at the end of the experiment for both yogurt and lemon juice. However, yogurt showed a significant increase in saliva secretion compared to baseline than lemon juice. CONCLUSIONS: Our findings suggest that yogurt is a potential candidate for the treatment of dry mouth.

Modified schirmer test--a screening tool for xerostomia among subjects on antidepressants.

OBJECTIVE: The aim of the present study is to assess salivary flow rate in the subjects who were on antidepressant medications and its comparison with healthy controls and assessment of unstimulated salivary flow rate by modified Schirmer test (MST) and volumetric method (spitting method) for evaluation of xerostomia and whether any correlation exists between two methods. MATERIAL AND METHODS: Thirty subjects who were on antidepressants were divided into two groups: tricyclic antidepressants (TCA) and selective sertonin reuptake inhibitors (SSRI) of 15 each, compared with 30 age and gender matched controls. Unstimulated salivary flow rate was measured by both MST and spitting method. RESULTS: The unstimulated salivary flow rate measured by MST at the end of 3rd minute was 13.7 ± 10.08, 19.86 ± 8.95 and 31.0 ± 5.4 mm and by spitting method was 0.12 ± 0.07, 0.19 ± 0.10 and 0.30 ± 0.75 ml/min in TCA, SSRI and controls respectively (p<0.001). The Pearson correlation coefficient of r=0.85 shows excellent correlation between the two screening tests. Sensitivity and Specificity of MST was 90.9% and 31.5%. CONCLUSION: Salivary flow rate was less in antidepressant subjects when compared to the healthy controls. Results of the present study showed an excellent correlation excellent correlation between the two screening tests which suggests that MST can be routinely used as chair-side screening tool to evaluate hyposalivation which is time saving, patient friendly and specific of salivary secretions.

The evaluation of effect of developer age in the detection of approximal caries using three speed dental x-ray films: an in-vitro study.

BACKGROUND AND OBJECTIVES: Ever since the first radiograph was taken in 1895, radiographs have become an essential part of dental practice. Since radiation exposure for the patients is a major concern, it is important for us to reduce the radiation exposure to the patient and surrounding environment, without compromising the quality of image. Since improper film processing is one of the major causes of poor image quality, it is very important to test dental films under a variety of processing conditions. So this study was conducted to compare the diagnostic accuracy between Kodak Ultraspeed, Ektaspeed and Agfa Dentus M2 Comfort films for the detection of approximal caries in fresh as well as in aged processing solution. METHODS: Hundred extracted unrestored maxillary and mandibular teeth were aligned in a group of five teeth in each plaster model. Total of 20 plaster models were constructed and only 3 teeth in the middle were utilized for the study. The final sample consisted of 60 teeth in the study. The exposure time for Ultraspeed film was standardized at 0.5 seconds and for Ektaspeed and Agfa Dentus M2 films, the exposure time was 0.32 seconds. For each radiograph two blocks were used simulating bitewing radiograph. All 20 plaster blocks were exposed using three film types at standardized exposure timings with 30 radiographs each week. The procedure was repeated every week until 6 weeks. Radiographs were evaluated by an observer and assessed by following four point scale 0- sound tooth, 1- lesion in enamel, 2- lesion in amelodentinal junction, 3- dentinal lesion. Only distal surfaces were assessed. Thereafter all the teeth were subjected for histological study and actual depth of the lesion was recorded which acted as gold standard and this reading was subtracted in observer readings after radiographic examination. All data collected were analyzed statistically using ANOVA, paired and unpaired t-tests. RESULTS: Ektaspeed and Agfa films required less exposure compared to Ultraspeed film. With respect to film, all films had equal diagnostic accuracy upto three weeks. From fourth week Ultraspeed and Agfa films were considerably better than E speed film. E speed film was inferior in the depleted solution compared to other two solutions. With respect to lesion detection Agfa film was inferior to other two films. CONCLUSION: All three films had equal diagnostic accuracy in fresh solution. Considering the significant reduction in patient radiation with Ektaspeed film, this should be the film of choice whenever possible. As far as the diagnosis of approximal caries is concerned processing solutions should not be used longer than 3 weeks.

Mucormycosis in a diabetic ketoacidosis patient.

Oral cavity is considered to be a kaleidoscope for body's general health. Many systemic conditions do present with diverse oral manifestations. Mucormycosis involving the oral cavity is one such entity that presents as necrosis of bone in immunocompromised patients. Mucormycosis is an opportunistic fungal infection that mainly affects the patients with uncontrolled diabetes mellitus. Hereby, we report a case of mucormycosis involving the palate in a patient with diabetic ketoacidosis.