Expression of epithelial growth factor receptor as a protein marker in oral reticular and erosive lichen planus.

BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory mucosal disease that is classified as a premalignant condition. Epithelial growth factor receptor (EGFR) is associated with tumorigenesis and tumor progression and is overexpressed in several oral malignant disorders. Despite the association of EGFR overexpression with oral potentially malignant lesions, few studies have analyzed its expression in OLP, showing controversial results. This study aimed to compare the expression of EGFR as a protein marker in Reticular and Erosive OLP. METHODS: This descriptive-analytical cross-sectional was conducted on 15 paraffin blocks of reticular lichen planus lesions, 16 paraffin blocks of erosive OLP lesions, and 8 paraffin blocks of inflammatory fibrous hyperplasia lesions as the control group (39 in total). After immunohistochemical staining for EGFR, samples were simultaneously observed by two maxillofacial pathologist, and the percentage of stained cells, intensity of staining, pattern of staining, and the location of stained cells were obtained. RESULTS: The Mann-Whitney-U test showed that there was no significant difference in the mean percentage of stained cells between erosive OLP and reticular OLP (P-value = 0.213) and between reticular OLP and control group (P-value = 0.137), but there was a significant difference between erosive OLP and control group (P-value = 0.035). Fisher's exact test showed that there was no significant difference between the frequency distribution of staining patterns in three types of lesions (P-value = 0.90). Kruskal-Wallis test showed that there was no significant difference between the intensity of staining in the three groups (P-value = 0.19) and also there was no significant difference between the location of stained cells in different layers of the epithelium in the three groups (P-value = 0.90). CONCLUSIONS: The results of this study showed that in comparison of reticular OLP, erosive OLP, and the control group there was a significant difference just between erosive OLP and control group in the percentage of stained cells.

Evaluation of the effects of postprocessing settings in digital bitewing radiographs on proximal caries detection.

OBJECTIVE: Radiographs are an integral part of detecting proximal caries. The aim of this study was to evaluate the effect of contrast, brightness, noise, sharpness, and γ adjustment of digital intraoral radiographs on the diagnosis of proximal caries. MATERIALS AND METHODS: In this in vitro study, 40 extracted teeth including 20 premolars and 20 molars with enamel lesions (white spot or dentin discoloration seen through the enamel) were mounted together in groups of eight inside the skull. Bitewing radiographic images of each dental group were obtained by a photostimulable phosphor plate sensor with exposure conditions of 8 mA, 70 kV, and 0.2 s. The images were reconstructed by the built-in software and examined by two oral and maxillofacial radiologists in various settings of contrast, brightness, sharpness, noise, and γ. The teeth were then cut mesiodistally and the presence or absence of caries was confirmed by an oral and maxillofacial pathologist using a stereomicroscope. The data were then analyzed using the κ agreement coefficient, sensitivity, specificity, and accuracy (α = .05). RESULTS: Adjustment of brightness and contrast led to higher diagnostic performance with an accuracy of 82.5% and 83.8 (for observers 1 and 2, respectively) and 82.5% (for both observers), respectively. Noise adjustment was the least helpful approach for diagnosis of proximal dental caries among other adjustments, with an accuracy of 78.8% and 77.5% for observers 1 and 2, respectively. CONCLUSION: Brightness and contrast setting was more efficient in improving the diagnostic potential of bitewing radiographs compared to other adjustments.

Effect of two types of charcoal toothpaste on the enamel surface roughness of permanent teeth.

Background: Charcoal in the composition of some kinds of toothpaste has created concerns regarding abrasiveness and subsequent complications. Considering the popularity of charcoal toothpaste, and the manufacturers' claims that no porosity is caused by activated carbon, this study aimed to compare the effects of two charcoal kinds of toothpaste and three conventional tubes of toothpaste on enamel surface roughness of permanent primary teeth. Materials and Methods: This in vitro experimental study evaluated 75 teeth mounted in acrylic resin. Teeth were divided into five groups (n = 15). The primary surface roughness of teeth was measured by a profilometer. The teeth were then subjected to wear test in a V8 cross-brushing machine with Bencer and RP charcoal toothpaste, Crest 7, Colgate Optic White, and Bencer fresh mint toothpaste. After rinsing and drying specimens, their secondary surface roughness was measured. The mean changes in the roughness profile of specimens were analyzed by a one-sample Kolmogorov-Smirnov test at a 0.05 significance level. Results: There was no significant difference in the mean surface roughness of specimens before and after the wear test (P > 0.05). The difference in the mean wear of five types of toothpaste was not significant either (P = 0.597). The mean changes in surface roughness were 0.0685 µm for Bencer charcoal, -0.0620 µm for RP charcoal, 0.0765 µm for Crest 7, 0.1137 µm for Colgate Optic White, and 0.1052 µm for Bencer fresh mint toothpaste. Conclusion: Numerous kinds of toothpaste investigated in this study did not reveal any difference in terms of wear index; however, more studies are needed to evaluate the effectiveness and efficiency of these types of toothpaste.

Assessment of biochemical factors in blood serum of patients with oral squamous cell carcinoma.

Background: Recently, the role of biochemical factors in the etiology of oral squamous cell carcinoma (OSCC) has attracted some attention. Serum levels of biochemical factors may change in cancer patients. This study aimed to assess the serum level of folate, Vitamin B12, homocysteine, iron, copper, and selenium in patients with OSCC. Materials and Methods: This descriptive analytical study was conducted on 30 primary OSCC patients (15 males and 15 females) presenting to Imam Khomeini Cancer Institute, who had not yet undergone treatment. Blood samples were taken and serum levels of folate, Vitamin B12, homocysteine, iron, copper, and selenium were measured. Serum levels of micronutrients in patients with different tumor sizes were analyzed by one-way ANOVA. Serum levels of micronutrients were compared among groups with and without metastasis and lymph node involvement using Student's t-test (P < 0.05). Results: Serum levels of B12, folic acid, homocysteine, copper, iron, and selenium were 232.5 ± 102.68, 8.66 ± 4.06, 18.87 ± 8.81, 96.0 ± 22.64, 55.27 ± 40.58, and 92.47 ± 18.83 ng/mL, respectively. Relatively similar values were measured in patients with different tumor sizes with and without lymph node involvement and presence or absence distant metastasis. However, the serum level of folic acid in OSCC patients without lymph node involvement was significantly higher than that in OSCC patients with lymph node involvement (P < 0.05). Conclusion: Despite some variations, serum levels of micronutrients in OSCC patients were within the normal limits. Considering the variations in serum level of copper in OSCC patients, it may be used as a diagnostic marker. However, further studies are warranted in this respect.

Vascular and Neural Invasion in Oral Squamous Cell Carcinoma: A Study in an Iranian Population.

Background: Among various parameters used to predict the outcome of malignancy, nerve invasion has been widely considered as a sign of aggressive behavior in oral cancers. According to the importance of neural invasion in predicting the outcome of oral squamous cell carcinoma (OSCC), this study aimed to evaluate the prevalence of neural and vascular invasion in OSCC. Materials and Methods: In this descriptive, analytical, and cross-sectional study, paraffin-embedded tissues of 62 OSCC in the health center of surgery and pathology were evaluated (2013-2015). Patients' archives were evaluated and recorded in terms of their age and gender. Hematoxylin and eosin (H&E) slides were then examined by two oral pathologists and scrutinized for the presence of nerve involvement, tumor differentiation, vascular and lymph node invasion, and depth of invasion. Data were analyzed using SPSS version 23, t-test, and one-way ANOVA (P < 0.05). Results: Of 62 tumors, 12 patients showed only nerve invasion, 17 cases had only vascular invasion, and seven patients had both neural and vascular invasion, simultaneously, known as a neurovascular invasion. Furthermore, there was no vascular and neural invasion in 26 cases. There was a statistically significant correlation between vascular and neural invasion and the tumor site (P = 0.045). The highest frequency of neural invasion, as well as vascular invasion, was related to tongue tumors. Conclusion: The relation between neural and vascular invasion in OSCC with tumor's location was statistically significant. Lip and tongue carcinoma had shown more neurovascular invasion without relation to gender, age, and cell differentiation.

Evaluation of Dentists' Attitudes Towards Principles of Professional Ethics.

OBJECTIVE: The aim of this research was to investigate attitudes towards principles of professional ethics (PPE) amongst Iranian dentists working in Isfahan, Iran. METHODS: This pilot cross-sectional study was conducted amongst 273 dentists in Isfahan, Iran. A validated, comprehensive questionnaire including principles of respect for patient autonomy, nonmaleficence, beneficence, and justice was used to evaluate dentistry professional ethics aspects. Age, gender, marital status, type of graduate university, level of education, specialised field of study, work experience, workplace, and participation in ethics workshops and courses were registered from participants. Total and domains scores of used questionnaires were calculated and compared across categories of study participants' characteristics. RESULTS: Mean ± SD age of participants was 35.4 ± 10.7 years, and 57% were female; about 73% graduated from Isfahan University of Medical Sciences, and 65% were general dentists. The attitude total score of dentists towards PPE was 133.02 ± 13.16. Mean total score of the questionnaire and its domains was different significantly (P < .05) across categories of level of education, marital status, and passing the ethical courses. CONCLUSIONS: The attitude of dentists towards PPE was rated at a good level. However, improvement in attitudes of some specific subgroups such as general dentists and newly graduated ones is needed. Conducting specific workshops about professional ethics and incorporating these principles into university curricula can be beneficial.

A Comparative Analysis of Dominant Dietary Patterns in Patients with and without Oral Squamous Cell Carcinoma.

Background: As a modifiable risk factor, nutrition plays a pivotal role in the prevention or delay of oral squamous cell carcinoma (OSCC). This study was aimed to investigate and compare the dominant dietary patterns in the patients with and without OSCC. Materials and Methods: This case-control study evaluated the usual dietary intake of 80 cases and 120 controls during 2019-2020 using the 117-item Food Frequency Questionnaire, with confirmed validity and reliability. Factor analysis was used to detect the dominant dietary patterns. Data analysis was done by SPSS (version 21) using the Chi-square test, ANOVA, logistic regression analysis, and independent t-test (P < 0.05). Results: Three dietary patterns were identified, including the western dietary pattern, health dietary pattern, and traditional dietary pattern. The odds ratio (OR) = 1.181 and confidence interval (CI) = 0.671 and 2.082 were found for the western dietary pattern, OR = 1.087 and CI = 0.617 and 1.914 were detected for the healthy dietary pattern, and OR = 0.846 and CI = 0.480 and 1.491 were reported for the traditional dietary pattern. No significant difference was found between the study groups in the dietary pattern and the risk of disease. This relationship remained insignificant after adjustment for the energy intake and confounding factors. Conclusion: There was no significant relationship between adherence to healthy, traditional, and western dietary patterns and OSCC. Consumption of vegetables and nuts had a protective role against the disease, but risky behaviors such as smoking and alcohol use were directly associated with the incidence of the disease.

Evaluating histopathological factors of predicting the recurrence rate of odontogenic keratocyst.

Background: Odontogenic keratocyst (OKC) is one of the most common jaw cysts with high recurrence rate. Some possible factors affecting recurrence that have not been evaluated in previous studies are examined in this study. This study aimed to predict the recurrence rate of OKC and more viable treatment of OKC. Materials and Methods: In this descriptive, analytical, and cross-sectional study, 10 recurrent OKCs, which both slides before and after recurrence were accessible, were collected from oral and maxillofacial pathology department's archive. First, they were evaluated based on common histopathologic features. In the second phase, the frequency of these findings in 36 OKCs (24 samples with recurrence and 12 without recurrence after 5 years) was evaluated based on clinical, radiological, and histopathologic features. Data were analyzed by SPSS, Wilcoxon signed-rank test, McNamara, t-test, Chi-square, Mann-Whitney, Fisher's exact test, Cohen's kappa coefficient, and odds ratio (P < 0/05). Results: According to this study, OKC in women, with multilocular radiolucency and mitosis in basal layer of epithelium as well as diffused inflammation, were statistically associated with probability of recurrence (P = 0.05, 0.035, 0.033, and 0.045, respectively). The corrugated surface, reverse polarity, hypercellularity in parabasal, and satellite cysts can affect the recurrence of OKC with odds ratios = 2.364, 2.364, 1.190, and 1.500, respectively). Conclusion: Gender (women), multilocular radiolucency, diffused inflammation in stroma, and mitosis in basal layer of epithelial lining, can statically predict the possibility of recurrence rate. In addition, findings regarding the age (in younger patients), corrugated surface, reverse polarity, and sub-basal cleft can be helpful in predicting recurrence.

Estrogen receptor α expression in different stages of salivary gland mucoepidermoid carcinoma.

Background: Since salivary and breast glands are both considered as a tubulo-acinar, exocrine glands, and they have a common neoplastic morphology, it is not surprising if they share a similar molecular mechanism responsible for their neoplastic transformation. From the first description of estrogen receptor-α (ER-α) in salivary tumors, tremendous attentions have been attracted to this receptor for evaluating its impact in mucoepidermoid carcinoma (MEC). Materials and Methods: In this descriptive analytics, 28 samples of MEC (14 high grade and 14 low grade) were collected from the Oral and Maxillofacial Pathology Department of Isfahan Dental School and Isfahan Alzahra Hospital. All of these samples were stained with immunohistochemical technique with ER-α marker. The expression of the receptor was evaluated by two oral and maxillofacial pathologists. Statistical data were saved at SPSS and had been analyzed by Mann-Whitney U- and independent t-tests (significance level: P ≤ 0.05). Results: The high-grade MEC was more common in patients with a higher average age (55.9); on the other hand, low-grade MEC was mostly observed in those with a mean age of 39.2 years. Moreover, high-grade MEC was more prevalent in men rather than in women. The staining intensity distribution average in high-grade MEC and low-grade MEC was 2.4 and 0.8, respectively (P = 0.48). Conclusion: The expression of ER-α in high-grade MEC was significantly more than low-grade MEC, indicating that targeting this receptor alongside surgery could bring more advantages for patients.

Screening of oral squamous cell carcinoma by serum changes: A systematic review and meta-analysis.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the sixth common cancer in the world and 90% of oral malignant tumors. The aim of this study was the investigation of changes in some metabolic elements of OSCC patients' serum. MATERIALS AND METHODS: In this study, international databases such as PubMed, Science Direct, Scopus, Web of Science, and National (Magiran, IranMedex) were searched from 1980 to 2019. To analyze the data, a random-effects model was used to combine the differences in the mean of studies in STATA Software (version 12). RESULTS: A total of 724 articles were found with initial searching that 474 duplicate articles, 228 articles were excluded by reviewing the title and abstracts, and 17 articles were excluded from the study due to lack of inclusion criteria. Finally, five articles entered the meta-analysis phase. The mean difference value for zinc concentration of blood serum was 2.01 (95% confidence interval (CI): 0.36-3.66) and for copper was 1.04 (95% CI: 0.01-2.07). In both populations, the heterogeneity was found between studies (I 2 = 97.4, P < 0.001). CONCLUSION: Probably higher serum levels of copper and zinc could be one way to help to do a primary screening of OSCC in suspected patients.

IL29 expression in gingival tissues of chronic periodontitis and aggressive periodontitis patients: An immunohistochemical analysis.

BACKGROUND: Interleukin-29 (IL-29) is one of the cytokines which has immunomodulatory properties and might play a role in the pathogenesis of periodontal diseases. The aim of this study was an immunohistochemical analysis of IL-29 in gingival tissues of chronic and aggressive periodontitis. MATERIALS AND METHODS: In this cross-sectional study based on clinical evaluation and inclusion and exclusion criteria, 20 patients with generalized chronic periodontitis, 13 patients with generalized aggressive periodontitis, and 20 periodontally healthy individuals were enrolled. Gingival tissue samples were obtained during periodontal flap and crown lengthening surgery in periodontal patients and healthy individuals, respectively. Tissue samples were examined to determine the level of IL-29 expression by immunohistochemistry. The data were analyzed using SPSS and paired t-test, ANOVA test, and Tukey's test (P < 0.05). RESULTS: A total of 53 participants (34 females and 19 males) were enrolled in this study. IL-29 expression in the connective tissue of the patient groups was more than the healthy one (P < 0.001). In the aggressive periodontitis group, there was a significant increase of IL-29 expression compared to the other two groups, but there was no significant difference between the chronic periodontitis and healthy groups. CONCLUSION: According to the results of this study, IL-29 expression was increased in the gingival tissue of aggressive and chronic periodontitis. IL-29 local expression in aggressive periodontitis is higher than the chronic periodontitis and healthy groups, which could suggest the role of IL-29 in the etiopathogenesis of aggressive periodontitis.

Analysis of artifacts in oral and maxillofacial histopathologic sections and related reasons.

BACKGROUND: Artifacts, artificial structures at microscopic section, may lead to incorrect diagnosis and wrong treatment of a pathological entity. The aim of this study was to evaluate the frequency of various artifacts found in oral and maxillofacial histopathologic sections. MATERIALS AND METHODS: In this cross-sectional study, the specimens included the histopathologic sections along with their diagnosis that were collected from the archive of Isfahan Oral and Maxillofacial Pathology Department using systematic sampling method over a 10-year period. These histopathologic sections were studied by two oral pathologists and an expert laboratory technician for the presence or absence of various artifacts, and the specimens from inside and outside the university were compared. The data were analyzed by SPSS software using independent t-test at significance level α = 0.05. RESULTS: From among 237 specimens studied, 235 specimens (99.15%) had artifacts and two specimens had no artifacts. From among 21 different types of artifacts, folding (n = 158) and throughout cleft (n = 149) artifacts had the highest frequency. There was no significant difference between the specimens of inside and outside the university (P = 0.125). CONCLUSION: The results of this study showed a high number of artifacts in the histopathologic sections, the most frequent artifact being reported for the folding artifact. It seems adequate control of specimens and preventing technical errors can reduce the number of artifacts.

Seven-year follow-up of spontaneous bone regeneration following segmental mandibulectomy: Alternative option for mandibular reconstruction.

Bone formation in small deposits following the loss of part of the mandible has often been reported in the literature, but the long-term follow-up reports of bone regeneration extending over the mandible are rare. Even rarer, are reports on the behavior of such new bone in terms of facial development, over a long period and the effect of load on it. A unique case of bone regeneration after resection of a large portion of the mandible in a 9-year-old male patient with myxofibrosarcoma in the body of the mandible is presented here. Intermaxillary fixation and insertion of reconstruction plate after resection without continuity defect were employed. Spontaneous bone regeneration was noted 8 weeks after surgery, and the resected portion of the mandible was regenerated when the patient was seen again 7 years later. Mandibular growth was not significantly affected and almost 7 years after his treatment, without relapsing of pathologic condition, the shape of the mandible is satisfactory without any evidence of bone resorption.

Visfatin expression in gingival tissues of chronic periodontitis and aggressive periodontitis patients: An immunohistochemical analysis.

BACKGROUND: Visfatin, also known as nicotinamide phosphoribosyltransferase, has been suggested as a pro-inflammatory and immunomodulating marker for periodontitis. The aim of this study was an immunohistochemical analysis of visfatin in gingival tissues of patients with chronic periodontitis and aggressive periodontitis. MATERIALS AND METHODS: In this cross-sectional study based on clinical evaluation and inclusion and exclusion criteria. Twenty patients with generalized chronic periodontitis, 13 patients with generalized aggressive periodontitis, and 20 periodontally healthy individuals enrolled. Gingival tissue samples were obtained during periodontal flap surgery and crown lengthening surgery in periodontal patients and healthy group, respectively. Tissue samples were transferred to a pathology laboratory to determine the degree of inflammatory infiltration by hematoxylin and eosin staining and the level of visfatin expression by immunohistochemistry. The data were analyzed using SPSS version 20 statistical software and paired t-test, Mann-Whitney test, and Spearman rank correlation coefficient. P < 0.05 was considered statistically significant. RESULTS: Inflammation grading and visfatin expression were significantly higher in periodontally diseased gingiva compared to the control group (P < 0.05). However, no significant difference was found between two diseased groups. The relationship between inflammation grading and visfatin expression in aggressive periodontitis group was statistically significant, positive and relatively strong (P = 0.025, r = 0.617). However, no significant relationship has been found between visfatin expression and inflammation grading in the chronic periodontitits and control groups (P > 0.05). CONCLUSION: Visfatin expression was increased in gingival tissues of chronic periodontitis and aggressive periodontitis patients. Hence, visfatin may have a role in the etiopathogenesis of chronic periodontitis and aggressive periodontitis.

Comparison of immunohistochemical expression of CD10 in keratocystic odontogenic tumor and ameloblastoma.

BACKGROUND: Odontogenic keratocyst (OKC), also called keratocystic odontogenic tumor (KCOT), is a developmental lesion which should be carefully monitored and it exhibits development mechanisms and biologic behaviors different from those of other more common lesions such as dentigerous and radicular cysts. CD10 antigen is a cell surface metalloendopeptidase, which inactivates various peptides that are physiologically active. Studies have shown that increase in the expression of CD10 in the stromal cells helps the progression of the tumor. Ameloblastoma (AB) is a local invasive tumor and given the role of supporting connective tissue stroma in the aggression and progression. The aim of the present study was to comparatively evaluate the expression of CD10 in the connective tissue stroma of AB and OKC as a KCOT. MATERIALS AND METHODS: In this retrospective, cross-sectional study, 14 paraffin blocks of KCOT and 9 of AB (7 multicystic and 2 unicystic) were evaluated with CD10 immunohistochemical expression in the connective tissue stroma of AB and the connective tissue wall of KCOT. The data were analyzed with Fisher's exact test (P < 0.05). RESULTS: In 8 samples of 9 AB and in 13 samples of 14 KOT lesions, expression of CD10 was shown. Fisher's exact test did not reveal any significant differences between these two lesions in the expression of CD10 (P = 0.64). CONCLUSION: The results of this study propose that high expression rate of CD10 might be one of the reasons for the aggressive behavior of AB and high recurrence rate of OKC and reinforce the classification of OKC as an odontogenic tumor.