Nitric oxide and inflammatory periodontal disease.

Free radicals are species capable of independent existence that contain 1 or more unpaired electrons. These species are beneficial to the host if secreted in appropriate amounts, and may act as powerful antibacterial agents or help in the regulation of vascular tone in the endothelium. In healthy individuals, there is an appropriate balance between free radicals and their scavengers. This balance can be shifted to an unhealthy pro-oxidant state when the production of free radicals is increased, resulting in serious cell damage leading to progressive inflammatory diseases of the periodontium and periapical tissues, and/or precancerous and cancerous lesions of the oral cavity. Free radicals can be important biomarkers for these diseases when clinical symptoms are not present. Nitric oxide (NO) is a free radical gas and an inflammatory biomarker. The aim of this paper is to present the role of NO in periodontal health and inflammation.

Surgical crown lengthening: a periodontal and restorative interdisciplinary approach.

Surgical crown lengthening helps to provide an adequate retention form for proper tooth preparation, thus enabling dentists to create esthetically pleasing and healthy restorations. Long-term stability requires accurate diagnosis and development of a comprehensive treatment plan in each case. This sequence of events stresses the importance of communication between the restorative dentist and the periodontist. This article presents 2 cases that involve surgical crown lengthening (including mucoperiosteal flap and ostectomy) for the restoration of teeth.

Diagnosis and management of focal reactive overgrowths of gingiva--a case series.

Localized overgrowths of gingiva such as peripheral fibroma, peripheral ossifying/cementifying fibroma, pyogenic granuloma and peripheral giant cell granuloma belong to a common group of lesions designated as focal reactive overgrowths (FROG). These growths are reactive in nature. They occur in response to chronic, low grade irritation caused by plaque or any other irritant. Etiology, clinical features and treatment modes of these lesions are the same with slight variations. The present case series describes five different cases of FROG where the lesions were treated by surgical excision under local anesthesia followed by a three month re-evaluation where no recurrences were observed.

Desquamative gingivitis: what's behind it? A case report.

Desquamative gingivitis (DG) is a clinical term used to describe red, painful, glazed, friable gingiva. It may be a manifestation of a mucocutaneous condition, such as lichen planus or other vesiculobulous disorders. Dentists must be aware of this rare clinical entity in order to distinguish DG from the far more common plaque-induced gingivitis. This case is unique in that it involves oral lichen planus and chronic DG, which may be secondary to plaque or a manifestation of the oral lichen planus. Intraoral examination and biopsy reports revealed features of chronic DG and oral reticular lichen planus.

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.

Management of phenytoin-induced gingival enlargement: a case report.

Gingival enlargements may adversely affect speech, mastication, tooth eruption, and esthetics. These enlargements can occur as a result of the administration of certain anticonvulsants, immunosuppressants, and calcium channel blockers. The present case report describes the treatment of a patient with a phenytoin-induced gingival enlargement. A case of gingival enlargement should be treated in a step-wise manner, including consultation with the patient's physician, substitution of the drug, nonsurgical therapy, surgical therapy (if needed), and supportive periodontal therapy after every 3 months. In this case, healing was uneventful, and no recurrences occurred 3 months postoperatively.

Comparative evaluation of anti-plaque efficacy of herbal and 0.2% chlorhexidine gluconate mouthwash in a 4-day plaque re-growth study.

BACKGROUND: Chlorhexidine gluconate mouthwash has earned eponym of gold standard to treat and/or prevent periodontal disease. However, it has been reported to have local side-effects on long-term use. To explore a herbal alternative, the present study was carried out with an aim to compare the anti-plaque efficacy of a herbal mouthwash with 0.2% chlorhexidine gluconate mouthwash and normal saline. MATERIALS AND METHODS: It was an examiner-blinded, parallel designed clinical trial, in which 90 pre-clinical dental students with gingival index (GI) ≤1 were enrolled. To begin with, GI and plaque index (PI) were recorded. Then, baseline plaque scores were brought to zero by professionally cleaning the teeth with scaling and polishing. After that, randomized 3 groups were made (of 30 subjects each - after excluding the drop-outs) who were refrained from regular mechanical oral hygiene measures. Subjects were asked to swish with respective mouthwash (0.2% chlorhexidine gluconate mouthwash, herbal mouthwash, or normal saline) as per therapeutic dose for 4 days. Then, GI and PI scores were re-evaluated on 5(th) day by the same investigator, and the differences were compared statistically by ANOVA and Student's 't'-test. RESULTS AND OBSERVATIONS: Least post-rinsing GI and PI scores were demonstrated with 0.2% chlorhexidine gluconate mouthwash, followed by herbal mouthwash and highest scores with normal saline. The difference of post-rinsing PI scores between the chlorhexidine and herbal mouthwash groups was statistically non-significant, whereas this difference was significant between chlorhexidine and saline groups, and the difference between herbal and saline groups was non-significant. It was concluded that 0.2% chlorhexidine gluconate mouthwash remains the best anti-plaque agent. However, when socio-economic factor and/or side-effects of chlorhexidine need consideration, presently tested herbal mouthwash may be considered as a good alternative.

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.

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.

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.

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.

Quantitative evaluation of serum fucose in oral squamous cell carcinoma patients.

BACKGROUND: Cancer, a disorder of cellular behavior is characterized by the alteration of serum glycoproteins, which are composed of different monosaccharides. One of the monosaccharides is l-fucose, a methyl pentose, which is the terminal sugar in most of the plasma glycoproteins. Elevated levels of protein-bound fucose have been reported in various disease states as well as in malignancies. AIM: To ascertain the role of serum fucose as a biomarker and to correlate with other studies for its effective clinical application. MATERIALS AND METHOD: T0 he study was carried out on 67 subjects, including 14 healthy individuals and 53 oral squamous cell carcinoma cases. The serum fucose level estimation was done based on the method as adopted by Winzler using cysteine reagent. Statistical analysis included Chi-square test, Karl Pearson correlation test and Student's t test to evaluate the significance and variability of values between groups. RESULTS: Serum fucose levels were independent of age and sex. However, there was significant increase in mean serum fucose level of oral squamous cell carcinoma patients compared with healthy controls. The results correlated well with other studies. CONCLUSION: Serum fucose can be used as an effective diagnostic biomarker in oral squamous cell carcinoma patients.

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.

Odontogenic myxoma of the maxilla: A report of a rare case and review of the literature.

Odontogenic myxoma represents an uncommon benign neoplasm comprising of 3-6% of all odontogenic tumors. This article presents a rare case of odontogenic myxoma occurring in the maxilla of a 7-year-old male patient with a brief review of the pathogenesis, clinical, radiological, histopathological, ultrastructural and immunohistochemical characteristics of odontogenic myxoma.