Assessment of sex and sexual dimorphism in children from Tamilnadu, India through odontometrics in primary dentition - a cross sectional study with discriminant function analysis.

One of the crucial steps in the process of identification of human remains is sex determination of an unknown individual. Sex can be determined using the human skeleton, especially by examining the pelvis and skull. Odontometric analysis and assessment of sexual dimorphism of the human dentition has been less investigated, especially in primary dentition. Hence, this research was designed to verify the presence of sexual dimorphism through odontometric approach in paediatric population of Tamil Nadu, India. The present study was performed on 229 females and 244 males between 3 and 6 years of age. Linear measurements such as maximum mesio distal width, maximum bucco lingual width and clinical crown length were measured in all the primary teeth. Statistical analysis was performed using the Statistical Package for Social Science version 20.0 software (SPSS Inc., Chicago, IL, USA). Mann-Whitney-U test was used to check the statistical significance of the differences observed between males and females. Six equations were derived by discriminant function analysis for practical use. Sexual dimorphism existed in odontometric parameters of primary dentition. The maximum sexual dimorphism was observed in maximum bucco lingual width of 51 and maximum bucco lingual width of 75. The equations derived using discriminant function analysis yielded a jackknife accuracy ranging between 87.5% and 99.8%. These equations may be used to assess the sex from the children of Tamil Nadu, India.

Protein Drug Delivery Using a Novel Maxillofacial Technique Targeting the Visual Pathway in the Brain, the Optic Nerve, and the Retina.

Protein drugs are used for treating many diseases of the eye and the brain. The formidable blood neural barriers prevent the delivery of these drugs into the eye and the brain. Hence, there is a need for a protein drug delivery system to deliver large proteins across blood-neural barriers. Low half-life, poor penetration of epithelial barriers, low stability, and immunogenicity limit the use of non-invasive systemic routes for delivering proteins. In this pre-clinical study, the efficacy of a new maxillofacial route for administering protein drugs using a novel drug delivery system is compared with systemic administration through intra-peritoneal injection and ocular administration through topical eye drops and subconjunctival and intravitreal injections. Bevacizumab and retinoschisin proteins were administered using the maxillofacial technique along with systemic and ocular routes in wild-type male C57BL/6J mice. Liquid chromatography with tandem mass spectrometry and western blot was used to detect bevacizumab in tissue samples. Furthermore, immunohistochemistry was performed to detect the presence and localization of bevacizumab and retinoschisin in the retina and brain. The maxillofacial route of delivery could target the brain including regions involved in the visual pathway and optic nerve. The maxillofacial technique and intravitreal injection were effective in delivering the drugs into the retina. A new concept based on the glymphatic pathway, cerebrospinal fluid drug distribution, and the crossover of ipsilateral optic nerve fibers at optic chiasma is proposed to explain the presence of the drug in contralateral eye following maxillofacial administration and intravitreal injection.

Localized juvenile spongiotic gingival hyperplasia.

Localized juvenile spongiotic gingival hyperplasia (LJSGH) is a poorly understood entity and is probably a misnomer too. Although this lesion is thought to be predominantly found in young children, a significant number of cases have also been reported in adults. A 41-year-old female patient presented with an erythematous, velvety-appearing gingival mass in the mandibular anterior region. The lesion was recurrent in nature, although it was asymptomatic. A diagnosis of LJSGH was made after correlating the clinical and histopathological features. A literature search revealed that a large number of cases have been reported in adults, some as old as 87 years old. There seems to be no gender predilection, and the lesion is frequently noticed in relation to maxillary anterior gingiva. Recurrence is a characteristic feature of this lesion, although its etiology and pathogenesis are poorly understood till date. Since it has a unique behavior in terms of high recurrences, dentists and periodontists need to be made aware about spongiotic gingival hyperplasia since the lesion may be mistaken for common reactive lesions.

Effect of radiotherapy on phagocytosis percentage and index in patients with oral squamous cell carcinoma.

BACKGROUND: Phagocytosis plays an important role in the fundamental process of immunity and maintains systemic tissue homeostasis. Phagocytosis function is assessed in radiotherapy to signify the prognosis of patient. Therefore, we designed a study to assess and compare the phagocytosis percentage and phagocytic index of the leucocytes in patients with oral cancer before and after radiotherapy. MATERIALS AND METHODS: A total of 60 subjects of both genders, between 50 and 75 years old, were included in the study. The subjects were categorized into three groups: group I: oral squamous cell carcinoma (OSCC) patients before radiotherapy (n = 20), group II: OSCC patients after radiotherapy (n = 20), and group III: control (n = 20). Further, 2-mL blood samples were collected from the patients during the 1st day before radiotherapy and at the end of radiotherapy. The obtained samples were centrifuged, separated leucocytes were incubated with C. albicans, and smears were made to determine the phagocytosis percentage and phagocytic index. The obtained values were tabulated and statistically analyzed. P < 0.05 was considered to be statistically significant. RESULTS: Phagocytosis percentage and phagocytic index of OSCC patients before radiotherapy, OSCC patients after radiotherapy, and in the control group and the difference was found to be statistically highly significant (P < 0.01). CONCLUSION: Phagocytosis function can be determined by assessing the phagocytic index and percentage to know the effect of radiotherapy-induced systemic immune suppression and predict the prognosis of OSCC patients after radiotherapy.

Estimation of salivary lactate dehydrogenase in oral squamous cell carcinoma, oral leukoplakia, and smokers.

Introduction: Lactate dehydrogenase (LDH) is an enzyme seen within every cell during their normal metabolic function. It is always confined within the cell cytoplasm and it becomes extracellular only when a cell dies. The extracellular presence of LDH is related to cell necrosis and tissue breakdown. Therefore, we designed a study to estimate and compare LDH levels in the saliva of patients with oral cancer, oral leukoplakia (OL), and smokers without lesions and in controls. Materials and Methods: A total of 81 subjects of both genders, between the ages of 20 and 70 years, were included in the study. The study group was divided into four: group I-controls (n = 20), Group II-smokers (n = 20), Group III-subjects with OL (n = 20), and Group IV-subjects with oral squamous cell carcinoma (OSCC) (n = 21). Five milliliters of unstimulated salivary sample was collected from each participant, and salivary LDH level was measured. The obtained values were tabulated and statistically analyzed. P < 0.05 was considered to be statistically significant. Results: The difference in LDH levels among the four groups was found to "BE" statistically significant. LDH values showed a marked increase in the leukoplakia group (49.79 ± 19.88 IU/L) and OSCC group (106.97 ± 32.75 IU/L) when compared to controls and smokers. Conclusion: We found that salivary LDH was increased in patients with leukoplakia and OSCC. Smoking alone did not produce any alterations in salivary LDH. It is possible that salivary LDH could be a potential biomarker to identify early premalignant or malignant changes in smokers.

Developing complex odontoma in a 4-year-old child with active ameloblastic follicles: A case report.

The World Health Organization (WHO) classification of odontogenic tumors, in its different iterations, has seen several modifications in benign mixed odontogenic tumors. Odontoma is a benign mixed odontogenic tumor that shows dental hard tissue formation to varying degrees. Although odontomas are the most common odontogenic tumors, they are mostly seen in the form of compound odontomas, where the dental hard tissues resemble tooth-like structures. Complex odontoma shows a haphazard mass of dental hard tissues and is generally identified at an older age (mean age of around 20 years). Incidence of complex odontoma in very young children is quite rare, with only around 10 cases associated with the primary dentition being reported in the literature till date. Unlike other odontomas, our case showed an active epithelial component in the form of tooth buds and ameloblastic follicles along with the hard tissues, which made it difficult to distinguish from other similar lesions like ameloblastic fibroma with hard tissue formation and ameloblastoma arising from an odontoma. This article reports the 11th case of complex odontoma associated with the primary dentition, and the youngest such case to be reported in the Indian population.

Evaluation of Micronuclei and Cytomorphometric Changes in Patients with Different Tobacco Related Habits Using Exfoliated Buccal Cells.

BACKGROUND: Tobacco is one of the main reasons behind the occurrence of oral cancer. Oral cancer, even though being the tenth most common cancer in the world, gets diagnosed at an advanced stage and ends up with poor prognosis. So early diagnosis is the need of the hour. Our study aimed to evaluate the genotoxic changes in patients with different tobacco habits using buccal exfoliated cells. METHODS: Buccal smears were taken from smokers (30), smokeless tobacco users (30), combined tobacco users (30) and controls (30) with clinically normal oral mucosa. All the smears were stained with Papanicolaou stain and Feulgen stain and viewed under light microscope for the evaluation of mean number of micronuclei, mean micronuclei per cell, frequency of cells showing micronuclei, nuclear area, cytoplasmic area, nuclear-cytoplasmic ratio. RESULTS: Mean number of micronuclei, mean micronuclei per cell, frequency of cells showing micronuclei, and nuclear area were significantly increased in tobacco users than controls, especially in combined tobacco users. Nuclear-cytoplasmic ratio was increased and cytoplasmic area was decreased in tobacco users than controls. CONCLUSION: Tobacco in any consumable form is genotoxic. Smoking and smokeless tobacco, when consumed together, synergistically causes higher genetic damage. Different tobacco habits have different deleterious effects on oral mucosa, and these effects are more pronounced when the patients have combined habits. So, detecting the genotoxic changes through exfoliative cytology can be used as a simple yet reliable marker for early detection of carcinogenesis.
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Evaluation of gingival and periodontal status in obese and non-obese type II diabetic patients - a cross sectional study.

OBJECTIVE: The aim of this study was to evaluate gingival and periodontal status in obese and non-obese type II Diabetic Patients. METHODS: The study population comprised of 75 subjects visiting the outpatient department of our institution, divided into three different groups, group 1 (obese diabetic), group 2 (non-obese diabetic), and group 3 (obese, non-diabetic). Diabetic status was assessed with HbA1c values and obesity status was assessed by body mass index (BMI) score greater than or equal to 30 kg/m2. Gingival and periodontal status were assessed using the Gingival Index (GI) and Community Periodontal Index (CPI) respectively. RESULTS: The mean gingival index score in group 1, group 2, and group 3 were 1.58, 1.54, and 1.25, respectively. Gingival status was poor among obese and non-obese diabetic subjects (Groups 1 and 2) when compared with obese non-diabetic patients (Group 3). The periodontal status showed that periodontal pockets were increased in diabetic obese group (15.4%), followed by diabetic non obese (4.66%), and non-diabetic obese (2%) group respectively and loss of attachment was severe in diabetic obese group (60.7%), followed by diabetic non obese (45.9%) and non-diabetic obese (15.3%) respectively. CONCLUSION: Gingival and periodontal status was poor in the obese diabetic group compared to non-obese diabetic and obese non diabetic group. Hence, the risk of gingivitis and periodontitis in obese diabetic patients should be addressed earlier to prevent further complications and achieve a good oral health status.

Biofriendly Substitutes for Xylene in Deparaffinization.

BACKGROUND: Xylene is an aromatic hydrocarbon that is routinely used in histopathological laboratories. It is biohazardous and produces many toxic effects like carcinogenesis. A safer substitute for xylene is necessary to minimize its usage. AIM: The aim of this study was to evaluate the effectiveness of 1.7% dishwashing solution, 95% lemon water, and 100% coconut oil when compared to xylene as a deparaffinizing agent during hematoxylin and eosin (H&E) staining. MATERIALS AND METHODS: Fifteen paraffin-embedded tissue blocks were selected. Four sections were made from each block. One section was stained with conventional H&E method using xylene (group A) as deparaffinizing agent and other three sections were stained with xylene-free H&E method using 1.7% dishwashing solution (group B), 95% lemon water (group C), and 100% coconut oil (group D), respectively. Slides were scored blindly by a single pathologist considering the parameters such as nuclear and cytoplasmic staining; uniformity, clarity, and crispness of staining; and presence or absence of wax retention. RESULTS: Adequate nuclear staining was noted in 100% of sections of groups A, B, C, and D (P < 0.001), whereas adequate cytoplasmic staining was noted in 93.33% each in groups A, C, and D when compared with 100% in group B (P > 0.05). Uniform staining was present in 80% of groups A and B and in 73.33% of groups C and D (P > 0.05). Clarity of staining was present in 86.66% of groups A and B and in 80% of groups C and D (P > 0.05), whereas crispness of staining was seen in 73.33% of groups A and D, 86.66% of group B, and 80% of group C (P > 0.05). Wax retention was noted in 20% of groups A and B, and 26.66% of groups C and D (P > 0.05). Adequate staining for diagnosis was noted in 100% of group A sections followed by 93.33% in group B, 86.66% in group C, and 80% in group D as compared with 90% in group B (P > 0.05). CONCLUSION: Dishwashing solution, lemon water, and coconut oil can be used as safer and cost-effective substitutes to xylene for deparaffinization in H&E staining procedure.

Son of Sevenless-1 genetic status in an Indian family with nonsyndromic hereditary gingival fibromatosis.

Hereditary gingival fibromatosis (HGF) is a rare condition affecting the gingiva and may or may not be a clinical feature of other syndromes. It has been classified as a nondental biofilm-induced gingival disease. The pathogenesis of this condition has been poorly understood till date. Although different genetic mutations have been implicated to play a role, there is considerable interest on an addition mutation of Son of Sevenless-1 (SOS-1) gene. We report a case of a 27-year-old male patient who came to us with the complaint of enlarged gums of several years' duration. There were other members in his family who were similarly affected. After the clinical diagnosis of HGF was confirmed, the patient and his available family members were subjected to a genetic analysis for identification of mutation in SOS-1 gene, which turned out to be negative. The patient was treated with nonsurgical periodontal therapy and is under regular follow-up. To the best of our knowledge, this is the first study to assess SOS-1 mutation in an Indian family.

Effect of Inhalational Therapy on Buccal Mucosal Cells in Asthmatic Patients: A Cytological Study.

OBJECTIVE: Inhalational drugs used in treating asthma have several side effects including those on oral tissues. We therefore designed a study to analyze the effects of inhalational drugs on the buccal mucosal cells of the oral cavity. METHODS: Smears were obtained from clinically normal buccal mucosa of 20 randomly selected asthmatic patients who had been under inhalational therapy for at least 6 months. The Papanicolaou-stained smears were then analyzed for average nuclear area, average cytoplasmic area, and average nuclear area:cytoplasmic area ratio for each patient, and the values were compared with those of 10 healthy controls. RESULTS: A statistically significant decrease in cytoplasmic area (P<0.001) was found in asthmatic patients compared to controls. A significant increase in mean nuclear area:cytoplasmic area ratio (P<0.001) was noted in asthmatic patients when compared to controls. CONCLUSION: Prolonged use of inhalational drugs in patients diagnosed with asthma is associated with changes in oral epithelial cells. There is a need to assess whether these are the direct adverse effects of such drugs and whether they have any long-term impact on oral tissues.

Expression of epithelial glycoprotein (EGP40) in oral epithelial dysplasia and oral squamous cell carcinoma (OSCC).

AIM: To study the expression of Epithelial Glycoprotein (EGP40) in various grades of Oral Epithelial Dysplasia namely mild, moderate and severe epithelial dysplasia and in various grades of Oral Squamous Cell Carcinoma (OSCC) namely well, moderate & in poorly differentiated squamous cell carcinoma. MATERIAL AND METHODS: This laboratory study comprised of 47 samples in which 27 samples were of three different grades of OSCC, Well (n=10), Moderate (n=10) and Poorly differentiated (n=7) and remaining 20 samples were of three different grades of dysplasia [Mild (n=7), Moderate (n=8), Severe dysplasia (n=5)]. All the 47 cases were subjected to immunohistochemical staining to evaluate the expression of EGP40. Chi square was used to analyze the significance of differences in different grades of oral epithelial dysplasia & in different grades of OSCC. RESULTS: The percentage of EGP40 immuno positivity was increased from mild to severe dysplasia and the percentage of EGP40 immuno positivity was increased from well to poorly differentiated carcinoma No statistical significance was observed in the immunoreactivity and in the intensity of expression between various grades of oral epithelial dysplasia and oral squamous cell carcinoma. CONCLUSION: The epithelial cell adhesion molecule can be considered as an early marker for predicting malignant transformation of dysplastic epithelial lesions and used as a marker in predicting the OSCC prognosis.

Inverted Sinonasal Papilloma Masquerading as a Malignancy - Report of an Unusual Case.

Inverted sinonasal papilloma (ISP) is a benign epithelial neoplasm arising from the Schneiderian membrane. We report a case of ISP in a 50-year-old male that clinically presented as a polypoid mass in the nasal cavity. Imaging studies revealed it to be an aggressive lesion showing intracranial extension. On histopathological examination of the excised specimen, a diagnosis of ISP was arrived at. However, an extensive sampling of the tissue revealed no evidence of any malignant transformation. Taking into account the suggested viral aetiology for such lesions and the aggressiveness observed in this case, human papillomavirus (HPV) profiling was done but it turned out to be negative. Only one other case of inverted sinonasal papilloma arising from the nasal cavity and involving the brain has been reported in the literature to date. Considering the alarming clinical course in spite of its benign nature, it is important for the pathologist and surgeon to be well informed about this lesion.

Intraosseous myofibroma of mandible: A rarity of jaws: With clinical, radiological, histopathological and immunohistochemical features.

Myofibroma is an uncommon benign mesenchymal neoplasm composed of myofibroblasts, but it can be confused with more aggressive spindle cell tumors. Solitary myofibroma is common in soft tissues of head and neck, but rare in the jaw bones with only 38 cases of central myofibroma of mandible reported in English medical literature. When encountered in the jaws, lesions exhibit clinical and radiographic features suggestive of odontogenic cysts/tumors or other neoplastic conditions. We hereby present the 39(th) case of intraosseous myofibroma of the mandible which had been reported to our institution. A 16-year-old male reported with a chief complaint of swelling in the right side of face. Intraorally there was a firm, nontender swelling in the right buccal aspect of the mandible. Radiologically the lesion was osteolytic, destroying the buccal cortical plate. Histologically, characteristic biphasic pattern of myofibroma was noticed. Immunoreactivity was positive for vimentin and αSMA but negative for desmin, thus confirming our diagnosis. The patient was treated by local-wide surgical excision of the lesion. A 3-year follow-up revealed no signs of recurrence. Occurrence of myofibroma involving the jaw bones is common in the younger age groups and represents a unique diagnostic and therapeutic challenge. Differentiating this lesion from other benign and malignant neoplasms is crucial in deciding between a radical and a conservative treatment approach.

Genetic alterations in syndromes with oral manifestations.

Ever since Gregor Johan Mendel proposed the law of inheritance, genetics has transcended the field of health and has entered all walks of life in its application. Thus, the gene is the pivoting factor for all happenings revolving around it. Knowledge of gene mapping in various diseases would be a valuable tool in prenatally diagnosing the condition and averting the future disability and stigma for the posterity. This article includes an array of genetically determined conditions in patients seen at our college out-patient department with complete manifestation, partial manifestation and array of manifestations not fitting into a particular syndrome.

Oral Crohn's disease without intestinal manifestations.

Crohn's disease is a granulomatous inflammatory bowel disease and was described in 1932 as a chronic granulomatous disorder of the terminal ileum and is now considered a distinct member of the inflammatory bowel disease family. It may affect any part of the gastrointestinal tract. Oral Crohn's disease has been reported frequently in the last three decades with or without intestinal manifestations. In the latter case, it is considered as one of the orofacial granulomatosis. There has been much doubt whether intestinal manifestations of Crohn's disease will eventually develop in the orofacial granulomatosis. We present a female patient aged 22 years with prominent clinical findings such as persistent swelling of lower and upper lip with fissuring and angular cheilitis, granulomatous gingival enlargement, and cobblestone or corrugated appearance of labial mucosa, which are suggestive of Crohn's disease, but with no evidence of other gastrointestinal involvement. The patient underwent surgical treatment with external gingivectomy procedure. A 6-month follow-up showed minimal recurrence.