Studying the use of a proposed three-level grossing protocol in the histopathological diagnosis of COVID-19-associated rhinomaxillary mucormycosis.

Introduction: Mucormycosis is an acute and rapidly progressing opportunistic fungal infection. COVID-19-associated mucormycosis (CAM) had re-emerged as a complication of COVID-19 infection during the second wave of the pandemic in 2021. The rhinomaxillary form is a variant of the rhino-cerebral mucormycosis that presents a diagnostic challenge to the dentist and the oral and maxillofacial pathologist. Gross examination of pathological specimens is the most undermined step even though it plays a vital role in the final diagnosis. No studies have described this post-clinical step for the maxillofacial soft and hard tissue submitted for examination. Material and Methods: A prospective comparative study was carried out on 52 COVID-19-associated rhinomaxillary mucormycosis (CARM) cases to achieve complete, representative, and informative sampling of the submitted tissue and establish a three-level gross macroscopic examination protocol. Complete clinical and radiological histories were recorded after informed, written consent from every patient was received. Details of the number and type of samples received were recorded, grossing procedure was done as per the proposed three-level grossing protocol and were then compared to the presence of fungal hyphae in the soft tissue or decalcified hard tissue. Result: All 100% of the samples consisted of soft tissue (maxillary sinus lining), while 90.4% of the samples contained different hard tissue specimens. Seventy percent of the grossing workload was carried out by first-year oral pathology residents. Sixty-seven point three percent of the total soft tissue samples submitted showed no presence of fungal hyphae, while 69.2% of total decalcified sections of hard tissue were positive for fungal hyphae with a positive correlation. Out of the 29 cases grossed via the three-level grossing protocol, 89.6% of the cases were histopathologically positive for fungal hyphae. Thus a positive association (P < 0.05) between histopathological diagnosis and the proposed three-level grossing protocol was found. Conclusion: It is imperative to recognise that no mucormycosis report is to be signed out without multi-site (three-level grossed) bone decalcified reports. There is an immediate need to realise how vital documentation, correct laboratory practices, and grossing are for accurate histopathological diagnosis.

Peripheral squamous odontogenic tumor masquerading as oral squamous cell carcinoma in an elderly female patient: A rare entity.

Squamous odontogenic tumor is a rare epithelial odontogenic tumor. Only a few cases have been reported in the literature, out of which central cases occurring within the jawbones are more common, and very rarely peripheral cases have been reported. Here, we report a rare case of a peripheral squamous odontogenic tumor occurring in the left lower gingivobuccal sulcus region in a 63-year-old female patient and presented as a firm and fibrotic swelling clinically. Radiographic examination revealed no evidence of a central lesion in the bone. Excisional biopsy of the lesion revealed the characteristic histopathological picture of peripheral squamous odontogenic tumor (PSOT). The healing was found to be satisfactory upon periodic evaluation of the patient done to study the healing and for any recurrence of the lesion.

Rare Calcifying Epithelial Odontogenic Tumor In A Hiv Positive Individual.

The calcifying epithelial odontogenic tumour (CEOT) is a rare but well recognized benign odontogenic tumour for any Pathologist. Histologically, it shows sheets of polyhedral epithelial cells with prominent intercellular bridges, hyperchromatic nuclei and globules of amyloid-like material among tumour cells which undergoes calcification. We present a case of CEOT with classical histopathological picture in a 37-year-old HIV positive patient with long evolution history. Its association with HIV positivity, long clinical history and delay in surgical treatment make it a challenging case to report.

Langerhans' Cell Histiocytosis Diagnosed through Periodontal Lesion in a 15-year-old Child: A Case Report.

Langerhans' cell histiocytosis (LCH) is a rare disease of the reticuloendothelial system in which there are abnormal proliferation and accumulation of histiocytes, abnormal cells deriving from bone marrow that can migrate from the skin to the lymph nodes. Langerhans' cell histiocytosis has three variants: unifocal (eosinophilic granuloma), multifocal unisystem (Hand-Schuller-Christian triad), and multifocal multisystem (Letterer-Siwe disease). We present a case of oral lesions associated with LCH in a young male aged 15 years. The history, radiological appearance, histopathology, and treatment options of the patient are discussed. How to cite this article: Soangra R, Kapoor A, Meena D, et al. Langerhans' Cell Histiocytosis Diagnosed through Periodontal Lesion in a 15-year-old Child: A Case Report. Int J Clin Pediatr Dent 2020;13(S-1):S115-S118.

Studying the multiple faces of nevoid basal-cell carcinoma syndrome: A case series.

Nevoid basal-cell carcinoma syndrome (NBCCS) or Gorlin-Goltz syndrome is an autosomal dominant-inherited condition that exhibits high penetrance and variable expressivity; however, this disorder can arise spontaneously. In 1960, Gorlin and Goltz described the syndrome as a condition, comprising the principle triad of multiple basal cell carcinoma, odontogenic keratocysts, and skeletal anomalies. The diagnostic findings of NBCCS in four patients were studied and compared with other reports in the Indian population. Early diagnosis of this syndrome is important for counseling of patients to prevent the life-long complications of this syndrome which includes the malignancy, oro-maxillofacial deformation, and destruction; this may be reduced if the diagnosis and treatment are made feasible at the earliest.

Non syndromic synchronous multiple odontogenic keratocysts in a western Indian population: A series of four cases.

Odontogenic keratocysts (OKCs) are developmental odontogenic cysts affecting the maxillofacial region and their association with a syndrome especially Naevoid basal cell carcinoma syndrome (NBCCS) is a common occurrence in comparison to non syndromic multiple OKCs. In a first, we present a series of four non syndromic cases with multiple OKCs in western Indian population. The presence of multiple OKC in our present case series may be because of the multifocal nature of the lesion rather than its association with any syndrome. Thus, a comprehensive evaluation of any patients reporting with multiple cysts/OKCs always has to be undertaken and the dental practitioner may be the play a key role in early detection and subsequent follow-up. Key words:Abnormalities, multiple; basal cell nevus syndrome, India, odontogenic cysts.

Genotoxic and Carcinogenic Effect of Gutkha: A Fast-growing Smokeless Tobacco.

Oral cancer is a highly lethal disease and one of the most debilitating and disfiguring of all malignancies in the world. According to Global Adult Tobacco Survey (GATS) 2010 report, 60% of tobacco users in India use only smokeless tobacco. Among 206 million smokeless tobacco users, 65.1 million are consuming gutkha. In recent years, gutkha is recognized as a life threatening disorder with the serious health consequences. The aim of this review is to increase the attention to complete ban of tobacco use, awareness, knowledge, and beliefs of public about the harms of not only gutkha but also all other tobacco products and also to promote the intentions to quit the habits.

A Review of Salivary Biomarker: A Tool for Early Oral Cancer Diagnosis.

The oral squamous cell carcinoma (OSCC) is one of the most common epithelial malignancies with significant morbidity and mortality. Recent observations indicate that the clinical and histological appearance of oral mucosa may not truly depict the damage occurring at the genetic level. This phenotypic and genotypic disparity may account in part for the failure to establish effective screening and surveillance protocols, based on the traditional clinical and microscopic examination. The tumor markers are playing an increasingly important role in cancer detection and management. These laboratory-based tests are potentially useful in screening for early malignancy, aiding in cancer diagnosis, determining prognosis, surveillance following curative surgery for cancer, up-front predicting drug response or resistance, and monitoring therapy in advanced disease. A systematic review of the literature was performed based on the English titles listed in the PubMed, EBSCO, Cochrane, Science Direct, ISI web Science, and SciELO databases using the keywords. Abstracts and full-text articles were assessed. This article may help to identify the potential biomarkers for screening and the molecular pathology analysis in the high-risk patients with the OSCC.

Comparative evaluation of bite forces in patients after treatment of mandibular fractures with miniplate osteosynthesis and internal locking miniplate osteosynthesis.

AIMS AND OBJECTIVES: The aim of present study was to compare the stability of fractured mandibular fragments under functional load, when fixed with conventional miniplate and internal locking miniplate. MATERIALS AND METHODS: Bite force (in kg) recorded in twenty mandible fractured patients and fifty normal healthy individuals. Bite force was measured at incisor and molar regions. Comparative evaluation of bite force generated was performed between 10 cases treated with conventional miniplates and 10 cases treated with internal locking miniplates. Bite force generated by patients in mandibular fracture between symphysis and the angle of mandible was recorded in incisor and molar regions preoperatively. The fracture fragments were fixed using the above fixation techniques. Then same recording was undertaken on the 7(th), 14(th), 21(st), 28(th), and 90(th) days postoperatively. RESULTS: Bite force generated by patients treated with locking plates at the 7(th), 14(th), 21(st), 28(th), and 90(th) postoperative days was significantly higher as compared to those in patients treated with miniplates. CONCLUSION: It was observed in our study that the locking plate/screw system offers significant advantages over the conventional plating system. There are no intraoperative difficulties associated with placement of the plate.

Exfoliative cytology of buccal squames: A quantitative cytomorphometric analysis of patients with diabetes.

BACKGROUND: Diabetes is a third leading cause of mortality and morbidity in the world. Diabetes is one of the most common endocrine metabolic disorders and its prevalence has been increasing worldwide. Oral exfoliative cytology may be a more appropriate adjunctive diagnostic tool in conditions like diabetes mellitus, where the invasive techniques lose viability. AIMS: The purpose of this study is to analyze the cytomorphometric changes in the exfoliated cells of the oral mucosa, as an adjunct to the diagnosis of diabetes. MATERIALS AND METHODS: Smears were taken from the buccal mucosa of 30 diabetes patients (study group) and 30 healthy individuals (control group). All the smears were stained with rapid Papanicolaou stain (PAP). In the PAP smears, the nuclear area (NA), cytoplasmic area (CA), and cytoplasmic-to-nuclear ratio (CNR) were evaluated for 50 cells in each smear, using the Image Analysis Software (Magnus Pro™) and research microscope (Lawrence and Mayo™). RESULTS: The results showed that the mean NA was significantly higher (P < 0.001) in the study group, whereas, the mean CA did not exhibit a statistically significant difference (P > 0.001). The mean CNR was significantly lower in the study group (P < 0.001). INTERPRETATION AND CONCLUSION: The results associated with the clinical observations suggest that diabetes can produce morphological and functional alterations in the oral epithelial cells, detectable by microscopic and cytomorphometric analysis using exfoliative cytology, which can be used in the diagnosis of the disease.

Ergonomics in an oral pathology laboratory: Back to basics in microscopy.

Ergonomics is simply a science focused on "study of work" to reduce fatigue and discomfort through product design. A comprehensive ergonomics program for the pathology laboratory has become necessary to prevent the occurrence of work related musculoskeletal disorders (MSDs) and accidents. Most of the literature on ergonomics involve various web links or occasional studies on the effect of laboratory work and associated MSDs. A Google search was carried out corresponding to the terms "ergonomics", "pathology laboratory", "microscope". All the relevant literature from web sources was sorted out and categorized. In this review, we intend to identify basic anthropometric factors, biomechanical risk factors, laboratory design considerations and specific microscopy-related considerations. The ultimate aim of ergonomics is to provide a safe environment for laboratory personnel to conduct their work and to allow maximum flexibility for safe research use.

Effect of traditionally used neem and babool chewing stick (datun) on streptococcus mutans: an in-vitro study.

PURPOSE: There are various plants, which are used as chewing sticks in different parts of the world. Several studies have been reported on the antimicrobial effects of chewing sticks on oral bacteria. This study was conducted to evaluate the effectiveness of traditionally used neem and babool chewing sticks (datun) extracts on Streptococcus mutans. MATERIALS AND METHODS: The present invitro study was conducted to assess effectiveness of 5%, 10%, and 50% neem and babool extract on Streptococcus mutans. The ditch plate method was used to test the antimicrobial activity. Ditches were prepared on blood agar plates with the help of punch having 6mm diameter. The plates were left for 1h at room temperature and then incubated at 37°C for 48h and examined for zone of inhibition. RESULTS: There was no zone of inhibition observed with 5% babool and neem aqueous extract. There was significant difference in mean diameter of zone of inhibition of 10% neem and babool extract (p-value 0.001 < 0.05). Similarly the mean difference in 50% neem and babool extract was found to be significant (p-value < 0.001). CONCLUSION: Both neem and babool extracts had antimicrobial activity against Streptococcus mutans, while antimicrobial activity was significantly higher in neem aqueous extract than babool aqueous extract.

Alteration in plasma lipid profile in oral submucous fibrosis patients: A case control study.

BACKGROUND: Lipids are major cell membrane components essential for various biological functions including cell growth and division of normal and malignant tissue. They are also required for maintenance of structural and functional integrity of all biological membranes. Alteration in the plasma lipid profile has been associated with a variety of cancers and precancerous conditions including those of the head and neck region. AIM: The present study aimed to evaluate the alteration in plasma lipid profile in oral submucous fibrosis (OSF) patients. MATERIALS AND METHODS: A total of 30 patients were included in the study, 20 with oral submucous fibrosis and 10 healthy controls. Fasting plasma lipid profile including Total Cholesterol (TC), Very Low Density Lipoproteins (VLDL), Low Density Lipoproteins (LDL), High Density Lipoproteins (HDL) and Tri-Glycerides (TG) were measured using semiautomatic analyser. The data obtained were analysed using independent sample 't' test. RESULTS: A statistically significant decrease in plasma total cholesterol, LDL and HDL was observed in patients with OSMF as compared to the controls, but it was not statistically significant for VLDL and TG values. CONCLUSION: The results of the present study show that there is an inverse relationship between lipid profile and the presence of oral submucous fibrosis. Hence, alteration in plasma lipid profile may have a diagnostic role in the future and can be used as a biochemical indicator to detect the initial changes seen in the neoplastic process.