Ossifying fibroma: the peripheral variant.

Introduction: Peripheral ossifying fibroma (POF) is a solitary gingival growth thought to arise from the gingiva, periosteum or the periodontal ligament. It is a slow-growing, benign, progressive lesion that is limited in size. Case description: This article describes a case of ossifying fibroma of a peripheral variant that occurred in a 26-year-old female in the anterior region of the lower jaw and presented as a growth on the gingiva. Since it was difficult to diagnose clinically, a pathological evaluation was mandatory. Upon pathological confirmation of the diagnosis, the lesion was surgically excised up to the periosteum. This was deemed to be the required treatment yet, since the recurrence rate is high for POF (8% to 20%), the patient must be followed up yearly to check for recurrence.

Introduction: Le fibrome ossifiant périphérique (FOP) est une excroissance gingivale solitaire dont on pense qu'elle provient des gencives, du périoste ou du ligament parodontal. Il s'agit d'une lésion progressive, bénigne et à croissance lente dont la taille est limitée. Description du cas: Cet article décrit le cas d'une variante périphérique du fibrome ossifiant survenue chez une femme de 26 ans, dans la région antérieure de sa mâchoire inférieure et se présentant comme une excroissance sur la gencive. Comme il était difficile d'établir un diagnostic clinique, une évaluation pathologique a été nécessaire. Après confirmation pathologique du diagnostic, la lésion a été excisée jusqu'au périoste lors d'une opération chirurgicale. On a jugé ce traitement nécessaire, puisque le taux de récidive du FOP est élevé (entre 8 % et 20 %). La patiente doit faire l'objet d'un suivi annuel pour rechercher toute récidive éventuelle.

Immunohistochemical expression of SOX2 in OKC and ameloblastoma: A comparative study.

Introduction: Odontogenic, non-inflammatory maxillofacial cysts and tumours vary greatly in their ability to grow and cause local tissue destruction. Despite their common embryologic origin, the biologic mechanisms responsible for this diverse array of clinical behaviour are largely unknown. Unfortunately, even with accurate tissue diagnosis and appropriate surgical management, these tumours have relatively high recurrence rates. While this may be related to surgical technique, it may also be due to intrinsic tumour biology. SOX2 is differentially expressed in odontogenic cysts and tumours, which has an impact over patient prognosis. This could be related to their diverse cells of origin or stages of histogenesis. SOX2 is expressed in OKC and ameloblastoma, and in this study, we look forward to find altered levels and intensity of SOX2 in the above-mentioned lesions. Aim and Objectives: To profile the expression of SOX2 in odontogenic keratocyst (OKC) and ameloblastomaTo compare the intensity of these lesions, analyse their intrinsic feature and predict their recurrence. Material and Methods: Histopathologically diagnosed cases of OKC and ameloblastoma will be selected (n = 40). Paraffin-embedded, formalin-fixed sections of these lesions will be stained for SOX2 marker using a standard immunohistochemical technique. Positive control will be taken as oral squamous cell carcinoma and negative control will be taken as normal oral mucosa. Results: A comparison between the stained cell types in odontogenic keratocyst and ameloblastoma revealed statistically significant differences. The immunoreactivity scores of SOX2 were analysed in both groups. The results indicated that 45% of OKC cases exhibited strongly positive reactivity, while 65% of ameloblastoma cases were negative. Statistical analysis demonstrated highly significant differences in the frequency of SOX2 expression between the two groups, with a higher frequency of negative expression in ameloblastoma. Conclusion: Stem cell markers have been observed in these lesions, suggesting the acquisition of stem-like properties by tumour cells, which can affect patient prognosis. Specifically, the marker SOX2 shows differential expression in odontogenic cysts and tumours. High expression of SOX2 in OKC indicates the presence of stem cells with significant self-renewal and proliferative properties, potentially signifying neoplastic behaviour. In contrast, weak or absent expression of SOX2 in ameloblastoma suggests different molecular pathways involved in its neoplastic behaviour.

Adenoid Cystic Carcinoma - A Case of an Aggressive Ulcerated Lesion of the Upper Lip.

Adenoid cystic carcinoma (ACC) is an unusual slow growing salivary gland malignancy with higher chances of recurrence. It is characterized by the proliferation of ductal (luminal) and myoepithelial cells in cribriform, tubular, solid, and cystic forms. Standard treatment, including surgery with postoperative radiation therapy, has attained reasonable local control rates, but distant metastases do not allow any improvement in the survival rate. We present a case of a 50-year-old female diagnosed with ACC involving almost the whole of the upper lip, with an aim to highlight its histologic evolution from it being clinically seen as severely ulcerated and necrotised upper lip mimicking a case of squamous cell carcinoma and its prognosis.

A novel mucocele: Myxoglobulosis.

Oral extravasation mucoceles are among the most widely recognized submucosal lesions which are usually a result of trauma involving salivary glands and their ducts. This paper reports a case of a 40-year-old female patient with a chief complaint of a painless swelling on the lower lip since 6 months. Upon a provisional diagnosis of mucocele, surgical excision was carried out. Histopathological examination revealed a mucus extravasation cyst having lumen filled with unique mucinous globular structures similar to a rare variant of appendiceal mucocele, myxoglobulosis.

Assessment of ergonomics to study the correlation between physical and psychological factors with prevalence of musculoskeletal disorders in practicing dentists.

Introduction: Musculoskeletal disorders are very commonly seen in dentists. These disorders can hinder their clinical practice and at times results in severe complications leading to an early retirement. Aim: The aim of this study is to find a correlation between physical and psychological factors with the prevalence of musculoskeletal disorders in practicing dentists. This study is a culmination of two fields of medicine, physiotherapy and dentistry, thus proving to be of significant value in terms of interdisciplinary approach to healthcare. Materials and Methods: The sample size consisted of 50 dentists. It was an observational cross-sectional study with a questionnaire divided into three sections. Inclusion and exclusion criteria includes Section 1 - Demographic data and basic questions related to the aim of the study. Section 2 - Cornell Musculoskeletal Disorder Questionnaire. Section 3 - General Health Questionnaire-12 for assessment of psychological stress. Results: Wrong posture, existing physical illness, lack of exercise and increases levels of psychological stress increase the prevalence of musculoskeletal disorders.This study could be used to implement better treatment options to dentists suffering from musculoskeletal disorders considering both physical and mental factors. Conclusion: It is very important to increase the awareness of ergonomics and the influence of psychological stress in practicing dentists so that they can avoid these disorders and provide a high-quality treatment to their patients without any hindrance in their professional careers due to these disorders.

Qualitative expression of hypoxia-inducible factor-1α in malignant transformation of oral submucous fibrosis: An immunohistochemical study.

BACKGROUND: Oral submucous fibrosis (OSF) is a precancerous condition predominantly seen in people of Asian descent. About 7%-12% of OSF patients develop oral squamous cell carcinoma. Morphological features of OSF, especially fibrosis, suggest a possibility of hypoxic environment in diseased tissues. Neovascularization and increased glycolysis, represent adaptations to a hypoxic microenvironment that are correlated with tumor invasion and metastasis. The adaptation of cells to hypoxia appears to be mediated through hypoxia-inducible factor-1α (HIF-1α). HIF-1α is said to be associated with malignant transformation of epithelium in other sites. AIM: The aim of this study was to investigate the relationship between the expression of HIF-1α in OSMF and its role in malignant transformation. MATERIALS AND METHODS: A retrospective study which included 20 histopathologically diagnosed cases of OSF was conducted. A qualitative evaluation of HIF-1α was performed. Statistical analysis was carried out using the IBM Statistical Package for Social Sciences 20.0 version (IBM Corporation, Armonk, NY, USA). RESULTS: Results showed an increased expression of HIF-1α in OSF. CONCLUSION: HIF-1α appears to play a role in malignant transformation of OSF.

Lung metastasis, an incidental finding in maxilla - A case report.

The aim of this article was to present an asymptomatic lesion with insignificant clinical findings which turned out to be metastatic lesion in the jaws with primary in lung. The most common site of lung metastasis in the orofacial region is the mandible, but in our case it was seen in the maxilla. Metastases to the jaw bones occur in later stages. Hence, a careful examination of patients with jaw bone lesions is strongly suggested. Metastasis to the jaw should be considered while doing oral examination as observed in the current case because such lesions usually develop at terminal stage of cancer.

Quantitative and Qualitative Analysis of Mast Cells in Oral Lichen Planus and Its Effect on Basement Membrane Using Special Stains.

BACKGROUND: Oral lichen planus (OLP) is characterized histologically by epithelial basal cell destruction and a dense subepithelial lymphocytic infiltrate. Mast cells (MCs) play a role in the pathogenesis and progression of the disease causing changes in the basement membrane (BM). BM is seen as continuous or fragmented, distinct or indistinct, and afibrillar or fibrillar extensions. AIMS AND OBJECTIVES: This study was done to demonstrate the BM using acriflavine stain in addition to hematoxylin and eosin (H-E) stain. An attempt was also made to study MC using Azure A stain and assess the degree of changes in the thickness of BM associated with degranulated MC in patients with OLP. MATERIALS AND METHODS: A total of 66 paraffin-embedded tissue sections which included 30 inflamed gingival mucosa (IGM) and 36 OLP were stained with H-E stain, Azure A, and fluorescent periodic acid-acriflavine stain. RESULTS: MC density was higher in OLP when compared with MC in IGM. Degranulated MCs were found in abundance in OLP. Thickness of BM was significantly less in OLP when compared with IGM. Significant fragmentation was seen in OLP when compared with BM of IGM. CONCLUSION: Degranulated MC in OLP may or may not alter the quality of BM but definitely seems to influence the thickness of the BM both directly and indirectly.

Inflammatory myofibroblastic tumor of the oral cavity: A case report and literature review.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor of unknown etiology and pathogenesis. The lesion has been recognized to occur at various sites but rarely affects the head and neck region. A 29-year-old male presented with a 13 months' history of a slow growing, painless growth in maxillary left posterior gingiva. An excisional biopsy was performed under local anesthesia. Microscopic examination revealed a compact cellular spindle cell proliferation with collagenous stroma having storiform architecture. Immunohistochemistry revealed that the tumor cells were positive for smooth muscle actin, CD-68 and negative for anaplastic lymphoma kinase. Oral IMT should be included in the differential diagnosis of localized gingival enlargement mimicking oral hyperplastic/reactive lesions.

The coronal pulp cavity index: A forensic tool for age determination in adults.

BACKGROUND: Various biochemical and histological methods are available for human age determination which are invasive and may require extraction of teeth. The present study aims to assess the accuracy of age estimation from tooth-coronal index (TCI) of known age and sex individuals and to present a noninvasive method for age estimation. MATERIALS AND METHODS: This retrospective study comprised 88 patients, which included 54 males and 34 females. An orthopantomogram of these individuals were taken, and premolars and molars in the same were evaluated. The height of the crown (coronal height [CH]) and the height of the coronal pulp cavity (coronal pulp cavity height [CPCH]) was digitally measured on the computer screen. The TCI given by Ikeda et al. in 1985 (TCI = [CPCH × 100]/CH.) was computed on each tooth and regressed on real age of the sample. The mean, median, range, and standard deviation of the computed index were calculated. The correlation between the actual age and the estimated age was calculated using t-test. P < 0.05 was considered significant. RESULTS: Results revealed that there is a significant correlation between the TCI with age. Increase in TCI observed with age; however, it showed no significant sex difference. CONCLUSION: TCI is a precise, noninvasive and easily used reliable biomarker for age estimation and is applicable to both living and dead individuals.

Odontometric analysis of canines to establish sexual dimorphism in an urban population.

BACKGROUND: Teeth are the most durable part of the skeleton. Under most of the adverse conditions occurring in nature like putrefaction, mutilation, fire and prolonged immersion in water, teeth are the most indestructible part of the body and may survive all these challenges. Due to this, the use of dental morphology to determine sexual dimorphism is a procedure established in anthropological and biological studies. Among all teeth, canines are found to exhibit greatest sexual dimorphism. AIMS AND OBJECTIVES: This study aimed to determine the gender of an individual based on the bucco-lingual dimensions of the canines and the inter-canine arch width and analyse if any sexual variation existed in them. SETTING AND DESIGN: It was a cross sectional study. MATERIALS AND METHODS: In the present study, 50 male and 50 female volunteers residing in Navi Mumbai; in the age group of 18-60 years were selected to observe the sexual dimorphism in the bucco-lingual crown dimensions of the canine and difference in inter-canine width. The bucco-lingual dimensions were measured on the study casts as the greatest distance between the buccal and the lingual surfaces of the canine crown with a digital Vernier calliper. The inter-canine width was measured between the tips of the canines with the calliper beaks placed along the long axis of the teeth. STATISTICAL ANALYSIS USED: Unpaired 't' test and ROC curve using SPSS 21.0 statistical programme for Windows. RESULTS: It was found that the bucco-lingual dimension was significantly larger in males as compared to females and the difference was statistically significant. The difference in mandibular inter-canine arch width was statistically significant. CONCLUSION: The study defines that the bucco-lingual dimensions are more reliable criteria for sexual dimorphism in Navi Mumbai population than the inter-canine arch width. Thus, it is indicated that the dimorphism in canines can be of immense medico-legal use in identification and gender determination.

Comparative analysis of oral rinse-based cytology and conventional exfoliative cytology: A pilot study.

BACKGROUND: Oral exfoliative cytology is a novel technique of using cells to detect dysplastic changes in the oral cavity in potentially malignant disorders and malignant oral lesions in resourced challenged areas. The aim of this study was to compare specimen adequacy and cellular clarity between oral rinse-based smears and conventional smears in normal controls, histologically confirmed and clinically diagnosed squamous cell carcinoma, and oral leukoplakia. For many years, oral rinse-based cytology has been used to detect candidal colonization in microbiology. Emphasis has been placed to detect changes in oral rinse-based cytology. From this research and development, oral rinse-based cytology has evolved as a method of preparing samples for examination in cytopathology. MATERIALS AND METHODS: Oral exfoliated cells from 10 cases of smears of potentially malignant disorders (oral leukoplakia), 10 cases of histologically confirmed and clinically diagnosed squamous cell carcinoma, and 10 controls with healthy mucosa were taken. Smears were stained with the Papanicolaou stain and were examined independently by two different oral pathologists. The results were compared to assess four parameters such as nuclear cytoplasmic ratio, sample adequacy, cellular distribution, and cellular clarity in both the smears. The results were then analyzed with SPSS (version 20) software using the descriptive statistics such as mean and standard deviation and inferential statistics such as t-test and one-way ANOVA. The level of significance was set at 5%. RESULTS: Oral rinse-based cytology was significantly more efficient than conventional exfoliative cytology in terms of cellular clarity (P < 0.001), cellular distribution (P < 0.001), and sample adequacy (P < 0.001). CONCLUSION: Oral rinse-based cytology shows overall improvement in cellular clarity, sample adequacy as compared to traditional exfoliative cytology.

Palatoscopy and odontometrics for sex identification and hereditary pattern analysis in a Navi Mumbai population: A cross-sectional study.

BACKGROUND: Identification of an individual is a challenging task in the field of forensic odontology. Sometimes, the identity of individuals by fingerprints is difficult; hence, the examination of palatal rugae and the human dentition is a viable option. AIMS AND OBJECTIVES: The objective of the present study was to determine the sex of an individual and the hereditary pattern using three parameters are as follows: palatine rugae, dimensions of maxillary molar and maxillary canine. MATERIALS AND METHODS: A cross-sectional study involved a total of 200 participants which included 60 males, 60 females and 20 families with four members each. Maxillary impressions were made with elastomeric impression material, and dental stone was used to make the models. The parameters used were as follows: palatine rugae classified by Thomas and Kotze (1983), which included the shape, size, direction and unification pattern, mesiodistal (MD) width of canines and intercanine width and MD and buccolingual width of maxillary molars. STATISTICAL ANALYSIS: Unpaired t-test and the median test were used to assess the sex differences in the number and unification pattern for the palatal rugae and to compare dimensions measured for males and females for the odontometric data. The data collected was statistically analyzed using the Statistical Package for Social Sciences 17.0 statistical program for windows. The statistical significance was fixed at 0.05. RESULTS: Males showed more number of converging rugae and females showed more number of diverging patterns of rugae. The number of primary and forward rugae was more in both the genders and females showed more wavy rugae while males showed more number of straight and curved rugae. The maxillary canine and maxillary molar dimensions both were more in males than the females and also none of these parameters showed a hereditary pattern. CONCLUSION: Rugae pattern and the human dentition are both highly individualistic and can be used for personal identification and sex determination.

Pindborg tumor: Pathology with special stains.

Odontogenic tumors constitute a wide spectrum of lesions ranging from malignant and benign neoplasms to dental hamartomas, all derived from the epithelial and ectomesenchymal remnants of the tooth forming apparatus. Calcifying epithelial odontogenic tumor (CEOT) is an uncommon, benign epithelial odontogenic tumor first described by Pindborg in 1956. It is a universally accepted eponym for this neoplasm. Pindborg tumor or CEOT is a locally aggressive neoplasm that accounts for 1% of the total odontogenic tumors, with recurrence in 14% of cases. The etiology of this tumor remains an enigma to the clinician. Pindborg suggested that the tumor arises from the remnants of reduced enamel epithelium of an unerupted tooth. Recent studies in literature report that the tumor arises from stratum intermedium. We report a case of Pindborg tumor in a 22-year-old male patient in the left mandibular posterior region. Radiographically, a well-defined radiolucency was associated with unerupted mandibular second molar which was displaced to the inferior border of the mandible. Along with routine haematoxylin and eosin stains, this case reports histopathological findings using Congo red stain and modified Gallegos stain.

Keratoacanthoma of the lip: A case report with emphasis on histogenesis.

Keratoacanthoma (KA) is a benign epithelial tumor which presents clinically as a proliferating dome-shaped keratin-filled crater. The lesion occurs predominantly upon sun-exposed areas of the body and is known to arise from hair follicle. Actinic rays are a major contributing factor in the etiology. It simulates grossly as well as microscopically a low-grade squamous cell carcinoma. KAs occur habitually on the mucous membrane as well, but their origin in these cases is debatable, owing to the lack of hair follicles in these sites. Our report is an attempt to demonstrate the cells that could be responsible for initiation of this lesion on the oral mucosa.

Verruciform xanthoma of the lip: A rarity.

Verruciform xanthoma (VX) is an uncommon, benign, asymptomatic mucocutaneous lesion of an unknown etiopathology. It usually presents as a papule or single plaque with a verrucous or a papillomatous surface and pale yellowish to red in color. It occurs primarily on the masticatory mucosa of middle-aged individuals. We report a case of VX on the lip of a 59-year-old man. Histopathologically, VX is diagnosed by the presence of foam cells in the papillary region of the connective tissue. Differentiating a verrucous carcinoma from VX is important, especially in small superficial lesions, which may lead to inappropriate and excessive surgical intervention. Treatment of VX consists of simple surgical excision and recurrence is rare.

Peripheral Clear Cell Variant of Calcifying Epithelial Odontogenic Tumor: Case Report and Review of the Literature.

Calcifying epithelial odontogenic tumor (CEOT) is classified as an uncommon, benign, odontogenic neoplasm that is exclusively epithelial in origin. Of all reported cases, peripheral tumors account for 5-6 %, among which clear cell variants are still rare. A rare case of peripheral clear cell variant of CEOT occurring in the mandibular gingiva of a 47-year-old female is presented.