Ganglion cyst of temporomandibular joint - A systematic review.

Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.

Analysis of Metabolic Regulators PGC1-α and PGC1-ß in Oral Squamous Cell Carcinoma with and without Hyperglycemia.

AIM: To assess the expression of PGC1-α and PGC1-ß in Oral squamous cell carcinoma in the presence and absence of hyperglycemia. MATERIALS AND METHODS: Fresh tissue samples were collected from 14 well differentiated OSCC patients with hyperglycemia, 14 OSCC patients without hyperglycemia  and 14 healthy controls and subjected to quantitative real-time PCR to assess expression of PGC1-α and PGC1-ß. The relative gene expression of PGC1-α and PGC1-ß was calculated using the double delta Ct method. A two-fold difference was defined as over or under- expression.  To further evaluate clinicopathological association, Independent t-test was employed. RESULTS: The expression of both PGC1-α and PGC1-ß were increased in OSCC patients when compared to healthy controls and similar findings were observed on calculating the fold change healthy controls and OSCC study groups. On assessing the expression of target genes within study groups, they did not present with significant fold change and the hyperglycemic status of the individual did not contribute to the expression of the target genes as P value obtained for PGC1-α and PGC1-ß were >0.05. CONCLUSION: The hyperglycemic status of the individual does not influence the expression of PGC1-α and PGC1-ß in OSCC tissues and the cause for over-expression of the study targets in OSCC tissues must be further evaluated  to assess their potential as possible candidates for targeted therapy in OSCC patients.

Salivary and serum acetaldehyde levels in betel quid chewers, pan masala chewers with or without tobacco and tobacco smokers: A comparative study using head space gas chromatography.

Background: Acetaldehyde, a natural by-product of combustion and photo-oxidation, has been detected at low levels in cigarette smoke. Various literature studies have shown increased salivary acetaldehyde production among smokers and heavy drinkers. Aim: The present investigation was performed to estimate the salivary and serum acetaldehyde levels in pan masala chewers (with or without tobacco), betel quid chewers and tobacco smokers. Methodology: Blood and Saliva samples were collected from 40 participants. The study participants were categorized into 4 groups of 10 individuals each. Subjects with no habits, betel quid chewing habit, pan masala chewing habit with or without tobacco and tobacco smoking habit. All the samples were centrifuged and subjected to gas chromatography (GC) analysis as per standard protocols provided by the manufacturer. Results and Discussion: No statistically significant difference in either serum or salivary acetaldehyde levels between Pan Masala chewers (with or without tobacco) and smokers was noted. However, higher mean serum and salivary acetaldehyde levels than the normal subjects and betel quid chewers was observed. It may be speculated that natural acetaldehyde, may not be released in estimated quantity of acetaldehyde by head space GC. Nevertheless, it is possible that addition of acetaldehyde as flavoring agents or preservatives for improving acceptability of the product can be a possible cause for these observations. Conclusion: Owing to various socio, economic and political reasons, implementation of the ban remains to be a formidable challenge. With these observations, we believe that absolute ban of all pan masala product is the ideal solution for minimizing the oral cancer burden in India.

Smokeless Tobacco Products (STPs) Harbour Bacterial Populations with Potential for Oral Carcinogenicity.

INTRODUCTION: Smokeless Tobacco Products (STPs) vary significantly in their carcinogenicity, a feature accredited to the variation in the concentrations of carcinogenic chemicals. Tobacco associated bacteria are known to produce Tobacco-specific N-nitrosamines (TSNAs) and hence are determinants of TSNA levels in Tobacco. The primary objective of this study was to conduct a microbiological survey of STPs and to provide a baseline information of the bacterial communities present in the STPs. MATERIALS AND METHODS: The present study analyzed the constituency of microbial communities in 7 different smokeless Tobacco products including four chewable (T1_CW to T4_CW), two snus (T5_Snus and T6_Snus) and one snuff sample (T7_Snuff) using high-throughput sequencing of the 16S rRNA based next generation sequencing. The Tobacco samples were also analyzed for pH and moisture content. Statistical analysis of the data obtained was done using SPSS software version 20. Pearson's Correlation was done to analyze the correlation between pH and moisture content of the Tobacco samples. RESULTS: A total of 11 phyla were identified in all smokeless Tobacco products. A total of 36 classes were identified across all smokeless Tobacco products and bacilli was the predominant class in all the products followed by Actinobacteria and Bacteroidia. In species level, a total of 2369 species were identified across all smokeless Tobacco products. In T1 chewable Tobacco products, predominant species was staphylococcus whereas in T2 and T3, Bacillus subtilis and pumilus were predominant. In T4 chewable Tobacco product, Virgibacillus was predominant followed by halodentrificans, staphylococcus epidermidis. In snus 1 and 2, Bacillus pumilus and subtilis were predominant. In snuff, Bacillus cereus was predominant. Snus products had the highest moisture content (15.4% and 14.3%) compared to the chewable Tobacco and snuff products. The snus products analyzed had alkaline values (pH 8.50 and 8.15) and snuff and chewable Tobacco had acidic values ranging from 5.62 to 6.09. CONCLUSION: The current study demonstrates that ST products differ qualitatively, quantitatively, and in their bacterial composition. There is a possibility that some of these species may contribute to oral carcinogenesis, either by influencing levels of TSNAs or directly inducing chronic inflammation.

Dentin degradonomics - The potential role of salivary MMP-8 in dentin caries.

BACKGROUND: Dentin caries involves dissolution of minerals which eventually leads to degradation of organic matrix. This degradation which was thought to be by bacterial proteases is now considered to be orchestrated by endogenous collagenases such as Matrix Metalloproteinases (MMPs). This paper aims to estimate the salivary levels of MMP-8 in dental caries and also to asses the various risk factors that contribute to the formation of dental caries. MATERIAL AND METHODS: A random sample of 75 adults aged 18-35 were included and categorized based on the number of caries lesions (MCL). Standard clinical examinations were performed, and stimulated saliva was collected and analyzed for concentrations of MMP-8 using enzyme-linked immunosorbent assay. Caries risk factors were assessed using a chair-side kit. Correlation of MMP-8 in varying MCL using Spearman's correlation was done. Multiple linear regression analysis was done to asses the relationship between various caries risk factors with MMP-8 and MCL as dependent variable. RESULTS: The study results showed a statistically significant higher concentration of MMP-8 in carious group (MCL 1-2) and MCL ≥3 compared to non-carious group. On correlating, the levels of MMP-8 were seen to be higher in MCL ≥3 than in MCL = 0 and MCL 1-2. The mean MMP-8 of controls, MCL 1-2, and MCL ≥3 were 131.34ng/ml, 230.14ng/ml, and 391.91ng/ml respectively. Multiple linear regression analysis with MMP-8 as the dependent variable revealed caries, buffer capacity and S. mutans count as significant variables. Using MCL as the dependent variable the only significant variable was MMP-8 levels. CONCLUSIONS: The study suggests that subjects with caries have elevated MMP-8 levels compared with subjects with no carious lesions. There is also a positive correlation between the number of carious lesions and MMP-8 levels suggesting that MMP-8 plays an important role in the degradation of dentin and causes progression of caries. Key words:Caries, Dentin, Enzyme-linked Immunosorbent Assay, MMP-8.

Diagnostic Utility of Cytology in Assessment of Ploidy Status in Potentially Malignant Oral Disorders.

INTRODUCTION: Oral leukoplakia, the most common potentially malignant oral disorder (PMOD) may progress to oral squamous cell carcinoma (OSCC). Although, the current standard of care for assessing its malignant potential remains histological examination and assessing the severity of dysplasia, DNA ploidy analysis has been suggested as a surrogate marker to predict the behaviour of PMODs. OBJECTIVES: To detect aneuploidy and to correlate ploidy status with different grades of dysplasia in both tissue and cytology samples to predict the behaviour of these potentially malignant disorders and to assess the diagnostic utility of cytology samples for ploidy analysis. METHODOLOGY: After obtaining ethical clearance and consent, tissue and cytology samples of leukoplakia were collected and grouped based on the dysplastic findings into low-risk (n=20) and high-risk (n=20). DNA ploidy analysis was done using high resolution flow cytometry and its diagnostic utility was assessed. RESULTS: Diagnostic utility was expressed in terms of sensitivity, specificity, PPV and NPV. On comparing the ploidy status of individual cases between tissue and cytology samples, cytology was able to accurately determine the ploidy status in majority of the cases. In the low-risk group, cytology had a sensitivity and specificity of 100% and a PPV and NPV of 100% with an overall diagnostic accuracy of 100%. Among the high-risk group, cytology had a sensitivity of 80% and specificity of 100% with a PPV of 100% and NPV of 83.33% and had an overall diagnostic accuracy of 90%. Combining both groups together, it had a sensitivity of 85.71% and specificity of 100% with a PPV of 100% and NPV of 92.31% and had an overall diagnostic accuracy of 94.74%. CONCLUSION: Overall, this study showed a positive correlation between cytology and tissue samples and ploidy and grade of dysplasia and cytology proved to be a simple and efficient with a reasonable diagnostic value.

Evaluation of antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on Streptococcus mutans, Lactobacillus species and Actinomyces viscosus: An in vitro study.

INTRODUCTION: The Ayurvedic system of medicine is popular in India and has gone through various change and remains as the mainstay of medical relief to a large population. Dental caries is the one of the major issue in the recent time, and there is no definite caries prevention method so far apart from Topical fluoride application, regular oral hygiene measures, pit and fissure sealants and diet measure. In spite of the above mentioned preventive measures the people are still prone to dental caries. In order to find a better solution the present study evaluates the antimicrobial properties widely available and cost effective herbal extracts of Solanum xanthocarpum and Pistacia lentiscus extract on cariogenic oral microbial flora. AIM: To Evaluate the Antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on cariogenic oral microbial flora. METHODOLOGY: The antimicrobial properties of Solanum xanthocarpum and Pistacia lentiscus extracts on cariogenic oral microbial flora (streptococcus mutans, lactobacillus, actinomyces viscosus) by different culture techniques to estimate the zone of inhibition (well diffusion method) and minimum inhibitory concentration (tube dilution method). RESULTS: The antimicrobial efficacy of Solanum xanthocarpum and Pistacia lentiscus on test bacteria were analysed using kurskal wallis test and values of 0.003 and 0.002 were obtained respectively, since the p values were less than 0.005, indicating that both herbal products possess statistically significant antimicrobial properties. CONCLUSION: The antimicrobial effects of the herbal extracts were almost on par with commercially available allopathic agents like chlorhexidine on oral cariogenic microbes. The efficacy should be further validated in a large scale studies and can be utilized for caries prevention in the form of mouth rinses, dentifrices and topical application in the future.

Salivary and Serum Interleukin-6 Levels in Oral Premalignant Disorders and Squamous Cell Carcinoma: Diagnostic Value and Clinicopathologic Correlations

Aim: To assess the diagnostic utility of serum and salivary interleukin 6 (IL-6) levels in the differential diagnosis of potentially malignant lesions and conditions (PMLs/PMCs) and oral squamous cell carcinoma (OSCC) in a high oral cancer prevalence region. Methods: After appropriate ethical clearance and informed consent, salivary and blood samples were collected from 100 participants in each group (OSCC, PMLs, and healthy controls). Serum and salivary IL-6 levels were measured by enzyme-linked immunosorbent assay and data were subjected to appropriate statistical analysis. Results: Significant differences in IL-6 concentration were noted between OSCC and PML/C patients in both serum and saliva, with salivary levels being 2 to 3 fold higher than serum values in all the groups. Receiver operating characteristic curve analysis demonstrated 96% specificity and 99% sensitivity for salivary IL-6 in differentiating PML from OSCC. Conclusions: The results of the present study suggest that the pro-inflammatory cytokine, IL-6, is elevated in the saliva of patients with OSSC compared to PMD and controls, and thus may prove to have diagnostic and/or prognostic significance.

Primary intraoral granulocytic sarcoma: A rare case presenting as generalized gingival enlargement.

Granulocytic sarcoma (GS) is an extremely rare condition involving infiltration of myeloblasts or immature myeloid cells in an extramedullary site. It is also known as chloroma, myeloid sarcoma or extramedullary myeloid tumor. It usually occurs concomitantly with acute myelogenous leukemia or with the onset of blastic phase of chronic myelogenous leukemia. On rare occasions, it evolves even before the onset of leukemias, and when it precedes leukemias without any overt signs, it is referred to as the primary type. Although GSs can involve any body part, localization in the oral cavity is extremely rare. The recognition of this rare primary entity is important because early aggressive chemotherapy can cause regression of the tumor and improve survival. Here, we report a rare case of GS in a nonleukemic 62-year-old female who presented with generalized gingival enlargement involving both maxilla and mandible.

Salivary Her2/neu Levels in Differentiation of Oral Premalignant Disorders and Oral Squamous Cell Carcinomas.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is thought to develop from precancerous dysplastic lesions through multistep processes of carcinogenesis involving activation of oncogenes and loss of tumor suppressor genes. The human epidermal growth factor receptor 2 (Her-2/neu [erbB-2]), a cell membrane glycoprotein, is a growth factor receptor that has receptor tyrosine kinase activity. Her2/neu activation plays a central role in cell proliferation and survival. It has been shown that overexpression of Her2/neu increases the rate of cell division and growth, leading to precancerous changes. The aim of the present study was to compare the serum and salivary Her2/neu levels between cases with premalignant and malignant oral lesions. MATERIALS AND METHODS: Fasting blood samples and unstimulated saliva by passive drooling were collected from three groups of healthy control (n=20), premalignant disorder (PMD) (n=20) and OSCC (n=25) subjects. The HER2 extracellular domain (HER2 ECD) levels were measured using ELISA. RESULTS: The levels of serum Her2/neu showed no significant differences between any of the groups but on the other hand salivary Her2/neu levels were found to be significantly (p<0.05) higher when compared between control (median 68.7 pg/ml, range: 21.5 - 75.8) and OSCC (median 145.6 pg/ml, range: 45.1-191.1). A similar trend was observed when comparing between PMD (median 43.3, range: 22.1 -94.7) and OSCC with a statistical significance of p<0.05. CONCLUSIONS: Our study provided evidence of increased salivary Her2/neu in OSCC when compared to PMD and control which was not the case for serum levels. This suggests that probably Her2/neu is not highly amplified as in breast cancer so as to be reflected in serum. Since saliva is in local vicinity of the OSCC, even a mild increase might be mirrored. On the whole, this study proposes Her2/neu as marker for distinguishing premalignant and malignant conditions.

Dental fluorosis: A histological study using Light and Confocal microscopy.

AIMS: To observe and characterize the histological features of fluorosed teeth under light and confocal microscope (CFM). MATERIALS AND METHODS: A total of 25 fluorosed teeth and 5 normal teeth were collected from dentists across Dindigul, a known endemic area of fluorosis in South India. Ground sections of respective teeth were observed under light microscope and the sections were subsequently stained with acridine orange and studied under CFM. RESULTS: Histological changes were observed in the ground sections of fluorosed teeth as compared with the normal teeth. Depending on the degree of fluorosis, the affected teeth showed various features of hypomineralization in enamel and dentin. CONCLUSIONS: Fluoride interacts with both mineral phases and organic macromolecules by strong ionic and hydrogen bonds resulting in incomplete crystal growth at prism peripheries. This presents as hypomineralization of enamel and dentin.

Oral mucocutaneous lesions - a comparative clinicopathological and immunofluorescence study.

BACKGROUND: Oral mucosa is often affected by many diseases including mucocutaneous disorders. The diagnoses of these disorders are primarily based on history, clinical features, and histopathology. For the past few years' immunofluorescence techniques emerged as an important tool to study the pathogenesis and in the diagnosis of oral mucocutaneous and vesiculobullous disorders. The present study was designed to carry out retrospective and prospective analysis of oral mucocutaneous lesions to elucidate the clinicopathologic features and its immunofluorescence findings. MATERIALS AND METHODS: A total of 70 subjects with oral mucocutaneous lesions were retrieved from the oral pathology files of Tamil Nadu Govt. Dental College and their clinical features were evaluated, and the histopathology was also evaluated with the help of hematoxylin and eosin stained sections. For the prospective study, biopsy from 12 subjects with oral mucocutaneous lesions was subjected to routine histopathological examination and DIF to evaluate the consistency of the methods. RESULTS: In the retrospective analysis of 70 subjects with oral mucocutaneous lesions in relation to clinical features and histopathology, most of the findings were similar to the previous studies except for few criteria like male predilection in lichen planus and mucous membrane pemphigoid (MMP) and more prevalence of pemphigus vulgaris than MMP (2:1). In the prospective analysis of 12 subjects, the histopathological diagnosis was consistent with DIF study in 66% of cases. CONCLUSION: The diagnostic efficiency of oral mucocutaneous lesions can be improved by modern tools like DIF studies in addition to traditional methods like clinical and histopathology.

Rhinosporidiosis presenting as a facial swelling: a case report.

Rhinosporidiosis caused by Rhinosporidium seeberi is a fungal infection, which affects chiefly the mucus membranes of the nose, oropharynx, and nasopharynx, as well as the larynx, skin, eyes, and genital mucosa. Soil and water act as a reservoir for the organism. Here, we present a case of Rhinosporidiosis, which clinically manifested as a facial swelling indicating that fungal infections should also be considered as one of the differential diagnoses whenever facial swellings are encountered.

Evaluation and Comparison of Vascular Endothelial Growth Factor Expression between Ameloblastoma and Keratocystic Odontogenic Tumor.

BACKGROUND: Odontogenic keratocyst (OKC) is a developmental odontogenic cyst with an aggressive clinical behavior suggesting a change in its terminology from a cyst to a tumor and has now been renamed as keratocystic odontogenic tumor (KCOT). The purpose of this study was to assess and compare angiogenesis in ameloblastoma and OKC. MATERIALS AND METHODS: Angiogenesis was assessed by studying the immunohistochemical expression of vascular endothelial growth factor (VEGF). The study samples included 15 ameloblastomas and 15 KCOTs. The immunoreactivity was statistically evaluated using Mann-Whitney U-test. RESULTS: VEGF expression was higher in ameloblastoma than KCOTs. However, a non-significant difference of VEGF expression was noted between ameloblastoma and KCOTs (P = 0.345). CONCLUSION: The results suggest that tumor angiogenesis may play a significant role in aggressive biologic behavior of KCOT. Thus, angiogenesis could be a potent target for developing anatiangiogenic therapeutic strategies.