A Comparison of Proliferative Capacity of Reticular and Erosive Variants of Oral Lichen Planus by Argyrophilic Nucleolar Organizer Regions Method.

Background: Oral lichen planus (OLP), an immune mediated disorder, has been recognized since 1869 and is presented as any one of the six variants. Reticular and erosive are the most frequently encountered. Its proliferative capacity can give some information regarding its progression. We adopted the argyrophilic nucleolar organizer regions (AgNORs) method because of its simplicity to use and dependable results. We evaluated AgNORs in basal, suprabasal, and squamous cell layers. We also compared these three layers within two variants, reticular, and erosive. Materials and Methods: Thirty clinically diagnosed patients of OLP were included in the study. Reticular and erosive variants were included in our study. This was followed by hematoxylin and eosin staining and later by the AgNOR method. The mean number of AgNORs per nucleus was calculated. Results: Thirteen males and 17 females were the gender distribution. Twenty-three (76.67%) had reticular pattern and seven (23.33%) had erosive pattern. The basal cell layer had the highest mean AgNOR compared to suprabasal and squamous layers. Even among, erosive and reticular variants, the former had higher mean AgNOR counts. Discussion: Our results suggest that the inflammatory infiltrate close to the epithelial cells can alter the proliferation index for the pattern of protein synthesis of these cells. Moreover, the high proliferative index in OLP can be related to a specific immunologic response. Conclusion: We conclude that AgNOR can be used as a proliferative marker in earlier lesions to detect the severity.

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.

Evaluation of immunohistochemical expression of E-cadherin in pleomorphic adenoma and adenoid cystic carcinoma.

Background: Pleomorphic adenoma (PA) and adenoid cystic carcinoma (ADCC) are benign and malignant salivary gland tumors, respectively, with distinct behavior. They have similar origins and cell components. E-cadherins are the main homophilic cell adhesion molecules, which play a central role in maintaining epithelial integrity, functioning in intercellular adhesion and differentiation. Hence, changes in E-cadherin function are reflected in the morphologic events associated with the cellular arrangement, movement and wound healing. Aim: To study and compare the expression of E-cadherin immunostaining in PA and ADCC. Materials and Methods: Fifteen cases of each PA and ADCC were immunohistochemically stained with E-cadherin. Five cases of normal salivary gland tissues were taken as the positive control.Mann-Whitney U-test was used for statistical analysis. Results: About 86.6% of PA cases showed homogeneous staining. 66.6% of cases of ADCC showed heterogeneous staining. PA, cribriform and tubular patterns of ADCC predominantly showed moderate immune-staining and solid patterns of ADCC exhibited predominantly mild immunostaining. Depending on the intensity of staining, we found a significant P value between PA and the solid variant of ADCC. Conclusion: E-cadherin proved to be a better marker for epithelial phenotypes in PAs. In ADCC difference in staining intensity between different histological subtypes suggests that further studies should be done to assess the usefulness of an immuno-marker to know the aggressive behavior of ADCC.

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.

Goldenhar Syndrome in a Young Girl.

Goldenhar or oculo-auriculo-vertebral (OAV) syndrome is a congenital disorder that is usually apparent at birth. Sometimes, its diagnosis can be delayed and it is first diagnosed in adolescents or adults. We present a case of an 18-year girl who presented with chief complaint of multiple carious teeth and was found to have abnormal facies. On examination, it was found that the patient had asymmetry of face due to hypoplastic maxilla and mandible on the left side. Patient also had presence of ocular dermoid in the left eye, pre-auricular tags, scoliotic posture, ankyloglossia and fissured tongue, which were in accordance with OAV syndrome. This case report unveils the need for an early diagnosis and prompt treatment of the anomalies found in this syndrome.

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.

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.

Hypohydrotic Ectodermal Dysplasia in an Indian Family.

Hereditary ectodermal dysplasia (HED) is a rare genetic disorder chiefly affecting ectodermally derived structures including hair, nails, sweat glands etc. with pathognomic manifestations such as hypotrichosis, hypohidrosis, and hypodontia. Hypohidrotic ectodermal dysplaisa, being the most frequently encountered subtype and HED, being the rare subtype. HED is primarily transmitted through X-linked recessive trait in which the gene is carried by the female and manifested in male. Although rare, this disorder may be seen affecting lot of members of the same family. We hereby report a series of four cases with common classical manifestations accompanied with spoon shaped nails, hyperpigmentation, oligodontia and hypotrichosis. The patients were treated for prosthetic rehabilitation and were asked to wear cool clothing.

Clear Cell Myoepithelial Carcinoma of the Upper Lip -A Rare Case Report.

Myoepithelial carcinomas are quite infrequent neoplasms and coupled with their diverse morphological appearance are interesting as far as diagnosis and management is concerned. They account for less than 1% of all salivary gland tumors. The variable morphologic appearance of myoepithelial carcinoma leads to a wide differential diagnosis, including primary salivary gland tumors and metastatic tumors. The prognosis of these tumors is not fair as they are locally aggressive and approximately one third of the patients die of the pathology. We report a case of clear cell variant of myoepithelial carcinoma in an unusual location, i.e. the upper lip. The treatment carried out was wide surgical resection. The patient was followed up for 2 years and was symptom free. The clear cell variant of myoepithelial carcinoma is extremely rare and only about 51 cases of this variant affecting the salivary glands have been reported worldwide so far.

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.

Evaluation of Mitotic Figures and Cellular and Nuclear Morphometry of Various Histopathological Grades of Oral Squamous Cell Carcinoma: Comparative study using crystal violet and Feulgen stains.

OBJECTIVES: The objectives of this study were to quantitatively estimate the number of mitotic figures (MFs) and evaluate the cellular and nuclear features of various histological grades of oral squamous cell carcinoma (OSCC) using Feulgen and 1% crystal violet stains. METHODS: This case-control study took place at the Dr D. Y. Patil Dental College & Hospital in Mumbai, Maharashtra, India, between June and December 2016. A total of 51 samples were retrieved from the hospital archives. Of these, 15 well-differentiated, 15 moderately-differentiated and six poorly-differentiated OSCC samples formed the case group while 15 samples of normal gingival mucosa constituted the control group. Each sample was dyed using Feulgen and 1% crystal violet stains and the mitotic count, nuclear area (NA), cellular area (CA), nuclear perimeter (NP), cellular perimeter (CP) and nuclear-to-cytoplasmic (N/C) ratio was calculated using computer-aided morphometry techniques. RESULTS: The number of MFs visible per field was significantly higher in Feulgen-stained sections as compared to those stained with crystal violet (P = 0.050). In addition, the NA, NP, CA and CP values and N/C ratios of samples in the experimental group increased significantly in accordance with an increase in OSCC grade (P <0.001). CONCLUSION: The Feulgen stain is more reliable than 1% crystal violet in terms of the selective staining of MFs. Moreover, the findings of this study indicate that computer-based morphometric analysis is an effective tool for differentiating between various grades of OSCC.

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.

Recurrent Psammomatoid Juvenile Ossifying Fibroma with Aneurysmal Bone Cyst: An Unusual Case Presentation.

Juvenile ossifying fibroma (JOF) is a rare, benign, locally aggressive entity of the extragnathic craniofacial bones with a high tendency towards recurrence. Two distinctive microscopic patterns of juvenile ossifying fibroma have been described: a trabecular juvenile ossifying fibroma (TrJOF) and a psammomatoid juvenile ossifying fibroma (PJOF). Psammomatoid variant is predominantly a craniofacial lesion and occurs rarely in the jaws. The pathognomonic histopathologic feature is the presence of spherical ossicles, which are similar to psammoma bodies. Aneurysmal bone cyst exists as a secondary lesion arising from another osseous condition such as fibrous dysplasia, ossifying fibroma and giant cell granuloma. Very few cases of juvenile psammomatoid ossifying fibroma in association with the secondary aneurysmal bone cyst formation have been reported in the literature. Treatment consists of complete surgical removal; the incomplete excision has been associated with a high local recurrence rate. The authors report a case of recurrence of psammomatoid juvenile ossifying fibroma with aneurysmal bone cyst in an 8-year-old boy emphasizing the point that concomitant occurrence of these locally aggressive lesions requires adequate surgical removal and long-term follow-up.

Keratocystic odontogenic tumor with ossification and calcification: A case report with unusual histological findings.

The keratocystic odontogenic tumor (KCOT), formerly known as odontogenic keratocyst, is a benign developmental odontogenic tumor with many distinguishing clinical and histologic features. Hard tissue deposits, which usually take the form of dystrophic calcifications, cartilaginous tissue, or dentinoid, are uncommon findings in the connective tissue capsule of the KCOT. We report a case of a 33-year-old female with KCOT showing osseous tissue and calcified deposits close to its epithelial lining, which is an extremely rare occurrence. A brief review on the reported prevalence of hard tissue deposits in KCOTs and possible mechanisms that has been implicated in mineralization and bone formation has been discussed.

Gingival crevicular fluid: As a diagnostic marker in HIV positive patients.

OBJECTIVE: To determine the utility of gingival crevicular fluid (GCF) for the detection of anti-HIV antibodies in human immunodeficiency virus (HIV)-infected individuals using enzyme linked immunosorbent assay (ELISA) with respect to their CD4 counts. MATERIALS AND METHODS: The study was carried out between 37 seropositive (37GCF, 10 saliva) and 37 seronegative (GCF) individuals for a period of 7-8 months in GDC Nagpur. Thirty-seven GCF and 10 whole saliva samples were collected from the same patient. GCF samples were collected from gingival crevice with the help of Kimble disposable microcapillary. Saliva was collected by asking the patient to bend forward. The drooling saliva was collected in a sterile bottle and stored at Minus 20°C (-20°C). After the clinical observations the data were collected and tabulated for statistical analysis. RESULTS: When compared with serum, the sensitivity, specificity, and positive and negative predictive values of GCF were 100% respectively. CONCLUSION: All the above findings are suggestive of GCF being a better diagnostic medium than saliva.