Herniation of Parotid Gland into Masseter Muscle: A Rare Case Report.

A herniation is the abnormal protrusion of an organ or other body structure through a defect or natural opening in a covering membrane, muscle, or bone. The parotid gland is the largest of the salivary glands, which is situated below the external acoustic meatus and overlaps the masseter muscle anteriorly. In this rare case report, a 35 years old female patient complained of pain in the cheek region for 3 years and gave a history of pain aggravating while having sour food. On palpation, multiple nodules were found bilaterally in the cheek area which was tender. Ultrasonography of the masseter and parotid region showed herniation of the lower lobe of the parotid gland into the masseter muscle which is 1 cm on the right side and 0.8 cm on the left side. The findings obtained from ultrasound images were further confirmed with Magnetic Resonance Imaging (MRI).

Expression of Salivary miRNA 21 in Oral Submucous Fibrosis (OSMF): An Observational Study.

OBJECTIVE: To observe the expression patterns of salivary mRNA 21 in different stages and grades of OSMF and also in habitual areca nut chewers without OSMF. SUBJECTS AND METHODS: The study consisted of a total of 185 samples, where 61 patients had chewing habits (chewing gutkha and other forms of areca nut) and had OSMF (Group 1). 61 patients had chewing habits but did not have OSMF (Group 2), and 63 were normal healthy patients (control group) without any chewing habits (Group 3). Unstimulated saliva samples were collected from patients following the standard operating procedures. miRNA 21 was isolated and purified from saliva samples using the miRNeasy Mini Kit, Qiagen. The primers for miRNA relative quantification analysis were designed using the Primer Express software of Applied Biosystems. Quantification of all the samples was carried out using SYBR chemistry in an Applied Biosystems Real-Time PCR. RESULTS: There was no statistically significant difference between the demographic characteristics of patients. There was a statistically significant difference between the expressions of miRNA 21 amongst the three groups noted in Kruskal Wallis test. (<0.001*) A post hoc test was perfomed to confirm the statistical difference between patients within all three groups. There was no statistically significant difference noted between the OSMF group and patients with chewing habits group (G1 vs. G2 p: 0.10), but there was a significant difference when compared with normal patients. (G1 vs. G3 p: <0.001*) and (G2 vs. G3 <0.001*). CONCLUSION: This study concludes that miRNA 21 is overexpressed in OSMF and chewing habit patients. But the expression levels were not significantly associated with the severity of the disease process. A long term and large scale studies are required to assess its application as a diagnostic profibrotic marker in OSMF.

Assessment of epithelial-mesenchymal transition signatures in oral submucous fibrosis.

BACKGROUND: Recently, the concept of field cancerization has questioned the accuracy of biopsy site selection clinically. Oral submucous fibrosis (OSMF) has a global malignant transformation rate of 7.6% despite having less dysplastic changes clinically or histologically. Hence, this study was undertaken to evaluate the expression of vimentin, epithelial-cadherin (E-Cad) and collagen IV in OSMF, using immunohistochemistry and polymerase chain reaction (PCR). MATERIALS AND METHODS: One hundred and eighty- five patients with OSMF (61), with habits and no OSMF (61) and patients without habit and OSMF (63) were subjected to biopsy for sample collection. The samples were analyzed immunohistochemically for vimentin, E-Cad and collagen IV. The PCR values for vimentin and E-Cad were also done. RESULTS: Vimentin expression was increased in OSMF patients, whereas E-Cad expression was decreased in OSMF patients. CONCLUSION: Epithelial-mesenchymal transition signatures are definitely positive in OSMF cases.

Habit History in Oral Submucous Fibrosis: Have We Over Emphasized?

Aim: Correlation of habit duration and frequency with clinical grading and histopathologic grouping of oral submucous fibrosis (OSMF). Materials and methods: 48 patients with OSMF were included in the study. Detailed history of each patient, clinical profile and habit history were recorded. Biopsy was performed for histopathological correlation. All the findings were correlated with Kerr et al and Khanna and Andrade classification. Statistical Analysis: Kruskal-wallis test was performed to assess the correlation between the study findings. Results: Out of 48 OSMF cases majority were males. Maximum cases were in clinically and histopathologically respectively. Mouth opening was directly proportional with histopathological grouping as per Khanna et al. No correlation between frequency and habit duration with respect to different stages or severity of the OSMF was noted. Conclusion: Disease staging of OSMF clinically and histopathologically is not directly impacted by habit duration and frequency. Rather than habit centered history and management accordingly, more focus should be given to genetics and susceptibility of patient for OSMF development and progression.

Proliferative endophytic lesion of the maxilla: A diagnostic challenge.

Carcinoma cuniculatum (CC) is an extremely rare neoplasm of the oral cavity. It is essentially a well-differentiated variety of squamous cell carcinoma and shows lower metastasis risk. The histological features of CC can mimic that of papillary squamous cell carcinoma or verrucous carcinoma. CC commonly affects the plantar region of the foot, and very few cases have been described in the oral cavity. The classical histological characteristics noted are infiltration of underlying connective tissue by squamous epithelium with keratin cores and keratin-filled crypts. Herewith, we present a case of CC of the right maxilla in a young Dravidian male patient who works in a battery factory. The case presented a diagnostic challenge both clinically and histopathologically before it was completely resected using a total maxillectomy technique. The case delineates the diagnostic challenge and management of the disease.

Is Optimal Management of Recurrent Aphthous Stomatitis Possible? A Reality Check.

Recurrent Aphthous Stomatitis (RAS) is a condition in which aphthous ulcers repeatedly occur in the oral cavity. It is prevalent in developed countries, occurring in all ages, geographic regions and races and about 80% of people have one episode of oral aphthous ulcers before the age of 30 years. With no laboratory procedures to confirm the diagnosis, treatment is mainly empirical in nature and focuses on short-term symptomatic management. Although numerous treatment modalities have been recommended, only a few are evidence based and can be considered for the optimal management of RAS. Biologic agents are a new category of drugs which acts by blocking specific pathways associated with the pathophysiology of neoplastic or immune-mediated diseases. These agents have targeted immunosuppressive or anti-inflammatory actions. In patients of RAS who were not responding to standard therapy, etanercept, adalimumab, infliximab and Interferon-Alpha (INF-α) were found to be useful. The objective of this review was to propose and review a treatment protocol to be followed for the optimal management of RAS. We reviewed several evidence-based studies and through this review we recommend topical interventions as the first-line of therapy since they are associated with low risk of systemic side effects. Due to limitations in the number of evidence-based trials and the insufficient data to support or refute the efficacy of the therapies prescribed, larger evidence-based clinical studies and literature reviews are needed to further improvise the optimal methodology for the effective management of RAS.

Idiopathic leukoplakia- report of a rare case and review.

Idiopathic leukoplakia is a rare potentially malignant lesion, usually found on the tongue with an increased risk of malignant transformation as compared to the tobacco associated form. The risk of malignant transformation increases with age. Diagnosis poses a challenge to the clinician as it is diagnosed by exclusion of other possible causes leading to hyperkeratosis. We present one such rare case in an elderly male patient who was followed up for a year to record the course of the lesion and to report recurrences, if any.

Rheumatoid arthritis affecting temporomandibular joint.

Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune inflammatory disorder that is characterized by joint inflammation, erosive properties and symmetric multiple joint involvement. Temporomandibular joint (TMJ) is very rare to be affected in the early phase of the disease, thus posing diagnostic challenges for the dentist. Conventional radiographs fail to show the early lesions due to its limitations. More recently cone-beam computed tomography (CBCT) has been found to diagnose the early degenerative changes of TMJ and hence aid in the diagnosis of the lesions more accurately. Our case highlights the involvement of TMJ in RA and the role of advanced imaging (CBCT) in diagnosing the bony changes in the early phase of the disease.

Serum lipid profile in patients with oral cancer and oral precancerous conditions.

BACKGROUND: The present study was undertaken to estimate and compare the levels of plasma total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL) and triglycerides in patients with oral precancerous lesions/conditions, oral cancer and normal subjects. MATERIALS AND METHODS: The study comprised of 60 patients with oral precancerous lesions/conditions, 60 patients with oral cancer and a control group of 60 healthy individuals. The diagnosis of oral precancerous lesions/conditions and oral cancer was confirmed histopathologically. Under aseptic condition 5 ml venous blood of overnight fasting patient was withdrawn from each individual. Serum was separated by centrifugation and plasma levels of TC, LDL, HDL, VLDL and triglycerides were estimated. Descriptive statistical analysis has been carried out in the present study. Analysis of variance has been used to find the significance of study parameters between three or more groups of patients, Post-hoc test as Tukey has been used to find the pair wise significance. Significance is assessed at 5% level of significance. RESULTS: Statistically significant decrease in levels of plasma TC, LDL, HDL, VLDL and triglycerides was observed in the precancerous and cancerous groups as compared to the control group. On comparison between precancerous and cancerous groups, significant decrease was observed in cancerous group. CONCLUSION: The change in lipid levels may have an early diagnostic or prognostic role in the oral premalignant lesions/conditions and oral cancer. The presence of decreased plasma lipid profile should increase the suspicion of these lesions to be investigated further.

Giant cemento-ossifying fibroma of the mandible.

Cemento-ossifying fibroma (COF) is classified as a fibro-osseous neoplasm and included among the non-odontogenic tumors derived from the mesenchymal blast cells of the periodontal ligament, with a potential for forming fibrous tissue, cementum and bone, or a combination of such elements. These are slow-growing lesions, and are more frequent in women between the third and fourth decades of life. Case reports of massive expansile COF, measuring more than 10 cm are rarely reported in the literature. We report a case of giant cemento-ossifying fibroma of the mandible in a 34 year old female patient.

Mycological and histological associations of Candida in oral mucosal lesions.

The present study aimed to assess the presence and level of colonization of Candida in patients with oral mucosal lesions, to determine the presence or absence of candidal hyphae in biopsy specimens and to correlate the degree of epithelial dysplasia with the number of colony-forming units of Candida. We performed a prospective study including 50 patients diagnosed as having oral potentially malignant and malignant disorders. These patients had lesions such as leukoplakia, lichen planus, lichenoid reaction, verrucous carcinoma and oral squamous cell carcinoma. An oral swish with 10 mL of normal saline was performed, and this was collected in a sterile plastic container. Candidal colony-forming units were assessed in the specimen. This was followed by a biopsy of the lesion, which was sent for histopathologic examination for dysplasia and severity, and to assess the presence or absence of candidal hyphae. The results of the present study revealed a correlation between higher Candida colonization and increasing severity of dysplasia. An effort was made to correlate Candida by histologic and mycologic means with epithelial dysplasia. If such a correlation is strongly established, then the importance of antimycotic therapy can be emphasized to avoid deterioration.

Assessment of immediate pain relief with laser treatment in recurrent aphthous stomatitis.

OBJECTIVES: To compare immediate pain relief, healing time between minor recurrent aphthous ulcers treated with a single session of carbon dioxide (CO2) laser and a placebo. STUDY DESIGN: A prospective clinical study was performed on 25 patients with minor recurrent aphthous stomatitis. Pretreatment pain levels were recorded using a numerical rating scale. Ulcers were randomized to either receive treatment or placebo. Pain levels were assessed immediately after treatment and after 24 h. Healing was assessed on days 3 and 4, and once every 2 days thereafter for 2 weeks. RESULTS: Mean pain scores in the laser group were significantly reduced immediately after treatment (0.68 ± 0.6) compared with pretreatment (8.48 ± 0.71; P < .001). In contrast, the placebo group showed little difference in pain scores between pretreatment (8.08 ± 0.70) and immediately after treatment (7.96 ± 0.84). In the laser group, significant improvements in healing times were observed (4.08 ± 0.81 vs. 7.84 ± 0.90 days; P < .001). CONCLUSION: CO2 laser therapy in recurrent aphthous stomatitis (RAS) provides immediate pain relief sustained over 24 h, along with accelerated healing time.

Efficacy of colour Doppler ultrasound in diagnosis of cervical lymphadenopathy.

OBJECTIVES: The purpose of the study was to evaluate the efficacy of colour doppler ultrasound (CDUS) in diagnosis of cervical lymphadenopathy. MATERIALS AND METHODS: The study group consisted of 30 patients with clinical evidence of cervical lymphadenopathy (19 patients with clinically suspected reactive/benign cervical lymphadenopathy and 11 patients with clinically suspected malignant/metastatic cervical lymphadenopathy). CDUS examinations were carried out for one lymph node (LN) in each patient and fine needle aspiration cytology of the same LN was obtained. To evaluate the efficacy of CDUS, comparison between clinical features, CDUS features and cytological features of enlarged cervical LNs were then done. RESULTS: Clinical examination evaluated 54 cervical LNs. CDUS evaluation discovered an additional 55 LNs (54 + 55 = 109). Accuracy of the CDUS examination was higher than clinical evaluation. Patterns of colour doppler flow signals when correlated with cytological diagnosis showed central flow for benign nodes and peripheral flow for malignant nodes. The mean pulsatility index (PI) was 1.977 ± 0.669 in LNs involved with metastases and 0.839 ± 0.135in LNs affected by benign processes. LNs involved with metastases showed a characteristic high resistive index (RI) and a high pulsatility index than the lymph nodes affected by benign processes. The RI and PI were significantly different between LNs affected by benign versus malignant disease. CONCLUSION: Nodal vascularity of the LNs can be used to differentiate benign from malignant lymphadenopathy. CDUS can be trusted upon as a reliable marker for the diagnosis of cervical lymphadenopathy.

Attempting tobacco cessation--an oral physician's perspective.

INTRODUCTION: Tobacco use is a global health care problem. Repetitive exposure to nicotine produces neuroadaptation resulting in nicotine dependence. Smoking is associated with a range of diseases, causing high levels of morbidity and mortality and is one of the leading causes of preventable deaths, with more than 4.6 million smokers worldwide dying each year from smoking related illnesses. Stopping smoking has major health benefits. Quitting at any age provides both short and long term benefits. MATERIALS AND METHODS: 45 patients attending the outpatient department at the Oxford Dental College, Bangalore, were randomly allocated to three groups of interventions namely placebo, counseling and nicotine replacement therapy (NRT). Initially each one was assessed for carbon monoxide levels using a breath analyser (pico smokerlyser bedfont UK). They were followed up for six months and the carbon monoxide levels were again assessed using the same instrument. The paired t test was used to compare the results before and after the intervention. RESULTS: The scores before the initiation of intervention and after treatment were compared and all three interventions were found to be statistically significant after six months. It was noticed that patients with very low or low dependence followed by high dependence had good response in the placebo group (68% and 47.6% respectively), in the counseling group maximum response was seen in the medium followed by the very low group (61% and 59% respectively), and maximum response was seen in very high followed by the very low group with NRT (78.7% and 60.5% respectively). CONCLUSION: The inference that can be drawn from the present study is that non-invasive, non pharmacological methods like placebo and counseling are effective in low to medium groups, and NRT is effective with higher nicotine dependence.

Estimation of superoxide dismutase and glutathione peroxidase in oral submucous fibrosis, oral leukoplakia and oral cancer--a comparative study.

Present study was undertaken to estimate and compare erythrocyte superoxide dismutase (E-SOD) and Glutathione peroxidase (GPx) levels in oral submucous fibrosis, oral leukoplakia and oral cancer patients and age/sex matched healthy subjects, 25 in each group. Statistically significant (P<0.001) decrease in E-SOD and GPx levels were observed in OSF, oral leukoplakia and oral cancer groups as compared to the control group. Oral leukoplakia group showed lower levels in comparison with OSF (P>0.05). Oral cancer group had the lowest levels amongst the study groups. Imbalance in antioxidant enzyme status may be considered as one of the factors responsible for the pathogenesis of cancer and may serve as a potential biomarker and therapeutic target to reduce the malignant transformation in oral premalignant lesions/conditions.

Oral pigmentation: case report and review of malignant melanoma with flow charts for diagnosis and treatment.

The color of the human oral mucosa is not uniform. Chromatic variations can occur, depending on the degree of keratinization, melanogenic activity, number of melanocytes, vascularization, and type of submucosal tissue. If a pathological pigmentation is suspected, its benign or malignant nature will guide the treatment plan. This article presents a rare case of malignant melanoma of the anterior maxilla with asymptomatic palatal pigmentation and regional lymph node metastasis. Flow charts for the diagnosis and treatment of pigmented lesions (with special emphasis on treatment of primary and metastatic melanoma) are included.

Capdepont's teeth - a hereditary dentin defect: case report & review / IDientes de capdepont - un defecto de dentina hereditario. reporte de caso y revisión de la literatura

Dentinogenesis imperfecta is an autosomal dominant genetic disorder with abnormal dentin structure affecting both primary and permanent dentitions leading to discolouration and attrition of teeth. Diagnosis is usually based on family history, a detailed clinical examination and pedigree construction. Treatment involves preservation of teeth, removal of infection, restoration of function and esthetics.

La dentinogénesis imperfecta es un trastorno genético autosómico dominante, caracterizado por una estructura anormal de la dentina, que afecta tanto la dentición temporal como permanente, generando decoloración y desgaste de los dientes. El diagnóstico generalmente se basa en la historia familiar, el examen clínico detallado y la construcción de pedigrí. Su tratamiento implica la conservación de los dientes, eliminación de infección, y la restauración de la función y la estética.