Diagnostic and Therapeutic Challenges of a Large Tongue Lymphangioma in a Child: A Case Report.

Lymphangiomas are rare, painless, benign tumors in infancy or early childhood resulting from a congenital malformation of the lymphatic vessels with variable clinical appearance. We report the case of a six-year-old male child who presented with a micronodular surface of the tongue, a burning sensation, difficulties during swallowing and mastication, as well as speech disturbances. Histological examination of the excised tongue specimen showed an angiomatous lesion of the lamina propria that comprised many wide thin-walled spaces. MRI examination revealed an area of disparate T2 signal maximum diameter of 2-3 cm with cystic texture in the middle and frontal left part of the tongue. The lesion was diagnosed as a lymphangioma and was managed through pre-operative embolization and surgery. Tongue lymphangiomas may lead to aesthetic problems, functional issues (like dysphagia, airway obstruction, and speech difficulties), psychological disturbances, poor oral hygiene, and occasional bleeding associated with oral trauma. A major fraction of patients also experience infections, often leading to a significant increase in lesion size. A combination of preoperative embolization and surgical excision could be chosen considering its large size and the age of the patient, and to further eliminate the possibility of recurrence. Early diagnosis and radical treatment are critical in its management.

Comparison of Effectiveness of Moringa Oleifera Leaves Extract Gel (2%) with Retino A (0.1%) Cream for Treatment of Oral Leukoplakia: Double Blinded Randomized Control Trial.

AIM: The study aims to evaluate and compare the efficacy of Moringa oleifera leaf extract gel (2%) & Retino A cream (0.1%) in reducing the size of lesions in oral leukoplakia. OBJECTIVES: The present study aimed to evaluate the efficacy of two interventions, Moringa oleifera mucoadhesive gel and Retino-A cream, in reducing the size of lesions in patients with oral leukoplakia. Specifically, the objectives were: (1) to assess the efficacy of Moringa oleifera mucoadhesive gel in determining the reduction in lesion size, (2) to assess the efficacy of Retino-A cream in determining the reduction in lesion size, and (3) to compare the efficacy of Moringa oleifera mucoadhesive gel (2%) in determining the change in lesion size in oral leukoplakia patients. METHODS: Clinically diagnosed cases of oral Leukoplakia were included in this study. The sample size is 72. Thirty-six patients had lesion sizes ranging from 2- 4 cm, and 36 patients had lesion sizes ranging from 4.1 - 6 cm that were equally distributed in the case and control groups using the chit system. The case and control groups had 36 patients with an equal size range of lesions. The case and control group participants will be advised topical application of the intervention and Retino-A thrice daily using a sterile cotton bud. RESULTS: M. oleifera gel (2%) was found to be more effective in the reduction in the size of the lesion as compared to Retino-A in the treatment of oral leukoplakia patients. CONCLUSION: This study showed that M. oleifera mucoadhesive gel (2%) is an effective and safe treatment option for oral leukoplakia patients. It demonstrated a significant reduction in lesion size compared to Retino-A cream (0.1%) after 3 months of therapy, without any reported adverse effects. However, long-term follow-up studies are needed to evaluate its long-term effectiveness. The potent antioxidant property of M. oleifera makes it a promising candidate for further studies with concentration variations and in other potentially malignant oral disorders, such as lichen planus and OSMF. The development of chemotherapeutic drugs from M. oleifera for cancer treatment should also be considered. Overall, M. oleifera appears to be a promising natural alternative to synthetic drugs for the treatment of oral leukoplakia. KEY WORDS: Leukoplakia, Oral leukoplakia, premalignant lesion, precancer, potentially malignant disorders.

Altered Presence of Cancer Stem Cell ALDH1/2 in Oral Leukoplakias and Squamous Cell Carcinomas.

INTRODUCTION: Cancer stem cells (CSCs) are responsible for initiating the process of carcinogenesis by enabling the self-renewal and self-proliferation of the cancer cells. This study aimed to investigate the presence of epithelial cells with cancer stem cells characteristics (ALDH+) in the early stages of oral precancerous lesions (Oral Leukoplakias) and the frequency of these cells in the different stages of oral squamous cell carcinomas (OSCCs). MATERIALS & METHODS: The aim of this study was the detection of the immunohistochemical pattern of expression of CSC protein-biomarker ALDH1&2 (sc-166362, Santa Cruz Co, Dallas, Texas, USA) in paraffin-embedded samples of 30 cases of leukoplakia of all degrees of dysplasia and 21 cases of oral squamous cell carcinomas (OSCC) of all degrees of differentiation compared to the histologically normal oral epithelium. The samples were retrieved from 2009-2019 from the archives of the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece. The samples were evaluated through a three-tier scale (positive cells Ι: 6-35%, ΙΙ: 36-70%, ΙΙΙ: 71-100%). Statistical analysis was performed through SPSS Pearson Chi-square, and the significance level was set at 0.05 (p=0.05).  Results: The staining of ALDH1&2 was observed mildly in the cell membrane of cells in the stratum spinosum of the normal epithelium and the cell membrane of cells in the stratum basale of the normal epithelium, characteristically at the interface point with the basal membrane. ALDH1&2 were expressed significantly more in the OSCC than in the leukoplakia (p-value=0.0001) and the normal epithelium (p-value=0.0001). Mainly, ALDH1&2 were expressed significantly more in the severely and moderately dysplastic oral leukoplakia compared to the mildly dysplastic and non-dysplastic leukoplakia (p-value=0.001). DISCUSSION: The characteristic expression of ALDH in potentially malignant oral and OSCC lesions suggests the presence of CSCs and their possible implication in the early stages of oral tumorigenesis, even at the stage of oral leukoplakia.

Impact Strength of Various Types of Acrylic Resin: An In Vitro Study.

AIM: The aim of this study is to evaluate and compare the impact strength of conventional acrylic resin, high-impact acrylic resin, high-impact acrylic resin reinforced with silver nanoparticles, and high-impact acrylic resin reinforced with a zirconium oxide powder. MATERIALS AND METHODS: A total of 60 samples were prepared of dimensions 60 mm length × 7 mm width × 4 mm thickness to test impact strength. Machined stainless steel dies of the same dimension were used to form molds for the fabrication of these samples. Of 60 samples, 15 samples were prepared each from conventional acrylic resin (Group A1), high-impact acrylic resin (Group A2), acrylic resin reinforced with silver nanoparticles (Group A3), and acrylic resin reinforced with zirconium oxide powder (Group A4). Izod-Charpy pendulum impact testing machine was used. RESULTS: The impact strength of group A1 was in the range of 2.83-3.30 kJ/m2 (M = 3.12 kJ/m2, SD = 0.16), group A2 was in range of 5.10-5.78 kJ/m2 (M = 5.51 kJ/m2, SD = 0.18), group A3 was in range 3.18-3.56 kJ/m2 (M = 3.37 kJ/m2, SD = 0.11), and group A4 was in range 7.18-7.78 kJ/m2 (M = 7.5 kJ/m2, SD = 0.18). Statistical analysis using one-way ANOVA and t-test revealed significant differences (p < 0.001). CONCLUSION: High-impact acrylic resin reinforced with zirconium oxide powder has the highest impact strength. CLINICAL SIGNIFICANCE: This research sheds light on the usefulness of novel filler materials in clinical prosthodontics.

Efficacy of Spirulina 500 mg vs Triamcinolone Acetonide 0.1% for the Treatment of Oral Lichen Planus: A Randomized Clinical Trial.

AIM: The present study aimed at evaluating the efficacy of spirulina 500 mg in reducing the burning sensation and lesion size in oral lichen planus (OLP). MATERIALS AND METHODS: A total of 60 subjects who attended the oral medicine specialty clinic with histopathologically confirmed OLP and having symptoms of burning sensation were recruited for the study. They were randomly divided into two groups: group A (30) subjects were prescribed Spirulina 500 mg twice daily along with only a week application of topical triamcinolone acetonide 0.1% thrice daily; group B subjects were prescribed topical triamcinolone acetonide 0.1% alone thrice daily for 8 weeks. Both the groups were followed up posttreatment monthly for three consecutive months. RESULTS: Data were recorded, and statistical analysis by using ANOVA one-way test, and Chi-square test were performed, which showed statistically significant p-value (<0.005) for the parameters "burning sensation" and "size of the lesion". When compared between groups, group A showed a favorable outcome of the intervention. CONCLUSION: Spirulina 500 mg supplementation twice daily could be effective adjunct therapy with steroids to treat OLP. CLINICAL SIGNIFICANCE: This research allowed us to delve into spirulina as one of the treatment modalities for OLP. Further studies are needed as it is a rich source of proteins and vitamins and demonstrates potent anti-inflammatory, immunomodulatory, and antioxidant actions.

Hypertonic Saline Use and Traditional Nasal Irrigation: A Possible Preventative Measure against COVID-19.

Saline nasal irrigation (SNI) is a clinically established treatment that has been used to manage upper respiratory infections and allergies; there is also some indication that it may be effective in the setting of coronavirus disease-2019 (COVID-19). The possible advantages of SNI include the following benefits due to the well-known antiviral impact of sodium chloride (NaCl) and the mechanical cleansing effect arising from the irrigation method. First, there will most likely be a decrease in COVID-19 infection rates; second, illness severity will be lowered; and third, community transmission will be mitigated. Despite the need for more concentrated research into these aspects, public health organizations should emphasize alternate infection mitigation measures such as SNI in light of the ongoing COVID-19 problem, low global vaccine supply, and the rapid introduction of SARS-CoV-2 variants. Keywords: Community transmission, COVID-19, Pandemic, Prevention, Saline, SARS-CoV-2.

Silk Hydrogel for Tissue Engineering: A Review.

AIM: This review aims to explore the importance of silk hydrogel and its potential in tissue engineering (TE). BACKGROUND: Tissue engineering is a procedure that incorporates cells into the scaffold materials with suitable growth factors to regenerate injured tissue. For tissue formation in TE, the scaffold material plays a key role. Different forms of silk fibroin (SF), such as films, mats, hydrogels, and sponges, can be easily manufactured when SF is disintegrated into an aqueous solution. High precision procedures such as micropatterning and bioprinting of SF-based scaffolds have been used for enhanced fabrication. REVIEW RESULTS: In this narrative review, SF physicochemical and mechanical properties have been presented. We have also discussed SF fabrication techniques like electrospinning, spin coating, freeze-drying, and physiochemical cross-linking. The application of SF-based scaffolds for skeletal, tissue, joint, muscle, epidermal, tissue repair, and tympanic membrane regeneration has also been addressed. CONCLUSION: SF has excellent mechanical properties, tunability, biodegradability, biocompatibility, and bioresorbability. CLINICAL SIGNIFICANCE: Silk hydrogels are an ideal scaffold matrix material that will significantly impact tissue engineering applications, given the rapid scientific advancements in this field.

Severe Acute Respiratory Syndrome Coronavirus 2 Nosode: A Potential Alternative Vaccine Platform.

Besides conventional vaccinations, viable alternatives are needed to elicit an immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We propose and highlight the value of a homeopathic approach known as the "nosode" for the prevention of coronavirus disease-2019 (COVID-19). Nosode is an extract prepared from disease-affected tissues which is subsequently processed and administered as an antidote for the same medical condition. This concept might be a crucial therapeutic approach for viral infections since infected tissues contain a wide range of important viral antigens that could induce a functional host response via immunological sensitization. Thereby, nosode preparation produced from SARS-CoV-2-affected tissues may provide protection against COVID-19. "SARS-CoV-2 nosode" warrants more scientific investigation as a viable alternative vaccination platform. Keywords: COVID-19, Nosode, SARS-CoV-2, Variolation.

Yogic-humming: A Respiratory Defense Booster for COVID Times.

The traditional Indian healthcare system of Yoga contains a wealth of health-promotional practices-some of which are based on "humming." "Humming" is produced when a wordless sound is forced to exit through the nose while keeping the mouth either fully closed or nearly closed; it is a low, prolonged, and buzzing sound. In humming practices like "Bhramari pranayama" (normal inhalation followed by lengthened exhalation + bee-like humming), there is a full-mouth closure,1 and in practices like "OM chanting" (normal inhalation followed by lengthened exhalation +OM humming), there is a near-closure. Besides these, other mantra-oriented practices also generate a similar humming effect.

Florid Cemento-osseous Dysplasia: A Report of Two Cases and Literature Review.

AIM: This report aims to provide the clinical and radiographic features of two symptomatic Indian patients with florid cemento-osseous dysplasia (FCOD), along with a discussion of the differential diagnosis, potential challenges, and therapeutic implications. BACKGROUND: FCOD is a rare, multifocal, periapical, and bilateral condition involving the premolar and molar region of the posterior mandible and sometimes the maxilla. CASE DESCRIPTION: The first patient is a 30-year-old female with a recent history of dental pain. The patient was otherwise healthy and the medical history was unremarkable. The second patient is a 50-year-old female with a history of orthodontic therapy. Radiographic evaluation using cone-beam computed tomography (CBCT) revealed bilateral involvement of the posterior mandible, sparing the entire maxilla in both patients Clinical significance: For a pathognomonic condition like FCOD, a radiology survey alone is often sufficient to arrive at the final diagnosis, and therefore surgical interventions should ideally be avoided.

Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions.

AIM AND OBJECTIVE: This study aimed to evaluate the impact of the lockdown on oral oncology-related out-patient volume at Indian dental institutions. MATERIALS AND METHODS: The total number of newly diagnosed cases of oral submucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers, recorded at two dental institutional settings before lockdown (January-March 2020) and after lockdown (June-August 2020), were included retrospectively and compared. RESULTS: The study included a total of 797 cases at both institutions. At Institution-I, a total of 312 cases were recorded before the lockdown, and 63 cases were recorded after the lockdown. At Institution-II, a total of 311 cases were reported before lockdown, and 111 cases were recorded after lockdown. Comparisons between the pre-lockdown and post-lockdown data yielded a significant change in the proportions of oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers at both institutions (Chi-square test; p < 0.001). Following the lockdown, a substantial reduction was observed in the proportion of oral submucous fibrosis (OSMF) cases at both institutions, and the proportion of oral cancers increased at both institutions. There was a significant difference between the proportions of cases reported before lockdown at both institutions (p < 0.001). However, after-lockdown, no such differences were noted (p = 0.69); the absence of significance could most likely be due to the low sample size or low-power during the post-lockdown period. CONCLUSION: The oral potentially malignant disorders (OPMD) and oral cancer (OC) patient volumes reduced substantially following lockdown. During the post-lockdown period, the proportion of oral cancers increased, whereas the proportion of OSMF cases decreased. Results indicate that OPMD and oral cancer patients were impacted differently by the lockdown. CLINICAL SIGNIFICANCE: This study provides insight into the impact of lockdown and highlights the importance of reestablishing oral oncology-related patient care. A vital discussion is also provided on useful compensatory strategies that may reduce delays during the ongoing crisis. How to cite this article: Panta P, Reddy P, Misra SR, et al. Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions. J Contemp Dent Pract 2021;22(5):501-505.

Invasive oral squamous cell carcinoma induced by concurrent smokeless tobacco and creamy snuff use: A case report.

Oral squamous cell carcinomas (OSCC) are caused by chronic tobacco abuse. In this regard, the carcinogenic potential of smoking and smokeless forms of tobacco, including chewing tobacco and moist/dry snuff, has been widely documented. However, the effects of tobacco-containing products such as creamy snuff on oral health have not been widely reported. Here, we report on the clinical presentation of a patient with OSCC induced by concurrent chewing tobacco and creamy snuff use. The development and progression of mucosal carcinogenesis in the context of mixed tobacco use habits is discussed. With the increased availability of newer tobacco-containing products, it is important for clinicians to be aware of these products in the marketplace, including dentifrices and nicotine pouches, and counsel their patients regarding their health risks.

Do saline water gargling and nasal irrigation confer protection against COVID-19?

This report provides a perspective on the relevance of saline water gargling and nasal irrigation to the COVID-19 crisis. While there is limited evidence concerning their curative or preventive role against SARS-CoV-2 infection, previous work on their utility against influenza and recent post-hoc analysis of the Edinburgh and Lothians Viral Intervention Study (ELVIS) provide compelling support to their applicability in the current crisis. Saline water gargling and nasal irrigation represent simple, economical, practically feasible, and globally implementable strategies with therapeutic and prophylactic value. These methods, rooted in the traditional Indian healthcare system, are suitable and reliable in terms of infection control and are relevant examples of harmless interventions. We attempt to derive novel insights into their usefulness, both from theoretical and practical standpoints.