Comparative evaluation of two different dental age estimation methods using tooth pulp: A CBCT study.

AIM: To estimate the age of an individual based on 3D radiographic evaluation of pulp width of maxillary central incisor. MATERIALS AND METHODS: This study included 185 CBCT images of individuals within age range of 14-64 years. Images were evaluated for maxillary central incisors and pulp width measurements were taken from cementoenamel junction and middle third of root. Obtained data was subjected to correlation and regression analysis from which the age of an individual was predicted. Results of the present study were compared with another study by the same authors. RESULTS: A negative linear relationship was obtained between age and pulp width. The standard error of estimate (SEE) in sagittal section was 11.36 years and that in coronal section was 11.23 years. The coefficient of determination for sagittal section was 0.107 and for coronal section was 0.127. An obtained regression formula was highly significant. Division of samples into various age groups reduced SEE drastically. CONCLUSION: It can be concluded that pulp width of maxillary central incisor is a reliable indicator of age estimation.

Alpha-cyperone mitigates renal ischemic injury via modulation of HDAC-2 expression in diabetes: Insights from molecular dynamics simulations and experimental evaluation.

Chronic diabetes mellitus is reported to be associated with acute kidney injury. The enzyme histone deacetylase-2 (HDAC-2) was found to be upregulated in diabetes-related kidney damage. Alpha-cyperone (α-CYP) is one of the active ingredients of Cyperus rotundus that possesses antioxidant and anti-inflammatory effects. We evaluated the effect of α-CYP on improving oxidative stress and tissue inflammation following renal ischemia/reperfusion (I/R) injury in diabetic rats. The effect of α-CYP on HDAC-2 expression in renal homogenates and in the NRK-52 E cell line was evaluated following renal I/R injury and high glucose conditions, respectively. Molecular docking was used to investigate the binding of α-CYP with the HDAC-2 active site. Both renal function and oxidative stress were shown to be impaired in diabetic rats due to renal I/R injury. Significant improvements in kidney/body weight ratio, creatinine clearance, serum creatinine, blood urea nitrogen (BUN), and uric acid were observed in diabetic rats treated with α-CYP (50 mg/kg) two weeks prior to renal I/R injury. α-CYP treatment also improved histological alterations in renal tissue and lowered levels of malondialdehyde, myeloperoxidase, and hydroxyproline. Treatment with α-CYP suppressed the increased HDAC-2 expression in the renal tissue of diabetic rats and in the NRK-52 E cell line. The molecular docking reveals that α-CYP binds to HDAC-2 with good affinity, ascertained by molecular dynamics simulations and binding free energy analysis. Overall, our data suggest that α-CYP can effectively prevent renal injury in diabetic rats by regulating oxidative stress, tissue inflammation, fibrosis and inhibiting HDAC-2 activity.

Prevalence and factors associated with oral potentially malignant disorders and oral squamous cell carcinoma: An institutional study.

INTRODUCTION: Incidence & prevalence of OPMDs & OSCC is increasing day by day, thereby escalating the burden of oral cancer in India. Oral cancer ranks in the top three of all cancers in India and is quickly becoming a health priority. This study aims to assess prevalence and associated factors of OPMDs and OSCC in patients attending dental OPD and its association with age, gender, habit (type & duration), clinical presentation and site of involvement. MATERIAL AND METHODS: A prospectively 12 months study was conducted in the outpatient department. Patient's data whether suspected or proven cases of OPMDs & OSCC and fits in clinical criteria were reviewed and analysed for demographic data, oral adverse habit, clinical presentation and site of involvement. RESULTS: Overall 38,588 patient's data were analysed for 12 month time duration. Out of this 552 (1.43%) cases of OPMDs and 58 (0.15%) cases of OSCC were reported. Out of 552 maximum patients were reported with OSMF (34.4%), followed by other lesions and minimum with LP (7.9%). Age group most commonly affected was above 45 years (44.9%) of age. Males (81.1%) were affected more than females. OPMDs (92%) and OSCC (96.5%) were mostly associated with smokeless or smoking form of tobacco. CONCLUSION: Present study evaluated the prevalence rates and associated factors of OPMDs & OSCC, which is beneficial for general practitioner in early diagnosis, formulating better treatment plan and to educate general population about risk factors, early signs and symptoms of these lesions.

Lipoid proteinosis: Review of Indian cases.

Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the deposition of amorphous hyaline material in the dermis and submucosal connective tissue. To date <500 cases of LP have been described and oral manifestations described in a very few reports. Indian cases are much less reported and reviewed. Hence, here review of 51 Indian LP cases along with a case of histologically proven LP in 12-year-old male patient with typical skin, ocular, laryngeal, oral and radiographic features is done. Cases from 1969 to 2021 were collected using keyword LP on google and google scholar and Indian cases were analyzed afterward. Review with case presentation regarding oral manifestations will help the oral physician to diagnose LP in early stage.

Bone invasion in oral squamous cell carcinoma: Comparative analytic study in orthopantomogram and technetium 99 m bone scan.

Aims and Objective: To compare the bone invasion in orthopantomogram (OPG) and technetium 99 m bone scan in oral squamous cell carcinoma (OSCC). Materials and Methods: Clinically and histopathologically proven 30 cases of OSCC were randomly selected. OPG and Tech 99m bone scan was carried out in all selected patients. The results were analyzed according to age, sex, and site of involvement. OPG findings and bone scanning uptake were also compared according to site, grade, and difference of uptake. Results: Group of patients which showed definite bone invasion in OSCC were positive in radionuclide uptake imaging while another group of patients which showed no changes in OPG had some patients which were positive on radionuclide uptake imaging while few were negative on both OPG and bone scanning. Conclusion: Combination of OPG and Tech 99m bone scan was more accurate in detecting bone invasion in OSCC than OPG and bone scan alone.

Kimura's Disease: A Confounding Condition.

Kimura disease (KD) is a chronic inflammatory lymphoproliferative disorder of unknown etiology and unsure pathogenesis. It primarily involves the head and neck region, presenting as an asymptomatic unilateral soft-tissue mass in the head and neck, frequently involving subcutaneous tissues, major salivary gland, lymph nodes. Peripheral blood eosinophilia, elevated serum immunoglobulin E (IgE) levels, and the microscopically lymphoid proliferation with eosinophilic infiltration are the characteristic features. We report a case of KD in a 22-year-old Indian male who presented with an asymptomatic parotid gland enlargement with lymphadenopathy. The clinical presentation was suggestive of the benign lesion but histopathology, as well as microscopic findings, allowed us to make a definitive diagnosis of KD. The patient was treated with steroids and antihistamine and showed no recurrence on follow-up.

The Sclerotherapy-An Efficacious Approach in the Management of Vascular Lesions and Pyogenic Granuloma: Case Series with Literature Review.

Sclerotherapy is a targeted elimination of small vessels, varicose veins, and vascular anomalies by the injection of a sclerosant. Sclerotherapy aims to damage the vessel wall and transform it into fibrous tissue. The present study was conducted to evaluate the efficacy of a sclerosing agent 3% polidocanol in the treatment of vascular lesions and pyogenic granuloma. The solution was injected intralesionally at multiple sites and was repeated after an interval of 2 weeks. The treatment effect was determined by clinical examination. Sclerotherapy with 3% polidocanol is effective in the treatment of vascular lesions and pyogenic granuloma. This treatment modality offers an alternative to conventional methods such as surgical excision, laser therapy, cryotherapy, steroid therapy, etc., in cases where conservative treatment is preferable. The advantage is that it causes minimal discomfort, negligible blood loss, less cumbersome, and above all is economical. There is no requirement of local anesthesia or postoperative dressings or any specific care. The patient can resume his daily activities immediately.

Age estimation by assessment of dentin translucency in permanent teeth.

AIM: : To estimate the age by evaluating the length of dentin translucency in ground sections of extracted teeth using digital scanner and tools of GIMP 2.8 software for dental age estimation. MATERIALS AND METHODS: Fifty extracted single-rooted permanent teeth from 50 different individuals and their 0.25-mm thick sections were prepared. Each tooth section was scanned and the length of dentin translucency was measured in GIMP 2.8 software. RESULTS: A linear relationship was observed between dentin translucency and age in the regression analysis. Pearson's correlation analysis showed that there was positive correlation (r = 0.93, P = 0.001) between dentin translucency and age, and the difference between the chronologic age and real age is ± 4.88 years. CONCLUSION: Dentin translucency in the apical part of the tooth can be used for estimating the age of an individual. A method to digitally select and measure translucent root dentin length was used here. This software method is easy to use and less time-consuming. The measurements obtained using this method are more precise and thus help in more accurate age estimation. Considering these benefits, this study recommends the use of digital method to assess translucency for forensic purpose.

Comparison of panoramic radiograph and cone beam computed tomography findings for impacted mandibular third molar root and inferior alveolar nerve canal relation.

OBJECTIVES: This study was aimed at determining the specific signs of close relationship between impacted mandibular third molar (IMTM) root and inferior alveolar nerve (IAN) canal as visualised on digital panoramic radiograph or orthopantomograph (OPG) which should indicate as well as contraindicate the need for cone beam computed tomography (CBCT) imaging based on hierarchical model of Fryback and Thornbury. MATERIALS AND METHODS: The sample consisted of 120 individuals (200 IMTM) who had undergone OPG as well as CBCT imaging as preoperative radiographic evaluation before surgical extraction. On panoramic radiographs; Rood and Sheehab's radiographic signs of IMTM root and IAN canal, impacted third molar position based on Winter's classification and depth of impaction based on Pell and Gregory's classification were evaluated. On CBCT; presence/absence of corticalization and the status of the buccal and lingual cortices (thinning/perforation) were evaluated. These findings of OPG were compared to CBCT findings to determine the better modality based on hierarchical model of Fryback and Thornbury. RESULTS: Statistically significant association was found between radiographic signs of Rood and Sheehab such as 'no relation' and 'superimposition' on OPG and presence of corticalization between IMTM root and IAN canal on CBCT. Statistically significant association was also found between 'mesioangular' and 'vertical' positions of Winter's classification as well as 'class 1A' of Pell and Gregory's classification of IMTM on OPG and presence of corticalization on CBCT. CBCT was found to be having lesser variance and greater F value as compared to OPG for evaluation of IMTM. CONCLUSIONS: On OPG; Rood and Sheehab's radiographic signs such as 'no relation' and 'superimposition', Winter's 'mesioangular' and 'vertical' and Pell and Gregory's 'Class 1A' are not indicative for CBCT examination before surgical extraction is attempted. On OPG; Rood and Sheehab's radiographic signs such as interruption of white line, darkening of root, darkening of canal, deflection of root, narrowing of canal as well as diversion of canal are all frequently associated with absence of corticalization between IMTM root and IAN canal and hence require CBCT examination before surgical extraction is attempted so that post-operative neurological complications can be minimised. Also, Winter's horizontal, distoangular and others as well Pell and Gregory's classes 1B,1C,2A,2B,2C,3A,3B,3C are indicative for CBCT examination before surgical extraction is attempted. Fryback and Thornbury model-based comparison proves that CBCT is a better radiographic modality as compared to OPG for evaluation of IMTM relation with IAN canal.

Malignant peripheral nerve sheath tumor: A rare malignancy.

Malignant peripheral nerve sheath tumor (MPNST) is also termed as spindle cell malignancy of the peripheral nerve Schwann cell. It is a rare and highly aggressive, soft-tissue sarcoma of ectomesenchymal origin that accounts for 10% of all sarcomas and only 10%-12% of all lesions occur in the head-and-neck region, thus making it a rare entity. It arises de novo or from the preexisting benign neurofibroma. The diagnosis of MPNST is one of the most elusive among the soft-tissue tumors because of its greater variability in overall presentation both clinically and histologically. This difficulty can be overcome by the use of immunohistochemistry. This article presents a rare case of MPNST of the oral cavity in a 40-year-old female patient with a brief review of the current literature.

Age determination in children by orthopantomograph and lateral cephalogram: A comparative digital study.

BACKGROUND AND AIMS: The assessment of age is useful in forensic medicine and forensic odontology and in treatment planning in various branch of dentistry. The aim of study is comparative evaluation and assessment of applicability of Demirjian's method, Willem's method of dental age (DA) estimation, and Maria de Paula Caldas's method of skeletal age estimation for children aged 9-16 years. MATERIALS AND METHODS: A total of 140 individuals (70 females and 70 males) between the age group of 9-16 years were enrolled. These individuals were grouped by a difference of 1 year into 7 groups (each group comprising of 20 individuals: 10 males and 10 females). Dental age estimation was performed from orthopantomograph images of mandibular teeth of left quadrant by both Demirjian's and Willem's methods. Skeletal age estimation was done from Lateral Cephalogram by Caldas Digital Method. The differences between the chronological age and the estimated dental and skeletal ages were statistically tested using paired t-test. RESULTS: Demirjian's DA estimation overestimated males (0.4040 years) and females (0.1316 years). Willem's DA estimation method underestimated males (0.1386 years) and females (0.4210 years) and Caldas skeletal age estimation overestimated males (0.2982 years) and females (0.4259 years). CONCLUSION: The study concluded Willem's DA estimation method was the most accurate for male and Demirjian's method for female for Gujarati Population. Caldas's new computer-assisted method for skeletal age estimation used in the present study is easy to perform and less time-consuming and objective method and can be applied for Gujarati population.

Aggressive angiomyxoma of maxilla: A confounding clinical condition with rare occurrence!

The angiomyxomas are rarely reported in the head and neck region; this paper entails a case of aggressive angiomyxoma presenting as a growth in the maxillary anterior alveolar mucosa and lip region for 1 year, which was accurately identified and treated successfully by surgical excision. An attempt has been made to highlight the clinical and pathologic stand out features of this tumor with intricate emphasis, alongside a literary review.

Post Herpetic Frey's Syndrome.

Frey's syndrome is characterized by unilateral sweating and flushing of the skin in the area of the parotid gland, occurring during meal, or on salivary stimulation. It is a common complication following surgery/injury in the parotid gland region/temporomandibular joint surgery; however, very few cases have been reported of its occurrence following herpetic infection. It is important for the clinician to recognize its unusual symptoms as early as possible to prevent its potential negative social and psychological effect on the patient. It is diagnosed on clinical presentation and confirmed by objective testing methods. The treatment ranges from topical application of glycopyrrolate to local injections of botulinum toxin and lastly to surgical intervention. An interesting case of Frey's syndrome is presented in a young patient having the previous history of herpes zoster infection, which was diagnosed clinically and confirmed by starch-iodine test and was successfully treated with topical application of glycopyrrolate.

Gingival mass in acquired immune deficiency syndrome patient: An unusual manifestation.

Non-Hodgkin's lymphoma (NHL) is designated as an acquired immune deficiency syndrome defining condition. Although uncommon, it is essential to be wary of this neoplasm since intraoral manifestations may be the first clinical manifestation of HIV disease. The gingiva is one of the rarest intraoral sites with a prevalence of 0.6%. Careful evaluation of patients presenting with solitary atypical gingival mass can lead to early detection of HIV disease. Here, we report a case of NHL manifesting as a gingival mass in a 45-year-old HIV-positive female patient.

An ayurvedic proprietary herbal preparation, Calci-7, prevents ovariectomy-induced osteoporosis in rats.

INTRODUCTION: CALCI-7 (CA) is an ayurvedic proprietary medicine, used to treat osteoporosis in postmenopausal women. However, scientific proof for its anti-osteoporotic effect and mechanism of action remain unclear due to which present study was under taken. MATERIALS AND METHODS: Ovariectomy was performed to induce osteoporosis. Rats were given CA 100 mg/kg, p.o. and estrogen 0.0563 mg/kg, i.m. once a day from day 1 to day 42. Animals were weighed weekly for body weight variation. At the end of 42 days treatment, urine and the blood samples were collected for analysis of calcium, phosphorus and alkaline phosphatase. Immediately, after sample collection, the uterus was carefully removed and weighed. Results were analysed using ANOVA. RESULTS: CA treatment to ovariectyomized (OVX) rats showed significant improvement in body weight, increased levels of calcium and phosphorus levels in serum while levels were found to be decreased in urine as compared to OVX group. The significant increase in uterine weight and femur length were observed in treatment groups. In the histopathological examination bone structure showed a normal structure with lacuna and various lamellae without any damage or porosity in bone in the formulation and estrogen-treated group. CONCLUSION: The present findings are strongly suggestive that CA possesses comparable efficacy to estrogen and thus can be useful in the postmenopausal osteoporosis.

Anti-Viral Agents in Neurodegenerative Disorders: New Paradigm for Targeting Alzheimer's Disease.

Alzheimer's disease (AD) is a neurodegenerative disease affecting geriatric populations for which several causes have been proposed. These include a relationship with known pathogens although the exact nature of such a relationship remains uncertain. Herpes simplex virus-1 has been proposed as potential cause of AD because of its ability to form ß amyloid(Aß) and neurofibrillary tangles due to tau hyperphosphorylation and action of beta & gamma secretase on amyloid precursor protein(APP) together with genetic association with apolipoprotein-E4(ApoE-Ɛ4), which points out to latent Herpes Simplex virus-1 as an agent causing AD. There are numerous studies that linked HSV-1 with AD like anti-HSV-1 IgM antibodies, nectin-2, heme oxygenase-1, phosphorylated eukaryotic initiation factor-2A, caspase-8 and nucleus-specific alteration of raphe neurons. Various possible mechanisms by which HSV-1 might lead to development of AD such as ApoE, ß-amyloid, tau phosphorylation, inflammation and oxidative stress are also discussed. Thus, this review discusses patent information and a strong relationship between latent HSV-1 and AD and also proposes antiviral therapy for AD.

Sweet's syndrome.

Acute febrile neutrophilic dermatosis or Sweet's syndrome (SS) is characterized by painful, erythematous plaques of rapid onset accompanied by fever. The etiology of SS is unknown and it may be associated with antecedent infections, malignancies, autoimmune diseases, drugs and vaccines, upper respiratory or gastrointestinal infection, pregnancy, inflammatory bowel disease as well as chemotherapy or idiopathic. The standard therapy for SS is systemic corticosteroids. We report a rare case of 19-year-old young male patient with complaint of severe ill-defined type of pain in both jaws associated with plaques and papules on extensor surfaces of upper and lower extremities with bodyache and myalgia. Histopathological examination suggested perivascular neutrophilic infiltration with scattered eosinophils. Sweet syndrome has rare oral manifestations secondary to hematological changes. It can also present as a paraneoplastic syndrome (malignancy-associated form of condition, which is most commonly related to acute myelogenous leukemia), which leads to poor prognosis and thus it requires careful examination, early diagnosis and long-term follow-up.

Clinical correlative study on early detection of oral cancer and precancerous lesions by modified oral brush biopsy and cytology followed by histopathology.

BACKGROUND: Oral cancer accounts for 5% of all malignant tumors and 60% of these lesions are well advanced at the time of diagnosis. The early diagnosis could prevent a large number of deaths due to this disease. AIMS: This study aims to evaluate and compare the clinical usefulness of exfoliative cytology, modified brush biopsy (without computer assisted analysis), and biopsy in early detection of oral premalignant and malignant lesions. MATERIALS AND METHODS: Modified oral brush biopsy (using baby toothbrush) and exfoliative cytology was performed on 225 clinically diagnosed oral precancerous lesions (suspected) selected from among 1099 lesions in 877 patients. Scalpel or punch biopsy was performed based on clinic-cytological evidence (test result and/or clinical judgment) on only 117 lesions. All the specimens were analyzed manually in a double-blinded fashion. STATISTICAL ANALYSIS USED: RESULTS were analyzed using Statistical package for Social Sciences version 12 (SPSS Inc., Chicago, IL, USA) and subjected to Fischer exact test. RESULTS: Of 117 lesions that underwent all the three tests, modified oral brush biopsy showed a reasonably higher specificity (68.42%) and sensitivity (81.69%) when compared with specificity (86.48%) and sensitivity (48.57%) of cytology. CONCLUSION: The results demonstrate that modified oral brush biopsy has higher efficacy than routine cytology and can be used as a potentially practical oral cancer screening tool in resource challenged settings. However, clinical judgment is of prime importance. Immediate biopsy is mandatory in highly suspicious lesions proposed under the diagnostic criteria of "clinically diagnosed carcinoma in situ".

Necrotizing enterocolitis in very low birth weight infants: a systemic review.

Necrotizing enterocolitis (NEC) is the most common serious gastrointestinal disorder affecting very preterm or very low birth weight infants. The risk is inversely proportional to gestational age and weight at birth. Fetal growth restriction and compromise may be additional specific risk factors. Despite extensive research and animal studies etiopathogenesis, preventive strategies and management options remain controversial. The present paper reviews the literature for recent advances and newer insights for changing epidemiological trends, pathogenesis, role of inflammatory cytokines, and various preventive and management strategies.

Association between altered thyroid state and insulin resistance.

OBJECTIVE: To determine the association between altered thyroid hormones and insulin resistance (IR). MATERIALS AND METHODS: Eight euthyroid (EU), eight hypothyroid (HO), and eight hyperthyroid (HR) patients with no past medical history were studied in this cross-sectional study at the Care Institute of Medical Sciences, Ahmedabad, India, The fasting blood sample were analyzed for thyroid stimulating hormone (TSH), lipid profile, insulin, and glucose. Homeostatic model assessment (HOMA) was calculated for assessing IR. RESULTS: HOMA values were significantly higher in HR and HO groups as compared to the EU group (P < 0.05). Insulin levels were also found to be significantly increased in HR and HO groups as compared to the EU group (P < 0.05). Cholesterol, triglycerides (TG), and low density lipoprotein (LDL) were significantly raised in HO as compared to EU and HR groups (P < 0.05) whereas high density lipoprotein levels (HDL) were lower. HOMA and insulin were found to be positively correlated with TSH in HO and negatively in HR. CONCLUSION: Thyroid disorder, including both hypo- and hyper have been associated with IR due to various mechanisms such as altered insulin secretion and lipid levels. IR was comparable in patients with both HO and HR. Although HO and HR constitute an IR state, more studies need to be done in order to clarify the underlying pathogenic mechanism. Thus, an altered thyroid state can lead to IR leading to glucose-related disorder such as diabetes dyslipidemia.