Evaluation of Serum and Salivary Lactate Dehydrogenase Levels in Patients with Oral Potentially Malignant Conditions/Lesions: A Clinical and Biochemical Study.

Background: Oral cancer encompasses all malignancies that originate in the oral tissues and remains a major public health problem throughout the world as an important case of poor health and illness. Head and neck cancer accounts for 9.8% of the estimated 6,44,600 incidental cancer cases in India. Oral Squamous Cell Carcinoma (SCC) is a serious and developing concern globally, accounting for more than 90% of malignant cancers of the oral cavity. Salivary diagnostics have been demonstrated to have potential in the detection and screening of oral pre-cancer and cancer in a variety of research settings. The continual and close contact between saliva and the mucosa, where cancer develops, is the foundation of this diagnostic capability. Materials and Methods: This research utilized spectrophotometry to quantify Lactate Dehydrogenase levels in serum and saliva of 30 healthy people which consisted the control group and 31 Oral Potentially Malignant people which constituted the study group. Results: On estimation and comparison, the mean Lactate Dehydrogenase levels in serum (397.4968+71.6392 IU/L) and saliva (675.4935+139.3352 IU/L) among patients with Oral Potentially malignant lesions/conditions were higher than the mean Lactate Dehydrogenase levels in serum (390.8667+71.0953 IU/L) and saliva (201.3700+89.1439 IU/L) among controls. Conclusion: Higher serum and salivary LDH levels in Oral Potentially malignant lesions/conditions than in control groups signifies the importance of assessing salivary LDH levels, in the prognosis of the same. Further prospective longitudinal studies are required to assess the salivary LDH levels among the patients with malignant transformation of Oral Potentially malignant lesions/conditions to oral cancers.

Efficacy of Aloe Vera, Amlexanox (5%), and Triamcinolone Acetonide (0.1%) in the Management of Oral Lichen Planus.

Objective: This research assessed the efficiencies of aloe vera, 0.1% triamcinolone acetonide, and 5% amlexanox in the management of OLP. Materials and Methods: A total of 120 participants diagnosed with oral lichen planus (OLP) were equally divided into three groups and treated with: aloe vera, (Group A), 0.1% triamcinolone acetonide (Group B), and 5% amlexanox (Group C) topical medicaments. The patients were evaluated for pain, using the visual analogue scale (VAS). They were also evaluated for ulcerative lesion type and erosive area on days 1, 7, and 15 of the study. Results: There was a statistically considerable decrease in the VAS pain scale score, reduction in the erosive area on buccal mucosa, and healing of ulcer from day 1st to 15th day with all three tested drugs. Conclusion: All drugs used in this study; aloe vera, triamcinolone acetonide, and amlexanox were effective in treating OLP patients.

Assessment of Stress Distribution Around Dental Implants Based on the All-on-Four Treatment Concept using Finite Element Analysis.

The present study was conducted to assess stress distribution around dental implants based on the all-on-four treatment concept. The finite element analysis (FEA) models comprised cancellous bone covered with cortical bone. Four dental implants were placed in two different designs. In model 1, the four implants were placed parallel to each other, whereas, in model 2, the all-on-four concept was followed. The vertical and lateral loads of various values were applied, and stress was evaluated. In model 2, the least stress was observed in both lateral and vertical loading in the peri-implant region. The all-on-four concept proved to be beneficial in reducing the stress around dental implants, thereby reducing the treatment cost.

An Evaluation of the Effectiveness of Various Luting Cements on the Retention of Implant-Supported Metal Crowns.

Background and objective Cement-retained prostheses have replaced screw-retained prostheses as the preferred restoration in recent years in order to overcome the latter's limitations. In this study, four different luting cements were compared to evaluate their efficacy on the retention of cement-based metal crowns to implant abutments. Materials and methods In the right and left first molar regions, four implant analogs (Internal Hex, Adin Dental Implant Systems Ltd., Tel-Aviv, Israel) were screwed into epoxy resin casts (Araldite CY 230-1 IN, India) that were positioned perpendicular to the cast's plane. Four metal copings were created and cemented. Group A: polycarboxylate cement (DUR) (DurelonTM, 3M Espe, St. Paul, MN); Group B: PANAVIA™ F 2.0 dual-cure resin cement (Kuraray America, Inc., New York, NY); Group C: resin-modified glass ionomer (3M™ RelyX™ Luting, 3M Espe); and Group D: non-eugenol temporary resin cement (Kerr-Temp, KaVo Kerr, Brea, CA) were used to cement crowns. To check the retention capacity, samples were put through a pull-out test on an Instron universal testing machine (TSI­Tecsol, Bengaluru, India) with a crosshead speed of 0.5 mm/min. Each coping's de-cementing load was noted, and average values for every sample were computed and statistically analyzed. Results The findings demonstrated that non-eugenol temporary resin implant cement has the lowest retention value at 138.256 N, followed by resin-modified glass ionomer cement at 342.063 N, polycarboxylate luting cement at 531.362 N, and resin cement at 674.065 N. The average difference in retentive strength across all four groups was statistically very significant (p=0.001). Conclusion Based on our findings, non-eugenol temporary resin implant cement enables simple retrievability of the prosthesis in the event of a future failure and is appropriate for implant restorations with cement retention. Also, cements made of polycarboxylate and resin have the highest retention values.

Knowledge, Opinion, and Practices Towards Screening of Oral Cancer Among Homeopathy and Ayurveda Students in Indore, Madhya Pradesh, India.

INTRODUCTION: Oral cancer is one of the most common cancers in the world. Early recognition leads to higher cure rates and better quality of life. Homeopathy and Ayurveda can help improve the general well-being and vitality of patients without inducing any side effects. AIM: To assess knowledge, opinion, and practices towards oral cancer among homeopathy and ayurvedic students. OBJECTIVES: To find the correlation between knowledge and practices followed by homeopathy and ayurvedic students. METHOD: A descriptive cross-sectional study was conducted among 157 homeopathy and 153 ayurvedic students in Indore city, Central India. The subjects were selected using a convenient sampling technique, and the data was collected using a pre-tested close-ended self-administered questionnaire with 24 questions. The data were analyzed by IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. using descriptive and analytical (Chi-square and independent sample t-tests) statistics. Correlation analysis was performed to assess the relation between knowledge and preventive practices score. RESULTS: Homeopathy students showed a significantly higher mean knowledge (4.74+0.96) and practice score (4.82+1.54) as compared to ayurvedic students (knowledge score 4.49+1.11) (practice score 4.09+1.98). No significant differences were observed in the mean knowledge and practice scores of the homeopathy students. There was a statistically significant difference between the mean knowledge score and practice score of third-, fourth-, and fifth-year ayurvedic students at p-value <0.05. A positive (p-value <0.0001) correlation was observed between the knowledge and practice scores for ayurvedic students. As the year of professional studies increased, the overall practice of the students regarding oral cancer also increased, with fifth-year students showing significantly better practice (OR- 1, p-value = <0.05) than the other year students.  Conclusion: Homeopathy students showed better knowledge, whereas ayurvedic students showed better opinions and practices towards oral cancer.

Analysis of inferior nasal turbinate volume in subjects with nasal septum deviation: a retrospective cone beam tomography study.

Background: The association of the linear dimensions of the inferior turbinate hypertrophy with nasal septal deviation has been studied recently. However, the volumetric dimensions provide a more accurate status of the turbinate hypertrophy compared to linear measurements. The aim of this study was to analyze the association of inferior nasal turbinate volume with the degree of nasal septal deviation (NSD). Methods: A retrospective evaluation of the cone beam computed tomography (CBCT) scans of 412 patients was carried out to obtain 150 scans which were included in the study. The scans were categorized into three groups. Group 1 comprised of 50 scans of patients with no inferior turbinate hypertrophy (ITH) and no nasal septal deviation. Group 2 comprised of 50 scans of patients with ITH and no NSD; whereas Group 3 included 50 scans of patients with ITH and NSD. The total turbinate volume of inferior turbinates (bilateral) were determined by using Vesalius 3D software (PS-Medtech, Amsterdam, Netherlands). Results: The intraclass correlation coefficient (ICC) between the volumetric estimations performed by the two radiologists was 0.82. There were no significant age and gender related changes in the total turbinate volume. Patients in Group 3 had significantly higher (p = 0.001) total turbinate volume compared to Group 2 and Group 1. There was a positive and significant correlation (r = 0.52, p = 0.002) between the degree of septal deviation and total turbinate volume. When the total turbinate volume of the patients with different types of septal deviation was compared in Group 3, a statistically significant difference (p = 0.001) was observed. Regression analysis revealed that the septal deviation angle (SDA) (p = 0.001) had a relationship with total turbinate volume. From the results of the study we can conclude that the total turbinate volume is higher in patients with nasal septal deviation. It can also be concluded that the septal deviation angle has a positive correlation with total turbinate volume. The data obtained from the study can be useful in post-surgical follow up and evaluation of patients with nasal septal deviation and hypertrophied inferior nasal turbinate.

Oral Immune-Related Adverse Events - Current Concepts and their Management.

Recent advent of immune checkpoint inhibitors (ICIs) have made significant improvement in the treatment outcome of cancer patients. They are also known to increase the overall survival in many malignancies. They target key immune checkpoints, acting on the cytotoxic T-lymphocyte antigen-4, programmed death-1 (PD-1), and PD-1 ligand 1 pathways. ICIs are effective in cancer therapy, but also possess various adverse effects that are termed together as immune-related adverse events (irAEs). Information focusing only on the oral reactions of irAEs is scanty in the literature. Therefore, we performed a computerized database search in PubMed and Google Scholar to identify and collect data regarding the oral adverse effects of ICIs. The early recognition of oral irAEs and appropriative intervention may help in improving the quality of life in patients. This paper presents a brief review of oral irAEs and their management.

A rare case of long-standing mucoepidermoid carcinoma of minor salivary glands of the palate.

Salivary gland carcinomas are the uncommon and clinically diverse group of neoplasms with mucoepidermoid carcinoma (MEC) being the most common among them. MEC accounts for 5% of all salivary gland tumors. As the name implies, the tumor is composed of both mucus secreting cells and epidermoid type cells in varying proportions. Most patients are aware of the lesion for 1 year or less. We report clinical, radiographic and histological features of a long-standing case of mucoepidermoid carcinoma of minor salivary glands of the palate in a 35-year-old male patient. The patient reported with a slow growing swelling on the palate which began 15 years ago. The patient was treated with hemi-maxillectomy and is currently under follow up.

A Rare Clinical Presentation of an Osteochondroma of Coronoid Process of Mandible.

Osteochondroma (osteocartilaginous exostosis) is one of the most common benign tumors of bone but is rare in the craniofacial region. Only a few cases of osteochondroma of the coronoid process have been reported in the literature, since the time of its discovery (osteochondroma of a coronoid process) by Jacob in 1899. We present a case of osteochondroma of the left coronoid process in a 16-year-old female patient. Contrary to the literature, our patient had no limited mouth opening despite a close approximation of left hyperplastic coronoid process with zygomatic arch, making it a unique case among similar cases. Plain radiography can be used for this hyperplastic condition but due to its inherent distortion and being only two-dimensional (2D) it has a limited diagnostic advantage. Cone beam computed tomography (CBCT) was employed for necessary diagnostic information. We managed our patient with an intraoral coronoidectomy.

Status of Serum and Salivary Ascorbic Acid in Oral Potentially Malignant Disorders and Oral Cancer.

BACKGROUND AND AIMS: The aim of this study was to estimate the detoxification status of serum and saliva by assessing the serum and salivary Vitamin C in oral potentially malignant disorders and oral cancer. SUBJECTS AND METHODS: A total of 90 subjects, 30 subjects with oral potentially malignant disorders, 30 subjects with oral cancer, and 30 healthy subjects (controls) were included in the study. Serum and saliva were collected and levels of Vitamin C were assessed. Data obtained was analyzed using ANOVA test for the comparison between the groups. Post hoc Tukey's analysis was used for the comparison of the two study groups to the control group. Correlation between the groups was done using Pearson's correlation coefficient test. RESULTS: The mean serum and salivary Vitamin C levels were decreased significantly in potentially malignant disorders and oral cancer when compared to healthy subjects. CONCLUSIONS: As significant reduction of Vitamin C is seen in saliva, it can be stated that saliva can be used as a reliable, noninvasive biomarker in diagnosis and management of potentially malignant disorders and oral cancer.

Serum and salivary lactate dehydrogenase levels as biomarkers of tissue damage among cigarette smokers. A biochemical study.

OBJECTIVE: To estimate the serum and salivary lactate dehydrogenase levels in cigarette smokers and non-smokers. MATERIALS AND METHODS: In this study lactate dehydrogenase levels were estimated in 30 healthy individuals with no tobacco related habits and in 30 patients with history of smoking cigarettes for a minimum of 2 years using Spectrophotometry. RESULTS: The mean values for serum and salivary lactate dehydrogenase levels were higher in cigarette smokers when compared to non-smokers. Serum lactate dehydrogenase levels on comparison between the groups was statistically significant (p=0.04). The values of salivary lactate dehydrogenase levels between the groups was highly significant (p<0.001). CONCLUSION: Cigarette smoking leads to an increase in serum as well as salivary Lactate dehydrogenase levels as indicator of tissue damage in the oral cavity. The present study indicates saliva as a better test medium than serum in determination of lactate dehydrogenase levels.

Interdependence of antioxidants and micronutrients in oral cancer and potentially malignant oral disorders: a serum and saliva study.

OBJECTIVE: In our previous studies we have evaluated the role of antioxidants and trace elements in potentially malignant disorders and cancers of the oral cavity, taking into consideration the importance of antioxidants as biomarkers in cancer detection. We felt that other than evaluation, the correlation and interdependence that existed among antioxidants and trace elements require further evaluation in order to develop a better understanding. MATERIALS AND METHODS: Serum and salivary zinc, glutathione, and superoxide dismutase levels were evaluated in 65 healthy controls, 115 subjects with potentially malignant oral disorders, and 50 subjects with oral squamous cell carcinoma, using the atom absorption photometry, [5, 5-Dithiobis (2 nitrobenzoic acid)], and nitroblue tetrazolium methods, respectively. RESULTS: Serum zinc and serum glutathione showed significant positive correlation (r=0.76, P=0.01). Similarly, salivary glutathione and salivary zinc levels had a positive correlation (r=0.68, P=0.01). Serum superoxide dismutase showed a strong positive correlation with serum zinc (r=0.64, P=0.01). Similarly, there was a moderate positive correlation between salivary superoxide dismutase and salivary zinc (r=0.67, P=0.01). CONCLUSION: Our findings showed that trace elements and antioxidants exhibited interdependence in serum, as well as in saliva, in both physiologic and pathologic states such as oral cancer.

Osteoradionecrosis of the mandible and mastoiditis after radiotherapy for parotid mucoepidermoid carcinoma.

Osteoradionecrosis of the mandible in conjunction with mastoiditis is an extremely rare occurrence following irradiation of salivary gland malignancy in the orofacial region. We report one such case of a patient who presented to us with trismus, jaw pain, and ear discharge. Imaging of the jaws revealed classical features of osteoradionecrosis and mastoiditis. This case is important because presenting features like trismus and dental infection led us to investigative procedures that revealed extensive bone involvement including mastoiditis. Trismus progressively increased over a period of 8 years. In this case, we would like to emphasize the importance of good oral hygiene in the postradiotherapy stage for head and neck cancer.

Nevus of ota with buccal mucosal pigmentation: a rare case.

Nevus of Ota is a condition wherein the typical pattern of the bluish black pigmentation is noticed along with the cutaneous distribution of the trigeminal nerve. This condition is most prevalent in Japanese population but comparatively rare among Indians. We report a case of 23-year-old female presented with unilateral pigmented areas over the skin of forehead, malar area, ear and periorbital area. Blackish-blue pigmented areas were also noticed on the sclera. Brownish-black diffuse pigmented areas were also noticed on the buccal mucosa of the same side. The presence of pigmentation on the skin over pinna and oral pigmentation made our case a rare incidence. Oral pigmentations associated with nevus of Ota especially on the buccal mucosa have rarely been reported in the past.

Co-occurence of florid cemento-osseous dysplasia and simple bone cyst: a case report.

BACKGROUND: The purpose of this report is to present a rare case of co-occurrence of florid cemento-osseous dysplasia with simple bone cyst in a middle aged Asian woman. Most of the reported cases are isolated cases of simple bone cyst or florid cemento-osseous dysplasia, but co-occurrence of these two entities is extremely rare. METHODS: The authors report a 41 year old female patient with co-occurrence of mandibular florid cemento-osseous dysplasia with simple bone cyst. A thorough clinical and radiological examination was carried out. RESULTS: It was diagnosed mandibular cyst with possible co-occurrence of florid cemento-osseous dysplasia. Surgical exploration of the multilocular lesion was applied. Since, the patient was symptomatic at the time of presentation utmost caution was taken during the surgical procedure as florid cemento-osseous dysplasia is associated with hypo-vascularity of the affected bone. Based on histopathological, as well as supporting clinico-radiological findings a confirmative diagnosis of florid cemento-osseous dysplasia co-occurring with simple bone cyst was made. Patient was followed-up for a period of six months and was reported to be asymptomatic. CONCLUSIONS: Timely diagnosis and well planned treatment is important to obtain a good prognosis when a rare co-occurrence of two or more bone lesions affects the jaws.