Solitary Large Intraoral Neurilemmoma of the Maxillary Vestibule: A Rare Case with Brief Literature Review.

AIM: This current report aimed at presenting a rare case of a large solitary intraoral neurilemmoma of the buccal vestibule followed by a brief review of literature of neurilemmoma published between 1997 and 2017. BACKGROUND: The diagnosis of slow-growing intraoral lesions requires a thorough patient history and clinical examination. Despite the best efforts of even the most experienced oral medicine expert, a definitive diagnosis may sometimes only be reached through excisional biopsy and histopathological evaluation. CASE DESCRIPTION: To the best of our knowledge, there have been only two cases of neurilemmoma of the buccal vestibule reported in the literature till date and, looking at the size of the lesion, our case is the largest among the ones reported. CONCLUSION: In the present case, a rare presentation of solitary buccal vestibular neurilemmoma establishes the need for the consideration of a wide range of pathologies in the differential diagnosis. CLINICAL SIGNIFICANCE: Clinicians should include neurilemmoma in their differential diagnosis for asymptomatic, slow-growing intraoral growths and ensure complete excision to prevent tumor recurrence. The reader should be able to recognize the clinical features of neurilemmoma and describe the histopathological features and management of the condition.

Protein profile pattern analysis: A multifarious, in vitro diagnosis technique for universal screening.

Universal health care is attracting increased attention nowadays, because of the large increase in population all over the world, and a similar increase in life expectancy, leading to an increase in the incidence of non-communicable (various cancers, coronary diseases, neurological and old-age-related diseases) and communicable diseases/pandemics like SARS-COVID 19. This has led to an immediate need for a healthcare technology that should be cost-effective and accessible to all. A technology being considered as a possible one at present is liquid biopsy, which looks for markers in readily available samples like body fluids which can be accessed non- or minimally- invasive manner. Two approaches are being tried now towards this objective. The first involves the identification of suitable, specific markers for each condition, using established methods like various Mass Spectroscopy techniques (Surface-Enhanced Laser Desorption/Ionization Mass Spectroscopy (SELDI-MS), Matrix-Assisted Laser Desorption/Ionization (MALDI-MS), etc., immunoassays (Enzyme-Linked Immunoassay (ELISA), Proximity Extension Assays, etc.) and separation methods like 2-Dimensional Polyacrylamide Gel Electrophoresis (2-D PAGE), Sodium Dodecyl-Sulfate Polyacrylamide Gel Electrophoresis (SDS-PAGE), Capillary Electrophoresis (CE), etc. In the second approach, no attempt is made the identification of specific markers; rather an efficient separation method like High-Performance Liquid Chromatography/ Ultra-High-Performance Liquid Chromatography (HPLC/UPLC) is used to separate the protein markers, and a profile of the protein pattern is recorded, which is analysed by Artificial Intelligence (AI)/Machine Learning (MI) methods to derive characteristic patterns and use them for identifying the disease condition. The present report gives a summary of the current status of these two approaches and compares the two in the use of their suitability for universal healthcare.

Calcifying odontogenic cyst: a rare report of a nonneoplastic variant associated with cholesterol granuloma.

AIM: To report a case of a non-neoplastic variant of calcifying odontogenic cyst (COC) with the lining epithelium showing ameloblastomatous proliferation and capsule exhibiting features of a cholesterol granuloma. The importance of delineating this histologic variant from unicystic ameloblastoma and the formation of cholesterol granuloma in this variant is discussed. BACKGROUND: Calcifying odontogenic cyst is a developmental jaw cyst, which presents itself as both the neoplastic and the non-neoplastic forms. The ameloblastomatous variant of COC is often mistaken for unicystic ameloblastoma and treated aggressively. CASE REPORT: A 68-year-old female who presented with a cystic enlargement of the posterior mandible on the right side was suggestive of unicystic ameloblastoma based on radiography and initial biopsy report. Microscopic examination of the excision specimen, however, was fitting in favor of calcifying odontogenic cyst with ameloblastomatous proliferation. CONCLUSION: Identifying the non-neoplastic ameloblastomatous variant of COC from a cystic ameloblastoma is crucial as the treatment of the two lesions vary considerably. CLINICAL SIGNIFICANCE: This case emphasizes the need for thorough examination of the entire surgical specimen before arriving at an appropriate diagnosis.

Recurrent exophytic growth on maxillary posterior edentulous alveolar ridge--a diagnostic challenge.

Accurate diagnosis of recurrent intra-oral exophytic lesions require a thorough history, meticulous clinical examination and the experience of assessing these lesions, because they are not commonplace. Despite this, instituting the correct diagnosis tests the skills of an oral medicine expert. Therefore, the same is all the more challenging for a general practitioner who may encounter these lesions without any significant experience. The importance of diagnosing such lesions cannot be understated, as they may represent a myriad of conditions ranging from seemingly innocuous benign pathologic processes to much more sinister ones, like oral malignancy; occasionally some of these lesions may manifest atypically. Such atypical presentations may cloud the diagnostic process. Here a case uncharacteristic of the condition it represented is reported with the aim of increasing awareness of the diagnosis of such lesions.

Effect of Duration of Mobile Phone Use on the Salivary Flow and Total Antioxidant Capacity of Saliva and Salivary Immunoglobulin A Level: A Cross-sectional Study.

Introduction: The objective of this study was to observe the effects of the duration of handheld mobile phone usage on the salivary flow, salivary immunoglobulin A (IgA) level, and salivary markers for oxidative stress. Materials and Methods: Eighty-one students were categorized into three groups based on their duration of mobile phone usage after age- and gender-matching. Students were grouped as: mobile phone usage <20 min/day (Group A), mobile phone usage 20-60 min/day (Group B), and mobile phone usage >60 min/day (Group C). Saliva was collected to evaluate salivary flow rate, salivary IgA level, and salivary markers for oxidative stress. Results: The salivary flow rate showed no statistically significant difference between the three groups (P = 0.180). There was no statistically significant difference in the salivary IgA between the three groups (P = 0.237). There was a statistically significant difference in the malondialdehyde (MDA) level between the three groups (P = 0.042). On pair comparison between the groups, group B and group C had a statistically significant difference (P = 0.019) in the MDA level. There was no statistically significant difference in the salivary thiol level between the three groups (P = 0.237). Conclusion: The duration of handheld mobile phone usage did not show any significant effects on the salivary flow rate, salivary IgA, and thiol levels. There was an increase in the salivary MDA concentration in subjects using handheld mobile phones for a longer duration, indicating higher oxidative stress in salivary glands exposed to mobile phone radiofrequency electromagnetic waves for a longer duration.

Salivary IL-6 levels in oral leukoplakia with dysplasia and its clinical relevance to tobacco habits and periodontitis.

The development of oral cancer proceeds through discrete molecular changes that are acquired from loss of genomic integrity after continued exposure to environmental risk factors. It is preceded in the majority of cases by clinically evident oral potentially malignant disorders, the most common of which is leukoplakia. Early detection of these oral lesions by screening methods using suitable markers is critical as it mirrors molecular alterations, long before cancer phenotypes are manifested. Assessment of salivary interleukin-6 (IL-6) as a marker of malignant progression was undertaken in patients with leukoplakia having coexisting periodontitis (n = 20), periodontitis patients without leukoplakia (n = 20), and healthy controls (n = 20) by competitive enzyme-linked immunosorbent assay. Results showed elevation of IL-6 levels in leukoplakia with coexisting periodontitis and in periodontitis patients when compared to healthy control (P < 0.001). Within the leukoplakia group, IL-6 level was found to be increased with increase in the severity of dysplasia. The use of tobacco was seen to play a significant role in the elevation of salivary IL-6.The importance of IL-6 as a specific marker for leukoplakia with dysplasia and the role of tobacco as an independent risk factor has been highlighted.

Total anodontia in patient with hypohidrotic ectodermal dysplasia. Report of rare case of Christ-Siemens Touraine syndrome.

Ectodermal dysplasias are a complex group of genetically determined disorders clinically characterized by congenital alterations of the structures derived from the ectoderm. Even though ectodermal dysplasia with partial anodontia is common, this condition with total anodontia is not. We describe features of hypohidrotic ectodermal dysplasia with complete anodontia in a 6-year-old boy. In order to improve esthetics, speech and mastication, the child was provided with upper and lower complete dentures.

Comparison of efficacy of sodium hypochlorite with sodium perborate in removal of stains from heat-cured clear acrylic resin.

Acrylic resin bases of removable dentures attract stains and odor-producing organic and inorganic deposits. The use of chemical denture cleanser soaks is the most popular method of denture cleansing. This study was undertaken to compare the efficacy of two different denture cleansers--sodium perborate (Clinsodent) and sodium hypochlorite (VI-Clean)--in removing tea, coffee, turmeric and tobacco (paan) stains from heat-cured clear acrylic resins. Distilled water was used as a control. Both Clinsodent and VI-Clean were found to be the least effective in removing coffee stains and best for removing turmeric stain. It is necessary that the dental professional be aware of these results to ensure that denture wearers know how to select the appropriate denture cleanser.

Bilateral Bell's palsy in a young female: a rare case report.

Bell's palsy is described as a type of facial paralysis, which is unilateral in 70% of the cases. Bell's palsy accounts for about 23% of bilateral facial paralysis. Here, we present a rare case of bilateral Bell's palsy in a 15-year-old female who developed sudden facial weakness with no associated symptoms. The patient was subjected to thorough clinical, laboratory, and necessary radiological investigations. As there was no conclusive evidence from any of the investigations, this could be a case of idiopathic bilateral Bell's palsy. This is the first ever case of bilateral Bell's palsy in a young female which has been reported in the Indian population.

A review on human body fluids for the diagnosis of viral infections: scope for rapid detection of COVID-19.

Introduction: The unprecedented outbreaks of corona virus disease of 2019 (COVID-19) have highlighted the necessity of readily available, reliable, precise, and faster techniques for its detection. Nasopharyngeal swab has been the gold standard for the diagnosis of COVID-19. However, it is not an ideal screening procedure for massive screening as it implicates the patient's stay in the hospital or at home until diagnosis, thus causing crowding of the specimen at the diagnostic centers. Present study deal with the exploration of potential application of different body fluids using certain highly objective techniques (Optical and e-Nose) for faster detection of molecular markers thereby diagnosing viral infections.Areas covered: This report presents an evaluation of different body fluids, and their advantages for the rapid detection of COVID-19, coupled with highly sensitive optical techniques for the detection of molecular biomarkers.Expert opinion: Tears, saliva, and breath samples can provide valuable information about viral infections. Our brief review strongly recommends the application of saliva/tears and exhaled breath as clinical samples using technics such as high-performance liquid chromatography-laser-induced fluorescence, photoacoustic spectroscopy, and e-Nose, respectively, for the fast diagnosis of viral infections.

Photonics of human saliva: potential optical methods for the screening of abnormal health conditions and infections.

Human saliva can be treated as a pool of biological markers able to reflect on the state of personal health. Recent years have witnessed an increase in the use of optical devices for the analysis of body fluids. Several groups have carried out studies investigating the potential of saliva as a non-invasive and reliable clinical specimen for use in medical diagnostics. This brief review aims to highlight the optical technologies, mainly surface plasmon resonance (SPR), Raman, and Fourier transform infrared (FTIR) spectroscopy, which are being used for the probing of saliva for diverse biomedical applications. Advances in bio photonics offer the promise of unambiguous, objective and fast detection of abnormal health conditions and viral infections (such as COVID-19) from the analysis of saliva.

Remodeling of the antegonial angle region in the human mandible: a panoramic radiographic cross-sectional study.

OBJECTIVES: This study analyzed changes in the antegonial region in relation to age, gender, and dental status. STUDY DESIGN: A total of one thousand patients (five hundred males and five hundred females), who were prescribed panoramic radiograph for various purposes were included in the study. The patients were categorized according to age, gender and dentition status. Panoramic radiographs were traced and antegonial angles and depths were measured. RESULTS: A trend of decrease in the antegonial angle and increase in antegonial depth with age was observed in both males and females. Furthermore there were differences between right and left side antegonial angle and depth, with left side angle more than right and right side depth more than left. There was a significant decrease in the values of antegonial angle and significant increase in the values of antegonial depth as the dentition status changed from completely dentulous to partially dentulous and from partially dentulous to completely edentulous state. CONCLUSIONS: The antegonial angle decreases with the advancing age and thereby increases the antegonial depth. Similar trends are seen when teeth are lost. Furthermore there is an inherent asymmetry in the antegonial region in right and left side.

Oro-facial aspects of leprosy: report of two cases with literature review.

Leprosy is a chronic infectious disease affecting primarily the skin, peripheral nerves, respiratory system and the eyes. Leprosy induces various types of clinical presentation affecting the patient's immune response. Cell-mediated immunity is considered to be the crucial defence against the disease and the magnitude of this immunity defines the extent of the disease. The article presents two case reports of manifestations of leprosy in the oro-facial region, with a brief review of various other important oro-facial manifestations of leprosy. The first report deals with granulomatous nodules in the palate while the second report presents bilateral facial palsy in leprosy patients. Both the reports gain importance due to rare oral manifestation in a borderline leprosy patient in the first case, while the second case presents a rare bilateral Bell's sign. The role of the dental profession and especially the Oral Medicine specialist is of great importance in early diagnosis of oral lesions.

Non-syndromic oligodontia in permanent dentition of monozygotic twins: report of a rare case.

AIM: To report a case of non-syndromic oligodontia involving 26 permanent teeth in monozygotic twin sisters and to discuss the possible genetic etiology, inheritance pattern and associated dental anomalies of this condition. BACKGROUND: Hypodontia constitutes one of the most common developmental anomalies in humans and is defined as developmental absence of one or more teeth with reported prevalence of 1.6 to 9.6% in the permanent dentition. Oligodontia is defined as agenesis of six or more teeth excluding third molars. CASE REPORT: This article describes a case of non-syndromic oligodontia involving 26 permanent teeth in monozygotic twin sisters. The twins had positive family history of hypodontia in their paternal grandmother, parental consanguinity (first cousin) and similarity in pattern of oligodontia. Root formation of permanent maxillary first molars and central incisors was delayed in both the twins. SUMMARY: This article reports a case of non-syndromic oligodontia in permanent dentition of monozygotic twins. Possible genetic etiology, inheritance pattern and associated dental anomalies are discussed. CLINICAL SIGNIFICANCE: Strong genetic link associated with oligodontia help the dentist to know the possibility of its occurrence in other family members and in future generations.

Occupation-related musculoskeletal disorders among dental professionals.

BACKGROUND AND AIM: Dentists are exposed to a wide range of work-related factors that may result in various occupational diseases of which musculoskeletal disorders (MSDs) are common. The purpose of this study was to determine the prevalence and distribution of MSDs among dental professionals of our institution and to compare the prevalence of MSDs among the various dental specialists. METHODS: A self-administered questionnaire, which included basic demographic details, work experience in dentistry, and work profile related questions along with the Standard Nordic Questionnaire, was administered to the study participants. Statistical analysis for the data obtained was performed using SPSS Version 16.0 (Chicago, SPSS Inc.). The chi-square test was applied to test the association between MSD and variables such as gender, designation, type of dentistry and usage of computers. The Mann Whitney U test was used to assess the relationship between MSD and age, experience, sick leave, number of patients attended per day. A p-value < 0.05 was considered significant. RESULTS: 151 subjects participated in the study, and the prevalence of MSD in the last 12 months among dental professionals was 58.3% (88 out of 151 subjects). The most common site affected by MSD was the neck (66.7%). Also, it was noted that among various dental specialists, the Endodontists suffered the maximum (88.02%) musculoskeletal pain. Fifty individuals (33.11%) suffered from pain in multiple sites. CONCLUSION: Work-related musculoskeletal disorders and pain can be reduced through proper operator-patient positioning, taking adequate breaks between patients, maintaining good physical health through regular exercises.

Risk assessment for osteoradionecrosis of the jaws in patients with head and neck cancer.

OBJECTIVES: To identify the potential risk factors for the occurrence of osteoradionecrosis (ORN) of the jaws among patients who have been treated with radiotherapy for head and neck malignancy. METHODS: The study comprised of 231 patients treated with radiotherapy for head and neck malignancy at a tertiary referral center. The following details were recorded for each patient: age, gender, histopathological diagnosis, clinical staging, tumor site, treatment modality, radiation dose, radiation field, number of fractions, type of accelerator used, radiation area and duration of follow-up. Patient's tobacco, alcohol habit history, and history of extraction of teeth before/during/after radiotherapy were also noted. RESULTS: Thirteen patients had osteoradionecrosis (frequency 5.62%). Among the radiotherapy variables assessed, increased radiation area was found to be significantly associated with the occurrence of osteoradionecrosis. Among the 13 ORN cases, 10 (76.9%) had a history of tobacco consumption, 8 (61.5%) had a time interval between radiotherapy and occurrence of ORN of less than 1-year duration. CONCLUSIONS: We found a low cumulative incidence of osteoradionecrosis and a tendency to occur within a year of starting radiotherapy. Patients of older age, those with a prior tobacco habit may be considered more liable to develop osteoradionecrosis. A larger radiation field may also put patients at hazard for developing osteoradionecrosis.

Oral manifestations in chronic kidney disease patients undergoing hemodialysis: a hospital-based study.

BACKGROUND: Chronic kidney disease (CKD-HD) patients undergoing routine hemodialysis have been reported to have oral signs and symptoms due to disease process or various comorbidities like diabetes mellitus (DM). Both CKD and DM can cause oral changes. Hence this study aimed to evaluate the prevalence of oral symptoms and signs in CKD-HD patients and to rule out DM as possible confounding factor for the oral findings. METHODS: Oral manifestations were assessed in 102 CKD-HD patients, and compared with 100 DM patients and 101 non-diabetic patients with no renal impairment. RESULTS: Most common symptom reported by patients with CKD-HD were xerostomia, altered taste. The most prevalent objective findings were oral dryness. There was statistically significant difference in symptoms and signs between CKD-HD and non-CKD patients. However, no significant difference between CKD-HD with and without DM. CONCLUSIONS: This study showed increased prevalence of oral findings in CKD patients. It also revealed that Diabetes mellitus cannot be a contributing factor for increased prevalence of oral manifestations in CKD patients.

Oral manifestations as predictors of immune suppression in a HIV-/AIDS-infected population in south India.

The objectives of the study are to evaluate the relationship between common HIV-related oral lesions and absolute CD4+ count, age, gender, and medication used and to assess the sensitivity, specificity, positive and negative predictive value of oral manifestations for low absolute CD4+ counts. HIV-positive patients, 200, from south India were selected, whose absolute CD4+ counts were determined within 2 weeks of oral examination. Sociodemographic data was obtained using a structured questionnaire. Oral manifestations were diagnosed according to presumptive criteria of EEC-clearinghouse classification (1993). Four or more concurrent oral lesions were statistically significant with low CD4+ counts <200 cells/mm3 (P = 0.005). The highest and lowest mean CD4+ cell counts were seen in individuals with linear gingival erythema (LGE; 172.5 cells/mm(3)) and pseudomembranous candidiasis (PC; 87 cells/mm(3)), respectively. Smoking, age (<35 years), and males had a positive association with oral hairy leukoplakia (OHL; P < 0.05). Patients with CD4+ counts < 200 cells/mm(3) were associated with 15 times greater risk of PC and four times at greater risk for occurrence of any oral manifestation. Concurrent oral manifestations (>or=4) were good predictors (80-100%) of severe immune suppression. In most resource poor countries where facilities for undertaking CD4+ counts are not available, the presence of concurrent oral manifestations may be used as an indicator of deteriorating immune status.

Localization of impacted maxillary canines using panoramic radiography.

We aimed to establish a reliable method of localizing an impacted maxillary canine on the sole basis of assessment of a single panoramic radiograph, and to determine the validity and reproducibility of the method. Panoramic radiographs of 50 subjects with a total of 68 impacted canines were analysed. The Canine Incisor Index (CII), Canine Canine Index (CCI), control Canine Incisor Index (c-CII), Zone (apical, middle, coronal) and Sector (I, II, III, IV) were determined on digitized panoramic radiographs. Comparison of the CII and CCI values of labially or palatally impacted canines revealed a statistically significant difference (P < 0.05). Comparison of labial and central canine impactions revealed no relation to CII or CCI (P > 0.05). There was a significant difference between palatal and central canine impactions in relation to CII (P < 0.05), but no significant difference between the two with respect to CCI (P > 0.05). Correct prediction of palatal canine impactions by differential magnification on a panoramic radiograph is possible in 77% of cases. Vertical and horizontal restrictions have no value in recognition of labiolingual position of impacted maxillary canines. The panoramic radiograph cannot be used as a sole radiograph for reliable localization of impacted maxillary canines.

Palatal and labially impacted maxillary canine-associated dental anomalies: a comparative study.

AIM: To determine the association of impacted maxillary canines with other developmental dental anomalies and compare them with a control population and to compare palatally and labially impacted canine associated anomalies. METHODS AND MATERIALS: Ninety non-syndromic orthodontic patients from a south Indian population, with either labial or palatal impactions of one or both maxillary canine teeth, were selected for the study group. A group of 250 patients who had normally erupted maxillary canines were selected as controls. Clinical findings and panoramic radiographs were used to identify dental anomalies. RESULTS: Prevalence of premolar rotation was found to be 80% in the study group followed by canine rotation (20%), taurodontism (26.6%), infraocclusion of premolars (25.5%), impacted mandibular canine (11.1%), and peg lateral (7.7%). Forty-nine (54.4%) palatally impacted, 37 (41.1%) labially impacted, and 4 (4.4%) centrally impacted canines were also observed. Of the 250 subjects in the control group 78.8% presented with premolar rotation. Maxillary canine transmigration, infraocclusion of premolars, anomalies of maxillary lateral incisors, and taurodontism showed significant associations with palatally impacted canines (P<0.05). CONCLUSION: The present study illustrates a significant association of anomalous maxillary lateral, anomalous mandibular canine, taurodontism, infra occlusion of premolar, over retained deciduous molar, and maxillary canine transmigration with ectopically placed canines. These associations suggest these conditions may share a common genetic origin and existence of these anomalies can anticipate maxillary canine impaction which can help in cautious observation and early treatment for maxillary canine impaction. CLINICAL SIGNIFICANCE: Anomalous lateral incisors can serve as a predictor for palatal maxillary canine impaction. These anomalies could serve as an easily recognized, early warning sign for the monitoring of the canine position and timely early referral in appropriate cases.