Evaluation of pre-analytical biopsy specimen errors in the pathology laboratory of Hamadan school of dentistry [2009-2010]

Statement of Problem: Oral biopsy is important in the definite diagnosis of oral and maxillofacial lesions. This procedure as well as other laboratory services is prone to errors affecting the patients' safety

Purpose: The purpose of this study was to evaluate pre-analytical biopsy specimen errors in the Oral Pathology Laboratory of Hamedan School of Dentistry, west of Iran

Materials and Method: Ninety-one oral biopsy samples, obtained from departments of oral and maxillofacial surgery [34 samples, 37.3%], oral medicine [22 samples, 24.3%] and periodontics [10 samples, 10.9%], as well as private offices [16 samples, 17.6%] and hospitals [9 samples, 9.9%] were received and evaluated in the Oral Pathology Laboratory of Hamedan School of Dentistry considering pre-analytical errors

Results: The errors in the request forms included unmentioned names of patients [7.7%], age [3.3%], clinical history [4.4%], site of biopsy [10.9%], differential diagnosis [18.7%] and the name of the requesting clinician [8.8%], as well as lack of radiographs [4.4%] and previous biopsy results [2.2%]. Use of inappropriate fixative [5%], and specimen-containers with non-proportional volume [3%], and their small size inlets [3%] was also reported. Non-standard containers were seen in 19% of the cases, and mislabeling errors [31 missed, 2 incomplete defects, and 1 incorrect] in 34% of the cases. Of 105 specimens, 6.67% were small in size, 1.90% superficially removed, and 0.95% had been traumatized. Out of the 5 containers with more than one specimen, 4 containers did not have any markers

Conclusion: Considering the biopsy errors in the study specimens, training and surveillance to reduce the frequency of such errors seems necessary

[ comparative evaluation of senior students of dentistry and dental medical doctors' knowledge on harvesting and handling of oral biopsies]

Statement of Problems: An oral biopsy is essential for definitive diagnosis of oral lesions, and for planning the appropriate treatment. Any fault that happens in biopsy procedures may result in diagnostic errors by pathologists. Thus, inadequate awareness of dentists and patients about biopsy is a significant concern for both of them

Purpose: The aim of this study was to compare the senior students of dentistry and dental medical doctors' knowledge about harvesting and handling of oral biopsies in Hamadan city. [2009-2010]

Materials and Method: This cross-sectional study was conducted by using a questionnaire. The data were collected and analyzed through SPSS, version 15. Independent t-test was employed to determine the differences between groups

Results: Of the total 152 collected questionnaires, 42 and 110 were completed by dental students and general dentists, respectively. Accurate responses by the students [72.48+/-10.76%] was significantly higher than those of the dentists [62.22+/-14.99 % ; p =0.00]. There were no significant differences in the correct responses given by female [75+/-10.11 %] and male [70.20+/-11.05 %] students and also between female [61.11+/-14.66 %] and male [62.67+/-15.19 %] dentists [p >0.05]. Among general dentists, the differences of accurate responses between those with professional experience <10 years [62.44+/-15.64 %] and those with the professional experience >10 years [61.82+/-13.91 %] were not significant; [p =0.83]

Conclusion: This study revealed that dental medical doctors' awareness regarding harvesting and handling of oral biopsies is lower than that of the students of dentistry. Moreover, gender and professional experience did not affect the level of knowledge. Consequently, there is a need for further training in this respect for dental medical doctors

[ review of bisphosphonates and bisphosphonate-related osteonecrosis of the jaw]

Statement of Problems: Bisphosphonates are a class of agents used in treating a variety of bone diseases, including osteoporosis, multiple myeloma and hypocalcemia due to malignancy. Despite the benefits related to the use of these medications, in recent years, numerous cases of bisphosphonate-related osteonecrosis of the jaws [BRONJ] of patients treated with oral/IV bisphosphonates have been reported. The BRONJ phenomenon is a serious complication, presenting as an exposure of alveolar bone either spontaneously or secondary to invasive oral surgical procedures

Purpose: This review aimed to warn dentists and dental specialists about BRONJ and propose guidelines for diagnosis, staging, management and treatment selection based on the available data and the authors' experiences

Conclusion: All the patients treated with oral or IV bisphosphonate therapy are at risk of BRONJ. Suggested guidelines for these two applied forms of bisphosphonates vary. In IV bisphosphonate therapy, all dentoalveolar surgeries are contraindicated and should be avoided. However, the indications are more controversial in the cases of bisphosphonates administered via the oral route and are related to the duration of treatment

[ clinicopathologic study of odontogenic cysts and tumors in an Iranian sample population]

Odontogenic cysts and tumors are lesions that are found exclusively in the mandible and maxilla. These lesions are one of the main causes of jaw destruction. But unfortunately only a few studies have been conducted in Iran on relative frequency of these lesions. The aim of this study was to determine the relative prevalence of odontogenic cysts and tumors in Kerman province along with age, sex and site of presentation over a 12-year period and to compare it with previous reports from different parts of the world. This research reviewed 1320 biopsies in a 10-years period. Data on factors such as age, sex and location of the lesions were extracted from pathology reports and analyzed by SPSS statistical software. Of 1320 specimens, 221 were diagnosed as odontogenic cysts and 25 biopsies were diagnosed as odontogenic tumors. Odontogenic cysts and tumors occurred most frequently in the first to second decades of life and most commonly in the mandible. Cysts were more common in men than women. Radicular cysts were the most common one [33.9%], followed by dentigerous cysts [21.7%] and odontogenic keratocyst [15.4%]. The most prevalent odontogenic tumor was ameloblastoma [41.4%], Our study provides demographic data on odontogenic cysts and tumors in Kerman province. Odontogenic cysts have a predilection for certain ages, sexes and sites. To determine the real relative frequency of odontogenic tumors, further studies should be conducted, especially in Iran, by experienced pathologists in the field of odontogenic tumors

[Pattern of analgesics prescription by dentists in Iran]

Pain is the major reason for referring patients to dental clinics. Inappropriate use of analgesics can result in noticeable systemic side effects. Prescribing the best drug according to the severity, nature and quality of the pain can result in reduction of anxiety and stress which are aggravated with intensification of pain. The aim of this study was to investigate the analgesics prescription by dentists participating in the 9th Congress of Iranian Association of Endodontists in Esfahan/2006. A questionnaire for this cross-sectional study was designed for evaluating the patterns of analgesic prescription. It included some demographic information and drug selection to control severe, moderate and mild toothache. 113 collected questionnaires entered the study. Chi- square test was used for data analysis. Based on this study, a high percentage of responders selected Ibuprofen, acetaminophen with codeine for pain control in severe, moderate and mild toothache [96%, 81% respectively]. Most responders prescribed ibuprofen [400mg] before endodontic treatment. The results of the present study demonstrated discrepancy in the analgesics selection among participants

[Comparative study of p53 protein and ki67 antigen in homogeneous and non-homogeneous leukoplakia]

Leukoplakia is one of the most common premalignant or potentially malignant lesions of the oral mucosa. Its potential for malignant transformation is unpredictable.The aim of present study was to evaluate the expression of p53 and proliferation status of ki67 antigen in normal, homogeneous and non-homogeneous leukoplakia. The standard immunohistochemistry staining method [Biotin Streptavidin peroxidase] was used to study the expression of p53 and ki67 on formalin fixed, paraffin embedded blocks of 7 cases of homogeneous leukoplakia, 10 cases of non-homogeneous leukoplakia and 9 cases of normal oral epithelium. Data were analyzed using ANOVA, MC Nemar and Fisher's exact tests. No relationship was detected between p53 protein and Ki67 expression and clinical features of leukoplakia. The distribution patterns of p53 and ki67 were mainly localized in the basal layer of normal oral mucosa, while the expression of p53 and Ki67 were extended into suprabasal cell layer in leukoplakia lesions. Ki67 expression in dysplastic lesions was higher than non-dysplastic lesions. This study showed significant relationship between Ki67 and p53 protein. These findings showed that the expression of p53 and Ki67 in suprabasal cell layers in leukoplakia may be correlated with poor clinical outcome and alterations of p53 lead to increased cell proliferation

[Is the rate of response of oral carcinoma to radiotherapy predictable?]

Prediction of responsiveness of oral cancer cells to radiation is very important in planning of treatment and can play an important role in treatment strategy. If the clinician becomes aware that the tumor is not responsive to radiation, radiotherapy can be omitted from the treatment plan thus preventing any untoward side effects and loss of precious time. On the other hand, if a tumor is sensitive to radiation, radiotherapy can be used as the mainstay of treatment and as a matter of fact, radical surgeries can also be avoided. In this article, some of the molecular agents effective in determining the responsiveness of squamous cell carcinoma of the mouth to radiotherapy have been studied and reviewed. Similarly, the authors have tried to present certain factors which can be useful in predicting the responsiveness of squamous cell carcinomas of the mouth to radiotherapy

[Expression of P53 and Ki-67 Proteins in a odontogenic keratocysts]

P53 has been known as a tumor suppressor gene and also Ki-67 is a cell cycle regulator. The aim of present study was to investigate P53 and Ki-67 protein expression in the epithelial lining of odontogenic cysts and its correlation with their biologic behavior and the degree of inflammation within the cyst wall. P53 and Ki-67 immunoreactivity in 58 odontogenic cystic lesions including 19 Keratocysts, 20 dentigerous cysts and 19 radicular cysts were studied, using a biotin-streptavidin peroxidase method. Frequency of P53[+] Lesions in three groups was not statistically significant and there was no correlation between intensity of staining for P53 and Ki-67 proteins. But we found positive relationship between inflammation and intensity of P53 staining in odontogenic keratocyst. Ki-67 expression in odontogenic keratocyst was higher than dentigerous cyst and radicular cyst, but in this study we could not find any correlation between Ki-67 expression and degree of inflammation.Since we couldn't show any Discrepancies in distribution of P53, so the existence of greater proliferative potential and recurring of the odontogenic keratocyst may not be due to higher immortality and continual persistant, compared to other types of examined cysts, but it may be associated with increased potential of cell division. Mean while, expression of Ki-67 in OKC was higher than other cysts. Finallyinflammation may disturbe the natural trend of opotosis [P53[upwards arrow]] and facilate proliferetive ability of epithelial lining [Ki-67[upwards arrow]] in odontogenic keratocyst