Root canal widths of mandibular molars in predicting the legal age threshold 18 years in a sample of juveniles and sub-adults of south-indian origin: an orthopantomographic study.

Pursuing a proficient age estimation methodology introducing novel radiographic methods remains an ongoing and demanding aspect of forensic and medicolegal research. In 2017, Roberts GJ et al. (J Forensic Sci 62(2):351-4, 2017) described a new radiographic method, i.e., root canal width (RCW) patterns to assign a subject to above 18-year-age threshold. Since then, few researchers have investigated the validity of this radiographic method in other populations. The present study aimed to test the usefulness of these RCW patterns in predicting 18 years in a sample of South Indian juveniles and sub-adults aged between 16 and 23. Descriptive analysis revealed that pattern-A was initially observed at a minimum age of 16.08 and 16.22 years in males and females. Pattern-B at 16.31 years in males and 16.22 years in females, while pattern-C was initially recorded at 18.73 years in males and 19.01 years in females, respectively. In summary, if an individual, regardless of sex, exhibits a fully-formed (apex closed) mandibular first, second, and third molars and concurrently displays RCW-C, there is a strong likelihood that the person has exceeded the legally relevant age of 18 years. However, due to higher rate of technically unacceptable errors (adults wrongly identified as individuals below 18 years), reliance on this method alone should be restricted, and it is advisable to combine it with other methods.

Comparative evaluation of podoplanin in odontogenic cysts and tumours to determine their proliferative potential-An immunohistochemical study.

Context: Odontogenic cysts and tumours are a wide array of complex pathological entities ranging from mild indolent to aggressive detrimental in nature, which occur as a result of anomalous alterations in normal odontogenesis. Hence, these odontogenic lesions need to be evaluated extensively by using potential immunohistochemical markers. Aim: To evaluate and compare the expression of podoplanin, a lymphoendothelial IHC marker in odontogenic cysts and odontogenic tumours to determine their proliferative potential. Settings and Design: All the study samples were retrieved from the archives of the Department of Oral Pathology and Microbiology, PIDS&RC, Hyderabad. The study samples were selected as per the standard histopathological diagnostic criteria and subjected for IHC analysis using podoplanin. Method and Materials: Seventy paraffin-embedded tissue specimens of OKC, OOC, dentigerous cyst (DC) and ameloblastoma (AM) include study sample, which were stained with podoplanin IHC marker and staining properties were evaluated. All the cases were categorized as high, moderate, weak or negatively reactive on the basis of the composite scoring. Statistical Analysis Used: Statistical analysis was done using SPSS version 14, and then results were compared by ANOVA post hoc test and Kruskal Wallis Test. Results: In the comparison of composite scores of OKCs and AM, there was no significant statistical difference. Conclusion: The present study contributes to the significant association of podoplanin expression with cellular proliferation, cystic expansion and local invasiveness of odontogenic cysts and tumours through cytoskeletal reorganization and cell migration.

Oral Manifestations in HIV-TB Co- infected Patients and Their Correlation with CD4 Count in Telangana State, India.

AIMS AND OBJECTIVES: Human immunodeficiency virus (HIV)-related oral lesions are often an early finding, and they reflect the underlying immunosuppression, and tuberculosis (TB) coinfection can have further deteriorating effect. Hence, a cross-sectional study was conducted to evaluate clinical and oral presentations of patients coinfected with HIV-TB, correlating with various parameters such as the type of TB with CD4 cell count, the type of TB with oral manifestations, site of the lesion, oral manifestations with CD4 cell counts, age, and gender. MATERIALS AND METHODS: A cross-sectional study was conducted among selected 200 patients coinfected with HIV-TB, registered at Gandhi Medical College, Hyderabad, Telangana, India, and demographic data, CD4 count, diagnosis of TB, and clinical presentation of TB were correlated with site, age, gender, and the type of lesions in the oral cavity. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software, (IBM SPSS), version 20 (Chicago, IL, USA), with the chi-square test, and the significant P value for all the parameters was considered as <0.05. RESULTS: A total of 200 patients with HIV-TB coinfection, who presented with oral lesions of 258 coinfected cases, were examined. Among which, 129 patients were with pulmonary tuberculosis (PTB), 61 patients with extrapulmonary TB, 2 patients with disseminated TB, and 8 patients with PTB and pneumonia. There were multiple oral manifestations involving different sites of oral cavity, oral candidiasis (28.5%), angular cheilitis (24.5%), linear gingival erythema (21.5%), oral hairy leukoplakia (1.5%), melanotic pigmentation (29.0%), ulcers (20.0%), depapillation of tongue (26.5%), lobulated tongue (12.0%), hairy tongue (11.5%), and papules (10.0%). The correlation of the type of TB with CD4 cell count, oral lesions with the type of TB in tongue, labial mucosa, and palate was significant. CONCLUSION: A total of 77.5% patients coinfected with HIV-TB had shown oral manifestations emphasizing that the presence of oral lesions can be considered as a strong indicator of coinfection. The oral lesions might be used as a clinical indicator or screening mechanism in patients who were HIV seropositive for TB coinfection and should be necessarily evaluated for TB.

Insight into verruciform xanthoma with oral submucous fibrosis: Case report and review of literature.

Verruciform xanthoma (VX) is a rare benign mucocutaneous verrucopapillary lesion, which mainly involves masticatory mucosa and gingiva. Clinically, it presents as a solitary, sessile or pedunculated, white- or yellow-white-colored growth with a pebbled surface, hence often misdiagnosed as papilloma. The hallmark of histological diagnosis is the presence of foam cells or xanthoma cells confined to the connective tissue papillae. We present a case of VX on the maxillary gingiva in a 52-year-old male patient with oral submucous fibrosis (OSF) with a review on histopathology and concomitant oral lesions. The exact etiopathogenesis is not clearly delineated more so when it is associated with diverse local and systemic conditions. Its concomitant association with other conditions such as lichen planus, leukoplakia, oral squamous cell carcinoma and OSF is rare, with only three cases of VX associated with OSF reported earlier.

Applicability of Cameriere European formula for age estimation of 10-15 years legal threshold in South Indian population.

AIM: The aim of the present study is to assess the relationship between chronological age (CA) and the measurement of the open apices in teeth and also assess the accuracy of Cameriere methods on dental age (DA) estimation in the South Indian population. SUBJECTS AND METHODS: A sample of 200 orthopantomographs of children aged between 10 and 15 years were collected. The seven left permanent mandibular teeth were evaluated with Cameriere method. RESULTS: Regression analysis was carried out which derived the following linear regression formula: Age = 14.117 - 0.01 g - 1.732W3 + 0.016N0 - 0.289 × 5 - 0.099.s. N0. The equation explained 88.3% (R 2 = 0.883) of the total deviance. The accuracy of the European formula and South Indian formula was determined by the difference between the estimated DA and CA. Cameriere formula produced 32% and 18% of absolute residuals falls within the range of ± 1 and ± 0.5 years, whereas the new regression formula produced 72% and 35% within range of ± 1 and ± 0.5 years. CONCLUSION: This further highlight the importance of population-specific formula keeping in mind about variation in dental maturation across different regions.

Assessing alpha-tocopherol levels in patients with keratocystic odontogenic tumor: A cross-sectional study.

AIMS AND OBJECTIVES: A keratocystic odontogenic tumour (KCOT) is a benign uni- or multicystic, intraosseous tumour of odontogenic origin, with a characteristic lining of parakeratinized stratified squamous epithelium and potential for aggressive, infiltrative behaviour. Various studies in hamsters showed that, alpha-Tocopherol, which is an active biological form of Vitamin E, is a potent antioxidant known to inhibit tumour formation and also regression of established tumours. So, the aim of the present pilot study was to assess the levels of Alpha-Tocopherol(Vitamin E) in Patients with KCOT and compare them with Vitamin E levels in normal healthy individuals. MATERIALS AND METHODS: A sample of 20 individuals were taken and Alpha Tocopherol levels in serum were assessed. Independent sample t test was used to analyse the data. Serum Vitamin-E levels were found to be decreased in KCOT cases. RESULTS: Mean Vitamin-E level was found to be decreased (mean + S.D. = 10,549.34 +/- 2494.21 ng/mL) as compared to healthy controls (mean + S.D. = 13,982.42 +/- 2178.02 ng/mL). The reduction in serum vitamin E level was statistically significant (P < 0.05). CONCLUSION: The reduction in Vitamin E levels in KCOT patients might be suggestive of the possible interrelation between Vitamin E and KCOT invivo. Also, increase in intake of Vitamin E might help in reducing the risk of recurrence in KCOT by reducing the dysregulation of Cyclin D1 and Down-Regulation of mutant p53.

Diffuse Large B-Cell Lymphoma of Maxilla - A Case Report of Late Relapse.

Diffuse Large B Cell Lymphomas (DLBCL) encompasses a heterogeneous group of tumors that together constitute the commonest of all Non Hodgkin Lymphoma (NHL) and the proclivity of DLBCL to oral cavity is unknown. They mostly arise from soft tissues as asymptomatic lesions, mostly without 'B' symptoms and involvement of jaw bones is uncommon. Most studies and case reports of oral DLBCL's are based on, manifestation of primary extra-nodal disease or a component of a disseminated disease process involving regional lymph nodes. Many investigators have proposed that patients with this cell type who maintain a complete response for 24 consecutive months are cured because late relapses seldom occur. With advances in treatment modalities, many patients with NHL become long-term survivors and the risk of relapses or second tumors are of growing concern. We present a case of DLBCL which relapsed after five years of initial lesion in a 41 year old female patient and presented as a nonspecific bilateral anterior maxillary radiolucency. DLBCL usually express pan-B markers with small percentage expressing T-cell markers. Few rare cases of DLBCL have shown CD3 expression, which is a most sensitive T-cell marker which was focally expressed in the present case.

Actinomycotic Osteomyelitis of Maxilla Presenting as Oroantral Fistula: A Rare Case Report.

Actinomycosis is a chronic granulomatous infection caused by Actinomyces species which may involve only soft tissue or bone or the two together. Actinomycotic osteomyelitis of maxilla is relatively rare when compared to mandible. These are normal commensals and become pathogens when they gain entry into tissue layers and bone where they establish and maintain an anaerobic environment with extensive sclerosis and fibrosis. This infection spreads contiguously, frequently ignoring tissue planes and surrounding tissues or organ. The portal of entry may be pulpal, periodontal infection, and so forth which may lead to involvement of adjacent structures as pharynx, larynx, tonsils, and paranasal sinuses and has the propensity to damage extensively. Diagnosis is often delayed and is usually based on histopathology as they are cultured in fewer cases. The chronic clinical course without regional lymphadenopathy may be essential in diagnosis. The management of actinomycotic osteomyelitis is surgical debridement of necrotic tissue combined with antibiotics for 3-6 months. The primary actinomycosis arising within the maxilla with contiguous involvement of paranasal sinus with formation of oroantral fistula is rare. Hence, we present a 50-year-old female patient with chronic sclerosing osteomyelitis of maxilla which presented as oroantral fistula with suppurative and sclerotic features.

A Case of Intraoral Lymphangioma Circumscripta - A Diagnostic Dilemma.

Lymphangiomas are developmental malformations which present as benign hamartomas of lymphatic channels. They are commonly located in the head and neck region and are less frequently reported in the oral cavity. However affected sites in the oral cavity include the tongue, palate, gingiva, buccal mucosa, lips and alveolar ridge of the mandible. The most common site in the oral cavity is tongue. Lymphangioma of the buccal mucosa is rare as per the available literature and they usually occur as lobular masses or cystic lesions. Histopathologically, lymphangioma appear as proliferated lymphatic vessels lined by plump endothelial cells. Surgical excision, laser therapy and sclerotherapy are the eventual modes of treatment. This paper reports a rare case of lymphangioma of the buccal mucosa in a 60-year old male patient managed by surgical excision.

Age-related - oral manifestations and co-morbidities in human immunodeficiency virus-infected/acquired immune deficiency syndrome adults in Hyderabad, India.

BACKGROUND: The objective of the study was to clinically evaluate age-related - oral manifestations and co-morbidities in different age groups of human immunodeficiency virus-infected/acquired immune deficiency syndrome adults. MATERIALS AND METHODS: A cross-sectional study was conducted among 200 adult patients aged above 20 years at infectious diseases units, medical wards and ART centre of Gandhi Medical Hospital, Hyderabad. Oral manifestations were diagnosed according to the presumptive criteria of EC-Clearinghouse Classification, and clinical data were retrieved from patient's medical records. Chi-square test was used for statistical analysis. RESULTS: Men (72%) in the young age group of 21-30 years were commonly affected. Heterosexual mode of transmission was most common in all the age groups, and the overall distribution were statistically significant (P < 0.05). Most common oral findings seen in 21-30 years of age were depapillation (90%), hyperpigmentation (70% and 72%) in 31-40 and 41-50 years old and linear gingival erythema (68%) in above 50 years of age group. The various co-morbidities included the recurrent bacterial and skin infections (64% and 62% respectively) in the younger age group. Renal and cardiac diseases with pulmonary tuberculosis (74%) were commonly observed in middle-aged and elders. CONCLUSIONS: The underlying oral manifestations and co-morbidities could become very important variables that must be taken into account in determining treatment efficacy or health policy.