Response to Commentary: Fungal Infections of Oral Cavity: Diagnosis, Management, and Association with COVID-19.

This letter is a response to commentary by Ambadasu et al. on a review article by Santosh et al. on "Fungal Infections of Oral Cavity: Diagnosis, Management, and Association with COVID-19." In their commentary, Ambadasu et al. mentioned that in the list of COVID-19 associated fungal infections, mucormycosis should be added. In this response, we provide our thoughts on including mucormycosis in COVID-19 associated fungal infections of the oral cavity. We conclude that mucormycosis surge was more prevalent during the second wave of COVID-19 infection. Majority of published reports on oral fungal infections during the years 2019 and 2020 was focused on Oral Candidiasis, whereas mucormycosis appears to be re-emerging opportunistic entry of fungal infection among COVID-19 infection due to associated risk factors. Thus, Physicians and Dentists must be cautioned that other listed opportunistic fungal infections of oral cavity may also be seen among severe COVID-19 patients.be seen among severe COVID-19 patients.

Fungal Infections of Oral Cavity: Diagnosis, Management, and Association with COVID-19.

The frequency of fungal infections is increasing due to immunodeficiency viruses and immunosuppressive drugs. The most common fungal infection of the oral cavity is candidiasis. The existence of Candida can be a part of normal commensal; hence, the isolation of Candida in the absence of clinical symptoms should exclude candidiasis. The pathogenicity of Candida is witnessed as opportunistic when immune status is compromised. Oral fungal infections are uncommon, but when identified, these infections are associated with greater discomfort and are sometimes destruction of tissues. Cytology and tissue biopsy are helpful in confirming the clinical diagnosis. The management of oral fungal infections must strategically focus on signs, symptoms, and culture reports. This article reviews information on diagnosis and therapeutic management of aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, mucormycosis, and geotrichosis.

Viral infections of oral cavity.

Viral infections of the oral cavity usually manifest as either ulceration or blistering presentation of oral tissues. Oral viral infections are encountered in dental practice but received less clinical interest due to the lesser frequency of patients and diagnostic challenges. The clinical presentation, pathogenic mechanism, investigations, and management of oral viral infections are integrated into the article which will enable general dentists to develop critical thinking processes on differential diagnosis and management through a multidisciplinary approach with specialist dentists.

Calcifying cystic odontogenic tumor associated with ameloblastoma - A rare histological variant.

Calcifying odontogenic cysts (COCs) represent a heterogeneous group of lesions that exhibits a variety of clinical, behavioral, and histological features. COC or Gorlin's cyst is now classified by the World Health Organization as a tumor. Calcifying cystic odontogenic tumor (CCOT) is an uncommon developmental odontogenic lesion that demonstrates histopathologic diversity. Odontogenic tumors such as ameloblastoma have been reported to be associated with CCOT. In this paper, we report a case of ameloblastomatous CCOT in a 16-year-old girl with involvement of mandibular posterior region, which is an extremely rare histologic variant.

Cytological Changes in Normal Oral Mucosa of Individuals with Tobacco Habits: A Cytomorphometric Study.

INTRODUCTION: Oral cancer is one of the six most common cancers in the world, and globally more than 50% of head and neck cancers occur in Asia, remarkably in India. Overall, 200,000 cases of head and neck cancers occur each year in India, among which 80,000 are oral cancers. Epidemiological and clinical studies suggest a causative role of tobacco use in the evolution of oral potentially malignant and malignant disorders. AIMS AND OBJECTIVES: The aim of the study is to evaluate independently and compare the cytological effects of smoking, tobacco chewing, and smoking in conjunction with tobacco chewing on oral mucosa by cytomorphometric analysis. MATERIALS AND METHODS: The study included a total of 120 individuals subdivided into four groups, each group with 30 individuals. Group I was tobacco smokers, group II tobacco chewers, and group III both tobacco smokers and chewers. Group IV comprised 30 individuals without tobacco habit. Smears were prepared from buccal mucosa of both the study and control groups using a cytobrush and stained using Papanicolaou staining. The cells were quantified using image analysis software. RESULTS: The results of the study showed alterations in the nuclear and cellular parameters in the study groups when compared with control groups and were statistically significant (p < 0.05). CONCLUSION: The present study explains the significance of early identification of cellular changes in individuals with tobacco habits who require early intercession even without any visible oral mucosal changes. The study emphasizes that exfoliative cytology and cytomorphometry aid as a valuable tool to evaluate the effect of tobacco on oral mucosa. CLINICAL SIGNIFICANCE: Simple noninvasive techniques like exfoliative cytology can be employed as a chairside technique and in mass screening programs for identification of cellular changes in oral mucosa of individuals with tobacco habits. Thereby, it can be used as an early diagnostic tool for identification of potentially cancerous and cancerous lesions.

Honey and olive oil as bio-friendly substitutes for formalin and xylene in routine histopathology.

BACKGROUND: Formalin has long been the standard fixative and xylene has been the clearing agent for routine histopathology and immunohistochemistry worldwide. In recent years, as a result of increasing concerns about the potential carcinogenicity of formaldehyde and xylene, attempts have been made to find safer alternatives. In the present study, we considered honey as better alternative for formalin and olive oil as safer substitute for xylene. AIMS: The aim of this study was to know whether honey could be a possible substitute for formalin and olive oil could be a possible substitute for xylene. MATERIALS AND METHODS: Thirty routine biopsy tissues of 1-2 cm were taken. The study group was divided into Group A and Group B. Group A were subjected to normal processing. Group B were fixed into honey for 24 h after which it was taken through routine processing, and then immersed in olive oil instead of xylene. All the sections will be stained with routine hematoxylin and eosin staining. Compare the sections of both the methods. RESULTS AND CONCLUSION: The preservation of tissue by honey giving superior result when compared to that of formalin. Olive oil was found to be effective clearing agent compared to xylene.

Ultrastructural Analysis of Incinerated Teeth by Scanning Electron Microscope - A Short Study.

INTRODUCTION: In forensic context precise knowledge on physical and histological changes of teeth subjected to high temperatures is of great importance. Preserving fragile incinerated teeth for physical, histological and ultra structural examinations is essential in fire investigations involving the origin of fire, its cause as well as the identification of victims which relies on a thorough understanding of the structural changes in dental tissues subjected to heat. AIM: The study was conducted to evaluate the physical and ultrastructural changes seen in freshly extracted teeth when subjected to gradual heating at different temperatures using Scanning Electron Microscope (SEM). SETTINGS AND DESIGN: Freshly extracted teeth collected from subjects of different age groups were subjected to different temperatures using laboratory furnace and findings were correlated to the temperature. MATERIALS AND METHODS: The study was conducted on 60 healthy freshly extracted teeth belonging to age group between 20-30 years. Group A comprised of control group which included teeth that were not subjected to heat whereas Group B, C and D comprised of teeth that were subjected to different temperatures i.e., 100(o)C, 300(o)C and 600(o)C respectively for a time of fifteen minutes in laboratory furnace, after which they were processed for SEM examination. Each group included 15 teeth; 5 anteriors, 5 premolars and 5 molars. RESULTS: Examination under SEM revealed definite ultra structural changes which were explicitly seen at particular temperatures (100(o)C, 300(o)C and 600(o)C). The samples showed cracks and charring of the tooth structure with ultra structural findings such as pebbles, granules, dots on enamel surface; and soap bubble pattern, honey comb pattern and snail track pattern on cementum surface. CONCLUSION: Because of the consistency of morphological changes and the ultra structural patterns at various temperatures, evaluation of incinerated dental remains using SEM can provide additional investigative avenues in victim identification and in the areas of forensic fire investigations.

A Comparative Immunohistochemical Analysis of Langerhans Cells in Oral Mucosa, Oral Lichen Planus and Oral Squamous Cell Carcinoma.

BACKGROUND: Langerhans cells (LCs) are immunocompetent cells resident within oral mucosa which, together with intraepithelial lymphocytes, play a role in mucosal defence. LCs play a role in the pathogenesis of Oral lichen planus (OLP), a chronic mucocutaneous disorder thought to result from cell-mediated immune damage. In oral squamous cell carcinoma (OSCC), LCs are thought to present tumour antigens to the lymphocytes. AIM: To assess and compare LCs immuno-histochemically in normal mucosa, oral lichen planus and oral squamous cell carcinoma using anti S100 antibody and to know whether LCs play any role in local immune response to these diseases. MATERIALS AND METHODS: The study was carried out in 65 cases (study group), 30 oral lichen planus and 35 oral squamous cell carcinoma (15 well differentiated, 14 moderately differentiated and 6 poorly differentiated), that were randomly selected from the archives of department of oral pathology and along with control group consisting of 30 normal healthy mucosa. The tissue sections were stained immunohisto-chemically by using anti S100 antibody in each group for detection of LCs. RESULTS: There was significant change in mean value of number of LCs in the study groups i.e. OLP and OSCC when compared to that of control group. The results of our study also revealed that there was decrease in the mean value of langerhans cells as the tumour progressed from well differentiated squamous cell carcinoma to poorly differentiated LCs carcinoma. CONCLUSION: A better understanding and clarity of LCs is pivotal for designing novel or improved therapeutic approaches that will allow proper functioning of LC's in patients with OLP and OSCC, thus significantly reducing the morbidity of OLP and OSCC patients.

Oral Cysticercosis- A Diagnostic Dilemma.

Cysticercosis, a helminthic disease commonly seen in India, Latin America, Eastern Europe and Southern Africa, results from extraintestinal encystation of the larval form of Taenia solium. It is a condition in which man acts as intermediate host instead of definitive host. The most frequent sites of cysticercosis are subcutaneous layers, brain, muscles, heart, liver, lungs, and peritoneum. Oral cysticercosis is considered rare and cause cystic swellings or nodules in the mouth and a precise clinical diagnosis is not usually established. Here, we report a case of oral cysticercosis in a 32-year-old female occurring in the mentalis muscle presenting as asymptomatic nodule.

Mucoepidermoid Carcinoma of Floor of the Mouth - A Rarity.

Mucoepidermoid Carcinoma (MEC) is one of the most commonly occurring malignant salivary gland neoplasm, and contributes 2.8%-15% of all salivary gland tumours. More than half of these cases involve the major salivary glands, primarily the parotid glands and minor salivary glands. Sublingual salivary glands neoplasms are very rare and constitute 0.5% and 1% of all epithelial salivary tumours and approximately 1.5% of the major salivary glands carcinomas. Here we describe a case report of low grade mucoepidermoid carcinoma in the floor of the mouth in a 70-year-old female patient that was mimicking like a ranula clinically.

Pediatric odontogenic tumor of the jaw - a case report.

Central jaw tumors (intra osseous) in children occur infrequently and few oral pathologists have had the opportunity or experience in diagnosing these lesions and predicting their biological behavior. Some children are not diagnosed correctly at the initial stages as having a neoplasm and are wrongly treated for infections by antibiotic administration. Subsequent to an unresponsive antibiotic therapy radiographs are taken to reveal a radiolucent or radio dense lesion in the jaws. Finally a tissue diagnosis becomes necessary in order to diagnose and initiate proper therapy. One among the central jaw tumors that occur infrequently in children is Ameloblastoma. It is often aggressive and destructive, with the capacity to attain great size, erode bone and invade adjacent structures. Ameloblastoma not only accounts for 1% of all tumors of maxilla and mandible but also 11% of all odontogenic tumors. It has a high percentage of local recurrence rate and possible malignant development when treated inadequately. Here we present a central jaw tumor in an 8-year-old child which was a case of unusually large plexiform ameloblastoma involving entire ramus up to the condyle, and part of body of the mandible.

Microenvironment-a role in tumour progression and prognosis.

In addition to malignant cells, solid tumours comprise supporting stromal tissue that consists of Extra Cellular Matrix (ECM), connective tissue cells, inflammatory cells and blood vessels. The stromal compartment and the malignant cells together shape the tumour microenvironment that in turn determines tumour progression and efficacy of anti-tumour treatments. It is now recognized that the host microenvironment undergoes extensive change during the evolution and progression of cancer. This involves the generation of Tumour-Associated Fibroblasts (TAFs), which, through release of growth factors and cytokines, lead to enhanced angiogenesis, increased tumour growth and invasion. It has also been demonstrated that TAFs may modulate the Cancer Stem Cell (CSC) phenotype, which has therapeutic implications. Understanding the various components in the tumour microenvironment may afford us the opportunity to develop new drugs that target these reversible nonmutational events in the prevention and treatment of cancer.