Image collection and annotation platforms to establish a multi-source database of oral lesions.

OBJECTIVE: To describe the development of a platform for image collection and annotation that resulted in a multi-sourced international image dataset of oral lesions to facilitate the development of automated lesion classification algorithms. MATERIALS AND METHODS: We developed a web-interface, hosted on a web server to collect oral lesions images from international partners. Further, we developed a customised annotation tool, also a web-interface for systematic annotation of images to build a rich clinically labelled dataset. We evaluated the sensitivities comparing referral decisions through the annotation process with the clinical diagnosis of the lesions. RESULTS: The image repository hosts 2474 images of oral lesions consisting of oral cancer, oral potentially malignant disorders and other oral lesions that were collected through MeMoSA® UPLOAD. Eight-hundred images were annotated by seven oral medicine specialists on MeMoSA® ANNOTATE, to mark the lesion and to collect clinical labels. The sensitivity in referral decision for all lesions that required a referral for cancer management/surveillance was moderate to high depending on the type of lesion (64.3%-100%). CONCLUSION: This is the first description of a database with clinically labelled oral lesions. This database could accelerate the improvement of AI algorithms that can promote the early detection of high-risk oral lesions.

The chronology of third molar root mineralization in south Indian population.

The aim of present study was to determine the chronology of third molar root mineralization and to establish south Indian reference data. Therefore, a cross-sectional study was undertaken by evaluating 192 intraoral periapical radiographs in order to assess the root mineralization status of the mandibular third molar of south Indian individuals (101 males and 91 females) between the age of 13 and 25. The evaluation was carried out using the seven-stage developmental scheme of Kullman et al. (1992). The range, mean age, standard deviation, Student t test and percentile distributions are presented for each stage of mineralization. Statistically significant differences between males and females were not found. All individuals from this study with mature third molar roots were at least 18 years of age. For medicolegal purposes, the likelihood of whether a south Indian individual is older than 18 years or not was determined.

Adult-onset Langerhans cell histiocytosis - A Trojan horse of oral cavity: A case report with rare clinical presentation.

Langerhans cell histiocytosis (LCH), earlier recognised as histiocytosis X, is a rare haematological illness involving infants and young children. LCH is caused by unrestrained stimulation and proliferation of usual antigen presenting cells, Langerhans cells (LCs) and the disease demonstrates extensive clinical and radiographic features involving multiple sites. Since the incidence is relatively low limited data is available regarding the epidemiology of LCH, with approximation of 2-5 cases per million populations per year. LCH has male predilection with jaws involved in 10-20% cases and only 1% of the cases affecting maxilla, masquerading as periodontal or periapical pathology. We report a case of 48-year-old female with LCH involving posterior maxilla. This is a unique presentation corresponding to age, gender, location and severity. Dental clinicians should be aware of this and consider it to be a part of their differential diagnosis pertaining to unresolved periodontal pathology as it mimics clinically and radiographically.

Unusual association of torticollis with Russell-Silver syndrome.

Russell-Silver syndrome is a unique disorder characterised by intrauterine growth retardation before and after birth, large-sized head, a triangular facial appearance, a protuberant forehead, asymmetry and feeding difficulties. This extensive spectrum of features varies in both occurrence and gravity from one individual to another. Congenital muscular torticollis or commonly known as wry neck is one of the common presenting complaints in the outpatient department. It is characterised by rotational deformity of the cervical spine and consequently secondary tilting of the head.

Unusual case presentation associated with impacted mandibular molars: Clinicopathological correlation and immunohistochemical analysis.

ABSTRACT: Ewing's sarcoma of bone is a rare malignant round cell tumor of the head and neck. The jaw, particularly the mandible, accounts for 3% of occurrences in the head and neck area. These tumors have been reported more frequently in men than in women, and they are usually between 5- and 20-year-old. It is difficult for clinicians and pathologists to make a diagnosis based solely on clinical and microscopic findings. Immunohistochemistry presents a plausible tool that can help the pathologist to arrive at a confirmatory diagnosis. This jaw tumor has the best prognosis when detected and treated early in the disease course, so the importance of timely, and accurate diagnosis cannot be overemphasized. The highlighting feature of this case report of an 18-year-old male that was primary detected by immunohistochemically as Ewing's sarcoma and is localized to the impacted left mandibular molars.

Lateral Cephalometric Landmark Annotation Using Histogram Oriented Gradients Extracted from Region of Interest Patches.

Introduction: Two-dimensional cephalometric image analysis plays a crucial role in orthodontic diagnosis and treatment planning. While deep learning-based algorithms have emerged to automate the laborious task of anatomical landmark annotation, their effectiveness is hampered by the challenges of acquiring and labelling clinical data. In this study, we propose a model that leverages conventional machine learning techniques to enhance the accuracy of landmark detection using limited dataset. Materials and methods: Our methodology involves coarse localization through region of interest (ROI) extraction and fine localization utilizing histogram-oriented gradient (HOG) feature. The image patch containing landmark pixels is classified using the light gradient boosting machine (LGBM) algorithm. To evaluate our model's performance, we conducted rigorous tests on the ISBI Cephalometric dataset and Dental Cepha dataset, aiming to achieve accuracy within a 2 mm radial precision range. We also employed cross-validation to assess our approach, providing a robust evaluation. Results: Our model's performance on the ISBI Cephalometric dataset showed an accuracy rate of 77.11% within the desired 2 mm radial precision range. The cross-validation results further confirmed the effectiveness of our approach, yielding a mean accuracy of 78.17%. Additionally, we applied our model to the Dental Cepha dataset, where we achieved a remarkable landmark detection accuracy of 84%. Conclusion: The results demonstrate that traditional machine learning techniques can be effective for accurate landmark detection in cephalometric images, even with limited data. Our findings highlight the potential of these techniques for clinical applications, where large datasets of labelled images may not be available.

Diagnosis of the misdiagnosed: Mucormycosis depicting periodontitis.

Oral cavity is habitat for plethora of micro-organism causing various diseases. The most common includes dental caries, periodontal diseases, etc. Dental practice may rarely encounter unusual and subtle symptoms with nonpathognomonic clinical signs of several fatal diseases which may pretend like a common oral disease. Hence, the knowledge and clinical acumen of diagnostician are necessary for the early diagnosis of such fatal infections to prevent untoward consequences. Mucormycosis is an angioinvasive necrotic fungal infection with a high morbidity and mortality rate. It commonly occurs in patients with debilitating diseases and immunocompromised individuals. Clinically, it manifests as rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, renal, and disseminated form. Disease affecting the facial region is a challenge as it often disseminates with orbital and cranial involvement at the time of diagnosis. This article presents a case of mucormycosis which mimicked as severe periodontitis in a patient leading to delay in the diagnosis and challenges during the treatment.

Risk indicators of operculitis.

BACKGROUND: The aim of this study was to illustrate the features of tooth number 38 and 48 having acute operculitis employing clinical parameters and radiological distinctiveness. METHODS: Fifty subjects of both genders in the age range of 19-36 years with a diagnosis of acute operculitis comprised the group for study. After thorough clinical examination, uniform orthopantomograms (Rotograph 230 eur, Villa Sistemi Medicali, Buccinasco, Milan, Italy) for each of the individual subject participating in the study was made. Four parameters were evaluated as plausible prognostic factors for the progression of acute operculitis. The χ2 test was used to foretell the role of individual factors studied in the progression of acute operculitis. Significance was set at P less than 0.05. For all statistical analysis, the SPSS (version 16; SPSS Inc., Chicago, IL, USA) software was used. RESULTS: Based on the assessment of the parameters investigated in this study, most likely to be among the essential determinants of acute pericoronitis are vertical angulations, part (50%) encapsulation, eruption point underneath the occlusal plane and existence of an encroaching opposing 28 and 18. CONCLUSIONS: Prophylactic extractions may thus be recommended in such cases, as a delay may result in grave complications. All patients with impacted wisdom teeth should be evaluated and the treatment planned must be based on their individual presentation.

Oral Multifocal Epithelial Hyperplasia: An Unusual Entity.

Multifocal epithelial hyperplasia (Heck's disease) is a rare, contagious, asymptomatic, and benign disease affecting the oral mucosa. It is usually seen in childhood and adolescence and is noted only in specific groups in certain geographical regions. The lesion is clinically characterized by the presence of multiple small papules or nodules in the oral cavity, especially on the labial mucosa, buccal mucosa, and tongue. Histopathology is necessary to confirm the diagnosis. Treatment remains unspecific, although surgical excision, CO2 laser therapy, and topical antivirals are in use. We present a clinical case of a 65-year-old Indian male with multiple oral lesions that clinically and histologically resemble Heck's disease.

Stature estimation using odontometry and skull anthropometry.

OBJECTIVE: To investigate the possibility of estimating height from odontometry and anthropometric data of the skull for the positive identification of height in forensic investigations concerned with fragmentary human remains. MATERIALS AND METHODS: The study was carried out on 100 Mysorean patients, 50 males, and 50 females. Measurements of mesiodistal widths of the six maxillary anterior teeth, circumference of the skull, and height were made directly on each patient. Anteroposterior diameter of the skull was obtained on the lateral cephalograph. The data collected were subjected to statistical methods. The known heights of the combined data, data for males, and females were regressed against the odontometric and anthropometric variables using linear regression analysis. RESULTS: Significant sexual dimorphism was observed for the parameters studied ( P 0.05). Highly significant correlation was found between height and other parameters when combined data and data for males were regressed. The equation relating height to the combined mesiodistal width of maxillary anterior teeth was derived as height = 982.421 + 13.65 x combined mesiodistal width of maxillary anterior teeth ( P 0.0001). Similarly equations were obtained by regressing height to head circumference and skull diameter ( P 0.0001 for both). The above findings may hence provide reliable method of estimation of height from skeletal remains in the forensic setup.

Alterations of Serum Lipid Profile Patterns in Oral Lichen Planus Patients: A Case-Control Study.

BACKGROUND: Oral lichen planus (OLP) is a chronic disease of established immune-mediated pathogenesis. It most commonly, protractedly, and persistently involves the mucosa of the oral cavity. Antigen-specific and nonspecific mechanisms play a role in its pathogenesis, leading to T-cell accumulation in superficial lamina propria, intraepithelial T-cell migration, and keratinocyte apoptosis in OLP. Previous studies have indicated the possibility of serum lipid derangement in chronic inflammatory diseases such as systemic lupus erythematosus and psoriasis, which in turn results in elevated cardiovascular disease risk. Inflammation causes disturbances in lipid metabolism such as decrease in high-density lipoprotein-cholesterol (HDL-C) and increase in very low-density lipoprotein (VLDL)-cholesterol and hypertriglyceridemia due to direct effect on T-cell responses. Prolonged dyslipidemia, due to chronic inflammatory condition, enhances the formation of atherosclerotic plaques and thereby augments the risk of cardiovascular disease in such patients. With this background, a possible correlation between OLP and serum lipid level derangement can be anticipated. Hence, this study was taken up to probe into an association between the two. AIMS: To determine and compare the serum lipid levels in OLP patients and healthy controls, to inquire into the possible association of OLP with alterations in serum lipid profile patterns, and to determine if the clinical characteristics of OLP differed with alterations in serum lipid profile patterns. SUBJECTS AND METHODS: Sixty patients comprising 30 cases and 30 controls were enrolled for the study. Thirty cases of clinically and pathologically diagnosed OLP and 30 age- and sex-matched controls were subjected to blood examination for the assessment of serum lipid level, i.e., HDL, LDL, VLDL, and triglyceride. The obtained data were compared with standard values to assess any alterations of the serum lipid levels. STATISTICAL ANALYSIS USED: Cramer's V-test was performed for all the tests to measure association between two nominal variables. A P ≤ 0.05 was considered statistically significant. RESULTS: Dyslipidemia was observed in 13 (46.67%) cases as against 7 (23.33%) controls. Thus, a significant number of cases were found to have an associated serum dyslipidemia. However, pertaining to individual serum lipid levels in cases and controls, the association was found to be statistically insignificant. CONCLUSIONS: The current study suggested an evident association between dyslipidemia and OLP. We recommend imminent studies on a larger population to additionally substantiate a positive association between the two.

To Evaluate the Efficacy of Topical Propolis in the Management of Symptomatic Oral Lichen Planus: A Randomized Controlled Trial.

INTRODUCTION: Lichen planus (LP) is a chronic inflammatory, autoimmune, mucocutaneous disease of unknown etiology. The first line of treatment for oral LP (OLP) has been corticosteroids, but because of their adverse effects, alternative therapeutic approaches are being carried out, of which the recent natural alternative is propolis. AIM: This study aims to evaluate the efficacy of topical propolis in the management of OLP. MATERIALS AND METHODS: The research group consisted of 27 patients diagnosed with symptomatic OLP, among which 15 patients were in the control group and the rest 12 were in the study group. The patients in the control group received triamcinolone acetonide 0.1% (topical application) while the patients in the study group received propolis gel. Both the groups were evaluated for pain and erythema at baseline (1st visit), first follow-up (7th day), and second follow-up (14th day) using numerical rating scale and modified oral mucositis index. RESULTS: The patients in both the study and control groups showed a statistically significant reduction (P = 0.000 for the study group and P = 0.000 for the control group) in pain and erythema scores from baseline to second follow-up visit. However, on comparison of the reduction in pain and erythema scores between the two groups, the difference was found to be statistically insignificant (P = 0.255). STATISTICAL ANALYSIS USED: Chi-square and Cramer's V test were used. CONCLUSION: The topical propolis was found to be of comparative effectiveness with respect to triamcinolone acetonide 0.1% in the management of OLP.

Klestadt's cyst: a rarity.

Klestadt's cyst, more commonly known as the nasolabial cyst is an uncommon, non-odontogenic, soft tissue cyst characterized by its extra osseous location in the nasal alar region. Following its description first by Zukuerkandl in 1882, only 267 cases have been found in English literature. A case of nasolabial cyst in a 30-year-old female patient is presented.

Malignant peripheral nerve sheath tumour: an elusive diagnosis.

Malignant peripheral nerve sheath tumour (MPNST) also termed as spindle cell malignancy of the peripheral nerve Schwann cells or neurogenic sarcoma, represents approximately 10% of all soft tissue sarcomas. This tumour is usually found in the lower extremities and only 10-12% of all lesions occur in the head and neck region, which makes it a rare entity. The diagnosis of MPNST has been described as one of the most difficult and elusive diagnosis in the soft tissue diseases because of its non-specific presentation both clinically and histopathologically. This was overcome by the use of immunohistochemistry. A case of MPNST of the left maxillary antrum in a 45 -year -old male patient is reported.

Extragingival pyogenic granuloma.

Pyogenic granuloma is a well-known localized granulation tissue overgrowth in reaction to mild irritation. Although it is known to show a striking predilection for the gingiva, it can be found extragingivally with varying clinical features that sometimes may mimic more serious lesions such as malignancies. The clinical diagnosis of such an uncommon extragingival pyogenic granulomra can be quite challenging. The purpose of this article is to report an unusual case of extragingival pyogenic granuloma occurring on the lower lip, which presented as a cutaneous horn.

Palatal rugae pattern in Mysorean and Tibetan populations.

OBJECTIVES: To compare the palatine rugae pattern of Mysorean and Tibetan subjects, to assess the predominant palatine rugae pattern in Mysorean and Tibetan population, and to determine the uniqueness of palatine rugae pattern in an individual. MATERIALS: Maxillary study models of 60 subjects each (30 males and 30 females) of age group 17-23 years, of Mysorean population and Tibetan population were assessed for the length, shape, and unification of rugae based on the classification by Lysell et al. The palatine rugae were compared for the above mentioned parameters. 2 way ANOVA and Chi square tests were used for statistical analysis. RESULTS: Statistical analysis showed that males had significantly more number of total rugae on the right compared to the left side in both populations. Indian males had more primary rugae on the left side as compared to females and vice versa for the Tibetan population. Also, Indian males had more number of curved rugae on both right and left sides than Tibetan males and Tibetan females had more wavy rugae on right and left sides than Indian females. In other aspects, no significant difference or association was found. CONCLUSIONS: A statistically significant association between the total number of rugae and the gender in both the study populations exists. Parameters like the length and shape of the rugae show racial differences.

Oral epithelioid hemangioendothelioma.

Epithelioid hemangioendothelioma (HE) is an intermediate malignant potential vascular neoplasm with uncertain clinical behavior, wide variations in microscopic findings, and prognosis. According to the World Health Organization (2002) classification, epithelioid HE has been considered under malignant tumors which rarely metastasize. The epithelioid variant, the most aggressive one, has similar gender predilection and sporadic occurrence in children. The patients usually present with an asymptomatic oral mass whereas few cases may report with the painful bleeding lesion. We attempt to present a case in an adolescent male with previously never described biological behavior, diverse histopathological features, and immunohistochemistry findings.

Reliability of Panoramic Radiographs in the Localization of Mandibular Foramen.

OBJECTIVE: The present study evaluated the reliability and accuracy of panoramic radiographs in the localization of mandibular foramen. MATERIALS AND METHODS: Twenty five Indian dry human adult mandibles constituted the study material. Ten measurements were carried on each of them to evaluate the location of mandibular foramen with respect to adjacent anatomic landmarks. Panoramic radiographs were then made of the mandibles. Same distances were measured on the traced images of the radiographs. Paired t-test and Pearson's correlation test were applied to evaluate the accuracy and reliability of panoramic radiographs in localization of mandibular foramen. RESULTS: The mean distances measured on dry mandibles and panoramic radiographs showed statistically significant difference (p<0.05). There was strong positive correlation between the measurements on dry mandible and panoramic radiographs. CONCLUSION: The panoramic radiographs can serve as a guide in locating the anterosuperior point of mandibular foramen on panoramic radiographs.

Use of Curcumin Mouthrinse in Radio-Chemotherapy Induced Oral Mucositis Patients: A Pilot Study.

INTRODUCTION: Oral Mucositis is a complex and distinct pathobiologic entity resulting in injuries in mucosa that is a common complication in cancer patients undergoing chemotherapy (CT) and radiation therapy (RT). Phytochemicals, such as Curcumin, turmeric extract, has attracted great attention for its therapeutic benefits in clinical oncology due to its chemopreventive, antitumoral, chemosensibilizing and radiosensibilizing activities against various types of cancers and the complications associated with their management. AIM: To evaluate the efficacy and safety of curcumin mouthwash in the management of Oral Mucositis in cancer patients undergoing radio-chemotherapy. MATERIALS AND METHODS: The research group consisted of 20 adult cancer patients undergoing radio-chemotherapy at the Regional Oncology Centre, who were evaluated for signs and symptoms of oral mucositis and then randomly divided into two groups. Standard preventive oral care i.e. chlorhexidine mouthwash 0.2% was given to one group while the other group was provided with freshly prepared curcumin mouthwash; each to be used thrice daily. Oral mucositis was assessed at days 0, 10 and 20. The World Health Organization (WHO) scale, the Oral Mucositis Assessment Scale (OMAS), and a Numerical Rating Scale (NRS; patient reporting scale of 0-10) were used. Adverse events were tracked. STATISTICAL ANALYSIS: Descriptive statistics, Independent sample t-test and repeated measure ANOVA test were performed. RESULTS: Statistically significant difference was found in the NRS (p=0.000), Erythema (p=0.050), ulceration (p=0.000) and WHO scores (p=0.003) between the two groups. CONCLUSION: Curcumin was found to be better than chlorhexidine mouth wash in terms of rapid wound healing and better patient compliance in management of radio-chemotherapy induced oral mucositis. No oral or systemic complications were reported.