Peripheral adenomatoid odontogenic tumor in a cloak of an epulis: report of a rare case.

BACKGROUND: Adenomatoid odontogenic tumor constitutes an uncommon benign odontogenic tumor which is well-known as "two-thirds tumor" (two-thirds of adenomatoid tumors occur in the maxilla, two-thirds occur in young females, two-thirds of the cases are associated with un-erupted teeth and two-thirds of the affected teeth are canines). Larger part of these present as intra - osseous tumors while peripheral counterparts are extremely rare. Peripheral adenomatoid odontogenic tumor is a unique entity which generally presents as a slow growing gingival swelling with minimal bone involvement. This often leads to its erroneous diagnosis as a simple gingival lesion and the real diagnosis is only revealed after its microscopic evaluation. It exhibits a marked predilection for maxillary gingiva of incisor region and most commonly affects the younger females. CASE PRESENTATION: We report a case of 25 years old female patient of African ethnicity who presented with a 2 × 2 cm mass attached to the left mandibular gingiva in cuspid- bicuspid region which is an unusual site for AOT. It was accompanied by slight bone loss. With the differential diagnosis of gingival epulis and peripheral ossifying fibroma; surgical excision was performed. The light microscopic examination of the specimen aided the final diagnosis of Adenomatoid odontogenic tumor with the histopathological features identical to its intra osseous counterpart. CONCLUSION: In this case, the tumor is present on the mandibular gingiva in a 25 years old patient which is an atypical location and age for this tumor; also, the only individual case reported in an African patient. Only, a meager number of peripheral adenomatoid odontogenic tumor cases have been logged so far with majority of them occurring in maxillary gingiva. Furthermore, an ambiguity still prevails regarding its true origin and possible biological course. Hence, reporting of similar cases should be encouraged to facilitate the better understanding of its varied epidemiological details and clinical presentation.

Quantification of circulating plasma cell free DNA fragments in patients with oral cancer and precancer.

PURPOSE: Study was aimed to quantify plasma level of total, short and long fragmented cell-free DNA (cfDNA) along with DNA integrity in patients with oral cancer, oral precancer and tobacco users without lesions and normal controls. In addition, study evaluated the correlation of cfDNA with clinicopathologic parameters of oral cancer. METHODOLOGY: Plasma samples were collected preoperatively from 44 patients with oral cancer, 40 patients with oral precancer, 40 tobacco users without any oral lesion and 40 healthy controls without any tobacco habit. cfDNA extraction was carried out from the plasma followed by quantitative and qualitative assessment of extracted DNA. Quantity of short and long fragmented DNA was assessed by using PCR with two different primer sets for the beta-actin gene, amplifying short (102 bp) and long (253 bp) products. The DNA integrity index was measured by calculating the ratio of quantity of long fragmented to short fragmented DNA. All quantitative cfDNA parameters were statistically analyzed to verify their correlation with clinicopathologic parameters. RESULTS: Results showed that total cfDNA level, short and long fragmented cfDNA concentration and DNA integrity was significantly higher in oral cancer group as compare to other (p=0.0001). Study demonstrated that there is no correlation total, short and long cfDNA and DNA integrity with tumor size and histologic type or grading. But positive correlation of total cfDNA was found with nodal metastasis (p=0.001) and clinical stages (p=0.006). CONCLUSION: Quantitative analysis of total cfDNA may be applied as a screening marker for early detection of precancer and cancer as well as for prognostication of oral cancer. Additionally, plasma levels of short and long fragmented cfDNA and DNA integrity index can be applied for early detection of oral cancer.

Evaluation of Specificity and Sensitivity of Oral Fluid for Diagnosis of Hepatitis B.

INTRODUCTION: Hepatitis B viral infection is a global health issue. Various screening and confirmatory serological tests have evolved in the past few decades for detection of hepatitis B. However, oral fluid as an alternative to blood could provide substantial advantages. The study aimed to evaluate the diagnostic efficacy of oral fluid in detecting hepatitis B surface antigen using Enzyme Linked Immunosorbent Assay (ELISA). MATERIALS AND METHODS: Salivary and blood samples were collected from 40 seropositive and 40 seronegative patients of hepatitis B viral infection and were subjected to ELISA test for hepatitis B surface antigen. Mann-Whitney U test was used to test the statistical significance and Kappa (K) statistic was used to assess the degree of agreement between serum and oral fluid samples. The p-value <0.05 was considered as significant value. RESULT: A sensitivity and specificity of 100% of oral fluid assay was obtained for the diagnosis of hepatitis B infection. The degree of agreement between saliva and serum for detection of hepatitis B was found to be perfect (Kappa value =1). CONCLUSION: Oral fluid testing can be an interesting, alternative for hepatitis B infection for diagnosis and screening for epidemiological purposes. Further research necessitates for the implementation of saliva as a diagnostic tool.

Gutkha Addiction: Nicotine Dependence or a Conditioned Reflex?

BACKGROUND: A pre-packaged mixture of areca nut, tobacco, slaked lime, catechu, and flavoring agents is popularly known as Gutkha. Aim of study is to analyze the addiction biology of Gutkha chewing and to assess efficacy of a cessation program based on nicotine replacement therapy (NRT). MATERIALS AND METHODS: Patterns of addiction of 400 Gutkha chewers were analyzed with a questionnaire-based survey. Urine cotinine levels of 60 subjects undergoing NRT were periodically estimated using gas chromatography. RESULTS: Mean urine cotinine levels of relapse and relapse-free cases were 5800.38 µg/g of creatine and 5622.16 µg/g of creatine. The difference was not found to be statistically significant. A 83.3% of the subjects associated their chewing habit with day to day activities. Overall relapse rate was found to be 79%. The most common reported reason for relapse was unacceptable taste and form of nicotine chewing gums. CONCLUSION: Repetitive coexistence in time of an indifferent act and the act of chewing Gutkha where, the act of chewing is almost always preceded by the indifferent act sets in a conditioned reflex. Gutkha addiction can be considered as a form of conditioned reflex, rather than actual craving for nicotine.

Exploratory Study to Evaluate Changes in Serum Lipid Levels as Early Diagnostic and/or Prognostic Indicators for Oral Submucous Fibrosis and Cancer among Gutkha Consumers in India.

BACKGROUND: In India smokeless tobacco users account for 25.9% of total tobacco use, Gutkha being the most common form. This study evaluated the association between serum lipid profile and Gutkha use as an early diagnostic and/or prognostic indicator for oral submucous fibrosis (OSMF) and oral cancer (Oral Ca) in non-smokers and non-alcohol consumers. MATERIALS AND METHODS: A total of 163 participants were recruited from two sites in India. Participants were divided into four groups: individuals without any Gutkha chewing habit and without any oral lesions (control group), individuals with Gutkha chewing habit but without any oral lesions (GWL), patients with a confirmed clinical diagnosis of OSMF, and patients with a confirmed diagnosis of Oral Ca. Mixed linear modelling (MLM) was conducted to detect the change in mean serum lipid levels among four groups. RESULTS: The sample consisted of 69% males and 31% females. Results of MLM show an inverse relationship between serum lipid levels in OSMF, and Oral Ca groups when compared to the control group. CONCLUSIONS: The results of our study demonstrated that GWL, OSMF and Oral Ca patients had lower serum lipid levels. Low serum lipid levels could be an indicator of initial neoplastic changes in oral cancer.