Expression of CD 20 B-Lymphocyte in oral epithelial dysplasia and oral squamous cell carcinoma: A comparative immunohistochemistry study.

Background: As the progressive trends in the field of immunotherapy, it is very favourable to reconsider the role played by B lymphocytes in the tumor microenvironment. Both the protumorogenic and antitumorogenic responses have to be evaluated to formulate an effective immunotherapeutic protocol. Aim and objective: The study was primarily conducted to assess the qualitative expression of B lymphocytes in pretumorogenic (oral epithelial dysplasia) and tumorogenic environment (oral squamous cell carcinoma). The differential immunohistochemical staining of CD 20 immune marker was assessed in about 60 cases that included 30 cases of oral epithelial dysplasia and 30 cases of oral squamous cell carcinoma. Results: The study found significant correlation between CD 20 IHC immune expression and histopathological diagnosis along with significant correlation between the subject's age group and histopathological diagnosis. Conclusion: Modulating the immune response in a precancerous state can be highly beneficial in implementing better immunotherapeutic strategies to treat or prevent malignancy at an early stage.

Reliability of palatal rugae patterns in individual identification.

Background: Dental identification plays a major role in mass disaster identification of human remains. Palatal rugae can be used as a substitute for a comparative method of identification. Materials and Methods: The present cross-sectional study was done with 137 pre- and post-orthodontically treated casts of patients, which were divided into 50 cases each of extraction and nonextraction and 37 cases of palatal expansion involving both extraction and nonextraction. Hydrocolloid (alginate) impression of the upper jaw of the patient was taken and then cast in the dental plaster of Paris material. Palatal rugae pattern was classified according to Lysellm, and Thomas and Kotze classification. Two Observers recorded the data, mean of two were taken for analysis. Results: On the right side, there was no significant difference between the extraction and nonextraction groups; however, there was a rise in length in the nonextraction and palatal expansion groups. On the left side, there was little change between the nonextraction and palatal expansion groups, but the extraction group had a modest increase in length. Mean lengths compared within three groups revealed insignificant difference. Conclusion: Palatal rugae pattern can be used in establishing identity in forensic medicine provided antemortem data are available. Orthodontic treatment has an impact on stability of palatal rugae. Most reliable and stable points being third rugae, they could be used as reference points to evaluate tooth movements.

Immunohistochemical study of α-smooth muscle actin expression in oral leukoplakia and oral squamous cell carcinoma.

CONTEXT: It is important to evaluate the role of stromal myofibroblasts (MFs) in carcinogenesis and also as a predictive marker for lymph node (LN) metastasis at the invasive front of oral squamous cell carcinoma (OSCC). AIMS: To demonstrate the expression of α-smooth muscle actin (α-SMA) by MFs in the tissues of oral leukoplakia (OL) with dysplasia and OSCC. To record and compare the distribution of MFs in OSCC with LN metastasis and without LN metastasis. SETTINGS AND DESIGN: Fifty paraffin-embedded tissue blocks with 10 cases of normal oral mucosa, 10 cases of OL with dysplasia and 30 diagnosed cases of OSCCs were studied. SUBJECTS AND METHODS: The samples were subjected to heat-induced antigen retrieval method followed by staining using primary mouse monoclonal antibodies against α-SMA and visualized using super sensitive polymer-HRP detection system. STATISTICAL ANALYSIS: Descriptive statistical analysis and ANOVA test were used for statistical analysis. RESULTS: There was no α-SMA expression in normal oral mucosa or in OL with dysplasia. All tissues of OSCC were positive for α-SMA expression. The difference in the expression between OL with dysplasia and OSCC was statistically significant (P < 0.05). The mean α-SMA count of OSCC with LN metastasis is significantly greater than in the OSCC without LN metastasis (P = 0.001). In OSCC without LN metastasis, focal and spindle patterns were predominant and in OSCC with LN metastasis network pattern was more. CONCLUSION: α-SMA expression by MFs in OSCCs indicates its role in tumor growth and invasion. The mean α-SMA count was found to correlate with tumor invasiveness and locoregional LN metastasis.

Forensic odontology as a humanitarian tool.

Humanitarian forensic action is the application of skills of forensic science in a conflicts or disasters as a humanitarian action. Forensic odontologist promote forensic odontology and forensic science principles to caseworks with the purpose of preventing human right violation by human identification, age estimation and where ever dental evidence is involved. Forensic odontologist is involved in all phases of disaster victim identification. According to Disaster Victim Identification Guide, if a positive match is found using dental identification it can be trusted as a standalone identifier. Dental structures are well protected and the hardest structure of the body. They resist decomposition and high temperatures and are the last one to disintegrate after death. Dental hard tissue provide abundant information in disaster victim identification, missing and unidentified persons, child abuse and neglect, domestic violence and sexual abuse with bite mark evidence, age estimation of unaccompanied minors, border control and human trafficking. The present article highlights the role of forensic odontologist in human identification for the purpose of preventing human rights violation.

Odontogenic keratocyst arising in the maxillary sinus: A rare case report.

Odontogenic keratocyst is an aggressive cystic lesion and a common type of tooth derived cyst due to presence of odontogenic epithelial remnants in different regions of jaw. In majority of cases, it is located in mandibular posterior region. But it can also be found in the maxilla especially in the canine region. We present a rare case of OKC in maxillary sinus which associated with ectopic third molar. Also, it can be easily confused with other lesions of maxillary sinus like sinusitis or antral polyps, which usually resemble symptomatically. There can be malignant transformation of this benign condition towards squamous cell carcinoma or ameloblastoma. So an early and accurate diagnosis of odontogenic keratocyst is a challenge for pathologists.

Immunohistochemical study of alpha-smooth muscle actin in odontogenic cysts and tumors.

CONTEXT: Myofibroblasts (MFs) are fibroblasts with smooth muscle-like features characterized by the presence of a contractile apparatus. Alpha-smooth muscle actin (α-SMA) is the actin isoform that predominates within vascular smooth muscle cells and plays an important role in fibrogenesis. MFs are metabolically and morphologically distinctive fibroblasts expressing α-SMA, and their activation plays a key role in development of the fibrotic response. AIMS AND OBJECTIVES: The aim of this study is to demonstrate the frequency, distribution and expression of α-SMA-positive MFs in odontogenic keratocyst (OKC), dentigerous cyst (DC) and ameloblastoma and correlate it to their aggressive biological behavior. SETTINGS AND DESIGN: A retrospective study of 45 diagnosed cases, which includes 15 cases of OKC, 15 cases of DC and 15 cases of ameloblastoma, was undertaken to demonstrate expression of α-SMA retrieved from archives of our department. MATERIALS AND METHODS: α-SMA mouse anti-human antibody and horseradish peroxidase detection system were used in this study. STATISTICAL ANALYSIS: Descriptive statistical analysis and ANOVA test were used for statistical analysis. RESULTS: The difference in mean α-SMA count was found to be statistically significant between ameloblastoma and DC group (P < 0.001) as well as OKC and DC group (P < 0.001). No significant difference is observed between ameloblastoma and OKC group (P > 0.05). Results showed that mean number of stromal MFs in OKC and ameloblastoma were significantly higher than DC. CONCLUSION: The present study has shown that the mean number of MFs was higher in OKC and ameloblastoma, while the mean number of MFs in DC was quite low and significantly different from that of ameloblastoma and OKC.

Role of mast cells in inflammatory and reactive pathologies of pulp, periapical area and periodontium.

Mast cells (MCs) have been discovered over 130 years ago; their function was almost exclusively linked to allergic affections. At the time being, it is well known that MCs possess a great variety of roles, in both physiologic and pathologic conditions. In the oral tissues, MCs release different pro-inflammatory cytokines and tumor necrosis factor-alpha that promote leukocyte infiltration in various inflammatory states of the oral cavity. These cells play a key role in the inflammatory process and, as a consequence, their number changes in different pathologic conditions of the oral cavity, such as gingivitis and periodontitis. By understanding the role of MCs in the pathogenesis of different inflammatory diseases of the oral cavity, these cells may become therapeutic targets that could possibly improve the prognosis. Therefore, this review summarizes the current understanding of the role of MCs in various inflammatory pulpal, periapical and periodontal pathophysiological conditions.

The cusp of Carabelli: Frequency, distribution and type in the Bengaluru population.

AIMS: Detailed description and study of teeth traits could provide valuable information regarding phylogeny of man and distinctions between races and subraces. But morphological variations of the human dentition have not been utilized to their full potential by anthropologists concerned with patterns of human biological variation in Indian population. The aim of the present study is to detect the frequency and degree of expression of Carabelli's trait in Bengaluru population, this helps to develop a probabilistic model to distinguish individuals from specific human populations, particularly for forensic purposes. MATERIALS AND METHODS: A total number 400of age and sex matched individuals from four different ethnic groups - Hindu, Islam, Christian and Iranians were examined clinically and study casts were made. Permanent maxillary first molars were examined for the expression of Carabelli's trait, Dahlberg classification system was used to score the trait on the teeth. The scores were recorded on Osteoware Dental Morphology software. The cast were examined by 2 observers independently to eliminate intra observer variation in interpretation and mean of 2 was taken for analysis. The data so obtained was statistically analysed especially emphasizing on differences between above mentioned 4 ethnic groups. RESULTS: Cusp of Carabelli was present in 87% of the study population in maxillary first permanent molar. Type 3 was the most frequently expressed and Type 6 was the least frequently expressed and both type being expressed in Islamic groups. The expression of trait was bilateral in 90% of the surveyed groups. CONCLUSIONS: It was concluded that the prevalence of cusp of Carabelli in the small population from Bengaluru considered in the present study was found to possess a high degree of Carabelli trait expression.

Mast cells and angiogenesis in malignant and premalignant oral lesions: An immunohistochemical study.

INTRODUCTION AND OBJECTIVES: Angiogenesis is a complex event facilitated by angiogenic factors released from neoplastic and host immune cells. Among host immune cells, mast cells (MCs) may have greater significance in tumor progression through angiogenesis. The objectives of the study were to evaluate and correlate mast cell density (MCD) and microvessel density (MVD) in normal gingival tissue, leukoplakia with and without dysplasia and oral squamous cell carcinoma (OSCC) cases. MATERIALS AND METHODS: Among eighty selected cases, twenty were of normal gingiva, twenty each of leukoplakia without and with dysplasia and twenty of OSCC. The slides were stained with CD34 and counterstained with 0.1% toluidine blue, followed by quantification of MCD and MVD per high-power field (×40) using Image-Pro Express software. STATISTICAL ANALYSIS: Chi-square test and correlation coefficient were used for statistical analysis. OBSERVATION AND RESULTS: A statistically significant difference in the values of MVD and MCD between normal gingival tissue, leukoplakia with and without dysplasia and OSCC (P = 0.000) was observed. MVD and MCD showed a positive correlation between the study groups. CONCLUSION: MVD and MCD increased significantly in cases of OSCC as compared to leukoplakia with and without dysplasia and normal gingival tissue. It was concluded that MCs may play a significant role in angiogenesis by releasing pro-angiogenic and angiogenic factors which may in turn favor the progression of premalignant lesion to a malignant one.

Epigenetics in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the most common type of oral neoplasm, accounting for over 90% of all oral malignancies and 38% of head and neck tumors. Worldwide, OSCC is the eighth most common human cancer, with more than 500,000 new cases being diagnosed every year with a fairly onerous prognosis, encouraging further research on factors that might modify disease outcome. Genetic and/or environmental risk factors associated with the development of oral cancer have been sufficiently understood (smoking, alcohol, betel, diet, living habits, etc.). Knowledge of the genetic basis in oral carcinogenesis is still a challenging task. To improve the diagnosis and prevention, a previously unknown type of chromatin modification, known as epigenetic, which is defined as heritable DNA changes that are not encoded in the sequence itself and which are reversible and increasingly appear to serve fundamental roles in cell differentiation and development are studied. Tumors shed their DNA into the blood and epigenetic changes that occur early during tumorigenesis, sometimes even in premalignant lesions, can provide valuable biomarkers. Key components involved in epigenetic regulation are DNA methylation, histone modifications and modifications in micro ribonucleic acids (miRNAs). Epigenetic modifications may contribute to aberrant epigenetic mechanisms seen in oral precancers and cancers. In the near future, epigenetic variations found in oral dysplastic cells can act as a molecular fingerprint for malignancies.

Management of squamous cell carcinoma of the maxillary sinus.

Surgical management of malignant tumors disfigures and demoralizes individuals. Management of such patients requires concern humane approach, meticulous planning and judicious management of a case. It is the responsibility of a dentist to restore the lost function, speech and esthetics. This clinical case report signifies the role of the dentist starting from diagnosis, presurgical phase, surgical phase and postsurgical phase of a patient diagnosed with squamous cell carcinoma of the right maxilla.

Pulpal changes associated with advanced periodontal disease: A histopathological study.

INTRODUCTION: Over the past century, the dental literature has consistently reflected a controversy related to the effect of periodontal disease on the dental pulp. Nonetheless, practitioners are of the opinion that teeth having deep periodontal pockets show variable pulpal response, which may necessitate root canal treatment. Thus, this study aimed to evaluate the changes in pulp due to advanced periodontal disease. MATERIALS AND METHODS: Forty caries-free teeth affected with severe periodontitis were collected from patients aged between 18 and 55 years. The collected teeth were stored in formalin for 24 h and were then decalcified and examined histologically after staining with hematoxylin and eosin to note the changes that occurred in pulp. RESULTS: Pulpal calcification (52.62%) and partial necrosis of pulp (52.62%) were found to be the most common findings. Inflammation, which was found in 47.38% of the cases, ranged from mild to severe in most sections and was always chronic. Pulp with complete necrosis was seen in 26.32% of cases. Fibrosis and pulpal edema were seen in 36.84% of cases. CONCLUSION: In the presence of moderate to severe chronic periodontitis, degenerative changes such as inflammation, fibrosis, edema, calcification and necrosis were observed to variable degree.

A quantitative analysis of mast cells in inflammatory periapical and gingival lesions.

AIM: The aim of the study was to quantify the presence of mast cells in various inflammatory lesions like periapical granuloma, periapical cyst, inflammatory gingival hyperplasia and pyogenic granuloma. Mast cell degranulation and association with lymphocytes were also recorded in an attempt to understand the role of mast cells in the pathogenesis of these inflammatory lesions. MATERIALS AND METHODS: The quantification of mast cells was done on toluidine blue stained sections of all the four groups of lesions, using the image analyzer software, Image-Pro-Express (Media Cybernetics, USA). RESULTS: An increased number of mast cells in various inflammatory lesions with a significant difference between the four groups were noted. Mast cell number tended to be greater in the lesions present in the anterior region of the mouth than in the posterior region of the oral cavity. The mean mast cell number decreased with the increasing age which was directly correlated with the age of the patients. Mast cell site, distribution, degranulation and its association with fibroblasts, lymphocytes and blood vessels were noted. CONCLUSION: The location of mast cells in different areas, their association with lymphocytes, fibroblasts, endothelial cells, and the phenomenon of degranulation helps to appreciate the release of various mediators and multiple interactions among these cells, leading to increased vascular permeability, angiogenic response, collagen synthesis, regulation of inflammation, bone resorption, and extracellular matrix destruction, thus contributing to the pathogenesis of these inflammatory lesions.

Expression of maspin in benign and malignant salivary gland tumors: an immunohistochemical study.

CONTEXT: Maspin is a novel serine protease inhibitor (serpin) with multifaceted tumor-suppressive activities. It was originally identified in normal human breast myoepithelial cells and shows variable expression in different types of cancer cells. Maspin displays anti-metastatic properties in mammary and prostate cancer. Its expression is maintained during ovarian, lung and pancreatic carcinogenesis, indicating that Maspin regulated metastatic potential is tissue specific. Thus, it is possible that Maspin participates in salivary gland tumor biology as well. In this study, expression pattern of maspin in benign and malignant salivary gland tumors is analyzed, to understand the biological behavior of salivary gland tumors with respect to maspin expression. AIMS AND OBJECTIVES: The aim of this study was to demonstrate, record, and correlate the expression pattern of maspin in benign and malignant salivary gland tumors. SETTINGS AND DESIGN: A retrospective study of maspin expression in 30 diagnosed cases of benign and malignant salivary gland tumors retrieved from archives of our department. MATERIALS AND METHODS: Anti-maspin antibody and horseradish peroxidase detection system. STATISTICAL ANALYSIS: Descriptive statistical analysis and Chi-square/Fisher Exact test. RESULTS: Intense expression with P < 0.001 is associated with benign tumors, nuclear staining with P < 0.001 is significantly associated with benign tumors and cytoplasmic staining with P = 0.020 is associated with malignant tumors. CONCLUSION: Intensity of expression is more in benign tumors when compared with malignant tumors. The benign tumors showed both nuclear and cytoplasmic expression. Some malignant tumors did express maspin, but mainly in the cytoplasm.