Is nonsurgical management effective in temporomandibular joint disorders? - A systematic review and meta-analysis.

BACKGROUND: Various nonsurgical interventions have been used for the management of patients with temporomandibular joint (TMJ) disorders, but their clinical effectiveness remains unclear. Hence, the purpose of this systematic review and meta-analyses was to assess the evidence of the effectiveness of nonsurgical interventions in the management of TMJ disorders. MATERIALS AND METHODS: A literature search on five databases such as PubMed, PubMed Central Cochrane, TRIP, NGCH databases and hand searching was conducted for a period from October 1995 to 2015. Randomized control trials (RCTs) on the nonsurgical management of TMJ disorders were included and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the articles was assessed by JADAD scoring. Finally, out of 23 RCTs, 11 articles having any of the primary outcomes (pain pressure threshold [PPT], pain, maximal pain-free mouth opening, and level of dysfunction) were selected. The extracted data were analyzed using NCSS software. RESULTS: The results showed the evidence of pain reduction (P = 0.00), maximal pain-free mouth opening (P = 0.0138), and decrease in level of dysfunction (P = 0.0007) but no improvement in PPT to a significant level (P = 0.6600). CONCLUSION: Our results suggest that the simplest, cost-effective nonsurgical treatments have a positive therapeutic effect on the initial management of TMJ disorders. However, a consistent methodology recording both the objective and subjective outcomes would be a better choice for added reliability.

Juvenile primary extranasopharyngeal angiofibroma, presenting as cheek swelling.

Angiofibroma is a locally advancing immensely vascular tumor that essentially arises from the nasopharynx. The clinical characteristics of extranasopharyngeal angiofibroma (ENA) do not accord to that of nasopharyngeal angiofibroma and can present a diagnostic confront. We describe a case of primary juvenile ENA in a 19-year-old patient who presented with a rapidly enlarging mass of the cheek region. The case is unusual because of its anatomic location. The diagnostic and management particulars are sketched.

Expression of ß1integrin in normal epithelium, oral submucous fibrosis and oral squamous cell carcinoma.

INTRODUCTION AND AIMS: The possible reason suggested for epithelial atrophy in oral submucous fibrosis (OSMF) is ischemia. Dysregulation in the epithelial proliferation and maturation is also thought to be a cause. The ß1 integrin identifies the oral epithelial stem cells. The changes induced by the arecanut on these cells may result in epithelial alterations. The aim of this study is to evaluate the stem cells distribution and percentage by assessing the ß1 integrin expression. MATERIALS AND METHODS: The study included normal oral mucosa (15 cases) and disease group (97 cases). The disease group was further subdivided into early (29 cases), moderate (34 cases), advanced OSMF (18 cases) and oral squamous cell carcinoma(OSCC) associated with OSMF (16 cases). The tissues were stained for ß1 integrin antibodies. The positive cells and staining intensities were analysed to determine the staining index, and statistically evaluated using KW test statistics. RESULTS: ß1 integrin was observed in retepegs region and the percentage of positive cells was 14%- 30% in the control. In OSMF, the ß1 integrin positivity was observed in basal and suprabasal layers, and the percentage was ranged from 2%-71%. ß1 integrin expression in OSCC was observed both in central and peripheral cells and ranged from 17%-85%. On comparison, the difference in staining index among normal, OSMF and carcinomas was significant at p<0.01. The stem cells percentage was increased both in OSMF and carcinomas. The non-dysplastic epithelium of OSMF with severe atrophy showed lowest percentage. It is inferred that absence of stem cells and proliferation may attribute for the atrophy.

Marfan Syndrome.

Marfan syndrome (MFS) is the autosomal dominant-inherited multisystem connective-tissue disorder, with a reported incidence of 1 in 10,000 individuals and equal distribution in both genders. The main clinical manifestation of this disorder consists of an exaggerated length of the upper and lower limbs, hyperlaxity, scoliosis, alterations in the cardiovascular and pulmonary systems, and atypical bone overgrowth. Orofacial manifestations such as high-arched palate, hypodontia, long narrow teeth, bifid uvula, mandibular prognathism, and temporomandibular disorders are also common. Early diagnosis of MFS is essential to prevent the cardiovascular complications and treatment of orofacial manifestations, thus to increase the quality of life of the patient.

Comparative evaluation of serum and salivary immunoglobulin G and A levels with total serum protein in oral submucous fibrosis patients: A case control study.

AIM AND OBJECTIVE: The objective of this study is to estimate and compare the serum and salivary immunoglobulin G and A (IgG, IgA) levels in various stages of oral submucous fibrosis (OSMF) patients and relate it to total serum protein (TSP) and hemoglobin (Hb) levels. MATERIALS AND METHODS: The sample for the present study comprised a total of 20 healthy controls, 20 OSMF patients. About 5 ml of blood and 2 ml of saliva were collected. Quantitative analysis of serum and salivary IgG, IgA was done by turbidometric immunoassay. TSP and Hb were estimated by Biuret and cyanmethemoglobin methods, respectively. RESULTS: Serum and salivary IgA and IgG levels were statistically significantly increased (P < 0.001) in OSMF patients when compared to controls. Also serum and salivary IgG and IgA levels showed significantly increased (P < 0.01) in all the three staging of OSMF when compared to control group. Hb levels and TSP levels were significantly decreased (P < 0.001) in OSMF patients when compared to controls. One-way ANOVA, Pearson's correlation, and unpaired t-test were used for statistical analysis. CONCLUSION: The elevated levels of IgG and IgA are also in favor of polygammapathy, which are nonspecific and nondiagnostic objective reflections of an underlying disease. Decreased TSP is a result of host response and Hb, acts as an indicator of nutritional status plays an important role. It is also observed from the present study that the severity of OSMF was directly proportional to the estimated elevated levels of the major IgG and IgA. A need is also felt for the knowledge of immunoprofile estimation in etiology and pathogenesis that would prove a great asset in the proper assessment of this condition.

Large radiopaque lesion in the posterior mandible: A challenging case.

Radiopaque lesions of the jawbones are frequently encountered in dental radiographs. A variety of conditions such as chronic inflammation, soft tissue calcifications, fibrosseous lesions, odontogenic tumors, and bone neoplasms can manifest as radiopaque lesions on the jawbones. These radiopaque lesions are often difficult to distinguish from each other, hence making the formulation of differential diagnosis challenging. A thorough patient's history and clinical examination supplemented by appropriate investigations will enable the clinician in narrowing down the differential diagnosis and to identify the condition accurately. Presented here is a case of the large radiopaque lesion on posterior mandible surrounded by lytic areas in a 20-year-old male patient.

Caspase-3 expression in normal oral epithelium, oral submucous fibrosis and oral squamous cell carcinoma.

CONTEXT: The epithelium atrophy, as the oral submucous fibrosis (OSMF) progresses, is believed to be an after effect of stromal fibrosis, hyalinization, decrease in vascularity and cellularity and is considered as "ischemic atrophy." Due to hypoxia, caspase-3 get activation and subsequent decrease in viable cell count can occur. AIMS AND OBJECTIVES: To determine caspase-3 expression in various grades of OSMF and oral squamous cell carcinoma (OSCC) to find out whether upregulation of apoptosis is responsible for the epithelial changes in OSMF. SUBJECTS AND METHODS: The control tissue (15 samples from normal oral mucosa) and study group comprising 97 cases of OSMF of different grades and OSCC associated with OSMF were stained with caspase-3 antibody, and the percentage of positive cells was calculated using ImageJ software. STATISTICAL ANALYSIS: The results obtained were statistically analyzed using ANOVA and Tukey's honest significance difference test and Mann-Whitney U-test. RESULTS: There was a nuclear expression of caspase-3 in basal and parabasal layers of normal epithelium. There was cytoplasmic expression of caspase-3 in OSMF without dysplasia, total absence of caspase-3 expression in dysplastic epithelium and in majority cases of OSCC. The caspase-3 percentage was increased in OSMF (0%-53%) when compared with OSCC (0%-8%). The statistical comparison of caspase-3 among normal, OSMF and OSCC patients revealed significant correlation (P < 0.00010). The comparison within different grades of OSMF and between dysplastic and nondysplastic epithelium OSMF also showed significance (P < 0.019). CONCLUSIONS: The decreased expression of caspase-3 in disease progression reflects its role in the malignant transformation.

Evaluation of oxidant-antioxidant status in tissue samples in oral cancer: A case control study.

BACKGROUND: Imbalances between the oxidant-antioxidant status have been implicated in the pathogenesis of several diseases, including cancer. The aim of this study was to evaluate the extent of lipid peroxidation and antioxidants in the tissue samples of oral squamous cell carcinoma (OSCC) patients of different clinical stages in comparison with the healthy controls. MATERIALS AND METHODS: A case-control study was designed with 20 new histopathologically proven oral carcinoma patients and an equal number of age, sex, and tobacco chewing habit matched healthy subjects. Their tissue samples were subjected to evaluation of lipid peroxidation product and antioxidant enzymes, namely, superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), and glutathione peroxidase (GPx) using spectrophotometric methods. The data are expressed as mean ± standard deviation. The statistical comparisons between the study groups were performed by independent Student's unpaired t-test and one-way analysis of variance. Post-hoc analysis was performed for within study group comparisons. Karl Pearson correlation was performed for the biochemical parameters within the group and between the groups. For statistically significant correlations, simple linear regression was performed using SPSS (α=0.05). RESULTS: Significant reduction in lipid peroxidation (P < 0.001) SOD and CAT (P < 0.001) was observed in the tissue of OSCC patients as compared with the healthy controls. On the other hand, reduced GSH and GPx were significantly increased in tumor samples. CONCLUSION: Reduced lipid peroxidation and increased activity of reduced GSH and GPx provides the suitable environment for the local growth and invasion of the tumor and metastasis in the later stages. Among the antioxidant enzymes, GSH reductase appears to have a profound role in carcinogenesis and thus it can be considered as potential prognostic marker.

Reliability of lip prints in personal identification: An inter-racial pilot study.

CONTEXT: Forensic science is a branch of science that deals with the application of science and technology in solving a crime and this requires a multidisciplinary team effort. The word "Forensic" is derived from the Latin word, "Forensis" which means the study of public. Dental professionals should develop interests in contributing to legal issues. AIMS: To study the lip prints among people of different races. SETTINGS AND DESIGN: Descriptive study. SUBJECTS AND METHODS: The present study comprised of ninety subjects of which Group A comprised of Africans, Group B comprised of Dravidian, and Group C of Mongoloid race. Each group was then further divided into 15 males and 15 females for whom the lip prints were recorded and evaluated. STATISTICAL ANALYSIS USED: ANOVA test. RESULTS: ANOVA statistical analysis was used to compare three races of African, Dravidian, and Mongoloid races. The observed data among male and female were found to be significant with a P = 0.000492. CONCLUSION: The present study showed a significant difference in lip pattern among the three races. Perhaps future studies with a larger sample size and comparison between many other races may be done for better personal identification.

Effect of copper-based fungicide (bordeaux mixture) spray on the total copper content of areca nut: Implications in increasing prevalence of oral submucous fibrosis.

BACKGROUND: Potentially malignant disorders like oral submucous fibrosis (OSMF) often precede oral squamous cell carcinoma (OSCC). The rate of transformation of OSMF to OSCC ranges from 3 to 19%. OSMF is etiologically related to chewing of areca nut (betel nut), and the high copper content in areca nut plays an important role in the pathogenesis of the disorder. Even though many studies estimated and confirmed increased copper levels in areca nuts, studies tracing the source of the increased copper content are scarce. Interestingly, on review of agricultural literature, it was found that most of the areca nut plantations in South India commonly use a copper-based fungicide, bordeaux mixture (BM). AIM: The aim of the study was to estimate and compare the copper content in areca nuts from plantations with and without copper-based fungicide usage. MATERIALS AND METHODS: Four areca nut plantations from Dakshina Kannada district, Karnataka (group A) and four plantations from Ernakulam district, Kerala (group B) were selected for the study. The plantations from Karnataka used copper-based fungicide regularly, whereas the latter were devoid of it. Areca nut samples of three different maturities (unripe, ripe, and exfoliated) obtained from all plantations were dehusked, ground, and subjected to atomic absorption spectrometry (AAS) for copper analysis. RESULTS: There was statistically significant difference in the copper content of areca nuts from both groups. The areca nuts from plantations treated with copper-based fungicide showed significantly higher copper levels in all maturity levels compared to their counterparts in the other group (P < 0.05). CONCLUSIONS: The high copper content in areca nut may be related to the copper-based fungicide treatment on the palms. These areca nuts with high copper content used in quid or commercial products may be responsible for the increasing prevalence of OSMF.

Nonsurgical management of vascular malformation of masseter.

Intramuscular vascular anomalies are rare congenital hamartomatous lesions. Less than 1% of these occur in skeletal muscle out of which 15% arise in head and neck musculature. In the head and neck region, masseter muscle is the most common site. It accounts for about 5% of intramuscular vascular malformations. They are present from birth but are clinically apparent during infancy and childhood and occasionally during adulthood. Due to its location it is often mistaken for a parotid swelling. The usual treatment of choice is surgical excision with a margin. This is associated with loss of motor function, hemorrhage, nerve damage. Intralesional sclerotherapy, embolization are nonsurgical alternatives for treatment of slow flow venous malformations. Sclerotherapy can be used solely in multiple sittings or as an adjunct to surgery. This article presents a case report of a 28-year-old male with recurrent intramuscular vascular malformation in the masseter muscle, which was successfully treated by ethanol sclerotherapy.

Serotype specific polymerase chain reaction identifies a higher prevalence of streptococcus mutans serotype k and e in a random group of children with dental caries from the Southern region of India.

BACKGROUND: The development of dental caries has been associated with the oral prevalence of Streptococcus mutans. Four serotypes of S. mutans have been reported, namely serotype c, e, f, and k that are classified based on the composition and linkages of cell wall polysaccharides, response to physiological reactions, sero-specificity and 16s rRNA homology. Although the oral prevalence of S. mutans serotype c in Indian subjects with or without caries is known, the prevalence of the other three serotypes, e, f, and k are not known. Hence in this study, we have investigated the occurrence of the e, f, and k serotypes in children with or without caries within the age group of 6-12 years. MATERIALS AND METHODS: Genomic DNA isolated from whole saliva of caries active (CA) and caries free (CF) groups were first screened for the presence of S. mutans by strain specific polymerase chain reaction (PCR). Those samples that tested positive for the presence of S. mutans were further analyzed by serotype specific PCR to identify the prevalence of the serotypes. RESULTS: Strain specific PCR indicated a higher prevalence of S. mutans in CA group (80%) relative to CF group (43%). Further analysis of the S. mutans positive samples in both groups indicated a higher prevalence of serotype k and e, followed by serotype f in CA group. CONCLUSION: The present data clearly establishes a novel S. mutans serotype prevalence hierarchy in children from this region, compared with those that have been reported elsewhere. Besides, the data are also clinically significant as the occurrence of serotype k has been associated with infective endocarditis.

Traumatic myositis ossificans of the masseter muscle: a case report with conventional and advanced imaging features.

Myositis ossificans of the head and neck is a rare heterotopic, nonneoplastic bone formation within a muscle. Traumatic myositis ossificans (TMO), also known as myositis ossificans circumscripta, is the most common form, resulting in muscle ossification after trauma or hematoma. This article presents a case of TMO in the left masseter muscle of a 26-year-old male patient who suffered from epilepsy. The various types of myositis ossificans, its epidemiology, pathogenesis, differential diagnoses, and various treatment modalities are outlined.

Oxidant-antioxidant status in tissue samples of oral leukoplakia.

BACKGROUND: Imbalances between the oxidant-antioxidant status have been implicated in the pathogenesis of several diseases, including oral cancer. Majority of oral cancer are preceded by a well-recognized group of pre-malignant lesions. However, only a small fraction of those lesions, undergo malignant transformation. Hence, there is a great need to identify biological markers, which will assist in identifying lesion carrying high-risk. This study aims to evaluate and compare the status of oxidative stress and antioxidant enzymes in tissue samples of patients with various clinicopathological stages of oral pre-malignancy. MATERIALS AND METHODS: A case control study consisting of 20 new histopathologically proven leukoplakia patients and equal number of age, sex, and habit matched healthy subjects were recruited for this study. Their tissue samples were subjected to evaluation of lipid peroxidation product, thiobarbituric acid reactive substances and antioxidant enzymes, namely, superoxide dismutase (SOD), catalase (CAT), reduced glutathione (GSH), and glutathione peroxidase (GPx) using spectrophotometric methods. The data are expressed as mean ± standard deviation. The statistical comparisons were performed by independent Student's unpaired t-test and one-way analysis of variance. Pearson's correlation was performed for the biochemical parameters within the group and between the groups. For statistically significant correlations, simple linear regression was performed. P- value < 0.05 was considered statistically significant. RESULTS: Significant reduction in lipid peroxidation (P < 0.001) SOD and CAT (P < 0.001) was observed in the tissue of leukoplakia patients as compared to the healthy controls. On the other hand, GSH and GPx were significantly increased in tumor samples. CONCLUSION: Reduced lipid peroxidation and increased activity of GSH and GPx provides the suitable environment for the tumor growth and malignant transformation in the later stages. Among the antioxidant enzymes, glutathione reductase appears to have a profound role in carcinogenesis.

Slow growing, painful, nodular swelling on the buccal mucosa: a case report.

Nodular swellings of the oral cavity are frequently encountered in dental practice. The disease processes that give rise to nodular swellings in the oral cavity include inflammatory hyperplasias, obstructive minor salivary gland disorders, infections, benign connective tissue neoplasms and salivary gland neoplasms. Understandably, the nature of these entities also varies significantly, ranging from very innocuous to aggressive lesions, underscoring the need for accurate diagnosis.

Estimation and Comparison of Copper Content in Raw Areca Nuts and Commercial Areca Nut Products: Implications in Increasing Prevalence of Oral Submucous Fibrosis (OSMF).

BACKGROUND: Oral Squamous cell carcinoma (OSCC) is often preceded by potentially malignant disorders (PMDs) like oral submucous fibrosis (OSMF). The rate of transformation of OSMF to OSCC ranges from 3 to 19%. OSMF is etiologically related to chewing of areca nut (betel nut), a habit prevalent among the population groups in south-east Asia. Along with alkaloids, the high copper content in areca nut plays an important role in the pathogenesis of OSMF. The increased prevalence of OSMF in the last two decades or so corresponds with the increased processing and commercialization of areca nut products. AIM: The aim of the study was to estimate and compare the copper content of raw areca nuts in three different stages of maturity, and commercial areca nut products. MATERIALS AND METHODS: Raw areca nut samples of three different maturities were obtained from four plantations in Sullia, Karnataka, India and commercial areca nut products were obtained from local shops in Chidambaram, Tamil Nadu, India. The samples were grounded and subjected to Atomic Absorption Spectrometry (AAS) for copper analysis. RESULTS: There was statistically significant difference in copper content in raw areca nuts of all three maturities (p<0.05) and was highest in the exfoliated mature nuts. Importantly copper level was significantly higher in the commercial products compared to raw areca nuts of different degrees of maturity (p<0.05). CONCLUSIONS: The copper levels in commercial products are significantly higher than that of raw areca nuts in all three stages of maturity. The increase in copper content on processing and post commercialization can be related to the increasing prevalence of OSMF.

A rare clinical case of true hemifacial hyperplasia.

Hemifacial hyperplasia (HFH) is an unusual congenital anomaly of debatable aetiology. It is characterised by facial asymmetry that is caused by a marked unilateral and localised overgrowth of facial soft tissues, bones and teeth. We report a case of true HFH with typical manifestations with a brief review of the clinical features and radiological findings associated with HFH, the differential diagnoses that should be considered and the available treatment options for HFH. It is hoped that this report will supplement the existing literature on this anomaly.

PICA.

"PICA" means perverted appetite for substances not fit as food or of no nutritional value such as, bricks, clay, soil, ice, laundry starch, etc. The word ''PICA'' is derived from Latin word for Magpie, a species of bird that feeds on whatever it encounters. ''PICA'' has been observed in ethnic groups worldwide in primitive and modern cultures, in both sexes and in all age groups. The case presented here reports a 30 year old female patient who had craving for ingestion of gravel and brick fragments since the age of 13 years. Iron deficiency anemia was found after complete blood count and iron studies. The diagnosis of "PICA" requires that the patient is persistently eating non-food substances for at least 1 month and such behavior is appropriate for the child's stage of development.

A Case control study to evaluate oxidative stress in plasma samples of oral malignancy.

BACKGROUND: Imbalances between the oxidant -antioxidant status have been implicated in the pathogenesis of several diseases, including cancer. AIM: The aim of this study was to evaluate the extent of lipid peroxidation and antioxidants in the venous blood samples of oral squamous cell carcinoma patients of different Clinicopathologic stages in comparison with the healthy controls. SETTING AND DESIGN: A Case control study was designed in a hospital (Rajah Muthiah Dental College and Hospital, Annamalai University) based setting. MATERIALS AND METHODS: Twenty new histopathologically proven oral carcinoma patients, and equal number of age, sex and habit matched healthy subjects were recruited for this study. Their blood samples were subjected to evaluation of Thiobarbituric Acid Reactive Substances (TBARS) and antioxidant enzymes, namely, superoxide dismutase (SOD), Catalase (CAT) reduced glutathione (GSH) and glutathione peroxidase (GPx) using spectrophotometric methods. STATISTICAL ANALYSIS: The data are expressed as mean±SD. The statistical comparisons were performed by independent Student's t-test and One Way ANOVA. P value <0.05 was considered statistically significant. Karl Pearson correlation was performed for the biochemical parameters within the group and between the groups. For statistically significant correlations, linear regression was performed. RESULTS: Significant enhanced lipid peroxidation (P<0.001) with decrease in antioxidants (P<0.001) was observed in the venous blood of oral squamous cell carcinoma patients as compared with the healthy controls. Accordingly, significant (P<0.001) pattern of progression in TBARS levels was observed at various clinical stages of patients. (GSH) showed significant (P<0.01) negative correlation with TBARS and positive correlation (P<0.001) with SOD. On linear regression analysis, GSH showed significance for SOD (P<0.001), GPx, CAT and TBARS (P<0.01). It was also found that, 70% of variance in SOD can be attributed to the influence of GSH alone. CONCLUSION: Enhanced lipid peroxidation and compromised antioxidant defense in plasma indicate development of oxidative stress. Amongst the antioxidant enzymes, (GSH) appears to have a profound role in carcinogenesis.

Autosomal-dominant osteopetrosis: an incidental finding.

Osteopetrosis is a descriptive term that refers to a group of rare, heritable disorders of the skeleton. Osteopetrotic conditions vary greatly in their presentation and severity, from just as an incidental finding on radiographs to causing life-threatening complications such as bone marrow suppression. It is caused by failure of osteoclast development and function. Osteopetrosis can be inherited as autosomal-recessive, autosomal-dominant or as X-linked traits, with the most severe forms being the autosomal-recessive ones. The severity of the disease is mild to moderate in the autosomal-dominant forms, with normal life expectancy. Diagnosis is largely based on clinical and radiographic evaluation. The present paper reports a case of autosomal-dominant osteopetrosis complicated by osteomyelitis with a short review of the condition.