Metamorphosis of Dentigerous cyst: A case Series with Insight into Molecular Profiling.

The objective of this study was to review the clinical, radiologic, and histologic aspects of cases of dentigerous cysts metamorphosing into different entities along with comments on the molecular factors involved in the process. A series comprising 8 cases of dentigerous cysts was performed retrospectively along with a comprehensive literature review. Two cases of dentigerous cyst converting into mucous metaplasia were included, out of which one case was transformed into ameloblastoma after a year. The other two cases were reported as acanthomatous and unicystic ameloblastoma, whereas four transitioned to AOT. The complete review of cases and literature with molecular profiling concluded that the lining of dentigerous cysts has the potential for transforming into benign odontogenic tumors. Therefore, a careful clinical and histopathological examination is crucial for the correct diagnosis. Also, a thorough molecular understanding of the cystic lining is required.

B-cell Follicular Lymphoid Hyperplasia (Pseudolymphoma) of the Oral Cavity: A Diagnostic Quandary.

Pseudolymphoma is a reactive process involving lymphadenopathy, polyclonal proliferation of B or T-cells, simulating oral lymphoma. With its incidence being very rare, only four cases have been reported in oral cavity with the detailed immunocytochemical examination, which can be due to this entity's unawareness, underdiagnosis or overdiagnosis. It is prerogative to perform immunocytochemical investigations to prevent overdiagnosis as lymphoma, which can be debilitating to the patient. Wherein the treatment of pseudolymphoma initially includes topical or intralesional corticosteroid, antibiotics to surgical and radiotherapy based on its etiology. Herein, we discuss B-cell follicular lymphoid hyperplasia previously diagnosed as small round cell tumor.

Comparative assessment of cleaning efficacy of two exclusive paediatric rotary files in root canals of primary teeth: An in vitro study.

BACKGROUND: Paediatric rotary file systems have recently been developed for primary teeth use. AIM: To study the cleaning efficacies of two paediatric rotary endodontic files, the Prime PedoTM , and the Kedo-SG BlueTM against the standard H files. DESIGN: This in vitro study included 54 freshly extracted primary molars, which were randomised into three groups (n = 18 each) and were prepared using either Kedo-SG BlueTM , Prime PedoTM or hand H files after injecting methylene blue dye into the canals. Pre- and post-operative cone beam computerised tomography (CBCT) was performed to assess change in root canal volumes. Methylene blue dye removal from canals was assessed using stereomicroscopy, and canal cleanliness was examined by scanning electron microscopy (SEM). RESULTS: Both Prime PedoTM and Kedo-SG BlueTM files reduced significantly less dentine when compared with conventional hand filing with Prime PedoTM removing the least amount of dentine. No significant difference was found in median SEM scores among the groups in the cervical, middle and apical thirds of the roots. Stereomicroscopic assessment of root canal cleanliness using dye removal technique shows a statistically significant difference existing between Kedo-SG BlueTM and hand H files groups. CONCLUSION: Prime PedoTM removed the least amount of dentine. Kedo-SG BlueTM performed significantly better than conventional hand filing with H files when the root canal cleanliness was assessed.

Role of HIF-1α in Ameloblastoma: A Systematic Review.

Hypoxia-inducible factor-1α is a transcriptional protein that has been extensively researched in human cancers whose overexpression is found to be associated with unfavorable prognosis. Contemporary studies have proved its vital role in ameloblastoma by correlating its expression with the aggressiveness of the tumor. Therefore, an attempt was made to explore its significance in the malignant transformation and prognosis of ameloblastoma. The present systematic review aimed to understand the impact of HIF-1α in AMB which might lead to favorable outcomes in the treatment. An electronic search was carried out using PubMed, Scopus, Google scholar, Cochrane library, and EMBASE databases. Original articles from all languages involving HIF-1α in AMB were scrutinized by two independent authors. Data were compiled and tabulated in Microsoft Excel and the Risk of bias was analyzed using the JBI tool. Twelve eligible articles were included for the quantitative analysis comprising 305 cases of AMB in which HIF-1α expression was studied for various characteristics like pattern, intensity, and site of immunoexpression which were found to be increased with an increase in the aggressiveness of AMB. It was concluded that HIF-1α is proven to have a crucial role in the progression and aggressiveness of AMB. Extended research regarding the crucial role of HIF-1α in the initiation of tumors and therapies aiming at HIF-1α in AMB cases might show promising outcomes in the future.

Primary Follicular Lymphoma of Anterior Maxilla Rectifying the Importance of Diagnostic Algorithm: A Case Report.

Primary Follicular Lymphoma of the oral cavity is one of the rarest variants of non-Hodgkin's lymphoma b-cell subtype. Now a days, increased incidence of extranodal occurrence in oral cavity and its conjoining behavior with epithelial malignancies possess the need for precise and timely diagnosis of the entity to prevent abrupt over-treatment. In this string, we report a case of primary follicular lymphoma of oral cavity which initially masqueraded oral squamous cell carcinoma but later its diagnosis as follicular lymphoma led to early treatment of the patient which led to good prognosis. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03774-6.

Clinicopathological and Molecular Characteristics of Intraosseous Rhabdomyosarcoma Involving Head and Neck Region: A Systematic Review and Meta-Analysis.

Rhabdomyosarcoma with TFCP2 rearrangement is a newly introduced spindle cell neoplasm showing predilection for craniofacial bones exhibiting highly aggressive nature and poor prognosis. Therefore, an attempt was made to delineate the entity for improved understanding and treatment outcomes through comprehensive analysis of the clinicopathological and molecular characteristics. An electronic search was carried out using MEDLINE by PubMed, Scopus, Google scholar, Cochrane library, and EMBASE databases. Original articles and case reports involving intraosseous rhabdomyosarcoma arising in head and neck region with TFCP2 fusion were included. Data were compiled and risk of bias was analyzed using JBI tool. Thirteen eligible articles were included for the quantitative analysis, which revealed 33 cases with TFCP2 fusion. Majority of the affected individuals were females (58%) with mandible being the common site. Most of the patients died within few months after diagnosis demonstrating a low mean survival rate (30 months). Odds ratio, overall survival and disease-free survival were calculated and analyzed statistically concluding that intraosseous rhabdomyosarcomas harboring TFCP2 fusion are found to be novel and dreadful neoplasms. The predilection for young age with poor prognosis exhibited by these lesions demand early diagnosis and specific treatment planning to curtail mortality.

Dendritic cell-based immunotherapy: a potential player in oral cancer therapeutics.

Background & aim: Dendritic cell (DC)-based immunotherapy modulates a patient's immune system for recognition and subsequent removal of tumor cells. DC-mediated anticancer therapy has been considered in several studies/ongoing trials for multiple types of cancer. Our aim is to describe the potential and current status of DC-based immunotherapy in oral cancer therapeutics. Materials & methods: An internet-based literature search with relevant search terms from 2012 to 2022 post-screening resulted in 58 articles that were considered for systematic review. Results & conclusion: Evaluation of DC based immunotherapy exploiting the critical immune cells in well-equipped laboratories with adequately trained and skilled experts along with a synergistic approach that is affordable and approachable to the patients can prove as an efficient anticancer therapy.

Considering the grave scenario of cancer, several studies/ongoing trials have focused on dendritic cell (DC)-mediated anticancer therapy in many types of cancer, including oral cancer. DC-based immunotherapy is a personalized/customized treatment protocol that modulates a patient's immune system to recognize and remove tumor cells by identifying them as foreign. DCs process antigens (present in tumor cells) and present them on MHC class I molecules to CD8+ T cells or MHC class II molecules to CD4+ T cells for an immune response. The literature has evidence exhibiting activation of antigen-specific T cells after injection of antigen-pulsed DCs. In addition, DC-based vaccines have been attempted with successful outcomes in various cancer types. A combination of DCs and other treatment modalities such as immune checkpoint inhibitors appears quite promising. Evaluation of DC based immunotherapy exploiting the critical immune cells in well-equipped laboratories with adequately trained and skilled experts along with a synergistic approach that is affordable and approachable to the patients can prove as an effective anticancer therapy.

Expression and bioinformatics analyses show HSP70 complements BCL2 action in oral carcinogenesis.

Oral squamous cell carcinoma (OSCC) is a major form of oral malignant tumors (oral cancer) with less than 50% five year survival rate. Its pathogenesis involves dysregulation in apoptosis. Early dysregulation at molecular level could not be correlated with clinical presentations because of complex interactions at molecular levels. HSP70 (Heat shock Protein 70) and BCL2 (B cell lymphoma 2) are known molecular players in oncogenesis. However, their interaction is not known till date. Expression analyses of BCL2 and HSP70 was done through Enzyme Linked Immunosorbent Assay (ELISA) and Bioinformatic tools using blood samples from 41 OSCC, 35 Oral Potentially Premalignant Disorders (OPMD) and 4 controls in BCL2 study and 48 OSCC and 32 OPMD cases in HSP70 study. Bioinformatic software showed experimentally determined interaction value of 0.32 amongst the two, predicting similarity in molecular functions or pathways between the two, which was confirmed by ELISA. Our data showed that first HSP70 boosts BCL2 while in later stages of oncogenesis BCL2 consumes HSP70. Both molecules interact at several steps by complementing and supplementing each other. Because of this complex interaction various anti BCL2 therapies have not achieved desired results till date.

Evaluation of salivary oxidative stress in oral lichen planus using malonaldehyde.

Background: Oral lichen planus is a chronic, mucocutaneous, inflammatory disease, with an unknown etiology. Reactive oxygen species and oxidative damage to the tissues might be the cause. Malonaldehyde (MDA), a low molecular weight end product of lipid peroxidation reaction is a suitable biomarker of endogenous DNA damage. monitoring the oxidant-antioxidant status of saliva may serve as an efficient marker of disease development in oral lichen planus patients. Aim and Objectives: To evaluate salivary oxidative stress in oral lichen planus subject using MDA and compare it with control subjects. Furthermore, to compare MDA levels in erosive and hypertrophic lichen planus. Materials and Methods: The current study is case-control study. Unstimulated salivary samples in the morning hours were taken from oral lichen planus subjects (n = 25) and controls subjects without any oral disease (n = 25). The saliva was centrifuged at 900 g for 10 min at a temperature of 4°C. Then, the entire filtrate was transferred to Eppendorf test tubes and frozen at-80°C until analysis. Salivary MDA was done through thiobarbituric acid reactive substance assay as per the protocol laid down by the manufacturer (Sigma Aldrich Lipid Peroxidation Assay Kit). Results: The data were expressed as the mean ± standard deviation and the statistical analysis was done using Student's t-test using SPSS version 21 IBM software. The salivary level of MDA was significantly higher than that of controls (P < 0.05). Conclusion: The higher level of MDA in patients with oral lichen planus suggests that free radicals and the resulting oxidative damage may be important in the pathogenesis of oral lichen planus lesions.

A Systematic Review of Potential Immunotherapies Targeting PRAME in Retinoid Resistant Oral Potentially Malignant Disorders and Oral Cancer.

Backgound and objective: Early chemoprevention in Oral Potentially Malignant Disorders (OPMDs) and Oral Cancer (OC) has been extensively researched in order to mitigate the malignant transformation and progression of the lesion. Many agents have been attempted, but their cost inefficacy and inadequate outcomes posed a major hindrance in their successful adoption. Retinoid Based Therapy (RBT) though a cheap and effective treatment option, could not achieve much clinical usage because of variable responsiveness in clinical outcomes. Such clinical response variability may be attributed to the repression of retinoid receptors by Preferentially Expressed Antigen of Melanoma (PRAME) protein molecule. Therefore, in order to make RBT successful, targeting PRAME by various immunotherapies is an exciting area of research investigation. This review provides an insight into the various immunotherapeutic strategies targeting PRAME and their usefulness in retinoid-resistant OPMD and OC. Method of data collection: An exhaustive internet-based literature search following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was carried out in PUBMED and Google SCHOLAR database using terms 'Anti-PRAME' OR 'PRAME Immunotherapy' OR 'PRAME Vaccines' AND 'Cancer' AND 'Retinoid resistance'. Only articles in the English language with at least 1 citation, published in a journal with impact factor ≥ 1, having relevance to the context and availability of full text were considered. Results: After an initial search, 342 articles were yielded on the basis of inclusion criteria and, by reading the abstract and availability of full text, a total of 124 articles were selected. Further reading the full texts and considering articles from the references of the selected articles, a total of 65 articles were finally included in the review. Conclusion: Our analysis of the literature suggests that PRAME screening in OC and OPMDs prior to RBT should be done. In PRAME positive cases, approaches like PRAME based immunotherapy in the form of Cancer vaccine therapy [Acellular PRAME vaccine, PRAME pulsed Dendritic Cells (DC)]; Adoptive T Cell therapy/T Cell Receptor-T Cell therapy, Antibody therapy/Chimeric Antigen Receptor-T Cell therapy along with Presented antigen modulation Therapies employing histone deacetylase inhibitors and demethylation agents seem plausible. In the future, a combination therapy employing either PRAME vaccines or antibodies or Adoptive T cell Therapy and ATRA could be used in retinoid resistant OC and OPMDs.

Potential of Internet of Medical Things (IoMT) applications in building a smart healthcare system: A systematic review.

Sudden spurting of Corona virus disease (COVID-19) has put the whole healthcare system on high alert. Internet of Medical Things (IoMT) has eased the situation to a great extent, also COVID-19 has motivated scientists to make new 'Smart' healthcare system focusing towards early diagnosis, prevention of spread, education and treatment and facilitate living in the new normal. This review aims to identify the role of IoMT applications in improving healthcare system and to analyze the status of research demonstrating effectiveness of IoMT benefits to the patient and healthcare system along with a brief insight into technologies supplementing IoMT and challenges faced in developing a smart healthcare system. An internet-based search in PUBMED, Google Scholar and IEEE Library for english language publications using relevant terms resulted in 987 articles. After screening title, abstract, and content related to IoMT in healthcare and excluding duplicate articles, 135 articles published in journal with impact factor ≥1 were eligible for inclusion. Also relevant articles from the references of the selected articles were considered. The habituation of IoMT and related technology has resolved several difficulties using remote monitoring, telemedicine, robotics, sensors etc. However mass adoption seems challenging due to factors like privacy and security of data, management of large amount of data, scalability and upgradation etc. Although ample knowledge has been compiled and exchanged, this structured systematic review will help the healthcare practitioners, policymakers/decision makers, scientists and researchers to gauge the applicability of IoMT in healthcare more efficiently.

Diagnostic efficacy of neutrophil to lymphocyte ratio (NLR) in oral potentially malignant disorders and oral cancer.

BACKGROUND AND AIMS: Inflammation is considered to be the seventh hallmark of cancer and plays a pivotal role in all stages of tumor development. Systemic inflammatory responses in particular neutrophil to lymphocyte ratio (NLR) have garnered immense attention of current researchers and its role is well proven in various solid malignancies. Its prognostic role in oral cancer have been extensively studied. However, its diagnostic role is yet to be explored. The current study aims to investigate diagnostic utility of NLR in oral potentially malignant disorders and oral cancer, when compared to normal subjects. METHODS: A total of 150 subjects were involved in the study, a total of 2.5 ml of blood was drawn from the median cubital vein of the patient in an EDTA vial and hematological parameters were assessed using Erba-Transasia B7256 Autoanalyzer and reassessed manually by two experts. STATISTICAL ANALYSIS: The NLR values were recorded and tabulated as Mean ± S.D. and comparisons were analyzed using Kruskal Wallis and Mann Whitney post hoc U test. ROC curve analysis was performed to estimate cut-off values. RESULTS: The NLR values when compared between the 3 groups were statistically significant (P < 0.001). The cut off value between disease and normal subject was 2.33, while the cut-off value between potentially malignant and malignant condition is 3.20. CONCLUSION: NLR can be a valuable diagnostic adjunct in oral cancer and potentially malignant disorders of oral cavity.

Tongue and its ties: Posterior tongue width in gender estimation - A forensic gratuity.

BACKGROUND AND OBJECTIVES: Human identification is one of the challenging areas that man has been confronted with. The forensic odontologist deals with human identification based on unique features of the oral cavity. The human tongue is sheathed within the oral cavity, where it lies protected against the external atmosphere, just as the palatine folds. It is can be easily showed for inspection but at the same time be protected from the external environment. AIM AND OBJECTIVE: The objective of this study is to examine the uniqueness of tongue morphology and find out parameters to estimate gender of an individual using the same. METHODOLOGY: A total of 30 subjects (15 girls and 15 boys) were taken for this study whose tongue were examined, photographed and alginate impression were taken to create a database of tongue morphology. RESULT: The mean posterior width of the tongue was higher among the males in both cast as well as photographs.

Predicting transition from oral pre-malignancy to malignancy via Bcl-2 immuno-expression: Evidence and lacunae.

Bcl-2 (B cell Lymphoma -2) family comprises of both anti-apoptotic and pro-apoptotic proteins whose altered expression or change in ratio inhibits apoptosis, and promotes tumor progression. The aim of this study is to assess the usefulness of Bcl-2 in distinguishing dysplastic or malignant epithelium from non-dysplastic or normal epithelium to aid in prediction of malignant transformation potential. MATERIAL AND METHOD: Study group comprised of 30 cases of clinically diagnosed leukoplakia (OPMD), 15 cases of Oral Squamous Cell Carcinoma (OSCC) and 5 normal tissue samples. The labeling index of Bcl-2 was analyzed in immunohistochemically stained sections. Different statistical tools were used to analyze the data and to compare Bcl-2 expression qualitatively and quantitatively among all the groups. RESULTS: An increasing trend of Bcl-2 immunoexpression was observed from normal epithelium to non-dysplastic and from non-dysplastic to dysplastic lesions. In OSCC, the peripheral cells in the differentiating epithelial islands (within the connective tissue) showed Bcl-2 immuno-reactivity, which gradually decreased towards the center. In contrast, intense and diffuse Bcl-2 immuno-reactivity was seen in poorly differentiated carcinoma. But the overall Bcl-2 positivity was less in OSCC as compared to dysplastic lesions. CONCLUSION: Increased expression of Bcl-2 oncoprotein in sequentially progressing epithelial dysplasia and down-regulation in differentiating carcinoma (well and moderately differentiating OSCC) unveils the clinical relevance of Bcl-2 in early stages of OSCC tumorigenesis. The heterogenous expression of Bcl-2 in carcinoma with different grades of differentiation renders them unable to be used as an independent tool for predicting transition from oral pre-malignancy to malignancy.

Apoptosis and genes involved in oral cancer - a comprehensive review.

Oral cancers needs relentless research due to high mortality and morbidity associated with it. Despite of the comparable ease in accessibility to these sites, more than 2/3rd cases are diagnosed in advanced stages. Molecular/genetic studies augment clinical assessment, classification and prediction of malignant potential of oral lesions, thereby reducing its incidence and increasing the scope for early diagnosis and treatment of oral cancers. Herein we aim to review the role of apoptosis and genes associated with it in oral cancer development in order to aid in early diagnosis, prediction of malignant potential and evaluation of possible treatment targets in oral cancer. An internet-based search was done with key words apoptosis, genes, mutations, targets and analysis to extract 72 articles after considering inclusion and exclusion criteria. The knowledge of genetics and genomics of oral cancer is of utmost need in order to stop the rising prevalence of oral cancer. Translational approach and interventions at the early stage of oral cancer, targeted destruction of cancerous cells by silencing or promoting involved genes should be the ideal intervention.

Prevalence of oral cancer and oral epithelial dysplasia among North Indian population: A retrospective institutional study.

BACKGROUND: Despite our sincere and serious efforts, oral cancer (particularly oral squamous cell carcinoma [OSCC]) is the major cause of morbidity and mortality in the Indian population. Oral precancerous lesions show quite high malignant transformation rate. Epidemiological data of oral epithelial dysplasia (OED) and OSCC could help in early diagnosis and thus may improve the prognosis. The current study aims to retrospectively analyze the epidemiological profile of patients with different grades of OED and OSCCs. MATERIALS AND METHODS: The current study is a retrospective analysis of OED and OSCC reported in 5 years in our institution from 2014 to 2018. Data for the analysis were attained from the case sheets from the patients diagnosed with OED and OSCC. RESULTS: The mean prevalence of OED and OSCC was 5.71% and 9.85%, respectively. Among the dysplastic lesions, severe dysplasia was more common, while well-differentiated squamous cell carcinoma was more common among the carcinomatous lesions. The peak age prevalence of both the lesions was third to fifth decade. Males were more frequently affected than females, with buccal mucosa being the most common site. CONCLUSION: The data attained from this study highlight the need for community-based screening and awareness programs for general population and thus obtain a healthier society.

Telomerase in saliva: An assistant marker for oral squamous cell carcinoma.

INTRODUCTION: Telomerase is a ribonucleoprotein complex responsible for de novo telomere synthesis and addition of telomeric repeats to existing telomeres. Telomerase activity is generally found to be absent in normal tissues. Telomerase is known to be induced upon malignant transformation of human cells. METHOD: In the present study, we analyzed both telomere length and telomerase activity in saliva samples from oral carcinoma patients. The study was done to investigate the presence of telomerase activity in oral squamous cell carcinoma by TRAP assay. RESULT: Telomerase activity was detectable in 79 of 100 human OSCC and 51 of 100 premalignant cases and 8 of 100 normal patients. CONCLUSION: These results indicate that telomerase is activated frequently during the late stage of oral premalignancy and may play a crucial role in OSCC.

Heterogeneous conceptualization of etiopathogenesis: Oral pyogenic granuloma.

Oral pyogenic granuloma or granuloma pyogenicum is a conspicuous lesion. The word pyogenic granuloma is a misterm since the situation is not related with pus and histologically does not exemplify a granuloma. An oral pyogenic granuloma is obvious to involve the gingiva generally. Extragingivally, it can present on the buccal mucosa, lips, tongue, and palate. A report of trauma is prevalent in such sites. The pathogenesis of the lesion is still unclear, although it was initially supposed to be a botryomycosis infection. It is suggested that etiology of pyogenic granuloma was the reaction of tissues to minor injury or chronic irritation, thus open a pathway for the entrance of nonspecific microorganisms, although microorganisms are not often expressed within the lesion. Hence, this review recapitulates all diverse concepts of pathogenesis associated with this most often and most mysterious lesion of the oral cavity.

Salivary glucose levels and oral candidal carriage in Type 2 diabetics.

BACKGROUND: To assess the correlation between salivary glucose and blood glucose levels in diabetics and non diabetics and to study the association between salivary glucose levels and oral candidal carriage in patients with Type 2 diabetes mellitus. MATERIAL AND METHOD: The study sample was divided into two groups, control and study group. The study group was again divided into two separate groups controlled diabetics and uncontrolled diabetics. Blood and saliva samples (for fasting and postprandial) were taken from each individual. RESULTS: The salivary glucose levels, highly correlated with blood glucose levels in both diabetic as well as non diabetics subjects. Salivary candidal carriage was more in oral cavity of Type 2 diabetic subjects than control subjects. CONCLUSION: Saliva has the potential to be used as a noninvasive tool to monitor glycemic status of diabetic patients.