Mast cell expression in oral submucous fibrosis: A systematic review and metanalysis.

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic disorder associated with reduced mouth opening, burning sensation and listed as potentially malignant disorder. The role of mast cells in initiation and progression of this condition has been debated in last few years. It is imperative to understand the definitive role of mast cells and subsequently identify a possible cost-efficient treatment modality for OSMF. This review aimed to study the role of mast cells in OSMF by framing a research question that assessed the mast cell count (MCC), their degranulation and immunohistochemical analyses. We performed a comprehensive search of PubMed, EBSCOhost and general Google search that conceded 26 studies from which 15 articles were finalized for the review. The individual study syntheses revealed increased MCC in OSMF as compared to controls. Also, there was decreased MCC with the progression of OSMF. However, the metanalysis showed high level of heterogeneity as three studies out of eight studies found reduced MCC in disease when compared with controls. There is definite increase in mast cell in OSMF although the cell count falls with the advancement of OSMF. This increases the scope for further research to identify exact mechanism by which mast cells contribute to fibrosis and conduct the drug trials that can inhibit the mechanism. Key words:Oral submucous fibrosis, mast cell count, degranulated mast cells, stages of OSMF.Oral submucous fibrosis, mast cell count, degranulated mast cells, stages of OSMF.

Dental Students' Ability to Detect Only-Enamel Proximal Caries on Bitewing Radiographs.

Introduction The dental students are trained to identify the proximal carious lesion using clinical tools and radiography over three years of academic curriculum. During these years the students are expected to learn detection of incipient carious lesions and take appropriate preventive/restorative measure. Method This study aimed at evaluating the ability of the students and interns to detect only-enamel proximal caries on the five digital bitewing radiographs. The digital bitewing radiographs were having incipient carious lesions involving enamel on proximal surface of mandibular first molars. Results A total of 101 participants (M = 29, F = 72) from fifth (D5) and sixth (D6) years of dentistry evaluated the radiographs and the KR20 values for D5, D6, and total sample were 0.79, 0.64, and 0.41 respectively. Conclusion Overall students' assessment of detection of incipient carious lesion was low. There is need to enhance clinical and radiological cognitive skills among students with emphasis on interdisciplinary learning objectives.

Herpes zoster on the face in the elderly.

Herpes zoster is a localised disease caused by reactivation of the varicella zoster virus that enters the cutaneous nerve endings during an earlier episode of chicken pox, travels to the dorsal root ganglia, and remains in latent form. The condition is characterised by occurrence of multiple, painful, unilateral vesicles and ulceration, and shows a typical single dermatome innervated by single dorsal root or cranial sensory ganglion. Involvement of three or more dermatomes is known as disseminated zoster and seen in immunocompromised individuals. Complications of herpes zoster include ocular sequelae, bacterial superinfection of the lesions, meningoencephalitis and postherpetic neuralgia. The incidence of herpes zoster increases with age and immunosuppression, therefore prompt management is necessary to avoid morbidity and mortality in these individuals. We present two case reports of herpes zoster, one involving the maxillary and mandibular branches of the trigeminal nerve while the other involves all branches of the trigeminal nerve.

Eustachian tube dysfunction in OSMF- often present seldom discovered.

OBJECTIVES: To evaluate the effect of OSMF on the eustachian tube function and to correlate it with various grades of the disease. STUDY DESIGN: Twenty OSMF patients (40 ears) and 20 healthy controls (40 ears) were evaluated for eustachian tube function by eustachian tube function test, tympanometry and audiometry. RESULTS: The audiometric and tympanometric analysis showed no significant differences in hearing abilities of OSMF patients and controls and between various grades of OSMF, indicating no hearing impairment. However, eustachian tube function test revealed a statistically significant difference in eustachian tube function in OSMF patients and controls. Further, there was a significant increase in severity of dysfunction with increase in severity of disease. CONCLUSIONS: From the present study it is evident that the subjective function of Eustachian tube may be affected by disease process. But, probably the amount of deviation found in function of the eustachian tube is non contributing to cause a conductive hearing loss. Key words:Oral submucous fibrosis, eustachian tube function, tympanometry.

Infected complex odontoma: an unusual presentation.

Odontomas represent a hamartomatous malformation. They are usually asymptomatic and are diagnosed on routine radiological examination .The eruption and infection of odontoma are uncommon. Till now, only 20 cases of erupted odontoma are reported in the literature. We report an unusual case of infected complex odontoma with eruption of odontoma in the oral cavity and perforation of the cheeks with a tooth impacted upon which makes the presentation unusual that has not been reported earlier. The dentist should be familiar with common and unusual appearance of odontoma for proper diagnosis and management.

Role of hemoglobin and serum iron in oral submucous fibrosis: a clinical study.

BACKGROUND: Oral submucous fibrosis is a chronic, insidious oral mucosal condition affecting the most parts of the oral cavity with high malignant transformation rate triggered by areca nut chewing, nutritional deficiencies, immunologic processes, and genetic predisposition. OSF causes significant hematological abnormalities resulting in anemia and a decrease in serum iron levels. AIM: The aim of this study was to estimate the hemoglobin and serum iron levels among patients with oral submucous fibrosis and to compare the values with healthy subjects. MATERIALS AND METHODS: In this hospital-based study 30 diagnosed patients of OSMF and 15 healthy individuals were included, and the values of hemoglobin and serum iron levels were estimated using Sahli's and Ferrene methods. RESULTS: OSMF patients showed significantly lower levels of hemoglobin and serum iron when compared with the healthy subjects. CONCLUSION: The findings of the study emphasizes on the assessment of hemoglobin and serum iron for patients with oral submucous fibrosis. Also iron therapy should be instituted concomitantly with the initial diagnosis which helps to cease the further progression of the condition. Further extensive studies are indicated to understand the correlation between OSMF and iron deficiency.

Pemphigus vulgaris--a report of three cases.

Pemphigus vulgaris (PV) is a potentially life-threatening illness that manifests in the mouth and on skin. In a majority of patients it affects the oral mucosa and is sometimes difficult to diagnose when only mucosal involvement is present. In an attempt to highlight the proper treatment plan of this potentially fatal disorder, the authors document a report of three cases. These patients were prescribed conventional steroids which brought about partial relief but early recurrence with discontinuation of the drug. Subsequent management of these patients with azathioprine along with corticosteroids improved the outcome of the disease with longer remission periods. In this case series, the steroid sparing effect of azathioprine was achieved successfully and hence needs to be considered as a primary drug in management of PV.

A radiographic evaluation of temporomandibular and hand (Metacarpophalangeal) / wrist joints of patients with adult rheumatoid arthritis.

BACKGROUND: A review of literature revealed that, although the involvement of temporomandibular joint (TMJ) in rheumatoid arthritis (RA) patients is not uncommon, variation in presentation persist. Comparative studies of bony changes in the right and left TMJ with the right and left peripheral hand (Metacarpophalangeal-MCP)/wrist joints have not been done, to the best of our knowledge. MATERIALS AND METHODS: In this cross-sectional study, the temporomandibular and hand (MCP) and wrist joints of fifteen rheumatoid arthritis patients were evaluated with questionnaires, clinical and lab assessment and radiographically using conventional radiographs and computed tomography. Students t-test was applied for the statistical analysis of the data obtained and a P value of 0.05 was considered as statistically significant. RESULTS: Comparisons between the right TMJ with right MCP/wrist joint and left TMJ with left MCP/wrist joint did not reveal statistically significant results. Radiographically, flattening and erosions were the common manifestations. MCP joints were more affected than the wrist, but whenever the wrist was involved, it was more likely to be bilaterally affected. CONCLUSIONS: Although the TMJ showed osseous changes of a higher grade than the hand (MCP) and wrist joints radiographically, it was observed that patients were more aware of the peripheral joint discomfort. There were no significant differences between TMJ and peripheral joints on both right and left sides.

Brown tumour of the jaw.

Brown tumours are classic bony lesions that arise as a result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. They are erosive bony lesions caused by rapid osteolysis and peritrabecular fibrosis, resulting in a local destructive phenomenon. Facial skeleton is involved in about 2% of all cases of which the mandible is frequently affected. A 35-year-old female who was diagnosed with osteomalacia and brown tumour in posterior mandible as the sign of secondary hyperparathyroidism secondary to vitamin D deficiency is presented.

Nonsyndromic double mesiodentes--hidden lambs among normal flock!

Mesiodens, a common supernumerary tooth, is found in the midline in anterior maxilla between the incisors. Its occurrence as multiples is termed as 'mesiodentes'. Double mesiodentes, a rare phenomenon, is seldom reported in literature and show a plethora of manifestations as described in the case report. They may not be apparent clinically, necessitating the use of imaging modalities and require careful evaluation to prevent complications. This paper presents a report of six double mesiodentes cases with negative family history for supernumerary teeth and absence of any syndromes. This is an effort to educate dentists about signs, symptoms, complications and management of mesiodentes.

Extrafollicular adenomatoid odontogenic tumour.

Adenomatoid odontogenic tumour (AOT) is an uncommon, benign tumour that represents 3-7% of all odontogenic tumours. It is slow growing, occurs twice as common in females and usually in the second decade of life. There are three subclinical types of this tumour with identical histology: follicular type (73%), extrafollicular variant (24%) and peripheral form (3%). Here, the authors have presented two rare cases of extrafollicular varieties of AOT in 25-year-old female patients, of which one was situated in the maxillary canine area and the other one situated in an unusual location of mandibular premolar area. Such lesions may be confused as an odontogenic cyst and should be carefully differentiated from other benign and malignant lesions arising in this region.

Estimation of serum leptin in oral squamous cell carcinoma.

BACKGROUND: Cachexia contributes significantly to mortality in cancer patients; role of cytokines in inducing cachexia is an emerging view. Leptin, a homologous protein of cytokine family, is found to be decreased in serum with cachexia. The purpose of this study was to compare serum leptin levels of oral squamous cell carcinoma patients with that of control group and correlate it with body mass index. METHOD: Serum samples of 31 oral squamous cell carcinoma patients and that of 28 healthy individuals were subjected to evaluation of serum leptin levels (ng/ml) using enzyme-linked immunosorbent assay. RESULTS: A significant reduction in leptin level of oral squamous cell carcinoma patients was observed. Definite correlation between body mass index and serum leptin and also between serum leptin levels of various histopathological variants of oral squamous cell carcinoma was observed. CONCLUSION: The results of this study suggest that evaluation of serum leptin level can provide status of cachexia in oral squamous cell carcinoma patients.