Diagnosis of the misdiagnosed: Mucormycosis depicting periodontitis.

Oral cavity is habitat for plethora of micro-organism causing various diseases. The most common includes dental caries, periodontal diseases, etc. Dental practice may rarely encounter unusual and subtle symptoms with nonpathognomonic clinical signs of several fatal diseases which may pretend like a common oral disease. Hence, the knowledge and clinical acumen of diagnostician are necessary for the early diagnosis of such fatal infections to prevent untoward consequences. Mucormycosis is an angioinvasive necrotic fungal infection with a high morbidity and mortality rate. It commonly occurs in patients with debilitating diseases and immunocompromised individuals. Clinically, it manifests as rhino-orbito-cerebral, pulmonary, cutaneous, gastrointestinal, renal, and disseminated form. Disease affecting the facial region is a challenge as it often disseminates with orbital and cranial involvement at the time of diagnosis. This article presents a case of mucormycosis which mimicked as severe periodontitis in a patient leading to delay in the diagnosis and challenges during the treatment.

Oral Multifocal Epithelial Hyperplasia: An Unusual Entity.

Multifocal epithelial hyperplasia (Heck's disease) is a rare, contagious, asymptomatic, and benign disease affecting the oral mucosa. It is usually seen in childhood and adolescence and is noted only in specific groups in certain geographical regions. The lesion is clinically characterized by the presence of multiple small papules or nodules in the oral cavity, especially on the labial mucosa, buccal mucosa, and tongue. Histopathology is necessary to confirm the diagnosis. Treatment remains unspecific, although surgical excision, CO2 laser therapy, and topical antivirals are in use. We present a clinical case of a 65-year-old Indian male with multiple oral lesions that clinically and histologically resemble Heck's disease.

Alterations of Serum Lipid Profile Patterns in Oral Lichen Planus Patients: A Case-Control Study.

BACKGROUND: Oral lichen planus (OLP) is a chronic disease of established immune-mediated pathogenesis. It most commonly, protractedly, and persistently involves the mucosa of the oral cavity. Antigen-specific and nonspecific mechanisms play a role in its pathogenesis, leading to T-cell accumulation in superficial lamina propria, intraepithelial T-cell migration, and keratinocyte apoptosis in OLP. Previous studies have indicated the possibility of serum lipid derangement in chronic inflammatory diseases such as systemic lupus erythematosus and psoriasis, which in turn results in elevated cardiovascular disease risk. Inflammation causes disturbances in lipid metabolism such as decrease in high-density lipoprotein-cholesterol (HDL-C) and increase in very low-density lipoprotein (VLDL)-cholesterol and hypertriglyceridemia due to direct effect on T-cell responses. Prolonged dyslipidemia, due to chronic inflammatory condition, enhances the formation of atherosclerotic plaques and thereby augments the risk of cardiovascular disease in such patients. With this background, a possible correlation between OLP and serum lipid level derangement can be anticipated. Hence, this study was taken up to probe into an association between the two. AIMS: To determine and compare the serum lipid levels in OLP patients and healthy controls, to inquire into the possible association of OLP with alterations in serum lipid profile patterns, and to determine if the clinical characteristics of OLP differed with alterations in serum lipid profile patterns. SUBJECTS AND METHODS: Sixty patients comprising 30 cases and 30 controls were enrolled for the study. Thirty cases of clinically and pathologically diagnosed OLP and 30 age- and sex-matched controls were subjected to blood examination for the assessment of serum lipid level, i.e., HDL, LDL, VLDL, and triglyceride. The obtained data were compared with standard values to assess any alterations of the serum lipid levels. STATISTICAL ANALYSIS USED: Cramer's V-test was performed for all the tests to measure association between two nominal variables. A P ≤ 0.05 was considered statistically significant. RESULTS: Dyslipidemia was observed in 13 (46.67%) cases as against 7 (23.33%) controls. Thus, a significant number of cases were found to have an associated serum dyslipidemia. However, pertaining to individual serum lipid levels in cases and controls, the association was found to be statistically insignificant. CONCLUSIONS: The current study suggested an evident association between dyslipidemia and OLP. We recommend imminent studies on a larger population to additionally substantiate a positive association between the two.

Oral epithelioid hemangioendothelioma.

Epithelioid hemangioendothelioma (HE) is an intermediate malignant potential vascular neoplasm with uncertain clinical behavior, wide variations in microscopic findings, and prognosis. According to the World Health Organization (2002) classification, epithelioid HE has been considered under malignant tumors which rarely metastasize. The epithelioid variant, the most aggressive one, has similar gender predilection and sporadic occurrence in children. The patients usually present with an asymptomatic oral mass whereas few cases may report with the painful bleeding lesion. We attempt to present a case in an adolescent male with previously never described biological behavior, diverse histopathological features, and immunohistochemistry findings.

Use of Curcumin Mouthrinse in Radio-Chemotherapy Induced Oral Mucositis Patients: A Pilot Study.

INTRODUCTION: Oral Mucositis is a complex and distinct pathobiologic entity resulting in injuries in mucosa that is a common complication in cancer patients undergoing chemotherapy (CT) and radiation therapy (RT). Phytochemicals, such as Curcumin, turmeric extract, has attracted great attention for its therapeutic benefits in clinical oncology due to its chemopreventive, antitumoral, chemosensibilizing and radiosensibilizing activities against various types of cancers and the complications associated with their management. AIM: To evaluate the efficacy and safety of curcumin mouthwash in the management of Oral Mucositis in cancer patients undergoing radio-chemotherapy. MATERIALS AND METHODS: The research group consisted of 20 adult cancer patients undergoing radio-chemotherapy at the Regional Oncology Centre, who were evaluated for signs and symptoms of oral mucositis and then randomly divided into two groups. Standard preventive oral care i.e. chlorhexidine mouthwash 0.2% was given to one group while the other group was provided with freshly prepared curcumin mouthwash; each to be used thrice daily. Oral mucositis was assessed at days 0, 10 and 20. The World Health Organization (WHO) scale, the Oral Mucositis Assessment Scale (OMAS), and a Numerical Rating Scale (NRS; patient reporting scale of 0-10) were used. Adverse events were tracked. STATISTICAL ANALYSIS: Descriptive statistics, Independent sample t-test and repeated measure ANOVA test were performed. RESULTS: Statistically significant difference was found in the NRS (p=0.000), Erythema (p=0.050), ulceration (p=0.000) and WHO scores (p=0.003) between the two groups. CONCLUSION: Curcumin was found to be better than chlorhexidine mouth wash in terms of rapid wound healing and better patient compliance in management of radio-chemotherapy induced oral mucositis. No oral or systemic complications were reported.

Reliability of Panoramic Radiographs in the Localization of Mandibular Foramen.

OBJECTIVE: The present study evaluated the reliability and accuracy of panoramic radiographs in the localization of mandibular foramen. MATERIALS AND METHODS: Twenty five Indian dry human adult mandibles constituted the study material. Ten measurements were carried on each of them to evaluate the location of mandibular foramen with respect to adjacent anatomic landmarks. Panoramic radiographs were then made of the mandibles. Same distances were measured on the traced images of the radiographs. Paired t-test and Pearson's correlation test were applied to evaluate the accuracy and reliability of panoramic radiographs in localization of mandibular foramen. RESULTS: The mean distances measured on dry mandibles and panoramic radiographs showed statistically significant difference (p<0.05). There was strong positive correlation between the measurements on dry mandible and panoramic radiographs. CONCLUSION: The panoramic radiographs can serve as a guide in locating the anterosuperior point of mandibular foramen on panoramic radiographs.

Intravascular papillary endothelial hyperplasia: diagnostic sequence and literature review of an orofacial lesion.

Intravascular papillary endothelial hyperplasia or Masson's tumor is a rare reactive disease of vascular origin characterized by exuberant proliferation of endothelial cells notably occurring within blood vessels of head, neck, and extremities. The importance of this entity is its ability to mimic a variety of diseases both benign and malignant in the orofacial region. Here, we present a case of Masson's tumor within the masseter muscle in a 40-year-old female with emphasis on the sequential investigative procedures performed to diagnose this entity.

Report of rare palatal expression of Nevus of Ota with amendment of Tanino's classification.

Nevus of Ota, a benign melanocytic pigmentary disorder with rare malignant transformation potential, affects 0.014-0.034% of the Asian and Black population and has a strong predilection for females. It occurs in the area innervated by the first and second division of the trigeminal nerve. Oral manifestation is rarely noted with only 14 cases reported till date. This report documents a case of Nevus of Ota with the infrequently noted oral involvement, in an Indian lady. Since oral manifestation is not acknowledged in Tanino's classification, the authors propose a modification to the same.

Rhinolith.

Rhinoliths are rare entities encountered in clinical practice. They are calcified masses found within the nasal cavity. Which lesions can be encountered incidentally upon a routine dental radiograph. This article reports a case of such an incidental finding of rhinolith on a dental radiograph.