Comparative evaluation of genotoxicity and cytotoxicity of flowable, bulk-fill flowable, and nanohybrid composites in human gingival cells using cytome assay: An in vivo study.

Context: Biocompatibility is one of the major prerequisites for safe clinical application of materials. Resin composites release their components into oral environment following restoration which cause adverse reactions. Aims: To evaluate and compare the genotoxicity and cytotoxicity of flowable, bulk-fill flowable, and nanohybrid composites with glass ionomer cement in human gingival cells using epithelial-based cytome assay. Methodology: Sixty healthy patients with noncarious cervical lesions were selected and randomly assigned to four groups (n = 15): Group A, glass ionomer cement; Group B, flowable composite; Group C, bulk-fill flowable composite; and Group D, nanohybrid composite. Class V restorations were done in each group with the respective restorative materials. Samples of epithelial cells were collected from gingiva before (control) (T1) and after 10 and 30 days (T2 and T3) postrestoration and examined for the presence of micronuclei and other nuclear anomalies. Statistical Analysis Used: The results were subjected to statistical analysis using Friedman's test and Kruskal-Wallis test. Results: The highest level of cytotoxicity was noted at T2 time point with a significant decline at T3 time point. Least cytotoxic damage was exhibited by Group A followed by Group D. Highest cytotoxic effect was shown by Group B followed by Group C. There was no significant level of genotoxicity induced by any of the materials tested at different time points. Conclusion: There is significant cytotoxicity induced by the tested composite materials which had no long-term effects and no genotoxicity was induced by any of the restorative materials tested.

Metastatic Carcinoma of the Breast Presenting as Gingival Swelling in the Maxilla: A Case Report.

Background: Metastatic cancers in the oral cavity are usually very rare and are usually an indication of widespread malignancy. In some cases, oral metastasis was found to be the first presentation of distant site tumours. Even though oral metastatic lesions may be found anywhere in the oral cavity, they commonly present in the posterior areas of the jaw bones. Among the soft tissues, the gingiva is the most common site. The presence of inflammation in the gingiva and the role of periodontal microbiota are suggested to play a role in the attraction of metastatic cells. The purpose of this case report is to present a rare case of metastatic breast carcinoma presenting as a gingival enlargement in the maxillary anterior region. Case Presentation. A 37-year-old female patient who underwent modified radical mastectomy for invasive ductal breast carcinoma reported to the dental clinic with a gingival enlargement in the anterior maxillary region. Clinical and radiographic examination showed a rapidly enlarging gingival lesion with destruction of the underlying bone. A wide excision of the entire lesion was done. Histopathological and immunohistochemical (IHC) evaluations were suggestive of infiltrating poorly differentiated adenocarcinoma. Conclusion: This case report presents a metastatic oral lesion in the maxillary anterior region of the primary breast cancer site. The young age of patient and an uncommon site of metastatic lesion are the striking features of this case. We would like to highlight the importance of a thorough clinical, radiological, and histological evaluation of any gingival swelling as it could be a metastatic lesion. IHC staining helps in the diagnosis of the primary site of metastatic carcinomas. An early diagnosis and intervention could reduce the morbidity of the lesion and improve the survival rate.

Ligneous Periodontitis in a Patient with Type 1 Plasminogen Deficiency: A Case Report and Review of the Literature.

BACKGROUND: Ligneous periodontitis or destructive membranous periodontal disease is a rare condition involving gingival tissues, which is due to plasminogen deficiency and fibrin deposition. Plasminogen deficiency is an ultrarare autosomal recessive disease. The disease is characterized by gingival enlargement and periodontal tissue destruction that leads to rapid tooth loss despite treatment attempts. A defect in fibrinolysis and abnormal wound healing are the main pathogenesis of this condition. It is caused by mutations in PLG, the gene coding for plasminogen, which results in decreased levels and functional activity. Case Presentation. In this case report, clinical and histopathological findings of a 26-year-old male patient who presented with generalized membranous gingival enlargement are presented. He was the third child of consanguineous parents and had multicystic congenital hydrocephalus at birth. Besides the gingival enlargement, he also presented ligneous conjunctivitis since childhood. The intraoral examination revealed generalized periodontal breakdown. Radiographs showed alveolar bone loss present in every quadrant. All blood investigations were normal except for plasminogen deficiency. A biopsy sample was excised from affected gingiva and a series of histopathological evaluation was performed. Based on clinical and histopathological evidence, a diagnosis of destructive membranous periodontal disease or ligneous periodontitis was made. A clinical exome assay for the PLG gene was also done. It was confirmed as Type 1 plasminogen deficiency. CONCLUSION: Ligneous periodontitis has been rarely reported in India. The reasons could be because of the rarity of the disease or missed diagnosis. The need to take a proper history and perform a proper clinical examination and histopathologic evaluation has to be stressed when diagnosing and treating gingival enlargements. If a genetic condition is suspected, genetic screening is also needed. All these will help the clinician in correctly diagnosing the disease and formulating a proper treatment plan for managing the condition.

Oral Field Cancerization and Its Clinical Implications in the Management in Potentially Malignant Disorders.

Oral cancer is one of the common malignancies reported in India. Most of these cancers are preceded by potentially malignant disorders. Despite improvements in the management strategies of these cancers the posttreatment prognosis has remained poor. The 5-year survival rates of oral cancers in most countries are still below 50%. The poor outcomes in oral cancer prevention and treatment can be due to nature of the spread of genetically altered cells as fields within the epithelial compartment. The conventional management protocols need to be modified taking into consideration the field spread of genetically altered cells.

Epidemiology of Oral Lichen Planus in a Cohort of South Indian Population: A Retrospective Study.

BACKGROUND: Oral lichen planus (OLP) is an immune-mediated potentially malignant disorder of the oral cavity. Dysplastic OLP has an altered cytogenic profile and can progress into oral squamous cell carcinoma. The epidemiology of OLP is well-described in several relatively large series from various geographic locations, whereas such series from southern India is rare. The aim of the present study was to determine the epidemiology of OLP in a cohort of South Indian population. METHODS: All the case data records of 29,606 patients who visited Mar Baselios Dental College and Hospital, Kerala, India from 2014 to 2015 were retrospectively reviewed. For data review, 122 patients of OLP were selected Estimated were type, number, and location of lesions, clinical manifestation, age of the patient, gender, onset and duration of lesion, stressful life style, habits, skin involvement and associated systemic illness, and presence/absence of dysplasia. RESULTS: When the distribution of OLP among the gender was considered, we found more prevalence in females than males. Fifty-seven percent of patients were associated with stressful lifestyle. Reticular lichen planus was the most common clinical subtype found. Bilateral buccal mucosal was the common site, when the distribution of sites of OLP were compared (P < 0.05). Hypersensitivity reaction was frequently associated with systemic illness with OLP (P < 0.05). Anaplasia was found among 5% of lichen planus lesions. CONCLUSIONS: OLP patients had high incidence of hypersensitivity reactions and 5% of OLP lesions showed anaplasia. Long term follow-up is necessary to monitor the recurrence, prognosis, and malignant transformation of OLP.

A study of sister chromatid exchange in patients with dental amalgam restorations.

STUDY BACKGROUND: Dental amalgam is still widely used as a restorative material in developing countries due to its low cost and ease of manipulation. The health risks associated with the components of this restorative material has always been a matter of concern. Our study was designed to address this question regarding dental amalgam. OBJECTIVE: To study sister chromatid exchange (SCE) as an indicator of systemic genotoxicity, due to the exposure from the components of amalgam restorations during its placement and chronic use. MATERIALS AND METHODS: Systemic genotoxicity in subjects exposed to amalgam during its placement (Group II; n=5) and subjects with chronic exposure to amalgam (Group III; n=5) were compared with controls (Group I; n=5) by SCE assay in cultured peripheral blood lymphocytes. RESULT: Subjects exposed to amalgam during its placement and subjects having chronic exposure to amalgam showed an increase in the frequency of SCE, but the change was not statistically significant (P=0.84, P=0.123 respectively). CONCLUSION: Systemic genotoxicity was not observed due to the components of amalgam restorations released during its placement and chronic use. The findings of this study can be considered as preliminary information on the systemic toxicity due to the components of amalgam restorations.

Adult forensic age estimation using mandibular first molar radiographs: A novel technique.

OBJECTIVE: To develop an independent procedure for estimating age for Indian individuals using radiographs of multi-rooted posterior teeth with accuracy needed in forensic age prediction. MATERIALS AND METHODS: Orthopantomography (OPG) was obtained for 88 subjects. The subjects were divided into two sub sets; study subset (n = 60) which were used to find regression formula to calculate the age from pulp chamber height and test subset (n = 28) which were used to test the accuracy of this formula. RESULTS: There was a statistically significant strong correlation between chronological age and pulp chamber crown root trunk height ratio (r = -0.56; P = 0.000). The regression equation for estimating the age, derived from the study subset was estimated age = -100.920 (PCTHR) +55.415. (PCTHR is the pulp chamber crown root trunk height ratio). This equation was applied on the test subset and there was no significant difference between estimated ages and chronological ages (P = 0.639). The mean absolute error (MAE) was 6.96 years, which was within acceptable error limits for forensic age estimation (<±10 years). CONCLUSION: The procedure developed to estimate the age using height reduction in pulp chamber was found to be fairly accurate to perform forensic age prediction in Indian individuals.

Proliferative and morphologic characterization of buccal mucosal fibroblasts in areca nut chewers: a cell culture study.

OBJECTIVE: To isolate, culture and characterize fibroblasts from the buccal mucosa of areca nut chewers with and without oral submucous fibrosis (OSF). MATERIALS AND METHODS: Primary fibroblast cultures were established by the collagenase disaggregation technique and the phenotypic and growth characteristics were studied. RESULTS: Cells cultured from OSF showed a statistically significant increase in both the post-mitotic fibroblast subpopulation and the population doubling time when compared with controls. CONCLUSION: There was a significant increase in the pro-fibrotic, post-mitotic subpopulation of fibroblasts in areca nut chewers with OSF.

Review of paraneoplastic syndromes associated with oropharyngeal squamous cell carcinoma.

Malignancies are usually preceded by the presence of various paraneoplastic syndromes (PNS), which could be the indirect and/or remote effects of the metabolites produced by neoplastic cells. PNS manifested by oropharyngeal squamous cell carcinomas, which is the most common head and neck malignancy, are highlighted in this review. Knowledge of the clinical spectrum of these syndromes will equip the oral physician for early diagnosis and management of these hidden malignancies, especially of the pharyngeal region.