Plastination - A method for preservation of oral hard and soft tissue biopsy specimen v/s the conventional method of preservation with formalin.

Context: Plastination is one of the most advanced method for preserving perishable biological specimen as well as tissue samples as for a longer period of time using polymers. Aims: To evaluate the changes in dimension of hard and soft tissue specimens after plastination procedure and compare it with the conventional method of preservation in formalin. Settings and Design: Institution-based retrospective study. Methods and Material: The study included 20 formalin-fixed soft tissue and 10 formalin-fixed hard tissue specimens. All the specimens were plastinated which involved four basic steps of fixation, dehydration and defatting, impregnation with polymer and curing of polymer followed by finishing and storage. The specimens were analysed for shrinkage and dimensional changes and changes in colour and consistency between formalin-fixed specimen and plastinated soft tissue and hard tissue specimen. Statistical Analysis Used: Descriptive statistics were used. Results: After plastination, soft tissues showed average shrinkage of 3.49%with a range of 0.80-7.90% in comparison to the original size. In case of teeth and hard tissue specimen, there was no evidence of dimensional changes or shrinkage before and after plastination. Changes in colour and consistency of the soft tissue specimens were also noted before plastination and after plastination. Conclusions: Although the plastinated specimens in the current study showed minimal shrinkage rate, they have proved to be an excellent alternative to formalin-fixed specimens as they are easy to handle and maintain, non-infectious, non-toxic, user-friendly.

Compliance with COTPA (Packaging and Labeling) Rules, 2008 and its amendments in smokeless tobacco products sold across Mangaluru taluk, Karnataka, India.

Introduction: India introduced the Cigarettes and Other Tobacco Products Act (COTPA) (Packaging and Labeling [P and L]) Rules in 2008. These rules utilize the tobacco package to communicate tobacco-caused harms; it also seeks to restrict the delivery of misleading information about the product on the pack. The enormous burden of tobacco-related oral cancers in India necessitates the compliance with the law regarding presentation of information in powerful and salient ways, intentionally designed to increase the awareness in target individuals. Objectives: The objectives of the study are to assess the compliance to implementation and enforcement of the COTPA (P and L) Rules, 2008 and its amendments in 2014 and 2018. Materials and Methods: Chewing tobacco products were retrieved and evaluated for compliance with the law. The specified pictorial and textual health warnings, area, clarity, rotation, and language were assessed as per the recommendations. Results and Conclusion: Even though chewing tobacco products in India have introduced pictorial and textual health warnings, majority of them do not comply with the law. The products displayed the specified health warnings on a total of 70.6% on average, failing to abide by the government-specified average of 85%. 50% of the products did not follow the rotation of pictorial and textual health warning even after completion of the interregnum period of 12 months (September 2019). To ensure consumers' right to be informed about the health risks from a product, all the details regarding the contents, health warnings and messages, and product care instructions must be mentioned as specified under the law.

Mesenchymal tumours of the head and neck: a 10-year institutional archival study / Tumores mesenquimales de cabeza y cuello: estudio de archivo institucional de 10 años de duración

Introduction: Histopathological characterisation of benign and malignant lesions of the head and neck in a systematic and coherent way is an essential part of Oral Pathology and Oral Medicine. Objective: To describe the frequency and histopathological profile of connective tissue tumours in the head and neck region reported in an Indian institute. Methods: A retrospective analysis was made of the 10-year records of reports of biopsy samples of patients maintained by the department of oral pathology showing histopathological diagnosis of connective tissue neoplasms. The data obtained was compiled for age, gender, site and histopathology of the lesions. Results: Majority of the tumours were benign and patients were found to be in the 2nd or 4th decade of life with female preponderance. The most common benign tumour was fibroma where buccal mucosa was the commonest location and malignant tumour was osteosarcoma where mandible was the commonest site. While fibromas were seen among general adult population, osteosarcomas were more in the males (7.2 percent) and in the younger population (< 20 years). The uncommon tumours among benign variety were leiomyoma and teratoma while in malignant category 1 case of undifferentiated sarcoma was reported. Conclusion: The findings in this study may be of help to oral and maxillofacial surgeons and general dentists in formulating diagnosis and rendering patient care in the existing local population(AU)

Introducción: La caracterización histopatológica de las lesiones benignas y malignas de cabeza y cuello de forma sistemática y coherente es una parte esencial de la Patología Oral y la Medicina Oral. Objetivo: Describir la frecuencia y el perfil histopatológico de los tumores del tejido conjuntivo de la región de cabeza y cuello notificados en un instituto indio. Métodos: Se realizó un análisis retrospectivo de los registros de 10 años de informes de muestras de biopsia de pacientes mantenidos por el departamento de patología oral que mostraban diagnóstico histopatológico de neoplasias del tejido conectivo. Se recopilaron los datos obtenidos en cuanto a edad, sexo, localización e histopatología de las lesiones. Resultados: La mayoría de los tumores eran benignos y los pacientes se encontraban en la 2ª o 4ª década de la vida, con preponderancia del sexo femenino. El tumor benigno más frecuente fue el fibroma, cuya localización más frecuente fue la mucosa bucal, y el tumor maligno fue el osteosarcoma, cuya localización más frecuente fue la mandíbula. Mientras que los fibromas se observaron entre la población adulta general, los osteosarcomas fueron más frecuentes en los varones (7,2 por ciento) y en la población más joven (< 20 años). Los tumores menos frecuentes en la variedad benigna fueron el leiomioma y el teratoma, mientras que en la categoría maligna se registró un caso de sarcoma indiferenciado. Conclusiones: Los hallazgos de este estudio pueden ser de ayuda para los cirujanos orales y maxilofaciales y los odontólogos generales en la formulación de diagnósticos y la prestación de atención al paciente en la población local existente (AU)

Non-Invasive Saliva-based Detection of Gene Mutations in Oral Cancer Patients by Oral Rub and Rinse Technique.

BACKGROUND: Oral Squamous Cell Carcinoma (OSCC) is the most widely reported cancer worldwide. Liquid biopsy, a method that relies on identification of tumor-associated cells and/or cell free nucleic acids from body fluids is becoming increasingly popular in cancer diagnostics. The aim of the study was to evaluate the feasibility of Oral Rub and Rinse (ORR) technique in determining the genetic changes in common biomarkers of oral cancer such as TP53 using DNA obtained from saliva of oral cancer patients. METHODS: A total of 15 oral cancer patients were recruited in the study and pre-surgical saliva samples were collected using the ORR technique. Tissue samples included in the study were obtained during the surgical excision of the cancerous oral lesion. Genomic DNA was isolated from the salivary cell plug and the tissues and the TP53 gene was amplified by PCR. The PCR products of all the exons of TP53 (Exons 2 to 11) were electrophoresed on agarose gel, purified and sequenced by Sanger method. The obtained sequences were compared with the reference sequence of TP53 gene. STATISTICAL ANALYSIS USED: Descriptive statistics were used and reported as frequency and percentage. RESULTS: Capillary sequencing of TP53 gene from tissue DNA revealed the presence of codon 72 c.215C>G (p.Pro72Arg) polymorphism in 10 patients (67%) and a heterozygous mutation at codon 172 c.514 G>T (p.Val172Phe) in 2 patients (13%). Among the 10 samples that showed codon 72 polymorphism, matched salivary DNA was available for 6 samples and 4 out of these showed same genetic change at codon 72. Similarly, of the 3 samples that showed codon 172 mutation, matched salivary DNA was available for 1 sample and the mutation status was identical. CONCLUSION: The results suggest a potential for clinical applications of ORR technique as an alternative to invasive tissue biopsy for detection of genetic changes in candidate biomarkers in oral cancer.

Health tips in newspapers: a matter of concern.

Newspapers are a significant source of information to the general public as it reaches quite large numbers. Many readers make an essential health decision based on the information provided by the newspaper. Evidence suggests that quality of health reporting in the newspaper is poor. Most of the health tips in the newspaper may lead to self-medication, which is most dangerous. It is the responsibility of the newspaper to provide health information with scientific evidence and readers to be cautious before making any health-related decision based on newspaper information without consulting experts.

Single-nucleotide polymorphisms of methylenetetrahydrofolate reductase gene in a South Indian cohort with nonsyndromic cleft lip with or without palate.

OBJECTIVE: Clefts of the lip, with or without cleft palate and cleft palate only, collectively called as orofacial clefts (OFCs) are one of the most common congenital malformations with varying degrees of penetrance and phenotype expressions. The aim of this study was to investigate the association between methylenetetrahydrofolate reductase (MTHFR) cytosine-to-thymine (c. 677 C>T), adenine-to-cytosine (c.1298 A>C) single- nucleotide polymorphisms (SNPs) and South Indian patients with the nonsyndromic cleft lip with or without palate (NSCL ± P). METHODS: A cohort consisting of 25 cases of NSCL ± P and 18 controls from a South Indian cohort were included in this case-control study. Genetic analysis of c.677C>T and c.1298A C polymorphisms in the MTHFR gene was carried out using Sanger sequencing and analyzed from chromatogram profiles. Data interpretation was done using statistical software MedCalc Statistical Software version 16.2 and the Statistical Package for the Social Sciences (SPSS version 22.0). RESULTS: DNA sequence analysis of the MTHFR gene revealed c. 677C>T and c. 1298A>C polymorphisms in 16% and 76% of NSCL ± P cases, respectively. Heterozygous variant in MTHFR c. 1298A>C polymorphism was found to be a significant risk factor (P = 0.0164) for NSCL ± P in South Indian ethnic population. c.677C>T polymorphism, in particular, was apparently dormant overall in the study population. These results offer certain novelty in terms of the distinctive pattern in SNPs of genotypes observed in the study. CONCLUSION: NSCL ± P is one of the most common and challenging congenital malformations with complex etiological basis. Common risk factors such as MTHFR SNPs, namely c.677C>T and c.1298A>C, are subjected to variations in terms of ethnic group, geographic region and micro/macro-environmental factors. Overall, our study has explored part of South Indian ethnic population and revealed a different and unique distribution of mutations in this sample population.

Clinicopathologic Trends in Pediatric Oral Biopsies: A 10-Year Institutional Archival Study.

AIM: The aim of this study is to determine the clinicopathologic trends in oral pathological biopsies in children aged 14 years and below received for histopathological diagnosis in the institution. MATERIALS AND METHODS: The archives of the Department of Oral Pathology and Microbiology were retrospectively analyzed. Biopsy records of all oral lesions from pediatric patients, aged 0-14 years, in the files of the Department of Oral Pathology and Microbiology, A B Shetty Memorial Institute of Dental Sciences, Mangalore, DK, from 2007 to 2017 were considered. Descriptive statistical analysis and Pearson's Chi-square test using computer software were performed. RESULTS: About 3,590 biopsies were received during the period of which 93 (2.6%) belonged to pediatric population. Prevalence was more in males (58%) compared to females (42%). Commonly affected age group was 10-14 years. The most common category of lesions diagnosed was cysts, and pulp pathologies were the least. The most common location was the jaws of which mandible was more common compared to maxilla followed by the lower lip and buccal mucosa. Histopathologically, radicular cysts (11%) were the most common followed by equal frequency of dentigerous cysts, mucoceles, and odontomes (9%). A statistically significant association of age and gender was seen with the category of the lesion. CONCLUSION: This study shows a blend of similarities and contradictions as compared to other similar studies, which could be attributed to geographical diversity, and a number of biopsies received each year which needs to be further explored.

Spindle cell carcinoma in the maxilla: A rare case and literature review.

In India, oral squamous cell carcinoma accounts for 90%-95% of oral malignancies. The WHO classifies spindle cell carcinoma (SpCC) under malignant epithelial tumors of squamous cell carcinoma (SCC) and is a rare entity accounting for only 1% of SCCs. It is an aggressive biphasic neoplasm exhibiting high mortality rate owing to increased metastasis and recurrence which signifies the need for recognition and treatment of this perplexed tumor. We present a case of maxillary SpCC where histopathological evaluation alone was indecisive, requiring immunohistochemistry for confirmation of the diagnosis.

Root Canal Morphology of Maxillary First Premolars Using the Clearing Technique in a South Indian Population: An In vitro Study.

BACKGROUND: The success of root canal therapy requires a good knowledge of root canal morphology. Literature review shows variations in a number of roots and canal morphology in studies done across the globe. AIM: The purpose of this study was to evaluate the root canal morphology in maxillary first premolars using the clearing technique in a South Indian population. METHODOLOGY: Two hundred and twenty-five extracted noncarious, nonfractured, sound maxillary first premolars were collected, cleaned, and were injected with India ink to stain the root canals. Teeth were then decalcified and cleared using methyl salicylate. Teeth were then viewed under a stereomicroscope to evaluate the number of roots, root canal morphology based on the Vertucci's classification, variations, and additional features such as accessory root canals, lateral canals, furcation canals, isthmus, and apical delta. RESULTS: Nearly 52.88% of maxillary first premolars were single rooted, 44.88% had two roots, and 2.22% had three roots. Vertucci's Type IV root canal configuration was the most common type in maxillary first premolars and was seen in 66.51% of cases followed by Type II in 13.4%. Type I was seen in 9.76%, Type VI in 6.51%, Type VIII in 2.32%, Type III in 0.46%, Type V in 0.46%, and Type VII in 0% of teeth. CONCLUSION: The majority of the maxillary first premolars included in our study were single rooted and Vertucci's Type IV was the most common type of root canal configuration.

Salivary and Serum Aspartate Aminotransferases and Alanine Aminotransferases in Insulin-Dependent Diabetes Mellitus and Normal Children: A Comparative Study.

AIMS AND OBJECTIVES: The aim of the study was to estimate and compare aspartate aminotransferases (AST) and alanine aminotransferases (ALT) levels in saliva and serum of insulin-dependent diabetes mellitus (IDDM) and normal children, and the objective was to evaluate the significance of these enzymes in assessing the salivary gland injury in IDDM children. MATERIALS AND METHODS: The study group comprised of thirty children clinically and biochemically diagnosed for IDDM and thirty healthy children of similar age in the control group. Saliva and serum samples were collected and enzyme assay was performed by optimized ultraviolet test method (according to International Federation of Clinical Chemistry). The values obtained were subjected to statistical analysis using Mann-Whitney U-test for comparison of the variables and Karl-Pearson's coefficient test for correlation. The SPSS 16.0, (SPSS Inc., Chicago, USA) was used for statistical analysis. RESULTS: Higher values of AST (mean = saliva 91.60 IU/L) and ALT (mean = saliva 94.93 IU/L) were found in the saliva than in serum (AST serum = 15.83 IU/L) (ALT serum = 20.80 IU/L) among the patients and the differences were statistically highly significant (P = 0.001). A similar comparison in the control group did not show statistical significant difference (saliva - AST mean = 23.50 IU/L, ALT mean = 21.95 IU/L and serum - AST mean = 12.60 IU/L, ALT mean = 13.25 IU/L). On correlation between patient and normal group, greater values of AST and ALT were observed in saliva of patients and the difference was statistically highly significant ([AST-mean = patients 91.166 IU/L and controls = 23.500 IU/L] [ALT-mean = patients 94.933 IU/L and controls 21.950 IU/L]). The serum values of patients and controls did not show statistical difference. Although higher values of salivary ALT and AST were observed in patients with the disease for 0-5-year clinical duration (ALT mean = 100.21 IU/L and AST mean = 95.39 IU/L) than those with the disease for 6-10-year duration (ALT mean = 77.57 IU/L and AST mean = 77.28 IU/L), values were statistically nonsignificant. CONCLUSION: Elevated salivary AST and ALT levels in IDDM patients suggest the injury to salivary glands and could aid as a salivary marker for the involvement of salivary glands in IDDM.

Tetrad presentation of non-syndromic odontogenic keratocyst: An uphill diagnostic and therapeutic challenge.

Odontogenic keratocyst (OKC), in the last decade sceptically referred to as keratocystic odontogenic tumor (KCOT), is known for its subclinical extensive growth potential and significant rate of recurrences. Odontogenic keratocyst, being the third most common cystic lesion (10-20%) of the maxillofacial region, is often recognized as a sporadic lesion and is well-documented in the literature. Multiple presentation of these cysts over a lifetime is relatively uncommon and is usually seen in conjunction with nevoid basal cell carcinoma syndrome (NBCC), orofacial digital syndrome, Noonan syndrome, Ehlers-Danlos syndrome, Simpson-Golabi-Behmel syndrome, or other syndromes. The 'two-hit' hypothesis postulated by Knudson best explains this anomaly, wherein multiple OKCs associated with the syndromes arise as a consequence of the allelic loss in the patched (PTCH) gene, mapped to the long arm of chromosome 9q22.3-q31. A partial expression of the gene may result in multiple OKCs (5%) without any related syndromes. Though concurrent occurrence of non-syndromic multiple OKCs is a rare phenomenon, a handful of cases have been documented over the past few years. Adding to this, we report a case of multiple OKCs occurring synchronously and bilaterally in all 4 quadrants in non-syndromic, otherwise healthy persons, which could indicate a shift in trend.

Role of Biomarkers in Differentiating New-onset Seizures from Psychogenic Nonepileptic Seizures.

INTRODUCTION: Review of literature revealed very limited studies considering a combination of serum prolactin (PRL) and serum creatine kinase (CK) as markers for differentiating epileptic and psychogenic nonepileptic seizures (PNES). Therefore, in the present study, we analyzed the role of serum PRL and serum CK, individually and in combination. METHODOLOGY: This prospective study was conducted in a tertiary care medical teaching hospital over a period of 18 months. Patients aged over 15 years suspected to have new-onset seizures presenting within 5 h of ictus were included in this study. CK, serum PRL was measured at 0-1, 1-3, and 3-5 h after seizures. RESULTS: Hundred subjects were studied for the role of serum PRL and serum CK in differentiating epileptic and PNES. The mean age was 42.24 years with a male:female ratio of 1.27:1. All patients of generalized tonic-clonic seizures (GTCS), who presented within 1 h, had elevated PRL, whereas 75% of patients with partial seizures had elevated PRL within 1 h of presentation. Nearly 91.66% of patients with GTCS who presented within 1 h had elevated CPK, whereas 70% of patients with partial seizures had elevated CPK. None of the patients diagnosed with PNES showed rise in either of the markers. CONCLUSION: In the present study, none of the patients with PNES showed raise in either serum PRL or CK. However, there was no correlation between the types of seizure and PRL or serum CK levels.

Maintenance of antemortem dental records in private dental clinics: Knowledge, attitude, and practice among the practitioners of Mangalore and surrounding areas.

INTRODUCTION: With time, an increase in the number of crimes, mass disasters, and wars, has led to the identification of the deceased or assailant critical. In such circumstances, antemortem dental records play a crucial role. MATERIALS AND METHODS: A cross-sectional survey involved 95 dentists practicing in and around Mangalore. The structured questionnaire comprised 24 questions regarding the practice of maintenance of dental records. The questionnaire was given either personally or sent by post. The data obtained was subjected to descriptive analysis. RESULTS: With 87% of the dentists maintaining records, only 31% of them recorded all the details required to be present in a dental record. Of these 18% of them maintained the records for >5 years. CONCLUSION: The results suggest that most of the practicing dentists in this area either do not maintain or maintain inadequate records, which is alarming. Thus, there is a need to set protocols to increase the awareness for maintaining good dental records.

Fluorescence of Candida in diagnosis of oral candidiasis.

BACKGROUND: Many pathogenic fungi fluoresce in hematoxylin and eosin stained sections, and Papanicolaou (PAP)-stained smears under ultraviolet illumination. In theory, this phenomenon could aid in the diagnosis of common fungal infections without the delay which is usually associated with special stains. OBJECTIVE: To evaluate the role of fluorescence as a rapid screening technique for oral infections caused by Candida organisms in exfoliative smears of oral candidiasis. MATERIALS AND METHODS: Two smears and one swab were collected from each of 62 clinically diagnosed cases of oral candidiasis. Smears were stained with (PAP) and periodic acid-Schiff stain (PAS). Both smears were evaluated under light microscopy (LM). Later, PAP smears were observed under fluorescent microscopy (PAP-FM). The swab was inoculated on Sabouraud's agar plate. Each technique was evaluated for sensitivity and specificity. RESULTS: It was found that the PAS-stained smears were more reliable for detection of Candida species than other methods (sensitivity = 100%; specificity = 66.7%). The PAP-LM and PAP-FM showed less sensitivity (67.9% and 85.7%) and specificity (66.7% and 33.3%), respectively. Combined results of both light and fluorescent microscopy of PAP (LM + FM) showed increased sensitivity (89.3%) but reduced specificity (16.7%). CONCLUSION: PAP autofluorescence is less sensitive than PAS, still it accentuates the distinct morphological features of Candida.

Quantitative Analysis of Acute Phase Proteins in Post Chemo-Radiation Mucositis.

AIM: Oral mucositis induced by radiation is an inevitable but transient side-effect of radiotherapy. Acute phase proteins are a class of proteins whose phase concentrations fluctuate in response to inflammation. The best known of the acute phase proteins is C-reactive protein, a protein that rises in the blood with inflammation. MATERIALS AND METHODS: 30 patients undergoing chemo - radiotherapy for head and neck cancer were clinically evaluated for mucositis on day 0, 7, 14, 28 and 42. Blood investigations like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count were also conducted. RESULTS: There was a significant increase in the severity of mucositis during the course of treatment followed by a gradual decrease in severity towards the end of radiotherapy. Comparison of C-reactive protein levels from day 0 to day 42 in the study group showed a significant increase towards the end of radiotherapy. There was a significant increase in erythrocyte sedimentation rate levels till day 14 followed by a decrease towards the end of radiotherapy whereas total leukocyte count showed a significant decrease from day 0 to day 7 followed by an increase towards the end of radiotherapy. CONCLUSION: The oral mucosa bears only a small clinical spectrum of the side-effect conveyed by chemo-radiation. Both widespread and late effects do occur, and tissues may never return to normal completely. Inflammatory serum markers like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count can thus be used as an objective measure to study the complexities of radiation mucositis which is documented as one of the worst side effects of head and neck cancer therapy.

Status of trace elements in saliva of oral precancer and oral cancer patients.

BACKGROUND: Several studies in recent years have linked association between micronutrient levels and various forms of cancer. Copper and zinc have been the most researched micronutrients. AIM: The aim of the study was to evaluate the levels of copper, zinc and iron in saliva of patients with oral leukoplakia, oral submucous fibrosis and oral squamous cell carcinoma. RESULTS: There was a highly significant increase in the level of salivary copper in oral submucous fibrosis patients when compared to controls (P = 0.001). Salivary copper levels were also elevated in oral leukoplakia and oral cancer patients (P = 0.01). There was a significant decrease in the salivary zinc levels in all three study groups when compared to controls (P = 0.001). A highly significant reduction in salivary iron levels was noticed oral submucous fibrosis group. The copper to zinc ratio significantly increased in all the study groups when compared to controls. CONCLUSION: Results suggest that salivary copper zinc and iron could be used as biomarkers for oral precancer and cancer.