Salivary transforming growth factor beta in oral submucous fibrosis: A diagnostic and predictive marker.

CONTEXT: Growth factors and cytokines like transforming growth factor beta (TGF-ß) play a key role in the pathogenesis of oral submucous fibrosis. AIMS: To elucidate the role of Salivary TGF-ß isoforms as a predictive and diagnostic marker for oral submucous fibrosis. SETTINGS AND DESIGN: A total of 30 OSMF and 10 control patients were included in this study, and their clinic-epidemiological data was recorded. METHODOLOGY: The expression of TGF-ß genes-TGF-ß1, TGF-ß2, TGF-ß3-was studied by a real-time polymerase chain reaction in tissue and saliva. Patients were given medicinal intervention for 12 weeks along with jaw-opening exercises. Expression of salivary TGF-ß genes was studied at 12 weeks. STATISTICAL ANALYSIS USED: SPSS software version 20. RESULT: Expression of salivary TGF beta isoforms in OSMF was more than in the control group. There was an increase in salivary TGF-ß1, ß2, ß3 expressions with increasing clinical grades of OSMF and advancing the stage of the disease. Expression of all the TGF beta isoforms was decreased after treatment with statistically significant results. Statistically significant correlations were found between the mean difference of TGF-ß1 and the mean difference between mouth opening and tongue protrusion. CONCLUSION: Salivary TGF-ß isoforms may be used in diagnosis, risk assessment, and screening of the entire population at risk of OSMF after its clinical validation. However, adequate sample size and segmental assessment of the expression of TGF-ß isoforms are needed for further evaluation.

Basal Cell Adenoma of the Upper Lip: Report of a Rare Case With Literature Review.

Basal cell adenoma (BCA) is a rare, benign tumor originating from the epithelial cells of the salivary glands. It was earlier categorized as a subtype of monomorphic adenoma with distinctive histopathological features. BCA usually manifests as asymptomatic, slow-growing masses that exhibit a site and age predilection, commonly affecting the major salivary glands of elderly female patients. Histologically, solid, trabecular, tubular, and membranous patterns are recognized. It is imperative to establish a precise distinction between BCA, pleomorphic adenoma, and malignant salivary gland tumors before initiating treatment to ensure effective management. The standard treatment approach is surgical resection of the tumor. Recurrence and malignant transformation rarely occur, except for the membranous subtype. This article aims to report an unusual case of BCA arising from a minor salivary gland in the upper lip. The post-operative course was unremarkable, with complete healing of the surgical site. No recurrence was observed during a one-year follow-up. BCA arising from a minor salivary gland in the upper lip is an extremely uncommon entity. A comprehensive review of BCA in the upper lip, reported from 1991 to December 2023, revealed only 14 cases.

Nasopalatine Duct Cyst with Impacted Inverted Mesiodens: A Rare Case Report and Literature Review.

Nasopalatine duct cyst (NPDC) is a non-odontogenic, developmental epithelial cyst that accounts for 1% of maxillary cysts. It often arises due to the spontaneous proliferation of the epithelial tissue remnants, although trauma, bacterial infection, and mucous retention may also trigger the proliferation. Owing to its slow-growing, asymptomatic nature, the cyst is often discovered as an accidental finding during routine clinical and radiographic examinations. However, the majority of cases present as a tiny, asymptomatic swelling just posterior to the palatine papillae. Radiographically, it appears as a well-defined oval or round radiolucency in the maxillary anterior teeth region and should be differentially diagnosed with inflammatory periapical lesions and a wide incisive foramen. A pulp vitality test is essential to rule out lesions of endodontic origin. Microscopically, NPDCs display a mixed pattern of the epithelial lining and exhibit neurovascular bundles (small to medium-sized nerves, arteries, and veins), and minor salivary glands in the cystic connective tissue, a distinctive feature facilitating a confirmatory diagnosis. Enucleation and marsupialization remain the treatment of choice. NPDC associated with impacted mesiodens is an extremely uncommon entity. A comprehensive literature search carried out on the PubMed and Google Scholar search engines revealed only three cases of NPDC with impacted mesiodens to date. The purpose of this study is to report an extremely rare case of NPDC associated with an impacted inverted mesiodens in a 19-year-old male patient who presented with an asymptomatic swelling in the maxillary anterior teeth region. To the best of our knowledge, this is only the fourth reported case of NPDC with impacted mesiodens.

Calcifying odontogenic cyst: Report of an uncommon entity with a brief literature review.

The aim of this clinical report is to document a rare and unusual case of calcifying odontogenic cyst (COC) in the maxillary anterior region in a 13-year-old girl. A COC is an extremely uncommon developmental, odontogenic entity and accounts for 0.3%-0.8% of odontogenic cysts. The lesion presents as an array of varied radiographic and clinicopathological characteristics and biological attributes and exists in three histomorphologic patterns - benign cystic, solid (neoplastic) and aggressive (malignant) forms. Thus, several nomenclatures and classifications have been put forth to explain the nature of the clinical entity. However, ambiguities regarding the exact nature of the lesion still prevail. Due to nonspecific clinicoradiographic features, histopathological interpretation remains the key for diagnosis. We report an uncommon occurrence of COC in a 13-year-old female who reported to our Outpatient Department with an asymptomatic right midfacial swelling. The clinical and radiographic findings were suggestive of adenomatoid odontogenic tumor and dentigerous cyst. The decision to enucleate the lesion was considered, and histopathological features were compatible with the diagnosis of COC. Re-ossification with no recurrence was noticed after a 1-year follow-up. COC is an unusual developmental odontogenic cyst that clinically and radiologically simulates other more common jaw entities. Thorough knowledge of the bizarre presentation and biological attributes of such lesions are imperative for an early diagnosis and definitive treatment. Long-term follow-up is advocated to prevent recurrences.

Exploring the correlation between COVID 19 and periodontal disease.

An association of periodontal disease with the severity of COVID 19 disease has been observed during COVID 19 pandemic. This article explores the various hypotheses that link the two conditions, to understand their interrelationship. Targeted research may help elucidate evidence for screening of high-risk groups and identification of therapeutic targets.

Isolated Lichen Planus of the Lower Lip: Report of a Rare Case with an Updated Literature Review.

Lichen planus (LP) is a chronic inflammatory, autoimmune entity typically affecting the skin, oral and genital mucosa, and skin appendages, with an underlying malignant potential. Oral lichen planus (OLP) represents the mucosal counterpart of the cutaneous LP and exhibits episodes of exacerbation and remissions. OLP typically manifests as bilateral symmetrical lesions on the buccal mucosa, followed by tongue, and gingiva. However, the occurrence of LP lesions solely on the lip is rarely reported in the literature. The altered clinical appearance of the lip lesions poses a diagnostic threat and raises the possibility of a misdiagnosis. Our aim was to report an unusual case of isolated lower lip LP, and also to carry out a literature review about isolated lip LP lesions, thus, emphasizing the demographic, clinicopathologic attributes, and therapeutic regimen. We report an uncommon occurrence of an isolated lichen planus on the lower lip in a 53-year-old male patient. Clinical evaluation revealed a diffuse erosive crusted lesion bordered by peripheral lacy radiating streaks on the lower lip. After a confirmed OLP histopathology, the patient was treated with low potency topical steroids and Vaseline therapy, with almost completely resolved lesions after 2 months of therapy. We report a rare case of isolated lip LP, and our detailed review revealed 44 reported cases of lip LP till date. The majority of the cases were seen on the lower lip and exhibited an age and gender affinity (mostly in middle-aged males). Significant healing was observed after topical steroid therapy.

A review of the anticancer activity of Azadirachta indica (Neem) in oral cancer.

BACKGROUND: Azadirachta indica (neem), belongs to the family of Meliaceae plants, is found in the Indian subcontinent. The neem tree is colloquially referred to as the village pharmacy due to its array of biological properties. Every part of the neem tree like its bark, leaves, sap, fruit, seeds, and twigs find a multitude of uses. It is customary to use them for management of skin diseases and various other infections.The anticancer properties of neem have been studied in the past and these include its ability to modulate the tumour environment, increase the cytotoxic ability of host monocytes and suppress the proliferation of tumour cells. The present review was conducted with the objective of scrutinizing and assimilating data about the usefulness Azadirachta indica in oral cancer from all the previously done work. MATERIAL AND METHODS: A planned review was conducted of all the studies that investigated the role of Azadirachta indica in oral cancer. Literature search was carried out using PubMed, Scopus and Google scholar databases. In addition to electronic searching, hand searching, cross referencing and various internet engines were also used to collect data. The articles were perused and articles not pertinent to our search were omitted. RESULTS AND CONCLUSION: The anticancer properties of neem were evaluated and the active constituents of neem have been demonstrated to unequivocally have preventive and therapeutic potential against oral cancer. Although, greater exploration of the anticancer properties of neem are required in order to effectively integrate it into the routine management of oral cancer.

Detection of human papilloma virus-E6/E7 proteins of high-risk human papilloma virus in saliva and lesional tissue of oral squamous cell carcinoma patients using nested multiplex polymerase chain reaction: A comparative study.

INTRODUCTION: Human papilloma virus (HPV)-associated oral squamous cell carcinoma (OSCC) shows different biological behavior as compared to tobacco-induced OSCC. Mere presence of HPV in OSCC is of no clinical significance; however, the integration of HPV-DNA through E6/E7 gene into the host genome is important as it affects the development and progression of OSCC. AIM: The aim of this study was to determine the presence of E6/E7 proteins of high-risk (HR) HPV (HPV16 and HPV18) in saliva as well as lesional tissue of OSCC patients and to determine the use of saliva as an alternative to tissue for E6 and E7 proteins in OSCC. MATERIALS AND METHODS: Histopathologically confirmed 47 cases of OSCC were taken up for the study. The tumor tissue and saliva sample of each patient were obtained to detect the presence of HPV16 and HPV18 along with E6/E7 proteins in both samples by nested multiplex polymerase chain reaction (NMPCR). The data were analyzed using Student t-test (2 tailed) and Wilcoxon signed-ranks test. RESULTS: In tumor tissue, 40.42% of cases showed HPV16 (19/47) positivity while 34.04% were HPV18 (16/47) positive; whereas, in salivary sample, 31.91% showed HPV16 (15/47) positivity while 25.53% of cases were HPV18 positive (12/47). Mean age of participants was 46.7 years, males showed no significant difference from females in the prevalence of HPV 16/18 with tongue being the most common site for the occurrence. There was no statistically significant difference for HPV16/18 presence in tissue and saliva sample of OSCC. Taking lesional tissue sample as standard, sensitivity and specificity for HPV16 and HPV18 in saliva by NMPCR was estimated at 68.42% and 92.86%, respectively. The accuracy level of NMPCR detection for HPV16 was 82.98% and HPV18 was 65.96%. CONCLUSION: The study revealed no significant difference in the prevalence of HPV (16/18) among tissue and saliva of OSCC patients in Indian population. The study also found no difference in the level of DNA content of HPV in saliva and tissue indicating that saliva can be used as an alternative predictor of HPV positivity in OSCC.

Morphometric Analysis of Odontometric Parameters for Gender Determination.

INTRODUCTION: In contemporary human population, males exhibit larger size of dentition as compared to females. Additionally, these odontometric parameters show variation in members of same species and also show regional variation. AIM: To evaluate sexual dimorphism of four maxillary odontometric parameters such as Intercanine Width (ICW), Interpremolar Width (IPW), Arch Length (AL) and Combined Width (CW) of six maxillary anterior teeth, to determine percentage of sexual dimorphism of all four odontometric parameters singly or in combination and also to determine sensitivity, specificity and overall accuracy of odontometric parameters for sex determination. MATERIALS AND METHODS: This cross-sectional study was conducted on 200 subjects (100 males, 100 females). Four odontometric parameters ICW, IPW, AL and CW were measured directly on the subject and the data thus collected was subjected to statistical analysis. RESULTS: Discriminant statistical analysis (d square test) revealed that all the four odontometric maxillary parameters exhibited greater mean values in males as compared to females. The difference was found to be statistically highly significant (p<0.001) for ICW and IPW for sexual dimorphism. Also, combination of parameters such as ICW, IPW further improved assessment. CONCLUSION: The study concluded that linear odonotometric parameters ICW, IPW along with AL, CW show significant sexual dimorphism. Hence, odontometric parameters offer simple, reliable and cost-effective way of determining sex in any forensic investigation.

Telomerase: An exploration toward the end of cancer.

BACKGROUND: The distinguishing feature of cancer cells is their ability to proliferate indefinitely, which is in contrast to the restricted cell multiplication potential for somatic cells. A better understanding of this contrasting behavior was provided in the early 1990s with the discovery of a relationship between telomeres, telomerase, aging, and cancer. Telomeres (tandem repeat DNA sequence TTAGGG) are protective caps at the ends of human chromosomes. Normal human cells experience telomere shortening with each successive cell division. However, in tumor cells, an overexpression of telomerase confers limitless replicative potential to tumor cells by continuous elongation of telomeres. The objective of this review was to systematically assess the data available on telomerase expression in oral cancer, with special reference to its role in diagnosis, prognosis, and treatment. MATERIALS AND METHODS: A systematic review of studies that investigated the telomerase expression in oral squamous cell carcinoma (OSCC) was registered with PROSPERO. Subsequent to registration, a predetermined search strategy in accordance with PRISMA guidelines was formulated, and a literature search was conducted using online databases along with hand searching. RESULTS: Eighty-nine articles from PubMed, 83 from Scopus, 5 from BioMed Central, 43 from Google Scholar, and 2 from hand search were identified. A total of 21 articles were shortlisted that met strict inclusion and exclusion criteria and quality assessment. Each study was evaluated for the markers under study, type of sample used, study design/methodology, and statistical analysis. The studies were then grouped into three subheads depending on their implications in the diagnosis, prognosis, and treatment of OSCC. CONCLUSION: This review explains the basic biology and the clinical implications of telomerase-based diagnosis and prognosis, the prospects for its use in anticancer therapy, in the context of oral cancer.

Pigmented oral compound nevus of retromolar area - A rare case report.

Solitary pigmented melanocytic intraoral lesions of the oral cavity are rare. Oral nevus is a congenital or acquired benign neoplasm. Oral compound nevus constitutes 5.9%-16.5% of all oral melanocytic nevi. The oral compound nevus is commonly seen on hard palate and buccal mucosa and rarely on other intraoral sites. The objective of this article is to present a rare case report of oral compound nevus in the retromolar pad region along with a review of literature. A 22 year old female reported with a solitary black pigmented papule at retromolar pad region which was surgically removed and microscopic investigation confirmed the diagnosis of oral compound nevus.

Evaluation of Role of Myofibroblasts in Oral Cancer: A Systematic Review.

AIM: To conduct a systematic review on the role of myofibroblasts in progression of oral cancer. The myofibroblast is essential for the integrity of the mammalian body by virtue of its role in wound healing, but it also plays a negative role due to their role in promoting tumor development. SETTINGS AND DESIGN: Systematic review. MATERIALS AND METHODS: Bibliographic searches were conducted in several electronic databases using all publications in PubMed, PubMed central, EMBASE, CancerLit, Google scholar, and Cochrane CCTR between 1990 and June 2015. RESULTS: The search of all publications from various electronic databases revealed 1,371 citations. The total number of studies considered for systematic review was 43. The total number of patients included in the studies was 990. CONCLUSION: Myofibroblasts are a significant component in stroma of oral cancer cases, though not identified in all cases. This systematic review shows that clinical, pathological, and immunohistochemistry tests have correlated the presence of high myofibroblast count in oral cancer cell stroma. KEY MESSAGES: Myofibroblasts play a significant role in oral cancer invasion and progression. Various studies have demonstrated their association with oral cancer. This review tends to highlight their role in the pathogenesis of oral cancer over the decade. HOW TO CITE THIS ARTICLE: Sekhon HK, Sircar K, Kaur G, Marwah M. Evaluation of Role of Myofibroblasts in Oral Cancer: A Systematic Review. Int J Clin Pediatr Dent 2016;9(3):233-239.

Four odontometric parameters as a forensic tool in stature estimation.

OBJECTIVE: The study was conducted to investigate the possibility of predicting the height of an individual using selected odontometric parameters as a forensic tool. MATERIALS AND METHODS: The study sample consisted of 100 subjects (50 male and 50 female). Measurements of intercanine width (IC), interpremolar width (IP), mesiodistal dimension of six permanent maxillary anterior teeth (CW), and arch length (AL, canine to canine) were made directly on the subject. The data collected were subjected to statistical analysis and a linear regression formula was obtained against each odontometric parameter. RESULTS: Highly significant correlation was observed between height and intercanine width, interpremolar width (P < 0.0001), whereas correlation between height and the combined width of six anterior teeth and arch length was found to be not significant. The linear regression equation using formula y = c + mx was obtained for each odontometric parameter and also for combined parameters. CONCLUSION: Hence the study concludes that the two odontometric parameters such as intercanine width and interpremolar width can be used successfully to calculate the stature of an individual from fragmentary remains.

Role of heat shock proteins in oral squamous cell carcinoma: A systematic review.

BACKGROUND: Environmental and patho-physiologic stresses stimulate synthesis of heat shock proteins (HSPs) which enable the cell to survive and recover from stressful conditions, by as yet incompletely understood mechanisms. Heat shock proteins show an increased expression in a wide range of human cancers and have been associated with tumor cell proliferation, differentiation, invasion, metastasis, death, and recognition by the immune system. Yet the role of heat shock proteins in oral cancer is ambiguous. The objective of this review was to systematically assess the data available on the role of HSP expression in oral cancer with special reference to its role in diagnosis, prognosis and treatment. METHODS AND RESULTS: A systematic review of studies that investigated the HSP expression in oral squamous cell carcinoma using Scopus, Medline, Embase and Google scholar databases from their inceptions to 2013, without language restrictions was conducted. We selected 24 studies from which data extraction and validations were performed. CONCLUSION: The literature search revealed differential expression of HSPs during oral tumorigenesis with implications for the specific role of HSPs in the pathogenesis of oral cancer. HSP expression has been regarded as an independent prognostic factor for oral squamous cell carcinoma patients and HSPs are being explored as potent vehicles for delivery of preventive and treatment vaccines in cancer and other diseases.

The role of tobacco as an etiological agent for oral cancer: Cytomorphometrical analysis of the buccal mucosa in tobacco users.

BACKGROUND: Histopathological diagnosis of lesions arising from the intake of tobacco is based on subjective evaluation of morphological alterations within the lesional tissue. Oral exfoliative cytology is a non-invasive diagnostic technique for early detection of oral premalignant and malignant lesions. Morphometric techniques have been advocated as objective and reproducible methods of detecting changes before they are visible by routine microscopy and can facilitate differentiation of normal and abnormal epithelium. This study was conducted to assess the morphometric parameters (cell diameter, nuclear diameter and nuclear cytoplasmic ratio [N:C ratio]) in tobacco smokers and chewers and to evaluate the variations, if any. MATERIALS AND METHODS: The study was conducted on cytological smears obtained from oral lesions of patients with habit of tobacco smoking (Group B) and tobacco chewing (Group C). Group A comprised of subjects free from oral lesions and not using tobacco in any form. Patients with both the habits were excluded. The smears were stained using Papanicoloaou staining method. For morphometric analysis, Microimage 3.0 image analysis software was employed. The statistical test employed was an analysis of variance and P < 0.05 was considered as significant. RESULTS: The results of this study showed that the cellular diameter was progressively reduced and nuclear diameter progressively increased from Group A to Group B to Group C. The N:C ratio also showed a progressive increase from Group A to Group C. CONCLUSION: The results confirmed that tobacco chewing and smoking influenced the cytomorphology of normal appearing buccal mucosa and the degree of these changes were found to be greater in chewers as compared to smokers.

Salivary duct cyst on lower lip: A rare entity and literature review.

Mucocele forms because of salivary gland mucous extravasation or retention and is usually related to trauma in the area of the lower lips. Salivary duct cyst, however, is a type of mucous retention cyst which is almost never located on the lower lip. The aim of this paper is to report this extremely rare salivary duct cyst present on the lower lip and to critically review the literature to build important concepts that would help clinicians in the diagnosis and treatment of this pathology.

Expression of Bcl-2 and MIB-1 Markers in Oral Squamous Cell Carcinoma (OSCC)- A Comparative Study.

BACKGROUND: Neoplasia results from various genetic and epigenetic factors. Our study focused on the pathogenesis which involved an imbalance in various molecular mechanisms which regulated cell proliferation and apoptosis. The anti-apoptotic mechanism is regulated by Bcl-2 gene, while Ki-67 is expressed exclusively in nuclei of proliferating cells. This study was done to evaluate the basic pathologic process which underlay well and poorly differentiated oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Thirty cases of oscc were selected, out of which 11 were well differentiated, 9 were moderately differentiated and 10 were poorly differentiated. Three slides of 4µm thickness were prepared out of each sample, which were then subjected to Hematoxylin and eosin stain (H&E) staining and two types of immunohistochemical (IHC) staining. Immunohistochmical markers used were Ki-67 (proliferative marker using MIB-1 (Molecular Immunology Borstel 1) antibody) and Bcl-2 (anti-apoptotic marker). The number of MIB-1 and Bcl-2 positive cells was calculated from ten different high power fields, by counting the number of positive cells per 50 cells in each field, by making a grid pattern. The overall percentage value for each case was evaluated for MIB-1 and Bcl-2 positive cells. Karl-Pearson's co-relation coefficient was calculated between MIB-1 and Bcl-2 in each group. The aim of this study was to co-relate the expression of Ki-67, a proliferative marker, by using MIB-1 antibody and Bcl-2, an anti-apoptotic marker in various grades of oscc and also to determine whether there was any co-relation between these two markers in the 30 cases of oscc . RESULTS: A statistically significant increase for MIB-1 and a statistically significant decrease for Bcl-2 was found in well to moderately to poorly differentiated Squamous cell carcinoma (SCC). A statistically significant co-relation was also found between MIB-1 and Bcl-2 in poorly differentiated oscc . CONCLUSION: MIB-1 expression is predominant in well, moderate and poorly differentiated SCCs. Bcl-2 expression is predominant in well differentiated than in moderately and poorly differentiated oscc , which suggested that apoptosis probably played a major role in the early stages of carcinogenesis.

Determination of the biometric characteristics of palatine rugae patterns in Uttar Pradesh population: a cross-sectional study.

BACKGROUND: Identification is the establishment of identity of an individual. The basis of dental identification is based on the observation that no two individuals can have same dentition. Palatal rugae are irregular, asymmetric ridges of the mucous membrane extending laterally from the incisive papilla and the anterior part of the palatal raphe. The location of palatal rugae inside the oral cavity confers them with stability even when exposed to high temperatures or trauma. Their resistance to trauma and their apparent unique appearance has suggested their use as a tool for forensic identification. AIMS: To record the biometric characteristics of shape, size, direction, number and position of palatal rugae and analyze whether palatal rugoscopy can be used as a tool for personal identification and for sex determination. SETTINGS AND DESIGN: A cross-sectional study. MATERIALS AND METHODS: The sample consisted of 100 subjects (50 males, 50 females) between 18 and 25 years. Maxillary impressions were made with elastomeric impression material and dental stone was used to make models. The palatal rugae patterns were traced and analyzed with a magnifying hand lens. The biometric characteristics of number, size, shape, and direction were analyzed using Thomaz and Kotz classification (1983). The casts were coded to blind the examiners about the identity of the subjects. STATISTICAL ANALYSIS USED: Unpaired t-test and one-way ANOVA using SPSS 19.0 statistical program for Windows. RESULTS: The average number of rugae was slightly more in females. Wavy (44.9%) and curved (41.8%) shapes were more prevalent. Maximum number of rugae was found in E quadrant (40.73%). The average size was 9.221 mm. Most rugae were forwardly directed in both groups. CONCLUSION: This study concluded that rugae pattern are highly individualistic and can be used as a supplementary method for personal identification and sex determination. Further inter-observer and intra-observer variability were not found to be significant, which further validates the use of rugoscopy as a forensic tool.