Comparison of topical purslane & topical 0.1% triamcinolone acetonide in the management of oral lichen planus - a double blinded clinical trial.

AIM AND BACKGROUND: Oral lichen planus (OLP) is a chronic autoimmune mucocutaneous disorder of unknown etiology and treatment is targeted at alleviating symptoms. At present, corticosteroids are the mainstay treatment, and their side effects hamper their long-term use, demanding alternative therapy. This study intended to assess the efficacy of topical purslane (Portulaca oleracea) at two concentrations, 5% and 10%, in OLP and to compare the level of clinical improvement in comparison to topical 0.1% triamcinolone acetonide gel. MATERIALS AND METHODS: After sample size determination, thirty-four subjects confirmed histopathologically with OLP were included in the study. They were divided into 3 groups, Group 1(Control) was treated with 0.1% triamcinolone acetonide, and Group 2(Case) and 3 (Case) were treated with topical purslane 5% and 10%, respectively. They were examined at baseline, 14 days, 30 days, 60 days, and 90 days. Clinical improvement was then analyzed at the end of 90 days using a visual analog scale (VAS) and Thongprasom's criteria. RESULTS: The study was analyzed statistically and a P value of < 0.05 was considered statistically significant. Intragroup comparison revealed a statistically significant difference between the five time periods (baseline, 14 days, 30 days, 60 days, and 90 days) for the study variables (burning sensation, pain, lesion score, clinical response, symptomatic response) for all three groups (p = 0.001). Alleviation of all symptoms and remission of the lesion were noted for all three groups at the end of three months. CONCLUSION: Purslane is a magical herb with a plethora of rich nutrients, ease in accessibility and devoid of side effects. It was concluded that its preparation is beneficial and can be a safer alternative long-term drug for the management of OLP. CLINICAL SIGNIFICANCE: With available literature evidence, our present study is the first of its kind to formulate a topical gel with purslane to treat symptomatic OLP. Our study had a longer follow-up of 3 months compared to other studies in the literature.

Evaluation and Correlation of Condylar Cortication by Cone-Beam Computed Tomography: A Retrospective Study.

Background: Temporomandibular joint (TMJ) is a ginglymo-diarthroidial joint with fibroelastic cartilage. The chondrogenesis initiates from the 12th week of intrauterine life and the development of condyle is associated with growth. The condylar cortication shows distinct morphological variation for each individual in each stage of their life. The cortical bone around the condyle could be used as a factor for chronological age assessment and it can act as a tool in forensic medicine. Aim and Objective: The study was carried out to evaluate the cortical grading in mandibular condyle using two different applications and to correlate their grades with chronological age. Setting and Design: Hospital-based retrospective observational cross-sectional study. Materials and Methods: The study was carried out in 40 patients and 80 TMJs were assessed for cortication grades in Carestream 3D imaging and Image J applications. These grading from both the applications were correlated with the chronological age. Statistical Analysis: SPSS (Statistical Analysis for the Social Science) - Cohen's Kappa inter-examiner reliability and Spearman's correlation coefficient were used. Results: The radiological assessment of condylar cortication in individual application showed significant results and the relationship of cortication with chronological age showed a significant correlation. Conclusion: The condylar cortication grading is a simple technique and can be used as a factor for chronological age assessment. This is an initial study which used two different applications to view the cortication of the mandibular condyle and to correlate the cortication with chronological age. Hence, a large sample size-based study is required for further research.

Expression of E- Cadherin and Levels of Dysplasia in Oral Leukoplakia - A Prospective Cohort Study.

AIM: Enormous attempts have been made to develop and establish markers that determines the susceptibility of potentially malignant tissues to transform to oral cancer. E - cadherin encoded by CDH1 gene is a protein which plays an important role in cellular adhesion. This study aimed to assess the relationship between the expression of E- cadherin and different grades of epithelial dysplasia in oral leukoplakia. MATERIALS AND METHODS: Tumour biopsies from fifty leukoplakia patients was collected. Half of the tissue was sent for histopathological examination and other half was subjected to see E - cadherin expression by real time PCR. RESULTS: On assessing, the expression of E - cadherin was found to be high in samples with mild dysplasia followed by samples with moderate dysplasia. Samples with severe dysplastic feature showed least expression of E - cadherin. All statistical analyses were performed using Statistical Package for Social science (SPSS) and was proven that there is significant decrease in the expression of E - cadherin as the degree of dysplasia increases with a p value 0.001 and confidence interval 95%. CONCLUSION: We conclude that loss of E - cadherin can be used as a tumour marker that could determine the susceptibility of normal and potentially malignant tissues to transform into oral cancers. To generalise our results, further prospective studies with a large sample size using quantitative real time PCR to read the gene expression should be carried out at multi centre levels.
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Analysis of ARID2 Gene Mutation in Oral Squamous Cell Carcinoma

Background: The ARID2 gene, encoding a sub unit of the chromatin remodelling complex, has a possible tumour suppressor function and has been found to be frequently mutated in various tumours, including gingivo buccal oral squamous cell carcinomas. The present study was designed to analyse the presence of ARID2 gene mutations in the distinct genetic South Indian (Dravidian) population. Materials and Methods: Genomic DNA from thirty biopsy tissue samples of histopathologically confirmed cases of oral squamous cell carcinoma (OSCC) were subjected to PCR amplification with intronic primers encompassing exons 19 and 20 of ARID2. Subsequently, the PCR amplicons were purified and subjected to Sanger sequencing using forward primers for analysis of mutational status. Results: Our study yielded a 6% occurrence of mutations in the ARID2 gene among the thirty OSCC samples. Two samples showed a C(5174)A nonsense mutation whereby the "C" nucleotide was substituted with an "A" nucleotide at position 5174, resulting in the conversion of serine amino acid at codon 1725 to a premature STOP codon. Conclusion: Identification of ARID2 gene mutations in OSCCs in this distinct ethnic population reaffirms that aberrations in the chromatin remodelling complex could indeed also contribute to tumorigenesis, thus providing new insights for future research.

Pycnodysostosis: A bone dysplasia with unusual oral manifestation.

Pycnodysostosis, a sclerosing bone dysplasia, is a rare autosomal recessive disorder with an estimated prevalence rate of one in one million. Patients with pycnodyostosis usually have normal intelligence, sexual development and life span. This condition is characterized by increased bone density and fragility along with oral manifestations like malposition teeth, hypoplastic maxilla, receded chin and delayed eruption of permanent teeth with discharging sinuses in the jaws because of poor blood supply. This is one such rare case report of a 47-year-old patient presenting with a complaint of fractured jaw and reviewing the clinical and radiographic characteristics of pycnodysostosis.