Epithelial Atrophy, Fibrosis and Vascularity Correlation with Epithelial Dysplasia in Oral Submucous Fibrosis, a Prospective Study.

Background: The pathogenesis of oral submucous fibrosis (OSF) still remains conflicting and has been linked to alterations in epithelial thickness, fibrosis, and vascularity. Although changes in these individual parameters have been extensively studied in relation to epithelial dysplasia their combined relation with dysplasia has not been studied much. Any such relation, if present, may further help in understanding this disease process. Therefore, the aim of this study was to assess the relationship between epithelial thickness, fibrosis, and vascularity with dysplasia in OSF. Materials and Methods: The study consisted of 30 OSF patients. Incisional biopsy was taken from the most fibrosed area of the buccal mucosa. Hematoxylin-Eosin-stained slides were assessed for epithelial thickness, fibrosis, and vascularity using image analysis software. The slides were also assessed for epithelial dysplasia. Relationship of epithelial atrophy, fibrosis, and vascularity with dysplasia was assessed using one-way ANOVA. Pearson's correlation coefficient was used for evaluating the relationship between epithelial thickness, fibrosis, and vascularity. Results: Epithelial dysplasia was found in all patients. Eleven patients had mild (36. 67%), thirteen had moderate (43.33%), and six had severe (20%) dysplasia. None of the parameters were found to have a significant relationship with dysplasia. However, moderate and positive correlation was found between epithelial thickness and fibrosis. This relation was statistically significant. Conclusion: Positive correlation between epithelial thickness and fibrosis in present study therefore contradicts the hypothesis of fibrosis induced epithelial atrophy. As dysplasia is influenced by multiple factors therefore habits and burning sensation needs to be incorporated in future studies assessing dysplasia in OSF.

Oral submucous fibrosis and its impact on psychological stress: a case-control study.

Our aim was to evaluate the impact of OSF on psychological stress. Ninety OSF cases and age and sex-matched controls, enrolled from relatives or accompanying person were included in the study. Psychological stress was evaluated by the Psychological General Well Being Index short version (PGWBI-S). Sets of the psychological component were generated by principal component analysis (PCA). Association between components was accommodated for confounder and interaction was evaluated by conditional stepwise logistic regression analysis. Psychological component generated was component 1 (depressed mood, lack of positive well being, low vitality, anxiety, low vitality, and low self-control). The odds ratio (OR) of low score of component 1 for OSF was 3.66. Depressed mood, lack of positive well being, low vitality, anxiety, low vitality, and low self-control were associated with OSF. Psychological intervention should, therefore, be included in the management of OSF.

Assessment of the dimensions of the pterygoid hamulus for establishing age- and sex-specific reference standards using cone-beam computed tomography.

PURPOSE: This study was conducted to establish age- and sex-specific reference standards for pterygoid hamulus (PH) dimensions using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT scans of 1,000 patients (493 males and 507 females) were retrospectively assessed in coronal sections for length and width measurements of the PH by 3 investigators. The study data were divided into 3 age groups (group 1: <20 years, group 2: 20-50 years, group 3: >50 years). Length and width were compared using one-way analysis of variance and the t-test for age and sex, respectively. RESULTS: The length of the PH on the right side significantly increased from group 1 (6.11±1.47 mm), through group 2 (6.65±1.67 mm) to group 3 (6.99±1.79 mm) and on the left side from group 2 (6.58±1.63) to group 3 (6.98±1.70). The width of the PH significantly decreased from group 1 (1.81±0.39 mm) to group 2 (1.61±0.39 mm) on the right side, and similarly from 1.87±0.36 mm to 1.67±0.37 mm on the left side. PH length (7.18±1.81 mm on the right side and 7.10±1.72 mm on the left side) and width (1.68±0.38 mm on the right side and 1.74±0.36 mm on the left side) were significantly greater in males than in females. CONCLUSION: The length of the PH increased with age, whereas width first decreased and then increased. Length and width measurements were significantly higher in males than in females. These findings will aid in the diagnosis of untraceable pain in the oropharyngeal region related to altered PH morphology.

Efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and QOL in patients with OSF.

OBJECTIVES: To assess the efficacy of betamethasone, hyaluronidase and its combination on mouth opening, burning sensation and quality of life (QOL) in patients with oral submucous fibrosis. STUDY DESIGN: Sixty patients were divided in 4 groups; group A received 8 mg of betamethasone, group B received 3000 IU of hyaluronidase, group C received the combination of betamethasone and hyaluronidase and group D received saline injections biweekly for 5 weeks. Patients were also assessed using QOL questionnaire. RESULTS: Mouth opening and oral burning of the four groups for final visit, using the pretreatment opening as a covariate showed significant difference for group A, B, C. CONCLUSION: Betamethasone and hyaluronidase injections appears to be a viable option to increase mouth opening with reduction in burning sensation.

Validity of Chronic Oral Mucosal Diseases Questionnaire in oral submucous fibrosis.

OBJECTIVE: To validate the use of Chronic Oral Mucosal Diseases Questionnaire in oral submucous fibrosis. MATERIALS AND METHODS: Hundred consecutive oral submucous fibrosis (OSF) patients were requested to respond to Visual Analogue Scale (VAS) score and complete the Oral Health Impact Profile 14 (OHIP 14) and COMDQ. Spearman's rho correlation was used to assess the relationship between VAS and COMDQ score and COMDQ and OHIP 14 score. The reliability of the instrument was assessed using Cronbach's alpha analysis. Discriminant analysis was used to assess if COMDQ significantly differentiated between OSF population with and without any prior treatment done as well as OSF with mouth opening less than and more than or equal to 25 mm. RESULTS: The Spearman's correlation coefficient showed a high significance between the different domains of COMDQ and OHIP 14 and COMDQ and VAS. This study demonstrated a good convergent validity between the overall COMDQ and OHIP 14 scores (0.88).The overall Cronbach's alpha value was found to be 0.75 indicating an acceptable internal consistency reliability of COMDQ. The tool was unable to differentiate between patients with mouth opening between less than and more than or equal to 25 mm and patients with and without prior treatment. CONCLUSION: These results provide evidence that COMDQ can be used for OSF patients. CLINICAL RELEVANCE: COMDQ could be used as a valid and reliable tool for further clinical OSF research.

Diagnostic Value of Extraoral Periapical Radiograph in Comparison to Intraoral Periapical Radiograph: A Cross-sectional, Institutional Study.

BACKGROUND: Radiographs form an invaluable adjunct in diagnosis, treatment planning, and postoperative evaluation during patient management in the dental office where intraoral periapical (IOPA) radiographs are the ones most commonly used. However, certain conditions render the placement of film difficult. In such cases, a panoramic radiograph may be taken, but it has the disadvantage of higher radiation exposure and cost. Extraoral periapical (EOPA) technique allows radiographs to be taken on an IOPA film by placing it extraorally. We aimed to evaluate its diagnostic accuracy compared to intraoral bisecting angle technique. MATERIALS AND METHODS: Forty-five patients were randomly selected. Ninety radiographs were taken; two for each patient. First image was obtained by intraoral bisecting angle technique and second by EOPA technique. A scale was devised for the comparison of radiographs taken by the two techniques. Two experienced oral radiologists rated them based on the scale followed by statistical analysis. RESULTS: Patients reported increased compliance with the EOPA technique. 84.40% of the EOPA radiographs (EOPARs) were diagnostically acceptable; sensitivity and specificity was 84% and 55%, respectively. CONCLUSION: EOPAR is beneficial in cases where intraoral film placement is difficult, and a radiograph is necessary for patient management, even though it demonstrates comparatively lesser diagnostic accuracy.