Muscle Activity in Pre-Treatment and Post-Treatment Oral Submucous Fibrosis Patients: Electromyography Study.

Background: Oral submucous fibrosis (OSMF) is a premalignant condition of insidious onset which affects the oral mucosa, pharynx, and esophagus. The muscles of mastication are known to be affected resulting in limited mouth opening. Electromyography (EMG) is a sophisticated method of measuring and evaluating muscle activity. Previously, EMG was primarily utilized in medical sciences, but it is currently being used extensively in both the medical and dentistry fields. Objectives: The aim of the study is to evaluate the electromyographic activity of masseter muscle in OSMF patients before and after treatment and to compare with healthy controls. Materials and Methods: This prospective case-control clinical study comprised 180 OSMF patients who were divided into four groups and 45 healthy individuals served as the control group. The OSMF individuals were injected with hyaluronidase 1,500 IU mixed in 1.5 ml of dexamethasone and 0.5 ml of lignocaine HCL intralesionally twice a week for one month along with a basic physiotherapy regimen consisting of mouth exercises two times daily. The control subjects were given placebo capsules. The treatment was carried out for a month and the electromyographic masseter muscle activity was evaluated among the OSMF patients and control group before and after treatment. Results: The results revealed that the electromyographic activity of master muscles in OSMF patients showed increased activity when compared with healthy controls. Patients with OSMF showed decreased muscle activity after treatment. Conclusion: When compared with healthy controls, OSMF patients had higher electromyographic activity of the masseter muscles and the muscle activity was decreased following treatment. In OSMF patients, EMG may help in determining the involvement of the mastication and facial expression muscles. It can also be used as a diagnostic tool to assess the treatment outcome of muscle activity in OSMF patients.

The Reliability of a New Device for Measuring the Maximum Bite Force.

OBJECTIVE: To test the inter- and intraexaminer reliability of a recently developed instrument for measuring the maximum bite force (MBF). Material and Methods. Sixty patients who were clinically confirmed as having Oral Submucous Fibrosis (OSMF) and 60 healthy controls were included in this study. For each subject, age, gender, weight, height, and body mass index (BMI) were recorded. The maximum bite force was recorded in alternate order with a bite force sensor (D1) and an occlusal force meter (D2). Bite force was measured in the first molar region. Pearson's correlation coefficient and kappa statistic were applied to assess the reliability between D1 and D2 in the assessment of maximum bite force. The independent t-test was performed to find the statistical significance between the two study groups. The paired t-test was applied to find out the difference between the right and left disease in groups of two devices separately. The one-way analysis of covariance (ANOVA) was performed to find the significant difference between grades of OSMF. RESULTS: The results of the kappa values were 0.8531 ± 0.0724 and 0.7336 ± 0.0737 for interdevice reliability in OSMF patients in right and left sides. Similar findings were obtained in right and left sides of healthy individuals (0.7549 ± 0.0816 and 0.9440 ± 0.0806) and in the total sample (0.8132 ± 0.0544 and 0.8303 ± 0.0538). Pearson's correlation coefficient between two devices revealed a high and significant positive correlation between D1 and D2 separately and in the whole sample. CONCLUSION: The observations of the present study suggest that the bite force sensor can be used as a reliable device for measuring bite force.

Comparing the efficacy of chemiluminescence with lugol's iodine versus toluidine blue in the diagnosis of dysplasia in tobacco associated oral lesions - A diagnostic study.

Background: Chemiluminescence is the production of light as a result of a chemical reaction. Oral potentially malignant disorders (OPMDs) include both precancerous lesions and conditions that carry an increased risk of cancer. There are different etiological and risk factors for OPMDs such as smoking, alcohol consumption, infections such as viral and fungal, sun exposure and certain other genetic factors. The most common etiological factor for OPMDs is tobacco usage. Chemiluminescence is a light-based detection system and is very useful for detecting OPMDs for early intervention. Because it is a non-invasive procedure, it can be used to evaluate dysplastic changes in various OPMDs at their initial stage for timely intervention. Vital staining has also been used as a chair-side marker for delineating normal and dysplastic oral mucosal tissues. Aim: To compare the efficacy of chemiluminescence with Lugol's iodine to that with toluidine blue in diagnosing dysplastic changes in tobacco associated oral lesions. Methodology: A total of 84 patients with clinically suspicious oral mucosal lesions and OPMDs with tobacco habit history were included and randomly assigned to either of the diagnostic study groups (Group A: chemiluminescence with Lugol's iodine or Group B: chemiluminescence with toluidine blue). All these patients were subjected to a histopathological examination (reference standard). Results: The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristics (ROC) were 91.7%, 66.7%, 84.6%, 80%, and 0.792 for chemiluminescence with Lugol's iodine group (P = 0.001) respectively whereas for chemiluminescence with toluidine blue, the sensitivity, specificity, PPV, NPV and ROC were 100%, 60%, 93.3%, 100% and 0.800 (P = 0.002), respectively. Conclusion: The combination of chemiluminescence with toluidine blue had a better diagnostic efficiency in detecting dysplasia in tobacco-associated oral lesions when compared to the group of chemiluminescence with Lugol's iodine.

Impact of ERCC1 gene polymorphisms on response to cisplatin based therapy in oral squamous cell carcinoma (OSCC) patients.

BACKGROUND AND OBJECTIVES: Cisplatin is one of the major drugs that used in the treatment of oral cancer.Excision repair cross-complementation group 1 (ERCC1) is a key DNA repair gene in the nucleotide excision repair pathway which is activated in the repair of intra- and interstrand DNA crosslink caused by platinum-based treatment. The aim of this study was to investigate the association between polymorphisms in ERCC1 (C118T & C8092A) genes and the response to cisplatin-based chemotherapy. METHODS: ERCC1polymorphisms (C118T & C8092A) were studied using PCR-RFLP method from 150 OSCC patients as cases as well as 150 normal tissues from the same patients were collected as controls for this study. Results: Frequencies of ERCC1 C118C, C118T and T118T genotypes were 60%, 28% and 12% in OSCC patients and 78%, 19% and 3% in the controls, respectively. The C118T & T118T genotype had a 1.69 and 4.97 -folds increased risk for OSCC. Frequencies of ERCC1 C8092C, C8092A and A8092A were 78%, 18% and 4% in the OSCC patients and 89%, 10%, amd 1% in the controls, respectively. The C8092A genotype showed a 1.97-fold increased risk for OSCC. INTERPRETATION & CONCLUSIONS: In conclusion, this study highlights the DNA repair gene polymorphisms that might play a role in mediating susceptibility to oral squamous cell carcinoma and cisplatin therapy. Our data suggest that the ERCC1 C118T, T118T and ERCC1 C8092A genotypes are genetic risk factors for Oral squamous cell carcinoma and ERCC1 118 C/T and C8092A polymorphisms have significant influence on clinical outcome.

Ulcerated oral lichen planus of the lower lip, common disease with the uncommon presentation: A case series.

Dermatologic diseases are often associated with oral manifestations and sometimes the oral lesions are the sole presenting features of the disease. Diagnosing a dermatologic disease based on its oral manifestations is a challenge, especially in the absence of associated cutaneous lesions. Lichen planus is a common dermatologic disease that affects the oral mucosa in the adult population. While some patients have concomitant oral and cutaneous lesions, the oral lesions are persistent and seen for years together even after the cutaneous lesions have healed. Herein, we present two cases of oral lichen planus seen as an ulcerated lesion on the lower lip which is an uncommon manifestation of this otherwise common disease.

Achondroplasia: A form of disproportionate dwarfism - A case report.

Achondroplasia is a genetic disorder that is due to mutation of fibroblast growth factor receptor (FGFR3) gene and it results in dwarfism. It is inherited as an autosomal dominant trait. The classical clinical features seen are disproportionate dwarfism, rhizomelic shortening (proximal limbs), short fingers and toes with trident hands, large head with prominent forehead (frontal bossing), small mid face with flattened nasal bridge, spinal kyphosis or lordosis, varus (bowleg), and valgus (knock knee) deformities. Oral findings include macroglossia, tongue thrust swallowing pattern, posterior crossbite, anterior open bite, anterior reverse overjet, etc., This case report present the features and oral treatment protocol for Achondroplasia.

Assessment of Maximum Bite Force in Oral Submucous Fibrosis Patients: A Preliminary Study

Abstract Objective: To determine the maximum bite force (MBF) in oral submucous fibrosis (OSMF) patients and to compare them with that of healthy subjects. Material and Methods: Twenty patients who were clinically confirmed, as OSMF and 20 healthy controls matched for age, gender, and number of intact functional teeth were included in this study. For each subject, age, gender, weight, height and body mass index (BMI) were recorded. The MBF registration was carried out by the two evaluators, who were previously calibrated. Bite force was measured in the first molar region using a force transducer occlusal force meter for each subject seated at the upright position, with Frankfort's plane nearly parallel to the floor, and no head support. The Student's independent t-test was used to determine the statistical significance in relation to mean height, weight, BMI and the presence of number of intact teeth and MBF between the healthy subjects and OSMF individuals. A comparison of grades of OSMF with all variables was carried out by one-way ANOVA test. Results: No significant difference was found in mean age, mean height, weight, BMI and the presence of the number of intact teeth between healthy individuals and OSMF patients. The mean MBF in healthy subjects was 628.23 ± 24.39 N and 635.47 ± 31.22 N in OSMF patients. Even though the healthy subjects reported a higher MBF than OSMF patients did, the difference was statistically non-significant. With regards to sides, no significant difference was observed in mean MBF in healthy subjects and OSMF patients on the right (p=0.7818) and left side (p=0.6154). Conclusion: The healthy subjects reported higher MBF values than OSMF patients did and the difference was statistically non-significant.

Comparative Study of the Efficacy of Newer Antioxitands Lycopene and Oxitard in the Treatment of Oral Submucous Fibrosis

Objective: To compare the efficacy of oxitard and lycopene in the management of Oral Submucous Fibrosis (OSMF). Material and Methods: 120 subjects with clinicpathologically diagnosed OSMF were included in the study and divided equally in 2 groups, Group A (oxitard) and Group B (lycopene). Group A was administered 2 oxitard capsules twice daily and Group B was given 8 mg lycopene in 2 divided doses of 4 mg for 3 months. Gingival index and plaque index were documented for all patients and compared. Evaluation for different clinical parameters was done at regular intervals and data was analyzed using the Student's paired t test and Chi-square test. P-value <0.001 was considered to be statistically significant. Results: Clinical improvements in mouth opening and tongue protrusion was significant in Group A (p<0.001). Subjective symptoms of pain associated with the lesion (p=0.0001), difficulty in swallowing (p=0.0004) and speech (p=0.0002) significantly improved in the Group A. However, there was no significant improvement in burning sensation (p>0.001) among the 2 groups. Although the mean gingival index and plaque index in group A was reduced but it was found to be not statistically significant. Conclusion: Oxitard capsules can bring about significant clinical improvements in the symptoms like mouth opening, tongue protrusion, difficulty in swallowing and speech and pain associated with the lesion when compared to lycopene, thereby improving the quality of life of the affected individuals.

Three-Rooted Mandibular First Molars in a Saudi Arabian Population: A CBCT Study

Objective: To know the prevalence three-rooted mandibular first molars in a Saudi Arabian population by using CBCT. Material and Methods: A total of 428 CBCT scans in the database of the College of Dentistry, Jouf University, Kingdom of Saudi Arabia were analyzed. All well-developed permanent mandibular first molars were analyzed for the presence of extra root in three dimensions and the reconstructed volumetric images by two qualified and experienced observers. The total incidence, distribution and comparison regarding gender, bilateral and unilateral appearance, and the side of occurrences of these permanent three-rooted mandibular first molars were analyzed by the Chi-square test. The level of significance was set at 5%. Results: The CBCT scans of 14 subjects had three rooted mandibular first molars with a prevalence of 3.27%. The prevalence in males and females was 2.96% respectively, with no significant differences between genders (p=0.865). The frequency of bilateral three-rooted mandibular first molars was 1.16%, with unilateral frequencies of 1.40% and 0.70% on the right and left sides, respectively. No significant relationship between sides (p=0.981) and the bilateral prevalence of three-rooted mandibular first molars (p=0.668) was observed. Conclusion: Dental practitioners must be aware of the fact that though it is rare, an extra or third root can be present in mandibular first molars and CBCT can aid in accurate diagnosis of the presence of third root.

Metastatic hepatocellular carcinoma in the maxilla and mandible, an extremely rare presentation.

Malignancy is characterized by anaplasia, invasiveness, and metastasis. Primary oral squamous cell carcinoma is the most prevalent oral malignancy, but secondary malignancy from distant sites have also been reported. Hepatocellular carcinoma (HCC) is a common primary liver malignancy that frequently metastasizes during the course of the disease, but < 1% of cases show oral involvement. Such secondary neoplasms do not have any pathognomonic clinical or radiologic findings, and therefore they pose a diagnostic challenge. Hence, in the differential diagnosis of malignant tumors of the oral cavity, it is essential to consider the occurrence of both primary as well as metastatic tumors despite the low incidence of the latter. A rare case of HCC metastasizing to both the maxilla and mandible is presented, in which the patient succumbed to the disease as a result of the delay in diagnosis.

Hutchinson-gilford progeria syndrome: a rare genetic disorder.

Hutchinson-Gilford progeria syndrome (HGPS) is a rare pediatric genetic syndrome with incidence of one per eight million live births. The disorder is characterised by premature aging, generally leading to death at approximately 13.4 years of age. This is a follow-up study of a 9-year-old male with clinical and radiographic features highly suggestive of HGPS and presented here with description of differential diagnosis and dental consideration. This is the first case report of HGPS which showed pectus carinatum structure of chest.