Comparison of the Carcinogenic Potential of Smokeless Tobacco and Smoked Tobacco by Quantifying the Excretion of Nicotine Metabolite NNAL in Patients with Oral Leukoplakia.

The case control study was conducted to quantify the amount of the carcinogenic tobacco specific nitrosamine in smokeless tobacco users and smokers in patients with oral leukoplakia and also to emphasize the role of tobacco-specific nitrosamine in the incidence of oral leukoplakia. The study was conducted on 30 patients. The urine samples were obtained from smokeless tobacco users with oral leukoplakia, smokers with oral leukoplakia and non-tobacco users (i.e. people who do not use tobacco in any form). The collected samples were processed by gas chromatography-mass spectrometry. A highly significant difference of NNAL[4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol] in smokeless tobacco users than tobacco smokers P = 0.0002 (Table 1) was obtained. This significant difference shows smokeless tobacco is more carcinogenic than smoked tobacco. This study confirmed that NNAL is a potent biomarker for calculating the risk of occurrence of carcinoma in smokeless tobacco users and smokers, and that smokeless tobacco is more harmful than smoked tobacco.

Nasopalatine Canal Masquerading as a Periapical Cyst.

The incisive foramen is also called as nasopalatine foramen. It is a funnel-shaped opening in the anterior maxilla which opens immediately behind the central incisor teeth through which nasopalatine blood vessels and nerves pass. The incisive foramen is continuous with the incisive canal or nasopalatine canal (NPC). Variations in size, shape, position, and number of NPCs exist. Anatomical variations in NPC cannot be appreciated on two-dimensional radiographs. A case of anatomical variation of the nasopalatine canal misdiagnosed as a periapical cyst is discussed.

Assessment of canalis sinuosus, rare anatomical structure using cone-beam computed tomography: A prospective study.

Objectives: This prospective study was performed with cone-beam computed tomography (CBCT) images for evaluating canalis sinuosus (CS), determine its location and diameter in relation to gender, age, and distances from important structures, including floor of nasal cavity, incisive foramen, edge of buccal cortical bone, and palatal cortical bone. Material and Methods: The scans of 650 patients in total were included in this prospective analysis. Gender, age, the position of the CS, its presence or absence, diameter, and its location in reference to the adjacent teeth were the factors that were noted. Results: The study had 301 female participants and 349 male participants, with a mean age of 42.19. Compared to females, males had a statistically higher frequency of CS. Higher age groups showed a higher presence of CS in comparison to the other age groups. The mean distances of these parameters on the left and right side did not differ significantly. Nonetheless, the distance on both sides between CS and nasal cavity floor for males and females, as well as the diameter and border of buccal-palatal cortical bone on the right side, were statistically significant different. On the left side, both genders demonstrated significance in buccal cortical margin and nasal cavity floor. IIn addition, in females, the diameter of the CS on the right and left sides differed on average. The associations between age and number of CS, CS diameter, and number of CS versus sex were all extremely weak. Overall, the study findings showed that CS is a typical anatomical feature in anterior maxillary region, irrespective of age, or gender. Conclusion: The bony canal, CS is an obscure feature located in the frontal region of the maxilla. Surgeons can avoid complications by being aware of the auxiliary canals derived from this structure. With the use of CBCT, it is now feasible to examine the course of CS as it passes through the maxillary sinus's anterolateral wall with better radiological accuracy has already been documented.

Evaluation of Lingual Foramen in the South Indian Population Using Cone-Beam Computed Tomography: A Prospective Cross-Sectional Study.

Background: Surgical procedures in the anterior mandibular region require a profound understanding of the complex anatomical structures to ensure patient safety. The lingual foramen (LF) and its intra-osseous canal are pivotal structures, supplying vascular and neural support to the mental region. The prevalence of LF is widely recognized, with variations among populations. Methods: The study involved 650 adult participants. Data were collected using high-resolution cone-beam computed tomography (CBCT), and statistical analysis was conducted, establishing inter-rater agreement. Results: The population had a varied age distribution, with males comprising 53.23% and females comprising 46.77%. The median lingual canal was found in the Supra and Infra spinosum (65.38%). Most participants had lateral lingual canals (60.92%). The most prevalent lingual foramina was 4 (30.62%). The study found no significant associations between gender and LF diameter, distribution in different travel directions, or LF locations. However, males had a slightly larger diameter. Conclusion: The findings provide valuable insights into LF variations based on anatomical locations, and there were no statistically significant differences in measurements across different age groups. This knowledge contributes to the evolving field of oral and maxillofacial surgery, ensuring better patient outcomes.

Drug induced erythema multiforme of the oral cavity.

Drug induced erythema multiforme (EM) is a rare clinical entity which majorly involves the oral cavity. It commonly occurs due to intake of drugs such as NSAID'S, certain antibiotics, and anticonvulsants. It is characterized by rapidly rupturing vesicles leading to ill-defined erosions in the oral cavity and encrusted lip lesions. These lesions are usually difficult to differentiate from other vesiculo bullous and ulcerative lesions which would have a similar presentation and the absence of skin lesions can sometimes lead to misdiagnosis. Drug induced EM has an acute onset and is a self-limiting inflammatory hypersensitivity reaction that causes blistering and ulcerations of the skin and mucous membrane. The lesions heal following the discontinuation of the causative medications. This case report describes a case of drug induced erythema multiforme of the oral cavity that occurred consequent to the intake of Tab.Diclofenac Sodium and Tab.Cephelexin. The patient developed painful, bleeding, burning ulcerations with severe crustations on the upper, and lower lip, lateral and ventral surface of tongue, hard palate and retro molar regions. The case was managed with corticosteroids.

Microbiota of Dental Abscess and their Susceptibility to Empirical Antibiotic Therapy.

Context: Resistant pathogens to purulent odontogenic infections have evolved due to misuse of antibiotics. Hence, it is important to use a suitable antibacterial agent. Aim: This study aimed to identify the common bacterial species causing odontogenic infections and to determine their antibiotic susceptibility profile to amoxicillin, amoxicillin and clavulanic acid, azithromycin, and linezolid. Settings and Design: This was an in vitro cross-sectional study. Material and Methods: Fifty pus samples from odontogenic abscess were cultured and antibiotic susceptibility tests were performed as per the standard microbiological procedures. Statistical Analysis Used: Binomial test and Pearson's Chi-square test were used for statistical analysis. Results: Out of the 50 samples cultured, 30 samples showed growth. The distribution of growth among the 30 samples was Gram-positive cocci (n = 23, 67.65%) and Gram-negative bacilli (n = 11, 32.35%). Gram-positive isolates that were grown were Enterococcus faecalis (38.24%) followed by Staphylococcus aureus (29.41%) and Gram-negative bacilli that were isolated were Klebsiella pneumoniae (14.71%), Pseudomonas aeruginosa (8.82%), Escherichia coli (5.88%), and Enterobacter (2.94%). Enterococcus isolates were highly susceptible to amoxicillin (76.92%). An increase in the zone of inhibition to amoxicillin-clavulanic acid was appreciated more for Staphylococcus (50%) than Enterococcus (30.76%). Enterococcus and Staphylococcus showed high susceptibility of 92.31% and 90% to linezolid, respectively. E. coli and Enterobacter were 100% susceptible to amoxicillin. All the Gram-negative bacteria except for P. aeruginosa were 100% highly susceptible to amoxicillin-clavulanic acid. Conclusions: Culture-guided antibiotic prescriptions are necessary to prevent the emergence of antibiotic-resistant bacteria.

GSTM1 null polymorphism and palmar dermatoglypics in oral leukoplakia.

BACKGROUND: An individual's risk towards development of cancer depends not only on environmental factors or extrinsic exposure to carcinogens but also on individual's genetic susceptibility. AIM: To determine two genetically established parameters such as prevalence of GSTM1 null polymorphism and analysis of Palmar dermatoglypics (PD) in patients with Oral Leukoplakia (OL) and Controls. MATERIALS AND METHODS: Group I (cases) 30 patients with established histopathological diagnosis of OL and Group II (controls) 30 patients without any habits of tobacco, alcohol usage and without OL were selected. After informed consent, the palm prints were recorded using a Canon PIXMA MP250 scanner and 2 ml of blood was collected and transported under cold cycle and taken for evaluation of GSTM1 null polymorphism using Multiplex PCR. RESULTS: There exists a highly significant difference in GSTM1 null polymorphism (p-0.002), Finger ridge patterns (arches- p-0.027, loops p-0.001, whorls p-0.001), hypothenar pattern (p-0.015), ATD angle (p-0.001), AB count (p-0.007) between cases and controls. Similarly, when analysing the GSTM1 null polymorphism with PD among cases, there exists a significant association between loops (p-0.001), AB count (p-0.058) and hypothenar pattern (p-0.076), respectively 43% of OL cases had alteration in both which implies that those patients are at a higher risk of developing cancer. CONCLUSION: Not all patients who smoke or chew tobacco develop cancer. This could probably be due to the individual's genetic susceptibility. Environment gene interactions, in the form of GSTM1 polymorphism, and carcinogenesis, share links that can help in the prediction of risk for oral cancer development, and use of such markers can aid in prediction of oral cancer susceptibility in exposed individuals. Palm prints once formed do not change throughout life and are not influenced by environment. It can also serve as genetic markers to predict the risk of occurrence of oral cancer.

Assessing the Prevalence and Morphological Characteristics of Bifid Mandibular Canal Using Cone-Beam Computed Tomography - A Retrospective Cross-Sectional Study.

OBJECTIVES: To evaluate the prevalence, location and configuration of bifid mandibular canals so as to avoid injury to the nerve and inadequate anesthesia during surgical procedures. MATERIALS AND METHODS: CBCT scan of 203 patients (125 males and 78 females) was evaluated for the presence and the type of the bifid mandibular canal. They were classified according to Nortje et al. The prevalence rates were determined according to gender, location, and type of bifid mandibular canal. Statistical analysis was performed using IBM SPSS software version 24. RESULTS: The prevalence rate of bifid mandibular canals was found to be 10.3% with 12.8% in males and 6.4% in females. The Chi-square test reveals there is a statistically significant difference between the different locations of bifid mandibular canals and most of the canals were present on the right side. The most frequent type of bifid mandibular canal observed was type II dental canal (38.1%), followed by type III forward canal (28.6%), type I retromolar canal (14.3%), and type IV buccolingual canal (14.3%). CONCLUSION: CBCT is suggested for a detailed evaluation and identification of bifid mandibular canals before any surgical procedures to avoid post-operative complications.

Single-nucleotide polymorphism in Vitamin D receptor gene and its association with dental caries in children.

BACKGROUND: Though factors such as diet, oral hygiene, salivary flow and surface characteristics of the tooth enamel play a role in the causation of dental caries, genetic factors also contribute significantly in influencing the susceptibility or resistanance to the occurrence of caries. AIMS AND OBJECTIVES: To analyse the relationship between a single nucleotide polymorphism in the vitamin D receptor gene TaqI locus and associate its presence with dental caries in children. MATERIALS AND METHODS: A case control study was conducted among 120 children in the age group of 6-12 years. 60 cases with a DMFT of >3 and 60 controls with a DMFT of 0 were selected. Genomic DNA was extracted from salivary samples collected from the patients and presence of polymorphism was analyzed by PCR-RFLP. RESULTS: Pearson chi square test and Fisher exact tests were used for comparison of differences in genotypes or allele frequencies between groups. No significant difference between the cases and control was observed among the different genotypes and the alleles. However, there was an inclination in the incidence of caries with the genotype 'tt' and 'Tt' when compared with the genotype'TT'. CONCLUSION: In this study done to analyse the SNP in vitamin D receptor gene and its association with dental caries in children indicates a higher caries risk for a patient with't' allele and 'tt' genotype.

Comparative efficacy of analgesic gel phonophoresis and ultrasound in the treatment of temporomandibular joint disorders.

AIM: The aim of this study is to determine the efficacy of phonophoresis in patients with temporomandibular disorders. OBJECTIVE: To prove that phonophoresis could be an effective treatment modality in in patients with temporomandibular disorders. PROCEDURE: Fifty patients diagnosed clinically and radiographically as temporomandibular disorder were randomly assigned into either of the two groups, namely, (Group A) plain ultrasound and (Group B) phonophoresis. Acoustic gel containing no pharmacological agent was applied in the ultrasound group, whereas a gel containing aceclofenac was applied in the phonophoresis group. Each group was treated three times a week for 2 weeks. The assessment of pain and inflammation both before and after treatment were done using the visual analog scale (VAS) and Creactive protein (CRP). RESULTS: Intergroup comparison was done and analyzed statistically using independent ttest. Intragroup comparison was done using paired ttest. A significant difference in VAS scores and CRP levels before and after treatment were seen within both ultrasound phonophoresis PH groups. No significant difference was noted statistically between ultrasound and phonophoresis group. CONCLUSION: The results of this study suggests that though plain ultrasound as well as phonophoresis with aceclofenac gel are effective in the management of temporomandibular disorders. Phonophoresis was found be slightly superior as evident in VAS scores and CRP levels though not statistically significant.

A rare case of palatal schwannoma with literature review.

Schwannoma or neurilemmoma is a benign, slow-growing nerve sheath tumor arising from Schwann cells of the cranial, peripheral or autonomic nerves. Approximately 25%-40% of schwannomas occur in the head and neck region. Occurrences of intraoral schwannomas are rare with reported prevalence being 1%. Intraorally, schwannomas occur in the tongue, palate, buccal mucosa, lips and gingiva. This article provides an insight into a rare case of palatal schwannoma with literature review.

Age estimation using radicular dentine transparency: A new innovative approach.

AIM: To estimate the age of the individual from radicular dentine transparency and to derive a formula suitable for age estimation in the Indian population, using radicular dentine transparency. MATERIALS AND METHODS: Seventy teeth samples of known age were collected from patients belonging to different age groups ranging from 11 to 80 years whose teeth were extracted for various therapeutic purposes. The samples were grouped from A to G according to their age, each group consisting of 10 teeth samples. Buccolingual sections of 100 µm thickness were obtained using hard tissue microtome. The sections were scanned using a flat-bed scanner. The scanning base of the scanner was pasted with a graph sheet and the teeth samples pasted on to the graph sheet were scanned with a resolution of 600 dpi, and the images were stored in a computer. The graph sheet was clearly visible in the area of transparent dentine, and the length of transparent dentine (i.e., the number of millimeters on the graph) was measured from the scanned images, stored in the computer. RESULTS: A strong positive correlation between age and transparency of dentin was noted. The age was estimated with an accuracy of ± 5 years (61.4%) and ± 10 years (12.9%). The present study had a level of agreement of 71.4% with that of Bang and Ramm. CONCLUSION: Thus, transparency level of the radicular dentin increases with age, and it can be used as a single reliable parameter for age estimation.

Quest for haller cells: A digital orthopantomography study.

AIMS: Haller Cells refer to the ethmoidal pneumatization and are the extensions of anterior ethmoid sinus into the floor of the orbit and superior aspect of the maxillary sinus, basically an anatomic variation. They may be associated with orofacial pain, sinusitis, nasal obstruction, impaired nasal breathing, headache, chronic cough, and mucocele. The aim of the present study was to identify, determine the prevalence and characteristics of Haller's cells on Digital orthopantomographs in patient's reporting to a dental institution in Chennai. SETTINGS AND DESIGN:: This was a retrospective, cross-sectional study. SUBJECTS AND METHODS: The study group comprised 600 radiographs inclusive of both genders (379 females and 221 males) with an age range of 20-80 years. Retrospectively panoramic radiograph for each of the patients was viewed and interpreted for the presence of Haller's cells. The data collected was subjected to statistical analysis: frequencies/percentages, descriptive statistics to obtain the results. STATISTICAL ANALYSIS USED: Frequencies/percentages, descriptive statistics using SPSS for Windows Version 20 (SPSS Inc., Chicago, IL, USA), to obtain the results. RESULTS: Haller's cells were noted in patients, accounting for a prevalence of 23.61%. The majority of the cells were circular, ovoid, and irregular in shape. CONCLUSIONS: This study has attempted to explore the characteristics of Haller's cells on panoramic radiographs. A description of Haller's cells on these radiographs may prove vital in enumerating the differential diagnosis for patients afflicted with intractable orofacial pain and reduce the risk of untoward intraoperative complications during endonasal procedures.

A novel ROGDI gene mutation is associated with Kohlschutter-Tonz syndrome.

OBJECTIVE: Kohlschutter-tonz syndrome (KTS) is a rare neurodegenerative disorder that presents with seizures, developmental regression, characteristic hypoplastic dental enamel indicative of amelogenesis imperfecta and dysmorphologies. Genetic analysis has identified loss-of-function mutations within the coding region of the ROGDI gene in KTS patients of European or Jewish decent. In the present study, we have investigated the genetic status of ROGDI in a fourteen year old South Indian patient of Dravidian race born to consanguineous parents, who was clinically diagnosed with KTS STUDY DESIGN: To confirm the clinical diagnosis of KTS in the patient, primers were designed flanking each of the 11 exons of the ROGDI gene. We then used 50 nanograms of chromosomal DNA extracted from peripheral blood of the patient and his parents to amplify with above primers. The PCR amplicons were then subjected to direct sequencing with same set of primers. RESULTS: Genetic analysis identified a novel homozygous nonsense mutation in exon 6 of the ROGDI gene; the mutation caused premature termination of ROGDI translation, resulting in truncation and loss of function of the ROGDI protein. CONCLUSIONS: Taken together, the clinical presentation and loss-of-function mutation in the ROGDI gene confirms the clinical diagnosis of KTS.

Lab on a Chip: Conquer Disease at the Earliest.

Oral cancer is the fifth most common cancer in the world, accounting for numerous deaths annually. The 5-year survival rate remains approximately 50% for oral squamous cell carcinoma (OSCC) in the past several decades. Early detection plays a vital role in the survival rate of the patients. There is no accurate, cost-effective, and reliable method for the screening of patients with OSCC. Hence, many patients are diagnosed at advanced stages. Early detection would, therefore, help to identify patients and modify treatment with close monitoring. Lab on a Chip or micro-total-analysis systems are one of the microfluidics technologies that are defined as adaptation, miniaturization, integration, and automation of analytical laboratory procedures into a single device or "chip." This technology assures the replacement of complicated techniques with miniaturized, integrated, programmed, and economical diagnostic devices. Hence, this system provides a means for rapid, automated, molecular analysis of cancer cells.

Plummer Vinson Syndrome: A Rare Syndrome in Male with Review of the Literature.

INTRODUCTION: Plummer Vinson syndrome also known as Paterson Brown-Kelly syndrome is a syndrome associated with the triad of symptoms comprising microcytic hypochromic anemia, oesophageal strictures, and dysphagia. PVS is commonly found in women of middle age especially in the fourth and fifth decade of life and is rarely reported in males. CASE REPORT: The authors report a case of 43-year-old male patient who presented with the classic symptoms of Plummer Vinson syndrome. CONCLUSION: Dentists have to be familiar with symptoms of PVS and a thorough clinical examination of the patient is necessary for early diagnosis and treatment. As PVS is a precancerous condition with high malignant potential, early diagnosis is of utmost importance for better prognosis. CLINICAL SIGNIFICANCE: Mutual interaction of systemic and oral health has largely been underestimated by many patients in the developing countries and hence this report includes a note on importance of adequate medical history taking and its relevance to the dental health and treatment.

Oral gingival metastasis: A diagnostic dilemma.

Oral cavity is a rare target for metastasis with an incidence of 1% among all oral cancers. In 24% of such cases, oral metastasis is the first indication of an undiagnosed primary. Metastatic oral malignancies have been reported in the mandible, tongue, and gingiva. Although gingival metastasis has been reported from lung, prostate, rectal carcinoma in men and carcinoma of breast, adrenal glands, and genitalia in females, gingival metastasis from carcinoma of the penis has not been reported. Herein, a case of metastatic gingival carcinoma that developed after extraction of teeth from primary carcinoma of the penis is presented. An extensive literature search revealed no such similar case reports.

Stress as an etiologic co-factor in recurrent aphthous ulcers and oral lichen planus.

This study aimed to examine the role of stress in the occurrence of recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP), as well as to analyze the efficacy of saliva, urine, and serum cortisol levels as markers of stress. This study included 30 subjects with RAS (Group A), 30 with OLP (Group B), and 30 controls (Group C). The serum, salivary, and urinary cortisol levels were measured using electro-chemiluminescence immunoassay. The results were analyzed using the independent t-test, and a statistically significant difference (P = 0.000) was observed between the study and control groups. Further analysis was done using ANOVA and post-hoc tests. The results of this study suggest that RAS and OLP patients had higher cortisol levels than controls, indicating that stress acts as a co-factor in the pathogenesis of RAS and OLP. Although urinary cortisol level was found to be the best indicator of stress, saliva can also be used as a reliable marker. (J Oral Sci 58, 237-240, 2016).

Assessment of Function of Eustachian Tube in Oral Submucous Fibrosis - A Tympanometric Study.

INTRODUCTION: Oral Submucous fibrosis (OSMF) is a chronic insidious disease of oral mucosa that occurs due to areca-nut chewing, consumption of chillies, autoimmunity and genetic predisposition. The disease starts with burning sensation and inability to tolerate spicy foods with gradual reduction in mouth opening due to fibrosis of the oral mucosa. The extension of fibrosis into the naso pharynx leads to reduction in hearing efficiency. It is a potentially malignant lesion and can transform into oral cancer. AIM: To assess the functional impairment of eustachian tube by audiogram and tympanometry in both ears in stage IV and stage III OSMF cases. MATERIALS AND METHODS: This was a case-control study in which 30 cases of OSMF, which included 15 stage IV (30 ears), 15 stage III (30 ears) were compared with 15 normal controls. RESULTS: 1) Stage IV cases showed 76.3% positive audiogram with 63.3% of cases having Sclerosis of tympanic membrane i.e. As curve in Tympanogram; 2) 43.3% of Stage III cases showed positive audiogram with 46.7% of cases having Sclerosis of tympanic membrane i.e. As curve in tympanogram; 3) 100% negative audiogram with 100% normal A curve was seen in all controls. CONCLUSION: From this study, it is evident that functions of Eustachian tube were affected as fibrosis of oral mucosa progressed.