Mucormycosis occurring in an immunocompetent patient: a case report and review of literature.

Mucormycosis is an opportunistic fungal infection with a high fatality rate and is the third most common fungal infection that is invasive in nature, next to candidiasis and aspergillosis. The condition is generally vasotropic and angio-invasive in nature. It gets disseminated to a wider area locally and also exhibits a distant spread. It is usually associated with medically compromised patients. However, mucormycosis in immunocompetent individuals is gaining attention as several cases have been reported throughout the world with a high incidence of such cases being reported from the Indian subcontinent. It is attributed to the poor socio-economic status and triggered by the local trauma due to unhygienic setup or poor health care. The pathway of pathogenesis is not clearly understood in immunocompetent patients and therefore becomes a matter of great concern. Here, we report one such case of mucormycosis affecting the maxillary region following tooth extraction in a 42-year-old male.

Real time detection and quantification of Epstein Barr virus in different grades of oral gingivitis and periodontitis patients.

BACKGROUND: Periodontal diseases are of microbial etiology and are globally causing loss of teeth in adult population. Many severe oral diseases have been recently associated to Herpes viruses, of which Epstein Barr Virus (EBV) and human cytomegalovirus (HCMV) have been indicated in the etiology of periodontal diseases. AIM: The purpose of the study was to compare the effect of EBV in different types of periodontal diseases namely acute gingivitis, chronic gingivitis, acute and chronic, localized and generalized aggressive (juvenile) periodontitis and apical periodontitis. MATERIAL AND METHOD: 70 individuals were included in this study. Supragingival plaque and plaque from two deepest sites of the periodontal pockets were collected then stored at 70° c and prepared for nucleic acid extraction. For EBV detection, DNA were extracted from the plaque samples with the QIAamp DNA mini kit. Q-PCR was performed by targeting the non-polymorphic Epstein-Barr nuclear antigen-1 (EBNA-1) gene using Corbett Research 6000 Q-PCR instrument and Rotor gene 6000 software. RESULTS: Overall prevalence of EBV in the disease group was 60% (27/45 patients) as compared to only 8% (4/25 people) in the normal population. The mean copy number of EBV DNA was found to be significantly higher in periodontitis (2234 ± 1811.34) when compared to gingivitis (554 ± 537.64, p = .001) and normal patients (370 ± 161.03, p < .001). CONCLUSION: Here, we found that the prevalence of EBV as well as copy number of EBV was significantly higher in periodontitis patients as compared to gingivitis patients or normal population.

Necrotising sialometaplasia: a diagnostic perplexity? An innocent entity to malignant masquerade.

OBJECTIVE: Necrotising Sialometaplasia is a benign self limiting reactive condition of major and minor salivary glands, which can arouse suspicion for malignancy, clinically and histopathologically. Here, we report a case of 38-year-old female with a painful ulcer on the palate. The case enlightens the importance of clinicopathologic correlation and diligent follow up in diagnosis and management of the case.

Chronic non-healing ulcer of the oral cavity: tuberculosis or carcinoma?

OBJECTIVE: Tuberculosis is a chronic granulomatous lesion, which primarily has an affinity for the lungs. It can involve other sites like lymph nodes, kidney, oral cavity. Infection of the oral cavity by M. tuberculosis can be as a Primary infection or as a Secondary infection. Primary presentation of oral tuberculosis is in the form of the chronic non healing ulcer. A Primary infection or an Asymptomatic Secondary infection can impose a great diagnostic dilemma, as it may mimic neoplasia. Here we present a case of a 32-year-old asymptomatic female with secondary infection.

Oral squamous papilloma occurring on the palate with review of literature.

Squamous papillomas are common lesions occurring on skin, oral and nasal mucosa and male and female genital organs. Oral squamous cell papilloma (OSP) is a benign proliferation of the stratified squamous epithelium and is generally believed to be caused by Human Papilloma Viruses (HPV). It constitutes around 2.5% of all oral verruco-papillary lesions. We here, report a case of palatal OSP occurring in a 55-year-old male. The aetiological, clinical, diagnostic and treatment aspects of OSP are discussed here.

Multiple myeloma with an unusual oral presentation.

Multiple myeloma (MM) is a dyscrasia caused by neoplastic proliferation of somatically mutated plasma cells. Myeloma cells divide and expand within the bone marrow affecting multiple locations in the body where bone marrow is present. Oral manifestations, though common are usually not diagnosed. This report describes rare oral manifestations of multiple myeloma like oral petechiae and gingival swelling presented in a 40-year-old male patient. The diagnosis was established by blood examination & skeletal survey, while oral findings were later correlated with the diagnosis of MM. A brief review on MM is presented along with the demonstration of rare oral manifestations.

External Inflammatory Root Resorption in Mandibular First Molar: A Case Report.

External root resorption (ERR) is an irreversible loss of external tooth structure. Its etiology is multifactorial, but in many aspects remain unclear. Periapical inflammation sustained by infection can cause apical root resorption in permanent teeth. The infection may be asymptomatic for many years, although it is rarely misdiagnosed. Treatment of such lesions should include use of intracanal medicaments for complete debridement of the microbes. Here, we present a case of 21-year-old male patient who presented with external inflammatory root resorption.

Identification of the pattern of copper as an etiological factor in oral submucous fibrosis: a cytological study.

UNLABELLED: Oral Submucous Fibrosis (OSF) is a well-recognized, potentially malignant disorder causing generalized fibrosis of the submucosal oral soft tissues. Though this disease is believed to be multi-factorial, areca nut chewing has emerged as the most important causative factor for OSF. Areca nut is known to have high levels of copper, which is believed to cause lysyl oxidase associated fibrosis. AIM: To evaluate the pattern of copper in buccal mucosal cells of OSF patients, areca nut chewers and normal healthy individuals and to elicit the etiology of copper in OSF. MATERIALS AND METHODS: Patients were divided into three groups each comprising of 20 individuals- Healthy individuals (Group I); areca nut chewers without OSF (Group II); histopathologically confirmed OSF (Group Ill). The cytological smears made from each patient were stained with rhodanine stain for copper and evaluated for the qualitative and quantitative parameters of copper by using specific grading criteria. RESULTS: Quantitative estimation of copper content showed a marked variation in the mean values. Mean value of group I was 0.11 ± 0.39; group II was 1.09 ± 0.81 and group III was 2.34 ± 0.74 (p<0.001). Mean values for qualitative estimation of copper were - 0.01 ± 0.36 for group I, 1.08 ± 0.82 for group II and 2.39 ± 0.72 for group III (p<0.001). Chi square analysis was used to assess the percentage distribution of copper granules. This revealed that the colour intensity and the number of granules were seen to maximum in OSF patients, areca nut chewers without OSF having intermediated values and normal healthy individuals having the least values. CONCLUSION: An evident increase in the copper staining in group III individuals as compared to group I and group II was well appreciated. Increased copper levels in the local environment of the oral cavity indicates its role in lysyl oxidase associated submucosal fibrosis.

The perceived relevance of tooth carving in dental education: Views of practicing dentists and faculty in West India.

BACKGROUND: Teaching dental anatomy includes observation and analysis of natural teeth and carving wax models to accurately reproduce the morphology of teeth. The aim of this survey was to assess the importance of tooth carving in its relevance to clinical practice in the opinion of practicing clinicians throughout west India. METHODS: Faculties of 27 dental colleges and dental practitioners of the Rajasthan and Gujarat states in western India were contacted through e-mail, telephone and mail. A total of 1866 subjects were contacted of which 1722 responded. The perceived relevance of tooth carving in clinical practice was assessed through a 14-item multiple choice questionnaire. Questions ranged from the queries of clinicians' interest in tooth carvings, their opinion of the practical significance of this exercise during their training to their clinical practice, and their recommendations regarding tooth carving. RESULTS: A total of 69.1% of respondent practitioners believe that the tooth carving exercise influences their clinical practice, and 93.4% recommend tooth carving to be continued in the undergraduate dental curriculum. DISCUSSION: The results indicated that most dentists in west India valued what they learned through tooth carving and that they use this knowledge in their practice. This information supports the continued teaching of tooth carving in the undergraduate dental curriculum.

Comparative analysis of cheiloscopy, pulpal tissue and fingerprint for gender identification.

Background: The most important step in identifying an unknown person is determining one's gender and as a dentist, the oral tissues are potential sources of information in this aspect. A study was carried out to assess and evaluate the accuracy of cheiloscopy, pulp tissue, and fingerprints in determining gender. Material and Methods: A study comprising of 160 individuals (80 males and 80 females) was conducted. After obtaining informed written consent and recording their bio-data; lip prints, and fingerprints were recorded. The patients' extracted tooth was collected, their pulp extirpated, for assessment of the Barr body. Results: We found that every lip pattern was unique and hence can be used to identify an unknown individual. The occurrence of the Barr body was determined, and all female samples were found to be positive for the existence of the Barr body. In fingerprint patterns, a significant difference was noted between both sexes with ulnar loops and whorl patterns only. A highly significant difference was observed in the fingerprint ridge density between genders. Conclusions: We conclude that the Barr body in pulpal tissue can be considered as the best possible technique for gender determination within the dental tissues. Lip prints did not show any differences in genders and had no role to play in gender determination. Fingerprint ridge density can also be used to determine gender.

Jaw Swelling Back with Vengeance.

Rhabdomyosarcoma (RMS) is a highly aggressive lesion and is commonly seen in children below the age of 10 years. The survival rate is not very high as an early diagnosis is often difficult. However, the treatment involves mainly surgery followed by chemotherapy and sometimes radiotherapy.

Basaloid squamous cell carcinoma of gingiva: A rare case report.

Basaloid squamous cell carcinoma (BSCC) is an exceptional, aggressive variant of squamous cell carcinoma (SCC) because of its unique histological feature and an ominous clinical behavior. Recently, it has been recognized as a high-grade SCC. The most preferential site of occurrence is the upper aerodigestive tract. Because of its aggressive behavior and tendency to metastasize, BSCCs are considered to have poor prognosis. We present a BSCC case in a 60-year-old male, which was clinically diagnosed as an aggressive inflammatory lesion with a differential diagnosis of granulomatous lesion, involving the mandibular anterior gingiva. Till now, only 17 cases of BSCC with gingival involvement have been reported in the literature. Here, we present one additional case of BSCC involving gingiva.

Evaluation and Immunolocalization of BMP4 and FGF8 in Odontogenic Cyst and Tumors.

Growth factors like bone morphogenetic protein 4 (BMP4) and fibroblast growth factor 8 (FGF8) play a major role in organogenesis and specifically in odontogenesis. They are also believed to have a role in oncogenesis. Thus, any discrepancies in their standard behavior and activity would lead to serious abnormalities including odontogenic cyst and tumors. The present research work investigated the expression of BMP4 and FGF8 in odontogenic tumors (OT) and cyst as well as developing tooth germs to elucidate their roles. Dental organs of various odontogenic stages and 30 OTs including solid multicystic ameloblastomas (SMA, 10 cases), ameloblastic fibroma (AF, 10 cases), odontogenic myxoma (OM, 10 cases), and odontogenic cysts: odontogenic keratocyst (OKC, 10 cases) were evaluated in both epithelial and mesenchymal components for the expression of BMP4 and FGF8 using immunohistochemistry. The epithelial nuclear expression of BMP4 was highest in OKC (9 cases) while FGF8 was highest in SMA (10 cases). The mesenchymal nuclear expression of both BMP4 (8 cases) (p = 0.001) and FGF8 (9 cases) (p = 0.045) were significantly high in OMs among all OTs. Both growth factors were actively expressed in different stages of tooth development. The expression of BMP4 and FGF8 corelates well with the proliferative component of the pathologies, indicating a possible role in the pathogenesis and progression.

Correlation of salivary glucose level with blood glucose level in diabetes mellitus.

BACKGROUND: Saliva is a unique fluid, which is important for normal functioning of the oral cavity. Diabetes mellitus (DM) is a disease of absolute or relative insulin deficiency characterized by insufficient secretion of insulin by pancreatic beta-cells. The diagnosis of diabetes through blood is difficult in children, older adults, debilitated and chronically ill patients, so diagnosis by analysis of saliva can be potentially valuable as collection of saliva is noninvasive, easier and technically insensitive, unlike blood. The aim of the study was to correlate blood glucose level (BGL) and salivary glucose level (SGL) in DM patients. METHODOLOGY: A cross-sectional study was conducted in 120 patients, who were categorized as 40 controlled diabetics, 40 uncontrolled diabetics and 40 healthy, age- and sex-matched individuals constituted the controls. The blood and unstimulated saliva samples were collected from the patients at the different intervals for fasting, random and postprandial levels. These samples were then subjected for analysis of glucose in blood and saliva using glucose oxidase/peroxidase reagent in HITACHI 902(R) Automatic analyzer, and the results were recorded. RESULTS: The mean SGLs were higher in uncontrolled and controlled diabetic groups than in nondiabetic group. A highly statistically significant correlation was found between fasting saliva glucose and fasting blood glucose in all the groups. CONCLUSION: With increase in BGL, increase in SGL was observed in patients with diabetes suggesting that SGL can be used for monitoring glycemic level in DM.

Comparitive efficacies of a natural fixative with a conventional fixative.

INTRODUCTION: The quest for formalin substitutes has long been going on due to its health hazards. Honey has been recognized as a safe substitute for formalin. However, we explored jaggery as a natural substitute for formalin. The aim of this study was to compare the tissue fixation abilities of jaggery syrup (30%) with that of 10% neutral-buffered formalin (NBF) and to determine the best fixative among both. MATERIALS AND METHODS: A study was conducted with 65 pathological tissues. Each specimen was divided into two equal parts. One part was fixed in 30% jaggery solution (Group A), while the other half was fixed in 10% NBF solution (Group B). 24 h tissue fixation was attained at room temperature followed by evaluation of pre- and post-fixation, tissue shrinkage, weight difference and ease of sectioning, followed by evaluation of conventional processing and staining. The histomorphological assessment for each slide was made based on evaluation of cellular outline, cytoplasmic details, nuclear details, staining quality and overall morphology under light microscopy. Each criterion was rated on a scale of 1-4. Nominal categorical data between the groups were compared using Chi-squared test. RESULTS: The preservation of tissue specimen by jaggery syrup was comparable to that of formalin and surprisingly overall nuclear detail of the tissue was better than conventional formalin fixative. CONCLUSION: Jaggery can be successfully adopted in routine histopathology laboratories in place of formalin.

Gingival rhabdomyosarcoma in an adult: a unique entity.

Rhabdomyosarcoma is a disease that predominantly affects children. Approximately 40 per cent are located in the head and neck region but it is rare in the oral cavity. This article describes an interesting case of an embryonal rhabdomyosarcoma in a 36-year-old male, involving the mandibular gingiva. The lesion showed radiolucency with ill-defined margins that was crossing the midline. The history revealed a similar lesion six months back at the same site and the lesion had been completely excised. The biopsy reports confirmed the diagnosis of embryonal rhabdomyosarcoma after which en-bloc resection of the tumor was performed with administration of chemotherapy and radiotherapy. Due to high recurrence rate of rhabdomyosarcomas in adults, multimodal therapy should be planned for proper care of the patient. Clinical, radiological, histopathological and management aspects are discussed here.

Does Oral Submucous Fibrosis Affect the Hearing Ability of an Individual? A Cross-Sectional Study in North Indian Population

Abstract Objective: To evaluate the hearing efficiency of Oral Submucous Fibrosis (OSF) patients using Pure Tone Audiometry (PTA) and to correlate between the hearing efficiency and clinical stage of OSF. Material and Methods: Twenty-five patients clinically diagnosed as OSF were evaluated for hearing loss using 'PTA'. Patients were grouped as mild cases and severe cases. Mild cases comprised of Group A and B, and severe cases comprised of Group C and D. Patients suffering from the previous hearing were excluded from the study. The data were submitted to statistical evaluation using the Chi-square test. The level of significance was set at 5% Results: Out of the total patients, 52.4% were diagnosed as mild cases (Group M) OSF and 47.6% as severe cases (Group S). The analysis of the data of mild cases and severe cases revealed a significant association between advancing stages of OSF and hearing loss (p = 0.026). The cases in Group M after otoscopic evaluation demonstrated no visible ear defect. However, 30% of cases in Group S showed retraction of the tympanic membrane Conclusion: The results indicate an association between stages of OSF and hearing loss. With advancing stages of OSF, there may be involvement of muscles of soft palate namely the levator veli palatine or tensor veli palatine, which may lead to the narrowing of the Eustachian tube leading to a decrease in air conduction demonstrating it as hearing loss of varying degrees depending upon the involvement.

Odontogenic keratocyst: What is in the name?

The classification of odontogenic cysts is complicated and can create confusion for both clinicians and pathologists. The odontogenic keratocyst (OKC) is an enigmatic developmental cyst that deserves special attention. It has characteristic histopathological and clinical features; but, what makes this cyst special is its aggressive behavior and high recurrence rate. Despite of many classifications and nomenclature, unfortunately the clinicians still have to face difficulties in the management of this commonly found jaw lesion. This article is an effort to provide an overview of various aspects of OKC with emphasis on nomenclature, recurrence, molecular aspects, and management of OKC.

Immunohistochemical analysis of vimentin in oral submucous fibrosis.

Background. Oral submucous fibrosis (OSF), a precancerous condition, is characterized by abnormal accumulation of collagen fibers in oral submucosa. Vimentin is a Class 2 intermediate filament (IF) and primarily expressed in cells of mesenchymal origin. Vimentin is also found to be involved in cell growth, cell cycling, and tumour differentiation. Objective. The purpose of the study was to compare the expression of vimentin in various histological grades of OSF. Materials and Methods. To assess the immunohistochemical expression of vimentin in 20 mild cases of OSF, 20 severe cases of OSF, and ten cases of normal oral buccal mucosa. Results. The overall staining intensity of vimentin significantly increased statistically (P < 0.01) in OSF cases over normal control. A significant increase in the staining intensity of vimentin was also noted in the fibroblasts of severe cases of OSF (P = 0.03). Conclusion. Considering the marked vimentin expression in the present study, future studies should include cytoskeleton IF and other filaments in the fibroblasts of OSF.

Antimicrobial Property of Extracts of Indian Lichen against Human Pathogenic Bacteria.

Context. Usnea ghattensis G. Awasthi (Usneaceae) endemic fruticose lichen found growing luxuriantly in Northern Western Ghats of India, it also contains Usnic acid as a major chemical and tested against some human pathogenic bacteria. Objective. To explore antimicrobial properties of Usnea ghattensis against some human pathogenic bacteria. Materials and Methods. The lichen was extracted in acetone, methanol, and ethanol. In vitro antimicrobial activity was tested initially by Kirby-Bauer technique of disc diffusion method and was confirmed by minimum inhibitory concentration using Broth microdilution method according to the NCCLS guidelines. Results. Ethanol extract was most effective against Bacillus cereus and Pseudomonas aeruginosa with a zone of inhibition 29.8 ± 0.6 mm and 12.3 ± 0.5 mm diameters at a concentration of 0.2 mg/mL. Acetone and methanol extract demonstrated almost similar activity against Staphylococcus aureus and the zone of inhibition was 24.6 ± 0.5 and 24.7 ± 0.4 mm. Only methanol extract was showing activity against Streptococcus faecalis with a 13.5 ± 0.8 mm zone. MIC value noted against Staphylococcus aureus and Streptococcus faecalis was 6.25 µ g/mL and 25 µ g/mL, whereas against Bacillus cereus and Pseudomonas aeruginosa, MIC calculated was 3.125 µ g/mL and 200 µ g/mL, respectively. Conclusion. The present study demonstrates the relatively higher activity of this lichen against not only gram (+) but significantly also against gram (-) bacteria. This indicates that this lichen might be a rich source of effective antimicrobial agents.