Histological evaluation to study the effects of dental amalgam and composite restoration on human dental pulp: an in vivo study.

OBJECTIVE: To study and compare the effects of dental amalgam and composite restorations on human dental pulp. MATERIALS AND METHODS: One hundred sound premolars scheduled for orthodontic extraction were divided equally into two groups: group A, teeth restored with silver amalgam, and group B, teeth restored with composite resin. Each group was equally subdivided into two subgroups [extracted after 24 h (A-1 and B-1) or 7 days (A-2 and B-2)], and the histological changes in the pulp related to the two different materials at the two different intervals were studied. RESULTS: It was found that after 24 h, the inflammatory response of the pulp in teeth restored with amalgam and composite was similar (p = 1.00). However, after 7 days, the severity of the inflammatory response of the pulp in teeth restored with amalgam was less compared to that in teeth restored with composite (p = 0.045). CONCLUSION: This study confirmed that amalgam continues to be the mechanically as well as biologically more competent restorative material. Composite could be a promising restorative material to satisfy esthetic needs for a considerable period of time. However, its biological acceptance is still in doubt.

Identification of genetic instability in peripheral blood lymphocyte of oral squamous cell carcinoma patients assess by comet assay.

Context: Studies established that human cancer is principally a genetic disease; it arises as accumulation of a set of genetic changes. In the pathogenesis of cancer, genetic instability is the sequential event to a carcinogenic stimulus resulting in various genomic changes including DNA damage. Aims: To assess genetic instability, as susceptibility to DNA damage, we used single-cell gel electrophoresis (comet assay) to study double strand breaks in associated with the risk of oral squamous cell carcinoma (OSCC). Materials and Methods: We used comet assay to measure double strand break in individual peripheral blood lymphocytes from 50 individuals with OSCC and 30 healthy control subjects. All personal information was gathered from subjects including tobacco history. DNA damage was visualized as comet assay and quantified by movement of damaged strands as length of tail. Results: Study results of OSCC patients were observed in relation to clinical staging and histological grading of carcinoma. On the basis of clinical observation, cases were grouped in to Stage I, Stage II, Stage III and Stage IV. No stage I cases were in study sample. The mean DNA damage migration length was observed 4.600 ± 0.4613 µm in stage II, whereas in Stage III and Stage IV, it was observed to be 4.961 ± 0.5620 µm and 4.883 ± 0.410 µm, respectively. The DNA damage length in histological grades of squamous cell carcinoma patients in Grade I was 4.6437 ± 0.3061 µm and Grade II was 5.3533 ± 0.3831 µm. In comparison with control group and squamous cell carcinoma group, it was observed in the range of 0.02-0.36 µm and varied from 4.04 to 5.84 µm range, respectively. Thus, the results were statistically significant with the histological grading of OSCC. Statistical Analysis: Unpaired' test and "ANOVA" test are used for statistics. Statistical Analysis: Unpaired' test and "ANOVA" test are used for statistics. Conclusion: The amount of DNA strand breaks in peripheral lymphocytes are measured by comet assay which is associated with relative risk of OSCC.

Role of Nidogen-2 in diagnosis and prognosis of head and neck squamous cell carcinoma: A systematic review.

Context: Nidogen-2 (NID-2) hypermethylation has been implicated in many types of cancers, such as lung, bladder, and gastric carcinomas. However, its role has not yet been studied adequately in head and neck squamous cell carcinomas (HNSCC). HNSCCs constituting a major portion of the global cancer load, it is of importance to diagnose and treat them at earliest. This systematic review was performed to assess the role of NID-2 in HNSCCs and assess its utility as a diagnostic and prognostic marker. Materials and Methods: A systematic search was performed across multiple databases to identify studies pertaining to analysis of expression or methylation of NID-2 in HNSCCs. The sample size, type of cancer/premalignant condition studied, type of tissue/fluid analysed, and the various methodologies used and their results were extracted. PROSPERO registration number: CRD42021245326. Results: Four studies were identified after a systematic search of literature. The studies analysed NID-2 expression or methylation in conditions such as nasopharyngeal carcinoma, esophageal carcinoma, and oral squamous cell carcinoma (OSCC). NID-2 was found to be a highly specific marker for HNSCCs, and serum NID-2 levels also correlated with poor survival. Conclusion: Data from the reviewed studies indicate that hypermethylation of NID-2 is highly specific for HNSCC. The high specificity is maintained in salivary and serum samples, facilitating accurate and non-invasive prognostication of HNSCC. The relatively lower sensitivity of NID-2 methylation may be overcome by analysing it along with a panel of multiple biomarkers such as HOX-A2 and YKL20.

Florid cemento-osseous dysplasia: A case report.

Cemento-osseous dysplasia is non-neoplastic, reactive fibro-osseous lesions that affect the tooth-bearing areas of the jaws. Osseous dysplasia is further divided into three subtypes: Periapical osseous dysplasia, focal osseous dysplasia, and florid osseous dysplasia. We hereby, present a case of florid cemento-osseous dysplasia occurring in a 40-year old dentulous Indian woman. The patient presented with lesions involving the mandibular right and left quadrant.

Demographic study of 366 cases of oral leukoplakia and immunohistochemical analysis - An institutional study.

Background: It has been reported that oral squamous cell carcinoma (OSCC) is associated with the presence of potentially malignant disorders (PMDs) in 15%-48% of cases. Among PMDs, oral leukoplakia (OL) is the most common, with 16%-62% of cases associated with OSCC. Hence, in the present study, we have analyzed demographic data and re-evaluated immunohistochemical (IHC) data of OL cases and aimed to correlate the clinical, histopathological and IHC aspects of OL. Materials and Methods: The data of histopathologically diagnosed cases of OL were retrieved from the archives. These data were further evaluated for age, gender, duration, site, size, side, habits, clinical staging and histopathological grading. IHC re-evaluation of OL tissues was done using epithelial cadherin (E-cadherin), n = 20; human MutL homolog 1 (hMLH1), n = 30; CD1a (n = 30); vimentin (n = 30); Ki-67 (n = 30); heat shock protein-70 (HSP-70), n = 30; p16INK4, n = 20; and mucin-1 (MUC1), n = 30. All the results and observations were subjected to descriptive statistical analysis. Results: The male: female ratio was 7.5:1; right side and buccal mucosa were more commonly affected. The duration of the lesion ranged from 1 to 30 years. One hundred and twelve patients were habituated to tobacco chewing, while 171 patients came with a combined habit of smoke and smokeless tobacco usage. Clinically, most of the lesions were of stage 2 while histopathologically they were of mild dysplasia. There was a decrease in the immunoexpression of E-cadherin, hMLH1 and CD1a, while there was an increase in the immunoexpression of vimentin, Ki-67, HSP-70, MUC1 and p16INK4. Conclusion: The study of different biomarkers such as cytoplasmic, membranous and nuclear in OL will help in better understanding and application of a reliable marker for diagnostic and prognostic purpose.

Sarcomatoid squamous cell carcinoma of mandible: A report of two cases.

Spindle cell neoplasms comprise a diverse collection of benign and malignant tumors. These tumors are uncommon in the oral cavity, accounting for <1% of all tumors of oral region. Sarcomatoid squamous cell carcinoma (SSCC), also known as spindle cell carcinoma or Lane's tumor, is a rare and peculiar biphasic malignant neoplasm that occurs mainly in the upper aerodigestive tract. It is a variant of squamous cell carcinoma which has spindled or pleomorphic tumor cells which simulate a true sarcoma, but are epithelial in origin. It is an unusual aggressive variant that frequently recurs and metastasizes, reinforcing the importance of its correct diagnosis. We report two cases of SSCC with immunohistochemical findings.

Oral rhabdomyosarcoma in an adult male: A rare case report.

Rhabdomyosarcoma is a malignant neoplasm of mesenchymal cells, showing varying degrees of striated muscle cell differentiation. It predominantly occurs in children while rarely found in adults and involvement of the oral cavity accounts for only 10%-12% of all head-and-neck cases. Herewith, we present a rare case of spindle cell rhabdomyosarcoma in a 52-year old male, involving the mandibular gingiva, and describe the clinical, radiological, histopathological and immunohistochemical findings.

Expression of mucin-1 in oral squamous cell carcinoma and normal oral mucosa: An immunohistochemical study.

BACKGROUND: Mucins are high-molecular-weight glycoproteins with a high O-linked carbohydrate content, which are synthesized by many secretory epithelial cells as membrane-bound and/or secreted products. Mucin-1 (MUC1) is a transmembrane mucin that protects and lubricates the mucous membranes of the human body and involves itself in various cellular functions such as growth, differentiation and signaling. An aberrant expression of MUC1 has been demonstrated in various human cancers. Many studies on MUC1 expression have been conducted on a variety of neoplastic lesions other than head-and-neck region. In this study, an attempt has been made to evaluate the MUC1 immunoexpression in oral squamous cell carcinoma (OSCC) and normal oral mucosa (NOM). AIMS: This study aims to compare and correlate the immunoexpression of MUC1 in NOM and OSCC using immunohistochemical technique. SETTINGS AND DESIGN: Thirty patients of OSCC formed the study group and thirty patients were included in the control group (NOM). Formalin-fixed paraffin wax blocks were prepared from the tissue samples obtained. MATERIALS AND METHODS: Immunohistochemistry (IHC) for MUC1 was performed, and the overall percentage of positive cells along with distribution and localization of immunoexpression was studied. STATISTICAL ANALYSIS: Pearson's Chi-square test was used. P <0.05 was considered to be statistically significant. RESULTS: In OSCC study group, MUC1-positive immunoreaction was observed in 21 (70%) cases out of 30. All the samples in control group were negative for MUC1 immunoexpression. The immunohistochemical expression of MUC1 in OSCC group was statistically significant when compared with normal control group, as P < 0.05 (Pearson's Chi-square). CONCLUSIONS: MUC1 is a reliable biomarker for the diagnosis of OSCC, but further studies are required to prove its role in prognosis.

Odontogenic tumors: A 35-year retrospective study of 250 cases in an Indian (Maharashtra) teaching institute.

CONTEXT: This retrospective study was planned to ascertain the relative frequency of odontogenic tumors (OTs) in an Indian population in the light of the latest World Health Organization (WHO) classification. AIM: To compare data with various reports from other parts of the world. STUDY DESIGN: Retrospective study. MATERIALS AND METHODS: The histopathology records and archived slides of all lesions diagnosed as "OT" in the Department of Oral Pathology and Microbiology of Government Dental teaching institute, Mumbai, Maharashtra, India, were recovered from the period January 1981-December 2016. A total of 250 lesions thus classified were reviewed for age, gender, site of tumor, and histopathologic typing. The tumors were reclassified according to the WHO 2017 criteria. STATISTICAL ANALYSIS: Microsoft Excel 2010 was used for statistical analysis. RESULTS: In all, 250 cases of OTs were reported in a 35-year period. OTs in this study constituted 7.14% of all the 6797 registered biopsies. The most frequent histological type was ameloblastoma (AML) (30.8%), followed by odontoma (19.2%), unicystic ameloblastoma (18.4%), adenomatoid OT (14%), cementifying fibroma (6%), odontogenic myxoma and cementoblastoma (2.4% each), calcifying epithelial OT and odontogenic fibroma (2% each), ameloblastic fibroma (1.2%), squamous OT, dentinogenic ghost cell tumor, peripheral ameloblastoma, ameloblastic carcinoma and ameloblastic fibrosarcoma (odontogenic sarcoma) (0.4% each). CONCLUSION: A frequency of 7.14% of OTs was observed in this study. AML comprised the single most common tumor of all OTs. This study observed geographic variations in the frequency and distribution of OTs.

Controversies in Odontogenic Tumours: Review.

Odontogenic tumours are lesions that occur solely within the oral cavity and are so named because of their origin from the odontogenic (i.e. tooth-forming) apparatus. Odontogenic tumours comprise a variety of lesions ranging from non-neoplastic tissue proliferations to benign or malignant neoplasms. However, controversies exist regarding the pathogenesis, categorisation and clinical and histological variations of these tumours. The recent 2017 World Health Organization classification of odontogenic tumours included new entities such as primordial odontogenic tumours, sclerosing odontogenic carcinomas and odontogenic carcinosarcomas, while eliminating several previously included entities like keratocystic odontogenic tumours and calcifying cystic odonogenic tumours. The aim of the present review article was to discuss controversies and recent concepts regarding odontogenic tumours so as to increase understanding of these lesions.

Primary intraosseous squamous cell carcinoma - A rare odontogenic malignancy.

Primary intraosseous squamous cell carcinoma (PIOSCC) is a rare epithelial odontogenic malignancy affecting the jaws, especially in elderly population. It is a rare lesion, because very few cases of PIOSCC have been reported in the literature with not much of research done on this particular entity. In the present article, we report a case of PIOSCC with detailed discussion of clinical, radiographic and histopathologic features along with review of literature.

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Burkitt's lymphoma: A case report and review.

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma (DLBCL) and classical Burkitt's lymphoma (BL), is a diagnostic provisional category in the World Health Organization 2008 classification of lymphomas. This category was designed as a measure to accommodate borderline cases that cannot be reliably classified into a single distinct disease entity after all available morphological, immunophenotypical and molecular studies have been performed. Typically, these cases share features intermediate between DLBCL and classical BL or include characteristics of both lymphomas. The rarity of such cases poses a tremendous challenge to both pathologists and oncologists because its differential diagnosis has direct implications for management strategies. In this article, we present a "classical unclassifiable lymphoma with features intermediate between DLBCL and BL" in a young male patient and review of literature.

Dentinogenic ghost cell tumor.

Dentinogenic ghost cell tumor (DGCT) is a rare, odontogenic neoplasm which is considered to be a solid variant of calcifying odontogenic cyst (COC) with locally aggressive behavior. It accounts for only 2-14% of all COCs. To the best of our knowledge, only 88 cases of DGCT have been reported in the literature from 1968 to 2014. Herewith, we report a case of DGCT in a 68-year-old male patient with clinical presentation as a soft tissue growth over alveolar ridge and histopathologically characterized by ameloblastomatous epithelium, abundance of eosinophilic material and ghost cells.

Human MutL homolog 1 immunoexpression in oral leukoplakia and oral squamous cell carcinoma: A prospective study in Indian population.

BACKGROUND: Mammalian mismatch repair system is responsible for maintaining genomic stability during repeated duplications, and human MutL homolog 1 (hMLH1) protein constitutes an important part of it. Various isolated studies have reported the altered expression of hMLH1 in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC). Research is lacking in the quantitative estimation and comparison of hMLH1 expression in OL and OSCC. AIMS: To evaluate, quantify and compare hMLH1 immunoexpression in normal oral mucosa, OL and OSCC. SETTINGS AND DESIGN: Thirty patients of OL and thirty patients of OSCC formed the study group and thirty patients were included in the control group (normal oral mucosa). Formalin-fixed paraffin wax blocks were prepared from the tissue samples. MATERIALS AND METHODS: Immunohistochemistry for hMLH1 was performed, and the total number of positive cells was counted in high-power fields, and based on that percentage positivity of hMLH1 was calculated in all the cases. STATISTICAL ANALYSIS: Kruskal-Wallis and t-test were used. P < 0.05 was considered to be statistically significant. RESULTS: The mean hMLH1 value in control group, leukoplakia and OSCC was 78.26, 54.33 and 40.97 respectively. hMLH1 immunoexpression showed decreasing indexes from control group to leukoplakia and then further to OSCC. hMLH1 expression was significantly lower in OSCC as compared to leukoplakia. There was no significant correlation of mean hMLH1 expression between different clinical and histopathological stages of leukoplakia and OSCC. CONCLUSIONS: hMLH1 immunoexpression was inversely related to the degree of dysplasia. These findings suggest that there is a progressive decrease in hMLH1 expression from control to leukoplakia and further to OSCC. Thus, it can be concluded that hMLH1 can be used as a reliable biomarker for malignant transformation.

Adenomatoid odontogenic tumor: What is the true nature?

The Adenomatoid odontogenic tumor (AOT) is one of the most controversial benign odontogenic tumor, which has been known to the pathologists for the past 100 years. Since then the history, histogenesis and histopathologic designation of AOT remains a matter of debate. Some authors consider it as a true benign neoplasm while others consider it as a hamartoma and still others as an odontogenic cyst. Here we propose that the AOT should not be considered as a cyst because its true cystic nature remains questionable. We hypothesize that when the AOT arises from a change in REE covering of the impacted tooth, then it appears as cystic in nature & certainly not a true cyst by origin. Further studies on the histogenesis are required to change the nomenclature of AOT to adenomatoid odontogenic cyst (AOC).

Pathogenesis of Rushton bodies: A novel hypothesis.

Rushton bodies (RBs) are one of the characteristic features seen in the epithelial lining of odontogenic cysts mainly radicular, dentigerous and odontogenic keratocyst. It has two different histo-morphological appearances; granular and homogeneous. Although widely investigated, the exact pathogenesis and histogenesis of RBs is still an enigma. Many hypotheses were made in the literature but none has explained conceivably the two histo-morphological appearances of RBs and their association with inflammation. In the present paper the various pathogenesis for the formation of RBs proposed till date are discussed along with proposal for a novel hypothesis. The given hypothesis is mainly related to inflammation and its effect on pore size of basement membrane of odontogenic cystic epithelium. It explains RBs association with inflammation as well as existence of two histo-morphological appearances. The proposed hypothesis also justifies the RB's presence inside the lining epithelium of odontogenic cyst despite its hematogenous origin. Future studies are advocated for isolating RBs using laser capture microdissection and subsequent biochemical, histochemical and electron microscopic analysis to substantiate the proposed hypothesis.

Histopathological spectrum of polymorphous low-grade adenocarcinoma.

Polymorphous low-grade adenocarcinomas (PLGA) are distinctive salivary gland neoplasms, with an almost exclusive propensity to arise from the minor salivary glands. PLGA frequently manifests as an asymptomatic, slow-growing mass within the oral cavity, which must be separated from adenoid cystic carcinoma and benign mixed tumor for therapeutic and prognostic considerations. We report a case of a 67-year-old male, who presented with a long-standing mass in the palate. This lesion was diagnosed as PLGA based on histopathological findings, which was further confirmed by the immunohistochemical marker.

Leprous macrocheilia: A rare clinical presentation.

Oral leprosy, a granulomatous disease is classified under the term oro-facial granulomatosis which comprises a group of diseases characterized by noncaseating granulomas affecting the soft tissues of the oral and maxillofacial region. The most common clinical presentation of oro-facial granulomatous conditions is persistent swelling of one or both lips. Due to its rare incidence and clinical findings overlapping with other granulomatous conditions such as sarcoidosis, Crohn's disease, and cheilitis granulomatosa; it is practically difficult for a dental surgeon to easily diagnose this condition. This study presents a case of leprosy causing macrocheilia as the only clinical presentation and diagnosed initially as Miescher's cheilitis based on exclusion criteria.

Oral potentially malignant disorders: A proposal for terminology and definition with review of literature.

Several attempts to produce internationally accepted terminologies and definitions of 'oral precancer' have appeared in the literature. World Health Organizations (WHO) in 1972 subdivided 'precancer' into 'lesions' and 'conditions' with their definitions. Recent working group of WHO is not in favor of such subdivision and recommended the use of the term 'oral potentially malignant disorder (OPMD)'. This is mainly attributed to the recent advancement in molecular and genetic aspects of 'oral precancer'. But efforts to define OPMDs are few in the literature. 'Oral precancer' is ultimately colligated to oral squamous cell carcinoma (OSCC). With this semantics in mind, different OPMD and related terminologies in the literature used till date with their lexicographic analysis have been reviewed in the present paper. Attempt has also been made to propose desirable terminology and definition which suits to the current concept of OPMD. The proposed terminology and definition is based on the authors' opinions with a hope for further suggestions from readers.

Efficacy of crystallization test for screening of oral squamous cell carcinoma with clinico-pathological correlation.

AIM: To determine the efficacy of crystallization test for screening oral squamous cell carcinoma (OSCC) with clinico-pathologic correlation. MATERIALS AND METHODS: Fifty patients of OSCC and 30 healthy individuals were selected. One drop of blood was collected into 1 cc of doubled distilled water at room temperature to give a final dilution of 6% hemolyzed blood. 0.1 to 0.2 cc of blood sample was then subjected to crystallization test using 10% cupric chloride solution. RESULTS: In healthy control group, the typical pattern was an eccentrically placed center of gravity with needles arranged in radiating fashion, while in OSCC group, there was 'transverse form' (TF) formation. The sensitivity and specificity of this test was found to be 96% and 96.66%, respectively. The positive and negative predictive values were found to be 97.96% and 98.55%, respectively. The mean TF frequency was found to be increasing from grade I (3.20 ± 1.5%) to grade II (653 ± 2.23%) and difference was statistically significant (P = 0.0001). However, there was no correlation between mean TF frequency and TNM stages of OSCC. CONCLUSION: Crystallization test is a simple, reliable, economical, less time-consuming, and less invasive screening procedure, which can be used for early detection of OSCC.