Pyoderma Gangrenosum with Oral Involvement–Case Report and Review of the Literature

Pyoderma gangrenosum (PG) is a rare, noninfectious neutrophilic dermatosis. Clinically, it begins with sterile pustules that rapidly progress into painful ulcers of variable depth and size with undermined violaceous borders. The diagnosis of PG is based on the history of an underlying disease, a typical clinical presentation, histopathology, and exclusion of other diseases. The peak incidence occurs between the ages of 20 to 50 years with women being more often affected than men. There have been very few reports of pyoderma gangrenosum with oral mucosal involvement. Oral lesions in previously reported cases have included ulcers of varying sizes from a few mm to several cm and have been reported to have been found on the tongue, soft and hard palate, buccal mucosa, and gingiva. Some of these oral lesions have been associated with ulcerative colitis, inflammatory bowel disease, and polycythemia rubra vera. A few cases were reported with biopsy findings, the histological picture being nonspecific, showing ulceration, and necrosis with inflam- matory cell infiltrate. A peculiar case of pyoderma gan- grenosum with an oral lesion is presented here, and the differential diagnosis is discussed.

Quality of life and oral potentially malignant disorders: Critical appraisal and prospects

Quality of life(QoL) is a vital and often required health outcome measure that is relevant to patient care. A healthy oral cavity enables person to perform daily activities without any limitations. However, any disturbance may result in impaired QoL. The oral health-remains an essential element of people's health and well-being. In recent years, the tradition of clinical practice and research has been changed by incorporating QoL assessment, as it helps in assessment of patients' needs and monitoring treatment responses. Oral potentially malignant disorders(OPMDs) are a group of chronic disorders including oral leukoplakia(OL), oral lichen planus and oral submucous fibrosis(OSF). It is evident that patients with OPMDs experience significant health-related symptoms, functional limitations and psycho-social impairment, compromising their Qo L. Moreover, the worsening of Qo L has been associated with advanced stages of OPMDs. Despite of increasing number of OPMD cases in recent decades, limited literature is available regarding QoL in this population. Although, there is higher prevalence of habit-related OPMDs, particularly OSF and OL in Southern Asian countries, only a few studies have been performed in these populations. Moreover, these studies administered generic Qo L instruments, which offer less sensitivity to clinical changes. However, condition-specific instruments are more sensitive and allows better measurement of QoL. As the impacts of different conditions on OHRQoL may vary, the development and validation of a QoL instrument specific to each clinical entity of OPMDs is currently needed.

Photodynamic therapy of oral leukoplakia and orallichen planus using methylene blue:A pilot study

Premalignant lesions like oral lichen planus(OLP),oral leukoplakia(OL)has a fair probability of transforming into malignancy and they are perverse toward conventional therapies.Photody-namic therapy(PDT)has been considered as an alternative/complimentary therapeutic mo-dality for the management of premalignant lesions.In this study,methylene blue mediated photodynamic therapy(MB-PDT)was used as a possible alternative method for the treatment of OLP and OL.A total of 15 OLP lesions and 13 OL lesions were enrolled in the study.The patients were irradiated 1using metal halide lamp filtered at 630土10nm,with a light exposure dose of 120 J/cm^(2) per stting.For the OLP lesions,MB-PDT was performed once a week for four weeks and for the OL lesions,MB-PDT was performed twice a week for three weeks.Lesions were evaluated pre-and post-and at follow-u sessions by changes in sign and symptom scores,and size of lesions.We have observed a 53.3%of complete reduction in the treated OLP lesions and their decrease in size,sign and symptom score after treatment and at follow-up session was statistially signifcant.We have also observed complete response for one OL lesion of the 13 treated lesions.The result indicates that MB-PDT is an effective modality in management of OLP and OL.Among the two types of premalignancies treated with MB-PDT,OLP lesions responded much better than that of OL.

Squamous Papilloma:Case Report and Review of Literature

Squamous papillomas are common lesions of the oral mucosa with a predilection for the mucosa of the hard and soft palate. As an oral lesion,it raises concern because of its clinical appearance,which may mimic exophytic carcinoma,verrucous carcinoma or condyloma acuminatum. Its pathogenesis is related to human papilloma virus but there is controversy regarding its viral origin. We present a case of squamous papilloma presenting as oral lesion along with a review of the literature.

A rare case of intraoral lipoma in a six year-old child:a case report

One type of soft tissue lesions of the oral cavity is lipoma, which is a kind of benign tumor composed of mature lipid cells. Although the lipoma presents as one of the most common mesenchymal neoplasms, most tend to develop on the trunk and proximal portions of the extremities. However, lipomas in the oral and maxillofacial region are much less frequent. Here we present a case of an intraoral lipoma in a six year-old child.

The Determination of Heritability in palatal Rugae Pattern among Parents and their Off-Springs in Western India-A Cross-sectional Study

Background:Palatal rugae are asymmetrical elevations present on hard palate and are significant due to their uniqueness,stability and thus,aid in forensic identification.Objective:The objective is to determine palatal rugae morphology between parents and their offsprings and to determine their genetic inheritance.Materials and Methods:This randomized controlled cross-sectional single-blinded study was conducted on 50 families(randomly selected)who visited Vyas Dental College and Hospital.A total of 150 maxillary study models were examined and rugae were delineated and shape,size,and pattern of rugae were recorded.Results:Weak but significant correlation was seen in the nonspecific and angular type of palatal rugae between child and mother and child and father as P<0.05.Matching with either or both of their parent was seen for curved,wavy,divergent,straight,horseshoe,angular,and nonspecific type of rugae with the higher%of wavy pattern matching(52%with mother and 54%with father).A considerable number of samples showed high heritability of primary and secondary rugae from both parents,but more predominantly to their mothers(branched,nonspecific,and straight).Conclusion:Both environmental and genetic factors can influence the rugae pattern.Further,studies should be conducted on a larger sample size to get more significant results.

Comparison of the Anatomy and Adaptability of Reconstructed Teeth with Natural Teeth:An Innovative Approach in Forensic Dentistry

Background:Forensic tooth reconstruction is the technique of reconstructing the morphology of a missing tooth from the intra-alveolar morphology of dental sockets from skeletal remains.Aims and Objectives:The aim and objective of the study are to compare and investigate whether the anatomy and adaptability of reconstructed teeth simulate with the natural tooth and to investigate whether the dental materials have potential in reconstruction of teeth.Materials and Methods:An in vitro experimental study was undertaken on a human mandible.According to the Fédération Dentaire Internationale,charting will be done based on the number of teeth present.The entire study will be conducted in three phases using dental materials.Phase 1 comprised preparation for negative replica,where an impression will be taken,Phase 2 comprised preparation of a positive replica or cast,and Phase 3 comprised tooth reconstruction using the flowable composite.Results:The specimen tooth(which had been taken from its socket)and the newly constructed tooth were compared,and when the length of the newly constructed root was measured using digital vernier calipers,there was a disparity of 0.5-1 mm.The cone-beam computed tomography radiographs demonstrated the necessary flexibility.Conclusion:The present study demonstrated that dental information can be obtained even when teeth are absent postmortem by making an attempt to recreate the teeth using dental materials while documenting the intra-alveolar anatomy of the dental root socket.

Applications of snake venoms in treatment of cancer

Snake venoms are folk medicines used since ages. The components of snake venoms have high specific affinity and actions on cells and cell components. Also snake venoms are largely cytotoxic to tumor cells than normal cells. In addition to these, they have several therapeutic actions that make them an attractive option in the management of cancer. The advent of modern technologies has greatly helped in extracting and identifying new components of therapeutic interests in short time. The article highlights the importance of snake venoms in the management of cancer, so as to motivate curious researchers to devote their skills in this fascinating area. This in turn may bring hope, smile and relief to several cancer patients in future.

Salivary gland disorders:A comprehensive review

Salivary glands are complex in nature. They could be either tubulo acinar, merocrine or exocrine glands secreting mainly saliva. Salivary gland is one of the main soft tissue structures in the maxillofacial area. Saliva is a clear, slightly acidic muco serous fluid that coats the teeth, mucosa and thereby helps to create and maintain a healthy environment in the oral cavity. Salivary glands may be affected by a number of diseases: local and systemic and the prevalence of salivary gland diseases depend on various etiological factors. The glands may be infected byviral, bacterial, rarely fungal or its ductal obstruction which may cause painful swelling or obstruction, affecting their functions. The salivary gland may also be affected by a various benign and malignant tumours. This review article briefly describes about the various salivary gland disorders, diagnostic techniques and their management including the recent advances and the future perspective.

Ameloblastic carcinoma: Report of a rare case

Ameloblastic carcinoma is a rare odontogenic tumor exhibiting histological evidence of malignancy in the primary or recurrent tumor. It is characterized by rapid, painful expansion of the jaw, unlike conventional ameloblastomas. The tumor most frequently involves the mandible. The expanding lesion causes perforation of the buccal and lingual plates of the jaw and invades the surrounding soft tissue. Rapidly growing large tumor mass may cause tooth mobility. A mandibular tumor involving the mental nerve leads to paresthesia of the nerve. A maxillary tumor can produce a fistula in the palate and paresthesia of the infraorbital nerve. Most ameloblastic carcinomas are presumed to have arisen de novo with a few cases of malignant transformation of ameloblastomas. Although rare, these lesions have been known to metastasize, mostly to the regional lymph nodes or lungs. A case of ameloblastic carcinoma in a 60-year-old man is reported here and its clinical, radiological and histological features are discussed.

Role of artificial intelligence in the diagnosis of COVID-19:A mini review

The ongoing COVID-19 pandemic due to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has resulted in a significant public health care system crisis.This disease has resulted in devastating damage to human lives and significant disruption in economies.Use of“machine-learning”algorithms as tools of artificial intelligence may help identify a suspected or infected individual with an estimation of chances of survival.These algorithms make use of recorded observational data including medical histories,patient demographics as well as any related data on COVID-19.

Morphologic,Radiographic,and Stereomicroscopic Evaluation of Teeth Subjected to High Temperatures:An In vitro Forensic Study

Background:To evaluate morphologic,radiographic,and stereomicroscopic changes of teeth when subjected to specific high temperatures in both direct heat and gradual heat and to compare the changes among two heat groups and also among different types of teeth.Materials and Methods:An in vitro study was conducted on 90 healthy extracted human teeth,in which the teeth were divided into two groups.Group 1(45)was subjected to direct heat and Group 2(45)was subjected to gradual heat.Group 1 and Group 2 were further subdivided into three subgroups(A)anteriors,(B)premolars,and(C)molars each consisting of 15 teeth.Teeth were subjected to temperatures of 200°C,400°C,600°C,800°C,and 1000°C in a muffle electric furnace.The color changes were noted using the Revised Munsell soil color chart and the radiographic and stereomicroscopic changes were evaluated.The results obtained were subjected to statistical analysis.Results:Teeth in direct heat showed more destructive changes at lower temperatures,i.e.,400°C and 600°C when compared to gradual heat where changes are observed at 600°C and 800°C.Among different types of teeth,anteriors and premolars showed more changes when compared to molars.Interpretation and Conclusion:It can be concluded that dental evidence may provide clues to solve the mystery in fire investigations as dental structures are the last to be destroyed under extreme conditions,whether temperature,acid,or putrefaction.

Morphometric and Volumetric Evaluation of Maxillary Sinus as an Aid in Sex Identification in Forensic Odontology-A Cone-Beam Computed Tomography Study

Background:Various methods are used in forensic odontology for the purpose of sex and personal identification.Some of them include cheiloscopy,rugoscopy,mandibular measurements,and study of paranasal sinuses.In our study,we have used maxillary sinus as an aid in sex identification.For this purpose,we have evaluated the morphometric and volumetric measurements of the maxillary sinus using a 3-Dimensional imaging modality,Cone Beam Computed Tomography.Aims and Objectives:Sex and age identification are important in the process of identification of both the living and the dead.Hence,this transverse retrospective study was done to appraise the precision of the dimensions and volume of the maxillary sinus to aid in sex and age identification.Material and Methods:Eighty full Field of View(FOV)Cone-Beam Computed Tomography(CBCT)images were retrieved from the archives which were matched with age and sex.The maxillary sinuses on either side were measured mediolaterally in the axial section and supero-inferiorly in the coronal section.The volumetric analysis of the sinus was done in the sagittal section.The sex was classified using discriminant function analysis and the differences were compared using independent t-test.The differences with age were analyzed using one-way ANOVA.Results:Independent t-test was done for comparison of the sinuses between both sexes.Maxillary sinuses measurements were larger among the males both superior-inferiorly on either side(P<0.001)and mediolaterally on the right(P<0.049)showed statistically significant values.A significant correlation existed while comparing the maxillary sinus volume among both the sexes on either side(P<0.001 and<0.002 in the case of right and left respectively).On comparing the supero-inferior and mediolateral measurements and the maxillary sinus volume on either side among the various age groups,the values were statistically insignificant.Present study shows that the maxillary sinus measurements using Cone-beam computed tomography were diagnostic in the identification of sex but not in age estimation and can be used in forensic dentistry.

Mucormycosis in a diabetic ketoacidosis patient

Oral cavity is considered to be a kaleidoscope for body's general health.Many systemic conditions do present with diverse oral manifestations.Mucormycosis involving the oral cavity is one such entity that presents as necrosis of bone in immunocompromised patients.Mucormycosis is an opportunistic fungal infection that mainly affects the patients with uncontrolled diabetes mellitus.Hereby,we report a case of mucormycosis involving the palate in a patient with diabetic ketoacidosis.

Fascial space odontogenic infections: Ultrasonography as an alternative to magnetic resonance imaging

BACKGROUND The introduction of modern diagnostic tools has transformed the field of maxillofacial radiology.Odontogenic infection and fascial space involvement have been evaluated with many diagnostic tools,including ultrasonography(USG)and magnetic resonance imaging(MRI).AIM To explore USG as an alternative model to MRI in the detection of fascial space spread of odontogenic infections.METHODS Among 20 patients,50 fascial spaces were clinically diagnosed with odontogenic infection and included in this prospective study.Fascial space infection involvement was examined by USG and MRI.Results were compared for both and confirmed by microbiological testing.RESULTS Ultrasonography identified 42(84%)of 50 involved fascial spaces.Whereas MRI identified all 50(100%).USG could stage the infections from edematous change to cellulitis to complete abscess formation.CONCLUSION MRI was superior in recognizing deep fascial space infections compared to USG.However, USG is a significant addition and has a definite role in prognosticatingthe stage of infection and exact anatomic location in superficial space infections.

Nasopalatine Canal Revisited: An Insight to Anterior Maxillary Implants

Purpose: The study was performed to evaluate variability in nasopalatine canal using cone beam computed tomography (CBCT) in relation to age and gender. The study also provides an insight while considering anterior maxillary implants. Materials and Methods: The study included 200 subjects aged between 19 and 67 years who were divided into the following 3 groups: 1) 19 - 34 years old;2) 35 - 49 years old;3) >50 years old. The male and female subjects were 104 and 96 respectively. After obtaining a prior consent, CBCT was performed using a standard exposure and patient positioning protocol. The CBCT volume was sliced in three planes (X, Y, and Z) and was sequentially analyzed for the location, morphology and morphometric dimensions of the nasopalatine canal. The correlation of age and gender with all the variables were evaluated. Results: The present study revealed statistically significant differences in the length of the nasopalatine canal based on the age group. The slanted and the cylindrical variety of the nasopalatine canal were commonly observed in the study. However, no statistical differences were noted in the other variables such as number of openings at the nasal fossa, diameter of the incisive fossa, angulation of the canal as viewed in the sagittal sections and antero-posterior dimensions of the canal in the sagittal sections. Conclusion: The present study demonstrates the variability observed in the anatomy and morphology of the nasopalatine canal which is an important landmark for placing dental implants in the anterior maxillary region.

Curcumin in chronic lymphocytic leukemia——A review

Curcumin is a widely researched natural product and is known to possess anticarcinogenic properties.Chronic lymphocytic leukemia is a type of leukemia that principally affects patients with age higher than 60 years.Since the toxicity of conventional drugs exceeds the benefits of treating this leukemia type,patients are treated only in the advanced symptomatic stages.The current article reviews curcumin,its general actions and targets in cancer,and specifically that of it in chronic lymphocytic leukemia.

An Emergence of Dental Tissues in the Forensic Medicine for the Postmortem Interval Estimation:A Scoping Review

It is observed that there is not enough literature to support the usefulness of dental tissue in forensic medicine for the estimation of postmortem interval(PMI).Therefore,the authors of this article have systematically reviewed the available literature to understand the most used dental tissues,the methods employed to evaluate these tissues,and their reliability in PMI estimation.A MEDLINE-PubMed search engine was used to review the literature using the keywords“teeth,”“dental tissues,”“post‑mortem interval,”and“forensic dentistry”from 2001 until 2020.The most used tissue was dental pulp,but other cellular‑.and molecular‑level dental tissues such as enamel,dentin,cementum,periodontal ligament,odontoblast,and mitochondrial and nuclear DNA and RNA were also used.Based on this observation,the authors have provided the categorical classification to evaluate these dental tissues into morphological,histopathological,and molecular‑level examination to understand the reliability of these dental tissues.The molecular examinations to evaluate these tissues were widely employed and emerging in the estimation of PMI as this method could provide a reliable outcome when compared with others.Since the literature reviewed was not enough to answer our questions,however,to conclude,the dental pulp is the widely used tissue so far.Further,more studies are required to authenticate the role of other dental tissues to predict the PMI at an early stage with cost‑effective and most convenient techniques.

Mental Foramen:A Predictor of Age and Gender and Guide for Various Procedures

Background:The distance from the inferior border of mental foramen(MF)to lower border of mandible remains constant throughout the life.Considering this fact the present study was carried out to determine role of MF in age and gender estimation and also its importance in planning various treatments.Aims and Objective:(1)To determine the most common type and shape of MF 2)To measure the height of the mandibular body(H),the distance between the superior margin of the MF to the alveolar crest(SM-AC),the distance between the superior margin of the MF to the inferior border of the mandible(SM-IB),the distance between the inferior margin of the MF to the inferior border(IM-IB)on the right side and left side.(3)To compare the above measurements for age and gender determination.(4)To determine effect of various factors on above measurements(5)to evaluate whether any significant difference in measurement occurs on right and left side.(6)To derive a regression equation for age estimation.Materials and Methods:A total of 300 Orthopantomogram were studied.Measurements such as H,SM-AC,SM-IB and IM-IB were carried out on both sides on type II MF in males and females in all the six age groups.Statistical analysis was carried using IBM SPSS version 24 to determine differences in measurements and linear regression analysis was carried out to determine age of individuals.Result:The most common appearance of MF was type II and shape was oval.Statistically significant differences occurred in measurements using which regressive equation for age estimation was derived for males&females.Conclusion:MF,being a stable landmark in mandible,serves as a good indicator for the determination of age and gender.Hence,using certain measurements related to MF,it can help in determining the age of the individual.Further,its position and distance from the alveolar crest serve as a guide for orthognathic surgeries,implant placement,and pre-prosthetic surgery.

Radiographic Comparisons between Middle Phalanx of the Third Finger and Cervical Vertebrae Maturation for the Assessment of Skeletal Maturity

Sexual maturation characteristics,chronologic age,dental,and skeletal development are some of the more commonly used means to identify stages of growth.Hand wrist radiograph and cervical vertebrae maturation index(CVMI)are more reliable for skeletal development assessment.This study was conducted to compare the skeletal maturity using the maturational stages of middle phalanx of the third finger(MP3)with cervical vertebrae and then to evaluate the reliability of MP3 as a sole skeletal maturity assessment method.Chronological age group of the 112 subjects was 8-16 years for females and 10-18 years for males were selected for the study.Lateral cephalometry and intra oral peri‑apical radiograph of MP3 of the left hand of each patient were taken.Then,statistically it was correlated which was highly significant.Skeletal maturation of MP3 and cervical vertebrae stages progress with advancing chronological age.Female subjects were advanced on an average of 2 years earlier than male subjects at every stages of growth spurt.These results suggest that MP3 can substitute CVMI for skeletal maturity evaluation to determine optimal treatment time for various orthodontic procedures.The developmental stages of the MP3 could be used as a sole indicator in assessing the skeletal maturity.