Characterization of tumors of jaw:Additive value of contrast enhancement and dual-energy computed tomography

BACKGROUND Currently,the differentiation of jaw tumors is mainly based on the lesion’s morphology rather than the enhancement characteristics,which are important in the differentiation of neoplasms across the body.There is a paucity of literature on the enhancement characteristics of jaw tumors.This is mainly because,even though computed tomography(CT)is used to evaluate these lesions,they are often imaged without intravenous contrast.This study hypothesised that the enhancement characteristics of the solid component of jaw tumors can aid in the differentiation of these lesions in addition to their morphology by dual-energy CT,therefore improving the ability to differentiate between various pathologies.AIM To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw tumors.METHODS Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy CT.Morphological analysis of the tumor,including the enhancing solid component,was done,followed by quantitative analysis of iodine concentration(IC),water concentration(WC),HU,and normalized IC.The study population was divided into four subgroups based on histopathological analysis-central giant cell granuloma(CGCG),ameloblastoma,odontogenic keratocyst(OKC),and other jaw tumors.A one-way ANOVA test for parametric variables and the Kruskal-Wallis test for nonparametric variables were used.If significant differences were found,a series of independent t-tests or Mann-Whitney U tests were used.RESULTS Ameloblastoma was the most common pathology(n=20),followed by CGCG(n=11)and OKC.CGCG showed a higher mean concentration of all quantitative parameters than ameloblastomas(P<0.05).An IC threshold of 31.35×100μg/cm^(3) had the maximum sensitivity(81.8%)and specificity(65%).Between ameloblastomas and OKC,the former showed a higher mean concentration of all quantitative parameters(P<0.001),however when comparing unilocular ameloblastomas with OKCs,the latter showed significantly higher WC.Also,ameloblastoma had a higher IC and lower WC compared to“other jaw tumors”group.CONCLUSION Enhancement characteristics of solid components combined with dual-energy parameters offer a more precise way to differentiate between jaw tumors.

Role of angiogenesis in oral squamous cell carcinoma development and metastasis: an immunohistochemical study

Although a few studies have shown that vascularity is increased from normal mucosa to dysplasia to carcinoma suggesting that disease progression in the oral mucosa is accompanied by angiogenesis. The role in lymph node metastasis in oral squamous cell carcinoma （OSCC） is equivocal. Role of angiogenesis in OSCC development and metastasis is evaluated in this study. This retrospective study of 50 samples consisted of 9 normal buccal mucosa, 22 leukoplakias, and 19 OSCC. Polyclonal antibodies to von-Willebrand factor were used to highlight the microvessels. Images were captured and morphometric image analysis was done for microvessel density （MVD）, area, and perimeter. Highest, as well as mean values of these three parameters were compared. MVD and perimeter, but not area, are significantly different between normal mucosa and OSCC, and leukoplakia and OSCC. There were no differences between normal mucosa and leukoplakia. MVD, area, and perimeter were not significantly different between the OSCC with and without lymph node metastasis. The highest and mean values of MVD are significantly correlated. In the development of OSCC, angiogenic phenotypic change occurs in carcinomas rather than in the pre-cancerous stage, and quantification of angiogenesis in OSCC does not predict the risk of lymph node metastasis.

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.

COVID-19 and oral cancer:Critical viewpoint

The outbreak of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) has marked the beginning of a new pandemic named coronavirus disease 2019(COVID-19). The World Health Organization has announced it as a health emergency that is of international concern. The disease has been reported to cause respiratory illness, pneumonia and even hinder the immunity of an individual. Individuals with disturbed immune responses have been found to be quite susceptible to this viral infection. Oral cancer patients are also at high risk in this pandemic situation and might encounter severe detrimental outcomes. Angiotensin receptors, documented in studies as the path of entry of this virus, are highly expressed in the epithelial cells of oral mucosa, making the group of individuals with oral cancers even more vulnerable. Extracellular matrix metalloproteinase inducer is another potential target for SARS-CoV-2. An exhaustion of angiotensin converting enzyme 2 cell receptors leads to protumoral effects, whereas a downregulation of extracellular matrix metalloproteinase inducer leads to antitumoral effects. Thus, it causes a variation of the biological behavior of the tumor. This article focusses on the molecular mechanisms, effects and pathophysiology of COVID-19 in oral squamous cell carcinoma patients. The different molecular changes in oral squamous cell carcinoma in the background of COVID-19 will modify various environmental factors for this pathology and have an effect on the carcinogenesis process. Understanding the behavior of the tumor will help plan advanced treatment strategies for oral squamous cell carcinoma patients in the background of COVID-19.

Dynamic role of myofibroblasts in oral lesions

Fibroblasts are the most abundant cellular components of connective tissue. They possess phenotypical heterogenicity and may be present in the form of smooth muscle cells or myofibroblasts(MFs). MFs are spindle-shaped cells with stress fibres and welldeveloped fibronexus,and they display α-smooth muscle actin immunohistochemically and smoothmuscle myofilaments ultrastructurally. MFs play a crucial role in physiological and pathological processes. Derived from various sources,they play pivotal roles not only by synthesizing and producing extracellular matrix components,such as other connective tissue cells,but also are involved in force production. In the tissue remodelling phase of wound closure,integrinmediated interactions between MFs and type I collagen result in scar tissue formation. The tumour stroma in oral cancer actively recruits various cell types into the tumour mass,where they act as different sources of MFs. This article reviews the importance of MFs and its role in pathological processes such as wound healing,odontogenic cysts and tumours,salivary gland tumours,oral preneoplasia,and oral squamous cell carcinoma. Research oriented on blocking the transdifferentiation of fibroblasts into MFs can facilitate the development of noninvasive therapeutic strategies for the treatment of fibrosis and/or cancer.

Clinical characteristics and treatment of acute epiglottitis: A retrospective study of 28 cases

Objective:To evaluate the clinical profiles,diagnosis,and treatment of patients with acute epiglottitis at a tertiary care teaching hospital of eastern India.Methods:This is a retrospective study in which 28 patients of acute epiglottitis participated.This study was conducted between January 2016 and October 2019.The diagnosis of acute epiglottitis was based on the clinical presentations and fiberoptic laryngoscopic examinations of the larynx and hypopharynx.Details of age,gender,personal history,clinical symptoms,treatment,and hospital stay were evaluated.Results:Out of the 28 patients with acute epiglottitis,17(60.71%)were male and 11(39.29%)were female with age ranged from 4 years to 62 years and a mean age of 23.45 years.The median duration from the onset to resorting to physicians is 3 d.Among the 28 patients,4 patients(14.29%)were under the treatment for diabetes mellitus.Four cases(14.29%)required airway management with intubation and tracheostomy.Conclusions:Acute epiglottitis is an acute infectious condition of the supraglottis and may lead to airway obstruction.Clinical presentations alone are insufficient for the diagnosis of acute epiglottitis.Fiberoptic nasopharyngolaryngoscopic examination should be performed as soon as possible for confirmation of the disease.

Pharmacogenomics in oral diseases

The availability of newer technologies for identification and characterization of the human genome has enabled our understanding of the genetic variations in a majority of human diseases.Human genomic sequence varies in less than 1%among the different population group and these differences known as gene polymorphisms are the primary reasons for differences in individuals’response to various drug therapy.Also understanding the genetic changes may enable implementation of targeted therapy,thus providing for effective treatment strategies and minimizing the adverse side effects.Pharmacogenomics is a recent development in the field of personalized medicine which focuses on the genetic determinants of drug response at the levels of entire human genome.It primarily deals with tailoring of drug therapy for every individual based on their genetic make-up and identifying new target in various diseases for drug therapy.While the application of pharmacogenomics in systemic illness is well researched,its role in oral diseases needs documentation.Identifying specific targets in periodontitis,head and neck cancer,infections and genetic disorders can be beneficial in discovery of new drugs.This editorial provides an overview of basics of pharmacoge-nomics,its current role in disease management and its potential role in various head and neck diseases.

Unraveling the role of epidermal growth factor receptor in oral lesions: Key to non surgical treatment modes

Epidermal growth factor receptor(EGFR) is a transmembrane receptor with tyrosine kinase activity,mediating actions of various growth factors including EGF, transforming growth factor-α, and neuregulins.Protein binding to ligand induces receptor modification,tyrosine autophosphorylation leading to cell signaling resulting in cellular proliferation. This receptor playsdiverse roles in maintaining homeostasis and recent molecular advances identify that EGFR mutations are linked to several carcinomas. EGFR plays important roles in the development and maintenance of various oral structures, tooth development, eruption and morphogenesis. EGFR expression has also been studied in diverse oral pathologies like squamous cell carcinomas, potentially malignant lesions, lichen planus, salivary gland tumors and odontogenic cysts and tumours. The present review delves into the various general features of EGFR with an insight into its physiological and pathological role in the oral cavity. The clinical implications and upcoming role of EGFR inhibitors in the nonsurgical treatment of oral lesions has also been discussed.

Next generation sequencing in oral disease diagnostics

DNA sequencing is the method of identifying the precise order of DNA nucleotides within a molecule. The information of DNA sequencing is of prime requisite for basic biological research as well as in various clinical specialties.They can be used to determine the individual genetic sequence, larger genetic regions, chromosomes as well as to sequence RNA and proteins. Since the first DNA sequencing in 1970s, there has been tremendous advancements in the technologies aimed to determine the entire human genome. The need for rapid and accurate sequencing of human genome has resulted in the introduction of next generation sequencing(NGS) technology. NGS refers to the secondgeneration DNA sequencing technologies where millions of DNA can be sequenced simultaneously. Some of the next gen sequencing methods employed are Roche/454 life science, Illumina/Solexa, SOLiD system and HeliScope.Application of NGS in decoding the genomic database of various oral diseases may possess therapeutic and prognostic value. This presentation provides an overview of the basics of NGS and their potential applications in oral disease diagnostics.

Dentinogenic ghost cell tumor: A case report

BACKGROUND Dentinogenic ghost cell tumor(DGCT) is an uncommon locally invasive odontogenic neoplasm. It is considered to be a solid variant of calcifying odontogenic cyst(COC). This tumor makes up for only 2%-14% of all COCs and less than 0.5% of all odontogenic tumors which owes to its rarity. The purpose of this paper was to describe a case of DGCT and the treatment adopted in our case,and to provide a review of this case in the indexed literature.CASE SUMMARY In this article, we discussed a case of 18 year old male who reported with a chief complaint of a recurrent swelling and dull aching pain in upper left back region of the jaw. Computed tomography scan was carried out which revealed hypodense lesion with a few hyperdense flecks within it suggesting the presence of calcification. On incisional biopsy, diagnosis of COC was given. After segmental resection of the lesion, histopathogically odontogenic epithelium was noted along with calcifications, ghost cells and dentinoid material. Special staining was done with van Gieson and it showed pink areas of dentinoid material and yellow colour represented ghost cells. Hence, amalgamation of careful clinical examination, use of advanced radiographic imaging and detailed histopathological examination confirmed the diagnosis of DGCT. The patient was followed up for one year and there was no recurrence of the lesion or signs of any residual tumor.CONCLUSION Radical treatment should be carried out along with mandatory long-term follow up in order to avoid recurrence in aggressive lesions.

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.

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.

Proteomic profiling of various human dental stem cells-a systematic review

BACKGROUND The proteomic signature or profile best describes the functional component of a cell during its routine metabolic and survival activities.Additional complexity in differentiation and maturation is observed in stem/progenitor cells.The role of functional proteins at the cellular level has long been attributed to anatomical niches,and stem cells do not deflect from this attribution.Human dental stem cells(hDSCs),on the whole,are a combination of mesenchymal and epithelial coordinates observed throughout craniofacial bones to pulp.AIM To specify the proteomic profile and compare each type of hDSC with other mesenchymal stem cells(MSCs)of various niches.Furthermore,we analyzed the characteristics of the microenvironment and preconditioning changes associated with the proteomic profile of hDSCs and their influence on committed lineage differentiation.METHODS Literature searches were performed in PubMed,EMBASE,Scopus,and Web of Science databases,from January 1990 to December 2018.An extra inquiry of the grey literature was completed on Google Scholar,ProQuest,and OpenGrey.Relevant MeSH terms(PubMed)and keywords related to dental stem cells were used independently and in combination.RESULTS The initial search resulted in 134 articles.Of the 134 full-texts assessed,96 articles were excluded and 38 articles that met the eligibility criteria were reviewed.The overall assessment of hDSCs and other MSCs suggests that differences in the proteomic profile can be due to stem cellular complexity acquired from varied tissue sources during embryonic development.However,our comparison of the proteomic profile suffered inconsistencies due to the heterogeneity of various hDSCs.We believe that the existence of a heterogeneous population of stem cells at a given niche determines the modalities of regeneration or tissue repair.Added prominences to the differences present between various hDSCs have been reasoned out.CONCLUSION Systematic review on proteomic studies of various hDSCs are promising as an eye-opener for revisiting the proteomic profile and in-depth analysis to elucidate more refined mechanisms of hDSC functionalities.

Unusual aggressive behavior of central giant cell granuloma following tooth extraction

Central giant cell granuloma(CGCG) is found exclusivelyin jaws. Its etiopathogenesis is unclear; however it is suggested that it can arise as a reactive response to trauma. This report describes an aggressive variety of CGCG which raises a question; can extraction of tooth modify the behavior of CGCG? A 46 years old male had reported with a rapidly increasing intraoral and extraoral swelling of lower jaw following tooth extraction. Radiographic examination revealed a large multilocular lesion involving the body and ramus of mandible which had been proved to be aggressive CGCG on histopathological examination. The importance of radiographic examination prior to extraction of teeth and importance of inclusion of CGCG in jaw swellings associated with mobility of teeth or failure of healing sockets is emphasized.

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.

Probiotics——A complete oral healthcare package

Probiotics are living bacterial cells that have significant therapeutic potential for treating human infectious diseases.There is a huge market for probiotics in the pharmaceutical sector.They have been frequently used to treat the gastrointestinal diseases and improve gut immunity.In this review,the strains currently in use for manufacturing oral probiotic formulations are discussed.The review further recommends the use of probiotics for the control of various oral health disorders,like dental caries,periodontitis,gingivitis,halitosis,burning mouth syndrome,and oral cancer.Finally,this review also explores the use of various commercial probiotic products in maintaining oral health,their market values,and government acts and regulations that are relevant to the production and marketing of probiotics.Probiotics have tremendous therapeutic potential and more in-depth research must be done on these beneficial bacteria to make them one of the leading drugs in treating oral disorders.

Determination of Cusp Number and Occlusal Groove Pattern in Mandibular Molars:A Preliminary Epidemiological Study in an Indian Population

Teeth are excellent material in living and nonliving populations for anthropological,genetic,odontologic,and forensic investigations.The present study aims to study the number of a number of cusps in the first and second mandibular molar and to assess the frequency and expression of different types of occlusal groove pattern.The cross‑sectional study is carried out.One hundred patients attending the Outpatient Department of the hospital were recruited for the study based on exclusion and inclusion criteria.Clinical examination was done,and the morphological details of the crown(the number of cusps)were recorded.Dental casts of the mandibular teeth were made.The occlusal grooves were highlighted by using Indian ink and observed under the 2×magnification for the groove pattern(+or y type).Descriptive statistics were carried out for the study.In the case of mandibular first molar,the 5 cusp form was the most frequent occlusal configuration(82%)followed by 6 cusp variety(12%)and 4 cusp variety(4%)bilaterally.The predominant occlusal groove pattern seen in mandibular first molar was“y”shape(65%)followed by“+”pattern(28%).Hence,the most frequent occlusal surface configuration in case of first mandibular molar was“y5”form.In the case of mandibular second molar,the 4 cusp form was the most frequent occlusal configuration(86%),followed by 5 cusp type(12%)bilaterally.The predominant occlusal groove pattern seen in mandibular second molar was a“+”shape(85%)followed by“y”pattern(11%).Hence,the most frequent occlusal surface configuration in case of mandibular second molar was“+4”form.The study of dental morphological characteristics is important in forensic and anthropological research as it can provide information on the phylogenetic relationship between species,as well as variation and diversities within a population.

Sex Determination Using Cheiloscopy and Mandibular Canine Index as a Tool in Forensic Dentistry

Identification of a person's individuality and sex determination are important for legal as well as identification purposes.The aim of the present study was to check the reliability of cheiloscopy and mandibular canine index(MCI)in the detennination of sex in an individual.The aim of this study is to analyze difierent lip patterns reproduced by the natural dye(vermilion)and lysochrome(Sudan Black Ⅱ)dyes and to compare the MCI in males and females for the determination of sex and to check the reliability of cheiloscopy and MCI for the same.Latent lip prints were developed using natural dye(vermilion)and lysochrome(Sudan Black Ⅱ)dyes and their patterns categorized according to Tsuchihashi's classification.MCI were calculated.Analysis of the two was performed.According to discriminant functional analysis,percentage accuracy for cheiloscopy in the determination of sex was found to be 55%while for MCI,the same value was 85%.Natural dye(vermilion)was found as an efficient dye compared to lysochrome(Sudan Black Ⅱ)dyes for the development of latent lip prints.Both the dyes showed Type Ⅰ lip print pattern to be common in males and females.Furthermore,all the parameters in MCI were found to be significant in the determination of sex in an individual.The results of the present study revealed MCI to be more reliable in the determination of sex than cheiloscopy.

Age Estimation Using Single-Rooted Teeth of Indian Residents by Modified Kvaal’s Method:A Pilot Study

Background:This study aimed to create an age estimation formula with high sensitivity and specificity using the modified Kvaal’s dental radiographic method.The parameters for age estimation were assessed by measuring the length and width of tooth,root,and pulp with the help of a stereomicroscope and digital image analysis.Materials and Methods:Only single-rooted noncarious teeth were included.A total of 203 samples of teeth,with an age ranging from 15 to 85 years,were collected,of which only 123 samples were included in the study.Images of vertically sectioned teeth specimens were captured under a stereomicroscope(version SZ-790,×10 mm eyepiece),and parameters were measured using Adobe Photoshop.Results:Karl Pearson’s correlation coefficient was used to correlate age with the dental parameters,and step-wise regression analysis was used to derive the age estimation formula.A significant correlation of age with pulp length and root and pulp width having P<0.001 was observed,and an age estimation formula with a standard estimation error of 14 could be derived.Conclusion:Kvaal’s parameter in extracted single-rooted tooth showed a better reliability and reproducibility in age estimation.Further studies with a larger sample size and tooth-specific formula using principal component analysis should be considered to validate the accuracy of the present result.

Mouth the mirror of lungs： where does the connection lie？

Periodontitis is the chronic destructive disease of the periodontium （Gums） caused by host bacterial interactions. The effect of such host bacterial interactions in oral cavity also evokes a systemic response. Numerous studies have found common mechanisms of destruction for periodontal diseases and other chronic diseases like diabetes mellitus, atherosclerosis, respiratory diseases, and adverse pregnancy outcomes. Oral colonization by respiratory pathogens appears to be a risk factor for development of respiratory diseases and oral interventions aimed at reducing oral bacterial count have resulted in reduced incidence of these reparatory illness. This reflects the importance of oral hygiene among patients with respiratory illness. This review highlights the association between periodontal diseases and respiratory diseases.