Nirmala N Rao

A comparative evaluation of DIAGNOdent with visual and radiography for detection of occlusal caries: An in vitro study

BACKGROUND The diagnosis of dental caries is fundamental to the practice of dentistry. Despite the fact that dental caries has declined considerably, it is still a problem of great importance. The reduction in caries prevalence has not occurred uniformly for all the surfaces. The greatest reduction was observed at lesions located on smooth surfaces, so that occlusal caries are most common in children. AIM The purpose of this study is to determine the clinical efficacy of DIAGNOdent in detecting occlusal caries. MATERIALS AND METHODS A total number of 50 teeth were subjected for visual, radiographic, and DIAGNOdent examinations. All the three methods were compared to histology which is a gold standard. RESULTS The result obtained showed that DIAGNOdent is superior to visual and radiographic methods in diagnosing occlusal caries.

Evaluation of collagen in connective tissue walls of odontogenic cysts ― A histochemical study

BACKGROUND The purpose of this study was to evaluate the nature of collagen in the connective tissue walls of odontogenic cysts, like the odontogenic keratocyst (OKC), dentigerous cyst and radicular cyst using picrosirius red stained sections. Furthermore, it was intended to assess if the capsular connective tissue can affect the nature of overlying epithelium, thus emphasizing the role of epithelial-mesenchymal interactions in biological behaviour of the cysts. MATERIALS AND METHOD The material for the study included 51 formalin-fixed paraffin-embedded tissue blocks (15 odontogenic keratocyst, 15 dentigerous cysts, 15 radicular cysts and four normal mucosa and two dental follicular tissue as controls), retrieved from the Department of Oral Pathology and Microbiology, MCODS, Manipal. Tissue blocks were sectioned at 5-μm thickness, stained with picrosirius red stain and observed with polarization and light microscopy. RESULTS Few sections of OKC and dentigerous cyst exhibited greenish-yellow birefringence in sub-epithelial region, whereas others showed a yellowish-orange birefringence under polarization microscopy. Most radicular cysts had yellowish-orange to orange birefringence. Shift in colour in case OKC and dentigerous cyst was attributed to the presence of inflammation in those sections. These regions also exhibited either a change in phenotype or thickness of overlying epithelium. CONCLUSION This technique can be used to study the nature of collagen fibres in odontogenic cyst walls. Further studies with an increased sample size and using various epithelial and mesenchymal markers and ssDNA antibodies should be carried out to confirm the effect of epithelial-mesenchymal interactions on the nature of epithelium of odontogenic cysts.

Analysis of gonial angle in relation to age, gender, and dentition status by radiological and anthropometric methods

Background: With development and function, the mandibular angle has shown changes in size and shape. A variation in mandibular angle with age, gender, and even the dental status has been observed, which is supported by radiographic and anthropometric studies. Aims: The aim of this study were to evaluate relationship between complete loss of teeth and changes in the gonial angle; the study further intends to evaluate any variation in gonial angle with age and gender. The study intends to assess the reliability and accuracy of age and gender determination using gonial angle as a parameter. Materials and Methods: A total of 185 subjects (91 males; 89 females) were included in the study and were divided into five groups on the basis of the chronological age. Physico-forensic anthropometry and lateral cephalometric methods were used to record the gonial angle. Results: The present study shows a definite decrease in the gonial angle with advancing age, but the intergroup analysis does not follow a significant pattern. The study showed no correlation of gonial angle with gender. However, the study observed a 6° increase in gonial angle for edentulous subjects. Conclusion: Gonial angle has been used as an adjuvant forensic parameter, but its reliability is questionable, as the mandible does not follow one characteristic pattern. Gonial angle does show changes with dentition status, which may be attributed to physiologic function of the mandible. However, when evidence is scanty, it can be used to direct the investigation.

A comparative analysis of langerhans cell in oral epithelial dysplasia and oral squamous cell carcinoma using antibody CD-1a

BACKGROUND The integrity of the immune system is necessary to control tumor progression and a compromised state contributes to tumor escape. AIMS The study intends to evaluate the presence and distribution pattern of Langerhans cells (LC) in Oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) oral epithelial dysplasia and oral squamous cell carcinoma and elucidate their role. The study analyses LC in histological zones of the epithelium and connective tissue, which has seldom been attempted previously. MATERIALS AND METHODS Forty-five microscopic sections (i.e. 5 normal, 15 OED and 25 OSCC) were examined for expression of LC marker CD1a using immunohistochemistry. LCs were counted in zones of epithelium and connective tissue. STATISTICAL ANALYSIS USED Results were analyzed using SPSS Version 16.0 and subjected to one-way ANOVA comparison and Students t-test and Wilcoxon Z test. RESULTS Significant decline in LC count was observed with progressing grade of OED and OSCC. The basal and suprabasal zones in OED and superficial zone in OSCC exhibited the highest density of LCs. The low LC count in severe dysplasia was attributed to paucity in the basal zone. There was a significant paucity of LCs in the sub-epithelial zone of all the grades of OSCC, with high influx of LCs within the tumor stroma. Also, poorly differentiated OSCC exhibited a significant decrease in the LC count within the overlying epithelium as well as the tumor stroma. CONCLUSION The present study suggests that there is a recruitment of LCs in the neoplastic process. Changes observed in LC distribution within the zones of dysplastic epithelium and tumor stroma can be interpreted as their pathophysiologic function.

Rhabdomyosarcoma of mandible: A diagnostic predicament

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children under 15 years of age and rare among persons older than 45 years of age. It is considered to result from malignant transformation of primitive mesenchymal cells. Although it has a relative predominance for head and neck region, it is found less often in oral cavity. Here we report a case of RMS of mandible in an adult patient, which was initially diagnosed as carcinosarcoma. Clinical and pathologic findings are described, which were confirmed by histochemical and immunohistochemical stains.

Bisphosphonate-associated osteonecrosis of the jaws.

Bisphosphonates constitute a group of drugs capable of modulating bone turnover and reduce its remodeling when an excessive resorption occurs. This is why they are indicated in a large group of bone diseases like postmenopausal osteoporosis or osteolysis associated with breast cancer or multiple myeloma. Over the last few years and due to their extensive use, many cases of complications associated with their use have been published. Among the most important possible adverse effects are the oral ones, with the appearance of ulcerations and, especially, osteonecrosis of the jaws associated with this therapy. In this paper, we have analyzed the general characteristics of these drugs and their mechanisms of action as well as the described adverse effects, especially oral and maxillofacial, have been made special reference, regarding the prevention of osteonecrosis of the jaws, heightened by cases described in the medical and odontological literature. The preventive protocol backs up the fundamental role of the odontologist in the effective prevention of this process before, during and after the treatment.

Rare case of giant unicystic ameloblastoma: Luminal variant

Abstract Objective and importance: Ameloblastoma is a locally aggressive benign tumor, commonly occurring in the mandible. While giant ameloblastoma of multicystic or plexiform variant have been reported, the authors report a rare case of giant unicystic ameloblastoma of luminal variant, which was treated by compartmental resection and planned for delayed reconstruction. Clinical presentation: A 46 year old male patient reported to the oral surgery out-patient department with a swelling of the left side mandible region of 2 years duration. He had undergone ayurvedic treatment for the same with no improvement. The size of the lesion on presenting was approximately 9 × 12 cm. Intervention: Compartmental resection with plan for secondary reconstruction, after adequate follow up period. Conclusion: While conservative management is being explored as a treatment option for unicystic ameloblastoma, resection is still the standard of care regardless of the histopathological subtype for giant lesions.

Immunohistochemical characterization of cyclin dependent kinase-4 in different histological grades of oral leukoplakia and oral squamous cell carcinoma.

Background: Cyclin dependent kinase-4 (CDK4) encoded by CDK gene, is a heterodimer protein of cell cycle in G1-S transition. This study aimed to characterize the CDK4 immunoreactivity in different histological grades of oral leukoplakias (OLs) and oral squamous cell carcinomas (OSCCs) and also aims to discuss its probable role in the tumor biogenesis. Materials and Methods: Expression of CDK4 was investigated in total of 52 samples including OL (15), OSCCs (30) and normal oral tissues (07). A labeled Streptavidin-Biotin immunohistochemistry assay was performed and staining intensity was evaluated. Results: The staining pattern was similar in all tissues and was located in both nuclei and cytoplasm. Dysplastic epithelium displayed a progressive increase in nuclear expression of CDK4 when compared to normal tissues. Also, positive staining cytoplasm was highly evident in OSCC with loss of differentiation. Conclusion: Our study indicated a progressive over expression of CDK4 from normal to leukoplakias (various histological grades of dysplasias) and OSCCs.

An Erupted Silent Tumour

Odontomas are the most common odontogenic tumors of the oral cavity which are nonaggressive, hamartomatous in nature consisting of enamel, dentin and cementum. They are called as composite because they contain more than one type of tissue. They are generally asymptomatic, hence recognised on routine radiologic examination. The compound odontoma is composed of multiple small tooth like structures, whereas the complex odontoma consists of a conglomerate mass of enamel and dentine, which bears no anatomical similarity to the tooth. The eruption and infection of odontoma are uncommon, only few cases of erupted complex odontoma are reported in the literature. We report a case of silent erupting complex odontoma.

Immunohistochemical analysis of tenascin expression in different grades of oral submucous fibrosis

Aim: Tenascin, a glycoprotein, is one of the major constituents of extracellular matrix, which may function in organizing the stroma in normal and pathological conditions. The study aimed to correlate the structural organization of tenascin with the pathological progression of disease from early, moderate and advanced changes in oral submucous fibrosis (OSMF). Study Design: A retrospective cross-sectional immunohistochemical (IHC) analysis of OSMF cases was performed. Total 70 slide samples were prepared for the study from 35 formalin-fixed paraffin-embedded tissue blocks with 10 each from histologically proven and graded as early, moderate and advanced OSMF and 5 of normal oral mucosa. The IHC sections were analyzed for the intensity and pattern of tenascin expression at the junction of epithelium and connective tissue (ECJ) and deeper connective tissue (CT), as well as presence or absence of staining around inflammatory cells, fibroblast and endothelial cells using anti-human tenascin. Result: Most of the OSMF cases showed retention of antigen at ECJ and in deeper CT. Its expression varied in different grades as well as around inflammatory cells, fibroblast and endothelial cells in same tissue section. Highly significant P values of 0.001 and 0.003 were obtained for tenascin intensity and pattern, respectively, at ECJ in different OSMF grades. In addition, for the expression of tenascin pattern in deeper CT among different OSMF grades, a significant P value of 0.018 was obtained. Conclusion: A differential expression of tenascin was observed with the progression of disease. The expression of tenascin as bright and continuous deposition at ECJ in early and moderate stages of OSMF signifies either proliferative organization within the overlying epithelium or an epithelial-mesenchymal interaction. However, a weak immunoreactivity of tenascin at ECJ was observed in advanced stage of OSMF.