Nithya Jagannathan

Oral Field Cancerization: An Update on Current Concepts

There always exists a field with genetically altered cells with a high risk of developing premalignant and malignant lesions. It may often happen that an individual stem cell is genetically altered and can cause the formation of a clone or a patch which is likely to turn into a tumor. This explains the higher recurrence rates following tumor resections. It is essential to identify and to treat this field in order to have greater chances to prevent cancer and achieve a better outcome. This article reports concepts, theories and markers for the assessment of field cancerization.

Metastasizing Ameloblastoma – A perennial pathological enigma? Report of a case and review of literature

The Ameloblastoma is a slow growing locally invasive odontogenic epithelial neoplasm with a high recurrence rate and a low tendency to metastasize. Metastasis in Ameloblastoma was first described by Simmons and Emura in the 1920s. Slootweg and Muller proposed the term Malignant Ameloblastoma to describe a well-differentiated ameloblastoma that metastasizes but maintains the characteristic cytologic features of the original tumour and the term Ameloblastic Carcinoma to an ameloblastoma with malignant cytological features. About 2% of ameloblastomas undergo metastasis. So far there have only been two cases of Metastasizing Ameloblastoma reported from the Indian Subcontinent. We present the case of a 22-year-old male Indian patient, who presented with a diffuse swelling in the left posterior mandible. Radiographs revealed a multilocular radiolucency in the left mandible. On histopathological examination, the lesion was diagnosed as follicular ameloblastoma. Four years later the patient presented with a swelling in the left submandibular region. Histological examination revealed metastatic ameloblastoma within the cervical lymph node.

Antibiofilm efficacy of photoactivated curcumin, triple and double antibiotic paste, 2% chlorhexidine and calcium hydroxide against Enterococcus fecalis in vitro

Root canal disinfection is one of the most important factors governing success of root canal treatment, especially when regenerative strategies are used. This study evaluated the efficacy of 5 intracanal medicaments against mature biofilms of Enterococcus fecalis in vitro: Light activated curcumin, triple antibiotic paste (TAP), double antibiotic paste (DAP), chlorhexidine, calcium hydroxide. Untreated teeth with biofilms served as controls. Confocal microscopy was used to analyse the biofilm mass and percentage of live/dead bacteria within the root canal as well as dentinal tubules. Dentinal shavings obtained from the root canal walls (at 200 and 400 microns depth) were used to quantify the colony forming units/mL. The results showed that light activated curcumin and triple antibiotic paste brought about complete disruption of the biofilm structure (P < 0.05) while chlorhexidine and calcium hydroxide were not significantly different from the control (P > 0.05). Light activated curcumin brought about the highest percentage of dead cells at both depths, but this was not significantly different from triple antibiotic paste (P > 0.05). Curcumin, TAP and DAP brought about a significant reduction of CFU/mL at both depths compared to the control and other groups (P < 0.05). Light activated curcumin brought about a 7 log reduction of bacteria at both depths.

Epithelial Maturation Pattern of Dysplastic Epithelium and Normal Oral Epithelium Exposed to Tobacco and Alcohol: A Scanning Electron Microscopic Study

Abstract Background: The detection of oral cancer at an early stage is an optimal strategy and is the most effective approach for preventing further progression. The rationale of the study was to evaluate the epithelial maturation pattern in oral mucosa exposed to tobacco/alcohol and on dysplastic oral mucosa using the scanning electron microscope. Methods: Fifteen subjects were selected based on clinical examination and divided into three groups: group 1—patients with apparently normal oral mucosa; group 2—patients with oral mucosa exposed to tobacco/alcohol; group 3—patients with clinical diagnosis of leukoplakia. An incisional biopsy was performed from the buccal mucosa. One part of the specimen was prepared for light microscopy and the other part was prepared for scanning electron microscopy. Results: Light microscopy revealed nonkeratinized stratified squamous epithelium in group 1, while group 2 demonstrated hyperparakeratinized stratified squamous epithelium with mild cytological atypia, and group 3 showed architectural and cytological changes. Scanning electron microscopy demonstrated flat-surfaced cells with equidistant parallel microridges in group 1, while group 2 showed irregular and widened microridges with numerous pits and absence of honeycomb pattern. Group 3 showed irregularly arranged broad and swollen cells with numerous pits and irregular microvilli projecting over the surface. Conclusion: The present study establishes the relationship of the surface abnormalities to the tendency of the cells to become malignant and thus serves as a tool in early detection of squamous cell carcinoma. It also emphasizes the need of routine follow-up in these high-risk patients for progression of carcinoma.

The Efficacy of Pre-Procedural Mouth Rinse on Bacterial Count in Dental Aerosol Following Oral Prophylaxis

Background. The aerosols produced by ultrasonic devices are heavily contaminated by microorganisms which pose a serious health threat to the clinician. Thus protection of the clinician against these microorganisms becomes mandatory. Dental handpieces, ultrasonic scalers, air polishers and air abrasion units produce visible aerosols. Objectives. The study was performed to assess the efficacy of pre-procedural rinsing with chlorhexidine mouth wash in reducing bacterial aerosol contamination following oral prophylaxis. Material and Methods. The study was designed to include 20 systemically healthy patients within the range of 25–40 years of age. The subjects were randomly assigned into two groups. Group I subjects were given saline mouth rinse and the patients of group II were given chlorhexidine mouth rinse prior to the treatment. The aerosol produced by the ultrasonic unit was collected at the 6 o’clock position on blood agar plates within a range of 3 feet in both of the groups and the samples were inoculated onto blood agar plates. The blood agar plates were incubated for 24 hours and the total number of colony forming units (CFUs) were counted. Results. The results showed that CFUs decreased in patents who had a pre-rinse with chlorhexidine mouth wash when compared to patients with saline mouth rinse. Conclusions. Pre-procedural use of mouth rinse using chlorhexidine can significantly reduce the viable microbial content of dental aerosols and protect the operator from the bacterial hazards (Dent. Med. Probl. 2016, 53, 1, 78–82).

In vitro analysis of particle penetration of smokeless tobacco forms using egg shell membrane as a substrate

AIMS The aim of the following study is to determine the particle sizes of smokeless tobacco forms and thereby evaluate the degree of diffusion of the products using an egg shell membrane as a natural substrate by scanning electron microscopy (SEM). SUBJECTS AND METHODS The particle size of smokeless tobacco forms namely mawa, gutka, khaini, and tobacco leaves was determined by image analysis and the products were subjected on an egg shell membrane subjected to artificial saliva along with constant grinding force. The processed egg shell membrane was then examined by SEM to evaluate the morphology and the degree of diffusion of these particles. RESULTS The morphometric image analysis revealed khaini to be smallest in size followed by mawa, gutka, and tobacco leaves. The control group (egg shell membrane not subjected to any products) under SEM demonstrated intricately woven collagen meshwork, which was regular in length, branched and anastamosed with each other. Khaini exposed membrane demonstrated maximum particle diffusion with disruption of collagen meshwork. Mawa exposed membranes demonstrated minimal particle penetration which were adherent to the collagen meshwork which was irregular with increased interfibrillar space. The egg shell membrane exposed to gutka demonstrated particle penetration at higher magnification with more or less a regular collagen meshwork. The tobacco leaf exposed egg shell membrane demonstrated minimal blebs on the meshwork surface. CONCLUSIONS The degree of diffusion gradually increased with a decrease in the particle size establishing an inverse relationship.