Preethi Balan

Xeroderma Pigmentosum: Man Deprived of His Right to Light

Xeroderma pigmentosum (XP) is a hereditary autosomal recessive disorder characterized by photo hypersensitivity of sun exposed tissues and subsequent several-fold increased risk for malignant changes resulting from impaired ability to repair UV-induced DNA damage. Estimated incidences vary from 1 in 20,000 in Japan to 1 in 250,000 in the USA, and approximately 2.3 per million live births in Western Europe. Diagnosis is made clinically by the presence of unusual sunburns or lentiginosis or onset of cancers at an early age. It is confirmed by cellular tests for defective DNA repair. Although there is no cure for XP as of now, skin problems can be ameliorated with the use of sunscreens, sun avoidance methods, and recurrent tumor excisions. Oral isotretinoin and topical application of 5-fluorouracil to treat actinic keratoses are other therapeutic options. T4N5 and photolyase liposomal lotions are innovations in the therapy of XP. Genetic counselling implicating the effect of consanguineous marriages should be considered in the management of XP patients.

Candida Carriage Rate and Growth Characteristics of Saliva in Diabetes Mellitus Patients: A Case-Control Study.

Background and aims. The aim of this study was to establish a relationship between salivary glucose levels and Candida carriage rate in type 2 diabetes mellitus patients and assess the growth characteristics and acid production of Candida in glucose-supplemented saliva. Materials and methods. A total of 90 subjects, 30 with controlled type 2 diabetes, 30 with uncontrolled type 2 diabetes and 30 without diabetes (control subjects), aged 30‒60 years, participated in the study. Unstimulated saliva was collected and investigated for glucose levels (GOD-POD method), colony-forming units (CFU) of Candida and salivary pH, using Indikrom paper strips). Analysis of statistical significance of salivary glucose and PH levels was carried out using post hoc Tukey HSD test. Correlation of Candida carriage rate with salivary glucose and salivary PH in the study groups and control group was made using Pearson’s correlation. Results.Candida CFUs were significantly higher in diabetic subjects, with a significant and positive correlation with salivary glucose levels. There was a negative correlation between salivary PH levels and Candida carriage rate. Conclusion. Increased salivary glucose was associated with increased prevalence of oral Candida in diabetic subjects. The growth of Candida in saliva was accompanied by a rapid decline in PH, which in turn favored their growth.

Can saliva offer an advantage in monitoring of diabetes mellitus? – A case control study

Objectives: Diabetes Mellitus is emerging as a major health problem over these years. Present method of blood glucose monitoring by venepuncture is invasive leading to reduced patient compliance and thereby ineffective judicious monitoring. The need of the hour is to direct research in the direction of establishing painless and more acceptable blood glucose analysis method.The objective of the study is to conduct a comparative analysis of the concentrations of salivary glucose and blood glucose in type 2 diabetes mellitus patients. Study Design: This study assessed glucose levels using the glucose oxidase method in blood and unstimulated saliva in 90 subjects who were divided into 3 equal groups of controlled type 2 diabetes, uncontrolled type 2 diabetes and those without diabetes. Statistical analysis was carried out using one way ANOVA, Post hoc Tukeys tests and Pearson’s correlation coefficient test. Results: Salivary glucose levels were significantly higher in patients with diabetes than controls. There was a significant positive correlation between salivary and plasma glucose levels in patients with diabetes. Conclusions: Glucose concentration in saliva is higher in diabetics but hyperglycemia does not influence salivary glucose levels. Further clarification is required to claim the diagnostic potentials of saliva in diabetes. Key words:Salivary glucose, type 2 diabetes mellitus, blood glucose.

Evaginated odontome on maxillary lateral incisor and #8212;a reverse and a rare presentation

Evaginated odontome or talon cusp is an uncommon dental anomaly with accessory cusp-like projection arising from the cingulum area of the maxillary or mandibular anterior teeth. This anomalous cusp resembles an eagles talon and hence the name. It occurs in both the primary and the permanent dentition. The presence of talon cusp on the lingual surfaces of primary permanent teeth is considered to be pathognomic, but the case reported here is an unusual case which is present in the facial aspect in a female patient. As per the existing literature only seven case reports of facial talon in permanent maxillary teeth have been reported.

Osteogenesis Imperfecta (Type IV) with Dental Findings in Siblings

Osteogenesis imperfecta (OI) is a hereditary disorder characterized by increased tendency for bone fractures due to high fragility. The clinical and radiological features of OI manifest in different age groups, although the disease is congenital in nature. Besides bone fragility, features like laxity of the ligaments, blue sclera, growth retardation, and scoliosis are also observed. In severe cases, respiratory distress and death have been reported. The most important oral finding in OI is the presence of yellowish-brown-coloured brittle teeth characteristic of dentinogenesis imperfecta. Genetic factors play a very important role in the pathogenesis of OI either as a dominant or recessive factor. When a child has OI, there is a 25% chance of the sibling to have the same disorder. We report two cases of OI in siblings born to parents with a history of consanguineous marriage. The clinical and radiological features of the two cases are described in detail.

Oral Health in Pregnant Chinese Women in Singapore: A Call to Go beyond the Traditional Clinical Care

Objective: To examine the correlations among oral health knowledge, attitude, practices and oral disease among pregnant Chinese women in Singapore. Methods: A descriptive correlational study was conducted in pregnant Chinese women in Singapore. A questionnaire was used to collect data of oral health knowledge, attitude and practices. Plaque index scores were used to assess the oral health of subjects. Results: A total of 82 pregnant women participated in the study, out of whom 38% showed adequate oral health knowledge, nearly half of them achieved adequate and oral health attitude and practice scores while 34% had good Plaque index scores. The lower income group had higher experience of self-reported dental problems during pregnancy than those in the higher income group (p = 0.03). There were significant positive correlations between scores of oral health practice, attitude and oral health knowledge levels. The plaque index scores negatively correlated with the oral health practice scores (p = 0.02). Conclusions: Our findings provided evidence that oral health knowledge, attitude and practices among Chinese pregnant women were not optimal which implies the importance of promoting their oral health during pregnancy through the improvement of knowledge and attitudes. This would facilitate formulation and implementation of appropriate oral health promotion policies.

Keystone species in pregnancy gingivitis: A snapshot of oral microbiome during pregnancy and postpartum period

It is well known that pregnancy is under the constant influence of hormonal, metabolic and immunological factors and this may impact the oral microbiota toward pregnancy gingivitis. However, it is still not clear how the oral microbial dysbiosis can modulate oral diseases as oral microbiome during pregnancy is very poorly characterized. In addition, the recent revelation that placental microbiome is akin to oral microbiome further potentiates the importance of oral dysbiosis in adverse pregnancy outcomes. Hence, leveraging on the 16S rRNA gene sequencing technology, we present a snapshot of the variations in the oral microbial composition with the progression of pregnancy and in the postpartum period and its association with pregnancy gingivitis. Despite the stability of oral microbial diversity during pregnancy and postpartum period, we observed that the microbiome makes a pathogenic shift during pregnancy and reverts back to a healthy microbiome during the postpartum period. Co-occurrence network analysis provided a mechanistic explanation of the pathogenicity of the microbiome during pregnancy and predicted taxa at hubs of interaction. Targeting the taxa which form the ecological guilds in the underlying microbiome would help to modulate the microbial pathogenicity during pregnancy, thereby alleviating risk for oral diseases and adverse pregnancy outcomes. Our study has also uncovered the possibility of novel species in subgingival plaque and saliva as the key players in the causation of pregnancy gingivitis. The keystone species hold the potential to open up avenues for designing microbiome modulation strategies to improve host health during pregnancy.

Giant cell fibroma - A Case Report

The Giant cell fibroma (GCF) is a lesion of fibrous connective tissue origin. The giant cell fibroma is a fibrous tumour with distinct clinicopathologic features which sets it apart from the conventional fibroma. The most common site for occurrence of giant cell fibroma is gingiva followed by tongue, buccal mucosa, palate, lip and floor of mouth. It is most commonly seen in the Caucasian population. It represents approximately 2% to 5% of all oral fibrous proliferations submitted for biopsy. GCF usually affects patients in the 2nd and 3rd decades of life with approximately 60% of cases found in the first three decades of life. We hereby present a case of a giant cell fibroma in the left buccal mucosa in a 38 year old female.

Intraoral Lipoma: A Rare Case.

Sir, Lipoma is a benign, slow-growing neoplasm of the adipose tissue. It is one of the most common mesenchymal tumour in the body. However, its occurrence intraorally is rare. Lipomas of the head and neck region involve about 15% to 20% of all lipomas, of which only 1% to 4% affect the oral cavity (1). Lingual lipomas account for only 0.3% of tongue neoplasms (1). The buccal mucosa and the tongue are the most predominant sites in adults with some studies showing female preponderance while others show no gender predilection (1). Patients with lipoma present with a single or lobulated, painless lesion attached by either a sessile or pedunculated base (2). The clinical course is usually asymptomatic unless the lesion acquires a size leading to complaints of dysphagia, dysarthria or stridor due to the space occupying effect of the lesion (3‒5). The aim of the present report is to describe a case of intraoral lipoma occurring in the tongue. A 62-year-old male patient presented to us with complaints of a slow growing swelling of four years duration in the right lateral under surface of the tongue. He had been symptom free until the swelling reached to a size that caused functional disturbances and led him to seek medical advice. On intraoral examination, a well-defined yellowish swelling was noticed on the right lateral and undersurface of the tongue. The overlying mucosa was smooth and intact with superficial blood vessels over the mass (Fig. 1). On palpation, the swelling was soft in consistency, non-fluctuant and non-tender. Based on these clinical features a provisional diagnosis of lipoma on the ventral aspect of the tongue was made. Under local anaesthesia an elliptical incision was made over the mucosa covering the tumour on the ventral surface of the tongue. Blunt dissection was used throughout. The tumour mass emerged from underneath the mucosa (Fig. 2). The gross specimen was yellowish in colour, with glossy surface and was well-encapsulated (Fig. 3). LETTERS TO THE EDITOR

Goldenhar syndrome- A case report

Goldenhar syndrome is a birth defect resulting from the maldevelopment of the first two branchial arches with the incomplete development of the ear, nose, soft palate, lip and mandible. Goldenhar syndrome is a rare inherited condition, which has a multifactorial ethiopathology that includes nutritional and environmental factors which can result in developmental disturbances. Goldenhar first described this condition in 1952 as a disease that presents a combination of several anomalies such as microtia, hemifacial microsomia, pre-auricular skin tags, epibulbar dermoids, and vertebral malformations. In this case report we report a case of 30 year old male patient with a mild variant of Goldenhar syndrome with review of literature.