Pushparaja Shetty

Status of salivary lipid peroxidation in oral cancer and precancer.

Introduction: Lipid oxidation gives rise to number of secondary by-products. Malondialdehyde (MDA) is the principal and most widely studied product of polyunsaturated fatty acid peroxidation. This aldehyde is a highly toxic molecule and should be considered as more than just a marker of lipid peroxidation in oral carcinogenesis. Materials and Methods: Salivary malondiadldehyde was evaluated in 65 healthy controls (HC), 115 subjects with oral, potentially malignant disorders (PMD) and 50 subjects with oral squamous cell carcinoma (OSCC) using the Thiobarbituric-Trichloroacetitic acid (TBA-TCA) method. Results: A consistent elevation in the levels of salivary MDA was observed in HC with tobacco related habits, subjects with PMD and subjects with OSCC. The elevation in the salivary MDA was significant (P = 0.001) in the groups PMD and OSCC and group OSCC when compared to HC. Conclusion: The significant and encouraging findings of this study thus validate and reinforce that salivary malodialdehyde analysis can be used as an efficient, noninvasive tool for the early diagnosis of PMD and OSCC for planning comprehensive treatment protocol.

Status of trace elements in saliva of oral precancer and oral cancer patients

BACKGROUND Several studies in recent years have linked association between micronutrient levels and various forms of cancer. Copper and zinc have been the most researched micronutrients. AIM The aim of the study was to evaluate the levels of copper, zinc and iron in saliva of patients with oral leukoplakia, oral submucous fibrosis and oral squamous cell carcinoma. RESULTS There was a highly significant increase in the level of salivary copper in oral submucous fibrosis patients when compared to controls (P = 0.001). Salivary copper levels were also elevated in oral leukoplakia and oral cancer patients (P = 0.01). There was a significant decrease in the salivary zinc levels in all three study groups when compared to controls (P = 0.001). A highly significant reduction in salivary iron levels was noticed oral submucous fibrosis group. The copper to zinc ratio significantly increased in all the study groups when compared to controls. CONCLUSION Results suggest that salivary copper zinc and iron could be used as biomarkers for oral precancer and cancer.

Evaluation of micronutrient status in serum and saliva of oral submucous fibrosis patients: A clinicopathological study.

Background: Oral submucous fibrosis (OSMF) is one of the most commonly occurring potentially malignant disorders in India and south East Asian countries where betel chewing is common practice. Iron and ascorbic acid are important agents for collagen synthesis. Aims: The aims of this study were to estimate the levels of iron and ascorbic acid in serum and saliva in patients with OSMF and to correlate change in levels of iron and ascorbic acid with the histopathological grading of OSMF. Materials and Methods: The study group comprised of 65 clinically diagnosed and histopathologically confirmed cases of OSMF; 21 age- and sex-matched controls were also enrolled in the study. Serum and salivary ascorbic acid were analyzed by the dintrophenyl hydrazine method whereas serum and salivary iron were analyzed by the dipyridyl method. Results: The serum and salivary ascorbic acid levels consistently decreased with the progression of histopathologiocal grading of OSMF. Serum and salivary iron levels were also decreased in OSMF patients, but this was not significant. Conclusion: Ascorbic acid and iron may have been used for the excessive collagen synthesis occurring during progression of OSMF. Hence, serum and salivary monitoring may play a crucial role in the early diagnosis and prognosis of OSMF.

Quantitative Analysis of Acute Phase Proteins in Post Chemo-Radiation Mucositis.

AIM Oral mucositis induced by radiation is an inevitable but transient side-effect of radiotherapy. Acute phase proteins are a class of proteins whose phase concentrations fluctuate in response to inflammation. The best known of the acute phase proteins is C-reactive protein, a protein that rises in the blood with inflammation. MATERIALS AND METHODS 30 patients undergoing chemo - radiotherapy for head and neck cancer were clinically evaluated for mucositis on day 0, 7, 14, 28 and 42. Blood investigations like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count were also conducted. RESULTS There was a significant increase in the severity of mucositis during the course of treatment followed by a gradual decrease in severity towards the end of radiotherapy. Comparison of C-reactive protein levels from day 0 to day 42 in the study group showed a significant increase towards the end of radiotherapy. There was a significant increase in erythrocyte sedimentation rate levels till day 14 followed by a decrease towards the end of radiotherapy whereas total leukocyte count showed a significant decrease from day 0 to day 7 followed by an increase towards the end of radiotherapy. CONCLUSION The oral mucosa bears only a small clinical spectrum of the side-effect conveyed by chemo-radiation. Both widespread and late effects do occur, and tissues may never return to normal completely. Inflammatory serum markers like C-reactive protein, erythrocyte sedimentation rate and total leukocyte count can thus be used as an objective measure to study the complexities of radiation mucositis which is documented as one of the worst side effects of head and neck cancer therapy.

Etiological Trends in Oral Squamous Cell Carcinoma: A Retrospective Institutional Study

Aim: Oral squamous cell carcinomas (OSCCs) are among the most common cancers that affect human population worldwide. This study aims to analyze the epidemiology, risk factors, clinical and histopathological features, and metastasis in OSCC cases. Methods: This retrospective cross-sectional study included the subjects reported to Department of Oral Pathology and Microbiology in A B Shetty Memorial Institute of Dental Sciences between 2009 and 2013. Data on age, gender, tumor location, lymph node metastasis, associated risk factors, and histopathological grades were recorded and subjected to Pearson′s Chi-square analysis for any correlation between habits and other variables. Results: A total of 61 cases were included. Male: female ratio was 2.6:1 with maximum cases seen in the fifth and sixth decades of life. Totally, 59 cases reported tobacco chewing habit and 2 cases reported sharp teeth. Quid chewing was the most frequently reported habit and buccal mucosa was the common site. Most cases were well differentiated, associated with quid chewing and without nodal metastasis. The correlation of habits to other variables was statistically insignificant (P < 0.05). Conclusion: In this study, betel quid chewing was the most important etiological agent of OSCC and was associated with the few cases of poorly differentiated OSCC.

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.

Fluorescence of Candida in diagnosis of oral candidiasis

Background: Many pathogenic fungi fluoresce in hematoxylin and eosin stained sections, and Papanicolaou (PAP)-stained smears under ultraviolet illumination. In theory, this phenomenon could aid in the diagnosis of common fungal infections without the delay which is usually associated with special stains. Objective: To evaluate the role of fluorescence as a rapid screening technique for oral infections caused by Candida organisms in exfoliative smears of oral candidiasis. Materials and Methods: Two smears and one swab were collected from each of 62 clinically diagnosed cases of oral candidiasis. Smears were stained with (PAP) and periodic acid–Schiff stain (PAS). Both smears were evaluated under light microscopy (LM). Later, PAP smears were observed under fluorescent microscopy (PAP-FM). The swab was inoculated on Sabourauds agar plate. Each technique was evaluated for sensitivity and specificity. Results: It was found that the PAS-stained smears were more reliable for detection of Candida species than other methods (sensitivity = 100%; specificity = 66.7%). The PAP-LM and PAP-FM showed less sensitivity (67.9% and 85.7%) and specificity (66.7% and 33.3%), respectively. Combined results of both light and fluorescent microscopy of PAP (LM + FM) showed increased sensitivity (89.3%) but reduced specificity (16.7%). Conclusion: PAP autofluorescence is less sensitive than PAS, still it accentuates the distinct morphological features of Candida.

Detection of Candida species by acridine orange fluorescent dye in exfoliative smears of oral candidiasis

Background: Oral candidiasis continued to receive attention due to its evidenced association with its evidenced association with acquired immunodeficiency syndrome. In spite of considerable improvements in the laboratory diagnostic methods, there is still a need for more reliable, definitive and less time-consuming diagnostic techniques for Candida infection. Many of the studies were done utilizing acridine orange (AO) as a basic fluorescent dye for the demonstration of yeast in cultured Candida species and in histopathological sections. However, only very few studies report this technique to demonstrate Candida organisms in oral smears. The present study was carried out to assess the diagnostic reliability of detection of Candida by utilizing AO fluorescent dye in oral exfoliative smears of oral candidiasis. Materials and Methods: A total of 62 clinically diagnosed cases of oral candidiasis were studied. Two smears and a swab were collected from each suspected lesion. Each slide was stained with, periodic acid Schiff (PAS) reagent and AO. PAS stained smears were then evaluated for the presence of Candida species under light microscopy. AO stained smears were observed under fluorescent microscopy. After inoculation of swab on the saborouds agar plates, the growth of Candida species was evaluated by Gram stain and germ tube test. Each technique was evaluated for sensitivity, specificity, positive predictive value and negative predictive value. Results: It was found that the PAS stained smears were more reliable for detection of Candida species (sensitivity = 100%, specificity = 66.7%), than AO method (sensitivity = 87.5%; specificity = 0%). Conclusion: Acridine Orange fluorescent technique even though rapid lacks specificity for Candida.

Regional odontodysplasia crossing the midline: A unique case associated with bilateral impacted supernumerary teeth

Regional odontodysplasia (RO) is an uncommon developmental anomaly affecting a localized area of dentition, with distinctive clinical, radiographic, and histological findings. It is presumed to be the result of a developmental disturbance that locally affects the odontogenic ectodermal and mesodermal tissues. In general, it is limited to only one arch and sometimes it can occasionally cross the midline. Supernumerary teeth (ST) are mammalian developmental abnormalities characterized by the presence of extra teeth in addition to the normal eruption series. Here, we report a case of RO that affected right maxillary teeth crossing the midline and showed two maxillary bilateral impacted ST.

Status of salivary iron in oral cancer and oral potentially malignant disorders

Introduction: Iron (Fe) is an important micronutrient which is utilized in human body for the transportation of oxygen, hematopoiesis, production of enzymes, and immune surveillance. Existing clinical, epidemiological, and experimental studies have shown that decreased levels of Fe contribute to increased risk of cancer. Although extensive, serum Fe analysis studies have done recently the analysis of salivary Fe has not been studied for its role in oral malignancies. Materials and Methods: Salivary Fe levels were evaluated in 65 healthy controls (HC), 115 subjects with oral potentially malignant disorders, and 50 subjects with oral squamous cell carcinoma using the bathophenanthroline method. Results: A decrease in the levels of salivary Fe was observed in subjects with potentially malignant disorders and subjects with oral cancer. The decrease in the salivary Fe was significant (P = 0.05) in group comprising of potentially malignant disorders and oral squamous cell carcinoma when compared to HC. Conclusion: The significant and encouraging findings of the present study thus validate and reinforce that; salivary Fe analysis can be used as an efficient, noninvasive, patient-friendly tool for the early diagnosis of oral potentially malignant disorders and oral squamous cell carcinoma for planning comprehensive treatment protocol.