Shweta Rehani

Age estimation in Indian children and adolescents in the NCR region of Haryana: A comparative study

Introduction: Age estimation is a preliminary step in the identification of an individual. It is a crucial and often most critical step for forensic experts. The assessment has been standardized utilizing common dental diagnostic x-rays, but most such age-estimating systems are European population-based and their applicability has not been determined in the context of the Indian population. Aims and Objectives: To assess the applicability and to compare the methods of dental age estimation by Demirjians method and the same method as modified by Willems (i.e. the Willems method) in Indian children of the National Capital Region (NCR). Also, to find a correlation among skeletal maturity using the Cervical vertebrae maturation index (CVMI), dental maturity, and chronological age in the same population. Materials and Methods: This cross-sectional study was conducted using dental radiographs of 70 orthodontic patients (37 males, 33 females) in the age range 9-16 years selected by simple random sampling. pantomogram were used to estimate dental age by Demirjians method and the Willems method using their scoring tables. Lateral cephalograms were used to estimate skeletal maturity using CVMI. The latter was compared with Demirjians stage for mandibular left second molar. Results: Overestimation of age among males by 0.856 years and 0.496 years was found by Demirjians and the Willems methods, respectively. Among females, both the methods underestimated the age by 0.31 years and 0.45 years, respectively. Demirjians stage G corresponded to CVMI stage 3 in males and stage 2 in females. Conclusion: In our study, the Willems method has proved to be more accurate for age estimation among Indian males, and Demirjians method for Indian females. A statistically significant association appeared between Demirjians stages and CVMI among both males and females. Our study recommends the derivation of a regression formula by studying a larger section of the Indian population instead of applying the European system of age estimation directly to the Indian scenario.

Cytomorphometric analysis and morphological assessment of oral exfoliated cells in type 2 diabetes mellitus and healthy individuals: A comparative study

Context: Oral exfoliative cytology is a simple, nonaggressive technique that is well accepted by patients. Therefore, it is an attractive option, which aids in the diagnosis and observation of epithelial atypias associated with oral mucosal diseases. Aims: The aim of this study was to evaluate and compare the quantitative and qualitative alterations in exfoliative smears from type 2 diabetics and healthy individuals. Patients and Methods: The study includes 30 type 2 diabetics and 30 healthy persons of both sexes. PAP and hematoxylin and eosin (H and E) stained smears were prepared from buccal mucosa (BM), tongue (T), floor of the mouth (FOM), and palate (P). Under a light microscope, 50 clearly defined unfolded epithelial cells were quantitatively evaluated for cellular area (CA), nuclear area (NA), and cellular-to-nuclear area ratio (CA:NA) and assessed for morphological features. Statistical Analysis: Collected data was manually entered into the Statistical Package for the Social Sciences version 13.5 for analysis. Student′s t-test was used at 95% confidence interval. Results: Quantitative assessment of the overall mean CA was less, mean NA was more, and mean CA:NA was less in diabetics than that in healthy persons at all the four sites. Diabetic oral cells showed qualiative cytoplasmic and nuclear alterations: cytoplasmic vacuoles, karyorrhexis, karyolysis, pyknosis, peri-nuclear halo, binucleation, nuclear vacuoles, inflammation, and microbial colonies. Conclusion: Oral cytology from type 2 diabetics is associated with detectable cytomorphological changes with alteration in size of the cell and nucleus, which is site specific, indicating epithelial cell degeneration in cytoplasm and nucleus.

Architectural Analysis of Picrosirius Red Stained Collagen in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma using Polarization Microscopy.

INTRODUCTION Collagen degradation is important both for carcinogenesis and in its progression. Research regarding the co-relation of collagen with Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC) is less explored. AIM To elucidate the nature of collagen in Oral Epithelial Dysplasia (OED) and Oral Squamous Cell Carcinoma (OSCC) using Picrosirius Red Stain (PSR) under polarizing microscopy. MATERIALS AND METHODS The study consisted of a total 40 samples which were divided into three groups. Group I included buccal mucosa as negative and irritation fibroma as positive control, group II consisted of OED and group III consisted of Oral Squamous Cell Carcinoma (OSCC). A histochemical analysis was conducted using PSR-polarization method by two independent observers. RESULTS The control group shows predominantly reddish-orange birefringence. In OED with the advancement of grades, the colour changed from yellowish-orange colour to yellow-greenish with progressive increase in greenish hue. As OSCC regresses from well to poorly differentiated, the colour changed from reddish-orange to yellowish orange to greenish-yellow suggesting a transition from mature to immature collagen. CONCLUSION An observable gradual change in collagen of both OED and OSCC was noted as they were proceeding from benign to critical step. Thus, PSR is a useful tool for studying stromal changes as supporting collagen shows the transition in the form besides the alterations in epithelial cells.

Stromal fibers in oral squamous cell carcinoma: A possible new prognostic indicator?

Background: Many studies have been carried out to study the role of extracellular matrix proteins, growth factors and matrix metalloproteinases on tumor invasion. However, literature related to the analysis of connective tissue fibers in varying grades of oral squamous cell carcinoma (OSCC) is very limited. Aim: To analyze the changes in collagen and elastic fibers in varying grades of (OSCC). Settings and Design: This retrospective study was carried out using a light and polarizing microscope. Materials and Methods: Three sections each were cut from fifty samples of varying grades of OSCC and ten samples of control followed by staining with H and E, Picrosirius-Red and Verhoeff–Van Gieson. Qualitative and quantitative analysis of collagen and elastic fibers were accomplished using set criteria. Statistical Analysis: Data were entered into the Statistical Package for Social Sciences (SPSS) version 13.5 for analysis. Results: A change in colors of collagen fibers was seen on progressing from well to poorly differentiated OSCC. Thin collagen fibers predominantly exhibited greenish yellow, but the thick fibers exhibited a variety of colors. As the grade of OSCC progressed, collagen fibers were loosely packed haphazardly arranged. Statistically insignificant results were obtained for quantitative analysis of collagen and qualitative analysis of elastic fibers. Conclusion: The collagen fibers undergo a change in color, orientation and packing in the stroma of varying grades of OSCC. The uniqueness of this study lies in the exploration of elastic fibers in OSCC which has not been done so far.

An unusual case report of basal cell adenoma: A Diagnostic Enchanter

Oral lesions show a wide range of biologic behaviours. There are various lesions which may mimic others and present in such an unusual manner thus making them very difficult to diagnose clinico-pathologically. An accurate diagnosis is not only important for correct treatment planning but also for determination of prognosis. Thus, it is very important for a surgical pathologist to be aware of the various atypical presentations of the lesions. The present unusual case report of basal cell adenoma occurring on upper lip with frank areas of calcifications and abundant inspissated mucoid secretions is an example of one such case. BCA is an uncommon benign epithelial salivary gland neoplasm. It is one of the nine subcategories of salivary gland epithelial tumours according to WHO 2005 classification of salivary gland tumors. It is composed of basaloid cells organized with a prominent basal cell layer and distinct basement membrane-like structure and no myxochondroid stromal component as seen in pleomorphic adenomas. To our best knowledge, no case in English literature has been reported BCA with exuberant inspissated mucoid secretions and frank areas of calcifications to such a large extent and this is the first case to report the same. Key words: Basal cell adenoma, calcifications, diagnosis, inspissated mucoid secretions, surgical pathologist.

Seroprevalence and vaccination status of hepatitis B amongst dental health-care workers in North India

Sir, The burden of hepatitis B virus (HBV) infection is high in the developing world particularly Asia and sub-Saharan Africa [1]. India belongs to the group of countries with an intermediate prevalence (2% to 7%) of HBsAg positivity [2]. HBVinfection is a major public health problem in India, as there are 45 million estimated carriers. Health-care workers (HCWs) who perform invasive procedures, for example, surgeons, dentists, emergency workers and those who handle human specimens like the laboratory technicians, have been consistently shown to have a higher prevalence of HBV infection than their counterparts [3]. The dental environment has especially been shown to be a highrisk setting for HBV infection amongst dentists and, possibly, their patients. HBV has been detected in the blood and saliva, which are common contaminants in the dental environment. Since the availability of the first vaccines against HBV in 1982 and with increasing vaccination coverage, the prevalence of infection has been gradually falling [4]. The prevalence rate of HBV infection amongst HCWs in 1992 [5] was 10 %, whereas a 1998 study [6] reported the prevalence rate to be 2.2 %, and a 2008 study in a tertiary care hospital in Delhi reported that only 1 % of HCWs were HBsAg positive [3]. So far, only a handful studies have been conducted in India to estimate the HBsAg seropositivity, especially amongst the dental HCWs. During September–October 2012, we conducted anonymous testing for HBsAg in the capillary blood for 240 volunteers amongst the dental HCWs, after written informed consent, using an in vitro immunochromatography-based rapid diagnostic kit named BIOTEST (Endocrine Technologies Pvt. Ltd., Hyderabad, India) at a dental college in North India. Institutional ethical committee clearance was taken before proceeding with the study. A predesigned questionnaire was the tool for data collection regarding knowledge and awareness about hepatitis B. Our study revealed that the seroprevalence of HBsAg amongst 240 dental HCWs was 1.25 % and was found only in dental students with only up to 3 years of clinical experience (Table 1). Of the dental professionals, 59.5 % were vaccinated against HBV, whereas only 3.3 % of the non-teaching staff members had taken the vaccine. This indicated a moderately good awareness about vaccination amongst the dental professionals (students and teaching staff members) as compared to other non-teaching staff members of the institute. Although HBsAg positivity was very low, there is a need for increased hepatitis B awareness and vaccination amongst HCWs in the dental sector.

Analysis of stromal mucin in oral epithelial dysplasia & oral squamous cell carcinoma- A histochemical study

Background Mucins are glycoproteins that act as a selective molecular barrier and its alterations usually accompany the carcinogenesis. Aim To evaluate the transition of mucins in the grades of oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC) using histochemical stains. Materials & Method A total of 66 samples of variable grades of OED and OSCC and each section was stained with PAS, Alcian blue- PAS (AB-PAS) and Aldehyde fuschin - Alcian blue (AF-AB). Mucins pattern and intensity were examined at 5 randomly selected fields on 10x magnification. Results 1. PAS stain - Predominantly OED and OSCC showed a diffuse pattern with a gradual decrease in intensity in OED and overall a weak intensity in OSCC. 2. AB-PAS stain - Neutral mucins showed gradual increase in its intensity in grades of OED and OSCC with no predominant pattern. The intensity for the acid mucins remains weak in all the grades of OED and OSCC with diffuse distribution, except in higher grades of OED and OSCC. 3. AF- AB stain - For sulphated mucins, in OED a focal and diffuse pattern was observed in OSCC with minimal intensity. The carboxylated mucin was absent in both. Conclusion Mucins undergo change in its pattern and intensity in varying grades of OED/OSCC. Although in GIT and other mucosa, the expression of altered mucin is a recognized factor, seldom research has been done in OED and OSCC. Thus, the present study could be the stepping stone in the exploration of mucinous alteration in OED and OSCC.

Osseous choristoma of submental region: A rare occurrence

Osseous choristoma is a rare, benign lesion of the oral cavity. This report presents a case of osseous choristoma in the submental region of a 30-year-old female subject. Her chief complaint was a painless swelling in the submental region. Panoramic radiography showed a well-defined, round, radiopaque lesion near the inferior border of the left mental region. The lesion was diagnosed as an osseous choristoma based on the histopathological examination of the surgical specimen. This paper is an attempt to bring forward a unique occurrence of osseous choristoma, which would further help the medical fraternity in improvising their knowledge, diagnosis, and treatment of this entity.

Bacterial Viability within Dental Calculus: An Untrodden, Inquisitive Clinico-Patho- Microbiological Research.

INTRODUCTION Chronic inflammatory periodontal diseases i.e. gingivitis and periodontitis are one of the most common afflictions faced by human beings. Dental plaque, which is a pool of pathogenic microorganisms, remains to be current mainstay in etiopathogenesis. Dental calculus, which is a mineralized product of this plaque remains ignored and is considered merely as an ash heap of minor significance. However, the intriguing array in disease etiopathogenesis bulldozed researchers to suspect the role of calculus in disease chrysalis but still the viability of bacteria inside calculus and thus its pathogenicity remains an intricacy; the answer to which lies in the Pandoras Box. AIM The present study was undertaken to investigate the viability of bacteria within dental calculus along with their identification. Also, to classify dental calculus on the basis of mineralization and to observe the variation of viable microflora found in dental calculus with the extent of mineralization and disease severity. MATERIALS AND METHODS A total of 60 samples were obtained, by harvesting two samples of supragingival calculus from each patient having chronic inflammatory periodontal disease. These samples were divided into two groups (Group A and Group B). Samples of Group A were kept non-irradiated and samples of Group B were exposed to UV radiation. The samples were categorized into less, moderately and highly mineralized according to the force required for crushing them. All the crushed calculus samples were then divided into three parts. These were used for dark-field microscopy, gram staining and bacterial cultures. Bacterial identification of the cultures obtained was also carried out by performing various biochemical assays. RESULTS The present study revealed the presence of motile spirochaetes within the samples under dark-field microscope. Gram staining revealed presence of numerous gram positive cocci and gram negative bacilli. Bacterial cultures showed growth of variety of aerobic and capnophilic microorganisms. CONCLUSION The present study concludes the presence of viable aerobic and capnophilic bacteria inside dental calculus which may reside within the lacunae and channels in the calculus.

Basal Cell Adenoma with Perplexity in Diagnosis - A Case Report.

Every salivary gland tumour irrespective of its benign or malignant nature or occurrence, exhibits certain unique and overlapping histopathologic features. Basal Cell Adenoma (BCA) is a rare salivary gland tumour and hence it becomes our responsibility to report every case with unique histopathologic features so that it can add to our present knowledge of this lesion. Often, the pathologists experience difficulty while diagnosing lesions like BCA which contain basaloid cells due to its similarity with other lesions of similar histological appearance. Hence, this paper discusses a case of BCA with rare histopathologic features along with the possible differential diagnosis.