Soheyl Sheikh

Correlation of serum oestrogen with salivary calcium in post‐menopausal women with and without oral dryness feeling

OBJECTIVE The aim of this study was to verify the association between salivary calcium and serum oestrogen levels with oral dryness in post-menopausal women. Also, the correlation between these variables was evaluated. METHODS A case-control study was carried out on 60 selected menopausal women with and without oral dryness feeling (30 as case and 30 as control) conducted in the Department of Oral Medicine and Radiology, Maharishi Markandeshar University, Mullana, India. Paraffin-stimulated saliva samples were obtained by expectoration. Salivary calcium concentrations were assessed colorimetrically using Arsenazo III reaction. The serum oestrogen concentration was measured using ELISA. Statistical analysis of Students t-test and Pearson correlation was used. RESULTS There was significant difference in mean values of both salivary calcium concentration and serum oestrogen between case and control groups. The result obtained also showed that an inverse correlation was found between salivary calcium concentration and serum oestrogen levels in both the groups and in total sample size. CONCLUSION Oral dryness in post-menopausal women is associated with high levels of salivary calcium and low levels of serum oestrogen. The concentrations of salivary calcium and serum oestrogen are inversely correlated in post-menopausal women, regardless of the presence or absence of oral dryness.

To evaluate the efficacy of ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings

AIM To evaluate the efficacy of Ultrasonography compared to clinical diagnosis, radiography and histopathological findings in the diagnosis of maxillofacial swellings. MATERIAL AND METHODS The study was conducted on forty-five patients with maxillofacial swellings. The clinical diagnosis, radiographic diagnosis and ultrasonographic diagnosis were made which was compared to the histopathological diagnosis. The maxillofacial swellings included cystic lesions, benign swellings, malignant swellings, lymphadenopathies and abscesses and space infections. RESULTS The diagnostic accuracy and contingency coefficient was evaluated considering histopathology as gold standard. The diagnostic accuracy of ultrasound was found to be 92.30% in the diagnosis of cystic lesions, 87.5% in benign tumors, 81.8% in malignant tumors, 100% in lymphadenopathies and 90% in space infections and abscesses. The contingency coefficient of 0.934 was obtained when ultrasonography was compared to the histopathology, which was highly significant. Similar significant results were obtained comparing ultrasonography with clinical diagnosis (0.895) and radiographic diagnosis (0.889). CONCLUSION Ultrasonography provides accurate imaging of the head and neck region and provides information about the nature of the lesion, its extent, and relationship with the surrounding structures. As the conventional and digital radiography enable the diagnosis of the presence of the disease, but do not give any indication of its nature. So, together with clinical and histopathological examinations, real time ultrasound imaging works out as a valuable adjunct in the diagnosis of orofacial swellings.

Correlation Between Clinical Findings of Temporomandibular Disorders and MRI Characteristics of Disc Displacement.

Objectives : Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The first step in MR imaging of the TMJ is to evaluate the articular disk, or meniscus, in terms of its morphologic features and its location relative to the condyle in both closed- and open-mouth positions. Disk location is of prime importance because the presence of a displaced disk is a critical sign of TMJ dysfunction. However, disk displacement is also frequently seen in asymptomatic volunteers. It is important for the maxillofacial radiologist to detect early MR imaging signs of dysfunction, thereby avoiding the evolution of this condition to its advanced and irreversible phase which is characterized by osteoarthritic changes such as condylar flattening or osteophytes. Further the MR imaging techniques will allow a better understanding of the sources of TMJ pain and of any discrepancy between imaging findings and patient symptoms. Henceforth, the aim of the study was to evaluate whether MRI findings of various degrees of disk displacement could be correlated with the presence or absence of clinical signs and symptoms of temporomandibular disorders in symptomatic and asymptomatic subjects. Materials and Methods : In this clinical study, 44 patients (88 TMJs) were examined clinically and divided into two groups. Group 1 consisted of 22 patients with clinical signs and symptoms of TMDs either unilaterally or bilaterally and considered as study group. Group 2 consisted of 22 patients with no signs and symptoms of TMDs and considered as control group. MRI was done for both the TMJs of each patient. Displacement of the posterior band of articular disc in relation to the condyle was quantified as anterior disc displacement with reduction (ADDR), anterior disc displacement without reduction (ADDWR), posterior disc displacement (PDD). Results : Disk displacement was found in 18 (81.8%) patients of 22 symptomatic subjects in Group 1 on MRI and 4 (18.1%) were diagnosed normal with no disc displacement. In Group 2, 2 (9.1%) of 22 asymptomatic patients were diagnosed with disc displacement while 20 (90.1%) were normal. Sensitivity and Specificity tests were applied in both the groups to correlate clinical findings of TMD and MRI characterstics of disc displacement and results showed Sensitivity of 90% and Specificity of 83.3%. Conclusion : Disk displacement on MRI correlated well with presence or absence of clinical signs and symptoms of temporomandibular disorders with high Sensitivity and Specificity of 90% and 83.3% respectively.

Desmoplastic Ameloblastoma: A Case Report

Desmoplastic ameloblastoma is a rare variant of ameloblastoma. Up until now, less than 150 patients have been reported in the literature. We report a case of desmoplastic ameloblastoma in a 45-year-old female with a painless swelling in the left anterior maxillary region. Fine needle aspiration yielded no fluid. Periapical and panoramic radiographs as well as computer tomography scan showed a mixed lesion with multilocular appearance. The present case deserves special importance be-cause of its unfamiliar appearance, potentially aggressive nature and high chances of misdiagnosis. Moreover, the radio-graphic features of this lesion rarely point towards ameloblastoma. A partial maxillectomy for tumor resection was per-formed and the involved teeth were removed. This report is an attempt to help the dental community in developing familiarity with the clinical presentation and at the same time advocating to develop a high index of suspicion in recognizing such cases.

Toluidine blue staining as an adjunctive tool for early diagnosis of dysplastic changes in the oral mucosa

Prognosis of oropharyngeal squamous cell carcinoma depends on early diagnosis, despite advanced surgical techniques, the 5-year survival rate remains ~40-50%. Unfortunately, it is usually detected when it becomes symptomatic. This requires treatment which gives rise to a high rate of morbidity and mortality and, furthermore, early detection of oro-pharyngeal pre-malignant lesions is important to improve the survival rate and quality of life. Since dysplasia and in situ carcinoma contain much more DNA and RNA than the normal surrounding epithelium, the use of in vivo staining, by means of toluidine blue dye, is based on the fact that it is an acidophilic dye that selectively stains acidic tissue components such as DNA and RNA. Toluidine blue staining is considered to be sensitive in identifying early oro-pharyngeal premalignant and malignant lesions. In the present study, the use of toluidine blue staining was taken into consideration to identify clinically doubtful oro-pharyngeal lesions and to compare toluidine blue stain and with the histological evaluation. Key words:Early detection, improved survival, pre-cancer, toluidine blue, vital staining.

Oral cavity and leprosy

Although leprosy involves the oral cavity in up to 60% of the patients, examination of the oral cavity in leprosy clinics or oral health science clinics is often neglected. Oral involvement in leprosy can broadly be divided into non-specific and specific lesions. In this review, we discuss various oral manifestations in leprosy patients so as to increase the awareness about this aspect among dermatologists and dental surgeons.

Evaluation of salivary calcium and salivary parathyroid levels in postmenopausal women with and without oral dryness.

Objective: The primary objective of this study is to estimate and secondary objective is to compare the salivary calcium levels, salivary parathyroid hormone (PTH) levels in postmenopausal women with and without oral dryness (OD). Materials and Methods: A case-control study was carried out on 80 selected postmenopausal women. Salivary calcium concentrations were assessed through Semi Autoanalyzer by Arsenazo III reaction. The salivary PTH concentration was measured by the enzyme linked immunosorbent assay. Severity of OD was assessed by a questionnaire through which the xerostomia inventory (XI) score could be measured. Statistical analysis of Students t-test, Mann-Whitney test and Pearsons correlation was used. Results: There was a significant difference in mean values of both salivary calcium concentration and XI score in postmenopausal women with/without OD (P < 0.001). No statistically significant difference (P > 0.05) was found in salivary parathyroid levels in postmenopausal women in both groups. A positive correlation was found between the salivary calcium concentration and XI score in both case and control groups (P < 0.05). Conclusion: Severity of OD in postmenopausal women is associated with the high levels of salivary calcium. However, the correlation of severity of OD with PTH could not be established.

Colposcopy: a new ray in the diagnosis of oral lesions.

Oral squamous cell carcinoma is the most common cancer of the oral cavity. The survival rates for oral cancer patients will significantly be improved provided lesions are detected and treated at the infancy stage. Early diagnosis is therefore of paramount importance. Histopathological examination is considered as the gold standard in diagnosing oral lesions. Therefore, the selection for a biopsy site is highly significant. In this article, we present a current review of the colposcope and oral application of the colposcopy technique and its use as an adjunct in the early diagnosis of premalignant and malignant lesions of the oral mucosa. We stress upon the fact that colposcopy (direct oral microscopy) of oral mucosal lesions helps in selecting more representative sites for biopsy than routine clinical examination alone. Because of its precision, versatility, ease of use, and being a non-invasive technique, colposcopy might prove to be a useful step toward continuing to learn and improve the care for our patients.

Adenomatoid odontogenic tumor with dentigerous cyst: Report of a rare case with review of literature.

Adenomatoid odontogenic tumor (AOT) is a benign lesion derived from the complex system of dental lamina or its remnant. It is categorized into three variants (follicular, extrafollicular, and peripheral). We present a rare case of AOT arising from a dentigerous cyst around the unerupted canine in a 28-year-old female. We believe that this case z an odontogenic cyst with neoplastic development, containing both epithelial and mesenchymal components. As more cases accumulate, we will be able to study these rare lesions further whether the AOTs derived from an odontogenic cyst could represent a distinct “hybrid” variant separate to the three variants described thus far.

Invasive rhinomaxillary mucormycosis: a case report with a review of the literature

Mucormycosis is a rare, often fatal disease that is caused by zygomycetes, which are common fungi frequently found in the soil and decaying vegetation. Diabetes mellitus, malnutrition, and an immunocompromised state favor the growth of various microorganisms, including zygomycetes and the normal flora of the oral cavity, which are otherwise nonpathogenic, leading to opportunistic infections. Here we report a case of mucormycosis presenting with extensive necrosis of the maxilla along with rhinocerebral involvement in a 60-year-old patient suffering from uncontrolled diabetes with ketoacidosis.