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Background: Despite much research, there is a lack of a definite protocol or method for documenting oral submucous fibrosis (OSMF) site presentation. In this study, we propose a new potential oral mapping (OM) method and evaluated its use in recording OSMF-affected mucosal sites., Methods: Fifty OSMF patients were evaluated by 15 primary care dental practitioners using both, a conventional subjective recording method and a new OM method, to document the degree of involvement of affected oral mucosa with a crossover study design. Mann-Whitney test (non-parametric test) was used to make comparison between groups to determine any significant differences between the two identification methods. Wilcoxon tests were used to evaluate any significant differences in the difficulty in identification of two methods., Results: There was a low agreement between the two methods used to detect OSMF in affected mucosal surfaces (P-value < 0.0001). More lesions were identified using the proposed OM method, and less discrepancy was found among dental practitioners. A difference in difficulty of OSMF documentation was found (Wilcoxon z = 3.615, P-value < 0.001), with the proposed OM method found to be easier., Conclusion: The proposed OM method appears to be useful for documentation, can easily be adapted in clinical practice, and effectively administered in clinical research. Additionally, it could be a useful tool to helping to maintain an OSMF database., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

A 35-year-old male patient reported with the chief complaint of a large swelling in the right side of the upper lip. The lesion measured 6.5 cm measuring from the infraorbital region to the lower border of mandible on the right side of the face and 7.5 cm from the right ear lobule to the contralateral commissure of the left side of the face. On palpation, the swelling was soft, fluctuant and compressible. Pulsations were felt, and on auscultation, bruit was also heard. Computed tomography angiogram of the neck and circle of Willis showed serpiginous hyperdense vascular channels causing significant soft-tissue thickening of the upper lip, right cheek region and philtrum. Hence, the diagnosis of diffuse subcutaneous facial arteriovenous malformation involving the right cheek and philtrum was given. The entire lesion was excised. In the postoperative 2 nd month, secondary cosmetic correction or lip reconstruction was done. The patient was reviewed after 3 years; there was no recurrence of the lesion., Competing Interests: There are no conflicts of interest.

Developmental defects of enamel may range from slight abnormalities of the tooth's color, shape and size to a complete absence of the enamel. Permanent first molar may show large variations in their morphological features and forms. Such changes may be in the form of anomalous cusps or variations in the occlusal surface showing globular shaped additional cusps and also increased in number of roots. However, to the best of our knowledge, this is the first nonsyphilitic case with the occurrence of multiple globular cusps. In the present case, occlusal anatomy is abnormal, with numerous disorganized globular projections involving all four permanent first molars. The projections of 2 mm × 2 mm in size and globular in shape were seen in the maxillary and mandibular cast. The features resemble the surface of mulberry and hence diagnosed as mulberry molars., Competing Interests: There are no conflicts of interest.

Aims and Objectives: A dental student in his/her life goes through several academic stresses. Mild stress may be beneficial in cognitive tasks and performance, while persistently high stress may lead to anxiety and depression. Thus, the aim is to compare the stress levels in students appearing for previva and postviva during university examinations., Materials and Methods: The study was carried out on 70 3 rd year Bachelor of Dental Surgery students who were appearing for their university practical examination. Heart rate, oxygen saturation and stress levels were measured using Android S-HEALTH software. The data were compared and tabulated. Results obtained were statistically analyzed using paired " t "-test., Results: Heart rate, oxygen saturation and stress levels were statistically high in previva of all the students., Conclusion: It can be concluded that examination is a situational stress resulting in anxiety due to increased levels of plasma cortisol reflected by an increased heart rate, oxygen saturation and stress levels. It is important for students to use stress-reducing measures or to reduce them as much as possible to avoid factors that can affect themselves and their patients in stressful way., Competing Interests: There are no conflicts of interest.

Background: We have evaluated the rationale of existing grading and staging schemes of oral submucous fibrosis (OSMF) based on how they are categorized. A novel classification and staging scheme is proposed., Methods: A total of 300 OSMF patients were evaluated for agreement between functional, clinical, and histopathological staging. Bilateral biopsies were assessed in 25 patients to evaluate for any differences in histopathological staging of OSMF in the same mouth. Extent of clinician agreement for categorized staging data was evaluated using Cohen's weighted kappa analysis. Cross-tabulation was performed on categorical grading data to understand the intercorrelation, and the unweighted kappa analysis was used to assess the bilateral grade agreement. Probabilities of less than 0.05 were considered significant. Data were analyzed using SPSS Statistics (version 25.0, IBM, USA)., Results: A low agreement was found between all the stages depicting the independent nature of trismus, clinical features, and histopathological components (K = 0.312, 0.167, 0.152) in OSMF. Following analysis, a three-component classification scheme (TFM classification) was developed that describes the severity of each independently, grouping them using a novel three-tier staging scheme as a guide to the treatment plan., Conclusion: The proposed classification and staging could be useful for effective communication, categorization, and for recording data and prognosis, and for guiding treatment plans. Furthermore, the classification considers OSMF malignant transformation in detail., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Over the last 40 years, many theories linking oral submucous fibrosis (OSMF) to various risk factors have been proposed. Spicy, pungent foods and irritants such as supari (areca nut), paan (betel leaves), tobacco (through chewing or smoking)-the common Asian habits of chewing the aforementioned agents-have all been incriminated as causative agents. Systemic factors such as nutritional deficiency, genetic predisposition and autoimmunity have also been proposed in the pathogenesis of OSMF. However, the precise aetiology of OSMF is still unknown, and no conclusive evidence has been found despite many extensive investigations on implicated factors. Most of the ideas proposed have been derived from the existing clinical and epidemiological data. We present a comprehensive review of the various theories regarding the pathogenesis of the condition, but have not concentrated on malignant transformation in this article., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Twinning is referred to the development of two separate teeth that arose from the complete separation of one tooth bud. To the best of our knowledge very few cases of twinning in primary or permanent dentition have been previously reported. Here, we report an additional case of twinning involving primary maxillary left lateral incisor and a literature review of clinical and radiographic findings of previous reported cases of gemination and twinning is also discussed. A six-year-old male patient reported to the dental clinic with the complaint of decay in the left front teeth region of the upper jaw. On clinical examination, dentinal caries was observed on the labial surface of primary maxillary left lateral incisor. The tooth showed a deep groove present in relation to the labial surface and incisal edge and continued cervically as a shallow groove. The patient had normal compliment of teeth for his age. The intra-oral periapical radiograph of the maxillary anterior region revealed large crown and a radiolucent notch was observed in relation to the incisal edge of the maxillary left primary lateral incisor. Relatively one pulp chamber and two root canals were observed in relation to the primary maxillary left lateral incisor, which was suggestive of a case of twinning involving primary maxillary left lateral incisor. This present case is the first case report of twining seen in primary dentition.

Background: In the literature, many studies were attempted to analyze the distribution of oral reactive lesions in terms of age, gender and location. However, very few studies have focused on the detailed histopathological features of these reactive lesions of oral cavity. Thus, the purpose of this paper is to document the occurrence, distribution and various histopathological features of reactive gingival lesions., Materials and Methods: This study is a retrospective archival review of reactive gingival lesions of oral cavity such as irritational fibroma (IF), inflammatory gingival hyperplasia (IGF), pyogenic granuloma (PG), peripheral giant cell granuloma (PGCG) and peripheral ossifying fibroma involving gingival tissues. All the cases were histopathologically reviewed on some microscopical parameters according to the criteria given by Peralles et al ., Results: Regarding epithelial morphology, atrophy, ulceration and hyperplasia were found predominantly in PG. Connective tissue was predominantly dense in IGF and IF with fibroblastic proliferation; whereas loose connective tissue was seen in PG. Vascular proliferation, especially capillary, was commonly present in PG and inflammatory gingival hyperplasia (IGH). Inflammatory cell infiltrate was intense in both PG and IGH. Mineralization showed a marked affinity for peripheral cement-ossifying fibroma, and bone/bone-like areas were found in about ten cases of them. The Foreign body type of multinucleated giant cells was found exclusively on PGCG., Conclusion: Despite their clinical similarities, the findings of this study reports that all reactive gingival lesions show some differences in age, type, location, duration and histopathological features. Nevertheless, the differing histological pictures are a range of a single lesion in diverse stages of maturation. Essential in the treatment of reactive lesions is the total removal of the lesion with local irritants such as defective restorations or calculus formation., Competing Interests: There are no conflicts of interest.

Objective: The aim of the study was to determine blood groups and Rhesus factor from dentin and pulp using absorption-elution (AE) technique in different time periods at 0, 3, 6, 9 and 12 months, respectively., Materials and Methods: A total of 150 cases, 30 patients each at 0, 3, 6, 9 and 12 months were included in the study. The samples consisted of males and females with age ranging 13-60 years. Patient's blood group was checked and was considered as "control." The dentin and pulp of extracted teeth were tested for the presence of ABO/Rh antigen, at respective time periods by AE technique., Statistical Analysis: Data were analyzed in proportion. For comparison, Chi-square test or Fisher's exact test was used for the small sample., Results: Blood group antigens of ABO and Rh factor were detected in dentin and pulp up to 12 months. For both ABO and Rh factor, dentin and pulp showed 100% sensitivity for the samples tested at 0 month and showed a gradual decrease in the sensitivity as time period increased. The sensitivity of pulp was better than dentin for both the blood grouping systems and ABO blood group antigens were better detected than Rh antigens., Conclusion: In dentin and pulp, the antigens of ABO and Rh factor were detected up to 12 months but showed a progressive decrease in the antigenicity as the time period increased. When compared the results obtained of dentin and pulp in ABO and Rh factor grouping showed similar results with no statistical significance. The sensitivity of ABO blood grouping was better than Rh factor blood grouping and showed a statistically significant result.

Introduction: Cyclin B1 is important in the cell cycle progression from G2 to M phase. Cyclin B1 binds to CDC2, which then becomes dephosphorylated and gets relocated to the nucleus, ensuring the transition toward mitosis., Aim: Over expression of Cyclin B1, has been reported more recently in breast, colon, prostate, oral and esophageal carcinomas. Thus, the aim of the present study was to examine the expression of Cyclin B1 in hyperplasia, dysplasia and Oral Squamous Cell Carcinomas (OSCC)., Materials and Methods: A total of 64 histopathologically diagnosed cases of epithelial hyperplasias, dysplastic oral epithelium and OSCC were included in the study. Immunohistochemical procedure was carried out using the monoclonal mouse Cyclin B1 antibody (Clone V-152). The Cyclin B1 positive tumor cells counted were expressed as percentage of positive tumor cells. Nuclear and cytoplasmic labeling index (n&cLI) were calculated. The results were tabulated and statistically analyzed by Kruskal Wallis test- One Way ANOVA and Mann Whitney U- test., Results: Combined n&cLI was considered only in 28.57% of epithelial hyperplasias, 40.7% of oral epithelial dysplasias and 72% of OSCC showed over expression of Cyclin B1 with p value being 0.029. Cyclin B1 expression was not significantly different between the grades of dysplasia, between the grades of OSCC and between the marginal groups., Conclusion: The present study demonstrates more than 50% of the study group showing less than 20% of nuclear staining. The importance of such variations within a type of lesion requires further investigation, since Cyclin B1 has proved useful in many studies from esophageal and laryngeal squamous cell carcinoma as a prognostic indicator, an indicator of recurrence and as an indicator for tumor sensitivity to radiotherapy. Further studies are to be extended towards evaluating the role of Cyclin B1 as a prognostic indicator.

Angiosarcomas of oral cavity and salivary gland represent 1% of all cases reported in the literature and are therefore considered as extremely rare. To the best of our knowledge very few cases of angiosarcomas involving mandibular gingiva have been reported previously. Here, we report a case of angiosarcoma occurring in the gingiva with review of literature on clinical features. A 30-year-old female patient presented with a complaint of a small growing mass in relation to lower front teeth. Intraoral examination revealed a soft sessile growth arising from the labial gingiva in relation to 31 and 41 on the labial aspect extending distally to 32. The lesion was locally excised. Histolopathological analysis showed that the tumour was composed of spindle shaped to polygonal cells with hyperchromatic nuclei, conspicuous nucleoli and intracytoplasmic vacuoles, mitotic figure were also scattered. Immunohistochemical staining revealed that the tumour cells was positive for factor VIII-related antigen, CD31 and CD34. An excisional biopsy showed a diagnosis of angiosarcoma. After two months patient reported back with the same chief complaint. This present case is a 17(th) case report of angiosarcoma arising in anterior mandiblular gingiva.

Background: Fixation is the most imperative step in the practice of diagnostic histopathology, which is intimately linked to 10% formalin. As a result of increasing concerns about the potential carcinogenicity of the formaldehyde, attempt to find safer alternatives is necessary. Honey has been shown to possess antimicrobial, antiviral and antimutagenic properties. Many studies have reported that honey possesses dehydrating and preserving effects also., Aims and Objectives: To study the fixative properties of processed and unprocessed honey in oral tissues followed by comparision with formalin., Materials and Methods: The study group comprised 12 different tissues. Each tissue was cut into 3 segments and were immediately fixed in bottles containing 10% unprocessed honey, 10% processed honey and 10% formalin, respectively, for 24 h at room temperature. After fixation, tissues were processed using the routine standard processing protocol followed by hematoxylin and eosin staining. Data were statistically analyzed using descriptive statistics such as mean, standard deviation and percentage. Kruskal-Wallis test followed by post hoc Dunn's multiple comparisons test and Chi-square test or Fisher's exact test for small sample size. A P < 0.05 was considered as significant. Data analysis was done by using software Minitab v14.0., Results: When all the stained sections were assessed for the parameters, there was no statistically significant difference between tissues fixed in processed and unprocessed honey compared to formalin (P = 0.004). The tissue morphology and staining adequacy for diagnosis in honey fixed tissue was at par with formalin fixed tissue. Hence, our results suggest that both processed honey and unprocessed honey can be used as a safe alternative for formalin.

Introduction: The fixation of cytological smears using ethanol is the gold standard. But, there exists a quench to search a new alternative for it due to it being expensive, carcinogenic and not freely available. Honey has various properties, like dehydrant, anti-bacterial and antioxidant. The use of honey as a preservative in funerary practices is well documented. A thorough search in the literature did not reveal any matter for the utility of honey as a fixative in cytological smear, but its use in histopathology is well recognized., Aims: To analyze the efficacy of cytological smears fixed in ethanol and 20% unprocessed honey and to compare the efficacy between the two fixatives., Materials and Methods: The study group comprised of 30 normal healthy individuals who willingly gave written consent. Prior to the collection of buccal cells, subjects were asked to rinse their mouth with water. Buccal cells were collected using a wooden ice cream stick. Two smears were collected from each subject. One smear was fixed in ethanol and the other was fixed in unprocessed 20% honey. The slides were washed in tap water for about 30 s, following which they were subjected to the conventional Papanicolaou staining procedure. The slides thus fixed were evaluated separately for ethanol and honey. The cytoplasmic and nuclear details were scored for 50 cells in each slide. Data were statistically analyzed using the chi-square test and P < 0.05 was considered statistically significant., Results: Ninety percent of the ethanol-fixed (EF) smears were adequately fixed as compared with the honey-fixed (HF) smears, which were 80% adequate. The P-value obtained was 0.47 and the data were statistically insignificant., Conclusion: Both EF and HF smears were at par with each other, and honey can be safely used as a substitute to ethanol.

Background: Leprosy is primarily a disease of developmental countries. About 4 million people have or are disabled by leprosy. Eighty-six percent of leprosy patients reside in Southeast Asia and Brazil. India accounts for up to 70% of total cases., Aim: To evaluate the incidence of orofacial lesions in treated leprosy patients., Materials and Methods: Thirty treated leprosy patients were examined clinically and the percentage of orofacial lesions were evaluated., Results: On evaluating the orofacial lesions, incidence of hypopigmentation on face and oral mucosa were highest (63%) followed by depressed nasal bridge and fissured tongue (33%). The incidence of crenated tongue was seen to be the lowest (3.3%)., Conclusion: Orofacial lesions in leprosy patients develop insidiously, generally are asymptomatic and are secondary to nasal changes. Oral lesions may contribute to the diagnosis of the disease and be attributed to involvement of Mycobacterium leprae.

Although oral submucous fibrosis (OSMF) is thought to be multifactorial in origin, the chewing of areca nut is thought to be the main cause. Alkaloids and tannins in areca nut are responsible for fibrosis, but recent evidence has suggested that copper ions are also an important mediator, and in a small pilot study we recently found that OSMF was significantly associated with a raised concentration of copper in drinking water. We have further investigated this association in a heterogeneous population in Hyderabad-Karnataka, India, a region with a high incidence of the condition. We evaluated 3 groups, each of 100 patients: those with OSMF who chewed gutkha, those who chewed gutkha but did not have OSMF, and healthy controls who did not chew gutkha. The difference between the groups in the mean concentration of copper in water measured by atomic absorption spectrometry was significant (p<0.001). There were also significant differences between the groups in mean concentrations of serum copper, salivary copper, and ceruloplasmin (p<0.001). Our results confirm that copper in drinking water contributes to the pathogenesis of OSMF, but ingestion of copper is unlikely to be the sole cause., (Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

We aimed to investigate the concentration of copper ions in drinking water and to assess whether copper has a role in the pathogenesis of oral submucous fibrosis (OSMF). We studied 50 patients with clinically and histologically diagnosed OSMF from the Yadgir district of Karnataka in India. Fifty healthy people matched for age and sex were used as controls. In both groups concentrations of copper ions in serum, saliva, and home drinking water were measured using atomic absorption spectroscopy and intelligent nephelometry technology. Serum ceruloplasmin concentrations were also estimated in both groups. The mean (SD) concentration of copper in the home drinking water of patients with OSMF was significantly higher (764.3 (445.9)μmol/L) than in the controls (305.7 (318.5)μmol/L) (p<0.001). Patients with OSMF also had a significantly higher copper concentrations in serum and saliva, and serum ceruloplasmin than controls (p<0.001). For the first time these data have shown a positive association between copper concentrations in home drinking water and OSMF. It raises the possibility that increased copper in drinking water contributes to the development of OSMF, and adds to that ingested when areca nut is chewed., (Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Context: Oral submucous fibrosis (OSMF) has a multifactorial etiology. Recent studies have shown that there is an increased level of fibrinogen degradation products (FDP) in plasma of OSMF patients suggesting its possible role in etiopathogenesis of OSMF., Aims: To detect the presence of FDP in the plasma of betel nut chewers with and without OSMF and in normal subjects without any habits, to correlate these levels with respect to the clinical and histological grading of OSMF and whether it can be used as a nonsurgical diagnostic aid in detection of suspected OSMF cases., Materials and Methods: Study comprised of 35 cases of betel nut chewers with OSMF, 10 patients with betel nut chewing habit but having apparently normal oral mucosa, and 10 normal patients without any habits. The patients were evaluated for plasma FDP levels., Results: All the betel nut chewers with OSMF showed the presence of plasma FDP. However, controls and subjects with habit, but without OSMF did not show FDP in the plasma. Spearman's rank correlation was used to find the association between the clinical and histological grades and it was not statistically significant (P = 0.910) and the correlation being 0.020., Conclusion: Since only those patients with OSMF have showed the presence of FDP in plasma, we suggest that our test can be utilized as a nonsurgical diagnostic aid in suspected OSMF patients.

Aims. The aim is to present a case of rare giant granular cell ameloblastoma and to review the pertinent literature highlighting the molecular aspects of its pathogenesis by analyzing the expression of CD-68, Bcl-2, and β -catenin. Methods. H and E stained sections showed large odontogenic islands showing peripheral ameloblast-like cells and central stellate reticulum-like cells with extensive granular cell transformation surrounded by fibrous stroma. Polyclonal rabbit anti-CD 68, anti-Bcl2, and anti- β -catenin were stained immunohistochemically. Results. CD-68 showed a moderate to strong staining intensity in granular cells. Moderate staining of Bcl-2 was expressed by the peripheral columnar cells of tumor islands and negative in the granular cells. Expression of β -catenin was generally weak, except for only the focal areas that showed a moderate staining intensity and weak in peripheral cells. Conclusion. The present case of giant granular cell ameloblastoma is a rare entity. Development of monstrous size is indicative of ameloblastomas persistent growth. Granular cell transformation in ameloblastomas probably occurs as a consequence of extensive molecular changes. Immunohistochemical studies help us to know the pathogenesis of this granular cell ameloblastoma. Therefore, an effort has been made here to study the expression of Bcl-2, CD-68, and β -catenin.

Keloids extend beyond the borders of the original wound invading normal skin. Usually appear as firm nodules, often pruritic and painful, and generally do not regress spontaneously. Most often occur on the chest, shoulders, upper back, back of the neck, and earlobes. The aim of the paper is to discuss a case of keloid, review the pathophysiology and also to highlight the differences between keloid and hypertrophic scars. A 26-year-old female complains of swelling on ear lobe since 3 years. Swelling was firm, non-tender, dumbell-shaped with central wooden stick still present, measuring 3 cm in diameter medial to the inferior part of the helix. A clinical diagnosis of keloid was given. Histopathological sections showed hyperorthokeratinized stratified squamous epithelium with deep dermal sclerosis showing large dense bundle of glassy collagen diagnostic of Keloid. Special stain like Van Gieson's was used to identify collagen bundles. The sections were also subjected to immunohistochemical markers such as α-SMA (alpha Smooth muscle actin), Desmin, and S-100. Despite decades of research, the pathophysiology of keloids remains incompletely understood. Recent studies indicate that TGF-β (Transforming growth factor beta) and PDGF (Platelet-derived growth factor) play an integral role in the formation of keloids. In future, development of selective inhibitors of TGF-β might produce new therapeutic tools with enhanced efficacy and specificity for the treatment of keloids. Patients with a previous history of keloid or other risk-factors should avoid body piercing and elective cosmetic procedures. Keloid scars should be sent for histopathology in order to avoid missing potentially malignant conditions particularly those showing unusual features.

Aims and Objectives: To study the clinical, histological features of peripheral and central ossifying fibromas and also to compare between them., Materials and Methods: The sample comprised a total 50 cases of ossifying fibromas [25 central ossifying fibromas (COF) and 25 peripheral ossifying fibromas (POF)] inclusive of cemento-ossifying fibromas., Results: The mean age is 28.2 years in POF and 24.7 years in COF. The male: female ratio was 1:1.5 in POF and 1:1.8 in COF. The size of the lesions varied from 0.45 to 2.75 cm in cases of POF and in COF, it ranged from 1.25 to 13.5 cm. COF showed more duration (1-8 years) when compared with POF (1-3). Majority of cases of COF showed radiolucent, mixed radiolucent and radiopaque unilocular lesions. The predominant cell type in both POF and COF was a combination of both ovoid and spindle cells. Regarding vascularity it showed mild, moderate and intense vascularity. On comparison of all stromal changes between POF and COF showed no statistically significant difference., Conclusion: The clinical parameters and radiographic changes of POF and COF in our study were similar to the previous studies. Histopathological features like type of cells, cellularity and vascularity in POF and COF were similar to previous studies. However, when clinical and histopathological features were compared between POF and COF showed no statistical significance except for site of the lesion. These features signify the behavior of two lesions. Further research on larger sample might give more insights into these lesions.

Background: Palatal rugae comprises three to seven ridges radiating out tangentially from the incisive papilla on the anterior part of the palate. These rugae patterns are studied for various reasons, mainly in the fields of anthropology, genetics, orthodontics, prosthodontics, and forensic science., Objective: To compare the palatal rugae pattern in two different populations (Manipuri and Kerala), and to assess the predominant pattern if any in the selected groups., Materials and Methods: Sixty maxillary study models (30 from each group including males and females) were examined in the age group ranging from 17 to 23 years. Palatal rugae pattern were analyzed on the right and left sides of the palate for total number, length, shape, direction, and unification., Results: After analyzing the rugae patterns in both the groups and between the two sides of the palate, the wavy pattern was found to be predominant followed by curved, straight, and circular in overall population. Manipuri population showed predominant curved shape than the Kerala population and was statistically significant. Females in general had slightly more rugae than males and the left side of the palate showed comparatively more number of rugae than on the right side., Conclusion: A statistically significant association between the shape of the rugae and population exists although, subtle. Parameters like direction and unification need more attention for better understanding.