In Vitro comparison of the microbial leakage of obturation systems: Epiphany with resilon, guttaflow, and ah plus with gutta percha

AIM

To compare the microbial leakage of three root canal filling materials: AH Plus with Gutta-percha, Epiphany with Resilon, and Guttaflow using Enterococcus faecalis as the bacterial marker.

MATERIALS AND METHODS

In total, 30 caries free, human maxillary incisors with straight roots were used. The teeth were de-coronated with a diamond disc and the length was standardized for all specimens. Access opening was done through the coronal portion and the working length was determined. All the teeth were prepared to a standardized size apically and coronally. The teeth were then randomly divided into three experimental groups each. After obturation of the root canals, the outer surfaces of the teeth were coated with two layers of nail enamel except the apical 2 mm. The teeth were then subjected for bacterial leakage test using E. faecalis as a bacterial marker in dual chamber bacterial leakage model for a period of 30 days.

STATISTICAL ANALYSIS USED

Chi-square test.

RESULTS

Results showed that Resilon/Epiphany (Group-2) demonstrated less leakage and Gutta-percha/AH Plus (Group-1) showed maximum leakage with the statistically significant difference between the two (P < 0.05). Guttaflow (Group-3) also showed less leakage than Gutta-percha/AH Plus (Group-1) with the statistically significant difference between the two (P < 0.05). There was no statistically significant difference between Resilon/Epiphany (Group-2) and Guttaflow (Group-3).

CONCLUSION

Resilon/Epiphany and Guttaflow groups demonstrated less microbial leakage than Gutta-percha/AH Plus group.

Evaluation of salivary metabolomics in oral leukoplakia and oral squamous cell carcinoma

BACKGROUND

Metabolomics is the study of metabolome which describes the full repertoire of small molecules, and the analysis of salivary metabolomics may help in identifying tumor-specific biomarkers for early diagnosis and prediction of tumor progression. The aim of the study was to evaluate the clinical utility of salivary metabolites in oral leukoplakia and oral squamous cell carcinoma.

METHODS

Salivary metabolomic profile of patients diagnosed with oral leukoplakia (n = 21) and oral squamous cell carcinoma (n = 22) was compared with apparently normal controls (n = 18) using Q-TOF-liquid chromatography-mass spectrometry. MassHunter profile software and Metlin database were used for metabolite identification. ANOVA to identify the regulation of metabolites between the three groups, t test (P < 0.05) to signify the changes between two groups, and chi-square test (P < 0.05) to indicate the presence or absence of metabolites in the study participants of the three groups were performed.

RESULTS

Significant upregulation of 1-methylhistidine, inositol 1,3,4-triphosphate, d-glycerate-2-phosphate, 4-nitroquinoline-1-oxide, 2-oxoarginine, norcocaine nitroxide, sphinganine-1-phosphate, and pseudouridine in oral leukoplakia and OSCC was noted. Downregulated compounds in the diseased groups included l-homocysteic acid, ubiquinone, neuraminic acid, and estradiol valerate.

CONCLUSION

A range of salivary metabolites were significantly altered in oral leukoplakia and oral squamous cell carcinoma. Further, it is necessary to evaluate the clinical utility of the individual metabolites in preventing malignant transformation of oral leukoplakia and to improve prognosis of oral squamous cell carcinoma.

Odontogenic myxoma in an 8-year-old girl: A case report with review of literature

Aggressive enlargements of maxilla in pediatric patients are uncommon and present with diagnostic and therapeutic dilemma. The decision on therapeutic modality is based on an early and accurate diagnosis, minimizing disease-associated morbidity which is of utmost importance considering the young age and thereby resulting in better prognosis. Odontogenic myxoma is a locally aggressive lesion which is primarily seen in relation to odontogenic apparatus in mandibular posterior region in association with an impacted tooth. This presentation describes a unique case of odontogenic myxoma of anterior maxilla in an 8-year-old girl with emphasis on its diagnosis and treatment planning.

Oral bacterial flora and oral cancer: The possible link?

Oral cancer exhibits multifactorial etiology with tobacco and alcohol long been implicated as the primary risk factors. In addition, betel nut, dietary factors and poor oral hygiene have also been found to have a role in the etiology of oral cancer. Past research has uncovered a great deal of information regarding the association of exogenous bacteria with cancer. However, our definitive knowledge of the oral commensal bacteria and oral cancer link remains inadequate. In the present article, we hypothesize a causal role for oral bacterial flora in oral cancer although an indirect one. We propose that the normal bacterial flora in conjunction with the already established risk factors such as alcohol consumption may play a role in cancer development. The continued exploration of this topic may aid in better understanding of the pathogenesis of oral cancer thereby helping in appropriate treatment and better prognosis.

In vivo autofluorescence of oral squamous cell carcinoma correlated to cell proliferation rate

CONTEXT

Loss of cell differentiation and increased cellular proliferative activity during malignant transformation leads to alteration of biochemical content of cells. This is reflected in the fluorescence profile of tissues.

AIMS

(1) To evaluate the efficacy of autofluorescence in clinical detection of oral cancer. (2) To correlate it with the rate of cell proliferation by analyzing argyrophilic nucleolar organizer regions (AgNORs).

SUBJECTS AND METHODS

Autofluorescence status was studied by devising a visual enhancement system using ultraviolet light, followed by an incisional biopsy. Tissue was sent for fluorescence spectroscopy and analyzed by routine histopathology and AgNORs staining. The obtained results were statistically analyzed using Chi-square test (P < 0.05) and one-way analysis of variance.

RESULTS

A statistically significant correlation was seen between autofluorescence (AF) and clinical diagnosis as well as autofluorescence and histopathological diagnosis. The importance of autofluorescence as a screening tool was further supported by a statistically significant correlation between autofluorescence status and cell proliferative rate.

CONCLUSION

A preliminary effort was attempted at delving into this relatively unexplored arena of optical biopsy systems through this study. They can be used to monitor treatment and potential complications, surgical margins, detection of nodal metastasis, etc. They can provide a diagnosis noninvasively, in situ, and in real time.

Serum metabolomics in oral leukoplakia and oral squamous cell carcinoma

CONTEXT

Metabolomics is a core discipline of system biology focusing on the study of low molecular weight compounds in biological system. Analysis of human metabolome, which is composed of diverse group of metabolites, can aid in diagnosis and prognosis of oral squamous cell carcinoma (OSCC).

AIM

The aim of the present study is to analyze and identify serum metabolites in oral leukoplakia and OSCC as a potential diagnostic biomarker and a predictor for malignant transformation of oral leukoplakia.

SUBJECTS AND METHODS

Serum metabolomic profile of patients diagnosed with oral leukoplakia (n = 21) and OSCC (n = 22) was compared with normal controls (n = 18) using quadrupole time of flight-liquid chromatography-mass spectrometry. MassHunter profile software was used for metabolite identification, and statistical analysis to assess the variation of the metabolites was performed using Mass Profiler Professional software. Statistical significance between the three groups was expressed using ANOVA (P < 0.05), and intergroup comparison was done using Student's t-test (P < 0.05).

RESULTS

Significant upregulation of estradiol-17-beta-3-sulfate, L-carnitine, 5-methylthioadenosine (MTA), 8-hydroxyadenine, 2-methylcitric acid, putrescine, and estrone-3-sulfate was seen in oral leukoplakia and OSCC than in normal controls. Furthermore, significant upregulation of 5,6-dihydrouridine, 4-hydroxypenbutolol glucuronide, 8-hydroxyadenine, and putrescine was evident in OSCC group than in oral leukoplakia.

CONCLUSION

Upregulation of L-carnitine, lysine, 2-methylcitric acid, putrescine; 8-hydroxyadenine; 17-estradiol; 5,6-dihydrouridine; and MTA suggests their diagnostic potential in oral leukoplakia and OSCC. Further, a significant upregulation of putrescine, 8-hydroxyadenine, and 5,6-dihydrouridine in OSCC than in oral leukoplakia indicates their potential role in predicting the malignant transformation of oral leukoplakia.

Extracellular matrix in oral squamous cell carcinoma: Friend or foe?

BACKGROUND

Oral squamous cell carcinoma (OSCC) primarily spreads through direct invasion and/or lymphatic route. During the invasion, tumor cells break through the basement membrane, penetrate the connective tissue to interact with the extracellular matrix (ECM). An attempt was made to evaluate the connective tissue changes in different grades of OSCCs and their influence in predicting the biological behavior of these tumors.

MATERIALS AND METHODS

A total of 30 histologically proven cases comprising 5 normal mucosa, 10 well-differentiated OSCC's, 10 moderately differentiated OSCC's, and 5 poorly differentiated OSCC's were examined for the presence of any ECM changes by using special stains. Interpretation of staining intensity was carried out and statistically analyzed.

RESULTS

Van Gieson stain showed abundant thick collagen fibers, dispersed collagen fibers, thin few dispersed collagen fibers in well-, moderately- and poorly-differentiated OSCC's, respectively. Verhoeff's Van-Gieson showed negative staining for elastic fibers around tumor islands in different grades of OSCCs. PAS stain showed moderate staining for glycoprotein in well-differentiated OSCC and negative in moderately and poorly differentiated cases. Picrosirius red stain showed Type 1 collagen fibers in well and moderately differentiated OSCC cases and Type 3 collagen fibers in poorly differentiated cases.

CONCLUSION

The observations of this study revealed altered staining reactions of the collagenous stroma and glycoproteins suggesting that tumor cells may release certain enzymes that play a role in the manipulation of ECM to enhance their own survival.

Spindle Cell Carcinoma of the Mandibular Gingiva - A Case Report

Spindle cell carcinoma is a malignancy of epithelial origin often mimicking its mesenchymal counterpart thus posing a diagnostic challenge. It is a rare biphasic malignant tumour mostly encountered in the upper aerodigestive tract. The chief differential diagnoses of spindle cell carcinoma are true superficial sarcomas and they especially need to be differentiated from fibrosarcoma. This presentation reports a spindle cell carcinoma of the gingiva and highlights the difficulties encountered in the diagnosis. It also emphasizes the importance of accurate and thorough diagnosis of malignant spindle cell lesions to determine the appropriate therapeutic modality.

Burkitt’s lymphoma of maxillary gingiva: A case report

Burkitt’s lymphoma (BL) is an aggressive form of non-Hodgkin’s B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.

Epidemiology, control and prevention of tobacco induced oral mucosal lesions in India

Oral cancer is one of the leading causes of human morbidity and mortality especially in developing countries like India. Tobacco consumption in smokeless and smoking form along with alcohol is considered as the primary risk factors. Tobacco is a major health challenge with various tobacco products available for use which are known to have deleterious effects on the oral mucosa. The oral lesions caused by tobacco are inclusive of those that are less likely to progress to cancer; lesions with increased tendency to develop into cancer and cancerous lesions. Prevention and control of tobacco induced oral mucosal lesions is the prime requisite currently and mainly involves measures undertaken at primary, secondary and tertiary levels. Primary prevention plays a pivotal role in tobacco induced lesions and steps can be taken at policy level, community as well as individual level. This review paper focuses on the epidemiological data of tobacco induced oral mucosal lesions in India available in the literature with an overview on various strategies for their prevention and control.

Matrix metalloproteinases and periodontal diseases

Periodontitis is a chronic inflammatory disorder characterized a complex interaction between periodontopathic bacteria and the host inflammatory response resulting in release of pro-inflammatory cytokines leading to the destruction of periodontal tissues and alveolar bone. One of the important host factors involved in periodontal diseases is matrix metalloproteinases (MMPs), which is responsible for collagen and extracellular matrix (ECM) degradation of the periodontal tissues. MMPs comprise a family of around 25 members broadly categorized into six groups, which are involved in various physiological and pathological conditions. The activities of MMP are generally balanced by endogenous inhibitors such as tissue inhibitors of metalloproteinase (TIMP), and any imbalance between MMP and TIMP levels plays an important role in the disease progression. Assessment of MMP in tissues, GCF, and saliva may serve as an important biomarker in diagnosis of periodontal diseases and also for prognostic follow-up. Targeted therapy aimed at reducing effects of MMP may serve as a useful adjunct for treatment of periodontitis. This review provides an overview of MMP and its role in various physiological and pathological conditions with emphasis on its association with periodontal diseases. A note on its inhibitors and therapeutic importance is also provided.

Fluorescence in-situ hybridization technique as a diagnostic and prognostic tool in oral squamous cell carcinoma

Background and Objectives:

Early diagnosis and appropriate management are of prime importance for oral squamous cell carcinoma (OSCC) in the present scenario. Molecular changes in OSCC are well documented with the occurrence of a wide range of genetic damage. Identification of the genetic damage in OSCC using various diagnostic aids is mandatory, and one of the important advances in this field is cytogenetics using fluorescence in-situ hybridization (FISH). The aim of the present study is to analyze the genetic alteration in OSCC using FISH as a diagnostic aid.

Materials and Methods:

Peripheral blood was analyzed in 20 clinically and histopathologically proven OSCC cases and 10 healthy controls for chromosomal alteration under standardized conditions.

Results:

Of the 20 OSCC cases, 7 (35%) cases showed chromosomal alterations. No cases from the control group showed any chromosomal changes. Of the positive cases in OSCC, 30% cases showed increased copy number of cyclin D1 gene and 1 (5%) case showed positivity indicating extra copy of chromosome 11p11.11-q11 region.

Interpretation and Conclusion:

Increased genetic damage in OSCC which is a prominent feature can be identified by the use of FISH as seen from the present study. The findings suggest that FISH can be used as a diagnostic aid in the detection of genetic changes occurring in OSCC. The present study also suggests the importance of peripheral blood as a medium for assessing cytogenetic damage in OSCC.

Keratinization and its disorders

Keratins are a diverse group of structural proteins that form the intermediate filament network responsible for maintaining the structural integrity of keratinocytes. In humans, there are around 30 keratin families divided into two groups, namely, acidic and basic keratins, which are arranged in pairs. They are expressed in a highly specific pattern related to the epithelial type and stage of cellular differentiation. A total of 54 functional genes exist which codes for these keratin families. The expression of specific keratin genes is regulated by the differentiation of epithelial cells within the stratifying squamous epithelium. Mutations in most of these genes are now associated with specific tissue fragility disorders which may manifest both in skin and mucosa depending on the expression pattern. The keratins and keratin-associated proteins are useful as differentiation markers because their expression is both region specific and differentiation specific. Antibodies to keratin are considered as important tissue differentiation markers and therefore are an integral aid in diagnostic pathology. The present review discusses the structure of keratin, the various types of keratin and their distribution and the disorders associated with keratinization with special emphasis on the disorders of the oral cavity. A brief note on the clinical significance of keratin is also mentioned.

Toluidine blue: A review of its chemistry and clinical utility

Toluidine blue is a basic thiazine metachromatic dye with high affinity for acidic tissue components, thereby staining tissues rich in DNA and RNA. It has found wide applications both as vital staining in living tissues and as a special stain owing to its metachromatic property. Toluidine blue has been used in vivo to identify dysplasia and carcinoma of the oral cavity. Use of toluidine blue in tissue sections is done with the aim to highlight components, such as mast cells granules, mucins, and cartilage. This article provides an overview on chemistry, technique, and the various applications of toluidine blue.

Nitric oxide and oral cancer: a review

Nitric oxide (NO), a short-lived, endogenously produced gas, plays key role in various physiological as well as pathological processes. NO-inducing cell signaling events within the cell producing it and the diffusibility of it in other cells have led to the discovery of various physiological functions of NO including vasodilation, respiration, cell migration, immune response and apoptosis. On the other hand, excessive and unregulated NO synthesis has been implicated in many pathophysiological conditions including cancer. Research on NO, during the past few years is one of the growing areas in cancer biology. The high incidence of oral cancer and precancer has been linked with habits of tobacco chewing and smoking and NO has been said as the "messenger of death" in tobacco related diseases. NO seems to play a part in various stages of carcinogenesis from initiation to progression. However, there is considerable controversy and confusion in understanding its role in cancer biology. It is said to have both, tumoricidal as well as tumor promoting effects and these depend on its timing, location and concentration. Further, NO has also been shown to have antitumor, chemopreventive and therapeutic abilities. Here is an overview in which efforts are made to understand the role of this molecule in oral carcinogenesis.

Candida in oral pre-cancer and oral cancer

Oral pre-malignancies and carcinomas are common epithelial pathologies caused by a variety of etiological factors. In the oral cavity, candidiasis is the most frequent opportunistic fungal infection. Since the initial reports of an association between candidiasis with oral pre-cancer and cancer, various theories have been debated regarding the role of candida in development and transformation of oral pre-malignancies. However, the exact role is still unclear. In the present article, we hypothesize a causal role for candidiasis in oral pre-cancer and cancer albeit an indirect one. We also suggest that candida along with other co-factors may play a role in initiation and promotion of carcinogenesis.

Oxidant-antioxidant status in blood and tumor tissue of oral squamous cell carcinoma patients

BACKGROUND AND OBJECTIVE

Increased oxidative and nitrosative stress associated with disturbances in antioxidant defense system have been implicated in the pathogenesis of several diseases, most notably oral cancer. The aim of this study was to evaluate the oxidant-antioxidant status in blood samples and tumor tissue in oral squamous cell carcinoma (OSCC) patients in comparison with the healthy controls.

METHODS

Blood and tumor tissue samples from the diseased individuals and the normal controls were analyzed for malondialdehyde (MDA) and nitric oxide (NO) as indicators of oxidative stress and nitrosative stress respectively; superoxide dismutase (SOD) and catalase enzymes as indicators of antioxidant defense by UV visible spectrophotometer.

RESULTS

Malondialdehyde and NO levels were significantly elevated in the blood and tissue samples of OSCC patients as compared with the healthy controls. The antioxidant enzymes SOD and catalase were significantly reduced in tissue samples of OSCC group than in the control group while in the erythrocytes, catalase levels were significantly reduced and the SOD levels were higher in OSCC group in comparison with the healthy controls.

INTERPRETATION AND CONCLUSION

Increased levels of MDA and NO indicate an increase in the oxidative stress in OSCC patients associated with a deficient antioxidant defense mechanism. This oxidant-antioxidant imbalance may be considered as one of the factors responsible for pathogenesis of cancer. Future studies regarding assessment of oxidant-antioxidant status in OSCC patients in view of selecting appropriate mode of therapy and the effectiveness of such therapy in limiting the tumor progression and recurrence is to be carried out.

Congenital hairy polyp associated with cleft palate-a rare entity

Hairy polyps are common congenital benign lesions of oroand nasopharynx containing elements of both ectodermal and mesodermal origin. However, their occurrence in palate is quite rare. Here we present a case of hairy polyp associated with palatal cleft in an eight months old female infant. We discuss the clinicopathological features, etiology, proposed theories related to its formation and its significance.

Congenital osteolipoma associated with cleft palate: a case report

Congenital tumors of the oral cavity are uncommon. Teratoid tumors account for most of the reported cases and are infrequently associated with a cleft of the soft palate. Of the remaining tumors associated with pediatric cleft palate, congenital lipoma is rare. Lipomas of the oral cavity may show cartilaginous or osseous changes. These changes have not been reported in lipoma associated with cleft palate. A rare case of congenital osteolipoma associated with cleft palate and showing osseous change is presented here. The pathogenesis of the lesion and the osseous metaplasia are described. The present case is the second case of congenital lipoma associated with cleft palate in the literature.