Publications by authors named "Natarajan Srikant"

43 Publications

Log odds of positive lymph nodes as an independent predictor of overall survival in oral squamous cell carcinoma.

J Oral Maxillofac Pathol 2020 Sep-Dec;24(3):576. Epub 2021 Jan 9.

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, A Constituent Unit of Manipal Academy of Higher Education, Manipal, Karnataka, India.

Context: Log odds of positive lymph nodes (LODDS) have been recently demonstrated as a very promising staging model and have outperformed AJCC pN, lymph node ratio (LNR) category in major cancers. Literature is scarce concerning the prognostic ability of LODDS in oral squamous cell carcinoma (OSCC) patients.

Aims: The present study was aimed to evaluate the importance of LODDS in predicting locoregional recurrence and overall survival (OS) in patients with OSCC compared to LNR.

Settings And Design: The retrospective study was carried out on 194 patients with OSCC cases treated by surgery ± adjuvant therapy from 2008 to 2014 at our institution.

Subjects And Methods: Demographical and clinicopathological details of study cases were recorded. LNR and LODDS were calculated and expressed as a percentage and mean ± standard deviation.

Statistical Analysis Used: The OS analysis was done by the Kaplan-Meier curve followed by log-rank (mantel-cox) test. Univariate and multivariate survival analysis was done to analyze the prognostic ability of LNR% and LODDS after adjusting the clinicopathological parameters by the Cox proportional hazards model.

Results: Patients with cut off values of LODDS >-1.2 and LNR% >4 had significantly lower mean OS ( ≤ 0.001). Multivariate analysis indicated that only mean LODDS >-1.2 was significantly associated with poor OS. Although there was a correlation with locoregional recurrence, LODDS and LNR failed to be the independent predictors of locoregional recurrence.

Conclusions: LODDS was an independent reliable prognostic indicator for patients with OSCCs than conventional staging systems and LNR.
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http://dx.doi.org/10.4103/jomfp.JOMFP_110_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083415PMC
January 2021

Comparison of the efficacy of parental brushing using powered versus manual tooth brush: A randomized, four-period, two-treatment, single-blinded crossover study.

J Indian Soc Pedod Prev Dent 2021 Jan-Mar;39(1):95-100

Professor & Head, Pediatric & Preventive Dentistry, Manipal College of Dental Sciences, Mangalore (MAHE, Manipal) Light House Hill Road, Mangalore, Karnataka, India.

Background: Children <5 years of age need parental assistance with tooth brushing.

Purpose: The aim is to compare the efficacy of manual and powered toothbrushes for plaque removal when used by parents to brush their children's teeth.

Methods: This randomized, four-period, two-treatment, examiner-blinded, crossover clinical trial comprised children aged 3-5 years. Tooth brushing was performed by the parent using a manual or powered toothbrush. Pre- and post-brushing plaque assessments were performed using the Turesky Modified Quigley-Hein Plaque Index. Differences in plaque scores were calculated using the paired t-test.

Results: A significant difference (P < 0.001) in the reduction of the plaque score was observed between the manual and powered tooth brushing groups.

Conclusion: Powered toothbrushes performed significantly better than manual toothbrushes in terms of plaque removal when used by parents to brush their child's teeth.
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http://dx.doi.org/10.4103/jisppd.jisppd_465_20DOI Listing
April 2021

Evaluation of Cognitive Impairment in Type 2 Diabetic Patients with Chronic Periodontitis: A Cross-sectional Study.

J Int Soc Prev Community Dent 2021 Jan-Feb;11(1):50-57. Epub 2021 Jan 30.

Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Background: Type 2 diabetes mellitus is an important risk factor for dementia; it also shares a bidirectional relationship with periodontitis. It is hypothesized that the increased severity of periodontitis is associated with cognitive decline in patients having uncontrolled diabetes mellitus. An added risk for future development as well as progression of dementia may be prophesied in such a scenario. Therefore, the present study was conducted to find a correlation between the cognitive impairment (CI) and periodontitis in type 2 diabetes mellitus patients.

Materials And Methods: A total of 160 older adults aged ≥60 years in Mangalore, Karnataka, India, were included in the present analysis. Known T2DM patients aged ≥60 years and diagnosed with periodontitis with a minimum clinical attachment loss (CAL) of ≥2 mm were considered in the present study. Montreal cognitive assessment test assessed the CI. The analysis was carried out using the χ test, an independent -test. Binary logistic regression analysis (enter method) was performed to derive the odds ratios (95% confidence interval).

Results: The study included 160 participants, out of which 120 had CI and 40 did not have CI. A statistically significant association was observed between moderate-to-severe periodontitis, HbA1c levels ≥7%, and CI after excluding the confounding factors like age, gender, diet, lifestyle habits, and education.

Conclusion: In the present study, cognitive impairment was found to coexist with HbA1c levels ≥7% and moderate-to-severe periodontitis in the elderly diabetics. The clinical implication of these findings adds opportunities to form disease modifiable areas in the elderly diabetic population at a risk for the development of dementia. Additionally, the impact of pre-existing CI on progression of periodontitis and vice versa has been discussed.
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http://dx.doi.org/10.4103/jispcd.JISPCD_349_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934817PMC
January 2021

Assessment of knowledge of use of electronic cigarette and its harmful effects among young adults.

Open Med (Wars) 2020 25;15(1):796-804. Epub 2020 Aug 25.

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Karnataka, India.

Background: The practice of young adults smoking e-cigarette may have been adopted as a way of smoking cessation or just to follow a trend. Most people still remain unaware of the detrimental effects of e-cigarette. This study was carried out to assess the prevalence of the habit of smoking e-cigarette and the awareness of its harmful effects among adults aged 18-23 years.

Methods: A questionnaire adopted from a study conducted in Italy was used in the study following due permission. After taking their consent, participants were requested to fill the survey irrespective of their smoking status.

Results: In total the study comprised 710 participants aged 20.7 ± 1.7 years (females = 412 and males = 298) from six countries. Most respondents were from India followed by the USA and then the UK. The most common mode of information for the participants on the existence of e-cigarette was from the family members, friends followed by Internet search engines and TV/newspaper advertisements. Among the participants, e-cigarette had a prevalence of 5.63%. Among these, 26 participants were using e-cigarette for less than 1 year and 2 participants for more than 5 years. E-cigarette smokers also experienced sore throat, cough, headache, dizziness and sleeplessness.

Conclusion: Majority of the young population was unaware about the use and harmful effects of e-cigarette.
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http://dx.doi.org/10.1515/med-2020-0224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711978PMC
August 2020

Morphometric and Volumetric Measurements of Orbit With Cone-Beam Computed Tomography.

J Oral Maxillofac Surg 2021 Mar 22;79(3):652-664. Epub 2020 Oct 22.

Professor, Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Purpose: The purpose of this study was to determine cone-beam computed tomography (CBCT) as a tool for measuring morphometric and volumetric measurements of the orbit. Also, to assess gender and age variations and compare traditional methods of measurements in dry-skull, cadaveric, and other imaging modalities.

Patients And Methods: Morphometric and volumetric values of 98 orbits (49 subjects, 21 men/28 women) were measured using CBCT. Their mean and standard deviation were measured and analyzed. The gender and age variability older and younger than 40 years were evaluated. They were compared with other dry-skull and imaging studies done among different populations.

Results: CBCT could accurately measure the various morphometric and volumetric parameters of the orbit. From the reference point infraorbital foramen (I) to lacrimal fossa (F1), inferior orbital fissure (F2), inferior orbital rim (F3), and the optic canal (F4) were (in mm) (mean ± SD) 22.88 ± 1.08, 32.53 ± 0.88, 7.44 ± 0.71, and 51.45 ± 1.28, respectively. From the reference point, superior orbital notch/foramen (S) to superior orbital fissure (S1), lacrimal fossa (S2), and the optic canal (S3) were 49.29 ± 2.1, 26.39 ± 1.58, and 46.82 ± 0.88, respectively. From the reference point frontozygomatic suture (L) to lacrimal fossa (L1), superior orbital fissure (L2), the optic canal (L3), and inferior orbital fissure (L4) were 18.19 ± 0.88, 39.91 ± 1.44, 47.63 ± 1.11, and 35.19 ± 1.02, respectively. Orbital volume was found to show a significant difference between older and younger than 40 years of age, though not significant compared between men and women.

Conclusion: CBCT is a viable tool for morphometric and volumetric measurements of the orbit and other orocraniofacial structures. It can also assess age and gender variability. The low cost, high accuracy, low radiation, and ease of use can help in reproducibility among the different living populations.
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http://dx.doi.org/10.1016/j.joms.2020.10.026DOI Listing
March 2021

Influence of Psychosocial Factors and Parafunctional Habits in Temporomandibular Disorders: A Cross-Sectional Study.

Perm J 2020 22;24. Epub 2020 Apr 22.

Manipal Academy of Higher Education (MAHE), Karnataka, India.

Introduction: Temporomandibular disorders (TMDs) are abnormalities affecting the temporomandibular joint, jaw muscles, or both. An intrinsic relationship reportedly exists between TMDs and psychosocial factors, including stress. Parafunctional habits such as bruxism and clenching are also known to be responsible for TMDs.

Objective: To determine the association of anxiety, depression, and bruxism with TMD symptoms and their relationship with age and sex.

Methods: Patients included in the study reported, as their chief concern, pain lasting for more than a week in the temporomandibular joint area and/or masticatory muscles. The patients were divided into age groups as follows: Younger than 20 years, 21 to 30 years, 31 to 40 years, 41 to 50 years, 51 to 60 years, and above 60 years. Patients were examined clinically and were asked to complete an anamnestic questionnaire (modified version of Helkimo Anamnestic Index) and the Hospital Anxiety and Depression Scale (HADS).

Results: Seventy-five patients (55 women, 20 men) were included in the study. The prevalence of TMDs was higher in female patients, of whom 33 (60%) had moderate to severe TMDs. Of the 20 male patients, 12 (60%) had signs and symptoms of moderate TMDs. Anxiety and depression scores were higher in female patients. No significant correlation was found between degree of malocclusion and TMDs.

Discussion: We found correlations between the degree of TMD with age, sex, parafunctional habits, and psychosocial factors. Symptoms of TMD seemed to increase in patients with parafunctional habits, from younger to older age groups, and with increased anxiety and depression scores.

Conclusion: The degree of TMDs is higher in women, and TMDs are associated with higher anxiety and depression scores. Correlation between these factors paves the way for preventive actions aimed at those with moderate and severe signs of TMDs.
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http://dx.doi.org/10.7812/TPP/19.144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213367PMC
April 2020

Detection of Salivary Alkaline Phosphatase Levels in Smokers, Diabetic Patients, Potentially Malignant Diseases and Oral Malignant Tumours.

J Pharm Bioallied Sci 2020 Aug 28;12(Suppl 1):S430-S435. Epub 2020 Aug 28.

Department of Oral and Maxillofacial pathology, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India.

Aim: Alkaline phosphatase (ALP) is present in human and plays a key role in intracellular destructive processes and cellular damage. It has bicarbonate and phosphate ions, which help in buffering against acids. ALP activity is affected by smoking, which changes pH in oral environment and has harmful effects. Thus, the evaluation of ALP activity of smokers and healthy nonsmoker along with patients who were diabetic, potentially malignant, and malignant was carried out in this study.

Materials And Methods: The study took place between 2016 and 2017. A total of 150 smokers, non-smokers, and patients who were diabetic, potentially malignant, and malignant were included. Collection of unstimulated whole saliva was done from each participant, and salivary ALP levels were measured by spectrophotometric assay.

Results: Mean salivary ALP levels were significantly higher in smokers compared to those in nonsmokers. Mean ALP levels were also increased in patients who were diabetic, potentially malignant, and malignant compared to those in controls.

Conclusion: ALP levels were significantly higher among smokers when compared to a healthy control group. Oral tissue function and side effects among smokers can be evaluated by these salivary enzyme alterations, which can serve as biomarkers for the diagnosis of any disease process. These salivary alterations could potentially be used as biochemical markers for the evaluation and early diagnosis. The higher levels were also found in patients who were diabetic, potentially malignant, and malignant, and ALP levels may also be used as biomarkers for the evaluation of the disease process.
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http://dx.doi.org/10.4103/jpbs.JPBS_129_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7595559PMC
August 2020

Cellular and Biochemical Changes in Different Categories of Periodontitis: A Patient-based Study.

J Int Soc Prev Community Dent 2020 May-Jun;10(3):341-349. Epub 2020 May 7.

Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangaluru, Karnataka, India.

Objectives: The aim of this study was to study the effects of periodontitis, diabetes mellitus (DM), and tobacco smoking and chewing habits (TBSCH) on the oxidative stress biomarker levels, namely malondialdehyde (MDA), and the mucosal genotoxic nuclear damage in the marginal gingival cells of subjects. Furthermore, the correlation of the biomarkers, MDA, and nuclear changes in the form of micronucleation (Mn) and binucleation (Bn) was investigated.

Materials And Methods: Forty study participants were divided into five subject categories, which were established based on the presence of periodontitis, DM, and TBSCH. Whole saliva and marginal gingival smears collected from subjects were used to determine MDA levels and nuclear changes, respectively. A full-mouth assessment of periodontal pocket depth, clinical attachment loss, and bleeding on probing was performed for each subject to determine periodontal status.

Results: MDA and Mn levels between control group and subjects with only periodontitis (MDA: < 0.9990; Mn: < 0.8200) showed no significant difference, whereas levels among subjects with DM, TBSCH, and periodontitis, and all other categories were statistically significant (MDA: < 0.001). DM and/or TBSCH superimposed on periodontitis cause an exponential increase in biomarker levels. Furthermore, MDA and Mn showed poor correlation ( = 0.162; = 0.318). Periodontitis alone did not significantly increase oxidative stress levels compared to healthy controls, whereas DM and TBSCH resulted in augmented oxidative stress levels, implying that increased stress produced by DM and TBSCH aggravates or exaggerates periodontal inflammation.

Conclusion: Poor correlation between MDA and Mn indicated that the mechanisms involved in their production are independent of each other.
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http://dx.doi.org/10.4103/jispcd.JISPCD_42_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402257PMC
May 2020

Recognition of lysyl oxidase as a potential predictive biomarker for oral squamous cell carcinoma: an immunohistochemical study.

Minerva Stomatol 2020 Dec 3;69(6):360-369. Epub 2020 Aug 3.

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, India.

Background: Lysyl oxidase (LOX) is a copper amine oxidase which belongs to the LOX multigene family and is normally involved in cross-linking of stromal collagen fibers. LOX expression has been found to be associated with increased episodes of recurrence, metastasis and overall poor prognosis in renal cell carcinomas and melanomas. This study aimed to assess the effects of LOX on the prognosis of oral squamous cell carcinoma (OSCC), which is one of the most common cancers in India.

Methods: The immunohistochemical expression of lysyl oxidase using LOX2 primary antibody was assessed at the tumor proper, invasive tumor front and peritumoral stroma in tissue sections from 40 cases of histologically proven OSCC.

Results: LOX expression was elevated in OSCC patients who had lymph node metastasis and in those who died of disease. No significant variation was seen with histological grade.

Conclusions: LOX has a 'pro-neoplastic' effect as it modulates the host stroma to favor increasing tumor mass and worsening prognosis. Increased expression of LOX causes increased collagen fiber cross-linkage that stiffens the stromal matrix. This increases compressive stresses contributing to tissue hypoxia that elevates Rho GTPase-dependent cytoskeletal tension leading to erratic tumor cell morphogenesis that in turn confers motility to these cells resulting in metastasis. Inhibitors of LOX can potentially down-regulate LOX levels in the tumor micro-environment by controlling tissue hypoxia and curtailing the production of hypoxic LOX molecules.
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http://dx.doi.org/10.23736/S0026-4970.20.04356-3DOI Listing
December 2020

Effect of three silver diamine fluoride application protocols on the microtensile bond strength of resin-modified glass ionomer cement to carious dentin in primary teeth.

J Indian Soc Pedod Prev Dent 2020 Apr-Jun;38(2):138-144

Department of Pediatric and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India.

Background: Use of silver diamine fluoride (SDF) after selective caries excavation can arrest the further progress of the carious lesion. Application of potassium iodide (KI) can reduce the staining due to SDF.

Aim: The aim of the study was to evaluate the effect of the application of SDF, with and without acid etching and KI on the bond strength of resin-modified glass ionomer cement (RMGIC) to the carious dentin of primary teeth.

Materials And Methods: In thisin vitro study, caries was induced on the occlusal surface by inoculating Streptococcus mutans strain in 36 extracted primary molars. The teeth were divided into four groups (n = 9), and the following treatments were done to the carious dentin prior to final restoration with RMGIC: Group I: 10% polyacrylic acid conditioner, Group II: 38% SDF, Group III: 37% phosphoric acid etchant followed by 38% SDF, and Group IV: 37% phosphoric acid etchant followed by 38% SDF and 10% potassium iodide solution. The microtensile bond strength was measured using universal testing machine. Failure modes were recorded using a scanning electron microscope.

Results: There was no significant difference in microtensile bond strengths between the groups (P = 0.665), with the highest value seen in Group III.

Conclusions: Application of SDF with or without acid etching and KI does not affect the bond strength of RMGIC to carious dentin of primary teeth.
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http://dx.doi.org/10.4103/JISPPD.JISPPD_159_20DOI Listing
July 2020

Patterns of Tobacco Use and its Relation to Oral Precancers and Cancers among Individuals Visiting a Tertiary Hospital in South India.

J Contemp Dent Pract 2020 Mar 1;21(3):304-309. Epub 2020 Mar 1.

Department of Oral Medicine and Radiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangaluru, Karnataka, India.

Aim: The aim of this study was to evaluate the use of tobacco and its association with oral precancers and cancers.

Materials And Methods: Medical records of 1,007 individuals were assessed for the patterns of tobacco abuse and the presence of tobacco-related oral mucosal alterations.

Results: This study comprised 1,007 individuals (M:F: 95.4%:4.6%). In the cohort, 60.1% had smoking habit and 56.1% had smokeless habit. Of the bidi smokers, 18.2% developed carcinoma, 14.3% developed leukoplakia, which is statistically significant ( < 0.001). A logistic regression analysis of the development of oral submucous fibrosis (OSMF) shows that habit of smokeless forms of tobacco has an odds ratio (OR) of 18+ when compared with smoking. Combination of bidi and gutkha had 12.3 times higher risk of developing oral cancer and 4.4 times risk of developing leukoplakia. A total of 33.3% betel quid and gutkha chewers presented with tobacco pouch keratosis, which is statistically significant.

Conclusion: Smoked and smokeless forms of tobacco were equally popular among the study population. The packeted form of smokeless tobacco (gutkha) was more prevalent. Oral submucous fibrosis was more common than leukoplakia, and oral cancer developed more frequently in elderly men smoking bidis.

Clinical Significance: This study throws light on the fact that the use of both smoke and smokeless forms of tobacco is still prevalent, and the use of gutkha was most prevalent. These findings will help tobacco cessation and counseling centers to focus their effort in motivating people to stop gutkha chewing habit. This also brings to the forefront the need to create better treatment strategies to manage OSMF.
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March 2020

Efficiency of Mobile Video Sharing Application (WhatsApp®) in Live Field Image Transmission for Telepathology.

J Med Syst 2020 May 2;44(6):109. Epub 2020 May 2.

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, India.

Telepathology is in its nascent stages in India. Video calling applications in mobile phones can be efficiently used to transmit static and live field microscopic images hastening low cost telepathology. To evaluate the efficiency of WhatsApp® Video Calling for dynamic microscopy in distant diagnosis. Thirty haematoxylin and eosin stained slides of common pathologies were retrieved from the archives of Department of Oral Pathology and Microbiology, coded with relevant history and given to three untrained investigators. The investigators then connected a mobile phone with VOIP facility to a microscope using a custom adaptor. Dynamic fields were transferred to three independent pathologists via WhatsApp® video call. The pathologists attempted to diagnose the lesion based on the live field video over their display screen (phone). Audio quality was found to be better than that of video. In 70% of the cases, pathologists could render a diagnosis (13% gave a confirmed diagnosis, 57.7% gave a probable diagnosis). The average time taken for connecting the adaptor, connecting the call to the pathologist and then receiving the diagnosis was 9:30 min. In addition, proper history taking and staining of the tissue slides were critical to arrive at the diagnosis. WhatsApp® free VOIP facility helped untrained investigators to send the live-field pathologic fields to a specialist rendering histopathological diagnosis. The factors affecting the diagnosis included network stability, clarity of images transmitted, staining quality and contrast of nuclear details of the stain. The history, clinico-pathologic correlation, transmission of static images, training of the person transmitting the images plays a vital role in rendering accurate diagnosis. Telepathology over WhatsApp® video calling could be used as an efficient screening tool to identify suspicious lesions and follow-up critical cases.
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http://dx.doi.org/10.1007/s10916-020-01567-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7196079PMC
May 2020

Assessing the behavior management problems during the first dental visit of preschool children using a doll placement test.

J Indian Soc Pedod Prev Dent 2020 Jan-Mar;38(1):41-47

Department of Paedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.

Context: Assessing dental anxiety as a predictor of the likely behavior of the child in the dental operatory is of paramount importance for a clinician to render quality care.

Aim: This study aims to correlate the dental anxiety of preschool children as shown during the doll placement test with that of their behavioral patterns during the first dental visit.

Settings And Design: This cross-sectional study was conducted between the ages of 3-7 years.

Materials And Methods: During their first dental visit, the background variables were elicited from parent/guardian at the reception desk. Later at the play area, the child was given a set of dolls representing dentist, child, and mother to place them in a model dental office having a dental chair. The child was then taken for the initial oral examination, during which the behavior of the child was rated using Frankl's Behavior Rating Scale. The data collected were analyzed using Chi-square test and binary regression analysis.

Results: The observed association between the doll placement pattern and the behavior of the patient during dental treatment was statistically significant (P < 0.001). The binary regression analysis showed that the child's unpleasant previous medical and parent's unpleasant dental experiences had higher odds favoring uncooperative behavior (46.63 and 41.93, respectively).

Conclusions: The child's behavior on the dental chair is associated with the doll placement pattern, which is also influenced by experiences of the child during his/her encounter with the medical doctor and previous dental experiences of their parents.
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http://dx.doi.org/10.4103/JISPPD.JISPPD_206_19DOI Listing
March 2020

Comparison of Transcutaneous Electric Nerve Stimulation (TENS) and Microcurrent Nerve Stimulation (MENS) in the Management of Masticatory Muscle Pain: A Comparative Study.

Pain Res Manag 2019 23;2019:8291624. Epub 2019 Nov 23.

Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.

Introduction: Temporomandibular disorders (TMDs) are a heterogeneous group of pathologies affecting the temporomandibular joint (TMJ), the jaw muscles, or both. Epidemiological studies of TMD reveal a prevalence of 82% in the general population with 48% of them presenting with clinical features of muscle tenderness and difficulty in mouth opening. TMD are considered to be the most common orofacial pain conditions of nondental origin.

Methods: The patients with TMD were randomly divided into two groups, A and B, based on their VAS scale. Group A consists of two subgroups 1 and 2 each consisting of 15 patients. Group B consists of two subgroups 3 and 4 consisting of 15 patients. Patients in Group A were given TENS for twenty minutes, and the frequency is adjusted as follows: (i) subgroup 1: TENS frequency at a range of 0-5 (VAS measuring 1-5) and (ii) subgroup 2: TENS frequency at a range of 5 and above (VAS measuring 6-10). Patients in Group B were given MENS for twenty minutes, and the frequency adjusted as follows: (i) subgroup 3: MENS frequency at range of 0-5 (VAS measuring 1-5) and (ii) subgroup 4: MENS frequency at a range of 5 and above (VAS measuring 6-10). Each patient was recalled for five consecutive days for the treatment, and the same intensity and frequency were maintained throughout the treatment period.

Results: The improvement in VAS is seen to be highly significant statistically in MENS subgroup 4 (moderate-to-severe pain). Subgroups 1 and 3 had improvement in VAS which was comparable in both TENS and MENS groups.

Conclusion: In the present study, it was found that TENS and MENS are equally effective in improving the functional mouth opening. MENS showed better and immediate effect in relief of pain. Microcurrent also has the advantage of being subthreshold, and hence the side effects such as tingling sensation and paresthesia seen to occur in some patients following TENS are absent. TENS and MENS can be considered as the first line of treatment in patients with acute and chronic masticatory muscle pain and also as an effective treatment option in cases of functional mouth opening.
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http://dx.doi.org/10.1155/2019/8291624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906807PMC
April 2020

Comparative analysis of the remineralization potential of CPP-ACP with Fluoride, Tri-Calcium Phosphate and Nano Hydroxyapatite using SEM/EDX - An study.

J Clin Exp Dent 2019 Dec 1;11(12):e1120-e1126. Epub 2019 Dec 1.

MDS, Senior Lecturer, Department of Pedodontics and Preventive Dentistry, Indira Gandhi institute of dental sciences, Nellikuzhi, Kothamanagalam, Kerala -India. Kerala University of health sciences.

Background: In recent years, the non-invasive management of non cavitated caries lesions using remineralization systems to repair the enamel have received more attention from the scientific community. Aim: To quantitatively evaluate the remineralization potential of Casein phosphopeptide-amorphous calcium phosphate-fluoride(CPP-ACPF), Tri-calcium phosphate(TCP) & Nano-hydroxyapatite(nHAP) using Scanning Electron Microscopy(SEM) and Energy dispersive X-ray Analysis(EDX).

Material And Methods: 40 enamel specimens were prepared, and immersed in demineralising solution at a pH of 4.4 for 96 hours at 37°C, to induce artificial carious lesions. Remineralization was carried out for a period of 30 days using CPP-ACPF, TCP, nHAP. The specimens were evaluated for calcium and phosphorus content using SEM-EDX.

Results: The Ca/P mass % after remineralization was significantly higher with CPP-ACP-F and TCP-F followed by nHAP.

Conclusions: CPP-ACP-F and TCP can promote significant remineralization of incipient carious lesions. These are excellent delivery vehicles available in a slow release amorphous form to localize calcium, phosphate and fluoride at the tooth surface. Remineralization, in vitro; CPP-ACP fluoride, Nano-hydroxyapatite, Tri-calcium phosphate, SEM/ EDX.
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http://dx.doi.org/10.4317/jced.55941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894921PMC
December 2019

Assessment and comparison of nuclear changes seen in gingivitis and periodontitis using fluorescent microscopy.

Rev Esp Patol 2019 Oct - Dec;52(4):208-213. Epub 2019 May 21.

Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, India.

Introduction And Objectives: The objective of this study was to observe the evolution of genotoxicity (micronucleation, binucleation and multinucleation) from normal to periodontally compromised gingival epithelium (gingivitis and periodontitis) and to compare the severity of damage.

Methods And Material: 45 participants formed 3 different categories; a control group of 15 healthy subjects, 15 subjects with gingivitis and 15 with chronic periodontitis. Smears were collected from all the gingiva and stained with acridine orange stain. A total of 500 cells were evaluated under fluorescent microscopy for nuclear abnormalities such as micronuclei, binucleation and multinucleation. The statistical analysis used was one way ANOVA and posthoc Tukey test.

Results And Conclusion: A statistically significant difference was observed when the age of the 3 groups were compared (p=0.002); the control group were younger than those with chronic periodontitis or gingivitis. With respect to genotoxic changes, the differences for binucleation (p=0.002) and multinucleation (p<0.001) were statistically significant thus suggesting advanced damage in the nucleus. Such changes in genotoxicity could be of help to a clinician in determining prognosis.
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http://dx.doi.org/10.1016/j.patol.2019.03.002DOI Listing
June 2020

Comparative evaluation of sealing ability, penetration and adaptation of a self etching pit and fissure sealant- stereomicroscopic and scanning electron microscopic analyses.

J Clin Exp Dent 2019 Jun 1;11(6):e547-e552. Epub 2019 Jun 1.

Associate Professor. Department of Pedodontics and Preventive Dentistry, Mangalore, Manipal Academy of Higher Education, Manipal.

Background: The efficacy of pit and fissure sealants in preventing occlusal caries is a well-established fact. Considering the difficulty in achieving strict isolation for a longer duration while treating the pediatric patients, a simplified procedure of sealant application is desirable. While, a self-etching sealant, Prevent Seal offers a quick procedure, the physical properties of this material haven't been studied yet. Thus, this study was aimed to comparatively evaluate sealing ability, penetration and adaptation of a self-etching pit and fissure sealant and a conventional resin sealant.

Material And Methods: This was an intergroup comparative study, which consisted of 2 groups- Group I (Conventional acid etch sealant, Clinpro) and Group II (Self etching sealant, Prevent Seal). Out of 32 selected teeth 16 were used to study microleakage, with the help of dye penetration test using Övrebö and Raadal criteria. Remaining 16 were used to evaluate sealant penetration and adaptation viz bubbles in the bottom of fissure, debris in the fissure, tags in the bottom of the fissure and tags at cuspal slopes and fissure entrance was done using stereomicroscope. Post stereomicroscopic evaluation 4 samples each were randomly chosen from both the groups and checked for etching pattern using Scanning electronic microscope.

Results: The comparison of tested properties between the groups was done using Chi square test. There was no statistically significant difference observed when microleakage and sealant penetration / adaptation properties were compared between two groups (=0.63 and = 0.131, 0.131, 0.302, 0.106 respectively). No conclusive results could be withdrawn while etching patterns were compared between the groups (=0.717).

Conclusions: The self-etching sealant Prevent seal was found to have similar microleakage, sealant penetration and adaptation properties as conventional acid etch sealant. Pit and fissure sealant, self-etching, scanning electron microscope, sealing ability.
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http://dx.doi.org/10.4317/jced.55624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6645258PMC
June 2019

A Prospective Study of the Clinical and Demographic Profile of Type 2 Diabetes Mellitus Patients Receiving Antidiabetic Drug Combinations.

Curr Diabetes Rev 2020 ;16(5):503-508

Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka 575001, India.

Background: The specific treatment recommendations for type 2 diabetes mellitus (T2DM) differ based on a particular guideline. The goal of pharmacotherapy is to achieve the target HbA1c and fasting and postprandial blood glucose levels to avoid disease complications.

Objective: To evaluate the profile of T2DM patients on different antidiabetic treatment regimens and the factors leading to dose escalation in these patients.

Methods: A prospective descriptive study was conducted at Kasturba Medical College Hospital, Mangalore, a tertiary care teaching hospital, over a period of one year. The study population comprised of patients with T2DM for ≥5 years. The demographic and clinical data were collected during the baseline and follow-up visits.

Results: Of the 119 patients studied, 59.7% were males; 32.8% were ≥65 years of age. A significant decrease in the fasting blood glucose (FBG) on follow-up was seen (p = 0.028) in patients on sulfonylurea and metformin combination. A significant decrease in the glycated haemoglobin (HbA1c) was seen in patients on sulfonylurea with metformin and pioglitazone (p = 0.011); sulfonylurea with metformin, pioglitazone, and sitagliptin (p = 0.026); and metformin with insulin (p = 0.001). Patients who received dose escalation had a longer duration of the disease (p = 0.042), higher FBG (p = 0.039) and HbA1c (p = 0.05).

Conclusion: A combination of metformin with sulfonylurea was the preferred first-line treatment; insulin was added when HbA1c was >9. Patients who received dose escalation had a longer duration of the disease and higher FBG and HbA1c.
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http://dx.doi.org/10.2174/1573399815666190619125857DOI Listing
June 2020

Remineralising Effectiveness of Two Fluoride Varnishes Containing Additives: An In Vitro Study.

Oral Health Prev Dent 2019 ;17(4):385-393

Purpose: To assess the remineralising efficacy of fluoride varnish containing additives and conventional sodium fluoride varnish.

Materials And Methods: 72 extracted upper central incisors specimens were randomly allocated to four groups after demineralisation: control; 5% sodium fluoride varnish (FV) (Fluoritop-SR); resin modified glass ionomer-based calcium phosphate containing fluoride varnish (CV) (Clinpro XT); fluoride varnish with xylitol coated calcium phosphate (cXp) (Embrace). Change in surface morphology, calcium phosphorous ratio and fluoride content of enamel were evaluated using scanning electron microscope and energy dispersive X-ray analysis (SEM-EDAX). Change in surface roughness was evaluated using profilometer analysis. All readings were taken at baseline, after demineralisation, at 2 weeks and 4 weeks of remineralisation.

Results: At 4 weeks of remineralisation surface roughness values were ranked as follows: control > FV = cXp > CV. Calcium phosphorus ratios were in the order: CV > FV = cXp > control and fluoride content (for treatment groups): CV = cXp > FV. Scanning electron microscopy images showed mineral deposition on the surfaces of the treatment groups with different deposition pattern of minerals.

Conclusion: Fluoride varnishes with or without additives are effective in remineralisation of early enamel lesions. Glass ionomer-based fluoride varnish results in better remineralisation than xylitol coated calcium phosphate containing fluoride varnish and 5% sodium fluoride varnish.
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http://dx.doi.org/10.3290/j.ohpd.a42686DOI Listing
November 2019

A correlation of immunohistochemical expression of and severity of inflammation with varying grades of oral squamous cell carcinoma.

J Cancer Res Ther 2019 Jul-Sep;15(3):564-570

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India.

Purpose: Epithelial cells exposed to carcinogens and genetic damage, once surpass reversible cell damage, either undergo apoptosis or transform into malignancy, chiefly oral squamous cell carcinoma (OSCC). Progressive accumulation of genetic errors in TP53 results in tumorigenesis. Inflammation is also a modulator in this process. The present study attempted to correlate the immunohistochemical expression of TP53 with increased aggressiveness of OSCC, to determine how these immune cells regulate the path of carcinogenesis and to define the role of inflammation in TP53 immunoexpression.

Materials And Methods: Tissue sections from 24 biopsy-proven cases of OSCC were stained with anti-TP53 antibody. Five hundred neoplastic epithelial cells and inflammatory cells, each, were counted at invasive tumor front. Two hundred peritumoral neutrophils were counted based on nuclear lobes present.

Results: The least TP53 expression was seen in well-differentiated OSCC (P < 0.001), whereas neutrophil count and plasma cell count were found to be least in well-differentiated OSCC (P < 0.001), whereas the number of lymphocytes and macrophages decreased with increased grading of OSCC (P < 0.001). Four- and five-lobed neutrophils were found to be highest in poorly differentiated OSCC (P < 0.001), whereas two-lobed neutrophil count was seen to be maximum in well-differentiated OSCC (P < 0.001).

Conclusion: TP53 plays a significant role in the initiation and progression of OSCC. Inflammation plays a role of friend and a foe simultaneously, and little modification in the present treatment modalities for OSCC can bring a favorable change in the life of cancer survivors.
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http://dx.doi.org/10.4103/jcrt.JCRT_8_17DOI Listing
November 2019

Evaluation of the effectiveness of a custom-made toothbrush in maintaining oral hygiene and gingival health in cerebral palsy patients.

Spec Care Dentist 2018 Nov 23;38(6):367-372. Epub 2018 Oct 23.

Department of Paedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Manipal, India.

Aim: To evaluate and compare the efficacy of customized toothbrushes in maintenance of oral hygiene and gingival health with that of conventional toothbrushes in children with cerebral palsy.

Methods: Thirty patients with cerebral palsy in the age group of 6 to 18 years were randomly divided into two groups-group I (normal toothbrush) and group II (customized toothbrush). Common oral hygiene instructions were given to both the groups. Before beginning the study, plaque index (PI) and modified gingival index (MGI) were recorded, following which patients were made to practice their routine twice a day brushing with either normal toothbrush or custom-made toothbrush for 3 weeks. At the end of 3 weeks, PI and MGI were rerecorded. The subjects belonging to group II were also made to perform muscle exercises using the modified brush head.

Results: Significantly high percentage drop between the pre- and post-PI as well as MGI (31.55% and 30.23%, respectively) was observed in the custom-made toothbrush group, while the percentage drop of only 8.34% (PI) and 14.51% (MGI) was seen in the normal toothbrush group.

Conclusions: Custom-made tooth brushes increased the efficiency of maintaining oral hygiene and gingival health of individuals with cerebral palsy.
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http://dx.doi.org/10.1111/scd.12334DOI Listing
November 2018

Expression of α-smooth muscle actin in benign and malignant salivary gland tumors: An immunohistochemical study.

Indian J Pathol Microbiol 2018 Oct-Dec;61(4):479-484

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, Karnataka, India.

Background And Objectives: Myoepithelial cells (ME) are known to contribute in the patterning of salivary gland neoplasms (SGN) and possess cytoplasmic smooth muscle actin (SMA) revealed by alpha SMA (α-SMA). The present study aimed to assess the expression of α-SMA in selected benign and malignant SGN (pleomorphic adenoma [PA], mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ACC), and polymorphous low-grade adenocarcinoma (PLGA).

Materials And Methods: The intensity and pattern of expression of α-SMA were studied in 25 cases of SGN's ACC (n = 7), MEC (n = 8), PA (n = 8), and PLGA (n = 2), and correlated with the histological patterns.

Results: Maximum expression of α-SMA in the epithelial compartment was seen in ACC, followed by PA, whereas MEC and PLGA showed completely negative staining. The connective tissue expression was mild in ACC and MEC. The myxoid stroma of PA with "melting" pattern was weakly positive for α-SMA. The stroma in PLGA showed complete negativity. In ACC, α-SMA-positive cells were lining the cribriform spaces, small islands, and dispersed within large islands. Small nests showed complete positivity for α-SMA.

Interpretation And Conclusion: In ACC, α-SMA expression supports the involvement of ME in epithelial organization explaining the histological patterns seen. In PA, the expression correlates with the predominantly secretory nature of ME. The absence of epithelial positivity in MEC and PLGA suggest that ME has less role to play in their histogenesis. The weak stromal positivity observed in MEC and ACC may be attributed to the positive immunoreactivity of myofibroblasts playing a role in modulating the course of SGN's.
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http://dx.doi.org/10.4103/IJPM.IJPM_482_17DOI Listing
February 2019

Surgical Management of Complex Odontoma Associated with Agenesis of a Molar.

Contemp Clin Dent 2018 Sep;9(Suppl 2):S388-S390

Departement of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Karnataka, India.

Odontomas are mixed odontogenic tumors composed of mineralized tissue of ectomesenchymal origin. These are usually detected in routine radiographs and may have a variable etiology such as local trauma, genetic mutation, or infection. They are classified into two main types: complex and compound. Complex odontomas are rare and they rarely erupt into the oral cavity as they lack periodontal ligament. This is the report of one such case of complex odontoma where an 11-year-old girl reported with an asymptomatic swelling, in relation to the left angle of the mandible. The case report highlights the clinical and radiographic findings, investigations done to arrive at the diagnosis and the treatment rendered. This report is of clinical importance because of its rare association with the agenesis of a molar tooth.
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http://dx.doi.org/10.4103/ccd.ccd_789_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169269PMC
September 2018

A correlation of immunohistochemical expression of and in oral epithelial dysplasia and oral squamous cell carcinoma.

J Cancer Res Ther 2018 Apr-Jun;14(3):666-670

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India.

Purpose: Oral epithelial dysplasia (OED) occurs on exposure of epithelial cells to carcinogens and genetic alteration. Once the reversible cell damage is surpassed, cells either undergo apoptosis or transform into malignancy, chiefly oral squamous cell carcinoma (OSCC). Progressive accumulation of genetic errors (including mutations in TP53 and CDKN1A) is associated with the initiation and progression of potentially malignant oral lesions toward frank malignancy. The present study attempted to correlate the immunohistochemical expression of CDKN1A and TP53 with increasing severity of OED along with increased aggressiveness of OSCC as reflected in the clinicopathologic variables.

Materials And Methods: Tissue sections from forty biopsy-proven cases of OED and OSCC were stained with anti-TP53 and anti-CDKN1A mouse monoclonal antibodies. One hundred cells in each case were counted under high power magnification.

Results: Poorly differentiated OSCC showed the highest TP53 expression (mean = 70.285), with least expression seen in mild dysplasia (mean = 22.125) (P < 0.001). Higher TP53 count was seen in cases with margin involvement, without recurrence and lymph node involvement and in cases which died of disease. CDKN1A expression was seen only in five cases and that too focally in the cytoplasm, thereby warranting removal of analysis of CDKN1A positivity from the study.

Conclusion: The expression of TP53 in OED highlights its role in initial carcinogenesis. Although the role of CDKN1A in the cell cycle has been documented, its relationship to various clinical and pathological variables of OSCC and its different treatment modalities could not be adequately assessed.
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http://dx.doi.org/10.4103/0973-1482.180683DOI Listing
November 2018

Remineralizing Effectiveness of Calcium Sucrose Phosphate and Fluoride Dentifrices: An Study.

Contemp Clin Dent 2018 Apr-Jun;9(2):276-282

Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Karnataka, India.

Context: Dentifrices-containing remineralizing agents are known to be effective in remineralization of early enamel lesions.

Aims: This study aimed to compare and evaluate the changes in surface roughness, surface morphology, and mineral content of demineralized enamel lesion after treatment with dentifrices-containing sodium monofluorophosphate, amine fluoride, and Anticay (calcium sucrose phosphate with inorganic amorphous calcium phosphate).

Settings And Design: This was an study.

Subjects And Methods: Eighteen extracted maxillary molars were decoronated and sectioned into four to obtain 72 specimens. Specimens were demineralized and randomly divided into four different test groups: Group A: no treatment (control), Group B: sodium monofluorophosphate dentifrice (Colgate), Group C: amine fluoride dentifrice (Amflor), Group D: Anticay dentifrice (EnaFix) and subjected to pH-cycling for 4 weeks. After 4 weeks, they were assessed using a profilometer and scanning electron microscope (SEM)-energy dispersive X-ray analysis (EDAX) for changes in surface roughness, surface morphology, and mineral content.

Statistical Analysis Used: Intergroup comparison was done using repeated measures ANOVA.

Results: Intergroup comparison revealed no significant difference in surface roughness and mineral content after remineralization between the groups. SEM images showed mineral deposition in all the dentifrice groups obliterating the defects caused due to demineralization.

Conclusions: Sodium monofluorophosphate, amine fluoride-containing dentifrices, and calcium sucrose phosphate with inorganic amorphous calcium phosphate-containing dentifrice were found equivocal in their remineralizing effectiveness of early enamel lesions.
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http://dx.doi.org/10.4103/ccd.ccd_862_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968695PMC
June 2018

Expression of Laminin in Oral Squamous Cell Carcinomas

Asian Pac J Cancer Prev 2018 Feb 26;19(2):407-413. Epub 2018 Feb 26.

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, India. Email:

Background and objectives: Laminin is a significant basement membrane (BM) glycoprotein, the expression of which reflects BM integrity more precisely than do other ECM proteins. The present study aimed to evaluate laminin expression in oral squamous cell carcinomas OSCC and to determine any associations with clinico-pathological parameters (surgical margin status, lymph node involvement, survival and recurrence). Methods: Laminin expression was evaluated in 31 cases of biopsy-proven OSCC by immunohistochemical staining and its association with prognosticators and the Brynes grading system was determined by appropriate statistical analysis. Results: We observed a significant increase in linear staining pattern (p<0.001) at the tumour-host interface in well-differentiated OSCC cases, in contrast to poorly differentiated lesions which exhibited intense cytoplasmic expression within tumour cells. Higher cytoplasmic laminin expression was seen in 33.3% of cases with involved surgical margins and 69.2% of cases with lymph node metastasis (along with weak/absent staining of laminin around the tumour-host interface – Basement membrane around tumour islands). Similarly, in 60% of the cases who died and in 81.8% of cases with tumour recurrence, moderately intense cytoplasmic laminin expression was seen within tumour cells. On comparing variables of the Brynes grading system, significant cytoplasmic expression of laminin was linked with mild inflammation (p<0.0016) and increased mitotic activity (p<0.008). Conclusion: Based on these observations, immunohistochemical expression of laminin might be useful to evaluate histological differentiation and aggressiveness of OSCCs.
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http://dx.doi.org/10.22034/APJCP.2018.19.2.407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5980927PMC
February 2018

Oncocytes in Mucoepidermoid Carcinoma of the Palate: Diagnostic Challenges.

Case Rep Dent 2017 28;2017:5741821. Epub 2017 Dec 28.

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Mangalore, India.

The origin of a salivary gland tumour is attributed to cells at various levels of differentiation which present histologically as diverse tissues and cellular patterns. Mitochondria-rich, eosinophilic oncocytes are cells commonly encountered in salivary gland neoplasms. We report a case of mucoepidermoid carcinoma (MEC) in the palate of a 43-year-old female that exhibited a prominent oncocytic component. While the parotid and submandibular glands have been reported as predominant sites for oncocytic MEC (OMEC), the palate and minor salivary glands are rare sites for occurrence. Also, most of the reported cases of OMEC have been histologically of low-grade mucoepidermoid carcinoma with large cystic spaces and good prognosis. In this article, we discuss the differential diagnosis and diagnostic workup of an MEC presenting with oncocytes.
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http://dx.doi.org/10.1155/2017/5741821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763101PMC
December 2017

A Comparison of Clinicopathological Differences in Oral Squamous Cell Carcinoma in Patients Below and Above 40 Years of Age.

J Clin Diagn Res 2017 Sep 1;11(9):ZC46-ZC50. Epub 2017 Sep 1.

Professor, Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal University Mangalore, Karnataka, India.

Introduction: Recent times have revealed an increase in incidence of Oral Squamous Cell Carcinoma (OSCC) in young adults including those who lack association with typical risk factors such as tobacco. There are reported variations in clinical behaviour of tumours in young and older individuals.

Aim: Present study evaluated differences in clinicopathological characteristics between two groups of OSCC, below and above 40 years of age.

Materials And Methods: An analytical study was performed on two groups of OSCC patients, below and above 40 years of age. Clinicopathological parameters of site distribution, type of habit, histological grade, nodal metastasis, margin status, mitotic index and Argyrophilic Nucleolar Organizing Regions (AgNOR) count were compared. Chi-square test and Students t- test were applied for statistical analysis.

Results: Present study revealed that mean AgNOR count was significantly higher in older group (6.38) than younger group (4.27). However, no significant differences were noted in site distribution, tobacco habit, histological grade, mitotic index, nodal metastasis and status of resected surgical margins between the two age groups. A trend for increased metastasis and poor histological differentiation was also observed in the older and younger age group respectively. Most common site was buccal mucosa followed by tongue in both groups.

Conclusion: Reasons for documented variability in tumour characteristics between young and older patients are currently unclear. Difference in AgNOR count found in present study is suggestive of variability in proliferative and ploidy characteristics between different age groups and supports the hypothesis of genetic and epigenetic influences in development of oral cancer.
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http://dx.doi.org/10.7860/JCDR/2017/27828.10600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5713854PMC
September 2017

Understanding patterns of invasion: a novel approach to assessment of podoplanin expression in the prediction of lymph node metastasis in oral squamous cell carcinoma.

Histopathology 2018 Mar 14;72(4):672-678. Epub 2017 Dec 14.

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, Manipal University, Karnataka, India.

Aims: Cellular motility is considered to be central to the process of metastasis, and podoplanin expression can be explored as a prospective link, owing to its ability to modulate the actin cytoskeleton. We aimed to evaluate the tumoral expression of D2-40 (monoclonal antibody against podoplanin) in pathologically neck-node-negative/positive cases (pN0/N+) to characterise the pattern of invasion, potentially explaining the role of various patterns of invasion in causing tumour metastasis.

Methods And Results: Paraffin-embedded tissue blocks of 60 oral squamous cell carcinoma cases of known nodal status were selected for immunohistochemical staining of tumour (invasive front) by D2-40 along with routine staining by haematoxylin and eosin. Various staining patterns were assessed and evaluated for D2-40 expression, and correlated with nodal status. Tumoral D2-40 expression correspondingly increased with nodal metastasis (P = 0.261). Furthermore, D2-40 staining was more efficient in detecting individual tumour cells, and also characterised the motility factor irrespective of the pattern of invasion (P = 0.001). The pattern of D2-40 staining did not show a significant association with tumour grade, indicating that motility is an overlooked, albeit important, component of the pattern of invasion in routine histological grading.

Conclusions: D2-40 expression successfully identifies the motility profile of tumour, irrespective of the pattern of invasion. The presence of larger motile islands in the tumour cohort supports the concept of 'collective cell migration'. Podoplanin also aids evasion of immune responses by inducing platelet aggregation over tumour cells, thereby favouring distant metastasis. A multivariate model using immunohistochemical staining with D2-40 provides greater sensitivity for the prediction of lymph node metastasis.
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http://dx.doi.org/10.1111/his.13416DOI Listing
March 2018

Pulpal Response to Ferric Sulfate and Diode Laser When Used as Pulpotomy Agent: An In vivo Study.

J Clin Diagn Res 2017 Jun 1;11(6):ZC87-ZC91. Epub 2017 Jun 1.

Professor, Department of Paedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India.

Introduction: Ferric sulfate and Laser has been used for conventional pulpotomy therapy. Clinical and radiographic evaluation of pulpotomies using these have been done in numerous studies but there exists few studies analysing the histologic response of pulp to laser and ferric sulfate.

Aim: The aim of the study was to evaluate and compare histological changes seen in the pulp following ferric sulfate and laser pulpotomy and compare these effects.

Materials And Methods: This was a single blind in vivo study, consisting of 24 primary teeth. The teeth were randomly divided into two groups based on the material to be used and subgrouped based on the time period (30 and 45 days) of evaluation. The teeth were extracted after the study period and tissue processing done and subjected to Haematoxylin and Eosin staining procedure. The tissues were evaluated for dentin bridge formation, quality of dentin formation in the bridges, location of dentin bridges, tissue reaction to the material, inflammatory cell response and necrosis. The statistical analysis was done using SPSS 20.0 software. Intragroup comparisons of the observed values were analysed using Chi-square test.

Results: Statistical analysis revealed non-significant difference between the two materials to produce reparative dentin and also the quality of dentin bridges formed in both the groups during both the observational periods. Majority of the samples in both ferric sulfate and laser group exhibited dentin bridge at the interface of the exposed pulp, bridging or attempting to bridge the site exposed to the pulpotomy material. The ability of the materials to evoke a foreign body and inflammatory cell responses in the pulpal tissue was not significant. All the samples of both the groups showed signs of necrosis with two samples of laser group showing severe necrosis in 45 days period. The difference between the groups in 30 days group was statistically significant.

Conclusion: Laser and ferric sulfate are found to be able to initiate dentin bridge at the interface between the pulp and the material but the quality of bridge formed was better in laser group. Laser group showed more macrophage infiltration, inflammatory cell infiltration and areas of necrosis compared to ferric sulfate group though not statistically significant.
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http://dx.doi.org/10.7860/JCDR/2017/25180.10121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535488PMC
June 2017