Publications by authors named "Nidhi Manaktala"

17 Publications

  • Page 1 of 1

Pan-dent-emic: safety considerations for dental surgery in the era of COVID-19.

Patient Saf Surg 2021 Apr 12;15(1):16. Epub 2021 Apr 12.

Department of Oral Pathology and Microbiology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka, 575001, India.

The global coronavirus disease 2019 (COVID-19) pandemic spread has seized the entire world and has created extensive health concerns in the general population. Despite various efforts to prevent the pandemic spread, the flare-up of this disease is still soaring due to the community spread in every area. The droplet spread from the afflicted is of the highest concern because of its rapid spread to uninfected individuals. Dental treatments have to be planned and carried out with extreme caution and dental personnel should take extreme care and follow meticulous guidelines when treating an individual with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. This article highlights the clinical picture of COVID-19 (coronavirus diseases 2019) and presents a summary of precautionary and prophylactic measures in preventing the cross-infection and the nosocomial spread of the infection in a dental setting.
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http://dx.doi.org/10.1186/s13037-021-00289-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040369PMC
April 2021

Pan-dent-emic: a dentist's dilemma in the COVID-19 era.

Patient Saf Surg 2021 Feb 14;15(1). Epub 2021 Feb 14.

Department of Conservative Dentistry and Endodontics Manipal College of Dental Sciences, Manipal Academy of Higher Education, Karnataka, 575001, Mangalore, India.

The aftermath of the COVID-19 pandemic has been unfathomable. It has affected every sector within health care industry with dentistry being one of the worst hits. Not only has it impacted the dental practice, the field of dental education has been affected as well. There has been loss in terms of delayed to no treatments, finances, psychology and most importantly breaks in ongoing education and research practices. The present article attempts to explain the dilemma of the current situation from a dentist's perspective. Since, the effects of the contagion are seen across each level of dentistry, the current situation can truly be termed as a "Pan-dent-emic".
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http://dx.doi.org/10.1186/s13037-021-00282-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882246PMC
February 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

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

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

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

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

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

Odontogenic Cyst with Verrucous Proliferation Exhibiting Melanin Pigmentation.

Case Rep Pathol 2017 20;2017:5079460. Epub 2017 Mar 20.

Department of Oral Pathology, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka 575001, India.

Verrucous proliferation arising from odontogenic cysts is a rare entity. We report an unusual case of an infected odontogenic cyst with verrucous proliferation and melanin pigmentation in a 13-year-old male patient who presented with an intraoral swelling in relation to impacted teeth 26 and 27. The enucleated lesion was diagnosed as an odontogenic keratocyst and the patient died within two years of presentation due to multiple recurrences. The clinical, radiological, and microscopic features of the lesion are presented with an attempt to discuss the etiopathogenesis. The case hereby reported is uncommon with only eight cases reported in the literature.
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http://dx.doi.org/10.1155/2017/5079460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376934PMC
March 2017

Dysgenetic Polycystic Disease of Minor Salivary Gland: A Rare Case Report and Review of the Literature.

Case Rep Pathol 2017 19;2017:5279025. Epub 2017 Jan 19.

Kasturba Medical College, Mangalore, Manipal University, Manipal, India.

Polycystic (dysgenetic) disease of the salivary glands is a rare entity that has only recently been described in the literature. The disease is more commonly seen in females and majority of the cases have presented as bilateral parotid gland swellings. This case presenting in a 21-year-old male is the first of this unusual entity involving solely the minor salivary gland on the lower lip. This case report highlights the importance for the clinician to be aware of this differential diagnosis, when treating an innocuous lesion like a mucocele.
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http://dx.doi.org/10.1155/2017/5279025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288519PMC
January 2017

Tumour-Associated Tissue Eosinophilia in Oral Squamous Cell Carcinoma- A Boon or a Bane?

J Clin Diagn Res 2016 Apr 1;10(4):ZC65-8. Epub 2016 Apr 1.

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

Introduction: The infiltration of tumour stroma by eosinophils, Tumour-Associated Tissue Eosinophilia (TATE) is known to modulate the evolution of Oral Squamous Cell Carcinoma (OSCC). Identification of eosinophils in the inflammatory stroma has been proven to be an important factor in prognostication of malignant tumours including cancers of mouth, oesophagus, larynx, pharynx, breast, lung, intestine and genitourinary tract.

Aim: Our study aimed to assess the role of TATE as a prognosticator in OSCC as visualized by Haematoxylin and Eosin (H&E) and congo red staining.

Materials And Methods: Thirty histologically-proven cases of OSCC were retrieved from the archives of Department of Oral Pathology, Manipal College of Dental Sciences, Mangalore, Manipal University, Karnataka, India. Two serial sections of 4μm thickness were made and subjected to routine staining with H&E and modified congo red staining, where eosinophil granules stained red and nuclei stained blue. In 40x magnification, 10 HPF at invasive tumour front were assessed for counting eosinophils by placing a 49 square grid (measuring 0.0289 sq mm).

Statistical Analysis: The TATE was compared with the prognosticators using Mann-Whitney U-test. The grades of carcinoma were correlated with TATE using Kruskal-Wallis test followed by Post-hoc Bonferronis correction. Agreement of the number of eosinophils counted in the two staining techniques (H&E and Congo red) in OSCC was achieved using interclass correlation coefficient, and Friedman's test. A value of p< 0.05 was considered statistically significant.

Results: Our results showed that tissue eosinophil counts were higher in well-differentiated cases of OSCC, cases with lymph node involvement, decreased survival, without margin involvement and in cases that did not recur. H&E stain showed significantly better visualization of eosinophils resulting in higher eosinophil counts than when seen with Congo red (p=0.008).

Conclusion: Thus, TATE can be used as a surrogate marker in prediction of survival and recurrence in OSCC. H&E proved to be a better stain for evaluation of eosinophils.
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http://dx.doi.org/10.7860/JCDR/2016/16440.7637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866253PMC
April 2016

Computer-based method of bite mark analysis: A benchmark in forensic dentistry?

J Forensic Dent Sci 2016 Jan-Apr;8(1):32-9

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

Aim: The study aimed to determine the technique with maximum accuracy in production of bite mark overlay.

Materials And Methods: Thirty subjects (10 males and 20 females; all aged 20-30 years) with complete set of natural upper and lower anterior teeth were selected for this study after obtaining approval from the Institutional Ethical Committee. The upper and lower alginate impressions were taken and die stone models were obtained from each impression; overlays were produced from the biting surfaces of six upper and six lower anterior teeth by hand tracing from study casts, hand tracing from wax impressions of the bite surface, radiopaque wax impression method, and xerographic method. These were compared with the original overlay produced digitally.

Results: Xerographic method was the most accurate of the four techniques, with the highest reproducibility for bite mark analysis. The methods of wax impression were better for producing overlay of tooth away from the occlusal plane.

Conclusions: Various techniques are used in bite mark analysis and the choice of technique depends largely on personal preference. No single technique has been shown to be better than the others and very little research has been carried out to compare different methods. This study evaluated the accuracy of direct comparisons between suspect's models and bite marks with indirect comparisons in the form of conventional traced overlays of suspects and found the xerographic technique to be the best.
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http://dx.doi.org/10.4103/0975-1475.176944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799517PMC
April 2016

Demirjian's method in the estimation of age: A study on human third molars.

J Forensic Dent Sci 2015 May-Aug;7(2):153-7

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

Aim: The primary aim of the following study is to estimate the chronological age based on the stages of third molar development following the eight stages (A to H) method of Demirjian et al. (along with two modifications-Orhan) and secondary aim is to compare third molar development with sex and age.

Materials And Methods: The sample consisted of 115 orthopantomograms from South Indian subjects with known chronological age and gender. Multiple regression analysis was performed with chronological age as the dependable variable and third molar root development as independent variable. All the statistical analysis was performed using the SPSS 11.0 package (IBM ® Corporation).

Results: Statistically no significant differences were found in third molar development between males and females. Depending on the available number of wisdom teeth in an individual, R (2) varied for males from 0.21 to 0.48 and for females from 0.16 to 0.38. New equations were derived for estimating the chronological age.

Conclusion: The chronological age of a South Indian individual between 14 and 22 years may be estimated based on the regression formulae. However, additional studies with a larger study population must be conducted to meet the need for population-based information on third molar development.
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http://dx.doi.org/10.4103/0975-1475.155081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430575PMC
May 2015

Estimation of time elapsed since the death from identification of morphological and histological time-related changes in dental pulp: An observational study from porcine teeth.

J Forensic Dent Sci 2015 May-Aug;7(2):95-100

Department of Oral and Maxillofacial Pathology and Microbiology, MCODS, Mangalore, Karnataka, India.

Aim: Putrefaction of the human body with its rate and stages of the various changes occurring in this entire process have been explored widely by the forensic medicine experts to estimate the time elapsed since death. However, experimental data reported in literature pertaining to rates of putrefaction of the dental pulp retrieved from jaws of the dead is scarce. This study makes an attempt to find out the series of various changes which occur during the process of putrefaction of the dental pulp in a coastal environment like that of Southern India. An attempt has also been made to estimate the time elapsed since the death by assessing the duration for which dental pulp remains microscopically intact.

Materials And Methods: Three different study setups at different times, followed one by other were created. In each setup, 10 specimens of porcine jaws with teeth were buried in surface soil and 10 specimens in subsurface soil. Dental pulp was retrieved at an interval of every 24 h to see for the various changes. All the environmental parameters including average daily rainfall precipitation, temperature, soil humidity, soil temperature, and soil pH were recorded.

Results: A specific series of morphological changes in terms of changes in size, color, consistency, and odor; and a sequence of histological changes were observed from both surface and subsurface samples.

Conclusion: Dental pulp buried in a coastal environment goes through a specific series of morphological and histological changes which can be interpreted up to 144 h from burial, after which pulp ceases to exist.
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http://dx.doi.org/10.4103/0975-1475.154594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430582PMC
May 2015

Post-radiation changes in oral tissues - An analysis of cancer irradiation cases.

South Asian J Cancer 2014 Jul;3(3):159-62

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

Introduction: Radiation, commonly employed as neoadjuvant, primary, and adjuvant therapy for head and neck cancer causes numerous epithelial and stromal changes, prominent among which is fibrosis with its early and late consequences. Very little is known about the true nature of the fibrosed tissue and the type of fibers accumulated. Radiotherapy affects the supporting tumor stroma often resulting in a worsening grade of tumor post-radiation.

Aim: To study epithelial, neoplastic, stromal, and glandular changes in oral cavity induced by radiation therapy for oral squamous cell carcinoma (OSCC) using special stains.

Materials And Methods: The study included 27 samples of recurrent OSCC following completion of radiotherapy (recurrence within an average span of 11 months), and 26 non-irradiated cases of OSCC. Patients with a history of combined radiotherapy and chemotherapy were not included in the study. The epithelial changes assessed included epithelial atrophy, apoptosis, necrosis, dysplasia, and neoplasia. The connective tissue was evaluated for amount of fibrosis, quality of fibers (using picrosirius red staining), fibrinous exudate, necrosis, pattern of invasion, vessel wall thickening, and salivary gland changes. The aforementioned changes were assessed using light and polarizing microscopy and tabulated.

Statistical Analysis: Epithelial and connective tissue parameters were compared between the irradiated and non-irradiated cases using chi square and t-tests.

Results: Epithelial and connective tissue parameters were found to be increased in irradiated patients. Pattern of invasion by tumor cells varied from strands and  cords between the two groups studied. The effect of radiation was seen to reflect on the maturity of fibers and the regularity of their distribution.
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http://dx.doi.org/10.4103/2278-330X.136785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134606PMC
July 2014