Background: Detection of oral cancer at an early stage is of utmost importance to decrease morbidity and mortality. Tumor stroma plays a critical role during carcinogenesis. There is lack of information regarding the characteristics of the stroma in relation to the invading malignant epithelial cells and the interdependence between stroma and tumor cells in different grades of oral squamous cell carcinoma (OSCC). Aim: The present study was aimed to analyze and compare the nature of stroma in the vicinity of invading tumor islands in different grades of OSCC, using a histochemical technique picrosirius-polarization method. The present study also evaluated and correlated the possible role of inflammatory response in determining the nature of the stroma. Subjects and Methods: The study included thirty cases of different grades of histologically diagnosed OSCC and ten sections of normal buccal mucosa as a control group. Nature of collagen was analyzed using picrosirius-polarization method, and intensity of inflammatory cell infiltrate was recorded using ImageJ software (1.42q, NIH, USA). The results were tabulated and analyzed statistically. Results: Normal oral mucosa showed predominantly reddish birefringence. All cases of well-differentiated OSCC showed reddish-orange color. Nearly 70% moderately differentiated cases showed yellowish-orange (YO) and 60% of poorly differentiated cases, showed greenish-yellow (GY). The mean inflammatory cell count was highest in well-differentiated group. There was shift to YO and GY collagen when the cell differentiation and inflammatory cell count decreased in moderate and poorly differentiated cases. Conclusion: Both inflammatory cells and tumor cells have a role in determining the nature of the collagen fibers in tumor stroma of OSCC, probably with opposing effects on stromal behavior and hence both are significant in predicting prognosis.

Background: The oral mucosa lining the oral cavity is composed of epithelium supported by connective tissue. The shape of the epithelial-connective tissue interface has traditionally been used to describe physiological and pathological changes in the oral mucosa. Aim: The aim is to evaluate the morphometric complexity in normal, dysplastic, well-differentiated, and moderately differentiated squamous cell carcinoma (SCC) of the oral mucosa using fractal geometry. Materials and Methods: A total of 80 periodic acid–Schiff stained histological images of four groups: normal mucosa, dysplasia, well-differentiated SCC, and moderately differentiated SCC were verified by the gold standard. These images were then subjected to fractal analysis. Statistical Analysis: ANOVA and post hoc test: Bonferroni was applied. Results: Fractal dimension (FD) increases as the complexity increases from normal to dysplasia and then to SCC. Normal buccal mucosa was found to be significantly different from dysplasia and the two grades of SCC (P < 0.05). ANOVA of fractal scores of four morphometrically different groups of buccal mucosa was significantly different with F (3,76) = 23.720 and P< 0.01. However, FD of dysplasia was not significantly different from well-differentiated and moderately differentiated SCC (P = 1.000 and P = 0.382, respectively). Conclusion: This study establishes FD as a newer tool in differentiating normal tissue from dysplastic and neoplastic tissue. Fractal geometry is useful in the study of both physiological and pathological changes in the oral mucosa. A new grading system based on FD may emerge as an adjuvant aid in cancer diagnosis.

Background: Dental stem cells derived from tooth structures are adult stem cells that have received attention of researchers over the past decade. Dental stem cells can be used to regenerate dental tissues as well as non dental organs. These dental stem cells are readily accessible as compared to other sources of stem cells and can be obtained and stored for future use through minimally invasive procedures. Research in this field is growing at a fast pace and it is essential that awareness regarding the same should be present amongst professionals. Aim: This study was carried out to assess the knowledge and attitude of Indian dentists regarding dental stem cells. Material and Methods: A cross sectional descriptive, questionnaire based survey based on Knowledge, Attitude and Practice (KAP) was conducted and a total of 823 dentists from Maharashtra, India participated in the survey. The Pearson's Chi-Square Test and percentages of the total were used for statistical analysis. Results and Conclusion: A total of 823 dentists completed the questionnaire survey; out of which 396 were male and 427 were female. Maximum respondents (53%) were dental graduates, followed by post graduates (45%) and PhD (1.7%). Data from the study revealed that there is good awareness regarding stem cells in general. However; the awareness, knowledge regarding sources, applications, uses and clinical research guidelines regarding dental stem cells is lacking amongst most dentists. Despite this lack of knowledge, dentists are keen on updating their knowledge regarding dental stem cells.

Background: Understanding the mechanical properties is important in predicting the clinical behavior of composites. Finite element analysis (FEA) evaluates properties of materials replicating clinical scenario. Aim: This study evaluated polymerization shrinkage and stress, wear resistance (WR), and compressive strength (CS) of silorane in comparison with two methacrylate resins. Settings and Design: This study design was a numerical study using FEA. Materials and Methods: Three-dimensional (3D) models of maxillary premolar with Class I cavities (2 mm depth, 4 mm length, and 2.5 mm width) created and restored with silorane, nanohybrid, and microhybrid; Groups I, II, and III, respectively. Loads of 200–600 N were applied. Polymerization shrinkage was first determined by displacement produced in the X, Y, and Z planes. Maximum stress distribution due to shrinkage was calculated using AN SYS software. 3D cube models of composite resins were simulated with varying filler particle size. Similar loads were applied. WR and compressive stress were calculated: K W L/H and load/cross-sectional area, respectively. Statistical analysis done using one-way ANOVA, Kruskal–Wallis, and Tukey's honestly significant difference test (P < 0.05). Results: Polymerization shrinkage (0.99%) and shrinkage stress (233.21 Mpa) of silorane were less compared to microhybrid (2.14% and 472.43 Mpa) and nanohybrid (2.32% and 464.88 Mpa). Silorane (7.92×/10¹¹ μm/mm³) and nanohybrid (7.79×/10¹¹) showed superior WR than microhybrid (1.113×/10¹⁷). There was no significant difference in compressive stress among the groups. Conclusion: Silorane exhibited less polymerization shrinkage and shrinkage stress compared to methacrylates. Silorane and nanohybrid showed greater WR compared to microhybrid. CS of all groups was similar.

Aims and Objective: The objective of this study was to assess the effectiveness of low-level laser therapy (LLLT)/low intensity laser therapy (LILT) in the management of temporomandibular joint (TMJ) pain in a random and double-blind research design. Materials and Methods: TMJ pain patients, randomly assigned into two groups: Group 1 (n = 20) and Group 2 (n = 20), received 2–3 treatments per week for 8 sessions of active LILT with diode laser (gallium aluminum arsenide, 810 nm, 0.1 W). Measures of TMJ pain during function were evaluated at baseline, after completion of 8 sessions of laser treatment, and 30 days after the final laser therapy. Results: At the final treatment point, within-group, pain reduction was observed in both active LLLT and placebo groups at day 0 (P = 0.000), 8^th session (P = 0.000), and 1 month (P = 0.001). Between the groups, there is no significant difference at day 0 (P = 0.214), 8^th session (P = 0.806), and 1 month (P = 0.230). Significant increased mouth opening was observed in both Group 1 and Group 2 (P = 0.006 and P = 0.021, respectively) after treatment. However, no significant difference was found between the two groups (P = 0.330). Furthermore, significant improvement in clicking was recorded before and after treatment both in Group 1 (P = 0.000) and Group 2 (P = 0.001). Conclusion: The study suggests that LLLT is not better than placebo at reducing TMJ pain during function. It may be assumed that a more tailored application of LLLT should be developed to take into account the multifactorial aspect of the disorder.

Background: Osteoporosis and periodontitis have several risk factors in common. The majority of studies evaluating periodontal bone loss and systemic bone mineral density have found that low bone mineral density systemically is significantly associated with an increase in loss of alveolar bone height and periodontal destruction. Hence, the purpose of the study was to determine the effect of periodontitis on mandibular radiomorphometric indices, serum calcium and serum estradiol levels in postmenopausal women. Materials and Methods: Forty female patients in the age group of 35–55 years were included in the study. The participants were divided into two equal groups, i.e., control group A (twenty - postmenopausal women with healthy periodontium) and study group B (twenty - postmenopausal women with periodontitis). A thorough clinical examination of all the forty patients was carried out to detect the presence of periodontitis on the basis of clinical attachment level. Quantitative indices were measured on digital panoramic radiographs, and serum calcium and estradiol levels were estimated. Results: No statistically significant correlation of periodontitis with any of the radiomorphometric indices, serum calcium and serum estradiol levels was observed in postmenopausal women. Conclusion: There is little evidence of correlation of serum estradiol, serum calcium levels, and morphometric indices with periodontitis and therefore detailed further research about this correlation is required.

Background: Carcinogenesis is a multistep process where a healthy cell has initially a precancerous stage and finally an early cancerous stage. The process of carcinogenesis can be divided into three stages of initiation, promotion, and progression. In this process, there is increased turnover, secretion, and/or shedding from malignant cells. Glycoproteins like sialic acid are expressed on the cell surface. In oral potentially malignant disorders (OPMDs) and oral cancer (OC), the sialic acid level is seen to increase due to high cell turnover and shedding of malignant cells which, in turn, results in the release of glycoproteins like sialic acid into circulation. Glycoproteins also form an important constituent of salivary mucins and hence due to the same mechanism, an increase in sialic acid level is also seen in saliva. Objective: The aim is to estimate serum and salivary sialic acid levels in healthy controls, patients with OPMDs and patients with OC. Materials and Methods: In this observational cross-sectional study, serum and salivary sialic acid levels were estimated in thirty healthy controls, thirty patients with OPMDs and thirty patients with OC. Results: Serum and salivary sialic acid levels obtained were subjected to statistical analysis. Post hoc Tukey test was used to compare the serum and salivary sialic acid levels of the two study groups to the control group. ANOVA test was used for the comparison of sialic acid levels between the groups. Pearson's correlation coefficient was used to assess correlation (P < 0.05 was considered statistically significant). The mean serum and salivary sialic acid levels were increased significantly in subjects with OPMDs and OC when compared to healthy controls. Conclusion: This study highlights the high expression of sialic acid on outer cell membranes, due to the significant increase in subjects with OPMDs and OC when compared to healthy controls. A significant increase in sialic acid level is also seen in saliva. Hence, it can be stated that saliva can be used as a reliable, noninvasive tool in diagnosis and management of OPMDs and OC.

Introduction: The effectiveness of ProTaper Universal and ProTaper Retreatment rotary instruments was compared to the Hedström files in the removal of filling material from root canals. Materials and Methods: Thirty-six extracted human mandibular premolars with a single straight root canal were shaped and filled with gutta-percha and AH Plus. The specimens were stored for 6 months at 37°C and at 100% relative humidity, and then randomly divided into three groups: PTU - removal of filling material performed with ProTaper Universal instruments; PTR - removal of filling material performed with ProTaper Retreatment instruments; HF – removal of filling material performed with Gates-Glidden burs, Hedström files and solvent. After the filling material removal and diaphanization, the specimens were longitudinally sectioned and images of the canal surfaces were scanned. The remaining areas of filling material were measured (Image Tool 3.0), and data was analyzed statistically (Kruskal-Wallis and Dunn tests). The time required for filling removal in each group was also recorded (one-way ANOVA and Tukey's HSD test). Results: All groups presented remnants of filling material; PTU had the smallest amount and HF group presented the highest mean value (P< 0.05) in all the thirds. The cervical third had the smallest amount of material when compared with the other thirds (P< 0.05). HF group required a longer mean time, presenting significant difference (P< 0.05). Conclusion: Considering the time required and the amount of the filling removal, ProTaper Retreatment were not superior to ProTaper Universal, but both rotary instruments were more effective and less time-consuming than Hedström manual files.

Aim: The aim of this study is to compare oral signs, symptoms and oral lesions type and prevalence, in end stage renal disease (ESRD) with non-end stage renal disease (NESRD) in diabetes mellitus (DM) patients. Methodology: Two groups of DM patients were studied, Group 1 includes 100 patients with ESRD, who were under hemodialysis therapy, and Group 2 includes100 patients with NESRD whose serum creatinine level is <2.0 mg/dl. The DM status and other laboratory investigations were recorded, with the patients consent and thorough oral examination was performed and the findings were recorded. All the data were entered into Microsoft Excel sheets. Statistical analysis including Pearson's correlation analysis, Chi-square test, and t-test were done using SPSS software SYSTAT version 7.0. Results: On thorough clinical examination, the prevalence of oral lesions was found to be higher in ESRD patients. The most common lesions such as saburral tongue (P ≤ 0.002), petechiae/ecchymoses (P ≤ 0.000), pale mucosa (P ≤ 0.000), stomatitis medicamentosa (P ≤ 0.043) fissured tongue, smooth tongue, candidiasis, dry and fissured lips, angular cheilitis, uremic stomatitis, signs such as uremic fetor (P ≤ 0.000), xerostomia and symptoms like burning tongue, unpleasant taste are noted. Conclusion: The high prevalence of uremic fetor, saburral tongue, pale mucosa, and petechiae/ecchymoses in ESRD patient group can be considered as a possible sign of undiagnosed advanced stage of renal disease in other diabetic patients.

Background: Asphalts are bitumens that consist of complex of hydrocarbon mixtures and it is used mainly in road construction and maintenance. Aim: This study was undertaken to evaluate the micronucleus (MN) assay of exfoliated buccal epithelial cells in road construction workers using liquid-based cytology (LBC) preparation. Materials and Methods: Three different stains (May–Grunwald Giemsa, hematoxylin and eosin, and Papanicolaou) were used to evaluate the frequency of MN in exfoliated buccal epithelial of 100 participants (fifty road construction workers and fifty administrative staff) using LBC preparation. Statistical analysis was performed with Student's t-test, and P< 0.05 was considered statistically significant. Results: The mean frequency of MN for cases was significantly higher than that of controls (P = 0.001) regardless of staining method used and also cases with exposure period of more than 5 years had statistically significant difference (P < 0.05) than cases with <5 years of exposure. Conclusion: The present study concluded that workers exposed to asphalts during road construction exhibit a higher frequency of MN in exfoliated buccal epithelial cells and they are under the significant risk of cytogenetic damage. LBC preparation has potential application for the evaluation of frequency of MN. This technique may be advocated in those who are occupationally exposed to potentially carcinogenic agents in view of improvement in the smear quality and visualization of cell morphology.

Context: Oral and pharyngeal cancer, grouped together, is the sixth most common cancer in the world. In the past few years, human papillomavirus (HPV) infection has been suggested as a risk factor for oral cancer apart from traditional risk factors such as smoking, tobacco, and alcohol consumption. Aims: The aim of this study was to determine HPV status of the tumors using polymerase chain reaction (HPV-DNA PCR) and p16 immunostaining and to correlate p16 overexpression as an indicator of HPV-associated oral dysplasia and carcinoma. Settings and Design: A prospective study was conducted in fifty cases of suspected oral cancer. Materials and Methods: PCR Amplification of extracted HPV-DNA was done for HPV-DNA status in fresh tissue of suspected oral cancer cases. Histomorphological features of the cases were analyzed, and p16 immunohistochemistry was performed on the same specimen after making paraffin blocks to study p16 overexpression. Statistical Analysis Used: Chi-square test was used to analyze the differences between discrete variables. Results: 5/6 (83.3%) HPV-DNA-positive cases were positive for p16 expression, whereas 26/44 (59.09%) p16-positive cases which were negative for HPV-DNA. Sensitivity and specificity of p16 as a surrogate marker for HPV-DNA were found to be 83.3% and 40%, respectively. Conclusions: p16 immunostaining is a good first-line assay for eliminating HPV-negative cases from additional analysis, but other causes of p16 overexpression in oral tumorigenesis related to tobacco consumption in keratinizing squamous cell carcinoma needs to be explored further.

Background: Lobular capillary hemangioma is a common benign vascular tumor seen in the oral cavity. It occurs in response to various stimuli such as low-grade local irritation, traumatic insult, and hormonal factors or as a response to a wide variety of drugs. Materials and Methods: All patients presenting to the Department of Dentistry, Shyam Shah Medical College, Rewa, Madhya Pradesh during July 2014 to June 2016, who were diagnosed by histopathologic confirmation as oral lobular capillary hemangioma (OLCH), were evaluated for the area involved, clinicopathologic presentation, demographic features, and treatment. Results: A total of 94 cases were identified as OLCH by histopathologic confirmation during this period. The lesion occurred most commonly in the age group of 21–30 years. A characteristic female predominance (female: male ratio of 2.24:1) was seen. Anterior maxillary labial gingiva was most frequently involved (34.04%) followed by posterior maxillary buccal gingiva (14.89%). Conclusion: The clinicopathologic picture of OLCH found in this study was similar to other studies conducted on same as well different ethnic and geographical populations. Poor oral-dental-hygiene was observed in majority of patients (87.23%) dental health education should be an integral component of imparting oral health care by health providers. Surgical excision as a treatment modality renders good results with low recurrence rate.

Background: Although the literature has shown that the lip response to maxillary incisor retraction varies, these studies have been done on a noncleft lip/palate sample. Aim: The aim of this study is to evaluate response of operated cleft lip to orthodontic tooth movement and to determine if there are any differences in the response between the operated cleft lip and the noncleft lip. Settings and Design: This was a hospital-based retrospective study using radiographs. Materials and Methods: Lip changes were evaluated using pre- and post-operative lateral cephalometric radiographs. The experimental group consisted of 12 patients with operated cleft lip while the control group consisted of 12 noncleft patients with dental and skeletal Class I malocclusion. Statistical Analysis: ANOVA was used for statistical analysis. Results: The operated lip responded less to incisor movement than the noncleft group (P < 0.05). While the cleft group demonstrated an increase in upper lip thickness measurements at Point A and vermilion following incisor retraction, the control group showed a decrease in thickness of the upper lip at Point A and an increase at vermilion. Conclusion: The cleft team should be aware that the operated lip responds differently to incisor movement. This will enable them to better plan comprehensive treatment for the cleft lip and palate patient.

Background: This study evaluated the effect of different surface treatments on the repair bond strength of nanohybrid (Empress Direct) and nanofilled (Filtek Z350 XT) composite resins. Materials and Methods: A total of 120 specimens of each material (7.5 x 4.5 x 3 mm) were prepared and polished with SiC paper. Half of the specimens were kept in water for seven days and the other half for six months; they were then divided into six groups according to the type of surface treatment: negative control (no treatment), Al₂O₃sandblasted, liquid acetone, acetone gel, liquid alcohol and alcohol gel. Following application of the silane coupling agent and the adhesive system, composite resin cylinders were fabricated on the specimens and light cured (20 seconds). The same composite resins were used for the repair. Additionally, ten intact specimens of each composite resin (without repair) were prepared (positive control). The specimens were then loaded to failure in the microshear mode. Three additional specimens were fabricated in each group, and the surface treatments were analyzed by atomic force microscopy, energy-dispersive X-ray spectroscopy (EDS) and scanning electron microscopy (SEM). Results: The nanofilled composite resin showed higher cohesive strength and repair bond strength than the nanohybrid composite resin. The aging process affected the repair bond strength of the nanofilled composite resin. Al₂O₃sandblasting was more efficient for the nanofilled composite resin and promoted greater surface roughness in both materials. The solvents demonstrated higher efficacy for the nanohybrid composite resin. Conclusion: The strengths resulting from the solvents were material dependent, and Al₂O₃sandblasting resulted in superior repair bond strength in both materials.

Aim: Temporary coverage of a prepared tooth is an important step during various stages of the fixed dental prosthesis. Provisional restorations should satisfy proper mechanical requirements to resist functional and nonfunctional loads. A few studies are carried out regarding the comparison of the effect of curing environment, air and water, on mechanical properties of autopolymerizing acrylic and composite resin. Hence, the aim of this study was to compare the transverse strength of autopolymerizing acrylic resin and autopolymerizing composite resin as influenced by the temperature of air and water during polymerization. Materials and Methods: Samples of autopolymerizing acrylic resin and composite resin were prepared by mixing as per manufacturer's instructions and were placed in a preformed stainless steel mold. The mold containing the material was placed under different controlled conditions of water temperature and air at room temperature. Polymerized samples were then tested for transverse strength using an Instron universal testing machine. Results: Alteration of curing condition during polymerization revealed a significant effect on the transverse strength. The transverse strength of acrylic resin specimens cured at 60°C and composite resin specimens cured at 80°C was highest. Polymerizing the resin in cold water at 10°C reduced the mechanical strength. Conclusions: Polymerization of the resin in hot water greatly increased its mechanical properties. The method of placing resin restoration in hot water during polymerization may be useful for improving the mechanical requirements and obtaining long-lasting performance.

Background: Dentin hypersensitivity results when patent tubules are exposed to pain-inducing external stimuli. Aim: This study aims to compare the effects of two desensitizing dentifrices containing NovaMin and arginine on dentinal tubule occlusion with and without citric acid challenge in vitro using confocal laser scanning microscopy (CLSM). Materials and Methods: Forty dentin discs were randomly divided into Groups I and II containing twenty specimens each, treated with NovaMin and arginine-containing dentifrices, respectively. Groups I and II were divided into subgroups A and B where IA and IIA underwent CLSM analysis to determine the percentage of tubule occlusion while IB and IIB underwent 0.3% citric acid challenge and CLSM analysis. A novel grading system was devised to categorize tubule occlusion. Results: In Group II, the percentage of occluded tubules was highest for IIA (72.25% ± 10.57%) and least for IIB (42.55% ± 8.65%) having statistical significance (P < 0.0005). In Group I, the difference between IA (49.9% ± 12.96%) and IB (43.15% ± 12.43%) was statistically insignificant (P = 0.249). On the comparison between IB and IIB statistically indifferent result was obtained (P = 0.901), whereas the difference between IA and IIA was statistically significant (P < 0.001). The results of grading system were for IA 50% of samples belonged to Grade 2, for IIA 60% - Grade 3, and for IB 70% and for IIB 90% - Grade 2. Conclusion: Dentinal tubule occlusion with arginine-containing dentifrice was significantly higher than NovaMin. However, it could not resist citric acid challenge as effectively as NovaMin. The effects of NovaMin were more sustainable as compared to arginine-containing dentifrice, thus proving to be a better desensitizing agent.

Gingival fibromatosis with hypertrichosis syndrome is an extremely rare genetic condition characterized by profound overgrowth of hair and gums, as well as other variable features. Gingival fibromatosis is characterized by a large increase in the gingival dimension which extends above the dental crowns, covering them partially or completely. They were found to have a genetic origin, may also occur in isolation or be part of a syndrome, or acquired origin, due to specific drugs administered systemically. Congenital generalized hypertrichosis is a heterogeneous group of diseases with continuing excessive growth of terminal hair without androgenic stimulation. It has informally been called werewolf syndrome because the appearance is similar to that of a werewolf. Various syndromes have been associated with these features such as epilepsy, mental retardation, cardiomegaly, or osteochondrodysplasia. As so far very few cases have been reported in literature, we are reporting a series of three cases with management of the same. The excess gingival tissues, in these cases, were removed by conventional gingivectomy under general anesthesia. The postoperative result was uneventful and the patient's appearance improved significantly. Good esthetic result was achieved to allow patient to practice oral hygiene measures. Though this is not a serious condition clinically, psychosocial trauma cannot be neglected owing to the cosmetic disfigurement it produces.

Midline diastema, which occurs as spacing between the upper central incisors, is a common occurrence seen in the pediatric population. In the ugly duckling stage of development; no treatment is generally advocated as the diastema is a transient one. When diastemas occur due to other pathologies, they pose several problems in relation to esthetics and speech in a growing child. With the advent of time, patient's demand for esthetics has greatly increased. Along with this, a less time-consuming treatment option is a favorite. Proper diagnosis of the diastema, unfolding its etiology, helps in devising an adequate treatment plan. This eventually will lead to stability of the final result. The present case report presents a different and unique approach for the esthetic closure of midline diastema following frenectomy procedure. The approach proves to be a quick and simple option for closure of midline diastemas in cases with concomitant incisal edge irregularities.

Background: Adolescence is a very delicate and vulnerable age when children are exposed to the harmful and damaging culture of the society. Tobacco habits are increasingly becoming an annoying menace to the Indian society since the past few years. The teenage group is fast catching up the tobacco habits because of its easy availability in the local Indian markets. Thus, this study was envisaged to analyze the factors responsible for this adverse habit and to obtain an overview of the trends in tobacco habits in young children of North India. Methods: Eight hundred and sixteen schoolchildren in the age group of 14–19 years of different schools of Meerut city were instructed to fill the prepared questionnaires. Results were formulated and statistical analysis was done. Results: Chi-square analysis revealed significant difference between tobacco users and nonusers. Smokeless habit was more prevalent among adolescent boys. Peer pressure was the most cited reason for initiating the tobacco habit while parental influence helped the most in abstaining from this adverse addiction. Conclusion: Despite the existence of anti-tobacco regulations in India, tobacco dependence in adolescents raises an alarm for the Indian community and stringent steps are required to remove this menace.