Dentofacial and Cranial Changes in Down Syndrome

AbstractObjectivesThis study aimed to determine the prevalence of certain oral characteristics usually associated with Down syndrome and to determine the oral health status of these patients.MethodsThe cross-sectional study was conducted among patients attending a special education program at Faculty of Dentistry, Jamia Millia Islamia, Delhi, India. The study design consisted of closed-ended questions on demographic characteristics (age, sex, and education and income of parents), dietary habits, and oral hygiene habits. Clinical examination included assessment of oral hygiene according to Simplified Oral Hygiene Index (OHI-S), dental caries according to decayed, missing, and filled teeth (DMFT) index, periodontal status according to the Community Periodontal Index of Treatment Needs (CPITN), and malocclusion according to Angles classification of malocclusion. Examinations were carried out using a using a CPI probe and a mouth mirror in accordance with World Health Organization criteria and methods. Craniometric measurements, including maximum head length and head breadth were measured for each participant using Martin spreading calipers centered on standard anthropological methods.ResultsThe majority of the patients were males (n = 63; 82%) with age ranging from 6–40 years. The Intelligence Quotient (IQ) score of the patients indicated that 31% had moderate mental disability and 52% had mild mental disability. 22% exhibited hearing and speech problems.12% had missing teeth and 15% had retained deciduous teeth in adult population. The overall prevalence of dental caries in the study population was 78%. DMFT, CPITN and OHI scores of the study group were 3.8 ± 2.52, 2.10 ± 1.14 and 1.92 ± 0.63 respectively. The vast majority of patients required treatment (90%), primarily of scaling, root planing, and oral hygiene education. 16% of patients reported CPITN scores of 4 (deep pockets) requiring complex periodontal care. The prevalence of malocclusion was 97% predominantly of Class III malocclusions. Further 14% presented with fractured anterior teeth primarily central incisor. The percentage means of cephalic index was 84.6% in the study population. The brachycephalic and hyperbrachycephalic type of head shape was dominant in the Down syndrome individuals (90%).ConclusionThe most common dentofacial anomaly seen in these individuals was fissured tongue followed by macroglossia

Procjena dvadeset nemetričkih karakteristika zubne krune u različitim vrstama malokluzija na uzorku iz Indije, populacija New Delhija

Background: Dental phenotype shows variation in the form of various metric and non-metric traits, primarily due to gene-environment interplay. It gives an insight into the evolutionary trends, ancestry, and food habits. Recently, it has been explored for genetic affinity with several growth anomalies and development of craniofacial skeleton which is also responsible for dental and skeletal malocclusions. Objectives: The current study aims to investigate the non-metric dental crown traits (NDCTs) using Arizona State University Dental Anthropology system (ASUDAS) in different types of malocclusions in Delhi, National Capital Region (NCR) population. Materials and methods: The study design was observational and retrospective. The total sample comprised of 240 pairs of dental casts divided into four equal groups of 60 subjects each (30 male and 30 female), based on malocclusion. The four groups of malocclusions were: Angle’s Class I, Class II division 1, Class II division 2, Class III. The investigator was blinded for patient ID and sex before recording the data. The data for cast were recorded by three observers independently in a modified malocclusion- non-metric dental crown traits (M-NDCT) anthropological variants chart and statistically analyzed for association with different malocclusions and sex. Results: Significant differences were found in the expression of several NDCTs (both in presence and scoring) in different malocclusions. Class I malocclusion showed predominantly winging, shoveling –upper central and lateral incisor, protostylid, hypoconulid absence in lower second molar, and cusp number. Class II malocclusion showed double shoveling, interrupted groove, tuberculum dentale, canine mesial ridge, premolar accessory cusp, Carabelli’s trait, lingual cusp vari-ation, and seventh cusp in the lower left first molar. Class III malocclusion showed the absence of hypocone in upper second molar, deflecting wrinkle, distal trigonid crest, and Y groove in left lower second molar. Besides, sexual dimorphism was seen in shoveling –upper central and lateral incisor, canine mesial ridge, Carabelli’s trait, 3-cusp in upper second molar, and cusp number. Conclusions: Significant association was found between non-metric dental traits and malocclusions (Class I, Class division 1, Class II division 2, and Class III). Significant sex-linked differences were also found. Further studies can be performed at multicenter pan-India level or across ethnicities with a standard robust protocol and a large sample.Uvod: Dentalni fenotip pokazuje varijacije u obliku različitih metričkih i nemetričkih svojstava, uglavnom zbog međudjelovanja gena i okoline. Daje uvid u evolucijske trendove, podrijetlo i prehrambene navike. Nedavno je istražen njegov genetski afinitet s nekoliko anomalija rasta i razvoja kraniofacijalnog kostura koji je također odgovoran za dentalne i skeletne malokluzije. Ciljevi: U ovoj studiji autori istražuju nemetričke značajke zubne krune (NDCTs) korištenjem sustava dentalne antropologije Državnoga sveučilišta u Arizoni (ASUDAS) u različitim vrstama malokluzija u populaciji Delhija (regija glavnoga grada – NCR). Materijali i metode: Dizajn studije bio je promatrački i retrospektivan. Ukupni uzorak činilo je 240 pari gipsanih modela podijeljenih u četiri jednake skupine od po 60 ispitanika (30 muškaraca i 30 žena) na temelju malokluzije. Četiri skupine malokluzija bile su: Angleova klasa I, klasa II / 1, klasa II / 2 i klasa III. Istraživaču su bili nepoznati ID-i pacijenta i spol prije snimanja podataka. Podatke za gipsane modele očitala su tri neovisna promatrača u modificiranoj tablici antropoloških varijanti malokluzije – nemetričke značajke zubne krune (M-NDCT) radi povezanosti s različitim malokluzijama i spolom. Rezultati: Pronađene su znatne razlike u ekspresiji nekoliko NDCT-a (i u prisutnosti i u bodovanju) kod različitih malokluzija. Nepravilna okluzija klase I pokazala je pretežno rotirane gornje središnje sjekutiće, lopataste sjekutiće – gornji središnji i lateralni inciziv, protostilid, odsutnost hipokonulida u donjem drugom kutnjaku i broj kvržica. Klasa II malokluzije pokazala je dvostruki lopatasti sjekutić, isprekidanu brazdu, tuberculum dentale, mezijalni greben očnjaka, dodatnu kvržicu pretkutnjaka, Carabellijevo svojstvo, varijaciju lingvalne kvržice i sedmu kvržicu u donjemu lijevom prvom kutnjaku. Malokluzija klase III pokazala je odsutnost hipokonusa u gornjemu drugom kutnjaku, deflektirajuću boru, distalnu crista trigonida i Y-utor u lijevomu donjem drugom kutnjaku (26,7 %). Uz to, spolni dimorfizam uočen je u lopatastim sjekutićima – gornji središnji i lateralni sjekutić, mezijalni greben očnjaka, Carabellijevo svojstvo, tri kvržice u gornjemu drugom kutnjaku i broj kvržice. Zaključci: Pronađena je značajna povezanost između nemetričkih karakteristika zuba i malokluzija (klasa I, klasa 2/ 1, klasa II /2 i klasa III). Također su pronađene značajne spolno povezane razlike. Buduće studije mogu se provesti na multicentričnoj sveindijskoj razini sa standardnim robusnim protokolom i velikim uzorkom

Telomerase: An exploration toward the end of cancer

Background: The distinguishing feature of cancer cells is their ability to proliferate indefinitely, which is in contrast to the restricted cell multiplication potential for somatic cells. A better understanding of this contrasting behavior was provided in the early 1990s with the discovery of a relationship between telomeres, telomerase, aging, and cancer. Telomeres (tandem repeat DNA sequence TTAGGG) are protective caps at the ends of human chromosomes. Normal human cells experience telomere shortening with each successive cell division. However, in tumor cells, an overexpression of telomerase confers limitless replicative potential to tumor cells by continuous elongation of telomeres. The objective of this review was to systematically assess the data available on telomerase expression in oral cancer, with special reference to its role in diagnosis, prognosis, and treatment. Materials and Methods: A systematic review of studies that investigated the telomerase expression in oral squamous cell carcinoma (OSCC) was registered with PROSPERO. Subsequent to registration, a predetermined search strategy in accordance with PRISMA guidelines was formulated, and a literature search was conducted using online databases along with hand searching. Results: Eighty-nine articles from PubMed, 83 from Scopus, 5 from BioMed Central, 43 from Google Scholar, and 2 from hand search were identified. A total of 21 articles were shortlisted that met strict inclusion and exclusion criteria and quality assessment. Each study was evaluated for the markers under study, type of sample used, study design/methodology, and statistical analysis. The studies were then grouped into three subheads depending on their implications in the diagnosis, prognosis, and treatment of OSCC. Conclusion: This review explains the basic biology and the clinical implications of telomerase-based diagnosis and prognosis, the prospects for its use in anticancer therapy, in the context of oral cancer

The role of tobacco as an etiological agent for oral cancer: Cytomorphometrical analysis of the buccal mucosa in tobacco users

Background: Histopathological diagnosis of lesions arising from the intake of tobacco is based on subjective evaluation of morphological alterations within the lesional tissue. Oral exfoliative cytology is a non-invasive diagnostic technique for early detection of oral premalignant and malignant lesions. Morphometric techniques have been advocated as objective and reproducible methods of detecting changes before they are visible by routine microscopy and can facilitate differentiation of normal and abnormal epithelium. This study was conducted to assess the morphometric parameters (cell diameter, nuclear diameter and nuclear cytoplasmic ratio [N:C ratio]) in tobacco smokers and chewers and to evaluate the variations, if any. Materials and Methods: The study was conducted on cytological smears obtained from oral lesions of patients with habit of tobacco smoking (Group B) and tobacco chewing (Group C). Group A comprised of subjects free from oral lesions and not using tobacco in any form. Patients with both the habits were excluded. The smears were stained using Papanicoloaou staining method. For morphometric analysis, Microimage 3.0 image analysis software was employed. The statistical test employed was an analysis of variance and P < 0.05 was considered as significant. Results: The results of this study showed that the cellular diameter was progressively reduced and nuclear diameter progressively increased from Group A to Group B to Group C. The N:C ratio also showed a progressive increase from Group A to Group C. Conclusion: The results confirmed that tobacco chewing and smoking influenced the cytomorphology of normal appearing buccal mucosa and the degree of these changes were found to be greater in chewers as compared to smokers

Florid osseous dysplasia

The concept of ‘fibro-osseous lesions’ of bone has evolved over the last several decades and now includes two major entities, viz., fibrous dysplasia and ossifying fibroma, as well as other less common entities such as periapical dysplasia, focal osseous dysplasia, florid osseous dysplasia and familial gigantiform cementoma. Florid osseous dysplasia is a central lesion of the bone and periodontium, which has caused considerable controversy because of confusion regarding terminology and criteria for diagnosis. This paper reports a rare case of florid osseous dysplasia affecting maxilla and mandible bilaterally in a 14-year-old Indian male patient

Nasopalatine Duct Cyst with Impacted Inverted Mesiodens: A Rare Case Report and Literature Review

Nasopalatine duct cyst (NPDC) is a non-odontogenic, developmental epithelial cyst that accounts for 1% of maxillary cysts. It often arises due to the spontaneous proliferation of the epithelial tissue remnants, although trauma, bacterial infection, and mucous retention may also trigger the proliferation. Owing to its slow-growing, asymptomatic nature, the cyst is often discovered as an accidental finding during routine clinical and radiographic examinations. However, the majority of cases present as a tiny, asymptomatic swelling just posterior to the palatine papillae. Radiographically, it appears as a well-defined oval or round radiolucency in the maxillary anterior teeth region and should be differentially diagnosed with inflammatory periapical lesions and a wide incisive foramen. A pulp vitality test is essential to rule out lesions of endodontic origin. Microscopically, NPDCs display a mixed pattern of the epithelial lining and exhibit neurovascular bundles (small to medium-sized nerves, arteries, and veins), and minor salivary glands in the cystic connective tissue, a distinctive feature facilitating a confirmatory diagnosis. Enucleation and marsupialization remain the treatment of choice. NPDC associated with impacted mesiodens is an extremely uncommon entity. A comprehensive literature search carried out on the PubMed and Google Scholar search engines revealed only three cases of NPDC with impacted mesiodens to date. The purpose of this study is to report an extremely rare case of NPDC associated with an impacted inverted mesiodens in a 19-year-old male patient who presented with an asymptomatic swelling in the maxillary anterior teeth region. To the best of our knowledge, this is only the fourth reported case of NPDC with impacted mesiodens