In the past few decades, various tools have emerged that claim to enhance detection of oral cancer. The most important prognostic factor in patients with oral cancer is lymph node status: the presence of nodal spread decreases the 5-year survival rate by approximately 50%. Differentiation between reactive and metastatic lymphadenopathy is thus vital, and one differentiating criterion is hardness (elasticity) of the lymph node. The purpose of this review is to highlight a promising new ultrasound technique, known as elastography, which measures the characteristics of tissue compliance. The principles underlying elastography are that tissue compression produces strain (displacement) within the tissue – which is lower in harder tissues than in softer tissues – and that malignant tissues are generally harder than normal surrounding tissue. Therefore, elastography might yield clinical information useful in diagnosing cervical metastasis and improving prognosis in oral cancer. It has long been used for cancers of the breast, pancreas, and thyroid, and its use in cervical lymphadenopathy is now being explored, which could lead to great advancements in the diagnosis and prognosis of oral cancer. (J Oral Sci 53, 137-141, 2011)

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Current projected missions to Mars will require 18 to 24 months of exposure to microgravity conditions, which might have serious effects on human physiology, including that of the oral cavity. Very few studies have been published on the effect of microgravity on the oral cavity, although it has been reported that microgravity increases the prevalence of periodontitis, dental caries, bone loss and fracture in the jaw bone, pain and numbness in teeth and oral cavity tissue, salivary duct stones, and oral cancer. Aeronautic dentistry is a new field, so further study of the effects of microgravity are required. In this article, we review the role of aeronautic dentistry in space missions and offer our recommendations for the future growth of this field. (J Oral Sci 53, 143-146, 2011)

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The surface of mucosal sites, such as the intestinal tract, are covered by epithelial cells. To protect the intestinal environment from invading pathogens and maintain homeostasis, the human body developed an exquisite acquired immune system, referred to as the mucosal immune system, in which epithelial cells and lymphocytes function cooperatively. The main player in this immune system is the polymeric immunoglobulins (pIgs), in particular dimeric IgA (dIgA). To exert its protective effect, dIgA produced in the lamina propria must be transported to the intestinal lumen across epithelial cells. This process is called transcytosis and is mediated by polymeric immunoglobulin receptor (pIgR), which is exclusively produced by intestinal epithelial cells (IECs). DIgA is captured by pIgR on the basolateral surface of IECs and transcytosed to the opposite side of IECs. The dIgA-pIgR complex is expressed on the apical surface of IECs and proteolytically cleaved to generate secretory IgA (SIgA). This review describes the current understanding and recent progress in this research field. (J Oral Sci 53, 147-156, 2011)

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Tenoxicam is an effective analgesic and anti-inflammatory agent for symptomatic treatment of various conditions. The purpose of this study was to evaluate clinically the effectiveness of prophylactic tenoxicam and prophylactic ibuprofen in reducing post-endodontic pain compared with placebo. A total of 48 patients consented to a double-blind, single dose, prophylactic oral administration of 20 mg of tenoxicam, 200 mg of ibuprofen, or a placebo before root canal treatment. The root canal treatment was performed in one visit. The patients registered their degree of discomfort on a 100-mm visual analog scale, immediately postoperative, and 6, 12, 24, 48 and 72 h after initiation of root canal treatment. The two-way ANOVA test and Tukey HSD post hoc test showed that in the 6-h period, both 20 mg of tenoxicam and 200 mg of ibuprofen provided significantly better pain relief than the placebo. Prophylactic administration of a single dose of 20 mg tenoxicam or 200 mg ibuprofen before RCT provides an effective reduction at 6 h (P < 0.05). Because of the advantages of tenoxicam, it may be useful as a prophylactic analgesic when post-endodontic pain is anticipated. (J Oral Sci 53, 157-161, 2011)

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This in vitro study aimed to analyze the effect of including xylitol into a fluoridated dentifrice to provide protection against enamel erosion with or without abrasion. Bovine enamel specimens were subjected to erosion or erosion plus abrasion (7 days) and the treatment with the following dentifrices: 10% xylitol; 10% xylitol plus 1,030 ppm F (NaF); 1,030 ppm F; and placebo. The erosive challenges were performed 4 times a day (2 min at a time). The specimens were exposed to the slurries of the dentifrices 2 times daily (15 s at a time). Half of the specimens per group were additionally abraded using an electrical toothbrush (F = 1.5 N). Between the challenges, the specimens were remineralized by artificial saliva. Enamel loss was measured profilometrically (μm). The data were statistically analyzed by two-way ANOVA and Bonferroni's post-hoc test (P < 0.05). Ten percent xylitol plus F and F dentifrices significantly reduced enamel erosion compared to placebo and xylitol dentifrices. On the other hand, all dentifrices presented a significant potential to protect against enamel erosion plus abrasion compared to placebo, with 10% xylitol plus F showing the best results. Based on this result, the inclusion of 10% xylitol increased the effect of the fluoridated dentifrice against enamel erosion plus abrasion in vitro. In situ or clinical studies are needed to confirm the data. (J Oral Sci 53, 163-168, 2011)

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Previously, CD47 gene expression has been shown to increase during mandible development using a micro array technique. To determine the function of CD47 in osteoblasts, CD47 was silenced using siRNA in vitro. The TGF-β1 and phosphorylated-Smad2 levels and transcription factor genes related to bone metabolism increased dose-dependently with CD47 silencing. Furthermore, we determined the distribution of CD47 in mouse embryonic E13 and E15 in vivo. The CD47-positive cells were localized in Meckel's cartilage and antenatal mandibular bone. These results suggest that TGF-β1 signaling and mandible development might be regulated by CD47. (J Oral Sci 53, 169-175, 2011)

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To establish efficient methods for self-prevention of oral diseases, assessment of dental health behavior and knowledge in various social classes is necessary. The main purpose of this study was to determine the major differences in oral health knowledge and behavior in a group of Iranian pre-university students. In this cross-sectional study, 591 pre-university students from different regions of Mashhad, Iran were randomly selected to complete a questionnaire consisting of two parts including dental health behavior and knowledge. Scores were recorded and statistical analyses performed to determine the correlation between dental health behavior and knowledge. Data was analyzed with Student's t-test, one-way analysis of variance and Pearson correlation. The mean score of dental health knowledge was significantly lower than the dental health behavior (2.95 ± 0.02 vs. 3.31 ± 0.05, P < 0.001). This difference was observed with gender, birth location and major subject of study. The dental health behavior of Iranian pre-university students was inadequate and their dental health knowledge was at a lower level compared to their behavior. Experimental science students had better oral health behavior compared to other students. (J Oral Sci 53, 177-184, 2011)

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A community intervention trial was conducted to assess the feasibility of APF gel as a caries-preventive agent in a high-risk group of school children in Bangalore City. The study was conducted in two schools, randomly selected from a list of schools catering to underprivileged children. These schools were randomly allocated into experimental and control groups. Children aged 9-16 years having three or more incipient or cavitated primary or secondary carious lesions were enrolled in the study. In the experimental group, APF gel was applied and oral health education was provided to both groups at baseline and 6 months. Follow-up examination was performed at 6 and 12 months and the caries status was recorded by an investigator who was blinded to the allocation of intervention. There was no statistically significant difference in DMFT and DMFS values, but a significant difference was seen in incipient carious lesions between the experimental and control groups at 6 and 12 months. These results suggest that biannual APF gel application is an effective preventive measure in reversing incipient carious lesions. (J Oral Sci 53, 185-191, 2011)

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This study examined the association of IL1 genetic polymorphisms (IL-1A +4845, IL-1B +3954 & IL-1RN +2018) with periodontal disease status of Down syndrome (DS) individuals. Fifty-four DS patients (18-56 yr, 48.15% male, 77.78% Caucasians) were recruited from the Georgia Regional Hospital (GRH) health care system. Two comparable groups (71 mentally retarded patients and 87 control subjects) were also recruited. All subjects were nonsmokers. Periodontal evaluations (plaque index, gingival index, bleeding-on probing and clinical attachment levels (AL)), personal and professional dental care habits were recorded. Blood was collected by a venipuncture. The IL-1A +4845, IL-1B +3954 & IL-1RN +2018 loci were genotyped by the TaqMan assay. No statistically significant differences were noted in the distribution of IL-1 gene polymorphisms between the three groups. The IL-1 variant genotypes varied by race; for both IL-1A and IL-1RN, the variant gene was significantly more prevalent among whites than non-whites (ps > 0.1). ANCOVA, which also adjusted for age, showed a 3-way interaction among dental visits, gene variation and Down status [(F(1, 179) = 3.96, P = 0.048 in White subjects and F(1, 241) = 2.96, P = 0.087 in all subjects). Post-hoc t-tests confirmed lower levels of AL in IL-1RN-variant Down subjects receiving more frequent dental visits (P < 0.05). ANCOVA, which also adjusted for age, showed an interaction between IL-1A/B gene variation and Down status (F(1, 174) = 3.04, P = 0.083 in White subjects and F(1, 235) = 3.72, P = 0.055 in all subjects). Post-hoc t-tests confirmed lower levels of AL in IL-1A/B-variant Down subjects (P < 0.05). The distribution of variant IL-1 genes in DS subjects was not different from the general population. However the association between the carriage of the IL-1 rare alleles and periodontitis differed between the Down and non-Down subjects. The carriage of the IL-1 rare alleles in the Down subjects tended to confer a protective effect against loss of periodontal attachment. (J Oral Sci 53, 193-202, 2011)

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Human Immunodeficiency Virus (HIV)-related oral lesions can be used as markers of the immune status. The present cross-sectional study was conducted to identify the oral manifestations in HIV-infected individuals and their association with reduced Cluster of Differentiation 4 (CD4) count. The study population included known HIV-positive patients. A detailed case history of 399 HIV-positive patients was obtained and general examination was carried out. Diagnosis of oral lesions was done based on presumptive criteria of EEC Clearinghouse, 1993. The CD4 count was determined in 369 patients and correlated with oral manifestations. The prevalence of oral lesions was found to be 76.70% (n = 306). Oral candidiasis (157 (39.3%)) was the most common oral lesion associated with HIV infection. Amongst various forms of oral candidiasis, erythematous candidiasis (122 (39.3%)) outnumbered the other forms. The mean CD4 count of patients with oral lesions (207 cells/mm³) was less than in patients without oral lesions (291 cells/mm³) (P = 0.002). Oral candidiasis was found to be significantly correlated to a reduced CD4 cell count below 200 cells/mm³ (P = 0.000; Odds ratio = 3.1; 95% Confidence interval 1.9-4.9) with good sensitivity, best specificity and positive predictive value. Oral manifestations may be used as an alternative to CD4 count at field-based settings to diagnose the immune compromised status of HIV-infected individuals. (J Oral Sci 53, 203-211, 2011)

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Although ameloblastoma and adenomatoid odontogenic tumor (AOT) belong to the same group according to the World Health Organization, they show different biologic behaviors. PCNA, an amplifier of cell proliferation, and p53, a tumor suppressor protein, are overexpressed in some odontogenic lesions. The purpose of this study was to immunohistochemically evaluate the expression of p53 and PCNA to clarify the possible role of these proteins in different behaviors of ameloblastoma and AOT. The immunohistochemical expression of PCNA and p53 was determined in 30 solid ameloblastomas and 12 AOTs. Statistical tests including one-way ANOVA, t-test, chi-square, Mann-Whitney U and Kendall were used to analyze the data. All tissue sections (except one specimen of plexiform ameloblastoma) exhibited immunoexpression for p53. PCNA was expressed in all specimens. There was no significant difference in PCNA expression between ameloblastomas and AOTs (P > 0.05). For p53, there was no statistical difference between subtypes of ameloblastomas (P > 0.05), whereas statistical differences were observed between ameloblastomas and AOTs (P < 0.001). There was no statistical difference in PCNA intensity of staining between ameloblastomas and AOTs (P > 0.05), whereas the p53 intensity in ameloblastomas was stronger than AOTs (P < 0.05). Positive correlation between PCNA and p53 was observed. We concluded that PCNA overexpression is not responsible for the difference in clinical behavior of these two lesions, whereas the expression of p53 in ameloblastoma may explain the more aggressive nature of this tumor compared with AOT. (J Oral Sci 53, 213-217, 2011)

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This study used transparent epoxy-resin root canal models to evaluate different main root canal tapers and various methods of vertical compaction for warm gutta-percha obturation of lateral depressions. The root canal models had straight main root canals with three tapers and four lateral depressions at right angles to the main root canal, 1.0 mm and 3.0 mm from the apex. Three types of experimental stainless steel pluggers with different flat-tip diameters and tapers were used to compact the warm gutta-percha. The Obtura II was used for obturation. After obturation, the depth of penetration into lateral depressions was measured under a stereoscopic microscope, and the effects of root canal taper and plugger size were analyzed by using two-way analysis of variance. The penetration of warm gutta-percha into lateral depressions using the smallest-diameter plugger decreased with increasing main root canal taper. Penetration into lateral depressions increased with the use of pluggers of the correct size. There was a close relationship between plugger size and canal taper. The results suggest that main root canal taper and plugger size should be closely matched so as to promote gutta-percha obturation of lateral depressions. (J Oral Sci 53, 219-224, 2011)

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The purpose of this study was to evaluate the effects of aminoguanidine (AG) as a selective inhibitor of inducible nitric oxide synthase (iNOS) on the degree of inflammatory response in periapical lesions in the canine teeth of cats. Root canals from 52 cat canine teeth were exposed to the oral cavity and sealed after 7 days. One day before pulp exposure, cats were administered either AG (experimental group) or normal saline (control group), which was continued on a daily basis until the day of sacrifice. Animals were sacrificed at 28 days after pulp exposure. Inflammatory response in the periapical zones was analyzed histologically. The degree of periapical inflammation in the AG group was significantly lower than that in the control group (P < 0.05). Selective iNOS inhibitors such as AG thus reduce the intensity of inflammatory responses in periapical lesions. (J Oral Sci 53, 225-230, 2011)

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The purpose of this study was to determine the prevalence of developmental dental anomalies in an Indian population and to statistically analyze the distribution of these anomalies. The study was based on clinical examination, evaluation of dental casts, and panoramic radiographs of 1123 Indian subjects (572 males, 551 females), who visited the outpatient clinic at Government Dental College, Indore between November 2009 and September 2010, after obtaining their informed consent. These patients were examined for the following developmental dental anomalies: shape anomalies (microdontia, talon cusp, dens evaginatus, fusion, taurodontism), number anomalies (hypodontia, oligodontia, anodontia), structural anomalies (amelogenesis imperfecta, dentinogenesis imperfecta) and positional anomalies (ectopic eruption, rotation, impaction). The percentages of these anomalies were assessed for the whole group and compared using statistical analysis. Among the 1123 subjects, a total of 385 individuals (34.28%) presented with the selected developmental dental anomalies. The distribution by sex was 197 males (34.44%), and 188 females (34.06%). Out of the total 1123 individuals, 351 (31.26%) exhibited at least one anomaly, 28 (2.49 %) showed two anomalies and 6 (0.53%) displayed more than two anomalies. P values indicated that the dental anomalies were statistically independent of sex. On intergroup comparison, positional anomalies were significantly most prevalent (P < 0.05) in the Indian population. The most common developmental dental anomaly was rotation (10.24%), followed by ectopic eruption (7.93%). The next common group was number anomalies. The most common number anomaly was hypodontia (4.19%), which had a higher frequency than hyperdontia (2.40%). Analyzing the next prevalent group of shape anomalies, microdontia (2.58%) was found to be the most common, followed by taurodontism (2.49%), dens evaginatus (2.40%) and talon cusp (0.97%). Dentinogenesis imperfecta (0.09%) was the rarest, followed by amelogenesis imperfecta (0.27%) and fusion (0.27%). (J Oral Sci 53, 231-238, 2011)

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Oral malignant melanoma is a rare aggressive neoplasm of melanocytic origin, usually found on the hard palate and gingiva, and representing 0.2-8% of all melanomas. Unfortunately, oral mucosal melanomas have by far the worst prognosis, and therefore early detection is indispensable for improving their prognosis. Histopathological examination of any pigmented lesion is essential to rule out this lethal entity. Computed tomography is of help for assessing both the extent of the lesion and the presence of regional metastasis to the lymph nodes. Malignant melanoma cells stain positively with antibodies against HMB-45, S-100 protein and vimentin, and so immuno-histochemistry can play a crucial role in evaluating the depth of invasion and location of metastasis. The presence of satellite/in transit lesions is an important factor affecting prognosis. Here we report a 30-year-old female patient with malignant melanoma of the gingiva and hard palate with a satellite lesion, highlighting the role of various diagnostic tools in its detection, and the prognosis associated with satellitism. (J Oral Sci 53, 239-244, 2011)

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Mesenchymal chondrosarcoma is an infrequent malignancy of bone and soft tissue, characterized by its peculiar bimorphic histological pattern. The use of fine-needle aspiration (FNA) in the diagnosis of bone tumors is controversial. A 31-year-old woman presented with a mandibular lesion detected on routine examination for orthodontic treatment. Radiography revealed an ill-defined mixed radiolucency in the premolar region of the right mandible with invasive characteristics such as root resorption and widening of the periodontal ligament space of neighboring teeth. Blood clots obtained at FNA were fixed in formalin and exhibited spindle cells surrounding islands of pleomorphic chondroblasts against a bloody background. Histopathologically, clusters of spindle cells juxtaposed with mesenchymal tissue were detected, with a large hemangiopericytomatous component. In the present case, cytological findings combined with clinical and radiological data provided valuable information in establishing the diagnosis of malignancy and in planning further procedures and treatment. (J Oral Sci 53, 245-247, 2011)

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Ectopic thyroid gland is rarely seen in the submandibular region, thereby posing difficult diagnostic and management problems. Two Caucasian women presented with painful swelling in the submandibular region, which increased in size considerably during the preceding months. Ultrasound-guided fine needle biopsy (Ug-FNB) revealed ectopic thyroid tissue. In conclusion, ectopic thyroid gland with or without pathology should be included in the differential diagnosis of submandibular swelling and Ug-FNB should be one of the first diagnostic tools utilized for this rare clinical entity. (J Oral Sci 53, 249-252, 2011)

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Nevoid basal cell carcinoma syndrome (NBCCS) is an uncommon autosomal dominant inherited disorder with high penetrance and variable expressivity. It affects multiple organ systems, including the stomatological, skeletal, skin, eye, reproductive, and central nervous systems. It is caused by mutations in the patched tumor suppressor gene, PTCHI, located in the 9q22.3-q31 chromosome. To our knowledge, this is the first report of a patient with unusual radiological features, i. e. dextrocardia and situs inversus totalis, in conjunction with common features including multiple keratocystic odontogenic tumors, bifid ribs, palmar and plantar pits, bridging of the sella turcica and calcification of the falx cerebri. We examined whether these genetic conditions were associated, as both involve ciliary dysfunction. (J Oral Sci 53, 253-256, 2011)

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We evaluated and treated a 54-year-old woman with gingival swelling. Conventional intraoral and panoramic radiography did not provide sufficient information for either determining the cause of gingival swelling or planning treatment of clinical symptoms. The 3D Accuitomo XYZ Slice View Tomograph (3DX) is a compact dental computed tomography device that allowed for accurate identification and optimal treatment of the causes of gingival swelling. At four years after treatment, 3DX radiographs showed no abnormalities in treated teeth or healing of surrounding structures. We conclude that high-resolution 3D images obtained with 3DX promise to be very effective for diagnosing oral diseases and determining effective treatment. (J Oral Sci 53, 257-261, 2011)

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