Leukemia is a malignancy of the bone marrow and blood. It is the most common childhood cancer in India. Advances in the treatment regimens have greatly increased the chances of survival. Both the disease and its treatment change the oral environment. In some cases, oral manifestations are the presenting feature of the disease and it will be the dentist's responsibility to identify the underlying disorder and guide the diagnosis of the patient. Hence, the aim of present article is to review the literature concerning the oral health of children with acute lymphoblastic leukemia (ALL).

Fibronectin is a main component of connective tissue and has various biologically significant roles to play in tissue integrity, remodelling and repair, apart from influencing pathological processes. This review looks into the physiology of fibronectin and its influences in health and disease.

Context (Background): Stem cells are a unique subpopulation of cells in the human body with a capacity to initiate differentiation into various cell lines. Tumor stem cells (TSCs) are a unique subpopulation of cells that possess the ability to initiate a neoplasm and sustain self-renewal. Epithelial stem cell (ESC) markers such as octamer-binding transcription factor 4 (OCT4) and sex-determining region Y (SRY)-box 2 (SOX2) are capable of identifying these stem cells expressed during the early stages of tooth development. Aims: To detect the expression of the stem cell markers OCT4 and SOX2 in the normal odontogenic tissues and the odontogenic cysts and tumors. Materials and Methods: Paraffin sections of follicular tissue, radicular cyst, dentigerous cyst, odontogenic keratocyst, ameloblastoma, adenomatoid odontogenic tumor, and ameloblastic carcinoma were obtained from the archives. The sections were subjected to immunohistochemical assay by the use of mouse monoclonal antibodies to OCT4 and SOX2. Statistical Analysis: The results were evaluated by descriptive analysis. Results: The results show the presence of stem cells in the normal and lesional tissues with these stem cell identifying markers. SOX2 was found to be more consistent and reliable in the detection of stem cells. Conclusion: The stem cell expressions are maintained in the tumor transformation of tissue and probably suggest that there is no phenotypic change of stem cells in progression from normal embryonic state to its tumor component. The quantification and localization reveals interesting trends that indicate the probable role of the cells in the pathogenesis of the lesions.

Panoramic radiography is a unique and a very useful extraoral film technique that allows the dentist to view the entire dentition and related structures, from condyle to condyle, on one film. Capturing a wide range of structures on a single film grounds the odds of errors in the digital panoramic radiographs. Improper positioning of the patient complicates it more, reducing the diagnostic usefulness of these radiographs. Wide knowledge about the common positioning errors and the ways to rectify it benefits the dentists in interpretation and diagnosis. Aim: This study is aimed at analyzing the 10 common positional errors (anteriorly positioned, posteriorly positioned, head tilted upwards, head tilted downwards, head twisted to one side, head tipped, overlapping of spine in lower anterior region, tongue not placed close to palate, patient movement, and ghost images) in 200 digital panoramic radiographs selected randomly. Materials and Methods: Two hundred digital panoramic radiographic images of the patients above 6 years of age were selected randomly from the stored data in the system, projected on the white screen, and studied. The radiographs were analyzed by two oral medicine and radiology specialists, by recording separately, and then the results were analyzed. Results: The most common error was failure to place the tongue close to the palate, which leads to the presence of radiolucent airspace obscuring the roots of the maxillary teeth.

Background: The medical and dental professionals have been included in the Consumer Protection Act (CPA) to shield the patients in case of any unethical treatment given by the doctor. Though there is ample literature regarding the CPA and its importance, insufficient data is available from the Indian subcontinent regarding the awareness of dentists in India and the problems faced by them in clinical practice. Thus, there is a need to know the awareness of the dental fraternity in India and their knowledge about CPA. Objective: To evaluate the knowledge, awareness, and practices regarding the CPA among dental professionals in India. Materials and Methods: In a cross-sectional study, a total of 467 dental professionals (198 males, 269 females) comprising (117) Bachelor of Dental Surgery (BDS) practitioners, (114) Master of Dental Surgery (MDS) practitioners, (104) interns, and (79) postgraduate (PG) students were surveyed using a self-administered structured electronic questionnaire. The questionnaire comprised 20 questions about the awareness of CPA and whether these professionals were following the recommendations of CPA. Chi-square test was used to know the significance. Results: The CPA awareness scores were significantly higher among MDS practitioners when compared with those of BDS practitioners, interns, and postgraduates. Almost 66% of the participants found the taking of written consent to be time-consuming. Nearly 70% and 69.3% of the BDS and MDS practitioners, respectively, were updating the medical ethics. Conclusion: Considering the present scenario, a better understanding of CPA is necessary for dentists in order to be on the safer side and an educational program would be helpful to increase the knowledge and confidence of dentists in any medical legal jurisprudence to avoid any litigation.

Objective: The purpose of this study was to compare the clinical performance of class II composite resin restorations placed by two different bulk-fill techniques according to the United States Public Health Service (USPHS) criteria. Materials and Methods: Sixty class II restorations were placed in 60 patients in the age range of 20-50 years. The patients were divided into three groups according to the technique of the restoration were applied. Group 1: Tetric Evo Ceram (Ivoclar Vivadent) was placed in 2 mm increments. Group 2: Tertic N Ceram Bulk Fill (Ivoclar Vivadent) was placed in single increment. Group 3: Sonic Fill (Kerr, Kavo) was placed in single increment by sonic vibration. The restorations were evaluated using modified USPHS criteria at baseline and then after 3 months, 6 months, 9 months, and 12 months. Results: After 12 months, 58 Class II restorations could be observed. Two cases were dropped out. All the restorations of the three groups showed acceptable clinical performance according to the modified USPHS criteria, and statistically there were no significant differences between the two bulk-fill techniques. Conclusion: Both the bulk-fill techniques performed satisfactorily over the 12-month observation period. Due to the low viscosity of Sonic Fill, it may preponderance Tertic N Ceram Bulk Fill in the regard to depth of cure and marginal integrity and marginal discoloration.

Aims: To investigate surface microhardness of nanocomposites after cyclic immersion in red and white wines. Materials and Methods: Seventy-two specimens of each resin composite were prepared. Before immersion, baseline data of Vicker's microhardness were recorded and surface characteristics were examined using scanning electron microscopy (SEM). Three groups of discs (N = 23) were then alternately immersed in red wine, white wine, and deionized water (as a control) for 25 min and artificial saliva for 5 min over four cycles. The specimens were then stored in artificial saliva for 22 h. This process was repeated for 5 days following immersion in artificial saliva for 2 days. Subsequently, the process was repeated. After immersion, specimens were evaluated and data were analyzed by two-way repeated analysis of variance (ANOVA) and Tukey's honest significant difference (HSD) (α = 0.05). Results: Microhardness values significantly decreased after being immersed in the red and white wines (P < 0.05). SEM photomicrographs presented surface degradation of all groups after immersion in red and white wines. Conclusion: The effect of red and white wines on surface microhardness of nanocomposite restorative materials depended on the physical and chemical compositions of the materials and the types of wine.

Background: The aim of the present study was to estimate the regulated on activation normal T-cell expressed and secreted (RANTES) levels in serum and gingival crevicular fluid (GCF) from patients with clinically healthy periodontium, gingivitis, and chronic periodontitis and after initial periodontal therapy, i.e., scaling and root planing (SRP) in the periodontitis patients. Materials and Methods: Periodontal examination and collection of GCF by extracrevicular method and serum were performed in sixty patients selected randomly and categorized into four groups as Group I (healthy, n = 20), Group II (gingivitis, n = 20), Group III (chronic periodontitis, n = 20) and Group IV (after treatment group, n = 20). SRP was performed and GCF and serum were collected initially and after 12 weeks of treatment. RANTES levels were estimated in GCF and serum samples by using enzyme-linked immunosorbent assay. Results: The results of the study suggest that mean concentrations of RANTES in GCF and serum were highest in chronic periodontitis group (Group III) and it differs significantly from that of Groups I, II, and IV. Further, the concentrations of RANTES in GCF and serum increase proportionally with progression of periodontal disease and decrease after SRP. Conclusion: The mean concentrations of RANTES in diseased group were significantly higher than in healthy and after treatment groups. These data indicate that the high GCF and serum levels of RANTES are at significantly greater risk for progression of periodontitis. However, controlled, longitudinal studies are needed to confirm this possibility.

Objective: To determine the prevalence of gingivitis and perception of gingival colour among pregnant women attending the antenatal clinic of a tertiary health institution in Lagos State, Nigeria. Materials and Methods: A single-point assessment was conducted using a self-reported questionnaire completed by participants. Information such as patients' age, gestational age, educational status, occupation, and perception of gingival colours was obtained. Furthermore, the participants were examined by trained dentists to determine their gingival colours and the presence and severity of gingival inflammation. The data obtained were processed, and descriptive and comparative analyses were done using Epi info version 3.5.1 (2008). Statistical significance was established at P values <0.05. Results: Four hundred and forty-five pregnant women aged between 18 years and 43 years [mean age: 30.3 (±4.61) years] participated in the study. Gestational age was between 4 weeks and 41 weeks with a mean of 23.49 (±9.53) weeks. The prevalence of gingivitis was 85.2%. Two hundred and thirty (51.7%) participants described their gingival colour as pink, 127 (28.5%) as red, 51 (11.5%) as black, 3 (0.7%) as white, 2 (0.4%) as brown, and 32 (7.2%) could not determine the colour of their gingivae. Two hundred and ten (47.2%) participants knew that pink was the normal colour of a healthy gingiva. From objective clinical examinations by dentists, 344 (77.3%) patients had pink gingivae, 85 (19.1%) had pigmented gingivae, and only 16 (3.6%) had red gingivae. Conclusion: The higher prevalence of gingivitis during pregnancy is well-established and that observation is corroborated by this study. Since a change in gingival colour may be an early indication of gingival inflammation, early detection and prompt treatment could prevent further periodontal deterioration. Hence, there is the need to incorporate and intensify oral health education during antenatal care so that pregnant women are able to identify changes in gingiva colour, especially when it is associated with periodontal inflammatory diseases.

Background and Aim: Recent studies demonstrate direct roles of different genes during formation of secondary palate, but there are no still data about local expression and distribution of gene products in cleft palate affected human tissue. Thus, the aim of our study was to investigate cleft disordered cartilage and bone for detection of local expression of key regulators of palatogenesis and its correlations. Materials and Methods: The study involved 16 patients with unilateral cleft lip and palate. Tissue samples were proceeded for detection of interferon regulatory factor 6 (IRF6), muscle segment homeobox 1 (MSX1), paired box gene 9 (PAX9), homeo box B3 (HOXB3), and related to tyrosine kinases with biotin-streptavidin immunohistochemistry. Distribution of immunoreactive structures was detected semiquantitatively. Statistical analysis included the Mann-Whitney test and Pearson's correlation test. Results: Statistically significant differences were found between expression of IGFR6, MSX1, and HOXB3 in the cartilage and bone. We also detected statistically significant correlation between the expressions of PAX9 and MSX1 in the bone tissue. Conclusions: Cleft lip and palate disordered cartilage is characterized by more pronounced expression of IRF6, MSX1, and PAX9. Expression of HOXB3 is more characteristic for cleft lip and palate affected bone. Considered as a whole, our results suggest that the cleft lip and palate affected cartilage seems more plastic in tissue remodeling what can probably result in qualitative postoperative tissue reconstruction.

Oncocytoma is a rare benign tumor of the salivary glands usually seen in elderly patients in the sixth to eighth decade. Microscopically, the hallmark of this lesion is the presence of oncocytes that comprise the entire tumor. These are large polygonal cells which have abundant eosinophilic granular cytoplasm, and from central to eccentric round nucleus. Several reactive as well as neoplastic lesions of salivary glands often have concurrent oncocytic changes. On fine-needle aspiration cytology, all of them have overlapping morphological features, thus making the diagnosis difficult by cytology alone. We report a case of oncocytoma of the right parotid gland in a 32-year-old Indian male. Although the tumor was initially suspected on cytology, confirmation was possible only after histopathological examination. The main purpose of this case report is to discuss the cytological differential diagnosis of oncocytic lesions of salivary glands and simultaneously emphasize the importance of histopathology for arriving at conclusive diagnosis in such cases.

Patients with primary hyperparathyroidism (HPT) may be asymptomatic and clinical presentation of the tumor in the jaws can be the first sign of the disease. Only 2% of all primary HPT cases occur in patients below the age of 30 years. ^[1] Owing to the improved methods of blood analysis in the last two decades, most of the recent cases of primary HPT are diagnosed early and asymptomatically. ^[2] Most cases of primary HPT are identified by hypercalcemia and hypophosphatemia on routine multi-panel serum testing. ^[3] This makes advanced disease with brown tumor extremely rare these days, the mandible being affected only in 4% of the cases. ^[2] Here, we report a case of a 23-year-old female patient who presented with a swelling at body of mandible, with hypophosphatemia, increased parathyroid hormone, and normal serum calcium levels based on which a diagnosis of brown tumor was given.

Foreign objects present in root canals and surrounding areas are troublesome incidents in endodontics. Chances of these objects getting impacted are more when the chamber is open either due to caries or traumatic injury. Moreover, when pushed apically, retrieval becomes complicated and apical surgical procedures unavoidable. A young male patient presented with a chief complaint of discolored anterior teeth. During routine radiographic examination, a linear appearing radio-opaque foreign body (approximately 15 mm in length), extending apically through the apex into the periapical region, was identified. There was also large periapical radiolucency (approximately 10 mm × 15 mm in size) on an adjacent tooth. This case report describes the successful retrieval of two foreign objects from the periapical region, and the management of a cystic lesion, through periapical surgery.