Papers by Rathy Ravindran
Journal of Indian Society of Periodontology, 2013
Journal of pharmacy and bioallied sciences, Apr 1, 2024
JOURNAL OF ORAL AND MAXILLOFACIAL PATHOLOGY, 2017
Lichen planus (LP) is a unique, common inflammatory disorder affecting the skin, mucous membrane,... more Lichen planus (LP) is a unique, common inflammatory disorder affecting the skin, mucous membrane, nails and hair that frequently affects the oral mucosa. Oral LP (OLP) affects approximately 0.1%-2% of the general adult population. [1] Clinically, OLP can present six different patterns: papule, reticular, plaque, atrophic, erosive and bullous each showing specific characteristics and appearing in either isolated or associated forms. [2,3] Both antibodies and T-cell-mediated activity have been implicated in the pathogenesis of LP. [1] Studies have reported that oxidative stress may play a role in OLP. [4] Oxidative stress is defined as the imbalance between the production of reactive oxygen species (ROS) and the ability of the biological system to readily detoxify the reactive Background: Lichen planus (LP) is a chronic, inflammatory disease that affects the skin, mucous membrane, scalp and nails that frequently involves the oral mucosa. Oxidative stress reflects an imbalance between the production of reactive oxygen species and the biological system's ability to readily detoxify the reactive intermediates or repair the resulting damage. It has been suggested that oxidative stress may play a role in the pathogenesis of LP. Aim and Objectives: To evaluate the role of oxidative parameters in the pathogenesis of oral LP, estimate the levels of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GPx) and uric acid (UA) in saliva of oral LP patients and to compare the levels of SOD, MDA, GP and UA in oral LP patients with healthy controls. Methodology: In this cross-sectional study, 1.5 ml of fasting saliva sample was collected using passive drool method from the study group (30 patients diagnosed as having oral LP) and the control group (30 age-matched healthy volunteers). The unstimulated saliva was collected were analyzed by spectrophotometry. Statistical analysis was done to evaluate and compare the values between groups. Results: The mean values of SOD and MDA in saliva in the study group showed a significant increase in amount when compared with the control group whereas GPx showed a significant decrease in the study group. UA value showed an insignificant difference in the same comparison. Interpretation and Conclusion: Oxidative stress markers as MDA and SOD are elevated, and GPx is decreased in the saliva of oral LP patients.
Journal of Dr. NTR University of Health Sciences, 2020
The objective of this article is to review the available literature on the pathogenetic mechanism... more The objective of this article is to review the available literature on the pathogenetic mechanisms involved in the association between oral cancer and periodontitis and its clinical implications. Periodontal diseases are characterized by chronic inflammation as a response to the host tissue invasion by multi-species microbial community. The activation of different inflammatory cascades by chronic periodontitis negatively affects the oral mucosa and has the potential to activate carcinogenesis. An electronic literature search was conducted in the MEDLINE and EMBASE databases. The search terms used were “CHRONIC PERIODONTITIS, ORAL CANCER, and PATHOGENESIS”. Original articles published between January 1990 and March 2018 was identified. Thirty-two potentially relevant articles were selected and included in the review after assessing the title and abstract. Several studies have shown that the inflammatory mediators produced in periodontal diseases may lead to angiogenesis and subsequently promote tumorogenesis. Periodontitis being a polymicrobial disease promotes carcinogenesis by evoking various inflammatory pathways. The rationale behind the association of oral cancer and periodontitis is that inflammation plays a key role in the pathogenesis of both conditions.
Journal of Oral and Maxillofacial Pathology, 2015
Background: Flexibility of digital photography enables it to be an integral part of pathology pra... more Background: Flexibility of digital photography enables it to be an integral part of pathology practice. An assessment of guidelines of imaging is essential for proper usage of photographs. Objectives: The purpose of the study was to assess awareness of oral pathologists about various aspects of medical photography. Methods: Questionnaire based on the availability of facilities, usage, technical details and ethical issues of medical photography was sent to postgraduate students and teaching faculties of Oral Pathology in various localities in India. Results: Photographs were taken mostly for the purposes of publication, medical documentation and education. Significant number of postgraduate students and faculties of Oral Pathology didn't receive any training or hadn't gone through any publications/books (P = 0.000) about medical photography. Consent for patient photography was taken by significant number of respondents (P = 0.000) but in a verbal form. Majority of people used image editing software, but 19.0% of faculties and 21.1% of postgraduate students were unaware of deleterious effect of image editing. Firm and sensible instructions concerning image storage, sharing and accessibility were not yet created. Conclusion: This survey drew attention towards lack of proper understanding about the technical details, medical protocols and ethical issues related to medical photography. These findings recommend implementation of basic training for medical photography and policy for image management for students and faculties in every health care institution.
Journal of Oral and Maxillofacial Pathology, 2017
Lichen planus (LP) is a chronic, inflammatory disease that affects the skin, mucous membrane, sca... more Lichen planus (LP) is a chronic, inflammatory disease that affects the skin, mucous membrane, scalp and nails that frequently involves the oral mucosa. Oxidative stress reflects an imbalance between the production of reactive oxygen species and the biological system's ability to readily detoxify the reactive intermediates or repair the resulting damage. It has been suggested that oxidative stress may play a role in the pathogenesis of LP. To evaluate the role of oxidative parameters in the pathogenesis of oral LP, estimate the levels of superoxide dismutase (SOD), malondialdehyde (MDA), glutathione peroxidase (GPx) and uric acid (UA) in saliva of oral LP patients and to compare the levels of SOD, MDA, GP and UA in oral LP patients with healthy controls. In this cross-sectional study, 1.5 ml of fasting saliva sample was collected using passive drool method from the study group (30 patients diagnosed as having oral LP) and the control group (30 age-matched healthy volunteers). The unstimulated saliva was collected were analyzed by spectrophotometry. Statistical analysis was done to evaluate and compare the values between groups. The mean values of SOD and MDA in saliva in the study group showed a significant increase in amount when compared with the control group whereas GPx showed a significant decrease in the study group. UA value showed an insignificant difference in the same comparison. Oxidative stress markers as MDA and SOD are elevated, and GPx is decreased in the saliva of oral LP patients.
Journal of international oral health : JIOH, 2019
Aims: The survival of oral squamous-cell carcinoma (OSCC) patients remains poor despite recent tr... more Aims: The survival of oral squamous-cell carcinoma (OSCC) patients remains poor despite recent treatment advances. A sensitive and specific biomarker is important in screening high-risk patients. The present study was undertaken to test a hypothesis whether salivary tumor necrosis factor-alpha (TNF-α) can be used as a biomarker for OSCC. The study aimed to assess salivary TNF-α in OSCC, leukoplakia, and whether it can be used as a biomarker for the early diagnosis of OSCC. The objectives are as follows: (1) To evaluate salivary TNF-α and compare with histological grades of OSCC. (2) To evaluate salivary TNF-α in leukoplakia and compare with different grades of dysplasia. (3) To compare TNF-α levels in the saliva of oral cancer patients with leukoplakia patients and with healthy control group. Materials and Methods: The study was conducted in 90 participants, of which 30 healthy individuals, 30 leukoplakia, and 30 OSCC patients. Whole unstimulated saliva was collected and analyzed using an ELISA test. Results: TNF-α was significantly elevated in leukoplakia, further elevated in OSCC as compared to controls. There was a significant difference in TNF-α between the different histopathological grades of OSCC and leukoplakia (P ≤ 0.01). There were also statistically significant differences in TNF-α level between different clinical stages in OSCC (P ≤ 0.05). ROC curve analysis and area under curve values showed high specificity and sensitivity in differentiating OSCC from leukoplakia and healthy controls. Conclusion: The present study shows that salivary TNF-α can be used as a marker for predicting leukoplakia and oral cancer. The study also showed a significant correlation between clinical staging and histopathological grading of OSCC and TNF-α level.
Journal of Oral and Maxillofacial Pathology, 2016
The current imaging modalities in pathology practice are static photomicrography of the slide, sl... more The current imaging modalities in pathology practice are static photomicrography of the slide, slide scanning by robotic microscope and whole slide imaging (WSI). Wetzel and Gilbertson developed automated WSI system in 1999 and since then methodology of imaging has been changing slowly but steadily. [1] Whole slide image (virtual image, digital slides) denote a digitalized image of entire histopathology slide or a selected area of it. [2] These digital images have high-resolution and offer access to all areas on a slide. These images can be viewed on personal computers, laptops or iPhones in any magnification. [3] DIGITALIZATION OF IMAGES The digital imaging has four important steps: Image acquisition, storage, editing and display of images. [4] Digitalization is performed with the help of WSI scanners, which has a hardware and software component. Hardware component is for handling and scanning the slides, storing the images, transmission and display of the images to pathologists. Software part facilitates formatting, compressing and viewing the images. Other important requirements associated with WSI system is high-speed internet connection and security measures to protect patient information. [5] Slide scanning can be done in tile or linear pattern. In tile pattern, the slide is scanned as a series of rectangular tiles [Figure 1a and b]. In linear pattern, image acquisition is done as long narrow strips [Figure 1c]. Focusing strategies can also vary among scanners. In "focus every field" method [Figure 1a], each field/tile is auto-focused and is imaged. It is an accurate but time-consuming method. In "focus every n th field" method [Figure 1b], focusing occurs every n th field. It is a faster and simpler method. "Focus map" method [Figure 1c] can be used with either tile or line pattern of scanning. Here, focus points Pathology practice is significantly advanced in various frontiers. Therefore, "slide less digital" pathology will not be a mere imagination in near future. Digitalization of histopathological slides (whole slide imaging [WSI]) is possible with the help of whole slide scanner. The WSI has a positive impact not only in routine practice but also in research field, medical education and bioindustry. Even if digital pathology has definitive advantages, its widespread use is not yet possible. As it is an upcoming technology in our field, this article is aimed to discussessential aspects of WSI.
Journal of Orofacial Sciences, 2021
Introduction: The emergence of coronavirus disease 2019 (COVID-19) crisis has evoked an exigent n... more Introduction: The emergence of coronavirus disease 2019 (COVID-19) crisis has evoked an exigent need to explicate the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and oral mucosal lesions. The present systematic review aims to elucidate the recent literature on oral manifestations related to COVID-19 so as to help the dental professionals for better screening and early diagnosis of the disease. Materials and Methods: A comprehensive literature search on PubMed, Science direct, Scopus, and Embase databases was carried out from December 2019 to March 2021 using keywords “Coronavirus,” “COVID-19,” “SARSCoV-2,” “Oral mucosal lesions,” and “Oral manifestation.” Additional information was obtained from Cochrane, World Health Organization, and Medscape. The full text articles of case reports and cross-sectional studies were analyzed and included. The review included 25 articles. Results: Four most common oral manifestations were found: gustatory and olfactory dysfunction, xerostomia, oral mucosal lesions, and salivary gland diseases. Vasculitis, opportunistic infections, drug eruption secondary to administration of Non-Steroidal Anti-inflammatory Drugs (NSAIDs), stress, immunosuppression, and hyperinflammatory immune response secondary to COVID-19 might be some of the relevant predisposing factors responsible for the onset of oral manifestations in patients with COVID-19. Conclusion: The early detection of oral symptoms of SARS-CoV-2 infection could help the clinicians to perform a better screening, and in recognizing early manifestations of the disease. However, the oral manifestations might be misdiagnosed due to subsequent challenge of undergoing oral examinations, hence diverse studies should be undertaken by the researchers to gain a better insight into the topic.
oral and maxillofacial pathology journal, 2011
Nanotechnology provide innovative tools that shed greater light on life cycle of normal cells and... more Nanotechnology provide innovative tools that shed greater light on life cycle of normal cells and the point at which molecular processes and changes within cells become correlated with development of cancer. It should be possible to obtain large amount of information from a small source. They aid in analysis of parameters such as cellular mechanics, morphology and cytoskeleton which has been hard to achieve using conventional technology. Nano devices can detect cancer cells, identify cancer signatures and provide targeted delivery of anti cancer therapeutics and contrast agents to tumour cells. The obstacle to early detection of cancer lies in the liability of existing tools to detect molecular level changes during early phases in the development of cancer. Nano Technology is potential tool that could help detect the molecular changes and assist in focusing on preventive efforts.
Journal of Oral and Maxillofacial Pathology, 2020
Background: Microscopically, groups of enamel rods run in unique direction, which differ from adj... more Background: Microscopically, groups of enamel rods run in unique direction, which differ from adjacent group of enamel rods and results in forming different patterns of enamel rod endings on tooth surface. These are called as tooth prints and they help in personal identification in forensic odontology. Aims and Objectives: The aim of the present study is to analyze the enamel rod end pattern on the tooth surface for personal identification and to analyze the familial inheritance of enamel rod end pattern. Materials and Methods: In the present study, 100 different families were considered for the analysis of tooth print pattern. In each family, four members were present. The maxillary central incisor, canine and first premolar were selected. Enamel rod end pattern was recorded using acetate peel technique and analyzed using Verifinger® standard SDK version 6.7 software. Statistical Analysis: Data analysis was performed using the SPSS software. Contingency coefficient statistical analysis was used for the comparison of tooth print pattern in incisors, canines and premolars based on age and gender. P < 0.05 was considered statistically significant. Results: The present study showed that a tooth print is composed of combination of eight distinct subpatterns, namely wavy branched, wavy unbranched, linear branched, linear unbranched, whorl open, whorl closed, loop and stem-like pattern. Wavy branched pattern was found to be the most predominant pattern in incisors, canines and first premolars in our study. Familial tendency of tooth print pattern in incisors, canines and premolars was noticed in 65%, 66% and 52% of the families, respectively. Conclusion: Tooth prints are unique to an individual and can be used as a valuable inexpensive tool in forensic odontology for personal identification.
Journal of Cytology, 2015
Squamous cell carcinoma (SCC) is the third most common cause of oral morbidity in India despite t... more Squamous cell carcinoma (SCC) is the third most common cause of oral morbidity in India despite the numerous advances made in the treatment protocol. To compare the cytomorphometric changes of oral mucosal cells in normal subjects (Group I) with that of tobacco users without any lesion (Group II), tobacco users with oral leukoplakia (Group III), and tobacco users with oral SCC (Group IV) through a semi-automated image analysis system. Oral mucosal cells collected from study subjects (n = 100) stained using rapid Papanicolaou stain. Photomicrograph of 50 nonoverlapping cells captured at 50× magnification with a digital image capture system. Cytomorphometric analysis of cells in the captured images was performed with Image-Pro image analysis software. Image analysis was performed to obtain cell diameter (CD), cytoplasmic area (CyA), nuclear diameter (ND), nuclear area (NA), and nuclear-to-cytoplasmic ratio. These values were statistically compared among the groups using one-way analysis of variance (ANOVA) and Mann-Whitney U test. The ND, NA, and nuclear-to-cytoplasmic ratio values were found to be increased in the samples collected from leukoplakia and oral SCC. The CD and CyA decreased compared to the normal mucosa in oral SCC samples. The cytomorphometric changes observed in samples from oral SCC and oral leukoplakia were consistent with the current diagnostic features. Hence, the semi-automated cytomorphometric analysis of oral mucosal cells can be used as an objective adjunct diagnostic tool in the diagnosis of these lesions.
International journal of odontostomatology, 2014
Epidermoid and dermoid cysts are hamartomas localized on the neck, head, or trunk, usually visibl... more Epidermoid and dermoid cysts are hamartomas localized on the neck, head, or trunk, usually visible at birth. In some instances, careful medical examination may help to find most epidermoid and dermoid cysts. Ambiguity about their exact pathogenesis exists and dysontogenetic, traumatic, and thyroglossal anomaly theories have been postulated. Histopathologically epidermoid cysts have a cystic capsule lined with thin stratified epithelium. Surgical excision though completes the treatment, complications have been reported. We report three cases of epidermoid cyst on the maxillofacial region.
Contemporary Clinical Dentistry, 2013
Osteoradionecrosis (ORN) of the jaws, particularly of the mandible, is a long-term and serious co... more Osteoradionecrosis (ORN) of the jaws, particularly of the mandible, is a long-term and serious complication of therapeutic radiotherapy for head and neck cancer. The mandible is affected more commonly than any other bones of the head and neck region. The incidence of ORN of mandible is reported to be between 2% and 22%. With the older radiation techniques, the rate of ORN was reported to be between 5% and 15%, whereas with newer techniques such as 3D conformal therapy and intensity modulated radiotherapy the rate of ORN has decreased to 6% or less. We here report a case of mandibular ORN and the literature review discusses the clinical features, pathogenesis, preventive measures, and management of ORN.
Journal of Orofacial Research, Oct 3, 2020
Background: To assess the knowledge, attitudes and practice of medical faculty regarding research... more Background: To assess the knowledge, attitudes and practice of medical faculty regarding research ethics and research ethics committees (RECs). Methods: A cross-sectional, questionnaire-based study was conducted in ESIC medical colleges in Bangalore among faculty using a validated questionnaire. Questions were designed to assess the knowledge, attitudes and practice of medical faculty regarding research ethics and research ethics committees. Statistical analysis was done using descriptive statistics and chi-square tests. Results: Majority (76%) of faculty had not undergone training in research ethics. Less than half of the participants answered correctly to a question on guidelines in research ethics, 60% responded correctly to question on research involving children. Majority responded correctly to question on role of a research ethics committee and confidentiality, informed consent and to question on composition of Institutional Ethics Committee. 68% taught that ethical review of research by an ethics committee would delay research. >90% were favourable towards research ethics training. Faculty held attitudes regarding certain research ethics practices that were not optimal, 96% believed that it is okay to fabricate data, 68% taught that if no surrogate is available to give informed consent for vulnerable groups, they could still be included. Conclusions: We conclude that among the medical faculties participating in our study, there is acceptance of RECs and training in research ethics, while there are knowledge gaps in research ethics guidelines, research involving children. There is need to train researchers and students to make them aware about various aspects of research.
Background: Oral cavity reflects the general health status of a person and diagnosing and treatin... more Background: Oral cavity reflects the general health status of a person and diagnosing and treating oral manifestations of systemic disease pose a greater challenge. Even though there is strong evidence that supports the relationship between oral health and diabetes mellitus, oral health awareness is lacking among diabetic patients and health professionals. The present study was undertaken to determine the oral health status in type II diabetic patients and also to compare the oral changes in controlled diabetes and uncontrolled diabetes. Materials and methods: Study population consists of 60 diabetic patients which is divided into 30 controlled and 30 uncontrolled diabetics; 60 healthy subjects. Each of these diabetic groups were again subdivided according to their dura-tion as patients having a disease duration below 10 years15 and
Nanotechnology provide innovative tools that shed greater light on life cycle of normal cells and... more Nanotechnology provide innovative tools that shed greater light on life cycle of normal cells and the point at which molecular processes and changes within cells become correlated with development of cancer. It should be possible to obtain large amount of information from a small source. They aid in analysis of parameters such as cellular mechanics, morphology and cytoskeleton which has been hard to achieve using conventional technology. Nano devices can detect cancer cells, identify cancer signatures and provide targeted delivery of anti cancer therapeutics and contrast agents to tumour cells. The obstacle to early detection of cancer lies in the liability of existing tools to detect molecular level changes during early phases in the development of cancer. Nano Technology is potential tool that could help detect the molecular changes and assist in focusing on preventive efforts.
Spindle cell Carcinoma is a rare biphasic neoplasm consisting of epithelial and mesenchymal compo... more Spindle cell Carcinoma is a rare biphasic neoplasm consisting of epithelial and mesenchymal components and accounts for less than 1% of all tumours of oral region. It is a rare aggressive variant of squamous cell carcinoma which frequently recurs and metastasizes with poor prognosis compared to classical squamous cell carcinoma. The biologic behaviour is comparable to poorly differentiated Squamous Cell Carcinoma. The 5 year disease free survival rate is approximately 30% for all Oral Tumors. The variants of squamous cell carcinoma frequently arise in mucosa of upper aerodigestive tract. The most common site in head and neck region is in larynx and hypopharynx; the oral cavity being rarely affected. This biphasic malignant neoplasm often assumes a sarcomatous appearance and may present diagnostic difficulty. Hence careful histopathologic analysis is warranted. We report a rare case of spindle cell carcinoma in unusual location with immunohistochemical findings and review of the lite...
Journal of International Society of Preventive & Community Dentistry, 2016
Aim and Objectives: To determine the prevalence of developmental defects of enamel in children ag... more Aim and Objectives: To determine the prevalence of developmental defects of enamel in children aged 12—15 years in Kollam district and to examine the etiological factors associated with the developmental defects of the enamel (DDE). Materials and Methods: A total of 2,500 children from 10 urban and 10 rural schools were examined using modified DDE criteria for recording enamel defects. Ten index permanent teeth were screened for the DDE. Results: The overall prevalence of the DDE was found to be 32% and the prevalence is higher in urban schools (34.3%) compared to rural schools (29.6%). The most common tooth affected by the defect was maxillary right lateral incisor (P = 28.6%) and the tooth least affected was maxillary right first premolar (P = 3%). The most common deformity was demarcated opacities (P = 28.76%) and the least common deformity was combination of diffuse opacities and hypoplasia and combination of demarcated, diffuse opacities, and hypoplasia (P = 0%). There was a ve...
Oral erythema multiforme presents with oral and lip ulcerations typical of erythema multiforme bu... more Oral erythema multiforme presents with oral and lip ulcerations typical of erythema multiforme but without skin target lesion. The primary attack is confined to oral mucosa but subsequent attacks can produce more severe forms of erythema multiforme involving skin. It is important to distinguish it from other oral ulcerative disorders for early diagnosis and treatment. Here we report a case of oral erythema multiforme induced by drug with literature review.
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Papers by Rathy Ravindran