Tuesday, 12 February 2019


This slow growing variant of squamous cell carcinoma (SCC) has features of both squamous and verrucous varaiants of SCC. A common form in the skin but rarely seen in the oral mucosa. Histopathologically displays the " Rabbit Burrow"  branching keratin filled crypts, that give it the name cuniculatus derived from cuniculus(small tunnel or burrow).

Mandana Donoghue [CC BY-SA 4.0], from Wikimedia Commons

Wednesday, 19 September 2018



Paramolars are developmental anomalies in the number of teeth. They presesnt as an extra tooth that resembles a rudimentary molar. 

Site: most common in maxillary arch, in relation to the buccal and less often palatal aspect of the molars. 

Symptoms: Mostly asymptomatic , unless soft tissue infringement occurs. 

Clinical significance : may cause displacement of neighbouring teeth or cause mucositis. 

In view of the current emphasis on  the role of chronic inflamation in carcinogenesis mucositis associated with the paramolar may be considered to increase malignant transformation risk in patients with high risk habits (smoking, tobacco, paan, or areca nut chewing). 

Advised treatment - extraction

Saturday, 8 September 2018


“But madam I haven’t a clue where to begin looking for the topic” was the bewildered query of most new entries to the postgraduate course in my department. While at the time I did not have a well-phrased way of telling them what to do, I used to describe the steps, which I accept were not novel, and possibly followed by most guides and mentors.
The process as I used to explain involved looking for an area or field of study that was of interest to the student and then reading as many literature reviews as possible to find, and understand the current knowledge and the gaps. Then progressively narrowing down to the most recent findings on a topic and then applying a different/advanced technique, a larger or different sample,  different criteria or different study type to the same problem /query.

This system of moving from known to peripheral unknowns worked. Now I realize it is a well-recognized concept termed as “Adjacent Possible” in innovative thinking that was popularized by Steven Johnson in an essay called "The Genius of the Tinkerer" .
In case you are looking for that, a spark of intuition, for a research topic and it doesn’t happen to take heart and look closely at what is already known, chances are your answer is closer than you think.

Thursday, 5 July 2018

Revisiting Oral Cancer Screening

Cancer screening is a familiar concept to most of us yet like most things in medicine, it is good to revisit the topic for a concept check periodically.

Screening to me was the examination of apparently healthy individuals to identify those who had the disease.  However, after reading a paper titled  Screening for oral cancer - a perspective from the Global oral cancer forum  Speight, P. M., Epstein, J., Kujan, O., Lingen, M. W., Nagao, T., Ranganathan, K., & Vargas, P. (2017). I realized I was missing an important part of the concept and that is the need for the process to be conducted at regular predefined intervals and on the same population. Therefore, cross-sectional studies cannot claim to be about cancer screening.

In addition, on the current stand on oral cancer screening the paper highlights that the best method right now is the opportunistic screening of high-risk individuals. Although this presents its own problems since there is no guarantee the high- risk, individuals will visit the same dentists at required intervals?

The paper provides a detailed review of the subject and lists priority areas for further research

BML0309 at English Wikipedia [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Friday, 20 April 2018


The guidelines for HPV testing of head and neck carcinomas 2017 is available with access to the early release article. Interesting reading and definition of the oral and oropharyngeal anatomic limitations are presented;
"Breaking from a tradition that has broadly grouped all carcinomas arising from the oral and oropharyngeal subsites as oral cancer, these guidelines maintain a sharp distinction between those carcinomas arising in the oropharynx and those arising in the oral cavity proper. Testing for the presence of HPV must be guided by a familiarity with head and neck anatomy, including those structures that define the oral cavity as separate from the oropharynx (Figure 2). The oral cavity proper comprises the lips, gingiva, retromolar trigone, hard palate, buccal mucosa, mobile tongue, and floor of the mouth, whereas the oropharynx comprises the palatine tonsils, soft palate, base of tongue (posterior to the circumvallate papillae), and lateral and posterior pharyngeal walls. Oropharyngeal tonsillar structures (i.e., lingual and palatine tonsils), particular hot spots for HPV-related carcinogenesis, are present in the oropharynx, but not in the oral cavity" Arch Pathol Lab Med. doi: 10.5858/arpa.2017-0286-CP) 

HPV 11- capsid protein
 Deposition authors: Bishop, B., Dasgupta, J., Chen, X.S.; visualization author: User:Astrojan [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons
Read the guidelines and download the infographic, teaching material and more

Thursday, 19 April 2018



The genomic data of over 10000 tumors (33 tumor types) has been made available by NIH funded researchers.

 “NIH completes in-depth genomic analysis of 33 cancer types was originally published by the National Cancer Institute.
The collection of papers that comprise the Pan-Cancer Atlas  and include head and neck carcinomas can be found at

Saturday, 24 September 2016


We know that each tooth is supported by ligaments, but do we pause to wonder if the periodontal ligament can suffer  a sprain like other ligaments in the body. What happens when a restoration is too high, when occlusal stops are disturbed and a tooth or group of teeth come under opposing forces. 

An article on Sprained Tooth Syndrome from Dentistry IQ takes a look at the causes, signs and management of  Sprained tooth syndrome