Precancerous lesions of oral mucosa

From Plate to Palette: Dietary Patterns and Their Role in Mucosal Lesions Among North Indian Communities: A cross-sectional study

Introduction

The global oral health scenario, as per WHO 2022 report, states that 3.5 billion people are affected by oral diseases. Despite oral mucous membrane's susceptibility to various diseases, scant information exists on oral lesions. This study aims to assess the impact of dietary habits on oral mucosal lesions in the North Indian population.

Material and Methods

A community-based cross-sectional survey was conducted in a rural area, involving 405 participants. Oral health questionnaires and clinical examinations were utilized for data collection. Chi-square test and Multivariate regression model were used for analysis.

Results

Lesser fruit intake was associated with high prevalence of candidiasis (30%). Sweets consumption was linked with ulcerations (44.4%) an abscess (44.4%) and 4 to 9 times increased risk of oral lesions whereas soft drinks were linked with leukoplakia and candidiasis in 30.8% participants. Tea/coffee consumption was linked to malignant lesions.

Conclusion

Significant proportion had oral mucosal lesions, notably influenced by diet and habits. Tea/coffee intake linked to malignant lesions; sweets to ulcers; soft drinks to leukoplakia. Tobacco showed significant associations. Oral lesion distribution varied across oral cavity regions, emphasizing diverse etiologies.

Effectiveness of Fenugreek as an Adjuvant in the Management of Oral Potentially Malignant Disorders: A Randomized Controlled Trial

AIM

This study aimed to evaluate the effectiveness of fenugreek as an adjuvant in managing oral potentially malignant disorders (OPMDs), specifically leukoplakia, lichen planus, and oral submucous fibrosis (OSMF).

MATERIALS AND METHODS

Twenty-one participants prediagnosed with OPMDs were randomly divided into a study group (SG) and a control group (CG), with 10 participants in SG and 11 in CG, respectively. The SG received 2 gm of fenugreek as an adjuvant with standard systemic treatments tailored to the respective lesions: intralesional injection of vitamin A 1,00,000 IU (Aquasol A) and topical application of triamcinolone acetonide 0.1% (Kenacort) for 2 months for leukoplakia. Subjects with oral lichen planus were administered prednisolone 5 mg/day (Wysolone), chlorhexidine mouthwash 0.2% (Peridex), and Zincovit once daily for 8 weeks. For subjects with OSMF, one capsule of SM Fibro once daily for 12 weeks along with dexamethasone 1.5 mL (Decadron) was given, and hyaluronidase 1,500 IU (Hynidase) with 0.5 mL lignocaine HCL (Xylocaine) was injected intralesionally biweekly and mouth exercise was advised for 2 months; control group received only the standard treatment. Sociodemographic data were collected, and clinical assessments, evaluating size and shape for leukoplakia, erythema, and burning sensation for oral lichen planus, and mouth opening, cheek flexibility, and burning sensation for OSMF were assessed from baseline through 2 months. Data collected were organized in Excel and analyzed using Statistical Package for the Social Sciences version 21.0.

RESULTS

The SG and CG had 10 and 11 participants, with 4 in each group for leukoplakia, 2 participants in SG and 3 in CG for lichen planus, and 4 participants for OSMF in each group, respectively. Most participants presented with leukoplakia under 2 cm on the buccal mucosa bilaterally, with no significant changes in size or shape postintervention. For lichen planus, mild erythema and burning sensation were noted, but there were no significant differences within or between groups postintervention. A mild burning sensation, a statistically significant improvement in mouth opening was observed in SG (p < 0.051) when compared with CG after 8 weeks postintervention in OSMF. Also, significant improvement in cheek flexibility was noted from baseline to the fourth follow-up in SG post intervention. However, there were no differences between groups during the follow-up period.

CONCLUSION

The findings from this trial suggest that SG showed significant improvement in OSMF than CG, whereas the improvements in leukoplakia and lichen planus remained same in both groups.

CLINICAL SIGNIFICANCE

Fenugreek, being a cost-effective and affordable agent known for its anticancer, anti-inflammatory, antioxidant, and antiulcerative properties, could be used as an adjuvant for its management in OPMDs. How to cite this article: Balasundaram N, Narayanan MBA, Arul Antony LS, et al. Effectiveness of Fenugreek as an Adjuvant in the Management of Oral Potentially Malignant Disorders: A Randomized Controlled Trial. J Contemp Dent Pract 2024;25(10):921-929.

Salivary Histamine Levels in Patients with Oral Lichen Planus Lesions

Background and Objectives: An oral lichen planus (OLP) chronic lesion refers to a group of oral potentially malignant disorders (OPMDs) that still lack a proper understanding from the point of view of relevant biomarkers for diagnostics and prognosis. The aim of the study was to assess the salivary histamine levels in patients with oral lichen planus lesions. Materials and Methods: The study included a group of 76 patients with oral lichen planus. General diseases and medication taken, smoking habits, severity of pain assessed using a visual analogue scale (VAS), oral hygiene status, and duration of OLP were evaluated. ELISA diagnostics for histamines in saliva levels were assessed. Results: The histamine levels in the OLP group were higher (0.468) in comparison with the control group (0.056), without a statistically significant value p = 0.090 (Mann-Whitney U Test). The median age of 76 OLP patients was 63 years (min 22.0-max. 81), with the biological sex being 80.3% females and 15 19.7% males. The average duration of OLP lesion presence was 29.4 months (SD 37.1) and the median value was 14.5 months. The median of the VAS was 3.0. OLP assessment in accordance with the Malhotra methodology showed the highest frequency-30.3% for only two of the point areas involved and 17.1% for three points. Clinical assessment of the different OLP grades, severity, and oral site involvement and the VAS in correlation with histamine salivary levels showed a lack of statistical significance in the investigated population. Conclusions: Undertaking further research could provide further possibilities for searching for general factors in OLP development.

m1A inhibition fuels oncolytic virus-elicited antitumor immunity via downregulating MYC/PD-L1 signaling

N1-methyladenosine (m1A) RNA methylation is critical for regulating mRNA translation; however, its role in the development, progression, and immunotherapy response of head and neck squamous cell carcinoma (HNSCC) remains largely unknown. Using Tgfbr1 and Pten conditional knockout (2cKO) mice, we found the neoplastic transformation of oral mucosa was accompanied by increased m1A modification levels. Analysis of m1A-associated genes identified TRMT61A as a key m1A writer linked to cancer progression and poor prognosis. Mechanistically, TRMT61A-mediated tRNA-m1A modification promotes MYC protein synthesis, upregulating programmed death-ligand 1 (PD-L1) expression. Moreover, m1A modification levels were also elevated in tumors treated with oncolytic herpes simplex virus (oHSV), contributing to reactive PD-L1 upregulation. Therapeutic m1A inhibition sustained oHSV-induced antitumor immunity and reduced tumor growth, representing a promising strategy to alleviate resistance. These findings indicate that m1A inhibition can prevent immune escape after oHSV therapy by reducing PD-L1 expression, providing a mutually reinforcing combination immunotherapy approach.

Electromyography Analysis of the Masseter Muscle's Activity in the Management of Oral Submucous Fibrosis

Introduction Oral submucous fibrosis (OSMF) is a persistent, collagen metabolic disorder distinguished by the presence of fibrosis of the connective tissue stroma in the oral mucosa with a higher malignant potential rate for oral cancer. This study aimed to analyze the utility of electromyography (EMG) as the prognostic assessment tool in the management of OSMF with conventional intralesional corticosteroid therapy. Materials and methods This study included 20 OSMF cases of age range 20 to 80 years without systemic comorbidities to assess pre-treatment and post-treatment changes with intralesional corticosteroid therapy as an intervention and to determine if it could be assessed using electromyographic study. Clinical and histopathological grading of OSMF was done. The five clinical parameters were evaluated for measuring treatment prognosis. Among them, mouth opening, tongue protrusion, and burning sensation assessments were quantitative parameters, and palpable fibrotic bands and mucosa colour were qualitative parameters. As OSMF involves changes in muscle plane in moderately advanced and advanced cases, EMG was used as an assessment tool for measuring muscle activity. Among the muscles of mastication, the masseter and temporalis were selected for evaluation. Twenty age and gender-matched healthy controls were required for this study as there are no standardized normal values for amplitude and onset of activity in muscle analysis. The EMG activity of the right and left temporalis and masseter muscles were recorded using surface electrodes and were correlated with five clinical assessment parameters. Results In the right masseter, the rest amplitude of 1.6010 µV of the OSMF was statistically significant (p-value: 0.050) when compared with 4.1275 µV of the control. The clench amplitude of 133.370 µV of the OSMF was statistically significant (p-value: 0.062) when compared with 94.310 µV of the control. In the left masseter, the rest amplitude of 1.6695 µV of the OSMF was statistically significant (p-value 0.066) when compared with 2.5735 µV of the control. In the left masseter, the onset of muscle action of 62.670 ms of the OSMF was statistically significant (p-value: 0.017) when compared with 131.835 ms of the control. The clench amplitude differences in the right masseter of 133.370 µV pre-treatment, and 102.775 µV post-treatment were statistically significant (p-value: 0.007). The clench amplitude in the left masseter of 102.535 µV pre-treatment, and 92.090 µV post-treatment were statistically significant (p-value: 0.036). The correlation was seen between tongue protrusion and rest amplitude in the right masseter in OSMF (r = 0.376, p-value: 0.023). Conclusion There was a correlation between tongue protrusion and rest amplitude in the right masseter muscle in OSMF patients before treatment. In the right and left masseter, during rest, the amplitude of the OSMF group was lesser than that of the control group. During clench, in the right masseter, the amplitude of the OSMF group was higher than that of the control group. During clench in the left masseter, the onset of muscle action was lesser in the OSMF group than in the control group. After treatment, there was a reduction in clench amplitude in OSMF patients from their pretreatment values signifying muscle relaxation and a better onset of muscle action.

Evaluation of nuclear morphometry in exfoliative cytology of buccal mucosa in patients with high risk of oral cancer

BACKGROUND

Oral cancer poses a significant global health burden, with India having the highest prevalence. Effective detection is crucial in effective prevention. This study aimed to evaluate nuclear morphometric parameters (NMPs) in buccal mucosa cells of smokers, correlate NMPs with dysplasia, establish cut off values for grading dysplasia, and investigate the relationship between NMPs and smoking.

METHODS

After obtaining ethical approval and informed consent, patients were recruited from the outpatient department of our institution. A target sample size of 250 was calculated. The data included smoking exposure quantified in pack-years, nuclear morphometric analysis (NMA) of buccal mucosa cells obtained through oral cytology using Image J, and the severity of dysplasia of the slides assessed by pathologists. Statistical analysis assessed the impact of dysplasia and the association between nuclear characteristics and smoking exposure. Receiver operating characteristic (ROC) plots determined the potential of these parameters to distinguish dysplasia levels.

RESULTS

Significant differences in NMPs were observed among different smoking groups. Dysplasia severity had a significant correlation with NMPs, and strong correlations were found between NMPs and lifetime smoking exposure. ROC analysis established cut off values for NMPs with good sensitivity and specificity for classifying dysplasia severity.

CONCLUSIONS

This study highlights the potential of NMA as a tool for oral cancer screening. NMPs can distinguish dysplasia severity and correlate with tobacco (smoking). The efficiency of NMA in a non-invasive oral cytology offers promise for patient-centered screening Additionally, the findings suggest future applications in telepathology and the potential for AI integration in automated screening after conducting multicentric large-scale studies.

Serum and salivary interleukin-1β level in oral precancer: An observational study

BACKGROUND AND AIM

Precancer biomarkers help in early detection and management of oral potentially malignant disorders (OPMDs). Interleukin-1β (IL-1β), a biomarker, is known to be altered in oral submucous fibrosis (OSMF) and oral leukoplakia (OL). Therefore, we evaluated and compared the serum and salivary IL-1β levels in patients with OSMF/oral leukoplakia and in gender- and age-matched healthy individuals.

MATERIALS AND METHODS

An in vivo, prospective, observational study was conducted on 40 subjects. Subjects were divided into two groups with 20 individuals in each group, that is, Group I: OSMF/oral leukoplakia and Group II: control group. Salivary and serum IL-1β levels were quantitatively estimated using enzyme-linked immunosorbent assay (ELISA). The statistical tests used were unpaired t-test and Chi-square test.

RESULTS

The serum IL-1β levels were significantly (P 0.001) lesser in Group I in comparison to Group II. The salivary IL-1β levels remained insignificant between both the groups. However, in both the groups, the salivary IL-1β levels were significantly higher compared to the serum IL-1β levels.

CONCLUSION

We found that the serum IL-1β level can be considered as a prospective biomarker for dysplasia, whereas salivary IL-1β alone needs more elaborated studies to account for its application as a potential biomarker in OPMD.

HPV related p16INK4A and HSV in benign and potentially malignant oral mucosa pathologies

BACKGROUND

The association of Human Papilloma Virus (HPV) and Human Syncytial Virus (HSV) infection with inflammatory and potentially malignant disorders of the oral cavity (OPMD) is unknown. The aim of this cross-sectional study was to stablish the expression of the p16INK4A and HSV proteins, to test potential correlation between those parameters in biopsies from clinically diagnosed oral lesions.

METHODS

Immunochemical analysis of 211 formalin-fixed, paraffin-embedded (FFPE) blocks from 211 individuals was provided. The clinical diagnosis included in the research were Oral lichen planus (N = 30), Oral Leukoplakia (N = 13) Mucocele (N = 25), Erosion/ulceration/ inflammation of mucosa (N = 8), Overgrowth of mucosa (N = 135).

RESULTS

Two hundred eleven analyzed FFPE samples resulted with the median age of 58.5 years (the average age 54.0 years and SD ± 17 years). The female/male ratio was 2.3 (69.7% vs 30.3% respectively). All the samples positive for HSV also expressed p16INK4A (p = 0.000), that's showed various levels of association with the diverse clinical diagnosis reaching the higher level in OM 49.1% (29 positive samples) and OLP 30.5% (18). p16INK4A was associated with OLP at 30.5% (18), and fibroma 30.5%. HSV expression was mostly present in fibroma at 47.6% (10 positive samples).

CONCLUSION

HSV and p16INK4A positivity in relation to diagnosis of the biopsies showed statistically most often p16INK4A in OLP and fibroma. The results of co-expression of p16INK4A and HSV in mucocele and fibroma in oral mucosa suggest a cooperation between the molecular alterations induced by these two viruses. Squamous papilloma samples positive for p16INK4A were also positive for HSV, suggesting that the putative pro-oncogenic action of HSV could be an early event.

Prevalence and risk factors of oral potentially malignant disorders in Indonesia: a cross-sectional study undertaken in 5 provinces

Detection of subjects with oral potentially malignant disorders in a population is key to early detection of oral cancer (OC) with consequent reduction of cancer-related morbidity and mortality. Our aim was to investigate the prevalence and associated risk factors for OPMD in representative provinces of Indonesia. This cross-sectional study was undertaken in five Indonesian provinces: West Java (WJ), Jakarta (JKT), West Papua (WP), West Kalimantan (WK) and Banda Aceh (BA). Respondents answered a previously validated questionnaire including information on ethnicity, occupation, socioeconomic status (SES), oral health practices, and behaviours associated with oral cancer. An oral examination was undertaken using WHO standardized methodology. Data were analysed using ANOVA, Chi-Square, and logistic regression to assess association between risk factors and mucosal disease. A total of 973 respondents between the ages of 17 and 82 years was enrolled (WJ 35.5%,JKT 13.3% WP 18.3%, WK 9%, BA 23.9%). Tobacco smoking (14.8%), Betel quid (BQ) chewing (12.6%) and alcohol drinking (4%) varied geographically. A well-established OPMD was detected in 137 (14.1%) respondents and 2 (0.2%) presented with chronic ulceration later diagnosed as OC. Leukoplakia was the most common OPMD found (9.7%), while the prevalence of oral submucous fibrosis (OSMF), not previously described in the nation, was 2.3%. Poor knowledge of OC risk factors, poor oral hygiene behaviours, low-income SES and ethnicity were significantly associated with the presence of an OPMD. There is a previously under-reported high prevalence of OPMD in Indonesia. Overall, we found a strong correlation between the presence of an OPMD and individual habituation to known risk factors.

Salivary Neutrophil-to-Lymphocyte Ratio as a Prognostic Predictor of Oral Premalignant and Malignant Disorders: A Prospective Study

INTRODUCTION

Inflammation is a definitive characteristic of carcinogenesis. The neutrophil-to-lymphocyte ratio (NLR) is an easy and efficient indicator of inflammation and a valuable marker in individuals with malignancies. The present study was performed to ascertain NLR values in salivary samples collected from individuals with oral premalignant disorders (OPMDs) and to assess the prognostic significance of NLR in distinguishing OPMDs from oral malignancies.

MATERIALS AND METHODS

This study was conducted on 50 patients histopathologically diagnosed with OPMDs with mild dysplasia. The patients were provided with standard medicinal treatment, encouraged to quit their habits, and followed up for one year at three-month regular intervals. During the follow-up, 29 (67.4%) patients completely recovered, whereas 14 (32.6%) developed oral malignancies. Salivary samples were collected at baseline (T0) and one-year follow-up (T1). The total salivary neutrophils and lymphocytes were counted using an improved cell counting method with a Neubauer chamber. The NLR values were calculated at T0 and T1. The paired t-test was used to compare the NLR values at T0 and T1. The cutoff value of the NLR was determined using the receiver operating characteristic (ROC) curve. The Youden index was used to determine the optimal cutoff NLR values in the groups. Statistical significance was set at p ≤0.05.

RESULTS

OPMDs were predominantly observed in males, with leukoplakia being the most prevailing one. Erythroplakia exhibited the highest propensity for malignant transformation, and habitual consumption of alcohol and tobacco was identified as a risk factor for this transformation. NLR increased in both premalignant and malignant conditions. NLR value equal to or exceeding 4 was determined to be a reliable indicator for the occurrence of oral cancer in patients with OPMDs. The ROC curve analysis yielded a sensitivity and specificity of 92%, with an area under the curve (AUC) of 0.928.

CONCLUSION

The poor prognosis of oral cancers was associated with higher NLR values. NLR values in salivary samples can serve as an independent reliable predictor in oral cancer and OPMDs.

[Precancers of the oral mucosa: clinic, diagnostics]

OBJECTIVE

The aim of the study. Improving the efficiency of diagnosis and detailing the features of the clinic of «potentially malignant» diseases of the oral mucosa.

MATERIALS AND METHODS

Clinical and laboratory examination of 124 patients of the department of oral mucosa diseases aged 35 to 80 years, among whom there were 75 women and 49 men, with diseases such as erythroplakia - 12 patients, verrucous leukoplakia - 52 patients, erosive form of leukoplakia - 35 patients, cheilitis Manganotti - 25 patients. Histological and immunohistochemical methods of investigation were used as diagnostics. To assess the proliferative activity of epithelial cells, the determination of the Ki-67 index was used. The synthesis of keratin 15 (K15) in epithelial layers was determined as a diagnostic criterion for the severity of neoplasia. The expression of human papillomavirus type 16 (HPV 16) antigens and p16INK4a protein in epithelial cells was studied, as well as the expression of p53 protein.

RESULTS

A high prevalence of p53 mutations was observed in patients with erythroplakia. In leukoplakia, the expression of the Ki-67 protein was detected in the cell nuclei in both the basal and parabasal layers of the multilayer squamous epithelium, in 77% of cases, the expression of the p16INK4a protein in the epithelial nuclei with varying degrees of dysplastic changes was noted, and a positive reaction to HPV16 was also observed in the cell nuclei and cytoplasm of epithelial cells in the basal, parabasal and spiny epithelial layers. The appearance of K15 in the cytoplasm of cells above the basal layer with abrasive precancerous cheilitis was found in 48% of cases.

CONCLUSION

To diagnose early manifestations of neoplastic processes in «potentially malignant» diseases of the oral mucosa, it is necessary to use both classical histological and immunohistochemical methods of investigation with various markers.

Antioxidant treatments in patients with oral submucous fibrosis: A systematic review

INTRODUCTION

Oral submucous fibrosis (OSMF) is a well-known precancerous oral lesion, characterized by scarring, tissue fibrosis, and premalignant lesions. The goal of clinical treatment is to reduce inflammation and improve patients' quality of life by enhancing mouth opening among others. Antioxidant treatment has shown promising results in inducing regression of lesions and preventing OSMF in high-risk individuals. This study investigates the effectiveness of various antioxidant agents against OSMF.

MATERIALS AND METHODS

The study followed PRISMA guidelines and searched three scientific databases: PubMed, Web of Science, and Scopus, using specific algorithms related to "antioxidant treatment," "burning sensation," and "mouth opening." The quality assessment of controlled clinical studies adhered to Cochrane guidelines.

RESULTS

The analysis included 19 clinical trials comparing different treatments, including various antioxidants. Aloe vera, curcumin, and lycopene, among others, showed positive outcomes in treating OSMF by improving burning sensation, mouth opening, tongue protrusion, and cheek flexibility.

CONCLUSION

Antioxidant therapies are found to be effective in treating OSMF, even when compared to conventional treatments such as corticosteroids. The study highlights the need for further research and standardization of clinical protocols.

Assessment of knowledge and awareness among North Indian populations about oral precancerous lesions (OPL): A cross-sectional survey study

Background

A precancerous lesion is a morphologically altered tissue in which oral cancer is more likely to occur than its apparently normal counterpart. They are quite common in the Indian population due to the habitual habit of chewing tobacco. The aim of this study was to evaluate the awareness of oral precancerous lesions by a questionnaire-based survey among the study subjects having been diagnosed with it.

Methods

In this descriptive study, a structured questionnaire having 11 survey questions has been used to record the response from study subjects who have been diagnosed and reported for treatment for oral premalignant lesions in the Department of Oral Medicine and Radiology. A total of 1013 study subjects were assessed for awareness about OPL and its consequences.

Results

44.3% of the study population was addicted to smoking tobacco (cigarettes) while 57.9% of study subjects were addicted to non-smoking tobacco (Pan masala). The reason behind their addiction was reported to be stress (54.9%) and workload (25.3%). Most of the study subjects were diagnosed with oral sub-mucous fibrosis (53.4%). 78.6% of study subjects diagnosed with OPL were not aware of it and 94% were willing to quit the addiction.

Conclusion

The awareness about OPL among patients was found to be low. Although many wanted to quit their addiction to smoking and chewing tobacco but were unable to do so. So it is a need for time to develop a national policy on tobacco use and related diseases. This policy will definitely reduce the burden of oral premalignant lesions and oral cancer in Indian population.

Formulation and Evaluation of Chitosan-PLGA Biocomposite Scaffolds Incorporated with Quercetin Liposomes Made by QbD Approach for Improved Healing of Oral Lesions

The current research aims to develop and evaluate chitosan-PLGA biocomposite scaffolds in combination with quercetin liposomes to accomplish the desired impact in oral lesions where pharmacotherapeutic agent treatment through circulation could only reach the low content at the target. Optimization of quercetin-loaded liposomes was carried out using 32 factorial design. The preparation of porous scaffolds comprising produced quercetin-loaded liposomes by thin-film method was carried out in the current study using a unique strategy combining solvent casting and gas foaming procedures. The prepared scaffolds were tested for physicochemical properties, in vitro quercetin release study, ex vivo drug permeation and retention research using goat mucosa, antibacterial activity, and cell migration studies on fibroblast L929 cell lines. Improved cell growth and migration were seen in the order control < liposomes < proposed system. The proposed system has been examined for its biological and physicochemical features, and it has the potential to be utilized as an efficient therapy for oral lesions.

A bird's-eye view of pathologist over diagnostic confusion of oral cavity lesions

Introduction

Oral cavity can be host to multitude of neoplastic, premalignant or non neoplastic pathological lesions. Diagnosis of lesions of oral cavity is always of interest to clinician and pathologist and rely on clinical appearance of lesions. There can be variation in diagnosis of clinical lesion with histopathology. Many oral carcinomas arise within the sites that previously had premalignant lesion. Incidence of oral cancers in population has increased among younger generations related to habits and lifestyle. These lesions during clinical presentation are misleading and create diagnostic dilemma owing to age, sex and distribution of lesions. Understanding distribution of oral mucosal lesions helps to diagnose lesions of oral cavity. Purpose of this study is to observe the variation in clinical diagnosis with histopathological diagnosis in patients with inflammatory, premalignant, benign and malignant lesions of oral cavity and oropharynx and also clinical distribution of lesions of oral cavity and oropharynx lesions by histopathology.

Observations

Out of total 105 lesions, ulcer in oral cavity seen in 58 (55.23%) of patients, followed by swelling or feeling of lump in oral cavity in 36 (34.29%) of patients and foreign body sensation in 23 (21.90%) of patients with tongue as most frequent site for most of lesions of oral cavity accounting in 33 (31.43%) of cases, and less frequently lesions were seen in retro molar trigone area in 2 (1.90%) patients. Histopathological diagnosis of premalignant, non neoplastic and inflammatory lesions was made in 24 (22.85%) cases, benign tumours were diagnosed in 14 (13.33%) cases and rest of 67 (63.81%) lesions were malignant. Mucocoel were seen in five (4.76%) cases, radicular cyst was seen in one (0.95%) case of female patient and four cases of Leukoplakia with one case showing mild dysplasia. Among benign tumours 11 (10.47%) patients presented with gingivitis turned out to be squamous papillomas were seen in five (4.76%) cases, fibroma was diagnosed in four (3.80%) cases, pyogenic granuloma was diagnosed in four (3.80%) cases most commonly seen over gingiva and myoepithelioma of minor salivary gland was observed in one (0.95%) case over soft palate. Out of 67 cases of malignant lesions squamous cell carcinomas were seen in 59 (88.05%) cases followed by verrucous carcinoma in 3 (4.47%) cases, 2 (2.99%) cases were basaloid squamous cell carcinomas, mucoepidermoid carcinoma was seen in 2 (2.99%) cases and 1 (1.49%) case of adenoid cystic carcinoma was seen. Majority of squamous cell carcinomas cases in study were well differentiated in 49 (73.13%) cases followed by moderately differentiated in 16 (23.88%) cases and poorly differentiated in 2 (2.99%) cases. Malignant transformation of tonsil tissue post operatively was observed in 1 (0.95%) patients on histopathology. One (2.5%) case of myoepithelioma was seen in 60 years male over soft palate.

Conclusion

Of all oral biopsies reported in study, increasing trend of malignancies in lower age groups of population making it an emerging threat to community and highlighting need to take effective measures to increase public awareness about risk factors and consequences of this condition. Screening programmes targeted to population over 25 years are recommended to overcome this.

Applications of yoga in oral oncology: A systematic scoping review

Background and Aims

Yoga is well-thought-out as an all-inclusive approach globally and can be administered in clinical care as an integrative or alternate approach to regular treatment. Yoga exercise has been disclosed to influence remission from cancer cells over a long period of time and also reverses epigenetic alterations. Applications of Yoga in the management of oral oncology patients are scarce, hence the need for a scoping review of the literature. Hence, this study aimed to conduct a scoping review of the existing empirical evidence on the applications of yoga in oral oncology.

Methods

The review methodology was informed by Joanna Brigg's Institute guidelines for systematic scoping reviews, and the review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Ten databases were searched. The records of all the literature retrieved from the search were imported into the Rayyan software for deduplication. After the full-text screening, only two were found eligible for inclusion in the scoping review. Data obtained in the included literature were extracted and synthesized.

Results

This review found that Yoga was not significantly effective in the management of stress among oral cancer patients (p-values > 0.04). However, it was found that Yoga significantly reduced anxiety, saliva stickiness, and episodes of falling ill (p-values < 0.05) while it improved mental well-being, cognitive functioning, emotional functioning, and head and neck pain of those oral cancer patients that received it (p-values < 0.05).

Conclusion

An integrative care approach that considers nonpharmaceutical techniques such as yoga could help to reduce care cost while improving care outcomes and quality of life of oral cancer patients. Hence, it is imperative to consider yoga along with its potential benefits, and we recommend gradual incorporation of yoga into oral cancer care.

Practice patterns for initial management of oral leukoplakia amongst otolaryngologists and oral and maxillofacial surgeons

OBJECTIVE

Oral leukoplakia is encountered frequently by otolaryngologists and oral and maxillofacial surgeons (OMFS). There are no consensus practice management guidelines for oral leukoplakia, resulting in heterogeneity in practice patterns. Characterization of practice patterns of providers who treat oral leukoplakia will be valuable to establish standards of care and future practice guidelines.

MATERIAL AND METHODS

A survey was designed by the American Head and Neck Society Cancer Prevention Service collecting demographic and practice management data for treating oral leukoplakia. The survey was approved and distributed to members of the American Academy of Otolaryngology-Head and Neck Surgery and American Association of Oral and Maxillofacial Surgeons. Data analysis was performed using chi square and t-test where appropriate.

RESULTS

396 responses were collected: 83 OMFS, 81 head and neck fellowship-trained providers, and 232 otolaryngologists (non-head and neck fellowship-trained). Providers saw a wide volume of oral leukoplakia (23.0% >30 cases/year, 35.1% 11-30 cases/year, 41.2% 10 or less cases/year), with OMFS seeing more cases of oral leukoplakia. Factors most associated with consideration of initial biopsy included physical exam findings (94.4%), erythroplakia (82.3%), and smoking status (81.6%). The majority of respondents saw patients in follow-up within 1 month (24.8%) or within 1-3 months (46.5%).

CONCLUSION

This survey identifies a range of practice patterns in initial management of oral leukoplakia, including indications for biopsy, and time for follow-up. This data provide insight into practice patterns amongst different groups of providers and can potentially lead to consensus guidelines for initial management of oral leukoplakia.

Silver Nanoparticles Phytofabricated through Azadirachta indica: Anticancer, Apoptotic, and Wound-Healing Properties

Silver nanoparticles (AgNPs) have unlocked numerous novel disciplines in nanobiotechnological protocols due to their larger surface area-to-volume ratios, which are attributed to the marked reactivity of nanosilver, and due to their extremely small size, which enables AgNPs to enter cells, interact with organelles, and yield distinct biological effects. AgNPs are capable of bypassing immune cells, staying in the system for longer periods and with a higher distribution, reaching target tissues at higher concentrations, avoiding diffusion to adjacent tissues, releasing therapeutic agents or drugs for specific stimuli to achieve a longer duration at a specific rate, and yielding desired effects. The phytofabrication of AgNPs is a cost-effective, one-step, environmentally friendly, and easy method that harnesses sustainable resources and naturally available components of plant extracts (PEs). In addition, it processes various catalytic activities for the degradation of various organic pollutants. For the phytofabrication of AgNPs, plant products can be used in a multifunctional manner as a reducing agent, a stabilizing agent, and a functionalizing agent. In addition, they can be used to curtail the requirements for any additional stabilizing agents and to help the reaction stages subside. Azadirachta indica, a very common and prominent medicinal plant grown throughout the Indian subcontinent, possesses free radical scavenging and other pharmaceutical properties via the regulation of proinflammatory enzymes, such as COX and TOX. It also demonstrates anticancer activities through cell-signaling pathways, modulating tumor-suppressing genes such as p53 and pTEN, transcriptional factors, angiogenesis, and apoptosis via bcl2 and bax. In addition, it possesses antibacterial activities. Phytofabricated AgNPs have been applied in the areas of drug delivery, bioimaging, biosensing, cancer treatment, cosmetics, and cell biology. Such pharmaceutical and biological activities of phytofabricated AgNPs are attributed to more than 300 phytochemicals found in Azadirachta indica, and are especially abundant in flavonoids, polyphenols, diterpenoids, triterpenoids, limonoids, tannins, coumarin, nimbolide, azadirachtin, azadirone, azadiradione, and gedunin. Parts of Azadirachta indica, including the leaves in various forms, have been used for wound healing or as a repellent. This study was aimed at examining previously biosynthesized (from Azadirachta indica) AgNPs for anticancer, wound-healing, and antimicrobial actions (through MTT reduction assay, scratch assay, and microbroth dilution methods, respectively). Additionally, apoptosis in cancer cells and the antibiofilm capabilities of AgNPs were examined through caspase-3 expression, dentine block, and crystal violet methods. We found that biogenic silver nanoparticles are capable of inducing cytotoxicity in HCT-116 colon carcinoma cells (IC50 of 744.23 µg/mL, R2: 0.94), but are ineffective against MCF-7 breast cancer cells (IC50 >> 1000 µg/mL, R2: 0.86). AgNPs (IC50 value) induced a significant increase in caspase-3 expression (a 1.5-fold increase) in HCT-116, as compared with control cells. FITC-MFI was 1936 in HCT-116-treated cells, as compared to being 4551 in cisplatin and 1297 in untreated cells. AgNPs (6.26 µg/mL and 62.5 µg/mL) induced the cellular migration (40.2% and 33.23%, respectively) of V79 Chinese hamster lung fibroblasts; however, the improvement in wound healing was not significant as it was for the controls. AgNPs (MIC of 10 µg/mL) were very effective against MDR Enterococcus faecalis in the planktonic mode as well as in the biofilm mode. AgNPs (10 µg/mL and 320 µg/mL) reduced the E. faecalis biofilm by >50% and >80%, respectively. Natural products, such as Syzygium aromaticum (clove) oil (MIC of 312.5 µg/mL) and eugenol (MIC of 625 µg/mL), showed significant antimicrobial effects against A. indica. Our findings indicate that A. indica-functionalized AgNPs are effective against cancer cells and can induce apoptosis in HCT-116 colon carcinoma cells; however, the anticancer properties of AgNPs can also be upgraded through active targeting (functionalized with enzymes, antibiotics, photosensitizers, or antibodies) in immunotherapy, photothermal therapy, and photodynamic therapy. Our findings also suggest that functionalized AgNPs could be pivotal in the development of a novel, non-cytotoxic, biocompatible therapeutic agent for infected chronic wounds, ulcers, and skin lesions involving MDR pathogens via their incorporation into scaffolds, composites, patches, microgels, or formulations for microneedles, dressings, bandages, gels, or other drug-delivery systems.

Tobacco use and Oral Premalignant Lesions among Auto-Rickshaw Drivers in Belagavi, North Karnataka

Background

Auto-rickshaw drivers (ARDs) are under constant physical and mental pressure due to illiteracy, poverty, lack of awareness about hazards of addictions, and other factors that lead to various habits majority being tobacco use. Studies have found that tobacco use is very prevalent among ARDs in comparison to general population. Tobacco use is commonly associated with cancers. Oral Pre-Malignant Lesions (OPMLs) are the strongest risk factor for majority of oral cancers. We studied the prevalence of OPML among ARDs of Belagavi and their association with tobacco use.

Methods

It was a cross-sectional study conducted among 600 regular ARDs of Belagavi City during January to December 2016. We selected two ARDs that were the last in line from 300 major auto-rickshaw stands. We adapted the questionnaire from Global Adult Tobacco Survey questionnaire. After getting informed consent, we collected the data by personal interview and performed an oral visual examination for OPML for all the study participants. Data were analyzed using SPSS software. Institutional Ethics Committee approved the study.

Results

Prevalence of tobacco was 62.17%. One-third of participants (30.17%) had OPMLs. Leukoplakia (62.43%) was the most common lesion. OPMLs were significantly associated with tobacco use and duration of tobacco use.

Conclusions

About 30% of ARDs had an OPML. Chewing tobacco, gutkha, lime with tobacco, and cigarette were significantly associated with OPML.

Retrospective Study of Oral Lichen Planus and Oral Lichenoid Lesions: Clinical Profile and Malignant Transformation

Statement of the Problem

Oral lichen planus (OLP) and other oral lichenoid lesions (OLL) are reported to have the potential of malignant transformation and dysplastic changes, turning into oral squamous cell carcinoma (SCC). While the world health organization (WHO) has classified OLP as a precancerous lesion of the oral cavity, there is still much debate among researchers about its risks and malignancy potential.

Purpose

The present study aimed to determine malignant transformation in OLP and OLL and understand related risk factors.

Materials and Method

This retrospective study was performed on 356 patients of the Oral Medicine Department of Dental School of Kerman Medical University from 1998 to 2020. All patients' records were gathered. In addition, patients were followed up routinely. Second biopsy was taken as needed. The samples, previously taken from the patients, were re-evaluated according to WHO histopathologic criteria for diagnosing OLP, OLL, dysplasia, and SCC by an experienced pathologist and compared with first reports.

Results

Dysplastic changes were observed in 6.2% of the patients. In more than half of the patients, dysplastic changes were present right from the start and 2.20% of the patients had experienced dysplastic changes averagely within 2.05 years of the onset of lesions. Multiple logistic regression showed that the risk of dysplasia increases with aging (p= 0.013), smoking (p= 0.0001), and thyroid disorders (p= 0.008).

Conclusion

Given the rather high prevalence of oral lichen planus and lichenoid lesions, further research appears to be needed to determine the etiology of these lesions, malignant transformations, and the factors affecting this probability. Considering the findings, it is imperative to meticulously record the information of all patients with oral lichen planus and lichenoid lesions in the initial examinations as well as close follow-ups and employ diagnostic tools such as toluidine blue staining or even repeat biopsy when necessary.

A Comparison of the Characteristics of Cytokine Storm between Lichen Planus and Oral Squamous Cell Carcinoma

INTRODUCTION

Lichen planus (LP) is a relatively common chronic mucocutaneous disease that affects the skin and mucous membranes, including oral mucosa. The etiology of the disease is unknown. Some evidence suggests that the immune system and inflammation may play a role in the formation and progression of lichen planus. Some authorities believe that LP is a precancerous condition. The purpose of this study was to investigate the serum levels of the inflammatory cytokines CRP, IL-1, IL-6, and TNF- in patients with oral lichen planus and oral squamous cell carcinoma (OSCC), as well as to assess the relationship between these cytokine levels and clinical symptoms.

METHODS

A total of 75 subjects, with 25 in each group of oral lichen planus, healthy control, and oral squamous cell carcinoma, participated in this cross-sectional study. Serum levels of IL-1α, TNF-α, IL-6, and CRP were determined and compared. In comparison to the healthy control group, the lichen planus and oral squamous cell carcinoma groups had higher levels of CRP, IL-1α, IL-6, and TNF-α.

RESULTS

We discovered that the mean mRNA and protein levels of CRP, IL-1α, IL-6, and TNF-α were significantly higher in the blood and tissue of lichen planus and OSCC patients than in normal controls.

CONCLUSION

Higher levels of CRP, IL-1α, IL-6, and TNF-α may be linked to OLP and oral carcinogenesis. More research with larger groups is required.

A nanoengineered topical transmucosal cisplatin delivery system induces anti-tumor response in animal models and patients with oral cancer

Despite therapeutic advancements, oral cavity squamous cell carcinoma (OCSCC) remains a difficult disease to treat. Systemic platinum-based chemotherapy often leads to dose-limiting toxicity (DLT), affecting quality of life. PRV111 is a nanotechnology-based system for local delivery of cisplatin loaded chitosan particles, that penetrate tumor tissue and lymphatic channels while avoiding systemic circulation and toxicity. Here we evaluate PRV111 using animal models of oral cancer, followed by a clinical trial in patients with OCSCC. In vivo, PRV111 results in elevated cisplatin retention in tumors and negligible systemic levels, compared to the intravenous, intraperitoneal or intratumoral delivery. Furthermore, PRV111 produces robust anti-tumor responses in subcutaneous and orthotopic cancer models and results in complete regression of carcinogen-induced premalignant lesions. In a phase 1/2, open-label, single-arm trial (NCT03502148), primary endpoints of efficacy (≥30% tumor volume reduction) and safety (incidence of DLTs) of neoadjuvant PRV111 were reached, with 69% tumor reduction in ~7 days and over 87% response rate. Secondary endpoints (cisplatin biodistribution, loco-regional control, and technical success) were achieved. No DLTs or drug-related serious adverse events were reported. No locoregional recurrences were evident in 6 months. Integration of PRV111 with current standard of care may improve health outcomes and survival of patients with OCSCC.

Setting up a Registry for Oral Potentially Malignant Disorders (OPMD)

Background: Oral cancer accounts for 3% of all malignancies. Progression to malignancy occurs with a gradual process. Oral potentially malignant disorders (OPMD) are associated with the development of malignant transformation toward oral cancer. Objectives: This registry aimed at introducing an exact data gathering method for detecting, managing, and monitoring patients with OPMD to decrease the occurrence of oral cancer. Methods: In this registry, all patients with OPMD such as leukoplakia, erythroplakia, and oral lichen planus at Shahid Beheshti Dental School, Tehran, Iran were included. Patients' information including demographics, clinical, and histopathological features, the type of OPMD, treatment measures, and lesion changes in follow-up intervals were recorded in the registry software. In addition, a quality assurance team supervised and guaranteed the quality control of the entire registry process. Results: The following measures have been accomplished so far: development of an ethically-approved proposal, development of a comprehensive data form, development of web-based registration software, development of a manual of operation, signing of a collaborative contract with more than 8 dental schools throughout Iran, identification of 100 eligible patients, signing a contract with the Research Deputy of Shahid Beheshti University of Medical Sciences, and codification of a verified and ethically approved quality assurance proposal. This registry is getting the advantage of being supervised and sponsored by the Disease Registry Center of Shahid Beheshti University of Medical Sciences. Conclusions: The prospect of this registry is to provide patients with OPMD with a nationwide diagnostic service and continuous monitoring protocol through a collaborative network of all dental schools in Iran.

Retrospective study of factors associated with late detection of oral cancer in alberta: A qualitative study

Oral cancer continues to be diagnosed in advanced stages, giving patients lower chances of survival. The objective of this study was to explore reasons for delayed diagnosis of oral cancer in Alberta. A retrospective qualitative design was implemented through seven steps suggested for conducting a narrative clinical document. Data was retrieved from the Alberta Cancer Registry database between 2005 and 2017. A sample of initial consultation notes (ICN) of oral and oropharyngeal cancer patients were identified through a purposeful sampling method and added to the study until saturation was achieved. A deductive analysis approach inspired by the model pathways to treatment health care provider (HCP) was employed. From the 34 ICN included in our analysis, five main categories were identified: appraisal interval, help-seeking interval, diagnosis interval, pre-treatment interval, and other contributing factors such as health-related behaviours, system delay, and tumor characteristics. These factors negatively contributed to early detection of oral and oropharyngeal cancers and affect treatment wait time with patients, providers, and the healthcare system. Patient's lack of awareness, provider's oversight and prolonged access to care were the main reasons of delay in cancer diagnosis and management in our study. A sustainable plan for public awareness interventions and implementation of a solid curriculum for medical and dental students is needed to enhance their related knowledge, competence in clinical judgement, and treatment managements.

Development and Validation of a Non-Invasive, Chairside Oral Cavity Cancer Risk Assessment Prototype Using Machine Learning Approach

Oral cavity cancer (OCC) is associated with high morbidity and mortality rates when diagnosed at late stages. Early detection of increased risk provides an opportunity for implementing prevention strategies surrounding modifiable risk factors and screening to promote early detection and intervention. Historical evidence identified a gap in the training of primary care providers (PCPs) surrounding the examination of the oral cavity. The absence of clinically applicable analytical tools to identify patients with high-risk OCC phenotypes at point-of-care (POC) causes missed opportunities for implementing patient-specific interventional strategies. This study developed an OCC risk assessment tool prototype by applying machine learning (ML) approaches to a rich retrospectively collected data set abstracted from a clinical enterprise data warehouse. We compared the performance of six ML classifiers by applying the 10-fold cross-validation approach. Accuracy, recall, precision, specificity, area under the receiver operating characteristic curve, and recall–precision curves for the derived voting algorithm were: 78%, 64%, 88%, 92%, 0.83, and 0.81, respectively. The performance of two classifiers, multilayer perceptron and AdaBoost, closely mirrored the voting algorithm. Integration of the OCC risk assessment tool developed by clinical informatics application into an electronic health record as a clinical decision support tool can assist PCPs in targeting at-risk patients for personalized interventional care.

Deep Learning Predicts the Malignant-Transformation-Free Survival of Oral Potentially Malignant Disorders

Simple Summary

Mouth cancer is the most common malignancy in the head-and-neck region. Usually, these tumors develop from white lesions in the mouth that appear long before cancer diagnosis. However, platforms that can estimate the time-factored risk of cancer occurring from these diseases and guide treatment and monitoring approaches are elusive. To this end, our study presents time-to-event models that are based on machine learning for prediction of the risk of malignancy from oral white lesions following pathological diagnosis as a function of time. These models displayed very satisfactory discrimination and calibration after multiple tests. To facilitate their preliminary use in clinical practice and further validation, we created a website supporting the use of these models to aid decision making.

Abstract

Machine-intelligence platforms for the prediction of the probability of malignant transformation of oral potentially malignant disorders are required as adjunctive decision-making platforms in contemporary clinical practice. This study utilized time-to-event learning models to predict malignant transformation in oral leukoplakia and oral lichenoid lesions. A total of 1098 patients with oral white lesions from two institutions were included in this study. In all, 26 features available from electronic health records were used to train four learning algorithms—Cox-Time, DeepHit, DeepSurv, random survival forest (RSF)—and one standard statistical method—Cox proportional hazards model. Discriminatory performance, calibration of survival estimates, and model stability were assessed using a concordance index (c-index), integrated Brier score (IBS), and standard deviation of the averaged c-index and IBS following training cross-validation. This study found that DeepSurv (c-index: 0.95, IBS: 0.04) and RSF (c-index: 0.91, IBS: 0.03) were the two outperforming models based on discrimination and calibration following internal validation. However, DeepSurv was more stable than RSF upon cross-validation. External validation confirmed the utility of DeepSurv for discrimination (c-index—0.82 vs. 0.73) and RSF for individual survival estimates (0.18 vs. 0.03). We deployed the DeepSurv model to encourage incipient application in clinical practice. Overall, time-to-event models are successful in predicting the malignant transformation of oral leukoplakia and oral lichenoid lesions.

Diagnostic Accuracy of Confocal Laser Endomicroscopy for the Diagnosis of Oral Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis

Background: Advances in treatment approaches for patients with oral squamous cell carcinoma (OSCC) have been unsuccessful in preventing frequent recurrences and distant metastases, leading to a poor prognosis. Early detection and prevention enable an improved 5-year survival and better prognosis. Confocal Laser Endomicroscopy (CLE) is a non-invasive imaging instrument that could enable an earlier diagnosis and possibly help in reducing unnecessary invasive surgical procedures. Objective: To present an up to date systematic review and meta-analysis assessing the diagnostic accuracy of CLE in diagnosing OSCC. Materials and Methods. PubMed, Scopus, and Web of Science databases were explored up to 30 June 2021, to collect articles concerning the diagnosis of OSCC through CLE. Screening: data extraction and appraisal was done by two reviewers. The quality of the methodology followed by the studies included in this review was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. A random effects model was used for the meta-analysis. Results: Six studies were included, leading to a total number of 361 lesions in 213 patients. The pooled sensitivity and specificity were 95% (95% CI, 92–97%; I² = 77.5%) and 93% (95% CI, 90–95%; I² = 68.6%); the pooled positive likelihood ratios and negative likelihood ratios were 10.85 (95% CI, 5.4–21.7; I² = 55.9%) and 0.08 (95% CI, 0.03–0.2; I² = 83.5%); and the pooled diagnostic odds ratio was 174.45 (95% CI, 34.51–881.69; I² = 73.6%). Although risk of bias and heterogeneity is observed, this study validates that CLE may have a noteworthy clinical influence on the diagnosis of OSCC, through its high sensitivity and specificity. Conclusions: This review indicates an exceptionally high sensitivity and specificity of CLE for diagnosing OSCC. Whilst it is a promising diagnostic instrument, the limited number of existing studies and potential risk of bias of included studies does not allow us to draw firm conclusions. A conclusive inference can be drawn when more studies, possibly with homogeneous methodological approach, are performed.

Assessment of Serum Selenium and Ceruloplasmin in Potentially Malignant Disorders and Oral Cancer

Introduction:

Despite extensive research and development, potentially malignant disorders (PMDs) of the oral cavity and oral cancer remain a serious concern. Diet and immunity have been identified as important modifiable factors in such diseases.

Materials and Methods:

A total of 20 patients and 10 healthy individuals, aged 30–60 years, were chosen from the outpatient Department of Oral and Maxillofacial Surgery, Yenepoya Dental College and hospital, Karnataka. The participants were grouped into three: Group 1: (10 healthy individuals), Group 2: (10 oral leukoplakia patients) and Group 3: (10 squamous cell carcinoma patients). Blood was chosen as the investigative medium. Ceruloplasmin was estimated by the diamine oxidase method. The technique of atomic absorption developed by Sir Alan Walsh in 1950 has become the preferred method of elemental analysis of selenium (atomic absorption spectrometer). Statistical analysis of the data obtained was done using one-way ANOVA test and the Turkey multiple comparisons test.

Results:

The intergroup comparison of ceruloplasmin shows that the mean value of Group I (Control) was 31.746 mg/dl, the mean value of Group II (leukoplakia) was 81.411 mg/dl, and the mean value of Group III (squamous cell carcinoma) was 90.7120 mg/dl. The intergroup comparison of selenium levels shows that the mean value of Group I (Control) was 119.937 (ng/ml), the mean value of Group II (leukoplakia) was 109.17 (ng/ml), and the mean value of Group III (squamous cell carcinoma) was 99.6230 (ng/ml).

Conclusion:

Antioxidants are an important defense system against free radical damage to cells. Ceruloplasmin and selenium levels in serum could be used as disease markers in leukoplakia and squamous cell carcinoma.

Influence of Life Style Factors on Oral Potentially Malignant and Malignant Disorders: A Cross Sectional Study

The incidence of oral cancer has risen in the past decades and is usually recognised when symptomatic and at a late stage. A premalignant lesion is like smoldering volcano, which if not taken care of, may erupt, often with disastrous consequences. Early detection is therefore very important to reduce morbidity and mortality. A descriptive cross-sectional study was done to assess the prevalence, clinical presentation, and association of various addiction habits in the patients who presented with potentially malignant and malignant lesions of the oral cavity in outdoor clinics of ENT and HNS department of a tertiary care center in Jaipur (Rajasthan). 351 patients of different oral mucosal lesions were examined from August 2019 to January 2020 among which 173(49.2%) patients of potentially malignant and malignant lesions comprise the study group. Clinical findings and detailed history including addiction habits with frequency and duration were noted. Cytological and histopathological examinations were done to conclude the diagnosis. Out of 173 patients of the study group, 146(84.4%) were diagnosed with potentially malignant lesions (PMLs) and 27(15.6%) with malignant lesions (MLs). The most prevalent PML was Oral submucous fibrosis (23%) followed by leukoplakia (7.6%). The most common involved site was buccal mucosa (45.0%) followed by the tongue (26.5%). Tobacco consumption was the most prevalent addiction habit (80%) in the study group. High prevalence of tobacco abuse in patients with potentially malignant and malignant lesions suggested a strong relationship between two. It necessitates adequate awareness in the general population as well as early detection and management of these lesions by an expert Otolaryngologist.

Notch signaling in oral pre-cancer and oral cancer

Notch signaling involves cell to cell contact. It is an ancient signaling mechanism that is conserved throughout the animal kingdom. The basic function of Notch signaling is to decide cell fate and execute asymmetrical division. Notch signaling is indispensable for embryo growth. Aberrant Notch signaling involves in cancer progression by altering cell proliferation rate, tumor micro-environment, stem cell activities. The role of Notch signaling in cancer progression is context-dependent. In breast cancer and T cell lymphoma Notch signaling is highly active, whereas in squamous cell carcinoma (SCC) as oral and skin cancer, the signaling is suppressed. It is believed that in SCC, Notch-mediated tumor growth is due to the cell non-autonomous function. Oral cancer is the 6th most risky cancer worldwide. In many patients, oral cancer is preceded by pre-cancer conditions. In this review, we have summarized the research knowledge related to the role of Notch signaling in oral cancer and pre-cancer conditions and the therapeutic options available targeting different components of Notch pathways.

Collagen deposition correlates with loss of E-cadherin and increased p63 expression in dysplastic conditions of oral submucous fibrosis

This paper focuses on the status of epithelial markers, E-cadherin, and p63 in the backdrop of an abnormal amount of collagen in the sub-mucosa of dysplastic and non-dysplastic grades of OSF. Histologically confirmed OSF and normal oral mucosa samples were procured. Samples were stained by Van Gieson's stain (VG) and immunohistochemistry. The captured images were analyzed by ImageJ software to quantify their grayscale intensities. There was a gradual increase in the intensity of VG stain from normal to non-dysplastic and dysplastic OSF and the differences in their mean grayscale values were found to be significant (p < 0.00001). The intensity of E-cadherin was found to be the highest in non-dysplastic conditions and lowest in dysplastic conditions. The intensity difference of E-cadherin between normal and non-dysplastic OSF was found to be significant (p < 0.00001). The grayscale scale intensity values for p63 in whole epithelium depicted significant differences between normal and diseased conditions but for its intensity, in basal cells, significant differences were found between non-dysplastic and other classes of tissues. There was a positive correlation observed between VG and p63 staining intensity. The diseased oral epithelium demonstrated greater deposition of sub-epithelial collagen fibers along with subsequent loss of E-cadherin and an increased p63 expression.

Automatic detection of oral cancer in smartphone-based images using deep learning for early diagnosis

SIGNIFICANCE

Oral cancer is a quite common global health issue. Early diagnosis of cancerous and potentially malignant disorders in the oral cavity would significantly increase the survival rate of oral cancer. Previously reported smartphone-based images detection methods for oral cancer mainly focus on demonstrating the effectiveness of their methodology, yet it still lacks systematic study on how to improve the diagnosis accuracy on oral disease using hand-held smartphone photographic images.

AIM

We present an effective smartphone-based imaging diagnosis method, powered by a deep learning algorithm, to address the challenges of automatic detection of oral diseases.

APPROACH

We conducted a retrospective study. First, a simple yet effective centered rule image-capturing approach was proposed for collecting oral cavity images. Then, based on this method, a medium-sized oral dataset with five categories of diseases was created, and a resampling method was presented to alleviate the effect of image variability from hand-held smartphone cameras. Finally, a recent deep learning network (HRNet) was introduced to evaluate the performance of our method for oral cancer detection.

RESULTS

The performance of the proposed method achieved a sensitivity of 83.0%, specificity of 96.6%, precision of 84.3%, and F1 of 83.6% on 455 test images. The proposed "center positioning" method was about 8% higher than that of a simulated "random positioning" method in terms of F1 score, the resampling method had additional 6% of performance improvement, and the introduced HRNet achieved slightly better performance than VGG16, ResNet50, and DenseNet169, with respect to the metrics of sensitivity, specificity, precision, and F1.

CONCLUSIONS

Capturing oral images centered on the lesion, resampling the cases in training set, and using the HRNet can effectively improve the performance of deep learning algorithm on oral cancer detection. The smartphone-based imaging with deep learning method has good potential for primary oral cancer diagnosis.

Prevalence of oral human papillomavirus infection among Indian HIV-positive men who have sex with men: a cross-sectional study

BACKGROUND

Oral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population.

METHODS

We tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history.

RESULTS

The prevalence of oral HPV was 23.7% (95% CI: 19-29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4-6.9]) in multivariable analyses.

CONCLUSIONS

This is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer.

Higher serum homocysteine level and frequency of hyperhomocysteinemia in carcinoembryonic antigen-positive or squamous cell carcinoma-antigen-positive oral leukoplakia patients

BACKGROUND/PURPOSE

Our previous study found significantly lower serum hematinic levels and higher serum homocysteine level as well as higher frequencies of serum hematinic deficiencies and hyperhomocysteinemia in oral leukoplakia (OL) patients than in healthy control subjects. This study evaluated whether carcinoembryonic antigen (CEA)-positive or squamous cell carcinoma-antigen (SCC-Ag)-positive OL patients had significantly lower serum hematinic levels and higher serum homocysteine level as well as significantly higher frequencies of hematinic deficiencies and hyperhomocysteinemia than CEA-negative or SCC-Ag-negative OL patients or healthy control subjects.

METHODS

The complete blood count, serum iron, vitamin B12, folic acid, and homocysteine levels in 184 OL patients including 85 CEA-positive, 99 CEA-negative, 25 SCC-Ag-positive, and 159 SCC-Ag-negative OL patients and in 184 age- and sex-matched healthy control subjects were measured and compared.

RESULTS

We found that the 85 CEA-positive or 25 SCC-Ag-positive OL patients had a significantly lower mean serum folic acid level and a significantly higher mean serum homocysteine level as well as significantly higher frequencies of serum folic acid deficiency and hyperhomocysteinemia than 184 healthy control subjects. Moreover, the 25 SCC-Ag-positive OL patients had a significantly higher mean serum homocysteine level than the 159 SCC-Ag-negative OL patients. The 85 CEA-positive OL patients had a higher mean serum homocysteine level and a higher frequency of hyperhomocysteinemia than 99 CEA-negative OL patients (marginally significant, P = 0.060).

CONCLUSION

CEA-positive or SCC-Ag-positive OL patients tend to have a higher mean serum homocysteine level and a higher frequency of hyperhomocysteinemia than CEA-negative or SCC-Ag-negative OL patients, respectively.

Local Anti-PD-1 Delivery Prevents Progression of Premalignant Lesions in a 4NQO-Oral Carcinogenesis Mouse Model

Although the principle of systemic treatment to prevent the progression of oral premalignant lesions (OPL) has been demonstrated, there remains a lack of consensus about an optimal approach that balances clinical efficacy with toxicity concerns. Recent advances in cancer therapy using approaches targeting the tumor immune microenvironment (TIME) including immune-checkpoint inhibitors indicate that these agents have significant clinically activity against different types of cancers, including oral cancer, and therefore they may provide an effective oral cancer prevention strategy for patients with OPLs. Our past work showed that systemic delivery of a monoclonal antibody to the programmed death receptor 1 (PD-1) immune checkpoint can inhibit the progression of OPLs to oral cancer in a syngeneic murine oral carcinogenesis model. Here we report a novel approach of local delivery of a PD-1 immune-checkpoint inhibitor loaded using a hydrogel, which significantly reduces the progression of OPLs to carcinomas. In addition, we detected a significant infiltration of regulatory T cells associated with oral lesions with p53 mutation, and a severe loss of expression of STING, which correlated with a decreased infiltration of dendritic cells in the oral lesions. However, a single local dose of PD-1 inhibitor was found to restore stimulator of interferon response cGAMP interactor 1 (STING) and CD11c expression and increase the infiltration of CD8⁺ T cells into the TIME irrespective of the p53 mutational status. Overall, we provide evidence for the potential clinical value of local delivery of biomaterials loaded with anti-PD-1 antibodies to prevent malignant progression of OPLs. PREVENTION RELEVANCE: Oral cancer is an aggressive disease, with an overall survival rate of 50%. Preinvasive histologic abnormalities such as tongue dysplasia represent an early stage of oral cancer; however, there are no treatments to prevent oral carcinoma progression. Here, we combined biomaterials loaded with an immunotherapeutic agent preventing oral cancer progression.

Correlation between endothelial CXCR7 expression and clinicopathological factors in oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) impairs functionality and sensuousness resulting in poor quality of life. Biomarkers can predict disease trajectory and lead to effective treatments. Transcriptomics have identified genes that are upregulated in tumor endothelial cells (TECs) compared with normal endothelial cells (NECs). Among them, chemokine receptor 7 (CXCR7) is highly expressed in TECs of several cancers and involved in angiogenesis of TECs. However, levels of CXCR7 in OSCC blood vessels have not been fully investigated. In this study, we analyzed the correlation between CXCR7 expression in TECs and clinicopathological factors in OSCC. Immunohistochemistry for CXCR7 and CD34 was performed on 59 OSCC tissue specimens resected between 1996 and 2008 at Hokkaido University Hospital. CXCR7 expression in blood vessels was evaluated by the ratio of CXCR7+/CD34+ blood vessels. CXCR7 expression was 42% and 19% in tumor and non-tumor parts, respectively, suggesting that CXCR7 expression is higher in TECs than in NECs. CXCR7 expression in TECs correlated with advanced T-stage and cancer stage. Overall survival and disease-free survival rates were higher in low-expressing CXCR7 patients than in high-expressing. These results suggest that CXCR7 expression in blood vessels may be a useful diagnostic and prognostic marker for OSCC patients.

Significantly higher serum tumor marker levels in patients with oral submucous fibrosis

Background/purpose

Our previous study showed that carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC-Ag), and ferritin are significantly higher in patients with oral potentially malignant disorders (OPMDs including oral leukoplakia, oral erythroleukoplakia, and oral verrucous hyperplasia) than in healthy controls (HCs). Oral submucous fibrosis (OSF) is also recognized as an OPMD. This study evaluated whether these three serum tumor marker levels were also significantly higher in OSF patients than in HCs.

Materials and methods

The serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients and 164 HCs were measured and compared. Patients with serum CEA level ≥3 ng/mL, SCC-Ag level ≥2 ng/mL, and ferritin level ≥250 ng/mL were scored as serum positive for CEA, SCC-Ag, and ferritin, respectively.

Results

We found significantly higher mean serum CEA, SCC-Ag, and ferritin levels in 41 OSF patients than in 164 HCs (all P-values < 0.05). Moreover, 41 OSF patients had significantly higher serum positive rates of CEA (39.0%), SCC-Ag (19.5%), and ferritin (53.7%) than 164 HCs (all P-values < 0.05). Of the 41 OSF patients, 26 (63.4%), 7 (17.1%), and 2 (4.9%) had serum positivities of one, two, or three tumor markers including CEA, SCC-Ag, and ferritin, respectively.

Conclusion

There are significantly higher mean serum CEA, SCC-Ag, and ferritin levels and significantly higher serum positive rates of CEA, SCC-Ag, and ferritin in OSF patients than in HCs. The serum CEA, SCC-Ag, and ferritin levels may be served as tumor markers for evaluation of malignant potential of OSF lesions.

Particle size penetration rate and effects of smoke and smokeless tobacco products - An invitro analysis

Utilization of tobacco products is a global epidemic that causes a health threat among the adolescents and adults of the world. If the current pattern perpetuates, it is estimated to cause 10 million deaths each year by 2020. According to the 2009-2010 survey by Global Adult Tobacco Survey, 53.5% of Indians use tobacco products (66.2% of men and 40% of women). Cancers of the lip and oral cavity are highly frequent in Southern Asia (eg: India and Sri Lanka) and it is also the leading cause of cancer death among men in India and Sri Lanka.

AIM AND OBJECTIVES

The aim of the study is to evaluate the particle size, and assess the penetration rate in egg shell membrane and proliferation rate using cell lines among 4 commercially available tobacco products.

MATERIALS AND METHODS

A total of 4 tobacco product samples namely Gutka, Khaini, Beedi and Cigarette was used to analyse the particle size using High resolution Scanning electron microscopy, the penetration rate on egg shell membrane using Spectroflurometry and proliferative rate using ELISA on cell lines respectively.

RESULTS

Khaini revealed the smallest particle size and highest penetration and proliferation rate compared to Gutka, Beedi and Cigarette.

CONCLUSION

Current evidence shows that individuals who consume Khaini are at high risk to develop potentially malignant disorders and oral squamous cell carcinoma when compared to Gutka, Beedi and Cigarette (in the order of occurrence).

[Optimization of the diagnosis of precancerous diseases of the oral mucosa and lips (Manganotti's abrasive precancerous cheilitis and erythroplakia)]

OBJECTIVE

To optimize the identification of precancerous diseases of the oral mucosa, such as Manganotti's abrasive precancerous cheilitis and erythroplakia of the oral mucosa using markers Ki-67 and keratin 15.

MATERIAL AND METHODS

The study group included 17 patients with Manganotti's abrasive precancerous cheilitis and 8 with erythroplakia of the oral mucosa. A histological analysis was carried out to scrutinize the biopsy material of the oral mucosa of the patients. Ki-67 protein and keratin 15 were used to assess the proliferative activity of epithelial cells and the severity of neoplasia. Results. Thirteen patients with Manganotti's cheilitis had dysplasia of varying degrees, and 4 had signs of malignancy. A high proliferative activity of the Ki-67 protein was found in the stratum basal and stratum spinosum of the epithelium. In 5 patients with erythroplakia, according to histological examination, grade 2-3 intraepithelial neoplasia was revealed and 3 patients had cancer in situ. The expression of keratin 15 in all patients with Manganotti's abrasive precancerous cheilitis and erythroplakia in the basal layer tended to decrease with an increase in the degree of dysplasia, however, the appearance of keratin 15 in the cytoplasm of cells located above the basal layer was discovered.

CONCLUSION

The use of Ki-67 protein and keratin 15 as immunohistochemical markers in the study of diseases such as Manganotti's abrasive precancerous cheilitis and erythroplakia of the oral mucosa makes it possible to identify the initial signs of malignancy more accurately in the epithelium.