Oral Potentially Malignant Disorders: Etiology, Pathogenesis, and Transformation Into Oral Cancer

Premalignant lesions of the oral cavity: a narrative review of factors and mechanisms of transformation into cancer

Oral squamous cell carcinoma (OSCC) is the most common type of head and neck cancer. The development and progression of OSCC are closely linked to various aetiological factors. Early signs of OSCC may manifest as oral lesions, genetic abnormalities, and chronic inflammation. Lesions with dysplastic features have a high risk of malignant transformation into OSCC. Moreover, dysplastic lesions are characteristic of many oral potentially malignant disorders (OPMDs). Currently, there is no unified standard of treatment for OPMD patients, due to the variability in risk factors and mechanisms of transformation. Therefore, it is essential to detect and manage OPMDs at an early stage in order to prevent their malignant transformation into OSCC. This necessitates analysing OPMD mechanisms to identify objective markers for predicting the risk of malignant transformation. The aim of this review was to describe the process of OPMD transformation into OSCC under the influence of environmental, immune, microbiome, and molecular factors.

Prevalence and determinants of oral potentially malignant disorders in western rajasthan

Oral cancer with incidence (10.2%) and mortality (9.3%) ranks as second most prevalent cancers in India. Oral cancer diagnosis at early stages through the detection of oral potentially malignant disorders (OPMDs) can lead to the prevention and reduction of mortality associated with oral cancer. The objective of the study was to estimate the prevalence and the determinants of OPMDs in Jodhpur, Rajasthan. A cross-sectional study was conducted in six blocks of Jodhpur, Rajasthan. The trained Community Health Officers (CHOs) of Ayushman Arogya Mandir (erstwhile Health and Wellness centers) performed an Oral Visual Examination (OVE) to screen the participants for OPMDs. The inclusion criteria comprised men and women aged 30 years or above or aged between 18 and 29 years with tobacco and/or alcohol consumption habits, visiting Ayushman Arogya Mandir. The association of the OPMD with socio-behavioral risk factors was determined through a bivariate chi-square test and multivariate-binary logistic regression analysis. The overall prevalence of OPMD was found to be 14.84%. The prevalence of leukoplakia (8.61%) was the highest, followed by oral submucous fibrosis (4.78%) and erythroplakia (2.87%). OPMD was significantly higher in lower socioeconomic status (SES). Smokeless tobacco consumption [AOR-8.751(1.500-51.046)], smoking [AOR-20.827 (2.204-196.832], and alcohol consumption [AOR-50.806 (3.617-713.687)] were significantly associated with OPMD. The synergistic effect of smokeless tobacco consumption, smoking, and alcohol consumption on OPMD was observed [AOR-26.222 (2.83-243.48)]. The mean duration and frequency per day of smokeless tobacco consumption and smoking were significantly higher in OPMD. We also found that oral cavity symptoms were strongly associated with OPMD, particularly persistent mouth ulcers and repeated biting injuries due to sharp teeth and dentures. To conclude, the study identified a high prevalence of OPMDs (14.84%) in Jodhpur, with leukoplakia being the most common OPMD. There was a significantly higher prevalence of OPMD in individuals from lower SES. The key modifiable risk factors, including smokeless tobacco use, smoking, and alcohol consumption, were strongly associated with OPMDs, with a notable synergistic effect observed when these behaviors coexisted. Additionally, oral cavity symptoms such as persistent mouth ulcers and repeated biting injuries due to sharp teeth and dentures were found to be determinants of OPMD. The study findings emphasize the need for targeted interventions addressing socio-behavioral risk factors to reduce the burden of OPMDs and prevent the progression to oral cancer.

Antioxidants for the management of oral leukoplakia: A systematic review of randomized controlled trials

Introduction

Oral leukoplakia (OL) is a potentially malignant disorder characterized by non-scrabble white lesions that may turn into invasive carcinoma if left untreated. Few antioxidant treatments have shown promising results in the regression of lesions and prevention of their progression to carcinoma. We aim to summarize the current evidence on the effectiveness of antioxidants in the management of OL.

Materials and methods

The present systematic review followed PRISMA guidelines and involved a thorough search of three scientific databases: PubMed, Scopus, and Cochrane. We used specific algorithms related to the keywords "antioxidant" and "Oral leukoplakia" to identify randomized controlled trials (RCTs) that have explored the utility of antioxidants in the management of OL. The risk of bias assessment was conducted using the Cochrane risk of bias tool (ROB 2.0), ensuring the reliability of our findings.

Results

Out of 2490 articles retrieved, only thirteen RCTs involving 1147 participants fulfilled the inclusion criteria. Lycopene was found to be the most consistently effective antioxidant, showing significant effectiveness in reducing lesion size, both in oral and topical forms. The trials incorporating other antioxidants, including vitamin A, vitamin C, β-carotene, and curcumin, demonstrated mixed results. Severe heterogeneity was detected in treatment forms, dosage, administration frequency, treatment duration, and follow-up time among all included trials.

Conclusion

Lycopene may play a significant role in the non-surgical management of OL. Future research with large-scale, well-designed, randomized controlled trials with standardized dosing, delivery methods, and outcome measures is mandatory to provide more robust evidence on the available antioxidant therapy for OL.

Network analysis of differentially expressed genes involved in oral submucous fibrosis and oral squamous cell carcinoma: a comparative approach

OBJECTIVE

Oral submucous fibrosis (OSMF) is categorized as an oral potentially malignant disorder (OPMD) with an increased risk of occurrence of oral squamous cell carcinoma (OSCC). In this study, we aimed to identify the hub genes associated with OSMF and OSCC.

STUDY DESIGN

Using RStudio, a set of differentially expressed genes (DEGs) were identified in (A) OSMF, (B) OSCC, and (C) comparative OSMF-OSCC category, obtained from Gene Expression Omnibus (GEO). The Protein to Protein Interaction (PPI) Network, hub genes, and functional annotation were determined using Search Tool for the Retrieval of Interacting Genes (STRING), Cytoscape, and SR-Plot, Database for Annotation, Visualization and Integrated Discovery (DAVID).

RESULTS

A total of 2081, 2320, and 3295 DEGs were obtained from the OSMF, OSCC, and comparative categories, respectively. Hub gene and gene enrichment analysis revealed that the genes in (A) MYH6, TTN, TNNT3, MYL1, TPM2, ACTN3, NEB, MYL2, TNNT1, and TPM1; (B) CD4, SELL, CD28, CD27, PRF1, CD80, GZMB, CD40LG, ITGAX, and IL4; and (C) CD4, CD8A, CTLA4, CD28, GZMB, IL79, CD69, CD40LG, IFNG, and CD80 categories, were associated with muscle contraction, cell proliferation, and malignant transformation.

CONCLUSIONS

Hub genes and functional enrichment analysis revealed the diagnostic genes and the genes responsible for the malignant transformation in OSMF, OSCC, and the comparative category. A panel of identified genes will be of clinical significance in targeted therapy in future studies. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

The relationship between oral burns and oral squamous cell carcinoma: a systematic review

Background

Micro-RNAs (miRNAs) have been found to play crucial roles in various biological processes and have been implicated in the development and progression of many diseases, including cancer. In recent years, several studies have suggested that miRNA may have a potential role in the relationship between oral burns and various. This systematic review aims to summarize the current evidence on the roles of miRNA in the relationship between oral burns and oral squamous cell carcinoma (OSCC).

Materials and methods

The present systematic review was performed using PubMed, Google Scholar, Science Direct, ProQuest, Ovid, and Embase from April 2024 to May 2024 following the "Preferred Reporting Items for Systematic Reviews" guidelines. The keywords, including "oral burn OR burning tongue OR burning mouth" AND "Oral squamous cell carcinoma" AND "miRNA."

Results

The study reviewed 9 publications, examining miRNA interactions common to oral burns and cancers. Among them, 5 studies focused on various burn types, while 4 addressed oral malignancies. Synthesizing these findings identified 5 shared miRNAs between burns and oral cancers. Regarding burn types, thermal burns were most mentioned, followed by carbon dioxide laser and chemical burns. For cancer, oral squamous cell carcinoma was predominant, with one study on tongue squamous cell carcinoma. Noteworthy miRNAs include hsa-miR-205, hsa-miR-18a, hsa-mir-23b, hsa-mir-203, and hsa-mir-150, each exhibiting distinct roles and expression patterns in burns and carcinogenesis.

Conclusion

Overall, the findings of this systematic review highlight the potential importance of miRNA in the relationship between oral burns and OSCC.

Loss of Heterozygosity in Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma - A Scoping Review

INTRODUCTION

This scoping review was conducted to ascertain the loss of heterozygosity (LOH) signatures reported in Oral Potentially Malignant Disorders (OPMD) and Oral Squamous Cell Carcinoma (OSCC), in the literature in the last fifty years.

METHODS

The Joanna Briggs Institute recommendations (2023) for scoping review were used to extract, analyze, and present the results. The review was reported according to the PRISMA guidelines for Scoping Reviews (PRISMA-ScR). The most commonly reported genes associated with LOH in OPMD and OSCC are discussed. The Gene Ontology functional enrichment analysis gives the significance of the protein-protein interactions (PPI) of these genes using the STRING database.

RESULTS

An exhaustive database search of the title, abstract, and full-text screening consistent with the eligibility criteria yielded 277 studies. LOH commonly studied in OPMD and OSCC include p53 gene, p16 gene, adenomatous polyposis coli gene, retinoblastoma (Rb) gene, fragile histidine triad (FHIT) gene and phosphatase and tensin homolog (PTEN) gene. Chromosome loci involving 17p, 9p, 5q, 13q, 3p, and 10q were frequently reported in OPMD and OSCC. PPI analysis demonstrated strong evidence of p53 interaction with p16, FHIT, and Rb.

CONCLUSION

Distinctive signatures of LOH are seen in OPMD and OSCC. The LOH patterns identified in this scoping review underline the significance of advanced molecular techniques and the need for long-term prospective cohorts to understand LOH pathophysiology in oral carcinogenesis to enable their usefulness as biomarkers in early diagnosis, treatment, and prognostication of oral cancer.

Portable SERS for salivary-based detection of oral pre-malignant lesions and carcinomas: a step toward clinical implementation

The rising incidence of oral cancer has emerged as a serious menace to our civilization. Modern dietary habits, lack of awareness, and delays in early detection are major contributing factors to the global spread of this issue. This work reports the promising findings for diagnostic accuracy of oral cancer in pre-malignant stages by analyzing surface enhanced Raman spectroscopy (SERS) profiles of different stages of oral cancer combined with multivariate analysis. Using 99 clinical samples from which 39 samples were from malignant stage, 28 from pre-malignant and 32 from healthy controls, SERS analysis was carried out by employing label-free silver nanorods as SERS substrates. The SERS spectra of malignant and pre-malignant samples manifest distinct peaks associated with varying concentrations of inorganic metabolites and proteins. Primarily, the elevated level of thiocyanate dominates the SERS spectra in malignant samples while antioxidants like uric acid, xanthine and hypoxanthine's are the key elements in the pre-malignant samples. A ratio-metric analysis of 2130 and 1435 cm-1 peak revealed that the pre-malignant lesions consistently lie between 2 and 3, whereas malignant samples have ratio greater than 3 due to higher intensity of thiocyanate peak. The multivariate analysis successfully separates between oral cancer positive and negative samples with a sensitivity and specificity of 93.5 and 92.7 % respectively. This study presents promising results for the early detection of oral cancer, which could assist clinicians in saving lives.

A collaborative immunohistochemical study of Drp1 and cortactin in the epithelial dysplasia and oral squamous cell carcinoma

OBJECTIVES

Oral squamous cell carcinoma (OSCC) accounts for more than 90% of oral malignancies. The poorly understood molecular and cellular mechanisms underlying the pathogenesis of OSCC remain a subject of paramount importance. For epithelial dysplasia, invasion, and metastasis to occur, tumor cells require energy obtained from the mitochondria and phenotypic cellular changes in the actin cytoskeleton. Dynamin-related protein1 (Drp1) is one of the main mitochondrial proteins regulating the mitochondrial dynamics. Cortactin is an actin-binding protein that promotes the actin polymerization and rearrangement. The interplay between both proteins in OSCC remains elusive. The current study aimed to investigate the immunohistochemical (IHC) expression of Drp1 and cortactin in tissues revealing propagating OSCC cases.

METHODS

The retrospective study was carried out on 35 formalin-fixed paraffin sections of nodal metastasizing OSCC cases selected from the Oncology Centre, Faculty of Medicine, Mansoura University archives from 2018 to 2023. Immunohistochemistry for Drp1 and cortactin was done. The immune reactivity of both proteins was evaluated using computer-assisted digital image analysis. Statistical analysis was performed to identify significant differences and correlations between both markers in tissues associated with progressing OSCC cases using Chi-Square, Monte Carlo, One-Way ANOVA, and Spearman tests. The p-value less than 0.05 was considered statistically significant.

RESULTS

Drp1 expression was statistically significant to grades of primary OSCC (p = 0.015), while insignificant to grades of epithelial dysplasia (p = 0.123) and metastatic lymph nodes (LNs) (p = 0.212). Statistically significant differences between dysplastic epithelium & primary tumor, dysplastic epithelium & metastatic LNs, and primary tumor and metastatic LNs were observed (p values were 0.014, 0.001, 0.034, respectively). On the other hand, Cortactin expression revealed no statistically significant differences across the three groups. However, statistically significant differences between dysplastic epithelium & primary tumor, dysplastic epithelium & metastatic LNs, and primary tumor and metastatic LNs were found (p values were 0.014, 0.001, 0.034, respectively). Moreover, the Spearman test presented a strong positive correlation between Drp1 and cortactin expression in the studied cases.

CONCLUSION

Expressions of both Drp1 and cortactin relatively explain their great role in the propagation and the carcinogenesis of OSCC.

Recent advances in delivery systems of ginsenosides for oral diseases

BACKGROUND

Ginsenosides, the principal active ingredients in ginseng, have anti-bacterial, anti-inflammatory, antioxidant, anticancer, osteogenic, cardioprotective, and neuroprotective properties. Oral diseases afflict about half of the world's population. Ginsenosides' multifunctional properties have led to substantial investigation into their potential to prevent and treat oral disorders. However, their low absorption and poor targeting limit their effectiveness.

PURPOSE

This review summarizes the latest research progress on ginsenoside-based drug delivery systems and the potential of ginsenosides in preventing and treating oral diseases to provide a theoretical basis for clinical applications.

METHODS

Using "ginsenoside", "drug delivery", "nanoparticles", "liposomes", "hydrogel", "oral disease", "toxicology", "pharmacology", "clinical translation" and combinations of these keywords in PubMed, Web of Science, and Science Direct. The search was conducted until December 2024.

RESULTS

The limitations of natural ginsenosides can be overcome by utilizing drug delivery systems to improve pharmacological activity, bioavailability and targeting. The multifunctional pharmacological activities of ginsenosides offer promising avenues for treating oral diseases. In addition, the susceptibility of the oral cavity to infection by pathogenic bacteria and the diluting effect of saliva pose significant challenges to treatment. The emergence of drug delivery marks a breakthrough in addressing these issues.

CONCLUSION

Ginsenoside-based drug delivery methods improve bioactivity, targeting, and reduce costs. This review emphasizes current advancements in ginsenosides within novel drug delivery systems, specifically on its potential in preventing and treating oral disorders. However, multiple well-designed clinical trials are needed to further evaluate the efficacy and safety of these drugs.

Comparative analysis of Ki-67, α-SMA, and MMP-9 expression in oral submucous fibrosis and oral leukoplakia with/without dysplasia: Insights into malignant transformation mechanisms

BACKGROUND

The present study aimed to comparatively analyze the immunoexpression of Ki-67, Alpha Smooth Muscle Actin (α-SMA), and Matrix Metalloproteinase-9 (MMP-9) between Oral Leukoplakia (OL) and Oral Submucous Fibrosis (OSMF), both with and without dysplasia. The objective was to determine the potential role of these biomarkers in the diagnosis and prognostication of oral potentially malignant disorders (OPMDs) and their potential as targets for interventions.

MATERIALS AND METHODS

Immunohistochemical staining for Ki-67, α-SMA, and MMP-9 was performed on seventy formalin-fixed paraffin-embedded tissue blocks, comprising normal buccal mucosa (n=10), OSMF (n=30), and OL (n=30) with 15 cases each of dysplasia and non-dysplasia. The expression of these markers was comparatively evaluated in OSMF and OL, with and without dysplasia.

RESULTS

The immunoexpression of Ki-67, MMP-9, and α-SMA was found to be significantly higher (p<0.001) in OSMF compared to OL for the respective dysplastic counterparts. Additionally, OSMF with dysplasia exhibited a significantly higher expression (p<0.001) of these markers compared to OSMF without dysplasia.

CONCLUSIONS

The present study reports differences in cell proliferation rates, myofibroblast and MMP-9 expression between OSMF and OL. The higher expression of these markers in OSMF with dysplasia suggests accelerated disease progression and enhanced potential for transformation into oral squamous cell carcinoma (OSCC). These findings highlight variations in the tissue microenvironment of OPMDs, influencing their biological behaviour and prognosis.

Nanoemulsion and nanoemulgel-based carriers as advanced delivery tools for the treatment of oral diseases

Oral diseases rank among the most widespread ailments worldwide posing significant global health and economic challenges affecting around 3.5 billion people, impacting the quality of life for affected individuals. Dental caries, periodontal disease, bacterial and fungal infections, tooth loss and oral malignancies are among the most prevalent global clinical disorders contributing to oral health burden. Traditional treatments for oral diseases often face challenges such as poor drug bioavailability, breakdown of medication in saliva, inconsistent antibiotic levels at the site of periodontal infection as well as higher side effects. However, the emergence of nanoemulgel (NEG) as an innovative drug delivery system offers promising solutions where NEG combines the advantages of both nanoemulsions (NEs) and hydrogels providing improved drug solubility, stability, and targeted delivery. Due to their minuscule size and ability to control drug release, NEGs hold promise for improving treatment of oral diseases, where versatility of these delivery systems makes them suitable for various applications, including topical delivery in dentistry. This review concisely outlines the anatomy of the oral environment and investigates the therapeutic potential of NE-based gels in oral disorder treatment. It thoroughly examines the challenges of drug delivery in the oral cavity and proposes strategies to improve therapeutic efficacy, drawing attention to previous research reports for comparison. Through comprehensive analysis, the review highlights the promising role of NEGs as a novel therapeutic approach for oral health management via research advancements and their clinical translation. Additionally, it provides valuable insights into future research directions and development opportunities in this area.

Automated Detection of Oral Malignant Lesions Using Deep Learning: Scoping Review and Meta-Analysis

OBJECTIVE

Oral diseases, specifically malignant lesions, are serious global health concerns requiring early diagnosis for effective treatment. In recent years, deep learning (DL) has emerged as a powerful tool for the automated detection and classification of oral lesions. This research, by conducting a scoping review and meta-analysis, aims to provide an overview of the progress and achievements in the field of automated detection of oral lesions using DL.

MATERIALS AND METHODS

A scoping review was conducted to identify relevant studies published in the last 5 years (2018-2023). A comprehensive search was conducted using several electronic databases, including PubMed, Web of Science, and Scopus. Two reviewers independently assessed the studies for eligibility and extracted data using a standardized form, and a meta-analysis was conducted to synthesize the findings.

RESULTS

Fourteen studies utilizing various DL algorithms were identified and included for the detection and classification of oral lesions from clinical images. Among these, three were included in the meta-analysis. The estimated pooled sensitivity and specificity were 0.86 (95% confidence interval [CI] = 0.80-0.91) and 0.67 (95% CI = 0.58-0.75), respectively.

CONCLUSIONS

The results of meta-analysis indicate that DL algorithms improve the diagnosis of oral lesions. Future research should develop validated algorithms for automated diagnosis.

TRIAL REGISTRATION

Open Science Framework (https://osf.io/4n8sm).

The dual role of diabetes on oral potentially malignant disorders

BACKGROUND

Observational studies suggest a link between diabetes and oral potentially malignant disorders (OPMDs), such as oral lichen planus (OLP) and oral leukoplakia (OLK). The causal relationship, as well as the type of diabetes that promotes OPMDs development, remains unclear. This Mendelian randomization (MR) study estimated the causal effects of diabetes-related traits on OPMDs.

METHODS

Large-scale genome-wide association study data on type 1 diabetes (T1D), type 2 diabetes (T2D), fasting glucose (FG), fasting insulin (FI), glycated hemoglobin (HbA1c), OLP, OLK, and actinic cheilitis (AC) were used. Causal effects were assessed using inverse-variance weighted (IVW), weighted median, and MR-Egger methods. Multivariable MR analyses evaluated the independent roles of these traits, with extensive sensitivity analyses.

RESULTS

Genetic susceptibility to T1D (IVW OR = 1.09, 95% CI 1.02-1.17, P = 0.007) and T2D (IVW OR = 0.91, 95% CI 0.86-0.97, P = 0.002) showed protective effects against AC. T1D was associated with an increased risk of OLP (IVW OR = 1.09, 95% CI 1.02-1.17, P = 0.007). The effect of T1D on AC and OLP remained robust after adjusting for FI, FG, and HbA1c, while T2D's effect on AC was not significant when considering these glycemic traits. No potential pleiotropy was detected (P > 0.05).

CONCLUSIONS

T1D may have a causal role in the development of OLP independent of glycemic traits, emphasizing the need for routine oral examinations in T1D patients. Conversely, genetically predicted T1D and T2D are significantly associated with a reduced risk of AC, challenging previous assumptions and offering new insights into the relationship between diabetes and OPMDs. Further extensive investigations are required to address the limitations of this study and to clarify these associations.

Artificial intelligence-based diagnosis of oral leukoplakia using deep convolutional neural networks Xception and MobileNet-v2

Objective

The present study aims to employ and compare the artificial intelligence (AI) convolutional neural networks (CNN) Xception and MobileNet-v2 for the diagnosis of Oral leukoplakia (OL) and to differentiate its clinical types from other white lesions of the oral cavity.

Materials and methods

Clinical photographs of oral leukoplakia and non-oral leukoplakia lesions were gathered from the SRM Dental College archives. An aggregate of 659 clinical photos, based on convenience sampling were included from the archive in the dataset. Around 202 pictures were of oral leukoplakia while 457 were other white lesions. Lesions considered in the differential diagnosis of oral leukoplakia like frictional keratosis, oral candidiasis, oral lichen planus, lichenoid reactions, mucosal burns, pouch keratosis, and oral carcinoma were included under the other white lesions subset. A total of 261 images constituting the test sample, were arbitrarily selected from the collected dataset, whilst the remaining images served as training and validation datasets. The training dataset were engaged in data augmentation to enhance the quantity and variation. Performance metrics of accuracy, precision, recall, and f1_score were incorporated for the CNN model.

Results

CNN models both Xception and MobileNetV2 were able to diagnose OL and other white lesions using photographs. In terms of F1-score and overall accuracy, the MobilenetV2 model performed noticeably better than the other model.

Conclusion

We demonstrate that CNN models are capable of 89%-92% accuracy and can be best used to discern OL and its clinical types from other white lesions of the oral cavity.

Toluidine Blue and Chlorin-e6 Mediated Photodynamic Therapy in the Treatment of Oral Potentially Malignant Disorders: A Systematic Review

Oral potentially malignant disorders (OPMDs) are conditions that carry an increased risk of malignant transformation, including oral leukoplakia and oral lichen planus. Current management approaches differ based on each condition's unique etiology and pathophysiology, but all available treatment methods have notable limitations. This has prompted continued efforts to identify more effective therapeutic options. Photodynamic therapy (PDT) has emerged as a minimally invasive yet potent alternative for treating OPMDs. This systematic review examines the efficacy of PDT mediated by toluidine blue and chlorin-e6 (Photolon) in managing OPMDs. Following the PRISMA guidelines, eight relevant studies published between 2010 and 2024 were included. Data on the study design, protocols, light parameters, and photosensitizer characteristics were collected to evaluate treatment outcomes. The reviewed evidence suggests that toluidine-blue- and chlorin-e6-mediated PDT holds promise as a minimally invasive treatment modality for OPMDs, especially for oral lichen planus and oral leukoplakia. Studies indicate its potential as an alternative or adjunct therapy, particularly for symptomatic or refractory oral lichen planus. However, discrepancies in study designs and treatment protocols, coupled with the limited number of trials, impeded direct comparisons. Toluidine-blue- and chlorin-e6-mediated PDT shows significant potential as a therapeutic option for OPMDs. Nonetheless, further investigations-including large-scale randomized controlled trials, standardized treatment guidelines, and the exploration of additional OPMDs beyond oral lichen planus and oral leukoplakia-are necessary in order to fully establish its clinical utility and facilitate widespread adoption.

Impact of oral precancerous lesions on oral cancer development in patients with oral lichen planus: a retrospective cohort study of 318 oral lichen planus patients

Background

Oral lichen planus (OLP) has been implicated as a potential risk factor for oral cancer. This study aimed to investigate the long-term determinants of oral cancer development following a diagnosis of OLP.

Materials and methods

A retrospective cohort study of 318 patients with histopathologically confirmed OLP was conducted at a tertiary medical center from 1995 to 2018. Patients were categorized into two groups based on the presence or absence of oral precancerous lesions (OPLs). Baseline characteristics, underlying medical conditions, and lifestyle factors were compared between groups. The hazard ratio (HR) and the 10-year cumulative risk for oral cancer development were estimated using logistic regression and Kaplan-Meier analysis, respectively.

Results

In our cohort, a total of 33 patients (10.38%) were diagnosed with oral cancer. After adjusting for confounders, OPLs (HR, 2.98), age over 50 years (HR, 4.36), chronic kidney disease (HR, 4.46), and alcohol consumption (HR, 4.23) emerged as independent risk factors for oral cancer development in patients with OLP (P < 0.05).

Conclusion

The current study indicates that the presence of OPLs, including histologically confirmed verrucous hyperplasia and varying degrees of oral dysplasia, is associated with an increased risk of oral cancer development in patients with OLP. Further research is needed to elucidate the underlying molecular mechanisms linking OLP, OPL, and oral cancer occurrence.

Viral Involvement in Oral Potentially Malignant Disorders: A Scoping Review

Purpose

The purpose of this scoping review was to investigate which viruses other than HPV and EBV-associated with OPMDs and investigate whether viruses are linked solely to the etiology of OPMDs, their malignant transformation (MT), or both.

Methods

A scoping review following PRISMA-ScR methodological framework was used during the process. We conducted thorough searches in the EBSCOhost and PubMed databases. The inclusion criteria were publications that described viruses in OPMDs and identified pertinent research published between 2014 and 2023. The articles included underwent a thorough analysis and synthesis process to map out viruses in OPMDs. Pertinent characteristics such as research domains, publication dates, authors, type of research studies, sample sizes, gender ratios, types of OPMDs lesions, detected viruses, and methodological detection approaches were incorporated into the analysis.

Results

A total of twenty-eight articles were eligible for inclusion. The prevalence of viruses detected in OPMDs was found to be 78.57%. Viruses detected in this study, including HPV (0% to 86.6%), EBV (8% to 95.7%), hepatitis B virus (HBV) (6.71%) and herpes simplex virus (HSV) (1%). The biggest risk factor for OPMDs found in this study was tobacco use.

Conclusion

Given that 90% of oral cancers worldwide are attributable to OSCC, it is crucial to understand the role of viruses such as HPV, EBV, HBV, and HSV, along with unhealthy risk factors like tobacco and alcohol, which may contribute to the etiology and progression of lesions into OPMDs. Global data indicate that these viruses play varying roles in the etiology of OPMDs, with significant geographic variability, co-infections, and interactions with lifestyle factors influencing their oncogenic potential. Although this study found that virus positivity rates were higher in the malignant stage (OSCC) than in OPMDs and that there is a high prevalence of viruses in OPMDs, further research is needed to clarify the direct causality of virus-induced malignant transformation in OPMDs.

Expression of CSTF2 in oral squamous cell carcinoma and its relationship with immune infiltration and poor prognosis

Background

Oral squamous cell carcinoma (OSCC) is a prevalent and devastating malignancy of the oral cavity that profoundly affects patient survival and quality of life (QOL). Cleavage Stimulation Factor Subunit 2 (CSTF2) is known to influence tumor development across multiple cancer types. However, its specific association with patient prognosis and immune cell infiltration in OSCC remains insufficiently understood.

Methods

To assess the expression levels and prognostic implications of CSTF2 in OSCC, comprehensive data were acquired from The Cancer Genome Atlas (TCGA) and subsequently normalized. Immunohistochemical staining of tissue microarrays was performed to analyze CSTF2 expression in the OSCC samples. Differences in CSTF2 expression between OSCC and adjacent non-cancerous samples were evaluated using the Wilcoxon rank-sum test. Functional enrichment analyses have been performed to identify biological pathways and functions associated with CSTF2. The relationship between the infiltration of various immune cells and CSTF2 expression levels was assessed using single-sample gene set enrichment analysis (ssGSEA). Ultimately, the prognostic significance of CSTF2 was evaluated through Kaplan-Meier survival analysis, in conjunction with univariate and multivariate Cox regression analyses, as well as receiver operating characteristic (ROC) curves.

Results

High CSTF2 expression was observed in OSCC and associated with unfavorable clinicopathological variables, including histological grade and lymphnode neck dissection. Functional enrichment analysis indicated that CSTF2 plays a role in epidermal development and differentiation, immunoglobulin complexes, peptidases and endopeptidase inhibitor activity, and cytochrome P450 metabolic processes. Additionally, the overexpression of CSTF2 exhibited a negative correlation with the infiltration of immature dendritic cells (iDCs), cytotoxic cells, and plasmacytoid dendritic cells (pDCs). Notably, elevated CSTF2 expression is significantly associated with reduced patient outcomes.

Conclusion

Elevated CSTF2 expression in OSCC is associated with poor prognostic outcomes, highlighting its capacity to function as an innovative prognostic biomarker and a target for therapeutic interventions.

Immunohistochemical Expression of DAPK-1 in Oral Leukoplakia And Oral Squamous Cell Carcinoma: A Preliminary Study

INTRODUCTION

The silencing of death-associated protein kinase 1 (DAPK-1) is an effective way of inactivating a tumor-suppressing mechanism. The aim of this study was to investigate the immunohistochemical expression of DAPK-1 in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC).

METHODS

The immunohistochemical (IHC) detection of DAPK-1 was carried out in cases of OLs and OSCCs. DAPK-1 molecules' tissue distribution in OLs/OSCCs tissues was evaluated using semiquantitative immunohistochemistry in representative paraffin-embedded tissue samples (57 in total) from 2004-2019, retrieved from the archives of the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece and the St Lukas Hospital of Thessaloniki, Greece. The inclusion criterion was the presence of sufficient precancerous or cancerous biological material (estimated as more than 70% per tissue specimen) in the paraffin cubes. The exclusion criterion was the opposite, i.e. the lack of sufficient material due to previous sections. Statistics for IHC were evaluated by a non-parametric Mann-Whitney U Test. A two-sided p-value < 0.05 was considered statistically significant.

RESULTS

DAPK-1 IHC expression was increased in OLs without dysplasia and with OLs with mild dysplasia compared to moderate/severe dysplasia (p=0.019, Mann-Whitney U Test) and OSCCs (p=0.003, Mann-Whitney U Test).  Conclusions: DAPK-1 seemed to function as an oncosuppressor molecular biomarker, as its expression was decreased in areas of cellular dysplasia in OLs and in areas of OSCCs composed of less differentiated cells. The clinical application of this biomarker is that the positively stained, potentially malignant lesions are less likely to transition into malignancy, and cancerous lesions are more likely to behave non-aggressively. On the other hand, the lack of staining could signify the loss of this oncosuppressing ability, and it could be a potential prognostic biomarker for OSCC's aggressive biologic behavior if considered with other clinical parameters and a prognostic factor of malignant transformation of potentially malignant lesions. Since this is a preliminary study, more studies with larger sample sizes are required to support these conclusions.

MicroRNA-Based Markers of Oral Tongue Squamous Cell Carcinoma and Buccal Squamous Cell Carcinoma

Background Oral cancers, including oral tongue squamous cell carcinoma (OTSCC) and buccal squamous cell carcinoma (BSCC), are known to be widespread and can progress aggressively within the oral cavity. Objective The primary aim of this study is to identify microRNA (miRNA)-based markers for OTSCC and BSCC. Materials and methods This observational study was conducted at Northampton General Hospital from January 2024 to December 2024. A total of 150 patients were recruited, and clinical and demographic data were collected, including age, gender, smoking and alcohol consumption history, tumor stage, and grade. Patients were randomly assigned to either the OTSCC or BSCC group using a computer-generated random sequence. Tumor tissue samples from both groups were obtained through biopsy or surgical resection for miRNA analysis. Results Data were collected from 150 patients, with a mean age of 55.4 years, slightly higher in the BSCC group. Males comprised 60% of the cohort, and smoking history was more prevalent in BSCC (73.3%) than in OTSCC (66.7%). Advanced tumor stages (III-IV) were predominant in both groups (61.3% overall), while comorbidities and a family history of cancer were observed in 36.7% and 22.0% of patients, respectively. MiR-21 demonstrated high diagnostic accuracy (area under the curve >0.90) and was independently associated with poor survival outcomes in both cancer types (p < 0.001). Functional analyses linked these miRNAs to key oncogenic pathways, including cell proliferation and metastasis. Conclusions miRNA-based markers, particularly miR-21, show significant potential for enhancing the diagnosis and prognosis of OTSCC and BSCC. Further studies are required to validate these findings and investigate their therapeutic applications.

The role of the microbiome in head and neck squamous cell cancers

The human microbiome has garnered tremendous interest in the field of oncology, and microbiota studies in head and neck oncology has also flourished. Given the increasing incidence and mortality of HNSCC, as well as the suboptimal outcomes of available treatments, there is an urgent need for innovative approaches involving the microbiome. This review evaluates the intricate relationship between the microbiome and HNSCC, highlighting the potential of the microbiome as a marker for cancer detection, its role in malignancy, and its impact on the efficacy of conventional treatments like chemotherapy and radiotherapy. The review also explores the effects of treatment modalities on the microbiome and discusses the potential of microbiome alterations to predict and influence treatment toxicities such as mucositis and xerostomia. Further research is warranted to characterize the microbiome-HNSCC association, which holds promise for advancing early diagnosis, enhancing prognostic accuracy, and personalizing treatment strategies to improve patient outcomes. The exploration of the microbiome in clinical trials indicates a burgeoning subject of microbiome-focused therapies, heralding a new frontier in most cancer care.

Novel transcripts of EMT driving the malignant transformation of oral submucous fibrosis

Oral submucous fibrosis (OSF) is a chronic, progressive, and fibrotic condition of the oral mucosa that carries an elevated risk of malignant transformation. We aimed to identify and validate novel genes associated with the regulation of epithelial-to-mesenchymal transition (EMT) in OSF. Genes regulating EMT were identified through differential gene expression analysis, using a LogFC threshold of -1 and + 1 and a padj value < 0.05, based on data from GEO datasets and the TCGA-HNSC datasets. The curated EMT genes were correlated with functional cancer states and subjected to clustering to identify candidate genes. Integration of bioinformatics and proteomics led to the discovery of the EMT genes MMP9, SPARC, and ITGA5 as novel candidates. Comprehensive pathway and immunohistochemical analyses confirmed their roles in regulating EMT in OSF, oral squamous cell carcinoma (OSCC), and OSF-associated squamous cell carcinoma (OSFSCC). The significant roles of MMP9, SPARC, and ITGA5 in fibrosis and malignancy suggest a novel mechanism in which fibrosis-associated type 2 EMT undergoes transition to type 3 EMT, driving OSF towards malignancy.

HOXC-AS1 and EZH2 interaction increase HOXC9 expression and promote the malignant transformation of oral leukoplakia

Objective: To investigate the role of HOXC9 in the transformation of oral leukoplakia (OLK) to oral squamous cell carcinoma (OSCC) and its effectiveness as a new molecular marker for oral leukoplakia carcinogenesis. Materials and Methods: We assessed HOXC9 in OLK and OSCC using immunohistochemistry (IHC). Colony formation and transwell experiment were employed to appraise the function of HOXC9 in the malignant transformation of OLK. ChIP-qPCR, CO-IP, RIP-qPCR, RNA pull down and mass spectrometry were using to evaluate the molecular mechanism of HOXC9. Results: HOXC9 expression was higher in patients with OSCC than in those with OLK, which is associated with increased malignant transformation of OLK. Functional experiments suggested that HOXC9 induces the acquisition of cancer stem cells (CSCs) and epithelial-to-mesenchymal transition (EMT). Subsequently, we found that the HOXC9-mediated malignant phenotype was reversed by HOXC-AS1 depletion. Mechanistically, HOXC-AS1 regulates H3K27me3 methylation and EZH2 as a potential HOXC-AS1-HOXC9 interacting protein. Finally, we found that the 251-619nt nucleotide of HOXC-AS1 competitively binds to EZH2. Conclusion: HOXC-AS1 competitively binds to EZH2, inhibiting its binding to H3 in the HOXC9 promoter region, resulting in a decrease in H3K27me3 and enhanced expression of HOXC9, thereby promoting CSCs and EMT in oral leukoplakia, ultimately leading to malignant transformation into oral squamous cell carcinoma.

Exosomes derived from human adipose mesenchymal stem cells act as a therapeutic target for oral submucous fibrosis

Oral submucosal fibrosis is a highly malignant oral condition that necessitates the use of sophisticated therapeutic procedures. OSF is a multifactorial precancerous condition induced by areca nut chewing, deficiencies in vitamins and trace minerals, immunological aspects, and hereditary factors. Adipose tissue-derived mesenchymal stem cells possess the capability for multidirectional activation and are extensively distributed throughout the body. They have minimal immunogenicity and are extensively utilized in cancer treatment. Exosomes are extracellular vesicles produced by the intracellular route. They are biological carriers comprising microRNA, messenger RNA, lipids and proteins crucial for intercellular communication. ADSC exosomes, serving as a vehicle for miRNA, possess accessibility and little immunogenicity. They can significantly contribute to adipose tissue regrowth, angiogenesis, immunological modulation, and tissue repair. ADSC-Exo exhibits antifibrotic properties and may serve as a potential treatment for OSF. This review presents a novel therapeutic approach and clarifies the precise mechanisms involved in the clinical management of OSF using ADSC-Exo.

Recommendations for Research to Develop a Patient-Centered Clinical Follow-Up Protocol for Oral Epithelial Dysplasia

Oral epithelial dysplasia (OED) is the primary histological marker for assessing the progression of oral potentially malignant disorders (OPMDs) to cancer. Despite challenges in grading and low inter-pathologist reproducibility, OED severity remains the key predictor of malignant transformation. However, globally accepted guidelines for OED monitoring are lacking, despite calls for individualized management based on host and lesion characteristics. The proposed research protocol involves acquiring high-quality intraoral images, assessing oral hygiene and periodontal status, eliminating chronic mechanical irritation and Candida infections, and applying adjunctive diagnostic methods like toluidine blue staining, optical evaluation, and brush cytology. Tailored follow-up regimens based on individual risk assessments are emphasized, with frequent monitoring for high-grade dysplasia or patients at higher risk of progression. Therefore, effective OED management should consider the patient's immune status, dietary habits, and oral microbiota, aiming to develop personalized treatment strategies that optimize patient-centered care.

Oral Microbiome Research in Biopsy Samples of Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma and Its Challenges

This study aims to evaluate the potential benefits and challenges of integrating oral microbiome research into the clinical management of oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC). The oral microbiome has gained significant attention for its role in the pathogenesis and progression of these conditions, with emerging evidence suggesting its value as a diagnostic and prognostic tool. By critically analyzing current evidence and methodological considerations, this manuscript examines whether microbiome analysis in biopsy samples can aid in the early detection, prognosis, and management of OPMD and OSCC. The complexity and dynamic nature of the oral microbiome require a multifaceted approach to fully understand its clinical utility. Based on this review, we conclude that studying the oral microbiome in this context holds significant promise but also faces notable challenges, including methodological variability and the need for standardization. Ultimately, this manuscript addresses the question, “Should such research be undertaken, given the intricate interactions of various factors and the inherent obstacles involved?”, and also emphasizes the importance of further research to optimize clinical applications and improve patient outcomes.

Histomorphometric Analysis of Oral Squamous Cell Carcinoma, Apparently Normal Adjacent Mucosa and Epithelial Dysplasia

Oral squamous cell carcinoma (OSCC) comprises more than 90% of oral cavity cancer and remains the leading cause of death in oral disease. Limited studies have been conducted to evaluate cellular histomorphometry changes in OSCC compared to premalignant lesions such as Dysplastic leukoplakia (DL), Nondysplastic leukoplakia (NDL), and normal epithelial. This cross-sectional descriptive-analytical study was conducted on total 72 samples, including superficial areas of squamous cell carcinoma (SCCSF), Invasive Front of Squamous Cell Carcinoma (SCCIF), Apparently Normal Adjacent Oral Mucosa (SCCANM) or normal margin, Dysplastic leukoplakia (DL), Nondysplastic leukoplakia (NDL), and normal oral mucosa tissue (NOM) (N = 12 per group). ANOVA was used to compare the nucleus-to-cytoplasm ratio (N/C), nucleus area (NA), and cellular area (CA) of the stained hematoxylin and eosin (H&E) samples in the studied groups. A P value less than 0.05 was considered to be a significant level. There was a significant increase in the CA, NA, and N/C in the basal and parabasal layers from normal epithelium to dysplastic epithelium and OSCC. The highest NA, CA, and N/C were in the SCCIF and SCCSF groups, respectively, and the lowest was observed in NOM. In addition, SCCANM basal and parabasal layer cells had a significant difference in N/C compared to NOM, which indicates a high risk of SCCANM transformation into malignancy. Cell histomorphometry changes were observed from normal tissue to premalignant lesions and OSCC. These parameters can be used as indicators of the potential for transformation into malignancy in premalignant lesions.

Evaluating the efficacy of curcumin in the management of oral potentially malignant disorders: a systematic review and meta-analysis

Background

Oral potentially malignant disorders (OPMDs) not only harbour the risk of malignant transformation but can also affect patients' quality of life owing to severe symptoms. Therefore, there is an urgent need for therapeutic strategies to improve patients' quality of life. The objective of this meta-analysis was to comprehensively assess the efficacy of curcumin in the management of OPMDs.

Methods

PubMed, Embase, the Cochrane Library, and Web of Science were searched for clinical trials evaluating the efficacy of curcumin in the treatment of OPMDs from inception until March 2024. RevMan 5.4 software was used to perform statistical and subgroup analyses.

Results

Sixteen randomised controlled trials (1,089 patients) were selected. Curcumin exhibited comparable efficacy to conventional controls in alleviating pain (I2 = 98%, P = 0.49) and improving tongue protrusion (I2 = 94%, P = 0.51) in oral submucous fibrosis (OSF). Additionally, topical use of curcumin had an efficacy equivalent to that of conventional therapy in reducing pain (I2 = 83%, P = 0.31) and facilitating clinical remission (I2 = 67%, P = 0.38) of oral lichen planus (OLP).

Conclusion

The topical use of curcumin may palliate pain and promote clinical healing in OLP patients. Systemic curcumin can ameliorate the degree of pain and tongue protrusion in OSF. Therefore, our study suggests that curcumin could serve as an alternative treatment for managing OPMDs with lower medical toxicity than steroids, especially when steroids are not suitable. Further studies with larger sample sizes and adequate follow-up periods are required to validate our results.

Diagnostic performance of artificial intelligence in detecting oral potentially malignant disorders and oral cancer using medical diagnostic imaging: a systematic review and meta-analysis

Objective

Oral cancer is a widespread global health problem characterised by high mortality rates, wherein early detection is critical for better survival outcomes and quality of life. While visual examination is the primary method for detecting oral cancer, it may not be practical in remote areas. AI algorithms have shown some promise in detecting cancer from medical images, but their effectiveness in oral cancer detection remains Naïve. This systematic review aims to provide an extensive assessment of the existing evidence about the diagnostic accuracy of AI-driven approaches for detecting oral potentially malignant disorders (OPMDs) and oral cancer using medical diagnostic imaging.

Methods

Adhering to PRISMA guidelines, the review scrutinised literature from PubMed, Scopus, and IEEE databases, with a specific focus on evaluating the performance of AI architectures across diverse imaging modalities for the detection of these conditions.

Results

The performance of AI models, measured by sensitivity and specificity, was assessed using a hierarchical summary receiver operating characteristic (SROC) curve, with heterogeneity quantified through I2 statistic. To account for inter-study variability, a random effects model was utilized. We screened 296 articles, included 55 studies for qualitative synthesis, and selected 18 studies for meta-analysis. Studies evaluating the diagnostic efficacy of AI-based methods reveal a high sensitivity of 0.87 and specificity of 0.81. The diagnostic odds ratio (DOR) of 131.63 indicates a high likelihood of accurate diagnosis of oral cancer and OPMDs. The SROC curve (AUC) of 0.9758 indicates the exceptional diagnostic performance of such models. The research showed that deep learning (DL) architectures, especially CNNs (convolutional neural networks), were the best at finding OPMDs and oral cancer. Histopathological images exhibited the greatest sensitivity and specificity in these detections.

Conclusion

These findings suggest that AI algorithms have the potential to function as reliable tools for the early diagnosis of OPMDs and oral cancer, offering significant advantages, particularly in resource-constrained settings.

Systematic Review Registration

https://www.crd.york.ac.uk/, PROSPERO (CRD42023476706).

Circ_0002722-induced regulation of YAP promotes platinum resistance in oral squamous cell carcinoma: Implications for verteporfin therapy

Oral squamous cell carcinoma (OSCC) poses a significant public health burden due to its high prevalence and poor prognosis. Platinum resistance is one of the major challenges in OSCC treatment. Yes-associated protein (YAP) has been identified as a pivotal player in OSCC tumorigenesis and progression. Circular RNA (circRNA) has been implicated in chemoresistance in various cancers by regulation the function of microRNA. Nevertheless, the specific mechanisms linking circRNA to YAP expression in OSCC remain poorly understood. In this study, we detected the YAP and circRNA hsa_circ_0002722 (circ_0002722) expression by western blot (WB) and quantitative polymerase chain reaction (qPCR). We found that YAP and circ_0002722 were up-regulated in platinum resistance in OSCC tissues. Furthermore, transfection of circ_0002722 siRNA into platinum-resistant cells revealed that circ_0002722 acted as a regulator of miR-1305, which influenced YAP expression and thereby affected platinum sensitivity. In vivo experiments corroborated the synergistic effects of cisplatin and verteporfin (a YAP inhibitor) in combating platinum resistance. Targeting YAP emerges as a promising therapeutic strategy for addressing platinum resistance in OSCC, with circ_0002722 serving as a potential therapy target and valuable diagnostic marker. These findings shed light on the underlying mechanisms of platinum resistance, paving the way for the development of effective treatment approaches.

Research progress of BRD4 in head and neck squamous cell carcinoma: Therapeutic application of novel strategies and mechanisms

Bromodomain-containing protein 4 (BRD4) belongs to the bromodomain and extra-terminal domain (BET) protein family, which plays a crucial role in recognizing acetylated lysine residues in chromatin. The abnormal expression of BRD4 contributes to the development of various human malignant tumors, including head and neck squamous cell carcinoma (HNSCC). Recent studies have shown that BRD4 inhibition can effectively prevent the proliferation and growth of HNSCC. However, the specific role and mechanism of BRD4 in HNSCC are not yet fully clarified. This article will briefly summarize the critical role of BRD4 in the pathogenesis of HNSCC and discuss the potential clinical applications of targeting BRD4 in HNSCC therapy. We further inquiry the challenges and opportunities for HNSCC therapies based on BRD4 inhibition, including BRD4 inhibitor combination with conventional chemotherapy, radiotherapy, and immunotherapy, as well as new strategies of BRD4-targeting drugs and BRD4 proteolysis-targeting chimeras (PROTACs). Moreover, we will also offer outlook on the associated challenges and future directions of targeting BRD4 for the treatment of patients with HNSCC.

Molecular Targets of Plant-Derived Bioactive Compounds in Oral Squamous Cell Carcinoma

BACKGROUND

With a significant increase in both incidence and mortality, oral cancer-particularly oral squamous cell carcinoma (OSCC)-is one of the main causes of death in developing countries. Even though there is evidence of advances in surgery, chemotherapy, and radiotherapy, the overall survival rate for patients with OSCC has improved, but by a small percentage. This may be due, on the one hand, to the fact that the disease is diagnosed when it is at a too-advanced stage, when metastases are already present.

METHODS

This review explores the therapeutic potential of natural herbal products and their use as adjuvant therapies in the treatment of oral cancer from online sources in databases (PubMed, Web of Science, Google Scholar, Research Gate, Scopus, Elsevier).

RESULTS

Even if classic therapies are known to be effective, they often produce many serious side effects and can create resistance. Certain natural plant compounds may offer a complementary approach by inducing apoptosis, suppressing tumor growth, and improving chemotherapy effectiveness. The integration of these compounds with conventional treatments to obtain remarkable synergistic effects represents a major point of interest to many authors. This review highlights the study of molecular mechanisms and their efficiency in in vitro and in vivo models, as well as the strategic ways in which drugs can be administered to optimize their use in real contexts.

CONCLUSIONS

This review may have a significant impact on the oncology community, creating new inspirations for the development of more effective, safer cancer therapies with less toxic potential.

Emerging functions of lycopene in the management of digestive premalignant lesions

Common digestive precancerous lesions, including oral potentially malignant disorders (OPMDs), gastric ulcers and colorectal adenoma, harbor high risk of cancerous transformation. Early intervention of these lesions is significant to prevent carcinogenesis and improve patients' prognosis. Lycopene, a carotenoid predominantly accumulated in tomatoes, is clinically recommended with its cis structure; as lycopene harbors the most potent antioxidative effects among carotenoids, its chemopreventive effects on the premalignant lesions is noted. Despite several reviews have assessed lycopene's efficacy for OPMDs, emerging studies have reported varying efficacy for digestive precancerous lesion with no comprehensive summary. Therefore, this review initially evaluates the efficacy and underlying mechanisms of lycopene for management of digestive precancerous lesions. According to the included studies, lycopene may show high promise in the management of digestive precancerous lesions, such as relieving mouth opening and burning sensation of oral submucous fibrosis (OSF), presenting potentially equivalent efficacy on managing oral lichen planus (OLP) as steroids and alleviating gastrointestinal precancers' symptoms, meanwhile lowering colon cancer risk. Moreover, its mechanisms for managing digestive precancerous lesions are concretely summarized, including anti-oxidative stress effects, anti-inflammatory response and regulation of cell proliferation and apoptosis, especially its modifications on TLR4/TRIF/NF-κB signaling pathway and p53-dependent cell cycle control and apoptosis. More studies are warranted to confirm its long-term efficacy and preventive role against malignant transformation of digestive precancerous lesions as evidence is insufficient.

A complete course of photodynamic therapy reduced the risk of malignant transformation of oral leukoplakia

BACKGROUND

Photodynamic therapy (PDT) has shown good short-term efficacy in the treatment of oral leukoplakia (OLK). However, the malignant transformation of OLK was seldom evaluated in most PDT studies. Therefore, this study evaluated the effect of PDT on the risk of malignant transformation of OLK.

METHODS

Kaplan-Meier survival analysis, COX regression, and sensitivity analysis were used to evaluate the effects of PDT on the risk of malignant transformation of OLK. Subgroup analyses were performed to explore the role of PDT in OLK patients with different clinical characteristics.

RESULTS

OLK patients with older age (HR=1.032, P = 0.018) and non-homogeneous lesion (HR=2.104, P = 0.044) had higher risk of malignant transformation. Patients who had finished a complete course of PDT (HR=0.305, P = 0.006) had a significant lower risk of malignant transformation, while those who hadn't finished a complete course of PDT (HR=0.692, P = 0.352) cannot be considered to have such a protective effect. In the subgroup analyses, complete PDT course showed a significant protective effect on malignant transformation of OLK in patients with female sex, no smoking or drinking habits, non-homogeneous lesions, lesions on oral mucosa outside the dangerous region, and any grade of epithelial dysplasia.

CONCLUSIONS

A complete course of PDT could significantly reduce the risk of malignant transformation of OLK, especially in those patients with risk factors of malignant transformation.

Prevalence of Oral Lesions in Relation to Tobacco and Alcohol Habits Using VELscope - A Retrospective Study

BACKGROUND

Tobacco consumption, in its various forms, is a primary cause of significant health conditions such as oral premalignant disorders and oral cavity carcinoma. This study investigates the current prevalence of oral lesions in the region, utilizing modern techniques to analyze the impact of tobacco on oral health.

AIMS AND OBJECTIVES

To evaluate the prevalence of oral lesions associated with tobacco and alcohol use, employing VELscope technology for assessment, and to evaluate the benefits of this recent technology in the assessment process.

MATERIALS AND METHODS

Patients with a history of tobacco and alcohol use were included based on specific criteria. The study documented oral manifestations, chief complaints, VELscope findings, and histopathological diagnoses, and correlated these data. Statistical analysis was conducted using IBM SPSS Statistics Version 21, with descriptive statistics (percentages, mean, and standard deviation) and categorical data comparisons (Chi-square test). A significance level of P ≤ 0.05 was used.

RESULTS AND CONCLUSION

The study found a notable shift from smoked to smokeless tobacco, predominantly affecting younger individuals. This highlights the need for targeted tobacco cessation efforts at the grassroots level. While VELscope can aid in diagnosis, it should not replace histopathological evaluation entirely.

The anticancer potential of tetrahydrocurcumin-phytosomes against oral carcinoma progression

BACKGROUND

Herbal medicine combined with nanotechnology offers an alternative to the increasing burden of surgery and/or chemotherapy, the main therapeutics of oral carcinoma. Phytosomes are nano-vesicular systems formed by the interaction between phospholipids and phyto-active components via hydrogen bonding, exhibiting superior efficacy over pure phytocomponents in drug delivery.

METHODS

Tetrahydrocurcumin (THC)-phytosomes were prepared by thin film hydration method. After characterization, in vitro cytotoxicity, antiproliferative capacity, antioxidant potential and full apoptotic workup were paneled on oral squamous cell carcinoma (SCC4) in comparison with native THC-solution and cisplatin (3.58 µg/mL intravenous injection), as positive controls. In addition, we tested the three medications on normal oral keratinocytes and gingival fibroblasts to attest to their tissue-selectivity.

RESULTS

Successful preparation of THC-phytosomes using 1:1 molar ratio of THC to phospholipid exhibited significantly increased aqueous solubility, good colloidal properties, and complete drug release after one hour. On SCC4 cells, THC-phytosomes, at their dose-/time-dependency at ~ 60.06 µg/mL escalated cell percentages in the S-phase with 32.5 ± 6.22% increase, as well as a startling 29.69 ± 2.3% increase in apoptotic population. Depletion of the cell colonies survival to 0.29 ± 0.1% together with restraining the migratory rate by -6.4 ± 6.8% validated THC-phytosomes' antiproliferative capacity. Comparatively, the corresponding results of THC-solution and cisplatin revealed 12.9 ± 0.9% and 25.8 ± 1.1% for apoptosis and 0.9 ± 0.1% and 0.7 ± 0.08% for colony survival fraction, respectively. Furthermore, the nanoformulation exhibited the strongest immuno-positivity to caspase-3, which positively correlated with intense mitochondrial fluorescence by Mitotracker Red, suggesting its implication in the mitochondrial pathway of apoptosis, a finding further explained by the enormously high Bax and caspase-8 expression by RT-qPCR. Finally, the THC groups showed the lowest oxidative stress index, marking their highest free radical-scavenging potential among the test groups.

CONCLUSIONS

THC-phytosomes are depicted to be an efficient nanoformulation that enhanced the anticancer efficacy over the free drug counterpart and the conventional chemotherapeutic. Additionally, being selective to cancer cells and less cytotoxic to normal cells makes THC-phytosomes a potential candidate for tissue-targeted therapy.

Qualitative evaluation of trace elements in commercially packaged forms of tobacco using laser-induced breakdown spectroscopy

Oral cancer is the most common malignancy in many developing countries, such as India, due to increased consumption of smokeless tobacco. The trace elemental components in commercially packaged forms of tobacco can play a significant role in the pathogenesis of oral cancer. To qualitatively assess the trace elements in various types of commercially packaged forms of tobacco using laser-induced breakdown spectroscopy (LIBS). Two popular varieties of 'Paan masala' that contained a mixture of slaked lime with areca nut, catechu, and other flavouring agents (tobacco was absent) and four types of packaged tobacco were obtained from 'Paan' shops. The contents in the packets were made into pellets using a hydraulic press and subjected to elemental analysis using LIBS. A ten-trial experiment was carried out on all six pellets. The National Institute of Standards and Technology (NIST) database was used to assess the emission lines. The elements obtained from commercially packaged tobacco and Paan masala were similar: calcium (Ca), iron (Fe), aluminium (Al), nickel (Ni), and chromium (Cr). Substances that cause DNA damage and carcinogenesis are inorganic elements such as nickel. Our study revealed that carcinogens such as nickel are present in the commercially packaged forms of tobacco and 'Paan masala' samples.

Oral Health and Nutraceutical Agents

Oral health is essential for both overall health and quality of life. The mouth is a window into the body's health, and nutrition can strongly impact the state of general and oral health. A healthy diet involves the synergistic effect of various nutraceutical agents, potentially capable of conferring protective actions against some inflammatory and chronic-degenerative disorders. Nutraceuticals, mostly present in plant-derived products, present multiple potential clinical, preventive, and therapeutic benefits. Accordingly, preclinical and epidemiological studies suggested a protective role for these compounds, but their real preventive and therapeutic effects in humans still await confirmation. Available evidence suggests that plant extracts are more effective than individual constituents because they contain different phytochemicals with multiple pharmacological targets and additive/synergistic effects, maximizing the benefits for oral health. Moreover, nutritional recommendations for oral health should be personalized and aligned with valid suggestions for overall health. This review is aimed to: introduce the basic concepts of nutraceuticals, including their main food sources; examine the logic that supports their relationship with oral health, and summarize and critically discuss clinical trials testing the utility of nutraceuticals in the prevention and treatment of oral diseases.

Comprehensive insights into oral squamous cell carcinoma: Diagnosis, pathogenesis, and therapeutic advances

Oral squamous cell carcinoma (OSCC) is considered the most common type of head and neck squamous cell carcinoma (HNSCC) as it holds 90 % of HNSCC cases that arise from multiple locations in the oral cavity. The last three decades witnessed little progress in the diagnosis and treatment of OSCC the aggressive tumor. However, in-depth knowledge about OSCC's pathogenesis, staging & grading, hallmarks, and causative factors is a prime requirement in advanced diagnosis and treatment for OSCC patients. Therefore present review was intended to comprehend the OSCCs' prevalence, staging & grading, molecular pathogenesis including premalignant stages, various hallmarks, etiology, diagnostic methods, treatment (including FDA-approved drugs with the mechanism of action and side effects), and theranostic agents. The current review updates that for a better understanding of OSCC progress tumor-promoting inflammation, sustained proliferative signaling, and growth-suppressive signals/apoptosis capacity evasion are the three most important hallmarks to be considered. This review suggests that among all the etiology factors the consumption of tobacco is the major contributor to the high incidence rate of OSCC. In OSCC diagnosis biopsy is considered the gold standard, however, toluidine blue staining is the easiest and non-invasive method with high accuracy. Although there are various therapeutic agents available for cancer treatment, however, a few only are approved by the FDA specifically for OSCC treatment. The present review recommends that among all available OSCC treatments, the antibody-based CAR-NK is a promising therapeutic approach for future cancer treatment. Presently review also suggests that theranostics have boosted the advancement of cancer diagnosis and treatment, however, additional work is required to refine the role of theranostics in combination with different modalities in cancer treatment.

Association of vitamin D levels and oral lichen planus. Systematic review and meta-analysis

BACKGROUND

Oral lichen planus (OLP) is an inmuno-mediated mucocutaneous chronical inflammatory disease. Multiple predisposing factors are considered, such as autoimmune response, microorganisms, medications, dental materials, psychological stress, genetic predisposition or nutritional deficiencies. The deficiency of vitamin D has been related to various autoimmune diseases like OLP.

MATERIAL AND METHODS

The electronic search was conducted in the MEDLINE (Pubmed), Scopus, Cochrane Library and Web of Science databases. To assess any potential risk of bias, the authors critically appraised each study by the Newcastle-Ottawa Scale for cohort and case-control studies. Pooled analyses were performed using a random-effects model. Heterogeneity of the studies was assessed by the I2 statistics. Forest Plots were performed to graphically represent the difference between vitamin D concentrations in the OLP compared to healthy group, with a 95% confidence interval.

RESULTS

After applying our inclusion and exclusion criteria, 7 articles were included in our review. The median concentration vitamin D in ng/ml found in serum for patients with OLP was of 26,6311,75ng/ml and for healthy patients was of 31,438,7ng/ml. Regarding the quantitative analysis, 7 studies were included. The difference in the concentration of vitamin D in healthy patients and patients with OLP statistically significant (Weighted Mean Difference (WMD): -6.20, 95% CI: -11.24 to -1.15, p=0.02 and I2 heterogeneity: 94%, p<0.00001).

CONCLUSIONS

The patients with OLP have statistically lower vitamin D levels than healthy patients.

Oral Pre-malignancy: An Update on Novel Therapeutic Approaches

PURPOSE OF REVIEW

This review aims to provide a comprehensive overview of the current advances in managing and preventing progression of oral potentially malignant disorders (OPMDs), focusing on their histological and clinicopathological features, and management.

RECENT FINDINGS

Recent studies, including a multicenter cross-sectional study, have identified oral leukoplakia as the most prevalent form of OPMD, comprising over half of the cases examined. Advances in histological grading, specifically the World Health Organization's three-tier system (mild, moderate, and severe dysplasia), have significantly enhanced the accuracy of risk assessment for malignant transformation. Additionally, treatments such as surgical interventions, photodynamic therapy, and chemopreventive and molecularly targeted agents are being evaluated for their safety and efficacy as well as, immune checkpoint inhibitors being evaluated as potential preventive strategies to halt the progression of OPMDs. The management of OPMDs remains challenging due to the lack of standardized screening protocols and varied clinical management approaches. Despite this, recent advancements in diagnostic grading and therapeutic interventions provide a framework for improved treatment outcomes. Continued research into the molecular and cellular mechanisms driving development and progression of OPMDs and innovative treatment trials are essential to optimize strategies that prevent malignant progression and thereby reduce the global health burden of oral cancer.

Stabilized oral lichen planus does not compromise dental implants survival: A systematic review and meta-analysis

BACKGROUND

This study aimed to evaluate the incidence of implant failure in patients with oral lichen planus (OLP) and investigate the potential association between OLP and peri-implant diseases.

MATERIALS AND METHODS

Embase, Web of Science, PubMed, and Scopus databases were searched for studies with no time restrictions. Meta-analysis was performed calculating pooled proportion of peri-implantitis (PI), peri-implant mucositis (PIM), and bleeding on probing (BOP) prevalence using fixed-effects model. Odds ratio and corresponding 95% CI were calculated to assess the potential risk of PI, PIM, and BOP in dental implant patients with OLP compared to healthy controls.

RESULTS

Implant failure rate was 4.38% at the patient level and 4.37% at the implant level. Six patients (3.92%) from five studies were diagnosed with oral cancer after receiving implant. The prevalence of PI, PIM, and BOP at the implant level were 14.00%, 20.00%, and 40.00%, respectively. There was no significant difference in the occurrence of PI and PIM between OLP patients and healthy controls.

CONCLUSIONS

Stabilized OLP is not considered a significant risk factor for peri-implant diseases. It is advised against placing implants or prostheses during the acute phase of the disease. Histopathological investigation to differentiate OLP from oral lichenoid dysplasia is crucial.

The Impact of Oral Microbiome Dysbiosis on the Aetiology, Pathogenesis, and Development of Oral Cancer

Oral squamous cell carcinoma (OSCC) is the most common head and neck cancer. Although the oral cavity is an easily accessible area for visual examination, the OSCC is more often detected at an advanced stage. The global prevalence of OSCC is around 6%, with increasing trends posing a significant health problem due to the increase in morbidity and mortality. The oral cavity microbiome has been the target of numerous studies, with findings highlighting the significant role of dysbiosis in developing OSCC. Dysbiosis can significantly increase pathobionts (bacteria, viruses, fungi, and parasites) that trigger inflammation through their virulence and pathogenicity factors. In contrast, chronic bacterial inflammation contributes to the development of OSCC. Pathobionts also have other effects, such as the impact on the immune system, which can alter immune responses and contribute to a pro-inflammatory environment. Poor oral hygiene and carbohydrate-rich foods can also increase the risk of developing oral cancer. The risk factors and mechanisms of OSCC development are not yet fully understood and remain a frequent research topic. For this reason, this narrative review concentrates on the issue of dysbiosis as the potential cause of OSCC, as well as the underlying mechanisms involved.

Expression Analysis of Circulating microRNAs in Saliva and Plasma for the Identification of Clinically Relevant Biomarkers for Oral Squamous Cell Carcinoma and Oral Potentially Malignant Disorders

This study aims to evaluate the expression of salivary and plasmatic miRNAs as diagnostic biomarkers in patients with oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs). A total of 25 patients were divided into three groups, according to their diagnosis: OSCC patients (n = 14); OPMDs patients (n = 6); and healthy controls (n = 5). At the time at diagnosis/enrolment, patients underwent salivary and plasmatic collection. The expression of miRNA -21, -31, -138, -145, -184, and -424 were evaluated by real-time PCR. An F-test and ANOVA test were performed to evaluate the miRNA levels (significance at p < 0.05). By comparing miRNA expression levels from saliva, a statistically significant difference emerged in the expression of miR-138 and miR-424 between the three groups (p < 0.05). In particular, these two miRNAs showed decreased expression levels in saliva samples from OSCC and OPMD patients compared to those from healthy controls. On the other hand, miRNA expression levels in plasma were low in all the groups, and no statistically significant differences were found. Overall, our results showed that liquid biopsy from saliva may be a useful tool for the identification of diagnostic molecular biomarkers in OSCC and OPMDs.

Stimuli-responsive materials in oral diseases: a review

OBJECTIVES

Oral diseases, such as dental caries, periodontitis, and oral cancers, are highly prevalent worldwide. Many oral diseases are typically associated with bacterial infections or the proliferation of malignant cells, and they are usually located superficially.

MATERIALS AND METHODS

Articles were retrieved from PubMed/Medline, Web of Science. All studies focusing on stimuli-responsive materials in oral diseases were included and carefully evaluated.

RESULTS

Stimulus-responsive materials are innovative materials that selectively undergo structural changes and trigger drug release based on shifts at the molecular level, such as changes in pH, electric field, magnetic field, or light in the surrounding environment. These changes lead to alterations in the properties of the materials at the macro- or microscopic level. Consequently, stimuli-responsive materials are particularly suitable for treating superficial site diseases and have found extensive applications in antibacterial and anticancer therapies. These characteristics make them convenient and effective for addressing oral diseases.

CONCLUSIONS

This review aimed to summarize the classification, mechanism of action, and application of stimuli-responsive materials in the treatment of oral diseases, point out the existing limitations, and speculate the prospects for clinical applications.

CLINICAL RELEVANCE

Our findings may provide useful information of stimuli-responsive materials in oral diseases for dental clinicians.

Targeting compensatory proliferation signals in oral cancer

Apoptosis is an orchestrated phenomenon that regulates cell populations in physiological and pathological conditions. Carcinogenesis involves a state of disequilibrium between cell proliferation and cell death. The resistance to conventional therapeutic modalities of cancer, including surgery, radiotherapy, and chemotherapy, can be explained by the compensatory repair and regeneration that occurs in the tumor microenvironment following apoptosis through the apoptotic compensatory proliferation signaling microvesicles (ACPSVs) or apoptotic extracellular microvesicles (ApoEVs). These microvesicles provide proliferative signals and act as mutagens, triggering cell proliferation, angiogenesis, immune evasion, metastasis, and invasion. This review discusses the phenomenon of apoptosis-induced proliferation and the role of ApoEVs in establishing an oncoregenerative niche, resulting in therapeutic resistance and recurrence of malignancies.

Analysis of methylation-driven genes for predicting the prognosis of patients with oral squamous cell carcinoma

Background

Oral squamous cell carcinoma (OSCC) is a highly aggressive malignancy that is characterized by early distant metastasis and poor prognosis. DNA methylation plays an important role in the etiology and pathogenesis of OSCC. This study aimed to identify methylation-driven genes through bioinformatics analysis as potential biomarkers for early diagnosis and prognostic assessment of OSCC.

Methods

Methylation data, RNA sequencing (RNA-seq) data and clinical prognosis information of OSCC patients were retrieved from The Cancer Genome Atlas (TCGA) database. The R packages MethylMix were employed to analyze the correlation between methylation status and corresponding gene expression in tumor and normal tissues to obtain methylation-driven genes. Univariate Cox regression analysis was developed to further screen methylation-driven genes associated with the prognosis of OSCC patients. Subsequently, multivariate Cox regression analysis was utilized to construct a linear prognostic risk prediction model. Furthermore, a combined survival analysis integrating methylation and gene expression was performed to investigate the prognostic value.

Results

A total of 374 differentially expressed methylation-driven genes were identified. Seven methylation-driven genes (BST2, KRT15, ZNF134, NT5E, GSTA7P, NAPRT, and GOLPH3L) were found to be significantly associated with patient prognosis. Additionally, four methylation-driven genes (BST2, KRT15, ZNF134 and NAPRT) were used to construct a linear prognostic risk prediction model for OSCC patients. Furthermore, a combined Kaplan-Meier survival analysis revealed that three methylation-driven genes (ZKSCAN7, MFF, ZNF134) alone can be used as independent prognostic markers or drug targets.

Conclusions

Our findings facilitate a better understanding of molecular mechanisms of OSCC and provide potential biomarkers of early diagnosis, precision treatment and prognosis evaluation.

A rural teledentistry care experience: a geriatric approach to assessing oral health status and treatment needs in older adults from a Mapuche community in Chile

Background

Limited attention has been given to oral health challenges faced by older Indigenous populations, especially in rural settings, where disparities exist. This study aims to assess oral health in a rural Mapuche community in southern Chile, utilizing geriatric technology support, and exploring the connection between geriatric health and oral well-being to fill a gap in this context.

Methods

A cross-sectional study was conducted involving 76 independent older adults from a rural Mapuche community who required dental care. Assessments were in a remote care setting gathering extensive data including comprehensive geriatric assessments, medical and dental conditions using a geriatric teledentistry platform (TEGO®). Statistical analysis involved descriptive analysis, logistic regression, and both multiple correspondence analysis and k-means cluster analysis.

Results

The sample comprised individuals with limited formal education and a high degree of vulnerability. Geriatric assessments unveiled cognitive deterioration, frailty, depression risk, and multimorbidity. A distribution of the DMFT index, number of remaining teeth, number of occluding pairs, number of teeth with restorative needs and other relevant clinical findings was conducted based on sociodemographic, and medical-geriatric-dental characteristics, and additionally, a Multinomial Logistic Regression Analysis of Dentition Variables in Relation to Geriatric Assessments was performed. The dental burden was substantial, with an average DMFT index of 25.96 (SD 4.38), high prevalence of non-functional dentition (89.3%), periodontal disease (83%), xerostomia (63.2%) and oral mucosal lesions (31.5%). Age, lower education, depression, daily medication number and sugary consumption frequency were associated with a decreased average number of teeth (p < 0.05). Multiple correspondence analysis and k-means cluster analysis identified 4 clusters, with the edentulous and functional dentition groups being the most distinct.

Conclusion

This study uncovers a substantial dental burden and intricate medical-geriatric conditions interlinked among Indigenous older adults in a rural Chilean Mapuche community. The implementation of a geriatric technological ecosystem in the community enabled the resolution of less complex oral health issues and facilitated remote consultations with specialists, reducing the necessity for travel to health centers. This underscores the need for innovative dental public health initiatives to address health disparities and improve the overall well-being of older Indigenous adults.

Usnic acid alleviates inflammatory responses and induces apoptotic signaling through inhibiting NF-ĸB expressions in human oral carcinoma cells

Usnic acid (UA) is a unique bioactive substance in lichen with potential anticancer properties. Recently, we have reported that UA can reduce 7,12-dimethylbenz[a] anthracene-induced oral carcinogenesis by inhibiting oxidative stress, inflammation, and cell proliferation in a male golden Syrian hamster in vivo model. The present study aims to explore the relevant mechanism of cell death induced by UA on human oral carcinoma (KB) cell line in an in vitro model. We found that UA can induce apoptosis (cell death) in KB cells by decreasing cell viability, increasing the production of reactive oxygen species (ROS), depolarizing mitochondrial membrane potential (MMP) levels, causing nuclear fragmentation, altering apoptotic morphology, and causing excessive DNA damage. Additionally, UA inhibits the expression of Bcl-2, a protein that promotes cell survival, while increasing the expression of p53, Bax, Cytochrome-c, Caspase-9, and 3 proteins in KB cells. UA also inhibits the expression of nuclear factor-κB (NF-κB), a protein that mediates the activation of pro-inflammatory cytokines such as TNF-α and IL-6, in KB cells. Furthermore, UA promotes apoptosis by enhancing the mitochondrial-mediated apoptotic mechanism through oxidative stress, depletion of cellular antioxidants, and an inflammatory response. Ultimately, the findings of this study suggest that UA may have potential as an anticancer therapeutic agent for oral cancer treatments.