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Li YN, Lu R, Zhang J, Zhou G. Inter-and intra-observer agreement on the judgment of toluidine blue staining for screening of oral potentially malignant disorders and oral cancer. Clin Oral Investig 2018; 23:1709-1714. [PMID: 30155573 DOI: 10.1007/s00784-018-2595-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/20/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Toluidine blue staining (TBS) is used for screening of oral potentially malignant disorders (OPMDs) and oral cancer. Nevertheless, the judgment of TBS is based on the observer's personal experience and largely considered subjective. The aim of this study was to evaluate the inter- and intra-observer agreement on the judgment of TBS for screening of OPMDs and oral cancer. MATERIALS AND METHODS Two hundred randomly ordered TBS images of OPMDs and oral cancer were judged twice independently by four clinicians and four graduated students majored in oral medicine, with an interval of 3 months. Inter- and intra-observer agreement was evaluated by the Cohen's kappa (κ) coefficient. The correlation between κ-value and individual experience was assessed by Spearman's correlation coefficient. RESULTS For the two sets of observation, good overall inter-observer agreement was found in the study (κ = 0.620 and 0.667). Sub-group analysis yielded good inter-observer agreement both for clinicians (κ = 0.613 and 0.611) and students (κ = 0.610 and 0.665). Pairwise inter-observer agreement was presented to be moderate to excellent between clinician and clinician (κ = 0.41~0.87, 0.43~0.81), moderate to excellent between student and student (κ = 0.43~0.71, 0.53~0.82), and poor to excellent between clinician and student (κ = 0.25~0.81, 0.35~0.87). Good to excellent intra-observer agreement (κ = 0.69~0.85) was presented for eight observers. However, no correlation was illustrated between years of experience and inter- or intra-observer agreement. CONCLUSION Judgment of TBS has a good overall inter-observer agreement and good to excellent intra-observer agreement, which guarantees its utilization and popularity in detecting OPMDs and oral cancer. CLINICAL RELEVANCE To our knowledge, this is the first study to investigate the inter- and intra-observer agreement of TBS judgment. The present results revealed a good inter-observer agreement and good to excellent intra-observer agreement, which provide a beneficial supplement to the knowledge of TBS technique.
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Affiliation(s)
- Ya-Nan Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Rui Lu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, China
| | - Jing Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, China
| | - Gang Zhou
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, People's Republic of China.
- Department of Oral Medicine, School and Hospital of Stomatology, Wuhan University, Luoyu Road 237, Wuhan, China.
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52
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Warnakulasuriya S. Diagnostic adjuncts on oral cancer and precancer: an update for practitioners. Br Dent J 2018; 223:663-666. [PMID: 29123318 DOI: 10.1038/sj.bdj.2017.883] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 01/16/2023]
Abstract
A variety of devices and techniques are now available to aid the clinician in visualising clinical changes that may be found in the oral cavity. These techniques can now be applied at chairside to characterise these changes and many offer a real time result at the point of care. They may assist in a practitioner referring a case earlier to a specialist to undertake further investigations. The translational value of the research published so far has been limited as these technologies have not been adapted for routine use in primary care. This review aims to examine the utility of these adjunctive aids in clinical practice based on the current available evidence.
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Affiliation(s)
- S Warnakulasuriya
- King's College London and WHO Collaborating Centre for Oral Cancer UK
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53
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Yang EC, Schwarz RA, Lang AK, Bass N, Badaoui H, Vohra IS, Cherry KD, Williams MD, Gillenwater AM, Vigneswaran N, Richards-Kortum RR. In Vivo Multimodal Optical Imaging: Improved Detection of Oral Dysplasia in Low-Risk Oral Mucosal Lesions. Cancer Prev Res (Phila) 2018; 11:465-476. [PMID: 29903741 DOI: 10.1158/1940-6207.capr-18-0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/17/2018] [Accepted: 06/07/2018] [Indexed: 12/12/2022]
Abstract
Early detection of oral cancer and oral premalignant lesions (OPL) containing dysplasia could improve oral cancer outcomes. However, general dental practitioners have difficulty distinguishing dysplastic OPLs from confounder oral mucosal lesions in low-risk populations. We evaluated the ability of two optical imaging technologies, autofluorescence imaging (AFI) and high-resolution microendoscopy (HRME), to diagnose moderate dysplasia or worse (ModDys+) in 56 oral mucosal lesions in a low-risk patient population, using histopathology as the gold standard, and in 46 clinically normal sites. AFI correctly diagnosed 91% of ModDys+ lesions, 89% of clinically normal sites, and 33% of benign lesions. Benign lesions with severe inflammation were less likely to be correctly diagnosed by AFI (13%) than those without (42%). Multimodal imaging (AFI+HRME) had higher accuracy than either modality alone; 91% of ModDys+ lesions, 93% of clinically normal sites, and 64% of benign lesions were correctly diagnosed. Photos of the 56 lesions were evaluated by 28 dentists of varied training levels, including 26 dental residents. We compared the area under the receiver operator curve (AUC) of clinical impression alone to clinical impression plus AFI and clinical impression plus multimodal imaging using k-Nearest Neighbors models. The mean AUC of the dental residents was 0.71 (range: 0.45-0.86). The addition of AFI alone to clinical impression slightly lowered the mean AUC (0.68; range: 0.40-0.82), whereas the addition of multimodal imaging to clinical impression increased the mean AUC (0.79; range: 0.61-0.90). On the basis of these findings, multimodal imaging could improve the evaluation of oral mucosal lesions in community dental settings. Cancer Prev Res; 11(8); 465-76. ©2018 AACR.
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Affiliation(s)
- Eric C Yang
- Department of Bioengineering, Rice University, Houston, Texas.,Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas
| | | | - Alexander K Lang
- The University of Texas School of Dentistry at Houston, Houston, Texas
| | - Nancy Bass
- The University of Texas School of Dentistry at Houston, Houston, Texas
| | - Hawraa Badaoui
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Imran S Vohra
- Department of Bioengineering, Rice University, Houston, Texas
| | | | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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54
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Olms C, Hix N, Neumann H, Yahiaoui-Doktor M, Remmerbach TW. Clinical comparison of liquid-based and conventional cytology of oral brush biopsies: a randomized controlled trial. Head Face Med 2018; 14:9. [PMID: 29843756 PMCID: PMC5975412 DOI: 10.1186/s13005-018-0166-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background Exfoliative cytology performed on oral brush samples can help dentists to decide, whether a given oral lesion is (pre-) malignant. The use of non-invasive brush biopsies as an auxiliary tool in the diagnosis of oral mucosal lesions has gained renewed interest since improvements in cytological techniques such as the development of adjuvant diagnostic tools and liquid-based cell preparation techniques. Methods The aim of this study was to compare the quality of two different preparation techniques (cell collectors): the conventional transfer procedure to glass slides and the so-called liquid-based cytology preparation method. Cell smears were collected from 10 orally healthy individuals (mean age: 24 years) from the palatine mucosa at two different times (baseline and 4 weeks later). Slides of both techniques were stained by Giemsa (n = 40) and May-Gruenwald Giemsa (n = 40). The statistical analysis was performed with Excel. Results On specimen analysis, the liquid-based cytology showed statistically significant improvement compared to conventional glass sides (p < 0.001). Thin layers, which were performed by liquid-based cytology showed significantly better results in the parameters (p < 0.001): uniform distribution, cellular overlapping, cellular disformation, mucus, microbial colonies and debris. The conventional glass slides approach showed more cell overlapping and contamination with extraneous material than thin layers, which were performed by Orcellex® Brush cell collectors. Conclusions Both techniques are diagnostically reliable. The liquid-based method showed an overall improvement on sample preservation, specimen adequacy, visualization of cell morphology and reproducibility. Liquid-based cytology simplifies cell collection due to easier handling and less transfer errors by dentists.
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Affiliation(s)
- Constanze Olms
- Department of Dental Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103, Leipzig, Germany.
| | - Nathalie Hix
- Department of Dental Prosthodontics and Materials Science, University of Leipzig, Liebigstraße 12, 04103, Leipzig, Germany
| | - Heinrich Neumann
- Institute of Cytopathology, Am Propsthof 3, 53121, Bonn, Germany
| | - Maryam Yahiaoui-Doktor
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Torsten W Remmerbach
- Section of Oral Medicine, Department of Head Medicine and Oral Health, University of Leipzig, Liebigstraße 10-14, 04103, Leipzig, Germany
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Kossatz S, Weber W, Reiner T. Detection and Delineation of Oral Cancer With a PARP1-Targeted Optical Imaging Agent. Mol Imaging 2018; 16:1536012117723786. [PMID: 28856922 PMCID: PMC5582799 DOI: 10.1177/1536012117723786] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
More sensitive and specific methods for early detection are imperative to improve survival rates in oral cancer. However, oral cancer detection is still largely based on visual examination and histopathology of biopsy material, offering no molecular selectivity or spatial resolution. Intuitively, the addition of optical contrast could improve oral cancer detection and delineation, but so far no molecularly targeted approach has been translated. Our fluorescently labeled small-molecule inhibitor PARPi-FL binds to the DNA repair enzyme poly(ADP-ribose)polymerase 1 (PARP1) and is a potential diagnostic aid for oral cancer delineation. Based on our preclinical work, a clinical phase I/II trial opened in March 2017 to evaluate PARPi-FL as a contrast agent for oral cancer imaging. In this commentary, we discuss why we chose PARP1 as a biomarker for tumor detection and which particular characteristics make PARPi-FL an excellent candidate to image PARP1 in optically guided applications. We also comment on the potential benefits of our molecularly targeted PARPi-FL-guided imaging approach in comparison to existing oral cancer screening adjuncts and mention the adaptability of PARPi-FL imaging to other environments and tumor types.
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Affiliation(s)
- Susanne Kossatz
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wolfgang Weber
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,2 Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,3 Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Thomas Reiner
- 1 Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,3 Department of Radiology, Weill Cornell Medical College, New York, NY, USA
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Yang EC, Tan MT, Schwarz RA, Richards-Kortum RR, Gillenwater AM, Vigneswaran N. Noninvasive diagnostic adjuncts for the evaluation of potentially premalignant oral epithelial lesions: current limitations and future directions. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:670-681. [PMID: 29631985 PMCID: PMC6083875 DOI: 10.1016/j.oooo.2018.02.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 02/23/2018] [Indexed: 12/15/2022]
Abstract
Potentially premalignant oral epithelial lesions (PPOELs) are a group of clinically suspicious conditions, of which a small percentage will undergo malignant transformation. PPOELs are suboptimally diagnosed and managed under the current standard of care. Dysplasia is the most well-established marker to distinguish high-risk PPOELs from low-risk PPOELs, and performing a biopsy to establish dysplasia is the diagnostic gold standard. However, a biopsy is limited by morbidity, resource requirements, and the potential for underdiagnosis. Diagnostic adjuncts may help clinicians better evaluate PPOELs before definitive biopsy, but existing adjuncts, such as toluidine blue, acetowhitening, and autofluorescence imaging, have poor accuracy and are not generally recommended. Recently, in vivo microscopy technologies, such as high-resolution microendoscopy, optical coherence tomography, reflectance confocal microscopy, and multiphoton imaging, have shown promise for improving PPOEL patient care. These technologies allow clinicians to visualize many of the same microscopic features used for histopathologic assessment at the point of care.
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Affiliation(s)
- Eric C Yang
- Department of Bioengineering, Rice University, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Melody T Tan
- Department of Bioengineering, Rice University, Houston, TX, USA
| | | | | | - Ann M Gillenwater
- Department of Head and Neck Surgery, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Nadarajah Vigneswaran
- Department of Diagnostic and Biomedical Sciences, University of Texas School of Dentistry, Houston, TX, USA.
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Irimie AI, Braicu C, Sonea L, Zimta AA, Cojocneanu-Petric R, Tonchev K, Mehterov N, Diudea D, Buduru S, Berindan-Neagoe I. A Looking-Glass of Non-coding RNAs in oral cancer. Int J Mol Sci 2017; 18:ijms18122620. [PMID: 29206174 PMCID: PMC5751223 DOI: 10.3390/ijms18122620] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 11/10/2017] [Accepted: 11/17/2017] [Indexed: 12/14/2022] Open
Abstract
Oral cancer is a multifactorial pathology and is characterized by the lack of efficient treatment and accurate diagnostic tools. This is mainly due the late diagnosis; therefore, reliable biomarkers for the timely detection of the disease and patient stratification are required. Non-coding RNAs (ncRNAs) are key elements in the physiological and pathological processes of various cancers, which is also reflected in oral cancer development and progression. A better understanding of their role could give a more thorough perspective on the future treatment options for this cancer type. This review offers a glimpse into the ncRNA involvement in oral cancer, which can help the medical community tap into the world of ncRNAs and lay the ground for more powerful diagnostic, prognostic and treatment tools for oral cancer that will ultimately help build a brighter future for these patients.
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Affiliation(s)
- Alexandra Iulia Irimie
- Department of Prosthetic dentistry and Dental materials, Division Dental Propaedeutics, Aesthetic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 23 Marinescu Street, 40015 Cluj-Napoca, Romania.
| | - Cornelia Braicu
- Research Center for Functional Genomics and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 23 Marinescu Street, 40015 Cluj-Napoca, Romania.
| | - Laura Sonea
- MEDFUTURE-Research Center for Advanced Medicine, University of Medicine and Pharmacy Iuliu-Hatieganu, 23 Marinescu Street, 40015 Cluj-Napoca, Romania.
| | - Alina Andreea Zimta
- MEDFUTURE-Research Center for Advanced Medicine, University of Medicine and Pharmacy Iuliu-Hatieganu, 23 Marinescu Street, 40015 Cluj-Napoca, Romania.
| | - Roxana Cojocneanu-Petric
- Research Center for Functional Genomics and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 23 Marinescu Street, 40015 Cluj-Napoca, Romania.
| | - Konstantin Tonchev
- Department of Maxillofacial Surgery, Medical University, 3 Hristo Botev Blvd, 4002 Plovdiv, Bulgaria.
- Clinic of Maxillofacial Surgery, University Hospital "St. George", 66 Peshtersko Shosse Blvd, 4002 Plovdiv, Bulgaria.
| | - Nikolay Mehterov
- Department of Medical Biology, Medical University Plovdiv, 15-А Vasil Aprilov Bul, 4002 Plovdiv, Bulgaria.
| | - Diana Diudea
- Department of Prosthetic dentistry and Dental materials, Division Dental Propaedeutics, Aesthetic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 23 Marinescu Street, 40015 Cluj-Napoca, Romania.
| | - Smaranda Buduru
- Prosthetics and Dental materials, Faculty of Dental Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, 32 Clinicilor Street, 400006 Cluj-Napoca, Romania.
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics and Translational Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 23 Marinescu Street, 40015 Cluj-Napoca, Romania.
- MEDFUTURE-Research Center for Advanced Medicine, University of Medicine and Pharmacy Iuliu-Hatieganu, 23 Marinescu Street, 40015 Cluj-Napoca, Romania.
- Department of Functional Genomics and Experimental Pathology, The Oncology Institute "Prof. Dr. Ion Chiricuta", Republicii 34th street, 400015 Cluj-Napoca, Romania.
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Müller HD, Caballé-Serrano J, Lussi A, Gruber R. Inhibitory effect of saliva on osteoclastogenesis in vitro requires toll-like receptor 4 signaling. Clin Oral Investig 2017; 21:2445-2452. [PMID: 28101679 PMCID: PMC5632348 DOI: 10.1007/s00784-016-2041-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 12/21/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Saliva can suppress osteoclastogenesis, but the underlying mechanism has not been discovered yet. Considering that endotoxins suppress osteoclastogenesis in bone marrow cultures and that saliva contains endotoxins, it was reasonable to hypothesize that the impact of saliva on osteoclastogenesis requires toll-like receptor 4 signaling. MATERIAL AND METHODS To test this hypothesis, we blocked toll-like receptor 4 signaling with TAK-242 in the presence of saliva in murine bone marrow cultures. Osteoclastogenesis was evaluated based on gene expression analysis and histochemical staining for tartrate-resistant acid phosphatase. Resorption was performed on dentine. RESULTS We report that TAK-242 reversed the inhibitory effect of fresh sterile saliva on the formation of multinucleated cells that stained positive for tartrate-resistant acid phosphatase. In line with this finding, TAK-242 increased the expression of the osteoclast functional genes cathepsin K, calcitonin receptor, and tartrate-resistant acid phosphatase in the presence of saliva. TAK-242 also supported the expression of NFATc1, the master regulator of osteoclastogenesis, as well as DC-STAMP and Atp6v0d2, both being cell fusion genes. In support of the hypothesis, depletion of saliva from endotoxin partially reversed the inhibitory effect on osteoclastogenesis. Moreover, salivary pellicle on plastic and titanium did not affect osteoclastogenesis. CONCLUSION Inhibition of toll-like receptor 4 signaling revealed that saliva can contribute to innate immunity by preventing hematopoietic progenitors to become osteoclasts. CLINICAL RELEVANCE Saliva can activate pattern recognition receptor signaling through endotoxins and other stress factors, indicating the demand for macrophages rather than for osteoclasts.
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Affiliation(s)
- Heinz-Dieter Müller
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Jordi Caballé-Serrano
- Department of Oral Surgery and Stomatology, School of Dental Medicine|, University of Bern, Bern, Switzerland
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Adrian Lussi
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - Reinhard Gruber
- Department of Preventive, Restorative and Pediatric Dentistry, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
- Department of Oral Biology, Medical University of Vienna, Sensengasse 2a, 1090, Vienna, Austria.
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Abstract
Oral potentially malignant disorders (OPMDs) refer to epithelial lesions and conditions with an increased risk for malignant transformation; oral leukoplakia is the most commonly encountered. Overall, OPMDs have a low risk for malignant transformation, yet the challenge is the difficulty to reliably identify and predict which patients with OPMDs are at the highest risk for malignant transformation. Future research is needed to elucidate the molecular aspects of OPMDs, to improve current diagnostic strategies, leading to personalized management.
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Jokstad A. Cochrane Collaboration Systematic Reviews may be based on trials not approved by a research ethics committee. Clin Exp Dent Res 2017; 3:179-182. [PMID: 29744198 PMCID: PMC5839214 DOI: 10.1002/cre2.79] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/12/2017] [Accepted: 08/15/2017] [Indexed: 12/05/2022] Open
Abstract
Systematic reviews (SR) may potentially contain reports of primary trials with ethical problems. The Cochrane Collaboration SRs are considered as the highest standard in evidence-based health care resources. All SRs completed during the last 5 years (2013-2017) under the management of the Oral Health Group of the Cochrane Collaboration were identified. All primary trials included in the Oral Health Group SRs were identified and examined to establish their status regarding pre-hoc approval of an independent ethics committee (EC), often termed Institutional Review Board (IRB) before commencing recruitment of trial participants. Ninety-five SRs contained 960 primary trials, of which 272 (28.3%) were not examined by the author of this paper. Amongst the remaining 688 primary trials, 198 (29%) contained no reference to study conduct approval by a research ethics committee. The majority of primary studies referred to an EC/IRB approval with or without identifying the name of the ethics committee (n = 401, 58%), whereas some papers identified both the committee name and a protocol or reference number of the EC/IRB approval (n = 89, 13%). The Cochrane Collaboration, along with other developers of SRs, should adopt the policy established by COPE with regard to what to do if one suspect an ethical problem, that is, request evidence of EC/IRB approval. All stakeholders should rest assured that clinical policies and practices based on SRs are based on ethically sound clinical research.
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Affiliation(s)
- Asbjørn Jokstad
- Department of Clinical Dentistry, Faculty of Health SciencesUiT The Arctic University of NorwayNorway
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Hirshberg A, Allon I, Novikov I, Ankri R, Ashkenazy A, Fixler D. Gold nanorods reflectance discriminate benign from malignant oral lesions. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2017; 13:1333-1339. [PMID: 28115253 DOI: 10.1016/j.nano.2017.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/13/2016] [Accepted: 01/01/2017] [Indexed: 12/26/2022]
Abstract
Nanoparticle-based contrast agents have been used as an imaging tool for selectively detecting cancerous processes. We aimed to evaluate the detection sensitivity of reflection measurements of gold nanorods (GNRs) bio-conjugated to anti-epidermal growth factor receptor (GNRs-EGFR) monoclonal antibodies in discriminating benign from premalignant and malignant human oral lesions. Tissue sections incubated with GNRs-EGFR and the reflectance spectrum was measured using hyperspectral microscopy. Reflectance intensity increased with the progression of the disease, lowest in the control group and increasing as the dysplastic changes increase (P<0.001 for linear trend of grade). Intensity was significantly higher in the moderate and severe dysplasias and cancer patients than in the controls and mild dysplasia (t test P=0.0003, Mann-Whitney P<0.0001). The GNRs reflection measurements can discriminate benign and mild dysplastic lesions from the more severe dysplasia and invasive cancer, suggesting an objective, not dependent on the qualification of a technician and with less interpretation errors.
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Affiliation(s)
- Abraham Hirshberg
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Irit Allon
- Department of Oral Pathology and Oral Medicine, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Novikov
- Biostatistical Unit, Gertner institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| | - Rinat Ankri
- Faculty of Engineering and Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan, Israel
| | - Ariel Ashkenazy
- Faculty of Engineering and Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan, Israel
| | - Dror Fixler
- Faculty of Engineering and Institute of Nanotechnology and Advanced Materials, Bar-Ilan University, Ramat-Gan, Israel
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62
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Affiliation(s)
- Toru Nagao
- Department of Oral and Maxillofacial Surgery Okazaki City Hospital
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63
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Saliva protein biomarkers and oral squamous cell carcinoma. Proc Natl Acad Sci U S A 2016; 114:E109-E110. [PMID: 28039438 DOI: 10.1073/pnas.1617811114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Curra M, Salvadori G, Junges R, Filho MS, Hugo FN, Martins MD. Accuracy of clinical diagnosis for the identification of potentially malignant disorders and malignant lip lesions. Braz Oral Res 2016; 30:e135. [PMID: 28001243 DOI: 10.1590/1807-3107bor-2016.vol30.0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/26/2016] [Indexed: 12/23/2022] Open
Abstract
The aim of this study was to assess the accuracy of clinical diagnosis for lip lesions based on sensitivity and specificity. The retrospective analysis focused on the detection of lesions caused by potentially malignant disorders (PMDs) and malignant lesions (n = 1195). All cases were classified as benign, PMD, and malignant lesions. Concordance between diagnoses based on clinical examination and those based on histopathological analysis was assessed, and accuracy for the identification of PMD and malignant lesions was calculated. Histopathological analysis revealed 44 lesion types; PMD and malignant lesions comprised 8.3% of all cases. Compared with histopathological analysis, clinical examination showed 97.4% accuracy for the identification of non-malignant and potentially malignant/malignant cases. Degrees of specific sensitivity ranged from 34% to 77% for different lesions, and were highest for autoimmune (77%) and reactive (72%) lesions. Positive and negative predictive values for the identification of PMD and malignant lesions were 81.9% and 98.9%, respectively. Clinical examination showed a high degree of accuracy for the detection of PMD and malignant lip lesions, indicating good reliability.
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Affiliation(s)
- Marina Curra
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Gabriela Salvadori
- University of Oslo, Faculty of Dentistry, Department of Oral Biology, Oslo, Norway
| | - Roger Junges
- University of Oslo, Faculty of Dentistry, Department of Oral Biology, Oslo, Norway
| | - Manoel Sant'ana Filho
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Center of Community Dental Health Research, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
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Abram TJ, Floriano PN, Christodoulides N, James R, Kerr AR, Thornhill MH, Redding SW, Vigneswaran N, Speight PM, Vick J, Murdoch C, Freeman C, Hegarty AM, D'Apice K, Phelan JA, Corby PM, Khouly I, Bouquot J, Demian NM, Weinstock YE, Rowan S, Yeh CK, McGuff HS, Miller FR, Gaur S, Karthikeyan K, Taylor L, Le C, Nguyen M, Talavera H, Raja R, Wong J, McDevitt JT. 'Cytology-on-a-chip' based sensors for monitoring of potentially malignant oral lesions. Oral Oncol 2016; 60:103-11. [PMID: 27531880 DOI: 10.1016/j.oraloncology.2016.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 06/30/2016] [Accepted: 07/02/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Despite significant advances in surgical procedures and treatment, long-term prognosis for patients with oral cancer remains poor, with survival rates among the lowest of major cancers. Better methods are desperately needed to identify potential malignancies early when treatments are more effective. OBJECTIVE To develop robust classification models from cytology-on-a-chip measurements that mirror diagnostic performance of gold standard approach involving tissue biopsy. MATERIALS AND METHODS Measurements were recorded from 714 prospectively recruited patients with suspicious lesions across 6 diagnostic categories (each confirmed by tissue biopsy -histopathology) using a powerful new 'cytology-on-a-chip' approach capable of executing high content analysis at a single cell level. Over 200 cellular features related to biomarker expression, nuclear parameters and cellular morphology were recorded per cell. By cataloging an average of 2000 cells per patient, these efforts resulted in nearly 13 million indexed objects. RESULTS Binary "low-risk"/"high-risk" models yielded AUC values of 0.88 and 0.84 for training and validation models, respectively, with an accompanying difference in sensitivity+specificity of 6.2%. In terms of accuracy, this model accurately predicted the correct diagnosis approximately 70% of the time, compared to the 69% initial agreement rate of the pool of expert pathologists. Key parameters identified in these models included cell circularity, Ki67 and EGFR expression, nuclear-cytoplasmic ratio, nuclear area, and cell area. CONCLUSIONS This chip-based approach yields objective data that can be leveraged for diagnosis and management of patients with PMOL as well as uncovering new molecular-level insights behind cytological differences across the OED spectrum.
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Affiliation(s)
- Timothy J Abram
- Rice University, Department of Bioengineering, Houston, TX, USA
| | | | | | | | - A Ross Kerr
- New York University College of Dentistry, Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York, NY, USA
| | - Martin H Thornhill
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Spencer W Redding
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry and Cancer Therapy and Research Center, San Antonio, TX, USA
| | - Nadarajah Vigneswaran
- The University of Texas Health Science Center at Houston, Department of Diagnostic and Biomedical Sciences, Houston, TX, USA
| | - Paul M Speight
- Academic Unit of Oral & Maxillofacial Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | | | - Craig Murdoch
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Christine Freeman
- Academic Unit of Oral & Maxillofacial Medicine & Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, UK
| | - Anne M Hegarty
- Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Katy D'Apice
- Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, UK
| | - Joan A Phelan
- New York University College of Dentistry, Department of Oral and Maxillofacial Pathology, Radiology & Medicine, New York, NY, USA
| | - Patricia M Corby
- New York University School of Medicine, Department of Population Health and Radiation Oncology, New York, NY, USA
| | - Ismael Khouly
- New York University College of Dentistry, Bluestone Center for Clinical Research, New York, NY, USA
| | - Jerry Bouquot
- The University of Texas Health Science Center at Houston, Department of Diagnostic and Biomedical Sciences, Houston, TX, USA
| | - Nagi M Demian
- The University of Texas Health Science Center at Houston, Department of Oral and Maxillofacial Surgery, Houston, TX, USA
| | - Y Etan Weinstock
- The University of Texas Health Science Center at Houston, Department of Otolaryngology-Head and Neck Surgery, Houston, TX, USA
| | - Stephanie Rowan
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry and Cancer Therapy and Research Center, San Antonio, TX, USA
| | - Chih-Ko Yeh
- The University of Texas Health Science Center at San Antonio, Department of Comprehensive Dentistry and Cancer Therapy and Research Center, San Antonio, TX, USA; South Texas Veterans Health Care System, Geriatric Research, Education, and Clinical Center, San Antonio, TX, USA
| | - H Stan McGuff
- The University of Texas Health Science Center at San Antonio, Department of Pathology, San Antonio, TX, USA
| | - Frank R Miller
- The University of Texas Health Science Center at San Antonio, Department of Otolaryngology-Head and Neck Surgery and Cancer Therapy and Research Center, San Antonio, TX, USA
| | - Surabhi Gaur
- Rice University, Department of Bioengineering, Houston, TX, USA
| | | | - Leander Taylor
- Rice University, Department of Bioengineering, Houston, TX, USA
| | - Cathy Le
- Rice University, Department of Bioengineering, Houston, TX, USA
| | - Michael Nguyen
- Rice University, Department of Bioengineering, Houston, TX, USA
| | | | - Rameez Raja
- Rice University, Department of Bioengineering, Houston, TX, USA
| | - Jorge Wong
- Rice University, Department of Bioengineering, Houston, TX, USA
| | - John T McDevitt
- Rice University, Department of Bioengineering, Houston, TX, USA; Rice University, Department of Chemistry, Houston, TX, USA; New York University, Department of Biomaterials, New York, NY, USA.
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Accuracy of autofluorescence in diagnosing oral squamous cell carcinoma and oral potentially malignant disorders: a comparative study with aero-digestive lesions. Sci Rep 2016; 6:29943. [PMID: 27416981 PMCID: PMC4945954 DOI: 10.1038/srep29943] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 06/24/2016] [Indexed: 02/05/2023] Open
Abstract
Presently, various studies had investigated the accuracy of autofluorescence in diagnosing oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) with diverse conclusions. This study aimed to assess its accuracy for OSCC and OPMD and to investigate its applicability in general dental practice. After a comprehensive literature search, a meta-analysis was conducted to calculate the pooled diagnostic indexes of autofluorescence for premalignant lesions (PML) and malignant lesions (ML) of the oral cavity, lung, esophagus, stomach and colorectum and to compute indexes regarding the detection of OSCC aided by algorithms. Besides, a u test was performed. Twenty-four studies detecting OSCC and OPMD in 2761 lesions were included. This demonstrated that the overall accuracy of autofluorescence for OSCC and OPMD was superior to PML and ML of the lung, esophagus and stomach, slightly inferior to the colorectum. Additionally, the sensitivity and specificity for OSCC and OPMD were 0.89 and 0.8, respectively. Furthermore, the specificity could be remarkably improved by additional algorithms. With relatively high accuracy, autofluorescence could be potentially applied as an adjunct for early diagnosis of OSCC and OPMD. Moreover, approaches such as algorithms could enhance its specificity to ensure its efficacy in primary care.
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Liu D, Zhao X, Zeng X, Dan H, Chen Q. Non-Invasive Techniques for Detection and Diagnosis of Oral Potentially Malignant Disorders. TOHOKU J EXP MED 2016; 238:165-77. [PMID: 26888696 DOI: 10.1620/tjem.238.165] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Dongjuan Liu
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University
| | - Xin Zhao
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University
| | - Qianming Chen
- State Key Laboratory of Oral Diseases, West China College of Stomatology, Sichuan University
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Walsh T, Liu JLY, Brocklehurst P, Glenny A, Lingen M, Kerr AR, Ogden G, Warnakulasuriya S, Scully C. Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults. Cochrane Database Syst Rev 2013; 2013:CD010173. [PMID: 24258195 PMCID: PMC7087434 DOI: 10.1002/14651858.cd010173.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The early detection and excision of potentially malignant disorders (PMD) of the lip and oral cavity that require intervention may reduce malignant transformations (though will not totally eliminate malignancy occurring), or if malignancy is detected during surveillance, there is some evidence that appropriate treatment may improve survival rates. OBJECTIVES To estimate the diagnostic accuracy of conventional oral examination (COE), vital rinsing, light-based detection, biomarkers and mouth self examination (MSE), used singly or in combination, for the early detection of PMD or cancer of the lip and oral cavity in apparently healthy adults. SEARCH METHODS We searched MEDLINE (OVID) (1946 to April 2013) and four other electronic databases (the Cochrane Diagnostic Test Accuracy Studies Register, the Cochrane Oral Health Group's Trials Register, EMBASE (OVID), and MEDION) from inception to April 2013. The electronic databases were searched on 30 April 2013. There were no restrictions on language in the searches of the electronic databases. We conducted citation searches, and screened reference lists of included studies for additional references. SELECTION CRITERIA We selected studies that reported the diagnostic test accuracy of any of the aforementioned tests in detecting PMD or cancer of the lip or oral cavity. Diagnosis of PMD or cancer was made by specialist clinicians or pathologists, or alternatively through follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts for relevance. Eligibility, data extraction and quality assessment were carried out by at least two authors independently and in duplicate. Studies were assessed for methodological quality using QUADAS-2. We reported the sensitivity and specificity of the included studies. MAIN RESULTS Thirteen studies, recruiting 68,362 participants, were included. These studies evaluated the diagnostic accuracy of COE (10 studies), MSE (two studies). One randomised controlled of test accuracy trial directly evaluated COE and vital rinsing. There were no eligible diagnostic accuracy studies evaluating light-based detection or blood or salivary sample analysis (which tests for the presence of bio-markers of PMD and oral cancer). Given the clinical heterogeneity of the included studies in terms of the participants recruited, setting, prevalence of target condition, the application of the index test and reference standard and the flow and timing of the process, the data could not be pooled. For COE (10 studies, 25,568 participants), prevalence in the diagnostic test accuracy sample ranged from 1% to 51%. For the eight studies with prevalence of 10% or lower, the sensitivity estimates were highly variable, and ranged from 0.50 (95% confidence interval (CI) 0.07 to 0.93) to 0.99 (95% CI 0.97 to 1.00) with uniform specificity estimates around 0.98 (95% CI 0.97 to 1.00). Estimates of sensitivity and specificity were 0.95 (95% CI 0.92 to 0.97) and 0.81 (95% CI 0.79 to 0.83) for one study with prevalence of 22% and 0.97 (95% CI 0.96 to 0.98) and 0.75 (95% CI 0.73 to 0.77) for one study with prevalence of 51%. Three studies were judged to be at low risk of bias overall; two were judged to be at high risk of bias resulting from the flow and timing domain; and for five studies the overall risk of bias was judged as unclear resulting from insufficient information to form a judgement for at least one of the four quality assessment domains. Applicability was of low concern overall for two studies; high concern overall for three studies due to high risk population, and unclear overall applicability for five studies. Estimates of sensitivity for MSE (two studies, 34,819 participants) were 0.18 (95% CI 0.13 to 0.24) and 0.33 (95% CI 0.10 to 0.65); specificity for MSE was 1.00 (95% CI 1.00 to 1.00) and 0.54 (95% CI 0.37 to 0.69). One study (7975 participants) directly compared COE with COE plus vital rinsing in a randomised controlled trial. This study found a higher detection rate for oral cavity cancer in the conventional oral examination plus vital rinsing adjunct trial arm. AUTHORS' CONCLUSIONS The prevalence of the target condition both between and within index tests varied considerably. For COE estimates of sensitivity over the range of prevalence levels varied widely. Observed estimates of specificity were more homogeneous. Index tests at a prevalence reported in the population (between 1% and 5%) were better at correctly classifying the absence of PMD or oral cavity cancer in disease-free individuals that classifying the presence in diseased individuals. Incorrectly classifying disease-free individuals as having the disease would have clinical and financial implications following inappropriate referral; incorrectly classifying individuals with the disease as disease-free will mean PMD or oral cavity cancer will only be diagnosed later when the disease will be more severe. General dental practitioners and dental care professionals should remain vigilant for signs of PMD and oral cancer whilst performing routine oral examinations in practice.
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Affiliation(s)
- Tanya Walsh
- School of Dentistry, The University of ManchesterCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Joseph LY Liu
- Scottish Dental Clinical Effectiveness Programme, NHS Education for ScotlandUniversity of Dundee, Dental Health Services Research UnitFrankland Building, Small's WyndDundeeUKDD1 4HN
| | - Paul Brocklehurst
- School of Dentistry, The University of ManchesterCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Anne‐Marie Glenny
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Mark Lingen
- University of ChicagoPritzker School of Medicine, Division of Biological Sciences, Department of Pathology5841 South Maryland AvenueChicagoIllinoisUSA60637‐1470
| | - Alexander R Kerr
- New York University College of DentistryDepartment of Oral and Maxillofacial Pathology, Radiology and Medicine345 East 24th StreetSchwartz BuildingNew YorkUSA10010
| | - Graham Ogden
- University of DundeeDivision of Oral and Maxillofacial Clinical Sciences, School of DentistryPark PlaceDundeeScotlandUKDD1 4HR
| | - Saman Warnakulasuriya
- King's College LondonClinical and Diagnostic SciencesBessemer RoadDenmark Hill CampusLondonUKSE5 9RW
| | - Crispian Scully
- University College London256 Gray's Inn RoadLondonUKWC1X 8LD
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