Lifestyle risk factors for oral cancer

Survival outcomes following modern multidisciplinary management of oral squamous cell carcinoma in Australia

OBJECTIVE

Oral squamous cell carcinoma (SCC) has been traditionally described as a highly lethal disease. This study aims to provide updated multi-institutional data on the survival of patients with oral SCC in Australia.

STUDY DESIGN

Retrospective survival analysis was performed between 2008 and 2016. All new patients with oral SCC treated with curative intent were recruited from 2 high-volume Australian head and neck oncology centers. Outcomes were measured in overall survival (OS), disease-specific survival (DSS), disease-free survival, and salvage rates for recurrences.

RESULTS

Survival analysis included 771 patients with oral SCC. Five-year OS and DSS were 66.1% and 79.7%, respectively. Stage I and II oral SCC had significantly better survival than higher stages. Five-year OS and DSS for patients with stage I SCC were 79.7% and 93.4%, respectively, and for patients with stage IVB they were 37.9% and 54.3%, respectively. Two hundred forty-nine patients had disease recurrence (32.3%), with 66 patients (26.5% remaining disease free post salvage treatment.

CONCLUSION

Survival outcomes for oral SCC among Australian patients have improved, possibly due to advances in multidisciplinary care. Early detection of oral SCC leads to highly favorable prognosis; there is therefore an opportunity for routine oral cancer screening to be performed by community health practitioners with the aim of improving survival from oral SCC.

Aberrant expression of DUSP4 is a specific phenomenon in betel quid-related oral cancer

Oral cancer due to betel quid chewing habit is very common in South Asian countries. We attempted to detect the presence of a novel gene in epithelial cells stimulated with arecoline, a main component of betel quid. Human gingival epithelial progenitors were cultured and treated with a 3-day alternating regimen with/without 50 μg/ml arecoline for 1 month. DNA microarray and methylation arrays were analyzed to identify the candidate genes. Immunohistochemical staining was performed in the tissue samples. Genome-wide analyses, quantitative reverse transcription PCR and quantitative methylation-specific PCR revealed DUSP4 as the most significant and promising gene. The methylation levels of DUSP4 were significantly higher in the betel quid-related oral squamous cell carcinoma (OSCC) than those in the non-related OSCC and controls (Mann-Whitney U test, p < 0.05). The number of DUSP4 immunopositive cells in betel quid-related OSCC was significantly higher than those from the non-chewing patients and the controls (p < 0.05). Hypermethylation of DUSP4 may be considered as a specific event in betel quid-related oral cancer.

The impact of delayed diagnosis on the outcomes of oral cancer patients: a retrospective cohort study

The contemporary literature is discordant regarding the role of delayed diagnosis in the prognosis of patients with oral cancer. This study examined data on a previously reported cohort of 101 patients with oral squamous cell carcinoma diagnosed at a single institution between 2008 and 2010. The time interval between symptom onset and initial histological diagnosis (diagnostic delay) was recorded for each patient, as were demographic data and cancer features such as T stage, nodal status, and smoking status. The mean follow-up period was 4 years 10 months. The mean diagnostic delay was 4 months, mean overall survival was 5years 6 months, and mean disease-specific survival was 4 years 9 months. No significant correlation was found between diagnostic delay and overall survival, disease-specific survival, or recurrence rates. Patients with node-positive disease were more likely to be diagnosed earlier, whereas women and non-smokers were more likely to have a delayed diagnosis. Inherent tumour biology is likely an important prognostic factor separate to diagnostic delay. Public education efforts should focus on symptom recognition and encourage early presentation for investigation of oral lesions, particularly for females and non-smokers, so that more aggressive tumours can be treated sooner to give the best chance at survival.

In silico drug design and molecular docking studies targeting Akt1 (RAC-alpha serine/threonine-protein kinase) and Akt2 (RAC-beta serine/threonine-protein kinase) proteins and investigation of CYP (cytochrome P450) inhibitors against MAOB (monoamine oxidase B) for OSCC (oral squamous cell carcinoma) treatment

The overexpression of Akt1 (RAC-alpha serine/threonine-protein Kinase) and Akt2 (RAC-beta serine/threonine-protein Kinase) is a hallmark of Oral Squamous Cell Carcinoma (OSCC). Because of the elevated frequency of OSCC occurrence in South Asian countries, novel therapeutic approaches are indispensable. Drugs that inhibit the overexpression of Akt1 and Akt2 proteins in Akt pathway and do not cause reduced expression of MAOB can be leads for OSCC treatment. In this study, Akt1, Akt2 and MAOB were targeted and 100 CYP inhibitors were screened through several in silico approaches and Galuteolin and Linarin were identified as potential leads for OSCC treatment as they inhibited Akt1 proteins with strong binding affinities of -12.3 and -11.5 kcal/mol respectively and also Akt2 proteins with strong binding affinities of -11.4 and -11.1 kcal/mol respectively, but they did not inhibit MAOB. Decreased expression of MAOB in tissues causes OSCC but overexpression is also responsible for other types of diseases and cancers. From the investigation of CYP inhibitors against MAOB, five CYP inhibitors- Diosmetin, Acacetin, Epicatechin, Eriodictyol and Capillin have expressed inhibitory action against MAOB without any interference with Akt1 and Akt2. This study mainly represents that Galuteolin and Linarin in the Akt pathway can be perceived for OSCC treatment and other five CYP inhibitors - Diosmetin, Acacetin, Epicatechin, Eriodictyol and Capillin for the treatment of other diseases and cancers caused by overexpression of MAOB. ADMET properties of CYP inhibitors obtained from admetSAR 2.0 and were compared with reference drugs for validation. Communicated by Ramaswamy H. Sarma.

High-throughput nucleotide sequencing for bacteriome studies in oral squamous cell carcinoma: a systematic review

PURPOSE

Dysbiosis has been identified in oral squamous cell carcinoma (OSCC). The aim of this study was to carry out a systematic review of an electronic research that was carried out on articles published between January 2008 and September 2018.

METHODS

Eight studies were selected after applying the inclusion and exclusion criteria.

RESULTS

All articles targeted the hypervariable regions of the 16S rRNA gene. At the phylum level, it was found reduction of Bacteroidetes (2/8 studies) and increase of Firmicutes (2/8 studies). At the genus level, Rothia increased (1/8 studies) and decreased (2/8 studies) in tumor samples, and Streptococcus also was found increased (3/8 studies) and reduced (3/8 studies). Fusobacterium only increased in OSCC samples (3/8 studies). At species level, an increase in F. nucleatum subsp. polymorphum was more associated to OSCC (2/8 studies) than with controls, as was P. aeruginosa (3/8 studies).

CONCLUSION

In summary, the results corroborated dysbiosis in OSCC patients, with enrichment of microbial taxa that are associated with inflammation and production of acetaldehyde. However, variations of study design and sample size were observed among the studies, as well as a shortage of more detailed analyses of possible correlations between risk habits and OSCC. This lack of more detailed analysis may be the cause of the inconsistencies in regard of the alterations reported for certain genera and species. In conclusion, there is an association between OSCC and oral microbiota dysbiosis, but its role in oral carcinogenesis needs to be clarified in more detail.

Epidemiologic aspects of oral cancer

Oral cancer is depicted by diverse geographic disparity in its incidence and prevalence, with a wide range of variation in its distribution across various parts of the world. The present review aims at focusing on the global epidemiological data of oral cancer and catalogues the available data from the past to till date on burden of oral cancer across different continents in the world. The review also suggests a few ideas on modifying the recording of the epidemiological data of the disease.

Tobacco, Alcohol and Family History of Cancer as Risk Factors of Oral Squamous Cell Carcinoma: Case-Control Retrospective Study

The aim of the study is to observe retrospectively the correlation between Oral Squamous Cell Carcinoma (OSCC) and risk factors; including tobacco, alcohol and Family History of Cancer (FHC). A total of 478 patients were included retrospectively from the database of the Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome. A Test Group (TG) consisted of 239 patients with a confirmed diagnosis of OSCC. A Control Group (CG) consisted of 239 patients without history and/or diagnosis of oral cancer. The logistic regression models were used to calculate the adjusted Odd Ratios (ORs) associated with alcohol, tobacco and FHC; including the General Family History of Cancer (GFHC) and Family History of Head and Neck Cancer (FHHNC) and their 95% Confidence Intervals (CI). The high rate of tobacco consumption was associated with an OR of 1.035 (95% CI 1.001–1.070) and a statistical significance (p = 0.041). Drinker patients showed a significant risk of developing OSCC (p = 0.05) and the OR was 1.035 (95% CI 1.010–1.061). The GFHC was associated with a marginal risk of OSCC with an OR of 1.095 (95% CI 0.953–1.259), without significance (p = 0.199). The FHHNC showed a notable risk increase with an OR of 1.871 (95% CI 0.902–3.882), without significance (p = 0.092). Alcohol and tobacco may be associated with an increase in the risk of OSCC.

Campaign to Increase Awareness of Oral Cancer Risk Factors Among Preadolescents

Oral squamous cell carcinoma (OSCC) represents one of the most common but scarcely known malignancies worldwide. The etiology of OSCC is strongly related to lifestyle habits and behavior, especially tobacco smoking and alcohol abuse. The mean age of individuals who start smoking and drinking alcohol is decreasing; thus, the aim of our campaign was to test the awareness and increase knowledge of oral cancer and its risk factors among young preadolescents. Six schools with 460 students aged 12-14 years were included in the campaign. A lecture about carcinogenesis and oral cancer was provided. Anonymous questionnaires were submitted to the students before and after the lecture, to test their knowledge, awareness, and understanding. Before the lecture, the students showed very little awareness of oral cancer (26.8%), although almost all of them identified tobacco smoking as a risk factor (92.2%). After the lecture, the students showed a significant understanding of the provided information, thus increasing their awareness. On scales of 1-10, the students rated the appropriateness of the campaign at 8.9 and their overall appreciation at 8.7. Social campaigns, especially among young students, seem to be appreciated and may represent a powerful strategy for increasing knowledge about cancer risk factors, especially when they are highly related to lifestyle habits and behavior.

Impact of Smoking Cessation on Periodontitis: A Systematic Review and Meta-analysis of Prospective Longitudinal Observational and Interventional Studies

AIMS

This systematic review aimed to estimate the effect of tobacco smoking cessation on the risk for periodontitis compared to the risk among never-smokers and to evaluate the effect of tobacco smoking cessation on the clinical outcomes of nonsurgical periodontal treatment.

METHODS

Electronic searches were performed in PubMed, Scopus, and Embase. Search strategy included MeSH and free terms: periodontitis, periodontal diseases, smoking, tobacco use, tobacco, tobacco products, cigarette, pipe, and cigar. Only original prospective longitudinal observational and interventional studies that investigated the association between smoking cessation and periodontitis onset or progression were included. Meta-analyses were conducted to summarize the evidence.

RESULTS

A total of 2743 articles were identified in electronic searches; out of which only six were included in the meta-analysis. Pooled estimates showed that the risk of periodontitis incidence or progression among those who quit smoking was not significantly different from the risk for never-smokers (risk ratio [RR] = 0.97; 95% confidence interval [CI] = 0.87% to 1.08%). Smokers had approximately 80% higher risk of periodontitis than quitters (RR = 1.79; 95% CI = 1.36% to 2.35%) and never-smokers (RR = 1.82; 95% CI = 1.43% to 2.31%). Periodontal therapy resulted in up to 0.2 mm (95% CI = -0.32% to -0.08%) higher gain in attachment level and extra 0.32 mm (95% CI = 0.07% to 0.52%) reduction in pocket depth among quitters over nonquitters after short follow-up (12-24 months).

CONCLUSIONS

Few studies on the topic were identified. Smoking cessation reduced the risk for periodontitis onset and progression, and improved the outcomes of nonsurgical periodontal therapy.

IMPLICATIONS

This review provides the first quantitative evidence of the impact of smoking cessation on the risk for periodontitis onset and progression. The findings have demonstrated that the risk for periodontitis becomes comparable to that of never-smokers and that nonsurgical periodontal treatment outcomes improve after smoking cessation. Dental professionals ought to consider smoking cessation interventions as a relevant component of the periodontal therapy.

Elective neck dissection versus observation for early-stage oral squamous cell carcinoma: Systematic review and meta-analysis

INTRODUCTION

Oral squamous cell carcinoma (OSCC) is the seventh most common cancer globally, and has been identified as a growing health concern. This study aims to evaluate the current literature comparing elective neck dissection to observation in the treatment of early-stage tongue SCC, focusing on nodal recurrence, overall survival, disease specific survival statistics from randomised controlled trials comparing the two interventions.

METHODS

Systematic review and meta-analysis was conducted according to PRISMA guidelines. The odds ratio (OR) was used as a summary statistic.

RESULTS

From 8 studies, there was a total of 372 cases of recurrence, 98 (15.1%) in END group and 274 (41.5%) in the Observation group. There was a significantly lower rate of recurrence in the END group compared to observation (OR 0.25, 95% CI 0.16-0.39, I² = 54%, P < 0.00001). END was associated with higher overall survival rates when compared with observation (OR 1.95, 95% CI 1.40-2.73, I² = 14%, P < 0.0001). END was also associated with higher disease-specific survival compared with observation (OR 1.88, 95% CI 1.21-2.93), I² = 47%, P = 0.005), with no significant heterogeneity noted.

CONCLUSIONS

END was associated with significantly lower recurrence rates and higher overall and disease-specific survival compared to a conservative observation approach in early-stage oral SCC with clinically N0 neck.

Detection of Occult Metastases in Patients with T1 and T2 Stage Lower Lip Squamous Cell Carcinomas after Positive Lymphoscintigraphy

The aim of this study was to detect lower lip squamous cell carcinomas (SCC) that had metastasized to the lymph nodes and to evaluate if neck dissection was necessary for patients with T1 or T2-stage lip cancer after a sentinel lymph node biopsy (SLNB). The study was conducted as a prospective clinical study to detect occult neck metastases in patients with T1 or T2 stage SCC of the lower lip. Thirty-one patients were eligible and underwent echo-ultrasound, computer tomography, magnetic resonance and lymphoscintigraphy (LSG) as diagnostic procedures. LSG was performed on the same day as the surgical procedure, after intradermal injection of 37 Mbq Tc99m-Sn-colloid/mL at four peritumoral sites. In patients with positive LSG results, the sentinel lymph nodes were extracted surgically. The risk factors for cancer development were sun exposure and smoking. The highest accuracy for detecting lymph node enlargements was achieved with magnetic resonance imaging (MRI; 80.7%). LSG showed excellent sensitivity (100%) and negative predictive value (NPV; 100%). Overall, occult metastases were diagnosed with an SLNB in eight (25.8%) patients. According to the results, with great caution, we suggest that an SLNB is reasonable to initiate only for patients with positive sentinel nodes by positive LSG, to be used as a lower morbidity approach for selected patients with T1 and T2 stage cancers.

[Relationship among areca nut, intracellular reactive oxygen species, and autophagy]

The relationship between areca nut as a primary carcinogen and oral cancer has been widely concerned. Areca can change the levels of reactive oxygen species (ROS) and autophagy in cells, and the levels of ROS and autophagy are closely related to the occurrence and development of tumors. This paper reviewed the relationships among areca nut, intracellular ROS, and autophagy.

Assessment of the Risk of Oral Cancer Incidence in A High-Risk Population and Establishment of A Predictive Model for Oral Cancer Incidence Using A Population-Based Cohort in Taiwan

We aimed to assess the risk of oral cancer incidence in a high-risk population, establish a predictive model for oral cancer among these high-risk individuals, and assess the predictive ability of the constructed model. Individuals aged ≥30 years who had a habit of smoking or betel nut chewing and had undergone oral cancer screening in 2010 or 2011 were selected as study subjects. The incidence of oral cancer among the subjects at the end of 2014 was determined. The annual oral cancer incidence among individuals with a positive screening result was 624 per 100,000 persons, which was 6.5 times that of the annual oral cancer incidence among all individuals screened. Male sex, aged 45-64 years, divorce, low educational level, presence of diabetes, presence of other cancers, high comorbidity severity, a habit of smoking or betel nut chewing, and low monthly salary were high-risk factors for oral cancer incidence (p < 0.05). The area under the curve of the predictive model for oral cancer incidence was 0.73, which indicated a good predictive ability. Therefore, the oral cancer screening policy for the high-risk population with a habit of smoking and/or betel nut chewing is beneficial for the early diagnosis of oral cancer.

Trajectories of returning to work and its impact on survival in survivors with oral cancer: A 5-year follow-up study

BACKGROUND

A return to work (RTW) is a challenge for survivors of oral cancer. Further light could be shed on the RTW of patients with oral cancer, which remains largely uninvestigated. The objective of this study was to investigate the trajectories of RTW and their impact on survival in workers with oral cancer.

METHODS

In total, 12,222 workers who were newly diagnosed with oral cancer were identified during the period from 2004 to 2015 and were included in this cohort study. The associations between independent variables and RTW were analyzed using Cox proportional hazard models.

RESULTS

Overall, 8793 workers returned to work in the first years after a diagnosis of oral cancer. Chemotherapy (hazard ratio [HR], 0.88; 95% CI, 0.78-0.99) and radiation therapy (HR, 0.83; 95% CI, 0.75-0.92) were inversely associated with RTW. Patients who had received surgical treatment (HR, 1.24; 95% CI, 1.01-1.53) were more likely to RTW. Employees with stage I (HR, 1.66; 95% CI, 1.47-1.87), stage II (HR, 1.52; 95% CI, 1.35-1.72), and stage III (HR, 1.32; 95% CI, 1.16-1.51) disease were associated with an increased likelihood of RTW in the fifth year after diagnosis. Kaplan-Meier survival analysis demonstrated better survival for the RTW group versus the non-RTW group in patients with stage III and IV oral cancer (P < .001). The fully adjusted HR indicated that the RTW group had significantly better outcomes than the non-RTW group in all-cause mortality (P < .001; HR, 0.36; 95% CI, 0.33-0.39).

CONCLUSIONS

Sociodemographic and medical factors affect the RTW of cancer survivors. RTW may have a beneficial effect on survival of patients with oral cancer.

Incidence and death in 29 cancer groups in 2017 and trend analysis from 1990 to 2017 from the Global Burden of Disease Study

Background and aims

Cancer has become the second most serious disease threatening human health, followed by cardiovascular diseases. This study aimed to quantitatively estimate the mortality, morbidity, and analyze the trends of 29 cancer groups in 195 countries/regions between 1990 and 2017.

Methods

Detailed information of 29 cancer groups were collected from the Global Burden of Disease (GBD) study in 2017 and age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR) of 29 cancer groups were calculated based on gender, age, region, and country. Trend analyses were conducted for major cancer types.

Results

In 2017, the global death population caused by cancer reached 9 million, which was nearly twice the number in 1990. The ASDR and ASIR of cancer in males were about 1.5 times those of females. Breast cancer showed the highest mortality rate in females in 2017. Individuals aged over 50 are at high risk of developing cancer and the number of cases and deaths in this age group accounted for more than 80% of all cancers in all age groups. Asia has the heaviest cancer burden due to its large population density. Different cancers in varied countries globally have their own characteristics. The ASDR and ASIR of some major cancers demonstrated changes from 1990 to 2017.

Conclusions

Analyses of these data provided basis for future investigations to the common etiological factors, leading to the occurrence of different cancers, the development of prevention strategies based on local characteristics, socioeconomic and other conditions, and the formulation of more targeted interventions.

Electronic supplementary material

The online version of this article (10.1186/s13045-019-0783-9) contains supplementary material, which is available to authorized users.

Association between p62 expression and clinicopathological characteristics in oral leukoplakia

Objective

Oral leukoplakia is keratinized lesions in the buccal mucosa, tongue, and gingiva. It is the most common oral precancerous lesion; oxidative stresses and irrelevant autophagy have been reported to be the cause of oncogenesis. p62, a cytoplasmic protein induced by oxidative stress, is an adaptor protein involved in the formation of protein aggregates and induction and inhibition of autophagy. The inhibition of autophagy induces p62 overexpression and promotes oncogenesis via the oncogenic signaling pathway. The aim of the present study was to elucidate the involvement of intracellular expression of p62 in oral leukoplakia and to address its potential clinical implementation as a biomarker to predict malignant transformation.

Material and Methods

Fifty samples from subjects with confirmed oral leukoplakia were evaluated by immunohistochemical staining for the expression of p62, 8-hydroxy-2'-deoxyguanosine (8-OHdG), Ki67, and p53. Univariate and multivariate logistic regression analyses were performed to evaluate the association between p62, 8-OHdG, Ki67, and p53 and clinical characteristics, including epithelial dysplasia.

Results

Significant associations were observed between p62 expression in the nucleus, p62 aggregation, and epithelial dysplasia (adjusted odds ratio [OR] = 5.75; 95% confidence interval [CI]: [1.28, 26.2]; .024 and OR = 6.16; 95% CI: [1.01, 37.4]; .048, respectively). The expression of p62 in the cytoplasm and the levels of 8-OHdG, Ki67, and p53 were not significantly associated with epithelial dysplasia. A significant relationship was found between p62 expression in the nucleus and p53 expression (OR = 3.94; 95% CI: [1.14, 13.6]; .031).

Conclusions

The results suggested that p62 expression in the nucleus and p62 aggregation can be potential markers to predict the malignant transformation of oral leukoplakia.

Case Studies of Gastric, Lung, and Oral Cancer Connect Etiologic Agent Prevalence to Cancer Incidence

Obtaining detailed individual-level data on both exposure and cancer outcomes is challenging, and it is difficult to understand and characterize how temporal aspects of exposures translate into cancer risk. We show that, in lieu of individual-level information, population-level data on cancer incidence and etiologic agent prevalence can be leveraged to investigate cancer mechanisms and to better characterize and predict cancer trends. We use mechanistic carcinogenesis models [multistage clonal expansion (MSCE) models] and data on smoking, Helicobacter pylori (H. pylori), and HPV infection prevalence to investigate trends of lung, gastric, and HPV-related oropharyngeal cancers. MSCE models are based on the initiation-promotion-malignant conversion paradigm and allow for interpretation of trends in terms of general biological mechanisms. We assumed the rates of initiation depend on the prevalence of the corresponding risk factors. We performed two types of analysis, using the agent prevalence and cancer incidence data to estimate the model parameters and using cancer incidence data to infer the etiologic agent prevalence as well as the model parameters. By including risk factor prevalence, MSCE models with as few as three parameters closely reproduced 40 years of age-specific cancer incidence data. We recovered trends of H. pylori prevalence in the United States and demonstrated that cohort effects can explain the observed bimodal, age-specific pattern of oral HPV prevalence in men. Our results demonstrate the potential for joint analyses of population-level cancer and risk factor data through mechanistic modeling. This approach can be a first step in systematically testing relationships between exposures and cancer risk when individual-level data is lacking.Significance: Analysis of trends in risk-factor prevalence and cancer incidence can shed light on cancer mechanisms and the way that carcinogen exposure through time shapes the risk of cancer at different ages.Graphical Abstract: http://cancerres.aacrjournals.org/content/canres/78/12/3386/F1.large.jpg Cancer Res; 78(12); 3386-96. ©2018 AACR.

Combinatorial therapeutic approach for treatment of oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is one of the common type of cancer in humans. A combinatorial approach has been done by using paclitaxel (PTX), 5-fluorouracil (5-FU) and ascorbic acid (AA) loaded solid lipid nanoparticles (SLN) for its treatment. SLN were made by high-speed homogenization and ultrasonication technique and they were used alone and in combination to check their efficacy against OSCC induced animal model. Pharmacokinetics and biodistribution study of the optimized formulations for PTX, 5-FU and AA loaded SLN was performed. The SLN shows a biphasic nature of drug release both in the in-vitro and in-vivo system. SLN loaded with PTX in combination with SLN loaded with AA shows a greater potency in the treatment of OSCC in-vivo. The Pharmacokinetic and biodistribution studies of SLN depict a better therapeutic efficacy. The combination of PTX and AA loaded SLN can be a novel approach for the treatment of OSCC.

Taiwanin C elicits apoptosis in arecoline and 4-nitroquinoline-1-oxide-induced oral squamous cell carcinoma cells and hinders proliferation via epidermal growth factor receptor/PI3K suppression

Oral Squamous Cell Carcinoma (OSSC) is a major life-threatening disease with high incidence in the Southeast Asian countries. Chronic exposure to arecoline causes genetic changes in the epithelial cells of the oral mucosa, induces proliferation through activation of the EGF receptor and promotes downstream COX-2 expression. Taiwanin C, a podophyllotoxin derived from Taiwania cryptomerioides Hayata is known to inhibit COX activity and to hinder PGE2 production in macrophages. In this study a tumor cell line T28 and a non-tumor cell line N28 derived from mice OSCC models were used to study the effect of Taiwanin C on PGE₂ associated COX-2 expression and cell cycle regulators. Taiwanin C activated p21 protein expression, down-regulated cell cycle regulatory proteins, elevated apoptosis and down-regulated p-PI3K/p-Akt survival mechanism in T28 oral cancer cells. Our results therefore emphasize the therapeutic potential of Taiwanin C against arecoline-induced oral cancer.

Genetic variations of TLRs and their association with HPV/EBV, co-infection along with nicotine exposure in the development of premalignant/malignant lesions of the oral cavity in Indian population

BACKGROUND

Despite being most preventable malignancies associated with smoked and smokeless tobacco products, squamous cell carcinoma of oral cavity is one of the most common malignancy in India. The aim of the present study was to evaluate the role of TLRs in oral pre-cancerous, cancerous cases and their genotypic correlation with HPV/EBV, co-infection & lifestyle habits in Indian population.

METHODS

The present study was conducted on 300 subjects (100 OSCC, 50 pre-cancer & 150 controls). The amplification of TLRs gene and HPV/EBV co-infection was assessed by Nested PCR, PCR-RFLP and further confirmation by direct sequencing.

RESULTS

The TLR 9(-1486 T/C), revealed that the TT vs. CT + CC genotype had a ˜5-fold increased risk for the development of pre-cancerous lesions as compared to controls (p = 0.0001). Further analysis showed that the risk of cancer was extremely pronounced in HPV/EBV, co-infection (p = 0.0141), implicating the possible interaction between TLR 9(-1486T/C) genotype and HPV infection in increasing cancer/pre-cancer risk. The 'G' allele of TLR 4(+896A/G) was also a higher risk of developing pre-cancerous lesions with 4.5 fold and statistically significant (p = 0.0001). The genotypic association of TLR 9(-1486T/C) in OSMF cases showed ˜8 fold increased risk and TLR 4(+896A/G) showed fourteen fold higher risk for leukoplakia (p < 0.0001, OR = 14.000).

CONCLUSION

Genetic polymorphism of TLR 9(-1486 T/C) and TLR 4(+896A/G) may influence the effects of HPV/EBV, co-infection and play the significant role in development of the disease. The significance of these TLRs seemed to be enhanced by tobacco chewing and smoking habits also, which act as an important etiological risk factor for OSCC.

Head and neck cancer prevention: from primary prevention to impact of clinicians on reducing burden

Survival from head and neck cancers (HNCs) of the lip, oral cavity, pharynx, and larynx has increased by 10% over the past few decades. Little over half of patients who develop HNCs will survive beyond 5 years. Survival is lower for individuals in many countries where traditional risk factors such as tobacco smoking, alcohol drinking, and betel quid chewing are highly prevalent but tertiary health care center access is limited or unavailable. Early diagnosis of HNC is the most important prognostic factor for each tumor site. Molecular-based research on HNC tumors holds promise for early stage detection, screening, vaccination, disease follow-up, and progression. Future investments for HNC control must consider both effectiveness and sustainability for both high- and low-resource countries alike, with priority toward risk factor prevention and earlier diagnosis.

Tobacco and alcohol-induced epigenetic changes in oral carcinoma

PURPOSE OF REVIEW

The present review aims to describe the epigenetic alterations observed in oral cancer linked to the exposure to alcohol and/or tobacco.

RECENT FINDINGS

Recent findings emphasize the importance of epigenetics in oral cancer progression and in how risk factors (as tobacco and alcohol) affect the basal epigenetic profiles. Deeper techniques and detailed approaches allowed the perception that individual CG changes and even subtle changes may represent important epigenetic alterations resulting in expression changes and other carcinogenic consequences. New classes of epigenetic alterations including noncoding RNAs have been gaining attention.

SUMMARY

Many epigenetic alterations have been described in oral carcinoma progression induced by tobacco and/or alcohol, including: promoter hypermethylation in genes with tumor suppressive activity, global (genome-wide) hypomethylation, change in methylation patterns throughout the genes, alteration in noncoding RNAs, and histones modifications. These changes represent progress in the knowledge of how these risk factors act in a molecular level. There is an urgent need for large independent studies to move these potential makers further and validate them to identify risk assessment, early diagnostic markers, and therapeutic targets, as well as to be the base for prevention and intervention strategies.

Tobacco use and oral sex practice among dental clinic attendees

Tobacco use and oral sex (OS) are important risk factors for oral and oropharyngeal Human papillomavirus (HPV) infection. Little is known about the prevalence of OS practice in South Africa. This study aimed to determine the prevalence of OS practice and tobacco use in a South African patient population. This cross-sectional study used a structured questionnaire to collect socio-demographic characteristics, tobacco use, betel nut use and OS practice data from consenting adults (≥18 years; n = 850). Oral sex practices were recorded for patients 18-45 years-old (n = 514). Data analysis included chi-square and multiple logistic regression analyses. Of the study population, 55.2% (n = 468) were female, 88% (n = 748) self-identified as black Africans and 45.1% (n = 383) were unemployed. Furthermore, 19.7% (n = 167), 6.4% (n = 54) and 2.1% (n = 18) were current smokers, snuff users and betel nut users, respectively. Out of the 514 who answered the questionnaire in relation to OS, 22.8% (n = 115) reported to practice it. Oral sex practice in the age group 18-45 years was most common among the self-identified white participants (41.9%); and among tobacco users than among non-tobacco users (30.9% vs. 20.5%; p = 0.022). A multivariable-adjusted regression model showed that white South Africans were more likely to use tobacco than black Africans (OR = 5.25; 95% CI = 2.21-12.47). The practice of OS was more likely among those 18-35 years-old (OR = 1.67; 95% CI = 1.01-2.74), but had no significant association with tobacco use (OR = 1.06; 95% CI = 0.62-1.83). The observed age and ethnic differences in both risk behaviours suggest a need for targeted population intervention in order to reduce the risk for oral HPV infection.

Employee Psychoactive Substance Involvement: Historical Context, Key Findings, and Future Directions

Humans have consumed psychoactive substances for millennia, and these substances have played an important role in human culture and human labor. This article investigates our current understanding of the general association between the workplace and employee involvement with psychoactive substances. I begin by briefly exploring the broad evolutionary and historical intersection of psychoactive substances, human culture, and human labor. I then outline the multidimensional nature of employee psychoactive substance involvement and look at its prevalence. Next, I summarize recent research on workplace antecedents, such as work stressors, substance availability, norms, and social control. I then summarize research on the adverse workplace outcomes experienced by employees who use psychoactive substances as well as the collateral effects of such use on coworkers. Throughout the article, I identify directions for future research.

Prosthodontic rehabilitation of a sub-total maxillectomy defect with a definitive hollow obturator prosthesis using the modified lost-wax concept: A novel technique

Squamous cell carcinoma (SCC) of the oral cavity is relatively common in the Indian subcontinent with surgical resection and adjuvant radiotherapy/chemotherapy being the treatment modality of choice. Prosthetic rehabilitation with an obturator following resection is more economical and yields satisfactory results. Better patient acceptance and comfort necessitates hollowing the prosthesis to a great extent. This novel method modifies the existing lost-wax technique in fabricating a definitive hollow maxillary obturator. An elderly man had reported to the Department of Prosthodontics with the chief complaint of a “big hole” in the mouth which affected his quality of life. He had undergone subtotal maxillectomy, following a histopathologic diagnosis of SCC, with adjuvant radiotherapy. Examination revealed an Aramany Class II defect with the healthy oral mucosa. A lightweight definitive obturator was designed and fabricated using a simple technique which utilizes easily available modeling wax. This article describes a relatively simple, single-step fabrication of a closed hollow-bulb obturator prosthesis with a uniform thickness of heat-cured resin encapsulating the hollow prosthesis.

The potential functions of FAM46C in oral squamous cell carcinoma

Purpose

FAM46C is known as a tumor suppressor in multiple myeloma. However, there are few studies about the expression and function of FAM46C in oral squamous cell carcinoma (OSCC), which is one of the most common oral cancers in the world.

Methods

mRNA and protein expression level were determined by real time PCR and Western blot, respectively. Cell Counting Kit-8 assay and flow cytometry analysis were used to analyze cell proliferation and apoptosis, respectively. Activity of caspase 3 and caspase 9 was determined using biochemical assays.

Results

Our results showed that the OSCC cells overexpressing FAM46C had a relatively slower cell proliferation rate and higher cell apoptosis rate compared with control groups. The results from Western blot showed that the expression levels of cleaved caspase 9 and cleaved caspase 3, which are the active forms of caspase 3 and caspase 9 in FAM46C overexpressed OSCC cells, were higher than in the control cells, while the phosphorylation of ERK1/2 together with its upstream regulators Ras and phosphorylation of MEK1/2 were relatively lower. Additionally, the results also showed that ERK1/2 agonist (EGF) or a caspase 3 inhibitor (Z-DEVD-FMK) inhibited activity of caspase 3 and caspase 9 and cell apoptosis rate. Furthermore, by analyzing FAM46C silencing OSCC cells, we found an increased proliferation rate and a reduced apoptosis rate compared with control cells. And those phenomena could be blocked by U0126, which is an ERK1/2 inhibitor.

Conclusion

Overall, our data suggest that FAM46C probably acts as a tumor suppressor gene in OSCC cells and the working mechanism of FAM46C may be involved in the caspases and ERK1/2 pathway.

Promoter DNA Methylation and mRNA Expression Level of p16 Gene in Oral Squamous Cell Carcinoma: Correlation with Clinicopathological Characteristics

The aim of this study was to investigate the relationship between p16 methylation and its expression in oral squamous cell carcinoma (OSCC). Also the contribution of clinicopathological factors, HPV infection and smoking in p16 expression and promoter methylation has been investigated. In this study 67 consecutive OSCC patients and 59 normal individuals were enrolled. All patients were candidates for surgery of oral cavity and fresh tumor biopsies were collected and processed for DNA and RNA extraction. Normal gingival tissues were collected from individuals referred to dentistry clinic and considered as controls. All the cases and controls were checked for HPV infection and then promoter methylation and expression of p16 gene were determined using Methylation-specific PCR (MSP) and real-time PCR (QPCR), respectively. Methylation of p16 in tumors and normal tissues were 59.7 and 38.9%, respectively. Most of hypermethylated samples (>82%) were in high grades. P16 methylation was comparable in HPV+ and HPV- patients or smokers. P16 was overexpressed (~3 fold; p = 0.044) in HPV+ tumors, but it was significantly down-regulated in smoker patients (40% of all tumors). Comparison of P16 expression in OSCC tumors with different degrees of promoter methylation further suggest the relationship of methylation rate and down-regulation of P16 expression. The p16 methylation and expression was differentially affected in patients with HPV infection and the smoker cases. Regardless of the influence of environmental factors, it appears that P16 status is useful for classifying patients with OSCC and for influencing treatment strategies in accordance with this classification. Moreover, targeting the upregulation of p16 could be a promising therapeutic option.

Cognitive and emotional processes influencing patient presentation or non-presentation of oral Cancer symptoms to healthcare professionals

OBJECTIVE

Greater time that patients take to present symptoms to health care providers (HCPs) increases the likelihood of later stage cancer, which increases mortality and morbidity in symptomatic cancers. The common-sense model (CSM) is used to understand time to first consultation with a healthcare provider, but inconsistencies exisy between its current use and important empirical findings.

METHOD

To resolve inconsistencies, we conducted a qualitative examination to determine how the CSM could be revised to better account for these findings. We conducted in-depth interviews of a consecutive sample of 38 recently diagnosed patients who described events from first noticing symptoms to first consultation. Framework analysis was used to develop a theoretical model of processes leading to presentation or non-presentation.

RESULTS

Patients reported median presentation times of 3-4 weeks. Early presentation was facilitated by pre-symptomatic perceptions of vulnerability to serious illnesses and beliefs that early intervention could mitigate illness. These patients rarely tried to identify symptoms. They responded inductively, seeking help because symptoms were unusual. Where patients did not describe pre-symptom perceptions of vulnerability, many deductively tried to identify symptoms but misattributed them to minor conditions. Pre-symptomatic perceptions of vulnerability could also prolong presentation. When vulnerability was characterized by intense fears of cancer and cancer treatment, patients tended to avoid thinking about symptoms which extended presentation time.

CONCLUSION

Risk perception theories explain how participants' pre-symptomatic perceptions of vulnerability and potential treatment outcomes influence presentation time. Incorporating risk perception perspectives into the CSM can improve its ability explain responses to ambiguous symptoms.

Human papillomavirus and oral and oropharyngeal carcinoma: the essentials

There is a global increase in the prevalence of human papillomavirus (HPV)-driven oropharyngeal squamous cell carcinoma (OPSCC) in Australia and New Zealand. Risk factors for HPV-positive OPSCC are male gender, white race, age older than 40 but younger than 59 years old, having multiple lifetime sex partners, having oro-genital and oro-anal sex. High-risk HPV subtypes play a major role in the pathogenesis of OPSCC, however, they play a much lesser role in oral squamous cell carcinoma (OSCC). Among the laboratory tests used to detect oncogenic HPV infection, polymerase chain reaction is a sensitive method but does not reflect the role of HPV in oncogenesis. While widely used, p16 immunohistochemistry is both a sensitive and a specific surrogate marker for oncogenic HPV infection in OPSCC, but not in OSCC. However, it is a useful prognostic marker in OPSCC. The current gold standard to accurately detect oncogenic HPV infection is E6/E7 mRNAin situ hybridization. Because both HPV-positive and p16-positive OPSCC have better short-term prognoses there is current debate and trials on treatment de-escalation in HPV-positive OPSCC. Dental practitioners can play an important role in early diagnosis of HPV-positive OPSCC.

Betel quid chewing among adult male immigrants from the Indian subcontinent to Italy

OBJECTIVE

Betel quid chewing (BQC) is an important oral cancer risk factor widespread in the Indian subcontinent. This usage also is common among migrants from this region. As the number of immigrants from South-East Asia is dramatically increasing in Italy, this survey was aimed at investigating BQC prevalence among immigrants from the Indian subcontinent.

SUBJECTS AND METHODS

First-generation adult male immigrants coming from Pakistan, India, Sri Lanka, and Bangladesh, living in Rome, were consecutively selected. They were interviewed using a validated questionnaire. Descriptive statistics were performed, and factors associated to regular BQC were investigated through regression analysis.

RESULTS

A total of 211 subjects (mean age, 33.8 years) living in Rome for 11 years, on average, participated in the study. BQC prevalence was 37.9% with few differences between Pakistani, Sri Lankans, and Indians. Prevalence among Bangladeshi was 7.3%. 69% of the consumers chewed BQ at least twice daily, 90% chewed BQ with tobacco; 30.3% subjects were smokers and chewers. Chewing parents, smoking, health illiteracy were associated with BQC. Most chewers believed that BQ helps to relieve stress.

CONCLUSIONS

The number of oral cancers in Italy is expected to increase because of BQC dissemination. Therefore, specific awareness campaigns directed to residents of South-East Asian origin are needed.

Meta-Analysis Results on the Association Between TP53 Codon 72 Polymorphism With the Susceptibility to Oral Cancer

Objectives: TP53 is an important tumor suppressor gene to maintain genomic integrity, and its mutations increase the susceptibility to oral carcinoma. Previous published studies have reported the relation of TP53 codon 72 polymorphism with the risk of oral carcinoma, but the results remain controversial and inconclusive.

Methods: We therefore utilized meta-analysis based on a comprehensive search in PubMed, EMBASE, and Google of Scholar databases up to August 19, 2017.

Results: Total 3,525 cases and 3,712 controls from 21 case-control studies were selected. We found no significant association between TP53 codon 72 polymorphism and oral carcinoma susceptibility in all genetic contrast models, including subgroup analysis based on control source and ethnicity. Furthermore, TP53 codon 72 polymorphism was not significant associated with oral carcinoma susceptibility in tobacco or alcohol use, and HPV infection status. Our results were confirmed by sensitivity analysis and no publication bias was found.

Conclusions: Taken together, our data indicate that TP53 codon 72 polymorphism is not associated with the susceptibility to oral carcinoma.

Differential impact of socioeconomic position across life on oral cancer risk in Kerala, India: An investigation of life-course models under a time-varying framework

OBJECTIVES

The incidence of oral cancer has been rapidly increasing in India, calling for evidence contributing to a deeper understanding of its determinants. Although disadvantageous life-course socioeconomic position (SEP) is independently associated with the risk of these cancers, the explanatory mechanisms remain unclear. Possible pathways may be better understood by testing which life-course model most influences oral cancer risk. We estimated the association between life-course SEP and oral cancer risk under three life-course models: critical period, accumulation and social mobility.

METHODS

We recruited incident oral cancer cases (N = 350) and controls (N = 371) frequency-matched by age and sex from two main referral hospitals in Kozhikode, Kerala, India, between 2008 and 2012. We collected information on childhood (0-16 years), early adulthood (17-30 years) and late adulthood (above 30 years) SEP and behavioural factors along the life span using interviews and a life-grid technique. Odds ratios (OR) and 95% confidence intervals (CI) were estimated for the association between life-course SEP and oral cancer risk using inverse probability weighted marginal structural models.

RESULTS

Relative to an advantageous SEP in childhood and early adulthood, a disadvantageous SEP was associated with oral cancer risk [(OR = 2.76, 95% CI: 1.99, 3.81) and (OR = 1.84, 95% CI: 1.21, 2.79), respectively]. In addition, participants who were in a disadvantageous (vs advantageous) SEP during all three periods of life had an increased oral cancer risk (OR = 4.86, 95% CI: 2.61, 9.06). The childhood to early adulthood social mobility model and overall life-course trajectories indicated strong influence of exposure to disadvantageous SEP in childhood on the risk for oral cancer.

CONCLUSIONS

Using novel approaches to existing methods, our study provides empirical evidence that disadvantageous childhood SEP is critical for oral cancer risk in this population from Kerala, India.

RNA interference: new mechanistic and biochemical insights with application in oral cancer therapy

Over the last few decades, the incidence of oral cancer has gradually increased, due to the negative influence of environmental factors and also abnormalities within the genome. The main issues in oral cancer treatment consist in surpassing resistance and recurrence. However, continuous discovery of altered signaling pathways in these tumors provides valuable information for the identification of novel gene candidates targeted in personalized therapy. RNA interference (RNAi) is a natural mechanism that involves small interfering RNA (siRNA); this can be exploited in biomedical research by using natural or synthetic constructs for activation of the mechanism. Synthetic siRNA transcripts were developed as a versatile class of molecular tools that have a diverse range of programmable roles, being involved in the regulation of several biological processes, thereby providing the perspective of an alternative option to classical treatment. In this review, we summarize the latest information related to the application of siRNA in oral malignancy together with molecular aspects of the technology and also the perspective upon the delivery system. Also, the emergence of newer technologies such as clustered regularly interspaced short palindromic repeats/Cas9 or transcription activator-like effector nucleases in comparison with the RNAi approach is discussed in this paper.

Overexpression of nicotinamide N-methyltransferase in HSC-2 OSCC cell line: effect on apoptosis and cell proliferation

OBJECTIVES

Oral squamous cell carcinoma (OSCC) is the most common malignancy of oral cavity. Despite advances in therapeutic approaches, the 5-year survival rate for oral cancer has not improved in the last three decades. Therefore, new molecular targets for early diagnosis and treatment of OSCC are needed. In the present study, we focused on the enzyme nicotinamide N-methyltransferase (NNMT). We have previously shown that enzyme expression is upregulated in OSCC and NNMT knockdown in PE/CA PJ-15 cells significantly decreased cell growth in vitro and tumorigenicity in vivo.

MATERIAL AND METHODS

To further explore the role of the enzyme in oral cancer cell metabolism, HSC-2 cells were transfected with the NNMT expression vector (pcDNA3-NNMT) and the effect of enzyme upregulation on cell proliferation was evaluated by MTT assay. Subsequently, we investigated at molecular level the role of NNMT on apoptosis and cell proliferation, by exploring the expression of β-catenin, survivin, and Ki-67 by real-time PCR. Moreover, we performed immunohistochemistry on 20 OSCC tissue samples to explore the expression level of NNMT and survivin ΔEx3 isoform.

RESULTS

Enzyme upregulation significantly increased cell growth in vitro. Moreover, a positive correlation between NNMT and survivin ΔEx3 isoform expression levels was found both in HSC-2 cells and in OSCC tissue samples.

CONCLUSION

Taken together, our results indicate a possible involvement of NNMT in the proliferation and tumorigenic capacity of OSCC cells and seem to suggest that the enzyme could represent a potential target for the treatment of oral cancer.

CLINICAL RELEVANCE

The involvement of NNMT in cell growth and anti-apoptotic mechanisms seems to suggest that this enzyme could be a new therapeutic target to improve the survival of OSCC patients.

Individual and Integrated Effects of Potential Risk Factors for Oral Squamous Cell Carcinoma: A Hospital-Based Case-Control Study in Jazan, Saudi Arabia

Background: Oral cancer is the sixth most common cancer in the world, with a high prevalence reported in Jazan province of Saudi Arabia. The objectives of this study were to check individual and integrated effects of potential risk factors for oral squamous cell carcinoma. Materials and methods: A case control study was designed with a sample of 210 subjects, in which histopathologically confirmed incident cases (n=70) and controls (n=140) matched for age, gender and referral route, were recruited. Differences in exposure to potential risk factors between cases and controls were assessed using chi-square and McNemar analyses. A logistic regression model with interactions was applied to check individual and integrated effects. Results: Mean age of the sample was 55 years (+ 20 years). Shammah (O.R = 33.01; C.I = 3.22 – 39.88), shisha (O.R = 3.96; C.I = 0.24 – 63.38), and cigarette (O.R = 1.58; C.I = 0.13, 2.50) consumption was significantly associated (P<0.05) with oral squamous cell carcinoma development. In contrast, Khat chewing (O.R = 0.67; C.I = 0.19-2.36) was without significant effect. An increase in odds ratios was observed when combinations of shammah and shisha (O.R = 35.03; C.I = 11.50-65.66), shisha and cigarettes (O.R = 10.52; C.I = 1.03 – 33.90) or shamma and cigarettes (O.R = 10.10; C.I = 0.50 - 20.40) were used. Conclusion: Combined exposure to risk-factors has serious implications and policies on oral cancer prevention should be designed with attention to this aspect.

Autoregulation of RANK ligand in oral squamous cell carcinoma tumor cells

Oral squamous cell carcinoma (OSCC) is the most common malignancy among oral cancers and shows potent activity for local bone invasion. Receptor activator of nuclear factor κB (RANK) ligand (RANKL) is critical for bone-resorbing osteoclast formation. We previously demonstrated that OSCC tumor cells express high levels of RANKL. In this study, confocal microscopy demonstrated RANKL specific receptor, RANK expression in OSCC tumor cell lines (SCC1, SCC12, and SCC14a). We also confirmed the expression of RANK and RANKL in primary human OSCC tumor specimens. However, regulatory mechanisms of RANKL expression and a functional role in OSCC tumor progression are unclear. Interestingly, we identified that RANKL expression is autoregulated in OSCC tumor cells. The RANKL specific inhibitor osteoprotegerin (OPG) treatment to OSCC cells inhibits autoregulation of RANKL expression. Further, we showed conditioned media from RANKL CRISPR-Cas9 knockout OSCC cells significantly decreased osteoclast formation and bone resorption activity. In addition, RANKL increases OSCC tumor cell proliferation. RANKL treatment to OSCC cells demonstrated a dose-dependent increase in RANK intracellular adaptor protein, TRAF6 expression, and activation of IKK and IκB signaling molecules. We further identified that transcription factor NFATc2 mediates autoregulation of RANKL expression in OSCC cells. Thus, our results implicate RANKL autoregulation as a novel mechanism that facilitates OSCC tumor cell growth and osteoclast differentiation/bone destruction.

Association of nonsteroidal anti-inflammatory drugs and aspirin use and the risk of head and neck cancers: a meta-analysis of observational studies

Purpose

Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, have emerged as the potential chemopreventive agents for a number of cancer types, however, previous studies of head and neck cancers (HNC) have yielded inconclusive results. We performed a meta-analysis of observational studies to quantitatively assess the association between NSAIDs use and the risk for HNC.

Methods

We searched Pubmed, Embase, Google scholar, and Cochrane library for relevant studies that were published in any language, from January 1980 to April 2016. We pooled the odds ratio (OR) from individual studies and performed subgroup, heterogeneity, and publication bias analyses.

Results

A total of eleven studies (eight case-control studies and three cohort studies), involving 370,000 participants and 10,673 HNC cases contributed to this meta-analysis. The results of these studies suggested that neither use of overall NSAIDs (OR=0.95; 95% CI, 0.81-1.11), aspirin (OR=0.93; 95% CI, 0.79-1.10), nor nonsteroidal NSAIDs (OR=0.92; 95% CI, 0.76-1.10) were associated with HNC risk. Similar nonsteroidal results were observed when stratified by HNC sites, study design, sample size, and varied adjustment factors. However, we found significant protective effect of ibuprofen (OR=0.85; 95% CI, 0.72-0.99) and long-term aspirin use (≧5years) (OR=0.75; 95% CI, 0.65-0.85) on HNC risk, with low heterogeneity and publication bias.

Conclusions

Our meta-analysis results do not support the hypothesis that overall use of NSAIDs significant reduces the risk of HNC. Whereas, we cannot rule out a modest reduction in HNC risk associated with ibuprofen and long-term aspirin use.

Elder neglect-Oral diseases and injuries

Elder neglect (EN) is the failure of a designated caregiver to meet the needs of a dependent older person. World EN prevalence, meta-analyzed in this study, is 1.0% or 1.8% according to different statistical methods. Referring alleged EN cases to Adult Protective Services (APSs) by healthcare workers (HCWs) is mandatory in many countries. However, only few claims are substantiated, as EN could be confused with Self-Neglect, and neglect could be unintentional or due to caregiver unawareness. Screening tools are inaccurate, and their use is discouraged by public health organizations, because they lead to too many false positives, which engulf the already overwhelmed APSs. HCWs need effective tools with objective judgments, which do not hamper the HCW-caregiver-patient rapport and prevent lawsuits when allegations are unfounded. Orofacial EN manifestations (poor oral/denture hygiene, lack of needed/improper dentures, dry mouth, skin/mucosal rashes) are essential Forensic Markers of EN. I classified EN-associated oral diseases according to the unmet needs into four groups: (1) traumatic injuries due to lack of caregiver vigilance (e.g., maxillofacial fractures); (2) diseases due to oral hygiene deficiency (e.g., root caries); (3) diseases typical of the elderly with late/no diagnosis (e.g., oral cancer); and (4) diseases typical of the elderly exacerbated by psychological distress (e.g., oral lichen planus).

Capsaicin: Friend or Foe in Skin Cancer and Other Related Malignancies?

Capsaicin is the main pungent in chili peppers, one of the most commonly used spices in the world; its analgesic and anti-inflammatory properties have been proven in various cultures for centuries. It is a lipophilic substance belonging to the class of vanilloids and an agonist of the transient receptor potential vanilloid 1 receptor. Taking into consideration the complex neuro-immune impact of capsaicin and the potential link between inflammation and carcinogenesis, the effect of capsaicin on muco-cutaneous cancer has aroused a growing interest. The aim of this review is to look over the most recent data regarding the connection between capsaicin and muco-cutaneous cancers, with emphasis on melanoma and muco-cutaneous squamous cell carcinoma.

Mobile microscopy as a screening tool for oral cancer in India: A pilot study

Oral cancer is the most common type of cancer among men in India and other countries in South Asia. Late diagnosis contributes significantly to this mortality, highlighting the need for effective and specific point-of-care diagnostic tools. The same regions with high prevalence of oral cancer have seen extensive growth in mobile phone infrastructure, which enables widespread access to telemedicine services. In this work, we describe the evaluation of an automated tablet-based mobile microscope as an adjunct for telemedicine-based oral cancer screening in India. Brush biopsy, a minimally invasive sampling technique was combined with a simplified staining protocol and a tablet-based mobile microscope to facilitate local collection of digital images and remote evaluation of the images by clinicians. The tablet-based mobile microscope (CellScope device) combines an iPad Mini with collection optics, LED illumination and Bluetooth-controlled motors to scan a slide specimen and capture high-resolution images of stained brush biopsy samples. Researchers at the Mazumdar Shaw Medical Foundation (MSMF) in Bangalore, India used the instrument to collect and send randomly selected images of each slide for telepathology review. Evaluation of the concordance between gold standard histology, conventional microscopy cytology, and remote pathologist review of the images was performed as part of a pilot study of mobile microscopy as a screening tool for oral cancer. Results indicated that the instrument successfully collected images of sufficient quality to enable remote diagnoses that show concordance with existing techniques. Further studies will evaluate the effectiveness of oral cancer screening with mobile microscopy by minimally trained technicians in low-resource settings.

A dysbiotic mycobiome dominated by Candida albicans is identified within oral squamous-cell carcinomas

The aim of this study was to characterize the mycobiome associated with oral squamous-cell carcinoma (OSCC). DNA was extracted from 52 tissue biopsies (cases: 25 OSCC; controls: 27 intra-oral fibro-epithelial polyps [FEP]) and sequenced for the fungal internal transcribed spacer 2 region using Illumina™ 2 x300bp chemistry. Merged reads were classified to species level using a BLASTN-algorithm with UNITE's named species sequences as reference. Downstream analyses were performed using QIIME™ and linear discriminant analysis effect size. A total of 364 species representing 160 genera and two phyla (Ascomycota and Basidiomycota) were identified, with Candida and Malassezia making up 48% and 11% of the average mycobiome, respectively. However, only five species and four genera were detected in ≥50% of the samples. The species richness and diversity were significantly lower in OSCC. Genera Candida, Hannaella, and Gibberella were overrepresented in OSCC; Alternaria and  Trametes  were more abundant in FEP. Species-wise, Candida albicans, Candida etchellsii, and a Hannaella luteola-like species were enriched in OSCC, while aHanseniaspora uvarum-like species, Malassezia restricta, and Aspergillus tamarii were the most significantly abundant in FEP. In conclusion, a dysbiotic mycobiome dominated by C. albicans was found in association with OSCC, a finding worth further investigation.

Maxillofacial prostheses challenges in resource constrained regions

BACKGROUND

This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations.

METHOD

A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries.

RESULTS

Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach.

CONCLUSIONS

In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities. Implications for Rehabilitation More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments. The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations. The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

Nonsteroidal anti-inflammatory drugs using and risk of head and neck cancer: a dose-response meta analysis of prospective cohort studies

Conflicting results identifying the relationship between nonsteroidal anti-inflammatory drugs using and head and neck cancer risk. Therefore, we performed this meta-analysis to clarify and quantitative assessed the relationship between nonsteroidal anti-inflammatory drugs using and head and neck cancer risk. Up to March 2017, 11 original publications were included in this meta-analysis. Our results showed statistically significant association between nonsteroidal anti-inflammatory drugs using and head and neck cancer risk reduction. Subgroups analysis indicated that Aspirin, COX 2 inhibitors, Ibuprofen and Other NSAIDs were associated with a significantly risk reduction of head and neck cancer. Furthermore, nonsteroidal anti-inflammatory drugs using was associated with a significantly lower risk of oral and oropharynx cancer, larynx cancer and hypopharynx cancer. In addition, increasing nonsteroidal anti-inflammatory drugs using (per 2 prescriptions/week increment) was associated with a 4% reduction in head and neck cancer risk, 5% reduction of aspirin using and 6% reduction of other nonsteroidal anti-inflammatory drugs using. Considering these promising results, increasing nonsteroidal anti-inflammatory drugs using might provide health benefits. More studies and large sample size are warranted to validate this association.