Oral cytologic patterns and nutritional status: some relationships in alcoholic subjects

Effect of ethanol on lipid metabolism and epithelial permeability barrier of skin and oral mucosa in the rat

BACKGROUND

Ethanol consumption induces changes in lipid metabolism. This might be reflected locally as an alteration in the epithelial lipid barrier.

METHODS

Rats were fed with an isocaloric liquid diet with, or without, ethanol (6.7%) and were sacrificed at 60 or 120 days. Plasma and liver triglycerides, gamma-glutamyl-transferase (GGTP) levels, and permeability (Kp) of skin and buccal mucosa to tritiated water and the tobacco carcinogen, nitrosonornicotine, were determined.

RESULTS

Significant elevation of GGTP at 120 days and triglycerides at both 60 and 120 days was observed for rats fed with ethanol diet. For this diet, Kp values to both penetrants increased significantly for skin in rats after 120 days compared to all other groups.

CONCLUSION

The parallel between changes in lipid metabolism and permeability suggests that one effect of ingested alcohol is to alter the lipid-containing permeability barrier of stratified squamous epithelium.

Effect of alcohol on the oral mucosa assessed by quantitative cytomorphometry

The effect of alcohol on the oral mucosa was assessed using quantitative cytomorphology applied to smears taken from clinically normal oral mucosa of patients attending an alcohol problem unit and results were compared to a control group (consisting of social and non-drinkers) attending a hospital for routine dental care. Smears were stained using the Papanicolaou method and the nuclear and cell boundaries of 50 randomly selected cells traced and mean areas (NA and CA, respectively) calculated. The average number of units of alcohol consumed were recorded for each group together with relevant blood tests. The alcohol group was further subdivided into "binge" and "regular" drinkers. No significant differences were found between mean NA and mean CA values for these two types of alcohol drinkers, despite a marked difference in weekly units consumed. However, a statistically significant reduction in mean cytoplasmic area (P < 0.001) and mean nuclear area (P < 0.01) was found for the alcohol group when compared to controls. In conclusion, excess alcohol intake may influence results for quantitative oral cytomorphology. Further research is indicated on the relative effects of alcohol (both topical and systemic).

The effect of distant malignancy upon quantitative cytologic assessment of normal oral mucosa

In 1962 Nieburgs et al. reported specific changes within cells taken from normal buccal mucosa, in those with malignant disease distant from the oral cavity. Few have attempted to confirm these findings. Given the potential application of the observations of Nieburgs et al., a quantitative investigation seemed necessary. Two groups were studied: 40 patients with malignant disease outside the oral cavity and 40 healthy patients attending for routine dental treatment. Both groups were matched for age and sex, with anemia excluded. Quantitative cytologic assessment of nuclear (NA) and cytoplasmic area (CA) and DNA distribution (using DNA cytophotometric study) were calculated from cells in normal buccal mucosal smears. No significant difference in NA (P = 0.28) was found between the two groups. However, a significant reduction in CA (P = 0.005) was found within the distant malignancy group. DNA distribution was invariably diploid. Previous studies on the effect of distant malignancy and nutritional deficiency have concentrated on examination of the nucleus, with exclusion of the cytoplasm. Important changes, such as the one reported, may therefore have gone unrecorded, particularly since oral smears have rarely been quantitatively assessed. The cause of this decrease in CA in distant malignancy patients is discussed with regard to the patients' nutritional state. The buccal smear may yet prove of value in assessing nutritional deficiency consequent to internal malignancy.