Contemporary concepts in the diagnosis of oral cancer and precancer

Patient perception after oral biopsies: an observational outpatient study

OBJECTIVE

The aim of this study was to evaluate the postoperative course in patients undergoing oral mucosal biopsies, considering clinical and patient's perception variables potentially correlated to poor healing.

SUBJECTS AND METHODS

Eighty patients underwent oral biopsies. All the variables connected with the surgery were recorded, and the harvested volume was calculated through image software (ImageJ, NIH, Betesda, USA). To evaluate the postoperative discomfort, the OHIP-14 and the numeric rating scale of pain (NRS) were administered at 6 h, 7 days and 21 days after biopsy.

RESULTS

Six hours after the biopsy, 22 (OHIP-14 ≥ 20) and 24 (NRS ≥ 4) patients experienced a troublesome or painful healing, respectively. A significant statistical correlation between poor healing and high scores of NRS and OHIP was detected (Pearson's correlation test p < 0.05). Higher values of OHIP-14 were correlated to the type of lesion (OR = 1.165; p < 0.05), whereas high values of NRS were correlated to the use of systemic drugs (p < 0.05). No surgical variable had a significant statistical correlation with any of the outcomes.

CONCLUSIONS

The clinical evaluation was correlated with the patient's perception of pain and discomfort. This finding could be suggestive of the fact that wound healing can be reliably monitored with the help of these tools.

CLINICAL RELEVANCE

Patient perception can be a predictor of the healing of biopsied tissues.

Possible association of periodontal disease with oral cancer and oral potentially malignant disorders: a systematic review

Background: Periodontitis has been associated with several systemic diseases and medical conditions, including oral cancer (OC). However, most studies reporting an association between OC and periodontal disease have used different clinical and radiographic criteria to define periodontal disease. This review aimed to evaluate the currently available evidence to determine an association between periodontal disease (extension and severity), OC, and oral potentially malignant disorders (OPMDs).Material and methods: A systematic search of studies published up to August 2018 was performed following the PRISMA guidelines in the electronic databases MEDLINE (PubMed) and COCHRANE (OVID). A methodological evaluation was made using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist.Results: Eight studies (case-control, cross-sectional and cohort) were included. An increased clinical attachment loss, plaque index, bleeding on probing, and radiographic bone loss was found in patients with OC and OPMDs. Differences in the methodological characteristics, case definition used for periodontal diseases, and OC location did not allow estimating the odds ratio required to conduct a meta-analysis.Conclusion: Some studies suggest a positive relationship between periodontal disease, OC, and OPMDs; however, the currently available evidence is insufficient to draw solid conclusions.

Analysis of octamer-binding transcription factor-4 expression in oral leukoplakia

Background:

Oral potentially malignant disorders have a risk for malignant transformation but are difficult to reliably identify and predict which patients are at the risk for malignant transformation. OCT4 has been hypothesized to play a key oncogenic driver in a variety of solid tumors. A deeper understanding of the aberrant molecular pathways which lead to carcinogenesis needs to be identified by the potential markers.

Aims:

To assess the OCT4 stemness factor in oral leukoplakia for its potential risk to malignant transformation.

Settings and Design:

20 cases of oral leukoplakia were obtained from archives at Oral Cancer Research & Coordinating center (OCRCC) Malaysia Subjects and Methods: 20 cases of oral leukoplakia were assessed by OCT4 immunohistochemically. Oral squamous cell carcinoma was used as a control.

Result:

no expression of OCT 4 was observed in any cases of oral leukoplakia.

Conclusion:

The molecular mechanisms of Oct4 regulation and in particular of its switch on and off in tissues depends upon its microenvironment, which makes it challenging in fundamental and applied research fields of regenerative medicine and cancer therapy. It's better that patients should undergo multiple biopsies for the early detection of malignant transformation with close follow-up during the first two to three years, a large amount of work remains to be done with multi-marker panel investigation, as cure rates have remained constant over three decades.

Comparison of expression of myofibroblasts in normal oral mucosa, oral epithelial dysplasia, and oral squamous cell carcinoma using α-SMA and vimentin: An immunohistochemical study

Background:

Myofibroblasts are thought to play critical roles in inflammation, growth, repair, premalignancy, and malignancy. This study was done to evaluate, compare and co- relate the progressive increase in the immunohistochemical expression of myofibroblasts in normal oral mucosa, epithelial dysplasia, and oral squamous cell carcinoma (OSCC). To compare and co-relate the expression of myofibroblasts in normal oral mucosa, epithelial dysplasia, and oral squamous cell carcinoma. To co-relate the progressive increase in myofibroblasts expression in normal oral mucosa, epithelial dysplasia, and oral squamous cell carcinoma.

Materials and Method:

Forty-nine paraffin-embedded tissue blocks with 7 cases of normal oral mucosa, 21 cases of epithelial dysplasia, and 21 diagnosed cases of OSCCs were studied. The samples were subjected to heat-induced antigen retrieval methods followed by staining using primary mouse monoclonal antibodies against α-smooth muscle actin (SMA) and vimentin. Staining index of all the sections was calculated. Statistical analysis was performed using the Kruskal–Wallis test, Mann–Whitney U test, and Chi-square test. Values of P less than or equal to 0.05 (P ≤ 0.05) were considered statistically significant.

Results:

Statistically significant staining index was obtained by α-SMA and vimentin between normal oral mucosa, epithelial dysplasia, and OSCC.

Conclusion:

Myofibroblast may play a role only during initial tumorigenesis that is the conversion of severe dysplasia into OSCC.

Assessment of the cancerization risk for oral potentially malignant disorders by clinical risk model combined with autofluorescence and brush biopsy with DNA-image cytometry

PURPOSE

To explore the feasibility of assessing the cancerization risk of oral potentially malignant disorders (OPMD) through a clinical risk model combined with autofluorescence and brush biopsy with DNA-image cytometry.

METHODS

We collected the baseline clinical data of 269 patients; then, performed autofluorescence, brush biopsy with DNA-image cytometry and histopathological examination. Then, we obtained the significant factors by univariate logistic analysis, constructed the clinical risk model by multiple logistic regression and selected the optimal cutoff value according to the maximum Youden index. Finally, we calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the clinical risk score ≥ cutoff value, autofluorescence and brush biopsy with DNA-image cytometry, and plotted the receiver-operating characteristic (ROC) curves and decision curve analysis (DCA).

RESULTS

The clinical risk model is represented by the formula: 1 × gender + 1.6 × age group + 1 × lesion site + 1.4 × local stimulus + 1.5 × drink. The area under the curve (AUC) was 0.83, and the optimal cutoff score was 3. The AUC indicated that the clinical risk score ≥ 3 (0.74) and autofluorescence (0.77) had a certain diagnostic values, while brush biopsy with DNA-image cytometry (0.92) displayed a good value. Besides, the DCA showed that all three tests had clinical significance.

CONCLUSIONS

The cancerization risk of patients can be assessed by the clinical risk model combined with sequence application of autofluorescence and brush biopsy with DNA-image cytometry, to decide whether histopathological examination or other intervention measures should be selected.

Oral Cancer Knowledge, Attitudes, and Practices among Dentists in Khartoum State, Sudan

The dental professions hold an important responsibility in the control of oral cancer and the early diagnosis highly depends on their knowledge. The present study was developed to assess the knowledge, attitude, and practice of dentists in Khartoum State regarding oral cancer prevention and early detection. An administered questionnaire was structured and sent to all licensed 130 dentists working in public dental clinics in Khartoum State. Responses to the questionnaire were analyzed using descriptive and analytical statistics. Although the majority of the dentists were knowledgeable about the major risk factors of oral cancer, more than half of the dentists reported they do not carry out any special examination to detect oral cancer in age 40 and above in asymptomatic patients. Dentists indicated their lack of training as the main barrier for conducting a comprehensive oral cancer examination. Interestingly, the vast majority of the dentists express their interest to have further oral cancer educational and training sessions. The findings of the present study suggested strongly that educational and training interventions are necessary to enhance preventive measures which may lead to reduce mortality and morbidity from oral cancer.

Hydrogen Sulfide Is Increased in Oral Squamous Cell Carcinoma Compared to Adjacent Benign Oral Mucosae

BACKGROUND/AIM

Hydrogen sulfide (H2S) and the enzymes that synthesize it, cystathionine-b-synthase, cystathionine γ-lyase, and 3-mercaptopyruvate, are increased in different human malignancies. Due to its short half-life, H2S concentrations have not been directly measured in a human malignancy. Here we directly measured in vivo H2S levels within oral squamous cell carcinoma (OSCC).

PATIENTS AND METHODS

Punch biopsies of OSCC and benign mucosae from 15 patients were analyzed by HPLC, western blotting, and tissue microarray analyses.

RESULTS

H2S concentrations were significantly higher in OSCC compared to adjacent benign oral mucosae. Western blot and tissue microarray studies revealed significantly increased cystathionine-b-synthase, cystathionine γ-lyase, and 3-mercaptopyruvate, phopho-Stat3, mitoNEET, hTERT, and MAPK protein levels in OSCC.

CONCLUSION

H2S concentrations and the enzymes that synthesize it are significantly increased in OSCC. Here, for the first time H2S concentrations within a living human malignancy were measured and compared to adjacent counterpart benign tissue.

Acetylshikonin suppresses invasion of Porphyromonas gingivalis‑infected YD10B oral cancer cells by modulating the interleukin-8/matrix metalloproteinase axis

The development of pharmaceutical agents possessing anti‑invasive and anti‑metastatic abilities, as well as apoptotic activity, is important in decreasing the incidence and recurrence of oral cancer. Cancer cells are known to acquire invasiveness not only through epigenetic changes, but also from inflammatory stimuli within the tumor microenvironment. Accordingly, the identification of agents that can suppress the inflammation‑promoted invasiveness of cancer cells may be important in treating cancer and improving the prognosis of patients with cancer. Acetylshikonin, a flavonoid with anti‑inflammatory activity, inhibits proliferation and induces apoptosis of oral cancer cells. In the present study, the anti‑invasive effect of acetylshikonin on YD10B oral cancer cells infected with Porphyromonas gingivalis, a major pathogen of chronic periodontitis, and the mechanisms involved were investigated. Firstly, we examined whether P. gingivalis infection increased the invasiveness of YD10B cells. Results suggested that YD10B oral cancer cells become more aggressive when they are infected with P. gingivalis. Secondly, acetylshikonin significantly inhibited the invasion of P. gingivalis‑infected YD10B cells by suppressing IL‑8 release and IL‑8‑dependent MMP release. These data suggest that acetylshikonin may be a useful preventive and therapeutic candidate for oral cancer that is chronically infected with periodontal pathogens.

Associated factors with oral cancer: a study of case control in a population of the Brazil's Northeast

OBJECTIVE

This study aimed at assessing the association between factors such as age, sex, skin color, occupation, educational level, marital status, place of residence, and tobacco and alcohol consumptions and oral cancer in individuals in a city in the northeast of Brazil between 2002 and 2012.

METHODS

This is a case-control study. The case group consisted of 127 people attended at the Oral Injury Reference Center with histopathological diagnosis of oral squamous cell carcinoma. The control group consisted of 254 individuals treated at the same center. The study considered two controls for each case. The cases and controls were adjusted according to sex and age. Univariate and bivariate analyses were performed (Pearson χ2-test) to verify the correlation between the dependent variable (oral cancer) and the independent variables; odds ratio (OR) and the confidence interval of 95% (95%CI) were calculated. Finally, in the multivariate analysis, it was used as the hierarchical model with logistic regression to explain the interrelationships between the independent variables and oral cancer.

RESULTS

Consumption of more than 20 cigarettes per day [OR = 6.64; 95%CI 2.07 - 21.32; p ≤ 0.001], an excessive alcohol consumption [OR = 3.25; 95%CI 1.03 - 10.22; p ≤ 0.044], and the synergistic consumption of tobacco and alcohol [OR = 9.65; 95%CI 1.57 - 59.08; p ≤ 0.014] are the most important risk factors for oral cancer.

CONCLUSION

It was concluded that tobacco and alcohol consumptions are the most important factors for the development of oral cancer. Sociodemographic factors were not associated with this neoplasm after adjusting for smoking and drinking.

Pan masala habits and risk of oral precancer: A cross-sectional survey in 0.45 million people of North India

OBJECTIVES

This cross-sectional community based study was conducted to estimate the prevalence of consumption habits for non tobacco pan masala (ASU) and the risk of developing oral precancer in North India.

METHODS

This study was conducted in the old town of Lucknow city in the state of Uttar Pradesh in India. Subjects residing for more than 6 months and aged 15 years or above, were enrolled in the study after their informed consent. A two page survey tool was used to collect the data. A three times more matched sample of non users was randomly obtained from this data to analyze and compare the final results.

RESULTS

0.45 million subjects were surveyed. Majority of tobacco users were in the age group of 20-35 years among males and 35-39 years among females. Consumption of non tobacco pan masala among males as well as females was most common in 15-19 years of age group. Prevalence of oral precancer (leukoplakia, submucous fibrosis, erythroplakia, lichen planus, smokers palate and verrucous hyperplasia) was 3.17% in non tobacco pan masala users and 12.22% in tobacco users. The odds of developing oral precancer in non tobacco pan masala users was 20.71 (18.79-22.82) and in tobacco users was 88.07 (84.02-92.31) at 95% confidence interval against non users of both.

CONCLUSION

The odds of developing oral precancer even with consumption of pan masala is high, even when it is consumed without tobacco. It is hence recommended to discourage this habit.

Accuracy of autofluorescence in diagnosing oral squamous cell carcinoma and oral potentially malignant disorders: a comparative study with aero-digestive lesions

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.

Oral Cancer Knowledge, Attitudes and Practices: A Survey of Undergraduate Medical Students in Himachal Pradesh, India

BACKGROUND

Oral cancer is the sixth most common cancer among Indian males and the third most common cancer among Indian females. Early detection of oral cancers makes them more amenable to treatment and allows the greatest chance of cure. Lack of awareness among the health care providers is the most significant factor in delaying diagnosis and treatment of oral cancer. So the aim of the study was to assess the knowledge, attitude and practices of oral cancer among undergraduate medical students in Indira Gandhi Medical College, Shimla, India.

MATERIALS AND METHODS

A cross-sectional questionnaire study was conducted among 186 undergraduate medical students between the third to fifth years in Indira Gandhi Medical College, Shimla. The questionnaire consisted of 15 questions, five each on knowledge, attitudes and practices. The data were analysed by Statistical Package for the Social Sciences version 16. Test used were t-test, Chi-square and ANOVA.

RESULTS

The response rate of the study was 96.5%. The mean knowledge percent of the sample was good. Mean knowledge percent was higher in females than males. Higher percentage of students in 5(th) year (internship) had excellent knowledge. The knowledge and practices about risk factors was not satisfactory. One hundred and twenty four (66.6%) of the subjects disagreed/strongly disagreed that their knowledge regarding the prevention and detection of oral cancer is current adequate. One hundred and seventy six and (94.6%) agreed/strongly agreed that there is need for additional training/information regarding oral cancer.

CONCLUSION

It can be concluded that though the mean knowledge of the population was good but the knowledge and practices about risk factors had to be reinforced among these students so that they can help the patients in tobacco and alcohol cessation and contribute in prevention of oral cancers.

Prolonged and repetitive exposure to Porphyromonas gingivalis increases aggressiveness of oral cancer cells by promoting acquisition of cancer stem cell properties

Periodontitis is the most common chronic inflammatory condition occurring in the human oral cavity, but our knowledge on its contribution to oral cancer is rather limited. To define crosstalk between chronic periodontitis and oral cancer, we investigated whether Porphyromonas gingivalis, a major pathogen of chronic periodontitis, plays a role in oral cancer progression. To mimic chronic irritation by P. gingivalis in the oral cavity, oral squamous cell carcinoma (OSCC) cells were infected with P. gingivalis twice a week for 5 weeks. Repeated infection of oral cancer cells by P. gingivalis resulted in morphological changes of host cancer cells into an elongated shape, along with the decreased expression of epithelial cell markers, suggesting acquisition of an epithelial-to-mesenchymal transition (EMT) phenotype. The prolonged exposure to P. gingivalis also promoted migratory and invasive properties of OSCC cells and provided resistance against a chemotherapeutic agent, all of which are described as cellular characteristics undergoing EMT. Importantly, long-term infection by P. gingivalis induced an increase in the expression level of CD44 and CD133, well-known cancer stem cell markers, and promoted the tumorigenic properties of infected cancer cells compared to non-infected controls. Furthermore, increased invasiveness of P. gingivalis-infected OSCC cells was correlated with enhanced production of matrix metalloproteinase (MMP)-1 and MMP-10 that was stimulated by interleukin-8 (IL-8) release. This is the first report demonstrating that P. gingivalis can increase the aggressiveness of oral cancer cells via epithelial-mesenchymal transition-like changes and the acquisition of stemness, implicating P. gingivalis as a potential bacterial risk modifier.

Knowledge, attitude and practices about oral cancers among dental students in H.P Government Dental College, Shimla-Himachal Pradesh

AIM

The aim was to assess the knowledge, attitude and practices among undergraduate dental students about oral cancer.

MATERIALS AND METHODS

A cross-sectional questionnaire study was conducted among undergraduate dental students between the 3rd and 5th years in H.P Government Dental College, Shimla. The questionnaire consisted of 15 questions, five each on knowledge, attitudes and practices. The data were analyzed by Statistical Package for the Social Sciences (SPSS Inc., version 16 for Windows, Chicago, IL, USA).

RESULTS

The response rate of the study was 90.6%. There were 23 (21.5%) males and 84 (78.5%) females in the study. There was a predominance of females (78.5%). The average knowledge percentage for the entire population is 81.9% (excellent knowledge). Tobacco and alcohol were correctly identified by 63.5% of the subjects. Squamous cell carcinoma was described as the most common type of oral cancer by 105 (98.3%) of the students. 60.7% of the subjects strongly disagreed that their knowledge regarding the prevention and detection of oral cancer is current and adequate, and 99% agreed that there is a need for additional training/information regarding oral cancer. About 92.5% of the subjects used to educate their subjects about the harmful effects of tobacco and alcohol.

CONCLUSION

The study implies that the knowledge, especially about the etiological factors of oral cancer needs to be reinforced throughout the undergraduate dental courses so that they can use the same in educating and motivating the masses to adapt healthy lifestyles.

The use of light-based (optical) detection systems as adjuncts in the detection of oral cancer and oral potentially malignant disorders: a systematic review

INTRODUCTION

In recent decades, optical techniques utilising the principles of chemiluminescence and tissue autofluorescence have emerged to facilitate the early detection of any oral mucosal changes suspicious of cancer.

PURPOSE

To evaluate the effectiveness of devices that utilise the principles of chemiluminescence and tissue autofluorescence as adjuncts in the detection of oral cancer and oral potentially malignant disorders (OPMDs).

METHODS

A systematic review of the published literature to evaluate the effectiveness of the ViziLite(®) and ViziLite(®) Plus with toluidine blue, MicroLux™/DL and the VELscope™ as aids in the detection of oral cancer and OPMDs.

RESULTS

Twenty-five primary studies published between 2004 and 2013 satisfied our criteria for selection - 13 utilised chemiluminescence and 12 tissue autofluorescence. Some had utilised both study methods on the same population. Chemiluminescence shows good sensitivity at detecting any OPMDs and oral cancer. However, it preferentially detects leukoplakia and may fail to spot red patches. The additive use of toluidine blue may improve specificity. Tissue autofluorescence is sensitive at detecting white, red and white and red patches, and the area of fluorescence visualisation loss (FVL) often extends beyond the clinically visible lesion. However, in addition to OPMDs, VELScope may detect erythematous lesions of benign inflammation resulting in false-positive test results.

CONCLUSION

There is limited evidence for their use in primary care, and these tools are better suited to specialist clinics in which there is a higher prevalence of disease and where experienced clinicians may better discriminate between benign and malignant lesions.

Chitosan-based mucoadhesive films containing 5-aminolevulinic acid for buccal cancer's treatment

Photodynamic therapy (PDT) is a relatively new method to treat various kinds of tumors, including those of the oral cavity. The topical 5-ALA-PDT treatment for tumors of the oral mucosa is preferred, since when administered systemically, there is a general photosensitization drawback in the patient. However, 5-ALA is a hydrophilic molecule and its penetration and retention is limited by topical route, including oral mucosa. We propose a topical delivery system of chitosan-based mucoadhesive film, aiming to promote greater retention of 5-ALA in tissue. The chitosan (CHT) films (4% w/w) were prepared using the solvent evaporation/casting technique. They were tested without 5-ALA resulting in permeability to water vapor (W.V.P=2.15-8.54 g mm/(h cm(2)Pa) swelling ∼300.0% (±10.5) at 4 h or 24 h and in vitro residence time >24 h for all tests. CHT films containing 10.0% (w/w) 5-ALA have resulted in average weight of 0.22 g and thickness of 0.608 mm as suitable characteristics for oral application. In the presence of CHT films both in vitro permeation and retention of 5-ALA (1.0% or 10.0%) were increased. However, 10.0% 5-ALA presented highest values of permeation and retention (∼4 and 17 times respectively, compared to propylene glycol vehicle). On the other hand, in vitro mucoadhesion of CHT films was decreased (18.2-fold and 3.1-fold) by 5-ALA addition (1.0% or 10.0% respectively). However, CHT film containing 10.0% of 5-ALA can be a potential delivery system for topical use in the treatment of tumors of the oral cavity using PDT because it favored the retention of 5-ALA in this tissue and has shown convenient mucoadhesion.

A rare presentation of multiple primary squamous cell carcinoma of the tongue in a patient with recurrent hepatitis C infection

Hepatitis C virus (HCV) infection has been implicated as a risk factor for development of oral squamous cell carcinoma (SCC). Multiple primary sites of oral SCC associated with HCV infection occurs infrequently. This case report describes a rare presentation of multiple primary SCCs of the tongue in a patient with recurrent HCV cirrhosis status post liver transplant that required interdisciplinary medical and surgical management. It is important for oral health care providers to understand the local and systemic implications of HCV infection and perform routine clinical examinations to monitor for development of oral lesions and associated complications.

Porphyromonas gingivalis-induced autophagy suppresses cell proliferation through G1 arrest in oral cancer cells

OBJECTIVES

We investigated the response of oral cancer cells to intracellular invasion of Porphyromonas gingivalis to define changes in the biological characteristics of oral cancer cells evoked by the presence of oral pathogenic bacteria within a tumour microenvironment.

DESIGNS

The proliferative activity, cell cycle, and autophagic response were evaluated in oral cancer cells infected with P. gingivalis 381. ROS generation was detected in these cells by DCFDA assay, and its role in the responses of oral cancer cells to P. gingivalis infection was further investigated.

RESUTLS

P. gingivalis inhibited proliferation of oral cancer cells by inducing G1 cell cycle arrest, but had no effect on apoptosis. Following infection with P. gingivalis, the expression of cyclin D1 and cdk4 was decreased in oral cancer cells, whereas p21, a Cdk inhibitor, was upregulated, in comparison with non-infected controls. Autophagy was prominently enhanced in these infected cells, presumably contributing to the suppressed proliferation. Further experiments revealed that such autophagic response was activated by the formation of reactive oxygen species, as evidenced by the lack of autophagic response and cell proliferation upon removal of reactive oxygen species.

CONCLUSIONS

These findings provide a novel insight into the mechanism by which cancer cells are influenced by tumour microenvironment including oral bacteria.

The Self-Reported Knowledge, Attitude and the Practices Regarding the Early Detection of Oral Cancer and Precancerous Lesions among the Practising Dentists of Dakshina Kannada-A Pilot Study

INTRODUCTION

Oral squamous cell carcinoma is one of the leading causes of mortality in India. The screening and the early detection of the premalignant and malignant lesions are the only means for controlling the disease. General dental practitioners can play a great role in this direction. The objective of the present study was to assess the self-reported knowledge, attitude, as well as the practices concerning the early detection of oral cancer among the dentists of Dakshina Kannada, Karnataka, India.

MATERIAL AND METHODS

About 200 clinicians (BDS/MDS) were randomly selected for an 18 itemed questionnaire survey. The aspects which were enquired into were the usage of exfoliative cytology in their clinical practice, the recent attempts which are made by dentists at updating their knowledge on oral cancer, their practical approaches towards the screening for oral premalignant diseases, etc.

RESULTS

Over 98% of the dentists reported to have not performed exfoliative cytology in their clinics. However, 85% had attended education programs on oral cancer. About 72% felt the need to be trained and they welcomed the suggestion of conducting practical workshops in this direction. 29.5% conducted biopsies when they encountered suspicious looking lesions, but only 13% counseled such patients for the habit cessation. 86% felt the need for Oral Pathology consultants in their clinics.

CONCLUSION

This pilot survey identified an existing gap in the knowledge and practices among physicians and dentists and this emphasises the need to increase the numbers of oral cancer detection workshops which are held among the professional groups.

MAPK/ERK-dependent translation factor hyperactivation and dysregulated laminin γ2 expression in oral dysplasia and squamous cell carcinoma

Lesions displaying a variety of dysplastic changes precede invasive oral and epidermal squamous cell carcinoma (SCC); however, there are no histopathological criteria for either confirming or staging premalignancy. SCCs and dysplasias frequently contain cells that abnormally express the γ2 subunit of laminin-332. We developed cell culture models to investigate γ2 dysregulation. Normal human keratinocytes displayed density-dependent repression of γ2, whereas premalignant keratinocytes and SCC cells overexpressed γ2 and secreted laminin assembly intermediates. Neoplastic cells had hyperactive EGFR/MAPK(ERK) signaling coordinate with overexpressed γ2, and EGFR and MEK inhibitors normalized γ2 expression. Keratinocytes engineered to express HPV16 E6 or activated mutant HRAS, cRAF1, or MEK1 lost density repression of γ2 and shared with neoplastic cells signaling abnormalities downstream of ERK, including increased phosphorylation of S6 and eIF4 translation factors. Notably, qPCR results revealed that γ2 overexpression was not accompanied by increased γ2 mRNA levels, consistent with ERK-dependent, eIF4B-mediated translation initiation of the stem-looped, 5'-untranslated region of γ2 mRNA in neoplastic cells. Inhibitors of MEK, but not of TORC1/2, blocked S6 and eIF4B phosphorylation and γ2 overexpression. Immunostaining of oral dysplasias identified γ2 overexpression occurring within fields of basal cells that had elevated p-S6 levels. These results reveal a causal relationship between ERK-dependent translation factor activation and laminin γ2 dysregulation and identify new markers of preinvasive neoplastic change during progression to SCC.

The findings of a nurse-lead intervention for detection and prevention of oral cancer. A pilot study

Despite the fact that South African men are among the group having the highest risk of developing oral cancer there is currently no population-based primary and secondary prevention services for oral cancer in South Africa. This study aimed to develop an intervention focusing on the prevention and detection of oral cancer and pilot test the intervention in a semi-urban resource-poor community in Tshwane. The intervention was assessed in terms of screening uptake, knowledge and awareness of oral cancer and perception of the educational material developed for the intervention. Statistics were used to calculate screening uptake while a pre- and post-intervention design was used to determine knowledge and awareness and perception of the educational material. Sampling was purposive and all people reporting for oral screening were recruited for the study. The sample totalled 65 (n= 65) and the participation rate was 100%. Notwithstanding a favourable report on the flyer as motivator to take up oral screening the number of people especially those in the high-risk group who reported for screening was disappointing. However, the strategy used to improve knowledge and awareness was successful. Ways to improve screening uptake should be explored and tested to improve the current intervention.