Oral mucosal malignancy and potentially malignant lesions: an update on the epidemiology, risk factors, diagnosis and management

Prevalence and risk factors of oral potentially malignant disorders in Indonesia: a cross-sectional study undertaken in 5 provinces

Detection of subjects with oral potentially malignant disorders in a population is key to early detection of oral cancer (OC) with consequent reduction of cancer-related morbidity and mortality. Our aim was to investigate the prevalence and associated risk factors for OPMD in representative provinces of Indonesia. This cross-sectional study was undertaken in five Indonesian provinces: West Java (WJ), Jakarta (JKT), West Papua (WP), West Kalimantan (WK) and Banda Aceh (BA). Respondents answered a previously validated questionnaire including information on ethnicity, occupation, socioeconomic status (SES), oral health practices, and behaviours associated with oral cancer. An oral examination was undertaken using WHO standardized methodology. Data were analysed using ANOVA, Chi-Square, and logistic regression to assess association between risk factors and mucosal disease. A total of 973 respondents between the ages of 17 and 82 years was enrolled (WJ 35.5%,JKT 13.3% WP 18.3%, WK 9%, BA 23.9%). Tobacco smoking (14.8%), Betel quid (BQ) chewing (12.6%) and alcohol drinking (4%) varied geographically. A well-established OPMD was detected in 137 (14.1%) respondents and 2 (0.2%) presented with chronic ulceration later diagnosed as OC. Leukoplakia was the most common OPMD found (9.7%), while the prevalence of oral submucous fibrosis (OSMF), not previously described in the nation, was 2.3%. Poor knowledge of OC risk factors, poor oral hygiene behaviours, low-income SES and ethnicity were significantly associated with the presence of an OPMD. There is a previously under-reported high prevalence of OPMD in Indonesia. Overall, we found a strong correlation between the presence of an OPMD and individual habituation to known risk factors.

Genetically predicted gut microbiome and risk of oral cancer

PURPOSE

Mounting evidence suggests a possible link between gut microbiome and oral cancer, pointing to some potential modifiable targets for disease prevention. In the present study, Mendelian randomization (MR) was used to explore whether there was a causal link between gut microbiome and oral cancer.

METHODS

The single nucleotide polymorphisms (SNPs) significantly associated with gut microbiome were served as instrumental variables. MR analyses were performed using genetic approaches such as inverse variance weighting (IVW), MR Egger and weighted median, with IVW as the primary approach, supplemented by MR Egger and weighted median. Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) and MR-Egger regression were used to detect the presence of horizontal pleiotropy and identify outlier SNPs.

RESULTS

Causal effect estimates indicated that genetically predicted abundance of Prevotellaceae was associated with higher risk of oral cancer (odds ratio (OR) 1.80, 95% confidence interval (CI) 1.16-2.81, p = 0.009). There was no evidence of notable heterogeneity and horizontal pleiotropy.

CONCLUSION

Genetically derived estimates suggest that Prevotellaceae may be associated with the risk of oral cancer. Such robust evidence should be given priority in future studies and explore the underlying mechanisms.

Clinical evaluation of photodynamic therapy for oral leukoplakia: a retrospective study of 50 patients

BACKGROUND

Topical photodynamic therapy (PDT) has demonstrated encouraging results in the treatment of oral leukoplakia (OLK). However, data on the clinical efficacy of PDT in Chinese patients with OLK are still limited.

METHODS

Fifty patients diagnosed with OLK were enrolled, including patients with various dysplastic tissues. All patients received topical PDT with 5-aminolevulinic acid (5-ALA) as a photosensitizer. Clinical efficacy was evaluated 4 weeks after treatment. Follow-up was performed every 3 months during the first year and every 6 months during the second year.

RESULTS

The overall response rate was 68% (34/50): 12% (n = 6) complete and 56% (n = 28) partial responses. Aneuploidy was reduced in the patients with dysplastic lesions. Oral pain and local ulcers developed in 52% of the patients (n = 26). Patients with a long history of OLK including hyperplasia and dysplastic lesions, as well as those with non-homogenous lesions, were more likely to develop pain and ulcer. During follow-up, the recurrence rate of hyperplasia and dysplastic lesions was 32% (n = 16) and the malignant transformation rate of dysplastic lesions was 4% (n = 2). Lesions on the buccal mucosa were associated with recurrence (P = 0.044; OR: 0.108, 95% CI: 0.013-0.915).

CONCLUSION

Topical 5-ALA-mediated PDT is an effective treatment for OLK, particularly for homogenous leukoplakia, with few side effects. The buccal mucosa may be a protective factor that can reduce recurrence.

A novel and independent survival prognostic model for OSCC: the functions and prognostic values of RNA-binding proteins

BACKGROUND

Oral squamous cell carcinoma (OSCC), exhibiting high morbidity and malignancy, is the most common type of oral cancer. The abnormal expression of RNA-binding proteins (RBPs) plays important roles in the occurrence and progression of cancer. The objective of the present study was to establish a prognostic assessment model of RBPs and to evaluate the prognosis of OSCC patients.

METHODS

Gene expression data in The Cancer Genome Atlas (TCGA) were analyzed by univariate Cox regression analysis model that established a novel nine RBPs, which were used to build a prognostic risk model. A multivariate Cox proportional regression model and the survival analysis were used to evaluate the prognostic risk model. Moreover, the receive operator curve (ROC) analysis was tested further the efficiency of prognostic risk model based on data from TCGA database and Gene Expression Omnibus (GEO).

RESULTS

Nine RBPs' signatures (ACO1, G3BP1, NMD3, RNGTT, ZNF385A, SARS, CARS2, YARS and SMAD6) with prognostic value were identified in OSCC patients. Subsequently, the patients were further categorized into high-risk group and low-risk in the overall survival (OS) and disease-free survival (DFS), and external validation dataset. ROC analysis was significant for both the TCGA and GEO. Moreover, GSEA revealed that patients in the high-risk group significantly enriched in many critical pathways correlated with tumorigenesis than the low, including cell cycle, adheres junctions, oocyte meiosis, spliceosome, ERBB signaling pathway and ubiquitin-mediated proteolysis.

CONCLUSIONS

Collectively, we developed and validated a novel robust nine RBPs for OSCC prognosis prediction. The nine RBPs could serve as an independent and reliable prognostic biomarker and guiding clinical therapy for OSCC patients.

"Salivary LINC00657 and miRNA-106a as diagnostic biomarkers for oral squamous cell carcinoma, an observational diagnostic study"

BACKGROUND

Early detection and diagnosis of malignant tumors is critical for improving the survival rate and treatment outcomes of oral cancer. Thus, the current prospective investigation was designed to verify the role, sensitivity, and specificity of salivary LINC00657 and miRNA-106a as diagnostic markers in oral squamous cell carcinoma patients as compared to oral lichen planus (as an example of oral potentially malignant disorders) and normal individuals, and to show LINC00657 relation to miR-106a.

METHODS

A total of 36 participants were included, subdivided into 3 groups: Group I: 12 patients diagnosed with oral squamous cell carcinoma (OSCC). Group II: 12 patients diagnosed with oral lichen planus (OLP). Group III: 12 systemically free individuals with no oral mucosal lesions. Unstimulated salivary samples were collected from all participants to evaluate level of LINC00657 and miR-106a in different groups using quantitative real-time PCR.

RESULTS

OSCC showed the highest LINC00657 and lowest miR-106a fold change among included groups. Receiver Operating Characteristic (ROC) curve analysis of the two biomarkers for detecting OSCC revealed that LINC00657 had higher diagnostic accuracy (DA) (83.3%) compared to miR-106a (80.4%). As for detecting OLP, ROC analysis showed that miR-106a had higher (DA) (61%) compared to LINC00657 (52.5%). To discriminate OSCC from OLP, the diagnostic accuracy of both markers is the same (75%). Moreover, differentiating OSCC grades II and III, ROC analysis showed that miR-106a had lower (DA) (60%) compared to LINC00657 (DA) (83.3%).

CONCLUSIONS

Salivary LINC00657 and miR-106a could be promising diagnostic markers for oral squamous cell carcinoma. Salivary LINC00657 may differentiate oral squamous cell carcinoma from oral potentially malignant disorders with considerable diagnostic accuracy. Moreover, low levels of salivary miR-106a could have the potential to indicate malignancy.

TRIAL REGISTRATION

The study was retrospectively registered on clinicaltrial.gov with NCT05821179 (first trial registration in 26/3/2023), date of registration: 19/4/2023.

Confocal microscopy in oral cancer and oral potentially malignant disorders: A systematic review

OBJECTIVE

To systematically identify and summarise current research on the utility of confocal microscopy in oral squamous cell carcinoma and oral epithelial dysplasia in oral potentially malignant disorders.

METHODS

Databases Medline, Embase, Evidence-Based Medicine, and Web of Science were searched with articles screened and included if their primary objective was the use of a confocal microscope in diagnosis of oral cancer or epithelial dysplasia, in vivo or ex vivo.

RESULTS AND DISCUSSION

Twenty-eight relevant studies were identified of which 21 studies included oral squamous cell carcinoma specimens. Fifteen studies included in vivo use. The studies included both qualitative and fluorescence confocal microscope and reflectance confocal microscope analysis along with quantitative analysis of carcinoma and dysplasia. Thirteen studies reported the predictive value of their confocal device in the diagnosis of dysplasia and carcinoma. The quantitative software-based studies show promise in objectifying the diagnostic process for identifying abnormalities within the microstructure of the oral mucosa.

CONCLUSIONS

There was heterogeneity in the criteria for diagnosis of dysplasia and oral squamous cell carcinoma with experience levels of assessors impacting method efficacy. Both qualitative and quantitative confocal assessment methodologies have been explored, the latter highlighting the potential of future machine-augmented diagnostic precision.

Electric Bioimpedance Sensing for the Detection of Head and Neck Squamous Cell Carcinoma

The early detection of head and neck squamous cell carcinoma (HNSCC) is essential to improve patient prognosis and enable organ and function preservation treatments. The objective of this study is to assess the feasibility of using electrical bioimpedance (EBI) sensing technology to detect HNSCC tissue. A prospective study was carried out analyzing tissue from 46 patients undergoing surgery for HNSCC. The goal was the correct identification of pathologic tissue using a novel needle-based EBI sensing device and AI-based classifiers. Considering the data from the overall patient cohort, the system achieved accuracies between 0.67 and 0.93 when tested on tissues from the mucosa, skin, muscle, lymph node, and cartilage. Furthermore, when considering a patient-specific setting, the accuracy range increased to values between 0.82 and 0.95. This indicates that more reliable results may be achieved when considering a tissue-specific and patient-specific tissue assessment approach. Overall, this study shows that EBI sensing may be a reliable technology to distinguish pathologic from healthy tissue in the head and neck region. This observation supports the continuation of this research on the clinical use of EBI-based devices for early detection and margin assessment of HNSCC.

Artificial Intelligence for Image Analysis in Oral Squamous Cell Carcinoma: A Review

Head and neck tumor differential diagnosis and prognosis have always been a challenge for oral pathologists due to their similarities and complexity. Artificial intelligence novel applications can function as an auxiliary tool for the objective interpretation of histomorphological digital slides. In this review, we present digital histopathological image analysis applications in oral squamous cell carcinoma. A literature search was performed in PubMed MEDLINE with the following keywords: "artificial intelligence" OR "deep learning" OR "machine learning" AND "oral squamous cell carcinoma". Artificial intelligence has proven to be a helpful tool in histopathological image analysis of tumors and other lesions, even though it is necessary to continue researching in this area, mainly for clinical validation.

A new method for oral cancer biomarkers detection with a non-invasive cyto-salivary sampling and rapid-highly sensitive ELISA immunoassay: a pilot study in humans

Introduction

Oral squamous cell carcinoma (OSCC) accounts for approximately 90% of oral malignancies and has a 5-year mortality rate close to 50%. A consistent part (70%) of all oral cancers is diagnosed at an advanced stage since available screening techniques are ineffective. Therefore, it would be urgent to improve them. The diagnostic gold standard is tissue biopsy with histological and immunohistochemical assessment. This method presents some limitations. Biopsy is invasive and the histopathological evaluation is semi-quantitative, and the absolute abundance of the target cannot be reliably determined. In addition, tissue is highly processed and may lead to loss of information of the natural state. The search for classical and new clinical biomarkers on fragments of tissue/cells collected with a cytobrush is a highly hopeful technique for early detection and diagnosis of OSCC, because of its non-invasive sampling and easy collection method.

Methods

Here we analyzed cytobrush biopsies samples collected from the oral cavity of 15 patients with already diagnosed OSCC by applying an innovative high-sensitivity ELISA technique, in order to verify if this approach may provide useful information for detection, diagnosis, and prognosis of OSCC. To this end, we selected six biomarkers, already used in clinical practice for the diagnosis of OSCC (EGFR, Ki67, p53) or selected based on recent scientific and clinical data which indicate their presence or over-expression in cells undergoing transformation and their role as possible molecular targets in immunecheckpoints blockade therapies (PD-L1, HLA-E, B7-H6).

Results

The selected tumor biomarkers were highly expressed in the tumor core, while were virtually negative in healthy tissue collected from the same patients. These differences were highly statistically significant and consistent with those obtained using the gold standard test clearly indicating that the proposed approach, i.e. analysis of biomarkers by a custom ELISA technique, is strongly reliable.

Discussion

These preliminary data suggest that this non-invasive rapid phenotyping technique could be useful as a screening tool for phenotyping oral lesions and support clinical practice by precise indications on the characteristics of the lesion, also with a view to the application of new anti-tumor treatments, such as immunotherapy, aimed at OSCC patients.

Cancer Stem Cells in Head and Neck Squamous Cell Carcinoma

Cancer stem cells (CSCs) are a small sub-population of cells within a tumor mass proficient of tumor initiation and progression. Distinguishing features possessed by CSCs encompass self-renewal, regeneration and capacity to differentiate. These cells are attributed to the phenomenon of aggression, recurrence and metastasis in neoplasms. Due to their cancer initiating and contributing features, a proper understanding of these CSCs and its microenvironment would aid in better understanding of cancer and designing better targeted therapeutic strategies for improved clinical outcome, thus improving the prognosis. This article dispenses a narrative review of CSCs in the context of head and neck carcinoma under the sub headings of overview of cancer stem cells, methods of isolation of these cells, putative CSC markers of head and neck cancer, signaling pathways used by these cells and their therapeutic implications.

Evaluation of crystallization patterns in oral potentially malignant disorders and oral malignancies: A prospective study

Background

Oral cancers are often detected at late stages, and patients usually had a 50% chance of a 5-year survival rate. Oral cancer usually has an early precancerous stage before its actual malignant transformation. Although there are various approaches to diagnose the early stages of cancer, there is one less explored, cost-effective, and simple technique known as the crystallization test. The aim of the study was to evaluate the crystallization patterns in tobacco users, oral potentially malignant disorders (OPMDs), and oral malignancies.

Materials and Methods

Fifteen patients with oral malignancies, 15 patients with oral potentially malignant disorders, 15 tobacco users, and 15 healthy individuals participated in the crystallization test. Single blood drop was used to perform this test and the obtained crystal patterns were analyzed.

Results

This test had a sensitivity of 93.3%, 80.0%, and 20.0% for oral malignancies, oral Potentially Malignant Disorders (PMDs), and tobacco users, respectively. Chi-square analysis revealed a highly significant transverse form between OPMDs and oral malignancies (P < 0.05).

Conclusion

Crystallization test was found to be a sensitive, reliable, economical, and less invasive procedure for screening of oral PMDs and oral malignancies under strictly maintained physical conditions.

Three-Dimensional Spheroid Configurations and Cellular Metabolic Properties of Oral Squamous Carcinomas Are Possible Pharmacological and Pathological Indicators

The objective of the current study was to elucidate the clinicopathological significance and appearance of in vitro three-dimension (3D) spheroid models of oral malignant tumors that were prepared from four pathologically different squamous cell carcinoma (OSCC; low-grade; SSYP and MO-1000, intermediate-grade; LEM2) and oral adenosquamous carcinoma (OASC; high-grade; Mesimo) obtained from patients with different malignant stages. To characterize the biological significance of these cell lines themselves, two-dimensional (2D) cultured cells were subjected to cellular metabolic analysis by a Seahorse bioanalyzer alongside the measurement of the cytotoxicity of cisplatin (CDDP). The appearance of their 3D spheroids was then observed by phase contrast microscopy, and both 2D and 3D cultured cells were subject to trypsin digestion and qPCR analysis of factors related to oncogenic signaling and other related analyses. ATP-linked respiration and proton leaking were significantly different among the four cell lines, and the malignant stages of these cultures were significantly associated with increased ATP-linked respiration and decreased proton leakage. Alternatively, the appearances of these 3D spheroids were also significantly diverse among them, and their differences increased in the order of LEM2, MO-1000, SSYP, and Mesimo. Interestingly, these orders were exactly the same in that the efficacies of CDDP-induced cytotoxicity increased in the same order. qPCR analysis indicated that the levels of expression of oncogenic signaling-related factors varied among these four cell lines, and the values for fibronectin and a key regulator of mitochondrial biogenesis, PGC-1α, were prominently elevated in cultures of the worst malignant Mesimo cells. In addition, although 0.25% trypsin-induced destruction was comparable among all four 2D cultured cells, the values for the 3D spheroids were also substantially varied among these cultures. The findings reported herein indicate that cellular metabolic functions and 3D spheroid architectures may be valuable and useful indicators for estimating the pathological and drug-sensitive aspects of OSCC and OASC malignancies.

Knowledge, Opinions, and Practices of Oral Cancer Prevention among Palestinian Practicing Dentists: An Online Cross-Sectional Questionnaire

Oral-health professionals play a critical role in the early recognition and prevention of oral cancer; however, most patients are diagnosed in the advanced stages that demonstrate poor prognosis. Therefore, this study aimed to investigate the knowledge, opinions, and clinical practices of practicing dentists related to oral cancer prevention and oral mucosal screening in Palestine. This research used an online cross-sectional questionnaire design. Practicing dentists in Palestine completed the 44-item questionnaire encompassing the following four sections: (a) personal data (6 items); (b) oral cancer knowledge (21 items); (c) opinions and beliefs related to oral cancer (10 items); and (d) clinical practices related to oral cancer (7 items). The questionnaire was sent to all eligible participants (N = 650) between July and September of 2022. The response rate was 39.1% (N = 254). About 70.1% of the respondents had poor knowledge of oral cancer and its risk factors, and almost 84.3% had positive opinions related to oral cancer prevention and oral mucosal screening. Concerning the clinical practices, only 29.9% routinely examined their patients every time their patients visited. More experienced dentists showed significantly more positive opinions and better clinical practices related to oral cancer prevention and screening; however, they had significantly lower knowledge scores compared with the younger dentists (p < 0.05). Inadequate training was the most reported perceived boundary against routine oral cancer screening. Palestinian dentists appeared to have positive opinions related to oral cancer prevention and oral mucosal screening. However, the assessment of the knowledge and clinical practices revealed deficiencies in this regard.

Evaluation of oral brush liquid-based cytology for oral squamous cell carcinoma: a comparative study of cytological and histological diagnoses at a single center

PURPOSE

Liquid-based cytology is highly useful in oral cytology. However, there are only few reports on the accuracy of this method. The current study aimed to compare oral liquid-based cytological and histological diagnoses and to evaluate items that should be considered in oral cytological diagnosis for oral squamous cell carcinoma.

METHODS

We included 653 patients who underwent both oral cytological and histological examinations. Data on sex, specimen collection region, cytological and histological diagnoses, and histological images were reviewed.

RESULTS

The overall male-to-female ratio was 1:1.18. The tongue was the most common specimen collection region, followed by the gingiva and buccal mucosa. The most common cytological examination result was negative (66.8%), followed by doubtful (22.7%) and positive (10.3%). The sensitivity, specificity, positive predictive value, and negative predictive value of cytological diagnosis were 69%, 75%, 38%, and 92%, respectively. Approximately 8.3% of patients with a negative cytological diagnosis had a histological diagnosis of oral squamous cell carcinoma. Furthermore, 86.1% of histopathologic images of cytology-negative squamous cell carcinomas exhibited well-differentiated keratinocytes lacking atypia on the surface. The remaining patients developed recurrence, or they had low cell counts.

CONCLUSION

Liquid-based cytology is useful in screening oral cancer. However, a cytological diagnosis of superficial-differentiated oral squamous cell carcinoma is occasionally inconsistent with the histological diagnosis. Therefore, histological and cytological examinations should be performed if tumor-like lesions are suspected clinically.

Mobile Health (mHealth) Technology in Early Detection and Diagnosis of Oral Cancer-A Scoping Review of the Current Scenario and Feasibility

Objective

Oral cancer is one of the most common types of cancer with dreadful consequences. But it can be detected early without much expensive equipment. Screening and early detection of oral cancer using Mobile health (mHealth) technology are reported due to the availability of the extensive network of mobile phones across populations. Therefore, we aimed to explore the existing literature regarding mHealth feasibility in the early detection of oral cancer. Materials and Method. An extensive search was conducted to explore the literature on the feasibility of mobile health for early oral cancer. Clinical studies reporting kappa agreement between on-site dentists and offsite health care workers/dentists in the early detection of oral cancer were included in this review. Studies describing the development of a diagnostic device, app development, and qualitative interviews among practitioners trained in using mobile health were also included in this review for a broader perspective on mHealth.

Results

While most of the studies described various diagnostic accuracies using mHealth for oral cancer early detection, few studies reported the development of mobile applications, novel device designs for mHealth applications, and the feasibility of a few mHealth programs for early oral cancer detection. Community health workers equipped with a mobile phone-based app could identify “abnormal” oral lesions. Overall, many studies reported high sensitivity, specificity, and Kappa value of agreement. Effectiveness, advantages, and barriers in oral cancer screening using mHealth are also described.

Conclusion

The overall results show that remote diagnosis for early detection of oral cancer using mHealth was found useful in remote settings.

Clinical and Histological Prognostic Factors of Recurrence and Malignant Transformation in a Large Series of Oral Potentially Malignant Disorders

Background

Oral potentially malignant disorders (OPMDs) represent a heterogeneous set of different histological lesions, characterized by the capacity to transform in oral squamous cell carcinoma (OSCC). Despite optimal surgical treatment, approximately 20%–30% of OPMDs may evolve into OSCC. No clear clinical/histological factors are able to identify OPMDs at higher risk of malignant transformation.

Materials and Methods

We considered surgically treated patients with a diagnosis of OPMDs, enrolled from 1996 to 2019 at ASST Spedali Civili of Brescia without a diagnosis of OSCC within the previous 2 years. Clinical and histological characteristics were recorded. Outcomes of interest were recurrence-free survival (RFS), defined as the time from surgery for primary OPMD to any relapse of OPMD or malignant transformation, whichever occurred first, and carcinoma-free survival (CFS), defined as the time from surgery for OPMD to malignant transformation.

Results

We retrospectively reviewed 106 OPMDs cases. Median age at first diagnosis was 64 years old (IQR = 18.75); female patients comprise 51.9% of the cases. During a median follow-up of 30.5 months (IQR = 44), in 23.5% of patients, malignant transformation occurred. RFS at 1, 5, and 10 years was 92.4%, 60.9%, and 43.2%, respectively. Female sex and history of previous OSCC were independent risk factors for RFS. CFS at 1, 5, and 10 years of follow-up was 97.1%, 75.9%, and 64.4%, respectively. Previous OSCC was an independent risk factor for CFS.

Conclusions

In this large series of OPMDs, only previous diagnosis of OSCC was a prognostic factor for further OSCC occurrence. Given the lack of additional clinical/pathological prognostic factors, we advocate further studies into molecular characterization of OPMDs to better stratify the risk of malignant transformation.

Prognostic Significance of CircRNAs Expression in Oral Squamous Cell Carcinoma

OBJECTIVE

This systematic review was aimed to comprehensively evaluate the clinicopathological and prognostic value of dysregulated expression of circRNAs in OSCC.

MATERIALS AND METHODS

The research was carried out by searching mainstream electronic databases including PubMed, Embase, Web of Science, Scopus, LILACS and Cochrane Library to collect relevant studies on prognostic role of circRNAs in OSCC. Pooled hazard ratios (HRs) and odds ratios(ORs) with 95% confidence intervals(CIs) were calculated to assess the association between circRNAs expression, overall survival(OS), disease/recurrence/progression survival(DFS/RFS/PFS) and clinical parameters.

RESULTS

This research included 1813 patients from 26 selected articles. The pooled HR values(95% CIs) in OS were 2.38(1.92-2.93) for oncogenic circRNAs and 0.43(0.28-0.66) for tumor-suppressor circRNAs respectively, in DFS/RFS/PFS were 2.34(1.73-3.17). The meta-analysis on clinicopathology features showed higher level of oncogenic circRNAs is related to advanced TNM stage and tumor stage, worse histological differentiation, lymph node and distant metastasis, while enforced expression of tumor-suppressor circRNAs is related to inferior TNM stage tumor stage and lymphatic metastasis.

CONCLUSION

Our meta-analysis implies that circRNAs may be candidate biomarkers for the prognosis and clinicopathology of OSCC.

Evaluation of correlation between CD44, radiotherapy response, and survival rate in patients with advanced stage of head and neck squamous cell carcinoma (HNSCC)

Purpose

Cancer stem cells (CSCs) constitute a distinctive subpopulation of cancer cells that are competent in tumor initiation, invasion, recurrence, and resistance to chemoradiotherapy. CD44, a hyaluronic acid (HA) receptor has been considered as a potential CSC marker in head and neck cancer. The purpose of this study is to evaluate the correlation between CD44 and clinicopathological parameters, treatment response, survival, and recurrence.

Methods

The CD44 expression was examined by immunohistochemistry (IHC) in 90 samples of head and neck squamous cell carcinoma (HNSCC) confirmed patients. The expression of CD44 and its association with clinicopathological parameters, treatment response, and survival was determined.

Results

In all HNSCC patient samples, CD44 was expressed consistently at different intensities. Tumor size (p < 0.001), stage (p < 0.001), and treatment response (p < 0.001) showed statistically significant association with CD44 expression. Alcohol and CD44 were observed as independent predictors of response to radiotherapy using multivariate ordinal logistic regression analysis. Analysis of 2‐year overall survival (OS) showed that CD44 expression (p = 0.02), tumor size (p = 0.001), lymph node status (p < 0.001), stage (p < 0.001), and grade (p = 0.007) were significantly associated with OS. Using Cox regression analysis, lymph node status (p = 0.001), grade (p < 0.001), recurrence (p < 0.001), and CD44 expression (p = 0.003) were found to be potential independent predictors of OS.

Conclusion

Our findings suggest that CD44 contributes to resistance to radiotherapy and poor OS. The results also suggest that except for CD44 there could be other factors such as lymph node metastasis, grade, and alcohol which should be investigated as potential targets for therapy.

Management of oral leukoplakia by ablative fractional laser‐assisted photodynamic therapy: A 3‐year retrospective study of 48 patients

Objectives

This study aimed to review the results of oral leucoplakia (OL) using ablative fractional laser‐assisted photodynamic therapy (AFL‐PDT) and to further evaluate the risk factors for recurrence and malignant transformation.

Materials and Methods

Forty‐eight patients diagnosed with OL using histopathology were enrolled in this study. All patients received one session of AFL‐PDT. Therapeutic efficacy was evaluated 1 month posttreatment. Follow‐up was scheduled every 3 months in the first year and every 6 months thereafter.

Results

An overall positive response rate of 87.5% (42/48) was achieved, including 62.5% (30/48) complete responses and 25.0% (12/48) partial responses. During the 3‐year follow‐up period, the recurrence and malignant transformation rates were 37.5% (18/48) and 8.3% (4/48), respectively. Lesions on gingiva/palate seemed to be associated with recurrence (p < 0.001; odds ratio [OR]: 1.64, 95% confidence interval [CI]: 1.13–2.37). The severity of epithelial dysplasia (p = 0.02; OR: 2.93, 95% CI: 1.96–4.42) and recurrence (p = 0.016; OR: 3.14, 95% CI: 2.04–4.84) were associated with a predisposition to malignant transformation.

Conclusions

AFL‐PDT is an effective management of OL, but requires close follow‐up. OL lesions on the gingiva/palate are predisposed to recurrence. OLs that recur with moderate/severe epithelial dysplasia have a higher risk of transforming into oral squamous cell carcinoma.

A Practical Guide to the Management of Oral Candidiasis in Patients with Plaque Psoriasis Receiving Treatments That Target Interleukin-17

Plaque psoriasis is an immune-mediated inflammatory skin disease associated with the dysregulation of cytokines, especially those involved in the interleukin (IL)-23/IL-17 pathways. In recent years, there has been growing interest in developing biologic therapies that target these pathways. However, inhibition of the cytokines of the IL-23/IL-17 pathways may increase patients' risk of developing fungal infections, particularly oral candidiasis. Therefore, it is important that dermatology practitioners can effectively diagnose and treat oral candidiasis. In this review, we examine the role of the IL-23/IL-17 pathways in antifungal host defense, and provide a practical guide to the diagnosis and treatment of oral candidiasis in patients with psoriasis. Overall, while treatment with anti-IL-17 medications leads to an increased incidence of oral candidiasis in patients with psoriasis, these cases are typically mild or moderate in severity and can be managed with standard antifungal therapy without discontinuing treatment for psoriasis. If applicable, patients with psoriasis should also be advised to practice good oral hygiene and manage or control co-existing diabetes, and should be provided with information on smoking cessation to prevent oral candidiasis.

Diagnostic accuracy of conventional oral examination for detecting oral cavity cancer and potentially malignant disorders in patients with clinically evident oral lesions: Systematic review and meta-analysis

This systematic review evaluates the diagnostic accuracy of conventional oral examination (COE) versus incisional or excisional biopsy for the diagnosis of malignant and/or dysplastic lesions in patients with clinically evident lesions. Searches were conducted across five electronic databases from inception to January 2020. Meta‐analyses were undertaken, where appropriate. Among 18 included studies, 14 studies were included in the meta‐analysis, giving summary estimates for COE of 71% sensitivity and 85% specificity for the diagnosis of dysplastic and/or malignant lesions. The pooled diagnostic accuracy of identifying malignant‐only lesions was reported in seven studies, giving a pooled estimate of 88% sensitivity and 81% specificity. Diagnostic accuracy of different types of dental/medical professionals in identifying dysplastic or malignant lesions gave varying estimates of sensitivity and specificity across three studies. Further research is needed to improve the diagnostic accuracy of COE for early detection of dysplastic and malignant oral lesions.

Diagnostic Adjuncts in Oral Cancer Evaluation

Oral cancer is a major health concern in developing countries like India which contributes one-third of the global oral cancer burden. Unlike other non-head and neck malignancies, oral cancer has a more curative treatment course. If detected early, oral cancer has the best treatment outcomes. However, most oral cancer has a dismal five-year survival rate as the majority are diagnosed in late/advanced loco-regional stages. Current methods of assessment for oral cancer include, thorough clinical examination under white light and biopsy. Over the years, a number of diagnostic tools have been created as adjuncts to white light evaluation to help with the early diagnosis of oral cancer. This article's goal is to discuss the present diagnostic techniques for oral cancer as well as potential future uses of cutting-edge, innovative technology for the detection of the disease. This may expand our diagnostic choices and enhance our capacity to accurately identify and manage lesions associated with oral cancer.

Comparison of transepithelial cytology and histopathology in the diagnosis of potentially malignant and malignant lesions of the oral mucosa

Background/Aim: The objective of the study was to compare cytological diagnoses using transepithelial cytology (oral brush biopsy) with histopathological diagnoses obtained by incisional biopsy in patients with benign lesions, oral potentially malignant disorders and oral squamous cell carcinoma. Material and Methods: The study included 57 patients. Brush biopsy was performed after local anaesthesia administration using the cervical brush. It was immediately followed by an incisional biopsy. Modified Bethesda System was used for cytological analysis and correlated with histopathological diagnoses according to intraepithelial neoplasia. Results: Good agreement was shown between cytological and histopathological diagnosis (kappa = 0.791). The sensitivity of the study was 92.85%, specificity 100%, positive predictive value (PPV) was 100% and negative predictive value (NPV) 93.54%. Conclusions: Oral brush biopsy, which allows the collection of epithelial cells of all layers can provide fast, precise and efficient cytological results which are in good agreement with the 'gold standard'-incisional biopsy followed by histopathology.

Mutations in p53 Gene Exons in a Sample from the South of Spain in Oral Cancer

Background

Cancer is a genetic disease caused by mutations in DNA and epigenetic alterations that control gene expression. The majority of epidermoid carcinomas develop within the fields of epithelial genetic alterations. The mechanisms underlying tumorigenesis of epidermoid carcinoma are as yet unknown; therefore, precise identification of the risk factors is needed. Aim: The main aim of this study is to analyse and identify the emergence of the mutations described in the literature of the p53 gene with regard to the emergence of cancer in a sample of dysplastic and cancerous lesions in oral cavity mucosa in the population of the south of Spain, in order to determine the presence of said mutations and the percentage of them in our population.

Material and Methods

A cross-sectional study was carried out, with a sample size of 22 patients with potentially malignant oral lesions ancillary to biopsy. All were patients, of both sexes, over 18 years of age from the Virgen del Rocío University Hospital with potentially malignant lesions in oral mucosa ancillary to biopsy (leukoplakias, erythroplasias or leukoerythopkias). An anatomopathological study was performed on all the samples and the lesions were divided into three types: low-grade dysplasia, high-grade dysplasia and squamous cell carcinoma. In respect of the genome study process, a complete search or scan for mutations in exons 5, 6, 8 and 9 of the p 53 gene was carried out, given that in the IARC database we observed that the 5 and 6 as well as the 8 and 9 exon sizes can be scanned completely in this way, since they have amplificon sizes of 476 and 445 base pairs respectively.

Results

In the scan for the complete exons 5, 6, 8 and 9 only a single result of interest was found to be described. In patient NBI 57 a change was observed in the TAT triplet by ATT of EXON 6, the change being of the T nucleotide by the A and in both directions both in Forward and Reverse. The exact location in the NCBI is GR Ch 37 p13 on chromosome 17, EXON 6 of the P53 gene and the change is in the C.613 T>A nucleotide; NM_000546.

Conclusions

On reviewing this genetic variant in different scientific databases, such as ENSEMBL among others, in at least 6 different biocomputing tools it is described as a pathogen, therefore we can conclude that it is a pathogenic mutation for this case in particular. The rest of the mutations described in the literature on exons 5, 6, 8 and 9 of the p53 gene have not been found in our sample.

Key words:Oral cancer, p53, Mutations, Exon.

Early diagnosis of oral squamous cell carcinoma may ensure better prognosis: A case series

Oral squamous cell carcinoma is an extremely malignant tumour: in order to reduce mortality and morbidity, early diagnosis and treatment is the clinician's best weapon.

Nonhomologous end joining repair pathway molecules as predictive biomarkers for patients with oral squamous cell carcinoma

Purpose

Nonhomologous end-joining (NHEJ) is critical for the repair of either pathologic double-strand breaks (DSBs) and/or for the repair of physiologic DSBs created during radiotherapy to kill the tumor cell. Therefore, patients with higher expression of NHEJ repair proteins might develop resistance to ionizing radiation, allowing the disease to recur. As cancer of the oral cavity is a serious health problem globally, the present study aimed to examine the expression of Ku70/80, X-ray repair cross-complementing protein 4 (XRCC4) and DNA ligase IV-core molecules of the NHEJ pathway in patients with oral cancer.

Materials and Methods

Protein expression of Ku70/80, XRCC4, and DNA ligase IV were studied by Immunohistochemistry and mRNA expression of Ku70 and Ku80 were studied using reverse transcription polymerase chain reaction. Data were analyzed statistically using SPSS.

Results

A univariate survival analysis revealed an association of Ku70 mRNA with shorter overall survival (OS). While protein expression of XRCC4 showed an association with reduced relapse-free survival and shorter OS. Multivariate survival analysis demonstrated that XRCC4 and DNA ligase IV are independent prognosticators for predicting adverse disease outcomes.

Conclusion

Strong expression of repair proteins - XRCC4 and DNA ligase IV is associated with unfavorable disease outcome in patients with oral squamous cell carcinoma.

Assessment of apoptotic index in various grades of oral epithelial dysplasia: A cross-sectional study

Context

: Oral cancer is a major health problem worldwide. In cancer, the equilibrium between cell proliferation and apoptosis is disturbed. The defect in the apoptotic pathway allows cells to proliferate with genetic abnormalities. Thus, the apoptotic index (AI) can be used to assess the significance of apoptosis as a proliferative marker in oral epithelial dysplasia.

Aims

To assess the apoptotic index in various grades of epithelial dysplasia.

Objectives

1) To calculate the apoptotic index in various grades of oral epithelial dysplasia, 2) To compare the apoptotic index between various grades of oral epithelial dysplasia, 3) To predict the biologic behavior of oral epithelial dysplasia based on an apoptotic index.

Settings and Design

Cross-sectional tissue analyzing study.

Methods and Materials

This study constituted 30 cases, previously diagnosed with various grades of oral epithelial dysplasia (OED). AI was calculated as the number of apoptotic bodies/cells expressed as a percentage of the total number of cells counted in each case.

Statistical Analysis Used

Statistical analysis was carried out using ANOVA test.

Results

A statistically significant difference was observed between mild dysplasia and severe dysplasia where P = 0.002. The mean AI was increased progressively with increasing grades of OED.

Conclusions

This study demonstrated the clinical significance of apoptosis in assessing disease progression in Oral Potentially Malignant Disorder (OPMD) which may be used as a prognostic indicator in OED. This would, in turn, help in knowing the prognosis of the disease and to develop targeted drug therapy.

Current Insights into Oral Cancer Diagnostics

Oral cancer is one of the most common head and neck malignancies and has an overall 5-year survival rate that remains below 50%. Oral cancer is generally preceded by oral potentially malignant disorders (OPMDs) but determining the risk of OPMD progressing to cancer remains a difficult task. Several diagnostic technologies have been developed to facilitate the detection of OPMD and oral cancer, and some of these have been translated into regulatory-approved in vitro diagnostic systems or medical devices. Furthermore, the rapid development of novel biomarkers, electronic systems, and artificial intelligence may help to develop a new era where OPMD and oral cancer are detected at an early stage. To date, a visual oral examination remains the routine first-line method of identifying oral lesions; however, this method has certain limitations and as a result, patients are either diagnosed when their cancer reaches a severe stage or a high-risk patient with OPMD is misdiagnosed and left untreated. The purpose of this article is to review the currently available diagnostic methods for oral cancer as well as possible future applications of novel promising technologies to oral cancer diagnosis. This will potentially increase diagnostic options and improve our ability to effectively diagnose and treat oral cancerous-related lesions.

Oral cancer histopathological subtypes in association with risk factors: a 5-year retrospective study

Background: Oral cancer is a worldwide public health problem, being the sixth most common neoplasm. The high mortality rate of this type of cancer is due to a delayed diagnosis, a fast evolution and metastasis, no primary symptomatology, the multitude of risk factors and the lack of awareness among the population concerning oral malignancy. Aim: The aim of this 5-year retrospective study was to evaluate the incidence of oral cancer patients in the Clinic of Maxillo-Facial Surgery, Emergency County Hospital, Timişoara, Romania and quantify the histopathological (HP) subtypes, localization, age, gender, tumor staging and differentiation, positive loco-regional lymph nodes and risk factors. Patients, Materials and Methods: A number of 129 patients diagnosed with oral cancer were included in the study and their medical records were analyzed. A statistical analysis was performed that included the variables gender, age, tumor staging, differentiation grade, HP subtype, lymph nodes, localization, and risk factors. Results: Our results outlined a high prevalence of oral cancer among males (65.9%), squamous cell carcinoma (SCC) being the most common HP subtype. Tumor staging revealed the fact that the majority of were T3 and T4 tumors with dissemination in the loco-regional lymph nodes. In 52% of the cases, tobacco was identified as a risk factor, and the association of tobacco and alcohol was present in 28.3% of the cases. Conclusions: The early diagnosis is crucial for the improvement of oral cancer survival rate. The oral cavity is permanently exposed to carcinogenic substances that associated with other risk factors have an influence upon the incidence of oral malignancies.

Downregulation of MicroRNA-130a Inhibits Oral Squamous Cell Carcinoma Proliferation and Metastasis via the Hippo-YAP Pathway

Introduction

Oral squamous cell carcinoma (OSCC) means oral epithelial cell injury caused by multiple genetic mutations of the cells. Dysregulation of microRNAs (miRs) can disrupt the progression of OSCC. This study explored the mechanism of miR-130a in OSCC progression.

Methods

miR-130a expression in OSCC cell lines was analyzed. Functional assays were utilized to test the alterations of OSCC cell proliferation, apoptosis and epithelial–mesenchymal transition (EMT) with downregulated miR-130a, shRNA-PTEN or/and YAP inhibitor verteporfin. Then, dual-luciferase reporter gene assay was performed to clarify the targeting relation between miR-130a and PTEN. After that, Hippo-YAP pathway-related protein levels were tested. Moreover, xenograft transplantation was applied to confirm the in vitro experiments.

Results

Highly expressed miR-130a was observed in OSCC cell lines. Silenced miR-130a reduced OSCC proliferation, metastasis, invasion and EMT while propelled apoptosis. Furthermore, miR-130a targeted PTEN to promote the OSCC progression. Downregulation of PTEN reversed the inhibition of silencing miR-130a on proliferation and migration of SCC-4 cells. miR-130a targeted PTEN to inactivate the Hippo-YAP axis. OSCC progression was notably promoted by a combination of YAP inhibitor verteporfin and miR-130a inhibitor. Additionally, silenced miR-130a inhibited OSCC progression in vivo.

Discussion

Silencing miR-130a inhibited OSCC progression by targeting PTEN and activating the Hippo-YAP axis. This investigation may provide novel insight for OSCC treatment.

Recent advances in point-of-care diagnostics for oral cancer

Early-stage diagnosis is a crucial step in reducing the mortality rate in oral cancer cases. Point-of-care (POC) devices for oral cancer diagnosis hold great future potential in improving the survival rates as well as the quality of life of oral cancer patients. The conventional oral examination followed by needle biopsy and histopathological analysis have limited diagnostic accuracy. Besides, it involves patient discomfort and is not feasible in resource-limited settings. POC detection of biomarkers and diagnostic adjuncts has emerged as non- or minimally invasive tools for the diagnosis of oral cancer at an early stage. Various biosensors have been developed for the rapid detection of oral cancer biomarkers at the point-of-care. Several optical imaging methods have also been employed as adjuncts to detect alterations in oral tissue indicative of malignancy. This review summarizes the different POC platforms developed for the detection of oral cancer biomarkers, along with various POC imaging and cytological adjuncts that aid in oral cancer diagnosis, especially in low resource settings. Various immunosensors and nucleic acid biosensors developed to detect oral cancer biomarkers are summarized with examples. The different imaging methods used to detect oral tissue malignancy are also discussed herein. Additionally, the currently available commercial devices used as adjuncts in the POC detection of oral cancer are emphasized along with their characteristics. Finally, we discuss the limitations and challenges that persist in translating the developed POC techniques in the clinical settings for oral cancer diagnosis, along with future perspectives.

Intraoral Photography Recommendations for Remote Risk Assessment and Monitoring of Oral Mucosal Lesions

Oral cancer is a global health issue with substantial morbidity and a high mortality rate mainly because of late-stage diagnosis. Cancerous lesions are often preceded by potentially malignant lesions that may be detected during routine dental examinations. Not only is the oral cavity easily accessible for screening, but the clinical risk factors of the disease are also known. However, patients may not always be able to access screening services or receive follow-up for diagnosed lesions. In these circumstances, intraoral photos are crucial for timely triage, risk assessment, and monitoring of oral lesions. Further, photos form an integral part of a patient's records, facilitate patient education and communication between health care providers, and provide important information during the referral process. To ensure that intraoral photos are of good quality and standardised there is a need to establish recommendations regarding intraoral photography in oral mucosal screening. This article recommends methods to help health professionals and patients obtain interpretable intraoral photographs. Suggestions to achieve ideal lighting, mirror placement, camera angle, and retraction have been discussed. These recommendations are adaptable to easily available smartphone or point-and-shoot cameras and may be further used to develop future teledentistry platforms.

Three-Dimensional Cell Culture Models to Investigate Oral Carcinogenesis: A Scoping Review

Three-dimensional (3-D) cell culture models, such as spheroids, organoids, and organotypic cultures, are more physiologically representative of the human tumor microenvironment (TME) than traditional two-dimensional (2-D) cell culture models. They have been used as in vitro models to investigate various aspects of oral cancer but, to date, have not be widely used in investigations of the process of oral carcinogenesis. The aim of this scoping review was to evaluate the use of 3-D cell cultures in oral squamous cell carcinoma (OSCC) research, with a particular emphasis on oral carcinogenesis studies. Databases (PubMed, Scopus, and Web of Science) were systematically searched to identify research applying 3-D cell culture techniques to cells from normal, dysplastic, and malignant oral mucosae. A total of 119 studies were included for qualitative analysis including 53 studies utilizing spheroids, 62 utilizing organotypic cultures, and 4 using organoids. We found that 3-D oral carcinogenesis studies had been limited to just two organotypic culture models and that to date, spheroids and organoids had not been utilized for this purpose. Spheroid culture was most frequently used as a tumorosphere forming assay and the organoids cultured from human OSCCs most often used in drug sensitivity testing. These results indicate that there are significant opportunities to utilize 3-D cell culture to explore the development of oral cancer, particularly as the physiological relevance of these models continues to improve.

Oral Cancer and Precancer: A Narrative Review on the Relevance of Early Diagnosis

Oral cancer (OC) is an uncommon malignancy in Western countries, being one of the most common cancers in some high-risk areas of the world. It is a largely preventable cancer, since most of the different risk factors identified, such as tobacco use, alcohol consumption, and betel nut chewing, are behaviors that increase the likelihood of the disease. Given its high mortality, early diagnosis is of utmost importance. Prevention and the anticipation of diagnosis begin with identification of potentially malignant lesions of the oral mucosa and with local conditions promoting chronic inflammation. Therefore, every lesion must be recognized promptly and treated adequately. The clinical recognition and evaluation of oral mucosal lesions can detect up to 99% of oral cancers/premalignancies. As stated by the World Health Organization, any suspicious lesion that does not subside within two weeks from detection and removal of local causes of irritation must be biopsied. Surgical biopsy remains the gold standard for diagnosis of oral cancer. Adjunctive tools have been developed and studied to help clinicians in the diagnostic pathway, such as toluidine blue vital staining and autofluorescence imaging. In the near future other methods, i.e., identification of salivary markers of progression may help in reducing mortality due to oral cancer.

Distinct phenolic, alkaloid and antioxidant profile in betel quids from four regions of Indonesia

Betel quid (BQ) is a chewing mixed package that mainly contains areca nut (AN), betel leaf (Leaf) or betel stem inflorescence (SI), and slaked lime, and is consumed with or without tobacco BQ chewing is common in South East Asia and has been strongly associated with malignant and potentially malignant diseases of the oral cavity. Alkaloids such as arecoline are often accounted for the carcinogenic potential of BQ, however the chemical composition of BQ has not been studied in detail. In the current study, we investigated the total phenolic content (TPC), antioxidant activity (by mean of ferric reducing antioxidant power, FRAP), radical scavenging activity (DPPH test), polyphenolic profile and arecoline content in different components of BQ, namely AN, Leaf or SI, Husk, and blended BQ (BQ mix, containing AN, Leaf or SI and slaked lime). Samples were imported from 4 major regions of Indonesia, namely: Banda Aceh (BA), North Sumatra (NS), West Kalimantan (WK) and West Papua (WP). The highest TPC, FRAP, and DPPH values were detected in AN samples compared to other BQ components, while samples from WP region were of higher values compared to the other regions. High performance liquid chromatography—Mass Spectrometry (LC–MS) analysis showed that Husk contains the widest range of polyphenols, including hydroxybenzoic acids, hydroxycinnamic acids, flavanols, flavonols and stilbenes. Catechin and epicatechin were the main polyphenols detected in BQ, and they were present at the highest concentrations in WP–AN sample. Arecoline was detected in all AN and BQ mix samples and was significantly correlated with catechin and epicatechin, and significantly negatively correlated with p-hydroxybenzoic acid. Notably, arecoline concentration changed significantly when AN was blended in BQ mixtures. The current study is the first to extensively characterise the chemical composition of BQ and provides insight for a better understanding of the interactions of BQ alkaloids and phenolics in the development of oral submucous fibrosis and oral cancer.

Early detection of oral cancer and potentially malignant disorders: Experiences, practices, and beliefs of prosthodontists practicing in Saudi Arabia

STATEMENT OF PROBLEM

Data on the oral cancer screening skills and beliefs of prosthodontists practicing in Saudi Arabia are lacking.

PURPOSE

The purpose of this survey was to assess the beliefs, experiences, and practices of prosthodontists practicing in Saudi Arabia regarding the early detection of oral cancer and potentially malignant disorders.

MATERIAL AND METHODS

A cross-sectional, questionnaire-based survey was conducted on prosthodontists practicing in Saudi Arabia. A 26-item questionnaire was sent to all eligible prosthodontists (N=250). The collected data were analyzed with a statistical software program.

RESULTS

The response rate was 57.2% (N=143). The majority of participants (79%) reported that they routinely examined all new patients for mucosal pathologies. However, only 58% reported that they examine their patients at recall visits, and only 61.5% stated that they provide tobacco use or smoking cessation advice. With regard to the respondents' experiences with suspicious mucosal lesions, the majority said that they had detected a suspicious lesion (79.7%) and had referred affected patients (83.2%) during their career. Most prosthodontists (65%) believed that they were able to detect oral cancer on their own, and 40% believed that they could influence their patients to stop smoking. A lack of training, confidence, time, and financial incentives were reported as barriers to oral cancer screening.

CONCLUSIONS

Most of the prosthodontists surveyed in this study appeared motivated to perform routine oral mucosal screening. However, more efforts are needed to help improve the attitudes, confidence, and skills of prosthodontists when it comes to identifying and referring suspicious oral mucosal lesions.

Gene expression analysis of autofluorescence margins in leukoplakia and oral carcinoma: A pilot study

OBJECTIVES

Autofluorescence is considered a useful technique in the early detection of oral mucosal alterations. However, its efficacy to discriminate tumor margins is still under debate. The purpose of this pilot study was to confirm the existence of molecular divergence from the center of a lesion compared to white light and autofluorescence (VELscope^TM ) visualized margins in leukoplakia and oral carcinoma.

MATERIALS AND METHODS

Molecular divergence from the center of the lesion to white light and VELscope^TM defined margins was compared in patients with leukoplakia (n = 3) and oral carcinoma (n = 4). Expression profiling of 45 selected genes was performed through custom-made TaqMan arrays. Gene Ontology was used for biological pathway analysis.

RESULTS

Irrespective of pathology, the greatest molecular divergence existed between the center of the lesion and both white light and VELscope^TM margins. VELscope^TM and white light margins were also molecularly distinct in oral carcinoma samples. Indeed, the white light margin retained molecular abnormalities observed in the center of the lesion thus suggesting the existence of a "partially transformed" cell population.

CONCLUSION

Despite the limited low number of patients, our data confirm the benefit of combining autofluorescence with conventional oral examination in identifying surgical margins during biopsy procedures for leukoplakia and oral carcinoma.

SmartProbe: a bioimpedance sensing system for head and neck cancer tissue detection

OBJECTIVES

This study presents SmartProbe, an electrical bioimpedance (EBI) sensing system based on a concentric needle electrode (CNE). The system allows the use of commercial CNEs for accurate EBI measurement, and was specially developed for in-vivo real-time cancer detection.

APPROACH

Considering the uncertainties in EBI measurements due to the CNE manufacturing tolerances, we propose a calibration method based on statistical learning. This is done by extracting the correlation between the measured impedance value |Z|, and the material conductivity σ, for a group of reference materials. By utilizing this correlation, the relationship of σ and |Z| can be described as a function and reconstructed using a single measurement on a reference material of known conductivity.

MAIN RESULTS

This method simplifies the calibration process, and is verified experimentally. Its effectiveness is demonstrate by results that show less than 6% relative error. An additional experiment is conducted for evaluating the system's capability to detect cancerous tissue. Four types of ex-vivo human tissue from the head and neck region, including mucosa, muscle, cartilage and salivary gland, are characterized using SmartProbe. The measurements include both cancer and surrounding healthy tissue excised from 10 different patients operated on for head and neck cancer. The measured data is then processed using dimension reduction and analyzed for tissue classification. The final results show significant differences between pathologic and healthy tissues in muscle, mucosa and cartilage specimens.

SIGNIFICANCE

These results are highly promising and indicate a great potential for SmartProbe to be used in various cancer detection tasks.

Orabase-Formulated Benzalkonium Chloride Effectively Suppressed Oral Potentially Malignant Disorder In Vitro and In Vivo

Oral potentially malignant disorder (OPMD) is associated with an increased risk of progression to oral cancer. Patients with dysplastic changes of the precancerous lesions have a higher malignant transformation rate than those without dysplastic changes. Radiotherapy and surgery are the traditionally preferred choices for OPMD treatment. However, side effects caused by radiotherapy and surgery may reduce the willingness of patients to accept therapy. Therefore, developing an Orabase-formulated drug, which can be non-invasively administered, may provide an alternative treatment choice. To find, verify, and develop a new anti-cancer drug cost a lot of time and money, while drug repurposing can shorten both time and cost. In this study, we utilized high-throughput screening library to identify clinical drugs, which may have new bioactivities. Herein, we report that benzalkonium chloride (BAK), an antimicrobial preservative for pharmaceutical products, significantly induced reactive oxygen species production and cell death in oral precancerous cells. Additionally, our results showed that phosphorylation of STAT3 (Tyr705) and Akt (Ser473) were involved in cell death caused by BAK in DOK cells. According to animal studies, the development of DMBA-induced oral precancerous lesions was inhibited by 2% BAK. In conclusion, Orabase-formulated BAK may be a potential treatment for OPMD in the future.

Prevalence of and related risk factors in oral mucosa diseases among residents in the Baoshan District of Shanghai, China

BACKGROUND

Oral mucosal diseases (OMDs) encompass a variety of different types of diseases. Our aim was to evaluate the prevalence and related risk factors of OMDs among residents in the Baoshan District of Shanghai, China, and provide a scientific basis for prevention and control strategies.

METHODS

A sample of 653 residents aged 17 to 92 years from the Baoshan community was investigated in 2014. Each resident was surveyed by questionnaire to evaluate their oral mucosa and oral mucosa examinations were conducted. We followed up with 607 residents in 2018. All data were statistically analyzed using the SPSS 25.0 software package (Chicago, IL, USA) at the general population, gender and age levels. A X2 test was used to compare rates of risk factors and logistic regression analysis was used to detect the correlation between disease and risk factors.

RESULTS

The prevalence rate of OMDs was found to be 9.19%-9.56% (2014-2018). The most common OMDs were atrophic glossitis (1.84%), recurrent aphthous ulcer (RAU, 1.68%), burning mouth syndrome (BMS, 1.38%), oral lichen planus (OLP, 1.23%) and traumatic ulcers (1.23%). The prevalence of RAU and BMS in different age groups was significantly different. Tobacco and alcohol use and psychological factors in the OMDs group were higher than the no-OMDs group. Systemic diseases including diabetes mellitus (DM) was significantly relevant to OLP.

CONCLUSION

Age, tobacco and alcohol use, and psychological factor correlated strongly with the occurrence and development of OMDs, and they should be the focus of primary prevention. General epidemiological studies suggested that OLP was closely related to DM.

Efficacy of Fluorescence Technology vs Conventional Oral Examination for the Early Detection of Oral Pre-Malignant Lesions. A Clinical Comparative Study

BACKGROUND AND OBJECTIVE

Oral cancer is one of the most common malignancies that affect human beings across the world and early detection of oral cancer is believed to reduce the morbidity significantly. Fluorescence diagnosis is emerging as a promising method in the differentiation of cancerous lesions and thus helping in the determination of resolution for the surgical resection of affected area of malignancy very accurately. The aim of this study was to evaluate the usefulness of an autofluorescence hand held device (OralID) to detect oral premalignant lesions.

METHODS

98 potentially high-risk oral cancer patients were divided into two groups (n=49/group). Both the groups were first examined by conventional oral examination under white light and oral findings were noted. Subjects under group B were further examined under fluorescence light through hand held device, i.e. OralID. After the examinations, a surgical biopsy sample was taken from the suspected lesions under local anaesthesia from both the groups to confirm the diagnosis through histopathological analysis.

RESULTS

The positive potential malignant lesions (PMLs) observed in Group A when compared with biopsy reporting was 89.47% true positive while in Group B was 95.24%. The sensitivity reported of Group A was 89.47% and Group B was 97.56%. We observed 8.09% more sensitivity and 11.36% more specificity when we incorporate adjunctive the fluorescence examination using OralID.

CONCLUSION

Results from this study suggests that OralID is a true adjunct to conventional oral examination in detecting early potential malignant changes in subjects visiting for regular dental check-up.

Orabase-formulated gentian violet effectively improved oral potentially malignant disorder in vitro and in vivo

Oral cancer is a prevalent cancer in male worldwide. Oral potentially malignant disorders (OMPDs) are the oral mucosa lesions that have high malignant transformation rate to oral cancer. The mainstay for OMPDs treatment includes carbon dioxide (CO₂) laser and surgery, which may lead to the side effects of scarring and impaired function of oral cavity in the patients and reduced their willingness to receive curative therapy. Therefore, developing a non-invasive and function-preserving therapy is clinically important. Since development of a novel chemotherapeutic drug requires a lot of time and cost, we applied the high-throughput screening (HTS) approach to identify new bioactivities for FDA-approved drugs, known as drug repurposing. Through this drug repurposing approach, we discovered that gentian violet (GV), which is well known for its antibacterial, antifungal, antihelminthic, antitrypanosomal and antiviral activities, was able to induce significant cell death in DOK oral precancerous cells through ROS production. Moreover, decreased phosphorylation of p53(Ser15) and NFκB(Ser536) was required for GV-induced cell death. In vivo, 3% GV orabase effectively suppressed the progression of DMBA-induced oral precancerous lesions. In conclusion, this new formulation of GV through drug repurposing has the potential to be further developed as a therapeutic drug for OPMD clinically.

Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study

Background

Delayed diagnosis of Oral Cancer (OC) can mean a difference in quality and expectancy of life for the patient. This delay could be from the healthcare side, or more importantly from the patient’s side. Globally, there are studies enumerating the causes for delays from the patients’ side in seeking healthcare for Oral Cancer; however, no similar research is found in the context of Pakistan. This study endeavoured to understand the health seeking behaviour, reasons for delay in consultation and the impact on OC patients’ lives.

Methods

In-depth interviews were conducted with randomly selected OC patients at a private sector tertiary care facility in Islamabad (who met the inclusion criteria of having successfully been treated for Oral Cancer) which caters to the most diverse population for the treatment of Oral Cancer. Theoretical saturation was achieved at 14 interviews. All participants gave verbal consent for participation, which was recorded prior to the interviews.

Results

Patients (age range 43–68 years) had received the surgical treatment and radiation. The reported delay before seeking a proper medical advice ranged from 1 month to 2 years. Lack of awareness about OC risk factors, symptoms, and whom to approach for treatment were the main reasons. Most respondents relied on self-treatment considering the non-healing wound/ulcer to be a minor issue until they were advised a consultation with a specialist. Treatment started within 1–3 months after a confirmed diagnosis on biopsy. The reported average expenditure on treatment was US$5000-10,000, mostly covered through a private health insurance and others borrowed the money.

Conclusion

A socio-behavioural change campaign for the general population can result in earlier presentation of the OC, minimizing the financial burden on the patient as well as the health system, and improving the quality of life of the patients.

Evaluation of SOX2 and podoplanin expression in oral epithelial dysplasia and its correlation with malignant transformation

AIM

Oral carcinogenesis cascade is a complex process, characterized by variable numbers of genetic and epigenetic alterations of various genes with manifold roles that could serve as biological hallmarks. This study was undertaken to assess the protein expression of SOX2 and podoplanin in oral epithelial dysplasia and correlate the expression with clinicopathological parameters and risk of malignant transformation.

METHODS

SOX2 and podoplanin expression were analyzed in 60 cases of oral epithelial dysplasia. The association between SOX2 and podoplanin expression with various clinicopathological parameters and transformation to oral cancer was analyzed.

RESULTS

A higher Histoscore was seen in 55% of moderate and 30% of severe dysplasia. 25% of the cases showed a negative podoplanin expression and 30% of patients had higher podoplanin expression (score 2 and 3). Though there was significant association of both SOX2 and podoplanin expression with the degree of dysplasia, the association of their expression with transformation to oral squamous cell carcinoma did not reach statistical significance.

CONCLUSION

Alteration in SOX2 and podoplanin is likely an important event in head and neck carcinogenesis; however, their expression may be valuable only in a few cases of oral epithelial dysplasia to assess the risk of malignant transformation.