Topical photodynamic therapy in the treatment of benign oral mucosal lesions: A systematic review

Salvianolic acid B as a potent nano-agent for enhanced ALA-PDT of oral cancer and leukoplakia cells

BACKGROUND

Photodynamic therapy (PDT) relies on the light activation of a photosensitizers to generate reactive oxygen species such as singlet oxygen, but its effect on cancer therapy is limited dramatically by hypoxia in the tumor microenvironment.

OBJECTIVES

To determine the potential of a nano-photosensitizer loaded salvianolic acid B (SalB) and 5-aminolevulinic acid (ALA) for enhancing the efficacy of PDT in oral squamous cell carcinoma Cal27 cells and leukoplakia Leuk1 cells.

RESULTS

Singlet oxygen sensor green (SOSG) assay showed that nano-SalB-ALA generated higher levels of singlet oxygen, compared to nano-SalB and nano-ALA. Cellular uptake assay showed that nano-SalB-ALA effectively absorbed by Leuk1 cells. Importantly, cell counting kit-8 and flow cytometry revealed that PDT with nano-SalB-ALA effectively inhibited the viability and induced the apoptosis of Cal27 and Leuk1 cells, respectively. Moreover, the tumor xenograft study revealed that PDT with nano-SalB-ALA had a stronger inhibitory effect on tumor growth of nude mice, compared to control groups.

CONCLUSIONS

The novel photosensitizer nano-SalB-ALA remarkably enhanced the efficacy of PDT by improving singlet oxygen production, inhibiting cell proliferation, promoting cell apoptosis, and suppressing tumor growth. These suggest PDT with nano-SalB-ALA could be a clinically significant and potent treatment for oral cancer and leukoplakia.

State of the Art in the Diagnosis and Assessment of Oral Malignant and Potentially Malignant Disorders: Present Insights and Future Outlook-An Overview

Oral Potentially Malignant Disorder (OPMD) is a significant concern for clinicians due to the risk of malignant transformation. Oral Squamous Cell Carcinoma (OSCC) is a common type of cancer with a low survival rate, causing over 200,000 new cases globally each year. Despite advancements in diagnosis and treatment, the five-year survival rate for OSCC patients remains under 50%. Early diagnosis can greatly improve the chances of survival. Therefore, understanding the development and transformation of OSCC and developing new diagnostic methods is crucial. The field of oral medicine has been advanced by technological and molecular innovations, leading to the integration of new medical technologies into dental practice. This study aims to outline the potential role of non-invasive imaging techniques and molecular signatures for the early detection of Oral Malignant and Potentially Malignant Disorders.

Efficacy of photodynamic therapy on candida colonization and clinical symptoms in denture stomatitis: a systematic review and meta-analysis

BACKGROUND

Photodynamic therapy (PDT) has been recently proposed as a promising alternative therapy for Denture Stomatitis (DS). The present systematic review and meta-analysis investigated the current available evidence regarding the efficacy of PDT in the management of DS.

MATERIALS AND METHODS

PubMed, Scopus, Web of Science, Google Scholar, and ProQuest were searched up to June 7, 2023. All relevant clinical trials were included. RevMan software was used for the statistical analyses.

RESULTS

Elven randomized clinical trials (460 DS patients) were included. Eight studies assessed the efficacy of PDT vs. topical antifungal therapy, while three studies assessed the adjunctive use of PDT (PDT + antifungal therapy) vs. topical antifungal therapy alone. The results revealed comparable efficacy of PDT and conventional antifungal therapy on candida colonization at 15 days (MD: 0.95, 95% CI: -0.28, 2.19, p = 0.13) and at the end of follow-up (MD: -0.17, 95% CI: -1.33, 0.98, p = 0.77). The pooled two studies revealed relatively better efficacy of adjunctive use of PDT with antifungal therapy on candida colonization compared to antifungal therapy alone at 15 days (MD: -6.67, 95% CI: -15.15, 1.82, p = 0.12), and at the end of follow-up (MD: -7.14, 95% CI: -19.78, 5.50, p = 0.27). Additionally, the results revealed comparable efficacy of PDT and topical antifungal therapy on the clinical outcomes.

CONCLUSIONS

PDT might be considered a viable option for DS either as an adjunct or as an alternative to the topical antifungal medications. Further studies with adequate sample sizes and standardized PDT parameters are warranted.

Personalized Medicine in Oral Oncology: Imaging Methods and Biological Markers to Support Diagnosis of Oral Squamous Cell Carcinoma (OSCC): A Narrative Literature Review

For decades, oral squamous cell carcinoma (OSCC) has been one of the most prevalent and mortal cancers worldwide. The gold standard for OSCC diagnosis is still histopathology but this narrative multidisciplinary review has the aim to explore the literature about conventional OSCC prognostic indicators related to the pTNM stage at the diagnosis such as the depth of invasion and the lymphovascular invasion associated with distant metastasis as indicators of poor life expectancy. Despite its multifactorial nature and recognizable precursors, its diagnosis at the early stages is still challenging. We wanted to highlight the importance of the screening as a primary weapon that a stomatologist should consider, intercepting all at-risk conditions and lesions associated with OSCC and its early stages. This narrative review also overviews the most promising imaging techniques, such as CT, MRI, and US-echography, and their application related to clinical and surgical practice, but also the most-investigated prognostic and diagnostic tissue and salivary biomarkers helpful in OSCC diagnosis and prognostic assessment. Our work highlighted remarkable potential biomarkers that could have a leading role in the future. However, we are still far from defining an appropriate and concrete protocol to apply in clinical practice. The hope is that the present and future research will overcome these limitations to benefit patients, clinicians, and welfare.

Revisiting the evidence of photodynamic therapy for oral potentially malignant disorders and oral squamous cell carcinoma: an overview of systematic reviews

BACKGROUND

This study summarized the available evidence about the use of photodynamic therapy (PDT) for the management of oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC).

METHODS

An overview of systematic reviews was undertaken based on the 2020 PRISMA statement. Electronic searches were performed in five databases. Studies published up to November 2022 were included. Risk of bias was assessed with the AMSTAR 2 tool.

RESULTS

A total of 30 studies enrolling 9,245 individuals with OPMD (n=7,487) or OSCC (n=1,758) met the selection criteria. All studies examined the efficacy and/or safety of PDT. OPMD were investigated individually in 82.8% of the studies, the most common being oral lichen planus and actinic cheilitis. OSCC was addressed separately in 10.3% of the studies, while only 6.9% evaluated both OPMD and OSCC. Fourteen different types of photosensitizers were described. PDT was used according to the following setting parameters: 417-670 nm, 10-500 mW/cm², 1.5-200 J/cm², and 0.5-143 minutes. Regarding OPMD, leukoerythroplakia showed the best response rates, while oral lichen planus presented a partial or no response in nearly 75% of documented cases. A complete response was observed in 85.9% of OSCC cases, while 14.1% had no resolution.

CONCLUSION

Overall, the response to PDT depended on the type of OPMD/OSCC and the parameters used. Although PDT is an emerging candidate for the treatment of OPMD and OSCC, there is heterogeneity of the methodologies used and the clinical data obtained, particularly regarding the follow-up period.

Impacted Palatal Canines and Diode Laser Surgery: A Case Report

Introduction

Maxillary canine is the most frequent dental element that could likely remain impacted in the bone structure, with a percentage between 1 and 5%. This study presents a case report using a diode laser for surgical-orthodontics disinclusion of a palatal mucosal impacted permanent left upper canine (2.3) and the simultaneous application of an orthodontic bracket.

Methods

After cementation of the trans-palatal bar to the upper first molars with a hook for orthodontic traction, local anaesthesia with articaine was performed, followed by surgical operculectomy using a diode laser (810 nm wavelength, continuous wave mode with a power output of 3 W, and a 0.4 mm diameter optical fiber), and the orthodontic bracket with a passive metal looped ligature was applied. Subsequently, active elastic traction was applied on 2.3 and the upper arch was bonded for the application of a series of orthodontic wires, lace-back, and metal ligatures. A progressive reactivation of the elastic traction and extraction of 6.3 was necessary to translate the canine into the correct arch position.

Results

Diode laser surgical-orthodontic disinclusion of impacted upper canine was performed successively, resulting in a dry surgical field ideal for orthodontic bracket adhesion. No pain and no swelling have been reported from the patient. The orthodontic treatment allowed the canine to be moved to the correct position in the arch.

Conclusions

This case showed that the diode laser is a valid alternative for the surgical-orthodontic disinclusion of an included tooth element.

Photodynamic Therapy Using 5-Aminolevulinic Acid (Ala) for the Treatment of Chronic Periodontitis: A Prospective Case Series

Aim: The objective of this study was to compare the efficacy of supportive periodontal therapy (i.e., scaling and root planning, SRP) alone versus ALADENT medical device used in association with SRP in the treatment of chronic periodontitis in adult patients. Materials and Methods: A total of 20 patients with a diagnosis of chronic periodontitis (40 localized chronic periodontitis sites) aged between 35 and 55 were selected. None of these patients previously received any surgical or non-surgical periodontal therapy, and they presented radiographic evidence of moderate bone loss. Two non-adjacent sites in different quadrants were identified and observed in each patient, analyzing treatment effectiveness (split-mouth design). Clinical pocket depth, clinical attachment loss, and bleeding on probing were evaluated at time 0 and after 6 months, while microbial analysis (MA) was conducted at baseline and after 15 days. Significant differences were calculated using SPSS program and paired simple statistic t-test. Results: Total bacteria loadings had a statistically significant reduction before and after treatment with SRP (left site) (total average decrease of 27%). The sites treated with SRP plus ALADENT (right) showed a significantly reduced total bacterial loading compared to the untreated sites (right) (total average decrease of 75%). Mean values of CAL/PD and percentages data of BOP, recorded after SRP + ALADENT therapy, showed a higher reduction (CAL = 2.42, PD = 2.87 mm, 90% of sites with no bleeding) than those obtained after SRP treatment (CAL = 4.08 mm, PD = 4.73 mm, 70% of sites with no bleeding). Conclusion: The treatment of moderate and severe chronic periodontitis should include, beside SRP, the use of ALADENT medical device, which has been proved to be a useful adjuvant therapy.

Noninvasive in vivo imaging of oral mucosa: state-of-the-art

Technological development has interested most of the dentistry's branches leading to the use of other medical technologies non previously involved in dental practice. This study aims to evaluate the potential role of non-invasive imaging techniques in oral pathology workflow. Optical coherence tomography has been described by several authors as a promising aid for differential diagnosis of autoimmune diseases and to detect epithelial subversion of the oral mucosa before the clinical manifestation of oral mucositis. High-frequency ultrasound offers the chance to assess lesional dimensions both in benign and malignant lesions with a high dimensional reliability compared with histopathology. Reflectance confocal microscopy seems to be helpful in the early detection of cytological changes due to its high resolution, suggesting a more interesting role in the analysis of malignant lesions. The study presented highlighted the potential role of noninvasive in vivo imaging although further studies are needed for the further validation of these techniques.

Noninvasive Imaging Methods to Improve the Diagnosis of Oral Carcinoma and Its Precursors: State of the Art and Proposal of a Three-Step Diagnostic Process

Simple Summary

Oral squamous cell carcinoma (OSCC) accounts for 90–95% of malignant tumors of the lip and oral cavity and is associated with high mortality in the advanced stages. Early diagnosis is a challenge for oral pathologists and dentists, due to the ambiguous appearance of early OSCC, which is often misdiagnosed, mistreated, and associated with diagnostic delay. The gold standards for OSCC diagnosis are biopsy and histopathological assessment, but these procedures are invasive and time-consuming. Adjunctive noninvasive techniques allow the definition of the malignant features of a suspicious lesion in real time and noninvasively, thus improving the diagnostic procedure. The present review aimed to focus on some of the main promising noninvasive imaging techniques, to highlight their perspective adoption in a three-step diagnosis, which is idealistically faster and better, as well as enables the patient’s compliance.

Abstract

Oral squamous cell carcinoma (OSCC) is the most prevalent form of cancer of lips and oral cavity, and its diagnostic delay, caused by misdiagnosis at the early stages, is responsible for high mortality ratios. Biopsy and histopathological assessment are the gold standards for OSCC diagnosis, but they are time-consuming, invasive, and do not always enable the patient’s compliance, mainly in cases of follow-up with the need for more biopsies. The use of adjunctive noninvasive imaging techniques improves the diagnostic approach, making it faster and better accepted by patients. The present review aims to focus on the most consolidated diagnostic techniques, such as vital staining and tissue autofluorescence, and to report the potential role of some of the most promising innovative techniques, such as narrow-band imaging, high-frequency ultrasounds, optical coherence tomography, and in vivo confocal microscopy. According to their contribution to OSCC diagnosis, an ideal three-step diagnostic procedure is proposed, to make the diagnostic path faster, better, and more accurate.