Prevalence of oral submucous fibrosis in patients visiting dental OPD of a dental college in Kanpur: A demographic study

Abdominal Dermal Fat Graft Versus Nasolabial Flap in Oral Submucous Fibrosis: A Randomized Clinical Trial

Introduction

A prospective study was conducted to find out an effective alternative in the form of non-vascularized abdominal dermal fat graft (ADFG) and to compare its efficacy with the vascularised nasolabial flap (NLF) for the treatment of oral submucous fibrosis (OSMF).

Method

Comparative study comprising of 30 patients with Grade 3 and 4A OSMF, randomly divided into 2 groups: Group A (ADFG) and Group B (NLF). They were evaluated for mouth opening (MO), graft uptake, time taken for mucosalization, pain, intercommissure distance (ICD), scar, duration of surgery (DOS), patient satisfaction and thickness of masseter muscle on ultrasonography.

Findings

At 6 months, MO improved by 22.4 and 36.2 mm in Group A and Group B, respectively. There was statistically significant difference (p < 0.05) seen for the values between the groups for all the parameters except for ICD and VAS score, which was statistically insignificant (p > 0.05). Intraoral hair growth, facial scar, orocutaneous fistula and commissure tear was seen in Group B. Complete necrosis of graft followed by recurrence was seen in three cases in Group A.

Conclusion

NLF holds better as compared to ADFG in the management of OSMF. However, the cornerstone of success remains habit cessation and aggressive physiotherapy. The limitations of the study are small sample size and short duration of follow-up.

PDE12 disrupts mitochondrial oxidative phosphorylation and mediates mitochondrial dysfunction to induce oral mucosal epithelial barrier damage in oral submucous fibrosis

Oral submucous fibrosis (OSF) is a chronic oral mucosal disease. The pathological changes of OSF include epithelial damage and subepithelial matrix fibrosis. This study aimed to reveal the epithelial injury mechanism of OSF. A histopathological method was used to analyze oral mucosal tissue from OSF patients and OSF rats. The expression of PDE12 in the oral epithelium was analyzed by immunohistochemistry. The epithelial-mesenchymal transition (EMT) and tight junction proteins in arecoline-treated HOKs were explored by western blotting. Epithelial leakage was assessed by transepithelial electrical resistance and lucifer yellow permeability. The expression of PDE12 and the mitochondrial morphology, mitochondrial permeability transition pore opening, mitochondrial membrane potential, and mitochondrial reactive oxygen species (mtROS) were evaluated in arecoline-induced HOKs. Oxidative phosphorylation (OXPHOS) complexes and ATP content were also explored in HOKs. The results showed significant overexpression of PDE12 in oral mucosal tissue from OSF patients and rats. PDE12 was also overexpressed and aggregated in mitochondria in arecoline-induced HOKs, resulting in dysfunction of OXPHOS and impaired mitochondrial function. An EMT, disruption of tight junctions with epithelial leakage, and extracellular matrix remodeling were also observed. PDE12 overexpression induced by PDE12 plasmid transfection enhanced the mtROS level and interfered with occludin protein localization in HOKs. Interestingly, knockdown of PDE12 clearly ameliorated arecoline-induced mitochondrial dysfunction and epithelial barrier dysfunction in HOKs. Therefore, we concluded that overexpression of PDE12 impaired mitochondrial OXPHOS and mitochondrial function and subsequently impaired epithelial barrier function, ultimately leading to OSF. We suggest that PDE12 may be a new potential target against OSF.

Sociodemographic and Clinical Profile of Oral Submucous Fibrosis

Background: Oral Submucous Fibrosis is a pre-cancerous, progressive condition caused by gutkha, areca nut consumption which is characterized by limited mouth opening, burning pain inoral cavity, stiffness and blanching of oral mucosa. Aim: To study sociodemographic characters and clinical profile of Oral Submucous Fibrosis and to assess the association of duration of adverse habits with clinical staging of Oral Submucous Fibrosis. Methodology: This cross-sectional study of 70 clinically diagnosed cases of oral submucous fibrosis was carried out at the Tertiary Health Care Centre in Central India. Over the course of two years, demographic and clinical information, including specifics on addiction and its duration, was gathered. On the basis of symptoms, the presence of palpable fibrous bands, and measuring mouth opening, clinical staging was carried out. Results: The average age of the patients in the study was 33.2 ± 12.66 years with Male female ratio of 3:1. Significantly higher proportion of patients belonged to low socioeconomic status. The maximum number of patients were seen in stage III (62.86%) followed by Stage II (21.43%) and subjects who had the adverse habits for a period of 5 to 10 years had more severe OSMF. Conclusion: In the present study, frequency of OSMF was more in young age group and in males. There was higher frequency of disease in lower socioeconomic status. Longer duration addiction was highly associated with severity of clinical stage of OSMF.

Prevalence of Oral Submucous Fibrosis With Other Oral Potentially Malignant Disorders: A Clinical Retrospective Study

Background  Oral submucous fibrosis (OSMF) is a chronic, progressive, and potentially malignant oral disorder that causes scarring of the oral cavity, pharynx, and upper oesophagus. It is most common in Southeast Asia, but it is also found in other parts of the world. Oral potentially malignant disorders (OPMDs) are a group of oral lesions that have an increased risk of developing into oral cancer. The study aimed to evaluate the prevalence of OSMF associated with other OPMDs. The presence of multiple OPMDs existing in one patient is a significant finding, as it is associated with an elevated risk of developing malignancy. The risk of malignant transformation increases with the number of OPMDs present in a patient; patients with two OPMDs have a three to four times higher risk of developing malignancy than those with a single OPMD. Patients with three or more OPMDs have a 7-10 times higher risk and the risk of malignant transformation depends on the type of OPMD. Materials and methods The study was conducted in the Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Chennai, India, to investigate the prevalence of OSMF with other OPMDs. The study team retrieved 630 case records of patients with OSMF from the electronic database between January 2018 and March 2023. All of the patients in the study had OSMF, as well as other OPMDs such as leukoplakia, candidiasis, actinic cheilitis, dyskeratosis congenita, erythroplakia, lichen planus, sideropenic dysphagia (Plummer-Vinson syndrome), and discoid lupus erythematosus. Both clinical and histopathological examinations confirmed these diagnoses. Oral mucosal lesions without coexisting OSMF were excluded. The study was done on the basis of age group, habits, type of habits, associated coexisting lesions, and systemic condition. Results The patients were clinically examined and diagnosed. Of the 630 cases, 10% had OSMF with OPMDs. The most common OPMDs associated with OSMF were leukoplakia (86%), followed by candidiasis (12%) and both leukoplakia and candidiasis (2%). Based on gender, the incidence of OSMF was higher in males compared to females with 67% and 33%, respectively. Conclusion OSMF is more likely to develop into malignancy; the widespread use of areca nut products in India has contributed to the rising incidence of OSMF. Accumulating epidemiological data can help to identify high-risk populations for prevention and control measures. Earlier oral cancer diagnosis and treatment can increase the likelihood of a favourable outcome.

A Novel Herbal Paste Formulation of Turmeric, Tulsi, and Honey for the Treatment of Oral Submucous Fibrosis

Background and objectives Oral submucous fibrosis (OSMF) is a condition that affects the oral cavity and is characterized by the development of fibrous bands in the submucosal layers, leading to progressive difficulty in mouth opening and other symptoms. Inflammation and advancing fibrosis of the submucosal tissues are the hallmarks of this chronic, disabling illness of the oral cavity. The disorder is well known for having a propensity for cancer and is particularly linked to the habit of chewing tobacco and areca nuts. The study mentioned aims to compare the effectiveness of a novel herbal paste formulation containing turmeric, tulsi (holy basil), and honey in managing OSMF. The use of herbal remedies is common in traditional medicine, and turmeric and tulsi are known for their potential anti-inflammatory and antioxidant properties. Honey, too, is believed to have some therapeutic benefits. Methodology A study was conducted at MNR Dental College and Hospital, Sangareddy, Telangana, India, in the Department of Oral Medicine and Radiology (OMR) on 80 oral submucous fibrosis patients to evaluate the efficacy of a novel herbal paste formulation of turmeric, tulsi, and honey, comprising 77 males and three females. Patients were given a novel herbal paste formulation consisting of 10 g of turmeric powder and 10 g of tulsi powder, mixed in 10 ml of honey, to study subjects, and a placebo consisting of anti-oxidants was administered to control subjects for three months. The subjective and objective symptoms were recorded and statistically analyzed. Results The majority of the subjects were in the age group of 18-22 years, with an average age of 28.09+/-8.38 years with the most predominant habit of gutka chewing. A statistically significant change in the mouth opening, tongue protrusion, burning sensation, blanching of the mucous membrane, and reduction in palpable fibrous bands was found in the study subjects when compared to control subjects. Conclusion The present study evaluated the efficacy of a novel herbal paste formulation of turmeric, tulsi, and honey in the management of OSMF.

Evaluation of Hearing Performance in Patients with Oral Submucous Fibrosis in Relation to Different Grades

Background

OSMF is now recognized worldwide as an Indian disease. Blanching and rigidity of the oral mucosa, impaired mobility of the soft palate and tongue, difficulty opening the mouth, burning sensation, lack of gustatory sensation, and mild deafness due to Eustachian tube dysfunction. Soft palatal muscles often affect Eustachian tube function.

Materials and Methods

Rama Dental College Hospital and research center Kanpur conducted a cross-sectional study. 60 OSMF patients were randomly selected for this study. Visible light was used for a detailed case history and clinical examination. OSMF was diagnosed by difficulty opening the mouth, blanched oral mucosa, and palpable fibrous bands. Burning, salivation, tongue protrusion, habits, and malignant changes were also diagnostic. ENT specialists used pure tone audiometry to examine the ear (PTA).

Results

Out of 60 patients 59 were males and 1 female. The participants who took part in this study ranged in age from 18 to 65. Pure tone audiometry of 120 years, 84 (70%) revealed normal hearing, 10 (8.33%) revealed minimal hearing loss, 14 (11.67%) revealed mild hearing loss and 12 (10%) revealed moderate hearing loss.

Conclusion

In order to improve the success rate of treatment, the protocol for managing OSMF patients should therefore include ENT consultation and hearing impairment treatment.

Prevalence of precancerous lesions and conditions in India: A systematic review and meta-analysis

BACKGROUND

Smoking and chewing tobacco are associated with numerous oral mucosal lesions and conditions, often leading to cancer progression.

AIM

To investigate the prevalence of precancerous lesions and conditions among the Indian population.

METHODS

Systematic search was conducted for population or community-based observational epidemiological studies in PubMed, EMBASE, Web of Science, IndMED, Google Scholar, reports of the WHO South-East Asia Region, MOHFW India reports, Science Citation Index, WHO Index Medicus of the South-East Asian Region, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Open Grey from the earliest available up to 31^st January 2022. The effect size was calculated for the prevalence of precancerous lesions and conditions.

RESULTS

One hundred sixty-two estimates from 130 studies yielded 52 high, 71 moderate, and seven low-quality studies from 823845. Point estimate based on cross-sectional studies for leukoplakia was 4.3% (95%CI: 4.0-4.6), oral submucous fibrosis was 2.7% (95%CI: 2.5-3.0), palatal lesions in reverse smokers and nicotine palatine were 5.8% (95%CI: 4.4-7.2), and Erythroplakia was 1.2% (95%CI: 0.7-1.7), and lichen planus was 1.1% (95%CI: 0.9-1.2). Amongst hospital-based studies, the pooled prevalence for Leukoplakia was 6.7% (95%CI: 6.0-7.3), oral submucous fibrosis was 4.5% (95%CI: 4.2-4.9), lichen planus was 7.5% (95%CI: 5.3-9.6), and erythroplakia was 2.5% (95%CI: 0.4-4.5), and palatal lesions in reverse smokers and nicotine palatini were 11.5% (95%CI: 8.0-15.0).

CONCLUSION

Precancerous lesions and conditions are prevailing problems among the Indian population. It is mainly due to tobacco use, the smokeless form of tobacco. The meta-analysis indicates that hospital-based studies have a higher effect size of 6.7% than community-based studies. Patients who have already developed this condition may be advised to reduce their exposure to the risk factor to prevent the condition from progressing further.

Efficacy of spirulina in management of oral submucous fibrosis − a systematic review

Objective: The aim of this systematic review was to evaluate the efficacy of spirulina in the management of oral submucous fibrosis. Methodology: Databases (MEDLINE via PubMed, Cochrane, EBSCO-host, Scopus, Science Direct, Clinical Trial Registry- India (CTRI) and Google scholar), review articles, bibliographies and related journal were searched from 1st January 2010 to 30th May 2020, using various combinations of MeSH terms and keywords. Results: A total of 5 clinical trials were analysed for the review, of which 4 were randomized controlled trials and 1 was non-randomized controlled trial. Mouth opening and burning sensation were analysed as primary outcome in all 5 studies. For both outcomes some studies reported statistically significant difference whereas others showed non-significant results on comparing with different interventions. Also, high risk of bias was observed among studies after performing quality analysis. Conclusion: Although the studies suggest efficacy of spirulina in management of OSF, but due to the high risk of bias there is a weak evidence regarding the effectiveness of spirulina in treating OSF. So, more uniform and standard trials on larger population should be carried out.

Tobacco Use Pattern, Dependence, Oral Cancer Awareness and Health Education needs Among Urban Slum Dwellers of Jodhpur City

Background

The rapid migration from rural to urban region results in mushrooming of slums in India. Urban-slums are comparatively poor vulnerable groups which are mostly affected with oral cancer due to higher exposure to risk factors like tobacco use.

Aims

To assess pattern of tobacco consumption, awareness about oral cancer and related health education needs in urban slums of Jodhpur city.

Methods

Study was conducted during July 2018Nov 2018 in slum of Jodhpur city. On the basis of cluster sampling strategy data were collected from 1200 participants regarding tobacco use and perception regarding oral cancer to identify health education needs in urban slums. Descriptive statistics, Chi-square test, multivariate logistics analysis were used and P < 0.05 was considered statistically significant.

Results

A total of 1200 participants were surveyed, out of which 48.5% were males. Among the study population, 58.5% (n = 462/789) males and 41.45% (n = 327/789) females were consuming tobacco in one or more forms. The statistical association between: age and bidi, gutka, zarda consumption; gender and bidi, cigarette, gutka consumption was found to be significant (P < 0.001). The younger population (1530 years) has more willingness to quit tobacco than the older population. (OR = 1.52, 95% CI = 1.092.11). Almost 56% were aware of oral cancer.

Conclusions

An effective information, education and communication (IEC) strategy for tobacco cessation should be designed with focus on different education needs according to age, gender, and education status of slum population.

Pulmonary function test: A critical domain in oral submucous fibrosis patients

INTRODUCTION

The study aims to measure and compare pulmonary function tests (PFTs) in oral submucous fibrosis (OSMF) patients (smokers/nonsmokers) and normal individuals.

MATERIALS AND METHODS

The study population included 150 participants that comprised 50 nonsmoker OSMF patients, 50 OSMF patients who smoke as well, and 50 patients with no deleterious habits. Spirometer was used to assess PFT.

RESULTS

Results showed that a significant P value was obtained for forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), and maximum voluntary ventilation (MVV) and also for the predicted values of FEV, FEV1, FEV1/FVC, PEFR, and MVV in OSMF (smokers/nonsmokers) study groups.

CONCLUSION

Thus, the decrease in pulmonary function can be an alarming sign for restrictive type of pulmonary disease.

Notch signaling in oral pre-cancer and oral cancer

Notch signaling involves cell to cell contact. It is an ancient signaling mechanism that is conserved throughout the animal kingdom. The basic function of Notch signaling is to decide cell fate and execute asymmetrical division. Notch signaling is indispensable for embryo growth. Aberrant Notch signaling involves in cancer progression by altering cell proliferation rate, tumor micro-environment, stem cell activities. The role of Notch signaling in cancer progression is context-dependent. In breast cancer and T cell lymphoma Notch signaling is highly active, whereas in squamous cell carcinoma (SCC) as oral and skin cancer, the signaling is suppressed. It is believed that in SCC, Notch-mediated tumor growth is due to the cell non-autonomous function. Oral cancer is the 6th most risky cancer worldwide. In many patients, oral cancer is preceded by pre-cancer conditions. In this review, we have summarized the research knowledge related to the role of Notch signaling in oral cancer and pre-cancer conditions and the therapeutic options available targeting different components of Notch pathways.

Evaluation of mast cells and burning sensation in various stages of Oral Submucous Fibrosis

Background

Oral Submucous Fibrosis (OSMF) is a potentially malignant disorder and burning sensation is the initial complaint among these patients. Scientific literature has established that mast cells play a major role in various inflammatory disorders. However, OSMF being an inflammatory disorder, the role of mast cells is yet to be established. Hence the aim of this study was to evaluate mast cells and burning sensation in various stages of Oral Submucous Fibrosis.

Methods

The study population comprised of forty subjects, thirty were clinically confirmed cases of OSMF and ten healthy individuals served as control. A complete history and clinical examination followed by an incisional biopsy was performed. Samples obtained were subjected to routine histopathological examination and mast cells evaluation.

Results

Mean number of total mast cells in Stage I, II and III OSMF were 8.5 ± 0.7, 11.31 ± 8.8 and 24.7 ± 21.2 respectively. There was a significant difference in total mast cell count between cases and controls. Degranulated mast cells was a significant predictor (p = 0.028), indicating role in clinical staging of OSMF. Degranulated mast cells had a significant role and was a positive predictor (B = 0.763, OR 2.145[95%CI 1.055-4.630]) at moderate levels of burning sensation. A significant difference (p = 0.029) in burning sensation across histopathological grades was also observed in the study.

Conclusion

Degranulated mast cells were found to have a significant influence in mild to moderate levels of burning sensation among OSMF patients. Role of degranulated mast cells were also found to be significant in various clinical stages of OSMF.