A prospective study of circulating estrogen in oral leukoplakia and oral squamous cell carcinoma

BACKGROUND

Reports suggested that hormone replacement therapy decreased the incidence of squamous cell carcinoma (SCC) of the oral cavity.

AIM

The aim of this study was to analyze and quantify the serum 17β-estradiol (E2) level by chemiluminescence immunoassay in four groups, Group I (control group with no habit of tobacco and areca), Group II (control group with a habit of tobacco and areca), Group III (potentially malignant disorder-leukoplakia), and Group IV (oral squamous cell carcinoma (OSCC)). It was the first study to evaluate E2 in four study groups with and without the habit of tobacco.

METHOD

The serum analysis was carried out in Cobas e411 analyzer by electrochemiluminescence immunoassay analysis.

RESULTS

As per the Kruskal--Wallis test, statistically significant rise in estradiol levels in Group IV as in comparison to Group III as compared with Groups II and I.

CONCLUSION

This study proved that irrespective of the gender bias, the female sex hormone, estradiol levels were significantly raised in OSCC patients. This study suggests that E2 may play a vital role in determining the patient prognosis in OSCC with tobacco habit. The confounding results of this preliminary study opened up new advents emphasizing the role of E2 in OSCC. The role of E2 in estrogen receptor regulation can also be a subject of study for targeted therapies in improving the patient's prognosis.

The Impact of COVID-19 on General and Dental Health

COVID-19 (Coronavirus disease 2019) is a contagious infection caused by novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). This novel virus was publicly announced as an infectious pathogen by the “Chinese Centre for Disease Control and Prevention” on 8 January 2020. The World Health Organization named COVID-19 a pandemic crisis all over the world on March 11, 2020. Aged people and medically compromised people like patients with diabetes, cardiovascular disease, chronic respiratory disease, and cancer are the vulnerable populations for developing an illness. A guideline has been postulated and described in the form of a journey map to avoid exposure of dental health care professionals to COVID-19. This review provides a comprehensive outlook for the current pandemic situation, its origin, spread, and preventive measures to be utilized in general and in dental practice.

Impact of Oral Lichen Planus on Oral Health-Related Quality of Life: A Systematic Review and Meta-Analysis

Oral health-related quality of life (OR-QoL) measurement in patients with oral lichen planus (OLP) can provide valuable information for the optimal management of their clinical conditions. The main objective of the present study was to assess the OR-QoL of patients with OLP as measured by the short-form Oral Health Impact profile-14 (OHIP-14) questionnaire. PubMed/MEDLINE, ISI/Web of Science, clinical trial registry, Embase, Scopus, and grey literature (via Google Scholar and Scilit) were searched. Reviewers independently screened titles/abstracts, assessed full-text articles, extracted data, and appraised their quality. Random effect analysis along with subgroup analysis for age, gender, and clinical type was performed. Seventeen studies were included. Mean overall OH-QoL was 15.20, [95% CI 12.176, 18.231]; a higher OHIP-14 score was seen in OLP patients, resulting in poor OH-QoL. The impact of OLP on OH-QoL life was moderate as compared to healthy subjects. However, medical treatment of the disease improved the OH-QoL and thus reduced the impact of OLP on it. OH-QoL among patients with OLP is generally poor. Clinicians and physicians should consider the OH-QoL of these patients as part of patients’ evaluation and modulate the administered treatment based on the OH-QoL response.

Why do Only Certain Cases of Oral Submucous Fibrosis Undergo Malignant Transformation?

Oral submucous fibrosis (OSMF) causes desmoplasia and rigidity of submucosa of the oral cavity, resulting in reduced mouth opening, and in advanced stage causes difficulty in swallowing. OSMF has poor morbidity in terms of oral function as well as general health due to loss of oral function, such as eating. In severe conditions, it can cause dysphagia and hearing loss. Various clinicians have tried the different treatment modalities to reverse the disease process, but with limited success and that too in alleviating the associated symptoms.

Oral health-related quality of life in oral cancer patients: systematic review and meta-analysis

Aim: The purpose of this meta-analysis was to evaluate the impact of oral health on quality of life in oral cancer patients (OCPs). Methods: PubMed, Scopus and Web of Science databases were searched for publications on oral health-related quality of life (OHRQoL) in OCP and the information was extracted according to the PRISMA guidelines. A random effect model was used to obtain the pooled standard mean differences of Oral Health Impact Profile (OHIP)-14 questionnaire responses in meta-analysis. Results: total of 12 research papers were analyzed and revealed poor OHRQoL in OCPs (standard mean difference: 2.53; 95% CI: 1.55-3.50; p < 0.00001) compared with healthy individuals due to the effects of oncotherapy. Moreover, OHRQoL deteriorated with combinations of different treatment modalities. Conclusion: Oral health and oncotherapy can affect the quality of life in OCPs.

EMMPRIN/BASIGIN as a biological modulator of oral cancer and COVID-19 interaction: Novel propositions

Extracellular matrix metalloproteinase inducer (EMMPRIN), which is also called BASIGIN/CD147, is a cell surface glycoprotein that belongs to the immunoglobulin superfamily and plays a significant role in intercellular recognition in immunology, cellular differentiation and development. Apart from ACE-2, recently EMMPRIN, has been regarded as a target for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) attachment and entry into the host cell. Since one of the routes of entry for the virus is the oral cavity, it becomes imperative to percept oral comorbidities such oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs) in terms of EMMPRIN as a target for SARS-CoV-2. In the present paper, it is proposed that OSCC, by the virtue of upregulation of EMMPRIN expression, increases the susceptibility to coronavirus disease (COVID-19). In turn, COVID-19 in OSCC patients causes exhaustion of EMMPRIN receptor due to binding with ‘S’ receptor leading to a downregulation of related carcinogenesis events. We proposed that in the ACE-2 depleted situation in OSCC, EMMPRIN receptor might get high jacked by the COVID-19 virus for the entry into the host cells. Apart from the anti-monoclonal antibody, it is recommended to explore the use of grape seed and skin containing mouthwash as an adjunct, which could also have anti EMMPRIN effects in patients with OSCC and OPMDs.

Face Validity and Psychometric Evaluation of the Available Oral Health-related Quality of Life Instruments: A Systematic Review

PURPOSE

A growing recognition of the importance of oral health-related quality of life (OHRQoL) has led to the development of several instruments to measure their relationship with health. The objective of this review was to update the knowledge on the general and psychometric characteristics of the instruments to measure the quality of life (QoL) related to oral health that emerged after publication in 1997 of the results of the conference 'Measuring Oral Health and QoL'.

MATERIALS AND METHODS

A bibliographic search was carried out to identify publications published in January from 1998 to June 2018, using EMBASE, PubMed, Scopus, CINAHL and Web of Science databases. Specific criteria were established based on international reference frameworks for the inclusion, collection, and analysis of general and psychometric properties of the instruments.

RESULTS

233 articles were identified, of which 10 met the eligibility criteria and were included. All the instruments were multidimensional, presented psychometric properties and were mostly based on prior measurement tools and the classification of impairments and disabilities. All studies presented information on the internal consistency of their instruments. Validity to discriminate was also rated positively in all of the instruments except OHRQoL-UK instrument. Among the instruments, the criterion that was found to be least was a response to change, as only three instruments met the criteria. Reliability and construct validity criteria were also present in most of the studies.

CONCLUSION

The dental profession has shown great progress towards a more comprehensive measurement of the oral health needs of the population, it is necessary to move from focusing on sick patients and theories of disabilities to incorporating healthy patients and resource-based theories and capacities in their measurements of OHRQoL, that would improve patient safety, quality of care and risk management, and improve clinical decision making for healthcare professionals.

A systematic scoping review on utility of cytomorphometry in the detection of dysplasia in oral potentially malignant disorders

Background

Oral exfoliative cytology is simple, non-invasive, inexpensive tools prone to subjective bias. Objective computer-based quantitative cytomorphometry technique was developed in last few decades to overcome its limitation. However, there is no consensus about the utility of cytomorphometry as a routine screening tool for early detection of dysplastic changes.

Objectives

To review the utility of cytomorphometry in OPMDs in the detection of dysplasia changes.

Method

A scoping review was undertaken focusing on cytomorphometric analysis in exfoliative cells for detection of oral epithelial dysplasia and cytomorphometric parameter denoting dysplasia. The systematic search was carried out in the online journal databases (Scopus, Google Scholar, PubMed, Web of Science) using keywords until December 2019 for the studies evaluated the cytomorphometry in the detection of dysplastic changes in OPMDs. Three authors independently extracted data using collection forms.

Result

The search strategy found seven analytical cross-sectional studies for scoping review after eliminating 8940 out of 8947 initial results. The scoping review showed that cytomorphometry is useful tool in detecting the dysplastic changes in OPMDs. In addition, decrease in mean cellular area, increase in mean nuclear area, and decrease in mean cell diameter, increase mean nuclear diameter, increase in mean nuclear and cytoplasmic area ratio, associated with development of dysplastic changes in OPMDs.

Conclusion

Cytomorphometry is promising tool, yet there is currently no-good evidence to support role of cytomorphometry in detecting the dysplastic changes in OPMDs in this setting. More research is required for refinement of cytomorphometry as a screening tool.

Localized peripheral autonomous neuropathy and dysfunctional myoepithelial cells: A novel hypothesis for xerostomia in oral submucous fibrosis

Oral submucous fibrosis (OSMF) is a potentially malignant disorder of the oral cavity characterized by submucosal deposition of dense collagen bundles leading to limited mouth opening. Besides, patients also complain about the burning sensation in the oral cavity and xerostomia. These symptoms have a major impact on the functional and psychological domains of oral health-related quality of life. However, the pathogenesis of xerostomia in OSMF is not yet well established. In our routine histopathology practice, we observed fibrosis surrounding minor salivary glands, distended acini, obliteration of acinar lumen and loss of interstitial spaces. Based on these features, we hypothesized that fibrosis in OSMF drives localized peripheral autonomous neuropathy in minor salivary glands, which leads to dysfunctional myoepithelial cells. These dysfunctional myoepithelial cells will unable to contract and expel saliva out of the salivary secretary unit, thus leading to xerostomia. In the present paper, experiments are recommended to prove this hypothesis, which can be exploited in the future for the development of appropriate drugs.

Natural history of trigeminal neuralgia-A hospital-based retrospective study

OBJECTIVE

The objective of this study was to assess the natural history of trigeminal neuralgia (TN) and pretrigeminal neuralgia (PTN) in a hospital-based sample using a retrospective and descriptive study design.

METHODS

This study followed a retrospective study design, which yielded a sample size of 216 patients who were reclassified as per the new classification and diagnostic grading for practice and research proposed by the American Academy of Neurology. Based on an in-depth analysis of patient history and the treatments administered, a possible state of PTN prior to TN development was determined.

RESULTS

TN shows a female predilection with predominantly unilateral involvement. A total of 45.83% of patients had left-side involvement with V3 primarily affected. Additionally, 11.11% of patients did not have any clinically apparent trigger zone, while 68.05% had a single trigger zone. Twenty-one patients were found to have suspected PTN prior to TN. The time interval between PTN onset and TN development ranged from 6 months to 6 years. The PTN pain varied, and the clinical overlap between the site of PTN and the site of future TN was 100%.

CONCLUSION

An in-depth patient history can serve as a reliable modality for TN diagnosis. PTN should be considered as a differential diagnosis for pain of orofacial origin because of its overlapping features with other painful conditions.

Usage Analysis of WhatsApp for Dentistry-related Purposes among General Dental Practitioners

INTRODUCTION

To assess the knowledge and extent of WhatsApp usage for dentistry related purposes among general dental practitioners (GDPs).

MATERIALS AND METHODS

A cross-sectional study was conducted among 105 randomly selected GDPs from Pune, Maharashtra, India. Data was collected in a personalized manner by means of validated questionnaire. Results and observations: A total of 105 dentists participated in the survey: 96.19% of dentists had WhatsApp installed in their phones; 67.32% of dentists sought second opinion on WhatsApp; 60.29% of dentists received prompt replies, while 38.23% received late replies; 98.52% of dentists sent clinical photographs and radiographs for second opinion. 88.11% of dentists were a part of various 'dentistry related groups' and 72.27% of dentists told that patients ask their queries on WhatsApp. 36.76% of GDPs obtained verbal consent from the patients for sending clinical materials for second opinion. Majority of population of GDPs 63.23% (43) did not obtain any form of consent from the patients.

CONCLUSION

Majority of GDPs uses WhatsApp for 'dentistry related purposes' and it has become an integral part of their day-to-day practice. GDPs should obtain written consent before sending clinical materials for second opinion.

CLINICAL SIGNIFICANCE

Till date, the extent of WhatsApp usage by general dental practitioners was not reported in the literature. It appears that, WhatsApp application has become an integral part of general dental practice in India. By virtue of this, obtaining second opinion, taking appointments and solving queries of patients are no longer a time consuming events. In future, instant messaging services might play major role in providing efficient services in health care industry.

Dysplastic features relevant to malignant transformation in atrophic epithelium of oral submucous fibrosis: A preliminary study

BACKGROUND

The grading of oral epithelial dysplasia (OED) is not applicable to oral submucous fibrosis (OSMF) cases due to the presence of atrophic epithelium. The mucosal margins associated with resected OSCC specimens are often closely related to transformed cells. In this study, we compared the histomorphological alterations (dysplastic features) in the atrophic epithelium of OSMF patients with the mucosal margins of OSCC associated with OSMF (OSCC-OSMF).

METHODS

We evaluated 17 dysplastic features in 37 patients with OSMF (biopsy site: buccal mucosa) and 37 patients with OSCC-OSMF (mucosal margins involving buccal mucosa) using histopathological staining.

RESULTS

Dysplastic features, such as keratin pearls within rete ridges, nuclear pleomorphism, and atypical mitotic figures, were not observed in the epithelium of the OSMF or OSCC-OSMF groups. Basal cell hyperplasia (P = .016), abnormal superficial mitosis (P = .010), increased nuclear-cytoplasmic ratio (P = .034), and hyperchromasia (P = .031) were predominantly seen in the OSCC-OSMF group. We found no statistically significant differences in the following parameters: irregular epithelial stratification (P = 1.00), loss of basal cell polarity (P = .237), presence of drop-shaped rete ridges (P = .077), increased number of mitotic figures (P = .154), premature keratinization in single cells (P = .499), anisonucleosis (P = .289), anisocytosis (P = .079), cellular pleomorphism (P = .317), and increased number and size of nucleoli (P = .129).

CONCLUSION

Increased basal cell layer hyperplasia, abnormal superficial mitosis, increased nuclear-cytoplasmic ratio, and hyperchromasia are high-risk features for OSMF, and affected patients should be followed on a priority basis for the early detection of OSCC.

Oral pregnancy tumor

Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury, or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous growth on a pedunculated or sometimes sessile base, which is usually hemorrhagic. Although excisional surgery is the treatment of choice , some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroids, and sodium tetradecyl sulfate sclerotherapy have been proposed. We present the case of a 25–year-old pregnant woman with large oral pyogenic granuloma.

Nitric oxide and oral cancer: a review

Nitric oxide (NO), a short-lived, endogenously produced gas, plays key role in various physiological as well as pathological processes. NO-inducing cell signaling events within the cell producing it and the diffusibility of it in other cells have led to the discovery of various physiological functions of NO including vasodilation, respiration, cell migration, immune response and apoptosis. On the other hand, excessive and unregulated NO synthesis has been implicated in many pathophysiological conditions including cancer. Research on NO, during the past few years is one of the growing areas in cancer biology. The high incidence of oral cancer and precancer has been linked with habits of tobacco chewing and smoking and NO has been said as the "messenger of death" in tobacco related diseases. NO seems to play a part in various stages of carcinogenesis from initiation to progression. However, there is considerable controversy and confusion in understanding its role in cancer biology. It is said to have both, tumoricidal as well as tumor promoting effects and these depend on its timing, location and concentration. Further, NO has also been shown to have antitumor, chemopreventive and therapeutic abilities. Here is an overview in which efforts are made to understand the role of this molecule in oral carcinogenesis.