Assessment of glutathione peroxidase enzyme response and total antioxidant status in oral cancer - Systematic review and meta-analysis

BACKGROUND

Oxidative stress induced by free radical accumulation contributes to many pathologies, including cancer. Antioxidant defense system fails to scavenge free radicals when it is excessively accumulated. Assessing individual antioxidant enzymes and total antioxidant capacity could direct the customized therapeutic strategies.

OBJECTIVE

Evaluation of total antioxidant status and enzyme glutathione peroxidase activity in the oral cancer group compared to the healthy control group.

METHOD

The literature search included databases PubMed, Science Direct, Wiley Online Library, Cochrane and Cross Reference between 1999 and 2021. The database search was completed in the month of August 2022. The extracted data were analyzed by Comprehensive Meta-Analysis (CMA) version 3 software (Biostat Inc. Englewood, NJ). Based on search strategies, 1435 articles have been retrieved from the database. In the segregated articles, 1365 were excluded due to duplicated articles, animal studies, low-quality studies, articles unrelated to the research question, and with unmatched objectives. Based on inclusion criteria, 70 articles were selected for full-text valuation. However, 33 articles were found highly suitable for inclusion and data extraction. Finally, 11 articles were selected for meta-analysis.

RESULTS

The meta-analysis of four included studies of tissue samples showed a significantly (p < .001) increased GPx activity in the oral cancer group, when compared to the control group, whereas three included studies of erythrocyte samples displayed a significantly (p < .001) decreased GPx activity in the oral cancer group than the control group with the pooled standardized mean difference value of -2.766 moles/min/g Hb at 95% CI (-3.297 to -2.234). The meta-analysis of the included studies depicted an insignificant (p = .947) reduction of salivary TAS levels in the oral cancer group when compared to the control group.

CONCLUSION

Our systematic review and meta-analysis depict antioxidant GPx enzyme activity in the regional tissue samples of the oral cancer group differs from other systemic biological fluid samples compared to the healthy control group.

Depleting levels of endogenous anti-oxidant superoxide dismutase in oral sub-mucous fibrosis: A systematic review and meta-analysis

Objective

The systematic review is aimed to assess the antioxidant status by superoxide dismutase level in oral sub-mucous fibrosis using available literature.

Materials and methods

A literature search was accomplished electronically in Pubmed (MeSH), Science Direct, Scopus, Web of Science core collection, Cochrane, and Cross-reference, using the keywords such as 'oral submucous fibrosis,' 'antioxidant status' and 'superoxide dismutase.'

Results

Of the 352 articles identified, only 16 satisfied the selection criteria and were included in the systematic review. Among the selected, six studies were included for serum level analysis of superoxide dismutase. The assessment showed a significant reduction of serum superoxide dismutase in oral submucous fibrosis patients than in control (p < 0.004). The mean difference in serum superoxide dismutase concentration between oral submucous fibrosis and healthy subjects was -86.23 U/ml (95% CI -145.30, -27.17). The serum SOD level was significantly reduced as the disease progressed to stage I or stage II (p < 0.001) compared to the control group.

Conclusion

The studies showed significantly lower levels of superoxide dismutase in various human samples of patients with OSMF. Therefore, further studies are required to estimate antioxidant status using different biomarkers of oral submucous fibrosis concerning different stages of the disease in order to augment future therapy.

Clinical relevance

Assessment of antioxidant activity helps to identify the patients at risk of malignant transformation. It serves as a reliable guide to validate therapy. It serves as a marker of prognosis in patients suffering from oral submucous fibrosis.

A Meta-analysis of Oral Squamous Cell Carcinoma in Young Adults with a Comparison to the Older Group Patients (2014-2019)

Background:

The oral squamous cell carcinoma (OSCC) often affects elderly aged adults, who had long-term tobacco exposure. In the recent past decade, there is an increasing incidence of OSCC in younger individuals, who had less tobacco association.

Aim:

The aim of this study is to examine the risk factors and to assess and compare the clinicopathological features and prognosis of OSCC in young patients with the older group patients.

Materials and Methods:

We included studies that addressed the OSCC involving young patients during the period between 2014 and 2019. Initially, we found 679 articles; after refined evaluation, 92 works had their titles matching to the present work. After extraction of case reports, reviews, and studies with un-matched objectives or inadequate data, we have chosen only 24 presentations matching to the abstract. The statistical analysis performed by Chi-square tests using SPSS 20.0 version for windows.

Results:

Of the total OSCC, 10% of patients belonged to the younger age group, and 90% were the older aged group. Both the groups showed male gender predominance and tongue as the predominant site of involvement. The younger patients tend to have significantly reduced tobacco exposure. The highly reported tumors were advanced staged and moderately differentiated tumors in both groups. There was a statistically evident high recurrence reported in the younger group. The overall survival seems to be similar for both groups.

Conclusion:

The identification of the potential risk factors, along with unique molecular mechanisms, and biological behavior of the disease is mandatory to control the incidence of OSCC in young adults.

The Knowledge and Awareness of Medical Emergencies and Management among Dental Students

Background:

Every dentist should anticipate being confronted with a medical emergency (ME), and one should always be ready to treat the most catastrophic ones.

Aim:

This study aimed to assess the knowledge of dental clinical students of Tamil Nadu in the ME understanding and management to create awareness toward patient care.

Methodology:

A total of 768 dental students, including final-year students and residents from different colleges, took part in the questionnaire-based cross-sectional study. The selection of study participants was by the convenience sampling method. The questionnaire contained thirty closed multiple-choice questions to assess their knowledge of MEs. Microsoft Office Excel software was used for compiling the answers. The descriptive analysis of the data is exhibited in graphs.

Results:

The majority of participants were mindful of the vital signs; only 55% of the participants know the importance of checking their respiration rate. The knowledge of identifying MEs such as anaphylaxis was 91%, and only 27%–37% of the respondents knew to identify angina, transient ischemia, and lidocaine toxicity. Approximately 15%–40% of the respondents only knew the management of angina, cardiac arrest, hyperventilation, respiratory obstruction, and seizure. Only 10% agreed that the best office emergency kit should be prepared by themselves. Roughly 78% of the respondents were conscious of the patient's referral whenever necessary and aware of state dental acts.

Conclusion:

This study reflects a significant need for training in executing ME among dental students who are to transmute into future dental professionals.

Assessment of Salivary Cortisol Concentrations as a Level of Stress Indicator among Individuals Undergoing Dental Extraction Procedure

Background:

Anxious patients tend to exaggerate the aversive events before the actual dental therapy. The anxiety and fear are the major factors that regulate cortisol levels.

Aim:

Our study aims to estimate the salivary cortisol among patients subjected to dental extraction and correlate any existence between pre- and post-extraction cortisol levels and vital parameters compared to the control group.

Methodology:

The study sample included sixty individuals, thirty patients indicated for a dental extraction, and thirty healthy patients between the ages of 18 and 60 years. We collected saliva samples from the control group and pre- and post-extraction samples from the study group participants and vital parameters. We used quantitative ELISA Kit, Diagnostics Biochem Canada Inc. (DBC), to estimate the salivary cortisol level. We evaluated the values using the Chi-square test, Pearson correlation test, and paired t-test using the JMP 15; JMP Pro, Version 15 (SAS) Microsoft^® Windows^® for × 64.

Results:

The mean value of cortisol concentration of saliva was significantly greater in the preextraction group (6.13 ± 0.53 μg/dl) than after extraction group (3.17 ± 0.14 μg/dl) (P < 0.001). There were no significant associations between hemodynamic parameters and salivary cortisol concentration except for the postextraction systolic blood pressure (BP). A comparison of hemodynamic parameters between the study and control group revealed substantial differences in systolic BP.

Conclusion:

The patient's anticipation and anxiety toward dental therapy elevate the cortisol level. Dental surgeons should treat the patients more conveniently and effectively without any strains and provide a comfortable atmosphere to avoid stress-related consequences.

Meta-analysis on risk factors of squamous cell carcinoma of the tongue in young adults

Tongue squamous cell carcinoma (TSCC) generally affects the older age group exposed to tobacco for an extended period. However, recent research points out that there is an increased incidence of TSCC in the younger age group without any traditional risk factors making TSCC as a distinct biological entity in this group. This study aims to assess the prevalence and risk factors of tongue carcinoma in the younger group of patients. This article included studies that addressed the TSCC involving young patients and that which are PubMed indexed. Initially, 390 articles were considered; but after refined evaluation, 123 articles had their titles and abstracts matching to this present work. After the extraction of the case reports, review articles and the articles without the assessment of the parameter of harmful habits, we have included only 23 articles in the sample matching the title. The statistical analysis was formed by using chi-square tests using IBM SPSS ver. 20.0. The cohort of the younger population in these studies was mostly in the 35- to the 45-year age group. The majority of reports (64%) classified the patients below 40 years of age as a young group. Though male predominance is reported to be 55%, female patients are also more affected (40%) in the younger age group compared with, the more typical and usual group of head and neck carcinoma patients. TSCC in older adults predominantly reported in tobacco users (70%) whereas in young adults, TSCC was associated with a higher incidence in nonsmokers (53%); the causes of these cancers in young adults remain unclear. The identification of the potential risk factors aside from traditional factors is vital to control the incidence of TSCC in young patients.

Tooth and Advanced Oral Submucous Fibrosis Obscuring Buccal Squamous Cell Carcinoma: A Case Report and Literature Review

Oral squamous cell carcinoma is a leading cause of mortality due to late diagnosis in India and most other developing countries. Buccal squamous cell carcinoma is almost always preceded by premalignant conditions that include leukoplakia, erythroplakia, oral lichen planus, and submucous fibrosis of the oral cavity. Hence, these patients warrant regular screening by oral health care professionals and proper monitoring for any dysplastic changes. Implementing social awareness about early signs and symptoms, as well as education on self-oral screening methods so as to avoid the risk of late presentation of oral squamous cell carcinoma, should be made mandatory for such individuals to prevent further complications.

Proposed classification for interproximal contacts of primary molars using CBCT: a pilot study

Background: Interproximal contact areas in primary teeth are known to be broader, flatter, and situated more gingivally than in permanent teeth. The objective of the present study was to evaluate the different types of intact interproximal contact areas in primary teeth using cone beam computed tomography (CBCT) among children. Methods: A cross-sectional study was designed with 74 contacts from 28 existing CBCT images of children aged between 3 and 14 years, obtained from the Indian Dental Education Academy, Chennai, India. The shape of the contact area was observed at three levels, the coronal, middle, and apical thirds, in three different sections of CBCT. Prevalence of the types of contact areas was expressed in the form of numbers and percentages. Results: The weighted Cohen's kappa values for inter-examiner reliability was 0.893 at baseline. Results exhibited four different types of contact areas between the primary molars, namely, O type, X type, I type, and S type, based on the shapes observed; hence, the proposed classification is referred to as OXIS. The most common pattern seen was I (66.2%), followed by X (21.6%), O (9.4%) and the least common was S (2.7%). Conclusion: The three-dimensional evaluation of intact interproximal contact areas between primary molars are of four types, O,X, I and S.

Proposed classification for interproximal contacts of primary molars using CBCT: a pilot study

Background: Contact areas in primary teeth are known to be broader, flatter, and situated more gingivally than in permanent teeth. The objective of the present study was to evaluate the different types of intact contact areas in primary teeth using cone beam computed tomography (CBCT) among children. Methods: A cross-sectional study was designed with 74 contacts from 28 existing CBCT images of patients aged between 3 and 14 years, obtained from the Indian Dental Education Academy, Chennai, India. The shape of the contact area was observed at three levels, the coronal, middle, and apical thirds, in three different sections of CBCT. The weighted Cohen's kappa values for inter-examiner reliability was 0.893 at baseline. Prevalence of the types of contact areas was expressed in the form of numbers and percentages. Results: Results exhibited four different types of contact areas between the primary molars, namely, O type, X type, I type, and S type, based on the shapes observed; hence, the proposed classification is referred to as OXIS. The most common pattern seen was I (66.2%), followed by X (21.6%), O (9.4%) and the least common was S (2.7%). Conclusion: The three-dimensional evaluation of intact interproximal contact areas between primary molars are of four types.

Verrucoid Variant of Invasive Squamous Cell Carcinoma in Oral Submucous Fibrosis: A Clinicopathological Challenge

Verrucous carcinoma (VC) is an exophytic, low-grade, well-differentiated variant of squamous cell carcinoma. It is described as a lesion appearing in the sixth or seventh decade of life that has minimal aggressive potential and, in long-standing cases, has been shown to transform into squamous cell carcinoma. Oral submucous fibrosis (OSMF) is a potentially malignant disorder, and about one-third of the affected population develop oral squamous cell carcinoma. The histopathological diagnosis of verrucous carcinoma is challenging, and the interpretation of early squamous cell carcinoma requires immense experience. Here we present a rare case of a 24-year-old male with OSMF transforming to verrucous carcinoma with invasive squamous cell carcinoma. Even though the case had a straightforward clinical diagnosis, the serial sectioning done for pathological diagnosis disclosed the squamous cell carcinoma.

Single Rooted Permanent Premolars and Molars - A Rare Clinical Presentation Confirmed using Cone Beam Computed Tomography

The morphology of the root and root canal system plays a significant role in the treatment outcome of endodontic procedures. The necessity of clear and high contrast images for tissues like bone and teeth has made the usage of newer imaging techniques inevitable. This is a rare case report wherein, the permanent posterior dentition of both arches was single rooted. While sporadic cases of single rooted teeth have been reported, it is rare for all the premolars and molars to show such variation. This rare clinical observation has been enhanced by Cone Beam Computed Tomography (CBCT), which provides a clear image with added benefits of 3D (Three Dimensional) image reconstruction, low dosage and rapid scan time.

Ultrasonographic evaluation of oral submucous fibrosis in habitual areca nut chewers

OBJECTIVES

To characterize the sonographic features of the buccal mucosa in patients with oral submucous fibrosis (OSF).

METHODS

Three groups (controls with areca-related habits, controls without areca-related habits and clinically diagnosed OSF cases), each comprising 30 subjects, were included in the study. After a thorough clinical examination, transcutaneous B-mode ultrasonography was performed with a multifrequency linear transducer (5-10 MHz) for anterior and posterior buccal mucosa bilaterally. Both clinical and ultrasound findings were recorded by three independent observers. One-way analysis of variance and Tukey's honestly significant difference post-hoc tests were used for statistical comparisons between groups and Pearson χ(2) tests to compare the proportions. Kappa statistics was used to determine the interobserver agreement.

RESULTS

The submucosa that appeared hypoechoic in the control groups had significantly increased echogenicity in the case group (hypo- to isoechoic in 46.7% and isoechoic in 53.3%). The differentiation between the submucosa and the muscle layer appeared distinct in the control groups while it was not clear in the case group (indistinct in 50% and completely lost in 50%). The number of sites found positive on the ultrasound was significantly greater than the number of clinically positive sites. There was a very good interobserver consistency in clinical and ultrasound findings.

CONCLUSIONS

Ultrasonography of the buccal mucosa demonstrates increased submucosal echogenicity and reduced echo differentiation between submucosa and muscle layer in OSF cases. Hence, it can be used as a non-invasive imaging modality to assess the disease extent and severity across the entire buccal mucosa to supplement clinical evaluation.

Mixed periapical lesion: differential diagnosis of a case

A radicular cyst associated with carious teeth is a very common odontogenic lesion in the oral cavity, but calcifications in residual radicular cysts are quite rare. We report one such case where a routine pre-implant radiographic assessment revealed a mixed periapical radiopaque radiolucent lesion in the right maxillary central incisor region. Histological and radiographic studies show that there is a slow increase in the mineralized deposits within the cyst lumen with time. This becomes prominent histochemically in cysts more than 8 years old and radiographically 6 years later, as seen in our case. In this paper we would like to highlight the importance of a residual radicular cyst with calcifications in the differential diagnosis of a mixed periapical radiopaque radiolucent lesion.

Maxillary cementoblastoma--a rarity

BACKGROUND

This paper highlights the unusual and rare presentation of a cementoblastoma in the maxilla. It also discusses a review on this odontogenic pathology.

CASE REPORT

We present a cementoblastoma appearing in an atypical site in a young girl. The presenting clinical features with radiologic features are reviewed. Also discussed is an approach to radiological interpretation. To the best of our knowledge, this is only the seventeenth case to be reported in literature.

DISCUSSION

Cementoblastoma is a benign true neoplasm which forms a mass of cementum or cementum-like tissue on the root surface of the tooth. As a maxillofacial practitioner, it is essential to consider cementoblastoma as one of the differential diagnosis, although rare, while considering maxillary swellings. The treatment remains fairly conservative, with an excellent prognosis.

Mucormycosis presenting as palatal perforation

Mucormycosis is an opportunistic fungal infection that is caused by normally saprobic organism of the class Zygomycetes. The main form of mucormycosis are pulmonary and rhinocerebral. Rhinocerebral mycormycosis typically starts in the maxillary antrum, particularly in poorly controlled diabetics. Invasion of surrounding tissue can cause necrotizing ulceration of palate with a blackish slough and exposure of bone. A case of mucormycosis presenting as palatal performation is discussed in this article.