Serum and salivary Cu/Zn ratio as a diagnostic biomarker for oral submucosal fibrosis: an analysis of trace metals and LOX gene variants

This study aimed to analyze the serum and salivary levels of copper (Cu), zinc (Zn), iron (Fe), chromium (Cr), manganese (Mn) and the Cu/Zn ratio and investigate the association between LOX gene variants (rs18800449 and rs2288393) and oral submucosal fibrosis (OSMF). A total of 250 subjects were included in the study: OSMF patients (n = 50), areca nut chewers without OSMF (n = 100) and controls (n = 100). Trace metals were measured using an atomic absorption spectrophotometer, while LOX gene variants were genotyped using the tetra primer amplification refractory mutation system (tetra ARMS) polymerase chain reaction (PCR) method. The results showed significant variations in serum and salivary Cu, Zn, Fe and Cr levels and serum Mn concentrations among the three groups (p < 0.0001). Serum Cu levels were significantly higher in OSMF patients, while serum Zn levels were significantly lower. Both serum and salivary Cu/Zn ratios demonstrated a statistically significant difference (p < 0.0001) and diagnostic potential to differentiate OSMF from chewers and controls. However, LOX gene variants did not show an association between OSMF and chewers, except for rs1800449 genotypes, which showed a significant and increased risk with the AA genotype in OSMF patients compared to controls (OR = 7.58; 95%CI 2.30-24.97). The study suggests that trace elements and genetic variants may impact the etiology of OSMF. The findings may aid in early diagnosis, suitable treatment, and as a prognostic indicator for disease progression.

Jiawei Danxuan Koukang Alleviates Arecoline Induced Oral Mucosal Lesions: Network Pharmacology and the Combined Ultra-High Performance Liquid Chromatography (UPLC) and Mass Spectrometry (MS)

Purpose

Arecoline is one of the main toxic components of arecoline to cause oral mucosal lesions or canceration, which seriously affects the survival and life quality of patients. This study analyzed the mechanism of Jiawei Danxuan Koukang (JDK) in alleviating arecoline induced oral mucosal lesions, to provide new insights for the treatment of oral submucosal fibrosis (OSF) or cancerosis.

Methods

Metabolomics was applied to analyze the composition of JDK and serum metabolites. The active ingredients of JDK were analyzed by the combined ultra-high performance liquid chromatography and mass spectrometry. The target network of JDK, metabolites and OSF was analyzed by network pharmacology, and molecular docking. Oral mucosal lesions and fibrosis were analyzed by HE and Masson staining. Cell differentiation, proliferation and apoptosis were detected. The expressions of α-SMA, Collagen I, Vimentin, Snail, E-cadherin, AR and NOTCH1 were detected by Western blot.

Results

Arecoline induced the gradual atrophy and thinning of rat oral mucosal, collagen accumulation, the increase expressions of fibrosis-related proteins and Th17/Treg ratio. JDK inhibited arecoline-induced oral mucosal lesions and inflammatory infiltration. Arecoline induced changes of serum metabolites in Aminoacyl-tRNA biosynthesis, Alanine, aspartate and glutamate metabolism and Arginine biosynthesis pathways, which were reversed by M-JDK. Quercetin and AR were the active ingredients and key targets of JDK, metabolites and OSF interaction. Arecoline promoted the expression of AR protein, and the proliferation of oral fibroblasts. Quercetin inhibited the effect of arecoline on oral fibroblasts, but was reversed by AR overexpression. Arecoline induced NOTCH1 expression in CAL27 and SCC-25 cells, and promoted cell proliferation, but was reversed by M-JDK or quercetin.

Conclusion

JDK improved the arecoline-induced OSF and serum metabolite functional pathway. Quercetin targeted AR protein to improve arecoline-induced OSF. JDK and quercetin inhibited arecoline-induced NOTCH1 protein expression in CAL27 and SCC-25 cells to play an anti-oral cancer role.

Clinicopathological characteristics of oral squamous cell carcinoma arising from oral submucous fibrosis: A systematic review

Introduction

Oral submucous fibrosis (OSMF) is considered to be a potentially malignant oral disorder with high risk of malignant transformation. Oral squamous cell carcinoma (OSCC) arising from OSMF has peculiar clinical and histopathological features.

Aim

To assess the clinicopathological features of OSCC arising in the background of OSMF in an attempt to identify the patients with OSMF who are at increased risk of developing OSCC.

Methodology

A systematic review was performed based on PRISMA guidelines to include articles published until May 2021 in English, relating the clinicohistopathological characteristics of OSCC arising from OSMF (OSMF-OSCC) or OSMF associated with OSCC (OSCC-OSMF). All the eligible articles were analyzed and relevant data were extracted.

Results

Seventeen articles were included for systematic review after following strict inclusion and exclusion criteria. The malignant transformation rate of OSMF-OSCC ranged from 1.9 to 9.13 and the prevalence of OSCC-OSMF ranged from 2.8 to 66. The mean age of the patients ranged from 36.6 years to 47.2 years and buccal mucosa was the common site to be affected. Majority of the OSCC-OSMF was well-to-moderately differentiated and majority of them did not metastasize to the lymph nodes.

Conclusion

OSCC associated with OSMF presents at a younger age with early tumor stage, better differentiation, and better prognosis when compared to OSCC not associated with OSMF. However, more multicentric prospective studies with large sample size are required to determine the true biologic behavior of OSCC arising in the background of OSMF to establish less aggressive treatment strategies considering them as a separate entity.

Evaluation of Copper Levels in Dental Calculus of OSF Patients with Chewing Dried Areca-Nut Quids in Hunan Province of Mainland China

Dental calculus is a potential material that can be used for assessing chronic exposure to trace heavy metals in oral cavity as it is a long-term reservoir. The aim of this study was to investigate the correlation between dental calculus copper levels and risk of oral submucous fibrosis (OSF) due to chewing dried areca-nut quids in Mainland China. This study included 34 OSF (grade 1) sufferers with dried areca-nut quids chewing as the patient group and 23 healthy individuals without areca-nut chewing as the control group. The dental calculus sample was obtained from all 57 participants and evaluated by inductively coupled plasma mass spectrometry (ICP-MS) for dental calculus level of copper. This work revealed that the mean copper level of dental calculus was significantly higher in OSF (grade 1) sufferers with areca-nut chewing than those in healthy individuals without areca-nut chewing (p < 0.001). This work provided an evidence to support that there may be a positive correlation between elevated levels of copper in dental calculus caused by chewing dried areca-nut quids and an increased risk of developing OSF in Mainland China.

Left colonic localization, non-granular morphology, and pit pattern independently predict submucosal fibrosis of naïve colorectal neoplasms before endoscopic submucosal dissection

BACKGROUND

Endoscopic submucosal dissection (ESD) represents the method of choice for removal of large colorectal neoplasms with suspected submucosal invasion. Presence and degree of submucosal fibrosis increases ESD duration and technical complexity, reduces the rate of curative resection and reduces safety profile. The aim of the study was to identify pre-procedural predictive factors of submucosal fibrosis in naïve colorectal neoplasms and to assess the impact of fibrosis on technical and clinical ESD outcomes.

METHODS

All consecutive ESD performed between 2014 and 2021 were retrieved from a prospectively collected database. For each patient, pre-procedural, procedural, and post-procedural data were recorded. Logistic regression was used to identify pre-procedural predictive factors for submucosal fibrosis. The study was approved by Institutional Reviewer Board and registered on ClinicalTrials.gov (NCT04780256).

RESULTS

One hundred-74 neoplasms (46.6% rectum, 21.8% left colon, 31.6% right colon; size 34.9 ± 17.5 mm) from 169 patients (55.0% male; 69.5 ± 10.4-year-old) were included. 106 (60.9%) neoplasms were granular type laterally spreading tumor (LST-G), 42 (24.1%) non-granular (LST-NG), and 26 (14.9%) sessile; invasive pit pattern was observed in 90 (51.7%) lesions. No fibrosis (F0) mild (F1) and severe (F2) were observed in 62 (35.6%), 92 (52.9%), and 20 (11.5%), respectively. Left colonic localization [OR 3.23 (1.1-9.31)], LST-NG morphology [OR 5.84 (2.03-16.77)] and invasive pit pattern [OR 7.11 (3.11-16.23)] were independently correlated to submucosal fibrosis. Lower curative resection rate (59.8% vs. 93.5%, P < 0.001) was observed in case of fibrosis; the incidence of adverse events was higher in case of severe fibrosis (35.5%) compared to no (3.2%) and mild fibrosis (3.3%; P < 0.001). Procedure time was significantly impacted by presence and degree of fibrosis (P < 0.001).

CONCLUSIONS

Left colonic localization, LST-NG morphology, and invasive pit pattern are independent predictors of fibrosis, affecting technical and clinical ESD outcomes. Pre-procedural stratification is pivotal to estimate procedure time, required operator's experience and advanced dissection techniques. Cecinato P et al. Left colonic localization, non-granular morphology, and pit pattern independently predict submucosal fibrosis of colorectal neoplasms before endoscopic submucosal dissection. Surg Endosc. 2023.

Factors for conversion risk of colorectal endoscopic submucosal dissection: a multicenter study

BACKGROUND

Endoscopic submucosal dissection (ESD) has become a widely accepted treatment method for colorectal tumors; however, there are some persistent problems. This multi-center study aimed to characterize the risk factors for incomplete resection and perforation in standardized colorectal ESD procedures.

METHODS

This study included 2423 consecutive patients who underwent ESD for 2592 colorectal tumors between August 2013 and December 2018 at 11 institutions (1 academic hospital and 10 affiliated hospitals) from the Hiroshima GI Endoscopy Research Group. We evaluated the risk factors for interruption, piecemeal resection, and perforation of standardized colorectal ESD in relation to clinicopathologic and endoscopic characteristics.

RESULTS

The incidences of interruption, piecemeal resection, and perforation were 0.7%, 2.9%, and 3.0%, respectively. Multivariate analysis identified the following risk factors for interruption: perforation during the procedure, deep submucosal invasion (> 1000 μm), poor scope operability, and severe submucosal fibrosis. The risk factors for piecemeal resection included poor scope operability, severe submucosal fibrosis, and procedure time (≥ 85 min). The risk factors for perforation during the procedure were severe submucosal fibrosis, poor scope operability, procedure time (≥ 85 min), and tumor size (≥ 40 mm). Independent risk factors for severe submucosal fibrosis included a history of biopsy and lesions located on the fold or flexure.

CONCLUSIONS

Severe submucosal fibrosis and poor scope operability are the common risk factors for interruption, piecemeal resection, and perforation in standardized colorectal ESD.

Clinicopathological Evaluation of Tobacco-related Oral Mucosal Lesions

AIM

To clinically evaluate the nature of precancerous and cancerous lesions associated with tobacco consumption habit and to correlate clinical profile with the histopathological findings of clinically suspected precancerous and cancerous lesions.

MATERIALS AND METHODS

These included the examination of patients who visited the outpatient department (OPD) of the institute that includes 1,500 patients who had tobacco chewing habits were classified into the following two groups according to their characteristics. The study group comprised 270 patients, of which 170 gave consent for biopsy and 100 patients who not gave consent were counseled for tobacco cessation.

RESULTS

Among 270 patients, the highest number of patients, 146 (54.07%) patients, were found to be smokeless tobacco consumers followed by 65 (24.07%) patients who were smoked tobacco consumers while 59 (21.85%) patients were found to have both the habits. Wide variation was noted in duration and frequency of habit. Most prevalent site was the buccal mucosa affected in 138 (51.11%) patients who consumed both smoked as well as smokeless tobacco. And on clinical examination, 138 (51%) patients had leukoplakia followed by 54 (20%) patients with oral squamous cell carcinoma and 40 (15%) patients with oral submucous fibrosis (OSMF). Other patients were tobacco pouch keratosis 17 (6%), smoker's melanosis 8 (3%), smoker's palate 7 (3%), and erythroplakia 6 (2%). The patients who gave consent (170 patients) were evaluated histopathologically to correlate with clinical findings.

CONCLUSION

Tobacco-related oral lesions are also high, which brings an alarming signal toward the development of cancer. Our contribution as healthcare providers can be made by conducting more oral health education programs and educating the general population about the adverse effects of tobacco. The appropriate clinical assessment and categorization of all these lesions aided us in motivating patients to undergo necessary treatments and also to discontinue their habits in order to prevent deterioration of their conditions.

CLINICAL SIGNIFICANCE

Set up de-addiction centers in dental colleges and help tobacco users in discontinuing their habits. Interestingly, this study also served as a mirror for those patients who were unaware of the lesions they were giving abode to in their oral cavities.

Nuclear Blebbing Frequency in Tobacco-Induced Oral Potentially Malignant Disorders: A Pilot Study

INTRODUCTION

Tobacco contains several genotoxic agents including N-nitrosamine which has the potential to cause significant nuclear damage. Nuclear blebbing is a form of protrusion on the nuclear membrane and could potentially be caused by tobacco-induced genotoxicity and is closely associated with malignancy. Thus, the present study aimed to assess if tobacco-associated oral potentially malignant disorders including oral submucous fibrosis (OSF) and oral leukoplakia have a higher nuclear blebbing frequency than patients with normal oral mucosa with no history of tobacco use.

METHODS

The sample consisted of patients with OSF (n = 30) and oral leukoplakia (n = 10) and normal oral mucosa (n = 10). Exfoliated cells collected from the study groups were smeared on a clean microscopic slide and stained by May-Grunwald-Giemsa stain. A baseline frequency of nuclear blebbing was evaluated using a bright-field microscope with a ×100 objective. The number of nuclear blebbing per 1,000 epithelial cells was recorded and expressed in percentage. ANOVA, the Mann-Whitney U test, and Spearman's correlation were used to analyze the data.

RESULTS

The mean rank of distribution of nuclear blebbing showed significant difference between all 3 groups, with the highest frequency noted in leukoplakia, followed by oral submucous and normal oral mucosa. Within OSF, the frequency of nuclear blebbing significantly increased from early stage to advanced stage. In OSF, a statistically significant positive linear correlation was noted between duration (in years), frequency (per day) of tobacco use, clinical grading, and nuclear blebbing.

DISCUSSION/CONCLUSIONS

The frequency of nuclear blebbing was significantly higher in oral potentially malignant disorders than normal mucosa. Nuclear blebbing also exhibited a strong dose- and time-dependent correlation with tobacco usage and clinical staging in OSF. The nuclear blebbing frequency could be a noninvasive, economic tool to assess malignant risk in tobacco-induced oral potentially malignant disorders.

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 submucous fibrosis in children: an alarming condition and challenges in management

Oral submucous fibrosis (OSF) is a well-documented potentially malignant condition. It affects most commonly the adult patients of India and Indian subcontinent, only few cases affecting children have been reported in the literature. This paper presents three cases of OSF below the age of 12 years and reviews the aetiology, clinical presentation, treatment modalities in children with improved follow-up results. Clinical features like restricted mouth opening, burning sensation and history of betel nut chewing helps in the diagnosis of the patients, which can be confirmed by histopathological examination. Conservative management and oral physiotherapy in children help in improved mouth opening. Counselling the children, their friends and parents also plays a vital role. The present paper highlights that children on a larger scale are using tobacco products and further studies are required with larger sample size.

Recognition of oral potentially malignant disorders and transformation to oral cancer

Oral potentially malignant disorders refer to oral mucosal disorders with increased risk for malignant transformation, primarily to oral squamous cell carcinoma (SCC). Leukoplakia and erythroplakia are the most common of these disorders, but others have been identified. Transformation rates to oral cancer vary based on multiple factors. Healthcare providers should be aware of risk factors and clinical manifestations of these disorders and should intervene early to monitor and/or treat them to reduce the potential for malignant transformation.

A systematic review on the mechanisms of malignant transformation of oral submucous fibrosis

Oral submucous fibrosis (OSMF), the most commonly encountered potentially premalignant oral epithelial lesion, is a chronic disorder associated with areca nut chewing. It has a relatively high potential for malignant transformation resulting into oral squamous cell carcinoma (OSCC), the most common oral malignancy with high mortality rate. Paymaster first described the malignant potential of OSMF in 1956, the rate of which had been estimated to be 7-13%. The pathogenesis of OSMF in itself is quite varied, and hence, its transformation to malignancy is also open to many varied mechanisms. The early diagnosis and sequentially, early treatment of OSMF is desirable so that the progression towards malignancy can be controlled. There are various theories that have been put forward explaining the probable pathway of malignant transformation of OSMF such as hypoxia, areca nut as a carcinogen or epithelial-mesenchymal transitions. Many recent molecular advances have also highlighted few biomarkers and genes that play a pivotal role in transformation of OSMF to OSCC. The purpose of this systematic review is to discuss all the possible mechanisms of malignant transformation of OSMF. Further research is still needed to establish the exact mechanism responsible for transformation of OSMF to OSCC and to reduce the mortality by newer interventions.

LINC00312/YBX1 Axis Regulates Myofibroblast Activities in Oral Submucous Fibrosis

Oral submucous fibrosis (OSF) has been recognized as a precancerous disorder in the oral cavity. Great effort has been made to inhibit the malignant progression of OSF over the past decades, but the cure of this fibrosis disease has not been discovered. In the present study, we found that a long noncoding RNA, LINC00312, was upregulated in OSF tissues, and positively associated with several fibrosis factors, such as α-SMA, type I collagen, and fibronectin. As such, we sought to investigate the role of LINC00312 in OSF progression and identify its interacting factor that mediated oral fibrogenesis. Our results showed that the inhibition of LINC00312 downregulated the myofibroblast activities, including collagen gel contractility, transwell migration, and wound healing, as well as the gene expression of myofibroblast markers. We verified that YBX1 was a downstream factor of LINC00312 and revealed that the downregulation of YBX1 repressed the gene expression of α-SMA and p-Smad2 along with the reduced myofibroblast phenotypes. Most importantly, we demonstrated that the LINC00312-induced myofibroblast activities were reverted by the knockdown of YBX1, suggesting that the LINC00312-mediated myofibroblast transdifferentiation was through YBX1. Collectively, our findings revealed that the LINC00312/ YBX1 axis may serve as a target for the development of therapies against OSF.

Variants in FAT1 and COL9A1 genes in male population with or without substance use to assess the risk factors for oral malignancy

A number of genetic variants were suggested to be associated with oral malignancy, few variants can be replicated. The aim of this study was to identify significant variants that enhanced personal risk prediction for oral malignancy. A total of 360 patients diagnosed with oral squamous cell carcinoma, 486 controls and 17 newly diagnosed patients with OPMD including leukoplakia or oral submucous fibrosis were recruited. Fifteen tagSNPs which were derived from somatic mutations were genotyped and examined in associations with the occurrence of oral malignancy. Environmental variables along with the SNPs data were used to developed risk predictive models for oral malignancy occurrence. The stepwise model analysis was conducted to fit the best model in an economically efficient way. Two tagSNPs, rs28647489 in FAT1 gene and rs550675 in COL9A1 gene, were significantly associated with the risk of oral malignancy. The sensitivity and specificity were 85.7% and 85.5%, respectively (area under the receiver operating characteristic curve (AUC) was 0.91) for predicting oral squamous cell carcinoma occurrence with the combined genetic variants, betel-quid, alcohol and age. The AUC for OPMD was only 0.69. The predictive probability of squamous cell carcinoma occurrence for genetic risk score without substance use increased from 10% up to 43%; with substance use increased from 73% up to 92%. Genetic variants with or without substance use may enhance risk prediction for oral malignancy occurrence in male population. The prediction model may be useful as a clinical index for oral malignancy occurrence and its risk assessments.

Insight on the relationship of ABO blood grouping associated with oral premalignant lesions, conditions and inherited oral cancer syndromes

BACKGROUND

Risk factors such as chronic use of tobacco, smoking and alcohol consumption of individual's lifestyle may possibly influence the significant role in the etiopathogenesis of precancerous lesions (PL) and Conditions (PC) and lead to oral cancer. Previous studies have revealed that genetic factors have contributed to a remarkable extent in the development of this chronic disease. Limited studies have confirmed that ABO blood groups remain reportedly possible genetic factor to the specific disease such as oral malignant. In this context, we have reported that individuals in a particular blood group are more prone to develop lesions and certain types of cancer. This has thrown a light to take up an effort to conduct this present study.

MATERIALS AND METHODS

The present study covering 105 patients and grouped into three subjects with 35 participants in each. a) oral squamous cell carcinoma b) oral leukoplakia and c) submucous fibrosis. Gender and age group impact was also made to understand the interaction between the focused sample groups. A separate control was gathered from a same geographical population composed of gender-matched healthy volunteers. Slide agglutination was employed for blood grouping and results were tabulated for statistical analysis.

RESULTS

Blood group "A" exhibited a significant relationship between oral squamous cell carcinoma patient and odd ratio shown 1.74 times higher risk of developing oral cancer. Gender different and habit stimulation have increased the risk. A significant relationship was observed between ABO blood group and oral leukoplakia and oral submucous fibrosis.

CONCLUSION

Study inferred that blood group "A" is found to be at the high risk in developing oral malignant syndrome due to its susceptibility, whereas oral pre-cancer is hypothesized that individual habits are the host risk factor and transformed to carcinoma by interacting genetic factors to act upon ABO blood group.

Oral submucous fibrosis: an etiological dilemma

Oral Submucous Fibrosis (OSF), is a well-recognized, oral potentially malignant disorder predominantly affecting the South- Asian countries. OSF causes unique generalized fibrosis of the submucosal oral soft tissues, resulting in marked rigidity of the oral mucosa leading to progressive inability to open the mouth, rigidity of lips and difficulty in protruding the tongue. In this review we have discussed the multifactorial etiology of this potentially malignant disorder, including Chillies, Nutritional Deficiencies, Inducible nitric oxide synthsis (iNOS), genetic and immunological predisposition; and most importantly the role of areca nut and the effect of copper content in it.

Rebamipide to Manage Stomatopyrosis in Oral Submucous Fibrosis

INTRODUCTION

Oral submucous fibrosis (OSF) causes progressive debilitating symptoms, such as oral burning sensation (stomatopyrosis) and limited mouth opening. The standard of care (SOC) protocol includes habit cessation, intralesional steroid and hyaluronidase injections, and mouth opening exercises. The objective of the study was to evaluate efficacy of rebamipide in alleviating burning sensation of the oral mucosa in OSF in comparison with SOC intralesional steroid injections.

MATERIALS AND METHODS

Twenty OSF patients were divided into two groups [rebamipide (100 mg TID for 21 days) and betamethasone (4 mg/mL biweekly for 4 weeks)] of 10 each by random sampling. Burning sensation was assessed every week for 1 month. Burning sensation scores were analyzed using repeated measures analysis of variance (ANOVA) and paired t-test.

RESULTS

Change in burning sensation score was significant (p < 0.05) in the first four visits. However, score between the 4th and 5th visit was not statistically significant (p > 0.05).

CONCLUSION

Our study has shown that rebamipide can be considered as an effective modality to manage burning sensation in patients suffering from OSF.

CLINICAL SIGNIFICANCE

Considering stomatopyrosis and trismus as a major cause for inability to eat in OSF, use of newer adjunctive modalities, such as rebamipide will ease patients suffering and also encourage them to consume food.

Oral Submucous Fibrosis Secondary to Iron Deficiency Anemia: A Case Report, Etiopathogenesis and Management

Oral submucous fibrosis (OSMF) is a premalignant condition that has received considerable attention in the recent past because of its chronic debilitating and resistant nature. Over the past decades, dental researchers have reported overwhelming evidence about various etiological factors of OSMF. It has been the subject of controversy ever since Schwartz first described the condition in 1952. Areca nut is considered the primary etiology along with other local irritants like capsaicin, pungent and spicy food, nutritional deficiency, defective iron metabolism, collagen metabolic disorder and genetic predisposition. Association of iron deficiency anemia and OSMF is very sparse in literature. Here, we present a case report of a 58 year old male patient where the patient presented with OSMF where iron deficiency anemia was found to be the main etiological factor.

Roles of CYP1A1 and CYP2E1 Gene Polymorphisms in Oral Submucous Fibrosis

Oral submucous fibrosis (OSF) is a precancerous condition with a 4 to13% malignant transformation rate. Related to the habit of areca nut chewing it is mainly prevalent in Southeast Asian countries where the habit of betel quid chewing is frequently practised. On chewing, alkaloids and polyphenols are released which undergo nitrosation and give rise to Nnitrosamines which are cytotoxic agents. CYP450 is a microsomal enzyme group which metabolizes various endogenous and exogenous chemicals including those released by areca nut chewing. CYP1A1 plays a central role in metabolic activation of these xenobiotics, whereas CYP2E1 metabolizes nitrosamines and tannins. Polymorphisms in genes that code for these enzymes may alter their expression or function and may therefore affect an individuals susceptibility regarding OSF and oral cancer. The present study was therefore undertaken to investigate the association of polymorphisms in CYP1A1 m2 and CYP2E1 (RsaI/PstI) sites with risk of OSF among areca nut chewers in the Northern India population. A total of 95 histopathologically confirmed cases of OSF with history of areca nut chewing not less than 1 year and 80, age and sex matched controls without any clinical signs and symptoms of OSF with areca nut chewing habit not less than 1 year were enrolled. DNA was extracted from peripheral blood samples and polymorphisms were analyzed by PCRRFLP method. Gene polymorphism of CYP1A1 at NcoI site was observed to be significantly higher (p = 0.016) in cases of OSF when compared to controls. Association of CYP1A1 gene polymorphism at NcoI site and the risk of OSF (Odd's Ratio = 2.275) was also observed to be significant. However, no such association was observed for the CYP2E1 gene polymorphism (Odd's Ratio = 0.815). Our results suggest that the CYP1A1 gene polymorphism at the NcoI site confers an increased risk for OSF.

Increased expression of carbonic anhydrase IX in oral submucous fibrosis and oral squamous cell carcinoma

BACKGROUND

Cumulative evidence has demonstrated that carbonic anhydrase IX (CAIX) is upregulated in many types of human cancers. We attempted to evaluate plasma levels of CAIX in patients with oral cancer and investigated whether plasma CAIX is correlated with the progression of this disease.

METHOD

In total, 191 patients with oral cancer, 30 patients with oral submucous fibrosis and 100 controls were recruited in this study. The plasma samples were collected and the levels of soluble CAIX in plasma were determined by the enzyme-linked immunosorbent assay (ELISA). Furthermore, the normal buccal mucosa fibroblast was challenged by arecoline, the major areca nut alkaloid, to assess the relationship between the levels of CAIX and areca nut chewing in oral cancer patients.

RESULTS

Results showed that patients with oral cancer exhibited significantly higher levels of soluble CAIX compared to controls (p<0.001). Plasma levels of CAIX in oral cancer patients were associated with clinical stages after adjusting for age and areca nut chewing (p<0.05). In addition, patients with areca nuts chewing had higher CAIX levels than those who have not chewed areca nuts. Total carbonic anhydrase activity and CAIX mRNA levels were significantly higher in oral submucous fibrosis fibroblasts than in normal buccal mucosa fibroblasts. Moreover, arecoline elevated CAIX expression in a dose-dependent manner in normal buccal mucosa fibroblasts.

CONCLUSIONS

Our results suggest that determining plasma levels of CAIX may be used as a non-invasive method for monitoring oral cancer progression and the involvement of areca quid chewing in oral carcinogenesis may be related to a higher expression of CAIX.

Inhibition of Tanshinone IIA, salvianolic acid A and salvianolic acid B on Areca nut extract-induced oral submucous fibrosis in vitro

Salvia miltiorrhiza Bunge has been reported to possess excellent antifibrotic activity. In this study, we have investigated the effect and mechanism of tanshinone IIA (Tan-IIA), salvianolic acid A (Sal-A) and salvianolic acid B (Sal-B), the important active compounds of Salvia miltiorrhiza Bunge, on areca nut extract (ANE)-induced oral submucous fibrosis (OSF) in vitro. Through human procollagen gene promoter luciferase reporter plasmid assay, hydroxyproline assay, gelatin zymography assay, qRT-PCR, ELISA and Western blot assay, the influence of these three compounds on ANE-stimulated cell viability, collagen accumulation, procollagen gene transcription, MMP-2/-9 activity, MMP-1/-13 and TIMP-1/-2 expression, cytokine secretion and the activation of PI3K/AKT, ERK/JNK/p38 MAPK and TGF-β/Smads pathways were detected. The results showed that Tan-IIA, Sal-A and Sal-B could significantly inhibit the ANE-stimulated abnormal viability and collagen accumulation of mice oral mucosal fibroblasts (MOMFs), inhibit the transcription of procollagen gene COL1A1 and COL3A1, increase MMP-2/-9 activity, decrease TIMP-1/-2 expression and inhibit the transcription and release of CTGF, TGF-β1, IL-6 and TNF-α; Tan-IIA, Sal-A and Sal-B also inhibited the ANE-induced activation of AKT and ERK MAPK pathways in MOMFs and the activation of TGF-β/Smads pathway in HaCaT cells. In conclusion, Tan-IIA, Sal-A and Sal-B possess excellent antifibrotic activity in vitro and can possibly be used to promote the rehabilitation of OSF patients.

Total, direct, and indirect effects of paan on oral cancer

PURPOSE

Paan (betel leaf and betel nut quid) used with or without tobacco has been positively associated with oral cancer. Oral submucous fibrosis (OSMF), a precancerous condition caused by paan, lies on the causal pathway between paan use and oral cancer. The purpose of this analysis was to estimate the effect of paan consumption on oral cancer risk when it is mediated by OSMF.

METHODS

We used mediation methods proposed by VanderWeele, which are based on causal inference principles, to characterize the total, direct, and indirect effects of paan, consumed with and without tobacco, on oral cancer mediated by OSMF. We reanalyzed case-control data collected from three hospitals in Karachi, Pakistan, between July 1996 and March 1998.

RESULTS

For paan without tobacco, the total effect on oral cancer was OR 7.39, 95 % CI 1.01, 38.11, the natural indirect effect (due to OSMF among paan users) was OR 2.48, 95 % CI 0.99, 10.44, and the natural direct effect (due to paan with OSMF absent) was OR 3.32, 95 % CI 0.68, 10.07. For paan with tobacco, the total direct effect was OR 15.68, 95 % CI 3.00, 54.90, the natural indirect effect was OR 2.18, 95 % CI 0.82, 5.52, and the natural direct effect was OR 7.27, 95 % CI 2.15, 20.43.

CONCLUSIONS

Paan, whether or not it contained tobacco, raised oral cancer risk irrespective of OSMF. Oral cancer risk was higher among those who used paan with tobacco.

Validation of Nepalese Oral Health Impact Profile14 and Assessment of Its Impact in Patients with Oral Submucous Fibrosis in Nepal

BACKGROUND

Oral Health Impact Profile-14 (OHIP-14) is one of the most internationally used oral health related quality of life (OHRQoL) questionnaire available in various languages. The study was aimed to validate Nepalese version of OHIP-14 and to assess impact of quality of life (QoL) in patients with oral submucous fibrosis (OSF).

METHODS

An interventional OHRQoL study was conducted among OSF patients visiting Department of Oral Medicine and Radiology, BP Koirala Institute of Health Sciences, Dharan using OHIP-14 after translation and validation process. Following the baseline questionnaire, 74 patients were treated with dexamethasone and hyaluronidase for 6 weeks and followed up for 6 months during which OHIP-14 was again administered.

RESULTS

For concurrent validity, Nepalese OHIP-14 scores were associated with self-perceived oral health status, self-perceived dental treatment need and satisfaction with oral health status. For internal reliability, inter-item correlation coefficient varied from 0.2-0.8. Corrected item-total correlation coefficients were between 0.43-0.80. Cronbach's alpha was 0.90. Commercial tobacco product chewing with arecanut (Gutka Ⓡ ) was seen among 45% with median frequency and duration of 7.5(0-20) times/day and 10(0-60) years, respectively. Median OHIP-14 score at baseline 18(0-45), was significantly (p<0.001) different from 6 months' follow-up [5(0-15)]. Impact score at baseline was mainly influenced by age (r(s) =0.32, p=0.005), frequency of habit (r(s) =0.44, p<0.001) and duration of habit (r(s) =0.31, p=0.006). s

CONCLUSIONS

Nepalese version of OHIP-14 is a valid and, reliable instrument to measure OHRQoL in OSF patients. OHRQoL in OSF patients can be improved after professional treatment regime.

Panax notoginseng saponins inhibit areca nut extract-induced oral submucous fibrosis in vitro

BACKGROUND

Oral submucous fibrosis (OSF) is a premalignant and fibrosing disease, which is closely associated with the habit of chewing areca nut. Panax notoginseng Buck F. H. Chen is an often used antifibrotic and antitumor agent. To treat areca nut-induced OSF, we have developed a chewable tablet, in which one of the major medicines is total Panax notoginseng saponins (PNS). In this study, we have investigated the antifibrotic effect and mechanism of PNS on areca nut-induced OSF in vitro.

METHODS

Through human procollagen gene promoter luciferase reporter plasmid, hydroxyproline assay, gelatin zymography, qRT-PCR, ELISA, and Western blot, the influences of PNS on areca nut extract (ANE)-induced cell growth, collagen accumulation, procollagen gene transcription, MMP-2/-9 activity, MMP-1/-13 and TIMP-1/-2 expression, cytokine secretion, and the activation of PI3K/AKT, ERK/JNK/p38 MAPK, and TGFβ/Smads pathways were detected.

RESULTS

Panax notoginseng saponins could inhibit the ANE-induced abnormal growth and collagen accumulation of oral mucosal fibroblasts in a concentration-dependent manner. PNS (25 μg/ml) could significantly inhibit the ANE-induced expression of Col1A1 and Col3A1, augment the ANE-induced decrease of MMP-2/-9 activity, inhibit the ANE-induced increase of TIMP-1/-2 expression, and decrease the ANE-induced transcription and release of CTGF, TGFβ1, IL-6, and TNFα. PNS (25 μg/ml) also significantly inhibited the ANE-induced activation of AKT and ERK/JNK/p38 MAPK pathways in oral mucosal fibroblasts and the ANE-induced activation of TGFβ/smad pathway in HaCaT cells.

CONCLUSION

Panax notoginseng saponins possess excellent anti-OSF activity, and its mechanism may be related to its ability to inhibit the ANE-induced activation of PI3K/AKT, ERK/JNK/p38 MAPK, and TGFβ/smad pathways.

Altered immunohistochemical expression of mast cell tryptase and chymase in the pathogenesis of oral submucous fibrosis and malignant transformation of the overlying epithelium

Mast cells (MCs) expressing serine proteases; tryptase and chymase, are associated with fibrosis in various diseases. However, little is known about their involvement in oral submucous fibrosis (OSF). Our goal was to evaluate the role of MC tryptase and chymase in the pathogenesis of OSF and its malignant transformation. Immunohistochemical expression of MC tryptase and chymase was evaluated in 20 cases of OSF, 10 cases of oral squamous cell carcinoma (OSCC) and 10 cases of healthy controls. Subepithelial zone of Stage 1 and 2 while deep zone of Stage 3 and 4 OSF demonstrated increased tryptase positive MCs. OSCC revealed a proportionate increase in tryptase and chymase positive MCs irrespective of areas of distribution. An altered balance in the subepithelial and deep distribution of tryptase and chymase positive MCs play an important role in the pathogenesis of OSF and its malignant transformation.

Identification of the pattern of copper as an etiological factor in oral submucous fibrosis: a cytological study

Oral Submucous Fibrosis (OSF) is a well-recognized, potentially malignant disorder causing generalized fibrosis of the submucosal oral soft tissues. Though this disease is believed to be multi-factorial, areca nut chewing has emerged as the most important causative factor for OSF. Areca nut is known to have high levels of copper, which is believed to cause lysyl oxidase associated fibrosis.

AIM

To evaluate the pattern of copper in buccal mucosal cells of OSF patients, areca nut chewers and normal healthy individuals and to elicit the etiology of copper in OSF.

MATERIALS AND METHODS

Patients were divided into three groups each comprising of 20 individuals- Healthy individuals (Group I); areca nut chewers without OSF (Group II); histopathologically confirmed OSF (Group Ill). The cytological smears made from each patient were stained with rhodanine stain for copper and evaluated for the qualitative and quantitative parameters of copper by using specific grading criteria.

RESULTS

Quantitative estimation of copper content showed a marked variation in the mean values. Mean value of group I was 0.11 ± 0.39; group II was 1.09 ± 0.81 and group III was 2.34 ± 0.74 (p<0.001). Mean values for qualitative estimation of copper were - 0.01 ± 0.36 for group I, 1.08 ± 0.82 for group II and 2.39 ± 0.72 for group III (p<0.001). Chi square analysis was used to assess the percentage distribution of copper granules. This revealed that the colour intensity and the number of granules were seen to maximum in OSF patients, areca nut chewers without OSF having intermediated values and normal healthy individuals having the least values.

CONCLUSION

An evident increase in the copper staining in group III individuals as compared to group I and group II was well appreciated. Increased copper levels in the local environment of the oral cavity indicates its role in lysyl oxidase associated submucosal fibrosis.

Editorial. Oral submucous fibrosis: revised hypotheses as to its cause

Oral submucous fbrosis (OSF), being a prototype of pathological fbrosis, remains enigmatic as regards its causation. The connective tissue production is permanent and there is no reversal of the condition even after cessation of the habit of areca-nut usage; prime suspect in its causation.(1) The bulk of the connective tissue consists of type-1 collagen(2) and its formation does not appears to be caused by excessive proliferation of fbroblasts.(3) The effect of areca nut extract on in vitro fbroblasts varies on a concentration gradient, predominantly suppressing rather than stimulating the growth of the cells.(4) Based on morphological characteristics, the fbroblast population in the diseased mucosa has been classifed in to types F1, F2 and F3 with F3 cells producing signifcantly more collagen than the other two cell types. It was concluded that a change of fbroblast population has occurred in OSF and that this relative increase of F3 cells in humans, could be committed to the production of large quantities of collagen formation in OSF. It has been proposed that fbroblasts are functionally heterogeneous, the composition of any given normal or diseased connective tissue being a consequence in part of its particular mixture of fbroblast subtypes and density. Subtype deletion or amplifcation can result from selective cytotoxic or mitogenic responses induced by the binding environmental ligands.(5) Against this backdrop, we propose few de-novo attributes, hitherto unreported, and seem to be of relevance in the pathogenesis of OSF; namely the role of autophagy in basic cellular homeostatic process, important to cell fate decisions under conditions of stress and also ECM producing cells (fbroblasts, myofbroblasts and smooth muscle cells) derived from epithelial and endothelial cells through process termed epithelial and endothelial-mesenchymal transition.

Effect of methylxanthines (coffee/tea consumers) on oral precancer and oral cancer patients with smoking and smokeless tobacco habits

AIM

To study, whether the consumption of regular tea/coffee (methylxanthines) increases the risk of oral cancer in patients with smoking and smokeless tobacco habits.

MATERIALS AND METHODS

This study was conducted on a total of 90 oral cancer and precancerous patients, from western Maharashtra (India) males in the age group of 20 to 45 years who were with smoking and smokeless tobacco habits; also regular tea/coffee consumers were subjected to biochemical parameters such as aspartate transaminase (AST) and alanine transaminase (ALT) from saliva and serum of patients with oral precancer (submucous fibrosis, leukoplakia) and oral cancer patients and compared with 90-age and sex-matched controls. Individuals consent was taken to measure their biochemical parameters, by using Hafkenscheid method in whole saliva and serum. Statistical analysis of variance (ANOVA) with Tukey's correction for multiple group comparisons was performed using Student t-test.

RESULTS

Results show, that a statistically significant increase in value (p < 0.05) in ALT, AST in both saliva and serum was observed in precancerous and oral cancer patients among the study group as compared to the control group.

CONCLUSION

In the present study, there was increase in the levels of ALT, AST enzymes in both saliva and serum levels in the study group as compared to the control group which was statistically significant (p < 0.05) suggesting that long-term exposure of methylxanthines results in impairment of salivary gland antioxidant system which may affect the anticarcinogenic action of saliva.

CLINICAL SIGNIFICANCE

Oral fluids may be utilized effectively to study the variations in the biochemical constituents of saliva of leukoplakia, submucous fibrosis and oral cancer patients.

Oral submucous fibrosis--a potentially malignant condition of growing concern

Oral submucous fibrosis (OSF) is a premalignant condition that primarily affects the oral cavity. The clinical hallmark of this disease is the development of progressive trismus. The latter is a direct consequence of loss of the normal fibro-elasticity of the oral mucosa and replacement of the fibromuscular connective tissue by the deposition of dense collagen. This change in the oral mucosa is aetiologically linked to the areca nut chewing habit where the development of OSF results from the interaction of the mucosa with the chemical constituents of areca. Areca nuts are used as a masticatory substance either alone, in a self-prepared quid or in various commercial preparations known as paan masala and gutka. The habitual usage of these products is rapidly increasing and oral health professionals globally are likely to encounter patients with this disease. The potentially malignant nature of OSF is well documented and habitual areca nut chewing even in the absence of tobacco is an independent risk factor for oral cancer. Public health education against the areca nut chewing habit is essential to eradicate the deleterious effects of this habit on oral health.

Plasma non-enzymatic antioxidants-vitamin C, E, beta-carotenes, reduced glutathione levels and total antioxidant activity in oral sub mucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSMF) is a crippling slowly progressive disease of oral cavity that predominantly affects people habit of consuming areca nut and its commercial preparations which generates high levels of reactive oxygen species (ROS) during their metabolism.

OBJECTIVE

The objective of this present study is to evaluate the role of oxidative stress in causation and progression of OSMF by measuring the levels of nonenzymatic antioxidants in OSMF patients.

MATERIALS AND METHODS

For this study we selected 27 newly diagnosed OSMF patients of both sex with age group between 23 to 40 years and the same number of age and sex matched healthy individuals were selected as control group. In both the groups we measured plasma non enzymatic antioxidants like vitamin A. E, C and reduced glutathione. Total antioxidant activity was also assessed in both the groups.

RESULTS AND CONCLUSIONS

We observed a very low levels of plasma non-enzymatic antioxidants (p < 0.001) and at the same time a very poor antioxidant activity (p < 0.001) in OSMF patients when compared to controls. Therefore, consumption of tobacco or areca quid creates an oxidative stress environment which might plays a major role in the causation of OSMF.

Assessment of genetic damage among chewers of mixture containing mainly areca nut and tobacco

Chewing mixture containing areca nut and tobacco is believed to be associated with oral cancer. Habit of chewing such mixture is prevalent among South Asian countries. This study aimed to evaluate the genotoxic effect of areca nut and tobacco on human lymphocytes. Peripheral blood from 107 subjects (nonchewers, 48; chewers, 59, including 20 subjects with oral submucous fibrosis [OSMF]) analyzed by cytokinesis-block micronucleus (CBMN) and alkaline comet assay. Nuclear anomalies, namely, binucleated cells with micronuclei (BN MN), total MN, nucleoplasmic bridge, and nuclear buds were higher in chewers whereas elevation in BN MN and total MN were significant among subjects with OSMF than nonchewers. DNA damage assessed by comet assay showed increased percentage of Tail DNA, Tail moment, and Olive tail moment among chewers as well as OSMF subjects. Significant positive correlation was observed between induction of CBMN and consumption of quids per day (r = .280, P = .033).

RESULTS

suggested cytotoxic and genotoxic potential of mixture containing areca nut and tobacco.

Oral submucous fibrosis: a clinicopathologic review of 205 cases in Indians

INTRODUCTION

Oral submucous fibrosis is a disease due to a chronic, insidious change in fibro-elasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oro-pharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once the disease has developed, there is neither regression nor any effective treatment. There are only few studies on the frequency and clinicopathological feature of oral submucous fibrosis in the Indian population in recent years.

MATERIAL AND METHODS

The present study evaluated 205 cases of oral submucous fibrosis for the age, sex, site of involvement, duration of disease at the time of diagnosis, associated habits and common presenting symptoms, presence of other mucosal lesions, malignant potential, and the histopathology.

RESULTS AND DISCUSSION

Oral submucous fibrosis was seen in younger age (20-30 years) than that reported in literature and showed a characteristic male preponderance. A strong association with smokeless tobacco use especially arecanut in the form of gutkha was established and was related to earlier development of oral submucous fibrosis (OSMF), i.e., within a year of the habit. A total of 11.6% of cases were associated with malignancy and occurred predominantly in males.

CONCLUSION

This article gives an insight into OSMF in this part of southern India and adds to its biologic profile.

Oral submucous fibrosis in a young patient

A seventeen-year-old male presented with a restriction in the oral cavity. The oral mucosa was white and he could not protrude his tongue. For 4 years he had habitually held a powdery material containing betel nut in the oral vestibule for several minutes a day. A biopsy of the labial mucosa was carried out and a diagnosis of oral submucous fibrosis was confirmed. This is a premalignant condition. Oral submucous fibrosis is very rare in young patients.

The role of gutka chewing in oral submucous fibrosis: a case-control study

OBJECTIVE

To learn about the use of various chewing substrates, such as areca nut and gutka, among subjects with oral submucosal fibrosis (OSMF) and controls with no oral mucosal lesions.

MATERIALS AND METHODS

In this hospital-based case-control study, 220 patients with OSMF were selected and compared with matched controls with regard to dietary habits, including spice use, smoking history, and preference for chewing substrates. Relative risk of various chewing habits was calculated using an odds ratio and logistic regression analysis to understand the influence of chewing habits, spices, and smoking on the development of OSMF. Discriminate analysis was employed to determine which risk factors were valid and reliable discriminators between individuals with or without OSMF.

RESULTS

The relative risk of developing oral submucosal fibrosis was highest with gutka-chewing habit (relative risk, 1,142.4), which was significant (P < .01) at 95% confidence interval. The next highest relative risk for development of oral submucosal fibrosis was observed for the combination of gutka with other chewing habits. The relative risk of developing submucosal fibrosis increased with the frequency of chewing habit up to 15 times daily with a duration of habit up to 4 years. The relative risk decreased with chewing frequency beyond 15 times daily and 4 years in duration. Logistic regression and discriminative analysis show that chewing areca nut and gutka, especially daily, greatly influence the development of submucosal fibrosis.

CONCLUSION

This study suggests that chewing commercially available areca-nut preparations such as gutka is strongly associated with the development of oral submucosal fibrosis.

Oral submucous fibrosis, a clinically benign but potentially malignant disease: report of 3 cases and review of the literature

Oral submucous fibrosis (OSF) is a premalignant condition mainly associated with the practice of chewing betel quid containing areca nut, a habit common among South Asian people. It is characterized by inflammation, increased deposition of submucosal collagen and formation of fibrotic bands in the oral and paraoral tissues, which increasingly limit mouth opening. Recently, OSF has been reported among South Asian immigrants in Canada, the United Kingdom and Germany. Dentists in western countries should enhance their knowledge of this disease as it seems to be increasing with population migration. In this paper, we review the literature on OSF and present 3 cases representing different stages of the disease to help dentists make an early diagnosis and reduce the morbidity and mortality associated with this condition.

Consumption of areca quid, cigarettes, and alcohol related to the comorbidity of oral submucous fibrosis and oral cancer

OBJECTIVE

Oral submucous fibrosis (OSF) is defined as a precancerous condition, and it is also commonly seen in clinical practice, coexisting with oral cancer. The aim of this study was to identify the effects of areca quid, cigarette, and alcohol on the coexistence of oral cancer and OSF.

STUDY DESIGN

This is a case-control study. One hundred four histologically confirmed male OSF subjects were included, which consisted of 65 OSF subjects without oral cancer (control group) and 39 OSF subjects with oral cancer (case group).

RESULTS

The cigarette consumption in the case group was significantly higher than the control group. In drinking habits, the mean consumption of alcohol in the case group was significantly higher than the control group. Logistic regression analysis was used to identify these risk factors. Age and alcohol consumption showed a significant effect, and the odds ratios were 1.07 in age and 1.5 in alcohol consumption.

CONCLUSION

Alcohol drinking could be a risk factor associated with an increased risk of malignant transformation and coexistence with oral cancer in OSF patients, but cigarette and areca quid were not risk factors in our study. For oral cancer prevention from OSF, more attention should be paid to the importance of public health strategies targeted toward preventing and reducing alcohol consumption.

The role of epithelial-mesenchymal transition in oral squamous cell carcinoma and oral submucous fibrosis

Epithelial-mesenchymal transition (EMT) is an indispensable mechanism during morphogenesis. Interest and research in EMT are currently at a high level due to its important role in cancer and fibrosis. Emerging evidence suggests that EMT is also a crucial event in oral squamous cell carcinoma (OSCC). Oral submucous fibrosis (OSF) is a chronic debilitating disease and a premalignant condition of the oral cavity. It is characterized by a generalized submucosal fibrosis. The pathogenesis of the disease is not well established. Epidemiological evidence strongly indicates an association between the betel quid (BQ) chewing habit and OSF. In a simplistic view, OSF represents a failed wound-healing process of the oral mucosa after chronic, sustained injury. This review highlights the signaling pathways involved in EMT, recent advances in the study of EMT in OSCC, and summarizes the evidence supporting a role for EMT in the pathogenesis of OSF.

[Oral submucous fibrosis in a 31-year-old Indian women: first case report from Germany]

BACKGROUND

Oral submucous fibrosis (OSF) is a chronic disease characterized by subepithelial collagen deposition with formation of bands involving the oral cavity and adjacent structures. Oral submucous fibrosis is a precancerous condition. It is caused by chewing of betel quid (Areca catechu L., Piper betle, lime and tobacco) and ready-made products like pan masala and gutka which also contain areca nut. These products are available all over South Asia. The hallmark of OSF is extremely restricted mouth opening.

CASE REPORT

A 31-year-old Indian woman who has lived in Germany since 1997 presented herself because of limitation of mouth opening. She reported that she has chewed pan masala and gutka since she was 17 years of age. History, clinical and histological findings clearly pointed to the diagnosis of OSF.

DISCUSSION

Conservative as well as surgical interventions for OSF have not resulted in adequate long-term results. Since OSF may occur in children and young adults, the primary aim should be to avoid progression of the disease, initially by physiotherapy. Surgical interventions should not be applied at an early stage of the disease because recurrences and further surgical interventions are often necessary. Due to the increasing numbers of migrants from South Asia more cases of OSF will probably also be observed in Germany, where areca nut-containing products are also available.

Oral submucous fibrosis: Review on aetiology and pathogenesis

Data from recent epidemiological studies provide overwhelming evidence that areca nut is the main aetiological factor for OSF. A clear dose-dependent relationship was observed for both frequency and duration of chewing areca nut (without tobacco) in the development of OSF. Commercially freeze dried products such as pan masala, Guthka and mawa (areca and lime) have high concentrates of areca nut per chew and appear to cause OSF more rapidly than by self prepared conventional betel quid that contain smaller amounts of areca nut. It is logical to hypothesise that the increased collagen synthesis or reduced collagen degradation as possible mechanisms in the development of the disease. There are numerous biological pathways involved in the above processes and, it is likely that the normal regulatory mechanisms are either down regulated or up regulated at different stages of the disease. Among the chemical constituents, alkaloids from areca nut are the most important biologically whilst tannin may have a synergistic role. These chemicals appear to interfere with the molecular processes of deposition and/or degradation of extracellular matrix molecules such as collagen. In vitro studies on human fibroblasts using areca extracts or chemically purified arecoline support the theory of fibroblastic proliferation and increased collagen formation that is also demonstrable histologically in human OSF tissues. The copper content of areca nut is high and the possible role of copper as a mediator of fibrosis is supported by the demonstration of up regulation of lysyl oxidase in OSF biopsies. It has been postulated that areca nut may also induce the development of the disease by increased levels of cytokines in the lamina propria. Increased and continuous deposition of extracellular matrix may take place as a result of disruption of the equilibrium between matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMP). Current evidence implicates collagen-related genes in the susceptibility and pathogenesis of OSF. The individual mechanisms operating at various stages of the disease-initial, intermediate and advanced-need further study in order to propose appropriate therapeutic interventions.

A review of premalignant oral conditions

The value of mass oral cancer screenings has come under scrutiny, as a consequence of a lack of improvement in the long-term outcomes associated with oral carcinoma over the past several decades. However, it is generally accepted that most oral carcinomas are preceded by visible changes to the mucosa and certain high risk lesions have been identified. The responsibility to evaluate the mucosal tissues of the oral cavity clearly falls under the purview of the dentist. The dentist must clearly grasp the distinction between reactive lesions which usually change in 7 to 14 days and malignant and premalignant lesions which do not. Therefore, appropriate diagnostic procedures (i.e., biopsy of the lesion) must be implemented as a matter of course in the evaluation of any lesion that does not respond to usual therapy in 7 to 14 days.

Epidemiological and etiological study of oral submucous fibrosis among gutkha chewers of Patna, Bihar, India

An etiological and epidemiological study of oral submucous fibrosis (OSMF) has been done in Patna, Bihar. Total 157 cases of OSMF and 135 control subjects were selected for study in the period of 2002-2004. It was observed that Male:Female ratio was 2.7:1. The youngest case of OSMF was 11 year old and the oldest one was 54 years of age. Maximum number of cases were belonging to 21-40 years of age and they were belonging to low or middle socioeconomic class. Most of the OSMF cases used heavy spices and chillies, where as control mild spices and chillies. Gutkha was the most commonly used by the OSMF cases only 3 per cent did not use any gutkha or other areca nut product where as 80 per cent control did not have any chewing habit. The OSMF cases used gutkha and other products 2-10 pouches per day and kept in the mouth for 2-10 minutes and they were using since 2-4 years. Most of the OSMF cases kept gutkha in the buccal vestibule or they chewed and swallowed it, only a small number of patients chewed and spitted it out. It was also observed that OSMF developed on one side of the buccal vestibule where they kept the chew and other side was normal.

Effect of betel chewing, tobacco smoking and alcohol consumption on oral submucous fibrosis: a case-control study in Sri Lanka

BACKGROUND

Oral submucous fibrosis (OSMF) is a chronic, insidious, disabling potentially malignant condition of the oral mucosa seen predominantly in south and Southeast Asia. No reports are hitherto available on the aetiological factors of OSMF based on Sri Lankan patients.

METHODS

A total of 74 patients with OSMF and 74 controls who consecutively attended the Oral Medicine clinic at the Dental Hospital (Teaching) Faculty of Dental Sciences, University of Peradeniya, Sri Lanka were included in the study. Binary logistic regression analyses were performed to model the influence of betel chewing, smoking and alcohol use and to determine the effects of different combinations of chewing habits on OSMF.

RESULTS

Betel chewing was the only significantly associated factor in the aetiology of OSMF (OR = 171.83, 95% CI: 36.35-812.25). There were no interaction effects of chewing, smoking and alcohol consumption in the causation of OSMF.

CONCLUSION

The present study has shown a strong association of betel quid chewing (including tobacco as an ingredient) with the causation of OSMF.