Abstract
A wide range of microbes inhabit the oral cavity, and bacterial and fungal communities most often exist as structured communities or biofilms. The use of tobacco alters the structure of the oral microbiome, including that of potentially malignant lesions, and the altered oral microbiome influences key microenvironmental changes such as chronic inflammation, secretion of carcinogenic toxins, cellular and tissue remodelling and suppression of apoptosis. Given this, it is clear that the bacterial and fungal biofilms in potentially malignant states are likely not passive entities, but could play a critical role in shaping potential malignant and carcinogenic conditions. This holds potential towards leveraging the oral microbiome for the management of tobacco-associated potentially malignant lesions and oral cancer. Here, we explore this line of investigation by reviewing the effects of tobacco in shaping the oral microbiome, and analyse the available evidence in the light of the microbiome of oral potentially malignant and cancerous lesions, and the role of dysbiosis in carcinogenesis. Finally, we discuss possible interventions and approaches using which the oral microbiome could be leveraged towards precision-based oral cancer therapeutics.
Highlights
Tobacco-associated disease is a global public health threat [1]
The process of tobacco curing, fermentation and ageing, results in the production of tobacco-specific nitrosamines (TSNAs), which are the major group of carcinogens in smokeless tobacco [17,18,19]
The most common form of oral cancer squamous cell carcinoma [22], which most often develops from potentially malignant lesions such as oral submucous fibrosis, leukoplakia, erythroplakia, among others [23, 24]
Summary
Tobacco-associated disease is a global public health threat [1]. There are ~1.3 billion users of tobacco worldwide [2], of which an overwhelming majority (~80%) live in lowand middle-income countries. Tobacco-associated potentially malignant lesions exist and develop in a dynamic oral microenvironment, that includes diverse, multi-species microbial communities [25,26,27,28], most often observed as biofilms. This offers the exciting possibility that the oral microbiome (or biofilms) can be a tool or target in the management of tobacco-associated potentially malignant lesions.
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