Betel Quid Chewing Research Articles

Assessing the Effect of Smokeless Tobacco Consumption on Oral Microbiome in Healthy and Oral Cancer Patients.

Oral cancer is a globally widespread cancer that features among the three most prevalent cancers in India. The risk of oral cancer is elevated by factors such as tobacco consumption, betel-quid chewing, excessive alcohol consumption, unhygienic oral condition, sustained viral infections, and also due to dysbiosis in microbiome composition of the oral cavity. Here, we performed an oral microbiome study of healthy and oral cancer patients to decipher the microbial dysbiosis due to the consumption of smokeless-tobacco-based products and also revealed the tobacco-associated microbiome. The analysis of 196 oral microbiome samples from three different oral sites of 32 healthy and 34 oral squamous cell carcinoma (OSCC) patients indicated health status, site of sampling, and smokeless tobacco consumption as significant covariates associated with oral microbiome composition. Significant similarity in oral microbiome composition of smokeless-tobacco-consuming healthy samples and OSCC samples inferred the possible role of smokeless tobacco consumption in increasing inflammation-associated species in oral microbiome. Significantly higher abundance of Streptococcus was found to adequately discriminate smokeless-tobacco-non-consuming healthy samples from smokeless-tobacco-consuming healthy samples and contralateral healthy site of OSCC samples from the tumor site of OSCC samples. Comparative analysis of oral microbiome from another OSCC cohort also confirmed Streptococcus as a potential marker for healthy oral microbiome. Gram-negative microbial genera such as Prevotella, Capnocytophaga, and Fusobacterium were found to be differentially abundant in OSCC-associated microbiomes and can be considered as potential microbiome marker genera for oral cancer. Association with lipopolysaccharide (LPS) biosynthesis pathway further confirms the differential abundance of Gram-negative marker genera in OSCC microbiomes.

Factors Causing Non-Adherence to Lifestyle Modification in type II Diabetes Patients: A Cross-Sectional Study

Aim: To determine the factors causing non-adherence to lifestyle modification in type II diabetes patients. Study design: A cross-sectional study Place and Duration: This study was conducted at Global Institute of Medical and Health Sciences Hyderabad Pakistan from June 2020 to June 2021 Methodology: The study included 374 individuals who were more than 20 years of age and had type II diabetes for more than 1 year. Different factors which might have an association with non-adherent behavior to lifestyle modification were assessed. The results were statistically analyzed using SPSS version 23. Results: It was observed that 88% of patients were non-adherent towards diet, 25% were towards exercises, 70% towards foot care, 6% towards smoking, and 25% towards skipping the betel quid chewing even after being instructed by the health care workers. Conclusion: Nonadherence towards lifestyle modification is quite challenging to achieve a healthy and stable lifestyle in diabetic patients. So such studies must be conducted on a larger scale to develop proper interventions. Keywords: lifestyle modifications, Prevalence, Risk factors, Type 2 diabetes

Cumulative Betel Quid Chewing and the Risk of Significant Liver Fibrosis in Subjects With and Without Metabolic Syndrome.

BackgroundBetel quid chewing is associated with metabolic disorders, oral cancer, cardiovascular disease, and chronic liver diseases. Metabolic syndrome (MetS) is also a factor associated with liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). However, studies on the relationship between betel quid and liver fibrosis while also considering MetS are lacking. The aim of this study was thus to investigate the association of betel quid chewing and liver fibrosis with MetS.MethodsA total of 9,221 subjects were enrolled after excluding subjects <18 years of age, with past history of chronic liver diseases, cancer, significant alcohol consumption, and incomplete data. Betel nut chewing habit was classified into three groups: none, former-chewing, and current-chewing, and cumulative exposure was calculated by multiplying the duration with the quantity. Liver fibrosis was evaluated based on the NAFLD fibrosis score (NFS), which is a composite score of age, hyperglycemia, BMI, platelet count, albumin, and the AST/ALT ratio. Significant liver fibrosis was defined as NFS ≥-1.455.ResultsAfter adjusting for other variables, MetS was positively associated with significant liver fibrosis. Subjects with both MetS and betel quid chewing had a higher associated risk of significant liver fibrosis than those with neither MetS nor betel quid chewing (adjusted OR: 3.03, 95% CI: 2.04–4.50, p < 0.001). Betel quid chewing was associated with significant liver fibrosis (adjusted OR: 2.00, 95% CI: 1.14–3.49, p = 0.015) in subjects with MetS, but not in subjects without.ConclusionMetabolic syndrome increased the associated risk of significant liver fibrosis. Cumulative betel quid exposure increased the associated risk of significant liver fibrosis in subjects with MetS, but not in subjects without.

HIF - 1α as a marker of risk assessment for malignant transformation in oral submucous fibrosis: An immunohistochemical study.

Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with habit of chewing betel quid containing arecanut. Morphological features of OSMF especially fibrosis suggests a possibility of the hypoxic environment in diseased tissues. The adaptation of cells to hypoxia appears to be mediated via hypoxia inducible factor-1α (HIF-1α) which is also said to be associated with malignant transformation of epithelial cells in various other carcinomas like prostate and cervical carcinoma. Therefore, the main objective of this study was to investigate the role of HIF-1α in progression and malignant transformation of OSMF. The study group consisted of histo-pathologically diagnosed 30 cases of oral submucous fibrosis and 10 cases of OSCC were taken as control. The immunohistochemistry was carried out on neutral buffered formalin-fixed paraffin-embedded tissue sections by using the monoclonal antibody of HIF-1α. Statistical analysis was done using SPSS software version 2.0. A gradual and significant rise in the expression of HIF-1α was observed in various grades of OSMF and OSCC cases. HIF 1α expression was increased in cases showing hylanization and constricted blood vessels. A cut off value of 39.6% of HIF-1α positive cells was determined statistically to categorize the cases into high risk and low risk group for malignant transformation. Overexpression of HIF-1α may contribute to the progression and malignant transformation of OSMF. Cases expressing more than 40% of HIF-1α positive cells are at a greater risk for malignant transformation.

Molecular Mechanisms of Malignant Transformation of Oral Submucous Fibrosis by Different Betel Quid Constituents-Does Fibroblast Senescence Play a Role?

Betel quid (BQ) is a package of mixed constituents that is chewed by more than 600 million people worldwide, particularly in Asia. The formulation of BQ depends on a variety of factors but typically includes areca nut, betel leaf, and slaked lime and may or may not contain tobacco. BQ chewing is strongly associated with the development of potentially malignant and malignant diseases of the mouth such as oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC), respectively. We have shown recently that the constituents of BQ vary geographically and that the capacity to induce disease reflects the distinct chemical composition of the BQ. In this review, we examined the diverse chemical constituents of BQ and their putative role in oral carcinogenesis. Four major areca alkaloids—arecoline, arecaidine, guvacoline and guvacine—together with the polyphenols, were identified as being potentially involved in oral carcinogenesis. Further, we propose that fibroblast senescence, which is induced by certain BQ components, may be a key driver of tumour progression in OSMF and OSCC. Our study emphasizes that the characterization of the detrimental or protective effects of specific BQ ingredients may facilitate the development of targeted BQ formulations to prevent and/or treat potentially malignant oral disorders and oral cancer in BQ users.

Current knowledge, attitude and practice among dental hygienists in oral cancer awareness: Systematic review.

ObjectivesEvidence on the awareness and knowledge level of oral cancer and its associated risk factors among dental hygienists is scarce; this systematic review aimed to synthesize their available evidence of the level of knowledge, attitude and practice.MethodsPubMed and Scopus were searched for publications from any year up to January 2021. Studies about knowledge and/or attitudes and/or practices of dental hygienists have been taken into account. Overall, 14 studies have been selected for the systematic review.ResultsExcluding tobacco use (99.8%–100%), considerable variability were found among dental hygienists about important oral cancer risk factors such as alcohol consumption (30.0%–90.0%), human papilloma virus (23.0%–90.0%), oldness (37.7%–69.3%), diet (30.0%–42.2%) and betel quid chewing (5.0% and 98.0%). There was a good level of awareness among dental hygienists regarding leukoplakia (86.5%), instead less than half recognized erythroplakia as a precancerous lesion. Moderate knowledge was recorded about frequent sites of oral cancer development. Most of dental hygienists reported to perform intraoral screening (85.2%–100%). To regard attitude, a great variability was found about adequacy of undergraduate training (15.7%–75.0%) and most of dental hygienists expressed the need for continuing education (92.7%–99.0%).ConclusionsDental hygienists play a key role in oral cancer detection. Low knowledge of oral cancer among dental hygienists is strongly associated with the low levels of early detection. These findings provide useful information to improve continuing education programmes pre‐ and post‐graduation targeted at the prevention of oral cancer in order to reduce oral cancer morbidity and mortality.

Risk Reversal of Oral, Pharyngeal and Oesophageal Cancers after Cessation of Betel Quid Users: A Systematic Review and Meta-Analysis.

Background:Areca nut (AN), the principal ingredient of betel quid (BQ) has been categorized as a human carcinogen associated with various cancers of upper aerodigestive tract. However, there has been no attempt at summarizing the risk reversal of oral and other cancers after cessation of BQ with or without tobacco (BQ+T/BQ-T).Objective:To analyze the effect of cessation of betel quid without tobacco (BQ-T) and with tobacco (BQ+T) on reversal of the risk of oral, pharyngeal and oesophageal cancers.Methods:A systematic literature search was conducted for publications evaluating risk of these three cancers among current and former users of BQ-T or BQ+T. The overall as well as subgroup meta-relative risks (meta-RR) were estimated using random-effect models.Results:A total of 14 studies, seven each providing estimates for BQ-T and BQ+T, were identified. For BQ-T and oral cancer, a 28.9% risk reversal was observed among former users (meta-RR 5.61, 95% CI 2.24–14.04) compared to current users (meta-RR 7.89, 95% CI 3.90–15.98). A risk reversal of 48% was noted for pharyngeal cancer – former users (meta-RR 2.50, 95% CI 1.43–4.38), current users (meta-RR 4.81, 95% CI 2.05–11.30). For oesophageal cancer, no appreciable difference in risk was observed between current and former users.For BQ+T and oral cancer the overall meta-RR indicated a higher risk in former than in current users. However, sensitivity analysis including only better-quality studies showed a modestly lower cancer risk in former than in current users. Compared to current users, the risk in former users who quit less than 10 years ago (meta-RR 1.21, 95% CI 0.90–1.63) was increased, but decreased in former users who quit more than 10 years ago (meta-RR 0.72, 95% CI 0.48–1.07).Conclusion:Our analysis highlights for the first time the potential of risk reversal for oral and pharyngeal cancers following cessation of BQ-T and for oral cancer in long-term quitters (greater than 10 years) of BQ+T. The suggestive evidence from this systematic review further supports the imperative need of a strong policy to reduce the initiation of BQ use and inclusion of interventions for BQ cessation in cancer control efforts especially in geographic regions where BQ chewing is prevalent.

Hygroscopic nature of betel quid: A cause for acinar cell degeneration and xerostomia

Betel quid (BQ) chewing, a highly prevalent habit in Asian countries, is on the rise due to its addictive potential and easy availability in the market. Mostly BQ is placed in the gingivo-buccal sulcus of the oral cavity for a variable period, frequency, and duration. In our recent laboratory experimentation, we observed an extremely high degree of hygroscopicity of BQ when mixed with normal saline and saliva. Based on this observation, we proposed chronic intermittent dryness of the oral cavity for a prolonged period leads to the compensatory secretion of saliva by the acinar cell of salivary glands. However, over a period, this continuous process can cause functional exhaustion of acinar cells and irreversible damage, and ultimately permanent xerostomia. Three-level experimentations (in-vitro, animal, and in-vivo) are proposed for testing the proposed hypothesis. In the future, salivary substitute intervention and stem cell-mediated rejuvenation of the acinar cells can be targeted to effectively achieve symptomatic control over the BQ chewers and oral submucous fibrosis (OSMF) patients.

Systemic and Local Effects Among Patients With Betel Quid-Related Oral Cancer.

The major predisposing factors of developing oral cancer include smoking, alcohol drinking, and betel quid chewing. Betel quid chewing could cause the abrasion and damage of oral mucosa by crude fibers, chemical insults by additive slaked lime, and arecoline from areca nut. These would lead to the local consequence of oral submucosal fibrosis, which is regarded clinically as a precancer lesion and a major cause of trismus. In addition, the components and additives in betel quid contain chemical toxins and carcinogens, which would further affect the oral mucosa and gradually develop a malignancy. Following literature review, aside from having a greater total tumor burden and more local diseases in the oral cavity and digestive tract, patients with betel quid-related oral cancer also have more systemic diseases from metabolic syndrome, hypertension, cardiovascular disease, type II diabetes mellitus, and obesity than those without this habit. In conclusion, those patients who have the history of smoking, alcohol drinking, and betel quid chewing would present much more unique clinical characteristics than those who only have a history of smoking and alcohol drinking. More attention should therefore be paid to pretreatment evaluation, treatment strategy, and posttreatment follow-up among betel quid chewers.

The Contribution of PDCD6 Polymorphisms to Oral Cancer Risk.

Programmed cell death 6 (PDCD6) is up-regulated and highly expressed in early apoptotic cells. In several types of cancer, such as cervical, breast and lung cancers, the association of PDCD6 genotypes have been investigated. However, the contribution of PDCD6 variant genotypes to oral cancer has never been examined. The current study aimed to evaluate the contribution of the PDCD6 rs4957014 and rs3756712 genotypes to the risk of oral cancer in Taiwan. The contribution of PDCD6 genotypes to oral cancer risk was examined among 958 patients with lung cancer and 958 age- and sex-matched healthy controls by polymerase chain reaction-restriction fragment length polymorphism (PCR- RFLP). The data showed that the hetero-variant GT and homo-variant GG genotypes of PDCD6 rs4957014 were associated with a decreased risk of oral cancer [odds ratio (OR)=0.81 and 0.39, 95% confidence interval (CI)=0.67-0.97 and 0.27-0.56, respectively]. The recessive and dominant models also showed that G carriers have protective effects (OR=0.43 and 0.72, 95% CI=0.30-0.61 and 0.61-0.87, respectively). The analysis of allelic frequency distributions showed that the G allele of PDCD6 rs4957014 was associated with reduced oral cancer risk (OR=0.71, 95% CI=0.62-0.82). There was no significant association between any PDCD6 rs3756712 genotype and oral cancer risk. In addition, the GG genotype at PDCD6 rs4957014 significantly decreased the risk of oral cancer among both males (adjusted OR=0.31, 95%CI=0.24-0.56) and females (adjusted OR=0.44, 95% CI=0.22-0.91). Furthermore, the GG genotype at PDCD6 rs4957014 significantly decreased the risk of oral cancer among smokers (adjusted OR=0.35, 95% CI=0.22-0.58), alcohol drinkers (adjusted OR=0.33, 95% CI=0.18-0.49), non-betel quid chewers (adjusted OR=0.33, 95% CI=0.17- 0.81), betel quid chewers (adjusted OR=0.34, 95% CI=0.21- 0.59), but not among never-smokers and non-alcohol drinkers. The G allele carriers of PDCD6 rs4957014 may have protective effects on oral cancer risk and serve as a practical marker for early detection of oral cancer in Taiwan.

Serum lactate dehydrogenase in the prognostic assessment of patients with oral squamous cell carcinoma.

Lactate dehydrogenase (LDH) has been proven to be a diagnostic marker in oral squamous cell carcinoma (OSCC). However, the prognostic value of serum LDH in OSCC is yet to be explored. The purpose of this study is to correlate the level of serum LDH with the degree of OSCC and to evaluate the role of serum LDH as a prognostic marker in OSCC. The investigators designed and implemented a prospective cohort study composed of patients with OSCC (n = 66) sub-grouped as follows: 2A-well-differentiated (n = 22), 2B-moderately differentiated (n = 22), 2C-poorly differentiated OSCC (n = 22), and normal healthy controls (n = 40). The primary outcome variable was the serum LDH measured at baseline (pre-treatment) and 2 and 12 months post-treatment in OSCC patients. The statistical analysis was performed using the student t-test and analysis of variance, and the P value was set at 0.05. The habit of alcohol consumption alone as a single habit was found only in males (17.5%) (P = 0.3343), whereas betel quid chewing was more common among females (P = 0.0182). A significant difference was observed in the mean serum LDH between OSCC subjects (pre-treatment) (831.56 ± 93.43 IU/L) and controls (188.82 ± 25.53 IU/L), P < 0.00001. The baseline serum LDH was significantly higher in subgroup 2C (933.41 ± 46.1969 IU/L) than in the 2A (742.59 ± 46.5676 IU/L) and 2B (818.68 ± 58.1643 IU/L) subgroups (P = 0). There was a significant decline in the serum LDH within 2 months after treatment, and a further decrement was observed during a 12-month follow-up among the survivors of all three subgroups; P < 0.00001. Serum LDH can play a dual role as a reliable indicator of the degree of OSCC for decision-making in treatment modalities and as a prognostic marker of response to therapy.

Association of EZH2 Genotypes With Oral Cancer Risk.

The over-expression of enhancer of zeste homolog 2 (EZH2) protein is found in oral cancer tissues. However, the genetic role of the enhancer of EZH2 in the etiology of oral cancer is unknown. The aim of this study was to evaluate the association of EZH2 genotypes with oral cancer risk among Taiwanese. Three polymorphic variants of EZH2, rs887569 (C to T), rs41277434 (A to C), and rs3757441 (T to C), were analyzed regarding their association with oral cancer risk among 958 oral cancer patients and the same number of healthy controls by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). In addition, the interaction of EZH2 rs887569, rs41277434, and rs3757441 genotypes with personal behaviors such as smoking, alcohol drinking, and betel quid chewing were also examined. The EZH2 genotypes rs887569, rs41277434, and rs3757441, were not significantly associated with oral cancer risk (p for trend=0.1735, 0.5658, and 0.4606, respectively). The analysis of allelic frequency distribution also supported the findings that the variant alleles at EZH2 rs887569, rs41277434, and rs3757441 may not serve as determinants of oral cancer risk (all p>0.05). There was no interaction between EZH2 rs887569, rs41277434, or rs3757441 genotypes with personal smoking, alcohol drinking or betel quid chewing behaviors. EZH2 genotypes cannot predict oral cancer risk in Taiwan.

Oral Squamous Cell Cancer Scenario in a Tertiary Hospital in Western Region of Nepal

Introduction: Oral squamous cell cancer involves oral subsites namely lip, buccal mucosa, gingivobuccal sulcus, mandible, retromolar trigone, tongue, floor of the mouth, maxilla and hard palate. It has multifactorial etiologies. Alcohol, tobacco chewing, smoking, betel quid chewing, trauma and HPV viruses are implicated as the predisposing factors of oral squamous cell carcinoma. If detected early, oral cavity cancer is easily preventable and curable. Aims: To evaluate oral squamous cell cancer demographics, as well as risk factors, site, grades, and stages. Methods: This prospective cross-sectional descriptive type of study was done in patients attending dental outdoor patient department of Nepalgunj medical college from July 2018 to August 2020. 46 patients selected by enumerative sampling method in the study after they were histopathologically confirmed with oral squamous cell carcinoma by biopsy. All included patients were having primary oral cancer, single, unilateral and untreated. After data collection current oral squamous cell cancer demographics, as well as risk factors, site, grades, and stages were established. Results: Out of 46 patients ranging from 32 to 79 years 28(60.8%) were males and 18(39.1%) were females with mean age range of 55.41 ± 10.84 years. 26(56.5%) of total displayed oral squamous cell carcinoma at buccal mucosa. 25(54.3%) of total consumed gutkha and paan with betel nut plus tobacco. 30(65.2%) of total were exposed to carcinogen for a period of 21-40 years. 32(69.5%) of total had well differentiated oral squamous cancer. 32(69.5%) of total were at stage III at the time of presentation. Conclusion: Oral cancer occurred more in males, at buccal mucosa and in people above 51 years, and in those who consumed gutka and paan, betel nut plus tobacco. It was also more in people with longer history of exposure to carcinogens.

Simultaneous determination of areca nut- and tobacco-specific alkaloids in saliva by LC-MS/MS: Distribution and transformation of alkaloids in oral cavity

Areca nut and tobacco are frequently used in combination. Cigarette smoking and betel quid (BQ) chewing habits impose greater oral cancer risk than either habit alone. Saliva is a better noninvasive diagnostic material as it is in direct contact with oral mucosa and cancerous lesions. This study describes the application of isotope-dilution LC-MS/MS for simultaneous quantitation of five areca nut-specific alkaloids (ASAs) and three tobacco-specific alkaloids (TSAs) in human saliva. With this method, we demonstrate that the distribution of ASAs vary significantly in smokers who chew BQ habitually, due to the hydrolysis of ASAs and metabolic activity in the oral cavity. The alkaline condition formed due to slaked lime in BQ, plays an important role in the distribution of ASAs and TSAs, by catalyzing the hydrolysis of ester forms of ASAs to their respective carboxylic acid forms besides facilitating the TSA (i.e., nicotine) absorption in the oral cavity. Moreover, our results reveal that oral mucosa rather than saliva contributes to the metabolism of ASAs at oral cavity. Less than 2.1% of ASAs were metabolized by saliva, as determined by in vitro test. Our findings may provide a better insight into the pathobiology of oral carcinogenesis due to BQ chewing.

The Reasons for Betel Quid Chewing Scale (RBCS) for Ex-Chewers: Assessment of Factor Structure, Reliability, Validity and Measurement Invariance across Gender in a Guamanian Sample

Background Over 600 million people chew betel nut worldwide and the behavior is classified by the World Health Organization (WHO) as a Group 1 carcinogen. Having a reliable and valid scale of reasons for chewing betel nut that can be used consistently across gender for both chewers and ex-chewers will assist practitioners to create culturally appropriate risk reduction and cessation programs and address an important public health concern. Purpose/Objectives: We sought to: 1) examine factor structure, reliability, and validity of the Reasons for Chewing Scale (RBCS) for ex-chewers; 2) examine the influence of social-cultural factors on chewing behaviors; and 3) examine if measurement invariance (MI) of the RBCS held consistently across gender groups. Methods A Confirmatory Factor Analysis (CFA), a multigroup CFA for testing measurement invariance (MI), and Structural Equation Modeling (SEM) were applied to the RBCS using a convenience sample of (N = 223) of ex-chewers from Guam. Results The majority of the items in the RBCS were found to be moderately or strongly correlated to each other. The CFA model fit the ex-chewers’ data well and the model suggested that the RBCS was found to be reliable and valid. The multi-group CFA showed this scale functions equivalently for both male and female groups. Conclusions/Importance: The RBCS is a valid and reliable measure that is invariant across gender and type of ex-chewer.

ORAL SUBMUCOUS FIBROSIS –A REVIEW

Oral sub mucous brosis is a potentially premalignant disorder which has multiple etiological factors among which habit of using tobacco especially chewing betel quid and arecanut is the important risk factor .The aim of this article is to emphasize on the etiopathogenesis and various recent treatment modalities that are available

Decreased Circulating Melatonin with Loss of Age-Related Biphasic Change in Patients with Oral Squamous Cell Carcinoma

Background: Melatonin, produced by the pineal gland, is known for its antioxidant, oncostatic, and anti-inflammatory properties. However, studies on serum melatonin levels in different cancer types have yielded conflicting results, and little is known about the clinical significance of serum melatonin in oral squamous cell carcinoma (OSCC) in the Southern Asian population. Therefore, we explored its role in OSCC in this study. Methods: A total of 67 male OSCC patients and 78 healthy controls were enrolled in this case–control study. The serum levels of melatonin were determined by enzyme-linked immunosorbent assay (ELISA) and compared between the two groups. Results: The serum melatonin levels were significantly lower in OSCC patients compared with healthy controls (mean ± standard deviation, 15.0 ± 4.6 vs. 18.5 ± 11.8 pg/mL, p = 0.02). In the subgroup of age less than 55 years (mean age of OSCC), OSCC patients had a significantly decreased melatonin level than healthy controls (mean melatonin, 15.7 ± 12.6 vs. 20.8 ± 3.9 pg/mL, p = 0.02). Decreased serum melatonin (odds ratio (OR): 0.95, 95%CI: 0.91–0.99), alcohol consumption (OR: 29.02, 95%CI: 11.68–72.16), betel quid chewing (OR:136.44, 95%CI: 39.17–475.27), and cigarette smoking (OR:29.48, 95%CI: 11.06–78.60) all increased the risk of OSCC under univariate analyses of logistic regression. Betel quid chewing (OR: 45.98, 95%CI: 10.34–204.49) and cigarette smoking (OR:6.94, 95%CI: 1.60–30.16) were the independent risk factors for OSCC in Taiwan. In addition, a negative correlation between age and melatonin level was observed in healthy controls (Pearson r = −0.24, p = 0.03). However, the negative correlation was lost in patients with OSCC. Melatonin concentration had no association with the severity of OSCC. Conclusion: Overall, our study provides evidence that serum melatonin levels decreased in OSCC patients in Taiwan and the decreased level is much significant in young populations and suggests that the decreased melatonin was associated with OSCC, especially in young populations. Further studies are warranted to investigate whether melatonin can be a useful non-invasive screening tool for OSCC.

Head and Neck Squamous Cell Carcinoma: Risk Factors, Molecular Alterations, Immunology and Peptide Vaccines.

Head and neck squamous cell carcinoma (HNSCC) arises from the epithelial lining of the oral cavity, hypopharynx, oropharynx, and larynx. There are several potential risk factors that cause the generation of HNSCC, including cigarette smoking, alcohol consumption, betel quid chewing, inadequate nutrition, poor oral hygiene, HPV and Epstein–Barr virus, and Candida albicans infections. HNSCC has causative links to both environmental factors and genetic mutations, with the latter playing a more critical role in cancer progression. These molecular changes to epithelial cells include the inactivation of cancer suppressor genes and proto-oncogenes overexpression, resulting in tumour cell proliferation and distant metastasis. HNSCC patients have impaired dendritic cell (DC) and natural killer (NK) cell functions, increased production of higher immune-suppressive molecules, loss of regulatory T cells and co-stimulatory molecules and major histocompatibility complex (MHC) class Ι molecules, lower number of lymphocyte subsets, and a poor response to antigen-presenting cells. At present, the standard treatment modalities for HNSCC patients include surgery, chemotherapy and radiotherapy, and combinatorial therapy. Despite advances in the development of novel treatment modalities over the last few decades, survival rates of HNSCC patients have not increased. To establish effective immunotherapies, a greater understanding of interactions between the immune system and HNSCC is required, and there is a particular need to develop novel therapeutic options. A therapeutic cancer vaccine has been proposed as a promising method to improve outcome by inducing a powerful adaptive immune response that leads to cancer cell elimination. Compared with other vaccines, peptide cancer vaccines are more robust and specific. In the past few years, there have been remarkable achievements in peptide-based vaccines for HNSCC patients. Here, we summarize the latest molecular alterations in HNSCC, explore the immune response to HNSCC, and discuss the latest developments in peptide-based cancer vaccine strategies. This review highlights areas for valuable future research focusing on peptide-based cancer vaccines.

New updated Classification and Treatment modality for Oral Submucous Fibrosis: A Review

Oral submucous fibrosis (OSMF) is a premalignant condition mainly associated with the practice of chewing betel quid containing areca nut, a habit common among South Asian people. Data from recent epidemiological studies provide overwhelming evidence that areca nut is the main etiological factor for OSMF. Over the years, many classification systems have been documented in medical literature based on clinical, histopathological, or functional aspects. Each classification has its own merits and demerits. An attempt is made to provide and update the knowledge of classification system of OSMF so that it can assist the clinicians, be beneficial in researches and academics in categorizing this potentially malignant disease for early detection, prompt management, and reducing the mortality. Keywords: Update classification, Blanching, Collagen, Fibrosis, Oral Submucous Fibrosis

Prevalence of Tobacco and Areca-nut Use and Awareness of Its Harmful Effects among Non-academic Staff at Faculty of Dental Sciences, University of Peradeniya

Background: Tobacco and areca nut (AN) are well known risk factors for oral cancer and awareness of these harmful risk habits will reduce the incidence of oral cancer in Sri Lanka. Faculty of Dental Sciences, University of Peradeniya plays a major role in this fight against oral cancer. Hence this study is aimed to evaluate the prevalence of these risk habits among its non-academic staff and their awareness of its harmful effects as they are also responsible stakeholders of the faculty. Method: An institutional based cross sectional study was conducted among 108 non-academic staff members of the faculty using a self-administered questionnaire on risk habit details and their awareness on its harmful effects. Results: Analyzed results revealed that only 4.6% of the sample had tobacco and AN use; betel quid chewing (2.7%) and tobacco smoking (1.8%). However, the awareness on the harmful effects of these products were not very satisfactory as only 48% were overall aware while the unhealthy effects of AN use were known only by 27% of the sample. Contradictorily, 70% of them informed that they have received information regarding the harmful risk habits. Conclusion: It is important to increase awareness among the non-academic staff of the faculty as they become important stakeholders of one of the leading centres in the fight against oral cancer.