Grades Of Oral Submucous Fibrosis Research Articles

Epithelial and Connective Tissue Changes in Oral Submucous Fibrosis ?? A Morphometric Analysis

Introduction: Oral Submucous Fibrosis (OSF) is a common oral health problem in the Indian subcontinent. It was first reported by Schwartz and defined by Pindborg. OSF is within a group of conditions that are classified under potentially malignant disorders of the oral cavity. Current evidence suggests that are coline in the areca nut is the key factor in initiating the disease process. Objective: The purpose of this study is to conduct the morphometric analysis of the epithelial and selected connective tissue changes related to capillaries and to determine mast cell density in different grades of OSF. Method: The study comprises 25 cases of OSF in varying grades (according to Pindborg and Sirsat classification) retrieved from the archives of department of oral pathology. The slides were prepared and stained in Hematoxylin and Eosin stain and 1% toluidine blue. All the slides are being studied under Trinocular research microscope Olympus BX-53 and further quantified in image capture software for morphometric analysis. Result: Morphometrical analysis of epithelial thickness and connective tissue changes highlightening the parameters of capillary density, luminal diameter and circumferences of the capillaries have shown that varying degree of alterations in different grades of OSF when the severity of the disease increases. This study also included the mast cell density analysis which have proven to undergo changes as the severity of the disease progress.

Assessment of correlation between clinical staging, functional staging, and histopathological grading of oral submucous fibrosis.

BACKGROUND:Oral submucous fibrosis (OSMF) is a premalignant condition with a greater prevalence in countries such as India. Various classifications have been put forth by multiple authors to determine the clinical, functional, and histopathological grade of the disease. The classification systems have greatly helped to determine the treatment modality for the patients. Understanding the correlation between the various classifications will help us determine the course of the disease, management, and prognosis of OSMF. This study assesses the correlation between clinical, functional, and histopathological grading of OSMF.AIM:To assess the correlation between clinical staging, functional staging, and histopathological grading of OSMF.MATERIALS AND METHODS:Thirty patients with clinical and histopathological diagnosis of OSMF were assigned into clinical stage, functional stage, and histopathological grade. The correlation between these three stages assigned was studied.STATISTICAL ANALYSIS:The degree of agreement between the clinical, functional, and histopathological classifications was quantified by the Weighted Kappa statistics. Correlation between the three classifications was done using Kendall's tau and Spearman's correlation coefficient.There was a good agreement and statistically significant correlation between clinical and functional grading. There was a poor agreement and no significant correlation between clinical and histopathological grading. There was a poor agreement and no significant correlation between functional and histopathological grading.

Oral submucous fibrosis in North Gujarat: A demographic study

Background: Oral submucous fibrosis (OSMF) is a premalignant disorder, mainly caused by betel nut chewing in various forms. It is found in the Asian subcontinent, mostly India, Pakistan, Sri Lanka, and Bangladesh. The understanding of the exact role of alkaloids and other etiological agents with respect to pathogenesis will help in the management and treatment modalities.Aim: The purpose of the study is to evaluate the epidemiologic profile of patients with OSMF in the North Gujarat population.Materials and Methods: Patients of OSMF attending the OPD of Siddhpur Dental College were selected for the study. Total numbers of 100 cases of clinically diagnosed OSMF were included for this study. A detailed case history was taken and clinical examination was done in visible light. The patients having difficulty in opening the mouth along with associated blanched oral mucosa with palpable fibrous bands were diagnosed as OSMF patients were included in this study. This study was done on the basis of age group, habit duration, types of habit, and clinical grading of OSMF. After collecting data, they were analyzed statistically.Results: From 100 OSMF patients majority had Grade III interincisal mouth opening. Among the groups divided based on age, Group II (15–30 years age) showed more prevalence than the others. Gutkha and masala (main content areca nut) were a powerful etiological factor (4%) among other etiological factors.Conclusion: OSMF predominantly affects younger age group adults with male predilection and the majority of patients presented with a progressive and advanced form of disease. Thus, advancement in diagnostic aids is required to arrest the disease in its initial stages.

Salivary malondialdehyde in oral submucous fibrosis - A marker for oxidative damage.

Background:Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral mucosa and its malignant transformation rate accounts to about 7%–13%. Oxidative damage and lipid peroxidation plays an important role in OSMF. Lipid peroxidation has not been widely investigated in OSMF patients with respect to clinical staging and histopathological grading. As human saliva is a diagnostic fluid which can be obtained in a noninvasive procedure as compared to the blood for serum analysis, the present study was aimed at evaluating the salivary malondialdehyde (MDA) levels in OSMF and comparison with respect to clinical staging and histopathological grading.Aim:This study aims to evaluate salivary MDA levels in OSMF and compare the levels with respect to clinical and histopathological grading systems.Materials and Methods:Forty cases of clinically diagnosed and histopathologically proven cases of OSMF were included for the purpose of this study. As controls 40 age-matched individuals without any systemic disease were selected. Unstimulated whole saliva was collected from each individual, centrifuged and frozen at − 20°C until analysis. Lipid peroxidation products MDA were analyzed by thiobarbituric acid reaction.Results:Salivary MDA levels were significantly increased in OSMF patients compared to controls. The progressively increased salivary MDA levels showed a positive correlation with the clinical stages and histopathological grades of OSMF and the results were statistically significant.Conclusion:The increased salivary MDA levels in OSMF patients compared to the control group suggests an increased oxidative stress levels in the potentially malignant disorders such as OSMF. The mean salivary MDA levels were increased significantly as the clinical stage and histopathological grade of OSMF advances, suggesting MDA to be used as a reliable biochemical marker and also a prognostic marker to assess the extent of oxidative damage in OSMF.

Immunohistochemical detection of 8-hydroxydeoxyguanosine: A biomarker of oxidative DNA damage in oral submucous fibrosis.

Background:Oral submucous fibrosis (OSMF) is one of the common potentially malignant disorders prevailing in India. The primary etiological factors include tobacco and arecanut, which contain numerous reactive oxygen species (ROS). ROS attack guanine bases in DNA and form 8-hydroxydeoxyguanosine (8-OHdG), which can be detected in patients who have diseases associated with oxidative stress. The oxidative DNA damage produced by oxidative stress may induce malignant transformation.Aim:The aim of the present study is to detect the expression of 8-OHdG in OSMF patients and compare the expression within different grades of OSMF and also normal buccal mucosa.Materials and Methods:A total of 30 samples were examined for the immunohistochemical expression of 8-OHdG. The control group included 10 formalin-fixed paraffin-embedded tissue blocks of the normal buccal mucosa. The study group includes 20 cases of formalin-fixed paraffin-embedded tissue blocks of OSMF (5 cases in each grade of very early, early, moderately advanced and advanced cases of OSMF). Three-micron thick tissue sections were made from each sample and stained with 8-OHdG antibody. The results were statistically analyzed using Kruskal–Wallis and Mann–Whitney U testResults:Statistically significant difference exists in the intensity of 8-OHdG expression between the study groups. The P-value obtained was <0.001, which was highly statistically significant.Conclusion:The present study is the first attempt to evaluate the expression of 8-OHdG in tissue samples of OSMF that revealed the role of free radicals and oxidative DNA damage in these patients. Further research with larger sample size, clinicopathologic correlation and long-term follow-up will shed more light on the pathogenesis of OSMF. It will also be useful for the development of new therapeutic strategies targeting treatment modalities for OSMF.

Assessment of Maximum Bite Force in Oral Submucous Fibrosis Patients: A Preliminary Study

Objective: To determine the maximum bite force (MBF) in oral submucous fibrosis (OSMF) patients and to compare them with that of healthy subjects. Material and Methods: Twenty patients who were clinically confirmed, as OSMF and 20 healthy controls matched for age, gender, and number of intact functional teeth were included in this study. For each subject, age, gender, weight, height and body mass index (BMI) were recorded. The MBF registration was carried out by the two evaluators, who were previously calibrated. Bite force was measured in the first molar region using a force transducer occlusal force meter for each subject seated at the upright position, with Frankfort's plane nearly parallel to the floor, and no head support. The Student’s independent t-test was used to determine the statistical significance in relation to mean height, weight, BMI and the presence of number of intact teeth and MBF between the healthy subjects and OSMF individuals. A comparison of grades of OSMF with all variables was carried out by one-way ANOVA test. Results: No significant difference was found in mean age, mean height, weight, BMI and the presence of the number of intact teeth between healthy individuals and OSMF patients. The mean MBF in healthy subjects was 628.23 ± 24.39 N and 635.47 ± 31.22 N in OSMF patients. Even though the healthy subjects reported a higher MBF than OSMF patients did, the difference was statistically non-significant. With regards to sides, no significant difference was observed in mean MBF in healthy subjects and OSMF patients on the right (p=0.7818) and left side (p=0.6154). Conclusion: The healthy subjects reported higher MBF values than OSMF patients did and the difference was statistically non-significant.

Predicting the Malignant Transformation of Oral Submucous Fibrosis Using Quantitative Biomarkers p63 and CD31

Introduction: Oral submucous fibrosis (OSMF) is a pre-malignant condition highly prevalent in India with a malignant transformation rate of 2–8%. Its incidence amongst younger population has risen due to increased consumption of commercial preparations of areca. p63, a homolog of p53, has a role in epithelial proliferation and is frequently altered in dysplasia and associated with tumorigenesis. CD31 is a highly specific endothelial marker with varied expression in epithelial dysplasia and carcinoma. Epithelial proliferation and underlying angiogenic support are vital processes for malignant transformation. Therefore the present study aims to determine if p63 and CD31 expression is associated with increased malignant transformation of OSMF. Materials and Methods: A cross-sectional study wherein n = 36 OSMF samples were histologically graded into Group I (Early-Ea), II (Moderately advanced-MA) and III (Advanced-Ad) and analysed for anti-p63 and anti-CD31 antibodies. The expression was evaluated quantitatively and by pattern of distribution across the groups and statistically analysed with Chi-Square and Kruskal-Wallis tests (SPSS v2.0). Results: p63 expression of epithelium in Group I ∼100% (basal, suprabasal), II − 60.9% (basal, spinous), III − 62.5% (basal, spinous, granular) with a significant P-value 50% (normal diameter) and III ∼ 75% (dilated) with a significant P-value of 0.02*. Conclusion: A significant linear increase in nuclear staining of p63 and involvement of epithelial strata observed from Ea → MA → Ad grade of OSMF. CD31 expression exhibited more dilated vessels as OSMF grade increased from Ea → Ad. Therefore p63 and CD31 could be used as quantitative predictive biomarkers of malignant transformation of OSMF.

Immunoexpression of alpha smooth muscle actin correlates with serum transforming growth factor-β1 levels in oral submucous fibrosis.

The aim of the present study was to correlate the immunoexpression of alpha-smooth muscle actin (α-SMA) for myofibroblasts with the serum levels of transforming growth factor-β1 (TGF-β1) in oral submucous fibrosis (OSMF). A total of 100 cases of histopathologically confirmed OSMF were assessed for α-SMA expression. Clinical data, such as age, sex, mouth opening, and habit history, were obtained for each case. Serum TGF-β1 levels were recorded in 73 patients with the help of enzymelinked immunosorbent assay technique. The staining index of α-SMA increased concomitantly with higher myofibroblast count in the increasing histopathological grades of OSMF (P≤.05). Serum TGF-β1 levels were highest in the intermediate grades of OSMF. Clinical parameters, such as mouth opening, cheek flexibility, and tongue protrusion, showed a direct correlation with increasing clinical grades of OSMF. The progressive increase in myofibroblasts from early to advanced stages suggests their potential use as markers for evaluating the severity of OSMF. Additionally, as myofibroblasts are responsible for producing a variety of factors that are involved in the fibrotic processes; they could be the key link in the pathogenesis of OSMF. Interruption of their development, recruitment, or activation could provide a unique therapeutic target for future treatment options in patients with OSMF.

Histochemical and Immunohistochemical Analysis of Collagen Fibers and Microvascular Density in Various Grades of Oral Submucous Fibrosis.

Background and Objective:This study was aimed to evaluate the collagen fibers qualitatively and its correlation with microvascular density in various grades of oral submucous fibrosis (OSMF). Material and Methods:The present study comprised of total 40 cases of oral submucous fibrosis. Picrosirius red staining was done on all the specimens’ sections. They were analyzed for the colour and orientation of collagen fibers. Morphometric measurements were done using image analysis on immunohistochemical stained sections for Factor VIII-related antigen and analyzed for microvascular density.Results:Picrosirius red polarizing microscopy results revealed that there was a shift in the colour of collagen fibers from greenish yellow to orange red and red colour as the severity of the oral submucous fibrosis increased. The collagen fibers showed mixed orientation in early oral submucous fibrosis and parallel orientation in advanced oral submucous fibrosis. There was a significant decrease in microvascular density from early to advanced oral submucous fibrosis.Conclusion:The change in the colours and orientation of collagen fibers in early and advanced oral submucous fibrosis could be attributed to the fibre thickness, type of collagen, alignment and packing, cross-linking of the fibers and the section thickness. However, in advanced cases the vascularity is reduced which may predispose to epithelial atrophy and subsequent malignant changes.

Role of angiogenesis in oral submucous fibrosis using vascular endothelial growth factor and CD34: An immunohistochemical study.

Oral submucous fibrosis (OSF) is an insidious, chronic, disabling disease, in which there is lack of perfusion due to reduced level of the vasculature and this is said to be responsible for the epithelial atrophy seen in OSF. The degree of vasculature of the affected mucosa and its effects on the epithelial thickness remains controversial till date. This study attempts to analyze the role of angiogenesis in OSF and its progression using vascular endothelial growth factor (VEGF) and CD34 markers. The study samples for the present study comprised of 10 cases each of early OSF, moderately advanced, advanced OSF, and 10 cases of normal oral mucosa were used as controls. All the cases were subjected to immunohistochemical staining with VEGF and CD34 markers. Among the different grades of OSF, we did not find any noticeable difference in VEGF expression although we found a upregulation in microvessel density (CD34) in early and moderately advanced OSF followed by a downregulation in advanced OSF. As the disease progresses, there is an increased production of the extracellular matrix component (collagen I and II and fibronectin) and results in fibrosis. Subsequently, it leads to the reduction in the level of corium vascularity and results in hypoxia which ultimately causes reduction and constriction of the vascular channels. This sequence of events alerts us to the relevance of early disease diagnosis and management in an irreversible pathology such as OSF.

Expression of cyclooxygenase 2 in oral submucous fibrosis: An immunohistochemical pilot study.

Introduction:Oral submucous fibrosis (OSF) is associated with inflammatory changes in at least some stages of the disease. Prostaglandin is one of the main inflammatory mediators and its production is controlled by various enzymes such as cyclooxygenase (COX). The genetic and pharmacological data strongly indicate that COX-2 should be investigated as a potential target for the prevention and treatment of OSF.Methodology:The study group comprised histologically confirmed specimens (n = 10 each) of early OSF, moderate OSF, advanced OSF and normal oral mucosa for comparison. Immunohistochemistry was performed with avidin–biotin technique and evaluated with scoring methods.Results:The difference in percentage of expression in normal tissue and OSF was statistically highly significant (P < 0.001). Positive COX-2 exhibited cytoplasmic staining. One-way analysis of variances test was performed to evaluate COX-2 expression in different grades of OSF. Cytoplasmic staining assessed in terms of intensity, percentage of expression and Q Score did not show any statistical difference (percentage of expression F = 0.029, P = 0.971; Q Score F = 0.154, P = 0.858).Conclusions:Our study indicates that COX-2 may be an important marker of disease progression and might be a reliable prognostic indicator.

Oral Submucous Fibrosis: Correlation of Clinical Grading to Various Habit Factors.

Objectives:The aim of this study was to correlate the clinical grading of oral submucous fibrosis (OSMF) with various habit factors and to observe the habit factors associated with the severity of OSMF.Materials and Methods:This study was carried out in the Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, Bhubaneswar, Odisha, India. Two hundred patients clinically diagnosed with OSMF were included in the study. The observations were tabulated and subjected to statistical analysis using chi-square test and Spearman’s rank correlation test.Results:A total of 200 subjects participated in the study of which 182 were males and 18 were females. Forty-eight males and nine females had Grade I OSMF. One hundred nineteen males and eight females had Grade II OSMF. Fifteen males and only one female had Grade III OSMF. On the basis of functional staging, the total participants in stage I, stage II, and stage III were 185, 14, and 1, respectively. The participants having Grade I, Grade II, and Grade III OSMF with functional staging I were 57, 122, and 6, respectively. The participants having Grade II and Grade III OSMF with functional staging II were 5 and 9, respectively.Conclusion:It is alarming that nearly half of the total subjects were in the younger age group and were having OSMF. Also, as the age increased, the subjects were found to be more attracted to consuming areca nut derivatives in the form of betel quid with or without tobacco. It is recommended that community-oriented outreach programs on oral health awareness be developed, emphasizing children who represent the upcoming future, to avoid/quit areca nut and its derivatives.

Estimation of serum sialic acid in oral submucous fibrosis and oral squamous cell carcinoma.

Background and Objectives:Sialic acid (SA) N-acetyl neuraminic acid is a negatively charged 9-carbon monosaccharide, commonly attached to the nonreducing residues of carbohydrate chains of glycoconjugates by glycosidic linkage. SA is widely distributed in glycoproteins (GPs) of cell membrane. The alterations in GPs start at an early stage of tumorigenesis. Hence, the aim of the present study is to evaluate the levels of serum SA in normal individuals, in patients with oral submucous fibrosis (OSMF), oral squamous cell carcinoma (OSCC), and compare the levels with respect to the clinical staging and histological grading.Materials and Methods:A total of 90 individuals were selected for the purpose of the study. Thirty cases of clinically diagnosed and histopathologically confirmed cases of OSMF and OSCC each were included. A control group of 30 age and gender-matched individuals with no systemic diseases were selected. Serum levels of SA were measured based on the reaction between SA and ninhydrin. The absorbance was read using a spectrophotometer.Results:Serum SA levels were significantly increased in OSMF, OSCC patients as compared with controls. When multiple comparison was done using post hoc Tukey test, there is a statistically significant difference between clinical staging and histopathological grading of OSMF and OSCC (P < 0.05).Conclusion:The serum SA levels in OSMF and OSCC patients were increased as compared with controls suggesting that, it can be used as a reliable biomarker for prognostic evaluation, and also give a clue about the amount of tumor burden in the individual.

Role of hypoxia in malignant transformation of oral submucous fibrosis

Context: In the Indian subcontinent and Southeast Asia, habit of chewing areca nut has been recognized as one of the most important risk factors leading to a ubiquitous oral potentially malignant disorder (OPMD), oral submucous fibrosis (OSMF).In OSMF, owing to fibrosis in the connective tissue, there is narrowing of blood vessels which further results in compromised blood supply to the local tissue milieu. This tissue hypoxia elicits the activation of the transcription factor Hypoxia-inducible factor 1-alpha (HIF-1 α). In OSMF, its expression shows significant correlation with degree of epithelial dysplasia. Aim: This study aims to evaluate the expression of HIF-1 α in OSMF. Settings and Design: Seventy-five histopathologically proven cases of OSMF were included in the study. The tissue sections were studied for histopathological evaluation and HIF-1α expression. Statistical Analysis Used: Descriptive and inferential statistics using one-way ANOVA and multiple comparison using Kruskal–Wallis test were used. Results: Comparison of HIF-1α expression in different grades of OSMF was done. There were 47 cases without dysplasia, whereas 16 and 12 were of low-risk and high-risk dysplasia, respectively. On comparison of HIF-1α expression in different grades of OSMF, it was found to increase significantly from normal oral mucosa (1.43 ± 0.89) to no dysplasia (3.97 ± 2.75) to low-risk epithelial dysplasia (4.93 ± 1.76) to high-risk epithelial dysplasia (5.66 ± 2.01). Conclusion: The altered expression of HIF-1α can signify the disturbed epithelial-mesenchymal interaction which indicates progression toward the malignant transformation of OSMF. Thus, HIF-1 α expression showed good correlation with increase in grades of epithelial dysplasia and thus can assist for grading/quantifying oral epithelial dysplasia in OSMF.

Ultrasonographic evaluation of submucosal thickness in oral submucous fibrosis patients: a cross-sectional study.

PurposeTo evaluate the role of ultrasonography in oral submucous fibrosis (OSMF) patients.Material and methodsA total of 150 subjects were divided equally into six groups (Group I: 25 healthy subjects; Group II: 25 healthy subjects with habit; Group III: 25 OSMF stage I; Group IV: 25 OSMF stage II; Group V: 25 OSMF stage III; and Group VI: 25 stage OSMF IVA). The grading of OSMF were done according the clinical classification given by Khanna and Andrade (2005). After fulfilling inclusion and exclusion criteria each subject underwent extraoral ultrasonographic evaluation of submucosal thickness and vascularity in terms of peak systolic velocity (PSV), bilaterally on buccal and labial mucosa. Furthermore, statistical comparison of each group was done, and sensitivity and specificity of USG measurements was obtained in comparison with clinical diagnosis. The statistical analysis was performed using SPSS ver. 20.0.ResultsA statistically significant increase in mean submucosal thickness was shown, and a decrease in PSV with the advancement of severity of the OSMF. In ultrasonographic diagnosis of OSMF, the reported submucosal thickness had a sensitivity, specificity, PPV, NPV, and accuracy was 80%, 100%, 100%, 71.4%, and 87%, respectively, but PSV failed to classify the lesion.ConclusionsBecause the severity of the disease showed a direct relationship with submucosal thickness and an inverse relationship with PSV, habit-induced mucosal alteration in submucosal thickness can be seen on USG, which cannot be appreciated on clinical examination. Hence, USG can be a promising tool for early diagnosis, assessment of the severity, and evaluation of prognosis of OSMF.

Correlation of Clinical and Histopathological Grades in Oral Submucous Fibrosis Patients with Oxidative Stress Markers in Saliva.

This study aimed to correlate the oxidative stress marker levels in saliva with the clinical stage based on mouth opening, fibrotic bands and histopathological grades of oral submucous fibrosis (OSF) patients. The study included patients clinically diagnosed with OSF (n=63) and equal number of age and gender matched controls. Patients with OSF were defined by mouth opening stage, fibrotic bands and histopathological grades. Unstimulated saliva from both control and OSF patients were analysed for oxidative markers like lipid peroxides (LPO), non-enzymic antioxidants [reduced glutathione (GSH), vitamin A, vitamin E, vitamin C] and enzymatic antioxidants [glutathione peroxidase (GPx), superoxide dismutase (SOD)] and correlated with different stages and grades. Total salivary protein and LPO were significantly increased in OSF group with no significant change in the levels of GSH compared to controls. In OSF patients, a significant decrease in the levels of vitamins A, C and E was observed. The activities of salivary SOD and GPx were significantly decreased in OSF patients compared to controls. These changes significantly correlated with the increasing and differing grades of OSF that reflects increased oxidative stress with the progress of OSF.

Evaluation of myofibroblasts in oral submucous fibrosis and oral squamous cell carcinoma: The pathogenesis and correlation.

Oral submucous fibrosis (OSMF) is a chronic debilitating disease of the oral cavity having premalignant potential and unclear pathogenesis. Recently, myofibroblast has been postulated to play an important role in its pathogenesis and in the process of carcinogenesis. The purpose of this study was to evaluate and compare the presence of myofibroblasts in normal mucosa, different grades of OSMF, and oral squamous cell carcinoma (OSCC). The present in vitro cross-sectional descriptive study sample consisted of three groups, including 40 OSCCs, 40 OSMF, and 10 sections of normal oral epithelium taken as control group. Alpha-smooth muscle actin was used to identify myofibroblasts using immunohistochemical technique. P < 0.05 was taken as statistically significant. The presence of myofibroblasts was significantly higher in OSMF cases when compared with normal epithelium specimens. The presence of myofibroblasts was significantly higher in OSCC compared to OSMF cases. A significant difference was not observed between the different grades of OSCC. These findings favor the possibility that OSMF actually represents an abnormal healing process in response irritation caused by areca nut. A significant increase in myofibroblasts in OSCC as compared to OSMF also highlights the possible role it may play in the malignant transformation of OSMF.

Estimation of hemoglobin, serum iron, total iron-binding capacity and serum ferritin levels in oral submucous fibrosis: A clinicopathological study.

Introduction:Oral submucous fibrosis (OSMF) is also considered as an Asian version of sideropenic dysphagia, wherein chronic iron deficiency leads to mucosal susceptibility to irritants, such as chillies and areca nut products. Hemoglobin (Hb) levels, in particular, serum iron levels, are considered as biochemical indicators for nutritional assessment. Serum iron content can thus be a predictor for the progression of the condition, and there appears to be an association between serum iron content and oral carcinogenesis. Therefore, biochemical assessment of oral precancerous conditions may help in early diagnosis and prognosis. Hence, the present study was aimed to evaluate Hb, serum iron, total iron-binding capacity (TIBC) and serum ferritin in OSMF patients.Materials and Methods:Forty cases of OSMF were staged clinically and graded histopathologically to assess the levels of Hb, serum iron, TIBC and serum ferritin and compared with normal subjects. The results were compared using t-test, ANOVA, and Tukeys multiple post hoc procedures.Results:It was observed that the levels of Hb, serum iron and serum ferritin levels gradually reduced in OSMF patients compared with controls and as the clinical stage and histological grade of OSMF progressed with a statistically significant P < 0.05. It was observed that the levels of TIBC gradually increased in OSMF patients compared with controls and as the clinical stage and histological grade of OSMF progressed with a statistically significant P < 0.05.Conclusion:The Hb, serum iron and serum ferritin levels in OSMF patients were reduced and TIBC increased as compared with controls and as the clinical stage and histological grade of OSMF advances indicating their role as a reliable biochemical indicator.

Caspase-3 expression in normal oral epithelium, oral submucous fibrosis and oral squamous cell carcinoma.

Context:The epithelium atrophy, as the oral submucous fibrosis (OSMF) progresses, is believed to be an after effect of stromal fibrosis, hyalinization, decrease in vascularity and cellularity and is considered as “ischemic atrophy.” Due to hypoxia, caspase-3 get activation and subsequent decrease in viable cell count can occur.Aims and Objectives:To determine caspase-3 expression in various grades of OSMF and oral squamous cell carcinoma (OSCC) to find out whether upregulation of apoptosis is responsible for the epithelial changes in OSMF.Subjects and Methods:The control tissue (15 samples from normal oral mucosa) and study group comprising 97 cases of OSMF of different grades and OSCC associated with OSMF were stained with caspase-3 antibody, and the percentage of positive cells was calculated using ImageJ software.Statistical Analysis:The results obtained were statistically analyzed using ANOVA and Tukey's honest significance difference test and Mann–Whitney U-test.Results:There was a nuclear expression of caspase-3 in basal and parabasal layers of normal epithelium. There was cytoplasmic expression of caspase-3 in OSMF without dysplasia, total absence of caspase-3 expression in dysplastic epithelium and in majority cases of OSCC. The caspase-3 percentage was increased in OSMF (0%–53%) when compared with OSCC (0%–8%). The statistical comparison of caspase-3 among normal, OSMF and OSCC patients revealed significant correlation (P < 0.00010). The comparison within different grades of OSMF and between dysplastic and nondysplastic epithelium OSMF also showed significance (P < 0.019).Conclusions:The decreased expression of caspase-3 in disease progression reflects its role in the malignant transformation.

Prognostic potential of AgNORs in oral submucous fibrosis

Aim and Objective:The role of prognosis cannot be stressed enough, especially when it comes to potentially malignant lesions. The argyrophilic nucleolar organizer regions (AgNORs), which is simple and cost-effective has been used in diagnostic and prognostic pathologies. This study seeks to identify the nucleolar organizer regions (NORs) in oral submucous fibrosis (OSMF), to correlate the AgNOR count with the histologic grade of OSMF, and to evaluate the prognostic potential of AgNOR.Materials and Methods:The sample size consisted of archival paraffin blocks of 35 cases of varying grades of OSMF and 10 cases of squamous cell carcinoma. Normal mucosa samples served as controls for the study. AgNOR staining in accordance with the method of Smith and Crocker was performed and Student's t-test was used for statistical analysis.Results:The results showed an increase in AgNOR counts with corresponding grades of OSMF, the count being least in normal mucosa and also an increase in AgNOR count with corresponding decrease in differentiation of oral squamous cell carcinoma.Conclusion:AgNOR staining is a rapid and inexpensive procedure representing cellular proliferation that can be used to assess the nature of the lesion and therefore, the prognosis.