Homogeneous Leukoplakia Research Articles

Proliferative verrucous and homogeneous Leukoplakias exhibit differential methylation patterns

AbstractObjectiveProliferative verrucous leukoplakia (PVL) is considered a clinically distinct entity from other oral leucoplakias (OLs) due to its clinical presentation and evolution. However, molecular differences between them remain unclear. We aimed to determine whether there are methylation differences between PVL and other forms of OLs.Materials and MethodsOral biopsies from 12 patients with PVL, eight patients with homogeneous leucoplakia (HL), and 10 healthy individuals were obtained for a genome‐wide DNA methylation analysis via the Infinium EPIC Platform.ResultsA total of 1815 differentially methylated CpGs were found between PVL and HL, with a prominent state of hypermethylation in HL patients. CpGs covered 813 genes with distinct roles, including cell adhesion, extracellular matrix organization, and cell and synaptic signaling. 43% of these genes had been previously described in cancer and associated with prognosis. We developed a multinomial logistic regression model able to differentiate HL, PVL, and control samples. The model had a cross‐validated estimate of 73% and included differentially methylated cancer‐related genes between the pathological conditions and the healthy donors, including ADNP, BRCA2, CDK13, GNB1, NIN, NUMB, PIK3C2B, PTK2, SHISA4, THSD7B, WWP1, and ZNF292. It also included CpGs covering differentially methylated genes in HL (MEN1 and TNRC6B) and PVL (ACOXL, ADH1B, CAMTA1, CBFA2T3, CPXM2, LRFN2, SORCS2, and SPN).ConclusionsPVL and HL present differential methylation patterns that could be linked to their differential clinical behavior. Our findings show the potential of methylation markers and suggest novel diagnostic biomarkers.

Clinical evaluation of photodynamic therapy for oral leukoplakia: a retrospective study of 50 patients

BackgroundTopical photodynamic therapy (PDT) has demonstrated encouraging results in the treatment of oral leukoplakia (OLK). However, data on the clinical efficacy of PDT in Chinese patients with OLK are still limited.MethodsFifty patients diagnosed with OLK were enrolled, including patients with various dysplastic tissues. All patients received topical PDT with 5-aminolevulinic acid (5-ALA) as a photosensitizer. Clinical efficacy was evaluated 4 weeks after treatment. Follow-up was performed every 3 months during the first year and every 6 months during the second year.ResultsThe overall response rate was 68% (34/50): 12% (n = 6) complete and 56% (n = 28) partial responses. Aneuploidy was reduced in the patients with dysplastic lesions. Oral pain and local ulcers developed in 52% of the patients (n = 26). Patients with a long history of OLK including hyperplasia and dysplastic lesions, as well as those with non-homogenous lesions, were more likely to develop pain and ulcer. During follow-up, the recurrence rate of hyperplasia and dysplastic lesions was 32% (n = 16) and the malignant transformation rate of dysplastic lesions was 4% (n = 2). Lesions on the buccal mucosa were associated with recurrence (P = 0.044; OR: 0.108, 95% CI: 0.013–0.915).ConclusionTopical 5-ALA-mediated PDT is an effective treatment for OLK, particularly for homogenous leukoplakia, with few side effects. The buccal mucosa may be a protective factor that can reduce recurrence.

Cryotherapy for oral potentially malignant disorders.

Four surgical treatment modalities namely cryosurgery, scalpel and blade surgery, diode LASER surgery and CO2 LASER surgery in the management of oral potentially malignant disorders (OPMDs) in terms of healing outcomes post operatively and recurrence is evaluated. The study included sixty outpatients whose biopsies revealed OPMDs (oral lichen planus, homogeneous leukoplakia, non-homogenous leukoplakia and erythroplakia). There is decrease in post-operative pain and oedema in all four treatment categories at one week follow up and two week follow up. It was observed that pain was low in cryosurgery treatment category at day of surgery as well as at one week of follow up as compared to diode LASER and CO2 LASER. Observations from the study highlights that all four surgical modalities used in this study were effective for treatment of OPMDs, and the overall summation of the results of the study showed that cryotherapy seems to offer better clinically significant results than laser therapy.

Risk assessment of oral leukoplakia malignant transformation based on the ubiquitin-proteasome system indicators

Relevance. The ubiquitin-proteasome system controls the activity and stability of various cellular proteins that affect cellular homeostasis by the regulation of signalling cascades. The system activity is associated with the onset and progression of oral squamous cell carcinoma, as the system participates in the specific proteolysis of most intracellular proteins involved in cancer pathogenesis.Material and methods. The study included 61 patients (28 men and 33 women) aged 21 to 75 y.o. The study determined chymotrypsin-like (CTL) and caspase-like (CL) activities of circulating and intracellular proteasomes in blood serum and biopsy specimens taken from the oral mucosa by hydrolysis of the corresponding fluorogenic oligopeptide on a «Cytation1» multi-mode microplate reader-imager at an excitation wavelength of 360 nm and an emission of 460 nm, the specific activity of the proteasomes was expressed in units of activity.Results. The value of the specific chymotrypsin-like activity of circulating proteasomes in non-homogeneous leukoplakia and oral squamous cell carcinoma was 1.76 (p < 0.001) times and 2.27 (p < 0.001) times higher relative to the comparison group. Pairwise comparison of signs showed a statistically significant difference in chymotrypsinlike activity between the groups of non-homogeneous and homogeneous leukoplakia (p < 0.001), non-homogeneous leukoplakia and oral squamous cell carcinoma (p = 0.04). The values of specific chymotrypsin-like and caspase-like activities of intracellular proteasomes in biopsy specimens taken from the pathological focus in the groups of homogeneous, non-homogeneous leukoplakia and squamous cell carcinoma of the oral cavity were 1.6, 2.38, 3 (p = 0.002, p = 0.004, p = 0.03) and 1.5, 2.8 and 3.3 (p = 0.003, p = 0.012, p < 0.001) times higher compared to the control group.Conclusion. The proposed logit model for risk assessment of oral leukoplakia malignant transformation, based on the indicators of the ubiquitin-proteasome system, can improve the quality of diagnosis.

Managing leukoplakia with diode laser: A report of two cases

Oral leukoplakia is the most common precancerous lesion of the oral mucosa. WHO defined it as a lesion which has a white patch or plaque on the oral mucosa that cannot be removed by scraping and cannot be classified clinically or microscopically as another disease process. Management of oral leukoplakia should begin with elimination of predisposing habit. There are currently different approaches in the management of Leukoplakia such as scalpel surgery, systemic carotenoids and antioxidants, electro cauterization, cryotherapy and Lasers. Even though on-surgical options are preferred choice of treatment, it takes time to achieve complete regression of lesion and sometimes may not achieve complete resolution. On the other hand, conventional surgical techniques are invasive and cause trauma to the patient. Excision of precancerous oral lesions using LASER offers comparative advantages over traditional scalpel excision. Laser is an acronym for Light Amplification by stimulated emission of radiation. It is surgical technique which excises the targeted tissue using emission of a monochromatic light of specific wavelength. Because of this property, laser excision of the tissue results in complete bloodless field of surgery, reduced chances of post-surgical inflammation and infections and hence better treatment compliance of the patients towards the surgery. This is one of the important goals for management of oral potentially malignant disorders. We present two case reports of homogeneous leukoplakia treated using diode lasers of wavelength 810nm with follow-up. Both cases did not report any post-operative discomfort or inflammation. The aim of this case report is to highlight the importance of laser excision with minimal complications and better treatment outcomes.

Management of Oral Leukoplakia – Non-Surgical and Surgical Treatment

Aim: To evaluate the efficacy of topical retinoic acid (A-RET gel-0.025%) in homogenous leukoplakia and diode laser in non-homogenous leukoplakia patients (speckled, nodular and verrucous). Study Design: Study included total 30 patients of clinically diagnosed cases of leukoplakia; homogenous leukoplakia (n = 15) and non-homogenous leukoplakia (n = 15). Material and Method: Homogenous leukoplakia patients were given treatment of topical A-RET gel and antioxidant, while non homogenous leukoplakia patients were surgically treated by diode laser. Patients were followed up for healing after diode laser. Results: Total regression was reported in almost all cases of homogenous leukoplakia within one month, without any recurrence. Speckled leukoplakia and buccal mucosa showed faster healing as compared to other types of nonhomogenous leukoplakia with laser. Conclusion: A-RET gel and diode laser gives excellent results in homogenous and non homogenous leukoplakia cases respectively. Type of leukoplakia and lesion site plays an important role in prognosis of the lesion.

Efficacy of Diode Laser Ablation and Low Level Laser Therapy on Healing and Bacterial Load Reduction at Intraoral Biopsy Site.

Statement of the Problem: Healing complications after the conventional surgical biopsy procedure along with bacterial colonization indicates scope for sophisticated techniques. Amalgamation of photo-disinfection along with healing properties of diode laser with practiced biopsy technique can help in dealing with post biopsy complications.Purpose: The present study will analyze the possibility of conjugation of conventional surgical biopsy technique with diode laser regarding its superior properties for achieving better healing and analgesia along with sterilization of the biopsy site.Materials and Method: A randomized control trial was done where punch biopsy procedure was performed for homogenous leukoplakia. Patients were randomly divided into laser group (Test group) and control group. Test group received laser ablation and low level laser therapy (LLLT) on surgical site along with warm saline rinses whereas control group was prescribed with systemic analgesic and antibiotics. Pain on visual analogue scale (VAS), erythema along with the size of defect was evaluated on day 0, 2 and 4. Swabs were collected from the biopsy site and culture was done for evaluation of bacterial load.Results: Highly statistical significant values indicating laser induced analgesia were obtained after analysis for 2nd and 4th day (p= 0.00). Erythema and biopsy defect size evaluation showed significant results for 2nd day (p value 0.023 and 0.004 respectively), which showed absence of erythema and enhancement of healing in test group compared to controls. Statistical significant results were obtained for estimation of bacterial colonization with p value as 0.00, 0.00 for 2nd and 4th day claiming laser supported bacterial disinfection. There was a significant percentage increase on 2nd (p= 0.013) and decrease on 4th post-operative day (p= 0.022).Conclusion: The results encourage the conjugation of conventional incisional punch biopsy with low level lasers to avoid systemic intervention for post biopsy complications.

Presence of oral mucosal lesions associated with tobacco use – among the patients visiting OPD: A prevalence study, at the oxford dental college Bangalore

Background: Use of tobacco in any form smoke or smokeless has been implicated with the development of oral mucosal lesions like Leukoplakia (LE), lichen planus (LP), oral lichenoid lesions (OLL), oral submucous fibrosis (OSF), smokers palate (SP) and smokers melanosis (SM).Aim: To assess the presence of oral mucosal lesions associated with the use of tobacco.Material and Methods: In this prevalence study 216 patients (200 males and 16 females) with habit of smoking, chewing tobacco in any form and smokeless tobacco users were enrolled and evaluated based on thorough history and soft tissue examination. Patients not willing to participate,those with infections, local trauma /irritation or systemic diseases that causes oral mucosal lesions and alcoholics were excluded. Statistical analysis was performed using statistical package for social sciences [SPSS] for Windows, Version 22.0.Released in 2013. Armonk, NY: IBM Corp.Result: Among the 216 participants, 200 (92.6%) were males and 16 (7.4%) were females; with the mean age of 46.03 years. The prevalence of smoking tobacco use was 60.6% and smokeless 39.4%.The most common finding was smoker’s palate (34.7%), tobacco pouch keratosis (25.5%), homogenous leukoplakia (20.8%) and smokers melanosis (14.4%).Conclusion: The study emphasizes the association of harmful effects of tobacco (smoke and smokeless forms) with the development of oral mucosal lesions.

Diode Laser in the Management of Leukoplakia - A Retrospective Study.

Leukoplakia is among the most common potentially malignant disorders encountered in clinical dental practice. The treatment of leukoplakia includes nonsurgical and surgical management. The surgical treatment includes excision, electrocauterisation, laser surgery or cryosurgery. This retrospective study aimed to analyse the efficacy of diode lasers in the management of leukoplakia. The sample consists of 56 cases with 77 leukoplakia sites treated with diode laser between January 2018 and December 2020 with a minimum of six months follow-up. For each patient, personal data was collected along with site of lesions, leukoplakia phase, type of treatment performed (laser ablation or laser excision), side effects, recurrences and malignant transformation. Inferential statistical analysis was then conducted. After applying exclusion criteria, 56 cases with 77 leukoplakia sites were included in this study. Males aged >45 years were predominantly affected. Homogeneous leukoplakia (48.1%) was the most common phase. Recurrences were noted in 19.48% of the cases. Compared to laser excision, laser ablation had more recurrences. Gingival lesions showed a higher recurrence rate than other sites in the oral cavity. None of the cases showed malignant transformation. Laser offers many advantages over other conventional methods including lesser postoperative pain and swelling, bloodless dry operating field and increased patient comfort and requires minimal local anaesthesia. The study concluded that diode laser is an effective surgical treatment modality for treating leukoplakia. Furthermore, the laser excision technique was found to be superior to laser ablation due to lesser recurrence.

Evaluation of the Relationship of Various Patterns of Quid Usage in Patients with Oral Submucous Fibrosis and Leukoplakia in Central India Population: A Cross Sectional Study

Background: Oral habits can cause severe oral potentially malignant disorders. There is a need to deeply analyse the role of betel nut in the causation of these disorders. Patients must be educated in order to prevent them from grabbing these conditions as inspection leads to prevention.
 Aim: The aim of our study was to study and analyse the different patterns of quid usage among the participants with oral submucous fibrosis and leukoplakia in Central India population.
 Patients and Methods: The study was performed on 90 patients amongst which 45 patients were clinically diagnosed of oral submucous fibrosis & the other 45 patients were diagnosed of leukoplakia. The cases were then subjected to a detailed questionnaire which aimed to extract information regarding the various types of quid usage habits, their frequency and duration. The data was recorded and statistical analysis was done.
 Results: The study included 90 subjects – 86 males & 4 females. Out of 6 types of quid habits it is found that type IV (processed areca nut), Type VI (combined quid usage) quid caused OSMF stage II, Stage III & homogenous leukoplakia respectively. There is a strong association between duration and frequency of habit in causation of OSMF & leukoplakia.
 Conclusion: The present study showed increased prevalence of OSMF & leukoplakia with type IV & VI quid usage among the population of Central India.

Comparative Evaluation of the Efficacy of Co2 and Diode Laser in the Treatment Outcome of Oral Homogeneous Leukoplakia

Background: “L.A.S.E.R” an acronym for “Light Amplification by Stimulated Emission of Radiation” works as an alternative to conventional surgical systems. It has many advantages and is widely used in the treatment of both oral hard and soft tissues. One of the most popular uses of lasers in the field of dentistry is in the treatment of precancerous lesions and conditions. Aim: This paper is based on the comparison of two laser techniques, carbon dioxide and diode lasers to assess the efficacy in the treatment outcome of oral homogeneous leukoplakia. Setting and Design: The study is a prospective pilot study and the study design is a hospital-based randomized clinical trial. Method and Material: The study compared two treatment groups; carbon dioxide laser on group A and diode laser on group B. The patients were assessed on the basis of postoperative signs and symptoms. Also, the rate of recurrence of oral homogeneous leukoplakia following two techniques was assessed. Statistical Analysis: One-way analysis of variance (ANOVA) test was applied and P value was measured. Study showed statistical significance with P value >0.05 for evaluation parameters such as pain, erythema, swelling, burning, and rate of recurrence. Result and Conclusion: The study concludes that carbon dioxide and diode lasers can be used as alternative treatment modalities for the excision of oral soft tissue lesions. Intraoperative and postoperative complications are rare, with minor bleeding being the only complication observed during the surgeries.

Prevalence and risk factors of potentially malignant disorders of the mucosa in the general population: Mucosa lesions a general health problem?

AimOral cancer mostly develops from oral mucosa regions with morphological alterations transforming malignant. These visible precancerous mucosa lesions are named potentially malignant disorders (PMD). We aimed to analyze the prevalence of PMD and its risk factors for PMD in a population-based sample in Northern Germany. Material and MethodsData of 6078 individuals from the population-based Study of Health in Pomerania (SHIP) was used. PMD were photographically documented and periodontal health was assessed in a standardized procedure. ResultsPMD were observed in 54 individuals (0.9%). The most prevalent PMD was homogenous leukoplakia (n = 37) followed by Lichen ruber (n = 9). Smoking (Odds Ratio (OR) 2.70; 95% confidence interval (CI): 1.24–5.87), male sex (OR 3.32; 95%-CI: 1.77–6.21), type 2 diabetes mellitus (OR 2.07; 95%-CI: 1.08–3.98) and body mass index (OR 1.09; CI 1.04–1.14) were significantly associated with PMD, with the corresponding area under the curve (AUC) being 0.696 (CI: 0.655; 0.737). ConclusionOur results suggest a clinically relevant prevalence of PMD in the population. We identified male sex, type 2 diabetes mellitus, current smoking, and obesity as risk factors. We recommend photographic documentation and intensified training of medical and dental staff to detect and monitor PMD.

Association of Candida and fluconazole therapy with proinflammatory cytokines in oral leukoplakia: a pilot study

<h3>Objectives</h3> Chronic inflammation caused by infection may lead to the production of proinflammatory cytokines (PICs) that can cause DNA damage and cell proliferation, thus playing a role in carcinogenesis. <i>Candida</i> infection has been reported to be increased in oral leukoplakia (OL) and is associated with an increased rate of malignant transformation into oral squamous cell carcinoma (OSCC). In vitro studies have demonstrated that the interactions between <i>Candida</i> and the oral epithelium lead to the release of PICs (interleukin [IL]-6, IL-8. IL-17, tumor necrosis factor [TNF]-α) that have also been found to be upregulated in OSCC and OL. This study aims to determine the correlation between <i>Candida</i> infection and PICs and their response to fluconazole therapy in OL. <h3>Methods</h3> Immunocompetent adult patients with OL (30 homogenous leukoplakia [HL], 30 nonhomogenous leukoplakia [NHL]) and 30 age- and sex-matched healthy control subjects (C) with no predisposing factors for oral candidal infection were recruited. Sterile cotton swabs and polyvinyl alcohol ophthalmic sponges were used to take samples from the lesional surface in OL and from the buccal mucosa in C for direct microscopy and culture for <i>Candida</i> and to determine levels of PICs (IL-6, IL-8, IL-17, TNF-α) by enzyme-linked immunosorbent assay, respectively. Sampling for PICs was repeated from the same sites in OL after treatment with tablet fluconazole 100 mg (oral rinse for 2 minutes and swallow) once daily for 14 days. Chi-square and Mann-Whitney <i>U</i> tests were used to estimate the difference between the groups. <h3>Results</h3> Forty percent of patients with NHL and 30% of patients with HL had positive findings for <i>Candida albicans</i>. Levels of IL-6, IL-8, and IL-17 were observed to be significantly higher (<i>P</i> < .05) in patients with NHL than in those with HL and in C. Patients with NHL and HL showing the presence of <i>C. albicans</i> had significantly (<i>P</i> < .05) higher levels of IL-6, IL-8, IL-17, and TNF-α than C and showed reduction in their levels and clinical improvement (decrease in size, thickness, and erythema) after fluconazole therapy. <h3>Conclusions</h3> Candidal infection is common in OL and causes release of PICs. There is a decrease in levels of these PICs and clinical improvement after fluconazole therapy in both NHL and HL. Hence, antifungal therapy in the management of OL can reduce the inflammatory milieu in which carcinogenesis can occur.

Immunohistochemical Expression of MMP-9, TIMP-1, and Vimentin and its Correlation With Inflammatory Reaction and Clinical Parameters in Oral Epithelial Dysplasia.

The aim of this study was to investigate the immunoexpression of matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), and vimentin (VIM) and its association with the inflammatory reaction (IR) and clinical parameters in oral epithelial dysplasia (ED). The sample was composed of 66 cases of ED, 27 oral squamous cell carcinoma (OSCC), and 28 non-neoplastic epithelium (NNE). ED was graded according to the binary system as low-risk ED (n=42) and high-risk epithelial dysplasia (HRED: n=24). The IR was defined as the median number of inflammatory cells present on the connective tissue in 5 consecutive fields. Tissue sections of paraffin-embedded samples were immunohistochemically stained; MMP-9 and TIMP-1 expression was analyzed separately in the epithelium and the connective tissue; VIM was analyzed in the epithelium. Clinical parameters such as age, sex, lesion site and clinical presentation, alcohol/tobacco use, and malignant transformation of ED were retrospectively obtained from medical records. Nonhomogeneous leukoplakia presented higher odds (3.857; 95% confidence interval: 1.16-12.85) of being graded as HRED than did homogeneous lesions. The IR was higher in OSCC and ED than in NNE, and correlated with the epithelial expression of VIM. HRED and nonhomogeneous leukoplakias presented higher IR than did low-risk ED and homogeneous leukoplakias. Alcohol users had higher IR than nonalcohol users. Smokers had higher epithelial expression of MMP-9 and VIM. High IR in OSCC and HRED, and its positive correlation with VIM expression suggest a contribution of the IR in the progression of OSCC. Moreover, the high expression of MMP-9 and VIM in smokers implies its involvement in tobacco carcinogenesis.

Comparison of the accuracy of diagnoses of oral potentially malignant disorders with dysplasia by a general dental clinician and a specialist using the Taiwanese Nationwide Oral Mucosal Screening Program

Screening for oral potentially malignant disorders (OPMDs) with dysplasia in high-risk groups is suggested in countries with a high prevalence of the disorders. This study aimed to compare the accuracy of diagnoses of OPMDs with dysplasia made by a primary examiner (general dental clinician) and a specialist (oral and maxillofacial surgeon) using the current Taiwanese Nationwide Oral Mucosal Screening Program (TNOMSP). A total of 134 high-risk participants were enrolled for oral mucosal screening via the TNOMSP. A primary examiner and a specialist examined each participant. Mucosal biopsies were obtained and subjected to histopathological analysis. The OPMD most frequently diagnosed by the primary examiner was thin homogeneous leukoplakia (48/134; 35.8%), and in 39/134 participants (29.1%) the diagnosis was uncertain, but abnormalities were suggested. The OPMDs most frequently diagnosed by the specialist were erythroleukoplakia (23/134; 17.2%) and thin homogeneous leukoplakia (21/134; 15.7%), and 51/134 participants (38.1%) were diagnosed with other diseases. Via histopathology, 70/134 participants (52.3%) were diagnosed with dysplasia, and 58/134 (43.3%) were diagnosed with benign conditions. The specialist's diagnoses exhibited a higher specificity, positive predictive value, and accuracy than the primary examiners. A specialist using the current TNOMSP for high-risk participants diagnosed OPMDs with dysplasia more accurately than a primary examiner. Early diagnosis of high-risk OPMDs is crucial in countries with a high prevalence of the disorders. Proficient examination via the current TNOMSP by trained clinician is effective for the management of OPMDs with dysplasia.

Clinical and histopathological presentation of oral leukoplakia among different forms of tobacco users: A comparative study

Aim: To compare the clinical and histopathological presentation of oral leukoplakia among different forms of tobacco users. Material and Methods: This study was carried out among 300 patients with oral leukoplakia, analyzing the corresponding clinical factors and histopathological findings, different forms of tobacco usage and assessing associations between the different clinical presentations and epithelial dysplasia. Results: Out of a total of 300 subjects, most (87.33%) of the subjects were males, among 138 tobacco chewers, maximum (60.87%) were having homogenous leukoplakia, among 85 tobacco smokers, maximum (61.18%) were seen with homogenous leukoplakia and among 77 subjects having mixed habit, maximum of 51.95% were diagnosed as having homogenous leukoplakia. The association between clinical type of leukoplakia and habit type was statistically not significant (Chi-square= 5.0806, p=0.5336). Majority of the cases which were diagnosed clinically diagnosed as leukoplakias presented a histological diagnosis of hyperkeratosis (45%) and mild epithelial dysplasia (33.33%). The association between histopathological type of leukoplakia and habit type was found to be statistically significant (Chi-square= 23.2166, p=0.0007). Conclusion: Most of the patients were having homogenous leukoplakia and majority of the cases which were diagnosed clinically diagnosed as leukoplakias presented a histological diagnosis of hyperkeratosis, mild epithelial dysplasia.

A case series of treatment of oral mucosal lesions using diode lasers

Background: Einstein's photoelectric amplification theory provided the template for the development of lasers. With recent technological advancements, the increasing use of lasers in dentistry has had a meaningful impact on the diagnosis and management of oral mucosal lesions. This case series highlights lasers' impact. Case Reports: Five patients with diagnoses of arteriovenous malformation, homogeneous leukoplakia, mucocele, traumatic fibroma, and erosive lichen planus were treated with a diode laser (1,200 J/s; wavelength of 940 nm; 1.5 W; pulse mode). The patients were followed up to evaluate lesion healing and complete healing of the lesion was rapidly achieved with minimal discomfort. Conclusion: Soft-tissue lasers are trending in the management of various oral mucosal lesions due to their advantages of providing higher precision, a clean surgical field with minimal blood loss, accelerated wound healing, and fewer postoperative complications.

Epidemiological and Clinicopathological Analysis of Oral Leukoplakia in Patna

Background: The early detection of oral potentially malignant disorder can reduce the transformation risk to oral squamous cell carcinoma, thereby reducing cancer morbidity and mortality. Aim: To obtain epidemiological information of oral leukoplakia (OL) and distribution of this disease in Patna. Subjects and Methods: Data were collected and analyzed for prevalence of OL among gender, age group, various oral sites, habits, and clinical and histopathological basis. Results: The overall prevalence shows high incidence of homogenous leukoplakia along with mild dysplasia in middle age male persons. Conclusion: Appropriate steps should be taken for early intervention, as it is the key to effective prevention.

Therapeutic effect of proton pump inhibitor (Omeprazole) on homogenous leukoplakia with clinico-fractal analysis: A pilot study

Background: Oral leukoplakia is a white patch or plaque that cannot be characterized clinically or pathologically as any other disease and is not associated with any physical or chemical causative agent except the use of tobacco. The prevalence of leukoplakia in India varies from 0.2% to 4.9% with variable clinical pattern and tendency towards malignant transformation. Current treatment strategies for oral leukoplakia include chemotherapeutic and surgical approaches. Aim and Objective: The study was done to compare the clinical and therapeutic effects of proton pump inhibitor therapy and vitamin-A therapy in oral leukoplakia. Setting and Design: Hospital based in-vivo prospective study. Materials and Method: The study compared two treatment groups; Proton pump inhibitor therapy-(Omeprazole - 20 mg) and vitamin-A therapy (200000 I.U.). The clinical assessment (size and surface texture), salivary pH and fractal dimension values were compared in pre-treatment and post-treatment periods. Statistical Analysis: SPSS® 25.0 (Statistical Package for the Social Sciences) was used for statistical analysis. Mean, standard deviation and independent t test were calculated. Results: The clinical assessment of pre-treatment and post-treatment revealed reduction in size and surface roughness in both the groups. The salivary pH and fractal dimension showed significant alterations in post treatment period of both groups but the P value (0.949) was not significant between the groups. Conclusion: This study demonstrated the efficacy of proton pump inhibitor therapy for oral leukoplakia in comparison with vitamin-A therapy. The study revealed reduction in the size, roughness of oral leukoplakia and alteration of salivary pH with proton pump inhibitor therapy.

Oral leukoplakia in the Sudan: clinicopathological features and risk factors

To analyse the clinical and histopathological features of oral leukoplakia (OL) in the Sudan, and to identify the risk factors associated with dysplastic and malignant changes. Records of 117 cases with the diagnosis of OL at the Department of Oral Pathology in the period from 2010 to 2017 were reviewed. Of the 117 cases included in this study, 30 cases (25.6%) showed carcinoma in the initial diagnostic biopsy. The mean age at diagnosis was 59.8years with a male/female ratio of 3.3:1. The lip (48.7%) and the gingiva (31.6%) were the predominantly affected sites. Multivariate regression analysis revealed that females were associated with 3.36-fold [95% confidence interval (CI), 1.36-10.76; P=0.012] higher risk of malignant transformation compared with males. Verrucous leukoplakia was associated with 3.38-fold (95% CI, 1.12-10.19; P=0.031) higher risk of malignant transformation compared with homogeneous leukoplakia. Exclusive Toombak dipping was the significant risk factor for the presence of dysplasia in OL (odds ratio, 9.35; 95% CI, 1.28-67.99; P=0.027). Clinical and histopathological features of OL were analysed and correlated. Toombak dipping was the significant risk factor for dysplastic changes, while female gender and verrucous leukoplakia were the factors associated with malignant transformation.