Number Of Oral Lesions Research Articles

Importance of P16ink4a marker in oral neoplasms

We have increase in number of oral lesions at ASRAMS, as it is a referral centre and there by we have determined to study the prevalence of these lesions and its association with P16ink4a marker.The purpose of this study is to evaluate the role of P16ink4a in oral epithelial dysplasias and oral squamous cell carcinoma by immunohistochemistry. In clinically significant patients, correlation between histopathology findings and its association with P16ink4a marker has been studied in Department of Pathology, ASRAMS. A retrospective study done from July 2017 to July 2019.The study was carried out after approval of the Institutional Ethics Committee. The biological material received was resection specimen and punch biopsies of the lesion which was fixed in 10% formalin for 6hrs later processed, followed by paraffin embedding and hematoxylin & eosin staining of the sections. Histopathological classification of lesions was done according to the criteria proposed by WHO for oral cavity lesions.Immunohistochemical analysis with P16ink4a was performed on the serial sections. Development of reactions was performed with DAB (Diamino benzidine). The panel used was clone E6H4, requiring no dilution followed by epitope retrieval solution. All data were tabulated in a Windows Excel spreadsheet (Microsoft Excel 2011) and statistically analyzed using software version. The expression of P16ink4a in various lesions was tabulated.The study included 29 cases of oral lesions, most of them belonged to age group of 40 to 60 yrs. Male preponderance is noted. Most of the cases in our study were located on tongue. Histopathologically well differentiated squamous cell carcinomas were more in number. The immunoexpression of p16 stain was present at nuclear and cytoplasmic level mainly found at the basal dysplastic epithelium. P16 had a weak intensity at level of tumor proper and also at invasion front.P16ink4a immunohistochemical marker can be used as a surrogate biomarker for HPV detection of oral epithelial dysplasias and oral squamous cell carcinomas. P16 is useful marker in identifying dysplastic lesions and decrease of its immunoexpression is a predictive factor notified for neoplastic transformation.

Oral disease is linked to low nestling condition and brood size in a raptor species living in a highly modified environment.

Anthropogenic stressors can favor the occurrence of noninfectious disease that can be worsened by the impact of opportunistic pathogens, making the epizootiology of environmental diseases difficult to unravel. The incidence and impact of oral lesions in nestlings of a facultative scavenger species, the black kite Milvus migrans, were examined over seven breeding seasons in the highly degraded environment close to Madrid, Spain. We found an overall prevalence of 31% of nestlings with oral lesions, with no clear spatial pattern in nests with affected and unaffected individuals. The occurrence and number of oral lesions were negatively associated with nestling body condition and brood size. Broods, where all siblings had oral lesions, were smaller than those where some or all siblings were apparently healthy, suggesting that oral disease could be causing nestling mortality and, consequently, brood size reduction. In turn, nestling body condition was negatively affected by lesion occurrence, brood size, and laying date. Although these relationships were bidirectional, piecewise structural equation modeling analyses showed a greater negative effect of body condition on lesion occurrence than vice versa, indicating that nestlings in poorer body condition were more likely to develop oral lesions (which could contribute to aggravate their state of deterioration) than those in better condition. Nestlings from small broods were also more likely to have oral disease (directly or indirectly through their lower body condition) than nestlings from large broods. Nestlings that hatched last in the broods showed greater development stress than those that hatched first. Anthropogenic stressors could trigger poor body condition, and contribute to microbiota dysbiosis-related diseases. Although further research is needed to determine the consequences for the long-term fitness of individuals, actions should be taken to mitigate adverse conditions that may favor the appearance of environmental diseases associated with peri-urban areas, given their rapid expansion over natural areas.

Increased levels of calprotectin in the saliva of patients with geographic tongue.

We investigated whether patients with geographic tongue have increased salivary levels of calprotectin and whether there is a correlation between the salivary levels of calprotectin and interleukin 8 (IL-8), which is another marker of inflammation. Twenty-three patients diagnosed with geographic tongue and 32 control subjects without oral mucosal lesions were included in the study. The patients with geographic tongue were classified based on clinical appearance and number of oral lesions. ELISAs were used to determine the levels of calprotectin and IL-8 in whole saliva samples. There was a statistically significant increase in the salivary output of calprotectin in patients with geographic tongue compared with the healthy controls (62±9,1 vs. 37,5±4,7µg/min; p=.0134). Furthermore, the levels of calprotectin correlated positively with the number of oral lesions in patients with geographic tongue. There was also a significant and positive correlation between the salivary levels of calprotectin and IL-8, both for the patients with geographic tongue and the controls. This study supports the notion that GT is an inflammatory disease, in which the activation of neutrophils and production of calprotectin in the saliva may play roles in its pathogenesis.

Prospective evaluation of clinical symptoms of chemotherapy-induced oral mucositis in adult patients with acute leukemia: A preliminary study.

ObjectiveThe objective of this study was to prospectively evaluate the clinical features of chemotherapy‐induced oral mucositis (CIOM) in adult patients with acute leukemia and the aggravating factors for such symptoms.SubjectsThirty‐seven prospective patients aged ≥19 years with acute leukemia undergoing chemotherapy were enrolled. Oral and clinical investigations were performed at baseline and on Day 14 after starting chemotherapy. The presence and severity of cancer‐induced oral mucositis were demonstrated using the World Health Organization (WHO) scoring system.ResultsOn Day 14, we found that oral mucositis had developed in eight patients (21.6%). Hematopoietic stem cell transplantation (HSCT) in patients was a predictor of increased WHO scores (β = 1.937, p < .001). Regarding oral sites, ventral tongue (β = 1.670), soft palate (β = 1.242), and buccal mucosa (β = 0.593) were predictors for increased scores. In addition, the increase in WHO scores was positively correlated with the number of oral lesions (r = .521), the difficulty in eating (r = .250), and the overall oral health (r = .534; all p < .05).ConclusionThe main factors affecting the severity of CIOM symptoms were the treatment with HSCT and the location of oral lesions. The incidence of CIOM and WHO scores were not significantly different between the subgroups of disease. Our findings will help clinicians investigate the oral findings after chemotherapy in adult patients with acute leukemia.

Oral mucosal status and salivaryIgAlevels ofHIV‐infected children

Pediatric HIV is a major world health problem, which is progressing at an alarming rate. Lesions in the mouth and in other tissues and organs (oral and systemic lesions) in pediatric HIV infection are diverse and show differences in clinical presentation and severity from that of adults. Very little data exist for oral lesions in pediatric population in India. To assess oral mucosal status of HIV-infected children and to correlate it with their salivary IgA levels. The study group consisted of 150 HIV-infected children aged 6-18 years. They were divided into two groups. Group 1: Children prior to anti-retroviral therapy, Group 2: Children undergoing anti-retroviral therapy (for not more than 3 years). Criteria given by Ramos-Gomez for diagnosis of oral lesions commonly associated with HIV infection in children were used to record the oral lesions. Salivary IgA levels were determined by enzyme-linked immunosorbent assay. Data obtained were subjected to statistical analysis. There was a significant difference in mean secretory IgA (SIgA) levels between the groups (P ≤ 0.05). All the children had one or more oral mucosal lesions, with angular cheilitis being the most common lesion. There was a significant inverse relation between SIgA levels and individual oral mucosal lesions (P ≤ 0.05). The number of oral lesions was inversely related to the SIgA levels. Oral mucosal lesions were a significant feature of HIV-infected infection, particularly in children prior to the onset of anti-retroviral therapy. All children showed low SIgA levels. Early recognition and management of oral conditions are important to improve the quality of life in these children.

Interrelationship of clinical, histomorphometric and immunohistochemical features of oral lesions in chronic paracoccidioidomycosis

This study aimed to analyze the oral lesions of chronic paracoccidioidomycosis concerning their histomorphometric, immunohistochemical, and clinical features in a standardized sample. Fifty biopsy specimens of oral lesions of chronic paracoccidioidomycosis were submitted to hematoxylin and eosin (H&E), Grocott-Gomori and immunohistochemical staining. Data regarding disease duration and size and number of oral lesions, as well as erythrocytes, leukocytes, lymphocytes, hematocrit, hemoglobin, and erythrocyte sedimentation rate, were collected from medical charts. Granuloma density and number and diameter of buds and fungal cells, and IL-2, TNF-alpha and IFN-gamma expression, as well as clinical and hematological features, were quantified and correlated. Bud diameter was significantly greater in intermediate density granulomas compared to higher density granulomas. The other variables (number of buds, number and diameter of fungi, expression of IL-2, TNF-alpha and IFN-gamma, and clinical and hematological features) did not significantly change with the density of granulomas. There was a positive correlation between bud number and fungal cell number (r = 0.834), bud diameter and fungal cell diameter (r = 0.496), erythrocytes and number of fungi (r = 0.420), erythrocytes and bud number (r = 0.408), and leukocytes and bud number (r = 0.396). Negative correlation occurred between number and diameter of fungi (r = -0.419), bud diameter and granuloma density (r = -0.367), TNF-alpha expression and number of fungi (r = -0.372), and TNF-alpha expression and bud number (r = -0.300). The histological, immunological, and clinical features of oral lesions evaluated did not differ significantly between patients in our sample of chronic paracoccidioidomycosis. TNF-alpha levels were inversely correlated with intensity of infection.

Does toluidine blue detect more oral cancer?

A randomised controlled trial. 28,167 individuals aged 15 years or older who were invited participate in a screening programme, 17,890 who lacked oral habits such as cigarette smoking or chewing betel quid were excluded leaving 10,277 eligible individuals. Of these, 2,302 refused to participate leaving a sample of 7,975 for randomisation. The test group gargled with toluidine blue solution while the control group was given a placebo dye of the same colour. Each participant was visually examined by one of six dentists with additional training. The presence of any visible lesion in the oral cavity (e.g. abnormal mucosal lesions related to OPMLs and other suspected lesions such as lichen planus, oral ulcer, hyperkeratosis, candidiasis, etc) was recorded as screen-positive. The screen-positive participants to a specialist were referred to a specialist for a definite clinical diagnosis within 10 to 14 days, to reduce false-positivity, and biopsies were arranged if oral lesions were present. The occurrence of oral cancer, survival status, and causes of death of the studied participants for the entire cohort was obtained from the National Cancer Registry and the National Household Registry until the end of 2004. The number of oral lesions, premalignant or not. In the test group 389 (9.5%) individuals had a positive screen compared with 322 (8.3%) in the control group. Two oral cancers were identified out of those with a positive screen presenting (n=320) for the referral examination from the test group with three oral cancers out of the 293 in those who complied in the control group. There were three oral cancers ascertained by the end of the follow-up among the screen-negatives in each arm (test and control) by the end of the followup period. The numbers of OPMLs in each arm of the study are shown in Table 1. We demonstrated that using toluidine blue as an adjunctive tool for visual screening can detect significantly more oral submucous fibrosis and slightly more leukoplakia among high-risk individuals with habits of cigarette smoking or betel quid chewing as compared with visual screening alone.

Arabic version of the geriatric oral health assessment Index

The purpose of this study was to translate the original English version of the Geriatric Oral Health Assessment Index (GOHAI) into an Arabic version, and to test the validity and reliability of the translated instrument (GOHAI-Ar) for use among the elderly in Saudi Arabia. The 12-item GOHAI was translated into Arabic using the back-translation technique and performing a preliminary test to determine the comprehensibility and readability of the Arabic language version. A total of 156 elderly patients answered the questionnaire, and underwent a clinical examination by one calibrated dentist. Information on subjects' socio-demographic background and oral health conditions was collected. Convergent validity was evaluated by identifying the associations between perceived oral health status, general health status, perceived need for dental care and GOHAI-Ar scores. Discriminant validity was examined by comparing the GOHAI-Ar scores and six oral health parameters. Internal consistency was measured by Cronbach's alpha. Test-retest reliability was assessed by intra-class correlation coefficient (ICC) and weighted kappa. Factor structure of GOHAI-Ar was evaluated using principal component factor analysis. The mean GOHAI-Ar was 32.1 (SD 12.2; range 11-59). Mean GOHAI-Ar scores were higher for the elderly who rated their oral and general health as good. Subjects with perceived dental treatment needs had a lower mean GOHAI-Ar score than those without any such needs. The caries experience, number of missing teeth, OHI-S score, number of pathologically mobile teeth and number of oral lesions were negatively correlated with the GOHAI-Ar score. The Cronbach's alpha (0.93) indicated a high degree of internal consistency and homogeneity between items. The ICC for GOHAI-Ar was 0.95, the weighted kappa coefficient for individual items varied between 0.42 and 0.71, and the correlation coefficients for the 12 items were above 0.70. Factor analysis didn't support the expected dimensions of the index, and only one factor was found at eigenvalue greater than 1. The findings suggest an excellent reliability and validity of GOHAI-Ar. Further research is needed to assess the value of this instrument in oral health-related quality of life studies in Arabic elderly population.

Hyperbaric Oxygen Treatment and Bisphosphonate-Induced Osteonecrosis of the Jaw: A Case Series

Bisphosphonate (BP)-associated osteonecrosis of the jaw (ONJ) is an emerging problem with few therapeutic options. Our pilot study of BP-ONJ investigated a possible role for hyperbaric oxygen (HBO(2)) therapy. A total of 16 patients, ranging in age from 43 to 78 years, with BP-ONJ were treated with adjunctive HBO(2) between July 2003 and April 2006. Staging was based on the size and number of oral lesions. Clinical response after treatment and at distant follow-up; the odds of remission, stabilization, or relapse; and time to failure analysis were calculated. The median time on BP therapy before appearance of ONJ symptoms was 18 months, and that from symptom onset to HBO(2) therapy was 12 months. Fourteen of 16 patients (87.5%) improved in stage. The size and number of ONJ lesions were decreased after HBO(2) therapy (P < .001 and P = .008, respectively; Wilcoxon signed-rank test). Immediately after HBO(2) therapy, 7 of 16 patients (44%) were in remission and 8 (50%) had stabilized; however, stabilization without remission was sustained in only 2 patients. At follow-up, 10 of the patients (62.5%) were still in remission or had stabilized. The 7 patients who continued on BP treatment during HBO(2) therapy had a shorter time to failure (8.5 months; 95% confidence interval [CI] = 7.1 to 9.8) than those who discontinued the drug (20.1 months; 95% CI = 17.5 to 23.9; P = .006 by the log-rank test). Clinical response was not associated with cancer type or malignancy remission status. Adjunctive HBO(2) therapy may benefit patients with BP-ONJ; however, the outcome is improved with cessation of BP administration.

Decline in the rate of oral opportunistic infections following introduction of highly active antiretroviral therapy.

In recent years the management of human immunodeficiency virus (HIV)-positive individuals has been based on highly active antiretroviral therapy (HAART) comprising a combination of nucleoside analogues or the combination of these agents with protease inhibitors. The aim of the present study was to describe the prevalence of oral lesions in a cohort of 103 HIV-seropositive patients on HAART, to compare these data with the prevalence of lesions prior to HAART and to correlate these finding with the immunologic data. A total of 103 HIV-seropositive patients on HAART were selected. Oral lesions associated with HIV infection and immunological parameters were registered. On re-examination 6 months after the first evaluation, 61/103 patients were available. Comparing the prevalence of oral lesions before and after the onset of HAART, the number of oral lesions was significantly lower (P=0.001). The number of CD4+ cells increased and the viral load decreased significantly after initiation of HAART (P=0.001 and P= 0.0001). On re-examination 6 months later, the prevalence of lesions again decreased significantly (P=0.001). The immunological benefits of HAART may prevent HIV-associated oral lesions in patients with advanced HIV disease. Our results showed that oral manifestations decrease on HAART, but in four patients the immunological effects of therapy did not provide sufficient protection against human papillomavirus (HPV)induced lesions.

Oral and nutritional status in allogeneic marrow recipients treated with T-cell depletion or cyclosporine combined with methotrexate to prevent graft-versus-host disease

To investigate how the use of T-cell-depleted marrow or a combination of cyclosporine and methotrexate to prevent graft-versus-host disease affect oral health and the ability to maintain adequate nutrition during the neutropenic phase after allogeneic bone marrow transplantation, 48 allogeneic bone marrow recipients were studied. From a group of adult leukemic marrow recipients of HLA identical sibling marrow, 23 patients were randomly chosen to receive T-cell-depleted marrow and 25 were selected to receive cyclosporine and four doses of methotrexate to prevent graft-versus-host disease. Before the transplantation, all patients were given all necessary dental treatment as well as oral hygiene and nutrition instructions. The oral mucosal and nutritional status in all patients (except one who died) were followed from 5 days before the procedure, during the neutropenic period after transplantation, and until discharge from the hospital. The number of oral lesions was similar in both groups. The subjective experience of orally related problems, such as pain from the oral cavity and number of days with total parenteral nutrition, was less in the T-cell-depleted recipients compared with those who received a graft-versus-host disease prophylaxis with cyclosporine and methotrexate ( p < 0.005). The oral cavity was considered to be the port of entry in four of six patients in the cyclosporine and methotrexate group who developed septicemia, compared with only one of six patients in the T-cell-depleted group with septicemia. The difference in the frequency of septicemia derived from the oral cavity did not, however, reach the significant level. No statistically proven difference was observed between the two groups as to weight loss and albumin levels before and after engraftment.

Effects of chlorhexidine mouthrinse on oral health in patients with acute leukemia

The effects of chlorhexidine mouthrinses, used as a supplement to mechanical oral hygiene measures, were studied in patients receiving treatment for acute leukemia. Twenty-eight patients were randomly divided into two groups. During two periods, when the patients were taking medication for the leukemia, one group rinsed with a 0.2% chlorhexidine solution twice daily and the other group did not. Chlorhexidine had no effects of any clinical significance on parameters such as number of days with fever, number of oral lesions, plaque score, gingival bleeding score, or occurrence of candidiasis. There was, however, an increased number of patients who had a burning sensation in the mouth, and a tendency toward increased numbers of salivary enterococci, enterobacteria, and/or Pseudomonas in patients who rinsed with chlorhexidine. The results of the present study do not support the use of chlorhexidine mouthrinses in patients who are able to maintain good oral hygiene by mechanical means during their illness.

Pitfalls in histologic diagnosis: A clinico-pathologic study

A number of oral lesions have been considered whose histologic diagnosis was not consistent with the clinical course of events. Among these lesions were pseudoepitheliomatous hyperplasia; clinical malignancy not accompanied by a significant histologic diagnosis; a hyperplastic reparative process of the mandible mistaken for fibrosarcoma; pseudotuberculosis; and chronic lymphatic leucemia.