Oral Potentially Malignant Disorders Patients Research Articles

Leveraging artificial intelligence for perioperative cancer risk assessment of oral potentially malignant disorders.

Oral potentially malignant disorders (OPMDs) are mucosal conditions with an inherent disposition to develop oral squamous cell carcinoma. Surgical management is the most preferred strategy to prevent malignant transformation in OPMDs, and surgical approaches to treatment include conventional scalpel excision, laser surgery, cryotherapy, and photodynamic therapy. However, in reality, since all patients with OPMDs will not develop oral squamous cell carcinoma in their lifetime, there is a need to stratify patients according to their risk of malignant transformation to streamline surgical intervention for patients with the highest risks. Artificial intelligence (AI) has the potential to integrate disparate factors influencing malignant transformation for robust, precise, and personalized cancer risk stratification of OPMD patients than current methods to determine the need for surgical resection, excision, or re-excision. Therefore, this article overviews existing AI models and tools, presents a clinical implementation pathway, and discusses necessary refinements to aid the clinical application of AI-based platforms for cancer risk stratification of OPMDs in surgical practice.

Clinical efficacy of photodynamic therapy of oral potentially malignant disorder

ObjectiveTo investigate the clinical efficacy of aminovalerate hydrochloride photodynamic therapy (PDT) for oral potentially malignant disorder (OPMD),oral leukoplakia (OLK), along with identifying the influencing factors.Additionally, the study aims to detect the rates of recurrence and malignancy after PDT. Method60 patients with OPMD who received PDT at our hospital from 2006 to 2021 were included in this study. Relevant patient medical data were collected and analyzed using SAS 9.4 software.The Mann-Whitney U test was used to retrospectively analyze the factors influencing clinical efficacy, as well as recurrence rate and malignant transformation rate (MTR) after treatment. ResultAmong the 60 OPMD patients receiving PDT, complete remission in 13 (21.67 %), partial remission in 39 (65.00 %), and no remission in eight (13.33 %), resulting in an overall effective rate of 86.67 %.Fifteen patients experienced relapse, leading to a recurrence rate of 25.00 %. Among these relapses,11 patients occurred within one year after treatment, corresponding to an 18.33 % recurrence rate during that period. Moreover, nine patients developed malignant transformation (MT), resulting in an MTR of 15.00 %. Out of these patients, six individuals developed MT within one year after treatment, resulting in a one-year MTR of 10.00 %. ConclusionThe study findings indicate that PDT shows promising clinical efficacy in the treatment of OPMD, with relatively limited and tolerable postoperative adverse reactions. However, there remains a certain rate of recurrence and malignancy after treatment. Therefore, close attention should be paid to postoperative monitoring, regular follow-up, and further expansion of the sample size to observe its long-term efficacy.

A novel saliva-based miRNA profile to diagnose and predict oral cancer

Oral cancer (OC) is the most common form of head and neck cancer. Despite the high incidence and unfavourable patient outcomes, currently, there are no biomarkers for the early detection of OC. This study aims to discover, develop, and validate a novel saliva-based microRNA signature for early diagnosis and prediction of OC risk in oral potentially malignant disorders (OPMD). The Cancer Genome Atlas (TCGA) miRNA sequencing data and small RNA sequencing data of saliva samples were used to discover differentially expressed miRNAs. Identified miRNAs were validated in saliva samples of OC (n = 50), OPMD (n = 52), and controls (n = 60) using quantitative real-time PCR. Eight differentially expressed miRNAs (miR-7-5p, miR-10b-5p, miR-182-5p, miR-215-5p, miR-431-5p, miR-486-3p, miR-3614-5p, and miR-4707-3p) were identified in the discovery phase and were validated. The efficiency of our eight-miRNA signature to discriminate OC and controls was: area under curve (AUC): 0.954, sensitivity: 86%, specificity: 90%, positive predictive value (PPV): 87.8% and negative predictive value (NPV): 88.5% whereas between OC and OPMD was: AUC: 0.911, sensitivity: 90%, specificity: 82.7%, PPV: 74.2% and NPV: 89.6%. We have developed a risk probability score to predict the presence or risk of OC in OPMD patients. We established a salivary miRNA signature that can aid in diagnosing and predicting OC, revolutionising the management of patients with OPMD. Together, our results shed new light on the management of OC by salivary miRNAs to the clinical utility of using miRNAs derived from saliva samples.

Assessment of programmed cell death ligand- 1 (PD-L1) expression in oral potentially malignant disorders and oral squamous cell carcinoma - An immunohistochemical study

OSCC is multifactorial and is a multistep process. It may arise de-novo or may be preceded by oral potentially malignant disorders(OPMD). During malignant transformation certain molecular changes are evident at cellular level even in the absence of phenotypic changes in the tissue. With the recent advances in molecular understanding of cancers, immune checkpoint inhibitors have been recognized as perpetrators or supporters in the pathophysiology of various cancers. One of the main immunosuppressive pathways is the programmed death 1 (PD-1)/programmed death-ligand 1 (PD-L1) in which there is an interaction between T-cell PD-1 receptor and PD-L1 on cancer cells. Upregulation of PD-L1 is associated with disease progression.To assess and compare the PD-L1 expression in OPMD and OSCC.64 Paraffin embedded tissue sections of histopathologically diagnosed cases of 32 OSCC and 32 OPMD were immunohistochemically stained with PD-L1 & its membranous expression was evaluated. Descriptive statistical analysis was applied.Thus the study showed 100 % PD-L1 positive expression in OSCC and PD-L1 expression increased with increase in histopathological. In case of OPMD 93.74 % showed positive PD-L1 expression. We found PDL1 expression is significantly higher in OSCC (Mean= 4.59 ± 1.965) compared to OPMD (Mean= 2.03 ± 1.204).Assessment of PD-L1 expression in OPMD patients will help us to screen the subjects with or without risk of malignant transformation as increase in PD-L1 expression signifies the increased risk of malignant change.

Systematic evaluation of TP53 codon 72 polymorphism associated with onset and progression of oral potentially malignant disorders

BackgroundRecently, a systematic review and meta-analysis demonstrated that overexpression of p53 immunoprotein was significantly associated with progression risk of oral potentially malignant disorders (OPMD). However, the results of investigations on TP53 genetic typing in OPMD were inconsistent and inconclusive.MethodsA systematic evaluation was conducted to identify all eligible case–control studies on the association of TP53 codon 72 polymorphism with both onset and progression of OPMD.ResultsA total of 768 OPMD patients and 1173 healthy individuals were identified from 12 eligible case–control studies on TP53 codon 72 polymorphism OPMD onset. In overall and subgroup analyses, no significantly risk of OPMD onset was observed in the cases for genetic models including allele C vs. G, homozygote CC vs. GG, heterozygote GC vs. GG, dominant GC + CC vs. GG, and recessive CC vs. GG + GC (all P-value of association test > 0.05). Further, a total of 465 OPMD patients and 775 oral squamous cell carcinoma (OSCC) ones were identified from 8 eligible case–control studies on this polymorphism in OPMD progression to OSCC. The analyses revealed that there was also no significantly risk of OPMD progression in the cases for the genetic models (all P-value of association test > 0.05).ConclusionOur data of a pooled-analysis indicates that TP53 codon 72 polymorphism may not act as genetic factor for the risk of OPMD onset and progression. Combined with the conclusion by a systematic review and meta-analysis, we put forward a new opinion that TP53 genetic typing cloud not influence p53 protein expression in OPMD.

Potential use of optical coherence tomography in oral potentially malignant disorders: in-vivo case series study

BackgroundEvidence confirms that the use of Optical Coherence Tomography (OCT) in oral medicine can be a reliable aid for the diagnosis and management of Oral Potentially Malignant Disorders (OPMDs). Several authors described the ability of this system to detect the structural changes of the epithelia involved by the OPMDs. The purpose of this case series is to provide a suggestion for interpretation of OCT images from different OPMDs, compared to OCT images of healthy tissues.MethodsA sample of 11 OPMDs patients was recruited and analyzed with OCT. The images obtained were then compared with an OCT repertoire image. In this work the reflectance degree was considered, together with the analysis of the increased/decreased thicknesses of the various layers. Keratin Layer (KL), Epithelial Layer (EP), Lamina Propria (LP), Basal Membrane (BM) assessment, for each lesion, was performed.ResultsOCT measurements of KL, EP and LP layers, together with BM assessing, should aid the physicians to recognize and describe different oral lesions, relating them to the corresponding oral pathology.ConclusionMore studies like this, on larger samples, are needed to validate the results and provide, in the future, a kind of manual that could guide clinicians to correctly interpret the OCT images in relation to the causing pathologies.

Comparative Evaluation of Serum Urea, Uric Acid, and Creatine Kinase Levels in Oral Cancer and Potentially Malignant Disorders of the Oral Cavity: A Clinico-Biochemical Study.

Introduction Evidence suggests that oral potentially malignant disorders (OPMDs) are linked to increased possibilities of malignant transformation, creating a challenging situation.If oral cancer is detected early, the prognosis is better.The purpose of this study was to compare the serum levels of urea, uric acid (UA), and creatine kinase in patients with provisionally diagnosed and histopathologically confirmed cases of potentially malignant disorders and oral cancer to those of age- and sex-matched healthy controls. Materials and methods Eighty patients over the age of 18 with a clinical diagnosis of oral potentially malignant disorder (OPMD) or oral cancer and verified histopathology were included in the research. Using the kinetic methodology, the enzymatic colorimetric method, and the UV-kinetic approach, respectively, the serum concentrations of urea, uric acid, and creatine kinase were quantified in vitro following the venipuncture of 2 mL of venous blood. The Statistical Package for the Social Sciences (SPSS) version 20 (IBM SPSS Statistics, Armonk, NY, USA) was used for the statistical analysis. Results Comparing OPMD and oral cancer patients to healthy controls, serum urea levels were found to be greater, uric acid levels to be lower, and creatine kinase levels to be higher. Conclusion Prognostic markers for OPMDs and oral cancer may include urea, uric acid, and creatine kinase. However, this may be accomplished by large-scale prospective research.

Clinical relevance of serum lipids in the carcinogenesis of oral squamous cell carcinoma

BackgroundDyslipidaemia is associated with cancers. However, the specific expression of serum lipids in oral potentially malignant disorders (OPMD) and oral squamous cell carcinoma (OSCC) remains unclear, and it remains unknown whether serum lipids are associated with the development of OPMD and OSCC. This study investigated the serum lipid profiles of OPMD and OSCC patients, and the association of serum lipids with the occurrence of OPMD and OSCC.MethodsA total of 532 patients were recruited from the Affiliated Hospital of Stomatology, Nanjing Medical University. Serum lipid parameters including total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A (Apo-A), apolipoprotein B (Apo-B), and lipoprotein (a) (Lpa) were analysed, and clinicopathological data were collected for further analysis. Furthermore, a regression model was used to evaluate the relationship between serum lipids and the occurrence of OSCC and OPMD.ResultsAfter adjusting for age and sex, no significant differences were observed in serum lipid or body mass index (BMI) between OSCC patients and controls (P > 0.05). HDL-C, Apo-A, and Apo-B levels were lower in OSCC patients than in OPMD patients (P < 0.05); HDL-C and Apo-A levels were higher in OPMD patients than in controls (P < 0.05). Furthermore, female OSCC patients had higher Apo-A and BMI values than males. The HDL-C level was lower in patients under 60 years of age than in elders (P < 0.05); and age was related to a higher risk of developing OSCC. Female patients with OPMD had higher TC, HDL-C, and Apo-A levels than males (P < 0.05); OPMD patients over 60 years of age had higher HDL-C than youngers (P < 0.05), whereas the LDL-C level was lower in elders (P < 0.05). The HDL-C and BMI values of the patients with oral leukoplakia (OLK) with dysplasia were more elevated than those of the oral lichen planus group, and the LDL-C, and Apo-A levels in patients with OLK with dysplasia were decreased (P < 0.05). Sex, high HDL-C and Apo-A values were associated with the development of OPMD.ConclusionSerum lipids exhibited certain differences according to the occurrence and development of OSCC; high levels of HDL-C and Apo-A might be markers for predicting OPMD.

The Impact of the COVID-19 Pandemic on the Management of Patients with Oral Potentially Malignant Disorders in a Tertiary Care Hospital, Sri Lanka

Introduction: Oral potentially malignant disorders (OPMD) have a higher risk to develop into oral cancer, which is the comments cancer in males in Sri Lanka. The covid-19 pandemic had significant ill effects on the health care systems, worldwide. Objective: To retrospectively investigate the management of OPMD patients presented to the oral medicine clinic of the University Dental Teaching Hospital Peradeniya, Sri Lanka before and during the pandemic. Methods: This was a hospital-based cross-sectional study using medical records. The pre-pandemic group included patients diagnosed with OPMD presenting between Jan 2018 - Dec 2019; the pandemic group from Jan 2020 to Dec 2021. Results: There were 321 eligible medical records. Of these, 247 belong to the pre-pandemic group and 74 in the pandemic (3:1). In the pre-pandemic group, 32% of biopsies were performed within the first week, while it was 56% in the pandemic group. We found a significant increase in the loss of follow-up in the pandemic group compared to the pre-pandemic group (p=0.01). The average delay for the 2nd visit was 27 days, for the 3rd visit it was 127 days in the pre-pandemic; and 89 and 152 days respectively in the pandemic group.Conclusions: We recommend following evidence-based practices for the management of OPMD in anticipated pandemics. Strategies to diagnose patients at home must be developed and implemented. There is a higher need for the prevention of habit-related risk factors. Biopsy at the first visit or first week is recommended. Patients should be monitored using digital technologies in the absence of physical follow-up.

Association of salivary cortisol and psychological burden in patients with oral cancer and oral potentially malignant disorders: A prospective study.

This study aimed to find an association between psychological burden (in terms of depression, anxiety, and stress) and salivary cortisol among oral cancer (OC) and oral potentially malignant disorder (OPMD) patients at various time frames. In total, 50 patients with OC and OPMD were studied after their informed consent along with 30 healthy controls. Depression, anxiety, and stress scale-21 (DASS-21) was administered and saliva was collected (non-invasively) at different stages including the time of diagnosis, one and three months after intervention (medical or surgical). To avoid diurnal variation, saliva was collected twice (morning and evening). To assess the linear relationship between depression, anxiety, and stress with salivary cortisol, a partial correlation was calculated. Comparison of salivary cortisol levels among control, OC, and OPMD groups showed a statistically significant difference in both morning and evening values at different point of time intervals. Higher values of salivary cortisol were observed in OC patients (both morning and evening) in comparison to the OPMD or control group. A positive correlation was discerned between stress and salivary cortisol in both OPMD and OC patients, while no association was found for depression and anxiety domains. The measurement of salivary cortisol effectively demonstrates raised stress levels in OPMD as well as OC patients. Therefore, it is recommended to institute stress management interventions in the patients as part of the treatment of OPMD and OC.

Association of salivary miRNAs with onset and progression of oral potentially malignant disorders: Searching for noninvasive biomarkers

Background/purposeThere is an urgent need for noninvasive biomarkers to diagnose oral potentially malignant disorders (OPMD). A wide range of over 20 miRNAs in saliva of OPMD patients have been investigated in different studies. Yet, which of the ones provide a better power of discrimination for the diagnosis of OPMD onset and progression are uncertain. Materials and methodsA total of 17 eligible studies including 426 cases of OPMD and 486 control subjects (352 normal mucosa and 134 oral squamous cell carcinoma) were summarized. ResultsThe bubble chart analysis showed that the most power salivary miRNA associated with OPMD onset was miR-21, followed by miR-31 and miR-142; the better power miRNAs associated with recurrence and malignant progression of OPMD were miR-31, miR-21, and miR-184. ConclusionSalivary miRNAs, especially miR-21 and miR-31, were associated with onset and progression of OPMD, and could then serve as noninvasive biomarkers for screening OPMD and detecting malignant changes.

Human Salivary microRNA as Biomarkers in Oral Potentially Malignant Disorder-A Narrative Review

Published on:June 2022 Journal of Young Pharmacists, 2022; 14(2):156-159 Review Article | doi:10.5530/jyp.2022.14.29 Authors: Kavitha Muthu1,*, Jayachandran Dorairaj2 1Department of Oral Medicine and Radiology, VMS Dental College, Vinayaka Mission’s Research Foundation (Deemed University), Salem, Tamil Nadu, INDIA.2Department of Periodontology, VMS Dental College, Vinayaka mission’s Research Foundation (Deemed University), Salem, Tamil Nadu, INDIA. Abstract: Oral potentially malignant disorders (OPMDs) denote mucosal disorders of oral cavity with higher possibility for malignant transformation. The relatively stable salivary single stranded non-coding RNAs (microRNA) can be utilized as biomarker in different malignancies for diagnosing and management purposes. This paper aims to assess the clinical application of salivary miRNAs in OPMD patients from the available literature for early discovery of oral cancer. A systematic electronic search was made and 13 articles were collected and included to fulfill the study objective. Evidence from numerous reports suggested that majority of the salivary miRNAs have significantly overexpressed in different OPMD patients. These include miR21,miR31,miRNA-184,miR-30e-3p, let-7a-5p,miR-335-5P,miR-144,miR- 25-3p,miR19a-3p,miR-25-3p,miR19a-3p,miR-660-5p,miR-140-5p,miR- 590-5p,miR-9. The downregulated markers are miR-27a/b,microRNA 320a,miR 200a,miRNA-145,miR-10b-5p,miR-99a-5p,miR-99b-5p,miR- 145-5p,miR-100-5p,miR-125b-5p,miR-181b,miR-181c, miR-331-3p, miR- 15a-5p, miR-708, miR-150-5p. Among the above mentioned markers, the miR-31,miR-21,miR-184,miR-27b have shown promising clinical utilization in OPMDs since the AUC results suggested acceptable to excellent discrimination between OPMDs from other study groups. Besides, the miR-31and miR-21 is frequently studied among others. Micro RNAs have distinctive expression patterns in OPMDs and furnish them a specific tool in diagnostic/prognostic applications in these patients. In addition, the miRNAs could also be used as therapeutic tool for specific gene target thereby improved management of OPMD patients is possible. Key words: Saliva, Biomarker, Oral potentially malignant disorders, microRNA, Oral cancer.

GIS to Explore the Geographical Mysteries of Oral Cancer: Geospatial Distribution of Patients Diagnosed with Oral Potentially Malignant Disorders at the University Dental Hospital Peradeniya

Background: Oral cancers which are often preceded by an oral potentially malignant disorder (OPMD) carries the highest mortality rate among all cancers in Sri Lanka. Dental Teaching Hospital, Peradeniya is one of the tertiary centres in Sri Lanka for treating OPMD with a high patient turnover. Objectives: This study aimed to determine the geospatial distribution of OPMD patients who attended Dental Hospital, Peradeniya (DHP) using geocoding methods. Materials and Methods: A retrospective study was done by obtaining data of 869 OPMD patients who visited DHP within the last 4 years to geo-code their addresses using GIS software. Results: The majority of the sample consisted of oral lichen planus (OLP) (52.47%). 29% and 18.64% of the patients were diagnosed with leukoplakia and oral submucous fibrosis (OSF) respectively. Most of the OPMD patients (60.64%) who visited the clinic were from the Kandy district and surprisingly the majority of OPMD patients had been reported from non-estate areas. The second and third highest number of patients were respectively from Nuwaraeliya (11.28%) and Kegalle (7.48%). More than half (57.19%) of the patients were living within 20 km of the hospital. Conclusion: The composition of patients with OPMDs visited the DHP had deviated from the national data. More than half of the sample residing within a reasonable travel distance to a specialist care centre.

Epstein- Barr viral load in exfoliated cells of oral squamous cell carcinoma and oral potentially malignant disorders - A cross-sectional study

Oral Squamous Cell Carcinoma (OSCC) has varied etiology. Among the etiological factors, genetic predisposition or the presence of oncogenic viruses can cause impairment in the physiological mechanisms of cellular proliferation control. The present study was chosen to determine the association of Epstein- Barr virus (EBV) with oral squamous cell carcinoma and oral potentially malignant disorders (OPMD). Oral exfoliated cells were collected from the subjects diagnosed with OSCC (n = 19), OPMD (n = 23) and healthy subjects without any deleterious condition (n = 39). The DNA extraction was performed with DNeasy Blood & Tissue Kits (Qiagen, Germany). Quantitative Real-Time PCR was then carried out with QuantiNova® SYBR® Green PCR Kit (Qiagen, Germany). Statistical analysis was performed using Chi-square test. EBV DNA was detected in all samples of all the three groups. Compared to healthy subjects, very high EBV load was observed in the oral exfoliated cells of OSCC and OPMD patients. The presence of EBV DNA in all the subjects of all the three groups reveals that EBV is an oral resident. Besides its presence, the abundance of EBV DNA among OSCC and OPMD suggests it's association to these pathologies. The high odds and risk ratio obtained for EBV copy number further supports a strong association of this virus to OSCC and OPMD. This may be the first study to quantify EBV DNA in oral exfoliated epithelial cells of OSCC and OPMD.

Validity and Reliability of Intraoral Camera with Fluorescent Aids for Oral Potentially Malignant Disorders Screening in Teledentistry.

There is limited documentation of using fluorescence images in oral potentially malignant disorders (OPMDs) and oral cancer screening through the field of teledentistry. This study aims to develop and evaluate the validity and reliability of the intraoral camera with the combination method of autofluorescence and LED white light used for OPMDs and oral cancer screening in teledentistry. The intraoral camera with fluorescent aids, which uses a combined method of both autofluorescence and LED white light, was developed before the device was evaluated for validity and reliability as a OPMDs screening tool for teledentistry. All lesions of thirty-four OPMD patients underwent biopsy for definitive diagnosis and were examined by an oral medicine specialist. Both images under autofluorescent and LED white light mode captured from the device were sent online and interpreted for the initial diagnosis and dysplastic features in addition to being compared to the direct clinical examination and histopathological findings. The combination method was also compared with autofluorescence method alone. The device provided good image quality, which was enough for initial diagnosis. Using the combination method, sensitivity, specificity, PPV, and NPV of the device via teledentistry were 87.5%, 84.6%, 63.6%, and 95.7%, respectively, which were higher than autofluorescence method alone in every parameter. The concordance of dysplastic lesion was 85.29% and 79.41% for category of lesion. The validity and reliability results of the combination method for the screening of dysplasia in OPMDs were higher than autofluorescent method alone. The intraoral camera with fluorescent aids for the OPMDs screening can be utilized for screening via teledentistry.

Relationship of DNA aneuploidy with distinctive features of oral potentially malignant disorders: A cytological analysis of 748 cases

Our previous study reported that clinical features, including the lateral/ventral tongue and non-homogeneous lesions, were associated with increased risk of malignant changes in cytological samples from oral potentially malignant disorders (OPMDs). This cross-sectional study aimed to evaluate the frequency and risk of DNA aneuploidy in the series of 748 patients with OPMD. The cut-off value of aneuploidy was defined as DNA index ≥3.5. We found that the frequency of DNA aneuploidy was higher in OPMD patients >60 years old, and in those with lateral/ventral tongue sites, non-homogeneous lesions, and high-grade dysplasia, than in control group (P < 0.01). Consistently, the risk of aneuploidy occurrence was higher in patients >60 years old (1.69-fold; P = 0.022), in those with lateral/ventral tongue sites (2.35-fold; P < 0.001), and in those with high-grade dysplasia (3.19-fold; P < 0.001). Collectively, increased frequency and risk of DNA aneuploidy occurred in OPMD patients aged over 60 years with high-grade dysplasia located at the lateral/ventral tongue. These patients should be required to intensive management and follow-up.

BIOCHEMICAL STUDY OF ANTIOXIDANT-OXIDANT INDEX IN ORAL POTENTIALLY MALIGNANT DISORDERS AND ORAL SQUAMOUS CELL CARCINOMA

The aim of present work was to evaluate and compare the salivary levels of nitric oxide, vitamin C, Total Sialic acid and GSH in cases of Oral Potentially Malignant Disorders (OPMDs) and Oral Squamous Cell Carcinoma (OSCC) and healthy controls. The mean nitric oxide level was 27.34±5.51 μmol/l in OSCC group, 22.5±2.33 μmol/l in OPMD group and 10.11±0.88μmol/l in control group. The glutathione reductase activity in control patients was found to be 0.0915 U/ml under optimal pH, temperature and Km. In OPMD group, the GR activity was found to be 0.0515 U/ml. Similarly, the activity in the OSCC group was found to be 0.0292 U/ml. The total sialic acid (TSA) in the saliva of control patients was found to be 41.241±5.3312μg/mL. In the case of OPMD patients, it was 64.25±4.33μg/mL and in the OSCC patients it was, 79.60±6.93 μg/mL., The levels of salivary vitamin C and glutathione were significantly reduced and those of nitric oxide and sialic acid were raised in patients having OPMD’s and oral squamous cell carcinoma. The anti-oxidant to oxidant index (AOI) was measured between NO and vitamin C; NO and GSH; total sialic acid and vitamin C and lastly, total sialic acid and GSH. Thus, the findings of the present study indicate that estimation of Vitamin C, NO, GSH and sialic acid can be suitably used and could assist in the early diagnosis of potentially malignant disorders and oral cancer using saliva.

Regular clinical follow-up of oral potentially malignant disorders results in improved survival for patients who develop oral cancer

ObjectivesTo evaluate whether clinical follow-up programs of oral potentially malignant disorders (OPMD) result in earlier detection and improved survival rates if malignant transformation occurs, as compared to OPMD patients without follow-up and other patients with oral squamous cell carcinoma (OSCC). Materials and methodsThree OSCC groups were retrospectively studied for disease stage at diagnosis and survival rates (N = 739): Group A, patients with OSCC with regular follow-up of preceding OPMD (N = 94); Group B, patients with OSCC with preceding OPMD but no follow-up (N = 68); Group C, patients with OSCC without previously known OPMD diagnosis (N = 577). ResultsThe patients with OPMD with follow-up (Group A) was diagnosed at a significantly earlier stage and have significantly higher survival rates compared to Group B (p < 0.001 and p = 0.022, respectively) and Group C (p < 0.001 and p < 0.001, respectively). There was no significant difference between Group B and Group C in terms of survival rate (p = 0.143) or stage at diagnosis (p = 0.475). Patients with OPMD and follow-up (Group A) had a 5-year net survival rate of 90.0% (95%CI 80.3–100.8%), as compared to 68.3% percent (95% CI 54.5–85.7) for Group B and 56.1% (95% CI 51.4–61.3) for Group C. ConclusionThe results of this study indicate that regular follow-up of patients with OPMD results in earlier detection of OSCC (if malignant transformation occurs) and improved survival.

Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions

This study aimed to evaluate the impact of the lockdown on oral oncology-related out-patient volume at Indian dental institutions. The total number of newly diagnosed cases of oral submucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers, recorded at two dental institutional settings before lockdown (January-March 2020) and after lockdown (June-August 2020), were included retrospectively and compared. The study included a total of 797 cases at both institutions. At Institution-I, a total of 312 cases were recorded before the lockdown, and 63 cases were recorded after the lockdown. At Institution-II, a total of 311 cases were reported before lockdown, and 111 cases were recorded after lockdown. Comparisons between the pre-lockdown and post-lockdown data yielded a significant change in the proportions of oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, and oral cancers at both institutions (Chi-square test; p < 0.001). Following the lockdown, a substantial reduction was observed in the proportion of oral submucous fibrosis (OSMF) cases at both institutions, and the proportion of oral cancers increased at both institutions. There was a significant difference between the proportions of cases reported before lockdown at both institutions (p < 0.001). However, after-lockdown, no such differences were noted (p = 0.69); the absence of significance could most likely be due to the low sample size or low-power during the post-lockdown period. The oral potentially malignant disorders (OPMD) and oral cancer (OC) patient volumes reduced substantially following lockdown. During the post-lockdown period, the proportion of oral cancers increased, whereas the proportion of OSMF cases decreased. Results indicate that OPMD and oral cancer patients were impacted differently by the lockdown. This study provides insight into the impact of lockdown and highlights the importance of reestablishing oral oncology-related patient care. A vital discussion is also provided on useful compensatory strategies that may reduce delays during the ongoing crisis. How to cite this article: Panta P, Reddy P, Misra SR, et al. Impact of COVID-19 Lockdown on Oral Oncology-related Outpatient Volume at Indian Dental Institutions. J Contemp Dent Pract 2021;22(5):501-505.

Malignant transformation of oral potentially malignant disorders in Taiwan: An observational nationwide population database study.

Oral cancer is one of the leading causes of cancer death, which are mostly preceded by oral potentially malignant disorders (OPMDs). Taiwanese government launched a free oral cancer screening program. The aim of this study was to analyze the malignant transformation rate of OPMDs.This study was based on national-wide oral screening databases. 3,362,232 people were enrolled. Patients clinically diagnosed with leukoplakia, erythroplakia, oral submucosal fibrosis (OSF), oral verrucous hyperplasia (OVH), and oral lichen planus (OLP), from 2010 to 2013, were identified. We followed up OPMD patients in cancer registry databases to analyze the malignant transformation rate.The malignant transformation rates from the highest to the lowest were: OVH > OSF > erythroplakia > OLP > leukoplakia. The malignant transformation rate was 24.55, 12.76, 9.75, 4.23, and 0.60 per 1000 person-years in the OVH, OSF, erythroplakia, leukoplakia, and comparison cohort. The hazard ratio was 8.19 times higher in the OPMD group compared with comparison cohort group, after age and habit adjustment. Female patients with OPMDs had a high risk of malignant transformation.Nationwide screening is very important for early diagnosis. OVH had the highest malignant transformation possibility. Female OPMD patients are a rare but have a relatively high malignant transformation rate.