Oral Potentially Malignant Disorders Research Articles

Recommendations for Research to Develop a Patient‐Centered Clinical Follow‐Up Protocol for Oral Epithelial Dysplasia

ABSTRACTOral epithelial dysplasia (OED) is the primary histological marker for assessing the progression of oral potentially malignant disorders (OPMDs) to cancer. Despite challenges in grading and low inter‐pathologist reproducibility, OED severity remains the key predictor of malignant transformation. However, globally accepted guidelines for OED monitoring are lacking, despite calls for individualized management based on host and lesion characteristics. The proposed research protocol involves acquiring high‐quality intraoral images, assessing oral hygiene and periodontal status, eliminating chronic mechanical irritation and Candida infections, and applying adjunctive diagnostic methods like toluidine blue staining, optical evaluation, and brush cytology. Tailored follow‐up regimens based on individual risk assessments are emphasized, with frequent monitoring for high‐grade dysplasia or patients at higher risk of progression. Therefore, effective OED management should consider the patient's immune status, dietary habits, and oral microbiota, aiming to develop personalized treatment strategies that optimize patient‐centered care.

Evaluating the efficacy of curcumin in the management of oral potentially malignant disorders: a systematic review and meta-analysis

Background Oral potentially malignant disorders (OPMDs) not only harbour the risk of malignant transformation but can also affect patients’ quality of life owing to severe symptoms. Therefore, there is an urgent need for therapeutic strategies to improve patients’ quality of life. The objective of this meta-analysis was to comprehensively assess the efficacy of curcumin in the management of OPMDs. Methods PubMed, Embase, the Cochrane Library, and Web of Science were searched for clinical trials evaluating the efficacy of curcumin in the treatment of OPMDs from inception until March 2024. RevMan 5.4 software was used to perform statistical and subgroup analyses. Results Sixteen randomised controlled trials (1,089 patients) were selected. Curcumin exhibited comparable efficacy to conventional controls in alleviating pain (I2 = 98%, P = 0.49) and improving tongue protrusion (I2 = 94%, P = 0.51) in oral submucous fibrosis (OSF). Additionally, topical use of curcumin had an efficacy equivalent to that of conventional therapy in reducing pain (I2 = 83%, P = 0.31) and facilitating clinical remission (I2 = 67%, P = 0.38) of oral lichen planus (OLP). Conclusion The topical use of curcumin may palliate pain and promote clinical healing in OLP patients. Systemic curcumin can ameliorate the degree of pain and tongue protrusion in OSF. Therefore, our study suggests that curcumin could serve as an alternative treatment for managing OPMDs with lower medical toxicity than steroids, especially when steroids are not suitable. Further studies with larger sample sizes and adequate follow-up periods are required to validate our results.

Cytokines levels in saliva in periodontitis, oral potentially malignant disorders and squamous cell carcinoma

Biopsy and histopathological examination continue to be the gold standards for diagnosing oral cancer and oral potentially malignant disorders (OPMD). The prognosis of these conditions is significantly influenced by established factors such as the degree of dysplasia, tumour size, grade, and patient age. While these traditional diagnostic approaches are crucial, there is a growing need for innovative methods to improve diagnosis and monitoring of these conditions. We hypothesize that identifying specific diagnostic biomarkers in human saliva, alongside traditional methods, could enhance clinical outcomes in managing both malignant and non-malignant oral pathologies. In this study, salivary levels of previously described biomarkers BDNF, IL-6, IL-8, IL-10, IL-15, IL-1RA, LIF, and TNF-α were compared among oral cancer patients, patients with OPMD, periodontal disease patients, and healthy volunteers. The results indicated that these cytokines have the potential to distinguish cancer cases, though they are less effective in differentiating between OPMD and periodontitis. Using pairs or groups of biomolecules could improve the ability to differentiate between different pathological entities. We found the following panel IL-6, IL-15, and IL-1RA to be particularly significant as diagnostic biomarkers for oral squamous cell carcinoma and OPMD.

Diagnostic performance of artificial intelligence in detecting oral potentially malignant disorders and oral cancer using medical diagnostic imaging: a systematic review and meta-analysis

ObjectiveOral cancer is a widespread global health problem characterised by high mortality rates, wherein early detection is critical for better survival outcomes and quality of life. While visual examination is the primary method for detecting oral cancer, it may not be practical in remote areas. AI algorithms have shown some promise in detecting cancer from medical images, but their effectiveness in oral cancer detection remains Naïve. This systematic review aims to provide an extensive assessment of the existing evidence about the diagnostic accuracy of AI-driven approaches for detecting oral potentially malignant disorders (OPMDs) and oral cancer using medical diagnostic imaging.MethodsAdhering to PRISMA guidelines, the review scrutinised literature from PubMed, Scopus, and IEEE databases, with a specific focus on evaluating the performance of AI architectures across diverse imaging modalities for the detection of these conditions.ResultsThe performance of AI models, measured by sensitivity and specificity, was assessed using a hierarchical summary receiver operating characteristic (SROC) curve, with heterogeneity quantified through I2 statistic. To account for inter-study variability, a random effects model was utilized. We screened 296 articles, included 55 studies for qualitative synthesis, and selected 18 studies for meta-analysis. Studies evaluating the diagnostic efficacy of AI-based methods reveal a high sensitivity of 0.87 and specificity of 0.81. The diagnostic odds ratio (DOR) of 131.63 indicates a high likelihood of accurate diagnosis of oral cancer and OPMDs. The SROC curve (AUC) of 0.9758 indicates the exceptional diagnostic performance of such models. The research showed that deep learning (DL) architectures, especially CNNs (convolutional neural networks), were the best at finding OPMDs and oral cancer. Histopathological images exhibited the greatest sensitivity and specificity in these detections.ConclusionThese findings suggest that AI algorithms have the potential to function as reliable tools for the early diagnosis of OPMDs and oral cancer, offering significant advantages, particularly in resource-constrained settings.Systematic Review Registrationhttps://www.crd.york.ac.uk/, PROSPERO (CRD42023476706).

Diagnostic Accuracy of Toluidine Blue Electrospun in Detecting Oral Potentially Malignant Disorders.

Oral potentially malignant disorders (OPMDs) with epithelial dysplasia can progress to oral squamous cell carcinoma (OSCC). Toluidine blue (TB) has been used in oral screening with various methods. This study aimed to evaluate the sensitivity and specificity of TB-containing electrospun fibers in detecting OPMDs with epithelial dysplasia compared to histopathology. The concentrations of polyvinylpyrrolidone (PVP) and TB were optimized for fiber diameter and puncture strength using the design of experiments method with a central composite design. These optimized fibers were tested on 36 suspected OPMD lesions in 30 patients, followed by a biopsy for histopathological examination. The quadratic and two-factor interaction models described the relationship between TB and PVP concentrations and fiber characteristics. The TB-containing electrospun fibers had 77.3% sensitivity and 35.7% specificity in detecting OPMDs with epithelial dysplasia. The TB-containing electrospun fibers offer advantages such as easy application, cost-effectiveness, and enhanced sensitivity in identifying OPMDs with epithelial dysplasia. However, their diagnostic accuracy is insufficient as a standalone diagnostic method, and they should be considered an adjunctive tool for detecting dysplastic changes in the oral epithelium. Thailand Clinical Trials Registry: TCTR20240429002.

Teledentistry in the detection of oral potentially malignant disorders and oral cancer in the Latin American region: a review of literature with current possibilities

Teledentistry has emerged as a promising tool in bridging the gap in healthcare accessibility, particularly in regions like Latin America region, where resources for oral healthcare are often limited. Drawing upon a comprehensive review of literature, this overview assessed the applications and clinical outcomes of teledentistry in diagnosing oral potentially malignant disorders (OPMDs) and oral cancer, highlighting the challenges and opportunities specific to the Latin American context. Moreover, it examined the integration of artificial intelligence algorithms and teledentistry for enhancing diagnostic accuracy, thereby optimizing resource allocation and improving patient outcomes. By elucidating the current landscape and future prospects, this overview provided insights for policymakers, healthcare providers, and researchers, fostering advancements in oral healthcare delivery with the aim of reducing the burden of OPMDs and oral cancer in the Latin American region.

Demographic and Clinical Characteristics of Pre-Malignant Oral Lesions and their Related Factors in an Iranian Population: A Registry-Based Study

Background: Oral Potentially Malignant Disorders (OPMDs) can lead to Oral Squamous Cell Carcinoma (OSCC). The sixth most common cancer in the world is OSCC. This study aimed to describe the demographical and clinical characteristics of OPMD patients and their risk factors registered at the Oral Medicine Department of Shahid Beheshti Dental School in 2019-2021. Methods: The observational-analytical study was conducted using the dental records of 96 consecutive patients using a web-based registration software (OPMDs registry). Information including demographics and clinical features, the type of OPMD, and risk factors were extracted. Data were analyzed using the Chi-square test, T-test, and Fisher’s exact test with SPSS version 21. Results: In this study, 96 patients (average age: 52.41±14.87) including 52 women and 44 men, participated. The most common OPMDs comprised 69 Oral Lichen Planus (OLP) and 15 leukoplakia. The most common location of lesions was the buccal mucosa (74%) with erosions and plaques being the most common morphology types. Most patients with leukoplakia were male, however, majority of the patients with OLP were female (p=0.001). In patients with leukoplakia, 66.5% were smokers; hence, a significant relationship between smoking and OPMD was observed (p=0.001). Patients with OLP commonly presented with burning symptoms, while patients with leukoplakia were mostly asymptomatic (p=0.004). Conclusion: A significant relationship was observed between gender, clinical symptoms, location of lesions, morphology, and type of OPMDs. Most patients with OPMDs were women with OLP in their buccal mucosa, suffering from burning sensation.

Application of Targeted Optical Coherence Tomography in Oral Cancer: A Cross-Sectional Preliminary Study.

The diagnosis of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) represent a significant challenge in oral medicine. Optical coherence tomography (OCT) shows promise for evaluating oral tissue microstructure but lacks standardized diagnostic protocols tailored to the structural variability and lesions of oral mucosa. This cross-sectional observational study aims to evaluate the diagnostic accuracy of targeted biopsy-based and site-coded OCT protocols for common OPMDs and OSCC. Adult patients clinically diagnosed with OPMDs, including oral leukoplakia (OL), oral lichen planus (OLP), and OSCC were enrolled. Clinical and OCT evaluation before and after punch scalpel-site registration preceding diagnostic biopsy on the target site was performed. Blinded observers analyzed the OCT scans for OCT-based diagnoses. Sensitivity, specificity, and diagnostic accuracy for OCT evaluations before and after punch scalpel-site registration were statistically compared with histological findings. A dataset of 2520 OCT scans and 210 selected images from 21 patients was obtained. Sensitivity and specificity post-target site registration were high for OSCC (98.57%, 100.00%), OL (98.57%, 98.57%), and OLP (97.14%, 98.57%). The positive predictive values ranged from 97.14% to 100.00%, while negative predictive values ranged from 98.57% to 99.29%. Inter-observer agreements were strong for OSCC (0.84) and moderate for OL (0.54) and OLP (0.47-0.49). Targeted OCT scans significantly improved diagnostic accuracy for all conditions (p < 0.001). This preliminary study supports using site-targeted OCT scans followed by a site-targeted punch biopsy, enhancing precision in oral diagnostics. This approach is foundational for developing pioneering automated algorithms guiding oral cancer and pre-cancer diagnosis via OCT imaging.

Reconstructing oral cavity tumor evolution through brush biopsy

Oral potentially malignant disorders (OPMDs) with genomic alterations have a heightened risk of evolving into oral squamous cell carcinoma (OSCC). Currently, genomic data are typically obtained through invasive tissue biopsy. However, brush biopsy is a non-invasive method that has been utilized for identifying dysplastic cells in OPMD but its effectiveness in reflecting the genomic landscape of OPMDs remains uncertain. This pilot study investigates the potential of brush biopsy samples in accurately reconstructing the genomic profile and tumor evolution in a patient with both OPMD and OSCC. We analyzed single nucleotide variants (SNVs), copy number aberrations (CNAs), and subclonal architectures in paired tissue and brush biopsy samples. The results showed that brush biopsy effectively captured 90% of SNVs and had similar CNA profiles as those seen in its paired tissue biopsies in all lesions. It was specific, as normal buccal mucosa did not share these genomic alterations. Interestingly, brush biopsy revealed shared SNVs and CNAs between the distinct OPMD and OSCC lesions from the same patient, indicating a common ancestral origin. Subclonal reconstruction confirmed this shared ancestry, followed by divergent evolution of the lesions. These findings highlight the potential of brush biopsies in accurately representing the genomic profile of OPL and OSCC, proving insight into reconstructing tumor evolution.

A Cross-Sectional Study on Oral Potentially Malignant Disorders: Diagnostic Challenges in Early Detection of Dysplasia and the Role of Velscope.

The oral cancer burden has become a global challenge in the present scenario. Early diagnosis of oral potentially malignant disorders (OPMDs) with dysplasia is crucial to increasing the overall survival rate of the patients. Efficient chairside techniques are much needed to enhance diagnostic efficacy at early stages. This study evaluates the effectiveness of Velscope in detecting dysplastic lesions and analyzes the impact of lifestyle factors on the prevalence and progression of oral potentially malignant disorders among 40 participants. A cross-sectional study was conducted with 40 participants diagnosed with OPMDs. Participants underwent a Velscope examination followed by incisional biopsy and histopathological evaluation. Data on lifestyle factors such as tobacco, alcohol, pan, and gutka use were collected through self-reported questionnaires. Data were analyzed to assess Velscope efficacy and correlations between lifestyle risk factors and lesion sites. Statistical analysis was performed using SPSS statistics for Windows (version 26.0, IBM Corp., Armonk, NY). The significance level was fixed at 5% (α=0.05). The data analysis of the study revealed that Velscope showed a sensitivity of 88.89% and a specificity of 46.15% (p = 0.013). The positive predictive value (PPV) of the Velscope was 77.42%, and the negative predictive value (NPV) was 66.67%. Overall, the diagnostic accuracy of the Velscope in this study was 75.0%. Cohen's kappa of 0.381 indicated moderate agreement with biopsy results. Biopsy results showed no statistically significant correlation was found between dysplasia and lesion site, gender, smoking, alcohol, or pan use except for gutka users, who had a significantly higher rate of dysplasia (p = 0.027). Velscope demonstrated high sensitivity but moderate specificity in detecting dysplasia, emphasizing its role as an adjunctive tool in early detection and delineation of oral lesions in conjunction with biopsies for accurate diagnosis. The higher rate of positive results for dysplasia among gutka users suggests that focused public health interventions are needed to address significant lifestyle risk factors, which in turn could reduce malignant transformations in OPMDs.

The Diagnostic Potential of Non-Invasive Tools for Oral Cancer and Precancer: A Systematic Review.

This systematic review aimed to analyse the published evidence for the use of non-invasive methods for the early detection of oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs). The literature was systematically searched through several databases: PubMed, Cochrane Library, and Web of Science. Additional exploration was performed through cross-checks on the bibliographies of selected reviews. The inclusion criteria involved studies assessing the application of non-invasive tests on humans in the screening, diagnosis, or surveillance of OSCC or OPMDs and reporting sensitivity (SE) and specificity (SP). The Newcastle-Ottawa scale (NOS) was applied to assess the quality of the studies included. The search strategy resulted in 8012 preliminary records. After a duplicate check, 116 titles remained. After abstract analysis, 70 papers remained. After full text analysis, only 54 of the 70 papers fit the inclusion criteria (28 were original articles and 26 were reviews). Those 26 reviews were used to manually search for further original articles. From this last search, 33 original articles were found. Thus, a total of 61 original studies were included and investigated. Findings from this systematic review indicate useful information, such as a description of the mechanisms, ease of use, limitations, and SE and SP values, to drive the choice of the optimal minimally invasive method to be utilized as an adjunctive tool to examine the suspicious lesions. Each of the analysed tools can be improved or implemented, considering their high SE and low SP. Despite advancements, incisional biopsy continues to be the gold standard for the definitive diagnosis of oral cancer and precancerous lesions. Further research and development are essential to improving the sensitivity, specificity, and reliability of non-invasive tools for widespread clinical application.

Differences in the landscape of colonized microorganisms in different oral potentially malignant disorders and squamous cell carcinoma: a multi-group comparative study

BackgroundThe role of microbes in diseases, especially cancer, has garnered significant attention. However, research on the oral microbiota in oral potentially malignant disorders (OPMDs) remains limited. Our study investigates microbial communities in OPMDs.Materials and methodsOral biopsies from19 oral leukoplakia (OLK) patients, 19 proliferative verrucous leukoplakia (PVL) patients, 19 oral lichen planus (OLP) patients, and 19 oral lichenoid lesions (OLL) patients were obtained. 15 SCC specimens were also collected from PVL patients. Healthy individuals served as controls, and DNA was extracted from their paraffin-embedded tissues. 2bRAD-M sequencing generated taxonomic profiles. Alpha and beta diversity analyses, along with Linear Discriminant Analysis effect size analysis, were conducted.ResultsOur results showed the microbial richness and diversity were significantly different among groups, with PVL-SCC resembling controls, while OLK exhibited the highest richness. Each disease group displayed unique microbial compositions, with distinct dominant bacterial species. Noteworthy alterations during PVL-SCC progression included a decline in Fusobacterium periodonticum and an elevation in Prevotella oris.ConclusionsDifferent disease groups exhibited distinct dominant bacterial species and microbial compositions. These findings offer promise in elucidating the underlying mechanisms of this disease.

Roles of intralesional bacteria in the initiation and progression of oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) is the predominant form of head and neck cancer, often diagnosed at late stages, resulting in a poor prognosis. Recent studies indicate a potential association between OSCC and microbial presence. Microorganisms have been identified in various tumors and lesions, including OSCC and oral potentially malignant disorders (OPMDs). Intralesional microbiota are considered important components of the tumor microenvironment (TME) and may contribute to carcinogenesis. Sources were collected through thorough searches of databases PubMed and Embase. The review focused on microbial characteristics, potential origins, and their impact on cancer progression. Bacteria display varying abundance and diversity throughout the stages of OSCC and OPMDs. Intraleisional bacteria may have diverse sources, including not only oral plaque and saliva but also potentially the gut. Intralesional bacteria have both pro-carcinogenic and anti-carcinogenic effects, affecting processes like cell proliferation, invasion, and immune response. Intralesional microbiota are crucial in OSCC and OPMDs, influencing both disease progression and treatments. Despite their significance, challenges like inconsistent sampling and microbial identification remain. Future research is required to fully understand their role and improve clinical applications.

Quantum leap in the diagnosis of oral potentially malignant disorders – A review of literature

Early diagnosis of oral potentially malignant disorders (OPMDs) can bring about considerable improvement in reducing the statistics related to morbidity and mortality associated with oral cancer. The objective of this review was to summarize advanced diagnostic aids used for OPMDs. Pubmed, Embase, and Cochrane Central Register of Controlled Trials electronic databases from 1969 to 2022 focus on advanced diagnostic techniques for potentially malignant disorders. An electronic database was searched for keywords: “Potentially malignant disorders”, “Early diagnostic aids”, advanced diagnostic aids in oral PMDs, precancerous lesions, precancerous conditions, diagnosis of potentially malignant disorders, and artificial intelligence in oral cancer. A total of 42 studies met inclusion and exclusion criteria. The mean standard deviation (σ) was calculated as 3.129 and specificity and sensitivity were obtained at a confidence interval (CI) of 95%. The pooled value for sensitivity and specificity of each modality of diagnostic aid was calculated. In conclusion, advanced diagnostic techniques would be very useful in the early detection of OPMDs. It is important for dentists and dental practitioners to be well versed in all available techniques of diagnosis. Implementation of early diagnostic aids at a larger screening platform could be beneficial in overcoming the cost factor involved and may improve the probability burden of oral cancer-related mortality.

Expression Analysis of Circulating microRNAs in Saliva and Plasma for the Identification of Clinically Relevant Biomarkers for Oral Squamous Cell Carcinoma and Oral Potentially Malignant Disorders.

This study aims to evaluate the expression of salivary and plasmatic miRNAs as diagnostic biomarkers in patients with oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs). A total of 25 patients were divided into three groups, according to their diagnosis: OSCC patients (n = 14); OPMDs patients (n = 6); and healthy controls (n = 5). At the time at diagnosis/enrolment, patients underwent salivary and plasmatic collection. The expression of miRNA -21, -31, -138, -145, -184, and -424 were evaluated by real-time PCR. An F-test and ANOVA test were performed to evaluate the miRNA levels (significance at p < 0.05). By comparing miRNA expression levels from saliva, a statistically significant difference emerged in the expression of miR-138 and miR-424 between the three groups (p < 0.05). In particular, these two miRNAs showed decreased expression levels in saliva samples from OSCC and OPMD patients compared to those from healthy controls. On the other hand, miRNA expression levels in plasma were low in all the groups, and no statistically significant differences were found. Overall, our results showed that liquid biopsy from saliva may be a useful tool for the identification of diagnostic molecular biomarkers in OSCC and OPMDs.

Comparative Evaluation of Pfeiffer’s Blood Crystallization Test for Early Detection of Epithelial Dysplasia in OSMF and Healthy Individuals: A Cross-Sectional Study

Background: Unlike other malignancies, oral cancer is preceded by Oral Potentially Malignant Disorders (OPMDs). Oral Submucous Fibrosis (OSMF) is one such OPMD with malignant potential of 7.6%. The purpose of present study was to determine the efficacy of Pfeiffer’s blood Crystallization test for early detection of epithelia dysplasia in OSMF individuals. Material and methods: The study participants included were involved 50 OSMF subjects and 50 healthy controls. The blood drop collected was subjected to crystallization test and the crystal patterns formed were analyzed after 20 hours. Incisional biopsy was performed in OSMF subjects to grade the degree of epithelial dysplasia. The data obtained was subjected to statistical analysis. Results: The participant’s age in the study groups ranged up to 56 years. Difference in the crystallization pattern between diseased group and non-diseased group was significant (p-value &lt; 0.05%) with more transverse pattern in diseased group. The OSMF participants with no epithelial dysplasia showed normal crystallization pattern and maximum participants with dysplasia showed transverse pattern and the difference was statistically significant (p-value&lt;0.05%). The sensitivity and specificity of crystallization test for OSMF was found to be 91.4% and 100.0% respectively. Conclusion: Pfeiffer's Crystallization test can be considered as a less invasive and reliable screening aid for OSMF which helps clinicians to identify high‑risk individuals for malignant transformation.

Precise Identification of Oral Cancer Lesions Using Artificial Intelligence.

Dentists, especially those who are not oral lesion specialists and live in rural areas, need an artificial intelligence (AI) system for accurately assisting them in screening for oral cancer that may appear in smartphone images. Not many literatures present a viable model that addresses the needs, especially in the context of oral lesion segmentation in smartphone images. This study demonstrates the use of a deep learning-based AI for simultaneously identifying types of oral cancer lesions as well as precisely outlining the boundary of the lesions in the images for the first time. The lesions of interest were oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) lesions. The model could successfully (1) detect if the images contained the oral lesions, (2) determine types of the lesions, and (3) precisely outline the boundary of the lesions. With future success of our project, patients will be diagnosed and treated early before the pre-cancer lesions can progress into deadly cancerous ones.

Betel-quid addictive use disorders and Oral potentially malignant disorders and Oral cancer in south, southeast, and East Asia: A systematic review and meta-analysis.

This study aimed to provide a comprehensive assessment of the measurement and prevalence of betel-quid (BQ) abuse, dependence, and BQ use disorder (BUD), as well as to evaluate the impact of BQ addiction on oral malignant diseases. We used the PRISMA guidelines to perform a systematic review and meta-analysis. We searched for relevant publications up to April 2024 in PubMed, Web of Science, and Embase. The articles were evaluated for BQ addiction and its relationship with oral potentially malignant disorders (OPMD) and oral cancer. The prevalence of BQ abuse, dependence, and BUD in South, Southeast, and East Asia varied between 0.8%-46.3%, 0.4%-43.5%, and 4.7%-39.2%, respectively. Among BQ chewers, the corresponding proportions of these disorders ranged from 40.5%-99.6%, 20.9%-99.6%, and 55.2%-99.3%. The pooled risks of OPMD associated with BQ abuse, dependence, and BUD were 16.3, 18.7, and 9.6-35.5, respectively. The risk of oral cancer for mild, moderate, and severe BUD was 8.5, 8.2, and 42.3, respectively. BUD mediates the link between BQ use and an increased risk of oral malignant disorders. Addressing and treating BQ addiction is an important component of comprehensive OPMD and oral cancer preventive and intervention programs that go beyond simple cessation efforts.

Surgical protocols for oral leukoplakia and precancerous lesions across three different anatomic sites.

This systematic review and meta-analysis aimed to compare the risk of recurrence and cancer progression after surgical treatment for oral potentially malignant disorders (OPMD) and precancerous lesions in different anatomical sites. A comprehensive search was conducted in nine databases and grey literature. We included randomized controlled trials assessing surgical treatment efficacy for OPMD and precancerous lesions of cervical, vaginal, anal, and penile sites. Excision or ablation surgical treatments were considered. Overall, 12 studies met the eligibility criteria for oral leukoplakia (OL), proliferative verrucous leukoplakia, cervical intraepithelial neoplasia (CIN), vaginal intraepithelial neoplasia, and anal intraepithelial neoplasia (AIN). In qualitative analysis of surgical protocols, the lack of margin description impacts the clinical outcomes of OL and AIN, and the ablative protocols were heterogeneous in both OPMD and precancerous lesions. No significant difference in OL (risk ratio 0.82 [95% CI: 0.59-1.15]) and CIN (risk ratio 0.31 [95% CI: 0.09-1.09]) for recurrence was observed when cold-knife was compared with ablative protocols. OL exhibited higher recurrence and cancer progression rates compared to CIN and AIN. There is no difference in recurrence risk post-surgical treatment for OL and CIN. Surgical protocols for oral leukoplakia and CIN/AIN lack standardized approaches.

Correlation between serum heavy metals and the risk of oral squamous cell carcinoma and oral potentially malignant disorders

Oral squamous cell carcinoma (OSCC) is a serious public health problem in various Asian countries, including Sri Lanka, and a combination of cultural practices, lifestyle factors, and genetic predispositions influences the incidence of these cancers. The examination of the connection between exposure to heavy metals and the probability of developing oral potentially malignant disorders (OPMD) and OSCC has been limited in its scope, and the overall consequences of such exposure remain largely unknown. This study aims to clarify the link between serum levels of heavy metals and the risk of OSCC and OPMD. The concentrations of seven heavy metals—namely, arsenic (As), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), lead (Pb), and zinc (Zn)—were analyzed in serum samples from 60 cases and 15 controls in the Sri Lankan cohort. The Inductively Coupled Plasma-Optical Emission Spectrometry (ICP-OES) was used for the analysis. Subsequently, the data underwent statistical evaluation via the Kruskal–Wallis H test, using the Statistical Package for Social Sciences (SPSS) version 28 software, with a confidence interval set at 95%. A p-value less than 0.05 was considered statistically significant. The cohort consisted of 48 men and 27 women, with 15 patients each diagnosed with OSCC, OSF, OLK, and OLP, and 15 healthy controls. The study used the Kruskal–Wallis Test to compare metal concentrations across groups, finding significant differences for all metals except As and Pb. Significant associations were observed between age, past medical history, drug history, gender, smoking, alcohol consumption, and betel chewing. The Spearman Correlation test showed significant correlations between the concentrations of Cr, Co, Cu, As, and Zn and the presence of cancer/precancer conditions. The study’s findings suggest that heavy metal contamination may be linked to the development of OSCC and precancerous conditions. When comparing OSCC and OPMD cases with controls, the serum concentrations of As and Pb did not differ significantly. However, Cd, Cr, Co, Cu, and Zn exhibited significantly higher concentrations among cases compared to controls (p < 0.05). This study observed significant variations in the levels of these five heavy metals among cancerous (OSCC), premalignant (OPMD), and healthy tissues, suggesting a potential role in the progression of malignancies. These findings underscore the importance of environmental pollution in this specific context.