Oral Premalignant Lesions Research Articles

Photodynamic therapy for early and recurrent oral cancers and pre-malignant lesions. Need of the hour for India

Oral cancer rates in India surpass those in any other nation, with patients manifesting varied disease stages, including pre-malignant phases. Tobacco chewing promotes field cancerization, and related surgical interventions can be remarkably morbid. Advanced-stage patients with frequent recurrences undergo treatments that significantly degrade their quality of life. In such instances, Photodynamic Therapy (PDT) emerges as an invaluable tool, enhancing both the longevity and quality of life. This paper elucidates two such cases benefiting from PDT, spotlighting its potential in transforming cancer care in India.

Oncogenic HRAS Induces Metformin Resistance in Head and Neck Cancer by Promoting Glycolytic Metabolism.

Metformin administration has recently emerged as a candidate strategy for the prevention of head and neck squamous cell carcinoma (HNSCC). However, the intricate relationship between genetic alterations in HNSCC and metformin sensitivity is still poorly understood, which prevents the stratification of patients, harboring oral premalignant lesions that may benefit from the chemopreventive activity of metformin. In this study, we investigate the impact of prevalent mutations in HNSCC on response to metformin. Notably, we found that the expression of oncogenic HRAS mutants confers resistance to metformin in isogenic HNSCC cell systems, and that HNSCC cells harboring endogenous HRAS mutations display limited sensitivity to metformin. Remarkably, we found that metformin fails to reduce activation of the mTOR pathway in HRAS oncogene-expressing HNSCC cells in vitro and in vivo, correlating with reduced tumor suppressive activity. Mechanistically, we found that this process depends on the ability of HRAS to enhance glycolytic metabolism, thereby suppressing the requirement for oxidative phosphorylation to maintain the cellular energetic balance. Overall, our study revealed that HNSCC cells with oncogenic HRAS mutations exhibit diminished metformin sensitivity, thus shedding light on a potential mechanism of treatment resistance. This finding may also help explain the limited clinical responses to metformin in cancers with RAS mutations. Ultimately, our study underscores the importance of understanding the impact of the genetic landscape in tailoring precision cancer-preventive approaches in the context of HNSCC and other cancers that are characterized by the presence of a defined premalignant state, and therefore, are amenable to cancer interception strategies. Prevention Relevance: Our findings highlight the challenges of using metformin for cancer prevention in RAS-mutant cancers, where elevated glycolysis may reduce drug efficacy. This underscores the need to explore metformin's potential in early, premalignant stages, before metabolic shifts render it less effective.

Heuristic strategy using hybrid deep learning with transfer learning for oral cancer detection

Oral cancer becomes the most disastrous ailment that affects the oral cavity parts of the mouth. Oral cancer diagnosis is the main challenge in the medical field. It becomes expensive and less capable of classifying oral cancer. In some cases, it may cause unnecessary morbidity and mortality. Recently, the detection of malignant and premalignant oral lesions has been a critical process owing to their low image resolution and lower acquisition time. Thus, a novel hybrid deep learning with meta-heuristic-based optimization is proposed. The pre-processing occurs by median filtering and Contrast Limited Adaptive Histogram Equalization (CLAHE). The CLAHE method is utilized to reduce unwanted noise. Finally, the classification is done by a proposed hybrid-based deep learning model termed as Recurrent Deep Belief Network (RDBN), in which the Deep Belief Network (DBN) is incorporated with the Recurrent Neural Network (RNN). Here, the RDBN helps to increase the performance classification. Furthermore, the hyperparameters of the RDBN model, such as learning rate, epochs and hidden neurons, are tuned using the proposed Hybrid Beetle-Barnacle Swarm Optimization (HBBSO) algorithm, where the Barnacles Mating Optimizer (BMO) is superimposed with Beetle Swarm Optimization (BSO) algorithms. In the given proposed model, the selected features are extracted by the optimization algorithms. Here, the parameters are fine-tuned to get the better optimal solution. From the experimental outcome, the developed model has acquired 5.2% better than PSO-RDBN, 5.6% improved than GWO-RDBN, 3.2% enhanced than BSO-RDBN and 3.5% superior to BMO-RDBN regarding accuracy. Thus, the proposed model achieves higher results for detecting oral cancer with enhanced classification performance than the existing approaches.

Detection of Molecular Biomarkers in Fanconi Anemia Mucosa

Introduction Fanconi anemia (FA) is the most common cause of inherited bone marrow failure, and a cancer predisposition syndrome caused by impaired DNA interstrand crosslink repair, also known as the FA repair pathway. Hematopoietic stem cell transplantations (HSCT) have improved survival in patients with FA, however, those have also heightened the risk of malignancies. Head and neck squamous cell carcinoma (HNSCC), and specifically oral SCC (oSCC), are the most common solid malignancies and the leading cause of death in adult patients with FA. By 45 years of age, HNSCC has a computed cumulative incidence of 50% and 100% in FA patients who did not and did undergo a HSCT, respectively. Historically, SCC in FA has been mostly diagnosed at an advanced stage of disease conferring poor outcome. FA-associated HNSCC are known to be enriched with p53 and structural variants. We aim to develop molecular screening tools and biomarkers of oSCC development in FA patients, to facilitate measurement of potential prophylactic therapies and allow for earlier detection of premalignant oral lesions and cancer. To that end, we are mapping somatic genetic variants in normal-appearing oral mucosa as well as oral lesions in patients with FA, and we plan to evaluate circulating cancer biomarkers. Methods This is a proof-of-concept study conducted in healthy controls (HC) and FA patients. We use a non-invasive oral brush biopsy to collect oral keratinocytes from six different sites of normal-appearing mucosa: retromolar area, side of the tongue and floor of the mouth, bilaterally. DNA is isolated and the exonic regions of the TP53 gene are sequenced using CleanPlex TP53 Kit on an illumina Miseq platform, to identify single nucleotide variants (SNVs), insertion-deletions (indels) at an allele frequency above 1%. Genome-wide SNP genotyping with Infinium Global Diversity Array (v1.0) is used for copy number variant (CNV) identification. Areas of visible changes/abnormal appearing mucosa are also brushed and are tested for the aforementioned genetic changes, as well as for cytology and DNA ploidy. Circulating plasma and serum biomarkers will be evaluated at the end of the study. Results The study is ongoing. 20 HC and 17 FA patients have completed the study to date. Median age of the HC and FA cohorts were 36.3 years (range 23-61) and 31.8 years (range 15-50), respectively. Sex distribution was similar with males consisting of 44% and 53% in the HC and FA cohorts, respectively. The HC cohort included significantly more tobacco smokers and alcohol consumers than the FA cohort (33.3% vs. 0 for smokers, and 83.3% vs.17.6% for alcohol consumers, in the HC vs. FA cohorts, respectively, p<0.05). Using an optimized DNA isolation protocol, we were able to obtain sufficient amount of high molecular weight DNA, for each of the six sites brushed. Both freshly collected and stored samples were successfully used for molecular studies. Storing of HC samples in SurePath preservation solution, for an average duration of 55 days, did not impair DNA yield or sequencing data. No somatic molecular changes were evident in the oral mucosa of the healthy controls (n=18) in over 100 samples taken. At least one somatic molecular change was evident in most participants with FA. Five out of the 15 participants (33.3%) in the FA cohort tested positive for 10 different clinically significant somatic TP53 SNVs. At least one CNV was detected in samples sequenced from non-lesional oral mucosa in 10 out of 15 FA participants (66.7%), with numerous samples testing positive for multiple CNVs. The most frequently observed CNV was chromosome 9p isodisomy, observed in 6/15 participants (40%). Molecular analysis of 13 brushed lesions demonstrated 2 distinct clinically significant TP53 somatic variants in one lesion and multiple CNVs in 3 lesions, all from one individual with FA. Cytology and DNA ploidy analyses were negative in 2 lesions, the third lesion showed suspicious cytology, resulting in a surgical biopsy, which was negative. Analysis of additional samples and recruitment of FA participants is ongoing. Conclusions This study validates noninvasive screening applications for identification of somatic molecular changes in the normal-appearing mucosa in patients with FA. Further studies will assess if these changes can be used as surrogate biomarkers of a short-term outcome for the evaluation of preventative treatment effectiveness in FA-associated oSCC and early diagnosis.

Oral Health Status of School-Going Children Aged 12-15 Years in Tiruvallur District, Tamil Nadu- A Cross-Sectional Study

Introduction and Aim: Oral health can have dire consequences on the physiological and psychosocial aspects of a child’s well-being. The prevalence of oral diseases among children varies with region and population subgroups. It is necessary to assess the oral health of children as this epidemiological data will serve as the foundation for developing appropriate preventive and treatment strategies. Hence, the aim of this study was to assess the oral health status of school going children aged 12-15 years in Tiruvallur district of Tamil Nadu, India. Methodology: This cross sectional study was conducted among 842 children aged 12-15 years who were chosen following a multistage random sampling technique. The oral health status of the children was assessed using Oral Hygiene Index- Simplified (OHI-S), Loe and Silness' Gingival Index (GI), Decayed Missing Filled Teeth (DMFT) index in permanent teeth, and the presence or absence of fluorosis & oral premalignant lesions (OPML). The recorded data was then subjected to statistical analysis. Results: The prevalence of gingivitis in the population was 53.4%. The highest mean DMFT was seen among males aged 12-13 years (3.20 +/- 3.102) and the least mean DMFT was seen among females aged 14-15 years (2.76 +/-2.67). 1.3% of the population had tobacco pouch keratosis and 10.8% of the population exhibited dental fluorosis. Conclusion: This study has established that the children of Tiruvallur exhibit poor oral health status. Data from this study can serve as a valuable contributor to the development of oral health initiatives with the ultimate goal being improvement in oral health.

Smokeless Tobacco: A Comprehensive Review of Molecular Effects, Societal Perception, and Cessation Strategies

Smokeless tobacco (ST) is an alternative to smoking, which involves not the burning of tobacco. Although ST has been used for thousands of years, its health effects are not well characterized, and it is the subject of misconceptions throughout society. Therefore, it is crucial to identify the risks associated with ST use. We conducted a comprehensive search of the scientific literature to identify studies reporting associations between tobacco chewing and the risk of oral cancer and premalignant lesions. Our review discusses the molecular mechanisms associated with ST components, along with the role of ST use in speech impairment and cancer progression. We also examine the effectiveness of tobacco cessation strategies and review the existing perceptions held by ST consumers. Our findings indicate significant health risks associated with ST use, including increased cancer risk and speech impairments. As societal perceptions and misconceptions about ST are important factors that influence its use, there is a need for comprehensive public awareness campaigns to correct these misconceptions and to promote healthier lifestyle choices. We call for further research to improve cessation interventions and to increase public awareness of relevant research discoveries. By providing a thorough discussion of the health impacts of ST, we aim to inform policy decisions and public health strategies to reduce the prevalence of ST use.

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.

A Review of Immunotherapy for Head and Neck Cancer

The introduction of immune checkpoint inhibitors (ICIs) to oncological care has transformed the management of various malignancies, including head and neck squamous cell carcinoma (HNSCC), offering improved outcomes. The first-line treatment of recurrent and malignant HNSCC for many years was combined platinum, 5-fluorouracil, and cetuximab. Recently, the ICI pembrolizumab was approved as a first-line treatment, with or without chemotherapy, based on tumor and immune cell percentage of programmed-death ligand 1 (PD-L1). Multiple head and neck (HN) cancer trials have subsequently explored immunotherapies in combination with surgery, chemotherapy, and/or radiation. Immunotherapy regimens may be personalized by tumor biomarker, including PD-L1 content, tumor mutational burden, and microsatellite instability. However, further clinical trials are needed to refine biomarker-driven protocols and standardize pathological methods to guide combined regimen timing, sequencing, and deescalation. Gaps remain for protocols using immunotherapy to reverse oral premalignant lesions, particularly high-risk leukoplakias. A phase II nonrandomized controlled trial, using the ICI nivolumab, showed a 2-y cancer-free survival of 73%, although larger trials are needed. Guidelines are also needed to standardize the role of dental evaluation and care before, during, and after immunotherapy, specifically in regard to oral immune-related adverse events and their impact on cancer recurrence. Standardized diagnostic and oral care coordination strategies to close these gaps are needed to ensure continued success of HN cancer immunotherapy.

Abstract A092: Tobacco use and prevalence of oral premalignant lesions, among Malayali tribes, Yelagiri Hills, Tamil nadu, India

Abstract BACKGROUND: India has the second largest tribal population of the world next to the African countries. About half of the world’s autochthonous people live in India, thus making India home to many tribes which have an interesting and varied history of origins, customs and social practices. The present study was conducted to assess the tobacco use and prevalence of precancerous lesions and oral cancer among Malayali tribes, Yelagiri Hills, Tamil nadu, India. METHODOLOGY The inhabitants of the 14 villages of the Yelagiri hills, who have completed 18years and residing for more than 15years present on the day of examination and who were willing to participate in the study were included. Data was collected from a cross-sectional survey, using a Survey Proforma, clinical examination and a pre-tested questionnaire. An intra-oral examination was carried out by a single examiner using WHO Oral Health Surveys – Basic Methods Proforma (1997). ResultsThe overall prevalence of smokeless and smoking tobacco was 78.8% and 65.2% respectively among 1550 study population. Of those who had the habit of smoking, 26% smoked beedi, 10.9% smoked cigarette, 65% chewed raw tobacco, 18% chewed Hans and 28% had a combination of smoking and smokeless tobacco usage. Around 49.8% of samples were stained positive for precancerous and cancerous lesions of the oral cavity. The highest number of positive samples were from buccal mucosa with 46.2% subjects and 12% for labial mucosa. The reason for practicing these habits were as a measure to combat the cold, relieving stress and body pain after work, and the lack of awareness of the hazards of the materials used. Prevalence of oral mucosal lesions in the study population was due to tobacco usage and alcohol consumption and lack of awareness regarding the deleterious effects of the products used. CONCLUSION Oral cancer is highly prevalent in this Malayali tribes owing to high tobacco consumption rates and habits warranting the cessation center a priority. Also, early detection and screening are vital to attaining better outcomes. Citation Format: Delfin Lovelina Francis. Tobacco use and prevalence of oral premalignant lesions, among Malayali tribes, Yelagiri Hills, Tamil nadu, India [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A092.

Differences in the Expression of Autophagy Markers Microtubule-Associated Protein Light Chains 3A and 3B in Oral Premalignant Lesions and Oral Squamous Cell Carcinoma: A Cross-Sectional Study.

Background Microtubule-associated protein light chains (LC) 3A and 3B are the structural proteins of the autophagosomal membrane widely used as endogenous autophagy markers. LC3A and LC3B autophagosomes reportedly have a distinct subcellular localization yet their role in the transition from premalignant to malignant phase remains unclear. This exploratory study aimed to investigate the expression of autophagy-related proteins LC3A and LC3B in oral premalignant lesions (OPL) and oral squamous cell carcinoma (OSCC) cases. Methodology A cross-sectional study was conducted on 100 OPL and 39 OSCC samples. OPL samples comprised both dysplastic and non-dysplastic lesions. The expression of LC3A and LC3B markers was evaluated in the study samples using immunohistochemistry and associated with dysplasia in OPL and with invasive OSCC versus OPL. Fisher's exact test was used for statistical analysis. Results There was a higher ratio of LC3A positivity in non-dysplastic OPL (31/38) compared to dysplastic premalignant lesions (36/62, p=0.017). There was a higher ratio of LC3B positivity in dysplastic OPL (16/62) compared to non-dysplastic lesions (4/38) with a trend towards statistical significance (p=0.075). There was no statistical difference in the ratio ofLC3A positivity between OSCC (23/39) and premalignant (67/100) lesions, while the ratio of LC3B marker positivity was higher in OSCC cases (18/39) relative to premalignant lesions (20/100, p=0.003). Conclusion Autophagy-related proteins LC3A and LC3B may have different roles to play in a disease context manner. LC3A is likely to be negatively associated with dysplasia in OPL while LC3B expression is positively associated with carcinogenesis of OSCC, possibly including dysplasia.

Efficacy of Aminolevulinic Acid Mediated Photodynamic Therapy in the Treatment of Oral Premalignant Lesions: A Systematic Review.

Aminolevulinic acid (ALA) mediated photodynamic therapy (PDT) is considered as an effective treatment option for oral premalignant lesions. ALA is a Food and Drug Administration (FDA) approved second-generation photosensitizer (PS) used both orally as well as topically. This systematic review aims to evaluate the efficacy of ALA-PDT for the treatment of oral premalignant lesions. The focused question was, "Is ALA-PDT effective in the treatment of oral premalignant lesions?"A literature search was made in PubMed/Medline and GoogleScholar using different combinations of the following keywords: photodynamic therapy, oral premalignant lesions, oral leukoplakia (OL), erythroplakia, oral erythroleukoplakia (OEL), oral verrucous hyperplasia (OVH); and oral lichen planus (OLP). Review articles, preclinical studies, case-reports, commentaries, letters to the Editor, unpublished articles, studies on photodynamic therapy used in areas other than the oral cavityand, articles published in languages other than English were excluded. The relevant information was summarized. There were initially 64 results for the above parameters; 47 studies were excluded, leaving 17 studies for analysis. Characteristics of the included studies, PS, and PDT protocol were summarized. The outcome of the included studies suggested that ALA-PDT is an effective, easy to perform technique, well tolerated treatment with encouraging achievements in the treatment of oral premalignant lesions. No systemic side effects and skin photosensitivity were reported with topical ALA even within initial 48 hours after PDT, and patients were not required to avoid exposure to light following treatment. The clinical outcome of the ALA-PDT application, as reported in the studies, was also very promising, with either diminution in the size of the lesion or complete remission or improvement in signs and symptoms as well as reduced recurrence.

Clinicopathological risk factors of oral second primary tumours

BackgroundOral second primary tumours (SPTs) have a poor prognosis due to late-stage diagnosis. This study evaluates the demographic and clinicopathological risk predictors of SPTs. MethodsPatients with oral squamous cell carcinoma, carcinoma in situ, or severe dysplasia were accrued into the Oral Cancer Prediction Longitudinal study within one year post-curative treatment. Data on demographics, risk habits, and primary tumour characteristics were collected. Clinical follow-up included assessing the presence of second oral premalignant lesions (SOPLs), clinicopathological features, and the results from toluidine blue staining and fluorescence visualization. ResultsAmong 296 patients, 23 (8 %) developed SPTs. Older age at primary cancer diagnosis (P = 0.008) and a history of chewing tobacco or betel nut (P = 0.043) increased the risk of SPTs. Patients with primary tumours located at low-risk sites had an increased risk of SPTs (P = 0.004), which often presented at high-risk sites. The presence of SOPLs (P < 0.001), and multiple lesions (P = 0.017) significantly increased the risk of SPTs. Positive toluidine blue staining indicated a trend toward higher risk of SPTs, whereas fluorescence visualization did not. The median time to SPT diagnosis was 3.25 years post-treatment. ConclusionsIdentifying second or multiple oral premalignant lesions is critical for predicting the risk of SPTs regardless of their clinical or histological characteristics. Routine biopsy of these lesions should be prioritized to ensure timely diagnosis. Incorporating these risk predictors into clinical follow-up can enhance early cancer detection and improve patient outcomes.

Immunohistochemical Verification of Oral Dysplasia, Premalignant Lesions and Oral Cancer by Use of Varied Expression of Cytokeratins; A Review

Oral cancer, predominantly squamous cell carcinoma, carries high morbidity and disease burden all over the world. Evaluation of the cellular basis of oral carcinogenesis has implied dysregulation in cytokeratins as one of the contributory factors. These intermediate filament proteins of the oral epithelium, guardian of cellular architecture, are known to maintain cellular interactions and are involved in various cell cycle regulation pathways. Oral premalignancy and neoplastic progression are often depicted by disturbed and/or haphazard expression of these cytokeratins. We present a summarized analysis of cytokeratins and explore their diagnostic potential using immunohistochemistry. CK 8/18 is a significant and reliable biomarker of oral precancer and cancer that can be utilized in addition to histopathology for early malignancy screening and intervention. Moreover, dysplastic oral lesions are attributed to downregulation and/or gradual disappearance of CK 4/13, CK 5/14, and expression of CK 17. Increasing the diagnostic strategy using immunohistochemical techniques on specific cytokeratins and extensive sample studies on premalignant lesions, dysplasia, and oral squamous cell carcinoma can open up many possibilities. Utilizing the enhanced diagnostic spectrum of specific cytokeratins can help clinicians and dental specialists diagnose early, thus timely managing and alleviating suffering associated with oral cancer.

Evaluation of Immunohistochemical Marker Bcl-2 in Epithelial Dysplasia and Squamous Cell Carcinoma of the Oral Cavity.

Squamous cell carcinoma of the oral cavity is the most common malignancy noted globally.Pathogenesis of premalignant and malignant oral lesions is mainly attributed to the alteration in the molecular mechanisms that regulate apoptosis and cell proliferation. B-cell lymphoma gene 2 (Bcl-2) is the anti-apoptotic gene that prolongs cell survival by inhibiting apoptosis and is associated with the aggressive behaviour of malignant tumours. The aim of the study was to evaluate Bcl-2 expression in oral squamous cell carcinoma and dysplastic lesions of the oral cavity and to compare its expression with various grades of dysplasia and carcinoma. A hospital-based cross-sectional study was done on 80 clinically suspected cases of dysplastic and malignant oral cavity lesions received in the histopathology section of the Department of Pathology of Shri BM Patil Medical College Hospital and Research Center, Vijaypura, Karnataka. Out of 80 cases, 40 were squamous cell carcinoma, and 40 were dysplastic lesions of the oral cavity. For each case, two sections measuring 4 μm thickness were prepared. Hematoxylin and eosin staining was performed on one section, and Bcl-2 IHC staining was performed on another. Bcl-2 expression evaluation was done for each case of oral epithelial dysplasia and squamous cell carcinoma. Out of 40 cases of squamous cell carcinoma, 15 were well-differentiated, 22 were moderately differentiated, and three were poorly differentiated. In well-differentiated oral squamous cell carcinoma, Bcl-2 positivity was grade 0 in 66.7% of cases and grade 1 in 33.3% of cases. In moderately differentiated oral squamous cell carcinoma, Bcl-2 positivity was grade 1 in 63.6% of cases and grade 2 in 36.4% of cases. In poorly differentiated oral squamous cell carcinoma, Bcl-2 positivity was grade 1 in 33.3% and grade 2 in 66.7% of cases. Out of 40 cases of dysplastic lesions, 11 cases showed severe dysplasia, 11 cases showed moderate dysplasia and 18 cases showed mild dysplasia. grade 2 positivity was seen in 72.7% of cases of severe dysplasia and 63.6 % of cases of moderate dysplasia. In mild dysplasia, all of the cases showed grade 0 Bcl-2 expression. In poorly differentiated oral squamous cell carcinoma Bcl-2 positivity was high and low in well-differentiated oral squamous cell carcinoma. Bcl-2 expression was higher in severe dysplasia compared to moderate dysplasia, which may indicate aggressive behaviour of tumour in poorly differentiated oral squamous cell carcinoma and severe dysplasia.

Advancements in diagnosing oral potentially malignant disorders: leveraging Vision transformers for multi-class detection

ObjectivesDiagnosing oral potentially malignant disorders (OPMD) is critical to prevent oral cancer. This study aims to automatically detect and classify the most common pre-malignant oral lesions, such as leukoplakia and oral lichen planus (OLP), and distinguish them from oral squamous cell carcinomas (OSCC) and healthy oral mucosa on clinical photographs using vision transformers.Methods4,161 photographs of healthy mucosa, leukoplakia, OLP, and OSCC were included. Findings were annotated pixel-wise and reviewed by three clinicians. The photographs were divided into 3,337 for training and validation and 824 for testing. The training and validation images were further divided into five folds with stratification. A Mask R-CNN with a Swin Transformer was trained five times with cross-validation, and the held-out test split was used to evaluate the model performance. The precision, F1-score, sensitivity, specificity, and accuracy were calculated. The area under the receiver operating characteristics curve (AUC) and the confusion matrix of the most effective model were presented.ResultsThe detection of OSCC with the employed model yielded an F1 of 0.852 and AUC of 0.974. The detection of OLP had an F1 of 0.825 and AUC of 0.948. For leukoplakia the F1 was 0.796 and the AUC was 0.938.ConclusionsOSCC were effectively detected with the employed model, whereas the detection of OLP and leukoplakia was moderately effective.Clinical relevanceOral cancer is often detected in advanced stages. The demonstrated technology may support the detection and observation of OPMD to lower the disease burden and identify malignant oral cavity lesions earlier.

Prevalence of Premalignant Conditions and Their Transformation Into Oral Cancers: A Clinical Study.

The purpose of this study is to look at how often premalignant oral diseases are among patients who visit a tertiary care center, as well as how often these problems progress to become mouth malignancies. Between 2017 and 2022, 200 patients at a tertiary care facility who were identified with premalignant oral lesions had their medical records retrospectively examined. Information on lesion features, histological results, and demographics was gathered. Statistical analysis was used to determine the prevalence of premalignant oral lesions and the rate at which these lesions turned into oral malignancies, with a significance threshold of P < 0.05. The research population's mean age was 55 years (SD ± 10), with a 65% male preponderance. The most prevalent premalignant lesions were leukoplakia (45%), erythroplakia (30%), and oral submucous fibrosis (25%). Remarkably, during follow-up, 40% of patients showed development of premalignant lesions into mouth malignancies. Based on statistical analysis, there were significant correlations (P < 0.05) between dysplastic alterations, age, tobacco use, and the development of oral malignancies from premalignant lesions. In conclusion, this study highlights the need of early diagnosis and focused therapies in tertiary care settings by offering important insights into the occurrence and evolution of premalignant oral lesions. The results provide important information that may be used to create screening programs and preventive measures that will lessen the incidence of oral cancer.

Exploring the prevalence and risk factors of benign and premalignant oral lesions in an adult population from Northern Spain: a pilot study.

The goal was to identify the lifestyle risk factors associated with benign and potentially malignant oral disorders. The study enrolled first-time patients from the Oral Pathology Section, volunteers from Oviedo, and first-time patients from the University of Oviedo dental clinic. Patients underwent a survey that included sociodemographic information, lifestyle habits, and medical history. A comprehensive examination of the oral mucosa was conducted. Univariate and multivariate logistic regression were conducted using R software. Among the 183 participants, the most prevalent lesions were varicose veins (43.20%), cheek/lip biting (34.97%), and coated tongue (33.33%). Among the oral potentially malignant disorders (16.39%) were oral lichen planus (12.64%) and leukoplakia (3.33%). Tobacco was associated with melanotic pigmentation (OR 3.87, P = .001) and coated tongue (OR 5.90, P = .001). Longer intervals since the last check-up were associated with traumatic keratosis (OR 2.95, P = .031). Age and heavy smoking were found to have higher risk of developing an oral potentially malignant disorder (OR 1.04, P = .035, and OR 7.35, P = .028, respectively). These data should be considered when organizing public health programs focused on the detection and screening of heavy smokers. It is also important to strengthen the oral pathology units in universities as reference centers for students to acquire the necessary knowledge for their diagnosis and treatment, while simultaneously promoting awareness of this risk factor for oral precancer among the general population.

Evaluation of Candidal Species in Oral Submucous Fibrosis and Oral Lichen Planus: A Microbiological Study

Background: Candida is opportunistic microorganisms in oral cavity, causes oral candidiasis. The presence of candida and subspecies in oral premalignant lesions may intensify the infection and transform pre malignant lesions into cancer. Objective: To isolate various types of candida species, among Oral submucous fibrosis (OSMF) and Oral lichen Planus (OLP) patients. Methodology: Total 60 individuals included and grouped as; OSMF (n=20) group A, Lichen Planus (n=10); group B and Controls (n=30) group C. Results: The higher candida carriage revealed in OSMF+ OLP groups (23.3%) as compared to controls (10%). The species level findings showed 13.3% of candida albicans in OSMF+ OLP and 6.7% in controls, candida krusei 6.7% in OSMF+ OLP and 3.3% in controls and non candida albicans were 10% in OSMF+ OLP and 6.7% in control group respectively. Conclusion: This basic understanding of candida species and their association with potentially malignant disorders will help in better interventions, so as to restrict the lesion before it transform in to malignancy.

Profile and Prevalence of Oral and Maxillofacial Diseases Among Armed Forces Personnel and Their Families in Military Dental Centre, Cumilla

Background: Oral and maxillofacial diseases encompass a wide range of conditions in and around oral cavity and in maxillofacial region. It includes maxillofacial trauma, cyst and tumour of jaw bones, conditions involving impacted wisdom teeth, oral premalignant and malignant lesions, fascial space infection around maxillofacial region, temporomandibular joint disorder, dental implantology, salivary gland disorder and congenital defects of jaw bones. Maxillofacial region is more vulnerable to sustain injuries in the battlefield. In peace time, various maxillofacial diseases reduce the overall performances of the troops. The aim of this study is to delineate rank wise distribution of armed forces personnel reported with maxillofacial diseases, gender distribution, types of maxillofacial diseases, different types of surgical procedures performed and types of anesthesia used. Methods: A descriptive cross-sectional study was conducted to assess the prevalence of maxillofacial diseases among the armed forces personnel and their entitled family members during the period of 1st January 2019 to 31st December 2019 in Military Dental Centre, Cumilla. Purposive sampling technique and semi structured questionnaire was used to include the patients in this study.Data were analyzed by using Statistical Packages for Social Sciences (SPSS) version 25. Results: A total of 170 cases were evaluated and treated. Male patients were 110(65%) and female were 60(35%). Among the military personnel numbers of sainik (privates) were highest 32(35%). Impacted wisdom teeth cases were mostly found 80(47%). In case of impacted teeth mesio angular impactions were most 35(35%). In case of maxillofacial pathological conditions cystic lesions were most in number 22(39%) (n=56). Maxillofacial soft tissue laceration cases were highest 05(29%) (n=17) among all trauma patients. Surgical extraction of wisdom teeth were mostly performed surgery 80(59%) (n=138). In regards to administration of anesthesia, 128(93%) cases were performed under local anesthesia and 10(7%) were under general anesthesia. Conclusion: The present study imparts valuable perception about the types and prevalence of maxillofacial diseases and the treatment modalities among the armed forces personnel and their families in Cumilla area. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 24-30

About a Possible Impact of Endodontic Infections by Fusobacterium nucleatum or Porphyromonas gingivalis on Oral Carcinogenesis: A Literature Overview.

Periodontitis is linked to the onset and progression of oral squamous cell carcinoma (OSCC), an epidemiologically frequent and clinically aggressive malignancy. In this context, Fusobacterium (F.) nucleatum and Porphyromonas (P.) gingivalis, two bacteria that cause periodontitis, are found in OSCC tissues as well as in oral premalignant lesions, where they exert pro-tumorigenic activities. Since the two bacteria are present also in endodontic diseases, playing a role in their pathogenesis, here we analyze the literature searching for information on the impact that endodontic infection by P. gingivalis or F. nucleatum could have on cellular and molecular events involved in oral carcinogenesis. Results from the reviewed papers indicate that infection by P. gingivalis and/or F. nucleatum triggers the production of inflammatory cytokines and growth factors in dental pulp cells or periodontal cells, affecting the survival, proliferation, invasion, and differentiation of OSCC cells. In addition, the two bacteria and the cytokines they induce halt the differentiation and stimulate the proliferation and invasion of stem cells populating the dental pulp or the periodontium. Although most of the literature confutes the possibility that bacteria-induced endodontic inflammatory diseases could impact on oral carcinogenesis, the papers we have analyzed and discussed herein recommend further investigations on this topic.