Oral Premalignant Research Articles

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.

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.

Oral Pre-malignancy: An Update on Novel Therapeutic Approaches.

This review aims to provide a comprehensive overview of the current advances in managing and preventing progression of oral potentially malignant disorders (OPMDs), focusing on their histological and clinicopathological features, and management. Recent studies, including a multicenter cross-sectional study, have identified oral leukoplakia as the most prevalent form of OPMD, comprising over half of the cases examined. Advances in histological grading, specifically the World Health Organization's three-tier system (mild, moderate, and severe dysplasia), have significantly enhanced the accuracy of risk assessment for malignant transformation. Additionally, treatments such as surgical interventions, photodynamic therapy, and chemopreventive and molecularly targeted agents are being evaluated for their safety and efficacy as well as, immune checkpoint inhibitors being evaluated as potential preventive strategies to halt the progression of OPMDs. The management of OPMDs remains challenging due to the lack of standardized screening protocols and varied clinical management approaches. Despite this, recent advancements in diagnostic grading and therapeutic interventions provide a framework for improved treatment outcomes. Continued research into the molecular and cellular mechanisms driving development and progression of OPMDs and innovative treatment trials are essential to optimize strategies that prevent malignant progression and thereby reduce the global health burden of oral cancer.

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

Past, Present, and Future Diagnostic Methods for the Early Noninvasive Detection of Oral Premalignant Lesions: A State of the Art and Systematic Review.

Objectives: To provide an in-depth analysis of noninvasive methods for the early diagnosis of oral premalignant lesions, focusing on novel biomarkers and optical technologies, and to discuss their potential in improving the prognosis of patients with oral oncological diseases. Methods: This state-of-the-art review examines various noninvasive diagnostic techniques, including the utilization of salivary microRNAs and optical technologies such as Raman spectroscopy, elastic scattering spectroscopy, diffuse reflectance spectroscopy, narrow-band imaging, autofluorescence imaging, toluidine blue staining, and microendoscopy. Results: Several noninvasive techniques have shown varying degrees of effectiveness in detecting oral cancer. Autofluorescence imaging exhibited sensitivities up to 100% but had variable specificity. toluidine blue staining reported sensitivity between 77% and 100% for high-risk lesions or cancer, with specificity around 45% to 67%. Spectroscopy techniques achieved 72% to 100% sensitivities and specificities of 75% to 98%. Microendoscopy presented a sensitivity of 84% to 95% and a specificity of 91% to 95%. Conclusion: The review highlights the strengths and limitations of each noninvasive diagnostic method and their recent advancements. Although promising results have been demonstrated, there is a need for further development of reliable strategies for early detection and intervention in oral oncology.

370 Point-of-Service Salivary Microbiome Analysis in the Prevention and Detection of Oral Premalignant Lesions

OBJECTIVES/GOALS: Our aim is to establish soluble salivary biomarkers indicative of increased risk of oral premalignancy to be used in a point-of-service technology. Our goal is to non-invasively assess risk level for premalignancy by characterizing a molecular signature pattern that can be applied to such a diagnostic tool at routine dental or medical visits. METHODS/STUDY POPULATION: Adult patients 18 years of age and older who are non-smokers and patients of the University of Maryland School of Dentistry Oral Medicine Clinic and have been diagnosed with oral premalignancy (proliferative verrucous leukoplakia) are eligible. Exclusion criteria include history of immunosuppression or immune compromise; use of antifungal, antibiotic, and/or antiviral medications within the past three months; and gross dental disease. Serial unstimulated saliva samples will be collected at baseline or diagnosis of oral premalignancy, 6 months and 12 months. Solubility testing will be completed to determine whether malignant markers such as EGFR/mTOR/PI3K/p53 are soluble in saliva, and patient samples will be analyzed by ELISA and compared to appropriate controls. RESULTS/ANTICIPATED RESULTS: We anticipate demonstrating increased activity of molecular pathways known to be involved in malignant transformation, such as EGFR/mTOR/PI3K/p53, or increased burden of select microbial pathogens to be associated with increased risk of oral premalignancy in the form of proliferative verrucous leukoplakia. Preliminary sensitivity and specificity testing of the identified markers will provide additional insight to the utility of a diagnostic tool with salivary specimen. Therefore, the microbiome and/or molecular profile proposed from these results will serve as a translational application to development of future point-of-service test devices to be used in the prevention and detection of oral premalignant lesions. DISCUSSION/SIGNIFICANCE: Oral cancer is the sixth most common cancer worldwide, and presents challenges in its diagnosis and clinical management. Later diagnosis is associated with poorer patient outcomes—therefore, a molecular and microbiome profile that may be used in a noninvasive diagnostic test technology would prove beneficial to providers and patients.

Knowledge and Awareness of Detecting Oral Premalignant Lesions among Dental Students, Interns, and Practitioners in Saudi Arabia.

Oral malignant lesions are the most common malignancy of which majority are diagnosed in advanced stages in Saudi Arabia. Patients with oral malignant lesion are first seen by general dental practitioners and dental students. Multiple surveys have been conducted and published to assess the students, interns, and dentists' awareness and attitude toward oral premalignant lesions worldwide. However, little is known about this issue in Saudi Arabia. We aimed to assess knowledge and awareness of detecting oral premalignant lesions among dental students, dental interns, and practitioners in Saudi Arabia. A cross-sectional questionnaire-based survey was conducted and electronically distributed. The questionnaire comprised of three sections including demographic variables, knowledge of risk factors of oral malignancy, and six clinical case scenarios. Descriptive statistics were used, and the results were reported using cross-tabulation and the Chi-square test. A 300 participants answered to the questionnaire, and 83% of respondents strongly agreed that smoking is a risk factor for oral malignancy. However, there was some uncertainty in responses for some more specific oral-related factors, such as a sharp-edged tooth and irritation from dental restoration. Furthermore, the knowledge and awareness of detecting frankly benign and frankly malignant lesions such as fibroma and squamous cell carcinoma are higher comparing to potentially malignant lesion, i.e. lichen planus. Knowledge and awareness of detecting oral premalignant lesions vary based on malignancy factors and by participants academic level. Fibroma and SCC are detected easily among all participants. However, lichen planus was the hardest to diagnose among oral lesions.

Whole-Slide Imaging (WSI) Versus Traditional Microscopy (TM) Through Evaluation of Parameters in Oral Histopathology: A Pilot Study.

histopathology plays a pivotal role in clinical diagnosis, research, and medical education. In recent years, whole slide imaging (wsi) has emerged as a potential alternative to traditional microscopy for pathological examination. This study aims to provide a comprehensive comparison of wsi and traditional microscopy(tm) in various aspects of histopathology practice. In this study, total of 30 cases comprising of oral premalignant and malignant cases which were diagnostically challenging was considered from the archives of the institute for validation. The slides were scanned with slide scanner and were evaluated by histopathologists. The comparative parameters which were noted were diagnostic discordances, number of fields observed to reach the diagnosis and time taken. The mean time taken by the pathologists to reach the diagnosis was significantly less in whole slide imaging technique. The average number of fields observed was higher by using wsi that too in a lesser time compared to tm, the results were found to be statistically significant with p=0.001.however the diagnostic disparity were seen to be maximum for verrucous lesions both in wsi and tm. wsi has facilitated the specialty with rapid mode of diagnosis in a more efficient and error less manner. It has also aided in case banking as well as research possibilities. Hence with the advent of telepathology it is very much necessary to get trained with wsi as early as possible so that the professionals can render correct diagnosis.

Salivary Neutrophil-to-Lymphocyte Ratio as a Prognostic Predictor of Oral Premalignant and Malignant Disorders: A Prospective Study.

Inflammation is a definitive characteristic of carcinogenesis. The neutrophil-to-lymphocyte ratio (NLR) is an easy and efficient indicator of inflammation and a valuable marker in individuals with malignancies. The present study was performed to ascertain NLR values in salivary samples collected from individuals with oral premalignant disorders (OPMDs) and to assess the prognostic significance of NLR in distinguishing OPMDs from oral malignancies. This study was conducted on 50 patients histopathologically diagnosed with OPMDs with mild dysplasia. The patients were provided with standard medicinal treatment, encouraged to quit their habits, and followed up for one year at three-month regular intervals. During the follow-up, 29 (67.4%) patients completely recovered, whereas 14 (32.6%) developed oral malignancies. Salivary samples were collected at baseline (T0) and one-year follow-up (T1). The total salivary neutrophils and lymphocytes were counted using an improved cell counting method with a Neubauer chamber. The NLR values were calculated at T0 and T1. The paired t-test was used to compare the NLR values at T0 and T1. The cutoff value of the NLR was determined using the receiver operating characteristic (ROC) curve. The Youden index was used to determine the optimal cutoff NLR values in the groups. Statistical significance was set at p ≤0.05. OPMDs were predominantly observed in males, with leukoplakia being the most prevailing one. Erythroplakia exhibited the highest propensity for malignant transformation, and habitual consumption of alcohol and tobacco was identified as a risk factor for this transformation. NLR increased in both premalignant and malignant conditions. NLR value equal to or exceeding 4 was determined to be a reliable indicator for the occurrence of oral cancer in patients with OPMDs. The ROC curve analysis yielded a sensitivity and specificity of 92%, with an area under the curve (AUC) of 0.928. The poor prognosis of oral cancers was associated with higher NLR values. NLR values in salivary samples can serve as an independent reliable predictor in oral cancer and OPMDs.

Perspectives on oral tissue biopsy surgery for patients with oral premalignant and malignant lesions

Perspectives on oral tissue biopsy surgery for patients with oral premalignant and malignant lesions

A Comparative Study of the Treatment of Oral Premalignant Lesions with Surgical Excision and Medical Therapy.

Potentially malignant oral epithelial lesions are a group of oral conditions with an altered morphological state of the normal mucosal lining and include different lesions such as leukoplakia, erythroplakia, submucosal fibrosis, and lichen planus. To compare the outcome of premalignant oral lesions after medical therapy consisting of submucosal intralesional injection of triamcinolone with hyaluronidase and surgical excision. This was a comparative prospective interventional study and the study was conducted among 50 patients presented to the Department of Otorhinolaryngology with premalignant oral lesions from the year 2020 to 2022. Patients were divided into two groups by random allocation, group A was treated with medical therapy, and Group B was treated with surgical excision and followed for a minimum of 6months and the outcome has been categorized. All patients were divided into two groups-group A and group B, group A consisted of 22 (44%) patients who were given medical therapy, and group B consisted of 28 (56%) patients who underwent surgical excision. In group A, the clinical response was seen in 8 (36.36%) and in group B, the clinical response was seen in 18 (64.29%) patients. Surgical excision was found to be better with more cases of clinical response (64.29%) when compared to medical treatment (36.36%) with a p value of 0.0497 which is significant whereas malignant transformation was almost equal in medical therapy and surgical treatment which was 13.64% and 14.28%, respectively.

Immunohistochemical Approach to Evaluate and Compare the Expression of CD44 in Oral Premalignant Disorders and Oral Squamous Cell Carcinoma - A Retrospective Study

Immunohistochemical Approach to Evaluate and Compare the Expression of CD44 in Oral Premalignant Disorders and Oral Squamous Cell Carcinoma - A Retrospective Study

A Clinicopathological Evaluation of Oral Cavity Lesions and the Role of Cytokeratin 8/18 as a Marker in Oral Premalignant and Malignant Lesions: A Hospital-based Cross-sectional Study

Introduction: The oral cavity is affected by a wide range of pathologic lesions that may originate from squamous mucosa, salivary glands, mesenchymal structures and lymphoid tissue. Alterations in Cytokeratin (CK) patterns have been reported in oral potentially malignant and malignant lesions, and its expression is a hallmark of tumour progression. Aim: To evaluate different oral cavity lesions, with an emphasis on using Cytokeratin 8/18 (CK8/18) to differentiate between benign, premalignant and malignant lesions. Materials and Methods: The present hospital-based crosssectional observational study was conducted in the Departments of Pathology and Otorhinolaryngology, Fakhruddin Ali Ahmed Medical College and Hospital, Barpeta, Guwahati, Assam, India, from September 2020 to August 2021. A total of 93 biopsied or resected specimens clinically presenting in the Otorhinolaryngology Department with oral cavity lesions were submitted to the Department of Pathology, Fakhruddin Ali Ahmed Medical College and Hospital for histopathological examination followed by Immunohistochemistry (IHC) with CK8/18 in all the tissue samples as per IHC protocol. Age, gender, clinical presentation and sites of lesions were also assessed, as well as, histopathological evaluation and IHC. All data were collected, compiled and subjected to suitable statistical analysis, such as one-way Analysis of Variance (ANOVA) and Fisher’s exact tests using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 28.0. Microsoft Office Word and Excel 2019 were used to generate graphs and tables. Results: The age of the patients ranged from 9-90 years and mean±Standard Deviation (SD) age was 52.69±15.81 years. Males, 59 (63.4%), were more commonly affected than females 34 (36.6%), with a male-to-female ratio of 1.73:1. Among the 93 various oral cavity lesions, 24 were located on the buccal mucosa, making it the most common site in our study. Of the 42 malignant oral cavity lesions, the most frequent was moderately differentiated Squamous Cell Carcinoma (SCC) with a frequency of 21 cases (50%), followed by well-differentiated SCC with 18 cases, including one case of Verrucous carcinoma. Poorly differentiated SCC was the least frequent, with three cases (7.14%). CK8/18 was positive in 33 of the 42 malignant cases, four out of the 20 dysplasia cases, and all the benign cases were negative for IHC of CK8/18. The maximal intensity of CK8/18 was seen in 13/21 (62%) cases of moderately differentiated oral SCC. Conclusion: In conclusion, the present study on oral cavity lesions in the lower Assam region highlighted the significance of clinical, histopathological and immunohistochemical evaluations, particularly with CK8/18 staining. A predominance of lesions on the buccal mucosa was found, with moderately differentiated SCC being the most common malignant type. CK8/18 expression showed a notable association with malignant lesions, especially in moderately differentiated SCC, suggesting its potential as a diagnostic marker. These findings contribute to a better understanding of oral cavity pathologies and may aid in early detection and management strategies.

Incidence of ABO Blood Groups in Patients with Oral Cancer, Premalignant Conditions, and Lesions: A Prospective Observational Study

Abstract Aim of the Study: The aim was to assess the incidence and to correlate ABO blood groups in patients with oral cancer, premalignant conditions, and lesions. Materials and Methods: It is a prospective observational study. ABO blood grouping was done on 120 cases, of which 60 were with oral cancer, 20 with oral submucous fibrosis, 20 with leukoplakia, and 20 with lichen planus. About 120 healthy subjects were selected after randomization. The obtained data were subjected to statistical analysis. Results: Out of 120 precancerous and cancerous cases, 26 had blood group A (21.6%), 46 had blood group B (38.3%), 5 had blood group AB (4.2%), and 43 had blood group O (35.83%). Among the controls, out of 120 subjects, 24 had blood group A (20%), 40 had blood group B (33.33%), 5 had blood group AB (4.2%), and 51 had blood group O (42.5%). The strength of association between was assessed using the odd’s ratio and found that people with blood group B had 1.24 times higher risk of developing oral precancerous and cancerous lesions compared to people of other blood groups. The relative risk was 1.11 for people with blood group A and 1 for those with blood group AB. The relative risk for people with blood group O was 0.75. Conclusions: In the present study, it was found that people with blood group B are at a greater risk of developing oral malignancies, followed by those with blood group A, AB, and O.

Estimation Of Salivary Copper In Smokeless Tobacco Users With Oral Premaligancies And Malignancies: A Cross Sectional Study

Introduction: The estimation of serum bioelements for the identification of oral premalignant and malignant lesions has been extensively studied. Higher amounts of copper have been found in all smoking and Smokeless Tobacco (SLT) products, which are responsible for the higher incidence of premalignant and malignant lesions in the oral cavity. Limited studies have shown the significance and role of salivary bioelements in premalignant lesions, such as Oral Submucous Fibrosis (OSMF) and oral leukoplakia, and malignant lesions like Squamous Cell Carcinoma (SCC) of the oral cavity. Aim: To estimate salivary copper levels in premalignant and malignant lesions of the oral cavity. Materials and Methods: The preent cross-sectional study was undertaken in Tagore Dental College and Hospital in Chennai, Tamil Nadu, India for a period of 6 months, from March 2022 to August 2022. A total of 50 patients were recruited and divided into five groups of 10 patients each: Group I- control group; Group II- SLT chewing habit without any oral lesion; Group III10 patients with Tobacco Pouch Keratosis (TPK); Group IV- 10 patients with OSMF; and Group V- 10 patients with oral SCC. About 5 mL of salivary samples were collected and centrifuged at 3000 rpm to obtain the supernatant saliva for analysis. The levels of copper were estimated using photo calorimetry. Statistical analysis was done using One-way Analysis of Variance (ANOVA) followed by a Post-hoc test. Results: A total of 50 patients with a mean age of 40±20 years were included in present study, comprising 46% females and 54% males. There was a statistically significant difference (p <0.05) between the mean salivary copper levels in the premalignant lesions of the oral cavity. Within the premalignant group, copper levels were found to be more in OSMF (Group IV: 296.64±56.08) compared to the other groups (Group II: 202.95±125.14; Group III: 229.25±73.35). In the oral cancer patients, no significant difference (p-value=0.174; not less than 0.001) obtained in salivary copper levels. Conclusion: Compared to the control group, salivary copper levels were significantly higher in cases of OSMF, followed by cases of TPK and non lesional cases.

A study to evaluate the role of antioxidants and iron as diagnostic markers in oral cancer

Oral cavity (OC) and oropharyngeal (OP) cancers afflict about 500,000 people globally. Dental health care practitioners need to understand the causes, diagnosis, and treatment of oral cavities and oropharyngeal cancer. The constant and direct exposure of oral mucosal cells to tobacco product chemical carcinogens such as polynuclear aromatic hydrocarbons and nitrosamines causes the generation of free radicals/reactive oxygen species. Changes in salivary antioxidant and micronutrient levels may prove to be an important factor in the pathogenesis of oral premalignant and malignant disorders. The present study aimed to evaluate the levels of Vitamin C, MDA and iron levels in oral cancer, pre-malignant group and the oral cancer group. 15 oral cancer patients, 30 premalignant condition patients, and 15 normal controls were analyzed in the study. Among the 30 patients of the premalignant conditions- group (Group S1) 12 were diagnosed with oral submucous fibrosis, and 18 of them were diagnosed with oral leukoplakia. The oral cancer patients (Group S2) were segregated based on the TNM system from stages I to IV. The oral submucous fibrosis patients were subdivided into four grades. The oral leukoplakia patients were categorized into homogenous and speckled types. A detailed history was obtained from the patients. After obtaining informed consent, saliva samples will be collected from patients who have not consumed any food or any form of tobacco 2 hours before collection. Following a thorough mouth rinse using distilled water, saliva is allowed to accumulate in his or her mouth for 5 minutes. Accumulated saliva is collected by the spit method. 5ml of blood sample will also be collected from these patients, Serum was separated by Centrifugation. Collected serum and saliva were stored at -80℃ until further analysis. The serum and salivary samples were then analyzed for Vitamin C, iron, and malonaldehyde (lipid peroxidation) according to the standardized protocol. In the present study, a total of 60 samples were screened for Vitamin C, Iron, and MDA in both serum and saliva of normal control, premalignant, and oral cancer patients. We found that there was a decreased level of Vitamin C and iron in both serum and saliva of premalignant and oral cancer patients. MDA level was higher in premalignant, and oral cancer patients and there was a significant increase in the level of MDA in oral cancer patients. Understanding antioxidants can help reduce the incidence of oral cancer in its early stages. More study is needed before this supplement may be recommended as an adjuvant treatment.

The effect of synergistic Candida albicans infection with P63 protein expression on the development of oral carcinom

Oral cancer accounts for 2-4% of all cancer cases. There is compelling evidence that suggest that Candida may influence the development of oral cancer by interfering with the expression of the Tp63 gene, which is crucial for tumor progression, and promotes proliferation. The goal was to assess the p63 expression, compare it qualitatively and quantitatively in a normal buccal mucosa, epithelial dysplasia, leukoplakia, and oral squamous cell carcinoma (OSCC), and also determine how does it relate to the Candida albicans infection. A retrospective cross-sectional study of 100 Formalin-Fixed Paraffin-Embedded (FFPE) cases and controls were studied, and they were divided into four groups: Group I, included 40 controls with normal oral mucosa; Group II, included 20 cases of dysplasia; Group III, included 20 cases of leukoplakia, and Group IV, included 20 cases of OSCC. C. albicans was examined by Real-Time PCR based on Erg11 gene and the immunohistochemical expression of p63 protein. Significant overexpression of p63 and positive PCR results of C. albicans were seen in noninvasive lesions (leukoplakia, epithelial dysplasia) and invasive OSCCs with an increased suprabasal expression in cases of leukoplakia and epithelial dysplasia. The mean of labeling index (LI) of p63 with C. albicans positive cases were found to be in increasing order from normal oral mucosa than leukoplakia and dysplasia to OSCC. These findings point to p63 association with oral carcinogenesis and candidal infection, and they also imply that dysplastic and leukoplakia lesions may have the ability to serve as a signal for oral premalignancy due to increased LI and higher suprabasal expression of this gene. 
 KEY WORDS: Candida albicans; epithelial dysplasia; Erg11; leukoplakia; p63 protein.

A clinicopathological study of oral premalignant and malignant lesions with a special focus on gingivobuccal complex in a tertiary care center

Background: Globally, oral cavity lesions are a serious public health issue. Premalignant lesions of the oral cavity, such as leukoplakia, erythroplakia, and oral submucous fibrosis, are common in India and are strongly associated with tobacco and betel nut use. These lesions have the potential to transform into malignancies, with squamous cell carcinoma (SCC) being the predominant type of oral cancer. Early detection and effective management of early malignant lesions are crucial to improving the prognosis for patients. Histopathological examination is a standard procedure used to identify these lesions. Aims and Objectives: The objective of this study is to examine the histopathology of premalignant and malignant lesions of the oral cavity, taking into account age, sex, site distribution, and their association with tobacco consumption. Materials and Methods: The study was a prospective, observational study carried out over a period of 3 years on patients with lesions of the oral cavity in a Government Medical College of Northern Odisha. Biopsies were obtained, fixed, and routinely processed. Sections were stained with Hematoxylin and Eosin. The final diagnosis was based on clinical, gross, and microscopic findings. The data was collected and analyzed. Results: Out of a total of 197 oral biopsies, 79 cases were malignant lesions, and 35 cases were pre-malignant lesions. The highest incidence of both pre-malignant and malignant lesions was observed in the age group of 51–60 years, with a male predominance. The buccal mucosa was the most affected site. The most frequent type of malignant lesion was well-differentiated SCC, while hyperkeratosis without dysplasia was the most common type of pre-malignant lesion. Conclusion: Cancers of the oral cavity are surface malignancies whose signs and symptoms can be recognized early. The most common subsite of cancer is the gingivobuccal complex, and site-specific carcinoma is often due to the use of tobacco and betel quid, as they are typically placed in the gingivobuccal sulcus. The occurrence of carcinoma can be minimized by creating public awareness regarding high-risk habits.

Evaluation of Oromucosal Natural Gum-Based Emulgels as Novel Strategy for Photodynamic Therapy of Oral Premalignant Lesions.

Photodynamic therapy (PDT) recently has been shown as a promising option in the treatment of premalignant lesions of the soft oral tissues. Effective delivery of photosensitizer is challenging due to poor drug adherence to the oromucosal epithelium. In the present work, emulgels composed of natural polysaccharide gums (tragacanth, xanthan and gellan) were evaluated as novel oromucosal platforms of delta-aminolevulinic acid (ALA) for PDT. Apart from mucoadhesive and textural analysis, the specific steps involved studies on drug penetration behavior and safety profile using a three-dimensional human oral epithelium model (HOE). All designed emulgels presented greater mucoadhesiveness when compared to commercial oromucosal gel. Incorporation of ALA affected textural properties of emulgels, and tragacanth/xanthan formulation with greater hardness and cohesiveness exhibited a protective function against the mechanical tongue stress. Permeability studies revealed that ALA is capable of penetrating across oromucosal epithelium by passive transport and all formulations promoted its absorption rate when compared to a commercial topical product with ALA. Importantly, the combination of tragacanth and xanthan profoundly enhanced photosensitizer retention in the buccal epithelium. Tested samples performed negligible reduction in cell viability and moderately low IL-1β release, confirming their non-irritancy and compatibility with HOE. Overall, the presented findings indicate that tragacanth/xanthan emulgel holds promise as an oromucosal ALA-carrier for PDT strategy.