Treatment Of Oral Leukoplakia Research Articles

Ferroptosis Induction Enhances Photodynamic Therapy Efficacy for OLK

Oral leukoplakia (OLK) is the most representative oral potentially malignant disorder, with a high risk of malignant transformation and unclear mechanisms of occurrence. Recently, photodynamic therapy (PDT) has exhibited great potential in the treatment of OLK. However, the efficacy of PDT is difficult to predict and varies from person to person. Ferroptosis-related pathways are upregulated in many cancers, and ferroptosis induction is considered to be a potential synergistic strategy for various antitumor therapies, but its role in OLK treatment remains unclear. This study aimed to determine whether ferroptosis induction can enhance the efficacy of PDT in OLK treatment. Our study revealed that solute carrier family 7 member 11 (SLC7A11), a component of a crucial amino acid transporter and a key negative regulator of ferroptosis, was found to be highly expressed in OLK patients with no response to PDT. 5-Aminolevulinic acid (ALA)-PDT is known to cause apoptosis and necrosis, but ferroptosis also occurred under ALA-PDT in OLK cells in our study. Using erastin to induce ferroptosis enhanced the efficacy of ALA-PDT on OLK cells by disrupting the antioxidant system and further elevating intracellular reactive oxygen species levels, leading to increased apoptosis. Furthermore, this combined modality also enhanced the efficacy of ALA-PDT on 4-nitroquinoline-1-oxide (4NQO)–induced OLK lesions in mice. In summary, ferroptosis induction may serve as a potential strategy to enhance the efficacy of ALA-PDT for OLK treatment.

A complete course of photodynamic therapy reduced the risk of malignant transformation of oral leukoplakia

BackgroundPhotodynamic therapy (PDT) has shown good short-term efficacy in the treatment of oral leukoplakia (OLK). However, the malignant transformation of OLK was seldom evaluated in most PDT studies. Therefore, this study evaluated the effect of PDT on the risk of malignant transformation of OLK. MethodsKaplan-Meier survival analysis, COX regression, and sensitivity analysis were used to evaluate the effects of PDT on the risk of malignant transformation of OLK. Subgroup analyses were performed to explore the role of PDT in OLK patients with different clinical characteristics. ResultsOLK patients with older age (HR=1.032, P = 0.018) and non-homogeneous lesion (HR=2.104, P = 0.044) had higher risk of malignant transformation. Patients who had finished a complete course of PDT (HR=0.305, P = 0.006) had a significant lower risk of malignant transformation, while those who hadn't finished a complete course of PDT (HR=0.692, P = 0.352) cannot be considered to have such a protective effect. In the subgroup analyses, complete PDT course showed a significant protective effect on malignant transformation of OLK in patients with female sex, no smoking or drinking habits, non-homogeneous lesions, lesions on oral mucosa outside the dangerous region, and any grade of epithelial dysplasia. ConclusionsA complete course of PDT could significantly reduce the risk of malignant transformation of OLK, especially in those patients with risk factors of malignant transformation.

Research Progress on Oral Leukoplakia

Oral Leukoplakia (OLK) is a common mottled oral mucosal disease with potential malignant changes, and it is one of the diseases of high concern in dentistry. Through in-depth analysis and review of the existing literature, this summarizes the epidemiological features, clinical characteristics, diagnosis and treatment progress of Oral Leukoplakia, OLK, in order to provide reference for the clinical prevention and treatment of OLK, so as to improve the diagnosis and treatment level.

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.

Retinoid Treatment for Oral Leukoplakia: Current Evidence and Future Development

Oral leukoplakia (OLK) is one of the most common oral potentially malignant disorders (OPMDs). Preventing malignant transformation is the main purpose of OLK treatment. The treatment approaches of OLK include surgery, chemotherapy, and other therapies, such as photodynamic therapy and CO2 laser. The application of genomic variation-based chemotherapy in OLK deserves further exploration. As chemopreventive drugs, drug resistance and disease recurrence have limited their use in OLK. In this review, we concentrate on the retinoid treatment for OLK, summarizing the current status of retinoids in the treatment of OLK, the mechanism of retinoid action, and the mechanisms of resistance to retinoid therapy, and we highlight the strategies to improve retinoid efficacy in the treatment of OLK, such as the combination of retinoids and epigenetic regulators or metabolism-blocking agents, new synthetic retinoids, and new drug delivery systems of retinoids, providing new methods for the successful clinical application of retinoids in the treatment of OLK.

Clinical evaluation of photodynamic therapy for oral leukoplakia: a retrospective study of 50 patients

BackgroundTopical photodynamic therapy (PDT) has demonstrated encouraging results in the treatment of oral leukoplakia (OLK). However, data on the clinical efficacy of PDT in Chinese patients with OLK are still limited.MethodsFifty patients diagnosed with OLK were enrolled, including patients with various dysplastic tissues. All patients received topical PDT with 5-aminolevulinic acid (5-ALA) as a photosensitizer. Clinical efficacy was evaluated 4 weeks after treatment. Follow-up was performed every 3 months during the first year and every 6 months during the second year.ResultsThe overall response rate was 68% (34/50): 12% (n = 6) complete and 56% (n = 28) partial responses. Aneuploidy was reduced in the patients with dysplastic lesions. Oral pain and local ulcers developed in 52% of the patients (n = 26). Patients with a long history of OLK including hyperplasia and dysplastic lesions, as well as those with non-homogenous lesions, were more likely to develop pain and ulcer. During follow-up, the recurrence rate of hyperplasia and dysplastic lesions was 32% (n = 16) and the malignant transformation rate of dysplastic lesions was 4% (n = 2). Lesions on the buccal mucosa were associated with recurrence (P = 0.044; OR: 0.108, 95% CI: 0.013–0.915).ConclusionTopical 5-ALA-mediated PDT is an effective treatment for OLK, particularly for homogenous leukoplakia, with few side effects. The buccal mucosa may be a protective factor that can reduce recurrence.

Photodynamic therapy (PDT) for oral leukoplakia: a systematic review and meta-analysis of single-arm studies examining efficacy and subgroup analyses

ObjectiveThis study aims to evaluate the efficacy of photodynamic therapy (PDT) in the treatment of oral leukoplakia and explore the subgroup factors that may influence its effectiveness.MethodsA systematic search was conducted in PubMed, Embase, the Cochrane Library, and Web of Science databases to identify relevant studies. Meta-analysis was performed using Stata15.0 software. Cochran’s Q test and I2 statistics were used to evaluate heterogeneity, egger’s test was used to evaluate publication bias.ResultsThe analysis of 17 studies included in this study suggests that PDT may be effective in achieving complete response (CR) [ES = 0.50, 95%CI: (0.33,0.66)], partial response (PR) [ES = 0.42, 95%CI: (0.27,0.56)], no response (NR) [ES = 0.19, 95%CI: (0.11,0.27)]in patients with oral leukoplakia. The recurrence rate was also evaluated [ES = 0.13, 95%CI: (0.08,0.18)]. Subgroup analysis showed that various factors such as light source, wavelength, medium, duration of application, clinical and pathological diagnosis classification influenced efficacy of PDT. The lesion areas of the leukoplakia after treatment were reduced by 1.97cm2 compared with those before treatment.ConclusionOur findings show that PDT is a viable treatment for oral leukoplakia. However, the effectiveness of the therapy may depend on several factors, as suggested by our subgroup analyses. (Registration no. CRD42023399848 in Prospero, 26/02/2023)

Management of oral leukoplakia with an 808-nm high-power diode laser: a single-center experience.

High-power diode laser emerges as a promising approach to the treatment of oral leukoplakia (OL); however, its short- and long-term effects have been barely explored. This study evaluated the postoperative endpoints and the recurrence rate of high-power diode laser treatment in a well-defined series of patients with OL. A prospective analysis was performed on 22 individuals comprising 31 OL. The lesions were irradiated using the following protocol: Indium-Gallium-Arsenide diode laser, 808nm, continuous-wave mode, 1.5-2.0 W, 780.0 ± 225.1J, and 477.1 ± 131.8s. Postoperative pain was assessed with a visual analog scale at three endpoints. Clinical follow-up was performed on all patients and the Kaplan-Meier test was used to analyze the probability of recurrence. The series consisted mostly of women (72.7%) with a mean age of 62.8years. A single laser session was performed in 77.4% of cases. The median score on the scale that assessed pain on the 1st, 14th and 42nd postoperative day was 4, 1, and 0, respectively. The mean follow-up period per lesion was 28.6months (range: 2-53months). A complete response was observed in 93.5% of OL cases, while 6.5% had recurrence. The probability of recurrence at 39months was 6.7%. No patient experienced malignant transformation. High-power diode laser for the treatment of OL is safe and effective during the trans- and postoperative period. These findings represent an alternative approach to the management of OL, mainly because a low recurrence rate was observed.

A comparative study to evaluate the therapeutic effects of nutraceuticals in oral leukoplakia:- A randomized clinical trail.

Oral leukoplakia, usually white changes in the oral mucosa, is one of the most common conditions affecting the oral cavity. Oral leukoplakia can occur anywhere in the mouth and is usually asymptomatic. Clinical diagnosis is reliant on visual inspection and manual palpation. It has a global prevalence of 2.6% and a malignant transformation rate of 0.13-34%. In India, OL has a higher prevalence (0.2-5.2%) but a lower a malignant transformation rate (0.13-10%). It was a randomized control trial in which study was conducted on clinically diagnosed 300 oral leukoplakia patients. All patients were randomly categorized in three groups of 100 each. Group-A: Patients were given commercially available curcumin 500 mg. daily orally. Group-B: Patients were given 4 mg of oral lycopene daily. Group-C: Patients were treated with 4 mg of lycopene + 500 mg curcumin daily by oral route. After recording the pre-treatment clinical findings, all the participants were evaluated regularly after 30 days, 60 days and 90 days of active treatment and once in a month for another 3 months of post-treatment follow-up and to evaluate concomitant medication, lesion(s), compliance, and adverse events. The clinical response was evaluated by bi-dimensional measurement of the lesions and color photography. Safety assessment measures: Physical examination and laboratory tests were performed at baseline, and every 30 days for 3 months after randomization. Number of participants cured after treatment with oral curcumin was 51%. Participants took lycopene tablets showed 63% cure rate and 72% participants cured after treatment with combination curcumin and lycopene. Results showed that curcumin, lycopene, and a combination of the two are effective in the treatment of oral leukoplakia. When compared, we found that lycopene is a better nutraceutical as compared to curcumin. When both nutraceuticals were given to the participants, they showed better results than single nutraceuticals when the data were analyzed after 90 days of treatment. There is a significant difference in the response of curcumin and combinations of both nutraceuticals, although the difference between lycopene and combinations of curcumin and lycopene is insignificant.

Comparison of Efficacy of Topical Application of Bleomycin with Adjuvant Antioxidants vs. Topical Curcumin Oral Gel with Adjuvant Antioxidants in the Treatment of Oral Leukoplakia

Introduction: Oral leukoplakia (OL) is an oral premalignant disorder (OPMD) defined as a white plaque of questionable risk, and the diagnosis is by exclusion. Aim: We aimed to compare the effectiveness of topical bleomycin with that of topical curcumin in patients with oral leukoplakia (OL). Materials and Methods: Bleomycin was assigned for group A and curcumin for group B patients. Both the drugs were applied topically with adjuvant oral antioxidants for both groups. Results: Group A (n = 10) patients showed partial to complete resolution of the leukoplakic lesions with a P value of 0.01, whereas in group B (n = 10) patients, resolution of the clinical lesion was not substantial, but a reduction of the erythroid component was observed along with histopathological improvement of dysplasia with a P value of 0.01. Conclusion: Comparatively, bleomycin was more efficient in producing clinical and histopathologic resolution of OL than curcumin.

Standardized diagnosis and treatment of oral leukoplakia

口腔白斑病（oral leukoplakia，OLK）是临床常见的口腔潜在恶性疾患。规范OLK的临床诊疗对降低OLK癌变的致畸和致残率，提高患者的生存率和生命质量具有重要意义。在OLK诊断方面，本文再次强调了OLK诊断确定性在OLK临床诊断中的重要作用。在OLK癌变预警方面，本文强调了临床高危因素和病理诊断的重要性，同时也推荐使用椅旁无创或微创辅助检查手段监测OLK的恶变风险。目前OLK的治疗方式主要包括去除刺激因素、药物治疗和去除病损的治疗等，其中光动力治疗作为OLK的可选疗法之一具有独特优势。本文结合中华口腔医学会2020年发布的《口腔白斑病临床诊疗循证指南》和课题组临床实践对以上内容进行阐述，以期进一步规范OLK的临床诊疗工作。.

Oral leukoplakia diagnosis and treatment in Europe and Australia: Oral Medicine Practitioners' attitudes and practice.

The management of oral potentially malignant disorders (OPMD) including oral leukoplakia (OL) is not currently structured according to agreed guidelines. The current report presents survey data gathered from Oral Medicine Practitioners (OMPs) in Europe and Australia and is aimed to investigate attitudes and practice in the diagnosis, risk stratification and treatment of OL. In the presence of a clinical provisional diagnosis of OL, respondents reported always undertaking biopsy in 83% of cases, with most OMPs also relying on diagnostic adjuncts. The potential for malignant transformation is almost invariably assessed through epithelial dysplasia status, with other biomarkers described in the literature used less often. Active treatment of OL was considered mandatory by 20% of OMPs, while others reserve treatment for selected cases only. OMPs are mostly driven to active treatment by lesion-related features which are frequently jointly considered including lesion site, clinical appearance and dysplasia status. Inconsistent assessment was observed regarding mild dysplasia, lesion size, presence of unavoidable trauma, exposure to tobacco and patient age. Frequently observed geographical variations were seldom statistically significant. In agreement with previous surveys, a lack of consensus around the management of OL was observed, supporting claims from learned academies and societies for treatment guidelines aiming to reduce inter-practitioner variability.

Application of 5-aminolevulinic acid-mediated Waterlase-assisted photodynamic therapy in the treatment of oral leukoplakia

Photodynamic therapy (PDT) is an alternative microinvasive approach with satisfying results in the treatment of oral leukoplakia (OL). PDT combined with laser irradiation shows promise, safety and efficacy in treating OL. The efficacy of waterlase (YSGG) combined with PDT was studied by brush and tissue biopsy. Seventy-one patients with histologically diagnosed OL were enrolled, including patients with mild to moderate dysplasia, severe dysplasia and various dysplastic tissues. Patients were evaluated at baseline (t0), the end of treatment (t1) and 1 year later (t2). At t1, PDT showed a significant therapeutic effect on OL with mild to moderate dysplasia. Clinical and histological examinations revealed 60 cases (84.51%) of complete remission and 11 cases (15.49%) of partial remission. On brush biopsy, all PDT-treated patients showed reduced aneuploidy and normal histological findings. Unfortunately, at t2, 9 patients relapsed with OL, which may be related to continued smoking and betel nut chewing. At t2, 5 patients developed new severe epithelial dysplasia and even carcinoma in situ in other areas, mostly the tongue. ALA-mediated PDT combined with YSGG is effective in treating OL, particularly that with mild to moderate dysplasia. However, severe dysplasia may present undesirable effects, and the mechanism remains to be further investigated. ALA-mediated PDT combined with YSGG provides a new method for OL treatment.

Oralna leukoplakija - pregled kliničkih karakteristika i trendova u lečenju

Introduction: Oral potentially malignant disorders (OPMD) conisit of the group of diseases of great importance for dentists. Oral leukoplakia (OL) has long been the subject of debate by numerous researchers. A common etiologic factor is tobacco, which is associated with oral cancer. The aim of the study is to indicate the severity of the lesion, the most common clinical characreistics and localization. The prevalence of leukoplakia in the world is 2.6% with a rate of malignant conversion ranging from 0.1% to 17.5%. Literature data about the prevalence and annual rate of malignant transformation, approximately 2%, indicate that these changes should be taken seriously and regularymonitored Conclusion: Occurate diagnosis provides the key to preventing to malignant transformation. Various medical and surgical treatment modalities for this lesion have been described. This article highlights various trends in the diagnosis and treatment of oral leukoplakia.

Treatment of oral leukoplakia with CO2 laser (10,600 nm): analysis of 37 cases

Oral leukoplakia is a potentially malignant disorder, defined as a white plaque that cannot be diagnosed as another known disease or disorder, and has an increased risk of malignancy. The aim of the present study was to evaluate the results of CO2 laser treatment in a well-defined cohort of patients with oral leukoplakia in order to identify the occurrence of clinical outcomes of relapse, resolution, or malignancy after treatment. The study group comprised 37 patients. Before treatment, clinical photographs and incisional biopsies were obtained in all cases. In addition, the post-treatment results were documented using photographs. Evaluation of treatment results was performed by an independent researcher who had not performed the surgery. The minimum, maximum, and mean values of continuous variables were calculated. Statistically significant relationships were tested using the Cox regression analysis. A survival curve was constructed according to the Kaplan-Meier method to analyze the malignant transformation and recurrence of oral leukoplakia. The clinical outcomes analyzed were resolution, recurrence, and malignancy. The mean follow-up period was 36 months (range, 6-239 months). In 13/37 patients, leukoplakia recurred between 6 and 93 months (mean, 38.2 months). In 8/37 patients, a malignant transformation occurred (mean, 50.6 months). In 16/37 patients, lesion resolution occurred. No risk factor was statistically significant for malignancy or recurrence of lesions. The treatment of the lesions by CO2 laser was efficient in the removal of the lesions; however, it did not avoid the clinical outcomes of recurrence or malignancy.

Randomized comparative study in the treatment of oral leucoplakia with laser and conventional surgery

Objective: High-energy lasers are used as an alternative to surgical treatment of potentially malignant disorders in the oral cavity. The present article aims to make a prospective randomised comparative clinical assessment of the effect of laser surgery and conventional surgery in the treatment of oral leukoplakia (OL). Materials and methods: In the study were included 89 patients with histologically confirmed oral leukoplakia lesions. Laser excision of the lesions using Er YAG laser was performed in 36 of the patients, while standard surgical excision was used in 53 of the cases. Following clinical assessment comparing the two treatment methods was conducted based on: pain, wound healing, infection and recurrence of the lesions. Results: A statistically significant difference between two groups according pain in the postoperative period was found. Patients treated with laser ablation experienced far less pain than those treated with surgical excision. The healing time was significantly faster in the group treated with Er YAG laser, and regarding the occurrence of postoperative infections, the results of the two methods did not differ significantly. Recurrence was observed earlier in the group treated with laser ablation, but the levels align over a longer period of time. Conclusion: Er YAG laser ablation is a contemporary method for the treatment of oral leukoplakia without dysplasia, providing similar success, compared to conventional surgical excision, with less postoperative discomfort for the patients. Keywords Er YAG laser; Leukoplakia; Potentially malignant disorders.

An overview of effect of lycopene and curcumin in oral leukoplakia and oral submucous fibrosis.

The purpose of the current article was to evaluate the recently published researches on the use of lycopene and curcumin in oral leukoplakia (OL) and oral submucous fibrosis (OSF). A comprehensive review of the current researches enveloping PubMed, Ovid, and Cochrane was made using the keywords [(Lycopene) OR (Curcumin) AND (Leukoplakia OR OL OR OSF OR OSMF OR OSF OR Submucous Fibrosis)]. We included only randomized control trials and in the English language. The search covers the data from 1994 to August 2020. Six studies (2 of OL and 4 of OSF) finally qualified are included in the study for the qualitative analysis of the result. Out of these six studies, four were found having high risk, one with unclear risk and one with low risk. Only one study came out as finally suitable for the quantitative analysis of the result. A total of 90 participants were included in this review, with a mean age of 32 with a range of 17–60 years. Out of 90 participants, 70 were male and 20 were female. It is evident from the result of this study that the use of oral curcumin and lycopene has significant improvement in the mouth opening, burning sensation, and cheek flexibility in comparison to the placebo. The use of oral curcumin and lycopene appears to be effective and safe in the treatment of OL and OSF but to read the result of use of oral curcumin and lycopene in OL caution should be taken because of bias.

Clinical research of CO2 laser combined with photodynamic therapy in the treatment of oral leukoplakia

Clinical research of CO2 laser combined with photodynamic therapy in the treatment of oral leukoplakia

Evaluation of Effect of Topical Melatonin in Treatment of Oral Leukoplakia

Evaluation of Effect of Topical Melatonin in Treatment of Oral Leukoplakia

Comparative evaluation of micronuclei in Saudi smokers and non-smokers without any visible oral lesions– A pilot study.

Objectives: A systematic review was conducted to evaluate effectiveness and safety of beta carotenes for the treatment of oral leukoplakia regarding clinical resolution and prevention of malignant transformation. Material and Methods: The systematic search was conducted in three electronic databases and the study’s selection was performed according to pre-set eligibility criteria. Four studies evaluating the efficacy of beta carotenes in oral leukoplakia compared to placebo were included in the review; three of which were assigned for quantitative analysis. Data were extracted, tabulated, quality assessed and statistically analyzed. Results: The meta-analysis revealed that when comparing clinical resolution the beta carotene group favored was favored compared to placebo, with statistically significant difference. However, a meta-analysis comparing beta carotene and placebo groups regarding malignant transformation as a primary outcome failed to show any significant benefit. Furthermore, results showed evidence of beta carotene safety. Conclusion: the overall quality of evidence about efficacy of beta carotene in oral leukoplakia treatment was not high. However, given the obvious safety of this agent, data suggests it could have a promising effect in clinical improvement of oral leukoplakia lesions. However, no evidence supporting its benefits in reducing risk of malignant transformation in these lesions was found. Therefore, further long term, well designed randomized clinical trials are highly recommended.