Clinical Review and Management of Oral Potentially Malignant Disorders with Epithelial Dysplasia

Background: Oral potentially malignant disorders (OPMDs) comprise any disorders, tumors, in addition to any microscopic alterations that have a risk of malignant development of cancers of the mouth. When epithelial dysplasia is detected in an oral lesion, it is termed as a precancerous lesion. Finding: Several changes in the color or thickness of normal oral mucosa might be detected during the clinical diagnosis of the oral lesions. Leukoplakia of the oral cavity is a clinical name for one of the most predominant OPMDs of the oral mucosa. When comparing oral examination with naked eyes to planning to apply staining with special stain or using an image of optical fluorescence, the incidence of patients with oral epithelial dysplasia may rise, as well as the clearing of the lesion boundary. Increased size of more than 2cm2, the presence of colored regions with a red hue, the presence of lichenoid process characteristics, and severe epithelial dysplasia are all considered risk factors. One-third of premalignant lesions may progress to cancer, whereas the other two-thirds may stay stable or regress without progressing to malignancy. Conclusion: It is critical to research the patients' unique characteristics, which include psychological, genetic, dietary, and dental problems. When epithelial dysplasia is present in an oral lesion, it is termed a precancerous lesion. Oral potential malignant diseases with epithelial dysplasia may or may not develop into carcinoma and may or may not be recurrent.

Oral Microbiota—A New Frontier in the Pathogenesis and Management of Head and Neck Cancers

Head and neck squamous cell carcinoma (HNSCC) comprises the majority of tumors in head and neck tissues. The prognosis of HNSCC has not significantly improved for decades, signifying the need for new diagnostic and therapeutic targets. Recent evidence suggests that oral microbiota is associated with carcinogenesis. Thus, we conducted a comprehensive systematic review to evaluate the current evidence regarding the role of oral microbiota in HNSCC and whether their targeting may confer diagnostic, prognostic or therapeutic utility. Following the screening of 233 publications retrieved from multiple databases, 34 eligible studies comprising 2469 patients were compiled and critically appraised. Importantly, many oral pathogens, such as Porphyromonas gingivalis and Fusobacterium nucleatum were linked to certain oral potentially malignant lesions and various types of HNSCC. Furthermore, we summarized the association between the expression profiles of different oral bacterial species and their tumorigenic and prognostic effects in cancer patients. We also discussed the current limitations of this newly emerging area and the potential microbiota-related strategies for preventing and treating HNSCC. Whilst many clinical studies are underway to unravel the role of oral microbiota in cancer, the limited available data and experimental approaches reflect the newness of this promising yet challenging field.

Evaluation of the Relationship of Various Patterns of Quid Usage in Patients with Oral Submucous Fibrosis and Leukoplakia in Central India Population: A Cross Sectional Study

Background: Oral habits can cause severe oral potentially malignant disorders. There is a need to deeply analyse the role of betel nut in the causation of these disorders. Patients must be educated in order to prevent them from grabbing these conditions as inspection leads to prevention. Aim: The aim of our study was to study and analyse the different patterns of quid usage among the participants with oral submucous fibrosis and leukoplakia in Central India population. Patients and Methods: The study was performed on 90 patients amongst which 45 patients were clinically diagnosed of oral submucous fibrosis & the other 45 patients were diagnosed of leukoplakia. The cases were then subjected to a detailed questionnaire which aimed to extract information regarding the various types of quid usage habits, their frequency and duration. The data was recorded and statistical analysis was done. Results: The study included 90 subjects – 86 males & 4 females. Out of 6 types of quid habits it is found that type IV (processed areca nut), Type VI (combined quid usage) quid caused OSMF stage II, Stage III & homogenous leukoplakia respectively. There is a strong association between duration and frequency of habit in causation of OSMF & leukoplakia. Conclusion: The present study showed increased prevalence of OSMF & leukoplakia with type IV & VI quid usage among the population of Central India.

Oral Submucous Fibrosis – A Clinicopathological Correlation

Objective: Oral Submucous Fibrosis (OSMF) is a potentially malignant disorder of the oral mucosa and collagen metabolic disorder caused by betel nut use. Diagnosis of this condition can be made clinically, but ascertaining its malignant transformation histopathology is mandatory. So, the correlation between the clinical and histopathology was conducted. Materials and Methods: The correlation study was conducted on 20 OSMF patients. Clinical diagnosis with histopathological confirmation was based on the standard approach. Study structure included gender, duration, frequency, and quid placement correlated with clinical and histopathological staging. Results: The current study has included most of the subjects being males and was below 25 years. Habit duration, frequency, and quid placement were correlated with clinical and histopathological staging and were directly related. Six subjects of (30%) Group 1 cases associated with 3 (42.9%) in the histologically early stage of the disease. Further, 14 (70%) cases in Group 2 clinical staging correlated with 8 (88.9%) cases in moderately advanced histological staging. Conclusion: The clinical and histopathological correlation was not obtained in the present study. The negative p-value could be because of certain factors like biopsy site selection and decreased study subjects. However, factors like frequency and quid keeping had a positive histopathological correlation.

Artificial Intelligence in Diagnosis of Oral Potentially Malignant Lesions- Need of the Hour

Artificial intelligence (AI) is a technological breakthrough that is rapidly progressing and has captivated the minds of researchers all over the world. AI can be used to make a diagnosis of oral cavity lesions, detect and identify suspicious changed oral mucosa undergoing premalignant and malignant transformations. The purpose of this review is to give a comprehensive summary of developing optical imaging technologies, innovative artificial intelligence-based techniques. The concepts of image-based techniques for identifying oral cancer are defined in terms of clinical requirements and features. Although artificial intelligence (AI) is beginning to have a significant impact on increasing diagnosis accuracy in a variety of fields of medicine, there has been limited research on oral cancer to date. These results suggest that combining artificial intelligence with imaging can improve oral cancer outcomes, applications ranging from very low-cost oral cancer screening with Smartphone-based probes to algorithm-guided identification premalignant lesion heterogeneity and margins using optical coherence tomography. Oral cancer outcomes can be improved by combining imaging and artificial intelligence technologies for better detection and diagnosis.

A Systematic Review of MicroRNA Signatures Associated with the Progression of Leukoplakia with and without Epithelial Dysplasia

Oral cancer is a significant public health issue, being the eighth most common cancer worldwide with over 300,000 cases diagnosed annually. Early diagnosis and adequate management of oral potentially malignant disorders (OPMDs) before transformation into oral squamous cell carcinoma (OSCC) is critical to reduce deaths, morbidity, and to improve overall prognosis. MicroRNAs (miRNAs) are small noncoding RNAs involved in the post-transcriptional regulation of protein expression and implicated in the control of numerous cellular pathways and impacting physiological, developmental, and pathological processes. Dysregulation of miRNAs has been reported in many cancers and has been demonstrated to play a critical role in cancer initiation, progression, apoptosis, invasion and metastasis. This systematic review provides a comprehensive summary of the prevailing literature on miRNA signatures in OPMDs, specifically leukoplakia with or without oral epithelial dysplasia, and their utility in predicting malignant transformation into OSCC. Eighteen articles describing 73 unique and differentially expressed microRNAs met the criteria for inclusion in this review. We reviewed the characteristics and methodology for each of these studies and assessed the sensitivity and specificity of the studied miRNAs in predicting malignant transformation. This systematic review highlights the significant interest in miRNAs and their tremendous potential as prognostic markers for predicting the malignant transformation of OPMDs into OSCC.