A revisit at 16 years for individuals from peri-urban New Delhi for tobacco use and associated oral lesions

Objectives: India has a high incidence of oral cancer due to multifarious tobacco use. The objective of this study was to assess the status of tobacco-related oral lesions over 16 years, in a screen-detected population. Methods: This cross-sectional study involved home visits of 2000 Delhi residents, previously screened for oral potentially malignant disorders/oral cancer and counseled for tobacco cessation. Their basic demographics and tobacco/alcohol history were noted followed by oral visual examination for any related mucosal abnormalities. The data thus obtained were statistically analyzed. Results: Two hundred and sixty-five individuals (13.2%) could be traced after 16 years. The status of oral lesions varied across the participants, mainly in terms of their location, type, number, and/or presence/absence; no oral malignancies were noted. Most individuals had either a decreased use (34%, p < 0.001) or had quit tobacco (25.7%, p < 0.001); 8.3% individuals from the former and 5.7% from the latter group showed complete lesion(s) regression. The overall change in the tobacco use and oral lesions showed a highly significant positive association ( p < 0.05). Conclusion: A direct relationship exists between tobacco use and oral lesions. Repeated, tobacco cessation counseling provided by health-care professionals is effective. Oral screening of high-risk individuals, along with tobacco cessation, is thus essential.

Expression and clinical significance of the receptors of the EGF family in oral squamous cell carcinomas

Objective: To examine the immunohistochemical expression of four members of the type 1 growth factor receptor family in oral squamous cell carcinomas (OSCCs) and to correlate with clinical outcomes. Materials and methods: Sixty OSCCs from a patient cohort in Sri Lanka were included in the study. Five sections from each carcinoma were immunostained with antibodies to epidermal growth factor receptor (EGFR)/c-erbB-1, c-erbB-2/HER-2/neu, c-erbB-3/HER-3 and c-erbB-4/HER-4. Two clones were used to stain for c-erbB-2/HER-2/neu. Semiquantitative analysis of immunoreactivity was carried out by scoring the intensity of expression and proportions of positively stained cells. A logistic regression analysis was performed to examine positive expression against overall survival. Results: There was heterogenous expression of the four receptors, positivity ranging from 26% to 60%. Co-expression of all four markers was observed only in 1–3% of the tumours. Both membranous and cytoplasmic expressions were observed, EGFR showing predominantly membranous expression and c-erbB-2 showing only cytoplasmic staining. In logistic regression analysis, none of the growth factor receptors were significantly predictive of overall survival. Conclusion: Type 1 growth factor receptors are highly expressed in oral carcinomas, EGFR being the predominant marker.

Top cited articles on ameloblastoma: A bibliometric analysis

Objectives: The purpose of this study was to review and evaluate the characteristics of 100 most cited articles on ameloblastoma (AB). Materials and Methods: A comprehensive list of citation classics in AB was generated by searching the Scopus database without year or language restrictions. The top 100 articles were retrieved after reading abstracts or full texts. The following study variables were evaluated: number of citations, citation density, journal name, impact factor, category and quartile of journals, publication year, authors with their affiliations, and article type. Results: The citation number ranged from 76 to 367, with a mean of 122.78 citations per article. The one hundred top cited articles were distributed in 41 journals with Cancer having the highest number of articles ( n = 16). There was a dominance of authors form United States (42 articles). The articles were published from 1955 to 2014, and eight authors published more than three papers. There were 57 research articles and 43 review articles. Conclusions: This first citation analysis provide a detailed list of the most influential articles on AB to help recognize the quality of the works, discoveries, and the trends steering the study of AB.

Patients with oral submucous fibrosis who visit dental hospitals have nonspecific chief complaints

Background: The first consultation with a health-care professional is crucial to make the correct diagnosis particularly with respect to narrating the symptoms encountered by the patient. Yet, currently, no information is available concerning the primary symptoms documented by patients with oral submucous fibrosis (OSF). Materials and Methods: A total of 158 OSF patients visiting outdoor patient departments (OSF-OPDs) and 104 pan shop customers (PSCs) were investigated. OSF-OPD cases and relevant PSCs cases were investigated to discover the chief complaints (CCs) leading to dental visits. Detailed demographic data, patient histories concerning relevant habits (with duration), and socioeconomic status were recorded. OSF cases were graded based on the degree of mouth opening. Results: Out of 158 OSF-OPD patients, only 43 (26.58%) reported relevant disease symptoms of OSF: in stage III, 28.57%, or stage IV, 38.09%. One hundred and sixteen patients (73.41%) reported CCs unrelated to OSF, and all of these cases were diagnosed with an early stage of OSF (stage I: 47.05% and stage II: 22.5%). Out of the total 104 PSCs, 66 PSCs have had prior dental consultations, but only five (4.80%) individuals had visited a health-care professional due to OSF-related CCs. Conclusion: A significant number of CCs made by OSF patients were unrelated to their disease signs and symptoms. There is a lack of awareness of OSF symptoms by pan chewers, thus hindering early detection.

Role of Candida infection in the malignant transformation of oral leukoplakia: A systematic review of observational studies

The aim of this systematic review was to investigate the malignant transformation of oral leukoplakia (OL) infected with Candida. Literature search was conducted using Medical Subject Heading terms ‘leukoplakia’, ‘neoplasms’, ‘ Candida’, ‘malignant transformation’ and ‘oral’ and included all results until February 2017. The initial search identified 372 articles, which was consolidated to 16 articles after applying inclusion and exclusion criteria. The occurrence of candidal infection in OL ranged from 6.8% to 100.0%. Only 3 of 16 studies reported malignant transformation rates of leukoplakia with Candida infection. The overall malignant transformation rates reported in these studies were 2.5%, 6.5% and 28.7%. This review supports the contention that candidal infection promotes cellular and dysplastic changes in OL. However, further follow-up studies are recommended to confirm the role of Candida infection in malignant transformation of OL lesions.

Antifibrotic effect of Ocimum basilicum L. and linalool on arecoline-induced fibrosis in human buccal fibroblasts

Aim: To explore Ocimum basilicum L. (sweet basil) and linalool for their antifibrotic activity in an arecoline-induced in vitro fibrotic model. Methods: Leaf extract of O. basilicum L. (LEOB) and linalool were used as experimental agents to test their antifibrogenic activity in vitro. Half-maximal inhibitory concentration (IC50) for arecoline, ethanolic LEOB, and linalool was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. To evaluate the antifibrotic effect of ethanolic LEOB and linalool on pretreatment, that is, both the testing agents were added to the human buccal fibroblasts (HBFs) prior to induction with arecoline, and reverse transcriptase polymerase chain reaction (RT-PCR) was carried out to study the response of transforming growth factor beta (TGFβ), collagen 1 subtype A2 (COL1A2), and collagen 3 subtype A1 (COL3A1). To appreciate the morphological alterations in HBFs on treatment with arecoline, ethanolic LEOB, and linalool, Masson’s trichrome staining was performed. Results: Arecoline enhanced fibrotic activity by upregulating TGFβ1, COL1A2, and COL3A1 levels, whereas ethanolic LEOB and linalool on pretreatment significantly downregulated the increased levels of TGFβ1, COL1A2, and COL3A1 in primary HBF cell cultures. Conclusion and implication to clinic: Both ethanolic LEOB and linalool exhibited significant antifibrotic activity in an in vitro model. Further studies in an in vitro model can help attain a foundation for an herbal formulation in gel form that can be prescribed to patients diagnosed with oral submucous fibrosis for topical application. It can also be used synergistically with Western medicine.

Human papillomavirus DNA prevalence and type distribution in oral squamous cell carcinoma in Ghana

Objective: To determine the prevalence of human papillomavirus (HPV) DNA in oral squamous cell carcinoma (OSCC). Methods: A total of 88 OSCC specimens collected between 2006 and 2013 were available for the study. DNA was extracted using formalin-fixed, paraffin-embedded specimens and analysed for the presence of 18 HPV genotypes using a nested polymerase chain reaction using consensus forward primer (GP-E6-3F) and two consensus back primers (GP-E7-5B and GP-E7-6B). Plasmid DNA of HPV 16 and 18 was used as positive controls. Results: HPV DNA was detected in 3 of the 88 samples, a prevalence of 3.4%. Genotypes detected were 16, 18 and 52. Conclusion: The overall prevalence of HPV DNA was 3.4%. Only high-risk genotypes were detected. This low prevalence of high-risk types of HPV suggests that the HPV virus may not have a significant role in the development of oral cancers in Ghana, unlike higher rates described elsewhere in the world, especially in Western countries. Surveillance of future prevalence of HPV and attention to other major risk factors is warranted.

Prognostic significance of Cep55 in oral squamous cell carcinoma

Objective: Currently, oral squamous cell carcinoma (OSCC) is one of the most fatal cancers of all head and neck malignancies. Despite advancements in therapy, the mortality and morbidity remain high. Hence, it is essential to identify useful prognostic markers for high-risk individuals with OSCC to decide on treatment protocols. Centrosomal protein 55 ( Cep55), a regulator of the cell cycle, has been considered to play a role in carcinogenesis. Although there are numerous studies on its role in various other epithelial cancers such as breast, ovarian and lung cancers, its significance in the behaviour of OSCC is yet to be studied. The present study aimed to study Cep55 expression in OSCC and correlate with the tumour characteristics and patient survival. Materials and Methods: Forty pathologically diagnosed cases of OSCC were included in the study: 20 each of early and advanced OSCC cases. Formalin-fixed paraffin-embedded archival samples were used. The sections were immunohistochemically stained with Cep55 antibody. The expression levels of Cep55 were correlated with clinical parameters and disease outcome. Results: A higher expression of Cep55 was observed in advanced stage compared to early stage of OSCC. The Cep55 expression showed no significant relation with respect to clinical staging, pathological grading and site, except for tongue. Cep55 overexpression is significantly associated with poor survival. Conclusion: The present study suggests that Cep55 could play an important role in determining the biological behaviour and survival of OSCC patients independent of tumour staging and pathological grading. Thus, assessment of Cep55 expression could navigate the surgeons to plan an appropriate treatment.

Human papillomavirus type 16 (HPV16) DNA copy number in oral rinse samples from oral cavity cancer patients

Objectives: The objective of this study is to examine the human papillomavirus type 16 (HPV16) DNA copy number in the oral cavity of cancer patients using oral rinse samples. Methods: We analyzed the HPV16 DNA copy number of oral rinse samples in 13 primary oral cavity cancer patients (mean age 67.8 years, range 48–84 years) who visited the Department of Oral and Maxillofacial Reconstructive Surgery of Hiroshima University Hospital (Hiroshima, Japan). The 13 oral cavity cancers included 6 carcinomas in situ and 7 squamous cell carcinomas. Real-time PCR analysis was performed to examine the number of HPV16 E6 viral copies in oral rinse samples. Additionally, the HPV16 integration status was investigated using the real-time PCR findings for HPV16 E2 genes in HPV16 E6-positive oral rinse samples. Results: HPV16 E6 copy numbers above the detection limit in a standard curve for HPV16 E6 DNA were assessed as HPV16 positive in oral rinse samples from 6 of 13 patients. The average number of HPV16 E6 viral copies was 1.71 ± 1.72 per cell (range, 0.39–4.96 copies/cell) in six oral rinse samples. The HPV16 E2 viral load was detected in four of the six HPV16-positive oral rinse samples. Two of the six HPV16-positive oral rinse samples showed HPV16 E2 copy numbers below the detection limit, indicating the full integration of HPV16 DNA. Conclusions: The number of patients in this study was small; therefore, further investigation using a larger number of participants is required to clarify the level of HPV16 viral copy number in the oral cavity of cancer patients.

Perspectives on areca nut with some global implications: Symposium report

Areca nut and products made from the nut, evaluated by the International Agency for Research on Cancer as carcinogenic to humans since 2004, are being increasingly used in India and South East Asia and exported to many countries. There is thus an urgent need to identify best control policies and research gaps. On 1 February 2018, a group of experts shared their latest knowledge and perspectives on areca nut at Healis-Seksaria Institute for Public Health in Navi Mumbai, Maharashtra, India. By itself, areca nut has been implicated in oral and oesophageal cancer. Areca nut users are also at high risk of oral submucous fibrosis, a debilitating and potentially malignant condition. Users may also suffer adverse health outcomes due to smokeless tobacco, commonly mixed with areca nut. The use of areca nut commonly begins in childhood and often proceeds to use with tobacco. Gutka, a widely consumed, industrially made areca nut product containing tobacco, has been banned in all states and union territories of India, but it is still widely available. Areca nuts contain arecoline, an alkaloid that stimulates various brain receptors, promoting physical dependence. Areca nut alkaloids have also been implicated in carcinogenesis. Other chemicals, introduced during cultivation and processing of areca nuts, contribute to oral submucous fibrosis and cancer. The wide variety of products, different storage conditions and lack of regulation can lead to significant variation in the content of toxicants, carcinogens and alkaloids, making the psychological and physical dependence issues even more challenging. Regulation of product contents is needed as a part of control measures to supplement product bans.