Oral submucous fibrosis

Objective. To assess the prevalence of oral potentially malignant disorders and to determine the potential risk factors for its development in Indian population.Materials and Methods. This cross-sectional study was carried out on 1241 individuals in Indore, Madhya Pradesh. A questionnaire was designed to record information about sociodemographic characteristics, oral hygiene practices, dietary habits, and risk factors for oral potentially malignant disorders. Oral mucosal lesions were examined by a skilled person.Results. The overall prevalence of oral potentially malignant disorders was found to be 13.7% with oral submucous fibrosis (8.06%) found to be more common and erythroplakia (0.24%) found to be least prevalent. Results of Logistic Regression analysis showed that males (OR = 2.09,Pvalue < 0.0001) who were ever consumers of tobacco (OR = 2.06,Pvalue = 0.030) and areca nut chewing (OR = 2.64,Pvalue = 0.004) were more likely to develop oral potentially malignant disorders com...

Oral cancers (OC) are among the most frequent malignancies encountered in Southeast Asia, primarily due to the prevalent habit of betel quid (BQ) and smokeless tobacco use in this region. Areca nut (AN), the primary ingredient in BQ, contains several alkaloids, including arecoline, arecaidine, guvacoline, and guvacine. These have been associated with both the AN abuse liability and carcinogenicity. Additionally, variations in AN alkaloid levels could lead to differences in the addictiveness and carcinogenic potential across various AN-containing products. Recent studies based on animal models and in vitro experiments show cellular and molecular effects induced by AN. These comprise promoting epithelial-mesenchymal transition, autophagy initiation, tissue hypoxia, genotoxicity, cytotoxicity, and cell death. Further, clinical research endorses these undesired harmful effects in humans. Oral submucosal fibrosis, a potentially malignant disease of the oral cavity, is predominantly repor...

The white lesions occurring in the oral cavity consist of 5% of the oral pathoses but some of these like leukoplakia, lichen planus, proliferative verrucous leukoplakia, etc have a high potential of malignant transformation up to 0.5-100%. As they are visualized as shades of white, they are of diagnostic challenge. Some of the lesions are also associated with other skin lesions viz. lichen planus, pemphigus, etc. The etiology, pathogenesis, and mode of treatment varies with the different type of lesions. This spectrum consists of lesions from harmless reactive lesions to dysplastic and malignant entities. The white appearance of these lesions is may be because of hyperkeratosis, acanthosis, intracellular/intercellular edema, necrosis of the epithelial cell or increased fibrosis. They are seen as patches, papules, or plaques unilaterally or bilaterally in the oral cavity involving buccal mucosa, tongue, palate, labial mucosa, gingiva etc. While there are a few clinical and histological elements that assist in the identification of this wide range of white lesions to arrive at an accurate diagnosis, further lending a hand in providing appropriate treatment for the same.

Background: Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy in India. The aggressiveness of OSCC is analyzed not only based on the dysplastic features and tumor infiltration pattern, but also by means of the stromal changes that pave the way for an invasion into the connective tissue. The role of elastic fibers in the progression of OSCC is still unknown because of sparse literature and the masking effect of overlying inflammatory cells and the lower number of elastic fibers in the lamina propria. The present study provides further insight into the qualitative assessment of elastic fibers in various grades of dysplasia and OSCC.

Oral submucous fibrosis (OSF) is a chronic, progressive, potentially malignant condition affecting the oral cavity and frequently involving the upper part of the aerodigestive tract including the oropharynx and the upper part of the esophagus. It is characterized by juxtaepithelial inflammatory reaction and progressive fibrosis of lamina propria, leading to stiffening of the oral mucosa eventually causing trismus. This condition is associated with significant morbidity and high risk of malignancy. Over the years, several drugs and combinations have been tried for the treatment of submucous fibrosis, but with limited success, because of its unclear molecular pathogenesis. Till date, there are no known effective treatments for OSF. The aim of this article is to emphasize on the molecular changes taking place in OSF and possible therapeutic interventions.

Objective: Squamous Cell Carcinoma is almost always preceded by potentially malignant disorders in the oral cavity before malignant transformation. Characterization of 8-OHdG from the saliva offers a relatively non-invasive, simple and efficient methodology for monitoring oxidative stress in subjects of Premalignant oral disorders (PMOD) and Oral Squamous Cell Carcinoma (OSCC). Hence the aim of the current study is to estimate the levels of salivary 8-hydroxydeoxyguanosine (8-OHdG) as a potential DNA Damage Biomarker in OSMF and OSCC patients in comparison to healthy individuals to assess disease progression from potentially malignant oral disorder to frank malignancy. Materials and Methods: The study was conducted among 90 patients [Oral Squamous cell carcinoma (n=30) and Oral Submucous Fibrosis (n=30) and healthy gender and age matched controls (n=30)]. 4ml of unstimulated saliva was collected from each of the subjects and was subjected to Sandwich ELISA for the quantification of salivary 8-OHdG. Statistical analysis was done using ANOVA, and p value was set at ≤0.05. Results: The mean age of OSCC patients were 56.8±11.8 years. Smoking was the most prevalent adverse habit among this group (66.6%) followed by Smokeless tobacco chewers (40%). The mean age of OSMF patients was 46.2± 9.8 years. Smokeless tobacco was the most predominant habit among the OSMF patients (83.33%) followed by smoking (33.33%). The mean OHdG levels among the controls was 6.59±1.47 (ng/dl) and almost doubled in patients of OSMF 13.89±1.96(ng/dL) and further raised in OSCC patients 19.96 ± 2.11 (ng/dL). These levels showed a highly significant difference (p <0.0001) in mean on comparison by using one-way ANOVA. Pearson correlation between the groups were also statistically significant (p=0.000). Conclusion: There were significant differences in the concentration of salivary 8-OHdG between healthy controls, OSMF, and OSCC patients. Hence, 8-OHdG can be used as a novel biomarker of DNA damage to assess disease progression.

Tumor markers are substances, which quantitatively changes in serum, during the tumor development, one such tumor marker is serum β2-microglobulin (β2-m). The aim of this study was to establish the role of β2-m as a biochemical parameter for diagnosis and prognosis of oral carcinoma by estimation of serum β2-m levels in potentially malignant lesions, conditions, and oral squamous cell carcinoma. The study was carried out on 48 subjects (16 control, 8 oral submucous fibrosis, 8 oral leukoplakia, and 16 oral squamous cell carcinoma patients of different stages), conducted at department of Oral Medicine, Kothiwal Dental College, Moradabad, India. Under aseptic precautions, 5 ml venous blood was drawn and serum was separated. Estimation of β2-m level in serum was carried out by enzyme linked immunosorbent assay. The data were analyzed by using the statistical package for social sciences (SPSS 17.0) software. Cases and controls were tested for statistical significance with one-way ANOVA ...

Oral cancers (OC) are among the most frequent malignancies encountered in Southeast Asia, primarily due to the prevalent habit of betel quid (BQ) and smokeless tobacco use in this region. Areca nut (AN), the primary ingredient in BQ, contains several alkaloids, including arecoline, arecaidine, guvacoline, and guvacine. These have been associated with both the AN abuse liability and carcinogenicity. Additionally, variations in AN alkaloid levels could lead to differences in the addictiveness and carcinogenic potential across various AN-containing products. Recent studies based on animal models and in vitro experiments show cellular and molecular effects induced by AN. These comprise promoting epithelial-mesenchymal transition, autophagy initiation, tissue hypoxia, genotoxicity, cytotoxicity, and cell death. Further, clinical research endorses these undesired harmful effects in humans. Oral submucosal fibrosis, a potentially malignant disease of the oral cavity, is predominantly reported from the geographical areas of the globe where AN is habitually chewed. OC in chronic AN users presents a more aggressive phenotype, such as resistance to anti-cancer drugs. The available evidence on the carcinogenicity of AN based on the findings reported in the recently published experimental studies is discussed in the present review.

Angiogenesis is the new growth in vascular network which is essential for cell proliferation. Since the proliferation, as well as metastatic spread, of cancer cells depends on an adequate supply of oxygen and nutrients through blood supply, it is inevitable to ignore levels of expression of angiogenic factors that reflect the aggressiveness of tumor cells. Despite of procuring numerous antiangiogenic therapy to date as per the theoretical efficacy, antiangiogenic treatments have not proved beneficial in terms of long-term survival. Thus the present study demonstrate the efficacy of direct oral microscopy or also referred as colposcope which is an advanced, contemporary and non invasive technique for screening of premalignant and malignant lesions of oral cavity; preferably at pre-invasive stage. The early detection of premalignant lesions of the oral cavity allows for treatment that may be sufficiently early to prevent their progression to an invasive carcinoma thus improving both the survival rate and the quality of life.

Background: This study aimed to investigate the association between oral potentially malignant lesions (OPML) and the consumption of areca nut and tobacco among individuals in the Dakshina Kannada district of Karnataka, India. Methods: This observational, cross-sectional analysis was conducted as part of the various outreach programs organized by the institution. Dental patients from the dental college, camps, and rural centers were screened for OPMLs. Participants with smokeless tobacco (SLT) habits were included. A validated questionnaire, administered in the local language, was used to gather demographic data and habit details. Subsequent oral examinations recorded OPML characteristics. Descriptive statistics and chi-square tests were utilized for analysis using IBM SPSS software. Results: Of the 4847 screened individuals seeking dental care, 330 SLT users were included. The majority (25.2%) were aged 51-60 years, predominantly male (69.4%), and from lower socioeconomic backgrounds (69.7%). Most resided in rural areas (95.2%), with some reporting a family history of cancer. Among SLT users, 37 also smoked, and 40 consumed alcohol. Various SLT forms were reported, with betel quid, areca nut, lime, and tobacco being the most common (63.6%). Of the participants, 38.8% had OPMLs, primarily oral submucous fibrosis (39.06%) and leukoplakia (14.8%). OPMLs were predominantly found on the buccal mucosa (76.5%). Significant associations were found between the type of tobacco products, method of consumption, duration of SLT use, and the presence of OPMLs. Conclusion: This study highlights a significant association between SLT habits and the presence of OPMLs among individuals in Dakshina Kannada. Understanding these associations can inform preventive strategies and oral health interventions to reduce the burden of potentially malignant lesions in this population.

OBJECTIVE: To determine the association among betel nut, betel quid or smoking alone, and betel quid combined with smoking in subjects reporting with oral sub mucous fibrosis, oral submucous fibrosis with malignant transformation in to cancer and oral squamous cell carcinoma. METHODOLOGY: An analytical cross sectional, multi centric study of n = 1009 cases collected through non-probability convenience sampling. These n=1009 subjects were subdivided into four groups: group 1, who consumed areca nut only; group 2, who chewed betel quid along with areca nut; group 3, who used betel quid and smoked; and group 4, who had no chewing habits history but were smokers. These changes were further confirmed with the help of biopsy reports of the subjects with OSMFCa and OSCC. Chi square test was performed to find out association of chewing habits with the progression of disease state. Level of significance was kept at p&lt;0.05. RESULTS: The mean age of the sample (n=1009) were 42.79±1.31 years...

BACKGROUND This study was conducted to determine the age, gender and pattern of associated chewing habits among cases of oral squamous cell carcinoma (OSCC) presenting with, (OSMFCa) and without, (Ca-OSMF) pre-existing clinical oral submucous fibrosis in Karachi, Pakistan. METHODS A cross sectional, multi centric study of (n=1009) cases with histologically confirmed oral squamous cell carcinoma seen at both public, private tertiary care hospitals and clinics over a period of eight years. A non-probability convenience sampling was used for selection of cases. Of these n=472 cases were reported as malignant transformation of clinical OSMF into OSCC: (OSMFCa) and n=537 were of OSCC without clinical evidence of OSMF: (Ca-OSMF). Qualitative analysis for gender and chewing patterns as well as chi square was performed for association. Age comparison between the OSMFCa and Ca-OSMF groups were performed by independent t test.. RESULTS A total of n=1009 cases presenting with OSCC were examine...

Background: Use of tobacco in any form smoke or smokeless has been implicated with the development of oral mucosal lesions like Leukoplakia (LE), lichen planus (LP), oral lichenoid lesions (OLL), oral submucous fibrosis (OSF), smokers palate (SP) and smokers melanosis (SM). Aim: To assess the presence of oral mucosal lesions associated with the use of tobacco. In this prevalence study 216 patients (200 males and 16 females) with habit of smoking, chewing tobacco in any form and smokeless tobacco users were enrolled and evaluated based on thorough history and soft tissue examination. Patients not willing to participate,those with infections, local trauma /irritation or systemic diseases that causes oral mucosal lesions and alcoholics were excluded. Statistical analysis was performed using statistical package for social sciences [SPSS] for Windows, Version 22.0.Released in 2013. Armonk, NY: IBM Corp. Result: Among the 216 participants, 200 (92.6%) were males and 16 (7.4%) were females; with the mean age of 46.03 years. The prevalence of smoking tobacco use was 60.6% and smokeless 39.4%.The most common finding was smoker's palate (34.7%), tobacco pouch keratosis (25.5%), homogenous leukoplakia (20.8%) and smokers melanosis (14.4%). The study emphasizes the association of harmful effects of tobacco (smoke and smokeless forms) with the development of oral mucosal lesions.

The antioxidant,anti-inflammatory,immunomodulatory and anti-tumorigenic properties of natural plant's extracts like aloe Vera and curcumin may produce beneficial therapeutic effects on OSMF patients and may lead to their symptomatic relief. Also, increase in the tissue elasticity with the help of oral physiotherapy excercises , would help in reinforcing increment in mouth opening. Aim: The aim of the study is to compare the efficacy of Curcumin gel with Aloe Vera gel when both the gel are supplemented along with oral physiotherapy in the management of OSMF. Materials and methods: A study of parallel group trial design, using simple randomization technique, was conducted on confirmed cases of OSMF. Patients were divided into two groups, one group(30 patients) was given curcumin gel(Curenext) and other group (30 patients) aloe Vera gel (Aloe Vera 100% relief) and each group was asked to do same oral physiotherapy excercises supplementally. Follow-up was done for 6 weeks and patients were assessed on the basis of improvement in mouth opening and burning sensation at 2, 4, and 6 weeks. Results: There was an improvement in both the parameters at subsequent visits, but the Aloe Vera gel showed better improvement than curcumin gel in burning sensation after 6 weeks of treatment which was highly statistically significant p< 0.01. Conclusion: Curcumin gel and Aloe Vera gel are effective in improving OSMF symptoms, but aloe Vera gel is more efficacious in burning sensation improvement without any side effects. Hence, we can advocate these drugs as adjuvant treatment in addition to the recommended treatment.

Background: Oral submucous fibrosis (OSMF) is a chronic debilitating disease and a well-recognized, potentially malignant condition of the oral cavity associated with betel quid chewing. Betel quid chewing is a popular oral habit in India and shows strong association in the incidence of OSMF. The objective of the study was to determine the levels of trace elements, prooxidants and reactive oxygen species (ROS) in saliva of betel quid chewers and OSMF patients, which may help in the diagnosis of cancer progression in the oral cavity. Methods: A total of 35 cases of OSMF and 35 cases of healthy individuals were included in the present study. The salivary status of ROS, pro-oxidants and some trace elements was studied in OSMF patients and normal healthy individuals. Results: The levels of lipid peroxides (P , 0.001), conjugated dienes (P , 0.01), hydroxyl radicals (P , 0.01), superoxide dismutase (P , 0.05), copper (P , 0.05), calcium (P , 0.01), magnesium (NS), potassium (P , 0.05) and iron (P , 0.05) in OSMF patients were elevated when compared with normal healthy individuals. The levels of hydrogen peroxide (P , 0.05) and sodium (P , 0.01) in OSMF patients were found to be decreased when compared with control subjects. A significant alteration was noticed after supplementing with a-tocopherol in oral precancerous patients. Conclusion: These parameters may help in the detection of the severity of oral diseases.

Oral lichen planus is a chronic inflammatory disease of unknown etiology, characterized by recurrent lesions, presenting as reticular lesions, sometimes accompanied by atrophic, erosive, and/or ulcerative areas. Despite being one of the most common conditions affecting the oral mucosa, oral lichen planus remains an ailment with undefined etiology and unclear pathogenesis, imprecise management, and uncertain premalignant potential. A narrative literature review study was conducted. A bibliographic search was carried out in databases such as PubMed, Hinari, SpringerLink, the National Center of Biotechnology Information, and Medline. Articles published from 1990 to 2023 were selected using various combinations of keywords: "oral lichen planus," and "epidemiology," "etiology," "pathogenesis," "symptoms," "management," "histopathology," and "malignant transformation." After processing the data from these databases, 475 full articles were found. The final bibliography comprised 50 relevant sources, considered representative of the materials published on the topic of this synthesis article. Results. Oral lichen planus is an inflammatory condition associated with T-cell-mediated immune dysfunction. Triggers include autoimmune responses to local antigens, microorganisms, and stress. The disease results from a complex interplay of host factors, lifestyle, and environmental factors leading to T-cell-mediated immune dysregulation. Diagnosis of oral lichen planus is based on clinical features (multiple, bilateral, symmetrically distributed lesions, occurring most commonly on the buccal mucosa, dorsal tongue surface, and gingiva), histopathological findings (predominantly lymphocytic bandlike infiltrate in the lamina propria, presence of apoptotic cells in the basal cell layer, absence of epithelial dysplasia), and immune-related changes (deposition of fibrinogen along the basement membrane zone, presence of granular fluorescent deposits containing IgA, IgG, and IgM in colloid bodies). Oral lichen planus is a chronic inflammatory condition mediated by T-cells in response to various extrinsic antigens, modified autoantigens, or superantigens, with periods of remission and relapse and the potential for malignant transformation. The etiology and pathogenesis of this condition are complex, diagnosis relies on clinical features, histopathological findings, and immunological data, patient treatment is symptomatic, and the potential for malignant transformation varies. Nevertheless, prospective studies with large sample sizes, adequate treatment duration, and long-term follow-up are needed.

Oral submucous fibrosis (OSMF) is a chronic, insidious, fibrotic disease that predominantly affects people of South-East Asian origin. The majority of patients present with an intolerance to spicy food, rigidity of lip, tongue and palate leading to varying degrees of limitation of mouth opening and tongue movement. The use of areca nut has been strongly implicated as the principal etiological factor in the pathogenesis of OSMF which involves cytokine mediated collagen synthesis and deposition and reduced collagen degradation. Various modalities have been proposed for the management of OSMF. Aimed primarily at increasing oral opening, surgical treatments have been hampered by relapse and medical agents have yielded limited success. In this prospective comparative study we tested a hypothesis that a combination of intralesional steroid and oral antioxidant would prove to be of maximal efficacy than either of the two agents used alone. Forty five patients with a clinical and histologic...

Persistent injury to oral mucosa due to habitual quid chewing, resulting in the upregulation of inflammatory cytokines and consequential myofibroblastic persistence, emphasizes the role of epigenetic aberration in the pathogenesis of oral submucous fibrosis (OSF). However, there is a dearth of research on the role epistasis plays in the pathophysiology of OSF. Among the important epistatic interactions in the pathophysiology of OSF are those between Phosphatase and Tensin Homologue (PTEN) and Insulin-Like Growth Factor 1, Transforming Growth Factor-β (TGF-β), Cyclooxygenases, and lipoxygenases (LOX). Additionally, PTEN and Nuclear Factor Kappa B (NF-κB) have an epistatic relationship that is particularly mediated by the p65 subunit of NF-κB. Given the importance of epigenetic modification in the pathogenesis of OSF, the potential use of DNA methyltransferase and Histone deacetylase inhibitors as a therapeutic option holds promise. Another in vivo epigenetic therapeutic option for treating OSF is using stimulatory microRNAs against antifibrotic genes and inhibitory microRNAs against profibrotic genes. This review aims to connect numerous epigenetic and epistatic components to the mechanism of OSF. A better understanding of the disease process may provide OSF management with newer therapeutic options. Article Highlights • Epigenetic changes from chronic oral injury drive persistent scarring and raise cancer risk in oral submucous fibrosis. • Unique gene-gene interactions amplify fibrosis, revealing new targets for future drug therapies. • Understanding these molecular pathways opens the door to innovative, precision-based treatments for this serious oral disease. • Cyclooxygenase (COX) and Lipoxygenase (LOX) enzymes that generate ROS and profibrotic mediators, contributing to PTEN inactivation and fibrosis.

The potential implications of Coronavirus disease-2019 (COVID-19) on oral squamous cell carcinoma (OSCC) development, chemo-resistance, tumor recurrence, and patient outcomes are explored, emphasizing the urgent need for tailored therapeutic strategies to mitigate these risks. The role of hypoxia-inducible factor 1-alpha (HIF-1α) in OSCC studies has highlighted HIF-1α as a crucial prognostic marker in OSCC, with implications for disease prognosis and patient survival. Its overexpression has been linked to aggressive subtypes in early OSCC stages, indicating its significance as an early biomarker for disease progression. Moreover, dysplastic lesions with heightened HIF-1α expression exhibit a greater propensity for malignant transformation, underscoring its role in early oral carcinogenesis. Cancer patients, including those with OSCC, face an elevated risk of severe COVID-19 complications, which may further impact cancer progression and treatment outcomes. Understanding the interplay between COVID-19 infection, HIF-1α activation, and OSCC pathogenesis is crucial for enhancing clinical management strategies. So, insights from this review shed light on the significance of HIF-1α in OSCC tumorigenesis, metastasis formation, and patient prognosis. The review underscores the need for further research to elucidate the precise mechanisms through which HIF-1α modulates cancer progression and chemo-resistance in the context of COVID-19 infection. Such knowledge is essential for developing targeted therapeutic interventions to improve outcomes for OSCC patients. Keywords COVID-19 • SARS-CoV-2 • Hypoxia-inducible factor 1-alpha • Oral squamous cell carcinoma • Chemoresistance • Cancer progression Abbreviations COVID-19 Coronavirus disease-2019 SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 OSCC Oral squamous cell carcinoma Eph Ephrin receptor NRP-1 Neuropilin-1

Oral sub-mucous fibrosis (OSF) is a chronic, insidious disease which might affect the oral cavity (oral mucosa) including pharynx and larynx. Numerous approaches and anticancer molecules have been explored in the literature to treat OSF with different modes of action. However, complete cure for OSF is limited due to the lack of an ideal carrier for safe and effective delivery of potent drug moieties. There are several challenges such as anatomical or histological barriers and appropriate animal model need to be explored and optimized to develop the efficient treatment for oral sub-mucous fibrosis. Constant progression in the development of new formulations has led to the effective management of the disease associated with the mucosa using mucosal or muco-adhesive drug delivery systems. Muco-adhesive drug delivery systems (such as gel and patches) have gained unique position as drug cargoes. Therefore, present review is an attempt to contemplate on OSF in terms of pathogenesis, curre...

Background and Aim: Lichen planus (LP) is an immunological disease of skin and mucous membranes. Cutaneous and oral LP (CLP and OLP) have almost similar histopathological changes determined microscopically with symptoms such as basal cell layer degeneration, hyperkeratosis,

In oral submucous fibrosis (OSF), the disease process is primarily dense fibrosis followed by reduced vascularity and subsequently epithelial atrophy. Further, this unique microenvironment augments the action of carcinogens from the areca nut on the epithelium and subsequently results in dysplastic epithelium and malignant transformation. This model of carcinogenesis and microenvironment is highly specific and unique for OSF malignant transformation. Hence, oral squamous cell carcinoma (OSCC) in the background of OSF (OSCC-SMF) has been proposed as a biologically and prognostically distinct entity. The identification of disease process in such a relationship would be immensely helpful to manage OSF cases at an early stage and prevent or identify the risk of malignant transformation. Recently, it was observed that some of the malignant transformation-relevant dysplastic features such as basal cell layer hyperplasia, abnormal superficial mitosis, increased nuclear size, increased nuclear:cytoplasmic ratio and hyperchromasia are especially useful

The aim of this study was to assess the prevalence and characteristic patterns of areca nut, gutka and tobacco chewing habits among school children. Materials and Methods: The study was carried out in the villages in and around Gandhinagar, Gujarat. All consenting school children of 1 th to 8 th class were interviewed individually by a pretested questionnaire about their chewing habits. After that thorough oral cavity examination for all students were carried out. Results: Of 1500 participants, 62% were boys and 38% were girls. Mean age of all the participants was 11.8 years. The prevalence of areca nut usage among boys and girls is seen to be 33.33% and 22.28% respectively, while it is 13.23% for gutka (contains tobacco) among boys. Majority of students started the chewing habit between 13 and 14 years. 49% of users were chewing these substances regularly for more than a year. Three-fourth of the participants was ignorant of associated health hazards or thought these substances to be harmless. About 39.5% of areca nut users were seen black staining of teeth. About 100 cases of oral submucous fi brosis were identifi ed among areca nut chewers. Conclusion: Awareness level of health hazards was very poor among the students. Health education and awareness against these substances at an early age may help in curbing this problem.

Oral submucous fibrosis (OSF) is a chronic progressive disease associated with increased collagen deposition and TGF-β1 release. The current therapy and management have been a limited success due to low efficacy and adverse drug reactions. This study aimed to evaluate epigallocatechin 3-gallate (EGCG) encapsulated nanoparticles loaded mucoadhesive hydrogel nanocomposite (HNC) for OSF. Developed HNC formulations were evaluated for their permeation behaviour using in vitro as well as ex vivo studies, followed by evaluation of efficacy and safety by in vivo studies using areca nut extract-induced OSF in rats. The disease condition in OSF-induced rats was assessed by mouth-opening and biochemical markers. The optimized polymeric nanoparticles exhibited the required particle size (162.93 ± 13.81 nm), positive zeta potential (22.50 ± 2.94 mV) with better mucoadhesive strength (0.40 ± 0.002 N), and faster permeation due to interactions of the positively charged surface with the negatively charged buccal mucosal membrane. HNC significantly improved disease conditions by reducing TGF-β1 and collagen concentration without showing toxicity and reverting the fibroid buccal mucosa to normal. Hence, the optimized formulation can be further tested to develop a clinically alternate therapeutic strategy for OSF. Keywords ex vivo permeation and retention • epigallocatechin 3-gallate • in vivo efficacy and safety studies • mucoadhesive hydrogel nanocomposite • oral submucous fibrosis

Abstracts, EACMFS XIX Congress ostectomy of adjacent bone, with no relapse. Two ofthree cases of the GCT appeared in women of the fifth decade and after one local relapse they died of lung metastases within three years time; 15-year old boy with partial maxilla resection is for four years in a stable remission. Both young men with terminal renal failure and BT of maxilla were successfully operated. Conclusion: Although these lesions are histologically similar, it is important to be precise in their distinction, because of their different treatment and biologic behavior. Percentual numbers of disease distribution in these two institutions differs, but the type of surgical apprach and results are almost the same.

Abstracts, EACMFS XIX Congress ostectomy of adjacent bone, with no relapse. Two ofthree cases of the GCT appeared in women of the fifth decade and after one local relapse they died of lung metastases within three years time; 15-year old boy with partial maxilla resection is for four years in a stable remission. Both young men with terminal renal failure and BT of maxilla were successfully operated. Conclusion: Although these lesions are histologically similar, it is important to be precise in their distinction, because of their different treatment and biologic behavior. Percentual numbers of disease distribution in these two institutions differs, but the type of surgical apprach and results are almost the same.

Reactive Oxygen Species are chemically unstable molecules generated during aerobic respiration, especially in the electron transport chain. ROS are involved in various biological functions; any imbalance in their standard level results in severe damage, for instance, oxidative damage, inflammation in a cellular system, and cancer. Oxidative damage activates signaling pathways, which result in cell proliferation, oncogenesis, and metastasis. Since the last few decades, mesenchymal stromal cells have been explored as therapeutic agents against various pathologies, such as cardiovascular diseases, acute and chronic kidney disease, neurodegenerative diseases, macular degeneration, and biliary diseases. Recently, the research community has begun developing several anti-tumor drugs, but these therapeutic drugs are ineffective. In this present review, we would like to emphasize MSCs-based targeted therapy against pathologies induced by ROS as cells possess regenerative potential, immunomodulation, and migratory capacity. We have also focused on how MSCs can be used as next-generation drugs with no side effects.

Objective: The present study aimed to compare and quantify the presence of Candida albicans in precancerous and cancerous oral mucosal lesions. Materials & Methods: A total of 135 cases were studied ［Group I,45 cases of precancerous lesions; Group II,45 cases of malignant lesions; and Group III, 45 cases of precancerous conditions such as lichen planus and oral submucous fibrosis (OSMF)］ . Three cytological smears were made from lesional tissue.One wet smear was made with 10% potassium hydroxide (KOH) solution and the two other smears were stained with Gramʼ s stain and periodic acid Schiff (PAS) stain. Colonies were cultured on Sabouraoudʼ s dextrose agar (SDA)medium followed by quantification on a colony counter. Germ tube test confirmed the species as C.albicans. Results: Using a two-way Anova test, a statistically significant association was found between C.albicans and precancer (p＜0.05,p＜ 0.01).Similarly,the frequency of oral yeast carriage was significantly greater (p＜0.05, p＜0.01) in the malignant lesions group than the precancerous lesions as well as precancerous conditions.However,no significant difference was observed between the two groups of precancerous lesions and precancerous conditions. Conclusion : The present results suggested a close correlation of Candida infections to leukoplakias and squamous cell carcinoma (SCC), supporting an association between Candida species and oral neoplasia.

Background: The present study was aimed to evaluate and analyze orientation and birefringence pattern of collagen fibers histopathologically in different grades of OSMF using the special stain (Picrosirius red) under polarizing microscope and relate these factors with the severity of OSMF. Materials and Method: 45 confirmed cases of OSMF were taken from the archives. The selection of clinical cases was done according to classification by J.N Khanna and Andrade (1999). These cases were correlated histopathologically as per the criteria given by Pindborg J.J and Sirsat S.M (1966). The sections were stained with H & E and Picrosirius red stains and assessment was done accordingly. 10 cases of normal mucosa were taken as control. Results: In clinical grade I, 60% of the cases showed histopathological grade II, while 53.4% cases in clinical grade II correlated with histopathological grade III and 33.4% of clinical grade III cases showed histopathological grade IV. Upon application of Fisher's exact test a significant P value <.01 was obtained suggesting no statistical significant correlation between these two parameters. However, the orientation pattern revealed a parallel orientation as OSMF advanced. Also as the severity of the disease increased, there was a gradual shift from green-greenish yellow colour of the fibres and a shift to orange red-red colour. Conclusion: Upon correlation of clinical grades with histopathological grades, no statistically significant difference was found. Birefringence pattern of collagen revealed similar findings as other studies in case of clinical grades but histopathological grades showed a contrast finding.

Oral submucous fibrosis (OSF) is a high risk precancerous condition characterized by changes in the connective tissue fibers of the lamina propria and deeper parts leading to stiffness of the mucosa and restricted mouth opening. Patients with severe cases have distinct difficulties in chewing, swallowing and speaking. It predominantly occurs in Indians and other population of the Indian subcontinent with certain oral habits. In patients with submucous fibrosis, the oral epithelium becomes atrophic and thereby becomes more vulnerable to carcinogens. It is now accepted that chewing areca is the most important aetiological factor for developing OSF. The atrophic epithelium shows first an intercellular edema and later epithelial atypia associated with moderate epithelial hyperplasia. From then on, carcinoma may develop any time. It is suggested that submucous fibrosis should be regarded as a condition that causes predisposition to the development of oral cancer. Here we are presenting two cases of oral submucous fibrosis showing malignant potential and development of oral squamous cell carcinoma.

Objective: The present study aimed to compare and quantify the presence of Candida albicans in precancerous and cancerous oral mucosal lesions. Materials & Methods: A total of 135 cases were studied ［Group I,45 cases of precancerous lesions; Group II,45 cases of malignant lesions; and Group III, 45 cases of precancerous conditions such as lichen planus and oral submucous fibrosis (OSMF)］ . Three cytological smears were made from lesional tissue.One wet smear was made with 10% potassium hydroxide (KOH) solution and the two other smears were stained with Gramʼ s stain and periodic acid Schiff (PAS) stain. Colonies were cultured on Sabouraoudʼ s dextrose agar (SDA)medium followed by quantification on a colony counter. Germ tube test confirmed the species as C.albicans. Results: Using a two-way Anova test, a statistically significant association was found between C.albicans and precancer (p＜0.05,p＜ 0.01).Similarly,the frequency of oral yeast carriage was significantly greater (p＜0.05, p＜0.01) in the malignant lesions group than the precancerous lesions as well as precancerous conditions.However,no significant difference was observed between the two groups of precancerous lesions and precancerous conditions. Conclusion : The present results suggested a close correlation of Candida infections to leukoplakias and squamous cell carcinoma (SCC), supporting an association between Candida species and oral neoplasia.

Background Oral submucous fibrosis (OSMF) is a chronic disease of the oral cavity which presents clinically with burning sensation, leathery consistency of oral mucosa with palpable fibrous bands leading to reduced mouth opening. Though the evaluation of quality of life (QOL) in health care is gaining importance, researches regarding the evaluation of QOL in OSMF individuals are very sparse. Aim The aim of the present study is to evaluate the QOL assessment in OSMF patients through WHOQOL-BREF questionnaire. Methodology The study includes a total of 300 participants recruited from the outpatient department. The quality of life was assessed using the WHOQOL-BREF questionnaire. The raw scores for the physical health, psychological health, social relationships and environmental health domains were done on 4-20 scale suggested by the WHOQOL procedural manual. The analysis of variance (ANOVA) was used for the simultaneous comparison of mean scores for the four domains, and independent t test was used for the comparison of two means of domain scores. The participants with OSMF have a significant negative impact on the quality of life when compared with the participants without OSMF (P = 0.002). The environmental factors in the WHOQOL-BREF have shown a significant difference in the QOL of participants with OSMF than without OSMF (P = 0.001). Conclusion The oral submucous fibrosis has a negative impact on the quality of life in participants with OSMF specifically in social and environmental domains of the WHOQOL-BREF questionnaire.

Salivary alkaline phosphatase (S-ALP) levels have been found to be elevated in cases of oral squamous cell carcinoma and Oral Potentially Malignant Disorder, but their level in Oral Submucous Fibrosis (OSMF) is less explored. The present study aims to investigate salivary alkaline phosphatase levels (S-ALP) as a diagnostic biomarker in oral submucous fibrosis (OSMF). The objective of the study is to measure and compare the S-ALP in individuals with/without the habit of chewing betel nuts and to assess the relationship between S-ALP in individuals with/without betel nut induced oral lesions. The samples were recruited by the stratified random sampling method. A total of 36 patients were divided into two groups, with 18 participants in each group. Group A-control group without habits and without lesions Group B (study group), Group B1-patients without betel nut induced lesions, and Group B2-Patients with betel nut induced lesions (OSMF). The data obtained were subjected to statistical analysis, and independent t-tests were done. The mean S-ALP was 8.2 IU/L for normal individuals without tobacco usage, 19.5 IU/L for patients with the habit of betel nut chewing but without lesions, and 49.4 IU/L for patients with betel nut chewing induced lesions. The mean difference between the groups was statistically significant (P < 0.001). The results of the present study suggest that S-ALP levels is markedly increased in patients with the habit of using smokeless tobacco suggesting that S-ALP can be used as a reliable non-invasive biomarker to monitor oral submucous fibrosis (OSMF)

Oral submucous fibrosis is a chronic debilitating disease associated with restricted mouth opening and poor oral hygiene. The treatment aims at good release of fibrosis and to provide long term results in terms of mouth opening. With the increasingly widespread application of reliable microvascular free tissue transfer techniques for oral cavity reconstruction, the routine need for a variety of local and regional flaps has decreased. Various local grafts have been used to cover the buccal mucosal defects after the fibrotic bands are released in oral submucous fibrosis. Successful use of inferiorly based nasolabial flaps in the management of oral submucous fibrosis is projected. In this article, the focus is on the utility of the pedicled nasolabial flap to achieve this goal. Care was taken for post-operative physiotherapy, and was followed up regularly for one year. Flap healed without evidence of infection, dehiscence, or necrosis. The inferiorly based nasolabial "islanded" flaps provide reliable coverage of defects of the buccal mucosa and improves mouth opening.

Background: The objective of this research was to evaluate the performance of specialists in oral medicine doing diagnosis of oral mucosa lesions through digital images comparing general dental practitioner in Chile. Material and Methods: 20 oral medicine specialists from the national registry of specialists in Chile and 20 general dental practitioners were invited to participate. Each participant reviewed 33 cases with digital images of oral mucosa lesions and was asked to submit diagnostic hypotheses. The proportions of correct diagnoses and diagnostic accuracy were determined. Analyses were performed using STATA 16.0. Results: Specialists presented a higher total proportion of correct diagnoses than general dental practioners (86.5% vs 49.2%). Specialists also showed higher sensitivity (88.5% vs 59.3%) and greater specificity (85.8% vs 48.6 %) than general dental practioners in the diagnosis of oral cancer and oral potentially malignant disorders compared to benign oral lesions. Conclusions: In Chile, oral medicine specialists are a reliable alternative to provide diagnostic guidance through e-consult, but its margin of error must be considered.

Objectives: To evaluate the efficacy of nasolabial island flap in the reconstruction of oral submucous fibrosis. Patients and Methods: A total of patients with moderate to severe degree of oral submucous fibrosis were treated surgically and the reconstruction was done using bilateral nasolabial island flaps. Pre-operative, intraoperative and post-operative mouth openings were recorded and compared with the pre-operative mouth opening. Results: Pre-operative openings ranged from 8mm to 15 mm, with mean of 11 mm. After six months of post-operative follow up, patients were able to maintain mouth openings ranging from 32mm to 37mm, with mean of 35mm. The observations proved the versatility of nasolabial island flap and its distinct edge in maintaining the mouth opening over other treatment modalities.

Objectives: To evaluate the efficacy of nasolabial island flap in the reconstruction of oral submucous fibrosis. Patients and Methods: A total of patients with moderate to severe degree of oral submucous fibrosis were treated surgically and the reconstruction was done using bilateral nasolabial island flaps. Pre-operative, intraoperative and post-operative mouth openings were recorded and compared with the pre-operative mouth opening. Results: Pre-operative openings ranged from 8mm to 15 mm, with mean of 11 mm. After six months of post-operative follow up, patients were able to maintain mouth openings ranging from 32mm to 37mm, with mean of 35mm.

Areca nut is widely used in India and the consumption has increased over the past two decades, with availability in new dry packaged forms (pan masala, gutka, mawa). Recent reports of increasing mouth cancer incidence have suggested an association with areca nut consumption. Here we have reviewed the evidence for carcinogenicity of areca nut, including epidemiological studies, several animal studies and mechanistic evidence. Studies primarily from India, providing odds ratios (ORs) or relative risks for precancers or cancer with use of areca nut without inclusion of tobacco is the focus of the review. Six casecontrol studies on oral submucous fibrosis (OSF) had significantly elevated ORs for use of areca nut in various forms. Six case-control studies on head and neck cancers, primarily oral cancer reported elevated ORs for chewing of betel quid without tobacco. Eight case control studies on oral cancer have reported elevated and significant ORs for betel quid with tobacco. A significant risk in oral cancer was noted in gutka users. Animal studies confirmed correlation between development of precancers or cancers and exposure to areca nut or pan masala without tobacco. Mechanistic evidence shows a role for areca nut alkaloids, polyphenols and copper in promoting carcinogenesis. Our review emphasizes control policies on areca nut products and appropriate mass communication programs for awareness of hazards of areca nut with emphasis on areca nut per se.

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 uni...

South Asia is a major producer and net exporter of tobacco. Over one-third of tobacco consumed regionally is smokeless. Traditional forms like betel quid, tobacco with lime and tobacco tooth powder are commonly used and the use of new products is increasing, not only among men but also among children, teenagers, women of reproductive age, medical and dental students and in the South Asian diaspora. Smokeless tobacco users studied prospectively in India had ageadjusted relative risks for premature mortality of 1.2-1.96 (men) and 1.3 (women). Current male chewers of betel quid with tobacco in case-control studies in India had relative risks of oral cancer varying between 1.8-5.8 and relative risks for oesophageal cancer of 2.1-3.2. Oral submucous fibrosis is increasing due to the use of processed areca nut products, many containing tobacco. Pregnant women in India who used smokeless tobacco have a threefold increased risk of stillbirth and a two-to threefold increased risk of having a low birthweight infant. In recent years, several states in India have banned the sale, manufacture and storage of gutka, a smokeless tobacco product containing areca nut. In May 2003 in India, the Tobacco Products Bill 2001 was enacted to regulate the promotion and sale of all tobacco products. In two large-scale educational interventions in India, sizable proportions of tobacco users quit during 5-10 years of follow-up and incidence rates of oral leukoplakia measured in one study fell in the intervention cohort. Tobacco education must be imparted through schools, existing government health programmes and hospital outreach programmes.

Introduction: Oral squamous cell carcinoma (OSCC) is the most common malignant tumor of the oral cavity and up to one third (3-33%) of oral precancerous lesions will eventually evolve into invasive OSCC. Survivin is a smallest member of the Inhibitor of Apoptosis (IAP) family of proteins which play an important role in apoptosis regulation. High expression of survivin is considered as an early event of carcinogenesis and may provide a useful tool for the identification of precancerous lesions at higher risk of progression into invasive carcinoma. The present study aims to evaluate the expression of survivin in oral submucous fibrosis and oral squamous cell carcinoma and also compares the expression of survivin in different histopathological grades of OSCC. Methods and Material: 15 patients with oral squamous cell carcinoma, 15 patents with oral sub mucous fibrosis were selected as subjects for the present study and 15 patients with normal oral mucosa were selected as controls and all were evaluated for expression of survivin. All sections were H & E stained and were studied immunohistochemically for the expression of survivin. Statistical analysis carried out with Chi square test. Results: Significant survivin expression was detected in oral submucous fibrosis and oral squamous cell carcinoma (P<0.001). Expression of Survivin was significant when compared with different histopathological grades of OSCC. Conclusion: Expression of survivin in oral submucous fibrosis may indicate potential risk of malignant transformation.

Background: Many studies have examined the association between smokeless tobacco and the risk of oral cancer. In South and Southeastern Asia, the use of smokeless tobacco, which increases the risk of oral cancer, is very common. The aim of this study is to provide a comprehensive review of studies conducted and published in a period of ten years to provide a more accurate assessment of the association between smokeless tobacco and oral cancer. Methods: An electronic search in six databases (PubMed, Scopus, Embase, Web of Science, ProQuest, and Cochrane Library) was conducted using keywords equivalent to oral cancer and smokeless tobacco. After selecting the articles according to the inclusion and exclusion criteria, a total of 30 prospective cohort and case-control studies from 2010 to 2020, which investigated the association of smokeless tobacco with oral cancer, were examined. The articles were qualitatively assessed using the Newcastle Ottawa Quality Assessment scale checklist. Then, study design (study type, setting, and duration of data collection), sample population (number, gender, and age), cancer type, smokeless tobacco type, effect size, and confounder adjustment were extracted from the studies. Results: Five studies examined smokeless tobacco and chewing tobacco, and 25 studies reported and evaluated the type of smokeless tobacco, most of which were related to betel quid and supari. While the results of 21 studies revealed a positive and significant relationship between oral cancer and smokeless tobacco use (OR: 0.67-149.5), seven studies did not find a significant correlation. Conclusion: This systematic review confirms the positive and significant association between non-smoking tobacco use and the risk of oral cancer.

Habitual betel quid chewing is known as risk factor of oral potentially malignant disorders. Comprehensive data on the history of usage patterns and the risk of oral mucosal disorders related to the habitual betel quid chewing had previously been limited in numerous Indonesian populations. The purpose of this study was to investigate the risk of habitual betel quid chewing patterns on the oral potentially malignant disorders in Samosir Island, province of North Sumatra Indonesia. The present study was conducted to the habitual chewers of betel quid in the working area of the local government clinic of Ambarita in Samosir Regency, North Sumatra Province, Indonesia. As study group, subjects with oral potentially malignant disorders i.e. submucous fibrosis and leukoplakia, and as control group, subjects without oral potentially malignant and malignant disorders, were assigned into study. The present study revealed the oral potentially malignant disorders were significantly associated w...

Context: Oral submucous fibrosis (OSMF) is a chronic insidious oral potentially malignant disorder characterized by increased collagen deposition and reduced collagen degradation causing burning sensation and difficulty in mouth opening. Aim: To assess the efficacy of topical Tulsi (Ocimum sanctum) paste for the management of OSMF. Settings and Design: Institution-based clinical trial. Materials and Methods: The study included a total of 60 OSMF patients categorized into three Groups A, B and C (20 in each) depending on the severity according to Lai DR et al. classification. The patients were advised for topical Tulsi paste application and were evaluated for the reduction in the burning sensation and improvement in mouth opening every month for 3 subsequent months using the numeric pain rating scale (NRS) and a Vernier calliper, respectively. Statistical Analysis: The baseline and 3-month recordings were subjected to inter-and intra-group statistical analysis using Kruskal-Wallis analysis of variance (ANOVA), Mann-Whitney U, one-way ANOVA, Tukey's multiple post-hoc and Wilcoxon matched-pairs tests. Results: There was a reduction in the burning sensation and improvement in the mouth opening in all three groups. The reduction in the burning sensation was statistically significant among all the groups (P < 0.05) and the NRS scores after 3 months among the three groups were not statistically significant (P > 0.05). There was a statistically significant difference (P < 0.05) in the improvement of mouth opening between Group A and B; A and C; but not between B and C. Conclusion: Tulsi paste showed a significant reduction in the burning sensation and improvement of the mouth opening thereby proving to be a safe and promising medicament for OSMF.

Various surgical modalities have been advocated for the soft tissue reconstruction of oral cavity with variable results. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) and oral squamous cell carcinoma (OSCC) in terms of healing and functional outcomes. In this prospective study, 47 patients with OSMF and 15 of OSCC were evaluated and selected for PMF reconstruction. OSCC was selected under TNMcategory only. Patients were operated under general anaesthesia followed by PMF grafting. In OSCC, ipsilateral and for OSMF, bilateral PMF was used. In 47 patients treated for OSMF, 46 were male and 1 female while 15 cases of OSCC, 10 were male and 5 females aged between 18 and 44 years. Intraoperative mouth opening was achieved up to 48 mm in OSMF followed by 42.5 mm postoperatively after 2 years. However, uneventful healing and acceptable scar on cervical region ...