Amniotic membrane in oral and maxillofacial surgery

Purpose

Following its renaissance in ophthalmology during the 1990s, preserved human amniotic membrane (HAM) has become an attractive biomaterial for all surgical disciplines. This article reviews the current and potential use of HAM in oral and maxillofacial surgery, its postulated properties and common preservation techniques.

Methods

Literature was identified by an electronic search of PubMed in July 2012; this was supplemented from the reference lists of the consulted papers.

Results

HAM has been used in the field of oral and maxillofacial surgery from 1969 onwards because of its immunological preference and its pain-reducing, antimicrobial, mechanical and side-dependent adhesive or anti-adhesive properties. The effects of HAM on dermal and mucosal re-epithelialisation have been highlighted. Typically, HAM is applied after being banked in a glycerol-preserved, DMSO-preserved or freeze-dried and irradiated state. Whereas the use of HAM in flap surgery and in intra-oral and extra-oral lining is reported frequently, novel HAM applications in post-traumatic orbital surgery and temporomandibular joint surgery have been added since 2010. Tissue engineering with HAM is a fast-expanding field with a high variety of future options.

Conclusions

Preserved HAM is considered to be a safe and sufficient biomaterial in all fields of oral and maxillofacial wound healing. Recently published novel indications for HAM application lack a high level of evidence and need to be studied further.     

Lichen planus orale e lesioni lichenoidi. Una guida per l’odontoiatra

Objectives

To provide dentists with up-to-date information on the management of patients with oral lichen planus (OLP).

Materials and methods

We reviewed clinically relevant papers retrieved via a search of PubMed, Embase, and Scopus databases.

Results

OLP is a chronic inflammatory disease of unknown etiology, which is characterized by bilateral, symmetrically distributed, reticular lesions involving the oral mucosa (although other clinical variants are frequently observed). Patients may be asymptomatic or complain of a burning sensation of variable intensity. The diagnosis is based on clinical and histological data. Because of the chronic nature of the disease, topical immunosuppressive drug therapy is indicated when there are symptomatic or ulcerated lesions. Periodic reassessment is useful because of OLP is potentially malignant.     

Role of propranolol in ulcerated haemangioma of head and neck: a prospective comparative study

Purpose

Infantile haemangiomas comprise the majority of vascular anomalies and are considered the predominant vascular tumour type 1. We performed this prospective study to evaluate the therapeutic response and propranolol tolerance in infants with ulcerated infantile haemangioma of head and neck region.

Methods

Sixty-four patients with ulcerated infantile haemangiomas (IHs) of head and neck region, without any prior treatment and with age older than 1 month, were included in the study, after informed consent was obtained, and were randomly divided into groups A and B. Group A patients were given oral propranolol at a dose of 2 mg/kg per day in three divided doses as outpatients. Group B patients were given oral ibuprofen at a dose of 10 mg/kg 8-hourly and paracetamol at dose of 16.2 mg/kg 8-hourly. Documentation of gender, age, haemangioma location, duration of ulceration and pain was measured on the second and fifth day after commencement of treatment in both groups using the Children’s Hospital of Eastern Ontario Pain Scale.

Results

There was no difference in pain score between the two groups (P value 0.074). Mean duration of healing of ulceration in group A was 17.93?±?2.22 days and in group B was 27.71?±?2.33 days (P value <0.001). In group A, out of 28 patients, 8 (28.5 %) were complete responders, 16 (57.1 %) were partial responders and 4 (14.2 %) were non-responders.

Conclusion

Propranolol is a valuable therapeutic alternative for treatment of ulcerated haemangiomas and effectively reduces pain.

     

Resolution of maxillary sinus mucositis after endodontic treatment of maxillary teeth with apical periodontitis: a cone-beam computed tomography pilot study

Introduction

Apical periodontitis (AP) is an inflammatory response that can affect the maxillary sinus. This study characterized maxillary sinus mucositis adjacent to teeth with AP and assessed its resolution after endodontic treatment.

Methods

Thirty maxillary sinuses in subjects (n = 29) who had AP associated with maxillary posterior teeth were imaged with cone-beam computed tomography (CBCT). When mucositis was detected, its resolution was assessed with CBCT scanning 3 months after treatment, and periapical healing was assessed using the periapical index (PAI) after 6 months.

Results

Excluding 5 sinuses obscured by sinusitis, mucositis was detected in 14 of 25 sinuses (56%). Nonsignificant inverse association was observed between the mucosal lining thickness and the distance from the sinus to root apices with AP. Four noncompliant subjects were discontinued. Three months after treatment, mucositis was fully resolved in 3 of 10 subjects (30%), partially resolved in 3 of 10 subjects (30%), unchanged in 3 of 10 subjects (30%), and worsened in 1 subject (10%). Six months after treatment, 6 of 10 subjects (60%) had reduced PAI scores classified as healed or healing. The subject with expanded mucositis at 3 months was not healing at 6 months.

Conclusions

Within the limited sample of this pilot study, CBCT imaging revealed a lower-than-expected prevalence of mucositis adjacent to teeth with AP. Fully resolved mucositis was not common 3 months after endodontic treatment, suggesting that in specific cases it might linger beyond 3 months after the elimination of the endodontic infection. Because of the low statistical power, the association between the resolution of mucositis and periapical healing could not be explored.     

Short- and medium-chain fatty acids exhibit antimicrobial activity for oral microorganisms

Objectives

This study assessed the antibacterial activity of short-, medium-, and long-chain fatty acids against various oral microorganisms.

Methods

The short-chain fatty acids [formic acid (C1), acetic acid (C2), propionic acid (C3), butyric acid (C4), isobutyric acid (C4), isovaleric acid (C5), hexanoic acid (C6)], medium-chain fatty acids [octanoic acid (C8), capric acid (C10), lauric acid (12)], and long-chain fatty acids [myristic acid (C14), palmitic acid (C16)], were investigated for antimicrobial activity against Streptococcus mutans, Streptococcus gordonii, Streptococcus sanguis, Candida albicans, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, and Porphyromonas gingivalis.

Results

The data demonstrated that the fatty acids exhibited patterns of inhibition against oral bacteria with some specificity that appeared related more to the bacterial species that the general structural characteristics of the microorganism. As a group the fatty acids were much less effective against C. albicans than the oral bacteria, with effectiveness limited to hexanoic, octanoic, and lauric acids. Formic acid, capric, and lauric acids were broadly inhibitory for the bacteria. Interestingly, fatty acids that are produced at metabolic end-products by a number of these bacteria, were specifically inactive against the producing species, whilst substantially inhibiting the growth of other oral microorganisms.

Conclusions

The results indicate that the antimicrobial activity of short-chain fatty acids (SCFAs), medium-chain fatty acids (MCFAs), long-chain fatty acids (LCFAs) could influence the microbial ecology in the oral cavity via at least 2 potential pathways. First, the agents delivered exogenously as therapeutic adjuncts could be packaged to enhance a microbial-regulatory environment in the subgingival sulcus. Second, it would be the intrinsic nature of these fatty acid inhibitors in contributing to the characteristics of the microbial biofilms, their evolution, and emergence of species within the biofilms. Further studies on these functions are required to better understand the nature of these potential microbial interactions in the biofilms.     

Chemo-radiotherapy induced oral mucositis during IMRT for head and neck cancer - An assessment

Background

This study is conducted mainly to evaluate the changes in quality and quantity of oral epithelial cells during the course of IMRT.

Material and Methods

30 Patients undergoing chemo-radiotherapy were followed through course of treatment. They were compared with a group of age- and sex-matched healthy individuals. The procedure involved WHO clinical scoring, collection of oral washings and preparation of buccal smears from both study group and control group. The changes occurred were recorded as a way of assessing the severity of oral mucositis.

Results

Revealed a significant occurrence of oral mucositis in almost all patients during weekly follow up. There was a significant increase in percentage of viable buccal epithelial cells in study group when compared to normal controls (P<0.005) during and at the end of chemo-radiotherapy.

Conclusions

Quantification of oral mucositis can be done at cellular level by determining the oral mucosal cell viability and their maturation during IMRT. Key words:Oral mucositis, in vitro assay, quantification, radiotherapy, chemotherapy, viable cells.     

Phenethyl isothiocyanate enhances TRAIL-induced apoptosis in oral cancer cells and xenografts

Objectives

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) has been regarded as a promising candidate for cancer therapy. However, most of oral cancer cell lines are resistant to the TRAIL-induced cytotoxicity. The aim of this study was to investigate the ability of phenethyl isothiocyanate (PEITC) to sensitize TRAIL-induced apoptosis in TRAIL-resistant oral cancer cells and xenografts.

Materials and methods

Terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay, Western blotting, and a mouse xenograft model were used to study the effects of PEITC and TRAIL on two TRAIL-resistant human oral cancer cells, SAS and Ca9-22.

Results

PEITC upregulated death receptor 4 (DR4) and DR5 protein expression and increased reactive oxygen species (ROS) production in both SAS and Ca9-22 cells. Antioxidant N-acetyl-l-cysteine (NAC) and c-Jun NH2-terminal kinase (JNK) inhibitor SP600125 inhibited PEITC-induced DR4 and DR5 expression. Inhibitor experiments showed that PEITC induced apoptosis through ROS-mediated JNK activation and upregulation of DR4 and DR5. Furthermore, treatment with PEITC significantly increased TRAIL-induced apoptosis in both cells. Combined treatment with PEITC and TRAIL had greater effect on the inhibition of tumor growth than either agent alone.

Conclusions

We showed for the first time that PEITC overcomes TRAIL resistance in oral cancer cells and enhance the therapeutic potential of TRAIL in vivo.

Clinical relevance

PEITC, either alone or in combination with TRAIL, can be used as a new therapeutic approach for the treatment of oral cancers.

     

LED and laser photobiomodulation in the prevention and treatment of oral mucositis: experimental study in hamsters

Purpose

This paper aims to evaluate the effects of laser (660 nm) and light-emitting diode (LED) (670 nm) irradiation in the cheek pouch mucosa of hamsters with oral mucositis (OM) induced by chemotherapy (Che) with 5-fluorouracil (5-FU).

Materials and methods

In the preventive groups, the photobiomodulation was started 1 day before the drug administration and was performed every 48 h (Ia, IIa, Ib, and IIb). In the therapeutic groups (IIIa, IIIb, IVa, and IVb), the irradiations were started on the third day after the Che d(0) and was performed every 48 h. In both groups, animals were sacrificed 7 or 14 days after Che. In the positive control groups, the hamsters were subjected to Che but did not receive irradiation, and they were sacrificed in 7 days (Va) or 14 days (Vb). In the negative control groups, no procedures were done and the animals were sacrificed 7 days (Vc) or 14 days (Vd) after the experiment started.

Results

The results indicated loss of body mass, xerostomia, and alopecia in the animals subjected to Che and the healing of OM to different degrees after the photobiomodulation treatment. Histologically, the positive control and experimental groups showed inflammation, predominately with lymphocytes and plasma cells, which tended to diminish with time. Epithelial atrophy, hyperemia, fibroblast proliferation, and vascular congestion were also observed at those intervals.

Conclusions

The best results were obtained from the preventive laser and LED photobiomodulation groups; both treatments were effective in diminishing the OM lesions.

Clinical relevance

A noninvasive and effective method with sparse side effects of OM would be desirable for use in cancer centers around the world.     

Double-blind,randomized pilot study of bioadhesive chlorhexidine gel in the prevention and treatment of mucositis induced by chemoradiotherapy of head and neck cancer

Background

To evaluate, in an initial way, the effectiveness of bioadhesive chlorhexidine gel 0.2% versus placebo as a preventive and therapeutic intervention of oral mucositis induced by radiation therapy and chemotherapy in patients diagnosed with head and neck cancer treated with chemoradiotherapy.

Material and Methods

In this pilot study, 7 patients (range of age: 18- 65), having histological documented diagnosis of squamous carcinoma on the head and neck region in stage III and IV, and receiving combined radiation treatment and chemotherapy (cisplatin 100 mg/m2 IV on days 1, 22, and 43 of irradiation) were studied. Simultaneously, a topical application was performed with bioadhesive chlorhexidine gel 0.2% in the study group, and the placebo gel for the control group in 5 applications per day, from the time of initiation of cancer treatment to 2 weeks after completion of chemo-radiotherapy treatment (11 weeks of follow-up). The gradation of mucositis, pain, analgesic consumption, infectious complications, and treatment tolerance was measured.

Results

After 7 patients completed the protocol, any differences were observed between groups in an interval analysis. Mucositis, pain, and tolerance was similar in both groups.

Conclusions

Our results must be interpreted with caution due to the reduced sample size, but the use of bioadhesive chlorhexidine gel 0.2% didn’t contribute clinical improvement to the oral mucositis induced by radiation therapy and chemotherapy. Key words: Chlorhexidine, mucositis, head and neck cancer.     

NF1 diagnosis criteria and associated sarcomatous tumor review of the literature and case report

Aim

This paper reports the case of a sarcomatous tumor (probably a pleomorphic sarcoma) in a patient with Neurofibromatosis type 1 (NF1) and discusses the association between these two diseases.

Background

NF1 is an autosomal dominant tumor predisposition syndrome. Malignant transformation is observed in patients with this disease, usually in the form of malignant peripheral nerve sheath tumors (MPNSTs).

Report

A 72-year-old female patient with diagnosis of NF1 presented with left mandibular region enlarged for about 6 months, intra-oral examination revealed a mass growth on the floor of the lower left posterior area of the oral cavity measuring 5 cm in its greatest diameter and covered by ulcerated mucosa.

Summary

Few cases of association of neurofibromatosis with other types of soft tissue sarcomas have been reported. Undifferentiated pleomorphic sarcomas are the most common of these tumors. We intend to call attention to the importance of patient follow-up and counseling.     

Methodological quality assessment of paper-based systematic reviews published in oral health

Objectives

This study aimed to conduct a methodological assessment of paper-based systematic reviews (SR) published in oral health using a validated checklist. A secondary objective was to explore temporal trends on methodological quality.

Material and methods

Two electronic databases (OVID Medline and OVID EMBASE) were searched for paper-based SR of interventions published in oral health from inception to October 2014. Manual searches of the reference lists of paper-based SR were also conducted. Methodological quality of included paper-based SR was assessed using an 11-item questionnaire, Assessment of Multiple Systematic Reviews (AMSTAR) checklist. Methodological quality was summarized using the median and inter-quartile range (IQR) of the AMSTAR score over different categories and time periods.

Results

A total of 643 paper-based SR were included. The overall median AMSTAR score was 4 (IQR 2–6). The highest median score (5) was found in the pain dentistry and periodontology fields, while the lowest median score (3) was found in implant dentistry, restorative dentistry, oral medicine, and prosthodontics. The number of paper-based SR per year and the median AMSTAR score increased over time (median score in 1990s was 2 (IQR 2–3), 2000s was 4 (IQR 2–5), and 2010 onwards was 5 (IQR 3–6)).

Conclusion

Although the methodological quality of paper-based SR published in oral health has improved in the last few years, there is still scope for improving quality in most evaluated dental specialties.

Clinical relevance

Large-scale assessment of methodological quality of dental SR highlights areas of methodological strengths and weaknesses that can be targeted in future publications to encourage better quality review methodology.

     

Influence of calcium hydroxide dressing and acid etching on the push-out bond strengths of three luting resins to root canal dentin

Objectives

This study aims to investigate the effects of calcium hydroxide (Ca(OH)₂) dressing in root canals and the effects of subsequent acid etching on the adhesion of luting resins to root canals.

Materials and methods

Root specimens were prepared from extracted human permanent molars. Specimen canals were (1) filled with etch-and-rinse (Nexus® third generation (NX3)) and two self-adhesive (RelyX Unicem, Maxcem Elite) luting resins, respectively; (2) dressed with Ca(OH)₂ before Ca(OH)₂ removal and luting resin filling; (3) dressed with Ca(OH)₂ before Ca(OH)₂ removal and post-cementation; or (4) treated as described in item (2) except that the canals were further etched with phosphoric acid before luting resin filling. Push-out bond strengths were measured and analyzed using one-way analysis of variance, and Fisher’s multiple comparison tests provided a follow-up comparison among these four canal treatments. Attenuated total reflectance-Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy (XPS), and scanning electron microscopy (SEM) were used to analyze the specimen surfaces.

Results

Ca(OH)₂ dressing adversely affected the bond strengths to canal dentin of the three luting resins tested. Acid etching did not increase the bond strengths. Infrared analysis revealed that Ca(OH)₂ dressing caused no structural changes on the dentin surface. XPS and SEM analyses revealed Ca(OH)₂ remnants as the ultimate chemical cause leading to the decrease in bond strength.

Conclusions

The bond strength of luting resin to dentin was affected by Ca(OH)₂ dressing. Acid etching treatment could not increase the bond strength.

Clinical relevance

Adhesion of the fiber post to the root canal wall may be compromised after Ca(OH)₂ dressing. An effective method for complete removal of Ca(OH)₂ dressing or increase of bond strength for luting resin needs to be developed.     

Correlation between peri-implant sulcular fluid rate and expression of collagenase2 (MMP8)

Objectives

The rapidly increasing numbers of inserted dental implants and the growing incidence of peri-implant mucositis and peri-implantitis with the current absence of reliable disease risk prediction highlight the importance of early and sensitive diagnosis of possible disease progression. The aim of this study is to assess quantitative and qualitative analysis of peri-implant sulcular fluid (PISF) during implant maintenance control and to identify whether there is a positive correlation and statistical significance between peri-implant sulcular fluid volume results and collagenase2 level obtained from both superficial and fundus area of peri-implant sulcus.

Material and method

Twenty-seven implants from patients under recall provided peri-implant sulcular fluid volume samples, which were collected with the Periotron 8000 micro-moisture meter, and collagenase2 levels, which were assessed using dentoTest aMMP8. Statistical analysis was obtained using Spearman’s correlation.

Results

Positive correlation was found between collagenase2 collected from sulcular and fundus areas on both mesial and distal sides. There was correlation between peri-implant sulcular fluid volume and collagenase2 level from fundus and distal area, but not from the mesial and superficial area.

Conclusions

Examination of collagenase2 is a sensitive method when examining early inflammatory changes but depends from the depth of the sample collection in the gingival pocket.

Clinical relevance

The examination of MMP8 seems to be a more sensitive method than the analysis of peri-implant sulcular fluid to detect peri-implant mucositis and peri-implantitis.

     

Correlation of MAGE-A tumor antigens and the efficacy of various chemotherapeutic agents in head and neck carcinoma cells

Objectives

The present study examined the relationship between MAGE-A tumor antigens and the efficacy of diamindichloridoplatin (DDP), 5-fluorouracil (5-FU), docetaxel, and paclitaxel for in vitro treatment of head and neck cancer.

Methods

In the present study, five cell lines of human squamous cell carcinomas were treated with DDP (25–400 μM), 5-FU (0.75–12 mM), docetaxel (1.56–25 nM), and paclitaxel (1.56–25 nM) for a period of 24 or 48 h. The efficacy of the agents was observed dynamically using real-time cell analysis. Subsequently, the expression levels of MAGE-A1, MAGE-A5, MAGE-A8, MAGE-A9, MAGE-A11, and MAGE-A12 were determined by quantitative real-time polymerase chain reaction. Chemosensitivity and MAGE-A-expression were correlated by linear regression.

Results

The tumor cell lines showed a highly differentiated response to the chemotherapeutic agents. Expression of MAGE-A11 was significantly associated with a poorer response to treatment with DDP, 5-FU, docetaxel, and paclitaxel. Two cell lines, one of which was MAGE-A11-positive, showed a significant and concentration-dependent cisplatin-induced growth spurt during the first 24 h after treatment. MAGE-A5 was connected to a positive effect on treatment with paclitaxel within the first 24 h after application. In association with docetaxel treatment, MAGE-A8 was connected to a poorer susceptibility.

Conclusions

The results describe, for the first time, a correlation between these MAGE-A tumor antigens and the susceptibility of head and neck cancer cells to DDP, 5-FU, docetaxel, and paclitaxel.

Clinical relevance

These findings could affect the antineoplastic treatment of patients with MAGE-A11-positive tumors.     

Pain mechanism of oral ulcerative mucositis and the therapeutic traditional herbal medicine hangeshashinto

Background

Oral ulcerative mucositis causes severe pain during eating and speaking, resulting in poor quality of life for patients with cancer undergoing chemoradiotherapy. Recently, some basic and clinical studies demonstrated that hangeshashinto, a traditional Japanese herbal medicine, alleviated oral ulcerative mucositis-induced pain. Here, we review a recently revealed pain mechanism underlying oral ulcerative mucositis in a preclinical rat model and the pharmacological analgesic effect of hangeshashinto.

The impact of sexual behavior on oral HPV infections in young unvaccinated adults

Objective

Different authors hypothesized an important impact of sexual behavior on the prevalence of oral human papillomavirus (HPV) infections. In order to investigate this relationship more in detail and in contrast to most other studies, the present work focused on the population group with the highest risk for sexually transmitted infections: young and sexual active adults.

Materials and methods

Three hundred and ten men and women aged 18–30 years could be recruited. After the completion of a risk-factor survey, brush smear samples for oral HPV detection were taken in every participant.

Results

In 18.1 %, oral HPV could be detected. Overall, smoking (p = 0.0074) and a high number of different sexual partners (vaginal: p = 0.0001; oral: p < 0.0001) were significantly correlated with a positive HPV testing. In case of high risk HPV infections, besides tobacco and sexual behavior, alcohol consumption showed a significant association with a positive testing (p = 0.0212).

Conclusions

Overall, the prevalence of oral HPV seems to be higher in young, sexual active adults compared to other population groups. Tobacco and alcohol may facilitate an oral HPV infection. Sexual behavior, especially oral sex practices, seems to play a crucial role in the transmission of oral HPV.

Clinical relevance

The presented data, especially the association of oral high risk HPV positivity and promiscuity, may lead to improvements in the existing oral HPV prevention strategies like a HPV vaccination for both genders.

     

Biological toxicity of acid electrolyzed functional water: effect of oral administration on mouse digestive tract and changes in body weight

Objective

Acid electrolyzed functional water has been used in a variety of ways because of its antiseptic action. In the present study, we investigated both the systemic and gastrointestinal effects of ingesting acid electrolyzed functional water, from the perspective of its use in mouthwash.

Materials and methods

Seventeen mice (three weeks old) were used in the experiment. Three of the mice (three-week-old group) were euthanized before having been given solid food, whilst the remaining 14 were divided into two groups, one given free access to acid electrolyzed functional water as drinking water (test group) and the other given free access to tap water as drinking water (control group). Changes in body weight, visual inspections of the oral cavity, histopathological tests, and measurements of surface enamel roughness and observations of enamel morphology were recorded after eight weeks.

Results

The results showed no significant difference in changes in body weight between the test and control groups. No abnormal findings or measurements were observed for the test group in terms of visual inspections of the oral cavity, histopathological tests, or measurements of surface enamel roughness. In terms of enamel morphology, attrition was seen in the test group.

Conclusions

These findings suggest that the use of acid electrolyzed functional water has no systemic effect and is safe for use in mouthwash.     

PRGF exerts a cytoprotective role in zoledronic acid-treated oral cells

Objectives

Bisphosphonates-related osteonecrosis of the jaw (BRONJ) is a common problem in patients undergoing long-term administration of highly potent nitrogen-containing bisphosphonates (N-BPs). This pathology occurs via bone and soft tissue mechanism. Zoledronic acid (ZA) is the most potent intravenous N-BP used to prevent bone loss in patients with bone dysfunction. The objective of this in vitro study was to evaluate the role of different ZA concentrations on the cells from human oral cavity, as well as the potential of plasma rich in growth factors (PRGF) to overcome the negative effects of this BP.

Material and methods

Primary human gingival fibroblasts and primary human alveolar osteoblasts were used. Cell proliferation was evaluated by means of a fluorescence-based method. A colorimetric assay to detect DNA fragmentation undergoing apoptosis was used to determine cell death, and the expression of both NF-κB and pNF-κB were quantified by Western blot analysis.

Results

ZA had a cytotoxic effect on both human gingival fibroblasts and human alveolar osteoblasts. This BP inhibits cell proliferation, stimulates apoptosis, and induces inflammation. However, the addition of PRGF suppresses all these negative effects of the ZA.

Conclusions

PRGF shows a cytoprotective role against the negative effects of ZA on primary oral cells.

Clinical relevance

At present, there is no definitive treatment for bisphosphonates-related osteonecrosis of the jaw (BRONJ), being mainly palliatives. Our results revealed that PRGF has a cytoprotective role in cells exposed to zoledronic acid, thus providing a reliable adjunctive therapy for the treatment of BRONJ pathology.

     

Salivary 8-hydroxy-2-deoxyguanosine,malondialdehyde, vitamin C,and vitamin E in oral pre-cancer and cancer: diagnostic value and free radical mechanism of action

Objectives

The objectives of this study are to analyze oxidative DNA and lipid damage using salivary 8-hydroxy-2-deoxyguanosine (8-OHdG), malondialdehyde (MDA), and vitamins C and E in oral lichen planus lesions, oral leukoplakia, oral submucous fibrosis, oral squamous cell carcinoma (SCC), and controls and to determine the value of salivary biomarkers in the diagnosis of oral pre-cancer and cancer patients.

Materials and methods

Unstimulated saliva was collected from a group of patients diagnosed with 40 oral squamous cell carcinoma (OSCC), 40 oral lichen planus lesions, 40 oral leukoplakia, 40 oral submucous fibrosis, and from a control group of healthy age- and gender-matched individuals. Salivary 8-OHdG, MDA, and vitamins C and E were measured.

Results

Squamous cell carcinoma and pre-cancer patients showed significantly higher levels of salivary 8-OHdG and MDA and lower levels of vitamins C and E when compared to levels in healthy normal subjects. The specificity and sensitivity of the combination of 8-OHdG, MDA, vitamin C, and vitamin E are high for the diagnosis of oral pre-cancer and SCC compared to an individual biomarker approach using either 8-OHdG, MDA, or vitamin C and vitamin E independently.

Conclusions

This study indicates the presence of oxidative DNA and lipid damage in pre-cancerous and SCC patients. It is postulated that the mechanism may have a significant link to carcinogenesis in oral cancer. Detection of salivary 8-OHdG, MDA, vitamin C, and vitamin E can act as suitable diagnostic biomarkers of oral pre-cancer and cancer.

Clinical relevance

Of clinical importance is that salivary 8-OHdG, MDA, vitamin C, and vitamin E could play a significant role in oral cancer and pre-cancer patients and could therefore be useful for diagnosis in patients with oral lichen planus lesions, oral leukoplakia, oral submucous fibrosis, and oral squamous cell carcinoma.

     

Oral lichen planus shows higher expressions of tumor suppressor gene products of p53 and p21 compared to oral mucositis. An immunohistochemical study

Objective

Oral lichen planus (OLP) has been speculated to be a chronic inflammatory disease with potential for malignant progression. The aim of this study was to establish a hypothesis on the difference between OLP and oral mucositis (OM) in terms of tumor suppressor gene expression.

Design

Computer based image analysis of immunohistochemical expressions of p53 and p21 was investigated in 18 samples of OLP, 10 normal oral epithelium (NOE), 10 oral squamous cell carcinoma (OSCC), 13 OM, 20 oral focal keratosis (OFK), and 30 samples of oral epithelial dysplasia (OED). Representative fields were digitized and analyzed.

Results

Using independent samples Student's t-test, p53 and p21 the mean percentages of positive nuclei (MPPN) of p53 (40.27%) and of p21 (39.98%) in OLP were significantly higher than that of NOE, OFK and OM (15.06%, 27.87%, 30.08% and 16%, 31.09%, 33.92% respectively, p < 0.001). MPPN of p53 in OLP was not different from that of mild OED (40.5%, p = 0.85) but lower than of moderate and severe OED, and OSCC (49.78%, 61.36%, 78.16% respectively; p < 0.001). MPPN of p21 in OLP was lower than that of moderate and severe OED, and OSCC (47.72%, 57.9%, 85.44% respectively; p < 0.001) but slightly higher than that of mild OED (39.86% p = 0.81).

Conclusions

As the expression of p53 and p21 in OLP was significantly higher than that of oral mucositis with no significant difference from mild epithelial dysplasia, OLP might need to be followed up and monitored more closely to detect early features of transformation, if any, compared to non-specific oral mucositis which needs no close follow-up.