Odontogenic Cysts and Tumors.

Importance Potentially malignant disorders of the oral cavity (OPMD) are a heterogeneous group of lesions associated with a variable risk of malignant transformation (MT) to invasive cancer. Leukoplakia (LE), lichen planus (LP), oral lichenoid lesions (OLL), oral erythroplakia (OE), oral submucous fibrosis (OSF), and proliferative verrucous leukoplakia (PVL) are among the most common of these lesions. Oral dysplasia is a mucosal area characterized by cellular and architectural derangement, which may be associated with OPMDs or not. Objective To define the MT rate of OPMDs and the risk of development into cancer of mild vs moderate/severe oral dysplasia. This in order to implement adequate follow-up strategies and treatment decisions. Study design We performed a systematic review and meta-analysis on studies reporting the MT rates of OPMDs and oral dysplasia. Ninety-two studies were included for the analysis. Cumulative rates were reported for OPMDs overall and as a subgroup, a comparison was made of mild vs moderate/severe dysplasia. Meta-regression on OPMD and year of publication was also performed. Main outcome and measures Overall MT rates of OPMDs and odds ratio of MT of mild vs moderate/severe dysplasia. Results Overall MT rate across all OPMD groups was 7.9% (99% confidence interval [CI] 4.9%-11.5%). MT rates of the specific OPMD subgroups were as follows: LP 1.4% (99% CI 0.9%-1.9%), LE 9.5 (5.9%-14.00%), OLL 3.8% (99% CI 1.6%-7.00%), OSF 5.2% (99% CI 2.9%-8.00%), OE 33.1% (99% CI 13.6%-56.1%), and PVL 49.5% (99% CI 26.7%-72.4%). Regarding the dysplasia grades comparison, the meta-analysis showed that moderate/severe dysplasia is meaningfully associated to a much greater risk of MT compared to mild dysplasia with an odds ratio of 2.4 (95% CI 1.5-3.8) [Correction added on 27 December 2019, after first online publication: CI updated from 99% to 95%.]. Heterogeneity was not significant. Annual MT rates were approximated based on the average follow-up as reported in the various subgroups. Lichen planus had an annual MT of 0.28%, OLL of 0.57%, leukoplakia of 1.56%, PVL of 9.3%, and OSF of 0.98%. Mild dysplasia had an annual MT of 1.7%, while severe dysplasia of 3.57%. Meta-regression showed a significant negative correlation of PVL MT rate and year of the study (P value Conclusions and relevance OPMDs and oral dysplasia are relatively common conditions that general practitioners, head and neck, and oral medicine specialists, face in their everyday practice. Our analysis confirms the significant risk of MT of these lesions, although variable among the subgroups. Moderate/severe dysplasia bears a much higher risk of cancer evolution than mild dysplasia. It is important to raise public health awareness on the MT rates of these conditions, at the same time efficacious communication with the patient is of utmost importance. This, coupled with strict follow-up measures and optimal treatment strategies, would help in reducing the transformation of these oral conditions into invasive cancer.

Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta‐analysis of malignant transformation rate by subtype

Histopathological examination is considered as gold standard procedure for arriving at a final diagnosis of various lesions of the human body. However, it is limited by a number of alterations of normal morphologic and cytological features that occur as a result of presence of artifacts. These artifacts may occur during surgical removal, fixation, tissue processing, embedding and microtomy and staining and mounting procedures. They can even lead to complete uselessness of the tissue. It is therefore essential to identify the commonly occurring artifacts during histopathological interpretations of tissue sections. This article reviews the common artifacts encountered during slide examination alongside the remedial measures which can be undertaken to differentiate between an artifact and tissue constituent.

A review of artifacts in histopathology

Cysts of the Oral and Maxillofacial Regions

The large multidisciplinary academic social website ResearchGate aims to help academics to connect with each other and to publicize their work. Despite its popularity, little is known about the age and discipline of the articles uploaded and viewed in the site and whether publication statistics from the site could be useful impact indicators. In response, this article assesses samples of ResearchGate articles uploaded at specific dates, comparing their views in the site to their Mendeley readers and Scopus-indexed citations. This analysis shows that ResearchGate is dominated by recent articles, which attract about three times as many views as older articles. ResearchGate has uneven coverage of scholarship, with the arts and humanities, health professions, and decision sciences poorly represented and some fields receiving twice as many views per article as others. View counts for uploaded articles have low to moderate positive correlations with both Scopus citations and Mendeley readers, which is consistent with them tending to reflect a wider audience than Scopus-publishing scholars. Hence, for articles uploaded to the site, view counts may give a genuinely new audience indicator.

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ResearchGate articles: Age, discipline, audience size, and impact

Background: Oral lichenoid lesions or reactions (OLLs/OLRs) are clinical and histological contemporaries of the classical oral lichen planus (OLP) that have generated a lot of debate in literature In contrast to the idiopathic nature of OLP, OLLs are often associated with a known identifiable inciting factor A superficial examination of these lesions clinically and histologically often reveals many similarities with OLP, but recent data indicate that distinguishable features do exist and form the basis of most classifications Aims and Objectives: This paper attempts to collate available data in English literature on OLLs, highlight distinguishing features clinically and histologically and reflect on the malignant transformation potential and treatment modalities of the condition Materials and Methods: A comprehensive search of medical and dental databases including PubMed, Ovid, Cochrane, Pubget, Researchgate, and non-medical search engines were utilized for the review The search words included oral lichen planus, oral lichenoid lesions, oral drug reactions, lichenoid dysplasia, and adverse effects of dental materials Review Results: OLLs seem to grossly underrated and most cases were clubbed as OLP Definite clinical and histological features were uncovered to establish the identity of this lesion Associations with dental restorative materials, drugs, and medications have been conclusively proven in the etiology of this condition Specific markers are being utilized to diagnose the condition and monitor its progress Conclusion: Substantial differentiating features were uncovered to delineate OLLs as a separate entity with definite etiology, pathogenesis, and a high malignant transformation rate compared with OLP

Oral lichenoid lesions - a review and update.

Aims and Objectives: Sexual dimorphism refers to the variations in tooth size and shape between the sexes. The consistency of these variations is valuable in the identification of the sex of an individual in times of mass disaster when whole body parts get destroyed or are unavailable. There exist differences in the expression of these variables across races and regions. This study aims to tabulate and identify the variations in tooth measurements using standarized reference points in an attempt to establish parameters of sexual dimorphism. Materials and Methods: 100 individuals (50 of each sex) in the age group 19-23 years were assessed for standard morphometric parameters of the maxillary central incisor, canine, premolar and molar. Odontometric measurements of established parameters were recorded from impression casts of the maxillary jaws. The mesiodistal width (MDW), the bucco-ligual width (BLW), the crown length (CL) and the cervical angle (CA) were charted among the teeth. The consistency of the variations was statistically analyzed and a logistic regression table was prepared to identify the sex of the individual from the tooth measurements.Results and Conclusions: The BLW, MDW and CL reflected significant variations among all the teeth to be effective in establishing sexual dimorphism. CA as a parameter was inadequate across all the teeth. The permanent maxillary canine was the most important tooth to be reflective of the gender and statistically significant to be utilized for gender determination.

Sexual dimorphism in tooth morphometrics: An evaluation of the parameters

The squamous odontogenic tumor (SOT) is a rare, benign, locally infiltrative neoplasm of the jaws that appears to originate from the rests of Malassez, gingival surface epithelium or from remnants of the dental lamina. SOT was first described by Pullon et al. (1975). Since then there has been paucity in the number of reported cases, especially in the Indian subcontinent. The tumor is often asymptomatic, although it can present with symptoms of pain and tooth mobility. The characteristic radiographic appearance is that of a triangular-shaped unilocular radiolucency associated with the roots of erupted, vital teeth and has a predilection for the anterior maxilla and the posterior mandible. Histologically, the tumor is characterized by the formation of variably sized nests and cords of uniform, benign-appearing, squamous epithelium with occasional vacuolization and keratinization. We report a case of SOT occurring in a 58-year-old male in the anterior mandible with unusual localization and appearance.

Squamous odontogenic tumor: A case report and review of literature.

Oral submucous fibrosis (OSMF) is a potentially malignant oral condition effectively linked to the causative habit of chewing areca nut. Since its first description in the 1950s, numerous epidemiological, biochemical, histological, and genetic studies have been reported. While most studies point out to the cause and effect of areca nut, co-additive factors are also implicated in the progression and malignant transformation of this condition. Biochemical investigations have concentrated on outlining such changes in the blood, serum or tissues of these patients and have given insights on the possible pathogenesis of OSMF. This article attempts to compile details of biochemical investigations in OSMF and summarize and infer on the findings. Key Words: Biochemical parameters, immunology, malignant transformation, oral submucous,fibrosis, trace elements

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Biochemical markers in oral submucous fibrosis: A review and update.

Background: Micronucleus is a microscopically visible round or oval cytoplasmic chromatin mass in the extra nuclear vicinity, originated from aberrant mitosis, which consists of eccentric chromosomes that have failed to reach spindle poles during mitosis and are used as biomarkers for assessment of DNA damage. Micronuclei are characteristically seen in exfoliated cells of the buccal mucosa and urinary bladder wall in precancerous and cancerous conditions. Oral habits of smoking tobacco or chewing areca nut damage the oral tissues. An assessment of the damage is feasible by the detection of micronuclei in exfoliated cells of the oral tissues using smears. Objectives: The present study was designed to assess the presence or increase of micronuclei in buccal smears of individuals with tobacco habits against a control group of teetotalers. Materials and Methods: Two groups (smokers and non-smokers) of 50 individuals each were examined. Buccal smears of all participants were taken using cytobrush and stained with standard Papanicolaou's (PAP) stain. Presence of micronuclei was assessed under Χ100 magnification and a count per 500 cells was determined. The results were analyzed statistically using t-test and Mann-Whitney test. Results: Smears of individuals with tobacco habits showed a significant increase in the total number of micronuclei per 500 cell counts. There was a definite correlation between the occurrence of micronuclei and the frequency and duration of smoking. A paradoxical age related increase in middle-aged groups was also observed. Conclusions: The genotoxic effects of tobacco smoke cause chromosomal damage in the epithelial cells of the oral mucosa and are reflected in the increased micronuclei in smokers. This is present even in the absence of clinically evident changes. This observation is vital in utilization of the micronuclei detection in smears as a prognostic, educational and interventional tool in the management of patients with smoking habits.

Venkatesh V Kamath

Papers

Oral lichenoid lesions - a review and update.

Sexual dimorphism in tooth morphometrics: An evaluation of the parameters

Squamous odontogenic tumor: A case report and review of literature.

Biochemical markers in oral submucous fibrosis: A review and update.

Micronuclei as prognostic indicators in oral cytological smears: A comparison between smokers and non-smokers