Showing papers in "Oral Diseases in 2021"
TL;DR: It is recommended the establishment of a global research consortium to further study the natural history of OPMDs based on the classification and nomenclature proposed here, and link them to evidence-based interventions, to facilitate the prevention and management of lip and oral cavity cancer.
Abstract: Oral potentially malignant disorders (OPMDs) are associated with an increased risk of occurrence of cancers of the lip or oral cavity. This paper presents an updated report on the nomenclature and the classification of OPMDs, based predominantly on their clinical features, following discussions by an expert group at a workshop held by the World Health Organization (WHO) Collaborating Centre for Oral Cancer in the UK. The first workshop held in London in 2005 considered a wide spectrum of disorders under the term "potentially malignant disorders of the oral mucosa" (PMD) (now referred to as oral potentially malignant disorders: OPMD) including leukoplakia, erythroplakia, proliferative verrucous leukoplakia, oral lichen planus, oral submucous fibrosis, palatal lesions in reverse smokers, lupus erythematosus, epidermolysis bullosa, and dyskeratosis congenita. Any new evidence published in the intervening period was considered to make essential changes to the 2007 classification. In the current update, most entities were retained with minor changes to their definition. There is sufficient evidence for an increased risk of oral cancer among patients diagnosed with "oral lichenoid lesions" and among those diagnosed with oral manifestations of 'chronic graft-versus-host disease'. These have now been added to the list of OPMDs. There is, to date, insufficient evidence concerning the malignant potential of chronic hyperplastic candidosis and of oral exophytic verrucous hyperplasia to consider these conditions as OPMDs. Furthermore, due to lack of clear evidence of an OPMD in epidermolysis bullosa this was moved to the category with limited evidence. We recommend the establishment of a global research consortium to further study the natural history of OPMDs based on the classification and nomenclature proposed here. This will require multi-center longitudinal studies with uniform diagnostic criteria to improve the identification and cancer risk stratification of patients with OPMDs, link them to evidence-based interventions, with a goal to facilitate the prevention and management of lip and oral cavity cancer.
306 citations
TL;DR: Oral manifestations developed during the lock-down period between the last week of March and the first week of April 2020, and consisted of pain, desquamative gingivitis, ulcers and blisters, and is the first case report describing of a COVID-19 patient with oral manifestations.
Abstract: 1 INTRODUCTION
Humans infected with SARS‐CoV‐2 are at risk of developing serious and life‐threatening conditions, such as severe acute respiratory syndrome.
Recent data suggest the more common signs and symptoms of SARS‐CoV‐2 infection to be headache, sore throat, hyposmia, hypogeusia, diarrhea, dyspnea, and in severe cases pneumonia. (Wang et al., 2020).
Some authors in Italy reported cases of dermatologic implication in patients affected by SARS‐CoV‐2 infection (Recalcati, 2020). Since then, we have seen more reports describing dermatologic involvement, including lesions that range from affectation of hands and feet in teenagers to vasculitis, rash, urticaria, and varicella‐like lesions. (Estebanez et al., 2020).
Spain has been severely affected by the COVID‐19 outbreak (Bonanad et al., 2020). The majority of dental clinics and university clinics are closed, only treating emergencies if the entity has the protective measures necessary. There is a nationwide lack of serological tests available, both for patients and for healthcare providers.
We here present three cases associated with this virus: two where there is a suspicion of COVID‐19 and one case of confirmed infection. All cases presented ulcers or blisters in the oral cavity, appearing and developing during the isolation period between the last week of March and the first week of April 2020. We were not able to examine them in our clinic due to the state of alarm declared from the 14th of March, but offered the possibility of video consultations.
2
PATIENT 1 A 56‐year‐old healthy male patient without any relevant medical history was isolated with suspected infection of SARS‐CoV‐2. He presented asthenia and fever for 2 days, reporting hyposmia, dysgeusia, and enlargement of lymph nodes in the neck. Testing for COVID‐19 was not performed in the hospital due to the non‐severity of his case. He was sent home by his general practitioner. He complained of pain in his palate and sore throat. We asked him to send us a photograph (Figure 1). The lesions resembled a herpetic recurrent stomatitis; however, it was the first time the patient had them. We prescribed valaciclovir 500 mg every 8 hr for 10 days, and topical antiseptics with chlorhexidine and hyaluronic acid. After 10 days, there was a full recovery of the oral lesions. The patient is currently waiting for serological testing to confirm whether or not he had a non‐severe COVID‐19 disease.
Figure 1 Multiple orange‐colored ulcers with an erythematous halo and symmetric distribution on the right hard palate of the patient
3
PATIENT 2
A 58‐year‐old male patient with diabetes and hypertension reported pain on his palate. He assumed it was a bacterial infection of a tooth and reached out to us for an appointment. His wife had been diagnosed with COVID‐19, and they were both isolated in their home. We asked for a photograph, and we could see multiple small ulcers on his palate with unilateral affection (Figure 2). The patient did not have any previous history of herpetic infection.
Figure 2
Multiple pinpoint yellowish ulcers with an erythematous halo on the left hard palate of the patient
The lesions were painful and solved within 1 week using topical antiseptic mouthwash.
4
PATIENT 3
A 65‐year‐old female patient developed high fever, diarrhea, and pain on her tongue, on the 12th of March 2020. She suffered from obesity and hypertension controlled by diuretics and an ACE inhibitor. A week after developing symptoms, she fainted at home and was taken to the hospital where she was diagnosed with bilateral pneumonia due to SARS‐CoV‐2 infection. She was given antibiotics, corticosteroids, and antiviral drugs (lopinavir 200 mg, ritonavir 50 mg, hydroxychloroquine 200 mg). On the 30th of March, she was discharged. On the 4th of April, she developed a rash under her breasts and other parts of the skin, including her back and genital area. She had complained of pain on her tongue from the beginning, but she told us she had not been given an intraoral examination yet. She was taken back to the hospital where the dermatologist performed a biopsy and prescribed antifungals. A week later, she developed blisters in her internal lip mucosa as well as a desquamative gingivitis (Figure 3). We prescribed hyaluronic acid and chlorhexidine mouthwash. Her general practitioner prescribed prednisolone 30 mg per day. Her lesions improved within 3 days, and she is now recovering in isolation at home. The result of the biopsy revealed non‐specific morphological findings with some criteria suggestive of viral exanthema or urticariform dermatitis with discrete blood extravasation.
Figure 3
(a) The aspect of the back of the patient the day the biopsy was performed at the hospital. The patient reported that the lesions were more pruritic than painful. (b) The patient presented 3 blisters on the inner lip mucosa. The blister located closer to her right commissure was intact and tense. The bulla located on the left appeared to be broken. The lesions were affecting both intra‐ and extraoral mucosa, and the patient developed crusts on the external lip mucosa 3 days after this photograph was taken
In our opinion, it makes good sense that this virus provokes exanthematic lesions that may resemble other viral processes we are used to diagnosing in the dental clinic.
The patients presented ulcers or blisters, which are common elementary lesions observed in other viral processes, such as aphthous fever, hand, foot, and mouth disease and herpetic gingivostomatitis, as described by Scully and Samaranayake (2016).
In the first 2 cases, lesions were affecting keratinized tissue, as seen in herpes simplex lesions (Scully & Samaranayake, 2016). In the last case, oral lesions affected both keratinized and non‐keratinized tissue and were more compatible with an erythema multiforme (Trayes, Love, & Studdiford, 2019; Schwartz & Janniger, 2020).
As we were not able to perform biopsies, further studies need to be carried out in order to determine whether oral manifestations are common in patients affected by SARS‐CoV‐2 infection or if the emotional distress of the situation itself could trigger such lesions (Suzich & Cliffe, 2018; Chida & Mao, 2009).
It is important to mention that the 3 cases all reported having had pain, oral ulcers, or blisters before seeking medical advice. We suspect that intraoral lesions often are misdiagnosed due to the lack of intraoral examinations, considering the severity of other pathological processes that might concur with this viral infection. To the best of our knowledge, this is the first case report of a COVID‐19 patient presenting intraoral manifestations.
We encourage all medical doctors, dentists, and dermatologists to perform intraoral examinations in patients suspected or affected by SARS‐CoV‐2, always when having the recommended protection measures available.
CONFLICTS OF INTEREST
None to declare.
AUTHOR CONTRIBUTION
Carmen Martin Carreras‐Presas: Writing‐original draft. Juan Amaro Sanchez: Writing‐original draft. Antonio Francisco Lopez‐Sanchez: Writing‐review & editing. Enric Jane‐Salas: Resources. Maria Luisa Somacarrera Perez: Supervision.
196 citations
TL;DR: It is proposed that reliable diagnostic criteria should be defined, which should include a set of essential criteria including the presence of white reticular lesions in any location of the oral mucosa, to determine the presence or absence of epithelial dysplasia.
Abstract: The objective was to assess the global oral lichen planus prevalence. We searched PubMed, EMBASE, Web of Science, and Scopus for studies published before September 2019. We evaluated the quality of studies and carried out several meta-analyses. The global pooled prevalence was 1.01%, with a marked geographical difference (p < .001). The highest prevalence was reported from Europe (1.43%) and the lowest in India (0.49%), where tobacco-associated keratosis appears to mask oral lichen planus resulting in attenuation of its prevalence. From the age of 40 years, the prevalence increases significantly and progressively (OR = 3.43, 95% CI = 2.48-4.73, p < .001). Studies that define diagnostic criteria report a higher prevalence (1.31% vs. 0.70%, p = .03), although the application of the WHO criteria (year 1978-2007) does not increase the ability to diagnose the disease compared with other criteria (p = .11). The studies performed by oral medicine/oral pathology specialists report significantly higher prevalence (1.80%) than dentists (0.61%) and dermatologists (0.33%; p < .001). In conclusion, we propose that reliable diagnostic criteria should be defined, which should include a set of essential criteria including the presence of white reticular lesions in any location of the oral mucosa. The impact of histopathological confirmation with defined diagnostic criteria must be researched in the future, although its main use should be to determine the presence or absence of epithelial dysplasia. The necessity to improve the knowledge of oral lichen planus among dentists and dermatologists through continuing education is apparent in the results of this meta-analysis.
155 citations
TL;DR: Urgent joined research efforts regarding the SARS‐COV‐2 rapid tests, accurate diagnosis, especially early recognition, and effective treatment of life‐threatening complications would be highly desirable for humanity and medical workforce all over the world that try to combat a current global pandemic threat.
Abstract: Health services across the world face an unprecedented situation as a result of a global COVID-19 outbreak. Urgent joined research efforts regarding the SARS-COV-2 rapid tests, accurate diagnosis, especially early recognition, and effective treatment of life-threatening complications would be highly desirable for humanity and medical workforce all over the world that try to combat a current global pandemic threat. Due to indirect complex effect, intensified COVID-19 therapies and multi-drug treatment, it is believed that some oral conditions could be aggravated by COVID-19 disease, particularly those with autoimmune aetiology, linked to compromised immune system or long-term pharmacotherapy.
100 citations
TL;DR: It is believed that the described oral vesiculobullous manifestations were suggestive of coronavirus disease 2019 (COVID-19) co-infections, which at present, are overlooked and poorly understood.
Abstract: We read with interest the series of cases reported by Martín Carreras-Presas et al. (2020). We believe that the described oral vesiculobullous manifestations were suggestive of coronavirus disease 2019 (COVID-19) co-infections, which at present, are overlooked and poorly understood (Cox et al., 2020). Increased disease severity and mortality amongst individuals with respiratory viral infections are often attributed to subsequent bacterial co-infections, accounting for approximately 95% of deaths during the 1918 Spanish flu pandemic (Morens et al., 2008).
100 citations
TL;DR: A review of proposed guidelines and recommendations for limiting the transmission of SARS‐COV‐2 from carriers to dentists and vice versa is provided, and a brief look at how the practice of dentistry may be impacted by COVID‐19, in the post‐pandemic era is concluded.
Abstract: On 11 March 2020, the World Health Organization (WHO) declared the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) as a pandemic. Until an effective treatment or a vaccine is developed, the current recommendations are to contain the disease, and control its transmission. It is now clear that the primary mode of SARS-CoV-2 transmission is aerosol/droplet spread, and by contacting virus-contaminated surfaces acting as fomites (inanimate vectors). Furthermore, recent data indicate that the live virus particles are present in saliva, and, more alarmingly, asymptomatic individuals may transmit the infection. By virtue of the nature of the practice of dentistry where intrinsically, a high volume of aerosols is produced, as well as the close proximity of dentists and patients during treatment, dentists and allied health staff are considered the highest risk health professional group for acquiring SARS-CoV-2 during patient management. Therefore, several organizations and specialty associations have proposed guidelines and recommendations for limiting the transmission of SARS-COV-2 from carriers to dentists and vice versa. This paper aims to provide a review of these guidelines, and concludes with a brief look at how the practice of dentistry may be impacted by COVID-19, in the post-pandemic era.
89 citations
TL;DR: Due to the risk of infection of both dental healthcare workers and patients, additional infection control measures for all patients are strongly recommended when providing dental health care.
Abstract: COVID-19 is an emerging infectious disease caused by the widespread transmission of the coronavirus SARS-CoV-2. Some of those infected become seriously ill. Others do not show any symptoms, but can still contribute to transmission of the virus. SARS-CoV-2 is excreted in the oral cavity and can be spread via aerosols. Aerosol generating procedures in dental health care can increase the risk of transmission of the virus. Due to the risk of infection of both dental healthcare workers and patients, additional infection control measures for all patients are strongly recommended when providing dental health care. Consideration should be given to which infection control measures are necessary when providing care in both the current situation and in the future.
77 citations
TL;DR: Preliminary studies have shown that hospitalized patients have different symptoms, including myalgia, whooping cough, fatigue, and dyspnea and gastrointestinal complains, and in more recent studies, skin manifestations have also been reported in covid-19 patients.
Abstract: In early December 2019, the acute respiratory illness began in the Wuhan, China, which quickly spread around the world, that today known as COVID-19. (Sun, Qie, Liu, Ren, & Xi, 2020) Preliminary studies have shown that hospitalized patients have different symptoms, including myalgia, whooping cough, fatigue, and dyspnea and gastrointestinal complains. (Guo et al., 2020; Zhang et al., 2020) In more recent studies, skin manifestations have also been reported in covid-19 patients.
72 citations
TL;DR: In this paper, the authors performed a bibliographic search in PubMed, Scopus, Web of Science, Embase, and Cochrane databases with keywords "oral leukoplakia", "oral cancer", ''oral carcinoma" and ''oral squamous cell carcinoma''.
Abstract: OBJECTIVE Oral leukoplakia (OL) is the most frequently encountered oral potentially malignant disorder. The aims of this systematic review are to estimate the overall malignant transformation of OL and to assess the risk factors associated with malignant transformation of OL published in the last 5 years (2015-2020). MATERIALS AND METHODS We performed a bibliographic search in PubMed, Scopus, Web of Science, Embase, and Cochrane databases with keywords "oral leukoplakia", "oral cancer", "oral carcinoma" and "oral squamous cell carcinoma". Meta-analysis was conducted using a random-effects model. RESULTS Twenty-four studies were selected, that reported a total of 16,604 patients. Malignant transformation proportion varied between 1.1% and 40.8%. Female gender, non-homogeneous clinical type, and presence of epithelial dysplasia were significantly related to MT. Other risk factors previously suggested did not show significant results. CONCLUSIONS The pooled proportion of malignant transformation MT was 9.8% (95% CI: 7.9-11.7). It is necessary to continue to conduct well-designed prospective clinicopathological studies on OL, using a uniform definition for OL to reduce the risk of bias for evaluating various factors associated with the MT.
71 citations
TL;DR: In this article, the use of histological features of epithelial dysplasia is discussed, and the predictive values of three-grade and binary systems are summarised, including lichenoid and verrucous lesions, keratosis of unknown significance, differentiated and basaloid epithelia.
Abstract: Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described, and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised, and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV-associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.
64 citations
TL;DR: The perspectives of dentists practicing in private practice and clinician‐researchers in academic dental institutions are shared about measures implemented to minimize risks of disease transmission, challenges in emergency dental care, impact on patients, as well as impact on the professional and personal lives of the dental team during the COVID‐19 crisis.
Abstract: The COVID-19 pandemic is a major public health crisis for countries around the world. In response to this global outbreak, the World Health Organization declared a public health emergency of international concern. Dental professionals are especially at high risk of contracting the COVID-19 virus due to the unique nature of dentistry, more specifically, exposure to aerosols and droplets. When it comes to dental emergencies, it was crucial to maintain urgent dental care services operational to help reduce the burden on our healthcare system and hospitals already under pressure. The COVID-19 pandemic has significantly impacted how dentistry is practiced in North America in both the private practice and academic settings. This article shares the perspectives of dentists practicing in private practice and clinician-researchers in academic dental institutions. More specifically, we discuss about measures implemented to minimize risks of disease transmission, challenges in emergency dental care, impact on patients, as well as impact on the professional and personal lives of the dental team during the COVID-19 crisis.
TL;DR: The recent COVID-19 pandemic and state's "Shelter in place" guidelines have restricted patient's access to dental services, including oral medicine, as well as continuity of clinical education for oral medicine residents.
Abstract: The recent COVID-19 pandemic and state's \"Shelter in place\" guidelines have restricted patient's access to dental services, including oral medicine, as well as continuity of clinical education for oral medicine residents. This has required immediate attention from clinicians and educators.
TL;DR: A critical review of the papers published in the international scientific literature on malignant transformation of oral lichen planus finds that the proportion of malignancy is higher in research carried out under strict methodological quality criteria.
Abstract: Objectives We present a critical review of the papers published in the international scientific literature on malignant transformation of oral lichen planus (OLP). Our aim is to report the most realistic estimate of the proportion of OLP cases with malignant transformation based on the highest quality of evidence. Materials and methods Following a literature search, we selected 89 papers that were published on this topic until November 2020. We applied to these papers an adaptation of the methodological quality criteria of the QUIPS tool and we ordered all of them according to their methodological quality. The papers that were in the upper quartile of methodological quality (10 papers) were selected and analyzed. Results The pooled proportion (expressed as percentage) of malignant transformation of OLP reported in these high methodological quality papers was 2.28% (95% confidence intervals = 1.49-3.20). Conclusions We observe that the proportion of malignancy is higher in research carried out under strict methodological quality criteria. In this critical review, we propose criteria for conducting follow-up studies on OLP to report on malignant transformation under strict quality standards.
TL;DR: The epidemic of Novel Coronavirus disease 2019 (COVID-19) has become a chief public health challenge for many countries around the world and in Italy, it started in January the 31st with the first 2 cases reported; on Monday the 13th of April, the total confirmed cases were 156.363 with 19.901 total deaths.
Abstract: Recently, the epidemic of Novel Coronavirus disease 2019 (COVID-19) has become a chief public health challenge for many countries around the world. In Italy, it started in January the 31st with the first 2 cases reported; on Monday the 13th of April, the total confirmed cases were 156.363 with 19.901 total deaths (www.who.int). Turin is the fourth Italian city, with roughly 862.000 inhabitants, and the capital of Piedmont region, one of the most affected by COVID-19.
TL;DR: Patients with diabetes have a higher prevalence and greater chance of oral cancer and OPMD development in comparison with non-diabetic patients, and patients with oral cancer suffering from diabetes haveA higher mortality compared to non-Diabetic patients with Oral cancer.
Abstract: The objective was to evaluate current evidence on the prevalence and risk of oral cancer and potentially malignant oral disorders among patients with diabetes mellitus. We searched PubMed, Embase, Web of Science, and Scopus for observational studies published before November 2019. We evaluated the study quality using GRADE, QUIPS, and a specific method for systematic reviews addressing prevalence questions. Meta-analyses were conducted, and heterogeneity and publication bias were examined. A total of 1,489 studies were found, 116 analyzed in full text, 52 included in qualitative synthesis and 49 meta-analyzed. Pooled prevalence (PP) of oral cancer in patients with diabetic was 0.25% (95% CI = 0.15-0.39)-250 per 100,000 patients with diabetes mellitus -with a greater chance of oral cancer among patients with diabetes mellitus (OR = 1.41 [95% CI = 1.10-1.81], p = .007). Patients with oral cancer and diabetes mellitus had a higher mortality than controls (HR = 2.09 [95%CI = 1.36-3.22], p = .001). Leukoplakia had a PP = 2.49% (95% CI = 1.14-4.29)-2,490 per 100,000 patients with diabetes mellitus -(OR = 4.34 [95% CI = 1.14-16.55], p = .03). A PP of 2.72 (95% CI = 1.64-4.02) was obtained for oral lichen planus among patients with diabetic -2,720 per 100,000 patients with diabetes mellitus (OR = 1.87 [95% CI = 1.37-2.57], p < .001). A low PP was estimated for erythroplakia (0.02%[95%CI = 0.00-0.12]-20 per 100,000 patients with diabetes mellitus. In conclusion, patients with diabetes mellitus have a higher prevalence and greater chance of oral cancer and OPMD development in comparison with non-diabetic patients. In addition, patients with oral cancer suffering from diabetes mellitus have a higher mortality compared to non-diabetic patients with oral cancer.
TL;DR: In this paper, a systematic review of systematic reviews and meta-analyses is presented on cancer development in oral lichen planus (OLP), OLL, and OLL reactions (OLR).
Abstract: A systematic review of systematic reviews-aka overview of reviews, a novel type of study design providing a tertiary level of evidence-is presented on systematic reviews (SR) and meta-analyses (MTA) evaluating the cancer development in oral lichen planus (OLP), oral lichenoid lesions (OLL), and oral lichenoid reactions (OLR). We searched for SR-MTA published before January 2021. We evaluated the methodological quality of SR-MTA using AMSTAR2 and checked the quality of evidence. Inclusion criteria were met by seven SR-MTA. Oral cancer ratios ranged between 0.44% and 2.28% for OLP, between 1.88% and 3.80% for OLL, and 1.71% for OLR. Significant factors on cancer development reported in SR-MTA were the presence of epithelial dysplasia, the consumption of tobacco and alcohol, the infection by the hepatitis C virus, the presence of atrophic and erosive lesions, and the location on the tongue. Only, one of the SRs assessed the quality of evidence, and most of them were judged to be of critically low methodological quality. In conclusion, based on the reported evidence on cancer incidence in OLP, our results reaffirm classifying OLP as an oral potentially malignant disorder. In relation to OLLs and OLRs, larger studies are necessary to provide further scientific evidence in this regard. Future follow-up studies on OLP and related lesions should be carried out under stricter criteria that improve their quality of evidence and methodological quality.
TL;DR: Concern is raised about how to manage patients with COVID‐19 before hospital discharging, thus avoiding contagion among their family members or a second coronavirus wave once the lockdown is over.
Abstract: We report two cases of COVID-19 showing negative respiratory swabs but positive salivary samples at the same time. These findings rise the concern about how to manage these patients before hospital discharging, thus avoiding contagion among their family members or a second coronavirus wave once the lockdown is over.
TL;DR: It is confirmed that close to 4% of patients diagnosed with OSF may develop oral cancer, and the demographic and clinicopathological factors contributing to the progression of OSF to cancer are evaluated.
Abstract: OBJECTIVES This systematic review and meta-analysis aimed to determine the proportion of patients who develop oral carcinomas following a diagnosis of oral submucous fibrosis (OSF) in reported longitudinal studies. We also aimed to evaluate the demographic and clinicopathological factors contributing to the progression of OSF to cancer. METHODS Individual search strategies were applied for the following bibliographic databases: MEDLINE by PubMed, Scopus, Embase, Web of Science, and Grey literature databases until August 30, 2020. Methodological assessment of the risk of bias of the included studies was undertaken using the modified Newcastle-Ottawa scale. Meta-analyses were conducted using a random-effects (DerSimonian and Liard) method to calculate the pooled proportion of the malignant transformation (MT) in OSF patients. RESULTS Out of 585 records screened, a total of 9 observational studies were included with a total number of 6,337 patients; of these, 292 OSF cases developed carcinomas. The pooled proportion of the MT was 4.2% (95% CI: 2.7%-5.6%) with an annual transformation rate of 0.73%. Subgroup analysis revealed that the pooled MT proportion was significantly higher among population-based studies in comparison with hospital-based ones (p < .005). Most of the studies showed a high risk of bias. In several studies, there was a lack of information about the demographic and clinicopathological characteristics of OSF patients and associated risk indicators; this insufficiency in details hindered the ability to conduct further subgroup analyses. CONCLUSIONS Despite the poorly reported and the limited number of studies, our analysis confirms that close to 4% of patients diagnosed with OSF may develop oral cancer. Cases with oral epithelial dysplasia had a higher potential for malignant transformation.
TL;DR: The World Health Organisation (WHO) declared on 11 March 2020 that the epidemic of the new coronav virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic now called COVID-19.
Abstract: An epidemic pneumonia was first reported in the city of Wuhan, China, in the end of December 2019, had its aetiological agent identified as a new coronavirus (Zhu et al., 2020). The World Health Organisation (WHO) declared on 11 March 2020 that the epidemic of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic now called COVID-19.
TL;DR: In this article, a lightweight deep convolutional neural network (CNN) was proposed for binary classification of oral lesions into benign and malignant or potentially malignant using standard real-time clinical images.
Abstract: Objectives To develop a lightweight deep convolutional neural network (CNN) for binary classification of oral lesions into benign and malignant or potentially malignant using standard real-time clinical images. Methods A small deep CNN, that uses a pretrained EfficientNet-B0 as a lightweight transfer learning model, was proposed. A data set of 716 clinical images was used to train and test the proposed model. Accuracy, specificity, sensitivity, receiver operating characteristics (ROC) and area under curve (AUC) were used to evaluate performance. Bootstrapping with 120 repetitions was used to calculate arithmetic means and 95% confidence intervals (CIs). Results The proposed CNN model achieved an accuracy of 85.0% (95% CI: 81.0%-90.0%), a specificity of 84.5% (95% CI: 78.9%-91.5%), a sensitivity of 86.7% (95% CI: 80.4%-93.3%) and an AUC of 0.928 (95% CI: 0.88-0.96). Conclusions Deep CNNs can be an effective method to build low-budget embedded vision devices with limited computation power and memory capacity for diagnosis of oral cancer. Artificial intelligence (AI) can improve the quality and reach of oral cancer screening and early detection.
TL;DR: The development of a successful vaccine against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in an unmatched period of ten months, is a tribute to human ingenuity in the face of a vicious pandemic as mentioned in this paper.
Abstract: The development of a successful vaccine against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the agent of coronavirus disease 2019 (COVID-19), in an unmatched period of ten months, is a tribute to human ingenuity in the face of a vicious pandemic. A return to pre-pandemic "normalcy" depends on the successful delivery of the vaccine to a majority (~70%) so as to develop herd immunity critical to arrest the community spread of infection. Vaccination against COVID-19 is particularly important for dentistry as the dental team works in an environment replete with aerosol-generating procedures (AGP) that facilitate virus spread. Hence, a COVID-19 vaccine is likely to be an obligatory requirement for the dental practice, and the latest addition to the extensive list of vaccines required for dental professionals for the safe delivery of dental care. Here, we review the currently available major candidate vaccines against SARS-CoV-2 and their benefits and risks. These include the vaccines developed on next-generation platforms (mRNA, DNA, and viral vector vaccines), and the classic platforms (the live-attenuated virus, and the protein subunit vaccines) The review concludes with a summary of impending issues and challenges facing the provision of COVID-19 vaccines for all stakeholders in dentistry.
TL;DR: DOX pH-resistant AuNPs enhance the cytotoxic effect against cancer cells in addition to acting as drug carriers, which was confirmed using in vitro and in vivo experiments without deleterious effects on blood cell count.
Abstract: Objectives Gold nanoparticles (AuNPs) are used to deliver drugs and therapeutic small molecule inhibitors to cancer cells. Evidence shows that AuNPs coated with nuclear localization sequence can cross the nuclear membrane and induce cellular apoptosis. To determine the therapeutic role of AuNPs, we compared two nanoconstructs conjugated to doxorubicin (DOX) through pH-sensitive and pH-resistant linkers. Materials and methods We tested DOX nanoconjugates' cytotoxicity, cellular and nuclear uptake in oral squamous cell carcinoma cell line. Furthermore, we evaluated the therapeutic effect of pH-sensitive and pH-resistant DOX bioconjugates in hamster buccal pouch carcinoma model. Results Our data indicate that pH-resistant and pH-sensitive DOX-nanoconjugates were equally localized in cancer cells, but the pH-resistant DOX nanoparticles were more localized in the nuclei inducing a 2-fold increase in the apoptotic effect compared with the pH-sensitive DOX nanoparticles. Our in vivo results show significantly higher tumor shrinkage and survival rates in animals treated with DOX pH-resistant AuNPs compared with pH-sensitive ones. Conclusion Our findings suggest that AuNPs enhance the cytotoxic effect against cancer cells in addition to acting as drug carriers. DOX pH-resistant AuNPs enhanced accumulation of AuNPs in cancer cells' nuclei inducing a significant cellular apoptosis which was confirmed using in vitro and in vivo experiments without deleterious effects on blood cell count.
TL;DR: A critical examination of the follow-up studies on OL published so far indicated that tissue biomarkers that could predict the risk of oral cancer in patients with OL are still in a discovery phase.
Abstract: OBJECTIVES We performed a systematic review to evaluate the published biomarkers related to oral leukoplakia (OL), aiming to identify the biomarkers that indicate any future risk of cancer in patients with oral leukoplakia. METHODS A search strategy was developed for three main electronic databases: PubMed, Cochrane Library, and EBSCO, and also for Google Scholar, until February 28, 2020. The study selection was performed in a two-phase process aiming at studies assessing tissue biomarkers for "malignant transformation of OL." Risk of bias analysis of included studies was performed using the Quality in Prognosis Studies Tool. RESULTS From 3,130 articles initially identified by searching databases, a total of 46 studies were included in this systematic review, with a combined sample of 3,783 patients, of whom 1,047 presented with malignant transformation of a previously diagnosed OL as reported by the authors. The cancer incidence in the whole group was 27.6% (range: 5.4% to 54.1%). The studies were derived from different geographic areas, including Asia (n = 21), Europe (n = 15), North America (n = 9), and Oceania (n = 1). There were 49 different molecular biomarkers evaluated in the 46 included studies: p53 and podoplanin proteins were the most frequently reported, followed by abnormalities at particular chromosomal loci (e.g., LOH). Risk of bias analysis revealed concerns associated with "measurement of prognostic factor," "study confounding" and "statistical analysis and reporting." CONCLUSIONS Substantial heterogeneity and lack of standardized reporting of data among the studies were identified. The most promising biomarkers reported to have a significant association with the malignant transformation in OL included podoplanin and chromosomal loci abnormalities. A critical examination of the follow-up studies on OL published so far indicated that tissue biomarkers that could predict the risk of oral cancer in patients with OL are still in a discovery phase.
TL;DR: The Coronavirus disease-2019 (COVID-19) pandemic, due to the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) was declared a public health emergency of international concern by the World Health Organization on 30th of January 2020 (World Health Organization, 2020).
Abstract: The Coronavirus disease-2019 (COVID-19) pandemic, due to the Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) was declared a public health emergency of international concern by the World Health Organization on 30th of January 2020 (World Health Organization, 2020). The first case of COVID-19 was reported in India on the same day, and at the time of writing, on 20th May 2020, India has reported over 106,000 patients, with over 3,300 related deaths. The country is under a state of lockdown since 25th March, 2020, and over 600 health care providers have been infected.
TL;DR: In this paper, the authors investigated the available evidence on the malignant transformation of oral proliferative verrucous leukoplakia (PVL) using a random-effects model.
Abstract: Objectives To investigate the available evidence on the malignant transformation (MT) of oral proliferative verrucous leukoplakia (PVL). Material and methods We searched six main electronic and three grey literature databases in a two-phase process. Cohort studies investigating MT of PVL were eligible for inclusion. The risk of bias (RoB) was assessed using a specific tool developed by the Joanna Briggs Institute. Proportion meta-analyses were performed using a random-effects model. Results Study selection resulted in the inclusion of 17 studies. The pooled proportion of MT was 43.87% (95% CI = 31.93-56.13). Females (64.02%, 95% CI = 54.87-72.75) were more affected by PVL than males (35.98%, 95% CI = 27.25-45.13). Gingiva (39.6%) and buccal mucosa (21.6%) were the most frequent PVL sites. No conclusive results were found between MT and sex or age distribution, tobacco, or alcohol consumption. Gingiva was the most common site for MT (39.9%), and the most frequent histopathological subtype was conventional squamous cell carcinoma (62.1%). Four studies were classified as low, nine as moderate, and four as high RoB. Conclusion The MT pooled proportion was 43.87%. Among OPMDs, PVL has the highest risk to transform to malignancy. Development and agreement on diagnostic criteria for PVL would reduce the heterogeneity among future studies.
TL;DR: A case report describing of a COVID-19 patient with oral manifestations including oral pain, desquamative gingivitis, ulcers and blisters is reported, and an atlas of these manifestations as a downloadable supplement is provided.
Abstract: Martín Carreras-Presas et al. (2020) reported a case in May in Oral Diseases that they suggested was the first case report describing of a COVID-19 patient with oral manifestations including oral pain, desquamative gingivitis, ulcers and blisters. Galván Casas et al. (2020) provided a description in April in the British Journal of Dermatology of the cutaneous manifestations of COVID-19 in an impressive 375 case series, and with that, they had documented for the first time the oral manifestations of the disease. The report includes an atlas of these manifestations as a downloadable supplement that includes apparently 150 different cases and among those, two cases with intra-oral manifestations that vary from ulcers in the palatal mucosa, to localized erythema in the palate and the margins of gingiva.
TL;DR: Several techniques that employ fluorescence for early diagnosis and surgical guidance in oral squamous cell carcinoma are discussed, future perspectives on the potential of fluorescence imaging in oral cancer in the near future are presented and high sensitivity and spatial resolution could assist in resection margin assessment during surgery.
Abstract: Early diagnosis and radical surgical excision of oral squamous cell carcinomas are essential for achieving optimal treatment outcomes. To date, diagnostic tools that rely on anatomical anomalies provide limited information and resolution in clinical practice. As a result, oral cancer is often detected in an advanced stage. Also, no reliable real-time intraoperative tools are readily available for the evaluation of surgical resection margins. Fluorescence imaging visualises biological processes that occur in early carcinogenesis and could, therefore, enable detection of small tumours in early stages. Furthermore, due to the high sensitivity and spatial resolution, fluorescence imaging could assist in resection margin assessment during surgery. In this review, we discuss several techniques that employ fluorescence for early diagnosis and surgical guidance in oral squamous cell carcinoma and present future perspectives on the potential of fluorescence imaging in oral cancer in the near future.
TL;DR: Evaluating the change of oral microbiome based on next‐generation sequencing (NGS)‐metagenomic analysis following periodontal interventions among systematically healthy subjects showed a complex change in oral microbiome afterperiodontal intervention.
Abstract: Objectives This systematic review was to evaluate the change of oral microbiome based on next-generation sequencing (NGS)-metagenomic analysis following periodontal interventions among systematically healthy subjects. Materials and methods A structured search strategy consisting of "metagenomics" and "oral diseases" was applied to PubMed, EMBASE, and Web of Science to identify effective papers. The included studies were original studies published in English, using metagenomic approach to analyze the effectiveness of periodontal intervention on oral microbiome among systematically healthy human subjects with periodontitis. Results A total of 12 papers were included in this review. Due to the heterogeneity of selected study, quantitative analysis was not performed. The findings as to how alpha diversity changed after interventions were not consistent across studies. Six studies illustrated clear separation of microbial composition between dental plaque samples collected before and after intervention using principal coordinates/component analysis. The most commonly detected genera before intervention were Porphyromonas, Treponema, Tannerella, and Prevotella, while Streptococcus and Actinomyces usually increased and became the dominant genera after intervention. Correlation network analysis revealed that after intervention, the topology of network was different compared to the corresponding pre-interventional samples. Conclusion Existing evidence of metagenomic studies depicts a complex change in oral microbiome after periodontal intervention.
TL;DR: Facial protection, either in the form of masks or alternates, appears to have mitigated the pandemic as seen from the minimal COVID‐19 spread in countries where public mask wearing is strictly enforced.
Abstract: We live in extraordinary times, where COVID-19 pandemic has brought the whole world to a screeching halt. Tensions and contradictions that surround the pandemic ridden world include the availability, and the lack thereof, various facial protection measures to mitigate the viral spread. Here, we comprehensively explore the different types of facial protection measures, including masks, needed both for the public and the healthcare workers (HCW). We discuss the anatomy, the critical issues of disinfection and reusability of masks, the alternative equipment available for the protection of the facial region from airborne diseases, such as face shields and powered air-purifying respirators (PAPR), and the skin health impact of prolonged wearing of facial protection by HCW. Clearly, facial protection, either in the form of masks or alternates, appears to have mitigated the pandemic as seen from the minimal COVID-19 spread in countries where public mask wearing is strictly enforced. On the contrary, the healthcare systems, that appear to have been unprepared for emergencies of this nature, should be appropriately geared to handle the imbalance of supply and demand of personal protective equipment including face masks. These are two crucial lessons we can learn from this tragic experience.
TL;DR: Despite the clear role of saliva in the continuous cleansing of oral cavity, this work focuses on proteins that illustrate antiviral activity, particularly against corona viruses.
Abstract: Human saliva is an inquisitively complex fluid and has an imperative role for prevention and protection from viral infection, particularly through innate immune system, which is a prominent first-line defense against viral infection (Malamud et al., 2011; Dawes et al., 2015). Despite the clear role of saliva in the continuous cleansing of oral cavity, we focus on proteins that illustrate antiviral activity, particularly against corona viruses.