Comparative clinicopathological study of the main anatomic locations of oral squamous cell carcinoma.

OBJECTIVE: To analyze the clinicopathological and evolutionary profile of the main locations of oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: This is a retrospective study on 133 patients treated for OSCC. The group was composed of 48 women and 85 men, with a mean age 63.9 ± 12.73 years. Most cases involved the lingual border of tongue (63), followed by the gingiva (36) and the floor of mouth (34). A comparative analysis was performed using multinomial regression. RESULTS: There were significant differences regarding age, sex, tobacco and alcohol consumption, liver pathology, oral potentially malignant disorders, and bone and perineural invasion. In multivariate regression, tobacco consumption, and bone invasion remained significant. There were no significant differences in relation to prognosis. CONCLUSION: The location of OSCC is an important factor in the clinicopathological assessment of this neoplasm. The main locations of OSCC show differential etiopathogenic and clinicopathological aspects. Tobacco consumption has a great relevance in the floor of mouth; nonetheless, it is less important in the tongue border and the gum, which suggests other pathogenic factors. It is necessary to consider the anatomical location of OSCC in preventive protocols, with the aim of reducing its high mortality.

Bleeding during tooth extraction in patients with chronic kidney disease: A cross-sectional pilot study.

OBJECTIVE: This work measures the intra-operative bleeding in end-stage renal disease patients and assesses whether laboratory coagulation tests and nitrogenous compounds are related to a higher bleeding risk. METHODS: Laboratory tests were performed on the day of surgery and some patients with thrombocytopenia and values above the normal levels of international normalised ratio (INR), thrombin time (TT) and activated partial thromboplastin time (aPTT) were identified. RESULTS: Haemostatic time ranged from 2 to 35 min (mean of 8.51 min) after suture. Bleeding volume ranged from 0.02 to 67.06 mL (mean of 4.38 mL) and the bleeding volume per minute ranged from 0.05 to 2.10 mL/min (median of 0.6 mL/min). Only seven patients (16.27%) had abnormal bleeding (more than 0.6 mL/min). Spearman's coefficient showed weak correlations between bleeding volume (mL/min) and serum urea (r = 0.226), TT (r = 0.227), plasma urea (r = 0.148) and creatinine (r = 146), as well as very weak correlations with all other variables (r < 0.140) such as age, haemodialysis time, glycaemia, glycated haemoglobin, platelets, INR, aPTT and fibrinogen. CONCLUSION: It was not possible to associate any laboratory test or nitrogenous compounds present in the blood and saliva with an increased bleeding.

Identification of Proteomic Biomarkers in Proliferative Verrucous Leukoplakia through Liquid Chromatography With Tandem Mass Spectrometry.

Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder associated with high risk of malignant transformation. Currently, there is no treatment available, and restrictive follow-up of patients is crucial for a better prognosis. Oral leukoplakia (OL) shares some clinical and microscopic features with PVL but exhibits different clinical manifestations and a lower rate of malignant transformation. This study aimed to investigate the proteomic profile of PVL in tissue and saliva samples to identify potential diagnostic biomarkers with therapeutic implications. Tissue and saliva samples obtained from patients with PVL were compared with those from patients with oral OL and controls. Label-free liquid chromatography with tandem mass spectrometry was employed, followed by qualitative and quantitative analyses, to identify differentially expressed proteins. Potential biomarkers were identified and further validated using immunohistochemistry. Staining intensity scan analyses were performed on tissue samples from patients with PVL, patients with OL, and controls from Brazil, Spain, and Finland. The study revealed differences in the immune system, cell cycle, DNA regulation, apoptosis pathways, and the whole proteome of PVL samples. In addition, liquid chromatography with tandem mass spectrometry analyses showed that calreticulin (CALR), receptor of activated protein C kinase 1 (RACK1), and 14-3-3 Tau-protein (YWHAQ) were highly expressed in PVL samples. Immunohistochemistry validation confirmed increased CARL expression in PVL compared with OL. Conversely, RACK1 and YWHA were highly expressed in oral potentially malignant disorder compared to the control group. Furthermore, significant differences in CALR and RACK1 expression were observed in the OL group when comparing samples with and without oral epithelial dysplasia, unlike the PVL. This research provides insights into the molecular mechanisms underlying these conditions and highlights potential targets for future diagnostic and therapeutic approaches.

Photobiomodulation in dental implant stability and post-surgical healing and inflammation. A randomised double-blind study.

BACKGROUND: The aim of this randomized clinical trial was to evaluate the effect of diode laser photobiomodulation (PBM) on post-surgical healing, inflammation and implant stability. METHODS: Forty dental implants were inserted into 13 patients. The implants were randomly divided into two groups. The test group (PBM+) underwent two sessions of PBM (combined diode laser of 630 and 808 nm), the first of which after surgery, and the second, 7 days after the surgical procedure. The control group (PBM-) received simulated laser treatment. The implant stability quotient (ISQ) was determined immediately after the surgical procedure, and 7 days, 4 and 8 weeks later. Post-surgical inflammation was assessed following the criteria described by Bloemen and Cols. Healing was calculated using the healing index (HI). RESULTS: No differences were found in terms of the mean values of implant stability between the test and control groups over time. Only two of the implants (18.2%) from the PBM- group were classified with the maximum healing index (HI = 5), whereas in the PBM+ group, nine implants (45%) were classified with the aforementioned index (P < 0.0001). Using the logistic regression, it was determined that the non-application of the laser in the PBM- group caused an OR of 4.333 times of presenting inflammation (IC95% 1.150-16.323; P = 0.030). CONCLUSIONS: The application of 808 nm infra-red laser for bone tissue, and 630 nm for mucosal tissue in two sessions is considered to be an effective way of reducing inflammation and improving early healing. More studies are needed to confirm these results.

Drug use, risk perceptions and attitudes towards drug use amongst medical and dentistry students.

AIMS: To analyse the use of psychoactive substances and the risk perceptions amongst odontology and medical students. To study their perceptions, attitudes and knowledge, and to evaluate their motivation when helping their patients to stop using these substances. METHODS: A cross-sectional study was conducted amongst 962 students in Spain, using validated questionnaires on an anonymous basis. RESULTS: Amongst these students, drug use varies and increases with age as assessed by the DAST and CAST tests, with more problematic use being observed as the academic cycle progresses (p < .001). Participants in the 2nd cycle presented higher consumption than those in the 1st cycle, in the univariate model (OR = 1.77, IC 95% 1.27-2.48, p = .001) and in the adjusted model (OR = 1.86, IC 95% 1.32-2.62, p < .001). Regarding CAST, non-problematic use in the 1st cycle versus the 3rd cycle presented an OR = 8.69 (IC 95% 4.50-16.78, p < .001) and for low risk use it presented an OR = 15.18 (IC 95% 1.83-14.68). Only 46.7% considered using marijuana on a regular basis as a high risk, whilst 60.5% stated that smoking a pack of cigarettes represents a high risk. Alcohol was the substance for which the risk perception was lowest. 66.2% are in the maintenance stage "I provide my regular drug-using patients help to give up," with women being more likely to be in this stage (p = .012). CONCLUSIONS: High risk of drug use increases after the 1st cycle in Dentistry and in Medicine. Training programmes should be implemented in both degrees, focusing on the 1st years in order to simultaneously prevent drug use amongst students.

Importance of the vaporization margin during CO2 laser treatment of oral leukoplakia: A survival study.

OBJECTIVES: The main purpose of this study was to assess the response of oral leukoplakia to CO2 laser vaporization treatment, as well as determining possible factors that may affect recurrence of lesions. MATERIALS AND METHODS: A retrospective study was conducted, in which the medical records of patients who had been clinically and histologically diagnosed with oral leukoplakia and treated with CO2 laser between 1996 and 2019 at the Oral Medicine Teaching Unit of the Faculty of Dentistry of the University of Santiago de Compostela were reviewed. RESULTS: Fifty-eight patients were included: 36 female and 22 male subjects, with a mean age of 63.7 years old (SD ±13.1). The average follow-up time was 57.5 months (SD ±57.9). A relapse rate of 52.6% was determined. Of all the studied variables, the margin was the only one for which a statistically significant association with recurrence of lesions was demonstrated (p < 0.05). CONCLUSION: The vaporization of lesions using CO2 laser with a safety margin of at least 3 mm from the clinical limits of OL is a key factor in preventing recurrence.

Xerostomia, the perception of general and oral health and health risk behaviours in people over 65 years of age.

BACKGROUND: This study investigated the association between xerostomia and health risk behaviours, general and oral health and quality of life. METHODS: A cross-sectional study involving 800 adults over 65 years of age residing in Spain using a computer-assisted telephone questionnaire. The severity of xerostomia was assessed through the Xerostomia Inventory (XI). Both univariate and adjusted multinomial logistic regression were used to determine the risk (OR) of xerostomia. RESULTS: The sample comprised of 492 females (61.5%) and 308 males, with a mean age of 73.7 ± 5.8 years. Some, 30.7% had xerostomia: 25.6% mild, 4.8% moderate and 0.3% severe, the majority being female (34.8% vs 24%; p = 0.003). The mean XI was 24.6 ± 6.3 (95% CI 19.2-24.8) for those with poor health, whereas it was 17.4 ± 6.3 (95%CI 16.1-18.6) in those reporting very good health (p < 0.001). This difference was also observed in terms of oral health, with the XI mean recorded as 14.7 ± 10.7 for very poor oral health and 6.4 ± 5.4 for those with very good health (p = 0.002). Logistic regression showed that the highest OR for xerostomia was observed among adults with poor general health (2.81; 95%CI 1.8-4.3; p < 0.001) and for adjusted model the OR was still significant (2.18; 95%CI 1.4-3.4; p = 0.001). Those who needed help with household chores had 2.16 higher OR (95%CI 1.4-3.4; p = 0.001) and 1.69 (95%CI 1.1-2.7; p = 0.03) in the adjusted model. Females had a higher risk of suffering from xerostomia than males. CONCLUSION: The strong association between xerostomia and the general and oral health status of older adults justifies the need for early assessment and regular follow-up.

DNA Methylation by Bisulfite Next-Generation Sequencing for MLH1 and MGMT in Oral Squamous Cell Carcinomas and Potentially Malignant Disorders: An Integrative Analysis towards Field Cancerization.

Background and Objectives: MGMT methylation is a well-described biomarker in several solid tumors and MLH1 seems to occur in the initial stages of oral carcinogenesis. The aims of this study were to evaluate MHL1 and MGMT methylation levels in oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMDs), and to integrate this information with The Cancer Genome Atlas (TCGA) database. Materials and Methods: To determine the percentage of gene methylation in MLH1 and MGMT, pyrosequencing analysis was conducted. Samples were divided as follows: (1) patients diagnosed with OSCC (N = 16); (2) patients with OPDM who developed OSCC in the same location (N = 47); and (3) patients with OPDM who developed OSCC in a different location (N = 22). As a validation cohort in this study, data from The Cancer Genomic Atlas (TCGA) database, particularly regarding Head and Neck Squamous Cell Carcinoma, was used. Results: Overall MLH1 methylation levels of 8.6 ± 11.5% and 8.1 ± 9.2% for MGMT were obtained. With regard to MHL1, the OSCC presented the highest degree of methylation with 9.3 ± 7.3% (95%CI 5.1-13.6), and with regards to MGMT, the simultaneous malignancy group presented the highest degree of methylation with 10 ± 13.5% (95%CI 6-10), although no significant differences were found between the groups (p = 0.934 and p = 0.515, respectively). The estimated survival was higher for MGMT methylated cases (19.1 months, 95%CI 19.1-19.1) than for unmethylated cases (9.4 months, 95%CI 6-12.8), but not statistically significant. Conclusions: Our results did not show a correlation between MGMT and MLH1 methylation and any clinicopathological feature or survival in our institutional cohort. MLH1 methylation was present mainly in OSCC, whilst MGMT in OPMD represented a modest contribution to field cancerization, with an overall consistency with the TCGA database.

Lichenoid areas may arise in early stages of proliferative verrucous leukoplakia: A long-term study of 34 patients.

BACKGROUND: Proliferative verrucous leukoplakia is considered an uncommon oral potentially malignant disorder with a high malignant transformation rate. The objective of this paper was to define its cancer incidence and related risk factors. METHODS: A retrospective audit of 34 patients diagnosed with proliferative verrucous leukoplakia from a university-based unit, during the period from 1995 to 2019 was performed. The mean number of visits was 23 ± 18.6. The follow-up was divided into four-time intervals to evaluate the clinical presentation, number of lesions, dysplasia grade, and malignant transformation rate. RESULTS: The majority of patients were females 29 (85.3%), with verrucous component (77.8%), with a gingival presentation (31.8%), and with a preceding lichenoid area (44.1%). Eleven patients (32.4%) were affected by oral cancer during the follow-up, developing a total of 15 carcinomas. The mean age of malignant transformation was 67.2 ± 12.9 years, particularly 8 ± 8.5 from the onset of the lesions. Warty forms presented a higher mean estimate for malignant transformation (15.2 years, 95% confidence interval 4.4-26 years) than nodular forms (1.9 years, 95% confidence interval 1.9-1.9) (p = 0.019). Patients with an initial proliferative verrucous leukoplakia diagnosis suffered a higher risk of malignancy, particularly 15.55 times (95% confidence interval 1.69-143.17; p = 0.015) than those who did present a preceding area with lichenoid morphology. CONCLUSION: Proliferative verrucous leukoplakia presented a high malignant transformation rate and sometimes displayed preceding oral lichenoid areas in early stages. Further studies are needed to understand the impact of these lichenoid areas in proliferative verrucous leukoplakia progression.

Critical update, systematic review, and meta-analysis of oral erythroplakia as an oral potentially malignant disorder.

BACKGROUND: Oral erythroplakia has been classically considered as the potentially malignant disorder with the highest rate of malignant development into squamous cell carcinoma. This critical systematic review and meta-analysis aim to estimate the malignant development rate of oral erythroplakia and identify the associated risk factors. METHODS: We performed a bibliographic search in PubMed, Scopus, Web of Science, Embase, and LILACS, with keywords "erythroplakia," "erythroplasia," "malignant transformation," "malignant development," "malignization," "carcinogenesis," "oral cancer," "oral squamous cell carcinoma," "mouth neoplasm," and "prognosis." Meta-analysis was conducted using a random-effects model. RESULTS: Ten observational studies with 441 patients met the inclusion criteria, whose mean malignant development rate was 12.7% and with a mean follow-up period of patients of 6.66 years. In the initial biopsy, 42.8% of oral erythroplakia were already squamous cell carcinoma. The buccal mucosa was the most frequent location of oral erythroplakia, but the floor of the mouth was the most common site of malignant development. All patients who underwent malignant development showed epithelial dysplasia on the initial diagnostic biopsy. CONCLUSION: Overall malignant development rate of OE in the meta-analysis was 19.9%. We could not associate any specific clinicopathological feature with the malignant development. The presence of epithelial dysplasia in the initial biopsy remains the worst prognostic factor. Further observational studies on OE are needed, with well-established diagnostic criteria and good clinical follow-up, in order to identify the true risk of malignant development of oral erythroplakia and the related risk factors.

Influence of loading and drilling on marginal bone loss around implants with a Dynamic Bone Management design: A single-blind, randomised, 12-month clinical trial.

PURPOSE: To evaluate marginal bone loss 6 and 12 months after prosthetic loading of implants with Dynamic Bone Management (Straumann, Basel, Switzerland) through the implementation of different drilling protocols. MATERIALS AND METHODS: A balanced, randomised, single-blind clinical trial was conducted with four parallel experimental arms: immediate loading and under-drilling, immediate loading and complete drilling, early loading and under-drilling, and early loading and complete drilling. Forty-four implants with a Dynamic Bone Management design and with a diameter of 3.75 mm and a length of 10.00 mm were placed in healed mature bone (more than 6 months post-extraction). RESULTS: The mean primary stability achieved was 60.6 ± 12.2 implant stability quotient, with a range from 21 to 75, and no differences were observed when considering the drilling protocol used, bone type or location. Early loading resulted in a loss of 0.728 mm (standard error 0.212; 95% confidence interval 1.134 to -0.325; t value -3.440), whereas immediate loading did not result in any bone loss. When the interaction between the loading and drilling protocols was studied, performing the complete drilling protocol in conjunction with early implant loading was found to result in lower marginal bone loss, with a marginal bone gain effect of 0.814 mm (standard error 0.283; 95% confidence interval -0.274 to 1.353; t value 2.880). CONCLUSIONS: Use of the complete drilling protocol in conjunction with early implant loading resulted in the lowest marginal bone loss at 12 months.

Efficacy of photobiomodulation in reducing pain and improving the quality of life in patients with idiopathic burning mouth syndrome. A systematic review and meta-analysis.

Burning mouth syndrome is a chronic condition, which is characterised by a burning sensation or pain in the mucosa of the oral cavity. Treatment options include antidepressants, antipsychotics, anticonvulsants, analgesics, hormone replacement therapies and more recently photobiomodulation. This study aims to perform a systematic review with meta-analysis in order to determine the effect of photobiomodulation on pain relief and the oral health-related quality of life associated with this condition. A bibliographical search of the Pubmed, Embase, Web of Science and Scopus databases was conducted. Only randomised clinical trials were included. Pain and quality of life were calculated as mean difference and pooled at different treatment points (baseline = T0 and final time point = Tf) and laser modality. From a total of 103 records, 7 articles were retrieved for inclusion. PBM group had a greater decrease in pain than control group at Tf with a mean difference = - 2.536 (IC 95% - 3.662 to - 1.410; I2 = 85.33%, p < 0.001). An improvement in oral health-related quality of life was observed in both groups, although this was more significant in the photobiomodulation group mean difference = - 5.148 (IC 95% - 8.576 to - 1.719; I2 = 84.91%, p = 0.003). For the red laser, a greater improvement than infrared was observed, in pain, mean difference = - 2.498 (IC 95% - 3.942 to - 1.053; I2 = 79.93%, p < 0.001), and in quality of life, mean difference = - 8.144 (IC 95% - 12.082 to - 4.206; I2 = 64.22%, p = 0.027). Photobiomodulation, in particular, red laser protocols, resulted in improvement in pain and in quality of life of burning mouth syndrome patients.

Malignant development of proliferative verrucous/multifocal leukoplakia: A critical systematic review, meta-analysis and proposal of diagnostic criteria.

BACKGROUND: Proliferative verrucous/multifocal leukoplakia (PVML) is an oral potentially malignant disorder (OPMD) that exhibits high rates of malignant development (MD). This study aimed to analyse the risk of MD of PVML, as well as to investigate the possible risk factors associated with its malignization. METHODS: A bibliographical search of the PubMed, Embase, Web of Science, and Scopus databases was conducted. PVML MD rates were calculated as a pooled proportion, and the risk factors were calculated as risk ratios, using fixed and random models based on the presence of heterogeneity. RESULTS: From a total of 417 records, 16 articles were retrieved for inclusion. The subgroup analysis revealed a higher MD rate in the studies that were conducted in America, and, likewise, said studies involved a longer follow-up time (>6 years). There was a non-significant lower risk of malignization among males. A negative correlation was observed between MD and the year in which the studies were published. CONCLUSIONS: The pooled MD of PVML was 65.8% (95% CI: 55.3-76.2, p < 0.001). Prospective studies of PVML must be designed using simple and universal clinical diagnostic criteria to be able to make an early diagnosis of this important OPMD and acknowledge the frequency of MD.

Medication-Related Osteonecrosis of the Jaw: A Critical Narrative Review.

BACKGROUND: Nearly two decades have passed since a paradoxical reaction in the orofacial region to some bone modifying agents and other drugs was recognized, namely medication-related osteonecrosis of the jaw (MRONJ). PURPOSE: The aim of this manuscript was to critically review published data on MRONJ to provide an update on key terminology, concepts, and current trends in terms of prevention and diagnosis. In addition, our objective was to examine and evaluate the therapeutic options available for MRONJ. METHODS: The authors perused the most relevant literature relating to MRONJ through a search in textbooks and published articles included in several databases for the years 2003-2021. RESULTS AND CONCLUSIONS: A comprehensive update of the current understanding of these matters was elaborated, addressing these topics and identifying relevant gaps of knowledge. This review describes our updated view of the previous thematic blocks, highlights our current clinical directions, and emphasizes controversial aspects and barriers that may lead to extending the accumulating body of evidence related to this severe treatment sequela.

Immunohistochemical Characterization of Bcl-2 in Oral Potentially Malignant Disorders.

Bcl-2 is a group of apoptotic proteins that play a key role in cellular homeostasis. Overexpression of Bcl-2 has been associated with the poor prognosis of oral squamous cell carcinoma (OSCC). The aim of this study is to analyze the immunohistochemical expression of Bcl-2 in healthy oral mucosa, different oral potentially malignant disorders and OSCC, and to determine its diagnostic value. A retrospective observational study was carried out in the Oral Medicine Unit of the University of Santiago de Compostela. All the clinicopathologic data were collected and paraffin-embedded blocks were available to perform the immunohistochemistry study with Bcl-2. We studied 18 fibromas, 15 OSCC, 29 oral leukoplakia lesions (OL), 59 oral lichen planus (OLP) cases, and 16 healthy controls. OL with epithelial dysplasia (31.2%) showed the highest expression of Bcl-2 and OLP (1.9%) showed the lowest expression of Bcl-2 (P=0.025). Receiver operating characteristics curves showed that the detection of Bcl-2 enables discrimination between OL and OLPs (sensitivity: 58.6%, specificity of 99.32%). Bcl-2 negative expression in the OLP diagnosis obtained an odds ratio of 13.750 (95% confidence interval: 3.354-56.369; P<0.0001) and the positive expression in the OL 4.468 (95% confidence interval: 1.889-10.565; P=0.001). Bcl-2 could be used as a diagnostic biomarker to study their malignant transformation.

Metabolic syndrome and masticatory hypofunction: a cross-sectional study.

The objective of this paper is to clarify the rate of abdominal obesity (AO), waist-to-height ratio (WHtR), metabolic syndrome (MetS) and determine the relationship with the masticatory capacity (MC) in terms of total functional tooth units (t-FTU) in a representative sample of older Spanish adults. This cross-sectional study included 544 adult subjects aged 50 or over, who were prospectively selected and who had participated in a survey conducted in a primary dental care service in a Public Oral Health Service in Spain. Anthropometric, clinical variables and t-FTUs were obtained through a calibrated and well-established protocol. Univariate and multivariate binary and multinomial logistic regression analyses were developed. With regards to the t-FTU or MC, it was poor in 60.3%, good in 17.6%, and complete in 22.1% of the sample. The univariate odss ratio (OR) for MetS and AO increased as the MC decreased and as the age group increased. With regards to gender, women presented with an OR of 5.56 (CI 95% 3.70-8.38). With regards to the WHtR-a3 (WHtR grouped into three categories), the univariate ORs were all significant for morbid obesity compared to the healthy group, with a risk of 6.86 (CI 95% 3.23-14.58) for patients with poor MC compared to those with complete MC. Masticatory hypofunctionality could be associated with the presence of MetS. Clinical relevance: The number of t-FTUs is directly related to AO.

Efficacy of different formulations of nystatin in an experimental model of oral candidiasis in sialoadenectomized rats.

BACKGROUND/PURPOSE: Oral candidiasis is the most common fungal infection of the oral cavity and has become a focus of attention in recent years because of its association with highly topical immunosuppressive conditions. The aims of this study were to determine the value of microbiological, clinical and histological parameters of Candida albicans colonisation of the dorsal tongue surface as indicators of disease severity, and to evaluate therapeutic response to different formulations of nystatin. MATERIALS AND METHODS: We used 84 males, 2-month-old Sprague-Dawley sialoadenectomized rats. Different formulations of nystatin were used to evaluate the therapeutic response. The animals were randomized to 2 groups with each of 42 animals and received the experimental treatments from day 17-22. RESULTS: 100% of the rats showed evidence of infection. At 5 and 10 days of starting treatment with nystatin + chitosan, and at 10 days of starting nystatin + orabase, the number of animals with positive dorsal tongue culture decreased significantly (p < 0.05), acting the Nystatin + chitosan more rapidly against Candida. In the control group, the percentage of normal papillae on day 22 and 27 was 83.33% (SD = 1.50) and 79.08% (SD = 2.30), respectively. Significant differences were observed in the mean O'Grady score at 5 and 10 days (p < 0.0001). CONCLUSION: The model has been shown to be effective in inducing infection, and that the combination of nystatin and chitosan yielded the best therapeutic outcomes at both 5 and 10 days after infection.

Immunoexpression of Apoptosis and Cell-cycle Arrest Markers in Oral Lichen Planus.

The expression pattern of a panel of 5 molecular markers (p53, cyclin D1, Ki-67, BCL-2, and BAX) was studied in samples from patients with oral lichen planus (OLP) and normal oral mucosa (NOM) of healthy controls to investigate the implications of cell cycle and apoptosis in OLP. The 59 OLP and 16 NOM biopsies were stained by an inmunoperoxidase technique for p53, cyclin D1, Ki-67, BCL-2, and BAX and assessed microscopically for semiquantitative analysis. Positivity for BCL-2 and Ki-67 was significantly more frequent in NOM than in OLP (P<0.05). p53 levels were upregulated in atrophic/erosive clinical presentations when compared with reticular presentations and in cases with discontinued inflammatory infiltrate. Multivariate analysis through logistic regression showed that BCL-2 in OLP versus NOM was the only significantly altered marker in the present cohort (adjusted odds ratio=12.42; 95% confidence interval: 2.5-61.65; P=0.002). The cell patterns in OLP and NOM are distinct according to the present molecular markers panel. The presence of BCL-2 altered expression may be related to various molecular pathways that connect/link this condition to other autoimmune disorders and also may be involved in complex roles that evoke malignant transformation of OLP.