Zinc-alpha 2 glycoprotein a diagnostic Biomarker for early stage oral Squamous Cell Carcinoma.

Objectives: In this study, we investigated the expression of zinc alpha-2 glycoprotein in oral squamous cell carcinoma tissue samples. Additionally, ascertained its association to the oral cancer stage and subscale parameters (TNM). Methods: This observational study was conducted at Ziauddin University from January to December 2020. Using the Open-Epi software, the sample size of 120 oral squamous cell carcinomas was calculated at 95% confidence interval and a 5% margin of error. Ethical approval was taken from the Institutional Ethical Review Committee. Histologically diagnosed cases of oral squamous cell carcinoma were obtained from the Histopathology Department of Ziauddin University, Karachi. Study data was analyzed through SPSS version-20 and p-value ≤0.05 considered as significant. One-way ANOVA and Multiple linear regression were applied for analysis of data. Result: In the study, none of the oral squamous cell carcinoma tissue samples from the later stages were stained for ZAG. However 71% (35/49) of the early stage OSCC samples showed positive IHC results for ZAG expression in the cytoplasm. One-way ANOVA indicates that high ZAG expression was significantly associated with smaller tumor size (p<0.001), lymph node involvement (p=0.002), early stages of OSCC (p<0.001) and less differentiated tumor (p=0.001). The site of the tumor was also significantly associated with ZAG staining (p<0.001). Conclusion: Zinc alpha-2 glycoprotein expressed in the early stages of oral cancer development so that effective treatment modalities can be planned as per the patient's status. This may also assist a clinician to achieve tumor-free surgical margins and monitor the post treatment outcomes.

Correlation between glycaemic state and tooth mobility in patients with periodontal disease.

OBJECTIVE: To evaluate the association of tooth mobility with glycaemic levels in patients with periodontitis. METHODS: The cross-sectional study was conducted at the Department of Oral Medicine, Ziauddin Dental Hospital, Karachi, from December 2018 to May 2019, and comprised patients of either gender with chronic periodontitis. After recording demographic details and dental charting, tooth mobility scores were correlated with gingival crevicular blood glucose, finger capillary blood glucose and glycosylated haemoglobin levels using Pearson's correlation. Linear regression was applied to assess the inter-relation between the variables. Data was analysed using SPSS 20. RESULTS: Of the 348 patients, 202(58%) were females and 146(42%) were males. The overall mean age was 43±10.4 years. The mean number of teeth in patients with glucose levels <180mg/dl was 25.5±2.5 compared to 23.2±2.9 in individuals with glucose levels >200mg/dl. A moderate positive correlation (r=0.658) was seen between gingival crevicular blood glucose levels and tooth mobility. Finger capillary blood glucose levels also showed good correlation (r=0.653) with tooth mobility scores. Glycosylated haemoglobin scores showed a strong positive correlation(r=0.733). Linear regression confirmed increased glycaemic levels as a risk factor for tooth mobility (p<0.001). CONCLUSIONS: Tooth mobility and glycaemic levels were found to be strongly interrelated.

Salivary Interleukin 1-beta levels and clinical periodontal parameters in habitual naswar users and non-users.

OBJECTIVES: Aim of our study was to assess the expression of salivary Interleukin 1-beta (IL-1ß) and clinical periodontal parameters in naswar users and non-users (controls). METHODS: Eighty four individuals (forty-two naswar users and forty-two controls) were included in the study which was conducted between August 2017 and May 2018. Salivary IL-1ß levels, plaque index (PI), bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL) was assessed in all the participants. RESULTS: PD of 4mm (p<0.05), PD of 5-6mm (p<0.05), CAL (p<0.001) and levels of salivary IL-1ß (p<0.05) were significantly higher among naswar users as compared to controls while PI, BOP and number of missing teeth showed no significant difference among the two groups (p>0.05). CONCLUSION: Periodontal inflammatory conditions were worse and salivary IL-1ß levels were elevated in naswar users as compared to controls.

Photodynamic therapy in the treatment of symptomatic oral lichen planus: A systematic review.

BACKGROUND: The aim of this systematic review was to assess the efficacy of photodynamic therapy (PDT) in the treatment of symptomatic oral lichen planus (OLP). METHODS: This systematic review aimed to address the following focused question: "Is PDT effective in the treatment of symptomatic OLP?" Indexed databases such as MEDLINE, EMBASE, and CENTRAL were searched up to and including August 2017. RESULTS: Six clinical studies were included. The risk of bias was considered high in 5 studies and moderate in one study. Parameters of PDT such as wavelengths, energy fluence, power density and exposure time ranged between 320-660 nm, 120 J/cm2 , 130 mW/cm2 , and 70-150 seconds, respectively. The follow-up period ranged from 4 to 48 weeks. All included studies reporting clinical scores showed that PDT was effective in the treatment of OLP in adult patients at follow-up. However, PDT did not show significant improvement when compared with steroid therapy. CONCLUSION: Photodynamic therapy appears to have some effect in the symptomatic treatment of OLP in adult patients. However, further randomized controlled trials with long follow-up period, standardized PDT parameters, and comparing the efficacy of PDT with steroid therapy are warranted to obtain strong conclusions in this regard.

Anti-plaque Efficacy of Herbal Mouthwashes Compared to Synthetic Mouthwashes in Patients Undergoing Orthodontic Treatment: A Randomised Controlled Trial.

PURPOSE: The present study compared the antiplaque effects of two herbal mouthwashes containing Salvadora persica and Azadirachta indica, respectively, with two synthetic mouthwashes containing either chlorhexidine or cetylpyridinium. MATERIALS AND METHODS: In this triple-blind, randomised controlled trial, 100 patients undergoing orthodontic treatment underwent scaling and polishing at baseline to obtain a plaque score of zero. In the first phase, they were given oral hygiene instructions and were provided with a standard toothpaste to be used twice daily for a period of three weeks. In the second phase, following scaling and polishing, they were randomly allocated to 4 groups according to 4 different types of mouthwash (A: chlorhexidine; B = cetylpyridinium; C = extracts of Salvadora persica miswak; D: extract of Azadirachta indica miswak) along with previously taught toothbrushing protocol for three more weeks. Plaque accumulation was scored three times according to the Modified Bonded Bracket Plaque Index: at the start, after the toothbrush-toothpaste trial, and at the end of mouthwash trial. The paired t-test was used to compare the pre-plaque and post-plaque indices in all groups. Analysis of mean differences of post-plaque indices between and within groups was performed using the post-hoc Tukey test. Qualitative variables were compared by Crosstab. RESULTS: Eighty participants completed the study - 63 females and 17 males. There was a statistically significant decrease in mean plaque scores after using mouthwashes in all four groups at follow-up when compared to the baseline plaque score (p = 0.001). The greatest reduction of plaque score was found in group C (extract of Salvadora persica) when compared with group A, chlorhexidine (p = 0.016). CONCLUSION: Compared to other mouthwashes, Salvadora persica miswak-based mouthwash showed a maximum reduction in the plaque scores among orthodontic patients.

Serum Levels of OX40 in Early and Late-Stage Oral Squamous Cell Carcinoma.

Background The tumor necrosis factor receptor superfamily, member 4 (OX40) and its ligand (OX40L) are members of the tumor necrosis factor superfamily and play roles as costimulatory immunomodulators to combat infectious diseases as well as cancers. Presently, many therapeutic agents focused on OX40 and OX40L are in trials for antitumor efficacy. In Pakistan, oral squamous cell carcinoma (OSCC) is the second most prevalent cancer with a mortality of 50% despite the availability of various therapeutic modalities. Data regarding serum levels of OX40 in patients with OSCC is lacking. Therefore, the study aimed to assess the OX40 levels in serum and their association with the clinicopathological features of the tumor. Methodology A cross-sectional study was conducted and serum samples of 78 biopsy-confirmed OSCC patients were collected prior to any treatment along with 10 healthy persons after informed consent. Serum levels of OX40 were measured via sandwich enzyme-linked immunosorbent assay (ELISA). Results The mean serum levels of OX40 were 1.65 ± 0.64 ng/ml and 2.39 ± 0.58 ng/ml in early and late-stage disease patients of OSCC, respectively (p =<0.005). However, based on gender and tumor site, male gender and buccal mucosa tumors in late-stage OSCC patients showed higher mean levels of OX40, 2.42± 0.58 ng/ml and 2.41 ± 0.58 ng/ml (p =<0.05), respectively. Patients with well-differentiated tumors demonstrated mean serum levels of 2.28 ng/ml, and in moderately differentiated tumors, the mean levels were 2.19 ng/ml (p =0.47). Conclusions A high OX40 level is associated with advanced-stage disease and a poor prognosis, possibly reflecting the immune-exhausted status against OSCC.

Differential expression of salivary S100A7 in oral submucous fibrosis.

AIM: To investigate the expression of salivary S100A7 levels among patients with oral submucous fibrosis (OSF) and healthy controls. METHOD: A total number of 60 participants were included in the study (30 OSF cases and 30 healthy controls). Demographic data was collected using a structured baseline questionnaire. Salivary S100A7 levels were quantified using enzyme-linked immunosorbent assay. Data was analyzed using Student t-test. Pearson correlation test was used to evaluate correlation between S100A7 levels and independent variables such as frequency and duration of areca nut use, gutka use, and mouth opening. RESULTS: The mean value of salivary S100A7 for OSF group was 0.275 ng/ml, whereas mean value of salivary S100A7 for healthy controls was 0.195 ng/ml. Student t-test indicated that there was statistically significantly higher levels of S100A7 in OSF group as compared to healthy controls (p < .001). When the clinical variables of individual groups were analysed, a significant negative correlation was found between salivary S100A7 and duration of areca nut (p = .009) and gutka chewing (p = .03), whereas a significant positive correlation was found for mouth opening (p = .04). CONCLUSION: OSF presented higher levels of salivary S100A7 levels as compared with healthy individuals and may be used as surrogate measure to identify subjects at risk for OSF.

S100 proteins in oral squamous cell carcinoma.

BACKGROUND: Controversy exists in the literature regarding the differential expression of S100 protein members and their functional correlations in oral squamous cell carcinoma (OSCC). The aim of the present study was to systematically review the expression of S100 protein family members among OSCC and healthy controls and to evaluate whether S100 protein members serve as diagnostic marker in OSCC. METHODS: Indexed databases were searched up to and including October 2017. Case-control/cross-sectional studies in human diagnosed clinically and/or histologically with OSCC and evaluated the expression of S100 protein family among OSCC and healthy controls were included. RESULTS: A total of 11 studies were included. Four studies were of good quality, 5 were of moderate and 2 were of poor quality. Five studies evaluated S100A2, A7 and A12 and showed overexpression of these protein levels in OSCC patients when compared to healthy controls. Three studies reported down-regulation of S100A1, A3, A6, A11, A13, A14, A16 and S100Z in OSCC patients as compared to healthy controls. Two studies reported overexpression of S100A9 and one study each reported overexpression of S100A4, A8, A10, and S100P in OSCCs as compared to healthy controls respectively. CONCLUSION: It remains debatable whether up-regulation or down-regulation of specific S100 protein members serves as a diagnostic marker in OSCC. With the findings of the present systematic review, the threshold for diagnostic levels of S100 proteins cannot be proposed. In addition, S100A7 protein could act as a potential OSCC marker. However, further case-control studies with larger sample size are required to obtain strong conclusion in this regard.

Mutiple keratocystic odontogenic tumors (KCOT) in a patient with Gorlin syndrome: a case report with late presentation and absence of skin manifestations.

BACKGROUND: Gorlin syndrome is a rare autosomal dominant syndrome characterized by multiple basal cell carcinomas, keratocystic odontogenic tumors (KOT) and falx cerebral calcifications, which occur due to mutation in PTCH gene. CASE PRESENTATION: A 36 year old Asian patient presented with jaw swelling and pain. Radiographic examination revealed six cysts in maxilla and mandible which were excised and histologically were compatable with keratocystic odontogenic tumors. CT scan also revealed falx cerebral calcification which led to the diagnosis of Gorlin syndrome confirmed on genetic testing. There was no evidence of basal cell carcinoma and other manifestations of Gorlin syndrome were absent. CONCLUSIONS: Multiple KCOT are hallmark of Gorlin syndrome and should always leads to its suspicion even in the absence of other manifestations and late presentation. Moreover, keratocystic odontogenic tumors have a particularly higher risk of recurrence and patients with Gorlin syndrome are prone to develop additional keratocystic odontogenic tumors from basal cells of oral epithelium. Therefore we suggest a stepwise approach to manage such patients which include a preoperative biopsy to establish a definitive diagnosis and complete removal of all keratocystic odontogenic tumors to prevent recurrence followed by close clinical follow up and early removal of any newly developed or recurrent cyst. Additionally thorough clinical examination is necessary to rule out the possibility of Gorlin syndrome in any patient with keratocystic odontogenic tumors as there are only subtle differences in histology of those cysts with a syndromic association and clinical features of Gorlin syndrome are markedly variable. Hence late occurrence of keratocystic odontogenic tumors and absence of skin manifestations like basal cell carcinoma should not preclude a diagnosis of Gorlin syndrome.

Association Between Grading of Oral Submucous Fibrosis With Frequency and Consumption of Areca Nut and Its Derivatives in a Wide Age Group: A Multi-centric Cross Sectional Study From Karachi, Pakistan.

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic, premalignant condition of the oral mucosa and one of the commonest potentially malignant disorders amongst the Asian population. The objective of this study was to investigate the association of etiologic factors with: age, frequency, duration of consumption of areca nut and its derivatives, and the severity of clinical manifestations. METHODS: A cross-sectional, multi centric study was conducted over 8 years on clinically diagnosed OSMF cases (n = 765) from both public and private tertiary care centers. Sample size was determined by World Health Organization sample size calculator. Consumption of areca nut in different forms, frequency of daily usage, years of chewing, degree of mouth opening and duration of the condition were recorded. Level of significance was kept at P ≤ 0.05. RESULTS: A total of 765 patients of OSMF were examined, of whom 396 (51.8%) were male and 369 (48.2%) female with a mean age of 29.17 years. Mild OSMF was seen in 61 cases (8.0%), moderate OSMF in 353 (46.1%) and severe OSMF in 417 (54.5%) subjects. Areca nut and other derivatives were most frequently consumed and showed significant risk in the severity of OSMF (P ≤ 0.0001). Age of the sample and duration of chewing years were also significant (P = 0.012). CONCLUSIONS: The relative risk of OSMF increased with duration and frequency of areca nut consumption especially from an early age of onset.

Rapid sarcomatous transformation of an ameloblastic fibroma of the mandible: case report and literature review.

Ameloblastic fibrosarcoma (AFS) is a rare malignant odontogenic tumour regarded as the malignant counterpart of ameloblastic fibroma. It is characterized by a benign epithelial component within a malignant fibrous stroma. AFS is a locally aggressive neoplasm with extremely low potential for metastasis. We report an extremely rare, rapidly progressive, and fatal case originating in the posterior mandible of a 20-year old female patient. Initially histopathologically diagnosed as a benign lesion, it rapidly recurred with apparent transformation into a high-grade sarcoma over a period of 6 months. Subsequent intracranial and pulmonary metastases were noted, and the patient died within 15 months of initial consultation. This case emphasizes the need for a high element of suspicion about clinically ambiguous lesions. We recommend more extensive or radical, primary excisions in lesions that have a known potential for recurrence or malignancy.