Presence of Candida and its associated factors in participants attending oral cancer screening in the lower northeastern area of Thailand.

BACKGROUND: Certain evidence indicated high prevalence of Candida in oral potentially malignant disorders (OPMDs) and oral cancer (OC). This study was aimed to investigate the presence of Candida and its associated factors in participants who attended the oral cancer screening program in the lower northeastern districts of Thailand. METHODS: Convenient participants residing in the lower northeastern districts of Thailand who attended the oral cancer screening were enrolled. A questionnaire retrieving demographic characteristics, risk factors of oral cancer, and risk of having Candida was completed. Oral examination was performed by oral medicine specialists or oral surgeons. The participants were categorized into 4 groups according to their clinical diagnosis, namely normal oral mucosa (NOM), OPMDs/OC, non-OPMDs/OC and clinically suspected oral candidiasis (CSOC). Stimulated saliva flow rate was measured. Dip-slide test was performed in each participant to evaluate the presence of Candida. The levels of Candida were categorized into high and low levels according to the score received from the dip-slide test. Factors associated with high levels of Candida were identified using multivariate logistic regression analysis. RESULTS: A total of 577 participants were recruited. High levels of Candida were found in 31.3%, 24.7%, 25.9% and 18.1% in the OPMDs/OC, the non-OPMDs/OC, the CSOC and the NOM groups, respectively. According to multivariate logistic regression analysis, age above 60 years, female gender, betel quid chewing habit, use of denture, hyposalivation, and being in the CSOC group were found to be significantly associated with high levels of Candida. CONCLUSION: Higher number of participants in the OPMDs/OC group was found to have high levels of Candida. Increasing age, female gender, betel quid chewing habit, use of denture, hyposalivation and having CSOC lesions were associated with high levels of Candida.

Histopathological and risk factor analyses of oral potentially malignant disorders and oral cancer in a proactive screening in northeastern Thailand.

BACKGROUND: Lip and oral cavity cancer has been reported as the 10th most common cancer in Thailand. Recently, a screening program for oral potentially malignant disorders (OPMDs) and oral cancer was conducted in the northeastern Thailand which took into consideration a total of 371,911 people who resided in the provinces of Buriram, Chaiyaphum, Nakhon Ratchasima, and Surin. METHODS: A total of 330,914 subjects were consecutively screened for risk factors of oral cancer by village health volunteers (VHVs) using a questionnaire (S1). Then, 186,710 subjects with one or more risk factors for oral cancer were referred for oral screening by dental auxiliaries or dentists at sub-district level hospitals (S2) where 86,941 subjects were subsequently screened. Afterwards, 1576 subjects with suspicious oral lesions for OPMDs or oral cancer attended local hospitals for further investigation and treatment. Oral medicine specialists, oral surgeons, and local dentists at the district level hospitals performed biopsies and the samples were sent for histopathological analysis. The objectives of the study were to report the histopathology findings from the biopsies obtained from these subjects and the associated risk factors. RESULTS: Out of 427 subjects who received biopsies, complete diagnostic results were obtained from 409 patients (462 specimens). The 5 most common histopathological results from these specimens were mild epithelial dysplasia (27.3%), fibroepithelial hyperplasia (14.5%), oral lichen planus/oral lichenoid reactions (11.5%), moderate epithelial dysplasia (8%), and acanthosis with or without hyperkeratosis (5%). Oral squamous cell carcinoma was detected in 14 subjects and 11 other forms of oral cancer were revealed. Among the analyzed risk factors, habitual betel quid chewing was established as a statistically significant risk factor associated with OPMDs and oral cancer. CONCLUSION: The most frequently observed histopathological results of clinically suspected oral cancer and OPMDs included mild epithelial dysplasia, fibroepithelial hyperplasia, oral lichen planus/oral lichenoid reactions, moderate epithelial dysplasia, and acanthosis with or without hyperkeratosis. Betel quid chewing habit was found to be associated with OPMDs and oral cancer.

An integrative analysis of genome-wide methylation and expression in ameloblastoma: A pilot study.

OBJECTIVE: DNA methylation regulates the expression of various genes involved in tumorigenesis. Ameloblastoma is a benign odontogenic jaw tumor. It is locally aggressive with a high level of recurrence. A delay in treatment can lead to severe facial disfigurement. To the best of our knowledge, this is the first integrated analysis of DNA methylation and gene expression in ameloblastoma with the aim to identify genes that may be regulated by DNA methylation. MATERIALS AND METHODS: We used an Infinium MethylationEPIC array to measure genome-wide methylation and the Illumina HiSeq platform to obtain gene expression data in ameloblastoma tissues from five patients and dental follicles from three healthy subjects. An integration analysis was performed using City of Hope CpG Island Analysis Pipeline software. RESULTS: We identified 25,255 differentially methylated CpG sites and 17 differentially methylated CpG islands; six of the islands were negatively correlated with the expression of BAIAP2, DUSP6, FGFR2, FOXF2, NID2, and PAK6. Pyrosequencing and immunostaining techniques were further used to validate FGFR2, NID2, and PAK6. CONCLUSIONS: This analysis identifies a group of novel genes that may be regulated by DNA methylation and will possibly lead to new insights into the pathology and invasion mechanism of ameloblastoma.

Exploring protein profiles and hub genes in ameloblastoma.

Ameloblastoma (AM) is a prominent benign odontogenic tumor characterized by aggressiveness, likely originating from tooth-generating tissue or the dental follicle (DF). However, proteomic distinctions between AM and DF remain unclear. In the present study, the aim was to identify the distinction between AM and DF in terms of their proteome and to determine the associated hub genes. Shotgun proteomics was used to compare the proteomes of seven fresh-frozen AM tissues and five DF tissues. Differentially expressed proteins (DEPs) were quantified and subsequently analyzed through Gene Ontology-based functional analysis, protein-protein interaction (PPI) analysis and hub gene identification. Among 7,550 DEPs, 520 and 216 were exclusive to AM and DF, respectively. Significant biological pathways included histone H2A monoubiquitination and actin filament-based movement in AM, as well as pro-B cell differentiation in DF. According to PPI analysis, the top-ranked upregulated hub genes were ubiquitin C (UBC), breast cancer gene 1 (BRCA1), lymphocyte cell-specific protein-tyrosine kinase (LCK), Janus kinase 1 and ATR serine/threonine kinase, whereas the top-ranked downregulated hub genes were UBC, protein kinase, DNA-activated, catalytic subunit (PRKDC), V-Myc avian myelocytomatosis viral oncogene homolog (MYC), tumor protein P53 and P21 (RAC1) activated kinase 1. When combining upregulated and downregulated genes, UBC exhibited the highest degree and betweenness values, followed by MYC, BRCA1, PRKDC, embryonic lethal, abnormal vision, Drosophila, homolog-like 1, myosin heavy chain 9, amyloid beta precursor protein, telomeric repeat binding factor 2, LCK and filamin A. In summary, these findings contributed to the knowledge on AM protein profiles, potentially aiding future research regarding AM etiopathogenesis and leading to AM prevention and treatment.

Prevalence of Xerostomia and Hyposalivation Among Individuals Attending Oral Cancer Screening in Thailand: A Cross-Sectional Study.

Aim: It has been speculated that the prevalence of xerostomia and hyposalivation might be higher among individuals attending oral cancer screening than among members of the general population. Therefore, this study investigated the prevalence of these conditions and their associated factors among individuals taking part in oral cancer screening and residing in the northeastern provinces of Thailand. Materials and Methods: This cross-sectional study recruited convenient individuals aged ≥40 years with at least one oral cancer risk factor. In total, 561 participants were included. Demographic characteristics and relevant oral cancer risk factors were recorded. A questionnaire comprising five items was used to assess xerostomia. Participants were then categorized into two groups based on the absence or presence of xerostomia. Subsequently, the stimulated salivary flow rate was assessed using the spitting technique to identify hyposalivation. Participants were then separated into two groups depending on the absence or presence of hyposalivation. Univariate and multivariate logistic regression analyses were then performed to identify factors associated with xerostomia or hyposalivation. Results: The mean age of participants was 65.62 ± 9.70 years, and approximately 60% of participants were post-menopausal women. The prevalence of xerostomia was 43.85%, and the prevalence of hyposalivation was 61.50%. It was revealed that age ≥65 years (odds ratio [OR] = 1.57, P = 0.02) and burning sensation in the mouth (OR = 5.36, P < 0.001) were strongly associated with xerostomia. Female participants were more likely to exhibit hyposalivation (OR = 2.38, P = 0.001). Oral cancer risk factors were not associated with xerostomia or hyposalivation. Conclusions: In this study, age ≥65 years and burning sensation were identified as risk factors for xerostomia, whereas female sex was a risk factor for hyposalivation. Dentists should be aware of both conditions. Various interventions to alleviate dry mouth symptoms might be useful for individuals with these risk factors.

The Development of Dental Informatics of Oral Cancer Screening for Prevention in Community Level: A Prototype Study in Thailand.

OBJECTIVE: The purpose of this study is to identify general dentists' information needs for oral cancer screening in community and the information sources they use to meet those needs in clinical settings so as to inform the design of dental information systems. METHODS: A semi-structured interview was conducted with a convenience sample of 8 general dentists and 5 dental assistant in the Public Health Region 9 area during clinical hours. One hundred and five patient cases were reported by these dentists. Interview transcripts were coded and analyzed using thematic analysis with a constant comparative method to identify categories and themes regarding information needs and information source use patterns. RESULTS: Two top-level categories of information needs were identified: foreground and background information needs. To meet these needs, dentists used four types of information sources: clinical information/tasks, risk factor of oral cancer in general people, surveillance in community and referral to oral cancer treatment. Major themes of dentists' unmet information needs include: (1) timely access to information on various subjects; (2) better visual representations of dental problems; (3) access to patient-specific evidence-based information; and (4) accurate, complete and consistent documentation of patient records. Resource use patterns include: (1) dentists information needs matched information source use; (2) little use of electronic sources took place during treatment; (3) source use depended on the nature and complexity of the dental problems; and (4) dentists and dental nurse routinely practiced cross-referencing to verify patient information. CONCLUSIONS: Dentists have various information needs of oral cancer at the point of care. For future development of dental information or clinical decision support systems, developers should consider integrating high-quality, up-to-date clinical evidence into comprehensive and easily accessible EDRs as well as supporting dentists' resource use patterns as identified in the study.

Pilot Model for Community Based Oral Cancer Screening Program: Outcome from 4 Northeastern Provinces in Thailand.

Management of advanced-stage oral cancer adds a great burden to individuals and health care systems. Community-based oral cancer screening can be beneficial in early detection and treatment. In this study, a novel oral cancer screening program was conducted utilizing an existing network of health care personnel, facilities, and digital database management for efficient coverage of a large population. The screening program considered 392,396 individuals aged ≥40 from four northeastern provinces in Thailand. Three levels of screening were performed: S1 by village healthcare volunteers to identify risk groups, S2 by dental auxiliaries to visually identify abnormal oral lesions, and S3 by dentists for final diagnosis and management. A total of 349,318 individuals were interviewed for S1, and 192,688 were identified as a risk group. For S2, 88,201 individuals appeared, and 2969 were further referred. Out of 1779 individuals who appeared for S3, oral potentially malignant disorders (OPMDs) were identified in 544, non-OPMDs in 1047, doubtful lesions in 52, and no results in 136 individuals. Final treatment was carried out in 704 individuals that included biopsies of 504 lesions, exhibiting 25 cancerous lesions and 298 OPMDs. This study is so far one of the largest oral cancer screening programs conducted in Thailand and showed effective implementation of community-based oral cancer screening.

Dexamethasone Injection Into Pterygomandibular Space Versus Sublingual Space on Post-Operative Sequalae of Lower Third Molar Intervention.

BACKGROUND: The surgical removal of lower third molar is still the most common surgical procedure that is done in oral and maxillofacial surgery field and creates the predictable post-operative sequelae such as pain, swelling, stiffness and difficulty in mouth opening. The purpose of this study is to compare pre-operative dexamethasone injection into pterygomandibular space (PGS) and sublingual space (SLS) in lower third molar intervention of post-operative pain, swelling, and limited mouth opening. METHODS: This study is the split-mouth, randomized crossover clinical trial in 30 healthy patients (mean age 21 years). These patients had similar bilateral lower third molar impactions. The patients were randomly divided into two groups receiving either 8-mg dexamethasone injection into SLS or PGS with the 4-week washout period intervention. Clinical assessment of facial swelling and maximum mouth opening was performed before operation and on day 2 and day 7 after operation. The post-operative pain was also measured by patients' response on pain visual analogue scale (VAS) on the first, second and third day after intervention. RESULTS: There is no significant difference between PGS group and SLS group in pain and swelling on the second and seventh day after operation. However, PGS group showed a greater degree of limited mouth opening than SLS group on the second day after operation. CONCLUSIONS: This study showed that 8-mg dexamethasone injection into PGS or SLS was not different in reduction of pain, swelling, and limited mouth opening. This result suggests that dexamethasone injection into PGS or SLS is similarly effective.

Antimicrobial effect of topical local anesthetic spray on oral microflora.

BACKGROUND: To evaluate the antimicrobial activity of lidocaine (LD) topical anesthetic spray against oral microflora. METHODS: Antimicrobial effects of 10% LD spray were assessed against six bacterial cultures obtained from volunteers: Escherichia coli, Enterococcus faecalis, Staphylococcus aureus, Streptococcus salivarius, Streptococcus pyogenes, and Streptococcus sanguinis. The filter papers contained 50-µl LD, brain heart infusion (BHI) broth, or 0.2% chlorhexidine. Papers were placed on the cultured blood plates for 1-3 min. After the papers were removed, plates were incubated for 24 h. Bacterial growth on the contact areas was recorded as the antimicrobial score. The split mouth technique was use in for sample collection in clinical study. Filter papers soaked with either BHI broth or LD were placed on the right or left buccal mucosa for 1 min, and replaced with other papers to imprint biofilms onto the contact areas. Papers were placed on blood plates, incubated for 24 h, and antimicrobial scores were determined. Experiments were conducted for 2- and 3-min exposure times with a 1-day washout period. RESULTS: LD exhibited bactericidal effects against E. coli, S. sanguinis, and S. salivarius within 1 min but displayed no effect against S. aureus, E. faecalis, and S. pyogenes. The antimicrobial effect of LD on oral microflora depended upon exposure time, similar to the results obtained from the clinical study (P < 0.05). LD showed 60-95% biofilm reduction on buccal mucosa. CONCLUSIONS: Antimicrobial activity of 10% LD topical anesthetic spray was increased by exposure time. The 3 min application reduced oral microflora in the buccal mucosa.

Calcifying cystic odontogenic tumor associated with other lesions: case report with cone-beam computed tomography findings.

The calcifying cystic odontogenic tumor (CCOT) simultaneously occurring with other lesions at different locations in the same patient is rare. We report a patient with CCOT associated with an odontoma, a supernumerary tooth, and a dentigerous cyst simultaneously occurring in the maxilla. Cone-beam computed tomography (CBCT) images showed a well-defined expansile lesion with internal calcification, high-density masses surrounded by low-density area, and a supernumerary tooth at the anterior maxilla. Posterolaterally to these lesions, an embedded canine with pericoronal radiolucency was detected. Histopathologic examination revealed a CCOT associated with an odontoma, a supernumerary tooth, and a dentigerous cyst of the embedded canine. Enucleation was performed, and a 2-year postoperative follow-up was uneventful. CBCT was useful in giving the differential diagnosis by depicting internal calcification of CCOT, and in revealing the extent and complex relationship of these lesions.

Effect of single dose preoperative intramuscular dexamethasone injection on lower impacted third molar surgery.

This study aimed to investigate the effects of dexamethasone intramuscular injection 1h preoperatively, in reducing facial swelling, pain and trismus after lower impacted third molar (LITM) surgery. Twenty healthy Thai patients with both LITM surgical extraction were enrolled in the study. The washout period was 1 month after the first operation. Clinical assessment of the facial swelling, pain and trismus were measured before and after operation for 7 days and the patient's total analgesic consumption was recorded. The level of significance used in the statistical decisions was P<0.05. Preoperative intramuscular injection of single-dose 8mg dexamethasone reduced postoperative swelling after LITM surgical extraction significantly on the second postoperative day, but immediately after surgery and on day 7 after the surgical extraction, no significant difference was found between the dexamethasone and control groups. Dexamethasone also reduced postoperative pain after LITM surgical extraction significantly on postoperative days 2 and 7. Additionally, the amount of paracetamol decreased significantly. There were no significant differences in trismus in the study and control groups 7 days after LITM operation. Single-dose intramuscular injection of dexamethasone can reduce postoperative facial swelling and pain, without affecting trismus after LITM surgical extraction.

Sinus floor elevation using autogenous bone or bone substitute combined with platelet-rich plasma.

OBJECTIVE: Sinus augmentation is a common approach for patients with severe alveolar ridge atrophy. However, autogenous bone sometimes results in donor site complications. Bone substitutes with platelet-rich plasma (PRP) promote early bone formation with autogenous bone. Use of PRP on autogenous bone and a bovine bone substitute were investigated in this split-mouth animal study. STUDY DESIGN: Premolars were extracted from minipigs. Each animal received sinus augmentation using a lateral approach with simultaneous insertion of 3 implants in each site. Groups were randomized using autogenous bone alone and combined with PRP or a bovine hydroxyapatite alone in combination with PRP. RESULTS: Microradiographic findings in the autogenous group did not show significantly different rates by using autogenous bone alone or combined with PRP. Using the bovine hydroxyapatite as augmentation material only at 8 weeks, a nonsignificant effect in the PRP group could be seen. At all other observation periods, no significant influence was observed. CONCLUSION: No significant influence of PRP was found.

Influence of platelet-rich plasma on a bioglass and autogenous bone in sinus augmentation. An explorative study.

Platelet-rich plasma (PRP) has been introduced to the field of oral and maxillofacial surgery for a decade, but its beneficial effects on maxillary sinus augmentation remain unclear. The aim of this study was to evaluate the short- and long-term effects of PRP on osseointegration following single-stage sinus augmentation in a randomized prospective animal study. The maxillary premolars of 24 minipigs were extracted bilaterally and allowed to heal for 2 months. Consecutively all animals underwent bilateral sinus floor elevation using autogenous bone, Biogran as well as a combination of the materials with PRP. Three dental implants (Ankylos, Dentsply Co., Mannheim, Germany) were installed in each sinus simultaneously. Four animals were sacrificed at each period of observation (1, 2, 8 and 12 months). Microradiographic images of the specimens were made for quantitative evaluation of the bone-implant contact (BIC) and light microscopic images were made for qualitative analysis. An increment of the BIC during the observation time could be seen over the observation time in all groups. Autogenous bone exhibited a level of BIC from 25.1 +/- 9.96% at 1 month to 55.1 +/- 13.10% at 12 months; on adding PRP, the BIC ranged from 28.4 +/- 4.64% to 52.5 +/- 17.06%. Biogran with and without PRP led to BIC levels from 16.3 +/- 4.64% to 37.6 +/- 16.40% and 21.7 +/- 4.33% to 46.6 +/- 19.37%, respectively. The results of this study did not show a significantly positive effect of PRP on the BIC following sinus augmentation in both groups.

Lack of beneficial effects of platelet-rich plasma on sinus augmentation using a fluorohydroxyapatite or autogenous bone: an explorative study.

BACKGROUND: Maxillary sinus augmentation is frequently necessary before placement of dental implants in the posterior maxilla. Besides autogenous bone graft, various bone substitutes have been used, with favourable results. Although platelet-rich plasma (PRP) has been used in the field of oral and maxillofacial surgery for years, its beneficial effects on osseous regeneration still remain unclear. The aim of this study was to evaluate the short and long time effects of PRP on single-stage sinus augmentation using autogenous bone or a fluorohydroxyapatite (Algipore) in a randomized prospective animal study. METHODS: After extraction of maxillary premolars of sixteen minipigs, the wounds were allowed to heal for 2 months. Then, sinus augmentations were performed bilaterally using one of the following grafting materials: autogenous bone and Algipore with or without PRP. Three dental implants (Ankylos) were installed in each sinus simultaneously. Four animals were euthanized at each period of observation (1, 2, 8 and 12 months). Implant-bearing specimens were sectioned bucco-lingually along the long axis of implants and undecalcified ground specimens were prepared. The bone-implant-contact (BIC) was measured by means of microradiographic examination. For histological evaluation, the specimens were stained with toluidin blue, and the percentage of the newly formed bone and the remaining bone substitute were evaluated. RESULTS: The grafting materials chosen showed increasing levels of BIC and newly formed bone throughout the period of observation in both PRP and non-PRP groups. Adding PRP resulted in lower BIC and newly formed bone compared with autogenous bone grafts or Algipore alone. However, a statistical significance was not found. The percentages of the remaining bone substitute in both the PRP and non-PRP groups were closely comparable in all observation periods. CONCLUSIONS: The application of PRP could not reveal significant beneficial effects on the BIC, the percentage of the newly formed bone and the remaining bone substitute in this study.