Evaluation of Oral Microbial Flora in Saliva of Patients of Oral Submucous Fibrosis.

Oral Submucous Fibrosis (OSMF) has a multifactorial origin and the risk factors vary across different parts of the world. Betel nut (areca nut) chewing is the leading cause of OSMF in parts of South East Asia as well as Indian subcontinent. Certain fungal species have been identified in the occurrence of various premalignant lesions including OSMF. Candida in mouth along with the epithelial changes like atrophy, dysplasia, and hypertrophy may predispose individuals to premalignancy. This study was carried out to evaluate the prevalence of microbial flora in saliva of patients of OSMF.METHODSThe study included a total of 48 subjects, with 24 clinically diagnosed OSMF patients and a control group of 24 healthy age sex matched patients. Demographic data and salivary samples were collected from both the groups. Swabs taken were subjected for Gram staining and Sabouraud’s Dextrose Agar. The positively cultured Candida samples were further analysed by using germ tube test for determining different Candida species.RESULTSIn total, 58.3% of the OSMF patients and 29.2% of the control patients yielded candida organisms on culture. The difference between the two groups was statistically significant (x2=4.148, p=0.042). Final results of the study indicate that presence of Candida is significantly higher in OSMF patients than healthy subjects. Thus, results of the present study confirm the phenomenon of high prevalence of oral colonization by yeast in OSMF patients than healthy subjects.CONCLUSIONSIn OSMF, there is an altered microbiome which may be used as an indicator for malignant transformation of OSMF. The present study shows higher incidence and intensity of candida in OSMF patients when compared to healthy individuals. Hence, it is mandatory to maintain proper oral hygiene status in OSMF patients to prevent further complications of candidiasis.

Oral submucous fibrosis: An enigmatic morpho-insight

Oral submucous fibrosis (OSMF) is a chronic progressive, scarring disease affecting oral, oropharyngeal, and sometimes the esophageal mucosa. It is characterized by the progressive fibrosis of the submucosal tissue. The pathogenesis of OSMF has been directly related to the habit of chewing areca nut and its commercial preparation, which is widespread in Indian subcontinent and Southeast Asia. The areca nut has been classified as a “group one human carcinogen.” Oral squamous cell carcinoma in the background of OSMF is one of the most common malignancies in South and Southeast Asian countries. Malignant transformation has been reported in 7%–12% cases of OSMF. Histopathological spectrum of OSMF includes the apparent alterations observed in the epithelium and connective tissue. Epithelial atrophy and sometimes epithelial hyperplasia with or without dysplasia are the peculiar alterations seen in the epithelium. In the connective tissue, there is extracellular matrix remodeling which results in excessive collagenization. Further cross-linking of collagen leads to hyalinization which makes the collagen resistant to proteolysis. Owing to fibrosis in the connective tissue, there is narrowing of blood vessels which further results in compromised blood supply to the local tissue milieu, that is, hypoxia. This tissue hypoxia elicits angiogenesis which may result in the malignant transformation of OSMF. Perpetual irritation of areca nut and its constituents to the oral mucosa leads to upregulation of pro-inflammatory cytokines and further juxtaepithelial inflammation. Thus, these coordinated reactions in epithelium and connective tissue leads the OSMF toward malignant transformation

Can One Predict the Incidence of Metastasis in Oral Squamous Cell Carcinoma Patients Using Tumor Thickness.

Aim: The present study was undertaken with the purpose to assess the correlation between the presence of lymph node metastases and the size of tumor and the thickness of the tumor mass. Methods: The study included 80 consecutive cases of oral squamous cell carcinoma, who underwent radical neck dissection. The various level of lymph nodes in these cases were checked for metastases, which was then correlated with the size of tumor and the thickness of the tumor. Results: In this study it was revealed that there is a statistically non-significant (p = 0.3204) correlation between size of the tumor and regional cervical lymph node metastases, but a significant correlation (p = 0.0148) between thickness of the tumor and regional cervical lymph node metastases was observed. Conclusion: Thus we conclude that the tumor thickness was more in cases with skip metastasis than in cases without skip metastasis and tumors greater than 10mm in thickness have more chances of regional metastases.