Evaluation of Serum and Salivary Lactate Dehydrogenase Levels in Patients with Oral Potentially Malignant Conditions/Lesions: A Clinical and Biochemical Study.

Background: Oral cancer encompasses all malignancies that originate in the oral tissues and remains a major public health problem throughout the world as an important case of poor health and illness. Head and neck cancer accounts for 9.8% of the estimated 6,44,600 incidental cancer cases in India. Oral Squamous Cell Carcinoma (SCC) is a serious and developing concern globally, accounting for more than 90% of malignant cancers of the oral cavity. Salivary diagnostics have been demonstrated to have potential in the detection and screening of oral pre-cancer and cancer in a variety of research settings. The continual and close contact between saliva and the mucosa, where cancer develops, is the foundation of this diagnostic capability. Materials and Methods: This research utilized spectrophotometry to quantify Lactate Dehydrogenase levels in serum and saliva of 30 healthy people which consisted the control group and 31 Oral Potentially Malignant people which constituted the study group. Results: On estimation and comparison, the mean Lactate Dehydrogenase levels in serum (397.4968+71.6392 IU/L) and saliva (675.4935+139.3352 IU/L) among patients with Oral Potentially malignant lesions/conditions were higher than the mean Lactate Dehydrogenase levels in serum (390.8667+71.0953 IU/L) and saliva (201.3700+89.1439 IU/L) among controls. Conclusion: Higher serum and salivary LDH levels in Oral Potentially malignant lesions/conditions than in control groups signifies the importance of assessing salivary LDH levels, in the prognosis of the same. Further prospective longitudinal studies are required to assess the salivary LDH levels among the patients with malignant transformation of Oral Potentially malignant lesions/conditions to oral cancers.

Oral Immune-Related Adverse Events - Current Concepts and their Management.

Recent advent of immune checkpoint inhibitors (ICIs) have made significant improvement in the treatment outcome of cancer patients. They are also known to increase the overall survival in many malignancies. They target key immune checkpoints, acting on the cytotoxic T-lymphocyte antigen-4, programmed death-1 (PD-1), and PD-1 ligand 1 pathways. ICIs are effective in cancer therapy, but also possess various adverse effects that are termed together as immune-related adverse events (irAEs). Information focusing only on the oral reactions of irAEs is scanty in the literature. Therefore, we performed a computerized database search in PubMed and Google Scholar to identify and collect data regarding the oral adverse effects of ICIs. The early recognition of oral irAEs and appropriative intervention may help in improving the quality of life in patients. This paper presents a brief review of oral irAEs and their management.

Status of thiocyanate levels in the serum and saliva of non-smokers, ex-smokers and smokers.

BACKGROUND: Use of tobacco is often implicated in the development of oral diseases. Questionable accuracy of the traditional questionnaires to assess cigarette exposure necessitates the use of biomarkers like thiocyanate which provide a definitive quantitative measure. OBJECTIVE: To assess the rise in the level of thiocyanate for measurement of smoking behaviour in adults. MATERIALS AND METHODS: Serum and salivary thiocyanate levels were estimated in 20 non-smokers, 20 ex-smokers and 40 smokers. Smokers were divided into two groups based on the presence or absence of oral mucosal lesions. RESULTS: The mean serum and salivary thiocyanate levels were increased significantly in smokers when compared to non-smokers and ex-smokers. The levels were not significantly different between ex-smokers and non-smokers and between smokers with tobacco related oral mucosal lesions and those without. Statistically significant correlation was seen between the serum and salivary levels of thiocyanate. CONCLUSION: This study highlights the high level of thiocyanate in the serum and saliva of smokers when compared to non-smokers and ex-smokers. Significant increase in thiocyanate level was also seen in saliva. Hence it can be stated that saliva can be used as a reliable, non-invasive tool to assess smoking behaviour in the population and its changes over time.

Sialic acid as a biomarker of oral potentially malignant disorders and oral cancer.

BACKGROUND: Carcinogenesis is a multistep process where a healthy cell has initially a precancerous stage and finally an early cancerous stage. The process of carcinogenesis can be divided into three stages of initiation, promotion, and progression. In this process, there is increased turnover, secretion, and/or shedding from malignant cells. Glycoproteins like sialic acid are expressed on the cell surface. In oral potentially malignant disorders (OPMDs) and oral cancer (OC), the sialic acid level is seen to increase due to high cell turnover and shedding of malignant cells which, in turn, results in the release of glycoproteins like sialic acid into circulation. Glycoproteins also form an important constituent of salivary mucins and hence due to the same mechanism, an increase in sialic acid level is also seen in saliva. OBJECTIVE: The aim is to estimate serum and salivary sialic acid levels in healthy controls, patients with OPMDs and patients with OC. MATERIALS AND METHODS: In this observational cross-sectional study, serum and salivary sialic acid levels were estimated in thirty healthy controls, thirty patients with OPMDs and thirty patients with OC. RESULTS: Serum and salivary sialic acid levels obtained were subjected to statistical analysis. Post hoc Tukey test was used to compare the serum and salivary sialic acid levels of the two study groups to the control group. ANOVA test was used for the comparison of sialic acid levels between the groups. Pearson's correlation coefficient was used to assess correlation (P < 0.05 was considered statistically significant). The mean serum and salivary sialic acid levels were increased significantly in subjects with OPMDs and OC when compared to healthy controls. CONCLUSION: This study highlights the high expression of sialic acid on outer cell membranes, due to the significant increase in subjects with OPMDs and OC when compared to healthy controls. A significant increase in sialic acid level is also seen in saliva. Hence, it can be stated that saliva can be used as a reliable, noninvasive tool in diagnosis and management of OPMDs and OC.

Serum and salivary lactate dehydrogenase levels as biomarkers of tissue damage among cigarette smokers. A biochemical study.

OBJECTIVE: To estimate the serum and salivary lactate dehydrogenase levels in cigarette smokers and non-smokers. MATERIALS AND METHODS: In this study lactate dehydrogenase levels were estimated in 30 healthy individuals with no tobacco related habits and in 30 patients with history of smoking cigarettes for a minimum of 2 years using Spectrophotometry. RESULTS: The mean values for serum and salivary lactate dehydrogenase levels were higher in cigarette smokers when compared to non-smokers. Serum lactate dehydrogenase levels on comparison between the groups was statistically significant (p=0.04). The values of salivary lactate dehydrogenase levels between the groups was highly significant (p<0.001). CONCLUSION: Cigarette smoking leads to an increase in serum as well as salivary Lactate dehydrogenase levels as indicator of tissue damage in the oral cavity. The present study indicates saliva as a better test medium than serum in determination of lactate dehydrogenase levels.

A rare variant of calcifying odontogenic cyst with ameloblastoma presentation.

Calcifying odontogenic cyst is a rare entity which was first described by Gorlin, and also accounts for 1% of the jaw cysts according to Shear. Due to its diverse histopathology and variable clinical features, there has been a doubt regarding its nature as a cyst or a neoplasm. In this report we present a case of calcifying odontogenic cyst with mural ameloblastomatous presentation in the left body of the mandible in a 19-year-old male patient. This is the 15th case of ameloblastomatous COC being documented in literature.

Can saliva offer an advantage in monitoring of diabetes mellitus? - A case control study.

OBJECTIVES: Diabetes Mellitus is emerging as a major health problem over these years. Present method of blood glucose monitoring by venepuncture is invasive leading to reduced patient compliance and thereby ineffective judicious monitoring. The need of the hour is to direct research in the direction of establishing painless and more acceptable blood glucose analysis method.The objective of the study is to conduct a comparative analysis of the concentrations of salivary glucose and blood glucose in type 2 diabetes mellitus patients. STUDY DESIGN: This study assessed glucose levels using the glucose oxidase method in blood and unstimulated saliva in 90 subjects who were divided into 3 equal groups of controlled type 2 diabetes, uncontrolled type 2 diabetes and those without diabetes. Statistical analysis was carried out using one way ANOVA, Post hoc Tukeys tests and Pearson's correlation coefficient test. RESULTS: Salivary glucose levels were significantly higher in patients with diabetes than controls. There was a significant positive correlation between salivary and plasma glucose levels in patients with diabetes. CONCLUSIONS: Glucose concentration in saliva is higher in diabetics but hyperglycemia does not influence salivary glucose levels. Further clarification is required to claim the diagnostic potentials of saliva in diabetes. Key words:Salivary glucose, type 2 diabetes mellitus, blood glucose.

Interdependence of antioxidants and micronutrients in oral cancer and potentially malignant oral disorders: a serum and saliva study.

OBJECTIVE: In our previous studies we have evaluated the role of antioxidants and trace elements in potentially malignant disorders and cancers of the oral cavity, taking into consideration the importance of antioxidants as biomarkers in cancer detection. We felt that other than evaluation, the correlation and interdependence that existed among antioxidants and trace elements require further evaluation in order to develop a better understanding. MATERIALS AND METHODS: Serum and salivary zinc, glutathione, and superoxide dismutase levels were evaluated in 65 healthy controls, 115 subjects with potentially malignant oral disorders, and 50 subjects with oral squamous cell carcinoma, using the atom absorption photometry, [5, 5-Dithiobis (2 nitrobenzoic acid)], and nitroblue tetrazolium methods, respectively. RESULTS: Serum zinc and serum glutathione showed significant positive correlation (r=0.76, P=0.01). Similarly, salivary glutathione and salivary zinc levels had a positive correlation (r=0.68, P=0.01). Serum superoxide dismutase showed a strong positive correlation with serum zinc (r=0.64, P=0.01). Similarly, there was a moderate positive correlation between salivary superoxide dismutase and salivary zinc (r=0.67, P=0.01). CONCLUSION: Our findings showed that trace elements and antioxidants exhibited interdependence in serum, as well as in saliva, in both physiologic and pathologic states such as oral cancer.

Intraoral Burkitt's lymphoma in an HIV positive patient.

Burkitt's lymphoma is an aggressive form of Non-Hodgkin's lymphoma composed of malignant cells of B lymphocyte origin. Burkitt's lymphoma is a rarity in the Indian subcontinent. Though intraoral Burkitt's lymphoma in HIV positive individuals is very uncommon, its importance lies in the fact that it is often the first sign of the underlying immunosuppression. We present a case of Burkitt's lymphoma in right maxillary region which was the first manifestation of HIV in the patient.

Malondialdehyde levels in oral sub mucous fibrosis: a clinicopathological and biochemical study.

BACKGROUND: Oral submucous fibrosis is one of the most commonly occurring potentially malignant disorders in the South-East Asia. Levels of lipid peroxidation product malondialdehyde have been recently correlated with clinical grades of oral Submucous fibrosis. AIMS: The aims of this study were to estimate the levels of malondialdehyde in serum, saliva and tissue in patients with oral submucous fibrosis, to correlate change in levels of malodialdehyde with the histopathological grading. MATERIALS AND METHODS: The study group comprised of 65 clinically diagnosed and histopathologically confirmed cases of oral submucous fibrosis, 21 age and sex matched controls were also enrolled into the study. The serum saliva and tissue samples in the study groups were evaluated by the thiobarbutric acid reactive substances. RESULTS: There was a significant difference between the serum and salivary malondialdehyde among the histopathological grades of oral submucous fibrosis. Tissue malonaldehyde levels were significantly higher as the grading progressed but tissue levels in grade 3 oral submucous fibrosis were lower than the controls. CONCLUSION: This decrease in tissue malonaldehyde could possibly be associated to collagen cross linking occurring during the advanced stages of oral submucous fibrosis.

Osteoradionecrosis of the mandible and mastoiditis after radiotherapy for parotid mucoepidermoid carcinoma.

Osteoradionecrosis of the mandible in conjunction with mastoiditis is an extremely rare occurrence following irradiation of salivary gland malignancy in the orofacial region. We report one such case of a patient who presented to us with trismus, jaw pain, and ear discharge. Imaging of the jaws revealed classical features of osteoradionecrosis and mastoiditis. This case is important because presenting features like trismus and dental infection led us to investigative procedures that revealed extensive bone involvement including mastoiditis. Trismus progressively increased over a period of 8 years. In this case, we would like to emphasize the importance of good oral hygiene in the postradiotherapy stage for head and neck cancer.

Adenoid cystic carcinoma of the buccal mucosa: A case report and review of the literature.

Adenoid cystic carcinomas are deceptive malignancies that show slow growth and local invasion with recurrences seen many years after diagnosis. Upto 50% of these tumors occur in the intraoral minor salivary glands usually in the hard palate. Buccal mucosal tumors are relatively rare. We determined the incidence of buccal mucosal adenoid cystic carcinoma by reviewing the number of reported cases in the literature. This is the first article to analyze the occurrence of adenoid cystic carcinomas in the buccal mucosa through a review of 41 articles. Our review revealed 178 buccal mucosal adenoid cystic carcinomas among a total of 2,280 reported cases. We present a case of adenoid cystic carcinoma occurring in the left buccal mucosa of a 45-year-old female.

Co-occurence of florid cemento-osseous dysplasia and simple bone cyst: a case report.

BACKGROUND: The purpose of this report is to present a rare case of co-occurrence of florid cemento-osseous dysplasia with simple bone cyst in a middle aged Asian woman. Most of the reported cases are isolated cases of simple bone cyst or florid cemento-osseous dysplasia, but co-occurrence of these two entities is extremely rare. METHODS: The authors report a 41 year old female patient with co-occurrence of mandibular florid cemento-osseous dysplasia with simple bone cyst. A thorough clinical and radiological examination was carried out. RESULTS: It was diagnosed mandibular cyst with possible co-occurrence of florid cemento-osseous dysplasia. Surgical exploration of the multilocular lesion was applied. Since, the patient was symptomatic at the time of presentation utmost caution was taken during the surgical procedure as florid cemento-osseous dysplasia is associated with hypo-vascularity of the affected bone. Based on histopathological, as well as supporting clinico-radiological findings a confirmative diagnosis of florid cemento-osseous dysplasia co-occurring with simple bone cyst was made. Patient was followed-up for a period of six months and was reported to be asymptomatic. CONCLUSIONS: Timely diagnosis and well planned treatment is important to obtain a good prognosis when a rare co-occurrence of two or more bone lesions affects the jaws.