Assessment of glutathione peroxidase enzyme response and total antioxidant status in oral cancer - Systematic review and meta-analysis.

BACKGROUND: Oxidative stress induced by free radical accumulation contributes to many pathologies, including cancer. Antioxidant defense system fails to scavenge free radicals when it is excessively accumulated. Assessing individual antioxidant enzymes and total antioxidant capacity could direct the customized therapeutic strategies. OBJECTIVE: Evaluation of total antioxidant status and enzyme glutathione peroxidase activity in the oral cancer group compared to the healthy control group. METHOD: The literature search included databases PubMed, Science Direct, Wiley Online Library, Cochrane and Cross Reference between 1999 and 2021. The database search was completed in the month of August 2022. The extracted data were analyzed by Comprehensive Meta-Analysis (CMA) version 3 software (Biostat Inc. Englewood, NJ). Based on search strategies, 1435 articles have been retrieved from the database. In the segregated articles, 1365 were excluded due to duplicated articles, animal studies, low-quality studies, articles unrelated to the research question, and with unmatched objectives. Based on inclusion criteria, 70 articles were selected for full-text valuation. However, 33 articles were found highly suitable for inclusion and data extraction. Finally, 11 articles were selected for meta-analysis. RESULTS: The meta-analysis of four included studies of tissue samples showed a significantly (p < .001) increased GPx activity in the oral cancer group, when compared to the control group, whereas three included studies of erythrocyte samples displayed a significantly (p < .001) decreased GPx activity in the oral cancer group than the control group with the pooled standardized mean difference value of -2.766 moles/min/g Hb at 95% CI (-3.297 to -2.234). The meta-analysis of the included studies depicted an insignificant (p = .947) reduction of salivary TAS levels in the oral cancer group when compared to the control group. CONCLUSION: Our systematic review and meta-analysis depict antioxidant GPx enzyme activity in the regional tissue samples of the oral cancer group differs from other systemic biological fluid samples compared to the healthy control group.

Comparison of the effectiveness of red ginseng herbal mouth rinse with chlorhexidine and saline in oral cancer patients: A pilot double-blinded randomized control trial.

Background: Red ginseng is an herb with many medicinal properties and aids as a mouth rinse with fewer side effects than chlorhexidine. Aim: The study aimed to compare the efficacy of red ginseng herbal mouth rinses with those of chlorhexidine and saline in oral cancer patients. Materials and Methods: The present pilot study was a double-blinded randomized control trial with 45 histopathologically diagnosed oral squamous cell carcinoma patients divided into three groups: two intervention groups (herbal and chlorhexidine mouth rinse) and one control group (saline). Saliva samples for each patient were collected at baseline and after 14 days of using the mouth rinses. A microbiological examination of salivary samples was done by analysing total oral bacterial load along with specific counts for Porphyromonas gingivalis and Fusobacterium nucleatum at baseline and after the usage of mouth rinse. Statistical Analysis: The data normality was analysed using the Shapiro-Wilk test, and following the normal distribution of data, parametric tests were employed. Paired t-test and one-way analysis of variance, followed by post hoc Bonferroni test, were used for inter-group and intra-group differences. Result: There was a significant mean difference in total colony count, Fusobacterium nucleatum, and Porphyromonas gingivalis with oral hygiene index and gingival index improvement in the red ginseng herbal mouth rinse group when compared to the chlorhexidine and saline groups. Conclusion: In this study, red ginseng mouth rinse exhibited an increased antibacterial effect compared to chlorhexidine and saline. Hence, red ginseng mouth rinse can be used in oral cancer patients to maintain oral health, thereby improving the prognosis of these patients.

Depleting levels of endogenous anti-oxidant superoxide dismutase in oral sub-mucous fibrosis: A systematic review and meta-analysis.

Objective: The systematic review is aimed to assess the antioxidant status by superoxide dismutase level in oral sub-mucous fibrosis using available literature. Materials and methods: A literature search was accomplished electronically in Pubmed (MeSH), Science Direct, Scopus, Web of Science core collection, Cochrane, and Cross-reference, using the keywords such as 'oral submucous fibrosis,' 'antioxidant status' and 'superoxide dismutase.' Results: Of the 352 articles identified, only 16 satisfied the selection criteria and were included in the systematic review. Among the selected, six studies were included for serum level analysis of superoxide dismutase. The assessment showed a significant reduction of serum superoxide dismutase in oral submucous fibrosis patients than in control (p < 0.004). The mean difference in serum superoxide dismutase concentration between oral submucous fibrosis and healthy subjects was -86.23 U/ml (95% CI -145.30, -27.17). The serum SOD level was significantly reduced as the disease progressed to stage I or stage II (p < 0.001) compared to the control group. Conclusion: The studies showed significantly lower levels of superoxide dismutase in various human samples of patients with OSMF. Therefore, further studies are required to estimate antioxidant status using different biomarkers of oral submucous fibrosis concerning different stages of the disease in order to augment future therapy. Clinical relevance: Assessment of antioxidant activity helps to identify the patients at risk of malignant transformation. It serves as a reliable guide to validate therapy. It serves as a marker of prognosis in patients suffering from oral submucous fibrosis.

Assessment of the anti-oxidant reduced glutathione in oral squamous cell carcinoma - Systematic review and meta-analysis.

Background: The excess reactive oxygen species or free radicals reaction leads to oxidative injury to the biological components such as cells and tissues, which would result in the initiation and progression of carcinogenesis. The magnitude of oxidative damage depends primarily on the balance between free radicals (pro-oxidants) and antioxidant system activity. Aim: To assess antioxidant status by evaluating the reduced glutathione (GSH) levels in various biological samples of patients with oral squamous cell carcinoma (OSCC) using available literature. Materials and Methods: An electronic literature search was carried out in PubMed (MeSH), Science Direct, Scopus and Cross Reference by using specific keywords. Results: The systematic electronic search identified 704 articles. After studying the articles' titles and abstracts, 657 articles were excluded for the following reasons; duplicated articles, animal studies, studies of low quality and not relevant to the research question. The remaining 47 articles were selected for full-text assessment. After eliminating the articles that did not match the objectives, the present qualitative synthesis finally included 27 articles for evaluation. The ten studies, which showed coherent data, were included in quantitative analysis. The GSH levels in OSCC groups are significantly decreased (P < 0.001) in plasma and erythrocyte samples compared to healthy controls. Conclusion: The selected studies showed significantly lower levels of GSH in various biological samples of OSCC. Hence, future studies are required to validate the expression of GSH as a prognostic biomarker in oral cancer.

A Meta-analysis of Oral Squamous Cell Carcinoma in Young Adults with a Comparison to the Older Group Patients (2014-2019).

BACKGROUND: The oral squamous cell carcinoma (OSCC) often affects elderly aged adults, who had long-term tobacco exposure. In the recent past decade, there is an increasing incidence of OSCC in younger individuals, who had less tobacco association. AIM: The aim of this study is to examine the risk factors and to assess and compare the clinicopathological features and prognosis of OSCC in young patients with the older group patients. MATERIALS AND METHODS: We included studies that addressed the OSCC involving young patients during the period between 2014 and 2019. Initially, we found 679 articles; after refined evaluation, 92 works had their titles matching to the present work. After extraction of case reports, reviews, and studies with un-matched objectives or inadequate data, we have chosen only 24 presentations matching to the abstract. The statistical analysis performed by Chi-square tests using SPSS 20.0 version for windows. RESULTS: Of the total OSCC, 10% of patients belonged to the younger age group, and 90% were the older aged group. Both the groups showed male gender predominance and tongue as the predominant site of involvement. The younger patients tend to have significantly reduced tobacco exposure. The highly reported tumors were advanced staged and moderately differentiated tumors in both groups. There was a statistically evident high recurrence reported in the younger group. The overall survival seems to be similar for both groups. CONCLUSION: The identification of the potential risk factors, along with unique molecular mechanisms, and biological behavior of the disease is mandatory to control the incidence of OSCC in young adults.

Estimation and comparison of salivary flow rate and its composition in diabetic patients and nondiabetic patients: A pilot study.

BACKGROUND: Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia irregularities in the metabolism of carbohydrates, lipids and protein. It is often associated with the development of microvascular and macrovascular complications and neuropathies. The health of oral tissues is known to be related to the quality and quantity of saliva both of which may be altered in diabetes. AIM: The aim of the present study was to determine the salivary flow rate, electrolytes and total proteins in saliva of Type II diabetic patients. MATERIALS AND METHODS: A total number of 120 participants were included in this study, in which 80 patients were suffering from Type II DM (which included both controlled and uncontrolled diabetes) and 40 nondiabetic persons (controls). The study population included both the genders, with an age range of 40-70 years. The study population was divided into three groups. RESULTS: The values of total protein, sodium, potassium and salivary flow rate among controls, controlled diabetes and uncontrolled diabetes were collected, formulated and multiple comparisons between the groups using the analysis of variance and post hoc Tukey honestly significant difference analysis were done in version 16.0 of SPSS software. CONCLUSION: Studies with larger sample size are warranted to know the exact pathophysiology of controlled and uncontrolled Type II DM in terms of salivary flow rate, salivary electrolytes and total protein.

Coronavirus disease 2019 and its vaccines: An update.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by coronavirus. Most of the people infected with the COVID-19 virus will experience mild-to-moderate respiratory illness and recover without requiring special treatment. Older people and those with underlying medical problems are more likely to develop serious illness. In December 2019, a novel coronavirus designated as severe acute respiratory syndrome (SARS) coronavirus 2 emerged in the city of Wuhan, China, and caused an outbreak of unusual viral pneumonia. Being highly transmissible, this novel coronavirus disease, also known as COVID-19, has spread fast all over the world. It has overwhelmingly surpassed SARS and Middle East respiratory syndrome in terms of both the number of infected people and the epidemic areas. Currently, there is no definite treatment for COVID-19 although some drugs are under investigation. Infections caused by these viruses are an enormous global health threat. Hence, the government has established fast-tracking research to develop rapid diagnostic test kits and vaccines at low cost. This review highlights the vaccines available against COVID 19 worldwide and its implications.

A Meta-Analysis in Assessing Oxidative Stress Using Malondialdehyde in Oral Submucous Fibrosis.

OBJECTIVE: This study aimed to evaluate the oxidative stress (OS) marker Malondialdehyde (MDA) in oral submucous fibrosis with available literature. MATERIALS AND METHODS: We conducted a literature search electronically in PubMed (MeSH), Science Direct, Scopus, and Google Scholar using specific keywords. RESULTS: A systematic search in PubMed, Science Direct, and Google Scholar identified 334 articles. Of these, four were duplicate reports, and three were animal studies. After reading the abstracts of the collected articles, 288 articles were excluded for the following reasons: low quality, not relevant to the research question, or did not meet the inclusion criteria. The remaining 46 articles were chosen for full-text assessment. Finally, the present qualitative synthesis included 23 articles for evaluation. The selected studies in MDA analysis in a random-effects model showed higher heterogeneity (Q = 477.636, p < 0.001, I2 = 95.394%). The standard difference in mean MDA concentration between oral submucous fibrosis (OSMF) and healthy subjects was estimated as 2.73 nmol/mL (95% confidence interval: 2.08-3.38). CONCLUSION: The selected studies showed significantly higher MDA levels in various biological samples of patients with OSMF. Therefore, further studies are needed to estimate oxidative stress levels by using different biomarkers in OSMF to direct future therapy.

Cemento-Ossifying Fibroma of Upper Lip in a Female Child.

Cemento-ossifying fibroma (COF) is a benign tumor classified under fibro-osseous lesions characterized by the proliferation of fibrous tissue associated with the presence of osteoid or cementicle-like masses. COF of bony origin is highly neoplastic in nature compared to their soft tissue counterparts which are relatively rare. The authors here present a case report of COF arising from the left upper lip in a 10-year-old female patient. The lesion was initially asymptomatic, slow-growing in nature, and later turned painful over a period of eight months. A medical CT was taken to elicit a calcified mass seen at the left subcutaneous plane of the upper lip. The lesion was surgically treated by complete excision under local anaesthesia and sutured. Follow-up was done for a period of one year to assess for recurrence which was not evident in this case. This case report, being a peculiar case of COF arising from the soft tissue of the upper lip, describes the clinical presentation, diagnostic imaging, histopathological evidence, and brief surgical management of the lesion.

Efficacy of herbal alternatives in maintaining oral health in cancer patients: A systematic review.

Herbal rinses possess different medicinal properties. Numerous studies have reported the usefulness of various herbal oral rinses. Few studies claimed that herbal rinses are superior to synthetic mouth rinses for certain purposes, but there appears to be a lack of sound scientific evidence to prove the efficacy of herbal rinses in controlling oral plaque in cancer patients. This review analyses the various clinical studies on herbal rinses and aims to find the safety and efficacy of red ginseng mouth rinses over other available mouth rinses in carcinoma patients. A thorough electronic search was conducted in various databases and 10 articles were included in the review based on the inclusion and exclusion criteria. The data extracted were tabulated and analyzed. The risk of bias table was drawn. Meta-analysis was not performed due to the heterogeneity of the included studies. Of the 10 clinical trials included in the review, three studies appeared to have low risk of bias. The mean follow-up period was 14 days, ranging from 7 to 21 days. The sample size in each study was reported to be between 10 and 50, except one study with 240 samples. Seven studies have reported a significant difference between the herbal mouth rinse group and the chlorhexidine group. Of all the herbal rinses, mouth rinses with ginger extracts show more efficacy over other herbal rinses and red ginseng appears to be a more safer herbal rinse. Based on the available evidence, herbal mouth rinses are comparable to synthetic mouth rinses in their anti-bacterial properties. The red ginseng with anti-bacterial, anti-inflammatory and anti-cancerous properties may be an alternative mouth rinse in cancer patients. However, further clinical trials with more samples are required for better evidence.

Knowledge, attitude and practice of dental practitioners, interns and post-graduate trainees about COVID-19 pandemic in Chennai.

BACKGROUND: Coronavirus disease-2019 COVID-19) pandemic has been sweeping around the globe and the cases have been reported in India since the second week of March, with Chennai being one of the most affected cities. Healthcare professionals, particularly the dental personnel have a higher risk of infection due to close face-to-face contact and the risk of inhalation of aerosolised particles. AIM: The aim of this study was to assess the knowledge, attitude and practice about COVID-19 among interns, post-graduate trainees and dental practitioners. MATERIAL AND METHODS: A cross-sectional survey was conducted using Google forms among three groups: interns, post-graduate trainees and dental practitioners. Data obtained was analysed by Chi-square test, Kruskal-Wallis and post hoc test using SPSS IBM software. RESULTS: Of total score of 9 for knowledge-based questions, the score obtained by interns, post-graduate trainees and practitioners were 7.2, 7.2 and 7.5, respectively, with no statistically significant difference among the groups (P = 0.24). Of total score of 4 for attitude-based questions, the score obtained by interns, post-graduate trainees and practitioners were 1.6, 2.0, and 1.9, respectively, with statistically significant difference among the groups (0.009). Of total score of 7 for practice-based questions, the score obtained by interns, post-graduate trainees and practitioners were 3.2, 3.3, and 3.1, respectively, with no statistically significant difference among them (P = 0.63). CONCLUSION: Though the knowledge about COVID-19 appeared adequate, the attitude and practice component needs improvement. Continuing dental education programs and webinars can be conducted to update the dental professionals about the protocols to be followed during COVID-19 pandemic.

Evaluation and Expression of Survivin in Potentially Malignant Lesions and Squamous Cell Carcinoma: A Comparative Study.

Introduction Overexpression of survivin, an anti-apoptotic protein, has been associated with the progression of cancer, resistance to drugs, and a poor prognosis. The expression level of survivin indicates the progression of the disease, early recurrence, and a failure to respond to therapy. Our study was a retrospective analysis performed on archival specimens. Materials and methods The study included a total of 50 histopathologically proven cases of potentially malignant lesions and squamous cell carcinoma. Immunohistochemical staining was carried out using primary rabbit monoclonal antibodies to survivin (PathnSitu, Telangana, India) along with a horseradish peroxidase detection kit (Leica Biosystems, Maharashtra, India). The intensity of staining of survivin in the epithelium was determined, and the data obtained from potentially malignant lesions, oral squamous cell carcinoma, fetal tissue, and normal oral mucosa were compared. Results The expression of survivin was positive in 70% of the samples of oral squamous cell carcinoma followed by 50% from cases of leukoplakia, 20% of oral submucous fibrosis samples, and 10% of lichen planus samples (P < 0.05). Conclusion Malignant transformation of these potentially malignant lesions increases with increased expression of survivin. This expression of the anti-apoptotic protein might be an early phenomenon in the initiation and advancement of oral squamous cell carcinoma. The prognosis of oral squamous cell carcinomas becomes poorer with increased expression of survivin. Therefore, survivin might be helpful as an important therapeutic target because it is expressed more in tumor cells and absent in most adult tissues.

Rare histologic presentation of pleomorphic adenoma: A diagnostic dilemma.

Pleomorphic adenoma is the most common benign salivary gland tumor deriving its name from varied morphological patterns in histopathology. The presence of chondromyxoid stroma in histopathology is characteristic of pleomorphic adenoma. Cellular variants without characteristic chondromyxoid stroma are rare and often pose a diagnostic challenge. We report a case of pleomorphic adenoma involving minor salivary glands of the palate presenting with a predominantly cellular histopathology. Immunohistochemical workup was pivotal in the diagnosis of this challenging case.

Meta-analysis on risk factors of squamous cell carcinoma of the tongue in young adults.

Tongue squamous cell carcinoma (TSCC) generally affects the older age group exposed to tobacco for an extended period. However, recent research points out that there is an increased incidence of TSCC in the younger age group without any traditional risk factors making TSCC as a distinct biological entity in this group. This study aims to assess the prevalence and risk factors of tongue carcinoma in the younger group of patients. This article included studies that addressed the TSCC involving young patients and that which are PubMed indexed. Initially, 390 articles were considered; but after refined evaluation, 123 articles had their titles and abstracts matching to this present work. After the extraction of the case reports, review articles and the articles without the assessment of the parameter of harmful habits, we have included only 23 articles in the sample matching the title. The statistical analysis was formed by using chi-square tests using IBM SPSS ver. 20.0. The cohort of the younger population in these studies was mostly in the 35- to the 45-year age group. The majority of reports (64%) classified the patients below 40 years of age as a young group. Though male predominance is reported to be 55%, female patients are also more affected (40%) in the younger age group compared with, the more typical and usual group of head and neck carcinoma patients. TSCC in older adults predominantly reported in tobacco users (70%) whereas in young adults, TSCC was associated with a higher incidence in nonsmokers (53%); the causes of these cancers in young adults remain unclear. The identification of the potential risk factors aside from traditional factors is vital to control the incidence of TSCC in young patients.

Cheiloscopy and dermatoglyphics as screening tools for type 2 diabetes mellitus.

AIM: The aim of this study is to evaluate the efficacy of cheiloscopy (the study of lip prints) and dermatoglyphics (the study of fingerprints) in screening diabetic patients. MATERIALS AND METHODS: The study sample comprised 100 individuals in the age group of 17-60 years, of which fifty were diabetics and fifty controls who reported to the Department of Oral Medicine, Thai Moogambigai Dental College and Hospital. Lip prints were collected and categorized based on the Suzuki and Tsuchihashi system. Fingerprint patterns were obtained and classified according to the Henry's system of classification. RESULTS: Type II and IV lip print patterns were predominant in diabetic patients and Type I lip print patterns in controls. The difference was statistically significant. There was no significant difference in fingerprint patterns between the study groups. Gender-wise analysis for lip print and fingerprint patterns did not yield significant results. CONCLUSION: Cheiloscopy is a potential screening tool for type 2 diabetes mellitus. Dermatoglyphics cannot be used as a screening tool in type 2 diabetes mellitus.

Fusion of maxillary central incisors with mesiodens.

Fusion and gemination are developmental anomalies which are quite similar to each other but can be distinguished from each other if properly assessed. Fusion and gemination have been described as a result of developmental anomalies of dental tissues. The exact etiology is still unknown, but a genetic predisposition is suggested. This article highlights the importance of clinical and radiographic correlation in arriving at a definitive diagnosis.

Dental anxiety and influencing factors: A cross-sectional questionnaire-based survey.

BACKGROUND: Dental treatment still remains as one of the most anxious visits despite awareness between dentists and patients in building trusting relationships. The fear of dental treatment determines the frequency of treatment availed with long-term implications in oral health maintenance. AIM: This study aims to estimate prevalence, extent, and factors influencing dental anxiety in a sample of the adult population visiting a private dental hospital in Chennai, India. MATERIALS AND METHODS: The study sample included 300 consecutive outpatients visiting a private dental hospital in Chennai. Any patient aged 18 and above was considered for the study. A structured custom-made questionnaire composed of ten questions was designed to assess the anxiety levels of dental patients. The level of the patient's anxiety was assessed taking into account various factors that could influence their mental state. This included their age, gender, educational qualification, number/frequency of their dental visits, reason for their visit, past dental experiences, and nature of the dental procedure planned. Enquiries about the related time of anxiety manifestations as well as their preferred anxiety reducing protocols were done as part of the study. STATISTICS: The data analysis was performed using SPSS Version 11.5. Analysis initially was performed with Chi-square test for frequency and reason of visit, with the independent samples t-test used for assessing mean score differences along with Pearson's correlation coefficient. RESULTS: The study revealed that dental anxiety has a wide prevalence rate encompassing both genders. Distinctive predominance among females (65.2%) and professionals (66.9%) exhibiting a greater degree of anxiety was identified. Pain and extraction have been cited as duress and anxiety inciting procedures (72.6%). CONCLUSION: This survey has revealed that age, gender, level of education, and procedure along with visit frequency has a direct effect on the patient's state of mind and anxiety.

Comparison of the efficacy of herbal mouth rinse with commercially available mouth rinses: A clinical trial.

AIM: The aim of the study was to compare the efficacy of an herbal mouthwash containing red ginseng extract with different brands of commercially available chemical mouthwashes. OBJECTIVE: The objective of the study was to evaluate the effectiveness of herbal mouthwash (Dr. Dental care liquid) in reducing the oral bacterial count and compare it with the efficacy of commercially available mouthwashes such as Rexidine, Listerine and Colgate Plax. MATERIALS AND METHODS: The study includes sixty normal individuals (aged 18-24 years) who were divided into four groups of 15 individuals each. The participants of each group were given four different mouthwashes (Dr. Dental Care liquid, Colgate Plax, Listerine and Rexidine) and asked to use it twice daily for 5 days. Saliva samples were collected before the use of mouthwash and also after 5 days of using the mouthwashes. Culture and microscopic examination of salivary samples was done, and oral bacterial load present in the saliva samples was counted before and after the mouth rinse use. RESULTS: The results were compared using Wilcoxon sign-rank test. Among the four mouthwashes, the herbal mouthwash, Dr. Dental care liquid exhibited maximum efficacy in reducing the amount of bacteria followed by Colgate Plax, Listerine and Rexidine. CONCLUSION: The herbal mouthwash, Dr. Dental care liquid, contains red ginseng extract, a herb with immense medicinal values. In this study, the herbal mouth rinse exhibited increased antibacterial action compared with other commercially available chemical mouth rinses. Hence, we conclude that the ginseng-containing herbal mouthwash can be considered as a safe and effective oral hygiene aid.