Differences among oral carcinomas arising de novo from those associated with oral potentially malignant disorders: a systematic review and meta-analysis.

OBJECTIVE: To analyze the frequency of sequential oral squamous cell carcinomas (s-OSCC), preceded by oral potentially malignant disorders, and OSCC de novo (OSCC-dn) and explore differences in their clinicopathologic presentations. STUDY DESIGN: A structured electronic search strategy identified studies that analyzed frequency, clinical, biological, demographic, biomarkers, and prognostic features of s-OSCC and OSCC-dn according to PRISMA guidelines in PubMed, Scopus, Cochrane Library, and Google Scholar, up to January 31, 2023. Inclusion criteria were original English, Spanish, Portuguese, French, Italian, and German cross-sectional, cohort, and case-control studies. The quality of studies was assessed using the Agency for Research and Health Quality tool and the Newcastle-Ottawa Scale tool. RESULTS: The final selection included 40 studies. OSCC-dn and s-OSCC represent, respectively, 71% and 29% of cases of OSCC (P = .00), showing a higher percentage of T1 or of T1+T2 in s-OSCC (P < .0001). The association meta-analysis showed OSCC-dn with a significant association. The meta-analysis showed that s-OSCC was significantly associated with smaller tumor size, absence of distant metastases, relapses, male sex, and tumor sites different from tongue; and OSCC-dn was associated with more advanced tumor size, more regional and distant metastases, more advanced stages, and worse survival. CONCLUSIONS: S-OSCC was less frequent than expected. OSCC-dn seems to have specific clinical, biological, and prognostic features. Future perspectives on oral cancer prevention should address novel approaches and alternatives to screening, such as urgent referral of OSCC-dn.

Manifestaciones gingivales de sífilis secundaria: serie de casos / Gingival manifestations of secondary syphilis: case series

Objetivo: La sífilis es una enfermedad de transmisión sexual con una incidencia creciente a nivel mundial. En la sí- filis secundaria, las lesiones orales son frecuentes, siendo a veces la única manifestación. El objetivo de este artículo es presentar una serie de casos clínicos de sífilis con localización predominante o exclusivamente gingival, destacando las ca- racterísticas clínicas más relevantes para su diagnóstico. Casos clínicos: Esta serie de casos clínicos incluyó nueve casos de sífilis secundaria con manifestaciones gingi- vales. El diagnóstico se realizó mediante pruebas serológicas (VDRL, TPPA, FTA-ABS y MHA-TP), y se describieron le- siones tanto gingivales como extragingivales. En la encía se observó sífilis secundaria afectando principalmente la región anterior ­tanto superior como inferior­, presentándose pla- cas rojas o blancas. Algunos casos también presentaban le- siones en otros sitios intraorales, tenían síntomas como dolor o sensación de ardor, o presentaban enfermedad periodontal dependiente de placa. El diagnóstico diferencial de sífilis se- cundaria gingival con condiciones periodontales inespecíficas es fundamental para un diagnóstico adecuado. Por lo tanto, se debe considerar el diagnóstico de sífilis secundaria cuando se enfrentan casos gíngivo-periodontales atípicos en la práctica diaria (AU)

Aim: Syphilis is a sexually transmitted disease with growing incidence worldwide. In secondary syphilis, oral le- sions are common, sometimes being the only manifestation. Gingival features of syphilis are rare and usually present mul- tiple oral lesions. The aim of this article is to present a series of clinical cases of syphilis with predominantly or exclusively gingival localization, highlighting the most relevant clinical characteristics for its diagnosis. Clinical cases: This clinical case series included nine cases of secondary syphilis with gingival manifestations. The diagnosis was made using serological tests (VDRL, TPPA, FTA-ABS, and MHA-TP), and both gingival and extragingi- val lesions were described. Secondary syphilis was observed in the gum, mainly affecting the anterior region ­both up- per and lower­, depicting red or white plaques. Some cases also presented lesions in other intraoral sites, had symptoms such as pain or burning sensation, or showed plaque induced periodontal disease. The differential diagnosis of second- ary syphilis considering non-specific periodontal conditions with gingival involvement is essential for a proper diagnosis. Thus, the diagnosis of secondary syphilis should be consid- ered when dealing with atypical gingivo-periodontal cases in everyday practice (AU)

Oral squamous cell carcinomas and oral potentially malignant disorders: A Latin American study.

OBJECTIVE: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. METHODS: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square. RESULTS: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. CONCLUSIONS: In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.

Oral squamous cell carcinoma arising from chronic traumatic ulcers.

BACKGROUND: A proportion of oral squamous cell carcinoma (OSCC) is preceded by oral potentially malignant disorders (OPMD), and the rest might not be associated with any well-established OPMD. Chronic traumatic ulcer (CTU) has been suggested as a lesion with potential for malignant transformation, but the evidence is inconclusive. OBJECTIVE: The aim of this study was to describe clinicopathological features of non-healing CTU (NHCTU) that later developed to OSCC. MATERIALS AND METHODS: A retrospective cohort study was performed of patients attending the Facultad de Odontología Universidad Nacional de Córdoba (2013-2019). The study included patients with a provisional diagnosis of CTU. CTUs without complete healing after removal of traumatic factors-non healing CTU (NHCTU)-were investigated by biopsy. A detailed description of cases where a malignancy was diagnosed is presented. RESULTS: A total of 107 CTU were included. Of these, 32 CTUs were considered NHCTU and two cases showed histological features of OSCC in the background of NHCTU. In both cases, lesions were found on the lateral tongue. Both were non smoking, non alcohol drinking individuals. Absence of any well-known OPMD was also registered. CONCLUSIONS: The possibility of malignant transformation in a subset of tongue NHCTU should not be underestimated. CLINICAL RELEVANCE: In a subgroup of patients, NHCTU could be considered an OPMD. Although the potential malignant transformation rate is low, these conditions should be always followed up.

Chronic mechanical irritation enhances the effect of tobacco and alcohol on the risk of oral squamous cell carcinoma: a case-control study in Argentina.

OBJECTIVES: Oral squamous cell carcinoma (OSCC) is a multifactorial disease. The individual effect of each risk factor for OSCC may be conditioned by the frequency of other factors. The objective of this study was to identify the association between chronic mechanical irritation (CMI) and OSCC and to analyse the influence of CMI on other important risk factors for OSCC. MATERIALS AND METHODS: A prospective and age/sex-matched case-control study was performed in two institutions from Argentina between 2009 and 2019, with consecutive and newly diagnosed OSCC. The frequencies of tobacco, alcohol, and CMI were analysed using conditional logistic regression. Cumulative tobacco consumption and the presence of CMI were analysed using the Mann-Whitney test. RESULTS: CMI and OSCC were associated with an OR of 7.02 (95% CI 3.57-13.78, p < 0.001). The combination of CMI and alcohol demonstrated the highest risk of OSCC (OR 53.83, CI 95% 8.04-360, p < 0.0001), followed by the combination of CMI, tobacco, and alcohol (OR 48.06, CI 95% 8.47-272, p < 0.0001). The combination of CMI and tobacco was also significant (OR 5.61, CI 95% 1.07-29.54, p = 0.042). Patients with CMI developed OSCC with less cumulative tobacco use compared with those without CMI. CONCLUSION: CMI is an independent risk factor for OSCC, and it could act as a risk modifier among tobacco and alcohol users having an enhancing effect. CLINICAL RELEVANCE: Elimination of CMI could decrease the risk of OSCC.

Effect of the accumulation of risk factors on the risk of oral squamous cell carcinoma / [Efecto de la acumulación de factores de riesgo en el riesgo de carcinoma de células escamosas bucal]

Introduction: the causative factors of oral squamous cell carcinoma are not necessary and not sufficient causes, even the most accepted ones, such as tobacco and alcohol. Little is known about the cumulative effect of all risk factors for oral cancer. The objective of this work was to analyze whether the sum of oral cancer risk factors is associated with an increase in its risk. Methods: a case-control study was carried out to determine the risk factors for oral cancer in the population under study, and then correlate the number of risk factors in each individual with the risk of oral cancer. Results: the accumulation of oral cancer risk factors, analyzed using different strategies, was always associated with a significant increase in the risk of oral cancer. Having 3 or more risk factors was associated with an increased risk of oral cancer (OR 110, p <0.0001) Conclusion: the main risk factor for oral cancer is the accumulation of its risk factors. The accumulation of risk factors could be considered a necessary cause for the development of oral cancer.

Introducción: los factores causales de carcinoma de células escamosas bucal son causas no necesarias y no suficientes, incluso los más aceptados, como tabaco y alcohol. Poco se conoce sobre el efecto acumulativo de todos los factores de riesgo de cáncer bucal. El objetivo de este trabajo fue analizar si la sumatoria de factores de riesgo de cáncer bucal se asocia con un aumento de su riesgo. Métodos: se realizó un estudio de casos y controles para determinar los factores de riesgo de cáncer bucal en la población bajo estudio, para luego correlacionar el número de factores de riesgo en cada individuo, con el riesgo de cáncer bucal. Resultados: la acumulación de factores de riesgo de cáncer bucal, analizada mediante diferentes estrategias, estuvo siempre asociada con un aumento significativo del riesgo de cáncer bucal. Tener 3 o más factores de riesgo estuvo asociado con mayor riesgo de cáncer bucal (OR 110, p<0,0001) Conclusión: el principal factor de riesgo de cáncer bucal es la acumulación de sus factores de riesgo. La acumulación de factores de riesgo podría considerarse una causa necesaria para el desarrollo de cáncer bucal.

Tinción con azul de toluidina en biopsia dirigida de lesiones displásicas de la mucosa bucal: informe de casos clínicos / Toluidine blue guided biopsy of dysplastic lesions of the oral mucosa: clinical cases report

Objetivo: Los desórdenes de mucosa bucal potencialmente malignos pueden presentar áreas displásicas. En estos casos, la biopsia es un procedimiento imprescindible para un correcto diagnóstico. La inspección visual y la palpación, como método de selección del área de biopsia, ofrecen sensibilidad y especificidad adecuadas pero mejorables. El objetivo de este artículo es presentar una serie de casos clínicos en los que se describen el empleo y la interpretación de la tinción vital con azul de toluidina como método complementario para contribuir a una mejor elección del área de biopsia. Casos clínicos: Se trata de siete casos de lesiones con sospecha de displasia epitelial en mucosa bucal. En cada uno se detalla la correlación de las áreas teñidas con las manifestaciones clínicas y con el diagnóstico de displasia. Además, se muestran patrones de tinción considerados falsos positivos. En la interpretación de la tinción positiva, se tuvieron en cuenta el aspecto superficial y el color de la lesión teñida. El empleo combinado de inspección, palpación y tinción vital podría constituir un procedimiento integral de utilidad para obtener mayor precisión en la determinación del sitio de biopsia en comparación con los mismos procedimientos aplicados de manera individual. En la interpretación de la tinción positiva con azul de toluidina deberían considerarse el aspecto superficial y el color de la lesión teñida (AU)

Aim: Potentially Malignant Disorders in the oral cavity can present dysplastic areas. In these cases, the biopsy is an essential procedure for a correct diagnosis. Visual inspection and palpation, are adequate methods to select the area for the biopsy, however there is margin for improvement. The objective of this article is to present a series of clinical cases in which the use and interpretation of vital staining with Toluidine Blue is described as a complementary method to contribute to a better choice of the biopsy area. Clinical cases: Seven clinical cases that presented lesions with suspected epithelial dysplasia in the oral mucosa were presented. The correlation of the stained areas with the clinical manifestations and with the diagnosis of dysplasia is detailed in each case. Staining patterns considered false positives are also shown. In the interpretation of the positive staining, the superficial appearance and color of the stained lesion were considered. The combined use of inspection, palpation and vital staining could constitute a useful comprehensive procedure to obtain greater precision in determining the biopsy site in relation to the same procedures applied individually. In the interpretation of the positive staining with Toluidine Blue, the superficial appearance and color of the stained lesion should be considered (AU)

Oral cancer associated with chronic mechanical irritation of the oral mucosa

Background: Most of the studies dealing with Chronic Mechanical Irritation (CMI) and Oral Cancer (OC) only considered prosthetic and dental variables separately, and CMI functional factors are not registered. Thus, the aim of this study was to assess OC risk in individuals with dental, prosthetic and functional CMI. Also, we examined CMI presence in relation to tumor size. Material and methods: a case-control study was carried out from 2009 to 2013. Study group were squamous cell carcinoma cases; control group was patients seeking dental treatment in the same institution. Results: 153 patients were studied (Study group n=53, Control group n=100). CMI reproducibility displayed a correlation coefficient of 1 (p< 0.0001). Bivariate analysis showed statistically significant associations for all variables (age, gender, tobacco and alcohol consumption and CMI). Multivariate analysis exhibited statistical significance for age, alcohol, and CMI, but not for gender or tobacco. Relationship of CMI with tumor size showed no statistically significant differences. Conclusions: CMI could be regarded as a risk factor for oral cancer. In individuals with other OC risk factors, proper treatment of the mechanical injuring factors (dental, prosthetic and functional) could be an important measure to reduce the risk of oral cancer (AU)

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Oral mucosal lesions in Anorexia Nervosa, Bulimia Nervosa and EDNOS.

OBJECTIVES: The aim of this study is to describe oral lesions in patients with eating disorders (ED), including Anorexia Nervosa (AN), Bulimia Nervosa (BN) and eating disorders not otherwise specified (EDNOS). MATERIAL AND METHODS: A prospective case-control study was carried out from April 2003 to May 2004. Inclusion criteria for the study group were individuals with a diagnosis of ED; age and sex-matched individuals without ED were included as controls. Clinical data regarding ED, medical complications and oral examination were performed by previously calibrated professionals. RESULTS: Study group (n = 65) presented 46 cases of BN (71%), 13 of EDNOS (20%) and 6 of AN (9%); also, 94% (n = 61) showed oral lesions. The most common were: labial erythema, exfoliative cheilitis, orange-yellow palate, hemorrhagic lesions, lip-cheek biting and non-specific oral atrophies. Only two patients of the study group had dental erosions, and no case of major salivary gland swelling was found. CONCLUSIONS: ED display a wide array of oral mucosal lesions that can be regarded as their early manifestations. The dentist could be the first professional to detect symptoms of eating disorders, potentially improving early detection and treatment of ED.

Characterization of Chronic Mechanical Irritation in Oral Cancer.

Objective. Oral mucosa could host many lesions originated by chronic mechanical irritation (CMI) from teeth or dentures, and it has been proposed as risk factor for oral cancer. Nevertheless, the features of CMI factors in oral cancer and other lesions are not assessed. The aim of this study is to describe CMI features regarding type (dental, prosthetic, and/or functional), localization, and time span. Materials and Methods. Three groups were studied in this cross-sectional study: Oral Cancer (OC); Chronic Traumatic Ulcer (CTU); and Benign Irritative Mechanical Lesions (BIML). All sources of mechanical irritation were included: dental, prosthetic, and functional. Results. 285 patients (176 females, 109 males) were studied: OC = 38, CTU = 44, and BIML = 203. The most frequent CMI factor was dental, followed by functional and prosthetic in all groups; 76.5% (n = 218) presented functional factors. Buccal mucosa (45%) and tongue (42%) were the most affected sites. Time of action of CMI displayed statistically significant differences between BIML, CTU, and OC groups, with a mean of 21, 33, and 49 months, respectively. Conclusions. CMI should be properly recorded with as much detail as alcohol and tobacco consumption. CMI associated lesions are produced by dental or prosthetic factors, usually in relation to functional factors, involving mainly tongue and buccal mucosa.

Oral varix: a review.

BACKGROUND: Ageing produces several changes on the oral cavity, and oral varix (OV) is among the most common, and they are related with some medical diseases; however, this association is not clear. OBJECTIVE: The aim of this article is to offer a review of OV, regarding aetiology, clinical and histological features, associated factors, treatment and its clinical significance. CONCLUSION: Except for a higher incidence of OV in elder individuals, there is limited evidence that supports its relationship with medical conditions such us cardiovascular diseases or portal hypertension. Also, there is no consensus regarding its pathogenesis, but the hemodynamic theory embodies the most comprehensive approach. The high prevalence in elderly people stresses the need for regular oral examination, but more detailed studies regarding OV in relation to systemic diseases are needed.

Characterization of maxillary central incisor: novel crown-root relationships.

OBJECTIVES: The periodontal biotype includes crown features of the maxillary central incisor (MCI), whereas root measures have been less studied. The aim of our study was to morphologically characterize MCI and search relationships between crown and root measures. MATERIAL AND METHODS: One hundred-fifty MCIs were used. On each tooth, several crown and root reference points were marked and the following measures were done: On crown: mesio-distal (MD = major, md = minor), axial (crown length, cervical convexity) and buccolingual diameters (Cbl); On root: mesio-distal (Rmd) and buccolingual diameters (Rbl); and tooth length. A ratio between md and MD was made in order to assess dental forms. Root diameter prediction was assessed by means of multiple and single linear regression analyses, with variable selection by backward method. Reliability of measurements was estimated by the Pearson correlation coefficient. RESULTS: Dental form groups were: Stout type 56.67 %, Intermediate type 22.67 %, and Strangled type 20.67 %. A significative association was found between Rbl and Cbl (p = 0,000), Rmd with md (p = 0.000), and Rmd with MD (p = 0.000). The results allow predicting root diameters through crown measures. CONCLUSIONS: There is a direct relationship between crown and root features, which allows the prediction of root diameters with a high accuracy (95 %), regardless of tooth form. CLINICAL RELEVANCE: The morphometric data assess tooth diameters more accurately and could improve treatment planning, offering a more comprehensive approach to the periodontal biotype concept.

Assessment of maxillary central incisor crown form.

Incisor crown form is thought to be associated with different periodontal features, and it is hypothesized that there are measures of the maxillary central incisor that can be used to characterize its form. The aim of this study was to assess maxillary central incisor crown dimensions to determine morphologic groups. One-hundred fifty sound maxillary central incisors without excessive evidence of incisal wear were utilized. On each crown, several reference points were marked and mesiodistal and axial diameters were measured using a digital caliper. A ratio between the minor and major mesiodistal diameters was determined to assess dental forms. Maxillary central incisor form was categorized into three groups based on the upper limits of three intervals as cutoff points. The measurements were performed in a double blind fashion. The reliability of measurements was estimated by the Pearson correlation coefficient for each tooth, setting a value > 0.8. The percentage of maxillary central incisors in each group was 56.67% for group 1 (stout), 22.67% for group 2 (intermediate), and 20.66% for group 3 (strangled). The results suggest that maxillary central incisor morphology can be properly assessed through quantifiable methods. The minor/major mesiodistal ratio is simple, quantitative, and easily reproduced. It is a quantifiable definition of dental forms based on characteristics that are not modified by the position of the gingival margin or incisal wear. Hence, the grade of cervical convergence could help clinicians assess tooth shape before performing restorative, orthodontic, or surgical treatments.

Relationship between chronic trauma of the oral mucosa, oral potentially malignant disorders and oral cancer.

BACKGROUND: Oral cancer represents 2%-5% of all cancers, being one of the 10 most frequent ones. Apart from oral cancer risk factors already described in literature, such as tobacco and alcohol consumption, others emerging risk factors have been proposed, such as chronic irritation from dental factors. The aim of this work was to assess the influence of chronic trauma of the oral mucosa (CTOM) in patients with oral potentially malignant disorders (OPMD) and cancer. METHODS: A retrospective study of 406 patients (both sexes; aged between 18 and 80 years; with OPMD and cancer) who attended the Department of Clinical Stomatology A of the National University of Cordoba was performed by non-probabilistic sampling. The association of variables and outcome variable diagnosis, with levels control, OPMD, oral cancer, was evaluated by multinomial regression model. RESULTS: Population under study was represented by 72% of control patients, 16% patients with OPMD and 11% of patients with oral cancer. It was observed a significant association between diagnosis and CTOM (P = 0.000), after adjustment of confounding factors (smoking and drinking habits, sex, cancer inheritance and denture use). CONCLUSIONS: Our results suggest that CTOM is, together with other factors, an important risk factor in patients with oral cancer diagnosis, but not for patients with OPMD.

Lesiones estomatológicas asociadas a terapia oncológica / Stomatological lesions associated with oncologic therapy

El propósito de este estudio fue analizar la prevalencia de efectos adversos bucales de la terapia oncológica (radioterapia más cirugía o quimioterapia) en pacientes con CCC. Se estudiaron 14 pacientes con CCC que recibieron como terapéutica alguna de las modalidades citadas. Los resultados mostraron que las lesiones más frecuentes fueron: hipo/disgeusia, 14 casos (100 por ciento); mucositis, 13 casos (92,8 por ciento) y xerostomía, 10 casos (76,9 por ciento). Concluimos que la terapia oncológica combinada siempre se acompaña de daños tisulares clínicamente observables, que deben ser tratados apropiadamente con el objeto de mejorar la calidad de vida de los pacientes con CCC sometidos a terapia oncológica (AU)