Chemopreventive Agents in Oral Premalignancy: A Medical Management Review.

AIMS AND OBJECTIVE: The term chemoprevention denotes the use of specific natural or synthetic chemical agents to prevent carcinogenesis. Chemoprevention may help delay the process of carcinogen activation and prevent the conversion of preneoplastic cells. These agents play an active role in the secondary level of prevention and reduce malignancy-associated morbidity and mortality. A new term, "prophylactic antioxidant therapy," was coined and proposed. This review has assessed all major chemopreventive agents used for oral premalignancy and malignant conditions, which will reduce the economic burden on the patients. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, Medline, Embase, Cochrane Library, and EBSCO search, with language restriction to English. The search incorporated published literature from 1990 to 2018 using the medical subject heading terms. Literature search was performed using the following keywords: Chemoprevention, Premalignancy, and Oral Malignancy. RESULTS: Of 99 publications related to the search strategy, 45 full articles relevant to the chemopreventive agents in premalignacy and oral malignancy were acquired for further inspection. Of the 45 articles, 30 met the inclusion criteria. Data were collected, and a brief summary of the studies regarding different chemopreventive agents that were most commonly used in oral premalignancy and malignancies was written. CONCLUSION: This review suggests administration of major chemopreventive agents for superior prognosis in individuals with an elevated risk of premalignancy and malignancy.

A Comparative Evaluation on the Effect of Oral Zinc 50 mg with or without 0.1% Triamcinolone Orabase on Oral Lichen Planus.

BACKGROUND: Lichen planus is a T-cell-mediated autoimmune disease, in which CD8+ T-cells releases the cytokines such as tumor necrosis factor-alpha and interleukin-12 disrupting basement membrane integrity. Treatment modalities were directed toward the relief in signs and symptoms and preventing recurrences. Zinc activates caspase-3 and DNA fragmentation, resulting in the apoptosis of keratinocytes. Prevention of matrix metalloproteinases1 (MMP1) activation, inhibits the Tcell accumulation in oral lichen planus (OLP) and by inhibiting MMP9, prevents the cleavage of collagen resulting in maintaining the integrity of the basement membrane. OBJECTIVES: The main objective of the study is to compare the efficacy of oral zinc 50 mg and 0.1% triamcinolone Orabase with 0.1% triamcinolone Orabase alone on the healing process of symptomatic OLP. MATERIALS AND METHODS: A total of forty participants were randomly categorized into two groups: Group A and Group B with 20 patients with OLP and having symptoms of burning sensation. Group A patients had received 0.1% triamcinolone Orabase twice daily application. Group B patients had provided with oral zinc 50 mg and 0.1% triamcinolone Orabase twice daily for 8 weeks. The follow-up period for both the groups was 6 months. Lesional size was measured by Thongprasom scale and burning sensation was assessed by visual analog scale at each visit till the cessation of treatment. RESULTS: There was decrease in the burning sensation and lesional size from the first visit to follow-up period which was statistically significant in both groups (P = 0.000). CONCLUSION: Oral zinc therapy was adjunctive in reducing the burning sensation and lesional size in the symptomatic OLP.

A Meta-Analysis on the Efficacy of Zinc in Oral Mucositis during Cancer Chemo and/or Radiotherapy-An Evidence-Based Approach.

Zinc in various therapeutic doses was used on patients suffering from oral mucositis during cancer treatment. A meta-analysis was conducted to probe the role of oral zinc as a possible treatment option for oral mucositis. A literature search was done using PubMed, EBSCO, Cochrane, MedLine, ScienceDirect, ResearchGate and Google Scholar with key words. The analysis was directed to recognize and identify the use of zinc supplementations at a confidence interval (CI) 95% with p value significance taken as <0.05. A total number of 21,428 articles was retrieved. After thorough screening and assessment of the eligibility criteria, 10 articles were included in qualitative and quantitative analysis in the study. The 10 articles constituted a total sample size of 299 in the case group and 294 in the control group. Oral zinc doses used were 25 mg, 30 mg, 50 mg and 220 mg capsules and mouthwash of 0.2% zinc, as well as 0.5 g of granules dissolved in 5% sodium alginate solution. Two studies showed no significance, with the overall effect 1.61. Eight studies favored zinc over a placebo with an overall effect size of -0.89 at 95% CI of -1.08 and -0.70 which was statistically significant (Z=9.27, p<0.00001). This analysis suggests that zinc usage has shown significant reduction in the severity of oral mucositis but not prevention. The onset of the reaction was delayed and hastened healing. Pharyngeal mucositis, pain and quality of life of the individuals received no effect from zinc therapy.

A New Intraoral Appliance for Trismus in Oral Submucous Fibrosis.

Trismus is the most common sequelae of various pathological processes leading to compromised nutritional state in addition to physical and psychological disabilities. Therapeutic interventions are available to relieve trismus, which range from oral usage of pharmacological agents to intralesional steroid therapy. Intraoral appliance therapy can be employed as an alternative or adjuvant treatment for radiotherapy-induced fibrosis and autoimmune disorders such as scleroderma, psychogenic trismus, and oral submucous fibrosis, decreasing the adverse effects associated with other pharmacological interventions. A novel intraoral appliance-"Nallan C-H"-has been developed and tried for trismus producing better results. A report on three such cases having trismus due to a premalignancy has been presented. It is hypothesized that the same appliance can be used for treating inoperable trismus in palliative care setting additionally or as an adjuvant to pharmacological approach.