Kamran H Awan

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer globally; however, the incidence is much higher in the developing countries, including Pakistan, India, and Sri Lanka. 1 Despite a decreasing incidence of HNSCC in general, attributed to a decrease in the prevalence of smoking, 2 the incidence of oropharyngeal squamous cell carcinoma is rising. 3,4 Human papillomavirus (HPV) has for some time been suggested to be involved in the carcinogenesis of oropharyngeal cancer. The HPV is a small, circular double-stranded DNA virus that was first identified in 1949. 5 Up till now, over 100 different HPV types have been identified. The HPV subtypes are divided into high-risk and low-risk HPV based on their malignant potential. Approximately, 15 high-risk subtypes are known but only HPV subtypes 16, 18, 31, 33, and 35 have been identified playing a role in the development of oropharyngeal head and neck cancer. The HPV 16 is the most common type detected in oropharyngeal cancer accounting for 90 to 95% of the HPV-positive tumors. 6 The International Agency for Research on Cancer (IARC) now recognizes HPV as a risk factor for oropharyngeal cancer, and accumulating molecular and epidemiological data now show that high-risk types of HPV are responsible for a subset of oropharyngeal cancer. 7 Majority of the HPV-positive oropharyngeal cancers lack association with the traditional risk factors, such as tobacco and alcohol. 8 Alike HPV-associated cervical cancers, HPV-positive oropharyngeal cancers are also sexually transmitted. It is assumed that HPV infection precedes the development of HPV-positive head and neck cancers, and the presence of high-risk HPV infection on the oral mucosa and seropositivity increases the risk of development of head and neck cancers. 9 Therefore, risk

BACKGROUND: Oral cancer is a serious global issue and early diagnosis of oral cancer is the key in reducing the high mortality rate. Autofluorescence properties of oral mucosa have been gaining interest in the field of early diagnosis of oral premalignant lesions.OBJECTIVE: The aim of the study was to evaluate the clinical usefulness of an autofluorescence based imaging system to detect oral premalignant and malignant lesions.MATERIALS AND METHODS: A systematic review of the English-language literature to evaluate the effectiveness of visually enhanced lesion scope (VELscope) published between 1966 and March, 2014 was undertaken. Data relating to study design, sampling and characteristics of the study group, interventions, and reported outcomes and diagnostic value of VELscope were abstracted from articles meeting inclusion and exclusion criteria.RESULTS: Eleven articles that met the inclusion criteria were included. In nine studies, all the lesions underwent histological assessment, whereas the remaining four studies only performed histological assessment on suspicious lesions. Visually enhanced lesion scope showed high sensitivity values in detecting oral premalignant and malignant lesions. However, most of the studies reported it inability in discriminating dysplasia cases from nondysplasia cases.CONCLUSION: There is insufficient evidence to support the use of VELscope in primary care setting, however, they may be useful in hands of a specialist.

OBJECTIVES: Early detection of oral cancer and their precursors is the key to reducing the high mortality rate attributable to oral cancer. A variety of new chair-side diagnostic tools are currently available that may enhance oral mucosal examination and facilitate the detection of benign and malignant disorders. The aim of this study was to investigate the accuracy of autofluorescence, chemiluminescence and toluidine blue (TBlue) when used in combination against conventional oral examination and surgical biopsy for the detection and assessing risk status of oral potentially malignant disorders.MATERIALS AND METHODS: A total of 126 patients, with white, red and mixed white and red patches were included. Following a comprehensive oral examination, all patients underwent a standard protocol of autofluorescence, chemiluminescence and TBlue examination. A surgical biopsy was performed to assess oral epithelial dysplasia.RESULTS: Seventy patients had leukoplakia/erythroplakia and 44 had epithelial dysplasia. In relation to leukoplakia/erythroplakia, autofluorescence, chemiluminescence and TBlue showed a sensitivity of 87.1, 77.1 and 52.9 % and a specificity of 21.4, 26.8 and 67.9 %, respectively. For dysplasia cases, autofluorescence, chemiluminescence and TBlue showed sensitivity and specificity of 84.1, 77.3 and 56.8 % and 15.3, 27.8 and 65.8 %, respectively.CONCLUSION: While all the three tests were useful in detecting oral mucosal changes, their accuracy in identifying oral potentially malignant disorders (OPMD) is questionable. However, in combination, the tests yielded better results, with improved specificity.CLINICAL RELEVANCE: These research tools are helpful in specialist clinics but further studies are necessary to examine their role in screening in primary care settings.

The aim of this study was to evaluate the prevalence and severity of temporomandibular disorders (TMDs) among male university students in Riyadh, Saudi Arabia. The role of relevant medical and dental histories in the assessment of TMD in this Arab population was also addressed. Required information was collected via a questionnaire. The first part of the questionnaire was used to obtain the medical and dental histories of participants. The second part included 10 questions regarding common TMD symptoms. Fonseca's anamnestic index (FAI) was used to classify TMD severity as "no dysfunction", "light dysfunction", "moderate dysfunction", or "severe dysfunction". Of the 600 distributed questionnaires, 400 questionnaires were completed (response rate: 66.6%). Mean age of eligible participants was 21.90 ± 1.79 years. Psychological stress (30.5%) and direct restorations (77%) were the most commonly reported items on the medical and dental histories respectively for the total number of participants. According to the FAI, 53.2% of participants were classified as having no dysfunction, followed by light (36.1%), moderate (9.6%), and severe dysfunction (1.1%). Based on the FAI, mild to moderate prevalence of TMD appears to exist among male university students in Riyadh. Histories of psychological stress and dental treatment were evident among these students. Information obtained from the FAI may be helpful in assessing the prevalence of TMD and has important implications for the early diagnosis of TMD and the prevention of future TMD-related complications.

Oral Diseases (2012) 18, 728–733Background:  The value of chairside adjunctive tests in the detection of oral potentially malignant disorders (OPMDs) remains uncertain.Objectives:  To determine the effectiveness of toluidine blue in detecting leukoplakia and erythroplakia and its accuracy in identifying cases with oral epithelial dysplasia.Materials and Methods:  Ninety-two patients attending two oral medicine clinics in London, presenting with white and red patches of the oral mucosa, were investigated by the application of toluidine blue. Eighty-two patients were clinically diagnosed as OPMDs and 10 were frictional keratoses. A surgical biopsy was performed to assess epithelial dysplasia.Results:  Of 64 oral leukoplakias, 34 (53.1%) were positive for toluidine blue and among nine erythroplakias seven stained positive. Of 41 oral dysplasia cases, a little more than half of the lesions (n = 23) were stain positive, an estimated sensitivity of 56.1%. TBlue test had a higher sensitivity for detecting higher-grade dysplastic lesions (5/8 moderate dysplasia, sensitivity 62.5%; 5/7 severe dysplasia; sensitivity 71.4%) compared with lower grades of dysplasia, but the differences were not significant (P = 0.60).Conclusions:  We report here the utility of TBlue for the detection of oral leukoplakia and erythroplakia. The test has the potential to detect OPMDs and yielded a sensitivity of 56.1% and specificity of 56.9% to detect oral epithelial dysplasia.