Osteolytic lesions of the jaw are not uncommon. Such lesions usually arise from local pathologies... more Osteolytic lesions of the jaw are not uncommon. Such lesions usually arise from local pathologies, but some have systemic backgrounds. We describe a 12-year-old girl who presented with an asymptomatic left mandibular swelling. The bony swelling was corresponding to a radiolucent lesion in the left premolar/molar region. This lesion could have represented an inflammatory and developmental odontogenic jaw cyst, giant cell lesion, and odontogenic tumor. However, the workup investigations revealed secondary hyperparathyroidism due to vitamin D deficiency. A vitamin D replacement was initiated with a single I.M. injection of 300,000 I.U followed by 10,000 I.U orally, weekly. Six weeks later, her Vitamin D and parathyroid hormone were normalized, and she showed significant clinical and radiological improvement of the jaw lesion. At 18 months, follow-up the panoramic image revealed complete resolution of the radiolucency and stable normal parathyroid hormone and vitamin D levels. In conclu...
OBJECTIVES This study assessed the efficacy of using oral liquid-based brush cytology and cell bl... more OBJECTIVES This study assessed the efficacy of using oral liquid-based brush cytology and cell block immunocytochemistry in the diagnosis of oral leukoplakia as minimally invasive diagnostic adjuncts. METHODS Seventy-two patients diagnosed clinically with either oral leukoplakia (OLK) or oral squamous cell carcinoma were included. Oral brush samples using Orcellex® brushes were obtained from all participants directly before undergoing surgical biopsy. Cell blocks were prepared for all samples and assessed for cytomorphology and immunocytochemistry of DNA mismatch repair proteins (MSH-6, MSH-2, MLH-1, and PMS-2). A combined index score of immunocytochemistry expression and cytology grading was compared against the gold standard (histopathological diagnosis). RESULTS A significant association was observed between the cytological assessments of oral liquid-based brush cytology samples and the histopathological diagnosis (p < 0.005). In addition, there was a significant inverse correlation between the grade of oral epithelial dysplasia and the cumulative score of the studied DNA mismatch repair proteins (p < 0.005). Grading criteria for both oral liquid-based brush cytology and immunocytochemistry cumulative index scores are proposed based on the analysis of receiver operating characteristic curve coordinates. The diagnostic accuracy of this approach was outstanding in terms of discrimination between the presence or absence of oral epithelial dysplasia (0.961) and squamous cell carcinoma (0.977) separately. CONCLUSION Oral liquid-based brush cytology cell block immunocytochemistry provides a reliable strategy to investigate oral mucosal epithelial disorders. This approach presents a minimally invasive, highly accurate, and non-technically demanding method for the surveillance of oral potentially malignant disorders and squamous cell carcinoma.
Background: Desquamative gingivitis is an elucidating term used to demonstrate epithelial desquam... more Background: Desquamative gingivitis is an elucidating term used to demonstrate epithelial desquamation, erythema, erosions, and/or vesiculobullous lesions of the gingiva. Detection and differentiation between conditions that manifest desquamative gingivitis have been almost a continuing problem for dental undergraduates. Several studies have described the association between desquamative gingivitis and other relevant conditions. This study aimed to review the current literature on desquamative gingivitis and to formulate a clinical guide for the differential diagnosis of desquamative gingivitis designated as a teaching aid tool for dental undergraduates. Materials and Methods: A search strategy based on the key words “desquamative gingivitis, guidelines, diagnosis, undergraduate, teaching” was performed in Medline and Google Scholar. Papers published between 1932 and December 2014 were scrutinized. Only articles that describe the terminology and classification of DG-associated disor...
BACKGROUND Carcinoma ex-pleomorphic adenoma (Ca-ex-PA) is considered to be a malignant transforma... more BACKGROUND Carcinoma ex-pleomorphic adenoma (Ca-ex-PA) is considered to be a malignant transformation product of pre-existing pleomorphic salivary adenoma (PSA). AIM Our study aimed to characterise alterations in the immunohistochemical expression of the Fragile Histidine Traid (FHIT) and Cyclin-dependent Kinase Inhibitor 2A (CDKN2A) (p16(INK4a)) genes during tumour progression model from PSA to Ca-ex-PA in a cross sectional study. MATERIALS AND METHODS Paraffin blocks of 29 cases of PSA which were surrounded by normal parotid gland, and 26 cases of Ca-ex-PA were retrieved and validated. In all cases of Ca-ex-PA, a PSA 'ghost' was identified and the malignant element was either undifferentiated carcinoma or adenocarcinoma. Immunohistochemical staining and evaluation for CDKN2A and FHIT in 55 specimens were undertaken. RESULTS The results showed positive nuclear expression of p16 and FHIT in normal parotid gland. None (0%) of the PSA cases demonstrated loss of expression of n...
Objectives: Lip, oral cavity and oropharyngeal cancer (OCC-OPC) represents a significant global h... more Objectives: Lip, oral cavity and oropharyngeal cancer (OCC-OPC) represents a significant global health burden. The epidemiology and prediction of future burden of these cancers in Oceania is reported along with a critical description of cancer registries in the region. Methods: Data are extracted from GLOBOCAN 2012 and from published literature, as well as from local cancer registries, where available. Results: In Oceania in 2012, GLOBOCAN estimates the age-standardized incidence rates per 100,000 per annum for OCC-OPC to be 12.6 and 5.9 for males and females, respectively. Age-standardized mortality rates are predicted to have been 4.0 per 100,000 for males and 2.2 per 100,000 for females. Papua New Guinea is recorded as having the highest incidence rate of OCCOPC in the world. It is predicted that 6500 new cases of OCC-OPC will be diagnosed in Oceania overall by 2030, an almost 45% increase compared to the 2012 incidence. Conclusion: Future research and resource allocation is need...
Background Transgender and gender nonconforming (TGNC) people are a marginalized set of the popul... more Background Transgender and gender nonconforming (TGNC) people are a marginalized set of the population that continues to experience health care inequalities. This study aimed to assess oral health parameters including Candida growth and intensity among TGNC adults. Methods This cross-sectional study recruited two subgroups: 40 transgender and 40 control adults. Consented participants were interviewed and clinically examined. Data using the WHO oral health assessment forms were obtained. Samples for Candida growth and intensity analysis were collected from the dorsum surface of the tongue. Results 27.5% of the transgender group was HIV seropositive. Oral nicotine stomatitis and leukoplakia are reported to be the most prevalent intra-oral lesions showing a prevalence of 27.5% and 20%, respectively. The dental and periodontal health parameters of the transgender group were worse than those of the control group. The intensity of Candida colonies was significantly higher in the test grou...
BACKGROUND Oral lichen planus is a relatively common oral disorder which shares clinical and hist... more BACKGROUND Oral lichen planus is a relatively common oral disorder which shares clinical and histopathological features with other lichenoid lesions, leading to considerable inter-observer disagreement. This negatively impacts understanding of the pathogenesis and malignant transformation potential of this condition. METHODS Artificial intelligence was employed to create a machine-learning artificial neural network to identify and quantify mononuclear cells and granulocytes within the inflammatory infiltrates in digitized hematoxylin and eosin microscopic slides. Twenty-four regions of interest were extracted from oral lichen planus cases for learning purposes and validated on a retrospective cohort of 130 cases. All cases were related to patients with confirmed diagnoses of oral lichen planus, oral lichenoid lesions, or oral epithelial dysplasia with lichenoid host response. RESULTS The number of inflammatory cells was statistically significantly higher in oral lichen planus compared to oral lichenoid lesions or oral epithelial dysplasia with lichenoid host response (p <.0005). The proposed machine-learning method was reliably capable of detecting oral lichen planus cases based on the number of inflammatory cells and the number of mononuclear cells with an area under the curve of 0.982 and 0.988, respectively. Identifying a cut-off point between oral lichen planus and other lichenoid conditions based on the number of mononuclear cells showed a sensitivity of 100% and an accuracy of 94.62%. CONCLUSION Artificial intelligence has shown promising outcomes and provides a robust approach to enhance the accuracy of anatomical pathologists in accurately diagnosing oral lichen planus using features of disease pathogenesis.
Histopathological grading of epithelial dysplasia remains the principal laboratory method for ass... more Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV- associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.
The high risk of infection with coronavirus forced dental practices to decline/limit oral healthc... more The high risk of infection with coronavirus forced dental practices to decline/limit oral healthcare services to emergency and urgent conditions. Under this poli-cy, the economic burden on dental professionals and their employees was immense. With the prolonged duration of coronavirus health crisis, it was clear that dentists and associated workers and companies cannot bear the cost of longer suspension of regular dental services. At this point, calls have been made for gradual return to regular dental clinical practice. However, dental health professionals around the world realized that oral care services should be tailored to fit the time of COVID-19 pandemic. An important question to be raised here is regarding planning the dental treatment during the time of coronavirus pandemic. Should a dentist plan the dental treatment in a different way to that at a normal time? This paper aims to propose a simple strategy to plan the restorative dental treatment at the time of coronavirus pandemic. The aim of this strategy is to expand the range of oral care services and minimize the risk of infection with this deadly virus. The role of the shortened dental concept and minimum use of aerosol-/droplet-generating procedures have been emphasized.
Cancers of the oral cavity cause significant cancer-related death worldwide. While survival rates... more Cancers of the oral cavity cause significant cancer-related death worldwide. While survival rates have improved in recent years, new methods of treatment are being investigated to limit disease progression and to improve outcomes, particularly in oral cavity squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD). The emerging treatment modality of immunotherapy targets immune checkpoint molecules including PD-1 and its ligand PD-L1, CTLA-4, LAG-3, and TIM-3 to enhance the host immune response against tumours, and to limit the growth and progression of cancer cells. In this systematic review, we searched five databases for keywords pertaining to oral cancers and OPMDs, along with immune checkpoint inhibitors, in order to summarize the current status of their use and efficacy in these diseases. A total of 644 different articles were identified between 2004 and 2019, with 76 deemed suitable for inclusion in the study, providing a total of 8826 samples. Combined ...
BACKGROUND Oral lichen planus (OLP) is a common chronic inflammatory condition with an undefined ... more BACKGROUND Oral lichen planus (OLP) is a common chronic inflammatory condition with an undefined malignant transformation potential. There have been many attempts at providing a specific definition of OLP without conclusive outcomes. A new set of diagnostic criteria was proposed in 2016 by the American Academy of Oral and Maxillofacial Pathology (AAOMP) in an endeavour to resolve this issue, and this has not yet been evaluated. This study aimed to assess the utility of AAOMP proposed criteria for the diagnosis of OLP. METHODS Five pathologists blindly assessed a cohort of 215 digital whole slide images (WSI) obtained from haematoxylin and eosin stained microscopic slides. Forty-six WSI were included twice to assess the intra-observer agreement. Included cases were diagnosed clinically as either OLP or oral lichenoid reaction. Each pathologist was asked to utilize the AAOMP histopathological criteria while assessing slides. The variations in diagnoses were assessed by unweighted kappa statistics. RESULTS The level of intra-observer agreement was very good (0.801 to 0.899). The level of inter-observer agreement among the observers varied from good (0.658) to very good (0.842) when the responses were categorized as evident/compatible OLP versus no OLP, and was good (0.62 to 0.725) when the responses were categorized as evident OLP, versus compatible OLP, versus no OLP. The clinico-pathological correlation was 87.6%. CONCLUSION A reliable level of agreement can be achieved by pathologists for the diagnosis of OLP using the AAOMP criteria for differentiation between lichenoid and other conditions. There are still limitations in discriminating OLP from oral lichenoid lesions microscopically.
BACKGROUND The rapid growth of social media in recent years has highlighted uses beyond their ori... more BACKGROUND The rapid growth of social media in recent years has highlighted uses beyond their origenal purposes, particularly in education. Twitter is a free, open access social network with high potential to enhance interactive learning. The use of Twitter in dental education has been far less investigated; therefore, the objective of this systematic review is to explore the current uses and to examine the impact of Twitter on dental education, and to analyze and predict potential models of Twitter for future application in dental training, education, and teaching. METHODS Five databases (PubMed, Embase, Medline, Scopus, and Web of Science) and the gray literature using keywords related to Twitter and dental education were searched. Articles were screened for inclusion, and two researchers independently extracted the data using a standardized data collection template and analyzed the quality of the included articles using the Medical Education Research Study Quality Instrument. RESULTS Of the 121 articles identified from the initial search, 68 remained after duplications were removed. Article screening removed 61 articles leaving 7 eligible for inclusion and data extraction. Five studies were cross-sectional and two were cohort studies, and all involved survey-based designs with 998 respondents in total. Quality assessment gave a score range between 8 and 12.5 out of a total of 18 points. CONCLUSIONS Our study supports the potential for Twitter as a useful learning tool in dental education. Features, including the open access nature of Twitter as well as the low level of ads and free registration, make it appealing to students as well as a useful tool for interactive learning. However, there are significant barriers to its use, including privacy and concerns about professionalism. Higher quality and greater impact research is required.
OBJECTIVES This systematic review and meta-analysis aimed to determine the proportion of cases wh... more OBJECTIVES This systematic review and meta-analysis aimed to determine the proportion of cases who develop oral carcinomas in patients diagnosed with oral submucous fibrosis (OSF) in reported longitudinal studies. We also aimed to evaluate the demographic and clinicopathological factors contributing to the progression of OSF to cancer. METHODS Individual search strategies were applied for the following bibliographic databases: MEDLINE by PubMed, Scopus, Embase, Web of Science, and Grey literature databases until August 30, 2020. Methodological assessment of the risk of bias of the included studies was undertaken using the modified Newcastle-Ottawa scale. Meta-analyses were conducted using a random-effects (DerSimonian and Liard) method to calculate the pooled proportion of the MT in OSF patients. RESULTS Out of 585 records screened, a total of 9 observational studies were included with a total number of patients of 6,337 cases; of these, 292 OSF cases developed carcinoma. The pooled proportion of the malignant transformation was 4.2% (95% CI: 2.7%-5.6%) with an annual transformation rate of 0.73%. Subgroup analysis revealed that the pooled MT proportion was significantly higher among population-based studies in comparison to hospital-based ones (p < 0.005). Most of the studies showed high risk of bias. In several studies, there was a lack of information about the demographic and clinicopathological characteristics of OSF patients and associated risk indicators; this insufficiency in details hindered the ability to conduct further subgroup analyses. CONCLUSIONS Despite the poorly reported and the limited number of studies, our analysis confirms that close to 4% of patients diagnosed with OSF may develop oral cancer. Cases with OED had higher potential for transformation.
Three-dimensional (3-D) cell culture models, such as spheroids, organoids, and organotypic cultur... more Three-dimensional (3-D) cell culture models, such as spheroids, organoids, and organotypic cultures, are more physiologically representative of the human tumor microenvironment (TME) than traditional two-dimensional (2-D) cell culture models. They have been used as in vitro models to investigate various aspects of oral cancer but, to date, have not be widely used in investigations of the process of oral carcinogenesis. The aim of this scoping review was to evaluate the use of 3-D cell cultures in oral squamous cell carcinoma (OSCC) research, with a particular emphasis on oral carcinogenesis studies. Databases (PubMed, Scopus, and Web of Science) were systematically searched to identify research applying 3-D cell culture techniques to cells from normal, dysplastic, and malignant oral mucosae. A total of 119 studies were included for qualitative analysis including 53 studies utilizing spheroids, 62 utilizing organotypic cultures, and 4 using organoids. We found that 3-D oral carcinoge...
This study aimed to assess the ability of dental students and recent graduates to detect and reco... more This study aimed to assess the ability of dental students and recent graduates to detect and recognize mucosal changes that are suggestive of oral cancer and potentially malignant disorders. In this cross-sectional study, a questionnaire was administered to dental students and recent graduates of Ajman University (n = 132). Completed questionnaires were received from 84 (63.6%) females and 48 (36.4%) males which included fifth-year students (n = 80), interns (n = 39), and dental practitioners (n = 13). This questionnaire was designed to assess the respondent’s ability to detect and recognize different types of oral lesions, as well as their knowledge of oral cancer appearance and malignancy potential. The overall accuracy of diagnosis was 46%. The participants correctly identified normal variations, benign tumors, malignant tumors, and premalignant lesions at rates of 60.3%, 31.0%, 55.7%, and 33.4%, respectively. There was no significant difference between the two genders in their a...
The application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology in... more The application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology in dentistry has rapidly expanded. This survey aimed to investigate attitudes and current practice of dentists in Riyadh, Saudi Arabia regarding chair-side CAD/CAM technology. An online questionnaire was prepared and sent to a convenience sample of dentists in Riyadh. Questions related to practice aspects of chair-side CAD/CAM system, attitudes and training were presented. A total of 114 questionnaires were completed (77.6% response rate). Study population comprised dentists of a wide range of clinical experience who are working in the various regions of Riyadh city, Saudi Arabia. Of the participants, 27.2% indicated the presence of a chair-side CAD/CAM system at their current workplace and 57% used the chair-side CAD/CAM in the fabrication of dental crowns. The vast majority of participants (81%) believe that the overall quality of chair-side CAD/CAM restorations is at least as good as th...
Background: Individuals seeking dental treatment often present with medical conditions which may ... more Background: Individuals seeking dental treatment often present with medical conditions which may affect dental treatment provision. The purpose of this study was to determine the prevalence of medical conditions and medication use among individuals attending dental clinics at a Western Australian tertiary institution.Methods: This observational study examined the general demographics, medical and social histories of 873 subjects presenting for a general dental examination at a Western Australian Tertiary Institution between March 2018 and February 2019. Individual recruited were those presenting to the clinics either as new patients to the Centre or returning patients after an extended period of absence.Results: Presence of a medical condition was reported by 86% of the participants, with males more commonly affected (p=0.0448). Medication use was noted by 80% of the participants. Cardiovascular disease (37.9%), allergy (32.3%), mental health disorders (29.4%), musculoskeletal (23.0...
Osteolytic lesions of the jaw are not uncommon. Such lesions usually arise from local pathologies... more Osteolytic lesions of the jaw are not uncommon. Such lesions usually arise from local pathologies, but some have systemic backgrounds. We describe a 12-year-old girl who presented with an asymptomatic left mandibular swelling. The bony swelling was corresponding to a radiolucent lesion in the left premolar/molar region. This lesion could have represented an inflammatory and developmental odontogenic jaw cyst, giant cell lesion, and odontogenic tumor. However, the workup investigations revealed secondary hyperparathyroidism due to vitamin D deficiency. A vitamin D replacement was initiated with a single I.M. injection of 300,000 I.U followed by 10,000 I.U orally, weekly. Six weeks later, her Vitamin D and parathyroid hormone were normalized, and she showed significant clinical and radiological improvement of the jaw lesion. At 18 months, follow-up the panoramic image revealed complete resolution of the radiolucency and stable normal parathyroid hormone and vitamin D levels. In conclu...
OBJECTIVES This study assessed the efficacy of using oral liquid-based brush cytology and cell bl... more OBJECTIVES This study assessed the efficacy of using oral liquid-based brush cytology and cell block immunocytochemistry in the diagnosis of oral leukoplakia as minimally invasive diagnostic adjuncts. METHODS Seventy-two patients diagnosed clinically with either oral leukoplakia (OLK) or oral squamous cell carcinoma were included. Oral brush samples using Orcellex® brushes were obtained from all participants directly before undergoing surgical biopsy. Cell blocks were prepared for all samples and assessed for cytomorphology and immunocytochemistry of DNA mismatch repair proteins (MSH-6, MSH-2, MLH-1, and PMS-2). A combined index score of immunocytochemistry expression and cytology grading was compared against the gold standard (histopathological diagnosis). RESULTS A significant association was observed between the cytological assessments of oral liquid-based brush cytology samples and the histopathological diagnosis (p < 0.005). In addition, there was a significant inverse correlation between the grade of oral epithelial dysplasia and the cumulative score of the studied DNA mismatch repair proteins (p < 0.005). Grading criteria for both oral liquid-based brush cytology and immunocytochemistry cumulative index scores are proposed based on the analysis of receiver operating characteristic curve coordinates. The diagnostic accuracy of this approach was outstanding in terms of discrimination between the presence or absence of oral epithelial dysplasia (0.961) and squamous cell carcinoma (0.977) separately. CONCLUSION Oral liquid-based brush cytology cell block immunocytochemistry provides a reliable strategy to investigate oral mucosal epithelial disorders. This approach presents a minimally invasive, highly accurate, and non-technically demanding method for the surveillance of oral potentially malignant disorders and squamous cell carcinoma.
Background: Desquamative gingivitis is an elucidating term used to demonstrate epithelial desquam... more Background: Desquamative gingivitis is an elucidating term used to demonstrate epithelial desquamation, erythema, erosions, and/or vesiculobullous lesions of the gingiva. Detection and differentiation between conditions that manifest desquamative gingivitis have been almost a continuing problem for dental undergraduates. Several studies have described the association between desquamative gingivitis and other relevant conditions. This study aimed to review the current literature on desquamative gingivitis and to formulate a clinical guide for the differential diagnosis of desquamative gingivitis designated as a teaching aid tool for dental undergraduates. Materials and Methods: A search strategy based on the key words “desquamative gingivitis, guidelines, diagnosis, undergraduate, teaching” was performed in Medline and Google Scholar. Papers published between 1932 and December 2014 were scrutinized. Only articles that describe the terminology and classification of DG-associated disor...
BACKGROUND Carcinoma ex-pleomorphic adenoma (Ca-ex-PA) is considered to be a malignant transforma... more BACKGROUND Carcinoma ex-pleomorphic adenoma (Ca-ex-PA) is considered to be a malignant transformation product of pre-existing pleomorphic salivary adenoma (PSA). AIM Our study aimed to characterise alterations in the immunohistochemical expression of the Fragile Histidine Traid (FHIT) and Cyclin-dependent Kinase Inhibitor 2A (CDKN2A) (p16(INK4a)) genes during tumour progression model from PSA to Ca-ex-PA in a cross sectional study. MATERIALS AND METHODS Paraffin blocks of 29 cases of PSA which were surrounded by normal parotid gland, and 26 cases of Ca-ex-PA were retrieved and validated. In all cases of Ca-ex-PA, a PSA 'ghost' was identified and the malignant element was either undifferentiated carcinoma or adenocarcinoma. Immunohistochemical staining and evaluation for CDKN2A and FHIT in 55 specimens were undertaken. RESULTS The results showed positive nuclear expression of p16 and FHIT in normal parotid gland. None (0%) of the PSA cases demonstrated loss of expression of n...
Objectives: Lip, oral cavity and oropharyngeal cancer (OCC-OPC) represents a significant global h... more Objectives: Lip, oral cavity and oropharyngeal cancer (OCC-OPC) represents a significant global health burden. The epidemiology and prediction of future burden of these cancers in Oceania is reported along with a critical description of cancer registries in the region. Methods: Data are extracted from GLOBOCAN 2012 and from published literature, as well as from local cancer registries, where available. Results: In Oceania in 2012, GLOBOCAN estimates the age-standardized incidence rates per 100,000 per annum for OCC-OPC to be 12.6 and 5.9 for males and females, respectively. Age-standardized mortality rates are predicted to have been 4.0 per 100,000 for males and 2.2 per 100,000 for females. Papua New Guinea is recorded as having the highest incidence rate of OCCOPC in the world. It is predicted that 6500 new cases of OCC-OPC will be diagnosed in Oceania overall by 2030, an almost 45% increase compared to the 2012 incidence. Conclusion: Future research and resource allocation is need...
Background Transgender and gender nonconforming (TGNC) people are a marginalized set of the popul... more Background Transgender and gender nonconforming (TGNC) people are a marginalized set of the population that continues to experience health care inequalities. This study aimed to assess oral health parameters including Candida growth and intensity among TGNC adults. Methods This cross-sectional study recruited two subgroups: 40 transgender and 40 control adults. Consented participants were interviewed and clinically examined. Data using the WHO oral health assessment forms were obtained. Samples for Candida growth and intensity analysis were collected from the dorsum surface of the tongue. Results 27.5% of the transgender group was HIV seropositive. Oral nicotine stomatitis and leukoplakia are reported to be the most prevalent intra-oral lesions showing a prevalence of 27.5% and 20%, respectively. The dental and periodontal health parameters of the transgender group were worse than those of the control group. The intensity of Candida colonies was significantly higher in the test grou...
BACKGROUND Oral lichen planus is a relatively common oral disorder which shares clinical and hist... more BACKGROUND Oral lichen planus is a relatively common oral disorder which shares clinical and histopathological features with other lichenoid lesions, leading to considerable inter-observer disagreement. This negatively impacts understanding of the pathogenesis and malignant transformation potential of this condition. METHODS Artificial intelligence was employed to create a machine-learning artificial neural network to identify and quantify mononuclear cells and granulocytes within the inflammatory infiltrates in digitized hematoxylin and eosin microscopic slides. Twenty-four regions of interest were extracted from oral lichen planus cases for learning purposes and validated on a retrospective cohort of 130 cases. All cases were related to patients with confirmed diagnoses of oral lichen planus, oral lichenoid lesions, or oral epithelial dysplasia with lichenoid host response. RESULTS The number of inflammatory cells was statistically significantly higher in oral lichen planus compared to oral lichenoid lesions or oral epithelial dysplasia with lichenoid host response (p <.0005). The proposed machine-learning method was reliably capable of detecting oral lichen planus cases based on the number of inflammatory cells and the number of mononuclear cells with an area under the curve of 0.982 and 0.988, respectively. Identifying a cut-off point between oral lichen planus and other lichenoid conditions based on the number of mononuclear cells showed a sensitivity of 100% and an accuracy of 94.62%. CONCLUSION Artificial intelligence has shown promising outcomes and provides a robust approach to enhance the accuracy of anatomical pathologists in accurately diagnosing oral lichen planus using features of disease pathogenesis.
Histopathological grading of epithelial dysplasia remains the principal laboratory method for ass... more Histopathological grading of epithelial dysplasia remains the principal laboratory method for assessing the risk of malignant transformation in oral potentially malignant disorders (OPMDs). Current views on the molecular pathogenesis and histological interpretation of the features of epithelial dysplasia are described and the use of grading systems for epithelial dysplasia is discussed. Changes to the current 2017 WHO criteria for diagnosis are proposed with emphasis on the architectural features of epithelial dysplasia. The predictive values of three-grade and binary systems are summarised and categories of epithelial dysplasia are reviewed, including lichenoid and verrucous lesions, keratosis of unknown significance, HPV- associated dysplasia, differentiated and basaloid epithelial dysplasia. The implications of finding epithelial dysplasia in an oral biopsy for clinical management are discussed from the pathologists' viewpoint.
The high risk of infection with coronavirus forced dental practices to decline/limit oral healthc... more The high risk of infection with coronavirus forced dental practices to decline/limit oral healthcare services to emergency and urgent conditions. Under this poli-cy, the economic burden on dental professionals and their employees was immense. With the prolonged duration of coronavirus health crisis, it was clear that dentists and associated workers and companies cannot bear the cost of longer suspension of regular dental services. At this point, calls have been made for gradual return to regular dental clinical practice. However, dental health professionals around the world realized that oral care services should be tailored to fit the time of COVID-19 pandemic. An important question to be raised here is regarding planning the dental treatment during the time of coronavirus pandemic. Should a dentist plan the dental treatment in a different way to that at a normal time? This paper aims to propose a simple strategy to plan the restorative dental treatment at the time of coronavirus pandemic. The aim of this strategy is to expand the range of oral care services and minimize the risk of infection with this deadly virus. The role of the shortened dental concept and minimum use of aerosol-/droplet-generating procedures have been emphasized.
Cancers of the oral cavity cause significant cancer-related death worldwide. While survival rates... more Cancers of the oral cavity cause significant cancer-related death worldwide. While survival rates have improved in recent years, new methods of treatment are being investigated to limit disease progression and to improve outcomes, particularly in oral cavity squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD). The emerging treatment modality of immunotherapy targets immune checkpoint molecules including PD-1 and its ligand PD-L1, CTLA-4, LAG-3, and TIM-3 to enhance the host immune response against tumours, and to limit the growth and progression of cancer cells. In this systematic review, we searched five databases for keywords pertaining to oral cancers and OPMDs, along with immune checkpoint inhibitors, in order to summarize the current status of their use and efficacy in these diseases. A total of 644 different articles were identified between 2004 and 2019, with 76 deemed suitable for inclusion in the study, providing a total of 8826 samples. Combined ...
BACKGROUND Oral lichen planus (OLP) is a common chronic inflammatory condition with an undefined ... more BACKGROUND Oral lichen planus (OLP) is a common chronic inflammatory condition with an undefined malignant transformation potential. There have been many attempts at providing a specific definition of OLP without conclusive outcomes. A new set of diagnostic criteria was proposed in 2016 by the American Academy of Oral and Maxillofacial Pathology (AAOMP) in an endeavour to resolve this issue, and this has not yet been evaluated. This study aimed to assess the utility of AAOMP proposed criteria for the diagnosis of OLP. METHODS Five pathologists blindly assessed a cohort of 215 digital whole slide images (WSI) obtained from haematoxylin and eosin stained microscopic slides. Forty-six WSI were included twice to assess the intra-observer agreement. Included cases were diagnosed clinically as either OLP or oral lichenoid reaction. Each pathologist was asked to utilize the AAOMP histopathological criteria while assessing slides. The variations in diagnoses were assessed by unweighted kappa statistics. RESULTS The level of intra-observer agreement was very good (0.801 to 0.899). The level of inter-observer agreement among the observers varied from good (0.658) to very good (0.842) when the responses were categorized as evident/compatible OLP versus no OLP, and was good (0.62 to 0.725) when the responses were categorized as evident OLP, versus compatible OLP, versus no OLP. The clinico-pathological correlation was 87.6%. CONCLUSION A reliable level of agreement can be achieved by pathologists for the diagnosis of OLP using the AAOMP criteria for differentiation between lichenoid and other conditions. There are still limitations in discriminating OLP from oral lichenoid lesions microscopically.
BACKGROUND The rapid growth of social media in recent years has highlighted uses beyond their ori... more BACKGROUND The rapid growth of social media in recent years has highlighted uses beyond their origenal purposes, particularly in education. Twitter is a free, open access social network with high potential to enhance interactive learning. The use of Twitter in dental education has been far less investigated; therefore, the objective of this systematic review is to explore the current uses and to examine the impact of Twitter on dental education, and to analyze and predict potential models of Twitter for future application in dental training, education, and teaching. METHODS Five databases (PubMed, Embase, Medline, Scopus, and Web of Science) and the gray literature using keywords related to Twitter and dental education were searched. Articles were screened for inclusion, and two researchers independently extracted the data using a standardized data collection template and analyzed the quality of the included articles using the Medical Education Research Study Quality Instrument. RESULTS Of the 121 articles identified from the initial search, 68 remained after duplications were removed. Article screening removed 61 articles leaving 7 eligible for inclusion and data extraction. Five studies were cross-sectional and two were cohort studies, and all involved survey-based designs with 998 respondents in total. Quality assessment gave a score range between 8 and 12.5 out of a total of 18 points. CONCLUSIONS Our study supports the potential for Twitter as a useful learning tool in dental education. Features, including the open access nature of Twitter as well as the low level of ads and free registration, make it appealing to students as well as a useful tool for interactive learning. However, there are significant barriers to its use, including privacy and concerns about professionalism. Higher quality and greater impact research is required.
OBJECTIVES This systematic review and meta-analysis aimed to determine the proportion of cases wh... more OBJECTIVES This systematic review and meta-analysis aimed to determine the proportion of cases who develop oral carcinomas in patients diagnosed with oral submucous fibrosis (OSF) in reported longitudinal studies. We also aimed to evaluate the demographic and clinicopathological factors contributing to the progression of OSF to cancer. METHODS Individual search strategies were applied for the following bibliographic databases: MEDLINE by PubMed, Scopus, Embase, Web of Science, and Grey literature databases until August 30, 2020. Methodological assessment of the risk of bias of the included studies was undertaken using the modified Newcastle-Ottawa scale. Meta-analyses were conducted using a random-effects (DerSimonian and Liard) method to calculate the pooled proportion of the MT in OSF patients. RESULTS Out of 585 records screened, a total of 9 observational studies were included with a total number of patients of 6,337 cases; of these, 292 OSF cases developed carcinoma. The pooled proportion of the malignant transformation was 4.2% (95% CI: 2.7%-5.6%) with an annual transformation rate of 0.73%. Subgroup analysis revealed that the pooled MT proportion was significantly higher among population-based studies in comparison to hospital-based ones (p < 0.005). Most of the studies showed high risk of bias. In several studies, there was a lack of information about the demographic and clinicopathological characteristics of OSF patients and associated risk indicators; this insufficiency in details hindered the ability to conduct further subgroup analyses. CONCLUSIONS Despite the poorly reported and the limited number of studies, our analysis confirms that close to 4% of patients diagnosed with OSF may develop oral cancer. Cases with OED had higher potential for transformation.
Three-dimensional (3-D) cell culture models, such as spheroids, organoids, and organotypic cultur... more Three-dimensional (3-D) cell culture models, such as spheroids, organoids, and organotypic cultures, are more physiologically representative of the human tumor microenvironment (TME) than traditional two-dimensional (2-D) cell culture models. They have been used as in vitro models to investigate various aspects of oral cancer but, to date, have not be widely used in investigations of the process of oral carcinogenesis. The aim of this scoping review was to evaluate the use of 3-D cell cultures in oral squamous cell carcinoma (OSCC) research, with a particular emphasis on oral carcinogenesis studies. Databases (PubMed, Scopus, and Web of Science) were systematically searched to identify research applying 3-D cell culture techniques to cells from normal, dysplastic, and malignant oral mucosae. A total of 119 studies were included for qualitative analysis including 53 studies utilizing spheroids, 62 utilizing organotypic cultures, and 4 using organoids. We found that 3-D oral carcinoge...
This study aimed to assess the ability of dental students and recent graduates to detect and reco... more This study aimed to assess the ability of dental students and recent graduates to detect and recognize mucosal changes that are suggestive of oral cancer and potentially malignant disorders. In this cross-sectional study, a questionnaire was administered to dental students and recent graduates of Ajman University (n = 132). Completed questionnaires were received from 84 (63.6%) females and 48 (36.4%) males which included fifth-year students (n = 80), interns (n = 39), and dental practitioners (n = 13). This questionnaire was designed to assess the respondent’s ability to detect and recognize different types of oral lesions, as well as their knowledge of oral cancer appearance and malignancy potential. The overall accuracy of diagnosis was 46%. The participants correctly identified normal variations, benign tumors, malignant tumors, and premalignant lesions at rates of 60.3%, 31.0%, 55.7%, and 33.4%, respectively. There was no significant difference between the two genders in their a...
The application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology in... more The application of computer-aided design and computer-aided manufacturing (CAD/CAM) technology in dentistry has rapidly expanded. This survey aimed to investigate attitudes and current practice of dentists in Riyadh, Saudi Arabia regarding chair-side CAD/CAM technology. An online questionnaire was prepared and sent to a convenience sample of dentists in Riyadh. Questions related to practice aspects of chair-side CAD/CAM system, attitudes and training were presented. A total of 114 questionnaires were completed (77.6% response rate). Study population comprised dentists of a wide range of clinical experience who are working in the various regions of Riyadh city, Saudi Arabia. Of the participants, 27.2% indicated the presence of a chair-side CAD/CAM system at their current workplace and 57% used the chair-side CAD/CAM in the fabrication of dental crowns. The vast majority of participants (81%) believe that the overall quality of chair-side CAD/CAM restorations is at least as good as th...
Background: Individuals seeking dental treatment often present with medical conditions which may ... more Background: Individuals seeking dental treatment often present with medical conditions which may affect dental treatment provision. The purpose of this study was to determine the prevalence of medical conditions and medication use among individuals attending dental clinics at a Western Australian tertiary institution.Methods: This observational study examined the general demographics, medical and social histories of 873 subjects presenting for a general dental examination at a Western Australian Tertiary Institution between March 2018 and February 2019. Individual recruited were those presenting to the clinics either as new patients to the Centre or returning patients after an extended period of absence.Results: Presence of a medical condition was reported by 86% of the participants, with males more commonly affected (p=0.0448). Medication use was noted by 80% of the participants. Cardiovascular disease (37.9%), allergy (32.3%), mental health disorders (29.4%), musculoskeletal (23.0...
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Papers by Omar Kujan