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 Table of Contents  
GUEST EDITORIAL
Year : 2015  |  Volume : 27  |  Issue : 2  |  Page : 169-170

Advances in diagnosis of oral potentially malignant disorders: A review


President, Indian Academy of Oral Medicine and Radiology, Professor and Head, Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission07-Oct-2015
Date of Acceptance17-Oct-2015
Date of Web Publication21-Nov-2015

Correspondence Address:
Jayachandran Sadaksharam
Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai - 600 003, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.170131

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How to cite this article:
Sadaksharam J. Advances in diagnosis of oral potentially malignant disorders: A review. J Indian Acad Oral Med Radiol 2015;27:169-70

How to cite this URL:
Sadaksharam J. Advances in diagnosis of oral potentially malignant disorders: A review. J Indian Acad Oral Med Radiol [serial online] 2015 [cited 2019 Dec 15];27:169-70. Available from: http://www.jiaomr.in/text.asp?2015/27/2/169/170131




Oral cancer detection at a late stage leads to high mortality and morbidity. The time of diagnosis influences the treatment and survival rate. Early diagnosis for detecting these lesions and predicting their progress is very important to provide care to patients and improve their quality of life and survival rate. So, the advances in diagnosis of oral potentially malignant disorders are reviewed here. In the past decade, there has been an abrupt rise in the incidence of oral cancer. It is usually detected at late stages or when it turns symptomatic, which affects the survival rate of the individual. Oral cancer is more common at 35 years of age. It affects males at twice the rate in females because of risk factors like tobacco and alcohol use. [1] Moreover, it takes years for malignant transformation, during which it is possible to prevent the lesion from developing. Regression of the premalignant lesion is possible by reducing the risk factors including tobacco and alcohol use. [2] Biopsy of the lesion with histopathological examination will always be the gold standard for diagnosis of oral cancer, which, however, has some limitations. It is time consuming, expensive, invasive, and needs a trained health care provider. Advances in detection methods that can be used for the early diagnosis of oral potentially malignant disorders to make oral cancer curable and increase the patient's survival include the following recent advances which are non-invasive, such as autofluorescence spectroscopy, photodynamic therapy, and Raman spectroscopy.


   Autofluorescence and Diffuse Reflectance Spectroscopy Top


When light interacts with biological tissue, there is excitation and re-emission of light of varying colors, which can be detected by sensitive spectrometers. As compared to normal tissues, diseased tissues contain intrinsic fluorophore of different morpho-histologic characteristics. At a suitable wavelength when the tissues are excited, they give rise to different fluorescence emission spectra. By analyzing these spectra, the physical and chemical properties of a tissue can be evaluated and it can be used to compare the autofluorescence spectra of diseased and normal tissues. [3] As a result of backscattering of single and multiple white excitation light, diffuse reflectance takes place. At a wavelength of 630 nm, endogenous autofluorescence has been noticed in tumor cells. This fluorescence is in association with porphyrins. The emission band at 400-405 nm is mainly due to the presence of collagen when excited at a wavelength of range 325-360 nm, while emission at 440-460 nm can be attributed to the presence of nicotinamide adenine dinucleotide (NADH) at an excitation wavelength of 290 nm. Also, 400-405 nm excitation is for porphyrin with emission at 630-690 nm and emission at 350 nm is for tryptophan with an excitation wavelength at 280 nm. [4] Studies have proved that the change in the fluorescence emission spectrum for both normal and OSF mucosa before and after treatment can be explained by analyzing the changes in the fluorescence intensity of the endogenous fluorophores. [3]


   Photodynamic Therapy Top


Photodynamic therapy can also be used in diagnosing oral cancer. The main principle behind photodynamic therapy is the selective uptake and retention of a local and systemically administered photosensitizer in the tumor tissue. The intracellular activation of the photosensitizer, when light of proper wavelength is used, produces free radicals or forms intracellular singlet oxygen. The immunomodulatory effects of photodynamic therapy can induce apoptosis in hyperproliferating inflammatory cells. Photodynamic therapy is found to be effective in the treatment of lichen planus and oral leukoplakia. [5],[6]


   Raman Spectroscopy Top


This method is capable of providing information biologically and morphologically at short acquisition times which can be used for diagnosis. Inelastic scattering of photons is the basis of Raman effect. Inelastic scattering followed by exchange of energy with the molecular vibrations takes place in a small fraction of photons. Raman spectroscopy has the advantage in in vivo condition due to the use of optical fibers for guiding the laser light to the desired site and also it helps in the in vivo measurements by collecting these Raman photons. It can, therefore, be used to record the in vivo spectra of tumor cells and normal cells of the same subject to provide a diagnosis in the least possible time. [7]


   Conclusion Top


Early diagnosis of oral cancer is an important objective in which Oral Medicine professionals play a vital role. Early detection would lead to less damage from treatment and better prognosis. There are a number of advanced techniques that may help with the diagnosis of oral malignancy and premalignancy. Light based detection systems have good sensitivity and specificity. The light based screening aid should only be used as an adjunct in clinical examination for identifying potentially malignant lesions. The limitation that hinder their use include lack of sound clinical trails.

 
   References Top

1.
Messadi DV. Diagnostic aids for detection of oral precancerous conditions. Int J Oral Sci 2013;5:59-65.  Back to cited text no. 1
    
2.
Mehrotra R, Gupta DK. Exciting new advances in oral cancer diagnosis: Avenues to early detection. Head Neck Oncol 2011;3:33.  Back to cited text no. 2
    
3.
Vedeswari CP, Jayachandran S, Ganesan S. In vivo autofluorescence characteristics of pre- and post-treated oral submucous fibrosis: A pilot study. Indian J Dent Res 2009;20:261-7.  Back to cited text no. 3
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4.
Jayachandran S, Gombra V, Sivabalan SG. Autofluorescence and diffuse reflectance spectroscopic analysis of oral premalignancy and malignancy. J Indian Acad Oral Med Radiol 2009;21:2.  Back to cited text no. 4
  Medknow Journal  
5.
Sadaksharam J, Nayaki KP, Selvam NP. Treatment of oral lichen planus with methylene blue mediated photodynamic therapy- A clinical study. Photodermatol Photoimmunol Photomed 2012;28:97-101.  Back to cited text no. 5
    
6.
Selvam NP, Sadaksharam J, Singaravelu G, Ramu R. Treatment of oral leukoplakia with photodynamic therapy: A pilot study. J Cancer Res Ther 2015;11:464-7.  Back to cited text no. 6
    
7.
Singh SP, Deshmukh A, Chaturvedi P, Krishna CM. In vivo Raman spectroscopy for oral cancers diagnosis. Biomedical Vibrational Spectroscopy V: Advances in research and industry. Proc SPIE 2012:8219:82190K.  Back to cited text no. 7
    




 

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