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The lactate dehydrogenase isoenzyme pattern of biopsies from Indian oral leukoplakia, submucous fibrosis and carcinoma of the oral mucosa as well as that of oral mucous membrane biopsies from clinically normal Indian persons has been studied. The LDHIV/LDHII isoenzyme ratios found for leukoplakias, carcinomas and control biopsies did not differ significantly. The mean isoenzyme ratio of Indian control biopsies was significantly above that reported for Danish control biopsies. Submucous fibrosis was accompanied by a significant depression of the isoenzyme ratio. No clear correlation between LDH isoenzyme pattern and epithelial thickness was found. Smoking and chewing habits, which may be correlated with prevalence and localization of oral leukoplakias and carcinomas, did not significantly influence the isoenzymatic structure. Although final conclusions cannot be drawn, the high isoenzyme ratio of the Indian control material may represent an early precancerous condition, unrelated to smoking and chewing, preceding the histopathological manifestations of precancerous lesions.

An international group of epidemiologists, clinicians and pathologists with a special interest in oral white lesions and their precancerous significance has reviewed earlier work on this topic and identified some of the problems associated with previous definitions, descriptions and classifications. Modifications to these definitions, descriptions and classifications have been proposed, accompanied by explanations of the reasons for identifying the need for changes to be made. Leukoplakia may be a provisional or definitive diagnosis dependent upon the circumstances of oral examination and the availability of other information. Guidelines are provided to assist in the application of the definitions of oral leukoplakia and illustrations depict the homogeneous and non-homogeneous clinical variants. Consideration is also given to the importance of a red component in a white lesion, or a lesion that is entirely red (erythroplakia). A new clinical staging procedure for oral leukoplakia is also proposed.

Oral mucosal lesion findings from a national multistage probability oral health survey of United States schoolchildren in kindergarten through grade 12 are reported. In the 1986-87 school year 39,206 children aged 5-17 yr were examined by 14 dentists trained in standardized clinical diagnostic criteria for dental caries, periodontal conditions and oral mucosal lesions. In addition all children were asked whether or not they ever had "cold sores," "fever blisters," or "canker sores", and adolescents (grades 6-12) were questioned about their history of tobacco use. About 4% of the children had one or more oral mucosal lesions present at the time of the examination, while 33 and 37% reported a history of recurrent herpes labialis and recurrent aphthous ulcers, respectively. The most prevalent lesions clinically observed were recurrent aphthous ulcers (1.23%), recurrent herpes labialis (0.78), smokeless tobacco lesions (0.71), and geographic tongue (0.60). Differences in prevalence were analyzed by age, sex, race, metropolitan area, and geographic region. Almost 10% of 12-17-yr-olds reported current use of some type of tobacco product. In adolescents the current use of tobacco products had a marked effect on the prevalence of oral lesions.

The melanin pigmentation in the palate of Indian reverse smokers was histologically studied in 80 biopsies, which were compared with corresponding tissue from 49 nontobacco users. The morphology of epithelium containing melanin in its basal part was normal in smokers and nonsmokers, in contrast to areas with a local melanin depigmentation of the epithelium found in some of the reverse smokers. Here an epithelial thinning, inflammation in the underlying connective tissue, and eventually a cancer was found. The histologic appearance was in accordance with the theory that as long as a smoker's melanosis or a genetic melanin pigmentation is present, melanin functions as a defence against toxic agents penetrating into the oral mucosa.

One hundred and twenty Danish homosexual men were enrolled to characterize risk factors for anal type-specific human papillomavirus (HPV) expression and to examine its association with anal epithelial atypia. Detection of HPV strongly correlated with immunosuppression measured by T-lymphocyte subset markers and rose nearly linearly from 7.3% among subjects with CD4/CD8 ratios above 1.0 to 35.3% among those with a ratio below 0.4 (p trend = 0.003). No association was found between presence of HPV and a wide range of lifestyle factors including number of sex partners/year, smoking, alcohol consumption and illegal drug intake. However, self-reported history of anal condyloma in the past year was correlated with HPV (p less than 0.001). Simultaneous testing for presence of HPV in the oral cavity showed evidence of HPV 16,18 and 31,33,35. Anal smears were abnormal in 19.5% of the men and correlated strongly with presence of HPV (OR = 6.1, p less than 0.001). Type-specific associations were found with HPV 31/33/35 (OR = 8.5) and HPV 16/18 (OR = 3.1) only. The association remained significant after adjusting for immune status. Overall, HPV was detected in 50% of the cases with abnormal smears. However, HPV was found in all subjects with abnormal smears and a CD4/CD8 ratio below 0.4, compared to only 3 of 14 subjects with abnormal smears and a ratio greater than or equal to 1.3. In conclusion, (1) HPV may be missed in a substantial number of infected subjects with a normal immune system. This may have an impact on studies trying to describe risk factors for HPV transmission and its correlation with cancer development. (2) The finding of HPV 16,18 and 31,33,35 in the oral cavity makes oral-genital sexual activity at least a hypothetical route of transmission for these HPV types. (3) HPV appears to play a central role in the development of anal epithelial abnormality.

A case-control study to elucidate the etiology of oral submucous fibrosis was conducted in Bhavnagar, Gujarat. Sixty consecutively arriving oral submucous fibrosis patients at a dental clinic were selected as cases. An equal number of controls matched for age, sex, religion and socioeconomic status were selected from individuals who did not exhibit any oral mucosal lesion or condition. Among cases, 98% chewed areca nut regularly in one form or the other whereas among controls 35% chewed areca nut, giving an overall relative risk of 109.6. Areca nut chewing was practiced most commonly in the form of mawa: a mixture containing mainly areca nut (over 90% by weight), some tobacco, and a few drops of lime. Mawa chewers and those who chewed mawa along with other chewing habits showed very high relative risks. The relative risks increased with increase in the frequency as well as the duration of chewing habits. In a bivariate analysis the effect of frequency and duration of chewing appeared to be multiplicative. The present findings confirm areca nut as the most important etiologic factor in oral submucous fibrosis.

Epstein-Barr virus and multivesicular structures appearing in lesions of hairy leukoplakia have been examined ultrastructurally in serial sections. It was found that both structures probably represent various levels of sectioning of transversely cut cell processes. The so-called viral nucleocapsid having a single membrane results when the plane of section is at right angles to one of the membranes but tangential to the other. While the so-called viral particle having two membranes would result if the plane of section is perpendicular to both the membranes of adjacent cells. The internal electron-dense core probably represents filaments enclosed within these processes and therefore does not represent DNA nucleotides. In addition, these nuclei contained bundles of filaments which probably represented tonofilaments. This was found to be due to tangential sectioning of the nuclear membrane surrounding deep cytoplasmic invaginations which led to the appearance of these filaments as if free within the nucleus.

Besides genetic factors, tobacco smoking is known to be the main cause of oral melanin pigmentation. The present study compares the frequency of oral melanin pigmentation in a large number of former smokers with that of non-smokers. It also describes in two patients the disappearance of smoker's melanosis in the buccal mucosa following a considerable reduction in smoking.

One hundred Danes with oral cancer who were collected consecutively from 1986 to 1991 were evaluated retrospectively. The study included subjective and objective observations in 56% men and in 44% women. M:F ratio was 1.2:1. Fifty percent of the patients were non-smokers. Nine percent were women who did not drink alcohol. Ten percent of the patients were between 40 and 49 years of age, 20% between 50 and 59 years, 35% were between 60 and 69 years and 20% between 70 and 79 years of age. This may reflect a tradition of early drinking and smoking. Doctor's delay was the cause of delayed referral in 14% of the cases while 72% of the patients were the cause themselves for the delayed referral.

A benign but locally invasive polymorphic neoplasm consisting of proliferating odontogenic epithelium, which usually has a follicular or plexiform pattern, lying in a fibrous stroma.

The classification applies only to carcinomas of the vermilion surfaces of the lips and of the oral cavity, including those of minor salivary glands. There should be histological confirmation of the disease.The following are the procedures for assessment of the T,N and M categories: T categories Physical examination and imaging N categories Physical examination and imaging M categories Physical examination and imaging

Histological Classification of Cancer and Precancer of the Oral Mucosa.- Definitions and Explanatory Notes.- Carcinomas.- Benign Lesions Capable of Microscopically Resembling Oral Squamous Cell Carcinoma and Oral Verrucous Carcinoma.- Precancerous Lesions (Clinical Classification).- Precancerous Lesions (Histological Classification).- Benign Lesions Capable of Resembling Oral Precancerous Lesions.- Precancerous Conditions.- TNM Classification of Lip and Oral Cavity Carcinomas.- Illustrations.

An international group of epidemiologists, clinicians and pathologists with a special interest in oral white lesions and their precancerous significance has reviewed earlier work on this topic and identified some of the problems associated with previous definitions, descriptions and classifications. Modifications to these definitions, descriptions and classifications have been proposed, accompanied by explanations of the reasons for identifying the need for changes to be made. Leukoplakia may be a provisional or definitive diagnosis dependent upon the circumstances of oral examination and the availability of other information. Guidelines are provided to assist in the application of the definitions of oral leukoplakia and illustrations depict the homogeneous and non-homogeneous clinical variants. Consideration is also given to the importance of a red component in a white lesion, or a lesion that is entirely red (erythroplakia). A new clinical staging procedure for oral leukoplakia is also proposed.

Oral submucous fibrosis (OSF) is a high risk precancerous condition, predominantly affecting Indians. Consumption of chilli was hypothesized as an etiologic factor on the basis of ecological observations and a solitary animal experimental study. Subsequent epidemiologic studies that included case-series reports, large cross-sectional surveys, case-control studies, cohort and intervention studies have identified areca nut as the major etiologic agent. Tissue-culture studies involving human fibroblasts, areca nut extracts and areca nut alkaloids supported this etiologic hypothesis by showing fibroblastic proliferation and increased collagen formation. Currently, the role of genetic susceptibility and that of autoimmunity are receiving attention. The influence of nutritional factors, if any, remains unclear.

A total of 84 HIV-infected homosexual men having either normal oral mucosa (NOM), erythematous candidiasis (EC) or pseudomembranous candidiasis (PsC) were included in the study. The patients were evaluated by median number of peripheral CD4+ cells, CD8+ cells and by lymphocyte function assessed by poke-weed mitogen test. There was a significant difference between CD4+ counts among patients with the two subtypes of candidiasis (95% CI of median difference: 10-240/mm3; P = 0.03), but not for pokeweed mitogen response. Survival analysis showed that after 2 y there was no significant difference in development of AIDS between patients with EC and PsC (P = 0.29). If patients with both types of oral candidiasis were pooled and compared with patients with NOM, a significant difference in development of AIDS was found (P = 0.04). It is concluded that HIV-infected patients with oral candidiasis of any subtype (EC or PsC) are significantly more immune suppressed and show a faster development of AIDS than HIV-infected patients with NOM. However, in this cohort, EC and PsC are of equal importance as predictors for immune suppression and AIDS development.

In 1967, the World Health Organization (WHO) established a WHO Collaborating Centre for Oral Precancerous Lesions in Copenhagen. In 1972, while work was being carried out at this center, a meeting arranged by WHO was held in Geneva with the aim of defining precancerous lesions in different organs of the body. As result of this meeting, the suggestion of distinguishing between precancerous lesions and precancerous conditions was made. A precancerous lesion is a morphologically altered tissue in which cancer is more likely to occur than in its apparently normal counterpart. A precancerous condition, on the other hand, is a generalized state associated with a significantly increased risk of cancer. Examples of precancerous conditions are syphilis, submucous fibrosis, and lichen planus.

This article introduces the revised World Health Organization (WHO) classification of odontogenic tumors and jaw cysts and certain bone lesions that either are peculiar to the jaws or have distinctive features in that location. The new and revised classification is compared with the previous version, the reasons for the changes are outlined, and reference is made to a number of newly characterized lesions that have been included.

As more than 40 different oral lesions may be associated with the HIV-infection there is a need for classifying these lesions as a tool to be used in epidemiological studies. The paper deals with the classification proposed by the European Community.

Infection with the human immunodeficiency virus (HIV) may cause a variety of oral lesions, such as candidiasis, periodontal disease, hairy leukoplakia, Kaposi's sarcoma and a number of miscellaneous lesions and conditions. One hundred HIV-infected patients, including AIDS patients, referred to a University Hospital in Amsterdam, were examined orally. Most patients were initially seen by the Department of Internal Medicine, the oral examination by a well-trained dentist being part of the routine screening of all HIV-infected patients. In 80 per cent of all patients one or more HIV-related lesions of the oral mucosa was recorded. In 6 per cent of those patients the oral lesion was the first manifestation of the HIV infection. Hairy leukoplakia was observed in 15 per cent of all patients. Candidiasis proved to be the most common oral disease. In patients with full-blown AIDS the pseudomembranous form of candidiasis was the most common one, while in HIV-infected patients the erythematous type prevailed. These results emphasize the role of the dentist in making an early diagnosis of HIV infection.

The calcifying epithelial odontogenic tumor (CEOT) was described as an entity by Pindborg in 1955. In 1976 a review of the world literature comprising 113 cases was published. Since then, several studies concerned with pathological aspects of this tumor have appeared. Many of these studies have focused on the nature of the amyloid-like material present in CEOT. In this paper a new case is presented and the literature after 1976 is reviewed with respect to histopathological aspects of CEOT.

Incidence of oral submucous fibrosis was calculated from a 10-yr prospective intervention study of 12,212 individuals with a strong component of health education on tobacco and area nut chewing. Based on 11 new cases among 6341 chewers, the annual incidence was 8.0 per 100,000 among men and 29.0 for women. An earlier 10-yr follow-up study, with no intervention component, served as control. Based on 11 new cases among 3,809 chewers, the annual incidence was 21.3 per 100,000 for men and 45.7 for women controls. Although the decrease in the incidence in the intervention cohort was not statistically significant due to small number of cases, the results underscored the causal role of areca nut chewing and indicated the potential for primary prevention of oral submucous fibrosis.