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Abstract Purpose In order to diagnose mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV) with gingival expression, clinical data must be compared with immunohistochemical data obtained using direct immunofluorescence (DIF). It is therefore essential to carry out a good quality mucosal biopsy for this vital additional test. To date, no study has been able to effectively guide clinicians in their choice of oral site for biopsy to guarantee the efficient contribution of DIF to diagnosis. We propose a systematic review of the literature and a meta-analysis to clarify this issue. Materials and Methods Electronic databases and bibliographies of articles were searched in April 2023. The primary outcome was the rate of DIF + contribution to diagnosis according to the location of the oral site biopsied. Results 16 studies were included. Gingival biopsies showed a rate of DIF + 100% [97%-100%] p = 0.998 I2 = 0.0% with no heterogeneity for PV, and 90.2% [66.5%-100%] p

Background/Objectives: The diagnosis of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) represent a significant challenge in oral medicine. Optical coherence tomography (OCT) shows promise for evaluating oral tissue microstructure but lacks standardized diagnostic protocols tailored to the structural variability and lesions of oral mucosa. Methods: This cross-sectional observational study aims to evaluate the diagnostic accuracy of targeted biopsy-based and site-coded OCT protocols for common OPMDs and OSCC. Adult patients clinically diagnosed with OPMDs, including oral leukoplakia (OL), oral lichen planus (OLP), and OSCC were enrolled. Clinical and OCT evaluation before and after punch scalpel-site registration preceding diagnostic biopsy on the target site was performed. Blinded observers analyzed the OCT scans for OCT-based diagnoses. Sensitivity, specificity, and diagnostic accuracy for OCT evaluations before and after punch scalpel-site registration were statistically compared with histological findings. Results: A dataset of 2520 OCT scans and 210 selected images from 21 patients was obtained. Sensitivity and specificity post-target site registration were high for OSCC (98.57%, 100.00%), OL (98.57%, 98.57%), and OLP (97.14%, 98.57%). The positive predictive values ranged from 97.14% to 100.00%, while negative predictive values ranged from 98.57% to 99.29%. Inter-observer agreements were strong for OSCC (0.84) and moderate for OL (0.54) and OLP (0.47–0.49). Targeted OCT scans significantly improved diagnostic accuracy for all conditions (p < 0.001). Conclusions: This preliminary study supports using site-targeted OCT scans followed by a site-targeted punch biopsy, enhancing precision in oral diagnostics. This approach is foundational for developing pioneering automated algorithms guiding oral cancer and pre-cancer diagnosis via OCT imaging. [ABSTRACT FROM AUTHOR]

Purpose: In order to diagnose mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV) with gingival expression, clinical data must be compared with immunohistochemical data obtained using direct immunofluorescence (DIF). It is therefore essential to carry out a good quality mucosal biopsy for this vital additional test. To date, no study has been able to effectively guide clinicians in their choice of oral site for biopsy to guarantee the efficient contribution of DIF to diagnosis. We propose a systematic review of the literature and a meta-analysis to clarify this issue. Materials and Methods: Electronic databases and bibliographies of articles were searched in April 2023. The primary outcome was the rate of DIF + contribution to diagnosis according to the location of the oral site biopsied. Results: 16 studies were included. Gingival biopsies showed a rate of DIF + 100% [97%-100%] p = 0.998 I2 = 0.0% with no heterogeneity for PV, and 90.2% [66.5%-100%] p < 0.001 I2 = 89.6% with high heterogeneity for MMP. For the other oral sites, this rate was 95.7% [87.4%- 100%] p = 0.011 I2 = 73.0% with moderate heterogeneity for PV, and 87.4% [70.1%- 98.7%] p < 0.001 I2 = 92.6% with high heterogeneity for MMP. In addition, meta-regression confirmed the significant association between the appearance of the biopsied mucosa and the rate of DIF + in MMP (p < 0.001), with no influence on residual heterogeneity. Conclusion: The nature of the oral mucosa biopsied does not influence the rate of DIF + to diagnosis. The choice of biopsy site should only take into account the characteristics of the clinical picture and the benefit/risk balance of the surgical protocol. The sample must be taken in healthy aeras as close as possible of active lesions: on the gingiva if the MMP and PV are strictly gingival, on the alveolar mucosa if the whole gingiva is altered and on any healthy mucosa if a large number of oral sites are affected. Clinical trials: CRD42023392345. [ABSTRACT FROM AUTHOR]

Background: Neural tumors are difficult to distinguish based solely on cellularity and often require immunohistochemical staining to aid in identifying the cell lineage. This article investigates the potential of a Convolutional Neural Network for the histopathological classification of the three most prevalent benign neural tumor types: neurofibroma, perineurioma, and schwannoma. Methods: A model was developed, trained, and evaluated for classification using the ResNet‐50 architecture, with a database of 30 whole‐slide images stained in hematoxylin and eosin (106, 782 patches were generated from and divided among the training, validation, and testing subsets, with strategies to avoid data leakage). Results: The model achieved an accuracy of 70% (64% normalized), and showed satisfactory results for differentiating two of the three classes, reaching approximately 97% and 77% as true positives for neurofibroma and schwannoma classes, respectively, and only 7% for perineurioma class. The AUROC curves for neurofibroma and schwannoma classes was 0.83%, and 0.74% for perineurioma. However, the specificity rate for the perineurioma class was greater (83%) than in the other two classes (neurofibroma with 61%, and schwannoma with 60%). Conclusion: This investigation demonstrated significant potential for proficient performance with a limitation regarding the perineurioma class (the limited feature variability observed contributed to a lower performance). [ABSTRACT FROM AUTHOR]

Background: Oral biopsy is an essential diagnostic tool for identifying a range of oral lesions, from benign conditions to malignancies. Despite its significance, gaps in knowledge and practice among dentists may hinder its effective utilization, impacting patient outcomes. Objectives: To evaluate dentists' knowledge, clinical practices, and perceptions regarding oral biopsy procedures and their role in diagnosing oral lesions. Methods: A cross-sectional study was conducted among dental surgeons at Baqai Dental College in Karachi, where a validated questionnaire was distributed to 196 dental professionals of various designations. The questionnaire included 22 questions (8 open-ended and 14 close-ended) divided into two sections. The collected data were analyzed using descriptive statistics with Statistical Packages for Social Sciences (SPSS) version 20 software. Results: The study assessed participants' knowledge regarding biopsies for diagnosing suspicious oral lesions. Out of 196 participants, 71 were house officers, 59 were lecturers, 20 senior lecturers, and 46 assistant/associate professors. The results showed that 96% of general dental practitioners (GDPs) believed biopsies were necessary for such diagnoses, with some considering them essential for premalignant, malignant, and cystic lesions, while others believed they were only necessary for premalignant and malignant lesions. About 43% of participants were familiar with all biopsy methods. Reasons for not performing biopsies included difficulty in handling, lack of experience, decreased self-confidence, and insufficient patient compliance. Nearly all dentists acknowledged the need to improve their knowledge of oral lesions and biopsy techniques. Conclusion: The study participants were aware of oral screening and biopsy procedures but hesitant to perform them. This suggests that general dental practitioners (GDPs) would benefit from dental education programs focused on oral precancerous and cancer detection, as well as screening and diagnostic techniques.

Objective: The aim of this study was to assess the quality of free‐to‐access videos on oral biopsy procedures on the YouTube platform. Materials and Methods: We conducted a search on YouTube using the term "oral biopsy" and selected the first 100 videos in order of relevance. The following exclusion criteria were applied: language other than English, videos that did not cover oral biopsy techniques, videos on nonhuman specimens, postoperative instructions, personal experiences, exfoliative cytology, or "brush biopsy." Forty‐seven selected videos were classified based on their duration, country of origin, date of upload to the system, author, information source and number of views, and likes and dislikes. Video quality was analyzed using DISCERN, the Global Quality Scale (GQS), and the Video Information and Quality Index (VIQI). Results: The majority (78.7%) of analyzed videos were uploaded by dentists, originating from India (48.9%), with a mean duration of 11.8 min (SD, 20.4), with 104.5 likes (SD, 186.4) and 7.1 dislikes (SD, 10.55). The mean values for DISCERN, GQS, and VIQI were 1.3 (SD, 0.52), 2.1 (SD, 1.04), and 9.62 (SD, 1.69), respectively. Conclusion: The majority of videos on oral biopsy published on YouTube are of low quality. [ABSTRACT FROM AUTHOR]

Intense pulsed light (IPL) is used for aesthetic and therapeutic purposes. According to recent literature, utilizing IPL may boost upregulation of anti-inflammatory cytokines, and downregulation of pro-inflammatory cytokines. Concerns have been raised about potential thermal damage to the soft and hard tissues in the oral cavity. Therefore, the aim of this study was to determine the safety of using IPL of various intensities in the tissues of the oral cavity. Methods: Three adult pigs were included in the trial. The oral cavity was divided into four quadrants and projected with a wide range of IPL settings. Alveolar bone, buccal mucosa, and gingival tissue samples were taken immediately and after 24 h. In each animal, one quadrant of the jaw was left untreated and served as a control. All samples were processed and stained with H&E. Results: Clinical examination showed no evidence of changes in the integrity of the examined tissues. Histological examination of the different tissues did not demonstrate significant thermal damage or changes in the characterization of the cells compared to the control tissues. Conclusions: The use of IPL in the oral cavity is safe and does not negatively affect the tissues. [ABSTRACT FROM AUTHOR]

Background/Objectives: The diagnosis of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) represent a significant challenge in oral medicine. Optical coherence tomography (OCT) shows promise for evaluating oral tissue microstructure but lacks standardized diagnostic protocols tailored to the structural variability and lesions of oral mucosa. Methods: This cross-sectional observational study aims to evaluate the diagnostic accuracy of targeted biopsy-based and site-coded OCT protocols for common OPMDs and OSCC. Adult patients clinically diagnosed with OPMDs, including oral leukoplakia (OL), oral lichen planus (OLP), and OSCC were enrolled. Clinical and OCT evaluation before and after punch scalpel-site registration preceding diagnostic biopsy on the target site was performed. Blinded observers analyzed the OCT scans for OCT-based diagnoses. Sensitivity, specificity, and diagnostic accuracy for OCT evaluations before and after punch scalpel-site registration were statistically compared with histological findings. Results: A dataset of 2520 OCT scans and 210 selected images from 21 patients was obtained. Sensitivity and specificity post-target site registration were high for OSCC (98.57%, 100.00%), OL (98.57%, 98.57%), and OLP (97.14%, 98.57%). The positive predictive values ranged from 97.14% to 100.00%, while negative predictive values ranged from 98.57% to 99.29%. Inter-observer agreements were strong for OSCC (0.84) and moderate for OL (0.54) and OLP (0.47–0.49). Targeted OCT scans significantly improved diagnostic accuracy for all conditions (p < 0.001). Conclusions: This preliminary study supports using site-targeted OCT scans followed by a site-targeted punch biopsy, enhancing precision in oral diagnostics. This approach is foundational for developing pioneering automated algorithms guiding oral cancer and pre-cancer diagnosis via OCT imaging.

There are different kinds of benign and malignant lesions in the oral cavity. Clinically, definite diagnosis can be confirmed only by doing adequate surgical biopsy and subsequent histopathological examination. Inadequate biopsy technique, unsuitable selection of the location for biopsy, inappropriate tissue handling and record of patients' information may lead to artifacts and misdiagnosis by the oral pathologists. Soft tissue stabilization is a challenge during oral surgery procedures. It needs the cooperation of operator, assistants, and patients to overcome the difficulty and ensure the successful outcome. In this article, we reviewed the procedures for clinical surgical biopsy, and raised three current tissue stabilization methods including fingers and gauze stabilization, stabilization with chalazion forceps and adapted instruments, and stabilization with retraction sutures. Moreover, some limitations were also presented. Clinician should examine the clinical characteristics of the oral lesion, the surrounding anatomical structures, and their own clinical experience and preference to select the appropriate tool. More understanding of these biopsy and tissue stabilization methods can effectively improve the biopsy procedures and obtain adequate tissues for histopathological examination and subsequent issue of an accurate pathological report. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the histological artifacts caused by high-power laser use compared to cold scalpel surgery in oral soft tissue lesions. Clinical studies that evaluated and compared histological artifacts resulting from the use of high-power lasers and cold scalpels in oral soft tissue lesions biopsies were retrieved from seven databases and four grey literatures, up to July 2022. The risk of bias was investigated using the ROBINS-I tool. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Seven studies were eligible for qualitative analysis. Based on the results obtained, those four studies had a low risk of bias, and three studies had an unclear risk of bias. The certainty of the evidence was classified as low. Limited evidence showed that epithelial artifacts such as loss of intraepithelial and subepithelial adhesions, accompanied by pyknotic, fusiform, and/or hyperchromic nuclei, were more common when a high-power laser device was used. Four articles reported that the use of high-power lasers did not interfere with the histopathological diagnosis of oral soft tissue lesions. Due to the heterogeneity of the data, a meta-analysis was not performed. Compared to the use of cold scalpels, histological artifacts, particularly those observed in epithelial tissue, are more common when high-powered lasers are used in oral lesions biopsies. The eligibility criteria and adequate indications of high-power lasers in different oral soft tissue lesion treatments must be respected to avoid tissue artifacts that impair precise histopathological diagnosis. [ABSTRACT FROM AUTHOR]

Intense pulsed light (IPL) is used for aesthetic and therapeutic purposes. According to recent literature, utilizing IPL may boost upregulation of anti-inflammatory cytokines, and downregulation of pro-inflammatory cytokines. Concerns have been raised about potential thermal damage to the soft and hard tissues in the oral cavity. Therefore, the aim of this study was to determine the safety of using IPL of various intensities in the tissues of the oral cavity. Methods: Three adult pigs were included in the trial. The oral cavity was divided into four quadrants and projected with a wide range of IPL settings. Alveolar bone, buccal mucosa, and gingival tissue samples were taken immediately and after 24 h. In each animal, one quadrant of the jaw was left untreated and served as a control. All samples were processed and stained with H&E. Results: Clinical examination showed no evidence of changes in the integrity of the examined tissues. Histological examination of the different tissues did not demonstrate significant thermal damage or changes in the characterization of the cells compared to the control tissues. Conclusions: The use of IPL in the oral cavity is safe and does not negatively affect the tissues.

IntroductionMucous membrane pemphigoid (MMP) is diagnosed on the basis of a characteristic clinical picture (a predilection for mucosal involvement and scarring in the affected tissues) and a positive direct immunofluorescence (DIF) result.MethodsIn this study, we compare the diagnostic and prognostic values of conjunctival and oral biopsies analyzed by DIF in patients with MMP. Sixteen patients with MMP and mucosal involvement as a predominant symptom were classified into three groups based on the clinical picture. Oral and conjunctival DIF were performed on all patients.ResultsOur study showed that patients with simultaneous oral and conjunctival involvement had a positive oral DIF in 83% and a positive ocular DIF in 100% of the examined cases, respectively. Patients with isolated ocular MMP had a positive oral DIF in 50% and a positive ocular DIF in 66% of the examined cases, respectively. Patients with only oral involvement with MMP had a positive oral DIF in 100% and a positive ocular DIF in 50% of the examined cases, respectively.DiscussionOral biopsy should be performed first and is usually sufficient for the diagnosis, even in patients with exclusively ocular MMP, whereas in patients without clinical ocular involvement, ocular DIF is positive in half of the cases and may be a predictive factor for ocular lesions in the future.

Abstract Objectives The primary aim of this ex vivo study was to evaluate thermal damage and cutting efficiency of micro and super pulsed diode lasers. The secondary aim was to suggest a guideline to perform simple surgical excisions adequate for histopathological evaluation. Material and Methods Ten groups of 10 specimens of pig tongues were excised using a blade (G1), a micro pulsed (G2–G9), and a super pulsed diode (G10) lasers. Different output power, pulse duration, pulse interval, and duty cycle were tested. Quantitative measures of thermal damage and excision times were recorded. Statistical analysis was performed at a significance level of 5%. Results The control group (G1) presented no thermal damage. Within the laser groups (G2–G10), no statistically significant differences in depth of thermal damage (µm) were noted. G3 showed significantly less area of thermal damage (mm2) when compared with G7 and G9 (p

Background: Electronic cigarettes are increasing in popularity, but there is only little information on their biologic effects on the oral epithelium, the initial site exposed to electronic cigarette smoke. Methods: We assessed the oral epithelium response to electronic cigarettes by comparing the histology and RNA transcriptome (mRNA and miRNA) of healthy electronic cigarette vapers to nonsmokers. mRNA was assessed based on: (1) genome‐wide; (2) genes previously identified as dysregulated in the oral epithelium of electronic cigarette vapers versus nonsmokers; (3) immune and inflammatory‐related genes previously identified as dysregulated in the nasal epithelium of electronic cigarette vapers compared to nonsmokers; (4) genes previously identified as dysregulated in the small airway epithelium of nonsmokers following an acute exposure to electronic cigarette; and (5) genes related to the initial steps of COVID‐19 infection. In addition, miRNA was assessed genome‐wide. Comparisons were performed using analysis of variance, and Benajmini–Hochberg corrected p < 0.05 was considered significant. Results: The histology of the epithelium, lamina propria and basal layer in electronic cigarette vapers appeared normal. Assessment of mRNA and miRNA, based on all gene lists, did not identify any genes significantly modified in the oral epithelium of electronic cigarette vapers in response to electronic cigarette use. Conclusion: An average history of 2 years of vaping results in no detectable histologic or transcriptome abnormalities in the buccal mucosa. [ABSTRACT FROM AUTHOR]

The aim of the study is to review the literature to observe studies that evaluate the extent of the thermal effect of different laser wavelengths on the histological evaluation of oral soft tissue biopsies. An electronic search for published studies was performed on the PubMed and Scopus databases between July 2020 and November 2022. After the selection process, all the included studies were subjected to quality assessment and data extraction processes. A total of 28 studies met the eligibility criteria. The most studied laser was the carbon dioxide (CO2) laser, followed by the diode laser 940 nm–980 nm. Six studies were focused on each of the Erbium-doped Yttrium Aluminium Garnet (Er:YAG), Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) lasers, and diode lasers of 808 nm and 445 nm. Three studies were for the Potassium Titanyl Phosphate (KTP) laser, and four studies were for the Erbium, Chromium-doped Yttrium, Scandium, Gallium, and Garnet (Er,Cr:YSGG) laser. The quality and bias assessment revealed that almost all the animal studies were at a low risk of bias (RoB) in the considered domains of the used assessment tool except the allocation concealment domain in the selection bias and the blinding domain in the performance bias, where these domains were awarded an unclear or high score in almost all the included animal studies. For clinical studies, the range of the total RoB score in the comparative studies was 14 to 23, while in the non-comparative studies, it was 11 to 15. Almost all the studies concluded that the thermal effect of different laser wavelengths did not hinder the histological diagnosis. This literature review showed some observations. The thermal effect occurred with different wavelengths and parameters and what should be done is to minimize it by better adjusting the laser parameters. The extension of margins during the collection of laser oral biopsies and the use of laser only in non-suspicious lesions are recommended because of the difficulty of the histopathologist to assess the extension and grade of dysplasia at the surgical margins. The comparison of the thermal effect between different studies was impossible due to the presence of methodological heterogeneity. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this ex vivo study was to evaluate thermal damage and cutting efficiency of micro and super pulsed diode lasers. The secondary aim was to suggest a guideline to perform simple surgical excisions adequate for histopathological evaluation. Material and Methods: Ten groups of 10 specimens of pig tongues were excised using a blade (G1), a micro pulsed (G2–G9), and a super pulsed diode (G10) lasers. Different output power, pulse duration, pulse interval, and duty cycle were tested. Quantitative measures of thermal damage and excision times were recorded. Statistical analysis was performed at a significance level of 5%. Results: The control group (G1) presented no thermal damage. Within the laser groups (G2–G10), no statistically significant differences in depth of thermal damage (µm) were noted. G3 showed significantly less area of thermal damage (mm2) when compared with G7 and G9 (p <.05). The median excision time of the control group and super pulsed diode laser group were significantly lower (p <.001) than the micro pulsed diode laser groups. Conclusions: The cutting efficiency of the super pulsed diode laser is comparable to traditional blade, and with appropriate parameters, these lasers can produce predictable surgical outcomes with less collateral damage. [ABSTRACT FROM AUTHOR]

Introduction: Various diagnostic procedures are available to reach a diagnosis in case of oral lesions/conditions. Biopsy is one of the important tools for confirmatory diagnosis. Therefore, the dentist should have adequate awareness regarding oral biopsy procedures. Objectives: The objective of the study was to determine the awareness of oral biopsy procedure among dentists in Haryana. Materials and Methods: It was a cross-sectional study conducted among dentists in Haryana, India, using a 16-item close-ended questionnaire. Google Forms was prepared via docs.google.com/forms, and the link was sent to the participants via social media platforms such as WhatsApp and Viber. The filled questionnaires were extracted from Google Forms and exported to Microsoft Excel 2016. Descriptive statistics such as frequency and percentage were calculated to present the data using the Statistical Package for the Social Sciences software, version 21. Results: Out of 68, only 35.3% and 50% of the dental surgeons were aware that the removal of tissue by laser or electrosurgery can introduce artifacts or tissue distortion and punch biopsy generally produces few artifacts within the biopsied sample, respectively. Among the respondents, 35.3% and 11.8% responded that formaldehyde and normal saline also can be used for fixation of the biopsy sample. Conclusion: Awareness of oral biopsy technique was not up to date among majority of the dentists. Eminent steps should be taken to increase the awareness of biopsy procedure among them.

Trial Design: The study was designed as an open label randomized comparative parallel group design with a 1:1 allocation ratio. Methods: All consecutive patients reporting for small biopsies (incisional or excisional) who gave written informed consent were included in the study between October 2018 and October 2019. They were randomized into two groups, Group A and Group B both receiving intervention in the form of 2.5% EMLA cream and 2% Lignocaine with 1:80,000 Adrenaline injection respectively, to anaesthetise tissue for small mucosal biopsies in the oral cavity. Results: EMLA was found to be as effective as lignocaine infiltration with a completely painless application and higher satisfaction for overall comfort during procedure. The duration required to achieve anaesthesia was however more. A particular subgroup of pathology was found to be completely resistant to anaesthesia by EMLA. Conclusion: We recommend the use of EMLA as a sole anaesthetic in small mucosal biopsies and shavings in all patients. We suggest it as a higher and first line recommendation for anaesthesia in needle phobic patients and children. [ABSTRACT FROM AUTHOR]

The aim of the study is to review the literature to observe studies that evaluate the extent of the thermal effect of different laser wavelengths on the histological evaluation of oral soft tissue biopsies. An electronic search for published studies was performed on the PubMed and Scopus databases between July 2020 and November 2022. After the selection process, all the included studies were subjected to quality assessment and data extraction processes. A total of 28 studies met the eligibility criteria. The most studied laser was the carbon dioxide (CO2) laser, followed by the diode laser 940 nm–980 nm. Six studies were focused on each of the Erbium-doped Yttrium Aluminium Garnet (Er:YAG), Neodymium-doped Yttrium Aluminum Garnet (Nd:YAG) lasers, and diode lasers of 808 nm and 445 nm. Three studies were for the Potassium Titanyl Phosphate (KTP) laser, and four studies were for the Erbium, Chromium-doped Yttrium, Scandium, Gallium, and Garnet (Er,Cr:YSGG) laser. The quality and bias assessment revealed that almost all the animal studies were at a low risk of bias (RoB) in the considered domains of the used assessment tool except the allocation concealment domain in the selection bias and the blinding domain in the performance bias, where these domains were awarded an unclear or high score in almost all the included animal studies. For clinical studies, the range of the total RoB score in the comparative studies was 14 to 23, while in the non-comparative studies, it was 11 to 15. Almost all the studies concluded that the thermal effect of different laser wavelengths did not hinder the histological diagnosis. This literature review showed some observations. The thermal effect occurred with different wavelengths and parameters and what should be done is to minimize it by better adjusting the laser parameters. The extension of margins during the collection of laser oral biopsies and the use of laser only in non-suspicious lesions are recommended because of the difficulty of the histopathologist to assess the extension and grade of dysplasia at the surgical margins. The comparison of the thermal effect between different studies was impossible due to the presence of methodological heterogeneity.

Introduction: Various diagnostic procedures are available to reach a diagnosis in case of oral lesions/conditions. Biopsy is one of the important tools for confirmatory diagnosis. Therefore, the dentist should have adequate awareness regarding oral biopsy procedures. Objectives: The objective of the study was to determine the awareness of oral biopsy procedure among dentists in Haryana. Materials and Methods: It was a cross-sectional study conducted among dentists in Haryana, India, using a 16-item close-ended questionnaire. Google Forms was prepared via docs.google.com/forms, and the link was sent to the participants via social media platforms such as WhatsApp and Viber. The filled questionnaires were extracted from Google Forms and exported to Microsoft Excel 2016. Descriptive statistics such as frequency and percentage were calculated to present the data using the Statistical Package for the Social Sciences software, version 21. Results: Out of 68, only 35.3% and 50% of the dental surgeons were aware that the removal of tissue by laser or electrosurgery can introduce artifacts or tissue distortion and punch biopsy generally produces few artifacts within the biopsied sample, respectively. Among the respondents, 35.3% and 11.8% responded that formaldehyde and normal saline also can be used for fixation of the biopsy sample. Conclusion: Awareness of oral biopsy technique was not up to date among majority of the dentists. Eminent steps should be taken to increase the awareness of biopsy procedure among them. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the postoperative course in patients undergoing oral mucosal biopsies, considering clinical and patient's perception variables potentially correlated to poor healing. Subjects and methods: Eighty patients underwent oral biopsies. All the variables connected with the surgery were recorded, and the harvested volume was calculated through image software (ImageJ, NIH, Betesda, USA). To evaluate the postoperative discomfort, the OHIP-14 and the numeric rating scale of pain (NRS) were administered at 6 h, 7 days and 21 days after biopsy. Results: Six hours after the biopsy, 22 (OHIP-14 ≥ 20) and 24 (NRS ≥ 4) patients experienced a troublesome or painful healing, respectively. A significant statistical correlation between poor healing and high scores of NRS and OHIP was detected (Pearson's correlation test p < 0.05). Higher values of OHIP-14 were correlated to the type of lesion (OR = 1.165; p < 0.05), whereas high values of NRS were correlated to the use of systemic drugs (p < 0.05). No surgical variable had a significant statistical correlation with any of the outcomes. Conclusions: The clinical evaluation was correlated with the patient's perception of pain and discomfort. This finding could be suggestive of the fact that wound healing can be reliably monitored with the help of these tools. Clinical relevance: Patient perception can be a predictor of the healing of biopsied tissues. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to evaluate post-biopsy pain using a questionnaire supported by a visual analog scale (VAS), and the role of pharmacological agents in pain relief. Method and Materials: Three hundred patients undergoing oral biopsy were included in the study and divided into three groups. Group A: Patients received no analgesic post biopsy, except when required (SOS). Group B: Patients received anesthetic mouthwash along with oral analgesic post biopsy. Group C: Patients received anesthetic mouthwash alone. The statistical analysis was done using statistical analysis software SPSS version 11.0. ANOVA was used to compare the VAS scores and hygiene status of the three groups, while Pearson's chisquare test was used for determining association between age, sex, educational status, and association of pain with biopsy site. Results: A highly significant difference was found between the VAS scores of patients in Groups A, B, and C, and significant correlation was observed between hygiene status and degree of pain. Conclusion: Oral biopsy is definitely associated with pain, if proper medications are not deployed. Anesthetic mouthwash alone is sufficient to relieve the pain produced by oral biopsy. Direct correlation exists between hygiene status and the level of discomfort, thereby indicating that pain control is essential for good oral hygiene maintenance. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate, ex vivo, the histological effects of 445-nm diode laser (Eltech K-Laser srl, Treviso, Italy), during an oral soft tissue biopsy. Materials and methods: Thirty samples from pig cadaver tongues were obtained, through five laser settings, in continuous and pulsed wave (CW and PW). Samples were divided into six groups of five pieces each. A control specimen was taken by a scalpel. All samples were examined with an optical microscope by a blinded pathologist. Thermal effects on epithelium and connective tissues were measured with LAS 4.8 software. Finally, a statistical evaluation was made using GraphPadPrism 7.0 software. Results: All specimens, except one, showed a damage lower than 1 mm. Readability was always optimal; there was a different thermal effect between epithelial and connective tissue and in CW and PW samples, confirmed by statistical analysis too. Conclusions: A 445-nm diode laser creates a minimum thermal effect, that has no implications in the histological evaluation of benign lesions. In suspicious lesions, a safety margin of 1 mm, compared with a scalpel, is preferable. Clinical relevance: A 445-nm diode laser has excellent surgical properties and can manage many arduous clinical cases, such as vascularized lesions. In the excision of suspected lesions, it is necessary to compare, case by case, clinical advantages to possible histological implications. [ABSTRACT FROM AUTHOR]

Background: The word biopsy originates from the Greek term bios (life) and opsis (vision): Meaning vision of life. In routine practice, the clinical diagnosis of oral lesions frequently must be confirmed by different procedures, among which oral biopsy constitutes an important tool by establishing the histologic characteristics. At times, it could be the only way to diagnose some oral lesions. Inaccurate diagnosis, or failure to diagnose oral disease, may have profound implications for both the patient and the clinician. It must be highlighted that oral biopsy is not only limited to diagnosis, but is also greatly useful to determine the nature of the lesions, i.e., benign/malignant and for designing effective treatment strategies. Aim: This study was designed to evaluate the knowledge and awareness of dental practitioners toward oral biopsy. Materials and Methods: A total of 50 dentists excluding the dental surgeons participated in this survey and it was completed successfully. The questionnaire used in this survey has a total of 12 questions which included the questions such as how often they come across an oral lesion requiring biopsy, reasons why they do not perform oral biopsy, knowledge regarding various types of biopsy and type of lesions they have come across in their practice and also whether they need to update their knowledge regarding lesions and biopsy procedures. The responses were collected and analyzed, and the results were presented as tables and pie charts. Results: From this study, it was found that 58% of dental practitioners perform oral biopsy and 34% do not perform oral biopsy. 76% of practitioners prefer to preserve in formalin because if the tissue is not preserved properly, it produces lot of artifacts which prevents the pathologist from giving an appropriate diagnosis, but few practitioners prefer alcohol (14%) and saline (4%) probably because they do not have the formalin in their clinics always since they seldom encounter lesions requiring biopsy. Conclusion: The awareness and practice of biopsy among dental practitioners were moderate. This survey helps to access the knowledge of dental practitioners toward biopsy and to create an awareness among them to avoid misdiagnosis of lesions. [ABSTRACT FROM AUTHOR]

Oral biopsy is a common surgical practice. To date, few authors have described the healing of mucosal wounds following oral biopsy. The aim of the present single-center, prospective, randomized, controlled study is to evaluate the differences between two chlorhexidine (CHX) mouthrinses and a treatment-free approach in the immediate postoperative period following oral mucosal biopsy. 354 patients were included in this study and were randomly allocated to three groups: A) CHX 0.12% mouthrinse (twice daily, 10 mL rinse for 30 s), B) CHX 0.20% mouthrinse (twice daily, 10 mL rinse for 30 s), and C) no topical treatment. 118 patients were treated in group A and 115 in group B; 121 received no therapy in group C, reporting the greatest improvement in related symptoms. Outcome variables included the age, gender, site and size of lesions, visual analog score (VAS), Oral Health Impact Profile questionnaire (OHIP-14), and number of painkillers taken during the first week post-surgery. Use of a CHX 0.12% mouthrinse exhibited the poorest outcome. On the other hand, best clinical healing was found for patients treated with CHX 0.20%. These findings suggest that regardless of its concentration, CHX was found to be ineffective in reducing related symptoms, whereas CHX 0.20% can be recommended to facilitate enhanced healing. [ABSTRACT FROM AUTHOR]

Cancer chemoprevention is a rapidly evolving approach to reverse or inhibit carcinogenesis, and there is active interest in development of effective chemopreventive agents against head and neck cancers. The retinoids are archetypal chemopreventive agents for oral premalignant lesions. They have significant clinical effect, but widespread use is limited by significant clinical toxicity. The Bowman-Birk Inhibitor is one of several nontoxic compounds exhibiting both potent anticarcinogenic activity and minimal toxicity. The purposes of the study were to summarize the preclinical and clinical development of Bowman-Birk Inhibitor and a Bowman-Birk Inhibitor concentrate against oral premalignant lesions and to evaluate Neu immunohistochemical staining intensity for lesions and simultaneously obtained biopsy specimens of normal-appearing mucosa from the Phase IIa Bowman-Birk Inhibitor concentrate oral leukoplakia chemoprevention trial.Part I is a selected literature review. Part II is a retrospective analysis of pathological specimens prospectively obtained from the Phase IIa clinical trial of Bowman-Birk Inhibitor concentrate.Thirty-two sets of biopsy specimens from lesions and uninvolved oral mucosa before and after treatment with Bowman-Birk Inhibitor concentrate in doses ranging from 200 to 1066 chymotrypsin inhibitory units were examined in blinded fashion for Neu immunohistochemical staining intensity using the 3B-5 monoclonal antibody. Staining intensity scores among the lesion and control biopsy specimens before and after Bowman-Birk Inhibitor concentrate treatment were analyzed and compared with previously obtained values for serum Neu, oral mucosal cell Neu, protease activity, and clinical response to treatment.Mean Neu staining score was significantly higher in lesions compared with uninvolved mucosa (P

Traditional telepathology techniques like whole slide imaging and robotic microscopy are too expensive to be used in developing countries. With the advent of smartphones with high-resolution cameras and faster internet services, it is now possible to send good-quality images to pathologist for diagnosis. To study the utility of WhatsApp image transfer in the histopathological diagnosis of common oral malignant and benign lesions. A total of 100 cases of oral biopsy were included in the study. These comprised of 58 cases of squamous cell carcinoma, 33 cases of oral leukoplakia, 3 cases of oral lichen planus and 6 cases of moderate to severe dysplasia. The conventional microscopy diagnosis made by glass slide viewing was taken as the gold standard and the concordance of the WhatsApp diagnosis with the gold standard was calculated for each category of diagnosis and also for all the 100 cases. The concordance rate for squamous cell carcinoma was 96.6%(56/58). For leukoplakia, there was 100%(33/33) concordance between the WhatsApp diagnosis and conventional microscopy. The concordance rates for dysplasia (4/6) and oral lichen planus (2/3) were 66.7% each. Hence, for all the categories taken together, the overall concordance rate was 95%. A concordance rate of 95% is very encouraging; however, for routine diagnostic use in telepathology, there is still a long way to go. With the availability of better smartphone cameras and faster internet, it will be possible to send better quality images in the future. The pathologists will also learn where to draw the line and ask for glass slides for final diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to evaluate secondary intention healing process and postoperative pain of oral soft tissues after laser surgery with the use of a compound containing chlorhexidine and sodium hyaluronate. Materials and methods: This double-blind, randomized clinical study included 56 patients affected by benign oral lesions and subjected to excisional biopsy with diode laser and randomly divided into three groups. Study group (SG) received 0.2% chlorhexidine digluconate and 0.2% sodium hyaluronate treatment; control group (CG) received 0.2% chlorhexidine digluconate; and placebo group (PG) followed the same protocol, taking a neutral solution having the same organoleptic characteristics. Wound healing was evaluated using percentage healing index (PHI). Numeric rating scale (NRS) was used to evaluate postoperative pain. Results: PHI (T1 = 7 days) was 67.25% for SG, 58.67% for CG, and 54.55% for PG. PHI (T2 = 14 days) was 94.35% for SG, 77.79% for CG, and 78.98% for PG. A statistically significant difference was between the groups for PHI at T2 p = 0.001. No difference was detectable for pain index. Conclusions: A solution containing sodium hyaluronate and chlorhexidine is a good support to increase wound healing by secondary intention after laser biopsy, but no differences were in postoperative perception of pain. Clinical relevance: The use of the tested solution can be recommended after laser oral biopsies, to achieve a healing without suture. About the postoperative pain, the compound has not showed the same results and did not have measurable effects. [ABSTRACT FROM AUTHOR]

Blue diode laser emits a 445 nm wavelength light, which is extremely effective with hemoglobin, and has an optimal hemostatic effect. This work analyzes its thermal effects and clinical efficacy, when used to perform excisional biopsies. Forty-two excisional biopsies were performed with the laser; then, the extent of perincisional thermal effects was evaluated and patients were followed up. Average alteration on epithelial tissue was 507.07 µm, and on connective tissue was 320.39 µm. In all the cases, it was possible to obtain a histological diagnosis. Diode lasers can be safely used to perform biopsies; various intra- and postoperative advantages were confirmed. [ABSTRACT FROM AUTHOR]

Introduction: Mucous membrane pemphigoid (MMP) is diagnosed on the basis of a characteristic clinical picture (a predilection for mucosal involvement and scarring in the affected tissues) and a positive direct immunofluorescence (DIF) result., Methods: In this study, we compare the diagnostic and prognostic values of conjunctival and oral biopsies analyzed by DIF in patients with MMP. Sixteen patients with MMP and mucosal involvement as a predominant symptom were classified into three groups based on the clinical picture. Oral and conjunctival DIF were performed on all patients., Results: Our study showed that patients with simultaneous oral and conjunctival involvement had a positive oral DIF in 83% and a positive ocular DIF in 100% of the examined cases, respectively. Patients with isolated ocular MMP had a positive oral DIF in 50% and a positive ocular DIF in 66% of the examined cases, respectively. Patients with only oral involvement with MMP had a positive oral DIF in 100% and a positive ocular DIF in 50% of the examined cases, respectively., Discussion: Oral biopsy should be performed first and is usually sufficient for the diagnosis, even in patients with exclusively ocular MMP, whereas in patients without clinical ocular involvement, ocular DIF is positive in half of the cases and may be a predictive factor for ocular lesions in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Jakubowska, Pietrzyk, Maciejewicz, Kowalewski and Wozniak.)

Introduction: It is mandatory for general dental practitioners (GDPs) to identify questionable oral lesions and provide a suitable diagnosis and treatment plan for the same. Biopsy serves as an important aid in establishing the histological characteristics of oral lesions leading to their accurate diagnosis. But most dentists are reluctant to perform biopsies and refer cases to higher centers. Aims and objectives: To explore the attitude of GDPs of Thrissur district of Kerala to biopsy of oral lesions, to explore the reasons for reluctance of GDPs to perform biopsies, to emphasize the importance of oral pathologists, and to create general awareness about the importance of oral biopsies. Materials and methods: A self-designed questionnaire detailing open- and close-ended questions regarding the sociodemographic and professional aspects of the dental practitioners and their knowledge about oral biopsy procedures filled in by the randomly selected dental practitioners was used. Results: Most dentists agreed that biopsy was important in diagnosis and management of oral lesions, though most of them did not perform biopsies due to various reasons. The knowledge of the practitioners regarding the various oral lesions, biopsy techniques, handling of specimen, and laboratory techniques were found to be inadequate. Conclusion: As of now, no emphasis is given regarding the mandatory need for biopsy by general dentists in the current curriculum of Dental Council of India (DCI) for the Bachelor of Dental Surgery degree. It is hoped that the study will help in emphasizing the need for specific training or continuing dental education (CDE) programs to enhance the practical skills of dental practitioners so that biopsy is regularly used as a tool in the diagnosis of questionable oral lesions. [ABSTRACT FROM AUTHOR]

Background and purpose: Accurate diagnosis of suspicious oral lesions is made by appropriate sampling and pathology examinations. Inappropriate biopsy can lead to diagnostic errors in histopathological examination of samples. The aim of this study was to evaluate the knowledge of general dentists in Sari, Iran and final-year dental students in Mazandaran University of Medical Sciences on transport and processing of oral biopsies. Materials and methods: This analytical cross-sectional study was carried out in 150 dentists and final-year dental students, 2015. Data was obtained using a researcher made questionnaire consisting of demographic characteristics and questions on transport and processing of oral biopsies. Data analysis was done in SPSS V.17 applying t-test, ANOVA, and Spearman correlation coefficients. Results: The questionnaires were completed by 150 people, including 106 dentists (50% males and 50% females, mean age: 39.9±6.2) and 44 final-year dental students (50% males and 50% females, mean age: 24.6±2.6). No significant difference was found between dentists and dentistry students in levels of awareness (54.4% and 55.1%, respectively, P=0.862). Attending retraining courses of oral pathology showed significant positive correlation with the level of awareness (P=0.017, r=0.219). Conclusion: The knowledge of dentists and dental students on transport and processing of oral biopsies was poor, therefore, retraining programs are needed to enhance this knowledge. [ABSTRACT FROM AUTHOR]

Introduction: The drastic epidemiological transition has created a huge void in evidence with regard to the health statistics of elderly population. Data are sparse on the oral mucosal conditions prevalent among the elderly Indian population. This study aimed to review the oral biopsies reported in the institute over the last 21 years and to examine the trends in geriatric oral pathologies.Methodology: A total of 964 histologically confirmed geriatric (age ranging 50-97 years) oral lesions among 4000 cases reported were retrieved from the files of Department of Oral Pathology and Microbiology of KLE VK institute, Belgaum, Karnataka commencing since 1992 till 2012. These cases were retrospectively evaluated for various parameters such as age, gender, duration, location and type of lesions.Results: The geriatric oral lesions were seen to occur predominantly in men (65%), especially the sixth decade of life (47%). The most common location was the buccal mucosa (29%). The malignant neoplastic lesions accounted for the majority of the geriatric lesions (36%) followed by non-neoplastic lesions (27%), potentially malignant disorders (26%) and benign neoplasms, which formed a minor proportion of (11%). The oral squamous cell carcinoma was the single most common geriatric lesion accounted. Gender and age-wise correlation analyses among the various lesion categories showed statistical significance.Conclusion: The study provides valuable information about major oral pathologies in our scenario that contribute to significant morbidity and mortality among the geriatric population. It also sheds light about the diseases that need to be targeted in future Indian public health policies and initiatives for geriatric care. [ABSTRACT FROM AUTHOR]

Twenty oral biopsies from 16 patients were analyzed both by traditional microscopy and by confocal laser scanning microscopy. Using conventional histopathological techniques, the diagnosis of amyloidosis was confirmed only in 15 biopsies. Using confocal laser scanning microscopy, amyloid deposits were detected in all of the samples. The current study shows that confocal laser scanning analysis helps to identify minimal amyloid deposits that could be overlooked using traditional microscopy, thus raising the sensitivity of oral biopsy up to 100%. [ABSTRACT FROM PUBLISHER]