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Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer

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A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Mechanisms of Diseases".

Deadline for manuscript submissions: closed (25 March 2022) | Viewed by 27457

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Special Issue Editors

Prof. Dr. Peter Polverini

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Guest Editor

School of Dentistry, University of Michigan, Ann Arbor, MI, USA
Interests: oral lesions; precision medicine; oral medicine; oral and maxillofacial pathology; vascular biology
Special Issues, Collections and Topics in MDPI journals

Dr. Francesco Bennardo

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Co-Guest Editor

School of Dentistry, Department of Health Sciences, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
Interests: dental implantology; oral surgery; osteonecrosis of the jaws; platelet concentrates; platelet-rich fibrin; third molar surgery
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

Precision medicine is a customized approach to disease prevention and treatment. It also facilitates stratification of patient populations that vary in their susceptibility to disease and response to therapy. The recognition of tobacco, alcohol, and human papillomavirus as causative agents in oral and head and neck cancer has accelerated the development of diagnostic aids and treatment strategies to mitigate cancer progression. New “omics” technologies have revealed unique tumor biomarkers that have facilitated precision diagnosis and customized therapy. Recent advances in tumor immunology have stimulated renewed interest in the development of precision immunotherapy of oral and head and neck cancer. The future success of early diagnosis and tailored medical treatment for cancer patients will depend on discovering new druggable targets with improved therapeutic efficacy. As precision medicine becomes integrated into dental practice, and chair-side technologies are developed to facilitate early detection and risk assessment, patients’ long-term health outcomes with oral cancer will improve dramatically.

Prof. Dr. Peter Polverini
Guest Editor

Dr. Francesco Bennardo
Co-Guest Editor

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Keywords

Dental practice
Chairside technologies
Oral cancer
Omics technology
Biomarkers
Immunotherapy
Health outcomes

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Published Papers (9 papers)

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Research

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14 pages, 606 KiB

Open AccessArticle

The Need for Oral Hygiene Care and Periodontal Status among Hospitalized Gastric Cancer Patients

by Flavia Mirela Nicolae, Francesco Bennardo, Selene Barone, Petra Șurlin, Dorin Nicolae Gheorghe, Daniela Burtea, Ștefan Pătrascu, Sandu Râmboiu, Adrian Petru Radu, Bogdan Silviu Ungureanu, Adina Turcu-Știolica, Andreea Cristiana Didilescu, Victor Dan Eugen Strâmbu, Valeriu Marin Șurlin and Dan Ionuț Gheonea

J. Pers. Med. 2022, 12(5), 684; https://doi.org/10.3390/jpm12050684 - 26 Apr 2022

Cited by 1 | Viewed by 2488

Abstract

Poor oral hygiene leads to the accumulation of dental plaque, thus contributing to the initiation of periodontal disease (PD). Local infections can lead to systemic inflammatory responses, which are essential mediators for the evolution of systemic conditions or cancer tumorigenesis. Often, patients hospitalized with life-threatening and incapacitating disorders such as gastric cancer (GC) might lose interest in keeping their mouth healthy. This study evaluates oral hygiene, periodontal status, and the need for oral care and medical personnel to assist in achieving it in patients hospitalized with GC. This study was carried out on 25 patients with a diagnosis of GC, divided into two groups (GP—14 patients from the Gastroenterology Department, and SP—11 patients from the 1st Department of Surgery). Patients were examined on the day of admission (T0), the day of the medical procedure of endoscopy or surgery (T1), and the day of discharge (T2), recording the number of absent teeth, dental plaque (PI), bleeding on probing (BOP), probing depths (PPD), frequency of toothbrushing, and if the oral hygiene had been self-performed or assisted. Data were subjected to statistical analysis. Our results showed that, in both the GP and the SP group, there were strong and statistically significant correlations between PI and BOP measured on the last day of hospitalization and the period of hospitalization after the medical procedure. Longer hospital stays and the presence of surgery were risk factors for changing toothbrushing frequency. Results also highlight the need for a dentist to diagnose and eventually treat periodontal disease before and after hospitalization, and for a trained nurse who should help take care of the patient’s oral hygiene during hospitalization. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

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13 pages, 1872 KiB

Open AccessArticle

Development and Validation of a Non-Invasive, Chairside Oral Cavity Cancer Risk Assessment Prototype Using Machine Learning Approach

by Neel Shimpi, Ingrid Glurich, Reihaneh Rostami, Harshad Hegde, Brent Olson and Amit Acharya

J. Pers. Med. 2022, 12(4), 614; https://doi.org/10.3390/jpm12040614 - 11 Apr 2022

Cited by 3 | Viewed by 2184

Abstract

Oral cavity cancer (OCC) is associated with high morbidity and mortality rates when diagnosed at late stages. Early detection of increased risk provides an opportunity for implementing prevention strategies surrounding modifiable risk factors and screening to promote early detection and intervention. Historical evidence identified a gap in the training of primary care providers (PCPs) surrounding the examination of the oral cavity. The absence of clinically applicable analytical tools to identify patients with high-risk OCC phenotypes at point-of-care (POC) causes missed opportunities for implementing patient-specific interventional strategies. This study developed an OCC risk assessment tool prototype by applying machine learning (ML) approaches to a rich retrospectively collected data set abstracted from a clinical enterprise data warehouse. We compared the performance of six ML classifiers by applying the 10-fold cross-validation approach. Accuracy, recall, precision, specificity, area under the receiver operating characteristic curve, and recall–precision curves for the derived voting algorithm were: 78%, 64%, 88%, 92%, 0.83, and 0.81, respectively. The performance of two classifiers, multilayer perceptron and AdaBoost, closely mirrored the voting algorithm. Integration of the OCC risk assessment tool developed by clinical informatics application into an electronic health record as a clinical decision support tool can assist PCPs in targeting at-risk patients for personalized interventional care. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

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11 pages, 443 KiB

Open AccessArticle

Neoexpression of JUNO in Oral Tumors Is Accompanied with the Complete Suppression of Four Other Genes and Suggests the Application of New Biomarker Tools

by Dominik Kraus, Simone Weider, Rainer Probstmeier and Jochen Winter

J. Pers. Med. 2022, 12(3), 494; https://doi.org/10.3390/jpm12030494 - 18 Mar 2022

Cited by 2 | Viewed by 2326

Abstract

Background. Our study describes the neoexpression (Juno) and suppression (catsperD, dysferlin, Fer1L5 and otoferlin) of selected genes in oral squamous cell carcinomas (OSCCs). As the expression pattern of these genes allows a “yes” or “no” statement by exhibiting an inverse expression pattern in malignant versus benign tissues, they represent potential biomarkers for the characterization of oral malignancies, particularly OSCCs. Methods. Differential expression analyses of selected genes of interest were examined by quantitative PCR of oral cancer tissues compared to normal. Results. Five candidates out of initially nine genes were examined, demonstrating Juno as a putative new tumor marker selectively expressed in OSCCs. Interestingly, the expression of four other genes in benign tissues was completely repressed in tumor tissues with a specificity and sensitivity of 100%. No correlation was observed regarding patients’ sex, tumor staging and grading, and tumor site. Conclusion. The present study shows novel candidates that might be useful tools for oral cancer diagnosis. The neoexpression of Juno in cancerous tissues makes it a promising target molecule regarding its potential in diagnosis as well a therapeutic tool. Moreover, our observations suggest that also the repression of gene expression can be used for diagnosing—at least—OSCCs. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

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11 pages, 259 KiB

Open AccessArticle

Leveraging Clinical Decision Support and Integrated Medical-Dental Electronic Health Records to Implementing Precision in Oral Cancer Risk Assessment and Preventive Intervention

by Donald B. Rindal and Patricia L. Mabry

J. Pers. Med. 2021, 11(9), 832; https://doi.org/10.3390/jpm11090832 - 25 Aug 2021

Cited by 2 | Viewed by 2866

Abstract

Introduction: Precision medicine is focused on serving the unique needs of individuals. Oral and oropharyngeal cancer risk assessment identifies individual risk factors while providing support to reduce risk. The objective is to examine potential current and future strategies to broadly implement evidence-based oral and oropharyngeal cancer risk assessment and screening in dental practices throughout the United States. Methods: Feasible and effective oral cancer risk assessment and risk reduction strategies, ripe for implementation in dental practice, were identified in the published literature. Results: The Screening, Brief Intervention, Referral for Treatment (SBIRT) model is a feasible approach to assessing individual oral cancer risk and providing risk reducing interventions in the dental setting. HPV is a more recently identified risk factor that dentistry is well positioned to address. Evidence supporting the utilization of specific risk assessment tools and risk reduction strategies is summarized and future opportunities discussed. Discussion: Current knowledge of risk factors for oral and oropharyngeal cancers support the recommendation for dental providers to routinely assess all patients for risk factors, educate them about their personal level of cancer risk, and recommend actions to reduce relevant risk factors. Individuals ages 9–26 should be asked about their HPV vaccination status, educated about HPV and oropharyngeal cancer and receive a recommendation to get the HPV vaccination. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

15 pages, 869 KiB

Open AccessArticle

Recurrent Convolutional Neural Networks for 3D Mandible Segmentation in Computed Tomography

by Bingjiang Qiu, Jiapan Guo, Joep Kraeima, Haye Hendrik Glas, Weichuan Zhang, Ronald J. H. Borra, Max Johannes Hendrikus Witjes and Peter M. A. van Ooijen

J. Pers. Med. 2021, 11(6), 492; https://doi.org/10.3390/jpm11060492 - 31 May 2021

Cited by 20 | Viewed by 3405

Abstract

Purpose: Classic encoder–decoder-based convolutional neural network (EDCNN) approaches cannot accurately segment detailed anatomical structures of the mandible in computed tomography (CT), for instance, condyles and coronoids of the mandible, which are often affected by noise and metal artifacts. The main reason is that EDCNN approaches ignore the anatomical connectivity of the organs. In this paper, we propose a novel CNN-based 3D mandible segmentation approach that has the ability to accurately segment detailed anatomical structures. Methods: Different from the classic EDCNNs that need to slice or crop the whole CT scan into 2D slices or 3D patches during the segmentation process, our proposed approach can perform mandible segmentation on complete 3D CT scans. The proposed method, namely, RCNNSeg, adopts the structure of the recurrent neural networks to form a directed acyclic graph in order to enable recurrent connections between adjacent nodes to retain their connectivity. Each node then functions as a classic EDCNN to segment a single slice in the CT scan. Our proposed approach can perform 3D mandible segmentation on sequential data of any varied lengths and does not require a large computation cost. The proposed RCNNSeg was evaluated on 109 head and neck CT scans from a local dataset and 40 scans from the PDDCA public dataset. The final accuracy of the proposed RCNNSeg was evaluated by calculating the Dice similarity coefficient (DSC), average symmetric surface distance (ASD), and

95 %

Hausdorff distance (95HD) between the reference standard and the automated segmentation. Results: The proposed RCNNSeg outperforms the EDCNN-based approaches on both datasets and yields superior quantitative and qualitative performances when compared to the state-of-the-art approaches on the PDDCA dataset. The proposed RCNNSeg generated the most accurate segmentations with an average DSC of 97.48%, ASD of 0.2170 mm, and 95HD of 2.6562 mm on 109 CT scans, and an average DSC of 95.10%, ASD of 0.1367 mm, and 95HD of 1.3560 mm on the PDDCA dataset. Conclusions: The proposed RCNNSeg method generated more accurate automated segmentations than those of the other classic EDCNN segmentation techniques in terms of quantitative and qualitative evaluation. The proposed RCNNSeg has potential for automatic mandible segmentation by learning spatially structured information. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

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18 pages, 2423 KiB

Open AccessArticle

Robust and Accurate Mandible Segmentation on Dental CBCT Scans Affected by Metal Artifacts Using a Prior Shape Model

by Bingjiang Qiu, Hylke van der Wel, Joep Kraeima, Haye Hendrik Glas, Jiapan Guo, Ronald J. H. Borra, Max Johannes Hendrikus Witjes and Peter M. A. van Ooijen

J. Pers. Med. 2021, 11(5), 364; https://doi.org/10.3390/jpm11050364 - 1 May 2021

Cited by 15 | Viewed by 3177

Abstract

Accurate mandible segmentation is significant in the field of maxillofacial surgery to guide clinical diagnosis and treatment and develop appropriate surgical plans. In particular, cone-beam computed tomography (CBCT) images with metal parts, such as those used in oral and maxillofacial surgery (OMFS), often have susceptibilities when metal artifacts are present such as weak and blurred boundaries caused by a high-attenuation material and a low radiation dose in image acquisition. To overcome this problem, this paper proposes a novel deep learning-based approach (SASeg) for automated mandible segmentation that perceives overall mandible anatomical knowledge. SASeg utilizes a prior shape feature extractor (PSFE) module based on a mean mandible shape, and recurrent connections maintain the continuity structure of the mandible. The effectiveness of the proposed network is substantiated on a dental CBCT dataset from orthodontic treatment containing 59 patients. The experiments show that the proposed SASeg can be easily used to improve the prediction accuracy in a dental CBCT dataset corrupted by metal artifacts. In addition, the experimental results on the PDDCA dataset demonstrate that, compared with the state-of-the-art mandible segmentation models, our proposed SASeg can achieve better segmentation performance. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

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Review

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10 pages, 628 KiB

Open AccessReview

Oral and Periodontal Implications of Hepatitis Type B and D. Current State of Knowledge and Future Perspectives

by Dorin Nicolae Gheorghe, Francesco Bennardo, Dora Maria Popescu, Flavia Mirela Nicolae, Claudiu Marinel Ionele, Mihail Virgil Boldeanu, Adrian Camen, Ion Rogoveanu and Petra Surlin

J. Pers. Med. 2022, 12(10), 1580; https://doi.org/10.3390/jpm12101580 - 26 Sep 2022

Cited by 3 | Viewed by 2881

Abstract

Periodontitis is characterized by low-grade inflammation of the periodontal tissues, the structures that support and connect the teeth to the maxilla and mandible. This inflammation is caused by the accumulation of subgingival bacterial biofilm and gradually leads to the extensive damage of these tissues and the consequent loss of teeth. Hepatitis B is a major global health concern; infection with the hepatitis B virus causes significant inflammation of the liver and the possibility of its gradual evolution to cirrhosis. Hepatitis D, caused by infection with the delta hepatitis virus, is manifest only in patients already infected with the type B virus in a simultaneous (co-infected) or superimposed (superinfected) manner. The dental and periodontal status of patients with hepatitis B/D could exhibit significant changes, increasing the risk of periodontitis onset. Moreover, the progression of liver changes in these patients could be linked to periodontitis; therefore, motivating good oral and periodontal health could result in the prevention and limitation of pathological effects. Given that both types of diseases have a significant inflammatory component, common pro-inflammatory mediators could drive and augment the local inflammation at both a periodontal and hepatic level. This suggests that integrated management of these patients should be proposed, as therapeutical means could deliver an improvement to both periodontal and hepatic statuses. The aim of this review is to gather existing information on the proposed subject and to organize significant data in order to improve scientific accuracy and comprehension on this topic while generating future perspectives for research. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

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13 pages, 317 KiB

Open AccessReview

Periodontitis, Metabolic and Gastrointestinal Tract Diseases: Current Perspectives on Possible Pathogenic Connections

by Dorin Nicolae Gheorghe, Adrian Camen, Dora Maria Popescu, Cerasella Sincar, Allma Pitru, Claudiu Marinel Ionele, Flavia Mirela Nicolae, Claudia Monica Danilescu, Alexandra Roman and Cristina Florescu

J. Pers. Med. 2022, 12(3), 341; https://doi.org/10.3390/jpm12030341 - 24 Feb 2022

Cited by 7 | Viewed by 2835

Abstract

Comprehensive research conducted over the past decades has shown that there is a definite connection between periodontal and systemic conditions, leading to the development and consolidation of the “periodontal medicine” concept. The 2018 classification of periodontal conditions uses this concept as a key element of the precise diagnosis of and individualized therapeutical protocols for periodontitis patients. The topic of this review is the pathogenic connections that exist between periodontal disease and metabolic/digestive tract conditions. It is important to remember that the oral cavity is a key element of the digestive tract and that any conditions affecting its integrity and function (such as periodontitis or oral cancer) can have a significant impact on the metabolic and gastrointestinal status of a patient. Thus, significant diseases with links to metabolic or digestive disruptions were chosen for inclusion in the review, such as diabetes mellitus, hepatic conditions and gastric cancers. Periodontal pathogenic mechanisms share several significant elements with these conditions, including mutual pro-inflammatory mediators, bacterial elements and genetic predisposition. Consequently, periodontal screening should be recommended for affected patients, and conversely, periodontitis patients should be considered for careful monitoring of their metabolic and digestive status. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

10 pages, 718 KiB

Open AccessReview

Usefulness of Magnetic Mallet in Oral Surgery and Implantology: A Systematic Review

by Francesco Bennardo, Selene Barone, Camillo Vocaturo, Ludovica Nucci, Alessandro Antonelli and Amerigo Giudice

J. Pers. Med. 2022, 12(1), 108; https://doi.org/10.3390/jpm12010108 - 14 Jan 2022

Cited by 26 | Viewed by 4012

Abstract

This systematic review aimed to answer the question: “Is the use of magnetic mallet effective in oral and implant surgery procedures in terms of tissue healing, surgery outcome, and complication rate compared to traditional instruments?” A literature search of PubMed, Scopus, and Web of Science databases (articles published until 1 October 2021) was conducted, in accordance with the PRISMA statement, using the keywords “magnetic mallet”, “electric mallet”, “oral surgery”, “implantology”, and “dental implant”. Of 252 articles, 14 were included in the review (3 for teeth extraction, and 11 for implant dentistry). Out of a total of 619 dental extractions (256 patients) performed with the magnetic mallet (MM), no complications were reported. Implants inserted totaled 880 (525 patients): 640 in the MM groups (382), and 240 in control groups (133). The survival rate of implants was 98.9% in the MM groups, and 95.42% in the control groups. Seven patients experienced benign paroxysmal positional vertigo after implant surgery, all in control groups. Results are not sufficient to establish the effectiveness of MM in oral and implant surgery procedures. Randomized controlled trials with a large sample size are needed. Full article

(This article belongs to the Special Issue Role of Dentistry in the Precision Diagnosis and Therapy of Oral Cancer)

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