The study confirms lichenoid features may be found in OEDs and epithelial dysplasia may be found in OLP/OLL. We reconfirm that these microscopic features may coexist. Our findings require further discussion by a panel of experts to redefine the entity known as 'lichenoid dysplasia'. Future studies should address the concept of lichenoid dysplasia that may assist to resolve any controversies with regard to the malignant potential of OLP.

The presence of Candida in OSCC solely does not justify its role in carcinogenesis. Further appraisal to evaluate a direct causal role of the micro-organism in potentially malignant disorders and OSCC is required.

Apart from the absence of an endophytic growth pattern in OVH, we noted the presence of dysplasia in OVH. This significant observation does institute a debate as to whether this enigmatic lesion could possibly be a precedent of oral squamous or verrucous carcinoma. We propose OVH is a distinct entity in our Indian population and should be considered in the classification of oral potentially malignant disorders.

The oral cavity being the hub of gamut of microbes, promotes the establishment of distinct microbial communities, such as on the mucosa and teeth. Metabolism of these organisms facilitates the attachment and growth of the subsequent colonisers. A delicate balance is maintained in the microbial ecosystem, with these organisms contributing to normal development and defences. However, any change or disruption in the microbial profile due to either intrinsic or extrinsic factors can result in an unfavorable shift toward pathogenic organisms triggering various diseases like dental caries or periodontitis. Furthermore, recent findings also state that these microorganisms may lead to systemic diseases like diabetes or atherosclerosis. This article is an attempt to give an overview of the altered flora in diseased states.

(1) Objective: To review the criteria proposed by Cerero-Lapiedra et al. and to retrospectively identify the under-diagnosed disease in patients diagnosed with proliferative verrucous leukoplakia. (2) Materials and methods: In this study, we included patients who were diagnosed with leukoplakia (histological label consistent with the clinical diagnosis, n = 95), and cases with a final diagnosis within the spectrum of proliferative verrucous leukoplakia (n = 110) as defined by Batsakis et al. We applied the criteria proposed by Cerero-Lepiedra et al. to screen for the possible cases of proliferative verrucous leukoplakia. (3) Results: Although many of our patients satisfied specific isolated criteria, only 11 cases satisfied specific combinations of the guidelines to satisfy a diagnosis of proliferative verrucous leukoplakia. However, due to the lack of follow-up data, the disease is not confirmed in these 11 cases. (4) Conclusion: A limited number of cases of proliferative verrucous leukoplakia were diagnosed using the criteria given by Cerero-Lapiedra et al. The true natural history of the disease could not be studied due to the lack of follow-up data. (5) Clinical relevance: Proliferative verrucous leukoplakia presenting as hyperkeratosis or mild epithelial dysplasia are often not followed up, and they subsequently transform into carcinoma. Thus, clinicians must be vigilant whenever they encounter leukoplakia, especially with multifocal presentations. In such cases, the follow-up data are the key to understanding the true nature of the disease entity.