In areas where the practise of betel quid chewing is widespread and the chewers also often smoke and drink alcohol, the relation between oral precancerous lesion and condition to the three habits is probably complex. To explore such association and their attributable effect on oral leukoplakia (OL) and oral submucous fibrosis (OSF), a gender -age-matched case -control study was conducted at Kaohsiung, southern Taiwan. This study included 219 patients with newly diagnosed and histologically confirmed OL or OSF, and 876 randomly selected community controls. All information was collected by a structured questionnaire through in-person interviews. A preponderance of younger patients had OSF, while a predominance of older patients had OL. Betel quid chewing was strongly associated with both these oral diseases, the attributable fraction of OL being 73.2% and of OSF 85.4%. While the heterogeneity in risk for areca nut chewing across the two diseases was not apparent, betel quid chewing patients with OSF experienced a higher risk at each exposure level of chewing duration, quantity and cumulative measure than those who had OL. Alcohol intake did not appear to be a risk factor. However, cigarette smoking had a significant contribution to the risk of OL, and modified the effect of chewing based on an additive interaction model. For the two oral premalignant diseases combined, 86.5% was attributable to chewing and smoking. Our results suggested that, although betel quid chewing was a major cause for both OL and OSF, its effect might be difference between the two diseases. Cigarette smoking has a modifying effect in the development of oral leukoplakia.

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Over a 10-year period (1982-1991); a total of 150 patients divided into two groups with varying degrees of oral submucous fibrosis (OSF) were treated by either medical or surgical therapies. Medical treatment involved (a) conservative oral administration of vitamin B-complex, buflomedial hydrochloride and topical triamcinolone acetonide 0.1%, or (b) conventional submucosal injections of a combination of dexamethasone and hyaluronidase, or (c) a combination of both (a) and (b). The surgical group was treated by the excision of fibrotic tissues and covering the defect with split-thickness skin, fresh human amnion, or buccal fat pad (BFP) grafts. Treatment was chosen according to the stage of clinical progression to gain maximal interincisal distance (ID). The cases were followed up by monthly examinations for at least two years, or when possible even longer. A combination of (a) and (b) medical treatment was satisfactory in cases of mild impairment (ID> 20 mm) but in the long term it led to symptomatic relief only. Surgical therapy, on the other hand, when accepted by the patients, led to a significant improvement of trismus in cases of severe limitation (ID < 20 mm). Following this strategy, an additional ID increase was observed in all patients. BFP grafting was particularly successful in diminishing scarring after two years as compared with the other two grafts. Together with a cessation of the betel quid chewing habit before and after therapy, these treatment regimens combined with daily mouth opening exercises were found to be necessary to manage OSF cases in early and advanced stages of progression.

Objectives: To determine the prevalence and pathogenesis of ponticulus posticus (PP) and ponticulus lateralis (PL) in children and adolescents. Methods: Cone beam CT scans of 576 patients were examined for PP and PL. The patients were divided into three age groups: 10 years and younger, 11-13 years and 14 years and older. Ponticulus formation was categorized as absent, partial or complete. Gender, race and location (right, left or bilateral) were recorded. Data were analysed with the x 2 test, with significance at p , 0.050. Institutional review board approval was granted. Results: Overall prevalence of PP was 26.2%, with complete lesions in 10.4%. The frequency of PP was greater in patients aged 14 years and older (p # 0.038). The occurrence of complete PP was greater in patients aged 11 years and older (p 5 0.028). Lesions were more common in males (p 5 0.014) and in blacks compared with other non-white races (p 5 0.035). Bilateral PP was more common than right-sided lesions (p 5 0.008) and more frequent in the oldest cohort (p 5 0.006). Overall prevalence of PL was 6.1% (3.0% complete), with no differences between age groups, genders, races or by location. Conclusions: PP is not uncommon even in the first decade and increases in frequency, completeness of calcification and numbers in mid-adolescence. It appears to be more common in males and in blacks. PP may be a congenital osseous anomaly of the atlas that mineralizes at various times. PL is less frequent with no demographic predilections.

The results of this study are consistent with those from previous analyses of p63 expression in human oral mucosa, suggesting that p63 may be associated with the regulation of epithelial differentiation and proliferation in DMBA-induced hamster buccal pouch squamous cell carcinogenesis. Further study is required to investigate which p63 isoform(s) is/are involved in hamster buccal pouch carcinogenesis.