Oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) present a remarkable public health challenge worldwide. They are the leading causes of cancer-related morbidity and mortality in low-resource regions. In rural and underserved populations, access to diagnostic facilities is limited, and delays in confirmation often result in late-stage presentations. Field screening camps frequently serve as the first and sometimes only point of contact for many at-risk individuals; however, conventional cytology relies on laboratory infrastructure and specialist review, making same-visit diagnoses unfeasible. Recent advances in artificial intelligence-driven systems have created opportunities for point-of-care (PoC) diagnosis, enabling real-time disease detection and triage directly in community settings. This study aims to develop and clinically validate a convolutional neural network (CNN)-enabled PoC cytology device for real-time screening of OPMDs such as leukoplakia, oral submucous fibrosis, erythroplakia and OSCC in community field settings, following Standards for Reporting Diagnostic Accuracy Studies 2015 (STARD) and Standard Protocol Items: Recommendations for Interventional Trials 2013 (SPIRIT) guidelines.

Objectives: Oral potentially malignant disorders may present as white, red, or mixed red-white lesions and require accurate early recognition. This study evaluated whether texture-analysis features extracted from clinical digital images could distinguish oral precancerous lesions from other oral mucosal lesions and normal mucosa using gray-level co-occurrence matrix (GLCM), gray-level run-length matrix (GLRLM), and wavelet analysis. Materials and Methods: Sixty-four clinical digital images were selected according to predefined inclusion and exclusion criteria. The dataset included leukoplakia, erythroplakia, oral submucous fibrosis, candidiasis, lichen planus, leukoderma, frictional keratosis, white spongy nevus, and normal mucosa. Regions of interest were extracted from each image, and texture features were derived using GLCM, GLRLM, and wavelet analysis. A support vector machine (SVM) classifier was then used to categorize images as oral precancerous lesions or non-precancerous/normal mucosa. Results: GLCM yielded the highest classification accuracy (88%), followed by GLRLM (81%) and wavelet analysis (79%). The corresponding sensitivity values were 77%, 64%, and 60%, and the specificity values were 93%, 90%, and 89%, respectively. The positive predictive values were 83% for GLCM, 75% for GLRLM, and 75% for wavelet analysis. Conclusion: GLCM-based texture features provided the best diagnostic performance in this dataset. These image-analysis methods may be useful as non-invasive adjuncts to conventional clinical examination and histopathological diagnosis; however, larger datasets and external validation are required before clinical implementation.

Recently, the WHO 5th edition has modified the new architectural and cytological features for the diagnosis of oral epithelial dysplasia (OED). However, the correlation of these histopathological features with malignant transformation (MT) and recurrence (RE) of the lesions remains controversial. There is no study investigated the association between architectural and cytological features of the 5th WHO criteria with a reliable diagnostic marker for MT in OED. Therefore, this study aimed to correlate the 5th edition WHO histopathological diagnostic criteria of OED with the immunohistochemical expression of CK13/CK17, one of reliable diagnostic markers for MT in OED. A total of 32 samples of leukoplakia, erythroplakia, and erythroleukoplakia which histologically proved OED were included in the study. The specimens were graded according to 5th edition WHO criteria and categorized as 15 mild OED and 17 moderate to severe OED. The architectural and cytological features from the 5th WHO diagnostic criteria for OED were collected. The CK13/CK17 immunohistochemistry was performed. The CK13 and CK17 expression was graded semi-quantitatively. The association between architectural and cytological features with CK13/CK17 immunohistochemical expression and with histopathological diagnosis were analyzed. Eight histopathological features: irregular epithelial stratification, reduced keratinocyte cohesion, abnormal variation in nuclear size and shape, abnormal variation in cell size and shape, single cell keratinization and increased nuclear size were significantly correlated with CK13 weak/CK17 strong expression pattern and the diagnosis of moderate to severe OED (p < 0.05). Larger samples are required to enhance the accuracy in the diagnosis and prediction in the OED lesions.

Oral potentially malignant disorders (OPMDs) such as leukoplakia and erythroplakia may harbor dysplasia or progress to oral squamous cell carcinoma (OSCC), yet visual inspection alone is unreliable for risk assessment. Cytology offers a minimally invasive adjunct, but conventional approaches depend on manual feature extraction and subjective review. Herein we report a deep learning (DL) object detection model that directly classifies four cell phenotypes: differentiated squamous epithelial (DSE) cells, small round (SR) cells, leukocytes, and lone nuclei. The DL model produced cytology-derived parameters that correlated strongly with histopathologic diagnoses across 692 subjects with OPMDs, OSCC, and healthy controls, including declining DSE cell proportion and increasing SR cells and leukocytes with disease severity (p < 0.0001). The oral cancer numerical index (OCNI) achieved AUROC values up to 0.99 for malignant versus healthy lesions, with excellent reliability (intra-class correlation coefficient ≥ 0.96). This reproducible, minimally invasive test provides a robust platform for early detection and surveillance of OPMDs.

Oral potentially malignant disorders (OPMDs) represent a wide range of oral lesions and conditions that carry a variable risk of malignant transformation to oral squamous cell carcinoma (OSCC). Clinically, the majority of OPMDs present as white and/or red lesions. Oral leukoplakia is one of the most common OPMDs. The reported global prevalence of OPMDs is 4.47%, although there is considerable variation between different geographical regions. One of the most serious consequences of OPMDs is malignant transformation to OSCC, with approximately 7.9% of OPMDs progressing to OSCC. The risk of malignant transformation varies substantially among different OPMDs, with proliferative verrucous leukoplakia having the highest malignant transformation rate at 49.5%, followed by oral erythroplakia at 33.1% and oral leukoplakia at 9.5%. Although the presence and grade of oral epithelial dysplasia (OED) are strongly associated with the risk of malignant transformation, we currently lack an established tool that can accurately identify OPMDs at high risk for such outcomes.This book chapter aims to provide a general introduction to OPMDs and their epidemiology, followed by a discussion of associated etiological factors, a proposed model of molecular pathogenesis, diagnostic approaches, common treatment modalities, and prognostic factors for oral leukoplakia.

A propolis-based nano-formulated bioadhesive oral gel (NBF gel) containing vitamins C and E has been proposed as a supportive topical therapy for oral mucosal lesions. The aim of this study was to evaluate clinical outcomes associated with the use of the gel during a 15-year institutional clinical experience and to assess its adjunctive effect on periodontal status in patients with intellectual disabilities. The study consisted of two components: a retrospective observational case series and a non-randomized controlled clinical study. In the retrospective component, 295 patients (219 females and 76 males) received topical NBF gel treatment for various oral mucosal conditions, including xerostomia-associated mucositis, inflammatory lesions, aphthous ulcers, herpes infections, glossodynia, leukoplakia, erythroplakia, and post-surgical conditions. Treatment response was assessed descriptively using patient-reported symptom improvement combined with clinical evaluation. Overall, treatment was considered successful in 265/295 patients (89.8%), while 14/295 patients (4.7%) were classified as ineffective and 16/295 patients (5.4%) as inconclusive. More favorable responses were observed in inflammatory and post-treatment lesions than in potentially premalignant or neuropathic conditions. In the controlled periodontal component, 40 patients with mild to moderate intellectual disabilities were allocated into a control group performing toothbrushing alone and a test group additionally receiving topical NBF gel application. Periodontal status was assessed using the Basic Periodontal Examination (BPE) index at baseline and after 1 and 2 weeks. Adjunctive gel application was associated with greater improvement in periodontal status compared with toothbrushing alone. No clinically relevant adverse effects were documented during the observation period; however, because adverse events were not assessed using a predefined safety-monitoring protocol, these findings should be interpreted cautiously. The present findings suggest that the investigated nano-formulated bioadhesive oral gel may represent a potentially useful adjunctive topical therapy in selected oral mucosal and periodontal conditions. Further randomized controlled studies with standardized objective outcome measures are required to confirm these preliminary findings.

Oral squamous cell carcinoma (OSCC) is one of the most prevalent cancers worldwide, leading to significant illness and death, particularly in low- and middle-income countries. In addition to tobacco, alcohol, and human papillomavirus (HPV), several culturally ingrained practices, such as areca nut chewing, toombak, khat, reverse smoking, and hot mate drinking, remain underrecognized but important cultural factors contributing to OSCC globally. These exposures operate through the formation of nitrosamine-induced DNA adducts, oxidative stress, chronic inflammation, and thermal injury. Areca nut and toombak are associated with oral submucous fibrosis and carcinoma, while reverse smoking and mate are linked to thermal and polycyclic aromatic hydrocarbon-related effects. Khat is connected to oxidative and cytogenetic damage. This narrative review combines epidemiological, mechanistic, and public health evidence on cultural carcinogens in OSCC, emphasizing prevention strategies that honor cultural identity through education, harm reduction, and community involvement. Dermatologists specializing in mucocutaneous oncology can detect early lesions like leukoplakia, erythroplakia, and oral submucous fibrosis. Including oral mucosal screening in routine care provides an effective, affordable way to prevent diseases in high-risk populations. Culturally sensitive, dermatology-focused prevention can help reduce OSCC incidence and disparities while respecting community identity.