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Oral Submucous fibrosis (OSMF) has traditionally been described as “a chronic, insidious, scarring disease of the oral cavity, often with involvement of the pharynx and the upper esophagus”. Millions of individuals are affected, especially in South and South East Asian countries. The main risk factor is areca nut chewing. Due to its high morbidity and high malignant transformation rate, constant efforts have been made to develop effective management. Despite this, there have been no significant improvements in prognosis for decades. This expert opinion paper updates the literature and provides a critique of diagnostic and therapeutic pitfalls common in developing countries and of deficiencies in management. An inter-professional model is proposed to avoid these pitfalls and to reduce these deficiencies.

Background Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist. Objective Our objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea. Data Sources Electronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices. Limitations While xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search. Conclusions We compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications.

Oral cavity cancer is associated with high morbidity and mortality, particularly with advanced stage diagnosis. Oral cavity cancer, typically squamous cell carcinoma (OSCC), is often preceded by oral potentially malignant disorders (OPMDs), which comprise eleven disorders with variable risks for malignant transformation. While OPMDs are clinical diagnoses, conventional oral exam followed by biopsy and histopathological analysis is the gold standard for diagnosis of OSCC. There is vast heterogeneity in the clinical presentation of OPMDs, with possible visual similarities to early-stage OSCC or even to various benign oral mucosal abnormalities. The diagnostic challenge of OSCC/OPMDs is compounded in the non-specialist or primary care setting. There has been significant research interest in technology to assist in the diagnosis of OSCC/OPMDs. Artificial intelligence (AI), which enables machine performance of human tasks, has already shown promise in several domains of medical diagnostics. Computer vision, the field of AI dedicated to the analysis of visual data, has over the past decade been applied to clinical photographs for the diagnosis of OSCC/OPMDs. Various methodological concerns and limitations may be encountered in the literature on OSCC/OPMD image analysis. This narrative review delineates the current landscape of AI clinical photograph analysis in the diagnosis of OSCC/OPMDs and navigates the limitations, methodological issues, and clinical workflow implications of this field, providing context for future research considerations.

•The incidence of oral and oropharyngeal cancers fluctuated, whereas the mortality increased from 2005 to 2013 in China.•A heavier burden from oral and oropharyngeal cancers was predicted in the next two decades in China.•This is the latest summarization of the epidemiological trends of oral and oropharyngeal cancers in China. Oral and oropharyngeal cancers are among the most common cancers globally. This study aimed to assess the incidence and mortality trends of oral and oropharyngeal cancers in China between 2005 and 2013. Estimates of national trends of oral and oropharyngeal cancers were based on the data from Chinese Cancer Registry Annual Reports. The crude incidence rates of oral and oropharyngeal cancers between 2015 and 2035 were evaluated. The age-standardized rate was based on the world standard population. It was estimated that 285,857 new cases and 132,698 deaths were related to oral and oropharyngeal cancers in China between 2005 and 2013, with mouth and tongue cancers being the most frequently diagnosed and the leading causes of death among all oral and oropharyngeal cancers. The incidence rates of oral and oropharyngeal cancer fluctuated from 1.69 to 1.89 per 100,000 person-years, and the mortality rate showed an increasing trend, ranging from 0.77 and 0.84 per 100,000 person-years. Males were more susceptible than females to oral and oropharyngeal cancers. The incidence and mortality rates of oral and oropharyngeal cancers were significantly higher in urban regions. The crude incidence rates of oral cancers are projected to increase from 2.26 to 3.21 per 100,000 person-years over the next 20 years in China. The incidence of oral and oropharyngeal cancers fluctuated, whereas the mortality rate showed an upward trend from 2005 to 2013. A heavier burden from oral and oropharyngeal cancers is predicted in the next two decades in China.

Objectives: To document the burden of oral cancer in South East Asia (SEA) and to examine the gaps in acquiring accurate data within these countries. Methods: Epidemiological data on oral cancer from countries in SEA were obtained and reviewed from public population-based databases. Descriptions on the incidence and mortality of oral cancer were based on data obtained from GLOBOCAN 2012, and prediction of the number of cases and deaths due to oral cancer were also taken from the same database. The availability of and accessibility to population-based cancer registry were also documented. Results: Five of the eleven countries in SEA have national cancer registries, but the reporting periods varied from 2002 to 2014 across these countries. Whilst incidence and mortality data were obtainable for all SEA countries from GLOBOCAN 2012, data quality varied substantially across the countries. Estimated incidences of oral cancer ranged from 1.6 to 8.6/100,000 per annum with similar rates in males and females for most countries. The incidence was the highest in Myanmar and Brunei for males and females, respectively. Mortality due to oral cancer was reported to be 0.4 to 5.3/100,000, with the highest mortality in Myanmar and Timor-Leste among males and females, respectively. Based on the predicted number of cases and deaths for 2020, oral cancer incidence and mortality is expected to increase and the trends are similar between males and females, which is not surprising as with population growth, the disease burden will rise further. Conclusion: This study demonstrates a severe lack of accurate epidemiological data on oral cancer and underscores the urgent need to develop expertise within this region that can address this issue. While there is a clear need for improved primary prevention, for increased skilled workforce and for improved diagnostic and treatment facilities, an essential first step is to establish robust cancer registries so that progress or lack thereof can be monitored accurately, and appropriate action planned.

The rising incidence of oral cancer and associated poor prognosis, primarily due to delayed diagnosis, highlight the urgent need for artificial intelligence tools in clinical detection. However, efforts in this regard are hampered by the lack of large and ethnically heterogenous image datasets of oral lesions with clinically validated diagnoses. To address this gap, oral mucosa images captured with mobile device cameras were collected from cohorts spanning five countries. The images were systematically annotated with lesion type classifications as well as specific clinical diagnoses, then assessed for quality. The diagnoses were verified retrospectively by biopsy, where applicable, or by consensus verification by dental experts. The final dataset consists of 30,039 oral mucosa images supplemented by clinical metadata, made available on the MeMoSA Workbench platform. We believe that the MeMoSA dataset will serve as a significant resource to drive the training, evaluation, and refinement of AI-driven diagnostic algorithms, potentially improving diagnostic accuracy and enabling rigorous benchmarking against clinical expert assessments, for the early detection of oral cancer.

Objectives: Our aim was to provide an up-to-date and review the incidence and mortality of oral and pharyngeal cancer in Europe. Methods: Data were retrieved from both national and regional population-based cancer registries. The online browser used in the present study was the European Network of Cancer Registries (EUREG. Version 1.0), which provided data for 22 countries of Northern and Eastern Europe and for 20 countries of Western and Southern Europe on the incidence of and mortality for oral and pharyngeal cancer. For countries not included in EUREG, data were retrieved from the European Cancer Estimates (EUCAN), the Global Cancer Estimates (GLOBOCAN) and Cancer Incidence in Five Continents. Oral cancer sub-sites were classified according to International Classification of Diseases and Related Health Problems, 10th Edition categories. Results: Hungary recorded highest rates among European countries for both morbidity and mortality. Historically, France has had high rates particularly in areas in the north of France, where oral cancer was the most common in men. A decline in the incidence has been noted in the past one and half decades. However, France still has the highest incidence rates of orophayngeal cancer, one of the highest in the world. Denmark records high rates of oral cancer in women and lip cancer incidence is high in Spain. Conclusions: In Europe, regional differences in oral and pharyngeal cancer in terms of incidence and mortality are evident not only between north and south and between east and west but also within single regions (e.g. between the Scandinavian countries and the former Soviet republics). These findings reflect differences in lifestyle and in exposure to risk factors such as smoking (e.g. high incidence in Danish women), alcohol (e.g. in Lithuanian men) or both (e.g. Belgium and Portugal). Other traditional factors, such as actinic radiation, are responsible for a considerable number of cases of lip cancer (e.g. Spain), and oncogenic potential of human papillomavirus explains the rising trend in oropharyngeal cancer in some countries (e.g. Denmark and Scotland).

Objectives: To document the burden of oral cancer in South East Asia (SEA) and to examine the gaps in acquiring accurate data within these countries. Methods: Epidemiological data on oral cancer from countries in SEA were obtained and reviewed from public population-based databases. Descriptions on the incidence and mortality of oral cancer were based on data obtained from GLOBOCAN 2012, and prediction of the number of cases and deaths due to oral cancer were also taken from the same database. The availability of and accessibility to population-based cancer registry were also documented. Results: Five of the eleven countries in SEA have national cancer registries, but the reporting periods varied from 2002 to 2014 across these countries. Whilst incidence and mortality data were obtainable for all SEA countries from GLOBOCAN 2012, data quality varied substantially across the countries. Estimated incidences of oral cancer ranged from 1.6 to 8.6/100,000 per annum with similar rates in males and females for most countries. The incidence was the highest in Myanmar and Brunei for males and females, respectively. Mortality due to oral cancer was reported to be 0.4 to 5.3/100,000, with the highest mortality in Myanmar and Timor-Leste among males and females, respectively. Based on the predicted number of cases and deaths for 2020, oral cancer incidence and mortality is expected to increase and the trends are similar between males and females, which is not surprising as with population growth, the disease burden will rise further. Conclusion: This study demonstrates a severe lack of accurate epidemiological data on oral cancer and underscores the urgent need to develop expertise within this region that can address this issue. While there is a clear need for improved primary prevention, for increased skilled workforce and for improved diagnostic and treatment facilities, an essential first step is to establish robust cancer registries so that progress or lack thereof can be monitored accurately, and appropriate action planned.

Objectives: Our aim was to provide an up-to-date and review the incidence and mortality of oral and pharyngeal cancer in Europe. Methods: Data were retrieved from both national and regional population-based cancer registries. The online browser used in the present study was the European Network of Cancer Registries (EUREG. Version 1.0), which provided data for 22 countries of Northern and Eastern Europe and for 20 countries of Western and Southern Europe on the incidence of and mortality for oral and pharyngeal cancer. For countries not included in EUREG, data were retrieved from the European Cancer Estimates (EUCAN), the Global Cancer Estimates (GLOBOCAN) and Cancer Incidence in Five Continents. Oral cancer sub-sites were classified according to International Classification of Diseases and Related Health Problems, 10th Edition categories. Results: Hungary recorded highest rates among European countries for both morbidity and mortality. Historically, France has had high rates particularly in areas in the north of France, where oral cancer was the most common in men. A decline in the incidence has been noted in the past one and half decades. However, France still has the highest incidence rates of orophayngeal cancer, one of the highest in the world. Denmark records high rates of oral cancer in women and lip cancer incidence is high in Spain. Conclusions: In Europe, regional differences in oral and pharyngeal cancer in terms of incidence and mortality are evident not only between north and south and between east and west but also within single regions (e.g. between the Scandinavian countries and the former Soviet republics). These findings reflect differences in lifestyle and in exposure to risk factors such as smoking (e.g. high incidence in Danish women), alcohol (e.g. in Lithuanian men) or both (e.g. Belgium and Portugal). Other traditional factors, such as actinic radiation, are responsible for a considerable number of cases of lip cancer (e.g. Spain), and oncogenic potential of human papillomavirus explains the rising trend in oropharyngeal cancer in some countries (e.g. Denmark and Scotland).

Objectives: To describe the incidence and mortality of oral and oropharynx cancers in South America using available public databases and to discuss the main pitfalls for acquiring reliable data. Methods: The incidence data for oral cavity and oropharynx cancers for South America were obtained from Cancer Incidence in Five Continents/International Agency for Research on Cancer for the period 1998–2007. Mortality rates in South America were obtained from the World Health Organization/IARC database for the period 1999–2012. The number of cases for Brazil was obtained from the National Cancer Institute/missing stage for the period 2000–2010, whereas the São Paulo cancer registry was used to collect data from the most populated state in Brazil for the period 2000–2008. Results: The incidence of oral and oropharynx cancers in South America varied, with the highest rates observed in Brazil among males. The mortality data in selected South American countries ranged from 0.72 to 6.04/100,000 and the proportion of ill-defined deaths in South America varied from 5.0% to 22.0%. Mortality trends for males decreased about 2.5% in most of the countries, excluding Brazil, whereas among females, a significant decrease occurred only in Colombia, with an increase in Brazil and Peru. Conclusion: Although there is a lack of reliable databases in South America, the available data demonstrate a decrease in mortality trends in most countries and the highest incidence in Brazil. The development and improvement of national cancer public databases in South America are highly desirable and necessary to better understand the characteristics and distribution of these neoplasms.