Objective: To Test the utility of toluidine blue staining in the early diagnosis of malignant and premalignant lesions. Materials and Methods: This was a Randomized control clinical trial, carried out at Oral and Maxillofacial Department Gajju Khan Medical College, Bacha Khan Medical Complex, Swabi from 15th April 2019 to 15th April 2020. Twenty two patients with the clinical suspicious lesions were selected. Oral rise was done with 1% acetic acid and later Toluidine blue (1%W/W) was applied with sterile swab stick. Again oral rise was done with normal saline. Colour of the lesion was noted. Later incisional biopsy was taken as gold standard. Results: Total of 22 cases the males were 14(63.6%) and females were 8(36.4%). The sensitivity and specificity of toluidine blue against gold standard of histopathology were 88.89% and 61.54% % respectively. The diagnostic accuracy of toluidine blue was 72.73%. Conclusion: Toluidine blue is very good, effective and simple staining procedure. The staining method is more tolerable by the patient. It may help not only in detecting early dysplastic and malignant lesions but will also help in determining the site of biopsy to be taken.

Objective: Patients with oral potentially malignant disorders (OPMDs) are at risk for development of malignancy and tobacco use contributes in its transformation. This study was designed to assess exfoliative cytological findings in OPMD cases using tobacco and healthy controls with no history of tobacco use. The aim was to screen OPMD cases for biopsy with the help of brush cytology. Materials and Methods: This comparative cross-sectional study was conducted at Histopathology Laboratory of Peshawar Medical College, Peshawar for which samples were collected from two dental hospitals and private dental clinics of Peshawar. The study included 20 cases of clinically diagnosed Oral Potentially Malignant Disorders (OPMDs) with history of tobacco use; including 10 cases of leukoplakia and 10 cases of oral lichen planus (OLP), and 20 age and gender matched healthy controls with no history of tobacco use, after observing a strict inclusion and exclusion criteria. A pre-designed proforma was used to collect the data, which was later analyzed in SPSS version 21. Results:  A total of 40 participants had a mean age of 48.25±10.01 years with gender distribution of 32(80%) males and 8(20%) females, giving a male to female ratio of 4:1. The duration of tobacco use in cases had a mean of 22.95 ± 9.17 years, while duration of lesion had a mean of 2.3±4.4 years. As per Oral Bethesda Criteria, 18 (90%) OPMD cases were Negative for Intraepithelial Lesion/Malignancy (NILM). Buccal mucosa 12(60%) was the most common site of lesions. On Oral Exfoliative Cytology (OEC), OPMDs showed mild to moderate cytological changes as compared to healthy controls. Conclusion: This study concluded that most of the OPMD cases show mild to moderate cytological changes as compared to healthy controls. Dysplastic changes were seen only in 10% of OPMD cases that needed further assessment through biopsy.