Evaluating Alterations of the Oral Microbiome and Its Link to Oral Cancer among Betel Quid Chewers: Prospecting Reversal through Probiotic Intervention

Abstract

Areca nut and slaked lime, with or without tobacco wrapped in Piper betle leaf, prepared as betel quid, is extensively consumed as a masticatory product in many countries across the world. Betel Quid can promote the malignant transformation of oral lesions as well as trigger benign cellular and molecular changes. In the oral cavity, it causes changes at the compositional level in oral microbiota called dysbiosis. This dysbiosis may play an important role in Oral Cancer in betel quid chewers. The abnormal presence and increase of bacteria Fusobacterium nucleatum, Capnocytophaga gingivalis, Prevotella melaninogenica, Peptostreptococcus sp., Porphyromonas gingivalis, and Streptococcus mitis in saliva and/or other oral sites of the cancer patients has attracted frequent attention for its association with oral cancer development. In the present review, the authors have analysed the literature reports to revisit the oncogenic potential of betel quid and oral microbiome alterations, evaluating the potential of oral microbiota both as a driver and biomarker of oral cancer. The authors have also shared a perspective that the restoration of local microbiota can become a potentially therapeutic or prophylactic strategy for the delay or reversal of lip and oral cavity cancers, especially in high-risk population groups.

Mechanisms and Potential Clinical Implications of Oral Microbiome in Oral Squamous Cell Carcinoma

“…Recently, more attention has been paid to the oral microbiome, as the structural, metabolic, and virulence characteristics of microbes are potential targets. The use of pre-or probiotics and salivary substitutes was also suggested based on differences in the salivary microbiota between patients with OSCC and healthy controls [110,111]. The concept of oncolytic bacterial immunotherapy has long been popular, as commonly used radiotherapy and chemotherapy have side effects owing to damage to healthy tissues, while microorganism therapy shows the merits of accurate target specificity, tissue penetration, and less treatment expense.…”

Gut microbiota and oral cavity cancer: a two-sample bidirectional Mendelian randomization study

“…With over 377,000 new cases annually, OCC, predominantly Oral squamous cell carcinoma (OSCC), represents the 16th most prevalent cancer globally and affects males, representing 70% of reported cases. Regional disparities in incidence, with Melanesia and South-Central Asia displaying the highest rates, underscore the multifaceted nature of this malignancy (1). In the United States, OCC accounts for 52,010 new cases annually, comprising 4% of all cancer incidences.…”

“…Understanding the underlying causes of OCC is crucial for developing effective preventive measures. While tobacco remains a primary contributor, certain geographic areas highlight areca nut as a significant carcinogen (1), and human papillomavirus (HPV) has been established as crucial in oropharyngeal SCC but not in OSCC (3,4), adds to the disease's complexity. Discrepancies arise from diverse factors such as tobacco and alcohol usage, dietary practices, oral hygiene, socioeconomic status, and HPV exposure (3,4).…”