Objectives: This study compares the proportional presence and the differences in means and medians of periodontal pathogens in cases of proliferative verrucous leukoplakia (PVL) versus patients diagnosed with oral lichen planus (OLP) with desquamative gingivitis (DG) and those with chronic periodontitis (CP). Materials and methods: The study evaluated the presence of periodontal pathogens in 38 PVL cases verified by clinicopathological criteria, an equal number of histologically verified DG cases, and another 38 cases of CP. All patients were treated at the Oral Medicine Department of the Dentistry Clinic, Pilsen Faculty Hospital, between 2012 and 2024. All cohorts experienced CP with a similar level of progression (moderate, with approximately 6-millimeter-deep pockets). Twelve different periodontal pathogens were identified using DNA tests (VariOr-Dento). The study focused primarily on the aggressive pathogens classified within the red and orange complexes. The status of periodontal resorption was diagnosed through orthopantomograms and clinical examinations of periodontal pockets. Results: The proportional dominance of red and orange complex periodontal pathogens in PVL was evident compared to gingival OLP and CP cases. PVL had the highest calculated risk for periodontal resorption and a greater mean number of aggressive bacteria per microliter. Conclusion: Our research underscores the significant association between aggressive red and orange complex periodontal pathogens and PVL. In our study, PVL exhibited a threefold higher number of these bacteria than controls with CP. These findings may highlight an important cofactor in the pathogenesis of PVL.

Chronic hyperplastic candidiasis (CHC) presents a distinctive and relatively rare form of oral candidal infection characterized by the presence of white or white–red patches on the oral mucosa. Often mistaken for leukoplakia or erythroleukoplakia due to their appearance, these lesions display nonhomogeneous textures featuring combinations of white and red hyperplastic or nodular surfaces. Predominant locations for such lesions include the tongue, retro-angular mucosa, and buccal mucosa. This paper aims to investigate the potential influence of specific anatomical locations, retro-angular mucosa, on the development and occurrence of CHC. By examining the relationship between risk factors, we present an approach based on machine learning (ML) to predict the location of CHC occurrence. In this way, we employ Gradient Boosting Regression (GBR) to classify CHC lesion locations based on important risk factors. This estimator can serve both research and diagnostic purposes effectively. The findings underscore that the proposed ML technique can be used to predict the occurrence of CHC in retro-angular mucosa compared to other locations. The results also show a high rate of accuracy in predicting lesion locations. Performance assessment relies on Mean Squared Error (MSE), Root Mean Squared Error (RMSE), R-squared (R²), and Mean Absolute Error (MAE), consistently revealing favorable results that underscore the robustness and dependability of our classification method. Our research contributes valuable insights to the field, enhancing diagnostic accuracy and informing treatment strategies.

The management of follow-up in proliferative verrucous leukoplakia (PVL) cases remains highly challenging due to the absence of established etiological factors and limited understanding of disease progression. The aim of this study was to identify optimal biomarkers of PVL behavior to facilitate decision-making in complex therapeutic management. Salivary levels of matrix metalloproteinases (MMPs) were evaluated in 54 confirmed PVL cases. All patients underwent follow-up at Oral Medicine Department, Dentistry Clinic at University Hospital Pilsen. Unstimulated saliva samples were collected and analyzed for MMP-1, -2, -3, -7, and − 9 concentrations. Criteria for PVL stability and progression were defined. Disease progression in individual cases was retrospectively correlated with salivary MMP levels to identify optimal prognostic markers. Assessment of PVL progression and stability was performed 6 months after salivary MMP sampling. Progression was observed in 63% of patients (34/54). Significant associations between elevated salivary MMP levels and PVL progression were confirmed for four of the five MMPs tested. MMP-1, -3, -7, and − 9 emerged as promising markers. A combination of MMP-3 and MMP-7 demonstrated the best prognostic performance, with a sensitivity of approximately 79.5% and a specificity of 89%. This is the first study to evaluate salivary MMPs for PVL monitoring. Our findings confirm an association between elevated salivary MMP levels and an increased risk of PVL progression. This non-invasive approach may improve clinical management and follow-up of patients with PVL. The online version contains supplementary material available at 10.1186/s12903-026-08211-y.

Chronic inflammation in the oral cavity has a negative effect on the course of chronic mucosal lesions. The present study aimed to compare the volume and proportional presence of aggressive periodontal pathogens in patients with oral lichen planus (OLP) accompanied by desquamative gingivitis (DG) vs. those with OLP without gingival involvement. All patients in the cohort were also diagnosed with moderate chronic periodontitis. The observed differences may help explain the higher risk associated with gingival involvement in OLP. The presence of periodontal pathogens was evaluated in 50 biopsy-confirmed OLP with DG cases and 50 OLP cases without gingival manifestations. All participants presented with chronic periodontitis of comparable severity (moderate: periodontal pocket depth (PPD) up to 6 mm). Aggressive periodontal pathogens were identified and quantified using DNA testing (VariOr®-Dento). The periodontal status was assessed using orthopantomography (OPG) or cone-beam computed tomography (CBCT), in combination with the clinical examination of periodontal pockets. In comparison with the non-gingival OLP cases, the OLP cases with gingival involvement exhibited a significantly higher proportional presence of aggressive periodontal pathogens (p = 0.0009) and a higher bacterial load (n/μL; p = 0.001). Desquamative gingivitis associated with OLP was also linked to an increased risk of subsequent periodontal resorption. Given the unstable chronic inflammatory environment, careful monitoring of periodontal tissues in OLP cases appears to be essential, as persistent inflammation may contribute to an elevated risk of malignant transformation. Our findings demonstrate a significant difference in the presence of aggressive periodontal pathogens between OLP cases with and without gingival involvement. The median pathogen volume in the OLP with DG cases was over 7.4 times higher. Chronic inflammation and bacterial by-products may act as cofactors in the development of dysplasia and the malignant transformation of oral lichen with dysplasia (OLD), which may present clinically as DG.

To assess the prevalence of oral paraneoplastic manifestations in patients with biopsy-confirmed extra-oral malignancies and to identify oral findings with

Background: Proliferative verrucous leukoplakia (PVL) is a very rare lesion of the oral mucosa with frequent development of oral epithelial dysplasia and a very high ratio of malignant transformation (MT). The aim of this study is to correlate radiographic assessment of alveolar bone resorption with the clinical manifestations and course of PVL in order to improve therapy. Materials and methods: The study evaluates the resorptive changes on alveolar ridges in 78 cases of PVL, confirmed by clinical and pathological criteria. All patients were treated at the Oral Medicine Department, Dentistry Clinic, University Hospital Pilsen. Each case was examined for bone defects using imaging methods such as X-ray intraoral scans, orthopantomograms, or cone beam computed tomography (CBCT). The location and extent of the resorption were correlated with the distribution of PVL lesions in the oral cavity and the course of the mucosal disease. Cases with MT underwent whole-body examination using hybrid imaging techniques, including positron emission tomography (PET) combined with either magnetic resonance imaging (MRI) or computed tomography (CT). Results: A correlation between the alveolar resorptive process and the development of PVL lesions was found in 66.7% of PVL cases (52/78). In one-sixth of cases (13/78), progressive bone loss paralleled worsening mucosal status and increased tooth mobility. Radiographic follow-ups delineated areas indicated for antimicrobial and anti-inflammatory therapy to address aggressive local cofactors in PVL. Oral squamous cell carcinoma developed in 37% of cases (29/78). Combined clinical and radiologic surveillance enabled early detection of malignant transformation (MT) in 5 cases (17% of MTs). Conclusion: Routine radiologic assessment is an essential component of PVL management. Radiography and CT improve detection of local cofactors, help define the scope of therapy, and may indicate the onset of MT before overt clinical manifestations.