Chewing coca leaves is a rooted habit in several localities in Latin America, especially in the Andean areas. This habit has been related to possible alterations in various components of the oral cavity. The purpose of this review is to describe the changes that oral cavity structures undergo by chewing coca leaves. Several studies will be presented where it is found that the frequency in addition to the alkaline substance used in chewing coca leaf affects the hard and soft tissues of the oral cavity. It is concluded in the review that chewing coca leaf leads to pigmentation of oral mucosa, dental wear and periodontal diseases. La masticación de hoja de coca es un hábito arraigado en varias localidades de Latinoamérica, sobre todo en las zonas andinas. Dicho hábito se ha relacionado con posibles alteraciones en diversos componentes de la cavidad oral. El propósito de esta revisión es describir los cambios que sufren las estructuras de la cavidad bucal por la masticación de hojas de coca. Se expondrán diversos estudios donde se encuentra que la frecuencia del consumo de la hoja, además de la sustancia alcalina que se emplea en la masticación, afecta a los tejidos duros y blandos de la cavidad oral. Se concluye en la revisión que la masticación de la hoja de coca conlleva a la aparición de pigmentaciones de la mucosa oral, desgaste dental y a enfermedades periodontales.

The digital transformation of medical research has outpaced the ethical frameworks designed to govern it, creating systemic vulnerabilities that legacy governance models cannot adequately address. Drawing on the Peruvian experience, we examine the convergence of metric-driven research evaluation, regulatory gaps, and digital disruption, and we argue for hybrid governance as an operational necessity for preserving scientific integrity. Our analysis reveals three interconnected findings. First, regulatory codification alone is insufficient to prevent misconduct. Peru’s National Code and RENACyT system proved vulnerable to large-scale authorship trafficking, exemplified by the “La Granja de Científicos Bamba” scandal involving over USD 53 million in state incentives. Second, institutional risk, assessed via SCImago IRIS, is not linked to the performance of university publications. Most of Peru’s top 20 universities fall into medium or significant risk categories, though low-risk cases indicate that maintaining integrity is possible at the institutional level. Third, the digital era compounds these vulnerabilities through challenges that legacy frameworks cannot address. We propose a reorientation of medical research ethics along five axes: from privacy to data justice, from consent to continuous engagement, from individual to systemic accountability, from voluntary RRI to mandatory Ethics by Design, and from national codes to global hybrid governance. The Peruvian case offers distinctive lessons for the international community: rapidly expanding research output, a regulatory framework that appears robust yet is operationally weak, and organized fraud at scale. This combination exposes the universal vulnerability of metric-driven systems to gaming when oversight lags behind digital realities.