Morphological Assessment of Oral Cytological Smears Before and After Application of Toluidine Blue in Smokers and Nonsmokers
Background: Oral habits like smoking, chewing tobacco etc. are documented as initiators of dysplastic changes in the oral mucosa. Toluidine blue has been propagated as an intra-vital stain for the demonstration of the dysplasia in vivo. Aims: To assess the cytological changes in smokers using Papanicoloau stain against control of non-smokers before and after application of toluidine blue in vivo. Materials and Methods: Twenty-five individuals in each group were included in the study. Two smears were taken from each individual and stained using Papanicoloau stain kit. The cytological features were assessed and computed statistically by Mann Whitney test. Results: The use of 1% acetic acid as part of the toluidine blue staining protocol increases the clarity of the cytological smears. Toluidine blue enhanced the staining characteristics of the components of Papanicoloau stain in terms of specificity (clinical site delineation) and sensitivity (improved stain quality and enhanced cytological features). Conflicting results were however detected in observation of keratinized cells and cellular clumping. Comparison of cytomorphological changes in the smokers and the nonsmokers groups revealed cellular pleomorphism, increased agglomerations, micronuclei, binucleation of cells, and keratinization in the smears from smokers. Conclusion: We conclude that use of toluidine blue is synergistic in assessment of cytological smears with Papanicoloau stain. Tobacco smoking produces cellular alterations in clinically normal buccal mucosa shown in exfoliative cytology and the results of cellular changes in these smears from smokers can be used as an educational tool in smoking cessation counseling.
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