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Exfoliative cytological study has significant role in cancer diagnosis. Normal epithelium undergoes exfoliation of its superficial cells due to physiological turnover. The cells of the deeper layers are adherent each other normally. When the epithelium becomes seat of any pathological condition, the cells may lose their cohesiveness, and the cells in the deeper layer may shed along with the superficial cells.these exfoliated cells as well as cells which are scrapped off by means of specific instruments can be studied qualitatively @ quantitatively. Considerable interest has developed in the use of exfoliative cytology for the diagnosi of oral mucosal lesions.

Von hamm cited numerous series of cases of patients with oral cancer in which the diagnostic accuracy of cytrologic smears was compared with that of surgical biopsy and was found to be almost identical.

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He concluded that Cytology is not a substitute but an adjunct to the surgical biopsy. It is a quick ,simple ,painless & bloodless procedure. It helps as a check against false negative biopsies. It is especially helpful in follow up detection of recurrent carcinoma in previously treated cases. It is valuable for screening lesions whose gross appearance is such that biopsy is not warranted.

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The prefered technique is simple one. It consists of cleansing the surface of the oral lesion of debris and mucin, &then vigorously scraping the entire surface of the lesion several times with a metal cement spatula, a moistened tongue blade or a cytobrush. The collected material is then quickly spread over a microscopic slide and fixed immediately before smear dries. The fixative may be either a commercial preparation such as sparycyte,95%alcohol or equal parts of alcohol and ether. After the slide is flooded with a fixative it should be allowed to stand for 30 minutes to air dry. Slides are never plane fixed as bacteriologic smears.

It is essential that the procedure be repeated and second smear for the submission to the cytologist. In preparing the duplicate slide a separate scraping should be utilized. Two smears are always submitted from each lesion,since additional staining techniques are frequently employed. The cytologic smear will be reported by the cytologist as falling into one of five classes.

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Class I (normal):Indicates that only normal cells were observed. Class II(atypical):Indicates the presence of minor atypia but no evidence of malignant tumours. Class III(indeterminate):This is an inbetween cytology that seperates cancer from noncancer diagnosis.The cells display wider atypia that may be suggestive of cancer,but they are not clear-cut and may represent percancerous lesion or carcinoma in situ.Biopsy is recommended.

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Class IV (suggestive of cancer):A few cells with malignant characteristics or many cells with borderline characteristics.Biopsy is mandatory. Class V(positive of cancer):Cells that are obviously malignant.Biopsy is mandatory. Though exfoliative cytological study has a significant role in cancer diagnosis,it has its own limitations.the presence or extent of invasion cannot be assessed.It should be remembered that the majority of beningns lesions that occur in the oral cavity do not lend themselves to cytologic smear.For example,lesions which have a normal appearance and an intact surface, such as a fibroma,should be excised and never smeared.

In addition,most authorities agree that leukoplakia does not itself to cytologic diagnosis because of the scarcity of viable surface cells in the smears taken from such lesions.Finally,it should be remembered that the negative cytology report does not rule out the cancer that a repeat smear or biopsy is indicated in all clinically suspicious lesions.

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Herpes simplex infection Herpes zoaster Pemphigus vulgaris Benign familial pemphigus Keratosis follicularis Heriditary benign intraepithelial dyskeratosis White spongy nevus Perinicious & sickle cell anemia

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Qualitative & quantitative studies in tobacco users, iron deficiency Estimation of antioxidant levels using oral exfoliated cells Forensic odontology(using household objectssuch as tooth brush)