In vivo autofluorescence spectroscopy of oral premalignant and malignant lesions: distortion of fluorescence intensity by submucous fibrosis

BACKGROUND AND OBJECTIVES: To test whether autofluorescence spectroscopy can be used for the diagnosis of oral neoplasia in a high-risk population, we characterized the in vivo autofluorescence spectra from oral submucous fibrosis (OSF) lesions and oral premalignant and malignant lesions in both OSF and non-OSF patients. STUDY DESIGN/MATERIALS AND METHODS: Autofluorescence emission spectra were measured under the excitation wavelength of 330 nm, using a Xenon lamp-based fluorospectrometer coupled to a handheld optical fiber probe. Autofluorescence spectroscopies were analyzed among patients with OSF lesions, and oral lesions of epithelial hyperkeratosis (EH), epithelial dysplasia (ED), and squamous cell carcinomas (SCC) and normal oral mucosa (NOM) of healthy volunteers. RESULTS: We found that the most intensely autofluorescence emission peaks occurred at 380 nm and 460 nm. For comparing the spectral patterns among different groups of oral lesions and NOM, ratios of the area under the spectrum of 460+/-10 nm to that under the spectrum of 380+/-10 nm (denoted as A(460+/-10nm)/A(380+/-10nm)) were calculated. The mean ratio values increased gradually from OSF to NOM, to EH and ED, and to SCC. The ANOVA test showed significant differences in the ratio value among all categories of samples (P<0.01). On the other hand, we found that EH, ED, and SCC lesions on OSF patients had distorted autofluorescence intensity. The mean ratio values of EH, ED, and SCC between non-OSF and OSF patients show significant differences. Furthermore, an ANOVA test showed NOM is not distinguishable from EH and ED lesions on oral fibrotic mucosa (P>0.05). CONCLUSIONS: Autofluorescence spectroscopy can be used to diagnose EH, ED, and SCC lesions in non-OSF patients but not in OSF patients.     

定期口腔健康宣教在牙周病患者种植术后护理中的效果评价

目的：评价定期宣教对牙周病患者种植术后护理的效果。方法：本课题选择西安交通大学口腔医院种植中心接受牙种植术的牙周病患者100名,将100名患者随机分为2组,干预组和对照组;干预组分别在术后1、3、6、12个月对患者进行定期口腔健康教育,而对照组仅实施常规的术后宣教和定期检查。观察各组种植术后社区牙周指数（CPI）的变化以及种植体周围情况的异同。结果：与对照组相比,干预组种植体累积存留率高;干预组牙周状况（CPI）亦优于对照组（P〈0．05）,且具有统计学意义。结论：实施口腔健康教育对牙周病患者种植术后护理有积极作用,可增加种植义齿及自然余留牙的长期稳定性。     

An advanced clinical trial with laser acupuncture anesthesia for minor operations in the oro-maxillofacial region

For the purpose of improving acupuncture and acupressure anesthesia, laser acupuncture as a new type of controlled anesthetic method has been used since 1979. A beam from a 2.8-6 mW helium-neon laser apparatus (Model CW-12, Chengdu Thermometer Factory) was delivered and focused to a red spot on the selected skin point of the patient. The laser was used instead of the routine acupuncture and acupressure anesthesia. This paper reports the clinical laser trial of 610 cases (562 cases of difficult exodontia and 48 cases of various minor operations in the oro-maxillofacial region). The effect of analgesia was satisfactory. No sedatives or analgesics were administered before or during operations. The helium-neon laser apparatus, selection of laser irradiating acupuncture points, distance, and duration of irradiation and clinical observations are described.     

肿瘤科护士对放化疗患者口腔评估的现状调查分析

目的探讨肿瘤科护士对放化疗患者口腔评估的现状,为规范放化疗患者口腔评估和预防口腔并发症提供依据。方法采用便利抽样法,抽取肿瘤科护士198名,对放化疗患者口腔评估现状进行问卷调查。结果 12.63%护士对口腔并发症出现前的初次放化疗患者进行口腔评估,其中12.63%使用评估工具进行评估;97.98%护士对出现口腔并发症患者进行口腔评估,其中46.97%使用评估工具;42.93%护士对再入院化疗患者进行口腔评估,其中10.10%使用评估工具。结论护士对口腔并发症发生前和再入院化疗患者的口腔评估重视不够,评估内容不足,且缺乏针对性口腔评估工具。应加强未发生口腔并发症患者和再入院患者的口腔评估,并完善评估内容与流程,制定针对性评估工具。     

Utility of toluidine blue in oral premalignant lesions and squamous cell carcinoma: continuing research and implications for clinical practice

Toluidine blue (TB) has been shown to aid in the detection and diagnosis of oropharyngeal squamous cell carcinoma (OSCC) and oral premalignant lesions (OPLs). TB has been shown to enhance visualization of oral lesions and assist in identifying sites of increased risk of dysplastic/malignant change and promote biopsy. TB has been shown to identify lesions with molecular changes associated with risk of progression of OPLs to OSCC. A recent prospective longitudinal study showed TB retention in histologic benign lesions and lesions with mild dysplasia that are at increased risk of progression to cancer. Clinical trials show that TB is useful in identifying asymptomatic OSCC and premalignant lesions at risk of progressing to SCC, which might otherwise be undetected until lesions become more advanced. The data supports TB use in oral examination of patients at risk of OSCC.     

A pilot study evaluating the safety and microbiologic efficacy of an economically viable antimicrobial lozenge in patients with head and neck cancer receiving radiation therapy.

BACKGROUND: Mucositis occurs in almost all radiotherapy-treated head and neck cancer patients, in approximately 75% of patients receiving hematopoietic marrow transplantation, and in approximately 40% of all patients who receive chemotherapy. Mucositis is painful, may affect all oral functions, and is a dose- and rate-limiting toxicity of therapy for cancer. Radiation-associated mucositis (onset, intensity, and duration) has been shown in recent clinical trials to be modified by the use of antibacterial/antifungal lozenges. PURPOSE: The aim of this collaborative two-center phase II study was to assess the toxicity and microbiologic efficacy of an economically viable antimicrobial lozenge in the management of patients receiving radiation therapy for head and neck cancer. MATERIALS AND METHODS: Seventeen patients scheduled to receive radical or postoperative radiotherapy were provided with bacitracin, clotrimazole, and gentamicin (BCoG) lozenges (one lozenge dissolved in the mouth qid from day 1 of radiotherapy until completion). Ease of use and palatability of the lozenges, patients' symptoms (swallowing and pain), and quantitative and qualitative microbiologic evaluation of an oral rinse collection was conducted at least once weekly during radiation therapy. RESULTS: No significant side effects were reported from the use of the lozenges. The lozenges were well tolerated at the beginning of treatment by all patients, with some minor difficulty associated with oral discomfort toward the end of the treatment. Microbiologic evaluation showed consistent elimination of yeast organisms in all patients. In four patients there was no growth of gram-negative bacilli on culture, whereas in two patients, fluctuating counts were seen, and one patient had increased counts. The remaining patients had significant reduction in the gram-negative bacilli counts. CONCLUSIONS: This study demonstrated that the BCoG lozenge is tolerable and microbiologically efficacious, achieving elimination of Candida in all patients and reduction in gram-negative flora in most patients. A phase III study is underway to evaluate the clinical efficacy of this lozenge.     

Exploring the link between microorganisms and oral cancer: A systematic review of the literature

The majority of cases of oral cancer have been related to tobacco use and heavy alcohol consumption. However, the incidence of oral cavity carcinoma appears to be increasing in many parts of the world in a manner that it is difficult to explain with traditional risk factors alone. Meanwhile, interest in the possible relationships between microorganisms and the different stages of cancer development has been rising and numerous mechanisms by which bacteria and yeast may initiate or promote carcinogenesis are currently under investigation. In particular, a persuasive body of evidence suggests a possible etiological role involving the metabolism and production of carcinogenic products, such as acetaldehyde. Other suggested mechanisms include the induction of chronic inflammation and direct interference with eukaryotic cell cycle and signaling pathways. This review aims to summarize the known associations between microbial infection and cancer and draw attention to how they may relate to oral carcinoma. © 2009 Wiley Periodicals, Inc. Head Neck, 2009     

Dental care and oral health in solid organ transplant recipients: a single center cross-sectional study and survey of German transplant centers

Aim of this study was to collect information about oral health of patients before and after SOT as well as information about center‐based recommendations for dental care. In a single center cross‐sectional study, the oral situation of 20 patients before and 20 after SOT were examined including dental (DMF‐T), periodontal (PSR^®/PSI), and oral hygiene findings (modified QHI). In a second project, a survey among 50 transplant centers in Germany was questioned regarding their recommendations for dental care of SOT recipients. Patients before and after SOT showed similar quality of dental findings (DMF‐T), but worse compared to the general population. In addition, most patients in both groups showed pronounced periodontal treatment need (PSR^®/PSI score 3 or 4). Oral hygiene findings (modified QHI) after SOT were significantly worse than in patients on the waiting list (P = 0.032). In a second project, the questionnaire was returned by 28 of 50 centers. Interpretation of data showed that 89% carry out a dental examination before SOT and 67% contacted the patients’ dentists. After SOT, 83% of the transplant centers recommend antibiotic cover before dental measures. The results of our study revealed lacks in the dental care of SOT recipients. Consistent recommendations regarding the dental care of patients before and after SOT should be determined.     

口腔口咽肿瘤切除术后较大缺损修复的研究

目的总结口腔口咽肿瘤切除后较大缺损的修复方法，讨论影响组织瓣相关并发症的因素。方法回顾性分析2004年12月～2006年4月我院头颈外科收治的部分口腔口咽肿瘤患者64例，肿瘤切除后出现较大缺损，使用组织瓣66块进行修复，其中带蒂组织瓣39块，游离组织瓣27块。结果27例游离组织瓣中，2例前臂皮瓣坏死，成功率92．6％；39例带蒂组织瓣中，4例胸大肌肌皮瓣出现部分坏死。成功率90％。64例患者中，除1例死亡外，全部恢复经口进食。带蒂或游离组织瓣的选择及术前放疗与否不影响组织瓣相关并发症的发生。结论对口腔口咽部肿瘤切除后的较大缺损，应视缺损的范围、大小及患者的一般情况、术前放疗、颈部手术史等综合考虑，选择最合适的组织瓣进行修复。如果出现皮瓣相关井发症，尤其对术前放疗者应积极处理。     

口腔擦洗结合牙龈按摩预防脑卒中患者肺部感染和口腔异味

目的探讨口腔擦洗结合牙龈按摩预防脑卒中患者肺部感染及去除口腔异味的作用。方法将200例脑卒中患者随机分为两组各100例。对照组使用湿棉球行常规口腔护理,观察组使用湿纱布擦洗并给予牙龈按摩。结果观察组肺部感染率及1级以上口腔异味发生率显著低于对照组(P<0.05,P<0.01)。结论口腔擦洗结合牙龈按摩可以减少脑卒中患者肺部感染和口腔异味的发生率。