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     

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.     

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。     

Understanding oral cancer in the genome era

Completion of the human genome project approximately 15 years ago was followed closely by advancements in array technology. Investigators quickly applied this new powerful tool to the genomic and proteomic study of oral squamous cell carcinoma (OSCC). Resultant publications documented chromosome, gene, mRNA, and protein alterations that characterize oral cancer. In this review, we summarize how the genomic, proteomic, and epigenetic array studies have provided insight into the process of oral carcinogenesis. We discuss the significant limitations and requirement for validation of these array studies. We also review the manner in which state‐of‐the‐art, high‐throughput approaches are being used to search for salivary and serum oral cancer biomarkers. © 2010 Wiley Periodicals, Inc. Head Neck, 2010     

老年人口腔管理的最佳证据总结

目的 对老年人口腔管理最佳证据进行评价及总结,为构建我国本土化老年人口腔管理方案提供依据.方法 系统检索指南相关网站及电子数据库,检索时限为建库至2020年6月1日.由2名研究员对指南质量进行独立评价,结合专业人士的判断,对符合纳入、排除标准的指南/专家共识进行资料提取.结果 共纳入8篇指南/专家共识(中文1篇,英文7篇).最佳证据包括口腔护理评估、实施、评价、义齿的护理、特殊口腔问题的护理,口腔护理教育、口腔护理管理7个方面,共27条证据.结论 临床护理人员应依据最佳证据,为老年人提供科学有效的口腔管理措施,提升口腔管理质量,促进老年人口腔健康及整体健康.     

Histopathologic parameters in the evaluation of T1 squamous cell carcinomas of the oral cavity

BACKGROUND: Prognostic indicators that could assist in a more precise selection of patients with small oral carcinomas for differentiated therapy would be valuable. A significant fraction of patients with stage I disease have a relatively poor prognosis despite the small size of the tumor, but in general stage I tumors of the oral cavity have a favorable prognosis. METHODS: Seventy-eight patients with stage I (T1N0M0) oral squamous cell carcinoma from two different ENT departments were included in the study. The pretreatment biopsy specimens were graded according to the modified classification of Jakobsson et al. Eight individual parameters were recorded, four parameters describing the tumor cell population and four parameters describing the tumor/host interaction. RESULTS: The only significant prognostic parameter for disease-specific survival was "mode of invasion." The histologic mean score was not significantly correlated to disease-specific or crude survival. CONCLUSIONS: Mode of invasion is the most important histologic parameter when evaluating the prognosis. Histologic evaluation of small squamous cell carcinomas of the oral cavity may assist the design of a differentiated treatment strategy (eg, monotherapy vs combined treatment).     

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.     

Risk Analysis of Thrombo-Embolic and Recurrent Bleeding Events in the Management Of Intracranial Haemorrhage Due to Oral Anticoagulation

Purposes : Intracranial haemorrhage (ICH) is a rare but potentially devastating complication of oral anticoagulants (OAC). This raises the difficult clinical choice between either permanent cessation of OAC, or continuing OAC and if so, when to restart. To make this choice, one needs to balance the thrombo-embolic risk after cessation of OAC against the risk of recurrent intracranial haemorrhage when OAC are restarted. There are few published data to base this difficult clinical decision on.

Methods : We present an observational study of a consecutive series of 108 patients, collected prospectively and admitted to our department, with an OAC-related intracranial haemorrhage, in whom we assessed the thrombotic event rate and the recurrent intracranial bleeding rate during follow-up.

Results : In the 25 patients in whom OAC were reinstituted no new thrombo-embolic events occurred (0/506 unprotected patient-days). In the group of patients in whom OAC were not restarted (n = 81), the thrombo-embolic event rate was 8/11590 unprotected patient-days, of which only 2 were cerebrovascular thrombo-embolisms. The overall risk of a thrombo-embolic complication can be estimated to be 0.66 events/1000 patient-days at risk (95% exact confidence limits of 0.3 to 1.3 events/1000 patient-days at risk). In three patients the thrombo-embolic event was fatal. We saw recurrent intracranial bleeding in eight patients, 2 of which were fatal. Seven of these occurred before the restarting of the OAC.

Conclusions : In OAC-related intracranial haemorrhages, OAC can be stopped safely for a considerable period, with a very low overall thrombotic event rate. The recurrent bleeding risk after restarting OAC is low. Recurrent bleeding mostly occurred before restarting OAC and is probably caused by insufficient or unsustained correction of the initial coagulation deficit. Immediate reversal of anticoagulation provides the patient with the best possible treatment options including surgery. OAC-related intracranial haemorrhages can therefore be actively treated.     

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.     

Long-term safety of the oral androgen testosterone undecanoate

In 35 men treated with testosterone undecanoate (TU) at a dosage of 80-200 mg/day, liver function was measured every 6 months for a period of 72 months. None of the parameters changed. In 8 subjects of 50-62 years of age upon starting this type of treatment, urine flow was not found to decrease over the test period of 72 months. Also other signs of benign prostatic hypertrophy were not reported. In 9 subjects for whom TU was the first type of androgen treatment, no signs of gynaecomastia were found during the first 6 months of the therapy or later. These data provide evidence that TU is a reasonably safe form of oral androgen therapy.     

Myopericytoma of the oral cavity

BACKGROUND: Myopericytoma is a rare mesenchymal neoplasm of pericytic cells demonstrating myoid differentiation. The lesion typically arises within the subcutaneous tissue of the extremities. We report a case that, to the best of our knowledge, is the first case of myopericytoma involving the soft tissue of the oral cavity. METHODS: A 36-year-old woman had a 5-mm sessile, whitish-pink, firm tongue nodule. The patient underwent excisional biopsy, and histopathologic examination as well as immunohistochemical analysis were performed. RESULTS: The differential diagnosis by histologic analysis included solitary fibrous tumor, myofibroma, glomus tumor, and myopericytoma. The results of immunohistochemical analysis, when combined with the histologic features, led to a diagnosis of myopericytoma. CONCLUSIONS: Applying strict morphologic criteria and appropriately selective immunohistochemical markers will help to distinguish myopericytoma in the oral cavity.