Malaria and oral health

Half of the world population resides in malaria-prone areas, and the disease is responsible for more than a million deaths annually. This is apart from the economic impact of the disease through resources expended towards treatment and prevention and the loss of manpower. In addition to the overt clinical signs and symptoms, the association of malaria with other diseases such as tuberculosis and HIV infection has been described. However few studies have attempted to investigate its relationship to oral diseases. This review provides an overview of the relevance of malaria to the mouth and adjacent structures. The need for further research is also emphasized.     

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口腔黏膜下纤维性变(oral submucous fibrosis,OSF)是一种慢性、隐匿性、具有癌变倾向的口腔黏膜病。本文对OSF的病名来由、病因、发病机制和病变的性质进行了系统的描述。     

Detection of survivin mRNA in healthy oral mucosa, oral leucoplakia and oral cancer

Background:  Survivin is involved in modulation of cell death and cell division processes. Survivin expression in normal adult tissues has not been fully understood, although it is markedly lower than in cancer, where it is over-expressed.
Objective:  To investigate survivin expression in normal, potentially malignant and cancerous oral mucosa.
Methods:  We measured survivin mRNA levels by real-time RT-PCR in specimens of oral mucosa (15 from normal mucosa, 17 from potentially malignant lesions, 17 from neoplasms). Scores were compared using Kruskal–Wallis test and post hoc according to Conover. Chi-squared test was used for dichotomous data.
Results:  The median relative levels of survivin mRNA resulted six for normal mucosa, eight for potentially malignant lesions, 13 for cancers: differences among these three groups were statistically significant, as between cancer and potentially malignant lesions. Expression in normal mucosa and potentially lesions group showed no significant difference. Low, but not marginal expression of survivin in normal mucosa is a new finding, and it could be explained with the higher sensibility of our methods.
Conclusions:  Survivin expression in oral potentially malignant lesions might indicate a progressive deregulation of expression paralleling oncogenesis, particularly during the first stages of process, suggesting a putative predictive role for survivin.     

Cytomorphometric analysis of squames obtained from normal oral mucosa and lesions of oral leukoplakia and squamous cell carcinoma

Ramaesh T, Mendis BRRN, Ratnatunga N, Thattil RQ: Cytomorphometric analysis of squames obtained from normal oral mucosa and lesions of oral leukoplakia and squamous cell carcinoma. J Oral Pathol Med 1998; 27: 83–6. © Munksgaard, 1998.
Cell and nuclear diameters (CD and ND) were measured in squames obtained from normal buccal mucosa and lesions of oral leukoplakia and squamous carcinoma (SCC) also from buccal mucosa. The study groups consisted of Group 1: normal buccal mucosa ( n = 40); Group 2: lesions with no epithelial dysplasia ( n = 58); Group 3: lesions with epithelial dysplasia ( n = 27); and Group 4: SCC lesions ( n = 51). The mean CD and ND values were: Group 1: 51.78 (± 0.11) and 8.36 (± 0.49); Group 2: 45.73 (± 0.16) and 8.31(± 0.68); Group 3: 41.32 (± 0.13) and 9.04 (± 0.46); Group 4: 38.58 (± 0.11) and 10.10 (± 0.56) urn, respectively. Correlation between the ND and CD was positive for Group 1 ( r = 0.78, P < 0.05) and Group 2 ( r = 0.33, P < 0.05). There were no significant correlations in Groups 3 and 4. ANOVA showed significant differences ( P < 0.05) for CD between all four groups. Except between Groups 1 and 2, the ND was significantly different ( P < 0.05) between all groups. The results indicate that ND and CD could possibly be sensitive parameters in the diagnosis of oral premalignant and malignant lesions.     

Metallothionein and p-Akt proteins in oral dysplasia and in oral squamous cell carcinoma: an immunohistochemical study

Background:  Oral leukoplakia (OL) is the main potentially malignant lesion of the oral cavity, and oral squamous cell carcinoma (OSCC) accounts for more than 95% of all malignant neoplasms in the oral cavity. Therefore, the aim of this study was to verify the immunoexpression of p-Akt and Metallothionein (MT) proteins in dysplasic and neoplasic oral lesions.
Methods:  Immunohistochemical studies were carried out on 10 normal epithelium, 30 OL and 15 OSCC paraffin-embedded samples. Immunoperoxidase reaction for p-Akt and MT proteins was applied on the specimens, and the positivity of the reactions was calculated for 1000 epithelial cells.
Results:  Using the ANOVA and the Tukey's post hoc statistical analyses, it was observed a significant difference in the immunoexpression for p-Akt and MT when the OSCC samples were compared with normal and dysplasic epithelial groups. In addition, the Pearson's correlation test showed a significant correlation between the proteins' expression.
Conclusion:  Based on the data obtained, p-Akt and MT activation may play an important role in the conversion of a potentially malignant oral lesion to a malignant carcinoma since its earlier stages.     

Epstein-Barr virus in tobacco-induced oral cancers and oral lesions in patients from India

D'Costa J, Saranath D, Sanghvi V, Mehta AR: Epstein-Barr virus in tobacco-induced oral cancers and oral lesions in patients from India. J Oral Pathol Med 1998; 27: 78–82. © Munksgaard, 1998.
We examined 103 oral squamous cell carcinomas (OSCC), 100 oral lesions consisting primarily of leukoplakia (82 cases), and 76 clinically normal mucosa specimens from the contralateral site in the oral cavity of individuals with oral lesions, for the presence of Epstein-Barr virus (EBV). Polymerase chain reaction (PCR) was used to amplify a 239 bp fragment of the BamHIL region of the EBV genome, followed by Southern blot hybridization with EBV oligonucleotide probe to increase further the specificity and sensitivity of the assay system. Since EBV seropositivity is frequent in populations, we also examined the peripheral blood cells (PBC) from 141 patients (50 oral cancer patients, 91 patients with oral lesions) for the presence of EBV We detected EBV in 25 of 103 (25%) OSCC, 13 of 100 (13%) oral lesions, 3 of 76 (4%) clinically normal mucosa samples and 10 of 141 (7%) PBC. Our results indicate that EBV may contribute as one of the multiple factors in oral cancers, in a certain proportion of Indian patients.     

Exfoliative cytology in clinical oral pathology

Exfoliative cytology is a rapid, non-invasive procedure for assessing dysplastic change within the oral epithelium. The indications for oral exfoliative cytology are reviewed and a technique for cell collection and smear examination is presented. The value of exfoliative cytology in oral cancer screening programmes as a public health measure is discussed.     

Outcomes of oral squamous cell carcinoma arising from oral epithelial dysplasia: rationale for monitoring premalignant oral lesions in a multidisciplinary clinic

Surveillance of oral epithelial dysplasia results in a number of newly diagnosed cases of oral squamous cell carcinoma (SCC). The clinical stage of oral SCC at diagnosis influences the magnitude of treatment required and the prognosis. We aimed to document the stage, treatment, and outcome of oral SCC that arose in patients who were being monitored for oral epithelial dysplasia in a dedicated multidisciplinary clinic. Those with histologically diagnosed lesions were enrolled on an ethically approved protocol and molecular biomarker study. Details of clinical and pathological TNM, operation, radiotherapy, recurrence, second primary tumour, and prognosis, were recorded in patients whose lesions underwent malignant transformation. Of the 91 patients reviewed (median follow-up 48 months, IQR 18-96), 23 (25%) had malignant transformation. All were presented to the multidisciplinary team with stage 1 disease (cT1N0M0). Of these, 21 were initially treated by wide local excision, 2 required resection of tumour and reconstruction, and 2 required adjuvant radiotherapy. At follow-up 3 had local recurrence, one had regional recurrence, one had metachronous lung cancer, and 5 had second primary oral SCC. There were further diagnoses of oral dysplasia in 5 during follow-up, and it is estimated that 76% of patients will have one or other event in 5 years. Disease-specific survival was 100% and overall survival was 96% (22/23). Median follow-up after diagnosis of oral SCC was 24 months (IQR 11-58). Specialist monitoring of oral epithelial dysplasia by a multidisciplinary team allows oral SCC to be detected at an early stage, and enables largely curative treatment with simple and usually minor surgical intervention. The high incidence of second primary oral SCC in high-risk patients with oral epithelial dysplasia further supports intensive targeted surveillance in this group.     

Patients with oral cancer developing from pre‐existing oral leukoplakia: do they do better than those with de novo oral cancer?

Background:  It has been suggested that patients with squamous cell carcinomas derived from oral leukoplakia have a better prognosis than patients with carcinomas that are not associated with oral leukoplakia.
Aim:  To study the mortality rate of 19 patients with a squamous cell carcinoma derived from pre-existing oral leukoplakia.
Method:  The mortality rate of 19 patients with a proven oral squamous cell carcinoma derived from a pre-existing oral leukoplakia was compared with that of a similar size group of patients with oral carcinoma without a pre-existing oral leukoplakia, being matched for gender, age, smoking habits, use of alcohol, oral subsite and histopathologic grade. Treatment in all patients was primarily by surgical excision. The mortality rates up to 5 years have been computed according to the Kaplan–Meier method.
Result:  No significant difference of the mortality rates up to 5 years of follow-up was observed between the two groups of patients.
Conclusion:  Patients with oral cancer developing from pre-existing oral leukoplakia do not do better than those with de novo oral cancer.     

Caregivers' oral health literacy and their young children's oral health-related quality-of-life

Abstract

Objectives: To investigate the association of caregivers' oral health literacy (OHL) with their children's oral health related-quality of life (C-OHRQoL) and explore literacy as a modifier in the association between children's oral health status (COHS) and C-OHRQoL. Methods. This study relied upon data from structured interviews with 203 caregivers of children aged 3–5 from the Carolina Oral Health Literacy (COHL) Project. Data were collected for OHL using REALD-30, caregiver-reported COHS using the NHANES-item and C-OHRQoL using the Early Childhood Oral Health Impact Scale (ECOHIS). This study also measured oral health behaviors (OHBs) and socio-demographic characteristics and calculated overall/stratified summary estimates for OHL and C-OHRQoL. Spearman's rho and 95% confidence intervals (CI) were computed as measures of correlation of OHL and COHS with C-OHRQoL. To determine whether OHL modified the association between COHS and C-OHRQoL, this study compared literacy-specific summary and regression estimates. Results. Reported COHS was: excellent—50%, very good—28%, good—14%, fair—6%, poor—2%. The aggregate C-OHRQoL mean score was 2.0 (95% CI: 1.4, 2.6), and the mean OHL score 15.9 (95% CI: 15.2, 16.7). There was an inverse relationship between COHS and C-OHRQoL: ρ = ?0.32 (95% CI: ?0.45, ?0.18). There was no important association between OHL and C-OHRQoL; however, deleterious OHBs were associated with worse C-OHRQoL. Literacy-specific linear and Poisson regression estimates of the association between COHS and C-OHRQoL departed from homogeneity (Wald χ ² p < 0.2). Conclusion: In this community-based sample of caregiver/child dyads, a strong correlation was found between OHS and C-OHRQoL. The association's magnitude and gradient were less pronounced among caregivers with low literacy.     

口腔黏膜病患者口腔念珠菌感染情况的分析

目的 分析了解口腔黏膜病患者感染白念珠菌的情况。方法 收集2019年就诊于口腔黏膜科并进行白念珠菌培养的2 289 例患者,收集其基本信息、临床资料及实验室检查情况。按年龄分组:0～16岁(1组,38例),17～29岁(2组,181例),30～39岁(3组,274例),40～49岁(4组,325例),50～59岁(5组,535例),60～69岁(6组,540例),70岁及以上(7组,396例)。结果 白念珠菌总感染率为 30.6%,且女性患者感染率高于男性(33.1% vs.25.1%,P<0.05)。随着年龄的增长,白念珠菌感染率总体是上升的,且第6、7组感染率明显高于第2、3、4、5组(P<0.05)。除了口腔念珠菌病本身,唇舌疾病及口腔斑纹类疾病中最容易检测出白念珠菌,且白念珠菌的阳性检出与唇舌疾病、干燥综合征、口腔斑纹类疾病等相关。在同时进行白念珠菌培养及真菌镜检且白念珠菌培养阳性的患者中,真菌镜检阳性为50例,阳性率为35.5%。对白念珠菌培养阳性患者进行制霉素片及2%～3%碳酸氢钠溶液的局部治疗,其药物有效率为81.36%。结论 口腔念珠菌病更容易发生于60岁以上老年女性;且与系统性疾病、口腔斑纹类疾病相关。制霉素片联合2%～3%碳酸氢钠溶液局部治疗口腔念珠菌病效果尚可。     

Cryotherapy for treatment of oral lesions

Cryotherapy is the deliberate destruction of tissue by application of extreme cold. It is well received by patients due to a relative lack of discomfort, the absence of bleeding and minimal to no scarring after healing. It has many applications in oral medicine and clinical oral pathology, and is extremely usefu in patients for whom surgery is contra-indicated due to either age or medical history. In this paper we outline the principles, mechanisms of action, and current applications of cryotherapy in the treatment of oral lesions, and present some clinical cases.     

口腔卫生师的职业与职责

口腔卫生师(hygienist)是口腔医疗卫生保健的特殊职业,是口腔卫生保健的专业人才,是口腔疾病预防的主力,作为口腔医学的重要组成部分,组成了口腔医疗的基本结构单元。口腔卫生师有明确的职业特征和社会属性,在大众的口腔医疗卫生保健中发挥独特的重要作用。口腔卫生师通过口腔卫生宣教,提高大众的口腔健康素质和修养;通过口腔照护,改善提高大众的口腔卫生水平;通过采取口腔预防措施,预防减少口腔疾病的发生,从而保证口腔健康和全身健康。国际口腔卫生师的职业是成熟的社会职业,我国尚未设立专门的口腔卫生师职业,但其确实是我国口腔公共卫生急需的具有社会公共价值的口腔医疗职业。目前国内关于口腔卫生师的专门论述和讨论较少,本文对口腔卫生师的职业与职责做一探讨,建议我国尽快建立口腔卫生师职业,为保证口腔健康和全身健康做出贡献。