Awareness about Oral Cancer among Dental Postgraduate Students in the State of Andhra Pradesh,India

The aim of the study was to evaluate the knowledge and awareness of dental postgraduate students regarding risk factors, signs of oral cancer, and treatment plan and post treatment complications. A questionnaire was given to the 450 dental postgraduate students of all specialties to various dental colleges in Andhra Pradesh. The questionnaire included 10 questions pertaining to knowledge about oral cancer, its risk factors, key symptoms, and treatment plan and post treatment complications. Majority of postgraduate students were aware that habits (94 %) were the main risk factor for most of oral cancer whereas 50 % of students were aware of clinical presentation of oral cancer and 67 % were confident about the proper treatment protocol. Majority of the postgraduate students were aware of the main risk factors. On the other hand, several aspects like clinical signs of oral cancer, treatment protocol, referrals, and post treatment complications need to be improved. Continuing dental education programs and workshops on oral cancer should be carried out to enhance the knowledge and awareness of the postgraduate students.     

Oral complications of cancer therapies. Oral complications in the pediatric population

A number of acute oral complications may be associated with cancer therapy in children, but the extent and duration of these complications, and the most effective management techniques. have not been well described. The few studies differ in design, making comparisons difficult. Well-controlled, prospective clinical studies are needed to define the most effective strategies for the management of acute oral complications in children. However, it is clear that dental intervention prior to cancer therapy is an important factor in the optimal preparation of the patient. During cancer therapy, intensive supervised oral preventive protocols appear to be of benefit to the child's oral health, overall comfort, and well-being. Furthermore, the prevention of oral infection may significantly reduce the morbidity associated with cancer therapy. Long-term preventive oral care may help prevent dental disease and infection in medically compromised children and contribute to improving the quality of life.     

A prospective cohort study on poor oral hygiene and pancreatic cancer risk

Poor oral hygiene has been proposed to increase the risk for pancreatic cancer. We aim to assess this hypothesis, using number of teeth, dental plaque and oral mucosal lesions examined at baseline as a proxy for oral hygiene. During 1973–74 a population‐based prevalence study of oral mucosal lesions was carried out in Uppsala County in central Sweden. We followed the study population through linkages with the Swedish Cancer and Total Population registers. A total of 19,924 participants were included, and 126 pancreatic cancer cases were identified during an average of 28.7 years of follow‐up. Hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) for pancreatic cancer were estimated using Cox proportional hazards regression models. Overall, subjects with fewer teeth at baseline tended to have an increased risk for pancreatic cancer, although the estimates were not statistically significant. Among subjects with more than 10 teeth, those with unacceptable dental plaque had an HR of 2.1 (95% CI: 1.0, 4.7), compared with those without dental plaque after adjustment for potential confounding factors. Individuals with Candida‐related or denture‐related oral mucosal lesions, or tongue lesions, compared with those without any of the three studied lesions, had a 70, 30 and 80% excess risk of developing pancreatic cancer, respectively. Presence of more than one type of studied lesions further increased the risk for pancreatic cancer. In conclusion, our findings provide evidence to support the hypothesis that poor oral hygiene plays an important role in the development of pancreatic cancer.     

Oral and Dental Complications of Radiotherapy for Head and Neck Cancer: Knowledge of Dental Practitioners in Saudi Arabia

Objectives: Toxicities of the oral soft and hard tissues due to the radiotherapy of the head and neck cancer can potentially lead to interruptions of cancer treatment and/or dose reduction, resulting in poorer outcomes. The aim of this study was to assess the knowledge of dental practitioners in Saudi Arabia about oral and dental assessment for and complications of radiotherapy of head and neck cancer. Materials and Methods: An online, already validated, self-administered questionnaire was sent via an online link through WhatsApp groups and other Social Media platforms to reach out to the majority of targeted samples (dental practitioners working in Saudi Arabia). Responses were statistically described and analyzed based on the different grouping factors: gender, specialty, working sector, region of work and experience. Results: There were 370 respondents, 257 (69.5%) of them were males. Most of the respondents were general dental practitioners [144 (38.9%)], The percentages of the correct answers range from as low as 26.2 to as high as 97%. The per cent of correct answers by the respondents in 18 out of 31 questions was above 75%. Females, dental specialists (specifically prosthodontics), working in public sectors and in the central and western regions of Saudi Arabia were associated with higher levels of knowledge. Conclusion: Our results show highly variable knowledge of dental practitioners on oral and dental assessment for, and complications and management of radiotherapy to the head and neck area; that knowledge seems to fluctuate considerably with gender, experience, work sector and specialty.     

Oral complications of cancer and cancer therapy

Answer questions and earn CME/CNE Oral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long‐term oral health and general well‐being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long‐term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long‐term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. CA Cancer J Clin 2012. © 2012 American Cancer Society.     

Knowledge and attitude towards risk factors in oral cancer held by dental hygienists in the Autonomous Community of Murcia (Spain): a pilot study

The objective was to study the knowledge and attitude on risk factors in oral cancer held by dental hygienists working in private dental practices in the Autonomous Community of Murcia, Spain. An anonymous phone survey was made after obtaining consent from the interviewee. A simple randomized study was carried out and 240 dental hygienists were selected. The questionnaire was divided into three different parts: (1) professional data and years of practice; (2) knowledge of the risk factors in oral cancer and (3) education and training needs on oral cancer. The response rate was 58.3%. Regarding knowledge of the risk factors in oral cancer, 100% correctly identified tobacco and 90% alcohol, while only 50.7% identified sun exposure with labial cancer. Only 51.4% of the dental hygienists routinely gave advice to their patients on prevention of oral cancer. Furthermore, 57.1% did not consider themselves sufficiently well trained to discover suspected oral cancer lesions, and 84.3% recognized that their academic training on the early diagnosis and prevention of oral cancer was insufficient for their professional activity. To reduce morbidity and mortality of oral cancer it is necessary to implement training programs on oral cancer for dental hygienists, so they may acquire the necessary skills for its detection and prevention.     

État dentaire des patients atteints d’un cancer des voies aérodigestives supérieures

In France, in 2005, there were approximately 16,000 new cases of head and neck cancer. These cancers have an unfavourable prognosis: the survival rates at 3 and 10 years are 50% and 10% respectively. The consumption of alcohol and tobacco is the most important risk factor; in some countries HPV infection was identified as a risk factor of head and neck tumours. Furthermore, a poor oral hygiene seems to raise this risk. We found many decay and periodontium problems in patients with an upper aerodigestive tract cancer. An evaluation of dental state is necessary before any cancer treatment. Treatments by radiotherapy engender noxious effects: hypocellular, hypovascularization, hypoxie of the irradiated tissues, which lead to immediate and chronically oral complications such as mucositis, fibrosis, xerostomia, decay, or osteoradionecrosis. An oral follow-up of these patients can prevent these complications, or reduce the severity of oral complications, and promote a good oral state.     

Oral Cancer: Awareness and Knowledge Among Dental Patients in Riyadh

More than 50 % of oral cancer cases are diagnosed at advanced stages. Public knowledge about oral cancer can help in prevention and early detection of the disease. The aim of the present study was to assess the levels of awareness and knowledge about signs and risk factors of oral cancer among dental patients in Saudi Arabia. A self-administered questionnaire was used to collect information from 1410 randomly selected patients attending dental departments within public hospitals in Riyadh, Saudi Arabia. The collected data were analyzed using SPSS software. The significance level was set at P?<?0.05. The study revealed that only 62.4 % were aware of oral cancer. Some 68.2 and 56.5 %, respectively, were able to correctly identify tobacco and alcohol as risk factors. More than two thirds of subjects had no knowledge about any signs of oral cancer. Participants with lower than university education were significantly less aware, and had much less knowledge, of the signs and risk factors of oral cancer. The knowledge regarding oral cancer among Saudi dental patients is alarmingly low. Interventions to improve public knowledge about oral cancer and attitudes towards early diagnosis and treatment are urgently indicated.     

Knowledge and Attitudes of Saudi Dental Undergraduates on Oral Cancer

Oral cancer awareness among future dental practitioners may have an impact on the early detection and prevention of oral cancer. A cross-sectional survey was undertaken to assess the current knowledge of future Saudi dentists on oral cancer and their opinions on oral cancer prevention. A pretested questionnaire was sent to 550 undergraduate dental students in the fourth, fifth, and sixth year of the Al-Farabi College for Dentistry and Nursing, Riyadh, Saudi Arabia. Questions relating to knowledge of oral cancer, risk factors, and opinions on oral cancer prevention and practices were posed. Four hundred seventy-nine students returned the questionnaire (87.1 %). Eighty-one percent of respondents correctly answered questions relating to oral cancer awareness. Eighty-seven percent of respondents felt confident in performing a systematic oral examination to detect changes consistent with oral malignancy. Interestingly, 57 % of respondents had seen the use of oral cancer diagnostics aids. Thirty-seven percent of respondents felt inadequately trained to provide tobacco and alcohol cessation advice. There is a need to reinforce the undergraduate dental curriculum with regards to oral cancer education; particularly in its prevention and early detection. Incorporating the use of oral cancer diagnostic aids should be made mandatory.     

Oral Cancer Awareness and Perception of Tobacco Use Cessation Counseling among Dental Students in Four Asian Countries

Background: The scientific evidence relating to the burden of oral diseases attributable to tobacco use hasbeen reviewed and the need for a well-structured dental teaching program concentrating on oral cancer educationand tobacco cessation interventions has been emphasized. The aim of our study was to evaluate the awarenessof oral cancer and perception of tobacco use cessation counseling among dental students at all study levels inIndia, Saudi Arabia, the United Arab Emirates, and Yemen. Materials and Methods: A structured, pre-tested,self-administered 15-item questionnaire was used to conduct a cross-sectional survey. Data analyses includingpercentages, frequency distributions and tests of chi-square were generated. Results: A total of 621 (97.6%)Indian, 493 (96.5%) Saudi, 194 (96.5%) Yemeni and 187 (98.4%) United Arab Emirates respondents recognizedthe association between oral cancer and cigarette smoking. Although more than 96% of the students surveyedrecognized the association between oral cancer and cigarette smoking and about 55% reported cigarette smokingas one of the etiological factors of oral cancer, more than 66% of students who reported cigarette smoking asan etiological factor of oral cancer disagreed/strongly disagreed with all the statements concerning tobacco usecessation. Conclusions: A higher level of oral cancer awareness did not have a positive impact on the perceptionof tobacco use cessation counseling among the sample surveyed.     

Awareness of Undergraduate Dental and Medical Students Towards Oral Cancer

Oral cancer is a common malignancy in Nepal and many other South East Asian countries, which is predisposed by a variety of potentially malignant oral diseases. Considering the importance of knowledge of health professionals and their role in early diagnosis and reduction of cancer statistics, this study aims to evaluate the awareness of undergraduate dental and medical students towards oral cancer. The study involved undergraduate dental and medical students of BP Koirala Institute of Health Sciences, Nepal. A self-administered questionnaire adapted from Carter to Ogden was distributed. One hundred forty-three dental and 311 medical students responded to the questionnaire. Significantly more dental (80.4 %) than medical students (36.0 %) were found to routinely examine the oral mucosa. Tobacco smoking and chewing were the most commonly recognized risk factors by both medical and dental students. Most of the students found ulcer as the common change associated with oral cancer. Only 30 out of the total students felt very well informed about oral cancer. This study has demonstrated a lack of awareness in some aspects of oral cancer among medical and dental students which highlights the need to frame new teaching methodologies. Similar studies from other health institutions would provide an insight regarding the same and could be a base for formulating a uniform curriculum in the implementation of knowledge regarding oral cancer.     

Oral manifestations of bone marrow transplantation

Bone marrow protection by transplantation permits the administration of large doses of antitumor drugs and radiation. Severe oral complications occur in about 70% of patients who have had allogeneic bone marrow transplants and to a lesser degree in patients who have had autologous and syngeneic transplants. Oral complications consist of mucositis, salivary gland dysfunction, loss of resiliency of perioral tissues, periodontal disease, and caries. Pre- and post-transplant oral care aimed at plaque control, control of dental pathology, and hydration of oral tissues are important factors in support therapy of bone marrow transplant patients.     

The role of saliva in oral health: strategies for prevention and management of xerostomia

Oral complications are the most frequent and debilitating sequelae of radiation treatment for patients with head and neck cancer. Impaired salivary function and consequent xerostomia can persist for years after radiation treatment, significantly increasing the risk of oral and dental disease and negatively affecting patients' quality of life. Current evidence indicates that many patients undergoing radiation treatment do not receive adequate oral and dental care and follow-up and that patients' compliance with oral care recommendations is frequently poor. Topical lubricants, coating agents,and saliva substitutes or lozenges may provide transient relief from xerostomia. Cholinergic stimulants such as pilocarpine improve salivary flow but have had mixed results in improving patients' assessments of symptoms or other quality-of-life measures. Advances in radiotherapy techniques, such as intensity-modulated radiation therapy, have enabled increased delivery of therapeutic doses of radiation to tumors while limiting exposure to normal tissues, thereby reducing the incidence, duration, and severity of xerostomia in some patients with head and neck cancers. Additionally, radioprotective agents such as amifostine have been shown to reduce radiation-induced toxicity to normal tissues within the radiation field. Studies are ongoing to determine the optimal approaches for these techniques and agents to maximize clinical response while improving the overall quality of life for patients with head and neck cancer.     

Dental hygienists and oral cancer prevention: knowledge, attitudes and behaviors in Italy

This study explored knowledge of risk factors and diagnostic procedures for oral cancer, attitudes and behavior among dental hygienists in Italy. A random sample of 500 dental hygienists received by mail a questionnaire focusing on demographics and practice characteristics, knowledge, attitudes and behaviors regarding oral cancer assessment practices. Almost all dental hygienists correctly indicated tobacco usage and having a prior oral cancer lesion as risk factors. Although 88.8% knew that the tongue is one of the two most common sites of oral cancer, only 13.5% identified the floor of the mouth. Less than half (42.8%) recognized that an early oral lesion usually is a small, painless and red area and only 4.2% knew the examination procedures of the tongue. Results of the multiple logistic regression showed that those dental hygienists who worked a higher number of hours and treated a lower number of patients in a week were more likely to indicate tobacco and alcohol use as risk factors for oral cancer. Higher number of years in practice, scientific journals and associations as sources of information about oral cancer, and knowledge that ventral lateral border of tongue is the most common site for oral cancer, significantly predicted compliance with oral cancer examination. Dental hygienists' sex, age, and years in practice were associated with a positive attitude towards oral cancer prevention. Further educational interventions in order to early detect and prevent oral cancer are strongly needed.     

Standards, Options and Recommendations (SOR) for good practices in dentistry for head and neck cancer patients. Federation of the French Cancer Centres (FNCLCC)]

CONTEXT: The Standards, Options and Recommendations (SOR), initiated in 1993, is a collaborative project between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcomes for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary experts group, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines for dentistry and oral hygiene in head and neck cancer patients. METHODS: Data have been identified by literature search using Medline (up to January 1999) and personal reference lists. The main end points considered were risk factors for treatment related late effects, safety and quality of life, efficacy of dental preventative measures and treatment. Once the guidelines were defined, the document was submitted to reviewers for peer review and to the medical committees of the 20 French Cancer Centres for review and agreement. RESULTS: The key recommendations are: 1) before receiving radiotherapy, surgery and chemotherapy for head and neck cancer, patients must benefit from a multidisciplinary approach including dental evaluation; 2) the patients must be informed of precautions and educated about oral hygiene; 3) after radiotherapy, the most important dental late effect to prevent is radionecrosis, in accordance with the oral and dental state, the dentist may propose conservation or extraction of teeth, fluoridation and regular follow-up; 4) during chemotherapy, the principal complications are mucositis, haemorrhage and infection risk; 5) after surgery, the dentist may propose prosthetic measures with the aim functional, aesthetic and psychological benefit; 6) in the particular case of children, treatment and prevention are the same as for adults but the follow-up is specific because of the dental development.     

Screening for Oral Cancer/Pre-cancer: Knowledge and Opinions of Dentists Employed in the Public Sector Dental Services of Sri Lanka

Objective: The aim of the present study was to assess knowledge and opinions related to oral cancer screeningamong dentists employed in public sector dental services in Sri Lanka. Materials and methods: The studypopulation consisted of a total of 1,020 dentists employed in the public sector dental services as at December2007. The data were collected by means of a postal questionnaire consisting of 23 items focusing on demographiccharacteristics, knowledge and opinions about screening for oral cancer/precancer. Results: 387 completedquestionnaires were returned giving a response rate of 38%. The overall knowledge score for oral cancer screeningwas 2.79 ± 0.76. There were no significant differences between time since graduation, position held and knowledgescores. Around 68-70% of respondents agreed/strongly agreed that their knowledge about oral cancer/pre cancerwas current. Though 77% agreed/strongly agreed that dentists are adequately trained in oral cancer screening,nearly 63% disagreed/strongly disagreed that medical officers are adequately trained to perform oral screening.Nearly 81% agreed/strongly agreed that they were adequately trained in oral cancer screening whilst 70% alsofelt that they needed further training in oral cancer screening. Conclusions: the results revealed that a fairlylarge proportion of respondents were knowledgeable about oral cancer screening but as there was a reasonablepercentage whose knowledge about oral cancer screening was poor there is a need for continuing educationprogrammes.     

Assessing Oral Cancer Knowledge in Romanian Undergraduate Dental Students

The aim of this study is to investigate the level of Romanian dental students’ knowledge regarding the oral cancer risk and non-risk factors as well as oral cancer signs, symptoms, and diagnostic signs. A total of 192 first- to sixth-year undergraduate dental students (mean age 22.20?±?2.94 years) who consented to participate in the study filled in a questionnaire enquiring about their knowledge of oral cancer. A score of the oral cancer knowledge was calculated for each participant based on their correct answers. Regarding the knowledge of oral cancer risk factors, the vast majority of the students correctly recognized tobacco (96.8 %), having a prior oral cancer lesion (85.1 %), the consumption of alcohol (77.7 %), and older age (64.2 %). Respectively, 87.7 and 54.3 % knew the tongue and the floor of mouth to be the most common oral cancer sites. Of the students, 71.3 % agreed that oral cancer examinations for those 20 years of age and older should be provided during regular periodic health examinations, 92.9 % considered that patients with suspicious oral lesions should be referred to specialists, and 84.6 % agreed that oral cancer examinations should be a routine part of a comprehensive oral examination. A significant association was found between the year of study in the dental school, age, and knowledge of the oral cancer knowledge scores. Although students’ knowledge increased with academic year, there is a clear need to enhance the dental curricula in oral cancer clinical training in oral cancer prevention and examination for dental students.     

A survey of prevention and treatment regimens for oral sequelae resulting from head and neck radiotherapy used in Dutch radiotherapy institutes.

Radiation treatment plays an important role in the management of head and neck cancer. Unfortunately several radiation-induced side effects may occur including mucositis, hyposalivation, radiation caries, trismus and osteoradionecrosis. It is generally accepted that most side effects can be prevented or reduced in severity. The purpose of this investigation was to make a survey of the prevention and treatment regimens for oral sequelae resulting from head and neck radiotherapy applied in all radiotherapy institutes in the Netherlands, and to evaluate the differences in these regimens. In all Dutch centers (n = 20) in which irradiation of head and neck cancer patients is performed, members of the staff responsible for prevention and treatment of oral side effects were interviewed. Questions referred to composition of the dental team, screening and care pre-irradiation, care during irradiation, and care post-irradiation. There appeared to be a great diversity in the preventive approach of the head and neck cancer patient in Dutch radiotherapy institutes. The most comprehensive counseling was performed by those centers in which a dental team was active, particularly when an oral hygienist was a member of such a team. The diversity is among others based on lack of well-defined guidelines in many centers, the spread of a relatively small patient group over a rather large number of centers, absence of a dental team in some centers, absence of an oral hygienist in some dental teams, and the observation that a rather large number of patients were not referred, or not timely referred to the dental team. There seems to be a need for the development of a general protocol for the prevention of oral complications applicable in all centers.     

Pretreatment strategies for infection prevention in chemotherapy patients

It is important to understand the pathogenesis of acute oral infections in patients with chemotherapy-induced myelosuppression in order to develop strategies to prevent such complications. Four distinct oral sites that can either be acutely infected or contribute to acute systemic infection are the oral mucosa, dental pulp and periapical tissues, periodontium, and salivary glands. Many cytotoxic drugs can be directly stomatotoxic to replicating oral mucosa. Once mucosal integrity is affected, secondary acute infection can occur. Even without clinical ulceration, deleterious shifts in the oral microbial population can develop. Gram-negative bacilli have been identified as frequent colonizers of myelosuppressed patients, although coagulase-negative staphylococci are being recovered with increasing frequency. Strategies to prevent oral mucosal infection include reducing trauma and preventing proliferation of organisms. Dental pulpal infection is most commonly caused by extensive dental caries. Most pulpal infection is of bacterial origin and can progress to involve the periapical tissues of the involved tooth if not treated. Specific endodontic interventions will usually stabilize or eliminate the source of the infection until the patient's hematologic status returns to normal and definitive pulpal therapy can be provided. In part because acute pulpal complications in the myelosuppressed cancer patient are relatively infrequent, research on the causative organisms and the appropriate therapy of acute, systemic infection of pulpal origin has been limited. Many adults have chronic, asymptomatic periodontal disease. In its advanced stages, extensive ulceration may be present that is not clinically observable. In patients with reduced host defenses, exacerbation of preexistent periodontal disease can have systemic sequelae and is associated with elevated levels of periodontopathic organisms or pathogens typically associated with systemic infection in myelosuppressed cancer patients. Mechanical and chemical antimicrobial techniques are available to reduce prevalence and improve patient comfort and oral hygiene. Dental extractions may be indicated to eliminate the nidus of infection of either pulpal or periodontal origin in patients who are scheduled to receive myelosuppressive chemotherapy. Data indicate that such procedures may be performed without undue risk. Unlike patients who undergo bone marrow transplantation or radiotherapy, patients who receive chemotherapy do not commonly experience subjective salivary gland dysfunction. Occasionally, a transient xerostomia may occur; this condition is frequently attributed to the patient's oral habits, such as breathing through the mouth. The dessicating effect of breathing through the mouth can contribute to oral mucosal injury during function as well as provide a setting for acute infection of commensal origin. More research is needed on the effects of chemotherapy on salivary host defenses.