Oral cancer: enduring characteristics and emerging trends

Oral cancer is arguably the most serious condition that dental providers may encounter in their practice. The relatively poor prognosis associated with oral cancer highlights the importance of the dental team's awareness of the disease. While many characteristics of oral cancer have endured over time, new research is revealing trends that are changing the way we approach its screening, diagnosis and treatment. In this report, we provide a translational overview of oral cancer, including risk factors, signs and symptoms, clinical management, as well as our recent findings on the role of chronic inflammation in the development of the disease. In addition, our recent genetic profiling approach in both cancer cell lines and in patients has identified potential biomarkers, molecular pathways and therapeutic drugs (Velcade and Aspirin) for oral squamous cell carcinomas. This comprehensive review should be of interest to all dental professionals.     

Outcomes of oral cancer early detection and prevention statewide model in Maryland

A high oral cancer mortality rate and a moderately high oral cancer incidence rate prompted Maryland to develop a statewide approach to oral cancer early detection and prevention. This approach can serve as a model for other states. Key lessons learned include the need to: develop a comprehensive plan that focuses on actions to increase awareness, education and training for the public, dental and non-dental providers and policy makers; include oral cancer in the state's comprehensive cancer control plan to keep attention focused on this disease; and maintain high vigilance among stakeholders to keep oral cancer prevention and early detection a high priority within the state. Future efforts will focus on: requiring all dental and dental hygiene students to perform a set number of supervised oral cancer examinations for licensure to ensure a dental workforce that is competent and predisposed to providing routine oral cancer examinations; training health care providers such as doctors, nurse practitioners, and physician assistants to perform oral cancer examinations as part of a comprehensive cancer screening exam to expand the number of individuals that receive oral cancer examinations; and continuing to educate the public about oral cancer risk factors, its symptoms, and ways to prevent it.     

Primary oral squamous cell carcinoma arising around dental osseointegrated implants mimicking peri-implantitis

Prosthodontic rehabilitation using dental implants has become a common practice in dentistry at the present time. The number of complications related to dental osseointegrated implants has increased according to the generalization of its use along the last decade. Among the most common of these complications are chronic inflammatory conditions affecting both hard and soft tissues around dental implants. Although severe complications are uncommon, in recent years several cases of oral squamous cell carcinoma adjacent to dental implants have been published. In this paper we present a new unusual case of primary oral squamous cell carcinoma arising around a dental fixed prosthesis over osseointegrated implants in a 76 male patient with no previous history of malignance and no risk factors related to oral cancer.     

口腔微生物与消化系统疾病关系的研究进展

人类微生物组计划使人们对口腔微生物的认识更加深入。口腔微生物不仅在龋病、牙周病、口腔癌等口腔疾病的病程中发挥重要作用,还与其他全身系统疾病关系密切。口腔微生物与消化系统疾病间存在紧密的相关性,可以促进结直肠癌的发生和发展。本文对口腔微生物与消化系统疾病的研究进展、口腔微生物在消化系统疾病进程中的重要作用以及口腔微生物作用于消化系统多脏器的途径进行综述,为口腔微生物与全身系统疾病的进一步研究提供参考。     

Oral squamous cell carcinoma around dental implants.

It is well documented that oral squamous cell carcinoma (OSCC) is related to risk factors such as smoking and alcohol consumption as well as premalignant lesions and conditions such as leukoplakia, oral lichen planus (OLP), and previous malignancy of the upper respiratory system and gastrointestinal tract. Osseointegrated dental implants are rarely reported in association with OSCC. This article presents 2 cases of OSCC adjacent to dental implants in patients at risk for oral cancer--1 was a heavy smoker with OLP; the other had a history of previous oral and colon cancer. Six additional cases of malignancy adjacent to dental implants were retrieved from the literature; the majority of cases had at least 1 recognized risk factor for oral cancer. Although such cases are rarely reported, patients at risk for oral cancer, especially those with multiple existing risk factors, that present with failing dental implants should be thoroughly evaluated to rule out the presence of malignancy disguised as peri-implant disease.     

The role of dental hygienists in oral health prevention

Most dental diseases are preventable. This indicates that the main concept of dentistry could be changed to a situation in which the dental hygienist becomes the principal oral care professional. The competencies of dental hygienists focus on disease prevention and oral health promotion; thus referral to a dentist would only become necessary in the event of a failure in the preventive program where disease cannot be controlled. Future oral health care personnel need to be better educated to encourage people to implement healthy lifestyles rather than to treat teeth. In addition, the connection between oral health, general health and health-related quality of life will necessitate a multidisciplinary approach to prevention and oral health promotion. To focus strictly on oral health would too narrowly define the role of the dental hygienist in comprehensive prevention and health promotion. There is no precise boundary between the oral cavity and the rest of the body. Dietary advice to prevent dental caries and smoking cessation counseling to prevent periodontal disease and oral cancer also promote general health. Consequently the focus on prevention and health promotion makes the dental hygienist a very important person in the dental team of the future.     

Oral surgery

An overview of the various possibilities for oral surgery urgent care to the oral region has been presented. Modern treatment procedures have been described. The recent advances in dental science have become superior to what they were just a few short years ago; however, we must never forget the variabilities of human responses to any of our treatment techniques, and we must not be dogmatic in our approach. We should all be able to diagnose, interpret, and alter any of our treatment techniques as necessary.     

Patterns of referral of patients undergoing surgical management for oral cancer

BACKGROUND: Oral cancer is most often diagnosed by dentists or dental specialists. We were interested in analyzing demographic and referral data for a cohort of patients referred for the management of oral cancer to our unit. METHODS: A consecutive review of all patients treated by oral and maxillofacial surgery at the Austin and Repatriation Medical Centre over the last 10 years. Inclusion criteria included those patients with malignant oral and perioral disease that underwent surgical management. Exclusion criteria included those patients who did not have malignant oral disease, who did not have surgical management and those patients who were not treated by our unit as the primary surgeon. RESULTS: A total of 113 patients were identified. The mean age for presentation for the group was 61.6 years and the male to female ratio was 1.2:1. Approximately 70 per cent of patients were smokers or had smoked in the past. Over the last 10 years there has been a steady increase in referrals to our unit. Over half of all patients referred were from the Royal Dental Hospital of Melbourne while the majority of the remainder of the referrals were from private oral and maxillofacial surgeons. A significantly increased number of referrals from other sources were identified. Surveillance techniques that can be used in general dental practice are also described. CONCLUSIONS: A high proportion of referrals from dental sources highlights the importance of the dentist and dental specialist in the diagnosis and referral of patients with suspected oral cancer. Patients can either be referred to a dental hospital, private oral and maxillofacial surgeons or directly to a public hospital oral and maxillofacial surgery unit treating oral cancer, such as the one at the Austin and Repatriation Medical Centre.     

5.1 The demography of oral diseases, future challenges and the implications for dental education

This Section considered the immense challenges presented by the changing demography of populations (in particular, cross-boundary flow), changing oral and dental disease trends. It also considered the difficulties of gathering data on such information. It then considered how these challenges may affect the education of the dental team in the future. The Section considered the concept of the 'global village' as a representation of the changing world demography. We were at pains to recognize that our role was in considering both emerging and established market economies. In fact, a major part of the Section's activities concentrated on the development of the professional ethic of social responsibility – represented at the local, regional, national and international levels. We considered a finite group of oral and dental diseases, namely dental caries, periodontal diseases, oral cancer and cranio-facial disorders. In addition, we chose to comment on systemic diseases influenced by oral diseases, oral diseases influenced by systemic diseases and iatrogenic diseases (including prion disorders and cross-infection control issues). The Section recognized the profound difference between needs and demands in the provision of oral and dental health care. We considered the concept of best practices within our working remit and named these as:

• • the gathering of valid data on health trends;

       
  
  

Caries management: technical solutions to biological problems or evidence‐based care?

Caries-related clinical decision-making remains a centrepiece of clinical dentistry. However, the oral disease patterns are rapidly changing towards the better among major sections of the populations, most notably in the high-income countries. The caries decline is well documented among children and younger adults, and is gradually seen to trickle into middle and old age as well. Although it is tempting for the dental profession to take the credit for this development, the evidence points in a different direction. The major contribution of dentistry seems primarily related to changes in the treatment philosophies towards a less interventionist approach. This review aims to spur a further change in the diagnostic and treatment criteria used in the management of dental caries for the benefit of the oral health status of our patients. We must come to terms with the fact that our traditional core skills, our manual dexterity and technical competence, have less to offer to oral health than we have been accustomed to think. The dental schools and the professional dental organizations must carry the responsibility for promoting the necessary changes in the caries related clinical decision-making strategies to allow practicing dentists to provide appropriate oral health care to our populations.     

Impact of improved dental services on the frequency of oral complications of cancer therapy for patients with non-head-and-neck malignancies

An earlier study by our group reported a frequency of about 40% for oral problems associated with cancer therapy for patients with non-head-and-neck malignancies. Since then, we have instituted a variety of preventive and treatment protocols aimed at the aggressive management of the mouth in patients being treated for malignant disease. In the present study we evaluated the frequency and nature of oral problems associated with cancer treatment in 495 patients treated for non-head-and-neck malignancies between 1978 and 1986. Our analysis indicates that the frequency of oral problems in the study population was 10.5%, compared to 38.7% in 1978. The specific nature and distribution of oral problems by diagnosis, by patient's age, and by type were remarkably consistent. Our results suggest that early and aggressive dental intervention in standardized protocols reduces the frequency of oral problems associated with cancer therapy.     

The management of Sj?gren's syndrome in dental practice.

BACKGROUND: Sj?gren's syndrome, or SS, is a multisystem inflammatory disorder of the exocrine glands with a wide range of extraglandular involvement. Symptoms of dry eyes and xerostomia, although not invariably present, are characteristic features of SS. An increased risk of oral and dental diseases is a prominent consequence of SS. TYPES OF STUDIES REVIEWED: The author reviewed recent medical and dental studies that have advanced our understanding of the causes and treatment of SS. She particularly focused on studies addressing the diagnosis and treatment of the oral component of the disease. RESULTS: Sj?gren's syndrome is a widely underdiagnosed disease. A delay in the diagnosis of SS may have a significant physical, psychological and economic impact on the affected person. The pathogenesis of SS appears to involve a number of factors: immunological, genetic, hormonal and possibly infectious. Successful management of SS requires a multidisciplinary approach, and the dentist plays an essential role in the diagnosis and treatment of the disease. ORAL IMPLICATIONS: Impairment of salivary function in SS increases the risk of developing oral diseases. Effective management of oral health comprises enhancement of salivary output (cholinergic agonist drugs such as pilocarpine or cevimeline) and prevention and treatment of dental caries, oral candidiasis and allergic mucositis. Finally, periodic evaluation of various clinical and laboratory parameters is needed to monitor disease status.     

Identification of risk groups for oral precancer and cancer and preventive measures

Oral squamous cell carcinoma is one of the ten most common cancers of the body. Prevalence of oral cancer increases with age and is more common in men. In recent years a rise in incidence and prevalence of oral cancer among younger persons has been described. The prevalence of oral leukoplakia differs worldwide. In a recent German study the prevalence for men was 2.3%, for women 0.9%. Tobacco and alcohol remain the primary factors in the etiology of oral cancer and precancer. Dietary factors seem to be important in the prevention of oral precancer and cancer as has been shown in a number of recent studies. Antioxidants which are contained in fruits and vegetables seem to have a preventive effect. Prevention of oral precancer and cancer may be exerted as primary, secondary or tertiary prevention. Primary prevention is focused on elimination of risk factors (tobacco, alcohol), and has widely been neglected for the prevention of oral precancer and cancer until now. The dental team has to be involved in primary prevention to reduce the number of tobacco users, to help smokers to give up their smoking habits, to keep non-smokers from being exposed to passive smoking and to convince people to give up other oral habits which are associated with the use of tobacco.     

Opportunities for prevention: more than 'just the mouth'.

This paper has been written by two dentists from Colombia who are currently waiting to take the International Qualifying Examination. They have been working as dental nurses in London and have gained insights into both NHS and non-NHS practice in London. They have a particular interest in preventive dentistry and have analysed recent developments in England with regard to the prevention of disease and oral disease in primary care. They propose a preventive approach which brings together recent policy developments in the United Kingdom and worldwide. They conclude that there are now potentially better opportunities than ever before to develop programmes to promote health and prevent oral disease, and to adopt a team approach to achieve these goals.     

Streptococcus anginosus infection in oral cancer and its infection route

OBJECTIVE: To elucidate a possible involvement of Streptococcus anginosus in oral cancer, we assessed the frequency of S. anginosus infection in oral cancer tissues, and investigated its infection route. MATERIALS AND METHOD: The tissue specimens were obtained from 46 oral cancer and three precancerous leukoplakia subjects. Frequency of S. anginosus infection was assessed by a species-specific polymerase chain reaction (PCR) assay. The genotype of the clinical isolates taken from cancer tissue and dental plaque samples was analyzed using pulsed-field gel electrophoresis (PFGE). RESULTS: S. anginosus DNA was frequently detected in squamous cell carcinoma (19/42), but not in other types of cancer (lymphoma and rhabdomyosarcoma) or leukoplakia samples. A subject-based analysis revealed that S. anginosus was solely detected in dental plaque and not in saliva from all 19 S. anginosus-positive squamous cell carcinoma cases. Further, the genotype of S. anginosus isolated from cancer tissue was identical to that from dental plaque of the same patients. CONCLUSION: Infection of S. anginosus could occur frequently in oral squamous cell carcinoma and that dental plaque could be a dominant reservoir of the S. anginosus.     

Oral cancer awareness for the general practitioner: new approaches to patient care

In Australia, oral cancer accounts for approximately 2-3 per cent of all cancers, and approximately 1 per cent of deaths from cancer. The incidence of intra-oral cancer is gradually increasing. It is now well established that early detection of potentially malignant disease can improve the clinical outcome for patients, and as such it is the responsibility of dentists to identify such lesions early. To facilitate early detection of suspicious oral lesions several clinical methods of detection can be used. In addition to conventional visual screening of oral tissues with the naked eye under projected incandescent or halogen illumination, there are many clinical diagnostic aids that can be undertaken to help detect oral cancer. In this article we explore clinically available modalities that may be used by the general dental practitioner, and highlight their inherent strengths and weaknesses.     

Issues in Financing Dental Care for the Elderly

The elderly make up an increasingly larger segment of the patient population in dental practices. This article reviews recent epidemiologic, demographic, and health services research, and concludes that significant segments of the elderly are at high risk for oral disease and/or limited access to dental treatment, and consequently warrant classification as high-risk groups for policy considerations. It then proposes policy options to the dental community and public decision makers. Oral care can be viewed as having three components. Two basic components are the primary care component--which includes diagnostic, preventive restorative, and periodontal care--and the acute care component--i.e., the treatment of oral pain, trauma, and infection. The third, rehabilitative component, has to do with the restoration of oral function, including prosthodontics and cosmetic dentistry. Viewing dental care in this perspective may help link funding for dental primary care services with that for other primary health services, and link restoration of function and improvement of quality of life with similar health services, like hearing, vision, and social services. In addition, approaching dental care policy makers on several levels--i.e., federal, state, and local--will contribute to our ability as a profession, in the decades ahead, to meet the oral health needs of more elders: including the frail, those at high risk for oral disease, and those with limited access to care.     

A simple self-report health assessment questionnaire to identify oral diseases

Background: One approach to addressing oral health disparities for at-risk populations has been to increase discussion of oral health by non-dental healthcare providers. This study examined the accuracy of a simple instrument to detect individuals with a history of dental disease, which would then allow referral for an oral health evaluation. Materials and methods: A two-question instrument was evaluated for the relationship to oral diseases, periodontal disease, and decayed, missing and filled teeth in 391 individuals seen in a dental school clinic for non-emergent dental care over a 3-month period. Clinical dental findings were used as outcome variables. The oral health parameters were dichotomised, using different levels of disease severity. The criteria were increased and decreased in an effort to test the robustness of our method. Results: While the sensitivity outcomes with one question alone showed significant ability to predict oral disease (59–71%), the addition of a second self-assessment question increased the sensitivity (76–91%) for all oral health parameters studied. As the criteria for oral disease increased so did the sensitivity of this instrument. Conclusion: The results presented here offer evidence that a simple two-item questionnaire is an efficient and effective method of detecting populations at-risk for oral diseases.Key words: Self-assessment survey, oral disease, primary healthcare, health personnel, healthcare providers     

Need for genetics education in U.S. dental and dental hygiene programs

The two major afflictions of the oral cavity are dental caries and gingival/periodontal disease. While microorganisms have long been acknowledged as important etiologic factors, the most recent research data demonstrate that both of these pathologic conditions have a strong hereditary base, i.e., even in the presence of putative pathogenic microorganisms, if the host individual is not genetically susceptible, ensuing disease will be mild or even nonexistent. In the face of this evidence for heritability of the two major oral diseases, we evaluated what educational experiences in genetics were provided to students in U.S. dental schools and dental hygiene programs in 2003-04. Our survey of fifty-four dental schools revealed that only one requires a formal genetics course before admission, and only six incorporate a required genetics course within the dental curriculum. Of the 264 dental hygiene programs surveyed, none require a formal genetics course as a prerequisite for admission, and none require a formal genetics course within their curricula. The enormous successes, and future promise, of the Human Genome Project suggest that genetics will soon dominate the future of medicine and dentistry, in prediction of diseases, disease diagnosis, and, eventually, therapy for genetically based disorders. It is therefore incumbent upon dental and dental hygiene education programs to provide genetics education for tomorrow's practitioners.     

Orthodontically assisted restorative dentistry

As treatment expectations of dental patients continue to escalate we, as restorative dentists, must provide an interdisciplinary treatment approach to ensure optimum results for our patients. In recent years the disciplines of periodontics, endodontics and oral surgery have continued to develop closer working relationships with the field of restorative dentistry. Unfortunately, this is not the common relationship that exists with the discipline of orthodontics. Most orthodontic therapy is directed at the treatment of malocclusion and is conducted with limited or no input from the restorative dentist. Orthodontics offers countless ways of assisting the restorative dentist in achieving treatment goals. Several of these orthodontic opportunities to enhance the restorative treatment plan are reviewed.