Assessing oral malignancies

Oral cancers account for approximately 3 percent of all cases of cancer in the United States. An estimated 30,000 people will be diagnosed with oral cancer this year, and about one half of them will eventually die of the disease. The most common type of oral cancer is squamous cell carcinoma. Sixty percent of oral cancers are well advanced by the time they are detected, even though physicians and dentists frequently examine the oral cavity. The two most important risk factors for oral cancer are tobacco use and heavy alcohol consumption. The keys to reducing mortality are prevention and control. The earlier any intraoral or extraoral abnormalities or lesions are detected and biopsied, the more lives can be saved. Controversy exists whether screening programs effectively reduce the mortality rate. Specific step-by-step guidelines should be followed to perform an adequate examination of the head and neck.     

The role of epithelial-mesenchymal transition in oral squamous cell carcinoma and oral submucous fibrosis

Epithelial-mesenchymal transition (EMT) is an indispensable mechanism during morphogenesis. Interest and research in EMT are currently at a high level due to its important role in cancer and fibrosis. Emerging evidence suggests that EMT is also a crucial event in oral squamous cell carcinoma (OSCC). Oral submucous fibrosis (OSF) is a chronic debilitating disease and a premalignant condition of the oral cavity. It is characterized by a generalized submucosal fibrosis. The pathogenesis of the disease is not well established. Epidemiological evidence strongly indicates an association between the betel quid (BQ) chewing habit and OSF. In a simplistic view, OSF represents a failed wound-healing process of the oral mucosa after chronic, sustained injury. This review highlights the signaling pathways involved in EMT, recent advances in the study of EMT in OSCC, and summarizes the evidence supporting a role for EMT in the pathogenesis of OSF.     

Porphyromonas gingivalis and digestive system cancers

Porphyromonas gingivalis(P. gingivalis) is an anaerobic gram-negative bacterium that colonizes in the epithelium and has been strongly associated with periodontal disease. Recently, various degrees of associations between P.gingivalis and digestive system cancers, including oral squamous cell carcinoma in the oral cavity, oesophageal squamous carcinoma in the digestive tract, and pancreatic cancer in pancreatic tissues, have been displayed in multiple clinical and experimental studies. Since P. gingivalis has a strong association with periodontal diseases, not only the relationships between P. gingivalis and digestive system tumours but also the effects induced by periodontal diseases on cancers are well-illustrated in this review. In addition, the prevention and possible treatments for these digestive system tumours induced by P. gingivalis infection are also included in this review. At the end, we also highlighted the possible mechanisms of cancers caused by P. gingivalis. One important carcinogenic effect of P. gingivalis is inhibiting the apoptosis of epithelial cells,which also plays an intrinsic role in protecting cancerous cells. Some signalling pathways activated by P. gingivalis are involved in cell apoptosis, tumourigenesis,immune evasion and cell invasion of tumour cells. In addition, metabolism of potentially carcinogenic substances caused by P. gingivalis is also one of the connections between this bacterium and cancers.     

Surgical treatment is recommended for advanced oral squamous cell carcinoma

Oral squamous cell carcinoma is one of the most frequent types of head and neck cancers in Japan. Although recent reports have shown positive results of non-surgical treatment for advanced head and neck squamous cell carcinoma, including tongue cancer, no clear treatment strategies have been established for oral cancers, except for tongue cancer. To assess appropriate therapies, we conducted a retrospective chart review of 114 Japanese patients with oral cancers that were pathologically diagnosed as squamous cell carcinoma, excluding tongue cancers. The overall and the disease specific 5-year survival rates were 53% and 61%, respectively. Univariate and multivariate analyses revealed a lower stage (I, II, or III) and non-surgical treatment as good and poor prognostic factors of oral squamous cell carcinoma, respectively, based on their hazard ratios of 0.17 (95% CI 0.045-0.60, p = 0.0061) and 5.3 (95% CI 2.7-11, p < 0.0001). Furthermore, impact of surgery was well documented in the operable stage IVa cancers (p = 0.00015). The surgical treatment consisted of the wide resection of the primary tumor and the neck dissection for stage III or IV tumors. The present data also suggest that adjunctive therapy, such as post-operative radiation therapy or post-operative chemo-radiation therapy, shows no survival benefit compared to the surgery alone. We therefore recommend the surgical treatment for advanced oral squamous cell carcinoma in Japanese patients. These results would be helpful in future clinical trials, especially in non-surgical treatment studies of oral squamous cell carcinoma in Japan.     

过敏性疾病在口腔中表现的研究进展

过敏性疾病是常见的全身疾病,可发生于口腔、皮肤、消化道、呼吸道等全身各系统器官。表现在口腔的过敏性疾病通常发生在摄入某些药物、食物或者接触过敏原后,可能局限于口腔,也可能作为整个病程的首发症状。过敏性疾病在口腔主要表现为药物过敏性口炎、接触过敏性口炎、血管神经性水肿、多形红斑及口腔过敏综合征等,病损形式多样,可无特异性,如充血、水肿、红斑、水疱、糜烂或者溃疡等。熟悉过敏性疾病在口腔中的不同表现,对于其诊治有重要意义。     

Evaluating the degree of knowledge on oral cancer among general practitioners and dentists in Qazvin

Rationale, aims and objectives Despite easy accessibility of the oral cavity to examination most oral cancers are only identified at advanced stages. The aim of this study was to assess the knowledge of general doctors and dentists on oral cancer in Qazvin to form the basis of development of undergraduate and postgraduate education programmes for early detection and prevention of oral cancer. Methods A cross‐sectional questionnaire‐based study was performed on general medical practitioners and general dental practitioners in 2009. Analysis was performed using spss software. Results The mean knowledge score of all participants was at moderate level and there was no significant difference between the two groups. There was a significant correlation between knowledge score and age, time from graduation and the interval since the last refresher course on oral cancer (P < 0.05). Smoking (78%) and alcohol consumption (34.9%) were noted as the two major risk factors by the entire population study. Approximately 80.9% of participants identified the tongue as among the most common sites for oral cancers while only 25.7% identified the floor of the mouth and 28.3% the lips as other areas of occurrence. Conclusion This study demonstrated an inadequate level of knowledge on oral cancers in both groups. Additional training in universities as well as continuing educational programmes on prevention and early detection of oral cancers is recommended.     

宏基因组学在口腔常见慢性感染性疾病中的研究进展

口腔中常见的慢性感染性疾病主要包括龋病、牙髓病、根尖周病、牙周病、智齿冠周炎和颌骨骨髓炎等,其发生通常与病原细菌有关,其病原学的研究也主要集中在发现疾病相关病原细菌.以往由于传统培养技术的限制,对微生物的认识不够全面,认为口腔慢性感染性疾病的发生是由某种特定的致病微生物感染所造成的.随着宏基因组学(Metagenomi...     

Modulation of oral cancer and periodontitis using chemotherapeutic agents - A narrative review

Periodontitis, an inflammatory condition, is linked to a higher risk of developing oral cancer. Periodontitis may be a precipitating factor for tumorigenesis and the aggressiveness of specific cancer variants. Although genetics is considered the primary etiologic factor for the development of most cancers, many factors have come to be recognized in the initiation and progression of oral cancer. Consecutively, it is suggestive that periodontitis and oral cancer are distinct disease entities but share common pathogenic mechanisms. Oxidative stress and epigenetic mechanisms are among the most researched mechanisms responsible for initiating apoptotic mechanisms implicated in periodontitis and oral cancer. Current research aims to formulate therapeutic agents to intercede in these mechanisms via host modulation therapy and epigenetic therapy. These advances can revolutionize the treatment of periodontitis and oral cancer. This review aims to shed light on the common pathogenic mechanisms of these diseases and the various host modulation agents that could be beneficial in their treatment.     

Assessing oral health literacy of university nursing students: A cross-sectional exploratory study

AimResearch has proven a link between oral health and numerous chronic systemic diseases. To achieve better health outcomes, there is a need to involve interprofessional primary health care providers, such as nurses to raise awareness and promote oral health. Nurses have regular contact with patients which provides a unique opportunity to impart disease-specific information and technical skills for patients to self-manage their oral health conditions. However, the baseline oral health literacy of undergraduate nursing students at the University of Sydney is not known. Before creating a targeted curriculum to improve oral health literacy amongst nursing students, it is essential to assess the baseline oral health knowledge of these students. This study aimed to assess the oral health literacy level among undergraduate nursing students of the University of Sydney, Australia.DesignAn exploratory research approach was used.MethodsA cross-sectional survey study was conducted using the validated Comprehensive Measure of Oral Health Knowledge (CMOHK) instrument. A univariate general linear model was used to explore the association of CMOHK total score with demographic and educational variables.ResultsA total number of 197 nursing students participated in the survey, with a mean CMOHK score of 15.48, SD 3.27. 72% were categorized as having good, 16% fair and 12% poor oral health knowledge. The analysis from the six individual knowledge domains of the CMOHK revealed lower percentages of correct responses in the periodontal disease and oral cancer knowledge domains. Students with English as their second language, on average, scored 2 fewer correct responses (p <.001) than students whose first language was English. Low socioeconomic status was not associated with a low level of oral health literacy.ConclusionThe baseline results show a good level of general oral health knowledge as measured by the CMOHK. However, periodontal disease and oral cancer were identified as the particular domains where a knowledge gap exists. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nursing students. Culturally responsive pedagogy may need to be considered for students with English as their second language. This baseline survey data may potentially facilitate integrating oral health in nursing education and practice.     

口腔并发症患者口腔pH值变化及护理探讨

目的：探索重危病人口腔并发症与口腔PH值的关系及有效的护理方法。方法：观察内科重危病人口腔并发症，并用精密试纸测量口腔PH值，将PH值异常的口腔并发症患者随机分为对照组和实验组，分别给予常规口腔护理和常规口腔护理加PH纠正液含漱。结果：无口腔并发症患者63例中，口腔PH值异常4例（6．35％）；有口腔并发症的176例病人中，口腔PH值异常84例（42．73％），P＜0．05，92例PH值正常口腔溃疡12例（13．04％），84例口腔PH值异常有口腔溃疡33例（39．28％），P＜0．05。对照组治愈率74．71％，实验组为88．76％，P＜0．05。平均治愈天数，对照组为9．14天，实验组为5．91天，结论：重危病人口腔并发症与口腔PH值异常密切相关，对口腔PH值异常者加用PH纠正液含漱较单纯用常规口腔护理效果好。     

Tumor invasion front in oral squamous cell carcinoma

Oral squamous cell carcinoma is a neoplasm that originates from the epithelial mucosa. It is usually more frequent between the fifth and sixth decades of life, and more than 90% of carcinomas of the oral cavity are squamous cell carcinoma. It is an invasive neoplasia with a significant recurrence rate; 40% of patients present with metastases in the cervical lymph nodes at the time of diagnosis. The tumor invasion front is a characteristic of tumor growth, which can be infiltrative or noninvasive. The histopathological parameters examined include the number of mitoses, depth of the tumor, invasion pattern, degree of keratinization, and nuclear pleomorphism. For the pathologist, these parameters are routinely evaluated but are not reported to the treating physician in all cases, which we consider to be useful information when determining the therapeutic route.     

Prevention and management of oral infections in cancer patients

 The successful prevention and management of oral infections and infections from the oral cavity in cancer patients are based on identification of risk patients, selection of patients for prophylactic measures, diagnosis of infection and implementation of directed or empiric antimicrobial therapy. Identification of patients at risk for infection is based on each patient's type of oral microbial colonization and the presence of latent viral infections. Systemic and local resistance to infection will be decisive, and in many patients the risk can be estimated from the expected myelosuppressive effect of anticancer treatment. Diagnosis of infection is often based on clinical findings together with the results of microbiological investigations. Biopsies could be useful, but can seldom be obtained. Blood samples are mandatory for isolation of microorganisms involved in systemic infections in myelosuppressed patients. Prevention of infection requires both local and systemic measures. Elimination of the risk of a breach in the first line of defence is urgent, and the maintenance of mucosal integrity is important. Monitoring microbial colonization is common, as is the institution of antiviral prophylaxis in patients with increased anti-HSV IgG (ELISA >10 000). Antifungal prophylaxis, to avoid colonization and superinfection, should be instituted in patients with low neutrophil counts. Gastrointestinal prophylaxis with quinolones is also commonly used in these patient groups. Treatment of oral infections in cancer patients should include systemic antimicrobial agents in most cases. Special attention should be directed to oral infections in neutropenic (<0.5×l0⁹/l) patients in whom oral microorganisms are the leading cause of bacteraemia. Invasive fungal infections of the oral cavity can be associated with systemic fungal infection and are indications for the use of liposomal amphotericin B. Published online: 21 May 1999     

The oral complications of specific anticancer therapy

Oral complications commonly affect cancer patients undergoing active treatment. These include oral infection, gingival bleeding, stomatitis/mucositis, xerostomia, dental caries and periodontal disease. The oral cavity also acts as an entry site for systemic infection, particularly in those who are myelosuppressed. This paper reviews the structure and function of the oral cavity and how this may be affected by anticancer therapy. Oral care procedures are discussed and controversial areas highlighted showing that, although it is generally agreed that oral care is essential in preventing/minimizing complications and maintaining general comfort, there is no general agreement about the frequency with which care is required or about the tools and agents to be employed. Areas for future research are highlighted.     

口腔鳞状细胞癌中细胞角蛋白研究进展

口腔鳞状细胞癌（OSCC）是口腔最常见的上皮源性恶性肿瘤，其中大多数是由15／腔黏膜癌前病变发展而来。细胞角蛋白（CK）是上皮细胞特征性标记物，CK19在OSCC的发生、发展和转移中出现了异常表达。本文综述OS-CC中CK19研究进展。     

Low-dose immunotherapy as a potentiator to increase the response with neo-adjuvant chemotherapy in oral cancers

Neo-adjuvant chemotherapy (NACT) is utilized in locally advanced oral cancers to reduce the tumor burden and downstage the tumor to be amenable for definitive surgical management. Its long-term results compared to upfront surgical resection was not encouraging. Immunotherapy has now been used not only in recurrence and metastatic setting but also in the locally advanced tumor management regimens. The purpose of this concept paper is to bring forward the rationale to use a fixed low-dose immunotherapy agent as a potentiator to the standard NACT regimen and recommend their future investigation in oral cancer management.     

Precancerous lesions of oral mucosa

Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral lichen planus is one of the potentially malignant disorders that may be seen in six different subtypes including papular, reticular, plaque-like, atrophic, erosive, and bullous type, clinically. Atrophic and erosive subtypes have the greater increased malignant transformation risk compared to another subtypes. Although there are various etiological studies, the etiology of almost all these diseases is not fully understood. Geographically, etiologic factors may vary. The most frequently reported possible factors are tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. Early diagnosis is very important and can be lifesaving, because in late stages, they may be progressed to severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma. For most diseases, treatment results are not satisfactory in spite of miscellaneous therapies. While at the forefront of surgical intervention, topical and systemic treatment alternatives such as corticosteroids, calcineurin inhibitors, and retinoids are widely used.     

Common oral lesions: Part II. Masses and neoplasia

Certain common oral lesions appear as masses, prompting concern about oral carcinoma. Many are benign, although some (e.g., leukoplakia) may represent neoplasia or cancer. Palatal and mandibular tori are bony protuberances and are benign anomalies. Oral pyogenic granulomas may appear in response to local irritation, trauma, or hormonal changes of pregnancy. Mucoceles represent mucin spillage into the oral soft tissues resulting from rupture of a salivary gland duct. Oral fibromas form as a result of irritation or masticatory trauma, especially along the buccal occlusal line. Oral cancer may appear clinically as a subtle mucosal change or as an obvious mass. Oral leukoplakia is the most common premalignant oral lesion. For persistent white or erythematous oral lesions, biopsy should be performed to rule out neoplastic change or cancer. Most oral cancers are squamous cell carcinomas. Tobacco and heavy alcohol use are the principal risk factors for oral cancer. Family physicians should be able to recognize these lesions and make appropriate referrals for biopsy and treatment.     

Effective elimination of contaminants after oral care in elderly institutionalized individuals

After mechanical cleaning in oral care, eliminating residual oral contaminants has an important role in preventing their aspiration, especially in individuals with weak airway protection. We examined the effectiveness of wiping the oral cavity after oral care on eliminating contaminants in 31 patients who were hospitalized in our neurology inpatient unit. The amount of bacteria on the tongue, palate, and buccal vestibule was counted before and just after oral care, after eliminating contaminants either by rinsing with water and suction or by wiping with mouth wipes, and 1 h after oral care. Oral bacteria amounts were decreased significantly by both elimination procedures after oral care. These findings suggest that wiping with mouth wipes is as effective as mouth rinsing to decrease bacteria following oral care. With a lower risk of contaminant aspiration, wiping may be a suitable alternative to rinsing, especially in dysphagic individuals.     

经口气管插管口腔护理方法改良与效果评价

目的:探讨经口气管插管病人口腔护理的有效方法,提高护士的技术操作能力和工作效率,保证经口气管插管病人的口腔护理质量。方法:将入选的116例经口气管插管病人随机分为2组,改良组60例,传统组56例。在口腔护理溶液相同的条件下,传统组按常规口腔护理操作方法;改良组在麻醉咽喉镜明视下用擦拭的方法进行口腔护理。每次口腔护理结束后观察口腔内污垢的残留,每日在进行口腔护理操作前观察口臭、口腔溃疡、牙菌斑的发生情况,连续观察7d,将所得的结果和对所需的人力、时间进行列表比较。结果:传统组污垢残留52例,口臭21例,口腔溃疡18例,牙菌斑21例;改良组污垢残留发生2例,口臭1例,口腔溃疡1例,牙菌斑2例。结论:在麻醉咽喉镜明视下进行口腔护理能提高经口气管插管病人口腔护理的质量,减少口臭、口腔感染并发症,可节省人力和时间。