56例合并系统性疾病的口腔癌患者的治疗效果评价

目的: 总结56例合并系统性疾病的口腔癌患者的诊疗经验。方法: 回顾56例口腔癌患者的临床资料,根据口腔癌的特征,分析和制订局部及全身治疗方案,评价治疗效果。结果: 56例患者分别接受手术、放化疗、免疫治疗等。对34例（60.71%）合并高血压患者、11例（19.64%）合并冠心病患者、1例（1.79%）合并严重心律失常的患者提出心血管治疗意见;对23例（41.07%）糖尿病患者提供了合理化控制血糖的方案;对19例（33.93%）合并呼吸系统疾病的患者提出了相应的肺功能检测及术后并发症的治疗方案。结论: 多学科协作对合并系统性疾病的口腔癌患者的诊疗合理、有效,值得完善和推广。     

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。     

口腔微生物群落在口腔与全身疾病预警中的作用

口腔微生物群落是指定植于人体口腔的微生物集合,多以生物膜形式行使微生物生理学功能。当微生物群落与宿主间生态关系失衡时,可诱发多种口腔感染性疾病,包括龋病、牙髓根尖周病、牙周病、智齿冠周炎、颌骨骨髓炎等,严重危害口腔健康。更为重要的是,口腔微生物群落与口腔肿瘤、糖尿病、类风湿性关节炎、心血管疾病及早产等系统性疾病紧密相关,口腔微生物群落结构特征可作为口腔及全身健康预警的重要标记。随着“人类微生物组计划”及其他微生物宏基因组学相关项目的开展,人们对口腔微生物群落的认识不断深入,已获得了海量大数据信息。在“后微生物组计划”时代如何有效地将微生物群落大数据转化为具有实际运用价值的临床诊疗手段,进而为患者提供有效的个体化医疗服务将是推动口腔疾病乃至全身疾病“精准医疗”的重大前沿问题。本文拟从常见口腔及相关系统性疾病微生物群落研究进展入手,阐述口腔微生物群落信息在疾病发生、发展及预后预警中的作用,提出建立基于口腔微生物群落疾病预警系统的必要性,为实现口腔疾病及相关系统性疾病的个性化诊疗提供新的思路。     

唾液外泌体与口腔疾病相关研究进展

唾液外泌体是指存在于唾液中的直径在30～150 nm的细胞外囊泡。随着近年来技术手段的发展,大量研究揭示唾液外泌体在多种口腔疾病的发生发展中发挥重要作用,如唾液外泌体CD9及CD81通过调控细胞粘附及运动促进肿瘤细胞转移、唾液外泌体miR-24-3p通过作用于PER1促进肿瘤细胞增殖、唾液外泌体程序性细胞死亡配体-1(programmed cell death-ligand 1,PD-L1)mRNA抑制炎症组织的破坏等,具有作为诊断口腔癌、牙周炎等口腔疾病的生物标志物的潜能。因此,唾液外泌体可作为口腔疾病潜在的预后和诊断标志物。唾液外泌体除与口腔疾病,如口腔癌、牙周炎、口腔扁平苔藓、干燥综合征等有关外,还同远处部位肿瘤如胰腺癌、肺癌等及系统性疾病如帕金森综合征、炎症性肠病等密切相关;深入研究唾液外泌体对口腔、全身系统性疾病的诊断与治疗作用,开发唾液外泌体作为疾病诊断的生物标志物的潜力具有重要意义。     

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提要：老年人除口腔组织产生各种增龄性的改变外,全身各器官也都相应地产生衰老的改变,生理功能适应性减退,同时心理状态也有不同程度的变化。此外,老年人还常伴有多种慢性疾病,服用多种药物。以上情况均可影响其口腔疾病的诊断、治疗和预后。这就要求医生必须掌握老年人的各种特点,采取不同于青、壮年人的措施,进行安全有效的治疗。本文介绍了对老年口腔病患者治疗的一般原则,老年人常见全身疾病和口腔治疗的关系以及拔牙、牙体牙髓病、牙周病及口腔修复的特点。     

口腔黏膜癌前病变和口腔癌动物模型的研究进展

口腔黏膜癌前病变和口腔癌是发展中国家的常见疾病尤其是在南亚地区,其癌变机制尚不明确,目前缺乏有效防治措施,因此口腔黏膜癌前病变及口腔癌动物模型建立显得尤为重要。本文结合相关研究,就近年来口腔黏膜癌前病变及口腔癌动物模型建立方法的进展作一综述。     

头颈部鳞癌免疫检查点抑制剂治疗专家共识

近年来免疫检查点抑制剂（ICIs）在恶性肿瘤治疗中有着突破性进展,并迅速被批准作为多系统恶性肿瘤的一线治疗方案。在头颈部鳞癌中,帕博利珠单抗单药或联合化疗方案已被国内外指南推荐用于复发/转移头颈部鳞癌的一线治疗。虽然ICIs在头颈部鳞癌治疗中有里程碑的意义,但当前仍然存在诸多需要重视的问题,如ICIs疗效预测因子的选择,肿瘤病灶对ICIs治疗反应的评价,免疫超进展的应对以及免疫相关不良反应的处理等。因此,本共识基于当前临床已有的循证医学依据,结合临床上关注的热点问题进行深入探讨,整合头颈部肿瘤各专业领域专家的临床工作经验而形成相对规范统一的认识。     

唾液蛋白质糖基化及其与全身和口腔疾病关系的研究进展

蛋白质糖基化是重要的蛋白质翻译后修饰方式之一,通过赋予蛋白质各种结构和功能特征而在生命活动中扮演重要角色。唾液作为一种获取简单且无创的生理物质,包含有来自血清、龈沟液、口咽黏膜分泌物的成分。近年来随着相关研究的深入,人们对唾液的认识被不断更新。研究发现,唾液蛋白质可以作为一些疾病的诊断指标,唾液中蛋白质糖基化修饰也与多种疾病状态密切相关。本文就唾液蛋白质糖基化及其与全身和口腔疾病关系的研究进展作一综述。     

Salivary metabolomics in the diagnosis of oral cancer and periodontal diseases

Metabolomics is a systemic study of metabolites, which are small molecules generated by the process of metabolism. The metabolic profile of saliva can provide an early outlook of the changes associated with a wide range of diseases, including oral cancer and periodontal diseases. It is possible to measure levels of disease‐specific metabolites using different methods as presented in this study. However, many challenges exist including incomplete understanding of the complicated metabolic pathways of different oral diseases. The review concludes with the discussion on future perspectives of salivary metabolomics from a clinician point of view. Salivary metabolomics may afford a new research avenue to identify local and systemic disorders but also to aid in the design and modification of therapies. A MEDLINE search using keywords “salivary metabolomics” returned 23 results in total, of which seven were omitted for being reviews or letters to the editor. The rest of the articles were used for preparation of the review, 13 of these were published in the last 5 years.     

Co-existence between oral lesions and opportunistic systemic diseases among HIV-infected subjects in Thailand

BACKGROUND: The purpose of this study was to determine whether any relationship exists between the occurrence of oral lesions and opportunistic systemic diseases among HIV-infected subjects. METHODS: A cross-sectional analytical study was performed in two hundred and seventy-eight HIV-infected heterosexual persons and intravenous drug users (IVDUs)(230 males and 48 females, aged 16-65 years, mean 31.9 years). Eighty-six HIV-free subjects from the same population were included as controls (61 males and 25 females, aged 17-63 years, mean age 33.1 years). The following information was recorded for each patient: age, gender, risk group and stage of HIV infection, immune status, medication, systemic disease and presence of oral lesions. RESULTS: Oral candidiasis was the most common oral lesion among HIV-infected individuals (40%), followed by hairy leukoplakia (HL)(26%). The three most common systemic diseases among the subjects were tuberculosis (TB)(53%), cryptococcosis (14%) and Pneumocystis carinii pneumonia (PCP)(11%). Logistic regression analysis revealed a significant association between the occurrence of TB and the presence of oral candidiasis (OR 2.8; 95% CI 1.6-4.8; P < 0.001), and the occurrence of PCP and the presence of HL (OR 2.2; 95% CI 1.1-4.3; P < 0.001). Positive predictive values of any oral lesions and oral candidiasis in predicting TB were 87% (95% CI 73.0-94.6) and 67% (95% CI 51.9-80.0), respectively. CONCLUSIONS: We concluded that oral candidiasis might be used as a clinical marker for TB, and HL for PCP. Recognition of the lesions by health-care providers may indicate the need for more intensive clinical and laboratory monitoring and possibly initiation of prophylaxis against these opportunistic systemic infections.     

Oral cancer and oral erythroplakia: an update and implication for clinicians

Despite recent advances in therapy and treatment for oral cancer, survival rates are still low. It is generally accepted that oral cancer may arise from potentially premalignant disorders. Oral erythroplakia has been identified as the one with the highest malignant transformation rates. The aim of this review was to provide detailed information on oral cancer and oral erythroplakia. Few data are available on oral erythroplakia and there is an urgent need for randomized controlled trials. Early detection and diagnosis is still the key to survival rates. Dentists and physicians may play an important role in the detection of premalignant lesions and therefore improve patients' outcome.     

Feasibility of integrating a dental hygienist into an inpatient medical team for patients with diabetes mellitus

Patients who are hospitalized face a high risk of poor oral health and experience a decline in oral hygiene over the course of hospitalization. Due to the documented links between diabetes and periodontal disease as well as the prevalence of diabetes in the hospitalized population, patients with type 2 diabetes mellitus were chosen as the population of interest for a pilot program of dental hygienist‐led care provision in the hospital. Inclusion criteria were established by agreement of a dentist and physician. Nursing and medical staff were provided with multiple opportunities to learn about the dental hygienist's role throughout the pilot. The dental hygienist utilized a fully mobile dental unit and bedside suction unit and followed all standard infection control procedures. This intervention identified a number of suboptimal oral health practices among patients and was perceived positively by patients and providers. No adverse events occurred.     

The heme oxygenase system and oral diseases

Oral Diseases (2011) 17 , 252–257 Heme oxygenase (HO) system catabolizes heme into three products: carbon monoxide (CO), biliverdin/bilirubin and free iron, which consists of three forms identified to date: the oxidative stress‐inducible protein HO‐1 and the constitutive isozymes HO‐2 and HO‐3. HO has been involved in many physiological and pathophysiological processes, ranging from Alzheimer’s disease to cancer. The interest in HO system by scientists and clinicians involved with the oral and maxillofacial region is fairly recent, and few papers currently cited on HO relate to diseases in this anatomical area. This review will focus on the current understanding of the physiological significance of HO‐1 induction and its possible roles in the oral diseases studied to date. The implications for possible therapeutic manipulation of HO are also discussed.     

Betel quid chewing,oral cancer and other oral mucosal diseases in Vietnam: a review

Background: Betel quid chewing (BQC) in Vietnam is still prevalent, however, no detailed information about its association with oral cancer and pre‐cancer are available in the English literature. Respective online searches (PubMed, Medline) were negative. Methods: Relevant publications in Vietnamese were collected by the authors and translated. Visits to cancer centres and institutes of odontology (Ho Chi Minh City, Hanoi) were made and seminars with respective scientists were held. Field excursions to local markets and interviews with betel quid vendors and individual BQ chewers gave further insights. Results: Generally, BQC is on the decline in Vietnam. 6.7% of the female population still seems to indulge in this habit. In an earlier study, a prevalence of 0.06% of oral cancer was reported. In a study of 1084 cases of oral cancer, the male:female ratio was 1.05:1 (1997). The age group between 60 and 75 years is most often affected by oral cancer. In BQ chewing women, the buccal mucosa (27.9%), tongue (23.1%) and lips (22.4%) are most often affected. Verrucous carcinoma is seen in the age group 70–79 years with women most often being affected (male:female ratio 1:3.4). The most important risk factor for oral cancer in women is BQC compared with men where smoking, alcohol drinking or combined smoking and drinking habits are the most common risk factors. Oral leukoplakia in BQ chewers is observed in 3.8%, oral submucous fibrosis in 13%. Conclusions: BQC in Vietnam is on the decline. Association between BQC and oral cancer in elderly women is still of importance. Eventually, the BQC habit will vanish and only play a role in socio‐ritual contexts.     

Prevalence of systemic diseases in Brisbane general and periodontal practice patients

BACKGROUND: Periodontitis has been associated with a number of systemic diseases such as atherosclerosis, coronary heart diseases, and respiratory diseases. This study aimed to determine whether there is a significant difference in the prevalence of systemic diseases (a) in patients referred for periodontal care compared to the general practice population, (b) in patients attending a public hospital and private practices, (c) in patients attending public and private periodontal practices, and (d) among patients with periodontitis of varying severity. METHODS: Charts of 1000 adult patients were selected from four clinics (University of Queensland (UQ) School of Dentistry Admissions Clinic, UQ School of Dentistry Periodontics Clinic, Private Periodontal Practice, and Private General Dental Practice). The prevalence of medical conditions was evaluated using validated self-reported health questionnaires. The periodontal condition was assessed from the most recent relevant radiographs in the files. RESULTS: Periodontal patients had a higher prevalence of systemic diseases compared to the general practice population. Public patients had a greater prevalence of systemic diseases compared to patients in private practice for both general practice and periodontal patients. In patients with advanced periodontitis, bronchitis, hepatitis and rheumatoid arthritis were most prevalent. Patients with periodontitis also took more medications and were more likely to suffer from multiple conditions compared to the general dental population. CONCLUSIONS: Patients attending public dental facilities have an increased prevalence of systemic disease compared to those attending private practices. Furthermore periodontal patients have a greater prevalence of diseases compared to general practice patients. Patients with moderate or advanced periodontitis show an increase in the prevalence of some systemic diseases previously reported to be risk factors for periodontal disease.     

Humoral leukocyte adherence inhibition response in patients with oral cancer

Abstract – Antitumor immunity was assessed in a group of 10 patients suffering from squamous cell carcinoma of the oral cavity using the humoral leukocyte adherence inhibition assay (H-LAI). A tumor extract from a person with cancer of the tongue was used as antigen. Sera from five patients with carcinoma of the tongue were all positive in the test. Of the other five patients, three had cancer of the lips while in two patients the type was unspecified. All patients except one with cancer of the lips gave a positive response in the test. Thus, of the 10 patients with carcinoma of the oral cavity, nine responded. Among nine controls, one person gave a positive response.     

Oral lesions of lupus erythematosus patients in relation to other chronic inflammatory oral diseases: an immunologic study

Abstract – The nature and distribution of mononuclear cells in non-ulcerated oral lesions of discoid (DLE) and systemic lupus erythematosus (SLE), were investigated and compared to other chronic inflammatory oral diseases (lichen planus (LP), contact lesion (CL), unspecified inflammation (UI), geographic tongue (GT), and leukoplakia (LK). For this purpose an immunoperoxidase technique based on staining with monoclonal antibodies was employed. In most LE specimens examined infiltrating cells consisted predominantly of a mixture of T cells (Leu 3a⁺ and Leu 2a⁺) that were distributed in the lamina propria, the submucosa, and occasionally also in the epithelium. In general, only few B cells were detected while macrophages were more frequent. In all LE specimens examined β₂-microglobulin expression was observed on a large proportion of cells including infiltrating mononuclear cells as well as resident keratinocytes. In addition, most infiltrating cells displayed MHC Class II antigens according to a pattern HLA-DR>DQ>DP. Interestingly, expression of Class II antigens was also observed on epithelial keratinocytes but was restricted to HLA-DR and -DP gene products (DR> >DP). HLA-DQ expression was never observed on keratinocytes. In most LE specimens studied a small proportion (<5%) of inflammatory cells had detectable interleukin-2 receptors (IL-2R) and/or transferrin receptors (transf-R). However, expression of transf-R was also observed on basal epithelial cells, being more pronounced in DLE than in SLE lesions. The above staining patterns observed in LE lesions, when compared to other chronic inflammatory oral lesions, did not disclose any striking differences that could support the specific diagnosis of LE. However, the findings of Class I and II MHC gene products on oral keratinocytes suggest an important accessory role for these cells in directing the migration of activated lymphoid cells in the epithelium in chronic inflammatory lesions of the oral mucosa.     

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.