The role of the dental team in preventing and diagnosing cancer: 4. Risk factor reduction: tobacco cessation

Tobacco use contributes to many oral and general health disorders.While cigarette smoking is the most hazardous and prevalent form of tobacco use in the industrialized countries, consideration also needs to be given to non-cigarette use such as bidi smoking in India, reverse smoking by several rural populations and use of snuff and chewing tobacco. CLINICAL RELEVANCE: Health professionals should encourage and aid cessation of tobacco use as a part of prevention of oral and other cancers.     

Candida-related denture stomatitis: a pilot study of the efficacy of an amorolfine antifungal varnish

PURPOSE: Candida albicans is a component of the normal oral microflora, but local and systemic factors can transform this commensal C albicans to a pathogen. The most frequent cause of Candida opportunistic infections (candidiasis) is dentures, especially if poorly fitting or poorly cleaned. Management of oral candidiasis depends on an accurate diagnosis, identification and elimination of predisposing factors, and, often, use of antifungal agents. The aim of this study was to examine fingernail varnish, currently used for onychomycosis therapy, to reduce the fungal colonization in prosthetic biofilms. MATERIALS AND METHODS: A varnish containing 5% amorolfine was applied once or twice a week for 6 months in six patients affected by nystatin-resistant denture-related stomatitis. In all six patients, the prostheses had previously been removed at night, and daily antimycotic topical therapy with nystatin had failed to resolve the stomatitis; after 30 days, these patients all showed persistence of candidal stomatitis. RESULTS: After 1 month, five of the six patients were negative for Candida; this situation was unchanged in the following monthly controls. Only in the patient with suspected Sj?gren syndrome was oral Candida found 15 days after the last varnish application. None of the patients had any complaints about the medication. CONCLUSION: This varnish containing 5% amorolfine, applied once or twice a week for 6 months, was able to suppress the nystatin-resistant denture-related stomatitis.     

Current controversies in oral lichen planus: report of an international consensus meeting. Part 1. Viral infections and etiopathogenesis

Despite recent advances in understanding the immunopathogenesis of oral lichen planus (LP), the initial triggers of lesion formation and the essential pathogenic pathways are unknown. It is therefore not surprising that the clinical management of oral LP poses considerable difficulties to the dermatologist and the oral physician. A consensus meeting was held in France in March 2003 to discuss the most controversial aspects of oral LP. Part 1 of the meeting report focuses on (1) the relationship between oral LP and viral infection with special emphasis on hepatitis C virus (HCV), and (2) oral LP pathogenesis, in particular the immune mechanisms resulting in lymphocyte infiltration and keratinocyte apoptosis. Part 2 focuses on patient management and therapeutic approaches and includes discussion on malignant transformation of oral LP.     

Epithelial biology

The oral mucous membrane has features similar to skin but also differs in several ways. This paper reviews the aspects of epithelial biology necessary for an understanding of the vesiculoerosive disorders.     

Gift not commodity? Lay people deliberating social sex selection

In this paper we explore lay people's discussions of the controversial topic of social sex selection (SSS). In the UK and many other countries, SSS is prohibited by law. In 2003 the UK Human Fertilisation and Embryology Authority, after an extensive public consultation, decided against changing the existing legislation. However, this initiative and similar consultation exercises have been criticised on the grounds that public opinion is poorly informed and reasoned. In our study, one of the most consistently expressed ideas was that children should be regarded as 'a gift' rather than 'a commodity'. In contrast, the 'gift not a commodity' argument is rarely cited positively in Anglo-American, secular-liberal bioethics. These metaphorical statements are condensed articulations of complex but coherent moral intuitions. Where much of the bioethics literature stresses parental autonomy, our lay discussants balanced this principle with ideas about the need to respect the personhood of the potential child, and the characteristics of a good parent. We conclude our analysis by considering the implications for expanding bioethics' knowledge base and improving the input of lay people in bioethical decision making.     

Inter- and intra-person cytomegalovirus infection in Malawian families

Sequence polymorphisms in the gN and gO genes of cytomegalovirus (CMV) amplified from mouth rinse and urine samples of 19 Malawian patients with Kaposi's sarcoma (KS) and 58 of their first-degree relatives were investigated. CMV-DNA was amplified from 41 people (53%) from either the gN or gO region in at least one sample, from 14 people (18%) in both domains in at least one sample, and from 13 (17%) in either domain in both samples. Twenty-one (51%) were seropositive for human immunodeficiency virus-1 (HIV). Identical gN sequences were recovered from eight families and non-identical sequences in six, while identical gO sequences were found in three families and non-identical sequences in five. Five people, four of whom were children, each carried multitypic gN sequences or gO sequences. The findings are consistent with CMV spread along intra- and extra-household routes, and with multiple intra-host CMV infection.     

Tobacco, oral cancer, and treatment of dependence

Tobacco dependence is recognised as a life-threatening disorder with serious oral health consequences which responds to treatment in the form of behavioural support and medication. While cigarette smoking is the most hazardous and prevalent form of tobacco use in the west, consideration also needs to be given to other forms such as bidi smoking in India, reverse smoking by several rural populations and use of snuff and chewing tobacco. The evidence that the use of tobacco is the major risk factor for oral cancer and potentially malignant lesions of the mouth is clear. Counseling to quit smoking is not applied in a systematic or frequent manner to people presenting with potentially malignant lesions of the oral cavity. This review makes recommendations for interventions by health professionals to encourage and aid cessation of tobacco use as a part of prevention of oral cancer.