An audit of the UK national cancer referral guidelines for suspected oral mucosal malignancy

BACKGROUND AND OBJECTIVE: This study aimed to assess the effectiveness of the UK National Guidelines for identifying patients with potentially malignant oral disease which were introduced in 2000. DESIGN: Retrospective audit. SETTING: The oral medicine unit in a university teaching hospital in London. METHODS: All new referrals over a one year period were retrospectively reviewed in a departmental audit to evaluate guideline effectiveness. Reasons for referral and final diagnosis were compared in a randomly selected sub-population. RESULTS: Four hundred and eighty-seven of 901 new patients referred were classified as having potentially malignant disease from the referral letter. In a randomly selected subgroup of 241 patients, 18 actually had malignant (8) or dysplastic lesions (10). Of 75 patients referred with a persistent oral ulcer, only nine were actually malignant or dysplastic. Eight of 116 patients referred with a white patch and none with red patches were found to have dysplastic or malignant lesions. The criteria failed to identify three carcinomas and two severely dysplastic lesions (15% of the malignant or dysplastic lesions). All of the latter had been referred by primary care physicians with orofacial pain of unknown cause. CONCLUSIONS: UK National Guidelines discriminate poorly between potentially malignant and other oral mucosal disease.     

Caries-risk assessment: the role of salivary tests

Although the incidence of caries has diminished dramatically over the past 3 decades, small groups of subjects remain highly susceptible and do not respond to conventional preventive programs. An accurate individual caries-risk assessment allows to identify the etiological factors responsible for the disease and design a rational approach to treatment, addressed to the specific needs of the patients. The use of appropriate caries-risk prediction models, which include the use of simple chairside caries-susceptibility salivary tests, is the most suitable and modern approach to the problem. A review of the literature on salivary tests, at present available, able to identify the factors contributing to caries susceptibility, is presented. Each test is accurately described, with regard both to its procedure and the interpretation of its results:     

Epithelial malignancies of the salivary glands: clinical experience of a single institution-a review

In this retrospective study we give a clinical review of our experience with different subtypes of salivary gland cancer. Between January 1983 and December 2002, a total of 155 patients with carcinomas of the salivary glands received initial treatment at the Department of Oral and Maxillofacial Surgery, Hanover Medical School. There were 79 (51.0%) adenoid cystic carcinomas, 42 (27.1%) mucoepidermoid carcinomas, 12 (7.7%) adenocarcinomas, 10 (6.5%) polymorphous adenocarcinomas and 12 (7.7%) other tumor entities of smaller number. Complete resection was reached for 63.5% of patients with high grade carcinomas and for 80.0% of patients with low grade carcinomas. 26.2% of patients with high grade carcinomas and 13.3% of patients with low grade carcinomas received postoperative radiation. Overall survival rates at 5, 10 and 15 years were 65.9, 48.0 and 39.8% with significant difference for patients with high grade and low grade carcinomas. Histopathologic subtype, tumor stage and margin status significantly influenced prognosis. Statistically, we were not able to demonstrate a positive effect for postoperative radiation. In the future, patients with salivary gland carcinomas should be randomised for prospective multicentric clinical trials, which could provide reliable information about adjuvant treatment modalities and their results even for rare subtypes of salivary gland cancer.     

Rhino-sinusitis related to endosseous implants extending into the nasal cavity. A case report

Rhino-sinusitis may develop as a result of an altered airflow in the nasal cavity causing irritation of the nasal mucosa. A patient is presented who developed recurrent rhino-sinusitis complaints following placement of endosseous implants in the maxilla. Inspection of the nasal floor revealed that two implants had perforated the floor of the nasal cavity. The part of the implants protruding in the nasal cavity was surgically resected via an endonasal approach whereupon the rhino-sinusitis complaints disappeared.     

Radiation doses of indirect and direct digital cephalometric radiography

AIM: The aim of this study was to measure organ doses and calculate the effective dose for indirect and direct digital cephalometric exposures. MATERIAL AND METHODS: Indirect digital cephalometric exposures were made of a Rando phantom head using a Cranex Tome multipurpose unit with storage phosphor plates from Agfa and the direct digital (Charge Coupled Device, CCD) exposures were made with a Proline Ceph CM unit. Exposure settings were 70 kV and 4 mAs for indirect digital exposures. Direct digital exposures were made with 70 kV, 10 mA and a total scanning time of 23 s. TLD700 dosemeters were used to measure organ doses, and the effective doses were calculated with (effective dose(sal)) and without inclusion of the salivary glands. A pilot study was carried out to compare diagnostic image quality of both imaging modalities. RESULTS: Effective doses were 1.7 microSv for direct digital and 1.6 microSv for indirect digital cephalometric imaging. When salivary glands were included in the calculation, effective doses(sal) were 3.4 microSv and 2.2 microSv respectively. Organ doses were higher for direct digital imaging, except for the thyroid gland, where the organ doses were comparable. Diagnostic image quality of indirect and direct digital cephalometric images seemed comparable. CONCLUSION: Effective dose and effective dose(sal) were higher for direct digital cephalometric exposure compared with indirect digital exposure. Organ doses were higher for direct digital cephalography. From preliminary data, it may be presumed that diagnostic image quality of indirect and direct digital cephalometric images are comparable.     

Dental treatment for children with chronic idiopathic thrombocytopaenic purpura: a report of two cases

Idiopathic thrombocytopaenic purpura (ITP) is the most common acquired bleeding disorder occurring in previously healthy children. The condition is benign and self-limiting, with a high possibility of recovery. Only 15-30% of children with acute ITP develop the chronic form. Clinically, ITP presents with petechiae, ecchymoses, haematomas, epistaxis, haematuria, mucocutaneous bleeding, and occasionally, haemorrhage into tissues. Oral manifestations include spontaneous gingival bleeding, petechiae or haematomas of the mucosa, tongue or palate. Two paediatric case reports are described concerning female patients diagnosed with chronic ITP. Oral findings and dental procedures are described. Standard dental treatment was performed with a platelet count higher than 50,000/mm3. The importance of adequate dental plaque control techniques in order to prevent inflammation, potential bleeding and infection in these patients is emphasized. The paediatric dentist must be aware of the clinical appearance of ITP in order to recognize the condition and successfully manage the patient.     

Occupation-related allergies in dentistry

BACKGROUND: Allergies to natural rubber latex (NRL) were unknown in dentistry until 1987. That changed with the publication of a report documenting NRL-based anaphylaxis in a dental worker. This case and others prompted regulatory and manufacturing changes in rubber products and increased awareness throughout the profession. However, other common dental chemicals cause allergic reactions and irritation and often are handled with insufficient precautions. Although recognition of NRL allergy has improved, awareness of other potential allergens and irritants in dentistry still is limited. OVERVIEW: Recent research indicates that the prevalence of NRL protein allergy may be decreasing. In contrast, occupation-related dermatoses associated with other dental products may be more common. Encounters with bonding agents, disinfectants, rubber, metals and detergents can cause occupation-based irritant contact dermatitis and allergic contact dermatitis. These conditions may be found in more than one-quarter of dental and medical personnel. Therefore, dental-specific information about the recognition and management of allergic and irritant reactions is needed. CONCLUSIONS AND CLINICAL IMPLICATIONS: The prevalence of occupation-related dermatitis may be increasing in dentistry. Reducing exposure to potential irritants and allergens and educating personnel about proper skin care are essential to reversing this trend.