口腔白斑患者相关健康状况的问卷调查研究

目的：研究口腔白斑对患者口腔健康及生活质量的影响,并分析其影响因素提出相应的护理对策。方法：选取2014年8月～2015年1月在我院口腔黏膜科就诊的50名口腔白斑患者作为研究组（ OLK组）,同时选取50名健康成人作为对照组。采用口腔健康影响程度量表（ OHIP-14量表）,分别从身体机能、口腔舒适度、心理情况和独立能力四个方面对白斑患者和健康成人进行口腔健康及相关生活质量的评估,并分析结果,提出针对口腔白斑患者的护理对策。结果：与健康成人相比,口腔白斑患者的身体机能、口腔舒适度、心理情况和独立能力均显著降低,差异具有统计学意义（P＜0.05）。结论：口腔白斑会降低患者相关生活质量,全身及口腔护理和心理干预将有助于提高口腔白斑患者的口腔健康及相关生活质量。     

Oral leukoplakia—to treat or not to treat

Various treatment modalities have been described for reducing or eliminating malignant development of oral leukoplakia, but no treatment has gained universal approval due to lack of randomized clinical studies. At present, it is uncertain whether we can do harm to the patients by treating or by not treating them. An essential aspect is the observation of cancer development even after surgical removal of the clinical lesions. Inadequate resection of the lesions or field cancerization may account for this phenomenon. Another challenge is whether surgical removal of the lesions in fact is associated with a cancer promotional effect resulting in increased risk of cancer. Moreover, unidentified existing cancer in non‐suspicious oral leukoplakias may for diagnostic purposes imply that surgical removal is recommendable as well as serial section of all excised tissue. Intensive follow‐up programmes for leukoplakias are important, independent of surgical intervention.     

Reversibility of snuff dippers'' lesion in Swedish moist snuff users: a clinical and histologic follow-up study

The purpose of this study was to assess possible reversibility of oral mucosal changes, associated with the use of Swedish moist snuff, after change of habit. Biopsies from a total material of 252 regular snuff users, 184 using loose snuff and 68 using portion-bag packed snuff, were screened microscopically to identify histopathologic epithelial changes in addition to, or differing from, those generally seen as a result of snuff use. The main basis for selection of these variables were the criteria of epithelial dysplasia as defined by WHO and the eight histologic features, which have been reported to be the most important discriminators to separate cases with leukoplakia that subsequently developed carcinoma, from those that did not. Twenty-nine subjects, 3 showing Degree 2 lesions, 21 Degree 3 lesions and 5 Degree 4 lesions, all of them loose snuff users were identified. All the 29 users were re-examined clinically and histologically after 3-6 months. The rebiopsy was always secured from the same mucosal area as the original biopsy. At follow-up, 20 subjects had either stopped their snuff habit or changed to portion-bags and changed placement of the quid. All of them showed a healthy mucosa at the previous biopsy site and normal tissue in the histologic examination of the rebiopsies. Seven subjects had changed to portion-bags and variably reduced their daily exposure to snuff. At follow-up they presented with less pronounced clinical changes and the rebiopsies showed evidence of reduced epithelial changes. One major conclusion from this study is that tissue changes, clinically as well as histologically, are reversible following cessation of snuff habit.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence study of oral mucosal lesions in a selected Cambodian population

Abstract The aim of this study was to investigate the epidemiology of oral mucosal lesions in a selected Cambodian population to obtain pilot data useful in planning an oral health data base for the country. Due to unstable conditions in Cambodia, the validity of population data related to present census information is highly questionable. Therefore, prior to this investigation a census registration was carried out using local health workers as registrars in nine villages of a commune. In the period July 4–31, 1991, a total of 1319 individuals (953 women, 366 men, 15–99 yr) were examined by one oral surgeon in the nine villages of Kok Trop Commune. Kandal Stung District, southwest of the capital Phnom Penh. Clinical diagnoses were based on WHO criteria. Information on smoking habits, betel nut chewing habits, and alcohol use was collected by 4 Khmer dental personnel. In total, 71 lesions were recorded in 64 (4.9%) individuals. Leukoplakia was found in 1.1%, lichen lesions in 1.8%, candidosis in 1.4%, submucous fibrosis in 0.2%, cancer in 0.1%) and other diagnoses in 0.8%. The prevalence of leukoplakia was 2.2% and 0.6% among men and women respectively, a statistically significant difference (P < 0.05). There were significantly more smokers (P < 0.01) among subjects with leukoplakia (64.3%) than among those without this lesion (28.6%). All subjects with lichen lesions were women. The age-adjusted relative risk for developing lichen among betel nut chewers as compared to non-chewers was 3.3. This study has provided information on epidemiological aspects of oral mucosal lesions, including the relationship to etiological factors such as tobacco smoking and betel nut chewing, which might prove valuable in planning future oral health studies and implementing preventive programmes in Cambodia.     

Proliferative verrucous leukoplakia and its progression to oral carcinoma: report of three cases

Proliferative verrucous leukoplakia (PVL) is a distinct clinical form of oral leukoplakia defined by its progressive clinical course, changing clinical and histopathologic features, and potential to develop into cancer. PVL behaves in a more aggressive and relentless manner than the more innocuous white oral lesions that it can resemble clinically. We present three cases of PVL that progressed to carcinoma and discuss the histopathologic findings that may either hinder or assist in the diagnosis.     

Epstein-Barr virus in tobacco-induced oral cancers and oral lesions in patients from India

D'Costa J, Saranath D, Sanghvi V, Mehta AR: Epstein-Barr virus in tobacco-induced oral cancers and oral lesions in patients from India. J Oral Pathol Med 1998; 27: 78–82. © Munksgaard, 1998.
We examined 103 oral squamous cell carcinomas (OSCC), 100 oral lesions consisting primarily of leukoplakia (82 cases), and 76 clinically normal mucosa specimens from the contralateral site in the oral cavity of individuals with oral lesions, for the presence of Epstein-Barr virus (EBV). Polymerase chain reaction (PCR) was used to amplify a 239 bp fragment of the BamHIL region of the EBV genome, followed by Southern blot hybridization with EBV oligonucleotide probe to increase further the specificity and sensitivity of the assay system. Since EBV seropositivity is frequent in populations, we also examined the peripheral blood cells (PBC) from 141 patients (50 oral cancer patients, 91 patients with oral lesions) for the presence of EBV We detected EBV in 25 of 103 (25%) OSCC, 13 of 100 (13%) oral lesions, 3 of 76 (4%) clinically normal mucosa samples and 10 of 141 (7%) PBC. Our results indicate that EBV may contribute as one of the multiple factors in oral cancers, in a certain proportion of Indian patients.     

Observer variability in the histologic assessment of oral premalignant lesions

Histopathologic examination of oral leukoplakias has a major impact on the assessment of prognosis and treatment planning. We investigated the extent of agreement in grading epithelial dysplasia between pathologists with the same or different educational backgrounds. Two general pathologists and two oral pathologists were each given 100 sections of oral leukoplakia to grade from no dysplasia to carcinoma in-situ. The interobserver agreement rates were in the range of 49% to 69%. The calculated kappa values were in the range of 27% to 45%), showing poor to moderate agreement between the pathologists. When comparing the kappa values between the two pairs of pathologists with the same education, these values did not diverge from the general level of kappa values, indicating that the interobserver variability was due to individual differences rather than to educational background.     

Oral findings in glassblowers

Oral changes related to the occupation of glassblowing have been examined in 74 Danish glassblowers, consisting of 44 active glassblowers (Group 1) and 30 past glassblowers (Group 2). In addition, 15 non-glassblowers (Group 3) were examined. All three groups worked in the same department of mouth-blown glassware in Holmegaard's Glassworks. White patches of the buccal mucosa occurred in 23 % of active glassblowers, but did not occur among past or non-glassblowers. Histologically, the white lesions revealed morsicatio buccarum-Like changes. The lesions are reversible and should be distinguished from leukoplakias. The term “glassblower's white patch” is suggested. Furthermore black discolorations of vermilion border and front teeth occurred in 30% and 62%, respectively, of active glassblowers. Tooth fractures, mostly enamel fractures, caused by the blowpipe were found in 43% of active glassblowers and 19% of past glassblowers.