Opinions and attitudes of the UK's GDPs and specialists in oral surgery, oral medicine and surgical dentistry on oral cancer screening.

OBJECTIVE: To survey two broad areas of oral cancer awareness and management of patients at risk of oral cancer by specialists in oral surgery, oral medicine, surgical dentistry and general dental practitioners (GDPs) in the UK. The first of these included knowledge and awareness of aetiological factors, changing patterns of disease, and screening/detection programmes including their effectiveness. The second included oral cancer detection methods, advice on avoidance of high-risk activity and self-examination, and referral pattern of GDPs. DESIGN AND METHOD: A pretested, 44-item questionnaire, a covering letter, a brief outline of the research protocol and return, stamped envelope were mailed in March 2003. A sample of 200 GDPs whose names were obtained from the General Dental Council's main list and 305 dental specialist names obtained from specialist's list in surgical dentistry, oral medicine and oral surgery were selected randomly. Information on oral cancer awareness and practice, screening practice and education was obtained. RESULTS: The response rate was 66.9%. The knowledge of the dental specialists was consistent with that in reports of current aetiological studies on oral cancer. However there were gaps in the GDP's knowledge and ascertainment of oral cancer risk factors. Over 70% of the dental specialists provided counselling advice on the risks of tobacco and alcohol habits compared with 41.2% of GDPs. More GDPs (52.4%) than specialists (35.4%) believed that oral cancer screening on a national basis would be effective in decreasing the mortality of oral cancer. Over 95% of all respondents used a visual examination for oral cancer screening and 89.9% of all respondents strongly believed that visual screening is effective in the early detection of oral cancer. CONCLUSION: The results showed that GDPs had knowledge gaps in their awareness of oral cancer risk factors and the application of preventive measures. Most dental health providers in the UK perform visual screening of the oral mucosa for their patients. Opinion was equivocal as to whether a nationally based screening programme similar to cervical cancer would be effective in improving the mortality and morbidity of oral cancer.

Oral lichenoid lesions related to dental restorative materials.

OBJECTIVES: To determine the effectiveness of replacing restorations considered to be the cause of an oral lichenoid lesion (oral lichenoid reaction)(OLL). DESIGN: Clinical intervention and nine-month follow up. SETTING: The study was carried out in the University Dental Hospital of Manchester, 1998-2002. SUBJECTS AND METHODS: A total of 51 patients, mean age 53 (SD 13) years, who had oral lesions or symptoms suspected to be related to their dental restorations were investigated. Baseline patch tests for a series of dental materials, biopsies and photographs were undertaken. Thirty-nine out of 51 (76%) of patients had their restorations replaced. RESULTS: The clinical manifestations of OLL were variable; the majority of OLL were found to be in the molar and retro molar area of the buccal mucosa and the tongue. Twenty-seven (53%) patients had positive patch test reactions to at least one material, 24 of them for one or more mercury compound. After a mean follow up period of nine months, lesions adjacent to replaced restorations completely healed in 16 (42%) patients (10 positive and 6 negative patch tests). Improvement in signs and symptoms were found in 18 (47%) patients (11 positive and 7 negative patch tests). CONCLUSION: OLLs may be elicited by some dental restorations. Replacing restorations adjacent to these lesions is associated with healing in the majority of cases particularly when lesions are in close contact with restorations. A patch test seems to be of limited benefit as a predictor of such reactions.

Opinions of UK specialists about terminology, diagnosis, and treatment of atypical facial pain: a survey.

There are few robust, evidence-based data about what constitutes the diagnosis of atypical facial pain and how it is best treated. We therefore aimed to find out the current opinion of those on specialist lists in the United Kingdom (UK) on whether they use the term atypical facial pain, how they reach their diagnosis, and what treatment they offer. We sent out questionnaires to 240 specialists randomly selected from the UK lists of those most likely to deal with atypical facial pain (oral and maxillofacial surgeons, oral medical specialists, ear nose and throat surgeons, anaesthetists, psychiatrists and neurologists). We divided the replies according to whether the specialists were medically or dentally based. Of the 209 valid questionnaires, 143 were returned (a response rate of 68%); 127 of the 143 used the term atypical facial pain, the others used various other terms. The two groups used significantly different criteria, mainly to exclude other conditions to achieve a diagnosis. About half used haematological tests and most used radiographic investigations routinely, and there were no significant differences among the specialities. No unified pattern of referral between different units was found. Treatment was mainly by antidepressant and anticonvulsant drugs, and counselling.

Healing of oral lichenoid lesions after replacing amalgam restorations: a systematic review.

OBJECTIVE: We sought to systematically review the literature related to oral lichenoid lesions (OLLs) and amalgam restorations. STUDY DESIGN: Cohort and case-controlled studies (no randomized controlled trials or controlled clinical trials available) were reviewed with respect to inclusion criteria and data on patients with OLLs, treatment interventions, and the measurement of outcomes. RESULTS: Fourteen cohort and 5 case-controlled trials met the criteria. The study population consisted of 1158 patients (27% male and 73% female; age range, 23-79 years). From 16% to 91% of patients had positive patch test results for at least 1 mercury compound. Of 1158 patients, 636 had to have their restorations replaced. The follow-up period ranged from 2 months to 9 1/2 years. Complete healing ranged from 37.5% to 100%. The greatest improvements were seen in lesions in close contact with amalgam. CONCLUSIONS: Protocols must be standardized to obtain valid results. The replacement of amalgam restorations can result in the resolution or improvement of OLLs. Patch testing seems to be of limited value. The topographic relationship between an OLL and an amalgam restoration is a useful--but not conclusive--marker.

Resin composite monomers alter MTT and LDH activity of human gingival fibroblasts in vitro.

OBJECTIVES: Substances such as monomers may be released from composite resin systems and may induce adverse effects in biological tissues. The aim of this study is to investigate the cytotoxic concentrations of resin composite monomers on cultures of human gingival fibroblasts. METHODS: A range of dilutions of five resin composite monomers (HEMA, HPMA, DMAEMA, TEGDMA, and Bis-GMA) were added to the culture medium of human gingival fibroblasts for 24 h. Their cytotoxic effects were measured by using two colorimetric functional assays, mitochondrial dehydrogenase activity (MTT) and lactate dehydrogenase activity (LDH) assay. The logP values (water/octanol partition) of test monomers were also calculated computationally. RESULTS: Mitochondrial reducing activity assessed with the MTT test was inhibited by all monomers and all the monomers increased the LDH release in a reproducible dose dependent manner. A wide range of TC 50 values (concentrations altering MTT and LDH activity by 50%) (0.32-5.8 mM by MTT assay and 0.36-6.7 mM by LDH assay) was observed. Ranking of composite resin monomer cytotoxicities (TC 50) were similar for both the MTT and LDH assays, (Bis-GMA>TEGDMA>DMAEMA>HPMA >HEMA). However, the MTT assay was found to be more sensitive than the LDH assay, particularly when lower doses of the tested monomers were determined. The ranking of TC 50 concentrations correlated with the calculated logP values. SIGNIFICANCE: Monomers used in dental restorative materials show a variety of toxic effects on gingival fibroblasts. A combination approach using MTT and LDH assays provides valuable information about their toxic effects.

Screening programmes for the early detection and prevention of oral cancer.

BACKGROUND: Although the second half of the last century has generated a rich and complex body of knowledge, the burden of oral cancer is still largely present. As with other cancers, there has been a strong debate whether screening strategies for oral cancer such as visual examination, the use of toluidine blue or newer methods such as brush biopsy or fluorescence imaging are effective in reducing the mortality rate associated with oral cancer. OBJECTIVES: To assess the effectiveness of current screening methods in decreasing oral cancer mortality. SEARCH STRATEGY: Electronic databases (MEDLINE, CANCERLIT, EMBASE, the Cochrane Central Register of Controlled Trials; 1966 to September 2002, The Cochrane Library - Issue 2, 2002), bibliographies, handsearching of specific journals and contact authors were used to identify published and unpublished data. SELECTION CRITERIA: Randomised controlled trials of screening for oral cancer or potentially premalignant oral lesions using visual examination, toluidine blue, fluorescence imaging or brush biopsy. DATA COLLECTION AND ANALYSIS: The search found 100 citations and these have been reviewed. One randomised controlled trial of screening strategies for oral cancer was identified as meeting the review's inclusion criteria. Validity assessment, data extraction and statistics evaluation have been undertaken by two independent reviewers. MAIN RESULTS: One ongoing randomised controlled trial has been included (n = 13 clusters: 153,708 eligible subjects, 130,799 included subjects). There was no difference in the age-standardised oral cancer mortality rates for the screened group (21.2/1000,000 person years) and the control group (21.3/100,000 person years). However this study has some methodological weaknesses. REVIEWER'S CONCLUSIONS: Given the limitation of evidence (only one included randomised controlled trial) and the potential methodological weakness in the included study, it is valid to say that there is no evidence to support or refute the use of a visual examination as a method of screening for oral cancer using a visual examination in the general population. Furthermore, no robust evidence exists to suggest other methods of screening, toluidine blue, fluorescence imaging or brush biopsy, are either beneficial or harmful. Further cost-effective, high quality studies to assess the efficacy and effectiveness of screening are required. In addition, studies to elucidate the natural history of oral cancer, prevention methods and the effectiveness of opportunistic screening in high risk groups are needed.

Mercuric chloride: toxicity and apoptosis in a human oligodendroglial cell line MO3.13.

A human-human oligodendroglial cell line MO3.13 was chosen in this study to model the loss of oligodendrocytes that occurs during episodes of multiple sclerosis. The influence of mercuric chloride (HgCl(2)) upon cell viability specifically the mode of cell death, whether by an active apoptotic mechanism or passive necrosis was determined by morphological and biochemical analysis. Mitochondrial dehydrogenase activity MTT assay showed that HgCl(2) had toxic effects on MO3.13 cells at levels of (5-25 microM) with approximately 50% cell death observed at 58 microM. Death of cells was dependent on both time and concentrations of HgCl(2). Differentiated MO3.13 cells exposed to low concentrations (25 microM) of HgCl(2) exhibited features of apoptotic cell death, including cell shrinkage and chromatin condensation. High doses of HgCl(2) (>100 microM) induced death with characteristics of necrosis. Biochemical analysis showed that HgCl(2) activated the caspase family of proteases. This was measured directly by cleavage of fluorescent substrates and by immunoblotting assay of caspase substrate proteins; alpha-fodrin, lamin B and poly (ADP-ribose) polymerase (PARP). These results indicate that HgCl(2) is toxic at low concentrations for oligodendroglial cells and that the MO3.13 cell line dies in an apoptotic manner when exposed to low concentrations of HgCl(2). However, blood mercury concentrations in vivo in a normal population with amalgam restorations are lower by a factor of some 500 times than those causing toxicity in vitro suggesting a good safety margin in respect of environmental uptake.

Attitudes to biopsy procedures in general dental practice.

AIM: To investigate biopsy procedures in general dental practice. OBJECTIVES: To assess the views and attitudes of: specialists on the dental specialist surgical registers; dentists in general practice (GDPs) and patients undergoing biopsy procedures. METHOD: Questionnaires were sent to 98 oral and maxillofacial surgeons and surgical dentists, 335 general dental practitioners and 220 patients attending the Oral Medicine Clinic at the Dental Hospital, Manchester. Participation rates were 68 (74%), 227 (72%), and 158 (76%) respectively. RESULTS: Specialists: 47 (70%) would discourage dental practitioners undertaking biopsies. Concerns were a lack of skills and delays in referral; 20 (30%) considered GDPs should be able to perform simple biopsies for benign lesions. Dentists: 33 (15%) reported they had performed oral biopsies in the last two years; 136 (60%) felt they should be competent to biopsy benign lesions. Their main concerns were lack of practical skills and the risk of diagnostic error. PATIENTS: 112 (65%) worried about their biopsy result, 67 (39%) would feel anxious if their dentist did the biopsy, although 40 (23%) were anxious when biopsied in the oral medicine clinic. CONCLUSIONS: Both specialists on the dental surgical registers and GDPs feel there is a need for further training in biopsy technique for GDPs and better advertised and accessible pathology support. The current fee for biopsies may need upward revision. A main concern of patients is fear of an adverse biopsy report. Whilst patients are satisfied with specialist management any concerns were an insufficient reason for biopsy of a benign lesion not being undertaken in general practice.

Persistent impairment of taste associated with terbinafine.

A second case of persistent taste disturbance associated with terbinafine is described. Taste disturbance associated with this drug is reviewed and a table is provided listing the more common drugs associated with taste disturbance.

Sensitivity of Candida albicans to negative air ion streams.

Negative air ions (NAIs) are known to kill C. albicans; however, their precise mechanism of action is uncertain. Elucidation of this has been hampered by a lack of reproducibility between results obtained by different investigators. The aim of this study was to determine the influence of variation in experimental parameters on the sensitivity of C. albicans to negative air ions and the role of ozone in this process. Ten strains of C. albicans were exposed to NAIs generated at different emitter distances, exposure times, relative humidities and under aerobic and oxygen-free conditions. In further experiments, ozone levels were measured under the same conditions. The effect of NAIs on C. albicans growth was assessed by measuring the area of the zone of inhibition generated around the electrode of the ionizer. There was a significant reduction in area of zone of inhibition with increasing emitter distance (P < 0.05), relative humidity (P < 0.05) or under oxygen-free conditions (P < 0.05). Increases in exposure time resulted in a significant increase in growth inhibition (P < 0.05). Ozone levels increased with increasing exposure times (P < 0.01) but were significantly reduced as emitter distance increased (P < 0.01). When utilized in a nonventilated room, levels of ozone produced did not exceed recognized safety limits. These results (a) demonstrate the importance of careful control of experimental parameters if reproducibility of studies involving NAIs is to be achieved, and (b) highlight the possible role of ozone in the microbicidal effects of NAIs.

Dental prescribing: minimising the cost to the patient and the NHS.

The high cost of prescription charges, changes in drug availability and the increase in private and independent dental practice means that NHS prescriptions may not be the cheapest or most appropriate way of providing drugs to patients. This article examines this complex area and provides some practical advice.

Ecstasy--dental implications.

Ecstasy (also known as 'love drug', 'XTC' or 'E') is the name commonly used for the illegal designer drug related to amphetamine, 3,4 methylenedioxy-methamphetamine (MDMA). MDMA was patented in 1914 as an appetite suppressant, has been investigated as a mood modifying agent, but with its predecessor 3,4 methylenedioxyamphetamine (MDA) is now widely (and wrongly), promoted as a safe, non-toxic means to 'warm loving relaxation'.

Spectral analysis of the masseter and anterior temporalis: an assessment of reliability for use in the clinical situation.

The electromyogram (EMG) of contracting muscles can be analysed in the frequency domain by spectral analysis. However, there is a need to establish the reproducibility of spectral parameters such as mean power frequency (MPF). This study examined the variation of MPF (masseter and anterior temporalis) between and within recording sessions. The MPF was found to be significantly reliable for both muscles, but considerable within-subject variation was found despite comprehensive measures to standardize recording methods and conditions. It is concluded that MPF may have clinical application in the diagnosis and treatment of patients with facial pain arising from muscle dysfunctions, but caution should be exercised in interpreting small changes in frequency, given the inherent variability of MPF.

A double-blind cross-over trial of a mucin-containing artificial saliva.

A double-blind, five phase, cross-over clinical trial was used to compare a mucin-based artificial saliva (Saliva Orthana) with its non-mucin base and water. Thirty patients, acting as their own controls, took part. Saliva Orthana offered significantly greater relief from xerostomia compared with its base or water, and was significantly better at relieving soreness than water. In terms of overall preference, it was ranked significantly higher than either alternative.