Detection and proportion of very early dental caries in independent living older adults.

BACKGROUND AND OBJECTIVES: Dental caries is an important healthcare challenge in adults over 65 years of age. Integration of oral health screening into non-dental primary care practice may improve access to preventive dental care for vulnerable populations such as the elderly. Such integration would require easy, fast, and accurate early caries detection tools. Primary goal of this study was to evaluate the diagnostic performance of optical coherence tomography (OCT) imaging for detecting very early caries in the elderly living in community-based settings. The International Caries Detection and Assessment System (ICDAS) served as gold standard. Secondary goal of this study was to provide baseline prevalence data of very early caries lesions in independent living adults aged 65+ years. MATERIALS AND METHODS: Seventy-two subjects were recruited from three sites in Southern California: a retirement community, a senior health fair, and a convalescent hospital. Clinical examination was performed using the ICDAS visual criteria and this was followed by OCT imaging. The two-dimensional OCT images (B-scan) were analyzed with simple software. Locations with a log of back-scattered light intensity (BSLI) below 2.9 were scored as sound, and areas equaling or exceeding 2.9 BSLI were considered carious. Diagnostic performance of OCT imaging was compared with ICDAS score. RESULTS: OCT-based diagnosis demonstrated very good sensitivity (95.1%) and good specificity (85.8%). 54.7% of dentate subjects had at least one tooth with very early coronal caries. CONCLUSIONS: Early coronal decay is prevalent in the unrestored pits and fissures of coronal surfaces of teeth in independent living adults aged 65+ years. Though OCT imaging coupled with a simple diagnostic algorithm can accurately detect areas of very early caries in community-based settings, existing devices are expensive and not well-suited for use by non-dental health care providers. Simple, inexpensive, fast, and accurate tools for early caries detection by field health care providers working in non-traditional settings are urgently needed to support inter-professional dental health management.

Head and neck, oral, and oropharyngeal cancer: a review of medicolegal cases.

OBJECTIVE: The purpose was to review cases of malpractice in head and neck cancer (HNC) in order to examine allegations and outcomes of the litigation and to assess the implications for best practices in the clinical care of patients with HNC. MATERIALS AND METHODS: Three U.S. legal databases were accessed to assess the basis of the cases and the outcomes reported. RESULTS: Dental and medical health care providers are identified in cases with alleged failure to diagnose or delayed diagnosis. In addition, inadequate prevention and management of oral complications of cancer therapy also may result in medicolegal action. In the dental cases, the mean recovery was $1,033,500.11, and in medical cases, it was $2,828,639.20. CONCLUSIONS: In addition to failure in the diagnosis of malignant disease, our review identified failure to properly prevent and manage oral complications as potential causes of medicolegal actions. Evidence-based care with a multidisciplinary team may promote diagnosis of disease and prevention and management of complications.

A prospective study to assess in vivo optical coherence tomography imaging for early detection of chemotherapy-induced oral mucositis.

BACKGROUND AND OBJECTIVE: Oral mucositis (OM) is a common and severe complication of many cancer therapies. Currently, prediction and early detection are not possible and objective monitoring remains problematic. Goal of this prospective study is to assess non-invasive imaging using optical coherence tomography (OCT) for early detection and evaluation of chemotherapy-induced OM in 48 patients, 12 of whom developed clinical mucositis. STUDY DESIGN/MATERIALS AND METHODS: In 48 patients receiving neoadjuvant chemotherapy for primary breast cancer, oral mucosal health was assessed clinically, and imaged using non-invasive OCT. Images were evaluated for mucositis using an imaging-based scoring system ranging from 0 to 6. Conventional clinical assessment using the OM assessment scale (OMAS) was used as the gold standard. Patients were evaluated on Days 0-11 after commencement of chemotherapy. OCT images were visually scored by three blinded investigators. RESULTS: The following events were identified from OCT images (1) change in epithelial thickness and subepithelial tissue integrity (beginning on Day 2), (2) loss of surface keratinized layer continuity (beginning on Day 4), (3) loss of epithelial integrity (beginning on Day 4). Imaging data gave higher scores compared to clinical scores early in treatment, suggesting that the imaging-based diagnostic scoring was more sensitive to early mucositic change than the clinical scoring system. Once mucositis was established, imaging and clinical scores converged. CONCLUSION: Using OCT imaging and a novel scoring system, earlier, more sensitive detection of mucositis was possible than using OMAS. Specific imaging-based changes were a consistent predictor of clinical mucositis.