Computer-assisted analysis of the oral brush biopsy.

Computer-assisted analysis of the oral brush biopsy is a recently introduced tool that determines the significance of an oral lesion. The oral brush biopsy is minimally invasive, requires no anesthesia, and definitively distinguishes benign from precancerous and cancerous lesions. Oral brush biopsy specimens are analyzed with the aid of a highly specialized neural network-based computer system specifically designed to detect oral epithelial precancerous and cancerous cells.

Prevention and detection of lip cancer--the dentist's role.

With their attention to the oral area, dentists are in an excellent position not only to diagnose lip cancer, but also to counsel patients in its prevention. Patients need to be educated on the dangers of ultraviolet radiation and the measures available to decrease exposure to it. This article discusses the circumstances that increase the chance of developing lip cancer, the variety of ways to decrease that chance, and the recognition and treatment of premalignant and malignant lip lesions.

Actinic cheilitis: a review of 152 cases.

OBJECTIVE: The purpose of this study was to determine whether any clinical or histopathologic variables are associated with the severity of epithelial change in lesions of actinic cheilitis. STUDY DESIGN: A total of 152 acceptable cases of actinic cheilitis were identified from 66,067 cases accessioned from February 1989 to June 1998. For each case, the clinical information supplied by the submitting practitioner at the time of the biopsy and 8 histopathologic variables were evaluated. RESULTS: The following 5 histopathologic variables were positively correlated with an increased degree of epithelial change: acanthosis, basophilic change within the connective tissue, the presence of inflammation within the connective tissue, perivascular inflammation, and thickness of the keratin layer. None of the clinical variables was associated with an increased degree of epithelial change. CONCLUSIONS: The presence of any of the aforementioned histopathologic changes should prompt a close evaluation of the lesion for the presence of either epithelial dysplasia or carcinoma.

The use of exfoliative cytology for the early diagnosis of oral cancers: is there a role for it in education and private practice?

BACKGROUND: Early detection of oral cancers is not easy, because oral precancerous lesions and early oral cancers can mimic many benign conditions in the mouth, leading to delays in diagnosis and treatment. There is a need to emphasize the early diagnosis of oral cancers in order to reduce the unacceptably high morbidity and mortality. METHODS: A survey regarding oral exfoliative cytology was completed by 132 dentists in Virginia who were randomly chosen from a mailing list. RESULTS: Less than half of the dentists (41.7%) had been taught how to obtain a cytologic smear, and only 26.0% knew the clinical indications for doing so. Only 9.2% of the dentists had ever obtained a cytologic smear in private practice. Of the 13 dentists in the survey who had done so, 12 had been trained in the technique. Interest in learning the cytologic technique and getting the needed supplies was indicated by 79.2% of the dentists. CONCLUSIONS: Diagnostic aids in the evaluation of oral mucosal lesions can serve an important role by identifying lesions that need to be biopsied in spite of a "benign" appearance. Exfoliative cytology, as well as vital staining, may aid in this goal. This has implications regarding undergraduate and postdoctoral education.

The effect of clinical information on the histopathologic diagnosis of oral epithelial dysplasia.

OBJECTIVES: The purpose of this study was to test the hypothesis that clinical information submitted with biopsy specimens helps pathologists be more consistent and accurate in diagnosing oral epithelial dysplasia. STUDY DESIGN: Each of six board-certified oral and maxillofacial pathologists examined the same set of 120 oral biopsies (involving diagnoses ranging from hyperkeratosis to severe epithelial dysplasia); they had examined these same biopsies in a previous study, but this time the clinical information was provided for each case. The examiner's diagnosis was compared to the sign-out diagnosis for each case. RESULTS: Rates of exact agreement with the sign-out diagnosis averaged 38.5%, and there was 85.4% agreement within one histologic grade. The rate of agreement in distinguishing epithelial dysplasia from no dysplasia was 71.4%. These results, when compared to those from a previous study in which the same examiners had evaluated the same slides but without clinical histories, represent a 2.5% to 20% decrease for exact agreement among the six pathologists, a 0% to 8.5% decrease for agreement within one histologic grade, and a 0% to 23.4% decrease for agreement regarding the presence or absence of epithelial dysplasia. CONCLUSIONS: When clinical information was used, accuracy and consistency among board-certified oral and maxillofacial pathologists in the diagnosis of oral epithelial dysplasia was not improved. In fact, there was a decrease in accuracy.

Dental and medical considerations of patients with renal disease.

Often a dentist will have a patient with a complicated medical condition that needs to be considered when providing treatment. Following is an in-depth discussion of the medical and dental considerations of patients with renal disease.

Large mucous retention phenomenon (mucocele) of the upper lip. Case report and review of the literature.

An unusual presentation of a mucocele of the upper lip has been described. Differential diagnosis, clinical presentation, histology, and treatment were discussed.

Adult smokeless tobacco use and age of onset.

To determine if an earlier age of onset is associated with greater levels of adult smokeless tobacco (SLT) use and to evaluate if this relationship differs by SLT type, 345 current adult SLT users were interviewed to obtain the age at first onset and current frequency of SLT use. The results indicated that more than twice as many SLT users began during adulthood than during preadolescence. Although preadolescent onset was associated with greater chewing tobacco use than adolescent onset, the greatest levels of both chewing tobacco and snuff use were associated with adult onset, suggesting an increased need for SLT prevention programs for young adults.

Needlesticks: what to do after it happens.

A needlestick injury can be a frightening and even potentially a life-threatening event. It needs to be treated with compassion and some urgency. The dentist-employer should act with knowledge of the current law and with the desire to do whatever is best for the affected people.

Intraexaminer and interexaminer reliability in the diagnosis of oral epithelial dysplasia.

OBJECTIVES: Pathologists differ in their definition of "dysplasia." This study was done to test the hypothesis that experienced oral pathologists are consistent in diagnosing epithelial dysplasia. STUDY DESIGN: Six board-certified oral pathologists examined 120 oral biopsies exhibiting simple hyperkeratosis to severe dysplasia. No clinical information was given, and presence of dysplasia was judged by histomorphology. Examiners' diagnoses were compared with sign-out diagnoses for each case. Months later, each examiner viewed 60 relabeled slides from the original 120. Each diagnosis was compared with the diagnosis in the first round. RESULTS: Exact agreement with the sign-out diagnosis averaged 50.5% (within one histologic grade 90.4%). Examiners agreed exactly with their own diagnoses 50.8% of the time (within one histologic grade 92.4%). Agreement distinguishing dysplasia from no dysplasia compared with original sign-out diagnosis was 81.5%. Agreement with themselves distinguishing dysplasia from no dysplasia was 80.3%. CONCLUSIONS: Accurate reproducible agreement among experienced board-certified oral pathologists diagnosing oral epithelial dysplasia is difficult to achieve.

Small cell carcinoma of the lung metastatic to the wall of a radicular cyst.

This case report details the unusual presentation of small cell carcinoma at the periapex of a maxillary left lateral incisor. The initial clinical presentation was that of a symptomatic, nonhealing, well-circumscribed radiolucency about the periapex of the tooth. The biopsy specimen submitted by the endodontist was diagnosed as small cell carcinoma. This report stresses the need for submission of all tissue removed from the oral cavity for histopathological examination.

Comparison of articles published in Oral Surgery Oral Medicine Oral Pathology in 1972 and 1992.

The articles published in the Oral Pathology section of Oral Surgery Oral Medicine Oral Pathology in 1972 and 1992 were analyzed and compared. A significant increase in the number of authors and the number of references per article was noted. There was also a significant increase in the number of articles that dealt with bacterial/viral/fungal diseases. A trend toward the origination of more articles from outside the United States was noted.

Adult rhabdomyoma. A light microscopic, ultrastructural, virologic, and immunologic analysis.

Adult rhabdomyoma is a rare benign tumor of skeletal muscle origin that frequently arises from musculature of the head and neck region. In this study we report five cases of adult rhabdomyoma. Light and electron microscopic examination revealed the typical cellular features as described by others. The results of immunophenotyping and quantitation of nucleolar organizer regions were consistent for a benign skeletal muscle tumor. Epstein-Barr virus and human papillomavirus genomic DNA could not be detected by in situ hybridization.

Oral melanotic macules. A review of 353 cases.

Clinical and histopathologic data were obtained on 353 cases of oral melanotic macules. The mean age at the time of diagnosis for all sites was 43.1 years. A significant predilection for females (p < 0.001) was noted and the most common location was the lower lip (33.0%). The mean size of the lesions was 6.8 mm. Brown was the most common color (64.9%), and most (66.0%) of the lesions were described as flat. Melanin was evident in both the basal cell layer and lamina propria in 93.5% of the cases.

The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors.

BACKGROUND: The widespread use of smokeless tobacco (ST) has prompted concern in regard to the development of oral lesions in long-term users. METHODS: For inclusion in the current study, a subject must have used an ST product, either snuff or chewing tobacco, for at least 6 months. The subjects were recruited by advertising, and none was referred for the evaluation of an oral lesion. The following were performed on all subjects: assessment of exposure to ST, cigarettes, and alcohol; examination of the oral cavity; a biopsy, if an oral lesion was found; and analysis of a blood sample for beta-carotene. The dietary intake of most of the subjects was analyzed. RESULTS: Of the 347 ST users, all of whom were white male subjects, 45 (13.0%) had an oral lesion. Thirty-five of the lesions were hyperkeratosis and 10 were epithelial dysplasia. CONCLUSIONS: Snuff exposure was associated significantly with the presence of an oral lesion (P < 0.0001). A decreased vitamin C intake also was found among the ST users with oral lesions (P < 0.01). The ST users with epithelial dysplasia, as compared with those with hyperkeratotic lesions, were slightly older, had a lower intake of vitamin C (P < 0.05), and were more likely to have used chewing tobacco than snuff.