Oral Potentially Malignant Disorders and Oral Cavity Cancer.

The Surveillance, Epidemiology, and End Results program from the National Cancer Institute reports that the aggregate number of oral cavity and pharyngeal cancer cases has been increasing over the past decade and, despite an overall decline in oral cavity cancers, this increase is largely related to a dramatic increase in cancers involving oropharyngeal subsites. Early detection of oral cavity cancers is commensurate with improved survival, and opportunistic screening by trained clinicians to detect oral cavity cancer and oral potentially malignant disorders is recommended by the American Dental Association and the American Academy of Oral Medicine.

Adjunctive Diagnostic Techniques for Oral and Oropharyngeal Cancer Discovery.

The most important prognostic factor in predicting the outcome of oral and oropharyngeal cancer (OPC) is the stage at which it is diagnosed. Only 30% of patients are diagnosed with early-stage disease. The oral health care provider performs an important role in early diagnosis of oral cancer. The conventional oral examination consists of a visual and tactile assessment of accessible oral, and head and neck structures. Any suspicious or equivocal lesion should be reevaluated within 4 weeks. Evidence supporting the use of adjunctive devices to improve the ability to screen for and identify OPCs and oral premalignant lesions remains low.

Oral and oropharyngeal cancer.

Oral and oropharyngeal cancer (OPC) is a complex and often relentless malignancy prone to local invasion and dissemination. Despite advances in understanding of the disease and improved therapeutic interventions, it continues to be diagnosed at an advanced stage and the survival rate remains poor. The financial cost of treating OPC may be the highest of all cancers in the United States and survivors often experience major detriments to quality of life. Major risk factors for OPC are tobacco, alcohol, areca nut, and human papillomavirus infection. This article updates medical practitioners on the causes, presentation, diagnosis, and management of OPC.

It's not just an "oral cancer" exam.

The early identification and treatment of cancer of the head and neck, including oropharyngeal cancer (OPC), is associated with an improved survival rate. Specific efforts to promote screening to improve the early detection of OPC have come under scrutiny, largely due to the low prevalence of the disease. However, screening the patient for OPC does not occur as an isolated event in contemporary practice, but as an integral component of the hard and soft tissue examination to determine the totality of the patient's oral health. Three patient vignettes are presented to demonstrate that, regardless the outcome of the debate over OPC screening, the oral health care professional who performs a thorough examination of the head and neck is often in the best position to discover early cancer affecting the head and neck.

Adjunctive diagnostic aids in oral cancer screening: an update.

During the past decade, several adjunctive aids have been introduced to the marketplace with the promoted goal of improving the dental practitioner's ability to screen for and identify oral premalignant and malignant lesions (OPMLs). These products include the OralCDx Brush Test, ViziLite Plus with TBlue, Microlux, VELscope Vx, Sapphire Plus, Identafi, and the DOE Oral Exam System. They are all marketed as aids for the clinician to use in addition to, not in lieu of, the accomplishment of a conventional oral examination (COE). Studies addressing the efficacy of these products when used in the general practice setting to screen for OPMLs are limited and conflicting. The ability to discriminate between truly dangerous OPML against the milieu of benign mucosal lesions remains a concern and further research is necessary to determine the true value of these products as marketed to the general practitioner. The attainment of a complete history and the accomplishment of a thorough and disciplined COE remains the foundation upon which the practitioner assesses the patient for OPMLs. Findings deemed suspicious or equivocal should be referred to an expert for further assessment or undergo immediate biopsy, while findings deemed innocuous should be re-evaluated within 2 weeks and referred to an expert for further assessment or undergo biopsy if still present.

White oral lesions, actinic cheilitis, and leukoplakia: confusions in terminology and definition: facts and controversies.

Many diseases affecting the cutaneous tissues may incur observable changes to the mucosal tissues of the oral cavity. As a consequence, the dermatologist should always assess the oral mucosal tissues of their patients as a matter of routine. Equivocal lesions should be referred to a dentist for further assessment. Although most encountered white oral lesions are innocuous, some potentially serious conditions may mimic an innocuous white lesion. As examples, oral lichen planus may cause significant patient discomfort and is associated with some degree of increased malignant risk, whereas actinic cheilitis and leukoplakia have a confirmed association with an increased malignant risk. This contribution reviews the characteristics and management strategies for some of the more common white oral lesions that the dermatologist may observe in clinical practice.

Assessment of the VELscope as an adjunctive examination tool.

The VELscope is a visualization-enhancement adjunct currently marketed to assist the clinician in assessing potentially dysplastic or malignant mucosal lesions in the oral cavity. The author examined 130 subjects, who smoked at least one package of cigarettes per day. The clinical findings derived from a conventional examination protocol were compared to the findings observed with the VELscope. Ten suspicious lesions were identified by conventional examination. No occult suspicious lesions were identified using the VELscope. VELscope interpretation did not enhance or otherwise alter the clinical management of the suspicious lesions. Several commonly occurring conditions, such as mucosal pigmentations, ulcerations, irritations, and gingivitis were associated with a loss of fluorescence using VELscope. The findings of this study raise questions concerning the utilization of the VELscope as a screening adjunct.

Antimicrobial efficacy of soap and water hand washing versus an alcohol-based hand cleanser.

The emergence of alcohol-based hand cleansers may represent an alternative to soap and water in the clinical dental setting. In this study, the antimicrobial efficacy of traditional hand washing vs. a unique alcohol-based hand cleanser with persistence was evaluated. Two experienced dentists participated over a 10-day period. On days 1-5, each clinician used an antibacterial liquid soap (Dial, Dial Corporation, Scottsdale, AZ). Days 6-10, an alcohol-based hand cleanser (Triseptin Water Optional, Healthpoint Surgical, Fort Worth, TX) was used. Sampling was by modified glove juice technique. The results indicate that the alcohol-based hand cleanser dramatically outperforms the traditional hand washing agent in the general dental setting.

Gastrointestinal illnesses and their effects on the oral cavity.

Many disease processes affecting the gastrointestinal (GI) tract may cause observable changes to the oral cavity. In fact, oral cavity changes may represent the first clinical manifestation of an underlying GI condition. Recognition and appropriate referral of a possible GI condition contribute to overall health and wellness in patients. Some of the more important GI conditions that may manifest oral cavity involvement include: reflux disorders, inherited GI polyposis syndromes, and inflammatory bowel disease. This article briefly reviews the aforementioned topics.

Risk stratification and dental management of the patient with thyroid dysfunction.

The thyroid gland produces hormones critical to the maintenance of the cellular metabolic rate. The actions of these hormones are far-reaching, affecting thermoregulation and calorigenesis; the metabolism of carbohydrates, fats, and proteins; and oxygen utilization. Thyroid hormones also appear to act synergistically with epinephrine and enhance tissue sensitivity to catecholamines. Signs and symptoms of hypothyroidism include listlessness, fatigue, cold intolerance, dry skin, hair loss, constipation, weight gain, muscle soreness, and slow heart rate. Signs and symptoms of hyperthyroidism include irritability, heat intolerance, tremors, increased sweating, frequent bowel movements, and quickened heart rate. The effect of inadequately treated or undiagnosed hyperthyroidism on the heart carries perioperative risks. To provide competent dental care to patients with thyroid dysfunction, clinicians must understand the disease, its treatment, and the impact the disease and its treatment may have on the patient's ability to undergo and respond to dental care.

Risk stratification and dental management of patients with adrenal dysfunction.

Intrinsic and extrinsic physiological stressors (physical, metabolic, or psychological) are constantly challenging the body's homeostatic mechanisms. Regardless of their nature, the body will initiate a series of autonomic responses in an effort to maintain homeostasis. For example, to cope with a perceived threat, cardiac output and respiration are increased, the availability of glucose is increased, and blood flow to the heart, brain, and muscles is increased. Conversely, once the threat subsides, conter-regulatory mechanisms act to down-regulate these responses. The adaptive stress response is essential for a patient's well-being. An altered adaptive stress response may lead to illness, and, at times, even to death. Oral healthcare providers must develop preventive and therapeutic strategies compatible with the functional capacity of a patient's adaptive stress response.

HIV: infection control issues for oral healthcare personnel.

AIM: To present the essential elements of an infection control/exposure control plan in the oral healthcare setting with emphasis on HIV infection. METHODS AND MATERIALS: A comprehensive review of the literature was conducted with special emphasis on HIV-related infection control issues in the oral healthcare setting. RESULTS: Currently available knowledge related to HIV-related infection control issues is supported by data derived from well-conducted trials or extensive, controlled observations, or, in the absence of such data, by best-informed, most authoritative opinion available. CONCLUSION: Essential elements of an effective HIV-related infection control plan include: (1) education and training related to the etiology and epidemiology of HIV infection and exposure prevention; (2) plans for the management of oral healthcare personnel potentially exposed to HIV and for the follow-up of oral healthcare personnel exposed to HIV; and (3) a policy for work restriction of HIV-positive oral healthcare personnel. CLINICAL SIGNIFICANCE: While exposure prevention remains the primary strategy for reducing occupational exposure to HIV, knowledge about potential risks and concise written procedures that promote a seamless response following occupational exposure can greatly reduce the emotional impact of an accidental needlestick injury.

Osteogenesis imperfecta.

Osteogenesis imperfecta is a relatively common hereditary connective tissue disorder characterized by bone fragility and fractures. Other frequently affected tissues include tendons, ligaments, skin, sclera, teeth, and middle and inner ear. Molecular studies have demonstrated that most cases result from mutations affecting the genes responsible for the formation of type 1 collagen. The phenotypic presentation varies from mild to lethal. Commonly observed dental abnormalities include dentinogenesis imperfecta and malocclusion. Medical therapies using bisphosphonates have resulted in reduced fracture risk and decreased bone pain. To date, no cases of bisphosphonate-associated osteonecrosis have been reported. With appropriate precautions, the patient with osteogenesis imperfecta can tolerate and benefit from the delivery of necessary dental care to control oral disease, improve function, and improve esthetics.

The patient with actinic cheilosis.

Recent research has greatly enhanced the understanding of the etiopathogenic pathways underlying squamous cell carcinoma (SCC) of the skin. The predominant etiologic agent is ultraviolet radiation. Excessive exposure to sunlight may lead to the development of sunburn, premature aging of the skin, cataracts, immune suppression, and skin cancer. Actinic keratoses represent an early clinical stage of a continuum that ultimately may progress to become SCC of the skin. Actinic cheiloses represent actinic keratoses that occur on the lip vermilion. While numerous therapeutic measures are available for managing actinic cheilosis, close follow-up, combined with strict measures to reduce future sun exposure, is mandatory. Oral health care providers are in a prime position to identify patients at risk for actinic cheiloses, educate patients on preventive measures to reduce and negate the damaging effects of sunlight, and (if necessary) manage early actinic cheiloses.