The barriers dentists face to communicate cancer diagnosis: self-assessment based on SPIKES protocol.

BACKGROUND: This study aimed to characterize the barriers faced by Brazilian dentists to deliver bad news (DBN) about oral and oropharyngeal cancer diagnoses to patients by using a questionnaire based on the guidelines of the SPIKES protocol. MATERIAL AND METHODS: This was an observational cross-sectional study. The questionnaire contained 27 questions based on the SPIKES protocol, which were answered in the SurveyMonkey platform. RESULTS: A total of 186/249 dentists answered the questionnaire. The main specialties reported were 36.02% oral medicine, 21.5% oral pathology, and 9.13% oral and maxillofacial surgery. A total of 44.6% expressed concern about the patient's emotional reactions, and 46.24% of respondents had never participated in any specific training to communicate bad news. CONCLUSIONS: The lack of training and low confidence in dealing with patients' emotional reactions dentists were considered the greatest barriers to DBNs. Moreover, most dentists who participated in the survey believe that a protocol to guide the communication of bad news would be useful for clinical practice. For those protocols to be used by dentists, training is critical for these protocols to be incorporated by professionals.

Panoramic and skull imaging may aid in the identification of multiple myeloma lesions.

BACKGROUND: The purpose of this study was to investigate the presence of punched-out lesions in craniofacial bones using three different radiographic protocols in a large cohort of patients. MATERIAL AND METHODS: One hundred fifty-five MM patients were evaluated using panoramic and skull (frontal and lateral) radiographs, which were performed in all patients at the time of MM diagnosis. The diagnostic potential for detecting punched-out lesions was compared among the radiographic techniques. RESULTS: MM punched-out lesions were identified in 135 (87%) panoramic radiographs, 141 (91%) frontal and 144 (93%) lateral skull radiographs. Punched out-lesions were synchronously present in skull and jawbones in 129 (83.23 %) cases. The lesions were detected exclusively in skull in 18 (11.61%) cases and exclusively in jawbones in 6 (3.87%) cases. Punched out-lesion mainly affected the skull and the jawbones in a synchronous way (p<0.001) rather than separately. CONCLUSIONS: All investigated radiographic techniques (panoramic, frontal and lateral skull approaches) demonstrated high detection rates for MM punched-out lesions in craniofacial bones. Panoramic radiography may aid to the radiographic protocols to identify multiple myeloma bone lesions.

The interface between oral and systemic health: the need for more collaboration.

The focus of this review is to highlight the need for improved communication between medical and dental professionals in order to deliver more effective care to patients. The need for communication is increasingly required to capitalise on recent advances in the biological sciences and in medicine for the management of patients with chronic diseases. Improvements in longevity have resulted in populations with increasing special oral-care needs, including those who have cancer of the head and neck, those who are immunocompromised due to HIV/AIDS, advanced age, residence in long-term care facilities or the presence of life-long conditions, and those who are receiving long-term prescription medications for chronic conditions (e.g., anti-hypertensives, anticoagulants, immunosuppressants, antidepressants). These medications can cause adverse reactions in the oral cavity, such as xerostomia and ulceration. Patients with xerostomia are at increased risk of tooth decay, periodontal disease and infection. The ideal management of such individuals should involve the collaborative efforts of physicians, nurses, dentists and dental hygienists, thus optimising treatment and minimising secondary complications deriving from the oral cavity.

Oral lesions and HIV. An approach to the diagnosis of oral mucosal lesions for the dentist in private practice.

The diagnosis and treatment of oral mucosal lesions in HIV infected individuals is of importance. Oral lesions are reliable indicators of HIV infection and immunosuppression. They are important for staging HIV disease, they have been used as clinical markers in trials to test drug efficacy, and to determine the correct time for institution of treatment for HIV or prophylaxis against opportunistic infections. For the patients, they can cause pain, loss of taste and severe discomfort, leading to decreased quality of life. In more severe cases, they can disseminate and become life-threatening. Several types of lesions may affect the oral mucosa of HIV infected individuals. Although caused by different etiological agents, these lesions may have similar clinical appearance. They may also look like other oral mucosal lesions not commonly associated with HIV infection. Their correct diagnosis is important so adequate treatment can be prescribed. This article provides information to the dentist in private practice on how to elaborate a differential diagnosis and arrive to a final diagnosis of oral mucosal lesions in HIV infected individuals.

Thalidomide treatment of mucosal ulcerations in HIV infection.

Pain relief and resolution of oral and perianal ulceration after treatment with thalidomide in a 14 year old girl with vertically acquired HIV infection is reported.

Oral histoplasmosis in HIV-infected patients. A report of two cases.

Histoplasmosis is a fungal infection caused by the organism Histoplasma capsulatum. Disseminated disease usually occurs in immunosuppressed patients or in patients with chronic illnesses. Although relatively uncommon, histoplasmosis has been reported in patients with AIDS, and oral lesions have been noted on multiple sites and in various clinical presentations. We present two HIV-positive cases with oral lesions as the initial signs of histoplasmosis. Both patients responded well to IV amphotericin B but later suffered recurrences despite being maintained on systemic antifungal therapy.

Percutaneous and mucous membrane exposure protocol in a southeastern dental school.

A southeastern dental educational institution formalized a Percutaneous and Mucous Membrane Exposure Protocol in 1990. This article outlines the development, implementation, and administration of the protocol including risk assessment and rationale for testing health care workers and source persons. Pretest and posttest counseling for HIV testing is also discussed.

HIV disease: medical and dental aspects and trends for the future. A literature review.

The pandemic dimension of HIV disease is a reality. The cases of acquired immunodeficiency syndrome (Aids) and of new infections with HIV continue to increase. Available antiretroviral therapy cannot halt the progress of the disease. However, because of early diagnosis and treatment, life expectancy has increased. Oral diseases in these patients have the potential to cause severe pain, discomfort, alter form and function and disseminate systemically. Comprehensive dental management may be complicated by complex medical problems. Nevertheless, as the epidemic grows, a higher number of infected individuals will need dental care. A comprehensive dental management concept of the HIV-seropositive individual still needs scientific investigation. There are several unresolved psychosocial issues concerning the willingness of dentists to treat HIV-infected patients. The possible transmission of the virus from a dentist to his patients in a dental office in Florida generated public and professional hysteria. Lack of knowledge about the disease contributed to this situation. This literature review presents the state-of-the-art information available on medical and dental aspects of HIV disease and trends for the future in dental research, education and patient care.

The Cytobrush Plus cell collector in oral cytology.

The Cytobrush Plus cell collector (cytobrush) was compared with the wooden tongue depressor during oral exfoliative cytology. The degree of patient discomfort, the convenience to the clinician, and the quantity and distribution of epithelial cells collected were evaluated. Two-factor analysis of variance and parametric and nonparametric analyses were performed. Because of the favorable findings revealed in this study, we recommend that the cytobrush be considered for use when obtaining diagnostic cytologic smears from the oral mucosa.

Use of exfoliative cytology in the diagnosis of oral hairy leukoplakia.

The possibility of diagnosing oral hairy leukoplakia by means of exfoliative cytology and the Papanicolaou stain was investigated. Exfoliative cytology and punch biopsy specimens were obtained from 10 lesions that demonstrated clinical features of hairy leukoplakia. All biopsy specimens demonstrated the characteristic histopathologic features of hairy leukoplakia whereas all Papanicolaou-stained cytologic smears demonstrated condensation and margination of the nuclear chromatin (nuclear beading). All biopsy specimens and cytologic smears displayed positive Epstein-Barr virus deoxyribonucleic acid in situ hybridization. We conclude that routine exfoliative cytology may be a reliable, noninvasive, and inexpensive technique for the diagnosis of hairy leukoplakia.

Reactivity of monoclonal antibodies 17.13 and 63.12 with 141 oral mucosal lesions.

We studied the reactivity of monoclonal antibodies (MAbs) 17.13 and 63.12 with normal and diseased human oral mucosa by means of the immunoperoxidase technique. The specimens included: 22 normal oral tissues, 20 benign tumors, 17 lichen planus, 23 focal keratosis and epithelial hyperplasias, 18 proliferative verrucous leukoplakias, 20 dysplasias, and 21 squamous cell carcinomas. In most cases of normal mucosa and benign lesions, MAb 17.13 stained basal epithelial cells only, whereas MAb 63.12 stained all cell layers above the basal cells. In the premalignant and malignant lesions MAb 17.13 stained above the basal cells and MAb 63.12 either stained areas not stained by MAb 17.13 or the staining was absent. Based on the different staining patterns observed, there appears to be a potential value of these new reagents in diagnostic histopathology regarding specimens with equivocal cellular morphology.

The simultaneous occurrence of oral herpes simplex virus, cytomegalovirus, and histoplasmosis in an HIV-infected patient.

Numerous publications have reviewed the oral manifestations of HIV infection and AIDS. Although uncommon, herpetic infections and histoplasmosis are among the diseases reported. The case that follows presents the first description of the simultaneous occurrence of oral herpes simplex virus, cytomegalovirus, and histoplasmosis in an HIV-infected person. These infections appeared as extensive oral ulcerations and were the only clinical manifestation of HIV infection. Eleven months after the initial presentation, the patient died of complications of AIDS.

Use of monoclonal antibody 17.13 in the diagnosis of human oral squamous cell carcinoma.

We assessed the ability of monoclonal antibody (MAb) 17.13 to react with human oral squamous cell carcinoma (OSCC) and other oral tissues. MAb 17.13 was reacted with acetone-fixed, serial frozen sections of 21 OSCC, 7 fibromas, 2 squamous papillomas, 1 melanosis and 3 normal oral mucosa, by means of an avidin-biotin-immunoperoxidase assay. Twenty-one of 21 tumors (100% sensitivity) reacted strongly with MAb 17.13, with a homogeneous staining pattern. Individual tumor cells could be clearly seen, improving the detection of microinvasion or borderline lesions. The epithelium of benign lesions and normal oral mucosa showed staining of the basal cells only. We conclude MAb 17.13 could be used as an accurate diagnostic tool for OSCC.

Findings in 50 AIDS virus-infected patients with positive oral Candida cultures.

Oral candidiasis is a common complication of HIV-infected-individuals. The purpose of this study was to evaluate clinical and laboratory findings to assess the impact and efficacy of antifungal treatment. This preliminary report describes findings in 50 HIV-positive, candida culture-positive subjects (49 males, 1 female; mean age: 39 years). The group had been known HIV-positive for a mean of 28 months, and 19 met the CDC/WHO definition for AIDS (63%, KS, 21% PCP). Thirty-four of the fifty patients had oral signs of candidiasis, with almost half having both atrophic (red) and pseudomembranous (white) components. In quantitating the cultures, the higher colony forming unit counts in general were correlated with clinical signs and pain. The other most common oral manifestations were periodontal disease, hairy leukoplakia and xerostomia. The most common candida species was albicans (84%). Response to initial antifungal therapy was satisfactory clinically, but erratic regarding CFU quantitation, species changes, and bacterial emergence. In summary, oral candidiasis is a complex infection with uncertainties as to the significance of quantitation and achieving control.

Kaposi's sarcoma of the oral cavity: a study of 134 patients with a review of the pathogenesis, epidemiology, clinical aspects, and treatment.

Since our first description and profile of patients with Kaposi's sarcoma (KS) in 1984, the relative rate of KS in patients with the acquired immunodeficiency syndrome has dropped from 34% to 20%. However, the absolute number is increasing. The pathogenesis of KS is still obscure, and its interaction with the human immunodeficiency virus infection remains unclear. Cause of death is usually opportunistic infections in both endemic and epidemic KS. The most common intraoral site is the palate, which is involved in 95% of our cases. The oral cavity may be the only or first site of KS, and therefore, becomes important in the diagnosis. More than 20% of our current patient population had the oral cavity as the initial site of manifestation. Because of functional impairment, bleeding, pain, or cosmetic reasons, treatment is frequently required. There are many modalities used, including chemotherapy, radiation, and laser resection. Radiation appears to be a most effective and practical control measure for oral KS.

Phenotypic identification of mononuclear cells in oral premalignant lesions and cancer by monoclonal antibodies.

To explore the nature and importance of mononuclear cells of different phenotypes in oral premalignant lesions and oral cancer, we studied biopsy specimens from 21 oral red and/or white lesions (6 hyperkeratosis, 3 mild dysplasia, 4 severe dysplasia and 8 squamous cell carcinoma), using monoclonal antibodies and avidin-biotin-peroxidase complex staining. Peripheral blood samples (PB) from 4 normal subjects and 5 reactive lymph nodes (LN) were used as controls for the technique. T11-positive cells were the predominant phenotype (74-78%) in all cases examined. The T4/T8 ratio in severe dysplasia was significantly lower than that in mild dysplasia (p less than or equal to 0.05). These observations support the hypothesis of a role for cellular immune responses in oral premalignant lesions and oral cancer. The predominance of T cells may represent the local expression of immunity against antigens (viral or other). The decreased T4/T8 ratio observed in severe dysplasia may represent a transitory stage of local immunosuppression, which may be of critical importance for the progression into carcinoma. Phenotypic variations in mononuclear cell infiltrates in these conditions could be diagnostic value.