Amelogenesis imperfecta: a diagnostic and pathological review with case illustration.

Amelogenesis mperfecta is an inherited disorder of enamel development, which results n morphological defects of both the primary and secondary dentition, usually in the absence of systemic involvement. Mutational defects involving the genes that encode for enamel matrix proteins and proteinases are mplicated in this disorder. The phenotypic expression is variable, spanning a spectrum from barely discernible changes to severe aesthetic and functional enamel defects. The specific type and location of the genetic mutation, as well as the mode of inheritance, determine the clinical presentation Clinical recognition and early therapeutic intervention are required for the most successful outcome. An essentia component of the treatment process includes patient counselling and education. Patient management requires a dedicated multi-disciplinary approach. The disorder is reviewed here with emphasis on the clinical significance for the oral healthcare worker. In addition, a case is presented in order to provide an example of treatment panning and dental management.

Clinical features of oral cancer.

Oral cancer (OC) is a major cause of global morbidity and mortality Squamous cell carcinoma accounts for more than 90% of oral malignancies and occurs most frequently in middle-aged to elderly patients who smoke and drink heavily. The overall outlook for patients diagnosed with oral squamous cell carcinoma (OSCC) remains poor, largely due to late clinical presentation. Early lesions are frequently undetected due to the lack of accompanying symptoms. Early recognition, diagnosis and treatment of OSCC significantly enhance patient survival and minimise the need for extensive surgery. It is thus essential that the oral health care worker (OHW) be familiar with the variable clinical manifestations of both potentially malignant disorders (PMD) as well as invasive malignancy. OC screening, particularly in high-risk patients should be an integral component of routine intra-oral clinical examination. The aim of this article is to highlight the varied clinical appearance of OC and to emphasise the importance of early recognition and diagnosis.

Oropharyngeal carcinoma: what the dentist should know.

HPV-related oropharyngeal carcinoma (OPC) is a clinically and molecularly distinct form of squamous cell carcinoma (SCC) which has recently shown a dramatc increase in global incidence. The aetiology, clinical presentation and overall prognosis differ from conventional tobacco and alcohol related SCC of the oral cavity. OPC is seen in a subset of younger predominantly male patients. Acquisition of high-risk HPV subtypes is related to oral sex practices with multiple partners. OPC originates deep within tonsillar crypts which hinders early clinical detection. Patients present with advanced disease and frequent cervical lymph node metastases. Despite its aggressive nature, the overall prognosis remains excellent compared wth conventional oral SCC. The increased incidence of OPC is of clinical significance to the general dentist and should always be considered in the clinical differential diagnosis in a young, otherwise healthy, patient with persistent cervical lymph node enlargement. Older patients with a history of tobacco usage and alcohol consumption may also present with conventional SCC of the oropharynx. Potentially malignant disease may precede tumour development at this site in such cases. Clinical examination of the oropharynx should therefore be performed as part of routine dental consultation.

HIV/AIDS associated malignancies of the head and neck.

Patients with HIV/AIDS are at increased risk for the development of malignancy. Kaposi's sarcoma, non-Hodgkin's lymphoma and cervical carcinoma in women are regarded as AIDS-defining malignancies. The spectrum of malignancy is, however, changing, particularly where patients receive highly active antiretroviral therapy (HAART). South Africa has the highest number of HIV-infected individuals globally. The possibility of the oral health care worker encountering HIV/AIDS-related pathology therefore seems inevitable. The aim of this article is to heighten the awareness of head and neck malignancies occurring in HIV/AIDS whilst highlighting some of the clinical features in order to facilitate early recognition and diagnosis. It is of clinical significance that in many instances, identification of these malignancies precedes HIV/AIDS diagnosis. Optimal patient management requires close co-operation between the oral health care practitioner and the extended health care team.