RESUMO
In response to the increasing incidence of certain oral and oropharyngeal cancers, the Society of Behavioral Medicine (SBM) calls on healthcare providers and legislators to expand awareness of oral and oropharyngeal cancer risk factors, increase early detection, and support policies that increase utilization of dental services. SBM supports the American Dental Association's 2017 guideline for evaluating potentially malignant oral cavity disorders and makes the following recommendations to healthcare providers and legislators. We encourage healthcare providers and healthcare systems to treat oral exams as a routine part of patient examination; communicate to patients about oral/oropharyngeal cancers and risk factors; encourage HPV vaccination for appropriate patients based on recommendations from the Advisory Committee on Immunization Practices; support avoidance of tobacco use and reduction of alcohol consumption; and follow the current recommendations for evaluating potentially malignant oral cavity lesions. Because greater evidence is needed to inform practice guidelines in the primary care setting, we call for more research in collaborative health and dental services. We encourage legislators to support policies that expand Medicaid to cover adult dental services, increase Medicaid reimbursement for dental services, and require dental care under any modification of, or replacement of, the Affordable Care Act.
Assuntos
Medicina do Comportamento/organização & administração , Detecção Precoce de Câncer/métodos , Neoplasias Bucais/diagnóstico , Neoplasias Orofaríngeas/diagnóstico , Adulto , American Dental Association/organização & administração , Conscientização , Atenção à Saúde , Unidade Hospitalar de Odontologia/métodos , Pessoal de Saúde , Humanos , Incidência , Medicaid/economia , Medicaid/legislação & jurisprudência , Neoplasias Bucais/epidemiologia , Neoplasias Bucais/prevenção & controle , Neoplasias Orofaríngeas/epidemiologia , Neoplasias Orofaríngeas/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Fatores de Risco , Sociedades , Estados Unidos/epidemiologiaRESUMO
Interprofessional education (IPE) is a relatively new part of dental education. Its implementation is mandated by accreditation standards, but it is also essential to good patient care. Diverse dental schools from various regions of North America outline problems they have faced in IPE and the solutions that they have found to surmount these problems. Commonalities and unique features of these problems and solutions are discussed.
Assuntos
Educação em Odontologia , Estudos Interdisciplinares , Faculdades de Odontologia , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente , Estados UnidosRESUMO
BACKGROUND: Tobacco use is the leading preventable cause of morbidity and premature mortality and is a significant factor in the development of oral disease. Tobacco dependence education (TDE) has not, however, been consistently integrated into predoctoral education. The authors conducted a study assessing the content and extent of TDE and intervention skills in US and Canadian dental schools. METHODS: In 2013, the authors contacted the academic deans of the 74 accredited US and Canadian dental schools to identify the educator who would be most appropriately described as the tobacco-use cessation "champion" at their institution. The authors e-mailed an introductory letter to each school's champion with a hyperlink to a 45-item survey; 2 follow-up emails were sent with links to the survey. RESULTS: The response rate was 66% (N = 49). TDE was taught at 92% of dental schools; 90% of respondents indicated that faculty members were confident to extremely confident in teaching tobacco-related pathology. Only 49% reported this level of confidence in teaching students how to help patients quit tobacco. TDE is taught in periodontics (82%), oral pathology (77%), clinic (66%), oral diagnosis (59%), public health dentistry (55%), pharmacology (55%), oral medicine (52%), and other disciplines (less than 50%). CONCLUSIONS: The survey responses revealed that TDE is not a curricular component in all US and Canadian dental schools. Faculty members were most confident in teaching tobacco-related pathology but may lack the interest and skills needed to integrate TDE as part of patient care. PRACTICE IMPLICATIONS: Patients who use tobacco in any form are at an increased risk of developing periodontitis, developing oral cancer, and having poorer surgical outcomes, emphasizing the need for the dental team to be well-prepared through predoctoral dental education.
Assuntos
Educação em Odontologia , Faculdades de Odontologia , Tabagismo , Canadá , Currículo , Humanos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Determining the potential for malignant transformation of oral lichen planus (OLP) is complicated by difficulties in diagnosis, differentiation from oral lichenoid lesions (OLLs) and the phenomenon of premalignant lesions' exhibiting lichenoid characteristics. The authors of this systematic review evaluated evidence regarding malignant transformation of OLP and characterized transformation prevalence, clinical characteristics of OLP lesions developing into squamous cell carcinoma (SCC) and time to transformation. TYPES OF STUDIES REVIEWED: The authors searched PubMed, Embase and Thomson Reuters Web of Science in a systematic approach. They evaluated observational English-language studies involving human participants published in peer-reviewed journals. Inclusion required patients to have the diagnosis of OLP or OLL as confirmed with biopsy results on initial enrollment. They excluded all patients who had dysplasia on initial biopsy of OLP or OLL lesions. RESULTS: Sixteen studies were eligible. Among 7,806 patients with OLP, 85 developed SCC. Among 125 patients with OLL, four developed SCC. The rate of transformation in individual studies ranged from 0 to 3.5 percent. The overall rate of transformation was 1.09 percent for OLP; in the solitary study in which investigators evaluated OLL, the rate of transformation was 3.2 percent. Patients' average age at onset of SCC was 60.8 years. The authors noted a slight predominance of female patients among those who experienced malignant transformation. The most common subsite of malignant transformation was the tongue. The average time from diagnosis of OLP or OLL to transformation was 51.4 months. PRACTICAL IMPLICATIONS: A small subset of patients with a diagnosis of OLP eventually developed SCC. The most common demographic characteristics of patients in this subset were similar to the most common demographic characteristics associated with OLP in general (that is, being female, being older and being affected in areas common to this condition). It is prudent for clinicians to pursue continued regular observation and follow-up in patients with these conditions, even in patients who do not fit a traditional high-risk category for oral SCC.
Assuntos
Transformação Celular Neoplásica/patologia , Líquen Plano Bucal/patologia , Erupções Liquenoides/patologia , Neoplasias Bucais/patologia , Humanos , Boca/patologia , Fatores de RiscoRESUMO
PURPOSE: To compare prevalence of systemic health conditions (SHC) between African American and Caucasian edentulous patients presenting for complete dentures (CD) at an urban dental school. METHODS: The study included patients presenting for CD 1/1-12/31/2010, ages 20 to 64 years, and either African American or Caucasian. Covariates included: age group, gender, employment status, Medicaid status, smoking history, and alcohol consumption. SHC included at least one of the following: arthritis, asthma, cancer, diabetes, emphysema, heart attack, heart murmur, heart surgery, hypertension, or stroke. RESULTS: The group (n = 88) was 44.3% African American, 65.9% ≥50, 45.5% male, 22.7% employed, and 67.0% with at least one SHC. African Americans were older (p = 0.001) and more likely to have one or more SHC (p = 0.011). Patients with at least one SHC were older (p = 0.018) and more likely female (p = 0.012). The total sample logistic regression model assessing SHC yielded only gender as statistically significant (males < OR 0.32, 95% CI 0.11 to 0.92). Caucasian males were less likely to have SHC (OR 0.17, 95% CI 0.04 to 0.77), and Caucasians ≥50 were more likely (OR 5.36, 95% CI 1.19 to 24.08). African Americans yielded no significant associations. CONCLUSIONS: Among selected completely edentulous denture patients at an urban dental school, two out of three patients had at least one SHC. This exploratory study suggests there may be health status differences between African American and Caucasian patients in this setting, calling for further study.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Prótese Total/estatística & dados numéricos , Nível de Saúde , População Branca/estatística & dados numéricos , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Artrite/epidemiologia , Asma/epidemiologia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Estudos Transversais , Diabetes Mellitus/epidemiologia , Enfisema/epidemiologia , Emprego/estatística & dados numéricos , Feminino , Sopros Cardíacos/epidemiologia , Humanos , Hipertensão/epidemiologia , Masculino , Medicaid , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Neoplasias/epidemiologia , Prevalência , Estudos Retrospectivos , Fumar/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Polymorphonuclear neutrophils (PMNs) produce and release copious amounts of reactive oxygen species (ROS) which target potential bacterial invaders but also contribute to the inflammation-associated organ injuries seen in sepsis. Calprotectin is an immune regulatory protein complex made of S100A8 and S100A9 that inhibits the oxidative metabolism of PMNs in vitro, an effect that can be potentiated by the controlled activation of the protease activated receptor-2 (PAR2). The aim of this study was to test the use of a dual strategy of calprotectin and PAR2 administration to mitigate the deleterious inflammation seen in sepsis. We hypothesized that exogenous calprotectin would protect against the injuries produced by lipopolysaccharides (LPS)-induced endotoxemia and that the controlled activation of PAR2 would potentiate this beneficial effect. Exogenous S100A8 and/or a PAR2 activating peptide (PAR2 AP) were administered in a mouse model of LPS induced endotoxemia. The survival rates as well as markers of inflammation and oxidative damage were measured in the lungs, kidneys, and livers of endotoxemic mice. Mice treated with S100A8 following LPS had less PMN infiltration and less severe histological changes in their lungs, kidneys, and livers. A significantly lower score of oxidative damage in the livers and lungs of S100A8/LPS treated mice was also noted when compared to mice treated with LPS alone. This protective and anti-inflammatory effect of S100A8 was potentiated by the controlled activation of PAR2. Finally, in further support to our hypothesis, the survival rate was almost doubled from 33% to 65% and 63% in mice treated by, respectively, S100A8 and PAR2 AP, whereas 85% of the mice treated with both PAR2 AP and S100A8 survived, a statistically significant higher rate. These results support an anti-inflammatory, anti-oxidative, and protective effect of S100A8 in sepsis, and warrant further studies on the role of PAR2.
Assuntos
Anti-Inflamatórios/farmacologia , Calgranulina A/administração & dosagem , Endotoxemia/tratamento farmacológico , Neutrófilos/efeitos dos fármacos , Oligopeptídeos/farmacologia , Sepse/tratamento farmacológico , Animais , Endotoxemia/induzido quimicamente , Endotoxemia/imunologia , Endotoxemia/mortalidade , Feminino , Rim/efeitos dos fármacos , Rim/imunologia , Rim/metabolismo , Lipopolissacarídeos , Fígado/efeitos dos fármacos , Fígado/imunologia , Fígado/metabolismo , Pulmão/efeitos dos fármacos , Pulmão/imunologia , Pulmão/metabolismo , Camundongos , Neutrófilos/imunologia , Neutrófilos/metabolismo , Oxirredução , Sepse/induzido quimicamente , Sepse/imunologia , Sepse/mortalidade , Taxa de SobrevidaRESUMO
BACKGROUND: Prenuptial tooth extractions, extractions of all teeth in at least one dental arch before marriage, are not identified in the dental literature. Driven by a professional encounter, the purpose of this study was to confirm the existence of this practice among Acadian women. METHODS: An 8-item survey instrument with space for comments was mailed to 182 dentists from traditionally Acadian regions of Canada. The survey was provided in English and French. RESULTS: Ninety dentists responded (50.3%); 8 of them (9%) had been asked to perform prenuptial extractions, and an additional 9 volunteered awareness of this practice. Awareness and requests were associated with dental practice in a county with a ≥20% French-speaking population. CONCLUSIONS: Prenuptial extractions in this population have been confirmed by the current cohort of dentists. The potential public health, clinical, and systemic health research implications for women who are edentulous for most of their adult life merit further study. Additionally, it is important to determine if interventions are needed to curtail cultural expectations of such practices.
Assuntos
Comportamento Ritualístico , Características Culturais , Casamento/etnologia , Padrões de Prática Odontológica/estatística & dados numéricos , Extração Dentária/estatística & dados numéricos , Saúde da Mulher/etnologia , Adulto , Atitude do Pessoal de Saúde , Canadá , Pesquisa em Odontologia , Odontólogos/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Percepção Social , Adulto JovemRESUMO
RNA expression analysis of oral keratinocytes can be used to detect early oral cancer, but a limitation is the inability to obtain high quality RNA from oral tissue without using biopsies. While oral cytology cell samples can be obtained from patients in a minimally invasive manner, they have not been validated for quantitative analysis of RNA expression. Earlier we showed RNA from brush cytology of hamster Oral Squamous Cell Carcinoma (OSCC) demonstrated differential expression of B2M and CYP1B1 using real time RT-PCR in a dibenz[a,I]pyrene, tobacco carcinogen, induced model of this disease. Here we show reproducibility of this approach to measuring gene expression in humans. Cytology brush samples from 12 tobacco and betel related OSCC and 17 nonmalignant oral lesions revealed B2M mRNA was enriched in tumor samples while CYP1B1 mRNA was reduced, similar to what was seen in the model system. Additionally, we showed that KRT17 mRNA, a gene linked to OSCC in another brush cytology study, was also enriched in OSCC versus nonmalignant lesions, again supporting the promise of using RNA from brush oral cytology to reproducibly monitor oral gene expression.
Assuntos
Hidrocarboneto de Aril Hidroxilases/metabolismo , Carcinoma de Células Escamosas/metabolismo , Queratina-17/metabolismo , Neoplasias Bucais/metabolismo , Fumar/efeitos adversos , Microglobulina beta-2/metabolismo , Adulto , Idoso , Animais , Hidrocarboneto de Aril Hidroxilases/genética , Carcinoma de Células Escamosas/patologia , Cricetinae , Citocromo P-450 CYP1B1 , Feminino , Humanos , Queratina-17/genética , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , RNA Mensageiro/metabolismo , RNA Neoplásico/metabolismo , Reprodutibilidade dos Testes , Adulto Jovem , Microglobulina beta-2/genéticaRESUMO
BACKGROUND: Different compositions of smokeless tobacco (ST) are widely thought to cause oral carcinoma at different rates but there is little direct evidence for this hypothesis. METHODS: We used a rat lip canal model to examine the mucosal changes induced by chronic daily exposure to four different brands of ST: Skoal, Copenhagen, Ettan Swedish Snus, and Stonewall, differing in measured levels of: tobacco specific nitrosamines (TSNAs), unprotonated nicotine, moisture, and pH. RESULTS: Exposure to the lip canal for 12 months produced changes in the mucosa marked by increases in S phase and M phase cells for the Skoal and Copenhagen exposed rats. This correlated with the high level of TSNAs and nicotine in these products. All the tobacco products, to different degrees, induced sites of moderate to severe dysplasia some with extensive rete peg outgrowth from the oral mucosa not seen in the controls. Many of these sites showed a loss of p16 expression. CONCLUSIONS: While all ST products caused dysplasia, the products with lower levels of TSNAs and unprotonated nicotine caused less, consistent with the model that tobacco with low levels of nitrosamines might potentially induce fewer carcinomas in human users.
Assuntos
Lábio/efeitos dos fármacos , Mucosa Bucal/efeitos dos fármacos , Tabaco sem Fumaça/efeitos adversos , Tabaco sem Fumaça/química , Animais , Proliferação de Células , Concentração de Íons de Hidrogênio , Técnicas Imunoenzimáticas , Proteínas de Neoplasias/análise , Nicotina/análise , Nitrosaminas/análise , Antígeno Nuclear de Célula em Proliferação/análise , Ratos , Ratos Sprague-DawleyRESUMO
Synovial chondromatosis is a rare, benign condition that usually affects the larger diarthroidal joints of the axial skeleton. Approximately 120 cases of synovial chondromatosis involving the temporomandibular joint (TMJ) have been reported. People with this condition may present with swelling, pain, intracapsular sounds and limitation of mandibular movement. Because it is important to differentiate synovial chondromatosis from other joint pathologies, a thorough history and appreciation of clinical features of these conditions are necessary. Radiographs are an important component of the diagnostic armamentarium for discerning conditions that mimic synovial chondromatosis. A case of synovial chondromatosis diagnosed radiographically with the aid of volumetric computed tomography is described, followed by a discussion of potential causative factors and management strategies. A brief review of the differential diagnosis of synovial chondromatosis involving the TMJ is also provided.
Assuntos
Condromatose Sinovial/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Humanos , Masculino , Côndilo Mandibular/diagnóstico por imagem , Radiografia Panorâmica , Amplitude de Movimento Articular/fisiologiaRESUMO
Teratomas, most often diagnosed in younger patients, represent the most frequently identified subtype of pediatric germ cell tumors. It is very uncommon for teratomas to present in the head and neck region and demonstrate malignant transformation. We present a case of squamous cell carcinoma arising in an alpha-fetoprotein-producing cystic teratoma of the mandible in a 2-year-old female that is, to the best of our knowledge, the first such published report. The patient was treated with surgical excision along with chemotherapy and has remained disease-free 2 years after the conclusion of therapy.
Assuntos
Carcinoma de Células Escamosas/etiologia , Neoplasias Mandibulares , Teratoma/patologia , alfa-Fetoproteínas , Carcinoma de Células Escamosas/terapia , Transformação Celular Neoplásica , Pré-Escolar , Intervalo Livre de Doença , Feminino , HumanosRESUMO
BACKGROUND: The etiology of idiopathic cervical root resorption has not been elucidated clearly. However, the process has been linked to trauma, intracanal bleaching, and partial-thickness connective tissue grafts. METHODS: This study describes a familial pattern of multiple idiopathic cervical root resorption in a father and son. RESULTS: The father was a healthy 63-year-old white male who presented with the first resorption lesion in 1983. Twenty-seven additional lesions were identified on 16 teeth over 22 years. Five teeth were lost as a result of extensive resorption. The son was a healthy 43-year-old when a resorption lesion was identified in 1993. A lesion identified on another tooth 12 years later resulted in extraction. CONCLUSIONS: Close relatives of those affected by multiple idiopathic cervical root resorption should be examined carefully for cervical resorption. This study also showed that early treatment can prevent or delay the need for extraction.
Assuntos
Reabsorção da Raiz/genética , Adulto , Saúde da Família , Humanos , Masculino , Pessoa de Meia-Idade , Colo do Dente/patologiaRESUMO
Recent research has yielded conflicting data regarding the relationship between dental disease, particularly periodontitis, and cardiovascular disease. A causative relationship would have major ramifications for health care. There is a plausible theoretical basis for such a link, as increased levels of inflammatory mediators may increase the risk of atherosclerotic plaque formation. Nevertheless, a clinical confirmation of a causative relationship has been difficult, in part because cardiovascular disease and periodontal disease share common risk factors such as increasing age and tobacco use, and because cardiovascular medications may increase the risk of periodontitis. Patients should be encouraged to control documented risk factors for cardiovascular disease and to maintain oral health for its well-known health benefits.