Influence of years of professional experience in relation to the diagnostic skill of general dental practitioners (GDPs) in identifying oral cancer and precancerous lesions.

OBJECTIVE: To evaluate skill in diagnosing cancer and oral precancerous lesions among general dentists in the Autonomous Community of Murcia (Spain). MATERIAL AND METHOD: Twenty randomly distributed clinical images were used, of which 45% corresponded to benign lesions, 35% to oral precancerous lesions, and 20% to oral cancer. Each case was accompanied by a summarised clinical history. The study sample comprised 150 general dentists divided into two groups: group I (60 recently graduated dentists without professional experience) and group II (90 dentists with established professional activity). RESULTS: In group I, the sensitivity of oral cancer diagnosis was 61.3% versus 85.5% in group II (p < 0.001), while the sensitivity of precancerous lesion diagnosis was 71.7% in group I versus 80.7% in group II (p = 0.004). CONCLUSIONS: The results obtained show that junior dentists and general dentists with public or private practice need more training and more experience in diagnosing cancer and oral precancerous lesions.

"Scheduling delay" in oral cancer diagnosis: a new protagonist.

Diagnostic delays in oral cancer have been classified as "patient delay" and "delay by the clinicians". However, the influence of the accessibility (scheduling delay) to the health care system in oral cancer diagnosis has not been studied before. To assess scheduling delay, a descriptive, cross-sectional study was designed. This study was based upon role-play telephone conversations with two standardised patients (lingual ulceration-SP1 and patient seeking fixed prosthodontics-SP2). that followed a structured script. The variables considered in the study were days to go until the arranged appointment, professional degree of the contacted person and referral to other provider of care. The scheduling delay for SP1 reached a median value of 1 day, and for SP2 was 6 days. When the professional degree (receptionist vs GDP) of the person arranging the appointment for the patient with lingual ulceration was considered, the scheduling delay was significantly shorter when the appointment was fixed by the GDP (X approximately i-X approximately j=4.5; 95%CI=-7.48,-1.51). GDPs gave priority to the patients with lingual ulcerations over those demanding fixed bridgework (X approximately i-X approximately j=6.48; 95%CI=-9.46,-3.50). The GDPs showed a high level of awareness of the oral cancer, however, educational interventions seem to be necessary for dental surgery receptionists.

Dark oral lesions: differential diagnosis with oral melanoma.

Oral melanoma is a neoplasm with a poor prognosis; its premature diagnosis is of foremost importance. We review here pathologic situations to be considered in the clinical differential diagnosis: tattoos, melanotic macules, Laugier's disease, melanocytic nevus, drug intake, some vascular lesions, and oral pigmented lesions associated with endocrine disorders or with different syndromes.

Oral mucosa: variations from normalcy, part I.

Many lesions can be identified in the oral mucosa. Some are indicative of pathologic conditions restricted to the oral cavity, whereas others are signs of systemic disorders. A third group of alterations is not severe enough to be considered pathologic; however, knowledge of this group is mandatory for a correct differential diagnosis to be established. This is the first article in a 2-part series concerning all of these pseudopathologic conditions.

[Dental caries in 2 families with tuberous sclerosis]. / Puits dentaires dans deux familles avec sclérose tubéreuse.

Four cases of tuberous sclerosis in two families are presented. We studied the oral manifestations of the disease and we suggest that dental pits should be taken as clinical markers for diagnosis in oligosymptomatic cases. We found that feature in all patients affected by tuberous sclerosis.

[Guidelines for antibiotic prophylaxis of bacterial endocarditis in patients undergoing dental therapy]. / Pautas de profilaxis antibiótica de la endocarditis bacteriana en pacientes sometidos a tratamiento odontológico.

The objective of the present work was to know the guidelines of antibiotic prophylaxis in bacterial endocarditis used in different spanish health centers. A general dental practitioner asked orally in 50 Cardiology and/or Internal Medicine departments throughout Spain which prophylaxis should be administered to a patient with a mitral valve prosthesis before a dental extraction. The results obtained showed that only 36 (72%) departments used the latest prophylactic guidelines recommended by the American Heart Association or the British Society for Antimicrobial Chemotherapy. Among penicillin allergic patients the antibiotic of choice was erythromycin (60%) followed by clindamycin (28%), although administered at very different dosages (11 and 3, respectively). Only in 44% of the surveyed departments did the guidelines for allergic and non allergic patients correspond to the recommended protocol by the same study group. The controversy generated regarding the prophylactic indications for bacterial endocarditis might partially account for the results obtained in this study.

[Oral herpes virus infection in immunodepressed patients: presentation of 2 cases. Review of the literature]. / Infección oral por herpes virus en pacientes inmunodeprimidos: presentación de 2 casos. Revisión de la literatura.

Two cases of herpetic intraoral infection, in inmunodepressed patients, are presented. We emphasize its diagnosis and therapeutical aspects. A bibliographic review is done.

[Toxic epidermal necrolysis associated with lymphoproliferative syndromes. Anatomo-clinical study. Presentation of 2 cases]. / Nécrolyse épidermique toxique associée à des syndromes lymphoprolifératifs. Etude anatomo-clinique. Présentation de deux cas.

Two cases of Toxic Epidermal Necrolysis, with a previous history of drugs intake, and associated to a lymphoma and to a chronic lymphoid leukemia, are presented. The oral lesions are described and the clinical and pathological particularities of the cases are commented. The rule of the drugs and of the neoplastic diseases in the aetiology of these cases is discussed. In conclusion, we emphasize the N.E.T. as an entity of stomatological interest.

[Detection of human papillomavirus antigens in papillomatous lesions of the palate]. / Detección de antigenos de Papilomavirus humano (HPV) en lesiones papilomatosas del paladar.

The presence of human papillomavirus antigen was studied in palate papillomas and in verruca vulgaris located in the palate using the Peroxidase-Antiperoxidase immunohistochemical methods. The antigens were detected only in the nuclei of cells of the stratum granulosum and stratum corneum in some cases of verruca vulgaris but not in any case of palate papillomas.

[Laugier-Hunziker syndrome. A clinical and anatomopathologic study. Presentation of 13 cases]. / Syndrome de Laugier-Hunziker. Etude clinique et anatomopathologique. Présentation de treize cas.

We report the clinico-pathologic characteristics of 13 cases of Laugier-Hunziker disease, consisting of the presence of oral melanotic macules associated or not to longitudinal nail pigmentation. The presence of regular acanthosis, basal pigmentation without increase in the number of melanocytes and the presence of melanophages in subepidermal connective tissue have been the most constant histopathological characteristics. The term "essential cutaneo-mucous hyperpigmentation" as synonym of Laugier-Hunziker disease is proposed.

[Lichen planus of the oral mucosa in the clinical course of chronic active hepatitis. Presentation of two cases]. / Liquen plano de la mucosa oral en el curso clínico de hepatitis crónica activa. Presentación de dos casos.

Two cases of oral lichen planus associated with chronic active hepatitis are presented. One of them it was also associated with achrosclerosis. A review of the literature is done, and it is suggested the possibility that oral lichen planus play a role of diagnostic importance in hepatic pathology.

[Oral manifestations in tuberous sclerosis. Report of 3 cases]. / Manifestaciones orales en esclerosis tuberosa. Presentación de tres casos.

We present three cases of Tuberous Sclerosis, studying its oral manifestations and suggesting that dental pits are clinical markers of diagnostic interest in the paucisymptomatic forms of the syndrome.

[Radioprotective effect of ascorbic acid on oral structures in patients with cancer of the head and neck]. / Efecto radioprotector del acido ascorbico sobre estructuras orales en pacientes con cancer de cabeza y cuello.

It is considered the radioprotective effect of ascorbic acid in patients with head and neck cancer. It is observed a reduction of yatrogenic effects over oral structures secondary to radiotherapy. It is recommended the oral administration of ascorbic acid in this type of patients.

Pautas de profilaxis antibiótica de la endocarditis bacteriana en pacientes sometidos a tratamiento odontológico / Guidelines for antibiotic prophylaxis of bacterial endocarditis in patients undergoing dental therapy

El objetivo de este trabajo fue conocer las pautas de profilaxis antibiótica de la endocarditis bacteriana empleadas en diferentes centros sanitarios españoles. Para ello un odontólogo preguntó de forma oral en 50 Servicios de Cardiología y/o Medicina Interna distribuidos por toda la geografía española la profilaxis que debía administrar a un paciente portador de una prótesis valvular mitral antes de una exodoncia. Los resultados obtenidos demuestran que sólo 36 (72 por ciento) utilizaron las últimas pautas profilácticas recomendadas por la Asociación Americana de Cardiología o la Sociedad Británica de Quimioterapia Antimicrobiana. En pacientes alérgicos a la penicilina el antibiótico de elección fue la eritromicina (60 por ciento) seguida de la clindamicina (28 por ciento), aunque administradas en posologías muy diferentes (11 y 3 pautas, respectivamente). Sólo en el 44 por ciento de los centros encuestados las pautas aplicadas a pacientes alérgicos y no alérgicos correspondían al protocolo recomendado por el mismo grupo de estudio. La controversia generada en torno a las indicaciones profilácticas de la endocarditis bacteriana podría justificar en parte los resultados de este trabajo (AU)

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