Oral soft tissue manifestation of multiple myeloma after kidney transplantation: a case report.

This report presents a case in which oral soft tissue lesions were the first signs of multiple myeloma (MM) following a solid-organ transplantation. A 75-year-old man presented with bilateral primary oral gingival masses in the posterior mandible approximately 2 months after tooth extractions. A panoramic radiograph appeared normal and did not reveal "punched-out" lytic lesions of the bone, a classic sign of MM. A biopsy of the gingival masses was performed, and the resulting diagnosis was a plasma cell neoplasm. After a hematologic screening, positron emission tomography/computed tomography, and bone marrow biopsy, the diagnosis of MM with extensive disease was confirmed. Oral manifestations of MM are common, making the patient's oral health history an integral part of diagnosis. Although the isolated gingival hypertrophy observed in the present case is an atypical oral presentation, an understanding of the maxillofacial manifestations of MM is important to ensure diagnosis in the early stages of disease.

The role of the parent-child relationship in fostering resilience in American Indian/Alaskan Native children.

Resilience is a key characteristic to study in families, particularly those who have experienced significant systemic risk factors. While much resilience research focuses on ethnic and cultural minorities, little research focuses specifically on American Indian/Alaskan Native (AI/AN) families. The parent-child relationship has been demonstrated to be a key characteristic in families, and this relationship may also serve as a protective factor for AI/AN families. Positive parent-child relationships are consistently linked to positive child outcomes, and parental psychological symptoms are linked with child psychological symptoms in non-Native families. These associations warrant further examination among AI/AN families. We hypothesized that the parent-child relationship would moderate the link between parent distress (i.e., depressive and anxious symptoms) and child internalizing problems in a sample of 57 AI/AN parents of children 3-5 years of age. As expected, the parent-child relationship moderated the associations between parent anxiety symptoms and child internalizing symptoms, and between parent depressive symptoms and child internalizing symptoms. Furthermore, the strength of the parent-child relationship buffered the effects of parent distress on child internalizing symptoms. Results highlight the potentially protective role of strong parent-child relationships in AI/AN families.

Progression of gingival squamous cell carcinoma from early to late stage after invasive dental procedure.

Early presentation of gingival squamous cell carcinoma (GSCC) is at times misdiagnosed as a benign inflammatory or reactive oral condition. Some misdiagnosed patients undergo unnecessary, invasive dental procedures, resulting in delayed cancer diagnosis and an increased risk of accelerated disease progression due to disruption of the periosteum and cortical bone. The records of 58 patients with biopsy-proven GSCC were retrospectively reviewed. The sample included 32 patients who underwent an invasive dental procedure (IDP) prior to cancer diagnosis and 26 patients who did not undergo an IDP (non-case group). Patients from both groups initially presented with similar symptoms. The median duration of symptoms at initial clinical presentation was 6 months for the IDP group and 2 months for the non-case group. In IDP patients, symptoms worsened after the IDP was rendered, with 37.5% presenting with a severe-grade symptom. In both groups, the majority of lesions were found on the posterior mandible and had a histologic grading of moderately differentiated GSCC. The odds of the IDP group having late-stage disease were 2.94 times greater than the odds for the control group. Stage T3/T4 malignancy was diagnosed in 77.4% of the IDP patients versus 53.8% of non-case patients. Disease-specific mortality was comparable; however, surgical treatment was significantly more extensive in the IDP group than in the non-case group. The disruption of alveolar periosteum in undiagnosed oral cancer patients results in significant delay in diagnosis, necessitating more complicated treatment regimens because of local tumor progression.

Social functioning in children with ADHD: an examination of inhibition, self-control, and working memory as potential mediators.

Children with attention-deficit/hyperactivity disorder (ADHD) experience a host of social problems, in addition to significant impairments in behavioral inhibition, working memory, and self-control. Behavioral inhibition and working memory difficulties have been linked with social functioning deficits, but to date, most studies have examined these neurocognitive problems either in isolation or as an aggregate measure in relation to social problems, and none has considered the role of self-control. Thus, it remains unclear whether all of these executive functions are linked with social problems or if the link can be more parsimoniously explained by construct overlap. Fifty-eight children with ADHD and 63 typically developing (TD) children completed tests assessing self-control, behavioral inhibition, and working memory; parents and teachers rated children's social functioning. Examination of potential indirect effects with the bootstrapping procedure indicated that working memory mediated the relation between group membership (ADHD, TD) and child social functioning based on teacher but not parent ratings. Behavioral inhibition and self-control did not have direct relations with either parent- or teacher-rated social functioning. These findings point to important differences regarding how executive functioning difficulties manifest at school compared to home, as well as the specific executive function components that predict ADHD-related social difficulties.

Enterococcus faecalis enhances cell proliferation through hydrogen peroxide-mediated epidermal growth factor receptor activation.

Enterococcus faecalis is a member of the intestinal and oral microbiota that may affect the etiology of colorectal and oral cancers. The mechanisms by which E. faecalis may contribute to the initiation and progression of these cancers remain uncertain. Epidermal growth factor receptor (EGFR) signaling is postulated to play a crucial role in oral carcinogenesis. A link between E. faecalis and EGFR signaling in oral cancer has not been elucidated. The present study aimed to evaluate the association between E. faecalis and oral cancer and to determine the underlying mechanisms that link E. faecalis to EGFR signaling. We report the high frequency of E. faecalis infection in oral tumors and the clinical association with EGFR activation. Using human oral cancer cells, we support the clinical findings and demonstrate that E. faecalis can induce EGFR activation and cell proliferation. E. faecalis activates EGFR through production of H(2)O(2), a signaling molecule that activates several signaling pathways. Inhibitors of H(2)O(2) (catalase) and EGFR (gefitinib) significantly blocked E. faecalis-induced EGFR activation and cell proliferation. Therefore, E. faecalis infection of oral tumor tissues suggests a possible association between E. faecalis infection and oral carcinogenesis. Interaction of E. faecalis with host cells and production of H(2)O(2) increase EGFR activation, thereby contributing to cell proliferation.

Visuospatial working memory in attention-deficit/hyperactivity disorder: Characterizing path length and path crossings as mechanisms of impairment.

OBJECTIVE: A growing body of research provides reliable evidence of moderate to large magnitude deficits in the visuospatial (VS) working memory (WM) of children with attention-deficit/hyperactivity disorder (ADHD), relative to typically developing (TD) children. Studies of ADHD-related Visuo-spatial Working Memory (VS-WM) functioning most often present sequential presentations of VS stimuli and examine general performance characteristics. Only a few studies have examined the effects of varying VS-WM task parameters on performance in children with ADHD, despite evidence from basic-cognitive research that indicates methodological heterogeneity in VS-WM task parameters yields significant performance variability that is associated with underlying mechanistic processes. This study is the first to examine the effect of the task parameters path characteristics and path crossings on performance in children with ADHD and TD children. METHOD: School-aged children with ADHD (n = 50) and TD children (n = 59) completed a VS-WM task that varied by path lengths and path crossings. RESULTS: Multilevel analyses indicated a negative effect of relatively long paths on VS-WM performance of both TD children and children with ADHD, and a negative effect of increasing path crossings that appears to be unique to TD children and dependent on path length. CONCLUSIONS: Overall, findings appear to suggest that school-aged children engage in dynamic rehearsal of VS information (i.e., mental rehearsal of path sequences), rather than static rehearsal (i.e., rehearsal of a gestalt). Moreover, ADHD-related VS-WM deficits are most likely to yield real-world impairments when information is presented with relatively long path lengths. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Chronic periodontitis and the risk of tongue cancer.

OBJECTIVE: To assess the association between the history of chronic periodontitis and the risk of tongue cancer. DESIGN: Case-control study using preexisting data from patients admitted between June 15, 1999, and November 17, 2005. SETTING: Department of Dentistry and Maxillofacial Prosthetics at Roswell Park Cancer Institute (RPCI), Buffalo, NY. PATIENTS: The cases comprised 51 non-Hispanic white men newly diagnosed as having primary squamous cell carcinoma of the tongue, and the controls, 54 non-Hispanic white men evaluated during the same period but with negative results for malignancy. Children (aged <21 years), edentulous or immunocompromised patients, and those with history of any cancer were excluded. History of periodontitis was assessed by alveolar bone loss measured from panoramic radiographs by 1 examiner blind to cancer status. MAIN OUTCOME MEASURE: Incidence of tongue cancer obtained from the RPCI Tumor Registry. RESULTS: After adjusting for the effects of age at diagnosis, smoking status, and number of teeth, each millimeter of alveolar bone loss was associated with a 5.23-fold increase in the risk of tongue cancer (odds ratio, 5.23; 95% confidence interval, 2.64-10.35). CONCLUSIONS: This study suggests an association between chronic periodontitis and the risk of tongue cancer in men, independent of smoking status, age, race, ethnicity, and number of teeth. This association needs to be confirmed by larger studies using quantitative assessment of lifetime tobacco exposure. If this association is confirmed, it has a potential impact on understanding the etiology of oral cancer as well as on its prevention and control.

Survival rates and prognostic factors for infiltrating salivary duct carcinoma: Analysis of 228 cases from the Surveillance, Epidemiology, and End Results database.

BACKGROUND: The survival rates and prognostic factors for salivary duct carcinoma (SDC) are not clear. METHODS: Survival estimates and prognostic factors were evaluated for 228 patients with SDC identified from the Surveillance, Epidemiology, and End Results (SEER) database. RESULTS: Median overall survival (OS) duration for patients with SDC was 79 months and 5-year disease-specific survival (DSS) rate was 64%. Among patients with SDC with lymph node involvement, larger primary tumor size (>3 cm) was associated with twice the risk of death (p < .03). Factors predictive of improved DSS were age (p = .01), tumor size (p = .006), tumor grade (p = .02), and lymph node involvement (p < .001). Adjuvant radiotherapy did not improve survival when compared to surgery alone for early-stage (I-II) disease (p = .28). CONCLUSION: Younger patients with SDC (<50 years) showed a better prognosis. Primary tumor size and lymph node involvement were independent and additive risk factors for poor prognosis. The role of adjuvant radiotherapy in the treatment of SDC needs to be explored further.

Osteonecrosis of the jaw - prevention and treatment strategies for oral health professionals.

Patients diagnosed with multiple myeloma and metastatic breast, prostate and renal cancers have a better opportunity for longer survival due to a myriad of chemotherapies regimens that attempt to manage disease progression while decreasing treatment-related side effects. Osteonecrosis of the jaws (ONJ) is a known side effect of bisphosphonates and other anti-neoplastic drugs. This complication can lead to oncologic treatment interruptions as well as diminished quality of life. Most recommendations for treatment of ONJ are based on position papers and case reports, while evidence-based treatment paradigms are lacking. With cancer survivorship on the rise, long-term chemotherapeutic side effects are becoming more prevalent and attention to untoward oral complications cannot be understated. In this review, the accepted recommendations for dental clearance prior to head and neck chemo-radiation therapy are put forth as a means of possibly preventing and treating drug induced ONJ.

Adjuvant intraoperative photodynamic therapy in head and neck cancer.

IMPORTANCE: There is an immediate need to develop local intraoperative adjuvant treatment strategies to improve outcomes in patients with cancer who undergo head and neck surgery. OBJECTIVES: To determine the safety of photodynamic therapy with 2-(1-hexyloxyethyl)-2-devinyl pyropheophorbide-a (HPPH) in combination with surgery in patients with head and neck squamous cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS: Nonrandomized, single-arm, single-site, phase 1 study at a comprehensive cancer center among 16 adult patients (median age, 65 years) with biopsy-proved primary or recurrent resectable head and neck squamous cell carcinoma. INTERVENTIONS: Intravenous injection of HPPH (4.0 mg/m2), followed by activation with 665-nm laser light in the surgical bed immediately after tumor resection. MAIN OUTCOMES AND MEASURES: Adverse events and highest laser light dose. RESULTS: Fifteen patients received the full course of treatment, and 1 patient received HPPH without intraoperative laser light because of an unrelated myocardial infarction. Disease sites included larynx (7 patients), oral cavity (6 patients), skin (1 patient), ear canal (1 patient), and oropharynx (1 patient, who received HPPH only). The most frequent adverse events related to photodynamic therapy were mild to moderate edema (9 patients) and pain (3 patients). One patient developed a grade 3 fistula after salvage laryngectomy, and another patient developed a grade 3 wound infection and mandibular fracture. Phototoxicity reactions included 1 moderate photophobia and 2 mild to moderate skin burns (2 due to operating room spotlights and 1 due to the pulse oximeter). The highest laser light dose was 75 J/cm2. CONCLUSIONS AND RELEVANCE: The adjuvant use of HPPH-photodynamic therapy and surgery for head and neck squamous cell carcinoma seems safe and deserves further study. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00470496.

Human papillomavirus and tobacco use in tongue base cancers.

Human papillomavirus 16 (HPV-16) infection and tobacco use are associated with human oropharyngeal cancers. We conducted a study of the role of HPV and tobacco use in base of the tongue (BOT) cancers. DNA from 34 such cancers was subjected to HPV-16 and HPV-18-specific polymerase chain reaction analysis. Demographic and clinicopathologic data were obtained from each patient's medical record. HPV-16 was detected in 68% of tumors. Tobacco use was the only factor found to be significantly associated with HPV status. Tumors from 100% of patients who had never used tobacco tested positive for HPV, compared with only 56% of those who had ever used tobacco (Fisher exact test, p = 0.024). All tumors were associated with either tobacco use or HPV infection. These findings are consistent with the hypothesis that either tobacco use or HPV infection is necessary to the etiology of BOT tumors, and they suggest that tongue base carcinoma may be prevented by combining HPV vaccination with tobacco avoidance.

Osteonecrosis of the jaw: dental outcomes in metastatic breast cancer patients treated with bisphosphonates with/without bevacizumab.

The etiology, optimal management, and outcome of osteonecrosis of the jaw (ONJ) are not well understood. Because healing after mucosal trauma requires revascularization, theoretically, the combination of bevacizumab (bev) and a bisphosphonate (BP) could affect the time to development of ONJ and/or the response to dental therapy. We reviewed all cases of ONJ in metastatic breast cancer patients treated at our institution with bev+BPs and BPs alone between October 2002 and April 2010. We identified 27 ONJ patients with a median age of 57 years (range, 40 to 68 years). Seven patients received bev+BPs; 20 patients received BPs alone. Patients received intravenous zolendronate (95%), pamidronate (20%), or both (15%). Patients were treated with antibiotics (93%), alveoplasty/debridement (67%), and chlorhexidine scrub (81%). There was no difference in dental treatment between the groups or by the year of diagnosis (before 2007 versus 2007-2010). Complete resolution (CR) was achieved in 24% of all patients; 33% treated with bev+BPs, and 21% treated with BPs alone. Rates of CR improved from 15% to 33% after 2007. The median time to response was 5.6 months (range, 1.3 to 67.5 months). The addition of bev to BPs did not appear to alter the time to development of ONJ (32.6 months versus 34.6 months, respectively). The number of BP treatments administered before the diagnosis of ONJ between bev+BPs and BPs (32 doses versus 36.5 doses) was similar. However, our sample size was too small to characterize the difference statistically. Because dental management of ONJ has not changed over time at our institute, early recognition and screening may account for the improvement in dental outcomes.

Photodynamic therapy for head and neck dysplasia and cancer.

OBJECTIVE: To determine the response of dysplasia, carcinoma in situ (CIS), and T1 carcinoma of the oral cavity and larynx to photodynamic therapy with porfimer sodium. DESIGN: Prospective trial. SETTING: A National Cancer Institute-designated cancer institute. PATIENTS: Patients with primary or recurrent moderate to severe oral or laryngeal dysplasia, CIS, or T1N0 carcinoma. INTERVENTION: Porfimer sodium, 2 mg/kg of body weight, was injected intravenously 48 hours before treatment. Light at 630 nm for photosensitizer activation was delivered from an argon laser or diode laser using lens or cylindrical diffuser fibers. The light dose was 50 J/cm(2) for dysplasia and CIS and 75 J/cm(2) for carcinoma. MAIN OUTCOME MEASURES: Response was evaluated at 1 week and at 1 month and then at 3-month intervals thereafter. Response options were complete (CR), partial (PR), and no (NR) response. Posttreatment biopsies were performed in all patients with persistent and recurrent visible lesions. RESULTS: Thirty patients were enrolled, and 26 were evaluable. Mean follow-up was 15 months (range, 7-52 months). Twenty-four patients had a CR, 1 had a PR, and 1 had NR. Three patients with oral dysplasia with an initial CR experienced recurrence in the treatment field. All the patients with NR, a PR, or recurrence after an initial CR underwent salvage treatment. Temporary morbidities included edema, pain, hoarseness, and skin phototoxicity. CONCLUSION: Photodynamic therapy with porfimer sodium is an effective treatment alternative, with no permanent sequelae, for oral and laryngeal dysplasia and early carcinoma. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00530088.

Chronic periodontitis and the incidence of head and neck squamous cell carcinoma.

Substantial evidence supports an association between chronic infections/inflammation, and cancer. The aim of this study was to assess the effect of chronic periodontitis on head and neck squamous cell carcinoma (HNSCC). The study population consisted of new patients at the Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute between 1999 and 2005. Cases were patients diagnosed with primary HNSCC. Controls were all patients seen during the same time period but negative for malignancy. Patients age <21 years, edentulous, immunocompromised, and those with history of cancer were excluded. Periodontitis was measured by alveolar bone loss (ABL) from panoramic radiographs by one examiner blind to cancer status. A total of 473 patients (266 cases and 207 controls) were included in the study. Each millimeter of ABL was associated with >4-fold increased risk of HNSCC (odds ratio, 4.36; 95% confidence interval, 3.16-6.01) after adjustment for age, gender, race/ethnicity, marital status, smoking status, alcohol use, and missing teeth. The strength of the association was greatest in the oral cavity, followed by oropharynx and larynx. The association persisted in subjects who never used tobacco and alcohol. There was a significant interaction between smoking and ABL (P = 0.03). Patients with periodontitis were more likely to have poorly differentiated oral cavity SCC than those without periodontitis (32.8% versus 11.5%; P = 0.038). This study suggests that chronic periodontitis is an independent risk factor for HNSCC and smoking modifies this association. These results have implications for practical and safe strategies for prevention, diagnosis, and treatment of HNSCC.