Epidemiology of oral, salivary gland and pharyngeal cancer in children and adolescents between 1970 and 2011.

OBJECTIVES: The age of oral and pharyngeal cancer patients has reportedly decreased over the last decade, but most of the peer-reviewed literature regarding oral and pharyngeal cancer in individuals 0-19years of age (Y) is limited to specific tumor sites and/or types, or a small number of cases. Our aim is to characterize oral, salivary gland and pharyngeal cancer (OSPC) in 0-19Y in order to improve knowledge of the disease in young individuals. METHODS: Data on OSPC between 1970 and 2011 was taken from the Israel National Cancer Registry, and included patient age, gender, tumor site and tumor type. Data analysis was performed by using IBM SPSS, Winpepi software and Joinpoint Regression Program. alpha<0.05 was deemed statistically significant. RESULTS: A total of 13,863 OSPC cases were diagnosed with 2.6% (N=357) of 0-19Y. The male to female ratio was 1.5:1. The rates of diagnosis decreased between 1991 and 2011 and were not significantly different between the genders. The nasopharynx was the leading tumor site (42.3%) followed by the salivary glands (20.5%), and both were more common in 14-19Y. The tonsils and other pharyngeal sites were common among 0-13Y. The main tumor types were lymphomas (20.7%) and carcinomas (19.9%). CONCLUSIONS: The general characteristics of OSPC remained unchanged over the last four decades. This may imply that environmental factors have not had any effect. Males are affected more than females and might have a genetic predisposition for nasopharyngeal malignancy. Health care providers should be aware of the common sites and tumor types among children and adolescents.

Protein S drives oral squamous cell carcinoma tumorigenicity through regulation of AXL.

The TAM family of proto-oncogenic receptor protein tyrosine kinases, comprising of TYRO3, AXL, and MERTK, is implicated in many human cancers. Their activation leads to cancer cell proliferation, enhanced migration, invasion, and drug resistance; however how TAMs are activated in cancers is less understood. We previously showed that Protein S (PROS1) is a ligand of the TAM receptors. Here we identify PROS1 as a mediator of Oral Squamous Cell Carcinoma (OSCC) in proliferation, cell survival and migration. We demonstrate that excess PROS1 induces OSCC proliferation and migration. Conversely, blocking endogenous PROS1 expression using shRNA significantly inhibits cell proliferation and migration in culture. This inhibition was rescued by the addition of purified PROS1. Moreover, PROS1 knockdown reduced anchorage-independent growth in-vitro, reduced tumor xenograft growth in nude mice and altered their differentiation profile. Mechanistically, we identify the downregulation of AXL transcripts and protein following PROS1 knockdown. Re-introducing PROS1 rescues AXL expression both at the protein and transcriptional levels. The anti-proliferative effect of the AXL inhibitor R428 was significantly reduced following PROS1 inhibition, indicating the functional significance of PROS1-mediated regulation of AXL in OSCC. Taken together, we identify PROS1 as a driver of OSCC tumor growth and a modulator of AXL expression. Our results point to PROS1 as a potential novel anti-cancer therapeutic target.

Periodontal pathogens Porphyromonas gingivalis and Fusobacterium nucleatum promote tumor progression in an oral-specific chemical carcinogenesis model.

Oral squamous cell carcinoma (OSCC) is a lethal disease whose incidence is increasing. Epidemiologic studies demonstrate an association between periodontitis and oral cancer, and periodontal pathogens are implicated in the pathogenesis of numerous disorders, including rheumatoid arthritis, cardiovascular diseases, diabetes and gastrointestinal malignancies. Nevertheless, a causal role for periodontal pathogens in OSCC has not been shown, partly due to the lack of an appropriate animal model. Here, utilizing a newly-established murine model of periodontitis-associated oral tumorigenesis, we report that chronic bacterial infection promotes OSCC, and that augmented signaling along the IL-6-STAT3 axis underlies this effect. Our results indicate that periodontal pathogens P. gingivalis and F. nucleatum stimulate tumorigenesis via direct interaction with oral epithelial cells through Toll-like receptors. Furthermore, oral pathogens stimulate human OSCC proliferation and induce expression of key molecules implicated in tumorigenesis. To the best of our knowledge, these findings represent the first demonstration of a mechanistic role for oral bacteria in chemically induced OSCC tumorigenesis. These results are highly relevant for the design of effective prevention and treatment strategies for OSCC.

How the insightful leadership of James English transformed a traditional dental school into a leading educational institution.

During the 1960s, the dental school at the University of Buffalo underwent a profound change, as a result of its merger with the State University of New York (SUNY), and, very importantly, because of the outstanding leadership provided by Dean James A. English. This article contrasts what the school was like in 1960 before Dean English's arrival, and what it had become in 1970 when his deanship ended. It also recounts the leadership qualities of Dean English and the measures he took to transform the dental school into a leading educational institution. During his tenure, the school experienced profound change, including integration of medicine with dentistry in the curriculum; "internationalization" of dental education and research; organization of the first Oral Biology Department and PhD graduate program in a dental school in the United States; insistence on "knowledge-driven" dental practice--a concept we now term "evidenced-based dentistry"; the establishment of novel approaches to dental education including the "diagonal" curriculum; incorporation of prevention in practice; elective courses for dental students; and comprehensive clinical care. All of these accomplishments were novel for the day and greatly influenced incorporation of similar innovations in many schools around the world.

Exceptional oral manifestations of amyloid light chain protein (AL) systemic amyloidosis.

Oral amyloidosis is usually presented in the tongue and is often associated with multiple myeloma. We present three patients with unusual oral manifestations of primary amyloidosis, which to the best of our knowledge have not been previously published. In two cases the oral manifestation was overt at the time of diagnosis and all cases ended in patient mortality. Since these oral manifestations can contribute to the diagnosis of systemic amyloidosis, clinicians should be made aware of them. Future research should assess the significance of oral manifestation as a prognostic indicator.

Examination of three different methods of dental caries scoring during eruption of the premolar and second molar teeth in 10- to 13-year-old children using cross-sectional data.

OBJECTIVE: Premolars and second permanent molars mainly erupt in children between 10 and 13 years of age. This age range provides a relatively large number of caries-free or near caries-free tooth surfaces at a baseline measurement that can become carious during such trials. Since traditional DMFS scoring does not take the addition of new surfaces into account, the aim of this study was to compare that scoring system to two methods where sound surfaces are included in the scoring. METHODOLOGY: The comparison was done in a cross-sectional caries prevalence study so that caries progression and tooth eruptions (as occurs in a longitudinal investigation) would not confound the methods assessments. A total of 729 children between 10 and 13 years of age were recruited from four public schools in Venezuela and assigned to age groups 10, 11, 12, and 13. Decayed, missing, and filled surfaces (DMFS) of their respective premolar and second molar teeth were scored by one calibrated examiner (CM) using a mirror and probe and the criteria reported by Radike, but with one major modification; that was, avoidance of any forceful probing of suspected non-cavitated pits and fissures for caries lesions. In each subject, traditional DMFS were determined in which sound surfaces were not considered. These scores were compared to the scoring of DMFS plus sound surfaces (DMFSS) as described by Katz, et al. and Huntington. RESULTS: Mean traditional DMFS scores (+/- SEM) obtained for the permanent premolars and second molars of 10-, 11-, 12-, and 13-year-old children were 3.06 +/- 0.27, 3.32 +/- 0.27, 3.44 +/- 0.27, and 5.69 +/- 0.37, respectively. A large difference in these scores was observed between the 12- and 13-year-old children, in contrast to smaller differences between the 10- and 11-, and the 11- and 12-year-olds. Eruption of premolar and second molar teeth examined at the same time showed per cent eruptions as follows: 27.2% at age 10; 60.8% at age 11; 84.9% at age 12; and 95.5% by age 13. Most eruption was observed in the 10- to 12-year-olds, in contrast to the largest DMFS differences appearing between children 12 and 13 years of age. Looked at longitudinally, the incongruence of prior eruption and resulting caries reaching detection levels was about one to two years. All three methods of scoring showed the sharp increment in their respective caries scores between ages 12 and 13, whereas smaller and directionally opposite score changes occurred between years 11 and 12. With the Katz, et al. and Huntington DMFSS methods, the scores between 11 and 12 years decreased, whereas traditional DMFS scoring showed an increase. Although these differences were not large, the pattern of traditional DMFS scoring differed significantly from the other two methods (p < 0.001). CONCLUSION: Traditional DMFS scoring in children between 10 and 13 years of age will not detect the new surfaces, and the resulting extra caries increments that would arise in a clinical trial. With the Katz, et al. or Huntington scoring methods, where these new surfaces are counted, adjustment is made for any such caries rate error. In caries remineralization studies, this could be of significance.

Use of essential oil-containing mouthrinses by xerostomic individuals: determination of potential for oral mucosal irritation.

PURPOSE: To assess the irritation potential of an essential oil-containing mouthrinse (Listerine Antiseptic) in a population with objectively documented xerostomia (hyposalivation) using an exaggerated-exposure clinical model. METHODS: Following a baseline oral soft tissue examination, 19 qualifying female subjects with a mean age of 61 years and a mean unstimulated baseline salivary flow of 0.06 mL/min were randomly assigned either the essential oil mouthrinse or a negative control rinse. They rinsed under supervision with 20 ml of their assigned rinse for 30 seconds and 5 minutes later a second salivary flow rate was determined. They then rinsed unsupervised with 20 ml for 30 seconds three times daily for the next 14 days, and received soft tissue examinations on days 7 and 14. After a 1-week interim period, subjects switched to the alternate rinse and the examination and rinsing regimens were repeated during the subsequent 2 weeks. RESULTS: The oral irritation potential of the essential oil mouthrinse was minimal. Oral mucosal abnormalities attributable to the test rinses were seen in only 2 subjects, both at the 7-day examination. These subjects were both using the essential oil mouthrinse. The abnormalities consisted of an asymptomatic "whitish slough" which was readily wiped off leaving a normal appearing, non-erythematous mucosa. In both subjects, the oral mucosa appeared normal at the 14-day examination.

Mid-line swelling of the palate.

Sarcoidosis is a multi-system, non-caseating granulomatous disease of unknown aetiology that may affect any organ. The oral involvement of sarcoidosis is rare and usually an initial manifestation of the disease. In this case report the authors present a 25-year-old African-American woman with palatal sarcoidosis treated successfully with intra-lesional corticosteroid injections. The oral manifestations of sarcoidosis are relatively uncommon and may be the only manifestation of the disease. Suspected cases of oral sarcoidosis should be biopsied and subsequently referred to a physician to rule out systemic involvement.

Dental profile of patients with Gaucher disease.

BACKGROUND: This study was conducted to determine whether patients with Gaucher disease had significant dental pathology because of abnormal bone structure, pancytopenia, and coagulation abnormalities. METHODS: Each patient received a complete oral and periodontal examination in addition to a routine hematological evaluation. RESULTS: Gaucher patients had significantly fewer carious lesions than otherwise healthy carriers. Despite prevalence of anemia, there was no increase in gingival disease; despite the high incidence of thrombocytopenia, gingival bleeding was not noted; and despite radiological evidence of bone involvement, there was no greater incidence loss of teeth or clinical tooth mobility. CONCLUSIONS: These data represent the first survey of the oral health of a large cohort of patients with Gaucher disease. It is a pilot study of a unique population and the results of the investigation are indications for further research. Based on our findings, we recommend regular oral examinations with appropriate dental treatment for patients with Gaucher disease as for other individuals. Consultation between the dentist and physician, preferably one with experience with Gaucher disease, should be considered when surgical procedures are planned.

Bite marks.

A simple and practical method for the evaluation of bite mark evidence has been described. There are many other methods, some quite complicated, using overlays, computer analysis and mathematical formulae. This author prefers to adhere to the "KISS principle: "Keep It Simple, Stupid." A jury is generally more willing to accept the positioning of a study model on a one-to-one life-size photograph rather than be led through a complicated analytical procedure. If the juror can hold the model and photograph in his/her hand and see that the teeth and bite mark match (or do not match), data summation can be much more direct. Numerous publications describe more complex matching procedures should circumstances warrant.