Early oral cancer diagnosis: The Aarhus statement perspective. A systematic review and meta-analysis.

BACKGROUND: Mortality is linked to diagnostic intervals in certain cancers. As symptom perception is conditioned by tumor site, a specific study on oral cancer is needed. METHODS: This study's inclusion criteria were original data, symptomatic primary oral squamous cell carcinoma, and exposure of interest, diagnostic interval, or diagnostic delay. The outcome of interest was survival and disease stage. A meta-analysis was undertaken to investigate the relationship between intervals to diagnosis, TNM classification, and survival in oral cancer. RESULTS: Regarding referral delay, the results present no heterogeneity and showed a risk increase in mortality of 2.48 (range = 1.39-4.42). The larger the diagnostic delay, the more advanced the stage at diagnosis. High quality studies reveal a higher risk increase than low quality studies (odds ratio [OR] = 2.44; 95% confidence interval [CI] = 1.36-4.36 vs OR = 1.53; 95% CI = 1.26-1.86). CONCLUSION: A longer time interval from first symptom to referral for diagnosis is a risk factor for advanced stage and mortality of oral cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2182-E2189, 2016.

Available web-based teaching resources for health care professionals on screening for oral cancer.

OBJECTIVES: To identify websites with adequate information on oral cancer screening for healthcare professionals (HCPs) and to assess both their quality and contents. STUDY DESIGN: Websites were identified using Google and HON medical professional search engines using the terms "screening for oral cancer". The first 100 sites retrieved by each engine were analysed using the DISCERN questionnaire (reliability), the V instrument (contents on oral cancer) and further by the Flesch-Kinkaid Reading Grade Level and the Flesch Reading Ease (readability). RESULTS: The overall rating showed minimal shortcomings in the quality of the information in the websites. The coverage and correctness of information on "visual examination" was rated as fair/good, whereas updating of contents resulted very variable (eg: 81% for visual examination and 18.2% for molecular biomarkers). These results permitted to rank the websites housing relevant information for oral cancer. Top ranking websites were affiliated to the Oral Cancer Foundation (USA), WHO Collaborating Centre for oral cancer (UK) whose webpage is entitled "Oral Cancer Education and Research", and the Clinical Guidelines maintained by the British Columbia Cancer Agency (Canada) and the British Dental Association (UK) respectively. CONCLUSIONS: There are web-based, HCP-addressed, resources on screening for oral cancer housing heterogeneous information both in quality and contents. The use of specific evaluation tools permits the selection of reliable websites on this topic with a potential to improve the existing educational gaps among HCPs.

An appraisal of oral cancer and pre-cancer screening programmes in Europe: a systematic review.

BACKGROUND: Close to 50% of oral cancer (OC) patients still present in advanced stages of disease. Screening, in medicine and dentistry, is a strategy to identify an unrecognised disorder in individuals without signs and symptoms. There are several cancers that fit valid criteria for screening, but whether or not to screen a population for OC remains a dilemma. However, many screening programmes for OC and detection of potentially malignant disorders are described. Many of these have been conducted in Europe, but the feasibility of screening for OC has not been systematically addressed. METHODS: A systematic review was conducted using the key words of interest. Based on our inclusion criteria, 16 European studies spanning three decades were selected from the published English literature. These studies were systematically analysed. The results were discussed with an expert EU consortium built with the task to promote the early detection of OC. RESULTS: There were no consistent results or conclusions across the studies reviewed, largely as a result of there being a wide variety in the screening models and methods of data analysis adopted by each group. In nine of the studies reviewed, whilst descriptive findings from screening were presented, the authors had not attempted to analyse the outcomes. Additionally, only one study reported follow-up data of the screened population. CONCLUSIONS: In order to uphold the benefits of screening, it is necessary to demonstrate an improvement in survival rates following early detection. No such randomised control trials (RCT) on OC have been undertaken in Europe. Undertaking such a RCT may be difficult in the European setting. However, the feasibility of screening for OPMDs by conventional oral examination has been demonstrated, supporting a strategy to adopt appropriate screening models, and further action from the European countries should be to demonstrate methods of halting their progression by tested interventions. We provide a brief guideline for future screening studies.

The 100 most cited articles in dentistry.

OBJECTIVES: To identify the 100 most cited articles published in dental journals. MATERIALS AND METHODS: A search was performed on the Institute for Scientific Information (ISI) Web of Science for the most cited articles in all the journals included in the Journal Citation Report (2010 edition) in the category of "Dentistry, Oral Surgery, and Medicine". Each one of the 77 journals selected was analyzed using the Cited Reference Search tool of the ISI Web of Science database to identify the most cited articles up to June 2012. The following information was gathered from each article: names and number of authors, journal, year of publication, type of study, methodological design, and area of research. RESULTS: The number of citations of the 100 selected articles varied from 326 to 2050. All articles were published in 21 of the 77 journals in the category. The journals with the largest number of the cited articles were the Journal of Clinical Periodontology (20 articles), the Journal of Periodontology (18 articles), and the Journal of Dental Research (16 articles). There was a predominance of clinical research (66 %) over basic research (34 %). The most frequently named author was Socransky SS, with 9 of the top 100 articles, followed by Lindhe J with 7. The decades with most articles published of the 100 selected were 1980-1989 (26 articles) and 1990-1999 (25 articles). The most common type of article was the case series (22 %), followed by the narrative review/expert opinion (19 %). The most common area of study was periodontology (43 % of articles). CONCLUSIONS: To our knowledge, this is the first report of the top-cited articles in Dentistry. There is a predominance of clinical studies, particularly case series and narrative reviews/expert opinions, despite their low-evidence level. The focus of the articles has mainly been on periodontology and implantology, and the majority has been published in the highest impact factor dental journals. CLINICAL SIGNIFICANCE: The number of citations that an article receives does not necessarily reflect the quality of the research, but the present study gives some clues to the topics and authors contributing to major advances in Dentistry.

Simulation for training in oral cancer biopsy: a surgical model and feedback from GDPs.

OBJECTIVES: To describe a new bench model for oral precancer/cancer biopsy training and to assess its effectiveness in terms of trainees' perception. STUDY DESIGN: Cross-sectional, descriptive, performed on 424 general dental practitioners (GDP) who undertook biopsies on a pig tongue. The participants were assessed by direct observation for 2.5 hours using specific check-lists and by means of a self-applied questionnaire. RESULTS: The workshop was perceived as "very interesting" even by those with previous surgical experience (Xi - Xj = 0.07; 95%CI= -0.20-0.09). Most GDPs considered themselves able to undertake oral biopsies on real patients after the workshop. Those who had previously received theoretical continuous education courses on oral biopsy scored higher values within the group (Xi - Xj = 0.20; 95%CI= 0.04-0.37). CONCLUSIONS: There is a need for including clinical abilities workshops when instructing on oral biopsy techniques. More studies are needed to validate the procedure and to address cognitive and communication skills.

Dental implants in the medically compromised patient.

OBJECTIVE: It has been suggested that some local and systemic factors could be contraindications to dental implant treatment. The objective of this paper was to evaluate whether success and survival rates of dental implants are reduced in the medically compromised patient. DATA/SOURCES: An extensive literature search was conducted using PubMed/Medline, Scopus, Scirus and Cochrane databases up to November 8, 2012. CONCLUSIONS: There are very few absolute medical contraindications to dental implant treatment, although a number of conditions may increase the risk of treatment failure or complications. The degree of systemic disease-control may be far more important that the nature of the disorder itself, and individualized medical control should be established prior to implant therapy, since in many of these patients the quality of life and functional benefits from dental implants may outweigh any risks.

Denosumab-related osteonecrosis of the jaw.

BACKGROUND: Osteonecrosis of the jaw (ONJ) is a debilitating chronic illness that has become one of the literature's most discussed adverse events in relation to advanced malignancy. In 2010, the first case reports of ONJ linked with denosumab administration were published. CASE DESCRIPTION: The authors describe a case of denosumab-related ONJ in a 73-year-old man with a diagnosis of prostatic adenocarcinoma, the treatment for which included the antiresorptive agent denosumab and who experienced severe pain and delayed healing after a mandibular molar extraction performed six months after the cessation of denosumab therapy. The patient had not received radiotherapy to the head and neck, nor had he received any bisphosphonate treatment. RESULTS: Clinicians established a diagnosis of denosumab-related ONJ. Follow-up across 12 months revealed that the patient needed long-term courses of antibiotics and that he experienced progressive bone destruction requiring surgical debridement. CONCLUSIONS: and CLINICAL IMPLICATIONS: The authors suggest that in patients receiving denosumab therapy, the dosing interval, the cumulative dose or both may be important in terms of the development of denosumab-related ONJ. This allows the hypothesis that preventive dentistry may reduce the prevalence of ONJ in those receiving denosumab as it has in those receiving bisphosphonates.

Continuing education in oral cancer prevention for dentists in Spain.

Continuing education (CE) can have a large impact on dentists' oral cancer attitudes, knowledge, and behavior. Reading scientific journals is a key component of CE. The objective of this study was to assess preventive and clinical attitudes of the participants in an educational intervention on oral cancer in Spain based on scientific journals. Members of the Spanish Board of Dentists and Stomatologists participated in an online, cross-sectional study, using an anonymous, self-administered questionnaire. There were 791 general dental practitioners (GDPs) invited to participate in the study. The large majority reported that they deliver tobacco-cessation counseling (93.6 percent) as well as advice on alcohol consumption (66.6 percent), but advice on vegetable intake was less frequently provided (42.4 percent). Alcohol intake advice, routine mucosa exploration, and biopsy performance on lesions suspicious of malignancy are preventive attitudes related to training. Compared with those who did not benefit from CE courses or did so only once, the GDPs who took four or more CE courses showed a doubling in the odds of giving alcohol advice to their patients and a tenfold increased odds of performing mucosa check on a routine basis; they were 3.5 times as likely to take biopsies of suspicious lesions. A longer experience as a GDP did not increase the probability of adopting preventive attitudes. In addition to presenting the results of this study, the article also discusses the general usefulness of other preventive measures in oral cancer.

General anesthesia increases the risk of bacteremia following dental extractions.

OBJECTIVE: The influence of oral health status, the number of teeth extracted, and the anesthetic modality used is currently a matter of debate in the prevalence of bacteremia following dental extractions (BDE). The aim of the present study was to analyze the factors affecting the prevalence, duration, and etiology of BDE. STUDY DESIGN: Blood samples were collected from 210 patients at baseline, 30 seconds, 15 minutes, and 1 hour after performing dental extractions. Samples were processed in the Bactec 9240 and the subculture and further identification of the isolates were performed using conventional microbiological techniques. RESULTS: The prevalence of BDE at 30 seconds, 15 minutes, and 1 hour were 71%, 45%, and 12%, respectively. In the multivariate analysis, the "anesthetic modality" (local anesthesia versus general anesthesia) was the only variable related to BDE. CONCLUSION: General anesthesia represents a risk factor for BDE, increasing its prevalence and duration.

Is diagnostic delay related to advanced-stage oral cancer? A meta-analysis.

Diagnostic delay in oropharyngeal cancer may be associated with poor prognosis. As controversy exists on this topic because of contradictory results, the aim of this study was to perform a systematic review of the relationship between total diagnostic delay and advanced disease stages. A systematic search of MEDLINE, EMBASE, and ISI proceedings was made to identify observational studies that provided relative risks (RRs) and 95% confidence intervals (CIs) for patients with confirmed pathological diagnosis. The outcome of interest was disease stage (TNM classification), while the exposure of interest was the total diagnostic delay. The study-specific adjusted log RRs for cohort studies were weighted by the inverse of their variance to compute a pooled RR and its 95% CI. The fixed-effects pooled RR of advanced stages of oropharyngeal cancer when diagnostic delay is present was 1.32 (95% CI: 1.07-1.62). This association was stronger when the analysis was restricted to oral cancer (pooled RR: 1.47; 95% CI: 1.09-1.99) and when delay was longer than 1 month (pooled RR: 1.69; 95% CI: 1.26-2.77). The probability for patients with delayed diagnosis to present an advanced-stage tumour at diagnosis was significantly higher than that of patients with no delay in diagnosis. However, new prospective studies with strict methodology are needed to shed more light on this association.

Metastatic tumours to the oral cavity: a survival study with a special focus on gingival metastases.

AIMS: To describe survival from oral metastases, particularly gingival metastases, and to identify clinical prognostic variables. MATERIALS AND METHODS: A series of 39 patients were studied, analysing age, gender, primary tumour site, oral metastases site and histological type. RESULTS: Mean age: 62.3+/-9.2 years, with similar prevalence by gender. The most frequent sites for primary tumours were the kidney (20.5%), lung (20.5%) and breast (20.5%). Gingival metastases represented 63.6% of all oral soft tissue metastases (7/11). The average time between primary tumour diagnosis and appearance of the gingival metastases was 9.7+/-13.4 months. The median survival time since gingival metastases appearance was 5.2 months [95% confidence interval (CI)=0-13.6]; no statistically significant difference with other oral locations was found by the Kaplan-Meier curves (log rank: 0.29; p>0.05). Oral metastases involving the gingiva were more frequently found in the maxilla (85.7%versus 14.3%), whereas intra-osseous metastatic tumours were more frequent in the mandible (77.8%versus 22.2%; p<0.05; odds ratio=21; 95% CI=2.0-210.1). None of the variables considered had a prognostic value as indicated by the Kaplan-Meier test. PRACTICAL IMPLICATIONS: The data in this paper show that 25% (and in other studies up to 37%) of oral metastases came from unknown primary tumours; thus a biopsy with histopathologic analysis is mandatory for every patient with a gingival mass. CONCLUSIONS: This study reinforces the significance of gingival metastases as a poor prognosis indicator. Dental practitioners should suspect that gingival masses mimicking benign or inflammatory lesions may represent a sign of underlying malignant tumours.

Drooling.

INTRODUCTION: Drooling is the overflowing of saliva from the mouth. It is mainly due to neurological disturbance and less frequently to hypersalivation. Drooling can lead to functional and clinical consequences for patients, families, and caregivers. The aim of this review is to emphasize the clinical aspects of the assessing and management of drooling. METHODS: All papers and clinical reviews of drooling in the electronic data bases (Medline, PubMed, Embase and the Cochrane Library) for the past 40 years in any languages have been evaluated. RESULTS: The severity of drooling and the effects on the quality of life of the patient and family, help to establish a prognosis and to decide the therapeutic regimen. Treatment options range from conservative therapy to medication, radiation, or surgery, and often a combination is needed. CONCLUSIONS: Chronic drooling remains a problem that can be difficult to manage. Despite the acceptable results obtained with most of the treatments, none is free of undesirable effects.

Patients' perception of recovery after third molar surgery following postoperative treatment with moxifloxacin versus amoxicillin and clavulanic acid: a randomized, double-blind, controlled study.

PURPOSE: To analyze the impact of the postoperative administration of moxifloxacin (MXF) on oral function and quality of life after third molar (TM) surgery. MATERIALS AND METHODS: A single-center, prospective, randomized, double-blind, controlled clinical trial was designed. The study population consisted of 100 patients who underwent impacted TM extractions. Patients were distributed into 2 groups of 50 individuals each. Postoperatively, one group was administered MXF (400 mg/24 hours for 5 days); the positive control group received amoxicillin and clavulanic acid (AMX-CLV) (500/125 mg/8 hours for 5 days). Follow-up was performed for 7 postoperative days, during which the patient recorded information on pain, the use of rescue analgesia, undesirable effects of the medication, difficulty in speaking, difficulty in chewing, diet consistency, difficulty performing oral hygiene, asthenia, time in bed, going out of the house, and returning to work. RESULTS: The administration of MFX was significantly associated with headache, and AMX-CLV was significantly associated with diarrhea. Greater difficulty in chewing and performing oral hygiene was observed in the AMX-CLV group compared with the MXF group. The percentage of patients who tolerated a diet of normal consistency was significantly higher in the MXF group compared with the AMX-CLV group. During the first 4 days of follow-up, the percentage of patients who returned to work was significantly higher in the MXF group than in the AMX-CLV group. CONCLUSIONS: Moxifloxacin shortens the period of postoperative recovery in terms of oral function and return to work. Therefore, MXF could be a useful option in TM surgery when antibiotics are indicated, particularly if patients are allergic to beta-lactams, their oral flora is resistant to macrolides, or they are intolerant of either of these antibiotics.

Individualized nasal mask fabrication for positive pressure ventilation using dental methods.

PURPOSE: The aim of this study was to develop a simple technique to manufacture individualized ventilatory nasal masks for pediatric patients using materials and procedures commonly applied in dentistry. MATERIALS AND METHODS: Three cases of pediatric patients who met with severe difficulties in their adaptation to commercially available nasal masks are described: one premature infant, one child diagnosed with achondroplasia, and one child with congenital central hypoventilation syndrome. RESULTS: In each case, a light nasal mask was designed with two independent parts that become perfectly adapted to the patient's nose: one soft for the skin contact, and another rigid for dimensional stability. In all patients, adequate levels of ventilation were reached. CONCLUSION: This easy, inexpensive nasal mask fabrication technique can be used in a great number of patients, increasing the efficacy of individualized masks.

Unsuspected foreign body aspiration.

Aspiration of foreign bodies is a serious complication that may occur during the course of dental treatment. A case report of a 60-year-old man with recurrent pneumonia is presented. One year after the onset of his initial symptoms, a hard substance that made a complete mold of the bronchial tree at the inferior right lobe was extracted with a rigid bronchoscopy. This green material of elastic consistency was dental impression material (polyvinylsiloxane). On careful questioning, the patient indicated that he had dental impressions taken 2 months before the onset of the symptoms. Surgery was indicated and lobectomy of the inferior right lobe was performed without incident. To avoid this complication, some preventive precautions such as identifying high-risk patients; using rubber dam; tethering any small instrument with a ligature; placing a gauze screen to protect the oropharynx in sedated patients; and using custom impression trays to minimize the amount of impression material required have been suggested. In case of a suspected aspiration, the patient must be referred to appropriate medical care.