Preclinical Assessment of the Effectiveness of Magnetic Resonance Molecular Imaging of Extradomain-B Fibronectin for Detection and Characterization of Oral Cancer.

PURPOSE: Oral squamous cell carcinoma (OSCC) has not seen a substantial improvement in patient survival despite therapeutic advances, making accurate detection and characterization of the disease a clinical priority. Here, we aim to demonstrate the effectiveness of magnetic resonance imaging (MRI) with the targeted MRI contrast agent MT218 specific to extradomain-B fibronectin (EDB-FN) in the tumor microenvironment for detection and characterization of aggressive OSCC tumors. PROCEDURES: EDB-FN expression was evaluated in human normal tongue and OSCC specimens with immunohistochemistry. Invasiveness of human CAL27, HSC3, and SCC4 OSCC cells was analyzed with spheroid formation and transwell assays. EDB-FN expression in the cells was analyzed with semiquantitative real-time PCR, western blotting, and a peptide binding study with confocal microscopy. Contrast-enhanced MRI with MT218 was performed on subcutaneous OSCC mouse models at a dose of 0.04 mmol/kg, using gadoteridol (0.1 mmol/kg) as a control. RESULTS: Strong EDB-FN expression was observed in human untreated primary and metastatic OSCC, reduced expression in treated OSCC, and little expression in normal tongue tissue. SCC4 and HSC3 cell lines demonstrated high invasive potential with high and moderate-EDB-FN expression, respectively, while CAL27 showed little invasive potential and low-EDB-FN expression. In T1-weighted MRI, MT218 produced differential contrast enhancement in the subcutaneous tumor models in correlation with EDB-FN expression in the cancer cells. Enhancement in the high-EDB-FN tumors was greater with MT218 at 0.04 mmol/kg than gadoteridol at 0.1 mmol/kg. CONCLUSIONS: The results suggest EDB-FN has strong potential as an imageable biomarker for aggressive OSCC. MRMI results demonstrate the effectiveness of MT218 and the potential for differential diagnostic imaging of oral cancer for improving the management of the disease.

Influence of demographics on patients' receipt of endodontic therapy or implant placement.

INTRODUCTION: With the recent advancement in dental treatment modalities, patients are increasingly faced with the dilemma of selecting between root canal treatment (RCT) and implant placement (IP). Data on the influence of demographics on the aforementioned choice appear to be limited. The purpose of this retrospective cohort study was to investigate any association between demographic attributes and patients' receipt of RCT or IP. METHODS: The study sample for this computerized retrospective cohort study included 4084 dental school patients who received RCT and/or IP between 2006 and 2011. The following data were abstracted for each patient: age, sex, ethnicity, insurance status, and zip codes; the last variable was the proxy for socioeconomic status (SES). Statistical analysis included descriptive, chi-square test, and computation of odds ratios. RESULTS: Patient age, sex, race, insurance status, and SES were significantly associated with the choice of endodontic or implant therapy. Older patients were 6 times more likely as younger ones to receive IP. Males were 1.3 times more likely as females to have received IP; whites were twice as likely as blacks for the same treatment. Insured patients were 1.6 times more likely to have received RCT compared with uninsured patients The odds of patients from high SES receiving IP was 2.4 times greater than those from low SES. CONCLUSIONS: Demographic attributes and insurance status significantly affected the receipt of RCT or IP. Clinicians need to be aware that patient demographics and/or dental insurance status play a role in treatment decisions.

Assessment of patients' awareness and factors influencing patients' demands for sedation in endodontics.

INTRODUCTION: Endodontic therapy is perceived by many as a procedure to be feared. Many studies have reported that fear and anxiety are major deterrents to seeking dental care in general, but only a few deal with the use of sedation in endodontic therapies. The purpose of this study was to assess patients' awareness of and factors influencing the potential demand for sedation in endodontics. We hypothesized that there is an association between demographic factors and the demand for sedation in endodontics. METHODS: A survey consisting of 24 questions was given to patients 18 years and older who presented to the graduate endodontic clinic. Results were collected and statistically analyzed. RESULTS: Thirty-six percent of patients reported that their perception of sedation was being put to sleep, and 27% perceived it as related to or reducing pain. Concerns associated with endodontic therapy were the fear of pain (35%), fear of needles (16%), difficulty getting numb (10%), and anxiety (7%). The 2 major demographic factors that influenced the demand for sedation were cost and the level of anxiety (P < .05). Fifty-one percent showed a positive interest in sedation for endodontic therapy if the option of sedation was available. CONCLUSIONS: The demand for sedation in endodontics is high. Patients' understanding of sedation varies. More patients would consider having endodontic procedures if sedation was available. The provision of sedation by endodontists could result in more patients accepting endodontic therapies.

The role of insurance and training in dental decision making.

INTRODUCTION: The purpose of this investigation was to evaluate (1) the differences in treatment planning decisions between dental general practitioners and specialists and (2) the role of patients' insurance and/or type of treatment in decision making. METHODS: One hundred eighty subject charts were selected from 1,740 dental charts. Two specialists examined radiographs and reviewed the charts and then independently generated treatment plans. If there was disagreement between the 2 specialists, they discussed all aspects of the case until a consensus was reached. RESULTS: Four subjects were excluded. Thus, 176 patients were evaluated. A statistically significant difference (χ(2) = 202.303, P = .0001) was found between treatment plans designed by GPs and those designed by specialists. Patients' insurance status did not influence the degree of agreement between specialists and GPs. The odds ratio for Medicaid was 0.431 (95% confidence interval [CI], 0.103-1.801; P = .249), and for self-pay, it was 0.801 (95% CI, 0.328-1.955; P = .627). However, logistic regression analysis showed that the type of treatment plan designed by GPs (ie, endodontic treatment, endodontic retreatment, and extraction followed by implant placement) was significantly related to the degree of disagreement with the specialists (odds ratio = 4.522; 95% CI, 1.378-14.84; P = .013). CONCLUSIONS: Insurance did not play a role in the decision-making portion of the treatment plan. However, the type of treatment was found to be significant. Implant cases had the highest disagreement between the specialists and the general dentists.