Should the HPV positive oropharyngeal cancer patient be considered for a two-stage dental assessment for their radiation treatment?

Patients due to commence head and neck radiation treatment are expected to undergo a dental assessment and be deemed 'dentally fit'. Though this intervention is welcomed by the dental fraternity it is not without its challenges especially in human papilloma virus (HPV) related oropharyngeal cancer (OPC) which has seen a phenomenal rise over the past decade. This perspective piece presents these challenges and proposes a potential adaption of the dental assessment for HPV OPC patients though not necessarily exclusive to this tumour sub-site.

Assessment of Psychological Disturbance in Patients with Tooth Loss: A Systematic Review of Assessment Tools.

PURPOSE: To systematically review the available evidence on screening tools to detect the psychological disturbance in patients with tooth loss and technically successful removable dentures (partial and complete). MATERIALS AND METHODS: The study protocol was registered with the National Institute of Health Research Database (I.D. CRD42017082125). The PICOS tool (patients, intervention, control, outcomes measure, and study design) was used to formulate an effective search strategy. Participants were adults (≥ 18), who were edentulous or had significant tooth loss (< 9 remaining teeth). The intervention included undergoing replacement with technically successful dentures (partial or complete). A control group of adults were either edentulous or had significant tooth loss and without dentures. Outcomes included assessing psychological disturbance due to treatment with dentures or due to no treatment using a validated tool. A structured search strategy was used to complete a standard systematic search of the electronic database without any date limit and/or language restriction. Only quantitative studies using a validated measuring tool to screen for psychological distress in adults with significant tooth loss were included. Two authors independently assessed the risk of bias in the included studies. Data homogeneity was assessed in regards to the screening tools to measure psychological disturbance following the management of tooth loss with dentures. The significant level was set at 0.05, using IBM SPSS Statistics 24.0 (SPSS Inc., New York, NY). The psychometric properties and the validation processes of the screening tools were assessed. RESULTS: From the original 3510 studies identified, only eight studies were found to meet the inclusion criteria. All eight studies used the same questionnaire to screen for the emotional distress of tooth loss. In addition, one study also used the Patient Health Questionnaire-9 (PHQ-9) to screen for the association of depression with tooth loss. Six studies suggested that a significant number of patients have difficulties in accepting tooth loss, were less confident, and had emotional distress related to tooth loss. However, two studies reported no significant link. All studies found a marked impact on functional activities and social interaction. However, four studies had a potentially biased selection process, and the questionnaire used was assessed to be at high-risk of measurement bias, as the development and validation process was not clear. There was also a lack of well-defined control groups in all studies. CONCLUSION: Tooth loss could cause psychological disturbance in some patients. To date, there is a lack of available tools that are suitable to screen and measure psychological disturbance in patients with tooth loss. Additional research is required to develop tools to identify and measure such impact and to recommend suitable interventions when needed.

Volume Assessment of the Effect of Obturators on Facial Form Following Surgery for Head and Neck Cancer Using Stereophotogrammetry.

PURPOSE: To determine if stereophotogrammetry could be used to determine the effects of obturators on facial contour in relation to the measurement of facial volumes. MATERIALS AND METHODS: Stereophotogrammetry images were recorded from 20 subjects with and without their obturators in place. These were converted into a stereolithographic format and overlaid. Registrations were made using the tissues on the normal areas of the face. Difference images were created, enabling surface areas and volumes to be calculated. To assess repeatability of measurement, 2 readings were recorded on each of 2 separate registrations. Data analysis between the sets of readings used correlation coefficients and paired t-tests. Coefficients of repeatability were also calculated. RESULTS: A comparison of readings for the surface areas showed the method of measurement was repeatable with no significant differences between the 2 repeated readings for registration 1 (p = 0.977, coefficient of repeatability = 101 mm2 ), registration 2 (p = 0.085, coefficient of repeatability = 106 mm2 ), and the mean of the two readings for registration 1 compared with registration 2 (p = 0.355, coefficient of repeatability = 103 mm2 ). Similar results were found for the volume measurements with no significant differences between the repeated readings for registration 1 (p = 0.862, coefficient of repeatability = 229 mm3 ), registration 2 (p = 0.200, coefficient of repeatability = 209 mm3 ), and the mean of the 2 readings for registration 1 compared with those for registration 2 (p = 0.131, coefficient of repeatability 339 mm3 ). There was a statistically significant range of volumes that appeared to have been restored by the obturators (p < 0.0005). CONCLUSIONS: Stereophotogrammetry is reliable in assessing the effects of obturators on facial form. In the sample of subjects, obturators generally appeared to be effective in supporting facial tissues following surgical resections of the maxilla and therefore contribute in some degree to the restoration of facial appearance.

Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients--the York Consensus Statement.

The Annual Conference of the BSSPD (British Society for the Study of Prosthetic Dentistry) was held in York on 6 and 7 April 2009. At the symposium on mandibular overdentures, presenters offered a synopsis of the research available on the efficacy of implant-supported mandibular overdentures in the edentulous mandible. Emphasis was given to both qualitative and quantitative research based on patient-centred outcomes of treatment. A draft consensus was circulated to all presenters and to the Council members of the BSSPD and to BSSPD members on the Society's website. The statement was modified in the light of their comments, audience feedback following the presentations and members' feedback. We hope that this consensus statement will be a useful guide for patients and clinicians and that it will act to stimulate wider debate. We also hope that it will prove useful to other patient and professional organisations and will inform discussions with providers of national healthcare and with independent funders.

In vitro assessment of image-guided otologic surgery: submillimeter accuracy within the region of the temporal bone.

OBJECTIVES: Application of image-guided surgery to otology has been limited by the need for submillimeter accuracy via a fiducial system that is easily usable (noninvasive and nonobstructive). METHODS: A dental bite-block was fitted with a rigid frame with 7 fiducial markers surrounding each external ear. The temporal bones of 3 cadaveric skulls were removed and replaced with surgical targets arranged in a bull's-eye pattern about the centroid of each temporal bone. The surgical targets were identified both within CT scans and in physical space using an infrared optical tracking system. The difference between positions in CT space versus physical space was calculated as target registration error. RESULTS: A total of 234 independent target registration errors were calculated. Mean +/- standard deviation = 0.73 mm +/- 0.25 mm. CONCLUSIONS: These findings show that image-guided otologic surgery with submillimeter accuracy is achievable with a minimally invasive fiducial frame. Significance In vivo validation of the system is ongoing. With such validation, this system may facilitate clinically applicable image-guided otologic surgery. EBM RATING: A.