ORONASAL SQUAMOUS CELL CARCINOMAS IN FRANÇOIS' LANGURS (TRACHYPITHECUS FRANCOISI).

Squamous cell carcinomas (SCCs) are common oronasal tumors in nonhuman primates. In this study, 11 cases of oronasal SCC in François' langurs ( Trachypithecus francoisi ) are described. Five initial cases were discovered on review of the North American François' langur studbook, with a potential familial pattern observed. The studbook was used to identify related individuals, and records were requested for review. Six additional cases were documented, and samples from all cases were submitted for microscopic review, as well as polymerase chain reaction (PCR), immunohistochemistry (IHC), and in situ hybridization (ISH), for generic papillomaviruses and PCR for herpesviruses because either virus may cause SCC in humans and other nonhuman primates. Affected langurs commonly presented with facial swelling or ocular discharge but frequently did not have clinical signs, and carcinomas were diagnosed during routine examinations. Carcinomas were located in the oral or nasal cavities affecting the oral mucosa, tongue, hard palate, or oropharynx. Histologically, SCCs comprised anastomosing cords and nests of neoplastic epithelial cells that differentiated synchronously and asynchronously from peripheral basal type cells to central squamous-type cells and were occasionally oriented around accumulations of necrotic cell debris. Nuclear pleomorphism, anisokaryosis, prominent nucleoli, occasional mitoses, and a scirrhous response were common features. All animals tested negative for both viruses, except two langurs that were positive for generic papillomavirus by PCR, but no papillomavirus was detected by either IHC or ISH. In most cases, affected animals died within 5 mo of diagnosis.

Neuroepithelial structures associated with the subepithelial nerve plexus of taste buds: a fortuitous finding resembling the juxtaoral organ of Chievitz.

Numerous embryologic epithelial remnants are described in the oral region, when intimately associated with peripheral nerves, may pose a diagnostic pitfall for pathologists. The literature contains cases in which the juxtaoral organ of Chievitz (JOC) was identified in specimens removed because of a malignancy and the correct recognition of this structure potentially avoids unnecessary treatment. To our knowledge, this is the description of neuroepithelial structures similar to the JOC were found in the posterior tongue in close association with the subepithelial nerve plexus of taste buds. Four cases are reported. The nerve fibers of the subepithelial nerve plexus showed strong positivity for S-100, CD56, and synaptophysin, and were intimately associated with epithelial islands. CD56 showed positivity around the periphery of the epithelial islands. Proper recognition of these anatomic structures is crucial to prevent misdiagnosis of squamous cell carcinoma with perineural invasion.

Assessing the association between bisphosphonate exposure and delayed mucosal healing after tooth extraction.

BACKGROUND: Tooth extraction in patients exposed to bisphosphonates (BPs) is considered a risk factor for osteonecrosis. The authors evaluated the time to mucosal healing and frequency of osteonecrosis after tooth extraction in participants exposed to BPs. METHODS: The authors compared wound healing after tooth extraction in participants exposed to BPs with that in control participants who had not been exposed to BPs. Variables included age, sex, type of BP therapy (oral or intravenous), BP exposure time and C-terminal telopeptide (CTX) test results. The authors followed up patients weekly or biweekly until healing was complete. They used multivariable analyses to model time to healing in the presence of covariates, and estimates provided hazard ratios (HRs) and 95 percent confidence intervals (CIs) adjusted for all variables in the model. RESULTS: The authors enrolled 53 participants with BP exposure and 39 control participants. Postextraction healing was significantly longer in participants exposed to BPs (P < .001) than it was in control participants. One patient (1.9 percent) developed osteonecrosis. A Cox proportional hazards model in which the authors controlled for age, sex and CTX values showed that BP exposure alone significantly (adjusted HR, 0.27; 95 percent confidence interval, 0.16-0.48) increased mucosal healing time [corrected]. CONCLUSIONS: The study results showed that postextraction healing was impaired in patients exposed to BPs. CTX values were not associated with delayed healing after tooth extraction. PRACTICAL IMPLICATIONS: Postextraction healing was delayed in patients receiving BP therapy. However, the risk of developing osteonecrosis was low.

How patients' lack of knowledge about oral bisphosphonates can interfere with medical and dental care.

BACKGROUND: Oral bisphosphonate use has been associated with a small risk of developing oral osteonecrosis that occurs spontaneously or after the patient has undergone dental surgery. The authors conducted a study to determine whether patients taking bisphosphonates had knowledge about the medical indication for the therapy and the duration of treatment, as well as whether they had been educated by their physicians about possible adverse reactions. METHODS: From June 2008 through April 2009, people seeking routine care in a dental clinic and who were being treated with bisphosphonates were invited to participate in the study. The participants were asked questions involving knowledge about the medical indications related to their taking bisphosphonates, the duration of their therapy and whether they had been educated about possible adverse reactions. RESULTS: The authors interviewed 73 participants; 84 percent stated they knew why they were receiving bisphosphonate therapy. However, 80 percent said they were unsure about the duration of therapy, and 82 percent could not recall if they had been told about the risk of experiencing adverse reactions, including oral osteonecrosis, by their physicians. CONCLUSION: People taking bisphosphonates may be unfamiliar with the drug and its possible adverse oral side effects. CLINICAL IMPLICATIONS: Dentists should be prepared to educate patients about the risks of developing oral complications resulting from bisphosphonate use and the need for appropriate dental care. Questions regarding discontinuation of bisphosphonate therapy should be answered by the physician.

Oral cancer: a prosthodontic diagnosis.

The prosthodontic literature is replete with articles addressing the reconstruction, psychological adaptation, prosthesis success, quality of life, need for careful follow-up, and many other issues related to the patient who has undergone surgery, radiation, and/or chemotherapy for oral malignant neoplasms. However, in the prosthodontic professional literature, there is a paucity of information related to the early diagnosis and referral of lesions that may represent premalignant or malignant neoplasia. This article will describe the rationale, epidemiology, and appearance of oral premalignant and malignant mucosal lesions as well as the state-of-the-art diagnostic tools currently available to prosthodontists to ensure that their patients are diagnosed at the earliest possible time.