Computer-assisted analysis of the oral brush biopsy.

Computer-assisted analysis of the oral brush biopsy is a recently introduced tool that determines the significance of an oral lesion. The oral brush biopsy is minimally invasive, requires no anesthesia, and definitively distinguishes benign from precancerous and cancerous lesions. Oral brush biopsy specimens are analyzed with the aid of a highly specialized neural network-based computer system specifically designed to detect oral epithelial precancerous and cancerous cells.

Prevention and detection of lip cancer--the dentist's role.

With their attention to the oral area, dentists are in an excellent position not only to diagnose lip cancer, but also to counsel patients in its prevention. Patients need to be educated on the dangers of ultraviolet radiation and the measures available to decrease exposure to it. This article discusses the circumstances that increase the chance of developing lip cancer, the variety of ways to decrease that chance, and the recognition and treatment of premalignant and malignant lip lesions.

Actinic cheilitis: a review of 152 cases.

OBJECTIVE: The purpose of this study was to determine whether any clinical or histopathologic variables are associated with the severity of epithelial change in lesions of actinic cheilitis. STUDY DESIGN: A total of 152 acceptable cases of actinic cheilitis were identified from 66,067 cases accessioned from February 1989 to June 1998. For each case, the clinical information supplied by the submitting practitioner at the time of the biopsy and 8 histopathologic variables were evaluated. RESULTS: The following 5 histopathologic variables were positively correlated with an increased degree of epithelial change: acanthosis, basophilic change within the connective tissue, the presence of inflammation within the connective tissue, perivascular inflammation, and thickness of the keratin layer. None of the clinical variables was associated with an increased degree of epithelial change. CONCLUSIONS: The presence of any of the aforementioned histopathologic changes should prompt a close evaluation of the lesion for the presence of either epithelial dysplasia or carcinoma.

The use of exfoliative cytology for the early diagnosis of oral cancers: is there a role for it in education and private practice?

BACKGROUND: Early detection of oral cancers is not easy, because oral precancerous lesions and early oral cancers can mimic many benign conditions in the mouth, leading to delays in diagnosis and treatment. There is a need to emphasize the early diagnosis of oral cancers in order to reduce the unacceptably high morbidity and mortality. METHODS: A survey regarding oral exfoliative cytology was completed by 132 dentists in Virginia who were randomly chosen from a mailing list. RESULTS: Less than half of the dentists (41.7%) had been taught how to obtain a cytologic smear, and only 26.0% knew the clinical indications for doing so. Only 9.2% of the dentists had ever obtained a cytologic smear in private practice. Of the 13 dentists in the survey who had done so, 12 had been trained in the technique. Interest in learning the cytologic technique and getting the needed supplies was indicated by 79.2% of the dentists. CONCLUSIONS: Diagnostic aids in the evaluation of oral mucosal lesions can serve an important role by identifying lesions that need to be biopsied in spite of a "benign" appearance. Exfoliative cytology, as well as vital staining, may aid in this goal. This has implications regarding undergraduate and postdoctoral education.

The effect of clinical information on the histopathologic diagnosis of oral epithelial dysplasia.

OBJECTIVES: The purpose of this study was to test the hypothesis that clinical information submitted with biopsy specimens helps pathologists be more consistent and accurate in diagnosing oral epithelial dysplasia. STUDY DESIGN: Each of six board-certified oral and maxillofacial pathologists examined the same set of 120 oral biopsies (involving diagnoses ranging from hyperkeratosis to severe epithelial dysplasia); they had examined these same biopsies in a previous study, but this time the clinical information was provided for each case. The examiner's diagnosis was compared to the sign-out diagnosis for each case. RESULTS: Rates of exact agreement with the sign-out diagnosis averaged 38.5%, and there was 85.4% agreement within one histologic grade. The rate of agreement in distinguishing epithelial dysplasia from no dysplasia was 71.4%. These results, when compared to those from a previous study in which the same examiners had evaluated the same slides but without clinical histories, represent a 2.5% to 20% decrease for exact agreement among the six pathologists, a 0% to 8.5% decrease for agreement within one histologic grade, and a 0% to 23.4% decrease for agreement regarding the presence or absence of epithelial dysplasia. CONCLUSIONS: When clinical information was used, accuracy and consistency among board-certified oral and maxillofacial pathologists in the diagnosis of oral epithelial dysplasia was not improved. In fact, there was a decrease in accuracy.

Needlesticks: what to do after it happens.

A needlestick injury can be a frightening and even potentially a life-threatening event. It needs to be treated with compassion and some urgency. The dentist-employer should act with knowledge of the current law and with the desire to do whatever is best for the affected people.

Intraexaminer and interexaminer reliability in the diagnosis of oral epithelial dysplasia.

OBJECTIVES: Pathologists differ in their definition of "dysplasia." This study was done to test the hypothesis that experienced oral pathologists are consistent in diagnosing epithelial dysplasia. STUDY DESIGN: Six board-certified oral pathologists examined 120 oral biopsies exhibiting simple hyperkeratosis to severe dysplasia. No clinical information was given, and presence of dysplasia was judged by histomorphology. Examiners' diagnoses were compared with sign-out diagnoses for each case. Months later, each examiner viewed 60 relabeled slides from the original 120. Each diagnosis was compared with the diagnosis in the first round. RESULTS: Exact agreement with the sign-out diagnosis averaged 50.5% (within one histologic grade 90.4%). Examiners agreed exactly with their own diagnoses 50.8% of the time (within one histologic grade 92.4%). Agreement distinguishing dysplasia from no dysplasia compared with original sign-out diagnosis was 81.5%. Agreement with themselves distinguishing dysplasia from no dysplasia was 80.3%. CONCLUSIONS: Accurate reproducible agreement among experienced board-certified oral pathologists diagnosing oral epithelial dysplasia is difficult to achieve.

Avoiding unsuspected respiratory side-effects of topical timolol with cardioselective or sympathomimetic agents.

Topical timolol given for the treatment or chronic simple glaucoma may cause unrecognised bronchospasm among elderly people. We recruited 80 patients aged over 60 years, who were without a history of airways disease and already used timolol, into a randomised crossover study comparing the effects on spirometry and exercise tolerance of changing to betaxolol or dipivefrine therapy. Results showed an increase of 13% and 8% in mean peak flow rate and forced expiratory volume in 1 s (FEV1), respectively, when using betaxolol; and of 14% and 11% when using dipivefrine. There was also improved exercise tolerance with both agents. More than a quarter of the patients showed at least a 15% improvement in FEV1 when changed from timolol. Analysis of enrolment symptoms and response to nebulised salbutamol failed to produce a method of identifying these patients. Timolol may impair respiratory function and exercise tolerance of elderly patients even if they have no history of reversible airways disease.

Oral melanotic macules. A review of 353 cases.

Clinical and histopathologic data were obtained on 353 cases of oral melanotic macules. The mean age at the time of diagnosis for all sites was 43.1 years. A significant predilection for females (p < 0.001) was noted and the most common location was the lower lip (33.0%). The mean size of the lesions was 6.8 mm. Brown was the most common color (64.9%), and most (66.0%) of the lesions were described as flat. Melanin was evident in both the basal cell layer and lamina propria in 93.5% of the cases.

Precancerous lesions of the mouth.

Leukoplakia is the only important precancerous lesion of the mouth. The epidemiology of oral leukoplakia has been well established in white adults in the United States. There is a hole in the epidemiologic literature, however, on leukoplakia in American minority populations. Recent literature has begun to address the issue of the pathophysiology of leukoplakia, its causes and treatment, and predicting its malignant transformation. Computerized image analysis, retinoid compounds, beta-carotene, and laser surgery are contributing to advances in these lines of research. Though leukoplakia is often seen in patients who use smokeless tobacco products, it is usually benign and reversible if use of the tobacco product is discontinued. The direction of current research in leukoplakia studies eventually should lead to an understanding of the nature and cure of this ubiquitous lesion.

Informatics in dental education: a horizon of opportunity.

Computers have presented society with the largest array of opportunities since the printing press. More specifically in dental education they represent the path to freedom from the memory-based curriculum. Computers allow us to be constantly in touch with the entire scope of knowledge necessary for decision making in every aspect of the process of preparing young men and women to practice dentistry. No longer is it necessary to spend the energy or time previously used to memorize facts, test for retention of facts or be concerned with remembering facts when dealing with our patients. Modern information management systems can assume that task allowing dentists to concentrate on understanding, skill, judgement and wisdom while helping patients deal with their problems within a health care system that is simultaneously baffling in its complexity and overflowing with options. This paper presents a summary of the choices facing dental educators as computers continue to afford us the freedom to look differently at teaching, research and practice. The discussion will elaborate some of the ways dental educators must think differently about the educational process in order to utilize fully the power of computers in curriculum development and tracking, integration of basic and clinical teaching, problem solving, patient management, record keeping and research. Some alternative strategies will be discussed that may facilitate the transition from the memory-based to the computer-based curriculum and practice.

Comparison between the peripheral ossifying fibroma and peripheral odontogenic fibroma.

This study presents previously unreported data on a series of 400 peripheral ossifying fibromas (POFs) and 13 peripheral odontogenic fibromas (PODFs). The differences between the two lesions are discussed, and comparisons are made with other reports in the literature. It is concluded that the lesions represent separate pathologic entities.

Odontomas.

A total of 351 odontomas were retrieved and analyzed from 53,824 submitted specimens. The majority (53.6%) were diagnosed in the second decade of life; the most common location was the anterior portion of the maxilla (33.9%), but there was no overall predilection for the maxilla. An associated unerupted tooth was present in at least 47.6% of the cases. Dentigerous cysts were diagnosed in conjunction with 27.6% of the odontomas, and a calcifying and keratinizing odontogenic cyst was seen in 0.9% of the cases.