Alcohol and mouth cancer.

There is now considered to be no safe limit for alcohol intake. Studies have shown that risk of mouth cancer increases with greater alcohol intake (in particular when associated with the use of tobacco). This paper reviews the role for alcohol in the aetiology of mouth cancer both in terms of how it may give rise to cancerous change and the relative risk it carries (arising from various systematic and meta-analyses reported over the last decade). While obtaining a reliable alcohol history can be problematic (with under reporting frequently suspected) greater awareness of the role of alcohol in both local and systemic disease (in particular that of cancer in an ever increasing number of sites) may serve as a motivator for behaviour change within our patients. To that end patients should be aware of the alcohol content in the drinks they consume and consider recording their alcohol intake over a defined period (eg, use of a diary or app over a two to four week period).

Retention of Asymptomatic Third Molars May be Unwise.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: What is the risk of future extraction of asymptomatic third molars? A systematic review. Bouloux GF, Busaidy KF, Beirne OR, Chuang S-K, Dodson TB. J Oral Maxillofac Surg 2015;73(5):806-11. SOURCE OF FUNDING: No external funding source is identified although all 5 authors appear to be on the American Association of Oral and Maxillofacial Surgery 3rd Molar Task Force TYPE OF STUDY/DESIGN: Systematic review.

Current practices and intention to provide alcohol-related health advice in primary dental care.

OBJECTIVES: To determine whether general dental practitioners (GDPs) currently provide alcohol-related advice (ARA) and to inform the development of an intervention, should one be required. METHOD: Cross-sectional postal survey of a random sample of 300 GDPs in Scotland. The questionnaire assessed beliefs derived from psychological models that explain behaviour in terms of beliefs that are amenable to change, and so may inform development of an intervention to encourage the provision of ARA. RESULTS: Sixty percent of GDPs responded. Eighty-three percent of participating GDPs (145/175) had not provided ARA to patients in the previous ten working days. Attitude (perceived consequences), control beliefs (perceived difficulty), subjective norm (perceived social pressure), and self-efficacy (confidence) significantly predicted intention to provide ARA. Alcohol-related knowledge or personal alcohol behaviour did not predict intention to provide ARA. CONCLUSIONS: There is scope to increase the provision of ARA in primary care dentistry and this study identified predictive beliefs, which could be targeted to encourage this behaviour. The next phase is to develop and test an intervention to encourage GDPs to provide ARA.

Delivering alcohol screening and alcohol brief interventions within general dental practice: rationale and overview of the evidence.

Alcohol consumption and affordability in the UK has increased over the last 50 years and is associated with a range of adverse oral health outcomes, the most serious of which, oral cancer, is also increasing in incidence. Despite this, routine screening and intervention relating to alcohol consumption within general dental practice remains uncommon. This review of the literature describes the background and outlines the evidence base for undertaking alcohol screening and delivering brief interventions in general dental practice. Consideration will be given to the rationale for, and range of issues related to, introducing this into general dental practice.

General dental practitioner views on providing alcohol related health advice; an exploratory study.

OBJECTIVE: To identify salient beliefs of general dental practitioners (GDPs) regarding their role in the identification of alcohol misuse and the provision of an alcohol related health message in the primary dental care setting. METHOD: A convenience sample of 12 GDPs practising in the North Highland region of Scotland underwent semi-structured interview. An inductive approach was used with subsequent basic thematic content analysis performed on the transcripts. RESULTS: GDPs universally agreed that alcohol consumption plays a role in both oral health and general health but this did not translate into effective communication about alcohol during dental consultation. Current knowledge of recommended safe alcohol consumption guidelines was poor - evidence of potential GDP training requirements. The primary barriers related to disruption of the clinician-patient relationship, embarrassment or the perceived irrelevance to the clinical situation. GDPs expressed low confidence in approaching alcohol related problems. CONCLUSIONS: GDPs felt that alcohol based discussions in primary care would not be relevant and would inevitably lead to disruption of the patient-clinician relationship. Further research is necessary to more fully understand the attitudes, behaviour and knowledge of GDPs regarding the provision of alcohol related health advice. The results of this study have informed the design of a paper postal survey for wider distribution.

Incidence of symptoms in previously symptom-free impacted lower third molars assessed in general dental practice.

AIM: To determine the potential of a pathology-free impacted lower third molar to cause symptoms within a year and whether these symptoms can be linked to clinical characteristics, lifestyle or socio-demographic status. DESIGN: One-year prospective cohort study of patients registered in general dental practice in Scotland with at least one asymptomatic impacted lower third molar. METHODS: All general dental practices with panoramic radiography facilities in Tayside, Fife and Greater Glasgow (Scotland, UK) were invited to participate in the study. Orthopantomographs taken between 1995 and 2002 were reviewed and eligible patients were contacted and invited to participate. Patients were assessed in their own dental surgery by the same research dentist. In this baseline assessment, the presence of impaction was confirmed and all patients with a previous history of symptoms and/or pathology were excluded from further analysis. Clinical characteristics such as the angulation and the degree of impaction were recorded. Patients also completed a socioeconomic questionnaire. Eligible patients were re-assessed by the same research dentist one year later when they were asked about their experience of symptoms within the past year. Information was cross-referenced with patients' dental records. RESULTS: A total of 613 patients attended the baseline appointment. Of those, 30 (4.89%) had a history of symptoms and were excluded from the study, leaving 583 (95.10%) eligible patients. From those, 421 (69%) patients with a total of 676 lower third molars were examined one year later. 22.67% of all vertically impacted teeth examined had developed symptoms, along with 13.15% of all mesially impacted, 30.69% of all distally impacted and 6.45% of all horizontal third molars. This association was statistically significant (p < or =0.001). 23.05% of all partially erupted teeth and a surprising 10.49% of all unerupted teeth were associated with symptoms during the study period. This association was also significant (p < or =0.001). There was also a statistically significant inverse association between the development of symptoms and age (p = 0.0028). CONCLUSIONS: The predictability that an impacted lower third molar will develop symptoms in future remains unclear. However, some clinical characteristics such as the angulation, the degree of impaction and the patient's age could be useful in predicting the likelihood of future symptomatology.

Detection of mucosal abnormalities in patients with oral cancer using a photodynamic technique: A pilot study.

Patients who have had one oral cancer are at increased risk of developing a further malignant tumour, the detection of which is made difficult (and is often delayed) by the innocuous appearance of the early oral lesion. A technique that could reliably detect early cancers would be useful to both oral and dental health specialists. We describe a pilot study in which we used a compact spectroscopic instrument designed to excite and measure fluorescence in the oral cavity. The data were processed using principal components analysis, and the results suggest that the technique might be valuable for detecting early oral cancers. Further work should be performed to investigate some unusual characteristics observed within our data to ascertain if these are significant, simply due to errors made due data collection, or are due to other lifestyle factors. Such work could also verify that the data are due to detection of ALA metabolite in cancer and not some other systemic effect.

Oral cancer awareness of general medical and general dental practitioners.

OBJECTIVE: To assess general medical practitioners' (GMPs') and general dental practitioners' (GDPs') awareness of prevention and early detection of oral cancer. DESIGN: Cross-sectional questionnaire-based study. SETTING: Primary care. METHOD: Questionnaires were delivered to all GMPs and GDPs in Tayside, assessing oral examination habits, delivery of advice on oral cancer risk factors, knowledge of oral cancer risk factors and clinical appearance, preferred point of referral and requests for further information. RESULTS: Response rates of 71% and 84% were obtained from GMPs and GDPs respectively. GMPs were less likely to examine patients' oral mucosa routinely, less likely to advise patients about risk factors for oral cancer, identified fewer risk factors for, and felt less confident about diagnosing oral cancer from clinical appearance than their dental counterparts. Seventy-one percent and 80% of GMPs and GDPs respectively requested further information about oral cancer. CONCLUSION: Patients with oral lesions often present to their general medical practitioner. The incidence of oral cancer is rising in the United Kingdom, therefore the role of general medical practitioners in prevention and detection of oral cancer is becoming ever more important. This study highlights the need for improved education of general medical practitioners on oral cancer.

Dyskeratosis congenita: oral hyperkeratosis in association with lichenoid reaction.

Dyskeratosis congenita is an inherited disorder that usually presents in males, consisting of a triad of leukoplakia of the mucous membranes, nail dystrophy and skin pigmentation. Whilst most cases are X-linked, autosomal dominant and recessive forms have also been reported. The significance of the condition lies in premature mortality arising from either bone marrow failure or malignant change within the areas of mucosal leukoplakia. We present a case (X-linked recessive form) where the classic triad of signs were present, along with the development of lichenoid reaction in the buccal and labial mucosa. This is believed to be the first case in which such a reaction has been noted together with the oral hyperkeratosis. The identification of a white patch within the mouth of a child, in the absence of any other obvious cause must arouse suspicion of this rare condition. All clinicians should be aware of this rare genetic disorder so that early referral can be made and appropriate management instigated.

Incidence of oral and oropharyngeal cancer in United Kingdom (1990-1999) -- recent trends and regional variation.

This study aimed to determine whether the incidence of oral cancer is continuing to rise in the UK and if this varies geographically. A descriptive epidemiological study of oral cancer incidence in 12 UK cancer registries (1990-1999) was undertaken. Poisson regression models were employed to assess trends. There were 32,852 oral cancer cases registered (1990-1999). Statistically significant increases in incidence of 18% and 30% were seen in males and females respectively (p<0.01). The trend was observed in younger (<45 years) and older (45+ years) age groups (p<0.01) with 3.5% and 2.4% average annual increases respectively. These increases were consistent for the majority of regions in the older group. For the younger group the increases in incidence were more rapid and differed geographically. Incidence remains higher in men than women, in older compared with younger groups, and in northern regions. These findings provide evidence of a continuing increase in the burden of oral cancer across the UK.

Vascularity and expression of vascular endothelial growth factor in oral squamous cell carcinoma, resection margins, and nodal metastases.

The role of vascularity as a predictor of the likelihood of lymph node metastases in oral cancer is not clear. To that end, the vascularity and expression of vascular endothelial growth factor (VEGF) was assessed at three specific regions: the tumour (inside and around the tumour); the resection margin; and the regional lymph nodes. Formalin-fixed paraffin-embedded specimens from 26 oral cancers (11 with no involved nodes and 15 with involved nodes) were stained immunohistochemically and examined. Staining for VEFG was significantly greater in the tumour than in the other sites. No significant differences were found in the intensity of staining in the primary tumour, resection margins, or nodes between cases in which the nodes were involved and in which they were not involved. We found no correlation between vascularity and VEGF staining, suggesting that VEGF is not the primary or only stimulator of angiogenesis in oral cancer. Greater understanding of the mechanisms of metastasis will lead to new treatments. The evidence that is accumulating for oral cancer suggests that such treatments may be better targeted at preventing lymphatic spread, rather than vascular spread.

Dyskeratosis congenita.

Dyskeratosis congenita is an inherited disorder that usually presents in males, consisting of the triad of leukoplakia of the mucous membranes, nail dystrophy and skin pigmentation. Whilst most cases are X-linked, autosomal dominant and recessive forms have been reported. The significance of the condition lies in premature mortality arising from either bone marrow failure or malignant change within the areas of leukoplakia. Various mucocutaneous and non-mucocutaneous manifestations have been reported. The syndrome arises from an inherited defect within the DKC1 gene that codes for the protein dyskerin in the X-linked recessive form of the disorder, whereas mutations in the RNA component of telomerase (TERC) result in the autosomal dominant form of the condition. The identification of a white patch within the mouth of a child in the absence of any other obvious cause should arouse suspicion of this rare condition. Greater understanding of the molecular biology surrounding this syndrome should lead to improvements in diagnosis, monitoring of disease progression and therapy.

The effect of the antibody used and method of quantification on oral mucosal vascularity.

A vast literature exists on angiogenesis particularly with regard to understanding tumour growth and development. This is no less true for oral cancer, where slight variations in protocols may invalidate comparison between studies. The influence of tissue processing, and the specific antibody and method of quantification used to identify blood vessels was assessed with respect to oral mucosal vascularity. The angiogenic profile of 20 frozen sections of clinically normal oral mucosa were compared with 16 paraffin-embedded specimens. Eight of the frozen specimens had matched paraffin-embedded tissue. Vascular antigens were identified immunohistochemically using four antibodies and blood vessel density was measured by three methods. CD31 and von Willebrand's factor (vWF) counts were higher than alpha-smooth muscle actin and alphanubeta3. Results for CD31 were higher in frozen tissue than paraffin-embedded tissue. Significantly more CD31-positive vessels were found in frozen tissue in the cohort of matched samples. For paraffin-embedded tissue vWF gave higher values for vascularity than CD31. The variation in antibody reaction to these markers of blood vessels suggests that the antibody employed and method of fixation is more important than the method of quantification used. Comparison of the results for fresh frozen tissue and paraffin-processed tissue suggests that this is acceptable for vWF but not for CD31.