Harold D. Sgan-Cohen

Oral cancer over four decades: epidemiology, trends, histology, and survival by anatomical sites

BACKGROUND Oral cancer is one of the few life-threatening oral diseases. The subtypes and different sites of oral cancer has different etiology epidemiology and survival rate. Prevalence of the various anatomical oral sites provided potential baseline for improvement of clinical approach. METHODS Incidence and survival rates were derived from the Israel National Cancer Registry and included all registered data between 1970 and 2006. Oral cancer included the lips, tongue, buccal mucosa, gums, vestibulum, floor of the mouth, and palate. RESULTS Most prevalent oral cancer subtype was squamous cell carcinoma (SCC) among men above the age of 55 years. Females had a higher incidence of SCC in lateral border of tongue, gums and buccal mucosa. Lymphoma and sarcoma were the most prevalent under the age of 20. Melanomas and metastatic disease revealed the lowest survival rate, while invasive or infiltrating basal cell carcinoma in the lips had the highest rate. The highest oral survival rate was for the lip, and the lowest was for the tongue and gums. CONCLUSIONS Early detection of oral cancer is important for all the medical health team. Decrease in lip carcinoma may be a result of occupational or awareness changes and should be studied. Non-epithelial tumors under the age of 20 should be considered as a differential diagnosis. A basic oral examination should be included in all routine medical examinations, with emphasis on high-risk patients and high-risk oral sites.

Lip cancer: incidence, trends, histology and survival: 1970–2006

Background  High levels of lip cancer have been reported among Israelis over the last four decades. Epidemiological descriptions and analyses for this region have not previously been presented.

Self – perceived and clinically diagnosed dental and periodontal health status among young adults and their implications for epidemiological surveys

BackgroundClinical (normative) and subjective (self-assessment) evaluation of caries and periodontal diseases have been reported to demonstrate a significant disparity. The dental public health team is obligated to recognize and understand this gap. The objectives of the study were to investigate the practical values of using questionnaires (self–perceived assessment) as compared to clinical examinations (normative assessment) and to evaluate the implications of the results in understanding the publics perception of oral health.MethodsThe investigation was performed on 4920, 21 year-old Israeli adults upon release from compulsory military service between 1996 and 1998. Participants were asked to fill in a questionnaire inquiring how they would rate their personal dental and periodontal health levels. Clinical examinations, employing the DMFT and CPITN indices, were performed to determine normative oral health status. Perceived and normative assessments were compared for sensitivity, specificity, positive and negative predictive values and overall proportions using the clinical examinations as a gold standard.ResultsThe sensitivity (disease perception) for dental status was found to be 0.34, while the specificity (health perception) was found to be 0.83. The positive predictive value for perceived dental status was found to be 0.68, whereas the negative predictive value was found to be 0.54. The sensitivity for perceived periodontal status was found to be 0.28, while the specificity was found to be 0.83. The positive predictive value for perceived periodontal status was found to be 0.05, whereas the negative predictive value was found to be 0.97. Regarding the overall proportions, a large discrepancy was found between self–assessment and professional assessment for both dental and periodontal health status.ConclusionsSelf-assessment questionnaires were of low value in evaluating oral health status both in the individual and public levels, though perception levels of health were higher than that of disease. Findings reflects a low level of awareness of the public that may influence care-seeking behavior and highlight the importance of oral health promotion and the crucial need for public health action.

Influence of Adapted Environment on the Anxiety of Medically Treated Children with Developmental Disability

OBJECTIVES To examine the influence of a sensory adapted environment (SAE) on the behavior and arousal levels of children with developmental disability in comparison with typical children, during a stress-provoking medical situation. STUDY DESIGN Sixteen children (6-11 years old) with developmental disability and 19 age-matched typical children participated in a cross-over trial measuring behavioral and psychophysiological variables, performed during a dental intervention. RESULTS Both groups performed better in the SAE compared with the regular environment (RE), by comparing: the mean duration of anxious behaviors in the SAE and RE (5.26 and 13.56 minutes; P <or= .001); the mean electrodermal activity for arousal levels, before commencement of treatment in the SAE and RE (784 and 349 Kohms; P= .002); and the mean electrodermal activity during treatment in the SAE and RE (830 and 588 Kohms; P= .001). A significant group by environment interaction was revealed, indicating that the difference in the 2 environments was greater in children with developmental disability than typical children in all 3 measures. CONCLUSIONS These findings indicate the importance of environment in determining the comfort level of all children. The greater difference in the 2 environments observed in children with developmental disability suggests that this group benefits more from sensory adapted environments.

Socio‐economic position, smoking, and plaque: a pathway to severe chronic periodontitis

AIM To report periodontal status and elucidate the relationship among socio-economic position (SEP), plaque accumulation, tobacco smoking, and periodontitis in a representative sample of adult Jewish people, aged 35-44 years, living in Jerusalem. METHODS This cross-sectional study was conducted using a stratified sample of two hundred and fifty-four 35-44-year-old adults in Jerusalem (limited to the Jewish population). A clinical examination (Community Periodontal Index and Plaque Index) and a self-administered questionnaire were applied. RESULTS Two hundred and fifty-four adults, mean age 38.6 (SD=3.3) years, participated. The response rate was 88%; intra-examiner κ values were above 0.87. The average number of healthy sextants was 1.18, while the average number of sextants with bleeding, calculus, shallow periodontal pockets, and deep periodontal pockets was 1.3, 2.6, 0.7, and 0.1, respectively. Lower level of education was associated with severe chronic periodontitis (SCP, p=0.012) and also with smoking (p=0.030) and higher level of plaque (p<0.001). Smoking was associated with higher level of plaque (p<0.001), which in turn was associated with SCP (p=0.020). CONCLUSION This study presented a potential explanatory pathway for the relationship between SEP and SCP. Low level of education was proposed as a distal determinant, leading to tobacco smoking and higher levels of plaque, and finally to SCP.

Sources of Stress among Israeli Dental Students

Abstract One hundred four Hebrew University-Hadassah dental students, graduates of 1981, 1982, 1983, and 1984, ranked a list of 17 potential stress sources in the dental school environment. The main self-reported stressors involved the specific method of teaching dentistry: the quantitative clinical requirements system, inconsistent and no positive feedback from faculty, and fear of falling behind or failing. Items related to time management occupied the middle section of the ranked stress items, while more “objective” and inherent components of dental training—understanding and covering the material taught, manual dexterity, new vocabulary, and treating adults—appeared at the bottom of the list. Treating children was ranked significantly more stressful than treating adults. The main reported stress items tended to increase over time: from fifth till sixth year, and from first till third trimester. Female dental students usually reported higher levels of stress sources than their male counterparts. Studie...

Traumatic dental injuries and related factors among sixth grade schoolchildren in four Palestinian towns

BACKGROUND Traumatic dental injuries (TDI) are recognized as an important dental public health issue among children. The West Bank, a part of the Palestinian Authority, is in immediate neighborhood to Israel. There are inadequate epidemiologic data among the Palestinian people, on dental health issues. AIM To determine the occurrence of TDI to permanent teeth among sixth grade Palestinian schoolchildren living in four large towns of the West Bank and to investigate associations with anatomic and demographic factors. MATERIAL AND METHODS Eight hundred and four children were sampled and examined in Ramallah, Bethlehem, Hebron and Jericho. Data collection included clinical examinations in schools and questionnaires for demographic and socio-economic background. RESULTS The prevalence of traumatic dental injuries was 17.7%. Enamel fractures and injuries involving dentine accounted for 41% and 42.5% of all injuries, respectively. The most affected teeth (89%) were upper central incisors. Only 5% of the injured teeth were treated. Results of multiple logistic regression confirmed that TDI were significantly (P < 0.001) more prevalent among boys, children presenting incisal overjet larger than 5 mm, and incompetent lip coverage. CONCLUSIONS The relative high prevalence and very low levels of treated TDI identified in this study suggested that both prevention and treatment of TDI in the West Bank were inadequate.

Psychological distress and social support are determinants of changing oral health status among an immigrant population from Ethiopia

OBJECTIVES To examine associations between psychosocial profile (psychological distress and social support) and changing oral health status (dental caries and periodontal disease), among a group of immigrants from Ethiopia to Israel. METHODS Three hundred and forty immigrants, aged 18-75 years, with a mean age of 38.4±13.5 years, comprised the study population and were followed over a 5-year period. Dental caries was recorded employing the DMFT index. Periodontal health status was recorded employing the Community Periodontal Index (CPI). Participants were interviewed using a structured written questionnaire which included two validated psychosocial scales, for psychological distress and social support. Bivariate and multivariate analyses were performed. RESULTS Among subjects with psychological distress, the adjusted mean caries (DMFT) increment in 2004-2005, since baseline (1999-2000), was 3.52±0.19 when compared to 0.35±0.15 among subjects with no psychological distress (P<0.001). Correspondingly, the percentage of people with increased periodontal pockets was 40%, when compared to 7%, respectively (P<0.001). In multiple linear regression analysis employing the DMFT as a continuous variable, and in multiple logistic regression analysis employing the DMFT as a dichotomous variable (% caries versus % caries-free), the four variables that reached statistical significance as predictors of caries status were previous caries experience, psychological distress, social support, and age. Gender, income, and education were not significantly related to current caries prevalence. In a multiple logistic regression analysis, the three variables that reached statistical significance as predictors of periodontal disease (shallow and deep pockets) were previous periodontal disease experience, psychological distress, and age. Social support, gender, income, and education were not significantly associated with periodontal disease prevalence. CONCLUSIONS This study presents persuasive evidence that supports the role of psychological distress and social support as determinants of changing oral health levels, among a low socioeconomic, relatively homogenous immigrant minority population.

Periodontal health status and smoking among young adults

AIM Our aim was to evaluate the periodontal status and present smoking habits among a representative sample of young adult Israelis and to investigate possible associations. MATERIAL AND METHODS A representative sample of young adult Israelis was examined and interviewed on the day of release from compulsory military service. Collected data included demographic background (gender, education level, family size and fathers country of origin) and current smoking habits. Clinical examination included the recording of periodontal health status according to the Community Periodontal Index (CPI). RESULTS Seven thousand and fifty-six young adults were examined. Sixteen per cent were classified as CPI 0, 78% as CPI 1-2 and 6% as CPI 3-4. In total, 36% of the sample reported a current smoking habit. Periodontal status was significantly improved among non-smokers, females and children of fathers born in Israel or Western countries. CONCLUSION Only 7% of the participants demonstrated signs of periodontitis and most young adults did not smoke; a dose-response association was revealed between present smoking habits and periodontal disease.

The effect of oral health on quality of life in an underprivileged homebound and non-homebound elderly population in Jerusalem.

OBJECTIVES: To measure the effect of oral health on quality of life in elderly people in Jerusalem and to compare homebound and nonhomebound people.