James Guggenheimer

Factors delaying the diagnosis of oral and oropharyngeal carcinomas

Most squamous cell carcinomas of the oral cavity and oropharynx are not diagnosed until they have attained at least the T2 stage (>2.0 cm). This study identifies factors which may contribute to the delayed diagnosis of these tumors, despite the fact that they frequently arise at sites readily accessible to examination. Personal interviews of 149 patients with oral and oropharyngeal squamous cell carcinoma revealed delays by patients of one day to more than one year (mean, 17 weeks) before seeking care. Furthermore, delay by doctors occurred in 45 instances (30%). Neither short nor long delays had a statistically significant relationship to tumor T stage at the time of diagnosis. The length of patient delay was also not related to age, gender, amount of education, or history of alcohol consumption. The authors concluded that the early carcinomas were probably asymptomatic and subsequent manifestations were commonly misinterpreted as benign or innocuous oral/dental problems. These inconspicuous or misleading perceptions may be primarily responsible for the advanced stages of these tumors at the time of discovery. Emphasis must, therefore, be placed upon gaining access to high‐risk individuals for periodic oral and oropharyngeal examinations and upon educational efforts to increase the skill of primary health care providers in recognizing this problem.

Clinicopathologic effects of cancer chemotherapeutic agents on human buccal mucosa

Specimens of buccal mucosa obtained at autopsy from 216 patients were examined for histopathologic alterations. Atrophic oral epithelium was found in thirty cases. A retrospective study of the hospital records revealed that thirteen of these latter patients had been on a cancer chemotherapeutic regimen prior to death. There was a significantly higher incidence of atrophy in the chemotherapy group (p less than 0.001) than in control patients. These findings, as well as the expected inherent susceptibility of rapidly replicating oral epithelial cells to metabolic inhibitors, suggest a causal relationship between oral atrophy and the administration of cancer chemotherapeutic agents. This atrophy may therefore represent a preliminary stage of mucosal alteration that ultimately progresses to the clinical sequelae of stomatitis and oral ulcerations frequently encountered during cancer chemotherapy. Some alternative mechanisms are also discussed.

Dental health status of liver transplant candidates

A prerequisite dental evaluation is usually recommended for potential organ transplant candidates. This is based on the premise that untreated dental disease may pose a risk for infection and sepsis, although there is no evidence that this has occurred in organ transplant candidates or recipients. The purpose of this study was to assess the prevalence of dental disease and oral health behaviors in a sample of liver transplant candidates (LTCs). Oral examinations were conducted on 300 LTCs for the presence of gingivitis, dental plaque, dental caries, periodontal disease, edentulism, and xerostomia. The prevalence of these conditions was compared with oral health data from national health surveys and examined for possible associations with most recent dental visit, smoking, and type of liver disease. Significant risk factors for plaque‐related gingivitis included intervals of more than 1 yr since the last dental visit (P = 0.004), smoking (P = 0.03), and diuretic therapy (P = 0.005). Dental caries and periodontal disease were also significantly associated with intervals of more than 1 yr since the last dental visit (P = 0.004). LTCs with viral hepatitis or alcoholic cirrhosis had the highest smoking rate (78.8%). Higher rates of edentulism occurred among older LTCs who were less likely to have had a recent dental evaluation (mean 88 months). In conclusion, intervals of more than 1 yr since the last dental visit, smoking, and diuretic therapy appear to be the most significant determinants of dental disease and the need for a pretransplantation dental screening evaluation in LTCs. Edentulous patients should have periodic examinations for oral cancer. Liver Transpl 13:280–286, 2007.

A survey of dental care protocols among US organ transplant centers

Abstract:  Untreated dental disease represents a potential risk for infection in transplant patients, but the vast transplantation literature has few references to this complication. There is also little information with regard to dental care protocols for patients before and after organ transplantation. To obtain more definitive documentation about the policies that deal with dental care and experience with dental infections, we conducted a survey of US transplant centers.The instrument consisted of eight questions that addressed pre‐transplant dental evaluation procedures, incidence of pre‐ and post‐transplant dental infections, and recommendations for antibiotic prophylaxis with dental treatment after transplantation. Questionnaires were sent to 768 medical and/or surgical directors at all US transplant centers. Responses were received from 294 recipients (38%). Among the respondents, 80% routinely requested a pre‐transplant dental evaluation, but 49% of these were only for specific organs. The occurrence of a dental infection prior to transplantation that resulted in a postponement or cancellation was reported by 38% of the respondents. Post‐transplantation sepsis from a suspected dental source was acknowledged in 27% of the surveys. Prophylaxis with antibiotics prior to dental care was recommended by 83%; 77% indicated that it be used for all dental procedures, whether invasive or not. Most respondents (96%) recommended the 1997 American Heart Association endocarditis prevention regimen. A survey of organ transplant centers has provided some information with regard to pre‐transplantation dental screening, dental infections, and the use of prophylactic antibiotics. Additional studies are needed in order to accrue more definitive data that will assist with the development of standardized and appropriate pre‐ and post‐transplant dental care protocols.

Oral manifestations of drug therapy

The oral cavity may be the target organ for a number of diverse abnormalities that develop from side effects of medications. Because of the widespread and increasing use of prescription, over-the-counter, and herbal remedies, it is becoming increasingly likely that the dentist will encounter soft tissue or dental pathologies that represent a complication of a therapeutic agent. The more common abnormalities that may occur include gingival hyperplasia, tooth discoloration, candidiasis, chemical injuries, and altered taste perception. The dental practitioner is often the primary health care provider who can recognize, diagnose, treat, and/or prevent these conditions.

Traumatic induction of an intraoral reinfection with herpes simplex virus: Report of a case☆

Abstract Intraoral ulcers developed at a traumatized site in a patient with a positive history of herpes labialis. Herpes simplex virus was isolated from the lesions. It is postulated that the trauma precipitated this intraoral reinfection by mechanisms similar to those responsible for the recurrent labial lesions.

Dental manifestations of the rubella syndrome

Abstract Enamel defects of the deciduous teeth occurred in twelve of fourteen children with documented manifestations of the rubella syndrome. Although the congenital rubella infection preceded the onset of enamel formation, studies since the 1963–1964 rubella epidemic have shown that the virus remains viable in the fetus and can still be isolated as late as 3 years after birth. The enamel lesions are, therefore, attributed to this prolonged effect of the virus on the ameloblasts.

Anticipation of dental anomalies induced by radiation therapy.

Therapeutic irradiation of the head and neck of children up to the age of 16 years can cause malformation and developmental arrest of the permanent teeth. Dental anomalies occurring after irradiation of the palatal tumor in an 8-year-old are described and compared with a normal 8-year-olds developmental sequence to demonstrate that the immature, noncalcified dental structures are most susceptible to radiation injury. The stage of dental development at the time of therapy may be precisely determined by a routine oral radiographic survey, which provides a reliable estimate of the deformation that may be anticipated following radiotherapy.

Medical conditions and medication use in a U.S. dental school clinic population.

OBJECTIVES The aim of the study was to characterize coexisting medical conditions and medication use in patients treated at a US dental school in 2010 and to assess their implications on providing dental care. STUDY DESIGN Data on the types and prevalence of self-reported medical conditions and the use of medications were extracted from the electronic health records of 1797 adult patients and compared against their socioeconomic status (SES). RESULTS Within this sample, 8.7% were classified as American Society of Anesthesiologists (ASA) physical status (PS) 1. The remainder were designated PS 2 to PS 4 for smoking, having one or more medical conditions that ranged from myasthenia gravis (<1%) to hypertension (24%), or both. Medications for hypertension were the most frequently reported (23%), followed by more than 40 other classes of drugs. CONCLUSIONS Dental practitioners must be prepared to treat larger numbers of older patients, whose life expectancies continue to increase as advances in pharmacotherapeutics and biomedical technologies improve the control of their chronic medical conditions.

A white lesion of the buccal mucosa

A A ss-year-old woman visited an emergency clinic (Department of Diagnostic Sciences, School of Dental Medicine, University of Pittsburgh) with a five -day history of dental pain. Her medical history included hypertension that was controlled with a calcium channel blocker, type 2 diabetes that was controlled with glyburide and an allergy to penicillin. The patient reported that her mandibular left second molar had been restored several years earlier. Within the previous week, however, she had begun to experience increasingly intense, throbbing pain and pain when chewing with that tooth. In an effort to relieve the discomfort, the patient took 200-milligram ibuprofen tablets every few hours, which provided only minimal relief. Several days later, she sought treatment. The extraoral examination revealed no facial swelling.