Jed J. Jacobson

Proliferative verrucous leukoplakia: a report of ten cases.

A particularly aggressive form of oral leukoplakia that commences with a hyperkeratosis, spreads to become multifocal and verruciform in appearance, and later becomes malignant has been termed proliferative verrucous leukoplakia. Ten patients with persistent multifocal verruciform white patches were investigated. Lesions were often bilateral and affected predominantly mandibular alveolar and buccal mucosa. At first biopsy no lesion was graded higher than a verrucous hyperplasia, but subsequently all patients had squamous cell carcinoma, and two patients have died of their disease. Lesions were managed with surgery, carbon dioxide laser, and photodynamic therapy. The patients presented here confirm the existence of proliferative verrucous leukoplakia as a clinicopathologic entity. Careful examination of the whole mouth is essential when a hyperplastic white patch is seen to check for possible proliferative verrucous leukoplakia. Early aggressive treatment must then be started, and regular long-term review is crucial.

The relationships among fluoride, cariogenic oral flora, and salivary flow rate during radiation therapy

Changes in the quantity of Streptococcus mutans, Lactobacillus species, and yeast Candida species were assessed in a cancer population undergoing head and neck radiation. The purpose of this study was to evaluate the effectiveness of a custom vinyl tray-applied fluoride gel to control cariogenic bacteria in a group experiencing hyposalivation because of radiation treatment. Twenty-two subjects participated in the study and served as their own controls. Whole resting and whole stimulated saliva were collected at weekly appointments beginning 1 week before and concluding 4 weeks after radiation therapy. Colony-forming units per mL of Streptococcus mutans and Lactobacillus species and semiquantitative counts of Candida species (0 = none; 1 = light; 2 = moderate; 3 = heavy) were determined from collected saliva. All patients were provided with custom vinyl vacuform mouthguards to be used daily with neutral fluoride gel (1.1% sodium fluoride). Whole stimulated and resting saliva productions decreased by 36.67% and 47.9%, respectively, by the end of 1 week of radiation therapy, and they remained low. No significant changes in cariogenic oral flora were seen during and early after radiation therapy, despite xerostomia. However, colonization by Candida albicans increased during radiation therapy for oropharyngeal cancers. Findings from this study suggest that changes in cariogenic flora may be suppressed through the use of daily topical neutral sodium fluoride gels and that colonization by Candida albicans increase during radiation therapy.

Chemoprophylaxis of prosthetic joint patients during dental treatment: A decision-utility analysis

A decision-analytic model and a cost effectiveness analysis was performed on 1 million hypothetic prosthetic joint patients undergoing dental treatment, to determine the most cost-effective strategy to prevent late prosthetic joint infections. The cost per quality-adjusted life-year saved (QALY) was determined for three preventive strategies: no prophylaxis, oral penicillin, and oral cephalexin. The UCLA Pain-Walking-Function-Activity Scale was used to obtain quality-of-life adjustments (utility assessment) for the study population. Costs were derived from 70 patients hospitalized between July 1, 1982, and June 30, 1986, at the UCLA Center for Health Sciences. The most cost-effective preventive strategy was the no prophylaxis alternative (

Dental treatment and late prosthetic joint infections

196,500/QALY). However, by recommending a 1-day strategy of oral cephalexin only to those dental patients at high risk for late prosthetic joint infections rather than a 3-day regimen to all patients, the cost effectiveness improved from

The cost burden of oral, oral pharyngeal, and salivary gland cancers in three groups: commercial insurance, medicare, and medicaid

1.1 million/QALY to

Oral staphylococcus in older subjects with rheumatoid arthritis.

446,100/QALY while maintaining a low risk of death (0.38 deaths per 10(6) dental visits).

Prophylaxis of candidiasis in patients with leukemia and bone marrow transplants

Hospital and dental charts of 2,693 patients in whom total prosthetic joints had been placed at the Veterans Administration Hospitals of Ann Arbor and Allen Park, Michigan, as well as at The University of Michigan Hospital, were analyzed. Of the thirty (1.1%) late prosthetic joint infections (greater than 6 months after placement), only one (0.04%) could be temporally associated with dental treatment. A Fishers exact test of the data reflected that dental treatment in this population did not increase the incidence of late prosthetic joint infections (p value is 0.0005). Nine of the thirty late infections occurred in insulin-dependent diabetic patients and patients on long-term immunosuppressive therapy. An analysis of the organisms isolated from the late infections shows that 54% where Staphylococcus epidermidis and Staphylococcus aureus. These data do not support the practice of prescribing prophylactic antibiotic coverage of prosthetic hip and knee joints prior to all dental therapy. Rather, use of antibiotics during dental treatment appears warranted only if a chronic bacteremia is anticipated or where a predisposing systemic condition may exist.

Caries-related salivary microorganisms and salivary flow rate in bone marrow recipients

BackgroundHead and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated.MethodsA retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients.ResultsTotal annual health care spending for OC/OP/SG patients during the year after the index diagnosis was

Bacteria isolated from late prosthetic joint infections: Dental treatment and chemoprophylaxis☆☆☆

79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance (

Probe placement during electric pulp-testing procedures

71,732, n = 3,918), Medicare (