Jose V. Bagan

Oral squamous cell carcinoma overview

Most cancer in the head and neck is squamous cell carcinoma (HNSCC) and the majority is oral squamous cell carcinoma (OSCC). This is an overview of oral squamous cell carcinoma (OSCC) highlighting essential points from the contributors to this issue, to set the scene. It emphasises the crucial importance of prevention and the necessarily multidisciplinary approach to the diagnosis and management of patients with OSCC.

Oral cancer: Clinical features

Oral squamous cell carcinoma (OSCC) is a well-known malignancy that accounts for more than 90% of all oral cancers. In this article we will perform a brief review of its clinical characteristics and the differential diagnosis. Regarding symptoms, pain is the most frequent presentation and the tongue and the floor of the mouth have the highest occurrence. OSCC in its initial stages shows an erytholeukoplastic area without symptoms but in advanced stages there are ulcers and lumps with irregular margins which are rigid to touch. The different diagnosis should be established with other oral malignant diseases such as lymphomas, sarcomas and metastasis, which have rapid growth rates as opposed to the typical OSCC.

Recent advances in Oral Oncology 2007: Epidemiology, aetiopathogenesis, diagnosis and prognostication

This paper provides a synopsis of the main papers on epidemiology, diagnosis and prognosis of oral and oropharyngeal squamous cell carcinoma (OSCC) and head and neck SCC (HNSCC) published in 2007 in Oral Oncology - an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, and all other scientific articles relating to the aetiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck, and orofacial disease in patients with malignant disease.

Psychiatric morbidity in burning mouth syndrome: Psychiatric interview versus depression and anxiety scales

Seventy-four patients with burning mouth syndrome underwent a psychiatric interview; Hamiltons Depression and Anxiety Scales were applied independently. A psychiatric diagnosis was established in 38 cases (51.35%). Depression was the predominant disorder. The evaluation scales showed that when present, anxiety greatly influences the psychiatric condition of these patients. The differences in the results obtained with the two methods are discussed.

Collagen telopeptide (serum CTX) and its relationship with the size and number of lesions in osteonecrosis of the jaws in cancer patients on intravenous bisphosphonates

Osteonecrosis of the jaws (ONJ) is an important possible late adverse effect of bisphosphonates. Serum C-terminal cross-linking telopeptide of type I collagen (CTX) can determine bone turnover and can act as a biological marker of bone resorption. We studied this biological marker in 15 patients (Group 1) with bisphosphonate-induced ONJ comparing with a control group of 10 healthy people matched by age and gender. We found no statistically significant relationships in Group 1 either between the serum CTX and the number of areas of exposed bone nor with the size of the osteonecrotic area.

Osteonecrosis of the jaws in patients treated with intravenous bisphosphonates (BRONJ): A concise update

Bisphosphonate-related osteonecrosis of the jaws (BRONJ) is a severe complication seen most frequently in patients on intravenous bisphosphonates treatment for malignant diseases. High potency bisphosphonates are generally implicated and risk factors also include dental extractions. Prevention is of paramount importance. Management is controversial but there is little evidence basis and the consensus is to be conservative. Recent advances in this area are summarised in this concise review.

Prevalence of psychopathology in burning mouth syndrome: A comparative study among patients with and without psychiatric disorders and controls

Forty-nine patients with burning mouth syndrome were simultaneously evaluated through a psychiatric interview and a psychopathologic questionnaire (SCL-90). The same protocol was applied to a control group (n = 47) free of oral complaints and with a similar age and sex distribution. The subgroup with burning mouth syndrome and associated psychiatric disorders differed from the subgroup of patients without psychiatric disorders in that the former exhibited significantly more symptoms of anxiety, depression, obsession, somatization, and hostility. This latter parameter appears to be present particularly among depressed persons. No significant psychopathologic differences were observed between the subgroup with BMS who exhibited no psychiatric disorders and the controls who were free of oral disorders.

Osteonecrosis of the jaws in intravenous bisphosphonate use: Proposal for a modification of the clinical classification

Osteonecrosis of the jaws induced by bisphosphonates, first reported by Marx is now widely recognised: more than 260 reports appear in Medline-PubMed. There are many series of cases presented in the last years. A clinical stage classification has been proposed, based on clinical symptoms (mainly pain) and the presence of lesions and complications such as jaw fractures and skin fistulas by Ruggiero et al. There are three stages in this Ruggiero classification: Stage 1 is exposed bone necrosis without symptoms; Stage 2 is exposed bone necrosis with symptoms; and Stage 3 is where there are jaw fractures, skin fistulas or osteolysis extending to the inferior border. This classification is used to guide treatment and may also be useful to establish international criteria. However, based on observations made since the original paper, we now propose the following two modifications of Stages 1 and 2; Stage 1. That the inclusion criteria include patients with an oral fistula without obvious bone exposure, since these patients cannot be classified in the original Ruggiero’s classification and yet must have a small intraoral fistula (Table 1). Stage 2. That the Ruggiero classification, which consists of a patient who has an exposed necrotic jaw bone with symptoms, should be divided.

Recent advances in oral oncology 2008; squamous cell carcinoma imaging, treatment, prognostication and treatment outcomes

This paper provides a synopsis of the main papers on diagnosis, imaging, treatment, prognostication and treatment outcomes in patients with oral and oropharyngeal squamous cell carcinoma (OSCC) and head and neck SCC (HNSCC) published in 2008 in Oral Oncology - an international interdisciplinary journal which publishes high quality original research, clinical trials and review articles, and all other scientific articles relating to the aetiopathogenesis, epidemiology, prevention, clinical features, diagnosis, treatment and management of patients with neoplasms in the head and neck, and orofacial disease in patients with malignant disease.

Dental endosseous implants in patients on bisphosphonate therapy.

About a decade ago, bisphosphonates were introduced as an alternative to hormone replacement therapies for osteoporosis and to treat osteolytic tumors. More recently, it has became evident that the bisphosphonates used intravenously such as pamidronate (Aredia; Novartis Pharmaceuticals Corp., East Hanover, NJ) and zoledronate (Zometa; Novartis Pharmaceuticals Corp.), in particular, could lead to painful refractory bone exposure (sometimes termed osteochemonecrosis or osteonecrosis) in the jaws. Patients with osteonecrosis of the jaws usually present after dental treatment with oral signs and symptoms of painful, exposed, and necrotic bone, primarily of the mandible and, to a lesser extent, the maxilla. Although the precipitating event that produces this complication may be spontaneous, there is little doubt that oral surgery and endosseous implants can be responsible. Exodontia is the main precipitant. The present postulated mechanism of osteonecrosis of the jaws is that prolonged use of bisphosphonates may suppress bone turnover to the point that the repair function of physiologic microdamage of bone is abolished. Such a mechanism could presumably interfere with the healing process after implant placement. Although, to our knowledge, there is no evidence that bone disorders are a contraindication to implants, there is evidence that bisphosphonate therapy is a contraindication. Where possible, extractions should be avoided, and it is best to avoid all elective oral surgery in patients on bisphosphonates, including endosseous implant placement, or the treatment should be performed well before commencing bisphosphonates. If surgery is essential on a patient taking bisphosphonate therapy, the patient must be counseled about the risks.