L. Lo Russo

The World Cancer Report and the burden of oral cancer

The WHO has recently provided the most comprehensive global examination of cancer to date, through the publication of the World Cancer Report (WCR). According to IARC-WHO estimates, cancer rates are set to increase at an alarming rate, from 10 million new cases globally in 2000, to 15 million in 2020. However, the report states that we have the opportunity to stem the predicted sharp increase in new cancer cases by taking action now, especially through planning effective cancer control strategies, such as reducing tobacco consumption, suggesting healthy lifestyle and diet, and performing early detection through screening. Although cancer of the oral cavity is largely related to lifestyle and can be easily detected and diagnosed at early stages through a 5 min visual inspection of the oral mucosa, actual figures concerning its prevention and early detection are dismal. Most oral cancers are detected at a late stage, requiring complex, costly and often ineffective therapies. Similarly, current research, educational and financial resources are focused on procedures burdened by high cost, high morbidity and unacceptable high mortality. Here we suggest that it is time to change this common point of view towards this disease and to alter this trend, stressing that there is no other oncologic specialty in which the WCR preventive guidelines could be applied in such an easy and effective manner, as in the field of oral cancer.

Clinical guidelines in early detection of oral squamous cell carcinoma arising in oral lichen planus: a 5-year experience

In recent years, studies on the malignant potential of oral lichen planus (OLP) provided clinical evidence that patients affected by OLP have an increased risk to develop oral squamous cell carcinoma (OSCC); nevertheless, controversies still exist as to whether OLP has inherent predisposition to become malignant, or not. We believe extremely careful management of OLP patient is mandatory, and the aim of this paper is to illustrate our clinical guidelines in evaluating the possible risk of transformation in OLP lesions. Five-hundred and two patients (311 women and 191 men) affected by OLP regularly undergo follow-up examination in our Department. Patients ages range from 18 to 83 years, with a mean of 55.4 years (57.5 for women and 53.9 for men); minimal follow-up period is 4 months, with a maximum of 12 years. In our group of OLP patients in the past 5 years we detected 24 carcinomas: excluding three cases in which diagnoses of OLP and OSCC were synchronous and three patients who had a history of tobacco use, thus possible malignant transformation of OLP would appear to be 3.7%. Clinical criteria used in our follow-up allowed us to detect 28.5% of tumours as in situ OSCC, 38% as microinvasive OSCC, 28.5% as stage I OSCC and 4.7% as stage II OSCC, with a remarkable improvement in prognosis compared to our previous study in which we adopted different criteria.

Oral manifestations of eating disorders: a critical review

BACKGROUNDnEating disorders (ED) are a group of psychopathological disorders affecting patient relationship with food and her/his own body, which manifests through distorted or chaotic eating behavior; they include anorexia nervosa, bulimia nervosa and ED not otherwise specified and may be burdened with life-threatening complications. As oral manifestations of ED can occur in many phases of disease progression, they play a significant role in assessment, characterization and prognosis of ED.nnnMETHODSnMucosal, dental, and salivary abnormalities associated with ED have been reviewed. Relations between oral menifestations and pathogenesis, management and prognosis of ED have been critically analysed.nnnRESULTSnOral manifestations of ED include a number of signs and symptoms involving oral mucosa, teeth, periodontium, salivary glands and perioral tissues; differences exist between patients with anorexia and bulimia. Oral manifestations of ED are caused by a number of factors including nutritional deficiencies and consequent metabolic impairment, poor personal hygiene, drugs, modified nutritional habits and underlying psychological disturbances.nnnCONCLUSIONnOral manifestations of ED can cause impairment of oral function, oral discomfort and pain, and an overall deterioration of aesthetics and quality of life. Their treatment can contribute to overall patient management and prognosis.

Effectiveness of small-volume, intralesional, delayed-release triamcinolone injections in orofacial granulomatosis: A pilot study

BACKGROUNDnOrofacial granulomatosis (OFG) is an idiopathic disorder characterized by chronic orofacial swellings causing significant cosmetic and functional problems. Treatment with high-volume triamcinolone injections has been shown to be effective but requires nerve block anesthesia and causes a dramatic temporary increase of lip swelling.nnnOBJECTIVEnWe have performed a noncomparative open-label pilot study in 7 patients with OFG in order to evaluate the effectiveness of small volumes of extended-release high-concentrate triamcinolone injections in reducing lip swelling and preventing recurrences.nnnMETHODSnSeven patients with OFG were studied. Small-volume, intralesional, high-concentrate, extended-release triamcinolone was injected on the basis of a weekly schedule. A standard cycle consisted of 2 or 3 injection sessions over 14 or 21 days, depending on the clinical response.nnnRESULTSnAfter cycle completion, all patients remained without recurrences or with cosmetically acceptable slight lip enlargement for a mean time of 19 months (range, 8-30 months). No side effects were observed, except in one patient with hypopigmentation of the skin of the upper lip.nnnCONCLUSIONSnSlow-volume, intralesional, high-concentrate, extended-release triamcinolone injections appear to be effective in reducing lip enlargement in patients with OFG and do not require nerve block anesthesia or cause a temporary troublesome increase of swelling. A long disease-free period is generally obtained.

Costs and effectiveness in the care of patients with oral and pharyngeal cancer : analysis of a paradox

Oropharyngeal cancer is estimated to be the ninth most common cancer worldwide. Its prognosis is largely dependent upon tumour-stage at the time of diagnosis. Stage I and II oropharyngeal cancers are characterized by a 5-year survival rate ranging from 70% to 90%, and the management of these early carcinomas is usually of short duration, easy and very cost-effective. On the other hand, the diagnostic evaluation, treatment and management of complications and recurrences of advanced stage oral tumours (stage III and IV) are often very long, complex and costly. They also have very poor prognosis with survival figures dropping to about 20%. Nowadays, most oropharyngeal cancers are detected at a late stage with an overall 5-year survival rate of around 45-50%, and with a conspicuous increase in treatment costs and a worsening of prognosis. Even if formal and comprehensive cost-effectiveness and cost-benefit analyses are not currently available in the oropharyngeal cancer literature, it seems clear that, in the care of these patients, the enormous consumption of resources is not associated with acceptable outcomes. New initiatives should be evaluated, planned and developed for the care of patients with oral and pharyngeal cancer. These strategies should be directed at prevention and early diagnosis in order to increase patient survival and quality of life and decrease the consumption of health care resources.

HCV infection and oral lichen planus: a weak association when HCV is endemic.

Abstractu2002 Oral lichen planus (OLP), an immune‐mediated disorder, has been reported as an extra‐hepatic manifestation of Hepatitis C virus (HCV) infection, especially in HCV hyperendemic areas such as southern Europe and Japan. The aim of this study was to investigate from an epidemiological standpoint whether HCV infection is an important factor affecting the relative risk of OLP in a Mediterranean population or whether this relates to the degree of HCV endemicity. Two cohorts of OLP patients resident in two different regions of southern Italy (Campania and Sicily; nu2003=u2003859) were evaluated for HCV infection status and categorized into five age classes to respective region‐matched controls. No significant difference was found between OLP patients and the general population in this area, when data were corrected by the age‐stratified prevalence of HCV. Therefore, the age‐specific prevalence of HCV infection in OLP patients shows a close trend of direct association with increasing age, without significant differences with the general population of each geographical area. An aetiological link between OLP and HCV cannot be inferred solely by epidemiological data.

Oral and pharyngeal cancer: lack of prevention and early detection by health care providers.

Worldwide, approximately 8% of all cancers in men occur in the mouth and pharynx, with a correspondŽ ing estimate for women being 4% Pindborg et al., . 1997 amounting to around 250 000 new cases in men each year and 120 000 in women. More than 90% of all oral and pharyngeal cancers occur in individuals older than 45, although there is evidence of an increasing incidence of tongue cancer in Ž . younger age groups La Vecchia et al., 1997 . Major risk factors include use of tobacco products, heavy alcohol consumption and exposure to the sun for lip cancer. According to late stages diagnosis, the 5-year survival rate is only 52%. In recent decades, in spite of advances in detection and treatment of many other malignancies, this rate has remained disapŽ pointingly low and relatively constant Greenlee et . al., 2000 . Treatment often produces dysfunction and distortions in speech, mastication, swallowing, dental health and even in the ability to interact socially. Thus, it must be considered among the most debilitating and disfiguring of all cancers. As is the case with most other malignancies, early detection of malignant and premalignant lesions and reduction of risk factors can produce a great improvement in the prognosis. Therefore, annual mouth examinations in people over 40 and the cessation of alcohol and tobacco consumption are the imperative goals of every health programme against Ž oral cancer American Cancer Society, 1992; British . Dental Association, 1998 . As many authors suggest ŽDanish Dental Association, 1990; Horowitz et al., . 1996 , dentists share an important role in secondary prevention of oral cancer. In fact, dental recalls are considered to be a great opportunity for the detection of asymptomatic early malignant neoplasm, for the differentiation of benign from precancerous conditions and for the undertaking of biopsies or referrals of patients to oral surgeons or oral medicine ENT specialists. This opportunistic screening of the oral mucosa, particularly in high-risk individuals, consists of soft tissue examination, which could be carried out as part of a 5-minute dental inspection. It is thought to decrease morbidity and mortality in the same way as other screening procedures, such as those used in respect of breast and cervical carcinomas. In the last few years other scientists have emphasized a more important role for dental practitioners, suggesting they should be responsible also for primary prevention, giving advice on smoking cessation, alcohol moderation and sun protection Ž . Macgregor, 1996; Johnson, 1997 . In spite of all these guidelines, in the past few decades no remarkable progress has occurred in improving the earlier diagnosis and prognosis of oral Ž . cancer Greenlee et al., 2000 . Most oral and pharyngeal malignancies are detected at a late stage and smoking and drinking habits still remain the major aetiological factors in the development of oral cancer, synchronous and metachronous second primary tumours of the upper aerodigestive tract. Tragically, only 14% of US adults reported having had oral Ž . cancer examinations Horowitz and Nourjah, 1996 . Surprisingly, many studies conducted to determine dentists’ attitudes and practices towards oral cancer prevention and early detection have shown contrary results. In a recent UK survey, 84% of dentists who replied claimed to provide routine oral mucosa exŽ aminations for all their patients Warnakulasuriya . and Johnson, 1999 . A similar US survey showed 81% of dentists reporting oral cancer examinations for 100% of their patients over the age of 40 and approximately 90% asking about cancer history and Ž . tobacco use Horowitz et al., 2000 . How is one to interpret these contrasting data? Worldwide, many authors report that most oral and pharyngeal carcinomas are not diagnosed until they have attained at least the T2 stage, revealing a delay of diagnosis varying from a few weeks to more than

Effect of desquamative gingivitis on periodontal status: a pilot study.

OBJECTIVEnDesquamative gingivitis (DG) represents the gingival manifestation associated with several mucocutaneous disorders and systemic conditions. Little is known of whether or not DG could influence the onset or progression of plaque-related periodontitis. In this study, the potential impact of DG on plaque-related attachment loss and pocket formation has been evaluated.nnnMETHODSnA cross-sectional evaluation of 12 patients with DG [eight oral lichen planus (OLP), four mucous membrane pemphigoid (MMP)], never treated for DG lesions or plaque-related periodontitis, was carried out. Probing depth (PD), clinical attachment loss (CAL), full-mouth plaque (FMPS), and bleeding (FMBS) scores were evaluated at six sites per tooth. Clinical parameters of sites with DG lesions were compared with that of DG unaffected sites.nnnRESULTSnMedian PD and CAL, as well as FMPS and FMBS, were not significantly different (P > 0.05 Mann-Whitney test) for both OLP and MMP patients. However, a negative association between DG lesions and PD < 4 mm (OLP: OR = 0.26; MMP: OR = 0.47), and a positive association with PD 4-6 mm (OLP: OR = 3.76; MMP: OR = 2.68) and with PD > 6 mm (only for OLP: OR = 3.83) were found to be significant.nnnCONCLUSIONSnThe potential interference between DG lesions and periodontitis needs further prospective investigation; nonetheless, a higher level of attention might be prudent.

An international survey of oral medicine practice: proceedings from the 5th World Workshop in Oral Medicine.

OBJECTIVESn(i) To define the current state of oral medicine clinical practice internationally, and (ii) to make recommendations for future modeling of the practice of oral medicine.nnnMATERIALS AND METHODSnA survey was designed by an international panel of oral medicine experts to assess the current state of oral medicine practice internationally. The survey was sent to oral medicine experts across the world, and responses were electronically stored and analyzed using descriptive statistics.nnnRESULTSnTwo hundred respondents completed the survey representing 40 countries from six continents. The two most common settings for an oral medicine practice were in a hospital and a dental school. More than 88% of respondents considered management of oral mucosal disease, salivary dysfunction, oral manifestations of systemic diseases, and facial pain in the definition of oral medicine.nnnCONCLUSIONSn(i) Oral medicine clinicians diagnose and manage a wide variety of orofacial conditions; (ii) There are significant differences in the definition of oral medicine clinical practice from country to country; (iii) India has the largest expansion of oral medicine services as defined by escalating numbers of clinicians within the specialty as compared with other countries; (iv) oral medicine practitioners have a wide range of professional responsibilities.

Aging and Oral Health: Effects in Hard and Soft Tissues

Changing demographics, including an increase in life expectancy and the growing numbers of elderly has recently focused attention on the need for geriatric dental care. Ageing affects oral tissues in addition to other parts of the human body, and oral health (including oral mucosa, lips, teeth and associated structures, and their functional activity) is an integral component of general health; indeed, oral disease can cause pain, difficulty in speaking, mastication, swallowing, maintaining a balanced diet, not to mention aesthetical considerations and facial alterations leading to anxiety and depression. The World Health Organization recommends the adoption of certain strategies for improving the oral health of the elderly, including the management and maintenance of oral conditions which are necessary for re-establishing effective masticatory function. Oral health is often neglected in the elderly, and oral diseases associated with aging are complex, adversely affecting the quality of life. Although oral health problems are not usually associated with death, oral cancers result in nearly 8,000 deaths each year, and more than half of these occur at an age of 65 years plus. This report, which is dedicated to geriatric physicians, geriatric dentistry and specialists in oral medicine reviews age-related oral changes in elderly patients and efforts to summarize the effects of aging in hard and soft oral tissues.