Peter B. Lockhart

Relationship of oral complications to peripheral blood leukocyte and platelet counts in patients receiving cancer chemotherapy.

Patients undergoing cancer chemotherapy often suffer from oral complications as a result of their disease and its treatment. The effects of the chemotherapy on the bone marrow and oral mucosa, coupled with the patients immunosuppressed state and altered oral microbial flora, predispose these patients to oral mucositis, infection, and hemorrhage. The oral mucosa appears to mirror the effects of the chemotherapy on the bone marrow, as there appears to be a direct relationship between the changing peripheral blood counts and the status of the oral mucosa.

Pretherapy dental status of patients with malignant conditions of the head and neck

Maxillofacial problems after radiotherapy to this region are common and have at least a temporal relationship to preexisting odontogenic disease. This study was undertaken to determine the dental status of patients before multimodality therapy for head and neck cancer. One hundred thirty-one patients were examined during their initial visit to a head and neck tumor clinic. The majority of dentulous patients were noncompliant with routine dental care (76%) and oral hygiene (65%). There was a high incidence of alveolar bone loss (66%), clinical caries (71%), and failing restorations (91%). Overall, 73 (97%) of the dentulous patients needed dental care before radiotherapy; however, follow-up visits revealed that 59 (81%) of these patients did not seek the indicated treatment. These data suggest that thorough oral examinations should be performed on all patients before radiotherapy that involves the oral cavity.

Oral pathoses as diagnostic indicators in leukemia.

A retrospective chart review of 500 leukemia patients was carried out to analyze the role of oral pathoses in the presentation of leukemia and to determine those factors which affect the frequency of oral involvement during the initial clinical phases of the disease. The data indicate that oral pathoses were frequent signs or symptoms in patients with undiagnosed acute leukemia but were less prevalent in patients with undiagnosed chronic leukemia. Neither age nor sex appeared to be a significant factor affecting oral involvement. Oral signs of thrombocytopenia were the most prevalent complaint of patients seeking diagnosis for their leukemia because of an oral problem, and they were also most frequently responsible for oral problems found at initial physical examination. Head and neck lymphadenopathy was also a frequent presenting sign or symptom. Dentists were responsible for initiating the diagnosis of leukemia in a significant number of patients with acute nonlymphoblastic leukemia.

Delayed extraoral hypersensitivity to dental composite material

Despite their similarities to acrylic resins, composite resins have not been reported to cause allergies. This report documents the case of a patient who experienced several delayed hypersensitivity reactions associated with epoxy-based materials, including dental composite resin. Patch testing confirmed her hypersensitivity to the composite materials. Removal of the composite restorations and replacement with acrylic restorations did not trigger further allergic reactions. Dentists using composite resin materials should be aware of both the possibility of delayed extraoral manifestations of hypersensitivity to those materials and the management of these patients.

Oral complications of multimodality therapy for advanced squamous cell carcinoma of head and neck

Investigational treatment of advanced localized stage III or stage IV squamous cell carcinoma of the head and neck may include chemotherapy in addition to radiotherapy and surgery. Such therapy, while effective in eradicating local tumors, often produces considerable oral toxicity. In this study we reviewed the oral complications of 22 patients receiving multimodality cancer treatment. The addition of chemotherapy to the treatment regimen did not increase the incidence of complications (osteoradionecrosis, mucositis, xerostomia, radiation caries, or infection) when compared with historical controls receiving radiotherapy alone. Pretreatment dental evaluation and close follow-up of these patients are encouraged.

Gingival pigmentation as the sole presenting sign of chronic lead poisoning in a mentally retarded adult

A diagnosis of chronic lead poisoning in a mentally retarded adult with pica was initially proposed because of the presence of a lead line on the patients gingiva. The patient had no other signs or symptoms suggestive of her toxic state. Lead poisoning is reviewed from the standpoint of epidemiology, pathophysiology, clinical and oral manifestations, and diagnostic procedures. Dentists working with children or mentally retarded patients should be aware of the increased incidence of lead poisoning in these patient populations and the importance of oral findings and lead-screening techniques in the detection of lead poisoning.

Severe oral hemorrhage and sepsis following bone marrow transplant failure

Aplastic anemia is a failure of all the cellular components of the bone marrow and, untreated, usually results in death from bleeding and/or infection within 4 months. Treatment by bone marrow transplantation offers the only means of survival. When a bone marrow graft fails, the patient is extremely susceptible to severe infection and/or hemorrhage. In this case, a bone marrow transplantation in a 34-year-old white man with aplastic anemia failed. Among the medical problems that subsequently developed were severe, prolonged and life-threatening oral bleeding and infection.