Tanya S. Rouleau

Risk of oral and gastrointestinal mucosal injury among patients receiving selected targeted agents: a meta-analysis

PurposeThe purpose of this study was to estimate the risk and severity of oral and gastrointestinal mucosal toxicities associated with selected targeted agents.MethodsWe searched the English-language literature in February 2011 for reports of randomized clinical trials comparing a FDA-approved targeted agent to a standard of care regimens. Long-term follow-up and secondary reports of trials were excluded, leaving 85 studies for analysis. Using meta-analytic methods, we calculated the relative risks of oral and gastrointestinal toxicities, adjusting for sample size using the inverse variance technique. For each targeted agent and each side effect, we calculated the number needed to harm, the number of patients that, if treated with the more toxic regimen, would produce one additional episode of the toxicity.ResultsOral mucositis was significantly more frequent among patients treated with bevacizumab, erlotinib, sorafenib, or sunitinib, although this difference was confined to low-grade mucositis. The clinical significance of these findings is unclear given its low incidence and mild severity. In contrast, diarrhea was significantly more frequent with most of the targeted agents studied, with adjusted relative risks between 1.5 and 4.5. An additional patient with diarrhea will be observed for every three to five patients treated with these targeted agents, compared with conventional regimens.ConclusionsOral mucosal toxicities occasionally complicate treatment with these targeted agents, but the clinical significance of this finding is not clear. Diarrhea is a hallmark of treatment with these targeted agents; this side effect should be carefully ascertained to permit early intervention and control.

Oral Complications of Sjögren's Syndrome

Numerous oral manifestations associated with salivary gland dysfunction, and particularly Sjögrens syndrome, have been reported in the literature. This article discusses the evidence on a wide range of oral manifestations associated with Sjögrens syndrome.

Receipt of dental care and barriers encountered by persons with disabilities

A study was conducted to describe the receipt of dental care by patients with disabilities and to understand their perspective with regard to barriers to dental care. Subjects for this study were recruited among patients with disabilities seen at Carolinas Rehabilitations outpatient clinic. A questionnaire consisting of 66 questions was completed by 344 subjects; with the topics related to both medical and dental care. Among the study population, 57.2% of subjects reported being seen by a dentist within the last 12 months, versus 67.3% before they became disabled. The last dental appointment was a routine examination for 59.5% of the respondents. Since becoming disabled, 16.6% of subjects reported problems receiving dental care. Financial challenges were the primary problem followed by physical accessibility issues. Further research is required to discover how barriers to care can be overcome to assure that those with disabilities receive adequate dental care.

The effect of air abrasion preparation on the shear bond strength of an orthodontic bracket bonded to enamel

The purpose of this study was to determine the method of preparation of enamel which best retains a bonded orthodontic bracket against a shear force. Two hundred and twelve human lower premolars were randomly divided into four equal groups. Group 1 underwent no air abrasion, group 2 received treatment with 25 microm aluminium oxide particles, group 3 with 50 microm particles, and group 4 with 100 microm particles. All groups were treated with a self-etching primer before bonding of an orthodontic bracket. Each tooth was tested in a JJ Lloyd M30K machine to determine the maximum shear force required to dislodge the bracket from the tooth. A one-way analysis of variance test conducted at a 95 percent confidence level (CL) demonstrated that there was a significant difference (P < 0.01) with respect to the four methods of preparation of the enamel surface. An unpaired t-test was then applied at a 95 percent CL. There was no statistically significant difference between groups 1 and 2. There was, however, a statistically significant difference between groups 1 and 3 (P < 0.01), as well as between groups 1 and 4 (P < 0.01). In addition, there was significant difference found between groups 2 and 3 (P < 0.05), groups 2 and 4 (P < 0.01), and groups 3 and 4 (P < 0.05).

Meta-analysis of cardiovascular toxicity risks in cancer patients on selected targeted agents

PurposeThe purpose was to estimate the risk and severity of cardiovascular toxicities associated with selected targeted agents.MethodsWe searched English-language literature for randomized clinical trials published between January 1, 2000 and November 30, 2013 of targeted cancer therapy drugs approved by the FDA by November 2010. One hundred ten studies were eligible. Using meta-analytic methods, we calculated the relative risks of several cardiovascular toxicities [congestive heart failure (CHF), decreased left ventricular ejection fraction (DLVEF), myocardial infarction (MI), arrhythmia, and hypertension (HTN)], adjusting for sample size using the inverse-variance technique. For each targeted agent and side effect, we calculated the number needed to harm. Results: Regarding CHF, trastuzumab showed significantly greater risk of all-grade and high-grade CHF. There was significant increased risk of all-grade DLVEF with sorafenib, sunitinib, and trastuzumab and high-grade DLVEF with bevacizumab and trastuzumab. Sorafenib was associated with significant increased all-grade risk of MI based on one study. None was associated with high-grade risk of MI or increased risk of arrhythmia. Bevacizumab, sorafenib, and sunitinib had significant increased risk of all-grade and high-grade HTN.ConclusionsSeveral of the targeted agents were significantly associated with increased risk of specific cardiovascular toxicities, CHF, DLVEF, and HTN. Several had significant increased risk for high-grade cardiovascular toxicities (CHF, DLVEF, and HTN). Patients receiving such therapy should be closely monitored for these toxicities and early and aggressive treatment should occur. However, clinical experience has demonstrated that some of these toxicities may be reversible and due to secondary effects.

A retrospective, cohort study of the prevalence and risk factors of oral burning in patients with dry mouth

OBJECTIVES The aims of this study were to evaluate the prevalence of oral burning in a dry mouth cohort of patients and to determine associated factors. STUDY DESIGN A retrospective cohort study was conducted by reviewing the charts of 170 patients who presented to Carolinas Medical Centers Department of Oral Medicine from January 2004 to June 2009. Information collected from their charts was extensive. RESULTS Forty percent (68 of 170) of dry mouth patients had a concomitant complaint of oral burning. Sixty-four were female and 4 were male. The mean age was 61.1 years (range 25-89). Cofactors associated with oral burning included age (OR 1.03, CI 1.00-1.05, P = .028) and use of herbal medications (OR .26, CI .10-.67, P = .005). CONCLUSIONS Oral burning is often concomitant with oral dryness. Targeting factors associated with oral dryness may help alleviate an oral burning complaint in select populations.

A systematic review of oral herpetic viral infections in cancer patients: commonly used outcome measures and interventions

PurposeTo review the literature for outcome measures for oral viral infections in cancer patients. A secondary aim was to update the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) clinical practice guidelines for the management of oral viral infections in cancer patients.MethodsDatabases were searched for articles published in the English language, 1981–2013. Studies that met the eligibility criteria were reviewed systematically. The data about the outcome measures were classified according to the aim of the study: prevention, treatment, or non-interventional. The results of interventional studies were compared to the 2010 MASCC/ISOO publication.ResultsMultiple clinical and laboratory tests were used to measure oral viral infections, with great variability between studies. Most of the studies were about Herpes Simplex Virus (HSV). The outcome measure that was most commonly used was the presence of HSV infection diagnosed based on a combination of suggestive clinical presentation with a positive laboratory result. HSV culture was the most commonly reported laboratory outcome measure. Acyclovir and valacyclovir were consistently reported to be efficacious in the management of oral herpetic infections. No new data on the quality of life and economic aspects was found.ConclusionsConsidering the variability in outcome measures reported to assess oral herpetic infections the researcher should select carefully the appropriate measures based on the objective of the study. Acyclovir and valacyclovir are effective in the management of oral herpetic infections in patients receiving treatment for cancer. Studies on newer anti-viral drugs may be useful to address the issue of anti-viral resistance.

Meta-analysis: Risk of congestive heart failure (CHF) in selected targeted agents.

64 Background: Congestive heart failure (CHF) is among the most serious cardiovascular side effects of targeted agents (TA) impacting the clinical outcomes (including survival) of cancer patients on this therapy. Although clinical trials have reported this toxicity, often sample sizes are small and systemic evaluations are lacking. The objective of this study is to estimate risk and severity of CHF due to selected TAs. METHODS We identified 110 English language studies of 26 TAs approved by the Food and Drug Administration as of November 2013 via MEDLINE. Of those, 8 studies including nearly 8000 patients provided TA-related data on the incidence and severity of CHF. Using meta-analytic methods, we calculated the relative risks of CHF, adjusting for sample size using the inverse variance technique. For each TA, we also determined the number needed to harm. RESULTS See table. CONCLUSIONS In 5 studies including more than 7,000 patients, trastuzumab showed significantly greater risk of CHF. For every 9 patients treated with trastuzumab, there was 1 additional case of CHF compared to control regimens. A careful patient selection before therapy and early detection of CHF by judicious monitoring of patients on this therapy may prevent serious complications and allow maintenance of cancer treatment. [Table: see text].