Use of oral nutritional supplements in irradiated patients with head and neck cancer

OBJECTIVES

Malnutrition is common among patients with head and neck cancer (HNC) and associated with poorer outcomes. Oral nutritional supplements (ONS) are often prescribed, with concerns raised about their cariogenicity. This study examined ONS use and caries experience in patients with HNC 12 months post-diagnosis.

METHODS

Fifty-four patients with HNC referred for pre-radiotherapy dental assessment were recruited. Data collected included: age, gender, residential postcode, smoking, alcohol use, HNC characteristics, dental history, oral hygiene habits, dietary advice and ONS use. Data was collected at diagnosis, during radiotherapy and 6 weeks, three, six- and 12-months post-treatment completion.

RESULTS

Fifty-one subjects completed the study. 76.5% of the participants used ONS for an average of 13.8 weeks. Caries developed in 22.9% of ONS users and 11.1% of non-users (p = 0.6585). The mean overall duration of ONS use was 18.7 weeks for the caries group and 8.5 weeks for the caries-free group (p = 0.1507). Lack of collaboration and disconnection was noted between dietary advice given by dieticians and dentists.

CONCLUSIONS

ONS use is common among patients with HNC. Larger studies are needed to establish the reasons for caries development and impacts of ONS use on oral health. Importance of multidisciplinary management of malnutrition is highlighted.

Clinical competency of dental health professionals and students in diagnosing oral mucosal lesions

OBJECTIVE

Proper identification of oral potentially malignant disorders (OPMDs) provides an opportunity for oral cancer prevention. This study aims to assess the competency of dental health professionals in identifying OPMDs and, in turn, reducing the incidence of oral malignancy by early detection.

METHODS

A 26-case online questionnaire of oral mucosal lesions was distributed to cohorts of 363 dental health professionals and dental students in Australia. The participants were asked to provide their provisional diagnosis for each case based on the available information.

RESULTS

The overall accuracy in identifying oral mucosal lesions was 65.9%. There were no significant differences in the overall diagnostic accuracies between dental specialists, general dental practitioners and final-year dental students (p > 0.05). The lowest diagnostic accuracies were associated with normal mucosal variations and OPMDs. The predoctoral dental curriculum showed statistically significant values in terms of improving skills in diagnosing oral mucosal lesions.

CONCLUSIONS

Lack of adequate knowledge in identifying OPMDs was evident among the participants, highlighting a non-promising figure in reducing the incidence of oral cancers in Australia. Comprehensive modifications of the current continuing professional development system are required to ensure adequate knowledge among dental health providers in Australia.

Anti-neutrophil cytoplasmic antibody associated vasculitis of the brain and oral cavity: a case report

We report a patient with a novel presentation of anti-neutrophil cytoplasmic antibody positive (ANCA+) vasculitis of the brain and oral mucosa. ANCA+ vasculitis of the brain is usually associated with pachymeningitis and hypophysitis, and there are no cases reported with simultaneous brain and oral mucosal involvement. A 35-year-old African Zambian man presented with headache and bleeding swollen gingiva. He was myeloperoxidase (MPO) antibody positive with cytoplasmic staining. His MRI showed stable small callosal, periventricular and subcortical white matter non-enhancing lesions, without change over 15 months-compatible with vasculitis. His gingival biopsy was consistent with vasculitis. His headache and oral lesions responded to oral corticosteroids and intravenous immunoglobulin which have induced clinical remission. Our patient expands the clinical syndrome of ANCA+ MPO+ C-type vasculitis of the central nervous system with headaches complicating cerebral vasculitis and oral mucosal involvement.

Changes in quality of life over time in patients diagnosed with oral leukoplakia: A prospective longitudinal study

BACKGROUND

Oral leukoplakia (OL) is one of the most prevalent oral potentially malignant disorders (OPMD). Although there is emerging evidence that quality of life (QoL) is impaired in subjects with OL; studies to date are based on single and heterogenous point-in-time assessments. The aim of this study was to ascertain if QoL scores change over time in individuals diagnosed with OL.

METHODS

Forty-one individuals with OL were administered the Short Generic Health Questionnaire (SF-12) and the discipline-specific Oral Potentially Malignant Disorder Questionnaire (OPMDQ) at four points in time: at the time of clinical diagnosis, at the post-biopsy review (confirmed diagnosis), and at 3- and 6-month follow-up appointments. Responses were compared between the four time points.

RESULTS

No significant differences were observed in the SF-12 questionnaire scores over time. However, a general improvement in the participants' life quality was evident over the 6-month period under investigation in the domains of psychological and social well-being (p = 0.0027) and effect of treatment on daily life (p = 0.0317) as well as in the total score (p = 0.0005) of the OPMDQ. Age, gender, medical status, tobacco/alcohol use, lesion site, size, the presence of dysplasia and treatment did not impact QoL scores over time.

CONCLUSIONS

QoL scores of OL subjects may improve with time. Our results suggest that studies examining QoL in individuals with OL should be controlled for time at which the participants are surveyed.

Factors influencing the cariogenic potential of oral nutritional supplements indicated for use in adults with or at risk of malnutrition

OBJECTIVES

Malnutrition can be a significant problem among older adults and the medically compromised individuals, contributing to morbidity and mortality. Causes of malnutrition are complex and varied. Oral nutritional supplements (ONS) are often prescribed to individuals with or at risk of malnutrition. Although beneficial, concerns have been raised about their cariogenic potential. The purpose of this study is to report on the currently available ONS in Australia, focusing on factors that impact their cariogenicity.

METHODS

A list of ONS was compiled based on their availability in Australia and indication for use in adults with or at risk of malnutrition. Data concerning composition, clinical indications and the recommended daily consumption was ascertained from product labels, company websites and customer services. Measurements of pH and viscosity were obtained for all ONS.

RESULTS

A total of 33 ONS were identified, which were noted to vary in their cariogenic potential.

CONCLUSIONS

Recognition of the possible caries risk associated with the use of ONS is important. Awareness facilitates the making of informed decisions when ONS are chosen. When the need arises to use ONS in individuals where the associated caries risk is considered significant, caries preventive protocols should be implemented by the prescriber.

Medical status of patients presenting for treatment at an Australian dental institute: a cross-sectional study

Background

Individuals seeking dental treatment often present with medical conditions which may affect dental treatment provision. The purpose of this study was to determine the prevalence of medical conditions and medication use among individuals attending dental clinics at a Western Australian tertiary institution.

Methods

This observational study examined the general demographics, medical and social histories of 873 subjects presenting for a general dental examination at a Western Australian Tertiary Institution between March 2018 and February 2019. Individual recruited were those presenting to the clinics either as new patients to the Centre or returning patients after an extended period of absence.

Results

Presence of a medical condition was reported by 86% of the participants, with males more commonly affected (p = 0.0448). Medication use was noted by 80% of the participants. Cardiovascular disease (37.9%), allergy (32.3%), mental health disorders (29.4%), musculoskeletal (23.0%), endocrine (22.4%) and respiratory disease (17.8%) were the most common conditions identified. Women were significantly more likely to report allergy (p = 0.0002) or a mental health condition (p = 0.0368).

Conclusion

Medical comorbidities are common among individuals presenting for student dental treatment in Western Australia, highlighting the importance of knowledge and teaching of internal medicine and its application to the dental setting.

Chronic disease comorbidity in patients with oral leukoplakia: A matched case-control study

OBJECTIVE

The purpose of this study was to investigate the presence of chronic diseases in patients with oral leukoplakia (OL) compared to controls matched for age group, gender, smoking and alcohol use.

SUBJECTS AND METHODS

This case-control study examined the general demographics, medical and social histories of 105 OL cases and 391 controls matched for age group, gender, tobacco and alcohol use. All OL cases were diagnosed based on both clinical and histopathological findings.

RESULTS

Chronic diseases were significantly associated with OL, namely dyslipidaemia (p < .0001), musculoskeletal diseases (p = .0101) and asthma (p = .0052). The use of ACE inhibitors (p = .0177), opioid analgesics (p = .0300), anticoagulants (p = .0055) and statins (p = .0010) was significantly associated with OL. Dyslipidaemia (p < .0001; odds ratio [95% CI]: 6.4 [3.5-11.6]) and asthma (p = .0110; odds ratio [95% CI]: 2.2 [1.2-4.0]) were identified as independent predictors of OL in multivariate analysis, both of which were significantly more common amongst cases than controls.

CONCLUSIONS

Results from this first Australian study suggest that dyslipidaemia and asthma may constitute independent predictors for the presence of OL. However, longitudinal studies are needed to ascertain the temporal relationship between OL and chronic disease comorbidity and the mechanisms underlying these associations.

Quality of life in patients with oral leukoplakia

BACKGROUND

Oral leukoplakia (OL) is the most common oral potentially malignant disorder, yet despite its chronic and potentially disabling nature, the literature concerning impacts of OL on quality of life (QoL) is limited. This study aimed to evaluate QoL in subjects with OL compared to controls using QoL questionnaires.

METHODS

Fifty individuals with OL and 50 controls matched for age, gender, smoking, and alcohol use were administered the Short Generic Health Questionnaire (SF-12) and the discipline-specific Oral Potentially Malignant Disorder Questionnaire (OPMDQ). Responses were compared between the two groups.

RESULTS

Subjects with OL reported poorer QoL scores compared to controls in two domains "Role limitations due to physical problems" and "Pain" of the SF-12 questionnaire, and in two domains "Difficulty with diagnosis" and "Effect of treatment on daily life" and in the overall scores of the OPMDQ. Females reported poorer QoL in the overall OPMD QoL score and in the domains of "Physical and function limitation" and "Psychological and social well-being," while older individuals in the domains of "Physical and function limitation" and "Effect of treatment on daily life." Non-alcohol drinkers and subjects with dysplastic or non-homogeneous OLs also reported poorer QoL scores.

CONCLUSIONS

Quality of life assessments provide useful insight into the impact of OL on an individual's life and opportunity to improve clinical care.

Oral nerve sheath myxoma: a rare and unusual intraoral neoplasm

We present a rare case of intraoral nerve sheath myxoma. Clinically, the neoplasm mimics many other oral mucosal pathosis, underscoring the importance of histopathology in ensuring accurate diagnosis of oral mucosal lesions. Reports of intraoral nerve sheath myxomas are essential to enhance our understanding of this rare intraoral entity.

Oral Leiomyoma in an Adult Male: A Case Report

Introduction:

Oral leiomyomas are rare, benign neoplasms of smooth muscle origin, presenting as a solitary, asymptomatic, nodular mass.

Case Presentation:

Here we present the case of a 54-year-old male with a lesion in the midline of his hard palate, which was diagnosed as a localized benign leiomyoma, along with a review of the recent literature.

Discussion:

Diagnosis of a leiomyoma must be based on the histopathological assessment of tissue as the clinical appearance is non-specific. The peak prevalence of head and neck leiomyoma is observed in the 4^th and 5^th decade of life with uncertain gender predilection. Histological features include interlacing fascicles of smooth muscle small cells with eosinophilic cytoplasm. Complete excision is usually curative and recurrence is rare.

Conclusion:

Due to their rare nature, it is important that cases of oral leiomyoma can be reported in the literature to improve our understanding of this entity.

Xerostomia and Salivary Gland Hypofunction in Patients with Oral Lichen Planus Before and After Treatment with Topical Corticosteroids

BACKGROUND

Oral lichen planus and mouth dryness are common pathoses, yet not entirely understood. These two conditions may be associated, with a few studies investigating the relationship between mouth dryness and oral lichen planus providing conflicting results. None of the studies have explored the specific impact of disease treatment on mouth dryness.

OBJECTIVE

The purpose of this observational before and after comparison study was to examine the effect of treatment of oral lichen planus with topical corticosteroids on mouth dryness.

METHODS

Nineteen subjects with oral lichen planus were evaluated for the severity of xerostomia using a xerostomia inventory and a visual analogue scale. Stimulated and unstimulated whole salivary flow rates, unstimulated salivary pH and buffering capacity were also measured. All subjects were evaluated before and after treatment with topical corticosteroids.

RESULTS

All subjects reported xerostomia before treatment with topical corticosteroids, with 79% reporting a significant improvement (P = 0.03) after treatment. Topical corticosteroid treatment was not associated with statistically significant differences in stimulated or unstimulated salivary flow rates, unstimulated salivary pH or buffering capacity.

CONCLUSION

The results of this study suggest that treatment of oral lichen planus with topical corticosteroids may decrease the severity of dry mouth symptoms.

Dry mouth: Xerostomia and salivary gland hypofunction

BACKGROUND

Mouth dryness may present as salivary gland hypofunction (SGH), xerostomia or both. It is considered one of the most underappreciated, underdiagnosed and undermanaged oral health conditions. Despite its common presentation and adverse impact on life quality, it is also generally poorly understood. Increased awareness of the condition is important in addressing these problems.

OBJECTIVE

This article discusses SGH and xerostomia, and the associated intra-oral and extra-oral implications. It also summarises currently available management approaches and the evidence behind them.

DISCUSSION

SGH and xerostomia are complex problems. None of the currently available management approaches are entirely satisfactory. Addressing the causative or contributing factors is therefore paramount. While oral health complaints are generally left up to the dental professional to manage, the nature of mouth dryness necessitates increased dialogue between the dental and 
medical professions to ensure optimal patient care.

Oral cavity squamous cell carcinoma - characteristics and survival in aboriginal and non-aboriginal Western australians

Background:

Squamous cell carcinoma (SCC) is the most common type of malignancy affecting the oral cavity. While exposures to main risk factors for oral SCC such as smoking and alcohol use are higher amongst the Aboriginal people, little is known about oral cancer in this population. This study aimed to describe characteristics and survival of oral SCC in Aboriginal and non-Aboriginal Western Australians.

Methods:

All primary oral SCC cases reported to the Western Australian Cancer Registry (WACR) between 1990 and 1999 were analysed with respect to person characteristics including: date of birth, sex and indigenous status; and disease characteristics including: date of biopsy, disease stage and site as well as date of recurrence and date of death. Exclusion criteria included diagnosis not based on incisional or excisional biopsy, diagnosis other than oral SCC or a history of another malignant neoplasm.

Results:

Aboriginal individuals were more likely to reside in rural areas. No statistically significant differences in oral SCC characteristics and survival were noted between Aboriginal and non-Aboriginal Western Australians.

Conclusion:

This study provides new information on person and disease characteristics of Aboriginal Western Australians diagnosed with oral SCC.

Expertise regarding dental management of oral cancer patients receiving radiation therapy among Western Australian dentists

OBJECTIVES

Dental care forms an important part of the multidisciplinary management of oral cancer patients. The aim of this study was to examine actual and self-perceived knowledge and clinical expertise regarding dental management of oral cancer patients receiving radiation therapy among Western Australian general dentists.

MATERIALS AND METHODS

An invitation to participate in a web-based questionnaire was emailed to 1095 dentists registered with the Australian Dental Association (ADA), WA branch. To assess dentists' knowledge and expertise, actual and perceived knowledge was investigated. Information regarding type of practice, practice location, year of graduation and number of oral cancer patients treated in the preceding 12 months was also obtained.

RESULTS

One hundred and ninety one dentists responded to the survey. General dentists who took part in the study appeared to possess some knowledge regarding dental management of oral cancer patients treated with radiation therapy. The majority of responders however identified deficiencies in their knowledge and willingness to participate in continuing education programs.

CONCLUSION

In view of the rising incidence of oral cancer in Western Australia, efforts should be made to provide more clinically relevant training to dentists in this area.

Knowledge and perceptions regarding oral and pharyngeal carcinoma among adult dental patients

BACKGROUND

The aim of this study was to assess awareness and knowledge of oral and pharyngeal carcinoma and risk perception for developing the cancer among adult patients attending a major dental centre in Perth. Influence of socio-demographic factors on awareness, knowledge and perception was ascertained.

METHODS

A random sample of 120 potential participants over the age of 18 who attended the Oral Health Centre of Western Australia between 14 and 18 June 2010 were invited to participate in the survey. A total of 100 participants completed a face-to-face interview guided by a questionnaire.

RESULTS

Seventy-two per cent of the participants had heard of oral and pharyngeal carcinoma. Sixteen per cent knew that both smoking and drinking increased the risk of oral and pharyngeal carcinoma and 49% knew at least one sign or symptom of the cancer. Language spoken at home, education, and employment influenced cancer awareness and knowledge. Sixty-two per cent of the participants considered themselves not at risk of developing the cancer.

CONCLUSIONS

The findings suggest that knowledge concerning oral and pharyngeal carcinoma in the community may be limited and educational strategies may be required to improve such knowledge.

Dental attendance of oral and oropharyngeal cancer patients in a public hospital in Western Australia

BACKGROUND

Dentists have recently seen the introduction of devices which aim to facilitate early oral cancer detection, sparking interest in opportunistic oral cancer screening. However, concerns have been raised about the lack of regular dental attendance amongst high risk individuals. The purpose of this study was to obtain information pertaining to dental attendance of oral and oropharyngeal cancer patients.

METHODS

All records of patients referred to the Oral Medicine Clinic at the Oral Health Centre of Western Australia, between January 2005 and December 2009, from one major teaching hospital were examined. Information extracted included age, gender, smoking status, referral date, tumour type, tumour site, disease stage (TNM classification), and information on dental attendance. Outcomes measured included time (months) since the patient's last dental visit and information concerning regularity of dental attendance.

RESULTS

No association was found between dental attendance and gender, smoking, disease stage or age at diagnosis. Most patients had not visited a dentist in the preceding 12 months. The mean date of last dental visit was 5.6 years prior.

CONCLUSIONS

More should be done in Australia to encourage patients at high risk of oral cancer to attend the dentist and undergo annual oral soft tissue examination.

Oral cavity squamous cell carcinoma survival by biopsy type: a cancer registry study

BACKGROUND

Biopsy of a suspected oral squamous cell carcinoma (SCC) is important for diagnosis. Concerns have been raised about the potential for tumour spread by incisional biopsy techniques. This study aimed to investigate the five-year survival and recurrence of oral SCC after incisional and excisional biopsy in total population data available from the Western Australian Cancer Registry (WACR).

METHODS

Total population data from the WACR, comprising all primary oral SCC cases diagnosed between 1990 and 1999, were examined. Information extracted included date of birth, gender, biopsy date, biopsy type, disease stage (TNM classification), disease site, date of recurrence and date of death. Records were excluded if the diagnosis was fine needle aspiration based, was not that of oral SCC and if a history was noted of another malignant neoplasm. Incisional and excisional biopsy cases were compared for five-year survival, adjusting for disease stage.

RESULTS

No association was found between biopsy type and five-year survival or recurrence amongst individuals with Stage I or II disease.

CONCLUSIONS

In this study, biopsy type was not associated with survival of oral SCC patients with Stage I or II disease, adding to the evidence that incisional biopsy of oral SCC can be a safe procedure.

Eating disorders and oral health: A review of the literature

This article is a review of the recent literature pertaining to the oral sequelae of eating disorders (EDs). Dentists are recognized as being some of the first health care professionals to whom a previously undiagnosed eating disorder patient (EDP) may present. However, despite the prevalence (up to 4 per cent) of such conditions in teenage girls and young adult females, there is relatively little published in the recent literature regarding the oral sequelae of EDs. This compares unfavourably with the attention given recently in the dental literature to conditions such as diabetes mellitus, which have a similar prevalence in the adult population. The incidence of EDs is increasing and it would be expected that dentists who treat patients in the affected age groups would encounter more individuals exhibiting EDs. Most of the reports in the literature concentrate on the obvious clinical features of dental destruction (perimolysis), parotid swelling and biochemical abnormalities particularly related to salivary and pancreatic amylase. However, there is no consistency in explanation of the oral phenomena and epiphenomena seen in EDs. Many EDPs are nutritionally challenged; there is a relative lack of information pertaining to non-dental, oral lesions associated with nutritional deficiencies.

An investigation into the use of pilocarpine as a sialagogue in patients with radiation induced xerostomia

BACKGROUND

Radiation therapy to the head and neck region can be an effective form of treatment for malignancies. Unfortunately damage to salivary glands may occur. Treatment of resultant dry mouth is at present very poor. The purpose of this pilot study was to investigate whether pilocarpine dissolved in artificial saliva and administered in a mouth spray would be effective in relieving such symptoms.

METHODS

Twenty-three patients with radiation induced hyposalivation were recruited for this randomized, double-blind investigation. Subjects were randomly allocated to placebo or control medicaments used for eight weeks. All subjects were evaluated for the severity of their xerostomia associated symptoms prior to administration of the spray and again eight weeks later.

RESULTS

The questionnaire and the visual analogue scale did not reveal any improvements in the dry mouth symptoms between cases and controls. Side-effects were reported among cases, mostly mild and tolerable. All patients taking pilocarpine (with base salivary flow rates > 0ml/min) demonstrated improvement in stimulated and unstimulated salivary flow rates. Candida counts decreased among the cases and controls although decrease among the cases was much greater.

CONCLUSIONS

The results obtained indicate that provided residual functioning salivary tissue exists, pilocarpine used as formulated is effective and warrants further investigation.