Proliferative verrucous leukoplakia/multifocal leukoplakia in patients with and without oral submucous fibrosis

BACKGROUND

Oral submucous fibrosis (OSF) and proliferative verrucous leukoplakia (PVL) are established as oral potentially malignant disorders. Dual pathology of the two conditions is not commonly encountered in clinical practice. This study aims to present a case series of multifocal leukoplakia in patients with and without OSF to outline the clinical behavior and challenges in the management of this high-risk group in clinical practice.

MATERIAL AND METHODS

We retrospectively analyzed cases of six Indian patients (four with OSF) managed over a period of 5.5 to 13 years at the Government Dental College, Nagpur. Patient data consisting of age, gender, medical history, habits, clinical findings, and biopsy reports were recorded at the initial visit. During follow-up visits, the clinicopathological data were reassessed. When surgical intervention failed to arrest the disease or when surgery was contraindicated metronomic therapy with Folitrax 15 mg once a week and Celecoxib 100mg twice daily was initiated.

RESULTS

All patients developed PVL after the initial pathology diagnosis of OSF or oral leukoplakia. Initial lesions were either homogenous or non-homogenous leukoplakia. All patients developed multiple recurrences, regional or systemic metastasis. Despite thorough interventions, the patients died of, or with the disease.

CONCLUSIONS

The occurrence of two or more oral potentially malignant disorders poses challenges in patient management and possibly presents a higher risk of malignant transformation. More clinical trials are necessary to assess the benefits of metronomic therapy for patients diagnosed with aggressive PVL concurrently found with OSF.

Cancer-Free Drive in Rural India: Constituency Wise Initiatives by Member of Legislative Assembly

Background and context: Reducing the rate of cancer through awareness and prevention programs as well improvements in screening and treatment techniques is paramount. Citizen especially in rural India tend to neglect health due to routine chores of family life. The nonavailability of facilities worsen the issue. Tobacco habits leads to potentially malignant disorders and oral cancers. There is increasing trend of breast cancer, uterine and cervical cancers and also oral cancers. In India oral cancers are main cancers in males. Member of legislative assembly is public representative to represent state of Maharashtra. Cancer Free Constituency Drive was for creating awareness and screening for villagers. Katol is a rural constituency. There are 288 constituencies in Maharashtra state. Aim: 1) To create public awareness of all types of cancers. 2) To provide diagnosis and investigations and treatment to affected population. 3) Capacity building of young medical and dental professionals in cancer diagnosis and paramedical workers in screening all types of cancers. Strategy/Tactics: 72,056 house visits by 220 Asha workers and 129 nursing students and 30 dental interns to sensitize about 3,00,000 people through well designed brochure for all cancers. Self-Mouth mirror examination was designed for oral cancers and awareness against tobacco. The persons with complaints were told to visit camps on scheduled dates at 10 primary health centers. Program/Policy process: The mammography facilities and Papanicolaou test examination, dental examination in mobile vans and self-mouth mirror examination for oral cancers with trained professional carried out diagnosis in 10 primary health centers with the help of experts in medical and dental professionals. Suspeced cases were referred to tertiary referral medical hospitals. Outcomes: 5100 (males 2216 and females 2954) with complaints visited. Total 813 patients suspected to have cancers were examined by specialists from gynecology(84) general surgery (374) otorhinolaryngology (77) pediatrics (37) dermatology (19) and dentistry (131). 38 abnormal on mammography in 132 females, 55 abnormal reports from Pap smears in 472 females were evaluated, however no cancer detected in three months span. Twelve cases of oral cancers were detected and treated. Six breast cancers were detected and treated. Seven other cancers were reported by medicine and pediatric specialists. 150 cases of potentially malignant disorders were also identified. 90 had the oral submucous fibrosis (inability to open the mouth) caused due to areca quid chewing. The self-mouth mirror examination helped to create awareness against tobacco. What was learned: Awareness of cancer leading to early detection and treatment is possible in rural areas through “Cancer-Free Constituency”. The concept will help to pave the way for improved strategies and policies to better control occurrence and treatment of cancer and to address tobacco related health disparities across cancer care continuum.

Self-Mouth Mirror Examination: A Boon to Tobacco-Related Potentially Malignant Lesions and Oral Cancer

Background and context: The tobacco related potentially malignant disorders and oral cancer occupies the major burden of diseases caused by smokeless and smoking tobacco in general in southeast Asia and in particular India. The major challenge is due to lack of awareness about ill effects of tobacco especially in rural India. Community awareness is adopted as a measure to reduce mortality and morbidity of oral cancer and also other cancers caused by tobacco. In developing countries like India, the problem is magnified because of low literacy levels and lack of logistics and IEC material. The qualified human resource especially professionals to assist is also another road block. Intervention is designed to create awareness about ill effects of tobacco through a simplified IEC pictorial brochure called Self-Mouth Mirror Examination (SELFMEE). Aim: To aware public about ill effects of tobacco and how to notice the disorders caused at early stages. Capacity building of dental and paramedical and nursing workers toward tobacco control. Strategy/Tactics: Young dental and medical professional and paramedical workers such as nursing students and ancillary workers were trained to educate public about self-mouth mirror examination. Thus spreading awareness against tobacco and promoting health by counseling and treatment of diseases diagnosed. Program/Policy process: Village constituency of a elected legislative member from rural India (katol) was considered to implement policy of SELFMEE. 75,000 homes coming under the ten primary health centers were surveyed nearly covering 200,000 population. The procedure was explained through visual demonstration of brochure. Sign and symptoms were explained and the sensitized populations was screened at primary health centers. Outcomes: 5100 citizens reported to have complaints which were examined by young dental and medical professionals mainly residents. 900 citizens were found to have oral diseases. Majority of the 800 showed the signs and symptoms of a potentially malignant disorder caused by smokeless tobacco and areca nut mixture (gutkha/kharra). Ten oral cancer cases were detected. Eight early cancers were treated at tertiary medical college centers. Two inoperable cases were given palliative treatment. The oral submucous fibrosis cases were advised tobacco and areca quid cessation. What was learned: Mouth mirror examination performed by self-helped tobacco users to observe the ill effects of tobacco habits by themselves thus becoming active partner in tobacco control. The self-motivation to quit habits is effective. Young dental and medical professions were trained in effective cancer control.

Efficacy trial of Camouflage Syringe to reduce dental fear and anxiety

AIM

Dental fear and anxiety in early childhood are widely prevalent and contribute to dental problems and behaviour in adulthood. Novel ways to reduce dental fear and anxiety in children are needed. Our aim was to conduct an efficacy trial of a novel Camouflage Syringe to reduce dental fear and anxiety in children.

STUDY DESIGN

randomised controlled trial of efficacy of the Camouflage Syringe. We designed a Camouflage Syringe with a toy-like appearance that veils the conventional syringe to permit topical application and injection of local anaesthesia and ensure more involvement of the patient in the treatment process. We conducted a concurrent parallel, randomised controlled trial (NCT01398007) on the efficacy of this Camouflage Syringe to reduce the dental fear and anxiety in children seeking dental treatment who required the use of local anaesthesia.

RESULTS

Using Venham's clinical rating scale, Venham's picture test, parental stress questionnaire and recall questionnaire, the efficacy of the Camouflage Syringe to reduce dental fear and anxiety ranged from 82% to 97% for various outcomes and from 60% to 100% for prevention of related adverse outcomes. For all outcomes, the number needed to treat was close to unity.

CONCLUSION

Our results strongly favour the use of Camouflage Syringe to reduce dental fear and anxiety in children.