Online audio-visual information on oral cancer for Spanish-speaking laypersons. A cross-sectional study

Background

Lack of knowledge and awareness of oral cancer seem to be the main causes of diagnostic delay. Online resources are often used by patients to obtain health/medical information. However, there are no reports on the quality and usefulness of oral cancer audio-visual resources in Spanish. The aims of this investigation were to disclose the type of information about oral cancer available, and whether it may be useful to shorten the patients’ oral cancer appraisal time-interval.

Material and Methods

Cross-sectional study undertaken at three video-sharing sites on October, 13th 2019. Keywords: “Cáncer oral”; “cáncer de boca”. The first 100 results in each viewing list were retrieved by three reviewers. Demographical data was recorded, and interaction indexes, viewing rates, comprehensiveness, and usefulness were calculated for each video. The presence of non-scientifically supported information was also assessed. A descriptive analysis was undertaken, and relationships between variables were explored using the Spearman correlation test.

Results

A total of 127 videos were selected. They were produced mainly by mass-media (46.5%; n=59) and their length ranged from 0.28 to 105.38 minutes (median 4.15 minutes; IQR: 2.34-9.67). The most viewed video (10,599,765 views; visualization rate 726,508.9) scored 0 both in usefulness and comprehensiveness. The most useful video gathered 44,119 views (visualization rate 2.033.13). A highly significant positive correlation (0.643; p<0.001) could be observed between usefulness and comprehensiveness of the videos, together with negative correlations between the visualization rate and usefulness (-0.186; p<0.05), and visualization rate and comprehensiveness (-0.183; p<0.05).

Conclusions

Online audio-visual material about oral cancer in Spanish is incomplete, of limited usefulness, and often includes non-scientifically supported information. Most of these resources are produced by mass media and healthcare professionals, with minor contributions from educational and healthcare institutions. Visualization rates negatively correlated with the usefulness and comprehensiveness of the contents in these digital objects.

Key words:Oral cancer, diagnostic delay, patient education, internet, audio-visual resources, Spanish.

People would rather see a physician than a dentist when experiencing a long-standing oral ulceration. A population-based study in Spain

BACKGROUND

Primary care physicians have been reported to be the first choice for patients with oral ulcerations. This study investigates the health-seeking behaviour of lay public in Galicia (North-western Spain) if experiencing a long-standing oral ulceration.

MATERIAL AND METHODS

Cross-sectional population-based survey of randomly selected respondents conducted from March 1, 2015 to 30 June 2016.

RESULTS

A total of 5,727 pedestrians entered the study (response rate: 53%), mostly in the 45-64 age group (30.2%; n=1,728), 47.7% of them (n=2,729) were males. Most participants (42.1%; n=2,411) reported to visit their dentist once a year and had secondary or compulsory education as their highest educational achievement (28.18%, n=1,614; 28%, n=1,600 respectively). When questioned what they would do if they had a wound/ulceration lasting longer than 3 weeks, most participants answered they would go to see their primary care physician (62.8%; n=3,597) and less than one quarter of the sample (23.8%; n=1,371) would seek consultation with their dentist.

CONCLUSIONS

General Galician population would seek professional consultation about a long-standing oral ulceration, relying mostly on primary care physicians. Those neglecting these lesions are elderly, less-schooled people and unaware of oral cancer.

Therapeutic approaches for actinic cheilitis: therapeutic efficacy and malignant transformation after treatment

Actinic cheilitis (AC) is a sun-induced premalignant lesion. AC is a clinical term housing a wide pathological spectrum ranging from hyperkeratosis to invasive squamous cell carcinoma. The aim of this systematic review was to examine the therapeutic efficacy of different approaches in clinical, histological, and cosmetic terms, and the malignization rate after treatment. A systematic search was undertaken in October 2016 and updated in April 2019 at MEDLINE (from 1966), Embase (from 1980), and Proceedings Web of Science (Conference Proceedings Citation Index-Science (CPCI-S) from 1990) databases. The search strategy was (("actinic" or "solar") AND ("cheilitis")) using both medical subject headings (MeSH) and freetext. A total of 392 potentially eligible reports were identified. After the selection procedure, 20 articles were included. It was concluded that surgical treatment is the first line of treatment for AC and has proved useful for the clinical and pathological control of the disorder. However, there was no evidence of effective treatment in preventing malignant transformations. Non-surgical procedures showed less consistent results, although drug therapy may improve the results obtained by other therapeutic approaches.

Oral mucosal peeling related to dentifrices and mouthwashes: A systematic review

Background

The aim of this systematic review was to summarise the clinical information available about oral mucosal peeling (OMP) and to explore its aetiopathogenic association with dentifrices and mouthwashes.

Material and Methods

PICOS outline: Population: subjects diagnosed clinically and/or pathologically. Intervention: exposition to oral hygiene products. Comparisons: patients using products at different concentrations. Outcomes: clinicopathological outcomes (primary) and oral epithelial desquamation (secondary) after use. Study design: any. Exclusion criteria: reports on secondary or unpublished data, in vitro studies. Data were independently extracted by two reviewers.

Results

Fifteen reports were selected from 410 identified. Descriptive studies mainly showed low bias risk, experimental studies mostly an “unclear risk”. Dentifrices or mouthwashes were linked to OMP, with an unknown origin in 5 subjects. Sodium lauryl-sulphate (SLS) was behind this disorder in 21 subjects, tartar-control dentifrices in 2, and flavouring agents in 1 case. Desquamation extension was linked to SLS concentration. Most cases were painless, leaving normal mucosa after desquamation. Tartar-control dentifrices caused ulcerations more frequently.

Conclusions

OMP management should consider differential diagnosis with oral desquamative lesions, particularly desquamative gingivitis, with a guided clinical interview together with pathological confirmation while discouraging the use of the product responsible for OMP.

Key words:Systematic review, oral mucosal peeling, dentifrices, sodium lauryl-sulphate, oral hygiene products.

The length of patient and primary care time interval in the pathways to treatment in symptomatic oral cancer. A quantitative systematic review

OBJECTIVES

To examine the relative length of the patient and primary care intervals in symptomatic oral cancer.

DESIGN

Quantitative systematic review.

SEARCH STRATEGY

Oral cancer OR oral squamous cell carcinoma OR oropharyngeal cancer AND time interval OR diagnostic delay.

SETTING

Primary and secondary care.

PARTICIPANTS

Oral and oropharyngeal cancer patients.

MAIN OUTCOME MEASURES

We computed five measures (patient, primary care, diagnosis, total diagnosis and total treatment intervals). Most studies did not provide any dispersion measure. We then used the sample size of each study to compute a weighted average of the mean intervals. When the median was provided, we assumed normality of the distribution of the means and used the median as a proxy of the mean.

RESULTS

A total of 1089 articles were identified, and 22 met the inclusion criteria, reporting on 2710 patients from Europe, USA, India, Australia, Japan, Argentina and Iran. The weighted average of patient interval was 80.3 days. Primary care interval was five times shorter: 15.8 days. The diagnostic interval was appreciably shorter (47.9 days) when compared with the patient interval during symptomatic period.

CONCLUSIONS

Patient interval represents the major component of waiting times since the detection of the first signs/symptoms to the definitive diagnosis of oral cancer. Thus, strategies focused on high-risk patients should be prioritised. Interventions aimed at optimising the health systems should be implemented by monitoring and facilitating diagnostic and treatment pathways of patients with oral cancer.

Diameter of alveolar antral artery in the lateral sinus wall: study of related factors

To identify the variables that influence the diameter of the artery in the lateral sinus wall, we studied 240 sinuses, focusing on sex, pattern of tooth loss, type of residual crest, thickness of the lateral wall, height and width of the ridge, and width of the sinus.

Distance of the alveolar antral artery from the alveolar crest. Related factors and surgical considerations in sinus floor elevation

Background

In a variable proportion of maxillary sinuses alveolar antral artery is located close to the residual ridge, increasing the chances for haemorrhagic complications during sinus floor elevation procedures.

Material and Methods

Retrospective observational study of CBCT explorations performed for implant-treatment planning. The upper first molar area was selected for this study. The relative uncertainty (standard deviation of the measurement divided by its mean and expressed as a percentage from 0% to 100%) was chosen for determining the observational errors. For modeling the chances of AAA detection, the generalized additive models (GAM) approach was chosen.

Results

A total of 240 maxillary sinuses were studied (46.25% males) whose median median age was 58 years old (IQR: 52-66). Univariate models showed that the chances for an AAA-alvelar crest distance ≤15mm increase in wider sinuses with lower, subsinusally edentulous crests. When distance is considered as a continuous variable, the best mutivariate model showed an explained deviance of 67% and included AAA diameter, distance AAA-sinus floor, sinus width, and shape, height and width of the residual ridge. Thinner AAAs are found closer to the crest (within the ≤15mm safe distance).

Conclusions

Bearing in mind the inclusion criteria and the limitations of this investigation, it is concluded that there is a high proportion of maxillary sinuses where AAA describes a course close to the alveolar crest (≤15mm), which was classically considered a safe distance for SFE. This position is related to the presence of atrophic crests (depressed ridge form) and wide maxillary sinuses where the distance of the vessel to the floor of the sinus is small. This information may permit a better surgical planning of SFE procedures.

Key words:Cone-beam computed tomography, blood vessels, sinus floor augmentation, intraoperative complications.

Key points and time intervals for early diagnosis in symptomatic oral cancer: a systematic review

The aim of this study was to identify key points and time intervals in the patient pathway to the diagnosis of oral cancer, from the detection of a bodily change to the start of treatment. A systematic search of three databases was performed by two researchers independently. Articles reporting original data on patients with symptomatic primary oral or oropharyngeal squamous cell carcinoma that was pathologically confirmed were included. These articles had to include an outcome variable of 'diagnostic delay', 'time interval', or 'waiting time to diagnosis', or report time intervals from first symptom to treatment. Furthermore, the outcome variable had to have a clearly defined start point and end point, with the time measurement presented as a continuous or categorical variable. A total of 1175 reports were identified; 28 articles on oral cancer studies and 13 on oral and oropharyngeal cancer studies were finally included. These papers showed poor quality in terms of questionnaire validation, acknowledgement of biases influencing time-point measurements, and strategies for verification of patient self-reported data. They also showed great heterogeneity. The review findings allowed the definition of key points and time intervals within the Aarhus framework that may better suit the features of the diagnostic process of this neoplasm, particularly when assessing the impact of waiting time to diagnosis.

[Update in family medicine: Periodontal disease]

About 85-94% of the Spanish adults older than 35 experience gum problems, and about 15-30% suffer from periodontitis, being severe in up to 5-11% of them. Unlike other inflammatory conditions, periodontal disease rarely causes discomfort, or limits life or causes functional limitations until its advanced stages, when clinical signs and symptoms arise (gingival recession, pathological teeth migration, or mobility). Lack of knowledge about the disease, together with the idea that tooth loss is linked to ageing, frequently results in a late diagnosis, requiring extensive treatments with a worse prognosis. At Primary Care level, there is series of drugs have been related to periodontal disease (anticonvulsants, immunosuppressive drugs, and calcium channel blockers) as secondary effects, which vary as regards their frequency and severity depending of the amount of accumulated plaque. Stress and depression have also been reported to alter the immune response and to increase the inflammatory response as well as periodontal susceptibility. Certain systemic conditions, such as diabetes mellitus, cardiovascular disorders, respiratory diseases, as well as low-weight pre-term birth, have also been linked to periodontitis.

Detection of the posterior superior alveolar artery in the lateral sinus wall using computed tomography/cone beam computed tomography: a prevalence meta-analysis study and systematic review

A systematic search of MEDLINE, Embase, and Proceedings Web of Science was undertaken to assess the prevalence of the posterior superior alveolar artery (PSAA) in the lateral sinus wall in sinus lift patients, as identified using computed tomography (CT)/cone beam computed tomography (CBCT). For inclusion, the article had to report PSAA detection in the bony wall using CT and/or CBCT in patients with subsinus edentulism. Studies on post-mortem findings, mixed samples (living and cadaveric), those presenting pooled results only, or studies performed for a sinus pathology were excluded. Heterogeneity was checked using an adapted version of the DerSimonian and Laird Q test, and quantified by calculating the proportion of the total variance due to between-study variance (Ri statistic). Eight hundred and eleven single papers were reviewed and filtered according to the inclusion/exclusion criteria. Ten studies were selected (1647 patients and 2740 maxillary sinuses (study unit)). The pooled prevalence of PSAA was 62.02 (95% confidence interval (CI) 46.33-77.71). CBCT studies detected PSAA more frequently (78.12, 95% CI 61.25-94.98) than CT studies (51.19, 95% CI 42.33-60.05). Conventional CT revealed thicker arteries than CBCT. It is concluded that PSAA detection is more frequent when CBCT explorations are used. Additional comparative studies controlling for potential confounding factors are needed to ascertain the actual diagnostic value of radiographic explorations for assessing the PSAA prior to sinus floor elevation procedures.