Estimating the direct costs of oral cancer in Spain: a retrospective hospital data analysis

BACKGROUND

Studies on the costs incurred from cancer in Spain are scarce and have focused on the most prevalent types such as colorectal, breast, and lung cancer. The aim of this study was to calculate the direct costs associated with the diagnostic, treatment and follow-up procedures for oral cancer in Spain.

MATERIAL AND METHODS

Applying a bottom-up approach, we retrospectively analyzed the medical records of a cohort of 200 patients with oral cancer (C00-C10), diagnosed and treated in Spain between 2015 and 2017. For each patient, we collected their age, sex, degree of medical impairment (American Society of Anesthesiologists [ASA] classification), tumor extent (TNM classification), relapses and survival during the first 2 years of follow-up. The final calculation of the costs is expressed in absolute values in euros as the percentage of the gross domestic product per capita and in international dollars (I$).

RESULTS

The total cost per patient rose to €16,620 (IQR, €13,726; I$11,634), and the total direct cost at the national level was €136,084,560 (I$95,259,192). The mean cost for oral cancer represented 65.1% of the gross domestic product per capita. The costs for the diagnostic and therapeutic procedures were determined by the ASA grade, tumor size, lymph node infiltration and presence of metastases.

CONCLUSIONS

The direct costs for oral cancer are considerable compared with other types of cancer. In terms of gross domestic product, the costs were similar to those of countries neighboring Spain, such as Italy and Greece. The main determinants of this economic burden were the patient's degree of medical impairment and tumor extent.

Assessment of the quality of oral biopsy procedure videos shared on YouTube

OBJECTIVE

The aim of this study was to assess the quality of free-to-access videos on oral biopsy procedures on the YouTube platform.

MATERIALS AND METHODS

We conducted a search on YouTube using the term "oral biopsy" and selected the first 100 videos in order of relevance. The following exclusion criteria were applied: language other than English, videos that did not cover oral biopsy techniques, videos on nonhuman specimens, postoperative instructions, personal experiences, exfoliative cytology, or "brush biopsy." Forty-seven selected videos were classified based on their duration, country of origin, date of upload to the system, author, information source and number of views, and likes and dislikes. Video quality was analyzed using DISCERN, the Global Quality Scale (GQS), and the Video Information and Quality Index (VIQI).

RESULTS

The majority (78.7%) of analyzed videos were uploaded by dentists, originating from India (48.9%), with a mean duration of 11.8 min (SD, 20.4), with 104.5 likes (SD, 186.4) and 7.1 dislikes (SD, 10.55). The mean values for DISCERN, GQS, and VIQI were 1.3 (SD, 0.52), 2.1 (SD, 1.04), and 9.62 (SD, 1.69), respectively.

CONCLUSION

The majority of videos on oral biopsy published on YouTube are of low quality.

The impact of COVID-19 on access to dental care for people with disabilities: a global survey during the COVID-19 first wave lockdown

BACKGROUND

It is unclear what immediate impact the COVID-19 pandemic has had on delivery of oral healthcare to people with disabilities worldwide.

AIM

To report the international impact of COVID-19 lockdown on oral healthcare provision for people with disabilities before, during and after the first lockdown (March to July 2020).

MATERIAL AND METHODS

Cross-sectional online self-administered survey of dentists who treat people with disabilities completed 10th to 31st of July 2020. Responses allowed comparison from before, during and immediately after the first wave lockdowns of the COVID-19 pandemic. Data were analysed using McNemar's test to compare reported practice before to during lockdown, and before to after lockdown.

RESULTS

Four-hundred-thirty-six respondents from across global regions reported a significant reduction from before to during and from before to after lockdown regarding: the proportion of dentists treating people with all types of disability (p <0.001) and the number of patients with disabilities seen per week (p<0.0001). The proportion reporting no availability of any pharmacological supports rose from 22% pre-lockdown to 61% during lockdown (p < 0.001) and a persistent 44% after lockdown (p < 0.001). An increase in teledentistry was observed.

CONCLUSIONS

During the first COVID-19 lockdown, there was a significant negative impact on the delivery of dental care to people with disabilities. Oral healthcare access was significantly restricted for people with disabilities with access to sedation and general anaesthesia particularly affected. There is now an increased need to ensure that no-one is left behind in new and existing services as they emerge post-pandemic.

Case report of segmental odontomaxillary dysplasia with cutaneous manifestations

BACKGROUND

Segmental odontomaxillary dysplasia is an uncommon nonhereditary growth disorder that affects the maxilla, gums and ipsilateral dentition. The disorder is diagnosed mainly based on dental (over-retention of primary teeth, dental agenesis and diastemas) and bone findings (bone sclerosis, irregular trabeculation of immature bone and reduced maxillary sinus). This paper provides a case report.

CASE REPORT

A 5-year-old child with skin manifestations including hypertrichosis, facial erythema and pigmented nevus was diagnosed with type II segmental odontomaxillary dysplasia based on clinical, radiographic and histopathological analysis.

CONCLUSION

The skin findings can help with the suspicion of segmental odontomaxillary dysplasia, although the definitive diagnosis is typically established by a paediatric dentist based on clinical and radiological findings.

Relationship between dental occlusion and functional dependence in elderly Caucasians

OBJECTIVE

To determine whether a relationship exists between the number of functional masticatory units (FMUs) and the level of functional dependence of elderly.

SUBJECTS AND METHODS

The study group comprised 502 elderly Caucasians living in nursing homes in north-west Spain and Portugal. The number of FMUs was counted on direct visual inspection. The degree of dependence was assessed using the Barthel index. The results were validated in a group of 156 elderly. Statistical analysis of the results was performed using a generalised linear model (GLM), a logistic GLM, a ROC-GLM curve and a confusion matrix.

RESULTS

The number of FMUs significantly affected the Barthel index score (explained deviance = 27.5%). The number of FMUs was significantly associated with a lower probability of dependence, both for women (explained deviance = 31%) and for men (explained deviance = 33%). The model based on FMUs showed a good discriminatory capacity for dependence (AUC = 0.84 in women and 0.82 in men). The predictive capacity of the dependence model based on FMUs was very high (sensitivity = 0.9 in women and 0.8 in men).

CONCLUSIONS

In institutionalised elderly Caucasians, the number of FMUs is significantly associated with the Barthel index score and could be a predictive factor for dependence.

A Dramatic Case of Odynophagia

We report the case of a 77-year-old male with a history of aortic stenosis and interstitial lung disease, who debuted 3 years ago with an outbreak of necrotic and very painful canker sores. The severity of the lesions and their refractory response to treatment led to several hospital admissions and multiple consultations to different specialists (ENT, rheumatology, dermatology, ophthalmology, cardiology, and internal medicine). During this time, the patient received central parenteral nutrition with an episode of catheter-related septicemia, and he came to require psychiatric assistance for autolytic ideation. Numerous diagnostic tests were performed with inconclusive results, including biopsy of the lesion (histological study, immunohistochemistry for CD68 + , CD4 + , CD8 + , CD20 + , MCT +, and cytomegalovirus, PAS, Grocott-Gomori and Zielh-Neelsen staining, and in situ hybridization for Epstein Barr virus). Numerous treatments were unsuccessfully tested until thalidomide was administered, thus completely remitting lesions but leaving retractable scarring sequelae. Since then, the patient has had two recurrences, coinciding with the reduction of thalidomide dosages, which were controlled by increasing the dose of the immunomodulator. Recurrent necrotizing major aphthous stomatitis (Sutton's disease) is a clinical variant of recurrent aphthous stomatitis that may have a dramatic course. Unfortunately, the lack of etiopathogenetic uniformity precludes any specific treatment. In severe cases, immunomodulators, including thalidomide, may represent a valid therapeutic option.

Cone Beam Computed Tomography evaluation of palatal bone thickness for miniscrew placement in Down's syndrome

OBJECTIVES

To quantify palatal bone thickness (PBT) in Down's syndrome (DS) patients in order to identify the best areas for miniscrew placement.

DESIGN

The study group was formed of 40 DS patients (25 male and 15 female) with a mean age of 18.4±6.3 years (range, 9-40 years). A control group of 40 non-syndromic age- and sex-matched individuals was selected. Maxillary CBCT images were available for all participants. Coronal sections of the hard palate were selected at 4, 8, 16 and 24mm posterior to the distal wall of the incisive foramen. PBT measurements were performed at 20 selected points on these coronal sections at the midline and at 3 and 6mm to right and left of the suture.

RESULTS

Overall, PBT was similar in DS and controls and it was not affected by age or sex. In both groups PBT decreased progressively with increasing distance from the posterior wall of the nasopalatine foramen in an anteroposterior direction, except along the median palatal suture. PBT along the suture was lower in DS than in controls in all the paracoronal image planes (P=0.02, 0.007, 0.01 and 0.02 at 4mm, 8mm, 16mm and 24mm, respectively, from the incisive foramen). PBT at the most anterior paramedian locations was also lower in DS than in controls (P=0.02 and 0.03, respectively, 3mm to the right and left of midline).

CONCLUSIONS

In DS individuals, the most suitable area for miniscrew placement in terms of bone volume is the median palatal suture, irrespective of age or sex, as occurs in the general population, followed by the paramedian sites closest to the incisive foramen.

Pharmacodiagnostic evaluation of EGFR expression in oral squamous cell carcinoma

OBJECTIVE

To determine epidermal growth factor receptor (EGFR) expression in oral squamous cell carcinomas (OSCC), and its possible relationships with clinical findings, histological findings, disease course and prognosis.

MATERIALS AND METHODS

Surgical specimens of 47 OSCCs were studied immunohistochemically for detection of EGFR using a standardized immunohistochemical detection system (EGFR PharmaDx kit). Statistical analysis was used to investigate possible relationships between EGFR expression and clinical findings, histological findings, cell proliferation (MIB1 labelling index), disease course and patient survival.

RESULTS

Epidermal growth factor receptor expression was absent or weak in 12 cases (25.5%) and moderate or intense in 35 cases (74.5%). However, EGFR expression did not show statistically significant associations with any of the clinical, histological, biological or prognostic variables considered.

CONCLUSION

First, despite previous suggestions that EGFR is a useful indicator of biological tumour behaviour, the present results suggest that EGFR is not a useful indicator of prognosis in OSCC. Secondly, the high prevalence of EGFR overexpression suggests that the possibility of anti-EGFR therapy in OSCC merits further investigation.

Triamcinolone acetonide mouth rinses for treatment of erosive oral lichen planus: efficacy and risk of fungal over-infection

OBJECTIVES

To assess the efficacy of triamcinolone acetonide mouthrinse for treatment of erosive oral lichen planus (OLP), and to evaluate the risk of fungal over-infection.

PATIENTS AND METHODS

Clinical records of all cases of erosive and erosive-ulcerative OLP treated in our Oral Medicine Service over the period 1993-2003 were reviewed. All patients had been treated with mouthrinses containing triamcinolone acetonide at 0.3% (T1) or 0.5% (T2). Clinical outcome for each patient was classified at 1, 3 and 6 months after start of treatment as total remission (TR), partial remission (PR) or no remission (NR). Fungal over-infection was also recorded.

RESULTS

A total of 35 cases were included in the study. Clinical outcomes considering both treatment groups together (T1 + T2) were as follows: at month 1, 28.6% TR, 62.9% PR, 8.6% NR; at month 3, 57.1% TR, 37.1% PR, 5.7% NR; and at month 6, 80.0% TR, 17.1% PR, 2.9% NR. In four patients (11.4%) fungal over-infection was noted during the study period.

CONCLUSION

Triamcinolone acetonide mouthrinse is an appropriate treatment for erosive OLP, in view of the high efficacy and low risk of fungal over-infection.

Lesions of the oral mucosa in cocaine users who apply the drug topically

The use and abuse of cocaine is increasingly frequent in many countries, and the associated problems are increasingly evident. The effects of cocaine in the oral cavity vary depending on the form used and the route of self-administration. In the present study we describe the lesions observed in four patients with a history of topical self-application of cocaine to the oral and/or nasal mucosa, with the aim of relieving pain produced by cocaine-induced cluster headache. In three of the four patients this practice has led to erythematous lesions, while the remaining patient showed gingival recession and bone sequestration. These lesions can probably be attributed to the vasoconstrictor activity of cocaine, and to its caustic effects on the mucosa.