Chemoprevention and oral cancer--(more) trials and (more) tribulations.
Explore the source record for details and available documents.
Anti-Inflammatory Agents, Non-Steroidal↗
Biomedical subjects
C Scully
Publications and source records attributed to C Scully.
European School of Oncology Advisory report to the European Commission for the Europe Against Cancer Programme: oral carcinogenesis in Europe.
A European School of Oncology Advisory Group has reviewed current knowledge on the epidemiology, treatment and prevention of cancer of the oral cavity. While the major factors in the aetiology of such cancers are thought to be well understood, i.e. tobacco and alcohol consumption, current increases in the occurrence of the disease, especially in young adults throughout Europe, are cause for concern. The reasons for such increases are not clearly evident and the Advisory Group has suggested further work which is required to be carried out to understand the aetiology. In treatment of the disease there have been no major improvements in survival for patients in recent decades and the importance of examining new radiotherapy modalities and defining the role of chemotherapy is emphasized. Primary prevention of oral cancer could be achieved by stopping smoking tobacco, limiting alcohol consumption to a minimum (2-3 drinks per day) and increasing intake of fruits and vegetables. To supplement these actions, while neither population screening programmes nor screening trials could be recommended by the Advisory Group, initial chemoprevention trials have produced some promising results and this represents an interesting area which is the focus of much current research.
Europe↗
Detection and treatment of early cancers of the oral cavity.
Explore the source record for details and available documents.
Adult↗
Emergence of azole drug resistance in Candida species from HIV-infected patients receiving prolonged fluconazole therapy for oral candidosis.
We examined the effect of different fluconazole treatment regimens on the emergence of azole drug resistance among Candida species recovered from the mouths of 54 HIV-infected individuals. Patients were assigned to one of three treatment groups depending on their history of oral candidosis and fluconazole use. Mouthwashes obtained at regular intervals were cultured and isolates identified using standard methods. Antifungal broth micro-dilution tests were performed to determine IC30s of fluconazole and ketoconazole. Sixty-four Candida albicans isolates from 20 patients with no evidence of oral candidosis who had not received fluconazole all had IC30s of < or = 4 mg/L. Thirty-four (83%) of 41 C. albicans isolates from ten patients receiving intermittent, short-term fluconazole treatment for oral candidosis had IC30s of < or = 4 mg/L, but only two isolates (5%) had IC30s > or = 64 mg/L. In contrast, 26 (40%) of 65 C. albicans isolates from 15 patients given long-term fluconazole (50-200 mg/day or 150 mg/week) were classified as resistant having IC30s of fluconazole of > or = 64 mg/L. Ten of these 26 fluconazole-resistant isolates were susceptible to ketoconazole with IC30s of < or = 4 mg/L suggesting azole drug cross-resistance is not inevitable. Tests on multiple colonies from individual isolation plates showed that it was not unusual to obtain differing IC30 values, indicating that a sweep inoculum is essential if resistance is to be detected. Nine (60%) of the 15 patients given long-term fluconazole harboured isolates of C. albicans that were resistant to fluconazole at some time during the study period. All had low CD4 counts and were approaching the final stage of their illness. Three patients on long-term treatment had resistant organisms at the outset of the study; in the remainder, resistant strains emerged during the study period. In six of the nine cases, emergence of resistance in vitro correlated with persistent clinical signs of oral infection. Thirty-six isolates of Candida species other than C. albicans were also recovered from patients receiving long-term fluconazole and 29 (81%) of these had IC30s of > or = 64 mg/L. Our experience with C. albicans in patients with HIV infection, suggests that the long-term azole drug use may be an important factor in the development of fluconazole resistance as such resistance was rare and transient in patients on intermittent short-term treatment.
Antifungal Agents↗
Mucocutaneous histoplasmosis in AIDS.
A 36-year-old man, who was an intravenous drug abuser, developed thoracic herpes zoster, paronychia, oral candidosis, necrotizing gingivitis and bilateral parotid salivary gland swelling. Granulomatous oral lesions and ulceration on the nose were shown to be due to disseminated histoplasmosis.
AIDS-Related Opportunistic Infections↗
Oral myiasis: report of two cases.
Case reports are presented of two patients from Oman who developed myiasis in the palate. Both suffered from cerebral palsy and had incompetent lips, anterior open bite and very poor oral hygiene. Both patients had denuded areas of hard palate anteriorly. In both cases large numbers of maggots were found under the surrounding mucoperiosteam. Removal of the maggots and debridement resulted in resolution of the condition.
Adult↗
Biotypes of oral Candida albicans isolates in human immunodeficiency virus-infected patients from diverse geographic locations.
Oral Candida albicans isolates from HIV-infected individuals in Hong Kong, Australia, Germany and England were characterised using a biotyping system based on enzyme profiles, carbohydrate assimilation patterns and boric acid resistance of the yeasts. A total of 44 biotypes were found amongst the 117 oral C. albicans isolates examined. The major biotype A1R accounted for 17.9% of all isolates while the second commonest biotype was A1S (11.1% of isolates). Whereas these two biotypes were isolated from all the regions studied, there were a number of other biotypes unique to individual countries. The data indicate that there are many different sub-strains of oral C. albicans in HIV-infected patients, some of which are globally prevalent. However, further work is required to ascertain the diversity of oral C. albicans biotypes, if any, in health and disease.
AIDS-Related Opportunistic Infections↗
Detection of cytomegalovirus and Epstein-Barr virus in labial salivary glands in Sjogren's syndrome and non-specific sialadenitis.
To investigate the role of herpes viruses in Sjogren's syndrome, minor (labial) salivary gland tissues from Sjogren's syndrome and from non-specific sialadenitis were examined for Epstein-Barr virus (EBV) and human cytomegalovirus (HCMV) DNA by the polymerase chain reaction. Almost half of all salivary glands studied contained EBV and/or HCMV. There was, however, no significant difference between the detection of EBV or HCMV in salivary glands from patients with Sjogren's syndrome or non-specific sialadenitis. The findings are consistent with the persistence of EBV and HCMV in minor salivary glands following primary infection, but do not indicate a direct role for either virus in the aetiology of Sjogren's syndrome, and do not exclude reactivation of the viruses in this disease.
Base Sequence↗
Oligonucleotide probes to the 16S ribosomal RNA: implications of sequence homology and secondary structure with particular reference to the oral species Prevotella intermedia and Prevotella nigrescens.
Eight oligonucleotides based upon regions of the small subunit 16S ribosomal RNA gene sequences were analysed against a background of their position within the molecule and their two-dimensional structure to rationalise their use in recognising Prevotella intermedia and Prevotella nigrescens. The 41 clinical isolates from both oral and respiratory sites and two reference strains were subjected to DNA-DNA hybridisation and multilocus enzyme electrophoresis to confirm their identity. Alignment of oligonucleotide probes designated I Bi-2 to I Bi-6 (for P. intermedia) and 2Bi-2 (for P. nigrescens) with the 16S rRNA suggested that these probes lacked specificity or were constructed from hypervariable regions. A 52-mer oligonucleotide (designated Bi) reliably detected both species. Because of the high degree of concordance between the 16S rRNAs of both species, it was necessary to vary the stringency of hybridisation conditions for detection of both species. Thus probe I Bi-I recognised P. intermedia while I Bi-I detected both P. intermedia and P. nigrescens at low stringency. However, under conditions of high stringency only P. nigrescens was recognised by probe 2Bi-I. These probes were highly specific and did not hybridise with DNA from the closely related P. corporis, nor other periodontal pathogens such as Fusobacterium nucleatum, Actinobacillus actinomycetemcomitans, Treponema denticola and several pigmented species such as Prevotella melaninogenica, P. denticola, P. loescheii, Porphyromonas asaccharolytica, Py. endodontalis, Py. gingivalis, Py. levii, and Py. macacae.
Bacterial Typing Techniques↗
Orofacial involvement by systemic mycoses in HIV infection.
Explore the source record for details and available documents.
AIDS-Related Opportunistic Infections↗
Cell biology of the periodontium in health and disease.
Explore the source record for details and available documents.
Congresses as Topic↗
Cross-infection compliance of UK dental staff and students.
OBJECTIVES: The objectives of the study were to determine the compliance of a group of dental health care workers and students in aspects of cross-infection control. DESIGN: The dentists and dental students working in a dental clinic were observed by a 'hidden' ceiling-mounted video camera. Procedures were recorded onto videotape and the actions of the observed clinicians and students assessed by two suitably qualified assessors. SETTING: An emergency Oral Medicine clinic in a dental hospital. SUBJECTS: Seventy nine dentists and 35 dental undergraduates. METHODS: The action of staff and students were recorded on videotape and assessed retrospectively. MAIN OUTCOME MEASURES: Degree of compliance with recognised infection control policies. RESULTS: Compliance with recommended guidelines for control of cross-infection was poor. In only 56% of health care worker-patient contacts were protective gloves changed between patients. Facemasks and protective eyewear were only worn in 38% and 29% of such contacts respectively. CONCLUSIONS: Compliance with cross-infection control measures are poor in dentistry--even when clinicians are provided with appropriate facilities.
Attitude of Health Personnel↗
Levels of serum IgG against Porphyromonas gingivalis in patients with rapidly progressive periodontitis, rheumatoid arthritis and adult periodontitis.
Levels of serum IgG against Porphyromonas gingivalis cell sonicate were determined in patients with rheumatoid arthritis (RA) (n = 25), rapidly progressive periodontitis (RPP)(n = 25) and adult periodontitis (AP)(n = 15) and controls (HP)(n = 10) utilizing the ELISA technique. Comparison between groups showed no significant differences between the HP and RA groups and also between the RPP and AP groups. The increased levels of IgG in the RPP and AP groups were comparable. Significant differences in IgG levels were noted between HP and RPP (p<0.05) and between HP and AP (p<0.01). The differences between RA and RPP and between RA and AP were highly significant (p<0.0001). Thus it was revealed that the serum levels of IgG against P. gingivalis in RPP and AP patients were elevated, whereas the levels in RA patients were comparable to those in controls.
Adult↗
The pattern of patient attendance for emergency care in a British dental teaching hospital.
All new patients attending a dental hospital emergency clinic over a 10 week period were surveyed as to their reason for attendance. Six hundred and seven patients were seen and surveyed. Most complained of orofacial pain (77 per cent), swelling (22 per cent) or a lost restoration (21 per cent) but only 11 per cent had had their problem for less than one day. Most (60 per cent) had had symptoms for more than two days, and 29 per cent had had problems for more than 1 week.
Adolescent↗
Willingness of dentists to treat an HIV-infected patient.
Explore the source record for details and available documents.
Adult↗
Working patterns of male and female dentists in the UK.
A random selection of male (250) and female (250) dentists in the Dentists Register 1992 were sent a postal self-administered questionnaire to determine their working patterns, places of work and whether or not they had children of school age or younger. There was also space for free comment. Responses from 75% of males and 81% of females were received. Results show that 79% of males, compared with 46% of females, work in full-time dentistry, chiefly in general dental practice. Family commitments were the principal reason for 30% of female dentists working part-time. A small number (14%) of male dentists work in a second career alongside part-time dentistry. As a female dentist's family becomes older and less dependent so the number of sessions worked increases. Overall, female dentists felt well suited and satisfied with their chosen profession. A small, but worrying group (4%) of male full-time general dental practitioners were very dissatisfied with dentistry as a career and showed clear signs of severe psychological stress expressed in the style and nature of free comments made.
Career Choice↗
The efficacy of management of acute dental pain.
The effectiveness of pain relieving treatments given for acute dental pain has been evaluated after 24 hours in 172 patients who presented to a dental hospital emergency department. Patients were contacted by telephone the day after attendance and graded their pain on a scale from 1 (no pain) to 5 (pain much worse). The mean pain scores for each diagnosis of cause of pain were calculated and related to the treatment given. Some 76% of patients were in pain due to the ravages of dental caries of periodontal disease. Overall, 87% received marked or total pain relief and this appeared to depend upon decompression of inflamed tissue. Oral administration of antimicrobial drugs alone produced little or no pain relief within 24 hours and anti-inflammatory analgesics offer poor pain control in these circumstances.
Acute Disease↗