Oral cancer: necessity for prevention strategies.
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Biomedical subjects
Publications and source records attributed to C Scully.
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La maladie du petit papier is the term given when patients relate their bodily complaints, with written lists. Sixteen patients with orofacial complaints attending with lists were studied. Eighty per cent were females and most had chronic oral discomfort. Many had several complaints and had sought multiple opinions. In none was evidence of an organic basis for their main complaint detectable, but this must always be thoroughly excluded.
The knowledge and attitudes of dental patients in the UK and Hong Kong towards aspects of cross-infection control have been surveyed. Almost all patients expected dentists to wear protective gloves but only 73% and 40% expected dental staff to wear protective face masks and spectacles respectively. Most patients were aware that such measures were for the benefit of both dental staff and patients. Just over 50% of patients believed that they could contact HIV from an HIV-infected dentist. UK and Cantonese patients had generally similar attitudes to cross-infection protection, but the latter were positively influenced by the routine use of masks and spectacles and were more concerned about HIV transmission than UK patients.
The pattern of university applications has been related to dental school application rates between 1985 to 1991. The academic standard of GCE 'A' level attainment acceptable to each school has also been related to the number of places available and number of places filled. Whilst the total number of university applications has increased over the period, dental applications have decreased, with a lower proportion of male applicants being noticeable. Some schools had lower application rates than others. There appeared to be a tendency for schools which had previously accepted slightly lower 'A' level standards for entry to receive a larger number of applicants. Some schools showed evidence of accepting lower 'A' level standards of entry presumably to meet the financial need to fill all available places.
Over a decade into the HIV epidemic there is still concern about occupational transmission of HIV despite a demonstrated exceptionally low risk. This paper reviews the possible routes of transmission of HIV other than proven parenteral routes. Some of the recently evaluated facts about HIV are reviewed in relation to the practice of clinical dentistry.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Thirty thousand dentists and clinical ancillary staff in the UK were surveyed in July 1991 to assess the current state of immunisation against hepatitis B virus (HBV). About 11,000 responded immediately and nearly 94% of these had been, or were being, immunised against HBV. Nearly all dentists and therapists (94% in each group), 95% of hygienists, and 96% of dental surgery assistants had been immunised. However, one half of the respondents were at or approaching 5 years post-immunisation, the time when booster immunisation is recommended. About 53% of most responding clinical dental staff had been vaccinated 4 to 5 years before the survey, but, of these, nearly 81% had not had booster immunisation. Booster immunisation will now be indicated for most dental clinical personnel.
Cytogenetic analysis has been carried out on 8 early passage cell lines derived from 8 untreated human oral squamous cell carcinomas. Clonal aberrations were detected in the karyotypes of each cell line. A high frequency of breakpoints were noted on chromosomes 1, 7, 8, 9, 11, and X. An isochromosome 8 was present in 6 out of 8 cell lines; isochromosome 9 (3 cell lines) and isochromosome 11 (1 cell line) were also found. In 4 out of 8 cell lines X chromosome harboured breakpoints, a novel finding in oral squamous cell carcinomas. Breakpoints were common on chromosome 1, with 1p12-p13 most frequently involved. Tandem duplication of 11q13-q23, which contains a number of growth regulatory genes, was also noted in 2 cases. We correlate the sites of proto-oncogenes and other growth control genes with chromosomal breakpoints and suggest that several of these may play a role in the pathogenesis of oral cancer.
There have been recent reports of substantial increases occurring in the incidence of and/or mortality from tongue and mouth cancers in several countries. In this paper using data from Scotland (1960-89) we report on time trends in pharyngeal cancer. Similar increases in rates are evident for cancers of the oropharynx and hypopharynx while there has been little change in the occurrence of nasopharyngeal cancer (which has distinct aetiological factors). It therefore seems that reported changes in the incidence of and mortality from oral cancer may be real, and in Scotland, this is most probably due to changes in alcohol consumption.
Intravenous midazolam in doses of between 0.07 mg/kg and 0.1 mg/kg has been recommended for sedation in dentistry and some medical procedures and investigations. This study examined the variable sensitivity of patients to midazolam. One hundred and thirty-four fit but anxious patients between the ages of 16 and 63 years received midazolam intravenously for sedation for minor oral surgery. Doses required ranged from 0.04 to 0.40 mg/kg. Nineteen patients required doses less than 0.07 mg/kg; 59 patients required doses greater than 0.1 mg/kg. The mean dose per kilogram required for males was significantly less than for females. The wide variation in sensitivity to midazolam is confirmed.
The responses of clinicians to results of hematologic and serologic investigation of 79 patients with recurrent aphthous stomatitis have been reviewed. Twenty percent of patients with abnormal results were not adequately managed by attending clinicians.
Post tooth extraction infective complications have occasionally been described in HIV-infected persons. However, there is little objective data as to the frequency of this and the need for antibiotic prophylaxis. Similarly the frequency of postextraction bleeding in patients infected with HIV, who may have thrombocytopenia, is unknown. In the present study the frequency of postextraction complications has been investigated in a group of 38 persons at stages 2 to 4 of HIV infection and 26 matched subjects from patients groups commonly at risk of HIV infection but not seropositive. During 40 clinical procedures in HIV-infected patients, 100 (range 1 to 23, median 1) teeth were extracted. Three episodes of delayed postextraction healing were recorded. During 30 procedures in the non-HIV-infected persons, 68 (range 1 to 5, median, 2) teeth were extracted, and two episodes of delayed postextraction healing were recorded. These differences were not significant. Only one HIV-infected patient had an episode of severe postextraction bleeding: this was a hemophiliac who bled despite receiving factor VIII prophylaxis. The bleeding occurred 7 days after the extraction and ceased with tranexamic acid and additional factor VIII. No control subject had severe postextraction hemorrhage. It is concluded that postextraction complications are uncommon in HIV-infected patients and that routine antibiotic prophylaxis is not indicated.
The frequencies of human leukocyte antigens--HLA-A, HLA-B, HLA-C, HLA-DR, and HLA-DQ1--were determined in a group of 40 white British patients with oral lichen planus and compared with those of healthy controls. Alterations in the frequencies of several HLA antigens were noted. In particular, an increase in HLA-Bw57 and a decrease in the frequency of HLA-DQ1 were seen in the group with lichen planus. When different clinical subgroups of lichen planus were compared with the control group, significant changes were also noted in the frequencies of HLA antigens. This suggests that lichen planus may represent a heterogeneity of diseases and that HLA-Bw57 may predispose a person to lichen planus whereas HLA-DQ1 may be associated with resistance to it.
Temporomandibular joint osteoarthrosis is common but typically asymptomatic. This article describes a patient with symptomatic left temporomandibular joint osteoarthrosis in whom pain in the right side of the tongue and ear, and dysphagia, subsequently developed simulating Eagle's syndrome. The concept of Eagle's syndrome is reviewed.
Paracoccidioidomycosis (South American blastomycosis) is an uncommon, progressive systemic mycosis, virtually only seen in persons who have visited Latin America. Reports of oral lesions are extremely rare in the English-language literature. Thirty-six adults with oral lesions as the first sign of paracoccidioidomycosis are described; this appears to be the largest series in the dental literature. All had chronic proliferative mulberry-like ulcerated oral lesions; the diagnosis was confirmed histologically. The gingiva or alveolar process was the typical site, but lesions were also seen particularly on the palate and lip. Most of the patients proved to have detectable pulmonary involvement. Patients with lesions in the oropharynx, tongue, or floor of mouth all had confirmed pulmonary lesions.