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Biomedical subjects

J B Epstein

Publications and source records attributed to J B Epstein.

190 records · Page 11Linked to original sources
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Periodontal pocketing in HIV-associated periodontitis.

Gingival and periodontal involvement has been described in individuals with Human Immunodeficiency Virus (HIV) infection. The manifestations often include erythematous gingivitis, necrotizing gingivitis, and periodontal involvement characterized by rampant loss of bone and soft tissue, resulting in recession without the formation of periodontal pockets. We present cases of HIV-associated periodontitis (HIV-P) in which advanced periodontal pocket formation was present. Periodontal disease may show a broad range of severity in patients with various T4 helper cell counts.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Surgical periodontal treatment in the radiotherapy-treated head and neck cancer patient.

A series of clinical cases is presented in which surgical periodontal therapy was conducted within the high-dose volume of prior radiation therapy. Close oral supervision is required in patients following head and neck radiation therapy. Non-surgical periodontal management is crucial in the care of these patients following radiation therapy. Careful selection of patients for possible surgical therapy and care in performing the procedure may allow successful periodontal management, as is demonstrated in the cases reviewed.

Adult↗
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Compliance with fluoride gel use in irradiated patients.

Patients who undergo radiation therapy that includes the salivary glands frequently experience severe xerostomia. The standard of care for these patients who have natural teeth has become daily application of fluoride by means of custom-fabricated carriers. The purpose of this study was to determine patient compliance with fluoride gel application using carriers. Using a structured verbal questionnaire, we interviewed 76 patients who had completed radiation therapy for head and neck cancer. Thirty of these patients were seen regularly in the dental clinic of the Cancer Agency (group 1); the remaining 46 were not seen on a regular basis (group 2). Overall, 43% of patients reported using fluoride gel regularly (once a day). In group 1, 67% of patients used fluoride regularly, as did 28% of patients in group 2 (p = 0.001). There were no significant differences between the groups in frequency of toothbrushing and use of dental floss. Compliance with the use of fluoride in carriers was not associated with differences in other oral care measures in the two groups, which suggests that fluoride application in carriers achieves limited compliance in relation to daily oral health care measures. Regular follow-up of patients after radiation therapy is needed to assess their need for, and compliance with, daily fluoride application.

Adult↗
PubMedDate not supplied

Complicating mucosal reactions in patients receiving radiation therapy for head and neck cancer.

Radiation mucositis is characterized by erythema, pseudomembranes, and ulceration of mucosa in the irradiated field. We present two cases of oral mucosal changes in patients treated with radiotherapy in the head and neck region, which included mucosal erythema and ulceration outside of the radiated fields. One case was confirmed as herpes virus infection, and the other was diagnosed as Sweet's syndrome. When mucositis extends beyond the radiation fields, the clinician should consider other causes of mucosal inflammation and erythema in order to begin appropriate management.

Diagnosis, Differential↗
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Assessing the patient at risk for oral squamous cell carcinoma.

Patients and health care workers require continuing education to promote knowledge of the signs, symptoms, and risk factors for oral cancer. This paper reviews the literature assessing diagnostic tools that are currently available or being developed, in order to assist in the biopsy site selection and subsequent diagnosis of patients at risk for oral cancer. There is a general consensus that oral examination of patients at risk for oral squamous cell carcinoma (SCC) should be conducted on a routine basis. However, there can be false-positive and false-negative findings. Toluidine blue has been shown to be useful as an adjunct to the clinical examination when used by experienced clinicians. Exfoliative cytology is not currently used as a routine measure for the evaluation of lesions of the oral mucosa, but further development and the application of biologic markers to cytologic specimens may increase its value. Fluorescent imaging of malignant lesions of the oral mucosa has been shown to be sensitive and specific in animal models but thus far has been reported in only one human trial. The sensitivity and specificity of these techniques when used by general practitioners need to be assessed. Further, none of the above procedures has yet been shown to be a cost-effective public health measure in screening for oral cancer.

Biomarkers, Tumor↗
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Assessment of objectives of post-doctoral general dentistry programs in Canada.

Objectives of hospital-based post-doctoral general dentistry programs in Canada were assessed by questionnaire. Seventy percent (14 of 20) of the program directors responded. Educational goals and objectives were assessed in professional skills and practice management, public health and preventive dentistry, oral medicine and pathology, special needs patient care, trauma and emergency care, restorative/prosthodontic care, endodontics, orthodontics/pediatric dentistry, oral surgery, periodontics, pharmacology, and functioning in a hospital. High rankings of proficiency were related to primary care, restorative/prosthodontic, endodontic, and surgical care. Emergency care, sedation, and pharmacology were also ranked highly. Lower rankings of proficiency were reported in orthodontics, aspects of public health dentistry, practice management, and advanced oral and maxiliofacial surgery. When the results of the Canadian survey were compared with those of a survey of US post-doctoral general dentistry programs, substantial similarity was seen. The findings support continuing reciprocity in accreditation standards between the Canadian and American Commissions on Dental Education and Dental Accreditation.

Anesthesia, Dental↗
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Understanding "alternative" dental products.

Alternative, complementary, integrative, and holistic health care are matters of public interest and include oral and dental care products. There are a variety of dental products promoted as "alternatives" to the standard commercial dental products that most dentists recommend and most patients use. These alternative products can be categorized as standard dental products made with natural ingredients, herbal products, homeopathic products, and synthetic alternative products. Dental health care providers should be aware of the range of "alternative" dental products and be able to counsel their patients to understand the type of support and evidence needed to determine safety and efficacy of treatment. The use of dental care products should be based upon sound basic science and sufficient clinical evidence of safety and efficacy.

Complementary Therapies↗
PubMedDate not supplied

Antimicrobial resistance: dentistry's role.

The resistance of bacteria, fungi and viruses to antimicrobials is increasing rapidly, with deleterious consequences. Dentistry's role in this development is unclear, because the necessary information has not yet been collected. Nevertheless, dentists should recognize that it is essential to use antimicrobials in an appropriate and responsible manner, both to treat infection effectively, and to minimize the likelihood that the bacteria in the general population will develop resistance to antimicrobials. The purpose of this article is to make dentists aware of the concerns raised by antimicrobial resistance, and how it can be avoided.

Anti-Bacterial Agents↗