Search PubMed⌕ Search

Biomedical subjects

J B Epstein

Publications and source records attributed to J B Epstein.

At least 55 records · Page 3Linked to original sources
PubMed1999

Pretreatment assessment and dental management of patients with nasopharyngeal carcinoma.

Patients who present with nasopharyngeal carcinoma (NPC) require through oral and dental assessment prior to treatment of the malignancy. We assessed the oral status of 57 consecutive patients with a diagnosis of NPC. In this study, identified risk factors for NPC were seen to be different in Asian versus non-Asian patients. Epstein-Barr virus seropositivity was seen in all Asian patients and in 69% of non-Asian patients (P = 0.00006), and reported alcohol use was greater in the non-Asian patients. In this study it was found that 68% of dentate patients required dental extractions primarily due to periodontal disease. Even in patients who reported receiving regular dental care (28%) extractions prior to radiation therapy were suggested. Oral complications of radiation therapy were reported by 84% of patients, with the most common being xerostomia. Clinical diagnosis of candidiasis (16%), rampant caries (10% of dentate patients) and difficulties with dentures (25% of denture wearers) were noted. In addition to pretreatment assessment, continuing oral and dental management is needed for patients with NPC.

Adult↗
PubMed1999

A double-blind crossover trial of Oral Balance gel and Biotene toothpaste versus placebo in patients with xerostomia following radiation therapy.

Following therapeutic irradiation of the head and neck, patients with profound xerostomia have complaints associated with oral dryness, effects upon use of oral prosthesis, speech, and taste. In addition, xerostomia may lead to risk of oral infections and rampant demineralization of teeth. The use of topical Oral Balance gel and Biotene toothpaste (Laclede Professional Products, Gardena, CA) versus carboxymethylcellulose gel and commercial toothpaste applications was assessed in a 2-week double-blind, crossover design. The palliative effects of Oral Balance gel and Biotene toothpaste were superior to the effects of a placebo. No effect on oral colonization by Candida species and cariogenic oral microflora was seen with use of the topical agents.

Adult↗
PubMed1999

Periodontopathic bacteria in English HIV-seropositive persons.

Selected periodontopathic bacteria were sought in 20 HIV-infected English patients and eight noninfected control subjects with similar periodontal status, using highly specific DNA probes. Actinobacillus actinomycetemcomitans (A. a), Porphyromonas gingivalis, Campylobacter rectus, Prevotella intermedia, and Fusobacterium nucleatum were more frequently detected and were found at higher levels in HIV-infected individuals than in controls. Significantly increased levels of Treponema denticola but, in contrast, lower levels of Eikenella corrodens were found in nonbleeding sites of HIV-infected patients compared with controls. The results of the present investigation on English patients suggest a periodontopathogenic role for A. a, P. gingivalis and C. rectus, and possibly P. intermedia and are in general accord with most previously reported data from the United States. Longitudinal studies are now required to determine more precisely the association between periodontopathic microflora, immune competence and periodontal health and disease in HIV-infected persons.

AIDS-Related Opportunistic Infections↗
PubMed1999

Basal cell carcinoma: what dentists need to know.

BACKGROUND: Basal cell carcinoma, or BCC, is a malignant epithelial tumor of the skin, commonly seen in the head and neck. Because dentists routinely evaluate the head and neck, the authors present three examples of BCC of the face and jaw to help clinicians recognize the condition. They also provide a literature review regarding BCC's etiology, classification, treatment and prevention. DESCRIPTION OF THE DISEASE: Sun exposure plays an important role in the development of BCC. The most susceptible people are those with minimal skin pigmentation. BCC is more frequently seen in men than in women. The most common form of BCC is the nodular type, which, if untreated, eventually ulcerates and may result in extensive local tissue destruction. The three cases described in this article highlight the range of BCC severity. CLINICAL IMPLICATIONS: Oral health care providers may play an important role in the recognition and diagnosis of BCC involving the head and neck. Early recognition and diagnosis may lead to management that results in improved cure rates, with reduced morbidity and reduced treatment costs.

Aged↗
PubMed1999

Infective endocarditis and dentistry: outcome-based research.

Antibiotic prophylaxis for prevention of infective endocarditis has long been recommended for patients receiving dental care. Two studies of patients with endocarditis found limited risk associated with dental treatment. It is imperative that guidelines for therapy be based on outcome studies and on evidence of safety, efficacy and cost effectiveness.

Antibiotic Prophylaxis↗
PubMed1998

Topical bleomycin for the treatment of dysplastic oral leukoplakia.

BACKGROUND: Because malignant transformation of dysplastic oral leukoplakia has been reported in up to 43% of cases, these lesions must be managed. METHODS: This study evaluated the use of topical 1% bleomycin in dimethylsulfoxide for the treatment of dysplastic oral lesions. Bleomycin was applied once daily for 14 consecutive days to lesions of the oral mucosa in 19 patients. Immediate posttreatment biopsies and the clinical response were evaluated and clinical follow-up was conducted for as long as possible. RESULTS: The mean age of the patients at diagnosis was 59.4 years and 74% were tobacco users. Seventy-five percent of patients had resolution of dysplasia at follow-up biopsy, with a mean improvement of two histologic grades of dysplasia after topical chemotherapy. Ninety-four percent of the patients attained at least partial responses. After a mean follow-up period of 3.4 years, 31.6% of patients had no clinically visible lesions and 47.4% of patients had clinically benign lesions of homogeneous leukoplakia or minimal visible leukoplakia. In 2 patients (11%) malignant transformation occurred a mean of 1.75 years after bleomycin treatment. CONCLUSIONS: Topical bleomycin may prevent the potential progression of leukoplakia through dysplasia to carcinoma. Close follow-up of all patients with dysplasia is required.

Administration, Topical↗
PubMed1998

Effect of impact and injury characteristics on post-motor vehicle accident temporomandibular disorders.

OBJECTIVES: The objective of this study was to assess the potential effects of motor vehicle accident impact and injury characteristics on post-motor vehicle accident temporomandibular disorders in terms of presenting signs and symptoms, diagnoses, treatment regimens, and outcomes. STUDY DESIGN: A retrospective chart review of 50 patients with post-motor vehicle accident temporomandibular disorders from a private oral medicine practice was undertaken. Various demographic data and data related to temporomandibular disorders and motor vehicle accident impact and injury characteristics were collected. Chi-square and Fisher exact tests and multiple regression analyses were performed. RESULTS: Patients involved in front-end collisions or motor vehicle accidents resulting in severe vehicle damage reported more direct orofacial injury. However, those in rear-end collisions or accidents resulting in minimal vehicle damage required more treatment. Direct head or orofacial injury was therefore not a prognostic indicator. From multiple regression analyses, indicators of a poorer prognosis were minimal vehicle damage, lack of headrest use, driver position, and settlement of insurance claim. CONCLUSIONS: In this patients group several prognostic indicators for patients with post-motor vehicle accident temporomandibular disorders were identified; these indicators may influence the management approach for this patient population.

Accidents, Traffic↗
PubMed1998

The relationships among fluoride, cariogenic oral flora, and salivary flow rate during radiation therapy.

Changes in the quantity of Streptococcus mutans, Lactobacillus species, and yeast Candida species were assessed in a cancer population undergoing head and neck radiation. The purpose of this study was to evaluate the effectiveness of a custom vinyl tray-applied fluoride gel to control cariogenic bacteria in a group experiencing hyposalivation because of radiation treatment. Twenty-two subjects participated in the study and served as their own controls. Whole resting and whole stimulated saliva were collected at weekly appointments beginning 1 week before and concluding 4 weeks after radiation therapy. Colony-forming units per mL of Streptococcus mutans and Lactobacillus species and semiquantitative counts of Candida species (0 = none; 1 = light; 2 = moderate; 3 = heavy) were determined from collected saliva. All patients were provided with custom vinyl vacuform mouthguards to be used daily with neutral fluoride gel (1.1% sodium fluoride). Whole stimulated and resting saliva productions decreased by 36.67% and 47.9%, respectively, by the end of 1 week of radiation therapy, and they remained low. No significant changes in cariogenic oral flora were seen during and early after radiation therapy, despite xerostomia. However, colonization by Candida albicans increased during radiation therapy for oropharyngeal cancers. Findings from this study suggest that changes in cariogenic flora may be suppressed through the use of daily topical neutral sodium fluoride gels and that colonization by Candida albicans increase during radiation therapy.

Adult↗
PubMed1998

Periodontal attachment loss in patients after head and neck radiation therapy.

OBJECTIVE: The purpose of this study was to determine the potential impact of head and neck radiation therapy on the progression of periodontal attachment loss. STUDY DESIGN: Ten patients who received unilateral radiation fields that included the dentition were assessed before radiation treatment and after irradiation at a mean age of 6.01 years. Complete oral, dental, and periodontal examinations were completed by one examiner. The results were assessed through use of paired t tests. RESULTS: More teeth were extracted because of periodontal disease in the field of radiation after irradiation. Remaining teeth in the radiated volume showed an increase in probing depth of 0.82 mm in comparison with 0.40 mm for teeth in the nonradiated region (P = .05). Recession on the facial aspects was 1.88 mm for teeth in the radiated volume and 1.16 mm for teeth in the nonradiated region (P = .001), and recession on the lingual aspects was 2.10 for teeth in the radiated volume and 0.91 for teeth in the nonradiated region (P = .05). Mean total attachment loss was 2.81 mm for teeth in the radiated sites; this compared with 1.43 mm for teeth in the nonradiated sites (P = .003). Increased mobility of teeth in the high-dose fields was seen (P = .02). CONCLUSIONS: This study showed that tooth loss and greater periodontal attachment loss occur in teeth that are included within high-dose radiated sites of patients treated with irradiation therapy for cancer. These findings should be considered in preradiation treatment planning.

Adult↗
PubMed1998

Melanoma arising from the mucosal surfaces of the head and neck.

Oral mucosal malignant melanoma is a rare disease. We reviewed 30 years of data from a tumor registry and identified 65 patients who had head and neck melanomas. Two thirds (43) of the 65 patients were identified as male, with the mean age in the sixth decade. Of the 65 patients, only 6 had melanoma that arose from the oropharyngeal mucosa. Of the lesions involving the oral mucosa, each lesion manifested itself as a mass or was associated with symptoms of discomfort; only one third (2) of the lesions were pigmented. The clinician must carefully examine the head, neck, and oral cavity, and any pigmented lesion that is not recognized as a specific entity, such as amalgam tattoo, should be biopsied. The more common presentation of amelanotic malignant melanoma requires a high index of suspicion for masses identified in the mouth and requires biopsy for definitive diagnosis. The prognosis for oral mucosal malignant melanoma is poor.

Aged↗
PubMed1998

Infective endocarditis: dental implications and new guidelines for antibiotic prophylaxis. American Heart Association.

The American Heart Association (AHA) has developed new guidelines for antibiotic prophylaxis for patients at risk of infective endocarditis (IE). These guidelines are based on the on-going study of endocarditis cases and continued experience with antibiotic prophylaxis, and are an update of the 1990 recommendations. The major changes from the 1990 guidelines are: the recognition that most cases of IE are not attributable to an invasive procedure; that cardiac conditions may present different levels of risk categories; increased delineation of when prophylaxis should be given in cases of mitral valve prolapse; a change to a single dose of antibiotic and changes in the antibiotics recommended for prophylaxis. The revised AHA guidelines parallel those in Europe and the United Kingdom. It is essential that all dental professionals be fully aware of the modifications to these guidelines because of their importance in patient care and their medico-legal implications.

Antibiotic Prophylaxis↗
PubMed1998

Head and neck and intra-oral soft tissue sarcomas.

Intra-oral soft tissue sarcoma is a rare disease. We reviewed a tumour registry over a 45 year period, between January 1951 and January 1997, and identified a total of 11,250 head and neck cancers in British Columbia. Of the head and neck cancers, there were 139 cases (1.24%) of sarcoma; and of these, there were only 16 cases (0.14%) of intra-oral soft tissue sarcoma. The initial presentation of intra-oral soft tissue sarcoma is most often as an asymptomatic mass and discomfort is reported by less than one half of the patients. The commonest lesion identified was rhabdomyosarcoma (RMS). In this review, we identified 2 unique cases, 1 case of intra-oral hemangiopericytoma and 1 case of oral carcinosarcoma. The prognosis remains poor. Treatment includes wide surgical excision which may be supplemented with radiotherapy and chemotherapy.

Adolescent↗
PubMed1997

The use of exfoliative cell samples to map clonal genetic alterations in the oral epithelium of high-risk patients.

Although it is widely accepted that clonal genetic alterations are an essential component of tumor progression, little is known of the distribution of such changes in high-risk lesions or how such clones are altered over time. We explored the feasibility of using exfoliative cells collected by scraping the mucosal surface to detect allelic loss in oral lesions of 22 patients (14 squamous cell carcinomas, 2 carcinomas in situ, and 6 dysplasias). The data show that the patterns of allelic loss observed in these samples closely represent those observed in biopsies of the same region. Furthermore, early indications are that this approach can be used to detect recurrent outgrowth of clones of altered cells in patients after therapy.

Adult↗
PubMed1997

Temporomandibular disorders, headaches, and neck pain after motor vehicle accidents: a pilot investigation of persistence and litigation effects.

STATEMENT OF PROBLEM: There is a lack of long-term follow-up studies that involve post-motor vehicle accident temporomandibular disorders and compensation. PURPOSE OF STUDY: The purposes of this retrospective pilot study were (1) to assess patients who had previously been treated for temporomandibular disorders after motor vehicle accidents to determine the nature of their symptoms in terms of jaw, head, and neck pain and jaw dysfunction and (2) to determine whether there was a difference in the pain and dysfunction between those who had settled and those who had not settled their insurance claims. MATERIAL AND METHODS: Thirty previously treated patients with temporomandibular disorders after motor vehicle accidents were questioned by telephone regarding litigation status and current jaw, head, and neck pain and jaw dysfunction symptoms. They did not differ substantially from a smaller group who were not able to be interviewed. Descriptive statistics were calculated and statistical tests were performed. A total of 22 patients had their claims settled. RESULTS: Approximately three fourths had persistent complaints of jaw pain, jaw dysfunction, and headache, and more than 80% reported persistent neck pain. No apparent differences were found between those who had and had not settled their insurance claims. CONCLUSION: Jaw, head and neck pain, and jaw dysfunction continued to be problems for the majority of this patient population, regardless of litigation status in this retrospective study.

Accidents, Traffic↗
PubMed1997

The utility of toluidine blue application as a diagnostic aid in patients previously treated for upper oropharyngeal carcinoma.

OBJECTIVES: This study evaluated the utility (usefulness) of toluidine blue application as an aid to the recognition and diagnosis of clinically evident lesions in a series of patients previously treated for oral cancer and monitored in a cancer center. In addition to increased risk of recurrence of cancer or new second primary lesions, patients who have had previous treatment for oropharyngeal cancer may be more difficult to assess because of tissue changes that occur as a result of previous radiation therapy. STUDY DESIGN: Patients with a history of oral malignancy were assessed by clinical examination followed by application of toluidine blue. Biopsy sites were determined on the basis of unaided visual examination and by the findings on toluidine blue application. Biopsy specimens were reviewed by a pathologist blinded to the clinical findings. RESULTS: Unaided clinical examination identified 78% of carcinoma in situ or invasive malignant lesions compared with toluidine blue application, which identified all (100%) carcinoma in situ or invasive malignant lesions (p = 0.02) and produced no false-negative findings. No differences were found between clinical examination and toluidine application in the detection of dysplastic lesions. CONCLUSION: Toluidine blue retention was seen in all cases of carcinoma in situ and invasive carcinoma, and no false-negative findings were seen with toluidine blue. When used by a trained and experienced clinician in a cancer center, toluidine blue was a valuable visual aid to clinical examination of oral mucosal lesions.

Carcinoma, Squamous Cell↗
PubMed1997

Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy.

Herpes viruses are characterized by their ability to establish and maintain latent infections that can be reactivated. Several stimuli can trigger the reactivation of herpes viruses, which are perhaps best recognized in the recurrent blisters and ulcers associated with herpes simplex virus. We present two clinical cases of reactivation of herpes simplex virus during radiation therapy for management of cancers of the head and neck. Although the role of ionizing radiation in the reactivation of herpes simplex virus has not been established, we review the viral and host events associated with the establishment of orofacial herpes simplex virus infection, latency, and reactivation of the virus. We discuss current models of viral reactivation and suggest directions for further clinical research into the reactivation of orolabial herpes simplex virus during radiotherapy.

Acyclovir↗
PubMed1997

Assessment of epidermal growth factor in oral secretions of patients receiving radiation therapy for cancer.

Biological response modifiers have been studied in animal models of oral mucositis. We assessed the presence of epidermal growth factor (EGF) in patients during radiation therapy for head and neck cancer. The findings of this preliminary study showed that it is possible to measure the presence of EGF in oral secretions during radiation therapy. EGF was shown to decrease during the course of radiation therapy, and a trend was seen with decreasing EGF and increasing oral ulceration (P = 0.10) and increasing total mucositis score (P = 0.09).

Adult↗