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PubMed2000

Chewing tobacco, alcohol, and the risk of erythroplakia.

Although chewing tobacco, smoking, and alcohol drinking have been suggested as risk factors for oral cancer, no study has examined the relationship between those factors and the risk of erythroplakia, an uncommon but severe oral premalignant lesion. In this study, we have analyzed the effects of chewing tobacco, smoking, alcohol drinking, body mass index, and vegetable, fruit, and vitamin/iron intake on the risk of erythroplakia and explored potential interactions between those factors in an Indian population. A case-control study including 100 erythroplakia cases and 47,773 controls was conducted, as part of an on-going randomized oral cancer screening trial in Kerala, India. The analysis was based on the data from the baseline screening for the intervention group, where the diagnostic information was available. The information on epidemiological risk factors was collected with interviews conducted by trained health workers. The erythroplakia cases were identified by health workers with oral visual inspections, and then confirmed by dentists and oncologists who made the final diagnosis. The odds ratios (OR) and their 95% confidence intervals (CIs) were calculated by the logistic regression model using SAS software. The adjusted OR for erythroplakia was 19.8 (95% CI, 9.8-40.0) for individuals who had ever chewed tobacco, after controlling for age, sex, education, body mass index, smoking, and drinking. The adjusted OR for ever-alcohol-drinkers was 3.0 (95% CI, 1.6-5.7) after controlling for age, sex, education, body mass index, chewing tobacco, and smoking. For ever-smokers, the adjusted OR was 1.6 (95% CI, 0.9-2.9). A more than additive interaction on the risk of erythroplakia was suggested between tobacco chewing and low vegetable intake, whereas a more than multiplicative interaction was indicated between alcohol drinking and low vegetable intake, and between drinking and low fruit intake. We concluded that tobacco chewing and alcohol drinking are strong risk factors for erythroplakia in the Indian population. Because the CIs of interaction terms were wide and overlapping with those of the main effects, only potential interactions are suggested.

Adult↗
PubMed2000

Micronucleus frequencies in exfoliated buccal cells in normal mucosa, precancerous lesions and squamous cell carcinoma.

OBJECTIVE: To assess the value of micronuclei in the characterization of precancerous lesions of the oral cavity with reference to their likelihood of progressing to malignant lesions. STUDY DESIGN: The frequency of micronuclei was determined in exfoliated cells from normal oral mucosa, a preneoplastic condition (leukoplakia) and precancerous lesions with and without dysplasia, squamous cell carcinomas and sites of previous carcinomas that had been removed. RESULTS: Average micronucleus frequencies were increased in precancerous lesions as compared to normal mucosa and further increased in carcinomas, suggesting that micronuclei are a biomarker of neoplastic progression in this type of cancer. With all samples, micronucleus frequencies were systematically higher when cells were collected by vigorous than by light scraping, suggesting a decreasing gradient from basal to superficial layers of mucosa. The micronucleus frequency did not vary with the sex or age of patients, while it did vary with the anatomic site of the lesions. CONCLUSION: Although the gradual increase in micronucleus counts from normal mucosa to precancerous lesions to carcinomas suggests a link of this biomarker with neoplastic progression, the large overlapping of data prevents its use as a predictor of progression of precancerous lesions to malignancy in individual patients.

Adult↗
PubMedDate not supplied

The oral brush biopsy: a new reason to screen every patient for oral cancer.

Awareness about the prevention of oral cancer by both the public and the dental professional is expected to increase significantly. This article provides timely information about the computer-assisted analysis of an oral brush biopsy, a practical and accurate aid to oral cancer screening.

Biopsy↗
PubMed2001

Premalignant oral mucosal diseases.

A premalignant phase in the development of oral cancer is predicted by the classic model of experimental epithelial carcinogenesis. Virtually all oral squamous cell carcinomas arise from a premalignant precursor, but it is difficult to specifically define the term premalignant. Oral pathologists use the term epithelial dysplasia to indicate microscopic features in a biopsy specimen that are associated with a risk of malignant change and then assign a grade of severity. There is good correlation between higher grades of dysplasia and increasing risk of cancer but less so with the lower grades. The clinical appearances manifested by oral epithelial dysplasia and early oral cancer include leukoplakia, erythroplakia, and speckled leukoplakia. This paper discusses and illustrates these clinical lesions, their associated risk factors, their relationship to epithelial dysplasia, and the associated risk of evolution into oral cancer.

Carcinoma, Squamous Cell↗
PubMed2000

Oral precancer and cancer: etiology, clinical presentation, diagnosis, and management.

Oral and oropharyngeal cancers represent 3% of all cancers in the United States annually, with nearly 50% of people diagnosed with oral and oropharyngeal cancers dying as a result of the disease. Because the dental practitioner is in an ideal position for recognizing any abnormality of the oral mucosa, he or she is involved in the battle against oral cancer by helping establish the diagnosis at an early stage. This article presents the clinical appearance, explains the origins, and describes steps for the management of oral precancer and cancer.

Alcohol Drinking↗
PubMed2001

Computer-assisted analysis of the oral brush biopsy.

Computer-assisted analysis of the oral brush biopsy is a recently introduced tool that determines the significance of an oral lesion. The oral brush biopsy is minimally invasive, requires no anesthesia, and definitively distinguishes benign from precancerous and cancerous lesions. Oral brush biopsy specimens are analyzed with the aid of a highly specialized neural network-based computer system specifically designed to detect oral epithelial precancerous and cancerous cells.

Biopsy↗
PubMedDate not supplied

Screening for oral cancer and precancer--a valuable new technique.

Many precancerous or cancerous oral lesions may resemble benign lesions and a definitive diagnosis on clinical grounds alone may be difficult, if not impossible, to make. The introduction of OralCDx, an oral brush biopsy procedure, permits the dental practitioner to determine which lesions contain atypical or dysplastic epithelial cells and require that a conventional scalpel biopsy be performed. This article reviews the features of the test, explains the clinical situations for which its use is recommended, and discusses the interpretation and significance of the biopsy reports.

Biopsy↗
PubMedDate not supplied

A comprehensive review of oral cancer.

Oral squamous cell carcinomas comprise 2-3% of all new malignancies diagnosed in the United States, making it the 10th most common malignancy. However, for the last few decades, the average five-year survival rate of 50% has not changed significantly. This article reviews the risk factors associated with the development of oral cancer and how premalignant (leukoplakia and erythroplakia) and actual cancerous lesions may appear. Diagnostic tools and aids to diagnosis are discussed, as are treatment modalities. It is imperative that all dental professionals perform a simple head and neck examination in addition to an oral examination during each new patient visit and each six-month recall appointment. Early detection saves lives.

Age Factors↗
PubMed2002

Chromosome instability in lymphocytes: a potential indicator of predisposition to oral premalignant lesions.

Oral premalignant lesions (OPLs) are related to tobacco use and mark individuals at high risk for oral cancer development. Increased mutagen sensitivity as measured by an in vitro mutagen challenge assay has been shown to be a risk factor for upper aerodigestive tract cancers. In this case control study, we used two assays with mutagens relevant to tobacco exposure (benzo[a]pyrene diol epoxide (BPDE) and bleomycin) to see whether sensitivity to these mutagens could be used as biomarkers for assessing risk of premalignant lesions. Furthermore, we evaluated whether 3p21.3 is a molecular target of BPDE damage in lymphocytes of patients with OPLs. There were 82 patients with OPLs and 89 healthy controls frequency matched to the cases on age, sex, ethnicity, and smoking status. These subjects' lymphocytes were treated in two separate experiments with either 2 microM BPDE for 24 h or 0.03 units/ml bleomycin for 5 h, and the frequency of induced chromatid breakage in Giemsa-stained preparations was determined. BPDE-induced 3p21.3 aberrations were scored by fluorescent in situ hybridization technique in 1000 interphases/sample. We found that the mean BPDE-induced chromatid breaks per cell were higher in cases than controls (1.05 +/- 0.40 and 0.55 +/- 0.27, respectively; P < 0.01). Similar results were evident with bleomycin-induced chromatid breaks per cell (0.78 +/- 0.37 and 0.57 +/- 0.31, respectively; P < 0.01). After adjusting for age, sex, ethnicity, and smoking status, significantly elevated odds ratios (95% confidence interval) for OPL risk were noted for BPDE sensitivity [12.96 (5.51, 30.46)] and bleomycin sensitivity [3.33 (1.64, 6.77)]. When subjects were categorized into quartiles of the number of breaks per cell, a dose response was observed for both assays. The adjusted odds ratios for subjects with increasing numbers of breaks per cell in quartiles were 2.34, 9.14, and 54.04 for BPDE sensitivity and 1.92, 3.33, and 7.15 for bleomycin sensitivity, respectively. Subjects sensitive to both mutagens had a 50-fold increased risk for OPLs. In addition, there were significantly more BPDE-induced chromosome aberrations at the 3p21.3 locus in cases (51.13/1000) than in controls (40.93/1000; P < 0.0001). However, no such difference was observed for 3q13, a control locus. BPDE-induced 3p21.3 aberrations were associated with an elevated risk for OPLs of 6.08 (2.57, 14.4). The degree of BPDE sensitivity at 3p21.3 and risk for OPLs increased in a dose-dependent manner. In summary, BDPE sensitivity and bleomycin sensitivity appear to be individually and jointly associated with elevated risk of OPLs. Furthermore, 3p21.3 may be a molecular target of BPDE in OPLs. This is the first study to examine mutagen sensitivity in a premalignant condition. The next step is to correlate these findings in surrogate (lymphocyte) tissue with molecular events in the target tissue.

7,8-Dihydro-7,8-dihydroxybenzo(a)pyrene 9,10-oxide↗
PubMed2002

[Update review on prevention and early diagnosis in oral cancer].

Oral cancer is a major health problem in some parts of the world, especially in developing countries. Worldwide, the annual incidence exceeds 3,000,000 new cases. The main risk factors are tobacco and alcohol. However, dietary factors, viruses and possibly genetic predisposition have also been associated with oral cancer. Several oral lesions such as leukoplakia, erythroplakia and lichen planus carry an increased risk for malignant transformation in the oral cavity. Prognosis of oral cancer differs significantly between specific oral locations, with cancer of the lip for example having a much better prognosis than at the base of tongue or on the gingiva. Prognosis of intra-oral cancer is generally poor, with a five-year survival less than 50 percent. Local recurrences as well as lymph node metastases occur in a significant percentage of patients, while distant metastases are less frequent. Prognosis correlates mainly with the size of the lesion and the nodal status at the time of diagnosis, therefore early detection of small, stage-1 oral cancer can reduce mortality and morbidity. Oral lesions can be easily observed by direct visualization, however, knowledge of the differential diagnosis of oral lesions is mandatory for early diagnosis of malignant and pre-malignant lesions in the oral cavity. Use of screening and detection aids such as vital stains and Oral CDX can increase the number of cases diagnosed at an early stage, or even in the pre-malignant stage. Development of molecular markers can improve the early diagnosis and can help in predicting treatment response. New treatment modalities including tumor specific antibodies and gene therapy are emerging, giving more hope for patients with oral cancer. There is an important role for the dentist in both early diagnosis of pre-malignant and malignant lesions, and in prevention by educating the patients of the risks associated with tobacco, alcohol and dietary factors.

Alcohol Drinking↗
PubMedDate not supplied

Oral cancer. Practical prevention and early detection for the dental team.

Approximately 2,000 patients a year are diagnosed with oral cancer in New York State. In an effort to control this deadly disease, Governor George Pataki has taken a leadership role in the United States by mandating and funding training for dentists in the prevention and early detection of oral cancer. The purpose of this article is to highlight the epidemiology of oral cancer, to show how the dental profession can contribute to the health of the citizens of New York State, and to provide practical guidelines for both tobacco cessation intervention and utilization of existing technology for the early detection of oral cancer and precancerous conditions in the general dental practice setting.

Adolescent↗
PubMed1975

[Variable pseudoerythroplasic telangiectasis balanitis].

This is a special case of balanitis, that authors separate from entities clinically established such as Erthroplasie of Queyrat, Balanitis of Zoon, Liquenoide Balantis with Plasmocytes and the Balantis of Sulsberger and Garbe's illness. The V. P. T. B. is clinically characterized by the presence of telangiectasies, ertroplasiform aspect, without any infiltration, non purpure, the V. P. T. B. goes through a first period truly esythematous and a second one in which these is also desquamation. That cycle is completed in a month. At the histopathologic level, the most important characteristics are: epidermis with its Malpighian layer in a normal state, the basal layers showing hidropic degeneration. The repper dermis shows a lichenoid picture that, in certain places affects the basal layer. The infiltrate is composed of: lymphocytes, monocytes and plasmocytes. Numerous telangiectasies are also observed.

Adult↗
PubMed2002

Advances in the diagnosis of oral premalignant and malignant lesions.

The diagnosis and treatment of oral premalignant lesions and squamous cell carcinoma are currently based on histopathologic features, site of involvement and stage of disease. Recent advances in techniques for detecting lesions and predicting their progression or recurrence are reviewed here. Adjuncts for detection of lesions and selection of biopsy sites include vital tissue staining (with toluidine blue) and exfoliative cytology. Advances in diagnosis and staging at the molecular level are expected to affect choice of treatment and patient outcomes. Oral health care providers should be aware of these advances in the evaluation and diagnosis of oral premalignant lesions and squamous cell carcinoma.

Biopsy↗