Monthly Archives: March 2007

Early Detection

  • 3/31/2007
  • web-based article
  • Barry F. Polansky, DMD
  • Dental Economics (de.pennnet.com)

In one of my favorite audio programs “The Strangest Secret” by Earl Nightingale, the speaker recounts the following incident:

“Some years ago, a reporter asked the late Nobel prize-winning doctor, Albert Schweitzer, ‘Doctor, what’s wrong with men today?’ The great doctor was silent a moment, and then he said, ‘Men simply don’t think!’”

Motivational speaker Jim Rohn suggests that all success begins with the development of a personal philosophy. Creating a philosophy requires lots of self-reflection and thinking. Henry Ford said, “Thinking is the hardest work there is.” Thinking is hard work because most efforts produce nothing at all, but if you spend time in thought, eventually an idea will come that could change a person’s life forever.

On the exhibit floor of the Jacob K. Javits Center at the Greater New York Dental Meeting, I was discussing a new technology, the VELscope from LED Medical Diagnostics. A mini-crowd was gathered around the booth, giving rapt attention to a salesman describing a technology that has been around for awhile, but primarily in the hands of dermatologists.

The salesman was doing a nice job of describing the mechanics of how the VELscope – an imaging device – could help dentists detect intraoral tissue changes at an early stage, thereby preventing oral premalignant lesions (OPL) from progressing to dysplasia and eventually to invasive forms of carcinoma, such as squamous cell carcinoma (SCC).

The salesman went on to point out that the incidence of oral cancer in the United States has been estimated at 34,000 new cases, with over 8,000 related deaths. He explained how dentists could play a major role in screening patients for this dreaded disease, and how the VELscope could assist the surgeon because it clearly outlined the extent of the lesions.

Diagnosing oral cancer is certainly one of the fundamental services dentists should provide for their patients. The problem is that most cancers are diagnosed in the later stages. I know that every case of oral cancer I have diagnosed has been in the late stages. The salesman at the Greater New York Meeting was trying to convince the doctors gathered around him that early detection was that important.

My personal story

That’s when I interrupted him and rolled up my pants to reveal a bandage halfway between my ankle and knee. The audience’s attention quickly turned to me and my story. I was still dressing a wound that I incurred from Mohs surgery to remove a squamous cell carcinoma. Four months post-surgery, I am still dressing that wound. I explained how the lesion just “appeared” one day. It would have been nice to know that below my skin, cells were being corrupted while I slept.

After I told my story, the questions began. People wanted to know more. They wanted to know more about squamous cell carcinoma and how it could impact them. This was the ultimate in “what’s in it for me” thinking! The technology was coming alive through my experience. The data and details the salesman presented paled next to the story of my own experience with squamous cell carcinoma.

It didn’t matter what the illumination, sophisticated filtering, and natural tissue fluorophores could do – these were just features related to the benefits. More important than features or benefits was what I brought home from the meeting … an epiphany.

Early detection is key

Early detection is what people really want! Not necessarily the technology, but the ability to prevent more invasive, time-consuming, and expensive procedures, not to mention the horrendous consequences. Prevention is a topic that dentists have been discussing since before the days of Robert Barkley and the Society of Preventive Dentistry.

No one could argue with the intellectual concept of prevention, but to bring it home, emotionally, that’s the key. No piece of diagnostic equipment without a strong philosophy of early detection will work.

A new attitude and the right diagnostic tools

Dentists have been trained to detect caries and periodontal disease. My new perspective led me to rethink entropy. One definition of entropy is the inevitable and steady deterioration of a system or society. This may sound a little depressing, but as a dentist – a physician of the masticatory system – I had to see entropy in a new light.

Not only could the VELscope help me detect cellular changes, I had to take on a new attitude about caries, periodontal disease, and, of course, what Pete Dawson claims to be the No. 1 threat to our dentitions – occlusal disease.

With my new attitude, I began to look at diagnostic tools as the key to implementing my early detection philosophy. The lesion on my leg made me think that although I considered myself a pretty good diagnostician, maybe I could see more. KaVo’s DIAGNOdent, the microscope, and the VELscope are some of the tools available that enable dentists to really get in there at a cellular level … beyond what is visible to the naked eye. That’s where the action is!

But finding the problem is just part of the story. As many of my mentors have said, “Getting it off the shelf is the hard part.”

Better verbal skills bring the message home

I love magic. Whenever I go into a magic shop, I ask for a demonstration of the newest magic trick. I usually buy the trick and learn how to perform it. One of the things that makes any magic trick work is the “patter,” the verbal skills that mesmerize the person observing the trick. Not that the diagnostic tools we use can be compared with magic, but we need to use better verbal skills to bring the information home. People respond to personal stories (like the squamous cell cancer in my leg).

When dentists can involve patients emotionally in understanding the importance of the services we provide, then their objections will diminish. Some patients embrace technology, others are suspicious of it, but everyone stands up and listens when they realize what’s in it for them. Dentists who have problems getting patients to accept radiographs need to improve their verbal skills rather than trying harder to describe the technology.

The future of medicine and dentistry is in early detection. You would be shocked to know what we have available right now in the field of early detection of cancer. Chew a pill and a biomarker will lead doctors to sites that were invisible. Baby boomers want this! I know because I do … and since I have embraced my new attitude, I see that my patients want it, too!

Albert Schweitzer, one of the greatest thinkers of modern times, once said, “A thinking man feels compelled to approach all life with the same reverence he has for his own. Thus, all life becomes part of his own experience.”

Maybe one day dentists will ask patients about preventing all the diseases that break down health and lead to cancer, caries, periodontal disease, and occlusal disease. Asking patients if they want to prevent disease is a lot more important than asking, “Are you happy with the color of your teeth?”

Barry F. Polansky, DMD, practices in Cherry Hill, N.J. Author of the book, The Art of the Examination, and publisher of “Dental Life,” Dr. Polansky is on the visiting faculty of the Pankey Institute. E-mail him at info@drbarrypolansky.com.

Source:
Polansky, Barry, Dental Economics March, 2007

March, 2007|Archive|

Massage and acupuncture reduce pain after cancer surgery

  • 3/30/2007
  • San Francisco, CA
  • press release
  • University of California San Francisco News Release

Massage and acupuncture are effective in decreasing pain and depression following surgery in cancer patients, according to a UCSF study.

The findings of the randomized controlled clinical trial are reported in the March 2007 issue of the “Journal of Pain and Symptom Management.”

“This pilot study confirmed that pain after surgery decreased when patients underwent a combination of massage and acupuncture. This is a significant finding because there are implications for further study to see if these therapies should be offered to hospitalized patients for symptom management,” said Wolf Mehling, MD, lead author and UCSF assistant professor of family and community medicine.

The study compared the post-operative symptoms of pain, nausea and mood and the cost of symptom-related medications in two groups of hospitalized patients during the first three days after cancer-related surgery. One group underwent a combination of massage and acupuncture in addition to usual care, and one group had usual care alone. Usual care is defined as traditional treatment through medication.

Study results showed a greater decrease in both pain and depressive mood in the group that underwent massage/acupuncture therapy along with usual care. The study was conducted at the UCSF Osher Center for Integrative Medicine.

According to Mehling, 40 percent of people with cancer are treated with complementary and alternative medicine therapies. Although the measurable benefits of these therapies have been promising, there have been no conclusive results, he said.

“The combination of massage and acupuncture for symptom management in perioperative cancer patients has never been studied,” said Mehling. “We know that integration of these therapies has shown short-term benefit on psychological well-being, but there has not been strong evidence to support it until now.”

In the study, cancer surgery was characterized as any surgery related to a diagnosis of malignancy: mastectomy or reconstructive surgery for breast cancer; abdominal surgery for intestinal or hepatic malignancies; pelvic surgery for ovarian, uterine or cervical malignancies; urological surgery for testicular, prostate, bladder or renal malignancies; and head and neck cancer surgery.

During the three-day post-operative period, patients used an 11-point (0-10) numeric rating scale to rank severity of current pain and of pain during the previous 24 hours.

“There was quite a variance when it came to level of pain for each patient. Patients who were very well medicated for pain and nausea still experienced dramatic ups and downs during their post-operative days,” Mehling said. “Getting up from bed for the first time after abdominal surgery or having a catheter removed probably contributed to the patient’s pain rating. For patients who received acupuncture and massage, it is possible that this personal attention contributed to a marked decrease in anxiety.”

Patients received Swedish massage, which involves kneading and applying long strokes to soft tissue and muscles, and an acupressure-type (shiatsu) foot massage for 10-30 minutes depending on their clinical needs and condition. Acupuncture treatment was based on the traditional Chinese medicine standardized core set of acupuncture points and was used to treat pain, nausea and anxiety.

“Pain decreased for those in the intervention group more than for those in the control group,” said Mehling. “Looking at an average pain baseline score, we found 1.1 point improvement in pain level on the first post-operative day for the group given massage and acupuncture, and only 0.1 point improvement in the control group that did not have intervention. Over the three days of the study, the average scores among patients reporting significant pain improved by 1.8 for the massage and acupuncture group compared to 0.3 in the control group.”

Pain ratings also differed according to the type of cancer surgery.

“We found the strongest improvement for pain among patients undergoing either prostate and testicular surgery or gastro-intestinal and gynecological cancer surgery, but therapies were not as beneficial for patients treated for kidney or bladder cancer,” he said.

Costs were compared for the entire post-operative hospital stay for all variables except medications, which were compared for the first three post-operative days only.

“Given the limited data, we could not find any cost saving benefits after application of these therapies, except for a reduction in anti-anxiety/sleep medication costs,” he said. “This preliminary data suggests looking at this further, with a larger control group and an ability to better assess individual medication usage.”

Study co-authors are Michael Acree, PhD; Leslie Wilson, PhD; Joseph Acquah, OMD; Beverly Burns, OMD; Jnani Chapman, RN, CMP; Frederick M. Hecht, MD; and Alan Bostrom, PhD, all from UCSF; and Bradly Jacobs, MD, MPH, and Jeremy West, BA, previously with UCSF.

Funding for this study was provided by the Mount Zion Health Fund, San Francisco.

UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.

March, 2007|Archive|

Oral Consumption of Pomegranate Fruit Extract Inhibits Growth and Progression of Primary Lung Tumors in Mice

  • 3/29/2007
  • Madison, WI
  • Naghma Khan et al.
  • Cancer Res 2007;67(7):3475-82

To develop novel mechanism-based preventive approaches for lung cancer, we examined the effect of oral consumption of a human achievable dose of pomegranate fruit extract (PFE) on growth, progression, angiogenesis, and signaling pathways in two mouse lung tumor protocols.

Benzo(a)pyrene [B(a)P] and N-nitroso-tris-chloroethylurea (NTCU) were used to induce lung tumors, and PFE was given in drinking water to A/J mice. Lung tumor yield was examined on the 84th day and 140 days after B(a)P dosing and 240 days after NTCU treatment.

Mice treated with PFE and exposed to B(a)P and NTCU had statistically significant lower lung tumor multiplicities than mice treated with carcinogens only. Tumor reduction was 53.9% and 61.6% in the B(a)P + PFE group at 84 and 140 days, respectively, compared with the B(a)P group. The NTCU + PFE group had 65.9% tumor reduction compared with the NTCU group at 240 days.

Immunoblot analysis and immunohistochemistry were used to determine effect on cell survival pathways and markers of cellular proliferation and angiogenesis. PFE treatment caused inhibition of (a) activation of nuclear factor-{kappa}B and I{kappa}B{alpha} kinase, (b) degradation and phosphorylation of I{kappa}B{alpha}, (c) phosphorylation of mitogen-activated protein kinases (extracellular signal-regulated kinase 1/2, c-Jun NH2-terminal kinase 1/2, and p38), (d) phosphatidylinositol 3-kinase (p85 and p110), (e) phosphorylation of Akt at Thr308, (f) activation of mammalian target of rapamycin signaling, (g) phosphorylation of c-met, and (h) markers of cell proliferation (Ki-67 and proliferating cell nuclear antigen) and angiogenesis (inducible nitric oxide synthase, CD31, and vascular endothelial growth factor) in lungs of B(a)P- and NTCU-treated mice.

Thus, our data show that PFE significantly inhibits lung tumorigenesis in A/J mice and merits investigation as a chemopreventive agent for human lung cancer.
Authors:
Naghma Khan, Farrukh Afaq, Mee-Hyang Kweon, KyungMann Kim, Hasan Mukhtar

Authors affiliation:
Department of Dermatology; and Department of Biostatistics and Medical Informatics, University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin

March, 2007|Archive|

Shock anti-smoking TV ads rescheduled after complaints

  • 3/29/2007
  • Singapore
  • Tan Hui Leng
  • Singapore News (www.channelnewsasia.com)

It was intended to shock, and it succeeded — so well, in fact, that a flood of complaints from parents has caused the Health Promotion Board (HPB) to reschedule the screening time of its anti-smoking advertising campaign on television.

It will now only be aired from 8pm, when youngsters are less likely to be watching TV.

The 30-second commercial, which first aired on all the four main language channels last week, is a graphic depiction of a woman afflicted with oral cancer. The camera zooms in on a tight shot of her face with a diseased tongue, decaying teeth and chapped lips riddled with sores.

Said HPB’s chief executive, Mr Lam Pin Woon: “HPB has reviewed and revised our advertising timing and channels to minimise causing any alarm to young children.”

Housewife Leong Sow Chan was one of the peeved parents. Her nine-year-old daughter was so traumatised by the commercial the first time she saw it that she had a nightmare that night.

“She started screaming at about 3am and woke my husband up. He had to attend to her,” said Madam Leong.

While she still does not think the commercial is in appropriate taste, she admitted that it “definitely turns me and my non-smoking family off. We are so disgusted we either switch channels when the ad comes on, or look away”.

Indeed, the preliminary results seem to prove the power of the shock tactics. According to the HPB, since last Tuesday’s launch of the three-month-long Smoking Control Campaign, its toll-free smoking QuitLine (1800-4382000) has seen a five-fold increase in the number of calls.

And significantly more of the callers are asking not just for information about smoking, “but are also expressing a desire to quit smoking and asking for advice on doing so”, said the HPB.

While some 70 to 80 per cent of the email feedback that the board has also received about the ad campaign has been positive, just to be on the safe side it is ensuring that other advertising channels — such as bus shelter boards — are situated away from childcare centres and primary schools.

On Wednesday, the HPB launched another advertising tactic at Raffles Place — featuring a “sick patient” on a stretcher being monitored by a doctor, and nurses distributing flyers to lunchtime crowds. The set-up will move to Orchard Walkway on Thursday.

Such in-your-face advertisements constitute Phase 1 of the campaign. Phase 2 will be rolled out in early May, and it will take on a more “encouraging and positive” approach.

This year’s campaign follows through on the revised graphic health warnings on tobacco packaging, introduced last November, which depict some of the many smoking-related diseases and conditions such as neck cancer, gangrene and a miscarried foetus.

According to a 2004 survey by the HPB, 21 per cent of smokers tried to abstain from the habit after reading health warning labels.

March, 2007|Archive|

Correction — Gentle Dental Evaluates New Technologies to Aid in Early Detection of Oral Cancer

  • 3/29/2007
  • Vancouver, WA
  • press release
  • PrimeNewswire (www.primenewswire.com)

A draft version of this press release was released by mistake on March 12, 2007. Gentle Dental apologizes for this error and the misinformation included in that draft. What follows is the corrected version of the press release.

Gentle Dental, a leading provider of comprehensive, convenient and high quality dentistry, announced that it is evaluating several technologies to aid in the early detection of oral cancer. Gentle Dental and its affiliated dentists in eight states recognize the importance of early oral cancer detection and have included visual and tactile screening for oral cancer during all exams for years. Recently new technologies have come to market that augment doctors abilities to see oral abnormalities at extremely early stages, increasing the effectiveness of their screening process. Gentle Dental is now evaluating two of these, the VELscope and ViziLite, in its offices.

Statistics from the Oral Cancer Foundation (www.oralcancer.org) indicate that the incidence of oral cancer is on the rise. In 2006 the number of people in the U.S. diagnosed with oral cancer rose for the first time in 50 years, and the Foundation predicts that this number will rise again this year by 11%, with approximately 34,000 people in the U.S. being diagnosed with oral cancers. Oral cancer will cause over 8,000 deaths, killing about one person every hour of each day.

According to the foundation, of those 34,000 newly diagnosed individuals only half will be alive in five years — a number which has not significantly improved in decades. This is largely because oral cancer is most frequently discovered in its later stages, when the survival rate is only 20 to 30 percent and often only when it has grown and spread to a more readily noticeable region outside the mouth, such as the lymph nodes of the neck. With early detection through opportunistic screenings and the use of tools like the ViziLite and VELscope, Gentle Dental affiliated providers are working to increase the number of cases caught in the earliest, highly survivable stages of the cancer.

“Dental professionals are the first line of defense in our battle against this killer. When they find early stage disease, they have significantly increased that person’s chances of survival,” stated Brian Hill, the Director of The Oral Cancer Foundation, and an oral cancer survivor. “In most situations early discovery has a greater impact on positive final outcomes than the treatments themselves. Dental professionals that incorporate a simple, painless, oral cancer screening into their practice are providing the highest standards of care to their patient populations. These are the doctors that will be responsible for reductions in the extremely high death rate associated with this disease.”

“I’m excited that doctors from our organization are involved in this important screening process, and with the introduction of these new technologies we are on the cutting edge of offering the most comprehensive service to our patients. As the son of a cancer survivor, I feel strongly about helping my patients and their loved ones avoid becoming victims of this terrible disease,” said Dr. Raul Amador, one of the Gentle Dental affiliated dentists evaluating the VELscope in the East Vancouver office where he practices.

“Oral Cancer is the ‘Great Imposter’ since it can mimic common mouth sores which are benign. Most patients do not experience noticeable symptoms in the early stage of the disease process, and that is where the true danger lies. Left undetected it has the opportunity to progress into a late stage killer,” said Gentle Dental affiliated dentist Dr. Edward Conzatti. “Early discovery of the disease by a trained professional will expose these cancers’ deadly work at a stage when treatment is most effective, and survival is most likely.”

Several lifestyle and chemical factors increase the risk for oral cancer, including tobacco and alcohol use. Prolonged exposure to sunlight is the primary cause of cancers of the lip. There is also evidence that the same version of the sexually transmitted Human Papilloma Virus (HPV16), already known as the primary cause of cervical cancers, is a factor in the increasing number of oral cancer cases involving younger, non-smoking patients.

Because early detection greatly improves chances of survival, all family members over 18 should be screened yearly, and more often should they engage in known risk factors such as tobacco use. In addition to twice yearly routine dental exams and cleanings, check with your dentist promptly if you or your family members experience any of the following possible signs of oral cancer:

* A sore that does not heal within 14 days
* An unusual lump or discoloration of the tissues inside the mouth
* Any unusual pain or difficulty in chewing, speaking, or swallowing
* Wart like masses
* Prolonged hoarseness
* Numbness in the mouth or facial region

About Gentle Dental

Gentle Dental is a leading group of affiliated dental providers offering multiple-specialty dental services in the United States. Gentle Dental and its more than 130 sister dental offices provide comprehensive, convenient and high-quality general dentistry, as well as dental specialties, including orthodontics, periodontics, endodontics, prosthodontics, pediatric dentistry and oral surgery.

March, 2007|Archive|

Stem Cell Marker Identified in Head, Neck Cancer

  • 3/27/2007
  • web-based article
  • staff
  • Journal of the American Dental Assoc, Vol 138, No 3, 296

Researchers have identified a marker on head and neck tumor cells that indicates which cells are capable of promoting the cancer’s growth. The finding, which appeared in the Jan. 16 issue of the Proceedings of the National Academy of Sciences, is the first evidence of cancer stem cells in head and neck tumors.
Researchers at the University of Michigan Comprehensive Cancer Center, Ann Arbor, and Stanford University School of Medicine, Stanford, Calif., took tumor samples from patients undergoing surgery for head and neck squamous cell carcinoma, including cancers of the tongue, larynx, throat and sinus. They separated cells from the samples according to whether they expressed a marker on their surface called CD44. They then implanted the sorted cells into immune-deficient mice to grow tumors.

The cells that expressed CD44 were able to grow new tumors, while the cells that did not express CD44 were not. Researchers found that the tumors that grew were identical to the original tumors and contained cells that expressed CD44, as well as cells that did not. This ability to both self-renew and produce different types of cells is a hallmark of stem cells.

The percentage of cells within a tumor expressing CD44 varied from one sample to the next, with one sample having as high as 40 percent of these cells. Studies in other cancer types have found the stem cell population to be less than 5 percent.

“The CD44-positive cells contain the tumorigenic cells, but we don’t think that’s a pure population of cancer stem cells,” said lead author Mark Prince, MD, assistant professor of otolaryngology, University of Michigan Medical School, and section chief of otolaryngology, VA Ann Arbor Healthcare System. “We still need to drill down further to find the sub-population of those cells that is the pure version.”

March, 2007|Archive|

Gum disease linked to diabetes, stroke, more

  • 3/25/2007
  • web-based article
  • staff
  • Palangkaraya Post (palangkarayapost.com)

This month, a team of researchers from London and the University of Connecticut announced that aggressive treatment of gum disease can improve the function of blood vessel walls in the body — potentially reducing the risk of heart attacks.

A few weeks before that, researchers from the Harvard School of Public Health reported a study of more than 51,000 male health professionals, which showed that men who had gum disease, or periodontitis, were far more likely than those without it to develop pancreatic cancer.

Other studies have shown links between gum disease and diabetes, heart disease, stroke and even — though this is more controversial — pregnancy problems such as low-birth-weight infants.

The evidence is accumulating faster than you can say “don’t forget to floss” that taking good care of your teeth — and treating gum disease aggressively — may be one of the best things you can do not just for your mouth, but for your overall health.

With pancreatic cancer, for instance, previous studies had suggested such a link, but those studies were muddied because many participants smoked — and smoking is a risk factor for both diseases.

This time, even among people who had never smoked, gum disease was linked to a doubling of the cancer risk, said epidemiologist Dominique Michaud, the first author, of the Harvard School of Public Health. It’s still not clear, cautioned Michaud, whether that means the gum disease led to the cancer.

Chronic inflammation anywhere — including swollen gums — makes the body release nasty chemicals called cytokines that have been linked to many problems, including diabetes and heart disease.

The crucial point is that “oral infections have systemic effects,” said Dr. Thomas Van Dyke, a professor of periodontology and oral biology at the Boston University School of Dental Medicine.

In some cases, these systemic effects are probably linked to the direct spread of oral bacteria through the bloodstream to other parts of the body.

In other cases, oral bacteria have been found in plaques in artery walls, although it is not clear whether these bacteria are a cause of heart disease or are merely incidental, said Dr. Bruce Pihlstrom, acting director of the center for clinical research at the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health.

But most of the systemic problems linked to periodontitis, which affects millions of Americans, are believed to be problems of chronic inflammation.

The clearest example is the association between periodontitis and diabetes, said Dr. Robert J. Genco, a periodontologist at the University of Buffalo.

He and others have shown that diabetics have more severe periodontal disease and have it at an earlier age than nondiabetics. And it’s a two-way street: People with diabetes with periodontitis have more trouble controlling blood sugar than diabetics without periodontitis.

It makes sense. Cytokines, such as those generated in chronic gum inflammation, can disrupt the system by which insulin, the hormone that escorts sugar into cells, sends chemical signals inside cells. This can trigger insulin resistance, which often leads to diabetes.

And obesity — long known as a major cause of diabetes, in part because fat cells in the abdomen pump out so many cytokines — is also now seen as a direct risk factor for periodontitis, said Genco.

(Like Van Dyke, Genco is a co-author of a Scientific American publication on oral health paid for by Proctor & Gamble, makers of Crest toothpaste and Oral-B electric toothbrushes. It is available online at dentalcare.com/soap/products/index_promotion_ sa.htm.)

Cytokines can also trigger inflammation in artery walls, raise blood pressure, worsen cholesterol profiles and increase the tendency for blood to clot, which can lead to potentially fatal heart attacks.

Animal studies have also shown that deliberately inducing periodontitis triggers plaque buildup in the coronary arteries, said epidemiologist Kaumudi J. Joshipura, director of the division of dental public health at the University of Puerto Rico in San Juan.

A large study published in 2003 in the online journal Stroke showed that people who had lost a lot of teeth were more likely to have severe periodontal disease and clogged coronary arteries.

Another study that year showed a direct link between periodontal disease and stroke in people who had never smoked. And a study published in 2005 in the journal Circulation showed that older adults with higher levels of periodontitis-causing bacteria in their mouths also had thicker neck arteries supplying the brain, a predictor of heart attack and stroke.

Pregnancy complications, too, have been linked to gum disease, perhaps because chronic inflammation leads to high levels of a hormone-like substance called prostaglandin E-2, which can induce labor.

But last year, a study in the New England Journal of Medicine of 823 women with periodontal disease showed that treatment did not lower the risk of premature or low birth-weight babies. A second government study of 1,800 more women is under way.

Bottom line?

“The associations between periodontitis and systemic disease are provocative and important,” said Pihlstrom of the national dental institute.

But even if there were no links to systemic health, “Taking care of your mouth is important for its own sake,” Pihlstrom said. Regular brushing, flossing and visits to a dentist can help reduce the risk of periodontitis — and can help you keep your teeth as you get older.

Source:
www.baltimoresun.com

March, 2007|Archive|

New approaches to the diagnosis of oral cancer

  • 3/25/2007
  • Bend, OR
  • Bend Weekly News Sources
  • Bend Weekly (www.bendweekly.com)

Oral cancer is diagnosed in more than 30,000 individuals in the US annually, claiming 10,000 lives each year. Early detection remains the best way to ensure patient survival and quality of life. Today, during the 85th General Session of the International Association for Dental Research, scientists from the University of California- Irvine present two novel, non-invasive, ultra-fast imaging approaches to oral cancer detection, diagnostic screening, and mapping.

More than 2/3 of all oral cancer cases documented by the National Cancer Institute are diagnosed at an advanced stage. The five-year survival rate is 75% for those with localized disease at diagnosis, but only 16% for those with cancer metastasis. Earlier detection of oral lesions would greatly improve the prognosis of these patients.

Accurate delineation of lesion margins would ensure effective removal of all the tissue that presents a threat to the patient’s long-term health.

Two basic facts indicate that early detection of oral malignancy should be possible to a far greater extent than is currently seen:

(1) Accounting for 96% of all oral cancers, squamous cell carcinoma is often preceded by lesions on the oral mucosa. Malignant transformation, which is quite unpredictable, occurs in 1-90% of lesions over five years. Thus, oral cancer is often preceded by lesions which are visible to the naked eye prior to transformation. A non-invasive diagnostic modality would permit regular monitoring of these lesions, detection of lesion transformation, and the identification of treatment needs at a very early, relatively harmless stage.

(2) High-risk populations are clearly defined: tobacco use, alcohol abuse, urban environment, specific ethnicities, poor diet, and frequent exposure to sunlight. A fast, mobile, relatively inexpensive and non-invasive diagnostic modality would permit the early detection and monitoring of oral lesions.

The researchers describe Three-dimensional Optical Coherence Tomography (3-D OCT) and Optical Doppler Tomography (ODT), which show surface and subsurface tissues at near-microscopic levels of resolution, with the potential for replacing conventional surgical biopsy and histopathology techniques. Combined with polarimetry, accurate delineation of lesion margins becomes possible. Scanning is painless and non-invasive, lasting less than one minute with a pen-sized hand-held probe. This device’s resolution or diagnostic capability may dictate its primary use as an indicator of the need for biopsy.

Later, this modality may progressively reduce the need for biopsy, define surgical margins, and permit the direct evaluation of cancer treatments. In combination with OCT-visible molecular probes, this modality will greatly advance cancer diagnostics.

March, 2007|Archive|

Where do the public seek advice about mouth ulcers

  • 3/23/2007
  • London, England
  • A. J. Mighell
  • British Dental Journal 202, 328 – 329 (2007)

– An investigation of where the Israeli public seek advice on mouth ulcers.

– Nearly one third of those surveyed had a history of mouth ulceration.

– Lay people could not distinguish an ulcer with features that would strongly suggest a malignant neoplasm from other types of mouth ulcer.

– The vast majority would first seek advice from their general medical practitioner.

-Less than 20% would first approach a general dental practitioner.
————————————————–
Abstract

Objective:
To investigate where the public seek advice about mouth ulcers and to what extent the public approach the community pharmacy for advice.

Subjects and methods:
One thousand members of the general public were randomly chosen and surveyed throughout the day in the main shopping streets of two towns in Israel, Haifa and Tel Aviv. All participants were presented with four standard verbal questions designed to identify reactions to and past experience of mouth ulcers. All responses were recorded immediately on to data sheets and transferred to a computer for analysis of frequencies and percentages and Chi-square analysis.

Results
Nearly one third of those surveyed admitted to a history of mouth ulceration. The vast majority (66-69%) would first approach their general medical practitioner for advice, 13-17% would first approach a general dental practitioner, and only a small minority of the public (4-10%) would first approach the community pharmacy. Lay persons could not distinguish an ulcer with features that would strongly suggest a malignant neoplasm from other types of mouth ulcer.

Conclusions:
The dental profession needs to collaborate more closely with the medical and pharmaceutical professions in order to offer patients better access to information and care.

Author’s affiliation:
Senior Lecturer and Honorary Consultant in Oral Medicine, Leeds Dental Institute

March, 2007|Archive|

Anatomy of a tongue – How a victim of cancer was able to talk again

  • 3/22/2007
  • Ottawa, Ontario, Canada
  • Lorianne Garrison
  • OttawaCitizen.com

For Donna Walsh, it began as a little nip on the tongue. It didn’t seem like much of a problem — sore, tender, but not a big deal.
Then, on Christmas Day in 2005, she experienced a terrible pain that “felt like something had exploded” in her mouth. A doctor sent her to a specialist, and then another specialist. On Feb. 1 — her 53rd birthday — Ms. Walsh, an Ottawa public school teacher, wife and mother, was diagnosed with tongue cancer.

“It surprised me incredibly, because I was never a smoker,” she said. “It was something I didn’t expect at all.”

A little more than two weeks after her diagnosis, Ms. Walsh had surgery to remove one-third of her tongue, to stop the cancer from spreading. She became one of between 25 and 30 people each year in Ottawa who have a unique procedure called a radial forearm free flap, involving the domino-like replacement of flesh from arm to tongue, and leg to arm.

Dr. Martin Corsten, a head and neck cancer specialist at the Ottawa Hospital, working with plastic surgeon Murray Allan, removed the cancerous portion of Ms. Walsh’s tongue, which was four centimetres long and one centimetre deep. Ms. Walsh was sedated, Dr. Corsten said, and the infected tissue cut out with an electric knife.

In cases where little of the tongue is removed, the patient doesn’t have much trouble adjusting to having “a little bit less tongue,” Dr. Corsten said. In cases such as Ms. Walsh’s, though, where a lot was lost, the patient would have trouble speaking and swallowing normally.
So the doctors removed a piece of Ms. Walsh’s left forearm, complete with vein, artery and nerve, and sutured it into her mouth to replace part of her tongue. “There is nothing in the body the exact same as the tongue,” Dr. Corsten said. But because the arm flesh is attached with a nerve, the piece of skin is able to act and feel similar to a real tongue. A piece of Ms. Walsh’s left inner thigh was then grafted to her forearm to replace the skin taken from there.
“I thought it was really neat how they were able to do that,” she said.

Dr. Corsten said the operation was not revolutionary. “This is something we do commonly, it’s just that people don’t hear about it very often,” he said.

After the operation, Ms. Walsh spent more than a month in recovery, which is normal, she said. The cancer was aggressive though, spreading into seven of her lymph nodes; intensive radiation treatments and chemotherapy were required for most of May and June.

“It was very, very tiring,” she said, adding it became worse as the weeks went on.

Radiation and chemotherapy are hard on patients, Dr. Corsten said. “Toward the end of (the treatment) it’s virtually impossible to swallow. The head and neck are also quite burned” (from radiation). But Ms. Walsh was determined to beat the disease, he said. “She was so motivated.”

Even with the refitted tongue, Ms. Walsh said she still had to “completely re-learn how to speak.”

It can take a patient who has had this kind of surgery weeks or even months to re-learn how to speak properly, but most do eventually recover “a high level of intelligibility,” according to Pam Maser, the acting chief of speech-language pathology and audiology at the Ottawa Hospital.

With the help of a speech pathologist, Ms. Walsh can now speak and swallow almost as well as she could before the cancer. The radiation therapy damaged her saliva glands, resulting in a permanently dry mouth, a common side-effect, Dr. Corsten said. There was also some scarring, on her neck and arm, and skin damage from the radiation.

Ms. Walsh went back to Hopewell Avenue Public School last September, where she teaches Grade 7 and Grade 8 science. She credits her recovery to the “amazing” support of her family and friends and people in the community who sent her cards and organized meals for her family while she was in the hospital.

Dr. Corsten said in cases such as Ms. Walsh’s, there is a 50-per-cent chance of remission.
Ms. Walsh is hopeful. “I’m very optimistic that we beat it,” she said.

According to Dr. Corsten, tongue cancer accounts for about one or two per cent of cancers yearly, with 75 to 100 cases in the Ottawa area. The disease begins with a spot on the tongue. As with all cancers, he said, early detection is important in treatment.

What caused Ms. Walsh’s cancer is unknown — in 90 per cent of cases, the disease is associated with smoking, Dr. Corsten said.

He said he has recently been seeing more cases of tongue cancer in young, non-smoking patients. One theory is the cancer may be associated with human papillomavirus (HPV), but no definitive link has been found.

March, 2007|Archive|