Monthly Archives: June 2018

How often should you see a dentist?

Source: www.bbc.com
Author: staff


Margie Taylor says seeing a dentist once a year – or even once every two years – is enough for many patients. Some dentists argue this could make it harder for them to spot diseases such as mouth cancer. And they say it could see the wealthy paying for private dental care – while the poor have less access to a dentist.

Ms Taylor met representatives of the British Dental Association (BDA) in Stirling on Wednesday afternoon to discuss their concerns.

What is the Scottish government proposing?
The Scottish government published its Oral Health Improvement Plan earlier this year, which says NHS dental services should focus on preventing oral health disease, meeting the needs of the ageing population, and reducing oral health inequalities between Scotland’s rich and poor.

The document says there is no clinical evidence that all patients need basic check-ups every six months – regardless of their oral health – as is currently the case. It quotes National Institute for Health and Care Excellence (NICE) guidelines, which state that “patients who have repeatedly demonstrated that they can maintain oral health and who are not considered to be at risk of or from oral disease may be extended over time up to an interval of 24 months.”

Risk assessment
Under the new system outlined by the government plans, an Oral Health Risk Assessment (OHRA) would be introduced for every patient – with the frequency of check-ups determined by their overall score.

This may mean that people will no longer have to attend every six months if they have good oral health and a healthy lifestyle. But patients who have poorer oral health and higher risk factors are likely to be seen more frequently.

The improvement plan also says that the traditional theory that the scale and polish procedure prevents gum disease has been thrown into considerable doubt in recent years. Instead, it says that “the most effective option for routine care is adequate oral hygiene by the patient themselves”.

What does Ms Taylor say about the plans?
The chief dental officer told BBC Scotland that medical evidence suggests many people can leave two years between basic check-ups without any problem. But she stressed that it was important to be realistic – and that it was not reasonable to expect people who are accustomed to having two check-ups a year to suddenly start seeing a dentist just once every two years.

She said: “At the moment, quite a lot of people come yearly and that’s fine for patients who are not at risk and who know how to look after their mouth and who have got a healthy diet.

“But it will be absolutely dependent on the risk as assessed by their own dentist, and there is no suggestion that everybody is to move to two-yearly checkups.

“And in fact we may want to see some patients more often than six months”.

Ms Taylor also insisted there was no intention to take NHS money from dentists in wealthier areas and giving it to those in poorer areas.

She added: “What we are talking about is making sure people in the poorer areas are able to get treatment”.

Ms Taylor stressed that everybody who needs a scale and polish – such as those suffering from periodontal disease – will still get one. But she conceded that the government had “more communicating to do” on the changes, which she said were about “evolution and not revolution”.

What do dentists say?
Ahead of their meeting with Ms Taylor, BDA Scotland released the results of a survey which it said suggested many of its members had “deep concerns” over the Oral Health Improvement Plan.

According to the survey:

  • Nearly two thirds of NHS dentists (62%) who responded had a “negative” or “very negative’ impression of the overall plan.
  • Three quarters had concerns about financial viability, and how the plan will be funded.
  • Almost 70% of respondents viewed the proposals to reduce the frequency of dental checks negatively.
  • About 80% had concerns about the proposed reduction in scale and polish treatments.

The BDA’s chairman in Scotland, Robert Donald, said: “Talk from government on prevention and tackling health inequalities is long overdue, but will remain warm words until they are backed up with needed investment.

“Vulnerable older patients deserve oral health care tailored to their needs, but this plan fails to spell out how it can be provided safely and effectively, or how it will be paid for. Sadly while officials have sketched out the big issues, they have skimped on the detail.”

Meanwhile, dentist John Davidson, who runs a practice in Edinburgh, told BBC Scotland that oral cancer is on the increase in Scotland and “the more often we see patients, the more likely we are to pick that up”.

He added: “We feel it is important that patients are seen more regularly, and it may get to the stage where patients pay themselves to come in and have their routine examinations and scale and polishes done.

“For a lot of patients it will not make a lot of difference for them (financially), but there are patients who just cannot afford to do that”.

The rise of HPV-related cancers in men

Source: www.tmc.edu
Author: Alexandra Becker

Scott Courville admired his full beard and round belly in the mirror: He was ready for the upcoming holiday season. It was November 2015 and Courville, who plays Santa Claus in Lafayette, Louisiana, was too excited about his favorite time of year to worry much about the pain developing in his jaw.

By February, though, the ache had worsened and was accompanied by new symptoms: white spots on his right tonsil, difficulty swallowing and lumps in his throat. He finally made his way to a walk-in clinic where he was diagnosed with tonsillitis and prescribed antibiotics.

“They sent me home and said, ‘In two weeks everything should clear up,’” Courville recalled.

But his symptoms only worsened. Courville made an appointment with a local ear, nose and throat (ENT) specialist who also diagnosed Courville with tonsillitis. The doctor prescribed more antibiotics and steroids, but two weeks later there were no improvements. Courville was referred to a dentist—“In case they see something we don’t”—but that, too, was a dead end.

Courville’s dentist insisted he return to his ENT, where he ultimately had a CT scan that revealed a mass in his throat. That was June 6, 2016. Two days later, Courville underwent a biopsy. When he awoke from the surgery, his doctor was standing over him.

Courville always gets choked up retelling this part of his story.

“The hardest part for me is always remembering when the doctor said, ‘I’m sorry, but you’ve got cancer.’”

Courville was referred to The University of Texas MD Anderson Cancer Center, where doctors confirmed that he had squamous cell carcinoma of the right tonsil. But there was more: Courville learned that his cancer had been caused by the human papillomavirus—HPV.

11 million men
Courville’s story is becoming increasingly common, with the annual incidence of HPV-related cancers of the throat, tonsils and the base of the tongue in men in the United States now outnumbering cases of cervical cancer in women, according to the U.S. Centers for Disease Control and Prevention (CDC). A 2017 research paper authored by scientists at Baylor College of Medicine and The University of Texas Health Science Center at Houston School of Public Health, among others, found the overall prevalence of oral HPV in men in the U.S. to be upwards of 11 million—much higher than previously believed.

“This has implications, because pretty much everyone is exposed to HPV,” said Andrew Sikora, M.D., Ph.D., one of the authors of the paper and vice chair for research and co-director of the Head and Neck Cancer Program at Baylor College of Medicine. “When we’re talking about the prevalence of oral HPV infection, we’re talking about that infection persisting inside the tonsils or on the base of the tongue of these men, and I think that’s what sets you up for cancer later in life—it may happen decades after you were exposed to HPV.”

That lag time, coupled with an absence of symptoms, is part of the reason HPV-related oropharyngeal cancers, also referred to as head and neck cancers, are increasing.

“What makes this cancer interesting is that it’s one of the only cancers in the body that we’re actually seeing more cases of year over year,” explained Ron J. Karni, M.D., who serves as chief of the division of Head and Neck Surgical Oncology at McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center. “In the U.S., we can expect a certain number of breast cancer cases and lung cancer cases every year, but this is actually starting to look a bit like an epidemic in that we are seeing more every year. It’s alarming.”

Holy grail
HPV is the most common sexually transmitted disease in the U.S., with an estimated 79 million individuals infected. According to the CDC, HPV is so common that most people who are sexually active will get the virus at some point in their lives if they do not get the HPV vaccine.

The virus is spread through vaginal, anal and oral sexual activity, and often exhibits no signs or symptoms. In many cases, HPV is cleared by the immune system and does not cause health problems, but it can also persist and show up decades later alongside conditions such as genital warts and cancer—including cervical cancer, anal cancer and oropharyngeal cancers. For reasons not well understood, oropharyngeal cancers predominately affect men.

Currently, there is no annual screening test for men to determine whether they have the virus. Women, on the other hand, are advised to get regular pap smears.

The Papanicolaou test, commonly known as the pap smear, involves collecting cells from inside a woman’s cervix to detect pre-cancerous changes. It is performed during a woman’s annual exam and has been widely credited for detecting early signs of HPV-related cervical cancer and saving countless lives. No such screening test has been successfully developed for oropharyngeal cancer—another reason cited for its steady rise.

“We’re at a huge disadvantage,” said Sikora, who, in addition to his research, treats patients at the Michael E. DeBakey VA Medical Center in Houston. “The pap smear, in terms of global health impact, is probably one of the best, most cost-effective things ever invented in terms of just the sheer number of women who have not had cancers because of it. We have nothing like that for men.”

Sikora explained that anatomy is, in part, to blame. Whereas the cervix is easily sampled, the tonsils are full of “nooks and crannies,” he said, and scientists have yet to develop a reliable technique for obtaining a representative sample of cells inside the throat, tonsils and back of the tongue.

“It’s sort of a holy grail for researchers in the field,” Sikora said. “It would be a game-changer in terms of prevention and early detection of cancer.”

Scientists at MD Anderson, where Courville was treated, may be closing in on some answers. Researchers, including Erich M. Sturgis, M.D., MPH, the Christopher & Susan Damico Chair in Viral Associated Malignancies, are currently conducting a clinical trial for an antibody test that could be used to screen for HPV-related throat cancer.

The HOUSTON study, an acronym for “HPV-related Oropharyngeal and Uncommon Cancers Screening Trial of Men,” is looking to recruit 5,000 men ages 50 to 64 years to provide blood and saliva samples for serologic HPV testing and oral HPV testing, respectively. If a subject is found to have a positive antibody test, he will be asked to participate in a second phase of the study, which includes an intensive screening program run through MD Anderson’s oral pre-cancer clinic.

“A researcher at Arizona State University, Dr. Karen Anderson, developed a serologic test that predicts extremely well the risk for HPV-related oropharyngeal cancer,” Sturgis explained. “We have been able to show that serum antibodies to HPV early proteins, which are rare in the general population, are markers for oropharyngeal cancer. Specifically, we found that those who had antibodies to certain HPV antigens have a greater than 450-fold higher risk of oropharyngeal cancer compared with those who do not have the antibodies.”

The hope is that this study will reveal that serological HPV antibody testing is an effective screening tool for HPV-related cancer in men: the equivalent to a pap smear.

A lump in the neck
If and when HPV-related cancer does develop, men often notice a pain in their jaw or throat, trouble swallowing, change or loss of voice that lasts more than a week or two, a sore spot on the tongue and, most often, a lump in the neck.

“There’s often a very small, primary tumor, which is the tumor that is in the tongue or in the tonsil, and it travels early to the lymph nodes,” Sikora explained. “Depending on what your neck looks like, lymph nodes can get pretty big before they become noticeable. But a lump in the neck is by far the most common symptom, and unfortunately it’s often detected much later than we would like.”

Even more troubling, many individuals who have these symptoms are commonly misdiagnosed and handed antibiotics, as in Courville’s case.

“The most important message I can convey is that if you have a lump in your neck, go see an ear, nose and throat doctor,” Karni said, emphasizing the importance of an informed diagnosis and specialized care.

Treatment for oropharyngeal cancers varies depending on the case and often involves a multidisciplinary team of clinicians, as well as some form of combined modality therapy such as radiation and chemotherapy. In the future, Sturgis sees novel therapies, including immunotherapy options, changing the landscape of treatment protocols.

Karni hopes UTHealth’s dedicated HPV-related throat cancer program will carry patients through the entire arc of treatment by offering minimally invasive robotic surgery for qualifying cases, as well as annual community-wide screening clinics, rehabilitation therapists, and numerous other specialists.

“We want to think about cancer the way Target thinks about shopping or the way the best airlines think about flying,” Karni said. “We designed a program that is patient-centered. We asked, ‘What does the patient need on their fourth week of radiation? What do they need on their third month post-radiation? How can we get that into one clinic space?’ It’s a large team and it’s all centered around this one disease.”

47th in the nation
In 2006, an HPV vaccine named Gardasil hit the market. It was originally intended to prevent HPV in females and, ultimately, HPV-related cervical cancer. But as scientists learned more about HPV—first that males could be carriers and later that it causes cancer in men, as well—public health professionals and clinicians unanimously recommended the vaccine to everyone. The CDC recommends all young women through the age of 26 and all young men through age 21 receive two doses for the vaccine to be effective.

And it is. A recent report published in May by Cochrane, a global independent network of clinical researchers and health care professionals, concluded that the HPV vaccine protects against cervical cancer in young women, especially when they are vaccinated between the ages of 15 and 26.

Which begs the question: Will the vaccine protect young men against the development of oropharyngeal cancers?

“There is a lot more data on cervical cancer in women and the vaccine than there is on head and neck cancer in men and the vaccine, but what data exists suggests that it is going to be a very effective intervention,” Sikora said.

Yet despite scientific evidence that prophylactic HPV vaccination of children and young adults will drastically reduce HPV-related cancers, vaccination rates in the U.S. remain alarmingly low—and Texas ranks 47th. Even more, several generations did not have the vaccine available to them and are currently at risk for HPV-related cancer.

As Karni said, it is alarming.

“Because the median age of oropharynx cancer related to HPV is about 55 and, in some studies, 60, and because the vaccine does not seem to work in individuals who have already been exposed, the benefits of vaccination on HPV-related cancer will not be realized for several decades,” Sturgis said. “Even if we vaccinate 100 percent of our boys and girls tomorrow, we have a whole generation or two who are at risk for this cancer and cannot do anything about it.”

Courville endured six rounds of chemotherapy and 33 daily rounds of radiation to treat his cancer. He lost a year of his life, 100 pounds, his taste buds and salivary glands, and can no longer grow his full beard— but his therapy was successful. He has now made it his life’s mission to inform the public about the importance of the vaccine as well as ongoing advocacy and research surrounding HPV-related cancers.

“If you can educate the public and educate the parents, they will vaccinate their kids,” Courville said. “And if we can vaccinate this generation, we could eliminate these types of cancers.”

Ask the Dentist: Cancer patients should be aware how radiotherapy can affect saliva

Source: www.irishnews.com
Author: Lucy Stock

SALIVA – we normally give little thought to our spit but we definitely notice when it’s not there. Every day in the UK 31 people are diagnosed with a head and neck cancer. With increasing numbers of people undergoing radiotherapy for head and neck cancers there are more people living with the side-effects of not having enough saliva.

Dry mouth, termed xerostomia, is common after radiotherapy. It’s not only extremely uncomfortable, it makes speaking and swallowing more difficult and alters how things taste. Food can taste saltier, metallic; you can lose your sense of taste totally; and perhaps even worse, foods can taste foul, like sour milk.

Not being able to chew and swallow easily can reduce how much you eat and how well you eat, leading to weight loss and poor nourishment.

Saliva performs numerous jobs. It starts digestion by breaking down food and flushes food particles from between the teeth. Crucially, saliva contains minerals such as calcium and phosphate that keep teeth strong. So no saliva means that teeth decay rapidly and extensively. Even voice quality can change.

Without enough saliva, bacteria and other organisms in the mouth take the opportunity to grow uncontrollably. Nasty sores and mouth infections, including yeast thrush infections, are run-of-the-mill.

Luckily a dry mouth is usually a temporary nuisance that clears up in about two to eight weeks but it can take six months or longer for the salivary glands to start producing saliva again after radiotherapy ends.

In a 2017 study, out of several treatments tested, the drug pilocarpine gave the most significant improvement in dry mouth following radiotherapy. However, you may experience a side effect, albeit short lived, from this medication and it can take a couple of months to work.

Artificial salivas are available as lozenges, sprays and gels, the downside being that their benefits last only a few hours. The Biotene range is specially designed to help relieve dry mouths and includes toothpastes, mouthwashes and gels to give comfort and protect the teeth.

You can buy small atomiser spray bottles from most chemists and fill them with water or fluoride mouthwash. If you cannot swallow, your nurse or doctor can give you a nebuliser to moisten your mouth and throat. Always visit your dentist before cancer treatments to maximise the health of your mouth.

Relieve a dry mouth by:

  • Sipping water often
  • Avoiding drinks with caffeine which dry out the mouth
  • Chewing sugarless gum
  • Avoiding spicy or salty foods, which may cause pain
  • Avoiding tobacco or alcohol
  • Using a humidifier at night.

Nivolumab Plus Stereotactic Body Radiotherapy Fails To Improve Outcomes in Head and Neck Cancer

Source: https://www.cancertherapyadvisor.com

 

CHICAGO—Although the addition of stereotactic body radiation therapy (SBRT) to nivolumab did not increase toxicity, it did not lead to any improvement in response rates or survival outcomes among patients with metastatic head and neck squamous cell carcinoma (HNSCC), according to an oral presentation at the American Society of Clinical Oncology 2018 Annual Meeting on Friday, June 1.

Researchers sought to determine whether or not SBRT to a single lesion plus nivolumab would improve abscopal responses (tumor regression in non-irradiated lesions) and other outcomes among this patient population.

In this phase 2 interventional study (ClinicalTrials.gov Identifier: NCT02684253), researchers randomly assigned 53 patients with metastatic HNSCC to receive nivolumab alone every 2 weeks or with SBRT between the first and second doses of nivolumab. The 2 study arms did not have any significant differences in terms of age, EBV/HPV viral status, primary site, or median lines of previous chemotherapy. The median follow-up was 12.8 months.

Results showed that the overall response rate (ORR) was 26.9% (95% CI, 13.7-46.1) compared with 22.2% (95% CI, 10.6-40.8) in the nivolumab alone arm and nivolumab plus SBRT arm, respectively (P = .94). Patients receiving nivolumab alone did not have an evaluable median duration of response (DOR) compared with 9.3 months (95% CI, 55.2-not reached [NR]) among patients in the SBRT arm.

The 1-year overall survival rate was 64% (95% CI, 47-88) in the nivolumab alone arm compared with 53% (95% CI, 36-79) in the nivolumab plus SBRT arm (P = .79); median progression-free survival (PFS) was 1.9 months (95% CI, 1.78-NR) compared with 2.4 months (95% CI; 1.0-11.4) with nivolumab plus SBRT (P = .8).

Treatment-related grade 3 and worse adverse effects were reported in 15% of patients who received nivolumab alone and in 11% of patients who received SBRT plus nivolumab (P = .96).

The authors concluded that “While safe, the addition of SBRT to nivolumab in M1 HNSCC failed to improve ORR, PFS, or OS. This is the first randomized evaluation of the abscopal response in any tumor histology.”

June, 2018|Oral Cancer News|