periodontal disease

New oral cancer saliva test could reduce false-positive results

Author: staff

Researchers at Texas A&M University Baylor College of Dentistry have discovered a new saliva test for oral cancer that could reduce false-positive results. As new oral cancer diagnoses rose to more than 41,000 in 2013, the demand for early detection continues to increase.

Yi-Shing Lisa Cheng, DDS, PhD, an associate professor in diagnostic sciences at Baylor College, has been working to develop a saliva test as an oral cancer screening tool, according to an A&M announcement. In 2009, she received a $381,000 R21 grant from the National Institutes of Health’s National Institute of Dental and Craniofacial Research to find reliable oral cancer salivary biomarkers, which can be used as indicators of disease or other health conditions.

Dr. Cheng recently received a $50,000 faculty bridge grant from Texas A&M Health Science Center and A&M Baylor College of Dentistry’s diagnostic sciences department to continue this research. The goal is to determine whether patients with oral lichen planus and periodontal disease exhibit false positives for the future oral cancer saliva tests.

Dr. Cheng noted that early detection of cancer is always good and using a saliva test is a noninvasive and relatively easy procedure. Her research differs from models that compare salivary biomarkers of oral cancer patients with those of completely healthy individuals. Instead, Dr. Cheng looked at the biomarkers of patients with noncancerous oral conditions.

It’s an effort that could save patients thousands of dollars, not to mention the stress and health complications associated with false-positive results. Dr. Cheng’s Baylor team and researchers from the University of Toledo in Ohio have identified some promising candidate salivary biomarkers, but more testing is needed to validate initial results.

Saliva samples are being collected from the following groups:

  • Patients with oral cancer
  • Patients with periodontal disease who are smokers and nonsmokers
  • Patients with active and inactive oral lichen planus
  • Healthy, nonsmoking patients who have none of these diseases
January, 2014|Oral Cancer News|

Dentists key to quitting ‘smokeless tobacco’


The National Institute for Health and Clinical Excellence (NICE) is recommending a key role for dental professionals in their public health intervention proposals to help stop the use of smokeless tobacco by people of South Asian Origin.

Dentists, dental nurses and dental hygienists may be asked to play a leading role as part of new proposals to stop the use of smokeless tobacco in the UK.

NICE has published a consultation on their proposals, which recommends a key intervention and education role for dental professionals.

It is also recommending more training for dental professionals to help them gain a greater understanding of smokeless tobacco including terminology, symptoms and approaches to successful intervention.

Smokeless tobacco is associated with a number of health problems including nicotine addiction, mouth and oral cancer, periodontal disease, heart attacks and strokes, problems in pregnancy and following childbirth and late diagnosis of dental problems as smokeless tobacco products can often mask pain.

Smokeless tobacco is mainly used by ‘people of South Asian origin’, which includes people with ancestral links to Bangladesh, India, Nepal, Pakistan or Sri Lanka.

The draft guidance recommends that dental professionals take specific actions including:
• Asking patients about their smokeless tobacco use and record the outcome in their patient notes
• Making users aware of the potential health risks and advise them to stop, using a brief intervention
• Referring users who want to quit the habit to tobacco cessation services that use counsellors trained in behavioural support
• Recording the person’s response to any attempts to encourage or help them to stop using smokeless tobacco in the patient notes.

Chief executive of the British Dental Health Foundation, Dr Nigel Carter, said: ‘Smokeless tobacco is a little known area for many health professionals in the UK so the current draft public health guidance is a positive step to bring greater knowledge and understanding.

‘The evidence that does exist indicates that South Asian women – the main users of smokeless tobacco – are approaching four times more likely to suffer from mouth cancer. Quite rightly, dental professionals have been identified as major players to help reduce these risks and prevent the serious health conditions caused by smokeless tobacco.

‘The British Dental Health Foundation supports NICE’s draft proposals and encourages all dental professionals to include the intervention of smokeless tobacco usage as part of their continuing professional development.’

March, 2012|Oral Cancer News|

Berry Nutrition

Author: Marie Spano, M.S., R.D., Contributing Editor

Nutritionally speaking, good things come in sweet—and tart—little packages. Research is discovering berries pack a nutritional punch due to their vitamin, fiber and antioxidant content.

Botanically speaking, berries are indehiscent fruits (they don’t need to be opened to release their seeds) that ripen through the ovary wall. However, any small, edible fruit with multiple seeds is typically considered a berry.

In addition to lending flavor and brilliant colors to a wide variety of dishes, all berries are packed with an array of antioxidants, nutrients and potential health benefits. Berries that are especially antioxidant-rich include fresh crowberries, bilberries, black currants, wild strawberries, blackberries, blueberries, goji berries, sea buckthorn, blueberries and cranberries. However, the antioxidant content of berries varies based on the geographical growing condition. And, while fresh berries are an excellent source of antioxidants, total phenol content drops during processing. In fact, processed berry jams and syrup contain approximately half the antioxidant capacity of fresh berries, and juices show the greatest loss of anthocyanins and tannins due to the removal of seeds and skin (Nutrition Journal, 2010; 9:3; Journal of Agricultural and Food Chemistry, Jan 13, 2012).

Botanical berries
Shiny, scarlet-colored cranberries are rich in vitamin C, loaded with antioxidants, including flavonoids, and score higher in their ORAC score than many other fruits (“Oxygen Radical Absorbance Capacity (ORAC) of Selected Foods—2007”, USDA ARS). Cranberries are perhaps best known for the role their juice plays in the prevention of urinary tract infections (UTI) in women, particularly those with recurrent UTIs (Cochrane Database Systems Review, 2008; 23:CD001321). However, cranberries may also inhibit the growth and proliferation of some types of cancer cells (Journal of Nutrition, 2007; 137:186S-193S), reduce low-density lipoprotein (LDL) oxidation and platelet aggregation, and improve vascular function (Nutrition Reviews, 2010; 68:168-177; Nutrition Reviews, 2007; 65:490-502). In addition, polyphenols isolated from cranberries appear to inhibit the formation of cariogenic bacteria and reduce both inflammation and the production of enzymes that contribute to the destruction of the extracellular matrix in periodontal disease, making them beneficial for oral health (Journal of the Canadian Dental Association, 2010; 76:a130).

Processing and storage affects the phytochemicals found in cranberries. Anthocyanins are present at much higher levels than flavonols in cranberries, but the reverse is true for cranberry juice, due, in part, to the instability of anthocyanins. Some flavonols are also degraded during processing but to a lesser extent than anthocyanins (Critical Reviews in Food Science and Nutrition, 2009; 49:741-781).

Also leading the nutritional way is the tiny blueberry. According to the U.S. Highbush Blueberry Council, Folsom, CA, blueberries are packed with vitamin C, dietary fiber, potassium and antioxidants, with a total of 6,552 ORAC units per 100 grams. Further, many studies have indicated blueberry supplementation can help mitigate age-related neurodegenerative diseases. In one study, for example, rats fed 18.6 grams of dried blueberry extract per kilogram of diet for eight weeks showed a reversal of age-related deficits in brain and behavioral function (The Journal of Neuroscience, 1999; 19:8,114-8,121). The phytochemicals in blueberries also may help protect against some cancers. A study that identified blueberry anthocyanins also determined their ability to inhibit the growth of colon, breast, oral and, especially, prostate cancer cell lines. The same study showed blueberries were effective in inducing cell death of colon-cancer cells (Journal of Agricultural and Food Chemistry, 2006; 54:9,329-9,339).

Other less commonly consumed berries show promising health benefits. Though relatively few health-related studies have been conducted using black, white and red currants, one study using mixed berries, including currants, found that consumption of two portions of berries daily (including black currant purée on alternating days) resulted in favorable changes in high-density lipoprotein (HDL) cholesterol, blood pressure and platelet functioning (American Journal of Clinical Nutrition, 2008; 87:323-331). Red and black currants are an excellent source of vitamin C, and black currants are also an excellent source of fiber and good source of manganese and potassium.

Wolfberries, otherwise known as goji berries, contain several antioxidants, notably zeaxanthin, one of the two antioxidants found in the retina of the eye. One double-blind, placebo-controlled study in healthy elderly subjects found that, compared to placebo, daily supplementation with goji berry (13.7 grams per day) for 90 days increased plasma zeaxanthin and antioxidant levels while protecting from hypopigmentation and soft drusen accumulation (yellow deposits under the retina) in the macula of the eye (Optometry & Vision Science, 2011; 88:257-262). Additional studies have found that goji berry juice improves antioxidant biomarkers in healthy humans (Nutrition Research, 2009; 29:19-25), subjective feelings of well-being, neurologic and psychologic performance and gastrointestinal functioning (Journal of Alternative and Complementary Medicine, 2008; 14:403-412).

More research needs to be done on the health benefits of gooseberries and muscadine grape berries, but they, too, have a great nutrition profile. Gooseberries are an excellent source of vitamins A and C, and a good source of potassium and fiber. Muscadine grape berries are an excellent source of manganese, a good source of fiber and contain reseveratrol (American Journal of Enology and Viticulture, 1996; 47:57-62).

Non-botanical berries
In addition to the nutrition attributes for botanical berries, non-botanical berries, including strawberries, chokeberries, blackberries and raspberries, are also loaded with nutrients and antioxidants.

Strawberries are an excellent source of vitamin C and also contain fiber, vitamins, potassium and phytonutrients. Animal research has shown that strawberries improve indices of memory and cognitive functioning (Current Opinion in Clinical & Metabolic Care, 2009; 12:91-94), while human intervention studies indicate that strawberries (in addition to chokeberries, cranberries and blueberries; fresh, as juice or freeze-dried) lead to significant improvements in LDL oxidation, lipid peroxidation, dyslipidemia and glucose metabolism (Nutrition Reviews, 2010;6 8:168-177).

Chokeberries (Aronia melanocarpa) contain a mix of many antioxidants, including procyanidins, anthocyanins and phenolic acids. A review of studies to date on chokeberries indicate they may be a promising functional food for diseases related to oxidative stress, but more rigorous scientific research is necessary (Phytotherapy Research, 2010; 24:1,107-1,114).

Blackberries are an excellent source of vitamin C and fiber. Studies show anthocyanin-rich fractions of blackberry extracts reduce UV-induced free radical damage to skin cells (Phytotherapy Research, 2012; 26:106-112), and freeze-dried blackberries reduce esophagus and colon cancer development in rodents (Nutrition and Cancer, 2006; 54:69-78).

Raspberries are an excellent source of vitamin C, manganese and dietary fiber, and a good source of vitamin K. However, much of the interest in raspberries stems from their anthocyanin and ellagic acid content. In vitro studies show ellagic acid is protective against cancer (Journal of Nutrition and Biochemistry, 2004; 15:672-678). And this antioxidant, as well as the overall antioxidant capacity of raspberries, is similar in fresh commercial, freshly picked and frozen raspberries (Journal of Agricultural and Food Chemistry, 2002; 50:5,197-5,201).

All berries are full of antioxidants and nutrients. And, the various colors, textures and different forms of berries, including frozen, fresh, dried and pulp, make berries a versatile, nutritious, eye-appealing and tasty addition to a variety of foods and beverages.

About the author:
Marie Spano, M.S., R.D., CSCS, is a nutrition communications expert whose work has appeared in popular press magazines, e-zines and nutrition-industry trade publications. She has been an expert guest on NBC, ABC and CBS affiliates on the East Coast.

February, 2012|Oral Cancer News|

Caring for the oral health of patients battling cancer: oral care before cancer treatment

Author: Dennis M. Abbott, D.D.S.

Cancer. The New Oxford American Dictionary defines it as “the disease caused by an uncontrolled division of abnormal cells in a part of the body;” but for the millions of people it has touched, cancer is so much more. Cancer is a constant unwanted companion that opens the door to an unchosen journey and demands to be followed. It affects individuals, families and friends. Cancer changes lives.

Beyond the emotional toll it imposes, cancer alters the well-being of those it afflicts. Modern treatment regimens given to combat this disease come with a host of deleterious side effects, many of which occur in the mouth. Dentists, dental hygienists and dental auxiliaries are in a unique and necessary position to make a positive impact in the lives of patients battling cancer

Making a difference begins with a desire to help and a willingness to take a risk. It is followed by a commitment to learn about the unique oral health care needs of patients engaged in the fight of their lives and put into practice skills that can literally provide comfort and hope. We, as dental professionals, can and should be a part of a comprehensive cancer care team for an ever-growing number of people facing cancer.

Dental Oncology
Dental oncology is a focus of dentistry dedicated to meeting the unique dental and oral health care needs that arise as a result of cancer therapy. It is an area of oral medicine devoted to improving the well-being and quality of life of people battling cancer. Dental oncology goes beyond the scope of general dental treatment to include management of the soft tissues of the mouth and care for oral side effects specific to cancer therapy. A dental professional knowledgeable in dental oncology plays an important role throughout cancer treatment by preventing and managing mouth sores, dental needs, oral pain and infections. As a member of the patient’s oncology care team, the dental professional communicates directly with the medical oncologist, radiation oncologist and other team members to provide optimal comprehensive care before, during, and after cancer treatments.

Ideally, a patient’s relationship with a dental professional begins as soon as possible after receiving the diagnosis of cancer. Most of the present-day treatments for cancer involve the administration of cytotoxic drugs, radiation, myelosuppressive treatments or some combination thereof. Having a baseline assessment completed before the implementation of immunosuppressive therapies allows the dental professional to have a pre-treatment reference point to compare oral and systemic health at future visits.

For the newly diagnosed patient with cancer who has not received regular dental and oral health care, a prompt visit to the dentist’s office also allows for immediate attention to unaddressed periodontal issues and unresolved dental needs before immunosuppression begins. During cancer treatments, bacterial components of calculus, dental plaque and oral biofilm can easily become vehicles for bacteremia or oral infections. Properly addressing these oral health concerns at this pre-treatment stage can prevent or significantly reduce the severity of oral issues that could complicate or even interrupt the patient’s cancer treatment schedule.

Oral Health Care Before Chemotherapy
Chemotherapy is the treatment of choice for a wide range of cancers. It can be used either alone or in combination with other treatment modalities. The goal of chemotherapy is to eradicate the rapidly dividing cancerous cells, but unfortunately these drugs often cannot differentiate between cancer cells and other types of cells that divide rapidly under normal conditions within the body. These cells include bone marrow, hair, and the mucosa of the entire gastrointestinal tract, including the mouth. It is the direct cytotoxic effect of the drugs as well as side effects that can cause intraoral complications. Because chemotherapeutic agents are used to combat cancers of all types, the dental professional is needed to care for patients with most kinds of cancer, not just malignancies relevant to structures within the head or neck.

Optimally, the patient should see a dental professional well enough in advance so that all dental procedures can be completed one week before beginning chemotherapy. At a minimum, dental procedures that might introduce bacteria into the bloodstream should be completed in this timeframe. Close communication with the medical oncologist is of paramount importance as each member of the oncology team needs to be aware of the scheduling of all care related to the patient. Communication should include a summary of the present oral health of the patient, a treatment plan of essential dental care, and an anticipated timeline of when that care can be completed. The dental professional should also confirm that the medical colleagues on the oncology team understand the nature of anticipated oral complications during treatment and be prepared to function as the expert able to address those oral health issues.

Dental management before chemotherapy should include a thorough baseline dental and periodontal assessment with close attentions paid to conditions that could be problematic during times of immunosuppression. Preemptive measures should be taken to correct or remove any possible sources of oral trauma. These might include broken teeth or ill-fitting existing restorations or prostheses. Non-restorable teeth that pose an infection risk in the short term should be extracted. This would include any tooth affected by severe periodontal disease or deemed to be of endodontic concern. Partially-erupted third molars should be evaluated and be extracted if they are at risk for pericornitis. A thorough dental prophylaxis including scaling and root planing must be completed. Decreasing the existing intraoral bacterial load is one of the best preventive services that can be performed for the patient scheduled to undergo chemotherapy. Carious lesions and tooth-born fractures should be restored. Resin modified glass ionomer is a good restorative material choice for these patients as xerostomia is anticipated during cancer treatment. Any orthodontic bands and wires should be removed and orthodontic treatment postponed until cancer treatment is completed. Oral hygiene instructions should be reviewed, even for regular dental patients. Educating about possible or anticipated oral issues and reassuring the patient and the family they are not alone in this battle builds confidence and strengthens the dental professional/patient relationship.

Oral Health Before Head and Neck Radiation Therapy
Radiation therapy is routinely used to treat tumors in the head or neck, often in combination with chemotherapy or immunotherapy. Head and neck radiation, unlike radiotherapy in other parts of the body, creates issues of particular concern for the dental professional. Patients undergoing head and neck radiation therapy often experience permanent life-changing side effects from their cancer treatment. Understanding these complications at the pre-treatment assessment positions the dental professional to be of the most service.

The pre-treatment assessment appointment for the patient undergoing head and neck radiation begins with a full-mouth series of radiographs. A clinical examination including complete periodontal charting must be combined with the radiographic evaluation to assess periodontal condition, to diagnose periapical pathology and to identify teeth requiring immediate attention. All possible sources of intraoral trauma must be resolved. Because trauma to irradiated bone poses a risk for osteoradionecrosis, the dental professional must evaluate the current condition of the teeth and periodontium and anticipate the patient’s ability to maintain meticulous oral hygiene for the remainder of his or her life, often in challenging intraoral conditions. All non-restorable teeth should be extracted. Those teeth with moderate to severe periodontal disease and partially-erupted third molars within the anticipated field of radiation should also be removed. Other teeth in the planned field of radiation should be evaluated in light of the patient’s current hygiene status and dental history, the presence of high-risk deleterious habits or co-morbidities (e.g. smoking and diabetes mellitus), the patient’s commitment to regular professional dental visits, and the risk of osteoradionecrosis. Any decision by the patient to refuse to comply with the dental professional’s recommendation should be well-documented in the patient’s chart. All remaining teeth must be thoroughly cleaned. Dental impressions should be taken from which fluoride trays can be fabricated for the patient’s at-home use. The dental professional should counsel the patient and his or her family concerning the anticipated complications of head and neck radiation therapy and the life-long changes that must be made in oral health care.

Communication between the dental professional and radiation oncologist is extremely important. The dentist should understand the anticipated scheduling of radiation treatments and must know the amount of radiation planned for each of the jaws. Similarly, the radiation oncologist should be aware of all necessary dental treatment and the anticipated timeline to complete it. The timing of dental surgery is of utmost importance: at least 14 days should be available for healing following any surgery before radiation therapy commences. The dental professional should understand that tumors of the head and neck are often times fast moving and require expeditious treatment. Every effort should be made to accommodate head and neck patients for treatment as soon as possible. There are times, however, when the nature of the tumor may be such that radiation therapy must be initiated immediately and not allow adequate time for dental work to be completed. In these cases, dental care should be postponed until the completion of radiotherapy and the patient has sufficiently recovered. Dental care should be avoided while the patient is undergoing radiation therapy, but should be completed as soon after radiotherapy as possible since bone changes associated with radiation worsen over time.

Oral Health Before Bisphosphonate Therapy
Bisphosphonate therapy is used extensively in patients with metastatic bone disease. These drugs, which include Zometa®(zoledronic acid) and Aredia®(pamidronate), are administered intravenously through a portacath. They fall into a unique class of drugs that are characterized by their affinity for bone and the ability to inhibit bone resorption through decreased osteoclastic activity. Because they limit bone turnover, these drugs have been implicated in osteonecrosis following dental surgery subsequent to bisphosphonate therapy. Drug potency and accumulation seem to be important factors in assessing whether or not a patient is at risk for developing bisphosphonate-related osteonecrosis of the jaw.

If non-restorable teeth exist in a patient who will be undergoing bisphosphonate therapy, they should be removed at least 14 days before the introduction of the drug, if possible. Partially-erupted third molars and teeth with moderate to severe periodontal disease should be considered for extraction. Precautions similar to those for patients undergoing head and neck radiation should be considered in evaluating teeth for possible extraction as the half-life bisphosphonates can exceed ten years. All dental professionals should be aware that a history of bisphosphonate disclosed in a medical history should be carefully considered and evaluated to assess the risk for bisphosphonate-related osteonecrosis of the jaw.

Cancer in the United States Today
According to the North American Association of Central Cancer Registries, the estimated new cancer cases in the United States in 2011 was approximately equivalent to the population of the entire state of Idaho. From the same source, the estimated number of U.S. deaths in the same year approximated the population of the entire state of Wyoming. It is important to note that these are annual numbers. Currently, approximately 12 million people in the United States are living with cancer. This number does not include cancer survivors considered cancer-free. In 2010, the national cost for cancer care in the US was over $124 billion. That number is expected to more than double, and possibly triple, by the year 2020.

Cancer is a significant healthcare concern in the United States and around the world. As the Baby-Boomer generation continues to age, the incidence rate in the United States is expected to increase. Cancer treatment has evolved from a required visit to one of just a few major national cancer centers to care that can be received close to home. With more and more local cancer treatment centers, there is a greater need for local dental professionals to become an integral part of oncology teams and provide the care that these patients so desperately need.

About the author:
Dennis M. Abbott, D.D.S. is the founder and CEO of Dental Oncology Professionals of North Texas, an oral medicine practice dedicated to meeting the unique dental and oral health needs of patients battling cancer. He holds a Bachelor of Arts in biology from Rice University in Houston, and is an honor graduate of Baylor College of Dentistry. After dental school, Dr. Abbott studied immunology, microbiology, and oral medicine at the School of Dental Medicine, State University of New York at Buffalo. In addition to private practice, he is currently on the dental oncology medical staff at Baylor Charles A. Sammons Cancer Center and Baylor University Medical Center in Dallas.

Dr. Abbott has most recently conducted studies focusing on bisphosphonate- related osteonecrosis of the jaw and xerostomia in patients with cancer. He is the previous recipient of the Dentist Scientist Award and the National Research Service Award, both granted by the National Institutes of Health. Dr. Abbott has been a visiting faculty lecturer for the University at Buffalo School of Dental Medicine continuing education program and has lectured throughout the United States

February, 2012|Oral Cancer News|

High risk of developing ONJ for cancer patients on bisphosphonates


Research has shown that cancer patients on bisphosphonates are at risk of developing osteonecrosis of the jaw (ONJ) and that those on the intravenous form of the drug are at a higher risk compared with those on the oral drugs.

However, a new study that looked at cancer patients on zoledronic acid (ZOL) and chemotherapy combined with the antiangiogenic agent bevacizumab (BEV) who underwent a dental exam before starting treatment found that none of them developed ONJ (JADA, May 2011, Vol. 142:5, pp. 506-513).

Researchers from the University of Siena in Italy investigated the incidence of and risk factors for ONJ in patients with metastases to the bone from solid tumors who received ZOL and BEV.

Their study included 59 patients (34 with breast cancer and 25 with non-small cell lung cancer [NSCL]) who received 4 mg of ZOL intravenously every four weeks and 15 mg per kg of BEV every three weeks. The median time the participants received ZOL therapy was 18 months, while the median time participants received BEV therapy was 16 months.

The researchers took several measures to reduce the study participants’ risk of developing ONJ, including the following:

  • Dental caries and periodontal disease were treated before starting study treatment.
  • Mouth rinses with chlorhexidine and local antibiotic agents were administered before baseline oral hygiene.
  • Recommendations were made for maintaining good oral hygiene.
  • Teeth were extracted at least four weeks before starting ZOL and BEV therapy.
  • Invasive dental procedures were avoided during treatment.
  • If invasive dental procedures were needed during treatment, ZOL and BEV were readministered after at least four weeks.

All the patients received a dental exam and panoramic x-rays before starting treatment and every three months until the patients died or were lost to follow-up. After a median follow-up period of 19 months, none of the study participants had developed ONJ.

“The number of patients investigated in this study is too low to make meaningful conclusions.”
— Tanja Fehm, MD

“Despite the fact that new and potent antiangiogenic therapies theoretically might enhance the antiangiogenic effects of ZOL on bone tissue, our findings do not indicate a trend of a higher incidence of BRONJ [bisphosphonate-related ONJ] in patients receiving ZOL and BEV,” the authors noted. “Nevertheless, evidence showing that antiangiogenesis is the main underlying mechanism of BRONJ still is lacking.”

They also noted that the preventive dental measures taken before the start of treatment could have contributed to the fact that none of the participants developed ONJ.

After the baseline dental exam, seven of the study participants needed tooth extractions, which were done before they started taking ZOL and BEV.

The participants avoided undergoing other dentoalveolar surgical procedures while they were receiving treatment, probably owing to the baseline preventive dental examination and the follow-up examinations, indicating that a dental exam prior to therapy can minimize the risk of developing ONJ, the authors noted.

“Although further research is needed, the results of our study suggest that ZOL combined with the antiangiogenic agent BEV does not predispose patients with metastases to the bone from breast and NSCL cancer to ONJ if they undergo a baseline dental examination,” they concluded. “Nevertheless, the results of the study must be considered in the context of the follow-up period used in the study and the use of the preventive dental protocol.”

Tanja Fehm, MD, from the department of obstetrics and gynecology at the University of Tübingen in Germany, has done similar research (Gynecologic Oncology, March 2009, Vol. 112:3, pp. 605-609). She told that the incidence of ONJ is low — between 1% and 4% — in metastatic breast cancer patients receiving bisphosphonates.

“Therefore, the number of patients (59) investigated in this study is too low to make meaningful conclusions,” she added. “However, the paper summarizes the preventive measures that can help avoid ONJ.”

James Berenson, MD, from the Institute for Myeloma & Bone Cancer Research has also done similar research (American Journal of Hematology, January 2011, Vol. 86:1, pp. 25-30) and agreed that this study was too small. He also felt the follow-up period was too short for any conclusive results.

Meanwhile, the study authors hope that these results help general dentists, oral surgeons, and oncologists in their efforts to prevent ONJ and identify at-risk patients by means of careful baseline and follow-up dental examinations.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.


Researchers study relationship of oral cancers and periodontal disease

Author: staff

During the 88th General Session & Exhibition of the International Association for Dental Research, in Barcelona, Spain, author J. Meyle, Justus Liebig University, Giessen, Germany, presented an abstract titled “P. gingivalis Infection and Immune Evasion of Oral Carcinomas.”

Meyle and his team are investigating the relationship of oral cancers and periodontal disease. They achieved results by infecting cell carcinoma cells SCC-25 with Porphyromonas gingivalis (P.g.) W83. After 48h the cells were stained with antibodies against human B7-H1, B7-DC and TLR4 and analysed by flow cytometry. RNA was extracted after 24h and gene expression of B7-H1, B7DC, TLR4, IFN-γ and IL-10 was quantified by real time PCR and analysed by the (2 triangles)CT method.

Up-regulation of B7-H1 in host cells may contribute to the chronicity of inflammatory disorders which frequently precede the development of human cancers. B7-H1 expression was detected in the majority of human cancers and leads to anergy and apoptosis of activated T cells, which might enable tumors to evade the immune response. TLR4 signalling has been shown to induce B7-H1 in bladder cancer cells.

P.g., a putative periodontal pathogen, is an etiologic agent of periodontitis and expresses a variety of virulence factors. In this study the expression of B7-H1 and B7-DC receptors and TLR4 on squamous cell carcinoma cells SCC-25 was analysed after infection with P.g. in vitro.

The research concludes that P.g. is able to induce the expression of the immune regulating receptors B7-H1 and B7-DC in squamous cell carcinoma which may facilitate immune evasion of oral cancers in patients with periodontal infections.

This is a summary of abstract #230, “P. gingivalis Infection and Immune Evasion of oral Carcinomas” presented by J. Meyle at the Centre Convencions Internacional Barcelona, Spain during the 88th General Session & Exhibition of the International Association for Dental Research.

Source: Ingrid L. Thomas, International & American Association for Dental Research

Dental Calamities That Can Truly Hurt

Source: New York Times

Writer: Nicholas Bakalar

DENTAL cavities are not good news, but when it comes to preventive oral health, they may be among the smaller problems.

The advice is familiar: brush and floss regularly, use fluoride mouthwash, limit snacks and sweet drinks, visit the dentist twice a year. Good suggestions, even if not everyone follows them: by age 12, 50 percent of children have cavities. But there are two much more serious problems, common dental diseases that can lead not only to loss of teeth but also to loss of life: periodontal disease and oral cancer.

Periodontal disease — a chronic bacterial infection of the gums that destroys the bone and tissues that hold the teeth — is the leading cause of tooth loss in adults. Some people are genetically susceptible, and the problem can be aggravated by smoking, taking certain medications, stress and other factors.

Several studies have found that gum disease is associated with an increased risk for heart attack. “It isn’t nailed down yet,” said Dr. Martin J. Davis, professor of clinical dentistryat the College of Dental Medicine at Columbia, “but there seems to be a link between the inflammation of gums and the inflammatory markers of heart disease.”

It may be that oral bacteria enter the bloodstream, attach to fatty plaques in the coronary arteries and cause clots to form. Or maybe inflammation itself increases plaque buildup. A 2007 study showed that periodontal disease increased the risk of heart disease in men by one third and doubled it in women, even after controlling for smoking.

Studies also suggest that gum disease is associated with the risk for stroke, altered glycemic control in people with diabetes and adverse pregnancy conditions like pre-eclampsia (pregnancy-induced high blood pressure), low birth weight and preterm birth. When periodontal disease is treated by reducing inflammation and lowering the quantities of harmful bacteria in the mouth, it can have a major impact on inflammation in the rest of the body.

Oral cancer is the second serious dental problem. It afflicts about 34,000 people a year and kills 8,000. Dr. Michael Kahn, a professor of oral pathology at Tufts University, compares oral cancer with the 11,000 cases of cervical cancer that are detected by the 60 million pap smears administered every year. “A person dies every hour around the clock from oral cancer,” he said, “yet it’s a struggle to get insurance to cover any of the new screening tests. It causes at least twice as many deaths as cervical cancer, but we’ve paid for pap smears — which have reduced cervical cancer by 90 percent.”

Smoking and alcohol abuse are the major causes, but 25 percent of oral cancers appear in people who have never smoked or drunk to excess. The suspected cause of at least some of these cancers is human papillomavirus, or H.P.V., the same sexually transmitted virus that causes most cervical cancers, which can invade the mouth during oral sex. “Some are already hypothesizing that if kids are inoculated against H.P.V.,” Dr. Kahn said, “there will be a turnaround in the oral cancers caused by H.P.V., too.”

For now, prevention, screening and early treatment are crucial to lowering the death rate.

The first sign of oral cancer is often a tiny white or red spot in the mouth, but the disease can be detected before a sore appears. In the last two or three years, manufacturers have produced noninvasive devices for detecting abnormal tissue that may be invisible to the naked eye, and some dentists are beginning to use them, even though their effectiveness remains controversial.

“The literature says they work,” Dr. Kahn said. “Some would like more or stronger evidence, but for others, they’re convinced. In dentistry, you don’t have much time to look. The theory is that if you use one of these devices, it gives you some additional help.” If a dentist finds a suspicious lesion, Dr. Kahn recommends referral to an oral pathologist as the next step.

There is more to good oral health than conscientious brushing and flossing, even though they remain important. “You have to take care of your mouth like any other part of the body,” Dr. Davis said, “because it’s linked to the rest of the body.”

February, 2009|Oral Cancer News|