Monthly Archives: October 2011

Monitoring Tobacco-Specific N-Nitrosamines and Nicotine in Novel Marlboro and Camel Smokeless Tobacco Products: Findings From Round 1 of the New Product Watch



Introduction: Information on chemical composition of the new oral “spitless” smokeless tobacco products is scarce, and it is not clear whether there is some variability as a function of purchase place or time due to either unintended or intended manufacturing variations or other conditions.

Methods: We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in Marlboro Snus, Camel Snus, and dissolvable Camel products Orbs, Sticks, and Strips that were purchased in various regions of the country during the summer of 2010.

Results: A total of 117 samples were received from different states representing six regions of the country. Levels of unprotonated nicotine in Marlboro Snus and Camel Snus varied significantly by regions, with the differences between the highest and the lowest average regional levels being relatively small in Marlboro Snus (∼1.3-fold) and large in Camel Snus (∼3-fold). Some regional variations in TSNA levels were also observed. Overall, Camel Snus had significantly higher TSNA levels than Marlboro Snus, and Camel Strips had the lowest TSNA levels among all novel products analyzed here. The amount of unprotonated nicotine in the dissolvable Camel products was comparable to the levels found in Marlboro Snus.

Conclusions: Our study demonstrates some regional variations in the levels of nicotine and TSNA in Marlboro and Camel novel smokeless tobacco products. Continued monitoring of this category of products is needed as the existing products are being test marketed and modified, and new products are being introduced. This information is particularly important given its relevance to Food and Drug Administration regulation of tobacco products.

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

October, 2011|Oral Cancer News|

Kentucky Cancer Center Urges Smokers to Switch to Smoke-Free Tobacco. But is it Really a Better Option?


In the smoker-heavy state of Kentucky, a cancer center is suggesting something that most health experts won’t and the tobacco industry can’t: If you really want to quit, switch to smoke-free tobacco.

The James Graham Brown Cancer Center and the University of Louisville are aiming their “Switch and Quit” campaign at the city of Owensboro. It uses print, radio, billboard and other advertising to urge smokers to swap their cigarettes for smokeless tobacco and other products that do not deliver nicotine by smoke.

Supporters say smokers who switch are more likely to give up cigarettes than those who use other methods such as nicotine patches, and that smokeless tobacco carries less risk of disease than cigarettes do.

“We need something that works better than what we have,” said Dr. Donald Miller, an oncologist and director of the James Graham Brown Cancer Center, which supports the effort along with the University of Louisville. “This is as reasonable a scientific hypothesis as anybody has come up with and it needs to be tried.”

The campaign runs counter to the prevailing opinion of the public health community, which holds that there is no safe way to use tobacco. Federal researchers, however, have begun to at least consider the idea that smokers might be better off going smokeless.

The National Cancer Institute at the National Institutes of Health says on its website that the use of all tobacco products “should be strongly discouraged,” and that there is “no scientific evidence that using smokeless tobacco can help a person quit smoking.” But this year it approved funding for a study that might provide some of that very evidence.

“Switch and Quit” is directed by Brad Rodu, a professor of medicine at the University of Louisville. He analyzed the 2000 National Health Interview Survey and found that male smokers who switched to smokeless tobacco were more likely to quit smoking than those who used nicotine patches or gum.

“Americans are largely misinformed about the relative risks. … They think smokeless tobacco is just as dangerous,” Rodu said. “This level of misinformation is an enormous barrier to actually accomplishing tobacco-harm reduction because if people believe that the products have equal risk, there’s not a real incentive.”

The program is funded through Rodu’s research money, which includes grants from the tobacco industry. Grants through the University of Louisville are unrestricted, which the program says “ensures the scientific independence and integrity of research projects and activities.”

“There’s absolutely no influence whatsoever,” Rodu said. “I decide, along with my colleagues, how we use the money, for what projects, and this is entirely the case. I would not have a situation where there was some control over the kind of projects I undertake.”

Tobacco companies want to market more smokeless tobacco and other cigarette alternatives to make up for falling cigarette sales. Some have introduced “snus” — small pouches like tea bags that users stick between the cheek and gum — and dissolvable tobacco — finely milled tobacco shaped into orbs, sticks and strips.

But they’re barred by federal law from explicitly marketing them as less risky than cigarettes — at least for now. That means the “Switch and Quit” program can do something the tobacco industry itself cannot: claim that smokeless tobacco has a health benefit when compared to smoking.

The program says smoking kills about 220 adults a year in and around Owensboro. The state of Kentucky, a leading tobacco grower, has the nation’s highest smoking and lung cancer rates.

Owensboro and the surrounding area consume about 3 million cigarettes a week, according to the program. That amounts to well over a pack for every man, woman and child in the community of about 115,000 people.

Owensboro resident Vernon Goode had smoked for about 10 years before he recently traded his Marlboros for dissolvable tobacco tablets. The campaign didn’t inspire him to quit, but he said he thought it was a good idea.

“I was just wanting to quit because, you know, I could feel it in my lungs,” Goode said. “I’ll smoke a cigarette every once in a while, but not very often. I want to quit altogether and I’m just using this right here as I guess what you’d call a stepping stone.”

The Owensboro program has raised concerns among some in the public health community who say organizers are claiming smokeless tobacco is a healthier alternative to smoking without approval from the Food and Drug Administration.

A 2009 law gives the FDA authority to evaluate health risks of tobacco products and approve those that could be marketed as safer than what’s currently for sale. None have been given the OK yet. The FDA also plans to regulate electronic cigarettes, battery-powered plastic and metal devices that heat a liquid nicotine solution in a disposable cartridge, creating vapor that users inhale.

Matthew Myers, president of the Campaign for Tobacco-Free Kids, called the program “a giant experiment with the people of Owensboro without rules or guidance designed to protect individuals from experimental medicine.”

Smokeless tobacco isn’t a safe alternative to cigarettes, according to the Centers for Disease Control and Prevention. Health warnings on the products required by the FDA state the same thing.

However, some studies, including a 2007 report from the Royal College of Physicians in London titled “Harm Reduction in Nicotine Addiction,” suggest that some smokeless tobacco products are about 90 percent less harmful than cigarettes.

“The worst that you can say about smokeless tobacco is that it’s the lesser of two evils,” said Dr. Randall Thomas, an oncologist with the Owensboro Medical Health System. The health system, the community’s largest employer, is going smoke-free in 2013 and is offering Rodu’s program as one of a variety of quit-smoking tools for its employees.

“I don’t think we have any problem in telling a person that drinks a six-pack a day that if they could cut it back to two beers a day or two drinks a day that their health risks are greatly reduced,” Thomas said. “Finding a way to let people have their nicotine that carries less risk, it’s the realistic solution.”

The Owensboro program doesn’t suggest pharmaceutical nicotine replacement gum or patches. That’s because they are regulated to provide very small doses of nicotine and are recommended for only a short period of time, while smokeless tobacco can be used as long as a smoker needs, Rodu said.

Myers, of the Campaign for Tobacco-Free Kids, said more research is needed before anyone should suggest that the nation’s 46 million smokers would be better off using smokeless tobacco. In the meantime, he said, there are a host of FDA-approved products that can help people give up smoking.

“There’s a right way and a wrong way to determine whether smokeless tobacco can and should be marketed as a way to help people quit,” Myers said.

The National Cancer Institute approved funding earlier this year for a nationwide 1,250-person study to look at whether being given a snus product changes the habits of smokers who are not motivated to quit.

The tobacco industry sees smokeless tobacco as its future, said Matthew J. Carpenter, a psychology professor at the Medical University of South Carolina who is conducting the yearlong study.

Carpenter said the snus study will examine what smokers do when given smokeless tobacco. He won’t look at the health effects, or advise smokers to use the snus to quit.

“They are probably safer than conventional cigarettes, if for no other reason than you’re not burning anything, you’re not smoking anything, you’re not inhaling any smoke,” he said.

“If you compare it to conventional cigarettes, they’re probably a little bit better. If you compare it to quitting, they’re absolutely worse.”

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

October, 2011|Oral Cancer News|

Packet Helps Smokers Hide Graphic Warnings


Sticky seals in the packets of one brand of cigarettes are helping smokers cover up graphic health warnings. Graphic images of illnesses like gangrene, mouth cancer and lung disease must be printed on every packet of cigarettes to cover 30% of the front and 90% of the back of the pack.

ONE News looked at a range of cigarettes from a number of companies. Dunhill was the only product found with a seal inside the packet that can be stuck on the outside. It is labelled “exclusively Dunhill”. The sticky ‘reloc’ seal is just the size to cover health warnings. Michael Colhoun of Action on Smoking and Health says nothing about a tobacco packet is accidental and the sticky seals have been included deliberately. “This seems to be a brand marketing exercise,” he said.

Fresh-seal stickers are used to cover graphic warning images

Manufacturer British American Tobacco says its design is not intended to undermine the law. “We do not condone the practice of using one part of the pack designed for a particular purpose to hide those warnings,” the company said. It said the seal is simply for keeping cigarettes fresh.

One smoker said the sticker is “sneaky”. Some smokers said they will continue using the sticker to hide the images. Quitline says since the graphic images first appeared in 2008, numbers of calls to its helpline have increased. But there are websites and even how-to videos dedicated to showing smokers how to cover the pictures up.

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

October, 2011|Oral Cancer News|

Ethics Being Questioned In Dentistry


Scandals, lawsuits, a growing focus on commercialization and self-promotion, and dentists who prescribe excessive treatments are tarnishing the profession’s image, according to a presentation on ethics at the recent ADA annual session in Las Vegas.

Most dentists may be surprised that a Google search on ethical scandals among health professions shows that dentistry now gets more hits than medicine, nursing, chiropractics, and pharmacology, according to Ann Boyle, DMD, interim provost and vice chancellor for academic affairs at Southern Illinois University.

Some of the public’s changing perceptions toward dentistry can undoubtedly be traced to ubiquitous media coverage of scandals and malpractice lawsuits involving medical professionals, Dr. Boyle noted.

Gordon Christensen, DDS, MSD, PhD, discussed the decline of dentists’ credibility in a 2001 article, noting a Gallup poll showed that their ranking among professions had fallen below nurses, physicians, and veterinarians (Journal of the American Dental Association, August 2001, Vol. 132:8, pp. 1163-1165).

Dentists were ranked third among the most trusted professionals in 1995 but slipped to ninth in 2001, according to Gallup poll rankings; they ranked sixth in 2009.

Negative influences, according to Dr. Christensen, included commercialization and self-promotion, excessive treatment and fees, providing service only when it’s convenient, and refusing to accept responsibility when treatment fails prematurely.

“These front-line physicians consider us uncaring, selfish, greedy, and unprofessional.”
— Ann Boyle, DMD, Southern Illinois University

Dr. Boyle pointed to a 1997 Reader’s Digest article about dentists’ honesty. In it, the author visited 50 dentists in 28 states to see how many different treatment plans he would get.

Before the survey, the author had exams and plans from his own dentist and three others who participated in the investigation. All determined that one tooth needed a crown. But the 50 treatment plans he received ranged from three dentists who said he needed no treatment to a recommendation for 21 crowns and six veneers at a cost of nearly $30,000.

“Whether we like it or not, this article clearly left the impression that some of us were planning excessive care and could not be trusted,” Dr. Boyle said.

Dentists who charge high fees without justification were also excoriated by Dr. Christensen. “It is our professional responsibility to provide oral care services at a level of efficiency that allows us to treat most of the patients who request our services, including some patients without the ability to pay,” he said. “If all of us treated only those who could pay high fees, we would not fulfill our responsibility as members of a profession.”

Dr. Boyle recalled hearing from frustrated emergency room doctors who complained that they cannot adequately treat dental emergencies and said many patients come to them because no dentist will see them.

“We know there are reasons for this that MDs don’t understand,” she said, “but we must also realize that these front-line physicians consider us uncaring, selfish, and greedy and unprofessional and will tell anyone who will listen, including politicians.”

Cheating in dental schools

Dr. Boyle also discussed the growing prevalence of cheating among dental students. In 2006 and 2007, cheating incidents at five dental schools became public, including instances involving patient care. And a 2007 survey in the Journal of Dental Education found that 75% of dental students admitted to cheating on exams, she said (August 2007, Vol. 71:8, pp. 1027-1039).

Cheating methods range from using new technology — using smartphones to look up answers, texting, and using cellphone cameras to capture exams for later reconstruction — to old tricks such as crib sheets hidden on thighs, the underside of caps, and on oversized erasers, Dr. Boyle said. One imaginative cheater peeled off the label of a water bottle, wrote answers on it, then replaced it on the bottle. The result was a magnified version of the information he was able to read during the test.

“Everybody has to empty their pockets before tests now, like airport security,” Dr. Boyle told the gathering.

Students have even performed unnecessary procedures, including root canals, to fulfill requirements, she noted. Forging faculty signatures for clinical work is another ploy. Online sites sell admission essays, including papers on dental ethics, Dr. Boyle wryly added.

A recent survey of ethics instructors at 56 U.S. dental schools revealed that “little time is devoted to ethics instruction in the formal curriculum” (Journal of Dental Education, October 2011, Vol. 75:10, pp. 1295-1309).

While the amount of time devoted to ethics instruction appears not to have changed much over the past 30 years, “what has changed are what qualifies as ethics instruction, the pedagogies used, and the development and availability of norm-referenced learning outcomes assessments, which are currently used by a number of schools,” wrote the study authors, from the University of Michigan.

Ethics need to be more fully integrated across the dental school curriculum, including carryover into the clinical years, and assessing and ensuring competence also is needed, the researchers concluded.

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

October, 2011|Oral Cancer News|

Possible Link Between HPV and Heart Disease


We already know HPV, or human papillomavirus, can cause cervical cancer. It’s also known to cause some kinds of oral cancer. But could HPV also cause heart disease? An intriguing new study is drawing a link.

The study found that women who are known to be infected with cancer-causing strains of the virus may be at increased risk for cardiovascular disease and stroke — even when they have none of the usual heart disease risk factors.

The study authors say their research is one of the first to investigate a potential link between heart disease and HPV, which is one of the most common sexually transmitted infections.

The Public Health Agency of Canada estimates that more than 70 per cent of sexually-active Canadian men and women will have a sexually transmitted HPV infection at some point in their lives.

They say they began the study because they wanted to know why some people have heart attacks even though they have none of the usual risk factors, like high cholesterol or high blood pressure.

About 20 per cent of patients with heart disease lack risk factors, which has left open the possibility that underlying “nontraditional” causes might be involved in the disease.

If there is indeed a link between the virus and heart disease, it could have a number of implications. It would mean that doctors would have to monitor patients with HPV to help prevent heart attack and stroke.

As well, there is the possibility that the HPV vaccine might also help prevent heart disease.

The study looked at nearly 2,500 women between the ages of 20 and 59 using data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES).

Among the study volunteers, 44.6 per cent were positive for the genetic material of HPV DNA, including 23.2 per cent who had known cancer-causing strains of the virus.

The researchers broke the women into groups: those with cancer-causing HPV strains; those with other HPV types; and those who were not infected.

They then looked at their history of heart disease, their heart disease risk factors, and their age, race, and lifestyle habits.

They found that cancer-causing strains of HPV were “strongly associated” with heart disease, but didn’t link HPV and other metabolic risks.

“Further, the link persevered after adjusting for cardiovascular risk burden and management, other medical conditions and health and sexual behaviors,” said Dr. Hsu-Ko Kuo, co-author of the study, which appears in the Journal of the American College of Cardiology.

If HPV does play a role in heart disease, the authors say it might be due to HPV’s role in inactivating two tumour suppressor genes, called p53 and retinoblastoma protein (pRb). The inactivation of those two genes is the same way that HPV is thought to cause cancer.

As well, p53 has been shown to be essential in regulating the process of atherosclerosis; the gene affecting retinoblastoma protein plays a pivotal role in regulating cell proliferation.

Dr. Eduardo Franco, director of the Division of Cancer Epidemiology at McGill’s Faculty of Medicine reviewed the study and says he finds the suggestions that HPV and heart disease could be linked “is not plausible” given what is known about the way different strains of HPV interact with their target cells.

He also found the high rate of HPV infection in the women “suspicious” because, given the ages of the women, the rates should have been much lower.

“Overall, this suggests errors, possibly due to contamination of specimens either during collection or pre/post-processing,” he said in comments to CTV News.

He suggested the researchers did not properly consider the marital status of the women, which might have accounted for the link they found between HPV and heart disease.

“Women (and men) without stable marital relations (and thus prone to stress that comes from the lack of a family support unit) are at greater risk of (heart disease). They are also the ones most likely to acquire HPV infection from multiple sexual encounters,” he said.

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
October, 2011|Oral Cancer News|

HPV Vaccine Recommended for Boys aged 11 to 12 Years


The CDC’s Advisory Committee on Immunization Practices today approved routine recommendation in favor of administering the quadrivalent HPV vaccine for boys aged 11 to 12 years.

Committee members decided that the vaccine (Gardasil, Merck) was safe, efficacious and cost-effective enough to warrant routine usage in this population. The recommendation issued in 2009 was permissive, meaning providers could give the vaccine to boys, but it was not routinely administered. This change would put the HPV vaccine into the regular vaccination schedule. The three-vaccination series can start as early as age 9 years.

“The committee recommended that routine vaccination of males aged 11 or 12 years with three doses of quadrivalent vaccine be given to prevent HPV infection and HPV-related disease,” Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a phone call with reporters. “Boys and young men 13 to 21 years of age who have not already received the vaccine should be vaccinated.”

Anne Schuchat, MD
Anne Schuchat, MD

Insurance companies typically cover HPV vaccine in boys, but that is not necessarily the case for a permissive recommendation, according to Schuchat, who said a routine recommendation for a vaccine usually translates into coverage without co-pays.

The committee voted 8-5 with one abstention in favor of recommending vaccination for young men up to age 21 years with permissive recommendation for men aged 22 to 26 years. The committee considered recommending vaccination up to age 26 years, which would have harmonized recommendations for men and women, but concluded that the vaccine was not cost-effective in men aged older than 21 years.

According to the committee, in extending the quadrivalent vaccine to young men, the vaccine was 89% effective against genital warts and 75% effective against precancerous anal intraepithelial neoplasia. Schuchat said the number of girls receiving vaccinations has been disappointing, and there is hope that vaccinating boys will protect both young women and young men.

“HPV vaccination for males offers an opportunity to decrease the burden of HPV-related disease in both males and females,” Schuchat said. “So in addition to providing direct benefit to boys by preventing future genital warts or anal cancer, there’s the potential that vaccinating boys will reduce the spread of HPV from males to females and reduce some of the HPV-related burden women suffer from.”

About 20 million Americans currently have an HPV infection. According to the CDC, an estimated 7,080 men and 14,720 women develop cancers associated with HPV types 16 and 18 every year. An estimated 80% of anal cancers, 65% of vaginal cancers, 50% of vulvar cancers, 35% of penile cancers and nearly all cervical cancers are HPV-related. Roughly 60% of oropharyngeal cancers are associated with HPV, and HPV-related disease costs an estimated $8 billion annually.

Committee staff said vaccinating boys aged 11 to 12 years would cost $24,000 to $62,000 per quality-adjusted life year and would become more expensive per quality-adjusted life year as more girls are vaccinated.

The recommendation will now go to the full CDC. Schuchat said the agency will likely vote on the recommendation in a few months.

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


October, 2011|Oral Cancer News|

CDC Committee Recommends Boys Receive HPV Vaccine


A federal government advisory committee voted Tuesday to recommend that boys and young men, from ages 11 to 21, be vaccinated against the human papilloma virus, commonly referred to as HPV.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices says the vaccine series can be started as early as age 9.

Twelve members of the committee voted in favor of a recommendation that 11- and 12-year-old boys be vaccinated; one member abstained.

A separate vote involving males age 13 to 21 was split. Eight voted for it; five voted against, and one abstained. The same recommendation said males age 22 through 26 may be vaccinated.

HPV is the No. 1 sexually transmitted disease in the United States. At least 50% of sexually active people will get it at some point in their lives.

Study: Males should get HPV vaccine too

The HPV votes took place as part of the advisory committee’s meeting in Atlanta, Georgia.

The HPV vaccine is already recommended for females between the ages of 9 and 26 to reduce the risk of cervical cancer. The CDC recommends girls get the vaccine at age 11 or 12.

The FDA approved the first HPV vaccine, Gardasil, back in 2006. The second vaccine, Cervarix, was approved in 2009.

The vaccine is given in three doses. Gardasil also protects against most genital warts and has been shown to protect against anal, vaginal and vulvar cancers, all of which are associated with HPV, according to the CDC.

Although the vaccine has been approved for males since 2009, it hasn’t been as heavily promoted for them.

Increase in oral cancers linked to HPV

One reason for the push now is that girls aren’t getting vaccinated in the numbers doctors expected. “If the boys are also immunized, it reduces the transmission back and forth,” said Dr. William Schaffner, chairman of the Department of Preventative Medicine at Vanderbilt University, who attended the CDC meeting as an adviser but not a voting member.

By receiving the vaccine, boys will also be protected against cancers of the penis and rectum. Also, there is growing evidence of HPV causing the recent increase in head and neck cancer. A study released earlier this month found approximately 70% of all oropharyngeal cancers are caused by HPV infection. The HPV vaccine protects against both, according to Schaffner.

Earlier this year, the American Academy of Pediatrics began including the HPV vaccine on its list of recommended vaccines for boys.

The HPV vaccine became a political hot potato when Republican presidential contender Michele Bachmann was critical of fellow Republican contender and Texas Gov. Rick Perry’s support of the vaccine for girls. In 2007, he signed an executive order that required Texas schoolgirls to receive vaccinations against HPV, although it wasn’t implemented.

The CDC notes that the Food and Drug Administration has licensed the vaccines as safe and effective. “Both vaccines were tested in thousands of people around the world. These studies showed no serious safety concerns. Common, mild adverse events reported during these studies include pain where the shot was given, fever, dizziness, and nausea,” according to the CDC website.

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

October, 2011|Oral Cancer News|

New Fire Pepper Jelly Proceeds Help Benefit The Bruce Paltrow Oral Cancer Fund


Jenkins Jellies was recently started by actress Hillary Danner, who was encouraged by a friend to invent a unique pepper jelly that has an extra kick of flavor. She brought in friends Maria Newman and Chef Jared Lavy to help out, resulting in the creation of the delicious, one-of-a-kind Hell Fire Pepper Jelly.

The jelly is headlined by a perfect balance between a sweet taste of jelly and the hot kick you would expect from peppers. Hell Fire Pepper Jelly is unique in that it is versatile, with an infinite number of uses. Couple it with a variety of cheeses to give your sandwiches an extra kick. Use it as a glaze or marinade on streak, salmon, pork or chicken. It also makes for a great topper on burgers, hot dogs and meatloaf.

The product is completely organic, with nothing artificial about it, which means you get the pure, unaltered natural blend of flavors. There are no preservatives, artificial flavors, high fructose corn syrup or food coloring. The ingredients strictly include a blend of seven fresh peppers, vinegar, organic sugar and pectin. Plus, the jelly is completely vegan friendly and gluten free.

This delicious product has rightfully been recognized by celebrities like Chef Mario Batali and actors Ed Begley, Jr. and Gwyneth Paltrow. It is a delicious topper that will make the boring burger or steak pop with a unique flavor. It is available at Dean & DeLuca stores across the country, as well as online. Part of the profits go to Green Wish and the Bruce Paltrow Oral Cancer Fund.


October, 2011|Oral Cancer News|

Proper dental care for cancer patients: why it is important

Author: Alan B. Sheiner DDS

Common side effects from radiation therapy are not stressed enough in dental schools, but they can be managed and even prevented.

A few weeks ago, I was contacted by a retired physician with whom I had not spoken for a number of years since he retired from practice to become a “gentleman farmer” in the country. While I was happy to hear from him, his news was not so good. He was calling because he had been treated for base of tongue cancer and his teeth were “coming apart”. His cancer treatment consisted of chemotherapy and radiation therapy. Unfortunately, he somehow “slipped through the cracks” and his oral cavity was now suffering from some of the side effects of the cancer therapy – fortunately he is currently cancer free.

The oral cavity, one of the most complex and visible organ systems in the body, is invariably compromised as a result of treatment for head and neck cancer. Whether the malignancy is to be treated by surgery, radiation therapy, chemotherapy or a combination of these modalities, the function, if not also the form, of the oral cavity will be impacted. Aside from the obvious physical changes after cancer surgery to the head and neck region, there are issues which usually accompany radiation therapy to the head and neck region.

There may be side effects from cancer therapy, some of which can be devastating, but preventable or manageable with proper precautions and care. The most common side effects for head and neck cancer patients who undergo radiation therapy are:

Dry Mouth (xerostomia)
Post Radiation Tooth Decay
Inability to open the mouth wide (Trismus)
Necrosis of soft tissue and bone (osteoradionecrosis)
Impaired ability to heal from wounds in the oral cavity

Prior to commencement of active treatment, each patient should be thoroughly evaluated by a dentist well versed in the management and care of the irradiated head and neck cancer patient. Unfortunately, this subject has not been stressed in dental school. Even if a dentist has had some instruction, his or her clinical experience might be quite limited. A real life example of this is a lady irradiated for a parotid gland tumor. The parotid gland (we have two) is a major salivary gland. Her general dentist provided her with fluoride applicators, but unfortunately this practitioner did not appreciate the importance of using a neutral pH fluoride gel. The acidulated fluoride gel, normally used when a dentist or hygienist gives a fluoride treatment, literally ate into the surfaces of this woman’s porcelain crowns. Now, in addition to having a dry mouth from radiation, she also has multiple crowns with surfaces like sandpaper. These expensive restorations could not be salvaged and required replacement. In short, the dentist remembered that radiated patients should have daily fluoride treatment. He just did not have a genuine understanding of how to accomplish the task properly.

The most common and profound side effects of irradiation to the head and neck region are: dry mouth (since the major salivary glands are almost always damaged by the therapy), post-irradiation dental caries (a preventable situation), the risk of osteoradionecrosis (non-healing chronic bone death in irradiated bone which has a compromised blood supply) and trismus (an inability to open the mouth fully).

As always, your dentist is the best resource and first person you should see for consultation.

October, 2011|Oral Cancer News|

The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery

Author: staff

The large defects resulting from head and neck tumour surgeries present a reconstructive challenge to surgeons. Although numerous methods can be used, they all have their own limitations.

In this paper, we present our experience with cervicofacial and cervicothoracic rotation flaps to help expand the awareness and application of this useful system of flaps.

Twenty-one consecutive patients who underwent repair of a variety of defects of the head and neck with cervicofacial or cervicothoracic flaps in our hospital from 2006 to 2009 were retrospectively analysed. Statistics pertaining to the patients’clinical factors were gathered.

Cheek neoplasms are the most common indication for cervicofacial and cervicothoracic rotation flaps, followed by parotid tumours.

Among the 12 patients with medical comorbidities, the most common was hypertension. Defects ranging from 1.5 cm x 1.5 cm to 7 cm x 6 cm were reconstructed by cervicofacial flap, and defects from 3 cm x 2 cm to 16 cm x 7 cm were reconstructed by cervicothoracic flap.

The two flaps also exhibited versatility in these reconstructions. When combined with the pectoralis major myocutaneous flap, the cervicothoracic flap could repair through-and-through cheek defects, and in combination with a temporalis myofacial flap, the cervicofacial flap was able to cover orbital defects.

Additionally, 95% patients were satisfied with their resulting contour results.

Cervicofacial and cervicothoracic flaps provide a technically simple, reliable, safe, efficient and cosmetic means to reconstruct defects of the head and neck.

Authors: Fa-yu Liu, Zhong-fei Xu, Peng Li, Chang-fu Sun, Rui-wu Li, Shu-fen Ge, Jun-lin Li, Shao-hui Huang, Xuexin Tan
Source: World Journal of Surgical Oncology 2011, 9:135

October, 2011|Oral Cancer News|