Third molars confusing the diagnosis of carcinoma

Clinical implications of recent exodontia before diagnosis of gingival squamous cell carcinoma: A new classification

BACKGROUND

The purpose of this study was to clarify the clinical implications of cases with recent dental extractions to establish a new classification of gingival squamous cell carcinoma (SCC).

METHODS

A total of 156 patients were enrolled in this study. The subjects were divided into 3 groups: type I (dentate; n = 46), type II (edentulous; n = 55), and type III (dental extraction; n = 55). Continuous clinical and treatment variables were analyzed by 1-way analysis of variance (ANOVA) or t test, and categorical variables were evaluated by chi-square tests. Assessment of 5-year survival rates were carried out by the Kaplan-Meier analysis, and the influence of related factors was evaluated by the log-rank test.

RESULT

The 55 type III patients showed a high probability of bony invasion (80%) and a lower 5-year survival rate (48%) than the other 2 groups.

CONCLUSION

Our proposed classification may help clinicians to identify patients with gingival SCC who present with more advanced disease status.

Delayed diagnosis of oral squamous cell carcinoma following dental treatment

INTRODUCTION

Oral squamous cell carcinoma (SCC) can present with a wide range of clinical appearances. Consequently, an oral SCC, particularly in its early stage, may not be considered suspicious by a clinician, thereby delaying diagnosis. Delayed diagnosis of an oral SCC could result in more advanced disease at the time of treatment, leading to more extensive and costly treatment, greater morbidity and poorer survival. The aim of this study was to identify cases of oral SCC treated at Southern Heath (Melbourne, Australia) with a history of prediagnosis dental treatment, and to determine the delay between dental treatment and appropriate surgical assessment of the oral SCC.

METHODS

Patients were identified from the head and neck tumour database at Southern Health who met the inclusion criteria and relevant data were recorded.

RESULTS

Twelve patients met the inclusion criteria and 83% of cases involved the mandible. Dental extraction was the most common prediagnosis treatment performed (75%). The average delay from dental treatment to surgical assessment was just over eight weeks and all patients were found to have stage IV disease. Most patients had received extensive surgical resections (83%), neck dissections (75%) and adjunctive therapy (83%).

CONCLUSIONS

Oral SCC can sometimes be difficult to diagnose, which can result in more extensive treatment and greater morbidity. Health professionals and patients need to be aware that non-healing oral lesions, even after dental treatment such as a dental extraction, need to be considered as suspicious and an appropriate surgical referral should be made.

Influence of preoperative dental procedures on the prognosis of patients with squamous cell carcinoma of the gingiva

Our aim was to investigate the prognosis of patients with squamous cell carcinoma (SCC) of the gingiva who had preoperative dental operations. We studied 102 patients who were being operated on for SCC of the gingiva with special reference to the effects of preoperative dental operations on the prognosis. Twenty-six patients had dental procedures such as tooth extraction, or incision, or curettage before they visited our hospital, while the remaining 76 had no such interventions. The percentage of patients with advanced T stage disease (T3 or T4) was higher among those who had interventions (17/26, 65%) than among those who had not (35/76, 46%). The difference was not significant. Histopathologically invaded nodes were detected in half the patients in the intervention group (13/26), while they were found in only 18/76 (24%) of those in the no intervention group (p<0.02). The incidence of nodal metastases with extranodal spread was significantly higher in the intervention group than in the no intervention group (p<0.05), and those in the intervention group were more likely to develop distant metastases than those in the other group (p<0.001). The 5-year survival in the two groups was 65% and 92%, respectively (p<0.01). Preoperative dental operations such as tooth extraction, incision, or curettage possibly lead to regional and distant metastases and therefore a poor prognosis in patients with SCC of the gingiva.

Oral carcinomas detected after extraction of teeth: a clinical and radiographic analysis of 32 cases with special reference to metastasis and survival

A study was performed of 32 oral carcinomas that were diagnosed after recent dental extraction with particular reference to metastasis and survival. Eighty-four per cent of the patients complained of local swelling and/or pain. Infection had been suspected in 74% of the patients by the referring doctors. The involved teeth had been extracted in all patients. Ulceration and granulomatous tissue suggestive of carcinoma were found in the extraction sites in 24 patients when they were referred to us. Radiographs at presentation, available in 26 patients, showed diffuse radiolucencies with irregular borders around the extraction sites. Tumor or carcinoma were the clinical diagnoses in 27 patients. All patients underwent chemotherapy, irradiation and/or surgery, or a combination of these with curative intent after the diagnosis was confirmed histologically. Compared to a group of patients in whom dental extraction was not performed, the incidence of pathologically positive lymph nodes was significantly higher in the extraction group (52% vs 26%). The five-year survival in the extraction group was also lower (35% vs 48%).

Prophylactic extraction of third molars in cancer patients

Most studies on third molar extractions focus on the potential of tooth-associated pathoses when justifying or questioning the extraction. Scant attention is paid to potential medical problems of the patient "attached" to the third molar. This study presents 28 consecutive cancer cases seen by one dentist over a 2-year period in which third molars had a significant impact on the health of the patient and on their course of cancer therapy. In 15 patients on whom extractions were performed, 40% experienced postoperative complications. Prophylactic extraction of partially erupted or impacted third molars in cancer patients before their cancer therapy is recommended on the basis of the following observations: (1) the increased risks and difficulties associated with post-cancer-treatment extraction, (2) the potential for third molars to produce pathoses in immunocompromised patients before, during, or immediately after their anticancer treatment, and (3) the management of third molars may interfere with the patient's cancer treatment.