Causes of oral cancer--an appraisal of controversies

Major risk factors for oral cancer are cigarette smoking and alcohol misuse. Among Asian populations, regular use of betel quid (with or without added tobacco) increases oral cancer risks. Dentists should be aware of some emerging risk factors for oral, and particularly oropharyngeal cancer such as the role of the human papillomavirus infection (HPV). Decreases in risk could be achieved by encouraging high fruit and vegetable consumption. Some controversies related to the aetiology of this disease also need clarification. The objective of this paper is to provide an opinion on these debated controversies.

Associations Between Periodontal Disease and Risk for Nosocomial Bacterial Pneumonia and Chronic Obstructive Pulmonary Disease. A Systematic Review

BACKGROUND

Several recent studies provide evidence that the oral cavity may influence the initiation and/or the progression of lung diseases such as pneumonia and chronic obstructive pulmonary disease (COPD).

RATIONALE

Studies have shown that poor oral hygiene and periodontal disease may foster colonization of the oropharyngeal region by respiratory pathogens, particularly in hospital or nursing home patients. If aspirated, these pathogens can cause pneumonia, one of the most common respiratory infections, especially in institutionalized subjects. Other cross-sectional epidemiologic studies point to an association between periodontal disease and COPD. This systematic review examines the literature to determine if interventions that improve oral hygiene reduce the rate of pneumonia in high-risk populations.

FOCUSED QUESTION

Do periodontal diseases or other indicators of poor oral health influence the initiation/progression of pneumonia or other lung diseases?

SEARCH PROTOCOL

MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and the Cochrane Controlled Trials Register were searched to identify published studies that related variables associated with pneumonia and other lung disease to periodontal disease. Searches were performed for articles published in English from 1966 through March 2002.

INCLUSION CRITERIA

Randomized controlled clinical trials (RCTs), longitudinal, cohort, and case-control studies were included. Study populations included patients with any form of pneumonia or chronic obstructive pulmonary disease (COPD) and periodontal disease, as measured by assessments of gingival inflammation, probing depth, clinical attachment level, and/or radiographic bone loss, or oral hygiene indices.

EXCLUSION CRITERIA

Limited to studies of humans.

DATA COLLECTION AND ANALYSIS

The summary statistics used to analyze the RCTs included weighted mean differences in rates of disease between control and intervention groups. For cohort studies that measured differences in rates of disease between groups with and without oral disease, weighted mean differences, relative risks, or odds ratios were compared. A meta-analysis was performed on the 5 intervention studies to determine the relationship between oral hygiene intervention and rate of pneumonia in institutionalized patients.

MAIN RESULTS

Of the initial 1,688 studies identified, 36 satisfied all inclusion criteria and were read. Of these, 21 (11 case-control and cohort studies [study population 1,413] and 9 RCTs [study population 1,759]) were included in the analysis. 1. A variety of oral interventions improving oral hygiene through mechanical and/or topical chemical disinfection or antibiotics reduced the incidence of nosocomial pneumonia by an average of 40%. 2. Several studies demonstrated a potential association between periodontal disease and COPD.

REVIEWERS' CONCLUSIONS

1. Oral colonization by respiratory pathogens, fostered by poor oral hygiene and periodontal diseases, appears to be associated with nosocomial pneumonia. 2. Additional large-scale RCTs are warranted to provide the medical community with further evidence to institute effective oral hygiene procedures in high-risk patients to prevent nosocomial pneumonia. 3. The results associating periodontal disease and COPD are preliminary and large-scale longitudinal and epidemiologic and RCTs are needed.

Peripheral ossifying fibroma in a child: report of case

A typical peripheral ossifying fibroma in the anterior maxilla of an 11-year-old boy is presented. The importance of differential diagnosis and proper treatment for prevention of recurrence is discussed.

Present and future technologies of tooth whitening

Dental stains can be broadly classified as intrinsic or extrinsic. Intrinsic stains are a result of defects in tooth development, fluorosis, or acquired through the use of tetracycline. Extrinsic stains are localized mainly in the pellicle and are generated by the reaction between sugars and amino acids or acquired from the retention of exogenous chromophores in the pellicle. Three clinical methods are currently used for measuring stain removal and tooth whitening in the development of new whitening technologies: Lobene Stain Index, Shade Guide Color Change, and Minolta ChromaMeter. Professional tooth whitening products rely on proven technologies--35% hydrogen peroxide for in-office power bleaching or 10% to 15% carbamide peroxide for at-home bleaching--to reduce intrinsic stain and change the inherent tooth color. Over-the-counter tooth whitening products use a combination of surfactants, abrasives, anticalculus agents, and low levels of hydrogen peroxide to reduce extrinsic stain and help maintain tooth whiteness after professional treatment. Future technologies for whitening teeth could involve the use of activating agents to enhance the performance of hydrogen peroxide and natural enzymes.

Management of dental staining: can low-abrasive dentifrices play a role?

Dental staining, while always a significant problem, has become more important in recent years with the introduction and increased use of chlorhexidine-based mouthrinses. Not only do these rinses themselves cause staining, they also enhance staining from other sources, such as diet or tobacco use. An understanding of the etiologies of dental stains will help today's practitioners become more effective in managing dental stains in their practices. Important strategies for managing stain are patient education about the causes of staining, careful consideration of product recommendations for home use, and routine office visits for prophylaxis. Ideal products for patient use are those with effective stain-removal properties and low abrasivity, which minimizes tooth wear.

Gingival recession: intra-oral distribution and associated factors

This study assesses the role of poor oral hygiene and forceful toothbrushing as risk factors for recession. As part of a cross-sectional root surface caries study, 298 subjects, 42 to 67 years of age, with at least one exposed root surface, were examined. Since 66% of the root surface exposure and practically all the abrasion was on buccal surfaces, the analyses focused only on the buccal surface. Analysis of variance on subject means for buccal recession showed both calculus and presence of buccal root surfaces with abrasion to be significantly associated with recession after adjusting for age and gender. Root surface abrasion was considered a surrogate variable for forceful brushing. An additional analysis utilized means for each tooth, aggregating across subjects. For each of the 32 tooth types mean buccal recession, percent of exposed root surfaces with abrasion (%ra), and mean debris and calculus scores were calculated. Partial correlation coefficients across tooth types between recession and calculus, adjusting for abrasion, and for recession and abrasion adjusting for calculus, were 0.55. Interpretation of the %ra as a crude measure of forceful brushing is supported by its strong negative correlation across tooth types, with mean debris (r = -0.8) and mean calculus (r = -0.7). Separate analyses on premolars and on molars suggested that recession on premolars may be primarily due to brushing force and on the molars may be primarily due to debris and calculus. The findings suggest that recession is positively associated with percent abrasion (reflecting forceful brushing) and with poor oral hygiene.

Periodic health examination, 1993 update: 3. Periodontal diseases: classification, diagnosis, risk factors and prevention. Canadian Task Force on the Periodic Health Examination

OBJECTIVE

To review the 1979 Canadian Task Force on the Periodic Health Examination recommendations on the diagnosis and prevention of periodontal disease.

OPTIONS

Self-care at home, professional care, treatment with antimicrobial agents and management of patients at high risk.

OUTCOMES

Maintaining the gingiva, alveolar bone and periodontal ligament in a healthy state (absence of gingival bleeding and no loss of epithelial attachment).

EVIDENCE

A literature search for articles published from 1980 to 1993 was conducted. Selected studies published before 1980 were also reviewed if there were no recent updates. Evidence was evaluated and classified as good, fair or poor according to the criteria of the task force.

VALUES

The task force's evidence-based rules for recommendations were used. In addition, whenever feasible, and on the basis of advice from the reviewers and experts, recommendations were modified in the interest of maintaining oral health (e.g., dental flossing in children).

BENEFITS, HARMS AND COSTS

The recommendations are not expected to increase the costs of preventing periodontal diseases for the general population. They could benefit dental patients and reduce costs because they are based on the periodontal needs of patients rather than on the current universal application approach.

Gingivitis and periodontal disease in pregnancy

Forty pregnant women in each of three trimesters of pregnancy and forty nonpregnant women of comparable age, socioeconomic status and dietary habit have been examined to evaluate the gingival condition and the calculus and debris deposits. The study has shown that: There is a significant increase in the severity of gingivitis during pregnancy; The gingival changes progressively increase during the course of pregnancy; The gingival changes are more marked than the periodontal changes seen during pregnancy (increase in periodontal disease was seen in only a limited number of cases); There was an appreciable increase in the calculus and debris deposits in the pregnant as compared to the nonpregnant women; Increase in the calculus and debris deposits was apparent in all the trimesters of pregnancy; Gingival changes showed a greater correlation with the calculus and the debris index in the pregnant than in the nonpregnant women; The role of the irritant oral deposits either as a precipitating or perpetuating factor in the genesis of gingivitis during pregnancy can not be excluded.

Caries due to food retention in nonsusceptible rats fed a noncariogenic diet

Ligation of mandibular first molars in Fischer rats resulted in extensive food retention and massive caries, although the rats were fed a high fluoride, noncariogenic diet. These experimental conditions were suggested as a model to study the relationship of food retention to caries.