Oral Site Research Articles

Oral lichen planus in childhood: a case series.

Although the exact incidence of pediatric oral lichen planus (OLP) is unknown, the oral mucosa seems to be less commonly involved, and the clinical presentation is often atypical. The aim of the study is to present a case series of OLP in childhood. From our database, we retrospectively selected and analyzed the clinical data of OLP patients under the age of 18 where the diagnosis had been confirmed by histopathological analysis. The case series from our database shows eight patients, four males and four females. The mean (±SD) age at the time of diagnosis of the disease was 13.5 (±2.73) years, ranging in age from 9 to 17. Clinically, a reticular pattern was present in six patients (75%), and the tongue was the most commonly involved oral site (six cases, 75%). We also report the first case of OLP in a 9-year-old girl affected by autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. We report the largest case series of pediatric OLP published in literature thus far. Differences in the disease between adults and pediatric patients have been detected, but further investigation and a larger case series are needed to establish any detailed differences in clinical outcomes.

Physiological oral melanin pigmentation in a South African sample: A clinical study.

Physiological oral melanin pigmentation is genetically determined, more frequently affecting people with darker skin. It can involve any oral mucosal site, but predominantly the gingiva. The aim of the present study was to determine the prevalence and to characterize the clinical features of physiological oral melanin pigmentation in a South African population sample. A trainee in the discipline of periodontology and oral medicine interviewed all participants and examined the oral soft tissues. The diagnosis of physiological oral melanin pigmentation was based on clinical findings and on the history reported by the patient. A predetermined list of exclusion criteria was applied. The study population comprised 430 participants, of whom 319 (74%) were black, 55 (13%) Indian, 54 (12.5%) white, and two (0.5%) were mixed race. A total of 182 participants were diagnosed with physiological oral melanin pigmentation. The overall prevalence of physiological oral melanin pigmentation in the ethnically-mixed study population was 42%: 54% of blacks were affected, 16% of Indians, and 21% of whites. The female (101): male (81) ratio was 1.2:1; the gingiva was the site most frequently affected (73%). The total number of oral mucosal sites with physiological oral melanin pigmentation in the study population was 263; 68% of participants had one, 22% had two, 7% had three, and 3% had four sites affected. There was no significant association between the number of sites affected and sex or age. In this study of a South African population sample, the prevalence of physiological oral melanin pigmentation was higher in blacks than in Indians or whites, and the gingiva was the oral mucosal site most frequently affected.

Comprehensible knowledge model creation for cancer treatment decision making

Background: A wealth of clinical data exists in clinical documents in the form of electronic health records (EHRs). This data can be used for developing knowledge-based recommendation systems that can assist clinicians in clinical decision making and education. One of the big hurdles in developing such systems is the lack of automated mechanisms for knowledge acquisition to enable and educate clinicians in informed decision making. Materials and Methods: An automated knowledge acquisition methodology with a comprehensible knowledge model for cancer treatment (CKM-CT) is proposed. With the CKM-CT, clinical data are acquired automatically from documents. Quality of data is ensured by correcting errors and transforming various formats into a standard data format. Data preprocessing involves dimensionality reduction and missing value imputation. Predictive algorithm selection is performed on the basis of the ranking score of the weighted sum model. The knowledge builder prepares knowledge for knowledge-based services: clinical decisions and education support. Results: Data is acquired from 13,788 head and neck cancer (HNC) documents for 3447 patients, including 1526 patients of the oral cavity site. In the data quality task, 160 staging values are corrected. In the preprocessing task, 20 attributes and 106 records are eliminated from the dataset. The Classification and Regression Trees (CRT) algorithm is selected and provides 69.0% classification accuracy in predicting HNC treatment plans, consisting of 11 decision paths that yield 11 decision rules. Conclusion: Our proposed methodology, CKM-CT, is helpful to find hidden knowledge in clinical documents. In CKM-CT, the prediction models are developed to assist and educate clinicians for informed decision making. The proposed methodology is generalizable to apply to data of other domains such as breast cancer with a similar objective to assist clinicians in decision making and education.

Oral hygiene and periodontal health status among khat chewers. A case-control study.

BackgroundHabitual khat chewing is a widespread male habit in Southern Arabia and East Africa. The aim of this study was to assess the effect of Khat chewing on oral hygiene and periodontal health status among Yemeni male khat chewers.Material and MethodsThis case- control study included 310 khat chewers, aged 20-65 years, and 72 age- and gender- matched non-chewers as controls. Periodontal examination included recording of dental plaque index (PI), gingival index (GI), probing pocket depth (PPD), attachment level (AL) and gingival recession (GR). Demographic data, oral hygiene practices, and duration, frequency and site of khat chewing were obtained using questionnaires. SPSS was used for data analysis. ANOVA and t- tests were used to compare groups.ResultsKhat chewers had significantly higher mean PI, AL, GR scores than non-chewers (P < 0.05). However, no significant differences in the GI and PPD mean scores were observed between both groups (p > 0.05). Interestingly, the results showed that the chewing side had less PI, GI and PPD than non-chewing side. However, gingival recession was significantly higher in the chewing side. The duration of chewing showed a significant effect on PI, PPD, AL, and GR but had no effect on the gingival condition. Likewise, the frequency of chewing showed a significant effect on PPD, AL, and GR, but had no effect on other indices (PI and GI).ConclusionsThe results of this study indicate that khat chewing have a detrimental effect on the periodontium. Key words:Khat chewing, periodontal health, oral hygiene.

Pediatric Emergency Department Use of Intranasal Fentanyl to Treat Pain in Children with Sickel Cell Disease and Its Impact on Discharge Rates: A Multicenter Perspective

▪Background: Pain is the leading cause of hospitalization and pediatric emergency department (ED) visits for children with sickle cell disease (SCD). The National Heart, Lung and Blood Institute (NHLBI) recommends an initial dose of parenteral opioids within 30 minutes (min) of triage for moderate-severe vaso-occlusive pain episodes (VOEs) in the acute care setting. Delays in pain management for children with SCD commonly occur across EDs despite these guidelines. Intranasal fentanyl (INF) provides rapid and powerful parenteral analgesia, with an onset of action of 5-10 min, and peak in 30 min. INF is a safe and effective method of pain management for children in the ED and other clinical settings.Objective:To assess the use and impact of INF and other common therapies for the treatment of children with SCD and VOE on discharge rates in EDs across the United States and Canada.Methods: A retrospective cohort study was performed evaluating practices in 20 consecutive charts per site from 20 high-volume EDs (n=400 charts total) including 14 Pediatric Emergency Care Applied Research Network (PECARN) sites, assessing children age 3-21 years with SCD/VOE requiring parenteral opioids. Variables evaluated for association with discharge included age, gender, triage level, time from triage/room placement (whichever came first) to 1st parenteral opioid use (intravenous (IV) or intranasal), INF use, dose of total parenteral opioid (TPO) equivalents (mg/kg/hr), ketorolac use, oral opioids, any use of IV fluids (bolus and/or maintenance), ED shift presentation (AM, PM or overnight) and site. Multiple logistic regression was performed using significant variables identified on univariate analysis. Regression analyses were restricted to the 15 sites that had INF available in their ED (n=294 subjects).Results: Mean age of the 400 children was 14±5 years; 54% were female; 92% had HbSS. Admission rate was 67%. All received parenteral opioids; 84% IV fluids, 66% ketorolac, and 26% oral opioids. INF was available at 15/20 sites and used at 10/20 sites; 19% (75/400) of all children received INF, 25% when restricted to the 15 sites with INF available. INF was used in 60% of patients receiving parenteral opioids within 30 min of triage/room placement at sites with INF available. Median time to 1st parenteral opioid in children receiving INF was 25 (26, 37) vs. 64 (38, 102) min (p<.0001) for those who received only IV opioids. The admission rate was 49% vs. 70%, p=.0009 (Fig 1) for those treated vs not treated with INF. Variables associated positively with discharge included: shorter time from triage to 1st parenteral opioid (p<0.05), INF use (p<.001), oral opioid use (p<.0001), younger age (p=0.03), and site (p<.0001), while increased TPO equivalents (p=0.05), and IV fluid use (p=.01) were negatively associated with discharge. On multiple logistic regression analysis, INF use, TPO, use of IV fluids and site remained in the model. The Odds Ratio (OR) and 95% Confidence Interval for INF use and ED discharge was 2.99[1.14, 7.82], p=.03 for those who received INF compared to those who did not. Time from triage to 1stopioid dose did not affect admission risk in multivariate analysis.Conclusions:It is notable that the odds of being discharged from the ED are nearly 3 times higher for patients who received INF compared to those who did not. Contrary to common belief, rapid delivery of first parenteral analgesia, a focus of the 2014 NHLBI guidelines for treatment of SCD/VOE, did not affect risk of admission in our cohort when controlling for other factors, although potential benefits related to pain relief and patient satisfaction were not evaluated. Variations in practice across the network and variables associated with ED discharge rate require further investigation. Causality of INF impact on discharge rates can't be shown without further study, however the rapid onset-of-action and ease of delivery without IV access offered by INF makes it an ideal initial parenteral analgesic in the treatment of children with SCD and pain in the acute care setting. [Display omitted] DisclosuresMorris:MAST: Research Funding; Pfizer: Consultancy; Calithera: Consultancy; Nourish Life: Patents & Royalties: I am the inventor of IP owned by UCSF-Benioff Children’s Hospital that is licensed to NL; Endeavor: Consultancy; Nestle: Honoraria. Dampier:Eli Lilly and Company: Consultancy, Research Funding. Hsu:Gerson Lehman Group: Consultancy; Centers for Medicare and Medicaid Innovation: Research Funding; Astra Zeneca: Consultancy, Research Funding; Sancilio: Research Funding; Purdue Pharma: Research Funding; EMMI Solutions: Consultancy; Mast Therapeutics: Research Funding; Hilton Publishing: Consultancy, Research Funding; Eli Lilly: Research Funding; Pfizer: Consultancy, Research Funding.

Clinical Epidemiological Study of Oral Pre-cancer and Cancer in a Tertiary/Referral Hospital

Abstract Aim: To study the prevalence of oral cancer in patients reported to the Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital. Materials and Methods: After selecting the patients with the clinical criteria the history of the habits, duration in months and frequency per day, duration of the symptoms, oral mucosal site involvement, lymph node involvement, associated with lesions were recorded in a structured proforma. Incisional biopsy under Local anaesthesia and histological examination was performed. The results obtained were analysed statistically. Results: 200 patients were diagnosed with oral cancer, 49% were male and 51% were females. In that 51(25%) were associated with premalignant lesions, 94 had only one habit, 74 had a combination of habits, 40% were histopathologically moderately differentiated followed by 33% poorly differentiated and 27% well differentiated. And patients with stage III (31%) and IV (43%) were reported predominantly than stage I (12%) and II (14%). Conclusion: Early diagnosis and intervention prevent the progression of oral cancer.

A review on gastroretentive drug delivery system

Oral controlled release and site specific drug delivery system has been of great interest in pharmaceutical field to achieve improved therapeutic advantage. Concept of novel drug delivery system arose to overcome certain aspect related to physicochemical properties of drug molecule and the related formulations. Gastro retentive drug delivery system is one of such novel approaches to prolong gastric residence time, thereby targeting site specific drug release in the stomach for local or systemic effects. This approach is useful particularly for the drugs which have narrow absorption window in the upper part of gastro intestinal tract. In this review we have been discussed various approaches of gastro retentive drug delivery system, such as floating and non-floating systems.

Quantifying the rambunctious journey of the anesthesia provider's hands during simulated, routine care

The role of anesthesia providers in dispersing potentially pathogenic material from one patient to another during intraoperative care needs further study. In this study we aimed (1) to quantify the dispersion of a surrogate pathogen from a simulated patient's mouth to the anesthesia workstation during routine anesthetic induction, (2) to test the hypothesis that there would be fewer contamination sites by providers who used a double-gloving technique, and (3) to examine the effectiveness of between-case anesthesia apparatus disinfection. Twenty subjects were randomized to a single pair of gloves group (group 1) or a double-gloved group (group 2) and completed a simulated general anesthesia induction, completing a standardized set of interventions. Dispersion of a surrogate pathogen dye placed in the oral cavity of the simulated patient was tracked by a blinded observer and photography. Standard cleaning of the workstation was performed, and residual dye was quantified. Group performance was plotted using regression analysis and rate of contamination compared using parametric statistics. Group 1 contaminated an average of 16.0 (SEM = 0.89) sites compared with group 2, who contaminated an average of 7.6 (SEM = 0.85). The cart drawers, gas flow dials, medication vials, and ventilator controls were significantly contaminated by group 1, but not by group 2 (P < .05 in all cases). There were similar rates of contamination in both groups for the airway equipment, breathing system, intravenous access ports, and the roll of tape used to secure the endotracheal tube. Once the airway management phase of the induction ended, new site contamination continued at a high rate in group 1 but not group 2. A double-gloving technique was associated with less spread of an oral inoculum to the workstation but was not uniformly protective. Between-case cleaning was ineffective in removing the contaminant, indicating that biologic material from one patient may be present when subsequent patients are cared for. This suggests risks for the current patient (eg, skin or oral site transfer to an intravenous site) and also may place future patients at risk. Importantly, using models that simulate actual clinical events can inform clinical practice and decipher challenging areas of ergonomics.

Lifestyle Factors Associated With Histologically Derived Human Ovarian Non-growing Follicle Count in Reproductive Age Women

STUDY QUESTION: Are lifestyle factors (smoking BMI alcohol use and oral contraceptive pill use) associated with the human ovarian reserve as determined by the total ovarian non-growing follicle number? SUMMARY ANSWER: Light to moderate alcohol use was significantly associated with greater ovarian non-growing follicle (NGF) count whereas other lifestyle factors were not significantly related. WHAT IS KNOWN ALREADY: A single previous investigation has suggested that smoking and alcohol use are associated with lower ovarian follicle density. However this investigation utilized follicle density as the outcome of interest rather than the estimated total ovarian NGF count. STUDY DESIGN SIZE DURATION: This cross-sectional investigation included a convenience sample of premenopausal women from two different academic sites the University of Washington (n = 37 from 1999-2004) and the University of Oklahoma (n = 73 from 2004-2013) undergoing incidental oophorectomy at the time of hysterectomy (total n = 110 age range 21-52 years). PARTICIPANTS/MATERIALS SETTING METHODS: Prior to undergoing oophorectomy participants completed detailed questionnaires regarding lifestyle exposures. Following surgery total ovarian NGF counts were determined with systematic random sampling rules and a validated fractionator/optical dissector technique. Associations between lifestyle factors and log-transformed ovarian follicle counts were determined using multivariable linear regression. MAIN RESULTS AND THE ROLE OF CHANCE: After controlling for age BMI oral contraceptive pill (OCP) use tobacco use and site of collection cumulative alcohol use (measured in alcoholic drinks per day multiplied by years of drinking) was associated with ovarian NGF count. Women reporting light (>0 to 3 drink-years) BMI OCP use nor tobacco use were significantly associated with the ovarian NGF count. Similar patterns of association with moderate cumulative alcohol use were observed when evaluating associations with pre-antral follicles and total follicle counts. LIMITATIONS REASONS FOR CAUTION: All participants in this convenience sample had a benign indication for hysterectomy and therefore may not be broadly representative of the population without such an indication. Additionally lifestyle factors were self-reported and the sample size of the present investigation limits our ability to detect associations of smaller magnitude. WIDER IMPLICATIONS OF THE FINDINGS: While our findings are in disagreement with a single investigation that utilized human follicle density as the outcome of interest they are consistent with many studies investigating the relationship between lifestyle factors and the age of spontaneous menopause. Furthermore they suggest a mechanism that does not involve accelerated follicular atresia to explain the association between smoking and an earlier age of menopause. STUDY FUNDING/COMPETING INTERESTS: This investigation was funded by NIA R29-HD37360-04 (N.A.K.) and OCAST HR04-115 (K.R.H.) and by the National Institute of General Medical Sciences Grant 1 U54GM104938 (J.D.P.). There is no conflict of interest. (c) The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions please email: journals.permissions@oup.com.

Oral, intestinal, and skin bacteria in ventral hernia mesh implants

BackgroundIn ventral hernia surgery, mesh implants are used to reduce recurrence. Infection after mesh implantation can be a problem and rates around 6–10% have been reported. Bacterial colonization of mesh implants in patients without clinical signs of infection has not been thoroughly investigated. Molecular techniques have proven effective in demonstrating bacterial diversity in various environments and are able to identify bacteria on a gene-specific level.ObjectiveThe purpose of this study was to detect bacterial biofilm in mesh implants, analyze its bacterial diversity, and look for possible resemblance with bacterial biofilm from the periodontal pocket.MethodsThirty patients referred to our hospital for recurrence after former ventral hernia mesh repair, were examined for periodontitis in advance of new surgical hernia repair. Oral examination included periapical radiographs, periodontal probing, and subgingival plaque collection. A piece of mesh (1×1 cm) from the abdominal wall was harvested during the new surgical hernia repair and analyzed for bacteria by PCR and 16S rRNA gene sequencing. From patients with positive PCR mesh samples, subgingival plaque samples were analyzed with the same techniques.ResultsA great variety of taxa were detected in 20 (66.7%) mesh samples, including typical oral commensals and periodontopathogens, enterics, and skin bacteria. Mesh and periodontal bacteria were further analyzed for similarity in 16S rRNA gene sequences. In 17 sequences, the level of resemblance between mesh and subgingival bacterial colonization was 98–100% suggesting, but not proving, a transfer of oral bacteria to the mesh.ConclusionThe results show great bacterial diversity on mesh implants from the anterior abdominal wall including oral commensals and periodontopathogens. Mesh can be reached by bacteria in several ways including hematogenous spread from an oral site. However, other sites such as gut and skin may also serve as sources for the mesh biofilm.

HIV-Associated Oral Mucosal Melanin Hyperpigmentation: A Clinical Study in a South African Population Sample.

Objective. The aim of the study was to determine the prevalence of HIV-associated oral mucosal melanin hyperpigmentation (HIV-OMH) in a specific population of HIV-seropositive South Africans and to analyse the associations between HIV-OMH clinical features and the demographic and immunological characteristics of the study cohort. Material and Methods. This cross-sectional study included 200 HIV-seropositive Black subjects. The collected data comprised age, gender, CD4+ T cell count, viral load, systemic disease, medications, oral site affected by HIV-OMH, extent (localized or generalized), intensity of the pigmentation (dark or light), and smoking and snuff use. Results. Overall, 18.5% of the study cohort had HIV-OMH. Twenty-two and a half percent had OMH that could not with confidence be attributed to HIV infection, and 59% did not have any OMH. There was a significant but weak association between smoking and the presence of HIV-OMH. Conclusions. The prevalence of HIV-OMH in the study population was 18.5%, the gingiva being the most commonly affected site. It appears that the CD4+ T cell count does not play any role in the biopathology of HIV-OMH.

The efficacy of eutectic mixture of local anesthetics as a topical anesthetic agent used for dental procedures: A brief review

Dental pain management is one of the most critical aspects of modern dentistry which might affect patient's quality of life. Several methods are suggested to provide a painless situation for patients. Desensitization of the oral site using topical anesthetics is one of those methods. The improvements of topical anesthetic agents are probably one of the most important advances in dental science in the past 100 years. Most of them are safe and can be applied on oral mucosa with minimal irritation and allergic reactions. At present, these agents are various with different potent and indications. Eutectic mixture of local anesthetics (EMLA) (lidocaine + prilocaine) is a commercial anesthetic agent which has got acceptance among dental clinicians. This article provides a brief review about the efficacy of EMLA as a topical anesthetic agent when used during dental procedures.

Lifestyle factors associated with histologically derived human ovarian non-growing follicle count in reproductive age women.

Are lifestyle factors (smoking, BMI, alcohol use and oral contraceptive pill use) associated with the human ovarian reserve as determined by the total ovarian non-growing follicle number? Light to moderate alcohol use was significantly associated with greater ovarian non-growing follicle (NGF) count, whereas other lifestyle factors were not significantly related. A single previous investigation has suggested that smoking and alcohol use are associated with lower ovarian follicle density. However, this investigation utilized follicle density as the outcome of interest rather than the estimated total ovarian NGF count. This cross-sectional investigation included a convenience sample of premenopausal women from two different academic sites, the University of Washington (n = 37, from 1999-2004) and the University of Oklahoma (n = 73, from 2004-2013), undergoing incidental oophorectomy at the time of hysterectomy (total n = 110, age range 21-52 years). Prior to undergoing oophorectomy, participants completed detailed questionnaires regarding lifestyle exposures. Following surgery, total ovarian NGF counts were determined with systematic random sampling rules and a validated fractionator/optical dissector technique. Associations between lifestyle factors and log-transformed ovarian follicle counts were determined using multivariable linear regression. After controlling for age, BMI, oral contraceptive pill (OCP) use, tobacco use and site of collection, cumulative alcohol use (measured in alcoholic drinks per day multiplied by years of drinking) was associated with ovarian NGF count. Women reporting light (>0 to <1 drink-years) and moderate (1-3 drink-years) alcohol use had greater NGF counts (β = 0.75, P = 0.04, and β = 1.00, P = 0.03; light and moderate use, respectively) as compared with non-users. Neither heavier alcohol use (>3 drink-years), BMI, OCP use, nor tobacco use were significantly associated with the ovarian NGF count. Similar patterns of association with moderate cumulative alcohol use were observed when evaluating associations with pre-antral follicles and total follicle counts. All participants in this convenience sample had a benign indication for hysterectomy, and therefore may not be broadly representative of the population without such an indication. Additionally, lifestyle factors were self-reported, and the sample size of the present investigation limits our ability to detect associations of smaller magnitude. While our findings are in disagreement with a single investigation that utilized human follicle density as the outcome of interest, they are consistent with many studies investigating the relationship between lifestyle factors and the age of spontaneous menopause. Furthermore, they suggest a mechanism that does not involve accelerated follicular atresia to explain the association between smoking and an earlier age of menopause. This investigation was funded by NIA R29-HD37360-04 (N.A.K.) and OCAST HR04-115 (K.R.H.) and by the National Institute of General Medical Sciences, Grant 1 U54GM104938 (J.D.P.). There is no conflict of interest.

Lichen Planus: Esophageal Involvement

Case Presentation: A 71-year-old white female with a past medical history of gastroesophageal reflux disease presented with intermittent dysphagia to solid food and odynophagia that had been progressing for the past few months. She also reported unintentional weight loss. Patient has history of erosive lichen planus that was causing ulcers in her oropharynx three years ago and it was treated with topical steroids. All her initial laboratory tests were normal, this includes CBC, BAMP, LFTs. Barium sallow was performed and showed narrowing in the proximal one-third of the esophagus. Subsequent upper endoscopy revealed ulcerated circumferential stricture in the proximal esophagus just 2 cm below the cricopharyngeal muscle. Upper endoscopy also showed moderate mid and distal esophageal strictures (Figure. 1). Esophageal biopsies were consistent with acute erosive esophagitis with lymphocytic predominance and with minimal eosinophils. Based on the presence of oral lichen planus, our patient's endoscopic apperance and the biopsy findings, the patient was diagnosed with esophageal lichen planus. She had undergone multiple esophageal dilatations since the initial presentation. She had also received a course of systemic steroids. On follow-up, the patient was clinically stable and had denied worsening of her symptoms.Figure 1Discussion: Lichen planus is a common idiopathic disorder involving skin, nail, and mucosal membranes. It is characterized by immune response attacking an antigen in the basal cells of squamous epithelium. Esophageal lichen planus is a relatively rare condition and the prevalence is unknown. The diagnosis can be challenging due to the subtle clinical findings and lack of characteristic histologic features. Esophageal lichen planus usually affects the upper and mid esophagus; in addition, it often spares the gastroesophageal junction when compared to reflux esophagitis. The history of oral lichen planus, endoscopic images and site of esophageal involvement are very helpful in differentiating between the latter two entities. Esophageal lichen planus has a tendency to be chronic disease with the potential risk of malignancy. Topical and oral steroids are the mainstay of treatment but to date there are no wellestablished guidelines. Conclusions: Oropharyngeal lichen planus is a chronic disease that can lead to recurrent esophageal stricture. Endoscopic findings and pathology may not be specific; however, clinicians should be aware of this entity and appropriate referrals should be made as patients might need repeated interventions to have a relief in their symptoms.

No role for human papillomavirus infection in oral cancers in a region in southern India.

Oral cancer is a major public health issue in India with ∼ 77,000 new cases and 52,000 deaths yearly. Paan chewing, tobacco and alcohol use are strong risk factors for this cancer in India. Human papillomaviruses (HPVs) are also related to a subset of head and neck cancers (HNCs). We examined the association between oral HPV and oral cancer in a sample of Indian subjects participating in a hospital-based case-control study. We recruited incident oral cancer cases (N = 350) and controls frequency-matched by age and sex (N = 371) from two main referral hospitals in Kerala, South India. Sociodemographic and behavioral data were collected by interviews. Epithelial cells were sampled using Oral CDx® brushes from the oral cancer site and the normal mucosa. Detection and genotyping of 36 HPV genotypes were done using a polymerase chain reaction protocol. Data collection procedures were performed by qualified dentists via a detailed protocol with strict quality control, including independent HPV testing in India and Canada. HPV DNA was detected in none of the cases or controls. Associations between oral cancer and risk factors usually associated with HPV infection, such as oral sex and number of lifetime sexual partners, were examined by logistic regression and were not associated with oral cancer. Lack of a role for HPV infection in this study may reflect cultural or religious characteristics specific to this region in India that are not conducive to oral HPV transmission. A nationwide representative prevalence study is needed to investigate HPV prevalence variability among Indian regions.

Oral erythema multiforme: trends and clinical findings of a large retrospective European case series

Erythema multiforme (EM) continues to be an underestimated disease with a lack of strict classification and diagnostic criteria. We present the analysis of a case series of 60 oral EM patients from 2 centers and illustrate the range of oral clinical presentations. Clinical data from 60 EM patients with oral involvement, diagnosed and treated between 1982 and 2014, were retrospectively collected from the archives of 2 independent hospitals. Statistical analyses of the data were performed using the Pearson χ-squared test and the Mann-Whitney U test. Thirty-one patients (51.7%) were male and 29 (48.3%) were female, with a mean (±SD) age of 37.9 years (±18.1). The frequency of previous occurrences ranged from 0 to 10 (mean ± SD: 1.4 ± 2.0). Twenty-nine patients (48%) had no previous occurrence. Medications (particularly antipyretics, food additives, and antibiotics) were the suspected precipitants in 28 patients (46.7%), whereas herpes simplex virus infection was suspected in 18 (30.0%). All but 1 patient had involvement of multiple oral sites, with the buccal mucosa being the most commonly involved oral site (75%), followed by the vermillion border (71.7%). Patients with EM may present initially to oral health care workers. Medications and herpes simplex virus continue to be the most typically involved precipitating factors. Our data highlight the additional role of food-derived antigens. Although laboratory tests can provide support diagnostically, EM diagnosis continues to be based on clinical features. A medication and food diary should be encouraged particularly in patients with recurrent forms.

Keratinized strap cells: a rare cytological atypia resembles Anitschkow cells, in human oral neoplasm.

Cytopathology of human oral squamous cell carcinoma reveals cytological pleomorphism. In this investigation, cytometry was used in an attempt to analyse the importance of the rare occurrence of keratinized strap cells in the buccal mucosa of human oral neoplasms. A case-control study was undertaken in which exfoliated cytosmears were collected, by scraping, from 136 clinically diagnosed oral cancer patients. Wet fixed cytosmears were stained by use of Papanicolaou's staining procedure and counter-stained with Giemsa's solution. One thousand cells were screened, and keratinized strap (Anitschkow) cells (KSC-A) and other cytological atypias were counted. Cytomorphometry was performed by use of a computer-assisted microscope camera. The findings were analysed statistically and interpreted in respect of age group, oral site, and sex. Transformation of an angulated and polygonal normal oral squamous cell into a keratinized narrow strip or ribbon-like flat projection results in what is called a keratinized strap cell (KSC). Nuclear pleomorphism in keratinized strap cells was observed to be narrow spindle, rod, and bar-shaped and to resemble Anitschkow cells. From the nature of the staining, the structural peculiarity, and the resemblance to Anitschkow cells, KSC, a rarely observed oral cytological atypia, were renamed as keratinized strap (Anitschkow) (KSC-A) cells. Cytometrically, the nuclear-to-cytoplasmic (N/C) ratio for KSC-A was calculated to be 1:11.2 for males and 1:11.3 for females; these are more than those for the normal counterparts. Rare occurrence, cellular keratinization, nuclear pleomorphism, hyperchromasia, and increased N/C ratios for KSC-A in oral carcinoma, for both sexes, indicate a state of malignancy; this finding is, thus, of practical value for early detection and diagnosis of oral squamous cell carcinoma patients.

Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery

To determine the relationship between oral antibiotic bowel preparation (OABP) and surgical site infection (SSI) rates in a national colectomy cohort. OABP for elective colorectal surgery has fallen out of favor. Large cohort studies show that OABP is associated with a 50% reduction in SSI after colectomy. A retrospective analysis of the National Surgical Quality Improvement Program colectomy cohort from 2011 to 2012 was performed to examine the association between use of OABP and outcomes of SSI, length of stay (LOS), and readmission after elective colectomy. Univariate and multivariable analyses for SSI were performed. The cohort included 8415 colorectal operations of which 5291 (62.9%) had a minimally invasive surgical (MIS) approach. Overall, 25.6% had no bowel preparation, 44.9% had mechanical bowel preparation (MBP) only, and 29.5% received OABP. The SSI rate was 11.1%, and it varied by preparation type: 14.9% no preparation, 12.0% MBP, and 6.5% OABP (P < 0.001). OABP group had significantly shorter hospital LOS: (median = 4, interquartile range: 3-6) versus other preparations (median LOS = 5) (P < 0.001). Readmission rates were lowest in OABP (8.1%) and highest in the no preparation group (11.8%). Multivariable logistic regressions found OABP associated with lower SSI [adjusted odds ratio (ORadj) = 0.46, 95% confidence interval (CI): 0.36-0.59]. Stratified models found OABP protective for SSI for both open procedures (ORadj = 0.40, 95% CI: 0.30-0.53) and MIS procedures (ORadj = 0.48, 95% CI: 0.36-0.65). OABP is associated with reduced SSI rates, shorter LOS, and fewer readmissions. Adoption of OABP before elective colectomy would reduce SSI without effecting LOS. The practice of MBP alone should be abandoned.

Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma

BackgroundResecting oral squamous cell carcinoma (SCC) with an appropriate margin of uninvolved tissue is critical in preventing local recurrence and in making decisions regarding postoperative radiation therapy. This task can be difficult due to the discrepancy between margins measured intraoperatively and those measured microscopically by the pathologist after specimen processing. Material and methodsA total of 61 patients underwent resective surgery with curative intent for primary oral SCC were included in this study. All patients underwent resection of the tumor with a measured 1-cm margin. Specimens were then submitted for processing and reviewing, and histopathologic margins were measured. The closest histopathologic margin was compared with the in situ margin (1 cm) to determine the percentage discrepancy. ResultsThe mean discrepancy between the in situ margins and the histopathological margins of all close and positive margins were 47.6% for the buccal mucosa (with a P value corresponding to 0.05 equaling 2.1), which is statistically significant, 4.8% for the floor of mouth, 9.5% for the mandibular alveolus, 4.8% for the retromolar trigon, and 33.3% for the tongue. ConclusionThere is a significant difference among resection margins based on tumor anatomical location. Margins shrinkage after resection and processing should be considered at the time of the initial resection. Tumors located in the buccal mucosa show significantly greater discrepancies than tumors at other sites. These findings suggest that it is critical to consider the oral site when outlining margins to ensure adequacy of resection. Buccal SCC is an aggressive disease, and should be considered as an aggressive subsite within the oral cavity, requiring a radical and aggressive resective approach.

Incidence and risk factors for colorectal neoplasia in patients with oral squamous cell carcinoma.

Colorectal adenoma and cancer are not regarded as being associated with primary oral cancer. The aim of this study was to determine whether screening colonoscopy should be performed for patients with oral cancer in addition to the upper gastrointestinal endoscopic screening that is now routinely performed. Between 2007 and 2013, 162 patients with oral squamous cell carcinoma were enrolled at Tokyo Dental College, Ichikawa General Hospital, and 136 individuals were assigned to colonoscopic surveillance. Advanced neoplasia was defined as an adenoma ≥ 10 mm, adenoma with villous histology or high-grade dysplasia regardless of size and invasive cancer. Associations between advanced neoplasia and clinical factors, including age, sex, body mass index, physical activity, smoking, alcohol consumption and oral cancer site and staging were determined. Advanced neoplasia, including five invasive cancers, was identified in 32 (23.5%) patients. An age- and sex-adjusted multivariate analysis revealed that smoking (Brinkmann index > 400; OR = 3.24, 95% CI = 1.28-8.18), alcohol consumption (lifetime pure ethanol consumption > 600 l; OR = 2.84, 95% CI = 1.18-6.79) and a diagnosis of cancer of the floor of the mouth (OR = 7.97, 95% CI = 2.49-25.46) were independent risk factors for advanced colorectal neoplasia. The prevalence of advanced colorectal neoplasia is unexpectedly high in patients with oral cancer. It should be recognized as a second primary tumour of oral cancer. Screening of oral cancer patients by colonoscopy should be routine practice, particularly among smokers and patients with a high intake of alcohol and cancer of the floor of the mouth.