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D J Krutchkoff

Publications and source records attributed to D J Krutchkoff.

At least 19 recordsLinked to original sources
PubMed2000

Food group intake and the risk of oral epithelial dysplasia in a United States population.

OBJECTIVES: Oral epithelial dysplasia (OED) is a histopathologic diagnosis associated with an increased risk of oral cancer. The paper explores the relationship between OED risk and food group intake. METHODS: In this case-control study, incident cases of OED were identified through two oral pathology laboratories. Controls, pair-matched 1:1 to cases on age (+/- 5 years), gender, appointment date (+/- 1 year), and surgeon, were identified through the office in which the respective case was biopsied. Exposure data were obtained via a telephone interview and mailed food-frequency questionnaire. Conditional logistic regression was used to obtain odds ratio point estimates. RESULTS: Based upon 87 matched pairs and after controlling for smoking, drinking, and other potential covariates there was an apparent inverse relationship between OED risk and the consumption of fruits and vegetables, with the intake of these foods being associated with a strong attenuating effect among smokers. OED risk decreased with increased poultry consumption, but increased modestly with bread/cereal and dairy food intake. CONCLUSIONS: This investigation provides evidence that some aspects of diet may be associated with the risk of OED. It also suggests that in oral carcinogenesis the role of diet is not simply one of a late effect.

Adult↗
PubMed1998

The effect of clinical information on the histopathologic diagnosis of oral epithelial dysplasia.

OBJECTIVES: The purpose of this study was to test the hypothesis that clinical information submitted with biopsy specimens helps pathologists be more consistent and accurate in diagnosing oral epithelial dysplasia. STUDY DESIGN: Each of six board-certified oral and maxillofacial pathologists examined the same set of 120 oral biopsies (involving diagnoses ranging from hyperkeratosis to severe epithelial dysplasia); they had examined these same biopsies in a previous study, but this time the clinical information was provided for each case. The examiner's diagnosis was compared to the sign-out diagnosis for each case. RESULTS: Rates of exact agreement with the sign-out diagnosis averaged 38.5%, and there was 85.4% agreement within one histologic grade. The rate of agreement in distinguishing epithelial dysplasia from no dysplasia was 71.4%. These results, when compared to those from a previous study in which the same examiners had evaluated the same slides but without clinical histories, represent a 2.5% to 20% decrease for exact agreement among the six pathologists, a 0% to 8.5% decrease for agreement within one histologic grade, and a 0% to 23.4% decrease for agreement regarding the presence or absence of epithelial dysplasia. CONCLUSIONS: When clinical information was used, accuracy and consistency among board-certified oral and maxillofacial pathologists in the diagnosis of oral epithelial dysplasia was not improved. In fact, there was a decrease in accuracy.

Biopsy↗
PubMed1997

Mouthwash use and dentures in relation to oral epithelial dysplasia.

This case-control study investigated the potential association between oral epithelial dysplasia (OED) and both mouthwash and denture use. Incident OED cases aged 20-79 years were identified through two oral pathology laboratories. Controls were pair-matched (1:1) to cases on age (+/- 5 years), gender, appointment date and surgeon. A telephone interview was used to obtain exposure information. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were generated using conditional logistic regression. Based upon 127 case-control pairs and after adjusting for smoking, drinking, education and either denture or mouthwash use, the OR for OED and regular mouthwash use (1+ uses/week for 6+ months) was 0.8 (95% CI, 0.4-1.5) while the OR for OED and wearing a denture was 0.7 (95% CI, 0.4-1.3). There were no clear trends of increased OED risk with increased mouthwash use or years of denture wearing. Our findings suggest that neither mouthwash nor denture use are associated positively with OED risk.

Adult↗
PubMed1996

Smoking and drinking in relation to oral epithelial dysplasia.

Oral epithelial dysplasia (OED) is a histopathological diagnosis that is associated with an increased risk of oral cancer. The purpose of this case-control study was to measure the association between OED and the use of smoking tobacco and alcoholic beverages. Incident cases of OED (n = 127) were identified through two oral pathology laboratories. Controls, pair-matched 1:1 to cases on age (+/- 5 years), gender, appointment date (+/- 1 year), and surgeon, were identified through the office in which the respective case had been biopsied. Exposure information regarding smoking, drinking, and other potential risk factors was obtained through a standardized telephone interview. Conditional logistic regression was used to calculate measures of association and statistical significance. The odds ratio (OR) for current smoking adjusted for drinking, mouthwash use, denture status, and education was 4.1 (95% confidence interval, 2.1-7.9) relative to never/ex-smokers. The risk of OED increased with increasing levels of smoking and declined following smoking cessation, with ex-smokers of 15+ years demonstrating no excess risk relative to never smokers. Individuals drinking 7+ drinks/week, relative to less than that amount, had over twice the risk of OED (OR, 2.4; 95% confidence interval, 1.2-4.8) after controlling for smoking, mouthwash use, denture status, and education. Adjusted ORs tended to increase with increasing levels of alcohol intake. An exploratory analysis suggests that the joint effect of smoking and drinking may be more than additive as regards the risk of OED. The findings of this case-control study implicate smoking and drinking as important risk factors for OED.

Adult↗
PubMed1995

Squamous cell carcinoma of the gingiva. A case series analysis.

Recent studies suggest that patients with carcinoma of the gingiva exhibit demographic features that differ from those of persons with squamous carcinoma at other intraoral sites. In this study, we sought to explore this hypothesis in greater detail. Records from the University of Connecticut Oral Biopsy Service from 1975 through 1992 inclusive were surveyed for cases of oral carcinoma. A total of 577 cases were retrieved and analyzed with respect to prevalence, gender distribution, and age at diagnosis. We found that the gingiva (alveolar ridge included) was the third most common site for oral squamous carcinoma after carcinoma of the floor of the mouth and tongue. Further, the relative proportion of gingival cancer versus carcinoma at other intraoral subsites remained essentially constant throughout the study period. Male-to-female ratios were significantly greater for cancer of the floor of the mouth as compared with both cancer of the tongue and cancer of the gingiva (ridge included). Age was not a significant predictor of oral cancer subsite, and there were no apparent differences between carcinoma of the dentate gingiva and that of the edentulous ridge. Results of this study indicate that gender-specific predilections exist for squamous cell carcinoma at different intraoral subsites. These differences suggest the possibility of different etiologic factors and pathogenetic mechanisms involved in carcinoma of the gingiva compared with surface carcinoma at other intraoral sites.

Age of Onset↗
PubMed1995

Intraexaminer and interexaminer reliability in the diagnosis of oral epithelial dysplasia.

OBJECTIVES: Pathologists differ in their definition of "dysplasia." This study was done to test the hypothesis that experienced oral pathologists are consistent in diagnosing epithelial dysplasia. STUDY DESIGN: Six board-certified oral pathologists examined 120 oral biopsies exhibiting simple hyperkeratosis to severe dysplasia. No clinical information was given, and presence of dysplasia was judged by histomorphology. Examiners' diagnoses were compared with sign-out diagnoses for each case. Months later, each examiner viewed 60 relabeled slides from the original 120. Each diagnosis was compared with the diagnosis in the first round. RESULTS: Exact agreement with the sign-out diagnosis averaged 50.5% (within one histologic grade 90.4%). Examiners agreed exactly with their own diagnoses 50.8% of the time (within one histologic grade 92.4%). Agreement distinguishing dysplasia from no dysplasia compared with original sign-out diagnosis was 81.5%. Agreement with themselves distinguishing dysplasia from no dysplasia was 80.3%. CONCLUSIONS: Accurate reproducible agreement among experienced board-certified oral pathologists diagnosing oral epithelial dysplasia is difficult to achieve.

Diagnostic Errors↗
PubMed1995

An assessment of oral cancer underregistration at the Connecticut Tumor Registry.

The purpose of this study was to investigate whether and to what extent cases of oral cancer diagnosed through the University of Connecticut Health Center Oral Pathology Biopsy Service went unregistered by the Connecticut Tumor Registry during the period 1984 to 1988. All Oral Pathology Biopsy Service pathology reports generated from 1984 to 1988 were reviewed to identify diagnosed oral cancer cases (International Classification of Diseases, 9th revision codes 140, 141, 143 to 145). The names of all identified patients were computer-linked to previously registered cases. Nineteen (8.6%) of the 221 reportable cases of oral cancer diagnosed through the Oral Pathology Biopsy Service from 1984 to 1988 went unregistered. The 19 unregistered cases represented 1.6% of all known Connecticut oral cancer cases diagnosed during the period. The finding of a past, albeit small, "gap" in oral cancer cases registered with the Connecticut Tumor Registry suggests that oral pathologists should confirm that cases of oral cancer diagnosed through their pathology services are being registered by their regional tumor registries.

Connecticut↗
PubMed1995

Epstein-Barr virus coinfection and recombination in non-human immunodeficiency virus-associated oral hairy leukoplakia.

Human immunodeficiency virus-associated oral hairy leukoplakia (HLP) is characterized by coinfection with multiple types and strains of Epstein-Barr virus (EBV) and recombination within the EBV genome. HIV-seronegative immunosuppressed and immunocompetent patients with HLP were examined to determine the pathogenic contribution of EBV coinfection and recombination to the development of HLP. Multiple coinfecting EBV strains were detected in both HLP specimens and peripheral blood lymphocytes (PBL) of HIV-seronegative persons with HLP. One specific EBV strain was detected in HLP specimens from 3 of 4 patients. Also, viral recombination during productive replication within HLP generated variants of the latent membrane protein-1 (LMP-1) and nuclear antigen-2 (EBNA-2) genes. Some variants were also detected within PBL. Thus, EBV coinfection and recombination are consistent findings in persons with HLP regardless of immune status. Virally mediated determinants may be important features of EBV pathogenesis.

Adult↗
PubMed1994

Smoking, gender, and age as risk factors for site-specific intraoral squamous cell carcinoma. A case-series analysis.

BACKGROUND: Studies assessing risk factors for oral cancer do not generally report results for specific oral sites. The purpose of the current study was to examine differences in the distribution of age, gender, and tobacco use by intraoral site in a series of oral cancer cases. METHODS: Information on gender, age at diagnosis, and lesion location was obtained for all incident cases of oral squamous cell carcinoma diagnosed through the University of Connecticut Oral Pathology Biopsy Service during the period 1987-1991 (N = 150). Information on tobacco use was obtained through a telephone interview or from medical or dental records. RESULTS: The tongue, floor of the mouth (FOM), and gingiva, respectively, were the most commonly affected sites. The male-to-female ratio was greatest for FOM cancer (3.4) and lowest for gingival cancer (0.5). The mean age at diagnosis did not differ significantly by site. The percentage of smokers among cases of FOM, tongue, and gingival cancer was 97%, 64%, and 50%, respectively. When multiple logistic regression was used to compare FOM and gingival cancer, gender and smoking remained significant predictors. The odds of smoking among patients with FOM cancer were 32 times the odds of smoking among patients with gingival cancer (odds ratio for age, gender adjusted = 32.6, 3.3-323.5). CONCLUSIONS: The findings suggest that cancer of the FOM is more strongly associated with smoking than is cancer of the gingiva and, perhaps, the tongue. The reported results should be interpreted cautiously in light of study limitations, which include the absence of information on alcohol consumption and lack of a noncancer control group.

Adult↗
PubMed1992

Lip cancer. Incidence trends in Connecticut, 1935-1985.

Suspicions have recently arisen that cancer of the lip may exert an undue influence on overall oral cancer statistics and, therefore, possibly distort the true image of intraoral cancer. The authors investigated this question through epidemiologic analysis. A total of 2291 cases of lip cancer accessioned by the Connecticut Tumor Registry (CTR) from 1935 to 1985 (23.6% of all oral cancer) were analyzed. Occurrence trends for males and females had different patterns: for men, the age-adjusted incidence rates showed a fivefold decrease during the 51-year study; for women, the rates were relatively low and constant during the same period. Analysis for age-specific rates revealed that the older the age group, the higher the incidence rates for both sexes. Squamous cell carcinoma accounted for at least 87.4% of all lip cancers (96.2% if nonspecified epithelial neoplasms are assumed to be squamous cell carcinoma). The vermilion border of lower lip was the most common site. Moderately differentiated tumors were most common (48.5%), closely followed by well-differentiated tumors (44.2%). Analysis by county showed that the crude incidence rates for males in New London and Windham counties exceeded the average Connecticut statewide rates. The authors concluded that the epidemiology of Connecticut lip cancer differs significantly from that of intraoral squamous cell carcinoma in the same population studied within the same period of time. Epidemiologic studies involving "oral cancer" should direct attention to anatomic subsite to consider differences in disease trends according to specific location.

Adenocarcinoma↗
PubMed1992

Lichenoid lesions of oral mucosa. Diagnostic criteria and their importance in the alleged relationship to oral cancer.

Lichen planus and other lichenoid disorders of oral mucosa occur commonly, and yet they are poorly understood. Further, the question of the premalignant potential of oral lichen planus remains deeply mired in controversy. The object of this article is to delineate these problems, clarify the issues, and present evidence to support the position that true lichen planus of oral mucosa is not only less common than generally appreciated but also has no inherent predisposition to become malignant. Rationale and data from the literature are offered in support of this position.

Humans↗
PubMed1991

Dying of cancer: a patient's recollection of her illness and of her doctors.

A personal account of a patient's long ordeal with cancer of the tongue is presented. The explicit journal begins at the time that a lesion was first detected and ends approximately 4 1/2 years later, just 8 1/2 months before the patient's death from local disease. Important principles of clinical diagnosis and patient management, vividly underscored by this case, are reviewed and discussed.

Attitude to Health↗
PubMed1991

Changing trends in oral cancer in the United States, 1935 to 1985: a Connecticut study.

An extensive epidemiologic study was undertaken in an attempt to analyze patterns of oral cancer distribution and demography in Connecticut between 1935 and 1985. Sources of data for the investigation included both the Connecticut Tumor Registry (CTR) and the University of Connecticut Oral Pathology Biopsy Service. During the 51-year study period, 9,708 cases of primary oral cancer were reported to the CTR. Male age-adjusted incidence rates for overall oral cancer remained stable between 1935 and 1964 (14.5 to 14.8 per 100,000), with a gradual decline to 10.9 per 100,000 in the early 1980s. In contrast, age-adjusted rates for females advanced approximately threefold, from 1.4 per 100,000 in the 1930s to 4.1 per 100,000 in the early 1980s. There was a decrease in age-specific rates of oral cancer in males aged 70 and older; in contrast, age-specific incidence rates in females increased steadily over the same period. It was also found that female birth cohorts born in 1900 and later exhibited higher oral cancer incidence rates than those of previous cohorts. Between the 1960s and the present, male patients 30 to 39 years of age exhibited a nearly fourfold increase in oral cancer incidence; this was not observed among similarly aged females. Connecticut counties with highest oral cancer incidence rates in both sexes were the more densely populated Hartford and New Haven counties. In general, the picture of oral cancer, as revealed through analysis of cases accessioned by the University biopsy service between 1975 and 1986, exhibited similar trends to those disclosed by analysis of CTR data.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Dysplasia of oral mucosa: a unified approach to proper evaluation.

The histologic features of fully developed epithelial dysplasia of oral mucosa are readily recognized. Early dysplastic change, however, may present a diagnostic challenge since its frequently subtle features may, on occasion, cause it to be overlooked and thus undercalled. The problem of underdiagnosis is further compounded in many instances by the markedly diverse manner in which altered surface epithelium is described, interpreted, and reported. In an effort to establish a more unified manner of histopathologic interpretation of oral epithelial tissue, we propose clear definitions for the terms atypia, dyskeratosis, dysplasia, and lichenoid, underscoring topographic as well as morphological criteria for each. Significant alterations in rete ridge architecture and maturation disturbance are identified as subtle yet important markers of dysplastic potential, even in the absence of atypical cytomorphology. Correlation of clinical and historical data with microscopic findings is also stressed as an important adjunct to the arousal of diagnostic suspicion. Interpretative rationale and an illustrative case are offered in support of points raised.

Humans↗
PubMed1990

Intraoral squamous cell carcinoma. Epidemiologic patterns in Connecticut from 1935 to 1985.

There were 6181 cases of invasive intraoral squamous cell carcinoma accessioned by the Connecticut State Tumor Registry from 1935 to 1985. Cases were analyzed for age, sex, lesion site, and histologic differentiation. Crude, age-specific, and age-adjusted incidence rates plus birth cohort analyses were also calculated. It was found that incidence rates for both men and women increased over the 51-year period of study. For men, age-adjusted incidence rates (1970 United States standard) increased from 4.9/100,000 in 1935 to 1939 to 8.5/100,000 in 1980 to 1985; for women, rates increased from 0.5/100,000 to 3.3/100,000 for the same period. The male-to-female ratio for intraoral squamous cell carcinoma declined dramatically from 9.8 to 2.6 during the 51-year study period primarily because of the steep rate of increased incidence in women relative to that seen in men. The peak age of intraoral squamous cell carcinoma was the seventh decade. Age-specific analysis showed that the older the age group, the higher the incidence for both sexes. During recent years, there was evidence of slightly increased incidence in men younger than 40. The tongue was the most common site for intraoral squamous cell carcinoma, followed closely by the floor of the mouth. Moderately differentiated tumors were most common (54.3% of the total), followed by both well-differentiated cases (29.1%) and those that were poorly differentiated (16.6%).

Adult↗
PubMed1990

Epidemiology of oral cancer in Connecticut, 1935 to 1985.

All cases of oral cancer (N = 9708) recorded by the Connecticut Tumor Registry from 1935 to 1985 were analyzed for time-trend patterns within 10-year age-groups. Crude, age-specific, age-adjusted incidence rates and birth cohort analyses were calculated. The average annual age-adjusted incidence rate was 12.9/100,000 for men and 2.9/100,000 for women (1970 US standard million population). The male age-adjusted incidence rate decreased 33% from the late 1930s to the early 1980s. The female age-adjusted incidence rate exhibited a threefold steady increase over this same time period. The male/female ratio for oral cancer incidence declined dramatically from 10.4 to 2.7 for the age-adjusted rate, nearly a fourfold decrease during the 51- year period. Birth cohort analyses for women indicated a marked increase in oral cancer incidence for the birth cohort of 1900, which was sustained in the birth cohorts that followed. Birth cohort analyses for men revealed a decline in oral cancer incidence for birth cohorts born after 1910. The highest incidence rates were found in the urban counties and the lowest in the rural areas.

Adult↗