Biomedical subjects

E H van der Meij

Publications and source records attributed to E H van der Meij.

At least 19 recordsLinked to original sources

PubMed2006

The possible premalignant character of oral lichen planus and oral lichenoid lesions: a prospective five-year follow-up study of 192 patients.

Recently, we reported the preliminary results of a prospective study on the possible premalignant character of oral lichen planus (OLP) and oral lichenoid lesions (OLL). Based on these data it was concluded that there was some but no convincing support for the hypothesis that patients with OLL have an increased risk of development of oral cancer, but not so in patients with OLP. In the present treatise the results of prolonged follow-up of this cohort of patients have been described. A study group of 192 patients, 67 patients diagnosed with OLP and 125 patients with OLL, according to revised World Health Organization diagnostic criteria, was followed for periods ranging from 7.6 to 96.9 months (mean, 55.9 months). The expected number of patients with oral cancer in the group of patients with OLP and in the group of patients with OLL was estimated by comparing the number of patients, their ages, sex, and the length of follow-up to annual incidence rates of oral cancer for the general population in The Netherlands. The binomial test was used to determine whether the observed number of cases of cancer in the OLP group and the OLL group exceeded the expected numbers. Four out of 192 patients, two men and two women, developed a squamous cell carcinoma of the oral mucosa during follow-up. All malignant transformations occurred in the OLL group. The malignant transformation of the OLL group, based on a mean follow-up of 53.8 months, was calculated at 0.71% per year. A comparison of the expected against actual figures for the development of carcinomas revealed no increase in patients with OLP and a 142-fold increase in patients with OLL, the latter being statistically significant, with a p-value of 0.044. The present data give support to the hypothesis that patients with OLL have an increased risk of development of oral cancer. There seems to be no increased risk in patients with OLP. In view of our results we advise to monitor only the subgroup of OLL patients twice a year for early detection of possible malignant transformation.

Adolescent↗

PubMed2006

Fibrodysplasia ossificans progressiva. An unusual cause of restricted mandibular movement.

A 9-year-old girl is presented who was initially misdiagnosed and finally diagnosed with fibrodysplasia ossificans progressiva only after presentation with progressive limitation of her mouth opening. The clinical, histopathological, and molecular biological aspects of this uncommon disorder will be discussed. Furthermore, dental and surgical guidelines will be described.

Child↗

PubMed2005

The combined use of two endosteal implants and iliac crest onlay grafts in the severely atrophic mandible by a modified surgical approach.

Seventeen patients, who received an iliac crest onlay bone graft augmentation to their severely atrophic mandible with simultaneous placement of two endosteal implants by a modified surgical approach, were studied retrospectively. Follow-up ranged from 0.5 to 7.9 years after implant loading with an average follow-up of 4.3 years. Frequency of wound dehiscences and other postoperative complications, the extend of resorption of the initial graft, and the implant success rate were assessed. Two patients, who had a previous history of preprosthetic and implantological procedures at the surgical site, developed a serious wound dehiscence with loss of two implants in one patient and need for antibiotic treatment and sequestrectomy in the other patient. One implant was lost in two other patients with a negative surgical history, resulting in an implant success rate of 88.2%. The average resorption at the last follow up visit was 15% of the initial graft. Damage of the mental nerve was seen in 14.7% of nerves. Our preliminary data indicate that the procedure presented provides a reliable and predictable method for the construction of an implant-bearing overdenture in patients with a severely atrophic mandible. This one-step procedure can not be recommended for patients with a history of surgery in the anterior mandible.

Adult↗

PubMed2003

Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications.

INTRODUCTION: Confirmation of a clinical diagnosis of oral lichen planus (OLP) by means of histopathologic study of a biopsy specimen is generally advised. However, hardly any data exist about the correlation between clinical and histopathologic diagnoses of OLP. The aim of the present investigation was to study the correlation between the clinical and histopathologic assessment of OLP, and to propose diagnostic refinements, if appropriate. METHODS: Clinical and histopathologic data of two previously published studies were used for this purpose. The number of clinical cases in which all clinicians agreed as well as the number of microscopic slides on which all reviewing pathologists agreed were calculated and compared with each other in order to assess the clinicopathologic correlation. RESULTS: In 42% of the cases in which all clinicians agreed about the clinical diagnosis being diagnostic of OLP, there appeared to be no consensus on the histopathologic diagnosis. Conversely, in 50% of the cases in which all pathologists agreed about the histopathologic diagnosis being diagnostic of OLP there was a lack of consensus on the clinical diagnosis. CONCLUSION: Based on the findings of the present study, there appears to be a lack of clinicopathologic correlation in the diagnostic assessment of OLP. We therefore propose a set of revised diagnostic criteria of OLP and oral lichenoid lesions, based on the WHO definition of OLP, including clinical as well as histopathologic aspects.

Biopsy↗

PubMed2002

Cost-effectiveness of screening for the possible development of cancer in patients with oral lichen planus.

INTRODUCTION: Several authors have expressed the view that patients with oral lichen planus (OLP) are at increased risk of developing oral cancer. Since OLP cannot be effectively treated, regular screening for the possible development of oral cancer might be considered. OBJECTIVES: (i) To calculate costs and effectiveness of screening for oral cancer in OLP patients with a decision model; (ii) to compare the cost-effectiveness of different screening scenarios; and (iii) to perform a sensitivity analysis of several variables used in this model. METHODS: Costs and effectiveness of a population of 100,000 OLP patients, being either screened or not screened for oral cancer, were calculated for the period of 1 year. Health gain was expressed as quality adjusted live years (QALY's) and equivalent lives saved (ELS). Cost-effectiveness was expressed as extra costs (costs of screening minus costs of no screening) per ELS. Then, the outcome was compared with the cost-effectiveness of a different screening scenario. Finally, the effect of varying the variables: (i) costs of cancer treatment; (ii) annual malignant transformation rate (MTR); (iii) sensitivity and specificity of an oral examination; and (iv) proportion of cancers found in stage I on extra costs per ELS were assessed in a sensitivity analysis. RESULTS: The health gain from screening was 592 QALY's or the equivalent of 23.68 lives saved, costing 1,265,229 dollars, meaning that one ELS costed 53,430 dollars. Increase of cancer-treatment costs will significantly decrease the costs per ELS. When the MTR is lower than 0.4% per year, extra costs per ELS will increase exponentially. The effect of sensitivity and specificity of an oral examination in detecting oral cancer on cost-effectiveness seems to be substantial. When the proportion of cancers found in stage I can be increased from 40% (without screening) up to at least 60% after screening, extra costs per ELS will decrease exponentially. CONCLUSIONS: Screening for oral cancer in OLP patients, based on the presently used model, seems attractive. However, varying the several variables in the decision model has a significant impact on the final costs and effectiveness. Only, when additional information about these variables will become available, a more precise and realistic calculation can be performed.

Cell Transformation, Neoplastic↗

PubMed2002

Interobserver and intraobserver variability in the clinical assessment of oral lichen planus.

BACKGROUND: In 1978, a clinical definition of OLP was formulated by the WHO. To date, the validation results of this clinical definition have not been published. The aim of this study was to evaluate interobserver and intraobserver variability in the clinical assessment of oral lichen planus (OLP). METHODS: Four clinicians examined a set of 159 clinical pictures of a white lesion in a group of 60 patients. Each reviewing examiner was asked to apply the WHO definition of OLP from 1978, and to categorise each case as either: (i) diagnostic of OLP, (ii) other definable lesion, or (iii) leukoplakia. After three months, each of the four reviewing clinicians was given the clinical pictures of 45 randomly retrieved cases from the original 60. Interobserver and intraobserver variability were assessed by calculation of unweighted kappa statistics. RESULTS: Interobserver agreement varied from 0.43 (moderate) to 0.77 (substantial), while the intraobserver agreement varied from 0.62 (substantial) to 0.92 (good). CONCLUSIONS: Although the clinical WHO definition of OLP seems to be more reproducible than the histopathological one, there is still a significant amount of subjectivity in using this definition. A set of clinical and histopathological diagnostic criteria with good interobserver and intraobserver agreements (kappa values > 0.8) is very important in enabling reproducible and reliable studies on OLP to be performed.

Diagnosis, Differential↗

PubMed2001

Tobacco usage in relation to the anatomical site of oral leukoplakia.

OBJECTIVE: Tobacco usage is the most important known aetiological factor in the development of oral leukoplakia. The purpose of this study was to investigate the possible relation of tobacco usage to the anatomical site of the leukoplakia. SUBJECTS AND METHODS: Clinical data regarding tobacco usage and localisation of leukoplakia obtained from 166 patients with oral leukoplakia. RESULTS: Leukoplakias in the floor of mouth appeared to be statistically significantly more often present in smokers than in non-smokers, compared to all other oral sites (P < 0.001; OR = 8.47 and 18.13 for men and women, respectively). On the contrary, leukoplakias on the borders of the tongue were statistically significantly more common among non-smokers, than smokers, compared to all other oral sites (P < 0.001; OR = 0.22 and 0.12 for men and women, respectively). CONCLUSION: The present study suggests that the influence of tobacco on the development of leukoplakia varies by anatomical site.

Adult↗

PubMed2001

Granular cells in oral lichen planus.

OBJECTIVE AND DESIGN: Three cases of granular cells associated with oral lichen planus (OLP) have been reported to date, which prompted us to look for the presence of granular cells in a consecutive series of 250 cases of OLP in the period 1996-1998. RESULTS: Only one case with granular cell changes was encountered in that series. H&E stained slides as well as direct immunofluorescence examination showed characteristics compatible with OLP. Part of the subepithelial connective tissue was replaced by a granular cell proliferation; S-100 protein was diffusely expressed in all granular cells, whereas no expression of smooth muscle actin was observed. CONCLUSION: Based on these findings it seems unlikely that the granular cells in the present case represent a so-called 'oral ceroid granuloma'. The presence of granular cells might rather have been a reactive phenomenon triggered by the inflammatory infiltrate or a granular cell tumour (GCT). Whether the simultaneous presence of a GCT and OLP in this particular case was based on a causal relationship or on coincidence still remains unknown.

Actins↗

PubMed2000

A modified classification and staging system for oral leukoplakia.

A proposal for a modified classification and staging system for oral leukoplakia (OLEP) has been presented in which the size of the leukoplakia and the presence or absence of epithelial dysplasia are taken into account. Altogether four stages are recognised. The presently proposed system should facilitate uniform reporting of treatment or management results of OLEPs in which a biopsy has become available. The system can easily be adjusted by replacing the histopathological criteria of epithelial dysplasia by a clinical subdivision in homogeneous and non-homogeneous leukoplakia for cases in which no biopsy is available.

Humans↗

PubMed2000

Hepatitis C virus infection and oral lichen planus: a report from The Netherlands.

The reported frequency of anti-hepatitis C virus (HCV) antibodies in groups of cutaneous lichen planus (CLP) and/or oral lichen planus (OLP) patients varies from about 4% to 65%. Most of these studies have been performed in countries with a high overall prevalence of HCV infection in the general population, such as the southern European countries and Japan. Limited data are available from areas with a low prevalence of HCV infection. Therefore, we investigated the prevalence of HCV infection in a series of 55 patients with OLP in the Netherlands, which apparently has a low prevalence of HCV infection. None of the 55 patients revealed serological evidence of antibodies to HCV. The present data suggest that HCV infection in OLP patients in the Netherlands is probably not very common. A larger study group with a sex- and age-matched control group is required to advise against routine serological examination for HCV infection in Dutch OLP patients.

Adult↗

PubMed1999

A review of the recent literature regarding malignant transformation of oral lichen planus.

On the basis of a literature review of the period 1950-1976, Krutchkoff et al questioned the possible premalignant nature of oral lichen planus. Their criticism was largely based on insufficiencies of data in support of the initial diagnoses of the condition. In this article, a review of the literature from the period 1977-1999 has been described; the criteria used were those of Krutchkoff et al. Thirty-three (34%) of 98 reported cases were accepted as having sufficiently documented evidence of malignant transformation of oral lichen planus. Although this percentage is somewhat higher than the percentage reported by Krutchkoff et al, there apparently remains a need for uniformly accepted criteria to establish a firm diagnosis of oral lichen planus. Only when such criteria are available will it be possible to conduct long-term prospective studies on the suggested possible premalignant nature of oral lichen planus.

Cell Transformation, Neoplastic↗

PubMed1999

Interobserver and intraobserver variability in the histologic assessment of oral lichen planus.

The purpose of this study was to evaluate interobserver and intraobserver variability in the histopathological assessment of oral lichen planus (OLP) since this may influence the outcome of studies on epidemiology, treatment and prognosis. Five oral pathologists examined 60 microscopic slides, not being informed about the original histopathological assessment. Forty-five of the cases had been originally signed out as OLP; the remaining 15 cases represented a mixture of other oral white lesions. No clinical information or patient data were provided with the cases. Each reviewing pathologist was asked to apply the WHO definition of OLP and to categorize each case as either: 1) evident OLP, 2) compatible with OLP, or 3) no histological support for OLP. After 2 months, each of the five reviewing pathologists were given 45 slides that were randomly retrieved from the original 60. Interobserver and intraobserver variability were assessed by calculation of unweighted kappa statistics. Interobserver agreement varied from 0.20 (poor) to 0.51 (moderate), while the intraobserver agreement varied from 0.50 (moderate) to 0.67 (substantial). Histopathological assessment of OLP, based on the available WHO definition, is a rather subjective and insufficiently reproducible process. Stricter diagnostic criteria are required in order to obtain a more reproducible diagnosis of OLP.

Diagnostic Errors↗

PubMed1998

Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands.

A follow-up study of a hospital-based population of 166 patients with oral leukoplakia revealed a 2.9% annual malignant transformation rate. The median follow-up period was 29 months. Parameters associated with an increased risk of malignant transformation were female gender (P < 0.025), absence of smoking habits in women (P < 0.05), and a non-homogeneous clinical aspect (P = 0.01). For uniform reporting, a recently proposed classification and staging system has been used. Leukoplakias in stage IV, consisting of lesions with moderate or severe epithelial dysplasia, were associated with an increased risk of malignant transformation (P < 0.01). There were no oral subsites associated with an increased risk. Patients who had any form of intervention did not have a statistically significantly lower chance for malignant transformation than patients who were kept under surveillance without intervention.

Adult↗

PubMed1997

Oral leukoplakia: a clinicopathological review.

Leukoplakia is the most common premalignant or potentially malignant lesion of the oral mucosa. It seems preferable to use the term leukoplakia as a clinical term only. When a biopsy is taken, the term leukoplakia should be replaced by the diagnosis obtained histologically. The annual percentage of malignant transformation varies in different parts of the world, probably as a result of differences in tobacco and dietary habits. Although epithelial dysplasia is an important predictive factor of malignant transformation, it should be realized that not all dysplastic lesions will become malignant. On the other hand non-dysplastic lesions may become malignant as well. In some parts of the world the tongue and the floor of the mouth can be considered to be high-risk sites with regard to malignant transformation of leukoplakia, while this does not have to be the case in other parts of the world. The cessation of tobacco habits, being the most common known aetiological factor of oral leukoplakia, has been shown to be an effective measure with regard to the incidence of leukoplakia and, thereby, the incidence of oral cancer as well. Screening for oral precancer may be indicated in individuals at risk.

Disease Progression↗

PubMed1996

Sweet's syndrome in a patient with oral cancer associated with radiotherapy.

Approximately 10-20% of the reported patients with acute febrile neutrophilic dermatosis (Sweet's syndrome) have an associated neoplasm. Oral findings of Sweet's syndrome are rarely reported, and no cases in patients with oral cancer have been reported to date. This report describes the clinico- and histopathological findings of Sweet's syndrome in a patient with oral cancer, treated with radiotherapy. After 10 fractions of external beam radiotherapy, treatment was interrupted because of severe oral mucositis which extended beyond the radiation fields. Two days later the patient developed multiple tender skin lesions and the diagnosis Sweet's syndrome was made. Skin and oral lesions resolved without additional treatment and did not recur upon resuming radiotherapy. As suggested in previous case reports, tumour antigens might play a role in the development of Sweet's syndrome. In this case, irradiation therapy may also have been a trigger for this syndrome.

Carcinoma, Squamous Cell↗

PubMed1996

Prevalence study of oral white lesions with special reference to a new definition of oral leucoplakia.

In this survey, the experiences with and implications of a revised definition of oral leucoplakia are described. One of the new aspects of the revised definition is the distinction between a provisional, clinical diagnosis and a definitive one for which histopathological examination is required. A prevalence study of white lesions of the oral mucosa among a selected population of 1000 consecutive patients from the Netherlands showed a prevalence of a provisional and definitive diagnosis of oral leucoplakia of 0.6 and 0.2%, respectively. For uniform reporting, a recently proposed classification and staging system has been used to stage leucoplakias with a definitive diagnosis. The use of the revised definition of oral leucoplakia, as well as the classification and staging system, seem very suitable for epidemiological studies.

Adolescent↗

PubMed1996

Effects of compliance with fluoride gel application on caries and caries risk in patients after radiation therapy for head and neck cancer.

The use of fluoride gel applied in a custom tray once daily has become standard for patients who have xerostomia after undergoing radiation therapy. Compliance may be poor as a result of the inconvenient method of application and because many patients with head and neck cancer have poor health behaviors. Our aim was to investigate the effect of compliance with fluoride gel application on caries and caries risk. Patients were prescribed neutral sodium fluoride gel (5000 ppm) before undergoing radiotherapy Fifty-two patients were willing to visit the dental clinic for dental examination, measurement of saliva, and quantitative culture of Streptococcus mutans and lactobacillus species. Before radiotherapy was performed, decayed, missing, and filled surfaces data were recorded for all patients in the study. Of these patients, 27 used fluoride gel once daily, as directed. Radiation dose, number of fractions, and duration of radiation had a significant inverse effect on postradiotherapy whole resting saliva (p = 0.04, p = 0.01, and p = 0.01) and on whole stimulated saliva (p = 0.02, p < 0.01, and p < 0.01). Patients with a subjective feeling of dry mouth had significantly less saliva production at rest (p = 0.01) and on stimulation (p = 0.01). A trend toward reduction of S. mutans counts was seen in those patients who used their fluoride gel regularly (p = 0.057). High lactobacilli counts were found in the patients with high and low compliance with fluoride gel use. Differences in the mean caries incidence between those who reported compliance with daily fluoride application and those who did not comply were not found significant because of the large SD in the patient groups, although differences in the mean for these groups were seen. The lack of a statistically significant difference may be due to the multiple factors associated with caries. Therefore patient care must be individualized, and patients must be assessed at regular intervals to determine the caries risk and caries activity to provide guidance for maintenance of the dentition.

Adult↗

PubMed1995

[Oral care in irradiated patients].

A group of 152 dentate patients who had been irradiated in the head and neck area, has been studied for several aspects of oral care. One third of them (34%) was referred for the first oral screening after radiotherapy had started. In spite of intensive oral and dental care during and after radiotherapy, several complications occurred. More valid methods are necessary to evaluate oral care in patients who are subject to head and neck radiotherapy.

Dental Care for Chronically Ill↗