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Biomedical subjects

J B Epstein

Publications and source records attributed to J B Epstein.

At least 19 recordsLinked to original sources
PubMed1998

Topical bleomycin for the treatment of dysplastic oral leukoplakia.

BACKGROUND: Because malignant transformation of dysplastic oral leukoplakia has been reported in up to 43% of cases, these lesions must be managed. METHODS: This study evaluated the use of topical 1% bleomycin in dimethylsulfoxide for the treatment of dysplastic oral lesions. Bleomycin was applied once daily for 14 consecutive days to lesions of the oral mucosa in 19 patients. Immediate posttreatment biopsies and the clinical response were evaluated and clinical follow-up was conducted for as long as possible. RESULTS: The mean age of the patients at diagnosis was 59.4 years and 74% were tobacco users. Seventy-five percent of patients had resolution of dysplasia at follow-up biopsy, with a mean improvement of two histologic grades of dysplasia after topical chemotherapy. Ninety-four percent of the patients attained at least partial responses. After a mean follow-up period of 3.4 years, 31.6% of patients had no clinically visible lesions and 47.4% of patients had clinically benign lesions of homogeneous leukoplakia or minimal visible leukoplakia. In 2 patients (11%) malignant transformation occurred a mean of 1.75 years after bleomycin treatment. CONCLUSIONS: Topical bleomycin may prevent the potential progression of leukoplakia through dysplasia to carcinoma. Close follow-up of all patients with dysplasia is required.

Administration, Topical↗
PubMed1998

Effect of impact and injury characteristics on post-motor vehicle accident temporomandibular disorders.

OBJECTIVES: The objective of this study was to assess the potential effects of motor vehicle accident impact and injury characteristics on post-motor vehicle accident temporomandibular disorders in terms of presenting signs and symptoms, diagnoses, treatment regimens, and outcomes. STUDY DESIGN: A retrospective chart review of 50 patients with post-motor vehicle accident temporomandibular disorders from a private oral medicine practice was undertaken. Various demographic data and data related to temporomandibular disorders and motor vehicle accident impact and injury characteristics were collected. Chi-square and Fisher exact tests and multiple regression analyses were performed. RESULTS: Patients involved in front-end collisions or motor vehicle accidents resulting in severe vehicle damage reported more direct orofacial injury. However, those in rear-end collisions or accidents resulting in minimal vehicle damage required more treatment. Direct head or orofacial injury was therefore not a prognostic indicator. From multiple regression analyses, indicators of a poorer prognosis were minimal vehicle damage, lack of headrest use, driver position, and settlement of insurance claim. CONCLUSIONS: In this patients group several prognostic indicators for patients with post-motor vehicle accident temporomandibular disorders were identified; these indicators may influence the management approach for this patient population.

Accidents, Traffic↗
PubMed1998

The relationships among fluoride, cariogenic oral flora, and salivary flow rate during radiation therapy.

Changes in the quantity of Streptococcus mutans, Lactobacillus species, and yeast Candida species were assessed in a cancer population undergoing head and neck radiation. The purpose of this study was to evaluate the effectiveness of a custom vinyl tray-applied fluoride gel to control cariogenic bacteria in a group experiencing hyposalivation because of radiation treatment. Twenty-two subjects participated in the study and served as their own controls. Whole resting and whole stimulated saliva were collected at weekly appointments beginning 1 week before and concluding 4 weeks after radiation therapy. Colony-forming units per mL of Streptococcus mutans and Lactobacillus species and semiquantitative counts of Candida species (0 = none; 1 = light; 2 = moderate; 3 = heavy) were determined from collected saliva. All patients were provided with custom vinyl vacuform mouthguards to be used daily with neutral fluoride gel (1.1% sodium fluoride). Whole stimulated and resting saliva productions decreased by 36.67% and 47.9%, respectively, by the end of 1 week of radiation therapy, and they remained low. No significant changes in cariogenic oral flora were seen during and early after radiation therapy, despite xerostomia. However, colonization by Candida albicans increased during radiation therapy for oropharyngeal cancers. Findings from this study suggest that changes in cariogenic flora may be suppressed through the use of daily topical neutral sodium fluoride gels and that colonization by Candida albicans increase during radiation therapy.

Adult↗
PubMed1998

Infective endocarditis: dental implications and new guidelines for antibiotic prophylaxis. American Heart Association.

The American Heart Association (AHA) has developed new guidelines for antibiotic prophylaxis for patients at risk of infective endocarditis (IE). These guidelines are based on the on-going study of endocarditis cases and continued experience with antibiotic prophylaxis, and are an update of the 1990 recommendations. The major changes from the 1990 guidelines are: the recognition that most cases of IE are not attributable to an invasive procedure; that cardiac conditions may present different levels of risk categories; increased delineation of when prophylaxis should be given in cases of mitral valve prolapse; a change to a single dose of antibiotic and changes in the antibiotics recommended for prophylaxis. The revised AHA guidelines parallel those in Europe and the United Kingdom. It is essential that all dental professionals be fully aware of the modifications to these guidelines because of their importance in patient care and their medico-legal implications.

Antibiotic Prophylaxis↗
PubMed1998

Head and neck and intra-oral soft tissue sarcomas.

Intra-oral soft tissue sarcoma is a rare disease. We reviewed a tumour registry over a 45 year period, between January 1951 and January 1997, and identified a total of 11,250 head and neck cancers in British Columbia. Of the head and neck cancers, there were 139 cases (1.24%) of sarcoma; and of these, there were only 16 cases (0.14%) of intra-oral soft tissue sarcoma. The initial presentation of intra-oral soft tissue sarcoma is most often as an asymptomatic mass and discomfort is reported by less than one half of the patients. The commonest lesion identified was rhabdomyosarcoma (RMS). In this review, we identified 2 unique cases, 1 case of intra-oral hemangiopericytoma and 1 case of oral carcinosarcoma. The prognosis remains poor. Treatment includes wide surgical excision which may be supplemented with radiotherapy and chemotherapy.

Adolescent↗
PubMed1997

The use of exfoliative cell samples to map clonal genetic alterations in the oral epithelium of high-risk patients.

Although it is widely accepted that clonal genetic alterations are an essential component of tumor progression, little is known of the distribution of such changes in high-risk lesions or how such clones are altered over time. We explored the feasibility of using exfoliative cells collected by scraping the mucosal surface to detect allelic loss in oral lesions of 22 patients (14 squamous cell carcinomas, 2 carcinomas in situ, and 6 dysplasias). The data show that the patterns of allelic loss observed in these samples closely represent those observed in biopsies of the same region. Furthermore, early indications are that this approach can be used to detect recurrent outgrowth of clones of altered cells in patients after therapy.

Adult↗
PubMed1997

Temporomandibular disorders, headaches, and neck pain after motor vehicle accidents: a pilot investigation of persistence and litigation effects.

STATEMENT OF PROBLEM: There is a lack of long-term follow-up studies that involve post-motor vehicle accident temporomandibular disorders and compensation. PURPOSE OF STUDY: The purposes of this retrospective pilot study were (1) to assess patients who had previously been treated for temporomandibular disorders after motor vehicle accidents to determine the nature of their symptoms in terms of jaw, head, and neck pain and jaw dysfunction and (2) to determine whether there was a difference in the pain and dysfunction between those who had settled and those who had not settled their insurance claims. MATERIAL AND METHODS: Thirty previously treated patients with temporomandibular disorders after motor vehicle accidents were questioned by telephone regarding litigation status and current jaw, head, and neck pain and jaw dysfunction symptoms. They did not differ substantially from a smaller group who were not able to be interviewed. Descriptive statistics were calculated and statistical tests were performed. A total of 22 patients had their claims settled. RESULTS: Approximately three fourths had persistent complaints of jaw pain, jaw dysfunction, and headache, and more than 80% reported persistent neck pain. No apparent differences were found between those who had and had not settled their insurance claims. CONCLUSION: Jaw, head and neck pain, and jaw dysfunction continued to be problems for the majority of this patient population, regardless of litigation status in this retrospective study.

Accidents, Traffic↗
PubMed1997

The utility of toluidine blue application as a diagnostic aid in patients previously treated for upper oropharyngeal carcinoma.

OBJECTIVES: This study evaluated the utility (usefulness) of toluidine blue application as an aid to the recognition and diagnosis of clinically evident lesions in a series of patients previously treated for oral cancer and monitored in a cancer center. In addition to increased risk of recurrence of cancer or new second primary lesions, patients who have had previous treatment for oropharyngeal cancer may be more difficult to assess because of tissue changes that occur as a result of previous radiation therapy. STUDY DESIGN: Patients with a history of oral malignancy were assessed by clinical examination followed by application of toluidine blue. Biopsy sites were determined on the basis of unaided visual examination and by the findings on toluidine blue application. Biopsy specimens were reviewed by a pathologist blinded to the clinical findings. RESULTS: Unaided clinical examination identified 78% of carcinoma in situ or invasive malignant lesions compared with toluidine blue application, which identified all (100%) carcinoma in situ or invasive malignant lesions (p = 0.02) and produced no false-negative findings. No differences were found between clinical examination and toluidine application in the detection of dysplastic lesions. CONCLUSION: Toluidine blue retention was seen in all cases of carcinoma in situ and invasive carcinoma, and no false-negative findings were seen with toluidine blue. When used by a trained and experienced clinician in a cancer center, toluidine blue was a valuable visual aid to clinical examination of oral mucosal lesions.

Carcinoma, Squamous Cell↗
PubMed1997

Reactivation of oral herpes simplex virus: implications for clinical management of herpes simplex virus recurrence during radiotherapy.

Herpes viruses are characterized by their ability to establish and maintain latent infections that can be reactivated. Several stimuli can trigger the reactivation of herpes viruses, which are perhaps best recognized in the recurrent blisters and ulcers associated with herpes simplex virus. We present two clinical cases of reactivation of herpes simplex virus during radiation therapy for management of cancers of the head and neck. Although the role of ionizing radiation in the reactivation of herpes simplex virus has not been established, we review the viral and host events associated with the establishment of orofacial herpes simplex virus infection, latency, and reactivation of the virus. We discuss current models of viral reactivation and suggest directions for further clinical research into the reactivation of orolabial herpes simplex virus during radiotherapy.

Acyclovir↗
PubMed1997

Assessment of epidermal growth factor in oral secretions of patients receiving radiation therapy for cancer.

Biological response modifiers have been studied in animal models of oral mucositis. We assessed the presence of epidermal growth factor (EGF) in patients during radiation therapy for head and neck cancer. The findings of this preliminary study showed that it is possible to measure the presence of EGF in oral secretions during radiation therapy. EGF was shown to decrease during the course of radiation therapy, and a trend was seen with decreasing EGF and increasing oral ulceration (P = 0.10) and increasing total mucositis score (P = 0.09).

Adult↗
PubMed1997

Management of oral Kaposi's sarcoma and a proposal for clinical staging.

Kaposi's sarcoma (KS) is the most common neoplastic disease in patients with disease due to human immunodeficiency virus (HIV), and oral KS (OKS) is the commonest oral neoplasia. OKS has been managed by local excision, intralesional chemotherapy regional radiotherapy, and systemic chemotherapy. Comparison between studies is difficult as the severity of oral involvement is not well defined in most studies. This paper reviews the approach to the management of OKS and also presents a proposal for the clinical staging of OKS. Clinical staging of OKS will facilitate comparisons of outcomes of treatment of OKS and improve our understanding of the natural history of the neoplasia, which has varied presentation and rates of progression.

Acquired Immunodeficiency Syndrome↗
PubMed1997

An atlas of HIV-associated oral lesions: a new classification and diagnostic criteria.

Many oral lesions are strongly associated with HIV infection. Along with the HIV-infected individual's T helper cell count (CD4 + cell count), they indicate the severity of immune suppression. It is important for dental professionals to recognize these lesions early, as it alerts patients to their HIV status, and allows them to receive appropriate and prompt treatment for their HIV infection and related oral conditions. An atlas of the oral lesions commonly associated with HIV infection is presented. To update dental providers and assist them in the recognition and diagnosis of these conditions, the recent criteria for diagnosis suggested by the European Economic Community (EEC) Clearinghouse on Oral Problems Related to HIV Infection and the World Health Organization (WHO) Collaborating Centre on Oral Manifestations of the Immunodeficiency virus are also presented.

AIDS-Related Opportunistic Infections↗
PubMed1997

Latex allergies.

Explore the source record for details and available documents.

Anesthetics, Local↗
PubMed1997

A comparison of TMD patients with or without prior motor vehicle accident involvement: initial signs, symptoms, and diagnostic characteristics.

The role of trauma in the etiology of temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare presenting signs, symptoms, and diagnoses in patients who had motor vehicle accident trauma-related TMD to patients who had nontrauma-related TMD. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed. Information concerning presenting pain, temporomandibular joint (TMJ) and related symptoms, examination findings, and diagnoses was recorded. Posttraumatic TMD patients reported higher facial (P = .006) and headache (P = .0001) pain ratings, neck symptom frequency (P < .01), ear-related symptoms (P = .02), sleep disturbance (P < .001), and occupational and avocational disability frequencies (P < .0001). They had greater masticatory muscle (P < .001), neck muscle (P < .001), and TMJ tenderness (P = .01) scores and myofascial pain (P = .006) and arthralgia/capsulitis (P = .008) diagnoses. The nontrauma group had more subjective (P = .02) and objective (P = .05) TMJ crepitus and higher self-reports of parafunctional jaw habits (P = .05). Trauma may be an important etiologic factor for some TMD patients.

Accidents, Traffic↗
PubMed1997

A comparison of TMD patients with or without prior motor vehicle accident involvement: treatment and outcomes.

The influence of previous trauma in the management of patients with temporomandibular disorders (TMD) is controversial. The objectives of this study were to compare treatment regimens and outcomes in motor vehicle accident trauma-related versus nontrauma-related TMD patients. Files of 50 trauma and 50 matched nontrauma TMD patients were reviewed. Information concerning treatment received, progress of symptoms with treatment, and findings from the final examination were recorded. As a whole group, posttraumatic TMD patients tended to receive more types of treatment (P < .0001), have more medications prescribed (including analgesics, P < .001; nonsteroidal anti-inflammatory drugs, P = .001; muscle relaxants, P = .001; and tricyclic antidepressants, P < .001), have more oral medicine clinic visits (P = .07) over a longer period of time (P = .06), and have a poorer treatment outcome (P < .001) as compared to the nontrauma group. When the patients were separated into TMD diagnostic classification subsets, only some of these differences between trauma and nontrauma patients were seen, but the subset group sizes were small and only a few of the groups could be compared. There did not seem to be a significant effect from settling insurance claims prior to the last clinic visit. Trauma may be an important prognostic factor in the management of some TMD patients.

Accidents, Traffic↗
PubMed1997

Topical clonidine for orofacial pain: a pilot study.

An open-label trial of clonidine, an alpha 2-adrenergic agonist, was prescribed for patients with a clinical diagnosis of oral neuropathic pain or neuralgia involving the oral cavity. Clonidine (0.2 mg/g) was prepared in a cream base and applied four times daily to the site of pain. Seventeen patients were assessed: 10 were diagnosed with neuropathic pain, and 7 with neuralgia. Two of the 17 patients had complaints overlapping both neuropathic and neuralgic pain. In the patients with neuropathic pain, an overall mean reduction in severity of burning of 36% (on a 10-point visual analogue scale) was reported. Half of these patients reported clinical improvement; however, no patients reported complete resolution of symptoms. Of the patients with characteristics of neuralgia, 57% improved; and in those who reported improvement, a mean reduction of approximately 54% was reported. In the 4 patients with neuralgia who responded, a 94% reduction in pain was reported, with complete resolution of pain in 2 patients. This open-label clinical trial suggests that topical clonidine may be effective in the management of some patients with oral neuralgia-like pain, but may have a more limited effect in those patients with oral neuropathic pain. Besides type of pain, no other variables predicted which of the patients would achieve pain reduction with topical clonidine. Although confirmation of clinical efficacy requires double-blind clinical studies, this initial trial suggests that further study is warranted.

Administration, Topical↗
PubMed1996

A comparison of computed tomography and panoramic radiography in assessing malignancy of the maxillary antrum.

Panoramic and computed tomographic images of 20 patients with antral malignancy were viewed separately and compared to determine the extent of bony destruction of the sinus walls seen in each film type. This study showed that panoramic radiographs can demonstrate antral malignancy at the time of diagnosis in 90% of cases. Panoramic radiographs possess the potential for identifying the need for further diagnostic procedures in evaluating the maxillary antrum. Health care workers should be aware of the value of panoramic radiographs in examining this region.

Aged↗