The correlation between prevalence of oral manifestations of HIV and CD4+ lymphocyte counts weakens with time.
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CD4 Lymphocyte Count↗
Biomedical subjects
Joel Epstein
Publications and source records attributed to Joel Epstein.
Antimicrobials, mucosal coating agents, anesthetics, analgesics, and nutritional supplements for alimentary tract mucositis.
This review focuses on the value of several groups of agents for the prevention and treatment of mucositis. The review refers to alimentary mucositis as a generalized term that includes oral mucositis and gastrointestinal mucositis. This paper is part of the systematic review made by the mucositis study group which operates in the Multinational Association of Supportive Care in Cancer (MASCC)/International Society of Oral Oncology (ISOO). Several new guidelines are suggested in this review as an update to the primary systematic review that was published by the same group in 2004.
Administration, Topical↗
Burning mouth syndrome.
Burning mouth syndrome (BMS) has been considered an enigmatic condition because the intensity of pain rarely corresponds to the clinical signs of the disease. As a result, BMS patients have variously been labelled as depressed, anxious or hypochondriacal and have often been underserviced by the medical and dental communities. Recently, there has been a resurgence of interest in this disorder with the discovery that the pain of BMS may be neuropathic in origin and originate both centrally and peripherally. This chapter discusses some of our recent understandings of the etiology and pathogenesis of BMS as well as the role of pharmacotherapeutic management in this disorder.
Burning Mouth Syndrome↗
Common benign oral soft tissue masses.
This article reviews some of the more common benign oral soft tissue masses with emphasis on their etiology, epidemiology, clinical presentation, histopathology, and treatment. These lesions include traumatic fibroma, mucocele, warts/papilloma, pyogenic granuloma, peripheral giant cell granuloma, generalized gingival hyperplasia, gingival fibromatosis, lateral periodontal cyst, lipoma, and denture-induced hyperplasia.
Adolescent↗
Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper.
BACKGROUND: This position paper addresses the prevention of bisphosphonate-associated osteonecrosis (BON) and the management of care of patients with cancer and/or osteoporosis who are receiving bisphosphonates and who have BON or are at risk of developing it. METHODS: The authors reviewed the literature available on this newly described oral complication. Information of interest included bisphosphonates, the medications associated with this oral complication; the patient population at risk of developing BON and the diseases being treated with this class of medications; the clinical presentation of the oral lesions; guidelines for managing the care of patients who develop BON; the prevention of this complication based on current knowledge; and recommendations for routine dental treatment of patients receiving bisphosphonates. RESULTS: There is strong evidence that bisphosphonate therapy is the common link in patients with BON. The pathobiological mechanism leading to BON may have to do with the inhibition of bone remodeling and decreased intraosseous blood flow caused by bisphosphonates. People at risk include patients with multiple myeloma and patients with cancer metastatic to bone who are receiving intravenous bisphosphonates, as well as patients taking bisphosphonates for osteoporosis. The risk of developing complications appears to increase with time of use of the medication. There are no guidelines based on evidence, and the clinical management of the oral complication is based on expert opinion. CONCLUSION: Prevention of BON is the best approach to management of this complication. Existing protocols to manage the care of patients who will receive radiation therapy or chemotherapy may be used until specific guidelines for BON are developed.
Antineoplastic Agents↗
Review of current treatment practices for carcinoma of the head and neck.
The past two decades have witnessed a paradigm shift in the treatment of squamous cell carcinoma of the head and neck. Innovation in chemotherapy, radiotherapy and surgery has led to the assimilation of these modalities into our treatment algorithms. This modern multipart treatment plan has led to improved survival; however, this has come at the cost of increased toxicity. New and future therapies will be more tumour specific and, ideally, less toxic. Current research centres on these tumour-specific therapies with the anticipation of improved survival with decreased toxicity. This article will review the standard of care, recent advances and unfulfilled needs in the treatment of squamous cell carcinoma of the head and neck.
Algorithms↗
Nonsteroidal anti-inflammatory drugs: confusion, controversy and dental implications.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used in the treatment of pain, including pain of dental origin, for many years. Even though they are effective in relieving symptoms, they are not without adverse events, most notably upper gastrointestinal toxicity. To prevent this side effect, the pharmaceutical industry developed NSAIDs that selectively inhibit the cyclooxygenase 2 (COX-2) isoenzyme, which is inducible and expressed at sites of inflammation, while sparing the COX-1 isoenzyme, which is associated with gastric protection. On September 30, 2004, the company that produced rofecoxib (Vioxx), a COX-2 inhibitor, voluntarily withdrew this product from the market based on the discovery of its association with increased risk of adverse cardiovascular events reported in an ongoing large clinical trial. This unexpected event caused the medical community to review existing literature regarding this and related medications and also led to the emergence of novel research to improve understanding of the potential mechanisms for this serious side effect. However, instead of clarifying the situation, reports created confusion and controversy regarding the safety of all types of NSAIDs. The major concern is an increase in adverse cardiovascular events with the use of individual drugs as well as the potential for a class effect. In this article, we review recent events and findings and discuss the implications for dentistry.
Acute Disease↗
Methamphetamine and its impact on dental care.
Dental professionals should be aware that methamphetamine (MA) use is on the rise in North America. MA is a potent central nervous system stimulant with limited therapeutic effects. The allure of this drug is its availability in many different forms that are relatively easy to make and distribute and inexpensive to purchase and that produce prolonged euphoria for the user. This euphoria results from alteration of the normal physiologic processing of several centrally acting neurotransmitters, which also causes neurotoxicity and neurodegeneration with long-term use. Long-term use of MA has been associated with severe oral health effects, the most notable being a distinctive pattern of caries called methamphetamine-induced caries. Dental professionals need to recognize and understand patients who may be using MA and the risk factors associated with its deleterious oral effects. This knowledge will allow appropriate and effective preventive and treatment strategies for users of this drug.
Adolescent↗
Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis.
BACKGROUND: Oral and gastrointestinal (GI) mucositis can affect up to 100% of patients undergoing high-dose chemotherapy and hematopoietic stem cell transplantation, 80% of patients with malignancies of the head and neck receiving radiotherapy, and a wide range of patients receiving chemotherapy. Alimentary track mucositis increases mortality and morbidity and contributes to rising health care costs. Consequently, the Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology assembled an expert panel to evaluate the literature and to create evidence-based guidelines for preventing, evaluating, and treating mucositis. METHODS: Thirty-six panelists reviewed literature published between January 1966 and May 2002. An initial meeting in January 2002 produced a preliminary draft of guidelines that was reviewed at a second meeting the same year. Thereafter, a writing committee produced a report on mucositis pathogenesis, epidemiology, and scoring (also included in this issue), as well as clinical practice guidelines. RESULTS: Panelists created recommendations from higher levels of evidence and suggestions when evidence was of a lower level and there was a consensus regarding the interpretation of the evidence by the panel. Panelists identified gaps in evidence that made it impossible to recommend or not recommend use of specific agents. CONCLUSIONS: Oral/GI mucositis is a common side effect of many anticancer therapies. Evidence-based clinical practice guidelines are presented as a benchmark for clinicians to use for routine care of appropriate patients and as a springboard to challenge clinical investigators to conduct high-quality trials geared toward areas in which data are either lacking or conflicting.
Antineoplastic Agents↗
Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy. Part 2: diagnosis and management of mucositis.
BACKGROUND: Oral mucositis is a common sequel of radiotherapy, chemotherapy, and radiochemotherapy in patients with cancer or patients requiring hemopoietic stem cell transplants. Mucositis has a direct and significant impact on the duration of disease remission and cure rates, because it is a treatment-limiting toxicity. Mucositis also affects survival because of the risk of infection and has a significant impact on quality of life and cost of care. METHODS: This article reviews publications on the diagnosis and management of oral mucositis accessible from a MEDLINE search using as key words mucositis, radiotherapy, chemotherapy, hemopoietic stem cell transplant, and oral. CONCLUSIONS: Conventional care of patients with mucositis is currently essentially palliative, with good oral hygiene, narcotic analgesics, and topical palliative mouth rinses.
Antineoplastic Agents↗
Oral and serum IL-6 levels in oral lichen planus patients.
OBJECTIVE: The purpose of this study was to compare IL-6 levels in oral exfoliated mucosal cell samples and in serum in subjects with oral lichen planus versus controls. Study design Ten patients with ulcerative OLP, 10 with reticular OLP, and 10 control subjects were recruited at a University Oral Medicine Clinic. Using smear tissue culture brushes, oral samples were collected from lesional sites for OLP patients and from buccal mucosa for controls into vials with 300 muL PBS. After centrifugation, the supernatants were aspirated for cytokine ELISA assay and protein assay. Venous blood was processed to serum for ELISA assay. Oral IL-6 was expressed as both pg/mL and pg/mug protein, and serum IL-6 was expressed as pg/mL. RESULTS: The mean oral IL-6 levels were higher in the ulcerative OLP group (11.19 +/- 5.34 pg/mL) than in the reticular OLP (1.05 +/- 0.34 pg/mL) and control (0.52 +/- 0.29 pg/mL) groups. There were significant differences between ulcerative OLP and reticular OLP groups (P < .039), and between ulcerative OLP and control groups (P < .009). After the standardization of IL-6 concentration by protein, a significant difference in IL-6 concentration was shown only between the ulcerative OLP (0.0245 +/- 0.0121 pg/mug protein) and control (0.0023 +/- 0.0012 pg/mug protein) groups (P < .029). Similarly, the ulcerative OLP group showed a significantly higher serum IL-6 level than the control group (P < .021). CONCLUSION: Both oral and serum IL-6 levels were higher in patients with ulcerative OLP. An oral exfoliated cell technique may be a useful and sensitive method to measure IL-6 in patients with OLP as it provided results consistent with those found in peripheral blood.
Aged↗
The Doubles: a case study on developing a technology-based substance abuse education curriculum.
The Doubles, funded by the National Institute on Drug Abuse, is a seven-episode series of media tools designed to teach third and fourth grade students about the science of drug addiction. The program's curriculum is delivered via a set of videos, interactive CD-ROMs, workbooks, or an Internet site. This article examines the process used to develop The Doubles and argues that its success stems from the careful balancing of the needs of the funding agency, state and national curricular guidelines, and the target audience.
Child↗
Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy: part 1, pathogenesis and prophylaxis of mucositis.
BACKGROUND: Oral mucositis is a common sequel of radiotherapy, chemotherapy, and radiochemotherapy in patients with cancer or patients requiring hemopoietic stem cell transplants. Mucositis has a direct and significant impact on the duration of disease remission and cure rates, because it is a cancer treatment-limiting toxicity. Mucositis also affects survival because of the risk of infection and has a significant impact on the quality of life and cost of care. METHODS: This article reviews publications on the etiopathogenesis and prevention of oral mucositis accessible from a MEDLINE search using as key words, mucositis, radiotherapy, chemotherapy, hemopoietic stem cell transplant, and oral. CONCLUSIONS: Of the current available products, ice chips and benzydamine have the strongest scientific evidence of support for prophylaxis of mucositis.
Antineoplastic Agents↗
Current developments in treating chemotherapy-related oral mucositis.
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Anesthetics, Local↗
A pilot study evaluating the safety and microbiologic efficacy of an economically viable antimicrobial lozenge in patients with head and neck cancer receiving radiation therapy.
BACKGROUND: Mucositis occurs in almost all radiotherapy-treated head and neck cancer patients, in approximately 75% of patients receiving hematopoietic marrow transplantation, and in approximately 40% of all patients who receive chemotherapy. Mucositis is painful, may affect all oral functions, and is a dose- and rate-limiting toxicity of therapy for cancer. Radiation-associated mucositis (onset, intensity, and duration) has been shown in recent clinical trials to be modified by the use of antibacterial/antifungal lozenges. PURPOSE: The aim of this collaborative two-center phase II study was to assess the toxicity and microbiologic efficacy of an economically viable antimicrobial lozenge in the management of patients receiving radiation therapy for head and neck cancer. MATERIALS AND METHODS: Seventeen patients scheduled to receive radical or postoperative radiotherapy were provided with bacitracin, clotrimazole, and gentamicin (BCoG) lozenges (one lozenge dissolved in the mouth qid from day 1 of radiotherapy until completion). Ease of use and palatability of the lozenges, patients' symptoms (swallowing and pain), and quantitative and qualitative microbiologic evaluation of an oral rinse collection was conducted at least once weekly during radiation therapy. RESULTS: No significant side effects were reported from the use of the lozenges. The lozenges were well tolerated at the beginning of treatment by all patients, with some minor difficulty associated with oral discomfort toward the end of the treatment. Microbiologic evaluation showed consistent elimination of yeast organisms in all patients. In four patients there was no growth of gram-negative bacilli on culture, whereas in two patients, fluctuating counts were seen, and one patient had increased counts. The remaining patients had significant reduction in the gram-negative bacilli counts. CONCLUSIONS: This study demonstrated that the BCoG lozenge is tolerable and microbiologically efficacious, achieving elimination of Candida in all patients and reduction in gram-negative flora in most patients. A phase III study is underway to evaluate the clinical efficacy of this lozenge.
Administration, Oral↗