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Biomedical subjects

P B Lockhart

Publications and source records attributed to P B Lockhart.

35 records · Page 2Linked to original sources

Oral considerations for the cancer patient.

An increasing number of patients are undergoing cancer chemotherapy and/or radiotherapy and are experiencing side effects in their mouths. A thorough oral examination is important in the overall pretherapy evaluation of these patients, and, along with a consideration for the patient's disease, treatment, prognosis and laboratory values, allows for realistic planning for dental management prior to, during and following cancer therapy. The early establishment of a good working relationship with the patient and those caring for him or her, and an understanding of the importance of compliance with oral hygiene will eliminate needless therapy-induced morbidity and mortality.

Antineoplastic Agents↗

Oral complications following neoadjuvant chemotherapy in patients with head and neck cancer.

Oral complications from cancer chemotherapy are well documented for the hematologic malignancies but are less well defined for cancers of the head and neck. This prospective study examined 82 patients with stage III or IV disease to determine the incidence and severity of oral sequelae following a total of 141 cycles of neoadjuvant chemotherapy. Taste alteration (37%) was the most frequent problem, followed by mucositis (30%) and ulceration (22%). Xerostomia, increased salivary flow, loss of appetite, weight loss, dysphagia, bleeding, and infection were also encountered. We conclude that oral problems are common following chemotherapy for head and neck tumors and that more aggressive investigational protocols will result in a much higher incidence and severity of problems. Prevention of these sequelae by conventional as well as investigational means is important to keep them from becoming dose-limiting problems.

Antineoplastic Agents↗

The use of infrared thermography in the evaluation of oral lesions.

We have attempted to quantify the degree of inflammation associated with oral lesions through the use of infrared thermography, since the increased vascularity associated with inflamed tissue might result in measurable increases in surface temperature. This would provide a better measure of the relief of pain and inflammation associated with cancer chemotherapy mucositis by an antiinflammatory drug such as benzydamine hydrochloride than the subjective pain scales now employed. One subject with normal oral mucosa and three subjects with oral lesions of varying aetiology were studied with a Hughes Series 4000 PROBEYE thermal video system utilizing an infrared imager and microprocessor. A 35-mm camera was used to obtain a colour photograph of each subject. Multiple thermograms were made in a temperature range of 30.0 degrees C to 34.2 degrees C at a sensitivity of 0.2 degrees C. Photographs were taken on different occasions to determine whether the temperature readings could be duplicated and to test the accuracy of each reading. The normal surface temperature of the control subject's mucosa was found to be significantly cooler than clinical areas of inflammation in patients with lesions induced by chemotherapy. The temperature of the areas of stomatitis was remarkably consistent (Subject C means 33.7 degrees C; Subject D means 33.9 degrees C). Interestingly, the necrotic center of a traumatic ulcer inhibited measurement of an underlying inflamed base and was thus equivalent in temperature to the normal control (Normal means 31.9 degrees C; Subject B necrotic lesion means 31.7 degrees C). These results suggest that infrared thermography may represent a means to assess quantitatively the degree of mucosal inflammation. Additional studies are in progress.

Adult↗

Oral complications of multimodality therapy for advanced squamous cell carcinoma of head and neck.

Investigational treatment of advanced localized stage III or stage IV squamous cell carcinoma of the head and neck may include chemotherapy in addition to radiotherapy and surgery. Such therapy, while effective in eradicating local tumors, often produces considerable oral toxicity. In this study we reviewed the oral complications of 22 patients receiving multimodality cancer treatment. The addition of chemotherapy to the treatment regimen did not increase the incidence of complications (osteoradionecrosis, mucositis, xerostomia, radiation caries, or infection) when compared with historical controls receiving radiotherapy alone. Pretreatment dental evaluation and close follow-up of these patients are encouraged.

Carcinoma, Squamous Cell↗

Dental complications during and after tracheal intubation.

Surveyed were 133 directors of training programs in anesthesiology. The directors reported an average incidence of 1:1,000 dental injuries during or after 1,135,212 tracheal intubations in 1 year. A well-documented dental evaluation before delivery of anesthetics and appropriate precautions and protective devices during intubation will prevent most dental trauma related to the delivery of general anesthetics. Also, early use of dental and risk management services often will ensure timely resolution of such problems.

Anesthesia, Endotracheal↗

The use of infrared thermography in the evaluation of oral lesions.

This study was conducted to quantitate the degree of inflammation associated with oral lesions by using infrared thermography. It was reasoned that the increased vascularity associated with inflamed tissue may result in measurable increases in surface temperature. One subject with normal oral mucosa and three subjects with oral lesions of varying causes were studied with a thermal video system, using an infrared imager and microprocessor. A clinical photograph of each subject was obtained. Multiple thermograms were made in a temperature range of 30.0 C to 34.2 C at a sensitivity of 0.2 C. Photographs were taken on different occasions to determine whether the temperature readings could be duplicated and to test the accuracy of each reading. The normal surface temperature of the control subject's mucosa was significantly cooler than were the temperatures of the inflamed areas in the subjects with lesions induced by chemotherapy. The temperature of the areas of stomatitis was consistent (subject 3, mean = 33.7 C; subject 4, mean = 33.9 C). The necrotic center of a traumatic ulcer inhibited measurement of an underlying inflamed base and, thus, was equivalent to the control in temperature (subject 1 (control), mean = 31.9 C; subject 2 (necrotic lesion), mean = 31.7 C). These results suggest that infrared thermography may provide a means to quantitatively assess the degree of mucosal inflammation.

Adult↗

Severe oral hemorrhage and sepsis following bone marrow transplant failure.

Aplastic anemia is a failure of all the cellular components of the bone marrow and, untreated, usually results in death from bleeding and/or infection within 4 months. Treatment by bone marrow transplantation offers the only means of survival. When a bone marrow graft fails, the patient is extremely susceptible to severe infection and/or hemorrhage. In this case, a bone marrow transplantation in a 34-year-old white man with aplastic anemia failed. Among the medical problems that subsequently developed were severe, prolonged and life-threatening oral bleeding and infection.

Adult↗

Gingival pigmentation as the sole presenting sign of chronic lead poisoning in a mentally retarded adult.

A diagnosis of chronic lead poisoning in a mentally retarded adult with pica was initially proposed because of the presence of a "lead line" on the patient's gingiva. The patient had no other signs or symptoms suggestive of her toxic state. Lead poisoning is reviewed from the standpoint of epidemiology, pathophysiology, clinical and oral manifestations, and diagnostic procedures. Dentists working with children or mentally retarded patients should be aware of the increased incidence of lead poisoning in these patient populations and the importance of oral findings and lead-screening techniques in the detection of lead poisoning.

Chronic Disease↗

Relationship of oral complications to peripheral blood leukocyte and platelet counts in patients receiving cancer chemotherapy.

Patients undergoing cancer chemotherapy often suffer from oral complications as a result of their disease and its treatment. The effects of the chemotherapy on the bone marrow and oral mucosa, coupled with the patient's immunosuppressed state and altered oral microbial flora, predispose these patients to oral mucositis, infection, and hemorrhage. The oral mucosa appears to mirror the effects of the chemotherapy on the bone marrow, as there appears to be a direct relationship between the changing peripheral blood counts and the status of the oral mucosa.

Adult↗

Prevalence and nature of orofacial and dental problems in family medicine.

OBJECTIVE: To determine the prevalence and nature of orofacial and dental problems in 2 family medicine practices. DESIGN: Prospective, cross-sectional analysis of consecutive patient visits. SETTING: Urban and rural family medicine practices. PATIENTS AND PARTICIPANTS: Four hundred seventy-two patients between age 10 and 86 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Prevalence and nature of patient visits to family medicine practices that were either initiated by problems in the region of the oral cavity or that involved questions raised by the patient concerning oral or perioral sites. RESULTS: Twenty-one patients (4.5%) of 472 met the inclusion criteria, 16 (76%) of whom had an oral problem as the primary or secondary reason for their visit. Perioral pain and mucosal ulcerations were the most common problems, and gingival tissue was the most common location. Almost two thirds of these patients had bacterial, fungal, or viral infections. Regarding treatment, 13 (62%) of these patients received advice, 10 (48%) received prescriptions, and 3 (15%) were referred to a dentist or another medical specialist. CONCLUSIONS: Oral and perioral problems are common in the practice of family medicine, which suggests the desirability for specific oral medicine topics in the training and continuing education of primary care physicians. Arch Fam Med. 2000;9:1009-1012

Adolescent↗