Promoting oral health: interventions for preventing dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. A report on recommendations of the task force on community preventive services. (33/358)

The Task Force on Community Preventive Services (the Task Force) has conducted systematic reviews of the evidence of effectiveness of selected population-based interventions to prevent and control dental caries (tooth decay), oral (mouth) and pharyngeal (throat) cancers, and sports-related craniofacial injuries. The Task Force strongly recommends community water fluoridation and school-based or school-linked pit and fissure sealant delivery programs for prevention and control of dental caries. Using the rules of evidence it has established, the Task Force found insufficient evidence of effectiveness or ineffectiveness of the remaining interventions reviewed. Therefore, the Task Force makes no recommendation for or against use of statewide or communitywide sealant promotion programs, population-based interventions for early detection of precancers and cancers, or population-based interventions to encourage use of helmets, facemasks, and mouthguards to reduce oral-facial trauma in contact sports. The Task Force's finding of insufficient evidence indicates the need for more research on intervention effectiveness. Until the results of such research become available, readers are encouraged to judge the usefulness of these interventions by other criteria. This report presents additional information regarding the recommendations, briefly describes how the reviews were conducted, and provides information designed to help apply the strongly recommended interventions locally.  (+info)

Surgeon information giving practices prior to laryngectomy: a national survey. (34/358)

Prior to the proposed development of a pretreatment counselling package for patients with cancer of the larynx or pharynx, a study was undertaken to determine current information giving practice prior to laryngectomy. A postal questionnaire was sent to all UK ENT consultants registered in the Medical Directory. The response rate was 88%, with 48% meeting the study's entry criteria. Counselling practice varies widely. Surgeons report an average of 15 min available for discussion with the patient: 84% gave the diagnosis and discussed the treatment options at the same consultation. The size of the department, as measured by cases seen per year, did not correlate with the consultation time although it did with the numerous different issues discussed. Whilst the survey supports the need and desire for an appropriate counselling package, many surgeons feel that they alone know what the patient's information needs are.  (+info)

Extranodal follicular dendritic cell sarcoma of the head and neck region: three new cases, with a review of the literature. (35/358)

Extranodal follicular dendritic cell (FDC) sarcoma of the head and neck region is uncommon, with 16 well-documented cases previously reported (four in the tonsil, four in the pharynx, two in the palate, five in the soft tissue, and one in the thyroid). We here report an additional three cases of extranodal FDC sarcoma in the tonsil (two cases) and pharynx (one case). In these new cases, the neoplastic cells were arranged in diffuse, fascicular, and vaguely whorled growth patterns. A background lymphocytic infiltrate was sprinkled throughout the neoplasms, with focal prominent perivascular cuffing. Scattered multinucleated giant cells were present. Immunohistochemically, tumor cells were strongly and diffusely positive for follicular dendritic cell markers CD21 and CD35. Tumor cells were diffusely positive for fascin and negative for leukocyte common antigen, S-100 protein, cytokeratin, and Epstein-Barr virus (EBV) latent membrane protein-1 (EBV-LMP). EBV was also not detected in the tumor cells by in situ hybridization for EBV-encoded RNAs. FDC sarcomas are probably an underrecognized neoplasm, especially when they occur in extranodal sites in the head and neck region. Two of the three new cases we report were initially misdiagnosed, and five cases of extranodal FDC sarcoma in the head and neck region reported in the recent literature were initially misdiagnosed. Our aim is to complement the current understanding of this neoplasm and alert pathologists to this rare entity in this region to avoid misdiagnosis. Recognition of extranodal FDC sarcoma requires a high index of suspicion, but this tumor has numerous distinctive histological features that should bring the neoplasm into the differential diagnosis. Confirmatory immunohistochemical staining with follicular dendritic cell markers such as CD21 and/or CD35 is essential for the diagnosis. Correct characterization of this neoplasm is imperative given its potential for recurrence and metastasis.  (+info)

Professional and community efforts to prevent morbidity and mortality from oral cancer. (36/358)

BACKGROUND: Oral and pharyngeal cancers cause significant morbidity and mortality, yet there has been little improvement in survival rates in the past 30 years. Because early diagnoses significantly increase survival rates, the authors summarize several approaches to educating and mobilizing the dental profession and the public about this problem. Clinicians are invited to initiate similar programs to catalyze change in their own communities. METHODS: The authors found that many approaches have been used to define the problem and initiate change. These include surveys, focus groups, development of consortia, media programs, flyers, leaflets, prescription pads, legislation and professional endorsements. RESULTS: In Maryland in 1996, only 20 percent of adults reported receiving an oral cancer examination, and most oral cancers were diagnosed at late stages by physicians, not dentists. Results of the public educational campaigns in the regions of New York/New Jersey and Maryland have not been formally evaluated, but there is a developing consensus that oral cancer diagnostic practices in the regions with active educational programs are increasing. CONCLUSIONS: Coalitions or partnerships among individuals and organizations from government, academia, private practice, industry, the general community and the media can affect awareness about oral cancer prevention and early detection on a regional basis. CLINICAL IMPLICATIONS: By increasing awareness of oral cancer among the dental profession and the public, earlier diagnosis of these cancers with consequent improved cure rates is likely. Providing oral cancer diagnostic services as a routine part of an oral examination also may motivate patients to visit the dentist at least once a year.  (+info)

Dentistry's role in tobacco control. (37/358)

BACKGROUND: Cigarette smoking remains the nation's leading preventable cause of premature mortality. Tobacco use also is responsible for 75 percent of deaths resulting from oral and pharyngeal cancer, more than one-half of the cases of periodontitis and numerous other oral health effects. METHODS: The author summarized the prevalence of tobacco use in the United States, evaluated recent literature on the status of tobacco control activities in dental schools and dental practice, and reviewed new guidelines on clinical and community-based interventions for tobacco use. RESULTS: Nearly 25 percent of adults and 35 percent of high-school students smoke cigarettes, and many use other forms of tobacco. More than one-half of adult smokers and nearly three-fourths of adolescents see a dentist each year. However, more than 40 percent of dentists do not routinely ask about tobacco use, and 60 percent do not routinely advise tobacco users to quit. Meanwhile, less than one-half of dental schools and dental hygiene programs provide clinical tobacco intervention services. CONCLUSIONS: At least 50 dental organizations have adopted policy statements about tobacco use, but much work needs to be done in translating those policy statements into action. Tobacco use remains prevalent in the United States, and dentistry has not yet maximized its efforts to reduce it. PRACTICE IMPLICATIONS: The recently issued U.S. Public Health Service guidelines on treating tobacco use and dependence provides evidence-based, practical methods for dentists and other primary care providers to incorporate into their practice. Because dentists and dental hygienists can be effective in treating tobacco use and dependence, the identification, documentation and treatment of every tobacco user they see need to become a routine practice in every dental office and clinic.  (+info)

Demographics and occurrence of oral and pharyngeal cancers. The outcomes, the trends, the challenge. (38/358)

OVERVIEW: This article summarizes current trends in the occurrence of, mortality rates associated with and rates of survival of oral and pharyngeal cancer. METHODS: The author reviewed relevant data and literature on these aspects of oral and pharyngeal cancer, including data from the National Cancer Institute's Surveillance, Epidemiology and End Results program collected from 1973 to 1998. RESULTS: The occurrence of oral and pharyngeal cancer in the United States remains constant, at about 30,000 new cases diagnosed each year. There has been no marked improvement in the five-year survival rates, which remain at about 50 percent, despite advances in surgery and radiation. Detection of early, localized lesions has not improved significantly during the past three decades. There is a minor trend toward a younger age at diagnosis and a slight increase among women. CONCLUSIONS: On the basis of epidemiologic data, it appears that the most important approach to decreasing morbidity and mortality associated with oral cancer is increasing early detection of localized lesions combined with appropriate treatment. Concomitantly, aggressive counseling is vital to prevent use and encourage cessation of tobacco and alcohol use. CLINICAL IMPLICATIONS: Professional and public education about oral and pharyngeal cancer needs to be improved, and clinicians must emphasize the need for and perform routine oral cancer examinations to promote early diagnosis and treatment.  (+info)

Total esophageal reconstruction after extraction of the esophagus. (39/358)

During the period between 1971 and 1974, 25 cases of carcinoma of the hypopharynx and cervical esophagus underwent esophageal extraction and total esophageal reconstruction without operative mortality. The operative methods used for this series were blunt dissection, or everting stripping of the thoracic esophagus without thoractomy followed by pharyngogastro or -colostomy as a one stage procedure via a posterior mediastinal route created by esophageal extraction. The operative technique of esophageal extraction without thoracotomy is described. It is obvious that mediastinal tunnel is the shortest route through which to put the chosen organ for esophageal substitution. This operation is to be recommended for lesion of the hypopharynx and cervical esophagus as well as some esophageal stricture because of its operative simplicity, ease, safety and rare postoperative complications.  (+info)

Relationship of Plummer-Vinson disease to cancer of the upper alimentary tract in Sweden. (40/358)

Sideropenic anemia with epithelial lesions (Plummer-Vinson syndrome) was previously very common among women in northern Sweden. The incidence of this condition is decreasing, however, because of better nutrition and improved health care. Plummer-Vinson syndrome as a sequela of previous sideropenic anemia still influences the pattern of hypopharyngeal and oral cancer in northern Sweden where the female/male ratio in these diseases is remarkably high and where cancer in the postcricoid part of the hypopharynx is relatively common. In Sweden as a whole, a decreasing trend in the incidence of hypopharyngeal cancer in women can be demonstrated, which is probably due to diminished prevalence of Plummer-Vinson syndrome.  (+info)