Epidemiologic characteristics of head and neck cancer in recreational marijuana users
The literature contains relatively few reports pertaining to the epidemiologic relationship between marijuana use and head and neck cancer (HNC). The objective of this prospective study was to examine the epidemiologic characteristics of head and neck cancer (HNC) in recreational marijuana users. The findings were published online November 22, 2018, in Journal of Otolaryngology-Head and Neck Surgery.From 2011 through 2014, researchers at 1 tertiary care center in Hamilton, Ontario, Canada, enrolled patients consecutively into the study at the time of HNC diagnosis. Of the 879 patients who met the inclusion and exclusion criteria, 74 (8.4%) were classified as marijuana users (that is, they reported at least once weekly use).
The investigators administered to participants a structured questionnaire requesting information about marijuana use, educational level, ethnicity, marital status, alcohol consumption, tobacco use, pack-year history, income, employment status, age, sex, and Karnofsky score. Investigators also collected diagnostic and treatment data, including the primary site of cancer, clinical T stage, clinical N stage, and treatment modality. For patients with a diagnosis of an oropharyngeal cancer, the researchers collected data regarding p16 status.
The mean age of patients was 62.3 years in the marijuana group and 56.8 years in the nonmarijuana group (P = .068), the authors wrote. The proportion of men in the marijuana group (85.1%) was significantly higher than that in the nonmarijuana group (71.2%) (P = .011). Patients in both groups were predominantly white.
Of the 74 participants in the marijuana group, 20 (27%) reported that they used tobacco compared with 439 of 805 participants (54.5%) in the nonmarijuana group (P = .001). Alcohol use did not differ significantly between the 2 groups (P = .183).
The study findings showed a statistically significant difference between the 2 groups with respect to marital status. In the marijuana group, 55.4% of participants reported being married compared with 63.2% in the nonmarijuana group (P = .048). Regarding educational level, income, employment status, and Karnofsky score, the researchers observed no significant differences between the 2 groups.
Concerning tumor characteristics, the study findings revealed statistically significant differences between the marijuana and nonmarijuana groups. Of the 74 patients in the marijuana group, 47 (63.5%) had oropharyngeal cancer compared with 160 of 805 patients (19.9%) in the nonmarijuana group (P < .0001). Furthermore, the proportion of oropharyngeal cancers that were p16 positive was significantly higher in the marijuana group (95.7%) than in the nonmarijuana group (82.5%) (P = .002).
The researchers observed no significant differences between patients in the marijuana group and those in the nonmarijuana group regarding clinical T stage (P = .076) or N stage (P = .144). However, patients in the marijuana group were more likely to receive chemoradiation as the primary treatment (48.6% versus 24.2%) and less likely to undergo surgery alone (10.8% versus 20.8%) (P < .0001) compared with those who did not use the drug.
The results of this prospective study revealed subtle differences in tumor and socioeconomic characteristics between patients with HNC who used marijuana and those who did not. This study will be a useful adjunct for future studies that explore the potential oncological and quality-of-life effects of marijuana on patients with HNC, the authors concluded.
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Vitamin D deficiency and recurrent aphthous stomatitis
Recurrent aphthous stomatitis (RAS) is a common disease affecting a large segment of the population. However, the exact etiopathogenesis of the disease remains unclear. In the past few years, several studies have examined the possible association between vitamin D deficiency and RAS. In this systematic review and meta-analysis, researchers explored this potential association. The study was published online September 6 in Oral Diseases.
In conducting this systematic review and meta-analysis, the researchers followed the Preferred Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. They included observational studies that assessed the relationship between serum levels of vitamin D (25-hydroxycholecalciferol) and RAS. Inclusion criteria were studies that included patients with RAS as well as a healthy control group, quantitative vitamin D levels were reported, and articles were in English. The researchers excluded single case reports, case series, in vitro studies, review articles, and studies lacking adequate quantitative data.
Two of the authors conducted a search of PubMed, Scopus, and Web of Science databases. They independently screened the titles and abstracts of the retrieved articles, and, of the 194 articles identified, 184 were excluded. The reviewers then critically assessed the full text of the remaining 10 articles, 5 of which did not meet the eligibility criteria and were also excluded. Thus, 5 studies that investigated 208 patients with RAS and 241 healthy controls were included in the systematic review and meta-analysis.
Two of the 5 controlled cross-sectional studies were conducted in Iran, 1 was conducted in Poland, 1 was conducted in Turkey, and 1 was conducted in Iraq. The mean age of study participants ranged from 27.44 years through 38.38 years. Of the 449 participants, 271 (60.4%) were female. Four studies were composed of patients with the minor form of the disease, while 1 study included patients with minor or major forms, as well as those with herpetiform RAS.
Of the 5 studies, 4 found significantly lower serum levels of vitamin D in patients with RAS than in control participants. In addition, investigators in 4 studies assessed the association between vitamin D levels and the duration, severity, and frequency of RAS. In 3 of these studies, they found no significant association between vitamin D levels and these RAS variables. Researchers in the fourth study reported an inverse relationship between vitamin D levels and the number of ulcers in each RAS attack.
The authors of the systematic review and meta-analysis assessed the quality of the 5 studies using the Newcastle-Ottawa Scale for Assessing the Quality of Non-Randomized Studies in Meta-Analysis. Accordingly, only 1 study was of high quality, while 4 studies were of moderate quality.
The results of the meta-analysis showed that patients with RAS had significantly lower vitamin D levels than control participants (weighted mean difference between the 2 groups, –9.67 nanograms per milliliter; 95% confidence interval, –15.68 to –3.65; I2 = 90%; P < .002).
The researchers noted several study limitations. First, the small number of included studies along with relatively small sample sizes posed a major limitation. Secondly, because the studies were observational, potential confounders might not have been well controlled, making it difficult to infer causality. Third, heterogeneity among the studies was high.
Despite these limitations, the results of this systematic review and meta-analysis suggest that low levels of serum vitamin D might be a risk factor for RAS. However, more well-designed, prospective, observational studies with larger sample sizes are needed to elucidate the role of vitamin D in the pathogenesis of RAS, the authors concluded.
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Oral findings in patients with eating disorders
General dentists play an important role in diagnosing eating disorders (EDs) owing to the oral manifestations, including dental erosion, an increased incidence of caries, and tooth sensitivity to heat, cold, or acidic substances. The aim of this study, published online August 21 in Special Care in Dentistry, was to summarize oral findings in patients with EDs.
The study sample was composed of 26 women with an ED diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The mean age of participants was 31 years (range, 20-43 years). Patients had had an ED—bulimia nervosa, anorexia nervosa, or 1 of 2 subgroups—for a mean of 14.8 years, and they had been in treatment for a mean of 8.07 years.
The researchers excluded patients with diabetes mellitus, pregnant women, patients who wore complete dentures, HIV-seropositive patients, and patients who had received antifungal or antimicrobial treatments.
Two examiners conducted clinical examinations, including a complete evaluation of the oral mucosa. They classified patients’ oral hygiene status according to the Simplified Oral Hygiene Index. In addition, they measured patients’ dental caries experience using the decayed, missing, and filled teeth (DMFT) index.
To evaluate tooth wear on the occlusal or incisal, buccal, and lingual or palatal surfaces, the examiners used the index by Sales-Peres and colleagues: 0 indicates normal (no evidence of wear); 1, incipient (tooth wear in enamel); 2, moderate (tooth wear in dentin); 3, severe (tooth wear in pulp or secondary dentin); and 4, restored (tooth wear leading to restoration).
In addition, the researchers administered a questionnaire to evaluate patients’ subjective sensation of dry mouth. A positive response to at least 1 of 5 questions was required for a diagnosis of xerostomia (for example, “Do you feel thirsty often?” “Do you need to keep your mouth moist?”).
The results of a Spearman correlation test showed a weak correlation between DMFT and disease duration (r = –0.09) and between tooth wear and disease duration (r = 0.29). The investigators observed no correlations between oral alterations and ED duration. The mean Simplified Oral Hygiene Index value was 1.13, and the mean tooth wear value was 1.15 (incipient wear in enamel). The researchers pointed out that many patients reported using fluoride-containing oral hygiene products, which may explain the low erosion index.
The mean DMFT index score was 8.75, indicating that study participants were not more susceptible to dental caries than other dental patients. Regarding oral lesions, 7 participants had angular cheilitis and 2 had oral candidiasis.
The study findings suggest that the DMFT index score and tooth erosion are not correlated with ED duration. However, the sample size was small (N = 26). The authors indicated the need for additional studies with larger sample sizes to elucidate the relationship between oral findings and disease duration.
Maintaining the oral health of patients with EDs requires strict clinical follow-up and comprehensive care by all health care providers, the authors concluded.
Read the original article here or contact the ADA Library & Archives for assistance.
Acute gingivostomatitis in a pediatric population
Acute gingivostomatitis is a painful oral infection that is relatively common in young children. In a retrospective study, researchers sought to determine the prevalence of acute stomatitis in pediatric emergency care, evaluate patients’ pain, and assess the analgesic treatments used in an emergency department (ED) and at discharge during the 5-year period before codeine use was restricted in France. This study was published in the February issue of Archives de Pédiatrie.
The investigators analyzed the electronic medical records of children brought to the ED of a hospital in Paris, France, from August 2008 through June 2013. The files they selected included International Classification of Diseases 10 codes for gingivostomatitis, stomatitis, aphthosis, vesicular oral lesions, herpes viral infection, vesicular pharyngitis, vesicular oral lesions, candida stomatitis, and dysphagia. A physician also checked the medical records manually to ensure inclusion of cases displaying clinical features of herpetic gingivostomatitis (HGS), coxsackievirus stomatitis (herpangina), or hand, foot, and mouth disease (HFMD).
Three scales were available to assess pain in the ED: the EVENDOL pain scale (scores ranged from 0-15), visual analog scale, and Faces Pain Scale (scores ranged from 0-10). In addition, the researchers collected data regarding analgesics and other treatments administered before the ED visit, administered during the ED visit, prescribed at discharge, and, where appropriate, administered during hospitalization based on inpatient records.
The study sample consisted of 702 children who had a total of 740 visits to the ED during the 5-year period. Patients’ mean age was 29 months (range, 14 days-18 years). Of the 702 children, 465 (66.2%) were brought to the ED within 3 days of symptom onset, the authors wrote. Before the ED visit, the parents of 290 children (41.3%) had already consulted a physician.
Clinical features were consistent with HGS in 372 children (53.0%), herpangina in 149 children (21.2%), and HFMD in 181 children (25.8%). The main symptoms reported by parents in the ED were fever, pain, and eating difficulties, with the latter 2 symptoms reported more commonly in children with HGS (P < .001).
Of the 702 children in this study, 457 (65.1%) received codeine before the ED visit, in the ED, or on discharge from the ED. According to the medical records, 314 patients in the HGS group (84.4%), 67 patients in the herpangina group (45.0%), and 76 patients in the HFMD group (42.0%) received codeine, most often at discharge from the ED (P < .001). Acetaminophen was the most frequently administered analgesic in this study (n = 221 before the ED visit, n = 108 in the ED, and n = 604 on discharge). Other analgesics received by children were nonsteroidal anti-inflammatory drugs, topical treatments, nalbuphine (1% of patients), and morphine (1% of patients).
Visits to the ED for acute stomatitis are relatively common. Although codeine use in children is now prohibited, codeine has been a cornerstone of analgesic management in children with this disease, the authors wrote. They also concluded that analgesic regimens that are at least as effective as codeine should be explored.
Read the original article here or contact the ADA Library & Archives for assistance.
What’s causing the oral issues for your patients?
It’s not every day that a patient comes in with premalignant lesions or significant dental erosion. Recognize the signs and the causes, so you effectively treat the patient and improve their health in any instance. The ADA offers CE courses that teach you how to conduct a comprehensive visual tactile exam and develop a differential diagnosis of common oral lesions and dental erosion:
- Differential Diagnosis of Oral Lesions
- Oral Cancer Screening and Radiotherapy Morbidity Management
- Management and Prevention of Dental Erosion
Visit ADACEOnline.org to find out more information about these and other pathology courses.
The consulting editor for JADA+ Specialty Scan — Oral Pathology is Faizan Alawi, DDS, Associate Dean for Academic Affairs and Associate Professor of Pathology, School of Dental Medicine; Associate Professor of Dermatology, Perelman School of Medicine; Director, Penn Oral Pathology Services; University of Pennsylvania |
The associate consulting editor for JADA+ Specialty Scan — Oral Pathology is Nasser Said-Al-Naief, DDS, MS, Professor, Dept. of Integrated Biomedical and Diagnostic Sciences, Oregon Health and Sciences University, School of Dentistry and School of Medicine. |
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