Search

Introduction: The present study evaluated a national social marketing campaign (SMC) conducted in 2008, with the ultimate aim of improving control of oral cancer in Sri Lanka. The approach was based on our published Risk Factor Model (RFM)., Methods: Social marketing tools were developed to educate the public on the major risk factors for oral cancer. A cross-sectional community-based cluster survey was carried out in 2013 by interviewing 491 citizens >25 years of age to assess any improvements to the level of disease awareness in the community. Changes in the number of case presentations were obtained from registrations at Government Hospital Dental Clinics (GHDC) from the year 2008-2015., Results: A random sample of 491 members of the public was interviewed in 2013. Most (93%) were aware of oral cancer; but only 45.4% of oral potentially malignant disorders (OPMD). Statistically significant improvements were observed on awareness of oral cancer and OPMD and of the risk factors for oral cancer. A marked increase in the detection of oral leukoplakia and of oral cancer occurred in the GHDC surveillance system in the years 2012 and 2013, at the time the SMC campaign was implemented., Conclusion: The improvement in public awareness of oral cancer and of its major risk factors, and the changed public behavior seen in the increased attendance at healthcare facilities for mouth examination, may be attributed, at least in part, to our SMC. Such Risk Factor-based approaches to social marketing are proposed for control of oral cancer., Competing Interests: None to declare., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Glycosylation is the most common post-translational modification (PTM) of proteins. Malignant tumour cells frequently undergo an alteration in surface protein glycosylation. This phenomenon is also common in cancers of the head and neck, most of which are squamous cell carcinomas (HNSCC). It affects cell functions, including proliferation, motility and invasiveness, thus increasing the propensity to metastasise. HNSCC represents the sixth most frequent malignancy worldwide. These neoplasms, which arise from the mucous membranes of the various anatomical subsites of the upper aero-digestive tract, are heterogeneous in terms of aetiology and clinico-pathologic features. With current treatments, only about 50% of HNSCC patients survive beyond 5-years. Therefore, there is the pressing need to dissect NHSCC heterogeneity to inform treatment choices. In particular, reliable biomarkers of predictive and prognostic value are eagerly needed. This review describes the current state of the art and bio-pathological meaning of glycosylation signatures associated with HNSCC and explores the possible role of tumour specific glycoproteins as potential biomarkers and attractive therapeutic targets. We have also compiled data relating to altered glycosylation and the nature of glycoproteins as tools for the identification of circulating tumour cells (CTCs) in the new era of liquid biopsy., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Oral diseases, including cancers, affect 3.5 billion people globally and remain largely untreated in low- to middle-income countries because of lack of resources. In Papua New Guinea (PNG), oral cancer has, for many decades, been identified as the most common cancer in men, but as the GLOBOCAN 2018 data are estimates extrapolated from surrounding countries, the real prevalence of this disease is not known. The PNG National Health Plan (2011-2020) highlights the need to improve health care, but oral health is not identified as a priority. Alcohol, tobacco, and areca nut/betel quid, which are the social and commercial determinants of oral cancer, are common risk factors, and there are robust data linking these risk factors to oral cancer in PNG. Our recent Global Challenges Research Fund Workshop on Oral Cancer, held in Port Moresby, PNG, brought together a number of researchers in oral cancer epidemiology and translational science with clinicians from PNG to assess the current situation and plan ways to move forward. In this article, we will review the literature on oral cancer in PNG, and make suggestions as to how, collaboratively, we can address the issues identified, ultimately, for the benefit of the people of PNG., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Chronic destructive periodontitis, a cause of systemic inflammation, affects some 10% to 15% of adults across the globe, with severity of disease increasing with age. The aim of this study was to explore the relationship between periodontitis and oral hygiene habits and upper aerodigestive tract (UADT) cancers., Study Design: We conducted a case-control study, which included 240 UADT cancer cases and 240 controls matched by gender and age (±5 years) from 2 different hospitals in Pune, India. In-person interviews and intraoral examinations were conducted for all patients., Results: Severe periodontitis and greater than 5 missing teeth were associated with a significant risk of UADT cancers (adjusted odds ratio [OR] 2.25, 95% confidence interval [CI] 1.12-4.91; adjusted OR 3.28, 95% CI 1.95-5.49). Among the self-reported oral hygiene habits, dental checkups only at the time of pain was associated with an elevated risk for UADT cancers (adjusted OR 4.12; 95% CI 2.63-6.47). Topical application of mishri (black powder obtained by roasting and grinding tobacco) on gums (adjusted OR 3.06; 95% CI 1.75-5.35) and toothbrushing frequency less than once daily; (adjusted OR 2.09; 95% CI 1.27-3.45) were also associated with an elevated risk. Furthermore, the habit of ever chewing tobacco was associated with an elevated risk of severe periodontitis., Conclusions: Severe periodontitis is associated with an elevated risk for UADT cancers, and tobacco chewing strengthens this association in this population., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: The role of immune function in susceptibility to medication-related osteonecrosis of the jaws (MRONJ) remains unclear. This study investigated whether full blood counts, as a measure of systemic health and immune function, predict the development of MRONJ., Study Design: A case-control study was conducted in Brisbane, Australia. A total of 57 cases diagnosed with MRONJ from January 2010 to March 2017 were identified from hospital records and individually matched with up to 4 controls using primary disease, sex, age, and antiresorptive therapy (total sample = 249). Demographic and clinical data were extracted and associations were investigated using conditional logistic regression., Results: A total of 67% of cases and 65% of controls reported at least 1 result outside of the laboratory reference range (odds ratio = 0.7; 95% confidence interval: 0.3, 1.5; P = .29). The most commonly reported abnormal results were low hemoglobin (53% of cases, 48% of controls) and low hematocrit (33% of cases, 25% of controls). There were no significant differences between groups in any of the reported parameters., Conclusions: Patients taking antiresorptive medications often return blood test results outside the standard laboratory reference range. Altered blood counts were not limited to patients who developed MRONJ and do not appear to be clinically useful in identifying patients at high risk for this condition., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Human papilloma virus (HPV) is the main culprit in cancers of the cervix, penis, anus, skin, eye and head and neck. Current treatments for HPV cancers have not altered survival outcomes for 30 years and there is a significant lack of targeted therapeutic agents in the management of advanced HPV-related HNSCC. Here we show that survival and maintenance of HPV-positive HNC cells relies on the continuous expression of the major HPV oncogene, E7, and that Aurora kinases are critical for survival of high-risk HPV-positive HNC cells., Materials and Methods: To assess the role of HPV E7 on HNC cell survival, RNA interference (RNAi) of the E7 gene was initially performed. Using an Aurora kinase inhibitor, Alisertib, the role of Aurora kinases in the carcinogenesis of HPV E7 positive HNC tumour lines was then investigated. An in vivo HNC xenograft model was also utilised to assess loss of tumour volume in response to RNAi E7 gene silencing and Alisertib treatment., Results: RNAi silencing of the HPV E7 gene inhibited the growth of HPV-positive HNC cells and in vivo tumour load. We show that HPV E7 oncogene expression confers sensitivity to Alisertib on HNC cells where Alisertib-mediated loss in in vitro cell viability and in vivo tumour load is dependent on E7 expression. Moreover, Aurora kinase inhibition induced degradation of MCL-1 in HPV E7-expressing HNC cells., Conclusion: Overall, we show that Aurora kinases are a novel therapeutic target for HPV-positive HNCs. It might be feasible to combine Aurora kinase and MCL-1 inhibitors for future HNC therapies., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: This study examines the association between the incidence of oral cancer in India and oral hygiene habits, diet, chewing and smoking tobacco, and drinking alcohol. We also assessed the effects of oral hygiene habits with oral cancer risk among chewers versus never chewers., Methods: A hospital-based case-control study was conducted in Pune, India, based on face-to-face interviews, anthropometry, and intra-oral examinations conducted for 187 oral cancer cases and 240 controls., Results: Poor oral hygiene score was associated with a significant risk of oral cancer (adjusted OR=6.98; 95%CI 3.72-13.05). When stratified by tobacco-chewing habit, the poor oral hygiene score was a significant risk factor only among ever tobacco chewers (adjusted OR=14.74; 95%CI 6.49-33.46) compared with never chewers (adjusted OR=0.71; 95%CI 0.14-3.63). Dental check-ups only at the time of pain by ever-chewers with poor oral hygiene was associated with an elevated risk (adjusted OR=4.22; 95%CI 2.44-7.29), while consumption of green, yellow, and cruciferous vegetables and citrus fruits was protective. A linear dose-response association was observed between oral cancer and chewing tobacco in terms of age at initiation, duration, and frequency of chewing per day (P<0.001). Smoking more than 10 bidis/cigarettes per day (adjusted OR=2.74; 95%CI 1.28-5.89) and for a duration >25 years (adjusted OR=2.31; 95%CI 1.14-4.71) elevated the risk of oral cancer., Conclusion: Good oral hygiene habits - as characterized by healthy gums, brushing more than once daily, use of toothpaste, annual dental check-ups, and a minimal number of missing teeth - can reduce the risk of oral cancer significantly. In addition to refraining from chewing/smoking tobacco, a diet adequate in fruits and vegetables may protect against the disease., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: The aim of this study was to measure quality of life (QOL) in patients with upper aerodigestive tract (UADT) cancer in comparison with hospital-based controls. We also assessed the impact of various clinical predictors at time of diagnosis of disease/cancer on QOL in these patients., Study Design: A case-control study was conducted (N = 480) with 240 UADT cancer cases and 240 controls matched by gender and age (≥5 years) from 2 different hospitals in Pune, India. The University of Washington Quality of Life Questionnaire was used to measure QOL and was administered through face-to-face interviews. Various QOL domains were analyzed by using one-way analysis of variance and Bonferroni adjustments for post hoc comparisons., Results: Cases had significantly lower scores across all domains of QOL compared with controls. Overall, the most affected domains were anxiety and mood. Cancer site significantly influenced QOL, with patients with cancers of the oropharynx and hypopharynx having the worst mean scores across all domains. Patients with stage IV cancer had the worst mean scores across the majority of the QOL domains. Our findings highlight the complex interactions between individual and clinical predictors that have an impact on QOL., Conclusions: QOL needs to be incorporated as an important outcome measure in an individualized approach to therapeutic and palliative care planning to enable a better quality of survival of patients with UADT cancers., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Conventional treatment strategies have done little to improve the prognosis or disease-free survival in head and neck cancer (HNC) patients. Recent progress in our understanding of molecular aspects of head and neck squamous cell carcinoma (HNSCC) has provided insights into the potential use of molecular targeted therapies in combination with current treatment strategies. Here we review the current understanding of treatment modalities for both HPV-positive and HPV-negative HNSCCs with the potential to use gene editing and silencing technologies therapeutically. The development of sequence-specific RNA interference (RNAi) with its strong gene-specific silencing ability, high target specificity, greater potency and reduced side effects, has shown it to be a promising therapeutic candidate for treating cancers. CRISPR/Cas gene editing is the newest technology with the ability to delete, mutate or replace genes of interest and has great potential for treating HNSCCs. We also discuss the major challenge in using these approaches in HNSCC; that being the choice of target and the ability to deliver the payload. Finally, we highlight the potential combination of RNAi or CRIPSR/Cas with current treatment strategies and outline the possible path to the clinic., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Objectives: To determine the association of body mass index (BMI) with dental caries in Indian schoolchildren, and to analyse the influence of socio-economic status (SES)., Methods: The study population consisted of 11- to 14-year-old children from Medak District in Telangana State, India. The Indian Academy of Paediatrics 2015 growth charts were used to categorise children as underweight, overweight, normal or obese, based on their BMI. Data on the SES of the family were collected through questionnaires. Clinical examination for dental caries was performed by a single examiner., Results: A total of 1,092 subjects returned questionnaires and were clinically examined (giving a response rate of 85%). There were no significant differences in caries prevalence and experience across the categories of BMI. However, caries prevalence and experience in overweight children were 24.8% and 0.69 ± 1.51, respectively, while the corresponding values in normal-weight children were 35% and 0.85 ± 1.50, respectively. Among children of high-SES families, overweight children had approximately 71% fewer caries than did those who were normal weight [incidence rate ratio (IRR) = 0.29; 95% CI: 0.11-0.78)]., Conclusions: BMI was not associated with dental caries prevalence and experience in this population. The association of BMI with dental caries varied across SES categories. In the high-SES category, overweight children experienced fewer caries than did normal-weight children., (© 2016 FDI World Dental Federation.)

Objective: The aim of this study was to develop and evaluate the validity and reliability of a quality-of-life (QoL) questionnaire for patients with oral potentially malignant disorders (OPMDs)., Study Design: For item generation, 15 personal interviews and three focus group discussions were conducted with OPMD patients existing QoL questionnaires were reviewed, and inputs from specialist clinicians (n = 10) were considered. Data collected from patients were analyzed by using NVivo. This led to the identification of themes, item writing, scaling, item reduction, formatting, and pretesting of the newly developed questionnaire. The validity and reliability of the questionnaire were assessed in a separate sample of 300 patients (150 each of patients with OPMD and healthy individuals)., Results: Sixty items were generated from the qualitative data and by reviewing existing questionnaires. After item reduction, the final questionnaire comprised 20 questions, which could be categorized under four domains. Exploratory factor analysis revealed a four-factor structure conforming to the four domains. The OPMD QoL questionnaire exhibited good discriminant and convergent validity, with OPMD patients reporting poorer QoL compared with healthy individuals and correlating significantly with existing questionnaires designed for similar purposes respectively., Conclusions: Our OPMD QoL questionnaire was found to be valid and reliable. We recommend that it be applied in epidemiologic and treatment studies of these disorders., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To synthesise data from the literature on the effects of various parent-related characteristics (socio-demographic, behavioural and family environment) on dental caries in the permanent dentition of children., Data: Available studies in which the effects of parent-related characteristics on dental caries experience in the permanent dentition of children aged 6-12 years were evaluated., Sources: PubMed, Medline via OVID and CINAHL Plus via EBSCO, restricted to scientific articles, were searched in April 2015. English language and time filters (articles published from 2000) were used., Study Selection: A total of 4162 titles were retrieved, of which 2578 remained after duplicates were removed. After review of titles and their abstracts by two independent reviewers, 114 articles were considered relevant for full text review. Of these, 48 were considered for final inclusion. Data extraction was performed by two authors using piloted data extraction sheets., Conclusions: Most of the literature on determinants of dental caries has been limited to socio-economic and behavioural aspects: we found few studies evaluating the effects of family environment and parental oral hygiene behaviour. Children belonging to lower socio-economic classes experienced more caries. In more than half the studies, children of highly educated, professional and high income parents were at lower risk for dental caries. There were conflicting results from studies on the effect of variables related to family environment, parents' oral hygiene behaviour and parent's disease status on dental caries in their children., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Malignancies of the upper aero-digestive tract are a major public health problem, especially in the Asia Pacific. Certain Human papillomaviruses (HPVs) are well-established risk factors for carcinoma of the uterine cervix and for a subset of head and neck carcinomata: however their true importance in different populations and anatomical subsites remains unclear. The major risk factors in Asia Pacific remain smoked/smokeless tobacco, areca nut, alcohol abuse and poor diet, with limited evidence for HPVs. We review published studies of association of HPV with anatomical site-specific Head & Neck Squamous Cell Carcinoma (HNSCC) in these populations and attempt a meta-analysis., Materials and Methods: From MEDLINE/PubMed/WEB-of SCIENCE/EMBASE/Scopus databases we found 67 relevant studies with a total of 7280 cases: 15 case-control studies met our inclusion criteria for meta-analysis, totaling 1106 cases & 638 controls. HPV detection rates, sample site and size, and methods of tissue preservation and HPV detection were tabulated for each study., Results: Studies were heterogeneous in terms of sample selection and method of detection of HPVs. Most were of limited quality. Averaging data from 67 studies of HNSCC, the prevalence of HPV of any subtype is approximately 36%. PCR (polymerase chain reaction) was the most used detection method and HPV16 the most common genotype reported. Meta-analyses of case-control studies from this region reveal significant heterogeneity but suggest higher HPV prevalence in oropharyngeal cancer (OR: 14.66; 95%CI: 6.09-35.26) compared to oral cavity cancer and laryngeal cancer; (OR: 4.06; 95%CI: 3.05-5.39 & OR: 3.23; 95%CI: 1.37-7.61) respectively., Conclusion: In view of the significant association of HPV with HNSCC, studies with accurate subsite classification and more sensitive detection methods are necessary. Accurate data from this geographical region are essential to inform public health policies and treatment decisions, especially as studies from Europe and North America reveal HPV-driven cancers to be less aggressive, permitting treatment de-intensification., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Upper aero-digestive tract (UADT) cancers are collectively cancers of various human body sites, such as the oral cavity, pharynx, oesophagus and larynx. Worldwide, they are the fourth most frequent cancer type and the fourth most common cause of mortality from cancer. Many studies have shown that several chronic diseases, such as cancer, which occur more commonly in later adulthood, are influenced by social and psychological circumstances during birth, childhood, adolescence and early adult life. It is suggested that the build up of problematic circumstances throughout life is the cause of disease, rather than circumstances that happen at one point in time. UADT cancer is a chronic disease of complex multifactorial origin and most of the underlying exposures/risks cannot be considered as individual factors or in isolation, as they act at different levels, which differ from time to time. Thus, life-course epidemiology, rather than drawing false dichotomies between different risk factors of the underlying disease, attempts to integrate biological and social risk processes that cause the chronic disease. It studies how socially patterned exposures during all stages of life--childhood, adolescence and early adult--influence disease risk in adulthood and socio-economic position and hence may account for social inequalities in adult health and mortality. Furthermore, varying health effects, according to the timing or duration of exposure to socio-economic circumstances, may indicate important traces to the causes of cancer. In this paper, we have attempted to draw a conceptual framework on the relationships between socio-economic inequalities, oral health risk factors along the life-course of an individual and incidence of UADT cancer., (© 2015 FDI World Dental Federation.)

There is a paucity of literature on quality of life (QoL) in patients with oral potentially malignant disorders (OPMDs) despite these conditions being relatively common, chronic, and potentially debilitating. The aim of this paper is to systematically review the literature on QoL in patients with OPMDs. A search from electronic databases PUBMED, MEDLINE, and CINAHL Plus retrieved 180 titles after removing duplicates, and a further 4 papers were identified by hand searching. Study of the abstracts identified 25 truly relevant articles, which were studied in full. Of these, 14 met our strict inclusion criteria. Most studies were cross-sectional; most were from Europe and have evaluated QoL in patients with oral lichen planus (OLP). The findings differ but, overall, do not provide evidence that patients with OPMDs have a poorer QoL compared with healthy patients. Several things may explain this apparently surprising conclusion. First, the quality of most articles was moderate or weak; second, most studies assessed QoL only in patients with OLP and cannot be generalized to all patients with OPMDs; last, direct comparisons between patients with OPMD and healthy controls were rarely included. The validity of the QoL instrument used for patients with OLP was frequently inadequate., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: Cost-utility analysis is widely used in high-income countries to inform decisions on efficient health care resource allocation. Cost-utility analysis uses the quality-adjusted life-year as the outcome measure of health. High-income countries have undertaken health state valuation (HSV) studies to determine country-specific utility weights to facilitate valuation of health-related quality of life. Despite an evident need, however, the extent of HSVs in low- and middle-income countries (LMICs) is unclear., Methods: The literature was searched systematically by using four databases and additional Web searches to identify HSV studies carried out in LMICs. The Preferred Reporting System for Systematic Reviews and Meta-Analysis (PRISMA) strategy was followed to ensure systematic selection of the articles., Results: The review identified 17 HSV studies from LMICs. Twelve studies were undertaken in upper middle-income countries, while lower middle- and low-income countries contributed three and two studies, respectively. There were 7 generic HSV and 10 disease-specific HSV studies. The seven generic HSVs included five EuroQol five-dimensional questionnaire, one six-dimensional health state short form (derived from short-form 36 health survey), and one Assessment of Quality of Life valuations. Time trade-off was the predominant valuation method used across all studies., Conclusions: This review found that health state valuations from LMICs are uncommon and utility weights are generally unavailable for these countries to carry out health economic evaluation. More HSV studies need to be undertaken in LMICs to facilitate efficient resource allocation in their respective health systems., (Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.)

Background: In 2009, the School of Dentistry and Oral Health, Griffith University, commenced a clinical placement in a remote rural and Indigenous community in Australia. This paper analyses the type of treatment services provided from 2009 to 2011 by year, type of patient and age of patient., Methods: All treatment data provided were captured electronically using the Australian Dental Association (ADA) treatment codes. Audited reports were analysed and services categorised into six broad treatment types: consultation, diagnostic, preventive, periodontics, oral surgery and restorative services., Results: The bulk of dental care episodes provided over the three-year period were for clinical examinations, restorative and oral surgery services. Preventive and periodontic services generally comprised less than 10% of the care provided. Over time fewer clinical examinations were conducted and restorative dentistry increased in the second and third years of the placement. There were no significant differences in the types of care provided to public and private patients., Conclusion: Clinical placement of final-year dental students in remote rural settings has helped address a largely unmet dental need in these regions., Implications: Dental student clinical placement is effective in providing care to communities in a remote rural setting. Student placements are, however, only able to deliver dental care in few remote rural communities, and therefore will make a negligible impact on the level of untreated dental disease in the short term. It is hoped that the experience will lead to more graduates serving some of their professional lives in remote communities., (© 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.)

Objectives: India has the highest number of cases of oral cancer in the world and this is increasing. This burden is not fully appreciated even within India, despite the high incidence and poor survival associated with this disease. Because the aetiology of oral cancer is predominantly tobacco-related, the immense public health challenge can be ameliorated through habit intervention., Methods: We reviewed current rates of incidence, mortality and survival, and investigated the determinants of disease and current prevention strategies., Results: In addition to tobacco smoking and the myriad other forms of tobacco use prevalent in India, risk factors include areca nut consumption, alcohol consumption, human papillomavirus, increasing age, male gender and socioeconomic factors. Although India has world-leading cancer treatment centres, access to these is limited. Further, the focus of health care services remains clinical and is either curative or palliative., Conclusions: Although the efforts of agencies such as the Ministry of Health and Family Welfare and the Indian Dental Association are laudable, enhanced strategies should be based on common risk factors, focusing on primary prevention, health education, early detection and the earliest possible therapeutic intervention. A multi-agency approach is required., (© 2012 FDI World Dental Federation.)

We investigated the prevalence of, and risk factors for, oral potentially malignant disorders (OPMDs) in rural Sri Lanka. A cross-sectional community-based study was conducted by interview and oral examination of 1029 subjects aged over 30 years. A community-based nested case-control study then took those with OPMDs as 'cases', "controls" being those with no oral abnormalities at time of initial screening. The prevalence of OPMD was 11.3% (95% CI: 9.4-13.2), after weighting for place of residence and gender. Risk factors were betel-quid (BQ) chewing daily [OR=10.6 (95% CI: 3.6-31.0)] and alcohol drinking daily or weekly [OR=3.55 (1.6-8.0)]. A significant dose-response relationship existed for BQ chewing. Smoking did not emerge when adjusted for covariates. A synergistic effect of chewing and alcohol consumption existed. The attributable risk (AR) of daily BQ chewing was 90.6%, the population AR 84%. This study demonstrates high prevalence of OPMD, betel-quid chewing with or without tobacco being the major risk factor., (Copyright 2010 Elsevier Ltd. All rights reserved.)

The periodontal diseases are highly prevalent and can affect up to 90% of the worldwide population. Gingivitis, the mildest form of periodontal disease, is caused by the bacterial biofilm (dental plaque) that accumulates on teeth adjacent to the gingiva (gums). However, gingivitis does not affect the underlying supporting structures of the teeth and is reversible. Periodontitis results in loss of connective tissue and bone support and is a major cause of tooth loss in adults. In addition to pathogenic microorganisms in the biofilm, genetic and environmental factors, especially tobacco use, contribute to the cause of these diseases. Genetic, dermatological, haematological, granulomatous, immunosuppressive, and neoplastic disorders can also have periodontal manifestations. Common forms of periodontal disease have been associated with adverse pregnancy outcomes, cardiovascular disease, stroke, pulmonary disease, and diabetes, but the causal relations have not been established. Prevention and treatment are aimed at controlling the bacterial biofilm and other risk factors, arresting progressive disease, and restoring lost tooth support.

Despite the reported increase in the incidence of oral squamous cell carcinoma (OSCC) in under 45-year-olds, little is known regarding the pattern and reasons for delay in presentation in this younger age group. The aim of this study was to investigate factors predictive of patient (primary) delay in a sample of 53 newly diagnosed patients under the age of 45 years. Multiple logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for primary delay (> or = 21 days between patient first noticing signs or symptoms and seeking professional advice). Self-reported delay ranged from less than 1 week to 104 weeks, with a median of 5 weeks. A total of 33 patients (62%) reported a delay of at least 21 days. Three variables: lack of further education, perceptions of being under stress in the period prior to diagnosis, and lower amounts of tobacco smoked per day were included in the final model and together explained 43% of the variance in patient delay (R2 = 0.432). Although OSCC is relatively rare in this age group, the rise in incidence and the change in profile of risk factors may increase the odds of patient delay. This has important implications for increasing sign and symptom awareness among the public and primary health care professionals such as general medical practitioners and general dentists., (Copyright 2004 Elsevier Inc.)

The incidence of oral cancer amongst young adults is increasing in many European and high incidence countries. The aim of this study was to evaluate the major risk factors for oral cancer in young adults using a case-control design. A sample of 116 patients aged 45 years and younger, diagnosed with squamous cell carcinoma of the oral cavity between 1990 and 1997 from the south east of England were included. Two-hundred and seven controls who had never had cancer, matched for age, sex and area of residence, were recruited. The self-completed questionnaire contained items about exposure to the following risk factors: tobacco products, cannabis, alcohol and diet. Conditional logistic analyses were conducted adjusting for social class, ethnicity, tobacco and alcohol habits. All tests for statistical significance were two-sided. The majority of oral cancer patients reported exposure to the major risk factors of tobacco and alcohol even at this younger age. The estimated risks associated with tobacco or alcohol were low (OR range: 0.6-2.5) among both males and females. Only smoking for 21 years or more produced significantly elevated odds ratios (OR=2.1; 95% CI: 1.1-4.0). Exposure associated with other major risk factors did not produce significant risks in this sample. Long term consumption of fresh fruits and vegetables in the diet appeared to be protective for both males and females. The results suggest that although this younger sample exhibit similar behavioural risk factors to older oral cancer patients, the low odds produced in addition to the relatively short duration of exposure, suggest that factors other than tobacco and alcohol may be implicated in the development of oral cancer in these younger patients.