Oral cancer awareness for the general practitioner: new approaches to patient care

In Australia, oral cancer accounts for approximately 2-3 per cent of all cancers, and approximately 1 per cent of deaths from cancer. The incidence of intra-oral cancer is gradually increasing. It is now well established that early detection of potentially malignant disease can improve the clinical outcome for patients, and as such it is the responsibility of dentists to identify such lesions early. To facilitate early detection of suspicious oral lesions several clinical methods of detection can be used. In addition to conventional visual screening of oral tissues with the naked eye under projected incandescent or halogen illumination, there are many clinical diagnostic aids that can be undertaken to help detect oral cancer. In this article we explore clinically available modalities that may be used by the general dental practitioner, and highlight their inherent strengths and weaknesses.

An orthodontic information package designed to increase patient awareness

BACKGROUND: Most patients and their parents experience difficulty in fully appreciating the implications and demands of orthodontic treatment. This is largely because of inadequate understanding of the process of treatment or the commitment required. OBJECTIVES: To determine if a specifically developed video information package could significantly increase patient awareness of the implications of a full course of orthodontic treatment. Changes in attitude to orthodontic treatment after viewing the package were also measured. METHODS: Year 7 (12 year-old) students in two primary schools in the City of Gold Coast, Australia were randomly allocated to either a study group or a control group. Knowledge of and attitude to orthodontic treatment were measured with self-administered questionnaires before and after viewing the information package. RESULTS: The intervention group showed a 15 per cent gain in knowledge (p < 0.001). There was no gain in knowledge for the 45 students in the control group. There was no measured change in perception of need for orthodontic treatment in the study group. There was, however, an increase in potential compliance and positive attitude to the appearance of orthodontic appliances. There was a small increase in willingness to undertake treatment, but this was not statistically significant. CONCLUSIONS: The information package developed for this study increased awareness of the implications and practical difficulties which may be encountered during a course of orthodontic treatment, and produced some changes in attitude to treatment.

Use of the Vector (TM) scaling unit in supportive periodontal therapy: a subjective patient evaluation

Background: Patient discomfort is one reason for poor compliance with supportive periodontal therapy (SPT). The aim of this study was to compare the levels of discomfort during SPT, using the Vector (TM) system and treatment with a conventional ultrasonic scaler. Methods: Forty-six patients with an SPT programme were debrided using both the Vector (TM) system and a conventional piezo-electric scaler (Sirona (TM)) in a split mouth design. A visual analogue scale was used to evaluate of pain scores upon completion of treatment. A verbal response scale(VRS) was used to assess discomfort, vibration and noise associated with the scaling system, as well as the volume and taste of the coolant used by these systems. Results: Patients instrumented with the Vector (TM) system experienced approximately half the amount of pain compared with the conventional ultrasonic scaling system. The VRS showed that the Vector (TM) system caused less discomfort than the conventional ultrasonic scaling system when assessed for pain, vibration, noise and volume of coolant. These findings were all statistically significant. There was, however, no statistically significant difference between the two systems when assessed for taste. Conclusion: During SPT the Vector (TM) system caused reduced discomforting sensations compared with conventional methods and may be useful in improving compliance with SPT programmes.

Analysis of the acute postoperative pain experience following oral surgery: identification of 'unaffected', 'disabled' and 'depressed, anxious and disabled' patient clusters

Background: Pain is defined as both a sensory and an emotional experience. Acute postoperative tooth extraction pain is assessed and treated as a physiological (sensory) pain while chronic pain is a biopsychosocial problem. The purpose of this study was to assess whether psychological and social changes Occur in the acute pain state. Methods: A biopsychosocial pain questionnaire was completed by 438 subjects (165 males, 273 females) with acute postoperative pain at 24 hours following the surgical extraction of teeth and compared with 273 subjects (78 males, 195 females) with chronic orofacial pain. Statistical methods used a k-means cluster analysis. Results: Three clusters were identified in the acute pain group: 'unaffected', 'disabled' and 'depressed, anxious and disabled'. Psychosocial effects showed 24.8 per cent feeling 'distress/suffering' and 15.1 per cent 'sad and depressed'. Females reported higher pain intensity and more distress, depression and inadequate medication for pain relief (p

Oral granular cell tumour of the lip in an adult patient

Oral granular cell tumour is a rare soft tissue tumour of mesenchymal origin. The most frequently affected site in the oral cavity is the tongue, followed by the floor of mouth, and buccal mucosa. In paediatric patients, 25% of cases have been reported to occur in the lip, but this presentation in adults is extremely rare. We report a case of oral granular cell tumour in a 35 year-old female, located in the lower lip. Histopathological examination revealed eosinophilic granular cells which stained positively for S-100 protein; a finding supportive of a neural origin. A history of trauma was elicited in this case, and the lesion was treated with surgical excision.