Faculty Bibliography

Oral squamous cell carcinoma (SCC) has an unpredictable capacity to metastasize to the neck, an event that dramatically worsens prognosis. Metastasis occurs even in earlier stages when no neck lymph node involvement is clinically detectable (N0). Management of the N0 neck, namely when and how to electively treat, has been debated extensively. This article presents the controversies surrounding management of the N0 neck, and the benefits and pitfalls of different approaches used in evaluation and treatment. As current methods of assessing the risk for occult metastasis are insufficiently accurate and prone to underestimation of actual risk, and because selective neck dissection (SND) is an effective treatment and has minimal long-term detriment to quality of life, the authors believe that all patients who have oral SCC, excluding lip SCC, should be prescribed elective treatment of the neck lymphatics. However, this opinion remains controversial. Because of the morbidity of radiation therapy and because treatment of the primary tumor is surgical, elective neck dissection is the preferred treatment. In deciding the extent of the neck dissection, several retrospective studies and one randomized clinical trial have shown SND of levels I through III to be highly efficacious

In this study, we investigated the role of the peripheral endothelin-1 (ET-1) concentration in a cancer pain model. To test the hypothesis that the concentration of ET-1 in the tumor microenvironment is important in determining the level of cancer pain we used two cancer pain mouse models that differed significantly in production of ET-1. The two mouse cancer models were produced by injection of cells derived from a human oral squamous cell carcinoma (SCC) and melanoma into the hind paw of female mice. Pain, as indicated by reduction in withdrawal thresholds in response to mechanical stimulation, was significantly greater in the SCC group than the melanoma group. The peripheral concentration of ET-1 within the cancer microenvironment was significantly greater in the SCC group. Intra-tumor expression of both ET-1 mRNA and ET-1 protein were significantly higher in the SCC model compared to the melanoma model. ET receptor antagonism was effective as an analgesic for cancer pain in the SCC model only. To address the potential confounding factor of tumor volume we evaluated the contribution of tumor volume to cancer pain in the two models. The mean volumes of the tumors in the melanoma group were significantly greater than the tumors in the SCC group. In both groups, the pain level correlated with tumor volume, but the correlation was stronger in the melanoma group. We conclude that ET-1 concentration is a determinant of the level of pain in a cancer pain mouse model and it is a more important factor than tumor volume in producing cancer pain. These results suggest that future treatment regimens for cancer pain directed at ET-1 receptor antagonism show promise and may be tumor type specific

PURPOSE: Squamous cell carcinomas of the hard palate, maxillary gingiva, and maxillary alveolus occur at relatively low rates compared with squamous cell carcinomas in other oral sites. There is little within the surgical literature to guide treatment for maxillary squamous cell carcinoma. To date, only 1 other group has addressed neck management in the oral maxillary squamous cell carcinoma patient presenting with a clinically negative neck. Adequate characterization of maxillary gingival carcinoma behavior with respect to regional cervical metastasis is wanting. PATIENTS AND METHODS: We present a retrospective review of our own clinical experience as well as a review of the existing literature. RESULTS: In our University of California San Francisco patient group, cervical disease was detected in 20% of those individuals with maxillary squamous cell carcinoma presenting for initial consultation. After ablative surgery, those individuals who presented with clinically negative necks had a 21.4% rate of regional node metastasis. Ultimately, 50% of our patients with squamous cell carcinomas of the palate, maxillary gingiva, and maxillary alveolus developed regional or metastatic distant disease; 42.9% of the patients manifested disease to the cervical lymph nodes alone. CONCLUSIONS: The cases of oral maxillary squamous cell carcinomas reviewed herein exhibit aggressive regional metastatic behavior comparable to that of such carcinomas of the tongue, floor of the mouth, and mandibular gingiva. Based on the findings presented herein, we recommend selective neck dissection in the setting of a clinically negative neck as a primary management strategy for patients with oral maxillary squamous cell carcinomas involving the palate, maxillary gingiva, and maxillary alveolus

We investigated the cannabinoid receptor (CBr) agonists Win55,212-2 (non-selective) and AM1241 (CBr2 selective) and the peripheral receptor (CBr1) in carcinoma-induced pain using a mouse model. Tumors were induced in the hind paw of female mice by local injection of a human oral squamous cell carcinoma (SCC). Significant pain, as indicated by reduction in withdrawal thresholds in response to mechanical stimulation, began at 4 days after SCC inoculation and lasted to 18 days. Local administration of Win55,212-2 (10 mg/kg) and AM1241 (10 mg/kg) significantly elevated withdrawal thresholds, indicating an antinociceptive effect. Ipsilateral expression of CBr1 protein in L5 DRG was significantly upregulated compared to ipsilateral L4 DRG and in normal tissue. These findings support the suggestion that cannabinoids are capable of producing antinociception in carcinoma-induced pain

For years, the notion of chin ptosis was somehow integrated with the concept of witch's chin. That was a mistake on many levels because chin droop has four major causes, all different and with some overlap. With this article, the surgeon can quickly diagnose which type and which therapeutic modality would work best. In some cases the problem is a simple fix, in others the droop can only be stabilized, and in the final two, definite corrective procedures are available. Of note, in certain situations two types of chin ptosis may overlap because both the patient and the surgeon may each contribute to the problems. For example, in dynamic ptosis, a droop that occurs with smile in the unoperated patient can be exacerbated and further produced by certain surgical methods also. This paper classifies the variations of the problems and explains the anatomy with the final emphasis on long-term surgical correction, well described herein. This article is the ninth on this subject and a review of them all would be helpful (greatly) for understanding the enigmas of the lower face

The routine evaluation of teaching effectiveness is important in improving faculty, departmental, and institutional efforts. There are three main categories of assessments: those performed by students, peers, and self. Although each category is independently valid, a collection of data from all three categories leads to a more comprehensive outcome and a creation of a triangulation model. The purpose of this study was to identify commonly used methods of assessing teaching effectiveness and to suggest the use of a triangulation model, which has been advocated in the literature on performance assessment as an optimal approach for evaluating teaching effectiveness. A twelve-question survey was sent to all U.S. dental schools to identify evaluation methods as well as to find evidence of triangulation. Thirty-nine out of fifty-seven schools responded. The majority of the schools used student evaluations (81 percent) and peer reviews (78 percent). A minority of schools reported using self-evaluations (31 percent). Less than one in five dental schools reported using all three strategies to achieve triangulation (19 percent). The three most commonly used evaluation methods ('performed routinely') were all in the student evaluation category. Less than half of the schools routinely evaluated clinical teaching effectiveness by any means (42 percent). In conclusion, dental schools should implement a triangulation process, in which evaluation data are obtained from students, peers, and self to provide a comprehensive and composite assessment of teaching effectiveness

The implementation of an implant dental curriculum in U.S. dental schools has been consistently increasing from 33 percent in 1974 to 97 percent in 2004. Among these, only 51 percent have clinical components implemented. A survey of students conducted in 2004 at New York University College of Dentistry (NYUCD) showed an inadequacy in clinical implant restoration experience by graduation. This prompted the development of an extensive dental implant curriculum at NYUCD to meet the needs of the dental students. This report addresses the challenges in implementing such a curriculum and describes a step-by-step approach to develop a program that encompasses didactic, simulation, and patient care components. In 2005, a fully integrated predoctoral implant curriculum was initiated. In 2008, nearly all of the NYUCD students (91.8 percent) completed implant restorations/prosthesis on patients. An assessment revealed a 30 percent increase in students' positive perceptions of the implant curriculum. Based on our experiences at NYUCD, it is recommended that an implant curriculum become part of the core predoctoral curriculum and be integrated throughout the four years of dental education. This article reports on a model for a pre-doctoral implant curriculum, which includes planning, curriculum implementation, program management, and post-implementation stages. Using this model, dental schools can develop implant education for their students that is adapted to their institutional missions, priorities, and resources

AIM: Static Hertzian contact tests of monolayer glass-ceramics in trilayer configurations (glass-ceramic/cement/composite) have shown that thick cement layers lower strength. This study sought to test the hypothesis that thick resin cement layers lower mouth motion fatigue reliability for flat glass-ceramic/cement/composite trilayer systems and that aging in water reduces reliability. METHODS: Dicor plates (n > or = 12 per group) (10 x 10 x 0.8 mm(3)) were aluminum-oxide abraded (50 microm), etched (60 s), silanized, and bonded (Rely X ARC) to water aged (30 days) Z100 resin blocks (10 x 10 x 4 mm(3)). Four groups were prepared: (1) thick cement layer (>100 microm) stored in water for 24-48 h, (2) thick cement layer stored for 60 days, (3) thin cement layer (< or =100 microm) stored for 24-48 h, and (4) thin cement layer stored for 60 days. The layered structures were fatigued (2 Hz) utilizing mouth motion loading with a step-stress acceleration method. A master Weibull distribution was calculated and reliability determined (with 90% confidence intervals) at a given number of cycles and load. RESULTS: The aged group (60 d) with thick cement layer had statistically lower reliability for 20,000 cycles at 150 N peak load (0.11) compared with both nonaged groups (24-48 h) (thin layer = 0.90 and thick layer = 0.82) and aged group with thin cement layer (0.89). CONCLUSION: Trilayer specimens with thick cement layers exhibited significantly lower reliability under fatigue testing only when stored for 60 days in water. The hypothesis was accepted. These results suggest that diffusion of water into the resin cement and also to the glass-ceramic interface is delayed in the thick cement specimens at 24-48 h.