Faculty Bibliography

OBJECTIVE:We aimed to characterize proliferative verrucous leukoplakia (PVL) from a clinical and histopathologic standpoint and suggest an updated classification. SUBJECTS AND METHODS/METHODS:Records of patients seen at three oral medicine centers with a clinical diagnosis of PVL were reviewed for clinical and histopathologic features, and malignant transformation (MT). RESULTS:There were 42 patients (median age: 69 years [range:36-88]; 35 females). 12.2% were current smokers. Family history of cancer was present in 43.7% of patients. Partial demarcation of lesion margins was present in 31.3% of lesions, followed by verrucous (27.5%), smooth (22.7%,) erythematous (22.3%), and fissured (18.3%) appearance. Large and contiguous, and multi-site and noncontiguous lesions, comprised 57.1% (24/42) and 35.7% (15/42) of PVL cases, respectively. 19.1% had prominent erythema (erythroleukoplakia). The most common histopathologic diagnosis at first visit was hyperkeratosis without dysplasia (22/42; 56.4%). MT occurred in 71.4% patients after a median of 37 months [range:1-210] from initial visit; erythroleukoplakia exhibited MT in 100% of cases. CONCLUSION/CONCLUSIONS:The generic term "proliferative leukoplakia (PL)" may be more appropriate than PVL because 18.3% were fissured and 22.7% erythematous. We also propose the term proliferative erythroleukoplakia to more accurately describe the subset of PL with prominent erythema, which had the highest MT rate.

Oral potentially malignant disorders (OPMDs) refer to epithelial lesions and conditions with an increased risk for malignant transformation; oral leukoplakia is the most commonly encountered. Overall, OPMDs have a low risk for malignant transformation, yet the challenge is the difficulty to reliably identify and predict which patients with OPMDs are at the highest risk for malignant transformation. Future research is needed to elucidate the molecular aspects of OPMDs, to improve current diagnostic strategies, leading to personalized management.

Introduction Oral mucositis (OM) is one of the most debilitating adverse effects in patients undergoing cancer treatment. Physiologically, chemotherapy (CT) and radiotherapy (RT) evoke a profound inflammatory response, resulting in mucosal injury, which can result in an increased susceptibility to infection. Objectives The objective of this pilot study was to asses the effects of a novel oral care protocol on OM severity and to evaluate salivary cytokines in head and neck cancer patients undergoing RT or CT/RT at the NYU Langone Laura and Isaac Perlmutter Cancer Center. Methods A total of ten participants were included in this study, and randomized to an InterventionGroup (IG), or ControlGroup (CG). Subjects assigned to the CG received a standard of care oral hygiene on a bi-weekly basis. Subjects assigned to the IG received the Oral Mucosal Deterging and Dental Prophylaxis (OMDP) protocol weekly, which consisted of a periodontal surface debridement and cleansing and deterging of the oral mucosa surfaces. Results Salivary inflammatory biomarkers, noted in levels of IFN-gamma, IL10, IL12p70, IL13, TNFalpha and IL-6 had a significant increase in the CG and reduced or stayed the same under the IG. Although not statistically significant, a tendency of pain decrease was observed in the IG and difficulty in swallowing was statistically significant when both groups were compared (p = 0,016). Conclusions These results suggest that overall inflammation was consistently higher as compared to baseline in the CG, providing encouragement for the effectiveness of the oral care protocol as a coadjutant treatment for this population

A guide to medications inducing salivary gland dysfunction, xerostomia and subjective sialorrhea: A systematic review sponsored by the World Workshop on Oral Medicine VI Background – Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness) and subjective sialorrhea cause significant morbidity and impair quality of life. However, evidence-based lists of medications that cause these disorders do not exist. Objective – To compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea. Data Sources – Electronic databases were searched for relevant articles published until June 2013. Data Synthesis – A total of 269 papers out of a total of 3867 screened records had an acceptable degree of relevance, quality of methodology and strength of evidence. We found 56 chemical substances with higher level of evidence and 50 with a moderate level of evidence of causing the above mentioned disorders. At the first level of the Anatomical Therapeutic Chemical classification system (ATC), 9 out of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices. Limitations – While xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when given in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or not detected in our search. Conclusions – A comprehensive list of medications having documented effects on salivary gland function or symptoms was compiled, which may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful for anticipating adverse effects and help practitioners to consider alternative medications

BACKGROUND: Medication-induced salivary gland dysfunction (MISGD), xerostomia (sensation of oral dryness), and subjective sialorrhea cause significant morbidity and impair quality of life. However, no evidence-based lists of the medications that cause these disorders exist. OBJECTIVE: Our objective was to compile a list of medications affecting salivary gland function and inducing xerostomia or subjective sialorrhea. DATA SOURCES: Electronic databases were searched for relevant articles published until June 2013. Of 3867 screened records, 269 had an acceptable degree of relevance, quality of methodology, and strength of evidence. We found 56 chemical substances with a higher level of evidence and 50 with a moderate level of evidence of causing the above-mentioned disorders. At the first level of the Anatomical Therapeutic Chemical (ATC) classification system, 9 of 14 anatomical groups were represented, mainly the alimentary, cardiovascular, genitourinary, nervous, and respiratory systems. Management strategies include substitution or discontinuation of medications whenever possible, oral or systemic therapy with sialogogues, administration of saliva substitutes, and use of electro-stimulating devices. LIMITATIONS: While xerostomia was a commonly reported outcome, objectively measured salivary flow rate was rarely reported. Moreover, xerostomia was mostly assessed as an adverse effect rather than the primary outcome of medication use. This study may not include some medications that could cause xerostomia when administered in conjunction with others or for which xerostomia as an adverse reaction has not been reported in the literature or was not detected in our search. CONCLUSIONS: We compiled a comprehensive list of medications with documented effects on salivary gland function or symptoms that may assist practitioners in assessing patients who complain of dry mouth while taking medications. The list may also prove useful in helping practitioners anticipate adverse effects and consider alternative medications.