Progression of oral lesions to cancer

A group of molecular markers have been identified that can help clinicians determine which patients with low-grade oral premalignant lesions are at high risk for progression to oral cancer, according to data from the Oral Cancer Prediction Longitudinal Study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

"The results of our study should help to build awareness that not everyone with a low-grade oral premalignant lesion will progress to cancer," said Miriam Rosin, Ph.D., director of the Oral Cancer Prevention Program at the BC Cancer Agency in Vancouver, British Columbia, Canada. "However, they should also begin to give clinicians a better idea of which patients need closer follow-up."

Oral cancers are a global public health problem with close to 300,000 new cases identified worldwide each year. Many of these cancers are preceded by premalignant lesions. Severe lesions are associated with a high progression risk and should be treated definitively. However, the challenge within the field has been to distinguish which low-grade lesions are the most likely to progress to cancer.

In 2000, Rosin and colleagues used samples of oral premalignant lesions where progression to cancer was known to have subsequently occurred in order to develop a method for grouping patients into low-risk or high-risk categories based on differences in their DNA. In their current population-based study, they confirmed that this approach was able to correctly categorize patients as less or more likely to progress to cancer.

They analyzed samples from 296 patients with mild or moderate oral dysplasia identified and followed over years by the BC Oral Biopsy Service, which receives biopsies from dentists and ENT surgeons across the province. Patients classified as high-risk had an almost 23-fold increased risk for progression.

Next, two additional DNA molecular risk markers called loss of heterozygosity were added to the analysis in an attempt to better differentiate patients' risks. They used the disease samples from the prospective study, and categorized patients into low-, intermediate- and high-risk groups.

"Compared with the low-risk group, intermediate-risk patients had an 11-fold increased risk for progression and the high-risk group had a 52-fold increase in risk for progression," Rosin said.

Of patients categorized as low-risk, only 3.1 percent had disease that progressed to cancer within five years. In contrast, intermediate-risk patients had a 16.3 percent five-year progression rate and high-risk patients had a 63.1 percent five-year progression rate.

"That means that two out of every three high-risk cases are progressing," Rosin said. "Identifying which early lesions are more likely to progress may give clinicians a chance to intervene in high-risk cases, and may help to prevent unnecessary treatment in low-risk cases."

Moms linked to teen oral health, says CWRU dental study

A mother’s emotional health and education level during her child’s earliest years influence oral health at age 14, according to a new study from Case Western Reserve University’s School of Dental Medicine.

Researchers started with the oral health of the teens and worked backwards to age 3 to find out what factors in their past influenced their oral health outcomes._While mothers were interviewed, lead investigator Suchitra Nelson, professor in the dental school, believes it can apply to whoever is the child’s primary caregiver.

Nelson’s team examined the teeth of 224 adolescent participants in a longitudinal study that followed very low birth weight and normal birth weight children. Over the years, researchers gathered health and medical information from the children and their mothers to assess the child’s wellbeing at age 3, 8 and now 14. _The researchers analyzed the teen’s oral health by counting the number of decayed, filled or missing permanent teeth and assessed the level of dental plaque, a symptom for poor oral hygiene.

Mothers completed a questionnaire about preventative treatments from sealants to mouthwashes, sugary juice or soft drink consumption and access to dental care and frequency of dental visits.

The data revealed that even with access to dental insurance, fluoride treatments and sealants as young children, it did not always prevent cavities by the age of 14, said Nelson, professor of community dentistry at Case Western Reserve dental school.

She is lead investigator on the Journal of Dental Research article, “Early Maternal Psychosocial Factors are Predictors for Adolescent Caries.”

What did prevent cavities in teens?

Using a statistical modeling program that tracked pathways from the teen’s dental assessments back to the source of where the oral health originated led researchers right to mothers and their overall emotional health, education level and knowledge when children were at ages 3 and 8.

The researchers found if mothers struggled in any of the three areas, the oral health of the teens at age 14 resulted in higher numbers of oral health problems.

“We can’t ignore the environments of these children,” Nelson said. “It isn’t enough to tell children to brush and floss, they need more—and particularly from their caregivers.”

The oral health boost comes from mothers, who muster coping skills to handle everyday stresses and develop social networks to provide for their children’s needs.

It was found that mothers with more education beyond high school, with healthy emotional states and knowledge about eating right had children with healthier teeth.

“We cannot ignore these environmental influences and need interventions to help some moms get on track early in their children’s lives,” Nelson concludes.

Nelson says moms need to care for themselves to help their children. She likens it to the emergency instructions on an airplane that mothers put on the mask first and then their children. “How can a mother help her child if she passes out,” asks Nelson. “It’s all common sense, but some mothers may need help.”

Poor Oral Health Can Mean Missed School, Lower Grades

Poor oral health, dental disease, and tooth pain can put kids at a serious disadvantage in school, according to a new Ostrow School of Dentistry of USC study.

“The Impact of Oral Health on the Academic Performance of Disadvantaged Children,” appearing in the September 2012 issue of the American Journal of Public Health, examined nearly 1500 socioeconomically disadvantaged elementary and high school children in the Los Angeles Unified School District, matching their oral health status to their academic achievement and attendance records.

Ostrow researchers had previously documented that 73 percent of disadvantaged kids in Los Angeles have dental caries, the disease responsible for cavities in teeth. The new study shines light on the specific connection between oral health and performance in school for this population, said Roseann Mulligan, chair of the school’s Division of Dental Public Health and Pediatric Dentistry and corresponding author of the study.

Children who reported having recent tooth pain were four times more likely to have a low grade point average—below the median GPA of 2.8—when compared to children without oral pain, according to study results.

Poor oral health doesn’t just appear to be connected to lower grades, Mulligan said, adding that dental problems also seem to cause more absences from school for kids and more missed work for parents.

“On average, elementary children missed a total of 6 days per year, and high school children missed 2.6 days. For elementary students, 2.1 days of missed school were due to dental problems, and high school students missed 2.3 days due to dental issues,” she said. “That shows oral health problems are a very significant factor in school absences. Also, parents missed an average of 2.5 days of work per year to care for children with dental problems.”

A factor in whether children miss school due to dental health issues was the accessibility of dental care. Eleven percent of children who had limited access to dental care—whether due to lack of insurance, lack of transportation, or other barriers—missed school due to their poor oral health, as opposed to only four percent of children who had easier access to dental care.

“Our data indicates that for disadvantaged children there is an impact on students’ academic performance due to dental problems. We recommend that oral health programs must be more integrated into other health, educational and social programs, especially those that are school-based,” Mulligan said. “Furthermore, widespread population studies are needed to demonstrate the enormous personal, societal and financial burdens that this epidemic of oral disease is causing on a national level. ”