Oral diseases最新文献

Background: This study examined the impact of early childhood exposure to China's 1959-1961 famine on the likelihood of adult edentulism.

Methods: We used data from 8209 adults surveyed in 2011-2012 China Health and Retirement Longitudinal Study (CHARLS). Logistic regression was used to analyze the odds ratios (ORs) and confidence intervals (CIs) of early starvation and edentulism in adulthood.

Results: Compared with unexposed individuals, famine-exposed individuals had a significantly increased odds of edentulism. After adjustment for age, sex, location, severity, income, education, smoking, drinking, hypertension, dyslipidaemia, diabetes, and heart disease, the final ORs (95% CIs) were 2.097 (1.047, 4.355) for the foetal exposure group, 2.625 (1.245, 5.746) for the preschool group, and 3.907 (1.608, 9.726) for the school-age exposure group.

Conclusions: Exposure to China's 1959-1961 famine during early childhood is associated with significantly increased odds of edentulism in adulthood, particularly among those exposed during school age (OR = 3.907; 95% CI: 1.608-9.726).

Objectives: Stable condyle positioning is crucial for temporomandibular joint (TMJ) function, but its long-term stability in patients undergoing segmental mandibulectomy with free fibular flap (FFF) reconstruction is unclear. This study aimed to assess the long-term stability of TMJ parameters and the factors influencing it.

Methods: This retrospective study included patients who underwent mandibular reconstruction using FFF with condyle preservation. CBCT was used to assess TMJ measurements at four time points: pre-surgery (T0), 1 ± 1 month (T1), 6 ± 1 months (T2), and at least 20 ± 4 months post-surgery (T3). Parameters such as condylar inclination, position, dimensions, and joint spaces were measured.

Results: A total of 89 patients participated (51 with conventional freehand, 38 with 3D procedure). Condylar position changed over time: the operated side showed a slight downward shift, and the contralateral side showed inward and medial movement. Factors affecting condylar stability included surgical accuracy, mandible angle involvement, defect location (especially if crossing midline), and postoperative radiation therapy (p < 0.05).

Conclusion: TMJ parameters are highly sensitive to skeletal changes post-reconstruction with condylar preservation. Our findings suggest that condylar position lacks long-term stability after surgery. Further studies are needed to assess clinical outcomes and disc-condyle relationship after mandibular reconstruction.

Background: Histological grading of oral epithelial dysplasia (OED) is used for predicting malignant transformation risk. However, grading is associated with significant subjectivity and observer variability leading to inconsistency in prognosis prediction. Alternate histological feature-specific models ('six-point' and 'two-point') have been shown to have potentially better prognostic reliability than conventional grading. This study conducts a multicentre validation of these models.

Methods: 102 OED cases (dating 2012-2017) were acquired from 4 independent centres (13 (13%) Sheffield; 40 (39%) Belfast; 30 (29%) Birmingham; 19 (19%) Piracicaba, Brazil) were independently scored using the 'six-point' and 'two-point' models. Feature prevalence, observer agreement and malignant transformation risk were evaluated and compared to conventional grading systems.

Results: The 'six-point' system demonstrated superior predictive value (AUROC of 0.81) compared to the 'two-point' system (AUROC = 0.73, p = 0.004), WHO grading (AUROC = 0.71, p = 0.03) and binary grading (AUROC = 0.68, p = 0.009). Transformation rate for the 'six-point' model was 50% (95% CI 27%-78%) when all 6 features were present compared to 14% (95% CI 5%-32%) when 2-3 features were present.

Conclusions: This study supports the superior performance of the 'six-point' system for transformation prediction on a multicentric sample. Findings indicate that feature-specific models may be more reliable than existing histological grading systems for prognosis prediction.

Objective: To estimate the time intervals from first symptom to treatment initiation and to explore the multifaceted challenges faced by patients with oral cavity and oropharynx squamous cell carcinoma (OCSCC and OPSCC) during their diagnostic journey.

Methods: A cross-sectional study was conducted with 182 patients diagnosed with OCSCC or OPSCC admitted at the São Paulo State Cancer Institute between January 2019 and November 2020. The patient interval (PI), health system diagnostic interval (HSDI), and pretreatment interval (PTI) were evaluated.

Results: Most patients were diagnosed at stage T3/T4 for both OCSCC (74.1%) and OPSCC (77.4%). The median PI was 1 month (IQR: 0-3), the median HSDI was 3 months (IQR: 2-6), and the median PTI was 3 months (IQR: 2-4). Patients with p16-positive OPSCC were slightly more likely to experience a longer PI (IRR = 2.38; 95% CI: 1.00-5.67; p = 0.0499). The number of healthcare services visited showed the strongest association with progressively increased HSDI.

Conclusions: Sociodemographic and clinical factors were associated with variations in the duration of the interval from symptom onset to treatment initiation. Targeted interventions to streamline referral pathways, strengthen professional training, and increase awareness among high-risk populations could substantially improve timeliness of care and patient outcomes.

Objective: To identify T1N0M0 oral tongue squamous cell carcinoma (OTSCC) patient subgroups benefiting most from neck dissection (ND) based on the SEER database.

Methods: Patients with T1N0M0 OTSCC were identified from the SEER database. Propensity score-matching (PSM) was utilized to balance baseline characteristics between ND and non-ND groups. Survival differences between these groups were compared using Kaplan-Meier (K-M) analysis and log-rank tests. Additionally, a multivariable Cox regression model was applied to the pre-matched cohort to identify independent prognostic factors.

Results: In total, 2426 cases were included. In the multivariable model adjusted for key prognosticators, ND was an independent factor associated with significantly improved OS and DSS. After PSM, 1702 well-balanced patients were analyzed. Subgroup analyses based on tumor characteristics revealed that favorable survival outcomes associated with ND were predominantly observed in patients with tumor sizes 11-20 mm and those with moderate or poor/undifferentiated differentiation. For patients with small tumors (1-10 mm) or well-differentiated histology, survival outcomes were comparable between the ND and observation groups.

Conclusion: ND was associated with improved survival for T1N0M0 OTSCC patients with 11-20 mm tumors and moderate/poor/undifferentiated differentiation. For patients with smaller tumors (1-10 mm) or well-differentiated histology, the observation strategy had demonstrated survival benefits comparable to ND.

Background: Cancer cells remodel blood vessels to create a tumor-supportive environment; however, the spatial distribution of these vessels and their prognostic significance in oral squamous cell carcinoma (OSCC) remain poorly defined.

Methods: We established an open-source pipeline to quantify vascular area (VA) in both the inner tumor (InT) and invasive tumor front (ITF) regions from CD31-stained whole-slide images (discovery cohort, n = 66). The associations between VA and patient survival were assessed via univariate and multivariate analyses. Findings were validated in an independent cohort (n = 70) immunostained with CD34.

Results: VA was significantly higher in the InT region compared to the ITF (p = 0.0079). A higher VA in the ITF was independently associated with favorable overall survival (discovery: HR 0.28, 95% CI 0.11-0.73, p = 0.009; validation: HR 0.18, 95% CI 0.07-0.47, p < 0.001) and disease-free survival (discovery: HR 0.34, 95% CI 0.14-0.81, p = 0.015; validation: HR 0.25, 95% CI 0.11-0.53, p < 0.001).

Conclusion: Our findings provide the first evidence that high VA in the ITF is associated with a better prognosis in OSCC.

Objectives: Oral frailty, an intermediate stage between healthy and declined oral function, involves impairments such as tooth loss and chewing difficulty. Socioeconomic conditions may influence oral frailty risk. This study examined the socioeconomic inequalities in oral frailty and its components among older adults in Japan.

Methods: This cross-sectional study used 2022 questionnaire data from the Japan Gerontological Evaluation Study of adults aged ≥ 65 years. Dependent variables included oral frailty and its five components. Oral frailty was defined as having ≥ 2 of the following: fewer teeth, dry mouth, and difficulty in chewing, swallowing, or speaking. Independent variables were socioeconomic factors, comprising educational attainment, income, wealth, and pension type. Age and sex were adjusted as confounders. The Slope Index of Inequality (SII) and Relative Index of Inequality (RII) were estimated after applying multiple imputation to address missing data.

Results: A total of 21,924 older adults were included. The prevalence of oral frailty was 33.6%. Significant inequalities were identified across all socioeconomic factors. Wealth showed the greatest inequality, with an adjusted SII of 0.17 (95% confidence interval (CI): 0.14-0.20) and RII of 1.66 (95% CI: 1.52-1.82).

Conclusions: Substantial socioeconomic inequalities in oral frailty were observed, with wealth being the most influential factor.