Dental treatments for preventing damage to the jawbones in people with cancer receiving radiotherapy to the head and neck

Osteoradionecrosis (ORN) of the jaws is a serious problem that can happen after people have radiotherapy as part of their treatment for head and neck cancer. ORN refers to the death and exposure of bone that result from damage to the tissues due to being exposed to radiation. ORN is very difficult to treat and it is important that steps are taken to prevent it. In this review, we looked at any treatments that have been used to prevent ORN. Continue reading

Surgical treatments for mouth and throat cancer: uncertainty in the evidence

Oral cancer is among the most common cancers worldwide, with more than 400,000 new cases diagnosed in 2012. This review looks at oral cavity cancer (mouth cancer) and oropharyngeal cancer (throat cancer). The treatment of these cancers can involve surgery, chemotherapy, radiotherapy or a combination of two or all three therapies. This topic area was identified as a priority by the an expert working group for oral and maxillofacial surgery in 2014. Continue reading

Preventing oral cancer by treating oral leukoplakia: limited evidence

shutterstock_163829423Oral leukoplakia is a white patch formed in the mouth lining that cannot be rubbed off. It often does not hurt and may go unnoticed for years. People with leukoplakia develop oral cancer more often than people without it. Preventing this is critical; rates of oral cancer survival longer than five years after diagnosis are low. Drugs, surgery and other therapies have been tried for treatment of oral leukoplakia. Medical and complementary treatments can be locally applied (i.e. directly onto the white patch) or systemic (affecting the whole body, e.g. taken as a pill). Continue reading

EGFR mAb shows promising results for the treatment of oral cancer

OLYMPUS DIGITAL CAMERAOral cancers (cancer of the mouth and cancer of the throat) are the sixth most common cancer worldwide, accounting for an estimated 4% of all cancers. There is a higher frequency of these cancers in men. Smoking, alcohol consumption and betel quid chewing are the main risk factors. Cancer of the throat is associated with infection from the human papilloma virus (HPV), which can be transmitted through sexual contact. Low socioeconomic status (a measure of a person’s income, education and occupation in relation to other people’s) is associated with a higher frequency of oral cancers and poorer survival rates. Survival following a diagnosis of mouth or throat cancer remains poor, with around 50% of people still alive at five years (five-year survival rate).

New therapies targeted at the cells that give rise to oral cancers are being developed. The advantage these may have over conventional chemotherapy is that rather than affecting both healthy and cancerous cells they just target cancer cells. Immunotherapy (also known as biological therapy, biotherapy or biological response modifier therapy) may improve the functioning of the immune system so it is more effective at destroying cancer cells. Local immunotherapy delivers treatment directly into the tumour and systemic immunotherapy targets the whole body, and may be useful for stopping the cancer spreading or the return of primary tumours in more advanced cancer. Continue reading

Testing for oral cancer

shutterstock_177881789Oral cancer (OSCC – oral squamous cell carcinoma) often occurs after a condition called PMD (potentially malignant disorder), which can sometimes progress to cancer. If conditions such as oral cancer or PMD are identified early enough, outcomes for patients can be improved. The current method of diagnosing cancer of the mouth or lips involves the surgical removal of a piece of affected tissue that is sent to a laboratory for histological examination using a microscope (scalpel biopsy). This is painful for patients and involves a delay. The aim of this review was to find out the accuracy of three alternative diagnostic tests that are less invasive and provide more timely results. Continue reading

Cochrane resources on mouth cancer

shutterstock_163829423November is Mouth Cancer Action Month, and the Cochrane Oral Health Group has a range of systematic reviews dedicated to the topic. Mouth cancer can affect anybody; in the UK more than 6,700 people were diagnosed with the condition last year, and more than 2,000 people died from the disease, more than testicular and cervical cancer combined. Here’s what the evidence says… Continue reading

Taking action on oral cancer


Biopsy of a highly differentiated squamous cell carcinoma of the mouth

Cancer of the mouth is a serious condition and only half of those that develop the disease survive after five years. It is the sixth most common cancer across the world. People who are heavy drinkers and also smoke have 38 times more risk of developing oral cancer than those who do neither. Geographic variation in the occurrence of oral cancer around the world is wide. It is the most common cancer for men in India, Sri Lanka and Pakistan and 30% of all new cases of cancer in these countries are oral cancer. Death rates from oral cancer and the negative effects of the disease are high and increasing compared with other forms of cancer, such as breast or colon cancer.

This month is Mouth Cancer Action Month, and the Cochrane Oral Health Group has published a new review and a review update on the diagnosis of oral cancer in The Cochrane Library. Continue reading

New publications from the Oral Health Group in the Cochrane Library, 2013, Issue 2

200Issue 2 of the Cochrane Library for 2013 was released today, and features one new review and three new protocols from the Oral Health Group.

We now have a total of 200 published systematic reviews and protocols on the Library, congratulations to all of our authors, editors and referees on this fantastic achievement!

New review:
Dental extractions prior to radiotherapy to the jaws for reducing post-radiotherapy dental complications
by Shiyana Eliyas, Ahmed Al-Khayatt, Richard WJ Porter, Peter Briggs

This new review aimed to assess the effects of maintaining the patient’s natural dentition during radiotherapy in comparison to extracting teeth before radiotherapy in areas that are difficult to access by the patient and the dentist, should reduction in mouth opening occur after radiotherapy to the jaws. No clinical trials were identified, and there is no high quality evidence on this clinically important topic.

New protocol:
Interventions for the treatment of oral and oropharyngeal cancers: targeted therapy and immunotherapy
by Kelvin KW Chan, Anne-Marie Glenny, Susan Furness, Helen V Worthington

This review is the fourth in a series of Cochrane reviews looking at different treatment modalities for oral cavity and oropharyngeal cancers: surgical treatment, chemotherapy and radiotherapy. There is a great deal of current research into new therapies for cancer and many of these make the headlines in the news. However, there is a significant time lag between laboratory discoveries and the introduction of new treatments into clinical care. This review will evaluate the randomised controlled trials of targeted and immunological therapies for patients with oral cavity or oropharyngeal cancer.

New protocol:
Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients
by Dimitrios Kloukos, Piotr Fudalej, Patrick Sequeira-Byron, Christos Katsaros

The conventional orthognathic surgery for correction of maxillary retrusion/hypoplasia is a Le Fort I osteotomy. Distraction osteogenesis is the surgical process of correction of skeletal deformity utilizing bone lengthening by gradual mechanical distraction. This review will compare the effectiveness of the two methods in patients with orofacial clefts.

New protocol:
Professionally-applied chemically-induced whitening of teeth in adults
by Alonso Carrasco-Labra, Romina Brignardello-Petersen, Nicolás Yanine, Ignacio Araya, Gabriel Rada, R Graham Chadwick

Professionally-applied bleaching treatments have been used for a long time. Despite all of the information available, it is difficult for clinicians to determine which is the most effective treatment for tooth discolouration and the level of potential harms of these treatments. This review aims to assess the evidence about the beneficial and adverse effects of in-office, professionally-applied chemically-induced whitening of teeth in adult patients. It will complement another Cochrane systematic review of the evidence for the use of home-based treatment methods.

New edition of the Cochrane Library is out today!

A new edition of the Cochrane Library has been published, and features one new review and 5 new protocols from the Oral Health Group, a bumper month!

New review: AntibioticsImage to prevent complications following tooth extraction
Giovanni Lodi, Lara Figini, Andrea Sardella, Antonio Carrassi, Massimo Del Fabbro, Susan Furness

This review looks at whether antibiotics, given to dental patients as part of their treatment, prevent infection after tooth extraction. There were 18 studies considered, with a total of 2456 participants who received either antibiotics (of different kinds and dosages) or placebo, immediately before and/or just after tooth extraction. Do they do more harm than good? Follow the link to read more!

New Protocol: Clinical assessment to screen for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults
Tanya Walsh, Joseph LY Liu, Paul Brocklehurst, Mark Lingen, Alexander R Kerr, Graham Ogden, Saman ImageWarnakulasuriya, Crispian Scully

This is a protocol for the Oral Health Group’s first review of diagnostic test accuracy, a new area of research for the Group. The objective of this review is to estimate the accuracy of the conventional oral examination (COE) used singly or in combination with another index test as a screening test for the detection of oral cancer and potentially malignant disorders (PMD) of the lip and oral cavity of apparently healthy adults.

New Protocol: Interventions for replacing missing teeth: alveolar ridge preservation techniques for oral implant site development
Momen A Atieh, Nabeel HM Alsabeeha, Alan GT Payne, Warwick Duncan, Marco Esposito

A protocol for a new review. The aim is to assess the clinical effects of various materials and techniques for alveolar ridge preservation (ARP) after tooth extraction compared with extraction alone and/or other methods of ARP for patients requiring oral implant placement following healing of extraction socket.

ImageNew Protocol:Lasers for caries removal in deciduous and permanent teeth
Alessandro Montedori, Iosief Abraha, Massimiliano Orso, Potito Giuseppe D’Errico, Stefano Pagano, Guido Lombardo

This protocol is for a new review which will compare the effects of laser-based methods to conventional mechanical methods for the removal of dental caries in deciduous and permanent teeth.

New Protocol: Maternal consumption of xylitol for preventing dental decay in children
Derek Richards, Brett Duane, Andrea Sherriff

Protocol for a new review. The aim is to evaluate the effects of xylitol (consumed by mothers) at reducing tooth decay in their children compared with alternative treatments (e.g. chlorhexidine, fluoride varnish, placebo, or no treatment).

New Protocol: Orthodontic treatment for bimaxillary proclination in children and adults
Padhraig S Fleming, Nikolaos Pandis, Zbys Fedorowicz, Reshma A Carlo, Jadbinder Seehra

This new protocol is for a Cochrane review which will assess the effects of different types of orthodontic treatment for bimaxillary proclination particularly their impact on occlusal results, facial outcomes and patient experiences.

Other highlights of the Cochrane Library, Issue 11, 2012:

There is also an editorial on Measuring the Performance of the Cochrane Library.

New titles registered with the Cochrane Oral Health Group

It has been a bumper month for new titles at the Cochrane Oral Health Group, with a total of 5 new title registrations:

Herbal medicine for gingivitis
Matthew Leach, Lisa Thoms

A new review which will look at all herbal medicines for treating gingivitis, including gels, mouthrinses and toothpastes.

Techniques for increasing acceptance of local anaesthetic in children having dental treatment
Joana Monteiro, Susan Parekh, Paul Ashley, Aviva Petrie, Ajit Tanday

A team from the Eastman Institute at University College London has registered a new title considering different approaches to administering dental anaesthesia to children.

Assessment of radioprotective agents for adverse effects of radiotherapy in adult patients with head and neck cancer
Adriana Dibo da Cruz,  Cassia Maria Fischer Rubira, Rebeca de Souza Azevedo, Ademar Takahama-Junior, Solange Maria de Almeida, Frab Norberto Boscolo, Glaucia Maria Bovi Ambrosano

This review on the important subject of preventing the adverse effects of radiotherapy will be undertaken by a team based in Brazil.

Adjunctive surgical interventions for accelerating tooth movement in patients undergoing orthodontic treatment
Padhraig Fleming, Nicolas Pandis, A Johal

Non-surgical interventions for accelerating tooth movement in patients undergoing orthodontic treatment
Ahmed El-Angbawi, David Bearn, Grant McIntyre

These two reviews will consider surgical and non-surgical ways of speeding up tooth movement during orthodontic treatment.

Look out for the protocols on the Cochrane Library!