1,721,100 research outputs found
Lifestyle risk factors for oralcancer
No full textThe ‘‘style of life is the unique way in which individuals try to realize their fictional final goal and meet or avoid the three main tasks of life: work, community, love” (Alfred Adler, founder of the Individual Psychology). Lifestyle refers to the way individuals live their lives and how they handle problems and interpersonal relations. The lifestyle behaviours associated to oral cancer with convincing evidence are tobacco use, betel quid chewing, alcohol drinking, low fruit and vegetable consumption (the detrimental lifestyle is high fat and/or sugar intake, resulting in low fruit and/or vegetable intake). Worldwide, 25% of oral cancers are attributable to tobacco usage (smoking and/or chewing), 7–19% to alcohol drinking, 10–15% to micronutrient deficiency, more than 50% to betel quid chewing in areas of high chewing prevalence. Carcinogenicity is dose-dependent and magnified by multiple exposures. Conversely, low and single exposures do not significantly increase oral cancer risk. These behaviours have common characteristics: (i) they are widespread: one billion men, 250 million women smoke cigarettes, 600– 1200 million people chew betel quid, two billion consume alcohol, unbalanced diet is common amongst developed and developing countries; (ii) they were already used by animals and human forerunners millions of years ago because they were essential to overcome conditions such as cold, hunger, famine; their use was seasonal and limited by low availability, in contrast with the pattern of consumption of the modern era, characterized by routine, heavy usage, for recreational activities and with multiple exposures; (iii) their consumption in small doses is not recognized as detrimental by the human body and activates the dopaminergic reward system of the brain, thus giving instant pleasure, ‘‘liking” (overconsumption) and ‘‘wanting” (craving). For these reasons, effective Public Health measures aimed at preventing oral cancer and other lifestyle-related conditions fail to realize their final goal to eradicate these lifestyles. Following Adler’s theory and the principles of the ‘‘Ottawa Charter for Health Promotion”, conditions such as education, sustainable resources, social justice, and equity must be satisfied before the implementation of physical health promotion campaign
Oral cancer screening usefulness: Between true and perceived effectiveness
No full textScreenings, introduced in the 1920s, became rapidly popular in healthcare settings. Chance is an intrinsic screening characteristic. Roughly one half of screened subjects are correctly classified merely by chance, and in high-prevalence settings, even inaccurate screenings detect several diseased individuals by chance, thus appearing effective. The viewpoint is another variable affecting screening perceived effectiveness. For example, public health officers, who seek for mortality rate reductions, look for high sensitivity, which, in turn, is affected by disease prevalence. The relative mortality rate reduction attributable to screening may therefore be significant in high-prevalence areas and irrelevant in low-prevalence areas. This explains why oral cancer visual screening is perceived effective in high-prevalence countries and ineffective in low-prevalence countries. Patients seek for reliable outcomes. Therefore, they require screenings with high positive (PV+) and negative (PV-) predictive values. In high-prevalence areas, PV+ is high, while PV- is low. The reverse occurs in low-prevalence areas. Thus, even for accurate screenings, the perceived effectiveness due to misclassification is low among false-negative patients in high-prevalence areas, who are misclassified as unaffected by the disease, and among false-positive patients in low-prevalence areas, who are subjected to psychophysical sufferings. This article explains the reasons for these and other paradoxes engendered by screening
Healthcare outbreaks associated with dental unit water systems. Strong scientific evidence of minimal risk
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Negative excess oral and pharyngeal cancer mortality in Europe during the early pandemic years
No full textObjective: The COVID-19 pandemic had direct and indirect effects on oral and pharyngeal cancer (OPC) mortality due to high COVID-19 mortality risk among cancer patients, and to the COVID-19 response that caused treatment delays and reduced routine visits. This study investigated the excess OPC mortality in Europe during the early pandemic years.
Methods: Mortality and population data were gathered from the Eurostat database. The 2011-2019 mortality rates were used to estimate the 2020-2021 expected rates through joinpoint trend analysis. The excess mortality rates (observed minus expected mortality) with 95% confidence intervals (95 CIs) were assessed.
Results: Statistically significant negative excess age-standardized and crude (age strata <65 and ≥65 years) OPC mortality rates in males and females, in the European Union (EU, 27 countries) and Europe were reported. The estimated OPC missing deaths in EU were 831 (95 CI, 630-985) and 1240 (95 CI, 1039-1394) in 2020 and 2021, respectively, with differences between sexes, age strata, and countries. The OPC deaths in the EU and Europe were 3.6% and 3.5% lower than expected.
Conclusion: Missing OPC deaths reported in Europe in 2020-2021 could be explained by changes in death certification of OPC patients who developed COVID-19, rather than a real OPC mortality declin
Advances in infection epidemiology and control in dental healthcare settings
No full textGuidelines for the control of infection in dental healthcare settings became necessary since the eighties, following shocking events, such as the lethal outbreaks of hepatitis B among dental patients and the episode of the Floridian dentist who infected five patients with HIV. Guidelines were produced by the US Centres for Disease Control and Prevention and were periodically updated. Their success was and actually is remarkable, as demonstrated by the facts that they were adopted by many national professional organizations in the world and that, following their implementation, cases of infection transmission from dental healthcare workers (DHWs) to patients and vice versa reported from all over the world drastically decreased. Guidelines, initially based on the precautionary principle, are updated following the advances in scientific and technical research and are based on the assessment of the true risk for infection for DHWs and patients and on the design of effective control measures. Nevertheless, guidelines are far from being perfect, since many questions remained unanswered and many problems unresolved. The papers presented at the international workshop. " Advances in Infection Epidemiology and Control in Dental Healthcare Settings" (February 9th 2013), organized by the Department of Public Health and Infectious Diseases of the Sapienza University of Rome (Italy), sought to bring some light in the shadowy areas of this field. There are four steps which lead to an effective infection control: the first of them is an efficient surveillance system of infections acquired in dental healthcare settings The second step is the specificity of scientific research. The third step is that guidelines must be applied by DHWs, who, therefore, must be involved in guideline design and in recommendation release. The fourth and final step is that infection control guidelines must be transnational. © 2013 Medicinski fakultet Niš
Tuberculosis: Occupational risk among dental healthcare workers and risk for infection among dental patients. A meta-narrative review
No full textObjectives: Tuberculosis transmission among healthcare workers (HCWs) and patients is due to the level
of Mycobacterium tuberculosis (MT) circulation in the community and in the healthcare settings where
HCWs are active. In contrast, most papers about dentistry reportthat dental HCWs (DHCWs) and patients
are at relatively high risk, mainly based on tuberculosis case series that occurred in the 80’s–90’s. This
meta-narrative review was designed to evaluate the tuberculosis risk in dentistry accounting for the
historical-geographical contexts.
Data: All available studies reporting data on MT infection (active/latent tuberculosis, tuberculin skin test)
among patients and DHCWs.
Sources: PubMed, Scopus, GOOGLE Scholar.
Keywords: MT/tuberculosis and dentistry/dentist/dental/dent*.
Results: 238 of the 351 titles were excluded because did not concern dental healthcare providing,
94 papers were excluded because they did not provide original data. Thirteen studies on occupational
risk, nine on transmission to patients remained. Some, often non-confirmed, cases of MT infection among
patients were reported in specific historical-geographical contexts where MT was endemic. The risk of
active pulmonary tuberculosis transmission from infected DHCWs to patients is minimal today, provided
that the basic infection control guidelines are applied. The development of active tuberculosis among
DHCWs is occasional and is associable to MT circulation rather than dental healthcare providing.
Clinical significance: Tuberculosis transmission in dental healthcare settings was due to the lack of basic
infection control measures, while the risk is acceptable (i.e., similar to the general population) nowadays.
Therefore, tuberculosis transmission can be safely prevented wearing gloves and surgical mask and
providing regular air changes in the operative and non-operative dental healthcare settings.
Precautionary Principle-based measures are implementable when patients with active pulmonary
tuberculosis are routinely treated
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