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Publishing Process Manager Anja Filipovic Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published March symptoms xanax withdrawal safe meclizine 25 mg, 2012 Printed in Croatia A free online edition of this book is available at Ogbureke and Christopher Bingham Chapter 2 Oral Squamous Cell Carcinoma Clinical Aspects 21 Nicolás Bolesina medications vs grapefruit cheap meclizine 25 mg without prescription, Fabián L medicine education order line meclizine. Morelatto and María Alicia Olmos Chapter 3 Oral Cancer – An Overview 47 Raghu Radhakrishnan, Bijayata Shrestha and Dipshikha Bajracharya Chapter 4 A Literature Analysis of the Risk Factors for Oral Cancer 65 Shih-An Liu Chapter 5 Oral Cancer and Potentially Cancerous Lesions – Early Detection and Diagnosis 79 C. McCullough Chapter 6 Environmental Factors Identified in the Etiology of Oral Cancers in Taiwan 107 Chi-Ting Chiang, Tsun-Kuo Chang, Ie-Bin Lian, Che-Chun Su, Kuo-Yang Tsai and Yaw-Huei Hwang Chapter 7 the Changing Aetiology of Oral Cancer and the Role of Novel Biomarkers to Aid in Early Diagnosis 129 Michael J. Gokul Chapter 13 Blood Groups and Oral Lesions Diagnostics 249 Carlos Campi, Livia Escovich, Liliana Racca, Amelia Racca, Carlos Cotorruelo and Claudia Biondi Chapter 14 Management of Early-Stage Tongue Cancer 267 Kiyoto Shiga, Katsunori Katagiri, Ayako Nakanome, Takenori Ogawa and Toshimitsu Kobayashi Chapter 15 Functional Biomarkers of Oral Cancer 277 Masumi Tsuda and Yusuke Ohba Part 3 Molecular Pathogenesis 295 Chapter 16 Epigenetic Profiling of Oral Cancer 297 A. Bufo Chapter 17 Model of Chromosomal Instability in Oral Carcinogenesis and Progression 327 Walter Giaretti Chapter 18 Expression of Metallothionein in Oral Cancer 339 Dziegiel Piotr, Pula Bartosz and Podhorska-Okolow Marzena Chapter 19 Reduced Expression of Syndecan-1 in Oral Cancer 359 Takashi Muramatsu Chapter 20 Epithelial-Mesenchymal Interactions in Oral Cancer Metastasis 373 Silvana Papagerakis and Giuseppe Pannone Preface Human cancers of the oral and oropharyngeal areas have since emerged as significant public health challenge globally, but particularly so in countries of the Southeast Asia. Although the oral cavity and oropharynx are as easily accessible as is the population at risk, early diagnosis has been painfully slow when compared to the enhanced early detection of cancers of the breast, colon, prostate, and melanoma. As a result, the mortality rate from oral cancer for the past four decades has remained high, at over 50%, in spite of advances in treatment modalities. This contrasts with a considerable decrease in mortality rates for cancers of the breast, colon, prostate, and melanoma during the same period. In spite of increased diligence on the part of the clinicians in their examination of patients at risk, early diagnosis of oral cancer continues to be impeded and elusive because of the persistence of outdated paradigms, and the lack of an easily available diagnostic adjunct. This book is an attempt to provide a comprehensive, yet reference-friendly, update encompassing the spectrum of etiologic/risk factors, current clinical diagnostic tools, management philosophies, and molecular biomarkers and progression indicators of oral and oropharyngeal cancers. Accordingly, the scope has necessitated the painstaking contributions, from notable experts drawn from across the globe, of detailed reviews and nascent research reports on aspects of the subject matter. Introduction Cancer is the second most common cause of death in the Western world, after cardiovascular diseases (Johnson, 1991; 2001). Worldwide, an estimated cancer incidence of about 10 million was reported for the year 2009 (Jemal et al. In the United States alone, an estimated 569,490 deaths from cancer are projected for the 2010 (Jemal et al. Recent published estimates of worldwide frequency of the 16 major cancers indicate that in developing countries with a high prevalence of infectious and nutritional diseases, cancer remains a major cause of death (Parkin, Laara and Muir, 1988). This may account partly for the current statistics whereby more than half the global incidence of cancer is from the so-called developing countries, since an estimated 70-80% of the global population resides in these areas (Parkin et al. The estimated annual incidence of cancer ranges from 48 to 225 per 100,000 in developing countries (Parkin et al. Oral cancer – Epidemiologic overview “Oral cancer” encompasses all malignancies originating in the oral cavity. Oral cancer ranks sixth in the overall incidence for the 10 most common cancer sites worldwide and third in the developing countries (Johnson, 2001)). There is also a marked disparity in geographic incidence between the “high” and “low” prevalence areas of the world, suggesting major geographic differences in risk factors (Johnson, 1991; 2001). For statistical purposes, oral cancer is often grouped together with cancers of the pharynx as “oropharyngeal” cancer (Daftary et al. In the Western world, oral cancer is relatively uncommon, and in the context of all malignant tumors, incidence in the United States and Great Britain ranges from 2 to 3% (Batsakis, 1979; Jemal et al. Relative incidence of * Corresponding Author 4 Oral Cancer up to 5% however has been reported for the United States (Batsakis, 1979), and higher rates have been reported for the so-called “high risk” areas of Europe with incidence equally varying with different socioeconomic groups within these areas (Johnson, 1991). Worldwide, it is estimated that about 300,000 people will be diagnosed with oral cancer in 2010 (Jemal et al. In the United States alone, an estimated 35,000 new cases of oral cancer will be diagnosed in 2009 with an estimated 7,500 resultant deaths (Jemal et al. In the Asian subcontinent of Bangladesh, India, Pakistan, and Sri Lanka, oral cancer is the most common malignancy, accounting for about one-third of all malignancies within the subcontinent (Daftary et al. About 100,000 new cases are estimated to occur annually in these regions that include Burma, Cambodia, Malaysia, Nepal, Singapore, Thailand, and Vietnam (Daftary et al. The paradox in the foregoing gloomy statistics is that, although the oral cavity and oropharynx are easily accessible to dentist and physicians for routine examinations and the biopsy of suspicious lesions that often present with outstanding features, early diagnosis has been painfully slow when compared with the enhanced early detection of breast, colon, prostate cancers, and melanoma (Mashberg A, 2000). As a result, the mortality rate from oral cancer for the past three and a half decades has remained high (over 50%) in spite of new treatment modalities.

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Mean values of total physical activity medications held before dialysis order meclizine overnight, cardiorespiratory Statistical analysis ﬁtness and body fat were not signiﬁcantly different across the data are presented as means and standard deviations tHcy quartiles in both children and adolescents (Fig treatment venous stasis cheap 25mg meclizine overnight delivery. No statistically signiﬁcant differences were found activity the square root was calculated treatment 2nd degree burn cheap meclizine 25mg visa. T Relationship between total plasma homocysteine and physical subgroups were compared by Tukey’s test. Variation in tHcy levels was not Multiple regressions were used to study the relationship signiﬁcantly explained by total physical activity, cardiorespira between tHcy and physical activity, cardiorespiratory ﬁtness tory ﬁtness or body fat (expressed as skinfold thickness) in any and body fat, after controlling for potential confounders. Homocysteine and modiﬁable factors 259 (a) 900 850 800 750 700 650 600 550 500 450 400 1 Quartiles of homocysteine (b) 54 52 50 48 46 44 42 40 38 36 34 32 1 2 3 4 Quartiles of homocysteine (c) 60 55 50 45 40 35 30 1 2 3 4 Quartiles of homocysteine Fig. Mean values of total physical activity (a), cardiorespiratory ﬁtness (b) and sum of ﬁve skinfolds stratiﬁed by quartiles of homocysteine for children(—†—) and adolescents (—A—). The levels of tHcy seen in the present Discussion study were within the normal ranges for these ages (Ueland & TheresultssuggestthattHcylevelsarenotinﬂuencedbythestu Monsen, 2003). Similar tHcy levels have been reported in Bel died modiﬁable factors in young subjects as other well-estab gian (De Laet et al. However, tHcy levels were signiﬁcantly on the association of tHcy levels with objectively measured 260 J. Theoretically, poor cardiorespiratory capacity may be the Physical activity and homocysteine consequence of pathological changes peripherally affecting the tissues and the associated vasculature or centrally perturb the association between physical activity and tHcy has been ing the heart and coronary arteries. In fact, elev week signiﬁcantly decreased tHcy levels in young overweight ated tHcy levels have been associated with an increased risk of and obese women with polycystic ovary syndrome, a group at decline in physical function in elderly people (Kado et al. Moreover, high tHcy levels have been negatively weight-reduction programme including physical activities had associated with estimated cardiorespiratory ﬁtness in adult a positive effect on the tHcy of obese children (Gallistl et al. We did not ﬁnd any association between total physical High cardiorespiratory ﬁtness during childhood and adoles activity and tHcy levels, even when the inﬂuence of physical cence has been associated with a healthier metabolic proﬁle activity intensity levels on tHcy levels was examined. Studies examining the inﬂuence of objectively (FoodandAssessmentoftheNutritionalStatusofSpanishAdo measured physical activity and physical activity intensity lescents) study showed signiﬁcant associations between levelsontHcyinchildrenandadolescentsarelacking. Interven increased cardiorespiratoryﬁtnessandafavourablelipidproﬁle tionprogrammesstudyingtheeffectofphysicalactivityamount and fasting glycaemia in both overweight and non-overweight and the inﬂuences of different physical activity intensities on adolescents aged 13–18 years (Mesa et al. The same relationship was Cardiorespiratory ﬁtness is a direct marker of physiological noted between cardiorespiratory ﬁtness and other features of status and recent data suggest that ﬁtness is one of the metabolic syndrome. However, we did not observe any the study was supported by grants from the Stockholm County association between cardiorespiratory ﬁtness and tHcy in chil Council (M. Diabetes limitation of the study is the lack of information on other fac Care 27, 2141–2148. The inclusion of available intake data on folate and (2003) Cardiorespiratory ﬁtness in young adulthood and the devel vitamin B12 was an attempt to overcome this. Int J Epi with changes in tHcy levels, indicating that tHcy may not be demiol 31, 59–70. Gutin B, Litaker M, Islam S, Manos T, Smith C & Treiber F (1996) study suggest that objectively measured physical activity, car Body-composition measurement in 9-11-y-old children by dual diorespiratory ﬁtness and body fat are not associated with energy X-ray absorptiometry, skinfold-thickness measurements, tHcy levels in children and adolescents, even after controlling and bioimpedance analysis. The Euro Selhub J (2001) Determinants of plasma total homocysteine con pean Youth Heart Study. Med Sci Sports Exerc 32, teine as a predictive factor for hip fracture in older persons. J Clin participation rates and representativeness in the Swedish part of Endocrinol Metab 87, 4496–4501. Am J Clin Nutr 2006; FromtheUnitforPreventiveNutrition,DepartmentofBiosciencesand 84:299–303. Validation studies examining the accelerometer Physical examination used in this study and the construction of summary variables for Height and weight were measured by the use of standardized intensity of movement suggest that this is a valid and reliable procedures. When expressed as energy expended in movement, heavier suprailiac and triceps surae areas on the left side of the body adolescents seem to be engaging in relatively large amounts of according to the criteria described by Lohman et al (24). Ifthedifferencebetweenthe2 activities of various intensities seems more pertinent for the measurements differed by 2 mm, a third measurement was purpose of making exercise recommendations (33). All variables were measurement of body fatness in children (7, 8), and because checked for normality of distribution before the analysis. The fatness rather than weight has been shown to be associated with sumof5skinfoldthicknesseswasnormalizedbytransformation poor health (26).

Management of the extrinsic acid from the diet medicine plus purchase 25 mg meclizine with amex, both food and condition for affected individuals should have drink medicine definition order meclizine pills in toronto, as well as intrinsic acid from the secondary prevention at its core medications to treat bipolar 25mg meclizine otc. At present stomach due to gastro-oesophageal refux, there is insuffcient evidence or rationale rumination, vomiting and eating disorders. The focus, therefore, or combined chemical and mechanical loss should be on the identifcation of individuals of hard tissue, through acids (extrinsic and/ who are giving concern because there is or intrinsic), which are of non-bacterial origin evidence of pathological wear. The impact of acid will depend on its pH, titratable acidity and 70 Delivering better oral health: an evidence-based toolkit for prevention its chemical composition. There is likely to be guides the management of the condition individual variation in response to the erosive for the practitioner (Bartlett, Ganss and effects of acids. Seeking medical advice for management saliva, features of the pellicle, individual habits of intrinsic sources of acid involving with regard to acid availablity. Furthermore, refux or eating disorders and/or the oral swishing, frothing and retention may management of medications. Current Advice that may be given to manage erosive evidence suggests that if erosion is present in tooth wear for affected individuals. This is pathological tooth wear, then fruit, and fruit based on professional advice and evidence based drinks, may be the most important from cross sectional studies of association or extrinsic risk factors. The aetiological risk laboratory or in situ studies of erosion should factors for mechanical tooth wear are listed in be tailored to individual patients and their table 9. Sensitive investigation of general health drinking acidic food or drinks (Bartlett, and diet as well as toothbrushing Fares et al. This is a partial scoring system anti-refux medication reduces enamel recording the most severely affected loss from gastric erosion (Wilder-Smith, surface in a sextant. Furthermore, there is clearance recent evidence that dietary intake nationally of fruit and vegetables may be reducing, particularly the latter (Department for Management of severe wear Environment 2013). In light of the paucity of intervention studies to support the avoidance For severe wear, consideration may be given of extrinsic acids, advice should stress the to the following: importance of healthy nutrition whereby fresh fruit is an important part of a healthy diet. Population advice As a nation, we are not at risk of excessive erosion because of fruit consumption. There is evidence that the majority of children and adults do not consume enough fruit and vegetables for a healthy diet. Nationally, surveys of diet and nutrition among young people aged 11 to 18 years suggest that only 11% of boys and 8% of girls in this age group met the fve-a-day recommendation (the population advice is to consume ‘at least fve-a-day’). The average consumption of fruit and vegetables was three portions per day for boys and 2. A higher, yet still relatively small, proportion of adults met the fve-a-day recommendation with 31% of adults and 37% of older adults eating fve or more portions per day (equivalent to 400g for adults) (Bates et al. Chewable vitamin C tablets Aspirin Some iron preparations Medications and other conditions reducing salivary fow Other rare sources Hydrogen peroxide Occupational exposure to acid Table 9. Clinical increasing sodium fuoride concentrations on study investigating abrasive effects of three erosion and attrition of enamel and dentine in toothpastes and water in an in situ model. Durability of the anti-erosive effect Years 1, 2 and 3 (combined) of the Rolling of surfaces sealants under erosive abrasive Programme (2008/2009 – 2010/11) 16. American Journal and associated risk factors in a sample of of Gastroenterology 104(11): 2788-2795. Erosive tooth wear: diagnosis, risk 74 Delivering better oral health: an evidence-based toolkit for prevention Section 10 Helping patients to change their behaviour Introduction Supporting behaviour change in a clinical setting is very important but this must be All healthcare providers, including dental underpinned by population and community teams, have a role in making every contact based oral health improvement strategies that count, helping their patients to change tackle the broader causes of poor oral health behaviour and improve their health and in society. However, the key issues Oral hygiene practices, tobacco and alcohol are summarised below. Dental infuenced by an array of individual, teams can provide guidance and support social and environmental factors. Socio using very brief advice and signposting (30 economic circumstances are a major second approach), brief interventions and infuence when appropriate, full support to enable their patients to change health related behaviour. All members of the dental team can be involved and it is Recognising different motivations for important that each member’s role is carefully change: considered and agreed within the team and the individuals have access to appropriate. For example, supporting behaviour change smokers wishing to quit might be motivated by the negative effects of Dental team members have skills that can smoking on their children, appearance, or support patients to change behaviour, which the costs of tobacco can positively impact on their oral health. It often cluster together in particular groups is important to consider the most appropriate of people team member to deliver the intervention.

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The two most demineralisation of tooth surfaces occurs important elements of a healthy diet are: after a sugar intake and the subsequent drop in pH that takes place in the mouth as oral symptoms schizophrenia cheap meclizine online master card. When sugar intakes are Eatwell Guide spaced some hours apart there is a good opportunity for remineralisation medicine used to stop contractions cheap meclizine online visa, which is also the Eatwell Guide is a key policy tool that more effective in the presence of fuoride fungal nail treatment buy meclizine 25 mg fast delivery. The impact easier to understand by giving a visual of frequent sugar intakes are illustrated in representation of the proportions in which Stephan’s curve in fgure 4. In this different types of foods are needed to have a case, sugar intakes are experienced on many well-balanced and healthy diet. Delivering better oral health: an evidence-based toolkit for prevention 35 Eatwell Guide Check the label on packaged foods Use the Eatwell Guide to help you get a balance of healthier and more sustainable food. Each serving (150g) contains It shows how much of what you eat overall should come from each food group. The Eatwell Guide or sugar, have these less often and in small encourages us to: amounts. A portion of fruit juice and other proteins (including two portions of or smoothie is 150ml and also only counts fsh every week, one of which should be oily) 36 Delivering better oral health: an evidence-based toolkit for prevention as one of your fve-a-day. Limit fruit juice on the amount of high fat, salt and sugar and smoothies to a combined total of 150ml foods and drinks we consume. There is Cut down on saturated fat evidence to suggest that people who eat lots of fruit and veg are less likely to develop Cutting down on saturated fat can lower your chronic diseases such as coronary heart blood cholesterol and reduce your risk of disease and some types heart disease. Potatoes, bread, rice, pasta and other the average woman should have no more starchy carbohydrates than 20g saturated fat a day. Children should Eat plenty of starchy carbohydrates, including have less saturated fat than adults. Choose A low-fat diet is not suitable for children under wholegrain varieties, or keep the skins fve. One of the easiest ways to cut down on potatoes, for more fbre, vitamins on saturated fat is to compare the labels on and minerals. Watch out for foods that are high in saturated fat, including fatty cuts Eat some dairy or dairy alternatives. You don’t need to stop eating these foods altogether, but eating too much of these Beans, pulses, fsh, eggs, meat and can make it easy to have more than the other proteins recommended maximum amount of Eat some beans, pulses, fsh, eggs, meat and saturated fat. If you eat more than 90g per day of red or processed meats, try to reduce the amount to no more Cut down on the amount and than 70g per day. Cutting down on these types of foods reduce dental caries advocate reducing the could help to control your weight as they are amount and frequency of foods and drinks high in calories. Foods high in fat, salt and sugar Regularly consuming foods and drinks high in these foods are not required as part of free sugars increases the risk of obesity and a healthy, balanced diet. Ideally, no more than 5% of the should only be consumed infrequently and in energy we consume should come from free small amounts. Delivering better oral health: an evidence-based toolkit for prevention 37 Sugary drinks have no place in a child’s Eatwell Guide. There are specifc dietary daily diet but account for a surprisingly large recommendations for infants and young proportion of the daily free sugar intake of children. Aim to swap sugary close and click on the babies and toddlers drinks for water, lower fat milk or sugar-free tab drinks, including tea and coffee. Most of the salt we eat Changing the diet is already in everyday foods such as bread, breakfast cereal, pasta sauce and soup. Drink plenty of water However, lowering the amount and frequency We should be drinking about six to eight of sugars consumed will have wider health glasses (1. When giving dietary advice to juices and smoothies count towards fuid reduce consumption of sugars it is essential consumption but are a source of free sugars to assess the overall pattern of eating to and so we should limit consumption to no establish the following information: more than a combined total of 150 ml a day. Between the ages of two caries protective effects of saliva are reduced) and fve, children should gradually move In some cases it can be helpful to use a diet to eating the same foods as the rest of the diary. An example of one type of diary is family, in the proportions shown in the provided in appendix 4. Rhubarb crumble and custard 7 pm Packet of Maltesers 8 pm bedtime Hot chocolate drink and Hobnob Delivering better oral health: an evidence-based toolkit for prevention 39 Record of food and drinks eaten and drink by. Products that do not contain fructose, glucose or sucrose are listed as sugar free. Information from the National Pharmacy Preparations containing hydrogenated Association leafet ‘Sugar in medicines’ glucose syrup, lycasin, maltitol, sorbitol or was adapted for use in previous editions xylitol are also listed as sugar free, since there of ‘Delivering better oral health’.

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