National Campaign Will Promote Oral Cancer Awareness

The message that "early detection of oral cancer is possible and painless" will be delivered via billboards in 10 cities and supplemented by taxi top, bus shelter, and subway signs. Kicking off in San Francisco and Chicago and working its way across the country, the campaign will continue until mid-February in Seattle-Tacoma, Denver, Houston, Kansas City, Miami, New York, Philadelphia, and Boston. Since the campaign will use outdoor advertising as the primary medium of communication, necessity dictates that the message about oral cancer be simple and direct.

"The message is powerful and concise," said Clay Mickel, associate executive director of ADA’s Division of Communications. Early detection is the key, and the campaign urges people to talk to their dentist for more information."

Experts agree that public awareness is essential in helping to prevent oral cancer, a disease that claims about 8,000 lives annually in the United States.

"Public awareness is key to improving the dismal statistics for oral cancer," said Raymond J. Melrose, DDS, chair of the Department of Oral and Maxillofacial Pathology at the University of Southern California School of Dentistry and president-elect of the California Division of the American Cancer Society. "The public really is not informed or knowledgeable about oral cancer because it has not been the principal interest or thrust of cancer awareness programs."

Melrose points out that many people associate oral disease with tobacco and spit-tobacco use and don’t understand other independent risk factors such as alcohol.

"Smoking and drinking substantially increase the risk of oral cancer, although people who neither smoke nor drink are still at risk," Melrose explained. "Other factors come into play, although at this point, we don’t know what those factors are."

Melrose adds that three things need to happen for oral cancer survival rates to increase. First, the public needs to know to see a dentist for an annual oral exam. Second, people need to know if they are getting a proper oral exam. Third, the public needs to demand oral exams if they are not routinely receiving them.

"The best person to conduct an oral exam is a dentist or trained hygienist supervised by a dentist," Melrose said. "An oral exam must include a thorough and systematic evaluation of the soft tissue of the entire oral cavity. The tongue should be pulled out and examined; and the floor of the mouth, the hard and soft palate, and the cheeks should all be looked at. The sites of major salivary glands should also be palpated."

In preparing dentists nationwide for the public awareness campaign, the ADA will mail a letter from President Robert M. Anderton, DDS, to all association members.

"I hope you are as excited as I am about the good this campaign can do for the public and the profession," Anderton writes in the letter. "During the campaign," he continues, "you may find patients asking about oral cancer diagnosis after seeing advertisements or media coverage."

Mickel said that member outreach is an important part of the campaign.

"We will be providing dentists with tools to help them communicate with patients," he said.

ADA will publish a news insert in the ADA News in August and will establish a repository of oral cancer information on its Web site, www.ada.org.

Melrose suggests the following guidelines to dentists who wish to advance the fight against oral cancer:

* Do a thorough oral cancer exam on every patient and look for signs of oral cancer and early abnormalities.

* During an exam, tell the patient what you are doing and why so he or she is aware of proper exam techniques.

* Assess the patient’s risk for oral cancer. Ask if they smoke or drink and how much. If a patient has quit smoking, find out when.

* Encourage patients to stop smoking and using tobacco products. Refer them to a smoking cessation clinic or to the American Cancer Society hot line, (800) 227-2345.

* Take advantage of continuing education classes on early detection, diagnosis, and treatment of oral cancer.

* Don’t fail to refer patients for a biopsy of any suspicious lesion. Biopsy remains the gold standard for early diagnosis.

By actively working to detect oral cancer in its early stages, dentists respond to a duty that is uniquely suited to their profession, Melrose said.

"Other than CPR," he said, "early detection of oral cancer is a dentist’s best opportunity to save a human life."

For more information on the ADA’s public awareness campaign on oral cancer, please e-mail Clay Mickel: mickelc@ada.org

Perio Bacterium Genome Sequenced

Scientists have sequenced the genome of Porphyromonas gingivalis, the bacterium believed to play a major role in adult periodontitis. It is the first oral disease-causing microbe to be completely sequenced.

The sequencing project, supported by the National Institute of Dental and Craniofacial Research, was carried out by scientists at the Institute for Genomic Research in Rockville, Md., in collaboration with the Forsyth Institute in Boston.

"P. gingivalis is one of the most intensely studied dental pathogens," says Dennis Mangan, PhD, chief of NIDCR’s Infectious Diseases and Immunity Branch. "There is a large cadre of researchers out there ready to use the sequence data to identify the genetic mechanisms for the organism’s virulence and to develop better approaches for preventing or eradicating periodontitis."

With the genetic blueprint for P. gingivalis in hand, dental researchers will be able to identify potential targets for periodontal vaccines and drug therapies.

The P. gingivalis sequence also provides the scientific community with information on an organism from a major group of bacteria not previously sequenced: the bacteroides group of gram-negative anaerobes. The sequence, which contains 2.3 million DNA base pairs, will be valuable for comparative genomics and for advancing researchers’ understanding of bacterial diversity. It will also enhance scientists’ ability to find new gene targets for antibiotics that work on gram-negative anaerobes.

These bacteria are naturally resistant to some antibiotics, and are acquiring resistance to many others.

* The P. gingivalis genome is available on the Comprehensive Microbial Resource Web site at http://www.tigr.org/tigr-scripts/CMR2/CMRHomePage.spl.

* Additional information on the P. gingivalis genome project can be found at http://www.pgingivalis.org.

AIDS: 20 Years and Half a Million Dead

Twenty years of AIDS has had a tremendous toll in the United States. Since the first case was identified in 1981, 774,467 AIDS cases have been reported, and approximately 450,000 Americans have died, according to the Centers for Disease Control and Prevention.

"The greatest impact of the epidemic is among [gay men] and among racial/ethnic minorities," CDC researchers write in the June 1 issue of the CDC’s Morbidity and Mortality Weekly Report, an issue commemorating the 20-year anniversary of the epidemic’s beginnings.

"AIDS continues to have a tragic impact, not only on those who have died or are living with HIV infection, but also on the many friends, families, and entire communities that have been forever changed by the epidemic," said CDC Director Jeffrey P. Koplan, MD, MPH.

Today, an estimated 500,000 to 600,000 people in the United States are living with HIV infection, and another 320,000 people are living with AIDS. New infections, which peaked at more than 150,000 in the mid-1980s, were reduced to an estimated 40,000 a year in the early 1990s. Since the beginning of the epidemic, well more than 1 million Americans have been infected.

The first suspected cases of AIDS were reported in the June 5, 1981, issue of MMWR.

The CDC does note, however, that there have been some public health achievements during the AIDS epidemic: Fewer than one in 450,000 to 660,000 screened blood donations are contaminated with HIV. In addition, from 1985 to 1999, AIDS cases among children declined 81 percent due to Public Health Service guidelines released in 1994 and 1995, suggesting that routine counseling and voluntary HIV testing be offered to pregnant women, and that AZT be offered to infected women and their infants.

Poll Finds Low Consumer Confidence In Managed Care

Consumer perceptions of the service provided by managed health care companies continues to be poor, according to a recent poll, and is expected to erode even further.

The 2001 poll by Harris Interactive shows than only 29 percent of adults surveyed believe that managed care companies are doing a good job serving their customers. While that figure is consistent with last year’s, the number has plummeted in the five-year life of the poll. Managed care companies have lost 22 points in the survey since 1997.

"The forces that have damaged public perception of [managed care companies] are still in place and are, we believe, likely to inflict more damage over the next few years," writes Humphrey Taylor, chairman of the Harris Poll, and Robert Leitman, group president of Health Care, Education and Public Policy.

"On balance, it seems more likely that the numbers will get worse before they get better," they predict.

Sleep Apnea Linked to Alzheimer’s Gene

A gene linked to Alzheimer’s and cardiovascular disease also has an association with sleep apnea, according to a report in the June 13 issue of the Journal of the American Medical Association.

Sleep apnea is marked by short interruptions in a person’s breathing during sleep that are often accompanied by snoring. As a result of the frequent interruptions in deep sleep, sufferers are often intensely tired throughout the day. Sleep apnea is estimated to affect 10 percent of the population.

In their study, Dr. Emmanuel Mignot of the Stanford University School of Medicine and his colleagues monitored 791 patients at a sleep disorders clinic. Each study participant had blood samples taken and analyzed for the presence of the Apolipoprotein E-4 gene variant. ApoE codes for a cholesterol-carrying molecule. Individuals have two ApoE genes, one from each parent.

Participants who carried the ApoE-4 gene were twice as likely to suffer from sleep apnea compared with those who did not. Those with two copies of the gene had an even higher risk of sleep apnea.

"Our results indicate that ApoE-4 is associated with sleep apnea," the researchers write.

The study is the first to link ApoE-4 to sleep apnea. That same gene also predisposes people to high cholesterol and cardiovascular problems. Because sleep apnea is a major predisposing factor for high blood pressure, stroke, and other cardiovascular problems, the findings may have important health implications for general population.

People With Arthritis Have More Perio Disease

Swollen joints and missing teeth often go hand in hand, according to a new study in the Journal of Periodontology.

In the Australian study of 130 people, the 65 people who had rheumatoid arthritis were more than twice as likely to have periodontal disease with moderate to severe jawbone loss as the control subjects. In addition, they averaged 11.6 missing teeth, compared with 6.7 in the control group.

"Periodontal disease and rheumatoid arthritis have very similar pathologies," said Robert Genco, DDS, PhD, editor of the Journal of Periodontology. "Damage caused by the immune system and chronic inflammation are central to both diseases. A better understanding of the biological processes common to these diseases may help us find new ways to treat them with medications that modify the body’s response to inflammation."

At this point, researchers are not saying the relationship between the two diseases is causal. However, some scientists think a bacterial infection may trigger the disease process in some of the estimated 2.1 million people with rheumatoid arthritis.

Greedy Brain Circuits Isolated

Using money as an incentive, researchers from Massachusetts General Hospital and two other institutions found that human neural responses accompanying the anticipation and experience of winning and losing in a laboratory gaming situation were similar to those noted in animals responding to tactile or gustatory stimuli or to euphoria-inducing drugs.

This suggests that the same neural circuitry is involved in the highs and lows of winning money, abusing drugs, or anticipating a gastronomical goodie.

The findings were published in the May 24 issue of Neuron.

The investigators found that the same regions of the brain respond to the prospects of winning and losing money while gambling as have been reported to respond to an infusion of cocaine in subjects addicted to that drug, and to low doses of morphine in drug-free individuals.

These common patterns of response support the view that dysfunction of neural mechanisms and psychological processes crucial to decision-making and behavior may contribute to a broad range of impulse disorders such as drug abuse and compulsive gambling.

Data analysis from the study revealed the following:

* Money, an incentive unique to humans, produced cerebral blood flow changes similar to those seen previously in response to other types of rewards, such as euphoria-producing drugs;

* Changes in the cerebral blood flow in the sublenticular extended amygdala and the orbitofrontal cortex tracked the expected monetary values, and as the expected monetary value increased so did responses in the nucleus accumbens, sublenticular extended amygdala, and hypothalamus;

* The blood flow responses in three areas of the brain rich in dopamine receptors roughly paralleled previously observed findings in monkeys during anticipation and experience of reward.

Honors

John S. Greenspan, BDS, PhD, has been named dean of research at the University of California at San Francisco School of Dentistry. The position was created to reflect the continuing need for the school to oversee and promote its research enterprise. Greenspan assumed the position July 1, 2001.

No-Hee Park, DMD, PhD, has been named the 2001 recipient of the Oral Medicine and Pathology Research Award, conferred by the International Association for Dental Research. Park, dean of the University of California at Los Angeles School of Dentistry, received the award in recognition of his fundamental contributions to the understanding of oral carcinogenesis.

Upcoming Meetings

2001

Aug. 17-18 Southern California Chapter of the Crown Council Annual Meeting, Los Angeles, (818) 998-1851

Sept. 6-9 American Academy of Pain Management Annual Clinical Meeting, Arlington, Va., (209) 533-9744, www.aapainmanage.org

Sept. 14-16 CDA Scientific Session, San Francisco, (916) 443-3382, Ext. 4470

Sept. 27-Oct. 1 FDI World Dental Congress, + 44 207 935 7852, www.fdi.org.uk

Sept. 30-Oct. 3 Pacific Coast Society of Orthodontists Annual Session, Honolulu, (800) 445-8667

Oct. 6-10 American Academy of Periodontology Annual Meeting, Philadelphia, (312) 573-3210

Oct. 13-17 ADA Annual Session, Kansas City, (312) 440-2500.

Nov. 4-10 U.S. Dental Tennis Association Annual Meeting, Palm Desert, Calif., (800) 445-2524

2002

April 12-14 International Dental Exhibition and Meeting, Singapore, 212 -974-8835, www.idem2002.com

To have a meeting included on this list, please send the information to Upcoming Meetings, CDA Journal, P.O. Box 13749, Sacramento, CA 95853 or fax the information to (916) 443-2943.