A multidisciplinary approach to meet effectively the complex needs of the terminally ill patient and associated family members has been widely utilized within hospice programs. Although oral problems are prevalent and hospice patient perceived dental concerns are frequently significant, dental professionals have been generally excluded from hospice care teams. Efforts need to be made both by hospice staff and the dental profession to assess and meet more successfully the dental needs of the terminally ill patient in order to enhance his or her remaining quality of life.
Early identification is key to reducing the morbidity and mortality of oropharyngeal cancer. This study identified factors associated with self-awareness among patients newly diagnosed with a premalignant oral lesion. Data describing sociodemographics, medical/dental histories, tobacco/alcohol use and oral health were obtained by questionnaire and clinical examination of 73 veterans at six U.S. Veterans Affairs Medical Centers. Lesion types included homogenous and non-homogenous leukoplakia, smokeless tobacco lesion (STL), papilloma, lichen planus and erythroplakia. Prior to diagnosis, 29 subjects (39.7%) were unaware of their lesion. In bivariate analyses, lesion self-awareness was associated with anatomic location, multifocal/generalized appearance, pain, oral sores, and cigar use (p<0.05). Awareness varied with lesion diagnosis and was more likely with STL and less likely with homogenous leukoplakia (p<0.05). In multivariate analyses, awareness was predicted by the presence of a lesion on easily visible mucosa (adjusted odds ratio, OR=11.2) and a history of mouth sores (OR= 11.2). These findings identified marked variations in patient self-awareness of oral premalignant conditions.
Bringing together healthcare professionals from several disciplines for a quality project can provide many benefits. This article describes the collaborative process between nursing and dental services at a Department of Veterans Affairs Medical Center as they assessed and evaluated the practice of oral hygiene among 120 long-term care patients. Enhancement of interdisciplinary collaboration occurred through appropriate disciplinary representation and leadership, clarification of disciplinary vocabularies, firsthand empirical assessment, and timely feedback. With each discipline combining resources, fostering open communication, and evaluating the project, the collaborative process was optimized. Benefits of this interdisciplinary quality project included (a) more comprehensive and holistic evaluation of patients' oral hygiene practices, (b) quality assessment in a timely fashion, (c) establishment of rapport between individuals who otherwise might not have an opportunity to interact, (d) improved communication and understanding between disciplines, and (e) development of better patient care indicators.
Objectives: This analysis examined the clinical and histopathological characteristics of white and red oral mucosal lesions and patient lifestyle behaviors to understand how the lesions changed over 19-23 years, including among patients who developed oral and pharyngeal cancer. Materials and methods: Seventy-five individuals with red and/or white oral mucosal lesions with clinical diagnoses of smokeless tobacco lesions, leukoplakia, erythroplakia, lichen planus, ulcer, and virus-associated lesions were identified in six Veterans Affairs Medical Center Dental Clinics (VAMC) from 1996 to 2001. Biopsy results and patients' sociodemographic, medical, and tobacco/alcohol use characteristics were obtained. Study dentists used standardized forms to capture information about the lesions. Study participants were re-examined at intervals through January 2002. In 2020, a retrospective review of VAMC and public records ascertained whether participants developed oral cancer or died. Results:The most common red or white oral mucosal lesions among the 75 study participants were leukoplakia (36.0%), smokeless tobacco lesions (26.7%), virus-associated lesions (18.7%), and lichen planus (16.0%). Lesions in 11% of participants with leukoplakia and one-third of participants with lichen planus persisted for 5 years or more. Dysplasia was present in four participants with leukoplakia. Seventeen percent of participants developed a new white or red oral mucosal lesion. Five patients (6.1%) developed oral or pharyngeal cancer, four among participants with leukoplakia (one with prior dysplasia) and one among participants with lichen planus. Four of the cancers developed 6-20 years after enrollment, and only one was at the original lesion site. Conclusions:The occurrence of oral and pharyngeal cancers in some study participants with white and red oral mucosal lesions many years after enrollment reinforces the need for patients, dentists, and health care systems to have better
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