Oral & Maxillo-facial Surgery, Cork University Dental School & Hospital, University College Cork, Ireland.
Oral Oncol. 2011 May;47(5):395-9. doi: 10.1016/j.oraloncology.2011.03.003. Epub 2011 Mar 26.
This study examines the prevalence of oral mucosal lesions and conditions among Irish addiction treatment centre residents and explores the feasibility and acceptability of a targeted oral cancer screening programme for such individuals. Four alcohol addiction treatment centres were visited periodically over a 12-month period. Two hundred and twenty residents (78% of 283 targeted) were interviewed regarding their alcohol, tobacco and drug habits (type, quantity, duration), and attitudes to dental care. Comprehensive oral examinations were performed. All potentially sinister soft tissue lesions/symptoms were referred for further investigation. Data analysis utilised SPSS-18. Ten participants who denied a history of alcohol/drug addiction were excluded from the main study. Remaining 210 participants comprised 148 males (70%) and 62 females (30%), ranging from 18 to 73 years of age, (mean 37.65; S.D. 13.82); 60% were under 40. High rates of tobacco and alcohol usage were recorded, 53% reported dual addiction (drug+alcohol), 44% alcohol only, 3% drug only. The prevalence of mucosal abnormalities was 29% with 84 mucosal abnormalities/symptoms detected in 61 subjects, comprising 28 extra-oral lesions/symptoms and 56 intra-oral lesions. Residents with mucosal abnormalities were significantly older (mean 41.8 years; S.D. 14.3) than those without such lesions (mean 35.95; S.D. 13.3), (p<0.05). Highest prevalences were noted for candidiasis (3.8%), facial scaring/laceration (3.8%), intra-oral lumps/swellings (2.9%), lymphadenopathy (2.9%) and hoarseness (1.9%). Four red areas suggestive of erythroplasia and two leukoplakic lesions were detected. Study addresses the paucity of data on the prevalence of oral mucosal lesions in addicted persons in Southern Ireland. Thirteen extra-oral lesions/symptoms and 19 intra-oral lesions were potentially significant. Despite the relatively poor follow-up compliance rate (33%), two premalignant lesions were confirmed in the main study group, yielding a detection rate of 0.9%. Results suggest that an oral cancer screening programme targeted at individuals in addiction treatment centres may provide a feasible way to access persons with a history of tobacco and alcohol abuse. A high rate of untreated disease and emergency only attendance was seen in this study suggesting a lack of engagement with GDP services. Opportunistic screening in primary care is therefore unlikely to capture this cohort. Inclusion of oral cancer screening in the routine medical examination given to residents of addiction treatment centres may provide an efficient and effective way to detect potentially malignant lesions in these high-risk individuals.
本研究调查了爱尔兰戒毒中心居民口腔黏膜病变和状况的流行情况，并探讨了针对此类人群的靶向口腔癌筛查计划的可行性和可接受性。在 12 个月的时间里，定期访问了四个酒精戒毒中心。对 220 名居民（目标 283 人的 78%）进行了关于他们的酒精、烟草和毒品习惯（类型、数量、持续时间）以及对牙科护理的态度的访谈。进行了全面的口腔检查。所有可疑的软组织病变/症状均被转介进行进一步检查。数据分析使用了 SPSS-18。10 名否认有酒精/药物成瘾史的参与者被排除在主要研究之外。其余 210 名参与者包括 148 名男性（70%）和 62 名女性（30%），年龄在 18 至 73 岁之间（平均 37.65；标准差 13.82）；60%的人在 40 岁以下。记录了高烟草和酒精使用率，53%的人报告双重成瘾（药物+酒精），44%的人仅酒精成瘾，3%的人仅药物成瘾。黏膜异常的患病率为 29%，在 61 名受试者中检测到 84 个黏膜异常/症状，包括 28 个口腔外病变/症状和 56 个口腔内病变。有黏膜异常的居民明显比没有此类病变的居民年龄更大（平均 41.8 岁；标准差 14.3），（p<0.05）。发病率最高的是念珠菌病（3.8%）、面部疤痕/撕裂伤（3.8%）、口腔内肿块/肿胀（2.9%）、淋巴结病（2.9%）和声音嘶哑（1.9%）。检测到四个红色区域提示红斑病和两个白色斑块病变。该研究解决了爱尔兰南部成瘾者口腔黏膜病变患病率数据不足的问题。13 个口腔外病变/症状和 19 个口腔内病变具有潜在意义。尽管随访依从率相对较低（33%），但在主要研究组中确认了两个癌前病变，检出率为 0.9%。结果表明，针对戒毒中心患者的口腔癌筛查计划可能是一种可行的方法，可以接触到有烟草和酒精滥用史的人。本研究中发现大量未治疗的疾病和仅急诊就诊，表明与 GDP 服务的参与度低。因此，初级保健中的机会性筛查不太可能捕获到这一人群。将口腔癌筛查纳入戒毒中心居民的常规体检可能是一种有效且高效的方法，可以在这些高危人群中发现潜在的恶性病变。
