Journal Club

Journal ClubPrepared By: Niyas UmmerOral Health-Related Quality of Lifeof Patients withOral Lichen Planus, Oral Leukoplakia, or Oral Squamous Cell CarcinomaJ Karbach, B Al-Nawas, M Moergel, M Daublander

J Oral Maxillofac Surg 72:1517-1522, 2014IntroductionPremalignant and Malignant DiseasesFrequently seen in oral and maxillofacial surgery

Malignant transformation rate: 1 to 18 %Monitoring by a specialist - strongly recommended

Malignant potential - only histologic evaluation

Early detection - survival and quality of lifeOral lichen planus (OLP)Oral leukoplakia (OL)Oral squamous cell carcinoma (OSCC)BackgroundImpact of OLP, OL or OSCC on oral health-related quality of life (OHRQoL) seems to be variable

Consultation of physicians can be delayedOLP and OHRQoLHigh levels of stress, anxiety, and depression - etiology of OLP (Chaudhary)Clinical management poses considerable difficulties to oral physician and dermatologistAsymptomatic/symptoms ranging from burning sensations to severe pain - interfere with speaking, eating, swallowingOHRQoL - chronic character, different clinical forms, psychological influences, and difficulties in treatment

OL and OHRQoLPremalignant lesionDifferential diagnosis from OLP - often difficult

OHRQoL of patients with OL has been evaluated in 2 articlesOSCC and OHRQoLProfiling of early OSCCAfter treatment, patients have impairment in OHRQoL, depending on tumor classification and therapyTo measure OHRQoL - European Organization for Research and Treatment of Cancer (EORTC) scaleEORTC QLQ-C-30 questionnaire

Impact of OSCC on patients OHRQoL at time of diagnosis and before treatment of OSCC - mentioned only in a small number of articles assess quality of life of patients with cancer supplemented by disease-specific modules for those with head and neck cancer (EORTC H&N-35)8Oral Health Impact Profile (OHIP)Common questionnaire for measuring OHRQoL During diagnosis and therapy of oral diseasesStudy MethodologyAimsTo measure and compare the OHRQoL of patients with OLP, OL, and OSCC using German version of 14-item OHIP (OHIP-G14)

To determine whether different clinical forms of OLP, OL, or OSCC and patients gender, age, alcohol usage, and smoking behaviour would have an influence on OHRQoL before therapyThe description of OHRQoL of these patients highlights the need for the improvement of the treatment depending on the influence of these diseases and their specific OHRQoL profile

11MaterialsDepartment of Oral Surgery, University Medical Center, Mainz, Germany in 2010154 new patientsClinical diagnosis of OLP, OL, or OSCCExamined previously or underwent therapyMethodsInformed verbal and written consent from each patient

Participants asked to complete OHIP-G 14

Refusal to ParticipateQuestionnaireOHIP-14 (short form) [Slade]Translated into German [John et al]Determine degree of impact of different oral diseases on 7 dimensions (2 items per dimension)

Answered using a Likert scaleMaximum score 56 (8 in each dimension)Analysis of total score or score for each subscaleNever0Barely1Sometimes2Often3Really often4OHIP-14 DimensionsFunctional limitationPhysical painPsychological discomfortPhysical disabilityPsychological disabilitySocial disabilityHandicapOHIP-G 14, as a standardized characterization of the subjective OHRQoL, was used as a snap-reading method to describe the oral pain and psychosocial effects on OHRQoLOHIP refers to past month - chosen because of common usage - useful in evaluating normal population data

15Categorization of OLPAndreasen (1968)

OHRQoL scores of patients with asymptomatic forms were grouped together and compared with symptomatic formsReticularPapularPlaquelikeAtrophicBullousUlcerativeCategorization of OLHomogenousNon-homogenousInhomogeneous leukoplakiaErythroleukoplakiaErythroplakia)Categorization of OSCCBy tumor size (greatest dimension) - TNM classificationT12 cmT2>2 cm to 4 cmT3>4 cmT4>4 cm or invades boneStatistical AnalysisQualitative variables - absolute and relative frequenciesKruskal-Wallis testUnivariate analysisWilcoxon signed-rank test Fisher exact testMultivariate logistic regressionVariable selection with backward eliminationSPSS 17.0(SPSS, Inc, Chicago, IL)Outcome with a P value less than .05 significantThe effect of possible indicators for high values of the total score on the OHIP-G 14 and on each subscale (ie, gender, age, alcohol usage, and smoking habits) was tested in the Fisher test

Wilcoxon - assess differences in each group (OLP, OL, and OSCC)

Kruskal-Wallis test - compare 3 groups of patients in relation to total score and within the subscales of OHIP-G 14

After calculating a full model, variable selection with backward elimination was conducted to find the best indicators for high values of the total score on the OHIP-G 14 and on each subscale in the 3 groups. Therefore, a significance level of P value less than .01 after Bonferroni correction for multiple testing was applied19ResultsTable 2 Gender and Age DistributionPatients (n=154)P ValueOLP (n=73)OL (n=44)OSCC (n=37)Men