FUTURE OFDENTISTRYjection of desired outcomes to affect tooth movement.
New techniques that cross specialty barriers (e.g.,
oseointegrated implants used for anchorage, distrac-
tion osteogenesis) will be utilized to achieve optimum
results in particularly challenging cases.
FUTURE CHANGES IN ORAL AND PHARYNGEAL
CANCERS RESEARCH
A number of new diagnostic approaches will facili-
tate an expanded role for dental practitioners in identi-
fying the risk for oral cancer, and the early diagnosis of
oral cancerous lesions. A recently introduced brush
biopsy-computerized cytological identification system
has shown promise for diagnosis of epithelial cancers
without the need for a surgical biopsy. In the future,
new saliva-based diagnostic approaches based on the
improved understanding of the genetic basis of oral
cancer will become available for clinical application.
Clinicians will be able to use algorithms to iden-
tify persons at greater risk for development of
malignancy. These algorithms will combine the
effects of environmental and genetic risk factors.
Other diagnostic procedures, including quantitation
of nuclear DNA, may be used to identify the prog-
nosis and predict the clinical outcome of patients
with intraoral epithelial dysplastic lesions.
Chemoprevention research is aimed at reversing the
growth of advanced premalignant lesions using
retinoic acid derivatives and other substances (Geyer
et al, 1998). This approach may also help prevent
new primary cancers in patients who already have
oral and pharyngeal cancers and may increase the
effectiveness of methods aimed at treating the primary
cancers themselves. Additional basic research and
clinical trials are needed to evaluate promising chemo-
prevention approaches more rapidly and effectively.
Since such individuals are at very substantially elevat-
ed risk of developing oral cancer, they could be prior-
itized for frequent oral examinations for early cancer
detection and for smoking and alcohol cessation inter-
vention programs (Prochazka, 2000).
Advances in the understanding of the molecular basis
for progression, angiogenesis, invasion, and metastasis
of oral cancers (Califano et al, 2000; Grandis et al,
2000; Hanzawa et al, 2000; Nitta et al, 2000; and
Smith BD et al, 2000) is especially important for devel-
oping new methods to detect these tumors and new
treatments to halt their growth and metastisis.
Future research should focus on the following
challenges and opportunities:
u Continued research on promising improvements
in the detection and diagnosis of oral mucosal
lesions, including cancers, using molecular tools:- Staining with toluidine blue to focus attention
on lesions progressing toward malignancy (Ephros
and Mashberg, 1999; and Kerawala et al, 2000). - A neural network computational approach using
an oral brush biopsy and computerized cytolog-
ical detection of abnormalities to facilitate detec-
tion of dysplasia and carcinoma (Sciubba, 1999). - Molecular assays such as those based on mito-
chondrial DNA mutations to provide highly sen-
sitiveand non-invasive early oral cancer detec-
tion (Fliss et al, 2000). - Following-up on a very exciting recent devel-
opment regarding the use of abnormal DNA content
(tetraploidy or aneuploidy) to assess the risk of cancer
development from oral leukoplakias (SudbØ et al,
2001). A carcinoma developed in only 3% of normal
diploid lesions, versus 60% of tetraploid and 84% of
aneuploid lesions during a mean follow-up period of
over eight years.
u New treatment approaches using gene therapy
combined with chemotherapies (Khuri et al,
2000), immunotherapy (Chikamatsu et al, 1999)
and approaches directed at reducing invasiveness
(Simon et al, 1999).u Investigating ways to reduce oral cancer patients’
excess morbidity and mortality from causes other
than due to oral cancer itself, mostly due to the
patients’ high levels of alcohol and tobacco use.uDeveloping more effective methods to educate
dental professionals about oral cancer risk factors
and to encourage high quality and frequent oral
examinations for early cancer detection (Yellowitz
et al, 2000).uResearch should also investigate optimal and cost
effective ways to inform both health professionals
and the general public about the great value of
decreasing high-risk behaviors such as smoking and
alcohol drinking and increasing consumption of
fruits and vegetables.Dental and Craniofacial Research