The coronavirus disease 2019 (COVID-19) pandemic has specific implications for oral and maxillofacial surgeons due to an increased risk of exposure to the virus during surgical procedures of the aero-digestive tract. The objective of this survey was to evaluate how the COVID-19 pandemic affected oral and maxillofacial surgery (OMFS) training programs during the early phase of the pandemic. Methods A cross-sectional survey was sent to the program directors of 95 out of the 101 accredited OMFS training programs between April 3 rd and May 6 th , 2020. The 35- question survey designed using Qualtrics software, to elicit information about the impact of COVID-19 on OMFS residency programs and the specific modifications made to clinical care, PPE and resident training/wellness to meet the response to the COVID-19 pandemic. Results The survey response rate from OMFS program directors was 35% (33/95) with most responses from states with high incidence of COVID19. All OMFS programs (100%) implemented guidelines to suspend elective and non-urgent surgical procedures and limited ambulatory clinic visits by third week of March, with an average date of March 16 th , 2020 (Date range March 8 th -23 rd ). Programs used telemedicine (40%) and modified in-person visit (51%) protocols for dental and maxillofacial emergency triage to minimize exposure risk of HCP to SARS CoV2. PPE shortage was experienced by 51% of the programs. Almost two-thirds (63%) of the respondents recommended the use of a filtered respirator (i.e., N95 respirator) with full face shield as their preferred PPE, while 21% recommended Powered Air Purifying Respirators (PAPRs) during OMFS procedures. Only (73%) of the programs had resources for resident wellness and stress reduction. Virtual didactic training sessions conducted on digital platforms, most commonly “Zoom” formed a major part of education for all programs. Conclusion All programs promptly responded to the pandemic by making appropriate changes to suspend elective surgery and, to limit patient care to emergent and urgent services. OMFS training programs should give more consideration to provide residents with adequate stress reduction resources to maintain their wellbeing and training to minimize exposure risk during an evolving global epidemic.

Oral cancer patients often have severe, chronic, and mechanically induced pain at the site of the primary cancer. Oral cancer pain is initiated and maintained in the cancer microenvironment and attributed to release of mediators that sensitize primary sensory nerves. This study was designed to investigate the histopathology associated with painful oral cancers in a preclinical model. The relationship of pain scores with pathologic variables was also investigated in a cohort of 72 oral cancer patients. Wild-type mice were exposed to the carcinogen, 4-nitroquinoline 1-oxide (4NQO). Nociceptive (pain) behavior was measured with the dolognawmeter, an operant device and assay for measuring functional and mechanical allodynia. Lesions developed on the tongues and esophagi of the 4NQO-treated animals and included hyperkeratoses, papillomas, dysplasias, and cancers. Papillomas included lesions with benign and dysplastic pathological features. Two histologic subtypes of squamous cell carcinomas (SCCs) were identified—SCCs with exophytic and invasive components associated with papillary lesions (pSCCs) and invasive SCCs without exophytic histology (iSCCs). Only the pSCC subtype of tongue cancer was associated with nociceptive behavior. Increased tumor size was associated with greater nociceptive behavior in the mouse model and more pain experienced by oral cancer patients. In addition, depth of invasion was associated with patient-reported pain. The pSCC histology identifies 4NQO-induced tongue cancers that are expected to be enriched for expression and release of nociceptive mediators.

Background. Oral human papillomavirus (HPV) infection is the principal underlying cause of a dramatic rise in oropharyngeal cancer. Dentistry can play an important role in developing clinical algorithms for secondary prevention. Methods. This cross-sectional pilot study was conducted with practices of the National Dental Practice-Based Research Network. It evaluated the feasibility and acceptability of screening and testing procedures as judged by practitioners and patients. Tablets were used for patient screening, obtaining consent and administering a confidential oral HPV risk factor survey. Results. Most patients (85%) were comfortable being asked about cigarette use, their sexual behavior (69%), and were interested in participating again (79%). Over 90% of practitioners were comfortable with study procedures except the extra time required for patient participation (75% comfortable). There were no problems with oral rinse collection as reported by patients or practitioners. Conclusions. It is feasible in community dental offices to collect oral rinses for HPV detection and to ask patients explicit questions about sexual history when using a tablet device for confidentiality Practical Implications. Discussing high-risk types of HPV and appropriately assessing that risk is a challenge for dental professionals. These results are positive from a research perspective but do not address the advisability of routine HPV screening in dentistry.

Oral cancer is a painful and debilitating type of cancer. Oral cancer patients frequently experience severe pain while eating and talking. Pain is attributed to neuronal sensitization by the release of chemical mediators from the cancer cells and cancer microenvironment. Not all oral cancers are painful. Patients with painful oral cancers are more likely to have worse prognosis and metastatic disease, and their pain is not well managed with NSAIDs or opioid analgesics. Therefore, there is an unmet clinical need to identify the underlying mechanisms of oral cancer pain. This study was designed to identify pathological lesions associated with increased pain in a preclinical model of oral cancer and pain. Forty C57BL/6 female mice were treated with 4-nitroquinoline 1-oxide (4NQO) for 16 weeks, and followed for the development of tongue lesions for 12 weeks. Concurrently, change in nociceptive behavior (i.e., the animal equivalent of pain behavior) was measured using a validated operant assay and device for measuring functional mechanical allodynia (the dolognawmeter). Nociception (pain) scores and histopathological data were obtained from 36 animals. Mice developed a spectrum of tongue and esophageal lesions including hyperkeratoses, papillomas (exophytic lesions), dysplasias and cancers. Papillomas included lesions with benign and dysplastic pathological features, indicating that both lesion types were in the continuum of malignant transformation. Mice harbored lesions associated with low pain scores (n=9), intermediate pain scores (n=16) and high pain scores (n=11). Three pathological subsets of squamous cell carcinomas (SCCs) were identified that displayed stromal invasion (iSCC), deep stromal invasion >1.5mm depth (diSCC) and cancers with exophytic and invasive morphology associated with papillary lesions (pSCCs). Increased nociceptive behavior was associated with pSCCs in univariate and multivariate analyses. Cancers of the pSCC subtype are expected to be enriched for expression and release of nociceptive mediators. The study demonstrates that the 4NQO model recapitulates human cancer with respect to development of cancers differing in level of cancer associated nociception. Citation Format: Keyur Naik, Malvin N. Janal, Jason Chen, Daniel E. Bandary, Branden Brar, Aditi Bhattacharya. Lesion pathology and oral-cancer associated pain in the 4NQO oral carcinogenesis model [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2041.

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