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Objectives By a scoping review, to evaluate whether patients with immune-mediated inflammatory disorders (IMIDs) treated with biological and conventional disease-modifying antirheumatic drugs (b/cDMARDs) and/or glucocorticoids (GCs) experience complications after invasive oral procedures. Materials and methods Primary search was conducted on PubMed/MEDLINE database, Google Scholar, Embase and Web of Science up to December 31, 2023. The PICO question was “Does a patient with IMIDs and treated with b/cDMARDs in mono/bi or combination therapies have delayed oral wound healing or infectious complications after an invasive oral procedure?”. To be included, references had to be primary studies written in English or French. Qualitative assessment was performed. Results From 1,494 initial articles, 59 full-text articles were selected, including 47 case reports and case series, 7 comparative non-randomized studies, 1 randomized clinical trial, 2 case-case studies, 1 case–control study, and 1 prospective cohort study. Most reports involved patients with rheumatoid arthritis on methotrexate and/or anti-TNF. Complications (medication-related osteonecrosis of the jaw, delayed healing, local infection) occurred predominantly after tooth extractions, particularly affecting women, patients over 50 with bisphosphonate use, unhealthy lifestyle habits, or diabetes. They were generally managed with prolonged antibiotic and antiseptic courses, and surgical interventions. Conclusions Local infectious complication or jaw osteonecrosis could occur post-invasive procedures, especially tooth extractions, in IMIDs patients on b/cDMARDs and/or GCs, often in patients with comorbidities and/or concurrent medications such as bone-modifying drugs. Clinical relevance It is essential for dentists to be alert to the existence of local or focal infectious complications after tooth extraction in patients with IMIDs on immunosuppressive therapy.

Background Alcohol is a well-established risk factor for head and neck cancer (HNC). This study aims to explore the effect of alcohol intensity and duration, as joint continuous exposures, on HNC risk. Methods Data from 26 case-control studies in the INHANCE Consortium were used, including never and current drinkers who drunk ≤10 drinks/day for ≤54 years (24234 controls, 4085 oral cavity, 3359 oropharyngeal, 983 hypopharyngeal and 3340 laryngeal cancers). The dose-response relationship between the risk and the joint exposure to drinking intensity and duration was investigated through bivariate regression spline models, adjusting for potential confounders, including tobacco smoking. Results For all subsites, cancer risk steeply increased with increasing drinks/day, with no appreciable threshold effect at lower intensities. For each intensity level, the risk of oral cavity, hypopharyngeal and laryngeal cancers did not vary according to years of drinking, suggesting no effect of duration. For oropharyngeal cancer, the risk increased with durations up to 28 years, flattening thereafter. The risk peaked at the higher levels of intensity and duration for all subsites (odds ratio = 7.95 for oral cavity, 12.86 for oropharynx, 24.96 for hypopharynx and 6.60 for larynx). Conclusions Present results further encourage the reduction of alcohol intensity to mitigate HNC risk.

A 41‐year‐old female patient in apparent good health presented to the dental emergency department with a 6‐week history of painless, nonpruritic left facial swelling, and dotted with purplish patches. She had consulted different physicians and dentists and received several ineffective treatments. After ruling out an oral cause, standard blood tests were initially prescribed. They showed an isolated elevation of creatine phosphokinase (CPK). Muscular weakness of the left arm and leg, pain on mobilization of the left thigh, and erythematous plaques on the left body then appeared. Infectious, granulomatous, and autoimmune diseases were investigated. Magnetic resonance imaging (MRI) showed diffuse muscle infiltration, suggestive of myositis. Myositis‐specific dot immunoassay identified antinuclear matrix protein 2 (NXP2) autoantibodies, enabling the diagnosis of dermatomyositis. The inaugural orofacial manifestations of dermatomyositis can be confused with pathologies of dental cause, such as cellulitis. In the absence of local warning signs, oral health professionals must consider a systemic etiology and rapidly refer the patient to avoid patient wandering.

Objectives The aim of the study was to provide an overview of the practices of French general dentists (GDs) and specialists (SDs) concerning the management of patients with inflammatory bowel diseases (IBDs), rheumatic inflammatory diseases (IRDs), and vasculitis on biologic disease-modifying antirheumatic drugs (bDMARDs), conventional DMARDs, or immunosuppressants (ISs). Materials and methods An online national cross-sectional survey with 53 questions was developed by a multidisciplinary team including rheumatologists, gastroenterologists and dentists based on their clinical experience. It was refined following a test with nine dentists in private practice and in hospital before being disseminated to the members of French scientific societies and colleges of dentistry teachers over 3 months. Responses of general dentists versus specialists were compared with respect to their experience in managing patients with IRDs or IBDs, knowledge/training, type of invasive procedure performed, management of medical treatment, perioperative oral-care protocols, and frequency of postoperative complications after invasive dental care procedures. Result In total, 105 practitioners fully completed the survey (participation rate 11.1%). SDs more frequently performed invasive surgical procedures and were more aware of the recommendations of learned societies than GDs. They encountered more post-operative complications for patients on bDMARDs. For both SDs and GDs, most patients were managed without stopping treatment and pre- and postoperative antibiotics were prescribed to more than 75% of patients. When medical treatment was stopped, the decision was made by the prescribing physician. Conclusion Complications were reported more frequently by SDs when highly invasive procedures were performed on patients under active drug therapy. Certain common procedures, such as scaling and root planing, appear to be safe, regardless of treatment management. However, adapted guidelines for the practice of dentistry are needed to standardize the management of patients on bDMARDS, conventional DMARDs, or ISs. Clinical relevance French dentists perform a wide range of oral procedures on patients on bDMARDS, conventional DMARDs, or ISs under antibiotic coverage and antiseptic mouthwashes. SDs reported more postoperative complications after extensive invasive procedures for patients under active drug therapy, despite their greater knowledge of recommendations on how to manage such patients.

Background Significant sex disparities exist in the incidence of lung and upper aero‐digestive tract (UADT) cancers. Inverse relationships have often been observed between exposure to hormonal factors and these cancers. Data from epidemiological studies are still inconsistent. Aims We investigated the association between hormonal factors and the risk of cancers of the lung and UADT in French women. Methods E3N is a French prospective population‐based cohort that recruited 98 995 women in 1990. We used a Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with age as the time scale. We also conducted a cluster analysis using the K‐means method to assess distinct patterns of hormone exposure and the cancer risk associated with them. Results 91 114 women were included (398 lung and 157 UADT). We highlighted 6 distinct exposure patterns of hormonal exposure, but no significant association was noted with cancer risk. Concerning individual factors, shorter menstrual cycles (≤ 24 days) were associated with a higher risk of developing female lung cancer even among never smokers (HR = 1.75, 95% CI = 1.01–3.01). Among never smokers, the risk of UADT was lower among women with at least 3 pregnancies compared to those with none (HR = 0.43, 95% CI = 0.20–0.91). Menarche under 12 years was associated with a non‐significant increase in the risk of UADT cancer among never smokers (HR = 1.76, 95% CI = 0.95–3.26). Conclusion Menstrual cycle length was significantly associated with higher risk lung cancer, while UADT cancer was inversely associated with the number of pregnancies. Our findings are widely consistent with the commonly adopted hypothesis of oestrogen deficiency as a mechanism for UADT risk but not for lung cancer. While larger studies are needed to confirm these findings, our study is novel, particularly for UADT cancer since our study is one of the first longitudinal studies among never smokers. Trial Registration: clinicaltrials.gov identifier: NCT03285230

Purpose To investigate the role of adiposity in the associations between ultra-processed food (UPF) consumption and head and neck cancer (HNC) and oesophageal adenocarcinoma (OAC) in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods Our study included 450,111 EPIC participants. We used Cox regressions to investigate the associations between the consumption of UPFs and HNC and OAC risk. A mediation analysis was performed to assess the role of body mass index (BMI) and waist-to-hip ratio (WHR) in these associations. In sensitivity analyses, we investigated accidental death as a negative control outcome. Results During a mean follow-up of 14.13 ± 3.98 years, 910 and 215 participants developed HNC and OAC, respectively. A 10% g/d higher consumption of UPFs was associated with an increased risk of HNC (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.14–1.34) and OAC (HR = 1.24, 95% CI 1.05–1.47). WHR mediated 5% (95% CI 3–10%) of the association between the consumption of UPFs and HNC risk, while BMI and WHR, respectively, mediated 13% (95% CI 6–53%) and 15% (95% CI 8–72%) of the association between the consumption of UPFs and OAC risk. UPF consumption was positively associated with accidental death in the negative control analysis. Conclusions We reaffirmed that higher UPF consumption is associated with greater risk of HNC and OAC in EPIC. The proportion mediated via adiposity was small. Further research is required to investigate other mechanisms that may be at play (if there is indeed any causal effect of UPF consumption on these cancers).

ObjectiveThe association between occupational exposure to chlorinated solvents and lung cancer remains inconclusive. This study investigated this relationship using data from the internationally pooled SYNERGY study.MethodsData from 14 case–control studies conducted in 13 European countries and Canada were pooled, including 28 048 participants (12 329 cases and 15 719 controls). Lifetime occupational exposure to chlorinated solvents was assessed using the ALOHA+job-exposure matrix. ORs and 95% CIs were estimated using unconditional logistic regression, adjusted for study centre, age, sex, smoking (pack-years and cessation), cumulative exposure to five occupational lung carcinogens (asbestos, hexavalent chromium, polycyclic aromatic hydrocarbons, respirable crystalline silica and diesel engine exhaust), cumulative benzene exposure and employment in high-risk occupations (‘List A’ jobs). Associations were estimated across categories of exposure levels, durations and analyses stratified by smoking status and lung cancer subtypes.ResultsWe found no evidence of an association between ever exposure to chlorinated solvents and lung cancer risk (OR 1.03; 95% CI 0.96 to 1.10). Among exposed individuals, a positive trend with cumulative exposure was observed (p=0.031), but not when non-exposed individuals were included (p=0.173). Positive trends were found with exposure duration (p=0.005 for exposed; p=0.048 overall); risks were modestly elevated (OR 1.11) in those exposed for 20 or more years. No increased risk was observed across smoking strata or lung cancer subtypes.ConclusionsThis pooled analysis provides limited evidence of an association between occupational exposure to chlorinated solvents and lung cancer, though exposure-response trends were noted among exposed individuals.

Lymphomas are malignant proliferations of B or T lymphocytes, classified as Hodgkin or non-Hodgkin lymphomas. The malignant proliferation of lymphoid cells mainly occurs in lymph nodes, but in a small number of cases, it can be extranodal. The oral cavity represents a very rare primary extra-nodal location for non-Hodgkin lymphoma and can pose a diagnostic challenge for the dentist. We report the case of a woman in her 50s presenting a primary oral manifestation of a diffuse large B-cell lymphoma (DLBCL). The patient was complaining of an inflammatory swelling of the vestibular gingiva of the left maxillary premolars, which had been growing for four months. She had consulted several dentists who suspected a dental cause, without any clear argument in favor of a periodontal or endodontic etiology. Periodontal treatments were initiated, and multiple courses of antibiotics were prescribed without improvement in the clinical presentation. Finally, the patient was referred to the hospital where a biopsy of the gingival lesion was performed. Histological and immunohistochemical examinations led to the diagnosis of a DLBCL. The patient was referred to a hematology-oncology department and received polychemotherapy treatment until complete remission. Initial oral manifestations of lymphoma may mimic dental, endodontic, or periodontal pathology. Appropriate oral clinical and radiological examinations should exclude local causes. If these examinations are inconsistent with the clinical presentation, systemic diseases should be considered, and a prompt biopsy of the lesion should be performed to obtain a definitive diagnosis. Early detection of a primary oral lymphoma can improve the prognosis with timely multidisciplinary medical management.

Background This study aims to provide new insights on the role of smoking patterns and cigarette dependence in female lung cancer, and to examine differences by histological subtype. Methods We conducted a population-based case-control study in the great Paris area among women including 716 incident cases diagnosed between 2014 and 2017 and 757 age-matched controls. Detailed data on smoking history was collected during in-person interviews to assess intensity and duration of tobacco smoking, time since cessation, smoking habits (depth of smoke inhalation, use of filter, type of tobacco, and type of cigarettes) and Fagerström test for cigarette dependence. The comprehensive smoking index (CSI), a score modelling the combined effects of intensity, duration and time since quitting smoking was determined for each subject. Multivariable logistic regression models were fitted to calculate odds ratios (ORs) and their confidence intervals (95%CI) of lung cancer associated with smoking variables. Results Lung cancer risk increased linearly with intensity and duration of tobacco smoking while it decreased with time since cessation, to reach the risk in never-smokers after 20 years of abstinence. The combined effect of intensity and duration of tobacco smoking was more than multiplicative (p-interaction 0.012). The OR in the highest vs the lowest quartile of CSI was 12.64 (95%CI 8.50; 18.80) (p-trend < 0.001). The risk of small cell or squamous cell carcinomas increased with the CSI more sharply than the risk of adenocarcinomas. Deep smoke inhalation, dark vs blond tobacco, conventional vs light cigarettes, and unfiltered vs filtered cigarettes, as well as having mixed smoking habits, were found to be independent risk factors. Having high cigarette addiction behaviours also increased the risk after adjusting for CSI. Conclusion This study provides additional insights on the effects of tobacco smoking patterns on lung cancer risk among women.

Circadian rhythm disruption due to night shift work and/or sleep disorders is associated with negative health outcomes including cancer. There is only scant evidence of an association with lung cancer, unlike breast and prostate cancer. We explore the role of sleep disorders and night shift work in lung cancer risk among women in a population-based case-control study, including 716 lung cancer cases and 758 controls. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) associated with sleep duration per day (<7 h, 7–7.9 h, ≥8 h), a summary index of sleep disorders, chronotype, and night shift work exposure metrics. When compared to women with an average sleep duration of 7–7.9 h per day, the OR was 1.39 (95% CI 1.04–1.86) in long sleepers (≥8 h) and 1.16 (95% CI 0.86–1.56) in short sleepers (<7 h). Overall, lung cancer was not associated with the sleep disorder index, nor with night shift work, regardless of the duration of night work or the frequency of night shifts. However, elevated OR associated with the sleep disorder index were found in the subgroup of current smokers. The U-shaped association of lung cancer with sleep duration was more particularly pronounced among women who worked at night ≥5 years. Our findings suggested that sleep patterns are associated with lung cancer risk in women with a potential modifying effect by night shift work duration or tobacco smoking.