Behçet's disease

Beh?et's disease is a multisystem inflammatory disorder, characterized by recurrent oral and genital ulceration and uveitis. Additionally, skin lesions, vasculitis, and arthritis may occur. The disease is chronic, with exacerbations and remissions. Treatment of Behcet's disease is symptomatic depending on the symptoms and their severity. Oral ulcers are seen in 98% of patients with Beh?et's disease. Some aspects of oral health, such as the amount of plaque and the presence of periodontal disease, and possibly also caries, are more prevalent in patients with the disease when compared to healthy persons. All oral health aspects will probably benefit from good oral health care. Medications which can be employed for treatment of the various symptoms of the disease are colchicine, corticosteroids, immunosuppressives, cyclosporine, pentoxyfylline, anticoagulants, and thalidomide.     

Inflammatory bowel disease: clinics and pathology. Do inflammatory bowel disease and periodontal disease have similar immunopathogeneses?

Inflammatory bowel disease (IBD) comprises two chronic, tissue-destructive, clinical entities Crohn disease (CD) and ulcerative colitis (UC) both apparently caused by immunological overreaction (hypersensitivity) to commensal gut bacteria. Under normal conditions the intestinal immune system shows a down-regulating tone ('oral tolerance') against dietary antigens and the indigenous microbiota. This local homeostasis is disturbed in IBD, leading to hyperactivation of T helper 1 (Th1) cells with abundant secretion of interferon-gamma and tumor necrosis factor (TNF) and production of IgG antibodies against commensal bacteria. In addition, UC includes genetically determined autoimmunity, particularly IgG1-mediated cytotoxic epithelial attack. Breaching of the epithelium is the best-defined event underlying abrogation of oral tolerance, but immune deviation caused by cytokines fiom irritated epithelial cells or subepithelial elements (for example, mast cells, natural killer cells, macrophages) may also be involved. Endogenous infection with local hypersensitivity likewise causes periodontal disease, reflecting 'frustrated' immune elimination mechanisms entertained by antigens from dental plaque. Altogether, perturbation of a tightly controlled cytokine network, with abnormal crosstalk between several cell types, apparently explains the progressive immunopathology of chronic inflammatory mucosal diseases in general. This adverse development will be influenced by numerous immunity genes, the dosage and potential pathogeniciy of commensal bacteria, general health, nutritional status, and psychological factors. Several targets for new therapy have tentatively been identified to block immunopathological mechanisms in IBD, and inhibition of TNF has a striking beneficial effect in CD, supporting a central role of this cytokine.     

Clinical characteristics of Mikulicz’s disease as an IgG4-related disease

Objectives

Mikulicz’s disease (MD) was considered to be a subtype of Sjögren’s syndrome (SS), based on histopathological similarities. However, recent studies have indicated that patients with MD show high serum IgG4 concentration, and suggested that MD is one of “IgG4-related disease” and distinguishable from SS. Therefore, we clinically and histopathologically examined the disease states of MD and SS in detail.

Materials and methods

Twenty patients with Mikulicz’s disease and 18 with SS were comparatively studied to determine clinical characteristics in MD patients.

Results

Sialography in MD patients did not show the “apple-tree sign” typically seen in SS. Serologically, high serum IgG4 levels but not anti-SS-A or anti-SS-B antibodies were observed in MD. SS showed lymphocytic infiltration of various subsets with atrophy or severe destruction of the acini, while MD showed selective infiltration of IgG4+ plasma cells with hyperplastic germinal centers and mild acini destruction. Corticosteroid treatment of MD reduced IgG and IgG4 levels and improved salivary function. A negative correlation between disease duration and increasing rate of salivary flow was observed in MD.

Conclusions

These results suggested that the pathogenesis of MD might be different from those of SS. Clinical Relevance: early diagnosis and treatment of MD is important for the improvement of salivary function.     

Is periodontal disease a risk factor for coronary artery disease (CAD)?

Coronary artery disease (CAD) remains the principal cause of death in most developed countries, despite significant preventive and therapeutic advances. Current epidemiological data imply that recent reductions in the prevalence of this disease are unlikely to be sustained until those at high risk are more precisely targeted. Although dental (especially periodontal) infections have been recently identified as independent risk factors for CAD, current evidence is insufficient to justify treatment of such infections to arrest or reverse CAD or other systemic conditions (e.g., diabetes mellitus, stroke or adverse outcomes of pregnancies).     

Does dental disease hurt your heart?

Recent research has yielded conflicting data regarding the relationship between dental disease, particularly periodontitis, and cardiovascular disease. A causative relationship would have major ramifications for health care. There is a plausible theoretical basis for such a link, as increased levels of inflammatory mediators may increase the risk of atherosclerotic plaque formation. Nevertheless, a clinical confirmation of a causative relationship has been difficult, in part because cardiovascular disease and periodontal disease share common risk factors such as increasing age and tobacco use, and because cardiovascular medications may increase the risk of periodontitis. Patients should be encouraged to control documented risk factors for cardiovascular disease and to maintain oral health for its well-known health benefits.     

Parkinson’s disease impairs masticatory function

Objective

To evaluate masticatory function in individuals with Parkinson’s disease (PD) during levodopa “on” period using new removable dental prosthesis.

Materials and methods

A total of 34 elderly individuals with PD (n = 17, mean age = 69.41 ± 4.65 years) or without PD (n = 17, mean age = 70.71 ± 4.65 years) were recruited for this study. Participants received new complete dentures and/or removable partial dentures. Two months after the subjects were free of any prostheses discomfort, masticatory function was assessed. A kinesiographic device was used to measure the range of jaw motion and jaw movements while chewing a silicone test material (Optocal). Masticatory performance was determined by median particle size (X₅₀) of the Optocal after 40 masticatory cycles. Maximum bite force was assessed by a strain sensor placed in the bilateral first molars region. Data were analyzed by t test (P < 0.05).

Results

The PD group showed a decreased range of jaw motion, longer duration and slower velocity of the masticatory cycle (P < 0.05), higher X₅₀ value, and lower maximum bite force (P < 0.05).

Conclusion

PD patients have impaired masticatory function during levodopa “on” periods compared to controls.

Clinical relevance

Knowledge that PD is associated with impaired masticatory function is important to dental professionals in decision making related to prosthetics and general dental treatment.

     

Behçet's disease: a review

Beh?et's disease (BD) is a multi-system inflammatory disorder dominated clinically by recurrent oral and genital ulceration, uveitis, and erythema nodosum. Beh?et's disease runs a chronic course, with unpredictable exacerbations and remissions whose frequency and severity may diminish with time. Beh?et's disease typically arises in young adults, although childhood-onset BD has also been reported. The disease can affect both genders and has a worldwide distribution, although it is more prevalent in countries of the ancient Silk Route. The cause of BD remains unknown, although an autoimmune reaction triggered by an infectious agent in a genetically predisposed individual has been suggested. The treatment of BD is symptomatic and empirical, but generally specific to the clinical features of each patient. The majority of affected individuals do not have life-threatening disease, although mortality can be associated with vascular-thrombotic and neurological disease.     

Relation between mercury and Alzheimer's disease?

Mercury from dental silver amalgam has been suggested to be linked with Alzheimer's disease. The percentage in the population (formerly) possessing amalgam restorations exceeds that of Alzheimer patients. Therefore, low levels of mercury in the brain are unlikely to cause the disease. However, studies indicating increased levels of mercury in Alzheimer brains compared to controls have been criticised. In contrast, it has been proven that an inherited trait accounts for a minor proportion of Alzheimer's patients. Moreover, education--or related psychosocial factors--instead of amalgam has been found to be associated with the disease. Therefore, it does not seem warranted as yet to conclude that mercury is an etiological factor in Alzheimer's disease.     

A rare condition of Hand-Schüller-Christian disease

The authors present the clinical case of a 61-year-old patient with Hand-Schüller-Christian disease associated with multisystemic involvement. The onset of such puzzling symptoms and the extremely rarity of this disease in a patient of such advanced age resulted in a delayed diagnosis and subsequently delayed treatment of the patient.     

Sjögren' syndrome: a progressive disease

Sj?gren's syndrome is an auto-immune disease resulting in, among other problems, serious eye and mouth dryness. The course of the disease, especially from an early towards a later phase, is largely unknown. The purpose of this study was to evaluate the symptoms and salivary gland function of Sj?gren's syndrome patients, in order to gain insight in the possible progression of the disease. Forty-three patients were followed during a mean period of 3.5 years. Patients with a longer duration of oral symptoms showed more subjective complaints and less salivary flow when compared to patients with recent oral complaints. The differences in both the subjective and objective signs disappeared almost completely during follow-up. From this study it was concluded that Sj?gen's syndrome is a progressive disease when diagnosed early. By asking specific questions the dentist can play an important role in early diagnosing the syndrome.     

Smoking--a proven risk factor for periodontal disease?

While bacterial dental plaque is widely considered as the etiological risk factor for the development of periodontal diseases, numerous publications from recent years pointed out the role of environmental factors like smoking as aggravating the severity of disease expression. The present paper reviews the updated literature linking epidemiologically between the presence of smoking habit and disease prevalence in the same population, as well as studies reporting on cell toxicity of nicotine and its by-products on gingival cells, negative effect on humoral and cell-mediated immune system, enhancement of bacterial plaque pathogeneity, and disruption of the wound healing processes. Finally, a negative effect is apparent on the supportive stage of the periodontal treatment, indicating lasting effect of smoking for years to come following the termination of active periodontal treatment.     

Periodontal disease in primary Sjögren's syndrome

Occurrence of periodontal disease in Sjögrens's syndrome (SS) is still controversial. OBJECTIVE: To examine if the risk of gingival and periodontal conditions was increased in SS compared to the general population. MATERIALS AND METHODS: Fifty‐seven patients (4 men, 53 women) with primary Sjögren's syndrome (Copenhagen criteria) and an age‐matched representative sample of the general population of 80 controls (all women) were examined for gingival and periodontal disease. RESULTS: Gingival bleeding and supra‐gingival calculus did not differ among SS patients and controls. Subgingival calculus occurred more often among the younger SS patients than controls, but did not differ among the older SS patients and controls. Periodontal pockets of 4–5 mm as well as pockets >5 mm occurred with similar prevalences among the two groups. Smoking habits did not influence the results. The health status of the gingival and periodontal tissues were thus similar in SS and controls. CONCLUSION: Primary SS is not associated with increased risk of periodontal disease.     

Exploring the periodontal disease—ischemic stroke link

Multiple risk factors are associated with ischemic stroke. Here, we highlight studies indicating that periodontal disease significantly increases the risk of both primary ischemic stroke and subsequent cardiovascular events. Additionally, studies have shown an association between periodontal disease and multiple causes of ischemic stroke. Finally, we describe an ongoing clinical trial testing the benefit of periodontal disease treatment as a strategy to reduce risk for recurrent cardiovascular events in patients who have had recent ischemic stroke or transient ischemic attack. This article is mostly based on a presentation given in honor of Steven Offenbacher (1950 to 2018).