Dental management prior to hematopoietic stem cell transplantation

The authors investigated oral health treatment in patients scheduled for hematopoietic stem cell transplantation. Fifteen patients were scheduled for bone marrow transplantation: 12 had leukemia, two had aplastic anemia, and one had myelodysplastic syndrome. Twenty-three patients were scheduled to undergo peripheral blood stem cell transplantation: 20 had malignant lymphoma and three had leukemia.
Patients with platelet counts of ≤ 50,000/mm³ who required tooth extraction and those with platelet counts of ≤ 30,000/mm³ who required scaling received platelet transfusions before the dental treatment. We saw no bleeding problems in these patients.
Dental care for patients who had neutrophil counts of ≥ 500/mm³ included tooth extractions or scaling, with no postoperative infection. Even those with severe immunosuppression (neutrophil count: 100–150/mm³) tolerated treatment when prophylactic measures, such as intravenous administration of antibiotics, were used. One patient with a neutrophil count of ≤ 50/mm³ developed an infection after even conservative therapy. Thus, caution should be exercised when treating patients scheduled for HSCT as even conservative therapy can initiate and infection.     

Prevalence of Candida species in AIDS patients and HIV-free subjects in Thailand

Teanpaisan R, Nittayananta W: Prevalence of Candida species in AIDS patients and HIV-free subjects in Thailand. J Oral Pathol Med 1998; 27: 4–7. © Munksgaard, 1998.
The purpose of this study was to examine the prevalence of Candida species among groups of HIV-infected and HIV-free subjects in Thailand and to ascertain whether particular Candida species were associated with HIV infection. Oral rinse specimens were collected from 45 AIDS patients (CDC stage IV), 74 HIV-free healthy subjects, and 42 HIV-free patients who had clinical candidiasis. Yeasts recovered in culture were identified and quantified. The mean ages of the cohorts were 30.75 ± 8.19 years (AIDS group), 28.50 ± 7.98 (HIV-free healthy group) and 41.83 ± 12.25 years (HIV-free candidiasis group). Yeasts were isolated from 30/45 (66.66%, range 6.6 ± 10²-5.7 × 10⁶ CFU/ml) of the AIDS group, 8/74 (10.81%, range 8.0 × 10¹-3.5 × 10⁴ CFU/ml) of the HIV-free healthy group, and 24/42 (57.14%, range l.0 × 10 10²-1.1 × 10⁵ CFU/ml) of the HIV-free candidiasis group. There were statistically significant differences in the Candida colony counts between the AIDS group without oral candidiasis and the healthy group ( P =0.0078) and between the AIDS group with candidiasis and the HIV-free, oral candidiasis group ( P = 0.0003). Candida albicans was the most common species recovered from AIDS patients (29 out of 30; 96.66%).     

Oral candidiasis and immune status of HIV-infected patients

A total of 84 HIV-infeted homosexual men having either normal oral mucosa (NOM). erythematous candidiasis (EC) or pseudomembranous candidiasis (PsC) were included in the study. The patients were evaluated by median number of peripheral CD4⁺ cells, CD8⁺ cells and by lymphocyte function assessed by poke-weed mitogen test. There was a significant difference between CD4⁺ counts among patients with the two subtypes of candidiasis (95% CI of median difference: 10 240/mm³; P =0.03). but not for pokeweed mitogen response. Survival analysis showed that after 2 y there was no significant difference in development of AIDS between patients with EC and PsC ( P = 0.29). If patients with both types of oral candidiasis were pooled and compared with patients with NOM. a significant difference in development of AIDS was found ( P = 0.04). It is concluded that HIV-infected patients with oral candidiasis of any subtype (EC or PsC) arc significantly more immune suppressed and show a faster development of AIDS than HIV-infected patients with NOM. However, in this cohort. EC and PsC are of equal importance as predictors for immune suppression and AIDS development.     

Oral manifestations of HIV infection in adult patients from the province of Sancti Spiritus, Cuba

Background:  Studies on the prevalence of HIV-related oral lesions (HIV-OL) have shown great variations among different countries. The aim of this study was to describe the prevalence of HIV-OL in adults infected with HIV in the province of Sancti Spiritus, Cuba, and to determine the factors associated with the presence of HIV-OL.
Methods:  A cross-sectional observational study was performed between November 2006 and August 2007 at the Hospital General Universitario 'Camilo Cienfuegos', Sancti Spiritus. One hundred and fifty-four HIV-infected patients were included. Patients were examined and interviewed by a periodontal specialist. Diagnosis of HIV-OL was based on clinical criteria. Demographical, clinical and laboratory data were obtained. Independent association of each factor with HIV-OL was assessed by logistic regression modelling.
Results:  The prevalence of HIV-OL was 40.9%. The commonest manifestation was oral hairy leucoplakia ( n  = 19; 12.3%); oral candidiasis ( n  = 17; 11%); herpes simplex virus infection ( n  = 11; 7.4%); and aphthous ulcer ( n  = 9; 5.8%). Principal factors associated with the presence of HIV-OL were CD4⁺ lymphocytes <500 cells/mm³ (OR: 2.06; 95% CI: 1.019–4.195) and smoking (OR: 2.03 CI: 1.037–3.982).
Conclusion:  This study described the prevalence of HIV-OL in 154 HIV-infected patients which represent about 80% of those known to be infected in the province of Sancti Spiritus. The prevalence of HIV-OL was lower than those reported from developing countries. Oral hairy leucoplakia and oral candidiasis were the most prevalent HIV-OL. Smoking and CD4⁺ cells count <500 cells/mm³ were the two factors independently associated with the presence of HIV-OL.     

Peripheral nerves and mast cells in normal buccal mucosa

The topographical distribution and relation to mast cells of PGP 9.5 (protein gene product 9.5. a major cytoplasmic neuron-specific protein with ubiquitin C-terminal hydrolase activity) and neurofilament (intermediate neuron-specific cytoskeletal filaments) in normal human buccal mucosa was studied in five healthy volunteers. Morphometric analysis disclosed the densest innervation to be in the middle layers of the lamina propria, with a mean number of 5.9–6.1 PGP 9.5 and/or neurofilament-immunoreactive nerve fiber profiles per one mm². In contrast, the mean mast cell number decreased from 110/mm² to 46/mm² from superficial to deep lamina propria, being 69–72/mm² in the most densely innervated middle layers. Only 16–17% of all fiber profiles contained substance P and 51–54% calcitonin gene-related peptide (CGRP). Finally, analysis of the spatial relationship between nerve fiber profiles and mast cells in a double staining procedure disclosed no preferential neuron-effector associations. All these findings suggest that such a relationship does not exist between peripheral nerves and mast cells in normal buccal mucosa.     

Distribution of Langerhans cells in clinically healthy human gingival epithelium with special emphasis on junctional epithelium

Abstract – Twenty-one biopsies of clinically healthy marginal gingiva from children, who performed conventional oral hygiene but received no additional professional prophylaxis, were studied in order to obtain information on distribution and density of Langerhans cells (LC) in the oral gingival epithelium (OGE), the sulcular epithelium (SE) and the junctional epithelium (JE). A simple freeze-separation technique was found to create acceptable histomorphology of JE in specimens obtained adherent to teeth, while partially and non-adherent ones were rejected. The majority of LC in OGE, were highly dendritic and stained intensively with OKT6 monoclonal antibodies. The distribution was network-like with a density of 21.0± 3.2 LC/0.1 mm² crosssectional epithelial area. A similar although less dense distribution was found in SE (8.6 ± 3.0 LG/0.1 mm²). These observations, confirm previous findings. In JE 2 groups of LC were identified: 1) Weakly stained LC with very few and short dendrites distributed in a scattered way (2.8± 1.4 LC/0.1 mm²) in the apical three-fourths of JE in most specimens. Present evidence suggests that these cells might be immature cells of Langerhans lineage. 2) Clusters of LC (9.4 ± 2.9 LC/0.1 mm²) with dendrites of moderate lengths and numbers and a varied fluorescence intensity; they were found in a few specimens in the coronal one-fourth of JE and at the border zone to SE. Such clusters might represent genuine variation in the distribution of LC or reactions to initial/ early plaque formation.     

Intraepithelial lymphocytes bearing the γ/δ receptor in the oral and jejunal mucosa in patients with dermatitis herpetiformis

Lymphocytes bearing T cell receptor (TcR) γ/δ are increased in the jejunal mucosa of patients with dermatitis herpetiformis (DH) and coeliac disease. In this study, we examined whether increased numbers of γ/δ TcR positive lymphocytes occur in the oral mucosa of patients with DH. Oral and jejunal rnucosal biopsies were taken from 13 newly diagnosed and 13 gluten free diet (GFD)-treated patients with DH. Monoclonal antibodies and avidin-biotin peroxidase method was used for staining, and TcR positive cells were counted from the buccal and jejunal epithelium. Very few γ/δ TcR positive lymphocytes were seen in the buccal epithelium of untreated or GFD-treated DH patients (median 0.4 and 0.3 cells/mm²), whereas α/β TcR positive lymphocytes were frequent in both groups of DH patients (154 and 250 cells/mm²) and healthy controls (135 cells/mm²). The numbers of γ/δ TcR positive intraepithelial lymphocytes were significantly increased in the jejunum of both untreated (43 cells/mm) and GFD-treated (27 cells/mm) DH patients compared to control patients (2.2 cells/mm). The present study did not, therefore, disclose any evidence for active recruitment of γ/δ TcR positive lymphocytes in the oral epithelium, but showed substantial amounts of intraepithelial γ/β TcR positive lymphocytes both in DH patients and healthy controls.     

Prognostic value of oral candidosis and hairy leukoplakia in 111 Mexican HIV-infected patients

A follow-up study was carried out to evaluate the prognostic value of hairy leukoplakia (HL) and oral candidosis (OC) in a cohort of 111 asymptomatic Mexican HIV infected patients. Oral exams were performed at baseline and every 6 months, from September 1989 to March 1994. Chi-square contingency table test, the Kruskall-Wallis one-way analysis of variance, the Kaplan-Meier product-limit method and the log rank test were used for the analysis. Univariate and multivariate Cox's proportional hazards analysis were also performed. Fifty-four patients (51%) progressed to AIDS (initially 36 CDC-II and 18 CDC-III). Individuals with HL and/or OC, showed faster development to AIDS than subjects without lesions or other HIV-related manifestations (P=0.008). The presence of OC, HL or both always remained significant despite adjustment for total lymphocytes, CDC stage, zidovudine therapy or its combinations. Oral lesions in HIV infection may be regarded with other clinical and laboratory studies as markers of HIV disease progression and as indicators to begin antiretroviral treatment.     

Quantitative assessment of mast cells in recurrent aphthous ulcers (RAU)

Previous studies on the frequency of mast cells (MCs) in recurrent aphtous ulcers (RAU) have yielded conflicting results. Monoclonal antibodies specific for tryptase (AA1) and anti-IgE (polyclonal antibody) were used to identify density and distribution of MCs in an immunohistochemical study of RAU (n=15), induced oral traumatic ulcers (TUs) (n=9), and control clinically healthy oral mucosa (n=15). Results were quantified by means of a VIDAS image analyzer. In all sections studies, IgE-positive cells showed similar frequency and distribution to tryptase-positive MCs. In RAU lesions, numerous tryptase-positive MCs were found in the sub-epithelial lamina propria, but MC numbers in the epithelium were low and present only in some RAU biopsies. MCs were also more numerous in RAU-inflammatory infiltrates (118±31 cells/mm²) than those seen in TU-inflammatory infiltrates (75±18 cells/mm², P < 0.001). MC activation/degranulation, as judged by diffuse extracellular tryptase staining, was a common feature within RAU-inflammatory infiltrates and at RAU-inflammatory infiltrates-connective tissue interfaces, which were often associated with connective tissue disruption. MC counts in the RAU connective tissue, lateral to the inflammatory infiltrates, were significantly greater than in the connective tissue of TUs and of control biopsies (124±36 vs 73±13 vs 69±21 cells/mm², respectively; P<0.001). Overall, MCs were significantly increased in aphthae (116±26 cells/mm²) compared with TU lesions (72±11 cells/mm², P<0.001) and controls (71±16 cells/mm², P<0.001). In conclusion, MC numbers are increased in a typical topographical pattern, and the local MCs show signs of activation/degranulation suggesting active involvement of this cell type in RAU pathogenesis.     

Biostereometric quantification of clinical denture tooth wear

In this study the wear of mandibular acrylic resin teeth opposed by porcelain maxillary teeth arranged in a lingualized occlusal scheme over a period of 3 years was measured. Six edentulous subjects received complete dentures as above and with three baseline markers of amalgam. At yearly intervals casts were made of the mandibular occlusal surfaces, including markers, and plotted by stereophotogrammetry. Volumetric loss of material was quantifiable. Ranges of 0·62–3·33 mm³/mm² on the left side and 0·71–1·64 mm³/mm² on the right were recorded. Friedman two-way ANOVA test indicated significant wear on teeth 35, 36, 45 and 46 but not on 34 and 44. A one-sided chewer displayed greater wear on the contralateral side, a finding difficult to explain.     

Association of cutaneous and oral diseases in HIV-infected men

OBJECTIVES: Mucocutaneous diseases are common in patients infected with human immunodeficiency virus (HIV). To identify cutaneous diseases for which HIV-infected people are at high risk, we sought those that are strongly associated with specific HIV-related oral lesions and with progression of HIV disease.
DESIGN: A cross-sectional study of HIV-positive outpatients referred to a university stomatology clinic for diagnosis and treatment of oral diseases. Each subject underwent both complete oral and cutaneous examinations.
RESULTS: Among 55 men, with a median age of 41 years and a median CD4 cell count of 125/ju.l (range 0–950/pil), 93% had active oral diseases or conditions, including candidiasis, hairy leukoplakia, ulcers, Kaposi's sarcoma (KS), and xerostomia, and 95% had skin conditions, including onychomycosis, dermatophytosis, seborrheic dermatitis, KS, folliculitis, xerosis, and molluscum contagiosum. Seborrheic dermatitis, xerosis, skin KS, and molluscum contagiosum were associated with oral HIV-sentinel lesions (oral candidiasis, hairy leukoplakia, and KS), with low CD4 cell counts, and with AIDS.
CONCLUSION: Our results suggest that xerosis and seborrheic dermatitis may be early harbingers of HIV disease progression. Their roles as predictors warrant further study, based on their associations with low CD4 cell counts and AIDS and strong co-prevalence with one of the most common HIV-related oral lesions, oral candidiasis.     

Oral HIV‐associated Kaposi sarcoma

J Oral Pathol Med (2012) Kaposi sarcoma (KS), an AIDS defining condition, remains one of the most commonly HIV‐associated neoplasms. While the use of highly active antiretroviral therapy (HAART) has brought about a dramatic decrease in the prevalence and incidence of AIDS‐KS worldwide, this has not been the case in resource‐poor sub‐Saharan African countries, where HIV has reached epidemic proportions and human herpesvirus‐8 infection is endemic. Oral involvement is a common manifestation of AIDS‐associated KS and may be an early presenting finding of HIV infection. The clinical manifestation of oral KS can vary and may have an unpredictable course ranging from mild to fulminant. Rapidly progressive facial lymphoedema associated with extensive advanced oral KS portends a poor prognosis. Oral KS may regress with antiretroviral therapy or may flare up as part of the immune reconstitution inflammatory syndrome. The oral lesions of AIDS‐KS are best managed with HAART together with systemic chemotherapy. This article provides a review of contemporary knowledge of the biology, pathology, clinical features and management of oral AIDS‐KS.     

口腔艾滋病的临床及研究进展

目的 被誉为世纪恶魔的艾滋病正在全球肆虐。根据国家最新资料,我国于1985年首次发现艾滋病病人。截止今年6月底,全国累计报告艾滋病病毒感染者26085例,其中艾滋病病人1111例,死亡584例。据专家估计,至2000年底,全国实际艾滋病病毒感染者已超过60万人,这不能不引起广大医务工作者,包括口腔医务工作者的高度警惕和重视。本文介绍了与艾滋病毒感染有关的主要口腔粘膜损害、交叉感染途径及治疗原则,旨在帮助口腔医务工作者对艾滋病的临床及研究进展有一个正确的认识。     

Oral manifestations of HIV infection by gender and transmission category in Mexico City

A cross-sectional analysis was conducted in Mexico City from September 1989 to March 1996, to determine the prevalence of HIV-related oral manifestations by gender and route of HIV transmission. The diagnosis of HIV-associated oral lesions was based on preestablished criteria. For the statistical analysis chisquared and Fisher's exact tests were used where appropriate. Odds ratios were calculated as estimates of the relative risks. Control of confounding factors was performed by logistic regression models. Oral lesions were present in 75% of 436 HIV⁺ patients. Hairy leukoplakia, erythematous and pseudomembranous candidosis, angular cheilitis and oral ulcers were frequently found. Patients who contracted HIV through blood transfusion were more likely to present erythematous candidosis (P=0.005) than subjects who acquired HIV through sexual transmission. Oral ulcers were seen only in men (P=0.02) and in individuals who contracted HIV through sexual transmission (P=0.02). This study brings valuable data in regard to differences in the type and prevalence of HIV-related oral lesions by gender and the risk categories analysed, particularly blood transfusion.     

Quantification of PCNA+ cells within odontogenic jaw cyst epithelium

The aim of this study was to investigate the reactivity of the epithelial linings of the three major types of odontogenic cyst with a monoclonal antibody to proliferating cell nuclear antigen (PCNA; clone PC 10). PCNA expression was studied in odontogenic cysts (n=31) and normal oral epithelium (n= 10) using a biotin-streptavidin method on routinely processed paraffin sections. PCNA⁺ cells were counted manually and related to the length of basement membrane (mm) and the epithelial area (mm²) as determined by TV image analysis. The epithelial linings of odontogenic keratocysts (OKC; n= 11) contained the highest number of PCNA⁺ cells, most of which were located in the suprabasal layers. The mean value of PCNA⁺ cells in OKC linings (94.4 ±22.7 cells/mm) was similar to that of oral epithelia (80.8 ± 20.6 cells/mm), but both were significantly higher than that of dentigerous (n = 10. 5.1 ± 3.0 cells mm) and radicular (n = 10, 11.0 ± 4.1 cells /mm) cyst linings (P- 0.005). The epithelial distribution of PCNA⁺ cells differed between groups with the basal/suprabasal PCNA⁺ cell ratio in OKC linings (0.05 ± 0.02) being significantly lower than that of normal oral epithelium (0.5 ± 0.14), dentigerous (l.6 ± 1.23) and radicular (l.9 ± 1.09) cyst linings respectively (P < 0.005). These results demonstrate differences in PCNA⁺ expression between the epithelial linings of the major odontogenic cyst types, indicating differences in proliferative and differentiation processes within these lesions.     

Langerhans cell surface densities in rat oral mucosa and human buccal mucosa

We determined surface densities of Langerhans cells (LCs) in rat oral mucosa and human buccal mucosa by enumerating ATPase-positive dendritic cells in epithelial whole mounts. For the rat, mean surface densities per mm² were 160 in anterior buccal mucosa, 640 in posterior buccal mucosa, 430 in the palate and 340 in the tongue. Human buccal mucosa showed a density of 890 cells per mm². We conclude that LC densities in oral mucosa approximate those of external body sites, making them available in numbers sufficient to accomplish their postulated antigen-presenting functions.     

Tongue disease in advanced AIDS

OBJECTIVE: This study describes the involvement and the histological alterations found in the tongues of 92 autopsied patients who died with AIDS. MATERIALS AND METHODS: Sex, age, CD4 cell count and clinical history were obtained from the files of 92 patients who died with AIDS. All the tongues were examined for macroscopical alterations and stained using H&E, Gomori-Grocott, Ziehl-Neelsen, PAS, Brow-Hopps and Mucicarmine. Histological autopsy findings were grouped based on a protocol that was designed following the World Health Organization recommendations. RESULTS: The mean age of the patients who died of AIDS and CD4 cell count were 36 years and 82 cells microL(-1), respectively. Histological alterations of the tongues were found in 75% of the cadavers. The most common lesions were hairy leukoplakia (HL) (42 cases), candidosis (31 cases) and non-specific chronic glossitis (29 cases), followed by concomitant lesions (28 cases), non-specific chronic ulceration (17 cases), melanotic pigmentation (13 cases), herpes simplex (10 cases), lymphoepithelial cysts (two cases), cryptococcosis (two cases), mycobacteriosis (one case), histoplasmosis (one case), cytomegalovirus infection (one case) and non-Hodgkin Lymphoma (one case). HL with oral candidosis (n = 13) were the most common concomitant lesions. CONCLUSION: These findings indicate that the tongue is a favorite site to occurrence of reactive, infectious and concurrent lesions in the end-stage of AIDS patients.     

Ultrasonic dispersion of pure cultures of plaque bacteria and plaque

Abstract – This study compared th somic sensitivity of 12 Gram-negative and two Gram-positive bacteria commonly encountered in plaque associated with periontal diseases. Pure bacterial cultures were groun to standard turbidity, diluted in 1/4 strength jprereduced anaerobically sterilized Ringer's solution, and aliquots dispersed for 0–180s, using and MSE sonic oscillator at 6 μm under 80% N² 10% H² and 10% CO². CO². Viable recoveries were determined on anaerobically cultured trypticase soy 5% blood agar plates. Breakage of T. denticola was assessed by electron microscopy. Gram-positive organisms tolerated sonication better than Gram-negative. A. viscosus was more resitant than Strep. sanguis. Gram-negative bacteria could be divided into groups according to their sensitivity. Eikenella corrodens was most resistant, followed by F. nucleatum. B. asaccharolyticus, Capnocytophaga gingivalis, A. actinomycetemcomitans, a strain (2097) of Group IV Racteroides, and B. melaninogenicus ss. intermedius ressted sonication better than "corroding" Bacteroides and oral Campylobacter. T. denticola, Selenomonas sputigena and Wolinella were most sensitive with viable counts which declined after sonication for 5–10s. Recoveries from plaque taken from five patients with periodontal diseases increased with sonication time, reaching higher values for supragingival than for subgingival samples.     

Oral manifestations in selective IgA deficiency

Abstract: Selective immunoglobulin A (IgA) deficiency is the most common of the primary immunodeficiencies with a frequency of 1/300–1/3000, depending on the screened population. As secretory IgA (SIgA) has a protective role in mucosal surfaces from invasion of microorganisms, it is thought that IgA-deficient subjects are susceptible to periodontal diseases and oral manifestations. Previous studies show contradictory results, concerning the involvement of the individuals' periodontium with IgA deficiency. The aim of this study was to investigate and compare the oral manifestations in IgA-deficient subjects with controls. Eleven selective IgA-deficient subjects aged 3–18 years with serum IgA levels <10 mg dl⁻¹ and 11 age–sex-matched healthy children as the controls entered the study. Oral mucosal investigation, dental caries, plaque accumulation and periodontal status were assessed. Serum immunoglobulin levels were measured by single radial immunodiffusion (SRID) method. Saliva immunoglobulins and secretory component levels were measured by enzyme linked immunosorbent assay (ELISA) methods. IgA-deficient patients had serum and saliva IgA levels less than 10 mg dl⁻¹ and 10 µg ml⁻¹, respectively, but other serum immunoglobulin levels were normal and saliva immunoglobulin M (IgM) levels were increased, compared with controls. There were no significant differences in oral manifestations between IgA-deficient subjects and controls, which may be a result of compensatory increase of saliva IgM or other non-immunological defence factors in saliva. Thus, it is not necessary to evaluate IgA and SIgA in all the patients with oral and dental lesions and it is thought that it is better to investigate other factors.