Investigation of functional gene polymorphisms: IL-1B, IL-6 and TNFA in benign migratory glossitis in Brazilian individuals

BACKGROUND: Benign migratory glossitis (BMG) is a very common immunological oral disease of unknown aetiology. METHODS AND SUBJECTS: Fifty-three consecutive subjects affected by BMG and 53 age- and sex-matched control subjects were genotyped for IL-1B, IL-6 and TNFA polymorphisms. Binary logistic regression models were fitted and values of P < 0.05 were considered significant. RESULTS: A significant difference in the distribution of IL-1B genotypes was observed in the group with BMG in univariate analyses (P = 0.01). The multivariate analyses showed that the CT genotype of the IL1-B gene was significantly associated with a high risk to develop BMG (P = 0.02, OR 2.76). The combined presence of IL-1beta high and intermediate producers genotypes was also associated with BMG in multivariate analyses (P = 0.01, OR 3.05). IL-6 and TNFA polymorphisms were not associated with BMG in the univariate and multivariate analyses. CONCLUSION: Our findings demonstrate that the polymorphism +3954 IL-1B is associated with an increased risk of BMG development and suggest a genetic basis for disease development.     

Acute periodontal lesions

This review provides updates on acute conditions affecting the periodontal tissues, including abscesses in the periodontium, necrotizing periodontal diseases and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, mucocutaneous disorders and traumatic and allergic lesions. A periodontal abscess is clinically important because it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth and bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly classified by their etiology, and there are clear differences between those affecting a pre‐existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, while an evaluation of the need for systemic antimicrobial therapy will be made for each case, based on local and systemic factors. The definitive treatment of the pre‐existing condition should be accomplished after the acute phase is controlled. Necrotizing periodontal diseases present three typical clinical features: papilla necrosis, gingival bleeding and pain. Although the prevalence of these diseases is not high, their importance is clear because they represent the most severe conditions associated with the dental biofilm, with very rapid tissue destruction. In addition to bacteria, the etiology of necrotizing periodontal disease includes numerous factors that alter the host response and predispose to these diseases, namely HIV infection, malnutrition, stress or tobacco smoking. The treatment consists of superficial debridement, careful mechanical oral hygiene, rinsing with chlorhexidine and daily re‐evaluation. Systemic antimicrobials may be used adjunctively in severe cases or in nonresponding conditions, being the first option metronidazole. Once the acute disease is under control, definitive treatment should be provided, including appropriate therapy for the pre‐existing gingivitis or periodontitis. Among other acute conditions affecting the periodontal tissues, but not caused by the microorganisms present in oral biofilms, infectious diseases, mucocutaneous diseases and traumatic or allergic lesions can be listed. In most cases, the gingival involvement is not severe; however, these conditions are common and may prompt an emergency dental visit. These conditions may have the appearance of an erythematous lesion, which is sometimes erosive. Erosive lesions may be the direct result of trauma or a consequence of the breaking of vesicles and bullae. A proper differential diagnosis is important for adequate management of the case.     

Betel chewer's mucosa - a review

Betel chewer's mucosa (BCM) was first described and defined in 1971. Its clinical appearance is characterised by a brownish-red discolouration of the oral mucosa with an irregular epithelial surface that has a tendency to desquamate or peel off. The buccal mucosa is most frequently affected. The prevalence of BCM varies between 0.2% and 60% in different studies from South and Southeast Asia. Women are more frequently affected than men. Betel chewer's mucosa may be found together with other oral mucosal lesions such as leukoedema, leukoplakia and ulceration. The histological features are characteristic. The epithelium is often hyperplastic, and brownish amorphous material derived from the betel quid may be demonstrated not only on the epithelial surface but also intra- and inter -cellularly. Ballooning of epithelial cells may occur. The etiology is traumatic and possibly chemical. Betel chewer's mucosa is most likely not precancerous. Differential diagnoses include cheek biting, with which it has a number of similarities, and other predominantly white lesions that may have taken up stains from tobacco and other substances. The natural history of BCM should be studied in more detail and its association with other oral mucosal diseases, particularly of a precancerous nature, should be the aim of further investigations.     

Oral aphthous-like lesions, PFAPA syndrome: a review

Aphthous ulcers are the most common oral mucosal lesions in the general population. Several precipitating factors for aphthous ulcers are suggested to operate on subjects with genetic predisposition. Sometimes aphthous ulcers can be the sign of systemic diseases. Therefore, it is essential to establish a correct diagnosis to determine suitable therapy. There are several diseases potentially responsible for oral ulcers. Sometimes appearance of periodic oral ulcers coincides with periodic fever and other symptoms leading to the diagnosis of a rare childhood disease: PFAPA (periodic fever, aphthous stomatitis, pharyngitis and adenopathy) syndrome. PFAPA or Marshall's syndrome is characterized by abrupt onset of periodic episodes of high fever accompanied by aphthous stomatitis, pharyngitis and cervical adenitis, often associated with headache and / or abdominal or joint pain. Owing to the periodic onset of oral symptoms, often an oral physician or pediatric dentist may be the first healthcare worker to evaluate a child with clinical signs compatible with PFAPA syndrome. Children diagnosed with this condition require systematic oral follow-up to monitor for signs of ulceration.     

Teeth and oral mucosa in neurocutaneous syndromes,metabolic diseases and in diseases with defects of DNA repair

Oral mucosa is frequently involved in a group of genetic diseases, which affect the skin and other organs, particularly the central nervous system. The lesions may be of characterized by inflammations in neurocutaneous syndromes and by tumoral lesions in those diseases with defects of DNA repair. The teeth are mainly involved in progeria, while jaw keratocysts are highly characteristic in Gorlin's syndrome.     

牙科用微弧氧化后锆基非晶合金的组织相容性研究

目的通过进行口腔黏膜刺激实验和皮下植入实验,研究微弧氧化后锆基非晶合金的组织相容性。方法实验参照ISO 10993-6:1994标准,分别将微弧氧化前后的锆基非晶合金和对照用的钛合金制备成直径5 mm,厚0.5 mm的圆片样品和直径1.5 mm,长5 mm的柱状样品,进行口腔黏膜刺激实验和皮下植入实验。结果口腔黏膜刺激实验未出现全身及局部不良反应,组织学观察与阴性对照无显著性差异;皮下植入实验结果显示1周时可见局部组织轻微红肿,组织切片可见少量炎细胞,4周、12周炎症反应随着时间的延长逐渐减轻,试件周围均形成了包膜,随着植入时间的延长包膜逐渐变薄、透明度增高,新生毛细血管的数量增加。各周期中微弧氧化后的锆基非晶合金组皆比实验组的炎细胞数目少,毛细血管数量多,包膜薄,透明度高。说明微弧氧化后的锆基非晶合金组织相容性好,具有良好的临床应用前景。结论作为新型口腔医学植入材料,锆基非晶合金性能优异,但是其生物惰性阻碍了这种材料的应用。微弧氧化处理有效的降低了锆基非晶合金的生物惰性,在保持了锆基非晶合金的优异性能的同时,获得了良好的组织相容性。     

Multiple and giant mandibular osteomas in a Gardner's syndrome. Case report

Though rare, Gardner's syndrome is a systemic disease with frequent jawbones involvement. Dento-maxillo-facial lesions both in early and in advanced stages should be known by dentists and other specialists. In fact, these lesions should be sought in patients with intestinal polyposis, while they could be the first sign of Gardner's syndrome not yet diagnosed.     

Red, blistering, and erosive lesions of the oral mucosa

Clinical diagnosis among the vesiculobullous diseases is difficult. Benign mucous membrane pemphigoid is a chronic condition, whereas bullous pemphigoid and erythema multiforme are self-limiting. Oral lesions can be the initial appearing feature of the disease. Therefore, routine histological examination with immunofluorescent studies and a good medical history will aid in differentiating among them. The case report described here shows a benign mucous membrane (cicatricial) pemphigoid in a 52-year-old female whose initial symptoms involved the oral mucosa with subsequent skin lesions. There is no other apparent mucosal involvement at this time. The symptoms are palliated with use of topical fluocinonide, but continued follow-up care is indicated.     

Oral lymphangioma-like Kaposi sarcoma: a Brazilian case report in a scenario of a still high number of HIV infections

We present a challenging case of HIV-related lymphangioma-like Kaposi sarcoma (LLKS) affecting the oral cavity. A 54-year-old Brazilian male patient was referred to our center complaining of bleeding lesions affecting the oral cavity for 2 months. Interestingly, these oral lesions were the first clinical manifestation of HIV infection. Clinically, multiple erythematous nodular and patch lesions were observed. An incisional biopsy was performed, revealing numerous microscopic angled and irregular vascular channels lined with flattened endothelial cells. More cellularized and solid areas consisting of more fusiform cells with little pleomorphism and with slit-like vascular channels were noted. Based on immunoreactivity for CD31, CD34, D2-40, and HHV-8, the final diagnosis was oral LLKS. Highly active antiretroviral therapy (HAART) was initiated with dolutegravir, tenofovir, and lamivudine. During follow-up, the patient showed KS metastases to other sites and a chemotherapeutic protocol was initiated. Regression of the oral lesion was clearly noted by the clinicians 1 year after the KS diagnosis. Dentists should be able to recognize systemic diseases that affect the oral cavity such as KS in order to make an early diagnosis of its oral manifestations and to implement effective therapeutic measures to ensure a better prognosis.

     

Angina bullosa haemorrhagica: presentation of eight new cases and a review of the literature

Angina bullosa haemorrhagica (ABH) describes the acute and sometimes painful onset of oral blood-filled vesicles and bullae not attributable to blood dyscrasia, vesiculo-bullous disorders, systemic diseases or other known causes. The haemorrhagic bullae spontaneously burst after a short time resulting in ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. Although the pathogenesis is still unclear, ABH seems to be a multifactorial phenomenon: dental or functional trauma seems to be the major provoking factor. The lesions of ABH can be easily confused with other mucosal diseases. It is important that the presentation of this benign disorder is distinguished from other more serious disorders with similar presenting features. The aim of this paper is to report the clinical features of eight cases of ABH, in an attempt to distinguish ABH from other blistering diseases of oral mucosa and to describe their management.     

Lichen planus with simultaneous involvement of the oral cavity and genitalia

Five women with reticular and/or erosive lichen planus of the oral cavity associated with mucous involvement of the genitalia are reported. The presence of a typical lesion in one of these sites requires search for other common sites of involvement as well as manifestations of systemic diseases. Early management and careful follow-up of patients with chronic erosive and atrophic lesions of the vulva should be instituted to prevent dyspareunia. The use of the term plurimucosal lichen planus instead of vulvo-vagino-gingival syndrome is proposed.     

Juvenile ossifying fibroma. An analysis of eight cases and a comparison with other fibro-osseous lesions

Juvenile ossifying fibroma (JOF) is a well-defined clinical and histological entity that has recently been separated from other fibro-osseous lesions, including cemento-ossifying fibromas. Its biological behaviour is well defined, but unexplained. Its behaviour, clinical and histological appearance, however, bears resemblance to osteofibrous dysplasia of long bones, a lesion that in some cases has been reported to be part of a spectrum of diseases associated with adamantinoma, thus accounting for its variable biological behaviour. Eight cases of JOF were examined for islands of epithelium or single epithelial cells using immunocytochemistry. While these cases of JOF could clearly be separated from other fibro-osseous lesions, and were histologically similar to osteofibrous dysplasia, the absence of cytokeratin-positive cells in all cases suggests that another reason for its biological behaviour has still to be found.     

Yellowish lesions of the oral cavity. Suggestion for a classification

The colour of a lesion is due to its nature and to its histological substratum. In order to ease diagnosis, oral cavity lesions have been classified according to their colour in: white, red, white and red, bluish and/or purple, brown, grey and/or black lesions. To the best of our knowledge, there is no such a classification for yellow lesions. So, a suggestion for a classification of yellowish lesions according to their semiology is made with the following headings: diffuse macular lesions, papular, hypertrophic, or pustular lesions, together with cysts and nodes. This interpretation of the lesions by its colour is the first step to diagnosis. It should be taken into account that, as happens with any other classification, the yellowish group of lesions includes items with different prognosis as well as possible markers of systemic disorders.     

Immunohistological identification of epithelioid cell granulomas in Crohn's disease and its diagnostic values especially in the differentiation from ulcerative colitis

We produced a monoclonal antibody against epithelioid cell granulomas (ECGs) by immunizing mice with a crude tissue extract of lymph nodes with sarcoidosis. The established antibody (ECM antibody) strongly reacted with epithelioid cells and Langhans' type giant cells of ECGs not only in cases of sarcoidosis, but also in cases of other granulomatous diseases such as tuberculosis and Crohn's disease. In this study, we used the ECM antibody to improve the histopathological diagnosis of Crohn's disease, in which the demonstration of ECGs is critical for diagnosis, but morphological identification of ECGs by hematoxyline and eosin (HE) staining is frequently difficult. When we examined the tissues removed at operation from 11 patients with Crohn's disease, we observed a total of 29 lesions of morphologically recognizable ECGs, all of which were immuonohistologically positive for the ECM antibody (granuloma pattern). In addition the ECM antibody revealed 43 nests of tiny inflammatory lesions (nested pattern) that could not be morphologically recognized as ECGs by HE staining only. Both the granuloma and nested patterns of ECM immunoreactivity were present in all cases of Crohn's disease we examined, but were absent in all 15 cases of ulcerative colitis that were used as controls. Thus, we concluded that the newly established ECM antibody is useful for detecting morphologically equivocal granulomatous Crohn's disease lesions, and should be helpful for the histopathological differentiation of this disease from other types of chronic inflammatory bowel diseases, such as ulcerative colitis.     

Gigantiform cementoma: clinicopathologic presentation of 3 cases

Gigantiform cementoma is a rare, benign fibro-cemento-osseous disease of the jaws, seen most frequently in young girls. Radiographically, it typically presents as multiquadrant, expansile, mixed radiolucent-opaque lesions that cross the midlines of the jaws. Although cases with a familial pattern are noted in a few publications, sporadic cases have been reported without a family history. The term gigantiform cementoma has been used interchangeably with designations of other fibro-osseous entities, yet its application should be restricted by the criteria defined herein. In this article, we report 3 cases of gigantiform cementoma. Clinical, radiographic, and microscopic features of these lesions are presented, along with criteria to differentiate gigantiform cementoma from other fibro-osseous diseases of the jaws. A possible pathogenetic mechanism and treatment recommendations are discussed.     

(A1) Identification of oral health care needs in children and adults, management of oral diseases

The workshop considered five questions reviewing the identification of international oral health care needs of children and adults, and the management of oral diseases in resource-poor countries: (1) What is the role of the dental profession in the management of the HIV-infected individual? (2) Identifying health care needs-What are the epidemiology and disparities of HIV-associated oral lesions in children from different continents? (3) How effective is HIV treatment in controlling oral diseases? (4) Could we develop basic inexpensive oral and dental care protocols for economically deprived HIV-infected patients? and (5) What is the best method of arranging resources to meet the oral health care needs of people with HIV disease? The consensus of the workshop participants was that there is a need to re-target research efforts to non-established market economy countries and prioritize research in these regions to children with HIV disease. It will be important to assess commonalities and variations in oral health needs across geographical and cultural boundaries, and research efforts should be centralized in resource-poor countries to support multi-center longitudinal standardized studies. It is essential that oral health research be integrated into other health care research programs, to make these research priorities and public health initiatives feasible.     

Treatment approaches to common symptomatic oral lesions in children

A variety of oral mucosal lesions can be symptomatic in children. This article describes the classic clinical appearance of the most common oral diseases and provides treatment recommendations that are tailored to the pediatric age group. When possible, more than one drug alternative is given for each of the different oral conditions for an improved success rate. It is essential for the clinician to understand that this article should be used as a guide for managing oral and perioral lesions in children and adolescents. Specific dosages and formularies of drugs may require modification in the young child. Consultation with a primary care physician and pharmacist often is needed to ensure the best possible outcome, especially when immunosuppressive drugs are indicated. Most importantly, oral lesions that do not respond to therapeutic protocols should be referred to the appropriate specialist for definitive diagnosis and treatment.     

骨基质明胶和壳聚糖复合修复下颌骨缺损的实验研究

目的 :探讨骨基质明胶 (BoneMatrixGelatin ,简称BMG)对骨诱导形成作用影响 ,评价骨基质明胶与壳聚糖 (Chitosan简称CH)复合修复骨缺损的作用。方法 :在 80例Wistar大白鼠的下颌骨缺损内植入BMG/CH复合材料 ,并设空白对照。植入后 1周、2周、4周、8周行X线摄片 ,组织学观察骨缺损区骨形成的情况。结果 :BMG/CH复合移植是较为理想的骨缺损修复材料 ,其成骨方式为软骨化骨。结论 :BMG/CH复合材料具有良好的骨诱导作用 ,是一种有临床应用前景的骨移植材料。     

Ethnobotanical tattooing of the gingiva: literature review and report of a case

BACKGROUND: Traditional gingival tattooing, practiced in Ethiopia and occasionally in other African and Middle Eastern nations, is performed for esthetic appeal or superstition, and it occasionally may be used as a homeopathic remedy for dental diseases. The authors provide a literature review and case report of this oral custom. CASE DESCRIPTION: A 54-year-old woman from Ethiopia reported that she had undergone tattooing of the maxillary gingiva six years previously for analgesic management of undisclosed oral disease. The gingiva was pierced with a needle, tipped with lantern soot and resin from the plant Datura stramonium (an herb that possesses potent anticholinergic tropane alkaloids and has demonstrated in vitro antimicrobial activity). However, the patient admitted that this procedure had provided no reduction in the pain. Clinical examination was significant for a pronounced blue pigmentation of the maxillary gingiva, generalized mild periodontitis and several carious lesions. CLINICAL IMPLICATIONS: Practitioners should ascertain whether gingival tattooing had been performed when patients manifest unusual oral pigmentation and be aware of its use in folk medicine for various oral conditions.     

Smoking and oral diseases

There are various oral diseases related to tobacco habits. In the majority of these diseases there is a dose-response relationship. This is particularly true for premalignant lesions, such as leukoplakia, and squamous cell carcinoma. Patients should be informed about the deleterious effects of tobacco on the oral tissues. At the same time the patient should know that cessation of the tobacco habits does eliminate the increased risk of developing oral precancer and cancer within a reasonable period of time.