An atypical lingual lesion resulting from the unhealthy habit of sucking the lower lip: clinical case study

Unhealthy oral habits may be involved in the etiology of a malocclusion, since they may affect development of the orofacial region. There is little information on the habit of sucking the lower lip, to which practitioners attribute less clinical consequences. However, lower lip sucking is a harmful habit which appears frequently in children, especially during situations requiring increased attention and mental concentration. In patients presenting lower lip sucking, strong contractions of the lower lip's orbicular's muscle and the mentalis muscle, associated with hypertonicity of the upper lip caused by sucking, has to be balanced by lingual thrusting during the act of deglutition. A case is presented in which failure to identify the habit of lower lip sucking led to an atypical lesion on the tongue, caused by the tongue's impaction against the orthodontic appliance prescribed to correct a malocclusion. The recognition and elimination of an unhealthy habit is of great importance in diagnosis and the establishment of a treatment plan, so that undesirable complications can be avoided.     

Mandibular prognathism in edentulous patients—a factor of skeletal pattern

Profile change in edentulous patients is a commonly observed phenomenon. It seems that the profile becomes more concave, either by loss of lip support or increased mandibular prognathism. It has been reported that the dentures migrate forward with time¹; therefore, loss of lip support cannot be a significant contributor to the increased convexity of the profile. Changes that take place over a period of time in the mandibular posture have also been reported.^2–6 However, those studies did not attempt to relate these changes to individual patients' characteristics. It might be possible that a particular skeletal pattern could affect the mandibular posture. Therefore, this report will deal with the influence of the skeletal pattern on mandibular prognathism as determined from cephalomet-ric films.     

Effect of chlorhexidine mouthrinse and periodontal treatment upon bacteremia produced by oral hygiene procedures

ABSTRACT – Toothbrushing for 2¹/₂ min and the use of toothpicks for 2¹/2 min produced bacteremia with streptococci in seven out of 13 patirnts with destructive periodontitis and in dontitis group and the "gingivitis" group was not significant, but there scemed to be more frequent bacteremia in the periodontal group. No correlation could be established between plaque-index, gingival-index and positive bacteremia. Barteremia seemed to be due primarily to pockets and interdental ulcerations. The use of chlorhexidine as a mouthriuse for 7 d did not reduce the bacteremia caused by the oral hygiene procedures in either of the two groups. After periodontal treatment no bacteremia was detected in the periodontitis group, whereas no reduction was obtained in the gingivitis group.     

RURS' elbow guard: an innovative treatment of the thumb-sucking habit in a child with Hurler's syndrome

Thumb sucking is the process of sucking on the thumb for oral pleasure. Thumb and finger sucking habits, or nonnutritive sucking, are considered to be the most prevalent of oral habits. Some parents are concerned by thumb sucking and may even try to restrain the infant or child. In most cases, this is not necessary. Most children stop thumb sucking on their own. When older children continue to suck their thumbs, it could mean they are bored, anxious, or have emotional problems such as depression. This article presents a case report of a child with Hurler's syndrome along with thumb sucking/biting habit. Hurler's syndrome, also known as mucopolysaccharidosis I, is a rare condition inherited as an autosomal-recessive trait. It represents the classical prototype of mucopolysaccharide disorder. A unique appliance to prevent thumb sucking/biting was developed and termed as "RURS' elbow guard," which was successfully used to break thumb sucking of the child with Hurler syndrome. The present report also describes the steps in fabrication of this new habit-breaking appliance, which is also designed to protect the finger from the effects of the sucking habit.     

Comparing dose–response measurements of oral habits on oral leukoplakia and oral submucous fibrosis from a community screening program

J Oral Pathol Med (2010) 39 : 306–312 Background: Many studies have reported that the interaction and dose–response effects of betel quid chewing, tobacco smoking and alcohol drinking habits are important risk factors for oral cancer and precancerous lesions or conditions. These results are useful for comparing statistics, but may not be informative for personal disease‐related information. Methods: This study used data from a community screening program to evaluate the dose–response effects of daily frequency and duration from oral habits in Taiwan. The receiver operating characteristic (ROC) curves were further used to compare exposure measurements on indicating the occurrence of lesions/conditions. Results: Our results showed that the highest prevalence was found in leukoplakia (11.1%) and followed by oral submucous fibrosis (OSF, 4.4%). Betel quid chewing habit was found to have dose–response effects on leukoplakia and OSF, cigarette smoking habit only has the dose–response effect on leukoplakia, and alcohol drinking was not associated with both oral precancers. The daily frequency of chewing habit is a better indicator than other dose–response measurements for the occurrence of precancers. In addition, the cut‐off points of two to five counts per day have about 60–82% of sensitivities and 79–88% of specificities. Conclusions: The cut‐off points from ROC curves can provide an informative message to people with oral habits and their chances of developing diseases. High daily frequency of chewing can lead to excessive irritation to oral mucosa. Although the tobacco is never added to chewing quid in Taiwan, intensive irritation may play an important role in developing oral precancers in Taiwan.     

Treatment of self-induced trauma in a patient with cerebral palsy

Factitious illness can be a problem for disabled patients who experience recurrent trauma or irritation to a particular part of the body. In this case, the patient's recurring lip trauma combined with his overlying physical disability presented a problem not easily solved with prior methods of treating lip trauma. Modifying the standard orthodontic appliance solved the problem; after a short period of use, the patient dropped the harmful habit that caused the lip trauma. The appliance was no longer needed.     

Stimulation of minor salivary glands by intraoral treatment with the cholinesterase inhibitor physostigmine in man

A large number of the population, especially the elderly, suffers from dry mouth. The aim of the present investigation was to stimulate the minor salivary glands by the topical application of the cholinesterase inhibitor physostigmine. In eight healthy subjects, 100 µl of the substance, in the concentration interval 2–8 mg/ml, was applied locally to the inside of the lower lip for 1 min. In a separate study comprising 12 dry-mouth patients, 10 ml of 0.4–1.6 mg/ml physostigmine was administered as a mouth rinse solution for 2 min. Secretion from the labial glands, assessed using the Periotron^® method, increased in a dose-dependent manner in response to physostigmine in both groups. Average peak secretion exceeded baseline by more than 50% throughout the 30- to 45-min observation period; from 1.71 to 2.62 µl cm⁻² min⁻¹ among the healthy subjects and from 1.17 to 1.84 µl cm⁻² min⁻¹ among the dry mouth patients. No systemic effects were registered as reflected by ECG, heart rate or blood pressure. It is assumed that intraorally applied physostigmine diffuses through the oral mucosa and acts by preserving acetylcholine released from the cholinergic, parasympathetic nerves that innervate the minor salivary glands. The topical application of physostigmine to the oral mucosa may, therefore, be an interesting approach for the treatment of dry mouth.     

Influence of the surgical technique and surface roughness on the primary stability of an implant in artificial bone with a density equivalent to maxillary bone: a laboratory study

Objective: The aim of this biomechanical study was to assess the effect of surgical technique and surface roughness on primary implant stability in low-density bone.
Material and methods: Eighty screw-shaped (Biocomp^®) implants with machined or etched surface topography were inserted into a low-density bone equivalent. Solid rigid polyurethane blocks (Sawbones^®) with two different bone densities (group A=0.32 g/cm³; group B=0.48 g/cm³) were used that are very similar to the density of the maxilla. The implant sites were prepared either by a press-fit or by an undersized technique. Peak insertion and removal torques were measured using a Digital^® torque gauge instrument.
Results: Independent of the surgical technique used, both implant types showed an increased mean insertion and removal torque value with increasing bone density. Insertion and removal torque values were 54.3±5.3 and 43.5±6.5 N cm for group A and 89.3±7.6 and 55±9.1 for group B, respectively. For group A and B, both implant types showed statistically higher insertion and removal torque mean values for the undersized compared with the press-fit technique ( P <0.01). In addition, etched implants showed statistically higher insertion and removal torque mean values compared with machined implants ( P <0.01).
Conclusion: The placement of etched implants in synthetic bone models using an undersized preparation technique resulted in enhanced primary implant stability; further, a correlation was found between primary stability and bone density of the synthetic bone, implying that in case of an implant site with low bone density, by changing the surgical technique and choosing an implant with an optimal surface roughness, the primary stability can be enhanced significantly.     

Antibacterial effect of myeloperoxidase against Streptococcus mutans

Myeloperoxidase-chloride-H₂O₂ antimicrobial system is an integral part of leukocyte defense against pathogenic microorganisms. The system is present in gingival crevicular fluid and in whole saliva and, thus, possibly contributes to the non-antibody defense in the human mouth. In fact, at physiological concentrations myeloperoxidase-Cl⁻-H₂O₂ system effectively killed Streptococcus mutans both at acid and neutral pH. However, thiocyanate (SCN⁻) ions at concentrations similar to those in human saliva abolished this bactericidal action indicating that SCN⁻ rather than Cl⁻ is the physiologic substrate of myeloperoxidase in whole saliva. The peroxidation of SCN⁻ (by myeloperoxidase or salivary peroxidase) yields oxidation products which inhibit the growth and metabolism of S. mutans without notable loss of cell viability. Our results suggest that the presence of SCN⁻ in saliva protects human oral tissues (and bacteria) from highly cytotoxic oxidation products of Cl⁻ and, instead, bacteriostatic and non-toxic oxidation products of SCN⁻ are generated. In the gingival crevices, however, the SCN⁻/ Cl⁻ ratio may be too small for effective block of Cl⁻ oxidation by myeloperoxidase, and the oxidation products of Cl⁻, such as hypochlorite or hypochlorous acid, may contribute to the breakdown of periodontal tissues during inflammation.     

Lip paresthesia associated with a jaw mass

A case is reported in which mandibular swelling and lower lip numbness were the first signs of a metastatic adenocarcinoma of the lung. The development of paresthesia, with or without other oral symptoms, requires that a diagnosis of malignancy be considered until confirmed or ruled out by tissue biopsy. A thorough head and neck examination in all patients, especially in those whose history or habits may indicate increased risk of malignancy is necessary.     

Clinical reliability of non-organoleptic oral malodour measurements

Aim: Measurement of volatile sulphur compounds (VSC) by portable sulphur monitors (Halimeter^®, OralChroma^™) is a common practice for diagnosis of oral malodour. In this study, the clinical value of these devices was examined.
Materials and Methods: Two hundred and eighty patients with bad breath complaints attending a halitosis consultation were enrolled. Organoleptic scores were given by a trained and calibrated judge, before measurement of the VSC levels (Halimeter^®, OralChroma^™), to avoid any bias.
Results: Significant correlations were found between the organoleptic assessment, the Halimeter^®, and the OralChroma^™ ( R =0.74 for organoleptic versus Halimeter^®; 0.66 for organoleptic versus OralChroma^™; 0.63 for Halimeter^® versus OralChroma^™). The sensitivity and specificity (with regard to the organoleptic score) to detect patients with/without oral malodour for the Halimeter^® were 63% and 98%, respectively, and for the OralChroma^™ 69% and 100% when using the cutoffs suggested by the manufacturer. By lowering these values, sensitivity could be improved without a significant decrease in specificity (both devices).
Conclusions: We concluded that the measurement of the VSC levels can be used as an adjunct to the organoleptic assessment. Thresholds should be revisited in order to improve their clinical utility. These devices can prove the absence of malodour in case of pseudo-halitosis.     

Defluoridation of drinking water with pottery: effect of firing temperature

Excessive fluoride (F) in drinking water should be removed, but simple, inexpensive methods of fluoride removal are not readily available. This study examines the F⁻-binding capacity of clay and clayware, especially the effect of the firing temperature on the F⁻-binding process. A series of pots were made from ordinary potter's clay and fired at 500–1000°C. Likewise, small clay bricks were fired and then crushed and sieved. NaF solutions containing 10 mg/l F⁻ (10 ppm F⁻) were prepared. Suitable aliquots of the solutions were poured into clay pots or exposed to powdered clayware. Samples were taken at storage periods of 30 min to 20 days and analyzed for F⁻ by ion-selective electrodes. The rate and capacity of F⁻-binding in the clayware varied with the firing temperature. Clay fired at approximately 600°C was most effective. Temperatures over 700°C caused a decline in F⁻-binding, and pottery fired at 900°C and above seemed unable to remove F⁻ from water. Pots fired at 500°C or less cracked in water. The findings indicate that clayware, fired at an optimal temperature, may be of practical value for partial defluoridation of drinking water.     

Clinical oral malodor measurement with a portable sulfide monitor

Objective:  The aim of this study was to evaluate the clinical ability of Breathtron^® by comparing it with other malodor measurement procedures: the organoleptic test (OT) and gas chromatography (GC).
Subjects and methods:  Patients were 475 patients who visited a fresh breath clinic. Oral malodor was measured with the OT, GC, and Breathtron^®. Correlation analysis and two linear regression analyses were conducted to examine the relationship of the Breathtron^® values with OT scores and volatile sulfide compound (VSC) concentrations by GC: i.e. the regression of Breathtron^® on OT and the regression of Breathtron^® on total VSCs by GC. Receiver operating characteristics (ROC) analysis was conducted to investigate the sensitivity and specificity of Breathtron^®.
Results:  The Breathtron^® values were significantly correlated with OT and VSCs by GC. In the regression analysis, predicted Breathtron^® values were 199.3 and 520.1 ppb for OT scores 1 and 2, and reasonably close to total VSCs by GC between 550 and 750 ppb. The ROC analysis demonstrated that Breathtron^® is a useful and valuable adjunct measurement tool.
Conclusions:  Breathtron^® is a simple, rapid and reliable appliance for screening oral malodor if an appropriate malodor threshold level is chosen.     

Combined inhibitory effect of fluoride and hypothiocyanite on the viability and glucose metabolism of Streptococcus mutans, se retype c

The separate and combined effects of peroxidase-generated hypothiocyanite (HOSCN/OSCN⁻) and F⁻ ions on glucose uptake and growth of Streptococcus mutans ATCC 25175 were investigated. S. mutans cells were grown to late exponential or stationary growth phase, harvested, washed and suspended in 2.0 ml of sterilized human whole saliva supplemented with 10 mM D-glucose. This saliva-bacteria mixture was supplemented with 5–150 μM H₂O₂ at pH 5.0 or 6.5. At pH 5.0, up to 103±21 uM HOSCN/OSCN⁻ was generated. After 20 h of incubation at 37°C, the saliva-bacteria suspension exposed to HOSCN/OSCN⁻ were plated on mitis salivarius agar plates and incubated anaerobically for 2 days. Identical experiments were made with F⁻ ions (0.5, 1.0 and 5.0 mM). Both HOSCN/OSCN⁻ and F⁻ caused a significant dose-dependent growth inhibition at pH 5.0, whereas no inhibition was observed at pH 6.5. When F- and HOSCN/OSCN⁻ were added simultaneously at pH 5.0, an additive effect of growth inhibition was observed. In glucose incorporation experiments the bacteria-saliva mixture was exposed to 1 μM HOSCN/OSCN⁻, 0.5 mM F⁻ or both. F⁻, HOSCN/OSCN⁻ or their combination in sterilized whole saliva at pH 5.0 caused 14.2, 67.8 and 74.2% inhibition, respectively. These observations indicate that F⁻ and HOSCN/OSCN⁻ ions have an additive inhibitory effect on S. mutans and therefore their combination is likely to be more antibacterial than either agent alone.     

Hydrogen sulfide inhibits cell proliferation and induces cell cycle arrest via an elevated p21 Cip1 level in Ca9-22 cells

Background and Objective:  Volatile sulfur compounds such as hydrogen sulfide (H₂S) and methyl mercaptan (CH₃SH) are the main causes of oral malodor. However, the physiological functions of H₂S have not been investigated in oral tissues. The aim of this study was to evaluate the effect of H₂S on cell proliferation and the cell cycle in oral epithelial-like cells.
Material and Methods:  Ca9-22 cells were used in this study. Cells were cultured in 5% CO₂/95% air with (5 or 10 ng/mL) or without H₂S. DNA synthesis was measured using a 5-bromo-2-deoxyuridine enzyme-linked immunosorbent assay. The cell cycle was analyzed using a flow cytometer. The expressions of phosphorylated retinoblastoma protein (Rb), p21^Cip1 and p27^Kip1 were evaluated by western blotting.
Results:  Exposure to 5 and 10 ng/mL of H₂S significantly decreased DNA synthesis ( p <  0.05). Cell cycle analysis also showed that exposure to both concentrations of H₂S significantly increased the proportion of cells in G₁ phase ( p <  0.001) and significantly decreased the proportion of cells in S phase ( p <  0.01). Western blotting showed that Rb phosphorylation was reduced and p21^Cip1 was enhanced by exposure to H₂S.
Conclusion:  The results indicated that H₂S inhibits cell proliferation and induces cell cycle arrest via the expression of p21^Cip1 in Ca9-22 cells.     

Mucosal cell-mediated immunological changes associated with experimental graft-versus-host disease

This study examined the histological changes and local cellular immune response induced within the lingual mucosa in an allogeneic F, hybrid rat model of graft-versus-host disease (GvHD) with a view to studying oral lymphocyte-epithelial cell reactions. Highest levels of disease, as reflected by both a GvHD index and the extent of the oral mucosal changes, were obtained using primed donor (Lewis rats) splenocytes and irradiated hosts (Lew/Da rats). The lingual mucosae of test animals were characterised by irregular epithelial keratosis, an absence of basal cell liquefaction and a diffuse inflammatory cell infiltrate, histological features consistent with an oral lichenoid tissue reaction. Immunohistochemical studies showed that mucosal involvement was characterised by infiltration of the lamina propria by NK cells (CD8⁺, CD5⁻), "activated" cells (CD25⁺) and T cells (CD5⁺) with selective migration of the latter, including a CD5⁺. CD8⁻ subset (helper/inducer T cell), into the epithelium. Epithelial expression of la was invariably associated with these inflammatory cell infiltrates and correlated with the GvHD index. These findings suggest the presence of local mucosal T cell activation in the absence of detectable epithelial cell damage, which may be equivalent to the early initiating events in the pathogenesis of oral lichen planus. However, whilst experimental graft-versus-host disease appears to be a useful model for studying lymphocyte-epithelial interactions, the induced oral mucosal changes are more consistent with a lichenoid reaction rather than lichen planus.     

Epithelial dendritic cells in pathological human oral tissues

Epithelial dendritic cells (EDC) were examined in human oral tissues with non-specific keratosis, lichen planus and squamous cell carcinoma. Acetone-fixed frozen sections were stained using an indirect immunoperoxidase technique and monoclonal antibodies to the human CD1 thymocyte (OKT6) and HLA-DR antigens. Significantly more T6⁺ and DR⁺ EDC were present in lichen planus tissues than normal controls, tissues with non–specific keratosis and the epithelia overlying/adjacent to squamous cell carcinomas, the latter tissues having comparable numbers of both T6⁺ and DR⁺ EDC. By contrast, significantly fewer T6⁺ EDC and significantly more DR⁺ cells were present in the invasive epithelium of squamous cell carcinomas than the overlying/adjacent epithelium of carcinomas, the non-specific keratosis group and the normal tissues. 23–60% of pathological tissues had either focal or general DR⁺ reactivity in keratinocytes, but there was no correlation between the density of T6⁺ or DR⁺ EDC and the keratinocyte DR status of the tissues. The results suggest that immunological enhancement occurs in lichen planus and possibly immunological impairment may characterize invasive squamous cell carcinoma.     

Recurrent buccal space abscesses: a complication of Crohn's disease.

Oral features of Crohn's disease include ulcerations, lip fissuring, cobblestone plaques, and mucosal tags. We report the case of a 16-year old male patient with a 3-month history of abdominal pain, diarrhea, and oral ulceration. Clinical examinations revealed established intestinal lesions, a marked cobblestone appearance in the oral cavity, and an unusual pattern of presentation not previously reported in the literature: persistent, recurrent buccal space abscesses.     

Lip buccal mucosa traumatic overgrowth due to sucking habit —A 10-year follow-up of a non-surgical approach: A combination of behavioural and myofunctional therapy

Objective. Traumatic lesion of the lip buccal mucosa may develop due to a repetitive lip sucking habit, secondary to a dental space which opened in the dental in adult patients. The non surgical treatment approach is based on increasing of patient's awareness to the sucking habit along with the creation of a change in the oral and dental surrounding tissues. The following case included a failure to identify a traumatic habit of lower lip sucking, resulting in a buccal mucosa overgrowth. Combined conservative periodontal and orthodontic approach will be presented to address this clinical issue without any need for surgical intervention. Material and methods. 56 year old female patient presented with a complaint of unaesthetic appearance of the intraoral right buccal mucosa of the lower lip at rest position due to an intensive repetitive sucking habit of the right lower lip segment. We initiated a non surgical treatment approach including increasing the patient's awareness to the sucking habit, controlling the periodontal disease and orthodontic treatment to align and level the dental arch and to close the residual space. Result. The soft tissue overgrowth on the lip buccal mucosa almost completely subsided spontaneously as a result of conservative dental and behavioral management without the need for any oral surgery intervention. A 10 years follow-up revealed no repetitive oral mucosa overgrowth, no spaces reopening and no sucking habit redevelopment. Conclusion. Implementation of a morphological correction will assist the patient in breaking the habit and creating an environment that may effectively prevent the reoccurrence of the habit.     

Oral signs and symptoms in patients with undiagnosed vitamin B12 deficiency

The oral manifestations of glossitis, stomatitis and mucosal ulceration in vitamin B₁₂ deficiency have long been recognised. These oral changes may occur in the absence of symptomatic anaemia or of macrocytosis. The aim of this paper is to describe a retrospective study of the wide range of oral signs and symptoms reported by 14 patients found to have a previously undiagnosed vitamin B₁₂ deficiency. None of the patients described in this study had generalised symptoms sufficiently advanced to arouse suspicions of vitamin B₁₂ deficiency. The essential criteria for the diagnosis of pernicious anaemia are also discussed.