Oral lichen sclerosus: an overview and report of three cases

Lichen sclerosus is an unusual, chronically relapsing mucocutaneous disease that usually afflicts the anogenital region. Oral lesions of lichen sclerosus are rare, with only 36 histologically verified cases reported to date. The classic histopathologic findings of oral lichen sclerosus include: an area of subepithelial hyalinization, loss of elastic fibres, and band-like mononuclear inflammatory infiltrate. Despite its rarity, oral lichen sclerosus should be included in the differential diagnosis of porcelain- or ivory-white macules. Here we present three new cases of oral lichen sclerosus. A review of these cases and the previously reported cases revealed that oral lichen sclerosus is slightly more common in women and can affect individuals of any age. Oral lesions of lichen sclerosus usually do not require treatment, except when there are significant symptoms or aesthetic complaint. Almost 50% of the patients with oral lichen sclerosus present with extraoral manifestations. Thus, referral to a dermatologist and a gynaecologist is advised. Although no cases of malignant transformation of oral lichen sclerosus have been reported, regular, long-term follow-up of patients with oral lichen sclerosus is indicated.     

Dental hygienists' knowledge and opinions of oral-systemic connections: implications for education

Although associations between periodontal and systemic health have been well established, there is little evidence regarding dental hygienists' knowledge of the oral-systemic connection. The purpose of this study was to determine the knowledge levels of North Carolina dental hygienists regarding oral-systemic connections and their attitudes and confidence about incorporating this knowledge into clinical practice. A survey was developed, pilot tested, revised, and mailed to 1,665 licensed dental hygienists in North Carolina. After three mailings, the response rate was 62 percent, with 52 percent (N=859) meeting the inclusion criteria. The majority (>80 percent) of the respondents correctly identified risk factors for diabetes and cardiovascular disease (CVD), but were less knowledgeable about risk factors for osteoporosis and adverse pregnancy outcomes. Most knew that there is strong evidence linking periodontal disease with CVD (77 percent) and diabetes (70 percent). The majority felt that dental hygienists should be trained to identify risk factors for oral-systemic disease (94 percent) and to actively manage patients with systemic disease (78 percent). Eighty-eight percent felt that dental and medical professionals should be taught to practice collaboratively. These dental hygienists had a high level of knowledge in some areas of oral-systemic disease but could improve their confidence levels and knowledge through expanded content in their educational programs and continuing education. Inter-professional education and collaboration would also assist in integration of knowledge into clinical practice.     

Aerotolerance of an endodontic pathogen

The purpose of this study was to determine the length of time it takes to kill obligate anaerobic bacteria in a root canal exposed to room air or 3% hydrogen peroxide. Twenty-five extracted, human, permanent teeth with single canals were used. All teeth were contaminated with the anaerobe, Porphyromonas endodontalis (ATCC #35406), and were divided into five groups of five teeth each. Group I was exposed to 5 min of atmospheric air. Group II was exposed to 3% hydrogen peroxide for 5 min. Group III was exposed to 45 min of atmospheric air. Group IV was exposed to 3% hydrogen peroxide for 45 min. Group V, the control teeth, never left the anaerobic gas chamber. The results showed that atmospheric air exposure for up to 45 min is inadequate for eliminating P. endodontalis. The groups that were exposed to hydrogen peroxide showed no growth of bacteria.     

Candida glabrata: an emerging oral opportunistic pathogen

Following the widespread use of immunosuppressive therapy and broad-spectrum antimycotic prophylaxis, C. glabrata has emerged as an important opportunistic pathogen in the oral mucosa. In the past, studies on the virulence factors and host-pathogen interactions of this organism were scarce, but continued to rise in recent years. Denture-wearing, immunosuppression, antibiotic therapy, and aging are risk factors for oral colonization or infection with C. glabrata. Compared with C. albicans, C. glabrata exhibits lower oral keratinocyte-adherence capacity, but higher denture-surface-adherence ability. The role of extracellular hydrolase production in the virulence of this organism does not appear to be as important as it is in C. albicans pathogenesis. Although traditionally thought of as a non-transforming yeast organism, both phenotypic switching and pseudohyphal formation have recently been identified in C. glabrata, but their role in pathogenesis is not known. With the exception of granulocyte monocyte colony-stimulating factor, C. glabrata triggers a lower proinflammatory cytokine response in oral epithelial cells than does C. albicans, in a strain-dependent manner. C. glabrata is less susceptible to killing by human beta-defensins than is C. albicans and exhibits various degrees of resistance to the antifungal activity of salivary histatins and mucins. In addition, C. glabrata possesses both innate and acquired resistance against antifungal drugs, due to its ability to modify ergosterol biosynthesis, mitochondrial function, or antifungal efflux. This resistance allows for its relative overgrowth over other susceptible species and may contribute to the recent emergence of C. glabrata infections in chronically immunocompromised populations. Further investigations on the virulence and host-pathogen interactions of C. glabrata are needed to better define the pathogenesis of oral C. glabrata infection in susceptible hosts.     

Osteogenic sarcoma of the jaw in an African community: report of twenty-one cases

Twenty-one patients with osteogenic sarcoma were treated at the University College Hospital, Ibadan, Nigeria, during the period from 1960 to 1984. Six of the 21 patients were younger than 20 years of age, and there was a predominance of male patients in the series. The maxilla was involved more frequently than the mandible. Surgery was the only treatment available. All of the patients are presumed to be dead.     

Areca nut chewing in an expatriate population in Sydney: report of two cases

Areca nut (betel nut) consumption occurs in a variety of forms, either on its own or with the addition of a number of products. This habit is prevalent in the Indian Subcontinent and South-East Asia. Recent immigration statistics indicate that 30% of new arrivals in Australia are from these geographical regions and are known to perpetuate this custom long after migration. The objective of this paper is to highlight the variety of oral presentations that may occur as a result of areca nut consumption in these particular demographic subgroups. Dental practitioners must be familiar with the wide spectrum of oral lesions that may present in this setting. More significantly, they must be aware that some of these lesions possess the potential for malignant transformation and hence require more specific management. Best practice mandates that dental practitioners in a multicultural society must: (1) be capable of recognizing the expatriate populations in which this custom is widely practised; (2) incorporate this particular line of questioning into the routine risk factor analysis that is undertaken for every patient from these particular sub-populations; and (3) institute appropriate referral and follow-up of these lesions if required.     

Life as an endodontic pathogen

This review describes the type of microbial flora in the untreated root canal and the root‐filled canal with persistent infection. Recent contributions of molecular methods of microbial identification are outlined along with a discussion of advantages and limitations of these methods. Ecological and environmental factors are the prime reasons for differences in the microbial flora in these distinct habitats. Shared phenotypic traits and an ability to respond to the modified environment select for the species that establish a persistent root canal infection.     

牙骨质撕裂三例

牙骨质撕裂是一类不常见的根折形式,在临床上很容易被误诊为单纯牙周和根尖周病变。因此,正确诊断和早期治疗牙骨质撕裂非常重要。本文报道3例牙骨质撕裂病例,以期为临床诊断和治疗提供参考。     

Ameloblastic fibroma: report of two cases

Summary. The ameloblastic fibroma is an odontogenic tumour with an unusual presentation. It is considered to have both epithelial and mesenchymal elements, but it läcks any calcifled dental structures. Two new cases are presented. The first of these began as a mandibular tumour whereas the second was discovered by chance. The radiographic finding in each case was a unilocular cystic radiolucency. Treatment consisted of excisional biopsy by enucleation in both patients. Histopathological findings were consistent with ameloblastic fibroma.