Squamous cell carcinoma of the gingiva presenting as localized periodontal disease.

Gingival squamous cell carcinoma represents less than 10% of diagnosed intraoral carcinoma. Many unique features of gingival squamous cell carcinoma clearly delineate it from oral squamous cell carcinoma arising in other sites. This article presents the clinicopathologic findings of a case. An 81-year-old woman presented for evaluation of multiple oral lesions primarily limited to the maxillary gingiva; the lesions had been present for about 2 years. Differential diagnosis included epithelial dysplasia, benign mucous membrane pemphigoid, inflammatory lesion of endodontic/periodontic origin, lichen planus, and squamous cell carcinoma. Clinical examination revealed extensive erythematous and ulcerative lesions of maxillary buccal and palatal gingiva extending into the maxillary buccal vestibule; the lesions did not respond to antibiotic therapy. Radiographic evaluation demonstrated advanced alveolar bone loss as well as displacement of the maxillary right first molar. Subsequent histology confirmed diagnosis of moderately differentiated squamous cell carcinoma. Gingival squamous cell carcinoma can mimic a multitude of oral lesions, especially those of inflammatory origin. In addition, predisposing and presenting factors are different from those of other oral squamous cell carcinomas. Careful examinations as well as routine biopsy are crucial for accurate diagnosis.     

Nicotine and lipopolysaccharide affect cytokine expression from gingival fibroblasts

BACKGROUND: This in vitro study investigated the influence of nicotine, lipopolysaccharide (LPS), and a combination of both agents on cytokine expression from human gingival fibroblasts (HGFs). METHODS: HGFs were exposed for 48 hours to 250 microg/ml nicotine, 1 microg/ml Porphyromonas gingivalis LPS, or both. The expression of multiple cytokines was detected in the HGFs conditioned media using cytokine protein arrays. RESULTS: The untreated HGFs expressed several cytokines, which included relatively high levels of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1). They also expressed low levels of growth-regulated oncogene (GRO), IL-3, and IL-10. Nicotine had the greatest effect on the expression of GRO-alpha, IL-7, IL-10, and IL-15 compared to the untreated control. P. gingivalis LPS had the greatest effect on the expression of GRO-alpha; IL-7; IL-10; and RANTES (regulated on activation, normal T-cell expressed, and presumably secreted) compared to the untreated control. The combination of both agents had the biggest impact on the expression of GRO-alpha, IL-7, IL-10, IL-15, RANTES, and interferon-gamma (IFN-gamma) compared to the untreated control. CONCLUSION: HGFs exposed to nicotine, P. gingivalis LPS, or a combination of both agents increased the expression of multiple cytokines.     

Screening for cardiovascular risk factors in a dental setting

BACKGROUND: The authors assessed the utilization of oral health care professionals (OHCPs) as a resource for identifying patients who were unaware of their increased risk of developing cardiovascular disease (CVD). METHODS: OHCPs administered a CVD risk-screening questionnaire, measured blood pressure and tested cholesterol levels, high-density lipoprotein levels and hemoglobin A1c (HgA1c) levels using "finger-stick" blood testing in 100 patients treated in a dental school clinic who were unaware of their CVD risk status. The authors determined the prevalence of specific risk factors (that is, smoking and abnormal levels of systolic blood pressure, lipids, body mass index and HgA1c) and calculated Framingham 10-year coronary heart disease (CHD) risk scores. RESULTS: Seventeen percent of the 100 patients (35 percent of men, 5 percent of women) had an increased global risk of experiencing a CHD event within 10 years (Framingham risk score>10 percent). Seventy-three percent of participants had one or more risk factors and 31 percent had two or more risk factors present. More men than women had low levels of high-density lipoprotein (45 percent [18/40] of men versus 3.3 percent [2/60] of women; P<.0001). The mean Framingham CHD risk score increased with increasing risk factor burden. CONCLUSIONS: OHCPs identified patients with an increased CHD risk who could benefit from primary prevention activities. A substantial proportion of study patients who were unaware of their risk status were at an increased risk of experiencing a CHD event within 10 years. OHCPs could contribute to public health CHD control efforts.     

Effect of anesthetics containing lidocaine and epinephrine on cardiovascular changes during dental implant surgery

The purpose of this study was to evaluate cardiovascular changes during dental implant surgery using 2% lidocaine with 1:80 000 epinephrine. Eleven normotensive subjects, ranging from 18 to 56 years, were selected to undergo dental implant surgery in the jaw. They were monitored in the pre-, intra-, and postsurgical periods by continuous noninvasive automatic arterial pressure and cardiac frequency measurements taken every 2 minutes. Parameter scores were obtained for the following phases: P1, 15 minutes during preparation of the patient (control period); P2, before anesthesia; P3, immediately after anesthesia; P4, 2 minutes into anesthesia; P5, during incision and detachment; P6, during perforation; P7, during implant placement; P8, during suturing; P9, on completion; and P10, 10 minutes after termination. Individualized statistical analysis for each group during the pre-, intra-, and postoperative periods were performed by analysis of variance. The greatest variations in systolic pressure were increases of 2.29% during phase P2 and 2.59% in phase P5. Diastolic pressure decreased during phase P6 (-2.58%) and increased in P10 (3.27%). The greatest changes in heart rate occurred in phase P10 (-3.24%). There were no statistically significant changes among the evaluated phases (P > .05). In conclusion, there were no changes in the analyzed cardiocirculatory parameters during dental implant surgery (systolic, diastolic, and mean arterial blood pressures and heart rate) in normotensive subjects anesthetized with 2% lidocaine with epinephrine 1:80000.     

Longitudinal study of bone density and periodontal disease in men

Bone loss is a feature of both periodontitis and osteoporosis, and periodontal destruction may be influenced by systemic bone loss. This study evaluated the association between periodontal disease and bone mineral density (BMD) in a cohort of 1347 (137 edentulous) older men followed for an average of 2.7 years. Participants were recruited from the Osteoporotic Fractures in Men Study. Random half-mouth dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque, and bleeding. BMD was measured at the hip, spine, and whole-body, by dual-energy x-ray absorptiometry, and at the heel by ultrasound. After adjustment for age, smoking, race, education, body mass index, and calculus, there was no association between number of teeth, periodontitis, periodontal disease progression, and either BMD or annualized rate of BMD change. We found little evidence of an association between periodontitis and skeletal BMD among older men.     

Gesichtsästhetik Teil 1: Die Bedeutung der Symmetrieebene des Gesichts

When humans observe a face, the eyes, mouth and nose regions are the preferred targets of the centre of gaze, with the outlines of eye position recordings approximating a triangle with vertices located in the centre of the eyes and mouth [31]. We studied the significance of cutaneous asymmetries inside and outside the Yarbus triangle on the basis of the assessment of digitally-manipulated images by 201 independent judges. We show that certain facial variations (such as naevi) are more attractive when asymmetrical than symmetrical (p<?0,001). They appear more attractive when located laterally rather than medially, particularly so when located outside the Yarbus triangle as compared to inside it (p<?0,001). The significance of facial symmetry increases significantly when approaching the Yarbus triangle or the midline, respectively.     

Levels of evidence and journal impact factor in oral and maxillofacial surgery

The aim of this study was to identify the relationship between quality of research, in terms of levels of evidence, and journal impact factor (IF), and to describe the pattern of publications in oral and maxillofacial surgery. All four major journals in this subject area only, and with a published IF, were included in the study. Latest published IF dated 2004 was chosen, and all articles related to its calculation were accessed and classified into four levels of evidence. Correlation between levels of evidence and IF was investigated and the pattern of publications was described. All eligible 932 published articles were analysed. None (0%) were level I evidence, 20 (2%) were Level II, 70 (8%) level III and 337 (40%) level IV; 465 (50%) articles were classified as non-evidence. IF ranged from 0.689 to 1.154. There were statistically significant correlations between levels of evidence and IF (rho=1.0, P<0.01). Among the 465 non-evidence articles, there were 219 (47%) case reports, 91 (20%) animal studies, 52 (11%) laboratory studies, 35 (8%) technical notes, 24 (5%) tutorial articles, and 16 (3%) reviews articles.     

Clinical and histological evaluation of immediate-loaded posterior implants in nonhuman primates

PURPOSE: To evaluate a square-thread design implant and compare the bone-implant contact percentage between immediate-loaded and nonloaded implants (controls) in nonhuman primates. MATERIALS: Five nonhuman primates each received 3 implants, with a total of 5 control implants and 10 immediate-loaded implants in posterior regions of the mouth. Ninety days after surgery (and function was appropriate), block sections of the implants were removed and sectioned in 200-mum thick pieces. The block sections were stained with modified Masson for evaluation of the bone-implant contact percentage. RESULTS: One of the immediate-loaded implants failed. The bone-implant contact percentage of control implants ranged from 50.34% to 64.13% and averaged 56.3%. The bone-implant contact percentage of immediate-loaded implants ranged from 43.23% to 75.72%, with an average of 62.4%. Two implants had lower bone-implant contact percentage than the others, and when these are not included in the evaluation, the bone-implant contact percentage average increased to 67.6%. CONCLUSIONS: Immediate-loaded implants in the nonhuman primates often have a higher bone-implant contact percentage at 90 days than unloaded implants. The bone remodeling is different for loaded implant-bone interfaces than for unloaded conditions. However, 1 immediate-loaded implant failed, and 2 implants had lower bone-implant contact percentage than controls. Therefore, although there are benefits of immediate loading, there appear to also be some risks.