Showing papers in "Journal of Oral Pathology & Medicine in 1995"
TL;DR: It was found by univariate analysis that alcohol consumption, smoking, betel quid chewing, educational level and occupation were associated with oral cancer, and there was a statistically significant association between oral cancer and betelQuid chewing alone.
Abstract: A hospital-based case-control study of matched pairs was conducted to explore (a) the relationship between the use of betel quid chewing, cigarette smoking, alcohol drinking and oral cancer and (b) synergism between these factors. The case group consisted of 104 male and 3 female oral cancer patients and these were compared with 194 male and 6 female matched controls. We found by univariate analysis that alcohol consumption, smoking, betel quid chewing, educational level and occupation were associated with oral cancer. The adjusted odds ratios were to be found elevated in patients who were smoking and betel quid chewing. After adjusting for education and occupation covariates, the incidence of oral cancer was computed to be 123-fold higher in patients who smoked, drank alcohol and chewed betel quid than in abstainers. The synergistic effects of alcohol, tobacco smoke and betel quid in oral cancer were clearly demonstrated, but there was a statistically significant association between oral cancer and betel quid chewing alone. Swallowing betel quid juice (saliva extract of betel quid produced by chewing) or including unripened betel fruit in the quid both seemed to enhance the risks of contracting oral cancer.
674 citations
TL;DR: Oral submucous fibrosis is a high risk precancerous condition, predominantly affecting Indians, and consumption of chilli was hypothesized as an etiologic factor on the basis of ecological observations and a solitary animal experimental study.
Abstract: Oral submucous fibrosis (OSF) is a high risk precancerous condition, predominantly affecting Indians. Consumption of chilli was hypothesized as an etiologic factor on the basis of ecological observations and a solitary animal experimental study. Subsequent epidemiologic studies that included case-series reports, large cross-sectional surveys, case-control studies, cohort and intervention studies have identified areca nut as the major etiologic agent. Tissue-culture studies involving human fibroblasts, areca nut extracts and areca nut alkaloids supported this etiologic hypothesis by showing fibroblastic proliferation and increased collagen formation. Currently, the role of genetic susceptibility and that of autoimmunity are receiving attention. The influence of nutritional factors, if any, remains unclear.
266 citations
TL;DR: The extent of agreement in grading epithelial dysplasia between pathologists with the same or different educational backgrounds was investigated, indicating that the interobserver variability was due to individual differences rather than to educational background.
Abstract: Histopathologic examination of oral leukoplakias has a major impact on the assessment of prognosis and treatment planning. We investigated the extent of agreement in grading epithelial dysplasia between pathologists with the same or different educational backgrounds. Two general pathologists and two oral pathologists were each given 100 sections of oral leukoplakia to grade from no dysplasia to carcinoma in-situ. The interobserver agreement rates were in the range of 49% to 69%. The calculated kappa values were in the range of 27% to 45%), showing poor to moderate agreement between the pathologists. When comparing the kappa values between the two pairs of pathologists with the same education, these values did not diverge from the general level of kappa values, indicating that the interobserver variability was due to individual differences rather than to educational background.
234 citations
TL;DR: These treatment regimens combined with daily mouth opening exercises were found to be necessary to manage OSF cases in early and advanced stages of progression.
Abstract: Over a 10-year period (1982-1991); a total of 150 patients divided into two groups with varying degrees of oral submucous fibrosis (OSF) were treated by either medical or surgical therapies. Medical treatment involved (a) conservative oral administration of vitamin B-complex, buflomedial hydrochloride and topical triamcinolone acetonide 0.1%, or (b) conventional submucosal injections of a combination of dexamethasone and hyaluronidase, or (c) a combination of both (a) and (b). The surgical group was treated by the excision of fibrotic tissues and covering the defect with split-thickness skin, fresh human amnion, or buccal fat pad (BFP) grafts. Treatment was chosen according to the stage of clinical progression to gain maximal interincisal distance (ID). The cases were followed up by monthly examinations for at least two years, or when possible even longer. A combination of (a) and (b) medical treatment was satisfactory in cases of mild impairment (ID > 20 mm) but in the long term it led to symptomatic relief only. Surgical therapy, on the other hand, when accepted by the patients, led to a significant improvement of trismus in cases of severe limitation (ID < 20 mm). Following this strategy, an additional ID increase was observed in all patients. BFP grafting was particularly successful in diminishing scarring after two years as compared with the other two grafts. Together with a cessation of the betel quid chewing habit before and after therapy, these treatment regimens combined with daily mouth opening exercises were found to be necessary to manage OSF cases in early and advanced stages of progression.
205 citations
TL;DR: The results suggest that overexpression of p53P, rather than increased numbers of p 53P+ cells, is related to proliferation in odontogenic epithelial lesions.
Abstract: Forty-five examples of epithelial odontogenic lesions (9 ameloblastomas (AB): 13 odontogenic keratocysts (OKC): 15 dentigerous cysts (DC): 6 radicular cysts (RC): and 2 odontogenic carcinomas (OC)) were immunohistochemically analyzed for the presence of p53 protein (p53P) and proliferative activity as indicated by positivity for Ki-67 antigen. p53P+ cells, detected as dense and/or faint nuclear staining, were found in 42 of the 45 odontogenic lesions examined. Dense p53P reactivity was most commonly detected in OKC, AB and OC, with other lesions generally exhibiting only weak nuclear reactivity. Numbers of Ki-67 positive cells as well as p53P+ cells were scored semiquantitatively. Although the presence/absence of densely stained p53P+ cells was broadly related to Ki-67+ cell numbers, there were no differences in p53P+ cell numbers between lesions exhibiting differences in proliferative activity. These results suggest that overexpression of p53P, rather than increased numbers of p53P+ cells, is related to proliferation in odontogenic epithelial lesions.
182 citations
TL;DR: The results of this study indicate that, in some cases, resistant BMS probably is of psychological origin.
Abstract: The effect of cognitive therapy (CT) on resistant burning mouth syndrome (BMS) was studied. Thirty patients with resistant BMS after odontological and medical treatment were randomly divided into two equal groups; a therapy group (TG) was treated with CT and an attention/placebo group (APG) served as a control group. The intensity of BMS, which was estimated by the use of a visual analogue scale, was significantly reduced in the TG directly after CT was completed and was further reduced in a 6-month follow-up. The APG did not show any decrease in intensity of BMS. The results of this study indicate that, in some cases, resistant BMS probably is of psychological origin.
176 citations
TL;DR: Two hundred and eighty-nine cases of odontogenic tumors that accumulated in the files of the biopsy service of the Lagos University Teaching Hospital during a period of 21 years were analysed and categorised according to the most recent World Health Organization (WHO) classification.
Abstract: Two hundred and eighty-nine cases of odontogenic tumors that accumulated in the files of the biopsy service of the Lagos University Teaching Hospital during a period of 21 years were analysed and categorised according to the most recent WHO classification of odontogenic tumors. Odontogenic tumors constituted 19% of all oral/jaw tumors and tumor-like lesions. Ameloblastoma, which accounted for 58.5% of odontogenic tumors in the series, was the most common, and showed a predilection for males and the posterior mandible. 94.8% of odontogenic tumors were benign, while malignant odontogenic tumors accounted for 5.2%. Odontogenic carcinoma was the most prevalent malignant odontogenic tumor; it showed a predilection for the mandible and occurred at a mean age of 37 years.
161 citations
TL;DR: Investigation of epithelial cell proliferation in the linings of odontogenic cysts, including three different subtypes of Odontogenic keratocyst (OKC), namely simple, recurrent and basal cell naevus syndrome-associated lesions revealed no significant difference between simple and recurrent lesions.
Abstract: The aim of the present study was to investigate epithelial cell proliferation in the linings of odontogenic cysts, including three different subtypes of odontogenic keratocyst (OKC), namely simple (non-recurrent), recurrent and basal cell naevus syndrome (BCNS)-associated lesions. Ki67 immunoreactivity in OKC (simple, n = 10; recurrent, n = 8; syndrome, n = 9), dentigerous cysts (DC, n = 5), radicular cysts (RC, n = 5) and normal oral mucosa (n = 7) was studied using a biotin-streptavidin-peroxidase method on paraffin sections after microwave treatment. Ki67+ epithelial cells were counted manually and related to the length of basement membrane (BM) as determined by TV image analysis. Data were analysed by the Mann-Whitney U test. The number of Ki67+ cells in simple OKC linings (53.1 +/- 17.8 cells/mmBM) was similar to that in oral epithelium (42.5 +/- 12.7 cells/mmBM; P > 0.2). However, both contained significantly more Ki67+ cells than DC (3.9 +/- 1.3 cells/mmBM) and RC linings (6.7 +/- 4.8 cells/mmBM; P 0.3). However, OKC associated with BCNS contained significantly higher numbers of Ki67+ cells (91.8 +/- 35.6 cells/mmBM; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
140 citations
TL;DR: It is suggested that HPV 16 infection may play an important role in the pathogenesis of PVL-associated oral dysplasia and possibly cancer, but is found in only a small proportion of the more common, non-PVL associated-oral lesions.
Abstract: Proliferative verrucous leukoplakia (PVL) is a recently described clinical entity characterized by multifocal oral lesions that frequently progress to oral cancer despite abstinence from tobacco use by most patients. To determine if this condition is associated with human papillomavirus (HPV), a polymerase chain reaction (PCR) for HPV DNA was performed on 9 lesions from 7 patients with PVL, histologically diagnosed with focal keratosis (1), papilloma (1), epithelial dysplasia (5) and squamous cell cancer (2). Eight (89%) were HPV positive, 7 for HPV 16. For comparison, we studied 55 non-PVL-associated oral specimens, including 24 oral squamous cell cancers. Of the cancers, 8 (33%) were HPV positive, 4 for HPV 16. These data suggest that HPV 16 infection may play an important role in the pathogenesis of PVL-associated oral dysplasia and possibly cancer, but is found in only a small proportion of the more common, non-PVL associated-oral lesions.
127 citations
TL;DR: There was a statistically significantly relationship between parafunctional habits and anxiety as indicated by the HAD scale, but not with depression.
Abstract: This study investigated 84 patients with burning mouth syndrome (BMS), who were asked to complete a hospital anxiety and depression (HAD) scale questionnaire. A control group of 69 patients was also included. All patients were interviewed regarding parafunctional habits and were subjectively examined for signs of occlusal wear of the natural teeth or dentures. The results demonstrated that parafunctional habits were present in 61% of patients with BMS. There was a statistically significantly relationship between parafunctional habits and anxiety as indicated by the HAD scale, but not with depression.
102 citations
TL;DR: There were no statistically significant associations between erosive oral LP and either anxiety or depression, as measured on the HAD Scale, or anxiety as measured by the Cattell 16 PF Questionnaire.
Abstract: 50 patients with oral lichen planus (LP) were investigated for current anxiety and depression and for related personality factors. Anxiety levels, as measured on the Hospital Anxiety and Depression (HAD) Scale, were elevated in 50% of cases while depression scores, measured on the same scale, were low in all but a few. The sample profile showed a slight tendency towards anxiety, as measured by the Cattell 16 PF Questionnaire, but did not confirm previous reports of high intelligence and intellectual orientation. There were no statistically significant associations between erosive oral LP and either anxiety or depression, as measured on the HAD Scale, or anxiety as measured by the Cattell 16 PF Questionnaire.
TL;DR: This work examined the contribution of mast cell mediators to inflammation in the oral cavity and found the density of mast cells in tissue compartments was related to the level of expression of E-selectin, an endothelial adhesion molecule known to be induced in skin by TNF derived from degranulating mast cells.
Abstract: Mast cells are granule-containing secretory cells which are distributed preferentially about the microvascular bed in oral mucosa. This work examined the contribution of mast cell mediators to inflammation in the oral cavity. Mast cells in oral tissues expressed the serine proteases, tryptase and chymase, with a minor subpopulation being chymase-negative. Mast cells contained the cytokine tumour necrosis factor-alpha (TNF) in their granules. Degranulation of mast cells was a consistent feature of inflammatory lesions (lichen planus, gingivitis, pulpitis, periapical inflammation). In lichen planus, intracellular stores of TNF were depleted, and expression of mRNA for TNF was upregulated, indicating ongoing production and release of the cytokine. The density of mast cells in tissue compartments was related to the level of expression of E-selectin, an endothelial adhesion molecule which is known to be induced in skin by TNF derived from degranulating mast cells. Further attention should be directed toward the role of mast cell products, particularly TNF, in inflammation in the oral cavity.
TL;DR: The present study and the survey of the literature suggest that radicular cysts associated with primary teeth are not rare.
Abstract: Radicular cysts originating from primary teeth are considered rare. The study analyzed 49 primary molars with radiolucent lesions ranging from 4-15 mm in diameter. 73.5% of the lesions were diagnosed as radicular cysts, and 26.5% as granulomas. The lesions were more frequent in the mandible. All lesions were associated with severely decayed teeth and only 4 had previous pulp therapy. The present study and the survey of the literature suggest that radicular cysts associated with primary teeth are not rare.
TL;DR: It is demonstrated that although ameloblastomas are regarded as a fairly homogeneous group of neoplasms, detailed investigations prove clinicopathologic diversity in a significant number of lesions.
Abstract: One hundred and eight ameloblastomas diagnosed in a rural black Africa population were analysed for clinicopathologic findings other than those classically described. One patient had a polycystic ameloblastoma adjacent to an ameloblastic fibroma. Two other polycystic ameloblastomas showed aneurysmal bone cyst formation and one mandibular tumour was diagnosed as a keratoameloblastoma. Microscopic changes resembling an adenomatoid odontogenic tumour were present in association with two unicystic ameloblastomas and a HPV18-positive verrucous lesion occurred in the lining of a cystic space of a polycystic ameloblastoma. Two ameloblastomas contained eosinophilic granules in all tumor cells and melanocytes were diffusely present in another. One case exhibited a focus of mucous cell metaplasia. Two polycystic ameloblastomas showed diffuse interstitial ossification. One mandibular tumor was diagnosed as a desmoplastic ameloblastoma and another as an odontoameloblastoma. This study demonstrated that although ameloblastomas are regarded as a fairly homogeneous group of neoplasms, detailed investigations prove clinicopathologic diversity in a significant number of lesions.
TL;DR: Evidence is provided that fibroblasts derived from oral submucous fibrosis (OSF) tissue and normal mucosa (NM), although similar in many respects, exhibit specific differences in proliferation rates and lysyl oxidase activity.
Abstract: Growth characteristics and lysyl oxidase activity of fibroblasts derived from human normal mucosa (NM) and oral submucous fibrosis (OSF) associated with betel nut chewing were compared in cell cultures. The growth rates of cultured cells were identified by plating 5×105 cells/35 mm culture dish (Day 0) and every 24 hours cell proliferation was determined by quantifying the cell number (using a hemocytometer). The third to seventh passages were used. A medium without serum but supplemented with 5 mg/ml bovine serum albumin was substituted for the original medium at the subconfluent period and cultured for an additional 24 h. The medium was collected and used for assays of protein content and lysyl oxidase activity. Lysyl oxidase activity was assayed with [4,5-3H] -lysine labelled purified chick - embryo aorta elastin substrate. After incubation for 10 h at 37°C, the enzyme activity was measured from 3HHO (tritiated water) separated by ultrafiltration using Amicon C-10 micro-concentrators. The results showed the mean doubling time of OSF fibroblasts was 3.2 days and of NM fibroblasts was 3.6 days. NM fibroblasts became confluent at day 6 as determined by cell number, while OSF fibroblasts were confluent by Day 5. Furthermore, the immunoenzymatic assay for BrdUrd incorporation revealed that OSF fibroblasts proliferate significantly faster than NM fibroblasts under standard culture conditions. Both total protein content (10.84±1.15 mg/ml) and lysyl oxidase activity (3558.6±345.5 cpm/106 cell) in OSF fibroblasts were greater than in NM fibroblasts (6.35±0.96 mg/ml and 2436.0±352.6 cpm/106 cell). The results of this study provide evidence that fibroblasts derived from oral submucous fibrosis (OSF) tissue and normal mucosa (NM), although similar in many respects, exhibit specific differences in proliferation rates and lysyl oxidase activity. Moreover, collagen deposition in OSF tissue may, at least in part, be ascribed to increased lysyl oxidase activity.
TL;DR: A retrospective study of the wide range of oral signs and symptoms reported by 14 patients found to have a previously undiagnosed vitamin B 12 deficiency, finding none of the patients described in this study had generalised symptoms sufficiently advanced to arouse suspicions of vitamin B12 deficiency.
Abstract: 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.
TL;DR: Results indicate a high prevalence of HCV infection in oral cancer patients, which warrants a systematic study of etiological associations between oral cancer and HCV.
Abstract: We have investigated the correlation between the prevalence of hepatitis C virus (HCV), which is detectable in saliva, and oral cancer and other digestive tract cancers in the Northern Kyushu region of Japan. Anti-HCV antibodies were detected in sera from 24 of the 100 patients with oral cancer (24%, p < 0.05 vs the control group, p < 0.01 vs the stomach cancer group), in 11 of 104 patients with non-malignant diseases receiving dental treatment (the control group, 10.6%), and in 12 of 113 patients with stomach cancer (10.6%). HCV-RNA was detected in sera from 17 of 100 oral cancer patients (17%, p < 0.05 vs the control group) and 4 of 104 patients of the control group (3.9%). These results indicate a high prevalence of HCV infection in oral cancer patients, which warrants a systematic study of etiological associations between oral cancer and HCV.
TL;DR: It is concluded that p53 protein may be detected early in the development of a subset of p53-positive oral squamous cell carcinomas, which may have prognostic implications in dysplasias and in situ lesions.
Abstract: Immunohistochemically detectable levels of p53 may be seen early in the malignant transformation of some neoplasms. To determine if p53 is immunocytochemically detectable, and therefore presumptively abnormal, in oral dysplasias and in situ carcinomas, and to explore the natural history of p53 protein expression in these lesions, sequential biopsies from patients with lesions occurring in the same anatomic site were examined. Formalin-fixed, paraffin-embedded sections from 19 patients were evaluated immunohistochemically for p53 protein using antibody clones Pab1801 and BP53-12. With two exceptions, comparable results were observed with these antibodies. p53 protein was detected immunocytochemically in 6 of 13 patients with dysplasias; 3 of these progressed to p53-positive invasive carcinoma, one advanced to a more severe grade of p53-positive dysplasia, one developed into a p53-negative verrucous carcinoma, and one represented a p53-positive dysplasia developing five years after treatment of a p53-positive carcinoma. The p53-positive dysplasias, which were found in all subtypes (mild, moderate, severe), preceded histologic malignant change by months to years. p53 detection was evident in 4 of 6 patients with in situ lesions. Sequential biopsies of three of these lesions showed no change in lesion histology or p53 staining, and one lesion advanced to a p53-positive carcinoma. It is concluded that p53 protein may be detected early in the development of a subset of p53-positive oral squamous cell carcinomas. This phenomenon may be seen in dysplasias and in situ lesions, and it may have prognostic implications.
TL;DR: Infants who routinely sucked a pacifier had a significantly higher rate of oral candidal carriage, suggesting a reservoir of infection.
Abstract: Asymptomatic oral candidal carriage has been extensively studied in adults, but only rarely in infants. The present investigation aimed to determine the asymptomatic oral carriage of candidal species in healthy infants and its relationship to age, sex, feeding pattern and use of a pacifier. The swab technique was used for oral candidal isolation. Candidal species were isolated from 48% of the infants without a significant relationship to age, gender or between breast-fed or bottle-fed infants. Similarly, a history of maternal vaginal candidosis, or presence of nappy rash, had no significant relationship to oral candidal carriage. Infants who routinely sucked a pacifier had a significantly higher rate of oral candidal carriage, suggesting a reservoir of infection.
TL;DR: Results indicate that the administration of rhIL-1 beta accelerated alveolar bone destruction in ligature-induced periodontal tissue inflammation over a two-week period.
Abstract: The effects of recombinant human interleukin-1 beta (rhIL-1 beta) on alveolar bone resorptive activity in rats were examined. Continuous administration of rhIL-1 beta or phosphate-buffered saline (PBS) was given via osmotic pumps for 3, 7 and 14 days to rats with silk ligatures around second maxillary molars. Other animals without ligatures received insertion of pumps containing rhIL-1 beta or remained untreated. Sections were subject to three different stains:--hematoxylin and eosin (H-E) for histology, acid phosphatase (ACPase) activity for osteoclast detection, and immunohistochemistry using anti-rat monocyte/macrophage monoclonal antibody (ED 1). In addition, body weight, plasma calcium and phosphorus levels were monitored. The mean body weight of rats receiving rhIL-1 beta was significantly lower (P < 0.05 to P < 0.01) compared with untreated rats throughout the experimental period. On Day 7, plasma calcium and phosphorus levels were significantly lower in rats receiving rhIL-1 beta than in rats receiving PBS only (P < 0.05). Sections revealed a moderate inflammatory cell infiltrate reaching near the alveolar crest in both groups with ligatures on Day 3. Only rats receiving rhIL-1 beta exhibited enhancement of inflammatory cell invasion on Days 7 and 14. In rats receiving rhIL-1 beta with ligatures, numerous resorption lacunae containing ACPase-positive multinucleated giant cells (MNGCs), coinciding with ED1-positive cells, were located on the mesial side of the septum where extensive bone resorption had occurred throughout the experimental period. In animals receiving rhIL-1 beta without ligatures, compared with untreated rats, increased ACPase-positive cells were observed on the mesial side of the septum on Day 3. In animals receiving PBS only, a few ACPase-positive cells were observed confined to the mesial regions where slight bone resorption occurred on Days 7 and 14. These results indicate that the administration of rhIL-1 beta accelerated alveolar bone destruction in ligature-induced periodontal tissue inflammation over a two-week period.
TL;DR: The results indicate that CMV and HP DNA can be found in separate oral mucosal ulcers in apparently immunocompetent adults.
Abstract: The possible involvement of Cytomegalovirus (CMV) and Helicobacter pylori (HP) in oral mucosal ulcers is suggested by their role in the development of ulceration at other mucosal sites of the gastrointestinal tract. A series of 29 incisional biopsies from 29 consecutive and apparently immunocompetent patients attending the clinic for oral ulceration were examined by routine histopathology as well as by in situ hybridisation (ISH) with biotinylated CMV and HP DNA probes. In 14/29 biopsies, Giemsa staining disclosed spiral bacteria. Six (20.7%) of these 14 Giemsa-positive samples showed HP DNA on ISH and 3 ulcers (10.3%) contained CMV DNA. In none of the specimens were CMV and HP detected simultaneously. Two of the ulcers containing CMV DNA were found on the labial mucosa and one on the posterior palatal mucosa, whereas all HP DNA-positive ulcers were located on the buccal mucosa. The results indicate that CMV and HP DNA can be found in separate oral mucosal ulcers in apparently immunocompetent adults.
TL;DR: Betel and miang chewing seem to be vanishing habits in Thailand in contrast to other Southeast Asian or South Asian countries, although chewer's mucosa has been observed.
Abstract: Historical aspects of betel and miang chewing in Thailand are described, as is the betel quid. Available literature on cancer and precancer in Thailand is reviewed. While oral cancer has been a major health problem in the past, changes in habit patterns with marked reduction of betel and miang chewing during the last decades have prompted a change in frequency of oral cancer in some provinces. Oral effects of miang chewing are less marked, although chewer's mucosa has been observed. Betel and miang chewing seem to be vanishing habits in Thailand in contrast to other Southeast Asian or South Asian countries.
TL;DR: Western-blot studies suggested that jaw cyst gelatinases were only in part complexed with and thus inhibited by TIMP-1 or TIMP/TIMP-2, suggesting that both MMP-9 and M MP-2 may participate in cyst expansion.
Abstract: The molecular mechanisms of jaw cyst expansion probably involve interactions of matrix metalloproteinases (MMPs) and the tissue inhibitors of MMPs (TIMPs). In this study, molecular species of gelatinases present in neutral salt extracts of cyst walls and cyst fluids were characterized by functional activity measurements (type I gelatin and α-casein zymography) and immunologically (Western-blotting). The effects of various protein thiol-group or cysteine-switch reactants involved in the activation of collagenases were studied on cyst gelatinases and a gelatinases purified from human gingival fibroblasts (72 kD MMP-2), gingival keratinocytes (92 kD MMP-9) and polymorphonuclear neutrophilic leukocytes (92 kD MMP-9). Western-blottings revealed the presence of both 92 kD (MMP-9) and 72 kD (MMP-2) gelatinases in cyst wall extracts and cyst fluids. Western-blot studies further suggested that jaw cyst gelatinases were only in part complexed with and thus inhibited by TIMP-1 or TIMP-2, suggesting that both MMP-9 and MMP-2 may participate in cyst expansion. MMP-2 was also partially fragmented to a 68 kD form and additional lower molecular weight proteinases (<60 kD) were detected by α-casein zymography and by Western-blotting, suggesting proteolytic fragmentation. MMP-9 was at least partially activated by all protein-thiol group reactants and rather resistant to oxidative inhibition by hypochlorite (NaOCl); in contrast, MMP-2 was activated by APMA but not at all by gold thioglucose (GTG) and was clearly inactivated by hypochlorite (NaOCl). This indicates MMP-specific sensitivity to oxidative agents, but more specifically to preferential oxidative activation of PMN 92 kD MMP-9 and oxidative inactivation of the fibroblast-type 72 kD MMP-2.
TL;DR: A patient who had severe recurrent oro-genital ulceration which was unresponsive to conventional therapy was taking non-steroidal anti-inflammatory drugs prescribed for osteoarthritis, and when she stopped this medication, she had no further genital ulcers and the pattern of her oral ulcers was dramatically improved.
Abstract: Recurrent oro-genital ulceration is a common condition of unknown aetiology. This paper describes a patient who had severe recurrent oro-genital ulceration which was unresponsive to conventional therapy. The patient was taking non-steroidal anti-inflammatory drugs (NSAIDs) prescribed for osteoarthritis. When she stopped this medication, she had no further genital ulceration and the pattern of her oral ulceration was dramatically improved. There have been no previously reported cases of recurrent oro-genital ulceration associated with NSAIDs.
TL;DR: Results are consistent with the hypothesis that, in OLP patients, diverse exogenous agents may cause upregulated expression of HSP by oral mucosal keratinocytes and a reaction of cytotoxic T lymphocytes to these activated keratinocyte may result in the tissue destruction which is characteristic of OLP lesions.
Abstract: To assess the potential role of heat shock protein (HSP) in the pathogenesis of oral lichen planus (OLP), sections of OLP, normal oral mucosa, non-specific oral ulceration (NSOU) and dysplastic OLP were assessed for HSP expression using avidin-biotin complex immunohistochemistry with an anti-HSP 70 polyclonal antibody. There were statistically significant differences in both the vertical and horizontal staining distribution when other groups were compared with the OLP group (p<0.01). Using microdensitometry, the mean staining intensity in OLP, dysplastic OLP and NSOU was elevated in comparison with normal oral mucosa (p<0.001). In a standard tritiated thymidine uptake assay, lymphocytes extracted from nine OLP lesions demonstrated significant proliferation when stimulated with purified protein derivative (PPD), of which HSP is a major constituent, with stimulation indices ranging from 2 to 132. These results are consistent with the hypothesis that, in OLP patients, diverse exogenous agenst may cause upregulated expression of HSP by oral mucosal keratinocytes. A reaction of cytotoxic T lymphocytes to these activated keratinocytes may then result in the tissue destruction which is characteristic of OLP lesions.
TL;DR: Six cases of oral psoriasis originally diagnosed by means of the histological changes found on biopsies of the oral lesions were presented, two of them complicated by psoriatic arthritis, one of them to the temporomandibular joint.
Abstract: This article presents six cases of oral psoriasis originally diagnosed by means of the histological changes found on biopsies of the oral lesions. Three of the patients presented with oral and skin psoriasis. Of the remaining three, two presented with oral manifestations alone, although their follow-up was short, whilst the third showed delayed dermatological changes. Two of the cases were also complicated by psoriatic arthritis, one of them to the temporomandibular joint.
TL;DR: Detailed case histories are presented to illustrate the role of azathioprine in treating oral lesions and to document a familial case of recurrent erythema multiforme, with severe mucosal involvement.
Abstract: Erythema multiforme may be recurrent and the oral cavity is often affected. A series of 82 patients with unequivocal recurrent cutaneous erythema multiforme were examined to determine the incidence and nature of oral lesions. Seventy per cent of patients had oral lesions, comprising multiple, large, shallow, extremely painful and debilitating ulcers, which affected the entire oral mucosa in over 20%. The buccal mucosa and tongue were the most frequently affected sites in the remainder and the lips were affected in 13% of patients. Lesions generally lasted for 1-3 weeks. In over 60% of cases these attacks followed an episode of herpes simplex virus infection during the preceding fortnight. Recurrent attacks showed a different site distribution from the initial attacks, with a greater proportion having genital as well as skin and oral mucosal involvement. Detailed case histories of five patients are presented to illustrate the role of azathioprine in treating oral lesions and to document a familial case of recurrent erythema multiforme, with severe mucosal involvement.
TL;DR: In conclusion, active bone resorption may contribute significantly to the growth of these lesions within the jaws.
Abstract: In an attempt to verify the nature of bone resorption processes on the bone surrounding radicular cysts, fragments of cysts with the adjacent bone tissue were studied by morphological, cytochemical and ultrastructural methods. Cyst fluid was analysed for its content of cytokines with osteolytic activity. The cyst wall exhibited several connective tissue extensions which penetrated the adjacent bone. Numerous multinucleated tartrate-resistant acid phosphatase (TRAP)-positive cells were seen at the tip of the intraosseous extensions of the cyst capsule and in direct contact with the bone tissue. Typical resorption lacunae were identified on the bone surface by scanning electron microscopy. Moreover, mononuclear TRAP-positive cells were seen within the cyst capsule. High levels of prostaglan-din E2 (PGE2) and interleukin-6 (IL-6) were detected in the cyst fluids. In conclusion, active bone resorption may contribute significantly to the growth of these lesions within the jaws.
TL;DR: A light and electron microscopic investigation of pseudomembranous candidiasis in HIV infection was undertaken as there is little data available on the ultrastructural features of the invasive phase of Candida in this disease as mentioned in this paper.
Abstract: A light and electron microscopic investigation of pseudomembranous candidiasis in HIV infection was undertaken as there is little data available on the ultrastructural features of the invasive phase of Candida in this disease. On examination of biopsy specimens of four patients, histopathology revealed the classic features of superficial candidiasis, including hyphal penetration down to the spinous cell layer, parakeratosis, acanthosis and spongiosis of the infected, superficial epithelium. However, in one case, hyphae traversed the entire epithelium and crossed the basal membrane, invading the adjacent connective tissue. Ultrastructural investigations revealed initial hyphal penetration through the intercellular spaces, possibly demonstrating thigmotropism. However, hyphal penetration was not solely confined to intercellular spaces, as some specimens demonstrated hyphal elements traversing both the cytoplasm and the nuclei of the spinous cells. In these areas of the epithelium appressoria-like appendages were often found at the hyphal tip. These phenomena, commonly described in plant fungi, have rarely been described in human material. Pools of desmosomes were seen in the vicinity of the hyphal pathways, implying that the penetration procedure is associated with detachment and congregation of desmosomes, possibly by enzymatic means. Interestingly, the host immune response to fungal invasion appeared to be minimal, as no immune-effector cells were seen closely associated with either the blastospores or the hyphae in any of the tissues examined. Whether the foregoing events are exaggerated by the abortive immune response seen in HIV-infected patients, or common in immunocompetent individuals during candidal invasion of epithelia, needs to be ascertained by further studies.
TL;DR: The results indicate that ras p21 overexpression may play an important role in the initiation and progression of oral SCCs in patients who are smokers and BQ chewers.
Abstract: Expression of ras p21 oncoproteins was examined in histological sections of oral squamous cell carcinoma (SCC), epithelial dysplasia, epithelial hyperkeratosis and normal oral mucosa using antibodies to ras p21 with an immunoperoxidase technique. Ras p21-positive staining was found in 47 of 51 (92.2%) cases of oral SCC, 4 of 4 (100%) cases of epithelial dysplasia, 7 of 7 (100%) cases of epithelial hyperkeratosis, and 1 of 6 (16.7%) cases of normal oral mucosa. The positive staining rate of ras p21 in oral SCC, epithelial dysplasia or epithelial hyperkeratosis was significantly higher than that in normal oral mucosa (P < 0.05). No correlation was found between ras p21 expression and patient age, tumour location, tumour size, clinical staging or histological differentiation of SCC. However, a significant positive correlation was found between ras p21 expression and patients' sex (P < 0.05) or regional lymph node status (P < 0.05). A significant positive correlation was also discovered between ras p21 expression and patients' smoking habits (P < 0.01), as well as daily or total betel quid (BQ) consumption (P < 0.05). Of the 47 immunostain-positive SCC patients, specimens from 6 patients were also obtained after chemotherapy, when ras p21 expression was found to be reduced. These results indicate that ras p21 overexpression may play an important role in the initiation and progression of oral SCCs in patients who are smokers and BQ chewers.