Malignant salivary gland tumours in Sweden 1960-1989--an epidemiological study.

Epidemiological data from the Swedish Cancer Registry of new cases of malignant major and accessory salivary gland tumors in Sweden between 1960 and 1989 are presented, including the total number and the age-standardised incidence rate per 1 million population, by site and sex, I(s). An analysis of the various histopathological types of malignant salivary gland tumours in the different sublocations is also given. A comparison is made between the three 10-year periods 1960-1969, 1970-1979 and 1980-1989 regarding total number and I(s). The total number of new malignant major salivary gland tumors was 2557, representing approximately 85 new cases per year and 0.3% of all new diagnosed cancers in Sweden. In addition, approximately 25 new cases per year of malignant accessory salivary gland tumors were reported. If all malignant salivary gland tumours were considered, the most common location was found in the parotid glands with a relative frequency of 57.5%, and the next most common site was malignant accessory salivary gland tumours with 22.6%. I(s) was 10.2 for the major and 3.0 for the accessory salivary glands. No major difference between the examined 10-year periods was found concerning the relative frequency, and no statistically significant difference in I(s) was found between the examined 10-year periods, except for a statistically significant decrease in the I(s) between the time periods 1960-1969 and 1980-1989 for the multiple or unspecified malignant salivary glands from 0.5 to 1.4. A difference in the distribution of various histopathological types of malignant salivary gland tumours was observed between the different time periods. This was particularly valid for the diagnoses adenoid cystic carcinomas and mucoepidermoid carcinomas which increased in number and the diagnosis malignant salivary gland tumours of mixed type, which decreased in number during the examined time periods.

Association between expression of stratum corneum chymotryptic enzyme and pathological keratinization in human oral mucosa.

Stratum corneum chymotryptic enzyme (SCCE) may function in the degradation of intercellular cohesive structures in the stratum corneum preceding desquamation. Previous results have suggested that SCCE may be specifically expressed in squamous epithelia undergoing terminal differentiation and keratinization. The aim of the present work was to further elucidate the association between SCCE expression and terminal differentiation in squamous epithelia. Using immunohistochemical methods, we have examined the expression of SCCE in two diseases of human oral mucosa, which produce a pathological keratinization of the epithelium at sites which are normally non-keratinized. Affinity-purified polyclonal rabbit antibodies raised against recombinant SCCE and monoclonal antibodies against the differentiation-specific keratins nos. 10 and 13 were used on formaldehyde-fixed and paraffin-embedded biopsies. Whereas there was essentially no expression of SCCE in normal, non-keratinized buccal mucosa, there was a strong expression in suprabasal cells in orthokeratotic and parakeratotic areas of the lesions of oral lichen planus (an inflammatory disease) and benign oral keratosis (a non-inflammatory disease). There was a close association between the expression of SCCE and keratin no. 10, i.e. a keratin which is specifically expressed in cornifying squamous epithelia. The results suggest that SCCE expression may be a true marker of terminal differentiation in squamous epithelia and give further evidence for a role of SCCE in the formation and/or turnover of the stratum corneum.

Life-style survey of patients with oral lichenoid reactions.

The occurrence of different life-style patterns, including marital status, educational level, nutrition, tobacco and alcohol use, and frequency of physical activity, in patients with oral lichenoid reactions (OLR) in total or partial contact with amalgam fillings was examined. When compared with an age- and sex-matched control group, the daily intake of carbohydrates, fibers, and iron was statistically significantly higher in the OLR patients. Regarding marital status, there was a statistically significant difference between the OLR patients and the control subjects, the former group containing more people who were divorced or whose spouse had died. The frequency of physical activity was also statistically significantly higher in the OLR patients than in the control group. Hypothetical mechanisms that may lie behind the results obtained are discussed.

Odontogenic keratocysts--a retrospective clinical and histologic study.

Including 25 recurrences, the material comprised 87 odontogenic keratocysts (OKCs) from 57 patients, who had been treated in 1974-93. The study included an analysis of clinical and histologic data from the patients' records and from pathologic reports. The men:women ratio was 1.5:1. Most of the patients belonged to the age groups 10-19, 20-29, 40-49, and 60-69 years. Almost 75% of the OKCs were localized in the mandible. The most common site was the angle and ascending ramus area. Recurrences comprised 30.5% of the OKCs. The symphysial area of the mandible had the highest recurrence rate (50%). The diagnosis of Gorlin's syndrome was established in two patients. The recurrence rates for the OKCs that were removed in one or in several pieces were 27.5% and 39%, respectively. In 14/87 (16%) cases, microkeratocysts were histologically found. Parakeratosis was observed in 78/87 (89.5%), ortho- and parakeratosis in 6/87 (7%), and orthokeratosis in 3/87 (3.5%) cases. The recurrence rates were 31.5% and 41% for the OKCs that were removed during 1974, 1984, and 1985-90, respectively. In no case could malignant changes be observed at histologic examination.

Amalgam-associated oral lichenoid reactions. Clinical and histologic changes after removal of amalgam fillings.

OBJECTIVE AND STUDY DESIGN: Forty-nine consecutive patients with clinically diagnosed oral lichenoid reactions in contact with amalgam fillings were studied clinically and histologically. The long-term effect of replacement of these fillings was also examined. RESULTS: Seventeen (35%) patients showed positive reactions to mercury at the epicutaneous patch test that was carried out before treatment. After treatment, total regression of the lesions was found clinically in 33 (69%) and histologically in 26 (55%) patients. Most of the remaining lesions changed clinically and histologically to a less pronounced tissue reaction. Lesions in direct contact with amalgam fillings (group I) showed significantly better healing results than lesions that exceeded the contact area (group II). No difference in healing capacity was noted in the two groups between patients with positive patch reactions to mercury compared with those with negative reactions. Lesions that histologically were classified as benign oral keratosis showed a similar healing pattern as those classified as oral lichen planus. CONCLUSION: In group I all lesions changed histologically and clinically to a normal mucosa or to a less affected tissue reaction. In group II this change was less pronounced, which suggests that the fillings themselves were not the only factor involved in the cause of these lesions. The results suggest that various etiologic factors are involved in lichenoid reactions and that the effect of removal of amalgam fillings cannot be predicted by epicutaneous patch testing and biopsies.

Psychologic aspects of patients with oral lichenoid reactions.

Psychologic aspects of 49 patients with oral lichenoid reactions (OLR) in contact with amalgam fillings were studied and compared with an age- and sex-matched control group. Psychologic factors such as personality, psychologic functioning, and quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). With regard to personality the OLR patients had significantly higher scores on the muscular tension and suspicion scales and significantly lower scores on the indirect aggression scale. In addition, the OLR patients were significantly more worried about their health and more helpful. With regard to psychologic functioning the OLR patients had significantly more sad thoughts, became dizzy more easily, found it harder to imagine themselves free from anxiety, and had more difficulty in concentrating. The results indicated that OLR patients had a tendency to be depressive. The need for a systemic investigation including odontologic, medical, and psychologic aspects was expressed.

X-ray microanalytical and morphological observations of the interface region between ceramic implant and bone.

In 8 monkeys both the maxillary lateral incisors were extracted. In the 16 extraction sites an Al2O3-ceramic dental implant (Frialit) was immediately inserted. Eight implants were submerged under the oral mucosa and the other 8 were allowed to penetrate through the mucosa during the observation period. None of the implants was loaded during the observation periods. After experimental periods of 1, 2, 4 and 8 months, the interface region between the implant and bone was examined using scanning-electron microscopy, X-ray microanalysis, back scatter, microradiography and light microscopy. The results showed that osseointegration of Al2O3-ceramic dental implant was obtained. The newly formed bone around the implant filled exactly the contours of the implant. Newly formed bone had a mineral content and a phosphorus-to-calcium ratio similar to that of the adjacent older mature jaw bone. There were no differences in the osseointegration rate between the submerged and the nonsubmerged implants. No leakage of aluminium from the implant could be detected in the bone.

Cognitive therapy in the treatment of patients with resistant burning mouth syndrome: a controlled study.

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.

Malignant oral tumours in Sweden 1960-1989--an epidemiological study.

Epidemiological data from the Swedish Cancer Registry of new cases of malignant oral tumours in Sweden 1960-1989 are presented, including the total number and the age-standardised incidence rate per 1 million population, by site and sex, (I(s)). An analysis of the various histopathological types of malignant oral tumours in the different sublocations is also given. A comparison is made between the three 10-year periods 1960-1969, 1970-1979 and 1980-1989 regarding total number and I(s). The total number of cases, 17,158, represented 1.8% of all newly diagnosed cancers in Sweden. The following relative frequencies were noted for the respective sites: intra-oral region 0.7%, lip 0.6% and pharynx 0.5%. The results indicated an increase in total number and a statistically significant increase of I(s) for malignant lip tumours in females over the whole period. A corresponding increase in total number during the periods 1960-1969 and 1980-1989 and a decrease in I(s) during the periods 1970-1979 and 1980-1989 in lip tumours for males was observed. For males there was an increase in total number and a statistically significant increase in I(s) for malignant tongue tumours, while the corresponding figures for females remained constant. For malignant floor of the mouth tumours there was an increase in total number and a statistically significant increase in I(s) for both men and women. In the intra-oral region, including the sublocations oral cavity-other sites, tongue and floor of the mouth, the male:female ratio was 1.8:1 and I(s) changed from 22.8 (1960-1969) to 29.6 (1980-1989).(ABSTRACT TRUNCATED AT 250 WORDS)

Personality characteristics of patients with resistant burning mouth syndrome.

The personality characteristics in 32 patients with resistant burning mouth syndrome (BMS) after treatment of diagnosed medical and odontologic diseases were examined and compared with a sex- and age-matched control group. After evaluation of burning mouth symptoms, the personality, the psychologic functioning, and the quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). The result showed that, compared with a control group, the patients with resistant BMS had a significantly lower score in socialization scale and significantly higher scores in somatic anxiety, muscular tension, and psychasthenia scales. Furthermore, the patients with resistant BMS were significantly more easily fatigued and more sensitive and showed a tendency to be more concerned about their health. With regard to the psychologic functioning, the BMS patients had significantly more problems taking the initiative, more easily became dizzy, and had more sad thoughts. They also showed a tendency to report palpitations and/or indigestions more often. The observed significant differences in personality and psychologic functioning might suggest that the burning sensations are psychosomatic symptoms in these patients. We recommend that patients with resistant BMS should undergo psychologic investigation. If psychologic and/or psychosocial disturbances are diagnosed, adequate treatment should be offered.

Worldwide survey on distance learning in dental education.

This paper reports the results of a worldwide survey on distance learning initiated by the FDI. The results indicate that dental associations in many countries are in the process of investigating the various options available, and in development, for bringing continuing education to their members with the maximum convenience and effectiveness. Details are given of advantages, disadvantages and relative costs of the different methods undertaken. Recommendations are made for future development and progress.

Exposure parameters and their effects on diagnostic accuracy.

A new method for analyzing diagnostic accuracy is introduced. A diagnostic accuracy curve may be obtained by plotting receiver operating characteristic analysis data, P(A), as a function of exposure. By means of diagnostic accuracy curves the effects on diagnostic accuracy of tube potential, exposure, and size of carious lesions was studied. It was found that the effect of the tube potential on the accuracy of caries diagnosis is negligible. About 25% of the variation in diagnostic accuracy depends on the exposure and about 80% on lesion depth. With the lesion depth constant, about 75% of the variance in diagnostic accuracy depended on observer performance. The peak of a diagnostic accuracy curve indicates optimum performance. This is found at an exposure that gives a radiographic density of about 1 in enamel and dentin although the tolerable exposure increases with increased lesion depth.

Clinical study of patients with burning mouth.

Analysis and treatment of dental and medical factors that can cause burning mouth were performed in 25 consecutive patients according to a treatment protocol. The effect of the dental and medical treatment on the burning mouth was evaluated. The sick leave profile was presented. Apart from burning mouth symptoms, the patients reported several oral and general symptoms, such as gustatory changes, xerostomia, back and joint muscle pain, headache, and dizziness. The most common dental diagnoses were temporomandibular joint, masticatory, and tongue muscle dysfunction and lesions in the oral mucosa. The most common medical diagnoses were low serum iron and hypersensitive reaction to mercury. None of the patients tested exceeded the limit of 100 nmol Hg/l urine. Replacement of amalgam fillings was the most common dental therapy, followed by treatment of dysfunction in the masticatory system. Iron replacement was the most frequent medical treatment. The patients had over 50% more days per year sick leave than an age- and sex-matched normal population. A follow-up found that the burning mouth had disappeared in 32% of the patients. This study confirms the opinion that burning mouth is multicausal. Hypersensitive reaction to mercury was more frequent than expected, but replacement of amalgam fillings relieved burning mouth in only two of five such patients, and one of these two patients had hypersensitive reactions to both mercury and gold. One reason that so many patients continued to have burning mouth might have been neglect of dental, medical, or both diagnoses. Another reason might be that assessment of the psychologic status of the patients and psychologic treatment when indicated were not done.

Media aids in dental distance learning.

The need for continuing education on a wide scale necessitates the use of techniques that are effective irrespective of the geographical spread or isolated locations of potential participants. This paper reviews the many possibilities for distance learning in dentistry made feasible by use of these different techniques and media.

Oral lichen planus lesions in contact with amalgam fillings: a clinical, histologic, and immunohistochemical study.

Fifty-one consecutive patients had clinically diagnosed oral lichen planus (OLP) lesions in total or partial contact with amalgam fillings. The clinical features of the OLP lesions were characterized and registered, and biopsies were obtained from each OLP lesion. Histologic and immunohistochemical studies were performed, as well as tests for allergy to dental materials. The clinical diagnosis of OLP corresponded to the World Health Organization (WHO) morphologic OLP criteria in 31 (61%) cases. The remaining lesions were histologically diagnosed as mild OLP in 11 (22%) or as benign oral keratosis in nine (17%) cases. The immunohistochemical examination showed a positive reaction to fibrinogen in the basement membrane zone (BMZ) in 10 (20%) patients and to complement C3 in one (2%) patient. No positive reactions in the BMZ were found for IgA, IgG, and IgM. In 17 (33%) patients, an allergic reaction to mercury was found, and candidiasis was diagnosed in 13 (25%) patients. The true nature of OLP-like lesions in contact with amalgam fillings still remains to be explained. For that matter, we do not know whether OLP is one disease or a number of similar immunologic or other responses to various interacting stimuli. One such stimulus might be mercury from corroding amalgam fillings.

Description of persons with symptoms presumed to be caused by electricity or visual display units--oral aspects.

A questionnaire containing 20 questions was sent to 127 members of the Association for Those Injured by Electricity and Visual Display Units in northern Sweden, of whom 103 (81%) answered. The questionnaire consisted of questions about age, sex, and place of work. Furthermore, the members were asked to state: 1) their general and oral symptoms; 2) whether they thought that dental amalgam and other types of dental filling materials had affected their symptoms; 3) whether they were replacing or had replaced their amalgam fillings and, if so, what effect it had had on their symptoms; 4) whether they had been medically examined; and 5) whether they were or had been sick-listed for their complaints. Of those who answered the questionnaire, 79% were women (mean age 45 yr) and 21% men (mean age 42 yr). Sixty percent worked in offices. In 82%, the symptoms had started at work. The mean duration of the symptoms was 5.2 yr. The symptoms were aggravated mostly in "electric environment in general" and in "office with computers". Skin complaints, fatigue, and eye symptoms were the most common general symptoms. Sixty-five percent mentioned that they had oral symptoms. Gustatory disturbances, burning mouth, and temporomandibular joint (TMJ) dysfunction were the most common oral symptoms. Fifty-six percent considered that dental amalgam and 24% that other dental materials affected the symptoms. Twenty-one percent were in the process of replacing the amalgam fillings; 40% had already done so. After replacement, 37% had noticed a decrease of symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of low level energy laser irradiation on wound healing. An experimental study in rats.

In this randomized experimental study the wound healing process in rats was investigated after treatment with low level energy laser. In the caudal area of the back of 38 rats, standardized full thickness wounds were punched out bilaterally. The animals were randomly divided into two groups, A and B with 19 rats in each group. Group A was laser irradiated on one side wound (A1), leaving the contralateral side as a control of possible systemic effects (A2). Group B was given placebo irradiation (ordinary light) on one side (B1) and the contralateral side was left without treatment (B2). Two animals from each group were sacrificed continuously every second day from day 3. Neither the clinical nor the microscopical examination of the wound healing process revealed any differences between group A1, A2, B1 and B2, during the observation period. This study did not confirm that low level energy laser treatment would affect the wound healing process.

Cell kinetics of head and neck squamous cell carcinomas. Prognostic implications.

Forty-three squamous cell carcinomas of the head and neck region were in vivo labelled with the thymidine analogue iododeoxyuridine. Combined flow cytometric (FCM) and immunohistochemical (IHC) analysis was performed, and the following parameters calculated: labelling index (LI), S-phase time (TS) and potential tumor doubling time (Tpot). Complete FCM and IHC analyses could successfully be performed in 31 cases, showing a median LI of 13.6% with FCM and 9.1% with IHC. A correlation achieved between LI/FCM and LI/IHC was due to the aneuploid cases, whereas the diploid cases showed no such correlation. Data indicated that Tpot calculated with LI from IHC (Tpot/IHC) might be a prognostic factor, in contrast to Tpot determined using LI/FCM.

Burning mouth syndrome: literature review and model for research and management.

The literature on burning mouth syndrome (BMS) is reviewed with particular reference to its prevalence, local and systemic etiologic factors, psychogenic background and treatment. Research requirements are discussed, which focus on different clinical and psychological parameters and the necessity to evaluate BMS. Finally, a treatment protocol including oral, medical and psychological investigations is presented.

Human pulpal response to direct filling gold restorations.

Class V cavities were prepared in 47 caries-free premolars intended to be extracted for orthodontic reasons. A powdered gold filling material, Goldent, which can be hand condensed, was used for direct fillings. The following test groups were used: (A) cavity preparation, no filling, (B) cavity filled with Goldent only, (C) cavity lined with Tubulitec and filled with Goldent, (D) cavity with Goldent filling, sealed with IRM, and (E) positive and negative controls. The teeth were extracted after 1-200 days and the pulpal response was histologically examined. The results revealed that only in Group B, i.e. when the cavity was filled with Goldent, was the risk of a pulpal reaction obvious, although the material per se (Group D) did not influence the pulpal tissue to any serious degree. Probably the Goldent material cannot provide a marginal seal tight enough to prevent microleakage, allowing microorganisms to give rise to pulp damage and inflammation. In those cases where the cavity had been isolated with Tubulitec liner before the gold restoration was made, the pulp was effectively protected from damage caused by microorganisms.