Oral Lichen Planus - Related Connection with HLA-System Antigens.

AIM: To determine whether there is an immunogenic connection and antigen difference between the HLA antigens in the erosive (EOLP) and reticular (ROLP) oral lichen planus. MATERIALS AND METHOD: 73 patients with ROLP and EOLP have been tested. Typing of the HLA antigens has been made for locus A and B. The typing of the HLA was conducted with the use of microlymphocyto toxic test by Terasaki. The reading of the findings has been conducted with an inverse microscope. When a reaction has 4 points it is considered to be positive. RESULTS: The most frequently typified antigens in ROLP from locus A are HLA А2 (57.57%) and А3 (33.33)%, and for locus B 21.21%. In EOLP it is А9 (8888%). In locus B a connection has been found with HLA B8 (77.77%). The statistical analysis with the ×2 test has shown that the carriers of HLA A9 display a relative risk (RR) of 3.65 and ×2=20.72. Consequently, there is high static importance for locus A p<0,001. For locus B, In EOLP for HLA B8, RR=6. 7 ×2=37.64 and p<0,001. ROLP has shown association with HLA A3, where RR=2. 31 and ×2 =9.14 and p<0.05. CONCLUSIONS: In ROLP A3 antigen and in EOLP A9 and A8 may be considered as carriers with proneness to OLP.

Exploring the Gingival Recession Surgical Treatment Modalities: A Literature Review.

Gingival recessions present complex soft tissue pathology, with a multiple aetiology and a high prevalence which increases with age. They are defined as an exposure of the root surface of the teeth as a result of the apical migration of the gingival margin beyond the cementum-enamel junction, causing functional and aesthetic disturbances to the affected individuals. Aiming to ensure complete root coverage and satisfying aesthetic outcomes, a wide range of surgical techniques have been proposed through the decades for the treatment of the gingival recessions. The following literature review attempts to provide a comprehensive, structured and up-to-date summary of the relevant literature regarding these surgical techniques, aiming to emphasise for each technique its indications, its long-term success and predictability, its advantages and disadvantages about each other.

Human Papillomavirus as a Potential Risk Factor for Oral Premalignant Lesions.

Oral premalignant lesions (OPLs) and numerous alterations of oral mucosa remain unsolved due to their complex etiopathogenesis. Human papillomaviruses (HPVs), in particular, have been reported as the possible risk factors or cofactors. The aim of the study was to determine the association of different HPV types with oral premalignant lesions, and the potential role of smoking and alcohol use. Eighty patients (mean age ± SD, 52.45±5.56) of both genders, 19 (23.75%) male and 61 (76.25%) female, were enrolled in the study. Study group included 40 patients diagnosed with OPLs (leukoplakia, erythroplakia, actinic keratosis and lichen planus), while control group included another 40 patients with healthy oral mucosa. Genotyping of the HPV types was performed by qualitative real-time HPV typing polymerase chain reaction test. HPV DNA was detected in 30% (12/40) of study group patients and 2.5% (1/40) of control group patients. The results revealed the presence of HPV16 in 15% (6/40), HPV56 in 10% (4/40), and HPV18 in 5% (2/40) of study group cases, and HPV31 in 1 (2.5%) control group patient. Th e association of oral HPV positivity and smoking/alcohol use in the study group was not statistically significant (p<0.05). In conclusion, high-risk HPV types are associated with oral premalignant disorders. However, it remains unknown whether HPV acts as an innocent bystander or it has a role in initiating development of premalignant lesions. Smoking and alcohol use were not associated with the existing oral HPV infection.

Clinical Therapeutic Effects of the Application of Doxycycline in the Treatment of Periodontal Disease.

OBJECTIVE: To compare the therapeutic effects of the application of doxycycline-full dose (100 mg) and sub-dose (20 mg) in the treatment of periodontal disease. MATERIAL AND METHODS: A total of 60 patients with periodontal disease were examined. Patients are divided into two groups: A) treated with antimicrobial dose of 100 mg doxycycline once daily for 30 days, and B) treated with 2 x 20 mg/day. doxycycline, during 75 days. Among all patients a conservative treatment was carried out and ordinated the proper dose doxycycline in total dose during treatment from 3 gr. Index of dental plaque by Löe-Sillness, index of gingival inflammation and gingival bleeding by Cowell were followed. RESULTS: Values of dental plaque in relation first examination, 10th, 20th day, 1 month and 2.5 months, showed that after 2.5 months, average value (x = 0.83) of dental plaque in second group is slightly less than the value (x = 0.93) of dental plaque in the first group. The average value (x = 0.17) of gingival inflammation in second group is significantly less than the value (x = 0.50) of gingival inflammation in the first group. The average value (x = 0.97) of gingival bleeding in patients from the first group was significantly higher than value(x = 0.37) of gingival bleeding in the second group. CONCLUSION: Patients whose therapy was helped by a sub-dose doxycycline demonstrated positive therapeutic effects on gingival inflammation and bleeding.

Role of humoral mechanisms in etiology of lichen planus.

AIM: To examine the role of IgA, CIC and component C3 as indicators of humoral immune response in the etiopathogenesis of oral erosive lichen planus (OELP). MATERIAL AND METHOD: The study comprised 19 patients with OELP whose samples of blood, saliva and tissue were obtained after carefully taken medical history and clinical examination. Samples of oral mucosa were taken from the site of lesion, i.e. exclusively from buccal mucosa (1 cm in width and length), and from the deep epithelium as well as a segment from the lamina propria. Determination of immunoglobulins in serum and saliva, and determination of component C3, was done using the micro-elisa technique by Rook&Cameron, Engvall and Ulman. Determination of CIC in serum and mixed saliva was done with the PEG (polyethylene glycol) method. Determination of immunoglobulin A and component C3 in biopsy material was done with direct immunofluorescence. RESULTS: Levels of immunoglobulin A in serum in OELP during exacerbation were decreased (1.04±0.49 gr/l) and during remission increased (5.92±0.62) in comparison with the control group (p<0.001). Levels of CIC during exacerbation and remission were increased (p<0.001), and component C3 levels were increased in both examined phases in the examined group compared with the control group (p<0.05). Deposits of IgA were registered in one (5.88%) patient with OELP and component C3 was registered in 3 (17.64%) patients. CONCLUSION: Changes in IgA values, as well as CIC and component C3, may correlate with changes in oral mucosa emphasizing the role of humoral immune response in the pathogenesis of oral lichen planus.

Therapeutic effect of proaftol in treatment of recurrent aphthous stomatitis.

UNLABELLED: Recurrent aphthous stomatitis (RAS) is a quite frequent, painful, ulcerative disease that affects the lining of the oral cavity and has an unknown etiology. The aim of this article is to examine the impact of the medication proaftol on epithelization speed and severity of pain in patients with RAS. In this randomized, double-blind, placebo-controlled study respondents were divided into two groups where one group was treated with proaftol spray and the other with a placebo. Aphthae considered for treatment had a diameter of 5-6 mm. The participants were given instruction on the use of the spray, two sprayings on the place of the aphtae 3-4 times a day. We examined two parameters in the symptomatology of RAS-lesion size (mm) and pain intensity (noted on four subjective levels: 0-no pain, 1-discomfort, 2-moderate pain, 3-severe pain). These parameters were noted on the baseline, the third, the fifth and the eighth days of examination. RESULTS: A significant faster reduction of the dimension of aphthous ulcers in patients treated with proaftol 3rd day p<0.001, 5th day p<0.0006, 8th day full epithelization in the control group. The magnitude of pain in the experimental compared with the control group on 3rd, 5th and 8th day was also significantly reduced: p<0.0001, p<0.007, p<0.007 respectively. CONCLUSION: The use of proaftol positively influences the rate of epithelization and reduction of subjective feeling of pain in patients with RAS. The action of propolis should be the goal of studies with a larger number of subjects.

T-cell subpopulations in lesions of oral lichen planus.

AIM OF THE STUDY: To determine the distribution and frequency of T(CD3) cells and cell sub-populations in tissue specimens of erosive lichen planus (EOLP). MATERIAL AND METHOD: Tissue specimens from buccal mucosa were taken from 14 healthy individuals--control group (CG)--and 17 subjects with EF-OLP. Applying monoclonal antibodies, T(CD3) cells, T cell subpopulations, The CD4, CD8 and CD4/CD8 ratios in both groups were determined. Cells in the epithelium and lamina propria were quantitatively and qualitatively determined in both groups. Data were analysed using the Student's t-test. RESULTS: There were 5.95 2.12% T(CD3) cells in the control group as against 9.80 4.04% in the examined group (p<0.001). The distribution of T(CD3) cells in the lamina propria was 25.35 12.04% in the examined group compared to the control group (p<0.001). There were 3.45 2.05% CD4 epithelial cells in the control group and 4.00 1.95% in the examined group (p<0.4). There were 2.50 1.8% CD8 cells in the control group and 5.80 3.72% in the examined group (p<0.001). The CD4/CD8 ratio was 0.51 0.12% in the examined group and it was evidently reduced in comparison with the control group. An increased distribution of CD4 cells (10.30 7.60%) and CD8 cells (15.05 5.20%) in the lamina propria compared with the epithelium was observed in the examined group (p<0.001). The CD4/CD8 ratio in the epithelium was 0.51 0.12% as against the ratio of the lamina propria, which was slightly increased (0.68 0.48%) with a low statistically significant difference (p<0.05). CONCLUSION: Differences in the distribution of T-lymphocyte subsets between the control and examined groups were found (p<0.001). An increased distribution and frequency of CD4 and CD8 cells in the lamina propria was observed. These were predominantly located in the sub-basal region of the stratum papillare and rarely seen in the intra-epithelial region.

Oral findings in end-stage renal disease.

The aim of the study was to analyse and compare the most frequent clinical oral symptoms, signs and lesions at end-stage renal disease (ESRD), before kidney transplantation (BKT) and after kidney transplantation (AKT). A total of 35 subjects with ESRD were included, 19 in group A (BKT) and 16 in group B (AKT). Oral lesions were classified according to referent clinical diagnostic criteria: Serum albumins, urea, creatinine and salivary urea, creatinine uremic acid were determined by standard biochemical spectrophotometric methods (Human, Germany). For serum albumin concentration measurement (g/L) the method of bromcresol green assay was used while serum and salivary uric acid determination (µmol/L) was performed according the uricase/PAP method. Serum creatinine concentration was measured (µmol/L) with the Jaffe kinetics method, without deproteinization. Oral signs, symptoms and lesions were higher in group A: metallic taste (O.R. = 6.61/ ± 95% CI : 1.13 < O.R. < 38.69), dry mouth (O.R. = 30/ ± 95% CI : 3.15 < O.R. < 285.71), uremic stomatitis (O.R. = 6.5/ ± 95% CI : 1.47 < O.R. < 28.80 and coated tongue (O.R. = 11.73/ ± 95% CI : 2.31 < O.R. < 59.54). On the other hand, in group B, gingival enlargement (O.R. = 59.5/ ± 95% CI : 7.41 < O.R. < 478.05) was more common. High statistically significant differences were recorded between group A and B for dry mouth and gingival enlargement (p > 0.001). Blood urea, creatinine and albumin levels, as well as salivary urea creatinine and uraemic acid values, were significantly higher in group A. Chances of the appearance of all symptoms, clinical signs and lesions, except gingival enlargement, were greater in group A as against group B. Some of our findings correspond with the stage of the disease and some with the use of medicaments in treatment.

IL10 -1082, IL10 -819 and IL10 -592 polymorphisms are associated with chronic periodontitis in a Macedonian population.

Genetic polymorphisms in the interleukin 10 (IL10) gene have been reported to influence the host response to microbial challenge by altering levels of cytokine expression. We analyzed nucleotide polymorphisms in the promoter region of the IL10 gene and its relation with periodontal disease in a Macedonian population. The study population consisted of 111 unrelated subjects with chronic periodontitis and 299 healthy controls. DNA was isolated and IL10 genotyping performed by PCR-SSP (Heidelberg kit) for the alleles and genotypes of IL10 -1082, IL10 -819 and IL10 -592. Frequencies of IL10 haplotypes and the haplotype zygotes were also examined. Comparisons between groups were tested using the Pearson's p-value. After Bonferroni adjustment, significant associations were detected between subjects with chronic periodontitis and IL10 genotypes (IL10 -1082/A:G was negative or protective and IL10 -1082/G:G was positive or susceptible). Cytokine polymorphism on the IL10 gene appears to be associated with susceptibility to chronic periodontitis in Macedonians.

IL4 gene polymorphisms and their relation to periodontal disease in a Macedonian population.

Genetic polymorphisms in the interleukin-4 (IL4) gene have been reported to influence the host response to microbial challenge by altering levels of cytokine expression. We analyzed nucleotide polymorphisms in the promoter region of the IL4 gene and its relation with periodontal disease in a Macedonian population. The study population consisted of 92 unrelated subjects with chronic periodontitis and 286 healthy controls. DNA was isolated and IL4 genotyping performed by polymerase chain reaction-single-strand polymorphism (Heidelberg kit) for the alleles and genotypes of IL4 -1098, IL4 -590, and IL4 -33. Frequencies of IL4 haplotypes and the haplotype zygotes were also examined. Comparisons between groups were tested using the Pearson's p value. After Bonferroni adjustment, significant associations were detected between subjects with periodontitis and the following: (1) cytokine alleles IL4 -1098 and IL4 -33; (2) cytokine genotypes IL4 -1098/G:T; IL4 -1098/T:T, and IL4 -33/T:T, (3) cytokine haplotypes IL4/GCC, IL4/TCC, and IL4/TTC; and (4) cytokine haplotype zygotes IL4/TTC: TCC, IL4/TCT:TTT, and IL4/GCC:TTC. Cytokine polymorphism on the IL4 gene appears to be associated with susceptibility to chronic periodontitis in Macedonians.