Clear cell carcinoma of the palate.

A case of minor salivary gland clear cell adenocarcinoma of the palate with metastasis to the lungs in a 53-year-old female is presented. Histologically, the cells were characterized by glycogen rich clear cells arranged in solid nests, trabeculae, surrounded by hyalinized fibrous stroma. We believe this represents an aggressive form of this type of tumor.

Oral management of the patient with cancer in the head and neck region.

Cancer therapies--including surgery, radiation, and chemotherapy--may unfavorably affect the oral/dental health of patients. Existing dental problems can also result in serious complications that may be prevented by dental intervention prior to cancer therapy. This paper will be limited to a discussion of the detrimental effects of radiation therapy on the oral cavity and salivary glands and appropriate dental management.

Effectiveness of an oral and pharyngeal cancer awareness program for health professionals.

BACKGROUND: Of approximately 31,000 patients diagnosed as having oral/pharyngeal cancers (OPCs) each year in the United States, about half will die of the disease within five years, for reasons associated with patient behaviors as well as delays in diagnosis by health care professionals. METHODS: To address an apparent lack of OPC knowledge of health care professionals, a brief, non-discipline-specific, multi-component educational intervention was designed and presented to 352 health care professionals in community health centers and hospital training programs. OPC knowledge was assessed before and three months after the intervention. RESULTS: A 44% post-intervention response rate was obtained. There were significant (p < or = 0.05) increases in knowledge regarding oral sites at risk for OPC, etiologic factors, and early signs and symptoms. There were significant interactions (p < or = 0.01) between increases in knowledge and various health provider groups. A significant increase in perceived competency in OPC knowledge (p < or = 0.001) was reported, and significantly fewer participants felt the need for additional training. CONCLUSION: A brief, multi-component educational intervention can increase health care professionals' knowledge regarding OPC.

Odontogenic myxoma.

The odontogenic myxoma is an uncommon tumor that has the potential for extensive bony destruction, extension into surrounding structures, and a relatively high recurrence rate. Treatment often requires bone resection. The bland histologic features of a monotonous proliferation of a loose, mesenchymal fibrous tissue that lacks atypia may easily lead to a misdiagnosis. The primitive dental pulp, the dental papilla, and the tooth follicle are histologically similar to myxoma. These soft tissue fragments often separate from extracted developing teeth that are submitted to the pathologist and may easily be misinterpreted as an odontogenic myxoma. The pathologist must have good clinical and radiographic correlation to avoid a misdiagnosis and to prevent unnecessary additional surgery.

Subjective and clinical evaluation of oral lubricants in xerostomic patients.

The purpose of this investigation was to evaluate and compare four oral lubricants in relation to oral mucosal status, perceived relief of dry mouth symptoms, and patient acceptance. Three commercial oral lubricants--two sprays and one gel--and a home remedy of margarine were evaluated. Twenty-five xerostomic/salivary gland dysfunctional patients demonstrating < 0.20 mL/min of unstimulated whole saliva participated in the randomized, four-phase, cross-over study. Each phase included a ten-day use of oral lubricants, followed by a four-day washout period. On the first and tenth days of use, lip and buccal mucosa dryness and perceived oral dryness were evaluated. Patient acceptance of the oral lubricant was evaluated at the end of each ten-day period. The Wilcoxon matched-pairs signed-rank test was used to analyze data over time and between-group differences. The gel group reported a statistically significant improvement in perceived oral dryness from Day 1 to Day 10. No other significant within-group differences were found. Subjects rated the gel significantly better than margarine for convenience, perceived value, minutes of relief, and in the "overall" rating. No other significant between-group differences were noted.

Autoimmune progesterone dermatitis and stomatitis.

Autoimmune progesterone dermatitis is a rare clinical condition associated with variable cutaneous and mucosal eruptions such as urticaria, erythema multiforme, and eczema. Exacerbation is influenced by hormonal changes of the menstrual cycle. The patient described in this report had recurrent cyclic lesions on the skin, oral mucosa, and lips that appeared just before regular menstruation and persisted until a few days after. During each cycle, the eruptions appeared at the previously affected sites, mimicking the clinical feature of a fixed drug eruption. This rare phenomenon is attributed to an autoimmune reaction to female sex hormones. The condition failed to respond to therapy with prednisone, but improved with the use of an antiestrogen drug, tamoxifen. This medication suppresses ovulation and the post-ovulation rise in endogenous progesterone levels.

Oral mucosal melanomas: the WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology.

A workshop to discuss primary oral melanomas was convened at the annual Western Society of Teachers of Oral Pathology meeting in Bannf, Alberta, Canada. Fifty oral melanomas, identified from the files of the participants, were reviewed in order to better understand the clinical features, histologic spectrum, and natural history of these perplexing lesions. Results confirmed that oral melanomas occur in adults almost three times more frequently in men than women and have a decided predilection for the palate and gingiva. Some lesions exhibit a clinically detectable and prolonged in situ growth phase, whereas others seem to lack this property and exhibit only or predominantly invasive characteristics. Recurrences, metastases, and death from tumor were characteristic of the follow-up of a limited number of patients. Until definitive prospective data are collected that elucidate natural history, oral mucosal melanomas should be tracked separately from cutaneous lesions. All oral pigmented lesions that are not clinically diagnostic should be biopsied. Lesions with equivocal histopathologic features might be referred to as "atypical melanocytic proliferation" and should be excised. Recognition of lesions in an early in situ phase and aggressive treatment should have a favorable effect on prognosis. To enhance future or prospective study of these rare neoplasms, guidelines for reporting oral melanomas are suggested.

Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patients.

Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.

Late effects of head and neck radiation therapy and patient/dentist compliance with recommended dental care.

Head and neck radiation therapy patients have permanent damage to their salivary glands, tissue, and bone. This damage may result in late effects such as: xerostomia, rampant dental caries, demineralization, trismus, and osteoradionecrosis. Therefore, a pretherapy dental evaluation and treatment and compliance with a long-term oral care regimen are necessary. This retrospective study was designed to assess the late effects of radiation therapy and compliance with long-term care recommendations of patients seen in the Oncology Dental Support Clinic at the University of Missouri-Kansas City School of Dentistry during 1981 to 1989. Telephone interviews of patients and their dentists were conducted, and a written questionnaire to the dentists provided further data. Late effects were consistent with those reported in the literature. A compliance rate of approximately 50% was reported. Several measures have been implemented in an attempt to increase compliance.

Aneurysmal bone cyst: report of a case mimicking orbital tumor.

Aneurysmal bone cysts are rare bone tumors which normally affect the vertebral region or long bones. Involvement of facial bones is uncommon. Although nonneoplastic, these lesions are expansile and may cause local destruction of bone and soft tissues. When making the diagnosis, it is imperative to consider the clinical, radiologic, and histologic features of the entity to avoid confusion with other possibly malignant giant cell tumors. We report an unusual case involving the orbit in a 2 1/2-year-old girl.

Gingival response to subgingival placement of monolithic tetracycline-impregnated fibers: microscopic observations.

This study examines and characterizes the soft tissue wall of periodontal pockets after a 10-day in vivo exposure to monolithic tetracycline-impregnated fibers, with and without root planing. Four teeth from each of eight patients were randomly assigned to (1) nontreatment (controls), (2) treatment by root planing only, (3) treatment by tetracycline fiber only, or (4) treatment by scaling and root planing and tetracycline fibers. Ten days after initial therapy, all teeth were extracted with associated soft tissue pocket walls intact. Three specimens were obtained from each tooth for examination by scanning microscopy, energy dispersive spectroscopy, and light microscopy. Results indicated that use of tetracycline-impregnated fibers over a 10-day period did not adversely affect the epithelial lining and had no significant effect on the density or character of the inflammatory response present in adjacent soft tissue and confirmed the antimicrobial effects of the fibers.

Intraoral vesicles occurring after alginate impressions.

In 47 of 227 dental students intraoral vesicles developed after multiple alginate impressions. The lesions were generally solitary and clear, and appeared within 24 to 48 hours after the impression. They were most frequently located inside the vermilion border of the lips and resolved spontaneously in 2 to 5 days. The purpose of this study was to determine the cause of these reactions. Histopathologically one lesion was suggestive of a contact allergy. Cutaneous patch tests, which proved negative, were performed on 14 students to determine whether an allergy to the alginate flavoring existed. The surface of three lesions were cultured and the organisms identified. Contamination studies were carried out on seven unopened containers of the alginate powder and resulted in the isolation of some organisms similar to the mucosal cultures; however, no relationship can be proved. These findings indicate that the cause of the vesicles remains unknown, and further studies are necessary to establish the cause.