Oral epithelial hyperplasia in diabetes mellitus.

Diabetes mellitus is one of the chronic systemic disorders with major influences of the oral cavity microenvironment. Oral manifestations of diabetes are diverse; they are represented by candidose, lichen plan, recurrent aphthous stomatitis, gingivitis, salivary disorders, oral mucosa atrophy and rarely hypertrophy; a possible link between oral cancer and diabetes is suspected, both in animal models and humans. We report a case of a young woman with type 1 diabetes with class I Kennedy edentation with mobile denture prosthesis; latter in the clinical follow-up, a hyperplasic lesion of the oral mucosa with p53 expression within the epithelial nuclei was identified, p53 being the more likely pathogenic pathway involved in diabetes-related oral cancer. The approach of this patient required multidisciplinary investigations and careful follow-up.

Local immune alterations in oral mucosa of the edentulous patients; possible cause of teeth loss?

UNLABELLED: Edentulous patients represent a difficult group of patients, especially in those cases when restorative prostheses are tempted on few remaining elements that eventually will be lost. MATERIAL AND METHOD: We performed a comparative histopathological and immunohistochemical (IHC) analysis of 20 oral mucosa biopsies in total edentulous patients (15 cases - group A) and ofnontumoral mucosa in oncologic patients (5 cases - group B, control). RESULTS: In group A the inflammatory infiltrate was dominated by the presence of numerous plasma cells (80%) and in 60% of the cases more numerous T cells than B cells were identified. We noticed various aspects of inflammatory infiltrate distribution in cases with epithelial ulceration (either CD8+ T cells intraepithelial and CD4+ T cells beneath the epithelium and perivascular or both CD4+ and CD8+ T cells in both lamina propria and intraepithelial location). 5 of seven cases which included salivary gland tissue revealed moderately to severe inflammatory infiltrate consisting of lymphocytes and plasma cells with lymphoepithelial lesion stage 1 aspects (71.42%). The control group (group B) presented plasma cell inflammatory infiltrate in one case (20%). None of the control cases had lymphoepithelial-like lesions within the salivary tissue. CONCLUSIONS: Presence of intraepithelial T citotoxic cells (CD8+) is correlated with presence of ulceration of the alveolar crest covering mucosa in the edentulous patients. Lymphoepithelial-like lesions of the minor salivary tissue in edentulous patients suggest an autoimmune response in local mucosa.

Clinical and pathological aspects of epithelial hyperplasia.

In many cases, the oral health status indicates the general status of the body. 90% of the disorders of the body also manifest at the level of the oral cavity, which means that the dentist can draw the attention of a certain health problem. Diabetes mellitus is associated with a high prevalence of the lesions of the oral mucous, especially lichen planus, recurrent aphthous stomatitis or oral candidiasis. We present here a case of diabetes mellitus with hyperplasic lesion at the level of the inferior vestibule, extended to the right jugal mucosa. The lesion appeared pursuant to the application of removable prosthetics. The biopsy specimen was examined using normal and special staining (HE Hematoxiline - eosine, Van Gieson VG) and immunohistochemistry (IHC). In the HE stain, an epithelial hyperplasia was noticed as a result of the proliferation of the basal cells, associated with hyperkeratosis (parakeratosis or orthokeratosis). A moderated inflammatory limphoplasmocitary infiltrate, composed by lymphocytes and plasma cells, was present within the hyperplasic chorion. The immunohistochemical reactions revealed Ki-67 positive nuclei in the basal and suprabasal strata (indicating an increased proliferating activity); rare p53 positive nuclei in the basal stratum (indicating a suppressive action on the cell proliferation); CD3/CD8 positive cells in the inflammatory infiltrate (indicating an important number of T suppressor lymphocytes in the inflammatory infiltrate). In conclusion, diabetes mellitus is a disease which frequently determines major modifications at the level of the oral cavity. Interdisciplinary collaboration between the pathologist and the dentist is necessary for adequate diagnosis and successful treatment.

[Brown tumors of upper and lower jaws in Recklinghausen neurofibromatosis. A case report]. / Tumori brune ale maxilarului si mandibulei in neurofibromatoza Recklinghausen. Observatii pe marginea unui caz.

We report the case of a 41-year-old patient who presented multiple cafe au lait spots and exophytic tumors of the upper jaw, causing facial asymmetry and masticatory impairment. Physical examination and paraclinical investigations established the diagnosis of NF1 (type 1 neurofibromatosis) associated with brown tumors in jaws and left nasal bone, caused by a primary hyperparathyroidism (Oxyphilic adenoma). The parathyroidectomy determines brown tumors regression and sclerosis with no dependence on their localization.

[Oral modifications during menopause]. / Modificari orale la menopauza.

The menopause, a physiological process specific to elderly women (>50 years) is defined by various involutive phenomena occurred at general level and particularly in the stomatognatic system elements. The authors followed the influence of the oral contraceptives in changes of oral tissues during menopause. The study was carried on 148 elderly women during menopause split in two groups: group I (study group) who have used oral contraceptives in earlier years, group II (control group) without contraceptive therapy. The evaluation of the results was made using clinical exams and complementary investigations (X-ray, cytological, histopathological, mycological, salivary rate exams) and index quantification. The results showed the importance of the apparition of changes in to the oral tissues during menopause increased in comparison to the control group. Corresponding prevention strategies are the basis of oral health management in women at menopause.

[Plunging ranula]. / Ranula plonjanta.

The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a retrospective study over a 10 years period on patients suffering of plunging ranula treated in Oral and Maxillo-Facial Clinic, resumed by a clinical example. These 7 patients with plunging ranula are related to all the patients operated for ranula in the same period of time in our clinic and were analyzed on age, sex, imaging exploration technique, treatment, and outcome. We found this kind of lesion both in children and young adults, between 10 to 40 years, more frequent on male (1.33/1). Two patients presented only the cervical form of ranula instead of the other five patients (both oral and cervical ranula). Only two of them received IRM examination. All of them received surgical treatment, the approach being cervical; it was removed both the cyst and the sublingual salivary gland. The surveying period, except the last case, was 1 year and includes no recurrences. We consider, besides esthetic loss that the cervical approach of plunging ranula seems to be the optimal access both on lesion and sublingual gland.