Need and Demand for Oral Medicine Services in 1996. A report prepared by the Subcommittee on Need and Demand for Oral Medicine Services, a subcommittee of the Specialty Recognition Committee, American Academy of Oral Medicine.

The need and demand for oral medicine services in the United States and Canada was determined by a prospective survey of American Academy of Oral Medicine practitioners who attended the Academy's 1996 annual meeting. Of the 50 surveys returned from 149 eligible registrants, it was determined that, on the average, oral medicine practitioner respondents practiced 2.3 days per week and treated 8.7 patients per day; this amounts to more than 40,000 patient-care visits per year. Almost 90% of patients were treated because of medically compromising conditions, oral mucocutaneous disease, or chronic orofacial pain. Most of the care (52%) was provided in non-university settings. Most treatment involved the comprehensive evaluation of complex oral problems (36.7%), the prescription of medications (24.2%), or comprehensive dental treatment (21.8%) for patients with severe and life-threatening medical conditions. These results suggest that oral medicine services are needed and that demand for these services is high.

Case report: Langerhans cell histiocytosis associated with elevation of angiotensin-converting enzyme levels.

The authors describe a 22-year-old man with osteolytic mandibular and maxillary lesions. Biopsy substantiated the presence of Langerhans cell histiocytosis (eosinophilic granuloma). Levels of serum angiotensin-converting enzyme (ACE) were elevated repeatedly. After definitive therapy with excision and bone grafting, ACE levels returned to normal. The role of histiocytes in ACE production is discussed. Langerhans cell histiocytosis should be considered in the diagnosis of conditions occurring with elevation of serum ACE levels and clinical findings similar to sarcoidosis.

Suppurative stomatitis glandularis.

A case of diffuse, recurrent, suppurative sialadenitis and sialodochitis is presented. I believe this entity to be analogous to cheilitis glandularis and propose the name suppurative stomatitis glandularis.

Leiomyoma of the oral cavity: a light microscopic and immunohistochemical study with review of the literature from 1884 to 1992.

Leiomyoma is the most common benign neoplasm in the uterus and stomach but is rare in the oral cavity. There were only 5 oral cases in a series of 7748 leiomyomas of all sites. Benign smooth muscle neoplasms are classified into leiomyoma (solid leiomyoma), angiomyoma (vascular leiomyoma) and epithelioid leiomyoma (leiomyoblastoma). 6 cases diagnosed as leiomyoma were retrieved from the files of two oral biopsy services over the past 25 years. A light microscopic study including trichrome and phosphotungstic acid haematoxylin (PTAH) stains, and an immunohistochemical study with the following markers: desmin, muscle specific actin, myoglobin, vimentin, S-100 protein, neuron-specific enolase, factor VIII and Ulex europeus were done with suitable controls. The haematoxylin and eosin and Masson's trichrome stains supported a diagnosis of leiomyoma in all 6 cases but PTAH was positive in only 3 of them. The immunohistochemical study confirmed the diagnosis of leiomyoma in 3 cases. The other 3 were identified as granular cell tumour, myofibroma and neurofibroma, respectively. The review of the literature contributed the following data: mean age was 41 and median age 39 in 134/142 patients. A male sex prevalence 72/137 patients (54.0%) was noted. The lips were the most common site with 39 cases (27.46%) followed by the tongue 26 (18.30%), cheeks and palate 22 (15.49%), gingiva 12 (8.45%), and mandible 8 (5.63%). Prognosis of oral leiomyomas is excellent. Immunohistochemistry is a precise and reliable method for definitive diagnosis of oral leiomyoma.

An unusual skin reaction following local anesthetic injection. Review of the literature and report of four cases.

Four cases of an unusual skin eruption related to mandibular block injection are presented. The authors suggest an immunologic basis for the reaction, probably to the methylparaben preseravtive, and discuss a possible pathogenic mechanism. The medical-dental literature concerning untoward reactions to lidocaine is reviewed; particular attention is given alleged allergic reactions.