Sjögren's syndrome - an update for dental practitioners.

Sjögren's syndrome (SS), an autoimmune, multi-factorial disorder, affects around 5% of females and 0.5% of males in the general population. The dental practitioner has a key role in recognising the clinical features of this condition, organising referral for specialist care and managing the oral health of these patients. In this article, we summarise the clinical manifestations, diagnosis and management of SS relevant to dental practitioners.

Maxillary sinus disease: diagnosis and treatment.

The maxillary sinus is the paranasal sinus that impacts most on the work of the dentist as they will often be required to make a diagnosis in relation to orofacial pain that may be sinogenic in origin. Maxillary sinus disease is often coincidentally observed on radiographs, and dentists often have to make a diagnosis and plan treatment based on the interpretation of the image. This paper aims to guide the dental professional through some of the disease processes involving the paranasal sinuses and in particular the maxillary sinus. The outcome is to encourage comprehensive history taking and examination of the patient to facilitate an accurate diagnosis that will enable successful treatment.

General medicine and surgery for dental practitioners. Part 4 - skin disorders part B.

Skin disorders are potentially important to dentists in diverse ways. The skin disease itself might have oral manifestations, and drugs used to treat skin disorders may impact on dental management. This second paper on skin disorders continues with a consideration of those disorders, and aspects of their treatment, which could have relevance to dental practitioners.

General medicine and surgery for dental practitioners. Part 3 - skin disorders part A.

Skin disorders are potentially important to dentists in diverse ways. The skin disease itself might have oral manifestations, and drugs used to treat skin disorders may impact on dental management. This first paper considering skin disorders examines points to look out for in the history and considers specific groups of conditions. Further conditions will be discussed in part B.

Ectopic parotid gland as an unusual cause of cheek swelling.

There are numerous causes for chronic cheek swelling, including masseteric hypertrophy, lymphadenopathy, diffuse inflammatory changes and neoplasia. We report an unusual case where the swelling was the result of ectopic parotid tissue.

Mummy 1911-210-1.

An ancient Egyptian mummy from the collections of the National Museums of Scotland was examined using computerised tomography (CT) scanning as part of the NMS mummy project. A facial reconstruction was produced from the CT scans for comparison with a painted 'portrait' which covers the face of the wrappings. The scans indicated the mummified wrapped body of an adult male 1.65 m tall with excellent preservation of the body. An exact replica, translucent model of the skull was created from the CT scans and standard cephalometric analysis undertaken. The facial features were reconstructed onto a plaster model of the skull from known tissue depths using terracotta clay. The resultant face was compared with the portrait and an extremely close match obtained, suggesting this was an individual portrait painted around the time of death.

The relevance and effect of amalgam replacement in subjects with oral lichenoid reactions.

In this study we examined the prevalence of mercury hypersensitivity in patients with oral lichenoid reactions (OLR) and the effect of amalgam replacement in subjects with amalgams adjacent to OLR irrespective of their mercury sensitivity status. One hundred and ninety-seven patients with oral problems were examined: 109 with OLR, 22 with oral and generalized lichen planus, and 66 with other oral diagnoses, including aphthous ulcers and orofacial granulomatosis. Nineteen per cent of patients with OLR reacted to mercury on patch testing, significantly more than in those with generalized lichen planus (0%) and in those with other oral diagnoses (3%). Twenty-two patients with OLR and adjacent amalgams had amalgam replacement and, in 16 of 17 mercury-positive subjects and three of four mercury-negative subjects, the OLR resolved after amalgam removal. In conclusion, we found a significantly increased prevalence of mercury hypersensitivity in patients with localized OLR in comparison to subjects with other oral problems. Amalgam replacement resulted in resolution of OLR in the majority of patients with amalgams adjacent to OLR irrespective of their mercury sensitivity status.

Effects of radiotherapy on oral epithelium. Quantitative cytology using light and scanning electron microscopy.

OBJECTIVE: To determine the short- and long-term morphologic and morphometric effects of radiotherapy on exfoliated oral squames. STUDY DESIGN: Exfoliating squames were sampled from squamous carcinoma and contralateral clinically healthy sites from patients before and six weeks after radiotherapy and from patients who had received radiotherapy for oral squamous carcinoma five years previously. Morphologic and morphometric studies were undertaken using light and scanning electron microscopy (SEM). RESULTS: Six weeks after radiotherapy, nuclear area was significantly increased in cells from both healed tumor and contralateral sites. No differences were detected in cells from previous tumor and contralateral sites five years after radiotherapy. SEM revealed bizarre microplications in cells from malignant sites, and microplication widths were significantly increased. Occasional cells with atypical patterns were identified six weeks and five years after radiotherapy, but microplication dimensions were comparable to those of cells from contralateral clinically healthy sites. CONCLUSION: Radiotherapy produces a transient increase in nuclear area. Abnormal microplication patterns in cells from previous tumor sites five years after radiotherapy may reflect disordered maturation associated with radiation injury.

A mutation in the mucosal keratin K4 is associated with oral white sponge nevus.

White sponge nevus (WSN) is a benign autosomal dominant disorder which affects non-cornifying stratified squamous epithelia (MIM 193900) (ref. 1). Phenotypically it presents as white 'spongy' plaques (oral leukokeratoses), most commonly in the mouth but also reported in the esophagus and anogenital mucosa. Histologically, the plaques show evidence of hyperproliferation, acanthosis and tonofilament aggregation. These types of pathogenic changes are characteristic of many of the epidermal keratin disorders. Keratins are expressed in pairs by epithelial cells in a tissue and cell specific manner. The major differentiation specific keratins of the buccal mucosa, nasal, esophageal and anogenital epithelia are K4 and K13 (ref. 7). The tissue distribution and nature of the lesions in patients affected by WSN suggested that mutations in K4 and/or K13 might be responsible for this disorder. We have now confirmed this hypothesis and report here a three base-pair (bp) deletion in the helix initiation peptide of K4 in affected members from two families with this condition.

Sialadenosis of the salivary glands.

Sialadenosis (sialosis) is an uncommon, non-inflammatory condition which usually causes bilateral, diffuse enlargement of the salivary glands, particularly the parotid. We present a series of 7 patients with sialadenosis. Two had bilateral and 4 unilateral parotid involvement. One patient had unilateral submandibular gland sialadenosis. One patient had bilateral parotid and bilateral submandibular gland sialadenosis. The clinicopathological features and management of the condition are reviewed.

Feulgen hydrolysis profiles and acid-labile DNA in oral squamous cell carcinoma.

The full Feulgen hydrolysis profiles of healthy and malignant oral epithelial cells were compared by measuring the staining density of nuclei using microdensitometry after varying hydrolysis times. Malignant nuclei contained significantly increased levels of acid-labile DNA. The relative amounts of the rapidly hydrolysable fraction were compared after 5 min hydrolysis for exfoliating epithelial cells from healthy oral mucosa, healing chronic ulcers and squamous cell carcinomas. Although the latter exhibited a wide range of values, analysis of variance showed significant differences (P < 0.05) between healthy control and ulcer groups compared to oral carcinoma. The relative proportion of highly acid-labile DNA in malignant nuclei showed a significant positive correlation with mitotic score (P < 0.01) but no significant correlation with nuclear area. It was concluded that since the susceptibility of DNA to acid hydrolysis probably reflects functional differences in nuclear activity between cells, estimation of the highly acid-labile fraction may have diagnostic and/or prognostic value.

Morphological and morphometric studies of exfoliated oral squames from chronic inflammatory oral ulcers using light and scanning electron microscopy.

The morphological and morphometric features of exfoliated squames from the margins of chronic oral ulcers were studied by light and scanning electron microscopy. A variety of features consistent with a mixture of degenerative changes and regenerative activity were observed. None was sufficiently reliable to distinguish chronic inflammatory from malignant ulcers.

Resolution of lichen planus following removal of amalgam restorations in patients with proven allergy to mercury salts: a pilot study.

Thirteen patients with symptomatic oral lichen planus had been shown by patch testing to be allergic to ammoniated mercuric chloride. Replacement of amalgam restorations in these patients effected an improvement in all but one case. In some cases the resolution of symptoms was dramatic following the replacement of one or two fillings. The authors feel that the removal of all amalgam fillings need not be necessary except in the most intractable case.

Symptomatic and asymptomatic salivary duct abnormalities in Darier's disease: a sialographic study.

Symptoms of obstructive sialadentis have been occasionally reported as a feature of Darier's disease. Parotid sialograms of three patients with confirmed Darier's disease and histories suggestive of salivary obstruction revealed dilatation with periodic strictures and indentations affecting the main ducts. Similar parotid sialograms in three Darier's disease patients with no symptoms attributable to their salivary glands revealed seepage of contrast media associated with the secondary and tertiary ducts. These findings suggest that salivary glands may be more commonly involved in Darier's disease than previous reports indicate.

Congenital aplasia of major salivary glands in a 4-year-old child.

The case of a 4-year-old girl with marked xerostomia and rampant caries is described. Investigation revealed complete aplasia of all four major salivary glands, which is extremely rare. Eleven primary teeth were extracted and a strict caries-preventive regime introduced. The patient had previously been advised to suck citrus-flavoured sweets to stimulate saliva flow, but this must be discouraged.

Intralesional steroid injection after nerve block anesthesia in the treatment of orofacial granulomatosis.

BACKGROUND: The facial disfigurement produced by orofacial granulomatosis causes enormous embarrassment. None of the many therapies recommended is reliably successful. Oral corticosteroids cause significant side effects and repeated injections of small quantities of triamcinolone are painful. We have injected large volumes of triamcinolone after numbing the lips using nerve block anesthesia. OBSERVATIONS: Nine patients (six males and three females, aged 10 to 47 years) with orofacial granulomatosis were investigated. No evidence of an allergic cause was found using patch or contact urticaria tests. Eating chocolate produced lip swelling in one man, and his lip shrank in size after avoiding this for 12 months. Five patients, aged 10 to 24 years, were treated with high-volume intralesional triamcinolone injections (3 to 10 mL of 10 mg/mL) after first numbing the lips using infraorbital nerve branch and mental nerve block. After 6 weeks, the lip size returned to normal in four patients and was reduced in a fifth. One patient was injected on four occasions over a 2-year period; in four other patients treated once, lip size remained reduced for over 10 months. CONCLUSION: Intralesional triamcinolone reduces lip swelling in patients with orofacial granulomatosis. Numbing the lips by nerve block anesthesia before triamcinolone injection enables adequate volumes and repeated injections to be given painlessly.

Human labial orf: a case report.

A case of orf in a 59-year-old man with no direct contact with farm animals is reported. The patient presented with an ulcerating lesion on the upper lip and the diagnosis was confirmed by electron microscopy from a smear of the lesion. The unusual case history, differential diagnosis and method of diagnosis are discussed.