Immunohistochemical analysis of the oncoprotein c-erbB-2 expression in oral benign and malignant lesions.

Thirty-seven samples of oral mucosa were analysed and divided histologically into groups of normal mucosa (6), hyperplastic lesions (6), dysplastic lesions (14), and squamous cell carcinoma (11). All lesions displayed some expression of c-erbB-2 but the distribution and intensity of expression varied strongly according to the differentiation. The lower the epithelial differentiation of the sample, the higher the expression of c-erbB-2 oncoprotein showing very strong staining in carcinoma samples. This suggests that in oral carcinoma, transformation might be related to c-erbB-2 interaction.

Innervation of recurrent aphthous ulcers.

Specimens from nonkeratinized oral mucosa were obtained from diseased and clinically healthy mucosa from 7 patients with minor recurrent aphthous ulcers. The innervation of the specimens was visualized using antibodies to neuron-specific intermediate cytoskeletal neurofilament fiber, the cytoplasmic protein gene product 9.5 and a 38 kDa integral membrane protein of synaptic vesicles applied in avidin-biotin-peroxidase staining. Mapping with these 3 antibodies revealed dense and basically similar pattern of innervation in the specimens of the clinically healthy oral mucosa. In recurrent aphthous ulcers, all 3 general markers disclosed peripheral nerve fibers also in the lesions, apart from the necrotic area, among the inflammatory cells without signs of retraction from the diseased area. Synaptophysin staining suggested that these peripheral nerve fibers in the inflammatory areas still contained synaptic vesicles. Accordingly, they were shown to contain substance P and calcitonin gene-related peptide, which are known to be released upon stimulation of the nerve and can exert potent paracrine actions, possibly on the local inflammatory cells as suggested by a close spatial relationship between neuropeptide-containing nerves and inflammatory cells.

Mast cells in the labial salivary glands of patients with Sjögren's syndrome: a histochemical, immunohistochemical, and electron microscopical study.

Mast cells in labial salivary glands obtained from patients with xerostomia with or without focal sialadenitis/Sjögren's syndrome were studied. There was no significant correlation between the intensity of local lymphocyte infiltration and the morphometrically analysed number of mast cells staining positive with toluidine blue. Histamine staining with heterologous 11C antiserum showed significantly fewer positive cells than staining with toluidine blue (mean (SD) 62 (10) v 138 (30)). This suggests heterogeneity of the mast cell population. Furthermore, there was a correlation between the focus score and the number of mast cells containing histamine. This suggests that the proliferation of mast cells containing histamine may be locally regulated by the immune inflammation, possibly through mediators from macrophages and fibroblasts. In contrast, the number of mast cells staining positive with toluidine blue could not be used as a marker of the degree of local inflammation. Although transmission electron microscopic analysis did not disclose signs of 'en masse' mast cell degranulation, mast cells may have a role in the local disease process.

Signs and symptoms in the masticatory system in ten patients with mixed connective tissue disease.

Ten patients with mixed connective tissue disease (MCTD) were examined for signs and symptoms in the masticatory system. The study included clinical, radiological, histological and immunohistochemical examinations. The status of the teeth and periodontium did not seem to differ from that found in the general Finnish population. All 10 patients showed clinical dysfunction, and 7 had additional radiographic changes of the temporomandibular joints. Sialopenia was observed in 7 patients, and histological examination revealed sialoadenitis with a focus score exceeding 1 in the labial salivary glands in 9 patients. Only 1 patient had clinically detectable mucosal lesions. However, in 5 of 6 patients with normal-appearing mucosa, histological examination revealed chronic inflammation. Three of the 10 patients had clinically atrophic and erythematous oral mucosa; histological examination again revealed chronic inflammation. The signs and symptoms appearing in the masticatory system of these 10 MCTD patients were many and varied and indicate the importance of closely examining all oral structures. As with other connective tissue diseases, MCTD should be treated on a multidisciplinary basis.

Xerostomia due to Sjögren's syndrome. Diagnostic criteria, treatment and outlines for a continuous dental care programme and an open trial with Sulfarlem.

The initial evaluation of 25 patients suspected of suffering from Sjögren's syndrome (SS) disclosed that sialopenia and glandular atrophy without focal sialo-adenitis was the second most common cause, after SS itself, of patient complaints. This emphasizes the importance of conclusive diagnostic criteria to prevent overdiagnosis and to form a sound basis for management of xerostomia patients. We found that at the time of diagnostic evaluation, the dental status of our SS patients did not differ from that of the normal Finnish population. This suggests that SS patients can greatly benefit from adequate dental care, assuming that attention is paid to early diagnosis and management. Accordingly, the diagnostic and therapeutic approach needs to be multidisciplinary. We present our current programme for oral and dental care of xerostomia patients and the results of an open trial with Sulfarlem (trithioparamethoxyphenylpropene) which was found not to be the drug of choice in the treatment of dry mouth associated with SS.

Psychiatric disturbance in patients with oral lichen planus.

The degree of mental disturbance in 56 patients with clinically and histologically verified oral lichen planus (OLP) and in 44 non-OLP patients was investigated by means of the Cornell Medical Index psychological questionnaire. A statistically significant difference in mental disturbance between OLP patients and non-OLP patients was found, the OLP patients being more disturbed (p less than 0.01). The mental health of the non-OLP patients was equal to that of the general Finnish population. Of the OLP patients, 48.2% were mentally healthy, 21.4% had a mild mental disturbance, 5.4% had a moderate mental disturbance, and 25.0% had a severe mental disorder. The corresponding figures for the non-OLP patients were 72.7%, 9.1%, 11.4%, and 6.8%. Of the 56 OLP patients, 21 were randomly selected and referred for a psychiatric consultation. Five patients refused the psychiatric interview. Of the sixteen patients who were examined, five had a moderate psychiatric disorder, seven had a mild psychiatric disorder, one had signs of neurosis, and three were mentally healthy. Most of the patients had the subjective feeling that the clinical appearance of OLP, including discomfort, became worse during times of mental stress. None of the patients, however, had a subjective feeling of mental disturbance; nor did any of them feel any need for psychiatric treatment, except in one case.