Potential side effects of dental amalgam restorations. (I). An oral and medical investigation.

The aim of this study was to explore a possible association between health status and self-reported adverse effects related to dental amalgam restorations. A group of 50 consecutive patients (index group), referred for complaints self-related to dental amalgam restorations, was compared with a control group of individuals matched by age, sex and postal zip code. The patients underwent an oral, stomatognathic, medical and clinical chemistry examination. Mercury levels were examined in blood, urine and hair. The results revealed that somatic diseases were more common in the index group (38% versus 6%). Symptoms related to cranio-mandibular dysfunction were reported by 74% of the patients in the index group versus 24% in the control group, and were diagnosed in 62% and 36%, respectively. The oral health status and the number of amalgam surfaces were similar in the 2 groups. No positive skin patch test to mercury was found in any of the groups. The estimated mercury intake from fish consumption, occupational exposure, and mercury levels in blood and urine were also similar and far below levels, where negative health effects would be expected. The correlation between the number of amalgam surfaces and mercury levels in plasma and urine (r=0.43) indicated a release of mercury from dental amalgam restorations in both groups. Since the mercury levels were similar among index patients and controls, mercury was not a likely cause of the impaired health reported by the patients.

The prevalence of Staphylococcus aureus, Enterobacteriaceae species, and Candida species and their relation to oral mucosal lesions in a group of 79-year-olds in Göteborg.

A subject sample comprising 100 persons (47 men and 53 women) 79 years of age and selected on a statistical basis (representing all persons of that age living in Göteborg) was the object of a general medical, clinical, and microbiologic study of the prevalence of microorganisms in the oral cavity known to cause opportunistic infections. A high prevalence of diseases and frequent medications were recorded among the participants. Staphylococcus aureus was present in five patients and Enterobacteriaceae species in only one individual. Candida albicans was not found in any samples from the palatal mucosa of the 25 individuals without dentures. Of 36 healthy denture wearers C. albicans was found in 9 (25%). In 39 persons with denture stomatitis C. albicans was obtained in 11 (28%) of the samples from the mucosa, 29 (74%) from the dentures, and 10 (26%) from the angulus oris. The prevalence of S. aureus, enteric rods, and C. albicans was low in the elderly population and, when present, correlated with the presence of dentures. No association with the patients' general health or drug use was obtained.

Demographical, odontological, and psychological variables in individuals referred for osseointegrated dental implants.

Edentulism and/or the wearing of a removable denture always requires adaptation, not only on a functional, but also on an emotional, level. Four hundred and seventy-three patients referred for treatment with osseointegrated implants due to problems with removable prostheses entered the study and 315 (66.6%) completed it. The average age was close to 60 yr, and the majority of patients were women. The average time of edentulousness was 14.3 yr. Twelve percent experienced profound negative effects from wearing dentures, this to an extent that it led to overt psychological and social effects. Subjective ratings revealed that functional and/or intra-personal effects were of higher significance than social consequences. The group was found to be more depressed than average as well as having an external health locus of control orientation.

Phenotypic characterization of mononuclear cells and class II antigen expression in angular cheilitis infected by Candida albicans or Staphylococcus aureus.

In the present study we characterized the phenotypes of infiltrating mononuclear cells in angular cheilitis lesions to further explore the pathogenesis of this disorder. Frozen sections from lesions infected by Candida albicans and/or Staphylococcus aureus were subjected to immunohistochemical analysis utilizing monoclonal antibodies directed to subsets of T-lymphocytes, B-lymphocytes, and macrophages. In addition, the expression of Class II antigens (HLA-DP, -DQ, -DR), the interleukin 2- and transferrin-receptors was studied on resident and infiltrating cells. An intense infiltration of T-lymphocytes was accompanied by expression of Class II antigens on the epidermal keratinocytes in lesion infected by Candida albicans. The Staphylococcus aureus infected lesions displayed a diffuse infiltration of T-lymphocytes but virtually no expression of Class II antigen by epidermal keratinocytes. These observations suggest that the cell-mediated arm of the immune system is involved in the inflammatory reaction of lesions infected by Candida albicans. In addition, the present study confirms that epidermal expression of Class II antigens is closely related to the type and magnitude of the infiltrating T-lymphocyte. Finally, these findings indicate that the type of inflammatory reaction in angular cheilitis is primarily dependent on the isolated microorganism, although the clinical pictures of the disorder are virtually identical.

Class II antigen expression of epidermal Langerhans cells in renal allograft recipients.

This study was designed to investigate the influence of systemic immunosuppressive therapy on the HLA-DR expression of epidermal Langerhans cells. Fifteen renal allograft recipients immunosuppressed with cyclosporin A and steroids were studied. Skin biopsies were taken from the upper arm prior to transplantation and at different intervals during the post-transplantation period. The epidermis was separated from the dermis, and the epidermal sheet was subjected to immunohistochemistry in order to make the HLA-DR antigens on the Langerhans cells visible. Following 2 days of immunosuppression, the number of Langerhans cells expressing HLA-DR antigens started to decrease and after 1 week, only 60% of the initial number of positive cells were detected. The number of positive cells remained low throughout the experimental period. It is suggested that systemic immunosuppressive therapy will suppress the expression of HLA-DR antigens on epidermal Langerhans cells, something which may mirror a systemic effect on other antigen-presenting cells.

Treatment of angular cheilitis. The significance of microbial analysis, antimicrobial treatment, and interfering factors.

This prospective study evaluated the significance of microbial analysis and antimicrobial treatment for the cure of angular cheilitis. Furthermore, various etiologic factors were investigated for their relative effect on the healing process. The study included 1) an open trial with 50 patients infected by Candida albicans and/or Staphylococcus aureus, and 2) an intraindividual comparison of eight patients with bilateral lesions infected by Candida albicans as the only detected pathogen. After a base-line examination the patients received ointments containing nystatin and/or fusidic acid, on the basis of the outcome of an initial microbial analysis. The patients were evaluated clinically, photographed, and examined for microorganisms at different time intervals. Ninety-six per cent of the patients who participated in the open trial had no sign of infection after 42 days of treatment. Lesions in the double-blind study, treated with nystatin, were healed after 28 days, whereas lesions that received placebo persisted throughout the treatment period. Increasing age, dry skin, and extended skinfolds at the corner of the mouth were factors closely related to the length of the healing process.

Recurrence of angular cheilitis.

The incidence of recurrence of angular cheilitis following a successful antimicrobial treatment was studied in 48 patients. Clinical assessments including a microbial examination were carried out 8 months and 5 yr after termination of treatment. Eighty percent of the patients reported recurrence of their angular cheilitis on one or more occasions during the observation period. Patients with cutaneous disorders associated with dry skin or intraoral leukoplakia had an increased incidence of recrudescence. Neither the presence of denture stomatitis nor the type of microorganisms isolated from the original lesions of angular cheilitis, i.e. Candida albicans and/or Staphylococcus aureus, were associated with the number of recurrences. The present observations indicate that treatment of the majority of patients with angular cheilitis should be considered in a longer perspective than previously supposed, due to the short lasting therapeutic effects of the antimicrobial therapy.

Expression of Class II transplantation antigens by epithelial cells in oral candidosis, oral lichen planus and gingivitis.

Biopsies from normal oral mucosa and oral mucosa affected by candidosis, lichen planus or gingivitis were compared with respect to the expression of two Class II transplantation antigens, HLA-DR and HLA-DQ, by epithelial cells and the relationship of these antigens to the distribution and frequency of T-lymphocytes. Indirect immunohistochemistry with different mouse monoclonal antibodies was used on frozen and acetone-fixed sections. To evaluate the results, a score system based upon the expression of the Class II transplantation antigens by epithelial cells and the frequency of T-lymphocytes was used. In oral candidosis there was a marked expression of HLA-DR antigens throughout the epithelium. In addition, this type of epithelium was the only one that expressed HLA-DQ antigens. An intense intraepithelial infiltration of T-lymphocytes was observed. Oral lichen planus and gingivitis did, to a much lesser extent, cause the expression HLA-DR antigens by the epithelial cells. In both lesions, the number of T-lymphocytes within the epithelium did not exceed the number found in epithelium of normal mucosa. In these types of lesions, the subepithelial infiltrate varied in intensity but was mainly composed of T-lymphocytes reactive with anti-Leu 3a antibodies. The results of the present study imply that epithelial expression of the two different Class II antigens are related to the frequency of the T-lymphocytes and to the proximity of these cells to the epithelial cells.

Angular cheilitis: a clinical and microbial study.

The purpose of this prospective study was to re-examine the relative importance of various factors in the pathogenesis of angular cheilitis. Sixty-four patients with cheilitis were examined clinically and microbiologically. In addition, a subsample of 23 patients was examined for serum iron and transferrin. The clinical appearance of the lip lesions fell into 4 categories. A ground rhagad at the corner of the mouth involving adjacent skin, was the most frequent type among dentate patients, whereas among denture wearers a deep lesion following the labial marginal sulcus was frequently observed. Dentate patients and denture wearers with cheilitis often had atopic constitution or cutaneous diseases. Pathogenic microorganisms were cultured from the lesions in all 64 patients; Staphylococcus aureus in 40 patients and Candida albicans in 45. The results of this study indicate a correlation between angular cheilitis and pathogenic microorganisms. Furthermore, among dentate patients, a correlation exists between cutaneous discomfort and angular cheilitis. Other etiological factors suggested for this disorder were found to be of subordinate importance.

An oral and psychosocial examination of patients with presumed oral galvanism.

The present investigation was performed to elucidate possible etiological factors behind the complaints reported by 62 patients referred because of presumed oral galvanism. Twenty-nine patients, matched with a subsample of the test group regarding age and sex, comprised a control group. The patients were examined regarding oral medical and stomatognathic health. Their psychological and social health and symptoms were evaluated by means of a standardised interview and 5 self-rating questionnaires. A complex symptomatology including symptoms from both the oral regions and other parts of the body constituated the most distinctive feature of the patients in the test group. The clinical examination as well as patient-perceived symptoms revealed high prevalences of parafunction and dysfunction in the muscles of the stomatognathic system. Furthermore, general complaints were mainly related to muscles of the extremities, and diseases of the joints and muscles were the most commonly reported disorder. The findings at the oral medical examination revealed no differences between the groups, except for signs of parafunction. Patients in the test group gave evidence of being more exposed to negative social events and the results clearly indicate a psychogenic component behind the reported complaints.