The immune responses to human and microbial heat shock proteins in periodontal disease with and without coronary heart disease.

The human 60 kDa and microbial 65 kDa heat shock proteins (HSP) have been implicated in the pathogenesis of chronic periodontitis (P) and coronary heart disease (CHD). We have studied four male non-smoking cohorts of 81 subjects, matched for age. Group (a) consisted of a healthy group with minimal gingivitis (n = 18), group (b) were patients with P (n = 23), group (c) patients with CHD and minimal gingivitis (n = 20) and group (d) patients with CHD and P (n = 20). T cells separated from peripheral blood were found to be primed to both microbial HSP65 and human HSP60 but significant CD4, human leucocyte antigen (HLA) class II-restricted proliferative responses were found only with the human HSP60 in patients with P (P < 0.001) and CHD without (P < 0.001) or with (P < 0.00001) periodontitis. Dose-dependent inhibition of T cell proliferative responses was carried out to determine the receptors involved in recognition of HSP60 and HSP65. Monoclonal antibodies to CD14 showed inhibition of T cell proliferation stimulated by both HSP60 and HSP65, consistent with the role of CD14 as a receptor for these HSPs in P and CHD. The toll-like receptor 2 (TLR-) and TLR-4 were then studied and these showed that TLR-4 was recognized by microbial HSP65, whereas TLR-2 was recognised by human HSP60 in both P and CHD. However, a dissociation was found in the HSP60 and TLR4 interaction, as TLR4 appeared to have been recognized by HSP60 in P but not in CHD. The results suggest an autoimmune or cross-reactive CD4(+) class II-restricted T cell response to the human HSP60 in P and CHD. Further studies are required to determine if there is a common epitope within HSP60 that stimulates T cell proliferation in P and CHD.

Effect of two toothcleaning frequencies on periodontal status in patients with advanced periodontitis.

OBJECTIVE: To compare the effect of once a day toothcleaning with once in 2 days toothcleaning in patients with advanced periodontitis. MATERIAL AND METHODS: Twenty-two patients, aged 34-54 years were given intensive oral hygiene (OH) and half their mouth root planed with re-assessment 6 weeks later. The patients were randomised into either a once a day toothcleaning group or a once in 2 days toothcleaning group. The effects of the two cleaning regimens were assessed during a 6-week follow-up period. Two patients were excluded from the study. Analysis of covariance was used to test the difference between the two groups at baseline and at 6 weeks. RESULTS: There was a statistically significant difference between the two groups in plaque reduction (p=0.01) and reduction of probing pocket depth >6 mm (p=0.05) in the OH-only sites. No significant difference was found between the two cleaning regimens in the combined oral hygiene with root planing sites. CONCLUSION: The present study demonstrated that in patients with advanced periodontitis, once a day toothcleaning is more effective than once in 2 days toothcleaning in otherwise untreated sites.

Tooth brushing-induced seizures: a case report.

We report a 28-year-old woman of normal intellect, who had three late-onset seizures with unusual ictal features and secondary generalization during prolonged and vigorous tooth brushing. Neurologic examination and brain magnetic resonance imaging (MRI) were normal, but interictal EEG showed left frontal epileptiform activity. Reasonable precautions (regular but briefer and less vigorous brushing of her teeth) combined with a moderate dose of carbamazepine effectively prevented seizure recurrence. This case may be an example of cryptogenic form of reflex epilepsy with seizures induced exclusively by tooth brushing.

F-chronodispersion in patients on thalidomide.

OBJECTIVES: To describe abnormalities of F-chronodispersion in patients treated with thalidomide. METHODS: We retrospectively studies F-wave latency, persistence and F-chronodispersion in 12 patients on thalidomide treatment and compared them with a control group of another 12 patients with similar dermatological conditions who did not receive thalidomide. Furthermore, we prospectively performed longitudinal neurophysiological studies in 4 patients before and during thalidomide treatment. RESULTS: Seven of 12 patients in the retrospective study had abnormal F-chronodispersion while this was normal in all patients of the control group (P = 0.014). All other neurophysiological parameters were similar in the two groups. Two of the thalidomide patients with abnormal F-chronodispersion later developed sensory neuropathy. In all 4 patients in the prospective study though F-chronodispersion was normal before thalidomide it became markedly abnormal after exposure to this drug. CONCLUSIONS: Thalidomide may affect smaller diameter motor nerve fibres even before changes in sural sensory nerve action potentials. F-waves and F-chronodispersion should be routinely monitored in patients on thalidomide treatment.

Occupational exposure to methyl methacrylate monomer induces generalised neuropathy in a dental technician.

A 36-year-old dental technician for 14 years developed paraesthesia and numbness in her legs. Neurophysiological studies revealed absent sensory nerve action potentials (SNAPs) from her lower limbs and normal upper limb SNAPs on presentation. Motor nerve studies were normal. Repeat studies 2 months after leaving her job showed some improvement in the lower limb SNAPs. It is suggested that her symptoms were caused by occupational exposure to methyl methacrylate monomer.

Chronic relapsing multifocal sensory-motor neuropathy with conduction block.

A 47 years old man had 13 episodes of relapsing and remitting sensory-motor neuropathy involving the upper limbs over the last 20 years. All but the last episode resolved spontaneously within 2 months. Neurophysiology revealed multifocal motor and sensory conduction block in the upper limbs with normal terminal latencies. CSF analysis was normal and anti-GM1 antibodies were not detected. There was a dramatic clinical improvement after intravenous immunoglobulin treatment. This case represents an unusual multifocal variant of chronic inflammatory demyelinating neuropathy.