Association between expression of stratum corneum chymotryptic enzyme and pathological keratinization in human oral mucosa.

Stratum corneum chymotryptic enzyme (SCCE) may function in the degradation of intercellular cohesive structures in the stratum corneum preceding desquamation. Previous results have suggested that SCCE may be specifically expressed in squamous epithelia undergoing terminal differentiation and keratinization. The aim of the present work was to further elucidate the association between SCCE expression and terminal differentiation in squamous epithelia. Using immunohistochemical methods, we have examined the expression of SCCE in two diseases of human oral mucosa, which produce a pathological keratinization of the epithelium at sites which are normally non-keratinized. Affinity-purified polyclonal rabbit antibodies raised against recombinant SCCE and monoclonal antibodies against the differentiation-specific keratins nos. 10 and 13 were used on formaldehyde-fixed and paraffin-embedded biopsies. Whereas there was essentially no expression of SCCE in normal, non-keratinized buccal mucosa, there was a strong expression in suprabasal cells in orthokeratotic and parakeratotic areas of the lesions of oral lichen planus (an inflammatory disease) and benign oral keratosis (a non-inflammatory disease). There was a close association between the expression of SCCE and keratin no. 10, i.e. a keratin which is specifically expressed in cornifying squamous epithelia. The results suggest that SCCE expression may be a true marker of terminal differentiation in squamous epithelia and give further evidence for a role of SCCE in the formation and/or turnover of the stratum corneum.

Life-style survey of patients with oral lichenoid reactions.

The occurrence of different life-style patterns, including marital status, educational level, nutrition, tobacco and alcohol use, and frequency of physical activity, in patients with oral lichenoid reactions (OLR) in total or partial contact with amalgam fillings was examined. When compared with an age- and sex-matched control group, the daily intake of carbohydrates, fibers, and iron was statistically significantly higher in the OLR patients. Regarding marital status, there was a statistically significant difference between the OLR patients and the control subjects, the former group containing more people who were divorced or whose spouse had died. The frequency of physical activity was also statistically significantly higher in the OLR patients than in the control group. Hypothetical mechanisms that may lie behind the results obtained are discussed.

Amalgam-associated oral lichenoid reactions. Clinical and histologic changes after removal of amalgam fillings.

OBJECTIVE AND STUDY DESIGN: Forty-nine consecutive patients with clinically diagnosed oral lichenoid reactions in contact with amalgam fillings were studied clinically and histologically. The long-term effect of replacement of these fillings was also examined. RESULTS: Seventeen (35%) patients showed positive reactions to mercury at the epicutaneous patch test that was carried out before treatment. After treatment, total regression of the lesions was found clinically in 33 (69%) and histologically in 26 (55%) patients. Most of the remaining lesions changed clinically and histologically to a less pronounced tissue reaction. Lesions in direct contact with amalgam fillings (group I) showed significantly better healing results than lesions that exceeded the contact area (group II). No difference in healing capacity was noted in the two groups between patients with positive patch reactions to mercury compared with those with negative reactions. Lesions that histologically were classified as benign oral keratosis showed a similar healing pattern as those classified as oral lichen planus. CONCLUSION: In group I all lesions changed histologically and clinically to a normal mucosa or to a less affected tissue reaction. In group II this change was less pronounced, which suggests that the fillings themselves were not the only factor involved in the cause of these lesions. The results suggest that various etiologic factors are involved in lichenoid reactions and that the effect of removal of amalgam fillings cannot be predicted by epicutaneous patch testing and biopsies.

Psychologic aspects of patients with oral lichenoid reactions.

Psychologic aspects of 49 patients with oral lichenoid reactions (OLR) in contact with amalgam fillings were studied and compared with an age- and sex-matched control group. Psychologic factors such as personality, psychologic functioning, and quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). With regard to personality the OLR patients had significantly higher scores on the muscular tension and suspicion scales and significantly lower scores on the indirect aggression scale. In addition, the OLR patients were significantly more worried about their health and more helpful. With regard to psychologic functioning the OLR patients had significantly more sad thoughts, became dizzy more easily, found it harder to imagine themselves free from anxiety, and had more difficulty in concentrating. The results indicated that OLR patients had a tendency to be depressive. The need for a systemic investigation including odontologic, medical, and psychologic aspects was expressed.

Oral lichen planus lesions in contact with amalgam fillings: a clinical, histologic, and immunohistochemical study.

Fifty-one consecutive patients had clinically diagnosed oral lichen planus (OLP) lesions in total or partial contact with amalgam fillings. The clinical features of the OLP lesions were characterized and registered, and biopsies were obtained from each OLP lesion. Histologic and immunohistochemical studies were performed, as well as tests for allergy to dental materials. The clinical diagnosis of OLP corresponded to the World Health Organization (WHO) morphologic OLP criteria in 31 (61%) cases. The remaining lesions were histologically diagnosed as mild OLP in 11 (22%) or as benign oral keratosis in nine (17%) cases. The immunohistochemical examination showed a positive reaction to fibrinogen in the basement membrane zone (BMZ) in 10 (20%) patients and to complement C3 in one (2%) patient. No positive reactions in the BMZ were found for IgA, IgG, and IgM. In 17 (33%) patients, an allergic reaction to mercury was found, and candidiasis was diagnosed in 13 (25%) patients. The true nature of OLP-like lesions in contact with amalgam fillings still remains to be explained. For that matter, we do not know whether OLP is one disease or a number of similar immunologic or other responses to various interacting stimuli. One such stimulus might be mercury from corroding amalgam fillings.