Saliva and oxidative stress in oral cavity and in some systemic disorders.

Saliva is a liquid environment of the oral ecosystem that to some extent reflects the local state of oral cavity or the general state of health of the human body. Since saliva reflects general health status of the human organism and is easy to collect, it can be used as a non-invasive diagnostic tool. In the present review the authors discuss and highlight the role of oxidant-antioxidant balance in the blood and saliva in human pathology. Particularly, the evaluation of oxidative stress status was proposed as an important factor in diagnosing the development and progress of such general diseases as periodontal disease, oral cancer, diabetes, rheumatoid arthritis, chronic renal failure, obstructive sleep apnea syndrome, and HIV. Moreover, the tryptophan metabolites via kynurenine pathway measured in the plasma and saliva are proposed as new and sensitive markers of oxidative stress status. It is concluded that measurement of oxidative stress in salivary fluid may provide a tool for diagnosing, monitoring and treatment of some systemic diseases as well as of local pathologic disturbances (e.g. periodontal disease).

Reduced systemic bone mineral density associated with a rare case of tooth and nail syndrome.

PURPOSE: This is the first report of a rare genetic tooth and nail syndrome (TNS) diagnosed in a 14-year-old Caucasian girl with a complete absence of the permanent dentition and, additionally, reduced total and lumbar spine bone mineral density (BMD). This coincidence suggests a new clinical manifestation of the disorder in which genetic factors and/or shared mechanisms may be responsible for the deterioration of the stomatognathic system, anodontia, nail phenotype and osteopenia. Low bone mass appears to be a new component of the syndrome. There is a rationale for bone densitometry scans assuming that patients with TNS may have an increased risk of osteopenia. Reduced BMD and, possibly, impaired bone quality and strength may produce difficulties or even exclude such patients from future treatment with dental implants.

Preliminary evaluation of morphological parameters of the saliva in patients undergoing orthodontic treatment.

PURPOSE: In recent years, many reports have focused on clinical changes in the oral cavity of orthodontic patients, manifested in general inflammation of the mucosa. In order to better understand histopathological alterations in the mouth and the use of easily available diagnostic material, we decided to assess the morphology of salivary cells at different time points of treatment with orthodontic appliances. MATERIAL AND METHODS: The study material included non-stimulated saliva obtained from 21 orthodontic patients and 11 healthy secondary school students (controls). After fixation in 96% ethanol the smears were stained with PAS + hematoxylin or H+E, and using the methods of May-Grünwald-Giemsa and Feulgen. RESULTS: As revealed by the histopathological examinations of saliva smears, patients treated with intra-oral fixed orthodontic appliances showed morphological changes in oral epithelial cells and in the number of leukocytes as compared to the control group. The changes were most pronounced in the first months of treatment. CONCLUSIONS: The preliminary data indicate that orthodontic patients develop changes in the composition and morphology of salivary cells, the intensity of which depends on the time of exposure to the appliance.

Preliminary evaluation of saliva composition in allergic patients subjected to orthodontic treatment; morphological examination.

PURPOSE: Intra-oral fixed orthodontic appliances, so frequently used in the treatment of malocclusions, may cause pathomorphological changes in the mouth and can be a potential source of antigen stimulation. Therefore, the aim of the current study was to assess the changes in salivary cells of orthodontically treated allergic patients. MATERIAL AND METHODS: The study material was the non-stimulated saliva samples collected from 28 allergic patients subjected to orthodontic treatment with intra-oral fixed appliances and from 11 healthy secondary school students (controls). After fixation in 96% ethanol, saliva smears were stained with PAS + hematoxylin or H+E, and using the methods of May-Grünwald-Giemsa and Feulgen. The microscopic analysis was made of oral epithelial cells and inflow elements, with regard to their shape, size, the nucleus-to-cytoplasm ratio and nuclear chromatin condensation. RESULTS: The results of preliminary investigations indicate that allergic patients with fixed orthodontic appliances exhibit changes in the morphology and composition of salivary cells as compared to control patients. Differences in the morphological picture were most pronounced in the first months of orthodontic treatment. CONCLUSIONS: It was shown that the number and morphology of salivary cells in allergic patients altered in response to ions released from dental alloys. Thus, saliva can be used as diagnostic material.

Assessment of periodontal status following the alignment of impacted permanent maxillary canine teeth.

PURPOSE: The aim of the study was to assess the effect of orthodontic movement of the impacted canines after surgical exposure and alignment on the periodontal status of the transpositioned and adjacent teeth as well as to compare certain parameters with those of spontaneously erupted teeth. MATERIAL AND METHODS: Twenty-four patients (mean age 18.4 +/- 3.66) with unilaterally impacted 24 canines were enrolled in the study. The following parameters were assessed: pocket depth (PD), clinical attachment level (CAL), platelet index (PI) of Silness and Löe, and modified sulcus bleeding index (SBI). Optic density of the alveolar bone along the root surface of the aligned canine was analysed based on digital radiological images made with the right angle technique. Control group consisted of spontaneously erupted teeth. RESULTS: In comparison to the control group, in the orthodonticaly treated group PD was found to increase on the mesial buccal and palatal surfaces of the first premolar (p < 0.003, p < 0.04), on the treated side; on the distal buccal (p < 0.01), mesial buccal (p < 0.0005), mesial palatal (p < 0.02) and distal palatal surfaces of the canine (p < 0.02); and on the distal buccal (p < 0.04) and distal palatal surfaces of the lateral incisor (p < 0.048). CAL was statistically significant on the mesio-buccal and mesio-palatal surfaces of the aligned canine (p < 0.02). PI was statistically insignificant, while SBI values at the aligned tooth were statistically significant (p < 0.0004). Positive correlation was found between treatment duration and distance to the occlusal plane (d) expressed by the correlation coefficient r = 0.49 (p < 0.02). No relationship was observed between bone density within the canine alignment zone and the control, and there was no link between the method of treatment and periodontal status, either. CONCLUSIONS: The alignment of the impacted permanent maxillary canines poses a risk of periodontal deterioration. Patients subjected to surgical-orthodontic treatment require periodic periodontal follow-ups.

Oral cavity status and IgE level in orthodontic patients.

PURPOSE: Considering nickel release from fixed orthodontic appliances, determination of the relationship between the clinical status of the mouth, IgE level and treatment duration in orthodontic patients seems to be advisable. MATERIAL AND METHODS: Twenty-one patients with symptoms of nickel hypersensitivity observed during treatment with fixed orthodontic appliances were separated from a group of 50 subjects, aged 11-33 years, undergoing orthodontic treatment for malocclusion. The patients were divided into two subgroups PgA and PgB. RESULTS: The mean IgE level in PgA was 39.20 IU/ml and in PgB 210.61 IU/ml. In PgA, the majority of patients were wearing ear-rings (8/10), but not in PgB (4/11). The mean treatment duration in PgA was 21.3 +/- 4.83 months, while in PgB 14.4 +/- 2.84. There were no statistically significant differences in the symptoms indicating stomatitis between the groups of patients subjected to treatment with intra-oral appliances. CONCLUSIONS: The immunologic profile of the patient plays a key role in the choice of the type of appliance used to treat abnormalities of the masticatory organ. Determination of IgE is necessary in the case of allergy-positive history.

Recession occurrence in patients treated with fixed appliances--preliminary report.

PURPOSE: The aim of the study was to evaluate the dependence of gingival recession, malocclusion and factors that may lead to recessions of the gingiva in patients applying for orthodontical treatment. MATERIAL AND METHODS: The study involved 52 randomly selected patients treated with fixed appliances due to occlusal irregularities and dental abnormalities. Data obtained from the examination and selected parameters from cephalometric analysis were placed in a chart including ANB skeletal class and Wits parameter, lower incisor position IMPA, dental abnormalities, extractions due to orthodontical indications and recession etiopathic factors. Statistical analysis of obtained data was conducted using variance analysis. Statistically significant were assumed those calculations for which value of significance level p < or = 0.05. RESULTS: Recession was observed in 18 patients of the 52 examined. Skeletal I class was found in 11 patients (61.12%) and in 8 cases Wits parameter corresponded with skeletal class III (44.4%). Among the patients examined normal incisor inclination was observed in 6 patients (33.33%), whereas 12 cases revealed inclination irregularities (66.66%). Clinical examination disclosed dental defects in 13 patients (72.22%) and in 12 cases recession etiopathic factors were recognized (66.66%). Statistically significant differences between periodontal biotype and gingival recession of 43, 31, 33 teeth were estimated. CONCLUSIONS: Anatomical factors, malocclusion and dental irregularities were fund to be the main cause of the single and/or multiple recessions. Patients applying for orthodontic treatment due to occlusal abnormalities should remain under particular control in case of symptoms suggesting the incidence of recession, particularly when recessions are already present.

Complications in the course of surgical-orthodontic treatment of impacted maxillary canines.

PURPOSE: The purpose of the study was to assess the effect of gender and age of patients with impacted permanent maxillary canines on complications in the course of tooth transposition. MATERIAL AND METHODS: The study material included files of 82 patients with a diagnosis of unilateral or bilateral impaction of 102 permanent maxillary canines. The study group consisted of 65 female and 17 male subjects, aged 8.5-39 years (mean 14.5 years) divided into four age groups: group I--patients under 12, group II--12.0-13.9 years, group III--14.0-15.9 years and group IV--patients at the age of 16 and older. RESULTS: In the study population, the impacted teeth showed the following locations: palatal (67.64%), vestibular (19.60%) and alveolar (12.74%). Spontaneous resorption caused by abnormal tooth position was observed in 5 (4.9%) permanent maxillary lateral incisors. In 4 cases, the resorption was bilateral and all the five cases were recorded in group III. In group IV, one patient had alveolar process atrophy and severe resorption, while another one showed ankylosis of a permanent canine. Extraction of palatally impacted canines was done in 3.92% of cases. Complications were noted in girls and referred to 5.58% of the study cases. CONCLUSIONS: Orthodontic movement of the impacted teeth to the dental arch may result in complications. However, because of the major significance of the upper canine which is responsible for the behaviour of the frontal triad, surgical-orthodontic treatment should be undertaken to improve occlusion and the aesthetic look of patients. Thus, any case of the ectopic canine requires observation and proper choice of radiological diagnostics.

Tryptophan and its metabolites in patients with oral squamous cell carcinoma: preliminary study.

PURPOSE: It has been showed that tryptophan (TRP) degradation has been linked to modulation of cancer cell proliferation. The aim of our study was to estimate the concentration of TRP and its derivatives, such as anthranilic (AA) and kynurenic acid (KYNA) in plasma, saliva, squamous cell carcinoma (SCC) tissues and healthy oral mucosa in patients with oral SCC. MATERIAL AND METHODS: The study was performed on plasma, non-stimulated, mixed saliva and squamous cell carcinoma tissues and healthy oral mucosa in patients with oral SCC. The concentration of TRP and its metabolites were determined by high-performance liquid chromatography (HPLC). RESULTS: In plasma the concentration of TRP was 33.73 +/- 2.52 microM, of KYNA was 26.97 +/- 5.35 nM and of AA was 32.40 +/- 2.30 nM. In saliva the concentration of TRP was 3.81 +/- 0.62 microM, of KYNA was 8.06 +/- 1.86 nM and of AA was 20.41 +/- 10.77 nM. In cancer tissues the levels of TRP (30.21 +/- 5.88 microM), KYNA (15.85 +/- 1 .82 nM) and AA (265.32 +/- 1 51.45 nM) were higher in respect to the concentration of TRP (13.28 +/- 0.62 microM), KYNA (12.75 +/- 2.28 nM) and AA (31.68 +/- 8.89 nM) in normal tissues. The increase in the content of TRP, KYNA and AA in cancer tissues reached 127.48 +/- 5.95%, 24.31 +/- 4.35% and 737.50 +/- 206.96%, respectively. CONCLUSIONS: Our study has demonstrated the change of TPR metabolism, which is reflected by the increase TRP, AA and KYNA concentrations in patients with oral squamous cell carcinoma. We can suppose that these substances may be one of many factors responsible for cancer development.

The concentration of anthranilic acid in saliva of orthodontic appliances.

PURPOSE: Anthranilic acid is an important, the aromatic intermediate in the degradation of tryptophan in kynurenine pathway. This compound plays an important role in the regulation of immunological processes as well shows antibacterial activity. The aim of our study was to estimate the concentration of anthranilic acid in saliva of young patients with orthodontic apparatus. We also assessed correlation between saliva anthranilic acid concentrations and time of orthodontic treatment. For the first time we have demonstrated the enhanced concentration of anthranilic acid in saliva of young orthodontic appliances. MATERIAL AND METHODS: The study was performed on non-stimulated, mixed saliva of patients with orthodontic appliances. The concentration of anthranilic acid and was determined by high-performance liquid chromatography. RESULTS: The concentration of anthranilic acid was significantly higher in orthodontic patients (p = 0.043) in comparison to healthy volunteers. The mean time of orthodontic treatment was 15.0 +/- 2.03 months. We did not observe existence of correlation between anthranilic acid concentration in saliva and time of orthodontic treatment (r = -0.250; p = 0.517). CONCLUSION: These results might indicate that anthranilic acid can be one of many factors initiating of periodontal disease in orthodontic appliances.