[Foreign material in the gingival tissues admixed with a clinical picture of Mucous Membrane Pemphigoid: A coincidence or inter-related conditions?].

We present a case of a 74-year old female who complained of chronic vesicular and ulcerative lesions distributed on her gingivae. The lesions did not respond to conventional periodontal treatment. The clinical appearance was consistent - with vesiculo-bullous conditions, such as Pemphigus Vulgaris and Mucous Membrane Pemphigoid. These conditions have an auto- immune etiology, whereby pathologic auto-antibodies are generated against structures that constitute the epithelial cell-cell or cell-connective tissue attachment systems. Accurate diagnosis is mandatory due to the high risk, at least in part of them, to spread to extra- oral sites, such skin, eyes and other types of mucosae and cause severe morbidity and even death. Diagnosis is based on routine biopsy aimed to identify the characteristic histomorphological features and on direct immunofluorescence that highlights the type and pattern of the deposition of the auto-antibodies with the affected tissue. The present biopsy did not show features of a vesiculo-bullous condition. However, the presence of a foreign material in the form of fine granules was highlighted by polarized microscopy. Immunofluorescence revealed a %pattern of auto-antibodies that was supportive of Mucous Membrane Pemphigoid. In lack of involvement of any other oral site, the patient has been treated with local agents, as commonly accepted. The present case emphasizes the need to consult specialists from various disciplines, especially in those cases where the clinical response to a common practice is not as expected. Furthermore, diagnosis is not always straightforward, and sometimes a pathologic condition may be the "product" of more than one single etiology.

[Biopsy from the oral cavity: Why, when, how and especially what not].

Caries and periodontal disease are the most common pathologies encountered by general dental practitioners on a daily basis. Although less frequently, the oral cavity is also affected by a plethora of pathologic lesions that may represent either a local process or may be a manifestation of systemic conditions. The etiology of these lesions is diverse and ranges from congenital/ developmental, reactive, to neoplastic (benign and malignant), metabolic and hereditary. These lesions are expected to be recognized by the dental clinicians whose main concern would be to achieve a prompt and accurate microscopic diagnosis. The way to a microscopic diagnosis goes through a biopsy procedure. The principles that should guide the dental practitioner for producing a high quality, artefact-free tissue sample from the oral cavity are reviewed in the article together with notes on errors that should be avoided. The patient's life can sometimes depend on a tissue sample as small as 0.5 cm, hence the utmost importance of the strategic and technique-related considerations to be taken by the general dental practitioner prior to performing a biopsy from the oral cavity. In certain cases, the dental practitioner should use the services of specialists in oral medicine or oral and maxillofacial surgery in order to proceed with the biopsy procedure and get a prompt and accurate diagnosis.

[Manifestation of Zoster in the Oral Cavity].

Zoster (shingles) is assumed to affect 10-20% of the individuals who have been exposed to the varicella zoster virus (VZV). It is expected to develop among the elderly, usually on the background of a weakened immune system. In those cases that the trigeminal branches are involved by zoster, unilateral mucosal and cutaneous vesiculo-ulcerative lesions will develop. Intense pain usually precedes the overt lesions of zoster, which sometimes might mimic acute pain of dental origin. Careful anamnesis and thorough clinical examination should lead to a correct diagnosis. Since zoster, in general, is associated with serious morbidity, including post-herpetic neuralgia, ocular damage and hearing deficits, the Centers for Disease Control and Prevention (CDC) currently recommend shingles vaccination, especially for those who are > 60-year old.

[Nutraceuticals in the combat against oral cancer].

Head and neck squamous cell carcinoma (HNSCC), the eighth most common cancer worldwide, accounts for approximately 600,000 new cases per year. The mobile tongue is the most common site for oral cancer and is associated with a poorer survival than other HNSCC sites. Standard therapeutic strategies have failed to significantly improve survival rates that have remained around 50% over the past four decades. In the last decade intense investigations on oral cancer highlighted the mandatory role of the tumor microenvironment (TME), in addition to the genetic aberrations and molecular biology changes within the cancer cells. Furthermore, the molecular crosstalk between cancer cells and TME components (i.e., cancer-associated fibroblasts, inflammatory pro-tumorigenic cells, etc.) has a crucial role in growth, invasion, spread and metastases of the cancer cells and consequently leads to poor prognosis. Recent studies suggest that plant-derived dietary agents nutraceuticals, especially curcumin and green tea, have the advantage to combat both malignant cells and TME components, unlike standard anti-cancer protocols that target only cancer cells. However, due to a very low bioavailability, nutraceuticals do not currently constitute an integral part of these protocols. Ongoing developments in nanotechnology for improved delivery are expected to overcome their challenging pharmacokinetics.

[Potential risks, adverse effects and drug interactions associated with herbal medicine in dental patients].

Herbal medicine is an increasingly common form of alternative therapy in the United States. Most herbal products are considered dietary supplements and thus are not regulated as medicines. They are marketed without prior approval of their efficacy and safety by the Food and Drug Administration (FDA). Some herbal medications have potentially harmful side effects as well as adverse interactions with conventional drugs. The adverse reactions involve all systems, age groups and severity. It is important for dentists and other health care providers to obtain adequate information as to what herbal medications their patients are taking. It is also necessary for professionals to acquire knowledge regarding herbal medications as to their use and to educate their patients about the risk-benefit and potential interactions these medications may have with over-the-counter and prescription drugs. The purpose of this article was to review the literature on the potential risks of commonly used herbal medications: Ginkgo Biloba, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, Garlic, Kava and Ephedra.