Bisphosphonates treatment and orthodontic considerations.

Currently, the use of oral and systemic forms of bisphosphonates is increasing dramatically in a large group of patients either in the form of anti-osteoporosis medications or as a part of a chemotherapeutic regimen for several malignant diseases. As adult orthodontic treatment has become more widely accepted in most orthodontic practices, orthodontists must be aware of the risks, benefits, and effects of bisphosphonates use on the patient's general health status, as well as on their orthodontic treatment outcomes. This review aims to discuss the use of bisphosphonates, the complications associated with their use, and their impact on orthodontic treatment.

Soluble forms of Toll-like receptor 4 are present in human saliva and modulate tumour necrosis factor-alpha secretion by macrophage-like cells.

In health, mucosal inflammation is prevented by tightly regulated responses via Toll-like receptors (TLR) that interact with specific microbe associated molecular patterns. Currently, 13 TLRs have been identified. Based on the specificity of ligand recognition, TLR-2 and TLR-4 can recognize most oral commensal microorganisms. Recent identification of some soluble TLRs (sTLRs) suggests additional regulatory roles for these receptors. We report here the presence of sTLR-4 polypeptides in adult human saliva. Functionally, the salivary sTLR-4 suppressed cytokine secretion by activated macrophages. The sTLR-4 levels were elevated significantly in oral lichen planus (OLP), a chronic inflammatory condition of the oral mucosa characterized by clinical persistence. In contrast, the epithelial cells in the saliva of OLP subjects expressed significantly reduced TLR-2 and TLR-4 mRNA that correlated with fewer bacteria/salivary epithelial cells. Investigating the soluble and cellular components of saliva is useful in identifying potential biomarkers for oral mucosal lesions.

Hydroxyapatite/PMMA composites as bone cements.

Currently PMMA is the polymer most commonly used as a bone cement for the fixation of total hip prostheses. Ideally, a bone cement material should be easy to handle, biologically compatible, nonsupporting of oral microbial growth, available in the particulate and molded forms, easy to obtain, nonallergenic, adaptable to a broad range of dental and medical applications, in possession of high compressive strength, and effective in guided tissue regenerative procedures. One of the problems associated with the conventional types of bone cement used is their unsatisfactory mechanical and exothermic reaction properties. The purpose of this in vitro study was to investigate and compare the mechanical properties (three-point bending strength, energy-to-break, and modulus of elasticity) and physical properties (setting time, water sorption, and exothermic heat) of HA/PMMA (HA group) and bovine-bone originated HA/PMMA (BB group) composites. Composites samples were fabricated by admixing method. It was found that the addition of HA and BB particles increased the water sorption. Generally 10 v/o 20 v/o HA and 0 v/o to 10 v/o BB ratio combinations had significant beneficial effects on the mechanical properties. The heat generated during polymerization was influenced by the different admixtures. More than 40 v/o HA and 40 v/o BB should be mixed into PMMA to reduce the peak temperature. Overall evaluation indicated that the BB group had better properties than the HA group.

Transepithelial Brush Biopsy: an adjunctive diagnostic procedure.

The TBBCA is an easy-to-use, chairside technique for determining the significance of an oral lesion. It was accurate in the detection of precancerous and cancerous lesions in multicenter trials. It is well accepted by patients because there is almost no pain or discomfort, minimal bleeding, and no need for sutures. It is anticipated that the introduction of this diagnostic test will increase public and professional awareness of oral precancer and cancer by promoting early detection. The TBBCA overcomes obstacles that have impacted early oral cancer detection by eliminating guesswork about which lesion requires surgical biopsy, reducing the tendency to delay referral of patients for scalpel biopsy, and reducing patients' hesitation to comply with follow-up surgical biopsy.

Linear IgA disease histopathologically and clinically masquerading as lichen planus.

In each of 2 cases reported, the patient presented with features of erosive lichen planus or lichenoid drug eruptions and an incisional biopsy taken from the patient was diagnosed histologically as lichen planus. Subsequent recurrences or exacerbations were associated with vesiculobullous lesions. Simultaneous or subsequent direct immunofluorescence studies--from the same tissue sample in one case and from a similar site in the other case--demonstrated classic features of linear IgA disease. Both patients were originally treated for lichen planus with systemic and/or topical corticosteroids with limited success. One patient was treated with sulfapyridine with minimal improvement. Both patients were subsequently treated with dapsone and demonstrated significant clinical improvement. We propose that linear IgA disease may be more common than reported in the oral cavity, inasmuch as many cases of recalcitrant lichen planus, erosive lichen planus, and lichenoid drug eruptions, especially those with a vesiculobullous component, may in reality represent linear IgA disease. We recommend that direct immunofluorescence be done in any case in which bullous lichen planus is suspected.

Oral lichen planus: an immunohistochemical study of heat shock proteins (HSPs) and cytokeratins (CKs) and a unifying hypothesis of pathogenesis.

The expression of heat shock proteins HSP60 and HSP70 and cytokeratins CK1/10 and CK7/18 were compared in epithelium of oral lichen planus (OLP) lesions and oral fibromas using an avidin-biotin-peroxidase complex (ABC) immunohistochemical method. An immunostaining intensity distribution (IID) index was developed to assess staining intensity and the proportion of positively stained cells in different layers of the epithelium. The expression of HSP60 in the basal layer was significantly higher in OLP than in fibromas. No difference in HSP70 expression was evident between OLP and fibromas. The expression of CK1/10 in the epithelial basal and suprabasal layers was significantly higher in OLP than in fibromas. There was no demonstrable staining for CK7/18 in either OLP or fibromas. A significant correlation was evident between the expression of HSP60 and CK1/10 in the basal epithelial cells in OLP. The findings support a role for HSP60 in the pathogenesis of OLP. A unifying hypothesis of the pathogenesis of OLP, involving two sequential immune reactions, is proposed.

Vesiculobullous disease of the oral cavity.

This article reviews the clinical features of vesiculobullous diseases with oral manifestations. Oral vesiculobullous diseases may be viral, immunologically mediated, drug induced, hereditary, or traumatic in origin. A general approach to the diagnosis is outlined, including immunofluorescent testing of suspected vesiculobullous disease. Recommendations for treatment of oral vesiculobullous diseases are included.

Mouthwash and oral cancer.

Recently, a small but significant relationship has been identified between the use of over-the-counter mouthwash preparations containing greater than 25 percent alcohol and the development of oral cancer. This paper reviews the medical and dental literature, discusses the implications of long-term, excessive mouthwash use and makes recommendations regarding the use of mouthwash with a high alcohol content.

Oral hairy leukoplakia.

Oral hairy leukoplakia, usually observed on the lateral border of the tongue, may herald the development of symptomatic human immunodeficiency virus infection. This paper reviews the pertinent clinical features and differential diagnosis, histology, methods of establishing a definitive diagnosis, and management of the patient with this Epstein-Barr virus-associated lesion.

Oral focal acantholytic dyskeratosis.

Focal acantholytic dyskeratosis (FAD) is an uncommon lesion of the oral mucosa with only 22 cases reported in the medical/dental literature. Fifteen additional cases of solitary oral FAD are presented. Of these cases, 4 occurred clinically as leukoplakia. Leukoplakia-associated lesions may be an addition to the current classification of solitary FAD.

Melanoacanthosis (melanoacanthoma) of the oral mucosa.

A pigmented lesion of the oral mucosa that bears histologic resemblance to the cutaneous melanoacanthoma is discussed. A study of 22 cases, including 4 in the current series, shows that the intraoral lesion occurs most commonly in adult black women on the buccal mucosa and lip. The lesion is known to regress. The term melanoacanthosis is suggested for this condition.

Erythema migrans--a psoriasiform lesion of the oral mucosa.

Psoriasiform lesions are unusual occurrences on oral mucosa. Nineteen cases of erythema migrans are presented with a discussion of the literature. Fifty-eight percent of these cases presented with tenderness, pain, or roughness. One case was associated with geographic tongue and two cases with cutaneous psoriasis.

Oral condyloma acuminatum.

Fifty-one cases of oral condyloma acuminatum are reported, bringing the total number in the English medical/dental literature to approximately 156 cases. Ninety-five percent of the 59 new cases were in males. Eight-one percent occurred in the age range of 21-40 years. The most common locations were upper lip, lingual frenum, dorsum of the tongue, and lower lip. Thirty-four percent presented with multiple lesions.