Allergic reactions in oral and perioral diseases-what do allergy skin test results show?

OBJECTIVE: The aim of this study was to examine potential allergic reactions to different materials in oral and perioral diseases. STUDY DESIGN: The study included 230 consenting subjects in total-180 patients with oral and perioral diseases (30 patients each in the following groups: angioedema, oral lichenoid reactions [OLRs], burning mouth syndrome [BMS], gingivostomatitis, cheilitis, and perioral dermatitis) and 50 healthy controls. Comprehensive diagnostic workups were performed prior to patch testing with standard series allergens and with specific dental materials and skin prick testing (SPT) for food, preservatives and additives, and inhalants. RESULTS: Positive allergy test results were more common in patients with oral diseases than in controls, with significantly greater frequency of contact allergies in the cheilitis group (P = .048). The most common allergens in the majority patients were cobalt chloride (13.3% in BMS vs 10% in controls) and nickel sulfate (10% in gingivostomatitis and 6.7% in cheilitis vs 3.3% in controls), and preservatives (23.3% in angioedema and BMS). CONCLUSIONS: Allergy skin tests are reliable and justified for diagnosing allergies in cases of persistent or recurrent oral diseases. This is the only way to confirm allergies and is the basis for consequent allergen avoidance for the benefit of the patient.

Phagocytic functions of salivary neutrophils in oral mucous membrane diseases.

BACKGROUND AND PURPOSE: Phagocytic functions of salivary polymorphonuclear neutrophils (sPMNs) have not been comprehensively studied in patients with oral mucous membrane diseases, although available data suggest the role of immunity in their pathogenesis. SUBJECTS AND METHODS: Phagocytic functions of sPMN were determined in 15 patients with acute recurrent aphthous ulceration (RAU), 11 patients with oral lichen planus (OLP) and 20 healthy volunteers. In healthy subjects, the same parameters were also determined in peripheral blood polymorphonuclear neutrophils (bPMNs). Phagocytic activity (proportion of ingesting cells, PA), ingestion ability (number of ingested targets per 100 phagocytes, IA) and intracellular microbicidity (proportion of killed targets, IM) of PMNs separated from peripheral blood and the whole unstimulated saliva were determined by acridine orange method with living yeast cells as targets. RESULTS: Salivary PMNs in healthy individuals showed significant reduction in PA (33% vs. 76%; P < 0.009) and IA (0.47% vs. 2.93%; P < 0.009) and significant increase in IM (12.0% vs. 5.5%; P = 0.011) in comparison with bPMNs. In RAU patients, reduced PA (27% vs. 37%; P = 0.035) and IA (0.25% vs. 0.47%; P = 0.05) were detected, while in OLP patients enhanced IM was detected (12% vs. 19%; P = 0.033) in comparison with healthy controls. CONCLUSION: Salivary PMNs present functional features distinct from those in peripheral blood. Some phagocytic functions of sPMNs are reduced in RAU and enhanced in OLP, indicating their role in pathogenesis or reflecting clinical changes in these conditions.

Salivary levels of vascular endothelial growth factor (VEGF) in recurrent aphthous ulceration.

BACKGROUND: Vascular endothelial growth factor (VEGF) is a multifunctional angiogenic cytokine involved in angiogenesis and wound healing. Its presence in recurrent aphthous ulceration has not been reported to date. The aim of this study was to investigate the association of salivary levels of VEGF with various stages of recurrent aphthous ulceration (RAU). METHODS: VEGF levels were determined in a group of 27 age and sex-matched healthy controls and in 30 patients with minor and major RAU grouped into the three stages: (I) early active stage, (II) active stage, and (III) remission period. VEGF levels (pg/ml; mean +/- SD) in unstimulated whole saliva were determined by enzyme immunoassay. RESULTS: Patients with major RAU - stages I and II - had decreased VEGF values (765 +/- 458 and 341 +/- 109, respectively) when compared both to healthy controls (1652 +/- 567; P < 0.01) and to stage III major RAU (1524 +/- 784; P < 0.005). CONCLUSION: Salivary VEGF levels seemed to be associated with ulcer development in major RAU, showing stage-dependent alterations during the course of this disorder.

Helicobacter pylori colonization of tongue mucosa--increased incidence in atrophic glossitis and burning mouth syndrome (BMS).

Nested polymerase chain reaction (PCR) was performed to detect the presence of Helicobacter pylori in tongue mucosa in 268 patients divided into four groups according to their diagnosis: 87 with atrophic glossitis, 37 with benign migratory glossitis and 144 with burning mouth syndrome (BMS). The latter group was subdivided according to anatomic site of burning sensation: subgroup A (54 patients) with complaints limited to tongue and subgroup B (90 patients) with burning sensations in other parts of oral mucosa. H. pylori was found in 43 samples (16%). Bacteria were significantly less present in tongue mucosa affected with benign migratory glossitis compared with atrophic glossitis and BMS (P=0.025). This difference was more obvious when compared with atrophic glossitis only (P=0.006). Mucosal changes in these conditions might make the oral environment more acceptable for H. pylori colonization compared with normal mucosa, and this mechanism may play a role in its oro-oral transmission.

Xerostomia in patients with triple A syndrome--a newly recognised finding.

Triple A syndrome is characterised by achalasia, alacrima, adrenal insufficiency and progressive neurological abnormalities including impaired autonomic nervous function. We present five patients with triple A syndrome in whom we describe xerostomia for the first time, a symptom which was presumed to be practically exclusive to Sjøgren syndrome and familial dysautonomia. Conclusion We recommend the investigation of salivation in all patients with triple A syndrome and treatment of xerostomia in order to ease swallowing. Further, our results corroborate earlier doubts that some patients with Sjøgren syndrome, especially those with the so-called "achalasia sicca" syndrome and adrenocortical insufficiency, actually had triple A syndrome. Therefore, adrenocortical function should be assessed in all patients with Sjøgren syndrome, particularly in those with difficulties in swallowing, because even latent adrenocortical insufficiency could be life-threatening for these patients in stressful situations.

The p53 and nm23-H1 genes are not deleted in oral benign epithelial lesions.

In an effort to identify genetic changes that may be the early hallmarks of epithelial cell overproliferation, we searched for p53 and nm23-H1 allelic deletions in oral benign epithelial lesions. In the study group were 25 benign epithelial lesions (lichen planus--17; leukoplakia--8; recurrent aphthous ulcers--2; one specimen diagnosed as benign migratory glossitis). Among 21 samples analysed for exon 4 (p53 gene) LOH, only 6 were informative, with no loss of either allele. OF 23 samples tested for LOH at intron 6 of p53 gene, 8 were informative, again with no presence of LOH. For nm23-H1 gene, the analysis was performed on a total of 24 cases. Of them, 16 were informative, however, none exhibited LOH at this locus. In conclusion, whereas the presence of gross gene alterations (LOH) would have been definitive evidence for the involvement of p53 and/or nm23 in the hyperproliferation process, the absence of LOH does not exclude the presence of either smaller mutations, altered regulation of normal gene, or dysfunction at the level of wild type protein. Alternatively, p53 and nm23-H1 may have no relation to oral lesion formation, and cannot presently be considered as an early step in benign, tissue transformation.

Detection of Helicobacter pylori in various oral lesions by nested polymerase chain reaction (PCR).

Nested PCR was used for the detection of Helicobacter pylori DNA in specimens collected from seven different topographic sites in the oral cavity. Out of 161 patients, only 21 (13.04%) were positive. There was no correlation between H. pylori status and patient diagnosis and age. No preferential site for bacterial colonization was found in the oral cavity, nor was an association established between a bacterial presence and ulcerated versus non-ulcerated lesions. The results indicate that the oral mucosa does not appear to represent a preferred site of colonization for H. pylori. Furthermore, the evidence presented in this paper suggests that H. pylori is not pathogenic in the oral cavity, nor is it associated with common oral pathologic processes.

Reduction of epithelial dendritic cells in keratotic lesion of oral lichen planus.

The number and distribution of epithelial dendritic cells (EDC) in oral mucosal lesions are variable depending on the degree of epithelial maturation/differentiation and disease activity. Localized absence of EDC might impair mucosal immunologic protection, allow microbial colonization and enhance carcinogenesis. Increased number of EDC during the early stage of oral lichen planus (OLP) suggests their increased antigen-presenting capability and immunologic activity with inflammatory reaction, but their role in the process of keratinization remains unclear. Therefore, the purpose of this study was to determine the number and distribution of EDC in 33 biopsy specimens from lesions of OLP and from 18 control specimens of leukoplakia (LPL) at sites undergoing increased keratinization. Cells were identified immunocytochemically by the presence of antigen CD68 and labeled with acid phosphatase (AP) and alpha-naphthyl acetate esterase (ANAE) techniques. Numbers of EDC were expressed per mm epithelial surface length. Significantly more EDC with prominent histoenzymatic activity of AP and ANAE were present in OLP than in LPL. Intense enzymatic activity of ANAE was expressed in EDC of OLP with hyperparakeratosis. In the lesions with increased keratinization the number of EDC was markedly reduced in OLP while in LPL remained unchanged. Reduced number and subbasal redistribution of EDC in OLP suggest diminution of immunologic reaction and disease activity but also increased tissue vulnerability to various antigen challenges.

[Use of soft laser in the treatment of oral symptoms]. / Efikasnost mekog lasera u lijecenju oralnih simptoma.

Due to insufficient casual therapy of oral symptoms of dyniae and pyrosis, we applied infrared soft laser in treatment of patients with those oral symptoms. The laser had a wavelength of 904 nm and a radiation strength of 20 W. The tests were performed on 40 persons with stomatopyrosis and stomatodiniae symptoms, under application of laser through 5 days consecutively with radiation of mucosa lasting 3 minutes on 1 cm2. The testing group was represented by persons exclusively under the laser therapy and the control group was represented by 30 persons, who were under a medicamentose therapy with vasodilatator applied with iontophoresis. By persons with stomatopyrosis and stomatodiniae symptoms analgetic effect was attained through the therapy with the laser already after the first application, and the pain and aches intensity was relieved every day during the therapy, by stomatodinae to complete healing. The obtained differences in the intensity of symptoms before and after the therapy were statistically important. The thermoestesiometric determination of laser efficiency by vasodilatation showed differences which were not important, although the temperature during the therapy has slightly increased for 0.1 degrees C. The soft laser can be used as an effective remedy in the treatment of oral symptoms of stomatopyrosis and stomatodinae.