Mouth-rinsing with chlorhexidine causes a delayed, temporary increase in the levels of oral viridans streptococci.

The indigenous oral flora of 27 volunteers was monitored longitudinally over a 4-week period. Bacteria attached on buccal epithelial cells were counted by microscopy. Salivary bacterial colonies and the presence of alpha-hemolysis were examined after aerobic culturing on blood agar plates. The buccal and salivary bacterial counts were stably maintained in most subjects in the two repeated base-line samplings taken at 1-week intervals. Rinsing with a chlorhexidine mouthwash 45 min before sampling dramatically reduced the amount of epithelial cell-adherent bacteria. One day after the chlorhexidine rinse, however, the numbers of the epithelial cell-adherent bacteria exceeded the base-line level, and a similar decrease-increase pattern of changes was detected for the salivary alpha-hemolytic streptococcal counts. The non-hemolytic salivary bacterial counts were not affected by chlorhexidine. Subsequent weekly samplings showed no difference from the base-line samplings. The chlorhexidine-induced, delayed increase of viridans streptococci on oral epithelial surfaces should be considered a possible risk factor in medically compromised patients.

Chronic sclerosing osteomyelitis of the mandible in monozygotic twins.

Identical female twins with chronic sclerosing osteomyelitis of the mandible are presented. The diagnoses of both at the age of 12 years were based on typical history, and on clinical, radiographic, and histologic findings. High concentrations of IgA and IgG were detected in the serum of both patients, but deviations were not observed in other immunologic variables. The normally commensal organism, Propionibacterium acnes grew from a bone biopsy specimen from the mandible of one twin. No oral focus of the disease was confirmed in either case. We suggest that hereditary factors must have played a role in the pathogenesis of these cases of chronic osteomyelitis.

Gigantiform cementoma affecting a Caucasian family.

A Caucasian family is presented in which two out of three children showed lesions resembling gigantiform cementoma clinically, radiologically and histopathologically. Both affected children had swellings of the alveolar crest, caused by large, lobular, radio-opaque masses in all four quadrants of the jaws. Histologically, cementum-like masses were surrounded by inflamed fibrous connective tissue. There was evidence indicating that the late father had similar lesions which became malignant following radiation therapy.

Conventional radiographic and computed tomographic findings in cases of fracture of the mandibular condylar process.

A total of 40 patients with 46 fractures of the mandibular condylar process were examined an average of 47 months after the injury. The conventional radiologic examination consisted of panoramic radiography and lateral transcranial view of the fracture in the mouth-open and mouth-closed positions. Sixteen patients with 21 fractures of the condylar process were examined additionally by computed tomography (CT) because of temporomandibular joint problems in the sagittal and coronal projection. Computed tomography revealed bony changes in the fractured mandibular condyle and its position in the mandibular fossa more exactly than conventional radiographic examinations. Furthermore, the results showed that disturbances in the position and function of the articular disc may be more common than was earlier anticipated, suggesting the more frequent use of CT examinations to evaluate temporomandibular joint changes after condylar process fractures.

Hereditary gingival fibromatosis associated with growth hormone deficiency.

A case report of gingival fibromatosis in association with growth hormone (GH) deficiency due to a lack of growth hormone releasing factor (GRF) is presented. The girl is the youngest member of a family of eight children, five of whom lack the same hormone and have or have had similar gingival enlargements. After the growth hormone deficiency had been diagnosed and hormone substitute administered the dental age of the girl presented came closer to that of her age and sex-matched controls but did not reach the corresponding values even though the teeth were exposed by excising the overgrown gingiva. Test fibroblasts cultured from the overgrown gingiva proliferated at a slower rate than those cultured from age-matched controls. Total RNA was extracted from the test and three control fibroblasts and examined by Northern hybridisation using cDNAs for pro alpha 1(I) and pro alpha 1(III) chains. The amount of type I and III procollagen mRNAs were lower in the test fibroblasts as compared to the controls.

Treatment of mandibular fractures. Need for rigid internal fixation.

The treatment of 200 mandibular fractures was evaluated retrospectively with special reference to the need for rigid internal fixation (AO-plating), as indicated by the ASIF organization. It was shown that the treatment was most typically intermaxillary fixation (50%) followed by Gunning-type splints (17%), wire (16%) and plate (6%) osteosynthesis, while 11% received no active treatment. Complications during splinting were most common among patients treated by osteosynthesis via an extra-oral approach. Most of the fractures (73%) were estimated to be anatomically suitable for AO-plating. One fifth (22%) had relative indications for the use of rigid internal fixation, and 59% had absolute indications, mostly due to simultaneous condylar and corpus (body) fractures or due to fractures in the angle region.

Madelung's disease (benign symmetric lipomatosis).

Madelung's disease, benign symmetric lipomatosis, is a rare disease of undetermined cause characterized by symmetric deposits of diffuse adipose tissue on the cheeks, the neck, and the upper trunk. This article outlines our experience with four patients and presents a case report of a specifically remarkable affectation that agrees with previous data linking male alcoholics with this disease. The treatment in all cases was palliative surgical removal of excess fat from the neck and paracervical regions.

[Behavior of cysteine proteinase inhibitors in autologous epidermis transplanted into oral mucosa for relative elevation of the alveolar process]. / Das Verhalten der Cysteinproteinaseinhibitoren nach autologer Epidermistransplantation in die Mundschleimhaut zur relativen Erhöhung des Alveolarfortsatzes.

The presence of cysteine proteinase inhibitors was investigated in skin autografts into the gingiva of denture carriers. Acid cysteine proteinase inhibitors was present both in the transplant and the surrounding gingival epithelium, while neutral cysteine proteinase inhibitors was seen only in the gingival epithelium. The results indicate that the normal expression of cysteine proteinase inhibitors is conserved during the adaptation of the skin autograft into the oral surroundings.

Localization of three inhibitors of cysteineproteinases in the human oral mucosa.

3 known human cysteineproteinase inhibitors--neutral cysteineproteinase inhibitor (NCPI), acid cysteineproteinase inhibitor (ACPI) and serum alpha-cysteineproteinase inhibitor (alpha-CPI)--were localized immunohistochemically in the squamous epithelium of the mouth by using the peroxidase-antiperoxidase complex method and formaldehyde-fixed paraffin-embedded tissue sections. Neither ACPI nor NCPI was found in the 2 to 3 most basal cell layers of the epithelium, but a strong cytoplasmic reaction was seen in the upper cell layers by using either anti-ACPI or anti-NCPI serum. In some cells the most dense stain precipitate was seen around or in the nucleus, and in the highest cell layers the staining was sometimes associated with the cell membrane. alpha-CPI was localized mainly in the epithelial stroma and in the intercellular space of the epithelium.

Transplantation of free tibial periosteal graft on alveolar bone defect in adult rabbit.

The healing of bone defect in eight adult rabbits was studied. The age range of animals was 5-23 months. The bone defects were made symmetrically in the inferior surface of the mandibles. At the defect site the root surface of continuously erupting mandibular incisors was exposed. On the left side, the bone defect was covered with a local periosteal flap (control side) and on the right side the defect was covered with a free periosteal graft from the tibia (test side). The healing of bone defects and the amount of new bone were studied. The quality of the bone formed was investigated histologically. The findings of this investigation led to the following conclusions: (1) The bone defects healed on both sides. The amount of bone on the control side was identical to that in the anatomical region. On the test side the amount of bone formed was in seven cases two to threefold that formed on the control side. (2) The histological study proved that the bone formed was lamellar bone, being identical on both the control and the test side. (3) The ages of the animals or the length of follow-up time did not affect the amount of new bone, the healing of the defect or the quality of new bone. (4) The eruption of the incisors was symmetrical. In this study the free periosteal graft from the tibia led to better bone formation than the local periosteal flap in the induced bone defects of the tooth-bearing region in the mandible of the adult rabbit.

Evaluation of autotransplantations of completely developed maxillary canines.

Transplantation of 28 maxillary canines was followed up in 22 patients with an average age of 25.2 s.d. 9.9 years. The root was fully developed. The mean immobilization time was 6.6 weeks and the mean follow-up period 17.8 months. Results seemed to be better in the age group of 13--20 years than in 21--30 and 31--47 years. Statistically significant better results were found in the youngest than in the older groups in the return of vitality, vertical bone resorption, periodontal space in the lamina dura. Four of the 28 teeth were extracted because of great mobility caused by poor bone regeneration and vertical resorption of the alveolar bone: three in the middle age group and one in the oldest. Pulp extirpation was performed on nine teeth: six in the oldest group and three in the middle group. Vitality returned in only three teeth, all of which belonged to the youngest group. Root resorption was observed in all age groups; in 76% of the cases it occurred in the apical third, and was generally inflammatory. The causes of the failure of transplantation were considered to include damage of the transplant during removal from deep palatal malposition, poor regeneration of the bone around the transplant and chronic periodontal infection. The prognosis for transplantation was found to be fairly good for patients under 20 years of age but poorer for older age groups.

Midface deviation due to mandibular fractures. (An experimental study with clinical comparison).

An experimental study was undertaken into the effect of fractures produced in the body of the mandible, the base of the condylar process and the mandibular condyles, on the bones of the middle third of the face using rabbit sucklings. The rabbits were sacrificed when fully grown, when it was found that in all cases the bones of the middle face had deviated to the traumatized side in comparison with the neurocranium. The greatest asymmetry occurred after injuries to the condyles and least following injuries to the body of the mandible. A comparative study on patients past growing age who had had an injury to the condyle before the age of 10 years suggested a similar disturbance of development. The present material, however, was so limited that reliable conclusions could not be drawn.

Diagnosis of fractures of the head and neck with the aid of cylindrical pantomograms taken with a new device.

The use of cylindrical image layers in pantomographic roentgen diagnosis of fractures of the middle third of the face and base of the skull, is presented. Three dimensional pictures are presented from the horizontal, backward tilt (retroversion) and forward tilt (anteversion) projections as well as the projection of the base of the skull, which yield most information. Of these, the horizontal projection may be considered to be the projection which provides the best basic picture of the middle third of the face. The backward tilt projection reveals the bone structures of the central area and fractures in them best. Fractures in the lateral region are best seen in the forward tilt projection. The radiography of the base of the skull and the lateral walls on one film also presents a new application of the pantomographic technique. The positions of the patient used in taking these roentgenograms with a new pantomographic device developed for patients in a horizontal position are explained, and photographs of them presented. The future aims of this investigation series are referred to in the discussion.

A comparative study of gonial angle and growth of the lower third molar in cleft lip and palate. An orthopantomographical study.

In children and young adults with cleft lip and palate, the gonial angle, the angle between the lower second molar and the mandibular plane, the angle between the longitudinal axes of the second and third molars as well as the timing of the development of the third molar were investigated on the right and left side from orthopantomograms. The results were compared with the corresponding results in a noncleft Finnish material. The series consisted of 100 randomly selected subjects aged from 10 to 24 years, 57 males and 43 females. One to three orthopantomograms were available for each subject, totalling 201. The results were examined in a cross-sectional and longitudinal material. The right and left gonial angles were not found to differ in the different cleft groups. Among subjects with cleft lip and palate the gonial angle was found to be larger in the different age groups than the corresponding values in the comparison material. In both materials, the gonial angle was found to decrease between the ages of 10 and 15 years. In males with cleft lip and palate the decrease in this angle, however, continued up to the age of 19. The anterior angle between the longitudinal axis of the lower second molar and the mandibular base line was about 10 degrees larger than in the comparison material, being slightly larger than that in the Angle's Class III occlusion type in the comparison material. When examined by degrees of development the development of the lower third molar was delayed approx. 0.9 years in males and 1.6 years in females compared with the corresponding times in the comparison material.

Determination of the gonial angle from the orthopantomogram.

This study demonstrates that the size of the gonial angle can be determined from the orthopantomogram with the same degree of accuracy as from the generally used lateral cephalogram, the gonial angle being formed by the tangents of the lower border of the mandible and the distal border of the ascending ramus and the condyle on each side. It also shows that the right and left gonial angles can be quite easily determined individually from orthopantomograms, thus avoiding the disturbing influence of the superimposed images found on lateral cephalograms. It proves conclusively that the orthopantomogram is the more obvious choice for determination of the gonial angles.