Salivary secretion, mucin concentrations and Candida carriage in HIV-infected patients.

OBJECTIVES: To test whether the submandibular/sublingual (SMSL) salivary secretion, mucin concentration and candida carriage status were altered in human immunodeficiency virus-positive (HIV+) patients. SUBJECTS AND METHODS: SMSL saliva collected from 48 HIV-infected and 31 HIV-negative men were analyzed for flow rates, total protein and mucin concentrations. Salivary cultures were performed for Candida assessment. RESULTS: The salivary flow rate and protein secretion of the HIV+ patients was 37% and 32% less than that of the controls (P < 0.0001, P = 0.0087). The mucin concentrations (MG1 and MG2) were higher in the HIV+ subjects compared with controls (P = 0.0186, P = 0.0014); however, the mucin secretions were not different. The frequency of Candida-positive cultures was higher in the HIV+ subjects than in the controls (61.4%vs 24.1%, P = 0.0018). In the HIV-infected group, the unstimulated SMSL flow rates were lower in Candida-positive than in Candida-negative patients (P = 0.0158). CONCLUSION: The salivary secretion of the SMSL glands was reduced in HIV infection. Although the mucin concentration increased in HIV+ subjects, mucin secretion was not altered. Highly active antiviral therapy had no effect on salivary function. We found an association between the level of candida carriage and salivary flow rate in HIV-infected patients.

Buccal and palatal exostoses: prevalence and concurrence with tori.

OBJECTIVES: The aims of this study were to investigate the prevalence and location of oral exostoses and the concurrence of buccal and palatal exostoses with tori. STUDY DESIGN: With clinical inspection and palpation, 960 Thais were examined for the presence or absence of torus palatinus (TP), torus mandibularis (TM), and exostoses. RESULTS: Of the 960 subjects studied, 26.9% exhibited exostoses. Exostoses were more common in the maxilla than in the mandible (5.1:1). In addition, most of the exostoses were located on the buccal aspect of the jaws. The prevalence of exostoses increased with age (P = .000). Exostoses were significantly more common in men than in women (62.4% vs 37.6%, P =.000). Exostoses were concurrent with TM more frequently than with TP (36.2% vs 20.6%). The highest concurrence of exostoses with tori was observed in subjects who had both TP and TM (42.6%). CONCLUSIONS: The occurrence of exostoses is related to increasing age. TM and exostoses may share the same causative factors, and functional influences may contribute. Our findings lend support to the hypothesis that the etiology of exostoses involves an interplay of multifactorial genetic and environmental factors.

Herpes B virus infection.

Herpes B virus (B virus) infection is common in macaques. Primary infection of B virus in primates is similar to herpes simplex virus 1 infection in human beings, but B virus generally produces only mild localized lesions in its natural host. In human beings, however, B virus can cause severe infection that may lead to death from encephalitis. Contact with monkey saliva, tissues, or tissue fluids is the most commonly reported route of transmission of B virus; a single case of person-to-person transmission has been reported. Airborne transmission is postulated to have occurred as a result of clinical circumstances in two reported cases, but there is no strong evidence to support the hypothesis of aerosol infection. Because B virus infection in human beings is often fatal, awareness of the risk of B virus infection should be emphasized. Although B virus infection in human beings is rare, it is an occupational health risk in exposed health care workers and laboratory personnel. This review of the literature of B virus infection includes case reports and a discussion of the nature of the B virus, characteristics of B virus infection in primates and human beings, the treatment of human infection, and the implications for dental health care providers. This report also serves as an introduction of the disease to the dental literature.

Evaluation of medical consultations in a predoctoral dental clinic.

OBJECTIVE: A patient's medical condition can affect the delivery of dental care. Medical consultation is indicated for dental patients whose medical history is uncertain or when physical assessment may indicate an untreated medical problem. The aims of this study were to evaluate the use of medical consultation and determine how it affects dental treatment plans in a predoctoral dental clinic program. STUDY DESIGN: Reviews of 147 medical consultation requests were performed. RESULTS: The main reasons for medical consultations were cardiovascular assessment (51.5%) and diabetic status determination (12.6%). In the cardiovascular assessment category, hypertension (48.1%) and heart murmur (17.9%) were primary concerns. Main dental concerns were the need for preoperative antibiotic prophylaxis (33.3%) and the use of vasoconstrictors (20.4%). Overall, 32.1% of medical consultations resulted in an alteration in dental treatment plans. As a result of medical consultations, 8% commenced their medical management. CONCLUSIONS: These results indicated that medical consultations could reduce the medical risk associated with dental procedures and unnecessary antibiotic prophylaxis. Therefore for many dental patients, good communication between dentists and physicians is essential for adequate care.

Prevalence and clinical characteristics of oral tori in 1,520 Chulalongkorn University Dental School patients.

The objectives of this study were to determine the prevalence, size, shape and location of the oral tori in 1,520 Thai dental patients and to investigate the relationship between the findings with age and gender. The prevalence rates were 60.5% for torus palatinus (TP) and 32.2% for torus mandibularis (TM). The concurrence of TP and TM was noted in 23.2% subjects. The peak incidence of TP and TM was in the third decade of life. TP affected more women than men (70.5 vs. 48.8%, P < 0.001). Most TP were found in spindle shape (56%), small size (52.1%) and located at premolar region (47.4%). The occurrence of TM was higher in men than in women (36.3 vs. 28.6%, P = 0.002). TM was found most common in small size (65.6%), as bilateral multiple nodes (59.3%) and usually located at the premolars (89.2%). The age and gender-related differences with the size of tori were noted. Subjects who had larger TP or TM were older than those who had smaller TP or TM (P < 0.001 and P = 0.001, respectively). Women were more likely to have larger TP whereas men tended to have larger TM. This study showed high prevalence rates of TP and TM in dental patients and the occurrences were related to gender.

Allergic stomatitis.

There are basically two types of hypersensitivity reactions involved in allergic stomatitis, type I immediate hypersensitivity, and type IV delayed hypersensitivity. The allergic stomatitides may present with clinical appearances that mimic classic oral vesiculobullous and ulcerative lesions. Differential diagnosis from specific mucosal diseases is important in the treatment of oral allergy. Precise history taking and the elimination of the causative agents will be necessary. The mechanisms involved in oral reactions, etiologic factors, clinical manifestations, and treatment of allergic stomatitis will be described and discussed in this article.

Necrotizing sialometaplasia: review of 127 cases.

A review of 127 documented cases of necrotizing sialometaplasia is presented, mainly focusing on 96 palatal lesions. Necrotizing sialometaplasia is a benign, self limiting inflammatory lesion of the minor salivary glands. The cause is unknown but it may be related to oral trauma, tobacco use or inadequate blood supply. Male (mean age 49.8 yrs) to female (mean age: 36.3 yrs) ratio is 2.31:1. Because the clinical and histologic features mimic malignancy, proper diagnosis is of utmost importance in order to avoid unnecessary and extensive surgery and radiation therapy. The lesion heals spontaneously, regardless of therapy in two to eight weeks.

Oral mucosal conditions in elderly dental patients.

OBJECTIVES: The goals of this study were as follows: to obtain baseline information on the incidence of oral mucosal conditions in a population of elderly Thai patients and to investigate differences in the presentation of these findings in relation to age, sex and the wearing of dentures. SUBJECTS AND METHODS: The incidence of oral mucosal conditions was determined by the clinical examination of a sample of 500 Thai patients aged 60 years and older. RESULTS: The overall incidence of oral mucosal conditions was 83.6% with no significant difference between men (81.4%) and women (85%). The incidence of oral mucosal conditions indicated a significant increase with advancing age. Varices (59.6%), fissured tongue (28%) and traumatic ulcer (15.6%) were the three most common conditions; and the incidence increased with age. Leukoplakia and smoker's melanosis were more common in men whereas lichen planus was seen more frequently in women. Three cases of oral cancer were detected, representing an incidence of 0.6%. Denture wearers (62.7%) exhibited a significantly higher prevalence of oral mucosal conditions than subjects who had no dentures (28.5%) and subjects with crowns and/or bridges (8.8%). The three most common denture-related problems were traumatic ulcer (22.6%), denture stomatitis (14.3%) and angular cheilitis (4.8%). In addition, the incidence of denture-related conditions among complete denture wearers (46.3%) was higher than in those wearing partial dentures (40.8%). CONCLUSION: The current results regarding an elderly Thai population support the studies of other populations whereby the incidence of oral mucosal conditions in the elderly is related to age, sex and the wearing of dentures.

The relationship between salivary histatin levels and oral yeast carriage.

Candida species are common commensal inhabitants of the oral cavity. Human saliva contains antifungal proteins called histatins. We tested the hypothesis that oral yeast status is related to salivary histatin levels. Thirty subjects were divided into two groups based on the presence (n = 15) or absence (n = 15) of yeast on oral mucosa surfaces. Unstimulated and stimulated submandibular and sublingual and parotid saliva was collected from each subject. Salivary flow rates were measured and histatin concentrations were determined in the stimulated saliva samples. The yeast colony positive group showed lower median unstimulated parotid saliva flow rates as well as lower median concentrations of total histatins in submandibular and sublingual saliva. There was a negative correlation between yeast colony-forming units and unstimulated parotid saliva flow rates and between yeast colony-forming units and submandibular and sublingual saliva histatin concentration and secretion. The results suggest that oral yeast status may be influenced by unstimulated parotid saliva flow rates and by submandibular and sublingual histatin concentration and secretion.

Effect of folic acid on human oral epithelium in vitro.

The cytomorphological effects of folic acid were studied using in vitro established human oral epithelium. It was demonstrated that a concentration twice that used clinically (200 micrograms/ml) did not induce marked cytotoxic reaction in the cultured cells. The most pronounced changes were observed in cultures exposed to 200 micrograms/ml folic acid both in primary culture and subculture. The cultures displayed areas of degenerating cells showing oedema and increased translucency of the cytoplasm, flattened cells with distinct tonofilaments and atypical mitotic figures. Identical changes were found in cultures exposed to 50 and 100 micrograms/ml folic acid but to a lesser extent than in 200 micrograms/ml. These changes indicated that folic acid increased the number of cells undergoing terminal differentiation. From this study we suggested that folic acid when applied topically may play a role in local stimulation of epithelial cell differentiation leading to enhanced healing of oral ulcers.