Effects of an air-powder abrasive device used during periodontal flap surgery in dogs.

An air-powder abrasive system, the Prophy-Jet, is a commercially available product product intended for use during dental prophylaxis procedures. The purpose of this investigation was to assess the effects on periodontal tissues when the device is used as an adjunct to hand instrumentation in root preparation during periodontal surgery. The degree of tissue injury was assessed by evaluating clinical healing and by histometric analysis of the intensity of the inflammatory response at selected healing times. Surgical sites subjected to Prophy-Jet treatment tended to have slightly lower histometric inflammation scores than control sites treated by hand instrumentation alone. As judged by the inflammatory response and clinical healing, additional effects to surgical exposure of tissues of the periodontium were benign. Use of the Prophy-Jet instrument during periodontal surgery is effective and well tolerated.

Gingival fibromatosis with hypertrichosis. A case report.

A case of gingival fibromatosis with hypertrichosis is reported in a 3-year-old girl. Partial recurrence was observed 6 months after surgical treatment. Psychological benefits resulting from the cosmetic improvement may outweigh the probability of recurrences in this rare condition.

The effect of indomethacin on experimental dental periapical lesions in rats.

The role of prostaglandins in the pathogenesis of dental granulomas and associated bone loss was studied by testing the ability of indomethacin, a potent inhibitor of prostaglandin synthesis, to influence bone resorption in experimentally induced dental granulomas. The cusps of maxillary first molar teeth of Sprague-Dawley rats were ground away, exposing the dental pulps to the oral environment. Daily i.p. injections of 0.1 to 0.2 ml of indomethacin (10 mg per kg) dissolved in 95% ethyl alcohol were administered to one group of the rats while the other group received i.p. injections of 0.1 to 0.2 ml of 95% ethyl alcohol. The rats were killed after 6 wk and specimens of the molar teeth and surrounding jaw bone were taken for routine histopathological processing. The specimens from indomethacin-treated rats demonstrated milder inflammatory changes and a significantly lower degree of periapical alveolar bone resorption. These results support the suggestion that prostaglandins are involved in the events leading to bone resorption in dental periapical lesions.

Odontogenic myxoma.

The odontogenic myxoma is an uncommon tumor that has the potential for extensive bony destruction, extension into surrounding structures, and a relatively high recurrence rate. Treatment often requires bone resection. The bland histologic features of a monotonous proliferation of a loose, mesenchymal fibrous tissue that lacks atypia may easily lead to a misdiagnosis. The primitive dental pulp, the dental papilla, and the tooth follicle are histologically similar to myxoma. These soft tissue fragments often separate from extracted developing teeth that are submitted to the pathologist and may easily be misinterpreted as an odontogenic myxoma. The pathologist must have good clinical and radiographic correlation to avoid a misdiagnosis and to prevent unnecessary additional surgery.

Hyaline rings of the oral cavity: the so-called "pulse" granuloma redefined.

Hyaline ring-like structures are often encountered during microscopic evaluation of inflamed tissues from the oral cavity. The exact etiology remains unknown. Two theories exist. One favors intrinsic origin, most likely collagen, while the other suggests extrinsic origin, vegetable material. The literature is reviewed and histologic features are illustrated.

Diagnostic problems in oral pathology.

Diagnostic problems within the oral cavity may be associated with lesions of the odontogenic apparatus, salivary glands, bone, mucosa, and connective tissue. Some lesions are unique to the oral cavity, others have a systemic distribution. Several unique and controversial lesions have been selected for discussion, including (1) necrotizing sialometaplasia, a benign salivary gland disease easily mistaken for malignancy; (2) verrucous lesions including verrucous carcinoma, verrucous hyperplasia, and papillary carcinoma; (3) spindle-cell carcinoma, which is often confused with sarcoma; (4) named and unnamed embryonic rests, which may resemble metastatic carcinomas; (5) dental pulp mistaken for odontogenic myxoma; and (6) granular cell tumor with associated pseudoepitheliomatous hyperplasia.

Clear cell carcinoma of the palate.

A case of minor salivary gland clear cell adenocarcinoma of the palate with metastasis to the lungs in a 53-year-old female is presented. Histologically, the cells were characterized by glycogen rich clear cells arranged in solid nests, trabeculae, surrounded by hyalinized fibrous stroma. We believe this represents an aggressive form of this type of tumor.

Autoimmune progesterone dermatitis and stomatitis.

Autoimmune progesterone dermatitis is a rare clinical condition associated with variable cutaneous and mucosal eruptions such as urticaria, erythema multiforme, and eczema. Exacerbation is influenced by hormonal changes of the menstrual cycle. The patient described in this report had recurrent cyclic lesions on the skin, oral mucosa, and lips that appeared just before regular menstruation and persisted until a few days after. During each cycle, the eruptions appeared at the previously affected sites, mimicking the clinical feature of a fixed drug eruption. This rare phenomenon is attributed to an autoimmune reaction to female sex hormones. The condition failed to respond to therapy with prednisone, but improved with the use of an antiestrogen drug, tamoxifen. This medication suppresses ovulation and the post-ovulation rise in endogenous progesterone levels.

Herpes simplex and cytomegalovirus coinfected oral ulcers in HIV-positive patients.

Four HIV-positive patients with herpes simplex virus and cytomegalovirus coinfected oral ulcers are presented. All patients had persistent oral pain associated with nonhealing mucosal ulcers. Lesions occurred on the palate, retromolar pad, tongue, and lip, and the clinical appearance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nuclei and cytoplasm. Lesions in one patient responded to ganciclovir therapy. One patient improved with acyclovir, and another healed normally after excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.

Oral mucosal melanomas: the WESTOP Banff workshop proceedings. Western Society of Teachers of Oral Pathology.

A workshop to discuss primary oral melanomas was convened at the annual Western Society of Teachers of Oral Pathology meeting in Bannf, Alberta, Canada. Fifty oral melanomas, identified from the files of the participants, were reviewed in order to better understand the clinical features, histologic spectrum, and natural history of these perplexing lesions. Results confirmed that oral melanomas occur in adults almost three times more frequently in men than women and have a decided predilection for the palate and gingiva. Some lesions exhibit a clinically detectable and prolonged in situ growth phase, whereas others seem to lack this property and exhibit only or predominantly invasive characteristics. Recurrences, metastases, and death from tumor were characteristic of the follow-up of a limited number of patients. Until definitive prospective data are collected that elucidate natural history, oral mucosal melanomas should be tracked separately from cutaneous lesions. All oral pigmented lesions that are not clinically diagnostic should be biopsied. Lesions with equivocal histopathologic features might be referred to as "atypical melanocytic proliferation" and should be excised. Recognition of lesions in an early in situ phase and aggressive treatment should have a favorable effect on prognosis. To enhance future or prospective study of these rare neoplasms, guidelines for reporting oral melanomas are suggested.

Allergic reaction to orthodontic wire: report of case.

This case illustrates the importance of a thorough clinical history and the benefit of histopathologic examination. The history of contact allergy to jewelry provided an early clue, and the microscopic features confirmed the clinical impression of allergic stomatitis.

Gingival response to subgingival placement of monolithic tetracycline-impregnated fibers: microscopic observations.

This study examines and characterizes the soft tissue wall of periodontal pockets after a 10-day in vivo exposure to monolithic tetracycline-impregnated fibers, with and without root planing. Four teeth from each of eight patients were randomly assigned to (1) nontreatment (controls), (2) treatment by root planing only, (3) treatment by tetracycline fiber only, or (4) treatment by scaling and root planing and tetracycline fibers. Ten days after initial therapy, all teeth were extracted with associated soft tissue pocket walls intact. Three specimens were obtained from each tooth for examination by scanning microscopy, energy dispersive spectroscopy, and light microscopy. Results indicated that use of tetracycline-impregnated fibers over a 10-day period did not adversely affect the epithelial lining and had no significant effect on the density or character of the inflammatory response present in adjacent soft tissue and confirmed the antimicrobial effects of the fibers.

Aneurysmal bone cyst: report of a case mimicking orbital tumor.

Aneurysmal bone cysts are rare bone tumors which normally affect the vertebral region or long bones. Involvement of facial bones is uncommon. Although nonneoplastic, these lesions are expansile and may cause local destruction of bone and soft tissues. When making the diagnosis, it is imperative to consider the clinical, radiologic, and histologic features of the entity to avoid confusion with other possibly malignant giant cell tumors. We report an unusual case involving the orbit in a 2 1/2-year-old girl.

Late effects of head and neck radiation therapy and patient/dentist compliance with recommended dental care.

Head and neck radiation therapy patients have permanent damage to their salivary glands, tissue, and bone. This damage may result in late effects such as: xerostomia, rampant dental caries, demineralization, trismus, and osteoradionecrosis. Therefore, a pretherapy dental evaluation and treatment and compliance with a long-term oral care regimen are necessary. This retrospective study was designed to assess the late effects of radiation therapy and compliance with long-term care recommendations of patients seen in the Oncology Dental Support Clinic at the University of Missouri-Kansas City School of Dentistry during 1981 to 1989. Telephone interviews of patients and their dentists were conducted, and a written questionnaire to the dentists provided further data. Late effects were consistent with those reported in the literature. A compliance rate of approximately 50% was reported. Several measures have been implemented in an attempt to increase compliance.

Subjective and clinical evaluation of oral lubricants in xerostomic patients.

The purpose of this investigation was to evaluate and compare four oral lubricants in relation to oral mucosal status, perceived relief of dry mouth symptoms, and patient acceptance. Three commercial oral lubricants--two sprays and one gel--and a home remedy of margarine were evaluated. Twenty-five xerostomic/salivary gland dysfunctional patients demonstrating < 0.20 mL/min of unstimulated whole saliva participated in the randomized, four-phase, cross-over study. Each phase included a ten-day use of oral lubricants, followed by a four-day washout period. On the first and tenth days of use, lip and buccal mucosa dryness and perceived oral dryness were evaluated. Patient acceptance of the oral lubricant was evaluated at the end of each ten-day period. The Wilcoxon matched-pairs signed-rank test was used to analyze data over time and between-group differences. The gel group reported a statistically significant improvement in perceived oral dryness from Day 1 to Day 10. No other significant within-group differences were found. Subjects rated the gel significantly better than margarine for convenience, perceived value, minutes of relief, and in the "overall" rating. No other significant between-group differences were noted.

Oral management of the patient with cancer in the head and neck region.

Cancer therapies--including surgery, radiation, and chemotherapy--may unfavorably affect the oral/dental health of patients. Existing dental problems can also result in serious complications that may be prevented by dental intervention prior to cancer therapy. This paper will be limited to a discussion of the detrimental effects of radiation therapy on the oral cavity and salivary glands and appropriate dental management.