Burning mouth syndrome and psychological disorders.

Burning mouth syndrome (BMS) is an oral dysaesthesia that causes chronic orofacial pain in the absence of a detectable organic cause. The aetiology of BMS is complex and multifactorial, and has been associated in the literature with menopause, trigger events and even genetic polymorphisms. Other studies have found evidence for mechanisms such as central and peripheral nervous system changes, with clinical and laboratory investigations supporting a neuropathologic cause. These physiological explanations notwithstanding, there is still much evidence that BMS aetiology has at least some psychological elements. Somatoform pain disorder has been suggested as a mechanism and factors such as personality, stress, anxiety, depression and other psychological, psychosocial and even psychiatric disorders play a demonstrable role in BMS aetiology and symptomatology. In order to treat BMS patients, both physiological and psychological factors must be managed, but patient acceptance of possible components of psychological disease basis is a major hurdle. Clinical signs of patient stress, anxiety or depression are a useful reinforcement of clinical discussions. The current paper proposes a number of clinical signs that may be useful for both clinical assessment and subsequent patient discussions by providing visible supportive evidence of the diagnosis.

Multiple, large sialoliths of the submandibular gland duct: a case report.

This paper reviews the major clinical and radiographic features of sialoliths and illustrates these with an unusual case of multiple sialoliths within the submandibular gland duct. The differential diagnosis of other calcific structures both within and outside the salivary gland that may mimic a sialolith is also presented.

Scope of practice, referral patterns and lesion occurrence of an oral medicine service in Australia.

AIM: The purpose of this study was to examine the scope of practice, lesion occurrence and utilisation of referral-based hospital and private practice oral medicine and oral pathology (OMP) services in Australia. MATERIALS AND METHODS: Clinical records of patients referred to a hospital (n=500) and private (nbequals;1104) OMP clinic were audited. For each patient, the following parameters were recorded: age, gender, source of referral, reason for referral, site of lesion/condition if applicable, medical and drug history, diagnostic services utilised, clinical and histopathological diagnoses rendered, medications prescribed and further treatment required. RESULTS: A majority of the referrals were generated by general dental practitioners. The most commonly seen problems were epithelial hyperplasia/hyperkeratosis, oral candidosis, oral lichen planus, xerostomia, recurrent aphthous ulcers and burning mouth syndrome. OMP specialists requested diagnostic imaging for 13% of hospital and 9.42% of private patients, diagnostic biopsies were required for 18.4% of hospital and 19.3% of private patients, blood tests were ordered for 14.4% of hospital and 12.13% of private patients, while medications were prescribed for approximately 36% of hospital and 51% of private patients. CONCLUSIONS: This study is the first to detail the scope of practice, lesion occurrence and utilisation of services offered by OMP specialists in Australia. The demand for OMP services is strong.

Recurrent aphthous ulcerative disease: presentation and management.

Recurrent aphthous ulceration (RAU) is the second most common type of ulceration seen in the oral cavity. Notwithstanding an extensive literature and numerous proposed aetiologies, the cause of the disease remains obscure. In addition to the current conservative management of RAU lesions with corticosteroids, new treatment options are available and some have proven successful in open trials. This paper reviews patient work-up and management.

Supernumerary tooth with associated dentigerous cyst in an infant. A case report and review of differential diagnosis.

This paper reviews the topic of dental structures present at birth or erupting prior to the deciduous incisor teeth. A literature review shows a prevalence of one in every 2000 live births. At this rate of occurrence it is likely that the general dental practitioner may be called upon to offer advice. This review is supported by the presentation of an unusual case of a supernumerary maxillary incisor tooth with the hallmarks of a neonatal tooth and the development of a soft tissue dentigerous cyst. The differential diagnosis of soft and hard tissue swellings in infants is also presented together with rare syndromal associations of natal and neonatal teeth.

Cryotherapy for treatment of oral lesions.

Cryotherapy is the deliberate destruction of tissue by application of extreme cold. It is well received by patients due to a relative lack of discomfort, the absence of bleeding and minimal to no scarring after healing. It has many applications in oral medicine and clinical oral pathology, and is extremely usefu in patients for whom surgery is contra-indicated due to either age or medical history. In this paper we outline the principles, mechanisms of action, and current applications of cryotherapy in the treatment of oral lesions, and present some clinical cases.

Active case finding for carbapenemase-producing Enterobacteriaceae in a teaching hospital: prevalence and risk factors for colonization.

BACKGROUND: Over the past decade, the prevalence of carbapenemase-producing Enterobacteriaceae (CPE) has increased. Whilst basic infection prevention and control practices reduce the risk of transmission, cases of unrecognized carriage pose a potential risk of transmission. AIM: To estimate the prevalence of CPE and explore risk factors associated with colonization within a large teaching hospital with an established CPE outbreak. METHODS: All inpatients that had not previously tested positive for CPE were offered testing. Demographic and hospital episode data were also collected, together with antibiotic and proton pump inhibitor (PPI) use in the preceding 24h. FINDINGS: This study identified 70 CPE-positive cases (26 newly identified and 44 previously known) and 592 CPE-negative cases, giving a combined prevalence of 11% [95% confidence interval (CI) 8-13]. Medication (antibiotic and PPI use), previous admission, ethnicity and length of stay were assessed as risk factors for colonization, and none were found to be independently associated with CPE colonization. Using logistic regression, age [odds ratio (OR) 1.03, 95% CI 1.01-1.07] and antibiotic use (OR 2.55, 95% CI 1.08-6.03) were the only risk factors significantly associated with CPE colonization. CONCLUSION: This study has added to the evidence base by estimating the prevalence of CPE among inpatients in an acute hospital with an established CPE outbreak. A case-finding exercise was feasible and identified a number of new cases. Despite a small sample size, increasing age and prescription of an antibiotic on the day of testing were significantly associated with CPE colonization.

Central calcifying epithelial odontogenic tumour in the posterior maxilla: a case report.

The calcifying epithelial odontogenic tumour (CEOT), or Pindborg tumour, is a rare, benign odontogenic tumour. CEOT is usually asymptomatic and an incidental radiological finding, often presenting as a mandibular radiolucency with flecks of calcific material. We report an unusual case of CEOT in the left posterior maxilla of a 46-year-old male that was associated with an unerupted tooth. The tumour in this case caused non-specific sinus symptoms and appeared radiographically similar to an odontoma or ossifying fibroma due to its dense calcific contents. Diagnosis was confirmed histologically following surgical removal of the lesion, which showed classic CEOT histomorphology. We report this case to highlight the unusual clinico-radiologic presentation and illustrate the diagnostic difficulties that can occur with radiolucent and/or radiopaque lesions in the jaws.

Evaluation of patient-held carbapenemase-producing Enterobacteriaceae (CPE) alert card.

Public Health England recommends patient-held cards for those colonized with carbapenemase-producing Enterobacteriaceae (CPE). Alert cards were provided to 104 CPE-positive inpatients, with follow-up at six months. Excluding those who died, the response rate was 39%. Sixteen patients (46%) recalled receiving the card; 13 (81%) of these retained it, most (64%) of whom reported using it. This is the first evaluation of a patient-held alert card for any antimicrobial-resistant (AMR) bacteria in the UK. This study demonstrated that, when retained, CPE alert cards can be an effective communication tool. Further work is required to evaluate effectiveness and improve retention.

Interleukin-1 and its receptor.

Interleukin-1 (IL-1) is a polypeptide that is produced during infection, injury, or immunologic challenge. There are two molecular forms, IL-1-beta and IL-1-alpha, and despite only a 26% amino acid homology, both forms induce a wide variety of biological changes. These include systemic effects such as fever, sleep, ACTH release, and increased sodium excretion. In vitro, IL-1 activates T and B lymphocytes and induces a variety of lymphokines, interferons, and other cytokines, particularly tumor necrosis factor, for the induction of inflammatory changes such as prostaglandin synthesis, activation of endothelial cells, and bone resorption. Despite the broad range of tissue targets, IL-1 receptors have been described primarily on lymphocyte lines and fibroblasts. A feature of these studies is the low numbers of receptor sites and a relatively low-affinity binding. There is also evidence for the existence of a second class of high-affinity receptors. Molecular weights of IL-1 receptors vary with the cell source; these have been demonstrated with molecular weight of 80, 70, and 60 kDa. In general, there is a discrepancy between receptor number and affinity and biological responses to IL-1. One explanation for the mechanism of action of IL-1, particularly on T cells, is the requirement for cross-linking of two membrane proteins. In some cells, the binding of IL-1 to putative receptors may be fast and transient, accounting for activation of intracellular responses without a measureable biological response (such as increased DNA synthesis). IL-1 activation of cells is an important biological response, and its mechanism remains in an unexplored domain.

Oral viral infections and the therapeutic use of antiviral agents in dentistry.

This paper reviews the current concepts of viral classification, infection and replication. The clinical presentation of common oral viral infections encountered in the dental practice are discussed, including: herpes simplex virus types 1 and 2; Epstein-Barr virus; varicella-zoster virus; Coxsackie virus; human papilloma virus; and human immunodeficiency virus. The diagnosis, principles of management and pharmacological agents available for the treatment of oral viral infections are also discussed.

Oral candidosis and the therapeutic use of antifungal agents in dentistry.

This paper reviews the current concepts of mycology and candidal infections as they relate to the oral cavity. Proposed classification for the presentation of oral candidosis is outlined as are examples of these topical infections, such as erythematous, pseudomembranous and hyperplastic candidosis, as well as angular chelitis and median rhomboid glossitis. The diagnosis and principles of management of oral candidosis are discussed, the therapeutic agents available for the management of these infections are presented and a treatment protocol for the management of patients with oral candidosis is given.

Topical corticosteroids in dental practice.

Topical corticosteroids represent an important therapeutic aid in the management of a range of oral mucosal disease conditions. Like all medications, their successful use depends upon an understanding of the disease process. This includes an appropriate diagnosis, a clear view of the desirable treatment outcomes and knowledge of whether treatment is aimed at management of a chronic disease or enhanced resolution of a short-term condition. This paper reviews the use of topical corticosteroids and their possible roles in the management of oral disease.

Burning mouth syndrome: an update on recent findings.

Burning mouth syndrome (BMS) is characterized by a burning sensation of the oral mucosa in the absence of mucosal abnormality. Various local, systemic and psychological factors are associated with BMS, but its aetiology is not fully understood. Recently, significant inroads have been made, producing a better understanding of this complex condition. The aim of the current paper is to explore the condition of BMS in an educational context with the specific outcome of increasing awareness of the condition.

Digital display monitor performance in general dental practice.

BACKGROUND: The performance of computer displays represents an important factor influencing the quality of digital radiographs. The aim of this study was to evaluate the performance of computer displays used for the purposes of diagnostic radiology in a sample of dental practices in one Australian state. METHODS: Twelve dental practices comprising 29 displays elected to participate in a detailed performance evaluation of their computer displays according to the AAPM TG18 and DICOM part 14 GSDF standards. RESULTS: None of the 29 displays tested passed the primary or secondary acceptance criteria developed by the AAPM TG18. The greatest contributor to display failure, both prior to and following calibration, were specular and diffuse reflection. When the parameter of display reflection was ignored, the most frequent parameters contributing to display failure following calibration included the primary grade acceptance criteria of noise (n = 29, 100%), contrast ratio (n = 9, 31%) and maximum luminance (n = 12, 41%). However, display calibration resulted in a significant improvement in the parameter of contrast response. CONCLUSIONS: This study demonstrated significant problems concerning the performance of display monitors in the population surveyed. In recognition of the growing utilization of digital imaging in dentistry the importance of the computer display should be considered.

Interleukin-1 from baboon peripheral blood monocytes: altered response to endotoxin (lipopolysaccharide) and Staphylococcus aureus stimulation compared with human monocytes.

The baboon Papio ursinus does not elicit a febrile response upon injection with endotoxin, but fever is produced when injected with Staphylococcus aureus particles (Zurowsky, Y., H. Laburn, D. Mitchell, Can. J. Physiol. Pharmacol. 65, 1402-1407 (1987)). We address the question whether baboon peripheral blood monocytes produce interleukin-1 (IL-1) when stimulated with endotoxin or S. aureus particles in culture. Results show that little IL-1 biological activity was produced from endotoxin-stimulated baboon peripheral blood monocytes, compared with S. aureus-stimulated cells. Measurements of IL-1 beta by radioimmunoassay supported these data. This is contrary to data from human monocytes, which show greater sensitivity to endotoxin. Examination of IL-1 beta mRNA from endotoxin-stimulated and S. aureus-stimulated baboon monocytes, however, showed that more mRNA for IL-1 beta was present in endotoxin-stimulated monocytes than in cells stimulated with S. aureus. This illustrates the possibility that the production and/or the secretion of IL-1 beta is not as efficient in baboon monocytes as it is in human monocytes.

A specific and rapid determination of human skin dihydrotestosterone cytosol receptor.

The 5 alpha-Dihydrotestosterone (DHT) receptor in cytosol prepared from foreskin fragments was identified and measured by polyacrylamide gel electrophoresis (PAGE). 14 normal subjects, 4 boys with hypospadias and two patients with male pseudohermaphroditism (MPH) were studied. The amount of DHT receptor was comparable in the normal subjects and those with hypospadias. No receptor was found in the 2 cases of MPH.

Cloning of an antibody binding DNA sequence: pitfalls of DNA/protein immunoprecipitation reactions.

This paper presents evidence of cross-reactivity of a normal genomic DNA sequence to a number of antibodies raised against common proteins. This DNA fragment was inadvertently isolated during DNA-protein immunoprecipitation cloning experiments and was found to bind not only to the antibody used in the immunoprecipitation experiment, but to several different antibodies in gel-shift assays. This data demonstrates the ability of certain DNA sequences to bind non-specifically to antibodies and highlights the danger of DNA/antibody binding which can produce artifacts. Possible means of overcoming these reactions are discussed.

Reconstitution of cutaneous neural-immunological networks following bone marrow transplantation.

During allogeneic bone marrow transplantation (BMT), host epidermal Langerhans cells (LC) are depleted and replaced by LC derived from the bone marrow inoculum. LC have recently been shown to form intimate spatial associations with intraepithelial nerves (IEN), which release regulatory peptides. The present study investigated whether the IEN network within skin remains intact during BMT, and whether repopulating LC re-established contacts with IEN. Double-labeling immunohistochemical techniques were employed using antibodies to CD1a and neural cell adhesion molecule (CD56) to identify LC and IEN, respectively. LC were depleted by conditioning for BMT, and repopulating LC reached normal values after day +100. In contrast to fluctuations in the LC network, the frequency of IEN remained unchanged during the post-BMT period. Contacts between LC and IEN were present both before and after BMT, and repopulating LC established a spatial interaction with IEN similar to that seen before BMT. These data provide the first evidence for the dynamic nature of the spatial relationship of LC with IEN, and raise intriguing questions regarding the mechanisms that direct homing of LC within epithelia.