Quantitative assessment of morphological changes of dental pulp components of teeth affected by occlusal trauma.

AIM: In the general economy of the stomatognathic system functionality, the occlusal function has an important role, meaning both the dental-dental reports and the dynamic reports interarch-interarch. Because of the interrelationships and inter-dependency that govern the functioning of the biological systems, a pathological change affecting a component of the stomatognathic system produces impaired functioning of the others. The aim of the present study is to assess the morphological changes occurred in the dental pulp components of teeth affected by occlusal trauma. MATERIALS AND METHODS: Fragments of dental pulp coming from 45 patients with occlusal trauma were processed using classical histological techniques (formalin fixation and paraffin embedment) and stained with Hematoxylin-Eosin (HE), Masson's trichrome and anti-CD34 antibody immunostaining, in order to highlight the peripheral zone and central connective tissue of dental pulp morphological changes. A set of parameters namely thickness of peripheral zone components, calcifications, fibrosis and vascular density in the dental pulp were assessed individually and based on three topographical criteria namely the affected tooth, the position on the dental arches and the position according to sagittal plane. RESULTS: There was no correlation between morphological changes of dental pulp and the topography of teeth with occlusal trauma. The size of the peripheral area of the dental pulp and that of its components evolved in the same sense, whether it was growth or decrease. Decrease of the peripheral area was associated with the increase of collagen fibers density, calcium deposits and density of the capillary network. The direct correlation between the amount of collagen fibers and vascular density seems somewhat paradoxical but it can be explained by the reemergence of chronic inflammatory events located in the dental pulp. CONCLUSIONS: It seems that dental pulp morphological changes are not influenced by the teeth with occlusal trauma topography. With one exception (the components of peripheral zone), most of the correlations between the dental pulp morphological changes were only suggested but not validated statistically, which requires further studies on larger groups together with the introduction of inflammatory cell population studies.

Morphological changes of gums in occlusal trauma.

AIM: Occlusal trauma causes major modifications of the coverage periodontium, which in turn reflect on the dental unit. The aim of the present study is to evaluate some of the morphological modifications occurred in the marginal periodontium surrounding teeth affected by occlusal trauma. MATERIALS AND METHODS: Fragments of marginal periodontium coming from 51 patients with occlusal trauma were processed using classical histological techniques (formalin fixation and paraffin embedment) and stained with Hematoxylin-Eosin (HE), Masson's trichrome and anti-CD34 antibody immunostaining, in order to highlight the epithelial and connective tissue changes of gingival mucosa. A set of epithelial and connective tissue morphological parameters were assessed individually and based on three topographical criteria concerning the affected tooth. RESULTS: The epithelium and especially its superficial compartment presented changes depending on the tooth type and the dental arch. Epithelial thickness had the tendency to decrease as the fibrosis in both corium compartments and vascular density in the deep corium compartment were increasing. Leukoplakia present around the affected teeth but not always was related with the tooth type and was more obvious as the superficial compartment of the epithelium was thicker and as fibrosis was more reduced in the papillary compartment of the corium. Vascular density reduced when fibrosis process increased in the corium. CONCLUSIONS: Lesions determined by occlusal trauma and their topography can and are influencing locally the different structures of the surrounding periodontium.

Morphological aspects in tuberculosis of oral cavity - our experience and a review of the literature attempt.

AIM: The authors continue a started series of articles about extrapulmonary tuberculosis (EPTB) with the assessment of the mycobacterial lesions discovered on tissue samples of the oral cavity structures in the Department of Pathology of the Emergency County Hospital of Craiova, Romania, and the review of the cases reported in the literature available, between 1990 and 2013. MATERIALS AND METHODS: The studied material consisted, for our series, of samples obtained by biopsy or surgical excision, including the salivary glands and excluding the lymph nodes from 17 patients histopathologically diagnosed with tuberculosis and, for review series, 190 papers selected from PubMed database. RESULTS: The number of cases reported increased throughout the studied period. Most cases came from departments connected with oral pathology but also from various medical and surgical departments. In general, patients were adults with a mean age of around 40 years, with twice as many men than women, without no information or no clinical suspicion of tuberculosis (TB) at the admission. When reported, the provisional diagnostic was oriented most often towards neoplastic proliferation. There was no information about human immunodeficiency virus (HIV) testing in more than half of the case reports but when existed the result was two-fold more frequently negative than positive. TB lesions of the oral cavity were more often primary infections than secondary. From morphological point of view, the granuloma cellular population included both epithelioid and Langhans cells in most of the cases, the necrosis, present in most of the cases, displayed the whole range of morphological features, but mainly the acidophilic, microgranular one and the perilesional fibrosis was absent in almost all of the cases. As a whole, well-differentiated granulomas were the most frequent, usually of grade II - reactive type ("homeostatic") but with a significant contingent of grade I - hyperplastic ("protective") granulomas. Local extension was usually not present and, when present, regional lymph nodes were mainly involved. Coexistence of TB lesions with a neoplastic proliferation was very rare and when present it was mainly located in the parotid gland. Apart from this general profile, particular, individual profiles were observed for each of the oral cavity segments. CONCLUSIONS: TB lesions in the oral cavity are indeed a rare event but no swelling or ulcer in the oral cavity should be disregarded by the medical practitioners because it could be tuberculosis.

Lymph node tuberculosis - an attempt of clinico-morphological study and review of the literature.

AIM: The authors assessed the mycobacterial lesions in the lymph nodes discovered on tissue samples coming from the surgical stage in the Department of Pathology, Emergency County Hospital of Craiova, Romania, starting from 1990 until 2012. MATERIALS AND METHODS: The studied material consisted of lymph node (LN) tissue samples obtained by biopsy or surgical excision from 362 patients histopathologically diagnosed with tuberculosis. For confirming the diagnosis, Ziehl-Neelsen staining was carried out and, in some cases, PCR technique was used. RESULTS: Patients were mainly women, with a mean age of 35 years. The suspicion of diagnosis at admission was reduced, the most usual diagnosis being a very general and uncertain one of "adenopathy/polyadenopathy". In only few cases, other tissues/organs have been affected in the same time with the LN determination. Also, multiple LN group involvement was present in only five cases. The most affected LN groups were: the lateral cervical, submandibular, axillary, inguinal, supraclavicular and mesenteric. In paired LN groups, there was no predilection for any of the body sides. Epithelioid cells (ECs) and giant Langhans cells (GLCs) were present together in most of the granulomatous reactions. However, the presence of neutrophils in 10% of the cases should be noticed. Necrosis was present in almost all cases, displaying the whole range of morphological features, but usually the acidophilic, microgranular one. Fibrosis was rarely encountered. As a whole, well-differentiated granulomas were the most frequent but the presence of hyporeactive granulomas in more than a quarter of the cases and that of non-reactive granulomas in more than 10% of the cases should be noticed. The extension of TB process was not a rare event. CONCLUSIONS: LNs seem to be the favorite location of TB besides the lung. The overall morphological picture revealed an active and destructive profile of the bacillary aggression in the LN parenchyma, which could mean either a higher sensitivity of the LN tissue or a more vulnerable background of the patients with TBLN lesions.