A mutation in the mucosal keratin K4 is associated with oral white sponge nevus.

White sponge nevus (WSN) is a benign autosomal dominant disorder which affects non-cornifying stratified squamous epithelia (MIM 193900) (ref. 1). Phenotypically it presents as white 'spongy' plaques (oral leukokeratoses), most commonly in the mouth but also reported in the esophagus and anogenital mucosa. Histologically, the plaques show evidence of hyperproliferation, acanthosis and tonofilament aggregation. These types of pathogenic changes are characteristic of many of the epidermal keratin disorders. Keratins are expressed in pairs by epithelial cells in a tissue and cell specific manner. The major differentiation specific keratins of the buccal mucosa, nasal, esophageal and anogenital epithelia are K4 and K13 (ref. 7). The tissue distribution and nature of the lesions in patients affected by WSN suggested that mutations in K4 and/or K13 might be responsible for this disorder. We have now confirmed this hypothesis and report here a three base-pair (bp) deletion in the helix initiation peptide of K4 in affected members from two families with this condition.

The incidence and distribution of oral lesions in patients with Darier's disease.

Darier's disease is an uncommon autosomal dominant genodermatosis that may be accompanied by oral lesions. The incidence and distribution of oral manifestations was studied in 24 patients with cutaneous Darier's disease. Oral lesions comprising whitish papules of varying severity were present in 12 patients, with the palate being the most common site affected, followed by gingiva, buccal mucosa and tongue. Generally, the severity of the oral lesions paralleled that of the skin condition. Seven patients (30%), six of whom also had oral mucosal involvement, reported intermittent parotid swelling. Parotid sialograms of two patients revealed strictures in the main ducts, suggesting an obstructive aetiology.

Plasma cell gingivitis related to the use of herbal toothpaste.

Plasma cell gingivitis is an uncommon condition, characterised by a sharply demarcated, erythematous and oedematous gingivitis, often extending to the mucogingival junction. The condition is generally considered to be a manifestation of hypersensitivity, but often no antigenic agent can be identified. This report describes a case of plasma cell gingivitis, apparently associated with the use of a herbal toothpaste.

Resolution of lichen planus following removal of amalgam restorations in patients with proven allergy to mercury salts: a pilot study.

Thirteen patients with symptomatic oral lichen planus had been shown by patch testing to be allergic to ammoniated mercuric chloride. Replacement of amalgam restorations in these patients effected an improvement in all but one case. In some cases the resolution of symptoms was dramatic following the replacement of one or two fillings. The authors feel that the removal of all amalgam fillings need not be necessary except in the most intractable case.

Allergic reactions to rubber gloves in dental patients: report of three cases.

Three cases of allergy to rubber are described, in which the patients exhibited peri-oral rashes following dental treatment by personnel wearing latex rubber gloves. Two of the patients were aware of possible allergy to domestic rubber products but did not reveal this as part of their medical history. With the increase in numbers of dentists wearing rubber gloves it is probable that there will be many more such cases reported in the future. Rubber products must then be added to the list of potential allergens which may be of some import to the practice of dentistry.

Effects of cytotoxic chemotherapy on dental development.

A histological study of 21 teeth from 9 patients who had received cytotoxic chemotherapy for malignant disease showed increased prominence of incremental lines in the dentine. The number and distribution of these lines corresponded to periods of intravenous therapy and vincristine appeared to be the most likely cause. This effect was probably due to temporary disturbance of microtubular function in the odontoblasts resulting in decreased secretion of collagenous dentine matrix. Calcification appeared to be unaffected.

Squamous cell carcinoma arising in an odontogenic keratocyst.

A case of squamous cell carcinoma arising in an odontogenic keratocyst is described. A review of the literature revealed only one other adequately documented case.

A pigmented odontogenic keratocyst.

A pigmented odontogenic keratocyst arising in a white Caucasian female is reported. Melanocytes in the basal cell layer were identified by light and electron microscopy.

Sjögren's syndrome - an update for dental practitioners.

Sjögren's syndrome (SS), an autoimmune, multi-factorial disorder, affects around 5% of females and 0.5% of males in the general population. The dental practitioner has a key role in recognising the clinical features of this condition, organising referral for specialist care and managing the oral health of these patients. In this article, we summarise the clinical manifestations, diagnosis and management of SS relevant to dental practitioners.

Maxillary sinus disease: diagnosis and treatment.

The maxillary sinus is the paranasal sinus that impacts most on the work of the dentist as they will often be required to make a diagnosis in relation to orofacial pain that may be sinogenic in origin. Maxillary sinus disease is often coincidentally observed on radiographs, and dentists often have to make a diagnosis and plan treatment based on the interpretation of the image. This paper aims to guide the dental professional through some of the disease processes involving the paranasal sinuses and in particular the maxillary sinus. The outcome is to encourage comprehensive history taking and examination of the patient to facilitate an accurate diagnosis that will enable successful treatment.

General medicine and surgery for dental practitioners. Part 4 - skin disorders part B.

Skin disorders are potentially important to dentists in diverse ways. The skin disease itself might have oral manifestations, and drugs used to treat skin disorders may impact on dental management. This second paper on skin disorders continues with a consideration of those disorders, and aspects of their treatment, which could have relevance to dental practitioners.

General medicine and surgery for dental practitioners. Part 3 - skin disorders part A.

Skin disorders are potentially important to dentists in diverse ways. The skin disease itself might have oral manifestations, and drugs used to treat skin disorders may impact on dental management. This first paper considering skin disorders examines points to look out for in the history and considers specific groups of conditions. Further conditions will be discussed in part B.

Symptomatic and asymptomatic salivary duct abnormalities in Darier's disease: a sialographic study.

Symptoms of obstructive sialadentis have been occasionally reported as a feature of Darier's disease. Parotid sialograms of three patients with confirmed Darier's disease and histories suggestive of salivary obstruction revealed dilatation with periodic strictures and indentations affecting the main ducts. Similar parotid sialograms in three Darier's disease patients with no symptoms attributable to their salivary glands revealed seepage of contrast media associated with the secondary and tertiary ducts. These findings suggest that salivary glands may be more commonly involved in Darier's disease than previous reports indicate.

Wegener's granulomatosis. A distinct gingival lesion.

A hyperplastic (strawberry) gingivitis is a feature of Wegener's granulomatosis. A further case is described in which the only manifestations to date have been the gingival lesion. The diagnostic value of the ANCA test is discussed for patients who present with an unusual hyperplastic gingivitis.

Congenital aplasia of major salivary glands in a 4-year-old child.

The case of a 4-year-old girl with marked xerostomia and rampant caries is described. Investigation revealed complete aplasia of all four major salivary glands, which is extremely rare. Eleven primary teeth were extracted and a strict caries-preventive regime introduced. The patient had previously been advised to suck citrus-flavoured sweets to stimulate saliva flow, but this must be discouraged.

The relevance and effect of amalgam replacement in subjects with oral lichenoid reactions.

In this study we examined the prevalence of mercury hypersensitivity in patients with oral lichenoid reactions (OLR) and the effect of amalgam replacement in subjects with amalgams adjacent to OLR irrespective of their mercury sensitivity status. One hundred and ninety-seven patients with oral problems were examined: 109 with OLR, 22 with oral and generalized lichen planus, and 66 with other oral diagnoses, including aphthous ulcers and orofacial granulomatosis. Nineteen per cent of patients with OLR reacted to mercury on patch testing, significantly more than in those with generalized lichen planus (0%) and in those with other oral diagnoses (3%). Twenty-two patients with OLR and adjacent amalgams had amalgam replacement and, in 16 of 17 mercury-positive subjects and three of four mercury-negative subjects, the OLR resolved after amalgam removal. In conclusion, we found a significantly increased prevalence of mercury hypersensitivity in patients with localized OLR in comparison to subjects with other oral problems. Amalgam replacement resulted in resolution of OLR in the majority of patients with amalgams adjacent to OLR irrespective of their mercury sensitivity status.

The long-term effects of treatment on the dental condition of children surviving malignant disease.

Fifty-two long-term survivors of childhood leukemia or solid tumors had a clinical dental examination along with 49 of their sibling. The 52, with an additional 30 examined in a previous study, were studied radiologically with a panoramic tomogram. All children with leukemia had received chemotherapy for 2 or 3 years and irradiation on standard protocols and the solid tumor group had received chemotherapy for 6 to 24 months. There was no difference between siblings and patients for dental caries, gingivitis, and oral hygiene, mouth opening, overjet, and overbite. More solid-tumor patients had abnormal occlusion (P less than 0.02) and those with abnormalities tended to have been treated at an earlier age. Enamel opacities and hypoplasia were more common in patients than siblings and in the leukemia than in the solid tumor group. Sixty-five percent of the children had abnormalities on radiologic examination including failure of the tooth to develop, small crown, hypoplasia of the crown, and abnormal root development. In most cases the radiologic abnormality could be correlated in time with the patient's treatment and a knowledge of the normal time of tooth development. Three teeth extracted during the course of the study were examined histologically and these showed prominent incremental lines which could be correlated in time with vincristine treatment.