CD56 (NCAM) expression in ameloblastomas and other odontogenic lesions.

AIMS: Ameloblastomas recapitulate certain elements of tooth formation. CD56 is expressed by a variety of cells and is used in tumour diagnosis, but is also expressed in the enamel organ during tooth development. The aim of this study was to describe the expression of CD56 in odontogenic lesions with particular reference to the differential diagnosis of ameloblastoma and odontogenic keratocyst. METHODS: Cases were selected from the pathology archives at Glasgow Royal Infirmary, Glasgow, Royal Victoria Infirmary, Newcastle and Department of Diagnostic Sciences, Texas A&M Health Science Center Baylor College of Dentistry, Dallas. The study population included 38 ameloblastomas, 19 odontogenic keratocysts and a number of other odontogenic lesions, including nine compound odontomes. All sections were examined for CD56 immunoreactivity and the extent of staining was recorded. RESULTS: Thirty-seven of 38 (97%) ameloblastomas expressed CD56 on the cell membrane of peripheral cells in tumour nests (16 extensively, 21 focally). Immunoreactivity was lost in areas of inflammation, acanthomatous differentiation, in areas of cystic change and upon fusion with overlying surface epithelium. One odontogenic keratocyst expressed CD56 (5%, P < 0.0001). CD56 was expressed very focally in two odontomes, exclusively in stratum intermedium-like cells. CONCLUSIONS: CD56 expression in odontogenic epithelium is highly suggestive of ameloblastoma and can help in differentiating this from odontogenic keratocyst.

The unusual cyst: solitary bone cyst of the jaws.

UNLABELLED: Solitary bone cyst of the jaws is an uncommon lesion detected usually as an incidental finding on dental radiographic examination. Historically, this cyst has been known by several different names within the literature. It is usually asymptomatic but can present with buccal swelling, pain, paraesthesia and be associated with non-vital teeth. Radiographically, it has characteristic features that distinguish it from other lesions. The following is an overview of the literature, the experience of two centres over an eight-year period, and a discussion of the dental implications. Clinicians should be aware of this lesion and that unexplained radiolucent lesions of the jaws require referral. CLINICAL RELEVANCE: Clinicians should be aware of both the clinical and radiographic characteristics of solitary bone cyst of the jaws.

Paget's disease of bone and osteonecrosis.

UNLABELLED: Paget's disease of bone, although common in the long bones and pelvis, is less common in the head and neck. A 20-year follow-up is reported of a patient who was diagnosed with Paget's disease following the investigation of her initial oral complaint. Following surgical extraction of two teeth in her maxilla, the sockets have failed to heal, despite numerous attempted interventions. This case highlights both the cranio-maxillofacial and oral manifestations of Paget's disease of bone, its effects on surgical exodontia and the possible effects of bisphosphonate therapy. CLINICAL RELEVANCE: Paget's disease of bone does not manifest in the head and neck commonly but, when it does, there are significant implications for the dentist. Prevention and conservation of the patient's remaining teeth are paramount as the complications of extraction are significant.

Change in the number of occlusal contacts following splint therapy in patients with a temporomandibular disorder (TMD).

The mean number of occlusal contacts before and after occlusal appliance therapy were compared in three temporomandibular disorder groups and one control group. Only patients with a successful treatment outcome were considered in the statistical analysis. Statistically significant changes were seen in the disc displacement with reduction group, which was managed with anterior repositioning splint: the mean number of contacts increased 3 months after weaning off the splint. If the disc is out of position then the number of occlusal contacts appears to be reduced. It would therefore appear to be sound advice not to make permanent and irreversible adjustment to the occlusion in the presence of disc displacement as when the disc is repositioned occlusal contacts will change.

The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: a randomised controlled trial.

OBJECTIVES: To compare the effect of real acupuncture and sham acupuncture in the treatment of temporomandibulat joint myofascial pain, in order to establish the true efficacy of acupuncture. METHODS: A double blind randomised controlled trial conducted in the TMD Clinic, at the School of Dentistry, The University of Manchester. Twenty-seven patients were assigned to one of two treatment groups. Group 1 received real acupuncture treatment whilst Group 2 received a sham acupuncture intervention. Both the assessor and the patient were blinded regarding the group allocation. Baseline assessment of the outcome variables was made prior to the first treatment session, and was repeated following the last treatment. RESULTS: The results demonstrated that real acupuncture had a greater influence on clinical outcome measure of TMJ MP than those of sham acupuncture, and the majority of these reached a level of statistical significance. CONCLUSION: Acupuncture had a positive influence on the signs and symptoms of TMJ MP. In addition, this study provides evidence that the Park Sham Device was a credible acupuncture control method for trials involving facial acupoints.

Leiomyomatous hamartoma presenting as a congenital epulis.

An otherwise-healthy 11-month-old white girl presented with a polyp-like lesion on the anteromedial part of the maxillary alveolar ridge. It looked like a congenital epulis, but histological examination showed fascicles of smooth muscle cells dispersed in collagenous stroma with a few peripheral nerve bundles that were intermingled with smooth muscle fibres. The muscle cells stained strongly for desmin and alpha-smooth-muscle actin. However, S-100 was found only in peripheral nerve bundles. It was therefore a leiomyomatous hamartoma.

Focal palmoplantar and gingival hyperkeratosis: a case report.

UNLABELLED: We report a rare genetic condition characterized by gingival hyperkeratosis with skin changes affecting the hands and feet. The patient presented with asymptomatic oral lesions and the diagnosis was reached by taking a full clinical history and biopsy tests. Palmoplantar keratosis can be a feature of a range of different syndromes and can be associated with periodontal destruction, benign oral keratosis or cancer of the oesophagus. It is important for dentists to be aware that clues to diagnosis can be gained from examination of the hands and feet, in addition to an oral examination, particularly in recognizing oral genetic disorders. CLINICAL RELEVANCE: To inform clinicians of both the intra-oral and extra-oral features of focal palmoplantar and gingival hyperkeratosis.

Stabilization splint therapy for the treatment of temporomandibular myofascial pain: a systematic review.

The aim of this review is to establish the effectiveness of stabilization splint (SS) therapy in reducing symptoms in patients with myofascial pain. Searching of electronic databases, handsearching of relevant key journals, and screening of reference lists of included studies were undertaken. There was no language restriction, and unpublished research was sought. The selection criteria were randomized controlled trials comparing splint therapy to either no treatment or another active treatment. Data extraction and validity assessment were carried out independently and in duplicate. Studies were grouped according to treatment type. Twenty potentially relevant Randomized Controlled Trials (RCTs) were identified. Only twelve met the inclusion criteria. There is insufficient evidence either for or against the use of stabilization splint therapy over other active interventions for the treatment of temporomandibular myofascial pain. However, it appears that stabilization splint therapy may be beneficial for reducing pain severity at rest and on palpation and depression when compared to no treatment. The authors suggested the need for well conducted RCTs that pay attention to method of allocation, blind outcome assessment, sample size, and duration of follow-up. Various measures were adopted to assess the outcomes of treatment. Standardization of the methods used to measure outcomes of the treatment of myofascial pain should be established in future RCTs.

The role of cathepsin C in Papillon-Lefèvre syndrome, prepubertal periodontitis, and aggressive periodontitis.

We have previously reported that loss-of-function mutations in the cathepsin C gene (CTSC) result in Papillon-Lefèvre syndrome, an autosomal recessive condition characterized by palmoplantar keratosis and early-onset, severe periodontitis. Others have also reported CTSC mutations in patients with severe prepubertal periodontitis, but without any skin manifestations. The possible role of CTSC variants in more common types of non-mendelian, early-onset, severe periodontitis ("aggressive periodontitis") has not been investigated. In this study, we have investigated the role of CTSC in all three conditions. We demonstrate that PLS is genetically homogeneous and the mutation spectrum that includes three novel mutations (c.386T>A/p.V129E, c.935A>G/p.Q312R, and c.1235A>G/p.Y412C) in 21 PLS families (including eight from our previous study) provides an insight into structure-function relationships of CTSC. Our data also suggest that a complete loss-of-function appears to be necessary for the manifestation of the phenotype, making it unlikely that weak CTSC mutations are a cause of aggressive periodontitis. This was confirmed by analyses of the CTSC activity in 30 subjects with aggressive periodontitis and age-sex matched controls, which demonstrated that there was no significant difference between these two groups (1,728.7 +/- SD 576.8 micro moles/mg/min vs. 1,678.7 +/- SD 527.2 micro moles/mg/min, respectively, p = 0.73). CTSC mutations were detected in only one of two families with prepubertal periodontitis; these did not form a separate functional class with respect to those observed in classical PLS. The affected individuals in the other prepubertal periodontitis family not only lacked CTSC mutations, but in addition did not share the haplotypes at the CTSC locus. These data suggest that prepubertal periodontitis is a genetically heterogeneous disease that, in some families, just represents a partially penetrant PLS.

Low-grade malignant Triton tumor of the oral cavity: a case report.

Malignant Triton tumor (MTT) is a malignant peripheral nerve sheath tumor showing rhabdomyoblastic differentiation. It is considered a high-grade neoplasm with poor outcome. This report describes an MTT appearing in the oral cavity. On histologic examination the encapsulated lesion was composed of interlacing fascicles of spindle cells and scattered, large, strap-like pleomorphic cells with abundant eosinophilic cytoplasm. No cross striations were seen. Examination of levels through the tissue showed a total of only 4 normal mitoses and no necrosis. Immunohistochemistry demonstrated diffuse S100 positivity in the spindle cells. The large pleomorphic cells were weakly positive for alpha-sarcomeric actin and myoglobin, although variably but strongly positive for desmin. Management involved a small en bloc resection of the maxilla. After 33 months there was no sign of recurrence or distant metastasis. It was concluded that low-grade variants of MTT occur that do not have an aggressive clinical course.

Fixed drug eruption to oxybutynin.

Solitary fixed drug eruptions involving the lips and mouth are known to occur but are rarely seen in oral medicine clinical practice. Various drugs have been implicated as causative agents. We present a case of a fixed drug eruption on the lip caused by oxybutynin, a relationship not previously described.

Bone collected during dental implant surgery: a clinical and histological study.

Bone traps vary in design, although the effect of pore size on the nature of the debris collected in vivo has not yet been established. The aims of this study were 1) to compare the clinical performance of two bone collectors during implant surgery, ii) to establish the mass of tissue collected by each device, and iii) to characterize the nature of the collected debris. Thirty-eight patients (paired for implant site) were categorised into three clinical groups according to the site and the number of implants they were to receive. Patients underwent bone collection with the Frios bone trap or the Osseous Coagulum Trap according to a randomisation sequence. The samples were fixed in formalin, frozen, freeze-dried and weighed. Material from each sample was embedded in paraffin wax and stained with haematoxylin and eosin. All sections were examined by optical microscopy and the proportion of bone to coagulum was established histomorphometrically. During surgery, the Frios bone trap blocked once and the Osseous Coagulum Trap blocked 11 times. In all cases where blockage occurred, excess coagulum was apparent. All the samples that were collected by the Frios bone trap contained bone and coagulum, with a mean proportion of 90.6% bone. With regard to the Osseous Coagulum Trap, one sample contained no bone and two samples contained only trace amounts of bone; the remaining samples contained a mean proportion of 67.3% bone. Pore size affects both clinical performance and the histological composition of the debris collected, and this might have important implications if used as an augmentation material.