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.

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.

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.

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.

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.

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.

Oral mucosal Langerhans cells express DR and DQ antigens.

The expression of the Class II antigens HLA-DR and HLA-DQ in human oral mucosa was examined in health and in the presence of inflammation. DQ antigens were detected on dendritic intra-epithelial cells which expressed the Langerhans cells (LC) phenotype T6+, DR+. In healthy gingiva, DR and DQ were co-expressed on Langerhans cells, whereas in an experimental gingivitis (day 8), more LC expressed DR than DQ. Absolute LC numbers were increased in inflammation. Traumatic ulceration of the buccal mucosa resulted in a decrease in the density of T6-, DR-, and DQ-positive cells. Repopulation of migrating and regenerated epithelium was complete 10 days after ulcer induction. Disparity between DR and DQ expression was seen in both normal buccal mucosa and throughout the ulcer healing period. These results are in agreement with the reported sequence of Class II antigen expression on lymphoid cells.

Suppressor cell function in oral lichen planus.

Oral lichen planus (OLP) is a common inflammatory condition of the oral mucous membranes which affects between one and two percent of the general population. In accordance with the protracted clinical course of OLP and its association with known auto-immune diseases, the level of self-tolerance is questionable and possibly diminished in patients with this disorder. Normal suppressor T lymphocyte function is reputedly an essential element in the maintenance of self-tolerance, and deficient cell-mediated suppressor activity is implicated in the pathogenesis of auto-immune diseases. For assessment of in vitro cell-mediated suppressor activity in OLP, peripheral blood mononuclear cells (PBMC) from ten patients with OLP and from 11 control subjects were activated with the plant mitogen concanavalin A (Con A), followed by co-culture with autologous responder cells. The ability of irradiated Con A-activated cells to suppress the proliferation of Con A-stimulated responder cells was determined. Con A-induced suppressor activity of PBMC in the OLP patients was significantly less than that in control subjects (p = 0.001). Results of the present investigation complement previous in vitro findings which provided indirect evidence of deficient cell-mediated suppressor activity in OLP, particularly a decreased proportion of circulating CD4+CD45RA+ lymphocytes and reduced Con A-stimulated PBMC proliferation. The depressed Con A-induced suppressor activity of PBMC in the OLP patients provides direct evidence of deficient in vitro cell-mediated suppressor function in OLP, and suggests that defective cell-mediated suppressor circuits and reduced self-tolerance may be involved in the pathogenesis of this disorder.

The glandular odontogenic jaw cyst: report of a case.

A case of a rare odontogenic cyst arising in the lateral periodontal membrane in the mandible in a 14 year old girl is reported. This lesion appeared to be a new entity and has been named glandular odontogenic cyst (GOC) or sialo-odontogenic cyst. Histologically the lesion was lined by mucous producing cuboidal epithelium containing several areas of thickening and numerous duct-like structures. The cyst recurred with the same histology two years postoperatively.

Prenatal expression of growth hormone receptor/binding protein and insulin-like growth factor-I (IGF-I) in the enamel organ. Role for growth hormone and IGF-I in cellular differentiation during early tooth formation?

Immunohistochemistry was used to study the ontogeny of GH receptor/binding protein (GHR/BP) and IGF-I from the 13-day-old embryo (E13) to the E19 rat fetus in the developing incisor and molar. Analysis of serial sections revealed diffuse staining of GHR/BP and IGF-I at the bud and early cap stages within both the mesenchyme of the dental papilla and the ectodermal-derived enamel organ. Just before transition to the cap stage, immunoreactivity of GHR/BP and IGF-I increased in the epithelial bud and extended to the condensed dental mesenchyme. At the cap stage, the dental epithelium showed an intense expression of GHR/BP and IGF-I, whereas the dental mesenchymal cells showed very weak staining. The inner enamel epithelium and the outer enamel epithelium were positive for both GHR/BP and IGF-I in the bell stage. Differentiating ameloblasts, odontoblasts and the secretory ameloblasts and odontoblasts continued to express GHR/BP and IGF-I in incisors. These findings support the premise that growth hormone and IGF-I may play a role in embryonic tooth development by regulating the epithelial-mesenchymal interactions that influence events in growth and cytodifferentiation.

The effect of cyclosporin and lipopolysaccharide on fibroblasts: implications for cyclosporin-induced gingival overgrowth.

Drug-induced gingival overgrowth is an adverse side effect associated principally with 3 different types of drugs; specifically the antiepileptic phenytoin, the calcium channel antagonist nifedipine, and the immunosuppressant cyclosporin. The present study has analyzed the effect of cyclosporin and lipopolysaccharide on fibroblasts from 3 different sources: 1) normal healthy human gingiva (NHGF); 2) overgrown gingiva from 2 patients taking cyclosporin (CHGF); and 3) human fetal lung (WI-38). Fibroblasts isolated from cyclosporin-associated gingival overgrowth were significantly less responsive to cyclosporin in terms of DNA, total protein, and proteoglycan synthesis. This finding supports the in vivo response where few fibroblasts are seen but marked overgrowth of fibrous tissue occurs. Lipopolysaccharide derived from Fusobacterium nucleatum and Escherichia coli was capable of inhibiting DNA synthesis significantly in all 3 fibroblast types. Total protein synthesis by CHGF cells was inhibited differentially by Fusobacterium nucleatum LPS and addition of cyclosporin to this system resulted in reversal of the inhibition. A synergistic effect was noted when the proteoglycan output of NHGF cells was assessed in response to co-incubation with cyclosporin and Escherichia coli LPS. The study shows that bacterial LPS may be an important co-factor in the pathogenesis of cyclosporin-induced gingival overgrowth.

Cyclosporin-A-induced gingival enlargement. A case report.

Cyclosporin-A (CsA)-induced gingival enlargement has been reported in a small number of cases but may involve up to one third of all patients taking CsA. The present study reports a case of CsA-induced gingival enlargement during suppressive therapy for myasthenia gravis. Gingival tissues were examined histologically, histochemically, and immunohistologically. The basic tissue response seemed to be a dental plaque- and trauma-induced fibroblastic response characterized by large aggregations of plasma cells, macrophages and helper T lymphocytes. The reactive areas rapidly matured into noninflamed fibrocytic tissue. The suppressive effect of CsA appears responsible for removal of sectors of the normal immune response and, in combination with an elevated number of macrophages, may be instrumental in initiating a fibrous hyperplastic response.

Induction of the CD1a Langerhans cell marker on human monocytes.

Monocytes have recently been recognized as a precursor of Langerhans cells. This study examined the regulatory influence of the epithelial environment on the putative first step of the transition towards a Langerhans cell phenotype--the induction of CD1a antigen. The keratinocyte-derived cytokines granulocyte-macrophage-colony-stimulating factor, tumour necrosis factor-alpha, interleukin-6, and interleukin-1 beta induced CD1a expression, as did supernatants of keratinocytes extracted from inflammatory sites (periodontitis). Induction was abrogated by transforming growth factor-beta and a keratinocyte-derived interleukin-1 inhibitor. The optimal temperature for induction was 34 degrees C, not 37 degrees C. These results demonstrate that the components of the epithelial environment (cytokines and lower temperature) exert important influences, which may be part of local regulation of Langerhans cell development.