Molecular analysis of HLA class II genes in primary Sjögren's syndrome. A study of Israeli Jewish and Greek non-Jewish patients.

In an attempt to define the role of HLA class II genes in predisposition to primary Sjögren's syndrome, patients of two different ethnic groups (Israeli Jews and Greeks of non-Jewish origin) suffering from this disorder were studied. Oligonucleotide genotyping revealed the majority in both groups to carry either DRB1*1101 or DRB1*1104, alleles that are in linkage disequilibrium with DQB1*0301 and DQA1*0501. The high frequency of the two alleles in these SS patients is in contrast with the accepted association of primary SS with HLA-DR3 in Italian and American individuals. Molecular analysis of DQB1 and DQA1 alleles found in American Caucasian and American black SS (or SLE) patients demonstrated high frequencies of DQB1*0201 and DQA1*0501. The fact that the majority of SS patients, across racial and ethnic boundaries, carry a common allele, DQA1*0501, implies its involvement in the predisposition to primary SS. Based on sequence analysis and the computer imaging of the HLA class II molecule structure, a hypothetical model for the role of the DQ molecule in promoting primary SS is proposed.

Major salivary gland dysfunction in human acute and chronic graft-versus-host disease (GVHD).

Salivary gland dysfunction is frequently observed in patients suffering from acute (a) and chronic (c) GVHD. We studied the influence of GVHD on the function of major salivary glands in 20 patients with GVHD (cGVHD, 15; aGVHD, 5). A subjective evaluation of salivary function was performed, in which the score ranged from 0-4 where a higher score indicated more oral dryness. Patients with aGVHD scored 4.0 while patients with cGVHD scored 2.1 (P < 0.01). In addition to this subjective evaluation, patient's salivary flow rates were measured and a reduction of 90% and 60% in aGVHD and cGVHD patients respectively, was observed as compared to controls (P < 0.01; P < 0.05). No hyposalivation was observed in patients who underwent bone marrow transplantation but did not develop GVHD as compared to normal individuals. A direct correlation was observed between the degree of hyposalivation and the severity of the GVHD. Hyposalivation was also documented by scintigraphy of the major salivary glands in the GVHD patients. Furthermore, hyposalivation was associated with extensive mucosal atrophy, erythema, tongue surface depapillation, lichenoid lesions of the buccal and labial mucosa as well as lupus-like lesions. Routine assessment of these glands in patients with GVHD could play a role in monitoring response to therapy.

Effect of single versus fractionated doses of x-radiation on incisors in rats.

This study compares the effect of single vs fractionated doses of X-radiation on the incisor of the rat. The results showed that fractionated doses are more damaging than a single dose and that three fractionated doses have a stronger effect than five.

Tooth wear, solubility and fluoride concentration of molar-tooth surfaces in rats maintained on simultaneous or separate intake of food and fluoridated drinking water.

Eighty rats, 20 days old, were fed a hard pellet diet and deionized or fluoridated (25 parts/10(6) F-) drinking water respectively for 40 days. Half were maintained on simultaneous food and water intake for 3 h, daily, and the remainder on separate intake of food for 3 h followed by drinking water for 3 h, daily. Scanning electron micrographs of the occlusal surface of right maxillary first molars were used for scoring wear. The mandibular and left maxillary molar surfaces were used for solubility and fluoride concentration determinations. Intake of food and water separately did not affect wear significantly, whereas solubility and fluoride concentration of the molar surfaces were significantly increased. Wear, solubility and fluoride of the molar surfaces respectively were highly significantly increased in the rats provided with fluoridated water. Increase in fluoride uptake is due in part at least to the increase in sites available for uptake due to tooth wear. Acid dissolution of worn tooth-surface enamel is greater than that of intact enamel.

Enamel solubility profile of irradiated rat molars.

The solubility of molar enamel was tested in irradiated rats treated with fluoride (F-). Seventy-five 21-day-old rats were divided into five groups. The first group received F- in the drinking water (25 p.p.m.), one group was irradiated only (one single dose of 15 Gy to the head); one group was started on F- 3 weeks before irradiation, in one group the commencement of the F- regimen coincided with irradiation. The last group served as a control. The animals were sacrificed at 80 days old. Enamel solubility of the molar teeth, measured as Ca++ release in an etchant, was determined separately in three consecutive immersions. Fluoridation and irradiation reduced enamel solubility, albeit in a dissimilar depth-related amplitude. Whether administered prior to or following irradiation, F- reduced enamel solubility in a pattern resembling that of the non-irradiated F- treated group.

Thyroid papillary carcinoma presenting as jaw and parotid gland metastases.

A slowly progressing colloidal goiter of 20 years standing was excised in a 67-year old woman. Two years later, a metastatic tumor inducing facial swelling was diagnosed radiologically in the left parotid gland and left ascending mandibular ramus. The incisional biopsy confirmed papillary carcinoma of thyroid origin. The patient refused treatment. Six months later, she returned to the clinic and presented with advanced destructive changes of the involved structures. This rare case of unrestricted malignant growth may shed light upon the sequence and mode of metastatic invasion.

Overdentures for patients who are chronically ill: a 4-year follow-up.

In 12 chronically ill patients, 14 overdentures were inserted. The status of the retained teeth and the denture-supporting structures was evaluated annually for up to 4 years. The limitations and implications of this therapy as related to specific chronic diseases, medications, and patient behavior are emphasized. Based on short- and long-term follow-up, recommendations for the applicability of overdentures in systemically ill patients are offered.

Perioperative hemodynamic changes in ischemic heart disease patients undergoing dental treatment.

Twenty patients with stable ischemic heart disease in functional capacity Class II-IV underwent dental treatment. Scaling was performed in seven patients without local anesthesia. In the remaining 13 patients, pain control for restoration placement was obtained by local anesthesia: in seven patients, the anesthetics contained epinephrine, while in six this drug was omitted. Heart rate, blood pressure, and electrocardiograph were continuously monitored during the dental session. All patients had elevated systolic blood pressure and rate pressure product during treatment. In the patients who received plain local anesthetics only, the elevation in systolic blood and rate pressures was, however, significantly lower than the ischemic threshold. Arrhythmia or ST segment depression of > or = 1 millimeter were not recorded in any of the subjects. In severely compromised ischemic heart disease patients undergoing routine dental procedures of limited chair time, plain local anesthesia seems to be the preferred analgesic modality.

[Update on oral cancer--awareness equals survival?].

There is a trend towards higher prevalence of oral cancer and no progress has been achieved concerning survival rates during the last few decades. Despite the simplicity of the oral examination most of oral cancers are discovered at advanced stages bearing severe prognosis. Improved awareness of both the attendant medical team and the target population may improve the chances of prevention by earlier detection thus enhancing the survival rate. We present current diagnostic procedures for early detection of oral cancerous lesions together with a short review of epidemiology, clinical aspects, risk factors and treatment modalities.

[Oral manifestations of bulimia nervosa].

Bulimia nervosa (BN) is an eating disorder frquently accompanied by changes of the hard and soft tissues of the oral cavity and of the salivary glands. Routine dental examination in a 25-year-old woman disclosed oral signs and symptoms characteristic of BN and she was referred for psychiatric evaluation. Oral evaluation of patients suspected of BN is recommended to prevent irreversible damage to the oral and perioral structures.

Pilocarpine treatment in a mixed cohort of xerostomic patients.

OBJECTIVE: To compare the effect of a single 5-mg dose of pilocarpine hydrochloride on the salivary flow rate in three groups of xerostomic patients. SUBJECTS AND METHODS: Forty-five patients were divided into three groups according to the etiology of their xerostomia: (i) radiotherapy; (ii) Sjögren's syndrome; and (iii) sialosis and xerogenic medications. Following the oral administration of a 5-mg pilocarpine hydrochloride tablet blood pressure, heart rate, body temperature and saliva secretion rates were monitored hourly for 3 h and adverse events were reported. RESULTS: The most significant and persistent elevation of salivary flow rate was observed in the sialosis/drug-induced group followed by the Sjögren's syndrome group. The radiotherapy group presented a significant elevation of salivary secretion rate after 1 and 2 h, but returned to baseline at 3 h. No significant changes in vital signs were reported, except for low diastolic pressure measured at 1 h in the radiotherapy group. Several adverse events were recorded throughout the trial; however, only one patient withdrew from the study. CONCLUSION: Treatment with pilocarpine hydrochloride tablets may improve saliva secretion in patients taking xerogenic medications and/or suffering from metabolic sialosis expanding the beneficial potential of this sialogogue.

Pilocarpine for the treatment of salivary glands' impairment caused by radioiodine therapy for thyroid cancer.

OBJECTIVES: To study the effect of single-dose pilocarpine hydrochloride 5 mg on the whole unstimulated and stimulated salivary flow in patients suffering from thyroid cancer treated with radioiodine therapy, and to investigate the changes in vital signs during the treatment. SUBJECTS AND METHODS: Five such patients were referred with complaints of dry mouth, rampant caries, and pain in the parotid gland region or history of chronic recurrent suppurative sialodenitis. A single dose of 5 mg pilocarpine hydrochloride was administered to each patient and blood pressure, heart rate, body temperature and salivary secretion rate were monitored at 1, 2 and 3 h. RESULTS: A significant elevation of unstimulated and stimulated saliva flow rate was observed in four patients without significant alteration of the monitored vital signs. CONCLUSIONS: Treatment with pilocarpine hydrochloride may be beneficial in the case of impaired salivary function in patients treated with radioiodine.

A ten-year follow-up study of alveolar bone loss influenced by two dissimilar Class II amalgam restorations.

Twenty paired approximal amalgam restorations (E) extended and unextended (NE) placed in twelve patients were followed up for 10 years. Measurements of the distance between the alveolar crest and (a) the apical margin of the filling (E and NE) or (b) the cementoenamel junction of the untreated control surface (C) were performed 1, 4 and 10 years following restoration placement. The bone loss associated with NE filling did not differ significantly from that of the control group and amounted to 0.4 mm in 10 years. The 10-year cumulative bone loss adjacent to the extended restoration (E) was 1.07 mm. Bone loss associated with the E restoration was significantly higher (P less than 0.001) than that of the NE and control groups at every period measured. During the first 4 years the yearly bone loss of the E group was 0.14 mm and then decreased to 0.08 mm during the last 6 years.

Dysgeusia, gustatory sweating, and crocodile tears syndrome induced by a cerebellopontine angle meningioma.

Facial nerve involvement in cerebellopontine angle tumors, both during their development and after excision, may be expressed in irreversible dysfunction of the parasympathetic pathways. The exact location of the lesion along the efferent nerve fibers can be established through evaluation of the functional level of those organs supplied by the cholinergic motor secretory components. This report deals with a female patient in whom peripheral facial palsy developed shortly after removal of a right cerebellopontine angle meningioma. She had slight facial asymmetry and deafness in the right ear and complained of prandial flush and sweating of the right malar area. Occult ipsilateral hyposalivation and hypolacrimation were diagnosed. In patients with seventh and ninth cranial nerve pathoses, evaluation of the end organs that are supplied by their associated autonomous nerve fibers is mandatory to prevent late ocular and oral sequelae.

Lymphosarcoma of the mandible associated with macroglobulinemia of Waldenström.

Waldenström macroglobulinemia is a rare progressive immunoproliferative disorder involving lymphocytes and occasionally plasma cells. Unlike the multiple myeloma, this disease has minimal osseous lesions. Lesions in the jaws are very rare. This paper presents a case of lymphosarcoma in the mandible in a 68-year-old woman, who was diagnosed as suffering from Waldenström macroglobulinemia. The possibility of immunosuppression by Leukeran as an aetiologic factor causing the bone lesions is suggested.

Salivary gland involvement in Wegener's granulomatosis. A case report and review of the literature.

Late involvement of the parotid gland in a patient with a limited form of Wegener's granulomatosis is presented. We report the full course of the disease and the difficulties encountered in determining the nature of the parotid enlargement. We discuss the contribution of computerized tomography and ultrasonography to elucidate parenchymal morphologic findings and radioisotope studies to determine the functional capacity of the gland. In cases of Wegener's granulomatosis with salivary symptoms, measurement of salivary gland functional capacity, in addition to the c-ANCA test, may help to monitor disease activity. Despite the rarity of the disease, in cases when granulomatous diseases are considered, it should be recognized that Wegener's granulomatosis may result in salivary gland involvement.

Major salivary glands in branchial arch syndromes.

In five patients with branchial arch syndromes the presence of the salivary glands was demonstrated. Clinical, sialographic, and scintigraphic examinations revealed morphologic defects and diminished function of the parotid glands. Hyperfunction of the submandibular glands was assumed in the three patients in whom scintigraphic studies were performed. The findings may be of diagnostic value in patients in whom the clinical signs of the syndrome have remained occult.