Oral verrucous xanthoma with oral lichen planus: a case report.

Verrucous xanthoma is a rare benign muco-cutaneous lesion, whereas oral lichen planus is a chronic inflammatory disease relatively common in the clinical setting. Verrucous xanthoma and oral lichen planus can reportedly coexist according to foreign literature. Owing to the low incidence of verrucous xanthoma and the rarity of co-occurrence of these two diseases, the mechanism underlying the co-occurrence of the two diseases remains inconclusive. In this work, a case of oral verrucous xanthoma complicated with oral lichen planus was reported. Related literature was reviewed to discuss the clinical classification, pathological classification, and possible pathogenesis of the two diseases.

Diagnostic value of objective VELscope fluorescence methods in distinguishing oral cancer from oral potentially malignant disorders (OPMDs).

Background: The VELscope fluorescence method has been applied to the identification and detection of oral potentially malignant disorders, but autofluorescence visualization lacks objectivity and its diagnostic value varies greatly. The effectiveness of VELscope in detection of the cancer risk in oral potentially malignant disorders at different lesion sites remains unclear, given that only a few studies have investigated the value of VELscope for detecting high- and low-risk lesions in oral potentially malignant disorders. This study used the objective VELscope fluorescence method based on quantitative analysis to investigate its value in oral potentially malignant disorders for: (I) detecting oral cancer; (II) distinguishing high-risk lesions from low-risk lesions; and (III) measuring differences in oral cancer diagnostic accuracy between different sites. Methods: Conventional oral examination and subjective and objective VELscope examinations were performed on 59 oral potentially malignant disorders; autofluorescence results were compared with histopathological diagnosis. Results: The sensitivity of subjective and objective VELscope fluorescence methods for detecting oral cancer in oral potentially malignant disorders was 76.9% and 65.4%, respectively; specificity for distinguishing high-risk from low-risk lesions in oral potentially malignant disorders was 50.0% and 82.1%, respectively; and sensitivity for detecting oral cancer in oral potentially malignant disorders of lining mucosa was 81.0%, higher than that of the masticatory mucosa. Conclusions: The identification ability for low-risk lesions can be improved by combining it with objective autofluorescence. Autofluorescence has different screening abilities in different parts of the oral mucosa.

Difficult and complicated oral ulceration: an expert consensus guideline for diagnosis.

The complexity of oral ulcerations poses considerable diagnostic and therapeutic challenges to oral specialists. The expert consensus was conducted to summarize the diagnostic work-up for difficult and complicated oral ulcers, based on factors such as detailed clinical medical history inquiry, histopathological examination, and ulceration-related systemic diseases screening. Not only it can provide a standardized procedure of oral ulceration, but also it can improve the diagnostic efficiency, in order to avoid misdiagnosis and missed diagnosis.

Expression of keratinocyte growth factor and its receptor in oral lichen planus.

This study aimed to investigate the expression of keratinocyte growth factor (KGF) and its receptor KGFR in oral lichen planus (OLP). Oral mucosa specimens from 30 OLP patients and ten healthy controls were collected. The expression of KGF and KGFR proteins was detected by immunohistochemistry and the expression of KGF mRNA was detected by in situ hybridization. We observed KGF protein expression but not KGF mRNA expression in the epithelium of both OLP and normal oral mucosa. The expression intensity of KGF protein was much lower in the epithelium of OLP than in that of normal oral mucosa. KGF protein was also expressed in the cytoplasm of some fibroblasts and vascular endothelial cells in the connective tissues underlying the epithelium for both OLP and normal oral mucosa, but the expression intensity of KGF was lower in the connective tissues for OLP. KGF mRNA was expressed in the cytoplasm of some fibroblasts and vascular endothelial cells in the connective tissues underlying the epithelium for both OLP and normal oral tissues. Although KGFR was expressed in vascular endothelial cells of connective tissue and in all epithelium of normal oral mucosa, it was only expressed in the basal layer and prickle layer of the epithelium and in vascular endothelial cells of the connective tissue of OLP. Compared to normal oral mucosa, OLP had lower expression of KGFR in the epithelium but higher expression of KGFR in the connective tissue underlying the epithelium. In conclusion, this study revealed significant differences in the expression intensity and distribution of both KGF and KGFR between OLP and normal oral mucosa tissues. KGF and its receptor KGRF may play an important role in the development and progression of OLP.

The Effect of Pudilan Anti-Inflammatory Oral Liquid on the Treatment of Mild Recurrent Aphthous Ulcers.

Recurrent aphthous ulcers are the most common recurrent oral mucosal lesions characterized by recurrence and pain. The aim of this research is to evaluate the short-term curative effect of the traditional Chinese medicine "Pudilan anti-inflammatory oral liquid" on mild recurrent aphthous ulcers. A total of 234 patients were divided into a treatment group and a control group. Both groups used vitamin B2 as the basis of treatment. The treatment group took a Pudilan anti-inflammatory oral solution for 8 days while the control group was given a liquid placebo. The ulcer size, pseudomembrane, peripheral congestion, and pain scores of the treatment group were lower than before treatment. The curative effect on the Pudilan group was statistically significant compared with the control group. The final therapeutic effect on the treatment group was better than that on the control group. The healing time of mild recurrent aphthous ulcers can be shortened by Pudilan anti-inflammatory oral liquid, and pain is relieved without adverse reactions. Pudilan provides a new reference drug for the treatment of mild recurrent oral ulcers.

Clinical characteristics and analysis of familial oral lichen planus in eight Chinese families.

Oral lichen planus (OLP) is one of the most common oral mucosa diseases; however, familial OLP is uncommon. The present study reported and analyzed patients with familial OLP (n=18) in eight different Chinese families between January 1, 2012 and December 31, 2013. Parameters analyzed include gender, age at diagnosis, lesion distribution and lesion type. The follow-up period for each patient was a minimum of 1 year. In this survey, 18/88 individuals in the eight families were affected. Females were more frequently affected, and the female to male ratio for familial OLP (2.2:1) was higher compared with that previously reported for nonfamilial OLP (1.4:1). The age at diagnosis, lesion distribution and lesion type showed consistency with reports concerning nonfamilial OLP, with the exception of family VI, in which 4/5 children had OLP/LP lesions and were of an early age at diagnosis. There were two families in which three generations had been affected by OLP. In addition, it appeared that patients of the same generation in the same family were of a similar age at diagnosis. No malignant or premalignant lesion was identified in the 18 individuals diagnosed with OLP from the eight families. The present study supports the hypothesis that genetic predisposition may serve a role in the etiology of OLP.

[Study on the function of keratinocyte growth factor on apoptosis of oral mucosal epithelial cells].

OBJECTIVE: To study the function of keratinocyte growth factor (KGF) on apoptosis of oral mucosal epithelial cells and to provide a basis for further investigation of the role of KGF in the occurrence and development of oral mucosal diseases. METHODS: Different concentrations of KGF (control group, 0 ng x mL(-1); experiment 1 group, 5 ng x mL(-1); experimental 2 group, 25 ng x mL(-1); experiment 3 group, 50 ng x mL(-1)) were added in oral mucosa epithelial cells cultured in vitro. After training for 12, 24, and 48 h, cell morphology was observed under an inverted microscope. Apoptosis was detected by using a flow cytometry instrument, and mRNA expression of apoptosis-related genes Bcl-2 and Bax was detected by using Real-Time fluorescent quantitative detection. RESULTS: Cell adherence of the experimental group was more obvious than that of the control group, and the cell nucleolus of the experiment 3 group was obviously cultured at 48 h. After culturing for 48 h, the apoptosis rate and Bcl-2 and Bax mRNA expression among the four groups were statistically significant. The increase of KGF concentration, apoptosis rate, and Bax mRNA expression gradually reduced, whereas Bcl-2 mRNA expression increased (P < 0.05). CONCLUSION: KGF may inhibit epithelial cell apoptosis through upregulation of Bcl-2 mRNA and downregulation of Bax mRNA.

Anticoagulant and Fibrinolytic Disorders in Patients with Behçet's Disease and Recurrent Aphthous Ulcer.

Behçet's disease (BD) is a chronic multisystemic inflammatory disorder characterized by recurrent oral and genital aphthous ulcers, uveitis and skin lesions. Recurrent aphthous ulcer (RAU) is the most prevalent oral mucosal disease in humans. The pathogenesis and thrombopoiesis of BD and RAU have not been fully clarified. To reveal the haemostatic dysfunctions in the patients with BD and RAU, we evaluated the levels of coagulant, anticoagulant and fibrinolytic parameters in these patients.Factor VIII clotting activity (FVIII:c), protein C antigen (PC:Ag), total protein S antigen (TPS: Ag), tissue-type plasminogen activator antigen (t-PA:Ag), plasminogen activator inhibitor-1 antigen (PAI-1:Ag) and D-dimer were detected in 24 BD, 58 RAU patients and 50 controls. Results showed that levels of PC:Ag, TPS:Ag, PAI-1:Ag and D-dimer were significantly elevated in both BD and RAU patients compared with controls (P<0.01). PAI-1:Ag was even higher in BD patients than in RAU patients (74.99±12.28 vs. 69.57±13.11, P<0.05), whereas the level of t-PA:Ag was significantly reduced in patients with BD and RAU (P<0.01). In patients with RAU, PC:Ag was lower in major aphthous ulcer (MjAU) group than in minor aphthous ulcer (MiAU) group (P<0.05). The expression of FVIII:c was significantly elevated in MiAU patients compared with controls (P<0.01), while no difference was observed between MjAU patients and controls (P>0.05). Our studies showed that there were anticoagulant and fibrinolytic disorders in BD patients, which may be responsible for diminished fibrinolysis in BD. Some haemostatic parameters may be correlated with the severity of RAU.

OPN promotes survival of activated T cells by up-regulating CD44 in patients with oral lichen planus.

Oral lichen planus (OLP) is a chronic inflammatory disorder of oral mucosa, which represents cell-mediated autoimmune diseases. Pathological study demonstrated that abundant T lymphocytes infiltrated the oral mucosa, in which the activated T cells that trigger apoptosis of oral epithelial cells is an important mechanism for OLP. However, to date the molecular mechanisms underlying the T lymphocytes infiltration and accumulation in OLP remain unclear. In this paper, we found that the levels of plasma OPN were elevated and were associated with the up-regulated expressions of CD44 in OLP patients. In vitro, the addition of exogenous OPN can suppress the apoptosis of activated CD8(+) T cells via CD44, and this T cell resistance to apoptosis may be attributed to the reduction of endogenous mature granzyme B. Our results suggested that the abnormally elevated levels of OPN may contribute to the abnormal infiltration and accumulation of the activated T cells by up-regulating CD44 in OLP.

[The effect of interleukin-1beta and dexamethasone on keratinocyte growth factor expression level of cultured oral fibroblasts].

OBJECTIVE: To detect the effects of human interleukin-1beta (IL-1beta) and Dexamethasone (DEX) on the expression level of keratinocyte growth factor (KGF) in cultured human fibroblasts of normal oral and oral lichen planus (OLP) mucosa. METHODS: Three concentration gradients of IL-1beta and DEX were added to cultured fibroblasts of human normal oral and OLP mucosa respectively. 72 hours later, the supernatant was harvested for the detection of KGF concentration with enzyme linked immunosorbent assay (ELISA). Total RNA of the fibroblasts was extracted and reverse transcribed. The resulting cDNA was then amplified by polymerase chain reaction (PCR) to detect the KGF mRNA. RESULTS: The results of the ELISA and PCR showed that the expression levels of KGF protein and mRNA were higher if the cells were treated with IL-1beta. However, the expression levels of KGF protein and mRNA were significantly reduced if the fibroblasts were treated with DEX. CONCLUSION: IL-1beta can promote KGF expression levels of cultured normal oral and OLP fibroblasts, and it is concentration-dependent. While DEX can inhibit KGF expression of cultured normal oral and OLP fibroblasts, and it is also concentration-dependent.

[The expression of interleukin-10 mRNA in gingival lesion of different clinical states in patients with adult periodontitis].

OBJECTIVE: To investigate the expression of interleukin-10 (IL-10) mRNA in gingival tissue of active and stable stage in patients with adult periodontitis. METHODS: 12 patients with acute abscesses of the periodontium, 12 patients after periodontal initial treatment and 6 periodontal healthy patients having extraction of impacted wisdom tooth were randomly divided into group A (active stage group), group B (stable stage group) and the control group. Biopsies of gingival tissues were collected from every subject of three groups. Technique of in situ hybridization was applied to observe the expression of IL-10 mRNA in the biopsies from three groups semi-quantitatively. RESULTS: IL-10 mRNA was positively expressed in lymphocytes, macrophages and fibroblasts. The quantity of IL-10 mRNA of group A was the lowest in the three groups and was significantly lower than that of control group and group B respectively (P < 0.01). The quantity of IL-10 mRNA of group B was the highest in the three groups and was significantly higher compared with the control group and group A (P < 0.01). CONCLUSION: The quantities of IL-10 mRNA expression are closely related with various clinical states of periodontitis.

[Effect of periodontal initial therapy together with Chinese herbal compound for clearing heat and detoxification on interleukin-1 beta and tumor necrosis factor-alpha in gingival crevicular fluid of patients with chronic periodontitis].

OBJECTIVE: To observe the effect of periodontal initial therapy together with Chinese herbal compound for clearing heat and detoxification (Abbr. TCM) on the levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta) in gingival crevicular fluid (GCF) of patients with chronic periodontitis (CPD). METHODS: Thirty-four teeth of 24 patients with CPD were randomly assigned to the control group (17 teeth of 11 patients) and the treated group (17 teeth of 13 patients), they were treated for 8 weeks with periodontal initial therapy, but TCM was given additionally to the treated group. The GCF of the observed teeth was collected at the time before initial therapy (datum line) and at 2 and 8 weeks after treatment. At the same time, the clinical parameters, including probing depth (PD), clinical attachment loss (CAL), and bleeding on probing (BOP) were recorded, and the levels of TNF-alpha and IL-1 beta in GCF were measured by radioimmunoassay. RESULTS: The levels of TNF-alpha and IL-1 beta in GCF after treatment were significantly lowered in all patients as compared with those before treatment (P<0.01), while PD, CAL and BOP showed significant reduction (P<0.01). After treatment, TNF-alpha and IL-1 beta levels in the treated group were lower than those in the control group (TNF-alpha: 2.5551 +/- 1.0157 microg/L vs 3.4341 +/- 1.0762 microg/L, IL-1 beta: 0.1335 +/- 0.0216 microg/L vs 0.1471 +/- 0.0169 microg/L; P<0.05). CONCLUSION: TCM could enhance the effect of periodontal initial therapy in lowering TNF-alpha and IL-1 beta levels, which was attributed to reducing the inflammatory reaction of periodontal tissues.

Comparative observation on the effects of Radix tripterygium hypoglaucum tablet and Tripterygium glycosides tablet in treating erosive oral lichen planus.

OBJECTIVE: To compare the therapeutic effects of Radix Tripterygium hypoglaucum tablet (THT) and Tripterygium glycosides tablet (TGT) in treating erosive oral lichen planus (EOLP). METHODS: The patients were randomized into two groups, and they were treated with THT (n = 47) or TGT (n = 47), respectively. The therapeutic effects were evaluated after 3 months treatment. RESULTS: For the patients of grade 1, the total efficacy in TGT group was 85.71%, compared with 52.38% in THT group, the efficacy was statistically greater in the group receiving TGT (P = 0.043). However, for the patients of grade 2, the difference was not statistically significant (P = 0.173). CONCLUSION: TGT is more effective in treating EOLP than THT for grade 1 patients. However, TGT is not suitable for patients of child bearing age.

[Study on the expression of IL-10 mRNA and the protein in gingival tissues of patients with chronic periodontitis].

PURPOSE: To investigate the cell type which express IL-10 mRNA and the protein in gingival tissues of patients with chronic periodontitis. METHODS: 12 patients with chronic periodontitis who were undergoing flap operation were randomly chosen as periodontitis group;10 patients undergoing gingivectomy were chosen as gingivitis group;6 patients undergoing extraction of impacted teeth were chosen as control group. Assays of in situ hybridization and immunohistochemistry were used to observe the expression of IL-10 mRNA and the protein in gingival tissues of each group respectively . Wilcoxon test was used to compare the expression of IL-10 of each group at two levels; differences between the two groups were analyzed by one-way ANOVA test. RESULTS: IL-10 mRNA and the protein were all expressed in gingival tissues of periodontium,they were found in lymphocytes, fibroblasts and macrophages. There were no significant differences between two levels of IL-10 expression of periodontitis group and control group (P>0.05) gingivitis group,P<0.05). The IL-10 expression of periodontitis group was significantly higher than gingivitis group and control group (P<0.01); The IL-10 mRNA expression of periodontitis group was significantly higher than control group (P<0.01),but there was no significant difference between the IL-10 mRNA expression of periodontitis group and gingivitis group (P>0.05). CONCLUSION: There is a local secretion mechanism of IL-10 in the periodontal tissues.

[Changes of circulating IFN-gamma, IL-4 in patients with chronic periodontitis before and after periodontal initial therapy].

PURPOSE: To investigate the effect of periodontal initial therapy on circulating blood serum interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) in patients with chronic periodontitis. METHODS: 15 patients with chronic periodontitis and 15 healthy people were selected. Circulating blood serum IFN-gamma and IL-4 were measured using double antibody sandwich ELISA; Student's t test was used for comparing sulcus bleeding index (SBI), probing depth (PD), and circulating IFN-gamma, IL-4 in patients with chronic periodontitis that were assessed respectively before and 4 to 6 weeks after periodontal initial therapy. RESULTS: The level of blood serum IFN-gamma, IL-4 in patients with chronic periodontitis was significantly higher than the control group (P<0.01); After periodontal initial therapy, SBI, PD, and circulating IFN-gamma concentration were reduced significantly (P<0.01); IL-4 concentration had no significant difference (P>0.05). CONCLUSIONS: Blood serum IFN-gamma, IL-4 were associated with chronic periodontitis; The control of gingival infection may reduce blood serum IFN-gamma concentration; IL-4 concentration was not reduced with the control of gingival infection. Periodontal initial therapy.

[Biological effects of tetracycline on cultured human periodontal fibroblasts].

OBJECTIVE: To explore the biological effects of tetracycline on cultured human periodontal ligament fibroblasts (HPDLFs). METHODS: Increasing concentrations of tetracycline (1, 5, 20, 100, 500, 2500 microg/ml) were added to the medium of cultured HPDLFs, respectively. After co-incubated for 2 days, cell morphology was observed under reverse microscope, meanwhile, cell proliferation activity was assayed using MTT, the total amount of protein was detected with Coumassie Bright Blue method and DNA synthesis was measured by 3H-TdR. RESULTS: Over a concentration range of 1 to 100 microg/ml, cells demonstrated a normal appearance, spindle or fusiform shaped. Moreover, at a concentration range of 20 to 100 microg/ml, tetracycline significantly enhanced the proliferating activity and biosynthesis of HPDLFs (P < 0.01). However, higher concentration (2500 microg/ml) not only changed cell morphology, but also significantly inhibited cellular activity. CONCLUSION: The results suggested that proper doses of tetracycline could promote proliferation and biosynthesis of HPDLFs while higher concentrations of tetracycline had cytotoxic effect.

[Effects of minocycline on biobehavior of human periodontal ligament cells in vitro].

OBJECTIVE: To evaluate the influence of minocycline on the proliferation and biosynthesis of human periodontal ligament cells (HPDLCs) in vitro. METHODS: Various concentrations of minocycline (1, 5, 20, 100, 500, 2 500 mg/L) were added to the medium of cultured HPDLCs respectively. After co-incubated for 2 days, cell morphology was observed under reverse microscope, cell proliferation activity was assayed using MTT, the total amount of protein was detected with Coumassie Bright Blue method and DNA synthesis was measured by (3)H-TdR. RESULTS: The presence of minocycline not exceeding 500 mg/L in the medium resulted in no morphological change of HPDLCs. Moreover, at a concentration range of 5 to 100 mg/L, minocycline significantly enhanced the proliferative activity and biosynthesis of HPDLCs (P < 0.01). However, higher concentration (2 500 mg/L) not only changed cell morphology under microscope, but also significantly inhibited cellular activity. CONCLUSIONS: The results suggest that proper doses of minocycline could promote biobehavior of HPDLCs, while higher concentrations of minocycline had cytotoxic effect which may intervene affect tissue repair and regeneration.

[The effect of periodontal initial therapy on circulating TNF-alpha and HbA1C in type 2 diabetes patients with periodontitis].

OBJECTIVE: To investigate the effect and mechanism of periodontal initial therapy on type 2 diabetes patients with periodontitis. METHODS: 15 type 2 diabetes patients with periodontitis were selected. Their body mass index (BMI), sulcus bleeding index (SBI), probing depth (PD), circulating tumor necrosis factor-alpha (TNF-alpha) concentration, and the value of glycosylated hemoglobin (HbA1C), triglycerides (TG) and cholesterol (CHOL) were assessed respectively before and 4-6 weeks after periodontal initial therapy. RESULTS: After initial therapy, SBI, PD, circulating TNF-alpha concentration, and the value of HbA1C and TG were reduced significantly (P<0.05), while there were no significant differences in BMI and CHOL value (P>0.05). CONCLUSIONS: Periodontal initial therapy can effectively reduce HbA1C value in type 2 diabetes patients with periodontitis, possibly through the reduction of circulating TNF-alpha concentration.

[Change of circulating TNF-alpha in patients with advanced periodontitis before and after periodontal initial therapy].

OBJECTIVE: To investigate the effect of periodontal initial therapy on circulating tumor necrosis factor-alpha (TNF-alpha) in patients with periodontitis. METHODS: Patients with advanced periodontitis were selected. Sulcus bleeding index (SBI), probing depth (PD), and circulating TNF-alpha concentration were assessed respectively before and 4-6 weeks after periodontal initial therapy. RESULTS: The level of circulating TNF-alpha in patients with periodontitis was significantly higher than that in healthy control subjects (P < 0.01). After periodontal initial therapy, SBI, PD and circulating TNF-alpha concentration were reduced significantly (P < 0.01) in patients with periodontitis. CONCLUSION: Periodontitis may have profound effects on systemic health through the elevation of circulating TNF-alpha. Prevention and treatment of periodontitis should be important in maintaining systemic health.