Prompt healing of erosive oral lichen planus lesion after combined corticosteroid treatment with locally injected triamcinolone acetonide plus oral prednisolone.

BACKGROUND/PURPOSE: Erosive oral lichen planus (EOLP) is a T-cell-mediated inflammatory disease that is refractory to treat. This study tested whether local injection of triamcinolone acetonide plus oral administration of low- or medium-dose prednisolone could hasten the healing of EOLP lesions. METHODS: In this study, 50 EOLP patients were treated with local injection of Kenacort A (40 mg triamcinolone acetonide once weekly for 3 and 2 weeks for 30 major and 20 minor EOLP patients, respectively) plus oral administration of prednisolone (25-30 mg and 15-20mg of prednisolone once daily for 2 weeks for 30 major and 20 minor EOLP patients, respectively). The oral administration of prednisolone was tapered to 5mg per day and stopped in 7 days. Then, the patients were treated with topical Dexaltin (0.1% dexamethasone, once or twice per daily) and oral administration of vitamin Bc (one capsule twice daily) thereafter. RESULTS: After 3-week treatments, the 30 major EOLP patients showed complete response (lack of detectable erosive or ulcerative lesion with absence or regression of reticular or papular OLP) in 27 cases (90%) and partial response (reduction of erosive or ulcerative lesion by at least 30% in diameter with regression of reticular or papular OLP) in cases (10%); and 20 minor EOLP patients demonstrated complete response in 18 cases (90%) and partial response in two cases (10%). However, all the 45 complete response major or minor EOLP patients showed recurrence of erosive or ulcerative lesion after 3-24 (mean 12) months of follow-up. CONCLUSION: Prompt and complete healing of the EOLP lesions could be achieved in a relative short period of time after treatment with our protocol. Although complete response EOLP lesions recurred after a follow-up period of 3-24 months, patients did have an average remission period of 12 months after treatment with our protocol.

Odontogenic fibroma: a clinicopathological study of 15 cases.

BACKGROUND/PURPOSE: Odontogenic fibroma (ODF) is a rare odontogenic tumor. It can be further divided into peripheral odontogenic fibroma (PODF) and central odontogenic fibroma (CODF). This retrospective study evaluated the clinical and histopathological features of 15 ODFs in Taiwanese patients. METHODS: Fifteen consecutive cases of ODF were collected from 1984 to 2009. The clinical data and microscopic features of these cases were reviewed and analyzed. RESULTS: Twelve PODFs were excised from six male and six female patients (mean age: 35 years) and three CODFs from two male and one female patients (mean age: 11 years). Eight of the 12 PODFs were found on the mandibular gingiva and four on the maxillary gingiva, with the most common site being the mandibular anterior and premolar region (5 cases). Two CODFs were located in the molar region of the mandible and one in the anterior maxilla. Two CODFs showed a mixed lesion and one a radiolucent lesion. No recurrence of the 15 ODFs was found after total excision or enucleation. Microscopically 58.3% of the PODFs showed surface ulcèration. Calcified foci composed of osteoid, cementoid, or cementicle-like materials were noted in all 15 ODFs. Nests or strands of odontogenic epithelium were found in all 15 ODFs. The stromal component was mainly fibro-collagenous in nine of the 12 PODFs, whereas two of the three CODFs contained predominantly myxomatous stroma. CONCLUSION: PODFs occurred more commonly than CODFs. PODF showed an equal sex distribution and was found more frequently in patients in the third to fourth decades of life. The most commonly affected site was the mandibular gingiva, especially the anterior and premolar gingiva. Only three CODFs were found; therefore, we could not draw any conclusions about CODF in Taiwanese patients.

Clinicopathological study of 252 jaw bone periapical lesions from a private pathology laboratory.

BACKGROUND/PURPOSE: Periapical lesions are common sequelae of pulp diseases. This retrospective study evaluated the clinical and histopathological features of periapical lesions sent to a private pathology laboratory by dentists in private clinics. METHODS: Two hundred and fifty-two consecutive cases of periapical lesions were collected from September 2005 to October 2009. Clinical data and histopathological features of these periapical lesions were reviewed and analyzed. RESULTS: The 252 periapical lesions consisted of 128 periapical granulomas, 117 periapical cysts, and seven periapical scars. These 252 lesions were taken from 252 patients (92 men and 160 women; mean age = 43.6 years; range, 9-81 years). Of the 252 periapical lesions, 186 were found in the maxilla and 66 in the mandible. The most common site for periapical lesions was the maxillary anterior region (134 cases, including 73 granulomas, 54 cysts and 7 scars), and the most frequently involved tooth was the maxillary lateral incisor (64 cases, including 29 granulomas, 31 cysts and 4 scars). Of the 117 periapical cysts, 116 were lined by stratified squamous epithelium and one by mucoepidermoid epithelium. Hyaline bodies were discovered in the lining epithelium of four periapical cysts. Odontogenic epithelial rest, cholesterol cleft, foamy histiocytes, hemosiderin-laden macrophages, dystrophic calcification, foreign bodies, and bacterial clumps were found in five, three, nine, two, 28, 10 and one periapical granulomas, respectively, as well as in six, 11, eight, seven, 19, nine and eight periapical cysts, respectively. CONCLUSION: Granulomas and cysts were the two most common periapical lesions. Periapical lesions occurred more frequently in female patients and in those in their fourth to fifth decades. The most commonly affected site for periapical lesions was the maxillary anterior region, and the most frequently involved tooth was the maxillary lateral incisor.

Clinicopathological study of oral giant cell fibromas.

BACKGROUND/PURPOSE: Oral giant cell fibromas (GCFs) are found predominantly in Caucasians and rarely in other races. This retrospective study evaluated the clinicopathological features of 24 GCFs in Taiwanese patients. METHODS: Twenty-four consecutive cases of oral GCF were investigated from 1987 to 2008. Clinical data and microscopic features were reviewed and analyzed. RESULTS: The mean age of patients at the time of diagnosis was 29 years. Oral GCF occurred more commonly in patients between 11 and 40 years of age. There were 12 male and 12 female patients. The lesions were found more frequently on the tongue (8 cases) and gingiva (7 cases). The mean size of the lesion was 5.5mm (range, 2-10 mm) in greatest dimension. GCF is misdiagnosed frequently as fibroma (19 cases) or papilloma (5 cases). All tumors were treated by total surgical excision and no recurrence was found after treatment. Microscopically, the GCF was a sessile or pedunculated mass covered with a thin layer of parakeratinized or orthokeratinized stratified squamous epithelium. The tumor was composed mainly of loose or dense fibrous connective tissue with well-formed capillaries and no inflammation. The consistent and diagnostic feature was the presence of large stellate giant cells, usually with one or two nuclei. Multinucleated giant cells were seen occasionally. These giant cells were most numerous in the connective tissue just beneath the epithelium. CONCLUSION: Oral GCFs show no significant sex predilection and occur in patients in the second to fourth decades of life. Usually, the lesions are < 1 cm in diameter and are found more frequently on the tongue and gingiva. GCF resembles fibroma or papilloma and is difficult to diagnose correctly at the first glance. All GCFs can be treated by conservative surgical excision without subsequent recurrence.

Oral verrucous hyperplasia: histologic classification, prognosis, and clinical implications.

BACKGROUND: Oral verrucous hyperplasia (OVH) is a premalignant lesion that may transform into an oral cancer. METHODS: Sixty consecutive OVH cases were collected from 2003 to 2004. Clinicopathological features and the 5-year malignant transformation rate of these 60 OVH lesions were evaluated and analyzed. RESULTS: We found that 84% of OVH lesions occurred in patients between 40 and 69 years of age. The most common site for OVH lesions was the buccal mucosa (48%), followed by the tongue (20%), palate (18%), gingiva (7%), and labial mucosa (7%). Approximately 91% of OVH patients were areca quid chewers and 89% were smokers. When 60 OVH lesions were classified into 30 plaque-typed and 30 mass-typed OVH lesions, the mass-typed OVH lesions had a higher malignant transformation rate of 17% (5/30) than the plaque-typed OVH lesions (3%, 1/30) during a mean follow-up period of 59 +/- 7 months. The mean time for malignant transformation was 22 +/- 11 months. Of the 6 OVH lesions with malignant transformation, 2 underwent total surgical excision and 4 did not receive any form of therapy. CONCLUSIONS: We conclude that OVH lesions occur more commonly on the buccal mucosa and are highly associated with the areca quid chewing and cigarette smoking habits. The overall 5-year malignant transformation rate of 60 OVH lesions was 10%. The mass-typed OVH lesions had a higher malignant transformation rate than the plaque-typed OVH lesions and thus should receive an immediate treatment, such as total surgical excision or photodynamic therapy, after the histopathologic diagnosis.

Cardiovascular influence of dental anxiety during local anesthesia for tooth extraction.

OBJECTIVE: The present study evaluated whether dental patient anxiety has an effect on the cardiovascular response to the delivery of anesthetic to achieve mandibular anesthesia. STUDY DESIGN: One hundred eighty adult patients scheduled to receive routine dental extraction under local anesthesia were enrolled in this prospective study. Anxiety was measured at 15 minutes before local anesthetic delivery using Corah's Dental Anxiety Scale (Corah's DAS). Anesthetic was delivered using a standard technique for mandibular nerve block with the same dose (2 cartridges) given to all patients. Cardiovascular response data including blood pressure, heart rate, O(2) saturation, and electrocardiographic changes were measured at 5 time points from 5 minutes before to 15 minutes after the administration of anesthetic. RESULTS: The mean anxiety scale score before administration of anesthetic was 9.3 (SD +/- 2.5) with a range from 4 to 20. Women had a significantly higher mean dental anxiety level than men (P < .05). Younger age was associated with a higher anxiety scale score. Severe preoperative anxiety (Corah's DAS >12) was associated with significantly increased heart rate during administration of anesthetic. Patients with severe anxiety also had a significantly greater increase in heart rate during anesthetic administration (P < .001). Younger age was associated with increased likelihood of high dental anxiety and associated cardiovascular response to dental anesthesia (P = .001). Pain on injection was also associated with increased heart rate during anesthetic administration. CONCLUSION: This study showed that Corah's dental anxiety scale is a useful tool for estimating the impact of anxiety on the heart rate during local anesthetic delivery to achieve mandibular block for dental extraction. Younger patients undergoing tooth extraction were more likely to have high anxiety levels, and younger patients with high anxiety were more likely to report a traumatic dental history. High anxiety, younger age, and traumatic dental history were correlated with greater increases in heart rate during the administration of local dental anesthesia.

Ectopic mandibular third molar in the ramus region: report of a case and literature review.

OBJECTIVES: Ectopic mandibular third molar is a rare condition, and information is limited about its causes and characteristics. This article reports a case of ectopic mandibular third molar and reviews the literature on the clinical signs and symptoms and management of this condition. STUDY DESIGN: We report a case of an impacted mandibular third molar dislocated high on the right side of the mandibular ramus. Thirteen cases of ectopic mandibular third molars reported in the English-language literature over the past 25 years, identified from Pubmed and Medline databases are also reviewed. RESULTS: Among the 13 case reports identified, 10 occurred in women. Pain and swelling on the ispilateral side of the mandible or the preauricular region were the most common symptoms. Seven cases involved an ectopic mandibular third molar in the condylar or subcondylar region. Eight of the 11 cases included the description of a radiolucent image around the ectopic molar on the radiograph and described diagnosis of a dentigerous cyst. Seven of the ectopic third molars were extracted through intraoral access, and 3 were extracted through extraoral access. CONCLUSIONS: The etiology of ectopic mandibular third molars has not yet been completely clarified. Annual follow-up visits with panoramic radiographs are required for patients with symptom-free highly aberrant wisdom teeth. Treatment should be carefully planned according to the position of the ectopic tooth and the potential for trauma caused by the surgery.

Topical 5-aminolevulinic acid-mediated photodynamic therapy for oral verrucous hyperplasia, oral leukoplakia and oral erythroleukoplakia.

BACKGROUND: Our previous studies showed that a new topical 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT) protocol using a light-emitting diode (LED) light source is an effective and successful treatment modality for oral verrucous hyperplasia (OVH). In this study, we reported and compared the clinical outcomes of 24 OVH lesions, 97 oral leukoplakia (OL) lesions and 6 oral erythroleukoplakia (OEL) lesions treated with topical ALA-PDT in the National Taiwan University Hospital, Taipei, Taiwan from November 2001 to December 2005. METHODS: Twenty-four OVH lesions, 65 OL lesions and 6 OEL lesions were treated with topical ALA-PDT once a week and 32 OL lesions were treated with the same topical ALA-PDT twice a week. Their clinical outcomes between two different groups were compared by Chi-square test. RESULTS: All the 24 OVH lesions treated once a week showed complete response (CR) after 1-6 (mean, 3.5) treatments of ALA-PDT. The 65 OL lesions treated with topical ALA-PDT once a week showed CR in 5, partial response (PR) in 33 and no response (NR) in 27. The 32 OL lesions treated with the same topical ALA-PDT twice a week demonstrated CR in 11 and PR in 21. The 32 OL lesions treated twice a week had a significantly better clinical outcome than the 65 OL lesions treated once a week (P<0.001). The six OEL lesions treated with topical ALA-PDT once a week showed CR in four and PR in two. The 6 OEL lesions treated once a week had a significantly better clinical outcome than the 65 OL lesions treated once a week (P<0.001). CONCLUSION: We conclude that complete regression of OVH lesions can be achieved by less than seven treatments of topical ALA-PDT once a week. OL lesions treated twice a week have a significantly better clinical outcome than OL lesions treated once a week. In addition, OEL lesions treated once a week have a significantly better clinical outcome than OL lesions treated once a week.

Prognostic role of c-Jun activation in patients with areca quid chewing-related oral squamous cell carcinomas in Taiwan.

BACKGROUND: Overexpression or activation of c-Jun has been implicated in the pathogenesis of several types of cancer. Treatment of oral cells with areca nut extract in culture can increase c-Jun proto-oncogene mRNA levels. The purpose of this study was to investigate the possible role of c-Jun activation in the pathogenesis and prognosis of areca quid chewing-related oral cancer in Taiwan. METHODS: We immunohistochemically examined c-Jun protein activation in human oral squamous cell carcinomas (SCC) using an anti-phosphospecific c-Jun (pc-Jun) antibody on paraffin-embedded sections. RESULTS: Positive pc-Jun staining was observed in 42 of 70 (60%) cases of oral SCC. No significant correlation was found between pc-Jun expression and patients' age, gender, oral habit, cancer location, clinical stage, tumor size and lymph node status. Kaplan-Meier curves showed that oral SCC patients with positive pc-Jun staining or positive lymph node metastasis had significantly shorter overall survival (p < 0.018 and 0.001, respectively, by log-rank test). CONCLUSION: These results indicate that c-Jun activation may play an important role in the carcinogenesis of oral SCC. Positive pc-Jun staining may serve as an adjuvant marker of worse prognosis in patients with oral SCC in Taiwan.

Survivin expression predicts poorer prognosis in patients with areca quid chewing-related oral squamous cell carcinoma in Taiwan.

Survivin, a recently characterized novel member of the inhibitor of apoptosis (IAP) family, is not detectable in most differentiated normal adult tissues but is expressed in a wide range of cancer tissues. Its expression in cancer has been correlated with poor prognosis, cancer progression and drug resistance. We immunohistochemically examined the expression of survivin in 62 cases of oral epithelial dysplasia (ED) and 96 cases of oral squamous cell carcinoma (SCC). Cytoplasmic survivin staining was detected in 60 of the 62 (97%) ED specimens and 94 of the 96 (98%) SCC specimens but not in adjacent normal oral mucosal tissues. The labeling index (LI) for survivin protein significantly increased from ED (32.3+/-16.3%) to SCC samples (49.4+/-28.5%) (p<0.001). In addition, the mean LI for ED cases with further malignant transformation into SCC (45.6+/-8.8%) was higher than those without malignant transformation (30.1+/-16.3%) (p=0.008). No significant correlation was found between the survivin expression and the patients' age, sex, oral habit, cancer location, or STNM status in SCC cases. Kaplan-Meier curves showed oral SCC patients with high survivin expression (LI>25%), advanced stage, larger tumor size, or positive lymph node metastasis had significantly shorter overall survival (p=0.014, 0.012, 0.005 and 0.011, respectively by log-rank test) than others. The associations remained significant after adjusting for age. These results indicate that survivin protein expression may be an important early event in oral carcinogenesis and predicts unfavorable prognosis for oral SCC. Furthermore, the unique expression of survivin in cancer cells but not in most normal adult tissues suggests that modulation of survivin protein expression may provide a novel strategy for the therapy of oral SCC.

Prognostic role of p27(Kip1) expression in oral squamous cell carcinoma in Taiwan.

The cyclin-dependent kinase inhibitor p27(Kip1) can inhibit the G1 to S transition of the cell cycle and is a putative tumor suppressor. Decreased expression of p27(Kip1) protein has been correlated with poor prognosis in a variety of human tumors. We examined the expression of p27(Kip1) in oral squamous cell carcinoma (SCC), epithelial dysplasia (ED) and normal oral mucosa (NOM) using antibodies to p27(Kip1). Positive p27(Kip1) nuclear staining was detected in all the specimems from ED and NOM, whereas positive p27(Kip1) staining was observed in 16 of the 63 (25%) cases of oral SCC. The labeling index for p27(Kip1) protein was significantly reduced from NOM through ED to oral SCCs, indicating that changes of p27(Kip1) protein expression may be an early event in oral carcinogenesis in Taiwan. The Kaplan-Meier analysis showed patients with p27(Kip1)-positive tumors had significantly higher overall survival than those with p27(Kip1)-negative tumors in a total of 63 patients (P=0.015) and 47 patients with areca quid chewing habit (P=0.026). Multivariate analysis showed decreased p27(Kip1) protein expression was an independent significant predictor of poor overall survival in the patients with oral SCCs. These results indicate that p27(Kip1) protein expression may serve as a putative new adjuvant prognostic marker for routine assessment of oral SCC patients.