Sarcoidosis: oral and perioral manifestations.

A 46-year-old white woman with lesions on the lower lip, perioral area and in the soft tissues of the oral cavity (gingivae and palate) was examined. The clinical signs were recorded, and incisional biopsies from the oral lesions were taken. The diagnosis of sarcoidosis was established by the histopathological evidence of typical non-caseating granulomas from tissue biopsy, supported by serum ACE- 57.9 U/L, blood calcium 16.83 mEq/L and 24-hrs urine calcium 600 mg). Oral lesions may be the first or the only sign of sarcoidosis in an otherwise healthy patient.

The role of Candida in inflammatory papillary hyperplasia of the palate.

The objective of this study was to investigate the expression by immunohistochemistry of the major basement membrane (BM) components (laminin, collagen type IV, fibronectin) in specimens from the palatal mucosa lesions of patients with complete dentures and diagnosis of inflammatory papillary hyperplasia of the palate (IPHP). Furthermore to evaluate the potential role of candidal infection in patients with IPHP. Biopsies of palatal mucosa were obtained from patients with IPHP, generally healthy/orally healthy patients with dentures, and healthy subjects. Immunohistochemical studies performed with specific antibodies to BM proteins. Scrapings and swaps of oral lesions from all patients and control groups were taken from the palate, and Candida species colonization was assessed with mycology tests. Immunohistochemical expression of BM components revealed thin linear staining in the BM of healthy palatal mucosa. In IPHP discontinuities or disruptions in BM were observed at the interface between epithelium and the underlying connective tissue in the areas of severe inflammatory response. Our findings suggest an interaction between the expression of BM components and Candida involvement in the development of IPHP, a disorder involving inflammatory reaction and modification of soft tissues.

Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer: prevalence, azole susceptibility profiles and response to antifungal treatment.

Oral pseudomembranous candidiasis and mucositis were assessed in 39 patients receiving a total dose of 39-70 Gy radiotherapy for head and neck cancer. Mucositis was scored using the Radiation Therapy Oncology Group criteria, and oral candidiasis was diagnosed on the basis of clinical evaluation and quantitative laboratory findings. Radiation-induced mucositis was observed in 9/39 patients. Only 3/39 patients discontinued radiotherapy due to acute severe mucosal effects. Candidiasis (colony-forming units 35 to > or = 60/lesion) associated with mucositis was diagnosed in 30/39 patients: the most frequent aetiology of the infection was Candida albicans (n = 23), followed by Candida glabrata (n = 3), Candida krusei (n = 2), Candida tropicalis (n = 1) and Candida kefyr (n = 1). Patients with confirmed oral pseudomembranous candidiasis were treated with either fluconazole 200 mg/day or itraconazole 200 mg/day for 2 weeks. Clinical improvement and concomitant negative Candida cultures (mycologic cure) were the criteria determining a response to antifungal treatment. Etest revealed very low voriconazole MICs (0.004-0.125 microg/ml) for all isolates, and fluconazole resistance for eight C. albicans strains (MIC > 64 microg/ml) and for the C. krusei isolates (MIC > 32 microg/ml). The same strains showed itraconazole susceptibility dose dependence (MIC 0.5 microg/ml). Despite the itraconazole susceptible dose dependent MIC readings, all patients with oral pseudomembranous candidiasis caused by these strains responded to antifungal treatment with 200 mg/day itraconazole. Oral mycologic surveillance of patients undergoing radiotherapy for head and neck malignancies and susceptibility testing of isolates may be indicated in cases with mucositis-associated confirmed oral pseudomembranous candidiasis to ensure prompt administration of targeted antifungal treatment. On the basis of the low MIC values found, clinical evaluation of voriconazole is indicated for management of oral pseudomembranous candidiasis refractory to other azoles.

Salivary IgA and serum IgA and IgG antibodies to Candida albicans in HIV-infected subjects.

This study sought to determine IgA, IgG antibodies to Candida albicans in whole saliva and serum from HIV-infected patients and to compare them to a group of healthy controls. The study population consisted of 34 HIV-infected individuals free of any other systemic diseases and thirty healthy controls. IgA concentrations in saliva and IgA and IgG concentrations in serum were measured by a micro enzyme-linked immunosorbent assay. No significant differences were observed in salivary and serum IgA antibodies to C. albicans between the two study groups. Serum IgG antibodies were found to be significantly lower in the HIV-infected (P < 0.05). No significant changes were observed in the specific activity of anti-Candida IgA and IgG antibodies in saliva and serum, in both the study groups. The undifferentiated levels of secretory-IgA antibodies to C. albicans in the patients' and the controls' saliva could be an indicator of the high immune response to opportunistic infections of the HIV-infected subjects, a fact that is verified by the lack of oral candidiasis in the patients' group. The low levels of IgG antibodies in the serum of the HIV-infected patients confirm the high immune response of them.

Epidermal growth factor in saliva and serum of patients with cyclosporin-induced gingival overgrowth.

The purpose of this study was to investigate the presence of epidermal growth factor (EGF) in patients receiving cyclosporin therapy who had gingival overgrowth and to determine whether there were any differences between these patients and normal healthy controls. Seventeen patients with cyclosporin-induced gingival overgrowth and seventeen age- and sex-matched controls who were taking cyclosporin but had healthy gingiva were used for this study. Unstimulated whole saliva was collected from all individuals by expectoration. Gingival crevicular fluid (GCF) was also collected from all individuals. Blood was additionally collected from all subjects and serum was separated by keeping the samples overnight at 4 degrees C. EGF levels in all cases were measured by an ELISA assay. EGF concentrations were found to be significantly higher in the saliva of patients with cyclosporin-induced gingival overgrowth compared to the control group (401.2 +/- 31.1 pg/ml and 144.3 +/- 31.4 pg/ml, respectively), whereas the results were reversed in the serum (67.0 +/- 15.6 pg/ml and 141.6 +/- 17.7 pg/ml, respectively). EGF was not detected in the samples of GCF in either group. This study thus demonstrated an increase in EGF levels in the saliva and a decrease of EGF in the serum of patients with cyclosporin-induced gingival overgrowth.

Prevalence of oral lichen planus in diabetes mellitus according to the type of diabetes.

OBJECTIVE: The purpose of the present study was to determine the prevalence of oral lichen planus (OLP) in a population of patients with diabetes mellitus (DM) as compared with a control population. DESIGN: A clinicopathologic study. SUBJECTS AND METHODS: One hundred and thirty-nine patients with type I DM, 353 patients with type II DM and 274 controls were examined for clinical evidence of OLP. The clinical evidence of OLP in the diabetic and control patients was confirmed by histopathological examination. RESULTS: The prevalence of OLP in type I diabetic patients was 5.76%, in type II 2.83%, and 1.82% in the controls. The prevalence of OLP was significantly higher in patients with type I DM and slightly higher in patients with type II DM in comparison to the prevalence in the control sample. CONCLUSIONS: The above findings and the fact that type I diabetes and OLP are characterized by autoimmune phenomena and T cell immune responses respectively, suggest that the immune system may play a critical role in the appearance of OLP in patients with type I DM.

Concurrence of torus palatinus with palatal and buccal exostoses: case report and review of the literature.

Exostoses, also known as hyperostoses, are localized bony protuberances that arise from the cortical plate. These developmental anomalies, or hamartomas, frequently affect the skeletal jaw. Different types of exostoses have been described. Torus palatinus and torus mandibularis are two of the most common intraoral exostoses. Other types of exostoses, affecting the palatal aspect of the maxilla (palatal exostoses) or the buccal aspects of the jaws (buccal exostoses), are less commonly encountered. Concurrence of different forms of exostoses in the same individual is very rare. A 48-year-old woman manifesting excessive palatal exostoses, torus palatinus, and buccal exostoses is described. We present the clinical and histopathologic features and applied therapy and provide a comprehensive review of the current features of exostoses.

Salivary alterations in insulin-dependent diabetes mellitus.

OBJECTIVES: To examine the flow rate and composition of unstimulated whole saliva and of serum in children with newly diagnosed insulin-dependent diabetes mellitus (IDDM) and to compare these with values for a group of healthy controls. DESIGN: Cross-sectional. SETTING: Diabetic Department of a University Hospital in Thessaloniki, Greece. SUBJECTS AND METHODS: The test group was made up of 10 recently diagnosed child patients with IDDM, aged 4-15 years and free of other systemic disease. Ten healthy children aged 5-17 years served as controls. Children were clinically examined before unstimulated saliva was collected over a 5 minute period and blood samples taken. Saliva and serum measurements included glucose, total proteins, albumin and immunoglobulins (IgA, IgG). RESULTS: No significant difference was seen in salivary flow rate between the two groups. Significantly greater concentrations of glucose were seen in saliva and serum in children with IDDM. Neither total protein nor albumin differed significantly between the two groups. Salivary IgA concentration was higher in the test group as was serum IgG. CONCLUSIONS: Findings in this sample suggest that changes in salivary composition may, together with estimated glucose levels, play a helpful diagnostic role in the early stages of IDDM in some children.

Histopathological and immunohistochemical features of the labial salivary glands in children with type I diabetes.

The aim of this study was to investigate the morphological alterations of labial salivary glands in children with type I diabetes. For this purpose labial salivary glands under local anesthesia were excised from the lower lip of ten diabetic children at the onset of diabetes (mean age, 10 years). Additionally ten similar biopsies were obtained from ten healthy children (mean age, 9 years). The tissues were conventionally processed and embedded in paraffin wax. The first section was stained with hematoxylin/eosin, while two additional sections were stained immunohistochemically using the indirect immunoperoxidase avidin-biotin method to detect T and B lymphocytes. The results showed that a mononuclear infiltration was apparent in all diabetic children. Lymphocytes were particularly seen around various ducts. In contrast, the salivary glands of healthy controls were free of infiltrates. The immunohistochemical analysis showed that the majority of these cells were T cells. B cells were found to a lesser extent. These findings indicate that a destruction of labial salivary glands takes place in type I diabetes. This phenomenon is T-cell mediated. The similarity of this condition with the insulitis suggests that labial salivary glands and pancreas may share a common antigen that might be the target of the autoimmune process in type I diabetes.

Glutamic acid decarboxylase autoantibodies in saliva of children with type 1 diabetes.

The aim of this study was to investigate the presence of glutamic acid decarboxylase (GAD) autoantibodies in the saliva of children with type 1 diabetes. A total of 30 diabetic children were used in this study while 80 healthy individuals of similar age were used as controls. Total saliva and peripheral blood was collected from all diabetic children and controls. Determination of GAD autoantibodies was performed using an enzyme immunoassay (Varelisa) which is based on a recombinant human GAD65. The results of this study showed that GAD autoantibodies were found to be present in 21 out of 30 diabetic serum samples, while they were present in all samples of diabetic saliva. In contrast, they were absent from serum and saliva of healthy controls. Since GAD is considered one of the basic antigenic targets of the autoimmune process in type 1 diabetes in the pancreatic beta cells, its presence in the saliva may be relevant as a predictive marker.

Eosinophils in oral and cutaneous lesions of erythema multiforme.

The purpose of this retrospective clinicopathologic study was to investigate the presence of eosinophils in oral and skin lesions of erythema multiforme. Seventeen cases were selected which fulfilled clinical and histopathologic criteria for the disease. Twelve out of 13 sections taken from skin biopsies and 4 out of 5 sections taken from oral lesions contained eosinophils in varying densities. The occurrence of eosinophils in the lesions of erythema multiforme is parallelized and discussed with the existence of certain clinical and histopathologic aspects. Therefore, we suggest that eosinophils occur in cutaneous and oral lesions of erythema multiforme and are occasionally numerous.

Cyclosporin-induced gingival hyperplasia: an ultrastructural study of the oral epithelial prickle cells.

In this study the ultrastructural characteristics of the prickle cells of the human gingival epithelium after cyclosporin-A treatment are described. The prickle cell layer shows hyperplasia, along with the well known hyperplasia of the connective tissue components. The prickle cells show large numbers of free ribosomes, rough endoplasmic reticulum profiles and well developed Golgi complexes. The intercellular space is usually large and the neighboring cells are joined by desmosomes. In many cases the intercellular space is almost diminished and the cells are joined by a lot of desmosomes. Occasionally, a single cilium was observed to project into the intercellular space but the functional significance of this observation is unknown. The tonofilaments exhibit a specific arrangement in the cytoplasm of the prickle cells and it is believed that they contribute to the formation of a 'tonofilament network' which, along with the desmosomes, provide strength to the epithelium. Possible mechanisms regarding the gingiva overgrowth are discussed.