[Retrospective study on bleeding and thromboembolic complications related to tooth extraction, in 93 patients usually treated by antithrombotic therapy]. / Étude rétrospective évaluant les risques hémorragiques et thromboemboliques lors d'avulsions dentaires chez 93 patients habituellement traités par AVK et/ou AAP.

INTRODUCTION: Tooth extraction for patients treated by AVK and/or platelet aggregation inhibitor is performed according to local habits rather than to a consensus. We had for objective to assess hemorrhagic and thromboembolic risks for patients for whom treatment with AVK and/or platelet aggregation inhibitor was modified before tooth extraction. MATERIALS AND METHODS: Ninety-three patient files were examined retrospectively. The following data was collected: epidemiological data, ASA score, nature and changes of antithrombotic therapy, preoperative INR, number teeth extracted, postoperative complications (bleeding and thromboembolic events). RESULTS: Thirty-seven patients were treated with oral anticoagulants, 41 by a platelet aggregation inhibitor, 10 by double platelet aggregation inhibitor therapy, and 5 by an AVK-platelet aggregation inhibitor combination. At D0, the mean INR was decreased to 1.4, 4 patients with high thromboembolic risk had received heparin relay treatment; the treatment was stopped for 9 of the 56 patients on monotherapy with antiplatelet therapy, 4 were switched from clopidogrel to lysine acetylate; clopidogrel was stopped for 7 patients under combination therapy. Seven hundred and twenty-six avulsions (mean 8.1 per patient) were performed, 41 patients presented with mild/moderate bleeding, easily resolved. A patient presented with delayed hemorrhage at D6 (AVK overdose). No thromboembolic complication was reported. DISCUSSION: The modification of antithrombotic treatment, as for surgery at high risk of bleeding, seems to limit the risk of bleeding without increasing thromboembolic risk.

IL-1ra and IL-1 production in human oral mucosal epithelial cells in culture: differential modulation by TGF-beta1 and IL-4.

Regulatory cytokines mediate the participation of oral mucosal epithelial cells (OMEC) in local immune responses. The aim of this study was to characterize the isoforms of IL-1 receptor antagonist (IL-1ra) in cultured human primary OMECs and to compare its production with that of IL-1 alpha (IL-1alpha) and IL-1 beta (IL-1beta). Western blot analysis showed that IL-1ra was 22 kDa in size hence slightly smaller than monocyte IL-1ra (25 kDa). A minor form of 20 kDa was also found in unstimulated cell culture lysates. In culture supernatants, IL-1 bioactivity increased after IL-1ra neutralization, indicating that the baseline production of IL-1ra is biologically relevant. Immunohistochemistry showed a relation between IL-1ra and involucrin expressions, suggesting that intracytoplasmic IL-1ra may be involved in cell terminal differentiation. In unstimulated culture lysates, there was far more IL-1ra than IL-1alpha and IL-1beta. TGF-beta1 markedly increased the IL-1ra/IL-1beta ratio from 93.6 : 1 to 300 : 1. IL-4, which is generally described as an anti-inflammatory cytokine, increased IL-1 but not IL-1ra production. TNF-alpha increased intracellular production of the three IL-1 members. IL-1ra levels were lower in supernatants than in lysates of cultured cells. Our results show that human OMECs constitutively produce significant amounts of a biologically active form of IL-1ra. TGF-beta1 mu(p)-regulation points to a positive amplification loop and IL-4 to a down-regulation loop, both including Th2 cells and OMECs. They may be important in oral tolerance and IgA production, respectively.

IL-1 receptor antagonist in saliva; characterization in normal saliva and reduced concentration in Sjögren's syndrome (SS).

The characterization of a salivary factor cross-reacting with IL-1 receptor antagonist (IL-1Ra) is described. The apparent molecular weights of two species were 23 kD, consistent with the secreted peptide (sIL-1Ra), and 20 kD, consistent with the intracellular peptide (icIL-1Ra). It had an inhibitory activity on IL-1-stimulated fibroblasts, which is characteristic of IL-1Ra. Its source was the oral mucosa and not the salivary glands. Saliva from patients with SS contained significantly less IL-1Ra than saliva from controls. The decrease was marked in patients with early dental loss but whose xerostomia was still partial. In SS, the salivary IL-1/IL-1Ra imbalance may promote inflammatory lesions in the mouth and impede mucosal cell differentiation.

Early dental loss in Sjögren's syndrome. Histologic correlates. European Community Study Group on Diagnostic Criteria for Sjögren's Syndrome (EEC COMAC).

Early dental loss is a well-known complication of Sjögren's syndrome. Forty percent (n = 16) of 39 consecutive patients with the syndrome had early dental loss. Dental loss correlated positively with histologic grading at lip biopsy. There was no significant correlation with any other feature of Sjögren's syndrome, including saliva flow. In 11 partially edentulous or completely edentulous patients, dental loss occurred 9 years on average before the first symptom of xerostomia. Early dental loss may reflect a silent involvement of the salivary glands and suggests that changes in saliva biochemistry occur long before xerostomia.

Sequential immunopathologic study of oral lichen planus treated with tretinoin and etretinate.

Twenty-five patients with oral lichen planus confirmed by histologic examination were divided into three groups: 10 patients received topical treatment with tretinoin, 10 received systemic treatment with etretinate, and the five remaining patients, who received no treatment, served as a control group. An immunopathologic study with the use of monoclonal antibodies was carried out before and after the 3-month course of treatment and showed a variation in the distribution and phenotype of inflammatory cells. No difference between the two types of treatment was observed, but treated patients had a shorter evolution of the disease when compared with control patients.

[Ongoing clinical study of oral lichen planus (OLP) treated with retinoids: one used locally, (tretinoin) the other orally (etretinate)]. / Etude clinique évolutive du lichen plan buccal (LPB) sous rétinoîdes: l'un à usage local (trétinoîne), l'autre employé per os (étrétinate).

Twenty patients with oral lichen planus (OLP) were divided into two groups. The first group (8 reticulated OLP, 2 hyperkeratotic OLP) was treated with topical tretinoin. The second group (4 reticulated OLP, 6 eroding OLP) was treated with oral etretinate. All patients were regularly followed in order to observe over a period of five years the evolution of the lesions under treatment, the side-effects and recurrences when the treatment was discontinued.

[Solitary plasmocytoma of the mandible: study of a case]. / Plasmocytome solitaire de la mandibule: étude d'un cas.

The isolated plasmocytoma of the maxilla is an extremely rare tumor. It is classified in the group of low-grade B lymphomas. Its clinical and even radiological diagnosis remains difficult. Some authors, such as H.S. LOH in 1983, have attempted to regroup all reported cases in the literature, but many are incomplete, especially those which were first published. Most of the time, it is the pathological examination that rectifies the diagnosis and, currently, the immuno-chemical examination that confirms this diagnosis; this was demonstrated in the case reported here.