Human papillomaviruses in oral carcinoma and oral potentially malignant disorders: a systematic review.

OBJECTIVES: Human papillomavirus (HPV) in oral carcinoma (OSCC) and potentially malignant disorders (OPMD) is controversial. The primary aim was to calculate pooled risk estimates for the association of HPV with OSCC and OPMD when compared with healthy oral mucosa as controls. We also examined the effects of sampling techniques on HPV detection rates. METHODS: Systematic review was performed using PubMed (January 1966-September 2010) and EMBASE (January 1990-September 2010). Eligible studies included randomized controlled, cohort and cross-sectional studies. Pooled data were analysed by calculating odds ratios, using a random effects model. Risk of bias was based on characteristics of study group, appropriateness of the control group and prospective design. RESULTS: Of the 1121 publications identified, 39 cross-sectional studies met the inclusion criteria. Collectively, 1885 cases and 2248 controls of OSCC and 956 cases and 675 controls of OPMD were available for analysis. Significant association was found between pooled HPV-DNA detection and OSCC (OR = 3.98; 95% CI: 2.62-6.02) and even for HPV16 only (OR = 3.86; 95% CI: 2.16-6.86). HPV was also associated with OPMD (OR = 3.87; 95% CI: 2.87-5.21). In a subgroup analysis of OPMD, HPV was also associated with oral leukoplakia (OR = 4.03; 95% CI: 2.34-6.92), oral lichen planus (OR = 5.12; 95% CI: 2.40-10.93), and epithelial dysplasia (OR = 5.10; 95% CI: 2.03-12.80). CONCLUSIONS: The results suggest a potentially important causal association between HPV and OSCC and OPMD.

Review of linear epidermal nevus with oral mucosal involvement--series of five new cases.

INTRODUCTION: Linear epidermal nevi are sporadic hamartomatous alterations of the epidermis and superficial dermis that clinically appear as verrucous papules and plaques distributed in a linear pattern following Blaschko's lines. Their extent varies from unilateral involvement (nevus unius lateris) to extensive bilateral involvement (ichthyosis hystrix). Oral mucosal lesions have rarely been described. AIMS: We review the literature, focusing on the rare intraoral manifestations of linear epidermal nevus. CASE SERIES: We present a series of five new cases with oral mucosal involvement. Four cases had associated cutaneous lesions and one case had oral lesions exclusively. Histopathologic evaluation of lesional tissue in four cases showed hyperkeratosis, acanthosis, epithelial hyperplasia, and papillomatosis. Dental abnormalities, consisting of enamel hypoplasia and congenitally missing teeth, were noted in one patient adjacent to the oral lesions.

Primary tooth enamel surface topography with in vitro argon laser irradiation alone and combined fluoride and argon laser treatment: scanning electon microscopic study.

PURPOSE: The purpose of this descriptive scanning electron microscopic study was to characterize surface alterations in primary tooth enamel after in vitro argon laser irradiation alone and combined with topical fluoride treatment either before or after argon laser irradiation. METHODS: Twenty extracted or exfoliated primary teeth underwent soft tissue debridement and a fluoride-free prophylaxis. Buccal and lingual surfaces were determined to be caries-free by macroscopic examination (stereo-zoom binocular microscope, x16). Treatment groups were: (1) no-treatment control; (2) argon laser irradiation (ALI; 11.5 J/cm2); (3) 1.23% acidulated phosphate fluoride (APF before ALI); and (4) ALI before APF. Both buccal and lingual surfaces were evaluated following standard scanning electron microscopic preparation techniques. RESULTS: With controls, enamel surfaces were relatively smooth with occasional enamel prism ends present on their surfaces. There were no areas with cavitations or surface defects. With ALI, the lased surfaces were roughened mildly to moderately irregular without cavitation of the enamel or exposure of enamel prism ends. The surfaces possessed adherent granules to globules, with most being <3 microm in greatest dimension. Only occasional fine cracks and porosities in the surface coatings were noted and these were typically less than 1 microm in width or diameter. With APF before ALI, the surfaces possessed an irregular contour, with numerous granules to globules varying in size from 1 to 3 microm in greatest dimension. With ALI before APF, a homogenous confluent surface was present that masked typical enamel surface markings. The previously noted adherent granules and globules with argon laser treatment alone or APF before ALI were not seen. The argon laser effects on the enamel surfaces were masked by the uniformity of these surface coatings. CONCLUSIONS: Argon laser irradiation and combined APF and argon laser treatment of primary tooth enamel created surfaces that may provide a protective barrier against a cariogenic attack. The surface coatings associated with combined APF and argon laser treatment may contain fluoride-rich calcium and phosphate mineral phases that could act as reservoirs for fluoride, calcium, and phosphate and provide a certain degree of protection from a caries lesion challenge.

Restoration-enamel interface with argon laser and visible light polymerization of compomer and composite resin restorations: a polarized light and scanning electron microscopic in vitro study.

This polarized light (PL) and scanning electron microscopic (SEM) in vitro study investigated the effect of argon laser (AL) and visible light (VL) polymerization on the interfaces between compomer and composite resin restorations and the enamel cavosurfaces. Surface topography by SEM revealed a smooth transition between the restorative materials and adjacent enamel surfaces with no microspaces between the restorations and enamel surfaces. The enamel surfaces showed relatively smooth surface coatings with AL curing compared with exposure of etched prism endings with VL curing. The restoration-enamel interface by PL showed an intimate relationship between the restorative materials and the cavosurface enamel. No differences were found between AL and VL polymerization. With the restoration-enamel interface by SEM, compomers and composite resins were adapted closely to the cavosurface enamel and tags of restorative material protruded into the adjacent cavosurface enamel. Both VL and AL polymerization of compomers and composite resin restorations in vitro produced closely adapted restorations with intimate restoration-enamel interfaces. Such restoration-enamel interfaces may provide a certain degree of resistance against secondary caries formation, and this may be enhanced by the caries protective effect of argon laser irradiation.

Rhabdomyosarcoma of the head and neck in children.

OBJECTIVE: The purpose of this study was to determine the rhabdomyosarcoma types involving the head and neck (H&N) region in children and their immunophenotype. DESIGN: Anatomic pathology archives at Texas Children's Hospital were searched for all rhabdomyosarcoma cases over a 20-year period. One-hundred and thirty-seven cases were identified, with 50 being H&N cases. The cases were typed according to the Intergroup Rhabdomyosarcoma Study (IRS) criteria. Immunocytochemistry for myogenic and non-myogenic markers was performed on all H&N cases. Electron micrographs from cases (n=32) where ultrastructural examination had been performed at the time of original diagnosis were reviewed. RESULTS: Children with H&N rhabdomyosarcomas had a mean age of 5.3 years (median 4 years). There was a male predilection (1.7M:1.0F). Primary tumor sites were: face NOS (18%), orbit/periorbital (16%), nasal cavity/nose (14%), lymph nodes (12%), paranasal sinuses (10%), parameningeal (10%), parotid gland (6%), neck (6%), infratemporal fossa/zygoma (2%), buccal mucosa (2%), palate (2%), and larynx (2%). Metastatic disease at diagnosis (33% of all cases) occurred in the bone marrow (11%), cerebrospinal fluid (6%), peritoneal fluid (6%), lung (4%), parietal pleura (2%), pleural fluid (2%) and pericardial fluid (2%). Rhabdomyosarcoma types (IRS criteria) were: embryonal (60%), alveolar (classic and solid subtypes, 28%), botryoid (4%), undifferentiated (4%), spindle cell (2%) and anaplastic (2%). Immunocytochemical findings were: polyclonal desmin (96%); myogenin (96%); muscle-specific actin (74%), smooth muscle actin (12%). Nonmyogenic markers included: vimentin (100%), CD99 (16%), p53 (16%), pancytokeratin (10%), NSE (8%), LCA (6%), CD20 (6%), EMA (2%), and NB-84 (0%, neuroblastoma). Undifferentiated sarcoma expressed only vimentin. By ultrastructural examination, 44% had readily identified z-bands and myofilaments, 37% had infrequent to rare myofilaments and z-bands, and 19% had myotubular intermediate filaments. CONCLUSIONS: Distribution of H&N rhabdomyosarcoma IRS types is similar to that for all primary sites, with the exception that embryonal types are modestly increased while alveolar type is mildly decreased. There are many non-myogenic immunocytochemical markers that cross-react with rhabdomyosarcoma. Differentiation between favorable and unfavorable rhabdomyosarcoma types is important for appropriate therapy, and predicting prognosis and survival.

Plasmablastic lymphoma: an HIV-associated entity with primary oral manifestations.

Plasmablastic lymphoma is a relatively new entity that is considered to be a diffuse large B-cell lymphoma with an unique immunophenotype and a predilection for the oral cavity. We present a 50 year-old HIV-positive, bisexual, white male with a CD4 count 300/mm(3) and a viral HIV-RNA polymerase chain reaction (PCR) load of 237 copies/ml, who developed a painful, purple-red mass in the edentulous area of the maxillary right first molar. Erythematous gingival enlargements of the interdental papillae were seen in three of the dental quadrants. In addition, the patient was being managed with antiretroviral therapy and liposomal doxorubicin for recurrent cutaneous Kaposi's sarcoma (KS). Although oral KS was suspected, the gingival lesions were biopsied because they were refractory to chemotherapy and a lymphoma could not be excluded. Histopathologic examination revealed a lymphoid malignant neoplasm, consistent with a plasmablastic lymphoma. Immunoreactivity with vs38c, CD79a, kappa light chain, and IgG was readily identified in tumor cells; while only focal cells expressed CD20 and LCA (CD45RB). CD56, CD3, lambda light chain, and EMA were non-reactive. EBV was detected in the tumor by Southern hybridization, PCR amplification, in situ hybridization for EBER-1 DNA, and immunohistochemistry for latent membrane protein-1. The same tumor was negative for HHV-8 by PCR. Recognition of plasmablastic lymphoma is important, because it represents an HIV-associated malignancy that predominantly involves the oral cavity, may mimic KS and has a poor prognosis.

Persistent productive Epstein-Barr virus replication in normal epithelial cells in vivo.

Productive Epstein-Barr virus (EBV) replication characterizes hairy leukoplakia, an oral epithelial lesion typically occurring in individuals infected with human immunodeficiency virus (HIV). Serial tongue biopsy specimens were obtained from HIV-infected subjects before, during, and after valacyclovir treatment. EBV replication was detected by Southern hybridization to linear terminal EBV genome fragments, reverse-transcriptase polymerase chain reaction amplification of EBV replicative gene transcripts, immunohistochemical detection of EBV replicative protein, and in situ hybridization to EBV DNA. EBV replication was detected in both hairy leukoplakia and normal tongue tissues. Valacyclovir treatment completely abrogated EBV replication in vivo, resulting in resolution of hairy leukoplakia when it was present. EBV replication returned in normal tongue epithelial cells after valacyclovir treatment. These data suggest that normal oral epithelium supports persistent EBV infection in individuals infected with HIV and that productive EBV replication is necessary but not sufficient for the pathogenesis of oral hairy leukoplakia.

A natural history of cleidocranial dysplasia.

Cleidocranial dysplasia (CCD) is an autosomal dominant skeletal dysplasia associated with clavicle hypoplasia and dental abnormalities. The condition is caused by mutations in the CBFA1 gene, a transcription factor that activates osteoblast differentiation. Clinical characteristics associated with CCD have previously been described in case reports and small case series. This study was undertaken to gain a more complete delineation of clinical complications associated with CCD. The study population was composed of 90 CCD individuals and 56 relative controls ascertained from genetic and dental practices in the United States, Canada, Europe, and Australia. A number of previously unrecognized complications were significantly increased including: genua valga, scoliosis, pes planus, sinus infections, upper respiratory complications, recurrent otitis media, and hearing loss. Primary Cesarean section rate was significantly increased compared to relative controls and the general population rate. Finally, dental abnormalities, including supernumerary teeth, failure of exfoliation of the primary dentition, and malocclusion, are serious and complex problems that require intervention. Clinical recommendations based on the results of this study are included.

Gingival enlargement associated with a partially erupted mandibular molar.

Odontogenic lesions may present as enlarged opercula and result in the delayed eruption of teeth. This case report describes the clinical and microscopic features of a peripheral odontogenic fibroma in a 13-year-old boy that involved the overlying gingiva of a partially erupted, mandibular second molar. A differential diagnosis and treatment for lesions presenting as gingival enlargements in the molar region are discussed.

Palatal blue nevus in a child.

The intraoral blue nevus occurs infrequently in children. This case report describes the clinical features of an acquired blue nevus in a 7 year-old girl that involved the palatal mucosa. A differential diagnosis and justification for surgical excision of this oral lesion are discussed.

Delayed tooth eruption associated with an ameloblastic fibro-odontoma.

Delayed eruption of a single primary tooth is an uncommon event. Excluding a previous traumatic insult, the presence of a pericoronal odontogenic cyst or neoplasm is the primary cause for this abnormality. This case report describes the clinical and radiographic features of an ameloblastic fibro-odontoma in a young child, who presented with delayed eruption of the primary mandibular canine and prominent buccal expansion. A differential diagnosis for mixed, radiolucent and radiopaque lesions of the jaws will be discussed.

Kinetic cavity preparation effects on secondary caries formation around resin restorations: a polarized light microscopic in vitro evaluation.

The purpose of this in vitro study was to compare the effect of conventional handpiece and kinetic cavity preparation (KCP, air abrasion) techniques of cavity preparation on caries-like enamel lesion formation. After a fluoride-free prophylaxis, twelve human molars were examined macroscopically to ensure that buccal and lingual surfaces were caries-free. Unfilled cavities were prepared in mesiobuccal (conventional [CU]) and mesiolingual (air abrasion [AU]) enamel surfaces. Cavities were prepared in distobuccal (conventional [CF]) and distolingual (air abrasion [AF]) enamel surfaces and restored with composite resin following placement of a bonding agent. Acid-etching of cavity walls was performed only with the conventionally prepared cavities restored with resin. Air abrasion (KCP) prepared cavities were restored without acid-etching of the cavity walls. Teeth were thermocycled (500 cycles, 5 degrees to 50 degrees C, 500 cycles) and exposed to an artificial caries medium for caries initiation and progression. After caries formation, two longitudinal sections were taken from unfilled and filled cavity preparations and examined by polarized light microscopy for wall lesion presence and mean surface lesion depth. Surface lesion depths were similar among groups after the caries initiation period (CU = 225 microns; AU = 237 microns; CF = 241 microns; AF = 251 [p > .05, ANOVA, DMR]), and progression (CU = 437 microns; AU = 415 microns; CF = 405 microns; AF = 429 um [p > 0.05, ANOVA, DMR]). Extensive wall lesions were present in all CU and AU; while small wedge-shaped wall lesions were significantly (p < .05, ANOVA, DMR) fewer in CF (19 percent & 21 percent) and AF (17 percent & 21 percent) following caries initiation and progression compared with unfilled controls. Resin restorations placed in cavities prepared by air abrasion (KCP) and conventional handpiece techniques provided similar degrees of protection against a secondary caries-like challenge.

Parotitis as the initial sign of juvenile Sjögren's syndrome.

Parotid swelling may be associated with a variety of glandular disorders in children. This case report describes the characteristic features of juvenile Sjögren's syndrome in an adolescent girl who presented with recurrent and bilateral parotid gland enlargement. Special emphasis is placed on an age-specific differential diagnosis for major salivary gland enlargements.

Avoiding malpractice for nondental conditions. The example of human immunodeficiency virus.

BACKGROUND: Dentists are legally liable for failing to recognize medical conditions that they identify while providing dental care and for failing to refer patients for follow-up care and testing. This article suggests ways to avoid liability using human immunodeficiency virus, or HIV, infection as an example. TYPES OF LITERATURE REVIEWED: The authors conducted a review of the legal literature to determine circumstances that would cause dentists to have legal liability for failing to recognize a medical problem. The authors also conducted a review of the dental literature to identify the most common signs of HIV infection that dentists might see in practice. RESULTS: The legal literature indicates that dentists can be held liable for failing to recognize medical problems, including HIV and acquired immunodeficiency syndrome. The dental literature shows that there are multiple signs and symptoms that indicate the potential for HIV infection to be the underlying cause of many oral diseases. PRACTICE IMPLICATIONS: Dentists should be familiar with the most common oral manifestations of medical conditions that are likely to be identified in the dental office, including those associated with HIV infection. They must recognize medical conditions and arrange for appropriate referral to avoid liability.