Vitamin D Deficiency as It Relates to Oral Immunity and Chronic Periodontitis.

The biologically active form of vitamin D, 1,25 dihydroxyvitamin D (1,25(OH)2D) and its receptor, the vitamin D receptor (VDR), play roles in maintaining oral immunity and the integrity of the periodontium. Results of observational cross-sectional clinical studies investigating the association between vitamin D serum level and the incidence and severity of chronic periodontitis indicate that, perhaps owing to the immunomodulatory, anti-inflammatory, and antibacterial properties of 1,25(OH)2 D/VDR signalling, a sufficient serum level of vitamin D is necessary for the maintenance of periodontal health. In cases of established chronic periodontitis, vitamin D supplementation is associated with reduction in the severity of periodontitis. As cross-sectional studies provide only weak evidence for any causal association and therefore are of questionable value, either longitudinal cohort studies, case controlled studies, or randomized control trials are needed to determine whether or not deficiency of vitamin D is a risk factor for chronic periodontitis, and whether or not vitamin D supplementation adjunctive to standard periodontal treatment is in any way beneficial. In this article, we discuss the relationship between vitamin D, oral immunity and periodontal disease and review the rationale for using vitamin D supplementation to help maintain periodontal health and as an adjunct to standard periodontal treatment.

Osseointegration: biological events in relation to characteristics of the implant surface.

Osseointegration of titanium implants is a complex biological process involving interactions between immuno-inflammatory responses, angiogenesis and osteogenesis, all of which are influenced by the physical and chemical characteristics of the implant surface. An implant surface with moderately rough topography and high surface energy influences cellular activities, enhancing peri-implant bone wound healing. Primary mechanical stability of the implant is essential for osseointegration. In this article we review some of the more important biological events of peri-implant bone wound healing in the process of osseointegration, and discuss how the biophysical properties of implant surfaces influence cellular responses.

Oral sarcoidosis: a case report and review of the literature.

Sarcoidosis is a chronic multi-system immuno-inflammatory disorder characterized by non-caseating granulomatous infiltration of affected tissues that may result in fibrosis and organ dysfunction. It generally affects genetically predisposed young adults who develop a local dysregulated cell-mediated immune response towards an undefined 'sarcoidal antigen'. From recent data, it has become evident that Propionibacterium acnes and Mycobacterium tuberculosis are the probable antigenic agents which initiate sarcoidosis. Oral sarcoidosis is rare with only about 70 cases having been reported in the literature. The purpose of this report is to present a case of oral and cutaneous sarcoidosis in a black female that was probably triggered by mycobacteria.

Plasma cell gingivitis: does it exist? Report of a case and review of the literature.

Plasma cell gingivitis is an uncommon inflammatory condition of uncertain aetiology. It is characterized clinically by enlarged erythemathous gingivae, a velvety texture and histopathologically by a dense plasmacytic infiltrate in the lamina propria. We present a case of a 19-year-old female who had what appeared to be plasma cell gingivitis. The clinical and histopathological differential diagnosis of plasma cell gingivitis is discussed and an argument is presented raising certain doubts whether plasma cell gingivitis is a distinct clinicopathological entity or not.

Localized aggressive periodontitis associated with unusual gingival enlargement posing a diagnostic dilemma: a case report.

This is a case report of localized aggressive periodontitis associated with unusual gingival enlargement. There was difficulty both clinically and histologically in deciding whether the gingival enlargement was a pyogenic granuloma or a Kaposi sarcoma. The diagnosis of Kaposi sarcoma was eventually ruled out by the failure of immunohistopathological examination to demonstrate the presence of HHV-8 DNA markers, and by the clinical response of the lesions to antimicrobial agents. Once a definitive diagnosis was made, the patient was treated conventionally.

A report of oral extramedullary acute myeloid leukaemia (AML) in an 8-year-old girl with newly diagnosed AML-M4Eo.

Acute myeloid leukaemia (AML), characterized by proliferation of immature neoplastic myeloid cells, is uncommon in childhood. We present a case of an 8-year-old girl with AML-M4Eo who had an extramedullary leukaemic tumour in the oral cavity.

Herpes zoster post-herpetic neuralgia.

Post-herpetic neuralgia (PHN) is the most frequent complication of herpes zoster and often results in significant morbidity and a reduction in the patient's quality of life. The peripheral nerve injury that occurs during the acute phase of herpes zoster (HZ) leads to an abnormal tonic impulse discharge from primary nociceptive afferent neurons which induce slow temporal summation. This "wind-up" phenomenon is responsible for continuous partial depolarisation of second-order neurons with increased spontaneous impulse discharge and expanded receptive fields within the dorsal horn nociceptive neurons. The abnormal central processing involves the activation of N-methyl-D-aspartate (NMDA) receptors resulting in neuropathic pain, characterized by spontaneous pain, hyperalgesia and allodynia which is typical of PHN. In addition, tonic input from non-nociceptive AB afferent neurons, maintained by sympathetic efferent activity, contribute to the development and maintenance of neuropathic pain in general, and a burning sensation in particular.