Chronic Gingivostomatitis with Esophagitis in Cats.

BACKGROUND: Chronic gingivostomatitis in cats (FCG) is a debilitating disease with potentially deleterious effects on overall health. HYPOTHESIS/OBJECTIVES: Little is known about the pathophysiology and overall impact of FCG. The aims of our study were to investigate whether gingivostomatitis occurs concurrently with esophagitis, if FCG treatment contributes to esophagitis and if esophagitis exacerbates signs of FCG. ANIMALS: Fifty-eight cats with clinical signs of FCG and 12 healthy control cats exhibiting no signs of oral disease, all client-owned. METHODS: Prospective study. Physical, oral and endoscopic examinations were performed on all cats. Measurements of salivary and esophageal lumen pH were obtained from both groups. Biopsies were acquired from sites of esophageal inflammation in cats with FCG and from normal-appearing esophageal mucosa in control cats. RESULTS: The majority of cats with clinical signs of FCG exhibited some degree of esophagitis especially in the proximal (44/58) and distal (53/58) parts (P < 0.001) with or without columnar metaplasia, compared to controls. All cats lacked signs related to gastrointestinal disease. Salivary and esophageal lumen pH were not statistically different compared to controls. CONCLUSIONS AND CLINICAL IMPORTANCE: Feline chronic gingivostomatitis seems to occur concurrently with esophagitis. Esophagitis also should be managed in cats with chronic gingivostomatitis because it may aggravate the existing condition.

Fractalkine (CX3CL1) and fractalkine receptor (CX3CR1) in squamous cell carcinoma of the tongue: markers of nerve invasion?

PURPOSE: Perineural invasion (PNI) in oral squamous cell carcinoma (SCC) is an independent predictor of poor prognosis. As PNI is not always identified with routine histology, a surrogate marker of PNI would improve detection and better inform treatment planning. The chemokines fractalkine (CX3CL1) and its receptor (CX3CR1) have shown such potential in other cancers, but have yet to be investigated with respect to PNI in oral SCC. METHODS: Thirty SCCs of the tongue in which PNI was identified histologically, and 30 in which it was not, were stained for fractalkine and fractalkine receptor using polyclonal antibodies and an immunoperoxidase technique. Tumours were assessed as either positive or negative; no attempt was made to subjectively assess staining intensity or extent. RESULTS: Both markers labelled myofibroblasts in the stroma surrounding the tumour, various neural components, leucocytes, endothelium and salivary myoepithelial cells. Fractalkine also labelled salivary ductal epithelium, vascular smooth muscle and 12/30 SCC which showed PNI. Eight of 30 positive SCCs in which PNI was not identified were also positive for this marker. There was no statistically significant association between fractalkine staining and PNI (p = 0.273). No SCC was positive for fractalkine receptor, but immune dendritic cells within tumour islands were strongly positive, as was striated muscle. CONCLUSIONS: Neither fractalkine nor fractalkine receptor is a reliable surrogate marker of PNI in lingual SCC.

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.

Coexistence of mucous retention cyst and basal cell adenoma arising from the lining epithelium of the cyst. Report of two cases.

OBJECTIVE: To report 2 cases of coexisting mucous retention cyst and basal cell adenoma arising from the lining epithelium of the cyst. CLINICAL PRESENTATION AND INTERVENTION: Two cases of painless swellings, well-demarcated, soft to palpation, and located in the submucosa of the upper lip were clinically examined with the provisional diagnosis of mucocele or salivary gland tumor. Histological examination showed the presence of a large unilocular cystic cavity in many parts surrounded by single or bilayered lining epithelium composed of flattened to cuboidal cells, and in other parts surrounded by projections of cells arranged in a trabecular pattern far into the cystic cavity. The trabeculae were composed of basal and low columnar cells that sometimes formed small duct-like structures. Immunohistochemistry showed that the lining epithelium of the cystic cavity and the cells of the projections expressed cytokeratin 7 and high-molecular-weight cytokeratins. The cells of the projections were weakly positive for S-100 protein and negative for vimentin and alpha-smooth muscle actin. Based on the results, a diagnosis of coexisting mucous retention cysts and basal cell adenomas arising from the lining epithelium of cysts was made. CONCLUSION: The coexistence of mucous retention cysts and basal cell adenomas arising from the lining epithelium of the cyst is reported.

Human cytomegalovirus-associated oral and maxillo-facial disease.

Human cytomegalovirus is a ubiquitous pathogen with protean clinical manifestations. After initial infection, the virus remains in a persistent state in the host. Immunity plays a pivotal role in counteracting its virulence, albeit intermittent virus shedding occurs in immunocompetent individuals. Should deficiencies in immunity occur, e.g., as a consequence of AIDS or iatrogenic immunosuppression, then virus replication and subsequent pathogenic manifestations ensue. In the oral and maxillo-facial region, the virus causes a wide variety of diseases, mainly atypical chronic ulcerations and sialadenitis. These morbidities are rarely reported and sometimes cause significant problems for clinicians.

Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis.

Primary herpetic gingivostomatitis (PHGS) represents the clinically apparent pattern of primary herpes simplex virus (HSV) infection, since the vast majority of other primary infections are symptomless. PHGS is caused predominantly by HSV-1 and affects mainly children. Prodromal symptoms, such as fever, anorexia, irritability, malaise and headache, may occur in advance of disease. The disease presents as numerous pin-head vesicles, which rupture rapidly to form painful irregular ulcerations covered by yellow-grey membranes. Sub-mandibular lymphadenitis, halitosis and refusal to drink are usual concomitant findings. Following resolution of the lesions, the virus travels through the nerve endings to the nerve cells serving the affected area, whereupon it enters a latent state. When the host becomes stressed, the virus replicates and migrates in skin, mucosae and, in rare instances, the central nervous system. A range of morbidities, or even mortality, may then occur, i.e., recurrent HSV infections, which are directly or indirectly associated with PHGS. These pathological entities range from the innocuous herpes labialis to life-threatening meningoencephalitis.

Oral manifestations of infections of infections due to varicella zoster virus in otherwise healthy children.

Varicella zoster virus (VZV) causes varicella (or chickenpox) and establishes latency in nerve ganglia after the primary infection. The reactivation of virus later in life can cause mono- or polyneuropathy. The cranial nerves most commonly involved are five (herpes zoster or shingles), six, seven eight, nine and ten. In the present study we describe the oral lesions associated with VZV infections in normal children. In a 3 year period we examined 62 children, age 2 to 13 years old with diagnosed varicella and a 4 year old boy with herpes zoster at the 3rd branch of the trigeminal nerve. According to the clinical picture of varicella, the disease was defined as: (1) group A mild cases; (2) group B moderate cases; (3) group C severe. The manifestations of varicella were: mild varicella 19 children, moderate 26 children and severe 17 children. The results of the present study indicate that the prevalence of oral manifestations of varicella is related to the severity of the disease. In 17 severe cases, oral lesions were always present and the number was between 5 to 30. From 26 moderate cases, oral lesions were observed in 23 and the number was between 2 to 10. From 19 mild cases, oral lesions were present only in 6 cases and their number was 1 or 2. Often varicella's oral lesions resemble manifestations of other entities, and this may cause differential diagnostics problems.

Antibacterial properties of dentin bonding systems, polyacid-modified composite resins and composite resins.

This study examined the antibacterial activities of the bonding systems Syntac, EBS and Scotchbond 1, the polyacid-modified composite resins Hytac and Compoglass, and the composite resins Tetric, Z100 and Scalp-it. They were evaluated using the cariogenic bacteria Streptococcus mutans, Lactobacillus salivarius, Streptococcus sorbinus and Actinomyces viscosus in vitro with a modified cylinder drop plate agar diffusion assay. All adhesives of the dentin bonding systems and the polyacid-modified composite resins exhibited various degrees of antibacterial activity against all of the test bacteria. On the contrary, composite resins did not affect bacterial growth. The data suggest that the use of these adhesives and polyacid-modified composite resins may reduce the consequences of microleakage owing to their antibacterial properties.

Facial and perioral molluscum contagiosum as a manifestation of HIV infection.

Molluscum contagiosum (MC) is a self-limiting viral disease of the skin and the mucous membranes. Facial and perioral MC is seen with increasing frequency in human immunodeficiency (HIV) infection, particularly in HIV infected homosexual men. The purpose of this study was to describe clinical observations of facial and perioral MC in HIV infected patients. One hundred and eighty HIV-positive individuals (160 males and 20 females) were examined over a period of five years. Fifty-eight were homosexual men and 19 were bisexual men. Fifty-one of 180 patients at the time of the first examination had CD+4 count < 200 cells/mm3 and another 63 presented loss of CD+4 cells in this level, during this period. Three HIV infected patients (two homosexual and one bisexual) were affected with facial and perioral MC. At the time of MC diagnosis the CD+4 count was less than 200 cells/mm3 for all three patients. One patient died nine months after MC diagnosis and the other two are still alive. It is remarkable that in this study no clinical lesions were observed on other sites of the skin.

Concentration of 3 tetracyclines in plasma, gingival crevice fluid and saliva.

BACKGROUND: Systemically-administered tetracyclines have been used widely for treatment of periodontal diseases with little understanding of their delivery characteristics to periodontal tissues. This study was designed to measure concentrations of 3 tetracyclines in gingival crevice fluid (GCF), plasma and saliva of following systemic administration. METHOD: The concentration of tetracycline (TC), minocycline (MN) and doxycycline (DX) was measured in gingival crevice fluid (GCF), plasma and saliva of 20 subjects following single sequential standard oral systemic doses. Gingival crevice fluid concentration was measured at 4 sites (2 shallow and 2 deep) before administration, and at 1 h and 2 h following administration. Plasma and saliva concentrations were measured from in samples at the same time points. No antibacterial activity was detected before administration. The highest concentrations were measured 2 h after administration. RESULTS: The average concentrations at 2 h were highest in plasma (TC = 1.02, MN=2.18, DX=2.35 microg/ml). Intermediate concentrations were measured in GCF (TC=0.61, MN= 1.49, DX= 1.65 microg/ml). Saliva concentrations (TC=0.09 MN=0.31, DX=0.47 microg/ml) were the lowest of the 3 fluids monitored. Data are presented indicating that the average GCF concentration of systemically administered tetracyclines is less than the that of plasma concentration. The concentration of tetracyclines in GCF was strongly associated with plasma concentration, indicating a primary role of drug absorption in the delivery of these systemically administered antibiotics to the site of action in periodontal therapy. The average GCF concentration in individuals varied widely (between 0 and 8 microg/ml) with approximately 50% of samples not achieving levels of 1 microg/ml. CONCLUSION: These observations suggest that poor absorption of orally-administered tetracyclines in many individuals may account for much of the variability in clinical response to antibiotics observed in practice.

[Lithiasis of a minor salivary gland. Apropos a case]. / Lithiase d'une glande salivaire accessoire. A propos d'un cas.

Sialolithiasis of minor salivary glands is generally considered to be extremely rare, particularly in younger persons. In addition, the symptomatology of this entity is not always typical and, for this reason, clinical misdiagnosis is possible. A case of sialolithiasis of minor salivary glands of the cheek in a 20 year-old woman is reported. The clinical diagnosis is verified by the histopathological examination after surgical excision of the lesion.

Beta-lactamases producing anaerobic bacteria in dentoalveolar abscesses.

Pus samples of 30 patients with closed dentoalveolar abscesses who had not received antimicrobial therapy for at last two months were screened for the presence of beta-lactamase-producing anaerobic bacteria. From these 30 pus samples, a total of 112 bacterial strains were isolated; 83 of them were strict anaerobes and 29 were aerobes. beta-lactamases activity of the selected anaerobic bacteria was tested after identification of the isolates and was detected in 5 of the total 83 (6%) strict anaerobic isolates, whereas these 5 strains were isolated in 4 of the 30 (13.3%) pus samples. The species with beta-lactamase activity were in the Prevotella intermedia (4 from 14 isolates) and the Fusobacterium nucleatum (1 from 9 isolates) groups. None of the gram-positive and the other gram-negative anaerobic strains were beta-lactamase positive.

Granulomatous cheilitis: a study of six cases.

OBJECTIVE: Granulomatous cheilitis (GC) is a very rare disorder of unknown etiology. Clinically, GC is characterised by recurrent swelling of the labial tissues, which may be followed by a permanent enlargement. Histologically, the typical form of GC is characterised by the formation of scattered aggregates of non-caseating granulomas. GC is the most frequent sign of orofacial granulomatosis, a disorder under which also encompasses sarcoidosis, Crohn's disease, atypical tuberculosis, Anderson-Fabry disease, possibly some allergic reactions, and Melkersson-Rosenthal syndrome (MRS). Some consider GC as an oligosymptomatic or monosymptomatic form of MRS. SUBJECTS AND METHODS: In this study we examined the clinical records of six patients presenting with GC which were examined and treated in the Department of Oral Medicine and Pathology of the Dental School of Aristotle University of Thessaloniki (Greece) during a 16-year period. In five of six patients a persistent swelling of the lower lip was recorded, one of whom also developed swelling in the upper lip. In one case the swelling was present in both lips and in another the GC was the only clinical finding, while in the other five cases it was accompanied by at least one other feature of MRS. In five cases, the histological picture revealed non-caseating granulomas. RESULTS: The treatment with the intralesional infusion of corticosteroids in three cases and the oral administration of corticosteroids in two cases was successful. One of the patients refused to be treated. This patient also presented later with permanent swelling of the upper lip.

Oral tuberculosis.

A case with oral tuberculosis and unaware of systemic tuberculosis is reported. The oral lesions clinically manifested as two painless ulcerations in the hard palate. Pulmonary tuberculosis was diagnosed following the histopathologic and bacteriologic examination of the oral lesions.

Susceptibility of Capnocytophaga to antimicrobial agents.

A total of 22 clinically isolated Capnocytophaga strains were tested for their susceptibility to antimicrobial agents frequently used in dental practice. All strains were susceptible to penicillin, ampicillin, cefaclor, cefuroxime, erythromycin, clindamycin and tetracycline. Metronidazole had poor activity against most strains.

Median rhomboid glossitis. An oral manifestation in patients infected with HIV.

A follow-up study included the oral examination of 39 persons known to be infected with the human immunodeficiency virus. In addition to the other human immunodeficiency virus-associated oral lesions, lesions clinically similar to the smooth form of median rhomboid glossitis, which is now believed to be erythematous candidiasis located in the dorsum of the tongue, were found in seven patients (18%). Patients with median rhomboid glossitis were classified in different stages of the Centers for Disease Control 1986 classification system and showed an average of CD+4 cell counts 397.5/mm3. Also the presence or the absence of anti-p24 antibodies in the serum and stimulated whole saliva of the patients with median rhomboid glossitis did not correlate with the stage of the disease or with low levels of CD+4 cell counts as in other forms of oral candidiasis. Therefore our results suggest that median rhomboid glossitis should be included as a distinct form of oral candidiasis in the classification of the oral manifestations of infection with the human immunodeficiency virus.

Immunologic status in patients infected with HIV with oral candidiasis and hairy leukoplakia.

Although numerous studies of oral manifestations associated with HIV have been reported, only a few refer to the correlation of these lesions with laboratory parameters. In this study we investigated the relationships between the two most common HIV-associated oral lesions, oral candidiasis and hairy leukoplakia, with the stage of the disease, circulating CD4+ cell counts, and the presence of anti-p24 antibodies in serum and stimulated whole saliva in 43 known HIV-1-infected persons. Although oral candidiasis and hairy leukoplakia were exclusively observed in subjects who were classified as Centers for Disease Control and Prevention group IV, only the prevalence of oral candidiasis is strongly associated with circulating CD4+ counts less than 200/mm3 (p < 0.02). The prevalence of oral candidiasis and hairy leukoplakia was significantly related to the absence of anti-p24 antibodies in serum (p < 0.01 and p < 0.01, respectively), but was only statistically significant for hairy leukoplakia in stimulated whole saliva (p < 0.02). The results suggest that oral candidiasis and hairy leukoplakia in correlation with immunologic status as indicated by low circulating CD4+ cell counts and the absence of anti-p24 antibodies in serum and the loss of secretory anti-p24 antibodies in subjects with hairy leukoplakia, may constitute prognostic markers for the progression of HIV-infection to AIDS. Our results also indicate that the absence of anti-p24 antibodies is not only influenced by the low levels of circulating CD4+ cells but probably by the presence of oral candidiasis or hairy leukoplakia as well.

Oriental sore: a case report.

We report a typical case of an oriental sore (cutaneous leishmaniasis) in a 28-year-old patient. The lesion was located on the upper lip, causing macrocheilia and an esthetic problem to the patient, who required urgent treatment. N-Methylglucamine antimonate proved to be an effective, well-tolerated drug.

[Ex-vivo study of the capacity of bacteria of the genus Capnocytophaga to adhere to human buccal epithelial cells]. / Etude ex-vivo de la capacite des bactéries du genre Capnocytophaga à adhérer aux cellules épithéliales buccales humaines.

The bacteria of the genre Capnocytophaga are part of the subdominant flora of the oral cavity. For diverse microorganisms it has been proved that the adhesion constitutes the first step of the colonization of a place leading to the eventual pathology. The adhesion capacity to human epithelial cells (keratinised and non) of eight strains of genus Capnocytophaga has been studied. All strains appear to have a very weak capacity of adhesion. This diministe can be originated from the fact that the host cells have been harvested from healthy subjects.

Susceptibility of Eikenella corrodens to antimicrobial agents.

Twelve Eikenella corrodens strains were isolated from dental infections and tested for their susceptibility to antimicrobial agents by an agar dilution method. All strains were susceptible to penicillin, ampicillin and tetracycline, and resistant to cephalexin and metronidazole and moderately resistant to erythromycin, gentamicin and cefaclor.