Oral manifestations of Smith-Lemli-Opitz syndrome: a paediatric case report.

BACKGROUND: The Smith-Lemli-Opitz Syndrome (SLOS) is an autosomal recessive genetic disorder, characterised by multiple congenital malformations, dysmorphic facial features and mental retardation. SLOS is caused by a genetically inherited deficiency of the enzyme 7-dehydrocholesterol delta7 reductase (7-DHC reductase), the catalyst involved in the final step of cholesterol biosynthesis, with the consequence of an increased serum levels of 7-DHC and generalised cholesterol deficiency. CASE REPORT: A 5-year-old female child was referred to the Department of Paediatric Dentistry of the University of Palermo for caries, gingivitis and malocclusion. The medical history revealed the diagnosis of SLOS, confirmed by a biochemical analysis 5 weeks after birth. The child exhibited several dysmorphic craniofacial features, typical of SLOS. Dental treatment, including oral prophylaxis, was performed without sedation. Instructions on proper oral self-care and dental disease prevention were provided to the mother of the patient. CONCLUSION: Suggestions regarding comprehensive dental care may be important to properly treat children with SLOS in the dental office.

[Smoking cessation counselling and dental team]. / Counselling anti-fumo e team odontoiatrico.

The aim of this paper was to present specific strategies to guide dental professionals providing smoking cessation interventions. Original papers, reviews and current guidelines on this subject, published in English from 2001 to the first semester of 2005, were located in the MEDLINE/Pubmed database. Additional publications were obtained by searching the reference lists of retrieved studies. The "Five A's" strategic approach represents a brief and effective protocol for smoking cessation that members of dental team can use with all patients in their office practice. Intensive interventions, more effective than brief ones, can be further adopted with any smokers willing to make a quit attempt. All patients attempting to quit should also be encouraged to use the approved pharmacotherapy agents, including nicotine patch, nicotine gum, nicotine inhaler, nicotine nasal spray, and bupropion sustained released. These medications significantly increase success rates and offer valuable assistance in the reduction of nicotine withdrawal symptoms. The evidence presented supports the efficacy of smoking cessation counselling by oral health professionals. Dentists and dental hygienists, therefore, should be trained on smoking cessation counselling and dental offices should incorporate this service into routine patient care.

Detection of Epstein-Barr virus (EBV) DNA and antigens in oral mucosa of renal transplant patients without clinical evidence of oral hairy leukoplakia (OHL).

The use of the polymerase chain reaction (PCR) to detect the presence of Epstein-Barr virus (EBV) DNA in oral mucosa in the absence of specific lesions gives rise to the problem of identifying the real viral replication sites. To verify whether the detection of EBV is due to salivary contamination or its true replicative capacity in oral mucosa, saliva samples and exfoliated cells from four different oral mucosa sites were taken from 40 renal transplant patients and 20 normal subjects for examination by PCR using two pairs of primers specific for the BamHI-L and BamHI-K genomic regions. EBV-specific sequences were detected in one or more of the oral mucosa samples from 29 transplant patients (72.5%) and six healthy controls (30%), and in the saliva samples of 16 transplant patients (40%) and three healthy controls (15%). A total of 89 oral mucosa smears from 29 transplant patients, and 13 from healthy subjects, were EBV-positive. The positive samples were also investigated by means of in situ hybridization in order to confirm the intracellular presence of the viral genome, and by means of immunofluorescence testing with monoclonal antibodies to assess the possible expression of viral antigens. Hybridization with the EBV-specific probe was observed in 40/ 89 and 2/13 samples, respectively. Latent antigens (with or without lytic antigens) were detected in only 23 of the 40 samples (collected from eight different transplant patients) that were positive by in situ hybridization. Our data show that EBV is more frequently present in the oral mucosa of immunodeficient patients (where it can efficiently replicate) than in normal subjects.

Cyclosporin- and nifedipine-induced gingival overgrowth in renal transplant patients: correlations with periodontal and pharmacological parameters, and HLA-antigens.

The factors associated with cyclosporin A (CsA)- and nifedipine (Nif)-induced gingival overgrowth were investigated in 113 renal transplant recipients receiving CsA alone (Group 1) [n = 61], CsA and Nif (Group 2) [n = 28], or azathioprine (Aza) (Control Group) [n = 24]. Periodontal and pharmacological parameters were assessed for each patient. The patients with a gingival overgrowth index (GOI) score >1 were considered responders (R); those with a score 0.05). It is concluded that the prevalence and severity of gingival overgrowth are greater in patients receiving CsA+Nif. As overgrowth appeared to be unrelated to local irritants, gingival inflammation or pharmacological parameters, it may be related to individual susceptibility.