Homo sapiens, Chimpanzees and the Enigma of Language.

OBJECTIVES: The present study explores the hypothesis that the anatomical bone structures of the oral cavity have probably evolved under the influence of language function. The possible changes have been evaluated by comparing two close species essentially differentiated from each other by spoken language. MATERIALS AND METHODS: Twenty dry skulls and 20 mandibles of modern Caucasians were compared with 12 dry skulls and 12 mandibles of chimpanzees, with the analysis of 37 variables and the definition of new anatomical parameters. RESULTS: A number of highly significant differences were found between humans and chimpanzees. The human temporomandibular joint is comparatively less flat and has a more limited excursive movement range, with structural elements that seem to be lighter. A significant difference is noted in mandibular alveolar vergency and in the internal slope of the mandibular symphysis where the oral cavity's morphology is modified, thereby increasing the free space for tongue movements in humans. The chin, which is unique to the human species, is quantified through the external slope of the mandibular symphysis with a lesser angle in humans. DISCUSSION: It is obvious that there are differences between humans and chimpanzees in the bone morphology of the oral cavity structures. This has been confirmed with the analysis of new variables. Together with other factors (bipedalism, habits, and genetics) speech in humans must have played an important role in the aforementioned differences between humans and chimpanzees. The number of mandibular movements involved in speech is far greater than those used in chewing, which must have conditioned the evolution of the oral structures implicated in the development of language. On average, humans weigh 70 kg and chimpanzees 44 kg. However, the majority of the variables studied in skulls and mandibles are greater in chimpanzees, which suggests that the evolution of the oral zone in humans has suffered a reduction in size with changes in shape. The refinement of the supralaryngeal vocal tract in the human species must have co-evolved with speech fairly recently. The human skull has temporomandibular joints that are comparatively less flat with a more limited movement. There is a greater lingual space and there is also a chin that suggests a muscular stimulant. This leads to the conclusion that, at least in part, speech is behind all these changes, although it is difficult to establish a cause-effect relationship.

Morphometric analysis of the dorsum linguae in patientswith Oral Lichen Planus

Objective: Morphometric study of the dorsum linguae in patients with Oral Lichen Planus (OLP).Material and Method: In 236 patients with a clinicopathologic diagnosis of OLP, 111 were found to have involvementof the dorsum linguae. For the purposes of the study, 41 of these cases were used, due to the availabilityof photographic records fulfilling quality conditions according to objective criteria. The experimental variablewas defined as the proportion of affected dorsum linguae measured and calculated using the MIP4(R) computersoftware.Results: In 236 patients with OLP, the mucosa of the dorsum linguae was affected in 47.6% of the cases (total111). The proportion of affected area was studied in 41 of these cases, 8 men (19.5%) and 33 women (80.5%). In73% of these cases, the affected area was less than 50% of the total surface of the dorsum linguae. There wereno statistically significant differences (p=0.495) in relation to age and proportion of lingual surface affected. Onthe other hand, significant statistical differences were found between the period of disease evolution and area oflingual involvement (p=0.044).Conclusion: Lingual involvement is frequent in patients with OLP, and manifests as de-papillate areas to the leftand right of the median sulcus of tongue (occasionally linked by an isthmus) and having a certain "butterfly wing" symmetry (AU)

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Joint hypermobility and disk displacement confirmed by magnetic resonance imaging: a study of women with temporomandibular disorders.

OBJECTIVE: The objective of this study was to test whether or not there is an association between generalized joint hypermobility (measured using the Beighton score) and temporomandibular joint disk displacement in women who had sought medical attention for temporomandibular disorders (TMD). STUDY DESIGN: We studied 66 women who were attending the clinic for TMD. The patients were examined for joint hypermobility, and Beighton scores were calculated. When it was suspected that a patient suffered arthropathic complaints, magnetic resonance imaging of both temporomandibular joints was performed with the mouth closed and at maximal opening. The Pearson chi-squared test was used to test for an association between generalized joint hypermobility and disk displacement. RESULTS: We were unable to confirm the existence of an association between generalized joint hypermobility and temporomandibular joint disk displacement in women (chi(2) = 1.523; P = .02). CONCLUSION: Generalized joint hypermobility may be a factor related to TMD, but we did not find an association between generalized joint hypermobility and anterior disk displacement in women.

Morphometric analysis of the dorsum linguae in patients with Oral Lichen Planus.

OBJECTIVE: Morphometric study of the dorsum linguae in patients with Oral Lichen Planus (OLP). MATERIAL AND METHOD: In 236 patients with a clinicopathologic diagnosis of OLP, 111 were found to have involvement of the dorsum linguae. For the purposes of the study, 41 of these cases were used, due to the availability of photographic records fulfilling quality conditions according to objective criteria. The experimental variable was defined as the proportion of affected dorsum linguae measured and calculated using the MIP4(R) computer software. RESULTS: In 236 patients with OLP, the mucosa of the dorsum linguae was affected in 47.6% of the cases (total 111). The proportion of affected area was studied in 41 of these cases, 8 men (19.5%) and 33 women (80.5%). In 73% of these cases, the affected area was less than 50% of the total surface of the dorsum linguae. There were no statistically significant differences (p=0.495) in relation to age and proportion of lingual surface affected. On the other hand, significant statistical differences were found between the period of disease evolution and area of lingual involvement (p=0.044). CONCLUSION: Lingual involvement is frequent in patients with OLP, and manifests as de-papillate areas to the left and right of the median sulcus of tongue (occasionally linked by an isthmus) and having a certain " butterfly wing" symmetry.

Sleep apnea and mandibular advancement device. Revision of the literature.

Sleep apnea and hypopnea syndrome (SAHS) is a disorder characterized by intermittent and repetitive obstruction of the upper airway provoking pharyngeal collapse. It is characterized clinically by a triad of daytime hypersomnia, snoring and pauses in breathing during sleep that are normally reported by the partner. Polysomnography is the chosen method for diagnosing this pathology. Patients with this disorder tend to have the following dental and orofacial signs: a retrognathic jaw, a narrow palate, a wide neck, deviation of the nasal septum and relative macroglossia, among others. Dentists should be ready to evaluate the risk-benefit of certain dental treatment options for this public health problem. The treatment of this problem will depend on its severity, with one of the options being the Mandibular Advancement Device (MAD) that is used especially in the treatment of slight or moderate SAHS and in the treatment of snoring, with results that are occasionally very successful. The objective of this study is to carry out an up-to-date literature review of SAHS and to evaluate the role of the dentist when faced with this pathology.

Sleep apnea and mandibular advancement device. Revision of the literature

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Sleep apnea and hypopnea syndrome (SAHS) is a disorder characterized by intermittent and repetitive obstructionof the upper airway provoking pharyngeal collapse. It is characterized clinically by a triad of daytime hypersomnia, snoring and pauses in breathing during sleep that are normally reported by the partner. Polysomnography is the chosen method for diagnosing this pathology. Patients with this disorder tend to have the following dental and orofacial signs: a retrognathic jaw, a narrow palate, a wide neck, deviation of the nasal septum and relative macroglossia, amongothers. Dentists should be ready to evaluate the risk-benefit of certain dental treatment options for this public health problem. The treatment of this problem will depend on its severity, with one of the options being the Mandibular Advancement Device (MAD) that is used especially in the treatment of slight or moderate SAHS and in the treatment of snoring, with results that are occasionally very successful. The objective of this study is to carry out an up-to-date literature review of SAHS and to evaluate the role of the dentist when faced with this pathology (AU)

Reliability of an infrared auditory thermometer in the measurement of oral temperature.

AIM: To evaluate the reliability of the measurements obtained from different parts of the oral cavity using an infrared auditory thermometer, and to contrast these results with those obtained from the axilla and auditory canal. STUDY DESIGN: A comparative descriptive design was used to establish differences between the temperature recordings made in 66 healthy volunteers with an infrared auditory thermometer applied to different parts of the body (oral cavity and left ear) versus the recordings obtained with a glass mercury thermometer in the axillary zone. The study sample was balanced with respect to gender, and the mean age was 21.15 (+/- 1.61) years. RESULTS: The largest standard deviation of all the locations corresponded to the left ear. This variable did not present a normal distribution. However, there were no statistically significant differences among the consecutive measurements made in the different anatomical (oral or axillary) regions. CONCLUSIONS: The thermal device used in this study seems to fulfill most of the requirements of an ideal clinical thermometer for yielding objective information on body temperature. It is easy to use, noninvasive, inexpensive and rapid. The temperature in the oral cavity is very representative of body temperature.

Reliability of an infrared auditory thermometer in the measurement of oral temperature

Aim: To evaluate the reliability of the measurements obtained from different parts of the oral cavity using an infrared auditory thermometer, and to contrast these results with those obtained from the axilla and auditory canal.Study design: A comparative descriptive design was used to establish differences between the temperature recordings made in 66 healthy volunteers with an infrared auditory thermometer applied to different parts of the body (oral cavity and left ear) versus the recordings obtained with a glass mercury thermometer in the axillary zone. The study sample was balanced with respect to gender, and the mean age was 21.15 (± 1.61) years.Results: The largest standard deviation of all the locations corresponded to the left ear. This variable did not present a normal distribution. However, there were no statistically significant differences among the consecutive measurements made in the different anatomical (oral or axillary) regions.Conclusions: The thermal device used in this study seems to fulfill most of the requirements of an ideal clinicalthermometer for yielding objective information on body temperature. It is easy to use, noninvasive, inexpensive and rapid. The temperature in the oral cavity is very representative of body temperature

Biopsy of the buccal mucosa in oral lichen planus: the traditional method versus the use of a new pressure forceps.

BACKGROUND: The authors designed a pressure forceps, called the "B forceps," for use in performing biopsies. They compared biopsy specimens taken with and without the aid of the B forceps from buccal mucosa of 84 patients divided equally into two groups, all of whom satisfied the World Health Organization's diagnostic criteria for oral lichen planus. They analyzed the advantages and disadvantages of using this instrument. MATERIALS AND METHODS: The 42 patients in group A underwent a conventional biopsy (29 with a scalpel and 13 with a punch). The 42 patients in group B underwent a biopsy performed with the B forceps and a punch. The authors studied artifacts of fragmentation, pseudocysts, crushing, fissures and hemorrhages histologically in both groups. RESULTS: There were no significant differences within group A between the subjects who had undergone either the scalpel or the punch biopsy. There were, however, significant differences between groups A and B. Group B experienced less fragmentation (P = .021), fewer fissures (P = .001) and fewer hemorrhages (P = .001). CONCLUSIONS: The new B forceps was a useful aid in the performance of biopsies. It improved visibility and reduced the time needed for the procedure. Biopsy specimens taken with the B forceps also had histologically fewer artifacts than did those taken without the B forceps. CLINICAL IMPLICATIONS: This technique using the B forceps has several advantages, including speed, because the ischemia produced by the clamp stabilizes the tissue and increases visibility, facilitating dissection. The time needed for surgical removal thus is shortened.

Gingival involvement of oral lichen planus.

BACKGROUND: Oral lichen planus (OLP) is one of the most common oral mucosa disorders. OLP gingival involvement is very frequently observed and is characterized by a wide range of clinical appearance, symptomatology, and locations. The purpose of this study was to analyze the prevalence and clinical aspects of gingival lesions in a series of 213 patients affected by OLP. METHODS: We analyzed the prevalence and clinical aspects (location, morphology, and symptomatology) of the gingival lesions in a total of 213 clinically and histopathologically assessed patients affected by OLP. RESULTS: Gingival lesions were diagnosed in 38.4% of cases. White lesions were the most frequently observed in the gingiva (42.7%), followed by mixed lesions (31.7%), and red lesions (25.6%). For the three clinical forms, the most frequent gingival location was the simultaneous involvement of the attached and marginal gingiva. None of the white lesions presented symptomatology, whereas most red lesions or mixed forms presented symptoms that varied from discomfort to severe oral pain or a burning sensation. CONCLUSIONS: Considering the high frequency of gingival involvement in OLP, the diversity of clinical manifestations, and its potential relationship with general and oral health in patients, periodontists should be familiar with the most common clinical aspects of OLP in the gingiva.

Familial oral lichen planus: presentation of six families.

OBJECTIVE: To present a series of 13 different cases of oral lichen planus (OLP) in 6 different families. STUDY DESIGN: From 249 lichen planus cases, we found 13 that could be considered to be family related. A study of these 13 cases of OLP was carried out across the various generations, and the means of presentation, placement, and injuries were studied, as well as signs and symptoms. RESULTS: The predominant affectation was in the women; only 2 patients were male. The mothers showed predominance toward erythematous OLP with greater symptoms, and in their children, symptom-free white OLP was predominant. CONCLUSIONS: It seems there may be some genetic predisposition toward OLP.

A simple test for salivary gland hypofunction using Oral Schirmer's test.

OBJECTIVE: The objective of this study was to develop a test for detecting salivary gland hypofunction. STUDY DESIGN: Oral Schirmer's test was performed by placing a strip of filter paper on the floor of the mouth and measuring the wetted length after 5 min. The control group consisted of 70 healthy patients, while another group consisted of 61 patients with Sjögren's Syndrome (SS) and a third group of 31 patients who suffered from xerostomia caused by other pathologies. RESULTS: The mean saliva flow was 40.92 +/- 22.28 mm/5 min in the control group, 27.25 +/- 24.11 mm/5 min in patients with SS and 36.847 +/- 23.4 mm/5 min in the third group. The differences between the control group and the other two groups were statistically different (P > 0.001). CONCLUSIONS: The whole saliva test was used to distinguish between healthy adults and subjects with hyposalivation.

Pemphigus vulgaris. A presentation of 14 cases and review of the literature.

Pemphigus vulgaris (PV) is a chronic vesicular-ampullar mucocutaneous disease that almost always produces oral manifestations. The fact that blisters on the oral mucosa are sometimes the first manifestation of the disease implies that dental professionals must be sufficiently familiarized with the clinical manifestations of PV to ensure early diagnosis and treatment. We present a series of 14 patients with clinically and histologically diagnosed PV seen in the Teaching Unit of Oral Medicine of the University of Murcia (Spain) between 1981 and 2001. A thorough evaluation was made, recording patient age and sex, the location and extent of the lesions, and the signs and symptoms of the disease. Complementary studies were also carried out, with the evaluation of hematological parameters (including blood chemistry), the histology and immunohistochemical characteristics (direct immunofluorescence in 2 cases). Treatment comprised topical corticoids, in 12 cases combined with systemic corticoids, and associated to intralesional corticotherapy in one patient. A good response to treatment was observed in all cases.

Effects of scalpel (with and without tissue adhesive) and cryosurgery on wound healing in rat tongues.

OBJECTIVE: To evaluate wound healing of incisions created by steel scalpel (with and without the application of N-butyl-2-cyanoacrylate) and cryosurgery. STUDY DESIGN: Prospective blinded and randomized study. Adult albino rats (N = 93) were randomly assigned to 3 groups (31 animals per group) before making incisions on oral mucosa by steel scalpel (2 groups) or cryosurgical techniques (remaining group). No product was applied to the resulting wound in the first group, while N-butyl-2-cyanoacrylate was applied to the wounds made in the tongues of the second group. Hemostasis, postoperative oral intake, and wound healing were measured. Statistical analysis was performed using analysis of variance. RESULTS: The wounds to which N-butyl-2-cyanoacrylate had been applied showed no hemorrhaging and faster reepithelialization and resolution of the inflammatory response, and the animals gained weight more rapidly. CONCLUSIONS: N-butyl-2-cyanoacrylate is a good hemostatic for managing wounds in the oral mucosa provoked by steel scalpel.

Pénfigo vulgar. Presentación de catorce casos y revisión de la literatura / Pemphigus vulgaris. A presentation of 14 cases and review of the literature

El pénfigo vulgar (PV) es una enfermedad mucocutánea crónica de tipo vesículo-ampollares que casi siempre produce manifestaciones orales. El hecho de que en ocasiones sean las ampollas en la mucosa oral la primera manifestación de este desorden implica que los odontólogos deben conocer suficientemente las claves clínicas con el fin de realizar un diagnóstico y tratamiento precoces. El objetivo de este trabajo es presentar una serie de 14 casos diagnosticados clínica e histopatológicamente de PV, que acudieron a la consulta de la Unidad Docente de Medicina Bucal de la Universidad de Murcia entre 1981 y 2001. Se realizó un estudio completo de estos pacientes, valorando la edad y el sexo, localización y extensión de las lesiones, así como el curso de los signos y síntomas. Se llevaron a cabo diversos exámenes complementarios, estudiándose las características hemáticas (biometría hemática y química sanguínea), histopatológicas, e inmunohistoquímicas (inmunofluorescencia directa en dos de los pacientes). El tratamiento consistió en corticoides tópicos, combinado en doce casos con corticoides sistémicos, y en uno con corticoides intralesionales. En todos los pacientes se obtuvo una buena respuesta al tratamiento

Pemphigus vulgaris (PV) is a chronic vesicular-ampullar mucocutaneous disease that almost always produces oral manifestations. The fact that blisters on the oral mucosa are sometimes the first manifestation of the disease implies that dental professionals must be sufficiently familiarized with the clinical manifestations of PV to ensure early diagnosis and treatment. We present a series of 14 patients with clinically and histologically diagnosed PV seen in the Teaching Unit of Oral Medicine of the University of Murcia (Spain) between 1981 and 2001. A thorough evaluation was made, recording patient age and sex, the location and extent of the lesions, and the signs and symptoms of the disease. Complementary studies were also carried out, with the evaluation of hematological parameters (including blood chemistry), the histology and immunohistochemical characteristics (direct immunofluorescence in 2 cases). Treatment comprised topical corticoids, in 12 cases combined with systemic corticoids, and associated to intralesional corticotherapy in one patient. A good response to treatment was observed in all cases

Peripheral ameloblastoma of the gingiva: the importance of diagnosis.

BACKGROUND: Peripheral ameloblastoma is an extremely rare epithelial odontogenic tumor, limited to the soft tissues of the gums or oral mucosa. Although the lesion is benign, it may be locally aggressive. METHODS: The present study describes the case of a 31-year-old male presenting a firm, symptomless tumor mass of irregular appearance and measuring approximately 12 mm in diameter, located in the distal zone of 4.7. RESULTS: An excision biopsy was performed. The lesion was covered with hyperplastic squamous epithelium, with islets of epithelial cells located at subepithelial level. The cells in the peripheral zone adopted a palisade distribution, and presented the appearance of a lax reticulum at central level. A fibroblastic stroma was observed between the islets. The diagnosis was peripheral ameloblastoma. CONCLUSIONS: Although the origin of the lesion remains unclear, it is able to recur and undergo malignant transformation. Consequently, peripheral ameloblastoma should not be viewed as a harmless mass.

Consensus statement on antimicrobial treatment of odontogenic bacterial infections.

The infection of the oral cavity is a common public health problem and constant cause for antibiotic prescription, with 10% of antibiotics used to treat this problem. However, few studies have so far aimed to determine its incidence. Added to this, its relationship with certain sytemic diseases (cardiac, endocrine, etc) confers this pathology vital importance. In spite of the frequency and importance of odontogenic infection, the current dispersion in criteria regarding key aspects in classification, terminology and therapeutic recommendations is noticeable. The main objective of this document, compiled as a consensus statement by specialists in microbiology and odontology, is to establish useful recommendations for all of those involved in the clinical management of this pathology. Special attention has been placed on the rise in bacterial resistance observed over the last years, specifically the proliferation of betalactamase producing strains. Another important factor causing the resistance to appear is lack of therapeutic compliance, specially what regards dosage and treatment duration. Therefore, this pathology constitutes a complex problem which requires the instauration of broad spectrum antimicrobials, well tolerated and a convenient posology so that patients receive the adequate dose over the necessary period. High doses of amoxicillin/clavulanate (2000 mg/125 mg) have showed good results and power to overcome resistance. Other agents such as metronidazole and clindamycin, followed by de claritromycin and azithromycin have also proved to be active against most of microorganisms responsible for odontogenic infection.

Miescher's cheilitis granulomatosa. A presentation of five cases.

Miescher's cheilitis granulomatosa (CG) consists of the appearance of recurrent labial edema on one or both lips, which can become persistent. It has traditionally been considered as a monosymptomatic form of the Melkersson-Rosenthal syndrome, described as the association of recurrent labial and/or recurrent facial edema, relapsing facial paralysis and fissured tongue. The aim of this study is to present a series of five clinically and histopathologically diagnosed cases of CG that came to our clinic at the Teaching Unit of Oral Medicine, Faculty of Medicine and Odontology, University of Murcia. A complete study of these patients evaluated the age, sex, family history, and location and course of the signs and symptoms. Various complementary examinations were carried out, studying the hematic characteristics (hemogram, erythrocyte sedimentation rate, leukocyte count), including immunological and histopathological studies. The treatment consisted of intralesional corticoids, combined in some cases with anti-leprous drugs or systemic corticoids. A good response to treatment was obtained in all cases.