Multiple oral mucoceles treated with evening primrose oil: a report of two cases.

Multiple mucoceles of the minor salivary glands are rare in the mouth. Typically, the minor salivary glands of the soft palate are affected. We report two cases that responded entirely following systemic therapy with evening primrose oil. No recurrence was reported over a two-year follow-up period. Evening primrose oil is postulated to have an effect on the composition and/or viscosity of minor salivary gland secretions.

Application of teledentistry in oral medicine in a community dental service, N. Ireland.

Currently, patients with oral medicine conditions from all areas of Northern Ireland are referred by dentists and doctors to a small number of specialist services: predominantly, the Regional Oral Medicine Consultant at the School of Dentistry, Belfast. On receipt of the referral the consultant makes an assessment of the urgency of the case and the patient is placed on a waiting list. Until the recent implementation of waiting list initiatives (Elective Access Protocol, Department of Health, N. Ireland, 2006), patients remained on the waiting list for long periods of time. Analysis of these patient profiles highlights that many need both multiple treatment and review appointments of their chronic conditions, and consequently remain in the hospital system for significant periods of time. This increases the waiting time for these services. The idea of using teledentistry to triage referrals, and its potential as a tool to support locally based treatment, poses an alternative approach to the management of oral medicine referrals. It may be of particular interest to practitioners in rural locations where distance from the regional centre is significant. In 2005, to test this theory, a prototype teledentistry system was set up as part of a service improvement scheme by the Community Dental Service of the Homefirst Legacy Trust (now Northern Trust) in partnership with the Oral Medicine Department at the School of Dentistry, Royal Group of Hospitals Legacy Trust (now Belfast Trust). This paper describes the feasibility study.

Neuropeptide Y Y1 receptor in human dental pulp cells of noncarious and carious teeth.

AIM: To determine the distribution of the NPY Y1 receptor in carious and noncarious human dental pulp tissue using immunohistochemistry. A subsidiary aim was to confirm the presence of the NPY Y1 protein product in membrane fractions of dental pulp tissue from carious and noncarious teeth using western blotting. METHODOLOGY: Twenty two dental pulp samples were collected from carious and noncarious extracted teeth. Ten samples were processed for immunohistochemistry using a specific antibody to the NPY Y1 receptor. Twelve samples were used to obtain membrane extracts which were electrophoresed, blotted onto nitrocellulose and probed with NPY Y1 receptor antibody. Kruskal-Wallis one-way analysis of variance was employed to test for overall statistical differences between NPY Y1 levels in noncarious, moderately carious and grossly carious teeth. RESULTS: Neuropeptide Y Y1 receptor immunoreactivity was detected on the walls of blood vessels in pulp tissue from noncarious teeth. In carious teeth NPY Y1 immunoreactivity was observed on nerve fibres, blood vessels and inflammatory cells. Western blotting indicated the presence and confirmed the variability of NPY Y1 receptor protein expression in solubilised membrane preparations of human dental pulp tissue from carious and noncarious teeth. CONCLUSIONS: Neuropeptide Y Y1 is expressed in human dental pulp tissue with evidence of increased expression in carious compared with noncarious teeth, suggesting a role for NPY Y1 in modulation of caries induced pulpal inflammation.

Asymptomatic shedding of HSV-1 in patients undergoing oral surgical procedures and attending for noninvasive treatment.

Oral surgery and stress can trigger and/or increase asymptomatic shedding of herpes simplex virus type-1 (HSV-1) into human saliva. In this investigation we examined the frequency of HSV-1 shedding in 32 patients undergoing an oral surgery procedure compared with 40 control patients attending for noninvasive treatment. Control patients comprised 18 migraine patients and 22 patients with temporomandibular (TMD) joint problems. Nested-PCR was carried out on oral rinses collected from each patient prior to treatment and 7 days post-treatment. Fifty-two of sixty-one seropositive patients were positive for HSV-1 DNA in one or both oral rinses. The frequencies of HSV-1 shedding for the oral surgery and control patients were 84.6% and 85.7% respectively. Seropositive patients who started shedding after treatment were significantly higher in oral surgery patients (46.2%) compared to control patients (34.3%). Shedding of HSV-1 in the oral cavity is not only increased by direct surgical trauma, but also appears to be common in migraine and TMD patients attending for general dental treatment. Thus pain or pain-induced stress as well as anxiety associated with dental treatment may also be a risk factor for asymptomatic shedding in specific seropositive patients attending for dental treatment.

The feasibility of using infrared thermography to evaluate minor salivary gland function in euhydrated, dehydrated and rehydrated subjects.

BACKGROUND: Infrared thermography technique (IRT) is utilized by a growing number of disciplines within medicine and dentistry. However, IRT has not been employed in the evaluation of salivary gland dysfunction. The purpose of this study was to examine the feasibility of using thermographic imaging in the evaluation of minor labial salivary gland function in subjects during euhydration, dehydration, and rehydration states. METHODS: Ten subjects were studied. Upper labial minor salivary gland secretion was quantified whilst simultaneously visualizing lower minor salivary gland output thermographically during each state. RESULTS: A significant difference was observed in the minor labial salivary flow among euhydrated, dehydrated and rehydrated, states. Despite the lack of statistical difference in the thermographic findings, IRT images reflected noticeable differences among the three hydration states. CONCLUSION: The overall results of this study suggest that IRT could potentially provide a valuable non-invasive tool for evaluating the relationship between minor labial salivary gland function and hydration status.

Shear bond strength and residual adhesive after orthodontic bracket debonding.

OBJECTIVE: To compare the shear bond strength and determine the area of residual adhesive on teeth after the debonding of brackets bonded with two types of orthodontic adhesives. These were a resin-modified glass ionomer cement (RMGIC; Fuji ORTHO LC, GC Corporation, Tokyo, Japan) and a resin applied as a precoated bracket (APC bracket, 3M Unitek GmbH, Seefeld, Germany). MATERIALS AND METHODS: A total of 60 premolar teeth were randomly divided into two groups, and brackets were bonded according to the manufacturers' instructions. In group 1, the teeth were conditioned using 10% polyacrylic acid, and the brackets were bonded using Fuji Ortho LC in wet condition. In group 2, the teeth were etched using 37% phosphoric acid, and the APC brackets were bonded. Bond strength was measured using a testing instrument (2000S, Lloyds Instruments, Fareham, England) at a crosshead speed of 1 mm/min, and the residual adhesive was quantified using a three-dimensional laser scanning instrument. RESULTS: The Mann-Whitney test showed that the median bond strength of group 1 was significantly lower than that of group 2 (P < .001). A Pearson chi-square test of the Adhesive Remnant Index (ARI) revealed a significant difference among the groups tested. All the adhesives in group 1 failed at the enamel/adhesive interface (100%), whereas group 2 exhibited cohesive failure of the adhesive (90%). CONCLUSIONS: The bond strength values obtained with the RMGIC were above the minimum values suggested in the literature to achieve a clinically effective adhesion in orthodontics.

Personality analysis of patients complaining of sialorrhoea.

BACKGROUND: Sialorrhoea, the symptom of apparent excessive secretion of saliva is a relatively uncommon complaint. Some authors consider that in the absence of clinical findings, then these patients have a psychiatric disorder masquerading as a physical illness. However, there is little evidence in the literature to support this conclusion and a detailed psychological assessment of this population has not previously been reported. METHODS: In total, 18 patients and 18 age- and sex-matched controls were studied. All had a history of a complaint of excess salivation in the absence of any oral mucosal or systemic abnormality. All patients completed an Eysenck Personality Questionnaire. RESULTS: There were no differences in the extroversion of psychoticism scores between the study and control group. However, the result showed significant increases in the neuroticism and Lie Scale score in the patient group. CONCLUSIONS: The overall results of this study indicate that the complaint of sialorrhoea in otherwise healthy individuals does not have an organic basis and suggest that sialorrhoea is associated with high levels of neuroticism and a tendency to dissimulate.

Fitting acrylic occlusal splints and an experimental laminated appliance used in migraine prevention therapy.

OBJECTIVE: To evaluate clinical procedures and chair time required to seat and adjust hard, heat-cured acrylic occlusal splints and an alternative laminated appliance developed to simplify construction of migraine prevention appliances. DESIGN AND SETTING: Single-centre study in the Oral Medicine Clinic, The Royal Hospitals, Belfast, Northern Ireland. METHOD: Questionnaires were distributed, January-May 2003, to operators fitting occlusal splints for 100 consecutive patients selected for migraine prevention therapy. Half the appliances were made in heat-polymerised acrylic with the remainder using a novel combination of ethylene vinyl acetate and light-curing urethane dimethacrylate. Information on operator experience, the nature of any fitting surface and occlusal adjustments together with an estimate of the time taken to make alterations was recorded. KEY FINDINGS: The need for adjustment to seat appliances intraorally was significantly less for migraine prevention appliances made using an experimental laminating technique. Where modifications were necessary, there was no significant difference in the chair time required to fit either the heat-cured hard or experimental laminated migraine prevention appliance. CONCLUSION: Provision of migraine prevention appliances may be more time efficient if the dental practitioner considers a laminated approach to construction.

The efficacy of amlexanox OraDisc on the prevention of recurrent minor aphthous ulceration.

BACKGROUND: The study was designed to determine the efficacy of OraDisc (active component 2 mg amlexanox) on the prevention of aphthous ulcers treated at the prodromal stage. METHODS: Thermographic imaging was used to confirm the presence of a prodromal ulcer. Fifty-two patients were randomized to receive OraDisc (N = 26) or vehicle patches (N = 26). Patches were applied four times a day for 72 h over the prodromal area. The percentage of subjects who developed an ulcer at 72 h was compared between groups using the Fisher's exact test. RESULTS: About 50% of subjects in the OraDisc group developed an ulcer by day 4 compared with 69% in the vehicle group. Erythema score, ulcer size, pain scores and thermographically active area and temperature all showed trends towards healing in the OraDisc group. CONCLUSION: The OraDisc prevents ulcers from developing when compared with the vehicle patch.

Relationship between personality and satisfaction with the dentition in tooth wear patients.

This study was undertaken to identify whether personality traits had any relationship with patients' satisfaction with their dentition in tooth wear cases. One hundred tooth wear patients and one hundred controls were recruited into the study. A Dental Impact on Daily Living questionnaire was used to assess impact of tooth wear on day to day life and satisfaction with the dentition. An ordinal scale was used to assess tooth wear severity in tooth wear patients. The NEO Five Factor inventory was used to assess personal profiles. Tooth wear patients were less satisfied with their dentition, had higher Neuroticism, lower Extraversion, and higher Openness than the controls.

Detection of individual human neutrophil alpha-defensins (human neutrophil peptides 1, 2 and 3) in unfractionated gingival crevicular fluid--a MALDI-MS approach.

The role of antimicrobial peptides is particularly important in the oral cavity where there is constant challenge by microorganisms. The alpha-defensins are a group of cationic peptides that comprise 30-50% of the total protein in azurophilic granules of human neutrophils. They include the human neutrophil peptides (HNP) 1, 2 and 3 which have almost identical amino acid sequences but differ in their biological activities. The amino acid sequence similarities of the defensins have made it difficult to unequivocally determine the presence of individual defensins using antibody-based techniques. However, by virtue of their cationic nature we postulated that the defensins would fly particularly well in mass spectrometry and that this characteristic would allow facile identification of individual HNPs in unfractionated gingival crevicular fluid (GCF) from periodontitis patients and healthy controls. Although there was variability in levels of defensins detected in periodontal health and disease, HNP-1 was always identified as the major peak in the triad and HNP-3 as the minor peak, lending support to the hypothesis that HNP-2 may arise by post-translational proteoyltic cleavage of HNP-3 rather than HNP-1. The finding that the defensins were more abundant in a higher proportion of the healthy sites studied could be linked to a more intact defensin barrier in periodontal health.

Sjögren's syndrome: a condition with features of chronic graft-versus-host disease: does duct cell adhesion or permeability play a role in pathogenesis?

Primary and Secondary Sjögren's syndrome are disease complexes characterized by periductal inflammatory cell infiltration of the salivary and lacrimal glands and manifest as dry mouth and dry eyes. Secondary Sjögren's syndrome may be associated with a connective tissue disorder. Additional extraglandular features in Sjögren's syndrome include a generalized inflammatory exocrinopathy that might be associated with abnormalities of both humoral and cellular mediated immunity. Similar inflammatory changes and extraglandular features, including an altered immune response, have been reported in patients developing graft-versus-host disease after bone-marrow transplantation and in patients with primary biliary cirrhosis. The periductal nature of the inflammatory response involving minor salivary and other glands raises the possibility of altered duct cell adhesion or permeability in playing a role in the aetiopathogenesis of Sjögren's syndrome. The paper pulls together evidence that could be interpreted in this light. Evidence for bacterial or viral factor(s) altering the antigenicity of the histocompartibility (HC) complex on ductal cells in Sjögren's syndrome patients is also described. A hypothesis is proposed for Sjögren's syndrome in which the principal feature is an alteration in salivary gland duct cell adhesion or permeability. A re-evaluation of current knowledge of these two conditions from a clinical and experimental context are interpreted in this light.

Potentially malignant oral lesions in Northern Ireland: size (extent) matters.

OBJECTIVES: We examined clinical parameters of patients from Northern Ireland with potentially malignant lesions (PML) to determine association with development of intraoral squamous cell carcinoma (SCC). DESIGN: retrospective, cross-sectional, population-based, clinically validated, laboratory-verified. SUBJECTS AND METHODS: All patients who had more than one incisional oral mucosal biopsy diagnosed from 1975-1991 were abstracted from a database of all PML and SCC and their clinical records and biopsies reviewed. Patients were excluded if there was priorlsynchronous SCC or radiotherapy, frictional keratosis or lichen planus, missing clinical records/biopsy material or follow-up of <24 months. From the 50 suitable patients, gender, age, smoking status, site, clinical appearance and extent of lesion(s), treatment and year of diagnosis were recorded. Patients who developed SCC from PML were compared with those who did not. RESULTS: Squamous cell carcinoma occurred significantly more often in patients with single rather than multiple PML, those with 'non-homogenous' PML and in patients diagnosed prior to 1980. In Cox's survival analysis, only the clinical extent was predictive of SCC. CONCLUSIONS: Of all the features considered in our series, size (extent) was the most important clinical factor in determining the risk of future SCC in PML, particularly when several adjacent anatomical sites were affected.

Extraction and radioimmunoassay quantitation of neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP) from human dental pulp tissue.

The measurement of neuropeptides in complex biological tissue samples requires efficient and appropriate extraction methods so that immunoreactivity is retained for subsequent radioimmunoassay detection. Since neuropeptides differ in their molecular mass, charge and hydrophobicity, no single method will suffice for the optimal extraction of various neuropeptides. In this study, dental pulp tissue was obtained from 30 human non-carious teeth. Of the three different neuropeptide extraction methods employed, boiling in acetic acid in the presence of protease inhibitors yielded the highest levels of neuropeptide Y (NPY) and vasoactive intestinal polypeptide (VIP). High pressure liquid chromatography (HPLC) analysis of dental pulp tissue verified the authenticity of the neuropeptides extracted.

Suprabasal p53 immunoexpression is strongly associated with high grade dysplasia and risk for malignant transformation in potentially malignant oral lesions from Northern Ireland.

AIMS: No good predictive marker for the malignant transformation of potentially malignant oral lesions (PMOLs) is currently available. This study re-evaluated the value of p53 immunoexpression to predict malignant transformation of PMOLs after discounting possible confounding factors. METHODS: PMOLs from 18 patients who showed progression to carcinoma, 16 of the respective carcinomas, and PMOLs from 18 matched controls were evaluated by immunohistochemistry (IHC) for p53 expression. A mouse monoclonal antibody that detects wild-type and mutant forms of human p53 was used. The p53 immunostaining pattern was also correlated with the degree of dysplasia. RESULTS: Suprabasal p53 staining was significantly associated with high grades of dysplasia (p < 0.01). The specificity and positive predictive value (PPV) for malignant transformation of suprabasal p53 staining were superior to the assessment of dysplasia, but sensitivity was inferior. All carcinomas derived from PMOLs with suprabasal p53 showed strong p53 immunostaining. However, the absence of suprabasal p53 staining and/or dysplastic changes did not preclude malignant transformation in a considerable proportion of PMOLs. CONCLUSIONS: This study confirms and extends previous findings that suprabasal p53 immunoexpression has a high PPV for malignant transformation of PMOLs and can be used as a specific marker for lesions that are at high risk for malignant transformation. The absence of suprabasal p53 staining (that is, absence of, or basal, p53 staining) is non-informative for prognostic purposes. Because of its limited sensitivity, p53 IHC is not a substitute for the assessment of dysplasia in the evaluation of PMOLs. Instead, p53 IHC emerges as a clinically useful supplement of histopathological assessment in the prognosis of PMOLs.

Quantitative analysis of substance P, neurokinin A and calcitonin gene-related peptide in pulp tissue from painful and healthy human teeth.

AIM: The purpose of this study was to investigate the levels of substance P (SP), neurokinin A (NKA) and calcitonin gene-related peptide (CGRP) in painful and healthy human dental pulps. METHODOLOGY: Forty-six samples of pulp tissue were collected from extracted or endodontically treated painful teeth and 20 from clinically healthy teeth extracted for orthodontic reasons. All pulp samples were boiled in 0.5 m acetic acid for 10 min, centrifuged and the supernatant collected. SP, NKA and CGRP levels were measured using radioimmunoassay. RESULTS: Substance P and CGRP were present in all samples and NKA was detected in 96% of the pulps. CGRP was present in much higher concentrations than SP and NKA in both painful and non-painful teeth. The painful teeth had significantly higher concentrations of SP (P = 0.02), NKA (P < 0.001) and CGRP (P = 0.03) than non-painful teeth. The concentration of CGRP was significantly higher in the pulps of smokers compared with non-smokers (P = 0.02). CONCLUSIONS: Elevated levels of these neuropeptides in pulps from painful teeth indicate that they may play an important role in the process of pulpal inflammation and pain. Further investigation of the association between these neuropeptides and pulpal status may help to improve our understanding of pulpal inflammation and dental pain.

Quantitative analysis of MRP-8 in gingival crevicular fluid in periodontal health and disease using microbore HPLC.

BACKGROUND: The protein components of GCF can be separated by reverse-phase microbore HPLC on a C18 column with detection on the basis of 214 nm absorbance. A single major symmetrical protein peak eluting with a retention time of 26 min (50% acetonitrile) was evident in gingival crevicular fluid (GCF) from periodontitis patients but not in healthy GCF. This protein was identified as human MRP-8 by N-terminal amino acid sequencing and liquid chromatography quadropole mass spectrometry. AIMS: To quantify the amount of MRP-8 detectable in GCF from individual healthy, gingivitis and periodontitis affected sites and to study the relationship, if any, between the levels of this responsive protein and periodontal health and disease. METHODS: GCF was sampled (30 s) from healthy, gingivitis, and periodontitis sites in peridontitis subjects (n=15) and from controls (n=5) with clinically healthy gingiva and no periodontitis. Purified MRP-8 was sequenced by Edmann degradation and the phenylthiohydantoin (PTH) amino acid yield determined (by comparison of peak area with external PTH amino acid standards). This value was subsequently used to calculate the relative amount of protein in the peak eluting with a retention time of 26.0 min (MRP-8) in individual GCF chromatograms. RESULTS: Higher levels of MRP-8 were detected in inflammatory sites: periodontitis 457.0 (281.0) ng; gingivitis 413.5 (394.5) ng compared with periodontally healthy sites in diseased subjects 14.6 (14.3) ng and in controls 18.6 (18.5) ng, p=0.003. There was at least 20-fold more MRP-8 in the inflammatory compared with the healthy sites studied. CONCLUSIONS: The preliminary data indicate that MRP-8 is present in GCF, with significantly greater amounts present at diseased than healthy sites. A systematic study of the relationship of this protein to periodontal disease could prove useful in further clarifying whether MRP-8 could be a reliable GCF biomarker of gingivitis and periodontitis.

Patients' pain experience following oral mucosal biopsy under local anaesthesia.

OBJECTIVE: To examine the incidence and severity of post-operative pain and use of analgesics following biopsy of oral mucosal lesions. DESIGN: A patient survey using a self-completed pain diary. SUBJECTS AND METHODS: Seventy-six patients attending an oral medicine clinic for investigation of oral mucosal disease recorded overall and worst pain experiences and analgesic usage over 7 post-operative days following biopsy using visual analogue scales in patient completed diaries. RESULTS: One third of patients reported no post-operative pain on any day. Most patients recorded no pain or mild pain. The percentage experiencing pain dropped from the first day (61%) to the seventh day (21%). Most patients did not use any analgesics. Analgesic use was not related to the presence of pain. Only a small minority of patients recorded severe pain. CONCLUSION: Biopsy of oral mucosal lesions does not cause undue pain in most patients.

The influence of antifungal drugs on virulence properties of Candida albicans in patients with diabetes mellitus.

OBJECTIVE: This study investigated the influence of nystatin and fluconazole on virulence properties of Candida albicans. STUDY DESIGN: A total of 108 diabetic patients participated in the study. Eighty-eight patients had clinical oral candidosis. Drug therapy was given at 6 hourly intervals for nystatin or daily with fluconazole for a maximum of 2 weeks. Adhesion of C albicans to buccal epithelial cells was determined by using an autologous adhesion assay prospectively over 6 months. Phospholipase production was estimated by using an agar plate method. The data analysis included a paired Student t test and calculation of correlation coefficients. RESULTS: Unlike nystatin, treatment with fluconazole reduced the ability of C albicans to colonize the buccal mucosa for up to 8 weeks after the treatment. Patients without clinical signs of oral candidosis had significantly fewer C albicans isolates producing phospholipase than did patients with oral candidosis. Treatment with fluconazole, but not nystatin, reduced the production of phospholipase from C albicans oral isolates in patients with diabetes mellitus. CONCLUSIONS: In addition to being antifungal, fluconazole alters phospholipase production, modifies buccal epithelial cells, and reduces adhesion of C albicans to human buccal epithelial cells for up to 8 weeks posttreatment in diabetic patients with oral candidosis.