A case of odontogenic keratocyst in the buccal space: characterization by multimodality imaging including computed tomography, diffusion-weighted magnetic resonance imaging, and ultrasonography.

Odontogenic keratocyst (OKC) is a relatively common non-inflammatory jaw lesion. OKC is known to occur most often in the mandibular angle and mandibular ramus, but rarely outside the bone. In this report, we describe characteristic multimodality imaging of OKC in the buccal space, especially diffusion-weighted MR imaging (DWI) with apparent diffusion coefficient (ADC) mapping, extra-oral and intra-oral ultrasonography. On clinical examination, an approximately 20 mm in diameter mass with elastic hardness was found the left side of the buccal area. Contrast-enhanced CT showed areas of internal non-contrast lesions in the left buccal space. On T1-weighted image, the mass showed multilocular high signal intensity, and homogeneous internal. T2-weighted images revealed high signal at the marginal part and slightly median signal in the internal part. STIR images revealed a heterogeneous high signal in the interior. Furthermore, DWI and ADC map showed high signal and moderate-to-low signal intensity, respectively. ADC value of the lesion was 1.55 × 10-3 mm2 s-1. On extra-oral ultrasonography, the tumor showed clear boundary, hypoechoic, homogeneous internal architecture and vascular signals, and heterogeneous hard of the lesion. On intra-oral ultrasonography also showed clear boundary, hypoechoic, homogeneous internal architecture, heterogeneous hard of the tumor, and back echo enhance. The histopathologic diagnosis based on a full excisional specimen was odontogenic keratocyst. This case suggests that multimodality imaging, especially MR imaging with ADC and DWI, and extra and intra-oral ultrasonography with color Doppler imaging and elastography, could be effective for evaluating buccal lesions.

Study of clinical factors, focus score, lymphocyte type and NF-κB pathway in Sjögren's syndrome.

Sjögren's syndrome (SS) is an autoimmune disease that occurs predominantly in middle-aged and older women. Although focus score (FS) and lesion grade are determined at pathological diagnosis, few reports have examined whether these results reflect clinical symptoms. In this study, we examined and compared the results of comprehensive immunohistochemical staining of lymphocytes and NF-κB pathway in labial gland biopsies, clinical test data, and radionuclide imaging findings. One hundred labial gland biopsy specimens obtained from 20 female patients with primary SS (5 specimens per patient) were studied. Hematoxylin-eosin-stained specimens were reviewed and FS were calculated. Immunohistochemical staining of CD4, CD8, CD20, CD25, Foxp3, NF-κB, TNFAIP3 and IκBα was performed, and the results were compared with anti-SS-A/Ro (SS-A), anti-SS-B/La (SS-B) and antinuclear antibodies (ANA), and salivary gland scintigraphy findings. FS were significantly higher in the SS-A-, SS-B- and ANA-positive groups than in the respective -negative groups (p < 0.05). Of eight SS-A-positive and SS-B-negative cases, mean FS was 1.9 (seven cases: FS ≥ 1.0) and six cases were ANA-positive. In four SS-A-positive and SS-B-positive cases, mean FS was 3.2 (all cases: FS ≥ 1.0) and all cases were ANA-positive. In immunohistochemical staining, CD4-positive T cells tended to be more abundant than CD8-positive T cells. Small numbers of Foxp3-positive cells were found in all cases. NF-κB, TNFAIP3 and IκBα were positive in the acini, ductal epithelium, and lymphocytes in all cases. The above findings indicated a relationship between FS and clinical test data, and the association of NF-κB pathway with the pathophysiology of primary SS.

Pathogenesis of taste impairment and salivary dysfunction in COVID-19 patients.

Coronavirus disease 2019 (COVID-19) is a highly transmissible pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The characteristics of the disease include a broad range of symptoms from mild to serious to death, with mild pneumonia to acute respiratory distress syndrome and complications in extrapulmonary organs. Taste impairment and salivary dysfunction are common early symptoms in COVID-19 patients. The mouth is a significant entry route for SARS-COV-2, similar to the nose and eyes. The cells of the oral epithelium, taste buds, and minor and major salivary glands express cell entry factors for SARS-COV-2, such as ACE2, TMPRSS2, and Furin. We describe the occurrence of taste impairment and salivary dysfunction in COVID-19 patients and show immunohistochemical findings regarding the cell entry factors in the oral tissue. We review and describe the pathogeneses of taste impairment and salivary dysfunction. Treatment for the oral disease is also described. Recently, it was reported that some people experience persistent and prolonged taste impairment and salivary dysfunction, described as post-COVID-19 syndrome or long COVID-19, after the acute illness of the infection has healed. To resolve these problems, it is important to understand the pathogenesis of oral complications. Recently, important advances have been reported in the understanding of gustatory impairment and salivary dysfunction. Although some progress has been made, considerable effort is still required for in-depth elucidation of the pathogenesis.

Effectiveness of oral moisturizing gel and flavor on oral moisture and saliva volume: A clinical study.

STATEMENT OF PROBLEM: Oral dryness leads to problems in the oral cavity and pharynx and problems with dental prostheses. Although some moisturizing agents relieve the symptoms of oral dryness, the influence of the flavor of the moisturizing agent on the symptoms of oral dryness has not been clarified. PURPOSE: The purpose of this clinical study was to examine the effectiveness of moisturizing gels with different flavors. MATERIAL AND METHODS: Participants in this study consisted of 36 healthy adults and 20 individuals with oral dryness. They were randomly divided into 6 groups, and moisturizing gels with 5 different flavors (tasteless and odorless, sweet taste, acid taste with citric acid, acid taste with Japanese apricot extract, and Japanese apricot scent) were tested in 5 of the groups with 1 group acting as the control (no gel administered). Oral moisture and saliva volume were measured before applying the moisturizing gel, just after applying the moisturizing gel, and 10, 20, and 30 minutes after applying the moisturizing gel. Differences in oral moisture and saliva volume according to the gel flavor and duration of contact were analyzed by using 2-way analysis of variance (α=.05). RESULTS: Oral moisture did not differ among the gel flavors and the duration of contact. Saliva volume in the control (no gel administered) reported no statistically significant differences among any of the contact durations in both healthy adults and participants with oral dryness. The saliva volume in healthy adults increased after using the sweet taste (P=.012), acid taste with Japanese apricot extract (P=.006), and Japanese apricot scent (P=.005) moisturizing gels. The saliva volume in participants with oral dryness increased rapidly just after using the acid taste with Japanese apricot extract gel (P=.008) and increased slowly after applying the tasteless and odorless (P=.046), sweet taste (P=.048), and acid taste with citric acid moisturizing gels (P=.010). CONCLUSIONS: The effectiveness of moisturizing gel for increasing saliva secretion differed according to the flavor of the moisturizing gel. This suggests that the moisturizing gel's effect on increasing saliva secretion is related to the flavor of the gel in addition to the moisturizing agent.

Protein Ingredient in Saliva on Oral Dryness Patients Caused by Calcium Blocker.

Oral dryness as a side effect of certain drugs is increasing. The aim of this study was to examine the change of the protein ingredient in saliva of oral dryness patients caused by calcium blocker. Six patients taking calcium blocker and six healthy elderly were enrolled. Unstimulated salivary flow rate, protein concentration, and flow rate of protein were measured and compared between the patients taking calcium blocker and healthy elderly. iTRAQ (Isobaric Tag for Relative and Absolute Quantitation) proteomic analysis was performed to extract the salivary protein changed in patient taking calcium blocker, and the intensities of Western blotting products were quantified (unpaired t-test). Unstimulated salivary flow rate was significantly lower on patients taking calcium blocker (p < 0.01). Protein concentration tended to be higher and the flow rate of protein tended to be lower on patients. As the result of iTRAQ proteomic analysis, calmodulin-like protein 3, glutathione S-transferase P, and keratin type I cytoskeletal 13 increased characteristically in patient taking calcium blocker, and the expression in calmodulin-like protein 3 was significantly larger (p < 0.01). The results of this study indicated that calmodulin-like protein 3 increased in patients taking calcium blocker and could be a salivary biomarker for oral dryness caused by calcium blocker.

Measurement of Oral Moisture on Oral Dryness Patients.

Many elderly patients have oral dryness; thus, it is necessary to evaluate the oral moisture in a clinical setting. The aim of this study was to clarify the importance of controlling the measuring pressure of the oral moisture-checking device. The influence of the measuring pressure of the oral moisture-checking device was examined using agar under 10 measuring pressure conditions (Kruskal-Wallis test). Fifty-five oral dryness patients were examined the lingual moisture using the device with and without a tongue depressor. The tongue depressor was placed underneath the tongue to support it during the measurement. The mean value and the coefficient of variation of five measurements was evaluated (paired t-test or Wilcoxon signed-ranks test). The agar moisture values changed according to the measuring pressure (p < 0.05). The lingual moisture value with the tongue depressor was higher than that without the tongue depressor (p < 0.05). The coefficient of variation with the tongue depressor was smaller than that without the tongue depressor (p < 0.01). The results of this study indicated that the measuring pressure of oral moisture-checking device influenced the measurement value, and it is necessary to support the tongue for the measurement of lingual mucosal moisture in a uniform manner.

Single-photon emission computed tomography/computed tomography for evaluation of salivary gland dysfunction: preliminary study on diagnostic ability of maximum standardized uptake value.

OBJECTIVES: The aim of this study was to investigate of salivary gland dysfunction with single-photon emission computed tomography/computed tomography (SPECT/CT), especially the relationship between maximum standardized uptake value (SUVmax) of salivary glands and their dysfunction. METHODS: Five patients (2 submandibular sialolithiasis, 2 Sjögren's syndrome, and 1 parotitis) who underwent SPECT/CT were included in this study. The salivary gland excretion function was defined as A (pre-stimulatory 20 min after injection of Tc-99m pertechnetate)/B (post-stimulatory 40 min after injection of Tc-99m pertechnetate) using SUVmax of parotid and submandibular glands. RESULTS: SUVmax before stimulation of the submandibular gland with sialoliths in a patient was lower than that in the opposite submandibular gland without sialoliths (5.81 vs 51.37). Furthermore, the A/B using SUVmax in the other patient of submandibular glands with sialoliths was lower than that in the opposite submandibular glands without sialoliths (0.70 vs 1.85). The A/B using SUVmax of right and left parotid gland in a patient with Sjögren's syndrome was 1.06 and 0.74, respectively. Furthermore, the A/B using SUVmax of right and left parotid glands in the other patient with Sjögren's syndrome was 3.20 and 4.32, respectively. The A/B using SUVmax of right and left parotid glands in a patient with left parotitis was 2.26 and 1.58, respectively. CONCLUSION: The results of the present study indicate that SUVmax using SPECT/CT seems a useful tool for evaluation of the salivary gland dysfunction.

Levels of the antimicrobial proteins lactoferrin and chromogranin in the saliva of individuals with oral dryness.

STATEMENT OF PROBLEM: Many individuals in an aging society experience oral dryness. Maintaining the flow of saliva and the presence of antimicrobial substances is important to maintain oral health. The inhibition of the secretion of antimicrobial substances could lead to oral dryness. PURPOSE: The purpose of this study was to evaluate the antimicrobial substances lactoferrin and chromogranin A in the saliva of elderly individuals with oral dryness. MATERIAL AND METHODS: The study included 25 controls and 28 participants with subjective oral dryness. The levels of lactoferrin and chromogranin A were determined in unstimulated whole saliva with an enzyme-linked immunosorbent assay method. The differences in secretion of lactoferrin and chromogranin A between the controls and the participants with oral dryness were analyzed with the Mann-Whitney U test (α=.05). RESULTS: The flow rate of lactoferrin and chromogranin A was lower in the group of participants with oral dryness (lactoferrin, 7.43 ±7.08 ng/min; chromogranin A, 0.24 ±0.24 ng/min) than in the control group (lactoferrin, 21.52 ±7.67 ng/min; chromogranin A, 0.97 ±0.69 ng/min) (P<.01). The ratio of both antimicrobial proteins to total protein was also lower in participants with oral dryness than in the controls. CONCLUSIONS: The results of this study indicated that the levels of lactoferrin and chromogranin A were lower in those with oral dryness. A reduction in the secretion of these antimicrobial substances may be associated with oral dryness.

Clinical significance and diagnostic usefulness of anti-centromere antibody in Sjögren's syndrome.

Anti-SS-A/Ro antibody (SS-A) and anti-SS-B/La antibody (SS-B) are important serologic markers in the diagnostic criteria for Primary Sjögren's syndrome (SS). Although anti-centromere antibody (ACA)-positive SS is frequently experienced, ACA is not included in these criteria. The purpose of this study was to identify the clinical features of ACA-positive SS and discuss the usefulness of ACA in diagnosing SS. Forty-five patients with SS were divided into the following three groups: SS-A only-positive group (n = 17), SS-A and SS-B both-positive group (n = 18), and ACA only-positive group (n = 10). As a control, 54 patients without SS who were negative for antinuclear antibodies were also evaluated. The following items were compared among groups: Saxon's test, unstimulated whole salivary flow (UWSF), salivary gland scintigraphy (SGS), histopathologic examination of the minor salivary glands, Schirmer's test, and fluorescein staining of the cornea. In the ACA only-positive group, Saxon's test was 0.21 ± 0.26 g/2 min (mean ± SD) and UWSF was 0.16 ± 0.25 ml/10 min (mean ± SD), showing a significant decrease in salivary secretion (p < 0.05; vs. non-SS). On SGS, accumulation and disappearance of (99m)TcO (4) (-) were significantly decreased (p < 0.05; vs. non-SS). Histopathologic examination showed moderate or severe lymphocytic infiltration and tissue destruction in all cases, similar to that in the SS-A- and/or SS-B-positive groups. Schirmer's test and fluorescein staining were positive in 60% and 80%, respectively. Impaired lacrimal secretion and keratoconjunctivitis sicca were similar to those in SS-A- and/or SS-B-positive groups. These results suggest that ACA is an autoantibody reflecting impairment in the salivary and lacrimal glands and may be a useful serologic marker for SS.

Influence of swallowing saliva repeatedly on oral moisture.

PURPOSE: The aim of this study was to examine the influence of repetitive saliva-swallowing for the level of oral moisture using an oral-moisture checking device. METHODS: Subjects were 24 healthy adults (HA) and 20 patients with oral dryness, 10 of whom had Sjögren syndrome or who had undergone radiation therapy (ODSR) and 10 who had not experienced ODSR (ODNSR). Oral moisture was measured before swallowing saliva (B), and after swallowing saliva once (F), twice (S), and three times (T). Oral moisture was measured at the lingual mucosa using an oral-moisture checking device. Statistical analysis was performed using the Friedman test. RESULTS: Oral moisture of the lingual mucosa of the HA differed significantly between B and T, and F and T, and the oral moisture level tended to be higher the more times saliva was swallowed. However, oral moisture of lingual mucosa in the ODSR was not different at the different times of measurement, but the level of oral moisture tended to be lower the more times saliva was swallowed. Oral moisture of the lingual mucosa in the ODNSR differed significantly between B and T. The trends for the changes of the oral moisture level in the ODNSR were similar to those in the HA. CONCLUSIONS: The results of this study show that swallowing saliva repeatedly could lead the increase of oral moisture in HA and ODNSR not in ODSR.

Relationship between medicine and stimulated saliva and oral moisture.

PURPOSE: The aim of this study was to investigate the relationship between medicine and stimulated saliva and oral moisture. METHODS: Fourteen patients with subjective oral dryness and 13 healthy adults were enrolled in this study. Disease, medicine, and medicines that had a side effect of oral dryness were investigated. The Saxon test was performed by chewing a piece of gauze sponge for 2 min. Oral moisture was measured at the lingual and buccal mucosa using an oral moisture checking device. Statistical analysis was performed by the Mann-Whitney U-test and Student t-test. RESULTS: Stimulated saliva and oral moisture did not differ according to the number of diseases. Oral moisture at lingual mucosa was different between a minor medicine group (0-2 types of medicine) (31.3 +/- 1.9%) and a major medicine group (>or=3 types of medicine) (29.5 +/- 2.2%) (p = 0.05). Oral moisture differed between a group not taking any medicine that had a side effect of oral dryness (31.2 +/- 1.8% at lingual mucosa and 33.8 +/- 1.4% at buccal mucosa) and a group taking such medicine (29.3 +/- 2.3% at lingual mucosa and 32.4 +/- 1.8% at buccal mucosa) (p < 0.05). CONCLUSION: The results of this study showed that oral moisture tended to decrease in the subjects who took many types of medicine or who took medicine that had a side effect of oral dryness. The medicine did not influence the amount of stimulated saliva. Therefore, it was suggested that medicine could influence the moisture of the oral mucosa.