Analysis of desquamative gingivitis using direct immunofluorescence in conjunction with histology.

Chronic desquamative gingivitis (DG) is a common condition often first recognized by periodontists. DG is characterized clinically by erythema with epithelial desquamation, ulceration, and/or the presence of vesiculobullous lesions of the free and attached gingiva. However, DG is actually a clinical manifestation of several different disease processes, particularly lichen planus and benign mucous membrane pemphigoid. Correct diagnosis in DG is critical since proper treatment and follow-up will depend on which disease is involved. However, the diseases that cause DG frequently present diagnostic problems because their lesions often resemble each other clinically and routine histological examination sometimes cannot differentiate between them. Thus, immunohistology, particularly immunofluorescence, is increasingly being used with routine histology to more accurately diagnose DG diseases. This article reviews our experience over the past 10 years in the diagnosis of 72 cases of DG using direct immunofluorescent (DIF) in conjunction with histology and clinical evaluation. Of the 72 DG cases in this study, 30 cases were diagnosed as erosive lichen planus or lichenoid mucositis; 29 cases were diagnosed as benign mucous membrane pemphigoid; 2 cases each of linear IgA disease and pemphigus vulgaris were diagnosed; there was 1 case of bullous pemphigoid; and 1 suspected case of paraneoplastic pemphigus. Even with DIF analysis, 7 cases could not be definitively assigned a particular cause. DIF analysis is not only proving very useful for differential diagnosis, but also adds insight into possible pathogenic mechanisms of DG.

Expression of estrogen receptors in desquamative gingivitis.

BACKGROUND: Most cases of chronic desquamative gingivitis (CDG) are shown by direct immunofluorescence (DIF) to be immune mediated diseases. Some patients present with similar clinical and microscopic findings as CDG but DIF staining is negative. It has been suggested that those cases of CDG may be hormone (estrogen) mediated and may be treated with estrogens with favorable results. METHODS: Gingival tissue from 24 cases of CDG and one case of ordinary gingivitis were studied for estrogen receptor (ER) expression using immunohistochemical techniques. Twenty-four of the 25 cases were female. Using standard DIF analysis, 11 of the CDG cases were diagnosed as benign mucous membrane pemphigoid, 10 as lichen planus or lichenoid mucositis (LP), and one as pemphigus. The remaining 3 cases were not diagnostic for a specific disorder (idiopathic). Five of the females had a history of estrogen substitute therapy. RESULTS: Twenty-two of 23 female CDG cases were positive for ER, although the degree of staining varied. A 32-year-old female with ordinary gingivitis, whose gingivitis varied with her menstrual cycle, did not stain for ER. A 50-year-old male and a 76-year-old female, both with gingival LP, also had negative staining for ER. CONCLUSIONS: There appears to be no correlation between diagnosed diseases (immunological versus idiopathic) and expression of ER in CDG gingiva. ER expression in the gingiva is probably not related to the presence or absence of estrogen supplementation. The results of this study do not support the use of estrogen in the treatment of idiopathic CDG.

Central odontogenic fibroma mimicking a lesion of endodontic origin.

The central odontogenic fibroma is a rarely reported lesion that can be associated with vital teeth. Although it is uncommon and unlikely to recur after enucleation, the central odontogenic fibroma should be considered in a differential diagnosis of radiolucencies associated with vital teeth. This case report presents the radiographic and clinical signs of a central odontogenic fibroma occurring in the maxillary anterior region.

Intraoral multifocal adult rhabdomyoma. Report of a case and review of the literature.

Adult rhabdomyomas are uncommon, benign neoplasms of the head and neck region. They are usually solitary, but may rarely be multifocal. We report the clinical and morphologic features of a multifocal adult rhabdomyoma apparently present in the floor of the mouth of an elderly woman for 20 years. At the time of exploratory surgery, the surgeon believed there was diffuse multinodular enlargement of both sublingual glands. The differential diagnosis of a biopsy specimen that was taken for frozen section included salivary gland oncocytosis, a reactive process. On examination of permanent sections, however, the lesion was found to be a multifocal rhabdomyoma. No evidence of salivary gland tissue was found. Ultrastructural study demonstrated the characteristic attempts by this tumor to recapitulate its origin from skeletal muscle by the formation of abnormal contractile elements.

P53 and cyclin D1 staining patterns of malignant and premalignant oral lesions in age-dependent populations.

OBJECTIVE: Recent epidemiologic studies have identified a trend of increasing cancer incidence in younger patients. The purpose of this study was to determine whether this might be reflected by different molecular mechanisms for tumor development. STUDY DESIGN: Dysplastic and malignant oral lesions from age-distinct patient populations were immunohistochemically analyzed for expression of p53 and cyclin D1. Chi-square analysis was used to determine statistical significance. RESULTS: Eighty-two percent of "older" and 75% of "younger" carcinomas stained positively with p53; 63% of carcinomas in the older population and 55% of carcinomas in the younger population showed cyclin D1 positivity. Dysplasias showed similar cyclin D1 staining in both groups. Interestingly, 100% of "younger" dysplasias stained positively for p53, whereas 35.3% of "older" dysplastic lesions showed immunoreactivity. Staining of carcinomas was not statistically significant, whereas p53 staining of dysplasias proved highly significant (P < .025). CONCLUSIONS: p53 immunoreactivity is detectable at an earlier stage of carcinogenesis in younger patients than in the traditional risk population for oral cancer.

Asymptomatic periapical radiolucent lesion found in an area of previous trauma.

The case of an anterior mandibular radiolucent area, which unexpectedly yielded salivary gland tissue, is described. Salivary gland depressions in the posterior mandible are readily recognized because of their almost pathognomonic radiographic appearance. A salivary gland inclusion in the anterior mandible in the proximity of teeth may create a diagnostic dilemma where superimposed periapical pathosis is present. The clinical importance lies in the recognition and appropriate treatment of the lesion. For the anterior salivary gland inclusion, a biopsy and a microscopic examination provide the most reliable diagnosis.

Utilization of an oral pathology service: a professional responsibility.

The role of oral pathologists as members of the comprehensive health care team is reviewed. The importance of utilizing an Oral Pathology Service in the everyday practice of dentistry and medicine and the inherent medicolegal considerations are discussed. Standards of care for submission of surgically removed oral tissues is an issue that warrants further delineation.

Clinico-pathological conference 2002.

INTRODUCTION: Six cases are reported, each presented at the 11th Biennial Congress of the International Association of Oral Pathologists as an instructive case for differential diagnosis on the basis of clinical, imaging or histological features. CLINICAL PICTURE: Case diagnoses included a large, possibly intraosseous, myofibroma presenting with an oral mass; Langerhans cell histiocytosis with facial skin lesions; an intraosseous vascular hamartoma of the maxilla with worrying radiological features; an unusual mixed radiolucency of the jaw caused by cemento-ossifying fibroma; an osteosarcoma of the posterior mandible causing a well-defined radiolucency and an intraoral squamous cell carcinoma in a child.

Intraoral basal cell carcinoma, a rare neoplasm: report of three new cases with literature review.

Intraoral basal cell carcinoma (IOBCC) is an extremely rare entity that bears close microscopic resemblance to and is often confused with the peripheral ameloblastoma (PA). Basal cell carcinomas are thought to arise from pluripotential basal cells present within surface epithelium and adnexal structures, so theoretically they can arise within the oral cavity. Many of the early cases reported as IOBCC actually represent PA. Most of the well documented cases arise from the gingiva. The histologic features of basal cell carcinoma that help separate it from a PA include: tumor arising from surface epithelium, scattered mitotic figures and apoptotic cells, presence of mucoid ground substance and tumor infiltrating widely throughout the connective tissue and often exhibiting a prominent retraction artifact. Clinically IOBCC resemble carcinomas, compared to the benign and innocuous appearance of the PA and typically presents as surface ulcerations varying from rodent ulcer to an ulcerated erythroplakia appearance. This contrasts with the classic "bump on the gum" appearance of PAs with usually intact surface and appearing as small discrete, sessile, exophytic lesions. Importantly, the proliferative basaloid epithelium demonstrates positive immunoreactivity for the anti-epithelial antibody, Ber-EP4, a cell surface glycoprotein. The IOBCC has the potential for local recurrence and aggressive behavior and should be treated with wide surgical excision and close clinical follow up. We present 3 rare cases of IOBCC and discuss the salient histologic, immunohistochemical and clinical features.

Tooth pulp inflammation increases brain-derived neurotrophic factor expression in rodent trigeminal ganglion neurons.

Nociceptive pathways with first-order neurons located in the trigeminal ganglion (TG) provide sensory innervation to the head, and are responsible for a number of common chronic pain conditions, including migraines, temporomandibular disorders and trigeminal neuralgias. Many of those conditions are associated with inflammation. Yet, the mechanisms of chronic inflammatory pain remain poorly understood. Our previous studies show that the neurotrophin brain-derived neurotrophic factor (BDNF) is expressed by adult rat TG neurons, and released from cultured newborn rat TG neurons by electrical stimulation and calcitonin gene-related peptide (CGRP), a well-established mediator of trigeminal inflammatory pain. These data suggest that BDNF plays a role in activity-dependent plasticity at first-order trigeminal synapses, including functional changes that take place in trigeminal nociceptive pathways during chronic inflammation. The present study was designed to determine the effects of peripheral inflammation, using tooth pulp inflammation as a model, on regulation of BDNF expression in TG neurons of juvenile rats and mice. Cavities were prepared in right-side maxillary first and second molars of 4-week-old animals, and left open to oral microflora. BDNF expression in right TG was compared with contralateral TG of the same animal, and with right TG of sham-operated controls, 7 and 28 days after cavity preparation. Our ELISA data indicate that exposing the tooth pulp for 28 days, with confirmed inflammation, leads to a significant upregulation of BDNF in the TG ipsilateral to the affected teeth. Double-immunohistochemistry with antibodies against BDNF combined with one of nociceptor markers, CGRP or transient receptor potential vanilloid type 1 (TRPV1), revealed that BDNF is significantly upregulated in TRPV1-immunoreactive (IR) neurons in both rats and mice, and CGRP-IR neurons in mice, but not rats. Overall, the inflammation-induced upregulation of BDNF is stronger in mice compared to rats. Thus, mouse TG provides a suitable model to study molecular mechanisms of inflammation-dependent regulation of BDNF expression in vivo.

Epithelioid hemangioendothelioma of the head and neck: a clinicopathologic report of twelve cases.

Epithelioid hemangioendothelioma (EH) is a recently described unusual vascular neoplasm of the soft tissues. Apparently identical tumors have also been described in the lung and and liver. Although no previous reports have described these lesions in the head and neck, twelve cases from this region are reported here. There is a wide age distribution throughout adulthood of affected patients. The 4-year-old patient in this series is the youngest thus far reported. There is no sex predilection. The submandibular region is the head and neck site most frequently involved. The unusual histologic appearance of these tumors is demonstrated by the fact that only one case was originally diagnosed as a vascular neoplasm. Nests and cords of pleomorphic epithelioid cells, spindle cells, and vacuolated cells and a hyalinized or myxochondroid stroma are features that distinguish EH. All eight of the tumors tested showed factor VIII-related antigen immunoreactivity. EH has a biologic potential intermediate between that of hemangioma and conventional angiosarcoma.

Cartilage in the walls of odontogenic keratocysts.

Only one histologically documented case of cartilage in the wall of an odontogenic keratocyst has been reported in the English language literature. Four new cases are presented with the clinical, radiographic and histopathologic features described. To our knowledge this finding has not been reported in association with any other type of odontogenic cyst.

Unusual palatal presentation of oral psoriasis.

Oral lesions of psoriasis are rare clinical observations. Report on oral psoriasis that are well documented show no consistent lesion pattern. The oral lesions range in type from red plaques to white plaques to ulcers. In this report, an unusual palatal presentation of oral psoriasis with red serpiginous concentric arcs is described. The diagnosis of intraoral psoriasis is supported by clinical and microscopic findings.

Osteoporosis and mandibular bone resorption in the Sprague Dawley rat.

Mandibular bone resorption in normal and osteoporotic rats was measured using standard scintillation techniques for tritiated tetracycline (H3-TC). Thirty-four Sprague-Dawley rats were labeled with H3-TC at 4-9 weeks of age. Ten animals were then sacrificed for baseline radioactivity levels, while 12 experimental animals were given a high protein, low calcium diet, and 12 control animals were given a normal calcium diet. Osteoporotic and normal diets were instituted for 90 days. The results show a significant reduction in the quantity of bone in the experimental group (P less than .05) as compared to the control group. In addition, serum samples collected were found to contain significantly elevated (P less than .01) alkaline phosphatase level in the experimental group when compared to the control group.

Osteoporosis and mandibular bone resorption: a prosthodontic perspective.

Previous studies have examined the effects of osteoporosis on the vertebra, femur, and tibia. However, few studies have examined the effects on the mandible by using an animal model to quantify bone resorption. Osteoporosis was induced through pair feedings of a high protein, low calcium diet. Before this induction, experimental and control animals were injected subcutaneously with radioactive tritiated tetracycline. Bone resorption was quantified by measuring the amount of radioactivity present after the test diets were given for 90 days. Standard scintillation techniques were used for extracting the radioactivity from each half mandible. The following conclusions can be made from the results of this investigation: A significant difference in mandibular bone resorption was associated with an osteoporotic inducing diet high in protein and low in calcium. Bone resorption in the experimental group of animals was 17% greater than in the control group. Alkaline phosphatase may be an important indicator of osteoporosis in the Sprague-Dawley rat. Elevated levels were found in those with the osteoporotic diet. The animals in the control and experimental groups consumed similar amounts of their respective diets. No significant difference was found in the weight gains of either group. The histologic picture, although not pathognomonic for osteoporosis, was consistent with many findings in the literature describing osteoporosis. This study has shown that osteoporotic diets may increase the amount of bone resorption in the mandibles of Sprague-Dawley rats.

Rehabilitation of grossly deficient mandibles with combined subperiosteal implants and bone grafts.

1. This study has described the osseous reconstruction of deficient edentulous ridges in adult rhesus monkeys. The rebuilt osseous ridges did not resorb under complete prosthetic function over a 4 month period. 2. Remodeling of the graft proceeded along the usually observed patterns with mature cortices forming in the grafted areas within 6 months. 3. This procedure has been duplicated for clinical patients with reasonably good results, restoring function in otherwise untenable prosthetic situations whic had been refractory to other types of prosthetic and surgical treatment. 4. In the future, this method of marrow-bone grafting with a simultaneous subperiosteal implant may restore function in many edentulous patients who have experienced extreme resorption over the mandibular ridge and in whom conventional implant techniques or the usual type of bone grafting procedures has not been successful.

Evaluation of photoelastic stress patterns produced by various designs of bilateral distal-extension removable partial dentures.

The results of this study showed that: 1. The design of a retainer with a mesial rest in conjunction with a buccal I-bar or a wrought-wire and cast lingual arm exhibited the most favorable distribution of vertically applied forces. 2. Retainer designs with a distal rest tend to move the clinical crown distally and the root mesially at the apex, resulting in horizontal forces in the bone. 3. Placing rests of distal-extension removable partial dentures more anteriorly provides an axis of rotation that directs applied forces in a more vertical direction. 4. The distal rest in conjunction with circumferential retainers developed greater horizontal forces within the supporting structures.

Five-year survey of treatment with removable partial dentures. Part I.

A survey involving 137 patients treated with 203 removable partial dentures was conducted in England, the Netherlands, and the United States from samples of 1-year and 5-year posttreatment data. The objectives were to (1) develop a practical clinical and radiologic method to evaluate the results of removable partial denture treatment and (2) establish baseline values and results of removable partial denture treatment for use by all investigators. The results indicated the following: 1. Gingival pocket depth around abutment teeth was reduced at posttreatment examination. 2. There was an increase in posttreatment abutment teeth mobility that was greater in mandibular than maxillary teeth. Mobility increase was less for abutment teeth than for control teeth. 3. There was a slight loss of bone around abutment teeth that was about equal to loss around control teeth. 4. Oral care (plaque index) showed that 62.4% of all tooth surfaces had plaque accumulation at posttreatment examination. 5. Eleven of 616 abutment teeth (1.78%) were extracted.

Photoelastic analysis of stress patterns on teeth and bone with attachment retainers for removable partial dentures.

This investigation was designed to evaluate the forces developed in supporting structures by removable partial dentures with attachment retainers. The attachments tested were the (1) Sterngold type 7, (2) Dalbo MK, and (3) Thompson dowel. The study utilized a photoelastic model with stress areas recorded photographically. The results showed that: 1. Splinted abutments are indicated when using the tested attachment retainers. 2. With single abutments, the attachment retainers induced distal force on the teeth which resulted in unfavorable horizontal bone forces. 3. The Dalbo MK attachments produced the most force on the edentulous regions and the least force on the abutment teeth. 4. The Thompson dowel and Sterngold type 7 attachment retainers induced similar stress patterns on single abutments and both produced distal abutment forces. 5. The Thompson dowel induced more favorable stress patterns when the abutments were splinted.