Unusual peripheral odontogenic tumors in the differential diagnosis of gingival swellings

Differential diagnosis of gingival mass lesions includes several conditions and causes. Peripheral odontogenic tumors may mimic gingival swellings and, although rare, must be included in the differential diagnosis. The purpose of this article is to describe 3 different cases of peripheral odontogenic tumors and to discuss the differential diagnosis of gingival swelling. Histologic examination is mandatory when localized gingival swellings are surgically removed.

Periodontal status by CPITN, and associated variables in an Israeli permanent force military population

AIMS

The objectives were to determine periodontal treatment needs using the CPITN index, of Israeli permanent force military personnel.

METHODS

The study population consisted of 1300 military personnel aged 25-44 years (mean age 33.8 +/- 5.4), who attended obligatory routine medical and dental examinations. Clinical examinations were conducted by 3 calibrated examiners, employing flat dental mirrors, the specially designed WHO periodontal probes (FDI probes) and following CPITN criteria. The frequency distributions were studied with regard to age groups, gender and education, as well as differences in the severity of the disease. Also, the mean number of sextants affected per person by age was assessed.

RESULTS

Only 1.19% of the subjects demonstrated healthy periodontal tissue. Shallow pockets were similarly found among all age groups, and the number of persons with deep pockets increased with age. Deep pockets were found almost 3 x more among males (18.66%) in comparison with females (6.19%). Persons with higher education (> 12 years), had less deep pockets and bleeding than individuals with less than 12 years of education (p<0.05).

CONCLUSIONS

Compared with data from other countries reported by the WHO, this periodontal status indicates a relatively high level of treatment needs. This survey provides a substantial contribution to the national oral health data bank concerning the adult working population in Israel.

Cytokines and growth factors modulate cell growth and insulin-like growth factor binding protein secretion by the human salivary cell line (HSG)

The human salivary cell line (HSG) was investigated for the effect of various growth factors and cytokines on cellular proliferation and on the production of insulin-like growth factor binding proteins (IGFBPs). IGF-I increased cell growth by approximately 25%, and induced the appearances of three distinct protein bands on ligand blot of the cell culture. Two bands with molecular weights of 43 and 45 Kda, respectively, proved to be IGFBP-3 using a specific antibody, and the third was a 24 Kda species (probably, IGFBP-4). Similar IGFBPs were released by the cells following stimulation by EGF and insulin as well as following incubation with the IGF-I receptor antibody alpha IR3. Retinoic acid had an inhibitory effect (50%) on IGF-I-induced cellular proliferation and an attenuative effect on the 24 Kda band when it was combined with IGF-I, and to a lesser effect EGF; however, it enhanced IGFBP-3 production when incubated with IGF-I. The IGF-I receptor antibody had an agonistic effect on IGFBPs production when applied alone or together with IGF-I. TNF-alpha and INF-gamma had minimal effects on cell growth when added alone but when applied in combination, a marked inhibition of cellular proliferation was noted. These cytokines caused increased accumulation of IGFBP-3, -4, and -5. Addition of IGF-I to these cytokines enhanced the expression of these bands. These data demonstrate that growth factors and cytokines which modulate HSG cell growth, induce specific IGFBPs which may play a role in their effects on cell growth.

Tumor necrosis factor alpha and interferon gamma--induced cell growth arrest is mediated via insulin-like growth factor binding protein-3

Retinoic acid (RA), and the combination of TNFalpha and Interferon (IFN-gamma) inhibit human salivary gland tumor (HSG) cell growth with the combination of all three being even more inhibitory (P<0. 05). Previous studies have demonstrated that these inhibitory effects of RA, and the combination of TNFalpha and IFN-gamma are associated with increased accumulation of IGFBP-3 in the culture medium of HSG cells. Therefore, we set out to determine if the increase in IGFBP-3 was due to increased production of IGFBP-3 by the cells and whether IGFBP-3 played a causative role in the inhibition of cellular proliferation. TNFalpha and IFN-gamma induced a rise in IGFBP-3 mRNA levels between 4 and 8 h, which returned to control levels after 24 h. IGFBP-3 was shown to inhibit HSG cell growth at concentrations of >/=75 U (P<0.05). When antibodies to IGFBP-3 were used with TNFalpha and IFN-gamma, the inhibitory effect of the cytokines on cell growth was diminished. Retinoic acid with TNFalpha and IFN-gamma had a marked inhibitory effect (P<0.05) which was similarly reversed by increasing concentrations of IGFBP-3 antibody. The present data support the hypothesis that the combination of TNFalpha and IFN-gamma with retinoic acid exert their anti-proliferative effect on HSG cells by reducing the mitogenic effect of IGF-I due to a shift in IGF-I from the free to the IGFBP-3-bound form.

Human trophoblast responses to Porphyromonas gingivalis infection

Porphyromonas gingivalis is a periodontal pathogen that is also associated with preterm low-birthweight delivery. We investigated the transcriptional responses of human extravillous trophoblasts (HTR-8) to infection with P. gingivalis. Over 2000 genes were differentially regulated in HTR-8 cells by P. gingivalis. In ontology analyses of regulated genes, overpopulated biological pathways included mitogen-activated protein (MAP) kinase signaling and cytokine production. Immunoblots confirmed overexpression of the MAP kinase pathway components MEK3, p38 and Max. Furthermore, P. gingivalis infection induced phosphorylation and activation of MEK3 and p38. Increased production of interleukin (IL)-1beta and IL-8 by HTR-8 cells was demonstrated phenotypically by enzyme-linked immunosorbent assay of HTR-8 cell lysates and culture supernatants. Hence, infection of trophoblasts by P. gingivalis can impact signal transduction pathways and modulate cytokine expression, outcomes that could disrupt the maintenance of pregnancy.

The impact of HPV vaccination on the prevalence of oropharyngeal cancer (OPC) in a hospital-based population: A cross-sectional study of patient's registry

BACKGROUND

Human papillomavirus (HPV) vaccines have been used for the prevention of cervical cancers, and their clinical efficacy has not been well established in the prevention of oropharyngeal cancer (OPC), in spite of the common viral etiology. Therefore, they are still not routinely prescribed for the prevention of this cancer.

METHODS

We have used the i2b2 data repository to analyze the interrelations between the hospital population, OPC, vaccinated patients, and patients that were both vaccinated and developed OPC.

RESULTS

From a total hospital population of 1 310 334 patients, 23 174 (1.76%) patients were vaccinated for HPV. One third were males, and two thirds were females. The total number of OPC was 4380 (0.3%) from the total population, of which 3013 (69%) were men. The highest prevalence of OPC was found in the age-group of 65-74 (37% of all cases). Four patients (0.017%) of the vaccinated group had developed OPC. Patients who were not vaccinated for HPV had a 19 times increased risk of developing OPC compared with those who were vaccinated (RR 19.3657, 95% CI 7.2655 to 51.6177, P = .0001). The risk was increased in both sexes. The RR in the male group was 23.8 (P = .0015, 95% CI) and in the female group 9.34 (P = .0001, 95% CI 3.0110 to 29.0121). The age distribution in the OPC group was significantly different from the age distribution in the HPV-vaccinated group (P = .0418) by Mann-Whitney test. 4376 non-vaccinated patients have developed OPC.

CONCLUSIONS

The present study showed that HPV-vaccinated group had a reduced prevalence of OPC compared with the non-vaccinated group.

Regulation of insulin-like growth factor-I receptor gene expression by tumor necrosis factor-alpha and interferon-gamma

The insulin-like growth factor-I receptor (IGF-l-R) plays a critical role in normal and pathological growth processes. The expression of the IGF-l-R gene is regulated by various stimuli, including hormones and growth factors. We have investigated the molecular mechanisms by which two inhibitory cytokines, tumor necrosis factor-alpha (TNF-alpha) and interferon-gamma (IFN-gamma), regulate IGF-l-R gene expression. TNF-alpha and IFN-gamma reduced the proliferation rates of the osteogenic sarcoma cell line, Saos-2, and the human salivary gland cell line, HSG, in a dose- and time-dependent fashion. This effect was associated with significant reductions in the levels of IGF-l-R mRNA and protein, and with inhibition of IGF-l-R promoter activity, suggesting that TNF-alpha and IFN-gamma affect IGF-l-R gene expression at the transcriptional level. In addition, TNF-alpha significantly decreased IGF-l-R mRNA stability. Combined cytokine treatment inhibited cellular proliferation and promoter activity in an additive manner. Taken together, these results suggest that a novel potential mechanism by which TNF-alpha and IFN-gamma affect cellular proliferation involves suppression of IGF-l-R promoter activity, as well as destabilization of IGF-l-R transcripts.

Increased odds ratio for COVID-19 in patients with recurrent aphthous stomatitis

The ACE2 receptor, the binding sites for the COVID-19, is expressed abundantly in the oral cavity, raising the question of whether the mouth is a target for the virus in addition to organs such as kidneys and lungs. Recently, a flurry of individual case reports on oral manifestation of COVID-19 including ulceration, blistering lesions, and stomatitis were published. However, it is not clear whether the oral presentations that are not unique to the virus are indeed related to the virus and appear at a higher prevalence than in the general population. We used the i2b2 platform of hospital patient's registry to determine the odds ratio for COVID-19 in patients that were diagnosed with recurrent aphthous stomatitis, an entity restricted to the oral cavity. The overall odds ratio for COVID-19 in patients with recurrent aphthous stomatitis before adjustments was 14 and after adjustment for gender, race, and age was 13.9, 6.5, and 2.93, respectively. The odds ratio remained increased after adjustments of the comorbidities such as respiratory disease, endocrine disease, obesity, diabetes, circulatory disease, and smoking and was 3.66, 7.46, 4.6, 10.54, 7.37, and 7.52, respectively. When adjusted for recurrent aphthous stomatitis, the respiratory disease had an odd ratio of 8.56 to be associated with COVID-19. African American race and age-group 18-34 were additional significant risk factors. The present study has demonstrated a significant association between COVID-19 and RAS; however, additional longitudinal and laboratory studies are necessary to establish a cause and effect relationship between these 2 conditions.

Trismus in a 6 year old child: a manifestation of leukemia?

Trismus is a firm closing of the jaw due to tonic spasm of the muscles of mastication from disease or the motor branch of the trigeminal nerve. Trismus may be produced by a variety of reasons such as dental abscess, trauma, following mandibular block with local anesthesia, as a result of radiation to the facial muscles, and patients after chemotherapy. A case of a referral of a six-year-old boy to a dentist from an ENT due to severe limitation in jaw opening is presented. Intraoral examination and panoramic radiograph demonstrated no signs of infection and/or other pathology. After a diagnosis of trismus was made, due to his icteric appearance, the general fatigue and loss of appetite in the last few days, palpated and sensitive lymph nodes in the submandibular and cervical regions, the child was referred for a complete blood count and sedimentation rate. The laboratory and clinical findings resulted in the diagnosis of acute lymphoblastic leukemia (ALL). Dental and oral manifestations of ALL are discussed, and the trismus may be explained by an intensive infiltration of leukemic cells into the deep portion of the contracting muscles of the face. This case emphasizes the importance of physical examination and independent judgement made by dentists, even when patients are referred to them by other members of the medical communities.

Relationship of blood glucose level to community periodontal index of treatment needs and body mass index in a permanent Israeli military population

BACKGROUND

The goal of this study was to find a possible link between blood glucose levels and periodontal disease.

METHODS

In a prospective study the dental health of 10,590 military service men and women was examined. The relationships of periodontal condition, expressed as CPITN index, and blood glucose levels were tested. The effect of gender, body mass index (BMI), and smoking was also evaluated.

RESULTS

Blood glucose levels were significantly and positively associated with severe periodontal disease, men, and higher BMI. Smoking did not affect blood glucose levels.

CONCLUSIONS

Blood glucose levels might be associated with severe periodontal disease.

Macroglossia combined with lymphangioma: a case report

A four year old white female with a clinical presentation of macroglossia is described. Speech disturbances and occasional episodes of traumatic injury to the tongue with severe bleeding brought the patient to seek dental care. Lymphangioma was diagnosed after incisional biopsy. The differential diagnosis of tongue enlargement in children is discussed including review of the literature relevant to the diagnosis and treatment of lymphangioma.

RAGE expression and NF-kappaB activation attenuated by extracellular domain of RAGE in human salivary gland cell line

The receptor for advanced-glycation-end-products (RAGE) has been implicated as a pro-inflammatory factor in chronic inflammatory conditions such as diabetes mellitus and rheumatoid arthritis. The aim of this study was to investigate the inhibitory effect of the soluble-RAGE (sRAGE), the extracellular domain of RAGE, on RAGE expression and NF-kappaB translocation in human-salivary gland-cell-lines (HSG). Cells were stimulated with agonist S100A4, fusion protein of RAGE encompassing the extracellular domain of RAGE (ex-RAGE), ex-RAGE followed by S100A4, or S100A4 followed by ex-RAGE. Our study indicates that RAGE expression was highest at 150 microg/microl of S100A4 and efficiently down-regulated by 1.8-fold (P < 0.05) when ex-RAGE was incubated prior to agonist S100A4. RAGE protein was also consistently down-regulated by 20-40% with pre-incubation of ex-RAGE. More importantly, nuclear translocation of p65 and p52 of NF-kappaB by S100A4 was inhibited in the presence of ex-RAGE, confirming anti-inflammatory function of ex-RAGE. In conclusion, ex-RAGE down-regulates RAGE expression and inhibits p65 and p52 activation in HSG, providing evidence that ex-RAGE functions as a "decoy" to RAGE-ligand interaction and thus potentially dampening inflammatory conditions.

SIRT1 Gene SNP rs932658 Is Associated With Medication-Related Osteonecrosis of the Jaw

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious adverse drug reaction. Our previous whole-exome sequencing study found SIRT1 intronic region single-nucleotide polymorphism (SNP) rs7896005 to be associated with MRONJ in cancer patients treated with intravenous (iv) bisphosphonates (BPs). This study aimed to identify causal variants for this association. In silico analyses identified three SNPs (rs3758391, rs932658, and rs2394443) in the SIRT1 promoter region that are in high linkage disequilibrium (r2  > 0.8) with rs7896005. To validate the association between these SNPs and MRONJ, we genotyped these three SNPs on the germline DNA from 104 cancer patients of European ancestry treated with iv BPs (46 cases and 58 controls). Multivariable logistic regression analysis showed the minor alleles of these three SNPs were associated with lower odds for MRONJ. The odds ratios (95% confidence interval) and p values were 0.351 (0.164-0.751; p = 0.007) for rs3758391, 0.351 (0.164-0.751; p = 0.007) for rs932658, and 0.331 (0.157-0.697; p = 0.0036) for rs2394443, respectively. In the reporter gene assays, constructs containing rs932658 with variant allele A had higher luciferase activity than the reference allele, whereas constructs containing SNP rs3758391 and/or rs2394443 did not significantly affect activity. These results indicate that the promoter SNP rs932658 regulates the expression of SIRT1 and presumably lowers the risk of MRONJ by increasing SIRT1 expression. © 2020 American Society for Bone and Mineral Research (ASBMR).

Apical closure of mature molar roots with the use of calcium hydroxide

Calcium hydroxide may induce apical root closure in affected mature teeth as well as in immature teeth. Once an apical hard tissue barrier is formed, a permanent root canal filling can be safely condensed. Two cases are described in which calcium hydroxide induced apical root closure in mature molar teeth where the apical constriction was lost because of chronic inflammatory process.

Oral squamous cell carcinoma positive for p16/human papilloma virus in post allogeneic stem cell transplantation: 2 cases and review of the literature

Complications of allogeneic hematopoietic stem cell transplantation (allo-HSCT) includes the risk of secondary malignancies. This may be related to mechanisms including radiation and chemotherapy regimens, chronic graft-versus-host disease, inflammation, and prolonged imunosuppression. Oral squamous cell carcinoma (OSCC) is a complication associated with chronic graft-versus-host disease after allo-HSCT. Although human papillomavirus (HPV) is known to be associated with OSCC, the role of HPV in development of OSCC in post-HSCT patients has not been studied. We identified 2 cases of OSCC in allo-HSCT recipients. Both biopsy specimens tested positive for p16(INK4A), a surrogate marker for HPV. We propose that the association of OSCC and HPV in patients after allo-HSCT may not be incidental. Clinical implications of these cases may imply the need for a HPV screening, early intervention, and consideration of anti-HPV vaccination in this population. The effectiveness of such interventions could be validated in a prospective clinical study.

Cytokines modulate interleukin-6 production by human salivary gland cell line

The ability of HrTNF-alpha, HrIL-1 beta, and HrIFN-gamma to modulate IL-6 production by cultured human salivary cell line (HSG) was examined. IL-6 activity was measured by the hybridoma growth factor biologic activity. HrTNF-alpha had a significant dose-dependent effect, whereas HrIL-1 beta and HrIFN-gamma had moderate and minor effects, respectively. Maximal effect (920 units) was noted when cytokines were applied in combination (1000 units HrIFN-gamma and 20 units HrTNF-alpha) and incubated with human salivary gland cells for 72 hr. The same combination of cytokines had also a marked inhibitory effect (70% of control) on human salivary gland cell growth. This is the first report of these concomitant phenomena in a human cell line originating from salivary tissue.

IGF-1 and insulin receptor expression in the minor salivary gland tissues of Sjögren's syndrome and mucoceles--immunohistochemical study

OBJECTIVE

To investigate the expression of IGF-1 receptors and insulin receptors on the minor salivary gland (MSG) tissues of patients diagnosed with Sjögren's syndrome (SS) and normal salivary gland tissue surrounding mucoceles.

SUBJECTS AND METHODS

Five MSG tissue sections from SS and seven from mucocele patients were stained immunohistochemically using antibody to IGF-1 receptor and insulin receptor in a horse radish peroxidase and DAB system.

RESULTS

The expression of the insulin receptor was increased in the SS sections compared with controls, while the insulin-like growth factor-1 receptor was more intensely expressed in the controls.

CONCLUSION

The presence of differential expression of receptors for IGF and insulin might suggest a possible role of these growth factors in the pathogenesis of SS.

Lichenoid lesions of oral mucosa associated with ketoconazole

Summary: In eight consecutive patients successfully treated with ketoconazole for oral candidiasis and onychomycosis, a lichenoid dysplasia of the oral mucosa and skin occurred during the course of therapy. Some of the histological features mimicked lichen planus, whilst the immunof‐luorescent tests were negative for IgG, IgA, IgM, C3 and fibrinogen. The dermatosis persisted for more than three months after withdrawal of the drug. Various possibilities for the pathogenesis of the reactive disorder are discussed.

Zusammenfassung: Bei 8 hintereinander beobachteten Patienten, die erfolgreich mit Ketoconazol wegen oraler Candidose und Onychomykose behandelt worden waren, entwickelte sich unter der Therapie eine lichenoide Dysplasie der Mundschleimhaut und der Haul Einige histologische Charakteristika ähnelten einem Lichen ruber planus. Die Immunfluoreszenznntersuchungen ergaben keinen Nachweis von IgG, IgA, IgM, C3 oder Fibrinogen. Die Dennatose persistierte länger als 3 Monate nach Absetzen des Medikamentes. Verschiedene Möglichkeiten der Pathogenese dieser reaktiven Störung werden diskutiert.

Recurrent oral ulcerations associated with recurrent herpes labialis--two distinct entities?

We investigated the prevalence of recurrent aphthous ulcerations (RAU) and recurrent herpes labialis (RHL) in a young adult population. The study group consisted of 20,689 soldiers (aged 18-21 years, mean 19.8 +/- 1 years). There were 14,991 men and 5,698 women. Every patient was asked to complete a self-report health questionnaire which requested information about the occurrence of either RAU or RHL. Data were analyzed using the chi-square test, and the odds ratio was also determined. The prevalence of RAU and RHL was 6.2% and 5.4%, respectively. The prevalence among women was significantly higher (P<0.001), than among men for both RAU (7.1% and 5.8%, respectively) and RHL (6.8% and 4.9%, respectively). Among women, the chance of having RAU for those who were RHL positive was 6.88 greater than for those RHL negative. Among men, the chance of having RAU for those who were RHL positive was 12.37 greater than for those RHL negative. In women, the chance of having RHL for those who were RAU positive was 6.88 greater than for those who were RAU negative. In men, the chance of having RHL for those who were RAU positive was 12.37 greater than for those who were RAU negative. It is concluded that a similar underlying pathological process or unknown cofactor may be involved in both RAU and RHL.

Use of the carbon dioxide laser to locate small sialoliths

Six cases of small salivary duct sialoliths were treated using the carbon dioxide laser as a surgical dissector. When the laser beam encountered the small sialolith (3 mm or less), a light-scattering effect (flash or burst) was observed, thus enabling an almost immediate localization of the stone in the salivary duct or in the surrounding tissue. Stone extirpation is more rapid, with less surgical trauma, using this technique.

Gingival and other oral manifestations in measles virus infection

BACKGROUND

Measles is a highly contagious, viral infectious disease affecting mainly children and young adults. It is characterized by high fever, maculopapular rash, keratoconjunctivitis and pathognomonic oral Koplik's spots.

METHODS

During an outbreak of measles among soldiers in the Israeli military, patients were referred to one medical center where they were also examined for oral signs and symptoms of their illness.

RESULTS

We present a case of measles infection with distinct oral findings. These included Koplik's spots, various forms of ulcerations of the free mucosa, -like gingivitis and pericoronitis. All oral lesions resolved after cessation of systemic illness.

CONCLUSIONS

The measles virus is associated with a transient inhibition of the host response. Immunosuppression may create the necessary condition for the proliferation of pathobacteria associated with the observed pericoronitis and the other gingival lesions.

Cyclosporin-induced gingival overgrowth in a child treated with CO2 laser surgery: a case report

A case of a 10 year-old boy with gingival overgrowth due to cyclosporin therapy after heart transplantation is described. Different treatment approaches are discussed and the surgical effect of CO2 laser is illustrated. The critical role of routine professional cleaning and good oral health maintenance for the healthy status of the gingival tissue is also emphasized in this paper. Replacement of cyclosporin by tacrolimus, another immunosuppressive agent associated with minimal to none gingival overgrowth, might be considered in cases with reported recurrences.