Oral shedding of herpes simplex virus type 1: a review

Herpes simplex virus type 1 (HSV-1) and, to a lesser extent, type 2 (HSV-2) are the aetiological agents of recrudescent herpes labialis (RHL). The available literature on patterns of HSV-1 shedding into the oral cavity at the prodromal stage of disease, during recrudescences and also during asymptomatic periods, is reviewed, as are the potential sources of virus and the known trigger factors leading to viral reactivation. Attention is given to the methodologies in use for the detection of HSV-1 and the relevance to the risk of cross-infection in surgery. This review also discusses the increase in incidence of HSV-1 genital infections and the significance of salivary inhibitors of the herpes simplex type 1 virus.

Detection of herpes simplex virus type 1 shedding in the oral cavity by polymerase chain reaction and enzyme-linked immunosorbent assay at the prodromal stage of recrudescent herpes labialis

Recrudescent herpes labialis (RHL) is a disease caused by herpes simplex virus (HSV), predominantly type 1 (HSV-1). We have monitored HSV-1 shedding in the oral cavity by polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays (ELISA) using digoxigenin-labeled primers designed to amplify a 278 bp segment of the HSV-1 UL 42 region. Prodromal RHL was confirmed by thermographic imaging in 22 patients. Infectious virus was not detected using tissue culture for virus isolation (0/22). Using PCR and agarose gel electrophoresis, we could detect HSV-1 DNA in 8/22 patients. Using a biotinylated-probe internal to the predicted sequence of the PCR product, HSV-1 DNA was detected in 10/22 patients by ELISA. We conclude that HSV-1 DNA is shed into the oral cavity of patients presenting with sub-clinical RHL and that the PCR-ELISA technique represents a more sensitive method to monitor HSV-1 shedding than conventional tissue culturing or PCR-electrophoresis alone.

The in vitro adhesion of Candida albicans to buccal epithelial cells (BEC) from diabetic and non-diabetic individuals after in vivo and in vitro application of nystatin

Buccal epithelial cells (BEC) from 12 patients with diabetes mellitus and 12 age- and sex-matched non-diabetic subjects were tested in vitro for adhesion of Candida albicans following exposure to nystatin both in vitro and in vivo. Adhesion was significantly reduced (P < 0.002) to cells from both the diabetic and non-diabetic subjects after in vitro exposure to nystatin, but the reduction in adhesion was variable (5.0-50.7% in control subjects and 0.5-48.4% in diabetic subjects) and equivalent between the two groups. In vivo exposure to nystatin produced no overall significant reduction in candidal adhesion to cells from either diabetic or control subjects.

Thermographic assessment of root canal obturation using thermomechanical compaction

The temperature changes on the root surface of 30 extracted human premolar teeth during thermomechanical root canal obturation with gutta-percha were determined using an infrared thermal imaging camera. Three handpiece rotational speeds of 8, 12 and 16 x 10(3) r.p.m. were used, in conjunction with a Gutta Condensor. On completion of the procedure, the quality of tooth canal obturation was examined radiographically. Under the conditions of this experiment, surface root temperature rises of > 97 degrees C were recorded during all three speed settings. The radiographic quality of obturation between the groups appeared not to be significantly different. The clinical relevance of these findings is uncertain, but the temperatures reported are of a magnitude to be of biological importance.

Thermographic assessment of heat generated on the root surface during post space preparation

The mechanical preparation of a post space in a root filled tooth is commonly carried out using rotating instruments in a slow handpiece. This procedure creates frictional heat which may be transferred to the root surface. In this investigation, the temperature changes on the root surface of 12 root filled, extracted human premolar teeth during preparation of post spaces were analysed using an infrared thermal imaging camera. A rotational speed of 8000 r.p.m. was used and the teeth were prepared with size 2 and 3 Peeso reamers and a red Parapost drill to the optimal length. The results indicate that very large temperatures are generated on the root surface and that this is greatest during the Parapost preparation stage. The long-term clinical effects of post space preparation by engine driven drills would warrant further investigation.

Expression of CD1 and HLA-DR by Langerhans cells (LC) in oral lichenoid drug eruptions (LDE) and idiopathic oral lichen planus (LP)

Numbers of Langerhans cells (LC) expressing the common thymocyte antigen (T6/CD1) are similar in oral lichen planus (LP) and in normal oral epithelium; however, expression of class II major histocompatibility antigens (HLA-DR/Ia) by Langerhans cells is greater in lichen planus than in normal epithelium, a phenomenon believed to be associated with activation and antigen presentation. This study quantified the numbers of T6+ve and HLA-DR + ve Langerhans cells in oral lichen planus and lichenoid drug eruptions (LDE) to investigate whether differences may reflect differing routes of antigen presentation. Six patients with oral lichenoid drug eruptions and six control idiopathic oral lichen planus patients had lesional biopsies. An immunoperoxidase technique was used to demonstrate binding of T6 and HLA-DR antibodies to identify dendritic intraepithelial cells as Langerhans cells and activated Langerhans cells, respectively. In lichenoid drug eruptions, the number of HLA-DR + ve LC was significantly lower than the number of T6 + ve LC (P < 0.05), whereas in idiopathic lichen planus the numbers of T6 + ve and HLA-DR + ve LC did not differ significantly (P = 0.20). The results provide evidence for differences in the routes of antigen presentation in lichenoid drug eruptions and idiopathic lichen planus.

Contact hypersensitivity in patients with orofacial granulomatosis

BACKGROUND

Orofacial granulomatosis is a clinical entity presenting with chronic swelling of the oral or facial tissues in association with histological evidence of noncaseating granulomatous inflammation. Its cause remains unclear, but a possible role of contact sensitivity to dietary components has been proposed.

OBJECTIVES

This study was performed to document the prevalence of contact sensitivity to food additives in patients with orofacial granulomatosis and assess the role of elimination diets in management.

METHODS

Successive patients with a clinical diagnosis of orofacial granulomatosis were patch tested to the European Standard series and an Oral Battery containing common food additives. In addition, testing for immediate contact reactions to components of the Oral Battery was performed. In selected cases, appropriate elimination diets were implemented.

RESULTS

Forty-eight patients were investigated. Ten showed positive reactions to components of the Oral Battery on standard patch testing and, of these, seven showed improvement on an elimination diet.

CONCLUSIONS

Orofacial granulomatosis is a heterogenous clinical entity. Patch testing permits identification of a subgroup of patients likely to benefit from dietary manipulation and allows more appropriate targeting of such treatment.

Evaluation of major parotid glycoproteins in patients with burning mouth syndrome

OBJECTIVE

This study was to investigate the potential role of salivary glycoproteins in burning mouth syndrome.

STUDY DESIGN

This study compared major parotid glycoproteins in a group of patients with burning mouth syndrome and age-, sex-, race-matched healthy controls.

RESULTS

By use of a glycoprotein detection kit, saliva from both patients and controls exhibited three major parotid glycoprotein banding patterns consisting of either one or two bands, molecular weights 58 kDa and 77 kDa. The strong lectin reactivity of major parotid glycoproteins with Ricinus communis agglutinin suggests that galactose is the most prevalent terminal sugar. In addition, major parotid glycoproteins were shown to express blood group antigen H. On the basis of metachromatic characteristics and immunologic reactivity, major parotid glycoproteins appear to be members of the proline rich protein multigene family, proline rich glycoprotein, genetic polymorphism G1. No qualitative difference was observed in major parotid glycoprotein banding patterns between patients and controls.

CONCLUSION

These findings do not support a role for major parotid glycoproteins in burning mouth syndrome.

Cheilo-candidosis in an adult

A rare case of candidal infection of the lips is presented. Predisposing factors appeared to be intra-oral candidal carriage, actinic lip damage and Sjögren's syndrome. Systemic antifungal therapy with fluconazole resolved the initial infection and a subsequent recurrence.

Thermographic assessment of dentine pin placement

OBJECTIVE

This in-vitro study aimed to examine the change in surface temperature induced by the actions of drills for the placement of dentine pins.

METHODS

Ten decoronated extracted premolar teeth were embedded by the apical tip of their roots in orthoresin. They were held in a bench vice and allowed to reach the ambient temperature of 24 degrees C. A thermal imaging camera, Agema Thermovision 900 series, was positioned 0.05 m perpendicular to the decoronated surface. Sequential recording of a series of images was stored at a rate of three per second during each stage of the pin placement procedure. This included a pilot drill, a channel cutting drill and the pin placement. All pins were 0.675 mm diameter x 2 mm in length and were placed 1 mm from the amelo-dentinal junction using a Kavo handpiece rotating at 4000 rpm.

RESULTS

The mean baseline temperature for the thermally stabilized teeth was 23.9 degrees C. The action of the round pilot drill changed the temperature from baseline by 25 degrees C. The action of the channel drill generated the greatest heat, with a mean maximum temperature recorded during these procedures of 94 degrees C +/- 9 degrees C. The pilot drill produced a mean change from baseline of 31.3 degrees C +/- 17.7 degrees C during pin placement.

CONCLUSIONS

The placement of dentine pins produced a high temperature increase on the surface of the dentine. All stages of pin placement gave rise to an increased temperature, but this was maximal with the channel drill. Further studies are required to determine whether these surfaces temperatures are transferred to the pulpal chamber.

Unusual leiomyomatous hamartoma of the hard palate: a case report

Harmartomas of the head and neck are common lesions, often taking the form of melanocytic nevi or vascular malformations such as hemangiomas and lymphangiomas. Hamartomas composed of other tissue types are much rarer and within the oral cavity are usually located on the tongue near the foramen cecum or on the anterior hard palate near the incisive papilla. Although most occur as isolated phenomena, a small number may be associated with other local developmental defects or with a syndrome complex. A normal 5-year-old girl had a 1 cm soft sessile swelling in the vault of the hard palate on the left side. Histopathologic examination showed bundles of smooth muscle embedded in fibrovascular stroma and accompanied by abundant mature fat and a small amount of salivary tissue. The features were regarded as those of a leiomyomatous hamartoma and could be distinguished from a smooth-muscle tumor, teratoma, and benign mesenchymoma by virtue of the clinical and histopathologic features. No recurrence has been seen after excision.

Patient recognition of recrudescent herpes labialis: a clinical and virological assessment

OBJECTIVES

The purpose of this study was to ascertain how accurate the general public was at diagnosing the condition of recrudescent herpes labialis.

METHODS

An advertisement was placed in a local newspaper inviting patients to attend the Oral Medicine Clinic as soon as they thought they developed the clinically evident stage of herpes labialis. At the clinic, patients were examined to confirm the clinical presence of herpes labialis and also had a swab of the lesion(s) taken for virus culture. Virus culture was by the HEP-2 culture technique capable of detecting both herpes simplex Type 1 and herpes simplex Type 2. Patients also completed a detailed questionnaire concerning their knowledge of herpes labialis.

RESULTS

In total, 41 patients attended for screening. The findings were that all patients had clinical herpes labialis, and herpes simplex virus was isolated in 96% of cases. In contrast, in only about 50% of cases were patients aware that their herpes labialis was caused by a virus.

CONCLUSIONS

The general public are very good at recognizing herpes labialis lesions but need to be given more information about their infectivity.

Perception of stimulus size in patients with burning mouth syndrome

Twenty subjects with burning mouth syndrome (BMS) and 20 control subjects were tested for oral size perception. Blindfolded subjects assessed the size of holes (2.38-12.70 mm diameter) presented to the tongue, using their fingers to select a matching hole from a comparator series of 31 holes (0.76-15.87 mm diameter) using first static then phasic touch. Both groups overestimated the size of the holes less than 10 mm in diameter but no systematic disparity was evident with holes greater than 10 mm in diameter. The relationship between the stimulus size and the illusion (expressed as the ratio of apparent size to real size) was hyperbolic, with the illusion tending towards unity for holes greater than 10 mm. No differences were found in object size perception amongst patients with BMS or control subjects. It is therefore unlikely that altered oral size perception is a precipitating factor or accompanying feature in patients with BMS.

Efficacy of bioadhesive patches in the treatment of recurrent aphthous stomatitis

This study evaluated the efficacy of bioadhesive hydrogel patches, made of a pharmaceutical grade cellulose derivative, in the control of pain and as an aid to healing of aphthous ulceration. Patients kept a twice daily ulcer diary to record their pain level on a visual analogue scale. The sensitivity of the test ulcer was assessed by a challenge with pure orange juice as a stimulant before and after application of the patch by the patient. A significant reduction in stimulated pain was recorded following application of the patches to the ulcers (P < 0.01). The patches were found to adhere longer to large ulcers in the early stages of ulceration, when they achieved their maximum protective and pain-attenuating effects. The ulcer size was recorded daily by the patient and patients claimed a reduction in healing time following patch therapy.

Salivary cortisol and anxiety in recurrent aphthous stomatitis

Anxiety and salivary cortisol were measured in two groups of patients with recurrent aphthous ulceration. One group of patients had persistent aphthae (Group 1) and the others had been relieved of their aphthae following correction of detected haematinic deficiency states (Group 2). Anxiety was measured using the Hospital Anxiety and Depression scale and radioimmunoassay of salivary cortisol. There was a statistically significant increased proportion of borderline or clinically anxious patients in Group 1 compared to Group 2 (P < 0.05). Median salivary cortisol levels also showed a statistically significant elevation in Group 1 (P < 0.01). It is concluded that stress may play a role in the aetiology of recurrent aphthous stomatitis, particularly in patients who have an underlying anxiety trait.

Temperature changes in bovine mandibular bone during implant site preparation: an assessment using infra-red thermography

OBJECTIVES

Changes in bone temperature during the sequence of drilling for implant site preparation using the Branemark technique were monitored using infra-red thermography.

METHODS

Bovine mandibles were used to provide cortical bone of a similar quality to human mandibular bone. To ensure the consistency in the drilling procedure, one operator used a conventional dental handpiece with a motor provided by Nobelpharma. The manufacturer's specifications were followed during the implant site preparation, except that no irrigation was employed since infra-red radiation does not transmit through water. Thermal images were recorded using the Thermovision 900 system. A sequence of images was recorded during implant site preparation. Three drills were examined in terms of temperature changes during drilling over the entire area involved. The three drills used were a round bur, which determines the site of the fixture, a spiral drill (2 mm twist drill) which establishes the direction of the implant and finally a pilot drill (3 mm) which progressively increases the diameter of the site.

RESULTS

Average values (n = 10 drill sequences) for maximum recorded temperature (Max T degrees C), change in temperature (delta T degrees C) from baseline and the area of involvement (mm2) for each drill in the 10 drill sequences were as follows: round, spiral (2 mm) and pilot (3 mm) drills gave maximum temperatures of 82.7 degrees C, 130.1 degrees C and 126.3 degrees C, respectively. The changes in temperature, delta T degrees C, were 45.7 degrees C, 79.0 degrees C and 78.9 degrees C for the round, 2 mm twist and 3 mm pilot drill, respectively. The average areas recorded for the round, spiral and pilot drills were 49 mm2, 140.1 mm2 and 273.0 mm2, respectively.

CONCLUSIONS

It is concluded that the methodology employed accurately recorded temperature changes at and around the dental implant site, and provided preliminary baseline data against which the cooling efficacy of different irrigant systems may be compared.

Infrared thermography. Its role in dental research with particular reference to craniomandibular disorders

The use of infrared thermography in dentistry has been minimal, principally due to technological inadequacies of previous thermal imaging systems. However, with the ever-developing advancement in technology, current systems are capable of producing real-time, highly sensitive digitized thermal images. This development has led to an increased use of infrared imaging within both medical and dental research. The present paper describes these techniques and their previous applications within dentistry, and, through the use of a pilot study, highlights possible future applications in the assessment of craniomandibular disorders.

Mandibular tori, migraine and temporomandibular disorders

In this study the presence of mandibular tori was related to conditions associated with parafunctional activity. Parafunction in the form of tooth clenching or grinding has been associated with temporomandibular disorders (TMD) and recently migraine. Patients attending a facial pain clinic in Belfast were assessed for the presence of tori and results compared to age and gender matched controls. The findings were that mandibular tori were present significantly more commonly in both migraineurs and TMD patients. The results support an association with parafunction in the aetiology of mandibular tori and suggest that tori are a useful marker of past or present parafunction in some patients.

Burning mouth syndrome

Burning mouth syndrome is a common condition particularly affecting elderly women. Numerous precipitating factors are recognized that lead to a burning sensation in clinically normal mucosa. By taking each precipitating factor into account, a favorable treatment outcome usually can be achieved. This article highlights the significance of precipitating factors in burning mouth syndrome and suggests a treatment protocol based on current scientific evidence.

Electronic infrared thermography as a dental research technique

Electronic infrared thermography is an imaging modality for the accurate quantification of surface temperature. It has been used in medicine since the 1960s but its use in dentistry has been limited. Its use in dentistry could, however, be very useful, for example in objectively quantifying post-surgical inflammation and studying the effects of treatment with agents such as analgesics and anti-inflammatory drugs.

Anti-HIV antibody in saliva: an assessment of the role of the components of saliva, testing methodologies and collection systems

The various components of saliva, namely mixed saliva, parotid saliva, submandibular saliva, crevicular fluid and minor (labial) gland secretions, were collected from 63 known HIV antibody seropositive patients. A commercial test system, Wellcozyme HIV 1+2, and an antibody capture ELISA (GACELISA), were compared for sensitivity against all components. Sensitivity of the GACELISA system was 100% in 123 mixed saliva, 121 parotid saliva and 127 labial fluid samples, and 98% in 99 submandibular samples and 127 crevicular fluid samples. Respective figures for Wellcozyme 1+2 were 92%, 55%, 73%, 66% and 63%. Mixed saliva was most easily, conveniently and effectively collected using a plain Salivette. In 241 Salivette samples examined from the 63 patients, GACELISA proved 100% sensitive, and Wellcozyme 95% sensitive. Another form of Salivette impregnated with citric acid was unsuitable for GACELISA and gave a false negative value of 45%. In 197 samples from the gingival margin taken by a dry swab, GACELISA showed a sensitivity of 98% and Wellcozyme 81%. The most sensitive method for demonstrating anti-HIV antibody in saliva is to collect mixed saliva with the plain Salivette system and assay anti-HIV antibody levels by GACELISA.

Migraine: the effect of acrylic appliance design on clinical response

This study aimed to evaluate the relationship between the nocturnal wearing of an acrylic appliance of 2 mm thickness covering all occlusal surfaces of the teeth and the frequency of attacks of migraine. Nineteen patients were studied and all fulfilled accepted criteria for migraine with or without aura. Two appliance designs were employed, one covering the maxillary occlusal surfaces of the dentition and another which contacted the palatal mucosa only and was free of the occlusion. Treatment outcome was expressed as the number of attacks of migraine per week per patient. The occlusal cover appliance reduced the number of attacks on average to about 40% of that normally experienced. The improvement was most marked in those who had frequent attacks of migraine ie two attacks per week on a regular basis. In summary, acrylic appliance therapy is of value in migraineurs who have attacks on waking but the appliance design has to involve covering of the occlusal surfaces of all of the teeth.

Management of potentially malignant oral mucosal lesions by consultant UK oral and maxillofacial surgeons

This paper describes the results of a recent survey carried out under the auspices of the Professional Education and Evaluation Subgroup of the UK Working Group on Screening for Oral Cancer and Precancer. The aim of this survey was to assimilate information regarding currently used management options of potentially malignant oral lesions as a basis from which to rationalise our future approach to their management. The survey has confirmed that variation exists among oral and maxillofacial consultants in their approaches and a more formal approach to management may therefore be indicated.