Thermographic measurement of temperature change during resin composite polymerization in vivo

OBJECTIVES

To use the technique of infrared thermography for non-invasive monitoring of temperature changes during polymerization of resin composite by measuring the infra-red emission from the surfaces of resin composite restorations during photocuring.

METHODS

In this study 10 patient volunteers had resin composite restorations placed in upper incisor teeth and during photocuring the temperature rise within the composite was measured using the Thermovision 900 infra-red scanning system.

RESULTS

The results demonstrate that the exotherm is almost instantaneous, occurring as soon as the light source is activated and rising to a peak at approximately 30 s before levelling off. The measurements suggest that a maximum temperature increase of 12 degrees C could occur, although this may only be for a short period (< 15 s).

CONCLUSION

The range of temperature rise measured in this study (mean 5.4 degree C +/- 2.5 degree C) would suggest that the pulp may be endangered by the temperature rise which occurs during resin composite polymerization in vivo.

Linear IgA disease (LAD): immunoglobulin deposition in oral and colonic lesions

Two cases of adult linear IgA disease (LAD) with oral and colonic involvement are presented. Oral findings, for both patients, were of widespread painful ulceration present for two to three months and diagnosis was confirmed by biopsy and direct immunofluorescence. Colonic symptoms preceded oral symptoms in both cases and a number of investigations were undertaken, including routine histological examination, which suggested either lymphocytic colitis or Crohn's disease. Immunofluorescence studies showed linear IgA deposition confined to the distal colon. These cases highlight that large bowel involvement can be a feature of linear IgA disease and for the first time demonstrate IgA deposition at that site.

Oral disease in the elderly in long-term hospital care

OBJECTIVE

To obtain baseline information on the prevalence of oral problems and disease in institutionalized elderly in a Scottish hospital.

DESIGN

A cross-sectional clinical investigation with complementary microbiological studies as appropriate.

SUBJECTS AND METHODS

A cohort of 147 elderly in five long-term care wards; collection of demographic data; clinical examination to determine: i) the dental and denture status and associated lesions such as Candida-associated denture stomatitis and angular cheilitis, ii) oral mucosal disease; swabs as appropriate for microbiology.

MAIN OUTCOME MEASURES

Dental status, root caries prevalence; denture status and hygiene, and associated disease; oral mucosal health.

RESULTS

Median period of institutionalization of 147 patients was 15 months and 65% were aged 80 years or more; the majority were significantly mentally impaired; 52% wore complete dentures, 9% were partially dentate, 19% possessed partial or incomplete dentures; 20% were neither dentate nor had dentures. Of 80 patients who verbalised their complaints, 35% complained of dry mouth and 45% had denture-related problems, principally discomfort. The commonest oral finding was a coated tongue (56%); angular cheilitis was present in 25%, and Candida-associated denture stomatitis in 19%; none had oral ulcers.

CONCLUSIONS

There was considerable unmet dental need with significant oral disease and poor levels of oral and denture hygiene in this target group; both dental and medical professionals should act in concert to deliver curative as well as preventative dental care for the elderly living in institutions to improve their quality of life.

Burning mouth syndrome: the relationship between the HAD scale and parafunctional habits

This study investigated 84 patients with burning mouth syndrome (BMS), who were asked to complete a hospital anxiety and depression (HAD) scale questionnaire. A control group of 69 patients was also included. All patients were interviewed regarding parafunctional habits and were subjectively examined for signs of occlusal wear of the natural teeth or dentures. The results demonstrated that parafunctional habits were present in 61% of patients with BMS. There was a statistically significantly relationship between parafunctional habits and anxiety as indicated by the HAD scale, but not with depression.

Thermographic resolution of the prodromal phase of herpes labialis treated with acyclovir

We present a case of recurrent herpes labialis treated with acyclovir. The patient attended within 3 h of the onset of prodrome of the condition, when he appeared clinically normal. Electron infra-fred thermography of the face and lips was undertaken and demonstrated a significant sub-clinical local elevation in temperature of 1.7 degrees C at the site where prodromal symptoms were perceived. Treatment with topical acyclovir cream five times daily was commenced immediately and aborted the developing lesion. Two days after presentation the patient was thermographically normal. To our knowledge this is the first report documenting the abortion of herpes labialis treated with acyclovir where the prodrome was confirmed thermographically.

Electronic infrared thermography as a method of assessing herpes labialis infection

The purpose of this study was to ascertain the applicability of infrared thermography to study the natural history of herpes labialis lesions. Since thermography is capable of detecting changes not visible to the naked eye, then it may be of value in complementing clinical examination of the various stages of herpes labialis. In addition, thermographic imaging is quantitative and therefore allows for an accurate assessment of temperature changes accompanying the disease process, both within patients and between patients. Ten female patients suffering from herpes labialis were studies (mean age 25 +/- 5 years). In all cases herpes simplex virus Type 1 was isolated by the HEP-2 technique. No treatment was instituted and patients were clinically assessed and thermographically imaged daily from the prodromal phase through to resolution. A marked temperature increase (1 degree C minimum) was observed within hours of the prodromal phase and maintained until day 4. As the lesions progressed to vesicle formation, the central area of the vesicle was noted to be cooler due to the insulating effect of the fluid. Even by day 6 a significant 0.5 degree C temperature increase over background was present at the involved site and this returned to normal within 8 to 10 days. The area of thermographic involvement was three to four times larger than the clinical area of involvement (60-100 mm2 versus 20-25 mm2). To assess reproducibility, we also studied patients through two additional untreated herpes labialis episodes. The prodromal phase was reproducible thermographically and characterized by a temperature increase of 1.42 degrees C +/- 0.2 degrees C. Thermographic imaging may represent a new approach to quantifying disease activity in herpes labialis, particularly in the subclinical prodromal stage.

Relationship between iron status and recrudescent herpes labialis

A prospective study was undertaken to assess the relationship between recrudescent herpes labialis and host iron status. Forty-one patients with recrudescent herpes labialis, proven by herpes simplex virus isolation, were studied along with an equal number of age-and-sex matched control subjects. The iron status of patients and controls were assessed by haematine assay of ferritin. The iron (ferritin) level in patients with recrudescent herpes labialis was significantly (p < 0.01) lower than in the control group. Only one patient was anaemic. Side-ropenia appears to be a common finding in patients with recrudescent herpes labialis. The relationship between sideropenia and recrudescent herpes labialis requires further study as it may have implications for the management of the disease.

The recovery of proteolytic activity using the Salivette system

The recovery of proteolytic activity from human saliva was investigated using the Salivette system. Comparison of activity measurements with those obtained from whole saliva indicated that the Salivette system allowed increased recovery of proteolytic activity suggesting minimal enzyme binding to the cotton roll. The significance of these results is that previous estimates of proteolytic activity in mixed saliva may not have been due to increasing release of proteases by stimulation of secretion, but by altered binding properties of the sampling system used.

Contact sensitivity to menthol and peppermint in patients with intra-oral symptoms

We report 12 cases of contact sensitivity to the flavouring agents menthol and peppermint oil in patients presenting with intra-oral symptoms in association with burning mouth syndrome, recurrent oral ulceration or a lichenoid reaction. The patients were referred from the Glasgow Dental Hospital over a 4-year period for assessment of the possible contribution of contact sensitivity to their complaints. 5 patients with burning mouth syndrome demonstrated contact sensitivity to menthol and/or peppermint, with 1 patient sensitive to both agents, 3 positive to menthol only and 1 to peppermint only. 4 cases with recurrent intra-oral ulceration were sensitive to both menthol and peppermint. 3 patients with an oral lichenoid reaction were positive to menthol on patch testing, with 2 also sensitive to peppermint. 9 of the 12 cases demonstrated additional positive patch test results. After a mean follow-up of 32.7 months (range 9-48 months), of the 9 patients that could be contacted, 6 patients described clearance or improvement of their symptoms as a consequence of avoidance of menthol/peppermint.

Basal cell cytoplasmic autoantibodies in oral lichenoid reactions

One hundred sixty-one patients with a clinical diagnosis of an oral lichenoid reaction were evaluated serologically for circulating autoantibodies toward basal cell membrane components. The study group comprised 119 women and 42 men with a median age of 59 and 55 years, respectively. Most patients (n = 144) had an oral mucosal biopsy undertaken. Serologic investigation aimed to identify an IgG antibody that, under immunofluorescent staining, produced an annular fluorescence of basal cells and that has been referred to as basal cell cytoplasmic antibody. These basal cell cytoplasmic antibodies were significantly associated with systemic drug usage, histologic diagnosis of a lichenoid reaction, and a unilateral intraoral distribution of the clinical lesion. In the diagnosis of oral lichenoid reactions precipitated by drug therapy, the basal cell cytoplasmic phenomenon may be a useful adjunct to clinical and histologic investigation.

Multiple oral mucoceles treated with gamma-linolenic acid: report of a case

Multiple mucoceles are an extremely rare condition in the oral cavity. We report a case which responded entirely to systemic gamma-linolenic acid but which recurred several months following discontinuation of therapy. Spontaneous resolution of the condition seems unlikely and it would appear that gamma-linolenic acid could have an effect on minor salivary gland composition and/or viscosity and may be worth prescribing on a trial basis prior to surgical treatment of this rare condition.

Lip component of burning mouth syndrome

To our knowledge there has been no previous study of factors specifically involved in the pathogenesis of patients who complain of burning sensation of the lips when the lips appear clinically normal. The complaint is akin to patients who complain of a burning sensation of the mouth when it appears clinically normal, a condition known as burning mouth syndrome. This study therefore studied precipitating factors in patients with burning mouth syndrome who reported lip involvement. Previous studies have shown that the lips are the third most common site reported as involved in patients who have burning mouth syndrome. Indeed patients with burning mouth syndrome often report multiple oral site involvement. To investigate the precipitating factors involved in the lip component of burning mouth syndrome, we studied 104 patients who reported the lips as a site affected by the condition from a total population of 312 patients with burning mouth syndrome. Hematologic, biochemical, and microbiologic parameters were studied in these patients. Sialometry, patch testing, psychological testing, and examination of denture status as well as questioning of parafunctional habits were also undertaken. No clear differences were noted in relationship to the frequency of abnormalities in burning mouth syndrome alone or burning mouth syndrome with lip involvement suggesting that similar precipitating factors apply. The precipitating factors in patients with lip involvement were found to be the same as burning mouth syndrome in general. Treatment of patients with lip involvement alone in burning mouth syndrome or lip involvement in burning mouth syndrome in conjunction with other intraoral sites gave an equally good response.(ABSTRACT TRUNCATED AT 250 WORDS)

The recovery of human saliva using the Salivette system

Human saliva recovery using the Salivette system was investigated. Two Salivette systems were employed. The recommended centrifugation procedures for saliva recovery only recovered between 46% and 52% of the total volume. Modification of centrifugation speeds and duration allowed an 80% recovery. Differences were observed between the two Salivette systems tested with the newer system allowing a greater recovery. The findings have implications for saliva collection using this technique.

The effect of nebulised pentamidine on the concentration of intra-oral Candida albicans in HIV-infected patients

This prospective study investigated whether oral candidal carriage in HIV-infected patients was altered by pentamidine therapy. Repeated oral rinses were taken from 56 HIV-positive patients over a 2-year period. Oral candidal carriage was investigated in two groups of patients, one receiving prophylactic pentamidine therapy and the other not receiving regular prophylaxis. Patients receiving pentamidine had lower concentrations of Candida albicans intra-orally than patients who did not receive it. Furthermore, patients who received pentamidine at one stage of the study, but not another, also had lower concentrations of C. albicans intra-orally when receiving pentamidine. These findings indicate that pentamidine is useful as a local agent for prophylaxis against intra-oral candidosis in HIV-infected patients.

Secretor status and oral cancer

A prospective study was undertaken of 100 Sri Lankan patients with oral cancer and an equal number of age and sex matched control individuals. Each subject's secretor status was established from samples of appropriately prepared whole saliva using a haemagglutination technique. No significant differences were recorded in the distribution of secretors or non-secretors between the patient and control groups. In contrast to studies of Caucasians with potentially malignant oral lesions such as candidal leukoplakia in which non-secretor status predominates, secretor status does not appear to be an associated risk marker for the development for oral cancer in a selected Sri Lankan population.

Type 3 burning mouth syndrome: psychological and allergic aspects

A subgroup of patients with burning mouth syndrome was investigated. The clinical history of these patients differed from the norm in that symptoms were intermittent and affected unusual sites. In addition, routine investigations were supplemented with a more detailed psychological evaluation than reported previously and also a possible allergic component was studied by patch testing. The study has shown that this subgroup differs from burning mouth syndrome patients overall in that emotional instability and allergic reactions, particularly to food additives, are of etiological significance and require to be taken into consideration in terms of patient management.

The effect of exposure to chlorhexidine gluconate in vitro and in vivo on in vitro adhesion of Candida albicans to buccal epithelial cells from diabetic and non-diabetic subjects

The effect of 0.2% chlorhexidine gluconate on in vitro adhesion of Candida albicans to buccal epithelial cells (BEC) was studied in 12 healthy subjects and 12 patients with diabetes mellitus. Exposure of BEC for one minute with 0.2% chlorhexidine gluconate in vitro, or by rinsing the mouth in vivo, resulted in a significant reduction in candidal adhesion to BEC in both diabetic and non-diabetic subjects and between both groups. In addition to the known fungicidal effect of chlorhexidine, it also reduces Candida albicans adhesion to oral mucosal cells, a factor of importance in the establishment of candidal infection.

Orofacial artefactual disease

Self-induced lesions of the face and mouth may occasionally be encountered in dental practice. In general the deliberate creation of orofacial lesions is an indication of underlying psychiatric disease of various types that usually involve a personal gain by the patient from having such lesions. We present three cases of deliberately self-induced lesions and discuss the problem of diagnosis and management of these cases.

A model to study viral and cytokine involvement in Sjögren's syndrome

To investigate mechanisms that may be important in the pathogenesis of Sjögren's syndrome (SS) we developed a protocol for the growth of salivary gland epithelial cells in culture. We examined the effect that viral infection has on the cellular location of the autoantigen La. Autoantibodies to La are common in SS and it has been proposed that viral infection may result in cell membrane expression of La. Co-expression of MHC class II molecules in infected cells could lead to the presentation of La peptides to the immune system. Advenovirus infection of salivary gland epithelial cells resulted in an altered nuclear staining of La. Treatment with interferon-gamma resulted in the expression of La in the cell cytoplasm and HLA-DR molecules at the cell surface. These findings suggest that a cytokine-driven mechanism may generate an autoimmune response to La in SS. Using the polymerase chain reaction (PCR) we tested salivary gland epithelial cell cultures for the presence of human herpesvirus-6 (HHV-6) and Epstein-Barr virus (EBV). Only HHV-6 was detected in 2 of 10 salivary gland epithelial cell cultures although the presence of HHV-6 was not associated with SS. Primary salivary gland cultures may prove useful as an in vitro model to study mechanisms of autoimmunity in SS.

Sialectasis and HIV infection

The sialographic findings of the parotid gland of an HIV-positive patient are presented. Multiple areas of sialectasia were noted and their similarity to Sjögren's syndrome is discussed.

Pemphigus vulgaris precipitated by glibenclamide therapy

Pemphigus vulgaris (PV) is a rare but potentially fatal autoimmune bullous disorder which frequently affects the oral mucosa. Although the essential cause of PV is unclear, its onset has occasionally been associated with drug therapy, in particular penicillamine. The patient described in this paper was a 78-year-old diabetic man who developed oral lesions of PV following institution of glibenclamide therapy.

Mucous membrane pemphigoid. Treatment experience at two institutions

The initial oral findings and treatment in 50 cases of mucous membrane pemphigoid are presented. Histologic and immunologic studies were undertaken in each case to confirm the clinical diagnosis. The treatments prescribed are summarized and illustrate that topical steroids are effective, but in some cases systemic steroid therapy with or without other immunologically active drugs is required. A significant number of patients had extraoral manifestations of the disorder.

Oral presentation of pemphigus vulgaris and its response to systemic steroid therapy

This article reviews our experience during a 20-year period with patients with oral lesions of pemphigus vulgaris. Of the 30 patients, 20 were women and 10 were men, with an age range of 24 to 68 years. The soft palate was involved in 80% of cases at initial presentation. Direct immunofluorescence studies were positive for IgG in the intercellular region in all cases where lesional tissue was histologically studied. Systemic steroid therapy alone controlled the disease in 24 patients, one patient was given no treatment, and the remaining five required additional treatment with either azathioprine, cyclophosphamide, or gold. Steroid therapy was continued in the long-term at a reduced dose, but side effects such as diabetes mellitus, hypertension, and duodenal ulcers were observed. Long-term steroid therapy is therefore the treatment of choice for the oral lesions of pemphigus vulgaris, but in some cases alternative treatment options may be required.