Possibility of a viral etiology in recurrent aphthous ulcers and Behçet's syndrome

The clinical signs, laboratory data, and histological features of recurrent aphthous ulcers (RAU) and Behçet's syndrome suggest a viral etiology. In fact, there are reports of adenovirus isolations in herpetiform oral ulcers and on the isolation of a filterable agent in sporadic cases of Behçet's syndrome. However, isolation studies on the major and minor aphthous ulcers and more recent studies on Behçet's syndrome have been negative. A review of the literature on the role of viruses and autoimmunity in RAU and Behçet's syndrome is presented. Biopsy specimens of ulcerative lesions were grown in vitro for up to 300 days. Those cultures, along with leukocytes and body fluids, were examined by a variety of techniques for the presence of virus or viral antigens. Although a persistent or latent virus was not detected, these negative studies cannot exclude a viral etiology. In fact, the hypothesis of an infectious and viral etiology is still reasonable.

The relationship between immunological parameters and response to therapy in resistant oral candidosis

Eight patients with resistant oral candidal infection have undergone full immunological assessment. In four of these patients no significant abnormality of immune function was observed, and all responded to intensive antifungal therapy with nutritional supplements of iron and folic acids as required. The remaining four patients had abnormalities only of specific candida-related immune function and no detectable abnormality of general immune function. Surgical excision of affected areas of oral mucosa was found to be the most effective therapy in three of these four cases. The immunological findings in these cases are compared with those observed in five patients with chronic mucocutaneous candidosis in whom both specific candida-related and non-specific immune incompetence were present.

The periodontal management of a patient with a profound immunodeficiency disorder

A case of severe, uncontrolled periodontal disease in a patient with a profound immunodeficiency disorder is reported. The periodontal disease was noted before the age of 10 years and is generalized, with marked associated alveolar bone loss, even threatening a mandibular fracture. Severely involved teeth were allowed to exfoliate, and extractions were avoided. At the age of 17 years, the patient now has only nine remaining teeth. The management adopted and alternative approaches are critically reviewed. The implications of the dental findings for current concepts of the pathogenesis of periodontal disease and dental caries are discussed.

A radiographic study of the prevalence of chronic periodontitis in 14-year-old English schoolchildren

The prevalence of chronic periodontitis was investigated in six hundred and two 14-year-old English schoolchildren using a standardised radiographic technique. The interproximal spaces on the mesial and distal aspects of the first molar teeth were examined. Oral cleanliness and gingivitis for the anterior teeth and caries prevalence were also recorded. Radiographic evidence of chronic periodontitis was detected in 51.5% of the children examined. No significant relationship was demonstrated between bone loss associated with the first molars and any of the other parameters measured.

The association of the IGA levels of serum and whole saliva with the progression of oral cancer

Elevated IgA concentrations in the serum and whole saliva of patients with neoplastic disease have been reported. However, there does not seem to be any information available on the correlation of the secretory immunoglobulins of these patients with the progress of their disease. The whole saliva and sera of 102 cases of squamous carcinoma of the oral mucosa were studied. Patients were subclassified into age-matched groups of primary untreated cancer (21), recurrent cancer (18), and "cured" patients who had been free of disease for at least 9 months (16). A separate group of laryngeal (14) patients was included. Sixteen (16) patients treated by radiation therapy alone were also included to test the effects of radiation on whole saliva IgA. An age-matched group of patients (17) with moderate to severe periodontal disease served as controls. Unstimulated whole saliva was collected for 15 minutes and stored at 0 degrees C. IgA was quantitated by radial immunodiffusion on Hyland and Meloy Laboratory low level plates with 7S and 11S standards. Serum IgA was measured on Hyland plates with serum standards. Protein content of saliva was assayed by the Lowry method. Flow rate was quantitated for the 15-minute collection period. Primary oral and laryngeal cancer patients had a two-fold increase of serum and salivary IgA compared to controls. Recurrent cancer patients had even greater elevation of salivary IgA. Cured patients showed a persistent elevation of serum but a return to normal of salivary IgA. Radiation therapy did not markedly influence the level of salivary IgA. A followup study of 26 patients confirmed this pattern of a drop in whole salivary IgA with cure and a spike with recurrence. It would appear that IgA levels of whole saliva and serum are elevated in oral cancer patients, and that salivary IgA levels may prove useful in distinguishing patients with possible recurrent disease.

Experimental gingivitis in young and elderly individuals

The development of experimental gingivitis was studied in young elderly humans during a 21-d period of oral hygiene abstention. The state of the gingiva was assessed by the Gingival Index and by measurements of the amount of gingival exudate on filter paper strips placed at the entrance of the gingival sulcus of the lower lateral incisors and cuspids. Soft deposits were assessed by the Plaque Index and by differential counts of microorganisms in gram stained smears od ento-gingival plaque. At the end of the plaque growth period, the patients were given a thorough dental prophylaxis. Gingival condition and plaque were assessed at regular intervals during a subsequent period of controlled oral hygiene. The development of gingivitis during the oral hygiene abstention period was more rapid and more severe in old than in young individuals. Plaque accumulation was greater in the older persons. A definite difference in plaque consistency was alos observed. However, microscopic counts of various types of microorganisms did not reveal any differences throughout the period of plaque accumulation. When active oral hygiene was reinstituted, the state of the gingiva rapidly returned to pre-experimental levels in both groups. The findings of this study indicate that with age ther is an altered host response to the microorganisms of the plaque.

Leukocyte mediated cytotoxicity of chemically induced rat salivary gland neoplasms

Chemically induced tumors of the rat submaxillary glands were tested for the presence of tumor antigens by in vitro leukocyte mediated cytotoxicity assays. Since it has been reported that the saliva of humans with oral cancer contains markedly elevated levels of secretory antibody, the rats' saliva specimens were also tested for blocking and/or potentiating "antibody" activity. The results indicate that saliva from tumor-bearing animals potentiated tumor cell killing if either the tumor cells or leukocytes were pretreated. The effect was much more marked when tumor cells were pretreated. Furthermore, the addition of saliva to tumor cells imparted an immunologic cross reactivity which was not present with untreated tumor cells. Control saliva occasionally produced a similar effect, but not as consistently or with the potency of saliva from tumor-bearing animals. Heat inactivation did not abrogate this potentiation. It is inferred that this may indicate a new system of immunologic surveillance, i.e. arming or potentiation of leukocytes by soluble tumor antigens in glandular secretions.