T-lymphocyte and Langerhans cell distribution in normal and allergically induced oral mucosa in contact with nickel-containing dental alloys

Immunohistochemical and Histopathological Features of Persistent Gingival Enlargement in Relation to Metal Allergic Sensitisation during Orthodontic Treatment

This study aimed to analyse the immunohistochemical profile of inflammatory infiltrates in the gingival tissue of patients undergoing orthodontic treatment in relation to patients’ titanium and/or nickel allergy status. Patients with gingival enlargement received initial periodontal therapy, followed by external gingivectomy in the case of persistent gingival enlargement. The sample included 44 patients (22 had metal allergic sensitisation). Histopathological changes were assessed, and an immunohistochemical analysis was performed on formalin-fixed and paraffin-embedded gingival samples using antibodies against CD1a, CD3, CD4, CD8, CD20, CD68, and CD138. Computer-assisted image analysis was performed to evaluate the positive cell count in the gingival tissue. The gingiva of the sensitised patients was characterised by the absence of multifocal inflammatory infiltrates (p < 0.05), while pronounced exocytosis and band-like inflammatory infiltrates were more frequently observed in sensitised patients. In addition, there was an increase in Langerhans cells and T-helper lymphocytes and a decrease in naïve T-lymphocytes, cytotoxic T-lymphocytes, macrophages, and plasma cells in the sensitised subjects compared to non-sensitised. However, the differences were only statistically significant for macrophages, with a moderate effect size (82.8 vs. 133.9; p = 0.041; r = 0.308). The absence of multifocal inflammation appears to be the most characteristic histopathological feature of the gingiva of sensitised patients. Although their gingiva presented certain characteristics of late hypersensitivity immune reactions the observed changes imply dominant irritative effect e.

Release of HIV-1 sequestered in the vesicles of oral and genital mucosal epithelial cells by epithelial-lymphocyte interaction

Oropharyngeal mucosal epithelia of fetuses/neonates/infants and the genital epithelia of adults play a critical role in HIV-1 mother-to-child transmission and sexual transmission of virus, respectively. To study the mechanisms of HIV-1 transmission through mucosal epithelium, we established polarized tonsil, cervical and foreskin epithelial cells. Analysis of HIV-1 transmission through epithelial cells showed that approximately 0.05% of initially inoculated virions transmigrated via epithelium. More than 90% of internalized virions were sequestered in the endosomes of epithelial cells, including multivesicular bodies (MVBs) and vacuoles. Intraepithelial HIV-1 remained infectious for 9 days without viral release. Release of sequestered intraepithelial HIV-1 was induced by the calcium ionophore ionomycin and by cytochalasin D, which increase intracellular calcium and disrupt the cortical actin of epithelial cells, respectively. Cocultivation of epithelial cells containing HIV-1 with activated peripheral blood mononuclear cells and CD4+ T lymphocytes led to the disruption of epithelial cortical actin and spread of virus from epithelial cells to lymphocytes. Treatment of epithelial cells with proinflammatory cytokines tumor necrosis factor-alpha and interferon gamma also induced reorganization of cortical actin and release of virus. Inhibition of MVB formation by small interfering RNA (siRNA)-mediated silencing of its critical protein hepatocyte growth factor-regulated tyrosine kinase substrate (Hrs) expression reduced viral sequestration in epithelial cells and its transmission from epithelial cells to lymphocytes by ~60-70%. Furthermore, inhibition of vacuole formation of epithelial cells by siRNA-inactivated rabankyrin-5 expression also significantly reduced HIV-1 sequestration in epithelial cells and spread of virus from epithelial cells to lymphocytes. Interaction of the intercellular adhesion molecule-1 of epithelial cells with the function-associated antigen-1 of lymphocytes was important for inducing the release of sequestered HIV-1 from epithelial cells and facilitating cell-to-cell spread of virus from epithelial cells to lymphocytes. This mechanism may serve as a pathway of HIV-1 mucosal transmission.

Reliability performance of titanium sputter coated Ni-Ti arch wires: mechanical performance and nickel release evaluation

The present research was aimed at developing surface coatings on NiTi archwires capable of protection against nickel release and to investigate the stability, mechanical performance and prevention of nickel release of titanium sputter coated NiTi arch wires. Coated and uncoated specimens immersed in artificial saliva were subjected to critical evaluation of parameters such as surface analysis, mechanical testing, element release, friction coefficient and adhesion of the coating. Titanium coatings exhibited high reliability on exposure even for a prolonged period of 30 days in artificial saliva. The coatings were found to be relatively stable on linear scratch test with reduced frictional coefficient compared to uncoated samples. Titanium sputtering adhered well with the Ni-Ti substrates at the molecular level, this was further confirmed by Inductive coupled plasma emission spectroscopy (ICPE) analysis which showed no dissolution of nickel in the artificial saliva. Titanium sputter coatings seem to be promising for nickel sensitive patients. The study confirmed the superior nature of the coating, evident as reduced surface roughness, friction coefficient, good adhesion and minimal hardness and elastic modulus variations in artificial saliva over a given time period.

Allergy and orthodontics

The aim of this paper is to review the current literature on allergy in orthodontics and to identify the predisposing factors and the implications of the allergic reaction in the management of patients during orthodontic treatment. A computerized literature search was conducted in PubMed for articles published on allergy in relation to orthodontics. The MeSH term used was allergy and orthodontics. Allergic response to alloys in orthodontics, particularly nickel, has been extensively studied and several case reports of nickel-induced contact dermatitis have been documented. Current evidence suggests that the most common allergic reaction reported in orthodontics is related to nickel in orthodontic appliances and allergic response is more common in women due to a previous sensitizing exposure from nickel in jewellery. Studies have implicated allergy in the etiology of hypo-dontia. It has also been considered as a high-risk factor for development of extensive root resorption during the course of orthodontic treatment. This review discusses the relationship and implications of allergy in orthodontics.

Langerhans cells and their role in oral mucosal diseases

Dendritic cells are arguably the most potent antigen-presenting cells and may be the only cells capable of initiating the adaptive immune response. The epithelial residents of dendritic cells are Langerhans cells, which serve as the "sentinels" of the mucosa, altering the immune system not only to pathogen entry but also of tolerance to self antigen and commensal microbes. Oral mucosal Langerhans cells are capable of engaging and internalizing a wide variety of pathogens and have been found responsive to nickel in patients with nickel allergies, oral Candida species, oral lichen planus, lichenoid drug eruptions, graft versus host diseases, periodontal diseases median rhomboid glossitis, human immunodeficiency virus infection, hairy leukoplakia of the tongue, and oral squamous cell carcinoma. Review focuses on the role of antigen-presenting cells in particular Langerhans cells to better understand the mechanisms underlying immune responses. In this review, comprehensive detail about mucosal diseases has been compiled using the PubMed database and through textbooks.

Orthodontic appliances for patients with a nickel allergy

Nickel is the metal most likely to cause an allergic reaction and is also present in many orthodontic appliances. This article examines what a nickel allergy is and the considerations involved for patients with the condition

Pathophysiology of Langerhans cells

Langerhans cells (LCs) were first described by Paul Langerhans, in 1868, as dendritically shaped cells, which were located in the squamous epithelia of epidermis. Later on, these cells were identified in all stratified squamous epithelium of mammals. Dendritic cells (DCs) play an important role in local defense mechanisms in the epithelium. LCs are situated usually in the suprabasal layer of stratified squamous epithelia of oral mucosa and epidermis of skin. They constitute 3% of the cell population in epidermis. LCs are thought to act as antigen presenting cells (APCs) during initiation of immune responses. With the help of APCs, the lymphocytes are able to recognize and respond to specific microbes. In this paper we have reviewed the origin, distribution, demonstration and mechanism of action of LCs and their role in different pathological conditions.

Differential transmission of HIV traversing fetal oral/intestinal epithelia and adult oral epithelia

While human immunodeficiency virus (HIV) transmission through the adult oral route is rare, mother-to-child transmission (MTCT) through the neonatal/infant oral and/or gastrointestinal route is common. To study the mechanisms of cell-free and cell-associated HIV transmission across adult oral and neonatal/infant oral/intestinal epithelia, we established ex vivo organ tissue model systems of adult and fetal origin. Given the similarity of neonatal and fetal oral epithelia with respect to epithelial stratification and density of HIV-susceptible immune cells, we used fetal oral the epithelium as a model for neonatal/infant oral epithelium. We found that cell-free HIV traversed fetal oral and intestinal epithelia and infected HIV-susceptible CD4(+) T lymphocytes, Langerhans/dendritic cells, and macrophages. To study the penetration of cell-associated virus into fetal oral and intestinal epithelia, HIV-infected macrophages and lymphocytes were added to the surfaces of fetal oral and intestinal epithelia. HIV-infected macrophages, but not lymphocytes, transmigrated across fetal oral epithelia. HIV-infected macrophages and, to a lesser extent, lymphocytes transmigrated across fetal intestinal epithelia. In contrast to the fetal oral/intestinal epithelia, cell-free HIV transmigration through adult oral epithelia was inefficient and virions did not infect intraepithelial and subepithelial HIV-susceptible cells. In addition, HIV-infected macrophages and lymphocytes did not transmigrate through intact adult oral epithelia. Transmigration of cell-free and cell-associated HIV across the fetal oral/intestinal mucosal epithelium may serve as an initial mechanism for HIV MTCT.

Palladium alloys for biomedical devices

In the biomedical field, palladium has primarily been used as a component of alloys for dental prostheses. However, recent research has shown the utility of palladium alloys for devices such as vascular stents that do not distort magnetic resonance images. Dental palladium alloys may contain minor or major percentages of palladium. As a minor constituent, palladium hardens, strengthens and increases the melting range of alloys. Alloys that contain palladium as the major component also contain copper, gallium and sometimes tin to produce strong alloys with high stiffness and relatively low corrosion rates. All current evidence suggests that palladium alloys are safe, despite fears about harmful effects of low-level corrosion products during biomedical use. Recent evidence suggests that palladium poses fewer biological risks than other elements, such as nickel or silver. Hypersensitivity to palladium alone is rare, but accompanies nickel hypersensitivity 90-100% of the time. The unstable price of palladium continues to influence the use of palladium alloys in biomedicine.

A severe reaction to ni-containing orthodontic appliances

Exposure to nickel-containing orthodontic appliances may cause intra- or extraoral allergic reactions. Nickel is the most typical antigen implicated in causing allergic contact dermatitis, which is a Type IV delayed hypersensitivity immune response. This report presents an unusual reaction to nickel during the orthodontic treatment of an adult female patient. The patient had no previous history of allergy and had been wearing fixed metal upper appliances while in orthodontic treatment to assist the eruption of her impacted teeth. The adverse hypersensitivity reactions appeared only after the surgical exposure and included severe signs of eczematic and urticarial reactions of the face with redness, irritation, itching, eczema, soreness, fissuring, and desquamation as well as intraoral diffuse red zones. Diagnostic patch testing performed by the allergist revealed sensitization to nickel (++++ score). Treatment was achieved with nickel-free appliances.

Dendritic cells at the oral mucosal interface

The mucosal lining of the respiratory and digestive systems contains the largest and most complex immune system in the body, but surprisingly little is known of the immune system that serves the oral mucosa. This review focuses on dendritic cells, particularly powerful arbiters of immunity, in response to antigens of microbial or tumor origin, but also of tolerance to self-antigens and commensal microbes. Although first discovered in 1868, the epidermal dendritic Langerhans cells remained enigmatic for over a century, until they were identified as the most peripheral outpost of the immune system. Investigators' ability to isolate, enrich, and culture dendritic cells has led to an explosion in the field. Presented herein is a review of dendritic cell history, ontogeny, function, and phenotype, and the role of different dendritic cell subsets in the oral mucosa and its diseases. Particular emphasis is placed on the mechanisms of recognition and capture of microbes by dendritic cells. Also emphasized is how dendritic cells may regulate immunity/tolerance in response to oral microbes.

Nickel allergy and orthodontics

Nickel is the most common metal to cause contact dermatitis in orthodontics. Nickel-containing metal alloys, such as nickel-titanium and stainless steel, are widely used in orthodontic appliances. Nickel-titanium alloys may have nickel content in excess of 50 per cent and can thus potentially release enough nickel in the oral environment to elicit manifestations of an allergic reaction. Stainless steel has a lower nickel content (8 per cent). However, because the nickel is bound in a crystal lattice it is not available to react. Stainless steel orthodontic components are therefore very unlikely to cause nickel hypersensitivity. This article discusses the diagnosis of nickel allergy in orthodontics and describes alternative products that are nickel free or have a very low nickel content, which would be appropriate to use in patients diagnosed with a nickel allergy.

Palladium--a review of exposure and effects to human health

Palladium is a metal the output and use of which has more than doubled in the past ten years. It is used in dental appliances, chemical catalysts, electrical appliances and jewelry, but the greatest increase in Pd demand has been in automotive emission control catalysts. Studies on Pd concentrations in ancient ice and recent snow samples reflect the increase in mining, smelting and use of palladium in the last decades. Increases of palladium in the environment have been shown in air and dust samples. There is no data as yet available to assess the effect of this exposure. A major source of health concern is the sensitization risk of Pd as very low doses are sufficient to cause allergic reactions in susceptible individuals. Persons with known nickel allergy may be especially susceptible. Workers occupationally exposed to Pd include miners, dental technicians and chemical workers. The latter are exposed mainly to Pd salts several of which may cause primary skin and eye irritations. It is advised that persons with known Pd allergy should not work with Pd compounds. The general population may come into contact with palladium mainly through mucosal contact with dental restorations and jewelry containing palladium and possibly via emissions from Pd catalysts. Protection of the public from related adverse effects may be achieved by the use of alloys with high corrosion stability and thus minimal release of palladium. In general, in dental patients who are sensitive to Pd, restorations using Pd-containing materials should not be used although Pd has been used without allergic effects in some of these individuals. Further, those patients who have an allergy to nickel should be informed that use of Pd-containing dental materials may cause Pd allergy, though this risk appears to be low.

Mature dendritic cells infiltrate the T cell-rich region of oral mucosa in chronic periodontitis: in situ, in vivo, and in vitro studies

Previous studies have analyzed the lymphoid and myeloid foci within the gingival mucosa in health and chronic periodontitis (CP); however, the principal APCs responsible for the formation and organizational structure of these foci in CP have not been defined. We show that in human CP tissues, CD1a(+) immature Langerhans cells predominantly infiltrate the gingival epithelium, whereas CD83(+) mature dendritic cells (DCs) specifically infiltrate the CD4(+) lymphoid-rich lamina propria. In vivo evidence shows that exacerbation of CP results in increased levels of proinflammatory cytokines that mediate DC activation/maturation, but also of counterregulatory cytokines that may prevent a Th-polarized response. Consistently, in vitro-generated monocyte-derived DCs pulsed with Porphyromonas gingivalis strain 381 or its LPS undergo maturation, up-regulate accessory molecules, and release proinflammatory (IL-1beta, PGE(2)) and Th (IL-10, IL-12) cytokines. Interestingly, the IL-10:IL-12 ratio elicited from P. gingivalis-pulsed DCs was 3-fold higher than that from Escherichia coli-pulsed DCs. This may account for the significantly (p < 0.05) lower proliferation of autologous CD4(+) T cells and reduced release of IFN-gamma elicited by P. gingivalis-pulsed DCs. Taken together, these findings suggest a previously unreported mechanism for the pathophysiology of CP, involving the activation and in situ maturation of DCs by the oral pathogen P. gingivalis, leading to release of counterregulatory cytokines and the formation of T cell-DC foci.

Immunohistological and morphometric analysis of intra-epithelial lymphocytes and Langerhans cells in healthy and diseased human gingival tissues

Periodontal diseases are histologically characterized by an infiltration of several inflammatory cell populations into the gingival epithelium and connective tissue, associated with degradation of extracellular matrix components. The purpose of this in situ study was to evaluate the inflammatory state of gingival tissues by the number of intra-epithelial lymphocyte (IEL) subsets and the area fraction (AA%) occupied by collagen fibres in the upper gingival connective tissue, and also to evaluate the number of CD1a+ Langerhans cells (LC) in order to show correlation(s), if any, between these histological findings. The gingival samples were from 10 clinically healthy controls (group C), 8 patients with gingivitis (group G) and 9 with chronic adult periodontitis (group P). A quantitative evaluation of the number of cell populations (CD1a+, CD45RB+, CD3+, CD8+, CD20+, TIA-1+ and GrB+ cells) and the area fraction (AA%) occupied by collagen fibres in the upper gingival connective tissue was made by morphometric and automated image analysis. The results showed that, compared with group C, all IEL subset numbers were significantly increased (p<0.05) in G and P groups, CD20+ excepted. In addition, there was a significant increase in the cytotoxic TIA-1+ IEL number (p<0.05) in group P when compared with group G. The study also showed a significant decrease in the number of CD1a+ LC in groups G and P (p<0.02 and p<0.001, respectively) when compared with group C. No significant difference was found in CD1a+ LC number between groups G and P. The determination of coefficients of correlation (r) with data obtained for each patient showed that in group G, CD1a+ LC number was significantly correlated with CD45RB+ (p<0.05) and CD3+ (p<0.01) IEL numbers whereas during periodontitis, CD1a+ LC number was significantly and inversely correlated with CD20+ (p<0.01), cytotoxic TIA-1+ (p<0.01) and with activated cytotoxic GrB+ (p<0.01) IEL numbers. Moreover, in group P a significant (p<0.05) positive correlation was shown between CD1a+ LC number and the AA% occupied by collagen fibres. This work demonstrates a decrease in CD1a+ LC number according to the severity of the periodontal disease estimated by the number of IEL and by the area fraction occupied by collagen fibres in human gingiva. The decrease of such cells could represent a way to avoid immune overstimulation.

Biocompatibility of dental casting alloys: a review

STATEMENT OF PROBLEM

Dental casting alloys are widely used in applications that place them into contact with oral tissues for many years. With the development of new dental alloys over the past 15 years, many questions remain about their biologic safety. Practitioners must choose among hundreds of alloy compositions, often without regard to biologic properties.

PURPOSE

This article is an evidence-based tutorial for clinicians. Concepts and current issues relevant to the biologic effects of dental casting alloys are presented.

SUMMARY

The single most relevant property of a casting alloy to its biologic safety is its corrosion. Systemic and local toxicity, allergy, and carcinogenicity all result from elements in the alloy being released into the mouth during corrosion. Little evidence supports concerns of casting alloys causing systemic toxicity. The occurrence of local toxic effects (adjacent to the alloy) is not well documented, but is a higher risk, primarily because local tissues are exposed to much higher concentrations of released metal ions. Several elements such as nickel and cobalt have relatively high potential to cause allergy, but the true risk of using alloys containing these elements remains undefined. Prudence dictates that alloys containing these elements be avoided if possible. Several elements in casting alloys are known mutagens, and a few such as beryllium and cadmium are known carcinogens in different chemical forms. Despite these facts, carcinogenic effects from dental casting alloys have not been demonstrated. Prudent practitioners should avoid alloys containing these known carcinogens.

CONCLUSION

To minimize biologic risks, dentists should select alloys that have the lowest release of elements (lowest corrosion). This goal can be achieved by using high-noble or noble alloys with single-phase microstructures. However, there are exceptions to this generality, and selection of an alloy should be made on a case-by-case basis using corrosion and biologic data from dental manufacturers.

In situ microsampling technique for identification of elements of a restoration with exposed metal to identify potential allergens

STATEMENT OF PROBLEM

For clinical investigations of allergic reactions to dental materials, it is necessary to know the type of metal used in restorations in the mouth of the patient. However, an intraoral method of sampling the dental alloy without removing the metal restoration has not yet been established.

PURPOSE

This study attempted to establish a clinically serviceable method for microsampling dental alloy.

MATERIAL AND METHODS

A piece of silicone sampling tube is held on the surface of the metal restoration. This surface was ground with a carbide bur through the sampling tube, and the ground metal particles were then recovered from the inner surface of the tube. The recovered sample was subjected to energy-dispersive x-ray microanalysis. The percentage recovery of ground alloy by this microsampling method, which was the ratio of the recovered weight of metal to the total weight of the metal ground, was evaluated using 3 mm diameter x 1 mm thick disk-shaped specimens of Ag-Au-Pd and Ni-Cr alloys.

RESULTS

Elemental analysis of the retrieved alloys identified the component elements in the alloy compositions. The percentage recovery by this microsampling method was 75.0% for Ag-Au-Pd alloy and 69.9% for Ni-Cr alloy, respectively.

CONCLUSIONS

The microsampling method demonstrated a relatively high percentage recovery of the ground alloy particles. This microsampling method would be of great benefit clinically to patients who have allergic reactions to dental materials.

Immunocompetent cells in amalgam-associated oral lichenoid contact lesions

Inflammatory cells in amalgam-associated, oral lichenoid contact lesions (OLL) were studied in 19 patients by immunocytochemistry using monoclonal antibodies. Ten of the patients displayed allergic patch test (PT) reactions to several mercury compounds and nine were negative. The immunocytochemical quantification showed a uniform composition of the inflammatory mononuclear cells in the two study groups. The number of HLA-D/DR-positive dendritic cells (P<0.001) and CD1a-positive Langerhans cells (P=0.035) was significantly lower in the PT-negative than PT-positive patients. HLA-D/DR expression on keratinocytes varied from negative to full thickness staining of the epithelium. HLA-D/DR expression in the full thickness of epithelium (3) or through the basal and spinous cell layers (2) was seen in 5 of 8 PT-positive patients, whereas none of the PT-negative patients had this staining pattern (P=0.045). These patients also showed a good clinical response after amalgam removal. Consequently, OLL may represent a true delayed hypersensitivity reaction with a trans-epithelial route of entrance of the metal haptens released from dental restorative materials.

Nickel hypersensitivity reaction before, during, and after orthodontic therapy

Nickel is a strong biological sensitizer and consequently may induce a delayed hypersensitivity reaction (type IV immune response). Because nickel is a component of the majority of the orthodontic alloys, the objectives of this cross-sectional study were to determine the prevalence of nickel hypersensitivity reaction before, during, and after orthodontic therapy with conventional stainless steel brackets and wires; to evidence the induction of this reaction by the orthodontic appliances; and to characterize the nickel hypersensitive persons. Nickel patch tests and a questionnaire were used to evaluate the hypersensitivity to this metal. The total sample consisted of 170 patients, 105 females and 65 males, from the orthodontic department at Bauru Dental School, University of São Paulo. They were divided into three groups as follows: A (n = 60), patients before the beginning of orthodontic therapy; B (n = 66), patients currently undergoing orthodontic treatment, and C (n = 44), patients who had undergone orthodontic treatment previously. The chi-square test (chi2) showed an allergic reaction in 28.3% of the total sample with 23% female and 5.3% male. This indicated a gender difference (chi2 = 10.75, p < 0.001). There was a positive association between nickel hypersensitivity and previous personal allergic history to metals (chi2 = 34.88, p < 0.0001) as well as with the daily use of metal objects (chi2 = 11.95, p < 0.0005). There was no statistically significant difference in the prevalence of contact dermatitis among the three groups (chi2 = 0.39, p = 0.848). This suggests that orthodontic therapy with conventional stainless steel appliances does not initiate or aggravate a nickel hypersensitivity reaction.

Comparison between submucosal (extra-nodal) and nodal non-Hodgkin's lymphoma (NHL) in the oral and maxillofacial region

Fifty-two cases of non-Hodgkin's lymphoma (NHL) in the oral and maxillofacial region, comprising 31 submucosal (extra-nodal) and 21 cervical node NHLs, were investigated. The patients' ages ranged from 5 to 86 years, with a bimodal age distribution among young people below 12 years of age (average 8 years) and in those aged 30 years or older (average 60.3 years). The male-to-female gender difference ratio was 1.3:1. Patients presented with swelling as the major symptom. Histologically, diffuse, large cell malignant lymphoma was the most frequent type and 67.9% of lymphomas were of intermediate malignancy as defined by the Working Formulation for Clinical Usage. All submucosal lymphomas showed diffuse proliferation patterns, although follicular proliferation was identified in 5 of the 21 nodal lymphomas. Immunohistochemistry showed that the B-cell type was predominant, especially in nodal lymphomas.

Surface and volume density of CD1a+ Langerhans cells in the human oral mucosa: a stereological study using vertical sections

Quantification of the surface and volume density of CD1a+ Langerhans cells in the human oral mucosa was carried out using a recently described technique of intercept counting on vertical sections, and the point counting method, respectively. The surface density of LC, i.e. surface area of LC per unit epithelial volume, was estimated between 310.8 mm-1 621.0 mm-1 (mean 420.3 mm-1), and estimated coefficients of error (estCE) were between 2.92% and 22.15%. Estimates of the volume density of LC, i.e. fraction of epithelial volume occupied by LC, yielded values from 1.56% to 13.15% (mean 5.96%) with estimated CE's of 5.69% to 25.94%. The investigation demonstrates the value of newer and older stereological tools to quantify complex cells such as LC on ordinary vertical sections without expensive equipment.

Biological effects of palladium and risk of using palladium in dental casting alloys

In dentistry, palladium is a very common component of dental casting alloys of all types, and its use has increased over the past several decades in response to the increased cost of gold. However, there have been recent controversies, particularly in Germany, over possible adverse biological effects of using palladium in dental alloys. Therefore, the purpose of this paper is to review the known biological effects of palladium and the likelihood that these effects can be caused by dental alloys which contain palladium. In an ionic form and at sufficiently high concentrations, palladium has toxic and allergic effects on biological systems. Palladium allergy almost always occurs in individuals who are sensitive to nickel. The carcinogenic potential of the palladium ion is still unclear, although there is some evidence that it is capable of acting as a mutagen. However, there are no well documented cases of adverse biological reactions to palladium in the metallic state. Furthermore, in spite of the potential adverse biological effects of palladium ions, the risk of using palladium in dental casting alloys appears to be extremely low because of the low dissolution rate of palladium ions from these alloys.

Oral mucosal Langerhans' cells

Langerhans' cells (LC) are dendritic, antigen-presenting cells present within the epithelium of skin and mucosa, including that of the oral cavity. This article reviews the literature on the phenotypic and functional features of oral mucosal Langerhans' cells, and speculates on other aspects by extrapolating from data on their epidermal counterparts.

Hg-provocation of oral mucosa in patients with oral lichenoid lesions

Five amalgam-bearing patients, with clinically and histologically confirmed oral lichenoid lesions, were tested by applying 0.5% Hg in petrolatum for 10 min to clinically normal mucosa. Control sites were exposed to petrolatum only. Four amalgam-bearing patients with no clinical evidence of oral lichenoid lesions served as controls; they were subjected to similar Hg and petrolatum exposure. After 24 h, biopsies were taken and immunocytochemically analyzed with monoclonal antibodies to lymphoid and nonlymphoid cells. No distinct differences could be detected between the Hg-exposed areas of the lichen patients and those of the nonlichen patients. Furthermore, normal mucosa exposed to petrolatum only showed a staining pattern in the lichen patients which was no different from the nonlichen patients. The findings are discussed with respect to possible mechanisms of development of lichen-like lesions in oral mucosa.

Langerhans cells in oral mucosa of rhesus monkeys before and after infection by simian retrovirus-1 and simian immunodeficiency virus

To study the influence of experimental infection with simian retrovirus-1 and simian immunodeficiency virus on the number and distribution of Langerhans cells in oral mucosa of rhesus monkeys, 10 monkeys were intravenously inoculated with simian retrovirus-1, 7 with simian immunodeficiency virus, and 2 were mock-inoculated. Biopsies were taken from gingiva and cheek pouch before infection and at 1 (simian immunodeficiency virus group only), 4, and 7 months after infection. Langerhans cells were detected in frozen sections by immunohistochemistry with monoclonal antibodies Leu-6 and HLA-DR. The mean number of Langerhans cells per surface millimeter and square millimeter of epithelium was calculated under blind conditions. The results showed no statistically significant differences in the number or distribution of Langerhans cells in the three groups at the various time points of examination. Similarly, no differences were detected within any group over the observation period. Thus systemic infection of rhesus monkeys with either simian retrovirus-1 or simian immunodeficiency virus does not lead to a significant change in the number of Langerhans cells in oral mucosal epithelium.

Acquired resistance and persistence of Candida albicans following oral candidiasis in the mouse: a model of the carrier state in humans

In our experimental model of oral candidiasis in the CD1 mouse, the primary infection showed reproducible Candida overgrowth kinetics with a peak level on day 5 of the infection. After day 7, the population stabilized at about 300 colony-forming units per excised mucosal tissue. The primary infection triggered an inflammatory response that resolved in under 8 days. At this point, the histological pattern of the mucosa reached a new equilibrium between recruited and resident mononuclear cells. The primary infection also rapidly stimulated cellular immunity, as measured from day 4 by a delayed-type hypersensitivity footpad reaction. Following a second topical challenge with Candida 30 days after the primary infection, the infection was barely detectable and a typical local delayed-type hypersensitivity reaction occurred between 24-72 h. It is proposed that acquired resistance, in conjunction with low-level persistence of Candida in our model, mimics the carrier state in sensitized humans.

Langerhans cells: structure, function and role in oral pathological conditions

Langerhans cells (LCs) are dendritic bone marrow derived cells situated suprabasally in most stratified squamous epithelia, such as the epidermis and the epithelium of oral mucosa, including the gingiva. Langerhans cells are thought to act as antigen-presenting cells (APC) during induction of immune responses. The exact role of Langerhans cells in the oral mucosa is not fully understood although several investigations suggest that these cells are involved in reactions to antigen challenge under both normal and pathological situations. In this paper the structure, phenotypic markers and derivation of Langerhans cells are reviewed. In view of recent findings, the immunological characteristics and the implications of Langerhans cells in pathologic oral reactions are discussed.

Effects of nickel-chrome dental alloys used in dentistry on saliva and serum nickel levels, peripheral T-lymphocytes and some other blood parameters

Epidemiological investigations have shown that nickel is a potent sensitivity producing agent. However, it is not known if intra-oral use of nickel-chrome alloys can cause any sensitization reaction. The purpose of this study was to determine if nickel-chrome alloys used in dentistry influence nickel levels in saliva and serum and whether there were associated changes of some blood parameters such as lymphocyte, T-lymphocyte, neutrophil, eosinophil, basophil and monocyte. The study was performed on 10 patients all of whom had no medical and dental history of using nickel containing drugs or restorations. Four unit fixed partial prostheses containing 22.97% nickel and 22.65% chrome were constructed and worn by the patients. Blood and unstimulated whole saliva samples were taken from the patients before insertion of the prostheses and then 1 month and 6 months post-insertion. Hematocrit determinations, total and differential leucocyte count, total T-lymphocyte counts and serum nickel concentrations were determined from the blood samples and salivary nickel concentrations from the saliva samples. It was found that there were no significant changes in circulating T-lymphocyte and monocyte population but a decrease was found in circulating eosinophil and an increase in circulating neutrophil and basophil populations.

Tissue distribution and cytofluorometric analysis of oral mucosal T cells in the BALB/c mouse

The incidence and distribution of Thy-1.2+, Lyt-2.2+ and L3T4+ cells in the murine oral mucosa were investigated using qualitative and quantitative approaches. From immunostaining of frozen tissue sections, it appeared that the majority of oral T cells are located either in the epithelium or within the minor salivary gland network. The occurrence of Thy-1.2+, L3T4+ and Lyt-2.2+ cells at these sites points to two strategic lines of defence in the event of mucosal infections or aggression. A quantitative analysis of oral T-cell subsets was made possible by optimizing an enzymatic digestion procedure which preserves all three T-cell surface markers. Flow cytometric analysis of oral mucosal cells demonstrated that the helper phenotype is about twice as numerous as the cytotoxic/suppressor phenotype in the mucosa. Furthermore, in single cell suspensions, virtually all Thy-1+ cells were either L3T4+ or Lyt-2.2+ in the mucosa and in the spleen. From this frequency analysis and our previous studies, we conclude that T cells are a major component of the oral immune system, being 2-3 times as numerous as B cells or macrophages. Present data on the spatial distribution and characteristic ratio of T-cell subsets assess the basal activity of the local T-cell populations in healthy animals and lay the basis for comparative studies of both qualitative and quantitative variations occurring during mucosal infections or autoimmune reactions.

Langerhans cells of human mucosa

The ontogeny of human LC and their presence in all Malpighian epithelia underline their important role in immunoregulation of the skin and mucous membranes. LC are also found in buccal and esophageal mucosa, in cornea and conjunctiva, in pulmonary, vesical, vaginal and cervical epithelia as well as in placenta villi. In all these Malpighian epithelia, the presence of DR + LC is necessary and essential for the surveillance function against allergo-antigens and the emergence of neo-antigens associated with malignant transformations.

Quantification and distribution of lymphocyte subsets and Langerhans cells in normal human oral mucosa and skin

Normal human oral (check) mucosa was studied to discover whether the oral cavity resembles the Mucosal Immune System (MIS) or the Skin Immune System (SIS). Immunophenotypes of lymphocyte subsets and Langerhans cells (LC) with their exact locations in the epithelium and papillary layer of the normal buccal mucosa were determined and compared with data of normal human skin. In a double staining procedure, the distribution of T-lymphocytes in relation to blood and lymph vessels was determined. Immunophenotyping of LC was done with a CD1a monoclonal antibody. In contrast to the skin, T-lymphocytes in buccal mucosa are not primarily perivascular in location. They are more or less randomly distributed on both sides of the basement membrane. The epithelium of the buccal mucosa contains about 37 times as many T-lymphocytes as the epidermis of normal skin. T-cell numbers in the papillary layer are more or less comparable. The CD4/CD8 ratios of about 1/2 in the epithelium of buccal mucosa and 1/4 in the skin indicates preferential presence of the CD8 subset in both sites, but the helper/inducer T-lymphocytes play a much greater role in the epithelium of the buccal mucosa when compared with skin. B-lymphocytes were not found in the epithelium and papillary layer of the buccal mucosa. Thus, immune response associated cells in buccal mucosa do not show the MIS pattern since B cells are absent. It has more in common with SIS but differences are also apparent. In the epithelium of the buccal mucosa the density of LC does not differ significantly from that of the skin, but the papillary layer of the buccal mucosa contains significantly fewer LC than the skin. As in the skin most of the LC of the buccal mucosa are found in the epithelium.