Immunoglobulin clases IgG, IgM, IgA and complement component C3 in dental periapical lesions of patients with rheumatoid disease

Root canal treatment and general health: a review of the literature

REVIEW

The focal infection theory was prominent in the medical literature during the early 1900s and curtailed the progress of endodontics. This theory proposed that microorganisms, or their toxins, arising from a focus of circumscribed infection within a tissue could disseminate systemically, resulting in the initiation or exacerbation of systemic illness or the damage of a distant tissue site. For example, during the focal infection era rheumatoid arthritis (RA) was identified as having a close relationship with dental health. The theory was eventually discredited because there was only anecdotal evidence to support its claims and few scientifically controlled studies. There has been a renewed interest in the influence that foci of infection within the oral tissues may have on general health. Some current research suggests a possible relationship between dental health and cardiovascular disease and published case reports have cited dental sources as causes for several systemic illnesses. Improved laboratory procedures employing sophisticated molecular biological techniques and enhanced culturing techniques have allowed researchers to confirm that bacteria recovered from the peripheral blood during root canal treatment originated in the root canal. It has been suggested that the bacteraemia, or the associated bacterial endotoxins, subsequent to root canal treatment, may cause potential systemic complications. Further research is required, however, using current sampling and laboratory methods from scientifically controlled population groups to determine if a significant relationship between general health and periradicular infection exists.

Monoclonal and oligoclonal immunoglobulins localized in human dental periapical lesion

The gamma-globulin fractions of extracts obtained from 70 periapical lesions were studied by agarose gel electrophoresis and immunofixation. In agarose gel electrophoresis, homogeneous bands in the gamma-globulin region were found in 25 of 70 specimens (36%). Among the 25 specimens showing homogeneous bands, these bands in six specimens were identified as monoclonal or oligoclonal immunoglobulins. Local production of oligoclonal immunoglobulins was suggested since the corresponding homogeneous bands were not detected in the serum of the same patient. These immunoglobulins may be produced as a result of local immunogenic response against infecting bacteria in periapical inflammation.

Deposits of immunoglobulins and complement factor C3 in human dental periapical inflammatory lesions

Thirty-five human dental periapical lesions were studied by immunofluorescence technique using polyclonal anti-IgG (F(ab)2), anti-IgM (F(ab)2), anti-IgA (F(ab)2), anti-IgE and anti-C3c as well as monoclonal anti-IgE. Prewashed ethanol-fixed specimens showed a great number of plasma cells staining for IgG. Cells containing IgA, IgM or IgE were also seen. Deposits of immunoglobulins and C3c suggestive of immune complexes were demonstrated using a double staining technique combining FITC-labeled immunoglobulins with TRITC-conjugated C3c. The complexes were located intracellularly in macrophages, as well as in vessel walls and in the basement membrane zone of proliferating epithelium. Immune complexes may be involved in the epithelial proliferation in those granulomas which lead to cyst formation. Monoclonal anti-IgE demonstrated plasma cells and mast cells, as well as intercellular IgE in epithelial strands of granulomas. The role of IgE in the epithelium is obscure. The study strongly indicates the involvement of hypersensitivity reactions type I and III in periapical inflammatory lesions.

Quantitation of circulating immune complexes, immunoglobulins G and M, and C3 complement component in patients with large periapical lesions

The serum concentrations of circulating immune complexes, immunoglobulins G and M, and the C3 complement component of thirty patients with one to three large periapical lesions were measured and compared with those of patients with no periapical lesions. The results indicate that there is no statistical difference between the two groups, and it appears that chronic periapical lesions cannot act as a focus to cause systemic diseases via immune complexes.

In situ characterization of cell infiltrates in human dental periapical granulomas. 1. Demonstration of receptors for the Fc region of IgG

The aims of the present study were to demonstrate FcR activity of dental periapical granulomas and to correlate the activity with the degree of lymphoreticular cell infiltration. Cryostat sections of 46 out of 51 granulomas adsorbed sheep erythrocytes(E) sensitized with rabbit IgG antibodies (A) (EA). No adsorption occurred using erythrocytes sensitized with F(ab')2 fragments of IgG. IgG and Fc fragments of human of rabbit IgG inhibited the binding of EA, whereas F(ab')2 fragments, human IgA, IgM or albumin did not, indicating the presence of receptors for the Fc region of IgG. Periodate, neutral formaldehyde and phospholipase C abolished the FcR activity whereas neuraminidase had no effect. Comparison of sections binding EA and adjacent sections stained with haematoxylin and eosin showed that EA adhered to areas infiltrated with mononuclear cells. The degree of binding of EA coincided with the density of mononuclear cell infiltration. Point attachments between the tissue sections and the adsorbed EA could be demonstrated by scanning electron microscopy. Sections with no infiltrates did not bind EA.

Detection of immune complexes in human dental periapical lesions by anticomplement immunofluorescence technique

Twenty-five human dental periapical lesions were obtained. The lesions were frozen, sectioned, and examined for the presence of immune complexes by employing an anticomplement immunofluorescence (ACIF) technique. Twenty-three of the periapical specimens were positive for antigen-antibody complexes. No staining was noted in the two lesions that were histologically diagnosed as periapical scar tissue.

Immunopathogenesis of chronic periapical lesions. A review

The pathogenesis of periapical lesions has not been fully elucidated. Currently, the possibility of its being an immunologic phenomenon is receiving much attention. This article presents a review of the literature concerning immunologic reactions which may involve periapical lesions. It appears that antigen-antibody complexes and IgE-mediated reactions can initiate preliminary changes in periapical tissues. It is also likely that delayed hypersensitivity participates in the perpetuation and progression of periapical disease.

Soluble proteins in fluid from non-keratinizing jaw cysts in man

Fluids from non-keratinizing cysts of the jaws contain the main proteins found in plasma. The low relative concentration of macromolecular non-immunoglobulin proteins shows that there is no free passage of plasma proteins into the cyst fluid. Sufficient evidence was found to conclude that the immunoglobulins in cyst fluid are partly produced locally and partly derived from plasma. Cyst fluid immunoglobulins have antibody activity to rabbit erythrocytes. Accumulation of cyst fluid is primarily due to inadequate lymphatic drainage of the cyst cavity. Differential diagnosis between various types of non-keratinizing cysts cannot be based on the plasma protein patterns of their fluids.

IgG rheumatoid factor in dental periapical lesions of patients with rheumatoid disease

To detect "hidden" IgG rheumatoid factor in tissues from dental periapical lesions, 26 rheumatoid and 14 control patients were examined by the direct immunofluorescence technique for binding of FITC-labelled IgG before and after pepsin digestion. Whereas free rheumatoid factor was detected in only 1 rheumatoid tissue before digestion with pepsin, this tissue as well as 8 other rheumatoid tissues strongly bound heat-aggregated IgG after the digestion procedure. Six of these 9 tissues also bound native IgG. In no control tissue was free rheumatoid factor detected and in only 1 was "hidden" rheumatoid factor revealed after pepsin digestion. Hence, presence of IgG rheumatoid factor correlated positively with the presence of rheumatoid disease, and evidence was established that certain features of rheumatoid inflammation occur in dental periapical lesions of many patients with rheumatoid disease.

Occurrence of amyloid in the teeth-supporting tissues of patients with rheumatoid diseases. An immunohistochemical study

An investigation was carried out to determine whether amyloid could be detected in the dental periapical lesions or gingival buccal fold, or in both, of patients with rheumatoid disease but in whom amyloidosis had not been diagnosed. Tissue from the dental periapical lesions of 36 rheumatoid and 23 control patients, as well as from the gingival buccal fold of 11 of the rheumatoid and 11 of the control patients, were examined by the direct immunofluorescence technique and by polarization microscopy of sections stained with Congo red. Amyloid was observed almost 5 times more often, or in 19% of the dental periapical lesions of rheumatoid patients: it was detected by immunofluorescence in 7 rheumatoid patients and 1 control patient, and by polarization microscopy in 6 of these 7 rheumatoid patients as well as in the 1 control. Rectal biopsies performed on these 8 patients were positive in only 1 of the rheumatoid patients. Amyloid was not detected in any of the gingival biopsies. Serum samples from the rheumatoid and the control patients were tested for the presence of the nonimmunoglobulin amyloid fibril-related serum component, protein ASC. Nineteen of the 36 rheumatoid patients, including the 7 whose dental periapical lesions contained amyloid, had protein ASC in their serum.