Understanding the complex pathogenesis of oral cancer: A comprehensive review

The pathogenesis of oral cancer is a complex and multifactorial process that requires a deep understanding of the underlying mechanisms involved in the development and progress of malignancy. The ever-improving comprehension of the diverse molecular characteristics of cancer, the genetic and epigenetic alterations of tumor cells, and the complex signaling pathways that are activated and frequently cross talk open up promising horizons for the discovery and application of diagnostic molecular markers and set the basis for an era of individualized management of the molecular defects underlying and governing oral premalignancy and cancer. The purpose of this article is to review the key molecular concepts that are implicated in oral carcinogenesis, especially focusing on oral squamous cell carcinoma, and to review selected biomarkers that play a substantial role in controlling the so-called "hallmarks of cancer," with special reference to recent advances that shed light on their deregulation during the different steps of oral cancer development and progression.

The role of oral microbiome in pemphigus vulgaris

While the impact of oral microbiome dysbiosis on autoimmune diseases has been partially investigated, its role on bullous diseases like Pemphigus Vulgaris (PV) is a totally unexplored field. This study aims to present the composition and relative abundance of microbial communities in both healthy individuals and patients with oral PV lesions. Ion Torrent was used to apply deep sequencing of the bacterial 16S rRNA gene to oral smear samples of 15 healthy subjects and 15 patients. The results showed that the most dominant phyla were Firmicutes (55.88% controls-c vs 61.27% patients-p, p value = 0.002), Proteobacteria (9.17%c vs 12.33%p, p value = 0.007) and Fusobacteria (3.39%c vs 4.09%p, p value = 0.03). Alpha diversity showed a significant difference in the number of genera between patients and controls (p value = 0.04). Beta diversity showed statistical differences in the microbial community composition between two groups. Fusobacterium nucleatum, Gemella haemolysans and Parvimonas micra were statistically abundant in patients. We noticed the characteristic fetor coming out of oral PV lesions. Most of anaerobic bacteria responsible for oral halitosis are periopathogenic. Though, only F. nucleatum and P. micra were differentially abundant in our patients. Especially, F. nucleatum has been reported many times as responsible for bad breath. Furthermore, Streptococcus salivarius and Rothia mucilaginosa, species mostly associated with clean breath, were found in relative abundance in the healthy group. Consequently, the distinct malodor observed in PV patients might be attributed either to the abundance of F. nucleatum and P. micra and/or to the lower levels of S. salivarius and R. mucilanginosa in oral lesions.

The possible role of oral microbiome in autoimmunity

OBJECTIVE

The human microbiome refers to the entire habitat, including microorganisms, their genomes and the surrounding environmental conditions of the microbial ecosystem. When the equilibrium between microbial habitats and host is disturbed, dysbiosis is caused. The oral microbiome (OMB) has been implicated in the manifestation of many intra- and extraoral diseases. Lately, there has been an intense effort to investigate and specify the relationship between microbial complexes, especially that of the oral cavity and intestine and autoimmunity. This study aimed to review the current literature about the possible role of the OMB in the pathogenesis of autoimmune diseases.

METHODS

We searched for published articles in English indexed in PubMed, Medline, Research Gate and Google Scholar using a search strategy that included terms for oral microbiome, autoimmune diseases, dysbiosis and next-generation sequencing.

RESULTS

An important number of articles were gathered and used for the description of the possible impact of dysbiosis of OMB in the pathogenesis of Sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, Behcet's disease, Crohn's disease and psoriasis.

CONCLUSION

This review article draws attention to the relationship between OMB and the triggering of a number of autoimmune diseases. Although this specific topic has been previously reviewed, herein, the authors review recent literature regarding the full list of nosological entities related to the OMB, point out the interaction between the microbiome and sex hormones with regard to their role in autoimmunity and discuss novel and promising therapeutic approaches for systemic autoimmune diseases. Furthermore, the question arises of whether the OMB is associated with oral bullous autoimmune diseases.

Daylight photodynamic therapy for the management of actinic cheilitis

Early identification and adequate treatment of actinic cheilitis (AC), which affects the lower lip vermillion and is considered a precursor of squamous cell carcinoma, is mandatory. Photodynamic therapy (PDT) has been successfully used in AC. PDT with the use of daylight (DLPDT) is equally effective and more convenient than the conventional PDT. Data on short and long-term efficacy of DLPDT in AC are limited. Our primary purpose was to assess efficacy of DLPDT in AC as well as safety and tolerance. Twenty-two individuals with histologically confirmed AC received 2 MAL (5-aminolevulinic acid)-DLPDT sessions 1 week apart. Patients were evaluated clinically 3, 6, and 12 months after treatment. Non-complete responders were biopsied and excluded from the study if histological alterations were indicative of AC. Adverse events were recorded from baseline to the end of the 12-month follow-up period. Twenty patients completed the study. Overall, complete clinical response 12 months after treatment was 80% (16/20), while an association between treatment response and grade of dysplasia was observed (p = 0.016). With respect to response by grade, complete clinical response achieved in grade I AC was 100% (12/12) and 50% (4/8) in grade II AC. Main adverse events included mild erythema, oedema, and scaling, with no pain associated with DLPDT. According to our results, DLPDT seems to be of significant benefit for the treatment of grade I AC. Combination with the other treatment modalities could improve the efficacy in grade II AC. Further studies are needed for the assessment of late recurrences.

Chronic Gingivostomatitis with Esophagitis in Cats

BACKGROUND

Chronic gingivostomatitis in cats (FCG) is a debilitating disease with potentially deleterious effects on overall health.

HYPOTHESIS/OBJECTIVES

Little is known about the pathophysiology and overall impact of FCG. The aims of our study were to investigate whether gingivostomatitis occurs concurrently with esophagitis, if FCG treatment contributes to esophagitis and if esophagitis exacerbates signs of FCG.

ANIMALS

Fifty-eight cats with clinical signs of FCG and 12 healthy control cats exhibiting no signs of oral disease, all client-owned.

METHODS

Prospective study. Physical, oral and endoscopic examinations were performed on all cats. Measurements of salivary and esophageal lumen pH were obtained from both groups. Biopsies were acquired from sites of esophageal inflammation in cats with FCG and from normal-appearing esophageal mucosa in control cats.

RESULTS

The majority of cats with clinical signs of FCG exhibited some degree of esophagitis especially in the proximal (44/58) and distal (53/58) parts (P < 0.001) with or without columnar metaplasia, compared to controls. All cats lacked signs related to gastrointestinal disease. Salivary and esophageal lumen pH were not statistically different compared to controls.

CONCLUSIONS AND CLINICAL IMPORTANCE

Feline chronic gingivostomatitis seems to occur concurrently with esophagitis. Esophagitis also should be managed in cats with chronic gingivostomatitis because it may aggravate the existing condition.

Oral Granular Cell Tumor: Report of Case Series and a Brief Review of the Literature

Background/Aim: The present analysis focuses on examining a case series of eight patients diagnosed with a granular cell tumor located in the oral cavity. Case series: The patients’ clinical states were thoroughly studied, along with the histopathological and immunohistochemical examinations findings. Their surgical treatment and postoperative course are also within the scope of this analysis. Numerous histogenesis theories and the appropriate tumor treatment are mentioned within the article being always in accordance with the relative literature. Conclusions: Oral granular cell tumor is a benign oral disease of possible neural origin commonly located on the tongue. Surgical excision is the treatment of choice. In any case, histological and immunohistochemical examination confirm both the clinical diagnosis and the differential diagnosis between oral squamous cell carcinoma.

Utility of photodynamic therapy for the management of oral potentially malignant disorders and oral cancer

Photodynamic therapy (PDT), defined as “the light-induced inactivation of cells, microorganisms, or molecules,” combines the use of a photosensitive agent or photosensitizer (PS) activated by irradiation with a light source to produce reactive oxygen species and highly reactive singlet oxygen. PDT has been used for the treatment of different oral diseases with promising results. This review describes the basic principles of PDT, including the nature of PS and the light sources, and focuses on evaluating the efficacy of this method, according to the existing data, for the treatment of different oral diseases. PubMed was used as the source of the relevant literature, about the clinical application of PDT in actinic cheilitis (AC), leukoplakia, oral lichen planus, oral lichenoid lesions, and oral cancer. Complete response to PDT as high as 100% has been reported not only in cases of AC but also in dysplasias/carcinomas in situ, T1N0, and T2N0. According to the available data, PDT appears to be a safe, well-tolerated therapy with limited adverse effects and excellent cosmetic outcome. Although PDT is a very promising therapy, further research is needed in order to investigate the cases that fail to respond, to examine the long-term prognosis for cases of reported complete response and thus avoid the future recurrence of diseases.

Essential mixed cryoglobulinemia manifesting as recurrent perioral edema: report of a case

Cryoglobulins are immunoglobulins that precipitate in vitro at temperatures <37°C but that redissolve if heated; they are broadly divided into 3 classes. Cryoglobulinemia has a plethora of clinical manifestations, but it typically presents a vasculitic syndrome, most notably a triad of purpura, arthralgia, and weakness secondary to cryoglobulin deposition in small or medium-sized blood vessels. The highly variable clinical presentation and inconsistent laboratory isolation of cryoglobulins mean that the diagnosis may be one of exclusion or of retrospective review. We describe a case of a 67-year-old woman whose principal symptom was recurrent perioral edema, which was characteristically induced by cold. Raised cryoglobulins combined with a positive autoantibody screen suggested mixed cryoglobulinemia secondary to Sjögren syndrome. However, in the subsequent 6 years, she has remained generally well, having developed no autoimmune, neoplastic, or other disease, suggesting the diagnosis is one of "essential" mixed cryoglobulinemia. No treatment other than symptomatic analgesia has been required.

Angiofibrolipoma of the oral cavity

We describe an unusual and rare case of a lipoma variant known as angiofibrolipoma. A literature search revealed only a few cases of angiofibrolipoma which were located in different anatomical sites; no case of angiofibrolipoma in the oral cavity has been previously reported. We present and discuss the histopatholological-immunohistological findings and features. Angiofibrolipoma histologically consists of mature adipocytes, blood vessels, and bundles of collagenous connective tissue with low to moderate cellularity. It is not encapsulated, but is histologically distinct from surrounding tissue. Positive immunohistological staining with CD-34 presented a large number of blood vessels of different sizes located between collagen fibers and adipocytes. The treatment of choice for a patient with angiofibrolipoma is surgical excision, which is expected to be curative.

Hereditary angioedema: three cases report, members of the same family

BACKGROUND

This current clinical case report highlights three cases of Hereditary angioedema (HAE) patients who are all members of the same family (father and his two daughters). The father has C1-INH deficiency, while his daughters have low C1-INH levels: the first possesses only 10% function and the second has low C1-INH level with 0% function. Of note, the second daughter was discovered to have HAE at the age of 2, thus making her the youngest known HAE case report in the English literature.

METHODS

Assess the efficacy of administration of C1-INH before dental operation as regards the prevention of HAE episode, when total or partial C1-INH deficiency exist.

RESULTS

Acute angioedema leading to laryngeal oedema is a possibly fatal complication for HAE patients undergoing dental procedures. Use of both short-term and long-term HAE prophylaxis prior to dental operations might be life saving for those patients.

CONCLUSIONS

Prevention and early recognition of potential laryngeal oedema that can occur as a complication of dental procedures may be lifesaving for HAE patients.

Oral lesions leading to the diagnosis of Crohn disease: report on 5 patients

Crohn disease is a chronic granulomatous inflammatory disease of the gastrointestinal tract of unknown etiology. Oral lesions are significant, as they may occasionally precede intestinal and systemic manifestations. In this retrospective study, clinical and histopathologic data were reviewed from the files of 5 patients with Crohn disease diagnosed at the Department of Oral Medicine and Maxillofacial Pathology School of Dentistry, Aristotle University, Thessaloniki, Greece, and Division of Stomatology and Oral Surgery, Faculty of Medicine, University of Geneva, Switzerland. In the 5 patients, clinical signs included erosions, deep ulcers, cobblestoning of the buccal mucosa, mucosal tags, and lip swelling. Histopathologic examination revealed a granulomatous inflammation with noncaseating granulomas and deep fissuring of the oral mucosa. In all 5 patients, oral lesions were the early signs of the disease. The diagnosis of Crohn disease was confirmed by a colonoscopy and a biopsy of colonic lesions. Oral lesions may be significant and/or initial signs of Crohn disease. Recognition of the lesions may provide an early diagnosis.

Coexistence of mucous retention cyst and basal cell adenoma arising from the lining epithelium of the cyst. Report of two cases

OBJECTIVE

To report 2 cases of coexisting mucous retention cyst and basal cell adenoma arising from the lining epithelium of the cyst.

CLINICAL PRESENTATION AND INTERVENTION

Two cases of painless swellings, well-demarcated, soft to palpation, and located in the submucosa of the upper lip were clinically examined with the provisional diagnosis of mucocele or salivary gland tumor. Histological examination showed the presence of a large unilocular cystic cavity in many parts surrounded by single or bilayered lining epithelium composed of flattened to cuboidal cells, and in other parts surrounded by projections of cells arranged in a trabecular pattern far into the cystic cavity. The trabeculae were composed of basal and low columnar cells that sometimes formed small duct-like structures. Immunohistochemistry showed that the lining epithelium of the cystic cavity and the cells of the projections expressed cytokeratin 7 and high-molecular-weight cytokeratins. The cells of the projections were weakly positive for S-100 protein and negative for vimentin and alpha-smooth muscle actin. Based on the results, a diagnosis of coexisting mucous retention cysts and basal cell adenomas arising from the lining epithelium of cysts was made.

CONCLUSION

The coexistence of mucous retention cysts and basal cell adenomas arising from the lining epithelium of the cyst is reported.

Human cytomegalovirus-associated oral and maxillo-facial disease

Human cytomegalovirus is a ubiquitous pathogen with protean clinical manifestations. After initial infection, the virus remains in a persistent state in the host. Immunity plays a pivotal role in counteracting its virulence, albeit intermittent virus shedding occurs in immunocompetent individuals. Should deficiencies in immunity occur, e.g., as a consequence of AIDS or iatrogenic immunosuppression, then virus replication and subsequent pathogenic manifestations ensue. In the oral and maxillo-facial region, the virus causes a wide variety of diseases, mainly atypical chronic ulcerations and sialadenitis. These morbidities are rarely reported and sometimes cause significant problems for clinicians.

Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis

Primary herpetic gingivostomatitis (PHGS) represents the clinically apparent pattern of primary herpes simplex virus (HSV) infection, since the vast majority of other primary infections are symptomless. PHGS is caused predominantly by HSV-1 and affects mainly children. Prodromal symptoms, such as fever, anorexia, irritability, malaise and headache, may occur in advance of disease. The disease presents as numerous pin-head vesicles, which rupture rapidly to form painful irregular ulcerations covered by yellow-grey membranes. Sub-mandibular lymphadenitis, halitosis and refusal to drink are usual concomitant findings. Following resolution of the lesions, the virus travels through the nerve endings to the nerve cells serving the affected area, whereupon it enters a latent state. When the host becomes stressed, the virus replicates and migrates in skin, mucosae and, in rare instances, the central nervous system. A range of morbidities, or even mortality, may then occur, i.e., recurrent HSV infections, which are directly or indirectly associated with PHGS. These pathological entities range from the innocuous herpes labialis to life-threatening meningoencephalitis.

Oral tuberculosis associated with a treatment with anti-rheumatic drugs

BACKGROUND

The use of immunosuppressive medication is a dominant risk factor for infection in patients with rheumatoid arthritis (RA). Methotrexate (MTX) is one of the traditional disease-modifying antirheumatic drugs. Adalimumab [a human anti-tumor necrosis factor-alpha (anti-TNF-alpha) monoclonal antibody] represent an important advance in the treatment of RA and has been recently come in use. TNF-alpha plays a role in the host defense against Mycobacterium tuberculosis and notably in granuloma formation. Infections occur at a high rate among those who use one or the combination of the two medications.

METHOD

We examined a female patient that was referred to our department for evaluation and treatment of a granular lesion on the soft palate and uvula, complaining of mild dysphagia. The patient was treated for 4 months with MTX and adalimumab for RA before the oral lesion appeared.

RESULTS

The histopathological examination of a specimen of the oral lesion, taken by biopsy, showed a chronic inflammation characterized by tuberculous granulomas. Polymerase chain reaction test and culture of a new specimen was positive for M. tuberculosis.

CONCLUSIONS

The therapeutic use of MTX or/and adalimumab for the treatment of RA or few others diseases, can cause oral tuberculosis.

Facial and perioral primary impetigo: a clinical study

Impetigo is the most common skin infection in children. The face, especially the perioral region, is one of the most frequently involved areas. Impetigo is a disease that interests the pediatric dentist, as it poses significant problems in its differential diagnosis from other conditions. Sixteen otherwise healthy children were examined suffering from facial and perioral impetigo. The typical clinical appearance was scattered, painless, slightly pruritic erosions covered by "honey-colored" crusts. In 4 children impetigo was localized in the facial and perioral area, whereas in all other cases lesions were diffused in perioral area and several regions throughout the body. Four children exhibited neck lymphadenopathy and one had mild fever. The treatment of impetigo included the application of topical measures with the systemic antibiotic chemotherapy.

Localized B-cell non-Hodgkin's lymphoma of oral cavity and maxillofacial region: a clinical study

OBJECTIVE

Non-Hodgkin's lymphomas (NHL) are the third most common group of malignant lesions in the oral cavity and maxillofacial region. Most such lymphomas have been shown to be predominantly of B-lineage. The purpose of the present study is to analyze the clinical signs and symptoms and the clinical staging of B-cell NHL of this region.

STUDY DESIGN

Eighteen adults, with B-cell NHL manifestations of the oral cavity and maxillofacial region, were available for this study. The clinical stage according to the Ann Arbor system was assessed by history, physical, and laboratory examination. Hematoxylin and eosin--stained slides and paraffin blocks were available for all cases. Histologic diagnosis was based on the WHO classification of tumors.

RESULTS

The mean age of patients at the time of biopsy was 64 years. At the time of the disease presentation, according to the Ann Arbor system, 11 patients were in stage IE, 2 patients in stage IIE, 2 patients in stage IIIE, 1 patient in stage IVE, and 2 patients in stage IV. The typical clinical appearance was a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass. Tonsillar NHL was the most frequent site occurring in 8 patients followed by NHL of the oral cavity, of the salivary glands, and of the mandible. Grading revealed that most cases were high grade (11 cases), followed by the cases of low grade (5 cases) and intermediate grade (2 cases). All the different histologic types may be observed, but the most frequently encountered is the diffuse large type.

CONCLUSIONS

The B-cell NHL may involve both osseous and soft tissues of the oral cavity and maxillofacial region. The favored sites are tonsils, palatal mucosa and parotid glands. The typical clinical appearance is a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass. According to the Ann Arbor system, the majority of the cases at the time of diagnosis are in stage I or II. Most patients have high grade disease. All the different histologic types may be observed, but the most frequently encountered is the diffuse large type.

Acquired macroglossia due to lopinavir/ritonavir treatment

A HIV-positive patient, 3 months after the treatment initiation with lopinavir-/ritonavir (LPV/r) acquired macroglossia. The tongue biopsy revealed mature adipose tissue accumulated into submucosa. The drug was discontinued and the patient showed a significant improvement. This case is the first case in the medical literature of acquired macroglossia because of LPV/r, a drug causing changes in body fat composition.

Follicular lymphoid hyperplasia of the palate: report of a case and review of the literature

The follicular lymphoid hyperplasia of the palate is a very rare benign lymphoproliferative lesion that closely resembles lymphomas, clinically or histopathologically or both. A case of follicular lymphoid hyperplasia of the palate is reported. Clinically, the lesion presented as a firm, painless, nonulcerated, nonfluctuant and slowly growing swelling on one side of the palate. The biopsy showed the typical histologic features: multiple germinal centers with a rim of well-differentiated B lymphocytes together with a mixed, mainly mononuclear infiltrate with many plasmacytoid lymphocytes. The clinicopathologic features are described and integrated into a review of the 19 previously recorded cases. The diagnosis of a follicular lymphoid hyperplasia should always be considered in cases of palatal swelling.

Oral manifestations of infections of infections due to varicella zoster virus in otherwise healthy children

Varicella zoster virus (VZV) causes varicella (or chickenpox) and establishes latency in nerve ganglia after the primary infection. The reactivation of virus later in life can cause mono- or polyneuropathy. The cranial nerves most commonly involved are five (herpes zoster or shingles), six, seven eight, nine and ten. In the present study we describe the oral lesions associated with VZV infections in normal children. In a 3 year period we examined 62 children, age 2 to 13 years old with diagnosed varicella and a 4 year old boy with herpes zoster at the 3rd branch of the trigeminal nerve. According to the clinical picture of varicella, the disease was defined as: (1) group A mild cases; (2) group B moderate cases; (3) group C severe. The manifestations of varicella were: mild varicella 19 children, moderate 26 children and severe 17 children. The results of the present study indicate that the prevalence of oral manifestations of varicella is related to the severity of the disease. In 17 severe cases, oral lesions were always present and the number was between 5 to 30. From 26 moderate cases, oral lesions were observed in 23 and the number was between 2 to 10. From 19 mild cases, oral lesions were present only in 6 cases and their number was 1 or 2. Often varicella's oral lesions resemble manifestations of other entities, and this may cause differential diagnostics problems.

Antibacterial properties of dentin bonding systems, polyacid-modified composite resins and composite resins

This study examined the antibacterial activities of the bonding systems Syntac, EBS and Scotchbond 1, the polyacid-modified composite resins Hytac and Compoglass, and the composite resins Tetric, Z100 and Scalp-it. They were evaluated using the cariogenic bacteria Streptococcus mutans, Lactobacillus salivarius, Streptococcus sorbinus and Actinomyces viscosus in vitro with a modified cylinder drop plate agar diffusion assay. All adhesives of the dentin bonding systems and the polyacid-modified composite resins exhibited various degrees of antibacterial activity against all of the test bacteria. On the contrary, composite resins did not affect bacterial growth. The data suggest that the use of these adhesives and polyacid-modified composite resins may reduce the consequences of microleakage owing to their antibacterial properties.

Facial and perioral molluscum contagiosum as a manifestation of HIV infection

Molluscum contagiosum (MC) is a self-limiting viral disease of the skin and the mucous membranes. Facial and perioral MC is seen with increasing frequency in human immunodeficiency (HIV) infection, particularly in HIV infected homosexual men. The purpose of this study was to describe clinical observations of facial and perioral MC in HIV infected patients. One hundred and eighty HIV-positive individuals (160 males and 20 females) were examined over a period of five years. Fifty-eight were homosexual men and 19 were bisexual men. Fifty-one of 180 patients at the time of the first examination had CD+4 count < 200 cells/mm3 and another 63 presented loss of CD+4 cells in this level, during this period. Three HIV infected patients (two homosexual and one bisexual) were affected with facial and perioral MC. At the time of MC diagnosis the CD+4 count was less than 200 cells/mm3 for all three patients. One patient died nine months after MC diagnosis and the other two are still alive. It is remarkable that in this study no clinical lesions were observed on other sites of the skin.

Concentration of 3 tetracyclines in plasma, gingival crevice fluid and saliva

BACKGROUND

Systemically-administered tetracyclines have been used widely for treatment of periodontal diseases with little understanding of their delivery characteristics to periodontal tissues. This study was designed to measure concentrations of 3 tetracyclines in gingival crevice fluid (GCF), plasma and saliva of following systemic administration.

METHOD

The concentration of tetracycline (TC), minocycline (MN) and doxycycline (DX) was measured in gingival crevice fluid (GCF), plasma and saliva of 20 subjects following single sequential standard oral systemic doses. Gingival crevice fluid concentration was measured at 4 sites (2 shallow and 2 deep) before administration, and at 1 h and 2 h following administration. Plasma and saliva concentrations were measured from in samples at the same time points. No antibacterial activity was detected before administration. The highest concentrations were measured 2 h after administration.

RESULTS

The average concentrations at 2 h were highest in plasma (TC = 1.02, MN=2.18, DX=2.35 microg/ml). Intermediate concentrations were measured in GCF (TC=0.61, MN= 1.49, DX= 1.65 microg/ml). Saliva concentrations (TC=0.09 MN=0.31, DX=0.47 microg/ml) were the lowest of the 3 fluids monitored. Data are presented indicating that the average GCF concentration of systemically administered tetracyclines is less than the that of plasma concentration. The concentration of tetracyclines in GCF was strongly associated with plasma concentration, indicating a primary role of drug absorption in the delivery of these systemically administered antibiotics to the site of action in periodontal therapy. The average GCF concentration in individuals varied widely (between 0 and 8 microg/ml) with approximately 50% of samples not achieving levels of 1 microg/ml.

CONCLUSION

These observations suggest that poor absorption of orally-administered tetracyclines in many individuals may account for much of the variability in clinical response to antibiotics observed in practice.

Beta-lactamases producing anaerobic bacteria in dentoalveolar abscesses

Pus samples of 30 patients with closed dentoalveolar abscesses who had not received antimicrobial therapy for at last two months were screened for the presence of beta-lactamase-producing anaerobic bacteria. From these 30 pus samples, a total of 112 bacterial strains were isolated; 83 of them were strict anaerobes and 29 were aerobes. beta-lactamases activity of the selected anaerobic bacteria was tested after identification of the isolates and was detected in 5 of the total 83 (6%) strict anaerobic isolates, whereas these 5 strains were isolated in 4 of the 30 (13.3%) pus samples. The species with beta-lactamase activity were in the Prevotella intermedia (4 from 14 isolates) and the Fusobacterium nucleatum (1 from 9 isolates) groups. None of the gram-positive and the other gram-negative anaerobic strains were beta-lactamase positive.

[Lithiasis of a minor salivary gland. Apropos a case]

Sialolithiasis of minor salivary glands is generally considered to be extremely rare, particularly in younger persons. In addition, the symptomatology of this entity is not always typical and, for this reason, clinical misdiagnosis is possible. A case of sialolithiasis of minor salivary glands of the cheek in a 20 year-old woman is reported. The clinical diagnosis is verified by the histopathological examination after surgical excision of the lesion.

Granulomatous cheilitis: a study of six cases

OBJECTIVE

Granulomatous cheilitis (GC) is a very rare disorder of unknown etiology. Clinically, GC is characterised by recurrent swelling of the labial tissues, which may be followed by a permanent enlargement. Histologically, the typical form of GC is characterised by the formation of scattered aggregates of non-caseating granulomas. GC is the most frequent sign of orofacial granulomatosis, a disorder under which also encompasses sarcoidosis, Crohn's disease, atypical tuberculosis, Anderson-Fabry disease, possibly some allergic reactions, and Melkersson-Rosenthal syndrome (MRS). Some consider GC as an oligosymptomatic or monosymptomatic form of MRS.

SUBJECTS AND METHODS

In this study we examined the clinical records of six patients presenting with GC which were examined and treated in the Department of Oral Medicine and Pathology of the Dental School of Aristotle University of Thessaloniki (Greece) during a 16-year period. In five of six patients a persistent swelling of the lower lip was recorded, one of whom also developed swelling in the upper lip. In one case the swelling was present in both lips and in another the GC was the only clinical finding, while in the other five cases it was accompanied by at least one other feature of MRS. In five cases, the histological picture revealed non-caseating granulomas.

RESULTS

The treatment with the intralesional infusion of corticosteroids in three cases and the oral administration of corticosteroids in two cases was successful. One of the patients refused to be treated. This patient also presented later with permanent swelling of the upper lip.

Oral tuberculosis

A case with oral tuberculosis and unaware of systemic tuberculosis is reported. The oral lesions clinically manifested as two painless ulcerations in the hard palate. Pulmonary tuberculosis was diagnosed following the histopathologic and bacteriologic examination of the oral lesions.

Susceptibility of Capnocytophaga to antimicrobial agents

A total of 22 clinically isolated Capnocytophaga strains were tested for their susceptibility to antimicrobial agents frequently used in dental practice. All strains were susceptible to penicillin, ampicillin, cefaclor, cefuroxime, erythromycin, clindamycin and tetracycline. Metronidazole had poor activity against most strains.

Median rhomboid glossitis. An oral manifestation in patients infected with HIV

A follow-up study included the oral examination of 39 persons known to be infected with the human immunodeficiency virus. In addition to the other human immunodeficiency virus-associated oral lesions, lesions clinically similar to the smooth form of median rhomboid glossitis, which is now believed to be erythematous candidiasis located in the dorsum of the tongue, were found in seven patients (18%). Patients with median rhomboid glossitis were classified in different stages of the Centers for Disease Control 1986 classification system and showed an average of CD+4 cell counts 397.5/mm3. Also the presence or the absence of anti-p24 antibodies in the serum and stimulated whole saliva of the patients with median rhomboid glossitis did not correlate with the stage of the disease or with low levels of CD+4 cell counts as in other forms of oral candidiasis. Therefore our results suggest that median rhomboid glossitis should be included as a distinct form of oral candidiasis in the classification of the oral manifestations of infection with the human immunodeficiency virus.

Immunologic status in patients infected with HIV with oral candidiasis and hairy leukoplakia

Although numerous studies of oral manifestations associated with HIV have been reported, only a few refer to the correlation of these lesions with laboratory parameters. In this study we investigated the relationships between the two most common HIV-associated oral lesions, oral candidiasis and hairy leukoplakia, with the stage of the disease, circulating CD4+ cell counts, and the presence of anti-p24 antibodies in serum and stimulated whole saliva in 43 known HIV-1-infected persons. Although oral candidiasis and hairy leukoplakia were exclusively observed in subjects who were classified as Centers for Disease Control and Prevention group IV, only the prevalence of oral candidiasis is strongly associated with circulating CD4+ counts less than 200/mm3 (p < 0.02). The prevalence of oral candidiasis and hairy leukoplakia was significantly related to the absence of anti-p24 antibodies in serum (p < 0.01 and p < 0.01, respectively), but was only statistically significant for hairy leukoplakia in stimulated whole saliva (p < 0.02). The results suggest that oral candidiasis and hairy leukoplakia in correlation with immunologic status as indicated by low circulating CD4+ cell counts and the absence of anti-p24 antibodies in serum and the loss of secretory anti-p24 antibodies in subjects with hairy leukoplakia, may constitute prognostic markers for the progression of HIV-infection to AIDS. Our results also indicate that the absence of anti-p24 antibodies is not only influenced by the low levels of circulating CD4+ cells but probably by the presence of oral candidiasis or hairy leukoplakia as well.

Oriental sore: a case report

We report a typical case of an oriental sore (cutaneous leishmaniasis) in a 28-year-old patient. The lesion was located on the upper lip, causing macrocheilia and an esthetic problem to the patient, who required urgent treatment. N-Methylglucamine antimonate proved to be an effective, well-tolerated drug.

[Ex-vivo study of the capacity of bacteria of the genus Capnocytophaga to adhere to human buccal epithelial cells]

The bacteria of the genre Capnocytophaga are part of the subdominant flora of the oral cavity. For diverse microorganisms it has been proved that the adhesion constitutes the first step of the colonization of a place leading to the eventual pathology. The adhesion capacity to human epithelial cells (keratinised and non) of eight strains of genus Capnocytophaga has been studied. All strains appear to have a very weak capacity of adhesion. This diministe can be originated from the fact that the host cells have been harvested from healthy subjects.

Susceptibility of Eikenella corrodens to antimicrobial agents

Twelve Eikenella corrodens strains were isolated from dental infections and tested for their susceptibility to antimicrobial agents by an agar dilution method. All strains were susceptible to penicillin, ampicillin and tetracycline, and resistant to cephalexin and metronidazole and moderately resistant to erythromycin, gentamicin and cefaclor.

[Oral isolation of Neisseria gonorrhoeae in the presence of gonococcal urethritis]

The Neisseria Gonorrhoeae, the etiologic agent of the gonococcic urethritis, can produce other clinical manifestations, such as stomatitis, TMJ arthritis and sialadenitis. The investigation of this germ in the oral cavity of 50 patients with gonorrhea, was positive in only one case, which did not present any buccal symptom. It was concluded from this study that an oral gonococcic infection is extremely rare, and that the transmissibility of this germ orally is not frequent eventhough possible in theory. However the infection can spread through the blood stream and can induce other pathology.