Case challenge: persistent oral tenderness

An 81-year old male presents with a chief complaint of oral soreness, primarily involving the tongue and denture-bearing mucosa. Symptoms have been present for approximately two months and have not been relieved by denture adjustments.

A comparison of salivary calprotectin levels in subjects with and without oral candidiasis

OBJECTIVES

The purpose of this study was to compare salivary calprotectin levels in subjects with oral candidiasis to the levels in healthy age- and sex-matched control subjects and to investigate the relationship of salivary calprotectin to intensity of oral candidal carriage and infection and to predisposing factors for candidiasis.

STUDY DESIGN

Using enzyme-linked immunosorbent assay, we measured calprotectin in unstimulated whole saliva collected from 22 subjects with oral candidiasis and in saliva collected from 22 control subjects. Calprotectin levels in the 2 groups were compared by using the Wilcoxon signed rank test. The relationships between calprotectin levels and Candida counts were assessed by using the Spearman rank correlation test. The nonparametric 1-way analysis of variance test was used to study the relationship between calprotectin levels and presence of non-albicans Candida and individual predisposing factors for candidiasis. The Kruskal-Wallis test was used to evaluate the relationship between calprotectin and predisposing factors in subjects grouped by total number of predisposing factors identified.

RESULTS

No relationship was found between calprotectin and individual or total number of predisposing factors. Higher calprotectin levels were found in subjects with candidiasis, and calprotectin concentration positively correlated with intensity of candidal infection.

CONCLUSIONS

These findings suggest that calprotectin production, or release, or both, may be increased in subjects with candidiasis.

The effects of contamination on biological monitoring

We investigated the frequency and patterns of biological-monitoring-test contamination and the effect of contamination on the growth of test organisms. Overall, the contamination rate was 0.81%, but the rate of contamination varied significantly by sterilization method. Contamination did not appear to inhibit growth of test organisms.

Oral mucosal hyperpigmentation secondary to antimalarial drug therapy

A case of oral mucosal hyperpigmentation resulting from antimalarial drug therapy is presented. The patient reported a history of long-term quinacrine therapy and exhibited diffuse blue-gray pigmentation of the nail beds and the skin of the nasal ala. Microscopic examination of the involved mucosa showed macrophages, containing both melanin and ferric iron, scattered within the connective tissue adjacent to the epithelium. The clinical, historical, and microscopic features of antimalarial-induced pigmentation are discussed. Other causes of diffuse or multifocal oral pigmentation are also addressed.

Acquired tufted angioma: a unique vascular lesion not previously reported in the oral mucosa

We describe two patients with acquired tufted angioma, a unique vascular lesion not previously reported in the oral mucosa. In one patient, the lesion manifested as a purple-red papule and, in the other, as a blue submucosal swelling. Both lesions were non-painful and neither was associated with a history of trauma. The histopathological features consisted of scattered, irregularly shaped tufts, primarily composed of poorly formed capillary spaces and slit-like vascular channels. Capillary spaces were often closely packed, producing solid areas which stained for smooth muscle actin. Staining for factor VIII-related antigen was positive only within endothelial cells lining well-formed vascular channels. Both lesions were treated by excision; short-term follow-up of one patient revealed no evidence of recurrence. Similarities between this and other vascular processes may have resulted in misdiagnosis of this lesion in the past. The clinical significance of acquired tufted angioma in the oral mucosa is not known.

Cranial arteritis: a medical emergency with orofacial manifestations

BACKGROUND

Cranial arteritis, or CA, a vascular disease affecting primarily elderly people, may result in permanent blindness if untreated. Since it frequently mimics temporomandibular joint, myofascial or odontogenic pain, dentists must be familiar with this condition.

CASE DESCRIPTION

The authors present reports of two patients who had signs and symptoms of CA, some of which were suggestive of other head and neck pain disorders. In both cases, the diagnosis of CA was confirmed by temporal artery biopsy, and treatment with systemic steroids resulted in rapid resolution of symptoms.

CLINICAL IMPLICATIONS

Prompt diagnosis and treatment of CA not only results in resolution of symptoms, but also may prevent blindness, the most serious sequela of the condition.

Frequency, intensity, species, and strains of oral Candida vary as a function of host age

While the age of the host has been suggested as a determining factor in yeast carriage, no studies in which the genetic relatedness of isolates has been assessed in combination with the frequency and intensity of carriage as a function of host age have been performed in a single geographical locale and over a short time window. Therefore, by using a simple plating protocol to determine the frequency and intensity of carriage, sugar assimilation patterns to determine species, and Southern blot hybridization with the DNA fingerprinting probe Ca3 combined with computer-assisted analysis to determine the genetic relatedness of strains of Candida albicans, yeast carriage was analyzed as a function of age. All test individuals lived in the Iowa City, Iowa, locale and, except for some of the 0.5- to 1.5-year-olds, were dentate. The results demonstrate that for this test population, the frequency, average intensity, predominant species, and genetic relatedness of C. albicans strains varied as a function of host age. In addition, comparison with oral commensal organisms from the Ann Arbor, Mich., locale confirms the geographical specificity of C. albicans strains and the existence of an Iowa City-enriched strain which is most prevalent in elderly individuals.