Oral exfoliative cytology is one of simple examination methods in which cells are scraped from the surface of oral lesions observed under a microscope. The present report of 3 cases describes the patients showing the gingival diseases with vesiculobullous lesions that were presumptively diagnosed by exfoliative cytology. All 3 patients complained of painful and erythematous gingivae. Smears were obtained by brushing the attached gingiva using a cytobrush. Tzanck cells, which were demonstrated two-ton colored cytoplasm; eosinophilic in nuclear surroundings and light-blue in periphery of cytoplasm, were observed in 2 cases. Therefore, the possibility of pemphigus vulgaris was suspected. Cells where virus infection was suggested, those were demonstrated nuclear ground glass appearance and multi-nucleated; each nucleus was face to face with another squeezed together, were observed during the therapeutic process with applying topical corticosteroid in one of the same 2 cases, and additionally in another one case. Thus, the exfoliative cytology was useful in screening for herpes virus infection or pemphigus vulgaris on the gingival lesions in these 3 cases.

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Although hyperorthokeratosis and hyperparakeratosis are commonly seen in several oral mucosal lesions, their induced mechanisms are not known. Thus, the aim of this study is to analyze the induced mechanism of hyperkeratinization. We made keratinized oral mucosal epithelium (GE1) system by culturing oral mucosal cells at the air-liquid interface. Then, we analyzed the influence of inflammatory cytokines (TNF-α and IL-6), FGF10, and caspase family inhibitor on the cornified layer in this system. In results, TNF-α significantly thickened the cornified layers (P < 0.05). Simultaneously TUNEL-positive cells were significantly increased with TNF-α (ANOVA, P < 0.05) and also BrdU-incorporating cells (ANOVA, P < 0.05) were increased. Cornified layers were perfectly disappeared when keratinized oral mucosal epithelial cells were cultured with caspase family inhibitor. In conclusion, it is thought that TNF-α enhanced apoptosis and resulted in hyperkeratinization of the oral mucosal epithelium in air-liquid culture.

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Itraconazole oral solution (ITCZ-OS) exerts excellent efficacy but causes adverse reactions (gastrointestinal disorders) relatively frequently. To resolve this problem, we devised ITCZ-OS gargle remedy (intake of this drug by means of gargle). The present study was undertaken to evaluate the efficacy of this therapy and to explore the mechanism for action of this preparation through analysis of drug levels in mucosal tissue and plasma. The subjects of this study were 25 patients with oral candidiasis. Each patient took ITCZ-OS by means of gargle for 2 minutes twice daily (after breakfast and supper, 10 mL/dose) for a period of 15 days. Clinical response rate was 72.0%, the Candida eradication rate was 68.0%, and the overall (clinical + mycological) response rate was 88.0%. Adverse reactions were noted in 3 cases. These results suggest that this therapy is useful as a means of treating oral candidiasis. ITCZ was detected in the tissue, and very small amounts of ITCZ and OH-ITCZ were detected from plasma. Therefore, detection of the drug components in plasma, even in small amounts, indicates the necessity of paying attention to possible systemic adverse reactions as well.

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Mucous cyst is one of the most frequent cystic diseases in the oral mucosa. Most frequent site is a lip, especially lower lip and it is unlikely to be found in the gingiva. We report an unusual case of retention mucous cyst in the mucogingival junction. The patient was a 65-year-old woman who had first noticed the lesion 1 month earlier. As a cystic lesion was observed in her lower right mucogingival junction, it was surgically resected. Histopathologically, the lesion was diagnosed as mucous cyst with epithelial lining.

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We report two cases of orofacial granulomatosis in the oral region. Case 1: The patient was a 59-year-old woman who complained of swelling and redness of the gingiva. Biopsy specimens showed a non-caseating granulomatous inflammation. Blood analysis and chest radiograph showed no evidence of Crohn's disease or sarcoidosis. After treatment with oral prednisolone therapy, gingival symptoms clearly improved. Case 2: The patient was a 41-year-old man who had been followed by his physician for suspicion of sarcoidosis. He presented with a nodular lesion in the buccal mucosa. Pathology of the resected specimen showed a non-caseating epithelioid granuloma. Systemic and biochemical examination ruled out Crohn's disease and sarcoidosis. The final diagnosis of these two patients was orofacial granulomatosis.

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