Bullous pemphigoid (BP) is an autoimmune bullous disease characterized by the presence of circulating autoantibodies specific for hemidesmosomal proteins; BPAG I (230kD protein) and BPAG II (180kD protein). In order to explain why oral lesions are seldom seen in BP patients, the distribution of BPAG I and BPAG II in oral mucosa and skin was investigated. [Methods] Normal oral mucosa (gingiva, buccal mucosa, tongue dorsal mucosa n=3) and skin (n=3) were obtained during surgery, and cryosections were prepared. First antibodies were rabbit polyclonal antibodies against synthetic peptides of P1-1, P1-2 and NC16a. [Results] There were no differences in the staining pattern of BPAG I between oral mucosa and skin. All layers except the keratinized layer were stained by anti-BPAG II antibody in skin. However, positive staining was observed only of the basal cells in buccal mucosa and no staining in the tongue and gingiva showing a significant difference in the expression pattern of BPAG II between oral mucosa and skin.

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Oral Lichen planus (OLP) is a chronic inflammatory mucocutaneous disease in which basal epithelial cells are damaged. It is generally known that the epithelial damage of OLP occurs due to direct infiltration of killer T-lymphocytes. However, there is a hypothesis that loss of basal cells in OLP is due to apoptosis. There are few reports about the relationship between apoptosis and OLP. The purpose of this study was to investigate the distribution of cell proliferation and apoptosis on the epithelium of OLP. Fifty-one OLP and 12 normal mucosa were evaluated for proliferation cell nuclear antigen (PCNA), apoptosis-related proteins, Fas and Bcl-2, immunohistchemically. Further, sections were evaluated with a TUNEL assay that identify apoptotic DNA fragments. Epithelial cells in normal oral mucosa and OLP mucosa were negative for bcl-2. Fas expressed in the granular and prickle cell layers in OLP epithelium. The positive signs of TUNEL assay appeared to be scatter in the basal cells of OLP mucosa, whereas there were no signs in the same area of normal epithelium. These results suggested that the basal cell destruction with apoptosis occurred in OLP.

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Thirty-two cases of Sjögren syndrome were clinically analyzed. The patients were 1 male and 31 females and the average age was 56.4 years. Dry mouth was observed in about 90% of the patients. Saliva secretion was decreased within 3ml and 10ml in more than 80% of the patients under physiological and stimulated conditions, respectively. Parotid gland sialography revealed the characteristic findings in 16 of 29 cases (55.2%) and lip biopsy revealed the infiltration of lymphocytes in 22 of 30 cases (73.3%). Salivary gland scintigraphy revealed moderate or severe impairment of accumulation at the parotid gland in 13 cases (40.6%) and at the submandibular gland in 21 cases (65.6%), respectively. Keratoconjunctivitis sicca was found in 18 cases (56.3%). Serologically, anti-SS-A and anti-SS-B antibodies were positive in 20 cases (62.5%) and 8 cases (25.0%), respectively.

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The relationship among objective examinations in 32 cases of Sjögren syndrome were clinically analyzed. The objective degree of dry mouth was well correlated with the decrease of saliva secretion. The decrease of saliva secretion was also well correlated with the characteristic changes in sialography and scintigraphy of the parotid gland. On the other hand, the changes in the minor salivary gland of the lower lip and scintigraphs of the submandibular gland were also found in cases without severe decrease of saliva secretion. From the findings, in Sjögren syndrome, changes in the minor salivary gland of the lower lip and scintigraphs of the submandibular gland were early events and followed by the changes in sialographs and scintigraphs of the parotid gland, which were well correlated with the decrease of saliva secretion and the objective degree of dry mouth. Therefore, total evaluation of the objective examinations is helpful to know the degree of impairment in salivary gland function.

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Epithelial dysplasia was examined clinico-pathologically in 196 cases of oral leukoplakia according to WHO's criteria. Fifty-seven cases (29.1%) were found to have epithelial dysplasia. The tongue was the most prevalent site at which epithelial dysplasia occurred, that is 31 of 66 case (47.0%). In 12 tems of WHO's criteria for epithelial dysplasia, the items 2, 1, 12 and 4 which were reported to be important to evaluate the potentiality of malignant transformation, were frequently seen in that order. Malignant transformation occurred in 14 cases (7.1%) of oral leukoplakia, in which the tongue was the most frequent site of malignant transformation (12 cases). Of the 14 cases, 7 showed epithelial dysplasia before malignant transformation. The cases whose grade of epithelial dysplasia had increased with time had a tendency to develop into cancer. Thus attention should be paid to the existence and grade of epithelial dysplasia in the treatment of oral leukoplakia.

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Herpes zoster is a viral infection caused by the reactivation of the varicella zoster virus (VZV) which lies dormant in sensory ganglia of a patient. The chest has many ganglia: therefore, there are many cases of VZV there. It frequently occurs especially in the trigeminal nerve of each ganglion in the sequence of the first, second, third. It is often reported that herpes zoster infection of the second and third trigeminal nerve is sometimes followed by spontaneous tooth exfoliation and sequestration. This article reports a case of a 68-year-old male who had the osteonecrosis following the extraction of canine teeth, first premolar, and first molar, after herpes zoster infection of the third left trigeminal nerve.

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Five cases of nodular median rhomboid glossitis were clinicopathologically examined. The age of patients ranged from 47 to 60 years. The lesions appeared as an elevated oval or round lesion in the dorsal midline of the tongue. The lesion of 4 cases was excized and one biopsy was performed. Histopathologically, epithelial hyperplasia, subepithelial inflammation and thick band of hyalinized connective tissue were observed in all of the cases. Fungal hyphae were found in the parakeratoic layer in four cases. Nodular formation of the lesions was thought to be caused by proliferation of the epithelial and subepithelial tissue.

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