Pyogenic granuloma is one of the inflammatory hyperplasias seen in the oral cavity. This term is a misnomer because the lesion is unrelated to infection and in reality arises in response to various stimuli such as low-grade local irritation, traumatic injury or hormonal factors. It predominantly occurs in the second decade of life in young females, possibly because of the vascular effects of female hormones. Clinically, oral pyogenic granuloma is a smooth or lobulated exophytic lesion manifesting as small, red erythematous papules on a pedunculated or sometimes sessile base, which is usually hemorrhagic. The surface ranges from pink to red to purple, depending on the age of the lesion. Although excisional surgery is the treatment of choice for it, some other treatment protocols such as the use of Nd:YAG laser, flash lamp pulsed dye laser, cryosurgery, intralesional injection of ethanol or corticosteroid and sodium tetradecyl sulfate sclerotherapy have been proposed. Because of the high frequency of pyogenic granuloma in the oral cavity, especially during pregnancy, and necessity for proper diagnosis and treatment, a complete review of published information and investigations about this lesion, in addition to knowledge about new approaches for its treatment is presented. (J. Oral Sci. 48, 167-175, 2006)
The purpose of this study was to determine the usefulness of salivary biochemical markers for the screening of periodontal disease and examine the agreement between the results of saliva enzyme tests and those of probing depth. The present study included a total of 187 subjects who underwent annual medical check-ups at the Comprehensive Health Care Center, Honjo, Saitama Prefecture, Japan. Periodontal pocket probing was performed with a WHO probe, and various enzymes and biochemical parameters in saliva were measured. For lactate dehydrogenase (LDH), the proportions of the five isoenzymes were calculated. To decide the cut-off point for each enzymatic activity, receiver operating characteristic curves (ROC curves) were constructed and the points of minimum difference between sensitivity and specificity were decided. Among the biochemical markers tested, salivary LDH level had the highest sensitivity and specificity (sensitivity 0.66, specificity 0.67), while salivary levels of aspartate aminotransferase (AST) and blood urea nitrogen (BUN) also had sensitivity and specificity above 0.60. Among the LDH isoenzymes, LDH4 and LDH5 dominated in whole saliva samples. Salivary LDH may be a feasible and useful parameter for the screening of periodontal disease, while salivary AST and BUN also appear to be potentially useful for this purpose. (J. Oral Sci. 48, 177-183, 2006)
Lichen planus is a dermatologic disease of unknown etiology characterized by keratotic plaques on the skin. Many patients also harbor white lesions of the oral mucosa. The literature contains numerous reports of lichen planus-like lesions evolving in conjunction with the administration of a variety of pharmacologic agents. It is difficult, if not impossible, to distinguish such lesions from one another. The present study evaluated the epithelial and basement membrane thickness, mast cells (intact cells and degranulated cells subepithelially) and the presence or absence of blood vessels in oral lichen planus and oral lichenoid lesions. The evaluation was done using the periodic acid-schiff (PAS) and toluidine blue staining techniques on 20 cases each of oral lichen planus and oral lichenoid lesions and 5 control specimens of normal buccal mucosa. The results showed an increased number of degranulated mast cells in areas of basement membrane degeneration, increased vascularity and increased PAS-positive basement membrane thickness in oral lichen planus as compared with oral lichenoid lesions. Reduced epithelial thickness was found in oral lichen planus. The present study emphasizes the importance of these parameters in differentiating oral lichen planus from oral lichenoid lesions using special staining techniques. (J. Oral Sci. 48, 185-193, 2006)
Uncontrolled or poorly controlled diabetes mellitus may be a risk factor for the development of oral complications. The objective of this investigation was to determine the effect of diabetes mellitus progression on inflammatory and structural components of dental pulp. Male Wistar rats were given a single injection of Streptozotocin (STZ), and induction of diabetes was confirmed 24 h later. Dental pulp tissue samples were taken from central incisors and molars of diabetic rats 30 and 90 days after the STZ treatment. Plasma glucose levels in diabetic rats 30 and 90 days after STZ treatment were significantly increased when compared to control rats (P < 0.001). Nitrite and kallikrein levels in dental pulp tissue were higher in diabetic rats 30 days after STZ treatment than in controls, while only nitrite were decreased 90 after of STZ treatment. Myeloperoxidase activity showed changes 30 and 90 days after STZ injection when compared to controls. The activity of alkaline phosphatase showed significant changes 30 and 90 days after STZ treatment. On the other hand the concentration of collagen was decreased in diabetic rats 30 and 90 days after STZ injection. These results suggest that diabetes is a critical factor that has profound effects upon oral tissues, resulting in expression of inflammatory mediators and modifications of structural components of dental pulp. (J. Oral Sci. 48, 195-199, 2006)
The present study investigated the biocompatibility of a biopolymer based on vegetable latex extracted from the Hevea brasiliensis rubber tree, implanted into the bony alveolar cavity after dental extraction in rats. A granule of latex (area = 0.25 ± 0.04 mm2) was implanted inside the alveolus immediately after extraction of the upper right incisor, and the animals were sacrificed 7, 21 and 42 days after the procedure. The hemi-maxillas were decalcified and processed for embedding in paraffin to obtain semi-serial longitudinal sections 5 μm thick, and then stained with hematoxylin-eosin. The latex granule was observed in the cervical third of the alveolus without any foreign body reaction, or persistence of the initial acute inflammatory reaction. Bone repair in the areas adjacent to the material was quantified, and a decrease was noted in the thickness of the fibrous capsule surrounding the implants from 92.8 ± 9.3 μm on day 7 to 9.4 ± 1.8 μm on day 42 (ANOVA, P = 0.01). The quantitative data confirmed acceleration of bone formation (statistically significant at 5%) in parallel with a decrease of connective tissue in the areas around the implants. These results show that the tested material is biologically compatible, and progressively integrated into the alveolar bone, simultaneously accelerating bone formation and playing an important role in the healing process. (J. Oral Sci. 48, 201-205, 2006)
The aim of this study was to investigate, by means of histological and histomorphometric analysis, the effects of 24% ethylenediaminetetraacetic acid (EDTA) gel in periodontal tissue when used in combination with conventional periodontal treatment. Periodontitis was induced in the 2nd upper left permanent molars of 45 male Wistar rats by means of ligature. After 5 weeks, this was removed and debridement was performed. The animals were then randomly divided into 3 groups; group 1: mechanical treatment, group 2: mechanical treatment and EDTA gel application for 2 min, and group 3: mechanical treatment and placebo gel application for 2 min. After the treatment, rinsing was done with 0.9% saline solution for 1 min in all cases, followed by root notching in the deepest part of the pocket. After 4, 10, and 28 days the animals were sacrificed. The averages obtained were evaluated by means of test two-way analysis of variance (ANOVA) and Tukey statistical tests (P < 0.05). The results showed that with respect to the type of treatment employed, there were no statistically significant differences in the vitality of the periodontal tissue. It was concluded that 24% EDTA gel did not interfere with periodontal tissue repair when used in combination with conventional periodontal treatment. (J. Oral Sci. 48, 207-214, 2006)
The purpose of the current study was to evaluate the effect of functional monomers contained in the primers on adhesive bonding of a steel alloy. SUS XM27 steel was primed with one of the following materials; Alloy Primer, Estenia Opaque Primer, and V-Primer. The functional monomers in the primers were a phosphate (10-methacryloyloxydecyl dihydrogen phosphate; MDP) and a thione (6-(4-vinylbenzyl-n-propyl) amino-1,3,5-triazine-2,4-dithione, -dithiol tautomer; VTD) for Alloy Primer, MDP alone for Estenia, and VTD alone for V-Primer. The steel disks were bonded with an acrylic resin (Unifast Trad), and bond strength was determined. Of the three primers, both the Alloy Primer (33.3 MPa) and Estenia Opaque Primer (33.9 MPa) materials exhibited far better post-thermocycling bond strength than V-Primer (0 MPa). It can be concluded that the phosphate MDP is effective, whereas the thione VTD is ineffective for bonding SUS XM27 steel. (J. Oral Sci. 48, 215-218, 2006)
The aim of this study was to evaluate the physico-chemical and biocompatibility characteristics of two different hydroxyapatites. Physical and chemical properties were analyzed using granulometric analysis, scanning electron microscopy (SEM), X-ray energy-dispersion (EDX), X-ray fuorescence (XRF) and X-ray diffraction (XRD). Biomaterials were implanted into the subcutaneous tissue on the dorsum of 36 Wistar rats, divided into the following groups: Group 1 – Gen-Ox™ (natural); Group 2 – HA-U (synthetic) and Group 3 – Control (Sham). After 15 and 30 days, 6 animals/period were sacrificed and the subcutaneous tissue was taken for histological and histometric analysis, giving consideration to inflammatory reaction and granule area. The granulometric test results showed a mean granule diameter of 161.6 μm (min = 19.0 μm; max = 498.0 μm) and 48.7μm (min = 7.0 μm; max = 256.0 μm) for groups 1 and 2 respectively. Analysis with SEM demonstrated irregular and sharp-edge particles in group 1 (3332.8 ± 274.3 μm2) and irregular and rounded particles in group 2 (1320.8 ± 83.0 μm2) (P < 0.0001; Student's t test). EDX and XRF revealed calcium, carbon, oxygen, sodium and phosphorus in both groups. XRD indicated that both biomaterials were pure and crystalline. There was a statistically significant difference in granule area between the two groups after 15 days (P = 0.022; Student's t-test). After 15 days, an increased inflammatory response was seen in group 2 (P < 0.0001; ANOVA and Tukey's post hoc test) whereas it was more pronounced in group 1 after 30 days (P < 0.0001; ANOVA and Tukey's post hoc test). It was concluded that these biomaterials have similar physical, chemical and biocompatibility characteristics. (J. Oral Sci. 48, 219-226, 2006)
Porphyromonas gingivalis has been implicated as an important pathogen in the development of periodontitis. Hemagglutinins have been identified as important adhesion molecules, allowing Porphyromonas gingivalis to adhere to gingival tissue cells, and to attach and lyse erythrocytes in order to uptake Fe ions as essential nutrition. One hemagglutinin, hemagglutinin A (HagA), has been molecularly cloned via functional screening for hemagglutinating activity. We previously cloned the gene encoding the 200-kDa cell-surface antigenic protein that was reacted by sera from periodontitis patients and was identified as a truncated protein of HagA by nucleotide sequence analysis. We further subcloned the gene encoding an 122-kDa protein (122k-HagA) which is a fusion protein composed of an 80-kDa truncated HagA containing the functional motif PVQNLT and a 42-kDa maltose binding protein. Passive immunization against infectious pathogens by specific antibodies produced from hen egg yolk antibody (IgY) has been extensively developed. In the present study, to develop passive immunotherapy against periodontal disease, we purified the recombinant 122k-HagA and used this to immunize hens and produce IgY. The purified IgY reacted with the recombinant 122k-HagA and the synthetic peptide containing PVQNLT, and inhibited hemagglutinating activity of Porphyromonas gingivalis. Thus, the novel IgY may be useful in the development of a passive immunization against periodontal diseases caused by P. gingivalis infection. (J. Oral Sci. 48, 227-232, 2006)
The aim of this study was to examine the significance of evaluating dmft for predicting the incidence of permanent teeth caries in Japanese girls. The subjects were two birth cohorts in a Primary girls' school: cohort I composed of 45 girls born in 1981 and 1982 and cohort II composed of 53 girls born in 1989 and 1990. In both cohorts, there was a significant correlation between the dmft score in the first grade and the DMFT score in the sixth grade. The validity of employing dmft score was examined by receiver operating characteristic (ROC) curve and risk ratios. The shape of the curve and areas under the curve were similar in the two cohorts. In cohort II, sensitivity and specificity for the optimal cut-off level (dmft ≥ 5) were 0.519 and 0.923, respectively. The positive and negative predictive values for that level were 0.875 and 0.649, respectively. In cohort I, sensitivity and specificity were 0.741 and 0.722 for that level and positive and negative predictive values were 0.800 and 0.650, respectively. In both cohorts, the risk ratio for permanent teeth caries was significant for many cut-off levels of dmft. The results indicated that the dmft score is a useful predictor of the permanent teeth caries in Japanese primary school girls. (J. Oral Sci. 48, 233-237, 2006)
Peripheral ossifying fibroma (POF) is a common solitary gingival growth thought to arise from the periodontal ligament. Though the etiology of POF remains unknown, some investigators consider it an inflammatory or reactive process, while others suggest it is a neoplastic process. In this report, we present and discuss a unique case of multicentric POF, affecting the maxillary and mandibular gingiva of a 49-year-old Caucasian female with meticulous oral hygiene and routine dental care. Though biopsy samples from multiple sites revealed similar histopathologic features, consistent with POF, the fact that there was a multicentric presentation is a unique phenomenon for this lesion. Multicentric lesions presenting in the oral and maxillofacial region are not typical, but have been observed in conditions associated with known genetic mutations, such as nevoid basal cell carcinoma syndrome (multiple odontogenic keratocysts), multiple endocrine neoplasia type II (multiple neuromas), neurofibromatosis (multiple neurofibromas) and Gardner syndrome (multiple neoplasms). This case is the first one to demonstrate that there may be a multicentric variant of POF that has not been previously recognized, and given the clinical presentation and multifocal nature of disease, the lesions in this patient are likely the result of genetic mutation(s) that predisposes to gingival soft tissue overgrowths containing mineralized product. (J. Oral Sci. 48, 239-243, 2006)
Many studies suggest that mutans streptococci (MS), Lactobacillus (LB), and salivary buffering capacity are important risk factors for dental caries. However, target populations for most studies were children. In adult patients, the same risk factors affect the number of fillings or prostheses or secondary caries. It is therefore important to investigate these risk factors as predictors of caries in adults. In the present study, we evaluated the oral conditions of adult subjects at private dental offices using bite-wing radiographs. Detection of salivary LB level using Dentocult LB had a statistically significant correlation with the number of flat surface caries and approximal caries (P < 0.001). Detection of salivary MS level using Dentocult MS and salivary buffering capacity did not predict dental caries. Thus, detection of salivary LB level using Dentocult LB may be a useful tool for detecting approximal and secondary caries. (J. Oral Sci. 48, 245-251, 2006)
This paper reports a well-differentiated mucoepidermoid carcinoma containing numerous melanocytes in the parenchyma in a middle-aged Japanese man. In addition to the characteristic histopathologic features of well-differentiated mucoepidermoid carcinoma, various-formed and -sized, pigmented cells were widely distributed in the parenchyma. Many of these were considered to be melanocytes containing melanin in their cytoplasm. Perusal of the English-language literature revealed only four cases of salivary gland tumors with parenchymal pigmentation: three mucoepidermoid carcinomas and one pleomorphic adenoma. The possible histogenesis of melanocytes in the salivary gland lesions is discussed, although no firm conclusion could be drawn. (J. Oral Sci. 48, 253-256, 2006)
Papillon-Lefévre syndrome (PLS) is characterized by severe periodontal disease extending to destruction of the alveolar bone surrounding deciduous teeth and palmoplantar hyperkeratosis of the skin. Increased susceptibility to infection has been reported among individuals with the cathepsin C (CTSC) gene mutation. This article reports a 7-year-old Japanese girl who presented with deciduous tooth mobility and was diagnosed as having PLS. Radiographic examination revealed loosening of deciduous incisors and the right second molar of the maxilla, and destruction of the alveolar bone around the residual deciduous dentition. However, there was no destruction of the alveolar bone around the permanent molars. The patient did not show the typical signs of CTSC polymorphism, which almost always negatively impacts certain activating enzymes. With respect to immune function, analysis of the patient's leukocytes indicated that H2O2, chemotactic and phagocytotic functions were within the normal range. However, the special precautions normally applied to prevent infections in PLS patients undergoing dental treatment were taken. (J. Oral Sci. 48, 257-260, 2006)
This clinical report describes the fabrication and bonding of porcelain laminate veneer restorations in a patient with anterior open spaces. Laminate veneer restorations made of feldspathic porcelain were etched with 5% hydrofluoric acid, rinsed under tap water, ultrasonically cleaned with methanol, and primed with a chemically activated three-liquid silane bonding agent (Clearfil Porcelain Bond). The enamel surfaces were etched with 40% phosphoric acid, rinsed with water, and primed with a two-liquid bonding agent (Clearfil New Bond) that contained a hydrophobic phosphate (10-methacryloyloxydecyl dihydrogen phosphate; MDP). The restorations were bonded with a dual-activated luting composite (Clapearl DC). The veneers have been functioning satisfactorily for an observation period of one year. Combined use of the Clearfil bonding agents and Clapearl DC luting composite is an alternative to conventional materials for seating porcelain laminate veneer restorations, although the system is inapplicable to dentin bonding. (J. Oral Sci. 48, 261-266, 2006)
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