Emdogain is a commercial product of unknown composition and is clinically used to induce periodontal regeneration. This study aims to review current knowledge of the in vitro effects of Emdogain on oral tissues and, in particular, factors related to carcinoma. A systematic approach was used to review studies from the Embase and Pubmed databases; a total of 76 studies were included. These comprised in vitro studies of the cytokines in, or regulated by, Emdogain and assays designed to study the effects of EMD on human cells in oral tissues or malignant cells. Several studies have shown that EMD regulates the proliferation, migration, adhesion, gene expression, and cytokine production of (pre-)osteoblasts, periodontal fibroblasts, and gingival fibroblasts. However, the effects of EMD on malignant oral cells are not well understood. EMD seems to have broad regulatory effects on malignant cells and on several carcinoma-related factors. Evidence suggests that patients with premalignant or malignant mucosal lesions should not be treated with EMD. (J Oral Sci 52, 1-11, 2010)
Oral epithelial dysplasia (OED) is a histopathological diagnosis that is associated with an increased risk of oral cancer. The purpose of this study was to compare the clinical features and long-term outcome of OED between users and non-users of tobacco and alcohol. The hospital records of 456 patients diagnosed as having OED were reviewed. Two groups of patients were selected based upon tobacco and alcohol usage: 37 patients who had neither smoked tobacco nor drank alcohol and 419 patients who both smoked tobacco and drank alcohol. OED in non-users of tobacco and alcohol was uncommon, accounting for only 8.1% of all OED. There was a male to female ratio of 1:1 in the group. The tongue and buccal mucosa were the most commonly affected sites. An erythro-leukoplakic-type lesion with mild dysplasia was the common presenting feature. Mixed type lesions with severe dysplastic changes, particularly of the gingiva, may progress to malignancy. These findings support the notion that OED may also develop in persons who have never used tobacco or alcohol. Lesions more commonly occurred in women, especially in the tongue and buccal mucosa, and were mostly of the erythroplakic type. The presence of OED in patients who do not smoke tobacco or drink alcohol suggests that risk factors other than alcohol and tobacco may exist. (J Oral Sci 52, 13-21, 2010)
This study was done to assess the influence of the topical application of two different desensitizing agents on dentin permeability and dentinal tubule occlusion. Twenty-one rats provided 84 teeth: 36 for the in vitro and 48 for the in vivo investigation. The following agents were tested: Group 1, 2% potassium nitrate plus 2% sodium fluoride gel; Group 2, 5% sodium fluoride varnish; Group 3, 3% hydroxyethylcellulose gel (control). Cervical cavities were prepared and EDTA was applied to expose the dentinal tubules. After each treatment, Evans blue dye was applied to the teeth. Dentin permeability, scanning electron microscope (SEM) sections, and energy dispersive X-ray (EDX) were analyzed. One-way ANOVA was used to compare the data. There were significant differences (P < 0.05) among groups for dentin permeability, number of tubules/mm2, tubule area and tubular diameter. Groups 1 and 2 (both in vitro and in vivo) showed open and partially occluded tubules. Group 3 had the most open tubules. EDX revealed similar composition for both experimental conditions. Within the limits of the study, 2% nitrate potassium plus 2% sodium fluoride gel and 5% fluoride varnish decreased the dentin permeability, resulting in partial tubular occlusion. (J Oral Sci 52, 23-32, 2010)
Low-level laser therapy (LLLT) has been reported to improve tissue healing and might therefore be useful in dental pulp capping after trauma. We evaluated the effects of a low-level diode laser (λ = 680 nm) and dental pulp-capping substances on cell proliferation. Calcium hydroxide and adhesive resin were applied as conditioned media to cultures. Half of the samples received irradiation with the diode laser at a fluence of 4 J/cm2 for 60 s. Using a hemocytometer, cells were counted at 1, 3, 5, and 7 days, and the data were analyzed by ANOVA. All cultures exhibited continuous growth, except those treated with adhesive resin. As compared to the other two groups, cell proliferation was significantly lower in cultures treated with adhesive resin; it was also significantly lower in cultures treated with calcium hydroxide, as compared to the control group. When combined with dental pulp-capping materials, LLLT had no effect on L-929 cell proliferation. (J Oral Sci 52, 33-38, 2010)
Heparanase is an endoglycosidase that cleaves heparan sulfate (HS), thus participating in degradation and remodeling of the extracellular matrix (ECM). Heparanase up-regulation is correlated with lymph node and distant metastasis, microvessel density and reduced postoperative survival of cancer patients. In the present study, we carried out an immunohistochemical investigation of heparanase to extend and confirm present knowledge regarding its expression in ameloblastomas (AMs), which are characterized by locally aggressive behavior. Paraffin-embedded tissue specimens of 53 AMs were stained using an antibody against heparanase. Immunohistochemical reactivity for heparanase was detected in 94.3% of the AMs examined. Heparanase was expressed strongly in peripheral columnar cells and slightly in central stellate reticulum-like cells. Small tumor nests and budding epithelial branches showed a stronger staining pattern. Stromal cells were negative for heparanase, or showed diffuse expression. However, an enhanced positive immunoreaction was present specifically near osseous tissue and adjacent to the invasive front of tumor nests. Areas of cystic degeneration showed intense heparanase immunoreactivity. The enzyme may facilitate the function of HS-binding growth factors that elicit an angiogenic response and favor osteoclastogenesis in AM. (J Oral Sci 52, 39-47, 2010)
Mucoepidermoid carcinoma (MEC) corresponds to 5-12% of all salivary gland tumours, and is classified as low, intermediate or high grade. Traditionally, immunohistochemistry was considered as the complementary tool for diagnosis of salivary gland neoplasia. Lectin histochemistry has also been increasingly used in recent years. In this work, lectins were used as histochemical markers for normal and transformed parotid glands. Biopsy specimens of 15 cases diagnosed as MEC (low, intermediate and high grade) of the parotid gland were trypsin- and methanol-H2O2-treated and incubated with horseradish peroxidase (HRP)-conjugated lectins, Concanavalin A (Con A-HRP) and Ulex europeus I (UEA-I-HRP). Con A stained the neoplasic cells of MEC (all grades). In high and intermediate cases, ductal cells were weakly stained by Con A. UEA-I weakly stained normal cells of the excretory duct and neoplasic cells in high grade. Neoplasic cells in intermediate grade were moderately stained and in low grade, the cell membrane was intensely stained with UEA-I. Stroma presented a direct relation between malignancy and staining intensity for UEA-I. The results indicated that lectin histochemistry distinguished the cell biology among histological grades of MEC. (J Oral Sci 52, 49-54, 2010)
The chronic usage of nifedipine is associated with the appearance of gingival overgrowth (GO). The frequency of GO associated with chronic nifedipine therapy remains controversial and the possible subclinical effects of this drug on the gingival epithelium should be investigated. We investigated the epithelial proliferation index and apoptosis rate, and their association with epithelial enlargement. Proliferation (Ki67 and Cyclin B1) and apoptosis (BCL2, Bax and p53) markers were identified by immunohistochemistry in twenty-one samples of gingival tissue from patients undergoing chronic treatment with nifedipine and in eleven samples of gingival tissue from healthy patients who did not use drugs associated with GO (control). Our results show that the epithelial tissue of nifedipine users has considerably longer rete pegs compared to control (P = 0.01). However, the density of Ki67+ and Cyclin B1+ cells was similar in both groups. Regarding apoptosis, we found more BCL2+ cells in the nifedipine group when compared to controls (P = 0.12). An increase in Bax+ cells in the nifedipine group compared to control (P = 0.003) was also seen, and slightly lower levels of p53+ expression were observed (P = 0.51). Our results suggest that the chronic use of nifedipine is not associated with subclinical changes in gingival tissue. (J Oral Sci 52, 55-62, 2010)
When a guided tissue regeneration (GTR) membrane is placed in an interproximal area, adjustment of the membrane is difficult because of the complex anatomy of the root surface and presence of bone defects, thus prolonging the surgery. This report describes the clinical application of cone beam computed tomography (CT) images to aid insertion of a barrier membrane in the treatment of interproximal bone defects. Using CT images, the membrane can be pre-cut into the optimal shape to cover the bone defect and fit the roots tightly, thus shortening the time required to adjust the GTR membrane, and providing excellent clinical outcomes. (J Oral Sci 52, 63-69, 2010)
This study evaluated the effect of preliminary irradiation on the depth of cure and Knoop hardness of a veneering composite. The composite was filled into a mold, and irradiated with different irradiation duration or irradiance. After removing the mold, the depth of cure was measured, and the Knoop hardness number at each depth was determined and statistically analyzed using Mann-Whitney U test. Depth of cure of the composite polymerized by the Sublite S unit with a distance of 15 cm for 30 or 60 s was less than 2.0 mm. The Knoop hardness number of the group polymerized by the Hyper LII unit without preliminary irradiation and the group polymerized by the Sublite S unit with a distance of 3 cm was higher than that of the group polymerized by the Sublite S unit for 90 s or the group polymerized by the Solidilite unit, respectively, even though the depth of cure for these four groups was higher than 2 mm. Preliminary irradiation with long duration and low irradiance caused a low degree of polymerization, which is probably effective in enhancing the bond strength between veneering composite and cast framework. (J Oral Sci 52, 71-75, 2010)
The aim of this study was to compare the effect of Waterlase laser and ultrasonic root end cavity preparation on the integrity of root end in extracted human teeth. The canals of 60 extracted maxillary central incisors were cleaned, shaped, obturated and 3 mm of the root end was resected and examined for the presence of any cracks. Class I root-end cavities were then prepared using an ultrasonic unit or Waterlase laser. In the ultrasonic group, KIS 2D tip and medium intensity and in the laser group, 600 μm laser tips and an output power setting of 4 W with 55% water and 65% air were used to prepare the cavity which was studied for the presence of any cracks or chippings. One crack was found in the ultrasonic group, while no cracks were observed in the laser group. There was no significant difference between the two groups (P > 0.05). As for the chipping effect, seven cases (23%) had chipping after cavity preparation in the ultrasonic group but no chipping was found in the specimens of the laser group and the difference was statistically significant (P < 0.05). According to the results of this in vitro study, laser preserves the integrity of root-end cavities better than ultrasonic devices from the standpoint of producing chipping. (J Oral Sci 52, 77-81, 2010)
This ex vivo study compared saliva coronal microleakage in root canals filled with Resilon/Epiphany Self-Etch (SE) system after final irrigation with different solutions. A total of 60 extracted single-rooted human teeth were instrumented using Mtwo Ni-Ti rotary instruments and divided into two experimental groups (n = 20 each) and positive and negative control groups (n = 10 each). The canals were irrigated with 1.3% NaOCl during instrumentation. After removing the smear layer with 17% EDTA, the root canals in groups A and B were flushed with distilled water and 2% chlorhexidine (CHX), respectively, after which they were obturated with Resilon/Epiphany SE using lateral compaction technique. After sterilizing the whole system with gamma-rays, saliva leakage was tested using a split-chamber model. Specimens were monitored every 24 h for 60 days. The data collected were then analyzed using the chi-square test and Kaplan-Meier survival analysis. As compared with group A, the specimens in group B tended to be more resistant to saliva leakage; however, the difference was not significant (P > 0.05). In conclusion, our findings suggest that 2% CHX is a good conditioner for root canal dentin before use of Resilon/Epiphany SE. (J Oral Sci 52, 83-87, 2010)
The mechanical properties of luting agents are determined by the mixing ratio of powder and liquid. The purpose of this in vitro study was to evaluate the therapeutic range of zinc carboxylate cements by investigating the mechanical properties of such cements when formulated using erroneous powder/liquid ratios. Using the recommended powder/liquid ratio as a standard, four different mixing ratios (25% and 50% more or less powder) were used to prepare each carboxylate cement (Aqualox, Carboco, Durelon). A veneering composite (Sinfony) was used as control. Vickers hardness and three-body abrasion were evaluated. In each carboxylate cement, both a 25% and 50% increase in liquid content resulted in significantly lower Vickers hardness, whereas a higher powder content altered the saturation concentration but did not result in increased hardness; this effect was particularly obvious in Carboco. Durelon showed a linear relationship between wear and powder/liquid ratio, whereas Carboco and Aqualox displayed a more exponential increase in wear in mixings with an increased liquid content. The mechanical properties of carboxylate cements were altered in mixtures with an increased liquid content, but not in those with a high powder content. Mixing ratio errors greater than 25% may significantly affect the clinical performance of carboxylate cements. (J Oral Sci 52, 89-93, 2010)
Peripheral ossifying fibroma (POF) is a lesion of the gingival tissues that predominantly affects women and is usually located in the maxilla anterior to the molars. The definitive diagnosis is established by histological examination, which reveals the presence of cellular connective tissue with focal calcifications. Surgery is the treatment of choice, though the recurrence rate can reach 20%. We present a clinical and histological review – including a detailed immunohistochemical analysis – of four cases of POF diagnosed and treated at our hospital. All four patients were women, and two were pregnant. The immunohistochemical study revealed that the proliferating cells showed myofibroblastic characteristics and did not express estrogen or progesterone receptors. The lesions showed clinically benign behavior. Our results indicate that POF should be considered as a myofibroblastic proliferation, and although the clinical characteristics suggest hormonal influence, we were unable to demonstrate the expression of hormone receptors in the proliferating cellular component. (J Oral Sci 52, 95-99, 2010)
The objective of the present study was to evaluate the interest of both children and parents towards orthodontic treatment and compare it to the normative treatment need as well as to determine the factors related to such an interest. The sample consisted of 407 schoolchildren aged between 9 and 12 years and their parents from Nova Friburgo (Rio de Janeiro), Brazil. The orthodontic concern expressed by children and parents was obtained by means of a questionnaire. The normative need was evaluated using two components of the Index of Orthodontic Treatment Need (IOTN). Data analysis involved multiple logistic regression. Normative treatment need was greater than the children's self-perceived treatment need. The parents expressed more interest towards orthodontic treatment of their children than the children themselves. The orthodontic concern expressed by both groups was greater than the normative need for orthodontic treatment, and such a finding was associated with gender of the children (female) and self-perceived treatment need expressed by them. The lack of a relationship between the normative treatment need and the orthodontic concern of children and parents shows that such assessments should be performed when orthodontic treatment is indicated, particularly in terms of public health, as the demand is greater than the services supplied. (J Oral Sci 52, 101-107, 2010)
The present study measured the position of the greater palatine foramen relative to adjacent anatomical landmarks in Brazilian skulls. The perpendicular distance of the greater palatine foramen to the midline maxillary suture in Brazilian skulls was about 14 mm and the distance of greater palatine foramen to the incisive foramen was approximately 36 mm. The distance of greater palatine foramen to the posterior border of the hard palate was approximately 3 mm, and the mean angle between the midline maxillary suture and the line from the incisive foramen and the greater palatine foramen was 22.71°. In almost 70% of the cases, the greater palatine foramen opened in an anterior direction. The mean palatine length was approximately 52 mm. In the greater majority of the skulls (93.81%), the greater palatine foramina were opposite or distal to the maxillary third molar. These data will be helpful in comparing these skulls to those from various other regions as well as comparing skulls of different races. It can also provide professionals with anatomical references, in order to block the maxillary division of the trigeminal nerve through the greater palatine foramen. Our results would help clinicians locate the greater palatine foramen in patients with and without upper molars. (J Oral Sci 52, 109-113, 2010)
The present case-control study of 79 subjects (19-69 yr) was designed to assess the relationship of several psychological determinants to periodontal disease and obesity. Periodontal clinical examinations were performed, and the subjects were asked to complete a set of questionnaires measuring Type A personality, anxiety, depression, dental anxiety, hopelessness, emotional intelligence, stress, self-esteem, optimism and satisfaction with life. In a bivariate analysis, overweight individuals presented higher levels of smoking exposure, anxiety and depression and lower levels of optimism and satisfaction with life. They were mainly females, with a higher number of sites and teeth with probing depth (PD) >6 mm and clinical attachment level (CAL) >5 mm. Patients with a mean PD exceeding 3 mm and a bleeding on probing index of >25% presented higher values of dental anxiety and lower levels of self-esteem. Multiple linear regression analyses revealed that dental anxiety was positively associated with the number of teeth with a PD of >6 mm and with reasons for visiting a dentist, while satisfaction with life was associated with flossing frequency. We conclude that there is an association between several psychological determinants, periodontitis, and body mass index. (J Oral Sci 52, 115-124, 2010)
Bone sialoprotein (BSP) is a major non-collagenous, extracellular matrix glycoprotein associated with mineralized tissues. Fibroblast growth factor 2 (FGF2) is recognized as a potent mitogen for a variety of mesenchymal cells. FGF2 produced by osteoblasts accumulates in the bone matrix and acts as an autocrine/paracrine regulator of osteoblasts. We previously reported that FGF2 regulates BSP gene transcription through the FGF2 response element (FRE) and activator protein 1 (AP1) binding site overlapping with the glucocorticoid response element in the rat BSP gene promoter. In the present study, FGF2 (10 ng/ml) increased BSP and Runx2 mRNA levels at 6 h in MCF7 human breast cancer cells. Transient transfection analyses were performed using chimeric constructs of the human BSP gene promoter linked to a luciferase reporter gene. Treatment of MCF7 cells with FGF2 (10 ng/ml) increased the luciferase activity of the constructs between -84LUC and -927LUC. Gel mobility shift analyses showed that FGF2 increased the binding of AP1 and CRE2. The CRE2- and AP1-protein complexes were disrupted by antibodies against CREB1, c-Fos, c-Jun, Fra2, p300 and Runx2. These studies demonstrate that FGF2 stimulates BSP transcription in MCF7 human breast cancer cells by targeting the AP1 and CRE2 elements in the human BSP gene promoter. (J Oral Sci, 125-132, 2010)
The aim of the present study was to assess the levels of salivary cortisol, tumor necrosis factor-alpha (TNF-α) and nitric oxide (NO) before, during and after acute exercise. Acute exercise was induced using a standard treadmill test with Bruce protocol in ten physically active male participants. Unstimulated saliva was collected before, during and after exercise. The levels of salivary cortisol and TNF-α were assessed by enzyme immunoassays. Salivary NO was determined by the Griess reagent. The results showed that both salivary cortisol and TNF-α increased and peaked at 14 min during exercise and then decreased. The levels of NO were increased up to 1 h after exercise and subsequently lowered after 24 h. The results of the present study suggest that acute exercise may induce high levels of salivary cortisol, TNF-α and NO. (J Oral Sci 52, 133-136, 2010)
This article describes Colombia's development of formal dentistry, its dental school system, curriculum, and dental licensure, and current issues in oral health care. In 1969, there were only 4 dental schools in Colombia; at this writing there are 21. Five dental schools are public and the other 16 are private. Nearly all classes are conducted in Spanish. Undergraduate pre-dental coursework is not a prerequisite for dental school in Colombia. To obtain licensure, Colombian dental students must complete 5 years of study in dental school, earn a diploma, and work for the government for 1 year. There are approximately 41,400 dentists in Colombia, and the number is increasing quickly. However, the unemployment rate among dentists is very high, even though graduation from dental school is extremely difficult. Although the 1,100:1 ratio of citizens to dentists is considered satisfactory, access to dental care is limited due to the high rate of poverty. (J Oral Sci 52, 137-143, 2010)
Down syndrome (DS) children with sleep apnea often present with oral breathing associated with nasal obstruction. This causes the oral cavity and pharynx to become dry. We describe the treatment of three DS children with sleep apnea who were treated using products for oral dryness. Snoring disappeared after treatment in two of the children and apnea disappeared in all three. The symptoms of a reddened oral mucosa and coated tongue disappeared in all three DS children. Saliva pH testing demonstrated that the pH value increased in all of the children after treatment. These results indicate that oral care can improve the oral hygiene status of DS children, and that proper oral care can help prevent oral mucosal dryness and thereby reduce sleep apnea symptoms. (J Oral Sci 52, 145-147, 2010)
The success of endodontic therapy is based on good endodontic access, correct cleaning and shaping, and adequate root canal obturation. However, endodontic treatment is also dependent on a sound knowledge of the internal anatomy of human teeth, especially when anatomical variations are present. Certain anatomical changes may be present to varying degrees, and it is important to report these to improve the understanding and expertise of endodontic specialists. With this aim in mind, this study reports an example of a maxillary first molar showing unusual anatomy (four roots and six root canals) and describes the endodontic treatment that was employed. (J Oral Sci 52, 149-153, 2010)
We describe the treatment of a young adult male (aged 14 years 9 months) with Class III malocclusion using a mini maxillary protraction appliance, and discuss the results. The patient was treated with an acrylic cap splint-type expander and a modified maxillary protractor until a positive overjet was achieved. Edgewise fixed appliances were used to align the teeth. The treatment resulted in Class I molar occlusion, an ideal overjet, overbite and incisor angulation. A Class I molar relationship was achieved after 6 months of treatment, and the total treatment time was 1 year 6 months. Modified maxillary protractor treatment is effective for correcting skeletal Class III malocclusion. (J Oral Sci 52, 155-159, 2010)
Cleidocranial dysplasia is an autosomal dominant condition caused by mutation of RUNX2, characterized by generalized dysplasia of the bones and teeth. Affected individuals have short stature, atypical facial features, and skeletal anomalies affecting mainly the skull and clavicle. The dental manifestations are mainly delayed exfoliation of the primary teeth and delayed eruption of the permanent teeth, with multiple impacted supernumeraries, and absence of cellular cementum. The frequency of this disorder is 1 per million individuals. Here we report a rare case of CCD in a 9-year-old male patient having most of the characteristic features of this syndrome. Interestingly, disorganized dentinal tubules were found in the roots of an extracted deciduous first molar, which seems to be a unique feature not reported previously. (J Oral Sci 52, 161-166, 2010)
We report a rare case of osteoglophonic dysplasia affecting father and daughter. Osteoglophonic dysplasia is a very rare skeletal dysplasia with craniosynostosis, multiple radiolucencies of bone and clinical anodontia. It is an autosomal dominant disorder characterised by short stature. The affected children have normal intelligence. Close association with missense mutation of fibroblast growth factor receptor-1 has been reported. Life expectancy depends on the degree of cranial malformation. In previous reports, bone defects usually resolved by adulthood, but multiple tooth impaction may cause aesthetic and masticatory problems. Cytogenetic studies and routine laboratory tests were all within normal limits. (J Oral Sci 52, 167-171, 2010)
Angiofibrolipoma is a rare histopathological variant of lipoma, characterized by mature adipocytes, blood vessels and dense collagenous tissue. It is seldom seen in the oral and maxillofacial region. Clinically, as it shares macroscopic similarity with lipoma and fibroma, the diagnosis of angiofibrolipoma is only possible based on its histopathological features. The aim of this report is to present an unusual case of a 59-year-old female patient, who reported a pathological soft mass in the buccal mucosa of the left cheek which was present for 20 years. After excisional biopsy and histopathological evaluation of the sample, the diagnosis of angiofibrolipoma was made. (J Oral Sci 52, 173-176, 2010)
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