Biomedical subjects
Publications and source records attributed to T D Rees.
Recurrent aphthous stomatitis (RAS) is the most common oral mucosal disease in North America. In some instances, RAS represents the central feature of the multisystem disease complex Behcet's syndrome. This article reviews the clinical features, contributing etiologic factors, and etiopathogenesis of RAS and Behcet's syndrome and describes therapeutic considerations and strategies essential to management of patients suffering from recurrent mouth ulcers.
It has been proposed that healthy gingiva is in a continuous state of wound repair. Thus, one might expect to find cells in normal gingiva producing growth factors associated with wound healing such as platelet-derived growth factor B chain (PDGF-B). One might also expect to find increased numbers of these cells or increased amounts of these growth factors in conditions which involve increased tissue volume such as drug-induced gingival overgrowth (DGO). The purpose of this study was to quantify PDGF-B gene expression and identify cells producing PDGF-B in normal gingiva and DGO. Cyclosporine A (CSA) was selected as a prototype of the overgrowth condition. Twelve patients with clinical CSA DGO and 12 patients with no DGO or history of drugs known to cause DGO were selected for study. Frozen sections of gingival specimens from these patients were subjected to in situ hybridization for PDGF-B mRNA. Positive cells were counted and expressed as mean +/- SEM cells/mm2 of lamina propria. Morphometric analysis revealed 6.2 +/- 1.9 cells/mm2 for control gingiva and 10.3 +/- 3.4 cells/mm2 for CSA DGO samples. There was no statistically significant difference between groups. PDGF-B gene expression was measured in these cells and expressed as mean +/- SEM silver grains/cells. There was a significant upregulation of PDGF-B gene expression in cells from the CSA DGO group (39.5 +/- 14.7 silver grains/cell for normal gingiva vs. 255.3 +/- 77.1 silver grains/cell for CSA DGO samples; P < 0.001). The presence of PDGF-B in these cells was confirmed in all cases by immunocytochemical localization. Additionally, PDGF-B producing cells were identified as macrophages in sections taken from an additional patient with CSA DGO by double immunofluorescence labeling of the CD51 membrane marker for macrophages and intracellular PDGF-B. These findings are consistent with the concept that healthy gingiva is in a continuous state of wound repair and support the hypothesis that CSA DGO is associated with enhanced macrophage PDGF-B gene expression rather than an increase in the number of PDGF-B producing macrophages.
This study investigated the effectiveness of a low-dose cyclosporine rinse used in the treatment of oral erosive lichen planus. Fourteen patients with oral erosive lichen planus provided seven experimental sites treated with cyclosporine and seven control sites treated with a placebo. Participants rinsed with 5 ml (500 mg) of cyclosporine or 5 ml of a placebo for 5 minutes each day over a period of 4 weeks. Cyclosporine blood levels as well as complete blood cell counts with differential and serial multiple analysis were monitored throughout the study. Weekly quantitative measurements of lesion size and character (ulceration, erythema, and reticulation) were recorded with the use of an intraoral grid. Healing was defined as the transition from ulceration to erythema to reticulation or to complete resolution. Pain assessment with the use of a visual analogue scale and a questionnaire pertaining to any side effects of treatment were completed each week. At 4 weeks, a statistically significant difference was observed in lesion healing between the cyclosporine and placebo groups. All experimental sites demonstrated progressive healing with evidence of reduced erythema and ulceration, increased reticulation, and decreased pain scores. In contrast, control sites exhibited minimal change in lesion size or character, and patients reported unchanged or increased pain scores. No significant side effects were reported. Within the parameters of this investigation, topical cyclosporine proved to an effective alternative therapy to currently available medications used in the treatment of oral lichen planus.
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There are many systemic drugs taken by patients that affect their periodontal statuses. Dentists are in a position to diagnose and manage these problems and, when appropriate, discuss possible alternative drug therapies with physician colleagues.
This article reviews the use of a new mechanical surgical instrument, the D'Granulator, designed to quickly and easily remove granulation tissue while maintaining a blood-free field during periodontal and endodontic surgical procedures. A technique for minimally invasive periodontal bone grafting is also given. This technique allows for minimization of soft-tissue trauma and the removal of granulation tissue from periodontal defects using a much smaller surgical incision than that used in standard bone graft techniques.
This study evaluates hematomas requiring surgical evacuation following a face lift. Twenty-three hematomas occurred with 1236 consecutive face lifts (1.86 percent). All hematomas occurred within 48 hours. Fifty-seven percent were identified at less than 15 hours, 26 percent from 15 to 24 hours, and 17 percent from 24 to 48 hours. The incidence of hematomas for surgeons who performed more than 50 face lifts in this study varied from zero to 3.83 percent. This difference in incidence was statistically significant. A multivariant analysis of predetermined variables was done. Age, preoperative tests, medical history, gender, perioperative medications, type of anesthesia, number and combination of procedures, and treatment of the SMAS did not independently affect the incidence of hematomas. Preoperative and postoperative blood pressure did not affect the incidence. The incidence of hematomas with general anesthesia in this study was 7 of 630 (1.11 percent). In a similar 1973 study at this institution, the incidence with general anesthesia was 3.26 percent. This improvement was attributed to a change in anesthetic technique. Intraoperative hypotension was avoided in the current series. The incidence of hematoma in the local anesthesia group was 3.72 percent, and in the monitored intravenous sedation group it was 0.87 percent. Meticulous hemostasis, done with the patient's blood pressure in a normotensive state, appeared to be of primary importance.
DM is such a common disease in the United States that virtually every dentist encounters patients with known or undiagnosed diabetes. The dentist should be alert for both general and oral signs and symptoms suggestive of uncontrolled or poorly controlled DM, and laboratory or interoffice screening tests should be a part of dental practice. Under no circumstances, however, should the dentist attempt to diagnose the disease. Patients with suggestive symptoms or with abnormal blood glucose levels identified by screening tests should be referred to a physician for diagnosis and any treatment necessary. Uncontrolled DM may be associated with increased frequency and severity of oral infections, including periodontal disease and dental caries. In some diabetic patients, susceptibility to oral disease may continue despite establishment of effective metabolic control. Dental treatment can safely be performed on the controlled diabetic patient, but some adjustment of office protocol and of antihyperglycemic drug administration may occasionally be necessary. Finally, the dental treatment team must always be alert for signs and symptoms of developing diabetic emergencies and be prepared to provide treatment as necessary.
This retrospective study evaluates 11 infections requiring hospital readmission following 6166 consecutive face lifts (0.18 percent). Seven patients had surgical drainage of an abscess, and four patients were treated for severe cellulitis, Staphylococcus was the predominant organism in all abscess cultures. Of three patients admitted 3 weeks after surgery, two cultured gram-negative organisms in addition to Staphylococcus. This suggests that all patients should be treated initially with Staphylococcus coverage. If a patient is readmitted more than 1 week postoperatively, gram-negative coverage should be considered, pending culture results. There was no consistent finding regarding past medical history, the use of perioperative antibiotics, surgical equipment used, complexity of the surgical dissection, drains, or hematoma formation. No patients demonstrated systemic signs or grossly abnormal laboratory results on readmission. Eight patients had no sequelae from the infection. Three patients developed scarring that was considered minor by the affected patients. These data support the conclusion that major infections following a face lift are rare occurrences. Standard medical and surgical care, given in a timely fashion, usually results in a satisfactory outcome with minimal morbidity.
When a survey was distributed to students, faculty and staff of a dental school to determine the incidence of latex glove reactions, 15 percent reported adverse reactions to glove use. The most frequently reported symptom was dermatitis, followed by urticaria, sweating, conjunctivitis and rhinitis.
A histologic overview of a periodontal pocket at the distal of a maxillary first premolar is presented. The material studied is part of the Bernhard Gottlieb collection. This material demonstrated the topography of the periodontal pocket through its complete circumference as seen in transverse step serial sections. From these observations, it is also clear that multiple pockets had formed, each involving a different area of the root surface. The pockets terminated independently and are separated from each other by areas of tissue which progress from pocket epithelium to junctional epithelium to connective tissue attachment. The existence of independent pockets around the root surface of a single tooth points to the problem of access and thus the predictability of non-surgical therapy as well as concerns that surgical access will necessarily involve areas of unaffected tissues.
A review of the medical histories of 300 adult patients presenting for emergency dental care at a dental college revealed no individuals who identified themselves as allergic to latex. A 32-item survey was distributed to adult dental patients receiving care at the dental school. 323 patients volunteered to complete the questionnaire. 3.7% of the patients reported adverse reactions associated with wearing latex gloves. However only 8.8% of the patient population reported work-related latex glove use. The reported incidence of sensitivity to latex products such as rubber dam material and condoms was equal to that associated with gloves, and slightly lower in the case of enema tips (2.8%) and balloons (2.5%). Sensitivity to rectal and/or vaginal examination with latex gloves was reported by 5.5% of the population. Predisposing factors to reported latex sensitivity found to be significant (P < .01) included a history of eczema and a familial history of allergies. No significant differences were found with regard to age or gender. Only two individuals reported severe systemic symptoms related to latex exposure. Data suggest that careful questioning of patients regarding a history of sensitivity to multiple latex-based products can facilitate the identification of possibly latex sensitive individuals, thus preventing latex-related allergic reactions in the dental operatory.
Members of a large urban dental society and students of three Texas dental schools were surveyed concerning their attitude and actions regarding infectious disease (AIDS and hepatitis) and infection control measures. In general, the responses of clinicians in practice less than 10 years more nearly paralleled that of students. Although the majority of both groups felt they were well informed regarding appropriate infection control, the percentage was significantly greater for the practitioners. While infection control is imposed in all clinical situations in the dental schools, compliance for practitioners was not consistent with their reported level of awareness. A majority of both groups reported decreased apprehension because of their knowledge of infection control techniques in the treatment of HIV positive individuals. A significantly higher percentage of students had received hepatitis B vaccine. Similar percentages of both groups reported they would willingly treat HIV positive patients, although a higher percentage of students were undecided. Practitioners reported having treated a significantly higher percentage of HIV positive individuals than did students in their clinical years. The percentage of clinical students who felt it was their professional obligation to treat HIV+ patients was significantly higher than in practitioners. There was an increase in student perception of their knowledge across years in school and a significant reduction in fear associated with education. Education appeared to have no effect on opinions as to whether the HIV positive patient could be safely treated using appropriate infection control measures.
The initial oral findings and treatment in 50 cases of mucous membrane pemphigoid are presented. Histologic and immunologic studies were undertaken in each case to confirm the clinical diagnosis. The treatments prescribed are summarized and illustrate that topical steroids are effective, but in some cases systemic steroid therapy with or without other immunologically active drugs is required. A significant number of patients had extraoral manifestations of the disorder.
This article reviews our experience during a 20-year period with patients with oral lesions of pemphigus vulgaris. Of the 30 patients, 20 were women and 10 were men, with an age range of 24 to 68 years. The soft palate was involved in 80% of cases at initial presentation. Direct immunofluorescence studies were positive for IgG in the intercellular region in all cases where lesional tissue was histologically studied. Systemic steroid therapy alone controlled the disease in 24 patients, one patient was given no treatment, and the remaining five required additional treatment with either azathioprine, cyclophosphamide, or gold. Steroid therapy was continued in the long-term at a reduced dose, but side effects such as diabetes mellitus, hypertension, and duodenal ulcers were observed. Long-term steroid therapy is therefore the treatment of choice for the oral lesions of pemphigus vulgaris, but in some cases alternative treatment options may be required.
Drug abuse is a major problem in the U.S. and most other countries of the world today. Many studies, surveys, and case reports have described the adverse social and medical effects of drug abuse; yet surprisingly little is known about the specific effects of many of these drugs in the oral cavity. This article reviews the current state of knowledge concerning the systemic and oral effects of drugs of abuse and the dental management of addicted patients.
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