Biomedical subjects
Publications and source records attributed to W K Bottomley.
There are at least two treatment strategies in the diagnosis and treatment of oral vesiculobullous/vesiculoerosive disease. The relative merits of immediate biopsy and initial therapeutic trial regimens are debated.
Twenty severely retarded institutionalized epileptic adults with phenytoin-induced gingival hyperplasia were divided into two groups and received a daily 3 mg capsule of either folic acid or lactose for 16 weeks in a randomized, double-blind, parallel study. Serum folate and phenytoin levels were recorded at baseline and on completion of the study. Twelve areas of the gingiva on each patient were graded at 4-week intervals for 16 weeks with respect to the three indexes: hyperplasia, gingival health, and plaque index. There were no significant differences between treatment groups for any of the three indexes over time. The poststudy serum folate levels were three times baseline levels for the active drug group (p less than 0.001) but unchanged in the placebo group. Phenytoin blood levels that began within the therapeutic window (10 to 20 micrograms/ml) tended to remain within the therapeutic window for both groups, with no reported seizure activity. A single daily oral 3 mg capsule of folic acid did not show efficacy as the sole therapeutic agent in the reduction of phenytoin-induced gingival hyperplasia.
Proposed mechanisms of the side effect of drug-induced gingival hyperplasia are reviewed. Hypotheses with regard to inflammation from bacterial plaque, increased sulfated glycosaminoglycans, immunoglobulins, gingival fibroblast phenotype population differences, epithelial growth factor, pharmacokinetics and tissuebinding, collagenase activation, disruption of fibroblast cellular sodium/calcium flux, folic acid and a combination hypothesis are evaluated.
A 32-year-old woman with a 3-month history of severe major aphthous stomatitis covering the anterior dorsal third of the tongue was treated successfully with topical dexamethasone mouthrinse and oral azathioprine tablets. The lesion was resolved within 90 days without side effects.
Drug-induced gingival hyperplasia is well documented within the literature. It has been associated with phenytoin, cyclosporine, and calcium channel blocking agents. Nitrendipine is an experimental calcium channel blocking agent that also appears to cause the side effect of drug-induced gingival hyperplasia. The clinical and histologic presentation of this side effect and possible biochemical mechanisms of pathogenesis are discussed.
Ninety-two head and neck radiation/oncology patients were referred for a pre-irradiation dental examination. Of these patients, 48 required at least one extraction, and 51 required at least one restoration. Only 19 patients did not require extractions, restorations or endodontic therapy. All but one patient required a dental prophylaxis. The oral complications of head and neck irradiation therapy were evaluated and discussed. The importance of adjuvant oral/dental care for the head and neck radiation/oncology patient is addressed. The distribution of patients requiring treatment (extractions, restorations and/or endodontic therapy) versus no treatment (a dental prophylaxis only) showed that a significantly higher number of patients (chi-square = 37.5; p less than 0.01) required treatment over no treatment.
A retrospective survey of 981 patients seen in a private oral medicine practice from 1980-87 was conducted to gather information on several defined parameters. Inferences extracted from this information can be applied to long-range planning in clinical, educational, and research areas.
The case of a 65-year-old white man with painful oral soft tissue granulomatous lesions of histiocytosis X is reported. The clinical course and diagnostic and therapeutic measures are described. The manifestation of symptomatic oral soft lesions with no definable lesions of bone and the age of the patient are not consistent with the usual presentation of this disease, and thus emphasize its clinical variability. The rationale for the therapeutic regimen and the prognosis are reviewed.
Diseases of the oral cavity and related structures, either local or systemic, may have profound physical and emotional effects on a patient. In order to effectively manage these conditions, it is necessary that dentists have a basic understanding of diseases throughout the body. Such an obligation is tempered only by the extent to which diseases relate to the dental profession's anatomic field of responsibility or have clinical implications for office personnel, and the extent to which diseases require modification of dental therapy or alter the prognosis. A primary organic abnormality is typically reflected in the findings of radiographic, laboratory, and tissue studies. From the analysis of a large number of such profiles, certain patterns emerge that are sufficiently characteristic to suggest a specific diagnosis or groups of differential diagnoses for abnormalities that may prompt a request for urgent dental care.
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Recent concern about the effect of ionizing radiation on man has focused attention on the frequent use of diagnostic radiographs in dentistry. The clinician is expected to conduct his actions according to guidelines which reflect new information and changing technology in diagnostic dental radiography. Failure to do so may have severe legal consequences. Protection of the patient must be a matter of normal course, for each time the federal or state governments legislate toward safety in the healing arts, health professionals lose credibility and the confidence of the public. Implications of the federal radiation protection guidelines are discussed.
A case of pulmonary nocardiosis associated with primary nocardial infection of the oral cavity in a compromised host is presented. Nocardia asteroides, an aerobic, gram-positive, branching, filamentous fungus, was demonstrated in the sputum and in pathologic specimens from gingival sulci stained by Gram's method and the acid-fast method Kinyoun. The organism was identified in cultures made on Sabouraud's glucose agar. Marked clinical improvement was noted when the patient received high dosage of sulfisoxazole diolamine (8 to 12 Gm. per day) for a prolonged period of time (9 to 12 months). Because of an apparent relative increase in the incidence of nocardiosis and a paucity of information on the subject in the dental literature, this article is timely.
The efficacy of a water-soluble bioflavonoid-ascorbic acid complex was evaluated in the treatment of fifty episodes of recurrent herpes labialis. Twenty episodes were treated with a complex of 600 mg. of water-soluble bioflavonoids and 600 mg. of ascorbic acid, administered in equal increments three times daily. Twenty episodes were treated with a complex of 1,000 mg. of water-soluble bioflavonoids and 1,000 mg. of ascorbic acid, administered in equal increments five times daily. Ten episodes were treated with a lactose placebo. The therapeutic regimen was maintained for 3 days after the recognition of the initial symptoms associated with recurrent herpes labialis. The water-soluble bioflavonoid-ascorbic acid complex was observed to reduce vesiculation and to prevent the disruption of the vesicular membrane. The therapeutic measure was found to be most effective when initiated during the prodomal stage of the disease process. Optimum remission of symptoms was observed in 4.2 +/- 1.7 days with the 600 mg. dosage of the water-soluble bioflavonoid-ascorbic acid complex. No adverse reactions were reported by any of the patients who participated in this investigation.
Some signs of myasthenia gravis can be clearly identified in the oral cavity. The patient with progressive neuromuscular impairment may seek consultation because of dysphagia, impaired mastication, and dysarthia. The dentist should understand the pathophysiology of the symptoms and treat the myasthenic patient accordingly.