Adi A. Garfunkel

Inheritance patterns in recurrent aphthous ulcers: Twin and pedigree data

Nineteen sets of twins and 318 individuals from six families were examined and interviewed in order to ascertain whether a genetic component could be established for recurrent aphthous ulcers (RAU). While no specific mode of inheritance could be established, the data strongly support the hypothesis of a genetic factor involved in susceptibility to the disease.

The inheritance of recurrent aphthous stomatitis: Observations on susceptibility

In an effort to determine the prevalence of recurrent aphthous stomatitis (RAS), 1,303 children from 530 families were interviewed. While over-all disease prevalence in the children was 39.2 percent, there was a sharp difference in those children younger than 5 years (19.7 percent) and those 5 years of age and older (48.3 percent). Moreover, the prevalence of the disease in the children was significantly affected by whether RAS was present in none, one, or both of the parents. These observations suggest that disease susceptibility may be a complex interaction between host and environment.

A longitudinal follow-up of salivary secretion in bone marrow transplant patients

Salivary gland dysfunction is a common sequela of the bone marrow transplantation procedure. We determined the effect of different bone marrow transplantation protocols on parotid salivary flow rate. Salivary secretion was substantially reduced during conditioning of all the recipients. A gradual flow rate reconstitution could be detected as soon as a few days after the bone marrow transplantation. Eight patients conditioned with total lymph node irradiation and chemotherapy or chemotherapy alone displayed earlier and complete recovery of saliva secretions 2 to 5 months after the grafting. Recovery was delayed and incomplete when total body irradiation was added to the conditioning regimen (seven patients). Six of these patients also developed graft-versus-host disease. The results suggest that total body irradiation induces irreversible damage to the parotid glands resulting in profound xerostomia followed by opportunistic infections. Chemotherapy with or without total lymph node irradiation does not induce such damage.

Time limitations and the challenge of providing infection-preventing dental care to hematopoietic stem-cell transplantation patients

GoalOral-dental infection foci should be eradicated before the ablative chemo-radiotherapy regimen of hematopoietic stem cell transplantation (HSCT) commences. The rationale of oral-dental treatment is to prevent the future development and spread of infections in patients with compromised immune systems. This study aims to shed light on the challenges facing hospital dentists in the implementation of optimal oral-dental treatment prior to HSCT.Patients and methodsData regarding the medical status and dental treatment needs before HSCT were retrieved from the files of 86 consecutive patients post-HSCT. The timing of the oral-dental examination was also recorded.Main resultsDental treatments required before the HSCT were mainly combinations of scaling, plastic fillings, and extractions (47.8%, 39.1%, and 19.5% of the patients respectively). Patients presented at the clinic for oral-dental examination an average of 20.65±16.82 days before HSCT with a median of 15 (quarter interval range 10–15) days.ConclusionsOur data indicate a dense distribution of dental needs preceding the ablative conditioning regimen for HSCT. These facts accentuate the vital need for cooperation between hospital dentists and treating physicians.

Gram-negative enteric bacteria in the oral cavity of leukemia patients

We examined changes in the bacterial flora in hospitalized patients with leukemia. This study placed special emphasis on enteric microorganisms and their relation to the general status of the patient. One hundred thirty bacterial cultures from 16 leukemia patients and 16 control subjects, were obtained. The organisms were isolated on MacConkey agar and identified by the API-20E system. Enteric microorganisms were isolated from 62.2% of the leukemia patients as compared with 28% from the control group (p < 0.001). The enteric positive cultures were identified as Klebsiella (42.7%), Enterobacter (18.8%), and Pseudomonas (15.6%). In contrast to the negative cultures (1342), enteric microorganisms were cultured from 2948 specimens (p < 0.005).

Ultraviolet B irradiation: A new therapeutic concept for the management of oral manifestations of graft-versus-host disease

Ultraviolet irradiation inhibits the proliferative responses of lymphoid cells to mitogens and alloantigens by inactivation of T lymphocytes and antigen-presenting cells. Its immunosuppressive capacity led to the introduction of UV irradiation into clinical practice for the treatment of dermatologic manifestations of chronic graft-versus-host disease. The cumulative experience with psoralen-UV-A rays in the treatment of cutaneous and oral graft-versus-host disease was the incentive for the application of oral UV-B rays in 2 patients with oral graft-versus-host disease signs and symptoms after allogeneic marrow transplantation. Intraoral UV-B irradiation (0.02 mJ/cm(2)) was administered 2 or 3 times per week on an ambulatory basis; the dose was increased by 0. 02 mJ/cm(2) every fourth session. Both patients responded early and satisfactorily, displaying only minimal side effects at a relatively low cumulative dose. Intraoral UV-B proved a valuable modality in the treatment of resistant chronic oral graft-versus-host disease.

CO2 laser in oral graft-versus-host disease: a pilot study.

Summary:This paper is the first to report the benefits of CO2 laser treatment for pain control in severe oral chronic graft-versus-host disease (GVHD). A CO2 laser device was used during 17 treatment sessions in four patients. The CO2 laser was applied over the mucosal lesions using 1 W for 2–3 s/1 mm2. This treatment resulted in a consistent and significant decrease in pain, measured using a standard visual analogue scale. These results suggest that the CO2 laser can be used for the alleviation of pain in oral chronic GVHD.

Intraligamentary—intraosseous anesthesia: A radiographic demonstration

Intraligamentary dental anesthesia has become a widely accepted technique. The periodontal ligament seems to provide easy access to the tooth apex. In the present study, radiopaque material was injected into baboon monkeys. Serial radiographs during incremental injections showed clouding of the crestal bone. The material was seen gradually advancing through the alveolar bone crest, apically. The spread was noticed through the marrow spaces, unexpectedly avoiding the PDL route.

Oral candidiasis prevention in transplantation patients: a comparative study.

Abstract:  Aim:  Oral candidiasis occurs commonly in haematopoietic –stem cell transplantation (HSCT) patients carrying a risk of systemic candidemia and mortality. The aim of this pilot study was to design an effective protocol that prevents oral candidiasis and improves tolerability.

Intraligamentary anesthesia ― a histological study

Intraligamentary dental anesthesia is considered to be an efficient and clinically safe anesthetic technique, and as a result, is widely used. The present study evaluates histologically any possible damage to the periodontal apparatus, in baboon monkeys. The damage induced by the injection needle and/or the anesthetic solution, which was injected under high pressure, was localized, minor and reversible. In most of the specimens, all signs of damage disappeared within 8 days following injection. In others, some granulation tissue was evident in the lamina propria 15 days following injection. However, no bone or cemental damage was observed.