Austin H. Kutscher

Ultrastructure of Human labial salivary glands: II. Intranuclear inclusions in the acinar secretory cells

SummaryHuman labial salivary glands, obtained by biopsy from 32 subjects, were studied by light and electron microscopy. Intranuclear inclusions, unrelated to nucleoli, were present in many of the acinar nuclei in glands from 16 of the 32 donors. More than one inclusion was sometimes observed within a single nucleus. They measured about 1 μ in diameter, and were stainable in a variety of ways. They were eosinophilic, some were stained by Nile blue sulphate, some were PAS-positive, and all were Feulgen-negative. They were bounded by a single membrane, which never exhibited continuity with the nuclear envelope, and they showed considerable morphological variation. The more complex inclusions consisted of alternating shells of light and dark material with tiny dense granules embedded in the latter. The intranuclear inclusions, which apparently were non-viral in origin, were in some way related to the secretory cycle of the mucous cells, since they were found only in immature cells, and never in cells in which secretory products were abundant.

Triamcinolone acetonide in the treatment of acute and chronic lesions of the oral mucous membranes: Preliminary report☆

Abstract Triamcinolone acetonide was administered in a new vehicle adhesive to fifty-six patients with various acute and chronic lesions of the oral mucous membranes. Trimacinolone acetonide therapy was undertaken in many instances after relatively prolonged unsuccessful therapy with numerous other agents and/or placebos. The patients treated included six with erosive lichen planus, six with denture stomatitis, four with oral erythema multiforme, four with geographic tongue, three with orolingual paresthesias, eight with desquamative gingivitis or stomatitis, thirteen with recurrent ulcerative stomatitis, eight with denture irritations or other traumatic ulcers. two with chronic inflammatory lesions of unknown etiology, and two with postradiation (cancer therapy) stomatitis. Triamcinolone acetonide in the adhesive vehicle was found to have either (1) suppressant, (2) ameliorative, or (3) curative effects on the various oral mucosal lesions enumerated above, with the exception of the three patients with idiopathic orolingual paresthesia and the four patients with geographic tongue. Further studies with this agent in acute and chronic lesions of the oral mucous membranes, especially when combined with the new adhesive vehicle, seem indicated. Since triamcinolone acetonide is a powerful corticosteroid which is fully active systemically, the total dose administered and the duration of therapy must be considered carefully. It is also essential that, where possible, therapy be of a discontinuous nature and that particular advantage be taken of the adhesive vehicles ability to maintain a drug at the site of application.

A new vehicle (orabase) for the application of drugs to the oral mucous membranes.

Abstract A new vehicle for the application of therapeutic agents to the oral mucous membranes is described. Various clinical tests were undertaken on a total of 119 patients (784 applications) in order to study the usefulness of this material as a vehicle for the prolonged application of medications to the oral mucous membranes. The findings indicate that when approximately 60 mg. (Group I), 250 mg. (Groups II and III), and 125 mg. (Group IV) of this vehicle adhesive are applied to various sites of the oral cavity, the average duration of maintenance was as follows: dorsum of the tongue—twenty-five, fifty-eight, and fifteen minutes for Groups I, II, and IV, respectively; hard palate—twenty-three, eighty-one, and thirty-three minutes for Groups I, II, and IV, respectively; anterior labial gingivae—twenty-four, 109, ninety-four, and fifty-six minutes for Groups I, II, and III, and IV; lower lingual anterior—eighty-five, sixty-four, and thirty-four minutes for Groups II, III, and IV; mucosa of the cheek—twenty-five, ninety-one, and forty-five minutes for Groups I, II, and IV; inner surface of the lower lip—103 minutes for Group II; and mucobuccal fold—152, and 108 minutes for Groups II and III, respectively. In no instance was there observed any evidence of irritation or other side reaction or toxicity, either local or systemic, due to the vehicle being studied. These data indicate a potential usefulness of this material as a vehicle for topical oral medications and mechanical protection in the oral cavity.

Familial white folded hypertrophy of the mucous membranes; report of three cases.

Abstract Three patients, a 31-year-old mother and her two children (now aged 6 and 10 years), are described, bringing to eleven the total number of patients reported in the literature who have been observed to be afflicted with a familial white folded scrotal hypertrophy of the oral mucous membranes. An associated similar scrotal and hypertrophie involvement of the vaginal mucosa was also observed in the mother. Biopsy findings of the vaginal mucosa are described for the first time. A tabulated review of the literature with respect to history, physical and oral findings, and histopathologic observations on these eleven patients is presented.

Discoloration of the teeth in patients with cystic fibrosis of the pancreas: Histologic studies☆

Abstract Detailed histologic studies of teeth obtained from thirty-two patients with cystic fibrosis of the pancreas were undertaken with regard to the presence, distribution, and nature of the peculiar discoloration of the teeth observed in such patients. A yellow discoloration in dentine was usually observed in ground sections of these teeth when viewed by tungsten incandescent light. Fluorescence microscopy of these sections revealed fluorescent patterns which appeared to parallel the yellowish patterns observed under tungsten light. No such abnormalities were discernible in decalcified sections studied under tungsten light.

Oral lesions of interest to the prosthodontist: Part I. Denture stomatitis

Abstract A study was undertaken to evaluate the efficacy of a number of different therapeutic regimens in the treatment of denture stomatitis. The therapeutic agents employed included 2 per cent amphotericin B in an adhesive base, a denture adhesive, a diluted sodium hypochlorite solution as a soaking medium, and 0.1 per cent triamcinolone acetonide in an adhesive base. Various of these regimens of drug therapy were found to be useful, where indicated, as adjunctive aids in the management of denture stomatitis. However, the administration of drug therapy is not intended to replace or supersede complete and thorough prosthetic dental care for patients with denture stomatitis. A thorough examination of the mouth as well as a complete evaluation of the dentures is a necessary prerequisite to any anticipated therapy. Laboratory procedures to ascertain the presence or absence of C. albicans organisms must also be considered essential in most instances of denture stomatitis. Finally, no single, specific drug therapy, arbitrarily selected, should be relied upon.

Melanin spots of the oral mucosa and skin associated with polyps: Report of a case of peculiar pigmentation of the lips and mouth

Abstract As suggested by Peutz and Jeghers, there is a rare hereditary, familial syndrome consisting of characteristic melanin pigmentation of the oral mucosa and skin which may be associated with polyps. The polyps occur most frequently in the small intestine, although they may be widespread. In the intestine they may produce obstruction and on occasion, they may undergo malignant change. Awareness of this distinctive external pigmentation may be of considerable value in diagnosing the internal disease. Its presence should suggest intensive study of the patients gastrointestinal tract and a genealogic survey of his family. A case is reported with characteristic pigmentation associated with a nasal and a cervical polyp, hiatus hernia, diverticulosis, and clinical symptoms of gastrointestinal disturbance, but in whom no intestinal polyps have been observed thus far.

Reactions following the use of terramycin troches: A controlled study

T HERE is apparent from the literature an increasing awareness of the local and general side effects observed during topical and systemic antibacterial therapy.l-I2 Kutscher has reviewed the literature in detail concerning t,he oral reactions to antibiotic and sulfonamide therapy.l” Reports on systemic terramycin therapy indicate that its administration is accompanied by reactions of varyin g types and severity associated chiefly with the oropharyngeal region and the gastrointestinal tract.3, 14, I59 I6 However, considering the severity of the diseases under treatment and their response to systemic terramycin, the reported reactions have not usually been of sufficient importance to be considered a detriment to therapy. The topical application of terramycin in troches introduces the factor of prolonged contact of the drug with the oral mucosa. The side actions thus encountered should be weighed against the severity of t,he oral infection which requires specific treatment with topical terramycin. This study was undertaken to : (1) study and evaluate the reactions resulting from oral terramycin troche therapy; (2) attempt treatment of the reactions resulting from terramycin troche medication, the therapy to be based upon the possible causes of the reactions’” ; (3) inquire into the possibility of chemotherapeutic prophylaxis against such reactions ; and (4) determine the occurrence of systemic sensitization from topical terramycin medication.

Carisoprodol in the management of temporomandibular joint pain and dysfunction: a preliminary investigation.

In the medical and dental literature of the past twenty-five years many symptoms have been attributed to supposed malposition of the condylar head of the temporomandibular joint, particularly in the closed position. The symptoms described included loss of hearing, vertigo, and tinnitus, as well as pain in the temporomandibular joint. The usual explanation has been that, with missing posterior teeth, the condylar head of the temporomandibular joint causes pressure upward and backward upon various structures. Anatomic and clinical investigations during the past 10 years, however, support neither this symptomatology nor the concept upon which it is based. The present widely held view is that temporomandibular joint pain and dysfunction constitute a symptom complex. Malocclusion, instead of being considered the prime or even the only etiological factor, is now more accurately considered as one of many contributing factors. Spasm of the masticatory muscles is felt to be at the root of the disorder. Hence, the symptom complex associated with the temporomandibular joint is similar to myofascial pain syndromes that affect other areas of the body. The syndrome is most often found among women from 30 to 50 years of age. The most common complaint is that of a unilateral dull ache involving the face, temple, neck, and shoulder. In many cases clicking of the temporomandibular joint, its subluxation, or even actual dislocation, precede the actual limitation. When limitation is present, the mandible usually deviates toward the symptomatic side during the opening movement and sometimes also during protrusion. When dysfunction is present, the position of the jaw is sometimes so altered in its closed position as to cause a malocclusion of the teeth. Symptomatology is usually noted : first, upon awakening, presumably because of tooth-clenching or -grinding while asleep; second, after rapid or continuous opening such as yawning or following a dental appointment; and third, subsequent to changes in proprioception accompanying any alteration of the occlusion of the teeth through dental treatment. Upon clinical examination the most common findings are first, that mandibular movements are found to be limited and painful, and second, that masticatory muscles and temporomandibular joints are painful to palpation. Radiographic examination of the temporomandibular joints usually discloses no alteration of their bony contours. There is a limited range of condylar movement in one or both joints. In some cases spontaneous recovery occurs; in others, the symptoms continue for months and sometimes for years. A self-perpetuating pain-spasm Earache is a common complaint.

Familial white folded dysplasia of the mucous membranes: An atlas of oral lesions

Abstract An atlas of photographs of ten patients with familal white folded dysplasia of the oral mucous membranes is presented. A lesion of differential-diagnostic interest—the tobacco pouch lesion—is discussed.