Daniel E. Ziskin

Pregnancy gingivitis: History, classification, etiology

Abstract A comprehensive review of the history of pregnancy gingivitis is presented. Histologic studies were made of the gingivae of a large group of pregnant women, of whom twenty are reported in table form. The biopsies were taken at different months during gestation from those women exhibiting clinical manifestations of pregnancy gingivitis. Clinical photographs were also taken and are included. Histologic studies were made of the gingivae of patients with endocrine disturbances and of monkeys treated experimentally with hormones. Photo-micrographs and clinical photographs of representative cases are included. A clinical classification of pregnancy gingivitis, representing the progressive changes in pregnancy, is presented. The most prominent changes in the gingivae and oral mucous membranes during pregnancy were a loss of surface keratin, hydropic alteration of the stratum spinosum, hyperplasia of the stratum germinativum, and inflammatory changes in the lamina propria. A comprehensive review of endocrine and metabolic relationships is presented. This includes a consideration of the action of the hypophysis, the thyroid gland, the adrenal cortex, the ovaries, the placenta, and the vitamins. The histologic changes apparently do not arise from a single etiological factor. Rather they are a manifestation of the altered nutritional and the metabolic status of the individual during pregnancy. However, the immediate cause of the gingival changes appears to be a diminished utilization of estrogen or a modification of estrogen metabolism. The mechanism involved may be explained in several ways: (1) Estrogen during pregnancy is present in bound, inactive form, so that it may not be available to the gingivate to the expected extent, and hence does not have a proportional effect on the gingivae. (2) There may be a reduced ability of the oral tissues to utilize the available estrogen because of the increased amounts and modifying effect of progesterone. (3) The large amounts of chorionic gonadotropin may affect the gingivae directly or indirectly. (4) The increased activity of the thyroid gland and the adrenal cortex may modify the effect of available estrogen on the gingivae. (5) Nutritional factors may alter the amount of endogenous estrogens available for the gingivae. These factors indicate the probable causes of the gingival alterations reported here.

Chronic desquamative gingivitis

Abstract Twelve patients, aged 21 to 67 years, of whom ten were women and two men, presented with symptoms of desquamative gingivitis. A comprehensive review of the literature on this disease is included. Case reports illustrated with photographs and photomicrographs are given. The clinical and histopathologic findings are described. A method of clinical management and its rationale are discussed. The disease is hypothetically designated as a local manifestation of a metabolic disturbance. Various causes of the disturbed metabolism are considered. These include especially the abnormal functioning of the thyroid gland and the interrelation of the vitamins and estrogens. The data suggest that a local depletion of estrogen in the oral tissues may play a major causative role. Estrogen ointments applied topically are effective in controlling the disease.

Observations on Electrical Pulp Testing

In present day clinical practice, the chief purpose of pulp testing is to determine whether or not a pulp is normally vital. If not, it is desirable to ascertain to what degree degenerative processes have progressed. When degeneration has advanced to the point of necrosis, the resultant destructive action may often be easily determined in a radiographic study of apical and periapical tissue. The danger in the radiograph as an instrument of evidence, however, lies in its limitations; e.g., anatomical structures in bone and bone pathoses superimposed upon the shadow of the apex, which may or may not be associated with non-vital teeth, are open to misinterpretation. Moreover, the amount of other harmful change in the pulp, as well as necrosis not definitely ascertained clinically or radiographically, clearly demand a means of identification. For this differential diagnosis, various methods have been devised. Many are based upon physiological principles of nerve stimulation through the use of electrical devices. Thus far, however, the available equipment of this nature, in our opinion has not been wholly satisfactory. It is our object in this discussion to analyze and evaluate methods and apparatus which we have used in an attempt to overcome some existing shortcomings, and to scrutinize these in the light of their efficiency as a source of more accurate information as to the condition of the pulp.

Diabetes in relation to certain oral and systemic problems

This study deals with certain oral and systemic problems in juvenile diabetics. It treats of tooth development, the incidence of tooth decay, the condition of the gingivae, and related observations. The anterior pituitary gland is prominently involved in processes of bodily growth and development. Some of its hormones may also play a part in tooth development and eruption. Since the hypophysis has been implicated in the etiology of diabetes, the triangle of gross development, tooth development, and diabetes gives rise to questions of possible interrelationship (1). The opinion that tooth decay is facilitated by factors of poor nutrition has been expressed frequently in the literature. For example, the fact that excessive amounts of sugar are present especially in the diets of some children has led certain observers to hold this agent responsible in some degree for dental caries. Boyd and Drain (2) and others studied the incidence of caries in diabetic children. They found a significant reduction in tooth decay in juveniles under good diabetic control and attributed the change to improved nutritional status. Their conclusions are in sharp contrast to the findings of those investigators who believe that in this problem the chemical composition of the diet is of secondary importance whereas its physical characteristics and local environmental factors exert the major influence in producing dental caries. One phase of the present study concerns itself with testing these conflicting hypotheses.

Effects of Thyroidectomy and Thyroid Stimulation on Growing Permanent Dentition of Rhesus Monkeys

Diets were carefully compounded and the animals were observed regularly. Each animal was given 2 or more injections of a 2 per cent solution of Alizarin red S (Coleman & Bell) pre-experimentally, followed by from 1 to 3 injections during the course of experimentation. The dye was injected intraperitoneally. The dosage ranged from 50 to 75 mg. per kilogram of body weight. One red line for each Alizarin injection is formed in the growing dentin and, on sectioning the teeth, these lines are clearly visible under the microscope. By measuring between the lines with a filar eyepiece micrometer the rate of growth, pre-experimental and experimental, was determined on the same animal. (Some animals, as fig. 1 (ABC) shows, were used as, general controls for studying rate of dentin growth). In addition, the Grenz ray was used for studying calcification. Details are listed in the accompanying Table I.

Effects of Pregnancy, Mouth Acidity, and Age on Dental Caries

The widespread idea that pregnancy is a cause of dental decay has been questioned. In the present study an attempt was made to throw further light on the problem. An index of caries based on the number of decayed tooth surfaces (Bodeckers Caries Index) was calculated for each of 324 pregnant women referred routinely from the Sloan Hospital for Women (fig. 1). Each patient received full mouth radiographs, allowances were made for missing teeth, and occlusal grooves large enough to admit the sharp point of an explorer were set down as cavities. The caries noted is of course an accumulation (see Bodeckers Caries Index) so that allowance must be made for age in comparing the observations on teeth with the number of past pregnancies. A further supposedly relevant variable is the hydrogen ion concentration of the saliva, which was recorded in each case because of the oft presumed relationship of caries to mouth acidity. In recording the salivary pH, unstimulated saliva was analyzed by the colorimetric method. In addition to these pregnant women, 31 women who had never been pregnant were examined in the same way for comparison. The nonpregnant group consisted of a miscellany of hospital employees, patients coming in for reasons other than caries, et al. It is not possible to obtain a strictly comparable control of this nature, and the statistical results may perhaps be interpreted to mean that these 31 are not a random sample with respect to caries distribution, despite all precautions. Their mean caries index is substantially higher than that of the pregnant group, which may be interpreted to mean either that pregnancy prevents caries, or that the selection of cases

The Effect of Castration and Hypophysectomy On the Gingivae and Oral Mucous Membranes of Rhesus Monkeys

The material for this report is taken from studies on 3 groups of rhesus monkeys. Group I consists of 10 normal female monkeys of different ages and weights from which sections of gingival tissue were taken previous to any experiments. This represents the normal control series. Group II consists of 7 monkeys 4 females and 3 males. These animals were castrated and subsequently observed over varying periods of time before autopsy. No treatment other than castration was given. Group III consists of 5 hypophysectomized female monkeys. No treatment other than the hypophysectomy was given.

Interrelation of large parenteral doses of estrogen and Vitamin A and their effect on the oral mucosa

Abstract The problem is one of potential connection between the hyperkeratinization of oral mucous membranes seen in vitamin A deficiency and that produced in long-term large-dose estrogenic therapy. Hormones and vitamins have specific effects on the organism as a whole. Both of these substances affect epithelial structures in a definite manner. Do they at all times perform as separate entities or, under the conditions described, do they act, directly or indirectly, upon each other? In the first experiment, two subadult female rhesus monkeys, one normal and one ovariectomized, were given 1,000 R.U. of progynon B for fifty-three days, when biopsies showed a definite change in the alveolar and areolar gingivae as evidenced by hyperkeratinization and hyperplasia. Eight days after the observance of these changes, daily doses of vitamin A (10,000 I.U.), plus estrogen (500 R.U.), were given for thirty-one days, after which time the animals were sacrificed and sections of oral mucous membranes and vaginas were studied. The effect of the vitamin A upon the keratinization and hyperplasia produced by estrogen was a suppression or amelioration. In the second experiment on a female rhesus monkey, large doses of vitamin A (10,000 I.U.) daily for thirty days were followed by combined vitamin A (10,000 I.U.) and estrogen (1,000 R.U.) daily for thirty days. In general, the results of the vitamin A administration indicated a degenerative change in the gingivae. The addition of estrogenic hormone to the administration of vitamin A resulted in overcoming the high vitamin A effect, producing hyperplasia of the gingivae with marked restoration of tissue tone. Although the injection of the combined estrogen and vitamin A produced an amelioration of the previous treatment effects in both experiments, the results in each were dissimilar.

Hormonal Therapy for Some Gingival Conditions

Hormonotherapy is widely applied in medical practice today, and there is substantial evidence to indicate that its use may prove efficacious in certain oral disorders. It is the purpose of this paper to suggest a basis for hormonotherapy in dentistry. Only the sex hormones, male and female, are considered. Oral hormonotherapy reacts systemically, and its local use cannot be dissociated from its general medical aspects. Therefore, something must be said of the source of the hormones, their physiology, function and systemic relation. Female sex hormone (Estrogen). Estrogenic substances have been recovered from the ovaries, placenta, urine, blood, faeces, bile, colostrum, testes, adrenals, pituitary and, according to Fisher, Kron and Zuckerman (28), from the sexual skin, the fluid of the sexual skin, and the liver of monkeys. It is widely distributed in nature, being found in all vertebrates, in some invertebrates, and in seeds, potatoes, female willow catkins; and in bituminous substances such as lignite and petroleum (1). It was recently shown that the addition of dilute solutions of crystalline estrone hastened the development of flowers in several plants, thereby demonstrating a possible relationship between animal and plant hormones (2). The primary action of the estrogenic hormone is to stimulate the growth and development of the female genital tract and mammary glands. It also stimulates the endometrium to growth and regeneration. It inhibits temporarily the growth of the primary and secondary genital organs in young males when given in large doses. It affects uterine motility and the pituitary gland (3, 4). The method of disposal of the estrogenic hormone is uncertain (5, 6).

Studies in the etiology of idiopathic orolingual paresthesias

Studies in a comprehensive investigation of the etiology of idiopathic orolingual paresthesia included: extensive history, repeated oral examinations, physical examination, kodachrome photographs, intra-oral x-rays, blood chemistry,blood counts, Kline test, basal metabolic rate determination, nutrition study, psychiatric interview, 17-neutral kestosteroid determination,