G.P. Bombeccari

Diode Laser therapy for Heck's disease associated with HPV13 infection

© 2008 The Authors JEADV 2009, 23, 169–243 Journal compilation

Maxillofacial gunshot wounds and diagnostic tests for lead in the blood

We congratulate Edetanlen and Saheeb1 on their study of he potential association between people who have retained ead pellets after gunshot wounds to the craniomaxillofaial region, and the concentration of lead in the blood.1 The uthors indicated the possible toxic effects in the soft tissues f the face,1 but we would like to add a note of caution. In the patients and methods section, they state that “A samle of the serum (1 ml) was taken into a glass cylinder, and 0% concentrated nitric acid (5 ml) was added to digest the erum until the solution became clear”.1 From a toxicological oint of view, serum is not the best medium in which to meaure concentrations of lead.2–4 It is important to remember hat more than 90% of lead in whole blood is in the red blood ells.5 In the other studies that they cited, the measurements f the concentrations of lead were detected in whole blood. In conclusion, whole blood is the proper medium in which o analyse exposure to lead.5 Care should be taken to choose ensitive biological indicators (such as serum, or plasma or, hole blood, or combinations of them) to minimise the posibility of variability in the measurements.

An unusual green macular lesion of the gingiva: a foreign-body granulomatous reaction

The current clinical case highlights the diagnostic process in characterizing an unusual green macular lesion of the maxillary gingiva. A review of the history revealed that the patient had suffered trauma to the oral tissues during a soccer match 2 years prior. An incisional biopsy was performed and microscopic analysis demonstrated the presence of a granulomatous reaction to a needle-shaped, birefringent foreign material. Comparative analysis of a specimen collected from the soccer field confirmed that the foreign material was artificial grass. Foreign material was also found inside the gingival epithelial cells.

Increased levels of COX-2 and oral lichen planus

Editor We were interested in Danielsson et al.’s study on 20 OLP patients, which suggests that increased elevation of cyclooxygenase-2 (COX-2) are found in these patients as compared with control subjects matched for age and gender. The authors reported the first experimental observation that shows heightened expression of COX-2 in OLP tissue specimens. While awaiting the results of a new study that shed light on the potential clinical benefit of COX-2 inhibitors in OLP patients, Danielsson’s work has added one more piece of evidence to support the hypothesis that OLP is an autoimmune disorder. We would like to simply add another possible point, for which there is experimental evidence that mercury may increase the levels of COX-2 derived vasoconstrictor prostanoid in animal model. A recent study correlated mercury and COX-2. The biochemical evidence suggests that divalent mercury (Hg), which is released from mercury fillings, considerably contributes to elevation of COX-2 expression level. The authors correctly cited the original work of Cortés-Ramirez et al. linking OLP as well as oral lichenoid lesions with elevated COX-2 expression by immunohistochemical analyses. Given that there is a strong association between exposure to mercury from dental amalgam, delayed hypersensitivity to mercury and OLP, we think that future studies addressing COX-2 up-regulation and oral lichen may be enhanced by inclusion of the characteristics of filling material of OLP patients.