George E. Kaugars

Odontogenic keratocysts: A clinical and histologic comparison of the parakeratin and orthokeratin variants

Four hundred forty-nine cases of odontogenic keratocyst (OKC) were separated into three histologic categories: parakeratinized, orthokeratinized, or a combination of the two types. Demographic and clinical data, such as anatomic location and recurrence, were obtained from the biopsy forms. Results showed that 86.2% of the 449 cases were parakeratinized, 12.2% were orthokeratinized, and 1.6% had features of both orthokeratin and parakeratin. There were no statistically significant differences between orthokeratinized and parakeratinized OKCs when age, race, sex, presenting symptoms, and the clinical impression were compared. The orthokeratinized OKC was more often associated with an impacted tooth (75.7%), as compared with 47.8% for the parakeratinized OKC (P = .001). Parakeratinized OKCs recurred in at least 42.6% of the cases, compared with only 2.2% for orthokeratinized OKCs. This study emphasizes the importance of distinguishing between the parakeratin and orthokeratin variants of OKC. In addition, data are presented that show the need for longer follow-up than previously documented.

Comparison between the peripheral ossifying fibroma and peripheral odontogenic fibroma

This study presents previously unreported data on a series of 400 peripheral ossifying fibromas (POFs) and 13 peripheral odontogenic fibromas (PODFs). The differences between the two lesions are discussed, and comparisons are made with other reports in the literature. It is concluded that the lesions represent separate pathologic entities.

NASOPALATINE DUCT CYST : AN ANALYSIS OF 334 CASES

The nasopalatine duct cyst (NPDC) is the most common cyst of nonodontogenic origin in the maxilla. However, the information reported about this lesion consists primarily of small surveys and isolated case reports. The purpose of this retrospective investigation was to gather demographic, clinical, and histologic data on a large series of NPDCs, and to compare the findings with those of previous studies. In this study, the overall mean age at diagnosis was 42.5 years, and there was a slight male predilection. The mean radiographic diameter was 17.1 mm, but 75% of the lesions were 20 mm or less in diameter. Symptoms were present in at least 70% of the cases. Only 28% of the specimens contained respiratory epithelium. There was no correlation between radiographic size, patients age, presenting symptoms, or type of epithelium. Recurrence was noted in only 2% of the cases.

Actinic cheilitis: A review of 152 cases ☆ ☆☆

OBJECTIVE The purpose of this study was to determine whether any clinical or histopathologic variables are associated with the severity of epithelial change in lesions of actinic cheilitis. STUDY DESIGN A total of 152 acceptable cases of actinic cheilitis were identified from 66,067 cases accessioned from February 1989 to June 1998. For each case, the clinical information supplied by the submitting practitioner at the time of the biopsy and 8 histopathologic variables were evaluated. RESULTS The following 5 histopathologic variables were positively correlated with an increased degree of epithelial change: acanthosis, basophilic change within the connective tissue, the presence of inflammation within the connective tissue, perivascular inflammation, and thickness of the keratin layer. None of the clinical variables was associated with an increased degree of epithelial change. CONCLUSIONS The presence of any of the aforementioned histopathologic changes should prompt a close evaluation of the lesion for the presence of either epithelial dysplasia or carcinoma.

Cherubism: Diagnosis, treatment, and comparison with central giant cell granulomas and giant cell tumors

An extensive case of cherubism in a 17-year-old girl with no apparent familial history is presented. The rationale for treatment is presented and is compared with previous reports that have advocated nontreatment. The clinical and histologic similarities of cherubism to central giant cell granuloma and the giant cell tumor of bone are also discussed.

A clinical trial of antioxidant supplements in the treatment of oral leukoplakia

Seventy-nine patients with oral leukoplakia that was histologically verified as either hyperkeratosis or epithelial dysplasia with hyperkeratosis were enrolled in an antioxidant supplementation program for the treatment of the oral lesions. The patients received 30 mg of beta-carotene, 1000 mg of ascorbic acid, and 800 IU of alpha-tocopherol per day for 9 months. Clinical improvement of the oral lesion was noted in 55.7% of the patients and was more likely to occur in patients who reduced their use of alcohol or tobacco (p = 0.0056). Although risk-factor reduction was important, approximately half of the patients who did not alter their exposure to either alcohol or tobacco showed clinical improvement. The antioxidant supplementation significantly increased serum and tissue levels of beta-carotene, ascorbic acid, and alpha-tocopherol, but these changes did not correlate strongly with clinical improvement.

Traumatic bone cyst

A total of 161 cases of traumatic bone cyst, 94 from a review of the literature and 67 previously unreported ones, were analyzed for clinical and histologic features. No gender predilection was noted, and the history of prior trauma was equivalent to that described in the general population. The possibility of an association with florid osseous dysplasia is strengthened by the finding of a higher incidence of traumatic bone cyst in black females among the patients over the age of 30.

The prevalence of oral lesions in smokeless tobacco users and an evaluation of risk factors

Background. The widespread use of smokeless tobacco (ST) has prompted concern in regard to the development of oral lesions in long‐term users.

Dental radiologic survey of Virginia and Florida

The results of a survey of 2,257 dental offices recording dental radiology practices are presented and compared to earlier surveys. In many practices patients were exposed to radiographs at predetermined intervals; the variables of manual processing are not well controlled, and darkrooms had excessive light.

Use of antioxidant supplements in the treatment of human oral leukoplakia : review of the literature and current studies

An increasing public awareness of antioxidants may prompt a patients request to be treated without surgery if a leukoplakic lesion is discovered. However, surgical excision remains the treatment of choice for oral leukoplakia. The use of antioxidant supplements has shown some promise, but the predictability of success remains uncertain and long-term results are unavailable. Before the decision to use any antioxidant is made, it is critical to obtain a histopathologic diagnosis of the lesion. When dealing with a lesion diagnosed as hyperkeratosis, it may be appropriate to choose an antioxidant that may take some time for clinical improvement to occur. However, as the grade of epithelial dysplasia becomes more severe, consideration must be given to the possibility of malignant transformation during antioxidant treatment. We do not recommend the use of antioxidant supplements in the treatment of any carcinoma. The therapeutic use of antioxidant supplements outside of clinical trials conducted at academic medical centers should be done with considerable caution by practitioners in private practice. It should be emphasized that in these clinical trial patients were seen at frequent intervals to monitor their progress and to intervene if there was a noticeable deterioration in the clinical appearance of the lesion. In spite of the uncertainty with respect to antioxidant treatment, there are circumstances in which it should be considered. Recurrence after surgical excision when there is little reason to believe that a second surgical excision would be any more successful is an ideal candidate. Also, patients with widespread leukoplakia that involves a large area of the oral mucosa might be suitable for treatment with antioxidants, as well as patients who have extensive medical problems that make them surgical risks. The choice of which antioxidant(s) to use is complex because thus far there is no combination that is superior to the others. Beta-carotene with ascorbic acid or alpha-tocopherol is attractive because of a lack of side effects, but the range in reported values for lesion improvement has been broad and the clinical improvement typically takes several months. Clinical response with 13-cRA is faster but requires baseline and periodic serologic testing, as well as close monitoring for side effects. In those circumstances in which time is an important consideration, 13-cRA might be useful because clinical improvement can be evaluated within a matter of weeks as compared with beta-carotene. The group from M.D. Anderson Hospital has shown the value of an induction dose of 13-cRA that is followed by a lower maintenance dose. Unfortunately, the problem of recurrence after discontinuation of 13-cRA is quite common. One aspect that has not been evaluated is the combination of conventional surgical excision and the administration of postoperative antioxidants. This would have the obvious advantage of conventional treatment of surgery together with the possible protective effect of the antioxidants. Although this is an attractive hypothesis, we do not know of any studies that have proven this to be beneficial.