Göran Anneroth

Personality characteristics of patients with resistant burning mouth syndrome.

The personality characteristics in 32 patients with resistant burning mouth syndrome (BMS) after treatment of diagnosed medical and odontologic diseases were examined and compared with a sex- and age-matched control group. After evaluation of burning mouth symptoms, the personality, the psychologic functioning, and the quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). The result showed that, compared with a control group, the patients with resistant BMS had a significantly lower score in socialization scale and significantly higher scores in somatic anxiety, muscular tension, and psychasthenia scales. Furthermore, the patients with resistant BMS were significantly more easily fatigued and more sensitive and showed a tendency to be more concerned about their health. With regard to the psychologic functioning, the BMS patients had significantly more problems taking the initiative, more easily became dizzy, and had more sad thoughts. They also showed a tendency to report palpitations and/or indigestions more often. The observed significant differences in personality and psychologic functioning might suggest that the burning sensations are psychosomatic symptoms in these patients. We recommend that patients with resistant BMS should undergo psychologic investigation. If psychologic and/or psychosocial disturbances are diagnosed, adequate treatment should be offered.

Amalgam-associated oral lichenoid reactions: Clinical and histologic changes after removal of amalgam fillings*

OBJECTIVE AND STUDY DESIGN Forty-nine consecutive patients with clinically diagnosed oral lichenoid reactions in contact with amalgam fillings were studied clinically and histologically. The long-term effect of replacement of these fillings was also examined. RESULTS Seventeen (35%) patients showed positive reactions to mercury at the epicutaneous patch test that was carried out before treatment. After treatment, total regression of the lesions was found clinically in 33 (69%) and histologically in 26 (55%) patients. Most of the remaining lesions changed clinically and histologically to a less pronounced tissue reaction. Lesions in direct contact with amalgam fillings (group I) showed significantly better healing results than lesions that exceeded the contact area (group II). No difference in healing capacity was noted in the two groups between patients with positive patch reactions to mercury compared with those with negative reactions. Lesions that histologically were classified as benign oral keratosis showed a similar healing pattern as those classified as oral lichen planus. CONCLUSION In group I all lesions changed histologically and clinically to a normal mucosa or to a less affected tissue reaction. In group II this change was less pronounced, which suggests that the fillings themselves were not the only factor involved in the cause of these lesions. The results suggest that various etiologic factors are involved in lichenoid reactions and that the effect of removal of amalgam fillings cannot be predicted by epicutaneous patch testing and biopsies.

The snuff-induced lesion. A clinical and morphological study of a Swedish material.

Snuff-induced oral lesions were studied clinically, histologically and by electron microscopy. The material was collected from 21 male snuff users. The lesions had a characteristic whitish appearance with a wrinkled swollen texture and the most common localization was in the vestibular area of the upper jaw. In two cases gingival retraction was observed. The light-microscopical examination showed a mild epithelial dysplasia in five cases. No carcinoma in situ or invasive carcinoma was recognized. In some of the cases ultrastructural changes in the basement lamina region, such as defects of the basement lamina and the occurrence of basal cell processes in the connective tissue, were observed. Odland bodies were seen in the epithelium. In the connective tissue filamentous material of unknown nature was found. The ultrastructure of the filamentous material suggested that it might be amyloid. In summary, snuff-induced lesions should be diagnosed, patients should be informed and made to quit the habit, and remaining lesions should be followed up regularly.

Psychologic aspects of patients with oral lichenoid reactions

Psychologic aspects of 49 patients with oral lichenoid reactions (OLR) in contact with amalgam fillings were studied and compared with an age- and sex-matched control group. Psychologic factors such as personality, psychologic functioning, and quality of life were determined by using the Karolinska Scales of Personality (KSP), an additional Personality Scale (PS), a Psychological Functioning Scale (PFS), and a Quality of Life Scale (QLS). With regard to personality the OLR patients had significantly higher scores on the muscular tension and suspicion scales and significantly lower scores on the indirect aggression scale. In addition, the OLR patients were significantly more worried about their health and more helpful. With regard to psychologic functioning the OLR patients had significantly more sad thoughts, became dizzy more easily, found it harder to imagine themselves free from anxiety, and had more difficulty in concentrating. The results indicated that OLR patients had a tendency to be depressive. The need for a systemic investigation including odontologic, medical, and psychologic aspects was expressed.

Exposure parameters and their effects on diagnostic accuracy

A new method for analyzing diagnostic accuracy is introduced. A diagnostic accuracy curve may be obtained by plotting receiver operating characteristic analysis data, P(A), as a function of exposure. By means of diagnostic accuracy curves the effects on diagnostic accuracy of tube potential, exposure, and size of carious lesions was studied. It was found that the effect of the tube potential on the accuracy of caries diagnosis is negligible. About 25% of the variation in diagnostic accuracy depends on the exposure and about 80% on lesion depth. With the lesion depth constant, about 75% of the variance in diagnostic accuracy depended on observer performance. The peak of a diagnostic accuracy curve indicates optimum performance. This is found at an exposure that gives a radiographic density of about 1 in enamel and dentin although the tolerable exposure increases with increased lesion depth.

Cell kinetics of head and neck squamous cell carcinomas. Prognostic implications.

Forty-three squamous cell carcinomas of the head and neck region were in vivo labelled with the thymidine analogue iododeoxyuridine. Combined flow cytometric (FCM) and immunohistochemical (IHC) analysis was performed, and the following parameters calculated: labelling index (LI), S-phase time (TS) and potential tumor doubling time (Tpot). Complete FCM and IHC analyses could successfully be performed in 31 cases, showing a median LI of 13.6% with FCM and 9.1% with IHC. A correlation achieved between LI/FCM and LI/IHC was due to the aneuploid cases, whereas the diploid cases showed no such correlation. Data indicated that Tpot calculated with LI from IHC (Tpot/IHC) might be a prognostic factor, in contrast to Tpot determined using LI/FCM.

Comprehensive medical examination of a group of patients with alleged adverse effects from dental amalgams.

Mercury from dental amalgams does not seem to cause dose-related intoxications. However, animal studies have shown that high-dose exposure to mercury may support various types of immunologic reactions. Ten patients claiming that their symptoms were caused and aggravated by amalgam therapy were selected for a study of the effects of removal of one amalgam restoration followed by placing of a composite filling. Clinical symptoms and the result of laboratory tests were recorded. Six patients had contact allergies to metals, three of them to mercury ammonium chloride. The comparison of pre- and post-experimental test results showed significant reductions in p-IgE and dU-albumin and significant increases in p-C3d and dU-beta 2-microglobulin. There was no laboratory evidence of a direct toxic effect by mercury on the patients. The observed response by some of the studied factors to the low acute exposure to amalgam may imply that an activation of the immune system occurred.

Intraosseous salivary gland tissue of the mandible mimicking a periapical lesion

A case of an unusual site of salivary gland tissue is presented. The lesion appeared as a radiolucency between the apices of the lateral incisor and canine in a 57-year-old male patient and simulated a periapical lesion. The canine was found vital.

Urinary tract calculi dissolved by means of renacidin. An experimental study.

Removal urinary tract calculi by surgery may be difficult in patients with poor health or in patients who have been operated on earlier. By means of percutaneous nephrostomy it is possible to irrigate the renal pelvis with Renacidin to dissolve calculi. Renacidin is a buffer and mainly consists of citrate and gluconate. The solution makes it possible to dissolve some calculi. This study was carried out in order to evaluate the influence of the concentration of renacidin and of the speed of the irrigation. Urinary tract calculi were obtained from five patients. The calculi were cut into 2 mm thick slices. Each slice was weighed before it was placed in a chamber for irrigation. Irrigation of the slices by means of renacidin was performed at speeds of 30, 60 or 120 ml/h. Slices wre also kept in vessels containing renacidin without replacing the fluid during the irrigation. In two series dissolution was investigated for various concentrations of renacidin. Elementary analysis using absorption and spectrophotometric techniques was performed and a qualitative evaluation of the distribution of the inorganic components was carried out using the microradiographic technique. The speed of the dissolution of urinary calculi varied between 0.43 and 7.7 mg/h. Two stones were easily dissolved (5 and 7.7 mg/h) while the three others were more resistant (0.5, 1.0 and 3.0). Diluted renacidin fluid (1:3) was less effective and reduced dissolution from 5.8 to 0.7 mg/h. The speed of the irrigation was of minor importance in the experimental situation. The dissolving effect of renacidin varied for different calculi.(ABSTRACT TRUNCATED AT 250 WORDS)

Life-style survey of patients with oral lichenoid reactions

The occurrence of different life-style patterns, including marital status, educational level, nutrition, tobacco and alcohol use, and frequency of physical activity, in patients with oral lichenoid reactions (OLR) in total or partial contact with amalgam fillings was examined. When compared with an age- and sex-matched control group, the daily intake of carbohydrates, fibers, and iron was statistically significantly higher in the OLR patients. Regarding marital status, there was a statistically significant difference between the OLR patients and the control subjects, the former group containing more people who were divorced or whose spouse had died. The frequency of physical activity was also statistically significantly higher in the OLR patients than in the control group. Hypothetical mechanisms that may lie behind the results obtained are discussed.