Gordon S

Necrotizing stomatitis: report of 3 Pseudomonas aeruginosa–positive patients

Necrotizing oral lesions have been described in immunosuppressed patients, usually in association with gingival and periodontal pathoses. The etiology of these lesions has not been completely elucidated. We present 3 patients with a type of necrotizing stomatitis in which clinical patterns appear distinct from the periodontal forms of the disease. The lesions yielded bacterial cultures positive for Pseudomonas aeruginosa and reverted to no growth in 2 patients after proper antibiotic therapy. We propose that P aeruginosa may be responsible for selected necrotizing oral lesions with a clinical presentation lacking typical necrotizing periodontal disease and that this condition may represent the intraoral counterpart of ecthyma gangrenosum. In such cases, bacterial culture of the lesion becomes imperative because the disease does not respond to typical periodontal and antimicrobial therapy.

Effects of Caffeine on Salivation

Background: Caffeine is a methylxanthine which may decrease salivation through adrenergic mechanisms. Few studies have formally tested whether caffeine actually decreases saliva production. Methods: Eleven volunteers collected unstimulated 1-minute saliva production (1-MSP) after an overnight fast, followed shortly by a stimulated 1-MSP while chewing a stick of chewing gum. We then asked them to drink a beverage randomly selected to contain either regular or decaffeinated instant coffee. Caffeine content was doubleblinded. 1-MSP, both unstimulated and stimulated were then collected 30, 60, 90, and 120 minutes later. The following morning the subject followed the same protocol but drank the other kind of beverage. We used a mixedeffects linear model to analyze our data. Results: The adjusted mean difference between decaffeinated and caffeinated 1-MSP was -0.14 ml (p<0.05). Stimulation with chewing gum caused an unadjusted increase of 2.02 ml (p<0.001) and an adjusted increase of 2.01 ml (p<0.05). Variation for the unstimulated 1-MSP was much lower (SD 0.4 ml) than the stimulated 1-MSP (SD 1.01 ml), whereas variation for caffeinated 1-MSP (SD 1.29 ml) was similar to decaffeinated 1-MSP (SD 1.25 ml). Conclusion: Caffeine modestly but significantly decreased both Unstimulated and stimulated saliva production. The effect of caffeine was approximately 6.5% that of stimulation. The effect from caffeine was consistent across both stimulated and unstimulated samples. Additionally, caffeine did not increase the variability of saliva production either within or between individuals, in contrast to the effect from stimulation