Herbert F. Silvers

Triamcinolone acetonide in the treatment of acute and chronic lesions of the oral mucous membranes: Preliminary report☆

Abstract Triamcinolone acetonide was administered in a new vehicle adhesive to fifty-six patients with various acute and chronic lesions of the oral mucous membranes. Trimacinolone acetonide therapy was undertaken in many instances after relatively prolonged unsuccessful therapy with numerous other agents and/or placebos. The patients treated included six with erosive lichen planus, six with denture stomatitis, four with oral erythema multiforme, four with geographic tongue, three with orolingual paresthesias, eight with desquamative gingivitis or stomatitis, thirteen with recurrent ulcerative stomatitis, eight with denture irritations or other traumatic ulcers. two with chronic inflammatory lesions of unknown etiology, and two with postradiation (cancer therapy) stomatitis. Triamcinolone acetonide in the adhesive vehicle was found to have either (1) suppressant, (2) ameliorative, or (3) curative effects on the various oral mucosal lesions enumerated above, with the exception of the three patients with idiopathic orolingual paresthesia and the four patients with geographic tongue. Further studies with this agent in acute and chronic lesions of the oral mucous membranes, especially when combined with the new adhesive vehicle, seem indicated. Since triamcinolone acetonide is a powerful corticosteroid which is fully active systemically, the total dose administered and the duration of therapy must be considered carefully. It is also essential that, where possible, therapy be of a discontinuous nature and that particular advantage be taken of the adhesive vehicles ability to maintain a drug at the site of application.

Oral lesions of interest to the prosthodontist: Part I. Denture stomatitis

Abstract A study was undertaken to evaluate the efficacy of a number of different therapeutic regimens in the treatment of denture stomatitis. The therapeutic agents employed included 2 per cent amphotericin B in an adhesive base, a denture adhesive, a diluted sodium hypochlorite solution as a soaking medium, and 0.1 per cent triamcinolone acetonide in an adhesive base. Various of these regimens of drug therapy were found to be useful, where indicated, as adjunctive aids in the management of denture stomatitis. However, the administration of drug therapy is not intended to replace or supersede complete and thorough prosthetic dental care for patients with denture stomatitis. A thorough examination of the mouth as well as a complete evaluation of the dentures is a necessary prerequisite to any anticipated therapy. Laboratory procedures to ascertain the presence or absence of C. albicans organisms must also be considered essential in most instances of denture stomatitis. Finally, no single, specific drug therapy, arbitrarily selected, should be relied upon.

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,

Antihistaminic agents in the treatment of recurrent aphthous stomatitis

Abstract Antihistaminic therapy failed to cure recurrent aphthous stomatitis. The peripheral blood eosinophile count in recurrent aphthous stomatitis remained within normal limits.

Amphotericin B in the treatment of oral monilial infections.

Abstract Amphotericin B was administered to thirty-three patients with lesions of the oral mucous membranes in which C. albicans was implicated, either as a primary etiological factor or as a secondary invader. These lesions included denture stomatitis, angular stomatitis, oral moniliasis of unknown etiology or association, and antibiotic-induced stomatitis. Amphotericin B was found to have marked suppressant or curative effects on all lesions studied. Inasmuch as the lesions investigated are frequently dependent upon predisposing systemic factors, such as hypovitaminosis, or local exciting factors, such as closed-bite or trauma, the satisfactory management of these lesions demands the eradication of all influences predisposing to the disturbance.

Clinical laboratory studies on a new topical corticosteroid—Triamcinolone acetonide

Abstract Triamcinolone acetonide, a new corticosteroid which has been suggested as a highly active topical agent in the treatment of certain acute and chronic lesions of the oral mucous membranes, was studied with respect to its possible systemic actions. In order to determine any undesirable effects incident to topical therapy, we undertook detailed blood chemistry, hematologic, and urine studies in eleven patients treated with this corticosteroid. A comparative study of the before- and after-treatment blood and urine test values following the five-day period of drug therapy (including 1 mg. per day of the active agent, triamcinolone acetonide) did not reveal any discernible or noteworthy deviations. All test findings remained within the accepted normal range. Where posttherapy deviations within the normal range were found, no consistent pattern was evident.

Recurrent ulcerative (aphthous) stomatitis: Intradermal food test studies

Abstract Thirteen patients with prolonged history of recurrent ulcerative stomatitis were studied for food sensitivity by intradermal testing procedures. The pattern of skin sensitivity reactions elicited did not establish allergy to food as etiologically responsible for recurrent ulcerative stomatitis, in terms of the group as a whole or for individual persons therein, with regard to the group of foods as a whole or any food in particular.

Studies in the etiology of chronic desquamative and hyperkeratotic lesions of the oral mucous membranes.

Abstract 1. 1. Ten patients presenting with chronic oral mucous membrane lesions characterized by both desquamation and hyperkeratosis, six patients with chronic oral mucous membrane lesions principally hyperkeratotic in character, nine patients with chronic oral mucous membrane lesions principally desquamative in character, and thirty-two control patients were studied in an effort to correlate chronic oral mucous membrane lesions with systemic factors. 2. 2. The scope of this investigation included a comprehensive history, oral examination, physical examination, Kodachrome photographs, intraoral x-rays, blood chemistry, blood counts, Kline test, basal metabolic rate determinations, nutrition study, psychiatric interview, and urinary 17-neutral ketosteroid determination. 3. 3. Although in these tests certain differences were observed between the disease groups and the control group, and although the results of certain of these tests suggest that one or more systemic conditions may be concomitant with the oral lesions in some of the patients studied, we were unable consistently to correlate the chronic oral mucous membrane lesions under consideration with any definite systemic factors.

Treatment of some chronic lesions of the oral mucous membranes

Animal csprrimentation concerned with vitamin A, methyl testosterone, alpha estradiol, pant,othenic acid, alld biotin, alone and in combination, has produced significant changes in the oral mucous membranes. On a vitamin A deficient diet, King 1 found that rats dereloped hyperplasia of the gingivae including a thickening of the keratinous outer layer and snhgingival epithelium. He found that the hyperplasia sometimes took the form of a general increase in t.he number of cell layers and sometimes appeared as fingerlike processes projectin, w into the connective tissue. The hyperplasia was generally associated with varying degrees of cellular infiltration into the corium. Rlellanlg-* produced similar changes in dogs. Wolt~ach and Howe3 showed that in rats on a vitamin A deficient diet, the normal epithelium was replaced by stratified kcratinizing epithelinm in various parts of the alimentary tract, respiratory tract. and genitourinary tract, as well as in the eyes and paraocular glands. Thedescribed morphologic sequences showing that the “replacement of epithelium arises from focal proliferation of cells arising from the original epithelium and not by differentiation 01’ change of preesist,ing cells. . . . Growth activity of epithelium is not diminis’-ed. On the contrary, there is convincing evidence that it is grtatl~angment,ed. ” Working with monkey, Ziskin, Rosenstein, and Drucker’ found that continued administration of vitamin A (10,000 units per day) for thirty days -__ From the Denartments of Dentistry an,1 Biochemistry of the Faculty of Medicine, C~lumbia University. *Late F’rofessor of Dentistry. School of Dental and Oral Surgery. Columbia Unirel‘sity. **Research Associate in Dentistry, School of Dental and Or‘al Sutgery, Columbia L’niversity. ***Research -\ssociate in Dentistry, School of Dental and Oral Surgeiy, Columbia University. ****Clinical .&ssistant, Division of Research, School of Dental and Oral Surgery, Columbia University. *****Associate F’rofessor of Biochemistry, School of Dental and Oral Surgery and College of Physicians and Surgeons, Columbia IJnirersity. tThis investigation was suppor’ted, in part, by a research grant from the National Institute for Dental Research of the National Institutes of Health, Public Health Service. and, in part, bv R g-ran+ fl‘,,,,, +,,rs ,?‘nrh,7 \nni~~c--clr’~~ P--cJati”n.