Jacqueline M. Plemons

Effectiveness of a low dose of cyclosporine in the management of patients with oral erosive lichen planus

This study investigated the effectiveness of a low-dose cyclosporine rinse used in the treatment of oral erosive lichen planus. Fourteen patients with oral erosive lichen planus provided seven experimental sites treated with cyclosporine and seven control sites treated with a placebo. Participants rinsed with 5 ml (500 mg) of cyclosporine or 5 ml of a placebo for 5 minutes each day over a period of 4 weeks. Cyclosporine blood levels as well as complete blood cell counts with differential and serial multiple analysis were monitored throughout the study. Weekly quantitative measurements of lesion size and character (ulceration, erythema, and reticulation) were recorded with the use of an intraoral grid. Healing was defined as the transition from ulceration to erythema to reticulation or to complete resolution. Pain assessment with the use of a visual analogue scale and a questionnaire pertaining to any side effects of treatment were completed each week. At 4 weeks, a statistically significant difference was observed in lesion healing between the cyclosporine and placebo groups. All experimental sites demonstrated progressive healing with evidence of reduced erythema and ulceration, increased reticulation, and decreased pain scores. In contrast, control sites exhibited minimal change in lesion size or character, and patients reported unchanged or increased pain scores. No significant side effects were reported. Within the parameters of this investigation, topical cyclosporine proved to an effective alternative therapy to currently available medications used in the treatment of oral lichen planus.

Absorption of a topical steroid and evaluation of adrenal suppression in patients with erosive lichen planus

This study was designed to investigate the absorption of a topical steroid applied to the gingiva and buccal mucosa of patients with erosive lichen planus and to healthy control patients. In addition, adrenal suppression was assessed by measurements of serum and urine cortisol levels. Ten patients with erosive lichen planus and eight control patients provided urine and blood samples at baseline, day 3, and day 21. After establishment of baseline laboratory values, patients were instructed to apply 500 mg of a 0.05% fluocinonide gel to the gingiva and buccal mucosa three times a day for 3 weeks. Measurements of cortisol levels revealed no significant changes in either the disease or the control group. Although procedures were developed to detect fluocinonide, none of the patients showed evidence of the steroid during the study. It was concluded that the topical application of a fluocinonide gel to the gingiva and buccal mucosa over a 3-week period in patients with erosive lichen planus produced no adrenal suppression.

Salivary basic fibroblast growth factor in patients with oral squamous cell carcinoma or oral lichen planus

OBJECTIVE The objective of this study was to gather preliminary data concerning the feasibility of using salivary basic fibroblast growth factor (bFGF) for detecting development of oral squamous cell carcinoma (OSCC) in patients with oral lichen planus (OLP), and in patients with OSCC whose disease was in remission. STUDY DESIGN Saliva samples were collected from 5 patient groups: patients with newly diagnosed OSCC, patients with OSCC whose disease was in remission, patients with OLP in disease-active state, patients with OLP in disease-inactive state, and healthy controls. Salivary bFGF levels were determined by enzyme-linked immunosorbent assay, and data were analyzed using the Mann-Whitney U test. RESULTS Salivary bFGF levels were significantly elevated in patients with newly diagnosed OSCC compared with patients with OSCC in remission, patients with disease-active OLP, and healthy controls. No significant difference was found between patients with newly diagnosed OSCC and patients with disease-inactive OLP. CONCLUSIONS Our results suggested that salivary bFGF might be a potential biomarker for detecting OSCC development in patients with OSCC in remission, but not in patients with OLP.

A Comparison of the Periodontal Status in Patients With Mucous Membrane Pemphigoid: A 5-Year Follow-Up

BACKGROUND Mucous membrane pemphigoid (MMP) is a heterogeneous group of blistering autoimmune disorders of unknown etiology. Intraoral manifestations of MMP feature the formation of vesiculobullous lesions that eventually rupture, leading to pseudomembrane-covered, irregularly-shaped ulcerations. The presence of these often painful oral lesions may hinder oral hygiene efforts resulting in increased plaque accumulation and may increase the risk of developing periodontal disease. The purpose of this study was to evaluate the changes in periodontal status in patients with MMP after a period of 5 years. METHODS Twenty patients, 10 diagnosed with MMP and 10 controls matched for age, gender, and smoking history, were chosen to participate in a study evaluating their periodontal status. Parameters evaluated included the plaque index, gingival index, bleeding index, probing depths, recession, clinical attachment level, mobility, furcation involvement, number of missing teeth, and periodontitis. Data from the same MMP and control patients were available for comparison from an identical baseline evaluation performed 5 years earlier. RESULTS Patients with MMP exhibited a statistically significant higher gingival index and amount of lingual gingival recession at both time periods compared to controls. Both groups exhibited statistically significant increases in attachment loss and facial/lingual recession, but the difference in change between groups was not statistically significant. CONCLUSIONS The results of this study suggest that patients diagnosed with MMP appear to be no more at risk than controls matched for age, gender, and smoking history in developing or having an increased progression of periodontal disease.

Chronic periodontitis can affect the levels of potential oral cancer salivary mRNA biomarkers.

BACKGROUND AND OBJECTIVE More than 100 salivary constituents have been found to show levels significantly different in patients with oral squamous cell carcinoma (OSCC) from those found in healthy controls, and therefore have been suggested to be potential salivary biomarkers for OSCC detection. However, many of these potential OSCC salivary biomarkers are also involved in chronic inflammation, and whether the levels of these biomarkers could be affected by the presence of chronic periodontitis was not known. The objective of this pilot study was therefore to measure the levels of seven previously reported potential OSCC salivary mRNA biomarkers in patients with chronic periodontitis and compare them to levels found in patients with OSCC and healthy controls. The seven salivary mRNAs were interleukin (IL)-8, IL-1β, dual specificity phosphatase 1, H3 histone family 3A, ornithine decarboxylase antizyme 1, S100 calcium-binding protein P (S100P) and spermidine/spermine N1-acetyltransferase 1. MATERIAL AND METHODS Unstimulated whole saliva samples were collected from a total of 105 human subjects from the following four study groups: OSCC; CPNS (chronic periodontitis, moderate to severe degree, non-smokers); CPS (chronic periodontitis, moderate to severe degree, smokers); and healthy controls. Levels of each mRNA in patient groups (OSCC or chronic periodontitis) relative to the healthy controls were determined by a pre-amplification reverse transcription-quantitative polymerase chain reaction approach with nested gene-specific primers. Results were recorded and analyzed by the Bio-Rad CFX96 Real-Time System. Mean fold changes between each pair of patient vs. control groups were analyzed by the Mann-Whitney U-test with Bonferroni corrections. RESULTS Only S100P showed significantly higher levels in patients with OSCC compared to both patients with CPNS (p = 0.003) and CPS (p = 0.007). The difference in S100P levels between patients with OSCC and healthy controls was also marginally significant (p = 0.009). There was no significant difference in the levels of salivary IL-8, IL-1β and dual specificity phosphatase 1 mRNAs between patients with OSCC and patients with CPNS (p = 0.510, 0.058 and 0.078, respectively); no significant difference in levels of salivary ornithine decarboxylase antizyme 1 and spermine N1-acetyltransferase mRNAs between patients with OSCC and patients with CPS (p = 0.318 and 0.764, respectively); and no significant difference in levels of the H3 histone family 3A mRNA between patients with OSCC and either CPS (p = 0.449) or healthy controls (p = 0.107). CONCLUSIONS Salivary S100P mRNA could be a reliable biomarker for OSCC detection, regardless of the presence of chronic periodontitis. The presence of chronic periodontitis could significantly affect the levels of the other six mRNAs, and negatively influence reliability for using them as biomarkers for oral cancer detection.