Margot L. Van Dis

Proliferative verrucous leukoplakia: a report of ten cases.

A particularly aggressive form of oral leukoplakia that commences with a hyperkeratosis, spreads to become multifocal and verruciform in appearance, and later becomes malignant has been termed proliferative verrucous leukoplakia. Ten patients with persistent multifocal verruciform white patches were investigated. Lesions were often bilateral and affected predominantly mandibular alveolar and buccal mucosa. At first biopsy no lesion was graded higher than a verrucous hyperplasia, but subsequently all patients had squamous cell carcinoma, and two patients have died of their disease. Lesions were managed with surgery, carbon dioxide laser, and photodynamic therapy. The patients presented here confirm the existence of proliferative verrucous leukoplakia as a clinicopathologic entity. Careful examination of the whole mouth is essential when a hyperplastic white patch is seen to check for possible proliferative verrucous leukoplakia. Early aggressive treatment must then be started, and regular long-term review is crucial.

Prevalence of oral lichen planus in patients with diabetes mellitus

The purpose of this study was to determine the prevalence of oral lichen planus in a population of patients with diabetes mellitus compared with a control population and to determine if patient medications had any influence on the presence of such lesions. Two hundred seventy-three patients with diabetes and an identical number of age-, gender- and race-matched controls were examined for clinical evidence of oral lichen planus. Patient medication histories were also obtained from each group. Eleven diabetic patients (4%) and eight control patients (3%) had clinical evidence of oral lichen planus. Ingestion of nonsteroidal anti-inflammatory drugs or angiotensin-converting enzyme inhibitors was associated with the presence of oral lichen planus lesions in six patients. There was no apparent association of diabetes and oral lichen planus in this population, and the ingestion of medications known to cause lichenoid mucosal reactions had no influence per se on the presence of oral lichen planus lesions (p > 0.05). However, the type of medication ingested by those patients who had oral lichen planus lesions was either nonsteroidal anti-inflammatory drug or angiotensin-converting enzyme inhibitor, which was a significant association (p < 0.00).

Caries-related salivary microorganisms and salivary flow rate in bone marrow recipients

Cancer treatments often induce oral complications. In this study we investigate longitudinally the salivary gland function, the salivary caries-related microorganisms, and buffer capacity in bone marrow recipients. Stimulated saliva samples were taken midmorning. The salivary factors were studied in 42 patients from before transplant until 4 months after transplant. A dramatic reduction (66%) of salivary flow rate is noticed in all patients at 1 month after transplant, and only a partial recovery (42% reduction) is seen after 4 months. A clear shift toward a lower buffer capacity and a higher amount of cariogenic microorganisms is seen posttransplant. This shift is more pronounced when total body irradiation was included in the pretransplant conditioning therapy. These findings indicate that the studied parameters in transplant recipients can contribute to a higher caries risk and oral complications during the early posttransplant period.

Pilot study of controlled-release pilocarpine in normal subjects

OBJECTIVES Current systemic treatments with sialogogues for patients with xerostomia are limited because of minimal efficacy, short duration of activity, or problems with side effects. The purpose of this pilot study was an initial assessment of safety, efficacy, duration of action, multiple dose tolerance, and side effects of a controlled-release formulation of pilocarpine hydrochloride. STUDY DESIGN Eight healthy hospitalized subjects were given 15 mg of a controlled-release pilocarpine formulation every 12 hours for three doses. Saliva and blood samples were collected at assigned intervals. Repeated measures analysis and paired t tests were used for statistical analyses. RESULTS A significant (p < 0.05) increase in both parotid and whole saliva output followed all three doses beginning within 1 hour of dosing and lasting over 10 hours. Mean plasma pilocarpine concentration reached a maximum of 8.2 ng/ml at approximately 1 hour after the first dose, 11.5 ng/ml after the third dose, and declined to near baseline (0.06 ng/ml) 24 hours after the final dose. None of the participants showed evidence of adverse effects including complaints of sweating or gastrointestinal discomfort. CONCLUSIONS A controlled-release formulation of pilocarpine may overcome the therapeutic weaknesses of current pilocarpine preparations by prolonging salivary secretion and reducing undesirable side effects.

Information yield from a hand-held dental x-ray unit

The information yield from a hand-held radiographic unit was compared with that of a conventional dental x-ray unit. Ten observers were asked to detect radiographic details on films taken of a test object at eight different exposure settings with each radiographic unit. The viewers detected significantly more details on three films generated with the experimental unit. No significant difference was demonstrated in the number of details observed with either unit at the remaining exposure settings.

Assessment of the knowledge of graduating American dental students about the panoramic image

The objective of this study was to assess the capability of graduating dental students to identify the causes of undiagnostic panoramic images and to interpret anatomic landmarks on panoramic films. Seventeen dental schools were represented by 311 students. A radiology faculty member at each institution completed a questionnaire that addressed lecture time and experience provided to students in panoramic radiography. The faculty member administered a test instrument comprised of several panoramic radiographs that demonstrated one or more labeled anatomic structures, technical errors, or projection artifacts and multiple choice questions that addressed each entity. The mean percentage correct for the tested population on the entire test instrument was 72.9%. The mean percentage correct for questions addressing anatomy, error and artifact recognition, and error correction was 84.0%, 61.4% and 45.2%, respectively. Factors that significantly (p < 0.05) affected student performance were the number of lecture hours provided, whether or not students took panoramic radiographs of patients, and the method of student selection as participants. Laboratory or self-study projects and the number of panoramic radiographs (> or = 1) taken of patients did not significantly affect student performance on the test instrument.

Clinical evaluation of an illuminated dental mirror.

The purpose of this study was to determine whether the use of an illuminated mirror improved a dental students ability to detect oral disease or abnormalities and whether an oral examination could be conducted more efficiently with it when compared with the use of a conventional mirror and chair-mounted light source. Students examined patients with the illuminated mirror and with a standard dental mirror for caries, defective restorations, dental staining, etc. Students were observed to determine how often they adjusted the overhead light or shifted their positions to see better and the length of time the examination was noted. After each examination, students were asked to rate how well they could see in various intraoral sites. There was no difference in specificity ratios between the two techniques, and the only significant difference (p < or = 0.05) in sensitivity ratios was in the detection of caries. There was no difference in the number of position shifts or length of examinations; students made fewer external light adjustments when using the illuminated mirror. On a 10-point scale, students rated their ability to see intraorally better with the illuminated mirror.