Maria Malmström

Psychiatric disturbance in patients with oral lichen planus

The degree of mental disturbance in 56 patients with clinically and histologically verified oral lichen planus (OLP) and in 44 non-OLP patients was investigated by means of the Cornell Medical Index psychological questionnaire. A statistically significant difference in mental disturbance between OLP patients and non-OLP patients was found, the OLP patients being more disturbed (p less than 0.01). The mental health of the non-OLP patients was equal to that of the general Finnish population. Of the OLP patients, 48.2% were mentally healthy, 21.4% had a mild mental disturbance, 5.4% had a moderate mental disturbance, and 25.0% had a severe mental disorder. The corresponding figures for the non-OLP patients were 72.7%, 9.1%, 11.4%, and 6.8%. Of the 56 OLP patients, 21 were randomly selected and referred for a psychiatric consultation. Five patients refused the psychiatric interview. Of the sixteen patients who were examined, five had a moderate psychiatric disorder, seven had a mild psychiatric disorder, one had signs of neurosis, and three were mentally healthy. Most of the patients had the subjective feeling that the clinical appearance of OLP, including discomfort, became worse during times of mental stress. None of the patients, however, had a subjective feeling of mental disturbance; nor did any of them feel any need for psychiatric treatment, except in one case.

Immunological features of patients with chronic sclerosing osteomyelitis of the mandible

Immunological status was studied in 15 patients, aged 11 to 71 years, with chronic sclerosing mandibular osteomyelitis. Duration of disease ranged from 1 to 16 years. Routine serological and immunological tests revealed some abnormality in all patients. All except one had an accelerated ESR. The Waaler-Rose titre was raised in 3 patients; in 1 it was 2000 (normal less than 32). Nuclear antibodies were detected in 2 patients, organ-specific antibodies in 3, and antibodies to double-stranded DNA in 1. In only 4 patients were the serum concentrations of immunoglobulins IgG, IgA, IgM and IgE within normal limits; all had normal concentrations of C3 and C4. None had raised antibody titres against viruses or precipitating antibodies to either milk protein or gluten. In none could evidence of food allergy be detected. PHA stimulation of lymphocytes was normal in all patients. HLA-typing in 12 patients showed that 4 had the antigen B13, 3 had B27, and of these 3 patients had the combination B13, B27. The function of neutrophils was studied in 5 patients. In all these patients the chemokinesis was significantly increased, whereas other phagocytic activities were normal. Most of our patients had a hyperactive humoral immune response. The clinical relevance of this finding awaits further, mainly immunogenetic, study.

Evaluation of autotransplantations of completely developed maxillary canines

Transplantation of 28 maxillary canines was followed up in 22 patients with an average age of 25.2 s.d. 9.9 years. The root was fully developed. The mean immobilization time was 6.6 weeks and the mean follow-up period 17.8 months. Results seemed to be better in the age group of 13--20 years than in 21--30 and 31--47 years. Statistically significant better results were found in the youngest than in the older groups in the return of vitality, vertical bone resorption, periodontal space in the lamina dura. Four of the 28 teeth were extracted because of great mobility caused by poor bone regeneration and vertical resorption of the alveolar bone: three in the middle age group and one in the oldest. Pulp extirpation was performed on nine teeth: six in the oldest group and three in the middle group. Vitality returned in only three teeth, all of which belonged to the youngest group. Root resorption was observed in all age groups; in 76% of the cases it occurred in the apical third, and was generally inflammatory. The causes of the failure of transplantation were considered to include damage of the transplant during removal from deep palatal malposition, poor regeneration of the bone around the transplant and chronic periodontal infection. The prognosis for transplantation was found to be fairly good for patients under 20 years of age but poorer for older age groups.

Cyclosporin A mouthwash in the treatment of oral lichen planus

Seven patients with long-standing atrophic/erosive oral lichen planus were treated for 4 weeks with cyclosporin A as a mouthwash. At the end of the 3-month follow-up period, no improvement in disease status was noted in any of the patients, although two patients showed a slight improvement of their lesions at the end of 1 month of treatment. Cyclosporin A as a mouthwash does not seem to be an effective means of treating severe oral lichen planus.

Increased density of lymphocytes bearing γ/δ T-cell receptors in recurrent aphthous ulceration (RAU)

Lymphocytes bearing the T-cell receptor (TCR) gamma/delta are increased in the peripheral blood of patients with recurrent aphthous ulcers (RAU) and Behcets disease. In this study, we examined whether the density of TCR-gamma/delta bearing lymphocytes was also increased locally in RAU lesions. Ten RAU lesions from ten patients were compared with ulcer-free mucosa from sites contralateral to the lesions, and with 10 samples of clinically healthy oral mucosa taken from 10 healthy volunteers. Samples were labeled with a panel of monoclonal antibodies specific to CD3, alpha/beta TCR and gamma/delta TCR in avidin-biotin-peroxidase complex (ABC) staining. Lymphocytes expressing gamma/delta TCRs were very low in non-lesional mucosa and clinically healthy mucosa. By contrast, gamma/delta T-cells were numerous and observed in all RAU lesions especially within the epithelium, inflammatory infiltrates and at perivascular locations. The count of gamma/delta T-cells was high in connective tissue of RAU (200 +/- 126 cells/mm2) compared with connective tissue of controls (4+/-4 cells/mm2; P<0.0001) or non-lesional mucosa (5+/-7 cells/mm2). Interestingly, the density of gamma/delta T-cells was also high in the epithelium of RAU (70+/-34 cells/mm2) compared with the epithelium of non-lesional mucosa (2.8+/-06 cells/mm2; P<0.0001) or epithelium of healthy controls (1.2+/-1.5 cells/mm2; P<0.0001). Moreover, the mean percentage of gamma/delta+ T-cells among total CD3+ lymphocytes was increased in the connective tissue area from 4% and 5% in controls and non-lesional mucosa, respectively, to 19% in RAU. In epithelial areas, the average percentage was increased from 2% and 6% in controls and non-lesional mucosa, respectively, to 36% in RAU. These data showed that gamma/delta T-cells are more numerous in RAU lesions and such an increase was purely restricted to RAU inflammatory areas.

Immunogenetic markers and immune response in patients with recurrent oral ulceration

20 patients, aged 20 to 72 years (mean 36.5 years), 14 with recurrent (RAS) and 6 with recurrent cicatrizing (RCAS) aphthous stomatitis were studied. 3 patients (15%) had the HLA locus A11 antigen, whose frequency in the Finnish population is 8%. 5 patients (25%) had B12, which occurs in 15% of the normal population. Results of routine serological tests were normal. All had normal serum levels of IgG, IgM, IgA and complements C3 and C4. 4 patients, 2 with RAS and 2 with RCAS, had raised serum IgE. Precipitating antibodies against milk protein were detected in 2 patients and against gluten in 1. In 4 patients, tests for immediate allergy were positive. 5 patients had antibodies to double-stranded DNA. Delayed hypersensitivity reactions were normal, and the PHA stimulation of lymphocytes elicited normal T-cell responses in all patients except one with RCAS. In this patient, there was a striking parallelism between an increase in PHA-reactive lymphocytes and clinical improvement. The serum of this patient contained a binder for 125I-labelled PHA, a binder not consistently detected in the other patients with ROU. Lymphocyte dysfunction may play a rôle in ROU. Of the 16 biopsy specimens of aphthous tissue studied by direct immunofluorescence for IgG, IgM, IgA, fibrinogen and C3, 15 specimens contained deposits of C3 in and along mucosal vessels, whereas among the 15 controls only 1 specimen of erosive lichen planus showed deposits of C3 along capillary walls. Immune complexes precipitating in capillary walls appear to be a common feature of ROU.

Collagenase and stromelysin in recurrent aphthous ulcers (RAU)

Six patients with recurrent aphthous ulcers were studied for the presence of matrix metalloproteinases (MMP) 1, 3, and 8 in the lesions and in the clinically unaffected control mucosa obtained from the opposite side. MMP-type specific antisera were applied in the avidin-biotin-peroxidase complex staining method. Neutrophil-type collagenase (MMP-8) was found intracellularly in the connective tissue under the necrotized epithelium, and also laterally to the ulcer in association with the basement membrane. Fibroblast-type collagenase (MMP-1) and stromelysin (MMP-3) were found in the epithelial cells adjacent to the ulcerous lesion. They were found also in the endothelium of capillary blood vessels and postcapillary venules and also in some macrophage- and fibroblast-like mononuclear cells in the lamina propria laterally to the ulcer. A small number of MMP-1 and MMP-3 positive cells were noted in the control biopsies obtained from the clinically uninvolved control mucosa. These findings suggest regional differences in the distribution of the two main collagenases, implying distinct roles in tissue destruction and remodeling.

Topical treatment of oral leukoplakia with bleomycin

Ten patients with oral leukoplakia were treated topically with bleomycin. We found the method convenient but only successful where sufficient attention was paid to the activity of the bleomycin-dimethylsulphoxide solution. The initial epithelial dysplasia disappeared completely in five of the 10 patients, while in the remainder the dysplastic grade remained the same. Following treatment the thickness of the keratotic layer increased in four patients, became thinner in five and remained unchanged in one. Although clinically the results of treatment only appear some 3 months after bleomycin application, once the lesions are cured their recurrence seems to be slower than after surgery. Nevertheless we strongly emphasise that 3-monthly follow-ups are mandatory for patients with oral leukoplakias whether or not they have been treated successfully.

Acute tongue abscess: Report of two cases

Tongue abscesses are extremely rare. Two cases caused by periodontal pathogens are presented.

Sjögren's syndrome in systemic lupus erythematosus and rheumatoid arthritis: Immune effector cells in salivary glands

SummaryA simultaneously capturing azo dye method for acid α-naphthyl acetate esterase was used to characterize the cellular infiltrate in labial salivary glands in 25 patients with Sjögrens syndrome (SS). There was no significant difference in the T-pattern lymphocyte percentage in situ between the untreated group with SS and the group treated with 10±2 mg prednisone/day. There was a significant correlation (P<0.05) between the T-pattern lymphocyte percentage in situ and the focus-score value. In secondary (2°) SS in cases of systemic lupus erythematosus (SLE) and rheumatoid arthritis, respectively, 55%±4% (range 41–69) and 43%±7% (range 15–80) of all inflammatory cells in the periductal lymphocyte-rich infiltrates were T-pattern lymphocytes. In other SS patients the corresponding value was 28%±7% (range 4–50). The T-pattern lymphocyte percentage in situ was dependent on the disorder associated with SS (P=0.07). The present results indicate the dominance of T-lymphocytes in situ in 2° SS with SLE and suggest that there are differences in cell-mediated immunity in different clinical subgroups of SS.