Mervyn Gornitsky

Contributing factors to chronic myofascial pain: a case-control study.

This case–control study was designed to investigate the contributing factors for chronic masticatory myofascial pain (MFP). Eighty‐three patients with MFP, selected from the dental clinics of the Jewish General and Montreal General Hospitals, Montreal, Canada, and 100 concurrent controls selected only at the first clinic, participated in this study. The association with MFP was evaluated for bruxism, head–neck trauma, psychological factors (symptom check list 90 revised questionnaire, SCL‐90R) and sociodemographic characteristics by using unconditional logistic regression. Clenching–grinding was associated with chronic MFP in multiple models including anxiety (OR=8.48; 95% CI: 2.85; 25.25) and depression (OR=8.13; 95% CI: 2.76; 23.97). This association also remained for MFP, excluding all other temporomandibular disorders (TMD). Clenching‐only (OR=2.54; 95% CI: 1.10; 5.87) and trauma (OR=2.10; 95% CI: 1.0; 4.50) were found to be associated with the chronic MFP, when the level of anxiety was adjusted in the model. No significant change was noted when the effects of clenching‐only (2.76; 95% CI: 1.20; 6.35) and trauma (OR=2.08; 95% CI: 1.03; 4.40) were adjusted for depression. Clenching‐only and clenching–grinding remained related to MFP regardless of patients being informed about these habits. A higher score of anxiety (OR=5.12; 95% CI: 1.36; 19.41) and depression (OR=3.51; 95% CI: 1.07; 11.54) were associated with MFP, as well as other psychological symptoms. In addition, female gender had almost three times the risk of chronic MFP than males when the model was also adjusted for psychological symptoms. Grinding‐only, age, household income and education were not related with chronic MFP. Tooth clenching, trauma and female gender may contribute to MFP even when other psychological symptoms are similar between subjects.

Nifedipine-induced gingival hyperplasia. A comprehensive review and analysis.

A comprehensive review of the literature and analysis of the clinical history, mechanisms, pathogenesis, histology, and management of nifedipine-induced gingival hyperplasia is reported. A correlation to age, gender, drug, dosage, duration of drug therapy, location, and mode of treatment is discussed. The case report presented provides a model for management of nifedipine-induced gingival hyperplasia and other drug-induced gingival hyperplasia.

The use of implants for orthodontic correction of an open bite

This case illustrates the integration of maxillofacial surgery, orthodontics, prosthodontics and periodontics in the treatment of an adult male. A traumatic injury to the lower jaw was the stimulus for the patient to seek orthodontic correction of a severe malocclusion including crossbites and an anterior open bite. The loss of a large portion of the anterior alveolar process of the lower jaw including six teeth was corrected with an implant bearing prosthesis which was subsequently used as anchorage to correct the malocclusion. Through the combined efforts of the above disciplines, properly orchestrated, this patient was treated in an effective and successful manner.

Changes in natural immunity during the course of HIV-1 infection.

The role of natural killer (NK) and lymphokine‐activated killer (LAK) cell‐mediated cytotoxiciry in AIDS has yet to be established. The objective of this study was to determine inducible LAK cell responses at different stages of HIV‐1 infection, and specifically to establish the participation of CD8 lymphocytes in these responses. Peripheral blood lymphocytes (PBL) were isolated from healthy seronegative (CDC‐0) subjects and HIV‐1 individuals who were clinically asymptomatic (Centre for Disease Control group 2, CDC‐2) or symptomatic (CDC‐4) with regard to secondary opportunistic infection (OI). LAK cells were generated upon incubation of PBL with IL‐2 and their cytolysis of K562 and U‐937 targets was determined using chromium release assays. The role of CD8+ lymphocytes as progenitors and effectors of these LAK cell responses was determined by immunomagnetic depletion of CD8+ cells from precursor PBL and LAK cells, respectively. LAK cell‐mediated cytotoxicities in HIV‐1‐infected individuals were reduced compared with scronegativc controls without any corresponding changes in the relative proportions of CD56+ (NK) cells among groups. Depletions of CD8+ subsets from either PBL or LAK cells dramatically reduced total LAK cytotoxic responses and LAK activities per unit CD56+ cell in the OI‐CDC‐2 scropositive population. No corresponding changes in LAK activities in seronegative control or HIV+/OI+ CDC‐4 groups were observed. Levels of LAK activity against K562 targets in CDC‐0/HIV and CDC‐4/HIV+ groups correlated with the percentage of CD56+ LAK cells; corresponding LAK activity in the CDC‐2/HIV+ group correlated with the percentage of both CD56+ and CD8+ subsets. These findings suggest that adaptive changes in non‐MHC restricted cytotoxic responses occur in HIV‐1 individuals at early stages post‐HIV infection, before the onset of opportunistic infection.

Tongue, primary amyloidosis, and multiple myeloma

A case of macroglossia and resulting apertognathia because of primary amyloidosis in a 65-year-old man with multiple myeloma is described. In addition, a retrospective study of the oral manifestations of primary amyloidosis and multiple myeloma in the last 15 years is reported.

Oral stent as treatment adjunct for oral submucous fibrosis

Oral submucous fibrosis is a chronic inflammatory disease that results in progressive juxtaepithelial fibrosis of the oral soft tissues that can cause increasing difficulty in chewing, swallowing, speaking, and mouth opening. Many treatment regimens for oral submucous fibrosis have been proposed to alleviate the signs and symptoms of the disorder. In severe cases, surgical intervention is the only treatment modality, but relapse is a major problem. This article describes the use of an oral stent as an adjunct to surgery to prevent relapse.

The Canadian systemic sclerosis oral health study: orofacial manifestations and oral health-related quality of life in systemic sclerosis compared with the general population

OBJECTIVE The aim of this study was to compare oral abnormalities and oral health-related quality of life (HRQoL) of patients with SSc with the general population. METHODS SSc patients and healthy controls were enrolled in a multisite cross-sectional study. A standardized oral examination was performed. Oral HRQoL was measured with the Oral Health Impact Profile (OHIP). Multivariate regression analyses were performed to identify associations between SSc, oral abnormalities and oral HRQoL. RESULTS We assessed 163 SSc patients and 231 controls. SSc patients had more decayed teeth (SSc 0.88, controls 0.59, P = 0.0465) and periodontal disease [number of teeth with pocket depth (PD) >3 mm or clinical attachment level (CAL) ≥5.5 mm; SSc 5.23, controls 2.94, P < 0.0001]. SSc patients produced less saliva (SSc 147.52 mg/min, controls 163.19 mg/min, P = 0.0259) and their interincisal distance was smaller (SSc 37.68 mm, controls 44.30 mm, P < 0.0001). SSc patients had significantly reduced oral HRQoL compared with controls (mean OHIP score: SSc 41.58, controls 26.67, P < 0.0001). Multivariate regression analyses confirmed that SSc was a significant independent predictor of missing teeth, periodontal disease, interincisal distance, saliva production and OHIP scores. CONCLUSION Subjects with SSc have impaired oral health and oral HRQoL compared with the general population. These data can be used to develop targeted interventions to improve oral health and HRQoL in SSc.

Salivary biomarkers of oxidative stress: A critical review

Human saliva is an increasingly attractive medium for biomarker discovery due to its amenability to noninvasive and repeated sampling, ease of collection and processing, and suitability for single analyte or metabolomic measurements. Salivary biomarkers of oxidative stress reflect local and systemic pathologies and may inform on the diagnosis, prognosis, and therapeutic responsiveness of numerous human diseases. However, for many of the disorders investigated, data reporting on alterations in salivary redox homeostasis are often highly conflicted across studies. We surveyed the available biomedical literature on this topic and noted significant discrepancies in the study designs, target populations, and operating procedures which likely contribute to the discordant data sets reported. Based on these observations, guidelines are provided to minimize interlaboratory variability in redox biomarker discovery based on human saliva.

Involvement of Human Immunodeficiency Virus (HIV) in Gingiva of Patients with AIDS

The acquired immune deficiency syndrome, “AIDS”, is characterized by a reduction in the number and function of helper-inducer T cells, leading to severe immune suppression and allowing numerous opportunistic infections and neoplasms. Since the first reported case in July, 1982 (1), AIDS has achieved pandemic proportions, causing major health and socio-economic problems in several parts of the world. So far, AIDS remains an incurable disease which is fatal usually within three years.

The Canadian Systemic Sclerosis Oral Health Study IV: oral radiographic manifestations in systemic sclerosis compared with the general population

OBJECTIVE The aim of this study was to compare oral radiologic abnormalities associated with systemic sclerosis (SSc) against abnormalities in the general population. STUDY DESIGN Patients with SSc and healthy controls were enrolled in a multi-site cross-sectional study. Included in the radiology examination were a panoramic radiograph, four bitewings, and an anterior mandibular periapical radiograph. Radiographs were evaluated by two oral and maxillofacial radiologists tested for interobserver and intraobserver reliability. Chi-squared tests, Fisher exact tests, and Mann Whitney U tests were used to summarize the radiologic manifestations of patients and controls. RESULTS We assessed 163 SSc patients and 231 controls. Widening of the periodontal ligament space (PLS) (P < .001), with higher percentage of teeth with PLS widening (P < .001), was significantly more frequent in patients with SSc than in controls. The most significant differences between the two groups were found in the molars and premolars (P < .001). Moreover, 26% of the patients with SSc had a periapical PLS greater than 0.19 mm compared with 13% of the controls (P = .003). Patients with SSc had significantly more erosions compared with controls (14.5% vs. 3.6%; P < .001), mostly in the condyles (P = .022), coronoid processes (P = .005) and other locations (P = .012). CONCLUSION Patients with SSc had more teeth with PLS widening and erosions of the mandible compared with controls.