P.-J. Lamey

The usefulness of the HAD scale in assessing anxiety and depression in patients with burning mouth syndrome

A recent index of anxiety and depression (Hospital Anxiety and Depression Scale) was applied to 74 patients with burning mouth syndrome. The scale pointed to anxiety, more than depression, being a feature of burning mouth syndrome. The validity and clinical application of this scale to assess anxiety and depression in such patients are discussed.

Oral presentation of pemphigus vulgaris and its response to systemic steroid therapy

This article reviews our experience during a 20-year period with patients with oral lesions of pemphigus vulgaris. Of the 30 patients, 20 were women and 10 were men, with an age range of 24 to 68 years. The soft palate was involved in 80% of cases at initial presentation. Direct immunofluorescence studies were positive for IgG in the intercellular region in all cases where lesional tissue was histologically studied. Systemic steroid therapy alone controlled the disease in 24 patients, one patient was given no treatment, and the remaining five required additional treatment with either azathioprine, cyclophosphamide, or gold. Steroid therapy was continued in the long-term at a reduced dose, but side effects such as diabetes mellitus, hypertension, and duodenal ulcers were observed. Long-term steroid therapy is therefore the treatment of choice for the oral lesions of pemphigus vulgaris, but in some cases alternative treatment options may be required.

Sensitivity reaction to the cinnamonaldehyde component of toothpaste.

Sixteen patients developed a variety of oral lesions following a change in the toothpaste they used. Mucosal biopsy demonstrated features consistent with application of a topical medicament and patch testing, towards the constituents of the toothpastes, indicated the flavouring agent cinnamonaldehyde as being the likely responsible agent. Avoidance of the implicated toothpastes resulted in a considerable improvement in clinical signs and symptoms, whereas rechallenge in ten patients resulted in recurrence of symptoms in eight patients. It is concluded that sensitivity to the cinnamonaldehyde constituent of certain toothpastes, although uncommon, should be considered as a possible aetiological factor in patients presenting with non-specific oral changes

Mucous membrane pemphigoid. Treatment experience at two institutions.

The initial oral findings and treatment in 50 cases of mucous membrane pemphigoid are presented. Histologic and immunologic studies were undertaken in each case to confirm the clinical diagnosis. The treatments prescribed are summarized and illustrate that topical steroids are effective, but in some cases systemic steroid therapy with or without other immunologically active drugs is required. A significant number of patients had extraoral manifestations of the disorder.

Angina bullosa haemorrhagica: clinical and laboratory features in 30 patients.

Angina bullosa haemorrhagica (ABH) is a relatively recently recognized bullous disorder in which recurrent oral blood blisters appear in the absence of any identified systemic disorder. This study has examined the clinical, histologic, immunologic, and hemostatic features of 30 British patients and demonstrates that ABH is predominantly a localized disorder of middle-aged or elderly patients of either sex that is evident mainly as blood blisters on the soft palate. Trauma appears to be the most common identifiable precipitating factor, but the essential tissue defect is as yet unidentified.

Grinspan's syndrome : a drug-induced phenomenon ?

Three cases of apparently drug-induced Grinspans syndrome involving the triad of oral lichen planus, diabetes mellitus, and hypertension are reported. Because drug therapy for diabetes mellitus and hypertension is capable of producing lichenoid reactions of the oral mucosa, the question arises as to whether Grinspans syndrome is an iatrogenically induced syndrome.

The Effects of Diabetes and Autonomic Neuropathy on Parotid Salivary Flow in Man

Stimulated parotid salivary flow studies were performed on 20 non‐diabetic subjects and on 30 patients with insulin‐dependent diabetes mellitus who had been screened for autonomic neuropathy using tests of cardiovascular reflexes. Electrical gustometry was performed to detect the taste threshold.

Quantitative bacteriology of a case of acute parotitis.

It is generally assumed that the microorganisms responsible for acute suppurative parotitis are facultative anaerobes, primarily Staphylococcus aureus and Streptococcus viridans. A quantitative microbiologic investigation of an aspirate of pus from the case we report revealed a microbial flora (5.1 X 10(6) CFU/ml) consisting entirely of strict anaerobes (Fusobacterium nucleatum and Peptostreptococcus anaerobius). The strain of F. nucleatum was sensitive to metronidazole but resistant to penicillin, amoxicillin, and erythromycin (minimum inhibitory concentration greater than 16 micrograms/ml). P. anaerobius was sensitive to the antibiotics tested. It is concluded that a high concentration of viable anaerobic bacteria may be present in acute suppurative parotitis and thus pus obtained from cases of sialadenitis should be cultured with microbiologic methods capable of isolating strict anaerobes. Additionally, antibiotic sensitivity should be determined routinely.

Acute Suppurative Parotitis in Outpatients - Microbiologic and Posttreatment Sialographic Findings

The presenting clinical features of twenty-seven cases of acute suppurative parotitis seen in the Oral Medicine Unit, Glasgow Dental Hospital, between 1975 and 1985 are reviewed. The microbiologic findings plus the management and subsequent findings on sialography after recovery are summarized. Of the microorganisms isolated, alpha-hemolytic streptococci predominated, with many other bacteria similar in range to those reported in previous studies. Microbiologically, the drug of choice was erythromycin, closely followed by ampicillin. Sialography in the posttreatment phase demonstrated a local salivary gland abnormality in 70% of patients, and 22% of patients had a generalized salivary gland disorder. On the basis of these findings, a management regime for patients with acute suppurative parotitis is suggested.

Heck's disease

The clinical and histological findings in two adult caucasians with focal epithelial hyperplasia (Hecks disease) are described. The literature concerning this rare condition is reviewed