Russell J. Nisengard

Diagnostic importance of immunofluorescence in oral bullous diseases and lupus erythematosus

Immunofluorescent tests have proved to be of diagnostic importance for pemphigus, bullous pemphigoid, cicatricial pemphigoid, systemic lupus erythematosus, and discoid lupus erythematosus. Immunofluorescence test procedures, necessary specimens, and test findings have been reviewed as aids to dentists in the utilization and interpretation of these tests for the study of oral lesions.

Dermatitis herpetiformis: IgA deposits in gingiva, buccal mucosa, and skin

Fourteen patients who had dermatitis herpetiformis of the skin with no gingival lesions were studied. In each patient biopsy specimens of normal gingiva, buccal mucosa, and perilesional skin were examined for IgA and IgG deposits. Depending on the method of handling biopsy specimens for immunofluorescence, IgA deposits were detected in 21 to 25 percent of gingival specimens, 27 to 46 percent of buccal mucosal specimens, and 64 to 76 percent of skin specimens. The occurrence of IgA deposits in the gingival papillae, a site where lesions of DH have not been reported in the past or observed in this study, suggests that these IgA deposits alone may not play a primary role in the pathogenesis of this disease. Similar immunofluorescent findings of IgA deposits were observed in both quick-frozen biopsy specimens and those placed in holding solution, indicating the suitability of the holding solution for transporting suggested DH biopsy material.

Bacterial Invasion in Periodontal Disease

A workshop sponsored by the U.S. Spain Joint Committee for Scientific and Technologic Cooperation was held from May 16 to 18, 1986 in Niagara Falls, New York, to consider bacterial invasion in periodontal disease. Participants included representatives from the State University of New York at Buffalo, University of California at Los Angeles, University of Madrid, and the National Institute of Dental Research. This limited workshop provided an opportunity for those active in this area of research to exchange current research data, pool their expertise, and plan collaborative efforts to elucidate the role of bacterial penetration in the pathogenesis of periodontal disease. Included below are abstracts of the presentations by the U.S. and Spanish scientists.

Histopathologic, ultrastructural, and immunologic findings in an oral psoriatic lesion☆

There has been some controversy over whether psoriasis can involve the oral mucosa. An oral lesion in a 32-year-old man with a psoriatic scalp lesion has been studied by light and electron microscopy and by immunologic methods. Results from each of these three techniques are consistent with previous findings in psoriatic lesions and suggest that oral psoriasis can occur.

Gingival basement membrane antigens in desquamative lesions of the gingiva

Desquamative gingival lesions are a clinical manifestation of several entities where histologic alterations in the gingival basement membrane are frequent. Normal and lesional gingival specimens from six patients with desquamative lesions of the gingiva associated with cicatricial pemphigoid or lichen planus and from one normal subject were examined by indirect immunofluorescence for immunologic alterations in basement membrane antigens. In four out of five desquamative gingival lesions from patients with lichen planus, type IV collagen and EBA basement membrane antigens were interrupted, thickened, or partially or completely absent as compared to normal gingiva. One specimen showed multiplication and duplication of the basement membrane. In the two desquamative gingival lesions from patients with cicatricial pemphigoid, type IV collagen was either partially absent or associated with the connective tissue side of the subepithelial bullae. These results suggest structural alterations in antigens within the basement membrane of patients with desquamative lesions of the gingiva.

Experimental induction of periodontal disease with arthus-type reactions

Abstract Arthus reactions were induced in the gingivae of monkeys sensitized to bovine serum albumin or ovalbumin. Challenge by placing antigen-soaked threads into the gingival sulcus or by gingival injection of the sensitizing antigen elicited inflammatory infiltrates composed largely of mononuclear cells. Increased deposits of IgG and C4 were also observed particularly in perivascular locations. Injections with 100 or 10 μg yielded not only increased inflammation which extended deeper into the bone of the alveolar crest, but also osteoclastic activity similar to that observed in human periodontitis. Injections of heterologous antigens and other control injections failed to induce such changes. Similar arthus reactions to oral bacterial antigens may contribute to the pathogenesis of human periodontal disease.

Experimental periodontal disease: reverse passive arthus reactions.

Abstract Reverse passive Arthus reactions were induced in the periodontium and skin of monkeys by the local injection of antisera to BSA following the systemic administration of BSA. Animals received intravenous injections of antigen ranging from 100 to 5000 mg. Challenged sites received 0.1 or 0.2 ml of 16, 8, or 4 units of antisera/ml for 1 to 7 days prior to sacrifice. Immunofluorescence tests revealed deposits of IgG, C3, and BSA in the challenged sites. The histopathology of challenged sites was consistent with that of an Arthus reaction. Animals receiving the highest dosage of BSA (i.e., 5000 mg) had osteoclastic resorption of alveolar bone. Such findings did not occur in sites challenged with PBS or antisera directed against OA. These findings suggest a possible role for Arthus reactions in human periodontal disease.

Immunologic Cross‐reactivity Between Streptococcus Mutans and Mammalian Tissues

The presence of cross-reacting antigens shared by oral streptococci and human and monkey tissue was investigated by indirect immunofluorescence. Rabbit antisera prepared against two strains of each of the seven serotypes of Streptococcus mutans were incubated on sections of cardiac muscle, skeletal muscle, kidney, brain, liver, and skin. Antisera to S. mutans, serotype g, strain OMZ-65 reacted with cardiac muscle components. This reactivity could be reduced by absorption with bacterial cell membranes. Antisera to S. mutans serotype g, strain K-1 reacted with both cardiac and skeletal muscle but could not be reduced by absorption with bacterial cells, cell walls, or cell membranes. Antisera to S. mutans serotype g, strain OMZ-65 reacted with kidney glomeruli and could be completely absorbed by a cell wall preparation. S. mutans, serotype e, strain MT703 also reacted with kidney glomeruli but could not be reduced by absorption with bacterial antigens.

Effects of an immunofluorescent transport solution on the ultrastructure of human biopsies

Although immunofluorescent tests have been demonstrated to be of value in the diagnosis of many oral and skin lesions, the use of this technique has until recently been cumbersome because of the requirement for frozen tissue specimens. This has been circumvented by the development of a solution in which tissue can be transported to the testing laboratory at ambient temperatures. To verify that the immunofluorescent findings in gingiva and skin kept in this solution are not artifactual, ultrastructural studies were performed on such tissue. These revealed that over-all tissue architecture, individual cells, and the epidermal-connective tissue interface remain intact. Since the majority of oral lesions submitted for immunofluorescent testing are suspected of being pemiphigus or pemphigoid, the finding that these tissue features remain intact indicates that the distribution of immunofluorescence is related to definite morphologic structures and provides additional evidence for the validity of using the transport solution.