Vernon J. Brightman

Clinical Criteria for the Diagnosis of Salivary Gland Hypofunction

There is considerable difficulty in the making of initial clinical decisions as to whether a given patient has salivary gland hypofunction, and hence requires additional salivary gland evaluation. This study identified a set of four clinical measures that, together, successfully predicted the presence or absence of salivary gland hypofunction. The four measures were: dryness of lips, dryness of buccal mucosa, absence of saliva produced by gland palpation, and total DMFT; they were derived from discriminant analysis of data collected from 71 individuals with normal and low salivary flow rates. These measures are proposed as criteria for clinical decision-making, as well as for classification of patients in studies of salivary gland dysfunction syndromes. This study also identified unstimulated whole salivary flow rates of 0.12-0.16 mL/ min as the critical range separating individuals with salivary gland hypofunction from those with normal gland function.

Prediction of the Incidence of Recurrent Herpes Labialis and Systemic Illness from Psychological Measurements

About a third of variance in a years incidence of recurrent herpes labialis (RHL) was predicted from combinations of psychological and sociometric variables. Measures of social assets and psychological discomfort added significant predictive information when used in combination with measures of susceptibility to RHL (antibody titer or frequency of RHL determined by history).

Incidence of recurrent herpes labialis and upper respiratory infection: a prospective study of the influence of biologic, social and psychologic predictors.

In a 3-year prospective study of recurrent herpes labialis (RHL) in a population of 149 student nurses, 40 to 50 per cent of the variance in incidence could be explained by a small group of variables. Measures of previous experience with RHL accounted for the largest fraction of the explained variance, followed by upper respiratory infection (URI) rate, socioeconomic status, and mood trait, in order of declining influence. Timing of RHL episodes was not related to phase of the menstrual cycle.

Clinical and Laboratory Differentiation of Recurrent Intraoral Herpes Simplex Virus Infections Following Fever

Recurrent herpes simplex infections occurred over three times as frequently in a group of febrile patients as in a group of nonfebrile controls. Virus was isolated from patients without lesions, patients with lip lesions only, and patients with lip and intraoral lesions. Characteristic clinical features of the intraoral lesions found in association with herpes simplex virus (HSV) were identified.

Recurrent Herpes Labialis, Recurrent Aphthous Ulcers, and the Menstrual Cycle

A prospective study of 104 student nurses determined the frequency of recurrent herpes labialis and recurrent aphthous ulcers within the menstrual cycle. Each nurse kept daily calendars recording inter alia menses and episodes of lesions. Episodes of aphthae were not associated with any specific intervals in the menstrual cycle. There was a greater than expected incidence of episodes of herpetic lesions in the eight days preceding the onset of menses.

Idiopathic hypoparathyroidism, chronic candidiasis, and dental hypoplasia

Abstract The case of a 16-year-old boy with a syndrome of idiopathic hypoparathyroidism, chronic mucocutaneous candidiasis, and dental hypoplasia has been presented. Enamel hypoplasia was present in teeth which formed before there was evidence of hypocalcemia, and this dental defect, in addition to the candidiasis and photophobia, helped to determine the diagnosis of idiopathic hypoparathyroidism. Because of the danger of Candida fungemia and tetany, hospitalization was required for dental extractions under general anesthesia. Elevation of the serum calcium and extraction of the teeth appeared to result in clinical improvement of the oral candidiasis, and the patient has been able to function satisfactorily with full dentures.

A Prospective Study of the Distribution of Illness within the Menstrual Cycle

The cyclic physiological variations during the menstrual cycle are thought to be associated with change in emotional state, in susceptibility to illness, and in frequency of illness-related behavior. Variations in frequency of illness with the phases of the menstrual cycle were examined using data from a 3-year prospective study of social and psychological antecedents of viral illness in 94 student nurses. Reported illnesses, accidents, medical consultations, and hospital admissions were randomly distributed throughout the menstrual cycle. Subjects took more medication on the 1st day of menses than on any other day of the cycle; howeverreported menstrual symptoms were infrequent, with only 4% of the population reporting two or more such episodes. It was concluded that there was an increase in discomfort on the data of onset of menses which was self-medicated but not defined as illness. There was no discernible relationship of illness or disability to any phase of the cycle.

Serum immunoglobulins in patients with recurrent intraoral herpes simplex infections.

Recurrent infection of the oral tissues with herpes simplex virus (HSV) may be manifested as the familiar lesions of recurrent herpes labialis (RHL), as silent oral excretion of HSV (carrier state), or by oral excretion of HSV in association with the lesions of recurrent intraoral HSV infection (RIH). The latter two clinical manifestations may occur alone or in association with RHL (GREENBERG ET AL, J Dent Res 48:385-391, 1969; WEATHERS and GRIFFIN, JADA 81:81-88, 1970). Since levels of immunoglobulin A have been suggested as important humoral factors in susceptibility to recurrent herpes (TOKUMARU, J lInmunol 97: 248-259, 1966), serum concentrations of the three major immunoglobulins (IgG, IgA, IgM) were measured in patients who exhibited each of the three main types of recurrent herpes of the oral tissues. Serum was obtained from 58 febrile, hospitalized patients within three days after the onset of fever, and from 53 afebrile controls from the same ward (GREENBERG ET AL, 1969). Seventy-eight of the 111 patients had serum complement-fixing antibody to HSV and 14 of these had recurrent herpes confirmed by isolation of HSV at the time the serum was obtained. Four of the 14 had RHL only, six were carriers, and four had both RHL and RIH. IgA, IgM, and IgG were measured in each serum by a modification of the Mancini technique of immunodiffusion in agar gel.* To check the accuracy of the plates, a series of 18 determinations of IgG, IgA, and IgM were made on a serum sample. In this serum, IgG had a mean of 920, SD-+-58.2, mg % (CV, 7%); IgM a mean of 65, SD --+ 6.8, mg % (CV, 10.4%); and IgA a mean of 135, SD ± 3.7, mg % (CV, 2.7%).

Control Measures for Hepatitis B Problems in Dentistry

Infection with hepatitis B virus is a recognized occupational hazard of dentistry (1). There is considerable anecdotal evidence to support this; for example, most dentists, even if they have not been infected themselves, personally know other dentists or dental assistants who have been ill with this infection. The occupational nature of hepatitis B virus infection in dental personnel is also supported by the greater frequency of antibody to hepatitis B among dentists (and physicians) as compared with lawyers (professionals of similar socioeconomic status without occupational clinical contact), and by the gradual increase of the frequency of hepatitis B antibody in dentists (and physicians) to a maximum of about 20% over the normal span of dental and medical practice (2). Among dentists, the highest frequency of hepatitis B antibody occurs in oral surgeons and periodontists, with lower frequencies among general practitioners and pedodontists. The annual percentage increment of new infections for dentists and physicians is about 0.5, the increment for blood donors from the general population being about 0.087.