Yang Che Wu

Oral manifestations and blood profile in patients with iron deficiency anemia

BACKGROUND/PURPOSEnIron deficiency anemia (IDA) is the most common type of anemia. This study evaluated whether IDA patients had specific oral manifestations and a particular blood profile compared to normal controls.nnnMETHODSnThe oral manifestations and mean red blood cell (RBC) count, corpuscular cell volume, RBC distribution width, Mentzer index, and Green and King index as well as blood concentrations of hemoglobin, iron, total iron binding capacity, vitamin B12, folic acid, and homocysteine in 75 IDA patients and in 150 age- and sex-matched healthy controls were measured and compared.nnnRESULTSnIDA patients had significantly higher frequencies of all oral manifestations than healthy controls (pxa0<xa00.001 for all), in which burning sensation of oral mucosa (76.0%), lingual varicosity (56.0%), dry mouth (49.3%), oral lichen planus (33.3%), and atrophic glossitis (26.7%) were the five leading oral manifestations for IDA patients. Moreover, IDA patients had significantly lower mean hemoglobin level, RBC count, corpuscular cell volume, Mentzer index, iron level, and vitamin B12 level (pxa0<xa00.001 for all except pxa0=xa00.003 for vitamin B12) as well as significantly higher mean RBC distribution width, Green and King index and total iron binding capacity level (pxa0<xa00.001 for all) than healthy controls. However, no significant difference in the mean blood folic acid or homocysteine level was found between 75 IDA patients and 150 healthy controls.nnnCONCLUSIONnIDA patients have specific oral manifestations and a particular blood profile compared to normal controls.

Significant association of deficiencies of hemoglobin, iron, folic acid, and vitamin B12 and high homocysteine level with oral lichen planus

BACKGROUND/PURPOSEnA portion of patients with oral lichen planus (OLP) may have nutritional deficiency. This study evaluated whether there was an intimate association of the deficiencies of hemoglobin (Hb), iron, vitamin B12, and folic acid and high blood homocysteine level with OLP.nnnMETHODSnThe blood Hb, iron, vitamin B12, folic acid, and homocysteine concentrations in 352 OLP patients were measured and compared with the corresponding levels in 352 age- and sex-matched healthy control participants.nnnRESULTSnWe found that 77 (21.9%) OLP patients, 48 (13.6%) OLP patients, 25 (7.1%) OLP patients, and one (0.3%) OLP patient had deficiencies of Hb (men < 13xa0g/dL, women < 12xa0g/dL), iron (< 60xa0μg/dL), vitamin B12 (< 200xa0pg/mL), and folic acid (< 4xa0ng/mL), respectively. Moreover, 52 (14.8%) OLP patients had abnormally high blood homocysteine level. OLP patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency and of abnormally elevated blood homocysteine level than healthy control participants (all pxa0<xa00.001). Upon further dividing OLP patients into those with major erosive OLP (MjEOLP; nxa0=xa067), minor erosive OLP (nxa0=xa0202), and nonerosive OLP (NEOLP; nxa0=xa083), we found that MjEOLP patients had a significantly higher mean homocysteine level than NEOLP patients (pxa0=xa00.035).nnnCONCLUSIONnWe conclude that there is a significant association of deficiencies of Hb, iron, folic acid, and vitamin B12 and abnormally high blood homocysteine level with OLP. There may be a close relation of high blood homocysteine level to severity of OLP.

Significant association of deficiencies of hemoglobin, iron, vitamin B12, and folic acid and high homocysteine level with recurrent aphthous stomatitis

BACKGROUNDnA portion of patients with recurrent aphthous stomatitis (RAS) may have nutritional deficiency. This study evaluated whether there was an intimate association of the deficiencies of hemoglobin, iron, vitamin B12, and folic acid and high blood homocysteine level with RAS.nnnMETHODSnThe blood hemoglobin, iron, vitamin B12, folic acid, and homocysteine concentrations in 273 RAS patients were measured and compared with the corresponding levels in 273 age- and sex-matched healthy control subjects.nnnRESULTSnWe found that 57 (20.9%), 55 (20.1%), 13 (4.8%), and 7 (2.6%) RAS patients had deficiencies of hemoglobin (Men < 13 g/dl, Women < 12 g/dl), iron (<60 μg/dl), vitamin B12 (<200 pg/ml), and folic acid (<4 ng/ml), respectively. Moreover, 21 (7.7%) RAS patients had abnormally high blood homocysteine level. RAS patients had a significantly higher frequency of hemoglobin, iron, vitamin B12, or folic acid deficiency and of abnormally elevated blood homocysteine level than healthy control subjects (all P-values = 0.000 except for folic acid P = 0.022). If 273 RAS patients were further divided into 32 patients with major-typed RAS (MjRAS) and 241 patients with minor-typed RAS (MiRAS), we found that male MjRAS patients had a significantly lower mean hemoglobin concentration than MiRAS patients (P = 0.021), but MjRAS patients had a significantly higher mean homocysteine level than MiRAS patients (P = 0.000).nnnCONCLUSIONnWe conclude that there is a significant association of deficiencies of hemoglobin, iron, vitamin B12, and folic acid and abnormally high blood homocysteine level with RAS.

Oral manifestations and blood profile in patients with thalassemia trait.

BACKGROUND/PURPOSEnPatients with thalassemia trait (TT) may have anemia. This study evaluated whether TT patients had specific oral manifestations and a particular blood profile compared with normal individuals.nnnMETHODSnThe oral manifestations and mean red blood cell count, corpuscular cell volume, red blood cell distribution width, Mentzer index, and Green and King index as well as blood concentrations of hemoglobin, iron, total iron binding capacity, vitamin B12, folic acid, and homocysteine in 65 TT patients and in 130 age- and sex-matched healthy controls were measured and compared.nnnRESULTSnTT patients had significantly higher frequencies of all oral manifestations than healthy controls (p < 0.001 for all), in which burning sensation of oral mucosa (90.8%), lingual varicosity (90.8%), dry mouth (72.3%), atrophic glossitis (32.3%), and numbness of the oral mucosa (30.8%) were the five leading oral manifestations for TT patients. Moreover, TT patients had significantly lower mean hemoglobin level, corpuscular cell volume, Mentzer index, and Green and King index (p < 0.001 for all) as well as significantly higher mean red blood cell count and red blood cell distribution width (p < 0.001 for both) than healthy controls. However, no significant difference in the mean blood iron, total iron binding capacity, vitamin B12, folic acid, or homocysteine levels was discovered between 65 TT patients and 130 healthy controls.nnnCONCLUSIONnTT patients have specific oral manifestations and a particular blood profile compared to normal individuals.

Hematinic deficiencies and pernicious anemia in oral mucosal disease patients with macrocytosis

BACKGROUND/PURPOSEnMacrocytosis is defined as having the mean corpuscular volume (MCV) ≥ 100 fL. This study assessed hematinic deficiencies and pernicious anemia (PA) in oral mucosal disease patients with macrocytosis.nnnMETHODSnThe blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine concentrations and MCV in 60 oral mucosal disease patients with macrocytosis were measured and compared with the corresponding data in 120 age- and sex-matched healthy control participants. PA was defined by the World Health Organization (WHO) as having an Hb concentration < 13 g/dL for men and < 12 g/dL for women, an MCV ≥ 100 fL, a serum vitamin B12 level < 200 pg/mL, and serum gastric parietal cell antibody (GPCA) positivity.nnnRESULTSnWe found that 30 (50.0%), 7 (11.7%), 24 (40.0%), and three (5.0%) oral mucosal disease patients with macrocytosis had deficiencies of Hb (men < 13 g/dL, women < 12 g/dL), iron (< 60 μg/dL), vitamin B12 (< 200 pg/mL), and folic acid (< 4 mg/mL), respectively. Moreover, 38 (63.3%) and 16 (26.7%) macrocytosis patients had abnormally high blood homocysteine level (> 12.3 μM) and serum GPCA positivity, respectively. Macrocytosis patients had a significantly higher frequency of Hb, iron, or vitamin B12 deficiency, of abnormally elevated blood homocysteine level, and of GPCA positivity than healthy control participants (p < 0.001). However, only 16.7% of 60 macrocytosis patients were diagnosed as having PA by the WHO definition.nnnCONCLUSIONnOnly 16.7% of oral mucosal disease patients with macrocytosis are discovered to have PA by the WHO definition.

Langerhans cells in odontogenic epithelia of odontogenic fibromas.

BACKGROUND/PURPOSEnLangerhans cell (LC) is an antigen-presenting cell that is very important for T-cell-mediated immune reactions. Our previous studies have shown the presence of LCs in some odontogenic tumors and cysts. In this study, we further examined the presence of LCs in odontogenic epithelia of 16 odontogenic fibromas (OFs).nnnMETHODSnAnti-CD1a and anti-S-100 immunostains were used to detect the presence of LCs in nests or strands of odontogenic epithelia of 16 OFs.nnnRESULTSnThese 16 OFs included 10 peripheral OFs excised from seven male and three female patients (mean age, 38 years) and six central OFs (including one recurrent OF) removed from five male patients (mean age, 28 years). Of the 10 peripheral OFs, six were found on the mandibular gingiva and four on the maxillary gingiva. Four central OFs were located in the maxilla and two in the mandible. We found that both anti-CD1a and anti-S-100 immunostains had an equal ability to identify LCs in OFs. Positively stained dendritic LCs could be detected in nests and strands of odontogenic epithelia in nine (six peripheral and three central OFs) of the 16 OFs. In five peripheral OFs, dendritic LCs were found in occasional nests or strands of odontogenic epithelia. In one peripheral and three central OFs, dendritic LCs could be detected in at least half of the nests or strands of odontogenic epithelium in the tissue section.nnnCONCLUSIONnLCs can be detected in the nests or strands of odontogenic epithelia in approximately 60% of the 10 peripheral OFs and approximately 50% of the six central OFs detected.

High frequencies of vitamin B12 and folic acid deficiencies and gastric parietal cell antibody positivity in oral submucous fibrosis patients

BACKGROUND/PURPOSEnOral submucous fibrosis (OSF) is a chronic progressive scaring oral disease associated with areca quid chewing. This study evaluated whether OSF patients had anemia, hematinic deficiencies, and serum gastric parietal cell antibody (GPCA) positivity.nnnMETHODSnThe blood hemoglobin (Hb), iron, vitamin B12, and folic acid concentrations, mean corpuscular volume, and serum GPCA in 68 male OSF patients were measured and compared with the corresponding data in 136 age-matched male healthy control individuals.nnnRESULTSnWe found that five (7.4%), 14 (20.6%), 34 (50.0%), 28 (41.2%), and nine (13.2%) of the 68 male OSF patients had Hb (< 13xa0g/dL), iron (≤ 70xa0μg/dL), vitamin B12 (≤ 450xa0pg/mL), and folic acid (≤ 6xa0ng/mL) deficiencies, and serum GPCA positivity, respectively. Furthermore, OSF patients had a significantly higher frequency of Hb (pxa0=xa00.006), vitamin B12 (pxa0<xa00.001), or folic acid (pxa0<xa00.001) deficiency and of serum GPCA positivity (pxa0=xa00.011) than healthy control participants. Of the five OSF patients with anemia, two had thalassemia trait, one had iron deficiency anemia, and two had macrocytic anemia (mean corpuscular volumexa0≥xa0100xa0fL). In addition, of the nine OSF patients with serum GPCA positivity, six had vitamin B12 deficiency, five had folic acid deficiency, and two had iron deficiency. However, none of the nine GPCA-positive OSF patients had pernicious anemia based on the strict World Health Organization definition.nnnCONCLUSIONnWe conclude that there are high frequencies of vitamin B12 and folic acid deficiencies and of serum GPCA positivity in our male OSF patients.

Langerhans cells in the lining epithelia of odontogenic cysts

Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan Department of Oral and Maxillofacial Surgery, Division of Oral Pathology, School of Dentistry, University of Washington, Seattle, USA Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan

Hematinic deficiencies and anemia statuses in oral mucosal disease patients with folic acid deficiency

BACKGROUND/PURPOSEnFolic acid deficiency (FAD) may result in macrocytic anemia. This study assessed the hematinic deficiencies and anemia statuses in oral mucosal disease patients with FAD (defined as folic acid ≤ 6 ng/mL).nnnMETHODSnThe blood hemoglobin (Hb), iron, vitamin B12, and folic acid concentrations, serum gastric parietal cell antibody level, and mean corpuscular volume (MCV) in 198 oral mucosal disease patients with FAD were measured. Based on World Health Organization (WHO) criteria, anemia or Hb deficiency was defined as having an Hb concentration of <13 g/dL for men and <12 g/dL for women. In this study, macrocytic anemia due to FAD was defined as having an MCV ≥100 fL and folic acid ≤6 ng/mL; pernicious anemia as having MCV ≥100 fL, vitamin B12 < 200 pg/mL, and serum gastric parietal cell antibody positivity; iron deficiency anemia as having MCV <80 fL and iron <60 μg/dL; and thalassemia trait as having MCV <74 fL, red blood cell (RBC) count > 5.0 × 10(12)/L, and Mentzer index (MCV/RBC) < 13.nnnRESULTSnWe found that by WHO definitions, 73 (36.9%), 41 (20.7%), and 10 (5.1%) of our 198 FAD patients had concomitant Hb, iron, and vitamin B12 deficiencies, respectively. Of 73 anemic FAD patients, three had macrocytic anemia due to FAD, one had pernicious anemia, 14 had iron deficiency anemia, eight had thalassemia trait, and the resting 47 had normocytic anemia.nnnCONCLUSIONnIn addition to macrocytic anemia (2.0%), FAD patients may have concomitant normocytic (23.7%) or microcytic (11.1%) anemia.

Langerhans cells in keratoacanthoma

Keratoacanthoma is a self-limiting epithelial lesion with a clinical and histopathological feature similar to a welldifferentiated squamous cell carcinoma (SCC). In this case report we discuss a skin keratoacanthoma at the right anterior neck. Moreover, immunohistochemistry was used to study the Langerhans cells in the lesion. A 33-year-old male patient noticed an elevated domeshaped nodule with a central plug of keratin at the right anterior neck for 1 month. He came to our dental department for treatment of the tumor and was referred to the Oral and Maxillofacial Surgery Department for further management. Excisional biopsy was performed under local anesthesia. Grossly, the specimen was 1.0 cm 1.0 cm 0.7 cm in size. A histopathological examination of the excised specimen showed a keratoacanthoma composed mainly of an extensive epidermal proliferation with a central keratin plug. An acute angle was formed between the overlying surface epithelium and the lesional epithelium (Fig. 1A). The epithelium lining the central crater was benign-looking. However, nests of stratified squamous epithelium with central keratin pearl were found in the deep part of the tumor (Fig. 1B). Although the lesion looked like a well-differentiated SCC, the overall pattern of the lesion confirmed the diagnosis of