Patients with hyperplastic states of the gingiva, i.e., phenytoin hyperplasia, nifedipine hyperplasia, cyclosporin hyperplasia, gingival fibromatosis and others may be treated by laser gingivectomy as no bone surgery is involved in these cases. Patients who are mentally retarded may represent special care problems postoperatively after conventional surgical gingivectomy i.e., unintentional removal of surgical dressing, postoperative bleeding etc. Therefore, the potential use of CO2-laser gingivectomy for mentally retarded persons was evaluated in a prospective study comprising 15 patients with fenytoin hyperplasia of the gingiva. No intra- or postoperative bleeding occurred and no surgical dressing was applied. The majority of the patients did not need any analgesics postoperatively. Healing was uncomplicated and the time needed for healing was of the same order of magnitude as after surgical gingivectomy.
Aspects of the history of treatment of painful joints are commented upon. It is pointed out, that the medical and dental professions have for more than 125 years been aware, that immobilization of joints may have harmful effects. Still, research on therapeutic motion of painful joints dates back only 25 years. A case is reported of fracture associated constriction, possibly due to secondary involvement of the temporalis muscle and especially its tendineous insertion on the muscular process of the mandible. When the patient was treated with the CPM apparatus Mobilimb J1 the interincisal distance increased from 13 mm to 46 mm. According to literature CPM has so far been used only as adjunctive physical therapy after surgical intervention. On the basis of data in the literature the author is studying the effect of CPM on reduced mobility of the jaws as primary treatment without surgery.
The treatment of eight patients with histologically verified atrophic or erosive lichen planus are reported. The lesions of WHO-diagnosis code 697.02 were subdivided into three classes: atrophic, minor erosive and major erosive. Clobetasol Propionate ointment was placed in the buccal mucosa under an occlusive DuodermR dressing. Healing with striation was obtained in all of those lesions classified as atrophic or minor erosive, while major erosive lesions showed improvement, but persisted.
The principle of GTR, guided tissue regeneration, was developed by Scandinavian scientists in order to separate epithelium and connective tissue from periodontal ligament cells and bone, thereby eliciting new attachment after marginal periodontitis. In case of jaw fractures loss of attachment may be seen in relation to teeth in the line of fracture, especially after severe dislocation of the fragments. One such patient is reported in whom only emergency treatment was possible during the first 11 days due to a simultaneous cerebral trauma. As anticipated a deep osseous pocket developed on the actual tooth 43 even if the fractures were anatomically repositioned and fixed with osteosynthesis and even if the postoperative course was uneventful. Later, treated by interpositioning of a resorbable Vicryl membrane, new attachment formed with a gain of the order of magnitude of 8 mm with concomitant osseous regeneration. It is concluded that Vicryl mesh would definitely seem to have a place in the treatment of jaw fractures. However, there is an urgent need for a larger collection of meshes than presently available, including both larger sizes and other shapes.
Among the 765 dentists of the County of Aarhus , Denmark, a total of 65% answered a questionnaire on possible herpes panaritium experience. Among the answers 3.8% were positive. Among these, 10 had circulating antibodies against herpes simplex virus. During the study a case of recurrence of a panaritium , which appeared to be a herpes simplex infection, occurred.
In October 1979 an Omnibus Interview Survey was carried out covering 2308 persons living in Denmark east of the Great Belt. Type and amount of tobacco consumption were registered. The multivariate structure of the data was examined by the use of a log linear model for the pinpointing of sufficient marginals among multiple contingency tables. An important finding was that among today's teenagers, more have started smoking before the age of 14 than ever before, viz. 64% of males and 77% of females. The outlines for a person-oriented antitobacco intervention program mediated by medical and dental doctors is outlined. Apart from humanitarian aspects, a cost benefit analysis may well show that an intervention program may save money in the long run.
Tissue extracts from 18 oral carcinomas were tested in the leukocytes migration capillary technique(LMCT) against autologous leukocytes and against leukocytes of healthy matched controls. The normal range was defined as the mean migration index (MI) of the leukocytes of the normal control ±2SD. Three carcinoma patients showed significant inhibition and one was on the lower borderline on the normal range. None showed stimulation. When leukocytes of leukoplakia patients were tested against normal intesttine and two homologous oral carcinoma extracts, significantly different MI's were found between carcinoma and normal intensive. The finding are compatible with a state of tissue‐specific, cellular hypersensitivity against antigenic components present in oral leukoplakia and in oral carcinoma, and is possibly common between the two.
Oral leukoplakia patients who were smokers were asked to give up their smoking habits. It was found that leukoplakias present in persons with smoking habits might be reversible, when the smoking habit was reduced or given up. Leukoplakias which were not reversible could possibly be of the same idiopathic type as leukoplakias in non-smokers.
Thirty-eight biopsies of homogeneous oral leukoplakias were transplanted to subcutaneous sites of nude mice and protected from overlying cutaneous tissue by Millipore filters. The transplants were recovered after 21 d with a rate of successful recovery of 66%. The histologic epithelial features of the transplants were compared with those of the original leukoplakias. None of the leukoplakias from patients without tobacco habits lost the preexisting keratinization, whereas all 10 transplants demonstrating loss of keratinization belonged to patients with tobacco habits. This difference in behavior of transplanted leukoplakias from patients with and from patients without tobacco habits was statistically significant (P = 0.028). The results of the experimental study support the concept of two different types of leukoplakia, one possessing irreversible changes in epithelial keratinization, the other showing reversibility.
The appearance of an epithelial cell outgrowth in vitro from biopsies of oral leukoplakia is compared with the histologic appearance of the lesion. Tissue samples from oral leukoplakia of 20 patients were cultured to allow the outgrowth of populations of epithelial cells. Adjacent tissue within the lesions was fixed for routine histology. Epithelial cell outgrowth was successful from biopsies possessing the histologic characteristics hyperkeratosis (14 of 20 cases), altered epithelial thickness (14 of 19 cases) and increased mitotic activity (1 of 4 cases). No epithelial cell outgrowth was observed from leukoplakia tissue possessing signs of epithelial dysplasia (0 of 2 cases).
A study of 112 biopsy specimens from Danish oral leukoplakia patients and 145 biopsy specimens from Indian leukoplakia patients revealed a chevron-like keratinization of the epithelium in a number of cases. Clinically, this type of keratinization was often characterized by a pumice-like appearance. The clinical and histologic changes were only observed in tobacco users, and appeared to be associated particularly with use of pipes, snuff, and hooklis.
A 27‐year‐old female, after a fracture of the mandible treated with osteosynthesis and after a difficult extraction, developed osteomyelitis with fistulation and sequestration. Sequestrectomy and extraction of the teeth in the osleomyelitic area did not clear the patient of symptoms. A patch test to nickel turned out to be positive. After removal of the stainless steel cerclage in the mandible, clinical and radiographic changes returned to normal within 2 and 8 weeks, respectively. It is concluded that, whenever acute treatment docs not lake priority, patch tests comprising nickel, cobalt and chromium should he performed in patterns who are candidates for metal osteosynthesis.
An apparatus is described which supplies sterile, air-free physiologic saline as coolant at the tip of the handpiece. The device is activated by the foot control of the dental engine and the bur is flooded with saline the very moment the rotations begin. In the same way it stops instantaneously without afterdrip and without suckback. The components are either disposable or autoclavable. Metallic components are stainless steel.
Lipodystrophy, which may be subdivided into a partial and a total form, is not a commonly reported disorder. One patient is presented in whom the lipodystrophy was not only confined to the face but even to one side. Progressive hemifacial atrophy was excluded by roentgencephalometric analysis and electromyography. It is suggested that the reported entity be considered as a separate group under the name of hemifacial lipodystrophy.
Among 1,128 patients with oral leukoplakia and 326 patients with oral lichen planus included in long-term follow-up studies, thirty-two patients showed lesions of the oral mucosa which could be attributed to electrogalvanism. The material consisted of twenty female and twelve male patients. The clinical diagnosis was leukoplakia in sixteen patients and oral lichen planus in the remaining sixteen patients. Histopathologic characteristics were analyzed and correlated to the clinical findings. In five cases malignant transformation developed. The term electrogalvanic white lesions is suggested as a common denominator for these mucosal changes, which seem to take the shape of lichen planus as often as that of leukoplakia.