Vascular endothelial growth factor (VEGF) and chronic graft-versus-host disease (cGVHD) in salivary glands of bone marrow transplant (BMT) recipients

BACKGROUND: The purpose of this study was to compare the immunolocalization of vascular endothelial growth factor (VEGF) in salivary glands of bone marrow transplant (BMT) recipients with normal controls and between the different stages of chronic graft-versus-host disease (cGVHD). In addition, the impact of the immunolocalization of VEGF on the survival rate of BMT patients was investigated as well. METHODS: Labial salivary glands obtained at the day 100+ from 36 consecutive patients, who underwent BMT, were included in the study. The streptavidin-biotin-peroxidase complex stain was used to detect VEGF in the salivary glands. Time of death after BMT was displayed by means of the Kaplan-Meier method for the following parameters: age and gender of the patients, donor gender, acute GVHD, cGVHD staging at the labial salivary glands, primary disease, platelet and neutrophils counts on day of biopsy, stem cell, oral mucositis, parenteral nutrition, oral lichenoid lesions of GVHD, conditioning regimen and immunolocalization degree of VEGF in labial salivary glands. The data were initially analyzed by means of the log-rank test and then included in the Cox's proportional hazard model. RESULTS: No differences on the immunolocalization of VEGF in the labial salivary glands of BMT recipients and control group or between the different stages of glandular cGVHD were noted. Both univariate and multivariate analysis of the survival rate showed significance of 5% only for platelet count over 100 x 109/l on the day of biopsy and male donor gender. CONCLUSIONS: Platelet count over 100 x 109/l and male donor gender are positive predictive factors on the survival rate after BMT. In addition, the immunolocalization of VEGF in salivary glands is not altered in BMT recipients at day 100+ and is not influenced by the stage of cGVHD.     

Oro-facial manifestations in paediatric HIV: a comparative study of institutionalized and hospital outpatients

The aim of the study was to compare dental caries status and the number and type of oral mucosal lesions in HIV positive children from a hospital outpatient department and an institutionalized setting. Oral examinations were performed using presumptive diagnostic criteria. The Fisher's Exact and the Mann-Whitney tests were used for statistical comparison of the two study groups. A total of 169 children were examined of whom 42% were institutionalized and 58% hospital outpatients. One institutionalized child presented with Noma. Twenty-one percent of the institutionalized population presented with molluscum contagiosum, while none of the hospital outpatients presented with this condition. Significantly more intraoral mucosal lesions were observed in the hospital compared with the institutionalized group. The most frequently encountered oral lesion was candidiasis. Pseudomembranous candidiasis was the most common type. Twice as many intraoral ulcers were recorded in the institutionalized group. Thirty-nine percent of the hospitalized patients had multiple lesions compared with 28% in the institutionalized group. Almost three quarters of both populations were caries-free. The mean DMFT was considerably higher in the hospital population. For both the permanent and primary teeth, the decayed component (D/d) made up the major part of the DMFT/dmft, followed by the missing (M/m) component. No fillings were recorded in either the primary or permanent teeth for both groups. Oral lesions are common in HIV populations and were seen in both the hospital and institutionalized groups, at high prevalence levels (63 and 45%). HIV infected children should be considered high risk for caries because of the use of chronic medications, and to receive appropriate care in terms of both treatment and services.     

Oral shedding of HSV-1 and EBV and oral manifestations in paediatric chronic kidney disease patients and renal transplant recipients

Objective: Previous research demonstrated that salivary shedding of HSV-1 and EBV occurs often in adult renal transplant recipients, but there is a lack of studies on the presence of them in the saliva of paediatric population. Therefore, the objective of this study is to describe oral characteristics and to compare the shedding profile of HSV-1 and EBV in the saliva of children with renal transplant to that of chronic kidney disease patients and controls.

Methods: This is a cross-sectional study involving 100 children, being 25 renal transplant recipients, 25 chronic kidney disease patients and 50 healthy children. Demographic and oral clinical characteristics were assessed. Saliva samples were collected and submitted to screening for EBV and HSV-1 by using nested polymerase chain reaction technique. Fisher’s exact, Pearson’s chi-square and Kruskal–Wallis tests were used for statistical analysis at a significance level of 5%.

Results: Oral shedding of HSV-1 (28%) and EBV (60%) were significantly higher in renal transplant recipients compared to the other groups. Single vesicles in the oral mucosa were statistically associated with the presence of HSV-1 (p?=?.035). In children with chronic kidney disease, there was a higher prevalence of pale oral mucosa (32%) and enamel hypoplasia (40%) compared to paediatric renal transplant recipients and controls. Dental calculus (36%), candidiasis (8%), drug-induced gingival overgrowth (16%), mouth blisters (8%), xerostomia (12%) and salivary gland enlargement (20%) were more common in paediatric renal transplant recipients.

Conclusions: Therefore, it can be concluded that salivary shedding of HSV-1 and EBV in paediatric patients was more often found in renal transplant recipients than in the renal failure and control children. Transplanted recipients showed more oral manifestations than renal failure and control children did.     

慢性移植物抗宿主病口腔表征的临床及诊断分析

目的：评价异基因造血干细胞移植后患者慢性移植物抗宿主病在口腔的临床表征及诊断,为移植物抗宿主病口腔表征患者的诊治提供依据。方法：计算机检索PubMed数据库（1966年～2010年3月）,EMBASE（1989年～2010年3月）,中国生物医学文献数据库（1980年～2010年3月）中英文文献。纳入慢性移植物抗宿主病中有口腔表征及诊断的研究文献,对纳入文献的口腔慢性移植物抗宿主病进行分析。结果：文献显示慢性移植物抗宿主病口腔表征的发病率较高,临床表现多样化。诊断标准不统一。结论：口腔溃疡,红斑病损,网状白斑病损是慢性移植物抗宿主病在口腔的常见表征,多数患者伴有疼痛,唾液分泌减少。在临床上应该对口腔慢性移植物抗宿主病有较全面的认识,同时其诊断标准尚待进一步规范。     

Gingival lesions in a patient with chronic oral graft-versus-host disease: a case report

BACKGROUND: The patient reported in this study was diagnosed with acute nonlymphocytic leukemia and underwent an allogenic bone marrow transplantation. She was referred for persisting oral ulceration and pain associated with the transplant procedure. AIM: To present an unusual involvement of gingival tissues during a case of oral chronic graft-versus-host-disease. CONCLUSION: This is one of the very few reports in the dental literature of a case of oral chronic graft-versus-host disease that includes the unusual manifestation of prominent gingival lesions.     

Multiple squamous cell carcinomas of the oral cavity in a young patient with graft-versus-host disease following allogenic bone marrow transplantation

The development of secondary malignancies is a potential long-term complication after haematopoietic stem cell transplantation (HSCT). In particular, a higher incidence of oral squamous cell carcinoma (OSCC) has been reported in patients experiencing chronic graft versus host disease (cGvHD) secondary to HSCT. This report describes the development of two synchronous SCC of the buccal mucosa in a young female patient treated with HSCT for beta thalassemia major. She had undergone HSCT at the age of 9 years and developed oral GvHD 6 months after transplant. 17 years after HSCT she developed two synchronous carcinomatous lesions on the tongue and floor of the mouth. The current case highlights the association between oral cGvHD and OSCC, and the possible development of OSCC in young patients even many years after HSCT. This evidence suggests closer follow-up for all patients treated with HSCT who developed cGvHD, and more effective strategies to prevent and treat cGvHD.     

An unusual presentation of chronic graft-versus-host disease in an unrelated bone marrow transplantation

The case described is that of an unrelated bone marrow transplantation in a 43-year-old man. Although the major histocompatibility complex met the criteria for a perfect genotypic match, de novo graft-versus-host disease developed with unusual manifestations involving structures of the oral cavity and associated areas. The loss of taste and smell, as well as profound xerostomia, was treated by stimulating salivary flow. Synergistic sialagogues were used with the hope that an increase in salivary production would mediate an improvement in taste and smell.     

Oral manifestations of HIV infection in patients receiving highly active antiretroviral therapy (HAART) in Bahia, Brazil

Objectives: We investigated the oral manifestations of HIV‐infected patients in Salvador, Brazil, and their relationship to immunologic, sociodemographic, and therapeutic factors. Methods: This was a cross‐sectional study that used data from adult patients' medical records in the dentistry service of the AIDS Reference Center in Salvador, Brazil. We reviewed the patients' records to collect information concerning oral health status and data on socioeconomic status, immunologic status, and treatment. Results: A total of 993 patients were included in the study, of whom 473 (47.6 percent) were male. Approximately 5.5 percent of the patients presented with any oral lesions. Oral lesions were the most common in the patients with fewer than 350 CD4+T lymphocytes (8.4 percent) and with viral loads greater than 10,000 copies (8.3 percent). Conclusions: Our study shows that lesions are more common in patients with advanced immune suppression and low level of schooling. Oral candidiasis and angular chelitis were the most common lesions seen.     

Florid oral manifestations in an atypical familial adenomatous polyposis family with late presentation of colorectal polyps

Early identification and prophylactic surgery are essential in preventing development of malignancy in colorectal polyps in familial adenomatous polyposis (FAP). Previous studies indicate a 100% cumulative risk of developing colonic polyps in individuals with FAP by the age of 34 yr. However, we have previously reported late-onset and non-penetrance of polyposis in four families. We describe here in detail one of these families with florid oral manifestations detectable on panoramic radiography of the jaws, which were instrumental in the diagnosis of FAP in the index patient and for ascertainment of her family for screening. The pathological adenomatous polyposis coli (APC) gene mutation in this family was shown to segregate with dento-osseous changes. Panoramic jaw radiography is a common examination carried out prior to dental or oral surgical procedures. This case illustrates the importance of appropriate investigations, including family history and colonoscopy, even in relatively older patients with radiological findings such as those described here and in members of their families at risk of FAP.     

Significance of oral examination in chronic graft-versus-host disease

Fourteen patients who received allogeneic bone marrow transplantation (BMT) were examined 100 to 220 days after BMT. Ten out of 14 patients were diagnosed as having chronic graft-versus-host disease (cGVHD) in skin, liver, eyes and other organs. These cGVHD patients also had objective evidence of oral involvement. Subjective xerostomia was experienced by 7 cGVHD patients and decreased whole saliva flow was observed in 4 cGVHD patients. However, no patient had a history of parotid swelling or notable abnormality in parotid sialography. Labial salivary glands (LSG) of 9 cGVHD patients showed atrophy and/or destruction in association with diffusely infiltrating lymphocytes. The infiltrating lymphocytes were mainly CD3⁺ T cells with a predominance of CD8⁺ cells over CD4⁺ cells. Lichenoid lesions on the oral mucosa were also observed in 5 cGVHD patients. Thus, this study indicated that oral examination, including LSG biopsy, is useful in the diagnosis of cGVHD.     

Analysis of performed paediatric oral and maxillofacial procedures under general anaesthesia over a two-year period in a North London NHS Trust

Dental treatment remains one of the most common reasons for paediatric patients to undergo a general anaesthetic (GA). In addition to a wider scope of practice, oral and maxillofacial (OMF) surgeons are affiliated with this well-reported dentoalveolar surgical burden. Thus far much of the research has shown that the majority of these paediatric GAs are for the treatment of decayed teeth. The aim of this study was to evaluate reasons children in a North London region undergo GA procedures in an OMF department and this population’s associated demographic factors. Patients treated by this OMF unit from 2016 to 2017 aged 0-16 were included. Retrospective data was obtained; including age, gender, and ASA physical status. Deprivation was calculated from postcodes using the Index of Multiple Deprivation. Chi squared statistical tests were applied. Data from 600 children undergoing 790 procedures were analysed. A similar number of males and females were treated. The most common age group were the 13-16-year-olds. A total of 89.5% of the patients were ASA I. The greatest surgical burden was simple orthodontic extractions, accounting for 24.4% of all OMF paediatric GA procedures. Deprivation impacted the prevalence of the extraction of carious teeth, soft tissue trauma, and orthodontic-related surgery. In the region studied, more paediatric patients are undergoing GA for orthodontic-related surgery than for the extraction of decayed teeth. The type of facial trauma experienced changes with the age of the child.     

Contemporary profile of oral manifestations of HIV/AIDS and associated risk factors in a Southeastern US clinic

Background: Introduction of highly active antiretroviral therapy (HAART) has resulted in a significant decrease of oral manifestations (OMs). The profile and risk factors for OM in those individuals initiating HAART remain understudied in the Southeast of the United States, region of increasing HIV prevalence. Objective: To determine clinical, socio‐demographic, and laboratory characteristics associated with the presence of OM among patients initiating HAART. Methods: Retrospective review of electronically captured data from patients initiating HAART at a Southeastern US clinic. Prevalence was determined, and risk factors for overall OM, oropharyngeal candidiasis (OPC), and all other OM were evaluated using logistic regression. Results: In our sample (n = 744), majority of individuals were males (75 percent), African‐American (50 percent), mean age of 39 years, 42 percent of which reported sex with men (MSM). Two hundred sixty‐six had some type of OM. Compared with those without any OM, patients with OM had a lower mean baseline CD4+ T cells count (CD4 count) (331 ± 260 versus 179 ± 244 CD4 cells/mm³) and higher mean baseline HIV‐1 RNA viral load (4.0 ± 1.34 log₁₀ versus 4.6 ± 1.30 log₁₀) (P < 0.01). In the logistic regression models seeking to determine factors associated with an increased risk of OM and OPC, the only characteristic associated with the outcome was baseline CD4 value. Being male, African‐American, and heterosexual showed a protective role for OM other than OPC. Conclusion: OM continues to be common despite HAART. General OM and OPC were closely associated with a low baseline CD4 count. Knowledge of risk factors for OM can potentially help clinicians target oral evaluation of HIV‐positive individuals.     

Oral manifestations of toxic epidermal necrolysis (TEN) in patients with AIDS: report of five cases

OBJECTIVE: To describe oral findings in HIV-infected individuals with toxic epidermal necrolysis (TEN). PATIENTS: In a retrospective study over a 10 year period the medical histories of 931 hospitalised HIV-infected patients were reviewed for the occurrence of TEN.
RESULTS: Five cases of TEN were diagnosed (three men, two women; median age: 41 years; median CD4⁺ T lymphocyte count: 20/μl). Four patients had been treated with biweekly pyrimethamine/sulfadoxine for prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis. In one patient flucloxacillin was administered. Signs of TEN with cutaneous epidermolysis occurred and patients showed oral lesions characterized as oropharyngeal blisters and bullae on the palate, buccal mucosa, tongue and floor of the mouth initially. Antibiotics and corticosteroids were administered; none of the patients died.
CONCLUSION: Longacting sulfonamides and antibiotics have been implicated as the cause of severe mucocutaneous reactions. Since rash and oral blisters may be the first signs of TEN in patients receiving these it is mandatory to follow up these patients closely to detect oral or cutaneous changes indicating the development of TEN.     

Importance of oral health and dental treatment in organ transplant recipients

Objectives: The purpose of the present study was to investigate which peri-transplant dental treatments were deemed necessary, and to determine retrospectively how often these treatments were actually performed, in patients who had received organ transplants. Materials and Methods: Medical records of the Department of Advanced General Dentistry at Yonsei University Dental Hospital were searched to identify liver or kidney transplant recipients who attended from 1st March 2014 to 31st December 2017. A total of 418 patients were identified, and their medical charts were reviewed. Sex, underlying systemic disease, oral hygiene status, dental treatment deemed necessary, dental treatment actually performed and durations of follow-up were tabulated. Results: More than half (53.8%) of the liver transplant recipients had poor oral hygiene, and poor oral hygiene was statistically significantly more prevalent in the liver transplant group than in the kidney transplant group (40.3%). In liver recipients in whom scaling was deemed to be required pre-transplant, the rate of it actually being performed pre-transplant was high (83.2%). By contrast, the rates of tooth extraction and prosthetic treatment actually being performed pre-transplant were low (12.8% and 0%, respectively). In kidney recipients, the rates of scaling, tooth extraction and prosthetic treatment actually performed pre-transplant, when deemed to be required, were 93.5%, 10.0% and 0.0%, respectively. Conclusions: We recommend that patients scheduled to receive an organ transplant be referred to a dental clinic as soon as possible beforehand, to remove any potential sources of oral infection. Educating physicians, as well as their patients, about the importance of early dental screening and pre-transplant dental treatment is essential.Key words: Oral health, organ transplantation, oral hygiene, necessity of dental treatment, dental treatment     

The spectrum of orofacial manifestations in systemic sclerosis: a challenging management

Systemic sclerosis (SSc) is a rare multisystem connective tissue disorder characterized by the triad fibrosis, vasculopathy and immune dysregulation. This chronic disease has a significant impact on the orofacial region that is involved in more than two‐thirds of the cases. SSc patients can show a wide array of oral manifestations, which are usually associated with a severe impairment of the quality of life. They often present a decreased the salivary flow and a reduced mouth opening that contribute substantially to the worsening of the oral health status. Therefore, SSc patients require specific and multidisciplinary interventions that should be initiated as early as possible. The identification of specific radiological and clinical signs at the early stage will improve the management of such patients. This study reviews the wide spectrum of orofacial manifestations associated with SSc and suggests clues for the oral management that remains challenging.     

Electron microscopic studies of the early cellular events occurring in oral mucosa of rats affected by graft-versus-host disease (GVHD)

Previous histologic studies of tongue lesions in graft-versus-host disease (GVHD) in non-irradiated (Brown Norway×Lewis) F1 rats given parental spleen cells have demonstrated an increase in the number of MHC class II⁺ cells with dendritic shape in the lamina propria to be the earliest event in the development of the lesion. We studied this histologic finding by electron microscopy lo increase understanding of the early cellular events occurring in the lesion. Electron microscopically, the most prominent cell type observed in the lamina propria was the ceil with a dendritic shape. These dendritic cells possessed large nuclei that often showed irregular indentations and ample cytoplasm containing numerous filaments and mitochondria. A few lysosomal or phagocytic structures were also seen in the cytoplasm. No Birbeck granules were identified. These findings were very similar to those of indeterminate cells in the epidermis and dermis. Our data strongly support the hypothesis that MHC class IP cells with dendritic shape present antigen during the induction of local immunological responses in the tongue of GVHD rats.