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Statement of Problem: Reported incidences of altered sensation after placement of mandibular implants range from a low of 0% to almost 44%, making it difficult to advise subjects regarding risk., Purpose: This study involved presurgical and postsurgical assessment of sensation in the lips and chins of 75 subjects, all of whom objectively demonstrated normal sensation before surgery., Material and Methods: Objective and subjective tests were administered before, and at planned intervals for 12 months after, the placement of 2 implants in the anterior mandible., Results: Objective changes were observed in only 1 subject and then only at the 2-week postsurgery interval. There were significant differences for all subjects in subjective sensation changes from baseline to 2 weeks after surgery (P =.007) and from 2 weeks to 6 months (P =.003) or 12 months (P =. 003). There was a higher percentage of subjects with normal sensation before surgery who reported sensory changes 2 weeks after implant placement (34% vs 24% for all subjects), but only 1% of subjects still reported altered sensation 1 year later. Although there were no significant differences between men and women in reports of altered sensation, more women than men noted sensation changes 2 weeks after implants were placed (25% vs 13%). There appeared to be no relationships among gender, the degree of ridge resorption, and reports of altered sensation., Conclusion: Thus, although approximately 24% of subjects may report altered sensation in the short-term after implant surgery in the anterior mandible, the problem appears to be a transient one, with only about 1% experiencing sensation changes 1 year after implant surgery.

The common houseplant, dieffenbachia, causes painful edematous swelling of the oral mucous membranes when chewed. This property, which is well known to the staffs of poison control centers, can be dangerous to the unwary or to victims of practical jokes. The microscopic features of the injury are those of acute inflammation, but the nature of the plant's toxicity remains controversial. The numerous needles (raphides) of calcium oxalate, which are contained in specialized cells (idioblasts) in the plant, and proteases have both been implicated. When stimulated, the idioblasts fire the raphides with some force for a distance of two to three cell lengths. One possibility is that the local toxicity of dieffenbachia may be caused by a combination of this mechanical release of the raphides, which results in traumatic injury, and the effects of a chemical toxin carried on their surfaces and in their grooves.

Tongue necrosis is a rare complication in giant cell arteritis, an entity in which both temporal arteritis and rheumatic polymyalgia may be included as two different manifestations of the same pathologic process. The case of a 79-year-old patient who had tongue necrosis 3 hours after ingestion of 2 mg of ergotamine tartrate is presented. This complication was the basis for the diagnosis of temporal arteritis. We reviewed possible clinical manifestations of temporal arteritis and cases of tongue necrosis in the world literature. The possible existence of triggering factors that seemed to be present in 11 of the published cases was analyzed. In seven of these cases ingestion of ergotamine derivates had taken place.

A patient with a rare combination of bilateral lingual necrosis and intestinal infarction, caused by giant cell arteritis, is described and the literature reviewed.

To determine the prevalence of complications involving altered sensation after implant surgery in the mandible, a retrospective questionnaire study was conducted of 266 patients treated with osseointegrated implants. Of the responding patients (80%), 37% reported altered sensation following implant surgery, with long-term changes occurring in 13% of patients. In more than 60% of symptomatic patients the onset was within 1 week of the first stage of surgery and most frequently involved the lip and chin. Resolution of transient changes usually occurred within 6 months and the majority of patients who reported alterations in sensation believed that the benefits of the implant surgery outweighed the disadvantages experienced. The prevalence of altered sensation was significantly higher in women compared with men and in those with a history of diabetes. These data indicate the need for prospective studies to further evaluate altered sensation after mandibular implant surgery so that specific risk factors can be identified and more accurate information made available to prospective patients.

Two patients with Steinert's myotonic dystrophy are presented. The disease was suspected because of alterations in orofacial musculature clinically manifest as difficulties in swallowing, mastication, and speech, and as occlusal anomalies and maxillary bone deformities. The presumed diagnosis was reached as a result of the presence of percussion myotonia of the tongue; confirmation was based on family antecedents, electromyographic alterations, and muscle histopathologic findings.

We report a detailed study on oral lesions and their association with the WHO revised provisional case definition of AIDS as well as serologic signs of HIV infection among 186 patients in Dar Es Salaam, Tanzania. The patient material consisted of 39 hospitalized suspected AIDS patients, 44 medical nonsuspected patients, 53 dental outpatients, and 50 patients with sexually transmitted diseases. The male:female ratio was 2.1:1 on average. Oral examination was done without knowledge of the HIV status of the patients. Among 39 suspected AIDS patients 97% had WHO AIDS criteria and 90% were seropositive for HIV. Among the 147 patients not suspected of having AIDS 18 (12%) had AIDS criteria and 15% had serologic evidence of HIV infection. The presence of WHO AIDS criteria correlated significantly with the presence of HIV antibodies, but not with HIV antigen. Oral lesions were found in 54% of those with AIDS criteria and 52% of HIV-infected patients, as compared to 3% and 6% of the patients without AIDS criteria and HIV infection, respectively (p less than 0.01). Among patients with AIDS atrophic candidiasis occurred in 21%, pseudomembranous candidiasis in 23%, hairy leukoplakia in 36%, herpetic stomatitis in 2%, Kaposi's sarcoma in 4%, and nonspecific ulcer in 4%. The presence of oral lesions had a high predictive value for presence of AIDS criteria as well as for presence of HIV infection in this hospital setting. All patients should have a thorough oral examination and the presence of the aforementioned oral lesions should lead to testing for HIV infection.

A case is presented of a patient with progressive bulbar palsy, a form of motor neuron disease, which is a progressive degenerative disorder of the motor nuclei in the medulla producing atrophy and fasciculations of the musculature of the tongue, dysarthria, dysphagia, and excessive accumulation of secretions. The patient may initially seek dental consultation. Clinicians should be aware of the signs and symptoms of this inexorably fatal disease so that an early neurologic referral is made and the appropriate symptomatic therapies instituted.

The case of a 62-year-old woman with idiopathic primary hypothyroidism and persistent lingual ulceration is described. The patient had no previous history of any form of oral ulceration, and the ulcers healed rapidly after treatment of the hypothyroid state. The investigation of patients with suspected hypothyroidism is discussed briefly, together with the possible theoretical mechanisms which might predispose to ulceration.

Twenty-eight cases of central papillary atrophy of the tongue (CPA) are presented. Vegetative Candida species were commonly but not invariably seen on cytologic and histologic examination. Follow-up of fifteen cases showed spontaneous resolution of three. It is suggested that CPA of the tongue represents a clinical rather than a pathologic entity, and that the underlying disease process may not be identical in all cases.

A case of an injured, necrotic tongue in a child of 12 months was investigated. It was found that the patient was suffering from congenital analgesia. The injury was due to errupted lower incisor teeth, and the injury healed following their extraction. We believe that in cases of repeated self-injury of the tongue some form of sensory disturbance should be considered.

A retrospective study of the epidemiologic data of 4,417 subjects has been undertaken to study the possibility of a link existing between glossal central papillary atrophy (median rhomboid glossitis) and denture stomatitis. Neither the association between glossal central papillary atrophy and denture stomatitis nor the association between glossal central papillary atrophy and denture use was statistically significant. However, the correlation between wearing removable dental prostheses and finding candidal mycelia in smears from these tongue lesions was statistically highly significant. Debilitation caused by general age changes would not appear to predispose to atrophy of the pappillae of the middle portion of the tongue-dorsum.

Amyloidosis and its oral manifestations are briefly described. The techniques for antemortem tissue diagnosis of amyloidosis are reviewed and evaluated. In screening for amyloidosis, biopsy of specific oral lesions (when present) is recommended instead of the traditional biopsy of normal-appearing gingiva. This approach is illustrated with four cases. Although rectal biopsy is generally accepted as the screening technique of choice, it is suggested that intraoral biopsy be considered as an easier, safer, more comfortable, and possibly more fruitful technique. It is advocated that in cases of both documented and suspected amyloidosis both intraoral and rectal biopsies should be performed in order to help provide documentation of the most useful technique for routine screening.

Hemodialysis has permitted long-term survival of patients with kidney failure, but not without many complications, such as mineral loss from bones, secondary hyperparathyroidism, and increased risk of infection. Recently a new form of amyloidosis, AB2M, has been characterized that is specifically associated with long-term dialysis. The tissues and organs affected by deposits of AB2M appear to differ from those affected by the other major types of amyloidosis; AB2M affects mainly the carpal ligament, synovia of large joints, juxtaarticular bone, and intervetebral disks, while involvement of the oral tissues has been rare. We present here a case in which the biopsy of superficial lingual deposits of AB2M led to the recognition that the patient had developed hemodialysis-associated amyloidosis. It is suggested that periodic inspection of the oral soft tissues for signs or symptoms of amyloidosis should become a part of the dental care of patients undergoing dialysis.

A case of multiple myeloma has been presented where intraoral amyloidosis was the presenting symptom associated with the disease. Definitive diagnosis was based on the findings of hyperglobulinemia, marrow aspiration showing plasma-cell infiltration, proteinuria, amyloidosis, and anemia.

A review of the English literature revealed ten lesions classified as Riga-Fede's disease and nineteen lesions classified as traumatic eosinophilic granuloma. These two entities have the same histologic features and are often associated with a history of trauma. These are benign, reactive, nonosseous lesions that occur either in infancy or later in life. It is suggested that they be considered as one entity. To delineate them from more aggressive lesions, such as the eosinophilic granuloma of histiocytosis X, the author suggests the term traumatic ulcerative granuloma with stromal eosinophilia. Forty-one previously unreported cases are described. Histologic examination revealed the presence of mast cells in addition to eosinophils. A pathogenesis for traumatic ulcerative granuloma with stromal eosinophilia, based on the hypothesis that mast cells release an eosinophilic chemotactic factor and that eosinophils may act as cytotoxic agents, is suggested.