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Ameloblastic fibroma is a rare mixed odontogenic tumour which involves mostly the posterior mandible. Its peripheral variant is very rare. Only eight cases have been reported worldwide. In this report, we described a case of peripheral ameloblastic fibroma occurring in the maxillary gingiva in a 10 year-old child. The lesion was excised with a conservative surgical approach and no recurrence has occurred. Peripheral ameloblastic fibroma should be considered in the differential diagnosis of a slow growing lesion involving the gingiva.

The purpose of this study is to demonstrate that the GOCCLES® medical device allows proper autofluorescence examination of the oral mucosa in a dental care setting. This is a non-randomised multicentre clinical trial on consecutive patients at risk for oral cancer. Patients underwent a classical naked eye inspection of the oral cavity followed by autofluorescence examination wearing the GOCCLES® spectacles while the light from a dental curing light irradiated the oral mucosa. Lesions were defined as visible potentially malignant lesions and/or fluorescence loss areas. All persisting lesions underwent excisional or incisional biopsy. Sixty-one patients were enrolled. Data from 64 biopsies were analysed. Of the 62 lesions identified by the device, 31 were true positives. The device identified 31 of 32 true positive lesions. One lesion (an invasive carcinoma) was not visible to the naked eye. The device identified all lesions classified as moderate dysplasia to invasive cancer. In 56.7% of cases, true positive lesions showed greater extension when observed through the device. The GOCCLES® medical device allowed the direct visualisation of fluorescence loss in patients suffering from mild to severe dysplasia and in situ to invasive oral cancer. It allowed autofluorescence examination with each source of light used during the study. These results suggest that the role of the autofluorescence visualisation is that of a complementary inspection following naked eye examination when dealing with patients at risk for oral cancer. The device allows detection of otherwise invisible lesions and otherwise impossible complete resections.Scopo di questo studio è dimostrare che il dispositivo medico GOCCLES® permette di condurre l'esame dell'autofluorescenza del cavo orale nel setting odontoiatrico. Si tratta di uno studio multicentrico non randomizzato su pazienti consecutivi a rischio di cancro orale. I pazienti sono stati sottoposti ad ispezione del cavo orale ad occhio nudo seguita dall'esame dell'autofluorescenza condotto indossando gli occhiali GOCCLES® mentre una lampada fotopolimerizzante illuminava la mucosa orale. Le lesioni sono state definite come qualunque lesione precancerosa del cavo orale visibile ad occhio nudo o area di perdita di fluorescenza visibile con GOCCLES®. Tutte le lesioni persistenti sono state sottoposte a biopsia escissionale o incisionale. Sono stati reclutati 61 pazienti e analizzati i dati da 64 lesioni. Delle 62 lesioni identificate dal dispositivo, 31 erano veramente positive. Il dispositivo ha identificato 31 delle 32 lesioni veramente positive. Una lesione (un carcinoma invasivo) non era visibile ad occhio nudo. Tutte le lesioni classificate come displasia tra moderata e severa e ogni carcinoma sono stati correttamente identificati dal dispositivo. Nel Il 56,7% delle lesioni identificate dal dispositivo mostrava margini più ampi rispetto a quelli visibili ad occhio nudo. Il dispositivo medico GOCCLES® permette di osservare il fenomeno della perdita di fluorescenza in pazienti affetti da displasia o cancro del cavo orale. Ha permesso di effettuare l'esame dell'autofluorescenza con ciascuna lampada fotopolimerizzante testata. I risultati suggeriscono di impiegare GOCCLES® come esame complementare rispetto all'ispezione ad occhio nudo del cavo orale su pazienti a rischio per cancro orale. Il dispositivo permette di identificare lesioni altrimenti visibili o i cui margini sono sottostimati dall'ispezione ad occhio nudo.

Pemphigus is a group of potentially life-threatening autoimmune diseases characterized by cutaneous and/or mucosal blistering. Pemphigus vulgaris (PV), the most common variant, is characterized by circulating IgG antibodies directed against desmoglein 3 (Dsg3), with about half the patients also having Dsg1 autoantibodies. There is a fairly strong genetic background to pemphigus with linkage to HLA class II alleles and ethnic groups such as Ashkenazi Jews and those of Mediterranean and Indian origin, are especially liable. Oral lesions are initially vesiculobullous but readily rupture, new bullae developing as the older ones rupture and ulcerate. Biopsy of perilesional tissue, with histological and immunostaining examination are essential to the diagnosis. Serum autoantibodies to either Dsg1 or Dsg3 are best detected using both normal human skin and monkey oesophagus or by enzyme-linked immunosorbent assay. Before the introduction of corticosteroids, PV was typically fatal mainly from dehydration or secondary systemic infections. Current treatment is largely based on systemic immunosuppression using corticosteroids, with azathioprine or other adjuvants or alternatives but newer therapies with potentially fewer adverse effects, also appear promising.

Oral lichen planus (OLP), an immune-mediated disorder, has been reported as an extra-hepatic manifestation of Hepatitis C virus (HCV) infection, especially in HCV hyperendemic areas such as southern Europe and Japan. The aim of this study was to investigate from an epidemiological standpoint whether HCV infection is an important factor affecting the relative risk of OLP in a Mediterranean population or whether this relates to the degree of HCV endemicity. Two cohorts of OLP patients resident in two different regions of southern Italy (Campania and Sicily; n = 859) were evaluated for HCV infection status and categorized into five age classes to respective region-matched controls. No significant difference was found between OLP patients and the general population in this area, when data were corrected by the age-stratified prevalence of HCV. Therefore, the age-specific prevalence of HCV infection in OLP patients shows a close trend of direct association with increasing age, without significant differences with the general population of each geographical area. An aetiological link between OLP and HCV cannot be inferred solely by epidemiological data.

BACKGROUND:Pemphigus vulgaris (PV) is an autoimmune blistering disease of the skin and mucosa due to the presence of autoantibodies against the components of desmosomes. To date, less is known about the expression levels of beta- and gamma-catenins in blistering diseases. The objective of this study was to evaluate the role of beta- and gamma-catenins in the pathogenesis of acantholysis in pemphigus vulgaris. METHODS:beta- and gamma-catenin expression was evaluated by immunohistochemistry in 30 cases of PV at various stages of the disease and, as controls, in 18 specimens of the skin/oral mucosa of healthy patients. RESULTS:Healthy skin and normal oral mucosa showed a strong beta- and gamma-catenin expression in basal and spinous layers with a prevalent cellular membrane distribution; the intensity of staining progressively decreased toward the superficial layers of epithelium. In PV patients, cytoplasmic expression of gamma-catenin was detected in 28/30 cases, and in 19/30 cases of PV for beta-catenin. Moreover, a progressive displacement of the signal toward the nucleus was found in 14/30 cases for beta-catenin, with dyslocalization toward the nucleus, particularly in areas with intense acantholysis, and in 22/30 cases of PV for gamma-catenin. CONCLUSIONS:Abnormal distribution of gamma-catenin, consequent to PV IgG, may be considered a direct consequence of Dg3 dissociation from catenin. gamma-catenin likely plays a direct role in PV pathogenesis through its dyslocalization toward the nucleus or indirectly through the beta-catenin dyslocalization toward the nucleus, which is thought to induce transcription of selected target genes, such as uPAR.

Cell-to-cell adhesion is mediated by cadherins (integral membrane proteins), which form a complex with catenins (cytoplasmatic proteins). While E-cadherin expression has been extensively studied in many human skin diseases, less is known about the expression levels of catenins in oral blistering diseases. The purpose of this study was to evaluate the role of these proteins in the pathogenesis of acantholysis in oral pemphigus vulgaris. We evaluated by immunohistochemistry beta- and gamma-catenin expression in 7 cases of oral pemphigus vulgaris (PV) at various stages of the disease and, as controls, in 18 healthy patients. Healthy cases showed, as reported in the literature, a strong reactivity with both beta- and gamma-catenins, with the intensity of staining progressively decreasing from the spinous to the keratinised layers of epithelium, which had a prevalent cellular membrane expression. In PV patients, we detected a loss of membrane expression of these molecules with a progressive displacement of the signal toward the cytosol and, for gamma-catenin, nuclear dislocation, particularly in areas with intense acantholysis.

The extension of the blisters of pemphigus to the esophagus is relatively uncommon, especially in patients treated with corticosteroids who appear to be in clinical remission. The aim of this study was to evaluate the esophagus in eight patients affected by oral pemphigus in various stages of the disease. Upper gastrointestinal endoscopy revealed esophageal involvement in five patients (two men and three women); three had blisters or erosions in the upper esophagus, whereas two showed red longitudinal lines along the entire organ. Direct immunofluorescence was positive in all eight patients. It is suggested that endoscopic examination of esophageal mucosa is an objective criterion by which to judge the success of therapy of pemphigus vulgaris.

A typical case of Cowden disease is presented. This is rare mucocutaneous disease, genetically determined, with multiple organ system involvement in which a malignancy, particularly of breast and thyroid gland, may develop. The disease can be diagnosed in its early stages by gingival and cutaneous manifestations. We emphasize that the dentist may be the first health care professional who recognizes the syndrome, which is a crucial step to prevent and cure the predictable malignancy.

The Authors, after a short description of the anatomy of the root canal, deal with the aetiological factors of the periapical pathology, acute and chronic. They examine the pathogenetic mechanisms of acute flogistic process of the periapical tissue and consider the principal mediators involved in the tissue lesion.

A double-blind versus placebo clinical study has been carried out in order to assess the antiinflammatory and analgesic activity of nimesulide suppositories in pain-inflammatory pathologies of odontostomatological nature. Forty-four patients aged between 18 and 62 were recruited for the purpose and assigned at random to treatment with nimesulide or placebo for a minimum period of 3 days. Treatment with nimesulide reduced both the pain and the tumefaction due to the inflammatory pathology more rapidly and, by the 3rd day of treatment led to complete remission of the symptomatology. Tolerability of nimesulide was excellent.

The paper reports the findings of a study of 46 subjects affected by beta-thalassemia major who underwent periodic transfusion therapy. A reduced incidence of the caries process was observed, above all in subjects treated from the first months of life. After a short review of the main problems posed by these patients during dental treatment, the Authors propose a course of preventive antibiotic treatment to be carried out before the start of dental work.

After reporting some statistics, the procedures used in the dental treatment of the heart surgery patients subjected to anticlotting pharmacological treatment are described. Considering the considerable difficult in implementing the necessary pharmacological modifications and the high percentage of possible complications involved in these procedures, maximum interdisciplinary cooperation is recommended with heart surgery colleagues so as to carry out dental treatment in good time in patients who are candidates for heart and large vessel operations.

The aetiopathogenetic and evolutive problem of primary oral melanoma is examined with particular regard for melanosis and its relationship with oral naevi. These lesions are classified differently by Authors with different opinions regarding their ability to turn malignant. In this regard, the latest and most reliable hypotheses on the subject are put forward.

Numerous systemic syndromes with different aetiopathogenetic and clinical features are constantly accompanied by functional changes in polymorphonucleated neutrophils and, particularly, in their chemotactic properties. The function they perform, namely impeding invasion of the organism by external aggressive factors, cannot therefore be implemented. These patients are thus abnormally susceptible to infections and present a high frequency of serious periodontal disease.

Following a short review of the main aetiopathogenetic theories on dental agenesia, a personal statistical study of this pathology is reported. 1529 orthopantomographs of juveniles aged between 7 and 14 were examined. 79 cases of hypodentia were observed (5.2%), 32 in males (4.05%) and 47 in females (6.78%). The most interesting tooth was the second premolar with an incidence of 58.9% followed by the lateral incisor, with an incidence of 26.38%. This is in agreement with the international literature.

A case of ameloblastoma located at the upper maxillary, a site that is rare according to the literature, is reported. A perfect cure was obtained with conservative treatment without recurrence, as is shown by the four-year follow-up.

A clinical case of focal dermal hypoplasia or Goltz syndrome is described with details of the odontostomatological features both generally encountered and observed in the present case. The main aetiopathogenic hypotheses are also discussed and a dominant X-linked transmission is postulated.