Ausgabe 4/2005,   Jahrgang 2   (27.01.2006)

Seite 233
Editorial: A Message to Our Esteemed Readers
Wolters, Johannes

Seite 235 - 240
Topical Tacrolimus in Erosive Oral Lichen Planus: An Effective Treatment Approach
Eckardt, A./Völker, B./Starke, O./Kaever, V./Kapp, A.

Objective: Lichen planus is a chronic mucocutaneous disease with primary or secondary involvement of the oral mucosa. In particular in erosive lichen planus most patients experience no long-term symptom relief of conventional topical treatment such as corticosteroid ointments. Topical tacrolimus application to mucosal lesions seem to be an innovative treatment approach. We present data of a clinical phase-II study in patients with erosive lichen planus.
Patients and methods: A total of 18 patients (13 females, 5 males; mean age 64,5 years) have been recruited so far. All patients had a verified diagnosis of erosive lichen planus and had been intermittendly on local corticosteroid treatment without long-term benefit. Patients were instructed to self-administer tacrolimus 0.1% ointment on involved mucosal surfaces twice daily. Treatment period was 8 weeks with a follow-up period of 14 weeks. Blood levels of tacrolimus were assessed using an on-line SPE/HPLC/MS/MS system.Treatment response was assessed by visual analog scale (VAS range 0 - 10; 0=pain free, 10= severe pain). Treatment response was also assessed on mucosal biopsies with immunohistochemical staining for CD3, CD 4, CD 8, CD 68, CD79a and S100.
Results: Objective response rate was 100%, with a complete remission of 55%. Treatment response assessed by VAS scale revealed a significant decrease of VAS 5,96± 0.69 (week 0) to VAS 2,68±0,39 (week 8) (p=0.000). All biopsies showed a strong decrease of inflammatory cells supporting the immunomodulating effect of tacrolimus.
Conclusions: Topical tacrolimus ointment is a safe and very effective treatment approach for erosive lichen planus and deserves further investigation.

Schlagwörter: erosive oral lichen planus, tacrolimus, SPE/HPLC/MS/MS system, phase-II study, cytokines

Seite 241 - 248
TRPV1 Receptor Mechanisms Involved in Capsaicin-Induced Oedema in the Temporomandibular Joint Region
Hu, J. W./Fiorentino, P. M./Cairns, B. E./Sessle, B. J.

Purpose: Recent evidence indicates that capsaicin (CAP), the active and pungent ingredient of hot red peppers, can induce inflammation and pain when it is applied to peripheral tissues. It has been shown to excite small-diameter afferent nerve fibers supplying the tissues by acting on a specific membrane receptor, the TRPV1 (or VR1) receptor. Since it is unclear how CAP application produces an inflammatory action in temporomandibular joint (TMJ) tissues, the aim of this study was to determine if CAP application to the rat TMJ region induces inflammatory changes such as oedema through an action on the TRPV1 receptor.
Materials and Methods: In eight groups of anaesthetized rats (each group, n=8), CAP (0.001%, 0.01%, 0.1%, or 1%) was injected into the TMJ region and was preceded by injection of vehicle or the TRPV1 receptor antagonists capsazepine or ruthenium red. Oedema was monitored by expansion of the TMJ tissues.
Results: Compared with vehicle controls, CAP 1%, 0.1% and 0.01% induced significantly greater oedema (p<0.05, ANOVA) in a dose dependent manner. The oedema became apparent as early as 15 minutes after the CAP injection and lasted over 120 minutes. Both the competitive antagonist capsazepine and the non competitive antagonist ruthenium red could significantly reduce the CAP induced oedema.
Conclusions: These findings indicate that CAP can induce a significant inflammatory response within the TMJ region in a dose-dependent fashion, and that this effect is mediated, at least in part, by TRPV1 receptor mechanisms.

Schlagwörter: temporomandibular joint, oedema, capsaicin

Seite 249 - 251
Oral Hairy Leukoplakia in an HIV-Negative, Immunocompetent Patient
Moffat, M./Jauhar, S./Jones, M. E./MacDonald, D. G./Felix, D.H.

Oral hairy leukoplakia (OHL) is an Epstein-Barr virus-associated lesion, strongly associated with HIV infection. In recent years however OHL has also been described in iatrogenically immunosuppressed patients. Thus the lesion is no longer regarded as pathognomonic of HIV infection, but is related to immunosuppression in general. This report describes oral hairy leukoplakia in an HIV-negative immunocompetent patient using inhaled steroids.

Schlagwörter: hairy leukoplakia, immunosuppression, corticosteroids

Seite 253 - 257
Oral Histoplasmosis Associated with HIV Disease: Report of two Cases from Thailand
Siwamogstham, P./Reichart, P. A./Thosaporn, W./Prapamonton, N.

Introduction: Histoplasmosis caused by Histoplasma capsulatum (Hc) rarely affects the oral mucosa. Oral histoplasmosis (OH) may occur both in the immunocompetent individual as well as in patients with HIV-infection and AIDS. The majority of cases has been observed in the United States and South America. In South and Southeast Asia OH seems to be rare.
Patients and Methods: Two cases of OH in two Thai male patients (aged 30 and 43 years) are described. Clincally, ulcerated lesions with indurated borders were seen, which had persisted for some time. Biopsies revealed the Hc organism. Therapy consisted of administration of ketoconazole, itraconazole and/or amphotericin B. One patient was lost to follow-up, in the other complete healing of the oral lesions occurred.
Conclusions: Oral histoplasmosis in HIV-infected patients in Thailand is rare. The diagnosis is made on histopathologic and serologic parameters. Patients with active antiretroviral therapy or highly active antiretroviral therapy are unlikely to develop OH due to immunereconstitution.

Schlagwörter: histoplasmosis, oral, HIV infection, Thailand

Seite 259 - 264
Organ Transplantation - Assessment of Dental Procedures
Melkos, A. B./Massenkeil, G./Neuhaus, R./Hummel, M./Arnold, R./Reichart, P. A.

Purpose: Organ transplantation is now an established therapeutic strategy for treating many end-stage organ diseases and dysfunctions. The obligatory lifetime immunosuppressive therapy, which is necessary to prevent graft failure, predisposes the patient to infection. Because the oral cavity represents an important port of entry for systemic infections, a comprehensive clinical and radiographic oral examination and dental management of patients prior to transplantation will ensure the elimination of any active infection and minimize the possibility of infection after the transplantation. The aim of this retrospective study was to evaluate the significance of dental management prior to organ transplantation and to determine its relationship with graft rejection, morbidity and mortality of the patients.
Materials and Methods: A total of 102 patients (67 men, 35 women, median age: 42.8 years) who had undergone an organ transplantation were studied. 58 patients received allogeneic or autologous stem cell transplantation (SCT) and 44 patients had undergone liver (LTx) or heart (HTx) transplantation. Seventy of these received dental treatment prior to surgery. Lack of time and the individual health condition of the other 32 patients made possible only the initiation or reinforcement of a preventive dental and oral hygiene program. Prior to any invasive procedures screening laboratory tests were performed in order to reveal the coagulation status; additionally the need for antibiotic coverage was always discussed with the transplant surgeon.
Results: Postoperative complications such as infections, rejection of the transplant, GvHD, relapse of the malignancy and oral mucositis occurred in 80% of the patients who had undergone organ transplantation without dental interventions and only in 45.8% of the patients with completed dental treatment. Statistical analysis of data showed significant correlations (p<0,05), between complications and semi-impacted or impacted teeth making obvious the need for dental management before transplant surgery. A causative relationship between dental foci and life-threatening infections, graft rejection, morbidity and mortality could not be established in our study, a fact, which is probably the result of the great advances in immunosuppressive therapy.
Conclusions: Thus, it can be concluded that the dental concept prior to SCT, LTx and HTx does not have to be a radical one. Further research should clarify the causative association between oral and dental foci and the transplantation outcome.

Schlagwörter: dental focus, organ transplantation, dental evaluation, dental treatment

Seite 265 - 272
Dentin and Enamel Phenotype in Fabry Mice
Goldberg, M./Septier, D./Limaye, A./Sreenath, T./Kulkarni, A. B.

Our aim was to investigate the dental phenotype of α-galactosidase A deficient (AGA-/-) mice - the mutant mice that mimic human Fabry disease. Fabry mice were generated by the gene targeting technique. Segments of mandibles of 21- day-old mice were processed after demineralization for transmission electron microscopy. Comparison was carried out with teeth of mice heterozygous for α-galactosidase A deletion, AGA ±, (HT). In addition, undemineralized sections of mandibles from one-, six- and 18-month-old mice were observed with a scanning electron microscope. Electron-dense lysosomes containing myelin-like structures loaded the odontoblasts, whereas lipid-like structures were mostly present in intercellular spaces in the enamel organ. The diameter of collagen fibrils in the proximal and distal predentin was identical in the two groups. Metadentin was porous but not enlarged in the Fabry mice. Pericellular collagen fibrils filled the lumen of dentin tubules. Bubble-like structures were seen in the lingual part of mandibular incisors of six-month-old mice, with an increase in number and size at 18 months, suggesting that asymmetric differences exist in the Fabry mice in response to mechanical loading. Although the forming enamel of the Fabry mice displayed porosities containing cell membrane remnants, no defect was detectable in mature enamel. The phenotype differences detected between Fabry and HT mice were discrete and mostly related to odontoblast and dentin. Although the Fabry mice display a lysosomal storage disease, disorders of glycosphingolipid degradation seems to play only a minor role in odontogenesis.

Schlagwörter: A-deficient mouse, α-galactosidase, dental abnormalities, Fabry disease, odontogenesis