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Hany U, Watson CM, Liu L, Smith CEL, Harfoush A, Poulter JA, Nikolopoulos G, Balmer R, Brown CJ, Patel A, Simmonds J, Charlton R, Acosta de Camargo MG, Rodd HD, Jafri H, Antanaviciute A, Moffat M, Al-Jawad M, Inglehearn CF, Mighell AJ. Heterozygous COL17A1 variants are a frequent cause of amelogenesis imperfecta. J Med Genet 2024; 61:347-355. [PMID: 37979963 PMCID: PMC10982616 DOI: 10.1136/jmg-2023-109510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Collagen XVII is most typically associated with human disease when biallelic COL17A1 variants (>230) cause junctional epidermolysis bullosa (JEB), a rare, genetically heterogeneous, mucocutaneous blistering disease with amelogenesis imperfecta (AI), a developmental enamel defect. Despite recognition that heterozygous carriers in JEB families can have AI, and that heterozygous COL17A1 variants also cause dominant corneal epithelial recurrent erosion dystrophy (ERED), the importance of heterozygous COL17A1 variants causing dominant non-syndromic AI is not widely recognised. METHODS Probands from an AI cohort were screened by single molecule molecular inversion probes or targeted hybridisation capture (both a custom panel and whole exome sequencing) for COL17A1 variants. Patient phenotypes were assessed by clinical examination and analyses of affected teeth. RESULTS Nineteen unrelated probands with isolated AI (no co-segregating features) had 17 heterozygous, potentially pathogenic COL17A1 variants, including missense, premature termination codons, frameshift and splice site variants in both the endo-domains and the ecto-domains of the protein. The AI phenotype was consistent with enamel of near normal thickness and variable focal hypoplasia with surface irregularities including pitting. CONCLUSION These results indicate that COL17A1 variants are a frequent cause of dominantly inherited non-syndromic AI. Comparison of variants implicated in AI and JEB identifies similarities in type and distribution, with five identified in both conditions, one of which may also cause ERED. Increased availability of genetic testing means that more individuals will receive reports of heterozygous COL17A1 variants. We propose that patients with isolated AI or ERED, due to COL17A1 variants, should be considered as potential carriers for JEB and counselled accordingly, reflecting the importance of multidisciplinary care.
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Affiliation(s)
- Ummey Hany
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Christopher M Watson
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, UK
- North East and Yorkshire Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, UK
| | - Lu Liu
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, UK
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
| | - Claire E L Smith
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Asmaa Harfoush
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
| | - James A Poulter
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Georgios Nikolopoulos
- Institute for Fundamental Biomedical Research, B.S.R.C. 'Alexander Fleming', Vari, Attica, Greece
| | - Richard Balmer
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
| | - Catriona J Brown
- Birmingham Dental Hospital, Mill Pool Way, Edgbaston, Birmingham, UK
| | - Anesha Patel
- LCRN West Midlands Core Team, NIHR Clinical Research Network (CRN), Birmingham Research Park (West Wing), Vincent Drive, Edgbaston, Birmingham, UK
| | - Jenny Simmonds
- North East and Yorkshire Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, UK
| | - Ruth Charlton
- North East and Yorkshire Genomic Laboratory Hub, Central Lab, St. James's University Hospital, Leeds, UK
| | | | - Helen D Rodd
- Academic Unit of Oral Health Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Hussain Jafri
- Fatima Jinnah Medical University, Punjab Thalassaemia and Other Genetic Disorders Prevention and Research Institute, Lahore, Pakistan
| | | | - Michelle Moffat
- Paediatric Dentistry, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Maisoon Al-Jawad
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
| | - Chris F Inglehearn
- Leeds Institute of Medical Research, University of Leeds, St. James's University Hospital, Leeds, UK
| | - Alan J Mighell
- School of Dentistry, Clarendon Way, University of Leeds, Leeds, UK
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Oral Alterations in Heritable Epidermolysis Bullosa: A Clinical Study and Literature Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6493156. [PMID: 35686231 PMCID: PMC9173894 DOI: 10.1155/2022/6493156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/04/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022]
Abstract
Epidermolysis bullosa (EB) is a group of skin disorders with skin fragility characterized by blistering from minimal mechanical trauma with rupture at the dermoepidermal junction. There are four major classical heritable EB types, due to mutations in as many as 20 distinct genes: EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB), and Kindler EB (KEB). This study is aimed at reporting case series on patients (N = 8; males, n = 5 and females, n = 3, age range 12-68 years) affected by EB and performs a review of the literature on this topic. This group of disorders can affect oral soft and hard tissues in various ways, resulting in various effects including enamel hypoplasia, dental caries, microstomia, ankyloglossia, oral blistering, and ulcerations early-onset periodontal disease. From the sample results, it can be concluded that the clinical manifestation of EB patients is highly variable and very different in prognosis. Oral health deeply influences the quality of life of EB patients. Dental management is essential to prevent the aggravation of soft tissue damage and tooth loss and to improve the quality of life through prosthetic and restorative therapies. Dentists should consider the oral alterations of EB subtypes to perform a personalized approach to the patients' needs in a preventive and therapeutic point of view.
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Urzúa B, Krämer S, Morales-Bozo I, Camacho C, Yubero MJ, Palisson F, Fuentes I, Ortega-Pinto A. Case Report: Crown Resorption in a Patient With Junctional Epidermolysis Bullosa and Amelogenesis Imperfecta With LAMB3 Gene Mutations. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.704423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Epidermolysis bullosa (EB) corresponds to a series of conditions characterized by extreme fragility of the skin and/or mucous membranes. Of the four main types of EB, junctional EB (JEB) is the most associated with alterations in the teeth. The purposes of this study were to determine the clinical, histopathological, and ultrastructural characteristics of teeth with amelogenesis imperfecta (AI) in a patient with JEB, and compare them with control teeth, and correlate the findings with the mutations present in the patient.Case Report: The study was conducted on a 10-year-old patient with JEB carrier of two recessive mutations in the LAMB3 gene and absence of the laminin-332 protein (LM-332), determined by immunofluorescence on a skin biopsy. The patient presents hypoplastic AI with very thin and yellow-brown colored enamel. Extraction of two permanent molars was performed due to pain and soft tissue covering the crown, resembling pulp polyp or hyperplastic gingiva. Light and scanning electron microscopy (SEM) revealed very thin enamel varying from complete absence to 60 μm, absence of normal prismatic structure, and presence of a cross-banding with a laminated appearance. The histopathological study revealed granulation tissue causing external crown resorption.Conclusion: Although coronary resorption has been reported in patients with syndromic and non-syndromic AI, this is the first clinicopathological report of coronary resorption in partially erupted teeth in patients with JEB with mutations in the LAMB3 gene and hypoplastic AI. In patients with this condition, the presence of partially erupted teeth with soft tissue covering part of the crown, without a periodontal pocket, and with a radiographic image of partial coronal radiolucency should lead to suspicion of external coronary resorption.
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4
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Krämer S, Lucas J, Gamboa F, Peñarrocha Diago M, Peñarrocha Oltra D, Guzmán‐Letelier M, Paul S, Molina G, Sepúlveda L, Araya I, Soto R, Arriagada C, Lucky AW, Mellerio JE, Cornwall R, Alsayer F, Schilke R, Antal MA, Castrillón F, Paredes C, Serrano MC, Clark V. Clinical practice guidelines: Oral health care for children and adults living with epidermolysis bullosa. SPECIAL CARE IN DENTISTRY 2020; 40 Suppl 1:3-81. [PMID: 33202040 PMCID: PMC7756753 DOI: 10.1111/scd.12511] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inherited epidermolysis bullosa (EB) is a genetic disorder characterized by skin fragility and unique oral features. AIMS To provide (a) a complete review of the oral manifestations in those living with each type of inherited EB, (b) the current best practices for managing oral health care of people living with EB, (c) the current best practices on dental implant-based oral rehabilitation for patients with recessive dystrophic EB (RDEB), and (d) the current best practice for managing local anesthesia, principles of sedation, and general anesthesia for children and adults with EB undergoing dental treatment. METHODS Systematic literature search, panel discussion including clinical experts and patient representatives from different centers around the world, external review, and guideline piloting. RESULTS This article has been divided into five chapters: (i) general information on EB for the oral health care professional, (ii) systematic literature review on the oral manifestations of EB, (iii) oral health care and dental treatment for children and adults living with EB-clinical practice guidelines, (iv) dental implants in patients with RDEB-clinical practice guidelines, and (v) sedation and anesthesia for adults and children with EB undergoing dental treatment-clinical practice guidelines. Each chapter provides recommendations on the management of the different clinical procedures within dental practice, highlighting the importance of patient-clinician partnership, impact on quality of life, and the importance of follow-up appointments. Guidance on the use on nonadhesive wound care products and emollients to reduce friction during patient care is provided. CONCLUSIONS Oral soft and hard tissue manifestations of inherited EB have unique patterns of involvement associated with each subtype of the condition. Understanding each subtype individually will help the professionals plan long-term treatment approaches.
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Affiliation(s)
- Susanne Krämer
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
| | - James Lucas
- Dental DepartmentRoyal Children's HospitalMelbourneAustralia
| | | | | | | | - Marcelo Guzmán‐Letelier
- Hospital Base ValdiviaValdiviaChile
- Facultad de OdontologiaUniversidad San SebastiánValdiviaChile
| | | | - Gustavo Molina
- Universidad Nacional de CórdobaArgentina
- Universidad Católica de CórdobaArgentina
| | | | - Ignacio Araya
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
- Hospital Santiago OrienteMaxillofacial Surgery UnitChile
| | - Rubén Soto
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
| | | | - Anne W Lucky
- Cincinnati Children's Epidermolysis Bullosa CenterCincinnati Children's HospitalCincinnatiOhioUSA
- The University of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Jemima E Mellerio
- St John's Institute of DermatologyGuy's and St Thomas’ NHS Foundation TrustLondonUK
| | - Roger Cornwall
- Cincinnati Children's Epidermolysis Bullosa CenterCincinnati Children's HospitalCincinnatiOhioUSA
| | - Fatimah Alsayer
- Royal National ENT and Eastman Dental HospitalsUniversity College London HospitalsLondonUK
| | - Reinhard Schilke
- Hannover Medical SchoolDepartment of Conservative DentistryPeriodontology and Preventive DentistryHannoverGermany
| | | | | | - Camila Paredes
- Facultad de OdontologíaUniversidad de ChileSantiagoChile
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Brown C, Rinaldi CE, Ripple WJ, Van Valkenburgh B. Skeletal and Dental Development Preserve Evidence of Energetic Stress in the Moose of Isle Royale. Front Ecol Evol 2020. [DOI: 10.3389/fevo.2020.00272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Smith C, Poulter J, Brookes S, Murillo G, Silva S, Brown C, Patel A, Hussain H, Kirkham J, Inglehearn C, Mighell A. Phenotype and Variant Spectrum in the LAMB3 Form of Amelogenesis Imperfecta. J Dent Res 2019; 98:698-704. [PMID: 30905256 PMCID: PMC6535922 DOI: 10.1177/0022034519835205] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Amelogenesis imperfecta (AI) is a heterogeneous group of inherited disorders characterized by abnormal formation of dental enamel, either in isolation or as part of a syndrome. Heterozygous variants in laminin subunit beta 3 ( LAMB3) cause AI with dominant inheritance in the absence of other cosegregating clinical features. In contrast, biallelic loss-of-function variants in LAMB3 cause recessive junctional epidermolysis bullosa, characterized by life-threatening skin fragility. We identified 2 families segregating autosomal dominant AI with variable degrees of a distinctive hypoplastic phenotype due to pathogenic variants in LAMB3. Whole exome sequencing revealed a nonsense variant (c.3340G>T, p.E1114*) within the final exon in family 1, while Sanger sequencing in family 2 revealed a variant (c.3383-1G>A) in the canonical splice acceptor site of the final exon. Analysis of cDNA from family 2 revealed retention of the final intron leading to a premature termination codon. Two unerupted third molar teeth from individual IV:5 in family 2 were subject to computerized tomography and scanning electron microscopy. LAMB3 molar teeth have a multitude of cusps versus matched controls. LAMB3 enamel was well mineralized but pitted. The architecture of the initially secreted enamel was abnormal, with cervical enamel appearing much less severely affected than coronal enamel. This study further defines the variations in phenotype-genotype correlation for AI due to variants in LAMB3, underlines the clustering of nonsense and frameshift variants causing AI in the absence of junctional epidermolysis bullosa, and highlights the shared AI phenotype arising from variants in genes coding for hemidesmosome proteins.
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Affiliation(s)
- C.E.L. Smith
- Division of Molecular Medicine, Leeds
Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Oral Biology, School of
Dentistry, St James’s University Hospital, University of Leeds, Leeds, UK
| | - J.A. Poulter
- Division of Molecular Medicine, Leeds
Institute of Medical Research, University of Leeds, Leeds, UK
| | - S.J. Brookes
- Department of Oral Biology, School of
Dentistry, St James’s University Hospital, University of Leeds, Leeds, UK
| | - G. Murillo
- School of Dentistry, Universidad de
Costa Rica, Ciudad Universitaria Rodrigo Facio, San Pedro Montes De Oca, Costa
Rica
| | - S. Silva
- Cellular and Molecular Biology Centre,
Universidad de Costa Rica, Ciudad Universitaria Rodrigo Facio, San Pedro Montes de
Oca, Costa Rica
| | - C.J. Brown
- Birmingham Dental Hospital and School of
Dentistry, Edgbaston, Birmingham, UK
| | - A. Patel
- Birmingham Dental Hospital and School of
Dentistry, Edgbaston, Birmingham, UK
| | - H. Hussain
- School of Medicine, University of Leeds,
Leeds, UK
| | - J. Kirkham
- Department of Oral Biology, School of
Dentistry, St James’s University Hospital, University of Leeds, Leeds, UK
| | - C.F. Inglehearn
- Division of Molecular Medicine, Leeds
Institute of Medical Research, University of Leeds, Leeds, UK
| | - A.J. Mighell
- School of Dentistry, University of
Leeds, Leeds, UK
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7
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Lacruz RS, Habelitz S, Wright JT, Paine ML. DENTAL ENAMEL FORMATION AND IMPLICATIONS FOR ORAL HEALTH AND DISEASE. Physiol Rev 2017; 97:939-993. [PMID: 28468833 DOI: 10.1152/physrev.00030.2016] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/16/2022] Open
Abstract
Dental enamel is the hardest and most mineralized tissue in extinct and extant vertebrate species and provides maximum durability that allows teeth to function as weapons and/or tools as well as for food processing. Enamel development and mineralization is an intricate process tightly regulated by cells of the enamel organ called ameloblasts. These heavily polarized cells form a monolayer around the developing enamel tissue and move as a single forming front in specified directions as they lay down a proteinaceous matrix that serves as a template for crystal growth. Ameloblasts maintain intercellular connections creating a semi-permeable barrier that at one end (basal/proximal) receives nutrients and ions from blood vessels, and at the opposite end (secretory/apical/distal) forms extracellular crystals within specified pH conditions. In this unique environment, ameloblasts orchestrate crystal growth via multiple cellular activities including modulating the transport of minerals and ions, pH regulation, proteolysis, and endocytosis. In many vertebrates, the bulk of the enamel tissue volume is first formed and subsequently mineralized by these same cells as they retransform their morphology and function. Cell death by apoptosis and regression are the fates of many ameloblasts following enamel maturation, and what cells remain of the enamel organ are shed during tooth eruption, or are incorporated into the tooth's epithelial attachment to the oral gingiva. In this review, we examine key aspects of dental enamel formation, from its developmental genesis to the ever-increasing wealth of data on the mechanisms mediating ionic transport, as well as the clinical outcomes resulting from abnormal ameloblast function.
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Affiliation(s)
- Rodrigo S Lacruz
- Department of Basic Science and Craniofacial Biology, College of Dentistry, New York University, New York, New York; Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California; Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina; Herman Ostrow School of Dentistry, Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, California
| | - Stefan Habelitz
- Department of Basic Science and Craniofacial Biology, College of Dentistry, New York University, New York, New York; Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California; Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina; Herman Ostrow School of Dentistry, Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, California
| | - J Timothy Wright
- Department of Basic Science and Craniofacial Biology, College of Dentistry, New York University, New York, New York; Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California; Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina; Herman Ostrow School of Dentistry, Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, California
| | - Michael L Paine
- Department of Basic Science and Craniofacial Biology, College of Dentistry, New York University, New York, New York; Department of Preventive and Restorative Dental Sciences, University of California, San Francisco, San Francisco, California; Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, North Carolina; Herman Ostrow School of Dentistry, Center for Craniofacial Molecular Biology, University of Southern California, Los Angeles, California
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8
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Smith CEL, Poulter JA, Antanaviciute A, Kirkham J, Brookes SJ, Inglehearn CF, Mighell AJ. Amelogenesis Imperfecta; Genes, Proteins, and Pathways. Front Physiol 2017; 8:435. [PMID: 28694781 PMCID: PMC5483479 DOI: 10.3389/fphys.2017.00435] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/08/2017] [Indexed: 01/11/2023] Open
Abstract
Amelogenesis imperfecta (AI) is the name given to a heterogeneous group of conditions characterized by inherited developmental enamel defects. AI enamel is abnormally thin, soft, fragile, pitted and/or badly discolored, with poor function and aesthetics, causing patients problems such as early tooth loss, severe embarrassment, eating difficulties, and pain. It was first described separately from diseases of dentine nearly 80 years ago, but the underlying genetic and mechanistic basis of the condition is only now coming to light. Mutations in the gene AMELX, encoding an extracellular matrix protein secreted by ameloblasts during enamel formation, were first identified as a cause of AI in 1991. Since then, mutations in at least eighteen genes have been shown to cause AI presenting in isolation of other health problems, with many more implicated in syndromic AI. Some of the encoded proteins have well documented roles in amelogenesis, acting as enamel matrix proteins or the proteases that degrade them, cell adhesion molecules or regulators of calcium homeostasis. However, for others, function is less clear and further research is needed to understand the pathways and processes essential for the development of healthy enamel. Here, we review the genes and mutations underlying AI presenting in isolation of other health problems, the proteins they encode and knowledge of their roles in amelogenesis, combining evidence from human phenotypes, inheritance patterns, mouse models, and in vitro studies. An LOVD resource (http://dna2.leeds.ac.uk/LOVD/) containing all published gene mutations for AI presenting in isolation of other health problems is described. We use this resource to identify trends in the genes and mutations reported to cause AI in the 270 families for which molecular diagnoses have been reported by 23rd May 2017. Finally we discuss the potential value of the translation of AI genetics to clinical care with improved patient pathways and speculate on the possibility of novel treatments and prevention strategies for AI.
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Affiliation(s)
- Claire E L Smith
- Division of Oral Biology, School of Dentistry, St. James's University Hospital, University of LeedsLeeds, United Kingdom.,Section of Ophthalmology and Neuroscience, St. James's University Hospital, University of LeedsLeeds, United Kingdom
| | - James A Poulter
- Section of Ophthalmology and Neuroscience, St. James's University Hospital, University of LeedsLeeds, United Kingdom
| | - Agne Antanaviciute
- Section of Genetics, School of Medicine, St. James's University Hospital, University of LeedsLeeds, United Kingdom
| | - Jennifer Kirkham
- Division of Oral Biology, School of Dentistry, St. James's University Hospital, University of LeedsLeeds, United Kingdom
| | - Steven J Brookes
- Division of Oral Biology, School of Dentistry, St. James's University Hospital, University of LeedsLeeds, United Kingdom
| | - Chris F Inglehearn
- Section of Ophthalmology and Neuroscience, St. James's University Hospital, University of LeedsLeeds, United Kingdom
| | - Alan J Mighell
- Section of Ophthalmology and Neuroscience, St. James's University Hospital, University of LeedsLeeds, United Kingdom.,Oral Medicine, School of Dentistry, University of LeedsLeeds, United Kingdom
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9
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Abstract
Mucosal lesions occur with different prevalence and severity in all subtypes of hereditary epidermolysis bullosa (EB), a group of rare genodermatoses. They are associated with increased morbidity and mortality, especially in severe junctional and dystrophic subtypes. Despite progress in clinical approaches to curative therapy, the management of these patients is still primarily symptom-oriented. Current recommendations mainly rely on expert opinion and experience from health care professionals of specialized centers, since the rarity of this disease largely limits the availability and feasibility of randomized controlled trials. Accurate preventive and supportive care measures, however, can significantly lessen symptoms, avoid/ameliorate complications, and enhance the quality of life of these patients.
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Al-Abadi A, Al-Azri SA, Bakathir A, Al-Riyami Y. Dental and Anaesthetic Challenges in a Patient with Dystrophic Epidermolysis Bullosa. Sultan Qaboos Univ Med J 2016; 16:e495-e499. [PMID: 28003899 DOI: 10.18295/squmj.2016.16.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/19/2016] [Accepted: 06/23/2016] [Indexed: 11/16/2022] Open
Abstract
Epidermolysis bullosa is a group of rare genetic disorders characterised by skin and mucous membrane fragility and systemic manifestations of variable severity. We report a case of dystrophic epidermolysis bullosa in an 18-year-old male patient who presented to the Department of Oral Health at Sultan Qaboos University Hospital, Muscat, Oman, in 2015 with recurrent dental pain and infections. Due to the poor dental status of the patient and anticipated operative difficulties due to microstomia and limited mouth opening, the patient underwent full dental clearance under general anaesthesia. This article discusses the dental and anaesthetic challenges encountered during the management of this patient and provides a brief literature review.
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Affiliation(s)
- Ali Al-Abadi
- Department of Anaesthesia & ICU, Sultan Qaboos University Hospital, Muscat, Oman
| | - Salah A Al-Azri
- Oral & Maxillofacial Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Abdulaziz Bakathir
- Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yusra Al-Riyami
- Oral & Maxillofacial Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
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11
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Kawasaki K, Kawasaki M, Watanabe M, Idrus E, Nagai T, Oommen S, Maeda T, Hagiwara N, Que J, Sharpe PT, Ohazama A. Expression of Sox genes in tooth development. THE INTERNATIONAL JOURNAL OF DEVELOPMENTAL BIOLOGY 2016; 59:471-8. [PMID: 26864488 DOI: 10.1387/ijdb.150192ao] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Members of the Sox gene family play roles in many biological processes including organogenesis. We carried out comparative in situ hybridization analysis of seventeen sox genes (Sox1-14, 17, 18, 21) during murine odontogenesis from the epithelial thickening to the cytodifferentiation stages. Localized expression of five Sox genes (Sox6, 9, 13, 14 and 21) was observed in tooth bud epithelium. Sox13 showed restricted expression in the primary enamel knots. At the early bell stage, three Sox genes (Sox8, 11, 17 and 21) were expressed in pre-ameloblasts, whereas two others (Sox5 and 18) showed expression in odontoblasts. Sox genes thus showed a dynamic spatio-temporal expression during tooth development.
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Affiliation(s)
- Katsushige Kawasaki
- Division of Oral Anatomy, Department of Oral Biological Science, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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12
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Lieto LD, Swerczek TW, Cothran EG. Equine Epitheliogenesis Imperfecta in Two American Saddlebred Foals Is a Lamina Lucida Defect. Vet Pathol 2016; 39:576-80. [PMID: 12243468 DOI: 10.1354/vp.39-5-576] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Necropsy of two American Saddlebred fillies diagnosed with epitheliogenesis imperfecta (EI) revealed missing patches of epithelium of the skin and oral mucosa as well as dental abnormalities. Examination of the digestive tract did not reveal signs of pyloric atresia in either foal. Histopathologic examination revealed separation of the epidermis from the dermis. In both foals a division within the lamina lucida of the basal lamina was observed by transmission electron microscopy. In comparison with an age-specific control, the ultrastructure of intact skin from the EI-affected foals showed abnormal hemidesmosomes, which lacked a subbasal plate. The morphological and ultrastructural defects observed in the EI-affected American Saddlebred foals were similar to those observed in Herlitz junctional epidermolysis bullosa-affected human newborns, which is caused by a defect in one of the subunits of laminin-5. The close similarity of lesions of the human and equine diseases suggests that EI may be caused by a laminin-5 defect.
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13
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Kudva P, Jain R. Periodontal manifestation of epidermolysis bullosa: Looking through the lens. J Indian Soc Periodontol 2016; 20:72-4. [PMID: 27041842 PMCID: PMC4795140 DOI: 10.4103/0972-124x.164760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Epidermolysis bullosa (EB) is a genetic disease associated with fragility and bullous lesions of the skin and mucous membranes. There are various patterns of inheritance and histopathology. The disease is associated with systemic and oral manifestations. Treatment of this disease is multidisciplinary and remains only palliative till today. The present case report describes periodontal manifestations of EB and the treatment plan for the same.
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Affiliation(s)
- Praveen Kudva
- Department of Periodontics and Implantology, Jaipur Dental College, Jaipur, Rajasthan, India
| | - Rajsi Jain
- Department of Periodontics and Implantology, Jaipur Dental College, Jaipur, Rajasthan, India
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Leal SC, Lia EN, Amorim R, Dos Santos MV, de Araújo MC, de Medeiros RA, da Fonseca CA. Higher Dental Caries Prevalence and Its Association with Dietary Habits and Physical Limitation in Epidermolysis Bullosa Patients: A Case Control Study. J Contemp Dent Pract 2016; 17:211-6. [PMID: 27207200 DOI: 10.5005/jp-journals-10024-1829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM Epidermolysis bullosa (EB) represents a highly rare subgroup of skin diseases that affects skin and mucous membrane. The aim of the present study was to assess caries prevalence and its associated factors in EB subjects. Salivary status was also assessed. MATERIALS AND METHODS Ten subjects with EB who were under supervision were selected (cases) and matched by age and gender with unaffected individuals (controls). Dental caries were recorded using the World Health Organization (WHO) criteria. Oral hygiene and dietary habits were investigated by clinical examination and questionnaires. Both nonstimulated and stimulated saliva were collected and salivary pH, buffering capacity and mouth opening were evaluated. RESULTS The results showed that the median decay-missing-filled teeth was significantly higher (p = 0.0094) in EB cases 5 (3.9-20.3) than in controls 3 (2-3.25). The groups also differed when food consistency was analyzed. Individuals with EB have a higher intake of soft food. In addition, the median mouth-opening values from cases (0.84-2.84 cm) and controls (4.3-4.9 cm) have shown to be statistically different (p = 0.007). Considering the salivary parameters, none of them showed significant differences among groups. CONCLUSION Epidermolysis bullosa subjects present higher caries scores and might be related to their physical condition and dietary habits. CLINICAL SIGNIFICANCE There is a lack of information about oral status in EB subjects. Hence, our findings add useful information regarding the relationship between caries prevalence and associated risk factors in EB subjects.
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Affiliation(s)
- Soraya Coelho Leal
- Department of Dentistry, School of Health Sciences University of Brasília (UnB), Brasília-DF, Brazil
| | - Erica Negrini Lia
- Professor Faculdade de Ciencias da Saude, Department of Dentistry, School of Health Sciences, Departamento de Odontologia, Universidade de Brasília (UnB) Campus Darcy Ribeiro, Brasília-DF 70910-900, Brazil, Phone: +556131071803 e-mail:
| | - Rivadavio Amorim
- Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital, Harvard Medical School Boston, Massachusetts, USA
| | - Mateus Veppo Dos Santos
- Department of Dentistry, School of Health Sciences University of Brasília (UnB), Brasília-DF, Brazil
| | - Mayara Cundari de Araújo
- Department of Dentistry, School of Health Sciences University of Brasília (UnB), Brasília-DF, Brazil
| | - Rodrigo Antônio de Medeiros
- Department of Dental Materials and Prosthodontic, School of Dentistry, São Paulo State University (UNESP), São Paulo, Brazil
| | - Camila Abdanur da Fonseca
- Department of Dentistry, School of Health Sciences University of Brasília (UnB), Brasília-DF, Brazil
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Hayes E, Challacombe SJ. An Overview of Vesicobullous Conditions Affecting the Oral Mucosa. Prim Dent J 2016; 5:46-50. [PMID: 29029653 DOI: 10.1177/205016841600500105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vesicobullous diseases are characterised by the presence of vesicles or bullae at varying locations in the mucosa. The most common occurring in the oral cavity are mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). Both are autoimmune diseases with a peak age onset of over 60 years and females are more commonly affected than men. This paper reviews the structure of the oral mucosa, with specific reference to the basement membrane zone, as well as bullous conditions affecting the mucosa, including PV and pemphigoid, their aetiology, clinical presentation, and management.
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Affiliation(s)
- Emma Hayes
- Oral and Maxillofacial Surgery, St George's Hospital, London, UK
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16
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Wright JT, Carrion IA, Morris C. The molecular basis of hereditary enamel defects in humans. J Dent Res 2014; 94:52-61. [PMID: 25389004 DOI: 10.1177/0022034514556708] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The formation of human enamel is highly regulated at the molecular level and involves thousands of genes. Requisites for development of this highly mineralized tissue include cell differentiation; production of a unique extracellular matrix; processing of the extracellular matrix; altering of cell function during different stages of enamel formation; cell movement and attachment; regulation of ion and protein movement; and regulation of hydration, pH, and other conditions of the microenvironment, to name just a few. Not surprising, there is a plethora of hereditary conditions with an enamel phenotype. The objective of this review was to identify the hereditary conditions listed on Online Mendelian Inheritance in Man (OMIM) that have an associated enamel phenotype and whether a causative gene has been identified. The OMIM database was searched with the terms amelogenesis, enamel, dental, and tooth, and all results were screened by 2 individuals to determine if an enamel phenotype was identified. Gene and gene product function was reviewed on OMIM and from publications identified in PubMed. The search strategy revealed 91 conditions listed in OMIM as having an enamel phenotype, and of those, 71 have a known molecular etiology or linked genetic loci. The purported protein function of those conditions with a known genetic basis included enzymes, regulatory proteins, extracellular matrix proteins, transcription factors, and transmembrane proteins. The most common enamel phenotype was a deficient amount of enamel, or enamel hypoplasia, with hypomineralization defects being reported less frequently. Knowing these molecular defects allows an initial cataloging of molecular pathways that lead to hereditary enamel defects in humans. This knowledge provides insight into the diverse molecular pathways involved in enamel formation and can be useful when searching for the genetic etiology of hereditary conditions that involve enamel.
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Affiliation(s)
- J T Wright
- Department of Pediatric Dentistry, School of Dentistry, The University of North Carolina, Chapel Hill, NC, USA
| | - I A Carrion
- Meharry School of Dentistry, Nashville, TN, USA
| | - C Morris
- Bon Secours Pediatric Dental Associates, Richmond, VA, USA
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17
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de la Dure-Molla M, Quentric M, Yamaguti PM, Acevedo AC, Mighell AJ, Vikkula M, Huckert M, Berdal A, Bloch-Zupan A. Pathognomonic oral profile of Enamel Renal Syndrome (ERS) caused by recessive FAM20A mutations. Orphanet J Rare Dis 2014; 9:84. [PMID: 24927635 PMCID: PMC4071802 DOI: 10.1186/1750-1172-9-84] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/26/2014] [Indexed: 12/28/2022] Open
Abstract
Amelogenesis imperfecta (AI) is a genetically and clinically heterogeneous group of inherited dental enamel defects. Commonly described as an isolated trait, it may be observed concomitantly with other orodental and/or systemic features such as nephrocalcinosis in Enamel Renal Syndrome (ERS, MIM#204690), or gingival hyperplasia in Amelogenesis Imperfecta and Gingival Fibromatosis Syndrome (AIGFS, MIM#614253). Patients affected by ERS/AIGFS present a distinctive orodental phenotype consisting of generalized hypoplastic AI affecting both the primary and permanent dentition, delayed tooth eruption, pulp stones, hyperplastic dental follicles, and gingival hyperplasia with variable severity and calcified nodules. Renal exam reveals a nephrocalcinosis which is asymptomatic in children affected by ERS. FAM20A recessive mutations are responsible for both syndromes. We suggest that AIGFS and ERS are in fact descriptions of the same syndrome, but that the kidney phenotype has not always been investigated fully in AIGFS. The aim of this review is to highlight the distinctive and specific orodental features of patients with recessive mutations in FAM20A. We propose ERS to be the preferred term for all the phenotypes arising from recessive FAM20A mutations. A differential diagnosis has to be made with other forms of AI, isolated or syndromic, where only a subset of the clinical signs may be shared. When ERS is suspected, the patient should be assessed by a dentist, nephrologist and clinical geneticist. Confirmed cases require long-term follow-up. Management of the orodental aspects can be extremely challenging and requires the input of multi-disciplinary specialized dental team, especially when there are multiple unerupted teeth.
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Affiliation(s)
- Muriel de la Dure-Molla
- Laboratory of Molecular Oral Pathophysiology, INSERM UMRS 1138, Cordeliers Research Center, Paris, France.
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18
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Li Y, Konicki WS, Wright JT, Suggs C, Xue H, Kuehl MA, Kulkarni AB, Gibson CW. Mouse genetic background influences the dental phenotype. Cells Tissues Organs 2014; 198:448-56. [PMID: 24732779 DOI: 10.1159/000360157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2014] [Indexed: 11/19/2022] Open
Abstract
Dental enamel covers the crown of the vertebrate tooth and is considered to be the hardest tissue in the body. Enamel develops during secretion of an extracellular matrix by ameloblast cells in the tooth germ, prior to eruption of the tooth into the oral cavity. Secreted enamel proteins direct mineralization patterns during the maturation stage of amelogenesis as the tooth prepares to erupt. The amelogenins are the most abundant enamel proteins and are required for normal enamel development. Phenotypic differences were observed between incisors from individual Amelx (amelogenin) null mice that had a mixed 129xC57BL/6J genetic background and between inbred wild-type (WT) mice with different genetic backgrounds (C57BL/6J, C3H/HeJ, FVB/NJ). We hypothesized that this could be due to modifier genes, as human patients with a mutation in an enamel protein gene causing the enamel defect amelogenesis imperfecta (AI) can also have varied appearance of dentitions within a kindred. Enamel density measurements varied for all WT inbred strains midway during incisor development. Enamel thickness varied between some WT strains, and, unexpectedly, dentin density varied extensively between incisors and molars of all WT and Amelx null strains studied. WTFVB/NJ incisors were more similar to those of Amelx null mice than to those of the other WT strains in terms of incisor height/width ratio and pattern of enamel mineralization. Strain-specific differences led to the conclusion that modifier genes may be implicated in determining both normal development and severity of enamel appearance in AI mouse models and may in future studies be related to phenotypic heterogeneity within human AI kindreds reported in the literature.
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Affiliation(s)
- Yong Li
- Department of Anatomy and Cell Biology, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pa., USA
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19
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Poulter JA, El-Sayed W, Shore RC, Kirkham J, Inglehearn CF, Mighell AJ. Whole-exome sequencing, without prior linkage, identifies a mutation in LAMB3 as a cause of dominant hypoplastic amelogenesis imperfecta. Eur J Hum Genet 2014; 22:132-5. [PMID: 23632796 PMCID: PMC3865405 DOI: 10.1038/ejhg.2013.76] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/24/2013] [Indexed: 01/13/2023] Open
Abstract
The conventional approach to identifying the defective gene in a family with an inherited disease is to find the disease locus through family studies. However, the rapid development and decreasing cost of next generation sequencing facilitates a more direct approach. Here, we report the identification of a frameshift mutation in LAMB3 as a cause of dominant hypoplastic amelogenesis imperfecta (AI). Whole-exome sequencing of three affected family members and subsequent filtering of shared variants, without prior genetic linkage, sufficed to identify the pathogenic variant. Simultaneous analysis of multiple family members confirms segregation, enhancing the power to filter the genetic variation found and leading to rapid identification of the pathogenic variant. LAMB3 encodes a subunit of Laminin-5, one of a family of basement membrane proteins with essential functions in cell growth, movement and adhesion. Homozygous LAMB3 mutations cause junctional epidermolysis bullosa (JEB) and enamel defects are seen in JEB cases. However, to our knowledge, this is the first report of dominant AI due to a LAMB3 mutation in the absence of JEB.
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Affiliation(s)
- James A Poulter
- Section of Ophthalmology and Neuroscience, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Walid El-Sayed
- Section of Ophthalmology and Neuroscience, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
- Department of Oral Biology, Dental School, Suez Canal University, Ismailia, Egypt
- Department of Oral Medicine, Leeds Dental Institute, University of Leeds, Leeds, UK
| | - Roger C Shore
- Department of Oral Biology, Leeds Dental Institute, University of Leeds, Leeds, UK
| | - Jennifer Kirkham
- Department of Oral Biology, Leeds Dental Institute, University of Leeds, Leeds, UK
| | - Chris F Inglehearn
- Section of Ophthalmology and Neuroscience, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
| | - Alan J Mighell
- Section of Ophthalmology and Neuroscience, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
- Department of Oral Medicine, Leeds Dental Institute, University of Leeds, Leeds, UK
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20
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Fortuna G, Pollio A, Aria M, Moreno-Trevino MG, Marasca F, Salas-Alanís JC. Genotype-oropharyngeal phenotype correlation in Mexican patients with dystrophic epidermolysis bullosa. Int J Oral Maxillofac Surg 2013; 43:491-7. [PMID: 24210835 DOI: 10.1016/j.ijom.2013.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/22/2013] [Accepted: 10/01/2013] [Indexed: 11/16/2022]
Abstract
Previous investigations have attempted to correlate the genotype with the cutaneous phenotype in patients with epidermolysis bullosa (EB), but never with the oropharyngeal phenotype. Seventeen dystrophic EB (DEB) patients were genotyped for COL7A1 gene mutations and divided into five distinct groups. Oropharyngeal disease severity was assessed with the Epidermolysis Bullosa Oropharyngeal Severity (EBOS) score by an oral medicine specialist. The genotype-phenotype correlation was calculated by Kruskal-Wallis analysis of variance using the Mann-Whitney test, applying the Bonferroni correction. The most severe oropharyngeal phenotype was found in the group with the 2470insG/3948insT mutation, with a mean disease severity score of 18.50 ± 2.12; the mildest was found in the 6862del16 mutation group, with a mean disease severity score of 0.57 ± 1.13. The most significant difference in median score was found in the total score (P = 0.009), followed by tongue (P = 0.02) and upper lip (P = 0.021), but no correlation was found between disease severity and the groups (P>0.005, after Bonferroni correction). Multiple comparisons among the five different genotypic groups revealed no statistically significant genotype-oropharyngeal phenotype correlation; it was not possible to establish which group was more severe, or to associate a specific mutation to a specific oropharyngeal phenotype.
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Affiliation(s)
- G Fortuna
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA; DebRA Mexico Foundation, Guadalupe NL, Monterrey, Nuevo León, Mexico.
| | - A Pollio
- Department of Neurosciences, University of Padua, Padua, Italy
| | - M Aria
- Department of Economics and Statistics, Federico II University of Naples, Monte Sant'Angelo, Naples, Italy
| | - M G Moreno-Trevino
- Department of Basic Science, Universidad de Monterrey, San Pedro Garza García, Nuevo León, Mexico
| | - F Marasca
- Department of Stomatology, Cardarelli Hospital, Naples, Italy
| | - J C Salas-Alanís
- DebRA Mexico Foundation, Guadalupe NL, Monterrey, Nuevo León, Mexico; Department of Basic Science, Universidad de Monterrey, San Pedro Garza García, Nuevo León, Mexico
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21
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Kawasaki K. Odontogenic ameloblast-associated protein (ODAM) and amelotin: Major players in hypermineralization of enamel and enameloid. J Oral Biosci 2013. [DOI: 10.1016/j.job.2013.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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23
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Epidermolysis Bullosa Oropharyngeal Severity (EBOS) score: A multicenter development and reliability assessment. J Am Acad Dermatol 2013; 68:83-92. [DOI: 10.1016/j.jaad.2012.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 04/04/2012] [Accepted: 04/08/2012] [Indexed: 11/18/2022]
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Krämer SM, Serrano MC, Zillmann G, Gálvez P, Araya I, Yanine N, Carrasco-Labra A, Oliva P, Brignardello-Petersen R, Villanueva J. Oral health care for patients with epidermolysis bullosa--best clinical practice guidelines. Int J Paediatr Dent 2012; 22 Suppl 1:1-35. [PMID: 22937908 DOI: 10.1111/j.1365-263x.2012.01247.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide the users with information on the current best practices for managing the oral health care of people living with EB. METHODS A systematic literature search, in which the main topic is dental care in patients with Epidermolysis Bullosa, was performed. Consulted sources, ranging from 1970 to 2010, included MEDLINE, EMBASE, CINAHL, The Cochrane Library, DARE, and the Cochrane controlled trials register (CENTRAL). In order to formulate the recommendations of the selected studies the SIGN system was used. The first draft was analysed and discussed by clinical experts, methodologists and patients representatives on a two days consensus meeting. The resulting document went through an external review process by a panel of experts, other health care professionals, patient representatives and lay reviewers. The final document was piloted in three different centres in United Kingdom, Czech Republic and Argentina. RESULTS The guideline is composed of 93 recommendations divided into 3 main areas: 1) Oral Care--access issues, early referral, preventative strategies, management of microstomia, prescriptions and review appointments 2) Dental treatment: general treatment modifications, radiographs, restorations, endodontics, oral rehabilitation, periodontal treatment, oral surgery and orthodontics, and 3) Anaesthetic management of dental treatment. CONCLUSIONS A preventive protocol is today's dental management approach of choice.
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Affiliation(s)
- Susanne M Krämer
- Department of Paediatric Dentistry, Facultad de Odontología, Universidad de Chile, Santiago, Chile.
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25
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Umemoto H, Akiyama M, Domon T, Nomura T, Shinkuma S, Ito K, Asaka T, Sawamura D, Uitto J, Uo M, Kitagawa Y, Shimizu H. Type VII collagen deficiency causes defective tooth enamel formation due to poor differentiation of ameloblasts. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:1659-71. [PMID: 22940071 DOI: 10.1016/j.ajpath.2012.07.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 07/05/2012] [Accepted: 07/18/2012] [Indexed: 01/13/2023]
Abstract
Recessive dystrophic epidermolysis bullosa (RDEB) is caused by mutations in the gene encoding type VII collagen (COL7), a major component of anchoring fibrils in the epidermal basement membrane zone. Patients with RDEB present a low oral hygiene index and prevalent tooth abnormalities with caries. We examined the tooth enamel structure of an RDEB patient by scanning electron microscopy. It showed irregular enamel prisms, indicating structural enamel defects. To elucidate the pathomechanisms of enamel defects due to COL7 deficiency, we investigated tooth formation in Col7a1(-/-) and COL7-rescued humanized mice that we have established. The enamel from Col7a1(-/-) mice had normal surface structure. The enamel calcification and chemical composition of Col7a1(-/-) mice were similar to those of the wild type. However, transverse sections of teeth from the Col7a1(-/-) mice showed irregular enamel prisms, which were also observed in the RDEB patient. Furthermore, the Col7a1(-/-) mice teeth had poorly differentiated ameloblasts, lacking normal enamel protein-secreting Tomes' processes, and showed reduced mRNA expression of amelogenin and other enamel-related molecules. These enamel abnormalities were corrected in the COL7-rescued humanized mice expressing a human COL7A1 transgene. These findings suggest that COL7 regulates ameloblast differentiation and is essential for the formation of Tomes' processes. Collectively, COL7 deficiency is thought to disrupt epithelial-mesenchymal interactions, leading to defective ameloblast differentiation and enamel malformation in RDEB patients.
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Affiliation(s)
- Hiroko Umemoto
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abstract
BACKGROUND Epidermolysis bullosa (EB) is a skin disease characterized by epithelial fragility that leads to blistering and erosion of the skin and mucosae. The authors conducted a literature review to provide an update on oral manifestations and dental care of patients with EB. Literature Search. The authors reviewed the dental literature on EB in relation to clinical findings and provision of dental care. They searched textbooks and three databases: MEDLINE, Cochrane Library and Embase. The authors did not impose any date or publication status restrictions. They searched all databases up to August 2010. RESULTS The literature review revealed that four major groups and 32 subtypes of EB can be distinguished on the basis of the ultrastructural characteristics of skin cleavage, genetic mode of transmission and clinical phenotype. Oral manifestations differ in frequency and severity according to the disease subtype, but the most common are bullae, which leave painful ulcers on rupture, followed by scarring and tissue contraction. Although good oral health status is essential to maintaining oral function, dental treatment can induce new lesions and be hindered by the sequelae of existing lesions. CLINICAL IMPLICATIONS Dental treatment in patients with EB requires a multidisciplinary approach. Dental procedures must be minimally traumatic, and the effectiveness of treatment is determined mainly by the patient's general health, cooperation in the dental office and at home, oral hygiene and diet.
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Torres CP, Gomes-Silva JM, Mellara TS, Carvalho LP, Borsatto MC. Dental care management in a child with recessive dystrophic epidermolysis bullosa. Braz Dent J 2011; 22:511-6. [PMID: 22189648 DOI: 10.1590/s0103-64402011000600012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 10/01/2011] [Indexed: 11/22/2022] Open
Abstract
Epidermolysis bullosa (EB) is a heterogeneous group of rare genetic disorders characterized by marked fragility of the skin and mucous membranes in which vesiculobullous lesions occur in response to trauma, heat or no apparent cause. The recessive form of EB presents the greatest oral alterations including repeated blistering and scar formation leading to limited oral opening, ankyloglossia, tongue denudation, microstomia, vestibule obliteration and predisposition to oral carcinoma. Routine dental care may cause bullae formation on the lips and oral mucosa. Together with the ingestion of soft and frequently carbohydrate food, these anomalies lead to a high caries risk. This paper documents a case of a child diagnosed with recessive dystrophic epidermolysis bullosa (RDEB); describes the phases and difficulties of dental treatment and the measures that dentists and health care providers should adopt in order to provide a safe and effective dental treatment as well as earlier prevention to these patients.
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Affiliation(s)
- Carolina Paes Torres
- Department of Pediatric Clinic, Preventive and Community Dentistry, Ribeirão Preto Dental School, University of São Paulo, Ribeirão Preto, SP, Brazil
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28
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Reddy SS, Lanjekar A, Kaushik A. Dystrophic epidermolysis bullosa: report of a case with electron microscopic study. Indian J Dermatol 2011; 56:456-8. [PMID: 21965872 PMCID: PMC3179027 DOI: 10.4103/0019-5154.84718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sujatha S Reddy
- Department of Oral Medicine, Diagnosis and Radiology, M. S. Ramaiah Dental College and Hospital, MSRIT Post, New BEL Road, Bangalore, Karnataka, India. E-mail:
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29
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Abstract
Inherited epidermolysis bullosa (EB) encompasses a number of disorders characterized by recurrent blister formation as the result of structural fragility within the skin and selected other tissues. All types and subtypes of EB are rare; the overall incidence and prevalence of the disease within the United States is approximately 19 per one million live births and 8 per one million population, respectively. Clinical manifestations range widely, from localized blistering of the hands and feet to generalized blistering of the skin and oral cavity, and injury to many internal organs. Each EB subtype is known to arise from mutations within the genes encoding for several different proteins, each of which is intimately involved in the maintenance of keratinocyte structural stability or adhesion of the keratinocyte to the underlying dermis. EB is best diagnosed and subclassified by the collective findings obtained via detailed personal and family history, in concert with the results of immunofluorescence antigenic mapping, transmission electron microscopy, and in some cases, by DNA analysis. Optimal patient management requires a multidisciplinary approach, and revolves around the protection of susceptible tissues against trauma, use of sophisticated wound care dressings, aggressive nutritional support, and early medical or surgical interventions to correct whenever possible the extracutaneous complications. Prognosis varies considerably and is based on both EB subtype and the overall health of the patient.
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Affiliation(s)
- Jo-David Fine
- Department of Medicine (Dermatology, Vanderbilt University School of Medicine, Head, National Epidermolysis Bullosa Registry Nashville, TN, USA.
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Abstract
Epidermolysis bullosa (EB) is a class of intractable, rare, genetic disorders characterized by fragile skin and blister formation as a result of dermal-epidermal mechanical instability. EB presents with considerable clinical and molecular heterogeneity. Viable animal models of junctional EB (JEB), that both mimic the human disease and survive beyond the neonatal period, are needed. We identified a spontaneous, autosomal recessive mutation (Lamc2(jeb)) due to a murine leukemia virus long terminal repeat insertion in Lamc2 (laminin gamma2 gene) that results in a hypomorphic allele with reduced levels of LAMC2 protein. These mutant mice develop a progressive blistering disease validated at the gross and microscopic levels to closely resemble generalized non-Herlitz JEB. The Lamc2(jeb) mice display additional extracutaneous features such as loss of bone mineralization and abnormal teeth, as well as a respiratory phenotype that is recognized but not as well characterized in humans. This model faithfully recapitulates human JEB and provides an important preclinical tool to test therapeutic approaches.
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Abstract
The craniofacial and oral manifestations of the different epidermolysis bullosa (EB) types vary markedly in character and severity depending largely on the EB type. The tissues affected and the phenotypes displayed are closely related to the specific abnormal or absent proteins resulting from the causative genetic mutations for these disorders. In this article, the major oral manifestations are reviewed for different EB subtypes and are related to the causative genetic mutations and gene expression.
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Fine JD, Mellerio JE. Extracutaneous manifestations and complications of inherited epidermolysis bullosa: part II. Other organs. J Am Acad Dermatol 2009; 61:387-402; quiz 403-4. [PMID: 19700011 DOI: 10.1016/j.jaad.2009.03.053] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 02/22/2009] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
Abstract
It is well known, primarily via case reports and limited case series, that nonepithelial tissues may become injured in patients with epidermolysis bullosa. Only recently, however, have there been data generated from large, well characterized cohorts. Our objective is to provide dermatologists with a comprehensive review of each of these major extracutaneous complications, with a summary of the pertinent literature and evidence-based recommendations for surveillance, evaluation, and management. Some epidermolysis bullosa subtypes are at risk for severe injury of the bone marrow, musculoskeletal system, heart, kidney, and teeth, and for the development of squamous cell carcinoma, basal cell carcinoma, or malignant melanoma. If untreated, significant morbidity or mortality may result.
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Affiliation(s)
- Jo-David Fine
- The National Epidermolysis Bullosa Registry, and Department of Medicine (Dermatology), Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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Oliveira TM, Sakai VT, Candido LA, Silva SMB, Machado MAAM. Clinical management for epidermolysis bullosa dystrophica. J Appl Oral Sci 2009; 16:81-5. [PMID: 19089295 PMCID: PMC4327286 DOI: 10.1590/s1678-77572008000100016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 09/20/2007] [Indexed: 11/21/2022] Open
Abstract
Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented.
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Azrak B, Kaevel K, Hofmann L, Gleissner C, Willershausen B. Dystrophic epidermolysis bullosa: Oral findings and problems. SPECIAL CARE IN DENTISTRY 2006; 26:111-5. [PMID: 16774188 DOI: 10.1111/j.1754-4505.2006.tb01433.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Dystrophic epidermolysis bullosa (DEB) is one of the three major types of epidermolysis bullosa (EB), an inherited cutaneous disease with blister formation following minor trauma. A subtype of DEB is recessive dystrophic epidermolysis bullosa, Hallopeau-Siemens type (RDEB-HS), where marked scarring leads to deformities of extremities. In RDEB-HS the mucous membranes may also be involved and form adhesions with ankyloglossia and microstomia. Oral hygiene is difficult. A 7-year-old boy with RDEB-HS was brought to the Johannes Gutenberg University dental clinic with dental pain. He had multiple carious lesions, poor oral hygiene and gingivitis. Because he was noncompliant and had microstomia, he required dental therapy under general anesthesia. The recall visits over the past two years had demonstrated that the dental health of this patient with RDEB-HS could be maintained by means of improved oral home care, using antibacterial agents.
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Affiliation(s)
- Birgül Azrak
- Department of Restorative Dentistry, Johannes Gutenberg University, Mainz.
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Cagirankaya LB, Hatipoglu MG, Hatipoglu H. Localized epidermolysis bullosa simplex with generalized enamel hypoplasia in a child. Pediatr Dermatol 2006; 23:167-8. [PMID: 16650229 DOI: 10.1111/j.1525-1470.2006.00206.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epidermolysis bullosa is an uncommon disease characterized by the formation of blisters following minor trauma. The three major types are simplex, junctional, and dystrophic. Generalized enamel hypoplasia is accepted as a feature of the junctional type. Teeth with enamel hypoplasia are liable to destruction in the form of caries and/or gingivitis. In this report, a patient with epidermolysis bullosa simplex and severe enamel hypoplasia is described and the importance of early dental consultation for all children with this disease is stressed.
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Affiliation(s)
- Leyla Berna Cagirankaya
- Department of Oral Diagnosis and Radiology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.
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Abstract
OBJECTIVES The dental development of permanent mandibular teeth in a small group of children with dystrophic epidermolysis bullosa (DEB) was assessed from radiographs and compared to a healthy, age-and-sex-matched control group. METHODS This was a retrospective radiographic cross-sectional study. The sample consisted of a group of 44 children aged between 4 and 15 years with DEB and healthy, age-and-sex-matched controls. Two quantitative methods of assessing tooth formation were used: (1) a combination of information about tooth length and apex width; and (2) the use of tooth length to predict age. Panoramic radiographs were digitized in order to determine tooth length and apex width. Dental age was calculated, and the difference with real age was tested with Student's t-test. RESULTS The dentition of both the DEB and control groups was slightly delayed. Using the first method, the delay was 0.34 +/- 0.87 years for the DEB group and 0.29 +/- 0.97 years for the control group. Using the second method, the delay was 0.49 +/- 1.18 years for the DEB group and 0.23 +/- 0.62 years for the control group. This delay was not statistically significant for either method. CONCLUSIONS The dental formation of permanent mandibular teeth in the group of children with DEB was not significantly different to that found in the control group.
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Affiliation(s)
- H M Liversidge
- Paediatric Dentistry, Queen Mary, University of London, UK.
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Jälevik B, Dietz W, Norén JG. Scanning electron micrograph analysis of hypomineralized enamel in permanent first molars. Int J Paediatr Dent 2005; 15:233-40. [PMID: 16011781 DOI: 10.1111/j.1365-263x.2005.00644.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED First molars with cream- to yellow-coloured demarcated opacities of the enamel, often in combination with severe loss of substance, are common in many child populations. The aetiology is obscure. AIM AND METHOD The aim of this study was to study the ultrastructure of the enamel of 10 affected teeth by means of scanning electron microscopy (SEM) in order to gain a better understanding of the clinical appearance and treatment problems of this condition, and to find some clues to its aetiology. RESULTS The basic enamel structure with enamel rods and interrod zones was found in porous parts of the enamel, as well as in normal parts, but the packing of the hydroxylapatite crystals seemed to be looser and less well organized in the porous parts. The border between normal and hypomineralized enamel was usually distinct, and followed the direction of the rods. The preserved basic structure indicates normal function of the ameloblasts during their secretion phase, but impaired function during their maturation stage. CONCLUSION Considering the poor etch profile, it seems reasonable to recommend removal of all affected enamel surrounding the cavity, if possible, and to use a glass ionomer filling with its chemical bonding to tooth substrate, when restoring first molars with remaining affected enamel.
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Affiliation(s)
- B Jälevik
- Specialist Clinic of Pedodontics, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden.
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Abstract
Epidermolysis bullosa (EB) is a group of genetically determined disorders characterized by blistering of the skin and mucosae. There are three major forms--simple, junctional and dystrophic--and each has several varieties. The present case report describes a male child with junctional EB. The aim of the report is to present the dietary situation and the dental status of the child, examples of potential dental and nutritional consequences, and the therapeutic interventions possible for children with this disease.
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Affiliation(s)
- A Momeni
- Department of Paediatric and Community Dentistry, Philipps-University Marburg, Marburg, Germany.
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Swerczek TW, Lieto LD, Cothran E. Developmental defects of enamel in American Saddlebred foals with epitheliogenesis imperfecta. J Equine Vet Sci 2004. [DOI: 10.1016/j.jevs.2004.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Competing interpretations of human origins and evolution have recently proliferated despite the accelerated pace of fossil discovery. These controversies parallel those involving other vertebrate families and result from the difficulty of studying evolution among closely related species. Recent advances in developmental and quantitative genetics show that some conventions routinely used by hominid and other mammalian paleontologists are unwarranted. These same advances provide ways to integrate knowledge of the genotype into the study of the phenotype. The result is an approach that promises to yield a fuller understanding of evolution below the family level.
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Affiliation(s)
- Leslea J Hlusko
- Department of Anthropology, 109 Davenport Hall, MC-148, 607 South Mathews Avenue, University of Illinois, Urbana, IL 61801, USA.
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De Benedittis M, Petruzzi M, Favia G, Serpico R. Oro-dental manifestations in Hallopeau-Siemens-type recessive dystrophic epidermolysis bullosa. Clin Exp Dermatol 2004; 29:128-32. [PMID: 14987265 DOI: 10.1111/j.1365-2230.2004.01485.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Recessive dystrophic epidermolysis bullosa of Hallopeau-Siemens (RDEB-HS) is a rare genetic disorder characterized by trauma-induced blisters, milia, acral pseudosyndactyly, and scarring. RDEB-HS patients present with a distinct pattern of oral involvement consisting of microstomia, ankyloglossia, vestibule obliteration and dental caries. In this review, we describe the orodental manifestations of RDEB-HS and present our experience in a cohort of six new cases of RDEB-HS in children aged 6-10 years, documenting the presence of microstomia, ankyloglossia and vestibule obliteration in childhood. We also show that compared with unaffected control children, RDEB-HS subjects have a greater risk of developing high caries indices with early onset, both for permanent or deciduous teeth, and a worse oral hygiene index (scored as OHI). Tooth malpositions and the cross-bite relationship between maxilla and mandible could play a major role in promoting these events. We propose that dental management of RDEB-HS subjects should commence as soon as tooth eruption begins.
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Affiliation(s)
- M De Benedittis
- Department of Odontostomatology and Surgery, School of Dentistry, University of Bari, Bari, Italy.
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Hlusko LJ, Suwa G, Kono RT, Mahaney MC. Genetics and the evolution of primate enamel thickness: A baboon model. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2004; 124:223-33. [PMID: 15197818 DOI: 10.1002/ajpa.10353] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The thickness of mammalian tooth enamel plays a prominent role in paleontology because it correlates with diet, and thicker enamel protects against tooth breakage and wear. Hominid evolutionary studies have stressed the importance of this character for over 30 years, from the identification of "Ramapithecus" as an early Miocene hominid, to the recent discovery that the earliest hominids display molar enamel intermediate in thickness between extant chimpanzees and Australopithecus. Enamel thickness remains largely unexplored for nonhominoid primate fossils, though there is significant variation across modern species. Despite the importance of enamel thickness variation to primate evolution, the mechanisms underlying variation in this trait have not yet been elucidated. We report here on the first quantitative genetic analysis of primate enamel thickness, an analysis based on 506 pedigreed baboons from a captive breeding colony. Computed tomography analysis of 44 Papio mandibular molars shows a zone of sufficiently uniform enamel thickness on the lateral surface of the protoconid. With this knowledge, we developed a caliper metric measurement protocol for use on baboon molars worn to within this zone, enabling the collection of a data set large enough for genetic analyses. Quantitative genetic analyses show that a significant portion of the phenotypic variance in enamel thickness is due to the additive effects of genes and is independent of sex and tooth size. Our models predict that enamel thickness could rapidly track dietary adaptive shifts through geological time, thus increasing the potential for homoplasy in this character. These results have implications for analyses of hominoid enamel thickness variation, and provide a foundation from which to explore the evolution of this phenotype in the papionin fossil record.
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Affiliation(s)
- Leslea J Hlusko
- Department of Anthropology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61801, USA.
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Marini I, Vecchiet F. Sucralfate: a help during oral management in patients with epidermolysis bullosa. J Periodontol 2001; 72:691-5. [PMID: 11394407 DOI: 10.1902/jop.2001.72.5.691] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Epidermolysis bullosa (EB) is a group of genetic disorders that lead to blister formation at variable depths in skin and mucosa. Vesicles may arise spontaneously or be caused by friction or trauma. Oral tissue fragility and blistering is common in all EB types. The majority of patients with mild forms of EB are able to receive dental treatment. The prevention of dental caries is most challenging in subjects with severe mucosal involvement, as they are least able to routinely undergo correct preventive procedures. The aim of this study was to evaluate the effectiveness of a sucralfate suspension in reducing both pain and the number of blisters in patients with EB, and to obtain improved oral hygiene and a lower incidence of caries. METHODS Five patients with dystrophic EB were treated with sucralfate suspension for the prevention and management of oral blisters. Oral blisters were assessed using a quantitative scale, while pain was assessed using visual analogue scale (VAS), and hygiene was evaluated through plaque and gingival indexes. RESULTS The number of blisters, oral pain, and plaque decreased in all cases. CONCLUSIONS Oral prophylaxis with sucralfate prevented oral blisters and oral discomfort. The procedure proved to be cost effective and easy to administer. It did not show significant side effects and may be used routinely in patients with EB.
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Affiliation(s)
- I Marini
- Department of Oral Surgery, School of Dentistry, University of Bologna, Italy.
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44
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Hakki SS, Celenligil-Nazliel H, Karaduman A, Usubütün A, Ertoy D, Ayhan A, Ruacan S. Epidermolysis bullosa acquisita: clinical manifestations, microscopic findings, and surgical periodontal therapy. A case report. J Periodontol 2001; 72:550-8. [PMID: 11338310 DOI: 10.1902/jop.2001.72.4.550] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Epidermolysis bullosa acquisita (EBA) is an uncommon, acquired, chronic subepidermal bullous disease. This report describes a case of EBA with gingival involvement. A 43-year-old woman with EBA was referred to our clinic for periodontal therapy because of gingival tenderness and bleeding. She has been on cyclosporin A therapy for the last 2 years. METHODS Clinical findings were analyzed. Anterior gingivectomy operations were performed in 2 stages. The samples obtained during the surgery were examined using histopathologic, immunohistologic, and electronmicroscopic methods. Long-term effects of the surgical periodontal treatment on gingiva were evaluated both clinically and microscopically. RESULTS The dentition displayed minimal enamel hypoplasia. Decayed, missing, and filled surfaces score was found to be elevated. Periodontal examination showed generalized diffuse gingival inflammation and gingival enlargement localized mainly to the anterior region. Nikolsky's sign was positive. However, wound healing was uneventful after the operations. Microscopic findings were similar to those obtained from the skin. Twenty-one months after the operations, Nikolsky's sign was negative and no remarkable gingival inflammation was noted. Microscopic examination revealed that the blisters were fewer in number and smaller in size. CONCLUSIONS These results indicate that gingival tissues may also be involved in EBA. Uneventful wound healing after periodontal surgery in this case suggests that periodontal surgery can be performed in patients with EBA. Moreover, both our clinical and histopathologic findings imply that gingivectomy proves useful in maintaining gingival integrity in these patients. Our data may also suggest that the patients with EBA are highly likely to develop dental caries.
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Affiliation(s)
- S S Hakki
- Department of Periodontology, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
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45
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Kirkham J, Robinson C, Strafford SM, Shore RC, Bonass WA, Brookes SJ, Wright JT. The chemical composition of tooth enamel in junctional epidermolysis bullosa. Arch Oral Biol 2000; 45:377-86. [PMID: 10739859 DOI: 10.1016/s0003-9969(00)00003-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The junctionalis form of epidermolysis bullosa (EBJ) is associated with a number of clinical problems involving tooth enamel, including increased susceptibility to caries. The aim here was to carry out a chemical characterization of the enamel of teeth from EBJ patients compared with that of unaffected controls. The results showed that while protein concentration, amino acid composition and carbonate content were similar in both groups, EBJ enamel contained a significantly reduced mineral per volume content, resulting in enamel hypoplasia. In addition, Western blotting revealed the presence of serum albumin (a known inhibitor of enamel crystal growth) in EBJ enamel. This was not detected in control enamel or in enamel of teeth from patients with the dystrophic form of the disease. It is concluded that EBJ enamel is developmentally compromised and that the enamel defects are commensurate with the reported genetic lesions.
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Affiliation(s)
- J Kirkham
- Division of Oral Biology, Leeds Dental Institute, Clarendon Way, Leeds, UK.
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Salo T, Kainulainen T, Parikka M, Heikinheimo K. Expression of laminin-5 in ameloblastomas and human fetal teeth. J Oral Pathol Med 1999; 28:337-42. [PMID: 10478957 DOI: 10.1111/j.1600-0714.1999.tb02050.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Extracellular matrix proteins have been shown to play important roles in the cell migration and differentiation in both normal and pathological conditions. In the present study, we used immunohistochemistry and in situ hybridization to determine the distribution of laminin-5 in ameloblastomas and developing human teeth. In ameloblastomas, the immunoreaction for the laminin-5 gamma2 chain was confined to the tumor cells of the peripheral area. The staining reaction was variable, being mostly weak and fragmented in the basement membrane structures surrounding the neoplastic islands. Some peripheral epithelial cells and some invading small ameloblastoma cell islands showed intense intracellular staining for the gamma2 chain. Tumor cells in the proliferating areas of ameloblastomas expressed gamma2 chain mRNA. The laminin-5 gamma2 chain was located beneath the dental lamina and in the outer, but not in the inner, enamel epithelium of the developing teeth. During the early hard tissue apposition stage, intense staining for the gamma2 chain was confined to ameloblasts, which also gave a strong signal for gamma2 chain mRNA. These results suggest that laminin-5 may contribute to the infiltrative and progressive growing potential of ameloblastomas. During human tooth development, however, laminin-5 may participate in the terminal differentiation of ameloblasts and in enamel matrix formation.
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Affiliation(s)
- T Salo
- Department of Diagnostic and Oral Medicine, Institute of Dentistry, University of Oulu, Finland
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47
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Ryan MC, Lee K, Miyashita Y, Carter WG. Targeted disruption of the LAMA3 gene in mice reveals abnormalities in survival and late stage differentiation of epithelial cells. J Cell Biol 1999; 145:1309-23. [PMID: 10366601 PMCID: PMC2133157 DOI: 10.1083/jcb.145.6.1309] [Citation(s) in RCA: 240] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/1999] [Revised: 04/23/1999] [Indexed: 12/24/2022] Open
Abstract
Laminin 5 regulates anchorage and motility of epithelial cells through integrins alpha6beta4 and alpha3beta1, respectively. We used targeted disruption of the LAMA3 gene, which encodes the alpha3 subunit of laminin 5 and other isoforms, to examine developmental functions that are regulated by adhesion to the basement membrane (BM). In homozygous null animals, profound epithelial abnormalities were detected that resulted in neonatal lethality, consistent with removal of all alpha3-laminin isoforms from epithelial BMs. Alterations in three different cellular functions were identified. First, using a novel tissue adhesion assay, we found that the mutant BM could not induce stable adhesion by integrin alpha6beta4, consistent with the presence of junctional blisters and abnormal hemidesmosomes. In the absence of laminin 5 function, we were able to detect a new ligand for integrin alpha3beta1 in the epidermal BM, suggesting that basal keratinocytes can utilize integrin alpha3beta1 to interact with an alternative ligand. Second, we identified a survival defect in mutant epithelial cells that could be rescued by exogenous laminin 5, collagen, or an antibody against integrin alpha6beta4, suggesting that signaling through beta1 or beta4 integrins is sufficient for survival. Third, we detected abnormalities in ameloblast differentiation in developing mutant incisors indicating that events downstream of adhesion are affected in mutant animals. These results indicate that laminin 5 has an important role in regulating tissue organization, gene expression, and survival of epithelium.
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Affiliation(s)
- M C Ryan
- Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
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Zhou HM, Nichols A, Wohlwend A, Bolon I, Vassalli JD. Extracellular proteolysis alters tooth development in transgenic mice expressing urokinase-type plasminogen activator in the enamel organ. Development 1999; 126:903-12. [PMID: 9927592 DOI: 10.1242/dev.126.5.903] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
By catalyzing plasmin formation, the urokinase-type plasminogen activator (uPA) can generate widespread extracellular proteolysis and thereby play an important role in physiological and pathological processes. Dysregulated expression of uPA during organogenesis may be a cause of developmental defects. Targeted epithelial expression of a uPA-encoding transgene under the control of the keratin type-5 promoter resulted in enzyme production by the enamel epithelium, which does not normally express uPA, and altered tooth development. The incisors of transgenic mice were fragile, chalky-white and, by scanning electron microscopy, their labial surface appeared granular. This phenotype was attributed to a defect in enamel formation during incisor development, resulting from structural and functional alterations of the ameloblasts that differentiate from the labial enamel epithelium. Immunofluorescence revealed that disorganization of the ameloblast layer was associated with a loss of laminin-5, an extracellular matrix molecule mediating epithelial anchorage. Amelogenin, a key protein in enamel formation, was markedly decreased at the enamel-dentin junction in transgenics, presumably because of an apparent alteration in the polarity of its secretion. In addition, increased levels of active transforming growth factor-beta could be demonstrated in mandibles of transgenic mice. Since the alterations detected could be attributed to uPA catalytic activity, this model provides evidence as to how dysregulated proteolysis, involving uPA or other extracellular proteases, may have developmental consequences such as those leading to enamel defects.
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Affiliation(s)
- H M Zhou
- Department of Morphology, University of Geneva Medical School, Geneva, Switzerland
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Sahlberg C, Hormia M, Airenne T, Thesleff I. Laminin gamma2 expression is developmentally regulated during murine tooth morphogenesis and is intense in ameloblasts. J Dent Res 1998; 77:1589-96. [PMID: 9719032 DOI: 10.1177/00220345980770080601] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mutations in the laminin gamma2 gene cause junctional epidermolysis bullosa, and enamel hypoplasias are frequently seen in these patients. Laminin gamma2 is one of the three polypeptide chains forming the basement membrane glycoprotein laminin-5. We have localized the expression of the laminin gamma2 gene by in situ hybridization during mouse tooth development from early morphogenesis to completion of crown development. The expression was restricted to epithelial cells. During the early morphogenesis of the tooth germ, laminin gamma2 was expressed by the outer dental epithelium and by the stellate reticulum cells. No expression was detected in the cells of the inner dental epithelium giving rise to ameloblasts. The pre-ameloblasts remained negative during the early bell stage, but, interestingly, expression was very prominently upregulated as the cells differentiated into ameloblasts. This upregulation appeared to coincide with the start of enamel matrix secretion. The ameloblasts expressed laminin gamma2 intensely throughout the period of active enamel deposition. The expression continued at a lower level in the maturation-stage ameloblasts covering the enamel surface. Immunolocalization of laminin-5 with polyclonal antibodies indicated that the protein formed a continuous lining at the basal surfaces of the cells expressing the laminin gamma2 transcripts. We suggest that the role of laminin-5 during enamel formation may be to strengthen the anchorage of the ameloblasts to the enamel matrix, and that the pathogenesis of enamel hypoplasias in cases of laminin-5 mutations could be associated with detachment of the ameloblast cell layer from the enamel surface.
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Affiliation(s)
- C Sahlberg
- Institute of Biotechnology, University of Helsinki, Finland
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Yoshiba K, Yoshiba N, Aberdam D, Meneguzzi G, Perrin-Schmitt F, Stoetzel C, Ruch JV, Lesot H. Expression and localization of laminin-5 subunits during mouse tooth development. Dev Dyn 1998; 211:164-76. [PMID: 9489770 DOI: 10.1002/(sici)1097-0177(199802)211:2<164::aid-aja5>3.0.co;2-f] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Tooth morphogenesis is regulated by epithelial-mesenchymal interactions mediated by the basement membrane (BM). Laminins are major glycoprotein components of the BMs, which are involved in several cellular activities. The expression and localization of the alpha3, beta3, and gamma2 laminin-5 subunits have been analyzed by in situ hybridization and immunohistochemistry during mouse molar development. Initially (E12), mRNAs of all subunits were detected in the entire dental epithelium and the corresponding proteins were located in the BM. During cap formation (E13-14), transcripts for the alpha3 and gamma2 subunits were localized in the outer dental epithelium (ODE), whereas the beta3 subunit mRNA was present in the inner dental epithelium (IDE). During the early bell stage (E16), immunoreactivity for all subunits disappeared from the BM along the IDE, although intense signals for beta3 mRNA were detectable in cells of the IDE. Subsequently, when the dentinal matrix was secreted by odontoblasts (E18-19.5), mRNAs of all three subunits were re-expressed by ameloblasts, and the corresponding proteins were detected in ameloblasts and in the enamel matrix. Tissue recombination experiments demonstrated that when E16 IDE or ODE was associated with E18 dental papilla mesenchyme, immunostaining for all laminin-5 subunits disappeared from the BM, whereas when cultured with non-dental limb bud mesenchyme, they remained positive after 48 hr of culture. These results suggest that the temporospatial expression of laminin-5 subunits in tooth development, which appears to be differentially controlled by the dental mesenchyme, might be related to the enamel organ histo-morphogenesis and the ameloblast differentiation.
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Affiliation(s)
- K Yoshiba
- INSERM U424, Institut de Biologie Médicale, Faculté de Médicine, Strasbourg, France.
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