Oral manifestation as the only sign of Langerhans cell histiocytosis: A case report

Key Clinical Message

The manifestations of Langerhans cell histiocytosis can be limited in the oral cavity, including gingival recession, tooth mobility, and bone destruction. Dentists play a crucial role in the early detection and management of these oral symptoms, which can significantly impact the overall prognosis and quality of life for patients with this serious disease.

Abstract

The hyperplastic activity of bone marrow can lead to excessive histocyte proliferation, called Langerhans cell histiocytosis (LCH). Based on the accumulation location, it has various organ involvement, including skin, bone, and so forth. Oral manifestations such as tooth involvement, bone lesions, mucosal ulcers, and periodontal problems can occur, and they might be the only manifestation of LCH. A subtle diagnosis is crucial and can be started with dental examinations. A 5-year-old girl was examined with the chief complaint of gingival recession with no pain, caries, or calculus. The clinical and radiographical assessment led to further immunohistochemical (IHC) evaluations. The diagnosis was LCH based on S-100 and cluster of differentiation 1a (CD1a) markers. LCH can involve different cells and tissues locally or generally. The early detection and treatment of LCH increase children's survival rate and quality of future life. Therefore, an accurate diagnosis is important among dentists. They must consider that abnormal mobility, gingival, or periodontal problems with no logical cause might warn about a latent problem. Sometimes extraction of loose teeth is not the end of treatment; it is the start of neglecting a serious disease.

Effects of Iron Salts on Demineralization and Discoloration of Primary Incisor Enamel Subjected to Artificial Cariogenic Challenge versus Saline Immersion

AIM

This study aimed to assess the effects of iron salts on the demineralization and discoloration of primary incisor enamel subjected to artificial cariogenic challenge (ACC) versus saline immersion.

METHODOLOGY

In this in vitro experimental study, 90 primary incisors were evaluated in 10 groups (n = 9). Five groups were subjected to ACC, and the other five were immersed in saline. Ferrous sulfate, ferrous fumarate, ferrous ammonium citrate, and ferrous gluconate were added to both saline and cariogenic solutions. The solutions were refreshed every 48 h. After 14 days, the teeth were removed from the media and their demineralization was inspected via scanning electron microscopy (SEM). Energy-dispersive X-ray spectroscopy (EDX) was also performed. The color of the specimens was measured at baseline and after the intervention using the Vita Shade Guide.

RESULTS

Data were analyzed by the Kruskal-Wallis test, one-way ANOVA, and Tukey's test. The color change of specimens subjected to ACC was greater than the color change of those in saline (p = 0.083). The teeth subjected to ACC showed greater iron uptake than did those in saline (p = 0.023). SEM assessment revealed a regular pattern of enamel prisms, with some broken prisms and superficial cracks in the teeth immersed in saline. The teeth subjected to ACC showed numerous fractures and cracks, which were greater in the ferrous sulfate group.

CONCLUSIONS

Immersion in ACC increased the structural porosities and led to greater iron uptake and, consequently, higher discoloration. The maximum structural changes and subsequent staining were noted in the ferrous sulfate group, followed by ferrous ammonium citrate, ferrous fumarate, and ferrous gluconate.

Evaluation of inductive effects of different concentrations of cyclosporine A on MMP-1, MMP-2, MMP-3, TIMP-1, and TIMP-2 in fetal and adult human gingival fibroblasts

Background The etiology of gingival overgrowth due to cyclosporine A (CsA) is still unknown. The aim of this study was to determine the possible role of matrix metalloproteinases (MMPs) and tissue inhibitors of MMPs (TIMPs) on extra-cellular matrix (ECM) homeostasis when treated with different levels of CsA and its difference between fetal and adult human gingival fibroblasts (HGFs). Methods Each group of cells (adult and fetal) was cultured in 40 wells that consisted of four different CsA treatment concentrations. Every 10 wells were treated with 0, 50, 100, and 150 ng/mL of CsA which makes a total of 80 wells. Supernatants of every well were used to determine the concentration of MMPs and TIMPs using the Elisa kits from Boster, CA, USA. Results MMP-1 level increased with the treatment of CsA when treated with 50 and 150 ng/mL of CsA (p = 0.02 and p = 0.04) as TIMP-1 decreased (p < 0.0001) in adult group; while in the fetal group, TIMP-1 level increased with treatment of 150 ng/mL (p < 0.0001). MMP-2 level increased in both adult and fetal groups (p < 0.0001). MMP-3 level decreased in adult group (p < 0.0001) but went up in fetal HGFs (p = 0.01) when treated with 150 ng/mL CsA. TIMP-2 level increased in all wells significantly when treated with CsA (p < 0.0001). The study showed that CsA affects secretion of MMPs and TIMPs. MMP-1 increment and TIMP-1 decrement were observed, which indicate more degradation of ECM. This may be due to single donor use in this study. TIMP-2 and MMP-2 were both more active when treated with CsA which may be due to the gelatinase activity of them and that in CsA gingival overgrowth. There was more inflammation rather than fibrosis.

Comparison of antimicrobial effect of Ziziphora tenuior, Dracocephalum moldavica, Ferula gummosa, and Prangos ferulacea essential oil with chlorhexidine on Enterococcus faecalis: An in vitro study

BACKGROUND

Different irrigating solutions with high antimicrobial activity have been introduced for cleaning of the root canal system. However, effects of Prangos ferulacea (PF), Ziziphora tenuior (ZT), Dracocephalum moldavica (DM), and Ferula gummosa (FG) on oral and dental pathogens have not been extensively evaluated due to their optimal biocompatibility and insignificant side effects. The aim of this study was to evaluate the antibacterial effects of essential oils of mentioned plants on Enterococcus faecalis.

MATERIALS AND METHODS

In this in vitro study the plants were collected from Zanjan Province, Iran. Analysis of the essential oil was carried out by gas chromatography/mass chromatography. Micro-broth dilution and disc diffusion methods were used for assessment of the antimicrobial activity, and minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were evaluated.

RESULTS

All the four essential oils had antibacterial effects on E. faecalis, and ZT had the greatest antibacterial activity. Assessment of the mean diameter of the growth inhibition zone showed higher antibacterial activity of PF and ZT than that of chlorhexidine. The MIC and MBC of ZT showed that the antimicrobial activity of ZT against E. faecalis was greater than that of other plants evaluated in this study.

CONCLUSION

The results of this study indicated significant antibacterial effects of the mentioned plants on E. faecalis. The greatest antimicrobial activity belonged to ZT. The current study suggests extraction of effective compounds in these medicinal plants to use them in the clinical setting.

Types of Lasers and Their Applications in Pediatric Dentistry

Laser technology has been recently introduced into the dental field with the idea to replace drilling. Having a less painful first dental experience by the use of modern instruments like laser can be an efficient preventive and therapeutic strategy in pediatric dentistry. Pedodontists need to learn the new less invasive technologies and adopt them in their routine practice. This study aimed to review the available types of lasers and their applications in pediatric dentistry. An electronic search was carried out in IranMedex, InterScience, Scopus, Science Direct, PubMed, ProQuest, Medline and Google Scholar databases to find relevant articles published from 2000 to 2014. Relevant textbooks were reviewed as well. Laser can be used as a suitable alternative to many conventional diagnostic and therapeutic dental procedures. It is especially efficient for caries detection and removal, pulp therapy, lowering the risk of infection, inflammation and swelling and reducing bleeding. On the other hand, due to minimal invasion, laser treatment is well tolerated by children. Improved patient cooperation leads to higher satisfaction of the parents, dentists and the children themselves.

Phenytoin effects on inflammatory mediator's production by gingival fibroblasts: a comparative study in children and adults

BACKGROUND

About 30 to 50% of patients taking Phenytoin develop significant gingival alternations especially in buccal anterior part of oral cavity. This study was done to compare the synthesis of its inflammatory mediators and related gingival overgrowth in different ages.

METHODS

Samples were collected from biopsy of a healthy gingival of four adults in 35-42 years old through crown lengthening surgery and four children in 4-11 years old through impact tooth surgery, after local anesthesia and from the keratinized soft tissues around the teeth. Gingival biopsies were transferred to a medium which containing DMEM and cultured on specific plates 25 cm2 and put on incubator containing CO2 with temperature of 37 °C. MTT was used to compare the Proliferation rate of fi broblasts. Supernatant of culture medium of test and control sinks were collected by sampler and concentration of IL1β, PGE2, IL6, TGFβ, TNFα and IL8 were analyzed by ELISA.

RESULTS

Different proliferation rate of Phenytoin induced gingival fibroblasts in adults (0.073 ± 0.177) as compared to children (0.056 ± 0.028) was not significant. Production of PGE2, TGFβ and IL6 by Phenytoin induced gingival fibroblasts in children was increased as compared to adults (p < 0.05). Production of IL8 by Phenytoin induced gingival fibroblasts in children was decreased compared to adults (P = 0.02).

CONCLUSION

Phenytoin induced gingival fibroblasts of children produce more amounts of IL1β, PGE2, IL6, TGFβ and IL8 as compared to adults' fibroblasts. More Comprehensive studies with well-documented designs using other methods are recommended to verify these results.

Effect of phenytoin and age on gingival fibroblast enzymes

OBJECTIVE

The alteration of cytokine balance is stated to exert greater influence on gingival overgrowth compared to the direct effect of the drug on the regulation of extracellular matrix metabolism. The current study evaluated the effect of phenytoin on the regulation of collagen, lysyl oxidase and elastin in gingival fibroblasts.

MATERIALS AND METHODS

Normal human gingival fibroblasts (HGFs) were obtained from 4 healthy children and 4 adults. Samples were cultured with phenytoin. MTT test was used to evaluate the proliferation and ELISA was performed to determine the level of IL1β and PGE2 production by HGFs. Total RNA of gingival fibroblasts was extracted and RT-PCR was performed on samples. Mann-Whitney U test was used to analyze the data with an alpha error level less than 0.05.

RESULTS

There was a significant difference in the expression of elastin between the controls and treated samples in both adult and pediatric groups and also in the lysyl oxidase expression of adult controls and treated adults. No significant difference was found between collagen expression in adults.

CONCLUSION

The significant difference in elastin and lysyl oxidase expression between adult and pediatric samples indicates the significant effect of age on their production.