The Role of Molecular Chaperones (Hspas/Hsp70S) in Oral Health and Oral Inflammatory Diseases: A Review

Heat shock proteins of the 70kDa family (HSPAs/HSP70s) are major molecular chaperones and cytokines of most cells and microbes, extracellular and interstitial fluids, blood, synovial fluids and secretory body fluids like saliva. The induction of human HSPAs plays an important role at cellular level under most stress conditions; whereas microbial HSPAs improve microbial tolerance to environmental changes, and improve virulence and resistance against antimicrobial peptides. Extracellular HSPAs reveal cytoprotective properties and are involved in numerous physiological and pathological events, including modulation of cytokine release and immunity. Accordingly, HSPAs play a role in the maintenance of pulpal health, and the repair of injured dental hard tissues. HSPAs also play a role in stress adaptation of periodontal tissues, and in the maintenance of periodontal and mucosal health including defense against microbes, prevention of mucosal allergic reactions, and facilitation of healing of ulcers and wounds. Despite their advantageous effects maintaining health of several oral tissues, HSPAs are likely to play a role in the disadvantageous amplification of pulpal inflammatory response to bacteria, and in the formation of several periapical inflammatory lesions. HSPAs may also induce gingivitis under certain conditions, and play a role in the progression of periodontal bone defects. HSPAs may also play a role in atopic-type allergic reactions, autoimmune disorders, and haptenation in certain cases. Based on the above data, it can be assumed that HSPAs play an important role in oral defense under healthy conditions; however, their role is somewhat “Janus-faced” under pathological conditions.

Five-year follow-up of oral health and seizure condition of patients with epilepsy: a prospective observational study

OBJECTIVE

A five-year follow up of patients with epilepsy to examine the change in their oral health and seizure condition.

BASIC RESEARCH DESIGN

A prospective observational controlled epidemiologic study under natural treatment settings.

PARTICIPANTS

The epilepsy group consisted wholly of patients participating in an epidemiologic survey performed five years previously. The gender- and age-matched control (non-epilepsy) group consisted partly of subjects recovered from the previous study, and partly of new subjects.

INTERVENTIONS

Data pertaining to the disease were collected and a thorough dental examination was performed.

MAIN OUTCOME MEASURES

Indices quantifying oral hygiene, the number and condition of the remaining teeth and periodontium, and the degree of prosthetic treatment were measured. Statistical comparison was performed between the patient and the control group of the present study, and pair wise between the previous and the present survey.

RESULTS

The epileptic condition of the patients showed significant improvement upon follow-up, in contrast to a significant deterioration in their oral health as compared to the control group. Concerning oral health, dental indices describing oral hygiene and periodontal condition showed the most pronounced decline.

CONCLUSIONS

The improvement in the epileptic condition of patients is attributed to changes in treatment strategies. As the epileptic condition and oral health of patients changed in opposite directions, socioeconomic and educational factors appear to play a more important role in the poor oral health of these patients than disease-specific factors (e.g. oral cavity injuries, increased exertion on the teeth, antiepileptic drug effects). Furthermore, the periodontal condition seems to be main factor responsible for the unfavourable dental status.

Complex care by multiple medical and dental specialists of a patient with aggressive Gorlin-Goltz syndrome

Gorlin-Goltz syndrome is a genetically predisposed disease characterised by multiple basal cell carcinomas, odontogenic keratocysts and ectopic calcifications. The aim of this study was to show successful treatment of a 37-year-old male patient by cooperation between different dental and medical specialists. Because of the recurrence of a large basal cell carcinoma after multiple operations and a total dose telecobalt irradiation of 66 Gy, the patient's nose was ablated, with resection of the upper lip and part of the maxilla. The intraoral prosthetic treatment helped to restore the subtotal edentulousness. In order to enhance the application of the dental prosthesis, an Abbe plasty was performed at the second stage of surgery. As previous irradiation of the area precluded the use of facial implants immediately after the intraoral treatment, a temporary artificial nose prosthesis was created. The patient tolerated the procedures well and is completely disease-free 12 months after the surgery. Besides presenting a rare and complicated case of Gorlin-Goltz syndrome, the main purpose of this report is to show that, if different specialists in a dental-clinical team (maxillofacial surgeon, oncologist, radiation oncologist, prosthodontist and psychiatrist) combine their skills and expertise, successful management is possible even in a challenging complex case.

Salivary Genomics, Transcriptomics and Proteomics: The Emerging Concept of the Oral Ecosystem and their Use in the Early Diagnosis of Cancer and other Diseases

There is an increasingly growing interest world-wide for the genomics, transcriptomics and proteomics of saliva and the oral cavity, since they provide a non-invasive source of unprecedently rich genetic information. The complexity of oral systems biology goes much beyond the human genome, transcriptome and proteome revealed by oral mucosal cells, gingival crevicular fluid, and saliva, and includes the complexity of the oral microbiota, the symbiotic assembly of bacterial, fungal and other microbial flora in the oral cavity. In our review we summarize the recent information on oral genomics, transcriptomics and proteomics, of both human and microbial origin. We also give an introduction and practical advice on sample collection, handling and storage for analysis. Finally, we show the usefulness of salivary and oral genomics in early diagnosis of cancer, as well as in uncovering other systemic diseases, infections and oral disorders. We close the review by highlighting a number of possible exploratory pathways in this emerging, hot research field.

Evaluation of palatal saliva flow rate and oral manifestations in patients with Sjögren's syndrome

OBJECTIVE

The purpose of this study was to describe the oral properties of Sjögren's syndrome (SS), including the determination of palatal saliva (PS) flow rate.

SUBJECTS AND METHODS

Forty-nine SS patients and 43 healthy controls participated. Subjective symptoms were recorded and clinical assessments of the oral mucosal, dental and periodontal status were made. Unstimulated whole saliva (WS) and PS flow rates, the number of decayed, missing and filled teeth (DMF-T number), the gingival bleeding index (GBI) and the periodontal probing depth (PPD) were determined.

RESULTS

Despite the decrease in the flow rate of WS in SS patients, PS was not different from those of the controls (1.57 +/- 1.02 and 1.35 +/- 2.5 microl cm(-2) min(-1), respectively). GBI (20.0% vs. 10.5%, respectively), DMF-T (27.1 +/- 6.12 vs. 23.0 +/- 6.99, respectively) and PPD (2.28 +/- 1.09 mm vs. 1.82 +/- 0.73 mm, respectively) were higher in SS compared with the controls (P < 0.05). DMF-T and PPD showed a positive correlation with anti-SSA and/or anti-SSB antibody positivity in the serum (P < 0.05).

CONCLUSIONS

Data of the present study suggest that the subjective feeling of xerostomia in SS patients is the result of a decrease in the volume of the whole saliva, and not of the viscous PS. Correlation of DMF-T and PPD with autoantibody positivity reveals that the oral health status of SS patients may be associated with the general autoimmune process.

Measurement of periapical pressure created by occlusal loading

AIM

To develop an in vitro model in which the pressure in the periapical tissues can be measured during loading.

METHODOLOGY

Extracted human maxillary central incisors were embedded in resin blocks that had physical characteristics similar to those of bone and periodontal ligament. Each tooth was loaded with 20, 40, 50, 60, 75, 85, 100, 200, 300 and 450 N vertical forces from the incisal edge of the crown on three consecutive occasions. A minute resistor embedded in the periapical space was used to detect apical pressure changes during occlusal loading. The ratio of apical pressure changes (DeltaP) to the loading force changes (DeltaF) was calculated.

RESULTS

The periapical pressure detected was in direct proportion to the loading force. The mean value of DeltaP/DeltaF was 5.994 kPa N-1 (SD = 2.04).

CONCLUSIONS

Direct proportionality was found between the coronal loading and the apical hydrostatic pressure. The DeltaP/DeltaF ratio determined in this study makes it easier to estimate the apical hydrostatic pressure values during occlusal loading of single-rooted teeth. In this study, the apical pressure generated under occlusal loading was the same magnitude as that estimated with the finite element method.

[Investigation of the relationship between the posterior edge of the base of complete lower dentures and the mandibular tuberculum]

Surveying the data published in the literature one can establish that opinions of authors differ concerning the appropriate relationship between complete lower dentures and the tuberculum alveolare mandibulae (TAM). Some authors claim that, following extensional principles, the base of complete lower dentures must fully cover the TAM. Others think that it is enough if the base covers half of the TAM; yet others recommend that the base should merely extend as far as the mesial edge of the TAM. In the present investigations, we tried to find out what the relationship was between complete lower dentures prepared in everyday practice and the TAM. Dentists of the Clinic of Prosthetic Dentistry examined 8346 patients in eight different regions of Hungary over a period of three years. In the present analysis, we discuss the data of subjects wearing a complete lower denture. In the populations concerned, 669 subjects met these criteria. With respect to the relationship between the base and the TAM, we distinguished three groups. The first group was made up by cases where the base extended as far as the mesial edge of the TAM, the second group included subjects whose base reached the medial line of the TAM, whereas the third group comprised patients in whose case the base fully covered the TAM. The relationship between the base and the TAM was examined intraorally, by ocular inspection. The data were analysed with regard to gender and laterality, by the help of the SPSS software package and the chi 2 test. The investigations showed that, in everyday practice, an overwhelming majority (77.10%) of complete lower dentures had a base extending to the mesial edge of the TAM, and it was in a mere 3.9% of cases that the base covered (some of) the TAM. Cases where the edge of the base did not reach the TAM (19.01%) were taken as cases where the dentist disregarded the significance of the relationship between the base and the TAM. The tuberculum alveolare mandibulae is a structure made up by dense fibrous connective tissue that, in most cases, may get displaced over its base and is not pressure resistant, not able to provide a value-like seal and, therefore, not suitables for the extension of the base. Our results suggest that practising dentists have noticed this; furthermore, they have probably also noticed that whenever the base extends as far as the mesial edge of the TAM, leaning against it as it were, it effectively prevents the denture from shifting backwards, i.e. is an obstacle to its anteroposterior displacement.

[Cantilever bridges--a cross-sectional study]

Life expectancy and functional performance of the cantilever bridges is determined by the length of the cantilever pontic(s) and by the number and localisation of the abutment teeth. No overall epidemiological survey covering this topic was found in the literature. 529 distally cantilevered bridges were evaluated by the authors. There were 310 upper and lower cases. The following parameters were recorded: length of the cantilever part (number of units), the relationship of the cantilevered pontics and the bridge, and the position of the fixed restoration in the dental arch. Previously the cantilevered bridge design was not accepted in Hungary but in spite of this fact a large number of distally cantilevered bridges were made in the country. Most of the examined cantilever bridges are properly designed: two abutments are supporting one pontic (342 cases, 65.56%). However some of the solutions are too risky: one abutment, one cantilevered pontic (110 cases, 20.45%), or two abutments, two cantilevered pontics (53 cases, 9.85%).

[Study in dental laboratories: I. Complete dentures]

Introducing the quality control of ISO-900 into dentistry is very urgent and important task nowadays. In this article we report about: how we should be able to double check and evaluate the clinical part of the work in the dental laboratories. What kind of possibilities we have and how dependable they are, in order to control the different phases of the dental work. We also looked into the question whether dental technician get enough and dependable information from the dentists in order to make quality high standard work.

[The dental status of elderly people in Hungary--based on mass screening]

Twenty-three % of the Hungarian population was older than 60 years at the time of this epidemiological survey. This ratio increases gradually. So it is important to know the dental status of this population both from a professional and national health service point of view. The authors have evaluated the data of the dental health state of 2466 persons who were older than 60 years. The data were collected between 1986 and 1989. 1.8% of them kept all their teeth, 38.5% had no teeth at all. The average number of teeth was 3.49 on the upper and 4.57 on the lower jaw. 4-5% of the remaining teeth had caries. The ratio of filled teeth was 3.7% (male) and 6.8% (female). Periodontal problems were diagnosed in 34.2% (male) and 26.1% (female) of the patients. In 57.5% (male) and 73.0% (female) of the missing teeth were replaced. The cases where a large number of teeth were missing (class 2A, 2B, Fábián and Fejérdy classification) were quite often only partially treated.

[Study of the relationship of the mandibular alveolar tuberculum to the occlusal plane at complete lower dentures]

The distance between occlusal plane and alveolar crest has an influence on the stability of the lower denture. From the relationship of the occlusal plane to the tuberculum alveolare mandibulae we can conclude on the distance between the occlusal surface of the denture's molars and the alveolar crest. The relationship of the occlusal plane to the tuberculum alveolare mandibulae was examined in 688 patients with complete lower and upper dentures. Results have shown, that in 30.25% the occlusal plane of the lower dentures was at higher level, than the highest point of the tuberculum alveolare mandibulae, in 41.3% it was at the level of the highest point of the tuberculum alveolare mandibulae and in 28.45% it crossed the tuberculum below its highest point. From our results the conclusion can be drawn, that in most of the cases no attention to the tuberculum line, has been paid the interalveolar distance and the occlusal plane of the natural teeth at the set-up of the molars, so this has a negative effect in 69.5% of the examined cases on the stability of the lower complete dentures.

[Study of the inclination angle between the edentulous upper and lower alveolar ridge in the sagittal plane]

Angle of inclination between the upper and lower edentulous alveolar ridge in the sagittal plane was examined on 72 patients (55 woman and 17 men) in centric occlusion. Photos were taken by a special camera (Polaroid MACRO 5 SLR) of the functional casts mounted in average value articulators, on a special squared-film, from the left and right side. The angle between the lines connecting mesially the midline of the alveolar ridge, distally the highest point of the tuber alveolar maxillae and the line drown through the stop-lines, respectively was measured on both sides with 1 degree precision. Distally open angle (max. 7 degrees) was found in 11% of the examine group. The alveolar ridge lines were parallel in only 3% of the cases. Mesially open angle (max. 20 degrees) was found at 86%. Statistical analysis has shown, that there is a significant difference between men and women as well as the left and right side.

[Evaluation of the survival time of complete dentures with a mathematical method]

Based on the number of previous dentures and on the information given by the patients the authors describes a mathematical model for the estimation of the denture survival time. The distribution of edentulousness according to age (based on 9991 patients) shows a regular pattern and can be described by a second degree function. The survival time shows a similar regularity. The application of the Kaplan-Meier method can be used to estimate the survival time calculated only from a single cross-sectional study. This approach uses the survival time of the first set of complete dentures and the average edentulous time of the patients with their second complete dentures as a base for the calculation.

[Prosthodontic treatment of missing molars (distal edentulous state class 1B); practice in Hungary based on mass screening]

Between the years of 1985 and 1989 we examined 9991 people. From the examined patients those people were selected, who lost their molars on one or both side, but they had no greater continuous edentate area in their dental arch than four teeth. The recorded data were evaluated separately by arches. 486 upper and 1568 lower arches filled the requirements of us. Patients wore in the upper jaw in 216 cases (46%) fixed prostheses with posterior cantilever pontic, in 26 cases (5%) combined prostheses (fixed + removable partial denture), in 18 cases (4%) removable partial dentures. 208 (45%) cases were untreated. In the lower arch in 417 cases (27%) fixed prostheses with a posterior cantilever pontic, in 97 cases (6%) combined prostheses (fixed + removable partial denture), in 57 cases (3%) removable partial dentures were constructed. 997 cases were (63%) were untreated. The results of this study indicate, that the treatment of distal edenate arches in the everyday practice is also verifying our prosthetic planning guidelines.

[The effect of continuous clasps on the state of residual teeth]

170 removable partial dentures connected with continuous clasps (Kennedy bar) of 162 patients have been examined. In the case of 77 dentures the continuous clasps were tooth-supported, whereas in the other 93 cases tooth-supports has not been used. Authors examined the effect of dentures on the periodontal tissues, by measuring the frequency of occurrence of gingivitis, pocket formation, and increased tooth movability. Teeth, touching the tooth-supported clasps suffered from damage of the periodontal tissues in 20.1%. This value increased to 38.4% in the case of clasps without tooth-support.

[Evaluation of the dental status from he viewpoint of denture requirements in the adult population of Hungary]

Authors found a rather high number of missing teeth of the Hungarian population, whereas the claim of the patients to dentures is less than the capacity of the dental professionals. The percentage of the patients wearing fixed and/or removable dentures is only around 50% (mean value), in the aesthetically not disadvantageous cases (i.e.: classes 1/a; 2/a; Fábián-Fejérdy) only 30-40%, but in the aesthetically disadvantageous cases 70-80% (i.e.: classes 1/b; 2/a/1; 3; Fábián-Fejérdy). The percentage of the men wearing dentures is higher than the percentage of the men (61.9% and 44.9% respectively). Authors concluded that, the most important expectations of the patients to dentures are aesthetic. The injurious effects of not reconstructed missing teeth have minor effects on the patients motivation.

[In vivo and in vitro study of the marginal sealing in ceramic-covered gold inlays]

In the view of the patients, Galvano-Inlays fulfil esthetic requirements in contrast to cast restaurations. However, it was decided to evaluate the fine gold margins. The marginal seal of Galvano-Inlays in different stages of production was evaluated by means of light microscopy, and scanning electron microscopy. In addition Galvano-Inlays which had been in the mouth for two years, were evaluated in the same way. Besides good contact of the fine gold to the tooth, marginal discrepancies in the range of 60 to 160 microns were found which can hardly be improved by means of burnishing. After all, the insufficiency results from the inevitable gap of cementation or from breaking failure of the polished and thus hardened margin of the fine gold.

[Dynamics of tooth loss In the adult population in Hungary]

The authors examined the dental status of 9991 hungarian adult people and they drawn the conclusion of the tooth-loss dynamics of the '80-es. It has been found, that in comparison with international data the number of lost teeth was shaping unfavourable. Nevertheless the rate of completely edentate patients in all age-groups shows a favourable tendency.

[Distribution of the position of the last remaining tooth in otherwise edentulous mouth, based on mass screening]

The authors examined the frequency of the last remaining tooth's positions in both arches and they found the canine in the lower arch in 63% and the second molar in 13% of the second molar. In single remaining tooth situations the rate of wearing denture is 73%. The cariological status of these teeth is negligible in relation to the bad periodontal health conditions, which are not influenced essentially by crowns or wearing dentures.

[The volume of dental training around the second millenium]

The number of Hungarian dentists around the second millennium is analysed. Keeping the actual number of student's intake, the number of dentists will decrease significantly between 2002 and 2015. Therefore, the consideration of this possible critical situation is urgent.

[Clinical examination of the effect of the "Corega Junior" cleaning tablets for removable orthodontic appliances]

According to the authors' macroscopic and microbiological examinations Corega Junior prevents plaque formation on the orthodontic appliances and the establishment and multiplication of microorganisms and therefore has a favourable effect to the oral flora and last but not least to the general state of health of the patients. The usage of the Corega Junior cleaning tablets incites young people for the regular use of orthodontic appliances and indirectly for mouth care.

[Prosthetic implications of dental screening tests of adolescents]

The 700 teen-agers of 14 to 19 years of age observed in the course of national dental screen tests between 1985 and 1989 showed 1198 edentulousness and 154 destroyed teeth. Dental appliances were prepared but for 33 juveniles which, in case of 14 persons, were covering crowns or pin teeth while with 19 thereof it were bridges. Thereby 3.25% of the existing deficiencies were replaced. Removable dentures have not been prepared at all although it would have been justified.

[General experiences in dental screening of adolescents]

The dental and mouth hygiene of youth of 14 to 19 years of age have been separately analyzed from the results of the general dental screen test performed between 1985 and 89 by the Clinic of Prosthetic Dentistry of Budapest. The global DMF-T index of the first national sites was 8.99 and the OHI-S index was 1.37.

[Why should teeth, used for anchoring partial prostheses, also be used as their support?]

It is proved by means of static models that, as regards the load of the periodontium, the teeth employed for the dental supporting and anchoring of partial dentures are in a much more favourable situation than the teeth employed but for anchorage. Viz. while the resultant of the axially and laterally directed forces resulting from supporting and anchoring does not become eccentric, the direction of the but anchorage force points out of the structure and entails an unfavourable torque on the tooth.

[Restoration of unilateral borderline edentulousness (Fábián-Fejérdy prosthetic class 2A-2B)]

A frequent case of unilateral row and edentulousness is when, on one side, all three molars are missing and, thus, the second promolar is the last tooth. To solve such edentulousness a removable denture or a combined fix plus removable plate denture is suggested. By employing the principles of the prosthetical classification (Fábián-Fejérdy) the justification of the distally free end bridge is proved.

[Effect of partial dentures on the residual dentition and the periodontium]

The data of 969 dental arches replaced by partial denture, and 1282 dental arches of the same edentulousness but unreplaced, examined in an unselected population, have been analyzed from the point of view of the occurrence frequency of the gingivitis, the pocket, the movability and the caries. It has been stated that the effect of the prosthesis of the remaining teeth may be evaluated only by comparison with a suitable control group with no dentures. Furthermore, it has been stated that the remaining teeth are not damaged by well planned partial dentures (with metal base plates) while the wrongly planned dentures (with plastic base plates) develop a significant damaging effect.

[Evaluation of distal free-end dentures and partial plate dentures based on their effect on the remaining dentition]

The data of 3778 examined persons were processed. The effect of distally free end bridges made for replacing terminal endentulousness on the remaining teeth was compared with the condition of the remaining teeth of patients untreated, provided with partial dentures as well as with combined fix + partial denture. It was ascertained that in cases of replacements by distally free end bridges deterioration of the remaining teeth is essentially less.

[Analytic measurement of the solubility of the enamel surface exposed to acid and morphometric study of the resulting erosion in rat incisors treated with aluminum]

Their method of examination is based on the area analytical examination of scanning electromicroscopic photographs made of the enamel surfaces corroded with acid. By means of their method the area distribution of the enamel surfaces has been determined on which no detectable changes were formed after the acid action. The results obtained that way have also been compared with the results of analytical measurements. Their examinations were performed on uppar incisors of rats treated with aluminium.