Papulonecrotic tuberculide complicating scrofuloderma in a health-care worker.
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Adolescent↗
Biomedical subjects
S J Challacombe
Publications and source records attributed to S J Challacombe.
Gingival ulceration in HIV infection. A case series and case control study.
All cases of HIV-associated gingival ulceration seen at a dedicated dental clinic in a 5-year period were reviewed and compared against other patients attending the clinic. 94 (7.1%) of 1308 patients had 146 episodes of gingival ulceration. 89 patients had 140 episodes similar to acute necrotising ulcerative gingivitis (ANUG) and responded well to conventional treatment for ANUG. The cases were compared with 269 controls in logistic regression. Gingival ulceration was associated with oral candidiasis, lower age and lack of AIDS diagnosis possibly due to a protective effect of co-trimoxazole medication. 5 patients with neutropenia had extensive ulceration without the microflora of ANUG. Histopathology, viral and bacterial culture revealed non-specific changes. The ulcers did not respond to the treatment regimen for ANUG but responded to treatment of their neutropenia. Gingival ulceration is not common in HIV infection. Most cases resemble severe ANUG. It is more frequent in younger people, those with oral candidiasis and without AIDS. Co-trimoxazole may be protective. A minority of cases with ulceration and associated neutropenia resembled the non-specific oral ulceration associated with HIV.
Adult↗
Oral examination: a screening tool for HIV infection?
OBJECTIVE: To estimate the predictive values for HIV infection of diagnosis of oral manifestations of the infection. METHOD: Prevalence of oral manifestations was compared in cross sectional blinded clinical examinations of homosexual men attending a genitourinary medicine clinic. Data were extrapolated to populations in England and Wales based on estimates of the prevalence of HIV infection. RESULTS: Data were analysed for 572 HIV infected and non-infected men (312 and 260 respectively). Positive predictive values for erythematous candidiasis, hairy leucoplakia and pseudomembranous candidiasis were greater than 0.96 at the genitourinary medicine clinic and are estimated to be greater than 0.72 among homosexual men in London. CONCLUSIONS: Clinical diagnoses of mucosal lesions alone are poor predictors of HIV infection but are useful when used in conjunction with a social history to establish if there are risk factors for infection.
Adolescent↗
Ecological study of Streptococcus mutans, Streptococcus sobrinus and Lactobacillus spp. at sub-sites from approximal dental plaque from children.
Previous immunofluorescence (IF) studies have indicated that Streptococcus mutans may preferentially colonise specific sub-sites within approximal plaque. The present study aimed to extend these observations to other mutans streptococci and lactobacilli in such gingival margin plaque. Two hundred and seventy approximal plaque samples were taken from 90 teeth (3 from each tooth) in 64 children; three gingival margin sub-sites in relation to the contact area: away from (A), to the side of(S) and below (B) the contact area. Samples were processed by indirect IF using high-titred polyclonal anti-S. mutans 'c', anti-S. sobrinus 'd', anti-L. casei and anti-L. acidophilus antisera. An overall positive association was found between S. mutans 'c' and S. sobrinus 'd' (p < 0.001). Significant differences (p < 0.1) were found between the proportional counts at each sub-site for S. mutans 'c': A = 39%, S = 51% and B = 70%, and for S. sobrinus 'd' 21, 33 and 49%. Mutans streptococci (MS) appeared to preferentially colonise the sub-site below the contact area (B = 81%), compared with sub-sites A and S (48 and 62%, respectively). S. mutans 'c' and S. sobrinus 'd' were detected together at subsites A = 12%, S = 22%, and B = 38%, with proportional counts at B sites being higher than those at A (B > A, p < 0.01, and B > S, p < 0.05). Lactobacillus spp. were isolated rarely, and were usually found together with MS. There was a positive relationship between the presence of lactobacilli or MS and caries (white spot lesions only), although these species could frequently be isolated from noncarious sites. The presence of both S. mutans 'c' and S. sobrinus 'd' were strongly correlated with early caries lesions. In addition, this study confirmed the variation in the microflora at different sub-sites within approximal dental plaque.
Antibodies, Bacterial↗
Dental erosion in a wine merchant: an occupational hazard?
This paper reports a case of dental erosion apparently caused by wine tasting. Dental erosion can cause extensive damage to the dentition, thereby creating a variety of complex restorative problems. Within the literature dental erosion has been attributed to many factors, but to date there are no documented cases specifically linking it with wine tasting. The dental professional is ideally placed to implement early preventive regimes which would make the occupation less damaging to the dentition.
Food Handling↗
Variations in the predominant cultivable microflora of dental plaque at defined subsites on approximal tooth surfaces in children.
The distribution and composition of the resident microflora were determined in approximal gingival margin plaque from 21 premolars extracted from schoolchildren (mean age 12.0 +/- 1.8 yr). Indigo carmine (5% w v) was used to visualize plaque to facilitate sampling. About 1 mm2 of plaque was removed from sites away from (A), to the side of (S), and below (B) the contact area. Plaque samples were dispersed, serially diluted, and cultured on selective and non-selective agar media. An average of seven to nine species was found at each subsite. Streptococcus and Actinomyces were subdivided on the basis of a range of biochemical tests. The predominant Actinomyces and streptococcal species at most subsites were A. naeslundii and Strep. mitis biovar I. A. naeslundii and A. odontolyticus were isolated more often at subsite B (90.5 and 57.1%, respectively), and A. israelii at subsite S (66.7%) Strep. mitis 1 and Strep. sanguis were found more frequently at subsite S (76.2 and 66.7% respectively), whereas Strep mutans, Strep. sobrinus, Strep. gordonii and Veillonella spp. were recovered most commonly from subsite B (85.7, 33.3, 38.1 and 76.2%, respectively). The isolation frequencies of Strep. mutans and Strep. sobrinus were significantly higher at subsite B (A B p < 0.01 and p < 0.05, respectively). Veillonella spp. were significantly higher at subsites B and S (A < B, p > 0.01; B > S, p < 0.05), while Neisseria spp. were most common at subsite A (A > B. p > 0.03). IgAl protease-producing species were found at each subsite, but they formed only a small proportion of the total Streptococcus population. This study has shown that local variations were evident at different subsites, both with respect to species prevalence and to proportions of each species within each subsite. The population shifts in gingival margin plaque appear to relate to the location of plaque in relation to the most caries-prone site below the contact area B.
Analysis of Variance↗
The effects of surface machining on heat cured acrylic resin and two soft denture base materials: a scanning electron microscope and confocal microscope evaluation.
STATEMENT OF PROBLEM: Rough surfaces promote the adhesion and colonization of denture plaque, therefore it is important to know the character of the surface left by rotary instruments on denture base materials. As a single microscopic technique can introduce artifact, complementary microscope techniques need to be used. PURPOSE: This study investigated the surface characteristics of the machined surfaces of heat-cured acrylic resin, Molloplast B and Novus. MATERIAL AND METHODS: Scanning electron microscopy and confocal microscopy were used to investigate surfaces that had been prepared with appropriate clinical rotary instruments. Thirty samples of each material were prepared with steel and tungsten carbide burs, Molloplast stones, and Arbor bands. An analysis of variance, with the Scheffe multiple comparison of means test, was used to compare average surface roughness of the individual surfaces. RESULTS: The tungsten carbide bur produced a smoother nongrooved surface than the steel bur on acrylic resin. The roughest surfaces were produced on the soft lining materials by the Arbor band and Molloplast stone. CONCLUSIONS: The confocal microscope is a valuable complementary instrument to scanning electron microscopy and provides surface roughness data by using a noncontact method. Each type of rotary instrument produces its own characteristic surface on denture base materials.
Acrylic Resins↗
Changes in the oral streptococcal flora of children undergoing allogeneic bone marrow transplantation.
The changes in the oral streptococcal flora of twenty children undergoing allogeneic bone marrow transplant are described. Saliva was collected from each child on four separate occasions: (i) before the conditioning regimen; (ii) 7 days post-transplantation; (iii) when the neutrophil count had risen above 0.5 x 10(9)/l; (iv) 119 days post-transplantation. Indices for dental caries, plaque, gingivitis, herpetic stomatitis and mucositis were also recorded. There was a significant decrease in the total aerobic (P<0.001) and anaerobic counts (P<0.0002) between baseline and 7 days post-transplantation. The proportion of the 'Streptococcus oralis group' (Streptococcus mitis and S. oralis) increased significantly from baseline 12.1% to 48.4% at 7 days post-transplantation (P<0.003). The plaque and gingivitis indices increased significantly from baseline to 7 days post-transplantation (P<0.001). Twenty percent of the children had either positive blood cultures or Hickman line cultures for the 'S. oralis group', and it is possible that the inflamed gingival tissues are a further site of entry for these streptococci. There were no differences in the total anaerobic counts or the proportion of the 'S. oralis group' between baseline and the end of the study in the transplant children, or between the transplant and control children.
Bone Marrow Transplantation↗
Salivary, gut, vaginal and nasal antibody responses after oral immunization with biodegradable microparticles.
The aims of this study were to determine whether oral immunization with microparticles might lead to a common mucosal response including vaginal secretions. Female Balb/c mice were immunized orally with microparticles containing ovalbumin at 0 and 4 weeks or with soluble antigen. Antibody responses were assayed by ELISA in saliva, gut washings, vaginal washings and serum, and antibody producing cells were assayed by ELISPOT in salivary glands and nasal cavity. After primary immunization, IgA antibodies were detected in vaginal washings, saliva and in gut washings which were significantly greater than those detected with soluble antigen (P < 0.01). After secondary immunization, greatly enhanced antibody titres were found in three fluids. The specific activity (antibody per microgram IgA) of antibodies in vaginal fluid and saliva was significantly greater than in serum or gut wash (P < 0.01). Oral immunization also resulted in the development of antibody forming cells in salivary glands and in nasal associated mucosal tissue. Immunization with microparticles containing antigen should prove useful in immunization against infections affecting a number of different mucosal surfaces.
Administration, Oral↗
Chronic sialadenitis in patients with nodal osteoarthritis.
Amongst the patients attending our combined oral medicine/rheumatology clinic, we have identified a subset presenting with xerostomia due to non-specific sialadenitis, who also suffer from generalized nodal osteoarthritis (NOA). We have called this combination SOX syndrome: sialadenitis, osteoarthritis and xerostomia. In this study, we have examined the characteristics of these patients clinically and histologically, and then determined the prevalence of SOX syndrome in patients with NOA compared to healthy age-matched controls. Patients were obtained from rheumatology clinics and a local old people's home. The series consisted of 35 patients with NOA and 18 age- and sex-matched controls without evidence of NOA or inflammatory rheumatic disease. There was no significant difference in age and sex between the two groups. None were on drugs known to induce xerostomia. The subjects were assessed for whole salivary, parotid saliva and lacrimal flow, autoantibodies, rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR). The whole saliva flow (mean +/- 95% CI) was 0.32 +/- 0.07 ml/min for the NOA group and 0.54 +/- 0.17 ml/min for the control group. The difference is statistically significant (P < 0.05, two-tailed Student's t-test). No statistically significant difference was found in the parotid and lacrimal flow rates of NOA and controls. Nine of the 35 NOA patients had reduced whole salivary flow (normal range > 0.02 ml/min) compared with only one out of 18 in the control group (P > 0.05, chi 2 test). All NOA patients with xerostomia and reduced whole salivary flow were RF, anti-Ro and anti-La negative, and had a normal ESR. Thus, 25% of subjects with NOA had clinical and laboratory features of SOX syndrome, suggesting that this is a defined disease entity.
Adult↗
Scanning electron microscopy of the development of structured aerial mycelia and satellite colonies of phenotypically switched Candida albicans.
Candida albicans is an asexual diploid fungus that can express high frequency phenotypic switching. Switched variants can develop structured aerial mycelia (SAM) and cultures that have been grown for a protracted period exhibit satellite colonies. This study investigated the development of both SAM and satellite colonies by means of a freeze-drying technique and scanning electron microscopy. The results show that SAM may develop due to hyphae developing in the colony at the base of the structures. The development of satellite colonies is a result of cells that have grown deep into the agar re-emerging on to the agar/air surface and producing a new colony. Although both SAM and satellite colonies are often seen together on mature colonies, their cause and development are different.
Candida albicans↗
Bullous pemphigoid localized to the mouth.
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Aged↗
Age-related changes in salivary antibodies to commensal oral and gut biota.
The prevalence of mucosally derived infections appears to increase with age, suggesting dysfunction at the mucosal surfaces. The present investigation was undertaken to examine any age-related changes in secretion rates and concentrations of secretory antibodies in whole and parotid saliva in a healthy adult population. A total of 116 subjects were subdivided into the following age groups: 20-39 years, 40-59 years, 60-79 years and 80 years and over. Specific immunoglobulin A (IgA), IgG and IgM antibodies in whole and parotid saliva to Streptococcus mutans (serotype c), Actinomyces viscosus NCTC 10951, and Escherichia coli NCTC 10418 were quantified by enzyme-linked immunosorbent assay. IgA antibodies to all three organisms examined increased with age in both whole and parotid saliva, whereas IgG antibody levels to S. mutans in whole saliva were significantly decreased with age. IgG antibodies to E. coli in parotid saliva were reduced in older age groups. IgM antibody levels to S. mutans were reduced with age in both secretions, whereas IgM antibodies to A. viscosus were greatest in the oldest age groups. No significant changes with age were observed in salivary IgM antibody levels to E. coli. No significant reduction in the secretion rates of IgA antibodies were observed in parotid or whole saliva, whereas IgG and IgM antibody secretion rates to all three microorganisms were reduced in most age groups in both whole and parotid saliva. The results of this investigation have demonstrated age-related changes with salivary antibodies, but, whereas salivary IgG and IgM antibodies showed decreases, salivary IgA levels generally increased with age. This suggests that the ability to form IgA antibody responses is not impaired with increased age, and that secretion rates and functional properties of antibodies may be as important as concentrations in protection against mucosal infective diseases.
Actinomyces viscosus↗
Oro-facial granulomatosis and oral Crohns disease: are they specific diseases and do they predict systemic Crohns disease?
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Crohn Disease↗
Is erythematous candidiasis associated with advanced HIV disease?
OBJECTIVES: A multicentre collaborative study by the London HIV and Dentistry Group failed to associate the presence of erythematous candidiasis (EC) with advanced HIV disease. Data from a study of the periodontal health of homosexual men attending a genito-urinary medicine clinic presented an opportunity to investigate social and medical factors related to the presence of EC and mucosal disease. SUBJECTS AND METHODS: 312 men with HIV were examined by a single examiner blinded to HIV status; 22.8% had an indicator condition for AIDS; 37.8% had CD4 lymphocyte counts less than 200 cells mm-3; and 53.8% met the 1993 case definition for AIDS; 59.6% of the men with HIV had oral manifestations of the infection. The most common were: oral hairy leukoplakia, 44.2%; EC, 26.9%; and pseudomembranous candidiasis (PC), 11.5%. RESULTS: Advanced HIV disease was a less powerful predictor of EC than PC. Advanced HIV disease also predicted the presence of hairy leukoplakia and mucosal ulceration. EC was strongly associated with tobacco use. CONCLUSIONS: While methodological differences explain some variation with previous research, these data also suggest that EC and PC may not carry the same prognostic significance and longitudinal studies are required to confirm these findings.
AIDS-Related Opportunistic Infections↗
Periodontal health and HIV infection.
Despite a large amount of research of periodontal health seen in HIV infection, much remains to be learned. Very few large controlled studies of infected people at settings not self-selected for oral disease have been reported, and few have investigated the necrotising periodontal diseases described in HIV infection. In this paper we present a brief review of three approaches to identify periodontal changes associated with HIV infection and identify possible aetiological factors for them. First, we summarise the methods and findings of a controlled blinded study of the periodontal health of homosexual men attending a genito-urinary medicine clinic. Second, we precis a case-control study of gingival ulceration among patients at a dedicated dental clinic. Finally, we outline how the validity of diagnostic criteria for HIV-associated periodontal changes were tested against the data collected in the controlled study.
AIDS-Related Opportunistic Infections↗
Oral lesions of HIV and AIDS in Asia: an overview.
The magnitude of HIV infection in the Asian region is increasing dramatically. Oral disease represents an important health problem for HIV-infected individuals, because of its diagnostic, prognostic and therapeutic implications. The documentation and reporting of HIV infection and AIDS in most of the Asian countries has been superficial. Though the epidemiology of HIV infection in Asia has been studied by many investigators, few attempts have been made to summarise the data and assess the magnitude of the problem, the mode of transmission, the spread of infection and clinical pattern of illness. A review of the literature shows that there is hardly any published data on oral manifestations of HIV infection or AIDS from the Asian region. However, some preliminary information is available on the type of lesion presenting in patients from India and Thailand. These observations suggest that oral manifestations are common in HIV-infected and AIDS patients. The pattern of occurrence of various lesions reported appears to show variation from those reports from other parts of the world, but no definitive conclusion can be drawn from these preliminary observations. Further epidemiological studies are necessary to substantiate the present understanding of the nature of oral lesions found in Asian countries.
Acquired Immunodeficiency Syndrome↗
Salivary and mucosal immune responses to HIV and its co-pathogens.
The profound effects that HIV induces in systemic immunity have been well characterised, but the situation with regard to mucosal immune responses is less clear. Oral cavity fluids have been used as a marker of the mucosal immune system. Whole and parotid saliva IgA, IgA1 and IgA2 concentrations have been found to be lower in both HIV infection and AIDS subjects, whereas serum IgA and IgA subclasses are markedly raised, suggesting a dichotomy between systemic and secretory immunity. Salivary antibodies to HIV can be readily detected and secretory IgA antibody can be neutralising to some strains of HIV. HIV vaccines can also induce antibody responses in saliva, but vaccination routes other than parenteral immunisation are needed. Antibody responses to oral microbes have also been studied and it has been shown that IgA, IgA1 and IgA2 subclass antibody titres to Candida albicans and to Streptococcus mutans are increased in whole or parotid saliva from HIV patients, but reduced in AIDS patients, suggesting a compensatory response which is overcome with progressive immunodeficiency. The avidity of salivary IgA antibodies to Candida in HIV seems unimpaired, whereas relative avidities of serum antibodies in HIV patients with candidiasis are lowered. Non-specific factors which may inhibit Candida and other opportunist pathogens are also found in saliva. The candidacidal, myelomonocytic protein calprotectin is present in saliva at levels which are biologically active, although levels are lowered in HIV infection. Overall, HIV infection appears to be associated with disregulation of a number of immune factors at the mucosal surface, but the ability of patients with HIV infection to mount specific antibody secretory responses seems to be relatively intact until late in infection.
AIDS Vaccines↗