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Combined treatment of patients with cancer of the oral mucosa using a dynamic course of irradiation in combination with local hyperthermia was proposed. Altogether 55 patients were treated, of them in 51 (92.7%) complete tumor regression was achieved. The short-term results were indicative of the efficacy of the above method.
In 76 patients with untreated, advanced carcinomas of the oro-facial region the immune complex titer in the serum was determined by the C1q binding test. The determination of the immune complexes, accompanying the therapy, was carried out before onset of therapy and after surgical, combined radiosurgical and radiation therapy respectively. Immune complex values did not differ significantly before and after therapy and were of no value regarding the evaluation of the effectiveness of therapeutic measures.
52 patients, with different pattern of oral lichen planus, pre-malignant leukoplakia or geographic tongue, were treated with vitamin A acid. The systemic medication resulted in regression of discrete papules and leukoplakia-like appearance of oral lichen planus. Linear-hypertrophic pattern of the oral mucosa showed distinct involution only by topical administration of vitamin A acid. Also the patients suffering from pre-malignant leukoplakia or geographic tongue partly improved after a vitamin A acid therapy. Systemic side effects were noted after ignoring the tolerance limit (30 mg/day vitamin A acid/3 weeks). Inflammation and occasionally maceration appeared when local treatment was used over 3 weeks. Recurrence was observed in 11 patients.
The regeneration of the oral mucosa is zinc- and vitamin A-pathway dependent. Hyperkeratoses, a disturbed immune system and a higher incidence of oral malignancies have been reported in cases of deficiency. In this study, blood samples were taken from 97 patients with oral lichen planus, oral leukoplakia, oral squamous cell carcinoma (OSCC), and a control group. Besides routine blood analysis, serum levels of zinc (Zn), vitamin A (Vit A) and retinol binding protein (RBP) were identified. Mean values in lichen ruber planus were Zn 784 micrograms/l, RBP 5.26 mg/dl and Vit A 656 ng/ml; in leukoplakia Zn 696 micrograms/l, RBP 5.30 mg/dl and Vit A 652 ng/ml; and in OSCC Zn 659 micrograms/l, RBP 5.00 mg/dl and Vit A 617 ng/ml. Patients with lichen ruber planus showed no statistically significant differences, whereas in leukoplakia patients there were statistically lower values for Zn compared to the control group and the lichen ruber planus group (P < 0.05). Patients with oral malignancies showed lower serum levels for Zn, RBP and Vit A. Compared with the control group and the lichen ruber planus group, differences of the serum Zn levels proved to be statistically significant (P < 0.01). In patients with oral leukoplakia and patients with oral carcinoma and Zn deficiency, a substitutional therapy should be considered.
Recurrent aphthae (or aphthoses) are the most frequent inflammatory lesions of the oral mucosa. Aphthae can clearly be defined, but may also be barely discernible from aphthoid erosions and ulcers of heterogeneous origin. Although a subject of molecular research, the etiopathogenesis of oral aphthoses is still unknown. However, the clinical differentiation of a "benign" type of aphthosis from a "pernicious" one, such as Behçet's disease (BD), is a diagnostic matter of great significance. BD has been found clinically in increasing numbers in central Europe and represents an (auto-)hyperimmune multisystem life-threatening vasculitis. In this disorder possible damage can occur to many visceral organs and/or the cerebrospinal system. The prognosis of BD may depend on the changing involvement of very different organs, as well as the early recognition of the disease per se. The most prominent feature is a multilesional aphthous stomatitis that is almost never absent during acute episodes of BD. Hence, the occurrence of this peculiar type of aphthosis strongly indicates an active BD. The plethora of other aphthoid lesions can be challenging to the diagnostic competence of all physicians and may confuse the correct recognition of the severity of the disease present. This review particularly details the wide range of diagnostic, therapeutic and prognostic aspects of the various oral aphthoses.
Infections of the oral mucosa have become important with respect to acquired immunodeficiency syndrome (AIDS), particularly as opportunistic infections. In the first part of this overview the epidemiologic, clinical and therapeutical aspects of the HIV infection are addressed. By the end of 1998, WHO had registered 2 million cases of AIDS globally and 33.4 million HIV infections were estimated. Every day 16,000 new infections occur worldwide. Sub-Saharan Africa is the region which has been affected most. By the end of 1998, 18,000 cases of AIDS were registered in Germany, with an estimated 50,000-60,000 HIV infections. The majority of new infections was registered among homosexual men; however, heterosexual transmissions are increasing. Antiretroviral combination therapies had an impact on the clinical course of HIV infection, affecting both mortality and morbidity. The effectiveness of antiretroviral therapy is monitored by determination of the viral load in plasma and CD4(+)-cell counts. Triple therapy resulted in longer survival and a reduction in opportunistic infections. Oral opportunistic infections are also markedly reduced after the introduction of combination therapies. Combination therapies require stringent compliance and are often accompanied by serious side effects.
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The oralstereognostic and muscular-motoric ability of patients wearing different removable partial dentures was examined with the aid of different testbodies. As shown by the results the lingual-dental shill of patients was improved by dentures and denture adaptation was mainly dependent on the age of the person and not on extrusion.
Lichen ruber planus of the oral mucosa is shown in a few examples. Differential diagnosis to leucoplakia can usually be obtained clinically and is confirmed histologically. Treatment consists of the elimination of irritation factors, polyvitamin preparations and local application of beta methason.
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