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A rare case of metastasis to the gingiva from carcinoma of the lung has been presented. From the review of the literature, only ten other cases have met the criteria to be considered as metastatic malignancy to the gingiva.
During eruption of the mouse incisor part of the periodontal ligament moves along with the tooth in occlusal direction and is degraded in the gingiva, just apically of the junctional epithelium. When studied with the electron microscope some connective tissue cells (fibroblasts) showed disorganization of both nucleus and cytoplasm. In other cells vacuoles were observed containing partly degraded cellular constituents. Sometimes within these vacuoles electron dense material with the appearance of clumped chromatin was observed. On the basis of this observation it is concluded that heterophagocytosis contributes to the process of fibroblast breakdown. The ultrastructure of these heterophagic cells resembled that of fibroblasts. Collagenous fibrils were observed within cytoplasmic vacuoles of fibroblasts indicating that collagen is phagocytosed and probably digested in the lysosomal apparatus. Part of the intercellular space was filled with a homogeneous material of moderate electron density, intermingled with some collagenous fibrils. Within some cells of the junctional epithelium partly degraded material was observed which may indicate that the epithelium contributes to the removal of residual products of connective tissue degradation.
The epithelial lining of normal human vestibular gingiva and the adjoining alveolar mucosa was subjected to a comparative stereological analysis. Five biopsies collected from 11 to 12 year-old males and females were selected from a total of 14 specimens and, under standardized conditions, processed for light- and electron microscopy. At two levels of magnification, electron micrographs were sampled from five strata in the oral-gingival, and from four strata in the alveolar-mucosal epithelium, mostly in regions of epithelial ridges. Standardized sterological point counting techniques were employed to analyze a total of 710 and 540 electron micrographs from the oral-gingival and the alveolar-mucosal epithelium, respectively. The two epithelia, although of similar thickness, show different differentiation patterns. The oral-gingival epithelium consists of four cytologically different strata, the major differentiation step occurring between the lower and upper stratum spinosum of epithelial ridges. Standardized stereological point counting techniques were alveolar-mucosal epithelium, consisting of two cytologically different cell compartments, displays a broad, superficial zone of differentiated flat cells, with 60% of the cytoplasm filled with a dense network of cytoplamic filaments. The major differentiation step occurs between basal and lower spinous layers. Differentiation phenomena in both epithelia are discussed and individual variations are interpreted in view of genetically determined factors.
Grafting connective tissue from the palate to partial-thickness sites prepared in patients with an inadequate width of attached gingiva resulted in an increased width of keratinized mucosa. Biopsies of these grafts at the newly created mucogingival junction at 24 weeks showed the epithelium to be keratinized with a normal architecture, except over scar tissue at the edges of the grafts, where rete-peg formation was absent. The results support the concept that morphodifferentiation of gingival epithelium is influenced by the underlying connective tissue.
Seven beagle dogs were used to study the gingivitis-inducing potenial of a topically applied neutrophil leukocyte extract and to compare the vascular and cellular reactions with those induced by plaque extract applied in an identical manner. In four dogs neutrophil extract was applied onto the marginal gingiva in one jaw quadrant while Gey's medium was applied to the contralateral gingival units. In the remaining three dogs plaque extract and Gey's medium, respectively, were applied in the same way. After 6.5 h of topical application colloidal carbon (1 ml/kg bodyweight) was injected into a leg vein and after a further 1.5 h biopsies were obtained from the experimental regions. The results show that topical application of an extract from neutrophils induces both an increase in the number of crevicular leukocytes and an enhanced vascular permeability. As in previous studies plaque extract was found to promote the emigration of leukocytes and to alter the permeability of the dentogingival vessels. The vascular and cellular reactions were, however, more pronounced after application of plaque extract than after neutrophil extract.
A kindred affected with hereditary fibrous hyperplasia of the gingiva with varying penetrance and expressivity is described. Most of the affected members were short in stature. The pedigree strongly suggested an autosomal dominant mode of inheritance. The penetrance of the trait varied, and three unaffected persons had transmitted the disease to their offspring. There were two modes of expression. The mild form showed only bilateral rugose thickening of the palate, whereas the severe form showed gingival hyperplasia in addition to changes in the palatal mucosa. The changes were already present at birth. Histological examination showed large amounts of alcian blue-positive extracellular material in the subepithelial connective tissue of the hyperplastic mucosa. Loose collagen-poor connective tissue with alcian blue-positive extracellular material and dense collagen-rich connective tissue in the rugose projections of the palatal mucosa were often segregated.
The in vitro behavior of human gingiva was studied using a simple tissue culture technique. Gingival explants from adult patients undergoing periodontal surgery were cultivated in three different media for periods up to three weeks. It was demonstrated that primary epithelial cell cultures can be obtained under simple and predictable conditions. The migrating cells were compact and uniform in shape and resembled the spinous cell layer of a squamous stratified epithelium. Mitotic activity was regularly observed all over the outgrowth, which continued to grow throughout the entire experimental period.
Lymphatic vessels were traced in healthy and early inflamed gingivae of various nonhuman primates. Lymphatic capillaries and primary collecting vessels originated in the connective tissue papillae and stroma near or adjacent to the attachment epithelium. They emptied into thin-walled irregular-shaped collecting vessels that drained into the periodontal ligament. In early inflammation, all the lymphatic vessels of luminal caliber were distended within and/or surrounding the inflammatory infiltrate.
A case of epithelial dysplasia of the mandibular gingiva is reported. The significance of this lesion and its implications are discussed.
The ability of two different toothbrush bristle ends to produce traumatic gingival abrasion was assessed in a double blind study of 15 male and 15 female young adults. Brushing was performed in a circular fashion using a modified Bass Technique. An apparatus allowing continuous visual feedback of the average brushing force permitted a degree of standardization of the system. The upper left canine and bicuspid area had to be brushed for 30 seconds with cut toothbrush bristles (CP) and with round ended toothbrush bristles (RP) respectively. A two week interval separated the two brushing sessions. Traumatic lesions of the attached gingiva were stained with a disclosing solution, photographed and evaluated planimetrically. The "cut bristles" caused gingival abrasions 30% greater in extent than the round end bristles. The difference was not due to single brushing strokes accidentally greater for the "cut bristles". The size of the lesions was not sex dependent. To prevent gingival damage it is desirable to either round the bristles in production or to rid the bristle ends at least of sharp edges.
Exfoliative cytology allows important information to be obtained about the structure and function of individual sections of tissue. Use of this particular method of examination is characterized by simplicity and freedom from strain on the subject being tested. In addition, the method yields clear and comprehensive results. Smears obtained from different regions of the oral cavities of subjects with clinically healthy oral mucous membrans and intact teeth were carefully analyzed. Also examined by clinical methods as well as by exfoliative cytology was the healthy gingiva, with parodontopathia inflammata superficialis and parodontopathia inflammata profunda serving as reference groups.
Under standarized conditions, foils are applied and removed from the attached gingiva of the mandibular anterior region. The amount of epithelial cells clinging to the test foils was determined. When compared to toothpastes with the usual content of surface active substances, the short contact of a toothpaste containing a high percentage of wetting agents increases the number of epithelial cells loosened by mechanic forces.
The changes occurring in the oral mucosa, gingivae and periodontium of guinea pigs fed a vitamin C-deficient diet were determined by means of histological comparison with animals on a normal diet. The following results were obtained from the scorbutic guinea pigs: --detachment of the horny layer from the underlying epithelium, --bullous cells in the spinose and the granular layer, --formation of periodontal pockets, --reduction in number and disorientation of collagenous fibres of the periodontium associated with loosening of the molars.
Methods suitable for demonstrating previously unidentifiable substances in healthy and diseased gingiva via gas chromatography/mass spectrometry were described. The advantage of these methods is that the substances can be directly demonstrated from the tissue available. The steps necessary to isolate and demonstrate the substances were explained on the basis of the phytosterol campesterol.
With the help of a radioimmunoassay for prostaglandins E and F, an attempt was made to determine the actual concentration of these substances in normal and inflammatorily altered gingival tissue. The content of PGE and PGF was significantly higher in the inflammatorily altered gingiva than in normal tissue. Morphologic examination using immunologic methods showed prostaglandin E particularly in the monocytes.
A case of plasma-cell granuloma of the attached gingiva has been presented. The lesion was pedunculated and, clinically, resembled a traumatic fibroma. The microscopic picture was that of plasma-cell granuloma. Serum electrophoresis and radiographs were normal. A diagnosis of plasma-cell granuloma confirms a benign lesion of the oral cavity which must not be confused with the plasmacytoma, a possible precursor to multiple myeloma. This case emphasized the need for biopsy of lesions in order to establish a diagnosis. Only by biopsy and histologic study can rare lesions be diagnosed and their incidence studied.
Fourteen patients with recurrent blistering entirely restricted to the mouth have been observed for up to 7 years. Their average age was 52 years, and there was a predilection for females (ratio 2-5:1). Patients presented with thick-roofed blisters and denuded, red, boggy areas of mucosa. The area of maximal involvement with the labial gingiva, and whilst the blisters would arise spontaneously, mechanical trauma was the obvious provocative factor in all patients. Gentle friction on normal looking mucosa would produce a bulla which became blood filled. Re-epithelialization usually occurred within 1-3 weeks, with no scarring. Biopsies showed subepithelial bullae, and direct immunofluorescence was positive in the basement membrane zone of 2 of the 5 cases examined. The most striking feature was the extreme fragility of the epithelial attachment to the underlying corium, as shown by a useful clinical test with a probe. In 10 patients, the condition gradually remitted and the probe test became difficult to perform. The term acquired oral non-dystrophic epidermolysis bullosa was considered for the diagnosis, although a forme fruste of cicatricial mucous membrane pemphigoid remained an alternative.
The aim of the present investigation was to determine a method and a minimal frequency of plaque removal for the establishment and maintenance of clinically healthy gingivae in Rhesus monkeys. Six adult, male monkeys were used and divided into three groups. In each group different methods were used for plaque removal. Frequencies of plaque removal of one, two and three times per week for consecutive weeks were tested. The results showed that gingival health could be established and maintained with any of the methods used (toothbrushing and interdental flossing: toothbrushing and a 3-min application of 2% chlorhexidine gluconate) but only when plaque was removed 3 times a week. This frequency of plaque removal sessions is discussed in relation to the necessity for sedation of the animals with possible adverse side effects.