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Eleven HIV-positive patients with chronic oral candidiasis were supplemented with 60 to 120 mg of beta-carotene daily for 3 to 7 months. Lymphocyte profiles were evaluated at intervals to help assess immune competence. Although there was a modest increase in some lymphocyte values at 2 months, there was a significant decrease in numbers of CD4 and CD8 cells and CD4 percentage of lymphocytes after 6 months of beta-carotene supplementation. Serum triglyceride and liver enzyme levels were not affected by the beta-carotene supplementation. No improvement was observed in the control of the oral candidiasis. Under the conditions of the study, there was no indication that daily beta-carotene supplements enhanced immune competence or was of benefit in managing oral candidiasis.

Seventy-nine patients with oral leukoplakia that was histologically verified as either hyperkeratosis or epithelial dysplasia with hyperkeratosis were enrolled in an antioxidant supplementation program for the treatment of the oral lesions. The patients received 30 mg of beta-carotene, 1000 mg of ascorbic acid, and 800 IU of alpha-tocopherol per day for 9 months. Clinical improvement of the oral lesion was noted in 55.7% of the patients and was more likely to occur in patients who reduced their use of alcohol or tobacco (p = 0.0056). Although risk-factor reduction was important, approximately half of the patients who did not alter their exposure to either alcohol or tobacco showed clinical improvement. The antioxidant supplementation significantly increased serum and tissue levels of beta-carotene, ascorbic acid, and alpha-tocopherol, but these changes did not correlate strongly with clinical improvement.

The effects of bethanechol in the treatment of dry mouth were assessed in patients with xerostomia after radiation therapy to the head and neck. Bethanechol possesses muscarinic and nicotinic-cholinergic activity that likely accounts for its mode of action. Bethanechol (25 mg, three times daily) was not associated with significant side effects. Statistically significant increases in whole resting saliva (p = 0.003) and whole stimulated saliva (p = 0.001) were seen. In patients with pretreatment stimulated saliva volumes greater than resting saliva volumes, a positive response to subsequent use of the sialagogue was seen.

Immunosuppressed persons are at greater risk of developing malignancies. In human immunodeficiency virus (HIV) immunosuppression the most common oral cancers are Kaposi's sarcoma and non-Hodgkin's lymphoma. Squamous cell carcinoma has also been reported to be associated with HIV disease. Kaposi's sarcoma is the most frequent neoplastic disease in acquired immunodeficiency syndrome and is by far the most common in the head and neck area. This article reviews the prevalence, clinical features, and management of these diseases in HIV infection.

The findings in this prospective study of 214 patients with oral lichen planus were similar to those found in our 1985 evaluation of 570 patients with oral lichen planus. These two groups of patients with oral lichen planus patients constitute the largest series from one clinic. Oral lichen planus was found mainly in women and most commonly on the buccal mucosa. Spontaneous remissions were infrequent (6.5%), as were malignant transformations (2.3%) in a mean follow-up of 7.5 years. The erosive form of oral lichen planus was most common and was almost always associated with pain. Reproducibly successful management of this T-lymphocyte disease was obtained by selective use of systemic and/or topical corticosteroids. Oral lichen planus was not associated with any evident systemic disease, drug, smoking, or genetic predisposition. Although statistically Candida albicans does not appear to occur disproportionately in large samples of patients with oral lichen planus, in some of the Candida-positive patients, antifungal medications appeared to be useful.

Clinical characteristics and treatment responses were studied in 130 patients with burning mouth syndrome (BMS). Most patients were postmenopausal women, and the tongue was the most frequently afflicted site. Although 39% of the patients complained of dry mouth, no causative factors were evident. Therefore BMS is assumed to be a functional disorder. This was at least partially confirmed because the most effective management was in response to mood-altering drugs. From our data BMS appears to be a chronic condition with variations in symptoms among patients and without a predictable endpoint.

We investigated the value of image cytometry in predicting the prognosis of oral epithelial lesions, whether or not they show dysplasia. Thirty-five oral epithelial lesions were studied retrospectively. Of these, 23 had later transformed to carcinoma and 12 had not. By means of the Leitz TAS image analyzer, 200 nuclei of epithelial cells and 20 nuclei of lymphocytes from each section were individually assessed for eight features related to shape and amount of stain and for six features related to chromatin pattern. The mean, standard deviation, and interquartile range of each feature were calculated, first for each section and then for each group. With the use of linear stepwise discriminant analysis we constructed a predictive model, which consisted of three variables related to chromatin pattern. The variables were mean margination, standard deviation of clumping, and standard deviation of condensation. In the jackknife classification, this model predicted the malignant potential of the lesions that later transformed to cancer with 86% predictive value and 83% sensitivity.

Pyostomatitis vegetans is a rare oral disorder that is usually associated with bowel and/or skin disease. The clinical appearance is of soft hyperplastic folds of mucosa characterized by small miliary abscesses with superficial erosions. Upon analysis of the clinical, histologic, and immunofluorescent findings, cases of pyostomatitis vegetans may be classified as the oral manifestation of either pyoderma vegetans of Hallopeau, pemphigus vegetans of Hallopeau, or pemphigus vegetans of Neumann, although the exact definitions and even the existence of these diseases as separate entities are still a matter of controversy.

There has been a striking increase in the incidence of oral Kaposi's sarcoma in association with acquired immunodeficiency syndrome (AIDS). Oral lesions are seen in approximately 50% of AIDS patients with Kaposi's sarcoma. Lesions may appear as a flat or raised pigmented area, often resembling a benign vascular lesion, and are commonly found on the palate. Useful histopathologic criteria for the recognition and diagnosis of oral Kaposi's sarcoma include (1) atypical vascular channels (especially in early lesions), (2) a prominent spindle cell component in later lesions, (3) extravasated red blood cells, (4) hemosiderin, (5) the presence of eosinophilic bodies, (6) chronic inflammatory cells in early lesions, and (7) mitotic figures in tumor-stage lesions.

Two hundred thirteen adults in whom oral lichen planus had been diagnosed were studied in order to compare clinical and microscopic findings. In spite of considerable variabilities in both aspects, there was clinical and histologic agreement in 96 per cent. Alertness on the part of the clinician and pathologist is essential for diagnosis of atypical cases.

An objective evaluation of 55 patients with chronic vesiculoerosive oral diseases was made to compare the beneficial and adverse effects of prednisone treatment. Patients were divided into groups of high, intermediate, and low drug dosages, as well as short and long periods of administration. Prednisone benefited 49 patients in spite of the fact that 55% had some adverse side effects. The duration of prednisone administration appeared to have a larger impact on side effects than the daily amount given. The most common side effects were gastrointestinal disturbances, mood alterations, polyuria and insomnia. There were no significant changes in blood pressure, blood sugar level, weight, or white blood cell counts. This study confirmed that systemic prednisone is a useful and beneficial treatment modality for patients with chronic oral inflammatory diseases.

Face height and profile have two displacement dimensions that can be measured: the superior-inferior face height measurement, and the anterior-posterior displacement of the midsagittal profile measurement. The superior-inferior displacement is largely a function of movement of the lower lip and related mandibular structures. The anterior-posterior displacement is generally associated with movement of the upper lip, particularly the tubercle. The changes in one dimension are usually a function of change in the other dimension; that is, an increase in height may be associated with contraction of the dental arches; or conversely, reduction of vertical height may be associated with expansion of the dental arches.

Sixty-five patients with oral mucous membrane pemphigoid were examined, treated, and followed for a mean of 3.5 years. Seventy-two percent were women, and the mean age was 59 years. In most patients multiple oral sites were involved and the gingiva was affected in 94% of the patients. Seven patients had ocular lesions (symblepharon), and seven others had nasal, vaginal, or pharyngeal involvement. Persons with skin lesions (bullous form) were not included in this series. Topical and systemic anti-inflammatory/immunosuppressive medications were successful in controlling signs and symptoms. There were no spontaneous remissions. Candidiasis, tobacco, other diseases, and drugs did not appear to be related to the pemphigoid.

Six patients with pemphigus vulgaris (PV) who had been treated unsuccessfully with other modalities and who were maintained on prednisone for disease control were started on levamisole in addition to their minimum effective dose of prednisone (40 to 80 mg. daily). All patients responded within 2 to 8 weeks. The minimum effective dose range of prednisone when used with levamisole was reduced to 5 to 35 mg. daily. A temporary minor side effect occurred in only one patient. This corticosteroid-sparing, combination-drug approach for patients with PV has resulted in acceptable clinical control and diminution of the side effects that often interfere with high-dosage, long-term treatment.

Five hundred seventy patients with oral lichen planus were followed for periods ranging from 6 months to more than 10 years (mean, 5.6 years). The mean age was 52 years, and 67% of the patients were women. Erosive lichen planus was the most frequent clinical form, and the buccal mucosa was the most common site. Of the 75% patients treated with corticosteroids, 29% experienced complete remission and 63% had partial remission while maintained on medication. Fewer than 3% experienced spontaneous remission. Malignant transformation occurred in 7 patients (1.2%) in a mean time of 3.4 years after the onset of lichen planus. The onset of lichen planus could not be associated with any evident factors, such as family history, Candida albicans, glucose intolerance, and smoking.

Hematologic deficiencies have previously been described in some cases of recurrent aphthous ulceration (RAU). Ninety patients with RAU and twenty-three healthy control subjects were evaluated by complete blood count, serum iron, and total iron-binding capacity, serum vitamin B12, and serum or red blood cell folate. Only three of ninety RAU patients proved to have abnormalities. There were no statistically significant differences between the patient and control populations, and no one in either group had abnormal serum vitamin B12 or serum or RBC folate assays. None of the patients or controls gave a history or symptoms suggestive of iron-deficiency or megaloblastic anemia, and all were without gastrointestinal complaints. These results suggest that hematologic tests other than a complete blood count are not routinely indicated for patients with RAU.

Six cases of adolescent- and adult-onset histiocytosis X with oral involvement and their evaluation are described. Clinical findings can be mistaken for dental infection. Management involved a combination of low-dose radiation and chemotherapeutic drugs. The extreme variability of clinical signs and symptoms and the extent and progression of the disease suggest that the classic classification of histiocytosis X is inappropriate.

Junctional nevi of the oral mucosa are rare and may be precancerous. A patient who had an enlarging junctional nevus of the labial mucosa with an adjacent lentigo simplex was studied by light and electron microscopy. On the basis of morphologic similarities--dentritic appearance, lack of desmonsomes, proliferative melanin production, and lack of cytoplasmic fibrils--it appears that the nevus cell most likely develops from melanocytes. The reason for the transformation from melanocyte to nevus cell or junctional nevus cell hyperplasia is unknown.

The histopathologic tissue patterns found in twenty-five patients with oral erythema multiforme were as variable as the clinical appearances. The biopsies served an important role in ruling out malignancy, dysplasia, and other classified diseases. While all of the specimens were designated as showing nonspecific inflammatory reactions, in many biopsy specimens there were sufficient characteristic connective tissue and epithelial changes to suggest a tissue diagnosis consistent with the clinical diagnosis of erythema multiforme.

This study was undertaken to determine whether the speech of poorly rated esophageal speakers could be improved with the aid of a structured palatal prosthesis. Palatograms testing certain speech sounds critical to the plosive-injection technique for air intake showed that improvement resulted after one week of wearing the training prosthesis. All subjects showed some improvement in speech after wearing the prosthesis for one week. Eight out of 10 subjects showed marked improvement in speech. It is suggested that a physiologically structured palatal prosthesis can assist some esophageal speakers to improve their speech.

Since our first description and profile of patients with Kaposi's sarcoma (KS) in 1984, the relative rate of KS in patients with the acquired immunodeficiency syndrome has dropped from 34% to 20%. However, the absolute number is increasing. The pathogenesis of KS is still obscure, and its interaction with the human immunodeficiency virus infection remains unclear. Cause of death is usually opportunistic infections in both endemic and epidemic KS. The most common intraoral site is the palate, which is involved in 95% of our cases. The oral cavity may be the only or first site of KS, and therefore, becomes important in the diagnosis. More than 20% of our current patient population had the oral cavity as the initial site of manifestation. Because of functional impairment, bleeding, pain, or cosmetic reasons, treatment is frequently required. There are many modalities used, including chemotherapy, radiation, and laser resection. Radiation appears to be a most effective and practical control measure for oral KS.

Angiolymphoid hyperplasia with eosinophilia (Kimura's disease) primarily affects the skin of the head and neck and the oral mucosa. While the clinical picture is nonspecific, the variable microscopic tissue pattern often is diagnostic. The etiology is unknown, and treatment is unpredictable. A case is presented in which Kumura's disease was not suspected clinically prior to the biopsy. The patient responded to topical fluocinonide, and there was no evidence of an immunologic defect.

This report presents ten cases of a previously undescribed form of gingival ulceration. The lesions did not respond to the treatments given, but all were self-limiting. This condition may represent a reaction to an environmental toxin.

The chordoma is a slowly growing spinal cord tumor that rarely metastasizes. This is the first report in the literature of a chordoma with metastasis to the mandible. The mandibular involvement occurred 4 years after the primary sacral chordoma was controlled by excision and radiation. The jaw lesion did not respond to radiation but has been controlled by resection.

Limited Wegener's granulomatosis is a form of the disease in which only one or two organ systems are involved. A rare case is reported in which the initial symptoms were in the skin and the lip, complicated by skin lesions exhibiting features of a clinical variant of lupus erythematosus.

Seventy-five patients with oral/oropharyngeal carcinoma were studied to assess the relationship between serum zinc and copper levels, radiation-induced taste loss, and tumor status. There were no significant differences between pretreatment and posttreatment serum mineral levels in cancer patients and in 21 healthy persons who served as controls. Of 30 patients who did not experience spontaneous postradiation taste recovery and were supplemented with zinc sulfate daily for at least 1 month, 11 reported improvement in taste. Serum zinc levels rose markedly in the patients with taste improvement.

Up to 6% of oral leukoplakia, a relatively common mucosal disease, can be expected to become malignant. This report describes a long-term study of 30 patients in whom a particular form of leukoplakia was identified and labeled proliferative verrucous leukoplakia (PVL), a disease of unknown origin, which exhibits a strong tendency to develop areas of carcinoma. PVL begins as a simple hyperkeratosis but tends to spread and become multifocal. PVL is slow-growing, persistent, and irreversible, and in time areas become exophytic, wartlike, and apparently resistant to all forms of therapy as recurrence is the rule. The disease was most commonly seen in elderly women and had been present for many years. Patients were followed for 1 to 20 years. Thirteen died of or with their disease, 14 were alive with PVL, and 3 were alive without PVL at last contact. PVL rarely regressed despite therapy. All patients who died had persistent or recurrent disease. PVL appears to constitute a continuum of hyperkeratotic disease, ranging from a simple hyperkeratosis at one end to invasive squamous cell carcinoma at the other. Microscopic findings are dependent upon the stage of the disease's development and the location and adequacy of the biopsy.

Four hundred patients with oral cancer were studied to determine if there appeared to be a risk related to denture wearing. Forty-three percent of the group wore dentures, and there seemed to be no correlation between the wearing of dentures and any specific cancer site. Furthermore, there was no difference between denture and nondenture wearers relative to age, sex, time from first signs or symptoms to diagnosis, tumor stage, or tobacco use. In addition, a large number of individuals in the general population wear dentures, and carcinomas occur infrequently in denture-bearing sites. Other studies have shown no difference between denture wearers and control groups in the occurrence of oral cancer. Therefore, it does not seem plausable at this time to consider denture irritation as a significant carcinogenic aggravating factor.

Numerous studies have suggested that patients with oral cancer have an increased immune response to herpes simplex virus. However, the number of cases has always been small, and essential controls have not always been included. Laboratory experiments have shown that herpes simplex virus can be carcinogenic or cocarcinogenic under certain circumstances and so must be considered as a possible etiologic agent in oral cancer. This article reviews past research and suggests priorities for future investigations.

A study was initiated to determine whether a relationship exists in geriatric patients between self-image and the extent of their denture acceptance. Three assessing instruments were employed, namely, a "Focused Interview," the embedded-figures test, and projective figure drawings. Scores obtained were compared with scores on the Denture-Acceptance Rating Scale. The research results derived from the data follow: 1. Comparison of the degree of denture acceptance with the scores on all three assessing instruments showed significant relationships. Therefore, the hypothesis under study was accepted. 2. The "Focused Interview" appeared particularly well suited to a geriatric population, because it was nonthreatening, provided a communication outlet, and can be readily employed by a practitioner. 3. The embedded-figures test and the projective figure drawings appeared less appropriate for this population because of factors such as psychomotor retardation, perceptual difficulties, and diminution of ego strength which accompany the aging process. 4. The men in this study appeared to accept dentures more readily than the women, manifested higher morale, and were more field-independent. 5. Employed subjects, as compared to unemployed, showed significantly greater denture acceptance, higher morale and self-image, and a greater degree of field-independence. These factors appeared related to greater flexibility of adaptation. 6. Socioeconomic factors appeared to be significantly and positively related to morale factors. 7. Complaints regarding dentures were largely of a physical nature. They appeared to relate primarily to difficulties with adjustment to the new artifact which represented an alteration of body image for the subjects. 8. The study provided corroborative evidence of the need for the dentist to make an initial assessment of those personality factors in his patients which might limit his ability to provide adequate dental services.

One hundred thirty-two consecutive patients suspected of having malignant or precancerous oral lesions were studied by comparing toluidine blue dye uptake clinically with a simultaneous biopsy. The histopathologic diagnosis confirmed 57 squamous carcinomas, 42 epithelial dysplasias, and 33 benign mucosal changes. Overall accuracy of the toluidine blue uptake was 91%. In the dysplastic and malignant lesions the false negatives were 2%, and there were 30% false positives in the benign lesions. It was concluded that toluidine blue staining is a useful adjunct to careful examination, clinical judgment, and biopsy.

Erythema multiforme is a chronic, inflammatory mucocutaneous disease that can occur in both genders at any age. Although the cause remains obscure, a wide range of antigens and factors, including herpesvirus and other infections, has been suggested as triggering the disease. In the present study of 95 patients, we found that patients with oral involvement alone tend to predominate over those who have oral and lip, or oral, lip, and skin disease. There were also more women than men. Our study further confirmed that erythema multiforme cannot be characterized solely as a disease that is cyclical and self-limiting. The dramatic response to corticosteroids and to the immunoregulating agent levamisole, as well as the fact that patients with erythema multiforme are otherwise essentially healthy, suggests that erythema multiforme may be caused by a transient autoimmune defect, possibly triggered by multiple factors. Because 19 patients with oral candidiasis responded to antifungal therapy, a possible antigenic role for these organisms is suggested.

This article presented data on 92 edentulous patients in the age group of 54 to 84 years. The data describe the changes in vertical dimension of rest observed under different clinical conditions associated with the treatment procedures for construction of complete dentures.

Fifty-three homosexual men with Kaposi's sarcoma (KS) were studied. Twenty-seven had biopsy-proved oral KS, the palate being the most common site. Past or present infections with cytomegalovirus, hepatitis, venereal diseases, and gastrointestinal microorganisms occurred in more than 70%. Oral candidiasis was confirmed in 57%. Heavy marijuana smoking was the most common habit. Transmission of AIDS is thought to be by a viral agent. Precautions involving the use of gloves, eyeglasses, and masks, similar to those recommended for the management of patients with hepatitis B, are urged.

A case of granulocytic sarcoma, or chloroma, of the palatal mucosa, which developed 15 months before the onset of acute myelogenous leukemia (AML), is reported. The diagnosis was suspected on the basis of the light microscopic findings and confirmed by histochemical studies. Granulocytic sarcomas are rare, may be observed in a variety of body locations, and are considered specific lesions of AML or of the onset of blast crisis in chronic myelogenous leukemia. Primary granulocytic sarcomas of the oral cavity without systemic manifestations of AML are extremely rare. Clinical diagnosis of these lesions in patients with normal peripheral blood and bone marrow may be very difficult.

This pilot study of an experimental dental xeroradiography imaging system involved twelve oral cancer clinic patients. Xeroradiographs were compared with conventional intraoral film radiographs, taken with similar x-ray projections. The new dental xeroradiographic system was judged superior for the imaging of both osseous and soft-tissue structures. Especially significant was the new imaging system's ability to portray early bone erosion not detectable with the conventional intraoral film technique. These results point to the need for controlled clinical evaluations of dental xeroradiography, in order to assess the full potential of this rapid, low-radiation imaging system in the evaluation of oral cancer.

Sixteen cases of plasma-cell gingivostomatitis were studied at the University of California San Francisco between 1966 and 1971. Twelve women and four men made up the group, with ages ranging from 15 to 70 years. Prior to treatment, the duration of the disease ranged from 5 to 60 months. Each of the sisteen patients manifested a homogeneous, diffuse, erythematous gingivitis associated with a cheilitis, and fifteen also had a marked glossitis. Each subject was symptomatic, and nine also complained of bleeding. Every biopsy specimen demonstrated a characteristically diffuse and dense plasma-cell infiltrate. There were no spontaneous remissions. Six patients completely responded to systemic corticoids alone, two to discontinuation of gum chewing or the use of their dentifrice, one to antifungal therapy, and the other seven to a combination of the preceding modalities. After completion of therapy, fifteen patients were followed for 2 to 55 months without any evidence of recurrence. Of interest, 69 per cent were gum chewers. The therapeutic benefit of discontinuing gum chewing by itself was not clear. It is assumed that the now nonexistent plasma-cell gingivostomatitis syndrome was a hypersensitivity response to an unidentifiable antigen used in various substances.

This study reports the results of an interdisciplinary approach to the diagnosis of Sjögren's syndrome in 100 patients. Ocular and systemic diagnoses and oral features from the history and physical examination are correlated with measurements of stimulated parotid flow rate and labial salivary gland histopathology. A new diagnostic criterion is introduced whereby labial salivary gland focus scores are used to establish the presence of the oral component of Sjögren's syndrome in place of the subjective evaluation of xerostomia. The differential diagnosis of the oral clinical features of Sjögren's syndrome and the clinical management of the oral component of this disease are discussed.

Erythema multiforme is a chronic mucocutaneous inflammatory disease with a variable recurrent pattern. Thirty female and twenty male patients, ranging in age from 11 to 75 years, were studied. Twelve patients had oral lesions only, nineteen had oral and lip changes, and nineteen had oral, lip, and skin involvements. Most of the patients had a noncyclical pattern of attacks which required systemic corticosteroid therapy. When the disease attacks electively were not treated, healing would vary between 2 and 24 weeks. This study confirmed the idiopathic nature and extremely variable features of erythema multiforme. Frequency, location, duration, and severity of attacks did not shed any clues as to trigger mechanisms (etiology), persons who might be predisposed to such attacks, treatment responses, or prognosis.