Faculty Bibliography

Epidermolysis bullosa acquisita is a rare acquired autoimmune subepidermal blistering disease that clinically resembles other vesiculobullous lesions such as pemphigus vulgaris and cicatricial pemphigoid. Multiple myeloma is the most common plasma cell malignant disorder characterized by a single clonal expansion and increased level of a single immunoglobulin. Epidermolysis bullosa acquisita has been reported with other systemic diseases such as lymphoma. In this case report, we present a patient with paraneoplastic epidermolysis bullosa acquisita associated with multiple myeloma.

Dental management of patients with autoimmune vesiculobullous disorders is complicated because of prominent involvement of oral mucosa, increased risk of oral disease, and difficulty in rendering dental care. Although these diseases are relatively uncommon, dental practitioners should be familiar with the oral sequelae of these conditions and their management. Pemphigus vulgaris, cicatricial pemphigoid, and epidermolysis bullosa represent the most common autoimmune oral vesiculobullous diseases. This case-illustrated review summarizes the pathogenesis, diagnostic features, and natural history of oral vesiculobullous disorders, placing an emphasis on the treatment and prevention of associated oral disease aimed at maintaining a healthy, functional dentition.

There is compelling evidence for the cancer chemopreventive effects of vitamin E and related compounds. Of all the vitamin E derivatives that have been investigated to date, vitamin E acid succinate is the most effective anti-cancer agent. This report describes the preparation and testing of liposomal formulation of mono alpha-tocopheryl ester of succinic acid (alpha-TOS) for cytotoxicity against hamster cheek pouch carcinoma cell line (HCPC-1). Small unilamellar vesicles (SUV) of phosphatidylcholine incorporating 70 microM alpha-TOS were superior to alpha-TOS alone or SUV without incorporated alpha-TOS, as inducers of apoptosis in HCPC-1 cells. Liposomal alpha-TOS perturbed the lipid structure in cells, promoted apoptosis, and decreased cell viability. The mechanism of action of alpha-TOS appears to involve membrane damage and induction of ceramide mediated apoptosis.

PURPOSE: Osseointegrated implants lack a periodontal ligament. Nevertheless, masticatory function in subjects with implant-supported restorations appears similar to function in those with natural dentition. It is not clear how the neurophysiologic mechanisms that modulate jaw movement are associated with osseointegrated implants. This study examined the output from the inferior alveolar nerve during implant loading. MATERIALS AND METHODS: In 3 dogs, 3 premolars were extracted in the mandible and 2 endosseous titanium implants were placed, allowed to osseointegrate for 3 months, and loaded with vibration force at the threshold response for tooth vibration, at 2x threshold, and at 3x threshold. Neurophysiologic recordings were made from the inferior alveolar nerve during loading of both implants and the adjacent molar and canine. The response magnitude in action potentials in the 50- ms poststimulus period and latency of inferior alveolar afferents in milliseconds were compared following implant loading. RESULTS: Detectable inferior alveolar nerve responses were recorded following loading from both the implants and the teeth at 2x and 3x threshold. However, the response magnitude of teeth (canine, 2.38 +/- 0.18 at 2x, 2.78 +/- 0.2 at 3x; molar, 2.2 +/- 0.16 at 2x, 2.5 +/- 0.21 at 3x) was twice that of the implants (anterior, 1.3 +/- 0.12 at 2x, 1.68 +/- 0.13 at 3x; posterior, 0.8 +/- 0.1 at 2x, 1.53 +/- 0.15 at 3x). The differences in response magnitude between the teeth and implants were significant (P < .05). The latency of response was similar. DISCUSSION: Management of the occlusion for implant-supported restorations has been empirically developed. An underlying assumption has been that implant-guided jaw function lacks significant proprioception to modulate mastication and related jaw movements. This animal study provides preliminary evidence that force application to implants does elicit a proprioceptive response. CONCLUSION: Loading of implants does elicit a sensory response that can be observed in the inferior alveolar nerve. The implications are that during occlusal function, information from regions associated with the implant can provide knowledge that could potentially modulate jaw activity in a manner similar to natural teeth.

This study explored the feasibility of developing an animal model for radiation-induced salivary gland injury with a radiation protocol identical to current clinical practice. Three male Hanford minipigs were subjected to fractionated daily irradiation with a total dose of 70 Gy; structural and functional measures were compared with those of a control group of minipigs. We found that irradiated submandibular and parotid glands were one-third to one-half the gross size of control glands. Whereas no pathologic changes were noted in control glands, irradiated glands consistently demonstrated significant parenchymal loss with extensive acinar atrophy and interstitial fibrosis, enlarged nuclei in remaining acinar cells, and ductal dilatation and proliferation. Stimulated salivary flow was reduced by 81% in irradiated animals compared with preirradiation flow (P <.001); salivary flow in the control group increased by 30% during the same period (P <.001). The observed radiation-induced structural and functional salivary gland changes are comparable in every respect to those observed following irradiation of human salivary glands.