Lymphoid organisation in labial salivary gland biopsies is a possible predictor for the development of malignant lymphoma in primary Sjögren's syndrome

Objective The development of non-Hodgkin's lymphoma (NHL) confers a high risk of mortality in primary Sjogren's syndrome (pSS) patients, but the sensitivity and specificity of proposed lymphoma predictors are insufficient for practical use. The performance of lymphoid organisation in the form of germinal centre (GC)-like lesions was evaluated in labial salivary gland biopsies taken at pSS diagnosis as a potential lymphoma-predicting biomarker. Methods Labial salivary gland tissue biopsies available from two Swedish pSS research cohorts (n = 175) were re-evaluated by light microscopy in a blind study in order to identify GC-like structures as a sign of ectopic lymphoid tissue formation and organisation. A linkage study was performed with the Swedish Cancer Registry for lymphoma identification. The risk of developing NHL in GC-positive patients in comparison with GC-negative patients was evaluated using Kaplan-Meier statistics and log-rank test. Associations between GC-like structures and clinical and/or laboratory disease markers were also determined using. 2 or Fisher's exact tests. Results At diagnosis, 25% of pSS patients had GC-like structures in their salivary glands. Seven of the 175 patients studied (14% GC+ and 0.8% GC-) developed NHL during 1855 patient-years at risk, with a median onset of 7 years following the initial diagnostic salivary gland biopsy. Six of the seven patients had GC-like structures at diagnosis; the remaining patient was GC negative at the time of diagnosis (p=0.001). Conclusions The detection of GC-like structures by light microscopy in pSS diagnostic salivary biopsies is proposed as a highly predictive and easy-to-obtain marker for NHL development. This allows for risk stratification of patients and the possibility to initiate preventive B-cell-directed therapy

Oral Lichenoid Contact Reactions May Occasionally Transform Into Malignancy

The purpose was to identify cases of squamous cell carcinoma (SCC) of the tongue, in which a biopsy taken at the site preceding the cancer could be verified to show a lichenoid contact type of reaction (LCR). We retrieved all 724 SCC of the tongue from the Swedish Cancer Registry in the period 1995-2000. These cases were cross-searched with our own oral biopsy data files from 1988 to 1994, in order to identify biopsies with LCR-type lesions preceding the cancer. We found four verified and some additional tentative cases. The study demonstrated that there is a low incidence of malignant transformation in LCR-type oral lesions, not much different from what has been previously reported in oral lichen planus

Metacognitive Awareness in Problem-Based Learning

This project focuses on students’ proficiency to learn in a problem-based curriculum at the Faculty of Odontology at Malmö University. We have developed a series of metacognitive workshops designed to make students more aware of the structure of a fruitful problem-solving rationale. A play exemplifying a condensed low-achieving tutorial was performed live by students, followed by discussions. In other workshops, the students analyzed tutorial reports with reference to the problem-solving structure and also tried to write new cases from given curricular goals. The students exposed to the exercises displayed a higher metacognitive awareness than students not exposed and they also felt that their tutorial work had improved. In conclusion, to enhance learning, it is desirable to boost students’ metacognitive awareness and it is also possible to do so

Oral pathology in Swedish dogs : a retrospective study of 280 biopsies

The aim of this retrospective study was to investigate the frequency of different types of oral lesions in biopsies sent to a department of human oral pathology for histologic examination. The impact of gender, age, and breed was assessed. The biopsy specimens were reviewed and diagnosed according to human pathology nomenclature and the classification of different diagnoses used in human and veterinary pathology is discussed. Reactive lesions were diagnosed in 39 % of the biopsies, while benign and malignant neoplasms were diagnosed in 27 %, and 15 % of the biopsies, respectively. The most common diagnosis was reactive gingival hyperplasia (24 %), followed by peripheral odontogenic fibroma (21 %) and melanoma (8 %). Epulides comprised 69 % of all lesions. Dogs with malignant oral tumors were older than those with benign tumors, however there was no significant gender differences for any group of lesions Pure-bred dogs were more prone to develop pathology than mixed-breeds. Of the larger breeds in Sweden, Boxer dogs had the highest prevalence (3.77/1000) of biopsies submitted

Problem-solving in PBL

This project focuses on students´proficiency to learn in a problem-based curriculum We have developed a series of metacognitive workshops designed to make students more aware of the structure of a fruitful problem-solving rationale. A play exemplifying a condensed low-achieving tutorial was performed live by students, followed by discussions. In other workops, the students analysed tutorial reports with reference to the problem-solving structure ans also tried to write new cases from given curricular goals. The students exposed to the exercises displayed a higher metacognitive awareness than students not exposed and they also felt that their tutorial work had improved. In conclusion, it is desirable to boost students´ metacognitive awareness and it is also possible to do so

The Influence of pH and Nicotine Concentration In Oral Moist Snuff on Mucosal Changes and Salivary pH in Swedish Snuff

The use of Swedish oral moist snuff is a widespread habit in Sweden. In 1999, 25% of the adult male population and 3.1% of the female population were users of snuff. The aim of the present study was to evaluate how variations in pH and nicotine concentrations of snuff affect the oral mucosa, clinically and histologically, salivary pH and daily nicotine intake in 20 habitual users of loose snuff. The subjects were studied during use of their usual brand, after 12 weeks use of a snuff with lower pH and after another 12 weeks use of a snuff with both lower pH and lower nicotine concentration. Consumption data, oral soft tissue changes, salivary pH and nicotine intake were meas-ured. Further, biopsies were taken from the central part of the clinically observed lesions and histological changes were analysed. The subjects maintained their snuff consumption during the observation periods. The average salivary pH was higher during snuff use than in the morning. Further, it was higher shortly after the snuff was removed than during snuff use. After having switched to the snuff with both lower pH and lower nicotine concentrations, they showed a significant reduction in daily nicotine intake and developed significantly less pronounced clinical and histological changes. These results indicate that nicotine is one of the substances in snuff that has a biological effect on the oral mucosa. However, there also seems to be a synergistic effect between the pH and nicotine concentration in the snuff

Pharmacovigilance of oral bisphosphonates : adverse effects manifesting in the soft tissue of the oral cavity

PURPOSE: It is well known that oral bisphosphonates can induce necrosis of the osseous structures of the jaws. However, there seems to be a limited awareness that oral bisphosphonates can also induce adverse effects in the soft tissues of the oral cavity, as indicated by the paucity of reported cases in the literature. Because oral bisphosphonates are widely used drugs for several skeletal conditions, it is reasonable to assume that mucosal adverse effects are more common than the small number of published cases indicates. The purpose of this study was to investigate whether this adverse effect of bisphosphonates is represented as reports from health practitioners in an adverse drug reaction database, as well as to gain knowledge about which substances are being associated with adverse drug reactions affecting the oral mucosa. MATERIALS AND METHODS: The database of the Medical Products Agency-Sweden was searched for adverse effects from oral bisphosphonates manifesting in the oral and maxillofacial region. Reports of reactions limited to the soft tissues of the oral cavity were selected and further analyzed. Only those reports showing recovery or improvement after the cessation of bisphosphonate use were included in the study. RESULTS: A total of 83 cases of adverse reactions to oral bisphosphonates were retrieved from the search. Of these, 12 were included in the study. They were associated with the use of alendronate, etidronate and risedronate, in descending order. Sixteen percent of the reports comprising the oral and maxillofacial region were limited to the oral mucosa and reported recovery or improvement after discontinuation of the drug. CONCLUSIONS: Adverse effects of oral bisphosphonates with manifestations in the soft tissue of the oral cavity seem to be more common than the small number of published cases indicates. However, considering that oral bisphosphonates are widely used drugs, the incidence is still low. These adverse drug reactions are not limited to alendronate and may also be induced by etidronate and risedronate. Still, a significant proportion of the cases are associated with alendronate. Regardless of the substance used, discontinuing the drug is an effective treatment for the mucosal lesions

Web-Based Tutorial Group Support in Problem-Based Learning

This paper describes how dental hygienist students have used and developed a web site during a two year undergraduate programme. The programme is based on a Problem Based Learning concept at the Faculty of Odontology at Malmö University in Sweden. The web site was first used for administration of the courses, but with time different modes of supporting the PBL process were developed. These modes originated from both students and from the course director. In a questionnaire and in interviews, students were asked about how the web site had been used for communication between students and between students and teachers. They were also asked to comment on how their written tutorial reports, posted on the web site after each case, affected the collaboration in the tutorials and also their learning. Finally, we asked if the students thought that their use of the web site and computers in general had changed during the education. The questionnaire and the interviews were completed at the time of graduation. The written notes and reports of the cases enhanced and supported the students’ learning and some students recognized a change in how they used the web site. Most students also declared that their ability to use different computer programmes had improved. The students strongly recommended a continued use of the web site in the dental hygienist education. The communication and feed back between students and teachers were considerably improved, though new ways should be tried in order to stimulate experts to take more active part in the students’ learning process

Oral changes caused by tobacco free snuff

En 62-årig man remitterades för undersökning och behandling av en förändring i munslemhinnan innanför överläppen och som orsakats av påsförpackad tobaksfri snusprodukt (ONICO®, Swedish Match). Såväl den kliniska som den histopatologiska bilden var identisk med den man finner vid förändringar orsakade av tobaksbaserade påsförpackade snusprodukter. Patienten ombads att under en treveckorsperiod ändra applikation av snuset från vänster till höger sida. Efter dessa tre veckor hade förändringen helt försvunnit på vänster sida och en ny liknande den ursprungliga uppstått på höger sida