In order to compare delayed-type hypersensitivity (DTH) among different exposure sites, we evaluated the sensitization potency of mercuric chloride (HgCl 2 ) via exposure to the skin, or oral or esophageal mucosa using the mouse ear swelling test. Furthermore, we investigated in vitro splenocyte proliferation reaction and cytokine profile in HgCl 2 -exposed and control mice. Sensitization with HgCl 2 was established via the skin and oral mucosa but not via the esophageal mucosa. The splenocyte proliferation reaction was significantly enhanced to a similar degree in skin and oral mucosa-sensitized mice compared with in the control mice. IL-10 levels from cultured splenocytes were significantly increased in skin and oral mucosa-sensitized mice compared with those in control mice, whilst IFN-␥ significantly increased only in splenocytes from skin-sensitized mice. These results suggest that exposure of the skin or oral mucosa to HgCl 2 can induce DTH, but that Th1/Th2 balance differs according to the site of antigen exposure.
Metals used in the oral cavity have been reported to cause various allergic diseases of the skin and mucosa. Skin manifestations due to dental restorations appear not only in the oral cavity, but also on the hands, feet or the whole body, as in the cases of pustulosis palmoplantaris and lichen planus. These phenomena implicate different pathogeneses from that of conventional skin sensitization and tolerance. Therefore, we compared skin and oral mucosa sensitization with nickel and oral tolerance for nickel in a mouse model. Female C57BL/6J mice were sensitized by injection of NiSO 4 into the skin or oral mucosa. Allergic reactions were evaluated by the mouse ear swelling test and splenocyte proliferation and cytokine profiles. Skin and oral mucosa sensitization succeeded in all mice. Ear swelling was significantly greater in the skin-than in the oral mucosa-sensitized mice at 48 hr after challenge. Ear swelling was also suppressed by single oral administration of NiSO 4 in both the skin-and oral mucosa-sensitized mice to the level of that in nonsensitized mice. Splenocytes from skin-sensitized mice proliferated similarly to those from oral mucosa-sensitized mice. Splenocytes from orally-tolerized mice also showed similar proliferation activity to those from skin and oral mucosa-sensitized mice. In the challenge phase, IL-2, IFN-␥, and IL-10 production was induced in splenocytes from both skin-and oral mucosa-sensitized mice. However, IL-4 was induced only in those from skin-sensitized mice. In addition, IL-4 in splenocytes from oral mucosa-sensitized mice was up-regulated to the level in those from skin-sensitized mice by oral tolerance. These results suggest that sensitization sites in mice influence not only the degree of excitation, but also Th-1 and Th-2 balance in the challenge phase and oral tolerance.
We report a case of anti-laminin 332 mucous membrane pemphigoid that was localized in the oral cavity. The patient was a 63-year-old woman who had noticed gingival erosion for 3 weeks. As the symptom did not improve, she visited our department in late June 2006. Her physical condition and nutritional status were good, and no skin or mucosal abnormalities were found in any part of the body. In the oral cavity, an erosion was observed in the gingiva of the right mandibular molar region. Direct immunofluorescence revealed IgG and C3 deposition in the basal membrane zone, while indirect immunofluorescence using 1 M NaCl split skin showed deposition of IgG and IgA on the epidermal side and IgG on the dermal side. Because the patient was positive for the γ2 subunit on immunoblotting using purified laminin 332, anti-laminin 332 mucous membrane pemphigoid was diagnosed. The oral lesion resolved following oral administration of 15 mg/day prednisolone. In the present case, which was considered rare because the lesion was localized in the oral cavity, a favorable course was attributed to early diagnosis and steroid administration.
Two patients requiring surgical management for leakage of calcium hydroxide paste from a root canal into the infraorbital space are reported. A paste root canal treatment material used at the time of maxillary root canal treatment had leaked out of the root canal in both patients. Computed tomography confirmed displacement of the root canal treatment material into the soft tissue, with extension into the infraorbital space. In both cases, foreign body removal was performed. Root canal treatment using a calcium hydroxide paste should be performed carefully without strong pressure.
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