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We present a rare case of intraoral nerve sheath myxoma. Clinically, the neoplasm mimics many other oral mucosal pathosis, underscoring the importance of histopathology in ensuring accurate diagnosis of oral mucosal lesions. Reports of intraoral nerve sheath myxomas are essential to enhance our understanding of this rare intraoral entity.

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BACKGROUND: Malignant mesothelioma is a rare neoplasm that usually develops after exposure to asbestos and particularly involves the pleural cavity. It has a poor prognosis with aggressive local invasion and metastatic spread. METHODS: The literature relating to malignant mesothelioma metastatic to the oral region was reviewed. RESULTS: In all, 14 cases of malignant mesothelioma metastatic to the oral cavity were found. All were from pleural mesotheliomas, the tongue was the most common site of metastasis (8/14), and most metastases (9/13) were of the epithelioid type. The newly reported case is only the second report of a mesothelioma metastasizing to the buccal mucosa. It showed strong immunopositivity for keratin markers, vimentin, calretinin, and Wilms tumor product-1. CONCLUSIONS: The incidence of mesothelioma is predicted to continue to increase for at least another decade. Clinicians and pathologists should be aware of this lesion and its propensity to metastasize to the oral cavity.

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The hallmark of the histology of epithelial-myoepithelial carcinoma (EMC) is the presence of a regular repetitive mixture of bilayered duct-like structures with an outer layer of myoepithelial cells and inner ductal epithelial cells. Clear cell change in the myoepithelial component is common, but clearing of both cell types, giving an impression of a monocellular neoplasm, is rare. A parotid biopsy was received from an 83-year-old male and subject to routine histologic processing for conventional staining and immunohistochemistry. The encapsulated tumour was composed of sheets of PAS/diastase negative clear cells, separated by fibrous septae. The clear myoepithelial cells were positive for S-100 protein, SMA, and p63 and negative for CK19 and surrounded CK19-positive luminal cells. It is important to utilise immunohistochemistry to differentiate this tumour from others with a similar histologic pattern. Information about the behaviour of the double-clear EMC is limited since there are few cases reported.

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UNLABELLED: The biocompatibility of metal alloys has generated much concern for practitioners and patients alike over recent years. OBJECTIVES: To investigate dentists' experience of patient allergies to metal alloys used in prosthodontic restorations. DESIGN: Cross-sectional survey of New Zealand practising general dentists. METHODS: A random sample of 700 was taken from the New Zealand dental register. The questionnaire asked dentists whether any of their patients have encountered any allergic reactions to metal alloys. It also sought information on what alloys were being prescribed for use in different types of prosthodontic restorations. RESULTS: A response rate of 71.4% was obtained (N = 476). Some 83 dentists (17.4%) reported having encountered suspected metal allergies in patients; of those, 70 had had the allergies confirmed with a biopsy. Of the entire sample, 327 dentists (72.2%) were aware of the metals used in their restorations, and 201 (44.8%) specified the alloys used in their restorations. For cast removable prosthodontic restorations (such as removable partial dentures), base metal alloys were the most preferred choice; for full cast crowns, high noble alloys were the most favoured; noble alloys were the most favoured for both porcelain-fused-to-metal crowns and fixed-bridge restorations. CONCLUSION: As many as one in six general practising dentists have encountered allergic reactions to metal alloys in their patients. General practising dentists' awareness of the indications for the various metal alloys used in prosthodontic restorations should be raised, and biocompatibility issues should be clarified, so that dentists prescribe the optimum metal alloy for each type of restoration.

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Fungi comprise a minor component of the oral microbiota but give rise to oral disease in a significant proportion of the population. The most common form of oral fungal disease is oral candidiasis, which has a number of presentations. The mainstay for the treatment of oral candidiasis is the use of polyenes, such as nystatin and amphotericin B, and azoles including miconazole, fluconazole, and itraconazole. Resistance of fungi to polyenes is rare, but some Candida species, such as Candida glabrata and C. krusei, are innately less susceptible to azoles, and C. albicans can acquire azole resistance. The main mechanism of high-level fungal azole resistance, measured in vitro, is energy-dependent drug efflux. Most fungi in the oral cavity, however, are present in multispecies biofilms that typically demonstrate an antifungal resistance phenotype. This resistance is the result of multiple factors including the expression of efflux pumps in the fungal cell membrane, biofilm matrix permeability, and a stress response in the fungal cell. Removal of dental biofilms, or treatments to prevent biofilm development in combination with antifungal drugs, may enable better treatment and prevention of oral fungal disease.

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The School of Dentistry of the University of Otago operates a diagnostic oral pathology service, Medlab Dental, as a joint venture with the private pathology service Medlab South. This report reviews the use of the service in 2005 and provides information on current activities that highlights the importance of oral pathology diagnostic services in patient management.

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