Objective The goal of this preliminary study was to use metagenomic approaches to investigate the taxonomic diversity of microorganisms in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Study Design Samples of saliva for planktonic microbial analysis and biofilm cultivation were collected from 10 patients (5 with BRONJ and 5 non-BRONJ control subjects) who met all ascertainment criteria. Prophage induction experiments—16S rRNA polymerase chain reaction and 454 pyrosequencing—and epifluorescent microscopy were performed for characterization and enumeration of microbes and viruses. Results Three phyla of microbes—Proteobacteria (70%), Firmicutes (26.9%), and Actinobacteria (1.95%)—dominated all BRONJ samples and accounted for almost 99% of the total data. Viral abundance was ~1 order of magnitude greater than microbial cell abundance and comprised mainly phage viruses. Conclusions Individuals with jaw osteonecrosis harbored different microbial assemblages than nonaffected patients, and in general viral abundance and prophage induction increased with biofilm formation, suggesting that biofilm formation encouraged lysogenic interactions between viruses and microbial hosts and may contribute to pathogenicity.

Crohn's disease (CD) is a chronic relapsing inflammatory disorder of unknown etiology and uncertain pathogenesis with no known cure. CD can involve any segment of the gastrointestinal tract, and oral lesions consistent with granulomatous ulcers are considered an important extra-intestinal manifestation. Oral lesions in the absence of gastrointestinal involvement are rarely reported. We report a case of a 64-year-old man with a history of CD that was in remission for three decades, presenting with painful cobblestone-like ulcerations of the oral mucosa, but without gastrointestinal signs or symptoms. Surgical biopsy of the oral lesions revealed non-necrotizing chronic granulomatous ulcers on histopathologic examination, similar to results from a biopsy of his small intestine three decades previously which established his diagnosis of CD. The patient was successfully treated with potent topical corticosteroids which resulted in resolution of the oral lesions and associated symptoms.

Services (CPS) for further investigation and for ensuring child safety [6]. A diagnosis of HPV-positive multifocal oral lesions in a child could potentially represent condyloma acuminatum or Heck's disease since clinical and histopathology findings and the presence of HPV without specific subtyping are not pathognomonic for either disease. We report a unique case of a 12-year-old boy presenting with oral multifocal papillary mucosal lesions that were confirmed positive for HPV by histopathology and in situ hybridization. California CPS was notified as per our clinical protocols for further investigation. Case ReportA 12-year-old Hispanic boy was referred to the Orofacial Pain and Oral Medicine Clinic at the Herman Ostrow School of Dentistry for evaluation of multifocal intraoral lesions. Head and neck examination revealed the presence of multiple asymptomatic, pink to white in color, coalescing lesions of the lower lip, buccal mucosa, and commissures as demonstrated in Figure 1. Some of the lesions appeared sessile, others pedunculated, and others papillary; all had similar and overlapping features. The lesions were not painful and were rubbery soft to palpation. The remainder of the head and neck exam was unremarkable, and a review of systems and medical history were non-contributory. The patient was not taking any medications and the social history was non-contributory. The patient and his mother AbstractHuman papilloma virus (HPV) is a non-enveloped DNA virus that infects cutaneous and mucosal epithelial cells. Oral lesions of HPV can present as solitary or multifocal lesions, and multifocal lesions can represent a diagnostic challenge clinically with important medicolegal considerations in some cases. We report a unique case of a 12-year-old boy presenting with oral multifocal papillary mucosal lesions which upon biopsy was found to be consistent with a diagnosis of condyloma acuminatum or Heck's disease histopathologically; in situ hybridization studies also confirmed positivity for low risk HPV subtypes in affected tissue. Based on the pathology results and our clinical protocols, we contacted social servicesto rule out the sexually transmitted disease condyloma. A final diagnosis of Heck's disease was rendered after clinico-pathologic and social correlation. Cryotherapy with topical anesthesia was used to successfully treat the lesions with no evidence of recurrence on 6 month follow-up.