Inflammation is a well-organized protective response to pathogens and consists of immune cell recruitment into areas of infection. Inflammation either clears pathogens and gets resolved leading to tissue healing or remains predominantly unresolved triggering pathological processes in organs. Periodontal disease (PD) that is initiated by specific bacteria also triggers production of inflammatory mediators. These processes lead to loss of tissue structure and function. Reactive oxygen species and oxidative stress play a role in susceptibility to periodontal pathogenic bacterial infections. Periodontal inflammation is a risk factor for systemic inflammation and eventually cardiovascular disease (CVD). This review discusses the role of inflammation in PD and its two way association with other health conditions such as diabetes and CVD. Some of the mechanisms underpinning the links between inflammation, diabetes, CVD and PD are also discussed. Finally, we review available epidemiological data and other reports to assess possible links between oral health and CVD.
Lymphoepithelial cysts associated with human immunodeficiency virus (HIV) infection have been described in adults.l-' Approximately 6% of adult mv-infectedpatientshaveparotidswelling.'Inchildren, however, there are fewer reports of parotid swelling and cysts. It has been reported that approximately 10% of children with mv disease have parotid enlargement. 5 We present a case report of a 6-year-old child whose initial presentation ofmv was cystic enlargement ofthe parotid glands. The purpose ofthis article is to raise the awareness ofpractitioners regarding the association of parotid enlargement and HIV disease in children.
CASE REPORTA 6-year-old girl had a I-year history of painless parotid swelling bilaterally. There was no history of previous infection or trauma and the patient had been in good health. The patient had been to several practitioners and carried the diagnosis of EpsteinBarr virus infection. She was referred to the otolaryngology clinic.The mother stated the glands had been slowly enlarging. There were no complaints of pain, dry mouth, or difficulty with chewing or swallowing.Physical examination revealed 4 x 5-cm masses in the region of both parotid glands with no overlying erythema (Fig 1). On palpation the masses were soft and nontender, with a fluid-filled consistency. Flow from Stensen ' s ducts was clear. There was no trismus and facial nerve function was normal. Bilateral cervical adenopathy was seen.A computed tomography scan was obtained that showed multiple cysts contained within each parotid gland, within both the superficial and deep lobes (Fig 2).Fine needle aspiration was performed. Approximately 15 mL of clear yellow fluid was aspirated from each gland. Cultures ofthis fluid were negative. Cytology showed a proteinaceous background with a few atypical lymphoid cells and a few histiocytes present. The following laboratory values were obtained from the aspirated fluid: amylase 1,365 lUlL, protein 7,460 mgldL, lactate dehydrogenase 994 UI L, and glucose 31 mgldL.The patient subsequently underwent an mv test and was positive. The mother denied any risk factors or present illness. No other family members were known to be mv-positive.
DISCUSSIONEtiology. The origin of lymphoepithelial cysts is controversial. In the embryo at 5 weeks' gestation, lymph nodes are trapped within the capsule of the Fig 1. Six-year-old girl with bilateral parotid gland enlargement demonstrating massof left parotid.
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