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Letters to the Editor To the Editor: Re: Sarcoidosis Affecting the Periodontium: A Long- Term Follow-Up. Moretti AJ, Fiocchi MF, Flaitz CM. (J Periodontol 2007;78:2209-2215). We read with interest the excellent and well- documented case report of Moretti et al. 1 on periodon- tal sarcoidosis that mimicked aggressive periodontitis in an adult male patient. However, it would be inter- esting to know whether the patient currently has or used to have dental alloys containing beryllium. 2,3 Beryllium may be released from the dental metal framework by dental microwear and/or intraoral corrosion. 4-6 In humans, exposure and sensitization to beryllium may cause chronic beryllium disease (CBD) that significantly overlaps with sarcoidosis. 7-9 There are strong parallels between these two con- ditions: CBD has clinicopathologic similarities with sarcoidosis, and even their histomorphologic features are not distinguishable. 7,8,10 The U.S. Occupational Safety and Health Admin- istration (OSHA) highlights safety concerns regard- ing the use of beryllium-containing alloys in the dental laboratory. 11 Likewise, we should consider the risk posed by exposure to beryllium metal alloys used in crowns, bridges, or other metal frameworks among dental patients. Gianpaolo Guzzi, Italian Association for Metals and Biocompatibility Research, Milan, Italy; Lucia Brambilla, Institute of Dermatological Sciences, Institute of Re- covery and Cure of Scientific Characteristic (IRCCS) Maggiore Hospital, Mangiagalli and R. Elena Foun- dation, Milan, Italy; and Paolo D. Pigatto, Department of Technology for Health, Dermatological Clinic, IRCCS Galeazzi Hospital, University of Milan, Milan, Italy. REFERENCES 1. Moretti AJ, Fiocchi MF, Flaitz CM. Sarcoidosis affect- ing the periodontium: A long-term follow-up. J Peri- odontol 2007;78:2209-2215. 2. ADA Council on Scientific Affairs. Proper use of beryllium-containing alloys. J Am Dent Assoc 2003; 134:476-478. 3. Knoernschild KL, Tompkins GR, Lefebvre CA, Schuster GS. Porphyromonas gingivalis lipopolysaccharide af- finity for two casting alloys. J Prosthet Dent 1995;74: 33-38. 4. Lo ´ pez-Alias JF, Martinez-Gomis J, Anglada JM, Perarire M. Ion release from dental casting alloys as as- sessed by a continuous flow system: Nutritional and tox- icological implications. Dent Mater 2006;22:832-837. 5. Wataha JC, Lockwood PE, Mettenburg D, Bouillaguet S. Toothbrushing causes elemental release from den- tal casting alloys over extended intervals. J Biomed Mater Res B Appl Biomater 2003;65:180-185. 6. Geurtsen W. Biocompatibility of dental casting alloys. Crit Rev Oral Biol Med 2002;13:71-84. 7. Fireman E, Haimsky E, Noiderfer M, Priel I, Lerman Y. Misdiagnosis of sarcoidosis in patients with chronic beryllium disease. Sarcoidosis Vasc Diffuse Lung Dis 2003;20:144-148. 8. Infante PF, Newman LS. Beryllium exposure and chronic beryllium disease. Lancet 2004;363:415-416. 9. Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997;336:1224-1234. 10. Fireman E, Goshen M, Ganor E, Spirer Z, Lerman Y. Induced sputum as an additional tool in the identifica- tion of metal-induced sarcoid-like reaction. Sarcoido- sis Vasc Diffuse Lung Dis 2004;21:152-156. 11. OSHA. Preventing adverse health effects from expo- sure to beryllium in dental laboratories. Hazard In- formation Bulletins. HIB 02-04-19 (rev. 05-14-02). Available at: http://www.osha.gov/dts/hib/hib_data/ hib020419.html. Accessed April 19, 2002. Submitted December 30, 2007; accepted for publication December 30, 2007. doi: 10.1902/jop.2008.070674 Authors’ Response: We appreciate the very interesting comments presented by Drs. Guzzi, Brambilla, and Pigatto. However, we have found no evidence to implicate beryllium as the cause of the systemic and intraoral signs and symptoms of this patient. Antonio J. Moretti, Department of Periodontology, The University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, North Carolina; Maria F. Fiocchi, Department of Periodontics, The Univer- sity of Texas Dental Branch at Houston, Houston, Texas; and Catherine M. Flaitz, Department of Di- agnostic Sciences, The University of Texas Dental Branch at Houston. Submitted March 2, 2008; accepted for publication March 2, 2008. doi: 10.1902/jop.2008.086001 Volume 79 • Number 6 978

Letter to the Editor: Re: “Sarcoidosis Affecting the Periodontium: A Long-Term Follow-Up”

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Page 1: Letter to the Editor: Re: “Sarcoidosis Affecting the Periodontium: A Long-Term Follow-Up”

Letters to the Editor

To the Editor:

Re: Sarcoidosis Affecting the Periodontium: A Long-Term Follow-Up. Moretti AJ, Fiocchi MF, Flaitz CM.(J Periodontol 2007;78:2209-2215).

We read with interest the excellent and well-documented case report of Moretti et al.1 on periodon-tal sarcoidosis that mimicked aggressive periodontitisin an adult male patient. However, it would be inter-esting to know whether the patient currently has orused to have dental alloys containing beryllium.2,3

Beryllium may be released from the dental metalframework by dental microwear and/or intraoralcorrosion.4-6 In humans, exposure and sensitizationto beryllium may cause chronic beryllium disease(CBD) that significantly overlaps with sarcoidosis.7-9

There are strong parallels between these two con-ditions: CBD has clinicopathologic similarities withsarcoidosis, and even their histomorphologic featuresare not distinguishable.7,8,10

The U.S. Occupational Safety and Health Admin-istration (OSHA) highlights safety concerns regard-ing the use of beryllium-containing alloys in the dentallaboratory.11 Likewise, we should consider the riskposed by exposure to beryllium metal alloys used incrowns, bridges, or other metal frameworks amongdental patients.

Gianpaolo Guzzi, Italian Association for Metals andBiocompatibility Research, Milan, Italy; Lucia Brambilla,Institute of Dermatological Sciences, Institute of Re-covery and Cure of Scientific Characteristic (IRCCS)Maggiore Hospital, Mangiagalli and R. Elena Foun-dation, Milan, Italy; and Paolo D. Pigatto, Departmentof Technology for Health, Dermatological Clinic, IRCCSGaleazzi Hospital, University of Milan, Milan, Italy.

REFERENCES1. Moretti AJ, Fiocchi MF, Flaitz CM. Sarcoidosis affect-

ing the periodontium: A long-term follow-up. J Peri-odontol 2007;78:2209-2215.

2. ADA Council on Scientific Affairs. Proper use ofberyllium-containing alloys. J Am Dent Assoc 2003;134:476-478.

3. Knoernschild KL, Tompkins GR, Lefebvre CA, SchusterGS. Porphyromonas gingivalis lipopolysaccharide af-finity for two casting alloys. J Prosthet Dent 1995;74:33-38.

4. Lopez-Alias JF, Martinez-Gomis J, Anglada JM,Perarire M. Ion release from dental casting alloys as as-sessed by a continuous flow system: Nutritional and tox-icological implications. Dent Mater 2006;22:832-837.

5. Wataha JC, Lockwood PE, Mettenburg D, BouillaguetS. Toothbrushing causes elemental release from den-tal casting alloys over extended intervals. J BiomedMater Res B Appl Biomater 2003;65:180-185.

6. Geurtsen W. Biocompatibility of dental casting alloys.Crit Rev Oral Biol Med 2002;13:71-84.

7. Fireman E, Haimsky E, Noiderfer M, Priel I, Lerman Y.Misdiagnosis of sarcoidosis in patients with chronicberyllium disease. Sarcoidosis Vasc Diffuse Lung Dis2003;20:144-148.

8. Infante PF, Newman LS. Beryllium exposure andchronic beryllium disease. Lancet 2004;363:415-416.

9. Newman LS, Rose CS, Maier LA. Sarcoidosis. N EnglJ Med 1997;336:1224-1234.

10. Fireman E, Goshen M, Ganor E, Spirer Z, Lerman Y.Induced sputum as an additional tool in the identifica-tion of metal-induced sarcoid-like reaction. Sarcoido-sis Vasc Diffuse Lung Dis 2004;21:152-156.

11. OSHA. Preventing adverse health effects from expo-sure to beryllium in dental laboratories. Hazard In-formation Bulletins. HIB 02-04-19 (rev. 05-14-02).Available at: http://www.osha.gov/dts/hib/hib_data/hib020419.html. Accessed April 19, 2002.

Submitted December 30, 2007; accepted for publicationDecember 30, 2007.

doi: 10.1902/jop.2008.070674

Authors’ Response:

We appreciate the very interesting commentspresented by Drs. Guzzi, Brambilla, and Pigatto.However, we have found no evidence to implicateberyllium as the cause of the systemic and intraoralsigns and symptoms of this patient.

Antonio J. Moretti, Department of Periodontology,The University of North Carolina at Chapel HillSchool of Dentistry, Chapel Hill, North Carolina; MariaF. Fiocchi, Department of Periodontics, The Univer-sity of Texas Dental Branch at Houston, Houston,Texas; and Catherine M. Flaitz, Department of Di-agnostic Sciences, The University of Texas DentalBranch at Houston.

Submitted March 2, 2008; accepted for publication March2, 2008.

doi: 10.1902/jop.2008.086001

Volume 79 • Number 6

978