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Intraoral pyogenic granuloma after allogeneic bone marrow transplant. Report of three cases.

Allogeneic bone marrow transplant patients commonly have oral complications related to their disease or its treatment. Those reported include: xerostomia, mucositis, caries, infection, gingival hyperplasia, periodontitis, and graft-versus-host disease. These complications may be responsible for significant morbidity. This article reviews commonly reported oral complications of bone marrow transplantation and presents three cases in which intraoral pyogenic granuloma occurred. The cause of these lesions in post-bone marrow transplant patients is discussed.

Adult↗

Oral health and treatment needs in institutionalized psychiatric patients in India.

The caries prevalence, oral hygiene status, periodontal health and treatment needs were evaluated in a group of institutionalized psychiatric patients in Goa, India. Of the total 153 inmates, males constituted 59 percent, the mean age was 25 years, 96 percent were self sufficient and the response rate was 84 percent. 63 percent were diagnosed with schizophrenia. They did not receive any assistance in daily self-care activities including oral hygiene maintenance. None of the 5 edentulous patients had dentures, 5% had been referred for emergency dental care during the period of institutionalization. 15 subjects (12%) were caries-free, the stepwise linear regression analysis showed that the mean DMFT index significantly increased with age (t = 2-819, PL 0.05). Two third of the study population (88%) were in need of conservative dental treatment. The stepwise linear regression analysis showed that the mean OHI-S index significantly increased with age (t = 2.412, P < 0.01). Only 5.4% reported a healthy periodontium whereas 16.27% required complex periodontal therapy. Soft tissue lesions included dorsal lingual depapillation/heavily coated areas and angular cheilitis in addition to incidental observations such as mucosal hyperpigmentation, gingival hyperplasia, and leucoedema. Bruxism and factitious injuries were also noted. The onus of meeting the oral health needs of this marginalized patient population therefore depends on the effectiveness of community dentistry programs vis a vis the efforts of the staff of the institution to provide such services on a regular basis.

Adult↗

Phenobarbital vs. phenytoin for grand mal epilepsy.

The chief side effect of phenobarbital is drowsiness, which is usually associated with overdosage. Phenytoin, on the other hand, causes gingival hyperplasia in many patients, irreversible hypertrichosis in some patients and lethal reactions, such as Stevens-Johnson syndrome, in a few patients. Antiepileptic therapy should always be started with one drug. Phenytoin is specifically contraindicated as the drug of first choice for infants, females (especially adolescents) and children receiving orthodontic treatment.

Adolescent↗

A 5-year prospective randomized clinical trial on the influence of splinted and unsplinted oral implants retaining a mandibular overdenture: prosthetic aspects and patient satisfaction.

Prosthetic outcome and patient satisfaction were evaluated in order to investigate whether there is a need or advantage to splint two implants in the mandible retaining a hinging overdenture. This study included 36 fully edentulous patients randomly divided into three groups according to the attachment system they received: magnets, ball attachments or straight bars (reference group). None of the implants failed during the whole observation period in any of the groups. After 5 years of observation, the Bar group presented the highest retention capacity and the least prosthetic complications but revealed more mucositis and gingival hyperplasia. Patient satisfaction rated similar for all groups although the Magnet group showed lower retention forces. All patients would repeat the same treatment even though the majority of the Magnet group would prefer a more retentive solution because of limited denture stability.

Adult↗

Clinical, histologic, and ultrastructural findings in two cases of infantile systemic hyalinosis.

Two unrelated infants had stiff skin and painful joint contractures in the first few months of life. Other features included gingival hyperplasia, small papules on the face and trunk, perianal nodules, and bloody diarrhea. Hyaline material was evident in the papillary dermis and gut mucosa in both patients. Ultrastructural examination revealed a distinctive fibrillogranular appearance. These infants have the same clinical, histologic, and ultrastructural features as four infants we reported previously with infantile systemic hyalinosis. One of the patients described here demonstrated some features that overlap with those of juvenile hyaline fibromatosis.

Biopsy↗

Drug-associated gingival enlargement: case report and review of aetiology, management and evidence-based outcomes of treatment.

"Gingival enlargement" is the term now used to describe medication-related gingival overgrowth or gingival hyperplasia (AAP, 2004), a condition commonly induced by three main classes of drugs: anticonvulsants, antihypertensive calcium antagonists and the immunosuppressant cyclosporin. It is important that the health practitioner is aware of the potential aetiologic agents and characteristic features in order to be able to accurately diagnose and successfully manage patients who present with a condition such as outlined in the following case presentation.

Adult↗

Wegener granulomatosis simulating bacterial endocarditis.

Cardiac involvement in Wegener granulomatosis is uncommon. We report a case of Wegener granulomatosis that presented as culture-negative endocarditis with aortic valvular vegetation. The clinical manifestations included gingival hyperplasia, gangrenous digital infarcts, mononeuritis multiplex, high fever, inflammatory arthritis, pansinusitis, splenic infarct, and aortic valvular vegetation, which underscore the difficulty of distinguishing systemic vasculitis from bacterial endocarditis. Contrary to the common notion that valvular vegetation is invariably associated with bacterial endocarditis, this case proves that such findings can occur in Wegener granulomatosis as well. Clinicians are guided toward early treatment with corticosteroids and cyclophosphamide to prevent fatal complications.

Aortic Valve↗

[Adverse drug effects in the oral region].

Syphilis was previously termed "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. This role has been taken over by drugs, and this also applies to adverse drug reactions in the oral region. Accordingly, a careful drug history, including identification of any prescription, over-the-counter, or herbal medicines used, may give an important clue to the differential diagnosis of oral diseases when the aetiology is not apparent. Virtually all drugs have the potential to cause oral adverse reactions, but some have a greater ability to do so than others. Among the numerous adverse oral manifestations are xerostomia, taste disturbances and ulceration. The reactions are often non-specific, but they may mimic specific disease states such as erythema multiforme, lichen planus and pemphigus. Drug-induced gingival hyperplasia is an example of a quite characteristic and easily recognisable oral side effect. This article briefly describes some of the presentations and mechanisms of oral manifestations of drug therapy and the drugs that most commonly are responsible. Just like approved pharmaceuticals, herbal medicines are also associated with adverse oral manifestations. Finally we comment on some of the more recent reports on osteonecrosis of the jaws associated with the use of bisphosphonates.

Diphosphonates↗

Oral-dental findings in a case of Maffucci's syndrome.

A case of Maffucci's syndrome (MS) in a 17-year-old Caucasian female is presented with a thorough intraoral examination. The prominent finding was recurrent gingival hyperplasia affecting both the free and attached gingiva with deep periodontal pockets, tooth mobility, pathological tooth migration, and severe alveolar bone loss. Furthermore, the pattern of alveolar bone destruction, in many ways, resembled that of localized juvenile periodontitis. Although there is always the possibility that these oral features may not be related with the syndrome, we suggest a careful dental and periodontal examination in future cases, which we believe will help develop a better description of oral findings in MS.

Adolescent↗

Strawberry gingiva: a distinctive sign in Wegener's granulomatosis.

A 37-year-old man presented with gingival hyperplasia accompanied by an ulcer on the eyelid, nasal obstruction, ear discharge, and discharging nodules on the cheek and back. An evaluation for infectious diseases and leukemia was negative. During his hospital stay, he had fever and migratory joint pains develop, suggesting a diagnosis of Wegener's granulomatosis, which was confirmed by a strongly positive cytoplasmic antineutrophil cytoplasmic antibody test. He responded promptly to treatment with oral prednisolone and cyclophosphamide. In retrospect, the diagnosis could have been suspected earlier because of the distinctive red, friable, and granular appearance of the gingiva.

Adult↗

Fetal PCB syndrome: clinical features, intrauterine growth retardation and possible alteration in calcium metabolism.

Pregnant mothers with yusho in Fukuoka, Nagasaki and Kochi Prefectures delivered babies with a peculiar clinical manifestation which will be called fetal PCB syndrome (FPS). The birth rate incidences were 3.6% (Fukuoka Prefecture), 4% (Nagasaki Prefecture), 2.9% (Kochi Prefecture) and 3.9% (total). The manifestations consisted of dark brown pigmentation of the skin and the mucous membrane, gingival hyperplasia, exophthalmic edematous eye, dentition at birth, abnormal calcification of the skull as demonstrated by X-ray, rocker bottom heel and high incidence of light for date (low birth weight) babies. We suggest that there may be a possible alteration in calcium metabolism in these babies, related to the fragile egg shells observed in PCB-contaminated birds and to the female hormone-enhancing effect of PCB. The high incidence of low birth weight among these newborns and two other similar studies indicated that PCBs suppress fetal growth.

Calcium↗

Polarization microscopy of picrosirius red-stained collagen from oxodipine-induced hyperplastic gingiva of beagle dogs.

Using the model of oxodipine-induced gingival hyperplasia in beagle dogs, we investigated the collagen fibres of the hyperplastic gingiva by measuring the polarization colours from Picrosirius-red stained sections. The predominant polarization colours of the thick collagen fibres (1.6-2.4 microns diameter) of male oxodipine-treated dogs were greenish-yellow to yellow, while in controls and in female oxodipine-treated dogs, the same size fibres mostly appeared orange and red. These differences may be indicative of gender variation in the genesis of hyperplastic gingiva in calcium channel blocker treated dogs.

Animals↗

Diagnostic value of magnetic resonance imaging and computed tomography for oral masses in dogs.

The purpose of this study was to determine the diagnostic value of magnetic resonance imaging (MRI) and computed tomography (CT) in oral masses of dogs. Nineteen dogs underwent clinical, MR and CT examinations. Eleven malignant and ten non-malignant masses were evaluated. Osteosarcoma was the most commonly found malignant oral mass and gingival hyperplasia was the most commonly found benign mass. The results showed that MRI provided more accurate information regarding the size of the masses and invasion of adjacent structures although MRI and CT show similar accuracy in assessment of bone invasion. Calcification and cortical bone erosion was better seen on CT images. Whereas contrast-MRI provided useful additional information, contrast-CT had no added benefit. In general, oral masses located in the caudal mandible, oropharynx and maxilla are better evaluated using MRI, once the histological type has been verified.

Animals↗

Primary generalized and localized hypertrichosis in children.

OBJECTIVE: To review the causes, presentation, and therapy of primary generalized and localized symmetrical hypertrichosis in children. DESIGN: Retrospective medical record review. SETTING: Academic specialty referral clinic for pediatric dermatological disorders. PATIENTS: Case series of 11 prepubertal male and female patients who had idiopathic hypertrichosis between July 1, 1990, and November 30, 1999. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Clinical distribution of increased hair growth and types of hair removal methods used. RESULTS: Seven girls and 4 boys, ranging in age from 4 months to 11 years, were evaluated. Four patients showed generalized hypertrichosis. The other 7 patients had localized symmetrical hypertrichosis, representing the subsets of hypertrichosis cubiti, anterior cervical hypertrichosis, posterior cervical hypertrichosis, and faun tail deformity. All patients with generalized hypertrichosis manifested the condition at birth; the age of onset in children with localized symmetrical primary hypertrichosis ranged from birth to 4 years. One girl with generalized hypertrichosis had gingival hyperplasia and the girl with faun tail deformity had bony diastematomyelia with spina bifida occulta. The medical histories and physical examination findings of all of the children were otherwise unremarkable. All patients were referred for diagnostic and therapeutic considerations. CONCLUSIONS: Primary hypertrichotic conditions, whether localized or generalized, are rare in pediatric patients and of unknown origin. Although otherwise benign, these disorders may result in cosmetic disfigurement and psychosocial trauma for patients and families. Patients and their families should be adequately advised of the available treatment methods for both temporary and permanent hair removal.

Child↗

Effect of calcium-channel blockers on cell proliferation, DNA synthesis and collagen synthesis of cultured gingival fibroblasts derived from human nifedipine responders and non-responders.

Human gingival fibroblasts from six patients who developed gingival hyperplasia as a result of nifedipine medication and five who did not were studied for the effects of calcium-channel blockers (nifedipine, diltiazem, verapamil and nicardipine) on cell proliferation, DNA synthesis and collagen synthesis. Phenytoin was used as a positive control. The fibroblasts from reactive patients gave trends toward better cell proliferation rates, DNA synthesis ([3H]-thymidine incorporation), and collagen synthesis ([3H]-proline incorporation) than those from non-reactive patients in the presence of 1 microM of calcium-channel blockers or phenytoin.

Adult↗

The spectrum of cutaneous reactions associated with calcium antagonists: a review of the literature and the possible etiopathogenic mechanisms.

Calcium antagonists (CAs) or calcium-channel blockers, are a common group of antihypertensive medications. These drugs have the property of blocking the calcium channels of the vascular and cardiac smooth-muscle fibers. They have been associated with cutaneous reactions ranging from exanthems to severe adverse events. The frequency of these reactions may be as high as 48 percent. The most common are ankle or pedal edema (up to 30 %), gingival hyperplasia (up to 21 %), and flushing (up to 10 %). Less common are facial or truncal telangiectasia, photosensitivity reactions, new-onset psoriasis (as well as exacerbation of it), purpuric exanthems, pemphigoid manifestations, subacute cutaneous lupus erythematosus, gynecomastia, erythromelalgia, and oral ulcers. Particular adverse manifestations relate to drug potency, degree of vasodilatation, patient age, coexistence of other diseases, co-administration of other cytochrome P450 CYP3A-metabolized medications, fibroblast stimulation, and blood cell effects. Calcium antagonists are associated with a wide range of skin reactions, and the dermatologist should include these in the differential diagnosis of cutaneous diseases.

Calcium Channel Blockers↗

Infantile systemic hyalinosis in a black infant.

A black girl was born with flexion contractures and experienced pain on movement by 1 week of age. She subsequently developed perioral papules, gingival hyperplasia, perianal nodules, torticollis, diarrhea, rectal prolapse, and inability to open her mouth. Her skin became increasingly sclerodermatous, and velvety, hyperpigmented plaques arose over bony prominences. A skin biopsy specimen showed hyaline material in the papillary dermis with lack of elastic fibers. Ultrastructural examination revealed fibrillogranular material around fibroblasts and blood vessels. This child had the clinical, histologic, and ultrastructural features of infantile systemic hyalinosis. This disorder has not been described in a black infant. Previous case reports of infantile systemic hyalinosis are reviewed and unusual features of our case are discussed.

Connective Tissue Diseases↗

The effects of phenytoin and sodium valproate on the periodontal health of adult epileptic patients.

The periodontal health of 30 adult epileptic patients treated with either sodium valproate or phenytoin was compared with a control group (n = 15) of otherwise healthy patients. The 3 groups were matched for age and sex. Patients on phenytoin therapy showed significantly higher plaque scores (P less than 0.05), gingival index (P less than 0.05) and pocketing (P less than 0.05) than patients in the control group. The % of gingival hyperplasia was significantly higher (P less than 0.05) in the phenytoin-treated patients than those on sodium valproate or in the control group. However, patients on phenytoin therapy had significantly less bone loss than those on sodium valproate (P less than 0.05) or in the control group (P less than 0.01). No significant differences were observed between the sodium valproate group and the control group on any of the parameters assessed. The results from this study would suggest that sodium valproate has no unwanted effects on periodontal health and may be considered a safe alternative, regarding the periodontal aspects, to phenytoin for the treatment of adult onset epilepsy.

Adolescent↗