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Progressive laser treatment of hereditary hemorrhagic telangiectasia of the gingiva: case report.

Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular malformation commonly found in the oral region. The symptoms range from minor epistaxis to severe, life-threatening hemorrhage. Red spots on the skin and in the mouth could lead to a diagnosis of HHT. The telangiectases can be irritated by normal dental procedures, and prophylactic antibiotics should be administered. The gingival HHT in this case demonstrates its significance to the dental community. A knowledgeable practitioner could be the first to recognize the potential diagnosis of HHT. Lesion variables will determine treatment parameters. Sequential photocoagulation with an argon laser appears to be an appropriate treatment algorithm.

Argon↗

[Parodontosis].

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Disease↗

Local chemotherapeutics as an adjunct to scaling and root planing.

Gingival diseases are the most widely held diseases in America. In some patients, periodontal disease appears in a generalized form, but more often it appears in localized areas. Furthermore, after treatment with scaling and root planing (SRP) in generalized cases, the disease is often reduced to a few local areas in the patient's mouth. Since periodontitis is a bacterial infection with known pathogenic microorganisms, the local delivery of antimicrobials has been considered to be a possible solution for treating and controlling localized forms of periodontal disease. Three current local chemotherapeutic agents are reviewed in this paper: doxycycline gel, chlorhexidine chip and minocycline microspheres. With the advancement of local drug delivery systems, clinicians and their patients have new alternatives for treatment of periodontal disease.

Chlorhexidine↗

Removal of hyperplastic lesions of the oral cavity. A retrospective study of 128 cases.

AIMS: Based on our accumulated experience, the present study evaluates and discusses the indications, advantages and inconveniences of oral cavity epulis resection using the carbon dioxide laser (CO2) versus the Erbium:YAG laser (Er:YAG), diode laser and surgical scalpel. MATERIAL AND METHODS: A retrospective study has been made of 120 patients involving the removal of 128 epulis lesions with the CO2 laser, Er:YAG laser, diode laser and surgical scalpel. Postoperative controls were carried out after 7, 15 and 30 days to evaluate healing and wound evolution, and after 3, 6 and 12 months to assess possible relapse. RESULTS: Two groups were defined, based on the clinical and etiopathogenic characteristics of the excised lesions: gingival hyperplastic lesions (77 cases) and fibromatous hyperplasia (51 cases). The lower jaw was the most frequent location of gingival hyperplasia (51.9%). Fibrous hyperplasia was the most common histological diagnosis (49 cases; 63.6%). Percentage relapse following removal was 9.1%, of which 5 cases corresponded to fibrous hyperplasia. Only one malignancy was identified, corresponding to infiltrating squamous cell carcinoma. On the other hand, of the 51 treated cases of fibromatous hyperplasia, 58.8% were located in the upper jaw. These were histologically confirmed to be fibrous hyperplasia, with relapse in 19.6% of the cases. CONCLUSIONS: Although the different surgical techniques used for removal of epulis of the oral cavity are appropriate, we consider the CO2 laser to be the treatment of choice, since it offers a number of both intra- and postoperative advantages. On the other hand, all oral lesions require histological study to establish a firm diagnosis.

Adolescent↗

Plasma cell granuloma of gingiva.

An exceedingly rare case of gingival plasma cell granuloma is reported in a 40-year old female patient. The case presented as an exophytic mass of gingiva, clinically resembling traumatic fibroma. Histopathologic findings revealed dense sheets of plasma cells infiltrate. Immunohistochemistry for kappa and lambda light chains showed polyclonal (benign) staining pattern confirming a diagnosis of plasma cell granuloma. It is important to recognise this peculiar lesion because of its highly unusual incidence in involving the periodontium. Clinical features are usually suggestive of traumatic fibroma (benign) but histopathologicaly in early stages it closely resembles plasmacytoma (malignant). This case highlights the need to biopsy unusual lesions to rule out potential neoplasms and also emphasizes the need to submit all the excised tissue for histological examination regardless of clinical impression and/or perceived surgical success. Only by such practice can rare lesion of this type be diagnosed and their incidence studied.

Adult↗

Necrosis of gingiva and alveolar bone caused by acid etching and its treatment with subepithelial connective tissue graft.

The misuse of various chemicals in dentistry may cause damage to gingiva and alveolar bone. In this case report, we describe necrosis of the gingiva and alveolar bone caused by acid etching. A patient whose caries on the cervical third of the root of his mandibular right first molar were treated 2 days earlier presented to our clinic with severe pain and discomfort in the treated area. Intraoral examination revealed a spreading gingival ulceration and exposed alveolar bone. The patient was followed and a week later, when the gingival inflammation had decreased, periodontal surgery was performed. A full-thickness flap was raised and necrotic gingiva and bone were removed. As a result, only a narrow band of keratinized gingiva remained. To treat the gingival recession and protect the underlying bone, a subepithelial connective tissue graft was placed during the same session. After the operation, the patient"s complaints resolved. Subepithelial connective tissue graft can be an important treatment approach in cases of necrosis and gingival recession caused by the misuse of various chemicals.

Acid Etching, Dental↗

A survey of localized lesions of oral tissues: a clinicopathological study.

OBJECTIVE: The purpose of this study was to establish the relative prevalence of the different histopathological aspects of biopsied localized soft tissue oral lesions in a university-based dental school biopsy service. STUDY DESIGN: A retrospective analysis of patients' records with localized lesions treated in the Department of Oral Medicine and Oral Surgery between 2001 and 2004 was conducted. The lesions were classified into either fibrous lesions or soft hemorrhagic lesions. Clinical data regarding age, gender, location, and treatment of the lesions were obtained for each case. RESULTS: The majority of the lesions were located in the gingiva. There were a total of 294 cases of which 182 (61.9%) were fibrous lesions and 112 (38.1%) were soft hemorrhagic lesions. All cases were treated by excisional biopsy and elimination of the chronic irritant. CONCLUSION: Although this data might be used as a guide for forming clinical impressions about oral lesions, the clinician must always be aware of the possible occurrence of more rare lesions. This study indicates there are some differences in age and gender distribution as well as in location between the different lesions.

Adolescent↗