Oral manifestations during chemotherapy for acute lymphoblastic leukemia: A case report

A 14-year-old, male patient was referred for the treatment of mucositis, idiopathic facial asymmetry, and candidiasis. The patient had been undergoing chemotherapy for 5 years for acute lymphoblastic leukemia. He presented with a swollen face, fever, and generalized symptomatology in the mouth with burning. On physical examination, general signs of poor health, paleness, malnutrition, and jaundice were observed. The extraoral clinical examination showed edema on the right side of the face and cutaneous erythema. On intraoral clinical examination, generalized ulcers with extensive necrosis on the hard palate mucosa were observed, extending to the posterior region. Both free and attached gingivae were ulcerated and edematous with exudation and spontaneous bleeding, mainly in the superior and inferior anterior teeth region. The tongue had no papillae and was coated, due to poor oral hygiene. The patient also presented with carious white lesions and enamel hypoplasia, mouth opening limitation, and foul odor. After exfoliative cytology of the affected areas, the diagnosis was mixed infection by Candida albicans and bacteria. Recommended treatment was antibiotics and antifungal administration, periodontal prophylaxis, topical application of fluor 1.23%, and orientation on and control of proper oral hygiene and diet during the remission phase of the disease.

Conduta no tratamento de gengivite ulcerativa necrosante (GUN) em serviço de urgência

Necrotizing ulcerative gingivitis is a periodontal disease which suddenly appears and presents an acute clinical course, characterized by patients' pain, discomfort and halitosis. Ulceration on papilla and marginal gingiva can be observed. For this reason, patients presenting this condition may seek dental assistance in Health Units or Graduation Institutions, being the dentist responsible for the adoption of a clinical treatment that minimizes symptomatology. The purpose of this case report is to expose and discuss aspects of clinical treatment for this disease applied to the reality of this service.

Conduta de tratamento de gengivite ulcerativa necrosante (GUN) em serviço de urgência

Necrotizing ulcerative gingivitis is a periodontal disease which suddenly appears and presents an acute clinical course, characterized by patients' pain, discomfort and halitosis. Ulceration on papilla and marginal gingiva can be observed. For this reason, patients presenting this condition may seek dental assistance in Health Units or Graduation Institutions, being the dentist responsible for the adoption of a clinical treatment that minimizes symptomatology. The purpose of this case report is to expose and discuss aspects of clinical treatment for this disease applied to the reality of this service.

Gengivite Ulcerativa Necrosante (GUN)

Introdução: A Gengivite Ulcerativa Necrosante (GUN) é uma das patologias orais com mais décadas de estudo. A sua designação foi evoluindo ao longo dos anos até ter sido englobada na categoria das doenças periodontais necrosantes (DPN). As lesões provocadas pela GUN são consideradas únicas entre as doenças periodontais, principalmente pela sua apresentação clínica bastante distinta (Rowland, 1999). Apesar de ser uma doença com sinais muito próprios e fatores predisponentes bem estabelecidos, a etiologia e patogénese das lesões são muito mal compreendidas. O objetivo deste trabalho é efetuar uma revisão bibliográfica dos principais conceitos relativos a esta doença, defini-la e classificá-la, assim como fazer uma abordagem ao seu diagnóstico e respetivo plano de tratamento. Materiais e Métodos: Foi realizada uma pesquisa na base de dados da PubMed e da b-ON, utilizando como palavras-chave: “Necrotizing ulcerative gingivitis”, AND “Necrotizing periodontal disease”. Apenas foram pesquisados artigos em português e inglês, não tendo sido empregues quaisquer limites temporais, resultando num total de 32 artigos, complementado com uma obra literária. Resultados/Conclusões: Após análise da literatura é possível verificar que, mesmo os estudos mais recentes, revelam muitas dúvidas sobre esta doença, apesar das décadas de existência. Porém todos os estudos são unânimes em realçar um aspeto muito importante, a realização de um diagnóstico precoce é a chave para um tratamento adequado, criando, aos pacientes, as condições mínimas necessárias para uma adequada higiene oral e alimentação, que até aí a doença os obrigava a privar.

Leukotoxic activity of Actinobacillus actinomycetemcomitans isolated from Brazilian periodontal patients

The leukotoxic activity of 31 Actinobacillus actinomycetemcomitans isolates from Brazilian periodontal patients [nine from Localized Juvenile Periodontitis (LJP) patients, 22 from patients with AIDS-associated Necrotizing Ulcerative Periodontitis (AIDS/NUP)], and from the reference strain A. actinomycetemcomitans ATCC43718, were analyses for their cytotoxicity on human monocytes. A cytotoxicity inhibitory assay of the isolate P35 and the reference strain ATCC 43718 with sera from ten LJP patients and ten healthy subjects was also performed and leukotoxin reactivity was evaluated with serum from rabbits immune to leukotoxin from A. actinomycetemcomitans ATCC 43718. The cytotoxicity results were not statistically different among groups of A. actinomycetemcomitans isolates from LJP and AIDS/NUP patients, but the individual analysis of each isolate showed two isolates (P24 and P35) from LJP patients with high leukotoxic activity (P<0.05). Also, a high leucotoxic inhibitory effect with LJP patients' sera compared with healthy subjects with sonic extract from isolate P35 (P<0.05) and the reactivity of rabbit antiserum to leukotoxin were observed. Both leukotoxic and non-leukotoxic activity is more frequent in PJL than AIDS/NUP patients. Even though A. actinomycetemcomitans exhibits leukotoxic activity, there is an immune response to the leucotoxin in LJP patients. (C) 2000 Academic Press.

Periodontite ulcerativa necrosante: tratamento fisico da superficie radicular com Er YAG laser

Necrotizing ulcerative periodontitis is associated with bacteria and predisposing risk factors. The treatment is centered in elimination and/or control of the bacteria and predisposing risk factors. However the disease acute phase could induce sequelae as periodontal tissue destruction which may be treated by periodontal surgical procedures.

Halitose bucal: importância da saburra lingual e periodontite na sua etiologia

In general the human breath doesn't have smell or it is so only lightly perceptible to the surrounding ones, varying of pleasant the unpleasant, being taken in consideration the sensibility of the person. Halitosis or bad breath doesn't truly represent a disease, being present in a considerable portion of the population. Ethiologically exist several involved factors, could make an appointment breathing, gastric intestinal, organic and psychic disturbances and mainly oral factors, being the microbial colonization of the tongue the most common, beside the pathological situations involving periodontitis, as necrotizing ulcerative gengivitis. For representing a true obstacle biopsicossocial, the halitosis it influences directally in the family life, work, the patients' atmosphere social, being its diagnosis specific, demanding in certain occasions treatment multidisciplinar. In that sense, the present study if report to a literary revision of the theme, approaching the main aspects of the development of the halitosis, as well as its biological origin and its clinical implications.

Halitose bucal: importância da saburra lingual e periodontite na sua etiologia

In general the human breath doesn't have smell or it is so only lightly perceptible to the surrounding ones, varying of pleasant the unpleasant, being taken in consideration the sensibility of the person. Halitosis or bad breath doesn't truly represent a disease, being present in a considerable portion of the population. Ethiologically exist several involved factors, could make an appointment breathing, gastric intestinal, organic and psychic disturbances and mainly oral factors, being the microbial colonization of the tongue the most common, beside the pathological situations involving periodontitis, as necrotizing ulcerative gengivitis. For representing a true obstacle biopsicossocial, the halitosis it influences directally in the family life, work, the patients' atmosphere social, being its diagnosis specific, demanding in certain occasions treatment multidisciplinar. In that sense, the present study if report to a literary revision of the theme, approaching the main aspects of the development of the halitosis, as well as its biological origin and its clinical implications.

Occurrence of yeasts, enterococci and other enteric bacteria in subgingival biofilm of HIV-positive patients with chronic gingivitis and necrotizing periodontitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Periodontitis and gingivitis in inflammatory bowel disease: a case-control study.

BACKGROUND: The oral cavity is frequently affected in patients with inflammatory bowel disease (IBD), especially in patients with Crohn's disease (CD). Periodontitis is thought to influence systemic autoimmune or inflammatory diseases. We aimed to analyze the relationship of periodontitis and gingivitis markers with specific disease characteristics in patients with IBD and to compare these data with healthy controls. METHODS: In a prospective 8-month study, systematic oral examinations were performed in 113 patients with IBD, including 69 patients with CD and 44 patients with ulcerative colitis. For all patients, a structured personal history was taken. One hundred thirteen healthy volunteers served as a control group. Oral examination focussed on established oral health markers for periodontitis (bleeding on probing, loss of attachment, and periodontal pocket depth) and gingivitis (papilla bleeding index). Additionally, visible oral lesions were documented. RESULTS: Both gingivitis and periodontitis markers were higher in patients with IBD than in healthy control. In univariate analysis and logistic regression analysis, perianal disease was a risk factor for periodontitis. Nonsmoking decreased the risk of having periodontitis. No clear association was found between clinical activity and periodontitis in IBD. In only the CD subgroup, high clinical activity (Harvey-Bradshaw index > 10) was associated with 1 periodontitis marker, the loss of attachment at sites of maximal periodontal pocket depth. Oral lesions besides periodontitis and gingivitis were not common, but nevertheless observed in about 10% of patients with IBD. CONCLUSIONS: IBD, and especially perianal disease in CD, is associated with periodontitis. Optimal therapeutic strategies should probably focus on treating both local oral and systemic inflammation.

Pyoderma gangrenosum after minor trauma in a pregnant woman, mistaken for necrotizing fasciitis: report of a case and literature review.

Abstract Background: Pyoderma gangrenosum is an ulcerative, non-infectious skin disorder. However, it can be mistaken as necrotizing fasciitis, a life-threatening infective condition. We describe here a case of pyoderma gangrenosum after minor trauma treated as necrotizing fasciitis. METHODS: Case report and literature review. CASE REPORT: A 27-year-old pregnant nurse had a pretibial wound after a fall on a rough surface. When erythema developed and no response to empirical antibiotic therapy was observed, multiple debridements were performed. Paradoxically, her condition became worse. The diagnosis of pyoderma gangrenosum was suspected. Treatment with corticosteroids was started and this was successful. CONCLUSION: Pyoderma gangrenosum can mimic infectious necrotizing fasciitis. Differentiating these two conditions is important because mistreatment of pyoderma can lead to disfigurement.

Oral manifestations of HIV/AIDS in China: a review

PURPOSE: The purpose of this study is to review the Chinese-language medical and dental literature from 1982 to 2008 on oral manifestations (OMs) of patients with HIV/AIDS for introducing the spectrum of OMs of the patients in China. MATERIALS AND METHODS: All data were extracted from 18 references which had used diagnostic criteria for HIV/AIDS. Four of the references had used the EC-Clearinghouse classification for oral lesions in HIV infection. The feasible overall rate and 95% confidence interval (95%CI) of the data on OMs were calculated. RESULTS: Risk group analysis revealed that, of 203 patients, 64.3% were men and 35.7% were women (age range, 5 months to 64 years; mean age in three studies, 34.0, 34.3, and 36.1 years). Of these patients, 22.2% were infected by sexual contacts, 11.8% by intravenous drug use (IDU), 59.6% by blood or its products, 2.9% by mother to child transmission, and 3.4% were unclear. In 203 patients, oral candidiasis (OC) was the most common lesion (66%, 95%CI = 59.48-72.52%), followed by herpes simplex (HS) (22.2%, 95%CI = 16.48-27.92%), ulcerative stomatitis (14.8%, 95%CI = 9.92-19.68%), salivary gland disease (11.3%, 95%CI = 6.94-15.66%), oral hairy leukoplakia (OHL) (9.8%, 95%CI = 5.71-13.89%), necrotizing gingivitis (5.9%, 95%CI = 2.66-9.14%), Kaposi's sarcoma (2.9%, 95%CI = 0.59-5.21%), other malignant tumors (2.9%, 95%CI = 0.59-5.21%), and linear gingival erythema (2.0%, 95%CI = 0.07-3.93%). CONCLUSIONS: The spectrum of OMs reported from China is similar to that described in the international literature. Present data are useful to supplement international resources of HIV/AIDS research.

Periodontitis and Gingivitis in Inflammatory Bowel Disease

BACKGROUND: The oral cavity is frequently affected in patients with inflammatory bowel disease (IBD), especially in patients with Crohn's disease (CD). Periodontitis is thought to influence systemic autoimmune or inflammatory diseases. We aimed to analyze the relationship of periodontitis and gingivitis markers with specific disease characteristics in patients with IBD and to compare these data with healthy controls. METHODS: In a prospective 8-month study, systematic oral examinations were performed in 113 patients with IBD, including 69 patients with CD and 44 patients with ulcerative colitis. For all patients, a structured personal history was taken. One hundred thirteen healthy volunteers served as a control group. Oral examination focussed on established oral health markers for periodontitis (bleeding on probing, loss of attachment, and periodontal pocket depth) and gingivitis (papilla bleeding index). Additionally, visible oral lesions were documented. RESULTS: Both gingivitis and periodontitis markers were higher in patients with IBD than in healthy control. In univariate analysis and logistic regression analysis, perianal disease was a risk factor for periodontitis. Nonsmoking decreased the risk of having periodontitis. No clear association was found between clinical activity and periodontitis in IBD. In only the CD subgroup, high clinical activity (Harvey-Bradshaw index > 10) was associated with 1 periodontitis marker, the loss of attachment at sites of maximal periodontal pocket depth. Oral lesions besides periodontitis and gingivitis were not common, but nevertheless observed in about 10% of patients with IBD. CONCLUSIONS: IBD, and especially perianal disease in CD, is associated with periodontitis. Optimal therapeutic strategies should probably focus on treating both local oral and systemic inflammation.

Quality of life in patients with ileal pouch for ulcerative colitis

INTRODUCTION:proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the standard surgical procedure for the treatment of ulcerative colitis (UC) and is associated with the prospect of cure. Experience gained over the years has demonstrated the occurrence of a high number of complications as well as bowel disorders that can compromise quality of life (QoL).OBJECTIVE:evaluate QoL in patients with IPAA for ulcerative colitis.PATIENTS AND METHODS:the Inflammatory Bowel Disease Questionnaire (IBDQ) was used to assess QoL in patients with IPAA after its validation in Portuguese.RESULTS:thirty-one patients submitted to IPAA by the same group of professionals were evaluated. QoL was classified as regular in all domains evaluated (intestinal and systemic symptoms and emotional and social aspects). There were no differences in relation to gender, type of pouch or postoperative time. However, elderly patients showed a tendency toward lower scores. Having a professional activity was associated with higher scores in systemic symptoms and social aspects (p < 0.05). Patients with ileostomy showed lower values in the domains of systemic symptoms, emotional and social aspects (p <0.05).CONCLUSION:in all domains assessed, patients with IPAA for UC had QoL classified as regular. Ileostomy and lack of professional activity negatively influenced QoL.

Double-blind, crossover, placebo-controlled clinical trial with clobetasol propionate in desquamative gingivitis

The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.