1/21. Combined treatment of periodontal disease and benign mucous membrane pemphigoid. Case report with 8 years maintenance.BACKGROUND: Desquamative gingivitis may be the clinical manifestation of one of several systemic diseases. The clinical course of the disease can be complicated by plaque-associated periodontitis. However, there is no information currently available for the concurrent management of both conditions. CASE REPORT AND RESULTS: This paper presents the treatment and 8-year maintenance of a patient with periodontal disease and benign mucous membrane pemphigoid (BMMP). The first phase of treatment included oral hygiene instructions and local corticosteroid administration, followed by scaling and root planing. The patient's compliance and excellent response to therapy allowed for subsequent surgical pocket elimination and augmentation of the zone of keratinized tissue for prosthetic reasons. Over the following 8 years, the patient's periodontal condition remained stable even though periodontal maintenance was erratic. For the control of BMMP, intermittent administration of corticosteroids was necessary, without any significant local or systemic side effects. CONCLUSIONS: We suggest that combined treatment and long-term maintenance of BMMP and periodontitis are feasible under certain conditions and propose a clinical protocol for treatment which could serve as a guideline for similar conditions.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/21. Immunopathological diagnosis of cicatricial pemphigoid with desquamative gingivitis. A case report.Cicatricial pemphigoid (CP) is a chronic subepidermal bullous dermatosis which primarily involves the mucous membranes. The oral cavity and the eye are most frequently involved. Since extension of the lesion into the pharynx and esophagus causes sore throat and dysphagia and progressive ocular lesions may cause blindness, early and valid diagnosis is very important. Here we present a case of cicatricial pemphigoid with onset at age 45 in a patient who manifested severe periodontal disease and showed the lesion on the mucous membranes of the mouth (desquamative gingivitis), skin, and eyes. Since definite diagnosis is very important, we describe how we made a differential diagnosis from other diseases which also accompany desquamative gingivitis. We examined the clinical manifestations, blood test results, HLA-genotype, histopathologic findings of the affected tissue, and immunological findings in relation to autoimmunity. Since many of the CP cases are first referred to periodontists or dentists, we believe that the diagnostic strategy described in the present study will be quite informative for making rapid and definite diagnoses of similar cases.- - - - - - - - - - ranking = 0.4keywords = membrane (Clic here for more details about this article) |
3/21. dyskeratosis congenita: report of a case.dyskeratosis congenita is a rare multisystem condition involving mainly the ectoderm. It is characterized by a triad of reticular skin pigmentation, nail dystrophy and leukoplakia of mucous membranes. Oral and dental abnormalities may also be present. Complications are a predisposition to malignancy and bone marrow involvement with pancytopenia. The case of a 14-year-old girl is described who presented with several of the characteristic systemic features of this condition, together with the following oral features: hypodontia, diminutive maxillary lateral incisors, delayed dental eruption, crowding in the maxillary premolar region, short roots, poor oral hygiene, gingival inflammation and bleeding, alveolar bone loss, caries and a smooth atrophic tongue with leukoplakia. Although this condition is rare, dental surgeons should be aware of the dental abnormalities that exist and the risk of malignant transformation within the areas of leukoplakia.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
4/21. Cicatricial pemphigoid with circulating IgA and IgG autoantibodies to the central portion of the BP180 ectodomain: beneficial effect of adjuvant therapy with high-dose intravenous immunoglobulin.Cicatricial pemphigoid (CP) is an autoimmune subepidermal blistering disease characterized by deposits of IgG, IgA, or C3 at the cutaneous basement membrane zone. CP may present with considerable variation regarding age, morphology of lesions, and mucosal involvement, which may heal with or without scarring. We describe a patient with CP who presented with circulating IgA and IgG autoantibodies to the epidermal side of salt-split human skin. By immunoblot analysis, the patient's IgA reacted with the soluble ectodomain of BP180 (LAD-1). This reactivity was mainly directed to the central portion of the BP180 ectodomain, a site that, to date, has not been described as the target of IgA autoantibodies. Different immunosuppressive treatment regimens including steroids and mycophenolate mofetil did not control this patient's disease, and severe scarring of the conjunctivae occurred with impairment of vision. Addition of adjuvant intravenous immunoglobulin (1 g/kg body weight on 2 consecutive days) every 4 weeks led to a dramatic improvement of conjunctivitis and gingivitis. Clinical improvement correlated with the serum's IgA immunoblot reactivity against LAD-1. Further studies on a larger number of patients with CP should try to correlate the specificity of autoantibodies in CP with the response to certain therapeutic regimens.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
5/21. Management of fused supernumerary teeth in children using guided tissue regeneration: long-term follow up of 2 cases.Surgical separation of supernumerary teeth fused to permanent incisor teethhas typically given rise to residual post surgical periodontal defects, induding loss of attachment and deep periodontal pocketing with persistent inflammation. Other complications include devitalisation of the retained tooth section, ankylosis, external and replacement resorption. A unique technique of using guided tissue regeneration has been successfully employed to promote periodontal healing, after 2 cases of surgical removal of a supernumerary tooth fused to a permanent maxillary lateral incisor tooth. In the first case, a 2-stage guided tissue regeneration technique was completed with a nonresorbable Gor-Tex membrane, and was followed up after 9 years. The second case was completed using a resorbable Vicryl membrane, in a single-stage guided tissue regenerative technique; and was followed up after 5 years.- - - - - - - - - - ranking = 0.4keywords = membrane (Clic here for more details about this article) |
6/21. Two cases of linear IgA disease with clinical manifestations limited to the gingiva.Linear IgA disease (LAD) is a chronic, subepithelial blistering disease that is associated with the presence of linear deposits of IgA along the basement membrane zone. Etiopathogenic aspects of LAD are only partially known. LAD is clinically characterized by vesiculobullous skin and mucous lesions. Although more than half of LAD patients present oral mucosal lesions, there are only a few cases reported of oral lesions as the only manifestation of LAD. This study presents 2 of these uncommon cases.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
7/21. Treatment of an osseous lesion associated with a severe palato-radicular groove: a case report.This is a case report that describes the management of a severe periodontal defect associated with a palato-radicular (palato-gingival) groove affecting the maxillary right lateral incisor of a 50 year-old male. The patient presented with pain, gingival swelling, and a 10 mm periodontal pocket on the distopalatal aspect of the right maxillary lateral incisor. The defect was initially treated by scaling and root planing. Several days later a flap was elevated, the osseous defect was debrided, and odontoplasty was performed to eliminate the groove. The root surface was treated with citric acid for 3 minutes, the osseous defect was filled with non-porous hydroxyapatite, a periodontal membrane was placed, and the flap was readapted to the tooth. postoperative care included systemic (minocycline) and local (chlorhexidine) antimicrobial therapy. The membrane was removed 6 weeks postoperatively and 14 months postoperatively the gingiva appeared healthy; radiographs suggested substantial resolution of the osseous defect and about 7 mm of probing attachment gain was recorded. Further studies are necessary to determine which of the several modes of therapy used to treat this lesion are necessary for success.- - - - - - - - - - ranking = 0.4keywords = membrane (Clic here for more details about this article) |
8/21. Desquamative gingivitis associated with IgG/IgA pemphigoid presents a challenging diagnosis and treatment: a case report.BACKGROUND: mucous membrane pemphigoid (MMP) is a heterogeneous group of autoimmune blistering disorders characterized by subepithelial separation and the deposition of immunoglobulins and complement along the basement membrane zone (BMZ). This disease is diagnosed with direct immunofluorescence testing showing a linear deposition of immunoglobulins and/or complement along the BMZ and indirect immunofluorescence testing showing circulating IgG (and sometimes IgA) autoantibodies along the BMZ. In this case report we describe desquamative gingivitis secondary to IgG/IgA pemphigoid and the management of this challenging variant of MMP. methods: Routine histology, direct immunofluorescence testing, and indirect immunofluorescence testing were utilized and correlated to the clinical findings to diagnose this unusual immunobullous disease. RESULTS: Direct and indirect immunofluorescence testing confirmed the clinical diagnosis of IgG/IgA pemphigoid as the cause of desquamative gingivitis and the other mucosal findings in this patient. A treatment program including dapsone and other drugs completely resolved the oral lesions after 14 months of therapy. CONCLUSIONS: Desquamative gingivitis associated with IgG/IgA pemphigoid can be challenging to diagnose and treat. After 14 months of treatment, a combination therapy consisting of dapsone with cimetidine and vitamin e to enhance drug efficacy and frequent intramuscular administrations of triamcinolone achieved control of both the oral and genital elements of IgG/IgA pemphigoid in this patient.- - - - - - - - - - ranking = 0.4keywords = membrane (Clic here for more details about this article) |
9/21. A case of imported paracoccidioidomycosis: an awkward infection in The netherlands.paracoccidioidomycosis is an important endemic mycosis in south america. In europe the disease is very rare and only found as infections in travelers to latin america. We report here the first case encountered in the netherlands for which the appropriate diagnosis was not attained for several months. A Dutch 60-year-old man presented with a painful ulceration in the buccal mandibular vestibular mucosa of three months duration. While his medical history was uneventful, he had worked, until 8 years prior to his presentation, as a carpenter for 25 years in the jungles of peru and ecuador. An aberrant chest radiograph, CT-scan of the lungs and increased erythrocyte sedimentation rate were suggestive of sarcoidosis or a bronchiolitis obliterans organizing pneumonia. There was no improvement in the patient's symptoms despite the use of budesonide and prednisone medication, as well as tuberculosis prophylaxis with isoniazide and rifampicin, and local use of miconazole. Quite to the contrary, as an irritated, irregular hyperemic mucosa and gingiva with ulceration were noticed during this period of time. These precipitated an incisional biopsy through which a mixed inflammatory cellular infiltrate and large yeast cells were found on histopathologic examination. Based on the patient's travel history and the multiple budding yeastlike cells revealed in the biopsy tissue, the diagnosis of paracoccidioidomycosis was finally made. This was supported by the isolation of paracoccidioides brasiliensis in culture. Antimycotic oral therapy with itraconazole was started and continued for 15 months. At two and five year follow-ups, the patient was asymptomatic. In europe, it may be expected that diseases that are endemic in other areas will be seen more frequently in countries where the diseases are not routinely encountered. It is most likely that the use of corticosteroid medication, with its inherent immunosuppressive effect, resulted in the reactivation of an infection acquired many years before in latin america. The etiologic agent then disseminated from the initial focal point to cause the ensuing oral mucous membrane lesions. The importance of the patient's prolonged residence in latin america was overlooked. The very long latency of endemic mycoses emphasizes the need for a meticulous history which should include not only recent trips, but also past residence in foreign countries.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
10/21. Childhood oral mucous membrane pemphigoid presenting as desquamative gingivitis in a 4-year-old girl.mucous membrane pemphigoid is a chronic inflammatory, bullous subepithelial auto-immune disease, with predominant involvement of the mucosal surfaces. Oral mucous membrane pemphigoid occurring in childhood is extremely rare. We describe a new case of this entity occurring in a 4-year-old girl who presented with desquamative gingivitis. diagnosis was based on clinical presentation, histopathology, immunofluorescence and immunoblotting examinations. Treatment and 2-year follow-up are described.- - - - - - - - - - ranking = 1.2keywords = membrane (Clic here for more details about this article) |
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