1/11. The relationship between peripheral levels of leukocytes and neutrophils and periodontal disease status in a patient with congenital neutropenia.BACKGROUND: Congenital neutropenia is characterized by an almost total absence of neutrophils and increased susceptibility to infection. oral manifestations include ulcerations of mucous membranes, acute gingival inflammation with focal necrosis, and rapid loss of attachment. Treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) increases neutrophil numbers and ameliorates the periodontal status. methods: We report the treatment of a 22-year-old male with congenital neutropenia (Kostman syndrome), referred to us due to periodontal disease, and the effect of treatment on peripheral neutropenia. diagnosis of neutropenia was made at year 1; at age 15, the patient started to receive injections of rhG-CSF, reducing the occurrence of infection and improving neutrophil count, although levels remained below normal. The patient underwent extraction of a molar at age 8; scaling, root planing, and modified Widman flaps at age 9; and oral hygiene maintenance every 2 to 3 months from age 18 to 21. At age 23, he initiated treatment at our periodontal clinic. The patient's gingiva was severely inflamed, and the dentition was covered with plaque and calculus. Attachment loss was advanced, all teeth were mobile, and bone loss was approximately 75% in most sites. Neutrophil counts were below normal, but other hematologic parameters were normal. Scaling and root planing were performed and the patient received antibiotics and chlorhexidine rinses twice each day for 2 weeks. Extracoronal splinting was performed, fluoride varnish was used to desensitize cervical areas, and tooth FDI #46 was restored. root planing and deplaquing were repeated, and the patient received subgingival chlorhexidine irrigation 13 times over one year. Assessments were made on presentation, after the initial treatment, and at 1 and 2 years post-treatment. RESULTS: Mean probing depth was reduced posttreatment with a further reduction during the maintenance period. This was correlated with an increase in attachment levels. Total white blood cells increased, due in part to an increase in neutrophils, reaching normal levels. CONCLUSIONS: This report demonstrates for the first time that periodontal therapy, resulting in decreased bacterial load, may result in restoration of normal levels of circulating neutrophils in individuals with congenital neutropenia under treatment with rhG-CSF. The results also suggest that periodontal pathogens may be associated with depressed neutrophil levels, even when patients receive treatment for neutropenia.- - - - - - - - - - ranking = 1keywords = leukocytes, white (Clic here for more details about this article) |
2/11. Interdisciplinary approach to treat dyskeratosis congenita associated with severe aplastic anemia: a case report.This paper reports on a 4-year-old male who had dyskeratosis congenita and who acquired severe aplastic anemia. The patient developed hyperpigmentation of the face, neck and chest region, arms, shoulders and legs. In addition, he had dry skin, deformed fingernails and toenails, sparse hair and eyebrows and hyperkeratosis of the dorsum of the hands and feet. Laboratory and histological analysis revealed severe pancytopenia and dyserythropoiesis of red blood cells, hypocellularity of white blood cells and decreased megakaryocytes with dysplasia. The intraoral examination identified bleeding gums; petechiae of the palate, tongue and cheek mucosa; and an atrophic, smooth and shining dorsal surface of the tongue. There were deep carious lesions in the deciduous mandibular molars and maxillary anterior teeth; as well as mobility of mandibular left canine, which had bone loss. The treatment for oral lesions included diet changes, improved oral hygiene, and extraction of the deciduous teeth destroyed by caries.- - - - - - - - - - ranking = 0.009600885249283keywords = white (Clic here for more details about this article) |
3/11. agranulocytosis--periodontal manifestations and treatment of the acute phase: a case report.A case report of oral and periodontal manifestation of agranulocytosis in a 12-year-old girl is presented. The agranulocytic state may have been caused by chronic brucellosis since childhood. On admission to the hospital, the acute oral symptoms were treated in order to enable the child to eat and perform standard oral hygiene measures. chlorhexidine gluconate 0.2% was irrigated daily under pressure for supra- and subgingival plaque control. Resolution of inflammation was achieved without increase in white blood count and thus can be attributed to the control of the local etiologic factor, i.e., plaque.- - - - - - - - - - ranking = 0.009600885249283keywords = white (Clic here for more details about this article) |
4/11. Localized prepubertal periodontitis: literature review and report of case.This case describes a young, healthy, white female who demonstrated anterior alveolar bone loss along with premature loss of her primary incisors. The alveolar bone loss remains unexplained. The root surfaces of most of the primary anterior teeth exhibited one or more eroded areas devoid of cementum with some evidence in two teeth of cellular resorptive activity. These findings suggest that premature root resorption was occurring concurrently with unexplained extensive alveolar bone loss. The child will be examined periodically to determine whether this process of bone loss with subsequent tooth loss will involve additional primary or permanent teeth.- - - - - - - - - - ranking = 0.009600885249283keywords = white (Clic here for more details about this article) |
5/11. Infantile agranulocytosis with survival into adolescence: periodontal manifestations and laboratory findings. A case report.A case of infantile agranulocytosis with survival into adolescence is presented. The polymorphonuclear leukocyte is considered an important source of lysosomal enzymes in gingival crevicular fluid, and evaluation of connective tissue-degrading enzymes in the fluid was performed. The activity of beta-glucuronidase, a ground substance-degrading enzyme that may serve as a marker for polymorphonuclear leukocytes, was markedly reduced in the fluid compared to samples from systemically healthy adults with periodontitis. The activities of the ground substance-degrading enzyme arylsulfatase, and collagenase, were in the low-normal range. The plaque microbiology, as characterized by dark-field microscopy and selective culturing, was consistent with advanced periodontitis. A review of the medical history revealed a series of bacterial infections since infancy. Improvement in the systemic health of the patient occurred at about the age of 15, and the intake of antibiotics to control infections was correspondingly reduced after this time. An exacerbation of the patient's periodontal disease, as evaluated by loss of alveolar bone on radiographs, occurred 1 to 2 years later. The progression of periodontal disease observed in this patient was apparently associated with the withdrawal of antibiotics administered for control of systemic (nonoral) infections.- - - - - - - - - - ranking = 0.24759977868768keywords = leukocytes (Clic here for more details about this article) |
6/11. Periodontal manifestations of the heritable Mac-1, LFA-1, deficiency syndrome. Clinical, histopathologic and molecular characteristics.The clinical, histopathologic and functional consequences of the genetic deficiency of leukocyte Mac-1, LFA-1 and p150,95 were assessed among three affected patients, heterozygotes and unaffected individuals among two generations of a single kindred. Longitudinal assessments of this family afforded the unique opportunity to characterize the natural history of severe periodontal manifestations associated with this disorder. Features uniformly observed among each patient included recurrent, necrotic soft tissue infections, impaired pus formation, delayed wound healing, constant granulocytosis, severe abnormalities of adhesion-dependent granulocyte functions and a profound deficiency (3%-6% of normal) of Mac-1 glycoproteins on granulocyte surfaces. Characteristic features of generalized prepubertal periodontitis including rapidly progressive alveolar bone loss affecting the primary and permanent dentitions (leading to premature tooth loss), recession, clefting and migration in association with intense gingival inflammation were uniformly observed. Biopsies of inflamed periodontal tissues in these individuals demonstrated dense infiltrates of mononuclear leukocytes but a striking absence of extravascular neutrophil granulocytes. Heterozygous family members demonstrated approximately half normal Mac-1 protein expression but no susceptibility to systemic infections and normal, adhesion-dependent leukocyte functions. Prepubescent heterozygotes demonstrated no periodontal manifestations but a 31-year-old heterozygous female exhibited clinical and radiographic features typical of postjuvenile periodontitis. The profound periodontal manifestations recognized in this clinical-pathologic model emphasize the physiologic importance of leukocyte adhesion reactions in defense of the periodontium and further suggest a possible pathologic role for Mac-1 proteins in other forms of early-onset periodontitis.- - - - - - - - - - ranking = 0.24759977868768keywords = leukocytes (Clic here for more details about this article) |
7/11. Endogenous endophthalmitis caused by actinobacillus actinomycetemcomitans.actinobacillus actinomycetemcomitans is a rare cause of infection in humans. It has been mainly reported in cases of endocarditis and destructive periodontal disease. This report describes the case of a 51-year-old female who had an acute onset of anterior iridocyclitis, followed by the appearance of a white nodule on the lens and subsequent involvement of the vitreous. The course of the disease was long and insidious. actinobacillus actinomycetemcomitans was isolated from 3 of 26 blood cultures drawn over a period of 40 days, and also from the vitreous. The patient had been suffering from periodontal disease for 3 months prior to her admission. Only two cases of endophthalmitis presumably caused by this organism have previously been reported, but the organism has never been recovered from the eye. This report presents the first case of culture-proven actinobacillus actinomycetemcomitans endophthalmitis following destructive periodontal disease.- - - - - - - - - - ranking = 0.009600885249283keywords = white (Clic here for more details about this article) |
8/11. Prepubertal periodontitis affecting the deciduous and permanent dentition in a patient with cyclic neutropenia. A case report and discussion.neutropenia is a transient or chronic blood disorder characterized by a decrease in the number of circulating polymorphonuclear leukocytes (PMNs). neutrophils are a major cellular defense against infection, and depletion of these cells is potentially fatal. stomatitis and gingivitis frequently are seen in patients with neutropenia. Therefore, the diagnosis of severe oral pathoses of obscure origin must include a differential white blood cell count. The importance of the dentist's role is dramatically illustrated in the rare case reported here, since the oral condition was the reason for this patient's definitive blood work-up. The report illustrates the importance of the laboratory assessment in dental patients with unusual periodontal destruction or other inexplicable oral changes.- - - - - - - - - - ranking = 0.25720066393696keywords = leukocytes, white (Clic here for more details about this article) |
9/11. Clinical, microbiological and immunological studies of a family with a high prevalence of early-onset periodontitis.Extensive clinical, laboratory and microbiological studies were performed on members of a family with an unusually high prevalence of early-onset severe periodontitis. Clinical observations included intraoral photographs and assessment of inflammation, plaque, probing depths and bone loss. Pocket bacteria were sampled, cultivated and identified. Immunological studies included assessment in vitro of neutrophil (PMN) and monocyte (MN) chemotaxis, assessment of PMN phagocytosis and other functions using the iodination assay, measurement of serum opsonic and chemoattractant activities and determination of levels of serum antibodies specific to various putative periodontal pathogens. The proband, a 19-year-old white woman, had rapidly progressive periodontitis (RP). Of her six siblings available for study, all had juvenile periodontitis (JP), and both parents had been edentulous since early adulthood. Early edentulism and recurrent infections, especially otitis media, were prevalent in the forebearers, especially on the maternal side. Two married sisters of the proband had young male children with recurrent infections. Abnormalities in leukocyte chemotaxis were found in the proband, in two of her siblings and in both parents. The pocket flora was predominantly Gram-negative, anaerobic rods with a high prevalence of bacteroides species, and serum antibodies specific to bacteroides species were detected in the sera of five of the seven patients studied. actinobacillus actinomycetemcomitans was not found in any of the pockets studied, nor were antibodies specific to any of the three known serotypes of this bacterium detected in the serum of any of the patients. There was a relatively good correlation between the bacterial species isolated from the periodontal pockets and the antibodies found in the serum. PMN iodination and serum opsonic activity were normal in all of the patients. Thus not all JP patients have detectable actinobacillus species in their periodontal pockets, nor do all have antibody detectable with the techniques we used specific to these bacteria in their serum. In contrast, JP patients may have bacteroides species in their periodontal pockets and antibody specific to bacteroides species in their serum. Although abnormal leukocyte chemotaxis is generally common in RP and JP patients, in this family the correlation between this defect and the presence of these diseases was poor.- - - - - - - - - - ranking = 0.009600885249283keywords = white (Clic here for more details about this article) |
10/11. Clinical and laboratory studies on human sclera allografts.In the first section of this two-part report human peripheral blood leukocytes were tested for reactivity to extracts of sclera. Absence of scleral antigenicity is suggested by the results which showed that the leukocytes reacted similarly in sclera stimulated cultures and in the controls. The second part of the report discusses the clinical aspects of sclera allografts and provides guidelines for their clinical use. A case is presented where a sclera graft was in position for approximately a year. The tooth was removed with the attached graft and a histologic study made.- - - - - - - - - - ranking = 0.49519955737536keywords = leukocytes (Clic here for more details about this article) |
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