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1/57. Necrotizing ulcerative periodontitis associated with severe congenital immunodeficiency in a prepubescent subject: clinical findings and response to intravenous immunoglobulin treatment.

    common variable immunodeficiency (CVID) is a rare multifactorial congenital disease of genetic origin caused by an impairment in the secretion of specific immunoglobulins. It manifests systemically through recurrent respiratory infections, gastrointestinal disorders and autoimmune diseases. oral manifestations may include gingivitis and lichenoid lesions with Wickham's striae. The treatment for CVID is supported by using intravenous infusion of immunoglobulins (IVIG) that allows for control of the disease and avoidance of recurrent opportunistic infections. This report presents a case of necrotizing ulcerative periodontitis (NUP) in a young patient with CVID, and correlates his periodontal status with systemic conditions before and after IVIG administration during 1 year of evaluation. ( info)

2/57. Metastasising malignant lymphoma mimicking necrotising and hyperplastic gingivostomatitis.

    This paper presents the case of a 65 year-old woman suffering from recurrent oral aphthoid ulcers which rapidly evolved towards hyperplastic and ulcerated lesions over the entire floor of the mouth. The initial lesions were interpreted as non-specific aphthoid ulcers. Later, a tentative diagnosis of necrotising stomatitis with secondary reactive proliferating epithelial hyperplasia was made. The clinical symptoms and the immuno-phenotyping of lymphocytes circulating in the peripheral blood suggested the diagnosis of CD30-positive large cell anaplastic lymphoma. The biopsy showed only a pseudoepitheliomatous hyperplasia, reactive infiltrates and no lymphoma cells. The disease ran a fulminant course leading to death within 4 weeks due to acute gastro-intestinal bleeding. autopsy revealed infiltrates of CD30 large cell anaplastic lymphoma in a submandibular lymph node, in a thrombus stenosing the right subclavian vein, in the spleen, the anterior and posterior gastric wall as well as in the depth of the tumour on the floor of the mouth. The clinical and histopathological spectrum of CD30 large cell anaplastic lymphoma is considerably variable. The particular feature of pseudoepitheliomatous hyperplasia has been reported especially in CD30 anaplastic large cell lymphomas. An early correct diagnosis is rendered difficult in insufficient biopsy size, becauses this type of lymphoma often simulates other inflammatory or neoplastic skin diseases. Thus, with a necrotising and hyperplastic gingivostomatitis, the diagnosis of a CD30 anaplastic large cell lymphoma should be considered. ( info)

3/57. Chronic ulcerative stomatitis: a case report.

    BACKGROUND: Certain mucocutaneous diseases present with painful, ulcerative, or erosive oral manifestations. Chronic ulcerative stomatitis is a newly recognized disease of unknown origin which presents clinically with features of desquamative gingivitis. This report marks only the thirteenth case reported in the world literature. A review of previous reports and studies is presented along with a review of immunofluorescence techniques critical to proper diagnosis. These diseases are difficult to diagnose without the use of immunofluorescence techniques. A 54-year-old Caucasian woman presented with a 2- to 3-year history of stomatitis and dry mouth. methods: Direct immunofluorescence revealed a speckled pattern of IgG deposits in the basal one-third of the epithelium, while indirect immunofluorescence confirmed the presence of stratified epithelium-specific antinuclear antigen (SES-ANA), both pathognomonic for chronic ulcerative stomatitis. RESULTS: The patient was successfully treated using topical corticosteroid therapy. ( info)

4/57. Gingival disease associated with a decorative crown.

    Decorative crowns for the teeth have gained a resurgence of popularity among adolescents. Similar to other forms of body art found in the mouth, these trendy crowns may be associated with a variety of oral complications. This case report describes a localized form of necrotizing ulcerative gingivitis, exacerbated by a cosmetic gold crown in a teenage girl. Healthier artistic options are discussed to replace this flashy dental fad. ( info)

5/57. Benign mucous membrane pemphigoid--a case report.

    Benign mucous membrane pemphigoid (BMMP) is a relatively rare, chronic vesiculobullous disease. It frequently affects postmenopausal women, although cases have been reported in younger individuals. Benign mucous membrane pemphigoid has a predilection to affect multiple mucosal surfaces including the gingivae, hard and soft palate, alveolar ridge, nose, pharynx, gastrointestinal tract, genitalia and the conjunctiva. It is seen clinically as bullae or erosions on the mucosae or gingivae. The bullae rupture after 24-48 hours and the erosions heal within 7-14 days, sometimes with scar formation. Scarring frequently occurs with ocular mucosa involvement and may contribute to blindness. In order to make a diagnosis, the clinical features must be correlated with microscopic and immunopathological findings. Benign mucous membrane pemphigoid is treated with high doses of corticosteroids and immunosuppressive agents. This paper is a presentation of a case report in a 36-year-old woman. ( info)

6/57. Developmental absence of the premolar teeth: dental management.

    A boy aged 11 years presented with dental pain, several carious teeth and a localized area of acute necrotizing ulcerative gingivitis (ANUG). Developmental absence of the premolar teeth was notable and additional anomalies included mid-facial hypoplasia, mandibular prognathism, transposed teeth and delayed exfoliation of the deciduous teeth. These abnormalities have significant oral, dental, orthodontic and orthognathic implications. ( info)

7/57. Oral pemphigoid masquerading as necrotizing ulcerative gingivitis in a child.

    BACKGROUND: Cicatricial pemphigoid (benign mucous membrane pemphigoid) is an autoimmune vesiculobullous disease that affects mucosal tissues of adults and rarely presents in children. Only 9 cases in the English literature have reported cicatricial pemphigoid in children, primarily as oral mucosal lesions. This paper presents a case of childhood cicatricial pemphigoid that clinically manifested as necrotizing ulcerative gingivitis (NUG). methods: A 9-year-old girl presented with gingival bleeding and discomfort for 2 weeks. NUG was suspected and the patient was treated with antibiotics and an oral hygiene regimen. When the condition did not improve after repeated treatment trials, routine hematoxylin and eosin (H&E) and direct immunofluorescence examinations were performed. RESULTS: Microscopic examination of H&E stained sections showed a non-specific ulceration with chronic inflammation. Direct immunofluorescence studies of peri-lesional tissue showed linear deposition of C3 at the basement membrane zone that was consistent with a diagnosis of cicatricial pemphigoid. CONCLUSION: Cicatricial pemphigoid is an autoimmune ulcerative condition that is rarely seen in children. Immunofluorescence studies are essential to differentiate this condition from other ulcerative oral lesions. ( info)

8/57. The risks of oral-genital contact: a case report.

    Our practice of dentistry allows us the opportunity to educate our patients about the many health risks that can affect the oral cavity. Certain behaviors have the potential for serious risk to dentists and staff as well as patients and their partners. This case report details the diagnosis, treatment, and discussion of oral gonococcal infection and the need for heightened awareness among the dental population. ( info)

9/57. The diagnosis of referred orofacial dental pain.

    Every patient's description of the location of pain must be treated with caution. In order to arrive at a diagnosis of pain a logical method should be employed. This consists of the history and clinical examination including pulp tests and radiographs. Where the patient complains of pain on hot or cold, an attempt should be made to reproduce the patient's pain to check on the accuracy of its description and to aid in localisation. patients frequently refer pain to previously endodontically-treated teeth. These may not be the cause of the problem. In order to facilitate the process of diagnosis the following hypothesis has been advanced. A tooth can only be the source of pain if there are objective signs associated with that tooth. Lack of response to pulp tests constitutes such a sign, provided the tooth has not previously been endodontically treated. If, however, such treatment has taken place, (regardless of whether this was well or poorly executed), a further objective sign other than lack of vitality is required before such a tooth can be implicated as the source of pain. The guidelines suggested are illustrated by means of clinical examples. ( info)

10/57. Fatal necrotizing stomatitis due to trichoderma longibrachiatum in a neutropenic patient with malignant lymphoma: a case report.

    Primary invasive mold infection of the oral cavity is a rare but serious complication in immunocompromised hosts. We report a case of fatal trichoderma longibrachiatum stomatitis in a 66-year-old female patient with malignant lymphoma. The infection rapidly disseminated from the oral mucosa to the lungs during neutropenia. Despite intensive antifungal therapy with amphotericin b and itraconazole, there was a fatal progression of the condition. While trichoderma species have been recognized to be pathogenic in profoundly immunosuppressed hosts, this is the first report of the primary oral focus causing a fatal infection. ( info)
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