Cases reported "Gingivitis"

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21/56. Dental treatment for children with chronic idiopathic thrombocytopaenic purpura: a report of two cases.

    Idiopathic thrombocytopaenic purpura (ITP) is the most common acquired bleeding disorder occurring in previously healthy children. The condition is benign and self-limiting, with a high possibility of recovery. Only 15-30% of children with acute ITP develop the chronic form. Clinically, ITP presents with petechiae, ecchymoses, haematomas, epistaxis, haematuria, mucocutaneous bleeding, and occasionally, haemorrhage into tissues. oral manifestations include spontaneous gingival bleeding, petechiae or haematomas of the mucosa, tongue or palate. Two paediatric case reports are described concerning female patients diagnosed with chronic ITP. Oral findings and dental procedures are described. Standard dental treatment was performed with a platelet count higher than 50,000/mm3. The importance of adequate dental plaque control techniques in order to prevent inflammation, potential bleeding and infection in these patients is emphasized. The paediatric dentist must be aware of the clinical appearance of ITP in order to recognize the condition and successfully manage the patient.
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22/56. Management of patients with foreign body gingivitis: report of 2 cases with histologic findings.

    Foreign body gingivitis is an inflammation of the gingiva, characterized by foci containing particles of foreign material in the connective tissue, which can have either a granulomatous or a lichenoid microscopic appearance. In clinical terms, it differs from other immune-mediated gingival disorders in its limited involvement of tissues other than the gingiva, as well as its relative resistance to treatment by topical corticosteroids. Two cases are presented, with a review of the clinical features, including characteristic desquamation and mottling of the marginal gingiva and symptoms of localized tenderness and pain; gingival recession was observed in both of the reported cases. Histologic examination revealed damaged epithelium and degeneration of the basal layer, as well as a mixed inflammatory cell infiltrate in the connective tissue with refractile or opaque particles of foreign material. Gingival inflammation and the severity of gingival erosions improved dramatically with careful debridement, improved home care and more frequent, diligent periodontal maintenance therapy. Free gingival grafts, together with excision of affected tissues, served to stabilize and reinforce the marginal tissues, as well as eliminating further clinical signs of the disease; excision alone was not as effective. patients require careful dental and periodontal management as well as appropriate oral home care to avoid further mechanical damage to the gingiva; in addition, the use of dental abrasives and polishing agents should be restricted, particularly if gingival lesions are present. Home care recommendations include avoidance of dentifrices with certain chemical additives and rinses with a high alcohol content.
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23/56. Periodontal antimicrobials--finding the right solutions.

    Strengthened by promising research data and commercial backing, interest in the field of anti-infective periodontal therapy is rapidly expanding. Management of the periodontal microbiota with antibiotic drugs and antiseptic agents in conjunction with mechanical debridement seems to be more effective than mechanical therapy alone, at least in the treatment of advanced periodontal disease. The choice of a periodontal chemotherapeutic regimen requires an understanding of the usual infecting flora, available antimicrobial agents, and pathogen susceptibility patterns. Systemic administration of combinations of metronidazole and either amoxicillin or ciprofloxacin has been widely used with great success; however the presence of subgingival yeasts and resistant bacteria can be a problem in some periodontitis patients. Valuable antiseptic agents for subgingival application include 10% povidone-iodine for professional use and 0.1-0.5% sodium hypochlorite for patient self-care. These antiseptics have significantly broader spectra of antimicrobial action, are less likely to induce development of resistant bacteria and adverse host reactions, and are considerably less expensive than commercially available antibiotics in controlled release devices. In practice, mechanical debridement combined with subgingival povidone-iodine application in the dental office and sodium hypochlorite irrigation for patient self-care are valuable antimicrobial remedies in the treatment of virtually all types of periodontal disease. Management of moderate to severe periodontitis may require additional systemic antibiotic and/or surgical treatment.
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24/56. Takayasu's arteritis: what should the dentist know?

    Takayasu's arteritis is a chronic inflammatory disease that affects large blood vessels, especially the aorta and/or its major branches. The condition presents with segmental lesions adjacent to normal, apparently unaffected, areas. The lesions include stenosis, occlusion, dilatations or aneurysm formations along the path of the affected artery. Because of the severity of the disease and the possibility of cardiovascular complications, patients with Takayasu's arteritis require medical treatment based on immunosuppressive and antihypertensive drugs, as well as regular follow up and surgical intervention in many instances. The aim of this paper was to describe the characteristics of Takayasu's arteritis, to report dental treatment carried out on an affected patient, and to discuss the main implications and care required during routine treatment for children in the dental office.
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25/56. Contact stomatitis due to palladium in dental alloys: a clinical report.

    A patient was treated with a maxillary gold-palladium alloy fixed partial denture (FPD). Shortly after placement, the patient contracted severe contact mucositis. Patch-testing revealed a positive reaction to palladium chloride (PdCl 2 , 1% petrolatum) but not to any other component of the prosthesis. After removal of the FPD and placement of a provisional acrylic resin restoration, all signs and symptoms disappeared. A definitive metal-ceramic (titanium-porcelain) prosthesis was placed, and no signs of lesions appeared. This clinical report demonstrates that titanium may be a satisfactory alternative for patients who require prostheses and are sensitive to other metals.
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26/56. Dental management of isolated growth hormone deficiency: a case report.

    In case of growth hormone deficiency, periodontal problems may accompany due to the abnormal formation of teeth making plaque accumulation easier. The purpose of this report is to describe dental management of a 14-year old female patient with isolated growth hormone deficiency. She was referred to the Department of Periodontology for treatment of severe gingival inflammation. Periodontal treatment was done by means of scaling and root planning and the patient as well as her father was instructed on better oral hygiene. Following completion of the initial periodontal treatment and improvement of oral hygiene, the dentin carious lesions in the upper incisors were restored. Orthodontic treatment as well as treatment with human growth hormone supplementation was planned.
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27/56. Clinical features, dental findings and dental care management in osteogenesis imperfecta.

    This article reports the case of a child diagnosed with type III osteogenesis imperfecta, assessing the clinical features observed, with emphasis on the craniofacial, oral and dental findings, and describes the dental care management rendered for this special needs patient. The issues addressed and discussed throughout the paper shows that, as far as the oral health professionals are familiarized with the disease-specific clinical manifestations and the possible implications of this condition, there are no hindrances for a successful, high-quality dental and behavioural management.
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28/56. Oral lichen planus and dental implants. Report of 3 cases.

    Oral lichen planus (OLP) is generally considered to be a contraindication for the placement of dental implants. This report describes 3 female patients in whom implants were installed, either before OLP developed or thereafter. OLP in all 3 patients was asymptomatic and mostly of the atrophic or mixed atrophic and reticular type. The implants were in place between 15 years and 3 months. bone resorption around the implants in all 3 patients was on average 3-4 mm. All implants were functioning well. patients with OLP of the asymptomatic type involving the gingiva may be treated with dental implants, however, strict follow-up is recommended.
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29/56. Periodontal disease in patients from the original Kostmann family with severe congenital neutropenia.

    BACKGROUND: patients with Kostmann syndrome (severe congenital neutropenia [SCN]) typically normalize their absolute neutrophil count (ANC) upon granulocyte colony-stimulating factor (G-CSF) therapy. However, although they no longer experience life-threatening bacterial infections, they frequently still have recurrent gingivitis and even severe periodontitis, often starting in early childhood. methods: We studied the periodontal disease in the four surviving patients belonging to the family originally described by Kostmann. Their odontological records, x-rays, color photos, bacterial cultures, serum antibodies to oral bacteria, and histopathological examinations were reviewed. The data were also correlated to previous investigations on their antibacterial peptides and molecular biology. RESULTS: Three patients had periodontal disease, despite normal ANC and professional dental care, and had neutrophils deficient in antibacterial peptides. One of these patients also had a heterozygous mutation in the neutrophil elastase gene, had severe periodontal disease and overgrowth of the periodontal pathogen actinobacillus actinomycetemcomitans in the dental flora, and 15 permanent teeth had been extracted by the age of 27. One bone marrow-transplanted patient had no periodontal disease. CONCLUSIONS: Normalized ANC levels are not sufficient to maintain normal oral health in SCN patients, and because neutrophils are important for first-line defense and innate immunity, the deficiency of the antibacterial peptide LL-37 probably explains their chronic periodontal disease. Professional dental care is still important for SCN patients, despite treatment with G-CSF and normal ANC levels. Whether antibacterial peptides play a role in the pathogenesis of periodontitis in other patients remains to be elucidated.
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30/56. Origin, diagnosis, and treatment of the dental manifestations of vitamin d-resistant rickets: review of the literature and report of case.

    Previous discussions center on early diagnosis, initial treatment, and follow-up therapy for the patient with vitamin d-resistant rickets. Both the medical and dental aspects of treatment for these patients has a long-range effect on the normal developmental patterns. Although treatment is begun at an early age, some rachitic skeletal effects such as minor bowing of the legs and bossing of the skull will invariably be noticed. In patients with controlled rickets the alveolar processes undergo normal development, with apparent normal dental eruption. The poor development and calcification of the alveolus seen in the untreated patient leads to loss of the lamina dura and periodontal ligament of the teeth. patients with resistant rickets possess a functional dentition, although not without inherent defects. Various degrees of fracture and attrition of enamel can be seen, and hypoplasia of dentin is nearly a universal result. Defects extending to the dentinoenamel junction have been shown in repeated cases. Cementum, because of its close relationship with dentin calcification, also appears abnormal. Pulp tissue may undergo abberations of physiology in resistant rickets, although further work in this respect is needed. With respect to the possible dental pathoses seen in this disease, the dental history of the patient with resistant rickets discussed in this report showed that several of the deciduous teeth, possibly the mandibular left second premolar and right first molar, and definitely the maxillary right second premolar and canine and the mandibular left canine had all undergone pulpal degeneration of apparently unknown causation. In the maxillary right second premolar and the mandibular left canine, enamel fractures were clinically and radiographically apparent. However, the maxillary right canine originally had an acute abscess with no defects other than normal, minimal wear facets. No causative factor for its necrosis could be found. Overt enamel fractures in the maxillary right second premolar and the mandibular left canine may have led to microexposures of the pulp with subsequent bacterial pulpal contamination. suppuration present in several of the pulps when first entered during endodontic treatment, as well as chronic fistulas in several areas, support the conclusion that contamination by some means does indeed occur.
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