Gingival lesions in a patient with chronic oral graft-versus-host disease: a case report

BACKGROUND: The patient reported in this study was diagnosed with acute nonlymphocytic leukemia and underwent an allogenic bone marrow transplantation. She was referred for persisting oral ulceration and pain associated with the transplant procedure. AIM: To present an unusual involvement of gingival tissues during a case of oral chronic graft-versus-host-disease. CONCLUSION: This is one of the very few reports in the dental literature of a case of oral chronic graft-versus-host disease that includes the unusual manifestation of prominent gingival lesions.     

Interproximal cervical lesions caused by incorrect flossing technique

This case report describes an interproximal cervical lesion caused by the incorrect use of dental floss. A 58-year-old man who was asymptomatic, presented with unusual notch-like cervical lesions. After clinical and radiographical examinations, it was concluded that the aetiology of these lesions was an incorrect flossing technique. The treatment plan included extraction of maxillary 3rd molars and re-education of the patient in oral hygiene technique. CONCLUSION: These lesions are irreversible and often go undiagnosed; therefore, it is important for the clinician to be familiar with the clinical presentation and aetiology.     

Bacteraemia due to dental flossing

Aims: The aims of this study were to (1) investigate the incidence of bacteraemia following flossing in subjects with chronic periodontitis or periodontal health; (2) identify the micro-organisms in detected bacteraemias; and (3) identify any patient or clinical factors associated with such bacteraemia.
Material and Methods: Baseline blood samples were obtained from 30 individuals with chronic periodontitis (17 M:13 F, 29–75 years) and 30 with periodontal health (17 M:13 F, 28–71 years) following a non-invasive examination. Each subject's teeth were then flossed in a standardized manner and blood samples obtained 30 s and 10 min. after flossing cessation. Blood samples were cultured in a BACTEC^™ system and positive samples subcultured for identification.
Results: Forty per cent of periodontitis subjects and 41% of periodontally healthy subjects tested positive for bacteraemia following flossing. Viridans streptococci, which are commonly implicated in infective endocarditis (IE), were isolated from 19% of positive subjects and accounted for 35% of microbial isolates. Twenty per cent of subjects had a detectable bacteraemia at 10 min. post-flossing. No patient or clinical factors were significantly associated with post-flossing bacteraemia.
Conclusions: Dental flossing can produce bacteraemia in periodontally healthy and periodontally diseased individuals at a rate comparable with that caused by some dental treatments for which antibiotic prophylaxis is given to prevent IE.     

Oral health attitudes and behaviours of final‐year dental students

Objectives: The objectives of this study of final‐year dental students in 10 classes (1997, 2001—2009) were to examine their self‐reported oral health attitudes and behaviours and describe any trends in these attributes. Participants and methods: Students were surveyed in final semester via an anonymous questionnaire (34 behaviour questions; eight attitude statements). Distributions, trends over time and attitude–behaviour associations were examined. Results: Of 583 students, 459 responded (79%). All tooth‐brushed with fluoride toothpaste; 80% brushed ≥2/day. Overall, 85% flossed; over time flossing behaviour increased significantly (P < 0.05), and those flossing 1—2/day increased (P < 0.005). Over time, significant decreases occurred in those taught toothbrushing (P < 0.001) and flossing (P < 0.05), and in use of mouth rinses (P < 0.05) and tooth cleansing sticks/picks (P < 0.001). Almost all (96%) had received a dental examination; 77% attended a dentist 1—3/year. Between‐meal snacking was common (84%); 71% chewed gum. Although 18% had ever smoked, 5% currently smoked. Most strongly agreed they expected to keep most of their teeth for all their life (76%); their future needs for fillings would be minimal (61%); smoking could adversely affect their teeth or gums (85%); and regular dental attendance was important for their dental health (51%). Congruent attitudes and behaviours favouring oral health were widely held concerning dental attendance, flossing and smoking. Conclusions: Final‐year dental students showed well established, favourable oral hygiene attitudes and behaviours, with evidence to suggest this knowledge was developed whilst in dental school. Despite many ceasing smoking, 5% still smoked. All dental students should receive training in motivational counselling and tobacco cessation to ensure this is included in patient care.     

An exploratory study into whether self-monitoring improves adherence to daily flossing among dental patients

Objectives: This exploratory study evaluated the effectiveness of an action‐control behavioral intervention on adherence to dental flossing in patients with periodontal disease. Action control, that is, monitoring one's behavior and evaluating it against a self‐set standard, has been suggested as a self‐regulatory strategy that can assist people who intend to engage in behavioral change. Methods: In a single‐center, single‐blind prospective trial, 73 dental patients received a behavioral intervention, which was either matched or mismatched to their stage of behavioral change. Through responses to a standardized self‐report measure, participants were classified either as motivational (i.e., not ready to change) or volitional (i.e., contemplating change) with regard to dental flossing. The intervention consisted of a simple self‐monitoring tool for dental flossing in the form of a diary. Flossing frequency, dental plaque, and bleeding scores were measured before and at 4 weeks postintervention. Results: Flossing frequency, dental plaque, and bleeding scores improved (P < 0.001) in both stage‐matched and stage‐mismatched patients. Conclusions: A brief behavioral intervention enhances adherence to dental flossing, regardless of participants' stage of change. Keeping a flossing diary can increase dental flossing and reduce plaque and bleeding scores in patients with periodontal disease, in the short term.     

Oral lichen planus: a condition with more persistence and extra‐oral involvement than suspected?

Background: Lichen planus is a relatively common and often studied chronic mucocutaneous condition. Reports detailing certain aspects relevant to patients affected have been lacking or inconsistent. Methods: A questionnaire‐based survey was employed to assess the duration of oral lesions and the prevalence of self‐reported potential extra‐oral manifestations associated with oral lichen planus in 87 patients. All patients had recognized clinical features of oral lichen planus, and most had had histopathological confirmation following oral biopsy. Results: We report the findings of a preliminary survey which assessed the duration of oral lesions and the prevalence of extra‐oral lesions consistent with lichen planus in patients presenting with oral lesions. The study confirmed the chronic nature of oral lichen planus and the rarity of spontaneous resolution. Most subjects had experienced symptoms for one to ten years (66 patients; 75.8%). Approximately 40% (36 patients) of the sample reported clinical features suggestive of extra‐oral manifestations of lichen planus by the time that their oral lesions were apparent. The most commonly reported extra‐oral manifestations involved the nails (27.6%, 24 patients). 25.3% (22 patients) reported a persistently sore throat suggestive of oesophageal or pharyngeal involvement. Skin (17.2%, 11 patients), and genital (10.3%, 9 patients) involvement was relatively infrequently reported. Most patients reported extra‐oral lesions at only one site. Conclusions: The survey results suggest that in patients with oral lichen planus oral lesions persist for a prolonged period, and that extra‐oral lesions may be more common than suspected. However, further studies involving specialists to examine extra‐oral sites are required.     

A case of squamous cell carcinoma presenting as localized severe periodontitis in the maxillary gingiva

Background: Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity. The clinical features of gingival SCC include alveolar bone loss and erythematous lesion. Therefore, gingival SCC sometimes presents as advanced periodontitis. This case report describes a patient diagnosed with gingival SCC after the extraction of molars presenting as being affected by localized severe periodontitis. Methods: The patient was a 61‐year‐old man whose chief complaint was pain in the left maxillary area. Clinical and radiographic examinations revealed common findings of a periodontal abscess on the left maxillary first and second molars. These teeth were extracted based on a diagnosis of a periodontal abscess. Three months later, a rapidly growing exophytic soft tissue mass was observed, and a biopsy of the mass was performed. Results: According to the biopsy, the final diagnosis was a well‐differentiated SCC. The patient was treated with a partial maxillectomy of the left maxilla and split‐thickness skin graft. Two years after treatment, the patient remained free of recurrence. Conclusions: Gingival SCC is quite different from other forms of SCC, mimicking localized periodontal disease. Therefore, it can be misdiagnosed as localized periodontal disease and is generally discovered after extracting teeth. Therefore, clinicians must diagnose these lesions carefully and follow up with the patient after tooth extraction.     

A case of upper gingiva carcinoma with chronic graft‐versus‐host disease after allogenic bone marrow transplantation

Oral squamous cell carcinoma (OSCC) is one of the most common solid tumours occurring after haematopoietic stem cell transplantation (HSCT), especially in patients with chronic graft‐versus‐host‐disease (cGVHD). We describe a case of OSCC that developed in a 51‐year‐old male 22 years after he had received allogeneic HSCT from his human leukocyte antigen‐identical sister as a treatment for acute myelocytic leukaemia. The patient had presented with multiple white patchy lesions on the palatal gingiva and mucosa 16 years after HSCT; these lesions were consistent with the clinical features of cGVHD. Six years later, oral examination and biopsy revealed upper gingival squamous cell carcinoma (SCC) in areas of cGVHD, and he underwent tumour excision. Follow‐up examination at 2 years and 4 months after the operation revealed no evidence of recurrence of local SCC or metastasis of the cervical lymph node. The current case highlights the susceptibility of patients with cGVHD to the development of OSCC even two decades after HSCT. Therefore, we recommend careful long‐term follow‐up of the oral cavity for patients with cGVHD.     

Periodontal diseases in Greek adults between 1985 and 2005--risk indicators

Aim : This study provides data on the periodontal status of Greek adults aged 35–44‐years‐old in relation to socio‐demographic and behavioural parameters and compares these data with those of 1985. Material and methods : A stratified cluster sample was selected according to WHO guidelines for national pathfinder surveys. Periodontal and oral hygiene status were assessed using the CPI index and the OHI‐S index respectively. Socio‐demographic and behavioural data were collected through face‐to‐face interviews. Results : In 2005, 9.5% of the participants had healthy periodontium, 16.2% bleeding on probing, 46.8% calculus, 24.2% shallow pockets and 3.3% deep pockets. Half of the individuals (52.1%) had good oral hygiene status, 39.8% fair and 8.1% poor. Most of them (79%) brushed their teeth at least once a day, but only 25.4% used dental floss. Higher CPI scores were associated with living in rural areas, having a lower educational attainment and brushing and flossing teeth less frequently. Better oral hygiene status was associated with having a higher educational attainment and income, as well as brushing and flossing teeth more frequently. Comparisons with the 1985 findings indicate that severe periodontal diseases may be declining in Greece, whereas gingivitis may be increasing. Conclusions : The prevalence of severe periodontal diseases in Greek adults is not high and their periodontal health has improved since 1985. As long as their oral hygiene status and preventive dental behaviour cannot be considered as satisfactory, there is room for further improvement.     

Oral self‐care habits of dental and healthcare providers

Abstract: Objective: To evaluate the self‐care level of dental and healthcare providers regarding prevention of oral diseases Methods: Healthcare providers (dental assistants and surgeons, laboratory personnel, biologists, medics, paramedics, corpsmen, nurses, pharmacists, physicians, physiotherapists, psychologists, social workers, speech therapists, X‐ray technicians) and non‐health care providing adults (the general population) were asked to respond to a questionnaire regarding their routine measures for maintaining oral health Results: Three hundred and twenty‐six healthcare providers and 95 non‐healthcare providers participated in the study. Regarding toothbrushing, flossing, undergoing periodic dental examinations and professional scaling/polishing, dental practitioners have better, but not perfect, maintenance habits than other healthcare providers. Non‐dental healthcare providers have better dental habits than the general population, and nurses and medical practitioners have better dental habits than medics, paramedics, corpsmen and para‐medical professionals. Among non‐dental healthcare providers, nurses have a relatively high frequency of toothbrushing and flossing but a low frequency of periodic examinations and scaling/polishing. Generally, females reported significantly higher frequencies of toothbrushing and flossing than males did. The toothpaste selection of the participants was primarily influenced by dentists’ recommendations, the flavour of the toothpaste, and its anti‐malodour effect were the most dominant factors. Conclusion: The compliance of health professionals, especially dental practitioners, with appropriate oral health measures is relatively high. However, the dental team cannot always assume that the dental patient, who also happens to be a healthcare provider, has meticulous oral habits. The dental hygienist and surgeon have to educate and motivate their patients, especially healthcare providers because of the influence of the latter on their own patients.     

Oral tuberculosis: a clinical evaluation of 42 cases

OBJECTIVES: A retrospective review of a large series of oro-facial cases of tuberculosis to analyse clinical, histopathological, and radiological aspects, as well as those of chemotherapy. MATERIALS AND METHODS: A total of 42 cases of tuberculosis of the oro-facial region were examined. Thirteen patients had a primary form and 29 a secondary form of the disease. Diagnosis was based on careful clinical examination, Mantoux reaction, histopathological examination, microbiological cultures and immunological investigation with the detection of antibodies against Mycobacteria in the patients' serum (ELISA). RESULTS: Cases examined consisted of 27 males and 15 females. The age range was 3 to 73 years (mean age 31 years). Clinical manifestations comprised oral ulcers in 69.1%, bone involvement in 21.4%, and salivary gland and/or lymph node involvement in 14.3%. A total of 79.4% patients with secondary disease had pulmonary lesions, 15 of whom showed clinical and radiological signs of activity; there was one case of bilateral renal lesions and two of skin lesions. CONCLUSIONS: Oro-facial tuberculosis is often difficult to diagnose and it should be an important consideration in the differential diagnosis of lesions that appear in the oral cavity. The most important diagnostic tools remain a careful clinical evaluation, biopsy for histologic study, as well as acid-fast stains, culture, and immunological assays, and skin testing.     

Three siblings with juvenile hyaline fibromatosis

Juvenile hyaline fibromatosis (JHF) is an extremely rare hereditary genetic disease of autosomal recessive transmission that is characterized by large cutaneous tumors commonly involving the scalp, papulonodular skin lesions, flexural joint contractures, gingival hyperplasia, and osteolytic bone lesions. JHF is usually diagnosed in young infants and in children younger than 5 years, and the lesions characteristic of this disorder consist of fibrous tissue and homogenous amorphous eosinophilic hyaline material. We report the case of a 9-year-old girl with severe gingival hyperplasia, nasal enlargement, mild osteoporosis, and multiple papulonodular skin lesions. Her two brothers (7 and 13 years of age, respectively) were also diagnosed as having JHF. In the patient described in this report, the maintenance of oral hygiene after gingivectomy enabled the continued resolution of gingival hyperplasia, although skin lesions recurred and nasal overgrowth persisted.     

Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia

Leukemic infiltration of the gingival tissue associated or not with gingival enlargement may be the first manifestation of acute leukemia, despite being rarely reported in the literature. A 10‐year‐old female patient presented with a 1‐month history of an asymptomatic, firm, and pinkish‐red generalized gingival overgrowth. There was no bone resorption. Incisional biopsy of the gingival tissue was performed, with histopathological examination revealing a diffuse and hypercellular infiltration of monocytoid cells. The patient was referred to a hematologist and underwent a bone marrow biopsy, which led to a conclusive diagnosis of acute myeloid leukemia. The patient was treated with chemotherapy and we observed regression of gingival enlargement after 4 weeks from the initial therapy.     

Oral piercing and oral trauma in a New Zealand sample

Abstract –  This study investigated the periodontal and dental trauma resultant from tongue and lip piercings in a convenience sample of 43 adult dental patients. Patients underwent an intra-oral examination followed by the administration of a questionnaire. Each patient was examined for lingual or buccal recession of the upper and lower incisors as well as the extent of abnormal toothwear or trauma on these teeth. Following bivariate analyses, regression analyses were conducted to test the study hypotheses and derive adjusted estimates for the dependent variables. Of the 43 individuals who participated (93.0% females; mean age 21 years; age range 14–34 years) 76.7% had a tongue piercing, 34.9% had a lip piercing, and 11.6% had both. Only four had had their piercing procedure provided by a doctor or dentist. Postpiercing complications were reported by 34.9%. Most of those with a labial piercing (80.0%) had 1+ labial site with gingival recession (GR), and almost one-third of those with a tongue piercing had at least one lingual site with GR. Age was a significant predictor of the prevalence of lingual recession, with the odds of having lingual recession increasing by 1.17 (95% CI 1.01, 1.35) for every year older than 14. Age was the only significant predictor of the number of lingual sites with recession, but was not a predictor of the prevalence of labial recession or the number of affected sites. There were no significant associations between piercings and abnormal toothwear or trauma. These findings suggest that oral piercings are associated with localized gingival recession, and that the providers of such procedures should ensure that, as part of the informed consent process, prospective patients are informed of the likelihood that their periodontal health may be compromised.     

Evaluating the efficacy of a new flossing aid

Abstract The purpose of this clinical trial was to compare the efficacy of a new flossing aid (Flosser®) with finger flossing on preventing plaque and gingival inflammation. 35 adults who did not use dental floss routinely were assigned randomly to one of 2 treatment groups (Flosser® or finger flossing) in a 2-period, single-blind crossover study. After prophylaxis, subjects were instructed to use the flossing aid or finger floss 1 × per day and to continue brushing for 30 days. Gingival inflammation (GI & BPI) and plaque (PI) were assessed prior to the prophylaxis and at 30 days. After a 30 day “washout” period, subjects were again reassessed for gingival inflammation and plaque, given a prophylaxis, assigned the opposite treatment (2nd treatment period) that they received the first treatment period, and assessed (GI, BPI & PI) after 30 days. Comparing the mean difference of the 30-day buccal interproximal scores between the treatment groups (flossing aid scores minus finger flossing scores) showed that the mean differences with 95% CI were: ?0.013±0.067 [GI], ?0.017±0.044 [BP] and 0.019±0.014 [PI]. No statistically significant differences from zero (0.05 alpha) were observed using the t-test. There was a high levei of compliance (90%) with the prescribed regiment, and subjects preferred (56%) the flossing aid slightly over finger flossing. Even though there were no statistically or clinically significant differences in gingivitis and plaque scores between the 2 flossing groups, the positive inclination for the flossing aid makes it a desirable addition to the armamentarium of preventive dentistry.     

Results of a 20-year oral hygiene and prevention programme on caries and periodontal disease in children attended at a private periodontal practice

To cite this article:
Int J Dent Hygiene 9 , 2011; 155–158
DOI: 10.1111/j.1601‐5037.2010.00455.x
Chambrone LA, Chambrone L. Results of a 20‐year oral hygiene and prevention programme on caries and periodontal disease in children attended at a private periodontal practice. Abstract: Objectives: The objective of this study was to evaluate the long‐term effect of an oral hygiene and prevention programme on caries and periodontal disease in a group of children attended at a private periodontal practice. Methods: A total of 50 systemically healthy children, 25 males and 25 females, 03–13 years old, were invited to join a long‐term plaque control programme. All children had no caries and had no evidence of clinical bone loss. The participants were selected amongst children whose parents (mother, father or both) were treated of gingivitis, aggressive periodontitis or chronic periodontitis in a private periodontal practice. Subjects were separated in groups according to their parents’ periodontal diagnosis, i.e., gingivitis, aggressive periodontitis or chronic periodontitis. The following outcomes were evaluated: a) probing depth, b) plaque (PI) and gingival (GI) indexes. The plaque control programme applied consisted of a regular maintenance regime at 6‐to 12‐month interval with an experienced periodontist. Results: In total 30 subjects fulfilled the 20‐year period of maintenance. The mean recall frequency was 6.4 (± 3.1) months, and the mean PI and GI were 0.4 (± 0.3) and 0.3 (± 0.3) respectively. The average rate of caries lesions was 1.0 (± 1.4). None of the patients exhibited clinical or radiographic evidences of alveolar bone loss, and no tooth was lost by caries. In addition, there were no statistically significant differences between groups (P > 0.05). Conclusions: Adequate oral hygiene measures and periodic professional plaque control led to low levels of dental plaque, gingivitis and caries lesions.     

Comparison of the plaque removal efficacy of a new flossing aid (Quik Floss®) to finger flossing

Abstract The purpose of this clinical trial was to compare the effectiveness and safety of a new dental flossing device (Quik Floss®) to finger flossing in plaque removal, reduction of gingival inflammation and patient preference. 30 healthy, non-flossing adults with 20 natural teeth, a plaque index (PI) of at least 1.8 and a gingival index (GI) of 1.3 or greater participated in this two-phase crossover design study. Patients were randomly assigned to use either the new flossing device or finger flossing first in the sequence. At baseline, data were collected and patients were given flossing method instructions. The Silness & Löe GI, Quigley-Hein PI, Eastman Bleeding Index (BI) and trauma were assessed at baseline. 15 and 30 days for each treatment period. After the initial 30-day treatment phase, patients were instructed to cease all flossing during a 14-day “washout” period. Subjects were then assigned to the opposite treatment group during the 2nd treatment phase. A 3-factor repeated measures ANOVA analyzed data for differences within and between groups over time. Results revealed statistically significant (p < 0.01) within group improvement in PI, GI, and BI for both treatment groups over time. No statistically significant between group differences were found for either group at any time period. In addition, no significant gingival trauma was recorded and no differences were found between groups. Quik Floss® was as effective as finger flossing. Subjects preferred (55%) Quik Floss® over finger flossing. In conclusion, Quik Floss® is a safe and effective oral hygiene measure for reducing plaque, inflammation and bleeding over time.     

Stability of Contour Augmentation and Esthetic Outcomes of Implant‐Supported Single Crowns in the Esthetic Zone: 3‐Year Results of a Prospective Study With Early Implant Placement Postextraction

Background: Early implant placement is one of the treatment options after tooth extraction. Implant surgery is performed after a healing period of 4 to 8 weeks and combined with a simultaneous contour augmentation using the guided bone regeneration technique to rebuild stable esthetic facial hard‐ and soft‐tissue contours. Methods: In this prospective study, 20 patients were treated with an implant‐born single crown and followed for 3 years. Clinical, radiologic, and esthetic parameters were recorded to assess treatment outcomes. Results: At the 3‐year examination, all 20 implants were successfully integrated, demonstrating ankylotic stability and healthy peri‐implant soft tissues as documented by standard clinical parameters. Esthetic outcomes were assessed by the pink esthetic score (PES) and white esthetic score (WES) and confirmed pleasing results overall. WES values were slightly superior to PES values. Periapical radiographs showed minimal crestal bone loss around used bone‐level implants with a mean bone loss of 0.18 mm at 3 years. Only two implants revealed bone loss between 0.5 and 1.0 mm. One of these implants had minor mucosal recession <1.0 mm. Conclusions: This prospective study evaluates the concept of early implant placement and demonstrated successful tissue integration for all 20 implants and stable bone‐crest levels around implant–abutment interfaces according to the platform‐switching concept. The midterm 3‐year follow‐up revealed pleasing esthetic outcomes and stable facial soft tissues. The risk of mucosal recession was low, with only one patient showing minor recession of the facial mucosa. These encouraging results need to be confirmed with a 5‐year follow‐up examination.     

Gingival enlargement as a diagnostic indicator in leukaemia. Case report

The acute leukaemias are a group of neoplastic diseases that are characterized by proliferation of immature white cells in the bone marrow and/or blood and are often associated with severe leukopenia, anaemia and thrombocytopenia. Oral manifestations are more common in patients with acute leukaemia. Oral bleeding, gingival enlargement, ulceration and infection in patients with leukaemia have been described. Leukaemic infiltrates in the gingivae are commonly seen in acute monocytic leukaemia. A case of acute monocytic leukaemia in a 34-year-old female who reported with gingival enlargement is presented here. The role of oral lesions as a diagnostic indicator is discussed.     

Multidisciplinary rehabilitation of eosinophilic granuloma with bone graft surgery and a modified implant‐supported hybrid prosthesis: A case report with a 6‐year follow‐up

Eosinophilic granuloma is the most common form of Langerhans cell histiocytosis and corresponds with bone lesions characterized by pain, rapid growth, and high tendency of recurrence after inadequate curettage. It is a rare disease that is difficult to diagnose clinically and radiographically because it mimics other odontogenic cysts and tumors. In this report, the reconstruction of an osseous defect with an iliac graft and a modified implant‐supported hybrid prosthesis after surgical excision of an eosinophilic granuloma in the mandible of a 27‐year‐old male patient was described. The patient was satisfied with the functional and esthetic results of the implant‐supported restoration and a 6‐year follow‐up showed no sign of recurrence.