Juvenile Hyaline Fibromatosis: A 10-year Follow-up.

Juvenile hyaline fibromatosis (JHF) is a rare hereditary disease with an autosomal recessive transmission. JHF is characterized by papulonodular skin lesions, osteolytic bone lesions, flexural joint contractures, and gingival hyperplasia and usually diagnosed in infancy or early childhood. JHF is thought to be a disorder of collagen metabolism and characterized by homogenous amorphous eosinophilic material and fibrous tissue. We report the case of a 14-year-old male child with multiple papulonodular skin lesions, progressive flexion contractures of joints, and severe gingival hyperplasia, with a 10-year follow-up. Although the lesions were totally removed thrice during the last 10 years, they recurred rigorously.

Proinflammatory and anti-inflammatory cytokines in gingival crevicular fluid and serum of patients with rheumatoid arthritis and patients with chronic periodontitis.

BACKGROUND: The aim of this study is to evaluate proinflammatory and anti-inflammatory cytokine levels in gingival crevicular fluid (GCF) and serum of rheumatoid arthritis (RA) and chronic periodontitis (CP) patients to assess whether cytokine profiles distinguish patients with RA and patients with CP while using healthy patients as background controls. METHODS: A total of 49 patients, 17 patients with RA (three males and 14 females; mean age: 47.82 ± 10.74 years), 16 patients with CP (10 males and six females; mean age: 44.00 ± 7.00 years), and 16 controls (eight males and eight females; mean age: 28.06 ± 6.18 years) were enrolled. Patients with RA were under the supervision of rheumatologists; 15 of the patients with RA were being treated with methotrexate-sulfasalazine combined therapy, and two of the patients were being treated with leflunomid therapy. Periodontal parameters (plaque index, gingival index, probing depth, and clinical attachment level) were recorded. Interleukin (IL)-1ß, IL-4, IL-10, and tumor necrosis factor-α (TNF-α) were determined in GCF and IL-1ß and IL-10 in serum by enzyme-linked immunosorbent assay. RESULTS: There were significant differences found among RA, CP, and control groups for all periodontal parameters (P <0.05). The total amount and concentration of GCF IL-1 ß, IL-4, IL-10, and TNF-α were similar in RA and CP patients (P >0.05). Although the total amount and concentration of serum IL-10 was not significantly different among the groups (P >0.05), serum IL-1ß was significantly lower in the RA group compared to CP patients and controls and was higher in GCF of the RA group compared to the CP group. CONCLUSIONS: Although clinical periodontal disease parameters indicated more severe periodontal disease in CP compared to RA patients, immunologic evaluation did not reveal consistent results regarding proinflammatory and anti-inflammatory cytokine levels. This might be a result of the use of non-steroidal anti-inflammatory drugs and rheumatoid agents by patients with RA.

Coronectomy in patients with high risk of inferior alveolar nerve injury diagnosed by computed tomography.

PURPOSE: Previous studies have suggested coronectomy as an alternative procedure to decrease the risk of inferior alveolar nerve (IAN) injury when there are high-risk findings observed on panoramic radiographs. However, the exact relation between the inferior alveolar canal and the roots is not obvious on 2-dimensional imaging. The aim of this study was to evaluate the success of coronectomy by comparing it with conventional extraction for the treatment of the patients who had clear IAN injury risks that were determined on 3 dimensions by computed tomography. PATIENTS AND METHODS: Two hundred and sixteen teeth of 124 patients were evaluated by computed tomography and 175 teeth of 120 patients were enrolled in the study. Teeth were divided into an extraction group (n = 87) and a coronectomy group (n = 88) according to the operations planned. RESULTS: The mean follow-up time of the study was 17.29 months. There were 2 patients in the extraction group who had moderate IAN injuries that resolved in 1 month. Also 1 case of dry socket was observed in the extraction group and 1 patient in the coronectomy group had minor infection 1 month postoperatively, which was treated with antibiotics and subgingival irrigations. There were 2 failed coronectomies and neither had any postoperative complications. No cases of lingual nerve injury were noted in this study. CONCLUSIONS: Coronectomy appears to be a preferable alternative with a low incidence of complications and therefore a suggested technique for the treatment of impacted mandibular molars when there is a high risk of IAN injury.

Nitric oxide in gingival crevicular fluid and nitric oxide synthase expression in the gingiva of patients with sickle cell disease.

OBJECTIVE: This study aimed to biochemically measure the production of nitric oxide in gingival crevicular fluid and immunohistochemically measure the expression of inducible nitric oxide synthase in the gingiva of patients with sickle cell disease. Additionally, we aimed to obtain insight into the immunopathology of sickle cell disease by comparing inducible nitric oxide synthase levels in patients with sickle cell disease and controls using gingiva and gingival crevicular fluid. METHODS: The study included 20 sickle cell disease patients and 20 healthy controls. Immunohistochemical analysis was used to measure inducible nitric oxide synthase expression in gingiva and nitric oxide levels in gingival crevicular fluid were spectrophotometrically measured. RESULTS: Nitric oxide levels in the patients and controls did not differ significantly (21.2±4.5 and 23.1±2.3 µM L-1, respectively, p>0.05). There weren't any statistically significant differences in infiltrated inflammatory cells, density of inflammatory cells that stained with inducible nitric oxide synthase, or nitric oxide expression in gingiva between the patient and control groups (p>0.05). CONCLUSION: To the best of our knowledge this is the first study to examine the expression of inducible nitric oxide synthase in the gingiva and gingival crevicular fluid in patients with sickle cell disease. Using the gingiva and gingival crevicular fluid we were unable to observe sickle cell disease-associated inducible nitric oxide synthase expression and a difference in nitric oxide levels.

Nitric oxide synthase in gingival tissues of patients with chronic periodontitis and with and without diabetes.

BACKGROUND: The purpose of this study was to evaluate the expression of inducible nitric oxide synthase (iNOS) in the gingival tissues of periodontitis patients with and without type 2 diabetes to assess whether NO plays a role in the severity of periodontitis in patients with diabetes. Patients with diabetes and healthy patients were used as controls. METHODS: A total of 80 patients were evaluated in four groups (with 20 subjects each): patients with chronic periodontitis and diabetes (12 males and eight females; mean age, 52.1 +/- 6.9 years), patients with chronic periodontitis who were otherwise healthy (12 males and eight females; mean age, 43.1 +/- 8.9 years), periodontally healthy patients with diabetes (12 males and eight females; mean age 50.9 +/- 6.3 years), and systemically and periodontally healthy control subjects (12 males and eight females; mean age 29.8 +/- 9.2 years). Periodontal parameters were recorded. Immunohistochemistry was used to detect inflammation and iNOS expression in gingival tissues. RESULTS: Although periodontal parameters were slightly higher in periodontitis compared to diabetic periodontitis, immunohistochemical parameters were higher in diabetic periodontitis compared to periodontitis. All periodontal parameters were higher in patients with periodontitis and with/without diabetes compared to controls and patients with diabetes. All immunohistochemical parameters were higher in patients with diabetes and periodontitis compared to patients with only diabetes or periodontitis, but there was no difference between the latter two groups. There was a correlation between the expression of iNOS and inflammatory cells in controls, patients with diabetes, and patients with periodontitis but not in patients with diabetes and periodontitis. CONCLUSIONS: Inflammation and iNOS expression were more prominent in the gingiva of the patients with both diabetes and periodontitis. However, iNOS expression did not seem to have an additional detrimental effect on the course of periodontitis in patients with diabetes compared to those with periodontitis alone.

Alport syndrome: significance of gingival biopsy in the initial diagnosis and periodontal evaluation after renal transplantation.

Alport Syndrome (AS) is an important hereditary disorder affecting the glomerular basement membrane. Diagnosis of AS is based on the presence of hematuric nephropathy, renal failure, hearing loss, ocular abnormalities and changes in the glomerular basement membrane of the lamina densa. The aims of this case report were to show the changes in the gingival tissues in a patient with AS under therapy with cyclosporin-A after renal transplantation and to discuss the possible role of type IV collagen in gingival basal lamina as an alternative approach for the diagnosis of AS. A 20-year-old male patient with AS underwent periodontal therapy including a series of gingivectomy surgeries. Gingival samples obtained during the second surgery were examined histopathologically and by transmission electron microscopy for further pathological examination. Gingivectomy procedures have been performed every 6 months over the last 4 years. The excessive and fibrous gingival enlargements resulted in migration of the anterior teeth, but no alveolar bone loss occurred. This is the first report to demonstrate the possible changes in the gingival tissues caused by AS. It is suggested that gingival biopsy can be an initial diagnostic tool instead of renal or skin biopsies. Proper dental and periodontal care and regular visits to the dentist could provide limited gingival hyperplasia to patients with AS.

Alport syndrome: significance of gingival biopsy in the initial diagnosis and periodontal evaluation after renal transplantation

Alport Syndrome (AS) is an important hereditary disorder affecting the glomerular basement membrane. Diagnosis of AS is based on the presence of hematuric nephropathy, renal failure, hearing loss, ocular abnormalities and changes in the glomerular basement membrane of the lamina densa. The aims of this case report were to show the changes in the gingival tissues in a patient with AS under therapy with cyclosporin-A after renal transplantation and to discuss the possible role of type IV collagen in gingival basal lamina as an alternative approach for the diagnosis of AS. A 20-year-old male patient with AS underwent periodontal therapy including a series of gingivectomy surgeries. Gingival samples obtained during the second surgery were examined histopathologically and by transmission electron microscopy for further pathological examination. Gingivectomy procedures have been performed every 6 months over the last 4 years. The excessive and fibrous gingival enlargements resulted in migration of the anterior teeth, but no alveolar bone loss occurred. This is the first report to demonstrate the possible changes in the gingival tissues caused by AS. It is suggested that gingival biopsy can be an initial diagnostic tool instead of renal or skin biopsies. Proper dental and periodontal care and regular visits to the dentist could provide limited gingival hyperplasia to patients with AS.

Oral health-related quality of life and periodontal health status in patients undergoing hemodialysis.

BACKGROUND: Health-related quality of life (HRQOL) is a multidimensional concept regarding quality of life (QOL) as it relates specifically to health and disease. The effect of ongoing hemodialysis on a person's oral health can be determined by clinical variables, but these do not reflect the person's perception of health versus illness. The authors conducted a study to determine the periodontal status, attitude toward oral health and self-perceived oral health in patients undergoing hemodialysis, as well as to evaluate the effect of oral health on QOL within this group. METHODS: Patients undergoing hemodialysis were evaluated for socio-demographic and periodontal variables. The authors evaluated oral health-related quality of life (OHRQOL) by means of the short-form Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI). They measured perceived oral health by asking a single question. RESULTS: The study involved 47 patients undergoing hemodialysis. Plaque index score, gingival index score, probing depth and bleeding-on-probing status were 2.21 +/- 0.66, 1.24 +/- 0.77, 2.17 millimeters +/- 0.53 mm and 33.51 percent +/- 24.58 percent, respectively. Participants reported being uncomfortable when eating or swallowing. Participants reported being sensitive to hot or cold (69.8 percent), having a worse sense of taste (90.8 percent) and having painful aching in the mouth (72.1 percent). The mean OHIP-14 and GOHAI scores were 19.40 +/- 7.74 and 15.72 +/- 8.68, respectively. CONCLUSIONS: The self-perceived health of 72.7 percent of participants undergoing hemodialysis was fair or poor, and the impact of OHRQOL was moderate, which means that oral health was not a major concern. These results underscore the importance of using subjective and self-reported oral assessments to determine more convenient and satisfying treatment approaches for each patient. CLINICAL IMPLICATIONS: Clinicians should use oral health assessment tools to determine individual treatment and approaches to promote the oral health of patients undergoing hemodialysis and improve their QOL.

Long-term clinical evaluation and SEM analysis of the e-PTFE and titanium membranes in guided tissue regeneration.

AIM: This study aimed to evaluate clinical outcomes of titanium membrane and compare these findings with clinical outcomes of e-PTFE membrane, and to investigate the effect of bacterial contamination on both membranes with SEM during long-term healing. RESULTS: Sixteen titanium and sixteen e-PTFE membranes were surgically placed adjacent to periodontally involved teeth. Seven titanium and 8 e-PTFE membranes were exposed between 4 and 6 weeks. There were no significant difference between groups for plaque and gingival index. Probing depth and clinical attachment level (CAL) were decreased in both groups when compared with baseline; however, these differences were not statistically significant. The CAL gains between the groups were statistically different in 3rd, 6th, 9th, 12th, and 24th months (p < 0.05), and the CAL gain was significantly higher in titanium membrane (p < 0.05). There was significant decrease in bleeding on probing from baseline in both groups (p < 0.05). Surfaces of 15 membranes were studied using SEM. The largest amount of bacteria was found on the external cervical surfaces of 15 exposed specimens. The entire surface showed the presence of slough epithelial cells, leukocytes, red blood cells, yeast, and microbial plaque. Thirteen external mid surfaces of the 15 specimens, external apical surfaces of three e-PTFE and 1 titanium membrane, internal collar surfaces of all specimens, internal mid surfaces of 5 e-PTFE and three titanium membranes and internal apical surface of only one e-PTFE membrane were infected. CONCLUSIONS: This study demonstrated that titanium membrane is equivalent to e-PTFE membranes for GTR in the treatment of periodontal defects.

Pain perception and anxiety during scaling in periodontally healthy subjects.

BACKGROUND: Dental pain, anxiety, and fear may result in avoiding dental treatment. In this study, we aimed to evaluate patients' pain perception during scaling and its relationship with dental anxiety. METHODS: One hundred thirteen patients (72 women and 41 men; mean age, 35.59 +/- 9.28 years) participated. Pain levels after scaling were assessed with a visual analog scale (VAS) and an anxiety questionnaire consisting of seven questions, each with five possible answers. RESULTS: The patients were asked to indicate their pain level on a 100-mm VAS, and the mean VAS score was 19.91 +/- 17.76 mm. No age and gender differences with regard to pain perception were found. VAS scores were significantly higher in non-smokers (P <0.001); there was a slightly significant relationship between smoking and pain (0.264; P <0.05). The anxiety score ranged from 7 to 35; the mean anxiety score was 14.00 +/- 5.30 (range, 7 to 29). The anxiety score was significantly higher in women (P <0.001). The only question correlated with pain during scaling in men was, "How fearful are you of having your teeth cleaned?" (0.322; P = 0.040). Scores for patients aged 29 to 39 years were significantly higher than scores for those aged 51 to 61 years (P <0.01). CONCLUSIONS: Although most patients experienced limited pain during scaling, a significant relationship was found between pain and smoking. Women and patients aged 30 to 40 years are likely to be more anxious during scaling. The question, "How fearful are you of having your teeth cleaned?" may not adequately cover all aspects of anxiety for patients' experience of pain during scaling. Clinicians should determine individual treatment approaches to reduce patients' fear, pain, and anxiety related to scaling.

Interleukin-1 and tumor necrosis factor-alpha gene polymorphisms in Turkish patients with localized aggressive periodontitis.

Localized aggressive periodontitis (LAgP) is a complex multifactorial periodontal disease to which genetic factors are thought to predispose individuals. Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) are potent immunomodulators and proinflammatory cytokines that have been implicated in the pathogenesis of autoimmune and infectious diseases and proposed to be risk factors for LAgP. Our aim was to investigate IL-1 alpha (+4845), IL-1 beta (+3954), and TNF-alpha (-308) gene polymorphisms in Turkish LAgP patients. We genotyped 31 LAgP patients and 31 healthy controls for IL-1alpha(+4845), IL-1beta(+3954), and TNF-alpha(-308) using standard PCR amplification followed by restriction enzyme digestion and gel electrophoresis. Higher prevalence of heterozygosity for IL-1alpha(+4845) was found in cases (65%) when compared to controls (35%) (P < 0.05). While homozygous allele 1 of IL-1beta(+3954) was the most frequent genotype in cases (62%), no controls were homozygous for this allele (P < 0.001). Homozygous allele 1 was the most common TNF-alpha genotype in both groups, however no significant difference in TNF-alpha genotypes was found between groups. In conclusion, in this Turkish population, susceptibility to LAgP is increased by heterozygosity for allele 1 of IL-1alpha(+4845) or homozygosity for allele 1 of IL-1beta(R+3954). Moreover, IL-1 gene polymorphisms appear to have a role in susceptibility to LAgP, and the above-mentioned genotypes could be an important risk factor for LAgP in the Turkish population.

Combined therapy in a patient with Papillon-Lefèvre syndrome: a 13-year follow-up.

BACKGROUND: Papillon-Lefèvre syndrome (PLS) is an autosomal recessive disease characterized by hyperkeratosis of the palms and soles combined with premature loss of the primary and permanent dentition. Several treatment regimens have been recommended in the literature; however, a definitive treatment protocol has not been established. This case report evaluates the success of combined therapy in managing a patient with PLS. METHODS: A 6-year-old girl diagnosed with PLS presented with aggressive periodontal destruction of her primary and permanent dentitions. After extraction of periodontally affected teeth, the edentate region was rehabilitated with different temporary dentures until her skeletal growth was complete. At the same time, her orthodontic treatment was performed. The early loss of her incisors resulted in inadequate alveolar bone height and width for esthetic-advanced prosthetic rehabilitation. Alveolar bone augmentation was performed, and 6 months later, two intraosseous dental implants were placed into the central incisor zone. RESULTS: After 13 years of treatment and follow-up, the patient had periodontally healthy permanent dentition. She had practiced meticulous oral hygiene, and the orthodontic treatment was successful and without incident. Alveolar ridge augmentation and placement of an intraosseous implant with guided bone regeneration were performed successfully. CONCLUSIONS: This case report demonstrates that individually developed treatment protocols can provide long-term dental/periodontal success in patients with PLS. A multidisciplinary approach with advanced periodontal surgery, orthodontic and prosthetic treatment, and implant therapy may be an appropriate treatment modality for dental rehabilitation in patients with PLS.

Excessive gingival bleeding in two patients with Glanzmann thrombasthenia.

BACKGROUND: Glanzmann thrombasthenia (GT) is an exceedingly rare but well-defined inherited disorder of platelet function caused by a defect in the glycoprotein IIb/IIIa complex. The association of GT with consanguinity has been noted, especially in geographic regions in which intermarriage is common. In most patients, GT is diagnosed during early infancy or before the age of 5 years. Common manifestations of this disorder are gingival hemorrhage, purpura, epistaxis, petechiae, and menorrhagia. Chronic, prolonged, untreated, or unsuccessfully treated bleeding may be life threatening. METHODS: We report two female patients with GT who were referred by our hematology clinic to our periodontology department for the treatment of excessive gingival bleeding. The first patient was treated with a platelet transfusion and underwent periodontal therapy (scaling and root planing and dental polishing). The second patient, whose GT was undiagnosed at the time of her referral to our department, applied to our emergency service because of uncontrolled gingival bleeding that developed after scaling and root planing was performed by her dentist. Both patients had been called for regular dental visits. RESULTS: All treated sites healed without complications. The first patient was monitored for 2 years, during which she practiced proper oral hygiene and experienced no periodontal complications. The other patient did not participate in follow-up. CONCLUSIONS: Gingival bleeding is usually the first sign of most hematologic disorders, and dentists must be alert for the signs of unusual gingival bleeding. In such cases, collaboration with a hematologist is essential. Under the proper circumstances, periodontal treatment can be performed with an acceptable outcome. With proper oral hygiene, we believe that there will be no complications and no gingival bleeding.

From alveolar diffuse atrophy to aggressive periodontitis: a brief history.

Technologic advances in mechanics, electronics, physics, chemistry, and computer science have contributed to advances in dental medicine. Periodontology is not only a clinical science but is also directly related to the basic sciences. Research is conducted in laboratories rather than in clinics now. During the last century, aggressive periodontitis has received attention from numerous researchers because of its multifactorial features. This paper explores the long scientific journey of aggressive periodontitis, beginning with its first definition as alveolar diffuse atrophy. Perhaps in the future, "alveolar diffuse atrophy" will be referred to by another name or term. However, this journey will never end.