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PubMed1978

Tetanus--review of the literature and report of case.

This case presents many of the difficulties of management that are inherent in a severe case of tetanus. Also it shows a seldom-considered therapeutic modality, that of dental extraction, gingival debridement, and gingivectomy with a confirmed case of tetanus without an established portal of entry. It is well known that periodontal and periapical locations can easily give rise to an anaerobic focus. In this case, anaerobic culture of C tetani was unsuccessful, possibly because of the inherent difficulty of anaerobic transfer from an oral locus and the extreme fastidiousness of the organism. As a rule, all patients who recover from tetanus do so completely, without any residual deficit. This was true in the case discussed here. Conclusions that can be drawn from this case are the following: a diagnosis of tetanus should be considered in any case of unexplained trismus; aggressive treatment of the immunologic deficit by antitoxin should be instituted along with a course of active immunization; and aggressive symptomatic treatment should be started. The bases of the treatment of this case were management of airways, sedation, treatment of autonomic crisis, and eradication of the causative agent. The result was that a severely ill patient reponded to treatment and completely recovered from a devastating disease.

Aged↗

PubMed1979

Gingival hyperplasia induced by diphenylhydantoin in a gorilla.

An adult male lowland gorilla had been treated with diphenylhydantoin for 6 months following several acute convulsive episodes. The gorilla remained clinically normal during that period. Then, for no apparent reason, it refused its usual diet. Physical examination revealed acute inflammatory gingival hyperplasia. Full mouth gingivectomy and antibiotic and analgesic therapy resolved the oral inflammation and the anorexia.

Animals↗

PubMed1995

A case study of lasers in cosmetic dentistry.

The dental laser offers revolutionary advantages over traditional cosmetic dental treatment for our patients. These advantages include precision, hemostasis, sterility, and minimal postoperative pain and swelling. The laser interacts with tissue to vaporize it in a predictable manner that produces predictable results. It is used in periodontal plastic surgery, gingivectomy, soft-tissue crown lengthening, crown and bridge gingival retraction, composite curing, biopsy, frenectomy, stage II implant recovery, and more. Fixed prosthetic impressions can be taken immediately following gingivoplasty and sutures and postoperative dressings are eliminated. This paper presents a case study in cosmetic dentistry to demonstrate many of these applications and summarizes current opinion regarding them. It also briefly describes what a laser is and how it works.

Adult↗

PubMed1994

Calcium channel blocker-induced gingival hyperplasia: case report and review of this iatrogenic disease.

Gingival hyperplasia is a common disorder associated with phenytoin and cyclosporine therapy. However, induction of this condition by calcium channel blockers is less well known. Inflammation of the gingival tissue from bacterial plaque and the subsequent development of gingival crevicular fluid may allow sequestration of the calcium channel blocker, thus predisposing the tissue to a localized toxic effect and the development of gingival hyperplasia. Calcium channel blockers have cellular effects similar to those of phenytoin and cyclosporine, including the production of a localized folic acid deficiency. All of the available calcium channel blockers have been reported to cause gingival hyperplasia. Treatment options include meticulous plaque control, and in severe cases, gingivectomy. Gingival hyperplasia can be prevented with meticulous plaque control or avoidance of the offending medication.

Aged↗

PubMed1994

[The evaluation of the analgesic and anti-inflammatory effects of flurbiprofen mouthwash and 100-mg tablets in oral medicine].

In stomatology, the use of non-steroidal anti-inflammatory drugs is very frequently reported in case of essential algia, of infections and in post-surgery prevention. In this open controlled study, efficacy and tolerability of two different formulations of a non steroidal anti-inflammatory drug were evaluated in patients requiring extraction of inferior VI molar (limb gingivectomy and osteotomy using a rotatory instrument in molar roots). 40 patients following a randomisation list, were allocated to two balanced groups. In both oral standardised antibiotic therapy was administered and the first group received 1 tablet of flurbiprofen 100 mg twice daily, the second received flurbiprofen mouth wash 10 ml (0.25%) rinsing their mouths 6 times daily for three minutes. The anti-inflammatory and antibiotic treatment started one day before the extraction and lasted for the following three days. Pain symptoms, post-operative edema and healing of the surgical wound were observed. The profile of intensity of pain was similar in the two groups, but improved more rapidly in the group receiving oral flurbiprofen, although the recovery from the edema was achieved quicker with the mouth wash rinses, as well as the healing of the wound. Tolerability was good for both the formulations, in fact no patients stopped the therapy because of adverse events.

Adult↗

PubMed1995

[Hereditary gingival fibromatosis: a case report].

Hereditary gingival fibromatosis is an uncommon congenital anomaly of undetermined etiology, the condition is manifested as a dense, diffuse, smooth or nodular overgrowth of the gingival tissue, usually begins with the eruption of the permanent incisors. However, it may happen as early as the eruption of the deciduous teeth. The case, a 30 years old woman with normal stature, visited our dental clinic because of "overgrown gum" which greatly affected mastication and appearance. A review of her past medical history revealed no relevant diseases. Oral examination showed gross fibrous enlargement of gingival without inflammation or swelling. Her father, two sisters and one daughter also suffered from this disease. Microscopically, there is a obvious increase in the amount of connective tissue that is relatively avascular and consists of densely arranged collagen bundles and numerous fibroblasts. The surface epithelium is thickened and acanthotic with elongated rete pegs. Gingivectomy with flap operation were performed to correct the gingival overgrowth. After periodontal treatment, two fixed partial dentures were constructed to replace the missing right upper and lower first molars. One year after operation, no obvious recurrence was noted clinically.

Adult↗

PubMed1996

An effective treatment for chronic periodontal abscesses.

In the past, chronic periodontal abscess was treated by conventional gingivectomy, flap access procedures, or by extraction of the affect tooth. A modified technique for the treatment of the chronic periodontal abscess is described. A surgical approach is combined with root conditioning with doxycycline. Application of this technique has resulted in rapid, uneventful healing in which neither further tissue breakdown or recurrence of the abscess has occurred.

Anti-Bacterial Agents↗

PubMed1996

Necotizing gingivostomatitis: NUG to noma.

Necrotizing gingivostomatitis (NG) is an increasingly rare but potentially serious infection that can present as a spectrum of clinical disease ranging from necrotizing ulcerative gingivitis to noma. The diagnostic triad for NG is pain, interdental ulceration, and gingival bleeding, but many cases also display fetid breath and pseudomembrane formation. Etiology is believed to be an opportunistic bacterial infection occurring in individuals debilitated by malnutrition, human immunodeficiency virus infection, or other systemic factors, including inadequate sleep, unusual stress, recent illness, alcohol use, and smoking. Treatment for NG includes bacterial control by strict oral hygiene, antiseptic rinses, antibiotic use in selected cases, and correction of predisposing factors. In compliant patients, gingivectomy or gingival grafting may be indicated after initial healing to resolve any residual defects.

Diagnosis, Differential↗

PubMed1994

The evolution of clinical periodontal therapy.

Periodontal diseases are considered as old as the history of mankind, Magical, religious and herbal treatments were demonstrated in almost all of the early writings. However, methodical, carefully reasoned therapeutic approaches did not exist until the middle-ages and modern treatment with a scientific base and sophisticated instrumentation did not develop until the 18th century. Prior to the 1950s, diseases were mostly treated by root debridement and the extraction of the affected teeth. Until the 1970s, it was primarily the symptoms of periodontal diseases that were treated. The goal was radical elimination of the periodontal pocket (resective therapy). The means were gingivectomy, flap procedures and osseous surgery. The disadvantages were the massive sacrifice of periodontal tissues, lack of regeneration and clinically elongated teeth. These disadvantages, along with the realization of the importance of aetiologic agents, raised questions about the necessity of total pocket elimination, and the control of subgingival infection by a thorough scaling and root planing (nonsurgical therapy), with and without antibiotics, became a commonly used treatment during the 1980s. Comparative longitudinal studies, surgical versus nonsurgical, demonstrated that both surgical and nonsurgical therapy result in limited regeneration and healing with a long junctional epithelium. The most important aspects of today's modern concept of periodontal therapy are causal, regenerative, and specific for disease type and severity. Although the regeneration of the periodontium can be accomplished with the biological principles of guided tissue regeneration and graft materials, compared to conventional methods, the restoration of a completely normal periodontal status has not yet been achieved. We are about to reach our ultimate goals and presently, the more promising research directions for a substantial regeneration seems to lie in biological mediators. Although the future of periodontal therapy is bright, it is still of critical importance to have a preventive strategy to keep individuals healthy beforehand.

Gingival Diseases↗

PubMed1994

Clinical evaluation of pulsed ND:YAG dental laser applied on oral soft tissues.

This investigation was conducted to evaluate the pulsed Nd: YAG dental laser, as a surgical tool for many of the oral surgical procedures. Gingivoplasty, minor gingivectomy, operculectomy excision of pedunculated tumors, frenectomy, incision and drainage of oral abscesses, control of oral bleeding and many other procedures were included in the study. The results presented here suggest that the pulsed Nd: YAG laser can be used to cut efficiently through vascular tissues, necrotic tissues and thin pedunculated masses. So it could be considered selective but not conclusive in surgery of the oral soft tissues.

Evaluation Studies as Topic↗

PubMedDate not supplied

[Gingival hyperplasia during treatment with nifedipine].

INTRODUCTION: Nifedipine is a relatively new and increasingly used medication for treatment of all kinds of angina pectoris and arterial hypertension. The principal action of nifedipine is to inhibit the influx of extracellular calcium ions across the membranes of cardiac and vascular smooth muscle cells, without changing serum calcium concentration (1). One of the side effects of this drug is gingival hyperplasia which was first described in 1984 by Lederman (2). He noted that gingival hyperplasia is mostly marked on the labial gingiva of the upper and lower anterior teeth and appeared 1 to 2 months after nifedipine therapy began at a dose of 90 mg per day, and never occurs in edentulous areas. This paper reports gingival hyperplasia in a patient treated with nifedipine. CASE REPORT: A 73-year-old man referred to the dental clinic for evaluation of gingival enlargement in the maxillar left quadrant which he had noticed about 3 months after starting the nifedipine therapy. Clinical examination showed gingival enlargement around the teeth 22, 23, 24 and 27, but with normal edentulous area (Fig. 1). The enlarged gingiva was red, smooth and shiny, with no pain on touch, and bled easily on probing. There were metal crowns with overhanging margins and pseudopockets--6 mm with dental plaque and calculus. Radiographs showed moderate alveolar bone resorption of horizontal type. The patient's maxillar left first premolar exhibited severe bone loss, resulting in a hopeless prognosis. This tooth was extracted under local anesthesia. The dental treatment included replacement of the ill-fitting metal crowns, scaling and root planning, and instructions on appropriate method for brushing teeth. 6 weeks later, the hyperplastic tissues were removed surgically. In a 1-year follow-up period, the patient was recalled at regular intervals for control, and no signs of recurrence of gingival hyperplasia have been observed in spite of continued nifedipine treatment. Biopsies taken from the gingivectomy specimens were handled with standard histological method. Histological examination showed a thick epithelium with parakeratosis and acanthosis, and irregular elongation of the rete peg. The underlying connective tissues contained dense fibers with inflammatory cell infiltrate mainly composed of plasma cells. DISCUSSION: The exact mechanism of action of nifedipine in causing gingival enlargement is unknown at present. There is also no answer to the question why gingival enlargement appears in some patients treated with nifedipine, but in others not. The clinical findings (3, 4, 5, 6, 7) and results of in vitro study (8) and this case report showed that hyperplastic change of gingiva started only in areas displaying signs of inflammation, but not in healthy and edentulous areas. These observations suggest that local factors and associated inflammation is essential for onset of the nifedipine-induced gingival hyperplasa. Moreover, it was suggested that duration of nifedipine therapy (more than 2 months) and drug dosage (90 mg per day) could be important (1,2,3). This case report also demonstrates that no signs of recurrence of hyperplasia were observed after elimination of the local inflammatory factors: extensive dental pluque control and surgical removal of the hyperplastic gingival tissue even though administration of nifedipine was continued. CONCLUSION: It was concluded that gingival enlargement occurs in patients with nifedipine therapy only in the areas where local inflammatory factors are present.

Aged↗

PubMed1951