Severe Chronic Gingivitis in Association With Hypothyroidism and Grade 2 Adenoid Hypertrophy: A Case Report.

Hypothyroidism is the second-commonest endocrine disorder in the world. Similarly, gingivitis is also a highly prevalent oral condition in every population globally. Adenoid hypertrophy and associated mouth breathing may aggravate preexisting gingival inflammation. Here, we are presenting the case of a 22-year-old female gingivitis patient with bleeding from gums on the slightest provocation and with a two-year history of preexisting hypothyroidism. Thorough systemic examinations and investigations ruled out the presence of hematological and/or coagulation disorders. However, she was found to have grade 2 adenoid hypertrophy along with a habit of mouth breathing. Periodontal and systemic management of the patient has resolved her gingival bleeding to a greater extent. Still, there remain a lot of ambiguity and a lack of clarity about the exact etiology and mechanism of pathogenesis behind her oral and general health status. Cases like these pose a diagnostic challenge for the treating dentist or periodontist and thus require a coordinated and collaborative effort of multiple health specialties.

Guided tissue regeneration and orthodontic movement for the treatment of pathological migration in esthetic zone.

Pathological migration is one of the chief complaints of patients-seeking dental treatment. It results in difficulty in mastication, speech, poor esthetic appearance, and decreased self-confidence. The prevalence ranges from 21.73% to 55.8% in patients having moderate-to-severe periodontitis. In this presentation, a 38-year-old adult male, systemically healthy, nonsmoking presented with the complaint of mobility and forward displacement of maxillary anterior tooth causing poor esthetic appearance and low self-esteem. He was treated with the interdisciplinary approach of periodontal and orthodontic intervention. Two-year posttreatment follow-up shows significant improvement in esthetics, periodontal status, and boosted the self-confidence of the patient and improved the oral health-related quality of life. This case emphasizes the importance of regenerative therapy and orthodontic movement for the treatment of periodontally compromised pathologically migrated tooth in adult patient.

An Unusual Simultaneous Occurrence of Diabetes and Hypothyroidism in a Periodontitis Patient: A Case Report.

Periodontal disease, diabetes mellitus, and hypothyroidism are commonly prevalent non-communicable diseases afflicting the human population all over the world, with the added burden on the health care system increasing the overall morbidity. It has been seen through various shreds of evidence that systemic diseases may influence the course of the localized disease and vice versa. Here, we report a case of 38-year-old female periodontitis patient also diagnosed with diabetes mellitus and hypothyroidism. Periodontitis is one of the complications of diabetes. But the occurrence of periodontal disease is a less common intra-oral finding in hypothyroidism as compared to diabetes. All these three chronic diseases were simultaneously observed in this patient, which is a rare occurrence and can adversely affect her overall prognosis. This case report highlights the need for a systematic interdisciplinary approach in the diagnosis and management of such cases.

ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity.

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry "Dentin Hypersensitivity," based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

Management and simultaneous implant placement of maxillary sinus membrane perforation: A report of two cases.

Rehabilitation of the long-standing edentulous posterior maxilla with dental implant poses a unique challenge. This is due to mainly two reasons - pneumatization of the maxillary sinus and atrophy of the alveolar bone. The challenge is intensified when the native bone is around 2-3 mm. This requires vertical bone augmentation in the form of direct sinus lift/lateral wall sinus lift procedure. The most common complication associated with this procedure is the sinus membrane perforation resulting in unfavorable stabilization of the graft and associated bone regeneration. Simultaneous implant placement becomes all the more difficult in such situations. As a result, of which implant placement has to be deferred resulting in extended treatment duration and multiple surgical appointments. The present case report represents two such sinus membrane perforation repair cases associated with lateral wall osteotomy approach for sinus augmentation with simultaneous implant placement in the posterior maxilla.

Three-rooted mandibular first molar: A consideration in periodontal therapy.

A deep understanding of the relationship between root morphology and periodontal destruction is crucial to successful periodontal care. Most mandibular molars have two roots (one mesial and the other distal) and three canals. The major variant of this tooth type is the presence of an additional third root distally or mesially or a supernumerary lingual root. This article presents a case report of a 14-year-old girl with mandibular first molar having three roots bilaterally which is contributing to the periodontal destruction. There were three walled defect distal to first molar with Grade II furcation involvement distally. Regenerative surgeries were performed and patient was kept under maintenance. The relationship between additional third root and periodontal destruction seldom has been described clearly. This paper has been presented in 34(th) national conference at Dharwad.

Gingival plasma cell granuloma.

Plasma cell granuloma is a rare reactive lesion composed of polyclonal plasma cells. It manifests primarily in the lungs, but may occur in various other anatomic locations like the oral cavity. Intraoral plasma cell granulomas involving the tongue, lip, oral mucosa and gingiva have been reported in the past. This case presents a 54-year-old female with chronic periodontitis and mandibular anterior gingival overgrowth treated by Phase I therapy (scaling and root planing) and excisional biopsy. Histological examination revealed inflammatory cell infiltrate containing sheets of plasma cells. Immunohistochemistry for kappa and lambda light chains showed a polyclonal staining pattern confirming a diagnosis of plasma cell granuloma. This case highlights the need to biopsy for unusual lesions to rule out potential neoplasms.

Unusual gingival enlargement with aggressive periodontitis: a case report.

AIM: This article describes the surgical management of a young, female patient with severe gingival enlargement of unknown etiology. BACKGROUND: Gingival enlargement frequently occurs as gingival hyperplasia, representing a reaction to a known stimulus or agent and, histopathologically, implies an increase in both extracellular matrix and cell numbers. The enlargement may range from mild, in which gingival architecture is minimally affected, to severe, in which the gingiva becomes bulbous and covers the clinical crowns of teeth. A number of local and systemic factors, such as plaque, hormonal changes, drug ingestion, and heredity, can cause or influence gingival enlargement. Mild to moderate increase in gingival bulk is relatively common, but massive gingival enlargement with associated bone resorption is rare. CASE DESCRIPTION: This case involved a 19-year-old female patient who presented with generalized severe gingival enlargement with aggressive periodontitis, a condition of some five to six months in duration. RESULTS: Based on a thorough clinical and radiographic examination, laboratory tests, and oral hygiene instructions, an internal bevel gingivectomy was performed to remove excess gingival tissue and areas of bone loss were debrided properly. There was no recurrence eight months following the last surgery. SUMMARY: Although we were not able to identify the exact cause of the gingival enlargement, amelioration of the unusual very soft, friable, enlarged gingivae and the severe periodontal attachment loss was observed. CLINICAL SIGNIFICANCE: Before initiating any periodontal management of a case of severe gingival enlargement with aggressive periodontitis, it is recommended to perform a complete extraoral and intraoral examination with radiographs, take a family and medical history, and determine if any medications may be responsible for the gingival enlargement. Additional testing and analysis, as described in this case, may be necessary.

Conservative management of amlodipine influenced gingival enlargement.

Gingival enlargement is a well recognized unwanted effect associated mainly with anticonvulsant drugs, immunosuppressant drugs and calcium channel blockers. Amlodipine influenced gingival enlargement is comparatively less prevalent amongst calcium channel blockers. It causes aesthetic disfigurement, speech disturbances, abnormal tooth movement and difficulty in mastication. The management of drug influenced gingival enlargement is a challenge for the periodontist, mainly due to less understanding of its pathogenesis, difficulties in selection of proper line of management and recurrence of the enlargement. This report discusses the importance of conservative approach (scaling and root planning along with drug replacement) in the management of a case of amlodipine influenced gingival enlargement. The need for extensive surgery was decreased after this approach.

Bilateral cervicoenamel projection and its management: A case report with lingual involvement.

Bacterial plaque has been implicated as the primary etiological factor in the initiation and progression of periodontal disease. Anatomic factors such as cervical enamel projections, enamel pearls, and developmental grooves are often associated with advanced, localized periodontal destruction. Enamel projections and pearls are mostly associated with molars. Enamel projections in the furcation areas of molars have no true attachment and are therefore highly susceptible to the creation of a deep periodontal pocket. A close association has been reported in the past between enamel projection and furcation involvement. Here, we present a case report with bilateral cervical-enamel projection and its management by flap operation with odontoplasty, and regenerative procedure by placement of graft in the osseous defect. Decreased pocket depth and a gain in clinical attachment level were observed on follow-up.