Oral Manifestations of Commonly Prescribed Drugs.

Drugs are being prescribed with more frequency and in higher quantities. A serious adverse drug event from prescribed medications constitutes 2.4% to 16.2% of all hospital admissions. Many of the adverse drug events present intraorally or periorally in isolation or as a clinical symptom of a systemic effect. Clinical recognition and treatment of adverse drug events are important to increase patient adherence, manage drug therapy, or detect early signs of potentially serious outcomes. Oral manifestations of commonly prescribed medications include gingival enlargement, oral hyperpigmentation, oral hypersensitivity reaction, medication-related osteonecrosis, xerostomia, and other oral or perioral conditions. To prevent dose-dependent adverse drug reactions, physicians should prescribe medications judiciously using the lowest effective dose with minimal duration. Alternatively, for oral hypersensitivity reactions that are not dose dependent, quick recognition of clinical symptoms associated with time-dependent drug onset can allow for immediate discontinuation of the medication without discontinuation of other medications. Physicians can manage oral adverse drug events in the office through oral hygiene instructions for gingival enlargement, medication discontinuation for oral pigmentation, and prescription of higher fluoride toothpastes for xerostomia.

Journey From Black To Pink Gums: Management Of Melanin Induced Physiological Gingival Hyper Pigmentation.

Smile is an expression of happiness, self-confidence, kindness and beauty. Along with teeth and lips, gingiva is also a vital component of smile. Melanin induced gingival hyper pigmentation may appear un-aesthetic especially when it is associated with high smile line, upper anterior labial segment and is uneven in appearance. It affects individuals from all races. Generally, it is believed that melanin induced gingival hyper pigmentation is confined to individuals from dark races. But studies have shown that Iranian, Indian, Italian, Arabian, Greek. German, French, Japanese, Chinese, Jewish, Thai, Malaysian and other ethnic groups also display clinical gingival pigmentation.1 Gingival hyper pigmentation may result in psychological distress especially when the appearance is of utmost importance for the individuals. This article aims to focus on the physiology, clinical appearance and treatment options available for the melanin induced gingival hyper pigmentation along with the reported recurrence in the light of current literature.

HATS syndrome: hemimaxillary enlargement, asymmetry of the face, tooth abnormalities, and skin findings.

Hemimaxillary enlargement, asymmetry of the face, tooth abnormalities, and skin findings (HATS syndrome) is a rare developmental disorder involving the first and second branchial arches. Physical manifestations may present at birth or during early childhood. Characteristic findings include unilateral abnormalities of the face involving the bones, teeth, gums, and skin. Among the characteristic cutaneous manifestations of HATS syndrome, Becker nevus is the most common. A variety of modalities have been utilized in the treatment of HATS syndrome, but no standardized therapy has been established. We report a case of this rare condition in a 14-year-old adolescent boy.

Association of aesthetic and orthodontic treatment in Parry-Romberg syndrome.

Parry-Romberg syndrome (PRS) is an uncommon degenerative condition characterized by a slow, progressive, and, generally, unilateral atrophy of facial tissues, including muscles, bones and skin. Ophthalmological and neurological manifestations have frequently been observed and few oral changes have been reported. This article reports a case of PRS in a 22-year-old woman, exhibiting facial asymmetry, hypoplasia of the right side of the face, areas of skin hyperpigmentation, and oral alterations, involving the mandible and teeth. These clinical and radiological findings led to the diagnosis of PRS. In an attempt to improve the patient's facial aesthetic and the dental functions, oral pentoxifylline, orthodontic rehabilitation, and subcutaneous injections of polymethylmethacrylate microspheres were used as part of the treatment for the facial atrophy. Together, these approaches accounted for a minimal invasive treatment with long term satisfactory results.

Treatment of a Gingival Injury From a Cosmetic Laser Burn: A Case Report.

Gingival depigmentation is a periodontal plastic surgery procedure for the removal of pigmented gingiva. A gingival depigmentation procedure can be accomplished with the use of a laser; however, as described in this case report, laser burns can be associated with such a procedure, and if one occurs it must be subsequently managed. In this case, the patient presented with a large elliptical ulceration at the right maxillary premolar region. The underlying alveolar bone was exposed and the surrounding gingival margins were inflamed. After debridement of the area and removal of sequestrated bone, a bone graft and subepithelial connective tissue graft were placed using a microsurgery technique to correct the defect. This case report is intended to raise awareness regarding the potential complications of laser gingival depigmentation and present a possible treatment approach for such complications.

Ancillary role of vitamin C in pink aesthetics.

A smile expresses feelings of joy, affection and self-confidence in an individual. Melanin hyperpigmentation of the gingiva jeopardises the aesthetics of an individual significantly. In the present case, gingival depigmentation was performed with a surgical scalpel along with local applications of ascorbic acid, yielding satisfactory aesthetic results with low subjective pain levels, and no recurrence has been observed after 9 months of follow-up.

Cutaneous manifestations of endocrine disorders: a guide for dermatologists.

Dermatologists may commonly see skin lesions that reflect an underlying endocrine disorder. Identifying the endocrinopathy is very important, so that patients can receive corrective rather than symptomatic treatment. Skin diseases with underlying endocrine pathology include: thyrotoxicosis; hypothyroidism; Cushing syndrome; Addison disease; acromegaly; hyperandrogenism; hypopituitarism; primary hyperparathyroidism; hypoparathyroidism; pseudohypoparathyroidism and manifestations of diabetes mellitus. Thyrotoxicosis may lead to multiple cutaneous manifestations, including hair loss, pretibial myxedema, onycholysis and acropachy. In patients with hypothyroidism, there is hair loss, the skin is cold and pale, with myxedematous changes, mainly in the hands and in the periorbital region. The striking features of Cushing syndrome are centripetal obesity, moon facies, buffalo hump, supraclavicular fat pads, and abdominal striae. In Addison disease, the skin is hyperpigmented, mostly on the face, neck and back of the hands. Virtually all patients with acromegaly have acral and soft tissue overgrowth, with characteristic findings, like macrognathia and enlarged hands and feet. The skin is thickened, and facial features are coarser. Conditions leading to hyperandrogenism in females present as acne, hirsutism and signs of virilization (temporal balding, clitoromegaly).A prominent feature of hypopituitarism is a pallor of the skin with a yellowish tinge. The skin is also thinner, resulting in fine wrinkling around the eyes and mouth, making the patient look older. Primary hyperparathyroidism is rarely associated with pruritus and chronic urticaria. In hypoparathyroidism, the skin is dry, scaly and puffy. Nails become brittle and hair is coarse and sparse. Pseudohypoparathyroidism may have a special somatic phenotype known as Albright osteodystrophy. This consists of short stature, short neck, brachydactyly and subcutaneous calcifications. Some of the cutaneous manifestations of diabetes mellitus include necrobiosis lipoidica diabeticorum, diabetic dermopathy, scleredema adultorum and acanthosis nigricans.

Management of acne scarring, part II: a comparative review of non-laser-based, minimally invasive approaches.

Acne scarring is a commonly encountered yet extremely challenging problem to treat for the dermatologist. As acne scarring can lead to significant psychological distress and low self-esteem, it is of utmost importance to have effective and satisfying treatments in the physician's armamentarium. However, many treatments are unsatisfying, leading to patient disappointment and frustration. Although early treatment of acne lesions and inflammation with isotretinoin is beneficial in preventing acne scarring, many patients still present with troubling noticeable scars. Despite the advances in pharmacology and technology, scar treatment still remains suboptimal and is tainted with several adverse effects. However, some treatments can provide benefits. This review article exhaustively discusses and analyzes the various minimally invasive approaches to the treatment of acne scarring with an emphasis on pharmacologic agents, such as isotretinoin for atrophic acne scars and corticosteroids and chemotherapeutic drugs for hypertrophic scars. Intralesional injections of corticosteroids are efficacious in reducing keloid scar formation in addition to preventing recurrence following surgical excision. In-office and minimally invasive procedural management, including chemical peels, dermabrasion, tissue augmentation, and punch excision is also discussed. Superficial chemical peels are efficacious in treating atrophic scars with relatively few adverse effects and complications. Although dermabrasion is used less often with the advent of laser resurfacing, this technique remains as a viable option for those with atrophic scars. Post-inflammatory hyperpigmentation can be managed successfully with topical agents such as azelaic acid and hydroquinone. The efficacy of various treatment modalities is highlighted with a focus on choosing the correct modalities for specific scar types.

Peeling gengival / Gingival peeling ­ case report

O objetivo desse trabalho foi relatar um caso clínico de despigmentação melânica utilizando a técnica de peeling gengival com lâmina de bisturi 15C no arco superior. A paciente em questão procurou a clínica queixando-se da cor da sua gengiva. Foi oferecida a ela a despigmentação melânica através da técnica de microabrasão. O resultado cirúrgico alcançado foi extremamente satisfatório quando a gengiva, após 30 dias, se apresentou rósea e seus aspectos de arco côncavo regulares. O pós-operatório vem sendo acompanhado há três meses, não havendo retorno da pigmentação melânica.

The aim of article was to report a case of melanin depigmentation trough the gingival peeling technique using a scalpel blade 15c in the anterior maxillary arch. The patient sought the clinics complaining about the color of its gingiva. After patient authorization, the microabrasion technique was proposed for depigmentation. The surgical result observed 30 days later was extremely satisfactory with a pink color and a regular scalloped margin. The postoperative results have been followed-up for 3 months and the previous tissue color condition did not demonstrate any signs of recurrency..

Estética gengival: despigmentação melânica / Gingival esthetics: depigmentation melanin ­ a case report

As pigmentações melânicas gengivais são manchas escuras localizadas na mucosa mastigatória, resultado da produção excessiva de melanina pelos melanócitos situados na camada basal do epitélio, entre algumas células epiteliais e em algumas células do tecido conjuntivo, podendo comprometer a estética bucal. Podem ocorrer em indivíduos de todas as raças e em fumantes, no entanto, na raça negra sua manifestação é mais frequente. O presente trabalho relatou um caso clínico de remoção cirúrgica de pigmentação melânica em paciente do sexo feminino, pela técnica da mucodermoabrasão com instrumentos manuais e abrasão epitelial com instrumentos rotatórios. A associação das técnicas mostrou-se efetiva na remoção do pigmento melânico, possibilitando satisfação estética ao paciente.

The dark spots of melanin pigmentation are located on the masticatory mucosa as a result of excessive production of melanin by melanocytes located in the basal layer of the epithelium, including some epithelial cells and certain cells in the connective tissue the may compromise the oral aesthetics. It can occurs in all races and in smokers, being, however, its prevalence higher in black patients. This paper reports a case of surgical removal of melanin pigmentation in female patient by manual dermabrasion and epithelial abrasion with rotary instruments. This combination proved to be effective to remove the melanin pigmentation, which allowed for patient esthetic satisfaction.

Chronic pigmented purpura associated with odontogenic infection.

Five patients with chronic pigmented purpura associated with odontogenic infection are described. Four patients had Schamberg's disease, and one had itching purpura. These patients were resistant to topical corticosteroid treatment, but appearance of purpuric spots ceased after treatment for periodontitis, pulpitis, or both. No circulating immune complexes were detected, and neither immunoglobulin nor complement was deposited in the papillary vessels of the skin. Odontogenic infection might be one of the precipitating factors for chronic pigmented purpura.

Tratamento de pigmentação melânica racial por meio de três técnicas distintas / Surgical treatment of racial melanin pigmentation by three distinct techniques. Case report

A pigmentação melânica racial é o resultado da produção excessiva de melanina pelos melanócitos situados na camada basal do epitelio. Em algumas situações, mesmo sendo uma condição fisiológica, pode causar um problema estético aos pacientes. A despigmentação gengival pode ser realizada por meio de técnicas cirúrgicas manuais ou rotatórias, uso de substâncias químicas, criocirurgia e laserterapia. 0 objetivo do presente artigo foi descrever um caso clínico de pigmentação melânica racial tratada por meio de três técnicas cirúrgicas, comparando-as com relação à sua efetividade. Após seis meses de acompanhamento, observou-se resultado clínico favorável e similar com as técnicas utilizadas e satisfação estética relatada pela paciente.

Tratamento de pigmentação melânica gengival por abrasão epitelial: relato de casos clínicos / Epithelial abrasion for the treatment of melanin gingival pigmentation: report of clinical cases

A hiperpigmentação melânica gengival não representa uma patologia, mas pode ser um problema estético para muitos indivíduos, especialmente quando associada à linha de sorriso alta. Existem várias alternativas de tratamento, incluindo a abrasão epitelial. O objetivo deste trabalho é apresentar uma condição clínica de hiperpigmentação melânica gengival tratados pela técnica da abrasão epitelial com instrumentos rotatórios. A técnica de abrasão epitelial mostrou-se efetiva na remoção do pigmento melânico, possibilitando satisfação estética aos pacientes. O acompanhamento pós-operatório mostrou que existe a possibilidade de repigmentação localizada à longo prazo.

Gingival melanin hyperpigmentation does not represent a medical problem, however it may cause an aesthetic problems, especially to those with gummy smiles. Epithelium abrasion represents one of the various techniques to remove melanin hyperpigmentation. The aim of the present paper is to present a-2-case-reports of treatment of gingival melanin hiperpigmentation by abrasion technique using a large, round diamond bur in a high-speed handpiece with abundant saline irrigation. The technique resulted in a successful depigmentation and patients satisfaction was impressive. However, during the follow-up, it was observed the possibility of partial repigmentation.