RESUMO
INTRODUCTION: Papillon-Lefèvre (PLS) and Haim-Munk (HMS) syndromes are rare autosomal recessive type IV palmar plantar keratosis (PPK), which are clinically different from other types of PPK by their association with aggressive periodontitis and genetically by the mode of transmission. CASE PRESENTATION: Two Jordanian sisters, aged 10 and 13 years, from a consanguineous family were preliminarily diagnosed as having PLS by a pediatric dentist who referred them to the periodontal clinic in May 2010 because of the presence of loose teeth and to a dermatologist for the management of existing skin lesions. Physical examination of the two sisters revealed severe bilateral hyperkeratotic lesions on the palms and soles extending to the lateral and dorsal aspects; bilateral pes planus; scaly patches on the knees and elbows; overgrown fingernails and toenails that were curved inward; and range of movement limitations in the fingers. The patients were treated with topical emollients and keratolytic preparations containing salicylic acid for the skin lesions. Oral radiographs showed generalized severe bone loss around the remaining primary and permanent teeth. Oral treatment included dental prophylaxis, chlorhexidine mouthrinse, amoxicillin syrup, and extraction of several teeth. CONCLUSIONS: The two patients in this case report presented atypical symptoms of PLS. Mutational genetic analysis is proposed to confirm whether PLS and HMS are the same or two different symptoms.
RESUMO
BACKGROUND, AIMS: Scoring of supragingival plaque is common to epidemiological studies, oral hygiene assessments and clinical trials of oral hygiene products. These clinical practices utilize indices such as the Turesky et al. (1970, Journal of Periodontology 41, pp. 41-43) modification [Turesky Plaque Index (TPI)] of the Quigley & Hein (1962, Journal of the American Dental Association 65, pp. 26-29) plaque index for evaluating plaque extension. Whilst this index is in common use by clinicians, there is potential for ambiguity in the interpretation of scores by different examiners. The aims of this study were to compare examiner agreement between a new method of plaque scoring (NMPS) and TPI, and to determine if there was a correlation between the two indices. METHODS: Simulated plaque was scored from eight study casts, each consisting of 14 teeth. The two indices were both scored twice from the study casts by eight examiners experienced in plaque scoring. The first readings obtained were analysed for a correlation between the indices and between-examiner variability. Within-examiner variability was assessed using both first and second readings of each index. RESULTS: A positive correlation was found between the two indices (r = 0.717). The NMPS was found to have better inter- and intra-examiner agreement than TPI. CONCLUSION: The NMPS was found to have less variability within and between examiners than TPI: evaluation of NMPS in a clinical setting would now appear warranted.