A long-term longitudinal study of gingival recession in dentists: A 15-year follow-up.

OBJECTIVES: To assess the prevalence, distribution pattern, and development/progression of gingival recession in a population of dentists, followed up over an additional 15 years, after an initial and previously published follow-up of 10 years. METHODS: This 25-year longitudinal gingival recession investigation started in 1994 at the Dental School with 60 final-year dental students; among them, 40 were re-examined in 2004, and 27 of those 40 were further examined in 2019 by the same examiner. A questionnaire session provided information on toothbrushing habits at each appointment. RESULTS: In this study, 27 individuals aged 31-44 years (724 teeth) were followed up. The prevalence of gingival recession was 100% after 15 years. A total of 204 and 317 recessions found in 2004 and 2019, respectively, were valid for the longitudinal evaluation. The highest recession incidence was observed in the molars during both examinations (p < 0.0001). The mean recession heights were 1.66 ± 0.87 mm and 1.85 ± 1.08 mm, respectively (p = 0.024). The difference between the means was 0.19 mm after 15 years. The mean probing depth and bleeding on probing at the point of the maximum recession decreased (p < 0.0001). A multiple regression analysis on the tooth level was performed and indicated that the keratinized gingival width was negatively associated with the severity of the buccal recession height. CONCLUSIONS: Fifteen years after the initial follow-up, the mean number of gingival recessions per dentist and the mean recession height increased, while toothbrushing habits remained nearly unchanged.

Pénfigo sifilítico: reporte de un caso

RESUMEN La sífilis congénita (SC) es el resultado de la infección producida por el Treponema pallidum al feto, en una madre con sífilis gestacional (SG). La enfermedad puede ser asintomática en el 60% de los recién nacidos (RN) afectados, siendo además difícil de diagnosticar clínica e histológicamente, porque tanto sus patrones clínicos como histológicos, pueden imitar otras enfermedades dermatológicas del RN. Siendo la SC una enfermedad prevenible, siguen presentándose casos con manifestaciones clínicas severas. Presentamos el caso de un RN con SC de presentación grave desde el nacimiento, con manifestaciones cutáneas que incluyeron múltiples lesiones tipo vesículas y bulas, con zonas hemorrágicas y áreas denudadas con maceración, descamación y costras, de predominio en palmas y plantas, compatibles con pénfigo sifilítico. Reconocer las diversas manifestaciones clínicas, en especial las cutáneas, es fundamental para realizar un diagnóstico oportuno de SC en RN y lactantes.

ABSTRACT Congenital syphilis (CS) is the result of an fetal infection caused by Treponema pallidum, in a mother with gestational syphilis (GS). The disease can be asymptomatic in 60% of affected newborns (NBs), and is also difficult to diagnose clinically and histologically, because both its clinical and histological patterns can mimic other dermatological diseases of the NB. Since CS is a preventable disease, cases with severe clinical manifestations continue to appear. We present the case of an NB with severe CS presenting from birth, with skin manifestations that included multiple vesicle and bulla-like lesions, with hemorrhagic areas and denuded areas with maceration, scaling and scabs, predominantly on the palms and soles, compatible with syphilitic pemphigus. Recognizing the various clinical manifestations, especially skin manifestations, in this disease, is essential to make a timely diagnosis of CS in newborns and infants.

Effect of the Addition of Saccharomyces Cerevisiae Yeast Cell Walls to Diets with Mycotoxins on the Performance and Immune Responses of Broilers.

This study was conducted to evaluate the effect of Saccharomyces cerevisiae yeast cell walls (YCWs) in diets with low doses of aflatoxin B1 (AFB1) and ochratoxin A (OTA), alone or in combination, on broiler performance and immune response. A total of 210 male broilers aged 1-21 days were used. Broilers were completely randomized into seven treatments with five replicates of six broilers each, as follows: 1) control diet; 2) control + 350 µg/kg AFB1; 3) Control + 350 µg/kg OTA; 4) Control + 350 µg/kg AFB1 and 350 µg/kg OTA; 5) Control + 350 µg/kg AFB1 and 1.5 kg/ton YCW; 6) control + 350 µg/kg OTA and 1.5 kg/ton YCW; 7) control + 350 µg/kg AFB1, 350 µg/kg OTA, and 1.5 kg/ton YCW. The broilers were housed under environmentally controlled conditions in Petersime battery cages. Weight gain, feed intake, and feed conversion index were measured. The relative weights of the thymus, spleen, and bursa of Fabricius (BF) were evaluated. The local immune response was assessed by quantifying the level of intestinal immunoglobulin A (IgA). The cellular immune response was evaluated using a delayed hypersensitivity test. Hemograms and blood cell counts were also performed. The results showed that mycotoxins decreased performance and reduced the immune response (p<0.05) of broilers. Weight gain and feed conversion improved in the groups receiving YCWs. The YCWs increased (p<0.05) intestinal IgAs and the cellular immune response (p<0.05). The addition of YCWs also affected the relative weight of the thymus, spleen, and BF (p<0.05), and the leukocyte, lymphocyte, and heterophil counts (p<0.05). The addition of YCWs can be an alternative to counterage the negative effect of low doses of AFB1 and OTA in broilers diets.

Assessment of arterial stiffness in periodontitis using a novel pulse wave imaging methodology.

AIM: We investigated the cross-sectional relationship between periodontal status and arterial stiffness, assessed through a novel Pulse Wave Imaging methodology. METHODS: Eighty volunteers were enrolled (39% male, age range 24-78 years) and 33 pairs were formed of periodontitis patients/periodontally healthy controls, matched by age and gender. A full-mouth periodontal examination was performed and the degree of stiffness of the right and left carotid arteries was assessed by measuring pulse wave velocity (PWV) and the uniformity in pulse wave propagation (R2 ). Wilcoxon signed-rank tests for paired observations were used to compare periodontitis patients and healthy controls. Univariate and multivariate analyses were performed to analyze the association between PWV and R2 and potential explanatory variables. RESULTS: Patients with periodontitis had a statistically significantly lower uniformity in wave propagation (R2 ) than controls (p = .01), but PWV did not differ between the two groups. Univariate analysis showed a significant negative association between R2 and periodontitis, body mass index and smoking; periodontitis remained statistically associated with R2 in the multivariate analyses. CONCLUSIONS: Patients with periodontitis and no established cardiovascular disease presented with lower degree of uniformity in the transmission of the pulse wave through the carotid arteries, suggesting an association between periodontitis and arterial stiffness/functional alterations.

An unexpected presentation of a traumatic wound on the lower lip: a case report.

INTRODUCTION: Traumatic lip injuries present major challenges in terms of reconstructive options and the outcome of surgical management. The aetiology of lip injuries includes human bite as interpersonal violence. Bite wounds are always considered to be complex injuries contaminated with unique polymicrobial inoculum. A classification of facial bite injuries has been included and the surgical management of these lesions has also been discussed. We report a rare bite injury on the lower lip that resembled an ulcerative process. CASE PRESENTATION: A 30-year-old African man presented with a severe tissue defect on his lower lip to a Dental and Oral Department in Tanzania. He explained that 12 days ago he had been involved in a fight and someone had bitten his lower lip. An orofacial examination confirmed a serious loss of lip tissue that resembled a chronic ulcerative process. Accurate assessment of the lesion was made by a thorough evaluation of some parameters such as size, depth, presence of granulation tissue, fibrin coverage, wound edges, exudates and/or necrosis. A surgical debridement under local anaesthesia was carried out. Afterwards a layered suture was performed. Eventually the healing was complete and satisfactory. CONCLUSIONS: A severe bite avulsive wound on the lower lip, despite the elapsed time before treatment, may have an excellent prognosis after a simple surgical procedure.

Ten-year longitudinal study of gingival recession in dentists.

AIM: To assess the prevalence and progression/regression of gingival recession in a population sample with a high standard of oral hygiene and broad knowledge of the role of traumatic tooth brushing in the aetiology of gingival recession. MATERIAL & METHODS: Forty dental students in their final year at Dental School were examined for gingival recession in 1994 and 10 years later by the same examiner. Tooth brushing habits were ascertained in a questionnaire. Clinical parameters recorded for each recession were: recession height, probing depth, width of keratinized gingiva and bleeding on probing. Full-mouth plaque index was recorded using the modified Quigley & Hein index. RESULTS: The prevalence of gingival recession was 85% and did not change after 10 years. A total of 210 recessions found at the initial examination and 299 at the second were valid for longitudinal evaluation. Statistical differences between recessions at both examinations were found in several clinical parameters. Subjects had a significant increase in the plaque index at the second examination despite very few changes in their oral hygiene habits (p < 0.0001). CONCLUSIONS: In dentists, after 10 years, mean number of gingival recession per person and mean recession height increased while plaque control decreased.

Glucose-regulated protein 78 and platelet deposition: effect of rosuvastatin.

OBJECTIVE: To investigate the effect of rosuvastatin on platelet deposition under controlled shear rate conditions and to identify new platelet proteins involved in the interaction with the activating substrate. METHODS AND RESULTS: Platelet-vessel wall interaction and thrombosis take place under dynamic conditions involving the interaction of the exposed damaged vascular wall with the circulating blood cells and proteins. Blood was perfused over type I collagen at different wall shear rates, and platelet deposition was measured by confocal microscopy. Perfused effluent blood was collected, platelets were sequentially extracted based on differential protein solubility, and proteins were separated by 2D gel electrophoresis. Blockade of 3-hydroxy-3-methylglutaryl-coenzyme A reductase significantly reduced platelet deposition and modulated the expression pattern of 18 proteins in the platelet subproteome. Among them, an increase in platelet surface 78-kDa glucose-regulated protein (GRP78), a stress-inducible multifunctional endoplasmic reticulum protein, was clearly apparent. Immunoprecipitation of platelet GRP78 revealed its interaction with tissue factor. Moreover, blockade of surface GRP78 resulted in a substantial increase in platelet deposition and tissue factor procoagulant activity and in a decrease in clotting time. CONCLUSIONS: These findings demonstrate that blockade of 3-hydroxy-3-methylglutaryl-coenzyme A reductase reduces platelet deposition and inhibits GRP78 translocation from the platelet surface after shear and collagen activation. For the first time to our knowledge, this study reports on the presence and functional role of GRP78 in platelets and indicates that GRP78 has additional functions beyond those of a molecular chaperone.

C-reactive protein isoforms differ in their effects on thrombus growth.

OBJECTIVE: We studied the impact of native (natCRP) and modified CRP (mCRP) isoforms on platelet adhesion and thrombus growth under arterial flow. METHODS AND RESULTS: Blood was perfused over type I collagen at a wall shear rate of 1500 s(-1), and platelet deposition and thrombus growth were evaluated by confocal microscopy. natCRP and mCRP were either incubated with blood before perfusion experiments or immobilized in the collagen surface and exposed to flowing blood. mCRP significantly increased platelet adhesion and thrombus growth when directly incubated with blood and when immobilized on a collagen surface (P<0.05). In contrast, natCRP did not exert any effect. Confocal immunohistochemistry revealed the presence of CRP on the surface of adhered platelets and within the thrombus and showed an upregulation of P-selectin and CD36 in effluent platelets preincubated with mCRP (P<0.05). Flow cytometry analysis of agonist-induced platelet activation demonstrated that mCRP, but not natCRP, significantly increased platelet surface P-selectin (P<0.05) without modifying CD63 and PAC-1. CONCLUSIONS: Our data indicate that whereas serum natCRP may not affect thrombus growth, mCRP displays a prothrombotic phenotype enhancing not only platelet deposition, but also thrombus growth under arterial flow conditions.

Prevalence and risk of gingival overgrowth in patients treated with diltiazem or verapamil.

OBJECTIVES: This study was conducted to determine the prevalence and risk factors for gingival enlargement in patients treated with diltiazem or verapamil. MATERIAL AND METHODS: A cross-sectional study was conducted and data from 46 patients actually taking diltiazem or verapamil were compared with 49 cardiovascular controls that never received any of these drugs. All patients were examined for the presence of gingival enlargement using two different indices, the vertical gingival overgrowth (GO) index, and horizontal Miranda & Brunet (MB) index in the inter-dental area. Gingival index, plaque index, and probing depth were also evaluated. RESULTS: The total study population was 95:32 diltiazem-treated, 14 verapamil-treated and 49 cardiovascular control subjects. Gingival enlargement occurred in 31% (GO index) and 50% (MB index) of the patients taking diltiazem. Gingival enlargement in the verapamil-treated group was 21% for the GO index and 36% for the MB index. The prevalence of gingival enlargement was higher in the diltiazem- and verapamil-treated patients than in controls for both indices. The difference between the diltiazem-treated group and control was statistically significant (p=0.022 for GO and p=0.001 for MB), while the difference between the verapamil-treated group and controls was not significant. The risk of gingival enlargement (OR--Odds Ratio) associated with diltiazem therapy was 4.0 (1.2-13.1) for the GO index and of 6.0 (2.1-17.3) for the MB index. When the OR were adjusted for gingival index (GI) values, the risk of gingival enlargement was 3.5 (1.0-12.4) for the GO index and 6.2 (1.9-20.0) for the MB index. In the verapamil-treated group the OR values were not significant. The level of concordance between GO and MB indices in all three groups showed a kappa-value of 0.72 (p<0.001). CONCLUSION: Patients taking diltiazem are at high risk for gingival enlargement and gingivitis has a stronger effect than the drug treatment on gingival enlargement risk.