Gingival bleeding is a useful clinical feature in the diagnosis of hereditary bleeding disorders in children.

The search for hereditary bleeding disorders (HBD) prior to invasive procedures in children is primarily based on personal and family bleeding history. Although several scores are available, they have only been evaluated in specific situations or in adults. Our monocentric retrospective study aimed to analyze the association between clinical history and four scores (HEMSTOP, PBQ, ISTH-BAT, TOSETTO) and the diagnosis of MHC in children referred to the University Hospital of Montpellier for hemostasis investigations. A total of 117 children were retrospectively included in the study. Of these, 57 (49%) were diagnosed with HBD, with 30 having primary bleeding disorders and 27 having coagulation disorders. The diagnosis of HBD was significantly associated with gingival bleeding, which was present in 30% of HBD patients. In our population, only the HEMSTOP score showed an association with the diagnosis of HBD, but it was positive in only 48% of patients. By including gingival bleeding as a factor, we modified the HEMSTOP score, which increased its sensitivity from 0.45 to 0.53. When examining primary bleeding disorders, the modified HEMSTOP score, with the inclusion of gingival bleeding, enables us to diagnose 63% of patients (see Fig. 1).    Conclusion: Therefore, gingival bleeding should be considered a useful factor in bleeding history for HBD diagnosis. Adding this symptom to a screening score such as HEMSTOP improves its sensitivity. To confirm our findings, a prospective study is required.    Trial registration: Study registration number: NCT05214300. What is Known: • Screening for hereditary bleeding disorder diseases is a necessity and a challenge in children. • Minor disorders of primary hemostasis are the most common, but often escape standard coagulation tests. What is New: • Gingival bleeding is a frequent symptom that is easy to investigate and may point to a primary hemostasis disorder. • Adding the gingival bleeding item to a routine screening score such as HEMSTOP improves sensitivity.

Dental plaque and gingival bleeding in adolescents with juvenile idiopathic arthritis and controls: a multilevel analysis.

OBJECTIVE: To explore whether plaque and gingival bleeding are more frequently experienced by adolescents with juvenile idiopathic arthritis (JIA) compared to matched controls without JIA; explore whether surface- and site-specific periodontal outcomes vary between the two groups; and for participants with JIA, investigate associations between disease-specific features and periodontal outcomes. MATERIAL AND METHODS: In this comparative cross-sectional study, selected surfaces, and sites of index teeth in 10-16-year-olds with JIA and matched controls were examined by modified versions of Simplified Oral Hygiene Index (OHI-S) and Gingival Bleeding Index (GBI). Mixed-effects logistic regressions, reporting odds ratios (OR) with 95% confidence interval (CI), were applied. Intra-class correlation coefficients (ICCs) were calculated to quantify the degree of dependency of measures within the same individual. RESULTS: 144 and 159 adolescents with JIA were evaluated according to OHI-S and GBI; corresponding numbers of controls were 154 and 161. Plaque and gingival bleeding were more frequent in individuals with JIA than controls. Adjusted analyses showed association between JIA status and OHI-S > 0 (OR = 2.33, 95% CI: 1.47 - 3.67, ICC = 0.45) and GBI > 0 (OR = 1.54, 95% CI: 1.10 - 2.16, ICC = 0.41 and 0.30). Surface-specific distribution of plaque varied among the two groups. CONCLUSIONS: Our results highlight the importance of increased awareness of oral health care in patients with JIA and that surface- and site-specific differences in periodontal outcomes exist between individuals with JIA and controls. Few JIA disease-specific variables associated with plaque or gingival bleeding.

Massive gingival bleed: a rare manifestation of cyclosporine toxicity.

A 12-year-old patient of thalassaemia major developed autoimmune cytopaenia after undergoing haematopoietic stem cell transplantation. She was started on cyclosporine (CsA) in view of poor response to steroids. She developed CsA toxicity manifesting as gum hyperplasia with multiple episodes of gum bleed. During endotracheal intubation for an elective splenectomy, she developed significant bleeding from gums requiring massive transfusion. Postoperatively the gum bleed persisted even after embolisation of facial artery and multiple transfusions. The catastrophic sequelae include transfusion-related lung injury, acute circulatory failure with subsequent cardiac arrest and death. Gum hyperplasia is a commonly reported toxic effect of CsA. Lethal presentations of this toxicity with such severity are limited in the medical literature. Evaluation of the patient's medical and laboratory records, along with a review of literature, was very helpful in understanding more about the toxicity of CsA.

General Health, Systemic Diseases and Oral Status in Adult Patients with Coeliac Disease.

The prevalence of coeliac disease in the general population is 0.5%-1%; however, most patients remain undiagnosed until adult age. In some cases, the onset is represented by sub-clinical signs, some of which can be found in the mouth. The aim of this research was to identify any associations between the clinical characteristics of coeliac disease and oral manifestations. A structured questionnaire was administered to a group of 237 individuals with coeliac disease. 100% of the subjects fully completed the questionnaire. Among them, 182 (76.7%) were female, 64 patients (27%) were aged 15 to 24 years, 159 (67%) were aged 25 to 55 and 14 (6%) were aged 56 and over. Significant associations were observed in caries prevalence and dentin sensitivity; in addition, an inappropriate diet was related to oral manifestations; following a gluten-free diet could be important to control the gingival bleeding levels and to manage oral symptoms associated to coeliac disease. In general, the presence of inflammatory symptoms in the mouth seems to be associated with general symptoms of inflammation related to coeliac disease.

Retrospective Clinical Study of a Freely Removable Implant-Supported Fixed Dental Prosthesis by a Microlocking System.

This retrospective clinical study was conducted to evaluate the clinical usefulness of a freely removable microlocking implant prosthesis (MLP) that was developed to overcome the problems with conventional implant prostheses. A total of 54 patients (male: 31, female: 23) and 100 implant prostheses were included. Patients were divided into three groups such as 6-12 months, 12-18 months, and 18-24 months according to the used period after implant prosthesis delivery, and the patients in each group were recalled for examinations of survival rate, marginal bone resorption, peri-implant soft tissue indices, and complications. The prosthetic complications were analysed by combining the recorded chart data during the periodic checks including the last call for this study. During a 2-year observation period, all the implants showed a 100% survival rate without clinical mobility and functional problems. There was no significant difference in marginal bone resorption, plaque index, and bleeding index over the observation period after implant prosthesis delivery. Probing depth of the 18-24 months group (1.5 ± 0.19 mm) was significantly lower than that of the 6-12 months group (p < 0.05). The main complication was abutment loosening (4%), followed by implant prosthesis fracture (2%) and food impaction (2%) which were recorded. Within the limits of the present study, the implant prostheses with MLP are considered to be an applicable and predictable treatment method.

Gingival bleeding and calculus among 12-year-old Chinese adolescents: a multilevel analysis.

BACKGROUND: Gingivitis is a common oral health problem, and untreated gingivitis can progress to periodontitis. The objectives of this study were to (1) explore associated factors of gingival bleeding and calculus among 12-year-old adolescents; (2) find predictive models for gingivitis management. METHODS: Four thousand five hundred twenty-five subjects aged 12 in Sichuan Province were investigated. The questionnaire and clinical examination were applied in schools, and two-level logistic regression models were constructed to interpret the effect of individual and contextual factors on Chinese adolescents' gingival bleeding and calculus. RESULTS: 46.63% (95%CI: 40.71, 51.60) and 66.94% (95%CI: 56.85, 67.45) of the subjects presented gingival bleeding and calculus, respectively. For the gingival bleeding cases, the model showed the significant associated indicators were hukou (OR = 0.61, 95% CI: 0.52-0.72), family size (OR = 1.41, 95% CI: 1.19-1.68), parental educational level (father: OR = 0.53, 95% CI: 0.45-0.63; mother: OR = 0.71, 95% CI: 0.59-0.86), tooth-brushing frequency (OR = 0.35, 95% CI: 0.26-0.48), dental floss use (OR = 0.58, 95% CI: 0.41-0.83), sugar-containing drink consumption (OR = 2.11, 95% CI: 1.80-2.49), and dental visit (OR = 1.44, 95% CI: 1.19-1.74). It also confirmed that gender (OR = 1.32, 95% CI: 1.13-1.54), hukou (OR = 0.69, 95% CI: 0.59-0.82), family size (OR = 1.34, 95% CI: 1.12-1.59), parental educational level (father: OR = 0.46, 95% CI: 0.39-0.54; mother: OR = 0.65, 95% CI: 0.59-0.82), tooth-brushing frequency (OR = 0.57, 95% CI: 0.42-0.78), dental floss use (OR = 0.66, 95% CI: 0.48-0.90) and sugar-containing drink consumption (OR = 1.30, 95% CI: 1.11-1.53) were associated factors for dental calculus. CONCLUSIONS: Gingival bleeding and calculus were common in western Chinese adolescents. Socio-demographic factors including gender, hukou and family factors are strong determinants of gingival health in Chinese adolescents. In addition, health-related lifestyle behaviors such as healthy diet, good hygiene care and more dental visits are good predictors of better gingival status.

Contrast medium-induced severe thrombocytopenia in patient on maintenance hemodialysis: a case report and literature review.

A 43-year-old male patient on maintenance hemodialysis had an enhanced computed tomography scan examination with iohexol for the first time 10 min before regular hemodialysis therapy. At the start of hemodialysis, no symptoms were observed, and the platelet count was 148,000/µl. Approximately 1 h after starting hemodialysis, dyspnea and chest discomfort appeared. Since oxygen saturation of the peripheral artery decreased to 87%, oxygen administration was immediately started while continuing hemodialysis therapy. Furthermore, gingival hemorrhage was observed, and the platelet count decreased to 5000/µl. We were carefully monitoring his conditions while continuing hemodialysis and oxygen administration, but no further deterioration was observed. Thereafter, these symptoms and severe thrombocytopenia gradually improved without additional treatment. At the end of hemodialysis, these symptoms completely disappeared. As well, the platelet count recovered to 35,000/µl at the end of hemodialysis and increased to 92,000/µl the next morning. From the clinical course, we diagnosed with contrast medium-induced thrombocytopenia. Acute thrombocytopenia is a rare complication induced by the contrast medium. Until now, 16 cases on contrast medium-induced thrombocytopenia have been reported. Our case spontaneously recovered from severe thrombocytopenia relatively earlier than previous reports. Our patient started hemodialysis therapy 10 min after an enhanced computed tomography examination. Early removal of contrast medium by hemodialysis might be associated with early improvement. We should acknowledge that contrast media have potential to induce severe thrombocytopenia, even in patients on maintenance hemodialysis.

Disruption of Monocyte and Macrophage Homeostasis in Periodontitis.

Monocytes and macrophages are major cellular components of the innate immunity that play essential roles in tissue homeostasis. The contribution of different subsets of monocytes/macrophages to periodontal health and disease has not been fully elucidated. Type 2 diabetes mellitus (T2DM) is a risk factor for periodontitis. We hypothesized that the monocyte/macrophage signaling is perturbed in periodontitis-affected sites versus periodontally healthy sites and that this perturbation plays a critical role in the pathogenesis of periodontitis. Pairs of gingival tissue samples (each from a periodontally healthy and a periodontitis-affected site of the same patient) were harvested from 27 periodontitis patients, with and without T2DM. Each sample was processed to form a single-cell suspension, and a flow-cytometry panel was designed and validated to study monocyte and macrophage phenotypes. In separate experiments, the transcriptional changes associated with a pro-inflammatory phenotype were also examined in monocyte/macrophage subsets obtained from peripheral blood of patients with T2DM versus diabetes-free controls. A significantly higher proportion of intermediate (CD14+CD16+) monocytes was observed in periodontitis-affected tissues compared to healthy tissues. These monocytes overexpressed HLA-DR and PDL1 molecules, suggesting their activated inflammatory status. PDL1 increase was specific to intermediate monocytes. The ratio of M1/M2 macrophages was also significantly higher in periodontally affected sites, signifying an imbalance between inflammatory and repair mechanisms. We found a significantly higher expression of PDL1 in overall monocytes and M1 macrophages in periodontitis-affected sites compared to controls. Importantly, we identified a subpopulation of M1 macrophages present in periodontally affected tissues which expressed high levels of CD47, a glycoprotein of the immunoglobulin family that plays a critical role in self-recognition and impairment of phagocytosis. Analysis of the transcriptional landscape of monocytes/macrophages in gingival tissue of T2DM patients with periodontitis revealed a significant disruption in homeostasis toward a proinflammatory phenotype, elevation of pro-inflammatory transcription factors STAT1 and IRF1, and repression of anti-inflammatory JMJD3 in circulating monocytes. Taken together, our results demonstrate disruption of myeloid-derived cell homeostasis in periodontitis, with or without T2DM, and highlight a potentially significant role of these cell types in its pathogenesis. The impact of macrophage and monocyte signaling pathways on the pathobiology of periodontitis should be further evaluated.

Molecular and clinical profile of type 2 von Willebrand disease in Iran: a thirteen-year experience.

Type 2 von Willebrand disease (VWD) is the most common congenital bleeding disorder, with variable bleeding tendency and a complex laboratory phenotype. In the current study, we report the clinical and molecular profile of a large number of Iranian patients with type 2 VWD. All exons, intron-exon boundaries, and untranslated regions were sequenced by Sanger sequencing for direct mutation detection. All identified mutations were confirmed in family members and by relevant bioinformatics studies. A total of 136 patients with type 2 VWD were diagnosed, including 42 (30.9%), 32 (23.6%), 38 (27.9%), and 24 (17.6%) patients with type 2A, type 2B, type 2M, and type 2N, respectively. Epistaxis (49%), gum bleeding (30.2%), ecchymosis (23.2%), and menorrhagia (16.3%) were the most common clinical presentations, while miscarriage (2.3%) and umbilical cord bleeding (0.8%) were the rarest. Thirty mutations were identified within the VWF gene, nine (30%) being novel, with p.Arg1379Cys (n = 20), p.Val1316Met (n = 13), p.Arg1597Trp (n = 13), p.Arg1374Cys (n = 10), p.Ser1506Leu (n = 10), and p.Arg1308Cys (n = 9) the most common. Type 2 VWD is a hemorrhagic disorder with variable bleeding tendency and a heterogeneous molecular basis in patients in Iran.

To what extent does smoking affect gingival bleeding response to supragingival plaque? Site-specific analyses in a population-based study.

BACKGROUND AND OBJECTIVE: The aim of this study was to investigate the influence of smoking on the site-specific association between bleeding on gingival probing and supragingival plaque and to assess whether this differs in different regions of the dentition. METHODS: Data from a representative sample of 1911 adults (20-79 years old) in Northern Norway were analyzed. Periodontal examinations consisted of full-mouth recordings of periodontal probing depth (PD), bleeding on probing (BOP), and presence of supragingival plaque. Smoking status and background characteristics were self-reported by questionnaire. The association between plaque and BOP was assessed in several three-level (subject, tooth, and site) random intercept logistic regression models adjusted for PD, smoking status, socioeconomic factors, and body mass index. In a further model, it was assessed whether the association between supragingival plaque and BOP differed in different parts of the dentition. RESULTS: For plaque-free sites, bleeding tendency was lower in smokers, the odds ratio (OR) was 0.773 with a 95% confidence interval of 0.678-0.881 as compared to non-smokers (OR: 1; ref., P < .001). The odds of BOP at plaque-covered sites in non-smokers were increased twofold (OR: 2.117; 2.059-2.177). Albeit bleeding tendency was slightly increased in plaque-covered sites in smokers, it was considerably lower as compared to plaque-covered sites in non-smokers (OR: 1.459; 1.282-1.662, P < .001). Smoking ≥ 20 pack-years further attenuated the association. In smokers, the odds of BOP were reduced in all parts of the dentition, lower and upper anterior and posterior teeth ( χ ( 4 ) 2 = 32.043, P < .001). When restricting the data to younger adults (20-34 year old), smoking had only a slight effect on the association between plaque and BOP. For plaque-free and plaque-covered sites, differences in ORs were not statistically noticeable (P = .221 and P = .235, respectively). CONCLUSIONS: Smoking considerably attenuates the site-specific association between plaque and BOP with a dose-dependent effect. The effect of smoking did not differ across tooth types.

Is dapsone still relevant in immune thrombocytopenia in resource limited settings?

Immune thrombocytopenia is an autoimmune disorder characterised by autoantibody production against platelets, increased platelet destruction and impaired thrombopoiesis. Steroids are the first-line agents whenever treatment is indicated; however, some patients may not respond and the responders may as well relapse while the dose is being tapered. Side effects of steroids prohibits their long-term use and patients often have to be switched to other agents. Standard drug management with intravenous immunoglobulins and thrombopoietin receptor analogues is difficult to administer in patients from low socioeconomic regions of the world making the management even more challenging. Hence, after reviewing the literature and considering the cost in comparison to all the second-line agents available, we tried dapsone in a steroid-dependent patient of immune thrombocytopenic purpura who had developed major steroid-related side effects. Patient showed good response to dapsone and has been in remission for around one and a half years.

Impact of smoking on gingival inflammation in representative samples of three South American cities.

The aim of this study was to investigate the impact of smoking on gingival inflammation in a representative sample of 1,650 adults from Santiago (Chile), Porto Alegre (Brazil), and Tucumán (Argentina). A questionnaire was administered to participants to gather demographic and behavioral characteristics, including smoking habits. The participants were clinically examined to obtain gingival index (GI), gingival bleeding index (GBI), visible plaque index (VPI), and calculus presence values. Gingival inflammation was defined as a mean GI > 0.5. Heavy smokers presented significantly lower levels of gingival inflammation, as reflected by both GI and GBI, than both light and moderate smokers, despite their having increased amounts of plaque and calculus. Being 50 years old or older [odds ratio (OR), 1.93], a VPI ≥ 30% (OR, 28.1), and self-reported diabetes (OR, 2.79) were positively associated with detection of gingival inflammation. In conclusion, the occurrence of clinically detectable gingival inflammation was lower in heavy smokers than light and moderate smokers. Older age, diabetes, and visible plaque emerged as risk indicators of gingivitis. Plaque and gingival indices are significantly associated regardless of the smoking status.

Congenital hepatic fibrosis and coexistent retinal macular degeneration: A case report.

RATIONALE: Congenital hepatic fibrosis (CHF) is an autosomal recessive disease characterized by periportal fibrosis, portal hypertension, and renal cystic disease. Essentially, CHF is a variant of fibrocystic disorder in which liver and kidney are commonly affected. Other frequently associated conditions include Caroli syndrome and polycystic kidney disease. CHF is also a known accompaniment in an array of inherited disorders with multiorgan involvement. PATIENT CONCERNS: The 20-year-old male patient with declining vision (14 years duration), intermittent gingival bleeding (7 years duration), and abdominal distension (5 years duration), presented with exacerbation of these symptoms during the prior 2 months. The patient had been previously diagnosed with retinal macular degeneration, idiopathic thrombocytopenic purpura, and hepatosplenomegaly. DIAGNOSES: Liver biopsy showed disordered hepatic acini and fibrous parenchymal banding, indicative of CHF. INTERVENTIONS: After the treatment of diuresis and liver protectants, the clinical symptoms of the patients were improved. We subsequently recommend chromosomal analysis, although the family refused. OUTCOMES: Three months after discharge, the patient was followed up by telephone. The patient had obvious abdominal distension and we advised that he should be admitted again. But the family refused. LESSONS: CHF is an AR disease resulting in portal hypertension and often associated with renal malformations. CHF is also linked to a number of other disorders, many of which are ciliopathies. Because the clinical manifestations of CHF are nonspecific or lacking, its diagnosis is problematic, relying largely on liver biopsy. Once CHF is identified, physicians are obligated to investigate other organ systems, particularly a search for neuromuscular, retina or renal involvement. This case underscores the value of radiologic imaging, pathologic examination, and genetic testing in successfully diagnosing a rare disease.

Gingivitis como primer síntoma de leucemia aguda mieloblástica / Gingivitis as a first symptom of acute myeloblastic leukemia

Las enfermedades hematológicas, entre ellas la leucemia aguda, pueden manifestarse al diagnóstico con afectación a nivel oral. Las leucemias agudas suponen casi el 10 % de todas las neoplasias. En adultos es más frecuente la leucemia aguda mieloide. Los síntomas son secundarios a las citopenias, así como a la infiltración de diferentes órganos. Debido a que se trata de neoplasias agresivas, el diagnóstico precoz es clave para instaurar el tratamiento lo antes posible, por lo que debemos considerar estas patologías en el diagnóstico diferencial ante la presencia de cuadros febriles de larga evolución o de signos de alarma de las mismas

Hematologic disorders, including acute leukemia, may present oral manifestations as initial evidence of the disease. Acute leukemia represents almost 10% of all types of neoplasia. Acute myeloid leukemia is more frequent in adults. Symptoms are secondary to cytopenias and to infiltration of different organs. Since these are aggressive malignancies, early diagnosis is key to establishing a treatment as soon as possible. We should thus consider these disorders in differential diagnosis when we detect the presence of long-standing fever or other warning signs

Oral tranexamic acid associated with platelet transfusion to prevent hemorrhage in a patient with Glanzmann thrombasthenia.

Glanzmann thrombasthenia (GT) is a rare genetic disorder that alters platelet function. The clinical manifestations include purpura, epistaxis, gingival bleeding, and menorrhagia. For patients with GT, conventional surgical dental treatment may result in hemorrhagic complications. There are many reported ways to prevent hemorrhage in patients with GT during surgical procedures but no standardized recommendations. In this case study, a woman diagnosed with GT required 2 types of surgery (periodontal surgery and third molar extractions), which were performed on separate days. Preoperative evaluation and planning with a hematology service led to the transfusion of 1 pack of platelet concentrate immediately before each surgery. Additionally, the patient was prescribed oral tranexamic acid, which was started 1 day before each surgery and continued for 3 additional days. A distal wedge procedure was performed for the mandibular right third molar, and later the maxillary and mandibular left third molars were extracted. The use of oral tranexamic acid associated with a single platelet bag was effective in the present case, and no bleeding or thrombotic events were observed after either surgery. Although this coagulopathy is rare, dentists must be aware of its implications, which necessitate specific precautions for oral surgical procedures. Multidisciplinary integration and surgical planning can reduce the risk of complications for the patient.

Immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy.

Gingival bleeding is a common intraoral finding, typically associated with inflamed tissues and periodontal disease. It is easily provoked by periodontal probing or toothbrushing. Spontaneous gingival bleeding rarely occurs and may be the only sign of systemic bleeding problems such as thrombocytopenia, leukaemia or coagulopathy. In pregnancy, acute onset of thrombocytopenia may occur in systemic disorders such as severe pre-eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) or the acute fatty liver of pregnancy. The diagnosis and management of such conditions may challenge physicians. It requires a systematic approach with a comprehensive history to exclude causes of gingival haemorrhage such as periodontal disease, anticoagulant therapy, maxillofacial trauma, haematological disorders or a bacterial infection. The authors describe a case of immune thrombocytopenic purpura presenting with spontaneous gingival haemorrhage in pregnancy. This case highlights the fact that medical intervention to correct the underlying aberration of haemostasis is necessary for local measures to stop the gingival bleeding successfully.

Oral Manifestations of Autoimmune Neutropenia: A Case Report.

Autoimmune neutropenia is a self-limiting condition characterized by the presence of granulocyte-specific autoantibodies. This case report describes a 2-year-old female who presented to the Department of Pediatric Dentistry with a history of oral ulceration, complicated by high temperature, gingival hypertrophy and gingival hemorrhage. These symptoms had precipitated an admission to a district general hospital and diagnosis of viral tonsillitis. The severity of the presentation to the Pediatric Dental Department prompted a review of recent discharge blood investigations, which revealed a neutrophil count of 0.07×109/L(1.0-8.5 ×109/L) indicating severe neutropenia. Urgent referral to Pediatric Hematology resulted in same-day admission and a diagnosis of autoimmune neutropenia was established. The patient was managed with chlorhexidine mouthwash, prophylactic antimicrobial and antifungal medication and granulocyte colony stimulating factor (G-CSF). Neutropenia may present with features exclusive to the oral cavity. Recognition of atypical presentations such as oral ulceration with associated systemic illness may assist in early diagnosis.

Spotting Zika spots: descriptive features of the rash used in 66 published cases.

Zika virus (ZV) is an important emerging infection. Rash is a key feature, but the summative literature lacks description of the rash beyond 'maculopapular'. Our aim was to identify the cutaneous features described in the published literature. A literature search using defined terms for ZV cases reports and series was performed on the OVID, Clinical Key and University of Dundee's e-library journals databases in December 2016; a later case report was included while the paper was under review. Diagnosis in all cases was via PCR. Exclusion criteria were Zika cases without rash or omitting any description of the rash. Ocular features (conjunctivitis) were not included. In total, 42 publications with 66 cases met the criteria. The most frequent descriptive features included maculopapular (59%), lower limb petechial purpura (11%) and erythematous/red (9%). Pruritus was described in 44% and tenderness in 3%. Lesions were located on the trunk (29%), limbs (5% arms, 11% both arms and legs), face (17%) and extremities (14%) or were diffuse/generalized (12%). There was facial sparing in 3%. Other features were centrifugal spread (6%), palmar and/or plantar involvement (6%), palmoplantar desquamation (2%) and malar erythema with oedema (2%). Mucosal features included gingival bleeding (11%), oral haemorrhagic blisters (8%) and painful blisters/vesicles (4%). Oedema/swelling was described in the upper limbs (5%), lower limbs (5%) and both (3%). Mean rash duration was 6 days (range 3-11 days). The ZV exanthema is most frequently maculopapular, pruritic, sometimes with centrifugal spread from the trunk to extremities. This may include lower limb petechial purpura, palmoplantar lesions, oedema of limb extremities, and gingival bleeding or painful oral bullae. As ZV becomes more prevalent, recognition of the clinical features will enable earlier diagnosis and appropriate testing.

Impact of smoking on gingival inflammation in representative samples of three South American cities

Abstract The aim of this study was to investigate the impact of smoking on gingival inflammation in a representative sample of 1,650 adults from Santiago (Chile), Porto Alegre (Brazil), and Tucumán (Argentina). A questionnaire was administered to participants to gather demographic and behavioral characteristics, including smoking habits. The participants were clinically examined to obtain gingival index (GI), gingival bleeding index (GBI), visible plaque index (VPI), and calculus presence values. Gingival inflammation was defined as a mean GI > 0.5. Heavy smokers presented significantly lower levels of gingival inflammation, as reflected by both GI and GBI, than both light and moderate smokers, despite their having increased amounts of plaque and calculus. Being 50 years old or older [odds ratio (OR), 1.93], a VPI ≥ 30% (OR, 28.1), and self-reported diabetes (OR, 2.79) were positively associated with detection of gingival inflammation. In conclusion, the occurrence of clinically detectable gingival inflammation was lower in heavy smokers than light and moderate smokers. Older age, diabetes, and visible plaque emerged as risk indicators of gingivitis. Plaque and gingival indices are significantly associated regardless of the smoking status.

[Autoimmune bullous diseases with gingival expression: A proposed non-iatrogenic gingival biopsy technique]. / Maladies bulleuses auto-immunes à expression gingivale : proposition d'une technique de biopsie gingivale non iatrogène.

BACKGROUND: Gingival expression of autoimmune bullous diseases (AIBD) may be inaugural, exclusive or dominant (mucous membrane pemphigoid, pemphigus vulgaris). Histology and direct immunofluorescence are essential to diagnosis. The location of the biopsy and the surgical technique determine the histological quality of the tissue sample. However, gingival tissue is often considered fragile and easily impaired during biopsy. We suggest an original biopsy protocol for the gingival papillae that is simple to perform, non-iatrogenic, and readily accessible to all practitioners who usually treat AIBD patients presenting isolated gingival expression (dermatologists, stomatologists, odontology specialists, ENT specialists). PATIENTS AND METHODS: We conducted a retrospective study from 2012 to 2017 identifying all patients presenting AIBD with gingival expression for whom we performed papillary gingival biopsy for diagnostic ends. Our main objective was to determine the diagnostic efficacy and safety of this surgical technique. RESULTS: Over the study period, 34 papillary gingival biopsies were taken from 19 patients : 15 for histopathological examination and 19 for direct immunofluorescence. Of the 34 biopsies, only one could not be properly analyzed due to lack of epithelium and a second tissue sample was therefore necessary. No short- or long-term complications occurred during post-operative follow-up. CONCLUSION: Gingival papilla biopsy is perfectly suited to the histopathological and immunohistochemical examinations needed for diagnosis of AIBD with isolated gingival expression. This surgical technique shows great efficacy and very good safety. However, additional studies are necessary to confirm our preliminary results, in particular the absence of iatrogenic effects.