Estomatitis Urémica como Complicación Oral de Insuficiencia Renal Crónica: Reporte de Caso y Revisión de la Literatura / Uremic Stomatitis as an Oral Complication of Chronic Renal Failure: Case Report and Literature Review

RESUMEN: La Estomatitis Urémica es una lesión oral poco frecuente que se presenta generalmente en pacientes con insuficiencia renal crónica avanzada o no tratada. A continuación, se reporta un caso clínico de un paciente masculino de 22 años de edad que acude a un servicio de urgencia con la presencia de placas blanquecinas indoloras en piso de boca, cara interna de mejilla, y lengua. Las probables causas, presentaciones clínicas, y manejo odontológico son discutidos.

ABSTRACT: Uremic stomatitis is a rare oral lesion that usually occurs in patients with advanced or untreated chronic renal failure. Here we report a case of a 22-year-old male patient who comes to an emergency department with the presence of painless whitish plaques on the floor of the mouth, internal cheek face, and tongue. Probable causes, clinical presentations, and dental management are discussed.

Gender differences in oral manifestations among HIV-infected Brazilian adults.

AIM: The purpose of this study was to compare gender differences in the prevalence of oral lesions in HIV-infected Brazilian adults. METHODOLOGY: A retrospective study was conducted of medical records from HIV/AIDS patients from 1993 to 2004. Oral lesions were only included in this study if definitively diagnosed through microscopic analysis, therapeutic test or according to EC-Clearing house criteria. RESULTS: A total of 750 men and 237 women were included in the study. Statistically significant differences were observed only for oral hairy leukoplakia, Kaposi sarcoma and lymphadenopathy (P < 0.01). However, a model of logistic regression showed that only oral hairy leukoplakia presented a significant association with gender and males had a significantly likelihood (four times higher than females) of presenting with this oral manifestation [OR 4.3 (95% CI: 1.39-13.36)]. CONCLUSION: These data shows that oral manifestations are less prevalent in females than in males, particularly oral hairy leukoplakia.

Comportamiento de la gingivitis ulceronecrotizante aguda: departamento de estomatología de Conuco Viejo / Behavior of acute ultranecrotizing gingivitis at the stomatologic Department of Conuco Viejo

Se realizó un estudio observacional descriptivo prospectivo de corte transversal, con el objetivo de determinar el comportamiento de la gingivitis ulceronecrotizante aguda, en 37 pacientes entre 15 y 50 años de edad, quienes acudieron al servicio de estomatología de Conuco Viejo, municipio García, en el período comprendido de enero a diciembre de 2009. Se caracterizaron a los pacientes estudiados según variables sociodemográficas, y se identificó los factores de riesgo presentes, así como el nivel de conocimientos sobre salud bucodental. Se les realizó un examen clínico minucioso y se le aplicó una encuesta de conocimiento de salud bucal. Se encontró que los adolescentes de 15-20 años y adultos jóvenes de 21-26 años fueron los más afectados, con un 32,44 por ciento y 29,73 por ciento, respectivamente. El sexo femenino, con un 62,16 por ciento, el nivel educacional secundaria básica con 40,55 por ciento fueron los de mayor porcentaje. Dentro de lo factores de riesgo, los mayores por cientos correspondieron a la gingivitis crónica en los locales, con un 75,67 por ciento, mientras que el estrés en los generales, con 59,45 por ciento. Al aplicarse la encuesta de conocimientos un 54,05 por ciento de los pacientes estudiados fue evaluado de mal...(AU)

We carried out a transversal prospective descriptive observational study with the objective of determining the behavior of acute ultranecrotizing gingivitis, in 37 15 to 50 years-old patients, who visited the Stomatologic Service of Conuco Viejo, municipality of García, in the period from January to December 2009. The studied patients were characterized according to sociodemographic variables and the present risk facts were identified, and also the level of knowledge on buccal dental health. A thorough clinic examination was made and the patients applied an inquiry of knowledge on buccal health. We found that 15-20 years-old adolescents and 21-25 years-old young adults were the most affected patients, with 32,44per cent and 29,73 per cent respectively. The female genre, with 62,16 per cent, and the high school scholarship with 40,55 per cent showed the highest percentages. Among the local risk facts, the highest percents corresponded to chronic gingivitis, with 75,67 per cent, while stress represented the highest percent among general risk facts, with 59,45 per cent. As the result of the enquiry, the knowledge of 54,05 per cent of the studied patients were evaluated as unsatisfactory...(AU)

Comportamiento de la gingivitis ulceronecrotizante aguda: departamento de estomatología de Conuco Viejo / Behavior of acute ultranecrotizing gingivitis at the stomatologic Department of Conuco Viejo

Se realizó un estudio observacional descriptivo prospectivo de corte transversal, con el objetivo de determinar el comportamiento de la gingivitis ulceronecrotizante aguda, en 37 pacientes entre 15 y 50 años de edad, quienes acudieron al servicio de estomatología de Conuco Viejo, municipio García, en el período comprendido de enero a diciembre de 2009. Se caracterizaron a los pacientes estudiados según variables sociodemográficas, y se identificó los factores de riesgo presentes, así como el nivel de conocimientos sobre salud bucodental. Se les realizó un examen clínico minucioso y se le aplicó una encuesta de conocimiento de salud bucal. Se encontró que los adolescentes de 15-20 años y adultos jóvenes de 21-26 años fueron los más afectados, con un 32,44 por ciento y 29,73 por ciento, respectivamente. El sexo femenino, con un 62,16 por ciento, el nivel educacional secundaria básica con 40,55 por ciento fueron los de mayor porcentaje. Dentro de lo factores de riesgo, los mayores por cientos correspondieron a la gingivitis crónica en los locales, con un 75,67 por ciento, mientras que el estrés en los generales, con 59,45 por ciento. Al aplicarse la encuesta de conocimientos un 54,05 por ciento de los pacientes estudiados fue evaluado de mal.

We carried out a transversal prospective descriptive observational study with the objective of determining the behavior of acute ultranecrotizing gingivitis, in 37 15 to 50 years-old patients, who visited the Stomatologic Service of Conuco Viejo, municipality of García, in the period from January to December 2009. The studied patients were characterized according to sociodemographic variables and the present risk facts were identified, and also the level of knowledge on buccal dental health. A thorough clinic examination was made and the patients applied an inquiry of knowledge on buccal health. We found that 15-20 years-old adolescents and 21-25 years-old young adults were the most affected patients, with 32,44per cent and 29,73 per cent respectively. The female genre, with 62,16 per cent, and the high school scholarship with 40,55 per cent showed the highest percentages. Among the local risk facts, the highest percents corresponded to chronic gingivitis, with 75,67 per cent, while stress represented the highest percent among general risk facts, with 59,45 per cent. As the result of the enquiry, the knowledge of 54,05 per cent of the studied patients were evaluated as unsatisfactory.

Ulcerativas Necrotizantes / Necrotizing Ulceratives

Las lesiones ulcerativas necrotizantes han sido documentadas a través de la historia. Su denominación, diagnóstico y tratamiento ha evolucionado con el paso de los años, hasta el presente, partiendo en Gingivitis Ulcerativa Necrotizante (GUN) caracterizada como una lesión de rápida evolución, de dolor paroxístico, confinada al margen gingival y papilar. La Periodontitis Ulcerativa Necrotizante (PUN), es ampliamente considerada como una evolución de GUN, involucrando al tejido óseo y a las estructuras de inserción, la falta de medidas terapéuticas ante estas entidades, generará la evolución a Estomatitis Ulcerativa Necrotizante (EUN), la cual involucra estructuras diferentes a los tejidos dentales y de soporte, como las mucosas circundantes. Dichas entidades exhiben signos patognomónicos comunes como sangrado, ulceración, necrosis papilar, supuración, dolor y mal olor, con predominio de microflora específica: fusobacterias y espiroquetas asociadasa factores predisponentes como stress, cigarrillo, desnutrición y alcohol. En la actualidad, la más fuerte asociación epidemiológica es con el Virus de inmunodeficiencia humana (VIH), en pacientes que presentan estados de inmunosupresión menores a 200.000 linfocitos T CD4, por tal motivolos portadores de cualquiera de estos tipos de lesión deben orientar al clínico la necesidad de confirmar el diagnóstico presuntivo de seropositividad. Los parámetros de tratamiento están encausados a la erradicación del agente etiológico, empleando medios mecánicos, como detartraje y alisado radicular apoyado en empleo de antimicrobianos locales y sistémicos, y el control de los factores de riesgo.

Necrotizing ulcerative lesions have been documented throughout history. Your name, diagnosis and treatment has evolved over the years, to date, starting in Necrotizing Ulcerative Gingivitis (NUG) characterized as a rapidly developing lesion, paroxysmal pain, confined to the gingival margin and papillary. Necrotizing Ulcerative Periodontitis (NUP) is widely regarded as an evolution of NUG, involving the bone and the insertion structures, lack of therapeutic measures against these entities generate evolution, Necrotizing Ulcerative Stomatitis (EUN), which involves different structures to the dental tissues and support, as the surrounding mucosa. Such entities exhibit common pathognomonic signs such as bleeding, ulceration, papillary necrosis, suppuration, pain and bad smell, with a predominance of specific microflora: Fusobacteria and spirochetes associated with predisposing factors such as stress, smoking, malnutrition and alcohol. Currently, the strongest epidemiological association is with the human immunodeficiency virus (HIV) in patients with immunosuppressive states below 200.000 CD4 T cells, as such carriers of either type of injury should guide the clinician to confirm the presumptive diagnosis of HIV infection. The treatment parameters are prosecuted to the eradication of the causative agent using mechanical means such as scaling and root planning supported employment for local and systemic antimicrobials, and control of risk factors.

Sequestro ósseo associado à progressão agressiva de gengivite ulcerativa necrosante: relato de caso / Osseous sequestrum associated with the aggressive progression of necrotizing ulcerative gingivitis

A gengivite ulcerativa necrosante (GUN) é uma infecção aguda caracterizada por necrose e ulceração da gengiva marginal, sangramento espontâneo e dor de moderada a grave. Complicações não são frequentes e estão relacionadas com a evolução rápida e com formas agressivas da doença. A seguir, será apresentado um caso raro de sequestro ósseo decorrente de evolução rápida de GUN, seu manejo e análise histológica. O caso envolve um paciente do gênero masculino, de 17 anos de idade, que se apresentou à Faculdade de Odontologia de Bauru/Universidade de São Paulo relatando severa e dolorosa inflamação da gengiva marginal. O exame clínico e a anamnese levaram ao diagnóstico de GUN. Realizou-se limpeza local e antibioticoterapia durante sete dias. Ao quinto dia, houve a ocorrência de um sequestro ósseo entre os dentes 26 e 27. A involução completa do quadro agudo foi observada no sétimo dia. No entanto, uma profundidade de sondagem de 5mm permaneceu no sítio do qual o sequestro foi removido, denunciando a perda de inserção local e alterando o diagnóstico inicial de GUN para periodontite ulcerativa necrosante (PUN). A análise microscópica do fragmento revelou tecido ósseo com lacunas, tanto celulares quanto vazias, atividade osteoclástica, espaços medulares com neutrófilos e reabsorção periférica. A evolução agressiva da GUN deve ser prontamente reconhecida e tratada, para evitar complicações e sequelas decorrentes dessa infecção microbiana do tecido ósseo.

Necrotizing ulcerative gingivitis (NUG) is an acute infection characterized by necrosis and ulceration of the marginal gingiva, spontaneous bleeding, and moderate to severe pain. Complications are not frequent and are related to rapid evolution and aggressive forms of the disease. A rare case of osseus sequestrum resultant from a rapid evolution of NUG, its management and histological analysis will be presented here. The case involves a 17 year-old male patient, who referred to the School of dentistry of Bauru, University of São Paulo, due to severe and painful inflammation of the marginal gingiva. Clinical examination and anamnesis confirmed the diagnosis of NUG. Gentle local cleaning and administration of systemic antibiotic were maintained for seven days. By the fifth day, an osseous sequestrum occurred between teeth 26 and 27. Complete involution of the acute condition was observed by the seventh day. Nevertheless, a probing depth of 5mm remained at the site from which the sequestrum was removed, confirming the local clinical attachment loss and altering the initial diagnosis of NUG to necrotizing ulcerative peridontitis (NUP). Histological analysis revealed bone tissue with cellular and empty lacunae, osteoclastic activity, marrow spaces with neutrophils and resorption at the sequestrum's periphery. Aggressive evolution of NUG must be promptly recognized and treated to avoid sequels and complications resultant from this microbial infection of the bone tissue.

Enfermedades periodontales asociadas a la infección del virus de inmunodeficiencia adquirida: reporte de lesiones orales y corporales / Periodontal diseases associated with acquired immunodeficiency syndrome: report of oral and body lesions

Desde el inicio de la epidemia infecciosa por el virus de inmunodeficiencia adquirida (VIH), se ha observado frecuentemente el compromiso de la cavidad bucal, los tejidos periodontales y los tejidos cutáneos. Formas severas de enfermedades periodontales se han presentado en los individuos con esta infección, entre éstas el eritema gingival linear, la gingivitis necrotizante ulcerativa (GUN), la periodontitis necrotizante ulcerativa (PUN), además de patologías como la candidiasis, leucoplasia pilosa y úlceras entre otras, y dermatitis seborreica, foliculitis y moluscos contagiosos como enfermedades cutáneas. Existe una predisposición a la periodontitis crónica en estos pacientes, y la PUN es una infección caracterizada por necrosis gingival, invasión de la papila, sangrado y dolor. La ocurrencia de las lesiones orales se ha correlacionado con las características clínicas, demográficas y los parámetros inmunológicos y virológicos. Se reportan diversas lesiones periodontales y corporales en un paciente masculino, de 21 años de edad, con diagnóstico presuntivo de infección por VIH/SIDA y GUN/PUN, quien acudió a la Clínica del Postgrado de Periodoncia de la Universidad Autónoma de Guadalajara, Jalisco. En conclusión, el periodoncista debe estar en capacidad de reconocer y tratar las lesiones periodontales asociadas con la infección por VIH, particularmente en las etapas iniciales de VIH/SIDA, conducente a mejorar la calidad de vida a estos individuos.

Gingivitis úlcero-necrosante y su relación con el VIH/SIDA / Necrotizing ulcerative gingivitis and its relationship with HIV/AIDS

En el presente trabajo se realizó una revisión de la literatura, con el fin de compartir con la comunidad odontológica la información recolectada sobre la Gingivitis Ulcero Necrosante (GUN) y su relación con el Virus de Inmunodeficiencia Humana y el Síndrome de Inmunodeficiencia Adquirida (VIH/SIDA).

This paper reports a literature review which shares the gathered information with the Dental community about Necrotizing Ulcerative Gingivitis associated to opportunistic infections related to the Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome (HIV /AIDS).

Oral manifestations during chemotherapy for acute lymphoblastic leukemia: a case report.

A 14-year-old, male patient was referred for the treatment of mucositis, idiopathic facial asymmetry, and candidiasis. The patient had been undergoing chemotherapy for 5 years for acute lymphoblastic leukemia. He presented with a swollen face, fever, and generalized symptomatology in the mouth with burning. On physical examination, general signs of poor health, paleness, malnutrition, and jaundice were observed. The extraoral clinical examination showed edema on the right side of the face and cutaneous erythema. On intraoral clinical examination, generalized ulcers with extensive necrosis on the hard palate mucosa were observed, extending to the posterior region. Both free and attached gingivae were ulcerated and edematous with exudation and spontaneous bleeding, mainly in the superior and inferior anterior teeth region. The tongue had no papillae and was coated, due to poor oral hygiene. The patient also presented with carious white lesions and enamel hypoplasia, mouth opening limitation, and foul odor. After exfoliative cytology of the affected areas, the diagnosis was mixed infection by Candida albicans and bacteria. Recommended treatment was antibiotics and antifungal administration, periodontal prophylaxis, topical application of fluor 1.23%, and orientation on and control of proper oral hygiene and diet during the remission phase of the disease.

Necrotizing ulcerative gingival lesions and clinical attachment loss.

This paper describes the association between the occurrence of necrotizing ulcerative gingival lesions and clinical attachment loss using multivariable logistic regression methods and data originating in an epidemiological study conducted among a random sample of adolescents (n = 9203). Results show that the presence of necrotizing ulcerative gingival lesions is strongly associated with the occurrence of clinical attachment loss, whether defined as the presence of clinical attachment loss > or= 1 mm in at least two teeth or as the presence of clinical attachment loss > or = 3 mm in at least one tooth. This contribution of necrotizing ulcerative gingival lesions appeared to occur independently of the contribution from known common risk factors. Our findings suggest that there are causes of necrotizing ulcerative gingival lesions, yet to be identified, which have a substantial impact on the occurrence of clinical attachment loss.

Infección viral por herpes simple: manejo clínico-farmacológico: su relación con la patología sistémica / Viral infection by herpes simplex: clinical and pharmacological management. Its relationship with systemic pathology

El virus del herpes simple causa infecciones que van de triviales a severas. Particularmente, en estos años, con el síndrome de inmunodeficiencia adquirida y los avances médicos en transplantes de órganos, estas infecciones han adquirido protagonismo. Este abordaje directo para el diagnóstico y tratamiento de la enfermedad contribuirá a resolver los desafíos terapéuticos que ofrece esta frecuente virosis, a menudo rebelde. Se presentan dos situaciones clínicas de correcta resolución en pacientes inmunocomprometidos (AU)

Necrotizing ulcerative periodontitis associated with severe congenital immunodeficiency in a prepubescent subject: clinical findings and response to intravenous immunoglobulin treatment.

Common variable immunodeficiency (CVID) is a rare multifactorial congenital disease of genetic origin caused by an impairment in the secretion of specific immunoglobulins. It manifests systemically through recurrent respiratory infections, gastrointestinal disorders and autoimmune diseases. Oral manifestations may include gingivitis and lichenoid lesions with Wickham's striae. The treatment for CVID is supported by using intravenous infusion of immunoglobulins (IVIG) that allows for control of the disease and avoidance of recurrent opportunistic infections. This report presents a case of necrotizing ulcerative periodontitis (NUP) in a young patient with CVID, and correlates his periodontal status with systemic conditions before and after IVIG administration during 1 year of evaluation.

Relación entre el cigarrillo y la enfermedad periodontal / Relationship between cigarette and periodontal disease

Se realiza una reseña sobre los posibles mecanismos de acción del cigarrillo y sus efectos sobre los tejidos periodontales que validan la asociación entre el hábito de fumar y las periodontopatías

Relación entre el cigarrillo y la enfermedad periodontal / Relationship between cigarette and periodontal disease

Se realiza una reseña sobre los posibles mecanismos de acción del cigarrillo y sus efectos sobre los tejidos periodontales que validan la asociación entre el hábito de fumar y las periodontopatías (AU)

Tabaco y periodoncia / Tobacco and periodontics

En las últimas dos décadas una importante bibliografía demostró que uno de los factores de riesgo más importantes para el avance de la lesión periodontal es el hábito de fumar. El tabaco, con los componentes nocivos que contiene, sumados a la combustión del papel, el escaso poder de filtración del filtro y el calor generado en la boca, son los factores que contribuyen al avance de la gingivitis, al desarrollo de la G.U.N.A., el aumento de la pérdida de inserción en la periodontitis y sería un factor determinante en la periodontitis refractaria. Además, es sabido que en enfermos con lesiones periodontales y con el hábito de fumar, deberán hacerse controles más periódicos y debe incentivarse la higiene bucal

Tabaco y periodoncia / Tobacco and periodontics

En las últimas dos décadas una importante bibliografía demostró que uno de los factores de riesgo más importantes para el avance de la lesión periodontal es el hábito de fumar. El tabaco, con los componentes nocivos que contiene, sumados a la combustión del papel, el escaso poder de filtración del filtro y el calor generado en la boca, son los factores que contribuyen al avance de la gingivitis, al desarrollo de la G.U.N.A., el aumento de la pérdida de inserción en la periodontitis y sería un factor determinante en la periodontitis refractaria. Además, es sabido que en enfermos con lesiones periodontales y con el hábito de fumar, deberán hacerse controles más periódicos y debe incentivarse la higiene bucal (AU)

Immunohistochemical study of linear gingival erythema from HIV-positive patients.

Severe forms of periodontal disease are frequent in patients with acquired immunodeficiency syndrome (AIDS). Linear gingival erythema (LGE) is a progressive disease described in HIV-positive patients and is considered to be an early stage of necrotizing periodontitis. Although clinical and microbiological differences are reported in LGE and non-specific gingivitis (NSG), a comparative immunopathological approach of both has not been performed yet. The purpose of this study was to compare relative populations of T-lymphocytes, B-lymphocytes, neutrophils, macrophages and IgG bearing plasma cells in gingival biopsies from sites exhibiting LGE and from sites exhibiting NSG. A biotin-streptavidin amplified system was used for identification of the following antigens: CD3 (T-lymphocytes), CD20 (B-lymphocytes), elastase (neutrophils), CD68 (macrophages) and IgG (plasma cell's secretors of IgG). The results have demonstrated decrease proportions of T-lymphocytes, macrophages and high percentage of neutrophils and IgG bearing plasma cells in LGE. In contrast with NSG, many neutrophils cells in LGE were found inside oral gingival epithelium. Our results highlight the idea that progressive periodontal disease is not only characterized by increased tissue inflammation, but, in addition, by significant changes in the proportion of specific inflammatory cells. The high number of neutrophils along the gingival epithelium is probably associated with the severe gingival necrosis reported in AIDS patients.

Oral manifestations associated with HIV-related disease as markers for immune suppression and AIDS.

BACKGROUND: Oral lesions are common findings in HIV-related disease, but little is known about their significance in predicting immune suppression among a representative group of HIV-infected persons. METHODS: Oral examinations were performed on 454 patients who came to an outpatient dental clinic for dental care. CD4+ cell counts were obtained within 2 months of the examination. RESULTS: In persons with a specific lesion and a CD4+ cell count below 200 cells/mm3 the corresponding mean CD4+ cell counts and predictive values were 149.5 cells/mm3 and 69.9% for candidiasis, 143.3 cells/mm3 and 70.1% for oral hairy leukoplakia, 126.0 cells/mm3 and 69.4% for xerostomia, 51.8 cells/mm3 and 95.1% for necrotizing ulcerative periodontitis, 98.7 cells/mm3 and 87.0% for long-standing herpes simplex virus infections, 66.6 cells/mm3 and 93.6% for Kaposi's sarcoma, and 33.7 cells/mm3 and 100% for major aphthous ulcers. The mean CD4+ cell count declined with increased numbers of different concurrent lesions. CONCLUSION: The presence of specific oral manifestations and the number of different concurrent intraoral lesions among HIV-infected persons are associated with severe immune suppression and AIDS. Oral examinations are an essential component for early recognition of disease progression and comprehensive evaluation of HIV-infected patients.