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RATIONALE: Epstein-Barr virus mucocutaneous ulcers (EBVMCUs) were officially recognized as a clinicopathologic entity in the 2017 revision of the World Health Organization classification, which often occurs in the elderly or in immunosuppressive condition presented as an isolated ulcerative lesion. EBVMCUs are defined as "shallow, sharply circumscribed, mucosal or cutaneous ulcers with underlying polymorphous infiltration." It mostly involves oral mucosa, but some appear in skin or gastrointestinal tract. Typically, patients with EBVMCUs display a slow disease progression and may even undergo spontaneous regression. PATIENT CONCERNS: This report describes the case of a 76-year-old woman who visited our outpatient clinic with the chief complaint of inflammation and ulceration on lower labial, lower right lingual gingiva seemed like acute necrotizing ulcerative gingivitis, and malignancy. DIAGNOSES: She was diagnosed with EBVMCU after tissue biopsy. INTERVENTIONS: Since most oral ulcerations usually appear in nonspecific form, it is important to check thoroughly for any underlying immunosuppressive systemic conditions and laboratory test results in case of viral infection. But she has no remarkable underlying immunosuppressive disorder. OUTCOMES: For this patient, she was initially diagnosed with EBVMCU and showed spontaneous healing, but then relapsed after 4 to 6 months. The patient was re-diagnosed as EBV-positive diffuse large B-cell lymphoma (EBV-positive DLBCLs) after re-biopsy. LESSONS: EBVMCU shows similar symptoms to malignant lesions or acute necrotizing ulcerative gingivitis but shows spontaneous healing. However, in case of EBV-positive DLBCLs, failing to detect and treat the disease in its early stages can lead to a fatal outcome. Thus, this case report highlights the differential diagnosis and appropriate treatment of EBVMCU and EBV-positive DLBCLs.
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Infecções por Vírus Epstein-Barr , Gengivite Ulcerativa Necrosante , Linfoma Difuso de Grandes Células B , Feminino , Humanos , Idoso , Herpesvirus Humano 4 , Úlcera/etiologia , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/patologia , Remissão Espontânea , Diagnóstico Diferencial , Gengivite Ulcerativa Necrosante/complicações , Gengivite Ulcerativa Necrosante/diagnóstico , Imunossupressores , Linfoma Difuso de Grandes Células B/patologiaRESUMO
INTRODUCTION: Noma is a rapidly spreading infection of the oral cavity which mainly affects young children. Without early treatment, it can have a high mortality rate. Simple gingivitis is a warning sign for noma, and acute necrotizing gingivitis is the first stage of noma. The epidemiology of noma is not well understood. We aimed to understand the prevalence of all stages of noma in hospitalised children. METHODS: We conducted a prospective observational study from 1st June to 24th October 2021, enrolling patients aged 0 to 12 years who were admitted to the Anka General Hospital, Zamfara, northwest Nigeria. Consenting parents/ guardians of participants were interviewed at admission. Participants had anthropometric and oral examinations at admission and discharge. FINDINGS: Of the 2346 patients, 58 (2.5%) were diagnosed with simple gingivitis and six (n = 0.3%) with acute necrotizing gingivitis upon admission. Of those admitted to the Inpatient Therapeutic Feeding Centre (ITFC), 3.4% (n = 37, CI 2.5-4.7%) were diagnosed with simple gingivitis upon admission compared to 1.7% of those not admitted to the ITFC (n = 21, CI 1.1-2.6%) (p = 0.008). Risk factors identified for having simple gingivitis included being aged over two years (2 to 6 yrs old, odds ratio (OR) 3.4, CI 1.77-6.5; 7 to 12 yrs OR 5.0, CI 1.7-14.6; p = <0.001), being admitted to the ITFC (OR 2.1; CI 1.22-3.62) and having oral health issues in the three months prior to the assessment (OR 18.75; CI 10.65, 33.01). All (n = 4/4) those aged six months to five years acute necrotizing gingivitis had chronic malnutrition. CONCLUSION: Our study showed a small proportion of children admitted to the Anka General Hospital had simple or acute necrotizing gingivitis. Hospital admission with malnutrition was a risk factor for both simple and acute necrotizing gingivitis. The lack of access to and uptake of oral health care indicates a strong need for oral examinations to be included in routine health services. This provision could improve the oral status of the population and decrease the chance of patients developing noma.
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Gengivite Ulcerativa Necrosante , Gengivite , Desnutrição , Noma , Criança , Pré-Escolar , Humanos , Gengivite/epidemiologia , Gengivite/complicações , Gengivite Ulcerativa Necrosante/complicações , Gengivite Ulcerativa Necrosante/epidemiologia , Hospitais Gerais , Desnutrição/complicações , Nigéria/epidemiologia , Noma/epidemiologia , Noma/etiologia , Estudos ProspectivosRESUMO
A 34-year-old male patient with poorly controlled HIV/AIDS presented with symptoms consistent with oral candidiasis and necrotizing ulcerative gingivitis. He was treated with systemic antifungal agent and topical and systemic antibiotics.
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Síndrome da Imunodeficiência Adquirida , Candidíase Bucal , Gengivite Ulcerativa Necrosante , Infecções por HIV , Masculino , Humanos , Adulto , HIV , Síndrome da Imunodeficiência Adquirida/diagnóstico , Gengivite Ulcerativa Necrosante/complicações , Candidíase Bucal/complicações , Candidíase Bucal/tratamento farmacológico , Dor , Infecções por HIV/complicações , Infecções por HIV/diagnósticoAssuntos
Colite Ulcerativa , Gengivite Ulcerativa Necrosante , Pioderma Gangrenoso , Estomatite , Humanos , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/etiologia , Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Estomatite/etiologia , Colectomia/efeitos adversosRESUMO
Chronic ulcerative stomatitis (CUS) is a rarely reported disease affecting the oral cavity, most often affecting middle-aged Caucasian females. The aim of the present study is to present the diagnosis, differentiation, and interdisciplinary treatment of this rare disease. CUS is characterized by the presence of an oral erosive or ulcerative lesion. The autoimmune pathogenesis of CUS includes affecting the antigen's activity by DNA-breaking and protein-hydrolyzing enzymes. The stratified epithelium-specific antinuclear antibodies (SES-ANA) are associated with CUS development. Clinically, the lesions presented in oral mucosa might resemble an erosive form of oral lichen planus, whereas gingival lesions seem to be similar to desquamative gingivitis related to dermatological diseases manifested in the oral cavity. Patients often report subjective symptoms related to oral mucosa and general symptoms. Histopathological presentation of CUS is often non-specific and includes sub-epithelial separation from underlying connective tissue, atrophic epithelium, and inflammatory infiltrate with an increased number of plasma cells and lymphocytes. Direct immunofluorescence (DIF) might be used in CUS diagnostics. CUS generally remains nonsusceptible to corticosteroid treatments; however, antimalarial drugs and calcineurin inhibitors are more effective. Further research should be conducted in order to implement a diagnostic protocol and observe the long-term results of CUS management.
Assuntos
Gengivite Ulcerativa Necrosante , Líquen Plano Bucal , Estomatite , Feminino , Humanos , Pessoa de Meia-Idade , Anticorpos Antinucleares , Doença Crônica , Gengivite Ulcerativa Necrosante/diagnóstico , Gengivite Ulcerativa Necrosante/tratamento farmacológico , Gengivite Ulcerativa Necrosante/patologia , Líquen Plano Bucal/diagnóstico , Líquen Plano Bucal/patologia , Estomatite/diagnósticoRESUMO
Inflammatory bowel diseases (IBD) are chronic inflammatory disorders of the digestive tract, and they involve systemic inflammatory diseases known as extra-intestinal manifestations (EIMs). Timely and correct diagnosis of mucocutaneous EIMs could assist with detecting and monitoring IBD. We present a case of 52-year-old male patient of ulcerative colitis with 2 rare EMIs together at the same time: pyostomatitis vegetans in the oral cavity and Sweet syndrome on the skin. They presented as multiple small white or yellow pustules on the surface of the hyperemic fragile oral mucosa and abrupt appearance of painful, swollen, and erythematous papules on the skin, respectively. The final diagnosis was made based on clinical manifestations, skin and oral tissue biopsies, and the ulcerative colitis history. This rare case report may remind dentists of rare mucocutaneous EIMs of IBD that might be overlooked. Dentists and dermatologists could contribute to the early diagnosis and management of systematic diseases.
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Colite Ulcerativa , Gengivite Ulcerativa Necrosante , Doenças Inflamatórias Intestinais , Estomatite , Síndrome de Sweet , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Humanos , Doenças Inflamatórias Intestinais/complicações , Masculino , Pessoa de Meia-Idade , Compostos Orgânicos , Estomatite/diagnóstico , Estomatite/etiologia , Síndrome de Sweet/complicações , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/tratamento farmacológicoRESUMO
RESUMEN El término de gingivitis descamativa ha evolucionado con el decursar de los años. La clasificación de la enfermedad periodontal vigente en Cuba la incluye dentro de los procesos inflamatorios crónicos superficiales. La Academia Americana de Periodontología y la Federación Europea de Periodoncia, han destinado un apartado para esta enfermedad denominado: alteraciones inflamatorias e inmunes. Se presentó una paciente de 27 años de edad, con ardor, sangramiento gingival y molestias al cepillado, la cual acudió a la consulta de Estomatología General Integral. Durante el examen clínico se constató la presencia de zonas eritematosas a nivel de encía marginal e insertada, con exposición del tejido conectivo. Luego de concluida la atención primaria en Periodoncia, la paciente fue remitida a la atención secundaria donde se le diagnosticó un liquen plano bucal con manifestaciones gingivales. Se instauró el tratamiento adecuado hasta la desaparición de las lesiones.
ABSTRACT The term desquamative gingivitis has evolved over the years. The current classification of periodontal disease in Cuba includes it among chronic superficial inflammatory processes. The American Academy of Periodontology and the European Federation of Periodontology have assigned a section for this disease called inflammatory and immune alterations. We present a 27-year-old female patient with burning, gingival bleeding and discomfort when brushing, who came to the General Comprehensive Dentistry consultation. Erythematous areas were observed during clinical examination, at the level of the inserted and marginal gingiva, with exposure of the connective tissue. After the completion of primary periodontal care, the patient was referred to secondary care where she was diagnosed with oral lichen planus with gingival manifestations. Appropriate treatment was instituted until the lesions disappeared.
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Gengivite Ulcerativa Necrosante , Líquen Plano Bucal , GengiviteRESUMO
Chronic ulcerative stomatitis (CUS) is a rare disease of the mucous membranes with characteristics similar to other autoimmune diseases. The aim of this study was to conduct a systematic review of the literature to recover all reported cases of CUS in order to summarize what are the clinical, demographic, microscopic, immunological features of CUS and its therapeutic response to different drugs. A systematic review of the literature was carried out following the statements of preferred reporting items for systematic reviews and meta-analyses (PRISMA). The searches were performed in the electronic databases PubMed, Scopus, EMBASE, LILACS, Opengrey, and Google scholar. Inclusion criteria were articles or abstracts reporting at least one case with a final diagnosis of CUS. A total of 696 records were identified through databases, and 25 studies were selected reporting 81 cases. CUS affects more females (92%), and a greater number of cases are reported in Caucasian patients (53%). The age of patients ranged from 20 to 86 years with a mean age of 60 years (±13.86), and 15% of cases reported concomitantly skin lesions. The clinical and histopathological characteristics of CUS are very similar to those of oral lichen planus. The direct immunofluorescence (DIF) remains the gold-standard diagnostic resource and was performed in 69 cases, revealing a dotted pattern of deposition of stratified epithelium-specific antibodies (SES-ANA). The serum of 38 patients was collected for the performance of the indirect immunofluorescence (IIF), and the use of epithelial substrates such as monkey and guinea pig esophagus often resulted in positive SES-ANA IgG. Most patients were treated with antimalarials, and the treatment of choice that proved to be effective is hydroxychloroquine (HCQ). This entity must be considered in the differential diagnosis of other autoimmune diseases, as it may be underreported.
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Doenças Autoimunes , Gengivite Ulcerativa Necrosante , Estomatite , Animais , Doenças Autoimunes/tratamento farmacológico , Doença Crônica , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Gengivite Ulcerativa Necrosante/diagnóstico , Gengivite Ulcerativa Necrosante/tratamento farmacológico , Gengivite Ulcerativa Necrosante/patologia , Cobaias , Hidroxicloroquina/uso terapêutico , Estomatite/tratamento farmacológicoRESUMO
Trench mouth, as it occurred especially in World War I in soldiers, is a necrotizing ulcerative gingivitis (NUG) in people who have poor oral hygiene, malnutrition, vitamin deficiency, a smoking history, and psychic stress. When not treated properly, this condition can lead to noma. NUG and noma are mainly seen today in severely malnourished, poorly cared for, and immunocompromised children in extremely poor living conditions, mainly in sub-Saharan Africa. In 20th century history, the occurrence of noma in Turkey was described by Albert Eckstein (1891-1959), but noma is particularly linked to the atrocious living conditions in the Nazi exterminations camps, such as Auschwitz, where large numbers of patients with noma were treated in Berthold Epstein's (1890-1962) Noma Department in the Zigeunerlager (Gypsy Camp) under the supervision of SS physician Josef Mengele (1911-1979). Although these patients were treated successfully, all of them, mostly children, were ultimately killed. The protocols of the noma research are lost, and descriptions from Auschwitz are scarce. Fortuitously, there are some testimonies, especially from postwar trials, that give insight on this ambiguous and repressed topic.
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Gengivite Ulcerativa Necrosante , Desnutrição , Noma , Criança , Humanos , Socialismo Nacional , Noma/terapiaRESUMO
'Necrotising periodontal diseases' is an umbrella term for necrotising gingivitis, necrotising periodontitis, necrotising stomatitis and noma. These rapidly destructive conditions are characterised by pain, interdental ulceration and gingival necrosis which, if left untreated, can result in osteonecrosis. Research indicates that patients with a history of alcohol misuse are at an increased risk of malnutrition, which negatively affects the immune response and predisposition to necrotising periodontal diseases. This article will discuss that osteonecrosis of the alveolar bone does not exclusively occur in association with antiresorptive medications, but can occur as a severe form of necrotising gingivitis. In this article, we will describe two cases to highlight the occurrence, presentation and management of necrotising periodontal diseases secondary to alcohol misuse.
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Alcoolismo , Gengivite Ulcerativa Necrosante , Gengivite , Noma , Osteonecrose , Doenças Periodontais , Alcoolismo/complicações , Gengivite Ulcerativa Necrosante/etiologia , Gengivite Ulcerativa Necrosante/terapia , Humanos , Osteonecrose/induzido quimicamente , Osteonecrose/terapiaRESUMO
A 51-year-old woman presented with a 4-month history of painful ulcers in the mouth and vulva, and painful vegetative plaques at intertriginous sites. Skin biopsies showed squamous hyperplasia and intraepidermal eosinophilic pustulation. Skin direct immunofluorescence (DIF) revealed intercellular deposition of IgG and C3 in the lower part of the epidermis, while serum indirect immunofluorescence (IIF) confirmed the presence of antiepithelial antibodies. The patient was diagnosed with pemphigus vegetans, and successfully treated with dapsone, prednisolone and topical steroids. Although pemphigus vegetans and pyostomatitis-pyodermatitis vegetans can show identical clinical and histological features, the presence or absence of comorbid inflammatory bowel disease, and the results of both skin DIF and serum IIF can be used to distinguish between these two conditions. This case report explores the challenges in making this distinction, and the implications of establishing the correct diagnosis.
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Gengivite Ulcerativa Necrosante , Pênfigo , Estomatite , Feminino , Humanos , Pessoa de Meia-Idade , Compostos Orgânicos , Pênfigo/diagnóstico , Pênfigo/tratamento farmacológico , Pele , Estomatite/diagnóstico , Estomatite/tratamento farmacológicoRESUMO
This article highlights the results of a study of blood parameters in animals with simulated necrotizing ulcerative gingivitis and compares them, under the same conditions, with animals that received local treatment with a developed complex of antioxidant drugs. Following the work tasks, the nature of changes in the state of the antioxidant - prooxidant system and their influence on quantitative and functional indicators of markers of inflammatory intensity was analyzed and investigated during the pathological process in the background and without treatment with a developed complex. This work shows the changes of malonic dialdehyde concentration as an indicator of lipid peroxidation intensity in experimental animals, the level of catalase activity in the blood of animals, and antioxidant-prooxidant balance in the dynamics of necrotizing ulcerative gingivitis.
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Antioxidantes/metabolismo , Gengivite Ulcerativa Necrosante/sangue , Animais , Biomarcadores/sangue , Catalase/sangue , Humanos , Peroxidação de Lipídeos , Masculino , Malondialdeído/sangue , Oxirredução , Coelhos , Espécies Reativas de Oxigênio/sangueRESUMO
The coronavirus disease 2019 (Covid-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that clinically affects multiple organs of the human body. Cells in the oral cavity express viral entry receptor angiotensin-converting enzyme 2 that allows viral replication and may cause tissue inflammation and destruction. Recent studies have reported that Covid-19 patients present oral manifestations with multiple clinical aspects. In this review, we aim to summarise main signs and symptoms of Covid-19 in the oral cavity, its possible association with oral diseases, and the plausible underlying mechanisms of hyperinflammation reflecting crosstalk between Covid-19 and oral diseases. Ulcers, blisters, necrotising gingivitis, opportunistic coinfections, salivary gland alterations, white and erythematous plaques and gustatory dysfunction were the most reported clinical oral manifestations in patients with Covid-19. In general, the lesions appear concomitant with the loss of smell and taste. Multiple reports show evidences of necrotic/ulcerative gingiva, oral blisters and hypergrowth of opportunistic oral pathogens. SARS-CoV-2 exhibits tropism for endothelial cells and Covid-19-mediated endotheliitis can not only promote inflammation in oral tissues but can also facilitate virus spread. In addition, elevated levels of proinflammatory mediators in patients with Covid-19 and oral infectious disease can impair tissue homeostasis and cause delayed disease resolution. This suggests potential crosstalk of immune-mediated pathways underlying pathogenesis. Interestingly, few reports suggest recurrent herpetic lesions and higher bacterial growth in Covid-19 subjects, indicating SARS-CoV-2 and oral virus/bacteria interaction. Larger cohort studies comparing SARS-CoV-2 negative and positive subjects will reveal oral manifestation of the virus on oral health and its role in exacerbating oral infection.
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COVID-19/complicações , Gengivite Ulcerativa Necrosante/complicações , Infecções por Herpesviridae/complicações , Úlceras Orais/complicações , Doenças Periodontais/complicações , Sialadenite/complicações , Estomatite Aftosa/complicações , Xerostomia/complicações , Enzima de Conversão de Angiotensina 2/genética , Enzima de Conversão de Angiotensina 2/imunologia , Anosmia/complicações , Anosmia/imunologia , Anosmia/patologia , Anosmia/virologia , COVID-19/imunologia , COVID-19/patologia , COVID-19/virologia , Disgeusia/complicações , Disgeusia/imunologia , Disgeusia/patologia , Disgeusia/virologia , Expressão Gênica , Gengivite Ulcerativa Necrosante/imunologia , Gengivite Ulcerativa Necrosante/patologia , Gengivite Ulcerativa Necrosante/virologia , Infecções por Herpesviridae/imunologia , Infecções por Herpesviridae/patologia , Infecções por Herpesviridae/virologia , Humanos , Boca/imunologia , Boca/patologia , Boca/virologia , Úlceras Orais/imunologia , Úlceras Orais/patologia , Úlceras Orais/virologia , Doenças Periodontais/imunologia , Doenças Periodontais/patologia , Doenças Periodontais/virologia , SARS-CoV-2/imunologia , SARS-CoV-2/patogenicidade , Serina Endopeptidases/genética , Serina Endopeptidases/imunologia , Sialadenite/imunologia , Sialadenite/patologia , Sialadenite/virologia , Estomatite Aftosa/imunologia , Estomatite Aftosa/patologia , Estomatite Aftosa/virologia , Xerostomia/imunologia , Xerostomia/patologia , Xerostomia/virologiaRESUMO
BACKGROUND: Although there are no population-based studies that support an association, there are reports in the literature of mucocutaneous, vesiculobullous and ulcerated lesions in the oral mucosa in cases of arbovirus infection. The aim of this study is to analyze the prevalence of ulcerative stomatitis in individuals affected by arboviruses in a population of the municipality of Arcoverde, Pernambuco, Brazil. MATERIAL AND METHODS: 1,003 people living in an area assigned to a Primary Health Care Unit were interviewed. A structured questionnaire was used for data collection, with questions about sociodemographic variables, residence conditions, general health information, as well as information about the general signs and symptoms of arboviruses and specifically about oral lesions. RESULTS: Of the 1,003 individuals interviewed, 815 (81.25%) were infected by one or more arboviruses. Of these, 147 (18%) reported ulcerated oral lesions during arbovirus infections. The association between arbovirus infections and the presence of ulcerated oral lesions was statistically significant (p = 0.000). CONCLUSIONS: In these cases, the ulcerated lesions on the oral mucosa appear to be associated with arbovirus infection, especially Chikungunya, although the pathophysiological mechanisms are not defined, and the studies are not sufficient to confirm this association
No disponible
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Gengivite Ulcerativa Necrosante/epidemiologia , Gengivite Ulcerativa Necrosante/virologia , Infecções por Arbovirus/epidemiologia , Prevalência , Inquéritos e Questionários , Fatores Socioeconômicos , Distribuição por Idade e Sexo , Brasil/epidemiologiaRESUMO
RESUMEN La estomatitis subprótesis es una de las lesiones más frecuentes encontradas en la consulta de Estomatología. Es una enfermedad comúnmente asintomática, cuya génesis es multifactorial, y tiene una alta prevalencia en pacientes portadores de prótesis removibles. Predecir su aparición resultaría muy oportuno pues permitiría alcanzar beneficios económicos y para la salud del individuo. Por ello, es importante desarrollar un modelo predictivo del riesgo a padecer estomatitis subprótesis. Se realizó este estudio en los pacientes que acudieron a la consulta de prótesis de la Clínica Estomatológica «Victoria de Santa Clara¼. Dicha investigación se caracterizó por la obtención de un modelo predictivo de la enfermedad. Los principales factores predictivos de la enfermedad fueron: la higiene bucal deficiente y la mala calidad de las prótesis. Se confeccionó una ecuación logística y se obtuvo un modelo predictivo con el propósito de conocer los pacientes con más probabilidades de padecer dicha enfermedad.
ABSTRACT Subprosthesis stomatitis is one of the most frequent lesions found in a dental consultation. It is a commonly asymptomatic disease, whose origin is multifactorial, and has a high prevalence in patients with removable prostheses. Predicting its appearance would be very timely as it would allow reaching economic benefits and benefits for individual's health. Therefore, it is important to develop a predictive model of the risk of suffering from subprosthesis stomatitis. This study was carried out on patients who came to the prosthesis consultation at "Victoria de Santa Clara" Dental Clinic. It was characterized by the elaboration of a predictive model of the disease. Poor oral hygiene and poor quality of the prosthesis were the main predictive factors of the disease. A logistic equation was made and a predictive model was obtained in order to know the patients with more probabilities of suffering from this disease.
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Fatores de Risco , Implantação Dentária , Gengivite Ulcerativa NecrosanteRESUMO
No disponible
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Humanos , Feminino , Pessoa de Meia-Idade , Gengivite Ulcerativa Necrosante/diagnóstico , Faringite/diagnóstico , Tonsilite/diagnóstico , Gengivite Ulcerativa Necrosante/microbiologia , Faringite/microbiologia , Tonsilite/microbiologiaRESUMO
A 7-year-old girl presented with necrotic gingival tissue manifesting as large ulcers in the labial and lingual gingival tissue along the region of the mandibular central incisors and right canine. The severe symptoms associated with the gingival lesions were an indication for the use of a topical tetracycline solution. The patient's parent was instructed to prepare the antibiotic solution by crushing a 250-mg tablet of tetracycline in 10 mL of distilled water. Initially, the patient was instructed to use the tetracycline solution 3 times daily for 7 days by swishing the solution around her mouth for 1 minute, expectorating the solution, and rinsing with water. After the first week, the lesions showed marked clinical improvement, and use of the antibiotic was prescribed for an additional 7 days. After 14 days of treatment, the patient presented with complete remission of the lesions. The results in the present case support the use of topical tetracycline as an effective treatment option for NUG.
Assuntos
Gengivite Ulcerativa Necrosante , Gengivite/tratamento farmacológico , Antibacterianos/uso terapêutico , Criança , Feminino , Gengiva , Humanos , Tetraciclinas , Resultado do TratamentoRESUMO
AIM: This study was designed to investigate the clinical and microbiological parameters with photochemotherapy (PCT) against conventional debridement (CD) among patients with necrotizing ulcerative gingivitis (NUG). MATERIALS AND METHODS: Patients with a diagnosis of NUG were divided into two groups: 'Group-PCT' that underwent indocyanine green-mediated PCT with adjunctive mechanical debridement, and Group-CD that underwent mechanical debridement with adjunctive 3 % hydrogen peroxide/chlorhexidine rinse. Clinical inflammatory gingival parameters including full-mouth plaque scores (FMPS), bleeding scores (FMBS), and probing depth (PD) were measured. Counts of Treponema microdentium, Fusobacterium nucleatum and Prevotella intermedia were assessed using polymerase chain reaction technique. All assessments were done at baseline, 3 weeks and 6 weeks. RESULTS: Twenty-six participants were contacted and agreed to participate in the trial. The mean age of participants in group-PCT was 24.5 years while the mean age of patients in group-CD was 26.7 years. FMPS showed significant but equal reduction in both the groups at 3 weeks and 6 weeks (p < 0.01). The reduction in mean FMBS was higher in the group-PCT at 6 weeks follow-up (p < 0.05). All bacterial levels reduced from baseline to follow-up with both PCT and CD groups (p < 0.05). Group-PCT showed significantly reduced counts of T. microdentium and F. nucleatum at 3 weeks and 6 weeks compared with group-CD (p = 0.024). Equal reduction was shown for P. intermedia between both the groups at 3 and 6 weeks, respectively. CONCLUSION: Application of adjunctive photochemotherapy was both clinically and microbiologically effective in the treatment of NUG.
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Gengivite Ulcerativa Necrosante/tratamento farmacológico , Gengivite Ulcerativa Necrosante/microbiologia , Fotoquimioterapia/métodos , Adulto , Clorexidina/uso terapêutico , Desbridamento , Feminino , Fusobacterium nucleatum , Hemorragia Gengival/microbiologia , Hemorragia Gengival/prevenção & controle , Humanos , Peróxido de Hidrogênio/uso terapêutico , Verde de Indocianina/uso terapêutico , Masculino , Índice Periodontal , Fármacos Fotossensibilizantes/uso terapêutico , Prevotella intermedia , Treponema denticolaRESUMO
Canine Chronic Ulcerative Stomatitis is a spontaneously occurring inflammatory disease of the oral mucosa. An immune-mediated pathogenesis is suspected though not yet proven. We have recently reported on the clinical and histologic features, and identification of select leukocyte cell populations within the lesion. A clinical and histologic similarity to oral lichen planus of people was proposed. In the present study, these initial observations are extended by examining lesions from 24 dogs with clinical evidence of chronic ulcerative stomatitis. Because dogs with chronic ulcerative stomatitis often have concurrent periodontal disease, we wondered if dental plaque/biofilm may be a common instigator of inflammation in both lesions. We hypothesized that dogs with chronic ulcerative stomatitis would exhibit a spectrum of pathologic changes and phenotype of infiltrating leukocytes that would inform lesion pathogenesis and that these changes would differ from inflammatory phenotypes in periodontitis. Previously we identified chronic ulcerative stomatitis lesions to be rich in FoxP3+ and IL17+ cells. As such, we suspect that these leukocytes play an important role in lesion pathogenesis. The current study confirms the presence of moderate to large numbers of FoxP3+ T cells and IL17+ cells in all ulcerative stomatitis lesions using confocal immunofluorescence. Interestingly, the majority of IL17+ cells were determined to be non-T cells and IL17+ cell frequencies were negatively correlated with severity on the clinical scoring system. Three histologic subtypes of ulcerative stomatitis were determined; lichenoid, deep stomatitis and granulomatous. Periodontitis lesions, like stomatitis lesions, were B cell and plasma cell rich, but otherwise differed from the stomatitis lesions. Direct immunofluorescence results did not support an autoantibody-mediated autoimmune disease process. This investigation contributes to the body of literature regarding leukocyte involvement in canine idiopathic inflammatory disease pathogenesis.