| The association of erythema nodosum and dental infectious foci has rarely been described in the literature. This report concerns four women who developed erythema nodosum either following dental treatment associated with gingival bleeding or due to infectious dental foci. In these cases, tooth extraction, removal of dental deposits, interrupted pulp treatment, apical periodontitis, or a relicted root were identified as causes of the development of erythema nodosum. Upon admission to the hospital, these patients also presented fever and and a maximally elevated erythrocyte sedimentation rate (ESR). In all instances, surgical treatment of the dental foci and/or administration of antibiotics rapidly led to the regression of the erythema nodosum, as well as to the normalization of body temperature and ESR. The cases described indicate that antecedent dental treatment and the possible presence of infectious dental foci should be considered in the differential diagnosis of erythema nodosum when taking the patient's medical history. This approach may avoid unnecessary, possibly invasive diagnostic procedures and can lead to rapid improvement in the patient's clinical status. ( info) |
| eosinophilic granuloma is the most benign disorder of the triad commonly known as histocytosis X. In this article a case of a 6 year old female child with multiple eosinophilic granuloma with additional liver dysfunction and its oral manifestation is presented. This case demonstrated that oral findings, may be an early manifestation of the disease, definitive diagnosis needs to be determined by correlation of the clinical findings with histologic features. For the duration of 8 years the case has been followed up, there has been a progressive healing of the lesion, the clinical manifestations of the disease resolved with only chemotherapy and provided a very good prognosis. ( info) |
43/109. Acute idiopathic thrombocytopenic purpura: a case report. This paper presents a case report of a patient who showed severe oral and skin manifestations of acute idiopathic thrombocytopenic purpura, followed by a discussion of the approach to its differential diagnosis and management in the context of the dental setting. ( info) |
44/109. Severe gingival bleeding in a myelodysplastic patient: management and outcome. BACKGROUND: The myelodysplastic syndromes (MDS) are a group of stem cell disorders characterized by a reduction in one or more elements of the peripheral blood. oral manifestations of the disease and oral complications of medical management may result in significant symptoms and have an impact on the systemic condition of the patient. The removal of the infectious focus, such active teeth infection or severe periodontal disease, remains controversial in these patients, due to the increased risk of bleeding and systemic infection. methods: This paper reports a case of MDS with spontaneous gingival hemorrhage and generalized gingival hyperplasia associated with periodontal disease. This patient underwent several platelet transfusions due to these oral complications. The patient received periodontal therapy, resulting in an improvement of the oral clinical situation and a decrease of gingival hyperplasia. RESULTS: The patient did not present any episode of gingival hemorrhage after the periodontal treatment. CONCLUSION: The results of this study suggest that periodontal therapy should be performed in MDS patients presenting thrombocytopenia, gingival hyperplasia, and gingival bleeding, with the intent of preventing further hemorrhagic episodes and possible systemic infection. ( info) |
45/109. Angina bullosa haemorrhagica: a case report and a concise review. Various differential diagnoses pertaining to angina bullosa haemorrhagica (ABH) have been reported in the dental literature; these differential diagnoses include mucous membrane pemphigoid, bullous pemphigoid, bullous lichen planus, epidermolysis bullosa, dermatitis herpetiformis, linear IgA disease, and oral amyloidosis. ABH is characterized by a solitary blood blister in the palate and may worsen progressively, leading to multiple lesions in other areas. The bullae usually rupture spontaneously and the sites heal uneventfully. Possible etiological factors include trauma, long-term use of steroids, diabetes, and hereditary predilection. Pathological studies have yielded nonspecific findings and the underlying etiopathology remains ill-defined. This article describes a case of ABH following the use of a 0.12% chlorhexidine gluconate mouthrinse and presents a concise review of the literature pertaining to ABH and differential diagnoses. ( info) |
46/109. Progressive laser treatment of hereditary hemorrhagic telangiectasia of the gingiva: case report. Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular malformation commonly found in the oral region. The symptoms range from minor epistaxis to severe, life-threatening hemorrhage. Red spots on the skin and in the mouth could lead to a diagnosis of HHT. The telangiectases can be irritated by normal dental procedures, and prophylactic antibiotics should be administered. The gingival HHT in this case demonstrates its significance to the dental community. A knowledgeable practitioner could be the first to recognize the potential diagnosis of HHT. Lesion variables will determine treatment parameters. Sequential photocoagulation with an argon laser appears to be an appropriate treatment algorithm. ( info) |
47/109. Dental treatment for children with chronic idiopathic thrombocytopaenic purpura: a report of two cases. Idiopathic thrombocytopaenic purpura (ITP) is the most common acquired bleeding disorder occurring in previously healthy children. The condition is benign and self-limiting, with a high possibility of recovery. Only 15-30% of children with acute ITP develop the chronic form. Clinically, ITP presents with petechiae, ecchymoses, haematomas, epistaxis, haematuria, mucocutaneous bleeding, and occasionally, haemorrhage into tissues. oral manifestations include spontaneous gingival bleeding, petechiae or haematomas of the mucosa, tongue or palate. Two paediatric case reports are described concerning female patients diagnosed with chronic ITP. Oral findings and dental procedures are described. Standard dental treatment was performed with a platelet count higher than 50,000/mm3. The importance of adequate dental plaque control techniques in order to prevent inflammation, potential bleeding and infection in these patients is emphasized. The paediatric dentist must be aware of the clinical appearance of ITP in order to recognize the condition and successfully manage the patient. ( info) |
48/109. A new candidate mutation, G1629R, in a patient with type 2A von Willebrand's disease: basic mechanisms and clinical implications. BACKGROUND AND OBJECTIVES: Type 2A von Willebrand's disease (VWD) refers to disease variants with decreased platelet-dependent function of von willebrand factor (VWF) associated with the absence of high molecular weight (HMW) multimers. The candidate G1629R mutation, identified in an Italian patient with type 2A VWD, was expressed to confirm the relationship between phenotype and genotype. DESIGN AND methods: plasma samples from the patient were studied after DDAVP or FVIII/VWF concentrate injections. Furthermore, an expression vector carrying the G1629R mutation was constructed by site-directed mutagenesis and transiently expressed in Cos-7 cells. The characteristics of the corresponding recombinant protein were analyzed. RESULTS: After 1-deamino-8-D-argine vasopressin (DDAVP) infusion, factor viii and VWF activities increased and HMW VWF multimers were transiently observed in the patient's plasma. VWF activity increased only after administration of a dual FVIII/VWF concentrate. ADAMTS-13 activity did not change significantly before or after the therapies. Secretion, in culture medium, of the corresponding mutated protein (R1629-rVWF) was slightly decreased and this rVWF contained intermediate and HMW multimers. Furthermore, binding of R1629-rVWF to platelet GPIb was moderately reduced compared to that of the wild-type rVWF. INTERPRETATION AND CONCLUSIONS: Based on the DDAVP and in vitro expression results, we classified the G1629R mutation in group 2 type 2A mutations. Our findings could explain why DDAVP may only be partially effective and suggest that FVIII/VWF concentrates should be used in cases of prolonged mucosal bleeding and major surgery when functional VWF is required. ( info) |
49/109. An unusual presentation of hypothyroidism. We describe a case of a 42-year-old male, with a 5-year history of recurrent gum bleeding, easy bruising, and chronic fatigue who presented for management of possible bleeding complications prior to a planned dental procedure. After extensive work-up, the patient was diagnosed with acquired von Willebrand disease and underlying hypothyroidism with a thyrotropin (TSH) of 321 mIU/L (0.35-5.5) and total thyroxine (T(4)) of less than 1 microg/dL (4.5-12.5). He was started on levothyroxine and therapy and when compliant with treatment, the mucosal bleeding and symptoms of hypothyroidism were resolved. A subsequent TSH and total T(4) samples were drawn and found to be 6.3 mIU/L and 4.1 microg/dL, respectively. ( info) |
50/109. Periodontal treatment in severe aplastic anemia. BACKGROUND: Aplastic anemia (AA) is a rare hematologic disease characterized by hypo-cellular bone marrow. The clinical features include fatigue, increased bruising, and gingival bleeding caused by anemia, leukopenia, and thrombocytopenia. A patient with AA is at high risk for infection because of leukopenia. The risk of systemic infection is especially high in AA patients with severe local infections, including periodontitis. Accordingly, periodontal treatment should include antibiotic prophylaxis to reduce the risk of systemic infection. However, treatment of periodontitis in the AA patient is significantly complicated by the bleeding disorder. We present a case report of the successful periodontal treatment of an AA patient with spontaneous gingival bleeding. methods: The patient was closely monitored for platelet and neutrophil counts before every treatment. The patient's platelet count was always under 10,000/microl. Therefore, it was necessary to increase platelet counts to over 25,000/microl by transfusion, after which subgingival scaling with anesthesia was performed. When the neutrophil count was less than 2,000/microl, local minocycline chemotherapy was applied to the pockets. Periodontal infection was monitored by detection of bacterial dna and measurement of serum immunoglobulin (Ig) G titer against periodontal bacteria. RESULTS: Following the physical and chemical treatment, the gingival appearance improved dramatically and the spontaneous gingival bleeding disappeared. Moreover, the IgG titer against periodontal bacteria decreased to normal range and specific periodontal pathogens were no longer detectable in the tested pockets. CONCLUSION: We believe that the treatment strategy in the present report provides new sight into treatment planning for severely medically compromised patients. ( info) |