Idiopathic thrombocytopenic purpura presenting as post-extraction hemorrhage.

J Contemp Dent Pract. 2007;8(6):43-9

Authors: Martini MZ, Lopez JS, Gendler JL, da Fonseca EV, Soares HA, Franzi SA

AIM: The aim of this article is to present a case of idiopathic thrombocytopenic purpura (ITP) in order to emphasize the importance of the clinical exam since the anamnesis leads to a diagnostic hypothesis of ITP. BACKGROUND: Acute ITP is considered an autoimmune disease characterized by the production of antibodies against platelets, antigens produced by a viral infection, or a platelet sparing drug combination. These antibodies adhere to platelets and are recognized and destroyed by the reticulo-endothelial system. Consequently, the platelet count gradually diminishes and is insufficient for the maintenance of primary hemostasis. REPORT: A 77-year-old woman presented with post-extraction intermittent bleeding. The physical examination revealed discoloration of the skin, multiple petechiae, hematomas, ecchymosis of the upper lip, bruises all over the body, gingiva that bled spontaneously, and a malformed blood clot at the extraction site of tooth #44. The hematological exams confirmed the hypothesis of ITP. The patient was immediately hospitalized in the Hematology Department of a local hospital and received platelet replacement, hydration, medication, and general care. After the spontaneous bleeding stopped, the malformed clot was removed using alveolar curettage along with a thorough cleaning of the extraction site with a 0.9% saline solution before suturing the wound and prescribing medication. After the sixth day of hospitalization, the patient presented with the following results: Hb: 12.3 mg/dL, Ht: 36.1%, and PC: 87,000 mm3. The patient was then discharged and was placed under outpatient follow-up care. SUMMARY: The importance of the clinical exam must be emphasized since the anamnesis leads to a diagnostic hypothesis of ITP and provides the dental surgeon with an opportunity to make important systemic alterations to improve the prognosis of a patient with ITP.

PMID: 17846670 [PubMed - indexed for MEDLINE]

Specialty dentistry for the hemophiliac: is there a protocol in place?

Indian J Dent Res. 2007 Apr-Jun;18(2):48-54

Authors: Kumar JN, Kumar RA, Varadarajan R, Sharma N

Restorative dental care for the hemophiliac patient is of paramount importance for the fact that advanced dental conditions and subsequent treatments prove to be more complicated and risky. Quite often, dental health is neglected by hemophiliacs for fear of bleeding during procedures. Surprisingly, even dental specialists avoid these candidates and contribute to the conversion ofa simple dental patient to an oral surgical patient. The complexities involved in diagnosing a bleeding disorder and the rarity of a standardized protocol to handle such patients contribute to this problem. This article prescribes a simple protocol to diagnose bleeding disorders and a modified scheme for endodontic and periodontal therapy in a hemophiliac patient.

PMID: 17502707 [PubMed - indexed for MEDLINE]

Severe hemorrhage during an incisional biopsy: a report of a case.

J Contemp Dent Pract. 2007;8(3):97-103

Authors: Cheng CK, Gaia BF, de Oliveira Neto HG, Martini MZ, Aburad A, Shinohara EH

BACKGROUND: Surgical procedures under local anesthesia are routinely employed by the dentist and are susceptible to significant complications which demand immediate care from the dental professional. REPORT: This report presents a case of severe arterial hemorrhage during a simple removal of a lesion during an incisional biopsy. SUMMARY: In the event of severe arterial hemorrhage in a conventional dental office, manual compression for containing the hemorrhage and use of an adequate light source to correctly visualize the origin of the bleeding is recommended. If visible, the dental surgeon must attempt to perform vascular ligature or an occlusive suture. If the hemorrhage cannot be controlled after these measures, the patient must be transported to a hospital while continuing local compression during transit.

PMID: 17351687 [PubMed - indexed for MEDLINE]

Hematoma following periodontal surgery with a torus reduction: a case report.

J Contemp Dent Pract. 2007;8(3):72-80

Authors: Mantzikos K, Segelnick SL, Schoor R

BACKGROUND: There are no published case reports that hematomas occur on the floor of the mouth as a result of periodontal surgery. REPORT: These three case reports document post surgical hematoma formation on the floor of the mouth that pose problems with the diagnosis, prognosis, and patient management. All cases involved periodontal surgery where extensive reduction of tori and bony exostoses were required. Two cases resulted in hematomas in the floor of the mouth. However, a change in the post surgical management for a third case demonstrated possible prevention of hematoma formation. SUMMARY: Hematomas in the floor of the mouth can be a resolving post surgical phenomenon or a serious vascular insult to this region of the oral cavity. This report clarifies the diagnosis, prognosis, and the best management protocol through the presentation of three cases.

PMID: 17351684 [PubMed - indexed for MEDLINE]

Evaluation of the marginal gingival health using laser Doppler flowmetry.

Braz Dent J. 2006;17(3):219-22

Authors: Develioglu H, Kesim B, Tuncel A

The purposes of this study were to compare the gingival blood flow (GBF) in test sites (teeth retaining fixed partial dentures) and control sites (contralateral natural teeth) and investigate whether there is any relationship between clinical indices and GBF values. Twelve healthy subjects (6 females and 6 males) aged 20 to 54 years were enrolled this study. The GBF was measured from the middle point of the marginal gingiva in the test and control sites using laser Doppler flowmetry (LDF). Additionally, plaque index, gingival index and probing depth measurements were recorded. Statistically significant difference (p<0.05) was found between the test and control sites for marginal GBF. In contrast, no significant difference (p>0.05) was found between test and control sites with respect to the clinical indices, except for plaque index. The findings of this study suggest that there is a significant relation between resin-bonded fixed partial dentures with margins located subgingivally and marginal GBF. Clinical indices are helpful to collect information about the clinical health status of gingival tissues, but GBF is a good tool to measure gingival tissue blood flow and assess periodontal health. In conclusion, laser Doppler flowmetry can be used together with clinical indices to evaluate the marginal gingival health.

PMID: 17262128 [PubMed - indexed for MEDLINE]

Bleeding gums: duloxetine may be the cause.

J Postgrad Med. 2007 Jan-Mar;53(1):44-5

Authors: Balhara Y, Sagar R, Varghese ST

Duloxetine is a newly introduced drug. It is being prescribed for the management of diabetic neuropathic pain and major depressive disorder. The most frequently observed adverse events with duloxetine are nausea, dry mouth and somnolence, constipation, diarrhea, decreased appetite, weight loss, feeling of fatigue, dizziness, somnolence, hypohidrosis, decreased libido and erectile dysfunction. One of the patients being prescribed the drug developed bleeding gums on being started with the drug which resolved on stopping it. We hereby report this case.

PMID: 17244971 [PubMed - indexed for MEDLINE]

Gingivitis susceptibility and its relation to periodontitis in men.

J Dent Res. 2006 Dec;85(12):1134-7

Authors: Dietrich T, Kaye EK, Nunn ME, Van Dyke T, Garcia RI

The objective of this cross-sectional study was to evaluate whether gingivitis susceptibility is associated with periodontitis. We analyzed data of 462 men in the VA Dental Longitudinal Study aged 47 to 92 years who had never smoked or had quit smoking 5+ years previously. Multiple logistic regression models, with tooth-level bleeding on probing at sites with attachment loss<or=2 mm as the dependent variable, were derived with adjustment for plaque, calculus, crown coverage, age, income, education, marital status, body mass index, diabetes, and vitamin C intake, and stratification by age (<65, 65+ years). Periodontitis and mean attachment loss were positively associated with bleeding on probing, with stronger associations among men<65 years old (for periodontitis, OR 2.1; 95% CI 1.5, 3.1) than men 65+ years of age (OR 1.2; 95% CI 0.9, 1.6). Our results suggest that among never and former smokers, gingivitis susceptibility is higher among men with periodontitis compared with that in men without periodontitis.

PMID: 17122168 [PubMed - indexed for MEDLINE]

Systemic lupus erythematosus.

Indian J Dent Res. 2006 Apr-Jun;17(2):91-3

Authors: Jayakumar ND, Jaiganesh R, Padmalatha O, Sheeja V

Desquamative gingival lesions are non-plaque induced inflammatory gingival lesions. It is a clinical description and not a diagnosis. These desquamative lesions represent oral manifestations of various dermatoses. Systemic lupus erythematous (SLE), one of the rare dermatoses shows desquamative lesions as the oral manifestation. We here with report a case of SLE with oral lesions involving gingiva of a 36 year old female patient. The clinical presentation, histological features, and investigatory findings are discussed.

PMID: 17051876 [PubMed - indexed for MEDLINE]

Clinical evaluation of an ionic tooth brush on oral hygiene status, gingival status, and microbial parameter.

Indian J Dent Res. 2006 Apr-Jun;17(2):74-7

Authors: Deshmukh J, Vandana KL, Chandrashekar KT, Savitha B

It has long been recognised that the presence of dental plaque leads to gingivitis and periodontal disease, as well as dental caries. Today tooth brushing is the most widely accepted method of removing plaque. Hence this present clinical study was undertaken to evaluate the effectiveness of an ionic toothbrush on oral hygiene status. For this study, 20 dental students in the age group of 18-20 years were included. All the subjects after undergoing dental prophylaxis were then provided with ionic toothbrushes, either active (equipped with lithium battery) or inactive (without lithium battery). Plaque index and gingival bleeding index were examined at 7th, 14th, and 21st day. Microbial assessment was done for detection of colony forming units (CFU) from the plaque samples which were collected on 0 day and 21st day, both before brushing and after brushing. Results shown a significant reduction in all the parameters and the reduction was more significant in active and inactive ionic toothbrush users. It was concluded that both active and inactive ionic toothbrushes reduced the plaque index and gingival bleeding index scores significantly and active ionic tooth brushes were more effective as compared to inactive ionic toothbrushes. There was no soft tissue trauma following the use of both type of toothbrushes, which showed that ionic toothbrushes were equally safe for regular long-term use.

PMID: 17051872 [PubMed - indexed for MEDLINE]

Detection and measurement of oral malodour in periodontitis patients.

Indian J Dent Res. 2006 Jan-Mar;17(1):2-6

Authors: John M, Vandana KL

BACKGROUND & OBJECTIVES: Malodour has been correlated with the concentration of volatile sulphur compounds produced in the oral cavity by metabolic activity of bacteria colonizing the periodontal sites and the dorsum of the tongue. The aim of this study was to detect malodour in mouth air organoleptically and using a portable sulphide monitor and to correlate it with the clinical parameters, halitosis linked toxins and BANA, using tongue and subgingival plaque samples. The halitosis grading is also correlated with the microbial colonies of the subgingival plaque sample. METHODS: 20 patients with chronic periodontitis with 5-7 mm pocket depth, radiographic evidence of bone loss and presence of oral malodour participated in this study. Assessment of mouth air was done organoleptically and by using a portable sulphide monitor. The clinical parameter, plaque index (PI), gingival index (GI), gingival bleeding index (BI), were obtained from all the areas. Samples for BANA and to detect halitosis linked toxins were taken from the dorsal surface of the tongue and periodontal pockets ranging 5-7 mm. Halitosis related microbial colonies were identified using anaerobic culturing from the subgingival plaque. RESULTS: The scores of PI, GI, BI and sample that tested positive for halitosis linked toxins and with the halitosis grading were not significant. The presence of tongue coating and the halitosis grading and toxin levels were significant. BANA has shown to be non contributory due to technical problems. Anaerobic culture has shown to identify Streptococcus, Bacteroides, Fusobacterium, Porphyromonas and Prevotella colonies. INTERPRETATION & CONCLUSION: The results confirmed that there was no correlation between the clinical parameters, halitosis linked toxins and halitosis grading. The microbial colonies have shown to correlate with the presence of oral malodour.

PMID: 16900888 [PubMed - indexed for MEDLINE]

A novel mutation in ALK-1 causes hereditary hemorrhagic telangiectasia type 2.

J Dent Res. 2006 Aug;85(8):705-10

Authors: Yan ZM, Fan ZP, Du J, Hua H, Xu YY, Wang SL

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal-dominant bleeding disorder and has two variants, HHT1 and HHT2, associated with mutations in the ENG and ALK-1 genes, respectively. We identified one Chinese HHT2 family to investigate the pathogenic gene and its possible mechanism of action by mutation screening and functional study. One substitution mutation (1717C>T) in exon 10 of the ALK-1 was found by sequencing of all exons of ENG and ALK-1 and caused a R479X mutation in the ALK-1 protein. ALK-1 mRNA and plasma thrombomodulin were measured by real-time quantitative PCR and ELISA, respectively. There was no significant difference in the expression levels of ALK-1 mRNA between patients and healthy individuals. A significantly higher level of thrombomodulin was found in HHT patients. These findings indicate that the mutation causes truncation of the ALK-1 protein at the post-transcriptional level; the plasma thrombomodulin may provide an easy diagnostic indicator in HHT patients.

PMID: 16861286 [PubMed - indexed for MEDLINE]

Hemorrhagic bullae with nebulised ipratropium bromide.

J Postgrad Med. 2006 Jul-Sep;52(3):235-6

Authors: Saravanan V, Bankar RN, Kumar S, Williams JG

PMID: 16855336 [PubMed - indexed for MEDLINE]

Oral ulceration and bleeding associated with pancreatic enzyme supplementation in a German shepherd with pancreatic acinar atrophy.

Can Vet J. 2006 Jun;47(6):579-82

Authors: Snead E

A 20-month-old German shepherd with primary pancreatic acinar atrophy and exocrine pancreatic insufficiency that was treated with pancreatic enzyme supplementation, vitamin B12, and cimetidine developed oral bleeding. Following discontinuation of the cimetidine, increased preincubation of the enzymes with the food, and symptomatic therapy for the ulceration, the dog's condition improved.

PMID: 16808232 [PubMed - indexed for MEDLINE]

Elevation of a periosteal flap with irrigation of the bone for minor oral surgery reduces the duration of action of infiltration anesthesia.

Anesth Prog. 2006;53(1):8-12

Authors: Yamazaki S, Seino H, Ozawa S, Ito H, Kawaai H

The aim of this study is to assess the difference in duration of action after infiltration anesthesia when elevation of a periosteal flap (EPF) was accomplished with water or saline irrigation versus nonelevation of a periosteal flap (NEPF). The 57 patients in this study were under conscious sedation. A long treatment time of more than 1 hour was used. Instances where peripheral nerve block or opioids were administered and infiltration anesthesia over 2 fields were excluded before the study. Patients were included in either an EPF group (n = 29) or an NEPF group (n = 28). Statistically significant differences were detected in the initial dose of anesthetic (EPF: 4.3 +/- 1.4 mL, NEPF: 1.8 +/- 0.9 mL), the time until initial supplemental anesthesia (EPF: 38 +/- 26 minutes, NEPF: 65 +/- 27 minutes), and the frequency of anesthesia administration (EPF: 2.5 +/- 1.2 times, NEPF: 1.3 +/- 0.7 times). These results suggest that the duration of anesthesia action in EPF decreases to half compared with NEPF, even if the anesthetic was infiltrated in double the amount. Although supplemental anesthesia is required frequently in EPF, it is not efficacious. We speculated that the residual anesthetics in tissue were washed out by irrigation and hemorrhage and that supplemental anesthesia became ineffective because of leakage from the opened flap. Elevation of a periosteal flap reduces the effect of infiltration anesthetics.

PMID: 16722278 [PubMed - indexed for MEDLINE]

Oral manifestations of aplastic anemia in children.

J Am Dent Assoc. 2006 Apr;137(4):474-8

Authors: Sep&#xFA;lveda E, Brethauer U, Rojas J, Le Fort P

BACKGROUND: Few studies concerning oral manifestations of aplastic anemia (AA) in children have been reported. The purpose of the authors' study was to describe oral lesions in children with AA. METHODS: The authors conducted a retrospective review using medical records of children diagnosed with AA who were treated at the Pediatric Service of the Regional Hospital of Concepción, Chile, between March 1996 and May 2001. They recorded episodes of oral mucosal lesions and assessed platelet and neutrophil counts at the time the oral lesions appeared. RESULTS: Twelve children (nine boys and three girls) were diagnosed with AA. Their age range was 3 to 12 years (median age, 7 years). Nine subjects were receiving immunosuppressive therapy, and three received only supportive care. The most common oral manifestation of the disease was hemorrhage, which developed most often in patients with platelet counts less than 25 x 10(9) cells/liter. The second and third most common oral manifestations were candidiasis and viral infection, respectively. CONCLUSIONS: Children with AA frequently exhibit oral manifestations of the condition. Prevention, early diagnosis and proper treatment of oral complications are essential to diminish morbidity and avoid a possible fatal outcome. CLINICAL IMPLICATIONS: Oral lesions can be the first manifestation of AA; consequently, dentists should be aware of these manifestations so that an early diagnosis of the disease can be made.

PMID: 16637476 [PubMed - indexed for MEDLINE]

Effects of periodontal treatment phase I on birth term and birth weight.

J Indian Soc Pedod Prev Dent. 2006 Mar;24(1):23-6

Authors: Sadatmansouri S, Sedighpoor N, Aghaloo M

Considering the high prevalence of preterm birth (PTB) and low birth weight (LBW) and their complications as well as the role played by periodontal disease in their incidence and the lack of any report of periodontal therapy on these problems in Iran, the goal of the present research was to determine the effects of periodontal treatment on PLBW incidence among women with moderate or advanced periodontitis who were referred to Javaheri hospital (2004-2005). This clinical trial research was conducted on 30 pregnant women age ranging from 18-35 years old, with moderate or advanced periodontitis. Fifteen subjects randomly underwent the first phase of periodontal treatment including scaling, root planning and the use of 0.2% chlorhexidine mouth rinse for one week. None of these steps were taken for the controls. After necessary follow ups, the effect of periodontal treatment on birth term and birth weight were analyzed statistically. This research was conducted on 30 subjects, 15 controls and 15 cases in study group. In the control group, the observed rate of PLBW was 26.7% whereas among periodontally treated group, phase I, PLBW infant was not observed (P < 0.05). Infants birth weight were (3059.3-389.7) gms in study group and (3371-394.2) gms in the control group and respectively (P < 0.05). Periodontal therapy, phase I, results in a reduction in PLBW incidence rate. Therefore, the application of such a simple method among periodontally diseased pregnant women is recommended.

PMID: 16582527 [PubMed - indexed for MEDLINE]

Acquired haemophilia heralded by bleeding into the oral mucosa in a patient with bullous pemphigoid, rheumatoid arthritis, and vitiligo.

Postgrad Med J. 2006 Jan;82(963):e3

Authors: Patel RS, Harman KE, Nichols C, Burd RM, Pavord S

Acquired haemophilia is rare and potentially fatal, with a mortality of 20% if left untreated. There is a strong association with other autoimmune diseases. This report describes a patient with rheumatoid arthritis, vitiligo, and bullous pemphigoid where the diagnosis of acquired haemophilia was made after an extensive bleed into a bullous lesion in the buccal mucosa. This case highlights some of the potential complications of acquired haemophilia and its treatment.

PMID: 16397069 [PubMed - indexed for MEDLINE]

Clinical evaluation of packable and conventional hybrid posterior resin-based composites: results at 3.5 years.

J Am Dent Assoc. 2005 Nov;136(11):1533-40

Authors: Poon EC, Smales RJ, Yip KH

BACKGROUND: The authors evaluated clinical performances of a packable and a conventional hybrid resin-based composite used with a self-etch adhesive system. METHODS: Three dentists placed 105 posterior restorations in 65 adults. They placed a packable (SureFil, Dentsply DeTrey GmbH, Konstanz, Germany) and a conventional (Spectrum, Dentsply DeTrey GmbH) resin-based composite using a self-etch resin adhesive system. The authors evaluated the restorations using Ryge modified criteria, photographs and die stone replicas. RESULTS: After 3.5 years, six large SureFil and two Spectrum restorations had failed from bulk fracture and secondary caries, resulting in cumulative survival rates of 81.3 and 92.0 percent, respectively. Failed SureFil restorations generally were larger than the remaining intact restorations. Other ratings were satisfactory, with no significant differences between the two materials for any restoration parameter. Alfa ratings for both materials were approximately 80 percent or greater for marginal discoloration, anatomical form, surface texture and surface staining. Lower percentages of restorations were rated Alfa for color match, marginal integrity and gingival health. No postoperative sensitivity was reported. Net mean occlusal wear (+/- standard deviation) was 28.9 (+/- 32.9) micrometers for SureFil and 33.8 (+/- 29.6) microm for Spectrum restorations; the difference was not statistically significant. CONCLUSIONS: When used with a self-etch adhesive, the 3.5-year clinical performances of both composites were similar and satisfactory for the restoration of Class I and moderate-sized Class II cavities. Clinical Implications. The two composites placed in this study have an increased risk of bulk fracture when placed in large intracoronal Class II molar preparations.

PMID: 16329416 [PubMed - indexed for MEDLINE]

Periodic exacerbation of gingival inflammation during the menstrual cycle.

J Oral Sci. 2005 Sep;47(3):159-64

Authors: Koreeda N, Iwano Y, Kishida M, Otsuka A, Kawamoto A, Sugano N, Ito K

Sex hormones are believed to be a risk factor for periodontitis because of their ability to proliferate specific periodontal microorganisms and affect host immunologic response. In this case report, gingival redness and swelling occurred during the menstrual cycle, although the patient maintained good oral hygiene during periodontal treatment. Medical history revealed that exacerbation of gingival inflammation corresponded to the menstrual cycle and occurred during the ovulation period, when estrogen levels are high. Mean bleeding index of the ovulation period (18.9%) showed higher levels than that during the menstrual phase (5.3%). This case indicates that frequent and effective maintenance should be provided while considering the influence of the menstrual cycle, as sex hormones may be involved in exacerbating gingival inflammation.

PMID: 16313095 [PubMed - indexed for MEDLINE]

[Anticoagulation therapy and oral surgery]

Tidsskr Nor Laegeforen. 2005 Nov 3;125(21):2999; author reply 2999

Authors: Tj&#xF8;nnfjord GE

PMID: 16276400 [PubMed - indexed for MEDLINE]

[Should warfarin and acetylsalicylic acid be withdrawn prior to tooth extraction?]

Tidsskr Nor Laegeforen. 2005 Sep 22;125(18):2498-9

Authors: Løkken P, Skjelbred P

PMID: 16186871 [PubMed - indexed for MEDLINE]

Association between serum concentrations of 25-hydroxyvitamin D and gingival inflammation.

Am J Clin Nutr. 2005 Sep;82(3):575-80

Authors: Dietrich T, Nunn M, Dawson-Hughes B, Bischoff-Ferrari HA

BACKGROUND: Vitamin D has been shown to have immunomodulatory effects in in vitro and in animal studies. However, data from clinical studies of inflammatory diseases are scarce. OBJECTIVE: The purpose of this study was to evaluate the association between serum concentrations of 25-hydroxyvitamin D [25(OH)D] and gingival inflammation. DESIGN: We analyzed data from 77,503 gingival units (teeth) in 6700 never smokers aged 13 to >90 y from the third National Health and Nutrition Examination Survey. Multiple logistic regression models adjusted for subject- and site-specific covariates included age, sex, race-ethnicity, income, body mass index, diabetes, use of oral contraceptives and hormone replacement therapy among women, intake of vitamin C, missing teeth, full crown coverage, presence of calculus, frequency of dental visits, and dental examiner and survey phase. Generalized estimating equations were used to account for correlated observations within subjects. RESULTS: Compared with sites in subjects in the lowest 25(OH)D quintile, sites in subjects in the highest 25(OH)D quintile were 20% (95% CI: 8%, 31%) less likely to bleed on gingival probing (P for trend < 0.001). The association appeared to be linear over the entire 25(OH)D range, was consistent across racial or ethnic groups, and was similar among men and women as well as among users and nonusers of vitamin and mineral supplements. CONCLUSIONS: Vitamin D may reduce susceptibility to gingival inflammation through its antiinflammatory effects. Gingivitis may be a useful clinical model to evaluate the antiinflammatory effects of vitamin D.

PMID: 16155270 [PubMed - indexed for MEDLINE]

Is periodontal disease mediated by salivary BAFF in Sjögren's syndrome?

Arthritis Rheum. 2005 Aug;52(8):2411-4

Authors: Pers JO, d'Arbonneau F, Devauchelle-Pensec V, Saraux A, Pennec YL, Youinou P

OBJECTIVE: To correlate the periodontal status of 15 patients with primary Sjögren's syndrome (SS) with their salivary levels of BAFF. METHODS: The periodontal status of 15 patients who fulfilled the criteria for primary SS was compared with that of 15 controls with xerostomia who did not fulfill the criteria for primary SS but had similar symptoms of dry mouth. The level of BAFF was measured in paired samples of saliva and serum using in-house enzyme-linked immunosorbent assays. Periodontitis was assessed by the plaque index, the modified gingival index, the papillary bleeding index, and the periodontal pocket depth. RESULTS: Notwithstanding the better oral hygiene practices of the patients with primary SS compared with those of the xerostomia controls and the subsequent reduction of their plaque index scores, complications of periodontitis, such as bleeding, gingival hypertrophy, and periodontal pockets, were not improved. This failure to ameliorate the complications of periodontitis in patients with primary SS was associated with high levels of BAFF in their saliva compared with the levels in xerostomia controls (7.4 +/- 2.1 versus 1.0 +/- 0.4 ng/ml [P < 0.002]). The levels of BAFF in saliva did not correlate with the levels in sera but did correlate with the periodontal pocket depth (P < 0.002). CONCLUSION: These findings are similar to the bone resorption observed in patients with rheumatoid arthritis. They suggest that the known effect of B cells in periodontitis would be partly mediated by salivary BAFF in patients with primary SS.

PMID: 16052575 [PubMed - indexed for MEDLINE]

The clinical significance and management of apical accessory canals in maxillary central incisors.

J Am Dent Assoc. 2005 Mar;136(3):331-5; quiz 379-81

Authors: Iqbal MK, Gartenberg J, Kratchman SI, Karabucak B, Bui B

BACKGROUND: The maxillary central incisor is considered to be the least difficult subject for a clinical endodontic experience. However, the internal anatomy of maxillary central incisors can present a number of variations, including multiple accessory canals. CASE DESCRIPTION: This article highlights the clinical significance and management of accessory canals located in the apical one-third of maxillary central incisors. The authors present two case reports in which failure to detect the accessory canals led to root canal failure and subsequent surgical intervention. Another two case reports present the serendipitous discovery and nonsurgical management of accessory canals during the initial treatment of maxillary incisors. CONCLUSIONS AND CLINICAL IMPLICATIONS: It is important for the clinician to be able to detect the signs suggesting the presence of accessory canals in maxillary central incisors. Failure to do so may lead to a less-than-optimal endodontic treatment outcome.

PMID: 15819346 [PubMed - indexed for MEDLINE]

A Stafne's cavity with unusual location in the mandibular anterior area.

Med Oral Patol Oral Cir Bucal. 2005 Mar-Apr;10(2):173-9

Authors: Belmonte-Caro R, V&#xE9;lez-Gutiérrez MJ, García De La Vega-Sosa FJ, García-Perla-García A, Infante-Cossío PA, Díaz-Fernández JM, Torres-Carranza E

The typical Stafne's cavity, located on the posterior portion of the mandible, is a relatively uncommon entity. However, when the defect is located in the anterior region of the mandible, it is quite rare, having thus far been described in only 36 cases in the scientific literature. Most of these defects appear in the fifth and sixth decades of life, are localized to the area of the canines and premolars, and have a predilection for males. The inferior dental canal, one of the anatomical-radiographic landmarks that aid in the diagnosis of Stafne's cavity in the posterior region, is rarely present anterior the mental foramen. For this reason, because of its more variable radiographic appearance compared to the posterior defect, its tendency to be superimposed over the apices of the teeth, and the rarity of its localisation to the anterior mandible, it is much more difficult to establish a definitive diagnosis of a Stafne's cavity in this location. It is therefore more likely that a diagnostic error can occur, especially early on. We present a new case in a 68-year-old male in which the diagnosis was serendipitous, and we review in particular the aetiology and pathogenesis, clinical aspects, and differential diagnoses for this condition.

PMID: 15735551 [PubMed - indexed for MEDLINE]

Periodontal disease and prematurity among non-smoking Sri Lankan women.

J Dent Res. 2005 Mar;84(3):274-7

Authors: Rajapakse PS, Nagarathne M, Chandrasekra KB, Dasanayake AP

The hypothesis that periodontal disease is associated with pre-term low birthweight was tested in a prospective follow-up study of rural prima-gravida women (N = 227) who were free of tobacco, alcohol, and drug use. Women with 3rd trimester mean probing pocket depths, plaque, and bleeding scores that were greater than the median value in the cohort were defined as "exposed". There were 17 (7.5%) preterm low birthweight singleton deliveries in the cohort (among "exposed" = 12%; among "unexposed" = 5.6%; Odds Ratio = 2.3; 95% CI = 0.9-6.3). After adjustment for the independent variables, the OR for preterm low birthweight in relation to "exposure" was 1.9 (95% CI = 0.7-5.4). Our results are only suggestive of an association between periodontal disease and preterm low birthweight, perhaps indicating that previously reported associations may have been subjected to residual confounding due to tobacco, alcohol, and drug use.

PMID: 15723870 [PubMed - indexed for MEDLINE]

Oral sex and gum disease.

Sex Transm Infect. 2004 Oct;80(5):418-9

Authors: Harville EW, Zhang J, Hatch MC

PMID: 15459418 [PubMed - indexed for MEDLINE]

A new candidate mutation, G1629R, in a patient with type 2A von Willebrand's disease: basic mechanisms and clinical implications.

Haematologica. 2004 Sep;89(9):1128-33

Authors: Hilbert L, Federici AB, Baronciani L, Dallagiovanna S, Mazurier C

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.

PMID: 15377475 [PubMed - indexed for MEDLINE]

Modulation of clinical expression of plaque-induced gingivitis: effect of incisor crown form.

J Dent Res. 2004 Sep;83(9):728-31

Authors: Trombelli L, Farina R, Manfrini R, Tatakis DN

Evidence indicates that incisor crown form correlates with clinical periodontal features. It was hypothesized that incisor crown form may explain subject differences in gingivitis expression. The present experimental gingivitis study aimed to assess the effect of incisor crown form on plaque accumulation and gingival inflammation, and on individual susceptibility to plaque-induced gingivitis. Eighty-five periodontally healthy subjects were evaluated. A negative correlation was found between incisor crown width/crown length ratio and bleeding score (p = 0.045). From the 85 subjects, two groups of subjects with either 'long-narrow' or 'short-wide' incisor form were identified. The 'long-narrow' group had a significantly higher bleeding score than the 'short-wide' group (p = 0.014). No significant differences were found in the incisor crown width/crown length ratio between previously identified 'high responder' and 'low responder' subjects (Trombelli et al., 2004a). In conclusion, incisor crown form appears to affect the bleeding response of inflamed gingival tissues, while it exerts no influence on explaining differences in individuals' susceptibility to plaque-induced gingivitis.

PMID: 15329381 [PubMed - indexed for MEDLINE]

Implants and arteries.

J Am Dent Assoc. 2004 May;135(5):566

Authors: Flanagan D

PMID: 15202745 [PubMed - indexed for MEDLINE]

Oral health is impaired in Behçet's disease and is associated with disease severity.

Rheumatology (Oxford). 2004 Aug;43(8):1028-33

Authors: Mumcu G, Ergun T, Inanc N, Fresko I, Atalay T, Hayran O, Direskeneli H

OBJECTIVES: This study aimed to investigate the oral health of Turkish patients with Behçet's disease (BD) and whether it is associated with the disease course. METHODS: One hundred and twenty patients with BD, 35 patients with recurrent aphthous stomatitis (RAS) and 65 healthy Turkish controls (HC) were included in the study. Oral health was investigated by indices applied in a BD out-patient clinic. RESULTS: The mean scores of plaque, sulcus bleeding and gingival indices, probing depth and the number of extracted teeth were observed to be higher in patients with BD and RAS compared to HC (P<0.05). In the linear regression analysis, plaque index score was associated with the presence of oral ulcers and male gender. An elevated plaque index score was observed to be a significant risk factor for increased severity score in patients with BD in the logistic regression analysis (P = 0.034). CONCLUSIONS: Oral health is impaired in BD and associated with disease severity. Improvement of the oral health of BD patients may affect their disease course, leading to a better prognosis.

PMID: 15161982 [PubMed - indexed for MEDLINE]

Adjunctive benefit of an essential oil-containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly: a six-month study.

J Am Dent Assoc. 2004 Apr;135(4):496-504

Authors: Sharma N, Charles CH, Lynch MC, Qaqish J, McGuire JA, Galustians JG, Kumar LD

BACKGROUND: Mechanical methods of oral hygiene can be complemented by the use of chemotherapeutic mouthrinses. The authors sought to quantify the additional benefit provided by an essential oil-, or EO-, containing mouthrinse in reducing plaque and gingivitis in patients who brush and floss regularly. METHODS: The authors randomly assigned patients with gingivitis to one of three treatment groups: brushing and rinsing with a control mouthrinse, or BC; brushing, flossing and rinsing with a control mouthrinse, or BFC; or brushing, flossing and rinsing with an EO-containing mouthrinse, or BFEO. Patients received a dental prophylaxis at baseline, and the authors followed them for six months. RESULTS: Of 246 enrolled subjects enrolled in the study, 237 subjects were evaluable at the study's conclusion. After six months, the subjects using the BFEO regimen had statistically and clinically significant lower mean Modified Gingival Index, or MGI, scores and Plaque Index, or PI, scores than did subjects in the BC group (29.9 percent and 56.3 percent, respectively; P < .001). Subjects in the BFC group had statistically significantly lower mean MGI and PI scores than did subjects in the BC group (11.2 percent and 9.3 percent, respectively; P < .001). Subjects in the BFEO group exhibited statistically and clinically significantly lower mean scores for MGI and PI than did subjects in the BFC group (21 percent and 51.9 percent, respectively; P < .001). CONCLUSIONS: This study confirms that for patients with gingivitis who brush and floss routinely, the adjunctive use of an EO-containing mouthrinse provides a clinically significant and meaningful additional benefit in reducing plaque and gingivitis. CLINICAL IMPLICATIONS: An EO-containing mouthrinse is an effective adjunct to regular brushing and flossing. Therefore, the BFEO regimen can be beneficial for patients with gingival inflammation.

PMID: 15127875 [PubMed - indexed for MEDLINE]

Sublingual hematoma formation during immediate placement of mandibular endosseous implants.

J Am Dent Assoc. 2004 Feb;135(2):168-72

Authors: Isaacson TJ

BACKGROUND: Sublingual hematoma during placement of mandibular endosseous dental implants is a rare, but potentially life-threatening, complication. The development of a sublingual hematoma during a dental procedure may result in the need for acute airway management, including intubation or even emergent tracheostomy. Dental implants are becoming a well-accepted treatment, and thousands of implants are placed every year by general practitioners and specialists, with few adverse sequelae. Clinicians rarely discuss this complication with patients before surgery, and no reports of death secondary to sublingual hematoma formation have been published. The incidence of this event is difficult to ascertain, and only, a few cases have been reported. CASE DESCRIPTION: A 56-year-old man with severe caries underwent multiple mandibular tooth extractions and alveoloplasty and received endosseous implants. During the surgical procedure, the patient developed a large sublingual hematoma that required hospitalization. CLINICAL IMPLICATIONS: Practitioners who perform implant surgery in the anterior mandible should notify patients of the potential risk of sublingual hematoma formation, and be able to manage acute airway issues that may result from this complication.

PMID: 15005432 [PubMed - indexed for MEDLINE]

Differential expression of RANKL and osteoprotegerin in gingival crevicular fluid of patients with periodontitis.

J Dent Res. 2004 Feb;83(2):166-9

Authors: Mogi M, Otogoto J, Ota N, Togari A

The receptor activator for NF-kappaB ligand (RANKL) plays an important role in osteoclast formation. A recent study with animal models suggests the involvement of RANKL in the pathogenesis of this periodontal disease. However, no one has examined the level of RANKL in the body fluid of human subjects. This communication reports on the in vivo concentrations of RANKL and the RANKL decoy receptor osteoprotegerin (OPG) in the gingival crevicular fluid (GCF) of periodontal subjects with severe, moderate, and mild forms of the disease. An increased concentration of RANKL and a decreased concentration of OPG were detected in GCF from patients with periodontitis (*p < 0.05 vs. control subjects). The ratio of the concentration of RANKL to that of OPG in the GCF was significantly higher for periodontal disease patients than for healthy subjects (*p < 0.01). Taken together, these data suggest that RANKL and OPG contribute to osteoclastic bone destruction in periodontal disease. Abbreviations: GCF, gingival crevicular fluid; IL, interleukin; OPG, osteoprotegerin; RANKL, receptor activator for NF-kappaB ligand.

PMID: 14742657 [PubMed - indexed for MEDLINE]

International Normalized Ratio (INR) increase in patients taking oral anticoagulant therapy (OAT) and using sildenafil (Viagra).

Haematologica. 2003 Dec;88(12):ELT34

Authors: Fern&#xE1;ndez MA, Romá E

PMID: 14688013 [PubMed - indexed for MEDLINE]

Lack of a scientific basis for routine discontinuation of oral anticoagulation therapy before dental treatment.

J Am Dent Assoc. 2003 Nov;134(11):1492-7

Authors: Jeske AH, Suchko GD, ,

BACKGROUND: There is a widespread belief among dental practitioners and physicians that oral anticoagulation therapy in which patients receive drugs such as warfarin sodium must be discontinued before dental treatment to prevent serious hemorrhagic complications, especially during and after surgical procedures. OVERVIEW: The authors examine the scientific basis for properly managing the dosage of anticoagulants for dental patients who are receiving anticoagulation therapy. The authors review the appropriate laboratory test values to which dentists should refer when evaluating for dental treatment patients who are receiving anticoagulation therapy. The authors also review clinical studies, published within the past five years, that focus on the frequency and degree of hemorrhagic and related complications among dental patients who are receiving anticoagulation therapy orally to prevent thromboembolic events. CONCLUSIONS AND CLINICAL IMPLICATIONS: The scientific literature does not support routine discontinuation of oral anticoagulation therapy for dental patients. Use of warfarin sodium as it relates to dental or oral surgical procedures has been well-studied. Some dental studies of antiplatelet therapy are consistent with the findings in warfarin sodium studies. Dental therapy for patients with medical conditions requiring anticoagulation or antiplatelet therapy must provide for potential excess bleeding. Routine discontinuation of these drugs before dental care, however, can place these patients at unnecessary medical risk. The coagulation status--based on the International Normalized Ratio--of patients who are taking these medications must be evaluated before invasive dental procedures are performed. Any changes in anticoagulant therapy must be undertaken in collaboration with the patient's prescribing physician.

PMID: 14664269 [PubMed - indexed for MEDLINE]

Smoking influences on the thickness of marginal gingival epithelium.

Pesqui Odontol Bras. 2003 Jan-Mar;17(1):41-5

Authors: Villar CC, de Lima AF

Smoking patients show reduction of inflammatory clinical signs that might be associated with local vasoconstriction and an increased gingival epithelial thickness. The purpose of this work was to evaluate the thickness of the marginal gingival oral epithelium in smokers and non-smokers, with clinically healthy gingivae or with gingivitis. Twenty biopsies were obtained from four different groups. Group I: non-smokers with clinically healthy gingivae (n = 5). Group II: non-smokers with gingivitis (n = 5). Group III: smokers with clinically healthy gingivae (n = 5). Group IV: smokers with gingivitis (n = 5). These biopsies were histologically processed, serially sectioned at 5 microns, stained with H. E., and examined by image analysis software (KS400), which was used to perform the morphometric evaluation and the quantification of the major epithelial thickness, the epithelial base thickness and the external and internal epithelial perimeters. Differences between the four groups were analyzed using ANOVA test and Tukey's test. The criteria for statistical significance were accepted at the probability level p < 0.05. A greater epithelial thickness was observed in smokers independent of the gingival health situation.

PMID: 12908058 [PubMed - indexed for MEDLINE]

Maximizing the safety of nonsteroidal anti-inflammatory drug use for postoperative dental pain: an evidence-based approach.

Anesth Prog. 2003;50(2):62-74

Authors: Ong KS, Seymour RA

This article reviews the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for postoperative dental pain. An evidence-based approach is used to evaluate the clinical studies to date on the safe use of these drugs in dental patients. No drugs are without adverse effects or are perfectly safe, but their safe use in clinical practice would entail maximizing the therapeutic efficacy and minimizing the adverse effects. Therapeutic recommendations are made after reviewing the evidence for the safe use of NSAIDs in postoperative dental pain.

PMID: 12866802 [PubMed - indexed for MEDLINE]

Alveolar soft-part sarcoma of the tongue.

AJNR Am J Neuroradiol. 2003 Jun-Jul;24(6):1156-8

Authors: Aiken AH, Stone JA

Alveolar soft-part sarcoma is a rare, aggressive malignancy of uncertain histologic origin with a propensity for vascular invasion and distant metastasis. This neoplasm may mimic benign vascular neoplasms or malformations but careful evaluation of the unique imaging features on CT scans, MR images, and angiograms lead to the correct diagnosis. We present a case of alveolar soft-part sarcoma of the tongue and emphasize its radiologic and clinical features.

PMID: 12812945 [PubMed - indexed for MEDLINE]

CT angiography before embolization for hemorrhage in head and neck cancer.

AJNR Am J Neuroradiol. 2003 Jan;24(1):140-2

Authors: Goodman DN, Hoh BL, Rabinov JD, Pryor JC

We present a patient with advanced head and neck carcinoma and a bleeding pseudoaneurysm diagnosed by means of CT angiography; this was not apparent on conventional digital subtraction angiograms. The information provided by CT angiography facilitated rapid identification of the pseudoaneurysm and treatment with embolization. CT angiography may be helpful before embolization in cases of hemorrhage in head and neck cancer.

PMID: 12533343 [PubMed - indexed for MEDLINE]

[Motivation on plaque control and gingival bleeding in school children]

Rev Saude Publica. 2002 Oct;36(5):634-7

Authors: Toassi RF, Petry PC

The objective of the study is to evaluate the impact of two pedagogical motivational approaches for plaque and gingival bleeding control among 135 students of local public schools in Santa Tereza, Brazil, in 1999 The motivational program consisted of different educational strategies offered to two distinct groups: Group A, who attended only one explanatory session about oral hygiene, and Group B, who attended a total of four pedagogical sessions. In order to evaluate the methodology applied, the visible plaque index (according to Ainamo & Bay, 1975) and gingival bleeding index (according to L e and Silness, 1963) were calculated. A highly statistically significant reduction in the visible plaque index and gingival bleeding index was observed in both groups after the educational sessions (p<0.001). Moreover, a higher reduction in the gingival bleeding index and an even more accentuated decrease in the visible plaque index was found in group B when compared to group A (p<0.001). In conclusion, the motivational reinforcement in educational and preventive programs has a positive effect for the reduction and control of gingival bleeding and bacterial plaque.

PMID: 12471391 [PubMed - indexed for MEDLINE]

Warfarin and extractions.

Br Dent J. 2002 Sep 28;193(6):302

Authors: Gibbons AJ, Evans IL, Sayers MS, Price G, Snooks H, Sugar AW

PMID: 12368872 [PubMed - indexed for MEDLINE]

AAOMP case challenge: hemorrhagic gingival mass.

J Contemp Dent Pract. 2001 May 15;2(2):93-7

Authors: Neville BW, Javed T

This 24-year old black female presented with a chief complaint of this gingival mass. She states she first noticed the lesion about three months ago and it has gotten progressively larger. What is your diagnosis?

PMID: 12167937 [PubMed - indexed for MEDLINE]

Post-surgical hemorrhage: formation of a "liver clot" secondary to periodontal plastic surgery.

J Contemp Dent Pract. 2001 May 15;2(2):62-71

Authors: Druckman RF, Fowler EB, Breault LG

Bleeding is a common sequela of periodontal and oral surgery. Generally, bleeding is self-limiting. Special circumstances require additional procedures to reduce or eliminate active hemorrhage. Occasionally hemorrhage can be under control when a patient is dismissed from their surgical appointment and, subsequently, the patient will experience either slow seepage of blood or extravascular clot formation. This case report describes the unique formation of a "liver clot" or "currant jelly clot" following periodontal plastic surgery. The clotting cascade and common laboratory tests to evaluate bleeding disorders are also presented.

PMID: 12167934 [PubMed - indexed for MEDLINE]

[Evaluation of the reduction of the visible plaque index and of the gum bleeding index in a program of oral health promotion for children]

Pesqui Odontol Bras. 2002 Apr-Jun;16(2):169-74

Authors: Silveira JL, Oliveira V, Padilha WW

The purpose of this research was to evaluate the reduction of the VPI (visible plaque index) and of the GBI (gum bleeding index) in children seen at a unit of SUS, in the state of Rio de Janeiro. A comparative and statistical procedure (t-test, by means of the GMC program) was employed in order to assess the variation between initial and final mean VPI and GBI values. Initial values were registered in the beginning of the assistance program, and final values were registered after the children had participated in health promotion activities, which included weekly supervised brushing sessions, individual dietary guidance, collective instructive activities in which parents were present, adjusting of the oral environment, as well as restorative and surgical dental care, during an average period of six months. The studied sample comprised fourty-two children, with an average age of nine years, who presented an average of four teeth affected by caries. The technique of indirect documentation, by means of documental research, was employed. The following results were obtained: initial VPI = 29%; final VPI = 11%; initial GBI = 13% and final GBI = 5%. The observed variations were statistically significant at the level of 1%, which was revealed by the applied statistical test. The program proved efficient as to plaque control, reducing VPI to a more acceptable level. Although GBI presented considerable reduction, the presence of bleeding at the end of the program calls for a better approach in motivating patients as to regular oral hygiene.

PMID: 12131992 [PubMed - indexed for MEDLINE]

Cell-surface proteoglycan expression by lymphocytes from peripheral blood and gingiva in health and periodontal disease.

J Dent Res. 2001 Aug;80(8):1704-10

Authors: Manakil JF, Sugerman PB, Li H, Seymour GJ, Bartold PM

Cell-surface proteoglycans are involved in lymphocyte migration and activation. This study investigated the expression of syndecan-1, syndecan-4, and glypican in peripheral blood lymphocytes and by lymphocytes in variously inflamed periodontal tissues. Gingival specimens from healthy, gingivitis, or chronic periodontitis sites were stained by means of antibodies against B- and T-lymphocytes and also syndecan-1, syndecan-4, and glypican. Syndecan-1 expression by peripheral blood mononuclear cells (PBMC) from healthy, gingivitis, and chronic periodontitis subjects was assessed by flow cytometry. Syndecan-1 was expressed by B-cells/plasma cells but not T-cells in both gingivitis and chronic periodontitis lesions. Both B-cells/plasma cells and T-cells in gingivitis and chronic periodontitis expressed syndecan-4. Glypican was expressed only by macrophages. Stimulation of PBMC with mitogens and growth factors modulated syndecan-1 expression in both the T- and B-cells. Thus, cell-surface proteoglycan expression by lymphocytes in periodontal inflammation is cell-type-specific and may be modulated by inflammation.

PMID: 11669479 [PubMed - indexed for MEDLINE]

Autogenous hard palate mucosa: the ideal lower eyelid spacer?

Br J Ophthalmol. 2001 Oct;85(10):1183-7

Authors: Wearne MJ, Sandy C, Rose GE, Pitts J, Collin JR

BACKGROUND/AIMS: Raising a displaced lower eyelid frequently involves recession of the lower eyelid retractors with interposition of a "spacer," and several materials for this purpose have been described. This study reviewed the results of autogenous palatal mucosa in the treatment of lower eyelid displacement, including assessment of any donor site morbidity. METHODS: A retrospective case note review of consecutive patients treated at Moorfields Eye Hospital between 1993 and 1998. All patients underwent insertion of hard palate mucosa between the inferior border of the tarsus and the recessed conjunctiva and lower eyelid retractors. Parameters studied included the underlying diagnosis, measurements of lower lid displacement or retraction, related previous surgery, the experience of the operating surgeon, intraoperative and postoperative complications, surgical outcome, and length of follow up. The main outcome measure was the position of the lower eyelid relative to the globe in primary position of gaze. RESULTS: 102 lower eyelids of 68 patients were included and a satisfactory lid position was achieved in 87/102 (85%), with inadequate lengthening or significant recurrence of displacement occurring in 15 cases. Donor site haemorrhage requiring treatment in the early postoperative period occurred in seven patients (10%). CONCLUSION: Autogenous hard palate mucosa is an effective eyelid spacer and provides good long term support for the lower eyelid. Donor site complications are the main disadvantage, but may be minimised by attention to meticulous surgical technique and appropriate postoperative management.

PMID: 11567962 [PubMed - indexed for MEDLINE]

Arteriovenous malformation of the mandible: embolization and direct injection therapy.

J Vasc Interv Radiol. 2001 Sep;12(9):1095-8

Authors: Siu WW, Weill A, Gariepy JL, Moret J, Marotta T

Arteriovenous malformation (AVM) of the mandible is a rare entity but one that can be potentially fatal as a result of massive hemorrhage. Traditional treatment involved extensive surgical resection of the mandible. With the advent of improved endovascular techniques, interventional radiology is now the best method to control active hemorrhage and ultimately cure these lesions. The authors describe three cases of successfully treated mandibular AVM by percutaneous and/or endovascular techniques.

PMID: 11535773 [PubMed - indexed for MEDLINE]

Comparative efficacy of an antiseptic mouthrinse and an antiplaque/antigingivitis dentifrice. A six-month clinical trial.

J Am Dent Assoc. 2001 May;132(5):670-5

Authors: Charles CH, Sharma NC, Galustians HJ, Qaqish J, McGuire JA, Vincent JW

BACKGROUND: The efficacy of an essential oil-containing antiseptic mouthrinse (Listerine Antiseptic, Pfizer) and an antiplaque/antigingivitis dentifrice (Colgate Total, Colgate-Palmolive) has been demonstrated in numerous double-blind clinical studies. This study was conducted to determine their comparative efficacy. METHODS: Three hundred sixteen subjects with mild-to-moderate gingival inflammation and plaque received a dental prophylaxis and began their randomly assigned brushing and rinsing regimen in an unsupervised setting. Subjects brushed for one minute and rinsed with 20 milliliters for 30 seconds twice daily for six months. The three groups were L (control toothpaste/Listerine rinse), T (Colgate Total toothpaste/control rinse) and P (control toothpaste/control rinse). RESULTS: Subjects in the L and T groups demonstrated statistically significantly lower (P < .001) Modified Gingival Index, or MGI; Bleeding Index, or BI; and Plaque Index, or PI, at both three and six months than subjects in the P group. The magnitude of reduction for the L group was 22.9 percent, 70 percent and 56.1 percent, respectively, and for the T group, 20.8 percent, 58 percent and 22.1 percent, respectively. Subjects in the L group were not different from subjects in the T group in regard to visual signs of gingivitis (MGI), but were more effective (P < .001) than subjects in the T group in experiencing reduced BI and PI. No product-related adverse events were reported. CONCLUSION: Although the Listerine Antiseptic and Colgate Total antiplaque/antigingivitis products produced similar, clinically significant reductions in gingivitis (as measured by MGI and BI), Listerine, when used in conjunction with a fluoride dentifrice and usual oral hygiene, provided a greater benefit in reducing plaque. CLINICAL IMPLICATIONS: When considering an antiplaque/antigingivitis product to recommend to patients, clinicians should consider Listerine Antiseptic, in conjunction with usual oral hygiene, if more rigorous plaque control is desired.

PMID: 11367972 [PubMed - indexed for MEDLINE]

Significance of detection of Porphyromonas gingivalis, Bacteroides forsythus and Treponema denticola in periodontal pockets.

Bull Tokyo Dent Coll. 2000 Aug;41(3):109-17

Authors: Kasuga Y, Ishihara K, Okuda K

The relationship between the detection of Porphyromonas gingivalis, Bacteroides forsythus and Treponema denticola in subgingival plaque samples of periodontal pockets and periodontal status was evaluated using the polymerase chain reaction (PCR). A total of 165 sites in 60 periodontitis patients were examined, and the relationships between the detection of each of the three bacterial species and the pocket depth and bleeding on probing (BOP) were analyzed. The detection ratios of P. gingivalis, B. forsythus, and T. denticola in samples from adult periodontitis lesions were 75.5%, 69.8%, and 72.6%, respectively. It was found that all sites where all three microorganisms were detected were BOP positive and had greater pocket depths than those where only one or two species were found. The detection rate of B. forsythus and T. denticola decreased with age in the sites in which PD was less than 4 mm. The present study indicates that detection of a mixed infection by P. gingivalis, B. forsythus, and T. denticola strongly correlated with adult periodontitis.

PMID: 11212582 [PubMed - indexed for MEDLINE]