Ulcerative Gingivitis Research Articles

NECROTIZING GINGIVITIS IN URGENCY DENTAL ATTENDANCE: A PRELIMINARY STUDY

Necrotizing gingivitis (NG) is an uncommon oral disease. It is an inflammatory illness in which interdental papillae and marginal gingiva are destroyed. Objective: To determine NG frequency related to sex, age, affected areas, and treatment in a dental urgency clinic, where an average of 4500 exams are performed per year. Study design: Electronic data were obtained from August 2006 to December 2017 related to NG occurrence. Diagnosis and treatment were performed by 5 experts who are responsible for attendances. Frequency tests were used when applicable. Results: In the study period, 151 patients were diagnosed with NG (0.30%). From these, 72 (47.68%) were men. Age ranged from 3 to 53 years old. There was an increased occurrence until 25 years of age. The region of the lower incisors were most affected in both men and women (P

Oral manifestations of HIV: Can they be an indicator of disease severity? (A systematic review).

To review the existing research literature on the paradigm that the oral lesions could be an indicator of the disease severity with the objective of documenting the current status of research, highlighting its major findings. Publications were identified through a careful search, of which a majority focused on oral lesions as an indicator for HIV progression. A PubMed journal search of 10years OF period publication (2009-2019) for "oral lesion, oral manifestation, indicator, HIV and HIV-associated" was performed and analysed. Various research methods were included within the study criteria including clinical study, clinical trial, comparative study and randomised control trial. A total 33 studies were obtained and analysed, including cohort study, cross-sectional study, case-control study, clinical trial, retrospective observational analysis study, prospective observational study and randomised control trial. The most common oral lesions found in the studies were Kaposi sarcoma (KS), followed by oral candidiasis, periodontitis, necrotising ulcerative gingivitis (NUG), necrotising ulcerative periodontitis (NUP) and oral hairy leucoplakia (OHL). The early diagnosis and accurate treatment plan were very important to indicate the disease severity related to HIV infection. Oral lesions reported in 39% articles and could be an indicator of HIV disease severity due to its effects on decreased cluster-differentiated (CD4+) T-cell count and increased viral load.

Stress and periodontitis

Gingivitis and periodontitis can worsen with reduced immune fitness. Various causes can reduce immune fitness in a host, as a result of which the balance between the host and the microbiome is disturbed. Among others, lifestyle factors, such as stress and smoking, can have a negative influence on immune fitness. An association has been demonstrated between stress and periodontitis and also acute necrotising ulcerative gingivitis or periodontitis. There are indications that neurons are able to secrete pro-inflammatory cytokines and chemokines that worsen chronic inflammatory reactions in the periodontium and compromise immune fitness. In vitro studies show high cortisol levels may contribute to the increased growth of P. gingivalis. Stress as a risk factor for periodontitis and the role of stress as a negative influence on the results of periodontal treatment are difficult to estimate clinically. Nevertheless, attention to and awareness of stress as an aspect of the comprehensive set of risk factors for periodontitis can diminish its negative impact on immune fitness.

Diagnostic oral biomarkers of immunosuppression in apparently healthy seropositive HIV population, in South Western Uganda

Background: Accurate diagnosis remain key to effective intervention of endemic and pandemic diseases even up to the developed world. Despite availability of many high-quality diagnostic tests for immunosuppression in the developed countries, they are neither available, affordable nor accessible in rural communities of Africa. Clinical diagnostic surrogate biomarkers may be suitable alternative. Objective: To evaluate oral clinical manifestations as biomarkers of immunosuppression in apparently healthy population of Human Immunodeficiency Virus (HIV) infected patients in resource poor Masaka, Mbarara and Rukungiri districts, of South Western Uganda. Methods: Visual oral inspection of 304 apparently health and HIV seropositive patients attending the AIDS Support Organization clinics in study districts of Uganda was done to detect and establish oral biomarkers associated with immunosuppression in HIV disease. Standard methods were used to reconfirm the HIV sero-positivity status and clinical staging of oral manifestations of consenting clients. Result: Figures 1-22 shows representative 304 oral manifestations of research participants. Figures 1-5 depicts 140 (46.1%) pseudomembranous candidiasis. Figures (6-9) depicts representative photographs of 53 (17.4%) erythemathous candidiasis (Figures 7 & 8) and also 63 (20.7%) shows erythemathous candidiasis found co-infecting with pseudomembranouse candidiasis in (Figures 9 & 10). Figure 10 shows linear gingival erythemathouse banding. Figures 11-15 shows Karposi sarcoma developmental stages and Figure 16-18 shows 7 (2.3%) Angular cheilitis. Figure 19 shows 3 (1.0%) aphthous ulceration of anterior portion of the tongue. Figure 20 shows 1 (0.3%) Acute necrotizing ulcerative gingivitis (ANUG) while Figures 21 & 22 shows 10 (3.3%) intra-oral pigmentation. Conclusion: Visual oral inspection of apparently healthy HIV seropositive individuals revealed different oral manifestations that may serve as diagnostic oral biomarkers of immunosuppression in apparently healthy but HIV infected population in Uganda. Poor resources drive the need for available and affordable diagnostic tools for improved and effective intervention.

Bactericidal and clinical efficacy of photochemotherapy in acute necrotizing ulcerative gingivitis.

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). 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. 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. Application of adjunctive photochemotherapy was both clinically and microbiologically effective in the treatment of NUG.

Evaluation of oral care protocols practice by dentists in Rio de Janeiro towards HIV/AIDS individuals

BackgroundThe aim of this study was to evaluate the dentists’ knowledge and practice regarding HIV positive individuals’ oral care in Rio de Janeiro State.MethodsDentists from Rio de Janeiro State (n = 242) answered an electronic questionnaire on biosafety procedures, oral manifestations of AIDS, and knowledge of HIV infection. Collected information was stratified by gender, and data were analyzed using Chi-square and t tests.ResultsFrom the 14 oral manifestations investigated, oral candidiasis, necrotizing ulcerative gingivitis, and hairy leucoplakia were more associated with HIV, with no differences between the responses from men and women. Above 85% of the participants would be concerned about becoming infected with HIV after a needle/ sharp object injury and more than 80% of them were willing to be tested for HIV. However, significantly more women (98.8%), compared to men (91.3%), said they knew that HIV/ AIDS patients can contaminate dental care professionals, p = 0.007. There was a significant difference in the answers for the questions: “Are there special dental clinics for treatment of HIV/AIDS patients in Brazil?” (p = 0.044), and “Do the negative HIV tests surely indicate that the persons are free of viruses?” (p = 0.005). Significant differences between men and women were also observed regarding use of disposable mask (p = 0.01), and cap (p < 0.0001).ConclusionMost dentists who participated in the study presented a good knowledge on the care of HIV/ AIDS individuals, including biosafety protocols and in terms of the oral manifestations commonly associated to AIDS.

Вільнорадикальна активність та показники антиоксидантного захисту крові на тлі та без використання комплексу антиоксидантних препаратів

Topicality. Periodontal diseases are among the most common dental diseases. This article highlights the results of a study of blood parameters in animals that underwent the simulation of ulcerative necrotic gingivitis and compared them with animals that under the same conditions received local treatment of this pathology with a developed complex of antioxidant drugs. The aim of the study was to analyze the nature of changes in the state of the antioxidant-prooxidant system during the pathological process without and on the background of treatment, and investigated their impact on quantitative and functional indicators of markers of inflammatory intensity. Materials and methods. The study was conducted on 18 rabbits. The model of ulcerous-necrotic gingivitis was obtained in animals by chemical burns. Experimental preparations were applied to the damaged gum area 2 times a day in 2 hours after feeding the animals at an approximate dose of 200 mg. The nature of the course of experimental ulcerous-necrotic gingivitis was investigated on the 3, 5, 7 and 10-th days of the healing process. Results and discussion. The maximum increase in the concentration of MDA in the blood of animals of the experimental group was observed in the first observation period. In the next two terms in this group there was a rapid decrease in the content of MDA. By its nature, the dynamics of API in animals of the experimental group of animals, which received according to the conditions of the experiment, the appropriate local treatment with the developed complex, differed markedly from the dynamics found in the control. At the end of the experiment (the10-th day), the API data completely coincided with the data same as of intact animals. Conclusions. Topical application of the developed complex reduces the content of lipoperoxidation products, in particular the concentration of MDA, which avoids overexertion and depletion of antioxidant defense systems, resulting in a shift of balance in the antioxidant direction and its normalization on the 7th day.

Використання Тантум Верде® в лікуванні виразкового гінгівіту

Використання Тантум Верде® в лікуванні виразкового гінгівіту

Acute Myelogenous Leukemia Presenting with Primary Oral Lesions Initially Diagnosed as Acute Necrotizing Ulcerative Gingivitis

Acute Myelogenous Leukemia Presenting with Primary Oral Lesions Initially Diagnosed as Acute Necrotizing Ulcerative Gingivitis

A difficult‐to‐diagnose case of extranodal NK/T‐cell lymphoma, nasal type, primary to maxillary gingival ulcers that developed after living‐donor liver transplantation

AbstractExtranodal nasal‐type NK/T‐cell lymphoma (ENKTL) is a hematopoietic malignancy that is rare in the oral cavity. We report a case of a 62‐year‐old woman who developed ENKTL after undergoing living‐donor liver transplantation at the age of 53 years. She had a history of hepatitis C‐related liver cirrhosis. After being diagnosed with necrotizing ulcerative gingivitis, she received antibiotic therapy; however, it was ineffective. Clinical findings suggested a neoplastic disease and necessitated a gingival biopsy. A definitive diagnosis of ENKTL was made based on the immunohistochemical analysis. She achieved a complete clinical response after two courses of SMILE chemotherapy.

LEVEL OF IMMUNOGLOBULINS OF CLASS G IN EXPERIMENTAL ANIMALS WITH AND WITHOUT TREATMENT BY A COMPLEX OF ANTIOXIDANT PREPARATIONS

The purpose of the study: to analize the dynamics of the concentration of IgG in thedevelopment of experimental ulcerous - necrotic gingivitis with and without the localtreatment by a complex of antioxidant preparations.Material and methods: the study was conducted on 18 rabbits. The model of ulcerous -necrotic gingivitis was obtained in animals by chemical burns. Experimentalpreparations were applied to the damaged gum area 2 times a day in 2 hours after feedingthe animals at approximate dose of 200 mg. The nature of the course of experimentalulcerous - necrotic gingivitis was investigated on the 3rd, 5th, 7th and 10th days of thehealing process.Results: On the 3rd day in control animals, IgG levels increased 50.0% above the level ofintact animals. On the 5th day, the prevalence over the index of physiological norm wasalready 30.0%. The indicated trend continued, although on the 7th day the data obtainedsignificantly differed from those of intact animals and prevailed 10.56%. Only at the endof the study (10th day), a result was obtained that statistically insignificantly differedfrom the indicator of intact animals and made it 104.45%.Conclusions: Local application of the developed complex of antioxidant preparationsallows to adjust the course of the inflammatory reaction in the damaged mucousmembrane of the oral cavity. As a result, moderate, less than in the control group, growthof the indexes of the markers studied in the initial phase and their complete normalizationhave been already seen on the 7th day of observation.

Diagnostic informativeness of laboratory control of the severity of inflammatory and osteodestructive processes in periodontium

Aim. To offer a set of laboratory tests and to assess its informativeness in characterizing the severity of inflammatory and osteodestructive processes in periodontium.&#x0D; Methods. At the first stage of the study, two groups were formed: the study group (clinical, n=95) and the control group (relatively healthy individuals, n=31). Further, depending on the clinical situation, the clinical group was divided into subgroups. Subgroup 1 (n=40) included patients with catarrhal and ulcerative gingivitis, subgroup 2 (n=32) with mild chronic generalized periodontitis and subgroup 3 (n=33) with moderate chronic generalized periodontitis. In patients gingival fluid or in the contents of periodontal pockets, the concentration of tumor necrosis factor-, osteotropic mediators (soluble receptor activator of nuclear factor-B ligand and osteoprotegerin) were determined by the immunoassay method.&#x0D; Results. In patients with chronic generalized periodontitis, as well as with increase of severity of periodontal lesions, in the gingival fluid the concentration of tumor necrosis factor- and soluble receptor activator of nuclear factor-B ligand increases and the content of osteoprotegerin decreases. The change in the concentration of osteotropic mediators in the fluid from periodontal pockets occurred prior to osteolysis in the periodontium. The widest range of statistically significant correlations with periodontal indices was established for the concentration of tumor necrosis factor- in the contents of the gingival sulcus with the depth of periodontal pockets (R=0.79; р 0.0001) and periodontal attachment loss (R=0.83; р 0.0001), as well as for soluble receptor activator of nuclear factor-B ligand with the depth of periodontal pockets (R=0.75; р 0.0001) and periodontal attachment loss (R=0.87; р 0.0001).&#x0D; Conclusion. In patients with mild chronic generalized periodontitis, a decrease in the concentration of osteoprotegerin (p 0.05) and increase in the content of soluble receptor activator of nuclear factor-B ligand (р 0.05) in the gingival fluid relative to the norm requires active radiological monitoring of bone resorption.

Gingival histoplasmosis: An atypical presentation of African histoplasmosis in three baboons (Papio spp)

Gingival lesions as the sole manifestation of African histoplasmosis (Histoplasma capsulatum var. duboisii) have never been reported in baboons. Grossly, lesions can be indistinguishable from bacterial ulcerative gingivitis or gingival hyperplasia. Clinical outcomes of primary gingival histoplasmosis in baboons are unknown and may complicate colony management decisions.

A novel treatment of necrotizing ulcerative gingivitis using ozone therapy

Introduction: Necrotising ulcerative gingivitis (NUG) is a microbial disease characterized by the death and sloughing of gingival tissue. This article presents a classic case with characteristic symptoms of gingival necrosis, punched out ulcerated papillae, pseudomembrane formation and pain. Case Report: The patient was treated with the conventional treatment modalities of antimicrobial treatment, swabbing of the pseudomembrane with H2O2 followed by irrigation at home mouth rinses. A soft toothbrush was advised without any adjunctive toothpaste. Additionally, ozone therapy was done on the 3rd day since the lesion persisted. Each arch was ozonated for five minutes using custom made silicon stents with nozzle in the front to allow the ozone generator to pass through. With adjunctive ozone therapy lesions had started to resolve by the 5th day and the patient was also relieved of all associated symptoms. Conclusion: Elimination of the bacteria is a very important part of treatment of NUG. Treponema, bacteroides intermedius and fusobacterium species are the principle bacteria involved in the disease. These bacteria are essentially anaerobic. Ozone therapy creates an aerobic environment for these bacteria inhibiting their growth and disrupting the integrity of the bacterial cell wall by oxidation and inactivating the existing bacteria. Ozone therapy does not damage the other surrounding healthy cells. These healthy cells have a coating of enzymes like catalase, glutathione perioxidase, reductase and superoxide dimutase which prevents the oxygen radical from penetrating them. Hence using ozone as an adjunctive therapy helps accelerate healing and treat the basic etiology in a very targeted manner.

Evaluation of dental students' knowledge and patient care towards HIV/AIDS individuals.

The aim was to evaluate the knowledge of the students of dental students regarding patients care towards HIV positive individuals. Two hundred and eighty-three dental students (pre-clinical, n=45; clinical, n=238) answered an electronic questionnaire, approaching biosafety procedures, oral manifestations of AIDS and knowledge of HIV infection. Data were present as an average from findings from students of nine different semesters, grouping them by pre-clinical (1-4) and clinical (5-9) semesters, from two different university campuses. Furthermore, data were analysed using the t test and chi-square test. Students' mean age was 24years. Amongst 14 oral manifestations questioned, Kaposi sarcoma, oral candidiasis, necrotizing ulcerative gingivitis and herpes simplex were more associated with HIV. Over 90% of the respondents would be concerned about becoming infected with HIV after a needle stick injury and were willing to be tested for HIV; know that HIV/AIDS patients can contaminate dental care professionals, that needle perforation can transmit HIV, and that medical professionals are more prone to cross-contamination. Regarding the use of physical barrier, almost all participants use disposable mask, goggles, cap and procedure gloves with all patients; the use of disposable lab coat and two pairs of gloves were the least used with all patients. Participating students have good knowledge on biosafety in the management of HIV/AIDS patients, as well as on the most commonly associated oral manifestations. However, there is a need for improvement on some topics related to HIV/AIDS, especially regarding less known oral lesions, and HIV diagnostic tests.

Guidelines for Clinical Management of patients with Acute Necrotizing Ulcerative Gingivitis: A Literature Review

The aim of this article is to review the literature for existing protocols on management of patients with acute necrotizing ulcerative gingivitis (ANUG) and to propose a protocol after compilation of various relevant protocols from literature. A literature search was conducted and articles were chosen with relevance to title and/or abstract with relevance to ANUG and treatment of ANUG. A systematic management regimen for different populations of ANUG patients namely – children, adults, and immunocompromised, has been formulated. This guideline is intended to help practitioners make decisions regarding treatment of ANUG and to help update their knowledge about the disease condition.

Hostile Tobacco and Oral Health-A Review

Tobacco is being used in various forms. Smoking type includes bidis, cigarettes, cigars and others. Smokeless tobacco products are Betel quid, mawa, dry snuff and many more. By 2020, it is predicted that tobacco will account for 13% of all deaths in India. Oral cavity is the first to encounter tobacco and the major tobacco related oral lesions are tooth stains, abrasions, Acute Necrotizing Ulcerative Gingivitis (ANUG), Periodontitis, dental implant failure, smoker's melanosis, nicotinic stomatitis, palatal erosions, pre-malignant lesions and oral carcinoma. Active role of dental professionals in tobacco control initiatives and cessation programmes is important due to their direct contact with patients who are at increased risk. This article emphasizes in detail on the various effects of tobacco on oral health.

Trench mouth: Is it a disease of the past? Diagnostic clincher: The underrated “urgent smear”

Vincent's infection is a progressive painful infection with ulceration, swelling, and sloughing of the dead tissue from the oral cavity and oropharynx caused by the fusiform bacillus (Fusobacterium fusiforme) and spirochetes (Borrelia vincentii). However, it is rare in the vocal cords. We present a case of Vincent's angina of the larynx in an otherwise immunocompetent patient. This case report is to highlight clinician's diagnostic challenge, the need for crucial interdisciplinary interaction with microbiologist, and the significance of “urgent smear” (which is most often overlooked) for timely curative patient care.

The correlation of pathognomonic periodontal manifestation with CD4+ level in people live with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in a Tertiary Hospital, Surabaya, Indonesia

Aim: The prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients worldwide continue increasing annually, thus it has become a global health problem and burden. An oral manifestation can be used as the clinical biomarkers in people living with HIV/AIDS (PLWHA) using the pathognomonic periodontal manifestation, such as Necrotizing Ulcerative Gingivitis (NUG) and Necrotizing Ulcerative Periodontitis (NUP). This study aims to investigate the prevalence and correlation of pathognomonic periodontal manifestations with Cluster of Differentiation 4 (CD4+) level in PLWHA in a tertiary hospital, Surabaya, Indonesia. Materials and Methods: It presents an observational analytical study with a cross-sectional and total sampling method conducted from July to August 2014 in Dr. Soetomo General Tertiary Hospital. There were 88 HIV-seropositive patients who have not received any antiretroviral therapy yet who were recruited for this study. The patients and their guardians were explained about the study aims and participation approval which was obtained by the written informed consents. The diagnosis of NUP and NUG in PLWHA was based on its clinical features. The CD4+ level the latest 6 months was obtained from medical record as a retrospective data. The correlation between low CD4+ levels with pathognomonic periodontal manifestation in PLWHA was analyzed by Spearman's correlation test. Results: There are 9 (10.23%) PLWHA with pathognomonic periodontal manifestation, 7 (77.7%) with NUG, and 2 (22.3%) with NUP. All PLWHA (100%) have low CD4+ level (<200 cell/mm3). The Spearman's correlation shows that there are a correlation between pathognomonic periodontal manifestation with CD4+ level in PLWHA (r = −0.464) (P = 0.03; P < 0.05). Conclusion: NUG and NUP are pathognomonic periodontal manifestation found in Indonesian PLWHA which are associated with low CD4+ level reflecting the immune suppression level, and it can be used to predict HIV/AIDS stage of progression.

Knowledge and Attitudes Towards Antibiotic Prescribing Among Dentists in Sudan

Objective: To evaluate antibiotic prescribing practices of dentists working in a major teaching hospital in Sudan, and to assess the need for establishing education programmes to enhance dentists’ awareness of antibiotic use. Material and Methods: A cross-sectional study was carried out by distributing an anonymous self-administered questionnaire to a convenience sample of dental practitioners at major teaching hospital in Khartoum/Sudan. The questionnaire investigated knowledge and attitudes of participants in relation to antibiotic prescribing in dental practice. Results: One hundred out of 135 dental practitioners working at the hospital participated in the survey with 48 males and 52 females. Most of the participants (N=44) did not specify their preferable drug reference, while 32 participants specified British National Formulary, and the practice was significantly associated with a higher professional rank (p<0.001). Metronidazole was the most frequently cited antibiotic for dentofacial infections (N=73) and Acute Necrotizing Ulcerative Gingivitis (N=56), while amoxicillin was the most frequently cited antibiotic for dento-alveolar infections and infective endocarditis prophylaxis (N=88 and N=47, respectively). Conclusion: Undergraduate, as well as postgraduate courses,, are required in Sudan to provide up-to-date orientation on antibiotic use, and to increase awareness of dentists about antibiotic prescribing.