Buccal Gingiva Research Articles

Dental Implant for a Patient with Narcolepsy: A Case Report

Narcolepsy is a neurological disorder characterised by cataplexy, sleep paralysis and excessive daytime sleepiness. The literature on dental managements of patients with narcolepsy is lacking with no set guidelines for dental practitioners. A 31-year-old female presented to the dental office with a dull pain related to the maxillary left lateral incisor with Grade 2 mobility and isolated 8 mm periodontal pocket. In addition, there was loss of buccal gingiva with radiographic changes suggestive of caries and fractured crown. The patient had a history of narcolepsy with cataplexy and hypertension controlled with bisoprolol and desvenlafaxine in addition to clonazepam 1 mg/day as needed to prevent episodes of cataplexy. Patient was asked to take 2 mg clonazepam and 600 mg ibuprofen one hour before procedure. The maxillary left lateral incisor was extracted atraumatically and an immediate implant combined with allogenic bone graft and collagen membrane was placed. The procedure was uneventful, and patient left conscious and stable. After three months, the implant was restored with porcelain fused-to-metal crown and followed-up for six months without any complications. This is the first case describing a narcolepsy patient who successfully received a dental implant without developing a cataplexy episode. Clonazepam prophylaxis may be considered prior to dental procedures for similar situations.

A comparative study between oral zinc therapy with or without steroid application in symptomatic oral lichen planus: a randomized controlled trial

Objectives Lichen planus is an autoimmune inflammatory disease affecting the buccal mucosa, tongue, and gingiva. As a result of its effect on matrix metalloproteinase, zinc is useful for treating the lesions and preventing their recurrences. This study aimed to compare the efficacy of a combination of oral zinc acetate 50 mg tablets and the 0.1% triamcinolone acetonide Orabase with Orabase alone in the healing process of symptomatic oral lichen planus (OLP). Study Design Forty patients attending the Department of Oral Medicine were randomly included in the study and were categorized into 2 groups, group A and group B. Group A (control group) and group B (case group) each comprised 20 patients with clinically and histopathologically confirmed OLP and symptoms of burning sensation. Group A received the 0.1% triamcinolone acetonide Orabase 2 times daily. Group B received 50 mg zinc acetate tablets plus Ora-base 2 times daily for 8 weeks. Orabase was discontinued after 1 week of application in the case group, whereas zinc acetate tablets were continued throughout the treatment period. The follow-up period was 2 months. Lesion size and burning sensation were measured by using the Thongprasom scale and the visual analogue scale (VAS) at initial and weekly visits till cessation of treatment. Results A decrease in pain intensity from the first visit to the follow-up visit was statistically significant in both groups (P = .000). Group B showed higher mean pain intensity from the initial visit to the follow-up visit compared with group A. Mean difference between the first and follow-up visits in the study group showed that there was a gradual decrease in pain intensity, whereas the control group showed minimal difference compared with the study group; the difference was not statistically significant (P = .498). There was statistically significant gradual decrease in lesion size till the follow-up period in both groups (P = .000). Conclusions Oral zinc therapy was found to be an adjunct in reducing burning sensation and lesion size in symptomatic OLP. Lichen planus is an autoimmune inflammatory disease affecting the buccal mucosa, tongue, and gingiva. As a result of its effect on matrix metalloproteinase, zinc is useful for treating the lesions and preventing their recurrences. This study aimed to compare the efficacy of a combination of oral zinc acetate 50 mg tablets and the 0.1% triamcinolone acetonide Orabase with Orabase alone in the healing process of symptomatic oral lichen planus (OLP). Forty patients attending the Department of Oral Medicine were randomly included in the study and were categorized into 2 groups, group A and group B. Group A (control group) and group B (case group) each comprised 20 patients with clinically and histopathologically confirmed OLP and symptoms of burning sensation. Group A received the 0.1% triamcinolone acetonide Orabase 2 times daily. Group B received 50 mg zinc acetate tablets plus Ora-base 2 times daily for 8 weeks. Orabase was discontinued after 1 week of application in the case group, whereas zinc acetate tablets were continued throughout the treatment period. The follow-up period was 2 months. Lesion size and burning sensation were measured by using the Thongprasom scale and the visual analogue scale (VAS) at initial and weekly visits till cessation of treatment. A decrease in pain intensity from the first visit to the follow-up visit was statistically significant in both groups (P = .000). Group B showed higher mean pain intensity from the initial visit to the follow-up visit compared with group A. Mean difference between the first and follow-up visits in the study group showed that there was a gradual decrease in pain intensity, whereas the control group showed minimal difference compared with the study group; the difference was not statistically significant (P = .498). There was statistically significant gradual decrease in lesion size till the follow-up period in both groups (P = .000). Oral zinc therapy was found to be an adjunct in reducing burning sensation and lesion size in symptomatic OLP.

ORAL MANIFESTATIONS IN LANGERHANS CELL HISTIOCYTOSIS. A CASE REPORT

We present a case of a 68-year-old woman diagnosed as having multisystem Langerhans cell histiocytosis (LCH) 8 years ago. She was treated with chemotherapy last year because systemic affectation; the patient has complained about intense pain and swelling of gums beginning 2 years ago. Intraoral examination reveals poor oral hygiene, gingival enlargement, and multiple necrotic ulcerations covered by pseudomembrane involving the upper buccal gingiva, the intercanine region, and the lower buccal and lingual gingiva of premolars, canines, and incisives. The orthopantomography reveals generalized alveolar bone loss. A biopsy was performed. The presence of a mixed inflammatory infiltration, and immunohistochemical staining positive for langerin and CD1 a confirms the diagnosis of the histiocytosis X. We proceed to the intralesional infiltration with triamcinolone acetonide 40 mg/mL once weekly for 4 weeks, and the complete cure of the oral lesions was achieved. Six months later no lesions were observed.

A rare case of non-Langerhans cell histiocytosis/ Erdheim-Chester disease presenting as desquamative gingivitis and oral mucosal erythema

Background Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis characterized by BRAFV600 E mutations in greater than 50% of patients; multisystemic involvement, such as skin (xanthelasma); heart (pericardial effusion); central nervous system (brain-stem lesions); and bone lesions. ECD has a distinct histopathology and immunochemistry profile, which is negative for CD1 a, S100, and Langerin. Craniofacial involvement has been reported in less than 10 cases and described as multiple, solitary, well-defined radiopaque/lucent lesions of the jaws. We report a case of ECD, which initially included desquamative gingivitis, mucosal erythema, and edema. Case Summary A 62-year-old white woman was referred by her local dentist to the Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, in December 2017, with the chief complaint of mouth sensitivity. Her medical history was notable for a 7-year history of intermittent bone pain, nonpruritic, erythematous, papular rashes of the neck, extremities, and trunk, as well as gingival erythema. She was diagnosed with ECD by a hematologist–oncologist in December 2010 based, in part, on tibial biopsy and the presence of BRAFV600 E mutation. Her medications included prednisone 40 mg 4 times daily by mouth, Bactrim 4 times daily by mouth, subcutaneous MTX 27.5 mg weekly injection, and dabrafenib 150 mg every 12 hours. She reported having a 10-year history of intermittent sensitivity, redness, and swelling of the gingiva, without any known triggers or patterns. On oral examination, there was diffuse desquamation, erythema, and edema of the buccal and palatal gingivae, as well as erythema of the mid–hard palatal mucosa. Differential diagnoses were ECD, vesiculobullous disorders, and vasculitis. With the patient's consent, an incisional biopsy specimen was obtained, and histopathology revealed the presence of chronic inflammation and a scant histiocytic infiltrate. The patient was managed with topical clobetasol 0.05% via custom trays to the maxilla and the mandible; the patient reported a greater than 75% improvement in sensitivity score after 1 month of use. Five months later, she presented with 2 erythematous nodules (#12 and #19), which were consistent with pyogenic granulomas on excisional biopsy. Conclusions This is the first report of potential oral mucosal involvement of ECD, with the noted desquamative gingivitis and erythema as its oral presentation.

MELANOACANTHOMA OF THE BUCCAL MUCOSA

Oral melanoacanthoma (MA) is a rare pigmented lesion characterized by hyperplasia of spinous keratinocytes and dendritic melanocytes that usually affects the buccal mucosa, lip, palate, and gingiva of adult women. An otherwise healthy 58-year-old female patient presented a diffuse pigmented dark brown lesion on the right buccal mucosa measuring 5 cm in greatest diameter. The clinical differential diagnoses included melanocytic macule, melanocytic nevus, and melanoacanthoma. Gross features included a whitish soft tissue showing superficial pigmented deposits. The microscopic evaluation showed marked acanthosis of parakeratinized stratified squamous epithelium of the oral cavity, which was associated with heavily pigmented dendritic melanocytes in the basal and suprabasal layers of the epithelium. The lamina propria presented melanophages and lymphocytic infiltrate containing eosinophils. The biopsy site healed completely without complications. Oral clinicians and pathologists should consider oral melanoacanthoma in the clinical differential diagnosis of oral pigmented lesions.

ORAL VERRUCOUS PEMPHIGUS VEGETANS. A CASE REPORT

Pemphigus vegetans is a chronic mucocutaneous autoimmune blistering disease that can involve oral mucosa, whose behavior is normally benign. We present a case of a 50-year-old man with an unremarkable past medical history who smokes 20 cigarettes every day. For the last 3 months, he has complained of pain on the gums. Clinical examination showed multiple white plaques on the buccal gingiva of all 4 quadrants, with a verrucous appearance, some of which had a reddish area. Incisional biopsies were performed of the lesions from the gingiva with clinical diagnosis of proliferative multifocal leukoplakia as well as a microbiologic culture intake. Histopathologic analysis, showing a verrucous epithelial hyperplasia with acantholysis, confirmed the diagnosis of verrucous pemphigus vegetans. Indirect immunofluorescence results for desmoglein 1 and 3 were negative. The patient remains under control after treatment with deflazacort and triamcinolone. This research was supported by a research group from UPV/EHU.

Multiple myeloma masquerading as medication-related osteonecrosis of the jaw: a case study

Background Bisphosphonates, such as zoledronic acid, are commonly used to treat bone metastasis from malignant conditions, such as multiple myeloma, or from solid tumors, such as breast or prostate cancer. Medication-related osteonecrosis of the jaw (MRONJ) is one of the complications of bisphosphonate treatment. The reported incidence of MRONJ among patients with cancers and bone metastases treated with zoledronic acid is 1.3%. MRONJ has been reported to have an incidence rate of up to 18.5%. The clinical and radiographic presentations of MRONJ are very similar to those of bone metastases, making early diagnosis and timely treatment challenging. This is a case report of a patient with multiple myeloma with a history of treatment with zoledronic acid and whose initial presentation of an intraoral lesion made it challenging to distinguish between bone metastasis and MRONJ. Case Summary This is a case report of a 67-year-old female with multiple myeloma, with a history of zoledronic acid, 28 doses taken from 2013 to 2016 and the disease in remission. The patient initially presented with a 1-week history of firm gingival swelling buccal and lingual to a fixed partial denture (FPD) in the left mandible. Panoramic radiography showed a well-defined radiolucent lesion. Considering her history of antiresorptive treatment, MRONJ was considered as one of the diagnoses. However, because of the unusual hyperkeratotic nature of the buccal gingiva, relapsed disease was included in the differential diagnosis. Because of the unconventional clinical manifestation and concerns about relapsed disease, computed tomography guided bone biopsy was performed, and it revealed plasma cell neoplasm and necrotic bone. The patient was treated with palliative radiation therapy and antibiotics, which resulted in a significant decrease in her symptoms. Eventually, a portion of the FPD was removed, and an exposed bony site with a mobile bony sequestrum was revealed. Removal of the sequestrum led to complete gingival healing of the exposed site. Conclusions Maxillofacial manifestation of bone metastasis is common but is often overlooked. Therefore, it should be considered in the differential diagnosis when a patient with a history of antiresorptive medications presents with a gingival mass and/or exophytic bone. Good clinical judgment and well-timed bone biopsy and diagnostic imaging can lead to the correct diagnosis and optimal treatment.

Gingiva thickening with a porcine collagen matrix in a preclinical dog model: Histological outcomes.

To compare 10-month histological and immunohistological outcomes after soft tissue thickening around teeth with a porcine collagen matrix (CM) versus a subepithelial connective tissue graft (SCTG). In eight beagle dogs, soft tissue thickening of the buccal gingiva of upper canines was performed with the SCTG or the CM. Connective tissue thickness (CTT) was histomorphometrically measured in the augmented regions. The augmented connective tissues were also histologically characterized and the collagen I and vascular endothelial growth factor (VEGF) expressions immunohistologically quantified. CTT significantly differed between groups (SCTG: 1.32mm±0.44mm; CM: 1.06mm±0.27mm; p=.008). Descriptive histological analyses revealed mature connective tissue that did not differ between groups. Immunohistological quantification of collagen I and VEGF expressions in the connective tissue also revealed no significant inter-group differences (collagen I: SCTG, 32.64%±7.09% vs. CM, 30.57%±7.83%; VEGF: SCTG, 39.06%±7.27% vs. CM, 37.15%±9.80%). SCTG is superior to CM with regard to CTT in this experimental model. The CM and the SCTG lead to comparable connective tissue quality ten months after connective tissue thickening.

Diode laser assisted excision of a gingival pyogenic granuloma: A case report.

Pyogenic granuloma is a non-neoplastic, exuberant, reactive lesion seen in response to local irritation or trauma caused by dental calculus, bacterial plaque, caries and restorations, with a strong predilection for the gingiva. It is among the frequently encountered oral lesions, occurring at a challenging oral site, the gingiva. Herein, we report a 71-year-old medically compromised Caucasian female who presented with a relatively large lobulated pyogenic granuloma on the buccal gingiva of the maxillary molar-premolar region. Total surgical excision was performed with an 840nm diode laser followed by the placement of hyaluronate gel and relevant periodontal dressing. Two weeks after surgical excision, complete healing was observed, but patient denied replacement of dental restoration. After 4 months of follow-up, an overall reduction of associated teeth mobility was also observed, with a minor recurrence in gingival inflammation. The objective of this report is to briefly review clinical, radiographic and histological findings of pyogenic granuloma along with a detailed discussion on its management through a diode laser.

The color of skin: blue diseases of the skin, nails, and mucosa

Diseases of the skin, hair, nails and mucosa can appear as flesh-colored lesions or may present as any of the colors of the visual spectrum. Diseases associated with blue (or shades of blue) discoloration represent a unique group of conditions that occur de novo or as a reaction to either a topical or a systemic agent to which the individual has been exposed. Blue diseases can affect the skin, the nails or the mucosal membranes of the mouth (buccal mucosa, gingiva, lips, palate or tongue) or eyes (sclera). In addition to appearing blue, they can also appear as blue-black, blue-brown, blue-gray, blue-green, blue-purple, blue-red, and blue-silver. The conditions range from those secondary to exogenous agents (systemic or tattoo or topical) to syndromes to systemic diseases to tumors (adnexal, melanocytic, vascular, or miscellaneous). A comprehensive attempt to include all conditions that have been described as blue (or a shade of blue) has been performed by evaluating the following terms using the medical search engine PubMed: blue and either gingiva, lips, lunula, mucosa, nails, oral, palate, sclera, skin, or tongue. Subsequently, the conditions were organized by color (blue and shades of blue) and within each color by location (skin, nails, oral mucosa and sclera). The results are presented in organized tables; in addition, there is discussion of some of the conditions that are unique to one or more specific locations. In conclusion, ‘preserve and cherish the pale blue dot’ and remember that a big red rock eater with chrysiasis is the answer to the riddle, “What is big and blue and eats rocks?”

Association between p62 expression and clinicopathological characteristics in oral leukoplakia.

ObjectiveOral leukoplakia is keratinized lesions in the buccal mucosa, tongue, and gingiva. It is the most common oral precancerous lesion; oxidative stresses and irrelevant autophagy have been reported to be the cause of oncogenesis. p62, a cytoplasmic protein induced by oxidative stress, is an adaptor protein involved in the formation of protein aggregates and induction and inhibition of autophagy. The inhibition of autophagy induces p62 overexpression and promotes oncogenesis via the oncogenic signaling pathway. The aim of the present study was to elucidate the involvement of intracellular expression of p62 in oral leukoplakia and to address its potential clinical implementation as a biomarker to predict malignant transformation.Material and MethodsFifty samples from subjects with confirmed oral leukoplakia were evaluated by immunohistochemical staining for the expression of p62, 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG), Ki67, and p53. Univariate and multivariate logistic regression analyses were performed to evaluate the association between p62, 8‐OHdG, Ki67, and p53 and clinical characteristics, including epithelial dysplasia.ResultsSignificant associations were observed between p62 expression in the nucleus, p62 aggregation, and epithelial dysplasia (adjusted odds ratio [OR] = 5.75; 95% confidence interval [CI]: [1.28, 26.2]; .024 and OR = 6.16; 95% CI: [1.01, 37.4]; .048, respectively). The expression of p62 in the cytoplasm and the levels of 8‐OHdG, Ki67, and p53 were not significantly associated with epithelial dysplasia. A significant relationship was found between p62 expression in the nucleus and p53 expression (OR = 3.94; 95% CI: [1.14, 13.6]; .031).ConclusionsThe results suggested that p62 expression in the nucleus and p62 aggregation can be potential markers to predict the malignant transformation of oral leukoplakia.

Diagnosis and treatment of oral focal mucinosis: a case series

BackgroundOral focal mucinosis, the oral counterpart of cutaneous focal mucinosis, is a rare disease. As it has no characteristic clinical or radiological features, diagnosis is established by histopathological and immunohistological examination. We present three cases of oral focal mucinosis occurring in the retromolar (which is extremely rare) and gingival regions.Case presentationCase 1 involved a 26-year-old Japanese man with radiolucency in the right retromolar region on panoramic radiograph and computed tomography; no obvious protrusion was observed in the region. This finding was clinically diagnosed as a tumor of the retromolar region. Case 2 involved a 60-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 7 × 6 mm and exhibited elastic hardness and healthy-colored mucosa. The lesion was diagnosed as an epulis. Case 3 involved a 47-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 10 × 10 mm and exhibited elastic hardness and redness of the surface mucosa. This lesion was also diagnosed as an epulis. Resection was performed in all three cases, and the lesions were histopathologically diagnosed as oral focal mucinosis. Postoperative courses were uneventful and, thus far, there have been no recurrences.ConclusionsAlthough it is difficult to diagnose oral focal mucinosis based on clinical symptoms and imaging findings, the disease should be considered a possibility when diagnosing benign oral tumors. We believe that an emphasis on histopathologic study is essential to confirm the clinical suspicion.

Evaluation of Caffeic Acid Phenethyl Ester Administration in Chronically Stressed Rats with Experimental Periodontitis.

Objectives: The aim of the present study was to investigate the therapeutic effects of systemic caffeic acid phenethyl ester treatment on oxidative stress and alveolar bone destruction in lipopolysaccharide (LPS)-induced periodontitis in chronically stressed rats.Materials and Methods: Fourty male Sprague Dawley rats were divided into four groups: 1) control group, 2) experimental periodontitis (EP), 3) EP and chronic stress (CS) group (EP-CS), and 4) EP-CS treated with CAPE (EP-CS-CAPE). To induce periodontitis, LPS was administered into the buccal gingiva of the test groups, and pure saline was administered for the control group. Two test groups were exposed to restraint stress and one group of these groups was treated with only a single dose of CAPE (10 mmol/kg). Likewise, saline was administered in the control, EP, and EP-CS groups. After 14 days, serum samples were collected from the heart, and all rats were sacrificed for analyses. Oxidative stress and interleukin (IL)-1β were investigated. The receptor activator of the nuclear factor kappa B ligand (RANKL) and alveolar bone loss were determined by immunohistochemical analysisResults: The oxidative stress, alveolar bone loss, IL-1β and RANKL levels were found significantly higher in the EP-CS group compared with control and EP groups (p<0.05). However, the administration of CAPE significantly reduced oxidative stress and IL-1β in the EP-CS-CAPE group compared with the EP-CS group (p<0.05). Also, CAPE treatment significantly reduced RANKL and alveolar bone loss in the EP-CS-CAPE group compared with the EP-CS group (p<0.05)Conclusions: The present results indicated that CAPE may inhibit alveolar bone loss by modulating the immune response and inflammatory process.

Buccal Nerve Dissection Via an Intraoral Approach: Correcting an Error Regarding Buccal Nerve Blockade

The buccal nerve (BN) supplies sensation to the skin over the anterior part of the buccinator, buccal mucosa, and buccal gingivae corresponding to the second and third molar teeth. Some dental anatomy books depict the main trunk of the BN coursing over the buccal shelf of the mandible, which leads to a serious misunderstanding of this anatomy. Therefore, this study aimed to show the course of the BN on the retromolar area and establish new evidence-based anatomy for appropriate BN blockade. Twenty sides from 10 fresh-frozen Caucasian cadaveric heads were used in this study. The closest distance from the BN to the injection site of the BN blockade (Dis A) was measured. The mean Dis A was 12.69±2.95mm. On 16 of 20 sides (80%), Dis A was longer than 10mm. In most specimens, the injection site of the BN blockade was too far from the course of the main trunk of the BN and the injection site should be changed to 10mm superolateral to the injection site based on the present results and those of other previous studies. Although the distribution of the BN is variable, in most specimens, the current injection site for BN blockade was too far from the course of the BN.

Retraction: Bacterial adhesion and colonization differences between zirconia and titanium implant abutments: an in vivo human study.

[This retracts the article on p. 217 in vol. 42, PMID: 23346465.].

Exfoliative Cytology of Oral Mucosa Epithelium: Cytochemical Study and Morphologic Analysis of Patients with Type 2 Diabetes

Background: Diabetes mellitus is a metabolic disease characterized by chronic hyperglycemia. An association between diabetes mellitus and periodontal disease has been reported. However, few comprehensive reports have examined the impact of chronic hyperglycemia on oral mucosal epithelial cells. This study clarified the effect of diabetes on oral mucosal epithelium cells. Methods: Cells from 44 patients with type 2 diabetes and 10 healthy controls were collected from the buccal mucosa, gingiva, and lateral margin of the tongue by exfoliation. Samples were subjected to Papanicolaou staining; immunochemical staining using anti-AGE antibody, anti-Ki-67 antibody, and anti-p53 antibody; and lectin chemical staining. Furthermore, the nuclear area and cytoplasmic area were measured, and the nuclear/cytoplasm ratio was calculated. Results: A chromatin condensation-like substance was found in samples from some diabetic patients. In AGE staining, positive cells were found in both groups, although the rate of positive cells tended to be higher in diabetic patients. No positive findings were found for Ki-67 and p53 antibodies. PNA and RCA120 showed differences in staining between diabetic patients and controls. The nuclear area was significantly expanded in diabetic patients (P Conclusion: These findings suggest that in patients with persistent hyperglycemia, changes in the sugar chain terminal of the cell surface may influence mucosal epithelial cell differentiation. The appearance of chromatin-like substances may be an indicator of the need for better management of type 2 diabetes.

Oral nodular fasciitis – A case report with a diagnostic schema

Introduction: The spectrum of myofibroblastic lesions of the oral cavity ranges from reactive to benign to malignant lesions with overlapping histopathologic and immunohistologic characteristics posing a diagnostic dilemma. Observation: A 30-year-old male presented with a spontaneous swelling over the right lower buccal gingiva giving a clinical suspicion of a benign mesenchymal tumor. The lesion presented with a varied biphasic microscopic appearance that posed as a challenge for diagnosis. Commentaries: The incisional biopsy of the lesion showed a highly collagenous stroma with spindle-shaped cells, while the excision biopsy revealed myxoid and hyalinized stroma. A panel of markers comprising of SMA (smooth muscle actin). CD-34, β-Catenin, and Alcian blue stain was employed to arrive at a diagnosis. Conclusion: Most myofibroblastic lesions present with diverse histological appearance which warrants a thorough assessment of the cellular and stromal components for an accurate diagnosis.

In vivo Raman spectroscopic characteristics of different sites of the oral mucosa in healthy volunteers.

Investigate the biochemistry of in vivo healthy oral tissues through Raman spectroscopy. We aimed to characterize the biochemical features of healthy condition in oral subsites (buccal mucosa, lip, tongue, and gingiva) of healthy subjects. More specifically, we investigated Raman spectral characteristics and biochemical content of in vivo healthy tissues on Brazilian population. This characterization can be used to better define normal tissue and improve the detection of oral premalignant conditions in future studies. For spectroscopic analysis a Raman spectrometer (Kaiser Optical Systems imaging spectrograph Holospec, f / 1.8i-NIR) coupled with a laser 785nm, 60mW was used. Raman measurements were obtained by means of an optical fiber (EMVision fiber optic probe) coupled between the laser and the spectrometer. Three spectra per site were acquired from the lip, buccal mucosa, tongue, and gingiva of ten healthy volunteers. This resulted in 30 spectra per oral sub-site and in total 120 spectra. We report detailed biochemical information on these subsites and their relative composition based on deconvolution studies of their spectra. Finally, we also report classification efficiency of 61, 83, 41, and 93% for buccal, gingiva, lip, and tongue respectively after applying multivariate statistical tools. We quantitated the contribution of various biochemicals in terms of percentage, and this will enable comparison not only across anatomical sites but also across studies. Raman spectroscopy can rapidly probe tissue biochemistry of healthy oral regions. Moreover, the study suggests the possibility of using Raman spectroscopy combined with signal processing and multivariate analysis methods to differentiate the oral sites in healthy conditions and compare with pathological conditions in future studies. The spectral characterization of the healthy condition of oral tissues by a noninvasive, label-free, and real-time analytical techniques is important to create a spectral reference for future diagnosis of pathological conditions.

Gingival clefts revisited: Evaluation of the characteristics that make one more susceptible to gingival clefts.

Orthodontic space closure after premolar extraction commonly results in the formation of a gingival cleft, which may contribute to orthodontic relapse and poor periodontal health. The purpose of this study was to examine clinical parameters that may predispose patients to gingival clefts. Twenty-nine patients planned for treatment with premolar extractions (n=87) and orthodontic space closure were evaluated in this prospective study. The clinical measures included width of keratinized buccal gingiva, thickness of buccal gingiva, thickness of buccal bone, time of space closure, and the occurrence (presence or absence) and severity (volume) of cleft formation. The association of the clinical measures with gingival cleft formation and severity was assessed separately for patients according to age group: young adolescent (≤13years of age), adolescent (14-18years of age), and adult (≥19years of age). The overall incidence of gingival cleft formation was 73.2%, with a trend toward greater cleft formation in the young adolescents (79.4%) than in the adolescent and adult groups (69.2% and 68.2%, respectively). The mean severity of clefts exhibited a significant positive association with age group-young adolescent (26.6mm2), adolescent (27.9mm2), and adult (41.5mm2). Buccal bone thickness was significantly correlated with gingival phenotype in the adolescent and adult groups (r=0.42 and r=0.52, respectively; both, P<0.05). Rate of space closure was significantly correlated with cleft formation (r=0.71; P<0.001) in the adult group. The formation of gingival clefts is common after premolar extraction and space closure. Adults with a thinner gingival phenotype were more likely to develop gingival clefts of greater severity. The rate of space closure was significantly and inversely correlated with cleft formation in adults, reflecting a greater likelihood of cleft formation with slower space closure. Although various clinical parameters show a correlation to both severity and incidence of clefts, all patients undergoing postextraction space closure appear to be at risk and should be monitored.

The Islamic Perspective of Lingual Dens Evaginatus in a Mandibular Left Second Premolar: A Case Report

Dens evaginatus (DE) is a developmental anomaly. It is an extra cusp or tubercle that protrudes from the occlusal surface of posterior teeth, as well as the lingual surface of anterior teeth. Tubercles are susceptible to pulp exposure from wear or fracture because of malocclusion;leading to pulpal complications early after eruption.DE may also complicate the process of daily routine oral health care. A 13-year-old girl presented to our polyclinic with sinus track at the posterior lower left buccal gingiva forthe past1 year. All 35 teeth were sound. At the lingual side, there was an accessory tooth in close relation to tooth 35 covered with supra-gingival inflammation. Electric pulp test (EPT) showed that tooth 35 was already non-vital. Intraoral periapical (IOPA) radiograph and cone beam computed tomography (CBCT) scan showed an abnormalappearing root which shows DE with radiolucency at the periapical area. Root canal treatment was performed using crown down pressureless (CDP) technique and obturation was done using lateral condensation technique. The tooth was restored using composite restoration. DE is a rare condition. It is quite a challenge for dental practitioner since the diagnosis is difficult and the treatment options are limited. In the case of DE with necrotic pulp and periapical abscess, root canal treatment is a treatment of choice. We have to accept and appreciate any gift from Allah SWT whether it is good or bad, no equal divine creation except from Allah SWT.Therefore we need to take care of our oral hygiene to prevent diseases. In every disease, there is a cure; we thus need to try to do the best to find the cure and to not easily get rid of the tooth and replace it with a denture. Early diagnosis of DE can lead to proper treatment which can result in high success rate if it is followed by adequate restoration.