Gingival Edema Research Articles

The effect of a new 3-hydroxypyridine derivative LHT-2-20 on free radical oxidation in experimental periodontitis

Aim. To study the effect of a new complex compound LHT-2-20 (2-ethyl-6-methyl-3-hydroxypyridine-2-(3benzoyl phenyl)-propanoate) on free radical oxidation in experimental periodontitis.Materials and methods. The experimental study was performed on 195 white mongrel mice weighing 19–23 g and 137 white mongrel rats weighing 180–220 g. The effect of a new complex compound LHT-2-20 (2-ethyl-6methyl-3-hydroxypyridine-2-(3-benzoyl phenyl)-propanoate) on the intensity of free radical oxidation and the local state of periodontal tissues during a course of intragastric administration was studied on the experimental model of periodontitis. Statistical processing of the results was carried out using the SPSS Statistics 20.0 software package with the analysis of variance (ANOVA) and the parametric Tukey’s test.Results. The LHT-2-20 compound reduced elevated levels of primary and secondary lipoperoxidation products (conjugated dienes, malondialdehyde in plasma and in erythrocytes during spontaneous and iron-induced oxidation) already at the early stages of the experiment, bringing the studied parameters closer to the reference values by the end of the course of treatment. The use of the compound LHT-2-20 contributed to an increase in the activity of the main antioxidant enzymes (catalase and superoxide dismutase), normalizing them to baseline values by the end of the experiment. With the correction of free radical processes, the use of LHT-2-20 limited the local inflammatory response in periodontal tissues, which was confirmed by a decrease in gingival edema and hyperemia, bleeding, depth of periodontal pockets, and tooth mobility.Conclusion. The results of this study confirm the anti-inflammatory potential of the compound and the multiplicity of its effects due to the impact on the mechanisms of oxidative stress. The expediency of further study of the drug is justified by the prospect of creating a new drug and its subsequent wide clinical application as part of the complex therapy of periodontal inflammation.

Chronic Suppurative Gingivitis: A Rare Manifestation of Lichen Planus Following SARS-COV 2 Infection

Post-COVID-19 chronic suppurative gingivitis is an emerging clinical entity that has attracted increasing interest in the medical and dental community because of its association with SARS-CoV-2 virus infection and its prolonged and potentially debilitating manifestation in the periodontal system. This article provides a comprehensive review of this entity, addressing its epidemiology, pathogenesis, clinical manifestations, diagnosis and current therapeutic approaches. The epidemiology of post-COVID-19 chronic suppurative gingivitis is characterized by its occurrence following SARS-CoV-2 infection, with a variable incidence in convalescent patients. A higher prevalence has been observed in individuals with underlying systemic diseases, such as diabetes mellitus and arterial hypertension, suggesting an individual susceptibility component. From a pathogenic perspective, it has been postulated that SARS-CoV-2 infection could trigger an overactive immune response and chronic inflammation at the gingival level, contributing to persistent suppurative gingivitis. The involvement of viral factors and host response in the pathogenesis of this entity are under ongoing investigation. The clinical presentation of post-COVID-19 chronic suppurative gingivitis includes characteristic signs such as gingivorrhage, gingival edema, superficial ulcerations, and the production of purulent exudate in the gums. These findings, in combination with a history of SARS-CoV-2 infection, are critical for diagnosis.

APPROACH TO THE DIFFERENTIAL DIAGNOSIS BETWEEN MULTIPLE MYELOMA OR OSTEONECROSIS: A CASE REPORT

A 67-year-old female patient, diagnosed with multiple myeloma (MM), reported intense pain in the right-side mandible and hemi-face. She was undergoing third-line chemotherapy associated with the use of zoledronic acid. Clinical exams showed drainage of purulent secretion in the gingival sulcus and gingival edema in the peri-implant region. Computed tomography showed an osteolytic lesion in the right mandible, with bone sequestration adjacent to the base of a dental implant leading to MM lesion or osteonecrosis hypothesis. Histological examination showed granulation tissue with a mixed inflammatory process and osteonecrosis with bacterial colonies. The diagnosis was osteonecrosis possibly related to peri-implantitis, occlusal trauma, and the use of bisphosphonates. Antibiotic therapy was implemented, reaching bone repair, no signs of infection, no pain, and no bone exposure. The importance of performing correct diagnoses and treating bone lesions in patients with MM, along with close follow-up, were verified. A 67-year-old female patient, diagnosed with multiple myeloma (MM), reported intense pain in the right-side mandible and hemi-face. She was undergoing third-line chemotherapy associated with the use of zoledronic acid. Clinical exams showed drainage of purulent secretion in the gingival sulcus and gingival edema in the peri-implant region. Computed tomography showed an osteolytic lesion in the right mandible, with bone sequestration adjacent to the base of a dental implant leading to MM lesion or osteonecrosis hypothesis. Histological examination showed granulation tissue with a mixed inflammatory process and osteonecrosis with bacterial colonies. The diagnosis was osteonecrosis possibly related to peri-implantitis, occlusal trauma, and the use of bisphosphonates. Antibiotic therapy was implemented, reaching bone repair, no signs of infection, no pain, and no bone exposure. The importance of performing correct diagnoses and treating bone lesions in patients with MM, along with close follow-up, were verified.

Evaluation of dental status using a questionnaire before administration of general anesthesia for the prevention of dental injuries.

Dental evaluation and protection are important for preventing traumatic dental injuries when patients are under general anesthesia. The objective of the present study was to develop a questionnaire based on dentition-related risk factors that could serve as a valuable tool for dental evaluation and documentation. We developed a questionnaire for dental evaluation before administration of general anesthesia, investigated the association between patient-and-dentist responses and mouthguard fabrication, and assessed response agreement between 100 patients. Protective mouthguards were fabricated for 27 patients who were identified as having a high risk of dental injury. There was a strong association between dentists' responses and mouthguard fabrication, depending on the general oral health status, use of ceramic prosthesis, presence of masticatory pain related to periodontal diseases, gingival edema, and implants (P < 0.05). Response agreement between patients and dentists for items related to dental pain, loss of dental pulp vitality, root canal therapy, dental trauma, aesthetic prosthesis, tooth mobility, and implant prosthesis was high (Cohen's kappa coefficient κ ≥ 0.6). A high agreement was observed between patient-dentist responses and a strong association with mouthguard fabrication for items pertaining to ceramic prosthesis, masticatory pain, and dental implants. Patients with a "yes" response to these items are recommended to undergo a dental evaluation and use a dental protective device while under general anesthesia.

GLANDULAR ODONTOGENIC CYST IN ANTERIOR MANDIBLE: A CASE REPORT

A 35-year-old male patient was referred to the oral clinic complaining of a sensitivity in the right lower canine, without gingival edema or any other sign. On radiographic examination, a well-defined multilocular, radiolucent lesion associated with the roots of the lower incisor and canine was noted. The initial clinical diagnostic hypotheses were ameloblastoma or keratocyst. After complete removal of the lesion by curettage, microscopic examination revealed a thin and friable cystic capsule and lining composed of nonkeratinized stratified squamous epithelium as well as superficial cuboidal eosinophilic cells and intra-epithelial microcystic structures. The final diagnosis of glandular odontogenic cyst was made. Surgical treatment of the lesion was successful and the patient is being followed up. Since surgical treatment, the patient has been followed up with no evidence of recurrence.

Eruption of temporary teeth in children

Teeth eruption is a multifactorial process, which requires a thorough evaluation of a child's general state of health. During temporary teeth eruption, unpleasant sensation associated with swelling and tenderness in the gingival area, which is accompanied by excessive salivation, fever, rhinorrhea, increased anxiety, poor appetite, etc. may occur. Today, there are pharmacological and non-pharmacological treatments for easing the symptoms of eruption of temporary teeth. The article presents feasible approaches to the relief of symptoms that occur at this period. It draws attention to the issue of competent and timely evaluation of symptoms and signs and identification of underlying causes of babies' unwellness, as well as risks of using pharmacological products. The prevailing opinion among parents and medical professionals suggests that the symptoms of teeth eruption can and should be controlled. The local symptoms during difficult eruption of temporary teeth include gingival edema and hyperemia, as well as tenderness on palpation in the eruption area. Different pharmacological and non-pharmacological methods are used to reduce the symptom load of teeth eruption in children. One of them is a baby herbal teething gel. Therapeutic indications for using the gel are pain syndrome in baby tooth eruption (for massaging gums). No contraindications have been identified. If the gel or its components cause a hypersensitivity reaction, its use is not recommended. Active ingredients are exclusively of natural origin. Non-pharmacological treatments to ease the symptoms of temporary teeth eruption include a simple and available method - massage of predeciduous dentition. Putting pressure on them reduces the pain syndrome. Specialized silicone brushes can be used for massage. Gel-filled cooling or silicone teething toys reduce swelling and relieve painful sensation.

Nickel Sensitivity in Children Due to Using Stainless Steel Crowns: A Narrative Review

Context: Stainless Steel Crowns (SSC) are stable and durable restorations and a valuable technique in repairing deciduous teeth with extensive caries. Nickel and chromium are the main composing elements of SSCs, i.e. released in the oral environment; they can cause allergic reactions, especially in nickel-sensitive children. The symptoms of these reactions include gingival edema and the loss of alveolar bone. Evidence Acquisition: The required data used in our review were searched from articles published until 2020 and collected from online databases, including Scopus, PubMed, Google Scholar, and Science Direct, using “Nickel, Allergy, and SSCs” keywords. Articles concerning SSCs and their application, nickel allergy released from crowns, and their symptoms were included in this study. After the abstract screening, we recalled relevant studies for full-text review. Results: We are exposed to nickel every day in various forms; some individuals present hypersensitivity reactions when exposed to the slightest amounts of this metal. Nickel is a base metal and among the elements used in SSCs. Nickel is released from SSCs during the corrosion process in the oral environment. Excessively released nickel ions cause chronic fatigue syndrome, sensitive lymph nodes, muscle aches, and headaches. Conclusions: The amount of nickel released from SSCs is less than the number of other sources; thus, the immunological reactions of a large percentage of the population to this excess amount of nickel ions in the bloodstream are normal and cause no severe problems.

Evaluation of the Effectiveness of the Use of the Diode Laser in the Reduction of the Volume of the Edematous Gingival Tissue after Causal Therapy.

Aim: The aim of this study was to evaluate and compare two different techniques for the treatment of plaque-induced gingivitis, demonstrating whether the causal therapy supported by diode laser can allow a resolution of the edema caused by gingivitis in less time compared to the single traditional causal therapy. Materials and methods: Twenty-five patients between 20 and 60 years of age with a specific diagnosis of gingivitis were evaluated at the CLID-HSR oral hygiene department. Once the clinical parameters (bleeding index, plaque index, recession, and clinical attack level) were recorded, each of them was subjected to a professional oral hygiene session and instructed in correct home hygiene procedures. Through a split-mouth protocol for each individual patient, hemi-arches were treated by simple randomization to be treated with causal therapy supported by the action of the diode laser (experimental therapy) and which with traditional causal therapy (control therapy). A first intraoral scan was performed before therapy (T0), which was repeated 20 min after rinsing with CHX. The intraoral scans were repeated at a control 7 (T1) and 14 days (T2) after the session. For each intraoral scan, a volumetric value was calculated, proportional to the edema of the gingival tissues, using special digital software. The operator who carried out the volumetric measurements on the software was not aware of the therapy implemented on each half-arch. The operator who carried out the statistical analysis was not aware of the therapy applied to each group. The collected data were statistically compared in order to detect any differences between the volumetric variations between the two therapy groups and within the therapy groups over time. After evaluating the distribution of data by means of the Kolmogorov-Smirnov statistical test, the appropriate nonparametric tests were chosen to carry out the statistical comparisons. Results: Based on the analysis of the gingival-periodontal health parameters and the volumetric value of the treated areas, no statistically significant differences were detected between the areas treated with the adjuvant action of the diode laser compared to those treated with causal therapy alone. Conclusions: With the limitations of this study, in accordance with the statistical results obtained, diode laser therapy does not allow a faster resolution of gingival edema compared to traditional therapy; the two treatment techniques for plaque-induced gingivitis, therefore, have the same efficacy.

A randomized prospective comparison of maxillomandibular fixation (MMF) techniques: “SMARTLock” hybrid MMF versus MMF screws

The aim of this study was to assess the efficacy of the "SMARTLock" hybrid system and determine whether it results in fewer intraoperative and postoperative complications compared with placement of intermaxillary fixation (IMF) screws in trauma patients. This prospective study, which was approved by the institutional review board, compared the results of MMF in mandibular fractures by using the Stryker "SMARTLock" hybrid system versus traditional IMF screws. Patients were recruited and assigned randomly to either group. The 2 groups were compared for placement time, intraoperative complications, loosening of hardware, postoperative complications, and time to device removal. We enrolled 32 patients in the study, with 13 patients randomized to the group receiving hybrid MMF (HMMF) with the SMARTLock system and 19 to the group of patients receiving MMF with traditional IMF screws. The mean application time for HMMF was 25.92 minutes compared with 18.28 minutes for IMF screws. After removal, the HMMF was associated with gingival overgrowth and gingival edema. This is the first study to compare HMMF with MMF with the use of IMF screws. Hybrid arch bars do require more manipulation for ideal placement compared with individually placed bone screws to achieve ideal MMF. Compared with IMF screws, the hybrid device was associated with gingival edema and overgrowth, but there was decreased incidence of loosening in the postoperative period.

Edema and gingival bleeding in anterior region have a negative influence on quality of life of adolescents.

The aim of the present study was to verify if clinical signs of gingivitis such as color changes, edema, and bleeding in the anterior region influence the OHRQoL of adolescents. We followed a cross-sectional convenience sample of 67 adolescents aged 11 to 16 years receiving dental treatment at the Federal University of Santa Maria (UFSM), in southern Brazil. The participants were evaluated for the following clinical variables: edema, gingival color alteration, and marginal bleeding of the gingival tissues, collected at 6 sites per tooth in the anterior region of the mouth. Socioeconomic variables were collected through questionnaires and OHRQoL was evaluated through the Brazilian version of the Children Perception Questionnaire (CPQ 11-14) short form. A Poisson regression model was used to verify associations between clinical variables and general CPQ11-14 scores. In the unadjusted analysis, edema, color alterations, and marginal bleeding in the anterior region were associated with worse scores of OHRQoL. Edema and marginal bleeding remained associated after adjusting for clinical and sociodemographic variables. Adolescents with higher levels of marginal bleeding and edema in the anterior region had higher mean CPQ11-14 scores. Therefore, the presence of bleeding and gingival edema in the anterior region can be considered clinical signs of gingivitis that are associated with a worse OHRQoL in adolescents.

Um Caso Raro de Dentes Neonatais

Neonatal teeth is a rare disorder of tooth eruption, arising in the oral cavity, usually in the anterior mandible, in the first month of life. Its etiology is unknown. This condition can cause breastfeeding difficulties, besides aspiration or swallowing of the teeth. We describe the case of a premature infant in the second day of life presented with gingival edema, redness and discrete swelling in the region of the mandibular central incisors. Ten days later, two small teeth with hypermobility were detected. Extraction of those teeth was performed. With this clinical case we intend to show the rarity of this entity, especially in premature infants, the possible association with various syndromes and the need for a multifactorial approach to the treatment decision (extraction / conservative treatment).

Oral, radiographical, and clinical findings in Weaver syndrome: a case report.

Weaver syndrome is a rare condition characterized by accelerated growth, advanced osseous maturation, and distinct craniofacial features that can occur in both males and females. Etiology is unknown and no definitive oral characteristics have been established. The objective of this case report is to describe the oral and radiographic findings of a 14-year-old male with Weaver syndrome. A comprehensive dental examination was performed under general anesthesia. The clinical findings were: severe generalized heavy plaque with subgingival calculus, gingival edema, malocclusion and maxillary atresia, mild micrognathia of the mandible, enlarged tongue, and bifid uvula. Clinical and radiographic caries were not found. Out of over 40 possible cases of Weaver syndrome previously reported in the literature, only two were related to the oral cavity. Bifida uvula was not mentioned until now as clinical findings associated with the syndrome. Autism, macroglossia, and cleft palate were seldom mentioned. The oral manifestations in Weaver syndrome are not yet well known. Future studies will be required to improve the subject matter.

Formulation and evaluation of medicated chewing gum as antiplaque and antibacterial agent

Aim: The aim of this study was to formulate chewing gum using chlorhexidine and chitosan and to prove its antibacterial and antiplaque properties effectively at low doses of chlorhexidine. Materials and Methods: Chewing gums were prepared by using chlorhexidine and various proportions of gum base and chitosan. Hot melt technique was used to prepare chewing gums. The prepared gums were evaluated for physical parameters, compatibility studies, drug content, moisture content, stability studies and in vitro drug-release testing. To carry out in vivo study on humans double-blind, crossover clinical trial was conducted on 18 adult volunteers from Department of Oral Medicine and Radiology, JSS Dental College, Mysore. The test group administered chewing gums containing chlorhexidine, with and without the polymer, while the control group administered dummy chewing gums. The volunteers were visually examined for presence or absence of gingival erythema, gingival edema and gingival bleeding and the antibacterial activity was assessed by the reduction in bacterial count in the plaque samples. Result: As the proportion of gum base was increased, an increase in hardness of the chewing gum was observed. The formulation, which contains highest concentration of chitosan, showed more in vitro release compared to other formulation. Analysis of variance revealed significant differences between subjects receiving F1 and F5 for antiplaque activity. The post plaque samples results showed significant reduction in microbial count (P Conclusion: The in vivo studies on human volunteers were carried out for optimized formulation F5 containing chitosan and antibacterial agent which showed a better reduction in the bacterial count and gingival index. The dose of chlorhexidine can be reduced significantly when used along with chitosan. Chitosan containing chewing gum has a greater antibacterial effect compared with gums containing only chlorhexidine. Key words: Chewing gum, chitosan, chlorhexidine, dental caries.

Acute Necrotizing Ulcerative Gingivitis

A 23-year-old man with no significant medical or dental history presented to the emergency department (ED) complaining of several days of gum pain, metallic taste, low-grade fever, and generalized malaise. The patient was in the military and had spent the last week living and training under austere field conditions. In the ED, he appeared to be in no acute distress, and his vital signs were within normal limits, except for an oral temperature of 101.1°F(38.4°C). The remainder of his physical examination yielded normal results except for diffuse gingival edema and ulcerations (Figure).

A resource guide for practice development through technology

A resource guide for practice development through technology

The biphasic virulence activities of gingipains: activation and inactivation of host proteins.

Gingipains are trypsin-like cysteine proteinases produced by Porphyromonas gingivalis, a major causative bacterium of adult periodontitis. Rgps (HRgpA and RgpB) and Kgp are specific for -Arg-Xaa- and -Lys-Xaa- peptide bonds, respectively. HRgpA and Kgp are non-covalent complexes containing separate catalytic and adhesion/hemagglutinin domains, while RgpB has only a catalytic domain with a primary structure essentially identical to that of the cata-lytic subunit of HRgpA. The multiple virulence activities of gingipains are reviewed in view of the biphasic mechanisms: activation and inactivation of host proteins. Rgps enhanced vascular permeability through prekallikrein activation or direct bradykinin release in combination with Kgp. This Rgp action is potentially associated with gingival edema and crevicular fluid production. Rgps activate the blood coagulation system, leading to progression of inflammation and consequent alveolar bone loss in the periodontitis site. Rgps also activate protease-activated receptors and induce platelet aggregation, which, together with the coagulation-inducing activity, may explain an emerging link between periodontitis and cardiovascular disease. Kgp is the most potent fibrinogen/fibrin degrading enzyme of the three gingipains in human plasma, being involved in the bleeding tendency at the diseased gingiva. Gingipains stimulate expression of matrix metalloproteinases (MMPs) in fibroblasts and activate secreted latent MMPs that can destroy periodontal tissues. Gingipains degrade cytokines, components of the complement system and several receptors, including macrophage CD14, T cell CD4 and CD8, thus perturbing the host-defense systems and thereby facilitating sustained colonization of P. gingivalis. Gingipains are potent virulence factors of P. gingivalis, and in many regards their pathogenic activities constitute new mechanisms of bacterial virulence.