Gingival Pain Research Articles

Effects of Self-Perceived Oral Health and Stress Levels on Subjective Oral Symptoms and Lifestyle of University Students in South Korea: A Cross-Sectional Survey.

Self-perceived oral health is related to clinical and subjective oral factors, socioeconomic factors, perceived stress, and oral health behavior. However, limited studies have examined whether self-perceived oral health is related to dry mouth, salivary viscosity, or lifestyle factors. Accordingly, this study aimed to verify the effect of self-perceived oral health and stress levels on subjective oral symptoms and lifestyle. The responses of 644 university students who agreed to participate in the study were analyzed. A chi-square test was used to determine whether self-perceived oral health and stress levels showed significant differences based on subjective oral symptoms and lifestyle. Logistic regression was used to analyze the effect of subjective oral symptoms and periodontal disease diagnosis on self-perceived oral health. Subjective oral symptom factors that showed significant differences depending on self-perceived oral health included gingival bleeding or pain, dry mouth, and saliva viscosity, and depending on lifestyle factors included the frequency of tooth brushing and beverage consumption. Additionally, subjective oral symptoms influenced self-perceived oral health. Self-perceived oral health was negative when there was gingival bleeding, pain (odds ratio (OR)=0.594, p=0.002), and dry mouth (OR=0.577, p=0.001). This study's results showed that self-perceived oral health significantly impacts gingival bleeding, pain, and dry mouth. Therefore, government intervention must provide and manage innovative and efficient education programs that promote self-perceived oral health management habits and maintenance and improvement of oral health.

Self-perceived oral health in hemato-oncological patients and the relation to quality of life

PurposeTo assess the self-reported oral health and oral health-related quality of life of patients diagnosed with hemato-oncological disease.Patients and methodsData was collected through a digital questionnaire in collaboration with the Dutch patient organization Hematon. The questionnaires EORTC-QLQ-C30, EORTC-QLQ-OH15, shortened Xerostomia Inventory (XI), and the OHIP-14 were used.ResultsSeven hundred five patients were included (52.5% female, mean age 63.2 ± 10.1). The majority was diagnosed more than 2 years ago (86%) and had received treatment (81%) for their disease. Lymphoma, leukemia, and multiple myeloma were the most frequent malignancies. Chemotherapy alone, chemotherapy in combination with targeted therapy or immunotherapy, and myeloablative chemotherapy followed by autologous stem cell transplantation were the most common treatment modalities. The XI identified that 40.5% met the criteria for xerostomia. Other complaints included mouth soreness and sensitivity, gingival pain and bleeding, problems with teeth or with an ill-fitting denture. Despite reporting oral complaints, most patients experienced a rather good OH-QoL. A high xerostomia score led to a significantly lower OH-QoL. Female gender, history of stem cell transplantation, radiation to head and neck, and multiple daily medication use were significant predictors of xerostomia.ConclusionPatients with hematologic malignancies frequently reported a dry mouth and other oral complaints including mouth soreness and sensitivity, gingival pain and bleeding, and problems with teeth. Despite these oral complaints, most patients experienced a relatively good OH-QoL. Future longitudinal studies are needed, and health professionals should have an active role in providing oral supportive care based on patients’ individual needs.

The link between cutaneous allodynia and pain/sensitivity in teeth and gums during migraine episodes

BackgroundMigraine is one of the most common primary headaches worldwide, while toothache is the most common pain in the orofacial region. The association of migraine pain, and oral pain is unknown. This study aims to investigate the association between migraine and dental and gingival pain with the presence of allodynia.MethodsA questionnaire comprising demographic data with the ID-Migraine (IDM) tool, an Allodynia Symptom Checklist (ASC), and inquiries about pain and sensitivity in the teeth and gums during migraine attacks was administered to the participants and 762 responded the survey. The study classified participants based on the ASC, and the relationship between allodynia and pain/sensitivity in the teeth and/or gums during migraine attacks was analyzed. The statistical analyses utilized Chi-square tests and the Fisher-Exact test.ResultsAmong 762 migraine patients, 430 (56.44%) were classified as allodynia (+), while 332 (43.56%) were classified as allodynia (−) (p < 0.001). Additionally, 285 participants (37.5%) reported experiencing pain and sensitivity in the teeth and gums during migraine attacks, with a significant relationship observed between allodynia and pain/sensitivity in the teeth and/or gums during migraine attacks (p < 0.001).ConclusionThe findings of this study have important clinical implications. For migraine patients who are non-allodynic, the presence of pain and sensitivity in their teeth and gums during migraine attacks may indicate underlying dental diseases or the need for dental treatment especially root canal treatment. However, for allodynic patients, such symptoms may not necessarily indicate the presence of dental diseases or the need for dental treatment especially root canal treatment. These results underscore the significance of considering the presence of allodynia in the assessment and management of oral symptoms during migraine attacks.

Influence of vitamin D in orthodontic tooth movement-a systematic review and meta-analysis of randomized controlled trials in humans.

Orchestration of tooth movement necessitates an equilibrium of bone synthesis and resorption. Vitamin D, through receptor-mediated actions, regulates the differentiation and maturation of osteoblasts and also induces osteoclastogenesis, maintaining this equilibrium. To analyze the impact of vitamin D in orthodontic tooth movement (OTM). A comprehensive exploration of the existing literature was conducted by systematic search through seven e-databases. The criteria for inclusion were established using the PICO format: Orthodontic patients treated with fixed appliance (P), administered with vitamin D3 (I), collated with appropriate control groups (C), with tooth movement as the primary outcome and root resorption, anchorage loss, gingival crevicular fluid (GCF) volume, pain perception, and alveolar bone density as the secondary outcome (O). After an extensive database search, 251 articles were obtained. Six articles were chosen following a stringent selection using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The critical appraisal of randomized control trials (RCTs) involved the meticulous application of the RoB 2 tool. The quantitative synthesis incorporated a subset of six articles only. In the meta-analysis investigating the influence of vitamin D on OTM, a notable disparity was evident between the vitamin D and control groups. Specifically, the standardized mean difference (SMD) stood at 1.43, accompanied by a 95% confidence interval (CI) ranging from 0.691 to 2.169 (P = .00154). For root resorption, the SMD was recorded at -0.51, with a 95% CI spanning from -3.051 to 2.031 (P = .11). The rate of tooth movement was enhanced by systemic and local administration of vitamin D. However, the inadequacy of available data is a hindrance in determining conclusively the impact of vitamin D on the extent of root resorption. The resolution of this quandary needs future human studies devoted toward investigating the influence of vitamin D in the realms of OTM and associated root resorption, thereby providing a definitive elucidation. Prospero- CRD42023491783.

Clinical efficacy of a two-piece abutment conforming to the concept of one abutment one time in the posterior region: A clinical pilot study.

To assess the impact of a two-piece abutment workflow on enhancing the stability of the alveolar bone and gingiva surrounding the dental implant, and to determine the level of patient satisfaction. A total of 48 patients with dentition defect in the posterior region were included and divided into two groups: the two-piece abutment workflow (TAW) and the sealing screw with submerged healing workflow (SHW). Marginal bone level (MBL), soft tissue indicators, oral hygiene indicators, and patient satisfaction were assessed and recorded partially at 0, 3, 6, and 12 months after surgery. The primary outcome was the change of MBL in different time periods. A generalized linear mixed model (GLMM) was used to take into account the correlated nature of the data, and adjust for potential confounding factors within inter-group differences. The survival rate of implants and prosthesis reached 100% at 12-month follow-up, with an average decrease of 0.25 mm (SD 0.23 mm) of MBL in the TAW group and 0.48 mm (SD 0.45 mm) in the SHW group. The change of MBL in the TAW group (0.15 ± 0.31 mm) was significantly lower than the SHW group (0.41 ± 0.41 mm) through the analysis of GLMM within 6 months, while no significance was found in 12 months. Moreover, less gingival pain and oppression during prosthesis loading, and less time consumption overall duration were showed in the TAW group through Visual Analogue Scale (VAS, p < 0.05). Within a 6-month period, the two-piece abutment workflow showed superior efficacy in preserving the integrity of the marginal bone level. Furthermore, it streamlined treatment procedures and mitigated discomfort, hence increasing patient satisfaction.

Periodontal and microbiological data in patients with mucous membrane pemphigoid in a French population in 2021-2022: A pilot cross-sectional study.

In the case of mucous membrane pemphigoid with gingival expression (gMMP), the complete healing of the gingiva is generally not achieved despite medical treatment. Therefore, patients' oral comfort is impaired. The dysbiotic periodontal microbiota, generated by a lack of oral hygiene associated with persistent gingival pain, could the immunopathological mechanism to persist. The main objective of this study was to characterize the subgingival microbiota of the gMMP patients, and to highlight a potential link between this microbiological data and the clinical data. Subgingival biofilm was collected from 15 gMMP patients, medically treated or not, but not receiving periodontal treatment. The usual clinical periodontal parameters were recorded. The biofilm was analyzed by polymerase chain reaction quantitative. The risk factors of severe erosive gingivitis and severe periodontitis were assessed using Chi-square or Fischer's exact test were used. Whatever the medical and periodontal conditions of the patients, the results showed the existence of three main communities of periodontopathic, dysbiotic bacteria. The first including Tannnerella forsythia, Peptostreptococcus micros, Fusobacterium nucleatum, and Campylobacter rectus, was found in 100% of the patients, the second enriched with Treponema denticola in 60% and the third enriched with Porphyromonas gingivalis and Prevotella intermedia in 26%. Furthermore, there was a significant positive link between the duration of gMMP and the severity of erosive gingivitis (p = 0.009), and the loss of deep periodontal tissue (p = 0.04). This pilot study suggests a high periodontal risk in gMMP patients. The pathological processes, autoimmune on the one hand and plaque-induced on the other, may amplify each other. The application of periodontal therapy is therefore necessary in parallel with medical treatment. Nevertheless, further controlled studies are required to validate and complement these preliminary results.

Comparative evaluation of the effect of impregnated retraction cord versus laser on gingival attachment level and pain perception following retraction for subgingival margins - A prospective, split-mouth, controlled, clinical study.

To evaluate and compare the effect of impregnated retraction cord vs Laser on gingival attachment level and pain perception following retraction for subgingival margins. Many methods for achieving and measuring the amount of gingival retraction in fixed prosthodontic work have been advocated. Though the gingival attachment level is crucial in Periodontology, the literature available regarding the effect of these retraction methods on the same is scarce. Hence, this clinical study was designed to compare the pain perception and amount of gingival recession when impregnated cord and laser were used for retraction. In 40 subjects (age range of 20 to 40 years) with single missing maxillary incisor, the abutments were prepared with subgingival margins, to receive a full coverage metal-ceramic fixed dental prosthesis. The gingiva was retracted on one of the abutments with impregnated retraction cord and on the other with diode laser. Gingival attachment levels were compared at six sites per abutment using superimposition of digital scans, preoperative and four weeks after cementation of final prosthesis. Statistical analysis of the data for gingival recession was done using t-test. Pain perception was analysed with Chi-square test. Pain perception by patients following retraction was compared with VAS scale. The average values of gingival recession on buccal side were 0.61 mm and 0.38 mm and on the palatal side were 0.58 mm and 0.35 mm for impregnated retraction cord and laser respectively. The P values of <0.01 indicated a highly significant difference between the two groups. Intragroup comparison did not show significant differences between various sites. Pain and discomfort produced by cord method was moderate in comparison with mild/no pain with diode laser and the difference was highly significant.Conclusion: Retraction cord produced more gingival recession than the diode laser, which was statistically highly significant on both buccal and palatal aspects of the teeth. Patients experience with diode laser technique was less painful in comparison with retraction cord method.

Lifestyle Changes Caused by COVID-19 Pandemic Increase Oral Disease Symptoms.

The COVID-19 pandemic has led to severe restrictions on society worldwide, and social restrictions can lead to poor physical and oral health. This study investigated the association between oral disease symptoms and changes in lifestyle due to COVID-19. A multivariate logistic regression analysis was used to analyze data from the 2021 Korea Youth Risk Behavior Survey (N = 54 848). It showed that most households' economic conditions as "did not change at all" (adjusted odds ratio [aOR] = 1.00), "no change" (aOR = 1.10), "slightly worsened" (aOR = 1.21), and "very worsened" (aOR = 1.24). Information in a with "did not change at all" (aOR = 1.00), "no change" (aOR = 1.13), "slightly worsened" (aOR = 1.15), and "very worsened" (aOR = 1.18) economic conditions experienced heightened gingival pain and bleeding. In conclusion, the COVID-19 pandemic has caused a change in lifestyle and worsened socioeconomic status. In addition, as lifestyle changed and socioeconomic status declined, symptoms of deteriorating dental health emerged.

Clinical effect of equol supplementation in the treatment of desquamative gingivitis with 1-year follow-up.

Desquamative gingivitis (DG) is characterized by desquamative erosion, edematous erythema, and vesicle formation on the gingiva. Because of its prevalence in women during the pre- and postmenopausal period, its potential association with female hormones has been suggested. Equol is a soy isoflavone metabolite with a chemical structure similar to estrogen. Scientific evidence suggests that equol helps in alleviating menopausal symptoms. This study evaluated the clinical effect of a 12-month equol supplementation as a substitute for estrogen to alleviate DG symptoms. The study enrolled 16 women with DG who regularly visited Nihon University School of Dentistry Dental Hospital. Urinary equol levels, periodontal tissue examination, O'Leary's plaque control record, stimulated saliva flow rate, and gingival pain-related questionnaires were evaluated before and after the 12-month daily intake of 10 mg equol supplement. Equol supplementation led to a statistically significant improvement in bleeding on probing, visual findings, and reductions in the frequency and severity of gingival pain. Urinary equol testing and equol supplementation may be novel treatment options for female patients with DG.

Management of initial and surgical management of amlodipine-induced gingival enlargement with multifactorial etiology: a case report with 6 months follow-up

Drug-induced gingival enlargement can be seen as a side effect of systemically used drugs such as calcium channel blockers, anticonvulsants, and immunosuppressants. One of these drugs is amlodipine, a dihydropyridine derivative calcium channel blocker used in the treatment of high blood pressure and coronary artery disease. Amlodipine-induced gingival overgrowth is rarely seen compared to other calcium channel blockers. The aim of this case is to present the diagnosis of gingival overgrowth due to amlodipine use and the identification of other etiologic factors such as labial frenulum, phase 1 initial, and phase 2 surgical treatment approaches. A 56-year-old female patient presented to our clinic with severe gingival overgrowth, intense bleeding, difficulty feeding, and pain. The anamnesis revealed that she had hypertension and had been taking amlodipine derivative Norvasc 10 mg once a day for 8 years. A look inside the mouth showed that there was a lot of gum tissue growing over the crowns from the labial and palatal sides, mainly in the front of the maxilla. Phase 1 treatment was initiated. As a result of the consultation with the patient's cardiologist, the hypertension medication Norvasc 10 mg was replaced with Candexil 16 mg by the medical physician. The preoperative tension and blanch test was positive, and the labial frenulum was seen to mobilize the free gingival margin of the central teeth. After the same session of gingivoplasty, the labial frenulum was removed by a frenectomy operation. After the operation, antibiotics, analgesics, and mouthwash were prescribed. The patient stated that he did not have any problems after the operation. 6-month follow-up showed uneventful healing. No recurrence of gingival growth was found in the 1st, 3rd, and 6th month follow-ups. In conclusion, this case report shows that non-surgical periodontal treatment alone isn't always enough to treat drug-induced gingival overgrowths. The gingival shape should be changed so that the patient can properly clean their teeth, and drug-induced gingival overgrowths, like the one in this case, may have more than one cause and may need additional surgery like a labial frenectomy.

Reliability of early stage symptoms/clinical findings of osteonecrosis of the jaw: Japanese Osteoporosis Intervention Trial-05 (JOINT-05).

To investigate the differences in the incidence rates of suspected stage 0/1 osteonecrosis of the jaw (ONJ) and incidence risk of relevant clinical findings of suspected stage 0 ONJ between patients treated with sequential therapy comprising weekly teriparatide for 72weeks followed by alendronate for 48weeks vs. those who received monotherapy with alendronate for 120weeks. Suspected stage 0/1 ONJ was defined by non-specific symptoms. Tooth mobility and periodontal symptoms (gingival bleeding, swelling, and/or pain) were selected as clinical findings of suspected stage 0 ONJ. Poisson regression models were applied to calculate the incidence rate ratios of suspected stage 0/1 between the teriparatide group (TG) and alendronate group (AG). Generalized linear models were used to calculate the risk ratios of clinical findings between groups. Two hundred and sixty-one participants in the TG and 344 in the AG answered a structured questionnaire on oral health and were included in this study. There were no significant differences between the groups in the incidence rate of suspected stage 0/1 ONJ at both 72 and 120weeks. The risk ratio of the TG to AG for tooth mobility was 0.34 (95% confidence interval [CI] 0.13-0.88, p = 0.02) at 72weeks and 0.90 (95% CI 0.40-2.03, p = 0.83) at 120weeks. The incidence rate of tooth mobility related to periodontal symptoms decreased in the TG and increased in the AG during the study. Tooth mobility accompanied by clinical periodontal symptoms may be a useful early sign of stage 0 ONJ.

NECROTIZING ULCERATIVE GINGIVITIS AS A COMPLICATION OF FEBRILE NEUTROPENIA IN ACUTE MYELOID LEUKEMIA PATIENT

Background: Necrotizing ulcerative gingivitis (NUG) is a periodontal disease characterized by gingival pain, interdental gingival necrosis, and bleeding. NUG is closely related to immunosuppression, smoking, poor oral hygiene, malnutrition, and stress. Acute myeloid leukemia (AML) is a bone marrow malignant neoplasm. Chemotherapy as the treatment for AML often causes febrile neutropenia which results in immunosuppression conditions and is a risk factor for NUG. This case report aimed to discuss NUG as a complication of febrile neutropenia. Case: A 22-year-old woman was referred from hemato-oncology with acute myelomonocytic leukemia (AML-M4) and febrile neutropenia due to her oral complaints. She had undergone one cycle of chemotherapy and developed febrile neutropenia. Intra-oral showed ulcers covered with white-grayish plaques on the gingival region 35 to 45 and 15 to 25. There were white plaques that could be removed leaving an erythematous area on the dorsal tongue. Blood laboratory tests showed pancytopenia and severe neutropenia. The diagnoses were necrotizing ulcerative gingivitis and pseudomembranous candidiasis. Case management: Debridement using 1.5% hydrogen peroxide solution, rinsing with 0.2% chlorhexidine gluconate, as well as cleaning teeth and tongue 2 times daily. The internal medicine department gave meropenem. The lesions and gingiva were healed after three weeks of therapy. Conclusion: Febrile neutropenia due to chemotherapy reduces the body's ability to fight infection, oral homeostasis is disturbed therefore bacterial growth increases, neutrophils carry out phagocytosis forming reactive oxygen species which causing necrotic cells and then NUG occurred. Appropriate, adequate, and immediate therapy is needed to avoid further complications. Keywords: Acute myeloid leukemia, Febrile neutropenia, Necrotizing ulcerative gingivitis

Comparative evaluation of the efficacy of BlueM active oxygen gel and Coe-pak dressing on post-operative healing of gingival depigmentation: a study protocol

Introduction Dark colored gingiva is an esthetic concern that cannot be ignored, especially when accompanied by a high lip line or gummy smile. Gingival depigmentation is a periodontal plastic surgical procedure wherein the hyperpigmentation is removed or reduced by various techniques. Protecting the wound from mechanical trauma and stability of the surgical site during the healing process are among the most important advantages of periodontal dressing application after surgery. Aim This study is aimed to comparatively evaluate the effectiveness of reactive oxygen gel species (BlueM gel) and the traditional Coe-Pack dressing on gingival healing and pain after surgical depigmentation. Protocol This split-mouth randomized clinical trial will be conducted on 20 patients aged 18–45 years with maxillary physiologic gingival pigmentation classes (II) (III) and (IV) according to the Dummett–Gupta Oral Pigmentation Index (40 treated sites). The maxilla will be randomly divided into two symmetrical parts—from the right second premolar to the midline and from the midline to the left second premolar—to receive either BlueM gel or Coe- Pack as a dressing after surgical depigmentation with a scalpel. Various indices will be assessed, such as plaque index, papillary bleeding index, pain index, healing index and reepithelization index with toluidine blue, and the follow-up period will be one month. Expected results- A total of 20 patients will be included in this study. Statistically significant differences are expected to show in the pain index and healing index after one, two, three, four, and five days. The BlueM gel group is expected to show a higher significant difference after one, two, three and four weeks in the reepithelization index.

Evaluation of gingival health and pain level in orthodontics treatment with clear aligners: A systematic review and meta-analysis

Objectives: The aim of the study was to assess the proficiency of clear aligners (CAs), and to evaluate all aspects of this orthodontic procedure including bleeding on probing (BOP), plaque index (PI), gingival index (GI), and probing pocket depth (PD), which all are clinical parameters of gingival inflammation in addition to the pain score. Material and Methods: We performed an electronic search in the different databases such as Cochrane CENTRAL for eligible studies, SCOPUS, PubMed, and Web of Science. The quality of the involved trials has been measured according to Cochrane’s risk of bias tool. The following outcomes have been assumed: BOP, PI, GI, probing PD, and pain score. The homogeneous and heterogeneous data have been evaluated using random-effects model and fixed-effects model, consistently. Results: Ten clinical trials have been included in the study. The pooled analysis that The CAs has been associated with a significant decrease in the pain score (standardized mean difference = 0.74 [0.46, 1.02]), (P = 0.0001). No significant variations between post-treatment and pre-treatment group were found regarding plaque index (mean difference [MD] = −0.11 [−0.45, 0.22]), (P = 0.5), BOP (MD = 0.20 [−0.01, 0.41]), (P = 0.06), GI (MD = 0.17 [−0.06, 0.40]), (P = 0.15), and BOP (MD = 0.01 [−0.16, 0.17]), (P = 0.94). Conclusion: Patients treated by CAs showed a noticeable decrease in pain scores. On contrary, there was not any difference between the pre-treatment data and post-treatment data regarding other indices.

Effect of the coronavirus disease 2019 pandemic on oral health of Korean adolescents.

To investigate the effect of the coronavirus disease (COVID-19) pandemic on Korean adolescents' oral health and identify the influential factors. The raw data from The Korea Youth Risk Behaviour Web-based Survey before (2019) and after (2020) the outbreak of COVID-19 were used in the study. Demographic characteristics and subjective general, mental, and oral health were analysed and compared between the 2 years. Further, the impact of changes in subjective mental health and the duration of indoor activity on oral health were analysed. Data were analysed using IBM SPSS Statistics, and all statistical significance was set at α=0.05. The analysis was performed using the complex sample analysis module. In 2020, compared with 2019, the proportion of adolescents who rated high on subjective academic performance, smoking, and drinking decreased (p < 0.001). However, there was no difference in the household economic status between 2020 and 2019 (p=0.917), while subjective mental health improved. In addition, the risk of tooth fracture was 1.321 times higher after the pandemic. After the outbreak of COVID-19, adolescents who were indoors for >24 h for non-learning activities on weekends were 2.97 times more likely to have reported gingival pain and bleeding (p < 0.05). After the outbreak of COVID-19, smoking and drinking decreased in Korean adolescents, while changes occurred in their learning patterns at home, and their mental health improved. Some oral symptoms increased or showed no change.

Oral symptoms of patients tested positive for COVID-19 with mild severity- a cross-sectional study

BACKGROUND: The pandemic of Coronavirus disease (COVID-19) has a major effect on the world. It has several signs and symptoms and the cause of some oral lesions may be related to this virus.OBJECTIVES: The aim of the study is to determine the proportion, and evaluate the different oral symptoms and their time of presentation in patients with mild COVID -19 infectionMATERIALS AND METHODS: The present study included 55 participants (40%) females and (60%) males, with an average age of 38.52 ± 10.46 years. RESULTS: About 80% (43 patients) had oral symptoms such as Xerostomia, Recurrent Herpes simples, aphthous stomatitis, gingival pain, or other symptoms.Conclusion: COVID-19 has been shown to have some effects on the mouth because a large proportion of COVID-19 patients had oral symptoms.CLINICAL SIGNIFICANCE: This research showed a high percentage of COVID-19 patients experienced dry mouth, after that the most likely lesions were Herpes; also, other lesions may occur. In addition, dentists should be conscious of oral manifestation, particularly during the Coronavirus pandemic.

A retrospective analysis of the complications associated with miniscrew-assisted rapid palatal expansion

Miniscrew-assisted rapid palatal expansion (MARPE) has recently been advocated as a treatment option for older adolescents and adult patients with maxillary transverse deficiencies. This study aimed to identify the complications associated with MARPE and the frequency of their occurrences. A retrospective analysis was conducted on 256 patients (mean age, 18.8 ± 8.6; 126 females and 130 males) who underwent MARPE at a private practice and a graduate orthodontic clinic. Specific complications and their severity were identified by reviewing clinical notes and photographs. Asymmetric expansion was measured for patients who had cone-beam computed tomography scans taken before MARPE and immediately after expansion. The midpalatal suture was separated in 87.8% of patients. The most common complication was gingival inflammation around the appliance, found in 83.9% of patients. 45% of patients reported some form of pain during and after expansion. Appliance breakage occurred in 10% of patients. 47.8% of patients showed >1 mm of asymmetric expansion. Rare complications included tooth discoloration (potentially indicative of tooth vitality loss), temporary hearing loss, numbness, swelling, severe gag reflex, and sinus infection. The most common complication was gingival inflammation followed by pain; major and long-term complications were rare with MARPE. Overall, patients should be informed that gingival inflammation and pain are common side effects of MARPE and that rare complications can occur. Although asymmetric expansion was common after the palatal split, most patients were managed with orthodontic treatment.

NECROTIZING ULCERATIVE GINGIVITIS LEADING TO SEPSIS IN ONCOLOGICAL PATIENT: A CASE REPORT FOCUSED ON ORAL DIAGNOSIS

Synovial sarcoma is a malignant soft tissue tumor occurring mostly in young adults that is treated with surgery, chemotherapy, and/or radiotherapy. The objective is to report a case of necrotizing ulcerative gingivitis (NUG) as a focus of sepsis in a patient with synovial sarcoma undergoing chemotherapy. A 26-year-old male patient with synovial sarcoma was admitted to the emergency room reporting gingival pain and swelling. Clinical examination showed erythematous and purplish lesions in the gingiva, necrotic tissue and pseudomembranes in the papillae, and purulent exudate, resulting in a diagnosis of NUG. It was necessary to transfer the patient to intensive care unit due to sepsis from the dental focus and febrile neutropenia. Treatment involved antibiotic therapy, improvement of oral hygiene, and photobiomodulation with a low-level laser. We highlight the importance of hospital dentistry in the multidisciplinary team for individual patient care leading to a specific dental diagnosis and prompt treatment. Synovial sarcoma is a malignant soft tissue tumor occurring mostly in young adults that is treated with surgery, chemotherapy, and/or radiotherapy. The objective is to report a case of necrotizing ulcerative gingivitis (NUG) as a focus of sepsis in a patient with synovial sarcoma undergoing chemotherapy. A 26-year-old male patient with synovial sarcoma was admitted to the emergency room reporting gingival pain and swelling. Clinical examination showed erythematous and purplish lesions in the gingiva, necrotic tissue and pseudomembranes in the papillae, and purulent exudate, resulting in a diagnosis of NUG. It was necessary to transfer the patient to intensive care unit due to sepsis from the dental focus and febrile neutropenia. Treatment involved antibiotic therapy, improvement of oral hygiene, and photobiomodulation with a low-level laser. We highlight the importance of hospital dentistry in the multidisciplinary team for individual patient care leading to a specific dental diagnosis and prompt treatment.

Dentists Knowledge about Association of Systemic Health with Periodontal Disease

Purpose: This study designed to evaluate the necessity for interdisciplinary dental and medical education by assessing clinicians' awareness of the relation between systemic health and periodontal disease. Study design: A Cross-sectional and Descriptive study. Place and Duration: In the Dental department of Hamdard University Dental Hospital, Karachi for six-months duration from July 2021 to December 2021. Methods: A sample of 200 dentists and physicians was designated using convenient technique of sampling. A self- validated and pre-validated questionnaire consisting of questions about the knowledge of the relationship between systemic health and periodontal disease among dentist was used. Data was analyzed using SPSS 24.0. Results: While 184 out of 200 dentists agreed that there was a link between periodontal disease and systemic health, 16 disagreed. Most (194) participants were aware of the periodontal disease and its associated signs and symptoms, and (6) were unaware of these symptoms. While most dentists (172) considered bleeding from the gingiva to be the major symptom clinically of periodontal disease, 102 dentists reported gingival pain as the primary symptom. In addition, most dentists (185) have stated that they have awareness about the relation between periodontal disease and diabetes, while 172 dentists have stated that cardiovascular disease and obesity are associated with periodontal disease Conclusion: The information on the association between systemic health with periodontal disease among practitioners was satisfactory. Keywords: Diabetes, cardiovascular diseases, obesity, gingival bleeding, systemic health and periodontal disease

Comparative study of the effect of BlueM active oxygen gel and coe-pack dressing on postoperative surgical depigmentation healing

IntroductionBlack colored gingiva is an esthetic concern, especially when accompanied by a high lip line or gummy smile.Surgical depigmentation with a scalpel is still considered the golden standard in gingival pigmentation management although it causes an area of open wound, which needs a special management with dressing.This study aimed to comparatively evaluate the effectiveness of reactive oxygen gel species (BlueM gel) and the traditional Coe-Pack dressing on gingival healing and pain after surgical depigmentation. Materials and MethodsThis split-mouth randomized clinical trial was conducted on 20 nonsmoking individuals aged 20–38 years with maxillary physiologic gingival pigmentation classes (III) and (IV) according to the Dummett–Gupta Oral Pigmentation Index (40 treated sites) who had requested an esthetic treatment for gingival hyperpigmentation of the maxillary gingiva.The maxilla was randomly divided into two symmetrical parts—from the right second premolar to the midline and from the midline to the left second premolar—to receive either BlueM gel or Coe-Pack as a dressing after surgical depigmentation with a scalpel. Various indices were assessed, such as pain and reepithelization index with toluidine blue, and the follow-up period was 1 month. ResultsA total of 20 patients were included in this study. There were statistically significant differences in the pain index after 1, 2, 3, 4, and 5 days. The BlueM gel group showed a higher significant difference after 1, 2, and 3 weeks in the reepithelization index. ConclusionHence, BlueM gel can be considered as a good alternative for the Coe-Pack dressing after gingival depigmentation owing to its pain reduction properties, acceleration of wound healing, and postoperative reepithelization.