DOCSLIB.ORG

Gingival Enlargement

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Gingival Enlargement CLINICAL PRACTICE DIAGNOSTIC CHALLENGE Gingival enlargement Gregory A. Pette, DMD, MS; Michael A. Siegel, DDS, MS, FDS RCSEd; William B. Parker, DDS THE CHALLENGE scribed valproic acid. Approximately eight A 29-year-old woman visited the postgraduate months after the patient ceased taking pheny- periodontics clinic at the College of Dental Medi- toin, she visited the postgraduate periodontal cine, Nova Southeastern University, Fort clinic. The patient’s oral hygiene was poor and Lauderdale-Davie, Fla., for a consultation in June she had received no professional prophylaxis or 2009 because she was experiencing gingival deep scaling since her last dental appointment enlargement. The periodontist (G.A.P.) elicited a five years earlier. history of grand mal epilepsy. The onset of the Initial therapy consisted of deep scaling and epilepsy occurred at the time of puberty. The root planing in four quadrants followed by the patient reported having no other medical condi- at-home use of chlorhexidine gluconate 0.12 per- tions. She indicated that she had four to five grand cent for a two-week period. The periodontist re- mal seizures per year coincident with her men- evaluated her condition six weeks later (Figure strual cycle. She also reported that her seizures 2). Excessive fibrotic gingival tissue remained, were preceded by auras. She had been under the with mild to moderate pseudopocketing and care of a neurologist since the onset of her moderate to severe loss of attachment. The epilepsy. The neurologist had prescribed a regimen periodontist performed guided tissue regenera- of phenytoin to treat the patient’s seizures. tion with a recombinant platelet-derived growth Before the patient sought care at the postgrad- factor and beta tricalcium phosphate in the uate periodontics clinic, a general dentist in pri- maxillary right and left posterior sextants, then vate practice, who was a family friend, noted the performed open flap curettage with apically gingival enlargement approximately five years positioned flaps at all other sites. All perio- after the onset of the seizures and encouraged the dontal surgery took place with the patient patient’s private-practice neurologist of record to under enteral sedation with lorazepam (2 mil- perform an oral examination (Figure 1). The ligrams by mouth). During periodontal surgery, patient had not seen a dentist during this five-year the periodontist removed excess gingival tissue period, so the periodontist (G.A.P.) could not ascer- and subsequently sent it for microscopic evalu- tain whether the gingival en largement predated ation and interpretation (Figure 3). As of this the onset of the seizure disorder. The neurologist writing, the patient is undergoing orthodontic discontinued the phenytoin treatment, because it therapy while she remains on a three-month is known to cause gingival enlargement, and pre- periodontal maintenance schedule (Figure 4). Figure 1. Initial presentation, Figure 2. Presentation after Figure 3. Photomicrograph Figure 4. Presentation after showing marked inflammation initial periodontal therapy, showing marked increase in surgical therapy. There is an and displacement of teeth. showing significant improve- collagen fibers with a mixed absence of inflammation and a ment in gingival color and inflammatory infiltration, acan- marked improvement in the architecture. thosis and elongated rete pegs gingival architecture. (hematoxylin-eosin, original magnification ×5). Can you make the diagnosis? A. Drug-influenced gingival enlargement C. Leukemic infiltration B. Hereditary gingival enlargement D. Tuberculosis © 2011 American Dental Association. Republished by Medical Online Publication SAL with permission of American JADA 142(11) http://jada.ada.org November 2011 1265 Dental Association. All rights reserved. JADA 2011, Volume 142, No 11, Page 1265-1268 JADA Middle East vol 3 No 1 Jan-Feb 2012 55 CLINICAL PRACTICE DIAGNOSTIC CHALLENGE THE DIAGNOSIS A. drug-influenced gingival enlargement “Drug-influenced gingival enlargement” and increased number of fibroblasts histologically.8,19 “drug-induced gingival overgrowth” are the pre- These findings indicate that, at a molecular ferred terms for what previously was referred to level, one etiologic factor of drug-induced gin- as “gingival hyperplasia,” “gingival hypertrophy,” gival enlargement may be the inhibition of col- “gingival fibromatosis” and “elephantiasis gin- lagen phagocytosis by means of reducing the 6 givae.” The medications commonly associated expression of α2 β1 integrins. Research suggests with drug-influenced gingival enlargement that integrins transduce information from the include antihypertensive agents such as the cal- extracellular matrix to the inside of the cell by cium channel blockers (including nifedipine, dilti- triggering intracellular signaling pathways.6 azem and verapamil, as well as antiseizure med- Antiepileptic, immunosuppressant, antidepres- ications such as phenytoin, sodium valproate, sant and calcium channel blocker drugs are valproic acid, phenobarbital and primidone.1-13 known to act as calcium antagonists. Intracel- Immunosuppressants such as cyclosporin A also lular calcium plays a role in the regulation of are implicated in gingival enlargement. While α2 β1 integrin-mediated collagen phagocytosis by some spontaneous resolution has been associated altering integrin affinity. Furthermore, the with discontinuing the use of certain medications actin-binding protein gelsolin is considered an such as nifedipine, this generally is not the rule.13 important factor in gingival enlargement. Gel- At this patient’s initial visit to the neurologist, solin contributes to the maintenance of normal she was receiving only phenytoin treatment. tissue integrity by regulating collagen phagocy- Therefore, her history supports a diagnosis of tosis through its integrin-binding affinity to phenytoin-influenced gingival enlargement. How- collagens.6 ever, because the gingival enlargement did not Treatment. Risk factors associated with appear to improve after the elimination of the phenytoin-induced gingival enlargement may phenytoin, one also must consider sodium val- have a synergistic effect, and bacterial plaque proate as a cause of the drug-influenced gingival appears to be the most important determinant enlargement.14 of severe phenytoin-influenced gingival enlarge- The information in the patient’s medical, ment.9 Still, to date, the most effective long- dental and drug histories and the clinical presen- term treatment for gingival enlargement is drug tation usually are sufficient to attain a diagnosis withdrawal.5 In addition to discontinuation of of drug-influenced gingival enlargement; there- drug treatment, periodontal therapy often is fore, a biopsy is not necessarily mandated. How- recommended in conjunction with oral hygiene ever, to demonstrate such a diagnosis more defin- instructions. Dannewitz and colleagues20 itively, a biopsy procedure certainly is preferred. showed that in patients who were receiving cal- The clinician must consider a biopsy if there are cium channel blockers, nonsurgical therapy for signs and symptoms that suggest a serious gingival enlargement consisting of full-mouth underlying etiology such as leukemia or tubercu- gross debridement, scaling and root planing and losis. The typical features of drug-influenced gin- short-term (two weeks’) use of 0.12 percent gival overgrowth include an increase in collagen chlorhexidine gluconate mouthrinse resulted fibers, inflammatory infiltration, acanthosis and in only 6 percent of teeth’s requiring surgical elongated rete pegs.14,15 intervention. The prevalence of gingival enlargement in healthy populations has been estimated to be DIFFERENTIAL DIAGNOSIS between 4.0 and 7.5 percent.10,12 Prevalence has Hereditary gingival enlargement. Patients been known to vary from 10 to 50 percent in with hereditary gingival enlargement exhibit populations of patients receiving phenytoin clinical signs identical to those of the patient therapy.7,11,16,17 Although the pharmaceutical described here. This diagnosis can be excluded effect and primary target tissues of antiepileptic, by questioning the patient about whether his or immunosuppressant, antidepressant and cal- her family members have similar gingival cium channel blocker medications are different, enlargement. As an isolated abnormality, gin- they act similarly on gingival connective tissue, gival enlargement is inherited as an autosomal causing fibrous gingival enlargement.18 In cases dominant trait or, rarely, as an autosomal reces- involving gingival enlargement, gingival connec- sive trait.21,22 Gingival enlargement may arise tive tissue does not necessarily exhibit an owing to a spontaneous gene mutation, so a neg- 56 JADA Middle East vol 3 No 1 Jan-Feb 2012 CLINICAL PRACTICE DIAGNOSTIC CHALLENGE ative family history alone cannot dismiss appropriate diagnostic testing such as blood hereditary gingival enlargement from the differ- testing or biopsy must be considered. Patients ential diagnosis completely. Gingival enlarge- with gingival enlargement should undergo ment has been associated rarely with a number appropriate laboratory testing to ensure that of syndromes such as inclusion-cell disease any underlying disorders are diagnosed and (mucolipidosis II), acanthosis nigricans, Borrone treated at the earliest possible time. ■ di Rocco Crovato syndrome, Cantu syndrome 21 When this article was written, Dr. Pette was a second-year resi- and Winchester syndrome. In this patient, dent
Load more

Recommended publications
  • Phenytoin-Induced Gingival Overgrowth Management
    Brazilian Dental Journal (2015) 26(1): 39-43 ISSN 0103-6440 http://dx.doi.org/10.1590/0103-6440201300029 Department of Dentistry, UFRN - Phenytoin-Induced Gingival Federal University of Rio Grande Overgrowth Management do Norte, Natal, RN, Brazil Correspondence: Dr. Bruno César with Periodontal Treatment de Vasconcelos Gurgel, Avenida Senador Salgado Filho, 1787, Lagoa Nova, 59056-000 Natal, RN, Brasil. Tel.: +55-84-3215-4103. e-mail: [email protected] Bruno César de Vasconcelos Gurgel, Carlos Roberto Batista de Morais, Pedro Carlos da Rocha-Neto, Euler Maciel Dantas, Leão Pereira Pinto, Antonio de Lisboa Lopes Costa Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed Key words: phenytoin, gingival and the patient is currently under follow-up for 4 years.
    [Show full text]
  • Controlling the Intraoral Environment Before and After Implant Therapy a Peer-Reviewed Publication Written by Richard Nejat, DDS; Daniel Nejat, DDS; and Fiona M
    Earn 4 CE credits This course was written for dentists, dental hygienists, and assistants. Controlling the Intraoral Environment Before and After Implant Therapy A Peer-Reviewed Publication Written by Richard Nejat, DDS; Daniel Nejat, DDS; and Fiona M. Collins, BDS, MBA, MA PennWell is an ADA CERP Recognized Provider Go Green, Go Online to take your course This course has been made possible through an unrestricted educational grant. The cost of this CE course is $59.00 for 4 CE credits. Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing. Educational Objectives smoking and drinking. The association between systemic Upon completion of this course, the clinician will be able to disease and periodontal health is well established, and the do the following: relationship between periodontal health and peri-implant 1. Understand the process of patient selection and the health is well established. For short- and long-term success systemic considerations that affect candidacy for of implants, patients must be willing and able to perform implant treatment effective oral hygiene measures to control the intraoral 2. List the adverse implant outcomes due to biological/ microbial environment. microbiological factors and mechanical factors 3. Control the intraoral environment during all three Patient Selection phases of implant treatment—presurgical, postsurgical, Patient selection during implant treatment planning involves and maintenance many considerations. In addition to the intraoral environ- 4. Understand the precautions to be taken when using ment, the patient’s general health status and smoking habits instruments around implants and the potential damage are highly relevant.
    [Show full text]
  • Comparative Evaluation of Two Different One-Stage Full-Mouth
    ORIGINAL RESEARCH Comparative Evaluation of Two Different One-stage Full-mouth Disinfection Protocols using BANA Assay: A Randomized Clinical Study Arjumand Farooqui1, Vineet V Kini2, Ashvini M Padhye3 ABSTRACT Aim: The aim of this study was to evaluate and compare two different one-stage full-mouth disinfection protocols in the treatment of chronic periodontitis by assessing dental plaque and tongue coat using BANA assay. Materials and methods: The present study was a prospective randomized clinical parallel arm study design including 40 healthy subjects randomly allocated into two groups, i.e., group A (Quirynen’s protocol of one-stage full-mouth disinfection) and group B (Bollen’s protocol of one-stage full-mouth disinfection). Subjects were assessed at baseline and six weeks using plaque index, gingival index, and sulcus bleeding index. Probing depth and relative clinical attachment level were also recorded at six weeks. Winkel tongue coat index and BANA were recorded at 8 weeks using subgingival plaque and tongue coat sample. Results: Both group A and group B demonstrated statistically significant reduction in plaque index, gingival index, sulcus bleeding index, Winkel tongue coat index, reduction in probing depth, and gain in relative clinical attachment level on intragroup comparison. There was no significant difference in BANA assay score of subgingival plaque and tongue coat samples in between group A and group B. Conclusion: From the findings of this study, both Quirynen’s protocol and Bollen’s protocol of one-stage full-mouth disinfection are effective in plaque reduction and tongue coat reduction and achieve comparable clinical healing outcomes. Clinical significance: The difference in duration and mode of use of chlorhexidine as a chemical plaque control agent in the two treatment interventions of Quirynen’s and Bollen’s protocol of one-stage full-mouth disinfection did not demonstrate statistical significance in reducing sulcus bleeding index scores, reducing probing depths, and gain in relative clinical attachment levels.
    [Show full text]
  • One-Stage, Full-Mouth Disinfection: Fiction Or Reality?
    FOCUS ARTICLE One-Stage, Full-Mouth Disinfection: Fiction or Reality? Marc Quirynen, Wim Teughels, Martine Pauwels, Daniel van Steenberghe Recent research indicated that periopathogens colonize, besides the pockets, also other niches within the oral cavity including: the soft tissues, the saliva, the tongue, and even the tonsils. Since the supragingival plaque and the bacteria in these niches have a major impact on the subgin- gival plaque colonisation but especially on the recolonation after debridement, it seems reason- able to expect that a one-stage, full-mouth disinfection protocol, involving the bacteria over the entire oro-pharyngeal area, has a significantly better outcome when compared to a more staged approach (e.g. with treatments per quadrant). Since several review papers recently discussed the benefits of a one-stage, full-mouth disinfection protocol, pointing to some shortcomings in the our research protocol or with an attempt to compare the data of the new approach with other studies (with unfortunately non comparable approaches), this review paper aims to clarify some of the confusion concerning the benefits of a one-stage, full-mouth disinfection approach. Key words: periodontal breakdown; periodontopathogens; mouth disinfection INTRODUCTION logy, 1996; Slots and Rams, 1991; Socransky and Haffajee, 1992; Wolff et al, 1994). The ef- Periodontal breakdown primarily develops when ficiency of the host defence is partially hereditary the microbial load within a periodontal pocket (Kinane and Hart, 2003) but environmental fac- overrules the local and systemic host defence tors such as bad oral hygiene, smoking, immuno- mechanisms. Such an imbalance occurs in differ- suppressive medication, stress and so on can fur- ent situations, including an aspecific increase in ther impair the immune defence mechanism.
    [Show full text]
  • P Age
    ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at: www.ijdsir.com Volume – 2, Issue – 6, November - December - 2019, Page No. : 510 - 517 Effects of full mouth disinfection procedure and doxycycline on the HbA1c levels among patients of moderate chronic periodontitis with type II diabetes mellitus: A randomised controlled clinical trial. Gaurav Bakutra, Assistant Professor, Department of Periodontics & Implantology, Manubhai Patel Dental College & Hospital,Vadodara, Gujarat, India. Grishma Patel, Ex Lecturer, Department of Periodontics & Implantology, Manubhai Patel Dental College & Hospital, Vadodara, Gujarat, India. Sarath Chandran, Professor & HOD, Department of Periodontics & Implantology, Manubhai Patel Dental College & Hospital, Vadodara, Gujarat, India. Shivlal Vishnoi, Associate Professor, Department of Periodontics & Implantology, Manubhai Patel Dental College & Hospital, Vadodara, Gujarat, India. Priyadarshini Nadig, Associate Professor, Department of Periodontics & Implantology, Manubhai Patel Dental College & Hospital, Vadodara, Gujarat, India. Ruchi Raval, Assistant Professor, Department of Periodontics & Implantology, Manubhai Patel Dental College & Hospital, Vadodara, Gujarat, India. Corresponding Author: Gaurav Bakutra, Assistant Professor, Department of Periodontics & Implantology, Manubhai Patel Dental College & Hospital,Vadodara, Gujarat, India. Type of Publication: Original
    [Show full text]
  • Efficacy of Alternative Or Adjunctive Measures to Conventional Treatment of Peri-Implant Mucositis and Peri-Implantitis
    Schwarz et al. International Journal of Implant Dentistry (2015) 1:22 DOI 10.1186/s40729-015-0023-1 REVIEW Open Access Efficacy of alternative or adjunctive measures to conventional treatment of peri-implant mucositis and peri-implantitis: a systematic review and meta-analysis Frank Schwarz*, Andrea Schmucker and Jürgen Becker Abstract In patients with peri-implant mucositis and peri-implantitis, what is the efficacy of nonsurgical (i.e. referring to peri-implant mucositis and peri-implantitis) and surgical (i.e. referring to peri-implantitis) treatments with alternative or adjunctive measures on changing signs of inflammation compared with conventional nonsurgical (i.e. mechanical/ultrasonic debridement) and surgical (i.e. open flap debridement) treatments alone? After electronic database and hand search, a total of 40 publications (reporting on 32 studies) were finally considered for the qualitative and quantitative assessment. The weighted mean changes (WM)/ and WM differences (WMD) were estimated for bleeding on probing scores (BOP) and probing pocket depths (PD) (random effect model). Peri-implant mucositis: WMD in BOP and PD reductions amounted to −8.16 % [SE = 4.61] and −0.15 mm [SE = 0.13], not favouring adjunctive antiseptics/antibiotics (local and systemic) over control measures (p > 0.05). Peri-implantitis (nonsurgical): WMD in BOP scores amounted to −23.12 % [SE = 4.81] and −16.53 % [SE = 4.41], favouring alternative measures (glycine powder air polishing, Er:YAG laser) for plaque removal and adjunctive local antibiotics over control measures (p < 0.001), respectively. Peri-implantitis (surgical): WMD in BOP and PD reductions did not favour alternative over control measures for surface decontamination.
    [Show full text]
  • A Case Series on Gingival Enlargement
    Acta Scientific Dental Sciences (ISSN: 2581-4893) Volume 2 Issue 9 September 2018 Case Report The Problem of Excess: A Case Series on Gingival Enlargement Deshpande Abhinav*, Mala Dixit Baburaj, Pimpale Sandeep and Tambe Lashika Department of Periodontics, Nair Hospital Dental College, Maharashtra University of Health Sciences, India *Corresponding Author: Deshpande Abhinav, Department of Periodontics, Nair Hospital Dental College, Maharashtra University of Health Sciences, India. E-mail: [email protected] Received: July 30, 2018; Published: August 24, 2018 Abstract Background: Inflammatory gingival enlargement represents an abnormal overgrowth of gingiva in response to local irritants. The overzealous reaction to irritants manifests in inflammation and enlargement of gingiva causing functional disturbances and hinder oralMethods hygiene: The maintenance. treatment strategy This case depends series reportsupon tissue 3 different changes. ways It involves of management a Non-surgical of inflammatory and surgical gingival approach. enlargement. Non-surgical ther- apy involving scaling and root planing aims to remove local irritants and reverse the inflammatory changes. Splinting of mobile teeth gingivectomy (External bevel or Internal bevel Gingivectomy) helps in restoring the gingival contours. helps in stabilizing dentition and providing optimum conditions for healing. When there is no significant reduction of enlargement, Results: Periodontal therapy aims to restore the health and function of the dentition. The systematic treatment approach resulted in uneventful healing and stable results which are easily maintained by the patients. Conclusion: As Periodontal therapy is diagnosis- driven, thorough periodontal assessment helps in development of a rational treat- ment plan. This should include modification of risk factors which potentiates progression of plaque induced periodontal disease.
    [Show full text]
  • Traumatic Injury to Primary Teeth Is
    Primary Tooth Trauma Leads to Developmental Disturbance of Permanent Dentition Traumatic Intrusion of Primary Teeth and Its Effects on the Permanent Successors: A Clinical Follow-Up Study. Altun C, Cehreli ZC, et al: Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107 (April): 493-498 Approximately 50% of the developing permanent teeth can be expected to have developmental pathology after corresponding primary tooth trauma/intrusion. Background: Traumatic injury to primary teeth is a very common phenomenon as kids are often involved in facial trauma, and because the central incisors hold a prominent position in the facial profile. The standard of treatment is to extract the teeth if severely mobile or to leave them if stable. Of interest is the effect of the injury to the developing permanent dentition. These effects can range from hypoplasia, crown dilaceration, root angulation, sequestration of the permanent tooth germ, and disturbances in eruption. Objective: To evaluate the effect of trauma to primary teeth on the developing permanent dentition, and to specifically see if the type of injury to the permanent dentition is correlated to the age at which injury occurred. Design/Participants: This prospective study took place over a 7-year period; 78 patients had a total of 138 affected teeth. Methods: The patient demographics, type of injury, and type of post-traumatic sequela were recorded. Patients were followed with clinical examinations and radiographs until complete eruption of the permanent incisors. At the end of follow-up, developmental disturbances were recorded. These included enamel hypoplasia, hypocalcification, hypoplasia, discoloration, tooth malformation, and ectopic eruption pattern.
    [Show full text]
  • Specialist Dental Perio Quadfold
    Treatment Please visit our website www.specialistdental.co.uk for further details about periodontal treatment We will be able to discuss your treatment options with you at your consultation. Our Opening Hours: Stabilisation The Full Mouth Disinfection - This is a technique where all the 9:00am to 5:00pm Monday, Tuesday, Thursday & Friday teeth are root planed (removal of plaque and calculus on the root 9.30am to 5.30pm Wednesday surface) in one day. In effect your mouth is completely disinfected, there is no chance of re-infection of the clean sites Closed on Sundays and Bank Holidays with bacteria from the diseased sites. Often, you will be asked to take a course of oral antibiotics. The antibiotics enhance the About Specialist Dental disinfecting process and effectively reduce disease activity in very deep pockets and may help with the body’s healing process. Usually the treatment is divided into two sessions in one day; one We are a multi-disciplinary specialist dental practice in in the morning and the other in the afternoon and each side of Guildford. All specialist dentists are registered specialists in their the mouth is treated in turn. You are given a local anaesthetic so fields with the dental governing body (GDC), who have had that you feel comfortable. formal post-graduate training, education and continuous professional development. They regularly attend conferences The full mouth disinfection is an effective way of reducing disease nationally and internationally in their specialist fields to deliver activity around your mouth. It prevents multiple visits and has the best possible treatments.
    [Show full text]
  • Evaluation of a Decontamination Protocol Prior to a Full-Mouth Disinfection Procedure: a Randomised Clinical Study
    Vol. 6(7), pp. 77-84, November 2014 DOI: 10.5897/JDOH2014.0126 Article Number: 966EA8648352 ISSN 2006-9871 Journal of Dentistry and Copyright © 2014 Oral Hygiene Author(s) retain the copyright of this article http://www.academicjournals.org/JDOH Full Length Research Paper Evaluation of a decontamination protocol prior to a full-mouth disinfection procedure: A randomised clinical study Anna Maria Genovesi, Simone Marconcini*, Massimiliano Ricci, Olivia Marchisio, Francesca Covani and Ugo Covani Tuscan Stomatologic Institute, Department of Dentistry, Versilia General Hospital, 335 Via Aurelia, Lido di Camaiore (LU), Italy. Received 21 July, 2014; Accepted 15 October, 2014 The objective of this study was to test the hypothesis that the application of a chlorhexidine-based decontamination protocol during two weeks prior to scaling root planing (SRP) would reduce bleeding on probing (BoP) at the time of SRP. Secondary outcomes were other clinical parameters. Another secondary aim was to assess whether the improvement of periodontal conditions, if any, would have a benefit up to 3 months later. In this mono-centre, parallel, single blind, randomised, controlled clinical study, thirty subjects affected by chronic periodontitis were randomly allocated 1:1 to either a control group (n=15, individuals subjected to a standard one-stage full-mouth disinfection procedure fifteen days after inclusion), or a test group (n=15, individuals had to apply a decontamination protocol consisting of tongue brushing and mouth rinsing with chlorhexidine-based products during the fifteen days intervening between inclusion and SRP. BoP, probing depth (PD), plaque index (Pl.I) and clinical attachment loss (CAL) were measured at the inclusion and at tSRP=baseline, when individuals were subjected to SRP, and after 30 and 90 days.
    [Show full text]
  • The International Journal of Periodontics & Restorative Dentistry
    The International Journal of Periodontics & Restorative Dentistry © 2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. 63 Full-Mouth Disinfection as a Nonsurgical Treatment Approach for Drug-Induced Gingival Overgrowth: A Series of 11 Cases Bettina Dannewitz, Priv Doz, Dr Med Dent1 Severe forms of gingival overgrowth Jörg Kristian Krieger, Dr Med Dent2 (GO) develop predominantly through Isabel Simon, Dr Med Dent2 use of systemic medication. Drugs 3 Jens Dreyhaupt, Dr Rer Nat, Dipl-Math associated with GO can be broadly 4 Hans Jörg Staehle, Prof Dr Med, Dr Med Dent divided into three categories: anti- Peter Eickholz, Prof Dr Med Dent5 convulsants, calcium channel blockers, and immunosuppressants.1,2 The The treatment of drug-induced gingival overgrowth is compounded by the high prevalence of drug-induced GO varies recurrence rate resulting from chronic use of the medication and the persistence among medications, and a variety of of other risk factors. In this case series, the treatment outcome of a nonsurgical risk factors have been identified and periodontal therapy, according to the concept of full-mouth disinfection in 11 reviewed recently, including age and patients with drug-induced gingival overgrowth, is described. All clinical parame- sex of the patient, drug variables, con- ters improved significantly after therapy. Only 6% of teeth received further surgical treatment. The clinical situation remained stable during the recall. The present comitant medication, genetic factors, case series suggests that full-mouth disinfection might be a beneficial treatment and the inflammatory status of the peri- 2,3 concept for drug-induced gingival overgrowth, reducing the need for further sur- odontal tissues.
    [Show full text]
  • Effect of Non-Surgical Periodontal Treatment by Full-Mouth Disinfection Or Scaling and Root Planing Per Quadrant in Halitosis—A Randomized Controlled Clinical Trial
    Clin Oral Invest DOI 10.1007/s00784-016-1959-0 ORIGINAL ARTICLE Effect of non-surgical periodontal treatment by full-mouth disinfection or scaling and root planing per quadrant in halitosis—a randomized controlled clinical trial Juliana Oliveira Silveira1 & Fernando Oliveira Costa1,4 & Peterson Antônio Dutra Oliveira2 & Bernardo Carvalho Dutra1 & Sheila Cavalca Cortelli3 & José Roberto Cortelli3 & Luís Otávio Miranda Cota1 & Alcione Maria Soares Dutra Oliveira2 Received: 21 August 2015 / Accepted: 5 September 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract organoleptic scores, and in CH3SH levels between times. Objective The objective of this study was to compare the ef- However, major reduction was observed in FMD group. fect of one-stage full-mouth disinfection (FMD) and conven- Conclusion Non-surgical periodontal therapy, regardless of tional quadrant scaling in four weekly sessions (QS) on peri- the protocol, was effective in improving periodontal clinical odontal clinical parameters and halitosis among individuals status of individuals, decreasing organoleptic scores and with advanced chronic periodontitis. CH3SH levels between times, as well as reducing halitosis. Materials and methods In this randomized controlled clinical Clinical relevance This study contributed to the knowledge trial, 30 individuals were divided into two groups: FMD that non-surgical periodontal therapy, whether by FMD or QS, (n =15)andQS(n = 15). The following data were collected was effective in reducing halitosis in individuals with ad- at the baseline and 90 days after treatment: plaque index, vanced chronic periodontitis. tongue-coating index (TCI), bleeding on probing, probing depth, and clinical attachment level. Halimetry was performed by the organoleptic method, and the levels of volatile sulfur Keywords Halitosis .
    [Show full text]