Abstract :papillon-Lefèvre Syndrome (PLS) Is A Very Rare Autosomal Recessive Disorder Characterized By Palmoplantar Hyperkeratosis And Severe Early Onset Of Destructive Periodontitis Leading To Premature Loss Of Both Primary And Permanent Dentitions. Here We Are Presenting Case Report Of Siblings Who Presented With Palmoplantar Hyperkeratosis And Aggressive Periodontitis.
Keywords: Papillon-Lefèvre Syndrome, Periodontitis, Palmoplantar, Hyperkeratosis, Cathepsin C
Syndromes affecting the periodontium khushbu13 4-08khushbu mishra
This document discusses various syndromes that can affect the periodontium. It begins by defining a syndrome and systemic conditions. It then classifies syndromes affecting the periodontium into 10 categories based on their effects. Several specific syndromes are discussed in more detail, including their definitions, etiologies, clinical features, diagnoses, and treatments. These include syndromes causing white lesions (focal palmoplantar and oral mucosa hyperkeratosis syndrome), red lesions (Klippel-Trenauny-Weber syndrome, Sturge-Webber syndrome, Melkersson–Rosenthal syndrome), and defects in the gingivolabial fold (orofaciodigital syndrome type
Papillon-Lèfevre Syndrome (PLS) is a rare genetic disorder that causes severe gum disease and early loss of both baby and adult teeth. It is caused by mutations in the CTSC gene which encodes an enzyme important for immune function. Patients with PLS experience rapid gum inflammation and bone loss around teeth from a young age, resulting in pain, infection, and premature tooth loss. Skin lesions also develop on the hands and feet. Treatment focuses on antibiotics, oral hygiene, gum treatment, and early tooth extraction to prevent further infection and bone loss, with the goal of restoring chewing function through prosthetics or implants.
Pediatric soft tissue lesions/certified fixed orthodontic courses by Indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses soft tissue oral lesions in children. It covers drug-induced gingival hyperplasia caused by phenytoin, which causes painless enlargement of the gums. Conditioned enlargements related to puberty can also occur due to hormonal changes. Nutritional deficiencies like scurvy from a lack of vitamin C can result in bleeding gums. Non-specific enlargements like granuloma pyogenicum present as tumor-like masses. Allergic reactions from drugs may also manifest as gingival inflammation. Juvenile periodontitis is an early-onset aggressive form of the disease typically affecting teens. Papillon-Lefevre syndrome is a rare condition characterized by palm and sole
This document provides information on oral submucous fibrosis (OSMF), including its definition, history, pathogenesis, clinical features, and staging classifications. OSMF is a chronic disease affecting the oral cavity and sometimes pharynx, characterized by juxtaepithelial inflammatory reaction and fibrosis of the lamina propria. Chewing betel quid and areca nut releases alkaloids and tannins that cause irritation and inflammation, activating fibroblasts and increasing production and cross-linking of collagen over time, resulting in stiffness and inability to open the mouth. OSMF is considered a precancerous condition due to its association with oral cancer. Staging systems describe progression from initial symptoms to trismus and possible malignancy
gingiva and periodontal problems in childrenGarima Singh
This document provides an overview of gingival and periodontal diseases in children. It begins with an introduction stating that many periodontal diseases originate during childhood, so early detection and treatment are important. It then covers topics such as the normal periodontium in children, classifications of gingival diseases including gingivitis, acute gingival diseases like herpetic gingivostomatitis, and gingival enlargement. It also discusses periodontitis, specifically aggressive periodontitis which can occur in adolescents, as well as systemic diseases associated with periodontal problems. The conclusion emphasizes that early detection and treatment of periodontal issues in children can prevent more advanced diseases and also identify underlying systemic conditions.
This document discusses various systemic conditions that can manifest orally and affect oral health. It covers conditions associated with oral ulcers, lesions, pigmentation changes, periodontal disease and tooth alterations. Specific conditions discussed in detail include lichen planus, lupus erythematosus, pemphigoid, pemphigus vulgaris, Crohn's disease, Behcet's syndrome and Sjogren's syndrome. It also covers syndromes associated with cleft lip/palate and factors that can cause delayed tooth eruption.
This document discusses various syndromes that can affect the periodontium. It begins by defining systemic conditions and syndromes. It then classifies syndromes affecting the periodontium into 10 categories based on their effects such as causing white lesions, red lesions, ulcers/erosions, pigmentation, lumps/swellings, bleeding, periodontal destruction, defects in the gingivolabial fold, and effects on the periodontal ligament. Several specific syndromes are discussed in detail for each category.
Syndromes affecting the periodontium khushbu13 4-08khushbu mishra
This document discusses various syndromes that can affect the periodontium. It begins by defining a syndrome and systemic conditions. It then classifies syndromes affecting the periodontium into 10 categories based on their effects. Several specific syndromes are discussed in more detail, including their definitions, etiologies, clinical features, diagnoses, and treatments. These include syndromes causing white lesions (focal palmoplantar and oral mucosa hyperkeratosis syndrome), red lesions (Klippel-Trenauny-Weber syndrome, Sturge-Webber syndrome, Melkersson–Rosenthal syndrome), and defects in the gingivolabial fold (orofaciodigital syndrome type
Papillon-Lèfevre Syndrome (PLS) is a rare genetic disorder that causes severe gum disease and early loss of both baby and adult teeth. It is caused by mutations in the CTSC gene which encodes an enzyme important for immune function. Patients with PLS experience rapid gum inflammation and bone loss around teeth from a young age, resulting in pain, infection, and premature tooth loss. Skin lesions also develop on the hands and feet. Treatment focuses on antibiotics, oral hygiene, gum treatment, and early tooth extraction to prevent further infection and bone loss, with the goal of restoring chewing function through prosthetics or implants.
Pediatric soft tissue lesions/certified fixed orthodontic courses by Indian d...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses soft tissue oral lesions in children. It covers drug-induced gingival hyperplasia caused by phenytoin, which causes painless enlargement of the gums. Conditioned enlargements related to puberty can also occur due to hormonal changes. Nutritional deficiencies like scurvy from a lack of vitamin C can result in bleeding gums. Non-specific enlargements like granuloma pyogenicum present as tumor-like masses. Allergic reactions from drugs may also manifest as gingival inflammation. Juvenile periodontitis is an early-onset aggressive form of the disease typically affecting teens. Papillon-Lefevre syndrome is a rare condition characterized by palm and sole
This document provides information on oral submucous fibrosis (OSMF), including its definition, history, pathogenesis, clinical features, and staging classifications. OSMF is a chronic disease affecting the oral cavity and sometimes pharynx, characterized by juxtaepithelial inflammatory reaction and fibrosis of the lamina propria. Chewing betel quid and areca nut releases alkaloids and tannins that cause irritation and inflammation, activating fibroblasts and increasing production and cross-linking of collagen over time, resulting in stiffness and inability to open the mouth. OSMF is considered a precancerous condition due to its association with oral cancer. Staging systems describe progression from initial symptoms to trismus and possible malignancy
gingiva and periodontal problems in childrenGarima Singh
This document provides an overview of gingival and periodontal diseases in children. It begins with an introduction stating that many periodontal diseases originate during childhood, so early detection and treatment are important. It then covers topics such as the normal periodontium in children, classifications of gingival diseases including gingivitis, acute gingival diseases like herpetic gingivostomatitis, and gingival enlargement. It also discusses periodontitis, specifically aggressive periodontitis which can occur in adolescents, as well as systemic diseases associated with periodontal problems. The conclusion emphasizes that early detection and treatment of periodontal issues in children can prevent more advanced diseases and also identify underlying systemic conditions.
This document discusses various systemic conditions that can manifest orally and affect oral health. It covers conditions associated with oral ulcers, lesions, pigmentation changes, periodontal disease and tooth alterations. Specific conditions discussed in detail include lichen planus, lupus erythematosus, pemphigoid, pemphigus vulgaris, Crohn's disease, Behcet's syndrome and Sjogren's syndrome. It also covers syndromes associated with cleft lip/palate and factors that can cause delayed tooth eruption.
This document discusses various syndromes that can affect the periodontium. It begins by defining systemic conditions and syndromes. It then classifies syndromes affecting the periodontium into 10 categories based on their effects such as causing white lesions, red lesions, ulcers/erosions, pigmentation, lumps/swellings, bleeding, periodontal destruction, defects in the gingivolabial fold, and effects on the periodontal ligament. Several specific syndromes are discussed in detail for each category.
This document discusses two metabolic disorders: Histiocytosis X and Niemann-Pick Disease. Histiocytosis X is characterized by proliferation of Langerhans cells and presents as eosinophilic granuloma, Hand-Schuller Christian syndrome, or Letterer-Siwe disease. It commonly involves bones, skin and oral mucosa. Treatment depends on localization but may include surgery, radiation or steroids. Niemann-Pick Disease results from lipid processing enzyme deficiencies, causing lipid accumulation and is classified into three types with varying symptoms and prognosis. Both disorders can initially present in the head and neck region.
This document summarizes various acute periodontal conditions, including abscesses of the periodontium (gingival, periodontal, pericoronal), necrotizing periodontal diseases (necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis), gingival diseases of viral origin (primary herpetic gingivostomatitis, recurrent oral herpes), recurrent aphthous stomatitis, and allergic reactions in the oral cavity. Treatment options focus on drainage, debridement, antimicrobials, pain control, and identifying/eliminating predisposing factors or allergens. Comprehensive evaluation and follow-up are important after resolution of acute
This document discusses oral manifestations of systemic diseases in older patients. It provides background on oral structures and functions. It then examines relationships between oral symptoms and conditions like drug reactions, fungal/viral infections, leukemia, Behcet's disease, Sjogren's syndrome, diabetes mellitus, nutritional deficiencies, and amyloidosis. For each condition, it describes common oral presentations and recommendations for treatment and differential diagnosis. The document concludes that the mouth can provide insights into a patient's immune function and that differential diagnosis is important.
This document discusses chronic periodontitis, the most common form of periodontitis. It is defined as an infectious disease resulting in inflammation and destruction of the tissues supporting the teeth. The key clinical features are plaque, gingivitis, attachment loss, bone loss, and inflammation. Chronic periodontitis is considered a site-specific disease where inflammation and bone loss occur at specific sites due to local plaque accumulation. The severity is classified as slight, moderate, or severe based on the amount of attachment loss. Risk factors include poor plaque control, systemic diseases, environmental/behavioral factors like smoking, and genetics. Treatment involves improving oral hygiene, nonsurgical treatments like scaling and root planing, and sometimes surgery.
Lesions of oral mucosa in children By Dr Sachin RathodDr Sachin Rathod
This document discusses various lesions that can occur on the oral mucosa of children. It covers developmental disorders including cleft lip, ankyloglossia (tongue-tie), geographic tongue and lingual thyroid. Infections such as herpes simplex, candidiasis, tuberculosis and scarlet fever are described. Traumatic lesions including ranula and mucocele are mentioned. Nutritional deficiencies that can cause oral lesions and various neoplasms such as rhabdomyosarcoma, lymphangioma and hemangioma are also summarized. Treatment approaches for selected conditions like ankyloglossia and mucocele are provided.
This document discusses various oral manifestations of systemic diseases. It begins by classifying systemic diseases into 14 categories that can present with oral lesions. Several infectious diseases are then discussed in detail, including viral infections like herpes simplex, herpes zoster, herpangina and hand foot mouth disease. Bacterial infections such as tuberculosis, syphilis and leprosy are also mentioned. Clinical features, diagnosis and treatment are provided for many of the infectious diseases.
This document discusses several conditions that can present with desquamative gingivitis including their clinical features, histopathology, diagnosis, and treatment. It describes desquamative gingivitis as an erythematous, desquamative, and ulcerative condition of the gingiva that can be associated with various underlying etiologies. It then summarizes several specific conditions in detail, including lichen planus, pemphigoid, pemphigus, linear IgA disease, chronic ulcerative stomatitis, and erythema multiforme. For each, it highlights key clinical manifestations, histopathological findings, diagnostic approach, and treatment options.
This document summarizes various causes of non-plaque induced gingivitis, including specific bacterial, viral, and fungal infections that can cause gingival inflammation and lesions. It describes conditions such as herpetic gingivostomatitis caused by the herpes simplex virus and candidosis caused by Candida albicans. It also discusses genetic causes like hereditary gingival fibromatosis and systemic diseases that can involve the gingiva, such as lichen planus, pemphigoid, and pemphigus vulgaris. Allergic reactions to dental materials and oral hygiene products are another potential cause of non-plaque gingivitis covered.
Gingivitis is the most common form of gingival disease and is caused by bacterial infection resulting in inflammation of the gingival tissue. The characteristics of gingivitis include redness, swelling, bleeding upon provocation, and a change in consistency but no loss of attachment or bone loss. Gingivitis can be classified as dental plaque-induced or non-plaque induced. Dental plaque-induced gingivitis can be modified by local factors, systemic factors, medications, or malnutrition. Non-plaque induced gingivitis can result from bacterial, viral, fungal infections or genetic conditions.
This document provides information on gingival and periodontal diseases. It discusses various types of gingival diseases like gingivitis, acute gingival diseases, gingival enlargement. It also covers different types of periodontal diseases like chronic periodontitis, aggressive periodontitis. Periodontal diseases are infectious diseases that cause destruction of tissues supporting the teeth. Nearly 75% of adults suffer from some form of periodontal disease. Early detection and treatment can help most people keep their teeth for life.
Common Benign Oral cavity disorders by. Dr.vijay kumarvijaymgims
The document discusses various types of oral lesions and conditions. It begins by describing the anatomy of the oral cavity and defines a lesion. It then classifies lesions based on their depth and texture. Specific lesion types are defined such as ulcers, erosions, abscesses, cysts, blisters, pustules, hematomas and plaques. Causes of oral lesions including congenital conditions, inflammatory/traumatic conditions, autoimmune diseases and precancerous lesions are listed. Finally, examples of benign tumors such as fibromas and pyogenic granulomas are provided along with more detailed descriptions of torus, lingual thyroid and inflammatory diseases like candidiasis and Vincent's angina.
This document provides an overview of a student presentation on pediatric oral pathology. It discusses various developmental conditions like orofacial clefts, palatal cysts of newborns, congenital epulis, natal/neonatal teeth, ankyloglossia, and congenital absence of teeth. It also covers odontogenic conditions, reactive lesions, infections, and developmental abnormalities seen in pediatric oral pathology. Treatment approaches for many of these conditions are mentioned as well.
This document provides an overview of periodontal abscesses. It defines a periodontal abscess as a localized collection of pus within the periodontal tissues. Periodontal abscesses are classified based on duration, number, location and etiology. The main causes are periodontitis, trauma from foreign objects, and certain dental procedures. Microbiologically, periodontal abscesses involve anaerobic bacteria normally found in the oral cavity like P. gingivalis, P. intermedia and F. nucleatum. Clinical features include pain, swelling and exudate from the gingiva. Management involves incision and drainage of the acute lesion along with antibiotics and treatment of the underlying condition like scaling or surgery.
Acute necrotising ulcerative gingivitis is a rare condition characterized by necrosis of the gingiva and interdental papillae. It frequently occurs during times of stress and poor oral hygiene. The condition is caused by fusiform bacillus and Borrelia vincentii bacteria. Clinically, the gingiva becomes painful and develops punched-out ulcers. It can spread to other oral tissues and rarely the skin, causing further complications.
This document discusses aggressive periodontitis, including localized aggressive periodontitis (LAP) and generalized aggressive periodontitis (GAP). It provides information on clinical findings, disease characteristics, associated bacteria, treatment approaches, and prevalence. For LAP, key points are rapid bone/attachment loss in first molars/incisors of young individuals, association with Aggregatibacter actinomycetemcomitans bacteria, and treatment involving non-surgical debridement and antibiotics. GAP affects multiple teeth, has an episodic nature, and treatment includes frequent maintenance and antibiotic therapy aimed at eliminating pathogenic bacteria. Risk is higher in African Americans and early diagnosis/treatment improves outcomes.
This document discusses various types of gingival pathology including acute and chronic conditions, localized and generalized manifestations, and inflammatory and neoplastic enlargements. It reviews clinical findings such as bleeding, color changes, consistency changes, surface texture changes, position changes and contour changes. Specific acute gingival infections discussed include necrotizing ulcerative gingivitis, primary herpetic gingivostomatitis, and pericoronitis. Chronic conditions and enlargements covered include inflammatory, drug-induced, idiopathic, pregnancy-related, puberty-related, vitamin C deficiency, plasma cell, leukemia-associated, and neoplastic enlargements. Treatment approaches are presented for different conditions.
This document discusses different types of necrotizing ulcerative periodontitis including non-AIDS type and AIDS-associated type. It also discusses refractory periodontitis caused by abnormal host response, resistant bacteria, failure to remove plaque, and smoking. Microbial complexes associated with refractory periodontitis include Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. Treatment involves antimicrobial therapy and local drug delivery. The document also discusses periodontitis caused by systemic diseases that impair neutrophil function such as Papillon-Lefèvre syndrome, Chédiak-Higashi syndrome, and Down syndrome.
Chronic periodontitis is characterized by inflammation within the supporting tissues of the teeth and progressive bone and attachment loss. It is caused by an extension of gingival inflammation into deeper periodontal tissues due to plaque accumulation. Key features include bleeding gums, deepening pockets between teeth and gums, and recession or loss of bone. Treatment involves nonsurgical procedures like scaling and root planing to remove plaque and tartar, as well as potential surgical procedures to reduce deep pockets and regenerate lost bone if nonsurgical methods are not fully effective. Prognosis depends on factors like severity, systemic involvement, remaining teeth and compliance with treatment and maintenance.
This document discusses several inherited oral diseases and disorders affecting the jaws, teeth, and oral mucosa. It provides details on Papillon-LeFèvre Syndrome, which causes hyperkeratosis of the palms/feet and severe early-onset periodontitis leading to tooth loss before age 14. Cherubism causes bilateral jaw swelling and tooth displacement typically in childhood that stabilizes after puberty. Cleidocranial dysplasia involves bone defects of the clavicles and skull, delayed tooth eruption, and supernumerary teeth. Crouzon syndrome and Apert syndrome are both craniosynostosis syndromes characterized by premature skull suture closure, midface hypoplasia, and in A
This document discusses two metabolic disorders: Histiocytosis X and Niemann-Pick Disease. Histiocytosis X is characterized by proliferation of Langerhans cells and presents as eosinophilic granuloma, Hand-Schuller Christian syndrome, or Letterer-Siwe disease. It commonly involves bones, skin and oral mucosa. Treatment depends on localization but may include surgery, radiation or steroids. Niemann-Pick Disease results from lipid processing enzyme deficiencies, causing lipid accumulation and is classified into three types with varying symptoms and prognosis. Both disorders can initially present in the head and neck region.
This document summarizes various acute periodontal conditions, including abscesses of the periodontium (gingival, periodontal, pericoronal), necrotizing periodontal diseases (necrotizing ulcerative gingivitis, necrotizing ulcerative periodontitis), gingival diseases of viral origin (primary herpetic gingivostomatitis, recurrent oral herpes), recurrent aphthous stomatitis, and allergic reactions in the oral cavity. Treatment options focus on drainage, debridement, antimicrobials, pain control, and identifying/eliminating predisposing factors or allergens. Comprehensive evaluation and follow-up are important after resolution of acute
This document discusses oral manifestations of systemic diseases in older patients. It provides background on oral structures and functions. It then examines relationships between oral symptoms and conditions like drug reactions, fungal/viral infections, leukemia, Behcet's disease, Sjogren's syndrome, diabetes mellitus, nutritional deficiencies, and amyloidosis. For each condition, it describes common oral presentations and recommendations for treatment and differential diagnosis. The document concludes that the mouth can provide insights into a patient's immune function and that differential diagnosis is important.
This document discusses chronic periodontitis, the most common form of periodontitis. It is defined as an infectious disease resulting in inflammation and destruction of the tissues supporting the teeth. The key clinical features are plaque, gingivitis, attachment loss, bone loss, and inflammation. Chronic periodontitis is considered a site-specific disease where inflammation and bone loss occur at specific sites due to local plaque accumulation. The severity is classified as slight, moderate, or severe based on the amount of attachment loss. Risk factors include poor plaque control, systemic diseases, environmental/behavioral factors like smoking, and genetics. Treatment involves improving oral hygiene, nonsurgical treatments like scaling and root planing, and sometimes surgery.
Lesions of oral mucosa in children By Dr Sachin RathodDr Sachin Rathod
This document discusses various lesions that can occur on the oral mucosa of children. It covers developmental disorders including cleft lip, ankyloglossia (tongue-tie), geographic tongue and lingual thyroid. Infections such as herpes simplex, candidiasis, tuberculosis and scarlet fever are described. Traumatic lesions including ranula and mucocele are mentioned. Nutritional deficiencies that can cause oral lesions and various neoplasms such as rhabdomyosarcoma, lymphangioma and hemangioma are also summarized. Treatment approaches for selected conditions like ankyloglossia and mucocele are provided.
This document discusses various oral manifestations of systemic diseases. It begins by classifying systemic diseases into 14 categories that can present with oral lesions. Several infectious diseases are then discussed in detail, including viral infections like herpes simplex, herpes zoster, herpangina and hand foot mouth disease. Bacterial infections such as tuberculosis, syphilis and leprosy are also mentioned. Clinical features, diagnosis and treatment are provided for many of the infectious diseases.
This document discusses several conditions that can present with desquamative gingivitis including their clinical features, histopathology, diagnosis, and treatment. It describes desquamative gingivitis as an erythematous, desquamative, and ulcerative condition of the gingiva that can be associated with various underlying etiologies. It then summarizes several specific conditions in detail, including lichen planus, pemphigoid, pemphigus, linear IgA disease, chronic ulcerative stomatitis, and erythema multiforme. For each, it highlights key clinical manifestations, histopathological findings, diagnostic approach, and treatment options.
This document summarizes various causes of non-plaque induced gingivitis, including specific bacterial, viral, and fungal infections that can cause gingival inflammation and lesions. It describes conditions such as herpetic gingivostomatitis caused by the herpes simplex virus and candidosis caused by Candida albicans. It also discusses genetic causes like hereditary gingival fibromatosis and systemic diseases that can involve the gingiva, such as lichen planus, pemphigoid, and pemphigus vulgaris. Allergic reactions to dental materials and oral hygiene products are another potential cause of non-plaque gingivitis covered.
Gingivitis is the most common form of gingival disease and is caused by bacterial infection resulting in inflammation of the gingival tissue. The characteristics of gingivitis include redness, swelling, bleeding upon provocation, and a change in consistency but no loss of attachment or bone loss. Gingivitis can be classified as dental plaque-induced or non-plaque induced. Dental plaque-induced gingivitis can be modified by local factors, systemic factors, medications, or malnutrition. Non-plaque induced gingivitis can result from bacterial, viral, fungal infections or genetic conditions.
This document provides information on gingival and periodontal diseases. It discusses various types of gingival diseases like gingivitis, acute gingival diseases, gingival enlargement. It also covers different types of periodontal diseases like chronic periodontitis, aggressive periodontitis. Periodontal diseases are infectious diseases that cause destruction of tissues supporting the teeth. Nearly 75% of adults suffer from some form of periodontal disease. Early detection and treatment can help most people keep their teeth for life.
Common Benign Oral cavity disorders by. Dr.vijay kumarvijaymgims
The document discusses various types of oral lesions and conditions. It begins by describing the anatomy of the oral cavity and defines a lesion. It then classifies lesions based on their depth and texture. Specific lesion types are defined such as ulcers, erosions, abscesses, cysts, blisters, pustules, hematomas and plaques. Causes of oral lesions including congenital conditions, inflammatory/traumatic conditions, autoimmune diseases and precancerous lesions are listed. Finally, examples of benign tumors such as fibromas and pyogenic granulomas are provided along with more detailed descriptions of torus, lingual thyroid and inflammatory diseases like candidiasis and Vincent's angina.
This document provides an overview of a student presentation on pediatric oral pathology. It discusses various developmental conditions like orofacial clefts, palatal cysts of newborns, congenital epulis, natal/neonatal teeth, ankyloglossia, and congenital absence of teeth. It also covers odontogenic conditions, reactive lesions, infections, and developmental abnormalities seen in pediatric oral pathology. Treatment approaches for many of these conditions are mentioned as well.
This document provides an overview of periodontal abscesses. It defines a periodontal abscess as a localized collection of pus within the periodontal tissues. Periodontal abscesses are classified based on duration, number, location and etiology. The main causes are periodontitis, trauma from foreign objects, and certain dental procedures. Microbiologically, periodontal abscesses involve anaerobic bacteria normally found in the oral cavity like P. gingivalis, P. intermedia and F. nucleatum. Clinical features include pain, swelling and exudate from the gingiva. Management involves incision and drainage of the acute lesion along with antibiotics and treatment of the underlying condition like scaling or surgery.
Acute necrotising ulcerative gingivitis is a rare condition characterized by necrosis of the gingiva and interdental papillae. It frequently occurs during times of stress and poor oral hygiene. The condition is caused by fusiform bacillus and Borrelia vincentii bacteria. Clinically, the gingiva becomes painful and develops punched-out ulcers. It can spread to other oral tissues and rarely the skin, causing further complications.
This document discusses aggressive periodontitis, including localized aggressive periodontitis (LAP) and generalized aggressive periodontitis (GAP). It provides information on clinical findings, disease characteristics, associated bacteria, treatment approaches, and prevalence. For LAP, key points are rapid bone/attachment loss in first molars/incisors of young individuals, association with Aggregatibacter actinomycetemcomitans bacteria, and treatment involving non-surgical debridement and antibiotics. GAP affects multiple teeth, has an episodic nature, and treatment includes frequent maintenance and antibiotic therapy aimed at eliminating pathogenic bacteria. Risk is higher in African Americans and early diagnosis/treatment improves outcomes.
This document discusses various types of gingival pathology including acute and chronic conditions, localized and generalized manifestations, and inflammatory and neoplastic enlargements. It reviews clinical findings such as bleeding, color changes, consistency changes, surface texture changes, position changes and contour changes. Specific acute gingival infections discussed include necrotizing ulcerative gingivitis, primary herpetic gingivostomatitis, and pericoronitis. Chronic conditions and enlargements covered include inflammatory, drug-induced, idiopathic, pregnancy-related, puberty-related, vitamin C deficiency, plasma cell, leukemia-associated, and neoplastic enlargements. Treatment approaches are presented for different conditions.
This document discusses different types of necrotizing ulcerative periodontitis including non-AIDS type and AIDS-associated type. It also discusses refractory periodontitis caused by abnormal host response, resistant bacteria, failure to remove plaque, and smoking. Microbial complexes associated with refractory periodontitis include Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia. Treatment involves antimicrobial therapy and local drug delivery. The document also discusses periodontitis caused by systemic diseases that impair neutrophil function such as Papillon-Lefèvre syndrome, Chédiak-Higashi syndrome, and Down syndrome.
Chronic periodontitis is characterized by inflammation within the supporting tissues of the teeth and progressive bone and attachment loss. It is caused by an extension of gingival inflammation into deeper periodontal tissues due to plaque accumulation. Key features include bleeding gums, deepening pockets between teeth and gums, and recession or loss of bone. Treatment involves nonsurgical procedures like scaling and root planing to remove plaque and tartar, as well as potential surgical procedures to reduce deep pockets and regenerate lost bone if nonsurgical methods are not fully effective. Prognosis depends on factors like severity, systemic involvement, remaining teeth and compliance with treatment and maintenance.
This document discusses several inherited oral diseases and disorders affecting the jaws, teeth, and oral mucosa. It provides details on Papillon-LeFèvre Syndrome, which causes hyperkeratosis of the palms/feet and severe early-onset periodontitis leading to tooth loss before age 14. Cherubism causes bilateral jaw swelling and tooth displacement typically in childhood that stabilizes after puberty. Cleidocranial dysplasia involves bone defects of the clavicles and skull, delayed tooth eruption, and supernumerary teeth. Crouzon syndrome and Apert syndrome are both craniosynostosis syndromes characterized by premature skull suture closure, midface hypoplasia, and in A
El documento habla sobre la redacción de textos. Explica que redactar es expresar pensamientos y conocimientos de manera organizada. Luego, detalla características como la coherencia, cohesión y claridad que debe tener un texto redactado. Finalmente, describe los tipos de textos como descriptivo, narrativo, expositivo y argumentativo.
This document contains photo credits for 9 different photographers who contributed photos to a Haiku Deck presentation on SlideShare. It lists the name of each photographer followed by their photo credit. It concludes by encouraging the reader to get started creating their own Haiku Deck presentation.
Neutropenia, pronounced noo-troh-PEE-nee-uh, is a decrease in the number of white blood cells. These cells are the body’s main defense against infection. Neutropenia is common after receiving chemotherapy and increases your risk for infections.
Hypophosphatasia is a rare, inherited disorder caused by deficient alkaline phosphatase activity. It presents with symptoms resembling rickets but is distinguished by abnormally low alkaline phosphatase levels. The document describes four cases showing signs of hypophosphatasia, including premature tooth loss, bone deformities, and low alkaline phosphatase. Testing found elevated levels of metabolites that accumulate due to low alkaline phosphatase, confirming a diagnosis of hypophosphatasia. The condition ranges in severity from lethal neonatal to milder childhood forms.
Polikistik over sendromu’ nda genital bölgede mantar enfeksiyonlarıBH KADIN SAĞLIĞI
Polikistik Over Sendromu' nda insülin direnci veya şeker hastalığı olan kadınlarda genital bölgede (Vajina, Vulva) tekrarlayan mantar enfeksiyonları daha sık görülmektedir.
This document presents information about Paget's disease of bone from a student presentation. It defines Paget's disease, discusses its signs and symptoms, causes including genetic and viral factors, pathophysiology involving abnormal bone turnover, risks such as age and family history, potential complications, diagnosis through tests such as x-rays and bone scans, and treatment including pharmacological therapies like bisphosphonates, non-pharmacological management, and possible surgical interventions. Epidemiology data is also provided stating prevalence is decreasing.
La neutropenia es la disminución de granulocitos en la sangre, lo que puede causar infecciones. Puede deberse a causas genéticas, congénitas o adquiridas como ciertos medicamentos. En la neutropenia hay una producción deficiente de granulocitos en la médula ósea o una destrucción prematura de los mismos. Los síntomas incluyen fiebre, escalofríos y úlceras bucales. El tratamiento incluye transfusiones de granulocitos en casos graves.
The document discusses the influence of systemic diseases on the periodontium. It begins by discussing various nutritional disorders like deficiencies in vitamins A, D, E, B complex, C, and protein and how they can affect the periodontium. It then discusses endocrine disorders like diabetes and hyperparathyroidism. It also discusses hematologic disorders such as leukemia, anemia, and thrombocytopenia. Finally, it briefly discusses psychosomatic and immunodeficiency disorders and their effects on oral health.
Paget's disease of bone is an osteolytic and osteosclerotic bone disease of unknown origin that can involve one or more bones such as the tibia, femur, pelvis, skull, and vertebrae. It progresses through three stages: an initial osteolytic stage, a mixed osteolytic-osteoblastic stage, and a final quiescent osteosclerotic stage.
Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow characterized by the rapid growth of abnormal white blood cells that build up in the bone marrow and blood. This document discusses the etiology, pathophysiology, clinical presentation, diagnosis, classification, and treatment of AML. It covers the French-American-British classification system and the newer World Health Organization classification system for AML subtypes. The WHO system categorizes AML based on recurrent genetic abnormalities, multilineage dysplasia with prior myelodysplastic syndrome, therapy-related AML, and other subtypes classified by morphology and cytochemistry.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Pierre robin syndrome_a_case_report_and_review_of_Ashwini617070
This document presents a case report of Pierre Robin syndrome and reviews management approaches. It describes the case of an infant born with micrognathia, tongue retraction, and airway obstruction consistent with Pierre Robin syndrome. The syndrome can be genetic in origin but was not associated with any other anomalies in this case. Management involved a multidisciplinary team and initial tongue-lip adhesion surgery to relieve respiratory distress, followed later by mandibular distraction osteogenesis. Non-surgical positioning and nasopharyngeal tubes are often successful initially in many cases. A small subset requires more invasive procedures like tongue-lip adhesion or tracheotomy. Early feeding via nasogastric tube can also help with weight gain and reducing calorie needs in these
This case report describes the diagnosis of a 65-year-old female patient with orofacial granulomatosis (OFG). The patient presented with swelling of the upper lip. An extensive diagnostic workup including biopsy and histopathological examination was performed to rule out other granulomatous conditions and confirm a diagnosis of OFG. A non-caseating granuloma was seen on biopsy. The patient responded well to intralesional corticosteroid injections but was lost to follow up. OFG is a rare disease that can mimic other conditions, making diagnosis challenging. A multidisciplinary approach including biopsy is needed to correctly diagnose and manage this condition.
2.Ismail Yazdi anda Amir Hossein Fakhraee Congenital Fusion of Maxilla and M...MohammedAbdulhammed
This case report describes a rare case of congenital fusion of the maxilla and mandible (bony syngnathia) in a newborn female with no other oral anomalies. Physical examination revealed complete adhesion of the jaws, preventing opening of the mouth. Surgical division of the bony fusion via an intraoral approach allowed opening of the mouth and normal feeding. The infant was discharged but later died of pneumonia at 7 months of age. Bony syngnathia is extremely rare and usually seen with other oral anomalies; this case presented an isolated occurrence of the condition.
This document provides information on aggressive periodontitis, including its historical background, classification, clinical presentation, epidemiology, etiology, and pathogenesis. Some key points include:
- Aggressive periodontitis is a rare, severe form of periodontitis characterized by early onset and familial aggregation. It includes localized aggressive periodontitis (LAP) and generalized aggressive periodontitis (GAP).
- LAP typically affects first molars and incisors in adolescents/young adults and is associated with A. actinomycetemcomitans infection, while GAP has a more generalized pattern of attachment/bone loss.
- Screening involves measuring attachment loss via probing or radiographic assessment of alveolar bone levels
Subacute cutaneous lupus erythematosus associated with lupus nephritisApollo Hospitals
Childhood onset systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. Subacute cutaneous lupus erythematosus (SCLE) is a rare subtype of juvenile onset SLE. Renal involvement is seen in 50–70% of cases of SLE in children and could be the initial presenting clinical feature in many cases. Here we present a child with lupus nephritis who later developed skin lesions suggestive of SCLE.
A case of childhood Burkitt's lymphoma with gingival swelling as the first sy...komalicarol
This case report describes a 4-year-old child who presented with gingival swelling as the initial symptom of Burkitt's lymphoma. The child was eventually diagnosed with stage IV Burkitt's lymphoma/leukemia based on bone marrow and genetic testing. After initial chemotherapy, the gingival swelling and right cheek swelling recurred, indicating disease recurrence. The child received further chemotherapy but ultimately passed away half a year later. This case highlights that gingival swelling can be an early oral symptom of systemic disease like Burkitt's lymphoma. Dentists and oral physicians play an important role in identifying signs of systemic conditions through oral examinations.
1) Premalignant lesions of the oral mucosa occur in 1.5-4.5% of the global population and account for 17-35% of new oral cancer cases, with an annual malignant transformation rate of 0.7-2.9%.
2) Common premalignant lesions include leukoplakia, erythroplakia, submucous fibrosis, and lichen planus. Leukoplakia may transform to cancer in 0.13-34% of cases depending on population.
3) Risk factors for oral premalignant lesions include smoking, smokeless tobacco, alcohol, HPV infection, and nutritional deficiencies. Early diagnosis and treatment can prevent malignant transformation
This case report describes a 9-year-old female patient with fibrous dysplasia of the maxilla and a port wine stain on her face. Clinical examination and radiographic imaging showed abnormal bone growth replacing the maxilla. A biopsy confirmed the diagnosis of fibrous dysplasia. The patient underwent surgical recontouring of the maxilla and was happy with the results at her 2-week follow up appointment. Fibrous dysplasia is a benign condition where abnormal bone growth replaces normal bone, usually becoming inactive in adulthood, though some cases like this one may continue progressing during childhood growth.
MSX1 Polymorphism in an Eastern Nepalese Non Syndromic cleft lip/palate patie...Ashok Ayer
This study was carried out to evaluate the role of MSX1 799 G >T gene polymorphism with non Syndromic cleft lip/palate in Eastern Nepalese patient population. For the study, whole blood samples (2 ml) were obtained from 40 subjects and controls. Genomic DNA was extracted from the blood of the subjects by using ethanol, chloroform treatment. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) method was used to check for the presence of polymorphism. The results indicated that a patient has MSX1 799 G>T variant. The
patient was a male aged 24 years was a complete unilateral left sided cleft lip/palate involving alveolus, hard and soft palate. He had normal development and no associated anomaly. There was no family history of cleft lip/palate and no history of any teratogenic exposure during embryonic life as revealed by his mother. This may be a case of sporadic polymorphism. It may be concluded that ,although we detected the presence of a MSX1 799 G>T polymorphism in one patient, a further investigation with large sample size, including many SNP’s on families must be performed to get conclusive results.
- The document presents updated national clinical guidelines for managing palatally ectopic maxillary canines from the Faculty of Dental Surgery at the Royal College of Surgeons of England.
- It describes five treatment strategies supported by levels of evidence: interceptive extraction of the deciduous canine, surgical exposure and orthodontic alignment, surgical removal of the ectopic canine, autotransplantation, and observation with no active treatment.
- The guidelines emphasize the importance of early diagnosis and management of ectopic canines to avoid complex treatment, damage to adjacent teeth, and potential litigation issues from treatment delays.
Ellis–Van Creveld Syndrome With Unusal Expression Of Multiple Supernumerary T...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This case report describes a rare case of a 56-year-old female patient who presented with four isolated gingival enlargements, one on each side of her upper and lower molars. Histopathological examination determined the lesions were epulides. This finding of four separate epulides was termed "Quadra Epulis". The epulides were surgically excised and antibiotics were prescribed. Follow up was recommended to minimize recurrence. This report describes a unique presentation of multiple epulis lesions not previously reported in the literature.
Pigmented Fungi Form Papilla of The Tongue – A Rare Entityclinicsoncology
We describe a case report of 20 years old female with pigmentation over the dorsum of the tongue since childhood. Examination of the oral cavity showed pigmentation of fungi form papilla on lateral and dorsal aspect of tongue...
Pigmented Fungi Form Papilla of The Tongue – A Rare Entitypateldrona
We describe a case report of 20 years old female with pigmentation over the dorsum of the tongue since childhood. Examination of the oral cavity showed pigmentation of fungi form papilla on lateral and dorsal aspect of tongue.
Dexmedetomidine or Clonidine: Anesthetist’s Choice in Laparoscopic Gynecologi...AnonIshanvi
Laparoscopic surgeries have revolutionized surgical domains. It involves inflation of abdomen with carbon dioxide (CO2) which alters hemodynamic and metabolic parameters. This randomized prospective study was conducted in the department of Anesthesiology, tertiary care government hospital on 48 patients undergoing diagnostic...
Pigmented Fungi Form Papilla of The Tongue – A Rare EntityAnonIshanvi
This case report describes a 20-year-old female patient presenting with pigmentation over the fungi form papillae on the dorsal surface of her tongue since childhood. Examination showed diffuse symmetrical pigmentation of the fungi form papillae. Pigmented fungi form papillae of the tongue is a rare benign condition where multiple projections on the tongue containing taste buds have pigmentation. It is more commonly seen in certain races like Asians and Africans. The pathogenesis is unclear but some studies have found associations with dermatological or systemic conditions. No treatment is required as it is a benign variant with differential diagnoses including other oral pigmentation conditions.
Pigmented Fungi Form Papilla of The Tongue – A Rare EntitySarkarRenon
We describe a case report of 20 years old female with pigmentation over the dorsum of the tongue since childhood. Examination of the oral cavity showed pigmentation of fungi form papilla on lateral and dorsal aspect of tongue...
Pigmented Fungi Form Papilla of The Tongue – A Rare Entitygeorgemarini
This case report describes a 20-year-old female patient presenting with pigmentation over the dorsum of her tongue since childhood. Examination showed pigmentation of fungal-like papillae on the lateral and dorsal aspects of the tongue. Pigmented fungi form papillae of the tongue is a rare benign condition where multiple projections on the tongue containing taste buds become pigmented. The pigmentation is usually diffuse and symmetrical with no associated symptoms. No treatment is required as it is a benign condition.
Diplopia Caused by Salmonella enteritidis Infectioniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Similar to Papillon–Lefevre Syndrome: A Case Report with Review of Literature (20)
Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an
esthetic and functional restorative treatment. . Fixed prosthodontic and removable prostheses, resin bonded retainers, orthodontic movement of maxillary
canine to the lateral incisor site and single tooth implants represent the available treatment modalities to replace congenitally missing teeth. This case report
demonstrates the team approach in prosthetic and surgical considerations and techniques for managing the lack of lateral incisors. The aims of this case
report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations.
Impacted Maxillary Central Incisors: Surgical Exposure and Orthodontic Treat...Abu-Hussein Muhamad
The maxillary permanent central incisor develops early in life and forms part of an aesthetic smile. Disruption of the formation or eruption of the permanent
central incisor has multiple etiological factors. Treatment options depend to some extent on the cause of failure of eruption of the central incisor. Generally,
the earlier treatment is provided, the higher the likelihood of success and the less the complexity. Our results suggest that close monitoring and interdisciplinary
cooperation during the treatment phases led to a successful esthetic result, with good periodontal health and functional occlusion.
Excess of space in the dental arch is diagnosed as a
generalised spacing or a local divergence, often
observed in the maxillary anterior region, as a median
diastema, traumatic loss of central incisors, or
congenital absence of lateral incisors. Furthermore,
spacing is observed in aging individuals, due to
pathological migration of teeth caused by
periodontitis. Finally, adult individuals with partial
edentulous jaws demand pre-prosthetic orthodontic
treatment from functional aspects. Thus, indication for
orthodontic treatment in subjects with spacing of teeth
exists for aesthetic reasons, but also for facilitating
prosthetic restorations with optimal occlusalstability.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting
cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically
induced failures, since low primary implant stability, low bone density, short implants and overload have been
identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a
successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field.
This document provides guidance on how to write and publish a scientific paper in 3 steps:
1. Plan adequate time for writing a high-quality paper that will be accepted for publication. Previous studies show lack of time is the top reason papers are not published.
2. Carefully review the instructions for authors on the target journal's website and adhere strictly to formatting requirements. Ignoring guidelines is a common reason for rejection.
3. The paper should have key sections - an informative abstract, introduction establishing the study's purpose and novelty, thorough methods section, clear results, and conclusions tying it all together. Following best practices increases the chances of successful publication.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations
Orthodontic tooth movement is basically a biologic response towards a mechanical force. Osteoclast and osteoblast cells mediate bone resorption and apposition, which eventually produces tooth movement. Researches showed that the rate of orthodontic tooth movement can be altered by certain drugs locally or systemically. The Objective of this article is to discuss the current data concerning the effect of drugs on orthodontic tooth movement.
Multidisciplinary Approach in the Rehabilitation of Congenitally Maxillary C...Abu-Hussein Muhamad
Objective: This case report describes the multidisciplinary
approach to treat a congenitally missed maxillary canine, how to
improve patient’s smile using orthodontic fixed appliance, endosseous
dental implant, and porcelain veneer to achieve the treatment results of
function and esthetic.
Materials and procedures: Unilateral agenesis of the permanent
maxillary canines in healthy individuals is extremely rare. This
paper presents the case of a female patient diagnosed with congenital
unilateral agenesis of the permanent maxillary canines as well as
occlusal abnormalities in the form of left-side crossbite. To restore the
proper aesthetics and function, interdisciplinary therapeutic treatment
was implemented. In the case presented in this paper, the aim of
oral rehabilitation was to restore a functional balance by obtaining
proper skeletal relationships, creating optimal occlusal conditions and
obtaining arch continuity.
Conclusion: Interdisciplinary treatment combined of orthodontics,
implant surgery, and prosthodontics was useful to treat a nonsyndromic
oligodontia patient. Especially, with the new strategy, implantanchored
orthodontics, which can facilitate the treatmentand make it
more simply with greater predictability.
The multifactorial factors influenc cleft Lip-literature review Abu-Hussein Muhamad
Congenital cleft-Lip and cleft palate have been the subject of many genetic
studies, but until recently there has been no consensus as to their modes of
inheritance. In fact, claims have been made for just about every genetic
mechanism one can think of. Recently, however, evidence has been
accumulating that favors a multifactorial basis for these malformations. The
purpose of the present paper is to present the etiology of cleft lip and cleft palate
both the genetic and the environmental factors. It is suggested that the genetic
basis for diverse kinds of common or uncommon congenital malformations may
very well be homogeneous, whilst, at the same, the environmental basis is
heterogeneous.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically induced failures, since low primary implant stability, low bone density, short implants and overload have been identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field
Over time, progressively shorter implants have been placed such that short implants are now available that are less than 6 mm in length. The viability and high success rates seen with short implants can be explained by osseointegration, the macro geometric design of the implant, as well as physics and the distribution of forces. This paper was aimed to review the stability and survival rate of short implants under functional loads. Numerical and clinical studies were reviewed. Keywords: Short dental implants, sinus augmentation, factors affecting bone regeneration in dental implantology
Porcelain laminate veneers are among the most esthetic means of creating a more pleasing and beautiful smile. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation, approximately 0.5 mm to 0.7mm of surface enamel reduction. This study describes the use of ceramic veneers without tooth wear, reinforcing the concept that minimally invasive porcelain laminate veneers could become versatile and conservative allies in the fi eld of esthetic dentistry. Keywords: Ceramics, dentin-bonding agents, esthetics
Immediate Restoration of Single Implants Replacing Lateral Incisor Compromis...Abu-Hussein Muhamad
Today, the diagnosis of internal root resorption is significantly improved by the three-dimensional imaging. Furthermore, the CBCT’s superior diagnosis accuracy resulted in an improved management of the resorptive defects and a better outcome of Implant therapy of teeth with internal resorption.Implant has become a wide option to maintain periodontal architecture. Diagnosis and treatment planning is the key factors in achieving the successful outcomes after placing and restoring implants placed immediately after tooth extraction. The purpose of this clinical update is to report on the success and survival of Immediate restoration of single implants replacing right lateral incisor compromised by internal resorption.
Immediate Implant Placement And Restoration With Natural Tooth In The Maxilla...Abu-Hussein Muhamad
Anterior tooth loss and restoration in the esthetic zone is a common challenge in dentistry today. The prominent visibility of the area can be especially distressing to the patient and requires a timely and esthetically pleasing solution. Immediate single-tooth implantation followed by immediate provisionalization is becoming an increasingly desirable treatment that offers numerous benefits over conventional delayed loading. Provisionalization for immediately-placed implants using the patient’s existing tooth can enhance the final aesthetic outcome if certain steps are
followed. If the natural tooth is intact and can be used as a provisional, the emergence profile can be very similar to the preoperative condition. This article outlines a technique to use the patient’s natural tooth after extraction to provisionalize an implant.
Clinical Management of Bilateral Impacted Maxillary CaninesAbu-Hussein Muhamad
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
“One-Piece” Immediate-Load Post-Extraction Implant In Maxillary Central IncisorAbu-Hussein Muhamad
Abstract: This case report describes extraction of a fractured left maxillary central incisor tooth, followed by immediate placement of an one-piece implant in the prepared socket and temporization by a bonded restoration.
Materials And Methods: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. The socket was prepared to the required depth and a Implant was inserted.
Results: The atraumatic operating technique and the immediate insertion of the one-piece Implant resulted in the preservation of the hard and soft tissues at the extraction site.
Conclusion: The “One-piece” dental implant and provisional restoration provided the patient with immediate esthetics, function, comfort and most importantly preservation of tissues. The one-piece implant design resulted in a high cumulative implant survival rate and beneficial marginal bone levels.
Single Visit Replacement of Central Maxillary Using Fiber-Reinforced Composi...Abu-Hussein Muhamad
Fiber reinforced composites are high strength filling materials composed of conventional composites and glass fibres. They exhibit extensive applications in different fields of dentistry. This clinical report present a case where FRC technology was successfully used to restore central maxillary incisor edentulous area in terms of esthetic-cosmetic values and functionality.
Zirconium Dental Implants And Crown for Congenitally Missing Maxillary Latera...Abu-Hussein Muhamad
Zirconia implants were familiarized into dental implantology. Zirconia appears
to be an appropriate implant material due to its low plaque affinity, tooth like color, biocompatibility and mechanical properties. The following a case presentations will show how the acid-etched zirconia Implant can be used to functionally and aesthetically replace congenitally missing left lateral incisor tooth germ in the maxilla, and achieve optimal soft tissues and health.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Papillon–Lefevre Syndrome: A Case Report with Review of Literature
1. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)
e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 2 Ver. X (Feb. 2016), PP 00-00
www.iosrjournals.org
DOI: 10.9790/0853-1521XXXXX www.iosrjournals.org 1 | Page
Papillon–Lefevre Syndrome: A Case Report with Review of
Literature
Abu-Hussein Muhamad*, Abdulgani Azzaldeen**,Chlorokostas
Georges***,Koyremada Thomy****
*University of Naples Federic II, Naples, Italy, Department of Pediatric Dentistry, University of Athens,
Athens,Greece.
**Department of Conservative Dentistry, Al-Quds University, Jerusalem, Palestine
***Implantologist,Private dental practice,Athens,Greece
****Hair Implant Surgeon, , London,UK
Abstract :papillon-Lefèvre Syndrome (PLS) Is A Very Rare Autosomal Recessive Disorder Characterized By
Palmoplantar Hyperkeratosis And Severe Early Onset Of Destructive Periodontitis Leading To Premature Loss
Of Both Primary And Permanent Dentitions. Here We Are Presenting Case Report Of Siblings Who Presented
With Palmoplantar Hyperkeratosis And Aggressive Periodontitis.
Keywords: Papillon-Lefèvre Syndrome, Periodontitis, Palmoplantar, Hyperkeratosis, Cathepsin C
I. Introduction
The Papillon-Lefevre Syndrome Was First Described In 1924 As A Rare Autosomal Recessive Genetic
Disorder By Two French Physicians Papillon And Lefevre.[1] Characteristically It Is A Diffuse Hyperkeratosis
Of Palm And Soles With Severe Periodontitis. Prevalence Of 1-4 Cases Per Million And Carrier Frequency Of
2-4 Per 1000 Population Is Reported With Equal Male And Female Predilection And No Racial
Predominance.[2] In Literature Various Terminologies Have Been Used For PLS; Palmar-Plantar
Hyperkeratosis With Severe Periodontal Dystruction Involving Both Primary And Permanent Dentition,
Palmoplantar Keratoderma With Periodontitis, Keratoris Palmoplantaris With Periodontopathia, Hyperkeratosis
Palmoplantaris With Periodontitis.[3] The Recently Identified Genetic Defect In PLS Has Been Mapped To
Chromosome 11q14–Q21, Which Involves Mutations Of Cathepsin C .[4] Studies In PLS Patients Have Shown
More Than 90% Reduction In Cathepsin C Activity. Despite These Advances In
Characterizing The Genetic Basis Of The Syndrome, The Pathogenic Mechanisms Leading To The
Periodontal Involvement Remain Elusive.[5] An Impaired Chemotatic And Phagocytic Function Of
Polymorphonuclear Leukocytes (Pmns) Has Been Described In Many Reports.In Contrast To The,Above
Studies, However, Reported Normal PMN Chemotaxis. Few Reports Have Addressed Lymphocyte Function In
PLS.[6]
Periodontal Effects Appear Almost Immediately After Tooth Eruption When Gingiva Become
Erythematous And Oedematous. Plaque Accumulates In The Deep Crevices And Halitosis Can Ensue. The
Primary Incisors Are Usually Affected First And Can Display Marked Mobility By The Age Of 3 Years. By The
Age Of 4 Or 5 Years, All The Primary
Teeth May Have Exfoliated [7]. Treatment With Oral Hygiene Instructions, Scaling And Root Planing
Has Been Reported Unsuccessful1[8]. Non-Surgical Treatment Combined With Use Of Systemic Antibiotics21-
24 And Additional Periodontal Surgery Has Also Been Reported To Fail. Following Such Tooth Loss, The
Gingival Appearance Resolves And May Well Return To Health Only For The Process To Be Repeated As The
Permanent Dentition Starts To Erupt1. The Majority Of The Teeth Are Lost By The Age Of 14–15 Years.[7,8,9]
Generally The Patient Consults Dentist First Because Of Premature Teeth Loss And Associated Problems. This
Clinical Report Describes Such A Rare Condition With Special Attention On Its Diagnostic Characterization,
Various Treatment Options And Prosthodontic Rehabilitation.
The Purpose Of This Paper Is To Demonstrate Clinical As Well As Radiological Features Of Papillion Lefevre
Syndrome.
II. Case Report
A 9-year old female,Syrian immigrants in Greece was referred to my pediatric dental clinic , complaining
of loose teeth, red bleeding gums and oral malodour.The patient presented with de-pigmented hair,white-pink
skin, nystagmus and palmoplantar keratosis with normal nails.
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Figure 1 a-b; Showing missing anterior teeth with red inflamed
The family history revealed consanguineous marriage of the parents. The parents and other family
members were not affected. Pregnancy and delivery were normal. The mother had noticed skin lesions on the
palms and soles of the children when they were 5 months old. Figur .1 a-b
Intraoral examination revealed that the patient had poor oral hygiene with most of his teeth mobile (grades I and
II); the gingiva was oedematous, inflamed and bled profusely when examined. The panoramic view showed
generalized advanced bone loss.It was found that the teeth numbers;16,26,36,46,41,42,31,32was presents,but
55,54,53,63,64,65,75,74,73,83,84,85 all are lost. Mobility was present in all the permanent teeth that were
present. The gingiva in relation to the existing permanent teeth was red, soft, and edematous, with deep
periodontal pockets and bleeding on probing. OPG of the patient showed severe alveolar bone loss in relation to
the existing permanent teeth up to the level of the apical third of roots, giving the teeth a “floating in air”
appearance. Figure.2
Figure 2: OPG showing severe loss of alveolar bone and teeth appear to be “floating in air.”
On extraoral examination, there were symmetrical, well-demarcated, keratotic, and confluent plaques affecting
the skin of the palms and soles, which extended to the dorsal surface of the finger joints. The skin was dry and
rough on palpation. The hair and nails appeared normal. Figure .3,4
Figure 3: Hyperkeratinization with keratotic plaque on the palmer surface of hand
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The dermatologist prescribed an abdominal ultrasound and a skull x-ray; results from both examinations were
normal with no hepatosplenomegaly and no dural calcifications, which are commonly found among PLS
patients. The results from a complete blood count examination revealed an elevated erythrocyte sedimentation
rate (ESR) count; (42 mm/h),suggesting an inflammation.
Figure 4: Keratotic plaque and hyperkeratinization of the palnter surface of feet
Treatment of the dermatology condition was conservatively planned, with emollients and keratolytics
including salicylic acid; this post;poned the use of ora! retinoids including acitretin, etretinate and isotretinoin
considering the patient’s age and their side effects, such as hepatic and renal toxicity arising from the use of oral
retinoids. As for dental cate, we began by enforcing oral-hygiene related-habits; by teaching and encouraging
the patient to brush his teeth and use mouth washes regularly. Full-mtuth scaling followed by extraction of the
painful mobile teeth was performed. Then, a combination of Augmentin (20–50 mg/kg/d) and Metronidazole
(15–35 mg/kg/d) in divided doses was prescribed, every 8 h for 14 days, after which the patient was followed-up
through monthly appointments.
In both case based on the history, clinical examination, and radiographic examination, a provisional
diagnosis of Papillon-Lefèvre syndrome was made. For the conformation of the diagnosis, dermatological
consultation was advised and blood samples were sent for genetic mapping . Result of the genetic mapping
revealed For the conformation of the diagnosis, dermatological consultation was advised and blood samples
were sent for genetic mapping . Result of the genetic mapping revealed abnormal gene at 11q14.1–q14.3 in both
cases. This gene is commonly defective in patients with Papillon-Lefèvre syndrome, which confirmed the
diagnosis of the case.
III. Discussion
PLS is an autosomal recessive inherited disorder, it means both parents will be phenotypically healthy
and must carry the autosomal gene for the syndrome, no family history of the disorder except for the affected
person and some siblings. PLS is suggested to be because of mutation in cathepsin C gene located on
chromosome 11q14.1-q21 [10]. This cathepsin C gene encodes for cysteine lysosomal protease known as
dipeptidyl-peptidase I. It removes dipeptides from amine terminals of the protein substrates. This gene is
expressed in epithelial regions and in various immune cells like PMNLs, macrophages and their precursors. [11]
In PLS, most severely affected regions are the keratinized gingivae of oral cavity, skin of palms and soles.
Lysosomal protease enzyme plays an important role in maintaining the balance between oral microflora and
immune system through protein degradation and proenzyme activation. Mutation in this enzyme lead to altered
host response to pathogenic microorganisms in dental plaque. It is documented in literature that alterations in
cathepsin C gene lead to pre pubertal periodontitis in PLS patients .[12] The characteristic dermatological
lesions of symmetric palmoplantar keratosis of hands and feet including the dorsal surfaces of the extremities
and others (elbows and knees) was first noticed at about the age of 2 years consistent with most reports in the
literature.[1,5,7] These lesions have been reported to be more severe during cold weather as also evidenced in
this case.[ 13] There was a positive history of manifestation of recurrent pyogenic skin infections since early
childhood, a finding which was also demonstrated by Subramaniam et al. and could be attributed to the
increased susceptibility to bacterial infections in these patients. Furthermore, the application of traditional
ointment could also predispose the patient to recurrent skin infection and perhaps aggravated it.[14] Severe
periodontal and alveolar bone destruction in children necessitates that a diagnosis should be reached to exclude
any life-threatening disorders. These include leukaemia and neutropenias, where loosening of the teeth is an
associated feature, along with extensive gingivitis, haemorrhage and ulceration . Other disorders where
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premature loss of primary and/or permanent teeth occur include; hypophosphatasia, Langerhan's cell
histiocytosis, Chediak–Higashi syndrome, acrodynia and acatalasia [15]. The patients discussed in this paper
presented with prepubertal periodontal destruction with concomitant palmar-plantar hyperkeratosis diagnosed as
PLS. Singh et al.[16] and Hattab et al.[17] attributed its etiology into three main factors which are reportedly
responsible for the initiation and progression of this syndrome. These are inflammatory/immunology,
microbiology, and genetic. An impairment of neutrophil chemotaxis, phagocytosis, and bactericidal activities
accompanied by a decrease in natural killer cellmediated cell killing via myeloperoxidase deficiency and low
integrin expression have been widely reported. In addition, there is functional impairment of the
immunemediated mechanism of monocytic and lymphocytic cells to pathogens, depression of helper/suppressor
T-cells ratio, elevation of serum IgG, and degenerative changes of plasma cells were identified. Furthermore,
disruption of fibroblast and cementoblast function with defective periodontal ligament attachment and gingival
epithelium has been observed the above mentioned have been widely reported in the literature as host
contributory factor in the development of PLS.[16,17]
Another component of PLS may be radiographic evidence of intracranial calcification in choroid
plexus and tentorium. Although this has been taken as cardinal feature, being inconsistent it is not considered
important for the diagnosis. Histopathological examination reveals non-specific hyperkeratosis, acanthosis focal
parakeratosis, psoriasiform hyperplasia, torturous capillaries in dermal papillae and superficial lymphocytic
infiltration[18]
Immunologic, microbiologic, and genetic bases have been proposed. A decreased chemotactic and
phagocytic function of neutrophils, myeloperoxidase deficiency, and low integrin expression has also been
suggested as the possible pathogenesis Capnophilic and facultatively anaerobic species mainly Capnocytophaga
spp and Streptococcus spp, have also been demonstrated by microbiological studies[19]. Some previous case
reports revealed that human herpes viruses (HSV) in concert with actinobacillous actinomycetemcomitans (AA)
play an important role in the development of PLS periodontitis.[20]
Recently, the molecular basis underlying the etiopathogenesis of PLS has been established. A
genetically demonstrated loss-of-function mutations affecting both alleles of the lysosomal protease CTSC gene
in patients with PLS and subsequent dysregulation of localized polymorphonuclear leucocytes in inflamed
periodontal tissues has been confirmed.[9,13] The CTSC gene, which is located on chromosome 11q14.1-q14.3
has endopeptidase activity, a lysosomal protein and is expressed in epithelial regions commonly affected by PLS
including palms, soles, knees, and keratinized oral gingival.[12,13] Furthermore, high levels of expression of
this gene have been found in various immune cells including polymorphonuclear leukocytes, macrophages, and
their precursors.[9,10] lysosomal protease enzyme plays an important role in maintaining the balance between
oral microflora and immune system through protein degradation and proenzyme activation. Hence, a mutation in
this gene with consequent dysfunction of this enzyme leads to the altered host response to pathogenic
microorganisms in dental plaque and periodontal pocket. It is documented in the literature that alterations in
CTSC gene lead to prepubertal
periodontitis in PLS patients.[21]
Gelmetti reported that retinoid therapy could posi-tively influence the development of normal dentition
in Papillon Lefevre Syndrome, if it is started during the eruption of the permanent teeth, and suggests that this
result can be maintained for a long time even after stopping therapy.[22] Treatment consisted of extractions of
periodontally involved teeth under antibiotic cover and treatment with etretinate resulted in a marked
improvement of the palmar and plantar skin lesions.[23,24]
A multidisciplinary approach is important for the care of patients with PLS. The skin manifestations of
PLS are usually treated with emollients. Salicylic acid and urea may be added to enhance their affects. Oral
retinoids including acitretin, etretinate and isotretinoin are the mainstay of the treatment of both the keratoderma
and periodontitis associated with PLS. Treatment may be beneficial if it is started during the eruption and
maintained during the development of the permanent teeth.[23,24,25] The periodontitis in PLS is usually
difficult to control. Effective treatment for the periodontitis includes extraction of the primary teeth combined
with oral antibiotics and professional teeth cleaning. A course of antibiotics should be tried to prevent
bacteremia and subsequent pyogenic liver abscess. The risk of pyogenic liver abscess should be kept in mind in
evaluating these patients when they present fever with unknown origin.[1,7,24,25] Because of the involvement
of several structures a multidisciplinary approach is required in the management of patients with LPS. Patients
were referred to the dermatologist for cutaneous lesion. For periodontitis, both the patients were prescribed
appropriate antibiotics with 0.2% chlorhexidine gluconate mouth rinse and the patients were educated about
importance of oral hygiene. Extraction of the mobile teeth with severe periodontitis was advised and the patients
were referred to the prosthodontics for prosthesis fabrication. Presently patients are undergoing planned dental
extractions with periodontal therapy & are kept on regular follow-ups.
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Good dental care with the use of prophylactic antibiotics aims to minimize periodontitis and the loss of
teeth by eradication of A.actinomycetemcomitans and Capnocytophaga. Alternatively, synthetic retinoids can be
used for this purpose.[28]
Most paitients end up losing all their teeth at an early age and are pretentied with prosthetic problems
posed by severely atrophic thin alveolar ridges. Preprosthetic surgical techniques have been introduced as to aid
retention and stability of dentures. Alternatively, dental implants that offer not only considerably better stability
and retention of prosthesis but also improved comfort and masticatory efficiency along with satisfactory
aesthetics are available. The use of titanium implants in patients with severe periodontitis has been reported, and
the results indicate that periodontally compromised patients can be successfully treated using this method.
IV. Conclusion
Papillon Lefevre syndrome is an uncommon inherited disorder which shows both cutaneous and oral
involvement affecting the social well-being of the patient. The dental surgeons and the der-matologist should be
aware of this unusual entity so as to diagnose and manage promptly and accordingly.Combined cooperation
from dermatologists, pediatrician, periodontists, and prosthodontists is critical for the overall care of patients
suffering from PLS, which although a very rare condition, can lead to long-lasting psychological and social
trauma to the growing patient.
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*Corresponding Author;
Dr.Abu-Hussein Muhamad
DDS,MScD,MSc,MDentSci(PaedDent) ,FICD
123Argus Street
10441 Athens, Greece