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Nevus flammeus, which is also known as port-wine stain (PWS), is one of the vascular birthmarks. PWS occurs in 0.3% of the newborns in both genders. It is a capillary vascular malformation, characterized by a pink or red stain and may involve skin, soft tissue and/or bone. There are a very limited number of reports regarding intraoral involvement of PWS. We report 2 female patients with PWS from date of birth. The first patient was an 11-year-old female who applied to our clinics for the treatment of her non-aesthetic and deviated intraoral view and discoloration of her gingiva, and the second patient was a 56-year-old female who applied for the extraction of her wisdom tooth. Extraoral examination in both patients revealed a diffuse PWS on the right side of their face over the cheek, extending from the midline. While the first patient had reddish skin, gingiva on right site her both jaws and lips, the second patient had only her upper jaw and lip. Because of the first patient’ age, the treatment postponed to her 20’, and the second patient did not accept any treatment. PWS is a rare and non-fatal condition; however, the unique appearance of these patients can lead to psychological problems especially in early ages. more...

Juvenile hyaline fibromatosis (JHF) is a rare hereditary disease with an autosomal recessive transmission. JHF is characterized by papulonodular skin lesions, osteolytic bone lesions, flexural joint contractures, and gingival hyperplasia and usually diagnosed in infancy or early childhood. JHF is thought to be a disorder of collagen metabolism and characterized by homogenous amorphous eosinophilic material and fibrous tissue. We report the case of a 14-year-old male child with multiple papulonodular skin lesions, progressive flexion contractures of joints, and severe gingival hyperplasia, with a 10-year follow-up. Although the lesions were totally removed thrice during the last 10 years, they recurred rigorously., Competing Interests: There are no conflicts of interest. What is new? The present case is unique due to 10 years follow up, rapidly progressive tissue overgrowth, and severe stiffness of the joints which is life threatening.The treatment of gingival hyperplasia due to JHF is surgical removal of the enlarged tissues; however, recurrences are common. more...

Unlabelled: Progressive speech and language disorders are commonly referred to as primary progressive aphasia (PPA), which is a clinical syndrome eroding both speech and language. Functional imaging may reveal the cause of this disorder even if structural imaging is absent. Fluorine-18- fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) allows the assessment of neuronal activity by semi-quantitatively measuring glucose metabolism in the brain. In medical literature, (18)F-FDG PET/CT studies show hypometabolic areas in different regions of the brain which are special clues for differentiating the subgroups of PPA., Conclusion: This case was reported to demonstrate the characteristic (18)F-FDG PET CT findings for a semantic variant of PPA. more...

Purpose: Previous studies have suggested coronectomy as an alternative procedure to decrease the risk of inferior alveolar nerve (IAN) injury when there are high-risk findings observed on panoramic radiographs. However, the exact relation between the inferior alveolar canal and the roots is not obvious on 2-dimensional imaging. The aim of this study was to evaluate the success of coronectomy by comparing it with conventional extraction for the treatment of the patients who had clear IAN injury risks that were determined on 3 dimensions by computed tomography., Patients and Methods: Two hundred and sixteen teeth of 124 patients were evaluated by computed tomography and 175 teeth of 120 patients were enrolled in the study. Teeth were divided into an extraction group (n = 87) and a coronectomy group (n = 88) according to the operations planned., Results: The mean follow-up time of the study was 17.29 months. There were 2 patients in the extraction group who had moderate IAN injuries that resolved in 1 month. Also 1 case of dry socket was observed in the extraction group and 1 patient in the coronectomy group had minor infection 1 month postoperatively, which was treated with antibiotics and subgingival irrigations. There were 2 failed coronectomies and neither had any postoperative complications. No cases of lingual nerve injury were noted in this study., Conclusions: Coronectomy appears to be a preferable alternative with a low incidence of complications and therefore a suggested technique for the treatment of impacted mandibular molars when there is a high risk of IAN injury., (Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.) more...

Background: The purpose of this study was to evaluate the expression of inducible nitric oxide synthase (iNOS) in the gingival tissues of periodontitis patients with and without type 2 diabetes to assess whether NO plays a role in the severity of periodontitis in patients with diabetes. Patients with diabetes and healthy patients were used as controls., Methods: A total of 80 patients were evaluated in four groups (with 20 subjects each): patients with chronic periodontitis and diabetes (12 males and eight females; mean age, 52.1 +/- 6.9 years), patients with chronic periodontitis who were otherwise healthy (12 males and eight females; mean age, 43.1 +/- 8.9 years), periodontally healthy patients with diabetes (12 males and eight females; mean age 50.9 +/- 6.3 years), and systemically and periodontally healthy control subjects (12 males and eight females; mean age 29.8 +/- 9.2 years). Periodontal parameters were recorded. Immunohistochemistry was used to detect inflammation and iNOS expression in gingival tissues., Results: Although periodontal parameters were slightly higher in periodontitis compared to diabetic periodontitis, immunohistochemical parameters were higher in diabetic periodontitis compared to periodontitis. All periodontal parameters were higher in patients with periodontitis and with/without diabetes compared to controls and patients with diabetes. All immunohistochemical parameters were higher in patients with diabetes and periodontitis compared to patients with only diabetes or periodontitis, but there was no difference between the latter two groups. There was a correlation between the expression of iNOS and inflammatory cells in controls, patients with diabetes, and patients with periodontitis but not in patients with diabetes and periodontitis., Conclusions: Inflammation and iNOS expression were more prominent in the gingiva of the patients with both diabetes and periodontitis. However, iNOS expression did not seem to have an additional detrimental effect on the course of periodontitis in patients with diabetes compared to those with periodontitis alone. more...

Alport Syndrome (AS) is an important hereditary disorder affecting the glomerular basement membrane. Diagnosis of AS is based on the presence of hematuric nephropathy, renal failure, hearing loss, ocular abnormalities and changes in the glomerular basement membrane of the lamina densa. The aims of this case report were to show the changes in the gingival tissues in a patient with AS under therapy with cyclosporin-A after renal transplantation and to discuss the possible role of type IV collagen in gingival basal lamina as an alternative approach for the diagnosis of AS. A 20-year-old male patient with AS underwent periodontal therapy including a series of gingivectomy surgeries. Gingival samples obtained during the second surgery were examined histopathologically and by transmission electron microscopy for further pathological examination. Gingivectomy procedures have been performed every 6 months over the last 4 years. The excessive and fibrous gingival enlargements resulted in migration of the anterior teeth, but no alveolar bone loss occurred. This is the first report to demonstrate the possible changes in the gingival tissues caused by AS. It is suggested that gingival biopsy can be an initial diagnostic tool instead of renal or skin biopsies. Proper dental and periodontal care and regular visits to the dentist could provide limited gingival hyperplasia to patients with AS. more...

Aim: This study aimed to evaluate clinical outcomes of titanium membrane and compare these findings with clinical outcomes of e-PTFE membrane, and to investigate the effect of bacterial contamination on both membranes with SEM during long-term healing., Results: Sixteen titanium and sixteen e-PTFE membranes were surgically placed adjacent to periodontally involved teeth. Seven titanium and 8 e-PTFE membranes were exposed between 4 and 6 weeks. There were no significant difference between groups for plaque and gingival index. Probing depth and clinical attachment level (CAL) were decreased in both groups when compared with baseline; however, these differences were not statistically significant. The CAL gains between the groups were statistically different in 3rd, 6th, 9th, 12th, and 24th months (p < 0.05), and the CAL gain was significantly higher in titanium membrane (p < 0.05). There was significant decrease in bleeding on probing from baseline in both groups (p < 0.05). Surfaces of 15 membranes were studied using SEM. The largest amount of bacteria was found on the external cervical surfaces of 15 exposed specimens. The entire surface showed the presence of slough epithelial cells, leukocytes, red blood cells, yeast, and microbial plaque. Thirteen external mid surfaces of the 15 specimens, external apical surfaces of three e-PTFE and 1 titanium membrane, internal collar surfaces of all specimens, internal mid surfaces of 5 e-PTFE and three titanium membranes and internal apical surface of only one e-PTFE membrane were infected., Conclusions: This study demonstrated that titanium membrane is equivalent to e-PTFE membranes for GTR in the treatment of periodontal defects. more...

Background: Health-related quality of life (HRQOL) is a multidimensional concept regarding quality of life (QOL) as it relates specifically to health and disease. The effect of ongoing hemodialysis on a person's oral health can be determined by clinical variables, but these do not reflect the person's perception of health versus illness. The authors conducted a study to determine the periodontal status, attitude toward oral health and self-perceived oral health in patients undergoing hemodialysis, as well as to evaluate the effect of oral health on QOL within this group., Methods: Patients undergoing hemodialysis were evaluated for socio-demographic and periodontal variables. The authors evaluated oral health-related quality of life (OHRQOL) by means of the short-form Oral Health Impact Profile (OHIP-14) and the General Oral Health Assessment Index (GOHAI). They measured perceived oral health by asking a single question., Results: The study involved 47 patients undergoing hemodialysis. Plaque index score, gingival index score, probing depth and bleeding-on-probing status were 2.21 +/- 0.66, 1.24 +/- 0.77, 2.17 millimeters +/- 0.53 mm and 33.51 percent +/- 24.58 percent, respectively. Participants reported being uncomfortable when eating or swallowing. Participants reported being sensitive to hot or cold (69.8 percent), having a worse sense of taste (90.8 percent) and having painful aching in the mouth (72.1 percent). The mean OHIP-14 and GOHAI scores were 19.40 +/- 7.74 and 15.72 +/- 8.68, respectively., Conclusions: The self-perceived health of 72.7 percent of participants undergoing hemodialysis was fair or poor, and the impact of OHRQOL was moderate, which means that oral health was not a major concern. These results underscore the importance of using subjective and self-reported oral assessments to determine more convenient and satisfying treatment approaches for each patient., Clinical Implications: Clinicians should use oral health assessment tools to determine individual treatment and approaches to promote the oral health of patients undergoing hemodialysis and improve their QOL. more...

Background: Dental pain, anxiety, and fear may result in avoiding dental treatment. In this study, we aimed to evaluate patients' pain perception during scaling and its relationship with dental anxiety., Methods: One hundred thirteen patients (72 women and 41 men; mean age, 35.59 +/- 9.28 years) participated. Pain levels after scaling were assessed with a visual analog scale (VAS) and an anxiety questionnaire consisting of seven questions, each with five possible answers., Results: The patients were asked to indicate their pain level on a 100-mm VAS, and the mean VAS score was 19.91 +/- 17.76 mm. No age and gender differences with regard to pain perception were found. VAS scores were significantly higher in non-smokers (P <0.001); there was a slightly significant relationship between smoking and pain (0.264; P <0.05). The anxiety score ranged from 7 to 35; the mean anxiety score was 14.00 +/- 5.30 (range, 7 to 29). The anxiety score was significantly higher in women (P <0.001). The only question correlated with pain during scaling in men was, "How fearful are you of having your teeth cleaned?" (0.322; P = 0.040). Scores for patients aged 29 to 39 years were significantly higher than scores for those aged 51 to 61 years (P <0.01)., Conclusions: Although most patients experienced limited pain during scaling, a significant relationship was found between pain and smoking. Women and patients aged 30 to 40 years are likely to be more anxious during scaling. The question, "How fearful are you of having your teeth cleaned?" may not adequately cover all aspects of anxiety for patients' experience of pain during scaling. Clinicians should determine individual treatment approaches to reduce patients' fear, pain, and anxiety related to scaling. more...

Localized aggressive periodontitis (LAgP) is a complex multifactorial periodontal disease to which genetic factors are thought to predispose individuals. Interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-alpha) are potent immunomodulators and proinflammatory cytokines that have been implicated in the pathogenesis of autoimmune and infectious diseases and proposed to be risk factors for LAgP. Our aim was to investigate IL-1 alpha (+4845), IL-1 beta (+3954), and TNF-alpha (-308) gene polymorphisms in Turkish LAgP patients. We genotyped 31 LAgP patients and 31 healthy controls for IL-1alpha(+4845), IL-1beta(+3954), and TNF-alpha(-308) using standard PCR amplification followed by restriction enzyme digestion and gel electrophoresis. Higher prevalence of heterozygosity for IL-1alpha(+4845) was found in cases (65%) when compared to controls (35%) (P < 0.05). While homozygous allele 1 of IL-1beta(+3954) was the most frequent genotype in cases (62%), no controls were homozygous for this allele (P < 0.001). Homozygous allele 1 was the most common TNF-alpha genotype in both groups, however no significant difference in TNF-alpha genotypes was found between groups. In conclusion, in this Turkish population, susceptibility to LAgP is increased by heterozygosity for allele 1 of IL-1alpha(+4845) or homozygosity for allele 1 of IL-1beta(R+3954). Moreover, IL-1 gene polymorphisms appear to have a role in susceptibility to LAgP, and the above-mentioned genotypes could be an important risk factor for LAgP in the Turkish population. more...

Study Objectives: To compare the clinical effectiveness of two peripheral nerve block techniques combined with sciatic nerve block: sciatic psoas compartment (SPC) and sciatic femoral 3-in-1 (SF 3-in-1) block., Design: Prospective, randomized study., Setting: Military medical academy hospital., Patients: Thirty-six ASA physical status I patients, aged 20 to 33 years, undergoing elective knee arthroscopy., Interventions: Patients having SPC block (n = 19) or SF 3-in-1 block (n = 17) received 40 mL of a mixture of solution containing 15 mL of 0.5% bupivacaine, 15 mL of 2.0% prilocaine, and 10 mL of 0.9% sodium chloride. In both groups, the sciatic nerve was blocked with 20 mL of the same solution. An intravenous bolus injection of fentanyl 0.1 mg was used if patients complained of pain., Measurements and Main Results: None of the patients in the SPC group experienced pain owing to the applied tourniquet during the operation, whereas 7 patients from the SF 3-in-1 group (41.2 %) reported tourniquet pain. All SF 3-in-1 group patients but only 5 patients (26.3 %) in the SPC group required fentanyl during the operation. In addition, 7 patients in the SF 3-in-1 group required second doses of fentanyl. Patient satisfaction was significantly higher in the SPC group than in the SF 3-in-1 block group (P < 0.0001)., Conclusions: Both SPC and SF 3-in-1 provided sufficient anesthetic efficacy for knee arthroscopy. However, SPC may be preferable to SF 3-in-1 block owing to better patient satisfaction and less requirement for opioid analgesics. more...

Background: Papillon-Lefèvre syndrome (PLS) is an autosomal recessive disease characterized by hyperkeratosis of the palms and soles combined with premature loss of the primary and permanent dentition. Several treatment regimens have been recommended in the literature; however, a definitive treatment protocol has not been established. This case report evaluates the success of combined therapy in managing a patient with PLS., Methods: A 6-year-old girl diagnosed with PLS presented with aggressive periodontal destruction of her primary and permanent dentitions. After extraction of periodontally affected teeth, the edentate region was rehabilitated with different temporary dentures until her skeletal growth was complete. At the same time, her orthodontic treatment was performed. The early loss of her incisors resulted in inadequate alveolar bone height and width for esthetic-advanced prosthetic rehabilitation. Alveolar bone augmentation was performed, and 6 months later, two intraosseous dental implants were placed into the central incisor zone., Results: After 13 years of treatment and follow-up, the patient had periodontally healthy permanent dentition. She had practiced meticulous oral hygiene, and the orthodontic treatment was successful and without incident. Alveolar ridge augmentation and placement of an intraosseous implant with guided bone regeneration were performed successfully., Conclusions: This case report demonstrates that individually developed treatment protocols can provide long-term dental/periodontal success in patients with PLS. A multidisciplinary approach with advanced periodontal surgery, orthodontic and prosthetic treatment, and implant therapy may be an appropriate treatment modality for dental rehabilitation in patients with PLS. more...

Background: Glanzmann thrombasthenia (GT) is an exceedingly rare but well-defined inherited disorder of platelet function caused by a defect in the glycoprotein IIb/IIIa complex. The association of GT with consanguinity has been noted, especially in geographic regions in which intermarriage is common. In most patients, GT is diagnosed during early infancy or before the age of 5 years. Common manifestations of this disorder are gingival hemorrhage, purpura, epistaxis, petechiae, and menorrhagia. Chronic, prolonged, untreated, or unsuccessfully treated bleeding may be life threatening., Methods: We report two female patients with GT who were referred by our hematology clinic to our periodontology department for the treatment of excessive gingival bleeding. The first patient was treated with a platelet transfusion and underwent periodontal therapy (scaling and root planing and dental polishing). The second patient, whose GT was undiagnosed at the time of her referral to our department, applied to our emergency service because of uncontrolled gingival bleeding that developed after scaling and root planing was performed by her dentist. Both patients had been called for regular dental visits., Results: All treated sites healed without complications. The first patient was monitored for 2 years, during which she practiced proper oral hygiene and experienced no periodontal complications. The other patient did not participate in follow-up., Conclusions: Gingival bleeding is usually the first sign of most hematologic disorders, and dentists must be alert for the signs of unusual gingival bleeding. In such cases, collaboration with a hematologist is essential. Under the proper circumstances, periodontal treatment can be performed with an acceptable outcome. With proper oral hygiene, we believe that there will be no complications and no gingival bleeding. more...

Technologic advances in mechanics, electronics, physics, chemistry, and computer science have contributed to advances in dental medicine. Periodontology is not only a clinical science but is also directly related to the basic sciences. Research is conducted in laboratories rather than in clinics now. During the last century, aggressive periodontitis has received attention from numerous researchers because of its multifactorial features. This paper explores the long scientific journey of aggressive periodontitis, beginning with its first definition as alveolar diffuse atrophy. Perhaps in the future, "alveolar diffuse atrophy" will be referred to by another name or term. However, this journey will never end. more...

Analgesic effects of cannabimimetic compounds have been known to be related to their central effects. Cannabinoid receptors also exist in the periphery but their role in pain perception has been remained to be clarified. Therefore, we assessed topical antinociceptive effects of WIN 55, 212-2, a mixed CB(1) and CB(2) receptors agonist, in mice using tail-flick test. Immersion of the tail of mouse into the WIN 55, 212-2 solution produced dose-dependent antinociception. This antinociceptive activity was limited to the portion of the tail exposed to WIN 55, 212-2. The antinociceptive response was dependent on duration of exposure to WIN 55, 212-2 solution. The topical antinociceptive effects of WIN 55, 212-2 were dose dependently blocked by topical pretreatment of CB(1) receptor-selective antagonist, AM 251. Thus, topical antinociceptive action of WIN 55, 212-2 involve CB(1) receptors. Intrathecal (i.th.) administration of WIN 55, 212-2 produced a dose-dependent antinociceptive effect. Interestingly, ineffective i.th. doses of WIN 55, 212-2 produced a marked antinociception when combined with topical application of WIN 55, 212-2 and topical antinociceptive effect was potentiated. The dose-response curve of i.th. WIN 55, 212-2 was shifted to the left 15-fold by topical WIN 55, 212-2. This finding suggests that there is an antinociceptive synergy between peripheral and spinal sites of cannabinoid action and it also implicates that local activation of cannabinoid system may regulate pain initiation in cutaneous tissue. Our findings support that cannabinoid system participates in buffering the emerging pain signals at the peripheral sites in addition to their spinal and supraspinal sites of action. In addition, an antinociceptive synergy between topical and spinal cannabinoid actions exists. These results also indicate that topically administered cannabinoid agonists may reduce pain without the dysphoric side effects and abuse potential of centrally acting cannabimimetic drugs. more...

A case of rhabdomyolysis from malignant hyperthermia occurred during renal transplantation surgery is presented. After the completion of vascular and uretherovesical anostomosis, the patient's heart rate began to rise, sweatiness was observed and body temperature increased to 41 degrees C. Additionally, metabolic and respiratory acidosis and hyperkalemia were detected. Serum creatine kinase and lactic dehydrogenase levels were increased significantly. After external cooling and the administration of dantrolene sodium, body temperature and heart rate were decreased. During this period; furosemide, mannitol and sodium bicarbonate were given. Three hours after the completion of surgery, urine output was begun and urine myoglobin was found to be positive. Renal function improved gradually and serum creatinine level decreased to 1.6 mg/dl on the 14th postoperative day. Malignant hyperthermia can lead to severe rhabdomyolysis and delayed graft function in renal transplant recipients. Early diagnosis and intervention is crucial for protecting renal function., (Copyright 2002 S. Karger AG, Basel) more...