Phillip J. Sheridan

Tetracycline and other tetracycline‐derivative staining of the teeth and oral cavity

Tetracyclines (TCN) were introduced in 1948 as broad‐spectrum antibiotics that may be used in the treatment of many common infections in children and adults. One of the side‐effects of tetracyclines is incorporation into tissues that are calcifying at the time of their administration. They have the ability to chelate calcium ions and to be incorporated into teeth, cartilage and bone, resulting in discoloration of both the primary and permanent dentitions. This permanent discoloration varies from yellow or gray to brown depending on the dose or the type of the drug received in relation to body weight. Minocycline hydrochloride, a semisynthetic derivative of tetracycline often used for the treatment of acne, has been shown to cause pigmentation of a variety of tissues including skin, thyroid, nails, sclera, teeth, conjunctiva and bone. Adult‐onset tooth discoloration following long‐term ingestion of tetracycline and minocycline has also been reported. The remarkable side‐effect of minocycline on the oral cavity is the singular occurrence of “black bones”, “black or green roots” and blue‐gray to gray hue darkening of the crowns of permanent teeth. The prevalence of tetracycline and minocycline staining is 3–6%. The mechanism of minocycline staining is still unknown. Most of the reviewed literature consisted of case reports; longitudinal clinical trials are necessary to provide more information on the prevalence, severity, etiology and clinical presentation of tetracycline and TCN‐derivative staining in the adult population.

Orofacial manifestations of Melkersson-Rosenthal syndrome : a study of 42 patients and review of 220 cases from the literature

We investigated orofacial manifestations in 42 patients with Melkersson-Rosenthal syndrome who were examined at our institution between 1965 and 1990. Patient histories and histologic and clinical findings were reviewed in detail. These data were compared with the oral findings in 220 cases that were reported in the literature between 1965 and 1990. There were 28 females in our study. The age at onset of signs and symptoms varied widely with a mean of 33.8 years. Most frequent initial signs were labial edema, facial swelling, and Bells palsy. During the course of the disease, 75% of all patients had labial swelling, 50% had facial edema, and 33% had Bells palsy. Swelling, erythema, or painful erosions that affected the gingiva, buccal mucosa, palate, or tongue were common intraoral symptoms. A comparison with patients reported in the literature revealed a similar frequency of extraoral symptoms but more prevalent intraoral symptoms in our patients.

Medically Induced Gingival Hyperplasia

Gingival hyperplasia or gingival overgrowth is a common occurrence in patients taking phenytoin, cyclosporine, or calcium channel blockers. Speech, mastication, tooth eruption, and aesthetics may be altered. Controlling the inflammatory component through an appropriate oral hygiene program may benefit the patient by limiting the severity of the gingival overgrowth. In patients in whom gingival overgrowth is present or may be anticipated, recognition of this condition and referral to a general dentist or periodontist are appropriate steps to management. The physicians awareness of the potential for development of overgrowth and the dental practitioners role in attempting to prevent or minimize this problem are important aspects. In this article, we discuss the medications associated with gingival hyperplasia and describe appropriate recommendations.

Desquamative gingivitis: clinical, histopathologic, immunopathologic, and therapeutic observations.

Desquamative gingivitis is characterized by a diffuse erythema of the marginal and attached gingivae associated with areas of vesiculation, erosion, and desquamation. Desquamative gingivitis is not a disease sui generis but represents a reaction pattern of the gingivae to various stimuli. Cicatricial pemphigoid, lichen planus, and pemphigus vulgaris may present as desquamative gingivitis. We observed forty-one patients whose disease was limited to the gingiva; studied them by light and direct immunofluorescence microscopy; classified them according to clinical, histologic, and immunopathologic observations; and followed them for an average of 3 years. Two patients had pemphigus vulgaris, and one each had lichen planus and contact stomatitis. Thirty-seven were classified as cicatricial pemphigoid suspects. In eighteen patients, the gingivitis developed into cicatricial pemphigoid, and in nineteen, it remained limited to the masticatory mucosa. Disease evolution is slow. The response to anti-inflammatory therapy, including topical corticosteroids and systemic dapsone or sulfapyridine, has been gratifying.

Denture sore mouth

The majority of the lesions associated with DSM are preventable and can be managed successfully by the dental professional. The hyperplastic tissue response seen in denture wearing patients generally requires surgical excision and follow-up. Health care providers should be encouraged to ask patients to remove their prostheses during a thorough examination of the oral tissues. In addition, patients should be asked about the fit and comfort of their dentures, and referred to their dental health care team for appropriate follow-up when required.

Oral manifestations of histoplasmosis

Abstract At the Mayo Clinic, from 1940 through 1970, thirty-four patients had progressive disseminated histoplasmosis. Fifteen of these patients had oral-pharyngeal lesions, with pain being the most common presenting symptom. This series demonstrates the varied clinical appearance of this fungus infection, discusses the methods of diagnosis and treatment, and suggests that these lesions are not a localized form of the disease but, rather, a manifestation of a systemic infection.

Intraoral lesions of adults associated with herpes simplex virus.

Abstract It now appears that the association of herpes simplex virus with oral lesions in adults is not as rare as was formerly believed and that many adults are not immune to this virus and hence are susceptible to primary infection. It is suggested that the diseases associated with herpes simplex virus be studied and that isolation of the virus not be rejected as indicative only of innocuous shedding. Because there are no reproducible data to refute the possibility, it is proposed that herpes simplex virus be considered as a potential pathogen whenever it is isolated.

Oral manifestations of hemochromatosis. Report of a case.

Abstract Although mucosal pigmentation is commonly associated with hemochromatosis, the dental literature apparently contains no case reports describing the oral pigmentation seen in this disease. The case of a 37-year-old woman with classic hemochromatosis and associated oral pigmentation is described.

Effective treatment of Dilantin gingival hyperplasia

Abstract Three cases are reported in which a positive-pressure appliance was used after gingival surgery in an attempt to prevent recurrence of Dilantin hyperplasia. The appliance appeared to be effective in preventing the recurrence of gingival hyperplasia for extended periods.

Treatment of protruding osseo integrated dental implant

Titanium dental implants have been used in the treatment of partial or complete edentulism. The height and width of the residual alveolus and surrounding anatomical structures can determine the proper position and path of insertion of dental implants. The following case report describes the treatment of a malpositioned osseo integrated dental implant with an apex perforating the buccal cortex of alveolar bone. A 61-year-old male was referred by his local dentist for the chief complaint of a swelling at site of tooth 14 where an implant was present. Intraoral clinical examination revealed an implant supported porcelain fused to metal crown replacing the maxillary right first premolar. A peri-apical radiograph of the implant revealed no signs of peri-implant bone loss or radiolucency. Surgical exploration and modification of the protruding implant. The area healed uneventfully without the need of explantation of the implant in site of tooth 14. We felt that the conservative treatment provided was prudent and treatment of choice and anticipate that the implant will most likely continue to function for a lifetime.