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Schei-Andersen AJ, van Oirschot B, Drissen MMCM, Schieving J, Schuurs-Hoeijmakers JHM, Vos JR, Barton CM, Hoogerbrugge N. Exploring the Prevalence of Oral Features for Early Detection of PTEN Hamartoma Tumour Syndrome. Int Dent J 2024:S0020-6539(24)00119-9. [PMID: 38697906 DOI: 10.1016/j.identj.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 05/05/2024] Open
Abstract
AIMS Patients with PTEN hamartoma tumour syndrome (PHTS) have an increased risk of developing cancer due to a pathogenic germline variant in the PTEN tumour suppressor gene. Early recognition of PHTS facilitates initiation of cancer surveillance which is highly effective in preventing the development of advanced malignancies. PHTS is rare and due to its varied phenotype, even within families, oral abnormalities may be a valuable tool in the identification of these patients at an early stage before cancer development. MATERIALS AND METHODS Between 1997 and 2020, phenotypic characteristics were evaluated in 81 paediatric (median age: 9 years) and 86 adult (median age: 40 years) PHTS patients by one of 2 medical experts during yearly surveillance visits at a Dutch PHTS expertise centre. Oral features evaluated included gingival hypertrophy, oral papillomas, and high palate (in adults). RESULTS Within adults, gingival hypertrophy was present in 94%, oral papillomas in 88%, and a high palate in 89%. All adult patients had at least one of these oral features, and 99% showed at least 2 oral features. Oral features were less common in paediatric patients, especially under 11 years of age. Gingival hypertrophy was observed in 44% and oral papillomas in 54% of paediatric patients. CONCLUSIONS The presence of 2 or 3 oral features may indicate PHTS in adults or adolescents, especially if macrocephaly is present. Dental professionals are well-positioned to recognise these oral manifestations could be related to PHTS. They can initiate an overall clinical assessment of the patient by alerting the patient's medical practitioner of the findings and the possible need for genetic testing. This could significantly improve outcomes, including life expectancy, for patients and possibly for their relatives. CLINICAL RELEVANCE Dental professionals are ideally placed to recognise oral features and initiate early assessment of PHTS which could significantly improve patient outcomes.
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Affiliation(s)
- Ane J Schei-Andersen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bart van Oirschot
- Department of Dentistry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Meggie M C M Drissen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jolanda Schieving
- Department of Paediatric Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janneke H M Schuurs-Hoeijmakers
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janet R Vos
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Claire M Barton
- PTEN Research Foundation, Registered office: 4th Floor, St James House, St James Square, Cheltenham, UK; Barton Oncology Ltd, Dormers, The Green, Croxley Green, Hertfordshire, UK
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, the Netherlands.
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Friedrich RE, Christ G, Scheuer HA. Mandibular symmetry on posterior-anterior cephalograms of neurofibromatosis type 1 patients with facial plexiform neurofibroma. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2023; 12:Doc11. [PMID: 38111842 PMCID: PMC10726724 DOI: 10.3205/iprs000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Introduction Neurofibromatosis type 1 (NF1) is an is an autosomal dominant heritable tumor predisposition syndrome.. Peripheral nerve sheath tumors (PNST) are a hallmark of NF1. Plexiform neurofibromas (PNF) are neoplasms that are characteristic of NF1, often causing disfiguring effects (e.g., on the face), and are considered precancerous lesions. Previous studies have shown that facial PNF (FPNF) have an impact on the shape of facial bones. This study examines deviations of mandibular symmetry from cephalometric reference planes considering the topography of FPNF. Material and methods The posterior-anterior (PA) cephalograms of 168 patients with NF1 were examined. We compared three groups: patients with FPNF (n=74), with disseminated cutaneous neurofibroma (DNF (n=94)), and control subjects without NF1 (n=23). The PNF group was subtyped with respect to facial PNST type and location. Typical mandibular cephalometric reference points were determined (condyle, antegonion, and menton). Results The skeletal measurement points of the mandible in FPNF patients often differ significantly from those of the DNF group. It has been proven that typical asymmetries of the median-sagittal measurement points are indicators of PNF. Differences within the trigeminal tumor spread patterns are indicated in the measured values. A local tumor effect (PNF) on the relation of the measurement points to the reference planes is made plausible by the study results. The investigations prove that tumor type (FPNF) and the number of FPNF affected branches of the trigeminal nerve may correlate with significant deviations of mandible from symmetry on PA projections. Conclusion The presented study shows that characteristic patterns of mandibular deformity can be measured on standardized radiographs in NF1 patients with FPNF. Mandibular deformities imaged on standardized radiographs may be initial indicators of a previously unrecognized NF1. Tumor-associated alterations of the mandible should be considered in the classification systems of pathognomonic, diagnostically pioneering osseous findings in NF1. The radiological findings provide clues for planning mandibular osteotomies in NF1 patients, especially for assessing facial regions typically highly vascularized by tumor spread. Furthermore, the radiological findings are an indication of a tumor potentially invading and destroying adjacent masticatory and mimic muscle, findings that may have an influence on surgical measures (function, aesthetics, and wound healing).
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Affiliation(s)
- Reinhard E. Friedrich
- Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Germany
| | - Georg Christ
- Oral and Craniomaxillofacial Surgery, Eppendorf University Hospital, University of Hamburg, Germany
| | - Hanna A. Scheuer
- Department of Orthodontics, Eppendorf University Hospital, University of Hamburg, Germany
- Private Praxis of Orthodontics, Lokstedt, Hamburg, Germany
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3
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Borges MI, Abreu JM, Ramalhosa F, Nogueira S, Corte Real A. Late-Onset Masseteric Metastasis of Malignant Melanoma in a Patient With Neurofibromatosis and Lipomatosis: A Diagnostic Challenge and Case Report. Cureus 2023; 15:e50847. [PMID: 38249267 PMCID: PMC10798650 DOI: 10.7759/cureus.50847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Melanoma and neurofibromatosis (NF) are distinctly separate conditions, each characterized by unique pathophysiological processes. Nevertheless, their clinical presentations can share overlapping similarities. This report highlights a unique case involving a 68-year-old male with NF1 and lipomatosis, whose unwavering belief that a developing mass in the masseter region was benign and linked to the pre-existing diagnoses contributed to a significant delay in seeking healthcare. Consequently, this postponement resulted in the late diagnosis of disseminated malignant melanoma (stage IV, T4N0M1c). Given the patient's prognosis and poor general health, a palliative treatment plan was devised, entailing the complete excision of the masseteric mass and vertebral radiotherapy. Following a rapid and extensive progression of the cancerous lesions, the patient passed away in a palliative care infirmary four months after surgery. The significance of this case, justified not only by its uncommon presentation and atypical differential diagnosis, highlights the critical necessity of regular follow-up protocols for melanoma patients, particularly those prone to metastasis, while ensuring patient attendance. Furthermore, it underscores the necessity of patient education, particularly in recognizing early signs and symptoms, and timely intervention in cases with complex comorbidities.
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Affiliation(s)
- Maria Inês Borges
- Department of Stomatology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - João M Abreu
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
- Department of Stomatology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Fátima Ramalhosa
- Department of Pathology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Simão Nogueira
- Department of Stomatology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Ana Corte Real
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
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4
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Couto DAF, Ito FA, Lima HGD, Ono E, Pires WR, Pereira-Stabile CL, Vitti Stabile GA, Takahama A. Asymptomatic unilateral facial swelling in 10-year-old boy. J Am Dent Assoc 2023; 154:843-848. [PMID: 36058727 DOI: 10.1016/j.adaj.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/25/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022]
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5
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Saad RH, Medra AM, Saadallah OA, El Mallah MM. Minimal intervention for neurofibromatosis type I manifestations: A case report. Int J Surg Case Rep 2023; 110:108691. [PMID: 37639966 PMCID: PMC10509802 DOI: 10.1016/j.ijscr.2023.108691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Neurofibromatosis type I (NF1, OMIM: 162200) is a benign, autosomal dominant, tumorigenic predisposing syndrome with variable manifestations. Both neurofibromatosis and soft tissue sarcomas are associated with the formation of hematomas. Moreover, skeletal manifestations of NF1 include focal or generalized forms and expansive or infiltrative growth types. CASE PRESENTATION A 19-year-old NF1 female patient presented with an expanding post-traumatic facial hematoma that resembled a soft-tissue tumor at initial presentation. A congenital neck mass was noted ipsilateral to her craniofacial skeletal deformities. Multiple imaging modalities were used to aid diagnosis, and urgent surgical intervention of the expanding facial lesion was performed. Her neck lesion and skeletal deformities were monitored, and her recovery was uneventful at 1-year follow-up, with no progression. CLINICAL DISCUSSION A palpable, non-pulsatile soft tissue mass is a common clinical presentation with a diverse differential diagnosis. Despite the low incidence of post-traumatic vascular injuries and lesions in the maxillofacial region, neurofibromatosis-associated vasculopathy remains an underestimated and serious manifestation of NF1. The reported zygomatic arch deformity is believed to be unique. However, the NF1 tumor-associated skeletal malformations are not linearly related. CONCLUSION NF1 is a multisystem disorder necessitating an early multidisciplinary team approach. Minimal intervention can help convert an emergent operation into an urgent one and preclude the need for major surgery. The case illustrated a rare example of simultaneous affection of soft tissue and jaw bones in NF1 patients.
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Affiliation(s)
- Reem Hassan Saad
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Azarita, Alexandria, Egypt.
| | - Ahmed Mohamed Medra
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Azarita, Alexandria, Egypt
| | - Omar Alaaeldin Saadallah
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Azarita, Alexandria, Egypt
| | - Mostafa Mohamed El Mallah
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Azarita, Alexandria, Egypt
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6
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Oral Mucosal Lesions in Childhood. Dent J (Basel) 2022; 10:dj10110214. [DOI: 10.3390/dj10110214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/12/2022] Open
Abstract
Childhood diseases are a continuous source of interest in all areas of general and dental medicine. Congenital, developmental, and hereditary diseases may either be present upon birth or appear in early childhood. Developmental anomalies, although often asymptomatic, may become grounds for different infections. Furthermore, they can indicate certain systemic disorders. Childhood age frequently brings about benign tumors and different types of traumatic lesions to the oral mucosa. Traumatic lesions can be caused by chemical, mechanical, or thermal injury. Mucocele and ranula are, by definition, traumatic injuries of the salivary glands or their ducts. Recurrent aphthous lesions are the most common type of ulcerations in childhood, and their etiology is considered multifactorial. Oral mucosal lesions in children require different treatment approaches depending on etiological factors and clinical presentation. Clinicians should have adequate knowledge of oral anatomy in order to diagnose and treat pathological conditions.
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7
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Abstract
Non-plaque induced diffuse gingival overgrowth represents a broad class of conditions caused by several etiological factors. The aim of this review is to highlight the most recent updates and classifications of all the existent gingival overgrowths. In addition, we highlighted the diagnostic pathway that should be employed in patients affected by gingival overgrowth. Gingival overgrowth can be related to syndromic diseases including a wide spectrum of genetic and chromosomal alterations. However, thanks to scientific sharing and the availability of genetic panels it is possible to obtain an accurate phenotypic identification of well-known syndromes and also to identify new ones. This narrative review shows that through rigid, strict diagnostic protocols, the work of the clinician is greatly facilitated, despite the wide variety of pathologies considered. In conclusion, the exchange of specialists’ competencies and the multidisciplinary management of these patients, are crucial to reach diagnosis and the correct clinical-therapeutic management.
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8
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Kotsanos N, Marks LAM, Arapostathis KN, Kubota K. Disabilities, Neuropsychiatric Disorders, and Syndromes in Childhood and Adolescence. Pediatr Dent 2022. [DOI: 10.1007/978-3-030-78003-6_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Aloyouny AY, Albagieh HN, Alweteid AS, Alsheddi MA. Mandibular neurofibroma with osseous deformities in a 3-year-old child with neurofibromatosis type 1: A case report presentation and diagnosis. Niger J Clin Pract 2021; 24:1755-1757. [PMID: 34782519 DOI: 10.4103/njcp.njcp_421_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a rare autosomal dominant genetic disorder. It is a multisystem neurocutaneous condition represented by multiple benign tumors of the nerves and skin known as neurofibromas and cafe' au lait spots. However, neurofibroma localized in the mandible is rare. We present a case of a 3-year-old, Egyptian girl with NF1. The girl presented with right mandibular swelling of undetermined duration and multiple hyperpigmented spots on the skin. This case report shows the important role of dentists, as demonstrated in the present case, in the diagnosis and management of this disease, since the diagnosis was made during dental consultation and subsequently managed by the team.
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Affiliation(s)
- A Y Aloyouny
- Basic Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - H N Albagieh
- Department of Oral Medicine and Diagnostic Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - A S Alweteid
- Oral and Maxillofacial Surgery, King Saud Medical Center, Riyadh, Saudi Arabia
| | - M A Alsheddi
- Basic Dental Sciences, College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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10
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Taneja L, Dokwal SK, Prajapat J, Arya V. Plexiform neurofibroma with nevus of ota-rare presentation. J Oral Maxillofac Pathol 2021; 25:374. [PMID: 34703146 PMCID: PMC8491357 DOI: 10.4103/0973-029x.325263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 11/05/2022] Open
Abstract
Plexiform neurofibroma (PNF) is a rare form of neurofibromatosis type 1 which is rarely seen isolated. This generally spreads along the peripheral nerve and may affect some nervous rami. This is a poorly circumscribed and locally invasive tumor. About 21% of patients with NF-I are affected with PNFs. The nevus of Ota also called oculodermal melanocytosis is a macular discoloration of the face. It is most commonly found in the Japanese and very rare in the Indian subcontinent. It is unilateral oculodermal melanosis along the first two branches of the trigeminal nerve. We hereby present a very rare case of occurrence of isolated PNF (not associated with neurofibromatosis type 1) along with nevus of ota of the left side of the face in a 28-year-old female with thorough radiographic work up.
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Affiliation(s)
- Lavina Taneja
- Department of Oral Medicine and Radiology, Post Graduate Institute of Dental Sciences, Rohtak, Haryana, India
| | | | - Jyoti Prajapat
- Department of Oral Medicine and Radiology, Private Practitioner, Haryana, India
| | - Vishal Arya
- Department of Pedodontics and Preventive Dentistry, SGT University, Gurugram, Haryana, India
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11
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Alqahtani ND. Successful treatment modalities for missing lateral incisors- A systematic review. Saudi Dent J 2021; 33:308-315. [PMID: 34434032 PMCID: PMC8376679 DOI: 10.1016/j.sdentj.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 06/28/2021] [Accepted: 07/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Effective management of Missing lateral incisor has remained a challenge for the clinicians. A multi-disciplinary approach involving orthodontist, restorative dental specialist, pediatric dental specialist, periodontist, oral surgeon and general dentist has proved ideal. Our aim is to review the ultimate esthetic success, and long term survival results between the orthodontic and restorative management of missing lateral incisor. MATERIALS AND METHODS Following the PRISMA guidelines, a systematic review of the published articles pertaining to the topic of interest was done. Searches were carried out in four different databases since February 2021 to April 2021. RESULTS A total of 580 references were found from searches conducted in PubMed, Scopus, Cochrane and Web of Science, and 19 articles were selected and analyzed fully, after screening the title and abstract, 6 articles were included for the study. CONCLUSION An essential orthodontic space closure in combination with modern aesthetic prosthetic tooth replacement techniques has been reported to achieve greater success.
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Affiliation(s)
- Nasser D. Alqahtani
- Pediatric Dentistry and Orthodontics Department, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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12
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Kapferer-Seebacher I, Foradori L, Zschocke J, Schilke R. Rare Genetic Disorders Affecting the Periodontal Supporting Tissues in Adolescence. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.687510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
In adolescents periodontal destruction may be the primary manifestation of an as yet unrecognized rare systemic disease, and it may be up to the periodontist to make the correct tentative diagnosis. Many genetic diseases that present with primary periodontal manifestations in adolescence affect immune function, sometimes with only mild or absent systemic features. They include periodontal Ehlers-Danlos syndrome (lack of attached gingiva, various connective tissue abnormalities), Papillon-Lefèvre syndrome (palmoplantar hyperkeratosis), and plasminogen deficiency (fibrin deposition within mucous membranes). Other immune disorders with severe periodontitis manifesting in adolescence are usually diagnosed in early childhood due to unmistakeable systemic features. They include Cohen syndrome (developmental disorder, truncal obesity, and microcephaly), Hermansky-Pudlak Syndrome (oculocutaneous albinism, bleeding diathesis, and other systemic manifestations), glycogen storage disease type 1b, and Chediak-Higashi syndrome (pyogenic infections, albinism, and neuropathy). The structural integrity of periodontal tissue is affected in genodermatoses such as Kindler syndrome, a type of epidermolysis bullosa. In primary hyperoxaluria, inflammatory periodontal destruction is associated with renal calculi. Breakdown of periodontal tissues independent of dental plaque biofilm-induced periodontitis is found in hypophosphatasia (highly variable skeletal hypomineralization) or isolated odontohypophosphatasia, hypophosphatemic rickets and primary hyperparathyroidism. Finally, alveolar osteolysis mimicking localized periodontitis may be due to neoplastic processes, e.g., in neurofibromatosis type 1 (typical skin features including café au lait macules and neurofibromas), Langerhans cell histiocytosis (locally destructive proliferation of bone marrow-derived immature myeloid dendritic cells), and Gorham-Stout disease (diffuse cystic angiomatosis of bone).
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13
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Kim KH, Lee DW, Lee ST. Delayed tooth eruption due to gingival neurofibroma in two children with neurofibromatosis 1. J Paediatr Child Health 2021; 57:1113-1116. [PMID: 32841438 DOI: 10.1111/jpc.15125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/01/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Keun-Hwan Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Dong-Woo Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, South Korea
| | - Sung-Tak Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, South Korea
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14
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Cartwright B, Corsar K. Neurofibroma of the hard palate. BMJ Case Rep 2021; 14:14/4/e239887. [PMID: 33827870 PMCID: PMC8030684 DOI: 10.1136/bcr-2020-239887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Neurofibromas are defined as benign tumours arising from peripheral nerve sheaths. Few intraoral palatal cases have been reported. Neurofibromas can occur as part of neurofibromatosis, type 1 (NF1) or type 2 (NF2). A 41-year-old patient presented with a slowly enlarging soft tissue mass on the hard palate. An incisional biopsy was performed, which confirmed the diagnosis of a neurofibroma associated with NF1. It should be considered that there is a chance of malignant transformation. Here, we discuss the clinical features, types, diagnosis, histopathology and treatment options.
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Affiliation(s)
- Bethany Cartwright
- Oral and Maxillofacial Surgery, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Kenneth Corsar
- Oral and Maxillofacial Surgery, Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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15
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Abstract
Introduction Neurofibromin, a protein encoded by the NF1 gene, is mutated in neurofibromatosis 1, one of the most common genetic diseases. Oral manifestations are common and a high prevalence of hyposalivation was recently described in individuals with neurofibromatosis 1. Although neurofibromin is ubiquitously expressed, its expression levels vary depending on the tissue type and developmental stage of the organism. The role of neurofibromin in the development, morphology, and physiology of salivary glands is unknown and a detailed expression of neurofibromin in human normal salivary glands has never been investigated. Aim To investigate the expression levels and distribution of neurofibromin in acinar and ductal cells of major and minor salivary glands of adult individuals without NF1. Material and method Ten samples of morphologically normal major and minor salivary glands (three samples of each gland: parotid, submandibular and minor salivary; and one sample of sublingual gland) from individuals without neurofibromatosis 1 were selected to assess neurofibromin expression through immunohistochemistry. Immunoquantification was performed by a digital method. Results Neurofibromin was expressed in the cytoplasm of both serous and mucous acinar cells, as well as in ducts from all the samples of salivary glands. Staining intensity varied from mild to strong depending on the type of salivary gland and region (acini or ducts). Ducts had higher neurofibromin expression than acinar cells (p = 0.003). There was no statistical association between the expression of neurofibromin and the type of the salivary gland, considering acini (p = 0.09) or ducts (p = 0.50) of the four salivary glands (parotid, submandibular, minor salivary, and sublingual gland). Similar results were obtained comparing the acini (p = 0.35) and ducts (p = 0.50) of minor and major salivary glands. Besides, there was no correlation between the expression of neurofibromin and age (p = 0.08), and sex (p = 0.79) of the individuals, considering simultaneously the neurofibromin levels of acini and duct (n = 34). Conclusion Neurofibromin is expressed in the cytoplasm of serous and mucous acinar cells, and ductal cells of salivary glands, suggesting that this protein is important for salivary gland function.
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16
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Buchholzer S, Verdeja R, Lombardi T. Type I Neurofibromatosis: Case Report and Review of the Literature Focused on Oral and Cutaneous Lesions. Dermatopathology (Basel) 2021; 8:17-24. [PMID: 33430291 PMCID: PMC7838883 DOI: 10.3390/dermatopathology8010003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 01/27/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a common genetic disease whose dermatological lesions are at the forefront of its development. Cutaneous manifestations include café au lait spots, intertriginous freckling, and neurofibromas which appear during childhood and adolescence and are part of the clinical criteria to diagnose NF1. However, it is only recently that oral manifestations have been highlighted in many studies as frequently associated to NF1. This article aims to review oral and cutaneous manifestations related to NF1 and to report a case of a 51-year-old male with skin and oral neurofibromas related to NF1. Our patient presented with lesions on the gingiva, a rare localization that takes a hypertrophic form mimicking other various pathological conditions. Although not frequent, malignant transformation in NF1, especially regarding plexiform neurofibromas, is well established. Patients with NF1 therefore have regular follow-ups based on clinical examination, as sarcomatous transformation brings an extremely poor prognosis, recurrences and distant metastasis being common.
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Affiliation(s)
- Samanta Buchholzer
- Unit of Oral Medicine and Maxillofacial Pathology, Division of Maxillofacial and Oral Surgery, Department of Surgery, Geneva University Hospitals, 1205 Geneva, Switzerland; (R.V.); (T.L.)
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17
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Fahy E, Mulvihill C, O'Donoghue G, O'Regan E, Collins M. Neurofibromatosis -1 diagnosed from an intraoral swelling - a case series. Aust Dent J 2020; 66:205-211. [PMID: 32990942 DOI: 10.1111/adj.12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2020] [Indexed: 02/02/2023]
Abstract
The neurofibromatoses [NF 1, NF 2 and schwannomatosis] are a group of genetic disorders that lead to the development of nervous system tumours and have diverse dermatologic, neurologic, ophthalmic, skeletal and vascular effects. The most common is NF 1 (Neurofibromatosis 1) also known as von Recklinghausen's disease, which is one of the most common human genetic diseases. Oral manifestations of NF 1 are reported in 72% of cases and in one of our cases precipitated attendance at a general dental practitioner (GDP), subsequent diagnosis and genetic screening for family members. This disease may go undiagnosed due to its variable expressivity of symptoms. The pivotal importance of a GDP in the discovery and early referral to an oral or oral and maxillofacial surgeon for further investigation and diagnosis of this condition is highlighted. Knowledge of the most common features of neurofibromatosis can facilitate the speedy referral and subsequent diagnosis of generalized neurofibromatosis, local surgical management of benign neoplasms and long term management of its other clinical features. Dentists should be aware of the classic symptoms of this condition and of their role in long-term care in view of the risk of local recurrence and malignant transformation.
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Affiliation(s)
- E Fahy
- Dublin Dental University Hospital, Dublin, Ireland
| | - C Mulvihill
- Dublin Dental University Hospital, Dublin, Ireland
| | - G O'Donoghue
- Dublin Dental University Hospital, Dublin, Ireland
| | - E O'Regan
- Dublin Dental University Hospital, Dublin, Ireland.,Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - M Collins
- Dublin Dental University Hospital, Dublin, Ireland
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18
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Craniofacial bone alterations in patients with neurofibromatosis type 1. Childs Nerv Syst 2020; 36:2391-2399. [PMID: 32583151 DOI: 10.1007/s00381-020-04749-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/16/2020] [Indexed: 12/26/2022]
Abstract
Osseous manifestations of neurofibromatosis 1 (NF-1) occur in a minority of the affected subjects but may be because of significant clinical impairment. Typically, they involve the long bones, commonly the tibia and the fibula, the vertebrae, and the sphenoid wing. The pathogenesis of NF-1 focal osseous lesions and its possible relationships with other osseous NF-1 anomalies leading to short stature are still unknown, though it is likely that they depend on a common mechanism acting in a specific subgroup of NF-1 patients. Indeed, NF-1 gene product, neurofibromin, is expressed in all the cells that participate to bone growth: osteoblasts, osteoclasts, chondrocytes, fibroblasts, and vascular endothelial cells. Absent or low content of neurofibromin may be responsible for the osseous manifestations associated to NF-1. Among the focal NF-1 osseous anomalies, the agenesis of the sphenoid wing is of a particular interest to the neurosurgeon because of its progressive course that can be counteracted only by a surgical intervention. The sphenoid wing agenesis is regarded as a dysplasia, which is a primary bone pathology. However, its clinical progression is related to a variety of causes, commonly the development of an intraorbital plexiform neurofibroma or the extracranial protrusion of temporal lobe parenchyma and its coverings. Thus, the cranial bone defect resulting by the primary bone dysplasia is progressively accentuated by the orbit remodeling caused by the necessity of accommodating the mass effect exerted by the growing tumor or the progression of the herniated intracranial content. The aim of this paper is to review the neurosurgical and craniofacial surgical modalities to prevent the further progression of the disease by "reconstructing" the normal relationship of the orbit and the skull.
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19
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Abstract
Oral pigmented lesions have a wide range of clinical presentations, some of which correlate with cutaneous pigmented lesions. This article highlights these correlates and underscores important differences that can potentially have clinical impact. Moreover, given a nonspecific presentation of an oral pigmented lesion, the article provides a reference to aid clinicians with differential diagnoses based on clinical features. This article is an overview of pigmented lesions of the oral cavity, including localized reactive pigmented lesions, neoplastic pigmented lesions, and pigmented lesions as sequelae of a systemic disease.
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Affiliation(s)
- Eugene Ko
- Department of Oral Medicine, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA.
| | - Neeraj Panchal
- Department of Oral Surgery, University of Pennsylvania, School of Dental Medicine, 240 South 40th Street, Philadelphia, PA 19104, USA
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20
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Pinna R, Cocco F, Campus G, Conti G, Milia E, Sardella A, Cagetti MG. Genetic and developmental disorders of the oral mucosa: Epidemiology; molecular mechanisms; diagnostic criteria; management. Periodontol 2000 2019; 80:12-27. [PMID: 31090139 DOI: 10.1111/prd.12261] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A large number of disorders may affect the oral cavity, including genetic diseases, infections, cancers, blood diseases, skin diseases, endocrine and metabolic disorders, autoimmune and rheumatologic diseases, local lesions, to name a few. Oral mucosa shows a considerable variation in its normal structure and a wide range of conditions may affect it. Such conditions are often harmless or minor and could be primary or secondary to systemic disease. Several of them are quite rare and, hence, the diagnosis is not easy. Clinically, lesions may appear as ulcers, discoloration of the oral mucosa and alterations in size and configuration of oral anatomy. Genetic disorders have specific manifestations and can be caused by a derangement of one or more components of the tissue. Many of them follow the skin or systemic signs of the underlying genetic disease, but in a few cases oral signs could be the first manifestation of the disorder. Among them genodermatoses are prominent. They are inherited disorders characterized by a multisystem involvement. This review describes chondro-ectodermal dysplasia, dyskeratosis congenita, Ehlers-Danlos syndrome, hereditary benign intraepithelial dyskeratosis, keratosis follicularis, lipoid proteinosis, multiple hamartoma syndrome, pachyonychia congenita, Peutz-Jeghers syndrome, tuberous sclerosis and white sponge nevus. Other genetic disorders not included in the genodermatosis group and reported in the present review are: acanthosis nigricans, angio-osteo-hypertrophic syndrome, encephalotrigeminal angiomatosis, familial adenomatous polyposis, focal dermal hypoplasia, focal palmoplantar and oral mucosa hyperkeratosis syndrome, gingival fibromatosis, Maffucci's syndrome, neurofibromatosis (type 1) and oro-facial-digital syndrome (type 1). Disorders during embryonic development might lead to a wide range of abnormalities in the oral cavity; some of them are quite common but of negligible concern, whereas others are rare but serious, affecting not only the oral mucosa, but also other structures of the oral cavity (ie palate, tongue and gingiva). Fordyce's granules, leukoedema, cysts of the oral mucosa in newborns, retrocuspid papilla, geographic tongue, fissured tongue, median rhomboid glossitis, hairy tongue, lingual varices and lingual thyroid nodule are described. This review may help dentists, dental hygienists, but also general internists and pediatricians to diagnose different disorders of the oral mucosa, to understand the pathogenesis and to schedule a treatment plan.
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Affiliation(s)
- Roberto Pinna
- Department of Surgery, Medicine and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Fabio Cocco
- Department of Surgery, Medicine and Experimental Sciences, University of Sassari, Sassari, Italy.,WHO Collaboration Centre for Epidemiology and Community Dentistry, University of Milan, Milan, Italy
| | - Guglielmo Campus
- Department of Surgery, Medicine and Experimental Sciences, University of Sassari, Sassari, Italy.,WHO Collaboration Centre for Epidemiology and Community Dentistry, University of Milan, Milan, Italy.,Klinik für Zahnerhaltung, Präventiv-und Kinderzahnmedizin Zahnmedizinische Kliniken (ZMK), University of Bern, Switzerland
| | - Giulio Conti
- IRCCS "Ca Granda-Ospedale Maggiore", University of Milan, Milan, Italy
| | - Egle Milia
- Department of Surgery, Medicine and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Sardella
- IRCCS "Ca Granda-Ospedale Maggiore", University of Milan, Milan, Italy.,Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy
| | - Maria Grazia Cagetti
- WHO Collaboration Centre for Epidemiology and Community Dentistry, University of Milan, Milan, Italy.,Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy
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21
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Tamiolakis P, Chrysomali E, Sklavounou-Andrikopoulou A, Nikitakis NG. Oral neural tumors: Clinicopathologic analysis of 157 cases and review of the literature. J Clin Exp Dent 2019; 11:e721-e731. [PMID: 31598201 PMCID: PMC6776406 DOI: 10.4317/jced.55944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background Oral neural tumors (ONTs) are rare lesions and represent reactive or neoplastic proliferations of nerve sheath cells. The purpose of the present study is to report the clinical, demographic and histopathologic features of 157 ONTs diagnosed in a single Oral Pathology Department and review the pertinent literature. Material and Methods 157 cases of ONTs diagnosed during a 44-year period were retrospectively collected and the diagnosis was reconfirmed by studying representative haematoxylin and eosin stained tissue sections. The patients’ gender and age, as well as the main clinical features of the lesions, were retrieved from the biopsy submission forms. Results The 157 ONTs represented approximately 0.4% of 35,590 biopsies accessioned during the study period. They affected 71 male and 86 female patients with a mean age of 38.4±18.8 years. They mainly appeared as asymptomatic nodules of normal or white colour on the tongue, lip mucosa and hard palate. The most common ONT was granular cell tumour (38.9%) followed by neurofibroma (19.7%), schwannoma (15.9%), traumatic neuroma (15.9%), palisaded encapsulated neuroma (8.3%) and nerve sheath myxoma (1.3%). Conclusions This study confirmed the rarity of ONTs. Their clinical characteristics mimic other oral lesions; thus, microscopic examination is the only mean to arrive at a definitive diagnosis. Key words:Oral neural tumors; oral neural neoplasms; neurofibroma; oral neurofibroma; schwannoma; oral schwannoma; neurilemmoma; oral neurilemmoma; granular cell tumor; oral granular cell tumor; traumatic neuroma; oral traumatic neuroma; palisaded encapsulated neuroma; oral palisaded encapsulated neuroma.
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Affiliation(s)
- Paris Tamiolakis
- DDS, MSc, Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Evanthia Chrysomali
- DDS, PhD, Associate Professor, Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Alexandra Sklavounou-Andrikopoulou
- DDS, MSc, PhD, Professor, Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Nikolaos G Nikitakis
- MD, DDS, PhD, Professor, Head of Department of Oral Medicine and Pathology, Department of Dentistry, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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Gingival Neurofibroma With Teardrop-Shaped Defects of the Interdental Alveolar Bone: An Unusual Oral Manifestation of Neurofibromatosis Type 1. J Craniofac Surg 2019; 30:e205-e207. [PMID: 30444769 DOI: 10.1097/scs.0000000000005094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Gingival enlargement, although frequently encountered in clinical settings, is rarely associated with systemic diseases or syndromes. Among the diverse pathological conditions of neurofibromatosis type 1 (NF-1), minor manifestations in the orofacial region are occasionally overlooked. Herein, the authors present an unusual case of gingival neurofibroma in a patient with NF-1 associated with characteristic osseous defects in the alveolus in the long-term course of 17 years from the first examination.A 5-year-old boy with NF-1 was referred for the evaluation of gingival enlargement in the posterior left maxilla. An incisal biopsy led to the diagnosis of neurofibroma. At 22 years of age, the patient was referred again with a complaint of bleeding and pain in the same region refractory to periodontal therapy. The gingiva and tuberosity were swollen, and the second molar was affected by the tumor. Radiography revealed a low level of the interdental septum beneath the tumor with a relatively intact periodontal cortical bone, exhibiting a teardrop-shaped bone defect. The lesion was completely resected with the periosteum.Gingival neurofibroma in NF-1 may be associated with osseous and dental abnormalities and can be mistaken for periodontitis. Raising awareness of this clinical entity can lead to proper management of the esthetic and functional problems in the oral and maxillofacial region.
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23
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Miller DT, Freedenberg D, Schorry E, Ullrich NJ, Viskochil D, Korf BR, Chen E, Trotter TL, Berry SA, Burke LW, Geleske TA, Hamid R, Hopkin RJ, Introne WJ, Lyons MJ, Scheuerle AE, Stoler JM. Health Supervision for Children With Neurofibromatosis Type 1. Pediatrics 2019; 143:peds.2019-0660. [PMID: 31010905 DOI: 10.1542/peds.2019-0660] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a multisystem disorder that primarily involves the skin and peripheral nervous system. Its population prevalence is approximately 1 in 3000. The condition is usually recognized in early childhood, when pigmentary manifestations emerge. Although NF1 is associated with marked clinical variability, most children affected follow patterns of growth and development within the normal range. Some features of NF1 can be present at birth, but most manifestations emerge with age, necessitating periodic monitoring to address ongoing health and developmental needs and minimize the risk of serious medical complications. In this report, we provide a review of the clinical criteria needed to establish a diagnosis, the inheritance pattern of NF1, its major clinical and developmental manifestations, and guidelines for monitoring and providing intervention to maximize the health and quality of life of a child affected.
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Affiliation(s)
| | | | - Elizabeth Schorry
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Nicole J. Ullrich
- Department of Neurology, Harvard Medical School, Harvard University and Boston Children’s Hospital, Boston, Massachusetts
| | - David Viskochil
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Bruce R. Korf
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama
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24
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Satir S. Determination of mandibular morphology in a TURKISH population with Down syndrome using panoramic radiography. BMC Oral Health 2019; 19:36. [PMID: 30808330 PMCID: PMC6390525 DOI: 10.1186/s12903-019-0722-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 01/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background Down syndrome (DS) is by far the most common known chromosomal disorder. Some characteristic features of DS are generalised growth deficiency, craniofacial abnormalities such as mandibular prognathism and underdevelopment of the midfacial region, dental abnormalities such as taurodontism and hypodontia. Individuals with DS have an increased prevalence of periodontal disease compared with age-matched control patients. The aim of the present study is to determine the morphologic features of the mandible among individuals with DS. Methods Thirty-four DS patients and thirty four age- and gender-matched control subjects underwent panoramic radiography, which included measurement of the mandibular canal (MC), the mandibular foramen (MF), the mandibular ramus (MR), the distance from the MC to the mandibular lower border (C-MLB), and the distance between the MC and the alveolar crest upper limit (C-AUL). Patients were separated into two groups based on age: < 15 (n = 15) and ≥ 15 (n = 19). In order to determine whether the MF, MR, MC, C-AUL, and C-MLB scores differed according to the groups (DS and control), one-way multivariate analysis of covariance (MANCOVA) was applied in which gender and age were taken as covariates. Results When the main effect according to the group was examined separately according to each measurement, the MF in the DS group was high with a moderate effect (F = 9207; p = 0.003). MR (F = 40,518; p < 0.001), MC (F = 23,747; p < 0.001), and C-AUL (F = 58,571; p < 0.001) in the DS group were lower with a larger effect. C-MLB did not significantly differ between the groups, and the effect size was quite low (p > 0.05). Conclusions Mandibular canal morphology may exhibit anatomical variations in DS. The alveolar bone level may differ from non-DS due to growth development retardation and/or periodontal diseases.
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Affiliation(s)
- Samed Satir
- Akdeniz University, Faculty of Dentistry, Oral and Maxillofacial Radiology, Akdeniz University Dumlupinar Boulevard 07058 Campus Antalya, Antalya, Turkey.
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25
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Wotjiuk F, Hyon I, Dajean-Trutaud S, Badran Z, Prud'homme T. Dental Management of Neurofibromatosis Type 1: A Case Report and Literature Review. Int J Clin Pediatr Dent 2019; 12:577-581. [PMID: 32440079 PMCID: PMC7229384 DOI: 10.5005/jp-journals-10005-1668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a clinically heterogeneous neurocutaneous genetic disorder that manifests in the form of coffee-milk spots on the skin, Lish nodules, lentigines on the underarms and on the inguinal region, and neurofibromas. Orofacial manifestations of NF1 are common. Through a review of the literature, bone lesions, orthodontic and dental abnormalities, periodontal manifestations, and caries related to NF1 will be explored. In this study, we present a clinical case of a patient with neurofibroma in the oral cavity and infraocclusion of primary molars, as well as his dental management.
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Affiliation(s)
| | - Isabelle Hyon
- Pediatric Dentistry Department, CHU/Université Nantes, France
| | | | - Zahi Badran
- Periodontology Department, CHU/Université Nantes, France; Faculty of Dentistry, McGill University, Montreal, Canada
| | - Tony Prud'homme
- Pediatric Dentistry Department, CHU/Université Nantes, France; UMR 1246 - SPHERE "Methods in Patient-centered Outcomes and Health Research", Université Nantes et Tours, France
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26
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Visnapuu V, Peltonen S, Alivuotila L, Happonen RP, Peltonen J. Craniofacial and oral alterations in patients with Neurofibromatosis 1. Orphanet J Rare Dis 2018; 13:131. [PMID: 30092804 PMCID: PMC6085685 DOI: 10.1186/s13023-018-0881-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/29/2018] [Indexed: 12/25/2022] Open
Abstract
ABTSRACT Neurofibromatosis type 1 (NF1) is one of the most common inherited syndromes. The literature on craniofacial alterations associated with NF1 has been limited and partially contradictory. This review is based on literature search and the results of the clinical study "Craniofacial and Oral Alterations and Speech in patients with Neurofibromatosis 1", carried out at the University of Turku and Turku University Hospital, Finland in 2006-2012. By the end of 2012, a total of 110 NF1 patients, 54 female and 56 male patients, were examined.A part of our results confirms pre-existing understanding, a part is contradictory to previous considerations based mainly on case reports, and some are entirely novel. Specifically, our results confirmed that enlargement the mandibular canal is the most common abnormality of the mandible in patients with NF1. It should be noted, however, that this finding does not require treatment. Caries was not a major problem. In fact, it was less frequent in NF1 patients compared to reference population. These findings abrogate some previous perceptions. Novel findings of our project include periapical cemental dysplasia in females; short jaws, a finding which usually does not affect bite; and immunohistological analysis of oral mucosal abnormalities. Pioneering study on speech showed that various deviations were very common: As many as 94% of the participants showed some alterations.To conclude, the awareness of craniofacial alterations common in NF1would help avoiding unnecessary and even harmful involvement, e.g. of periapical cemental dysplasia or enlarged mandibular canal which do not require treatment.
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Affiliation(s)
- Vivian Visnapuu
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
| | - Sirkku Peltonen
- Department of Dermatology, University of Turku and Turku University Hospital, TE6, Hämeentie 11, P O Box 52, FI-20521 Turku, Finland
| | - Lotta Alivuotila
- Department of Oral and Maxillofacial Surgery, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - Risto-Pekka Happonen
- Department of Oral and Maxillofacial Surgery, University of Turku, Lemminkäisenkatu 2, 20520 Turku, Finland
| | - Juha Peltonen
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Kiinamyllynkatu 10, 20520 Turku, Finland
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27
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Amaral FR, Ferreira MVL, Costa LAP, de Oliveira PAD, Soares BM, Souza PEA, de Sousa GR. Use of Surgical Laser for Excision of a Neurofibroma Associated With Neurofibromatosis Type-1. J Lasers Med Sci 2018; 9:219-222. [PMID: 30809335 DOI: 10.15171/jlms.2018.39] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder that affects approximately 1/3500 individuals. Various bone manifestations and peripheral nerves neoplastic lesions associated with NF1 are seen in the jaws. Several oral manifestations may occur in this disorder; therefore the dentist's knowledge and multidisciplinary management of these patients are extremely important. Case Presentation: In the present article, we present the use of a high-power surgical laser to excise a neurofibroma in a patient with several intraoral manifestations associated with NF1. Conclusion: The use of diode laser (808 nm) for excision biopsy of tongue nodules showed no thermal damage to the tissue, allowing an adequate histopathological analysis of the neurofibroma.
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Affiliation(s)
- Fabrício Rezende Amaral
- School of Dentistry, Centro Universitário Newton Paiva, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Betânia Maria Soares
- Bioengineering Laboratory, Universidade Federal de Minas Gerais, Minas Gerais, Belo Horizonte, MG, Brazil and Universidade de Itauna, Itauna, MG, Braz
| | - Paulo Eduardo Alencar Souza
- Department of Oral Pathology, School of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gerdal Roberto de Sousa
- School of Dentistry, Centro Universitário Newton Paiva, Belo Horizonte, Minas Gerais, Brazil
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28
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Friedrich RE, Reul A. Decayed, missing, and restored teeth in patients with Neurofibromatosis Type 1. J Clin Exp Dent 2018; 10:e107-e115. [PMID: 29670726 PMCID: PMC5899786 DOI: 10.4317/jced.54561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/23/2017] [Indexed: 12/26/2022] Open
Abstract
Background NF1 is a relatively frequently occurring autosomal dominant inherited disease. There are conflicting reports about oral health status in NF1. The aim of this study was to analyze the dental status of patients with neurofibromatosis type 1 (NF1). Material and Methods Radiographs of 179 patients with NF1 were analyzed for decayed, missing, and filled teeth (DMFT) in a cross-sectional, retrospective study. The results were compared to age- and sex-matched controls of individuals not affected by NF1. The NF1 group was differentiated for facial tumor type and localization. Results Missing teeth were more frequently registered in the NF1 group. On the other hand, decayed teeth were more frequent in the reference group. However, these findings had to be interpreted with caution, because the type and localization of the facial tumor affected the measured values. Conclusions Dental health in terms of DMFT differed between NF1 patients and the control group. The presented results indicate the need for special care in dentistry in NF1 patients in order to preserve dental health, particularly in individuals affected with certain types of facial tumors. Key words:DMFT index, neurofibromatosis type 1, plexiform neurofibroma, oral health.
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Affiliation(s)
- Reinhard E Friedrich
- Prof. Dr. med. Dr. med. dent, Department of Oral and Craniomaxillofacial Surgery
| | - Anika Reul
- Senior registrar, Department of Prosthodontics, Eppendorf University Hospital, University of Hamburg, Hamburg, Germany
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29
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Fjermestad KW, Nyhus L, Kanavin ØJ, Heiberg A, Hoxmark LB. Health Survey of Adults with Neurofibromatosis 1 Compared to Population Study Controls. J Genet Couns 2018; 27:1102-1110. [DOI: 10.1007/s10897-018-0229-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/29/2018] [Indexed: 02/06/2023]
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30
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Niño-Nuván FC, Gómez-Rueda PA, Lozano-Triana CJ, Quintero EM. Neurofibroma del hipogloso en un niño colombiano. Reporte de caso. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n1.56914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Se presenta el caso de un paciente masculino de 14 años de edad, con antecedente de dos intervenciones quirúrgicas debidas a la presencia de una masa a nivel sublingual —la primera a los 8 meses de edad y la segunda a los 13 años— y sin información de estudios histopatológicos. Cerca de 8 meses después de la última intervención quirúrgica es valorado por el Servicio de Cirugía Maxilofacial de la Fundación Hospital Pediátrico de La Misericordia en Bogotá D.C., Colombia, por crecimiento acelerado de la misma lesión y por problemas en la deglución y el lenguaje. En la revisión del paciente se encuentra una masa importante sublingual, dificultad en el lenguaje, deformidad mandibular y alteraciones en la mordida, por lo que se decide intervenir quirúrgicamente de nuevo. El resultado de la biopsia es un tumor mesenquimal benigno característico de neurofibroma, que por su ubicación sugiere probable compromiso del nervio hipogloso.
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31
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Bartzela TN, Carels C, Maltha JC. Update on 13 Syndromes Affecting Craniofacial and Dental Structures. Front Physiol 2017; 8:1038. [PMID: 29311971 PMCID: PMC5735950 DOI: 10.3389/fphys.2017.01038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/29/2017] [Indexed: 12/12/2022] Open
Abstract
Care of individuals with syndromes affecting craniofacial and dental structures are mostly treated by an interdisciplinary team from early childhood on. In addition to medical and dental specialists that have a vivid interest in these syndromes and for whom these syndromes are of evident interest, experts of scientific background-like molecular and developmental geneticists, but also computational biologists and bioinformaticians-, become more frequently involved in the refined diagnostic and etiological processes of these patients. Early diagnosis is often crucial for the effective treatment of functional and developmental aspects. However, not all syndromes can be clinically identified early, especially in cases of absence of known family history. Moreover, the treatment of these patients is often complicated because of insufficient medical knowledge, and because of the dental and craniofacial developmental variations. The role of the team is crucial for the prevention, proper function, and craniofacial development which is often combined with orthognathic surgery. Although the existing literature does not provide considerable insight into this topic, this descriptive review aims to provide tools for the interdisciplinary team by giving an update on the genetics and general features, and the oral and craniofacial manifestations for early diagnosis. Clinical phenotyping together with genetic data and pathway information will ultimately pave the way for preventive strategies and therapeutic options in the future. This will improve the prognosis for better functional and aesthetic outcome for these patients and lead to a better quality of life, not only for the patients themselves but also for their families. The aim of this review is to promote interdisciplinary interaction and mutual understanding among all specialists involved in the diagnosis and therapeutic guidance of patients with these syndromal conditions in order to provide optimal personalized care in an integrated approach.
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Affiliation(s)
- Theodosia N Bartzela
- Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité-Universitätsmedizin, Berlin, Germany.,Department of Orthodontics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Carine Carels
- Department of Oral Health Sciences, KU Leuven, Leuven, Belgium
| | - Jaap C Maltha
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, Netherlands
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32
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Venugopal R, Bavle RM, Konda P, Muniswamappa S, Makarla S. Familial Cancers of Head and Neck Region. J Clin Diagn Res 2017; 11:ZE01-ZE06. [PMID: 28764308 DOI: 10.7860/jcdr/2017/25920.9967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/30/2017] [Indexed: 01/12/2023]
Abstract
Cancers that occur in families more often than would be expected by chance are termed as familial cancers. They occur due to an inherited genetic mutation and account for 5%-10% of all cancers. This review article presents some of the common Familial Cancer Syndromes (FCS) such as MEN 2B, hyperparathyroidism-jaw tumour syndrome, familial oral squamous cell carcinoma, melanoma, nasopharyngeal carcinoma, paraganglioma, neurofibroma and other syndromes associated with head and neck region.
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Affiliation(s)
- Reshma Venugopal
- Senior Lecturer, Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Radhika Manoj Bavle
- Professor and Head, Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Paremala Konda
- Reader, Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Sudhakara Muniswamappa
- Reader, Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
| | - Soumya Makarla
- Reader, Department of Oral Pathology, Krishnadevaraya College of Dental Sciences, Bengaluru, Karnataka, India
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Alshehri M, Alshail F, Alshehri FA. Effect of scaling and root planing with and without adjunctive use of an essential-oil-based oral rinse in the treatment of periodontal inflammation in type-2 diabetic patients. JOURNAL OF INVESTIGATIVE AND CLINICAL DENTISTRY 2017; 8. [PMID: 26343552 DOI: 10.1111/jicd.12188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/04/2015] [Indexed: 01/11/2023]
Abstract
AIM The aim was to assess the effect of scaling and root planing (SRP) with and without adjunctive use of an essential-oil (EO)-based oral rinse in the treatment of periodontal inflammation in type-2 diabetic (T2D) patients. METHODS Sixty T2D patients were included. In Group 1 (n = 30), SRP was performed and patients were instructed to rinse twice daily with EO-based oral rinse for 30 days. In Group 2 (n = 30), SRP was performed and participants were instructed to rinse twice daily with water for 30 days. Periodontal parameters (plaque index (PI), bleeding on probing (BOP), and probing pocket depth (PPD) ≥ 4 mm) and hemoglobin A1c (HbA1c) levels were assessed at baseline and after 90 days. RESULTS In both groups, periodontal parameters were similar at baseline. After 90 days of follow-up, there was a significant reduction in the severity of periodontal parameters in patients in Group 1 compared with Group 2. After 90 days of follow-up, there was also a significant reduction in HbA1c among patients in Group 1 compared with Group 2. CONCLUSIONS Scaling and root planing with adjunct use of an EO-based oral rinse is more effective in the treatment of periodontal inflammation in T2D patients than SRP alone. This approach also helps reduce hyperglycemia in T2D patients as compared with when SRP is performed alone.
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Affiliation(s)
- Mohammed Alshehri
- Dental Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Alshail
- Department of Dentistry, Prince Faisal Bin Fahad Bin Abdulaziz-Sports Medicine Hospital, Riyadh, Saudi Arabia
| | - Fahad Ali Alshehri
- Department of Periodontics and Community Dentistry, King Saud University, Riyadh, Saudi Arabia
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Alshehri M, Alshail F, Alqahtani SH, Aloriny TS, Alsharif A, Kujan O. Short-term effects of scaling and root planing with or without adjunctive use of an essential-oil-based mouthwash in the treatment of periodontal inflammation in smokers. Interv Med Appl Sci 2015; 7:114-7. [PMID: 26524971 DOI: 10.1556/1646.7.2015.3.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of the present short-term follow-up study was to assess the effects of scaling and root planing (SRP) with or without adjunctive use of an essential-oil-based mouthwash in the treatment of periodontal inflammation in smokers. METHODS In total, 120 individuals were divided into 2 groups. In Group-1, 60 smokers with periodontal inflammation received SRP alone; and in Group-2, 60 smokers with periodontal inflammation received adjunct essential-oil mouthwash therapy. Periodontal parameters (plaque index [PI], bleeding-on-probing [BOP], and probing pocket depth [PD] ≥ 4 mm) were assessed at baseline and after 90 days of treatment. RESULTS There was no significant difference in periodontal parameters (PI, BOP, and PD ≥ 4 mm) among participants in Group-1 and -2. Participants in both groups showed significant reductions in PI (P < 0.01), BOP (P < 0.01), and PD ≥ 4 mm (P < 0.01) at follow-up compared to baseline. At 90 days of follow-up, PI (P < 0.05), BOP (P < 0.05), and PD ≥ 4 mm (P < 0.05) were significantly higher in Group-1 compared to Group-2. CONCLUSIONS SRP with adjunct essential-oil mouthwash therapy is more effective in the treatment of periodontal inflammation in smokers as compared to when SRP is performed alone.
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Alshehri M, Alshail F, Aldosary KM, Alamri AA. Comparison of an essential-oil-based oral rinse and chlorhexidine as adjuncts to scaling and root planing in the treatment of periodontal inflammation. Interv Med Appl Sci 2015; 7:78-84. [PMID: 26120480 DOI: 10.1556/1646.7.2015.2.6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 05/01/2015] [Accepted: 05/04/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of the present short-term follow-up study was to compare the effects of an essential oil (EO)-based oral rinse and chlorhexidine as adjuncts to scaling and root planing (SRP) in the treatment of periodontal inflammation. METHODS In Group-1, SRP was performed and participants were instructed to rinse with EO-based oral rinse; in Group-2, SRP was performed and participants were instructed to rinse with chlorhexidine; and in Group-3, SRP was performed and participants were instructed to rinse with water. Periodontal parameters (plaque index [PI], bleeding-on-probing [BOP], and probing pocket depth [PPD] ≥ 4 mm) were assessed at baseline and after 7 and 30 days. RESULTS In all groups, periodontal parameters (PI, BOP, and PPD ≥ 4 mm) were comparable at baseline. In Groups-1 and -2, there was a significant reduction in PI (P < 0.01), BOP (P < 0.01), and PD ≥ 4 mm after 7 days and 30 days of follow-up than baseline. In Group-3, there was a significant reduction in PI (P < 0.01) and BOP (P < 0.01) after 7 days of follow-up compared to baseline. There was no difference in periodontal parameters after 7 days and 30 days of follow-up in Groups-1 and -2. CONCLUSION EO-based oral rinses and chlorhexidine digluconate (CHX) are acceptable adjuncts to SRP in the treatment of periodontal inflammation.
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Cunha KS, Rozza-de-Menezes RE, Luna EB, Almeida LMDS, Pontes RRLDA, Almeida PN, de Aguiar LV, Dias EP. High prevalence of hyposalivation in individuals with neurofibromatosis 1: a case-control study. Orphanet J Rare Dis 2015; 10:24. [PMID: 25759173 PMCID: PMC4351927 DOI: 10.1186/s13023-015-0239-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 02/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background Neurofibromatosis type 1 (NF1) is one of the most common genetic diseases in humans and has widely variable expressivity. Oral manifestations are common, but there are no studies that investigated functional alterations in salivary glands in NF1. Our aim was to evaluate the salivary flow rate in NF1 individuals, comparing to a control group, and to investigate the possible causes and some consequences of salivary gland alteration. Methods This is a case–control study that evaluated the salivary flow rate of NF1 individuals (n = 49) and compared to an age and sex-matched control group. We have also investigated the possible causes and consequences of hyposalivation in NF1 individuals through anamnesis, a specific questionnaire, physical examination, tongue coating evaluation and cytopathological exam to assess the prevalence of oral candidiasis. Results Hyposalivation at rest was present in 59% (29/49) of NF1 individuals in contrast to 22% (11/49) in the control group, being statistically significant (P <0.0001; Wilcoxon rank-sum test). The analysis of the adjusted residual showed that the prevalence of hyposalivation in NF1 individuals (46.9%) was 4-fold higher than in controls (10.2%). None of the possible causes of hyposalivation (medications, low liquid intake, caffeinated or stimulant drink use, mouth breathers, alcohol, smoke and plexiform neurofibroma close to or involving major salivary glands areas) had important impact on the salivary flow rate in NF1 individuals. Conclusions Hyposalivation may be a consequence of NF1, as occurs in other genetic diseases. More studies are necessary to understand if there is and what is the relationship between NF1 and hyposalivation. Electronic supplementary material The online version of this article (doi:10.1186/s13023-015-0239-4) contains supplementary material, which is available to authorized users.
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Javed F, Vohra F, Al-Kheraif AA, Malmstrom H, Romanos GE. Comparison of periodontal inflammatory conditions among habitualgutkachewers and betel quid chewers. Oral Dis 2014; 21:437-42. [DOI: 10.1111/odi.12295] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/28/2014] [Accepted: 09/29/2014] [Indexed: 12/28/2022]
Affiliation(s)
- F Javed
- Division of General Dentistry, Eastman Institute for Oral Health; University of Rochester; Rochester NY USA
| | - F Vohra
- Department of Prosthetic Dental Sciences; College of Dentistry; King Saud University; Riyadh Saudi Arabia
- Department of Dentistry; Jinnah Hospital; Karachi Pakistan
| | - AA Al-Kheraif
- Dental Biomaterials Research Chair; Dental Health Department; College of Applied Medical Sciences; King Saud University; Riyadh Saudi Arabia
| | - H Malmstrom
- Division of General Dentistry, Eastman Institute for Oral Health; University of Rochester; Rochester NY USA
| | - G-E Romanos
- Department of Periodontology; School of Dental Medicine; Stony Brook University; Stony Brook NY USA
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