A rare case of intraoral schwannoma in gingiva

BACKGROUND

Schwannomas are benign, slow-growing encapsulated nodular lesions. As for the most benign encapsulated lesions, the treatment of choice is complete removal of the entire tissue with preservation of surrounding tissue.

METHODS AND RESULTS

The case presented is that of a 35-year-old female with the chief complaint of swelling on her gums in the lower left posterior region. Through intraoral and extraoral examinations the benign nature of the lesion was established. The excisional biopsy was carried out under local anesthesia, and the specimen was sent for histological examination, which gave a definite diagnosis of oral schwannoma. The patient was recalled at regular intervals so as to check for any recurrence of the lesion or occurrence of new lesions elsewhere in the body.

CONCLUSION

The present case reemphasizes the importance of thorough clinical examination along with appropriate investigations, especially histopathological and immunohistochemical, for establishing a definitive diagnosis, which eventually plays an important role in the choice and execution of appropriate treatment at the earliest for the best prognosis and outcomes.

KEY POINTS

Why is this case new information? To the best of the author's knowledge, this the first case report of oral schwannoma diagnosed in gingiva in Indian population. This case presented a diagnostic dilemma due to its unusual location. What are the keys to successful management of this case? Schwannomas when completely excised have low rate of recurrence. Accurate diagnosis of the lesion along with complete physical examination and follow-up at regular interval to rule out any recurrences are the keys to successful management of this case. What are the primary limitations to success in this case? Lack of data regarding residual tumor postoperative is a primary limitations to success of the case, as recurrence is associated with subtotal tumor removal.

A Study to Evaluate the Efficacy of an 810-nm Diode Laser in the Maintenance of Dental Implants: A Peri-Implant Sulcular Fluid Analysis

Biological implant failures are primarily related to biofilm, which can lead to peri-mucositis and, further on, peri-implantitis. The 810-nm diode laser has an affinity for pigmented chromophores, so its use in the peri-implant sulcus has a significant bactericidal effect on the black-pigmented anaerobes such as Porphyromonas gingivalis. Therefore, it can be used to eliminate or reduce the bacterial count in the peri-implant sulcular fluid (PISF), thus increasing the life of the implants and reducing the chances of failure. The purpose of this study was to evaluate the efficacy of the 810-nm diode laser for the maintenance of dental implants and its use as a regular in-office tool for limiting the microbiological count in the PISF. Twenty patients undergoing implant treatment at the Department of Periodontology and Oral Implantology were randomly selected for the study. PISF samples were collected before and after the sulcus was lased with an 810-nm diode laser and sent for quantitative microbiological analysis using universal bacterial count, and the quantity of P gingivalis was evaluated using real-time polymerase chain reaction (PCR). The analysis revealed that after diode application, the median percentage drop in the microbial count was 76.67% and the median percentage drop in P gingivalis count was 99.28%. The use of an 810-nm diode laser resulted in the following outcomes: (1) drastic reduction in the total bacterial count around the implant and (2) significant reduction in the P gingivalis count, as evaluated by real-time PCR.

The comparative effects of 0.12% chlorhexidine and herbal oral rinse on dental plaque-induced gingivitis: A randomized clinical trial

Background:

Chlorhexidine (CHX) is considered as a gold standard of antimicrobial rinses. Various herbal oral rinses are available in the market. However, little is known of its effectiveness.

Aim:

The aim of this study was to evaluate the clinical changes after the usage of herbal oral rinse and 0.12% CHX.

Materials and Methods:

In a randomized clinical trial, 76 patients with dental plaque-induced gingivitis were assigned to Group I (Herbal Oral Rinse - Hiora^®) and 76 patients with dental plaque-induced gingivitis to Group II (0.12% Chlorhexidine-Peridex^®). Gingival index and Plaque index scores were recorded at baseline and 21 days after scaling.

Results:

Intragroup comparison in both groups showed that plaque index and gingival index scores were statistically significant after 21 days as compared to baseline. Intergroup comparison showed that plaque index scores and gingival index scores were statistically significant in Group II as compared to Group I.

Conclusion:

When herbal oral rinse was compared to 0.12% CHX, 0.12% CHX mouth rinse effectively reduced the clinical symptoms of plaque-induced gingivitis.

Efficacy of curcumin in the treatment of chronic gingivitis: a pilot study

PURPOSE

To evaluate the efficacy of curcumin mouthwash as an adjunct to scaling and root planing in the treatment of chronic gingivitis and to compare curcumin to chlorhexidine in terms of its anti-inflammatory and anti-microbial properties.

MATERIALS AND METHODS

Thirty patients aged 20-40 years with generalised chronic gingivitis were included in the study. They were randomly divided into 3 groups of 10 each. In group 1, patients underwent scaling and root planing followed by chlorhexidine mouthwash (SRP/CHX Gr-1); in group 2, patients underwent scaling and root planing followed by curcumin mouthwash (SRP/CUR Gr-2); in group 3, patients underwent only scaling and root planing (SRP Gr-3). Gingival and plaque indices were recorded at baseline (day 0) and 7, 14 and 21 days. Differences between the groups were statistically analysed.

RESULTS

The clinical parameters showed improvement in all the three groups compared to baseline. When compared to the scaling and root planing group (Gr-3), both curcumin and chlorhexidine groups were found to have statistically significantly better results (P < 0.05). However, when curcumin and chlorhexidine groups were compared, the gingival (Löe and Silness) and plaque index (Silness and Löe) scores were not found to be statistically significant (P > 0.05).

CONCLUSION

Curcumin is comparable to chlorhexidine as an anti-inflammatory mouthwash. Thus, it can be considered as an effective adjunct to mechanical periodontal therapy.

Salivary pH: A diagnostic biomarker

OBJECTIVES

Saliva contains a variety of host defense factors. It influences calculus formation and periodontal disease. Different studies have been done to find exact correlation of salivary biomarkers with periodontal disease. With a multitude of biomarkers and complexities in their determination, the salivary pH may be tried to be used as a quick chairside test. The aim of this study was to analyze the pH of saliva and determine its relevance to the severity of periodontal disease.

STUDY DESIGN

The study population consisted of 300 patients. They were divided into three groups of 100 patients each: Group A had clinically healthy gingiva, Group B who had generalized chronic gingivitis and Group C who had generalized chronic periodontitis. The randomized unstimulated saliva from each patient was collected and pH was tested. Data was analyzed statistically using analysis of variance technique.

RESULTS

The salivary pH was more alkaline for patients with generalized chronic gingivitis as compared with the control group (P = 0.001) whereas patients with generalized chronic periodontitis had more acidic pH as compared with the control group (P = 0.001).

CONCLUSION

These results indicate a significant change in the pH depending on the severity of the periodontal condition. The salivary pH shows significant changes and thus relevance to the severity of periodontal disease. Salivary pH may thus be used as a quick chairside diagnostic biomarker.

Efficacy of chlorhexidine mouthrinses with and without alcohol - a clinical study

PURPOSE

To compare the efficacy of alcohol-free chlorhexidine mouthrinse to chlorhexidine with alcohol and a placebo (water) in controlling plaque and reducing gingival inflammation in patients with gingivitis.

MATERIALS AND METHODS

This was a single-blind, parallel-group study with 30 gingivitis patients in whom the plaque index (Silness and Löe) and gingival index (Löe and Silness) were recorded prior to treatment with 0.2% chlorhexidine mouthrinse with alcohol (group I, n = 10; CHX-A), 0.2% chlorhexidine mouthrinse without alcohol (group II, n = 10; CHXNA) or a placebo (water) (group II, n = 10; P). The plaque and gingival indices were recorded again at days 14 and 28 after the start of treatment.

RESULTS

There were significant differences in plaque and gingival indices with both chlorhexidine rinses compared to the placebo. The gingival index showed a greater clinical change in group II (CHX-NA) than in group I (CHX-A).

CONCLUSION

The alcohol-free rinse was as effective as the one containing alcohol in controlling plaque and reducing gingival inflammation. Therefore, its use can be recommended in all periodontal patients, but especially in those for whom the use of alcohol may lead to side effects.