Successful pregnancy and delivery management in a patient with Bernard Soulier Syndrome

Bernard Soulier Syndrome (BSS) is an inherited bleeding disorder characterized by macrothrombocytopenia and absence of ristocetin-induced platelet aggregation. Clinical findings vary from person to person. Most of the patients are diagnosed with muco-cutaneous bleeding such as purpura, epistaxis and gingival bleeding in early childhood. Few pregnant women with BSS are described in the literature. Management of thrombocytopenia during pregnancy and delivery requires a multidisciplinary approach. The family should be warned about the potentially life-threatening bleeding during pregnancy and the delivery and the decision about mode of delivery should be individualised, involving discussion with patient and multidisciplinary team.

Analysis of White Blood Cell Count and Its Differential Count in Gingival and Periodontal Conditions Associated with Bleeding Gingiva

Background: Bleeding gingiva is caused primarily due to the accumulation of plaque and calculus which eventually leads to gingivitis or periodontitis. Other causes of bleeding gingiva can be due to improper flossing, over brushing of the teeth and gingiva, hormonal changes due to pregnancy, ill-fitting dentures and any other dental appliances impinging the gingiva. The bleeding gingiva can also indicate serious health problems like leukemia, scurvy, idiopathic thrombocytopenic purpura, vitamin k deficiency and any bleeding disorder. Persistent gingival bleeding is a sign of serious medical problems like leukemia and platelet disorders. Leukemia is a group of cancer where there is an increased number of immature or abnormal white blood cells. In this study, the WBC and their differential count is analyzed in patients with bleeding gingiva to check the possibilities for the patient to get cancer. Aim: To measure and observe the WBC count and its differentials by testing the blood from patients with bleeding gingiva. Materials and Methods: The study was conducted in the clinical pathology lab at Saveetha Dental College and Hospitals, Chennai. 100 subjects were subjected to the study. Subjects with chief complaint of bleeding gingiva, without systemic diseases like diabetes, hypertension, and patients with the age of above 10 were included in the study. Results and Conclusion: This study was conducted to analyze the WBC count and differential count among the patients with bleeding gingiva. No significant correlation was found between bleeding gingiva and white blood cells & their differential count in this study.

Immune Thrombocytopenia: A Rare Presentation of Pulmonary Sarcoidosis

Thrombocytopenia may be the initial presentation of sarcoidosis, which is a systemic granulomatous disorder. Various pathophysiological mechanisms have been identified. Immune thrombocytopenia often has a severe presentation but may respond favourably to immunosuppressive therapy. There are no guidelines for the treatment of thrombocytopenia in sarcoidosis. However, in emergency situations with major bleeding, it seems reasonable to apply the current guidelines recommended for immune thrombocytopenia. The authors report a case of sarcoidosis presenting with severe thrombocytopenia, petechial rash, and nasal and gingival bleeding.

The Effect of Smoking on Salivary Calcium Levels, Calcium Intake, and Bleeding on Probing in Female

Introduction. Smoking is a bad habit that affects both systemic and oral conditions. Nicotine in cigarettes reduces estrogen production that can alter salivary calcium levels. Nicotine also causes vasoconstriction of the gingival blood vessels and decreases gingival bleeding. Low dietary calcium intake is also suspected to influence the low serum calcium levels in smokers. In this study, we evaluated the effect of smoking on salivary calcium levels, calcium intake, and BOP in women. Method. This was an analytical study using a cross-sectional approach. The subjects were 26 female smokers and 37 nonsmokers. Unstimulated saliva was collected by the spitting method. Salivary calcium levels were measured using an Atomic Absorption Spectrophotometer (AAS). The calcium intake was obtained by the Semiquantitative Food Frequency Questionnaire. BOP was measured by a gingival bleeding index by Ainamo and Bay in 1975. Results. All the basic characteristics including age, BMI, level of education, and occupation were statistically different between groups. The mean calcium level of female smokers was significantly lower than that of nonsmokers, whereas the mean BOP of female smokers was significantly higher. The total calcium intake per day of the two groups was not statistically different. The mean salivary calcium level and BOP decreased when the duration of smoking was longer. There was a positive correlation between salivary calcium level and BOP in the smokers’ group. Conclusion. A low level of education may be contributing to the smoking habit of subjects in this study. Salivary calcium levels were correlated with BOP in female smokers, which might be affected by the duration of smoking.

A Dynamic Technique of Oral Rehabilization Using Fixed Prosthesis and CSC Telescopic Denture for Severe Advanced Periodontitis with Secondary Occlusal Traumatism – A Long-term Case Report

Clinical reports of many literatures had documented that meticulous non-surgical periodontal therapy (NSPT) and combined with periodontal prosthesis application might not only improve periodontal parameters, but also provide effective reduction of microbiological organisms associated with periodontal pathogen. A 54-year old female individual visited with chief complains of gingival bleeding and mobile teeth, and recurrent periodontal abscess over # 13, # 11, # 21, and # 22. Periapical radiographs disclosed moderate periodontal bone loss on the total remained teeth of maxilla and mandible arches. A diagnosis of generalized severe advanced periodontitis (SAP) with secondary occlusal traumatism (SOT) was established. This present case was to document the treatment of a 6 years longitudinally retrospective evaluation of case affected SAP with SOT using treatment of the combination of periodontal and perio-prosthetic design. Results showed that the remarkable improvement of periodontal tissues, reconstruction of posterior bite occlusion and recovery of esthetic appearance. It can be concluded that the Sandwich’s technique in treating patients affected SAP with SOT is an effective and valuable option.

Periodontal clinical features of bronchial asthma patient using inhalation drugs

Introduction: Bronchial asthma patients use inhalation drugs as therapy to achieve a controlled asthma state. Inhaled corticosteroids and β2 agonists are the medication that is being used in this case. Prolonged use of inhalation drugs will affect the health of periodontal tissue. The effect of these drugs can reduce the periodontal defense mechanism and increase the risk of periodontal disease. This study aims to determine the periodontal clinical features of bronchial asthma patients using inhalation drugs. Method: This research was a descriptive study. The sample of the study were 22 females and 8 males bronchial asthma patients at the Community Lung Health Center of Bandung (Balai Besar Kesehatan Paru Masyarakat Bandung/BBKPM Bandung) who had been using inhalation drugs for at least one year. The periodontal clinical feature was assessed by employing a Community Periodontal Index (CPI) modified with probing the gingival sulcus to assess the presence of gingival bleeding, periodontal pocket, and loss of clinical attachment where then a periodontal status was obtained. The periodontal status data were then processed using the periodontitis case definitions from the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) to determine periodontal disease in asthmatics patients. Results: Clinical features of gingival bleeding were found in 26 asthmatic patients (86.7%), periodontal pockets in 18 asthmatic patients (60%), and loss of clinical attachment in 27 asthmatic patients (90%). Based on the CDC/AAP case definition, 23 asthmatic patients (76.7%) had periodontitis. Bronchial asthma patients who used inhalation drugs had a risk of periodontitis.Conclusion: Bronchial asthma patients who used inhalation drugs for at least one year had gingival bleeding and loss of clinical attachment and periodontal pocket.

Patient-reported experiences and outcomes following two different approaches for non-surgical periodontal treatment: a randomized field study

Context The current report is part of a prospective, multi-center, two-arm, quasi-randomized field study focusing on the effectiveness in general praxis of evidence-based procedures in the non-surgical treatment of patients with periodontitis. Objective The specific aims were to (i) evaluate patient-reported experience and outcome measures of treatment following a guided approach to periodontal infection control (GPIC) compared to conventional non-surgical therapy (CNST) and to (ii) identify potential predictors of subjective treatment outcomes and patient’s adherence to self-performed infection control, i.e. adequate oral hygiene. Methods The study sample consisted of 494 patients treated per protocol with questionnaire- and clinical data at baseline and 6-months. The GPIC approach (test) comprised patient education for adequate oral hygiene prior to a single session of full-mouth ultra-sonic instrumentation, while the CNST approach (control) comprised education and instrumentation (scaling and root planing) integrated at required number of consecutive appointments. Clinical examinations and treatment were performed by Dental Hygienists, i.e. not blinded. Data were processed with bivariate statistics for comparison between treatment groups and with multiple regression models to identify potential predictors of subjective and clinical outcomes. The primary clinical outcome was gingival bleeding scores. Results No substantial differences were found between the two treatment approaches regarding patient-reported experiences or outcomes of therapy. Patients’ experiences of definitely being involved in therapy decisions was a significant predictor for a desirable subjective and clinical outcome in terms of; (i) that oral health was considered as much improved after therapy compared to how it was before, (ii) that the treatment definitively had been worth the cost and efforts, and (iii) adherence to self-performed periodontal infection control. In addition, to be a current smoker counteracted patients’ satisfaction with oral health outcome, while gingival bleeding scores at baseline predicted clinical outcome in terms of bleeding scores at 6-months. Conclusions The results suggest that there are no differences with regard to patient-reported experiences and outcomes of therapy following a GPIC approach to periodontal infection control versus CNST. Patients’ experiences of being involved in therapy decisions seem to be an important factor for satisfaction with care and for adherence to self-performed periodontal infection control. Registered at: ClinicalTrials.gov (NCT02168621).

Scorbuto: ancora un problema dei nostri giorni?

Scurvy is a condition due to chronic ascorbic acid deficiency responsible for vascular fragility and impaired bone formation. The result is gingival bleeding, petechial lesions and articular and bone pain or limb swelling. Children may also present with irritability, limping or refusal to walk. Because of these symptoms it can be misdiagnosed with osteomyelitis, septic arthritis, bone and soft tissue tumour, leukaemia, bleeding disorders and other rheumatologic conditions. In highly developed countries it is rare, but should be suspected in children with underlying chronic condition characterized by selective eating as in developmental delay or autism spectrum disorders. The paper presents an emblematic case.

Adjunctive Effect of Green Tea Mouthwash Prepared at Different Steeping Temperatures on Gingivitis: A Triple-Blind Randomized Controlled Clinical Trial

Purpose: To compare the effect of green tea mouthwashes prepared at different steeping temperatures as adjuncts to mechanical plaque control on gingivitis. Methods: Forty-five women with gingivitis participated in this 4-week randomized controlled clinical trial. They received professional mechanical plaque control and rinsed daily with either warm green tea, hot–cold green tea or placebo. Dental plaque control record (PCR) and gingival bleeding indices (GBI) were recorded at baseline and 7, 14 and 28 days after. Results: Participants’ mean age was 20.7 ± 2 years. The mean scores for the PCR and GBI at baseline were 82.4 ± 19 and 85.8 ± 7, respectively. All groups showed significant reduction in PCR and GBI between Days 0 and 28 (p < 0.01). No significant differences in PCR were observed between the groups at any of the examinations (p > 0.01). The warm green tea group demonstrated significantly lower GBI at all examinations compared to the hot–cold group (p < 0.01). Conclusions: Within study limits, green tea-made mouthwashes significantly reduced plaque and gingivitis when used as adjuncts to mechanical plaque control. The green tea mouthwash prepared in warm water demonstrated significantly higher efficacy in lowering gingivitis compared to that prepared in hot water followed by ice.