Scleroderma and dentistry: Two case reports

© 2016 The Author(s).Background: Scleroderma is a chronic connective tissue disorder with unknown etiology. It is characterized by excessive deposition of extracellular matrix in the connective tissues causing vascular disturbances which can result in tissue hypoxia. These changes are manifested as atrophy of the skin and/or mucosa, subcutaneous tissue, muscles, and internal organs. Such changes can be classified into two types, namely, morphea (localized) and diffuse (systemic). Morphea can manifest itself as hemifacial atrophy (Parry-Romberg syndrome) although this remains debatable. Hence, we present a case of morphea, associated with Parry-Romberg syndrome, and a second case with the classical signs of progressive systemic sclerosis. Case presentation: Case one: A 20-year-old man of Dravidian origin presented to our out-patient department with a complaint of facial asymmetry, difficulty in speech, and loss of taste sensation over the last 2 years. There was no history of facial trauma. After physical and radiological investigations, we found gross asymmetry of the left side of his face, a scar on his chin, tongue atrophy, relative microdontia, thinning of the ramus/body of his mandible, and sclerotic lesions on his trunk. Serological investigations were positive for antinuclear antibody for double-stranded deoxyribonucleic acid and mitochondria. A biopsy was suggestive of morphea. Hence, our final diagnosis was mixed morphea with Parry-Romberg syndrome. Case two: A 53-year-old woman of Dravidian origin presented to our out-patient department with a complaint of gradually decreasing mouth opening over the past 7 years. Her medical history was noncontributory. On clinical examination, we found her perioral, neck, and hand skin to be sclerotic. Also, her fingers exhibited bilateral telangiectasia. An oral examination revealed completely edentulous arches as well as xerostomia and candidiasis. Her serological reports were positive for antinuclear antibodies against centromere B, Scl-70, and Ro-52. A hand and wrist radiograph revealed acro-osteolysis of the middle finger on her right hand. Hence, our final diagnosis was progressive systemic sclerosis. Conclusion: Through this article, we have tried to emphasize the importance of a general examination when diagnosing rare systemic diseases such as scleroderma and the role of the general dentist when caring for such patients, even though they can be quite rare in general practice.published_or_final_versio

Evaluation of efficacy of tacrolimus 0.1% in orabase and triamcinolone acetonide 0.1% in orabase in the management of symptomatic oral lichen planus randomized single blind control study

Objectives: Studies done on the management of oral lichen planus using tacrolimus are limited. The aim of the study is to compare the efficacy of tacrolimus with tramcinolone acetonide topically in the management of symptomatic oral lichen planus and also to evaluate adverse effects and opportunistic yeast infections. Materials and methods: A randomized controlled study was conducted on 60 patients with symptomatic lesions of oral lichen planus with biopsy proven who fulfilled the inclusion criteria. Study group comprised of 30 patients who received topical 0.1 tacrolimus in orabase therapy for 4 weeks. Control group comprised of 30 patients who received topical 0.1% triamcinolone acetonide in orabase for 4 weeks. Results: Significant improvement of symptoms (7.80 ΁ 1.90 to 1.2 ΁ 2.6) and clinical scores (3.1 ΁ 1.27 to 2.3 ΁ 1.1) in study group as compared to control group (7.60 ΁ 2.01 to 2.7 ΁ 2.5) and (2.73 ΁ 1.46 to 1.2 ΁ 1.4). No significant adverse effects were observed and no recurrence was noted during treatment and follow-up. Conclusion: Study group has shown significant clinical response (p = 0.002) when compared to control group. However, double-blind, controlled studies are needed to evaluate the efficacy of tacrolimus in the treatment of symptomatic oral lichen planus and to address the safety for long-term therapy

Evaluation of cystic schwannoma of masticator space – A case report

Schwannoma is a benign neoplasm originating from the neural sheath and occurring in up to 45% of the cases of extracranial neurogenic tumors. Schwannomas of masticator spaces are rare. This article reports the case of an intraoral schwannoma occupying the masseteric and buccal spaces of a 55-year-old woman, for whom detailed imaging investigations were performed, comprising conventional extraoral radiographs, ultrasound, and plain and contrast enhanced magnetic resonance imaging. The lesion was surgically resected

Nager′s acrofacial dysostosis

Acrofacial dysostosis (AFD) is a generic name for a variety of different but possibly related genetic disorders that result in craniofacial and limb malformations and are, therefore, categorized under oroacral disorders. Several different variants have been identified and Nager preaxial AFD represents the association of mandibulofacial dysostosis with limb anomalies, particularly hypoplasia of the radial aspect of the hand. This report features a case of a 21-year-old male presenting with malar hypoplasia, downward sloping palpebral fissures, high-arched palate, radioulnar synostosis, hypoplasia of the right thumb and lower limb anomalies

Zimmermann-Laband Syndrome: Report of a Case with Early Cardiac Complications

Laband syndrome (LS) is a rare autosomal dominant inherited disorder characterized by coarse facial appearance, gingival fibromatosis, and hypoplasia of the terminal phalanges and nails of hands and feet. Additionally, more variable features include hyperextensibility of joints, hepatosplenomegaly, mild hirsutism, and mental retardation. This paper reports a case study of 22-year-old male exhibiting symptoms of Laband syndrome, including cardiac involvement described only in one other case. Detection and timely recognition of such syndrome associated with gingival fibromatosis allows adequate dental care and cardiac evaluation at periodic intervals is merited to prevent complications and improve the overall quality of life for these patients. Dental practitioners should be alert for developmental abnormalities that may occur in patients with gingival fibromatosis as this may indicate the presence of a rare disorder like Zimmermann-Laband syndrome. A comprehensive medical history and physical systemic evaluation are essential for correct diagnosis, treatment and prevention of cardiovascular complications in future in these patients

A Multi-Center Disclusion Time Reduction (DTR) Randomized Controlled Occlusal Adjustment Study Using Occlusal Force and Timing Sensors Synchronized with Muscle Physiology Sensors

Objective—To perform a Randomized Controlled Trial (RCT) Disclusion Time Reduction (DTR) study at five Dental Colleges, using intraoral sensors and muscular electrodes. Methods and Materials—One hundred students were randomly assigned to a treatment group to receive the ICAGD coronoplasty, or a control group that received tooth polishing. All subjects answered symptom questionnaires: Beck Depression Inventory-II, Functional Restrictions, and Chronic Pain Symptom and Frequency. Subjects self-reported after ICAGD or placebo at 1 week, 1 month, 3 months, and 6 months. The Student’s t-Test analyzed the measured data. The Mann–Whitney U Test analyzed the subjective data (Alpha = 0.05). Results—The Disclusion Times, BDI-II scores, and Symptom Scales were similar between groups prior to treatment (p > 0.05). At 1 week, all three measures reduced in the treatment group, continuing to decline over 6 months (p p > 0.05). Symptom Frequency, Functional Restrictions, and Pain Frequencies were higher in the treated group (p p Conclusions—ICAGD reduced Pain, Functional Restrictions, Symptom Frequency, and Emotional Depression within 1 week, which continued for 6 months. The tooth polishing did not initiate a placebo response

Self-Inflicted Intraoral Hematoma in a Cardiac Patient Receiving Oral Anticoagulant Therapy- A Case Report

Intraoral hematoma secondary to systemic anticoagulant therapy is rare, but it is a potentially fatal condition requiring immediate medical management. Case report: Here we report a case of self-inflicted hematoma in the anterior maxillary gingival region in a 65year old female cardiac patient who was on systemic anticoagulant therapy with a poor periodontal condition, manifesting as a periodontal swelling for a period of one week. Oral anticoagulant therapy is considerably imperative to prevent thromboembolic complications in various medical conditions, in such patients there are chances for spontaneous bleeding or hematoma by means of minor trauma due to sharp teeth or dental prosthesis in the mouth leading to life threatening complications such as partial or complete airway blockage. Therefore,directives about possible bleeding complications secondary to anticoagulant drugs in the oral cavity and the importance of maintaining oral health hygiene are necessary for the patient