Pyogenic Granuloma in a Patient of Sturge-Weber Syndrome with Bilateral Port Wine Stain- A Rare Case Report

Sturge-Weber syndrome (SWS) also known as encephalotrigeminal angiomatosis. It is a neurocutaneous syndrome, characterized by a facial vascular birthmark and neurological abnormalities. An ipsilateral or bilateral facial cutaneous vascular malformation Port Wine Stain (PWS) usually affects the upper face. Other clinical manifestations are seizures, glaucoma, hemiparesis, mental retardation and delayed developmental milestones. The main objective of this case report is to unravel such a rarest syndrome with bilateral port-wine stain, which has intraoral manifestation of pyogenic granuloma involving gingiva in an 11 year old boy

commerciallyClinical study of rhino-orbital-cerebral mucormycosis in COVID-19 patients in a regional institute in South India

BACKGROUND: Rhino-orbital-cerebral mucormycosis (ROCM) is usually seen in immunosuppressed conditions like uncontrolled diabetes mellitus (DM). The pandemic of severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) and its associated immunosuppression and indiscriminate use of corticosteroids emerged as a new risk factor for ROCM during its’ second wave of coronavirus disease 2019 (COVID-19), especially in India. The lack of standardized management protocol for ROCM needs the attention of the ophthalmic community. COVID-19-associated risk factors have been linked to the pathogenesis of ROCM, which reached epidemic proportions during India’s second wave of the pandemic. The aim of the present study was to document cases of ROCM and to evaluate risk factors, including co-morbidities, clinical characteristics, diagnosis, management, and outcome at tertiary care centers during the Sars-CoV-2 (2021) pandemic. MATERIAL AND METHODS: It is a retrospective study of 42 patients of biopsy-proven mucormycosis. These patients’ records were reviewed from hospital data. All patients were subjected to complete ophthalmological, ortorhino laringological examination, and imaging studies. The orbital staging was done. Each case was treated by a multidisciplinary approach with functional endoscopic sinus surgery (FESS) and intravenous (i.v.) amphotericin B (AMB). Retrobulbar liposomal AMB and exenteration were performed whenever indicated. Statistical analysis was done using the Chi square test. A p-value ≤ 0.05 was considered significant. RESULTS: Total 42 patients of ROCM were documented. The mean age was 50.48 years, with a male preponderance (82.9%). 99.8% of patients had diabetes (39 patients) and all patients were COVID-19-positive. Concurrent steroid use was seen in 83.3% where 73.1% of patients had received oxygen support during COVID-19 infection. The most common ophthalmologic presentation was orbital/facial oedema (33) and pain, diminution of vision (24), and ophthalmoplegia (26). Direct nasal endoscopy and biopsy were done to establish a diagnosis. All patients were treated with FESS and i.v. AMB. Retrobulbar AMB was given to 11 patients. Exenteration was done in (n = 4) 10.5% of cases. 41 patients recovered, and one patient died CONCLUSION: The most significant predisposing factors for developing COVID-19-associated ROCM are corticosteroids and DM. Patients with COVID-19 must be followed up even after recovery. For a favorable outcome with lower mortality in COVID-19 recovered patients, we must have a high index of clinical suspicion with awareness of red flag signs and make a timely diagnosis

Ulcerative Uremic Stomatitis - Review of the Literature and A Rare Case Report

Uremic Stomatitis (US) represents a comparatively uncommon intraoral complication seen, mostly, in cases of end-stage renal disease or undiagnosed or untreated chronic renal failure. Its frequency has diminished due to the advent of renal dialysis. Clinically uremic stomatitis is characterized by the presence of painful plaques and crusts that are usually distributed on the buccal and labial mucosa, dorsal or ventral surface of the tongue, gingiva, and floor of the mouth. Ultimate treatment consists of improvement of blood urea concentration and underlying renal failure is supported by enhancement of oral hygiene with antiseptic mouthwashes and antimicrobial/antifungal agents, if necessary. Here we report a rare case of ulcerative type of uremic stomatitis occurring in a patient of chronic renal failure due to sudden relapse of uremia and reviewed the possible pathophysiology of oral symptoms of chronic renal failure

Role of oxidative stress in the pathogenesis of oral submucous fibrosis: A preliminary prospective study

Background: In the current scenario pathogenesis of majority of the diseases is deeply linked with the oxidative stress, irrespective of its etiology. Enumerable data suggests that reactive oxygen species play a key role in multistage carcinogenesis. Oral submucous fibrosis (OSMF) is considered as a potentially malignant disorder. Its increased incidence over recent years in the Indian subcontinent is a major health concern to oral physicians. However, the role of oxidative stress has not been widely investigated in OSMF. Aims: Is to evaluate both antioxidant and oxidant status in OSMF and to compare with controls. Settings and Design: Twenty patients and 20 controls of the same age group were enrolled in the study. Subjects and Methods: Five milliliters of blood were collected from each individual and serum was separated. Malondialdehyde (MDA) estimation using thiobarbituric acid (TBA) method, and antioxidant activity (AOA) using principle of TBA reactive substances was done using this serum, with a calorimetric method. Statistical Analysis Used: Student's t-test and ANOVA test. Results: The mean serum AOA status was seen to significantly decrease in OSMF patients, as compared to controls (P = 0.013). The increase in mean serum MDA level was highly significant in OSMF patients, as compared to controls (P < 0.001). Conclusion: The disparity between AOA and MDA levels in the patients clearly demonstrates the role of oxidative stress in the disease process. The results also suggest the use of antioxidants in the management of OSMF

Potential Association of Hypothyroidism and Cardiovascular Disorders among Type II Diabetes Mellitus Patients Visiting for Dental Treatment

Background: Diabetes is a group of etiologically different metabolic defects characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Aim and Objectives: The study intended to estimate prevalence of hypothyroidism among Type 2 Diabetes Mellitus (T2DM) patients and to substantiate the association of these two disorders with cardiovascular diseases. Material and Methods: The study included 208 T2DM patients; all were evaluated for diabetes mellitus, hypothyroidism and cardiovascular disorders by history, clinical examination and investigations. They were divided as Diabetes Mellitus (DM) and Diabetes Mellitus Hypothyroidic (DMH) categories. DM category was further divided as: Diabetic (D) and Diabetic Cardiovascular (DC) groups, DMH category as Diabetic Hypothyroidic (DH) and Diabetic Hypothyroid Cardiovascular (DHC) groups. Intra and inter category comparison of biochemical and clinical parameters were done. Results: Out of 208 T2DM patients, DM category had 102 patients and DMH category 106 patients, On intracategory comparison of various biochemical parameters between the two categories, in DM category, Fasting Blood Sugar (FBS) (p=0.00), Postprandial Blood Sugar (PPBS) (p=0.34 and p=0.02), Low Density Lipoprotein (LDL) (p=0.00 and p=0.20) were significantly higher and High Density Lipoprotein (HDL) was lower in both D and DC groups, total cholesterol in DC (p=0.23) group was significantly higher and triglycerides were within normal. In DMH category, FBS (p=0.01 and p=0.00), serum Thyroid Stimulating Hormone (TSH) (p=0.00), LDL, total cholesterol (p=0.00), LDL (p=0.02 and p=0.00) and triglycerides (p=0.00 and p=0.01) were significantly higher in both DH and DHC groups, the HDL was significantly lower in DHC group. There was no association between DM category with blood pressure and electrocardiogram parameters, but in DMH category there was significant association seen, as p=0.02 and p=0.06 respectively. On inter group comparison between DM and DMH categories for biochemical parameters, there was statistical significance was found with serum TSH (p=0.00), total cholesterol (p=0.01) and LDL (p=0.007), where as FBS, PPBS, triglycerides, HDL were not significant. Conclusion: Dental treatments are stress inducing, so cardiovascular events are more likely to occur hence complete evaluation by physician is mandatory

Survey on Awareness and Knowledge about the Effect of Diabetes Mellitus on Systemic and Oral Health in Patients Visiting General Medicine Outpatient Department in Dental Hospital

Objective: This survey was conducted on known diabetic patients to appraise the awareness and knowledge about the effect of diabetes mellitus (DM) on systemic and oral health and to evaluate the source of the information. Aim: The aim of this study was to gather baseline information on awareness and knowledge of diabetic patients regarding their systemic and oral health with the view of enhancing their oral health education. Which will help in updating their knowledge regarding strong association of DM on oral diseases, also about importance of maintaining glycemic levels and good oral health. Methodology: This experimental study was conducted on known diabetic patients visiting general medicine outpatient department for fitness to undergo dental treatments. Patients were evaluated by using a self developed questionnaire by interview method. The questions were about awareness regarding effect of DM on systemic and oral health, sources of information patients have received and elicit the symptoms of DM in those diabetics and educate them regarding importance of glycemic control and maintenance of oral health. Results: All the participants had Type 2 DM. The knowledge about DM disease was poor and most of them attended camps related to DM and their systemic consequences, but none of them attended DM associated oral health camps. Many patients(47.5%) were educated about the effect of DM on systemic organs and their prevention, by their treating physician, but none of the physicians informed about effect of DM on oral tissues (0%). Surprisingly, only some dentists (24%) told regarding oral complications of DM, large number of patients gathered information by other sources mainly from relatives and friends, who are diabetics (61.9%). So awareness of diabetic patients of their increased risk for oral diseases is low compared to their awareness of systemic diseases. Conclusion: It is of paramount importance for dental specialist to raise the attentiveness of diabetic patients of their increased risk for oral diseases and the impact of oral health on their general health. Research project on awareness for diabetic patients of their increased risk for oral and dental diseases and their approach to maintain good oral health will significantly impact their oral health-related quality of lif

Herpetic Recurrent Oral Erythema Multiforme

Erythema multiforme is considered as an immunologic disease possibly occurring because of predisposition to certain microorganisms, radiotherapy, systemic diseases, malignancy, and food or drug allergy. Here we report a case of herpes-induced recurrent erythema multiforme primarily manifesting in oral mucosa during first two episodes and third episode was characterized by oral lesions followed by skin lesions and the severity was increased with the subsequent episodes, during each incident we have successfully managed the case

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