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Introduction Diagnosis of underlying causes for desquamative gingivitis (DG) is often delayed in clinical settings, but little is known about factors influencing its delayed diagnosis. We investigated the diagnostic patterns and associated factors in a cohort of patients presenting primarily with DG.Materials and methods A total of 41 patients presenting primarily with DG were interviewed to evaluate professional and patient diagnostic delays. Severity of DG was evaluated using the desquamative gingivitis clinical score (DGCS) proposed by Arduino et al. (2017).Results The study sample was composed of 29 females and 12 males. On average, patients waited 10.8 ± 10 months (range 4-20 months) before seeking their first professional consultation (that is, patient delay). Less severe disease and female gender were significantly associated with longer patient delay. Patients consulted an average of 4.1 ± 2 healthcare professionals (range two to six) before a definitive diagnosis was reached, with an average professional delay of 7.3 ± 5 months (range 2-11 months). Professional delay was positively correlated with the number of professional consultations (r = 0.69) and absence of other oral mucosal lesions or extraoral involvement.Conclusions Considerable diagnostic delay is a feature of the natural history of DG. Increased patient knowledge and professional awareness regarding DG symptoms and diagnostic measures is needed to reduce diagnostic delay and improve patients' experience with this disease.

Direct oral anticoagulants (DOACs) are increasingly used as alternatives to warfarin because of the superior pharmacokinetic properties. Clinical guidelines on the influences of DOACs for dental procedures have emerged, but all of necessity based on low-quality available evidence. Herein, we share our experience with a case series, and propose a protocol regarding the management of dental patients taking DOACs.

To evaluate labial and palatal bone thickness at the maxillary anterior teeth as well as distance from cemento-enamel junction (CEJ) to bone crest using cone beam computed tomography (CBCT).Measurements were obtained for maxillary anterior teeth of 120 subject CBCT volumes including thickness of labial and palatal plates of bone (coronal, middle, and apical thirds), and distance between CEJ and alveolar bone crest mid-labially, mesially, and distally.The mean value of bone thickness at coronal, middle, and apical thirds of the labial side for central incisor roots were respectively: 0.73, 0.69, 0.60 (mm), for lateral incisors: 0.70, 0.61, 0.49 (mm), and for canines: 0.74, 0.53, 040 (mm). The thickness of palatal bone was significantly larger. The mean distance between CEJ and mid-labial bone crest for all sites was 2.16 mm.Labial bone thickness is thin in the vast majority of maxillary anterior teeth. Use of CBCT facilitates planning for immediate implant placement and is helpful in the decision-making process when further bone augmentation is needed.

Treatment planning for full-mouth rehabilitation in patients with generalized aggressive periodontitis often requires a staged approach. Few articles have addressed treatment planning and sequencing issues in this patient population. This report describes the multidisciplinary management of a young adult by a combination of periodontal and implant therapy and rehabilitation with fixed prostheses. At a 2-year follow-up, the patient's periodontal health and peri-implant conditions were stable. Prosthodontic rationale and treatment planning concepts in a patient with multiple challenges are discussed.

Inflammation is associated with the deterioration of solid-organ transplants. Chronic periodontitis is linked to systemic inflammation, although it is unknown whether it plays a causative or comorbid role. We hypothesized that transplant subjects have a greater prevalence of severe periodontitis, accompanied by higher levels of serum interleukin-6 (IL-6) and C-reactive protein (CRP), compared to systemically healthy subjects.We recruited 90 renal and cardiac transplant recipients and 72 age-matched controls and compared their periodontal and systemic inflammatory status.The prevalence of severe periodontitis was not statistically significantly different between transplant and control subjects. Serum IL-6 and CRP were higher in transplant subjects compared to control subjects and in subjects with severe periodontitis compared to subjects without periodontitis, but multivariate analysis showed that severe periodontitis was a significant positive predictor of serum IL-6 in the control group only. In the test group, significant predictors of systemic inflammation were age, diabetes, higher body mass index, and a cadaveric transplant donor.Despite the presence of higher levels of systemic markers of inflammation in transplant subjects with severe periodontitis compared to transplant subjects without periodontitis, periodontal parameters were not statistical predictors of systemic inflammation in this population in a multivariate model.

Oropharyngeal candidiasis (OPC) is an opportunistic infection caused by Candida, a ubiquitous fungal organism that is part of the normal microbiota of the oropharyngeal and gastrointestinal tract. OPC is a major cause of morbidity in immunocom-promised patients (7) and can predispose these patients to esophageal candidiasis (19, 46), an invasive form of infection with significant morbidity and higher risk for fatal, disseminated infection (42, 44). Candida albicans is the species implicated in the overwhelming majority of OPC cases in immunocompromised patients (7, 12), although other species such as Candida glabrata are recently emerging as possible etiological agents (8, 11). Invasive fungal infections attributed to Candida species are particularly prevalent after organ transplantation, especially in the immediate post-transplant period (30). Candida can trigger bloodstream, esophageal, gastrointestinal, respiratory and uri-nary tract infections in solid organ transplant recipients, with prevalence during the first 6 months after transplantation ranging between 5 and 50% depending on the type of transplant (e.g. renal vs. liver) (4, 19, 29). It was reported that up to 80% of Candida-esophagitis episodes in renal transplant patients were preceded by oral thrush or colonization (4, 19). In addition transplant patients with OPC, who are otherwise asymptomatic, are frequently discovered to have esophageal candidiasis upon endoscopy (21). Despite the increased prevalence of other fungal infections in solid organ transplant recipients, the overall significant morbidity of OPC, and its possible implications in more invasive esophageal infections, few studies have assessed the prevalence of OPC in this population and all of these were conducted outside the USA (3, 12, 18). In addition, the oral carriage frequency, intensity of carriage, and speciation of Candida colonizing transplant patients who are clinically stable, and consequently unlikely to present transient fluctuations in the oral microbial flora due to changes in the immunosuppressive regimen, have never been studied before. In this work we studied the prevalence of OPC, Candida carriage frequency, titers and species colonizing the oral mucosa, in clinically stable transplant patients who were at least 1 year post-transplant, and examined relevant risk factors.