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The evaluation of painting in terms of medicine and dentistry is increasingly shared in academic publications. The clear depiction of gingival inflammation seen in the female figure in Hendrick ter Brugghen's Unequal couple attracted our attention. It is interesting to note the meticulous transfer of the actual condition of the diseased gingival tissues and the painter's very high observational ability. Although there may be many more examples of observational depictions, we believe that 'dental humanities' will develop by discussing such art works.

Introduction: Pigmented gingiva is an aesthetic concern for many individuals. Various treatment modalities have been developed to address this condition, but each carries certain disadvantages. Recently, the use of herbal products has been considered as a treatment modality, as they are safe and readily available. P-Coumaric Acid (p-CA) and Quercetin are two plant-based chemicals that have shown depigmenting effects on the skin. Given the similar cellular structure of skin and gingiva, the present study aimed to test their depigmenting effects on the gingiva. Aim: To evaluate the effectiveness of two phytochemicals, p-CA (3 μM) and Quercetin (20 μM), in reducing the melanin content of pigmented gingival tissue. Materials and Methods: The study was an ex-vivo study conducted in the Department of Periodontology at Bharati Vidyapeeth Deemed to be University Dental College and Hospital, Pune, Maharashtra, India, from January 2024 to April 2024. A total of 10 patients with a Dummet Oral Pigmentation Index (DOPI) score of two were selected for the study. A surgical depigmentation procedure was performed and the excised tissue was divided into three parts. The first part of the excised tissue served as a control group (Group A), while the second and third parts were treated with p-CA (Group B) and Quercetin (Group C), respectively. Histological analysis was conducted using Haematoxylin and Eosin (H&E) staining and immunohistochemical analysis was performed using the Human Melanoma Black 45 (HMB-45) antibody test. The reduction in melanin content was recorded in all three groups and the results obtained were compared using a t-test. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis, with a p-value of ≤0.05 considered statistically significant. Results: Both p-CA and Quercetin demonstrated a reduction in the level of pigmentation. Comparative analysis indicated that p-CA had a stronger effect than Quercetin. Conclusion: The p-CA and Quercetin can be considered potential depigmenting agents.

The present review was intended to provide several important biological insights into the practice of implant dentistry. Despite many benefits, it’s clear that a dental implant does not share the features of a dentoperiodontal unit, and alveolar bone tolerates an implant, as far as its physiology goes, within the range of adequate response to direct masticatory load. The importance of a gingival tight seal around the transmucosal part of an implant cannot be overestimated from both biological and esthetic aspects. Considering the multifactorial nature of bone augmentation, the successful outcome of this type of surgery is still a matter of chance.

Estimating the post-mortem interval (PMI) is an essential step in forensic investigations, particularly those involving homicides and unwitnessed deaths. However, traditional methods occasionally yield inconsistent estimates. Histological and molecular techniques are considered crucial in forensic pathology and are frequently employed to estimate the time interval of death. The gingiva is an oral mucosal tissue used to estimate PMI. This review aimed to examine the potential of histological methods to determine PMI using oral mucosal tissue, namely the gingiva, and to investigate changes that occur in oral mucosal tissue at different time intervals when compared with those in normal tissues. The oral mucosa comprises layers of stratified squamous epithelium and connective tissue. Similar to other body tissues, changes are known to occur in the gingiva after death, and these cellular and tissue changes should also be considered. Alterations in the gingiva include homogenisation, karyorrhexis, pyknosis, karyolysis, chromatin clumping, eosinophilia, collagen fibre degradation, and the loss of tissue architecture. Reviews collating the results of original trials have consistently reported how the oral mucosa is altered by autolysis and how such changes can be observed in histological tissue morphology after death. Histology is an acceptably accurate technique for estimating PMIs.

In recent years, there has been an increase in the incidence of morbidity associated with digestive organ pathology in the pediatric population. The oral cavity is the digestive tract opening, sharing a common ectodermal origin with it. The changes in the cytogram of the oral mucous membranes can signal about exacerbation of pathological processes in the gastrointestinal tract. The aim of this work: to identify the features of gingival cellular composition in school-age patients with chronic gastritis and duodenitis in order to improve diagnostic methods at the disease stages. Examinations of the gingival cytogram in children aged 12-17 years with chronic gastritis and duodenitis (27 individuals with the disease in acute stage, 30 – in remission) were carried out. The control group included 28 children who did not have any somatic pathology by the results of the examination. For cytological examination, imprint smears from the gingival vestibular surface of the upper and lower jaws were made. The smears were fixed and stained by the May-Grunwald Pappenheim method, and then examined using a microscope with an im­mersion system. The percentage of epithelial cells and connective tissue cells was calculated per 100 cells. The number of pathologically altered epithelial cells was determined: with vacuolated cytoplasm, with nucleus deformation. In children with chronic gastritis and duodenitis disorders in the gingival cellular composition with a predominance of dystrophic components were found, that was manifested by a decrease in the proportion of epithelial cells at terminal stages of differentiation, an increase in the proportion of cells with cytopathological phenomena, polymorphonuclear leukocytes and lymphocytes. Changes in the cytogram were especially expressed in the phase of disease exacerbation. Knowing the phases of the wound process, based on the timing and sequence of the cellular ensembles seen in the cytogram, it is possible to control the disease periods, and timely apply measures to prevent exacerbations. This diag­nostic method is especially indicated for children who have relative and absolute contraindications for fibroesogastroduodenoscopy.

Background: Excessive gingival display (EGD), also known as a gummy smile, is characterized by overexposure of the maxillary gingiva on smiling. EGD can cause embarrassment and reduce patient satisfaction. This study aimed to evaluate the clinical and psychological effects of lip repositioning surgery on the management of EGD. Methodology: This experimental study enrolled 14 patients with EGD who had undergone a modified lip repositioning technique, which comprised moving two strips of mucosa bilaterally to the maxillary labial frenum and repositioning the new mucosal margin coronally. The extent of gingival display (GD), lip mobility (LM), total lip length (TLL), lip length (LL), and internal lip length (ILL) was measured at baseline and 6 months postoperatively. The pre-operative psychological assessment was conducted using the social appearance anxiety scale (SAAS) scores, whereas the postoperative assessment was conducted using SAAS and visual analog scale (VAS) scores at 1 week, 3 months, and 6 months postoperatively. Results: Among the clinical parameters, TLL increased by 2.0 ± 1.038, LL increased by 2.28 ± 0.99, ILL reduced by 2.78 ± 1.36, LM reduced by 3.21 ± 1.12, and GD reduced by 3.14 ± 0.77 at 6 months postoperatively. Among the psychological parameters, SAAS reduced by 31.42 ± 1.907 from the baseline to 6 months, whereas the VAS score reduced to 3.14 ± 0.27 at 6 months postoperatively. Conclusion: A significant reduction in GD, which is largely dependent on strict case selection, pain, and social anxiety was observed in this study, indicating that lip repositioning surgery is effective in managing EGD.

Pyogenic Granuloma (PG) is a benign reactive lesion characterised by tissue hyperplasia caused by local irritants. The gingiva is the most common site of occurrence in the oral cavity, followed by the tongue and buccal mucosa. It typically presents as a pedunculated or sessile mass. Removal of the irritants and complete excision of the lesion from its base usually results in complete resolution. In this case report, the authors present the case of a 44-year-old female patient, who presented to maxillofacial surgeons With complaints of difficulty in eating and speaking due to a large growth on her tongue that had been present for the past year. The mass, which was non-tender and non-indurated, nearly filled the oral cavity. Routine medical examination revealed iron deficiency anaemia, and systemic correction was initiated. Concurrently, the patient underwent surgical excision of the mass, which was initially diagnosed as a PG, under local anaesthesia. However, the final biopsy revealed poorly differentiated Squamous Cell Carcinoma (SCC). Subsequent radiological investigations revealed extensive local and regional disease spread with metastasis to the upper chest wall. As a result, the patient was advised palliative care by the Institution’s head and neck tumour oncology board.

Background: Pyogenic granuloma is a benign and non-neoplastic mucocutaneous lesion that has multiple causes and develops in response to local irritation, trauma, or hormonal changes during pregnancy. In the oral cavity, this lesion often involves the anterior of the maxillary gingiva, and rarely, the tongue, labial mucosa, and palatal mucosa are involved. The clinical appearance of the lesion was usually seen as a nodule with or without a base, with a smooth surface or lobulated surface. It is usually non-tender, but it can bleed on touch. This lesion may be seen in any size from a few millimeters up to several centimeters. It is more common in females. This case report presents a rare site of a pyogenic granuloma on the dorsal site of the tongue. Clinical symptoms, causes, differential diagnosis, histology of the pyogenic granuloma, and treatment were discussed in this case report.

Statement of the Problem: The occurrence of papillary defects adjacent to teeth or dental implants causes both the dental staff and the patients to be concerned about the esthetic issues. Interdental papilla reconstruction surgery is one of the most difficult and unpredictable mucogingival surgeries.Purpose: The present study aimed to investigate the efficacy of hyaluronic acid injection in the reconstruction of the interdental papilla.Materials and Method: This clinical trial study was conducted on four patients with 20 deficient interdental papillae who met the inclusion criteria. At first, local anesthesia was applied. Afterward, 0.2 mL of 1.6% hyaluronic acid (HA) gel was injected (at the tip of the papilla and 2-3 mm below the tip of the papilla) three times every two weeks. At baseline, three, and six months later, clinical photography was taken under standard conditions. The papilla height (the distance between the interdental papilla tip and the basis), black triangle area, and the distance between the interdental papilla tip and contact point of adjacent teeth were all measured using Image J software.Results: The effectiveness of using HA gel in reducing the black triangle area was 85.06%. Furthermore, the papilla length increased by 70.256% while contact to papilla distance decreased by 83.026%. At different times, the values of the studied variables in the three levels were significantly different (p< 0.05).Conclusion: Injection of HA with 1.6% concentration at two points of the interdental papilla was effective in interdental papilla reconstruction at the aesthetic zone, especially in long-term, follow-ups (especially 6 months).

Gingival recession being the most common mucogingival problem among adult patients is often associated with root hypersensitivity, erosion, root caries, and compromised aesthetics. The primary goal of treating gingival recession include complete root coverage along with improving gingival biotype to facilitate proper plaque control, improve patient aesthetics, and to prevent further periodontal breakdown. Although numerous root coverage techniques and regenerative materials are available, a novel technique involving the bilateral pedicle flap with subperiosteal tunnel in interdental papilla along with use of Titanium Prepared Platelet-Rich Fibrin (T-PRF) has been described in this case report. A 20-year-old male patient reported with the chief complaint of teeth sensitivity in lower front teeth. Intraoral examination revealed Recession Type 1 (RT-1) defects in mandibular central incisors which were treated using modified bilateral pedicle flap and tunnel technique combined with T-PRF. This technique allowed excellent blood supply at recipient site along with complete coverage of T-PRF membrane and root surfaces. The subperiosteal tunnel created in between the two affected teeth, allowed better stabilisation of membrane and inhibited apical retraction of flap during healing phase. Using this novel technique, complete root coverage was achieved along with gain in gingival thickness hence, it can be considered as a predictable approach for the treatment of RT-1 defects involving two adjacent teeth.

Objective To investigate the role of vascular endothelial growth factor (VEGF) and the Wnt/β-catenin signaling pathway in gingival tissues remodeling by measuring the changes in VEGF and β-catenin expression in mouse gingival tissues under hyperocclusion. Methods Thirty male Kunming mice aged four weeks were randomly divided into control group (n=15) and experimental group (n=15). All the right maxillary molars of mice in the experimental group were extracted to establish a hyperocclusion model. On the 3rd, 7th, 14th, 28th, and 56th days after operation, three mice in each group were randomly selected and sacrificed under anesthesia. Their left mandibular first molars with the gingival tissues were isolated. Hematoxylin-eosin (HE) staining was performed to observe the histological changes of the gingiva, and immunohistochemical staining was used to measure the changes in VEGF and β-catenin expression in the gingival tissues. Results The HE staining showed that in the experimental group, the thickness of gingival tissues and the number of blood vessels increased on day 14 after tooth extraction. The results of immunohistochemical examination showed that in the control group, there were no significant differences in the expression of VEGF and β-catenin in the gingival tissues between different time points (P>0.05); while in the experimental group, there were significant differences in that between different time points (F=250.4,343.9,P

Background: Lead usually is precipitated at the gingiva of the fuel station workers. Lead interacts with different molecules, thereby interfering with their function. An excess of lead contents could be toxic to the human body. Objectives: This proposed study was conducted for the evaluation of salivary lead level effect and the severity of gingival pigmentation in Iraqi fuel station workers. Materials and Methods: This study involves 40 individuals, who were asked to answer a questionnaire. The case sheet questions involve the personal details of participants such as gender, age, marital status, and working experience. It was filled by the participants. This is followed by an oral examination to assess the oral hygiene status and color of gingiva, then divided into three groups according to working period. To evaluate the level of lead within the saliva, it was estimated in teaching laboratories in Medical City by using atomic absorption spectrophotometer as well as clinical evaluation of the intensity of gingival discoloration according to the gingival surface and dental sites. Data were analyzed using IBM SPSS Statistics and descriptive statistics to calculate the absolute and relative frequencies. Result: It was shown that gingival discoloration was noticed in 40% of the total sample with light brown to mixed brown/pink (average lead level = 5.74 mg/dL). In addition, 30% of the sample had a mixed brown/pink pigmentation (average lead level = 6.75 mg/dL) and the rest (30%) presented with mixed brown/pink to dark brown (average lead level = 10 mg/dL). The working periods range from 3 months to 10 years, the lowest value and the highest of lead in saliva were 8.3 and 11.8 mg/dL, respectively. The average of these values is 10.00 mg/dL. Conclusion: The intensity and severity of gingival pigmentation are directly associated with the level of salivary lead. Occupational safeties are essential for workers who are at high risk of exposure to avoid adverse effects of this metal on general health.

Congenital adrenal hyperplasia (CAH) is a genetic disorder characterized by an impairment of steroid synthesis due to an altered production of 21-hydroxylase enzyme. Corticoid hormones are involved in the development and functioning of many organs. The aim of the present study was to review the international literature to collect data regarding oral manifestations of CAH. A review of the literature describing oral features of patients affected by CAH was performed using electronic databases (PubMed and Scopus). The data about number of patients, form of CAH, and oral findings were extracted and analyzed. Seven studies were included in the final analysis. The principal findings reported regarded an advanced dental development observed in patients with CAH. One paper reported amelogenesis imperfecta and periodontal issues. The dentist could be the first specialist involved in the CAH syndrome diagnosis, identifying the characteristic features described above, especially for the classical simple virilizing and non-classical form.

During pregnancy, a series of hormonal changes occur which cause a woman's body to experience various physical and physiological changes, including periodontium. Aim was to investigate the relationship between the level of oral hygiene and the severity of periodontal disease in order to reduce the incidence of periodontal disease in pregnant women in the Dringu district area. This type of research is cross-sectional with random sampling technique. Clinical assessment was carried out by measuring the patient's gingival status using the gingival index (GI) and Oral Hygiene Index Simplified (OHI-S). The result was found that 100% of pregnant women had gingivitis, and 19% of participants had severe gingivitis. Thirty-five percent of pregnant women experienced poor hygiene conditions. The analysis of the relationship between GI, OHIS, and sociodemographics based on the Mann-Whitney and Kruskall Wallis tests found significant differences between all variables and characteristics of sociodemographics. The result of the Spearman correlation test shows that there is a significant relationship between the GI and OHIS scores of pregnant women had a significant result, meaning that every increase in the OHIS score will be followed by an increase in the GI scores. This study indicated that the correlation between the GI and OHIS scores of pregnant women had a significant result. The better of the OHIS, the lower the gingivitis status. [ABSTRACT FROM AUTHOR]

Background: Focal tissue overgrowths on the gingiva and edentulous alveolar ridge are occasionally perplexing to periodontists, owing to the wide variety of differential diagnoses that may be responsible. As such, biopsy and microscopy are often required to establish a definitive diagnosis. The present study aimed to retrospectively evaluate focal gingival and alveolar ridge overgrowths at a single institution in Saudi Arabia. Materials and Methods: Histopathology reports and slides from patients presenting to King Saud University Hospital between 1984 and 2016, particularly those with focal gingival enlargements other than those due to gingivitis and periodontitis, were collected and analyzed based on age, sex, and location. Results: A total of 624 patient records were evaluated, with a mean age of 35 years (range, 1 week–91 years), peak incidence in the third decade of life, male-to-female ratio of 1:1.4, and a slightly higher prevalence of lesions in the mandible. The majority (88%) of the lesions were reactive or hyperplastic, followed by malignant (10%) and benign (2%) tumors. A total of 24 distinct histological entities were diagnosed across the three groups. The most common histologically diagnosed lesions were pyogenic granulomas (38%), fibromas (33%), peripheral ossifying fibromas (9%), squamous cell carcinomas (7%), peripheral giant cell granulomas (6%), neurofibromas (1%), and non-Hodgkin lymphomas (1%). Conclusion: Similar to what has been reported by most previous studies, reactive hyperplastic lesions were the most prevalent focal overgrowths found in the gingival and alveolar mucosae. Carcinomas at these sites, however, may be an understated but significant clinical and epidemiological problem in Saudi Arabia. Gingival and alveolar ridge lumps can serve as a nexus for cooperation between periodontologists and oral pathologists to improve diagnosis, disease classification, and patient management.

Teeth eruption is a multifactorial process, which requires a thorough evaluation of a child's general state of health. During temporary teeth eruption, unpleasant sensation associated with swelling and tenderness in the gingival area, which is accompanied by excessive salivation, fever, rhinorrhea, increased anxiety, poor appetite, etc. may occur. Today, there are pharmacological and non-pharmacological treatments for easing the symptoms of eruption of temporary teeth. The article presents feasible approaches to the relief of symptoms that occur at this period. It draws attention to the issue of competent and timely evaluation of symptoms and signs and identification of underlying causes of babies' unwellness, as well as risks of using pharmacological products. The prevailing opinion among parents and medical professionals suggests that the symptoms of teeth eruption can and should be controlled. The local symptoms during difficult eruption of temporary teeth include gingival edema and hyperemia, as well as tenderness on palpation in the eruption area. Different pharmacological and non-pharmacological methods are used to reduce the symptom load of teeth eruption in children. One of them is a baby herbal teething gel. Therapeutic indications for using the gel are pain syndrome in baby tooth eruption (for massaging gums). No contraindications have been identified. If the gel or its components cause a hypersensitivity reaction, its use is not recommended. Active ingredients are exclusively of natural origin. Non-pharmacological treatments to ease the symptoms of temporary teeth eruption include a simple and available method - massage of predeciduous dentition. Putting pressure on them reduces the pain syndrome. Specialized silicone brushes can be used for massage. Gel-filled cooling or silicone teething toys reduce swelling and relieve painful sensation.

Actinomycosis is a rare disease. Its diagnosis is challenging clinically as it mimics many other infectious diseases and neoplasms. In this scenario, a simple timely biopsy can come to the clinician’s rescue. Actinomycosis can be reliably diagnosed on histopathological examination accompanied by special stains without losing much time. Culturing this organism is a tedious job in view of its fastidious nature and requires a long waiting time. Polymerase chain reaction (PCR) can be useful and is less time-consuming, but histopathology is more cost-effective in our country like India. This case report emphasizes the fact that a rare possibility of actinomycosis should also be kept in mind even in immunocompetent individuals in rare sites like gingiva even if there are no discharging sinuses noted clinically. Actinomycosis requires long-duration antibiotic treatment, so if diagnosis time is reduced, timely treatment of actinomycosis can be started and complications can be prevented.

Metastatic oral malignancies have been reported in the mandible, tongue, and gingiva. Breast cancer oral metastasis usually presents as a benign oral lesion clinically. At histology, it shares several features with metastatic carcinoma. Immunohistochemistry (IHC) can be useful in the differential diagnosis. The clinical presentation consisted of swelling in the upper front tooth region in a 35-year-old woman. The lesion was excised under local anaesthesia and underwent histological and immunohistochemical examination to rule out any malignancy. Histological findings, Pan CK positivity suggesting the epithelial origin and the absence of reactivity to Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor-2 (HER2) indicated metastatic triple negative breast carcinoma. The histological diagnosis of metastatic breast carcinoma can be confirmed by IHC. The current case report illustrates the necessity of including a panel of IHC markers in confirming the diagnosis of metastatic lesions in oral cavity. By utilising such panels, one can expedite the prognosis and prevent delay in diagnosis.

Oral Focal Mucinosis (OFM) manifests on the gingiva as a painless mass, asymptomatic except for the presence of a fibrous mass, and is of the same colour as the surrounding mucosa. It is commonly reported on the gingiva. Histologically, it is characterised by focal myxoid degeneration of connective tissue. Its diagnosis seldom can be made clinically and predominantly relies on histopathological analysis. This case report is about a 40-year-old female who had a gradually increasing swelling on the palate in relation to upper right posterior teeth, for 4-5 months. The lesion was excised and sent for histopathological and immuno-histochemical analysis. There was presence of foci of loose mucinous connective tissue stroma interspersed within dense connective tissue stroma. The mucinous stroma showed numerous stellate and spindle-shaped fibroblasts evident between thin collagen fibres with evidence of separation of collagen fibres.

Gingival pigmentation(GP) manifests as dark pigmentation spots, such as black or brown spots, in the gums. It is mostly caused by the deposition of melanin particles secreted by melanocytes on the gingival epithelium. The influencing factors may be divided into two categories, exogenous and endogenous. Exogenous factors include heavy metals, tattoos, smoking or drug use, and endogenous factors are related to certain diseases. The clinical grading of GP helps make a reasonable assessment of the necessity of treatment and prognosis. The Dummett-Gupta oral pigmentation index is a commonly used grading method, and the new grading method formed by combining the etiology and clinical manifestations described the patient’s situation more comprehensively. It is necessary to ask for a detailed medical history, complete examination, and correctly differentiate between physiological GP and GP caused by pathological state. Laser treatment is the currenttreatment with a better treatment effect and higher patient acceptance, and it is more comfortable and convenient, including diode laser, Er: YAG laser, and Nd: YAG laser, etc. This article summarizes the formation factors, clinical manifestations and treatment methods of GP to provide ideas for the clinical diagnosis and treatment of GP.

Peripheral odontogenic fibroma (POdF) is a rare benign odontogenic tumor of ectomesenchymal origin which is composed of fibrous connective tissue containing islands, strands or cords of odontogenic epithelium. The lesion is more common among females, commonly seen between the second to fourth decades of life, mostly affecting the anterior region of mandible. Clinically, it may present similar characteristics with other more common gingival lesions such as pyogenic granuloma, peripheral ossifying fibroma and peripheral giant cell granuloma. So, histopathological examination is required for accurate diagnosis. We present here three rare clinical cases of peripheral odontogenic fibroma and their management by complete excision of the lesion with good postoperative outcomes.

The interplay among different cells in a tissue is essential for maintaining homeostasis. Although disease states have been traditionally attributed to individual cell types, increasing evidence and new therapeutic options have demonstrated the primary role of multicellular functions to understand health and disease, opening new avenues to understand pathogenesis and develop new treatment strategies. We recently described the cellular composition and dynamics of the human oral mucosa; however, the spatial arrangement of cells is needed to better understand a morphologically complex tissue. Here, we link single-cell RNA sequencing, spatial transcriptomics, and high-resolution multiplex fluorescence in situ hybridisation to characterise human oral mucosa in health and oral chronic inflammatory disease. We deconvolved expression for resolution enhancement of spatial transcriptomic data and defined highly specialised epithelial and stromal compartments describing location-specific immune programs. Furthermore, we spatially mapped a rare pathogenic fibroblast population localised in a highly immunogenic region, responsible for lymphocyte recruitment through CXCL8 and CXCL10 and with a possible role in pathological angiogenesis through ALOX5AP. Collectively, our study provides a comprehensive reference for the study of oral chronic disease pathogenesis.

Aim: The objective of this study was to evaluate the inflammatory process resulting from the use of two cyanoacrylate-based adhesives to stabilize grafts. Methodology: A total of 45 male Wistar rats were randomly divided into three groups (n = 15/group) treated with ethyl cyanoacrylate glue (TG1), octyl-2-cyanoacrylate glue (TG2) or suture threads (CG). After de-epithelialization in the anterior gingival region of the mandible, the graft was removed from the donor site (hard palate), taken to the recipient site and stabilized according to the protocol of each group. After 7, 14, and 45 days, the animals were euthanized. The graft area was analysed macroscopically, histologically, histochemically (Masson trichrome), and immunohistochemically positive cell count for TGF-β, α-SMA, RANKL, OPG, FGF, and IL-10. The Kruskal-Wallis/Dunn test (SPSS 20.0, p

Abstract Lipoma is a rare benign tumor. Fibrolipoma, a variant of lipoma, is relatively uncommon in mouth tissues. Among all benign lesions of oral cavity, the approximate incidence rate of lipoma is 1%–4%, with a prevalence rate of about 0.0002%. Fibrolipoma is an extremely rare subtype of lipoma, especially in the attached gingiva. This subtype accounts for 1.6% of all facial lipomas, with a prevalence rate of 1/5000 adults in the oral and oropharyngeal region. It is diagnosed by histopathologic and immunohistochemistry evaluation and treated by total excision. Due to the adhesion to the surrounding tissues and pseudo‐infiltrating characteristics of this lesion, it can get mistaken with malignant lesions; therefore, a histological examination is mandatory. In this paper, a case of a patient with attached gingiva fibrolipoma treated by surgical excision is reported. This case report is about a 26‐year‐old female patient in Shiraz School of Dentistry with a fibrolipoma of attached gingiva. Because of fibrolipoma's growth tendency, adhesion to the surrounding tissues, and specific histological characteristics, its differential diagnosis with malignant infiltrating tumors is important. Surgical excision is the gold standard for treatment. Accurate differential diagnosis, careful histological examination, and periodic follow‐up are essential.

Malocclusion can affect the quality of life related to oral health. A novel technique to expedite orthodontic tooth movement (OTM) in order to minimize treatment length and the side effects. Under orthodontic fore, MSCs transplantation might hypothetical^ accelerate the bone remodeling process, resulting in OTM acceleration. To investigate the number of osteoclasts and osteoblasts in the tension side during OTM after transplantation of normoxic or hypoxic preconditioned allogeneic gingival mesenchymal stem cells in vivo. The OTM animal model was 48 male rabbits (Oryctolagus cuniculus) aged 6 months with body weight about 3-4 kg. There were 4 experimental groups in this study: control negative group (C-): injected with PBS without OTM, positive control group (C+): 50g OTM with 20|jL PBS injection, treatment group 1 (T1): 50g OTM with 20|jL GMSCS normoxia in PBS, treatment group 1 (T2): 50g OTM with 20 µL GMSCS hypoxia in PBS. The injection was done in afflicted mandibular gingiva using µL small needle syringe with local infiltration technique. Every sample then was sacrificed after day 7, 14, and 28 respectively. The number of osteoblasts and osteoclasts in the alveolar bone during OTM was determined by hematoxylin and eosin staining. In T2 group, osteoblast was significantly enhanced on day 14 and 28 but not osteoclast number during OTM. There was significant different in osteoclast and osteoblast number between groups (p<0.05) GMSCs hypoxia preconditioned escalate osteoblast number but not decrease the osteoclast number in the tension side during orthodontic tooth movement in vivo. [ABSTRACT FROM AUTHOR]

Abstract A patient presented with ulcerations of the buccal mucosae, palate and gingiva. A gingival biopsy confirmed the diagnosis as pemphigus vulgaris. Despite medication with systemic corticosteroids and mycophenolate mofetil, desquamative gingivitis persisted. Adjunct treatment with rituximab was therefore introduced. Regular follow‐ups revealed no inflammatory gingival changes even 6 years later.

Plasma cell tumors consist of extramedullary plasmacytoma (EMP), multiple myeloma (MM), and solitary bone plasmacytoma (SBP). EMP is defined as neoplastic proliferation of plasma cells in soft tissues. It presents as a solitary discrete mass either in soft tissue as EMP or in bone as SBP or as disseminated MM. It is a very rare manifestation. It accounts for

Introduction. Epulis is a change in gingival tissue that occurs under the influence of chronic irritation. Histologically, there are several different types of epulis. Fibrous epulis is benign tumor of gingiva that most often occurs in interdental papilla area as a result of local irritation (inadequate restorative fillings, carious teeth, subgingival deposits or the combination of them). The aim of this paper is to present a clinical case of fibrous epulis. Case report. A 25-year-old girl reported to the Specialist Center for Dentistry in Foca. Clinical examination revealed a gingival tissue enlargement in the area of the upper jaw central incisors with speech and chewing function disturbances. Intraoral examination revealed a change above the level of gingiva, reddish-pink in color with smooth surface texture and soft consistency. The size of the change was 1 x 1.5 cm. It was connected to the interdental gingiva between teeth 12 and 21 by a narrower base. Clinically, a significant amount of soft and hard dental deposits surrounded the remaining teeth. Remaining gingiva was swollen, red, bleeding on provocation. The anamnesis did not confirm the presence of other acute and chronic diseases. The patient was not pregnant. She was informed about clinical condition assessment, as well as possible therapeutic procedures. Our patient was treated with non-surgical periodontal therapy and surgical excision of the enlargement. After histopathological examination of the removed tissue, the diagnosis was made: “Fibrous epulis cum ulceration”. Conclusion. Clinical examination is insufficient for definite diagnosis. Therefore, a histopathological examination of the tissue is mandatory for fibrous epulis definite diagnosis. Treatment of choice is surgical excision of the enlargement and removal of predisposing factors to avoid recurrence.

Giant Cell Fibroma (GCF) is a benign rare fibrous lesion that predominantly occurs on the mandibular gingiva. Clinically, it is presented as a sessile or pedunculated mass that frequently occurs in the third decade with a slight female predilection. The lesion is usually characterized by stellate and multinucleated fibroblasts located in the lamina propria near the overlying epithelium and radiographically treated as a benign lesion. A 20-year-old female was referred to the Oral and Maxillofacial Medicine Department of Semnan Dental School, with the chief complaint of tooth displacement and gingivitis. Clinical examination revealed maxillary protrusion, mouth breathing, localized gingivitis in the interdental areas of the papilla of the lateral and canine teeth; also alveolar bone with pus discharge in the right mandibular premolar area. Radiographically, the lesion leads to the bone resorption and linguistic movement of the teeth in the right side of Mandible. There were no root resorption and no bone expansion. Gentle scaling and root planning, biopsy, and second premolar extraction were performed. The presence of the giant fibroblasts in superficial connective tissue confirmed the diagnosis of Giant Cell Fibroma. At the follow-up session, tissue repair was accomplished, and the first premolar was immobile and was no longer loose. Nevertheless, further studies are required to investigate the precise nature of the mono or multinucleated cells, i.e., atypical fibroblasts that illustrate degenerative and functional changes. Moreover, a high index of suspicion and appropriate analytical examination is required for distinct lesions to achieve a proper diagnosis and suggest an appropriate treatment.

Background and Aim: C-reactive protein (CRP) is a type I acute phase protein, which can increase up to 1000 fold after the onset of a stimulus. It is a phylogenetically highly conserved plasma protein with homolog in vertebrates and many invertebrates that participate in systemic response to inflammation. Serum C-reactive protein levels are raised in patients with myocardial infarction and periodontitis, providing a potential mechanism to link destructive periodontal disease with an increased risk for other atherosclerotic complications. The purpose of the present study was to estimate and compare the levels of hs- C Reactive protein in chronic periodontitis patients before and after non-surgical periodontal therapy. Methods: The study sample consisted of 45 individuals of age group 30-60 years that was divided into two groups Group I (control) and Group II (patients with chronic generalized periodontitis). The clinical parameters such as plaque index, calculus index, gingival index, probing pocket depth, clinical attachment level, and serum hs-CRP levels were recorded for these individuals. Results: The patients with healthy gingiva possessed a mean hs-CRP level of 0.252 ± 0.0393 which was lower as compared to the patients with chronic periodontitis. In periodontitis patients mean levels of hs-CRP was 0.106 ± 0.029 which reduced to 0.044 ± 0.027 after periodontal therapy. A significantly elevated CRP level was found in subjects with periodontitis compared to the controls. Conclusion: The serum levels of C-reactive protein were elevated in patients with periodontitis and this might be a diagnostic marker for cardiovascular diseases.

Introduction: The use of botulinum toxin type A (BTX-A) to correct gummy smile has become popular in recent years. Objective: To evaluate the effects of BTX-A application in the correction of gummy smile 2 and 32 weeks after application. Methods: The sample comprised 35 patients (30 female, 5 male) at a mean age of 25.51 years (±5.59) with gummy smile due to muscular hyperfunction. In each patient, 2U of botulinum toxin was applied in the levator labii superioris alaeque nasi, 2 mm from the nasolabial fold. Photographs of spontaneous smiles were taken at 3 stages: before, 2 and 32 weeks after BTX application. Measurements of the gingival display were performed with the Radioface Studio 2 Software, and the calibration used the actual size of the right maxillary central incisor. Comparison of the three stages evaluated was performed with repeated measures ANOVA and Tukey tests. Results: Gingival display decreased significantly 2 weeks after BTX-A application and increased after 32 weeks but did not return to the initial value. Conclusion: There was a significant improvement in gummy smile 2 weeks after botulinum toxin application, and a significant relapse in the gingival display after 32 weeks, however not returning to baseline values.

BACKGROUND & OBJECTIVE: In Pakistan, there is lack of awareness to maintain oral hygiene and cleaning of oral structures. The current study aims to unveil homemade remedies and self-care methods followed by a majority of the rural population to cure dental pain in Sindh, Pakistan. METHODOLOGY: This cross-sectional descriptive study was conducted at dental OPD of the Secondary Health Care Facility of Sindh, Pakistan, by following a random sample selection approach. Patients from both genders representing oro-dental problems of ages ≥ 5 year were included in the study. Patient’s clinical and demographic data was collected, and further descriptive data analysis was done by using Microsoft Excel 2016. RESULTS: A total of 1627 patients fulfilled the inclusion criteria of the study. The highest number of cases (73.81%) were belonging to the age group 15-49 years, affirming that adults are at greater risk of developing toothache and dental pain. Surprisingly, about 78.97% patients had never visited any physician for seeking the clinical services. Similarly, 37.18 % of patients did not use any cleaning substance while 22.12 % patients preferred miswak for cleaning of their teeth. Only 2.95 % of patients visited dentists for proper care. CONCLUSION: Current research report concludes that from all the confirmed toothache cases, 22.13 % of patients sought care from general physicians in parallel with 22.34 % patients were preferring religious spells to manage their dental pain, which further multiplied the disease rate. However, general physicians at primary healthcare settings have limited knowledge and training in managing dental pain.

Polygoni Cuspidati Rhizoma et Radix (syn. rhizomes of Reynoutria japonica Houtt.) is a pharmacopoeial raw material in Europe and China. In traditional medicine, one of the applications for Reynoutria japonica rhizomes is wound healing. In a recent in vitro study, we demonstrated that ethanol and acetone extracts from this herbal drug have the potential to heal oral gum wounds. However, considering that a majority of herbal medicines have been traditionally administered as water decoctions, in the present study, a decoction of Reynoutria japonica rhizomes was prepared and detailed tests to determine its in vitro gingival wound healing activity were conducted. We used the primary human gingival fibroblasts (HGF) incubated with a decoction to determine cell viability (MTT assay), cell proliferation (the confocal laser scanning microscope—CLSM), and cell migration (wound healing assay). Moreover, the collagen type III expression was examined using immunocytochemical staining. The studied decoction was qualitatively and quantitatively characterized using the validated HPLC/DAD/ESI-HR-QTOF-MS method. The Folin–Ciocalteu assay was used to determine the total phenols and tannins content. Additionally, HPLC-RI analysis of decoction and the previously obtained ethanol and acetone extracts was used to determine the composition of saccharides. Low concentration (from 50 to 1000 µg/mL) of decoction after 24 h incubation caused a significant increase in HGF cell viability. No cytotoxic effect was observed at any tested concentration (up to 2000 µg/mL). The lowest active concentration of decoction (50 µg/mL) was selected for further experiments. It significantly stimulated human gingival fibroblasts to proliferate, migrate, and increase the synthesis of collagen III. Phytochemical analysis showed significantly fewer polyphenols in the decoction than in the ethanol and acetone extracts tested earlier. In contrast, high levels of polysaccharides were observed. In our opinion, they may have a significant effect on the oral wound healing parameters analyzed in vitro. The results obtained encourage the use of this raw material in its traditional, safe form—decoction.

Background: We have recently proposed an alternative strategy of free gingival graft (FGG) and connective tissue graft (CTG) using micronized-gingival connective tissues (MGCTs). The advantage of this strategy is that MGCTs from a small piece of maxillary tuberosity can regenerate the keratinized tissue band. However, safety and efficacy have not yet been established in patients. This clinical study was a pilot case series, and the objective was to assess the safety and the preliminary efficacy of MGCTs on peri-implant mucosa regeneration. Methods: This was a pilot interventional, single-center, first-in-human (FIH), open (no masking), uncontrolled, and single-assignment study. A total of 4 patients who needed peri-implant soft tissues reconstruction around dental implants received transplantation of atelocollagen-matrix with MGCTs micronized by the tissue disruptor technique. The duration of intervention was 4 weeks after surgery. Results: This first clinical study demonstrated that using MGCTs did not cause any irreversible adverse events, and it showed the preliminary efficacy for peri-implant soft tissues reconstruction in dental implant therapy. Conclusions: Though further studies are needed on an appropriate scale, as an alternative strategy of FGG or CTG, MGCTs might be promising for peri-implant mucosa reconstruction without requiring a high level of skills and morbidity to harvest graft tissues.

Pyogenic Granulomas (PG) are reactive hyperplastic lesions that are formed in relation to some chronic irritation, physical trauma or hormonal factors. The PG may present in various clinical and histological forms. These often present as a smooth lobulated exophytic lesions and at times may show a marked resemblance to Peripheral Ossifying Fibroma (POF). However, the characteristic histologic presentation helps in differentiating both the lesions. Microscopically, presence of ossification in pyogenic granuloma is not common and could possibly indicate an altered response of the connective tissue stroma. The present case report shows occurrence of pyogenic granuloma in a 12-year-old female which on histological examination not only exhibited proliferating blood vessels, endothelial cells and inflammatory cells which are typical features of pyogenic granuloma but also exhibited areas of ossifications which are not frequently encountered in PG. It is important to explore the underlying aetiological factors that could lead to formation of such ossifications. It has been suggested that pyogenic granuloma and peripheral ossifying fibroma could represent part of same spectrum of focal reactive lesions. However, it is still considered that these two lesions are separate clinical entities and the histologic presentations are different and unique to both of them.

In the review we analyze the basic surgical techniques applied to increase the volume of a keratinized gum and materials used for this procedure, such as dermal and collagen matrices. The results of clinical trials are presented on the effectiveness of collagen matrices, including Mucograft. The analysis of the literature highlights the main advantages and disadvantages of these methods and materials, as well as the most significant and promising areas for the further clinical research.

Abstract Background Oral focal mucinosis, the oral counterpart of cutaneous focal mucinosis, is a rare disease. As it has no characteristic clinical or radiological features, diagnosis is established by histopathological and immunohistological examination. We present three cases of oral focal mucinosis occurring in the retromolar (which is extremely rare) and gingival regions. Case presentation Case 1 involved a 26-year-old Japanese man with radiolucency in the right retromolar region on panoramic radiograph and computed tomography; no obvious protrusion was observed in the region. This finding was clinically diagnosed as a tumor of the retromolar region. Case 2 involved a 60-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 7 × 6 mm and exhibited elastic hardness and healthy-colored mucosa. The lesion was diagnosed as an epulis. Case 3 involved a 47-year-old Japanese woman. A tumor-like mass of tissue was identified on the buccal gingiva at the maxillary right canine and first premolar region. The lesion measured 10 × 10 mm and exhibited elastic hardness and redness of the surface mucosa. This lesion was also diagnosed as an epulis. Resection was performed in all three cases, and the lesions were histopathologically diagnosed as oral focal mucinosis. Postoperative courses were uneventful and, thus far, there have been no recurrences. Conclusions Although it is difficult to diagnose oral focal mucinosis based on clinical symptoms and imaging findings, the disease should be considered a possibility when diagnosing benign oral tumors. We believe that an emphasis on histopathologic study is essential to confirm the clinical suspicion.

Aim: The aim of this study is to evaluate the gingival melanin pigmentation in the Indian pediatric population. The aim of this study is to find any association between age and melanin distribution, age and intensity of melanin distribution, sex and melanin distribution, sex and intensity of melanin distribution, skin tone and melanin distribution, skin tone and intensity of melanin distribution and finally the association between melanin distribution and intensity. Background: Pigmentation on the interdental papilla, attached and marginal gingiva is commonly found in various races across the world. There is lack of literature for documentation of the same in the pediatric population. Materials and Methods: Intensity of melanin pigmentation was observed by the gingival melanin pigmentation index (class 1- class 6) as given by Ponnaiyan et al. This cross-sectional, observational study was conducted in the Institution. 100 children were selected from the age group of 1-12 years of age. The association between the various parameters were verified using Chi square test. Results: With the findings of the present study, it can be concluded that the distribution of melanin pigmentation is not affected by age, sex and skin color. The intensity of melanin pigmentation is not affected by age and sex. The skin colour can be used as a predictor to know the intensity of melanin pigmentation in both anteriors and posteriors.

Introduction: An exigency for a biomarker arises to expeditiously detect the periodontal disease evolution and to advocate more robust therapy efficacy measurements. Nitric oxide and sialic acid have been proved to be potential inflammatory markers. Hence, the evaluation of the involvement of nitric oxide and sialic acid in periodontal disease will enable us to assimilate the aspect of the complex process of periodontal disease progression. Aim: To estimate and compare the effect of nonsurgical periodontal therapy on serum and salivary sialic acid and nitric oxide levels in generalised chronic periodontitis patients. Materials and Methods: This study was a case-control as well as an interventional study. The subjects for this study were recruited from the Meenakshi Ammal Dental College and Hospital, Chennai from April 2017 to October 2018. Hundred patients were selected for this study. Control group consisted of 50 periodontally healthy subjects and test group consisted of 50 generalised chronic periodontitis subjects. After blood and saliva sample collection for determination of salivary and serum sialic acid and nitric oxide levels, evaluation of periodontal parameters like plaque index, probing pocket depth and Clinical Attachment Level (CAL) was done. Then the test group subjects underwent nonsurgical periodontal therapy and on 90th day post SRP parameters were re-evaluated. The collected data were analysed with IBM SPSS Statistics software, Version 23.0. In the above statistical tool the probability value 0.05 was considered as significant level. Results: The mean difference of plaque index, probing pocket depth, CAL, serum sialic acid, salivary sialic acid, serum Nitric Oxide (NO) and salivary nitric oxide: between the control and test group at baseline was -2.05, -5.01 mm, -5.56 mm, -12.515 mg/dL, -11.97 mg/dL, -129.762 µMol/L and -78.978 µMol/L respectively; for the test group at baseline and 90 days after nonsurgical periodontal therapy was 1.332, 3.15 mm, 3.285 mm, 14.206 mg/dL, 12.76 mg/dL, 130.082 µMol/L, 82.004 µMol/L, respectively. All the values were statistically significant with p-value

Human oral soft tissues provide the first barrier of defence against chronic inflammatory disease and hold a remarkable scarless wounding phenotype. Tissue homeostasis requires coordinated actions of epithelial, mesenchymal, and immune cells. However, the extent of heterogeneity within the human oral mucosa and how tissue cell types are affected during the course of disease progression is unknown. Using single-cell transcriptome profiling we reveal a striking remodelling of the epithelial and mesenchymal niches with a decrease in functional populations that are linked to the aetiology of the disease. Analysis of ligand–receptor interaction pairs identify potential intercellular hubs driving the inflammatory component of the disease. Our work establishes a reference map of the human oral mucosa in health and disease, and a framework for the development of new therapeutic strategies.

Introduction: Cobalt (II) chloride hexahydrate (CoCl2) is a material that frequently used as hypoxia mimicking agent (HMA) to induce hypoxia condition in the cell culture. CoCl2 may stimulate the adaptive state and maintain the stemness of mesenchymal stem cells (MSCs). Even though CoCl2 commonly administered for cell culture, the biocompabilty of this material should be examined before use on Gingival Mesenchymal Stem Cells (GMSCs). Purpose: the purpose of this study is to examine the biocompability of CoCl2 as HMA on Rabbit's (Oryctolagus cuniculus GMSCs by using cytotoxicity assay. Materials and Methods: Rabbit's GMSCs at fourth subculture obtained from cell stock was used in this study. CoCl2 with the concentration as much as 200 θM, 150 θM, 100 θM, 75 θM, 50 θM, 25θM was used to be compared in this study. Cytotoxicity test of CoCl2 on GMSCs was conducted by means of 3-(4,5-Dimethylthiazol-2-yl) 2,5-diphenyltetrazolium bromide (MTT) assay. The formazan crystal was observed in the viable cells. The data were analyzed using one-way Analysis of Variance (ANOVA) with p<0.05 considered as significant. Results: The formazan crystals were found in the GMSCs co-cultured with various doses of CoCl2. There was no significant difference in the cell viability percentage of GMSCs between groups treated with CoCl2 with various concentration (p>0.05). Conclusion: CoCl2 as hypoxia mimicking agent are biocompatible to be used on rabbit's (O. cuniculus) gingival mesenchymal stem cells. [ABSTRACT FROM AUTHOR]

Hereditary gingival fibromatosis (HGF) is a rare genetic condition characterized by slow and progressive gingival enlargement. The gingival overgrowth often delays teeth eruption and may cause serious functional and aesthetic problems. We reported a case of a 10-year-old female child presenting a generalized gingival enlargement covering almost all the maxillary and mandibular teeth and resulted in problems for swallowing, speaking, and poor aesthetics. An incisional biopsy was performed and revealed a hypocellular and hypovascular dense collagenous tissue covered by squamous epithelium exhibiting acanthosis and elongated rete ridges. The diagnosis was HGF. The treatment instituted was an association of gingivectomy with a rigorous program of oral hygiene and follow-up. Herein, we describe a rare non-syndromic case of generalized HGF, including clinical and microscopical features, as well as highlighting the importance of correct diagnosis of this genetic condition.

Background: Epidemiological data on gingival status in children is important because periodontal disease is one of the most prevalent diseases in Indonesia. This study aimed to assess the gingival health status and its associated factors among 12-year-old schoolchildren in Jakarta. Methods: This was a cross-sectional study of 12-year-old schoolchildren. There were 481 students who were recruited from 24 public and private junior high schools in Jakarta using multistage cluster proportional-to-size random sampling. Periodontal status was recorded using the community periodontal index based on World Health Organization standards. A self-completed questionnaire was given to the parents to collect information on children's backgrounds and oral health-related behaviours. Results: Only 3 of 478 participating children had healthy gums (no bleeding gums and no calculus). 99% of the children had bleeding gums and 84% had calculus. The prevalence of calculus was higher in girls than in boys. Periodontal status was not significantly related to tooth brushing habits or dental check-ups. Conclusions: Poor periodontal conditions were highly prevalent among 12-year-old schoolchildren in Jakarta. Oral health promotion and prevention strategies are urgently required.

Background: Pyogenic granuloma is a common tumor like growth of the oral cavity that has been considered to be non-neoplastic in nature and a reactive lesion. Objective: This study aimed to investigate the prevalence of pyogenic granuloma lesion in pathology Department of Tabriz Dental School between years 2006-2016. Methods: In this cross-sectional study, 1081 clinical records were analyzed. Findings: Eighty-two patients, 36 (43.9%) male and 46 (56.1%) female with pyogenic granuloma were identified. Most of patients (26.8%) were in the second decade of life. The frequency of this lesion was highest in the gingiva area (57.8%) and lowest in the lip and buccal mucosa (3.7%). Conclusion: Results showed that between years of study, 82 cases of pyogenic granuloma has been recorded. Prevalence of this lesions was higher in women and in second decade of life. Most of the lesions were in the gingival area.

Solitary myofibroma is an uncommon benign soft tissue neoplasm of myofibroblastic origin exhibiting head and neck region predilection but its presence in the jaws is rare. Myofibroma presents as painless mass and may demonstrate rapid enlargement and growth that clinically mimic malignancies. This report presents a 4-year-old male patient with a rapidly growing mandibular gingival mass with some evidence of underlying alveolar bone destruction. Incisional biopsy was performed and the specimen was stained with hematoxylin and eosin and immunohistochemical antibodies for αSMA, CD34, S100 and desmin. The diagnosis of myofibroma was made and the lesion was completely excised. The knowledge about microscopic features of this rare neoplasm helps to have a proper diagnosis and avoid unnecessary treatment.

Statement of the Problem: One major goal of tissue engineering and regenerative medicine is to find an appropriate source of mesenchymal stem cells (MSCs) with higher differentiation ability. Purpose: In this experimental study, the osteogenic and chondrogenic differentiation ability of buccal fat pad derived MSCs (BFP-MSCs) with gingival derived cells (GDCs) were compared. Materials and Method: BFP-MSCs and GDCs were cultured enzymatically and expanded. The expanded cells were analyzed for membrane-associated markers, using flow cytometry. Then the ability of these cells to differentiate into osteocyte and chondrocyte was assessed morphologically and by mRNA expression of collagen I (COLL), BGLA and bone morphogenetic protein 2 (BMP2) using qRT-PCR. Results: Flow cytometry analysis showed that both BFP-MSCs and GDCs expressed the characteristic stem cell markers such as CD73, CD44, and CD90, whereas they did not express hematopoietic markers. Mineralized calcium deposition was observed apparently in BFP-MSCs cultured in osteogenic medium but GDCs showed fewer mineralized nodules. The mRNA expression levels of BGLA and BMP2 showed 7×105 and 733-fold more mRNA expression in BFP-MSCs treated with differentiation media compared to the control group. In chondrogenic differentiation, BFP-MSCs transformed from a spindle to a cuboidal shape while GDCs showed only a slight transformation. In addition, mRNA expression of COLL showed 282-fold higher expression in BFP-MSCs in comparison to the control group. Such significant difference in mRNA expression of BGLA, BMP2, and COLL was not observed in GDCs compared to their corresponding controls. Conclusion: Based on the present results, BFP yields a greater proportion of stem cells compared to gingiva. Therefore, this tissue can be introduced as an easily available source for the treatment of periodontal defects and other maxillofacial injuries.

Immune thrombocytopenic purpura (ITP) is an immune-mediated acquired disease found in both adults and children. It is characterized by transient or persistent decreases in the platelet count. We report a case of ITP detected based on oral hemorrhagic symptoms. The patient was a 79-year-old female with no significant past medical history. She presented with sudden onset of gingival bleeding and hemorrhagic bullae on the buccal mucosa. Gingival bleeding was difficult to control. Laboratory tests revealed severe thrombocytopenia with a platelet count as low as 2000/μL. Under a provisional diagnosis of a hematological disorder, she was referred to a hematologist. A peripheral smear showed normal-sized platelets. A bone marrow examination revealed increased numbers of megakaryocytes without morphologic abnormalities. The patient was diagnosed with ITP and treated with a combination of pulsed steroid therapy and high-dose immunoglobulin therapy. However, her severe thrombocytopenia was refractory to these treatments. Then, a thrombopoietin receptor agonist was begun as a second-line treatment. Her platelets rapidly increased, and no bleeding complications were reported. Because oral symptoms can be one of the initial manifestations of ITP, dentists should be familiar with the clinical appearance of ITP, and attention must be paid to detect and diagnose unidentified cases.

Tuberculosis (TB) is a chronic infectious granulomatous disease that interfere various organs, including the lung. TB disease is caused by Mycobacterium tuberculosis (MTB). Until now, TB disease is still a health problem that can cause death in various countries, especially in Indonesia. TB disease may demonstrate clinical manifestations in the oral cavity such as tuberculous ulcers, noduls, and granulomatous lesion on gingiva. TB lesions in the oral cavity are clinically non-specific and often misdiagnosed by the dentist. As a dentist it is important to be aware of the clinical form of oral tuberculosis (TB) ulcer lesions and to consider in the differential diagnosis of other ulcer lesions. By knowing the clinical oral manifestations in TB patients, the dentist can help prevents the infectious tuberculosis transmissions among dentist, healtcare workers, and patients. This study aims to know the prevalence of oral tuberculosis ulcer in Dr. Soetomo Hospital in 2017.This research is a descriptive observational research with cross sectional design. This research using a purposive sampling technique. The study was conducted in outpatient TB DOTS, Dr. Soetomo hospital during July-November 2017. From 23 subjects, no oral ulcer tuberculosis (0%) was obtained. Not every tuberculosis case would show oral manifestations such as oral ulcer tuberculosis. [ABSTRACT FROM AUTHOR]