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Aggressive periodontitis with streptococcal gingivitis: a case report.

Kara C, Demir T, Tezel A, Zihni M - Eur J Dent (2007)

Bottom Line: Streptococcal infections of gingiva are seen rarely; also the origin of this gingival inflammation is occasionally different from that of routine plaque-associated gingivitis.The clinical features and treatment methods of these diseases are already reported in previous literatures.This case report describes a patient who presented with severe gingival inflammation and attachment loss that was diagnosed as an acute streptococcal infection associated with aggressive periodontitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey.

ABSTRACT
Acute streptococcal gingivitis is an acute inflammation of the oral mucosa and also may be seen with the other oral diseases as aggressive periodontitis that is characterized by a considerable attachment loss over a relatively short period of time. Streptococcal infections of gingiva are seen rarely; also the origin of this gingival inflammation is occasionally different from that of routine plaque-associated gingivitis. The clinical features and treatment methods of these diseases are already reported in previous literatures. This case report describes a patient who presented with severe gingival inflammation and attachment loss that was diagnosed as an acute streptococcal infection associated with aggressive periodontitis. In this study a supportive treatment option was demonstrated based on these data and antacid treatment as adjunctive to the recommended treatment modalities was used for streptococcal gingivitis.

No MeSH data available.


Related in: MedlinePlus

Pre-treatment clinical view of anterior region of the oral cavity showing severe gingival inflammation diffused periodontal and gingival abscess formation.
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f1-0010251: Pre-treatment clinical view of anterior region of the oral cavity showing severe gingival inflammation diffused periodontal and gingival abscess formation.

Mentions: The patient, a 26-year-old female, was referred to our clinic by her general dentist for severe bleeding gums, gingival hyperplasia, and halitosis. At the time, the patient was experiencing pain, severe bleeding with brushing related to her periodontal disease. She had a non-contributory medical history. However, prior to her visit to our clinic, she had never had a periodontal examination. On examination, generalized edematous, hyperplastic gingiva, bleeding on probing and calculus formation was seen (Figure 1). To determine the clinical situation of the subject, gingival index,6 plaque index,7 periodontal probing depths (PPD) and clinical attachment levels (CAL) of the teeth were recorded before and after the treatment by using a manual probe (Hu-Friedy Manufacturing Inc., Chicago, IL, USA) (Table 1). Periodontal examination revealed gingival swelling, 78.2% bleeding at probing sites, 52.7% plaque control record, and 72.9% of the sites had a periodontal pocket depth of 4 mm or more. Upon initial examination, radiographs demonstrated extensive generalized vertical intra-bony defects in the maxillary and mandibular arches (Figure 2). Based on the clinical and radiographic findings, a diagnosis of generalize AP was assigned to the patient. According to these findings, treatment was started with an initial phase of mechanical therapy; including systematic scaling and planing of all accessible root surfaces and the introduction of meticulous oral hygiene. During oral hygiene instruction and subsequent initial preparation as a chemotherapeutic support tetracycline (only first day 2 x 100mg and 1 x 100mg/day – Tetradox, Fako, Turkey) had been given to the patient with a mouth rinse including Chlorhexidine Digluconate (0.12%) and Benzidamin HCL (0.15%) (Kloroben, Drogsan, Turkey). And also to improve the patient’s oral and dental hygiene, a new soft toothbrush was referred for use as part of the oral care protocol. After optimal oral hygiene was provided, based on persistence of periodontal lesions, a second phase of therapy was planned and the advanced periodontal therapy, flap and gingivectomy operations were done and remaining roots were removed. After resolution of the periodontal infection (a period of seven weeks), the patient was placed on an individually tailored maintenance care program including continuous evaluation of the occurrence and the risk of disease progression. However, after a week, bleeding, edema and dark red discoloration on the marginal areas of gingiva developed again (Figure 3). Further medical tests were carried out to look for searching an underlying systemic disease and its impact on the etiology of the disease. Because of the results were in normal limits, we suspected acute streptococcal infection. Although acute streptococcal infection was suspected because of the clinical features of the patient, for being sure bacterial sample was obtained by scraping the surfaces of the gingival lesions with a sterile chip and the anaerobic-culture technique were used to identify the bacteria. Cultures of the gingival samples grew streptococcus pyogenes and a few other microorganisms. To prevent antibiotic resistance development with chemotherapeutic agents in the treatment of aggressive periodontitis, we decided to use an alternative treatment primarily, which was based on the microorganism’s growth characteristics. The acidic oral pH required for growing of the Streptococcus species was tried to change and the optimal oral pH in normal values was kept. For this purpose, an antacid chewing tablet (Rennie 680mg, Roche, Turkey), which includes calcium and magnesium carbonate, was offered two times a day for a week. To determine the effectiveness of this medication, normal whole saliva pH and whole saliva pH after using the antacid were measured (Inolab pH meter level 2, Wissenschafllich Technische, Germany) (Figure 4). This normal value was picked up of the same patient in different moments. At the end of this additional treatment, oral health was obtained (Figure 5).


Aggressive periodontitis with streptococcal gingivitis: a case report.

Kara C, Demir T, Tezel A, Zihni M - Eur J Dent (2007)

Pre-treatment clinical view of anterior region of the oral cavity showing severe gingival inflammation diffused periodontal and gingival abscess formation.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2609907&req=5

f1-0010251: Pre-treatment clinical view of anterior region of the oral cavity showing severe gingival inflammation diffused periodontal and gingival abscess formation.
Mentions: The patient, a 26-year-old female, was referred to our clinic by her general dentist for severe bleeding gums, gingival hyperplasia, and halitosis. At the time, the patient was experiencing pain, severe bleeding with brushing related to her periodontal disease. She had a non-contributory medical history. However, prior to her visit to our clinic, she had never had a periodontal examination. On examination, generalized edematous, hyperplastic gingiva, bleeding on probing and calculus formation was seen (Figure 1). To determine the clinical situation of the subject, gingival index,6 plaque index,7 periodontal probing depths (PPD) and clinical attachment levels (CAL) of the teeth were recorded before and after the treatment by using a manual probe (Hu-Friedy Manufacturing Inc., Chicago, IL, USA) (Table 1). Periodontal examination revealed gingival swelling, 78.2% bleeding at probing sites, 52.7% plaque control record, and 72.9% of the sites had a periodontal pocket depth of 4 mm or more. Upon initial examination, radiographs demonstrated extensive generalized vertical intra-bony defects in the maxillary and mandibular arches (Figure 2). Based on the clinical and radiographic findings, a diagnosis of generalize AP was assigned to the patient. According to these findings, treatment was started with an initial phase of mechanical therapy; including systematic scaling and planing of all accessible root surfaces and the introduction of meticulous oral hygiene. During oral hygiene instruction and subsequent initial preparation as a chemotherapeutic support tetracycline (only first day 2 x 100mg and 1 x 100mg/day – Tetradox, Fako, Turkey) had been given to the patient with a mouth rinse including Chlorhexidine Digluconate (0.12%) and Benzidamin HCL (0.15%) (Kloroben, Drogsan, Turkey). And also to improve the patient’s oral and dental hygiene, a new soft toothbrush was referred for use as part of the oral care protocol. After optimal oral hygiene was provided, based on persistence of periodontal lesions, a second phase of therapy was planned and the advanced periodontal therapy, flap and gingivectomy operations were done and remaining roots were removed. After resolution of the periodontal infection (a period of seven weeks), the patient was placed on an individually tailored maintenance care program including continuous evaluation of the occurrence and the risk of disease progression. However, after a week, bleeding, edema and dark red discoloration on the marginal areas of gingiva developed again (Figure 3). Further medical tests were carried out to look for searching an underlying systemic disease and its impact on the etiology of the disease. Because of the results were in normal limits, we suspected acute streptococcal infection. Although acute streptococcal infection was suspected because of the clinical features of the patient, for being sure bacterial sample was obtained by scraping the surfaces of the gingival lesions with a sterile chip and the anaerobic-culture technique were used to identify the bacteria. Cultures of the gingival samples grew streptococcus pyogenes and a few other microorganisms. To prevent antibiotic resistance development with chemotherapeutic agents in the treatment of aggressive periodontitis, we decided to use an alternative treatment primarily, which was based on the microorganism’s growth characteristics. The acidic oral pH required for growing of the Streptococcus species was tried to change and the optimal oral pH in normal values was kept. For this purpose, an antacid chewing tablet (Rennie 680mg, Roche, Turkey), which includes calcium and magnesium carbonate, was offered two times a day for a week. To determine the effectiveness of this medication, normal whole saliva pH and whole saliva pH after using the antacid were measured (Inolab pH meter level 2, Wissenschafllich Technische, Germany) (Figure 4). This normal value was picked up of the same patient in different moments. At the end of this additional treatment, oral health was obtained (Figure 5).

Bottom Line: Streptococcal infections of gingiva are seen rarely; also the origin of this gingival inflammation is occasionally different from that of routine plaque-associated gingivitis.The clinical features and treatment methods of these diseases are already reported in previous literatures.This case report describes a patient who presented with severe gingival inflammation and attachment loss that was diagnosed as an acute streptococcal infection associated with aggressive periodontitis.

View Article: PubMed Central - PubMed

Affiliation: Department of Periodontology, Faculty of Dentistry, Atatürk University, Erzurum, Turkey.

ABSTRACT
Acute streptococcal gingivitis is an acute inflammation of the oral mucosa and also may be seen with the other oral diseases as aggressive periodontitis that is characterized by a considerable attachment loss over a relatively short period of time. Streptococcal infections of gingiva are seen rarely; also the origin of this gingival inflammation is occasionally different from that of routine plaque-associated gingivitis. The clinical features and treatment methods of these diseases are already reported in previous literatures. This case report describes a patient who presented with severe gingival inflammation and attachment loss that was diagnosed as an acute streptococcal infection associated with aggressive periodontitis. In this study a supportive treatment option was demonstrated based on these data and antacid treatment as adjunctive to the recommended treatment modalities was used for streptococcal gingivitis.

No MeSH data available.


Related in: MedlinePlus