Author: muhadnoorman

dental undergraduate student, stomatologist in making..😄

CERVICOFACIAL EMPHYSEMA

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Muhad Noorman P- Dentowesome 2020

During impacted teeth extraction process,Surgical managment of facial fractures with high speed rotary instruments like airotor, blowing of compressed air into root canal , airotor in middle face fractures with use of air-pushing machine such as airotor or even an air syringe, Due to air leakage inside the tissues can cause the phenomenon of confined air within tissues called Cervicofacial Emphysema and is the result of air trapping, so use the micromotor handpiece instead of the airotor, because it is a dangerous condition._The treatment is only to reassure the patient that it will go away after 3-4 days. However rarely can cause Venous Air Embolism, mediastenal emphysema and rarely pneumothorax.

Clinically presented as unilateral swelling of face/neck with or without dysphagia resembling Angioedoema,however crepitus on palpation is a positive diagnostic feautre.

Another type is PNEUMOPAROTID,entrapment of air in parotid duct either accidental or by profession in trumphet blowing artist etc.. presenting with painful swelling in face over parotid region with froathy saliva.and ctepitus on palpation.

References: Shafer’s Textbook of Oral Pathology

Papillon–Lefèvre syndrome

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Muhad Noorman P – Dentowesome 2020

Papillon–Lefèvre syndrome (PLS) is a rare autosomal recessive disorder, characterized by diffuse palmoplantar keratoderma (hyperkeratosis) and precocious aggressive periodontitis, leading to premature loss of deciduous and permanent dentition at a very young age. Various etiopathogenic factors are associated with the syndrome, like immunologic alterations, genetic mutations, and the role of bacteria. Dentists play a significant role in the diagnosis and management of PLS as there are characteristic manifestations like periodontal destruction at an early age and an early eruption of permanent teeth. Here, we are presenting an elaborate review of PLS, its etiopathogenesis, clinical presentation, and management options.

Genetic studies of patients with Papillon-Lefèvre syndrome have mapped the major gene locus to chromosome 11q14-q21 and revealed mutation and loss of function of the cathepsin C gene. This gene is important in the structural growth and development of the skin and is critical for appropriate immune response of myeloid and lymphoid cells. Researchers believe that the loss of appropriate function of the cathepsin C gene results in an altered immune response to infection. In addition, the altered gene may affect the integrity of the junctional epithelium surrounding the tooth.

A closely related disease, Haim-Munk syndrome, also exhibits palmoplantar keratosis, progressive periodontal disease, recurrent skin infections, and several skeletal malformations. In this syndrome, the skin manifestations are more severe and the periodontal disease is milder. Studies have demonstrated that Haim-Munk syndrome and many examples of prepubertal periodontitis also exhibit mutation of the cathepsin C gene and represent allelic variants of the mutated gene responsible for Papillon-Lefèvre syndrome.

References: Shafer’s Textbook of Oral 9th edition

Photo credits: Dr Karthikeyan,PG final year Periodontics,Saveetha dental College, Chennai

Systemic Implications in Dental practice

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Cyclosporine therapy may cause gingival hyperplasia

Gingival growth occurs in patients taking phenytoin.

Patients with cardiac disease should receive dental treatment in minimal stressful environment. Anxiety,exertion and pain should be minimized.

Irregular pulse, engorged jugular veins and tachypnea may indicate the presence of cardiac disease.A history of hypertension, ischemic heart disease or any other cardiac problem particularly congenital heart disease and drug intake (anticoagulant, aspirin) should be sought.Angina may present as pain in the mandible, teeth and other oral Tissues Epinephrine in the local anesthesia may raise the blood pressure and precipitate dysarrhythmias.In patients with IHD, facilities for medical help, oxygen and nitroglycerine should be Available General anesthesia should be avoided for at least three months in patients with recent onset angina

Patient’s with Cushing’s syndrome more prone to get infections.(candidiasis)

Elective dental surgery should be deferred for 6 months following acute MI.Prophylaxis for infective endocarditis is mandatory in cases where there is a risk.Cardiac patients on anticoagulant drugs or aspirin are at increased risk of bleeding following dental procedures.Hence, these drugs should preferably be stopped a week before the procedure.Calcium channel blockers may cause gingival swelling and lichenoid lesions in the oral cavity. ACE inhibitorscan cause loss of taste, burning sensation in oral cavity,and angioedema. Dry mouth can result due toantihypertensive drugs such as d

Rifampicin can cause red saliva.

Elective dental care is avoided in patients with acuterenal failure

Elective dental procedures are better tolerated on non-dialysis days

Blood pressure measurement is advised at every visit.

Brown to black macular pigmentation in oral mucosa can be suspected for Addison disease.

Gonorrhea may present uncommonly with oral manifestations like tonsillitis, lymphadenitis, and painful oral and pharyngeal ulcers.

Oral manifestations in peptic ulcer disease are rare.However erosive dental lesions could be appreciated on lingual surface of lower incisors or palatal surface of upper maxillary teeth.