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OBJECTIVE: To report a case of severe necrotizing ulcerative periodontitis (NUP) with a rarely associated sequestrum formation in a Nigerian HIV-positive patient. CLINICAL PRESENTATION AND INTERVENTION: A 47-year-old HIV-positive male patient with no history of previous dental visits presented with a severe toothache in his lower jaw of 4 weeks' duration, which had affected his ability to chew properly. Clinical examination revealed marked gingival inflammation, moderate gingival recession and mobility of some of his lower anterior teeth: 31, 32, and 33. There was also a sequestrum present associated with the affected teeth. His CD4 cell count was 226 cells/mm(3). His viral load was very high (360,082 copies/ml). The intervention included thorough debridement of the necrotic lesion and sequestrectomy. The patient responded well to treatment after 1 week of follow-up. Unfortunately, the CD4 count was not assessed further because the patient was lost to follow-up. CONCLUSION: This case showed that a high CD4 cell count does not necessarily prevent the occurrence of NUP in HIV-positive patients. Intervention might have enhanced a rapid positive response to the treatment within a short time.

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Periodontal maintenance therapy is an integral aspect of any general dental or specialist practice. Numerous studies have indicated that periodontal therapy in the absence of a carefully designed maintenance program invariably results in the relapse of the disease condition. Accordingly, dental practices that provide periodontal care without a maintenance program deal with significant patient management and disease management issues. In this article, three cases are presented with varying levels of disease severity but all sharing the common trait of having being enrolled in a good maintenance program with positive treatment outcomes.

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PURPOSE: Hypesthesia or anesthesia of the lower lip (Vincent's symptom) is a common sign in patients with osteomyelitis of the mandible, especially in severe cases. PATIENTS AND METHODS: We observed an involvement of the inferior alveolar nerve in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ). Surprisingly, we found Vincent's symptom also in patients with limited and early stages of BRONJ. RESULTS: These patients were successfully treated by surgical removal of the necrotic bone combined with preoperative and postoperative administration of antibiotics. We report on the occurrence and management of an involvement of the inferior alveolar nerve in patients with BRONJ and discuss possible causes. CONCLUSION: We conclude that impairment of inferior alveolar nerve function can be an important early symptom or even the presenting symptom of BRONJ that is also easily detectable by bisphosphonate-prescribing physicians. Concerning the management of BRONJ, we conclude that surgical removal of necrotic bone combined with antibiotics is an adequate treatment in patients with osteonecrosis of the jaw.

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A 39-year-old Antillean woman was referred by her family doctor to an oral and maxillofacial surgeon because of an unusual and painful ulcer in the buccal region of the first left mandibular molar. Earlier that day, she was diagnosed as HIV-positive. The ulcer was diagnosed as an atypical necrotising ulcerating periodontitis. Antibiotics were subscribed and after removal of the first left mandibular molar, the ulcer healed. After several weeks, the patient was referred by her internist because of another ulcer at the lateral border of the tongue. This ulcer was diagnosed as an eosinophilic ulcer and was healing slowly. Both ulcer types are seen rarely and are strongly related to immunodeficiency diseases.

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The transposition of connective tissue to increase the zone of keratinized tissue or cover exposed root surfaces has become an integral part of the surgical dental practice. An effort to expand the surgical protocol to gingival recession of ulcerative etiology is presented. Parameters such as pathogenesis, clinical characteristic, and histopathology are analytically discussed. Furthermore, different aspects of the mucogingival therapy phase of the grafting procedure are presented.

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A 25-year-old male patient with skin lesions of Langerhans' cell histiocytosis (LCH) was referred for periodontal treatment because of bilateral severely inflamed ulcerative periodontal lesions at the mandibular second premolar and first molar. On the left side, significant bone loss was revealed. Anti-infectious and surgical periodontal therapy resulted in significant probing pocket depth reduction and clinical attachment gains that were maintained for up to 24 months after surgery. Biopsies were taken during periodontal surgery. Immunohistochemical staining revealed that the periodontal lesions were uncommon periodontal manifestations of LCH. Reports of oral manifestation of LCH and treatment methods are reviewed.

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Changes that occurred in the pattern of tooth extraction in the last 13 years among a population of children in Nigerian were studied. The result of this study was then compared to that of a past study done in the same institution 13 years earlier. Information on age, gender, and indication of tooth extraction was collected prospectively from 379 consecutive patients who visited the outpatient Pediatric Dental Clinic for the first time during the year 2002. Results showed tooth extraction due to caries decreased, while there was an increase in tooth extraction from an apparent increase in orthodontic treatment needs. Acute necrotizing ulcerative gingivitis (ANUG), a significant cause of tooth loss in the last decade, decreased significantly. The pattern of deciduous tooth loss also changed as more anterior teeth were lost for orthodontic reasons in this present study. The pattern of tooth loss in the permanent dentition remains very similar to that of the past study, though more premolars were lost in the present study. There appears to be an increasing need for tooth extractions in orthodontic treatment for this population of children. The focus of planned dental health care provisions, treatment policies, and training emphasis in child dental care may need to shift to addressing orthodontic needs.

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This report describes a case of rapidly progressive periodontal tissue breakdown and bone loss in an HIV-infected markedly immunosuppressed homosexual male. Within 6 months of initial presentation with a necrotizing ulcerative gingivitis, the lesion extended to a necrotizing ulcerative stomatitis involving the surrounding periodontium and palatal mucosa. With only partial compliance to local debridement, chlorhexidine oral rinses, and systemic metronidazole therapy, alveolar bone loss resulted in tooth mobility necessitating extraction of 2 involved teeth. This case illustrates the continuum of necrotizing ulcerative infections of the periodontium in the severely immunosuppressed patient. The implications of these oral manifestations of HIV infection are discussed.

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Benign soft tissue lesions of the mouth can be removed using the CO2 laser. This type of laser surgery is faster and offers less postoperative complication as compared with conventional surgery and electrosurgery. Presently, the CO2 laser can be used for intraoral biopsy of benign masses, gingivectomies, and frenectomies.

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Ameloblastoma usually presents as a painless swelling of the jaw, but the chief complaint is rarely of ulceration. A case of ameloblastoma with a complaint of gingival ulcer in a 75-year-old Japanese male who was treated by an en bloc removal of the tumor with gingival ulcer is described and discussed. There is no evidence of recurrence, and the postoperative course was uneventful.

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