b
Figure 9. Panoramic radiograph.
environment
and aspects
Figure 6. Panoramic
image. of cultivation consisting
of minimum three types of colonies both in aerobic
and anaerobic
environment.
The isolation
in
fluoride.
In addition,
there are general
factors such
anaerobic environment was practically impossible,
as: education, socio-economic status, behavior,
although some bacterial species had developed
health attitude, income. When one of the risk
in this environment too. Anyway, there were found
factors increases, it produces an imbalance,
Gram negative bacilli, perhaps
Enterobacteriaceae
leading
to caries
(Fig.
3). 5,6,7 perhaps Streptococcus
and Gram
positive
cocci,
The
sp. most complex and accessible microbial
ecosystem
of the
human
body
3.2. Case no.
2: M.Ş.,
f, age
25 lies in the oral cavity,
there
about
700 species
of approximal
known bacteria,
at
3.2.1. are
Oral
diagnosis
– active
caries:
least
30 on
species
of fungi
Candida)
and
mesial
12 and
22; (especially
cervical caries
lesions
several
species
of protozoa
(associated
food
distal on
43 and
44, facial
on 45 with
; chronic
bacteria)
some intracellular
viruses.
marginal and
periodontitis.
The exam
of the 8,9,10,11
marginal
In
a healthy oral revealed:
cavity, what tartar
is normally
is
periodontium
index found
34.48
percent; gum
inflammation
index 11.20
between
20-50
bacterial species,
the percent;
number
periodontal
index
6.03 percent;
going
up to inflammation
200-400, in case
of disease.
These
periodontal pockets with dimensions between
a
b
3-4 mm; the gum color changed from light red to
brick red, with a are
bordure
area (lisere)
microorganisms
always periphery
found in communities
12,13,14 the
and
ulceration
areas;
bleedings
at
slight
and vary with the cavity environment. touch;
The
periodontal
chart
revealed
slight
gum
at
dental surfaces and the mucosa are the retreat
areas of
the
level
of
the
front
inferior
incisive,
periodontal
microbial colonization. The constant production
pockets
11, the
12, intermittent
15, 27, 33, 42,
44, 45 with
and
of
saliva in and
food 43, feeding
slight dental mobility (first degree) at the inferior
sugars and amino acids generate nutrients for
incisive.
microbial growth. 15
3.2.2. Hematologic diagnosis – iron deficiency
The increased number of microorganisms, their
anemia due to metrorrhagia (Figures 8,9)
development
on HCT
a favorable
ground
the
HGB 10.47 g/dL;
33.75 %; RBC
3.61 and
106/μL;
association
with
the
inflammatory
response
of
the
MCV 79 fL; Fe 23 μg/dl
host
are
responsible
for
caries
development
under
Complementary exams: radiological, cytological,
the
plaque (Fig. 4). 16,17
immunohistochemical,
microbiological,
Immunity
is the ensemble of humoral and cellular,
immunoserological
specific
and nonspecific
factors, which protect the
3.2.3. Serology
– slight modification
human
infectious
diseases,
CRP 3.0 body
g/dL; against
IgA 3.63
g/l; IgG 11.84
g/l; parasites
IgM 1.82
aggressions
proliferation. The
g/l; C 3 1.2 g/l; and
C 4 0.4 malignant
g/l
3.2.4. Radiological
– generalized
presence
of microorganisms
and their horizontal
products
minimal bone
loss; radiotransparency
different
initiating
and producing
caries causes with
an immunity
site: cervical
on 43, on 44, specific
45; approximately
on 47
response
based
and nonspecific
18,19,20
and
48;
vertical
bone
resorption
on
13
(Figure
10).
factors.
3.2.5.
Cytological
–
the
following
were
observed:
A systemic disease can influence the effectiveness
microbial
loaded response
epithelial
cells;
connective
of
the immunity
which
can lead
to an
inflammatory
cells;
macrophages,
granulocytes,
intense microbial activity consequently with dental
lymphocytes;
cocci, diplococci, Treponema
or
periodontal manifestations.
denticola, fusobacterium, yeasts.
Cytological exam revealed: epithelial cells loaded
3. Cases reports
with germs, polymorphic microbial flora, important
3.1. Case no. 1: M.Ș., f, age 25
granulocyte infiltrate. The immune-histochemical
3.1.1.
Oral revealed:
diagnosis
– active of approximal
diagnosis
fragments
pavement
caries:
mesial
on
12
and
22; cervical
caries
stratified mucosa, presenting important
acanthosis
with epithelial cristae irregularly elongated. In
Stomatology Edu Journal
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Figure 12.
Radiograph aspect – – horizontal
horizontal bone
atrophy
with
9. Radiograph
bone atrophy
atrophy with
Figure 12.
Radiograph aspect
aspect – horizontal bone
localized
vertical
resorption.
with
localized
vertical
resorption.
localized vertical resorption.
lesions
distal on 43 and
44, facial
on 45;
chronic
the
under-epithelial
connective
tissue
there
was
the under-epithelial connective tissue there was
an
abundant
inflammatory
lymphoplasmacytic
marginal
periodontitis.
The
exam
of
the
marginal
an abundant inflammatory lymphoplasmacytic
infiltrate.
There revealed:
was a moderate
the
periodontium
calculus edema
index of
34.48
infiltrate.
There was a moderate
edema
of
the
epithelium
and
moderate
spongiosis
with
erosive
percent; gingival
inflammation
11.20
epithelium
and moderate
spongiosis index
with erosive
and
ulcerative
areas. inflammation index 6.03
percent;
periodontal
and
ulcerative
areas.
3.3
Case
no.
3:
S. M., f, age
41 with dimensions
percent;
periodontal
pockets
3.3
Case no.
3: S. M., f, age
41
3.3.1.
Oral
diagnosis
–
on
teeth
between
3-4
mm; gingiva
color diagram:
changed, active
from
3.3.1.
Oral
diagnosis
– on teeth
diagram:
active
cervical
lesions
on
13,
31,
41
and
43; arrested
light red lesions
to brick
a bordure
cervical
on red,
13, with
31, 41
and 43; periphery
arrested
brown
lesions and
on 37
and 48; on
periodontal
chart:
area (lisere)
ulceration
areas;
bleedings
at
brown
lesions on 37
and 48; on
periodontal
chart:
chronic periodontitis with tartar index of 25.89%;
chronic
periodontitis
with tartar
index
of 25.89%;
slight touch;
the periodontal
chart
revealed
slight
gum inflammation index of 10.71%; periodontal
gum
inflammation
of 10.71%;
periodontal
gingiva
recession at index
the level
of the front
inferior
inflammation index of 7.14%; generalized
inflammation
index
of
7.14%;
generalized
incisive, periodontal pockets in 11. 12. 15. 27.
gum retraction, with Stillman’s clefts on 16, 26;
gum
retraction,
clefts mobility
on 16, (first
26;
33. 42.
43. 44. exudate
45 with
and Stillman’s
dental
seropurulent
at slight
pressure
on the sides
of
seropurulent
exudate
at
pressure
on
the
sides
of
degree)
at the inferior
incisive
b). 43, 44;
the
periodontal
pockets
at 13, (Fig.
12, 5-a;
23, 37,
the periodontal pockets at 13, 12, 23, 37, 43, 44;
bleedings when touching gum level of the inferior
bleedings when touching gum level of the inferior
front incisive;
moderate
dental – mobility
(second
3.1.2.
Hematologic
diagnosis
iron deficiency
front incisive;
moderate
dental mobility
(second
degree).
anemia
degree). due to metrorrhagia: HGB 10.47 g/dL;
3.3.2. 33.75
Hematologic
diagnosis
iron 79 deficiency
HCT
%; RBC 3.61
10 6 /μL; – – MCV
fL; Fe 23
3.3.2. Hematologic
diagnosis
iron deficiency
anemia
(Figures
11,12)
μg/dL.
anemia (Figures 11,12)
HGB 10.8 g/dL; HCT 38 %; RBC 4.79 106/μL; MCV
HGB 10.8 g/dL; HCT
38 %;
RBC 4.79 106/μL;
MCV
Complementary
exams:
radiological,
cytological,
73.1 fL; Fe 21 μg/dl.
73.1 fL; Fe 21 μg/dl.
immunohistochemical,
microbiological, immuno-
Complementary exams: radiological, cytological,
Complementary exams: radiological, cytological,
serological.
immunohistochemical,
microbiological,
immunohistochemical,
microbiological,
3.1.3.
Serology – slight modification:
CRP 3.0 g/dL;
immunoserological
immunoserological
IgA
3.63
g/L;
IgG
11.84
g/L;
IgM
1.82
3.3.3. Serology – increase of the IgM g/L; C3 1.2
3.3.3.
Serology
– increase of the IgM
g/L;
g/L. IgA
CRP C4
5.5 0.4
g/dL;
1.93 g/l; IgG 12.4 g/l; IgM 2.40
CRP
5.5
g/dL;
IgA
1.93 g/l; IgG horizontal
12.4 g/l; IgM
2.40
3.1.4.
minimal
g/l ;C 3 3 Radiological
1 g/l ;C 4 4 0,2 –generalized
g/l
g/l
;C
1
g/l
;C
0,2
g/l
3
4
bone
radiotransparency
different bone
site:
3.3.4. loss;
Radiological
– general with
horizontal
3.3.4. Radiological – general horizontal bone
cervical
43.44.45;
on 47
48;
minimal on
loss;
proximal approximately
demineralization
on and
34 and
minimal loss; proximal demineralization on 34 and
vertical
bone
resorption
13 (Fig.
6).
recurrent
caries
lesion on
under
restoration
on 37
recurrent caries lesion under restoration on 37
3.1.5.
Cytologic appearance: microbial loaded
(Fig. 13).
(Fig. 13).
3.3.5. Cytological
– microbial
loaded
macrophages,
epithelial
cells were
observed
interspersed
in a
3.3.5. Cytological
– microbial
loaded
macrophages,
mixed cellular
component cells:
(epithelial
and
background
of
inflammatory
macrophages,
mixed cellular component (epithelial and
conjunctive), cocci,
bacilli, candida
filaments.
granulocytes,
lymphocytes
with
microbial
conjunctive), cocci, bacilli, candida filaments.
3.3.6. Histologically
– severe
inflammatory
elements:
cocci, diplococci,
Treponema
denticola,
3.3.6. Histologically
– severe
inflammatory
infiltrate
was
observed;
the
immunohistochemical
fusobacterium,
yeasts (Fig.
infiltrate was observed;
the 7-a).
immunohistochemical
diagnosis
revealed: fragments
of pavements
The
histopathologic
examination
revealed
diagnosis
revealed: fragments
of pavements
mucosa,
stratified
presenting
acanthosis
and
fragments
of squamous
mucosa acanthosis
with prominent
mucosa, stratified
presenting
and
parakeratosis
with
diffuse
spongiosis
and
minimal
acanthosis
with diffuse irregularly
elongated
parakeratosis with
spongiosis and
minimal
hyperemia and important interstitial edema.
hyperemia cristae
and important
interstitial
edema.
epithelial
and abundant
inflammatory
In the under-epithelial connective tissue, there
In the under-epithelial
connective
tissue,
there
lymphoplasmacytic
infiltrate
in lamina
propria.
was a minimal lymphoplasmocytic inflammatory
was a minimal
lymphoplasmocytic
Moderate
edema
within the lamina inflammatory
propria and
infiltrate, with rare and small debris of odontogenic
infiltrate, with
rare and small debris of odontogenic
moderate
tissue in the epithelial
chorion. spongiosis were noted;
tissue
in
the
chorion.
focally,
erosive and ulcerative
were present
3.3.7. Microbiological
– on a areas
rich macrophages
3.3.7. 7-b;
Microbiological
– on a rich macrophages
(Fig.
c).
inflammatory infiltrate ground, intercellular
inflammatory infiltrate ground, intercellular
cocci and bacilli phagocytosis, the presence of
cocci and bacilli phagocytosis, the presence of
a
b
c
a
b
c
Figure 13.
10. Laboratory
Laboratory aspects:
aspects:
inflammatory
lymphoplasmocytic
infiltrate
macrophages
loaded
with germs;
b.
Figure
a. a.
inflammatory
lymphoplasmocytic
infiltrate
with with
macrophages
loaded
with germs;
b. acanthosis
Figure 13. squamous
Laboratory aspects: a. inflammatory
lymphoplasmocytic
infiltrate
with macrophages
loaded with chronic
germs; infiltrate
b. acanthosis
acanthotic
with elongation
important
elongation
of the
interpapillary
cristae chronic
and abundant
in of
pavements
epithelium epithelium
with important
of the papillary
cristae
and abundant
infiltrate in chorion;
islands
pavements
epithelium
with important
elongation
of the
papillary macroscopic
cristae and abundant
chronic infiltrate in chorion; islands of
corion;
islands
of
odontogenic
epithelium
in
corion;
c.
aerobic
aspect.
odontogenic epithelium in chorion; c. mild vascular hyperplasia (IHC-CD34).
odontogenic epithelium in chorion; c. mild vascular hyperplasia (IHC-CD34).
c
Figure 10. Laboratory aspects: a. inflammatory infiltrate, macrophages, frequent cocci, bacilli, candida filaments;
7. Laboratory
aspects:
a. inflammatory
infiltrate, macrophages,
cocci,
bacilli, candida filaments; b.
b. Figure
abundant
inflammatory
infiltrate
in the corium (IHC-CD3);
c. mild vascular frequent
hyperplasia
(IHC-CD34).
abundant inflammatory infiltrate in the corion (IHC-CD3); c. mild vascular hyperplasia (IHC-CD34).
116
a
b
a
b
Figure
lesions: a. a. facial
facial aspect;
aspect; b. b. lingual
lingual
aspect.
11. Chronic
Chronic periodontitis,
periodontitis, active
active cervical
aspect.
Figure 8.
cervical lesions:
Figure 11. Chronic periodontitis, active cervical lesions: a. facial aspect; b. lingual aspect.
a
a.
b.
Figure 8. Chronic marginal periodontitis, active approximal and cervical caries lesions: a. facial aspect; b. lingual aspect.
Figure 5. Chronic marginal periodontitis, active approximal and cervical caries lesions: a. facial aspect; b. lingual aspect.
ORAL
MANIFESTATIONS
IN IRON
DEFICIENCY
ANEMIA: CASE REPORTS
EVALUATION OF THE THERAPEUTIC
BENEFITS
OF GENERAL
ANTIBIOTIC
THERAPY
EVALUATION OF THE THERAPEUTIC BENEFITS OF GENERAL ANTIBIOTIC THERAPY
IN PERIODONTAL DISEASE
IN PERIODONTAL DISEASE
EVALUATION OF THE THERAPEUTIC BENEFITS OF GENERAL ANTIBIOTIC THERAPY
ORAL MANIFESTATIONS IN IRON DEFICIENCY ANEMIA: CASE REPORTS
IN PERIODONTAL DISEASE
117
118
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