Pyogenic granuloma (PG) is a benign vascular lesion found predominantly in the oral cavity. Characterized by rapid growth and propensity to bleed, PG presents diagnostic challenges due to its similarity and alarming proliferation. This narrative review synthesizes current knowledge on the epidemiology, etiopathogenesis, clinical manifestations, and management of oral PG, with emphasis on recent advances in diagnostic and therapeutic approaches. The epidemiology of the injury is meticulously analyzed, revealing a higher incidence in women and a wide range of ages of onset. It delves into the etiopathogenesis, highlighting the uncertainty surrounding the exact causal factors, although historical attributions suggest an infectious origin. It exhaustively analyzes the clinical and histopathological aspects of oral PG, offering information on its various presentations and the importance of an accurate diagnosis to guide effective treatment. It details treatment strategies, emphasizing the personalized approach based on individual patient characteristics. This comprehensive review consolidates current knowledge on oral PG, highlighting the need for further research to clarify its pathogenesis and optimize treatment protocols.
Dentists are health care workers with the highest risk of exposure to COVID-19, because the oral cavity is considered to be a reservoir for SARS-CoV-2 transmission. The identification of SARS-CoV-2 in saliva, the generation of aerosols, and the proximity to patients during dental procedures are conditions that have led to these health care workers implementing additional disinfection strategies for their protection. Oral antiseptics are widely used chemical substances due to their ability to reduce the number of microorganisms. Although there is still no evidence that they can prevent the transmission of SARS-CoV-2, some preoperative oral antiseptics have been recommended as control measures, by different health institutions worldwide, to reduce the number of microorganisms in aerosols and droplets during dental procedures. Therefore, this review presents the current recommendations for the use of oral antiseptics against SARS-CoV-2 and analyzes the different oral antiseptic options used in dentistry.
In dental practice, impacted canines are common clinical conditions that compromise tooth mobility, thereby severely affecting functionality and esthetics. They also represent a significant challenge, particularly when associated with odontogenic pathologies such as dentigerous cysts and odontomas. These entities, despite benign, can cause complications, including tooth displacement, root resorption, and alterations in normal eruption, compromising both esthetics and function. We present the case of a 15-year-old female patient with no relevant medical history who attended for orthodontic treatment planning. Computed tomography scans revealed bilateral impaction of the mandibular canines, associated with radiolucent images consistent with dentigerous cysts. A mixed radiolucent-radiopaque image was also observed in the area of the lower right first premolar, suggesting an odontoma. Surgical management was proposed, including enucleation of the cysts, removal of the odontoma, and placement of orthodontic appliances on the exposed canines to facilitate their movement. Histopathological analysis confirmed the diagnosis of two dentigerous cysts and one compound odontoma. In the surgical follow-up, the intervention area evolved satisfactorily, with no signs of complications, such as infection, delayed healing, or recurrence of the lesion. One of the most complex clinical challenges is managing impacted mandibular canines when associated with odontogenic pathologies. The implementation of advanced diagnostic tools such as computed tomography, along with appropriate surgical techniques and strategic orthodontic planning, effectively addresses these clinical presentations. Timely multidisciplinary treatment promotes the resolution of associated pathologies and optimizes dental alignment, contributing to improved masticatory function and facial esthetics. These comprehensive approaches are essential to ensure predictable and successful outcomes in certain complex cases.
Oral pyogenic granuloma (PG) is generally a solitary benign connective tissue proliferation of unknown etiology. It is the most common type of oral inflammatory hyperplasia histologically characterized by proliferation of granulation tissue with inflammatory infiltrates and high angiogenic capacity. Vascular neoformations of different diameters are usually present. Due to their structural characteristics, tendency to bleed, and rapid and alarming growth rate, these neoformations may have serious consequences. Sometimes, it is complex to make an accurate diagnosis. Therefore, adequate management and treatment are based on the characteristics and systemic conditions of each patient. This review was carried out to provide an overview of the factors involved in, or attributed to the etiopathogenesis of oral PG. It describes the different forms of presentation and clinical evolution, as well as the most frequent signs and symptoms that characterize this disease, while incorporating recent radiographic and microscopic findings. In addition, it describes the different modalities for the management of oral pyogenic granuloma depending on the particular characteristics of each patient.
The association between periodontal diseases and gastrointestinal conditions, particularly those associated with Helicobacter pylori and systemic inflammation, has garnered increased scientific attention because of its clinical and public health implications. These diseases, which affect both the oral cavity and the digestive system, have shared pathophysiological mechanisms that link inflammatory processes and bacterial transmission pathways. The possible presence of H. pylori in the oral cavity has sparked interest regarding its potential colonization of periodontal tissues and acting as an extragastric reservoir. This narrative review describes H. pylori's possible survival mechanisms in this oral microenvironment and its clinical significance in the interaction between oral and gastric conditions. We propose that periodontitis might promote gastric H. pylori infection by stimulating systemic inflammation, and oral colonization might serve as a reservoir for gastric reinfection. Future studies may involve advanced technologies such as metagenomics and proteomics. The eradication of H. pylori in the oral cavity may provide a strategy to prevent gastric reinfection. The findings described herein highlight the importance of this bacterium in two different pathologies sharing a close anatomical relationship.
Introduction: This narrative review describes the scientific evidence on drug-induced gingival overgrowth (DIGO) in kidney transplant patients treated with immunosuppressive agents, particularly Cyclosporine A, focusing on its prevalence, pathogenetic mechanisms, and clinical management strategies. Content: This study was conducted including PubMed, Scopus, and Web of Science, highlighting clinical studies and case reports. Summary: DIGO is an oral complication in transplant patients treated with cyclosporine A, and its frequency may increase when combined with calcium channel blockers. However, tacrolimus has shown a lower incidence of DIGO compared with Cyclosporine A, making it a favorable therapeutic alternative in immunosuppressive regimens for renal transplant patients. Mycophenolate mofetil, despite being less directly linked to DIGO, can exacerbate gingival changes when combined with other immunosuppressants by promoting inflammation and connective tissue remodeling. Sirolimus is associated with a lower risk of DIGO compared with calcineurin inhibitors; however, some isolated cases have been reported, particularly in patients previously exposed to Cyclosporine A or when used in combination with calcium channel blockers. Management strategies include proper oral hygiene, dose adjustment or medication substitution, and, in some cases surgical intervention. Outlook: The fundamental keys to reducing its incidence and severity are a personalized immunosuppressive regimen with a multidisciplinary approach.