Antimicrobial resistance (AMR) is the ability of bacteria to change, rendering antimicrobials (such as antibiotics, antivirals and antimalarials) ineffective in treating common infections, or as prophylaxis after major surgery or cancer treatment. The World Health Organization (WHO) predicts that these ‘superbugs’ will become a major threat to public health. 1
Gingival pathology is a daily presentation, however a small number of systemic conditions can manifest similar to a common gingival condition and have fatal results. Dentist referred 56-year-old woman to Oral and Maxillofacial Surgery department with a 2-week medical history of gingival bleeding not responding to local measures. Biopsy showed eosinophilic infiltrate and vasculitis, and blood tests showed positive markers including cytoplasmic antineutrophil cytoplasmatic antibodies. Granulomatosis with polyangiitis is a rare disease affecting the respiratory tract, blood vessels and kidneys. Oral lesions are rarely the primary presenting feature. When left untreated, most cases are fatal within a year of diagnosis. The diagnosis can only be made when certain criteria are found, including granular oral lesions exhibiting an eosinophilic inflammatory infiltrate on biopsy. With 5% of cases showing intraoral lesions as the primary feature, it is essential that dentists have the knowledge of this rare disease to refer and not to treat as a common gingival condition.
With the number one reason for child admission to hospital in the UK being dental treatment and with anxiety towards the profession as a whole, efforts to improve outcome and experience could result in better long-term oral care.
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