This is a review and update on acute conditions affecting the gingival tissues, including abscesses in the periodontium, necrotizing periodontal diseases, and other acute conditions that cause gingival lesions with acute presentation, such as infectious processes not associated with oral bacterial biofilms, muco--cutaneous disorders, and traumatic and allergic lesions. A periodontal abscess is clinically important since it is a relatively frequent dental emergency, it can compromise the periodontal prognosis of the affected tooth, and because bacteria within the abscess can spread and cause infections in other body sites. Different types of abscesses have been identified, mainly by the type of etiology, and there are clear differences between those affecting a previously existing periodontal pocket and those affecting healthy sites. Therapy for this acute condition consists of drainage and tissue debridement, with individual evaluation of the need for systemic antimicrobial therapy. The definitive treatment of the pre--existing condition should be accomplished after the acute phase is controlled.

The presence of xerostomia and hyposalivation is frequent among diabetes mellitus (DM) patients. It is not clear if the presence of xerostomia and hyposalivation is greater in DM than non-DM patients. The aims of this systematic review are (1) to compare the prevalence rates of xerostomia, (2) to evaluate the salivary flow rate, and (3) to compare the prevalence rates of hyposalivation in DM versus non-DM population. This systematic review was conducted according to the PRISMA group guidelines by performing systematic literature searches in biomedical databases from 1970 until January 18th, 2016. All studies showed higher prevalence of xerostomia in DM patients in relation to non-DM population, 12.5%–53.5% versus 0–30%. Studies that analyzed the quantity of saliva in DM population in relation to non-DM patients reported higher flow rates in non-DM than in DM patients. The variation flow rate among different studies in each group (DM/CG) is very large. Only one existing study showed higher hyposalivation prevalence in DM than non-DM patients (45% versus 2.5%). In addition, quality assessment showed the low quality of the existing studies. We recommend new studies that use more precise and current definitions concerning the determination and diagnosis of DM patients and salivary flow collection.

Despite the limitations of the small sample size, it seems that lichen planus is not a prominent local player in the genesis of implant failure. Patients with DG should be carefully examined during follow-up care.

Side effects of certain drugs such as cyclosporin A (CsA) and phenytoin may induce gingival overgrowth which in some instances become unacceptable to the patient because esthetic, functional, and other effects. Use of these drugs is related to important medical situations, such as organ transplantation and control and withdrawal of the drugs is contraindicated. Tacrolimus is an immunosuppressant used to prevent graft rejection in organ transplant patients and has been shown to cause fewer oral side effects than CsA. This report deals with a case of probable synergism between the use of CsA and phenytoin which caused an intense gingival overgrowth in a kidney transplant patient. A treatment protocol including very thorough oral hygiene, scaling and root planing, clorhexidine digluconate rinses (0.12%), and substituting CsA with tacrolimus is described. Response to treatment after 6 months of tacrolimus use was excellent with almost complete reversion of the gingival enlargement. One-year follow-up demonstrated a stable gingival situation. The successful substitution of CsA with tacrolimus provides great expectations for the management of CsA-related gingival enlargement.

OBJECTIVE: The aim of this study was to analyse the prevalence of oral lesions in a group of renal transplant patients (RTPs) compared with healthy controls (HCs). SUBJECTS AND METHODS: The study included 500 RTPs (307 men, 193 women, mean age 53.63 years) and 501 HCs (314 men, 187 women, mean age 52.25 years). Demographic and pharmacologic data were recorded for all subjects. RESULTS: Forty percent of the RTPs presented with oral lesions compared to 23.4% of HCs. The most frequent lesion was candidiasis (7.4% in RTPs, 4.19% in HCs). Lip herpes simplex lesions were observed in 2.6% of RTPs and 2.2% of HCs; aphthae were observed in 2.2% of RTPs and 1% of HCs. Xerostomia prevalence was significantly greater in RTPs than HCs (1.4% vs 0.2%). Lichen planus appeared in 0.6% of RTPs, and one RTP suffered from hairy leukoplakia. CONCLUSIONS: We report a lower prevalence of oral candidiasis and hairy leukoplakia in RTPs than previous reports and describe other oral conditions not presented before in prevalence studies of RTPs, such as xerostomia, aphthous ulcers and lichen planus. These oral lesion changes in RTPs and the risk of malignancy emphasize the importance of regular oral screening in these patients. Oral Diseases (2010) 16, 89-95

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