After prophylaxis, 5 dental hygienists performed optimal oral hygiene under supervision for 6 months. At months 0, 1, 4 and 6, Plaque Index, Gingival Exudate Flow Rate and Gingival Index were assessed, and a buccal biopsy of their gingiva taken. Point counting procedures were performed at 2 different levels of magnification to estimate the volume densities of epithelium, infiltrated and non‐infiltrated connective tissue, and collagen. The percentages of fibroblasts, polymorphonuclear neutrophilic granulocytes, lymphocytes, plasma cells and macrophages were estimated by counting the number of profiles of these cells in the connective tissue area close to the apical end of the junctional epithelium. All the changes inside the tissue occurred slowly. During the 6‐month period there was a continuous increase of the volume density of the epithelium in the gingiva. An increase in the percentage of fibroblasts was observed between months 1 and 4 together with a decrease in the percentage of lymphocytes and in the volume density of the infiltrated connective tissue. Between months 4 and 6 an increase of the volume density of the collagen was found together with a further increase in the percentage of fibroblasts and a further decrease in the percentage of lymphocytes. After 6 months of perfect oral hygiene no more plasma cells were visible. This study has shown that, even in presence of clinically healthy gingiva, subclinical changes may take place. It appears realistic to accept the presence of a very mild gingivitis localized in an area adjacent to the attachment as compatible with gingival health.
A 34 year-old man from Eritrea presented with gradual onset bilateral loin and leg pain. Clinical examination revealed lower abdominal tenderness, ataxia and a tendency to fall backwards. The imaging and lumbar puncture provided new information. Our differential diagnosis included tuberculosis, lymphoma or other granulomatous illness. He was admitted and started on IV methylprednisolone with subsequent resolution of symptoms. Serum ELISA yielded a diagnosis of Schistosomiasis. Consequently treatment with Praziquantel was initiated and steroid therapy continued.
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