Dr. Rick Newhart Updates

MYELOID SARCOMA OCCURRING WITH GINGIVAL ENLARGEMENT

Yoon et al. (JPerio2006;77:119-122) report on a case of a myeloid sarcoma detected in the gingival tissue of a 63 year-old male patient taking a calcium channel blocker.  A preliminary diagnosis of drug-induced gingival hyperplasia was made for the patient.  The area was surgically reduced and a biopsy was taken, finding a dense infiltration of malignant cells.  A preliminary diagnosis of myeloid sarcoma was made for the patient.  Myeloid sarcoma is a malignant leukemia neoplasm, which presents itself in a non-bony site.  Approximately 2 months later, a bone biopsy was performed, and his diagnosis was changed to acute myeloid leukemia, which did not go into remission.  The patient died approximately 4 months after his diagnosis.  The authors conclude that myeloid sarcoma and other malignancies must be included in differential diagnosis of gingival enlargements, and that gingival biopsy of such lesions is indicated.  Dr.Newhart recommends biopsy of any abnormal gingival tissue.

HUMAN PAPILLOMAVIRUS IN THE MOUTH

Hormia et al. (JPerio2005;76:358-363) studied gingiva as a reservoir for HPV in 38 individuals with clinically diagnosed periodontal disease. HPV has been implicated in the squamous cell carcinoma and other tumors. Out of the 100 different HPV types, 30 of them have been detected in the mouth.  Hormia took gingival biopsies from 38 individuals and screened them for HPV DNA.  They found that 26% of the gingival biopsies included viral DNA, which seemed to be localized at the coronal part of the junction epithelium in the periodontal pocket.  The authors conclude that the pathological periodontal pocket may serve as reservoir for human papillomaviruses.

TWO ARE NOT ENOUGH

Weng et al. (IJPRD2007;27:35-41) studied the success rates of telescopic crowns on two implants or two natural canines to help retain and stabilize a maxillary over-denture. In this prospective clinical study, 14 implant patients had implants placed in the canine region with telescopic crowns, along with a control group of 8 patients who had telescopic crowns in the canine regions.  Bone levels and periodontal parameters were followed over time for survival rates for the maxillary prosthesis.  Unfortunately, survival rates for the implant group were only about 50% percent, while there was 100% survival rate for the control group using natural teeth. The authors concluded that two implants in the canine region were insufficient to support the load of a removable partial denture. Dr. Newhart recommends the use of a minimum of four, and preferably six, implants to support an upper denture. 

NEOPLASMS & PERIODONTITIS

Tezal, Grossi, and Genco (JPerio 2005; 76:406-410) studied the correlation between oral neoplasms and periodontal disease using the Third National Health and Nutrition Examination Survey (NHANES III).

Over 13,500 subjects aged 20 years and older participated in the study,

consisting of an oral clinical examination and other factors.  The authors found that clinical attachment loss was not related to any specific soft tissue lesion, such as benign fibromas. However, they did find a significant relationship between periodontal disease and precancerous or cancerous lesions and tumors.  There was even a stronger association for those participants who had periodontal disease and were smokers.  The authors hypothesize that the periodontal disease results in a weakened mucosal barrier, which allows the presence of carcinogens into the oral cavity.  Dr. Newhart feels that periodontal patients may be at higher risk for malignant neoplasms, and should be carefully checked for this during their periodontal maintenance visits.

And the angel answered and said unto the women, “Fear not, ye: for I know that ye seek Jesus, which was crucified.  He is not here: for he is risen, as he said.”

                                  Matthew 28:5-6a

Thank you for your continued referral of dental implant and periodontal patients!

Please visit our website at: thegumdr.com

Dr. Richard Newhart, Periodontist

Dental Implant Placement

1308 Market Street

Parkersburg , WV 26101

(304) 422-4867

Dr. Newhart ’s periodontal update is a scientific, referenced literature and research review and newsletter. Dr. Newhart is not claiming to perform, endorse, or achieve the results of every surgical technique or procedure published in this newsletter. Dr. Newhart is a licensed periodontal specialist, who has achieved significant post-doctoral implant and periodontal education & training.