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Abstract
Granulomatous diseases are chronic inflammatory disorders whose pathogenesis is triggered by an array of infectious and noninfectious agents, and may be localized or a manifestation of systemic, disseminated disease. As in the skin, oral manifestations of granulomatous inflammation are often nonspecific in their clinical appearance. Thus, in the absence of overt foreign material or a recognizable infectious agent, identifying the underlying cause of the inflammation can be challenging. This article highlights various conditions known to induce granulomatous inflammation within the oral soft tissues.
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Alhassani AA, Al-Zahrani MS, Zawawi KH. Granulomatous diseases: Oral manifestations and recommendations. Saudi Dent J 2020; 32:219-223. [PMID: 32647468 PMCID: PMC7336012 DOI: 10.1016/j.sdentj.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/25/2022] Open
Abstract
Granulomatous diseases may present with oral manifestations that are detectable by dental care providers. In certain cases, oral manifestations may precede systemic signs and symptoms. Dentists managing patients with these conditions may modify the dental treatment plan and possibly retain the support of other health professionals. This review gives an update on granulomatous diseases that can be faced by the dental practitioner.
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Affiliation(s)
- Ahmed A Alhassani
- Department of Periodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad S Al-Zahrani
- Department of Periodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid H Zawawi
- Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Gopakumar KG, Mohan N, Prasanth VR, Ajayakumar MK. Isolated parapharyngeal cold abscess in a 9-year-old boy. Paediatr Int Child Health 2019; 39:139-141. [PMID: 29493439 DOI: 10.1080/20469047.2018.1430666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Tuberculous adenitis presenting as an isolated cold abscess in the parapharyngeal space is very uncommon and has not been reported in the paediatric age group; presentation as a retropharyngeal abscess, however, is well known. Nine-year-old boy with a progressively increasing swelling on the right side of the neck for 2 months was referred with a clinical diagnosis of neuroblastoma. Surgical exploration of the parapharyngeal space by needle aspiration yielded a cheesy material and Mycobacterium tuberculosis was detected by DNA TB PCR. Tuberculosis should always be considered in the differential diagnosis of a cervical swelling in a child.
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Affiliation(s)
- K G Gopakumar
- a Department of Pediatric Oncology , Regional Cancer Centre , Trivandrum , India
| | - Neha Mohan
- b Department of Imageology , Regional Cancer Centre , Trivandrum , India
| | - V R Prasanth
- a Department of Pediatric Oncology , Regional Cancer Centre , Trivandrum , India
| | - M K Ajayakumar
- c Department of Pediatric Surgery , SAT, Government Medical College , Trivandrum , India
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Gingival manifestations of tuberculosis in pediatric patients: series of 4 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 128:508-514. [PMID: 30827855 DOI: 10.1016/j.oooo.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/04/2018] [Accepted: 01/03/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the gingival manifestations of tuberculosis (TB) in the oral cavity in pediatric patients. STUDY DESIGN Four pediatric patients were enrolled in the study. Clinical symptoms, auxiliary examinations, treatments, and outcomes were recorded and analyzed. Four pediatric patients who presented with atypical gingival lesions were thoroughly examined for local and systemic signs and symptoms, and a detailed history was obtained. All relevant investigations led to a definitive diagnosis of oral tuberculous lesions. On the basis of the final diagnosis, antitubercular therapy (ATT) was started for all the pediatric patients, and outcomes were measured. RESULTS All 4 patients responded very well to the treatment, with complete resolution of the lesions within 6 months after the initiation of ATT. CONCLUSIONS Health care professionals should rule out TB as one of the differential diagnoses in pediatric patients with atypical gingival lesions. ATT is strongly recommended for the treatment of oral TB to achieve good clinical outcomes. Rapid molecular tests based on nucleic amplification should be utilized for the diagnosis of TB in children and also for extrapulmonary TB because they are much faster and reliable compared with conventional methods.
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Sah SK, Zeng C, Li X, Shi X, Shrestha TK, Guo YY, Yin P, Wang J, Li Y. CT features and analysis for misdiagnosis of parotid tuberculosis. Clin Imaging 2016; 40:810-5. [PMID: 27130986 DOI: 10.1016/j.clinimag.2016.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/03/2016] [Accepted: 03/16/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze the computed tomography (CT) features and the reasons for misdiagnosis of parotid tuberculosis (TB). METHODS CT features of 13 cases of parotid TB identified more than a 10-year period (2005-2015) were retrospectively analyzed. The CT features were analyzed for nature, range, and extent of the various pathological patterns. RESULTS Because of the nonspecific CT features, 10 of 13 cases were misdiagnosed as benign and malignant tumors of parotid gland and received surgery. Ten cases of lymph nodal TB, one case of parenchymal TB, and two cases of mixed (concurrence of lymph nodal and parenchymal types) TB were found in the parotid gland. On contrast-enhanced CT scan, two cases showed homogeneous enhancement and eight cases showed ring enhancement (including five cases with thin-walled ring enhancement, two cases with flower-ring enhancement, and one case with thick-walled and eccentric ring enhancement); diffuse enhancement was seen in the one case of parenchymal type; the two cases of mixed type showed diffuse enhancement of parotid gland and ring enhancement of lymph node. Thickened skin around the parotid gland was seen in eight cases, including sinus tract between the lesion and skin in two cases. Ipsilateral cervical lymphadenopathy was found in 10 patients and bilateral was found in 3 patients. CONCLUSIONS Nonspecific CT features of parotid TB closely relate with pathological changes. Recognition and understanding the spectrum of CT features of parotid TB is helpful for differential diagnosis, but the definitive diagnosis still depends on laboratory and pathological examination.
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Affiliation(s)
- Shambhu Kumar Sah
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Xian Li
- Department of Pathology, Molecular and Cancer Research Center, Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Xiaoqing Shi
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Tej Kumar Shrestha
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - You You Guo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Ping Yin
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Jingjie Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Bakutra G, Manohar B, Mathur L. Tuberculous osteomyelitis affecting periodontium: A rare case report. J Indian Soc Periodontol 2015; 19:578-81. [PMID: 26644727 PMCID: PMC4645547 DOI: 10.4103/0972-124x.167163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 03/23/2015] [Indexed: 11/16/2022] Open
Abstract
Tuberculous lesions affecting periodontium are rare and seen as secondary infections localized to the soft tissues. With the advent of effective drug therapy, tuberculous lesions of the oral cavity have become rare. Involvement of the periodontium has seldomly been reported in the recent literature. We report a case of tuberculous osteomyelitis of mandible affecting periodontium leading to gingival recession and bone exposure in the mandibular premolar region in a 42-year-old female patient. The diagnosis was based on patient's medical and dental history, bacterial culture, clinical and radiographic examination, blood investigation, immunologic tests, histopathologic examination of the tissue specimen. Patient was already taking antitubercular chemotherapy prescribed by physician. Sequestrectomy and decortications were carried out to remove the affected bone. Healing was uneventful and there was no recurrence after 1½ year of follow-up. Antitubercular chemotherapy along with sequestrectomy and decortication are the treatment of choice for tuberculous osteomyelitic lesions affecting periodontium.
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Affiliation(s)
- Gaurav Bakutra
- Department of Periodontology and Implantology, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India
| | - Balaji Manohar
- Department of Periodontology and Implantology, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - Lalit Mathur
- Department of Periodontology and Implantology, Geetanjali Dental Research Institute, Udaipur, Rajasthan, India
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Jan SM, Khan FY, Bhat MA, Behal R. Primary tuberculous gingival enlargement - A rare clinical entity: Case report and brief review of the literature. J Indian Soc Periodontol 2014; 18:632-6. [PMID: 25425826 PMCID: PMC4239754 DOI: 10.4103/0972-124x.142460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 02/12/2014] [Indexed: 11/04/2022] Open
Abstract
Tuberculosis (TB) is a chronic specific granulomatous disease and a major cause of death in developing countries. The clinical presentation of TB lesions of the oral cavity varies widely and can manifest as ulcerations, diffuse inflammatory lesions, granulomas and fissures. Oral lesions generally appear secondary to primary TB infection elsewhere, although primary infection of the oral mucosa by Mycobacterium tuberculosis has also been described. We hereby report a case of primary TB of the gingiva manifesting as gingival enlargement. Diagnosis was based on histopathological examination, complete blood count, X-ray chest and immunological investigations with detection of antibodies against M. tuberculosis. Anti-tuberculous therapy was carried out for over 6 months and was followed by surgical excision of the residual enlargement under local anesthesia. After 1-year follow-up, there was no recurrence of the disease. This case report emphasizes the need for dentists to include TB in the differential diagnosis of various types of gingival enlargements.
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Affiliation(s)
- Suhail Majid Jan
- Department of Periodontics and Oral Implantology, Government Dental College and Hospital, Srinagar, Kashmir, India
| | - Fayiza Youqoob Khan
- Department of Periodontics and Oral Implantology, Government Dental College and Hospital, Srinagar, Kashmir, India
| | - Muzafar Ahmad Bhat
- Department of Periodontics and Oral Implantology, Government Dental College and Hospital, Srinagar, Kashmir, India
| | - Roobal Behal
- Department of Periodontics and Oral Implantology, Government Dental College and Hospital, Srinagar, Kashmir, India
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Submasseteric tuberculous lesion of mandible: report of a case and review of the literature. Case Rep Dent 2014; 2014:791630. [PMID: 25050183 PMCID: PMC4090539 DOI: 10.1155/2014/791630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/04/2014] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis is still a major health hazard in the developing world, while its incidence has recently started to escalate after decreasing for many years. It is a chronic granulomatous disease that can affect any part of the body, including the oral cavity. Oral lesions of tuberculosis, though uncommon, are seen in both the primary and secondary stages of the disease. This paper presents a case of tuberculosis of the submasseteric space, manifesting as a persistent swelling at ramus and angle of mandible. The diagnosis was confirmed based on histopathology after an open incisional biopsy. Patient underwent antituberculosis therapy and his extraoral swelling completely resolved after 4 months of the therapy. The purpose of this paper is to emphasize the importance of early and definitive diagnosis of orofacial tuberculosis, to recognize it based on signs and symptoms, and to refer the patients suspected of active tuberculous infection for appropriate medical treatment.
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Abstract
Upper respiratory infections are commonplace, especially in young people, and are often contagious Lower respiratory infections are often contagious and some are potentially fatal Asthma is common and may be life-threatening Chronic obstructive pulmonary disease is common and disabling Tuberculosis worldwide is an important infection, affecting people with HIV/AIDS or malnutrition particularly Lung cancer is common and usually has a poor prognosis
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Andrade NN, Mhatre TS. Orofacial Tuberculosis—A 16-Year Experience With 46 Cases. J Oral Maxillofac Surg 2012; 70:e12-22. [DOI: 10.1016/j.joms.2011.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/14/2011] [Accepted: 07/14/2011] [Indexed: 11/29/2022]
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Abstract
Tuberculosis of parotid is a rare clinical entity, and cases of bilateral tubercular parotitis are even rarer. We present a case of bilateral primary parotid tuberculosis in a 49-year-old female. The patient received anti-tuberculosis treatment for six months, resulting in complete resolution of the disease. We also review the theories related to the pathogenesis of tubercular parotitis, and propose a novel hypothesis about greater involvement of parotid gland as compared to other salivary glands in primary tuberculosis.
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Affiliation(s)
- JS Thakur
- Department of Otolaryngology-Head and Neck Surgery, I G Medical College, Shimla, India
| | - A Thakur
- Department of Pharmacology, I G Medical College, Shimla, India
| | - NK Mohindroo
- Department of Otolaryngology-Head and Neck Surgery, I G Medical College, Shimla, India
| | - S Mohindroo
- Department of Pathology, I G Medical College, Shimla, India
| | - DR Sharma
- Department of Otolaryngology-Head and Neck Surgery, I G Medical College, Shimla, India
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Primary tuberculosis of oral cavity: a rare entity revisited. Indian J Pediatr 2011; 78:354-6. [PMID: 21063810 DOI: 10.1007/s12098-010-0266-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
Abstract
Oral lesions of tuberculosis though uncommon, are seen both in the primary as well as the secondary stages of the disease. In secondary tuberculosis, the oral manifestations are accompanied by lesions in the lung, lymph nodes, or any other organ system of the body. This can be detected by the usual clinical history and systemic examination. Primary oral tuberculosis may thus present as a diagnostic challenge to the clinician. Amongst the oral lesions also, tongue is the usual site for tubercular infection, with the upper lip and soft palate being the least affected. The authors report two rare cases of children with isolated primary tuberculosis of the lip and uvula. Interestingly, the first case presenting just as a diffuse swelling of the upper lip, and the second as pain in throat with congestion and granulations on the uvula. We suggest a distinct Indian social habit which predisposes to primary lip and uvular tuberculosis, sites not common in the rest of the world. The habit of doing "datoon" i.e. brushing of the teeth with neem twigs in rural India, which at times causes trauma on the palate and thus predisposing to seedling of the wound with mycobacterium tuberculosis.
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Kumar S, Sen R, Rawal A, Dahiya RS, Dalal N, Kaushik S. Primary lingual tuberculosis in immunocompetent patient: a case report. Head Neck Pathol 2010; 4:178-80. [PMID: 20464535 PMCID: PMC2878622 DOI: 10.1007/s12105-010-0180-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 04/16/2010] [Indexed: 11/30/2022]
Abstract
Oral manifestations of tuberculosis are quite rare with an incidence rate of 1.4%. The tongue is the most common site of oral tuberculosis having varied presentations. Lingual tuberculosis is a diagnostic dilemma because of its rarity, particularly in immunocompetent patients. We are reporting a rare case of primary tuberculosis of the tongue in a 38 year old male diagnosed on fine needle aspiration cytology.
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Affiliation(s)
- Sanjay Kumar
- 4/9J, Medical Enclave, PGIMS, Rohtak, 124001 Haryana India
| | - Rajeev Sen
- Department of Pathology, PGIMS, Rohtak, 124001 Haryana India
| | - Anju Rawal
- Department of Pathology, PGIMS, Rohtak, 124001 Haryana India
| | | | - Nityasha Dalal
- Department of Surgery, PGIMS, Rohtak, 124001 Haryana India
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Nagalakshmi V, Nagabhushana D, Aara A. Primary tuberculous lymphadenitis: A case report. Clin Cosmet Investig Dent 2010; 2:21-5. [PMID: 23662079 PMCID: PMC3645454 DOI: 10.2147/ccide.s9733] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tuberculosis (TB) is a prevalent systemic bacterial infectious disease usually caused by Mycobacterium tuberculosis. It is estimated that approximately 8 million people develop TB each year, and 3 million people die of complications associated with the disease. In this article we report a case of a 17-year-old female patient with a painful swelling in her right submandibular region. She was diagnosed with right submandibular tuberculous lymphadenitis. Tuberculous lymphadenitis, when occurring in the cervical region, continues to be a common cause of extrapulmonary TB. TB is a recognized occupational risk for dentists, as they work in close proximity to the nasal and oral cavities of patients, with the possible generation of potentially infectious sprays during routine operative procedures.
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Affiliation(s)
- Velpula Nagalakshmi
- Department of Oral Medicine and radiology, Sri Sai College of Dental Surgery, Kothrepally, Vikarabad, Andhra Pradesh, India
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Tovaru S, Costache M, Sardella A. Primary oral tuberculosis: a case series from Bucharest, Romania. ACTA ACUST UNITED AC 2008; 105:e41-5. [DOI: 10.1016/j.tripleo.2008.01.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/23/2008] [Accepted: 01/23/2008] [Indexed: 11/28/2022]
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Prasad KC, Sreedharan S, Prasad SC, Chakravarthy Y. Tuberculosis of the temporomandibular joint and parotid secondary to tuberculous otitis media. Otolaryngol Head Neck Surg 2007; 137:974-5. [PMID: 18036436 DOI: 10.1016/j.otohns.2007.07.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 06/18/2007] [Accepted: 07/19/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Kishore Chandra Prasad
- Department of Otolaryngology-Head and Neck Surgery, Kasturba Medical College Mangalore, Karnataka State, India.
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Ertas U, Tozoglu S, Uyanik MH. Submandibular tuberculous lymphadenitis after endodontic treatment of the mandibular first premolar tooth: report of a case. J Endod 2006; 32:1107-9. [PMID: 17055918 DOI: 10.1016/j.joen.2006.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 01/06/2006] [Accepted: 01/07/2006] [Indexed: 11/29/2022]
Abstract
Cervical tuberculous lymphadenitis (scrofula) is an infectious granulomatous disease that requires a precise diagnosis. The differential diagnosis involves mainly the pathologic conditions involving the regional lymph nodes and the submandibulary salivary glands. Although tuberculous lesions generally develop secondary to pulmonary disease, clinical manifestations are occasionally seen with no evidence of involvement of the lungs. In this report, a case of tuberculous submandibular lymphadenitis developing after endodontic treatment of the mandibular first premolar tooth is described.
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Affiliation(s)
- Umit Ertas
- Department of Oral and Maxillofacial Surgery, Ataturk University Medical Faculty, Erzurum, Turkey.
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Abstract
Because of the relatively nonspecific clinical findings associated with a variety of granulomatous diseases, a microscopic diagnosis of granulomatous inflammation often presents a diagnostic dilemma for the clinician. The most common differential diagnosis includes foreign body reactions, infection, Crohn's disease, sarcoidosis, and orofacial granulomatosis. However, a variety of other conditions may be associated with granuloma formation. Often an extensive clinical, microscopic, and laboratory evaluation may be required to identify the source of the granulomatous inflammation. This article highlights the origin, clinical manifestations, current diagnostic modalities, and treatment of specific granulomatous diseases that may be encountered in clinical practice.
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Affiliation(s)
- Faizan Alawi
- Department of Pathology, School of Dental Medicine, University of Pennsylvania, 4010 Locust Street, Philadelphia, PA 19104, USA.
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Abstract
Tuberculosis (TB) is an infectious chronic disease. After decades of steadily declining prevalence, the disease has reemerged in the last 5 years. Symptoms of TB are mild and not specific and can be classified as either systemic or localized to target organs. Microscopic examination of the sputum remains an inexpensive and rapid way to identify highly infectious patients. Four different antimicrobial agents-rifampin, ethambutol, pirazinamide, and isoniazid-form the basis of currently recommended antituberculosis therapy. Tuberculosis could be an occupational risk for health care workers. Dentists must be involved in the health promotion and early detection of TB.
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Affiliation(s)
- Juan F Yepes
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Phildelphia 19104-6030, USA
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